Subject(s)
History, 20th Century , History, 21st Century , Humans , Brain Death , Coma/history , Advanced Cardiac Life Support , United StatesABSTRACT
En las últimas décadas es habitual, también en nuestro país, que muchas decisiones médicas sean sometidas al escrutinio judicial por diversas causas. La diversidad de motivaciones y la extensa temática que abarcan los problemas abordados requieren que cualquier comentario sobre tales procesos judiciales se refiera a la posibilidad de que se provoque un conflicto adicional al que los tribunales teóricamente están llamados a resolver. En este orden de ideas, este trabajo explora las repetidas circunstancias que por falta de normas concretas en el derecho positivo, o por equívocas interpretaciones de la legislación existente o por desconocimiento del progreso científico o de la realidad médica, conducen a la provocación de una medicina defensiva por omisión que resulta gravemente perjudicial para la sociedad. Muchas veces también la exagerada e inexplicable actitud médica temerosa transfiere al tribunal judicial decisiones que son de su exclusiva competencia. Esta conducta contribuye al desmantelamiento de una profesión que, como la médica, ya está sometida a la gravosa situación de diversos sistemas de salud que no cumplen adecuadamente su finalidad de cuidar a la sociedad que los necesita y los mantiene.
In the last decades, medical decisions are increasingly submitted to the courts of law for a number of reasons, also in our country. The various causes and different issues involved in such proceedings require comments referred to the possibility of causing an additional conflict to that which the courts of law are in theory required to address. In that context, this paper explores the repeated cases in which, due to the lack of positive legislation on a given issue, or due to different interpretations of existing legislation, or for lack of understanding of scientific progress or medical facts, defensive medicine finds its way to the detriment of society as a whole. In many other cases, fearful inexplicable attitudes of the doctors involved result in a transfer of exclusively medical decisions to the courts of law. This attitude contributes to the dismantling of a profession such as medicine, which is already subject to the difficult context of a variety of health systems that fail to sufficiently comply with their obligation of taking care of a community that needs and supports them.
Subject(s)
Humans , Decision Making , Defensive Medicine/legislation & jurisprudence , Jurisprudence , Legislation, Medical , Professional Practice/legislation & jurisprudence , Bioethics , Conflict, Psychological , Physician-Patient Relations , Professional Misconduct , Professional Practice , SocietiesABSTRACT
En Argentina, el síndrome de distrés respiratorio agudo (SDRA) representa el 7.7% de las admisiones en terapia intensiva y está asociado con una alta morbilidad y mortalidad (58%). Con frecuencia la muerte puede ser atribuida a más de una causa. La hipoxemia refractaria es una causa de muerte poco frecuente (15%) y en muchos casos puede coexistir con disfunción multiorgánica, sepsis o shock séptico. La utilidad de los esteroides como parte del tratamiento es aún motivo de debate a pesar de las múltiples series de casos y estudios clínicos publicados. En el artículo se evalúa la utilidad de los esteroides en el SDRA a través de la revisión de la bibliografía disponible. Se concluye que los esteroides estarían indicados en un pequeño subgrupo de pacientes con SDRA no resuelto o tardío, después de descartar o controlar una infección activa.
Subject(s)
Humans , Respiratory Distress Syndrome/drug therapy , Steroids/therapeutic use , Respiratory Distress Syndrome/mortalityABSTRACT
Technological progress in medicine regarding the application of life-sustaining treatment in the critical patient and the cultural changes that have taken place in contemporary society with respect to the patients' right to decide over the end of their lives, demand the existence of a definition of euthanasia that will acknowledge this new scenario. The concept of euthanasia would be very specifically limited by the exclusion of so-called passive forms of euthanasia and of omission as a possible procedure to cause death and the need for the explicit request of the patient involved. Likewise, the definition of euthanasia should include a specific reference to the means through which death is to be achieved. Euthanasia would thus be defined basically as causing the death of a patient suffering from a mortal disease, upon his or her request and for his or her own benefit, by administering a toxic or poisonous substance in mortal doses. This restrictive definition would differentiate euthanasia from cases of refusal to receive treatment, even if death is the consequence of such refusal, and also from cases in which life-sustaining treatment is withheld or withdrawn to enable the occurrence of death
Subject(s)
Humans , Euthanasia , Decision Making , Euthanasia, Active , Euthanasia, Passive , Life Support Care , Right to Die , Treatment RefusalABSTRACT
The concept of intervened death accounts for all those situations in which the withholding or withdrawal of life-sustaining treatment constitutes a limit to therapeutic action associated to the occurrence of the traditional cardio-respiratory death. The 1968 Harvard Report advanced a new definition of death through the concept of complete cessation of global brain functions and, more than thirty years later, this process of intervention in its diagnosis may be seen as a continuum link to the need to procure organs for transplant purposes and the need to avoid long agonies in unrecoverable patients. During the last decade, the ethical admissibility of withdrawing ordinary and advanced life-sustaining therapy in cases that do not amount to brain death diagnosis--such as vegetative states and other irreversible clinical situations--and even the advances made for purposes of obtaining organs for transplant purposes in these situations (with the explicit authorization of the donor or his/her representative) allows a joint interpretation of these situations through the acceptance that limits may be established in medical assistance. Reflection on intervened death as an emerging phenomenon of our culture is mandatory so that society may get involved in an issue of its absolute and exclusive interest (AU)#S
Subject(s)
Humans , Brain Death , Decision Making , Ethics, Medical , Life Support Care , Brain Death , Persistent Vegetative StateSubject(s)
Humans , Bioethics , Critical Care/methods , Critical Care/standards , Critical Care , Decision Making , Euthanasia, Passive , Informed Consent , Intensive Care Units/standards , Attitude to Health , Ethics Committees/standards , Professional-Family Relations , Quality of Life , Right to Die , Treatment RefusalABSTRACT
La utilización de variados procedimientos diagnósticos y terapéuticos que la moderna tecnología es capaz de aplicar en el paciente grave y crítico ha llevado a la generación de formas del morir incompatibles con la dignidad de la persona en circunstancias en que se demora inexplicablemente la llegada inevitable de la muerte. La indagación de los múltiples factores que influyen en la aparición de este fenómeno, asociado al desarrollo y avance de la medicina, conduce a la exploración de cuatro aspectos que se consideran esenciales en su determinación: el imperativo tecnológico, la santificación de la vida, la omnipotencia de la medicina y la ausencia de una decisión médica unívoca. A la inmensa disponibilidad de la alta tecnología se ha sumado el requerimento de la plena autonomía del paciente en la decisión final de la propia vida que comprende el debatido derecho a morir. Para luchar por una muerte digna en el campo de las decisiones concretas se hace referencia a: el rechazo de tratamiento, la irreversibilidad del cuadro clínico crítico y los cuidados paliativos y la abstención y el retiro de los métodos de soporte vital.