ABSTRACT
Los cuidados intensivos pediátricos son una especialidad nueva, con importantes avances tecnológicos que pueden prolongar el proceso de morir. Uno de los problemas bioéticos frecuentes es la limitación del esfuerzo terapéutico, que es la adecuación y/o proporcionalidad del tratamiento tratando de evitar obstinación y futilidad. OBJETIVO Conocer la experiencia de médicos que trabajan en unidades de cuidado intensivo (UCIP) ante decisiones ético-clínicas. SUJETOS Y MÉTODO Estudio observacional, descriptivo y transversal, aplicando una encuesta anónima a médicos de UCIP, solicitando datos sobre problemas éticos que se generan en la atención al niño crítico y su procedimiento de resolución. Aprobado por el Comité de Ética de la Investigación de la Facultad de Medicina de la Universidad del Desarrollo-Clínica Alemana. RESULTADOS Respondieron 126 médicos de 34 UCIP de Chile. El 98,41% ha tomado decisiones de limitación terapéutica. El tipo de limitación más frecuente mencionado fue la orden de no reanimar (n = 119), seguido por la no instauración de medicamentos (n = 113), limitación de ingreso a UCIP (n = 81), siendo la menos mencionada la retirada de tratamientos (n = 81). El 34,13% consideró que existían diferencias éticas entre no instaurar o retirar un determinado tratamiento. CONCLUSIONES Los dilemas ético-clínicos son comunes en la UCIP, siendo frecuentes las decisiones de limitación terapéutica. Muchos médicos reconocen no poseer conocimientos en ética clínica y necesitar formación continua en bioética.
Paediatric intensive care is a relatively new specialty, with significant technological advances that lead to the prolongation of the dying process. One of the most common bioethical problems is limitation of treatment, which is the adequacy and/or proportionality treatment, trying to avoid obstinacy and futility. OBJECTIVE To determine the experience of physicians working in Paediatric Intensive Care Units (PICU) when faced with bioethical decisions. SUBJECTS AND METHOD An observational, descriptive and cross-sectional study was conducted using an anonymous questionnaire sent to physicians working in PICU. The data requested was related to potential ethical problems generated in the care of the critical child, and the procedure for their resolution. The study was approved by the Ethics Research Committee of the Faculty of Medicine UDD CAS. RESULTS A total of 126 completed questionnaires were received from physicians working in 34 PICU in Chile. Almost all (98.41%) of them acknowledged having taken therapeutic limitation decisions (TLD). The most common type of TLD mentioned was the Do Not Resuscitate order (n = 119), followed by the establishment of no medications (n = 113), limited admission to PICU (n = 81), with the withdrawal of treatment being the least mentioned (n = 81). Around one-third (34.13%) felt that there were no ethical difference between introducing or removing certain treatments. CONCLUSIONS Bioethical dilemmas are common in the PICU, with therapeutic limitation decisions being frequent. Many recognise not having expertise in clinical ethics, and they need continuing education in bioethics.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Terminal Care/ethics , Health Knowledge, Attitudes, Practice , Withholding Treatment/ethics , Bioethical Issues , Pediatrics/ethics , Physicians/ethics , Intensive Care Units, Pediatric , Attitude of Health Personnel , Cross-Sectional Studies , Surveys and Questionnaires , Resuscitation Orders/ethics , Decision Making/ethicsABSTRACT
There has been a controversy in Korea regarding a 'death with dignity' in comparison to a 'natural death'. However, the issue of patient autonomy is often overlooked. Decision on withholding or withdrawing life-sustaining treatment should be based on the patients' selfdetermination, prefereably in the form of advance directives. Consensus developed by the National Evidence -based Healthcare Collaborating Agency is as follows: (1) a doctor should offer a detailed explanation to patients, including about hospice-palliative care and advance directives, (2) when a terminally ill patient expresses reluctance regarding cardiopulmonary resuscitation or an artificial respirator in advance, such medical actions can be removed, with basic nutrition supply and pain control maintained. However, more discussions should be made in the case of a patient in "persistent vegetative state".