ABSTRACT
No disponible
Subject(s)
Humans , Terminal Care , Internal Medicine , Hospitalization/statistics & numerical dataABSTRACT
No disponible
Subject(s)
Humans , Aged , Refusal to Treat/ethics , Cardiopulmonary Resuscitation/statistics & numerical data , Survivorship , Forecasting , Life Expectancy , Life Support Care , Advance Directive AdherenceABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Hospitalization/legislation & jurisprudence , Hospitalization/trends , Internal Medicine/organization & administration , Internal Medicine/standards , Chronic Disease/epidemiology , Health Services/standards , Health Services Needs and Demand/standardsABSTRACT
Decision making in the patient with chronic advanced disease is especially complex. Health professionals are obliged to prevent avoidable suffering and not to add any more damage to that of the disease itself. The adequacy of the clinical interventions consists of only offering those diagnostic and therapeutic procedures appropriate to the clinical situation of the patient and to perform only those allowed by the patient or representative. In this article, the use of an algorithm is proposed that should serve to help health professionals in this decision making process.
Subject(s)
Algorithms , Chronic Disease/therapy , Clinical Decision-Making , Humans , Terminal CareABSTRACT
La toma de decisiones en el paciente con enfermedad crónica avanzada es especialmente compleja. Los profesionales sanitarios estamos obligados a evitar el sufrimiento evitable y no añadir más daño al de la propia enfermedad. La adecuación de las intervenciones clínicas consiste en ofertar solo aquellos procedimientos diagnósticos o terapéuticos proporcionados a la situación clínica del paciente y llevar a cabo únicamente los consentidos por el paciente o representante. En este artículo proponemos la utilización de un algoritmo que nos sirva de ayuda en este proceso de toma de decisiones (AU)
Decision making in the patient with chronic advanced disease is especially complex. Health professionals are obliged to prevent avoidable suffering and not to add any more damage to that of the disease itself. The adequacy of the clinical interventions consists of only offering those diagnostic and therapeutic procedures appropriate to the clinical situation of the patient and to perform only those allowed by the patient or representative. In this article, the use of an algorithm is proposed that should serve to help health professionals in this decision making process (AU)
Subject(s)
Humans , Chronic Disease/epidemiology , Decision Making, Organizational , Palliative Care/organization & administration , Hospice Care/organization & administration , Bioethics/trends , Terminally Ill , Clinical ProtocolsSubject(s)
Humans , Male , Female , Official Instructions , Health Knowledge, Attitudes, Practice , Health Promotion/trendsABSTRACT
La toma de decisiones clínicas en el paciente en situación terminal esa veces difícil. Debemos evitar caer en el encarnizamiento o por el contrario en el abandono terapéutico. El encarnizamiento terapéutico consiste en la utilización de medios desproporcionados para prolongar la vida biológica de un paciente que padece una enfermedad terminal. Decidir si un determinado tratamiento resulta desproporcionado para un paciente en un determinado momento dependerá del tipo de tratamiento, de su situación biológica y de su voluntariedad. Los principios bioéticos nos pueden ayudar en el proceso de toma de decisiones. Utilizamos un caso clínico para ilustrar cómo una guía de utilización escalonada de los principios bioéticos nos puede resultar de ayuda en este proceso. Se presenta el caso de un paciente con una neoplasia de vejiga avanzada en el que se diagnostica una hipercalcemia tumoral y una infección respiratoria y se trata de valorar si el tratamiento de dichas complicaciones es apropiado o no. En primer lugar resulta relevante la diferenciación entre los conceptos de proporcionado/desproporcionado que dependen de la valoración del profesional, y los de ordinario/extraordinario que vienen definidos por el paciente. En segundo lugar se remarca la importancia de explorar los deseos del paciente con patologías crónicas sobre situaciones que se pueden plantear en la evolución de su enfermedad antes de que esta los incapacite para la toma de decisiones (AU)
Making clinical decisions for terminal patients is sometimes difficult. We must avoid both therapeutic obstinacy and withdrawal. Therapeutic obstinacy consists of using disproportionate means to extend an end-stage patients biological life. In these situations clinical decision making becomes a difficult task. Deciding whether a particular treatment is disproportionate at a particular time will depend on kind of treatment, the patient's biological situation, and the patients desires. Bioethical principles may help us in the process of decision making. We use a case report to illustrate how a set of step-by-step guidelines may help us in this process. This is the case of a patient suffering from an advanced bladder neoplasm in whom tumor-related hypercalcemia and a respiratory infection were diagnosed. The important thing is to value whether treatment is appropiate or otherwise. We are using this example to illustrate how step-by-step guidelines can help us in making such decisions. First, distinguishing between proportionate and disproportionate is of utmost importance, and this depends on the specialists criteria; also between ordinary/extraordinary, which are defined by the patient. Secondly, it is important to explore the desires of patients with chronic conditions regarding situations that may arise during the course of illness before they lose their ability to make such decisions (AU)