RESUMO
Medical decisions involving children raise particular ethical issues for physicians and other members of the health care team. Although parents and physicians have traditionally made most medical decisions on behalf of children, the developing autonomy of children is increasingly being recognized in medical decision-making. This poses a challenge for physicians, who must work with the child's family and with other health care practitioners to determine the child's role in decision-making. A family-centred approach respects the complex nature of parent-child relationships, the dependence and vulnerability of the child and the child's developing capacity for decision-making.
Assuntos
Bioética , Defesa da Criança e do Adolescente , Tomada de Decisões , Recusa do Paciente ao Tratamento , Adolescente , Neoplasias Ósseas/terapia , Canadá , Criança , Defesa da Criança e do Adolescente/legislação & jurisprudência , Proteção da Criança/legislação & jurisprudência , Pré-Escolar , Família , Feminino , Humanos , Lactente , Osteossarcoma/terapia , Cuidados Paliativos , Qualidade de Vida , Apoio Social , Recusa do Paciente ao Tratamento/legislação & jurisprudênciaRESUMO
We report a case of Trichosporon beigelii endocarditis in a 77-year-old diabetic man who presented with an embolic stroke 8 years ago after a porcine aortic valve replacement. He was treated successfully with amphotericin, rifampin, and replacement of the original porcine valve; however, he died suddenly 8 months later from unknown causes. Blood cultures 2 months prior to death were negative. The first manifestation of the endocarditis was a left hemiparesis followed some days later by a splenic infarction. Transthoracic echocardiography failed to demonstrate the aortic vegetation, which was clearly visualized subsequently by transesophageal echocardiography. The literature on Trichosporon beigelii endocarditis is reviewed.
