Bioethical conflicts in end of life care

Medeiros, Maria Olivia Sobral Fraga de; Meira, Mariana do Valle; Fraga, Fernanda Moreira Ribeiro; Nascimento Sobrinho, Carlito Lopes; Rosa, Darci de Oliveira Santa; Silva, Rudval Souza da

doi:10.1590/1983-80422020281375

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RESEARCH • Rev. Bioét. 28 (1) • Jan-Mar 2020 • https://doi.org/10.1590/1983-80422020281375 copy

Bioethical conflicts in end of life care

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This integrative review of the literature aims to identify the main conflicts between patients in palliative care, family and healthcare team from the point of view of the principialist ethics. A search was performed on databases, generating a final sample of 12 publications that, after being evaluated by the content analysis technique, enabled the emergence of three thematic categories: professional conduct – respect for the patient’s autonomy and the principle of beneficence; bioethical principles in the context of end of life care; and bioethical dilemmas in this context. We concluded that autonomy and beneficence stand out in the palliative care, ratifying the idea that the patient is the main actor and needs a humanized and comprehensive health care. In addition, we found some weaknesses in the process of education and communication in the healthcare team, patient and family relationship.

Ethics; Patient care team; Professional-family relations; Patient participation; Hospice Care

Article number	Journal, year, country, Qualis rating and database	Contribution
Article 1 ⁷	Revista Bioética, 2014, Brazil, B2, Lilacs	Teaching: development of communication skills among professionals. Practice: communication as an instrument conducive to autonomy in therapeutic relationships, psychological adjustment and resolution of pending issues.
Article 2 ⁸	Revista Online de Pesquisa Cuidado é Fundamental, 2016, Brazil, B2, Lilacs	Practice: improving the quality of life of patients with no therapeutic possibilities.
Article 3 ⁹	Medicine (Baltimore), 2016, Taiwan, B2, Medline	Practice: decision-making training for nurses based on ethical principles and better community palliative care programs to improve problems encountered.
Article 4 ¹⁰	Revista Bioética, 2015, Brazil, B2, SciELO	Practice: prudent and reasonable decision making, that is, moral deliberation.
Article 5 ¹¹	BMC Medical Ethics, 2015, Mexico, B2, Medline	Practice: rediscovery of values and virtues in palliative care, helping professionals find greater motivation and a new perspective of professional and personal growth.
Article 6 ¹²	Revista Bioética, 2016, Brazil, B2, Lilacs	Teaching: routine palliative care as a developing academic subject. Practice: narrative bioethics can offer important input to enrich professional practice.
Article 7 ¹³	Medicine, Health Care and Philosophy, 2016, Netherlands, B1, Medline	Practice: reflective and sensitivity balance of healthcare professionals to better meet the needs of patients. In addition, the results can help them deal with hope in order to improve and strengthen the relationship with patients.
Article 8 ¹⁴	The Oncologist, 2015, Germany, A1, Medline	Practice: encouraging a proactive attitude among oncologists regarding the preparation of terminally ill patients. More concrete guidance is needed on when to start end of life communication to improve decision making in cases of patients with advanced cancer.
Article 9 ¹⁵	Revista Bioética, 2016, Brazil, B2, Lilacs	Teaching: creating opportunities for discussion during medical training on how to deal with patients’ death. Research: new studies to further expand knowledge on the topic, involving other segments of society. Practice: experience of doctors and family members about end of life and death in order to redirect care in this difficult time of human life.
Article 10 ¹⁶	BMC Medical Ethics, 2014, Belgium, B2, Medline	Practice: different forms of closeness play an important role in caregivers’ understanding of their moral responsibilities. This process clarifies the reasoning of participants when involved in practices such as continuous end of life sedation.
Article 11 ¹⁷	Revista Bioética, 2016, Brazil, B2, Lilacs	Practice: nurses should reflect on their daily professional practice to avoid useless treatment and provide more humanized care, favoring the dignity of terminal patients, minimizing their suffering and that of their families.
Article 12 ¹⁸	BMC Medical Ethics, 2014, Australia, B2, Medline	Practice: Australian doctors use the principle of double effect despite considering it a controversial and inappropriate medical-legal framework. These professionals feel obliged to negotiate the decision-making process in end of life care between patients and family based on a restrictive legal framework whose results influence the experience of all involved.

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[1] Correspondence: Rudval Souza da Silva – Universidade do Estado da Bahia. Colegiado de Enfermagem. Campus VII. Rodovia Lomanto Júnior, BR 407, km 127 CEP 48970-000. Senhor do Bonfim/BA, Brasil.