Ethical dilemmas in palliative care: a literature review

Alcântara, Fabíola Alves

doi:10.1590/1983-80422020284434

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Research • Rev. Bioét. 28 (4) • Oct-Dec 2020 • https://doi.org/10.1590/1983-80422020284434 copy

Ethical dilemmas in palliative care: a literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Issues concerning the beginning and end of life are an immense challenge for they involve various concepts related to science and religion, and have humanistic, social, legal, bioethical, and moral character. This study aimed to present the ethical dilemmas experienced by health professionals when facing death. Among the various ethical impasses, the main ones are resource limitations, the difficulty in communication and decision-making. They make us reflect on various end-of-life factors, such as establishing integrated communication, always telling the truth, and understanding non-adherence, discontinuations, and treatment refusals.

Keywords:
Bioethics; Decision making; Terminal care; Health personnel

Author(s)/year	Title	Periodic	Objective	Method
Araújo, Neves; 2003 ²¹21. Araújo LZS, Neves WA Jr. A bioética e a fisioterapia nas unidades de terapia intensiva. Rev Fisioter Univ São Paulo [Internet]. 2003 [acesso 18 ago 2018];10(2):52-60. Disponível: https://bit.ly/30FOkbN https://bit.ly/30FOkbN...	“Bioethics and physiotherapy in intensive care units”	Revista de Fisioterapia da Universidade de São Paulo	Tracing the profile of physiotherapy professionals working in ICU and identifying their opinion on topics such as terminal patients, patient autonomy, euthanasia and dysthanasia.	Field research
Barnitt; 1998 ²²22. Barnitt R. Ethical dilemmas in occupational therapy and physical therapy: a survey of practitioners in the UK National Health Service. J Med Ethics [Internet]. 1998 [acesso 22 out 2020];24(3):193-9. DOI: 10.1136/jme.24.3.193 https://doi.org/10.1136/jme.24.3.193...	“Ethical dilemmas in occupational therapy and physical therapy: a survey of practitioners in the UK National Health Service”	Journal of Medical Ethics	Identify ethical dilemmas experienced by occupational therapists and physiotherapists working in the UK's National Health Service and compare ethical contexts, themes, and principles between the two groups.	Field research
Bélanger, Rodríguez, Groleau; 2011 ²³23. Bélanger E, Rodríguez C, Groleau D. Shared decision-making in palliative care: a systematic mixed studies review using narrative synthesis. Palliat Med [Internet]. 2011 [acesso 10 jan 2019];25(3):242-61. DOI: 10.1177/0269216310389348 https://doi.org/10.1177/0269216310389348...	“Shared decision-making in palliative care: a systematic mixed studies review using narrative synthesis”	Palliative Medicine	Synthesize the knowledge on shared decision-making process in palliative care.	Literature review
Chih and collaborators; 2016 ²⁴24. Chih AH, Su P, Hu WY, Yao CA, Cheng SY, Lin YC, Chiu TY. The changes of ethical dilemmas in palliative care: a lesson learned from comparison between 1998 and 2013 in Taiwan. Medicine [Internet]. 2016 [acesso 24 abr 2019];95(1):e2323. DOI: 10.1097/MD.0000000000002323 https://doi.org/10.1097/MD.0000000000002...	“The changes of ethical dilemmas in palliative care: a lesson learned from comparison between 1998 and 2013 in Taiwan”	Medicine (Baltimore)	Investigate the ethical dilemmas encountered by palliative care physicians and nurses in 2013 and compare the results with a research conducted in 1998.	Field research
Gjerberg and collaborators; 2010 ²⁵25. Gjerberg E, Førde R, Pedersen R, Bollig G. Ethical challenges in the provision of end-of-life care in Norwegian nursing homes. Soc Sci Med [Internet]. 2010 [acesso 24 abr 2019];71(4):677-84. DOI: 10.1016/j.socscimed.2010.03.059 https://doi.org/10.1016/j.socscimed.2010...	“Ethical challenges in the provision of end-of-life care in Norwegian nursing homes”	Social Science and Medicine	Examine the types and prevalence of ethical challenges in end-of-life care.	Field research
Mobasher and collaborators; 2013 ²⁶26. Mobasher M, Nakhaee N, Tahmasebi M, Zahedi F, Larijani B. Ethical issues in the end of life care for cancer patients in Iran. Iran J Public Health [Internet]. 2013 [acesso 24 abr 2019];42(2):188-96. Disponível: https://bit.ly/3d90AGP https://bit.ly/3d90AGP...	“Ethical issues in the end of life care for cancer patients in Iran”	Iranian Journal of Public Health	Identify the ethical dilemmas that Iranian oncologists may face in healthcare environment and determine the factors that influence decision-making processes.	Field research
Sorta-Bilajac and collaborators; 2011 ²⁷27. Sorta-Bilajac I, Baždarić K, Žagrović MB, Jančić E, Brozović B, Čengić T et al. How nurses and physicians face ethical dilemmas: the Croatian experience. Nurs Ethics [Internet]. 2011 [acesso 24 abr 2019];18(3):341-55. DOI: 10.1177/0969733011398095 https://doi.org/10.1177/0969733011398095...	“How nurses and physicians face ethical dilemmas: the Croatian experience”	Nursing Ethics	Evaluate the ethical dilemmas of nurses and doctors in clinical practice.	Field research
Granero-Moya and collaborators; 2016 ²⁸28. Granero-Moya N, Frías-Osuna A, Barrio-Cantalejo IM, Ramos-Morcillo AJ. Dificultades de las enfermeras de atención primaria en los procesos de planificación anticipada de las decisiones: un estudio cualitativo. Aten Primaria [Internet]. 2016 [acesso 24 abr 2019];48(10):649-56. DOI: 10.1016/j.aprim.2016.01.008 https://doi.org/10.1016/j.aprim.2016.01....	“Primary care nurses’ difficulties in advance care planning processes: a qualitative study”	Atención Primaria	To understand the difficulties primary care nurses encounter when establishing advance directives of will of the terminally ill.	Field research
Guardia Mancilla and collaborators; 2018 ²⁹29. Guardia Mancilla P, Montoya-Juarez R, Marti-Garcia C, Herrero Hahn R, García Caro MP, Cruz Quintana F. Percepciones de los profesionales sobre la atención prestada, obstáculos y dilemas éticos relacionados con el final de la vida en hospitales, centros de atención primaria y residencias de ancianos. An Sist Sanit Navar [Internet]. 2018 [acesso 24 abr 2019];41(1):35-46. DOI: 10.23938/ASSN.0170 https://doi.org/10.23938/ASSN.0170...	“Perceptions of health care professionals about end-of-life care, obstacles and ethical dilemmas in hospitals, primary care and nursing homes”	Anales del Sistema Sanitario de Navarra	Compare professional practice perception and the ethical dilemmas doctors and nurses face in terminal care in health centers, hospitals, and nursing homes.	Descriptive, cross-sectional, and multicenter study
Sánchez-García and collaborators; 2017 ³⁰30. Sánchez-García MR, Moreno-Rodríguez M, Hueso-Montoro C, Campos-Calderón C, Varella-Safont A, Montoya-Juárez R. Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales. Aten Primaria [Internet]. 2017 [acesso 24 abr 2019];49(5):278-85. DOI: 10.1016/j.aprim.2016.09.004 https://doi.org/10.1016/j.aprim.2016.09....	“Facilitators and barriers regarding end of life care at nursing homes: A focus group study”	Atención Primaria	Identify difficulties and factors faced by professionals working in nursing homes.	Field research
Motta and collaborators; 2016 ³¹31. Motta LCS, Oliveira LN, Silva E, Siqueira-Batista R. Tomada de decisão em (bio)ética clínica: abordagens contemporâneas. Rev. bioét. (Impr.) [Internet]. 2016 [acesso 24 abr 2019];24(2):304-14. DOI: 10.1590/1983-80422016242131 https://doi.org/10.1590/1983-80422016242...	“Decision making in clinical (bio)ethics: contemporary approaches”	Revista Bioética	Identify situations that distress health professionals and/or researchers in clinical practice, and briefly present reflections or approaches related to the decision-making process.	Literature review
Renner, Goldim, Prati; 2002 ¹⁸18. Renner AF, Goldim JR, Prati FM. Dilemas éticos presentes na prática do fisioterapeuta. Braz J Phys Ther. 2002;6(3):135-8.	“Ethical dilemmas experienced in physical therapy practice”	Revista Brasileira de Fisioterapia	Identify ethical dilemmas in physiotherapists’ practice.	Field research
Pereira; 2007 ³²32. Pereira RAB. Dilemas éticos ligados à prática do fisioterapeuta no atendimento da criança com deficiência física ou mental [dissertação] [Internet]. São Paulo: Universidade Presbiteriana Mackenzie; 2007 [acesso 6 out 2020]. Disponível: https://bit.ly/3d4m0oA https://bit.ly/3d4m0oA...	“Ethical dilemmas related to physiotherapy practice in attendance of children with physical and mental disability”	Master's dissertation	Verify in the professional practice of physiotherapists the ethical dilemmas that guide their therapeutic relationship with children with physical and/or mental disabilities and their family.	Field research
Lorenzo, Bueno; 2013 ³³33. Lorenzo CFG, Bueno GTA. A interface entre bioética e fisioterapia nos artigos brasileiros indexados. Fisioter Mov [Internet]. 2013 [acesso 24 abr 2019];26(4):763-75. DOI: 10.1590/S0103-51502013000400006 https://doi.org/10.1590/S0103-5150201300...	“The interface between bioethics and physiotherapy in Brazilian indexed papers”	Fisioterapia em Movimento	To study the theme and theoretical basis of the indexed articles that intended to discuss the interface between physiotherapy and bioethics.	Literature review

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