[Bioethics and spirituality at the end of life]. / Bioética y espiritualidad al final de la vida.

Understanding suffering and hope with people - children, youth and adults who die! Being with so many people waited, despaired, cried the lives of parents, children and friends, we will better understand the pain and suffering and spirituality of those at the end of life. With this essay, we intend to raise the reflection of health professionals to experience spirituality in caring for the end-of-life person. Study and hermeneutic analysis based on texts by Daniel Serr)o, Walter Osswald and Filipe Almeida. Results. Medicine and nursing are aware of human finitude, but of a finitude that is not identified with nothingness, emptiness, absence, but an ethic of hope ″(Moltmann, 2012). Bioethics in clinical practice calls for the humanization and spirituality of the dying process. Each sick person calls for a therapeutic response on the horizon of friendship, which refuses, therefore, disagreements generated in the corridors inhabited by moral strangers. Spirituality is also the therapeutic window of a universe that awaits intensity of glances, cuddling with outstretched hands, respect in the dignity that is recognized.

Ethical decision making in pain management: a conceptual framework.

INTRODUCTION: The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician-patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction; 5) concerns regarding "last-ditch" treatments of severe pain; and 6) failure to be accountable and equitable. OBJECTIVE: The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. METHODS: This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. DISCUSSION: We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid treatment as indicated in their cases, are unethical and should be reconsidered. CONCLUSION: Developing an ethical framework for pain management will result in enhanced quality of care, linking the epistemic domains of pain management to their anthropological foundations, thereby making them ethically sound.