[Clinical bioethics: how to practice?]. / Bioética clínica: como praticá-la?

To think about ethics means to go into the Bioethics universe. If it is understood that medical ethics deals with doctors within an organized society under legal purposes, consensus and ethics in the exercise of medicine it is observed that Bioethics came up due to the need to debate and decide on the ethic questions related mainly to research and scientific advances as well as conquests concerning human rights and social-cultural development: it is the critical expression of our interest in conveniently using the development of medical art and science. Within Medicine, clinical Bioethics arouse as a possibility of thinking and discussing the practice of medicine in the different social institutions which deal with health and with professionals in health area.

Clinical bioethics.

Clinical bioethics was born out of the need to introduce different ethical values involved in the relationships among physician, patient and health institutions which are outside the technical-scientific framework of routine medical practice. Physicians tend to adopt the norms and rules provided for in the Medical Ethics Code to guide the exercising of their professional practice. However, it has recently become challenging to apply these norms to all conduct since some issues faced in the professional practice are simply not provided for by such norms. Ethical consideration in practice drawing solely on the medical ethics code in Brazil has proved insufficient, both in the context of universal issues such as organ transplants, start and end-of-life, as well as in addressing specific issues such as allocation of funds for health. Clinical bioethics employs clinical cases and situations as an instrument for discussion. These discussions entail analysis of not only the facts and circumstances surrounding each case, but also the values which lead to patients, health teams and institutions opting to recommend, accept or refuse a given conduct.

Ethical aspects of brain death and end-of-life.

Ethical issues surrounding brain death and end-of-life have not been afforded in Brazil the same attention as in many developed countries. There appears to be reluctance on the part of Brazilian doctors to limit or suspend procedures or treatment which prolongs life of patients in terminal phases of severe incurable illness, or to suspend the artificial means of supporting vegetative functions in cases of brain death outside the context of organ and tissue donation for transplant. Fears grounded in possible administrative (Regional Medical Councils) or legal repercussions, as well as ambiguous interpretations of religious precepts, partially explain this reluctance which often results in unnecessary prolonging of patient suffering. A recent resolution by the Federal Medical Council on end-of-life may offer doctors some guidance and confidence in dealing with highly complex ethical situations.

Questões éticas relativas à morte encefálica e terminalidade da vida não têm ainda no Brasil o mesmo destaque que em países desenvolvidos. Os médicos brasileiros parecem ter resistência em limitar ou suspender tratamentos ou procedimentos de prolongamento da vida em pacientes em fase terminal de doença grave e incurável, ou em suspender os meios artificiais da manutenção de funções vegetativas em casos de morte encefálica fora do contexto de doação de órgãos e tecidos para transplante. Receio quanto a possíveis sanções administrativas (Conselhos Regionais de Medicina) ou legais, além de duvidosas interpretações de preceitos religiosos explicam, ao menos parcialmente, essa relutância, que freqüentemente resulta em prolongamento desnecessário do sofrimento dos pacientes. Uma recente Resolução do Conselho Federal de Medicina sobre terminalidade de vida oferece aos médicos orientação sobre como lidar com algumas dessas questões de grande complexidade ética.