Percepción familiar sobre la ortotanasia y distanasia en cuidadores de pacientes oncológicos / Family perception of orthothanasia and distanasia in caregivers of cancer patient

En la atención al paciente en estadío terminal de causa oncológica, un tema que cobra importancia es la percepción sobre la distanasia y ortotanasia en los cuidadores como alternativa sentida al final de la vida. El objetivo de la investigación fue caracterizar la percepción familiar de los cuidadores de los enfermos terminales sobre la distanasia y la ortotanasia como alternativa sentida al final de la vida en la Policlínica Universitaria Ángel Ortíz Vázquez. Se realizó un estudio cuantitativo-cualitativo. La muestra quedó conformada por 6 cuidadores. Se estudiaron las variables conocimiento real y referido en relación con enfermo terminal y enfermedad terminal, así como la ortotanasia y distanasia, la percepción familiar sobre la ortotanasia y distanasia y la elección de alternativa sentida al final de la vida. En el proceso investigativo se emplearon una encuesta, la entrevista, la entrevista en profundidad y la composición. El análisis de los datos se articula a través de la asunción de la triangulación como estrategia metodológica. Emergió que el 83,3 por ciento de los cuidadores refirieron como alternativa sentida de elección al final de vida la ortotanasia. Mostraron insuficientes conocimientos en relación con los conceptos enfermo terminal-enfermedad terminal y ortotanasia-distanasia en ambas técnicas. La percepción familiar es de aceptación. La percepción familiar de los cuidadores sobre la distanasia-ortotanasia es de aceptación, con actitudes positivas y la elección de la ortotanasia como alternativa sentida al final de la vida para el sujeto, pues consideran que la misma es la mejor opción para disminuir el sufrimiento(AU)

In the care of patients in the terminal stage of oncological causes, an issue that gains importance is the perception of distanasia and orthothanasia in caregivers as an alternative felt at the end of life. The objective of the research was to characterize the family perception of the caregivers of the terminally ill about distanasia and orthothanasia as an alternative felt at the end of life at the Ángel Ortíz Vázquez University Polyclinic. A quantitative-qualitative study was carried out. The sample was made up of 6 caregivers. The variables real and referred knowledge in relation to terminally ill and terminally ill were studied, as well as orthothanasia and distanasia, family perception of orthothanasia and distanasia and the choice of alternative felt at the end of life. In the investigative process, a survey, the interview, the in-depth interview and the composition were used. The data analysis is articulated through the assumption of triangulation as a methodological strategy. It emerged that 83.3 percent of the caregivers referred to orthothanasia as a felt alternative of choice at the end of life. They showed insufficient knowledge in relation to the terminally ill-terminally ill and orthothanasia-distanasia concepts in both techniques. The familiar perception is one of acceptance. The family perception of caregivers about distanasia-orthothanasia is one of acceptance, with positive attitudes and the choice of orthothanasia as an alternative felt at the end of life for the subject, since they consider that it is the best option to reduce suffering(EU)

Tipologías de los madrileños ante la etapa final de la vida mediante un análisis de clusters / Typologies of Madrid's citizens (Spain) at the end-of-life: cluster analysis

Objetivo: Establecer tipologías de la población general madrileña ante el final de la vida, mediante un análisis de clusters. Método: A la muestra (N = 425), perteneciente a un centro de salud de la Comunidad Autónoma de Madrid, se le aplicó el programa SPAD 8. Se efectuó una técnica de análisis de correspondencias múltiples, seguida de un análisis de conglomerados para lograr un dendograma jerárquico ascendente. Previamente se realizó un estudio transversal con los resultados de un cuestionario. Resultados: Se identificaron cinco clusters. Cluster 1: grupo que no respondió a numerosas preguntas del cuestionario (5%). Cluster 2: partidarios de recibir cuidados paliativos y de la eutanasia (40%). Cluster 3: se oponen al suicidio asistido y no solicitarían ayuda espiritual (15%). Cluster 4: partidarios de recibir cuidados paliativos y del suicidio asistido (16%). Cluster 5: contrarios al suicidio asistido y solicitarían ayuda espiritual (24%). Conclusiones: Sobresalieron estos cuatro clusters. Los clusters 2 y 4 eran partidarios de recibir cuidados paliativos, la eutanasia (2) y el suicidio asistido (4). Los clusters 4 y 5 practicaban mucho sus creencias y sus familiares no habían recibido cuidados paliativos. Por el contrario, los clusters 3 y 5 se oponían a la eutanasia y mayormente al suicidio asistido. Apenas practicaban sus creencias los clusters 2 y 3. Los clusters 2, 4 y 5 no efectuaron el documento de instrucciones previas. Este estudio se podría tener en cuenta para elegir los cuidados que mejoren la calidad del final de la vida

Objective: To establish typologies within Madrid's citizens (Spain) with regard to end-of-life by cluster analysis. Method: The SPAD 8 programme was implemented in a sample from a health care centre in the autonomous region of Madrid (Spain). A multiple correspondence analysis technique was used, followed by a cluster analysis to create a dendrogram. A cross-sectional study was made beforehand with the results of the questionnaire. Results: Five clusters stand out. Cluster 1: a group who preferred not to answer numerous questions (5%). Cluster 2: in favour of receiving palliative care and euthanasia (40%). Cluster 3: would oppose assisted suicide and would not ask for spiritual assistance (15%). Cluster 4: would like to receive palliative care and assisted suicide (16%). Cluster 5: would oppose assisted suicide and would ask for spiritual assistance (24%). Conclusions: The following four clusters stood out. Clusters 2 and 4 would like to receive palliative care, euthanasia (2) and assisted suicide (4). Clusters 4 and 5 regularly practiced their faith and their family members did not receive palliative care. Clusters 3 and 5 would be opposed to euthanasia and assisted suicide in particular. Clusters 2, 4 and 5 had not completed an advance directive document (2, 4 and 5). Clusters 2 and 3 seldom practiced their faith. This study could be taken into consideration to improve the quality of end-of-life care choices

Produção científica de enfermagem acerca da eutanásia: revisão integrativa da literatura / Producción científica de enfermería sobre la eutanasia: revisión integradora / The nursing’s scientific production on euthanasia: integrative literature review

Objective: to describe how euthanasia has been approached in Brazilian scientific publications authored by nurses and to discuss about the described bioethics aspects related to euthanasia. Method: this was an integrative literature review based on the BDENF, SciELO, and LILACS databases using the terms euthanasia and nursing as descriptors in complete texts in Portuguese. Results: a total of 24 articles were found, among them 6 contained complete texts; however, only 4 of them fulfilled the inclusion criteria and established consistent relationship with the subject. Conclusion: the theme is little discussed in the national level by nursing researchers. The selected studies did not address only euthanasia but included the end of one's life, palliative care, dystanasia, orthothanasia, and other actors involved in the decision-making process about one's death.

Objetivo: descrever como a eutanásia tem sido abordada nas publicações científicas nacionais realizadas por enfermeiros e discutir sobre os aspectos bioéticos descritos relacionados à eutanásia. Método: revisão integrativa de literatura nas bases de dados BDENF, SciELO e LILACS, por meio dos descritores eutanásia e enfermagem, utilizando-se textos completos e em português. Resultados: foram encontrados 24 artigos, dos quais 06 possuíam texto completo. Destes, foram selecionadas 04 publicações que atenderam aos critérios de inclusão e estabeleceram relação consistente com a temática. Conclusão: temática pouco explorada no cenário nacional por pesquisadores da enfermagem. Os estudos encontrados não versavam exatamente sobre a eutanásia apenas, mas sobre terminalidade da vida e cuidado paliativo, distanásia, ortotanásia, e falavam de outros atores envolvidos no processo de decisão no fim da vida.

Objetivo: describir cómo la eutanasia ha sido abordada en las publicaciones científicas nacionales realizadas por los enfermeros y discutir los aspectos de bioética descritos relacionados con la eutanasia. Método: revisión integradora de la literatura en las bases de datos BDENF, SciELO y LILACS, a través de los descriptores eutanasia y enfermería utilizándose textos completos en portugués. Resultados: fueron encontrados 24 artículos, de los cuales 06 tenían texto completo. De éstos, fueron seleccionadas 04 publicaciones que cumplieron con los criterios de inclusión y establecieron relación consistente con la temática. Conclusión: temática poco investigada en la escena nacional por los investigadores de enfermería. Los estudios encontrados no se referían exactamente sobre la eutanasia, sino sobre la terminalidad de la vida y los cuidados paliativos, distanasia, ortotanasia, y hablaban de otros actores involucrados en el proceso de decisiones al final de la vida.

[Dying in the intensive care unit]. / Sterben auf der Intensivstation.

Modern intensive care is responsible both for curative interventions in critical health situations and palliative terminal care for the dying ICU patient. By applying an integrated ethics approach, this article examines organizational and cultural factors shaping good terminal care in the ICU. Starting with a reflection on what it means to be human, ethical goals for care of the dying are formulated. Among them, the article focuses on practices ensuring a dignified dying process, on the structured engagement of patients' families, on respecting cultural and spiritual values, and on a clinical pathway for terminal care as an institutional framework. In conclusion, it becomes evident that good terminal care in the ICU not only depends on ethically sound decisions on withholding or withdrawing medical interventions but also on organizational and cultural aspects which must be acknowledged and shaped.

Bioética: visão multidimensional / Bioethics: multidimensional

O livro integra múltiplos assuntos específicos e atuais das mais diversas disciplinas, oferecendo posicionamento humano e adequado à realidade. Aborda a estrutura científica da Bioética, alteridade nas questões ambientais, a relação quanto às origens das políticas públicas de saúde, reflexão sobre a relação médico-paciente, a bioestatística frente aos resultados da investigação, a importância dos cuidados paliativos às pessoas sem possibilidades terapêuticas e os significados e interpretações da dignidade da morte. Trata do suicídio e suas implicações bioéticas, a espiritualidade como necessidade de atendimento humano e de saúde, os significados emergentes e os motivos de iatrogenia.

End-of-life care education for psychiatric residents: attitudes, preparedness, and conceptualizations of dignity.

OBJECTIVE: The authors examined psychiatric residents' attitudes, perceived preparedness, experiences, and needs in end-of-life care education. They also examined how residents conceptualized good end-of-life care and dignity. METHODS: The authors conducted an electronic survey of 116 psychiatric residents at the University of Toronto. The survey had a mix of qualitative and quantitative questions. RESULTS: Eighty-two of 116 invited psychiatric residents participated for a response rate of 71%. With favorable attitudes, residents felt least prepared in existential, spiritual, cultural, and some psychological aspects of caring for dying patients. Trainees conceptualized dignity at the end of life in a way very similar to that of patients, including concerns of the mind, body, soul, relationships, and autonomy. Residents desired more longitudinal, contextualized training, particularly in the psychosocial, existential, and spiritual aspects of care. CONCLUSION: This is the first study to examine the end-of-life educational experience of psychiatric residents. Despite conceptualizing quality care and the construct of dignity similarly to dying patients, psychiatric residents feel poorly prepared to deliver such care, particularly the nonphysical aspects of caring for the dying. These results will inform curriculum development in end-of-life care for psychiatric residents, a complex area now considered a core competency.