RESUMEN
La muerte siempre ha generado desconcierto, por lo que acompañar en este proceso de final de vida conlleva un alto compromiso existencial. Si a esta difícil tarea se le agregan los condicionantes hospitalarios o legales que sufren los enfermos en su agonía, estamos ante una muerte aterradora, muy distante de una partida que pueda ser considerada amorosa. Como sabemos, la palabra "clínica" hace referencia a la práctica de atender al pie de la cama del paciente, aliviando el dolor del que está por partir; sin embargo, el "corsé legal" de la muerte está alejando al médico de aquel que debiera recibir toda su atención y sus cuidados, atándole el brazo para acompañarlo en el buen morir. Deberíamos debatir y acordar una estrategia que enriquezca la experiencia del momento final de la vida, de modo que ese conjunto acotado de pacientes pueda elegir su forma de partir. Es de un valor incalculable despertar la compasión en este tema tan importante que preocupa al ser humano desde los inicios de la civilización. Sería muy fructífero que aprovechemos la transmisión de sabiduría de siglos de antiguas culturas que han sabido cuidar con humildad la vida hasta el instante de morir. (AU)
Death has always implied confusion, so accompanying this end-of-life process entails a highexistential commitment. If we add to this difficult task the hospital or legal constraints suffered bypatients in their agony, we are facing a terrifying death, very far from a departure that can be considered a loving one. As we know, the word "clinical" refers to the practice of caring for the patient very close to the bed, alleviating the pain of whom is about to leave; however, the "legal corset" of death is separating the doctor from the one who should receive all his attention and care, preventing him from accompanying the pacient in his/her good dying. We should discuss and agree on a strategy that enriches the experience of the end of life, so that patients could choose the way to leave. It is of incalculable value to awaken compassion on this important issue that has concerned human since the beggining of civilization. It would be very fruitful if we take advantage of the enormous wisdom of ancient cultures that have humbly cared for life until the moment of death. (AU)
Asunto(s)
Humanos , Cuidados Paliativos/legislación & jurisprudencia , Cuidado Terminal/legislación & jurisprudencia , Derecho a Morir/legislación & jurisprudencia , Actitud Frente a la Muerte , Enfermo Terminal/legislación & jurisprudencia , Muerte , Cuidados Paliativos/psicología , Argentina , Cuidado Terminal/psicología , Enfermo Terminal/psicología , Prioridad del Paciente/psicologíaAsunto(s)
Rol del Médico , Relaciones Profesional-Paciente/ética , Suicidio Asistido , Enfermo Terminal , Conducta de Elección , Toma de Decisiones , Humanos , Servicios Legales , Psicología , Psicología Social , Suicidio Asistido/ética , Suicidio Asistido/legislación & jurisprudencia , Suicidio Asistido/psicología , Enfermo Terminal/legislación & jurisprudencia , Enfermo Terminal/psicologíaAsunto(s)
Relaciones Profesional-Paciente/ética , Suicidio Asistido , Enfermo Terminal , Regulación Gubernamental , Humanos , Psicología , Psicología Social , Percepción Social , Suicidio Asistido/ética , Suicidio Asistido/legislación & jurisprudencia , Suicidio Asistido/psicología , Enfermo Terminal/legislación & jurisprudencia , Enfermo Terminal/psicologíaRESUMEN
End-of-life decision making involves clinicians, patients, and relatives; yet, the law in Israel hardly recognises the role of relatives. This raises the question of the law's impact in practice and, hence, whether it should be amended. This issue is examined on the basis of findings from a qualitative, interview-based study conducted in Israel among relatives of dying patients. The findings indicate that there are areas in which clinicians and relatives do not adhere to the law in the end-of-life decision-making process. For example, they do not always ascertain the patient's end-of-life preferences, which ignores a patient's right to autonomy and their right to make informed decisions. The apparent gaps between the actual conduct of clinicians and relatives on the one hand and the directives of the Israeli Dying Patient Act 2005 on the other, lead us to propose several changes to the Act.
Asunto(s)
Toma de Decisiones/ética , Familia , Autonomía Relacional , Cuidado Terminal/legislación & jurisprudencia , Enfermo Terminal/legislación & jurisprudencia , Femenino , Humanos , Israel , Masculino , Investigación CualitativaAsunto(s)
Eutanasia Activa Voluntaria/legislación & jurisprudencia , Suicidio Asistido/legislación & jurisprudencia , Enfermo Terminal/legislación & jurisprudencia , Adulto , Anciano , Anciano de 80 o más Años , Muerte , Toma de Decisiones/fisiología , Eutanasia Activa Voluntaria/ética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oregon/epidemiología , Suicidio Asistido/ética , Enfermo Terminal/estadística & datos numéricos , Victoria/epidemiologíaAsunto(s)
Trasplante de Células Madre/legislación & jurisprudencia , Células Madre/fisiología , Enfermo Terminal/legislación & jurisprudencia , Costos y Análisis de Costo , Aprobación de Drogas , Financiación Gubernamental , Humanos , Legislación Médica , Prioridad del Paciente , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Policy-makers, bioethicists, and patient advocates have been engaged in a fierce battle about the merits and potential harms of a federal right-to-try law. This debate about access to investigational medical products has raised profound questions about the limits of patient autonomy, appropriate government regulation, medical paternalism, and political rhetoric. For example, do patients have a right to access investigational therapies, as the right-to-try movement asserts? What is government's proper role in regulating and facilitating access to drugs that are still in development? In this review, we analyze the history of the right-to-try movement, review the arguments put forth by supporters and opponents of the legislation, and consider the movement's consequences. Two possible scenarios may emerge. One is that the right-to-try pathway may fail to meaningfully increase patient access to investigational products. Alternatively, certain companies may attempt to rely on the federal right-to-try legislation to sell investigational products, taking advantage of the provision that allows for direct costs, as there is currently no clear mechanism for enforcement or monitoring of cost calculations.
Asunto(s)
Drogas en Investigación , Aplicación de Nuevas Drogas en Investigación/legislación & jurisprudencia , Producción de Medicamentos sin Interés Comercial/legislación & jurisprudencia , Defensa del Paciente/legislación & jurisprudencia , Regulación Gubernamental , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Enfermo Terminal/legislación & jurisprudencia , Estados Unidos , United States Food and Drug Administration/legislación & jurisprudenciaRESUMEN
BACKGROUND: The Supreme Court of Canada removed the prohibition on physicians assisting in patients dying on 6 February 2015. Bill C-14, legalising medical assistance in dying (MAID) in Canada, was subsequently passed by the House of Commons and the Senate on 17 June 2016. As this remains a divisive issue for physicians, the Canadian Neurosurgical Society (CNSS) has recently published a position statement on MAID. METHODS: We conducted a cross-sectional survey to understand the views and perceptions among CNSS members regarding MAID to inform its position statement on the issue. Data was collected from May to June 2016. RESULTS: Of the 300 active membes of the CNSS who recevied the survey, 89 respondents completed the survey, 71% of whom were attending neurosurgeons and 29% were neurosurgery residents. Most respondents,74.2%, supported the right of physicians to participate in MAID with 7.8% opposing. 37% had current patients in their practice fitting the criteria for MAID. 23.6% had been asked by patients to assist with MAID, but only 11% would consider personally providing it. 84% of neurosurgeons surveyed supported the physicians' right to conscientious objection to MAID while 21% thought attending surgeons should be removed from the inquiry and decision-making process. 43.8% agreed that the requirment to refer a patient to a MAID service should be mandatory. Glioblastoma multiforme (65%), quadriplegia/quadriparesis secondary to spinal tumour/trauma (54%) and Parkinson's disease (24%) were the most common suggested potential indications for MAID among the neurosurgical population. CONCLUSIONS: Our results demonstrate that most neurosurgeons in Canada are generally supportive of MAID in select patients. However, they also strongly support the physicians' right to conscientious objection.
Asunto(s)
Toma de Decisiones Clínicas/ética , Neurocirujanos/ética , Suicidio Asistido/ética , Enfermo Terminal/legislación & jurisprudencia , Actitud del Personal de Salud , Canadá , Estudios Transversales , Humanos , Neurocirujanos/legislación & jurisprudencia , Autonomía Personal , Rol Profesional , Sociedades Médicas , Suicidio Asistido/legislación & jurisprudenciaRESUMEN
In this editorial, we argue that current attitudes toward terminally ill patients are generally too paternalistic, and that it is wrong to assume that patients suffering from mental health issues (including depression) cannot consent to assisted suicide.Declaration of interestNone.