Encuesta en población abierta respecto a términos relacionados con decisiones al final de la vida.

INTRODUCTION: Concepts related to end-of-life decisions, such as euthanasia, palliative care, advance directives and therapeutic obstinacy, are poorly understood by the general population, which, when facing a terminal situation, is not prepared to choose the best option. OBJECTIVE: Pilot study (n = 544) to find out what the open population understands about terms used in end-of-life situations in four cities of the Mexican Republic. METHOD: Survey via Internet with 18 questions about different terms. It was a descriptive, cross-sectional study. Statistical analysis was carried out. RESULTS: People older than 18 years who were not engaged in health-related professional activities were selected. CONCLUSIONS: Most terms related to end-of-life decisions were found not to be interesting to or understood by a part of the population. The least recognized term was therapeutic obstinacy (62.8%), and the most widely known, palliative care (91%); there was confusion between the terms euthanasia and assisted suicide (47.8%). Age and education level had more influence in the results, than other demographic variables.

INTRODUCCIÓN: Conceptos relacionados con las decisiones que se toman al final de la vida, como eutanasia, cuidados paliativos, voluntad anticipada y obstinación terapéutica son poco comprendidos por la población en general, que en el momento de enfrentar una situación terminal no está preparada para elegir la mejor opción. OBJETIVO: Estudio piloto (n = 544) para conocer lo que la población abierta entiende acerca de términos utilizados al final de la vida en cuatro ciudades de la república mexicana. MÉTODO: Encuesta vía internet de 18 preguntas sobre los distintos términos. Se trató de un estudio descriptivo, transversal, con análisis estadístico. RESULTADOS: Se eligieron personas mayores de 18 años que no trabajaran en profesiones relacionadas con la salud. CONCLUSIONES: La mayoría de los términos del final de la vida no interesaron ni fueron entendidos por parte de la población. El término menos reconocido fue la obstinación terapéutica (62.8 %) y el más conocido, cuidados paliativos (91 %); se confunden los términos eutanasia y suicidio asistido (47.8 %). La edad y escolaridad resultaron de mayor influencia en los resultados, que las otras variables demográficas.

Encuesta en población abierta respecto a términos relacionados con decisiones al final de la vida / Open population survey regarding terms related to decisions at the end of life

Resumen Introducción: Conceptos relacionados con las decisiones que se toman al final de la vida, como eutanasia, cuidados paliativos, voluntad anticipada y obstinación terapéutica son poco comprendidos por la población en general, que en el momento de enfrentar una situación terminal no está preparada para elegir la mejor opción. Objetivo: Estudio piloto (n = 544) para conocer lo que la población abierta entiende acerca de términos utilizados al final de la vida en cuatro ciudades de la república mexicana. Método: Encuesta vía internet de 18 preguntas sobre los distintos términos. Se trató de un estudio descriptivo, transversal, con análisis estadístico. Resultados: Se eligieron personas mayores de 18 años que no trabajaran en profesiones relacionadas con la salud. Conclusiones: La mayoría de los términos del final de la vida no interesaron ni fueron entendidos por parte de la población. El término menos reconocido fue la obstinación terapéutica (62.8 %) y el más conocido, cuidados paliativos (91 %); se confunden los términos eutanasia y suicidio asistido (47.8 %). La edad y escolaridad resultaron de mayor influencia en los resultados, que las otras variables demográficas.

Abstract Introduction: Concepts related to end-of-life decisions, such as euthanasia, palliative care, advance directives and therapeutic obstinacy, are poorly understood by the general population, which, when facing a terminal situation, is not prepared to choose the best option. Objective: Pilot study (n = 544) to find out what the open population understands about terms used in end-of-life situations in four cities of the Mexican Republic. Method: Survey via Internet with 18 questions about different terms. It was a descriptive, cross-sectional study. Statistical analysis was carried out. Results: People older than 18 years who were not engaged in health-related professional activities were selected. Conclusions: Most terms related to end-of-life decisions were found not to be interesting to or understood by a part of the population. The least recognized term was therapeutic obstinacy (62.8%), and the most widely known, palliative care (91%); there was confusion between the terms euthanasia and assisted suicide (47.8%). Age and education level had more influence in the results, than other demographic variables.

Percepción familiar del enfermo terminal sobre la distanasia y ortotanasia en la Atención Primaria / Family perception of the terminally ill patients about dysthanasia and ortothanasia in the Primary Care

La toma de decisiones al final de la vida es una cuestión generalmente asumida por los cuidadores que tienen en la ortotanasia y la distanasia alternativas discutibles. Se realizó un estudio cuantitativo, prospectivo, descriptivo y transversal por encuesta en un universo de 64 cuidadores, de 52 pacientes con enfermedad terminal de tipo oncológica, en las áreas de salud del municipio Manzanillo con el objetivo de valorar la percepción familiar de los enfermos terminales sobre la distanasia u ortotanasia como alternativa al final de la vida. Con nuestro trabajo pudimos constatar que el surgimiento de los cuidados paliativos eleva el tono de las discordancias sobre el proceso de toma de decisiones que acompaña el final de la vida y que hoy no encuentra un marco legal(AU)

The decision-making at the end of the life is a matter generally assumed by caregivers who see controversial alternatives in ortothanasia and dysthanasia. It was performed a quantitative, prospective, descriptive and transverse study by a survey in a universe of 64 caregivers, 52 patients with terminal cancer, in the health areas of Manzanillo municipality with the objective to evaluate the family perception of the terminally ill patients about ortothanasia or dysthanasia like an alternative at the end of life. With our work we found that the emergence of palliative care raises the level of disagreements of the process of decision-making that accompanies the end of life and does not find a legal framework nowadays(EU)

End-of-life care attitudes, values, and practices among health care workers.

INTRODUCTION: This study aims to ascertain attitudes of health care workers on end-of-life care (EOLC) issues and to highlight the disparity that exists in countries with different backgrounds. METHODS: It is a cross-sectional questionnaire survey across heterogeneous health care providers in India, Chile, the United Kingdom, and the Netherlands using an indigenously prepared questionnaire considering regional variations, covering different areas of EOLC. RESULTS: Of the 109 participants, 68 (62.4%) felt that cardiopulmonary resuscitation should be done selectively, 25 (22.9%) had come in contact with at least 1 patient who had asked them to hasten death, and 36 (33%) felt that training was insufficient to prepare them for skills in issues of EOLC. CONCLUSION: To avoid cumbersome through well-meant interventions, it is important that the caregiving team is aware of the patient's own wishes with respect to EOLC issues.

[Euthanasia and physician assisted suicide: what is the problem?].

Some persons with refractory and unbearable suffering caused by an illness or medical condition wish to die by euthanasia or physician assisted suicide in order to have a certain and painless death. Physicians who agree to help a patient to die have previously confirmed that his/her illness cannot be cured, his/her suffering cannot be relieved and he/ she is of sound mind. Being well informed of his/her condition, the patient arrives to the conclusion that in his/her situation being death is better that being alive. How to explain that there are very few places in which physicians are allowed to help their patients to die? The main arguments against legalizing physician-assisted death are analyzed in this article.

La familia y la limitación del esfuerzo terapéutico en los cuidados intensivos pediátricos: aspectos éticos / Family and limitation of the therapeutic effort in pediatric intensive care: ethical Issues

El hecho de mejorar la calidad de vida de los pacientes con enfermedades incurables, así como prolongar la vida en situaciones clínicas de gravedad extrema, se ha visto aparejado al problema de delimitar cuándo no es éticamente correcto prolongar más una agonía. Casi toda la literatura médica que trata este tema, se refiere al derecho del paciente y de la familia de limitar un esfuerzo terapéutico fútil y de lo acertado de esto para evitar el sufrimiento innecesario del enfermo; sin embargo, existe poca información acerca de cómo actuar ante situaciones en que los familiares de un niño en estadio terminal, insisten en continuar con tratamientos que no tendrán resultados y que solo provocarán dolor e incremento del sufrimiento, sin contar el gasto innecesario de recursos, lo cual pone al médico en una situación difícil. En este trabajo se exponen criterios derivados de la experiencia en la unidad de cuidados intensivos pediátricos, sobre todo, relacionados con la interpretación de los conceptos que se manejan en este contexto(AU)

The fact of improving the quality of life of patients with incurable diseases and prolonging life in extremely serious cases has been related to the problem of defining when it is not ethically correct to prolong the agony. Almost all the medical literature addressing this issue refers to the patient and familys right to limit a futile therapy and its usefulness to avoid the unnecessary suffering of the patient. However, there is little information on how to act when the ralatives of the terminally ill child insist on continuing futile treatments that will only cause pain and increased suffering, without mentioning the unnecessary expenditure of resources, which puts the physician in a difficult position. This paper presents the criteria derived from the experience in the pediatric intensive care unit, especially those related to the interpretation of the concepts used in this context(AU)

On euthanasia: exploring psychological meaning and attitudes in a sample of Mexican physicians and medical students.

Euthanasia has become the subject of ethical and political debate in many countries including Mexico. Since many physicians are deeply concerned about euthanasia, due to their crucial participation in its decision and implementation, it is important to know the psychological meaning that the term 'euthanasia' has for them, as well as their attitudes toward this practice. This study explores psychological meaning and attitudes toward euthanasia in 546 Mexican subjects, either medical students or physicians, who were divided into three groups: a) beginning students, b) advanced students, and c) physicians. We used the semantic networks technique, which analyzed the words the participants associated with the term 'euthanasia'. Positive psychological meaning, as well as positive attitudes, prevailed among advanced students and physicians when defining euthanasia, whereas both positive and negative psychological meaning together with more ambivalent attitudes toward euthanasia predominated in beginning students. The findings are discussed in the context of a current debate on a bill proposing active euthanasia in Mexico City.

Aborto e eutanásia: dilemas contemporâneos sobre os limites da vida / Abortion and euthanasia: contemporary issues on the limits of life

Este artigo analisa a polêmica em torno da determinação dos limites da vida, a partir do pressuposto de que a demarcação das fronteiras entre vida e morte envolve questões culturais, sociais, religiosas e políticas referentes à gestão da pessoa. Debates acerca do aborto e da eutanásia evidenciam concepções morais sobre os direitos individuais que, por sua vez, são passíveis de normatização em cada contexto. Tais temas revelam para além da criação e do desenvolvimento de novas tecnologias médicas, direcionadas à reprodução assistida, medicina fetal e manutenção artificial da vida, seja de prematuros ou de doentes fora de possibilidades de cura – valores e posicionamentos, muitas vezes contrastivos. A partir de levantamento de projetos de lei apresentados no âmbito legislativo brasileiro, constatou-se a presença de discursos opostos, oriundos da religião e de defensores da autonomia individual, o que ilustra os dilemas contemporâneos sobre os limites da vida.

This article analyzes the controversy surrounding what can be established as the limit of life, from the presumption that the frontier marks between life anddeath involve cultural, social, religious and political issues referred to personhood management. Debatesabout abortion and euthanasia make it clear that moral concepts on individual rights can be standardized in each context. These themes reveal –beyond new medical technology creation and development, focused on assisted fertilization, fetal medicine and maintaining life artificially, either forpremature babies or patients without possibilities of cure – values and viewpoints, often opposed. Fromthe survey of law projects, presented within Brazilian legislative field, opposite positions were revealed, fromreligion and defenders of individual autonomy, which illustrates the contemporary dilemmas on the limits oflife.

Aspectos bioéticos del final de la vida: el derecho a morir con dignidad / Bioethical aspects of end of life: the right to die with dignity

"El derecho a morir con dignidad" es una expresión del principio de autonomía o autodeterminación, significa poder elegir, gestionar la propia vida sus condiciones y su final. Expresa una exigencia ética, que no se refiere directamente al morir sino a la "forma" de morir, el tema se problematiza cuando la muerte es una elección y la vida una obligación. La eutanasia y otros problemas bioéticos relacionados con el final de la vida son siempre delicados de tratar, hasta hace apenas unas décadas, eran pocos y leves los problemas éticos relacionados con el inicio y final de la vida, ahora la situación ha cambiado. La asistencia sanitaria plantea en la actualidad cada vez más problemas, que no estan sólo relacionados con la vertiente médica, sino tambien, y de manera muy intensa con el mundo jurídico y el complejo mundo de los valores éticos, donde los protagonistas son los pacientes y sus familiares, los profesionales y la sociedad en general. En este sentido, se presenta una revisión que pretende responder a las siguientes preguntas ¿que se puede hacer para que el final de la vida sea confortable? ¿Cuales son los sistemas habilitados en la sociedad para ayudar a las personas con "enfermedad terminal"?, mediante el análisis del problema en el respeto a la autonomía del paciente, las dimensiones del problema (social, religioso, psicológico, económico y otros), la moralidad de "matar" o "dejar morir" y el "no poner" o "quitar" tratamientos; la medicina paliativa como una respuesta efectiva, congruente con una muerte digna a la cual todo ser humano tiene derecho.

Terminalidad de la vida: aspectos médico-legales de la eutanasia / End of life: medical and legal aspects of the euthanasia

El progreso de la ciencia médica y sus efectos sobre el ser humano encuentran en la muerte un límite ético a sus posibilidades. El progreso médico, en ocasiones, se opone a los derechos de los pacientes, apareciendo la eutanasia como uno de sus principales conflictos. La discusión bioética debe resolver el dilema sobre permitir o no la muerte de todo paciente terminal que así lo desee. Algunas legislaciones han permitido la eutanasia, basadas en la autonomía del paciente, cuando aparecen situaciones que no permiten una buena calidad de vida en pacientes que padecen enfermedades terminales. El propósito de este artículo es realizar un análisis acerca de la eutanasia con el objetivo de clarificar los conceptos, sus aspectos bioéticos y realizar un análisis del proyecto de ley que pretende aprobar la eutanasia en Chile, encontrándose en dicho proyecto muchas contradicciones dentro del mismo y en relación con la legislación chilena en general.

The progress of medical science and their effect on the human being find in the death the ethical limits to their possibilities. The medical science, sometimes, opposes to the patients rights, so appear the euthanasia like one of these principals' troubles. The bioethics discussion must to resolve the question about to permit the possibilities of death to all terminals patients who don't want to continue with their lives. Some legislation has permitted the euthanasia based on autonomy of the patients when some situation doesn't permit one well quality of life in patients with terminal illness. The purpose of this paper is to make an analysis about the euthanasia with the object to clarify some concepts, their bioethical aspects and to analyze the Chilean project of law which pretends to regulate the euthanasia, finding many contradictions inside the project and in their relation with the Chilean legislation in general.

Physicians' willingness to grant requests for assistance in dying for children: a study of hypothetical cases.

OBJECTIVE: To study the willingness of Dutch physicians to use potentially life-shortening or lethal drugs for severely ill children. STUDY DESIGN: We asked 63 pediatricians about their approach to 10 hypothetical cases of children with cancer. The age of the child (15, 11, or 6 years), the child's (explicit) request, and the opinion of the parents varied. Two hypothetical cases were also presented to 125 general practitioners and 208 clinical specialists. RESULTS: Most pediatricians were willing to increase morphine in all cases. A total of 48% to 60% of pediatricians were willing to use lethal drugs in children at the child's request, when the parents agreed; when parents requested ending of life of their unconscious child, 37% to 42% of pediatricians were willing; 13% to 28% of pediatricians were willing when parents did not agree with their child's request. General practitioners and clinical specialists were as willing as pediatricians to use lethal drugs at the child's request, but less willing to grant a request of parents for their unconscious child. CONCLUSIONS: Many Dutch pediatricians are willing to use potentially life-shortening or lethal drugs for children. The legal limit of 12 years, as the age under which voluntary euthanasia is forbidden, is not fully supported by Dutch physicians.

Eutanasia / Euthanasia

Nos ocupamos de la eutanasia por que ella existe, porque se desea y es una realidad angustiante en el trabajo médico asistencial. Está prohibida en la legislación Brasileña y Argentina. La "tentación eutanásica" aparece en nuestra mente como un resultado contratransferencial. Es decir que surge de la relación médico paciente-circunstancia y de impulsos primitivos inconcientes. Es una verdadera "neurosis de transferencia". La función del psicológo no es intervenir en el acto de la eutanasia, sino en plantear al profesional las probables razones verdaderas de su pensamiento. La investigación de las famosas cartas Einstein-Freud evidencian que el matar puede satisfacer necesidades instintivas pero que son neutralizadas por los AFECTOS, la CULTURA y la DERIVACION A ESTRUCTURAS SOCIALES SUPERIORES, íy ésta es la respuesta!!! Un hospital deberá contar siempre con un Comité de Etica o un Grupo Médico de Consulta, de fácil acceso para todos e integrado con un psicoterapeuta, cuya función no es ocuparse de los pacientes ni de la eutanasia, sino de los integrantes del Comité. Debe ser ajeno al hospital. Es el Comité de Etica o el Grupo Médico el que puede autorizar o no el acto eutanásico. Cuando lo contraindica debe aconsejar que otra cosa hacer en esa circunstancia. Cuando se indica lo que no se debe hacer, sin ofrecer una respuesta válida, eso es hipocresía. Las decisiones de un Comité de Etica, previamente elegido, prácticamento no son punibles. El médico no debería indicar a enfermería la realización de la inyección mortal. Es un procedimiento muy eficaz para perder el respeto de sí mismo. Todo profesional en relación con pacientes graves debe proteger su salud mental y para ello necesita alguien a quien preguntar: ¿Qué me está pasando a mí que siento el deseo de abreviar la vida de este paciente?. La propuesta para salir de lo que parece un tema difícil, puede ser tratar de comprender, reconocer e identificar lo que hacemos por el paciente, de lo que hacemos por uno mismo, en lo que puede ser una actuación psicopatológica omnipotente y respondiendo a motivaciones profundas, instintivas y racionalmente rechazadas. Todos los seres humanos y los médicos en particular, ante situaciones que juzgamos extremas o gravisimas, nuestro problema es la vida, la muerte siempre es la peor solución. (AU)

Eutanásia/distanásia: o direito de morrer com dignidade / Euthanasia/dysthanasia: the right to die with dignity

Este artigo faz uma breve reflexão sobre o tema eutanásia, distanásia na perspectiva da dignidade de morrer. Para tal análise, considera as várias óticas do conhecimento (do exercício médico, jurídico, teológico, psíquico, sociocultural, pessoal...). Muitas são as formas possíveis de morrer; todas válidas se houver consentimento dos envolvidos e dignidade até o fim. Porém, a gigantesca ambigüidade existente em torno da eutanásia e distanásia é decorrente do fato de que a decisão a ser tomada pode ser um bem. Entretanto, também pode promover um mal, expresso por meio de uma morte indigna (AU)

Eutanásia/distanásia: o direito de morrer com dignidade / Euthanasia/dysthanasia: the right to die with dignity

Este artigo faz uma breve reflexão sobre o tema eutanásia, distanásia na perspectiva da dignidade de morrer. Para tal análise, considera as várias óticas do conhecimento (do exercício médico, jurídico, teológico, psíquico, sociocultural, pessoal...). Muitas são as formas possíveis de morrer; todas válidas se houver consentimento dos envolvidos e dignidade até o fim. Porém, a gigantesca ambigüidade existente em torno da eutanásia e distanásia é decorrente do fato de que a decisão a ser tomada pode ser um bem. Entretanto, também pode promover um mal, expresso por meio de uma morte indigna

Attitudes to timeliness of death and euthanasia among first generation black Caribbean and white patients and their families living in the United Kingdom.

Attitudes to timeliness of death and euthanasia are little researched among people from different ethnic backgrounds or in socioeconomically deprived areas. We interviewed 50 bereaved family members of people from the black Caribbean community and 50 from the white community in the United Kingdom, using an established questionnaire, and compared reports of their and the reported patient views. In both groups more than two thirds of patients knew they might die, although in more than half of these cases no one had actually told them this. More than half of the respondents thought the deceased had died at the right time. One in five patients had talked about wanting to die sooner but this was not related to family members' own views. One patient in the black Caribbean group and two in the white group had talked about wanting euthanasia. The study highlights that communication with patients needs to be improved among both black Caribbean and white patients, but suggests that attitudes to timeliness of death are similar in both groups.

[Bioethics in the face of death]. / La bioética ante la muerte.

We review death, thanatology and bioethics concepts and precepts, the value scale and hierarchization; the changes in death vision according to culture, religion and hierarchy, changes in perception of, according to culture, religion and mores in different communities and times, as well with scientific and technological advances. We analyzed patient's reactions to death, and the reactions of people close to them. We describe and analyze the principal bioethical dilemmas associated with death: therapeutic overkill or dysthanasia, passive and active euthanasia, assisted suicide, orthothanasia, and organ transplants. We discuss the relationship between death and science, bioethics and thanatology, as a necessary discipline today.