Vigilia inconsciente. Análisis de un caso de estado vegetativo y diferentes modelos de toma de decisión / Awake but unaware. Analysis of a case of vegetative state and different decision-making models

El presente artículo analiza el caso de un paciente en estado vegetativo que -tras la solicitud de su familia de retirar la alimentación artificial- se presentó ante el Comité de Ética Asistencial del Hospital Universitario Vall d’Hebron, Barcelona. Partiendo de este caso, y de la revisión de otros casos mediáticos, se propone reflexionar sobre los diferentes modelos comúnmente aludidos para la toma de decisiones, haciendo hincapié en sus implicaciones éticas y limitaciones. El trabajo concluye con el análisis de un modelo de decisión deliberativo y compartido entre sanitarios y familiares que evita la omisión de las particularidades circunstanciales y relacionales de cada paciente

This article analyzes the case of a patient in a vegetative state that -after the request of the family to withdraw artificial nutrition- was presented to the Ethics Committee of the Vall d'Hebron University Hospital, Barcelona. Starting from this case, and a review of some other media cases, it is intended to reflect on the different models commonly used in the decision-making process, emphasizing in its limitations and ethical implications. The paper concludes with the analysis of a deliberative and shared decision-making model that includes both, health care providers and family, thus avoiding the omission of circumstantial and relational characteristics of each patient

Family presence during cardiopulmonary resuscitation: who should decide?

Whether to allow the presence of family members during cardiopulmonary resuscitation (CPR) has been a highly contentious topic in recent years. Even though a great deal of evidence and professional guidelines support the option of family presence during resuscitation (FPDR), many healthcare professionals still oppose it. One of the main arguments espoused by the latter is that family members should not be allowed for the sake of the patient's best interests, whether it is to increase his chances of survival, respect his privacy or leave his family with a last positive impression of him. In this paper, we examine the issue of FPDR from the patient's point of view. Since the patient requires CPR, he is invariably unconscious and therefore incompetent. We discuss the Autonomy Principle and the Three-Tiered process for surrogate decision making, as well as the Beneficence Principle and show that these are limited in providing us with an adequate tool for decision making in this particular case. Rather, we rely on a novel principle (or, rather, a novel specification of an existing principle) and a novel integrated model for surrogate decision making. We show that this model is more satisfactory in taking the patient's true wishes under consideration and encourages a joint decision making process by all parties involved.