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2.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395622

RESUMO

A 530-g girl born at 22 weeks and 6 days' gestation (determined by an ultrasound at 11 weeks) was admitted to the NICU. Her mother had received prenatal steroids. At 12 hours of age, she was stable on low ventilator settings. Her blood pressure was fine. Her urine output was good. After counseling, her parents voiced understanding of the risks and wanted all available life-supporting measures. Many nurses were distressed that doctors were trying to save a "22-weeker." In the past, 4 infants born at 22 weeks' gestation had been admitted to that NICU, and all had died. The attending physician on call had to deal with many sick infants and the nurses' moral distress.


Assuntos
Idade Gestacional , Cuidado do Lactente/ética , Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal/ética , Corpo Clínico Hospitalar/ética , Decepção , Feminino , Humanos , Lactente , Recém-Nascido , Futilidade Médica/ética , Corpo Clínico Hospitalar/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Gravidez , Estresse Psicológico , Confiança
3.
S Afr Med J ; 109(8): 552-554, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31456546

RESUMO

The Court of Arbitration for Sport recently confirmed that the decision by the International Association of Athletics Federations to require hyperandrogenic female athletes such as Caster Semenya to reduce their testosterone levels to compete in certain races has been widely condemned. The World Medical Association has warned doctors not to assist in implementing the decision, as it would be unethical. The same would apply in terms of the Health Professions Council of South Africa's rules of professional conduct. Such treatment is 'futile' in medical terms, and does not serve the purpose of providing healthcare. Therefore, doctors may lawfully refuse to prescribe it. The decision is a violation of Semenya's constitutional rights and would be regarded as unethical should doctors comply with it. However, the prescription of such drugs would not be unlawful if Semenya gave informed consent to taking them. Such consent would not be a defence to a disciplinary hearing on unprofessional conduct, but would be a good defence to any legal action arising from unpleasant side-effects - provided they were explained to her.


Assuntos
Antagonistas de Androgênios/administração & dosagem , Atletas , Hiperandrogenismo/tratamento farmacológico , Futilidade Médica/ética , Futilidade Médica/legislação & jurisprudência , Médicos/legislação & jurisprudência , Feminino , Humanos , Recusa do Médico a Tratar/legislação & jurisprudência , Medicina Esportiva/legislação & jurisprudência
6.
Fertil Steril ; 111(4): 659-663, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30871767

RESUMO

The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment. In most cases, clear communication can avoid a direct conflict, but clinicians ethically may refuse to provide treatment believed to be futile or to carry a very poor prognosis. In certain instances, clinicians may provide limited treatment which they judge likely to be futile, but must be vigilant in their presentation of risks, benefits, and alternatives. This version replaces the previous published draft of this name (Fertil Steril 2012;98:e6-9).


Assuntos
Infertilidade/diagnóstico , Infertilidade/terapia , Futilidade Médica , Técnicas de Reprodução Assistida/ética , Comissão de Ética , Prova Pericial , Feminino , Humanos , Futilidade Médica/ética , Gravidez , Prognóstico , Fatores de Risco
8.
Crit Care Med ; 47(2): 149-151, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30334821

RESUMO

OBJECTIVES: Evaluate the reasons why attempts at redirection, especially at the end of life, often fail, and patients and families insist on treating the underlying illness. SETTING: Conflicts between patients and caregivers regarding the appropriate course of treatment. MAIN RESULTS: Clinicians typically understand requests for treatment merely as means to obtain effective care. However, patients and families often request treatment as a way to exert their agency, avoid a sense of responsibility for unwanted outcomes, and express compassion. CONCLUSIONS: In response to devastating illness, patients and families are frequently motivated by factors that go beyond obtaining effective care. Awareness of these factors can help clinicians to identify sources of potential conflict and continue to provide compassionate care.


Assuntos
Família/psicologia , Futilidade Médica/psicologia , Humanos , Unidades de Terapia Intensiva , Futilidade Médica/ética , Motivação
9.
HEC Forum ; 31(2): 119-139, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29881898

RESUMO

Patient and family demands for the initiation or continuation of life-sustaining medically non-beneficial treatments continues to be a major issue. This is especially relevant in intensive care units, but is also a challenge in other settings, most notably with cardiopulmonary resuscitation. Differences of opinion between physicians and patients/families about what are appropriate interventions in specific clinical situations are often fraught with highly strained emotions, and perhaps none more so when the family bases their desires on religious belief. In this essay, I discuss non-beneficial treatments in light of these sorts of disputes, when there is a clash between the nominally secular world of fact- and evidence-based medicine and the faith-based world of hope for a miraculous cure. I ask the question whether religious belief can justify providing treatment that has either no or a vanishly small chance of restoring meaningful function. I conclude that non-beneficial therapy by its very definition cannot be helpful, and indeed is often harmful, to patients and hence cannot be justified no matter what the source or kind of reasons used to support its use. Therefore, doctors may legitimately refuse to provide such treatments, so long as they do so for acceptable clinical reasons. They must also offer alternatives, including second (and third) opinions, as well the option of transferring the care of the patient to a more accommodating physician or institution.


Assuntos
Tomada de Decisões/ética , Esperança , Futilidade Médica/ética , Religião e Medicina , Humanos , Futilidade Médica/psicologia , Assistência Terminal/ética , Assistência Terminal/psicologia
10.
Nurs Ethics ; 26(1): 248-255, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28481130

RESUMO

OBJECTIVES:: Futile medical care is considered as the care or treatment that does not benefit the patient. Staff of intensive care units experience moral distress when they perceive the futility of care. Therefore, this study aimed to determine the relationship between perceptions of nurses regarding futile medical care and their caring behaviors toward patients in the final stages of life admitted to intensive care units. METHOD:: This correlation, analytical study was conducted with 181 nursing staff of the intensive care units of health centers affiliated to Mazandaran University of Medical Sciences, Mazandaran, Iran. The data collection tool included a three-part questionnaire containing demographic characteristics form, perception of futile care questionnaire, and caring behaviors inventory. To analyze the data, statistical tests and central indices of tendency and dispersion were investigated using SPSS, version 19. Pearson's correlation coefficient, partial correlation, t-test, and analysis of variance tests were performed to assess the relationship between the variables. ETHICAL CONSIDERATIONS:: The study was reviewed by the ethics committee of the Mazandaran University of Medical Sciences. Informed consent was obtained from participants. RESULTS:: Our findings illustrated that the majority of nurses (65.7%) had a moderate perception of futile care, and most of them (98.9%) had desirable caring behaviors in taking care of patients in the final stages of life. The nurses believed that psychosocial aspects of care were of utmost importance. There was a significant negative relationship between perception of futile care and caring behavior. CONCLUSION:: Given the moderate perception of nurses concerning futile care, and its negative impact on caring behaviors toward patients, implementing suitable interventions for minimizing the frequency of futile care and its resulting tension seems to be mandatory. It is imperative to train nurses on adjustment mechanisms and raise their awareness as to situations resulting in futile care.


Assuntos
Empatia , Futilidade Médica/psicologia , Enfermeiras e Enfermeiros/psicologia , Percepção , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Irã (Geográfico) , Masculino , Futilidade Médica/ética , Pessoa de Meia-Idade , Inquéritos e Questionários
12.
Semin Neurol ; 38(5): 561-568, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30321895

RESUMO

As medical decisions fall under more scrutiny and society demands increasing transparency of care, it is likely that more opportunities for conflicts will emerge. Similarly, with increasing demand and a static supply, the issue of who receives treatment and for how long naturally will arise. This mismatch leads to discussions of resource utilization and limitation of care in light of patients' values and rights. Clinicians should always be forthcoming with the uncertainty of prognostication while also articulating the severity of a patient's disease in relation to the risk and benefits of an intervention. However, dispute over treatment course and the idea of futile care can arise for in a variety of reasons, both from the clinician and the patient. Without identifying the cause of these conflicts, it is impossible to have effective communication. At times, it is important to utilize various negotiating skills when resolving these disagreements. Regardless of the approach, practitioners need more training in and exposure to these types of conflicts. In this review, we provide a framework for the origins and current state of futility, challenges in the application of the term, and recommendations on how to approach conflict in these situations.


Assuntos
Cuidados Críticos/ética , Tomada de Decisões/ética , Ética Médica , Futilidade Médica/ética , Pacientes , Tomada de Decisão Clínica/ética , Tomada de Decisões/fisiologia , Humanos
13.
J Vet Intern Med ; 32(6): 2115-2122, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30320478

RESUMO

BACKGROUND: Concerns about ethical conflicts, moral distress, and burnout in veterinary practice are steadily increasing. Root causes of these problems have not been rigorously identified. Little research has been done to evaluate the existence of moral distress in North American veterinarians or to explore its impact on career sustainability and poor well-being. HYPOTHESIS/OBJECTIVES: Ethical conflict and resultant moral distress are common occurrences in contemporary veterinary practice and negatively impact daily practice life, but may not be identified or labeled by veterinarians as such. ANIMALS: No animals were used in this study. METHODS: Mixed methods sequential explanatory design; confidential and anonymous on-line sampling of 889 veterinarians in North America. RESULTS: A majority of respondents reported feeling conflict over what care is appropriate to provide. Over 70% of respondents felt that the obstacles they faced that prevented them from providing appropriate care caused them or their staff moderate to severe distress. Seventy-nine percent of participants report being asked to provide care that they consider futile. More than 70% of participants reported no training in conflict resolution or self-care. CONCLUSIONS AND CLINICAL IMPORTANCE: Veterinarians report widespread ethical conflict and moral distress across many practice types and demographics. Most veterinarians have little to no training on how to decrease the impact of these problems. Ethical conflict and resulting moral distress may be an important source of stress and poor well-being that is not widely recognized or well defined. Well-researched and effective tools used to decrease moral distress in human healthcare could be adapted to ameliorate this problem.


Assuntos
Princípios Morais , Estresse Ocupacional/epidemiologia , Médicos Veterinários/ética , Medicina Veterinária/ética , Animais , Humanos , Futilidade Médica/ética , Futilidade Médica/psicologia , América do Norte/epidemiologia , Estresse Ocupacional/etiologia , Animais de Estimação , Inquéritos e Questionários , Médicos Veterinários/psicologia , Médicos Veterinários/estatística & dados numéricos , Medicina Veterinária/estatística & dados numéricos
14.
J Crit Care ; 48: 78-84, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30172965

RESUMO

PURPOSE: To summarize and compare qualitative studies which explored attitudes of patients, families and healthcare providers towards medical futility. MATERIALS AND METHODS: A systematic search of qualitative studies via the PubMed database was conducted. Data were extracted in terms of two aspects: 1) Group of people, which were interviewed about futility; 2) Definitions of medical futility given by these participants. Data were analyzed and synthesized using the method of qualitative content analysis. RESULTS: The initial search identified 737 articles. 71 studies were reviewed in detail and 10 were finally selected. As a result, three groups of people (physicians, caregiver and patients) and six core categories could be identified: patient treatment, quantitative aspects, resources, professional aspects, reference to balance, definition challenges. CONCLUSIONS: This review describes existing opinions about medical futility and demonstrates the multifaceted understanding of medical futility by physicians, caregivers and patients. The difficulties in defining medical futility demonstrate the need for resources to help healthcare providers and patients to deal with decision-making in such situations.


Assuntos
Atitude do Pessoal de Saúde , Família/psicologia , Futilidade Médica/psicologia , Pacientes/psicologia , Tomada de Decisão Clínica/ética , Humanos , Futilidade Médica/ética , Pesquisa Qualitativa
15.
J Law Med Ethics ; 46(2): 241-251, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-30146983

RESUMO

Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes. Instead, we are welladvised to explore each patient's situation in a holistic approach that includes the patient, family members, and care providers in the decision-making process. The scope of the problem illustrated demonstrates the urgent need to definitively improve outcomes in people who use injection drugs. Increasing access to high quality medication-assisted treatment and psychiatric care for individuals with opioid use disorder will help our patients achieve a sustained remission and allow us to reach this goal.


Assuntos
Cuidados Críticos/ética , Futilidade Médica/ética , Futilidade Médica/legislação & jurisprudência , Transtornos Relacionados ao Uso de Opioides/terapia , Padrão de Cuidado/ética , Adulto , Idoso , Tomada de Decisão Clínica/ética , Cuidados Críticos/classificação , Estado Terminal , Feminino , Humanos , Masculino , Médicos/ética , Médicos/legislação & jurisprudência , Cooperação e Adesão ao Tratamento/psicologia , Resultado do Tratamento , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
16.
J Clin Ethics ; 29(2): 114-23, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30129737

RESUMO

This article elucidates the premises and limited meaning of medical futility in order to formulate an ethically meaningful definition of the term, that is, a medical intervention's inability to deliver the benefit for which it is designed. It uses this definition to show the two ways an intervention could become medically futile, to recommend an even more limited usage of medical futility, and to explain why an intervention need not be futile in order to be withdrawn over patient-based objections. If an intervention retains some benefit, then patients or surrogates might legitimately consider that benefit in their case and request the intervention. Physicians might still be justified in declining it on the grounds that the burdens greatly outweigh the benefits, but not on the grounds of futility. Finally, the article uses bioethics research and healthcare litigation to clarify the meaning of futility in practice and recommends alternative language when possible.


Assuntos
Ética Médica , Futilidade Médica/ética , Médicos/psicologia , Atitude do Pessoal de Saúde , Características Culturais , Tomada de Decisões/ética , Humanos , Terminologia como Assunto , Suspensão de Tratamento/ética
17.
Rev. bioét. derecho ; (43): 245-259, jul. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176776

RESUMO

Durante los primeros 6 meses de 2017 se desarrolló un encendido debate sobre el caso de un niño inglés con una enfermedad rara y muy grave. Charlie Gard permaneció 9 meses en una unidad de cuidados intensivos paralizado, sometido a ventilación mecánica y con una función neurológica en constante deterioro. Mientras, en la prensa especializada y en los medios de comunicación general se desarrollaba un debate sobre quien tenía que tomar la decisión de retirar o continuar con los tratamientos de soporte vital y cuáles eran los criterios que había que utilizar para tomarla. En este artículo, analizamos estos y otros problemas éticos y sugerimos que, para tomar las mejores decisiones, se ha ido evolucionando de los intentos de definir la futilidad y determinar quién decide, hacia el concepto de tratamientos potencialmente inapropiados y el recurso a estrategias de toma de decisiones compartidas


In the first 6 months of 2017, there was a heated debate about the case of an English child with a rare and serious illness. Charlie Gard spent 9 months in an Intensive Care Unit paralyzed, undergoing mechanical ventilation and with a deteriorating neurological function. Meanwhile, a debate took place in the specialized press and general media about who had to make the decision to withdraw or continue with life support treatments, and on the criteria necessary to make that decision. In this article, we analyze these and other ethical problems, and suggest that in order to make the best decisions, attempts to define futility, and determine who decides has evolved into the concept of potentially inappropriate treatments and shared decision-making strategies


Durant els primers 6 mesos de 2017 es va desenvolupar un encès debat sobre el cas d'un nen anglès amb una malaltia rara i molt greu. Charlie Gard va romandre 9 mesos en una unitat de vigilància intensiva paralitzat, sotmès a ventilació mecànica i amb una funció neurològica en constant deterioració. Mentre, en la premsa especialitzada i en els mitjans de comunicació generals, tenia lloc un debat sobre qui havia de prendre la decisió de retirar o de continuar amb els tractaments de suport vital i quins eren els criteris que calia utilitzar per prendre-la. En aquest article analitzem aquests i altres problemes ètics i suggerim que, a fi de prendre les millors decisions, s'ha anat evolucionant dels intents de definir la futilitat, i determinar qui decideix, cap al concepte de tractaments potencialment inadequats i el recurs a estratègies de presa de decisions compartides


Assuntos
Humanos , Masculino , Criança , Futilidade Médica/ética , Cuidados Paliativos na Terminalidade da Vida/ética , Cuidados Paliativos na Terminalidade da Vida/legislação & jurisprudência , Tomada de Decisões/ética , Futilidade Médica/legislação & jurisprudência , Doenças Raras , Cuidados Críticos/ética
19.
AMA J Ethics ; 20(1): 595-601, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29905139

RESUMO

Burn injuries raise questions about decision-making capacity, informed consent, medical decision making, patient autonomy, the patient-physician relationship, and medical futility that must be acutely addressed. A commonly used approach to managing ethical challenges focuses on moral principles including respect for patient autonomy, beneficence, nonmaleficence, and justice. Another paradigm for ethical analysis is the "four-quadrant" approach, which poses questions for a given case regarding medical indications, patient preferences, quality of life, and contextual features. We have found this approach to be very effective in the clinical setting. This article will highlight the use of the four-quadrant approach in the management of ethical challenges that arise in the care of the severely burned patient.


Assuntos
Temas Bioéticos , Queimaduras/terapia , Tomada de Decisões/ética , Análise Ética/métodos , Ética Médica , Assistência ao Paciente/ética , Humanos , Futilidade Médica/ética , Competência Mental , Satisfação do Paciente , Relações Médico-Paciente/ética , Qualidade de Vida
20.
J Clin Ethics ; 29(1): 114-123, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29916828

RESUMO

This article elucidates the premises and limited meaning of medical futility in order to formulate an ethically meaningful definition of the term, that is, a medical intervention's inability to deliver the benefit for which it is designed. It uses this definition to show the two ways an intervention could become medically futile, to recommend an even more limited usage of medical futility, and to explain why an intervention need not be futile in order to be withdrawn over patient-based objections. If an intervention retains some benefit, then patients or surrogates might legitimately consider that benefit in their case and request the intervention. Physicians might still be justified in declining it on the grounds that the burdens greatly outweigh the benefits, but not on the grounds of futility. Finally, the article uses bioethics research and healthcare litigation to clarify the meaning of futility in practice and recommends alternative language when possible.


Assuntos
Futilidade Médica , Médicos , Humanos , Futilidade Médica/ética
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