Challenges to implementation of advance directives of will in hospital practice. / Desafios da implementação das diretivas antecipadas de vontade à prática hospitalar.

ABSTRACT

OBJECTIVE: to understand the difficulties and limitations in the implementation of advance directives of will in the hospital context. METHOD: qualitative, exploratory and descriptive study conducted by means of semi-structured interviews with nurses, resident physicians and family caregivers. The data were analyzed by using discursive textual analysis based on the framework of bioethics principles. RESULTS: the following categories emerged Terminality as an expression of loss and cure as an option for care; concerns about legal implications; advance directives of will demand patient autonomy and proper communication. CONCLUSION: limitations and difficulties in practice of advance directives of will from the perspective of the participants show, apart from countless conflicts and dilemmas regarding end-of life matters, that impending death experiences obstruct patients' wishes.