RESUMO
The arguments for and against euthanasia present a complex picture that will need to be discussed and decided in Mexico. This article addresses some relevant aspects such as the legal determination of death, the field of bioethics intervention, terminology related to euthanasia, its classifications, international instruments promoting human rights, as well as reflections on the importance of palliative care and the patient's right to be in a terminal situation to act in accordance with their goals, expectations and beliefs, in the context of their family and social relationships.
Los argumentos a favor y en contra de la eutanasia exponen un panorama complejo, que será necesario discutir y decidir en México. En este artículo se abordan algunos aspectos relevantes, como la determinación legal de la muerte, el campo de intervención de la bioética, la terminología relacionada con la eutanasia, sus clasificaciones, los instrumentos internacionales promotores de los derechos humanos, y reflexiones sobre la importancia de los cuidados paliativos y el derecho que tiene el paciente en situación terminal para actuar conforme a sus objetivos, expectativas y creencias, en el contexto de sus relaciones familiares y sociales.
Assuntos
Morte , Eutanásia , Atitude Frente a Morte , Bélgica , Temas Bioéticos , Morte Encefálica , Colômbia , Estado Terminal , Eutanásia/classificação , Eutanásia/ética , Eutanásia/legislação & jurisprudência , Direitos Humanos , Humanos , Luxemburgo , México , Países Baixos , Cuidados Paliativos/legislação & jurisprudência , Cuidados Paliativos/métodos , Direitos do Paciente , Terminologia como Assunto , Estados UnidosRESUMO
End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices.
Assuntos
Diretivas Antecipadas/ética , Tomada de Decisões/ética , Demência , Ética Médica , Eutanásia/ética , Legislação Médica , Suicídio Assistido/ética , Diretivas Antecipadas/legislação & jurisprudência , Idoso , Bélgica , Bioética , Cultura , Eutanásia/legislação & jurisprudência , Família , Humanos , Consentimento Livre e Esclarecido , México , Países Baixos , Pessoalidade , Médicos , Políticas , Mudança Social , Fatores Sociológicos , Suicídio Assistido/legislação & jurisprudência , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudênciaRESUMO
This paper reviews the sentences dictated between 1993 and 2002 by the Supreme Courts of Canada and the Unites States, the House of Lords and Supreme Court of the United Kingdom and the European Human Rights Court, about the validity of the legal prohibition of assistance for suicide. These sentences constituted a judicial consensus about the right to die. This consensus recognized the legal right of patients to reject medical treatments but did not recognize the right to be assisted by a physician to commit suicide. This exclusion is changing in the recent case law of Canada and the United Kingdom, which accepts the fundamental right of terminal patients to medically assisted suicide.
Assuntos
Jurisprudência , Direito a Morrer/legislação & jurisprudência , Suicídio Assistido/legislação & jurisprudência , Canadá , Eutanásia/legislação & jurisprudência , Humanos , Autonomia Pessoal , Decisões da Suprema Corte , Doente Terminal/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Reino Unido , Estados UnidosRESUMO
IMPORTANCE: The increasing legalization of euthanasia and physician-assisted suicide worldwide makes it important to understand related attitudes and practices. OBJECTIVE: To review the legal status of euthanasia and physician-assisted suicide and the available data on attitudes and practices. EVIDENCE REVIEW: Polling data and published surveys of the public and physicians, official state and country databases, interview studies with physicians, and death certificate studies (the Netherlands and Belgium) were reviewed for the period 1947 to 2016. FINDINGS: Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016). Physician-assisted suicide, excluding euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20% of physicians report having received requests for euthanasia or physician-assisted suicide, and 5% or less have complied. In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests. Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70% of cases involved patients with cancer. Typical patients are older, white, and well-educated. Pain is mostly not reported as the primary motivation. A large portion of patients receiving physician-assisted suicide in Oregon and Washington reported being enrolled in hospice or palliative care, as did patients in Belgium. In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population. CONCLUSIONS AND RELEVANCE: Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.
Assuntos
Atitude do Pessoal de Saúde , Eutanásia/estatística & dados numéricos , Opinião Pública , Suicídio Assistido/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Colômbia , Europa (Continente) , Eutanásia/legislação & jurisprudência , Eutanásia/tendências , Humanos , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Guias de Prática Clínica como Assunto , Suicídio Assistido/legislação & jurisprudência , Suicídio Assistido/tendências , Inquéritos e Questionários , Terminologia como Assunto , Estados Unidos , Suspensão de Tratamento/ética , Adulto JovemRESUMO
This paper reviews the sentences dictated between 1993 and 2002 by the Supreme Courts of Canada and the Unites States, the House of Lords and Supreme Court of the United Kingdom and the European Human Rights Court, about the validity of the legal prohibition of assistance for suicide. These sentences constituted a judicial consensus about the right to die. This consensus recognized the legal right of patients to reject medical treatments but did not recognize the right to be assisted by a physician to commit suicide. This exclusion is changing in the recent case law of Canada and the United Kingdom, which accepts the fundamental right of terminal patients to medically assisted suicide.
Assuntos
Humanos , Direito a Morrer/legislação & jurisprudência , Suicídio Assistido/legislação & jurisprudência , Jurisprudência , Estados Unidos , Canadá , Eutanásia/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Doente Terminal/legislação & jurisprudência , Autonomia Pessoal , Decisões da Suprema Corte , Reino UnidoRESUMO
Se trata de una investigación de campo en relación al manejo terapéutico de un paciente en etapa terminal internado en la Unidad de Terapia Intensiva en el ámbito de la Provincia de Córdoba. En esta investigación se advierte que los médicos intensivistas, desconocen sus propios alcances y limitaciones en su actuar frente al paciente incompetente o paciente terminal. En los días posteriores a la promulgación de la ley 26742, cuya fecha de sanción fue el 09 de mayo del año 2012, y su emisor, el Poder Legislativo Nacional, en su respectivo sumario refiere: "Ley sobre derechos del paciente, historia clínica y consentimiento informado - Derechos del paciente en su relación con los profesionales e instituciones de la salud - Derechos esenciales en la relación entre el paciente y el o los profesionales de la salud - Muerte digna - modificación de la ley 26.529"
Abstract: This is a field research in the therapeutic management of a patient in terminal stage in ICU, in the city of Córdoba. This research warnas that intensive care physicians are unaware of their own achievements and limitations in their actions against the terminally ill or incompetent patient. In the days after the enactment of law 26,742, which was the date of enactment may 9th, 2012, the emitter was the national legislature, with national jurisdiction, where the summary referred to the "Law on patient rights, medical history and informed consent- patient rights in relation to professionals and health institutions - essential rights in the relationshp between patient and or health professionals will - Death with dignity - Amendment of law 26,529
Assuntos
Masculino , Feminino , Humanos , Eutanásia , Eutanásia/legislação & jurisprudência , Unidades de Terapia Intensiva , Jurisprudência , Direito a Morrer , ArgentinaRESUMO
This paper discusses from a sociological perspective one of Catholicism's fronts of public intervention in the development and enactment of health legislation. In particular we analyze the debate in parliamentary committees on the so-called "death with dignity" law (No. 26742), for which a group of bioethics experts was convened to counsel senators regarding the scope and limits of the law. The majority of the invited experts advocated a personalist bioethics perspective, which is a theological bioethics development of contemporary Catholicism. In the debate no representatives of other faiths were present, reinforcing the widely studied overlap between Catholicism and politics in Argentina.
Assuntos
Bioética , Catolicismo , Religião e Medicina , Direito a Morrer/ética , Direito a Morrer/legislação & jurisprudência , Teologia , Argentina , Dissidências e Disputas , Eutanásia/ética , Eutanásia/legislação & jurisprudência , Humanos , PolíticaAssuntos
Humanos , Direito a Morrer/legislação & jurisprudência , Eutanásia/legislação & jurisprudência , Futilidade Médica/legislação & jurisprudência , Direitos do Paciente , Cuidados para Prolongar a Vida/legislação & jurisprudência , Bioética , Direito a Morrer/ética , Eutanásia/ética , Futilidade Médica/ética , Medicina Paliativa , Cuidados para Prolongar a Vida/éticaRESUMO
O objetivo deste artigo é destacar a importância dos cuidados paliativos e da prática do cuidado humanizado diante do processo de terminalidade enfrentado pelos pacientes fora de possibilidades terapêuticas de cura. Foi sumarizada a literatura existente sobre os conceitos acerca desses cuidados, bem como sua trajetória histórica no Movimento Hospice Moderno. Além disso, pensou-se o processo de morte e morrer a partir da perspectiva das fases do luto, estimulando a reflexão dos dilemas bioéticos associados aos aspectos da dignidade da pessoa humana. A revisão narrativa empreendida surge como forma de referenciar a existência de lacunas na compreensão do tema, o que requer maior gama de estudos, sobretudo se considerarmos a importância desse conhecimento para a assistência digna e para a melhor qualidade de vida dessas pessoas. A despeito das questões éticas, o desafio é considerar a dignidade humana diante da proximidade da morte para além da dimensão físicobiológica e da perspectiva médico-hospitalar...
El propósito de este artículo es destacar la importancia de los cuidados paliativos, así como la práctica de la atención humanizada antes del proceso de terminalidad que enfrentan los pacientes con enfermedades terminales sin condiciones de tratamiento de cura. Se ha resumido la literatura existente sobre los conceptos de cuidado, su trayectoria histórica en el Movimiento Hospice Moderno, además de pensar el proceso de la muerte y el morir desde la perspectiva de las etapas del duelo, fomentando la reflexión de los dilemas bioéticos relacionados con aspectos de la dignidad de la persona humana. La revisión narrativa realizada surge como una manera de referirse a las lagunas en la comprensión de la materia, lo que requiere una mayor gama de estudios, especialmente teniendo en cuenta la importancia de este conocimiento para la atención digna y una mejor calidad de vida de estas personas. A pesar de los problemas éticos, el reto es tener en cuenta la dignidad humana ante el acercamiento hacia la muerte para el más allá de la dimensión físico-biológica y perspectiva médica...
Assuntos
Humanos , Masculino , Feminino , Assistência Terminal , Bioética , Cuidados Paliativos na Terminalidade da Vida , Códigos de Ética , Morte , Pesar , Política Pública , Relações Profissional-Família , Relações Profissional-Paciente , Direito a Morrer , Eutanásia/legislação & jurisprudência , Qualidade de VidaRESUMO
The recent enactment of a law that allows infant euthanasia in Belgium raises questions with varied answers. To contribute to a better understanding of the topic, euthanasia and legislation concepts are described. After a bioethical analysis, we propose as conclusion that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed. The answer should be that it is not acceptable in our setting, not until we have public policies, protocols and palliative care services for terminally ill children.
La reciente promulgación de una ley que permite la eutanasia infantil en Bélgica plantea interrogantes que admiten respuestas diversas. Para contribuir a una mejor comprensión del tema se describen los conceptos de eutanasia y la legislación pertinente. Después de hacer un análisis bioético, se plantea como conclusión que la eutanasia de niños podría ser aceptable sólo de manera muy excepcional ante situaciones en las cuales hubiesen fracasado las medidas de cuidado paliativo. Para nuestro medio la respuesta debería ser que no es aceptable, al menos mientras no existan políticas públicas, protocolos y servicios de cuidados paliativos para niños con enfermedades terminales.
Assuntos
Humanos , Lactente , Eutanásia/legislação & jurisprudência , Política de Saúde , Doente Terminal/legislação & jurisprudência , Bélgica , Temas Bioéticos , Eutanásia , Cuidados Paliativos/métodosRESUMO
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.
Assuntos
Eutanásia/psicologia , Médicos/legislação & jurisprudência , Suicídio Assistido/psicologia , Atitude Frente a Morte , Eutanásia/legislação & jurisprudência , Humanos , Suicídio Assistido/legislação & jurisprudênciaRESUMO
The recent enactment of a law that allows infant euthanasia in Belgium raises questions with varied answers. To contribute to a better understanding of the topic, euthanasia and legislation concepts are described. After a bioethical analysis, we propose as conclusion that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed. The answer should be that it is not acceptable in our setting, not until we have public policies, protocols and palliative care services for terminally ill children.