Informed Treatment Consent and Refusal in Advanced Endonasal Surgery: The Ethical Dilemma of Olfaction Sacrifice in Surgery for Chronic Rhinosinusitis with Polyposis

• Autor(a) principal: Subtil, J
• Data de Publicação: 2015
• Outros Autores: Araújo, JP, Saraiva, J, Santos, A, Vera-Cruz, P, Paço, J, Pais, D
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.26/10292
• topic: Alterações do Olfacto; Consentimento Informado; Ética Médica; Pólipos/cirurgia; Procedimentos Cirúrgicos Otorrinolaringológicos; Recusa ao Tratamento; Ethics, Medical; Informed Consent; Nasal Polyps/surgery; Olfaction Disorders; OtOtorhinolaryngologic Surgical Procedures; Treatment Refusal

INTRODUCTION: Olfaction is frequently affected in chronic rhino-sinusitis with polyposis and has been recognised to have important impact on quality of life. Surgical resolution on cases of maximal medical therapy failure is an option to relieve symptoms, with debates as to how extensive surgery should be. A more radical approach will achieve better disease control with less relapse, but can also compromise olfaction. This decision about a more radical surgical approach should be shared with the patient. Thorough informed consent regarding disease control and hyposmia should be taken. MATERIAL AND METHODS: Literature review and consultation with a board of experts. RESULTS AND DISCUSSION: We propose some elements to be included in the informed consent discussion, in order to broadly address the surgical limitations regarding anosmia as a frequent complaint, as well as the different options and their associated consequences. CONCLUSION: Radical surgery decision making should be shared with the patient and the informed consent should be as thorough as possible regarding disease control and hyposmia resolution.