Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.34632/cadernosdesaude.2021.10219 |
Resumo: | Introduction: Decision about initiating, withdrawing, or withholding artificial nutrition and hydration in patients with advanced dementia is challenging and a frequent ethical dilemma nowadays. Objective: To promote a bioethical reflection about artificial nutrition and hydration in situations of advanced dementia. Materials and methods: Clinical based bioethical analysis of complex issues concerning initiating, withholding, or withdrawing artificial nutrition and hydration, according to the core bioethical principles: beneficence, non-maleficence, autonomy and justice. Results: Beneficence and non-maleficence principles ought to be simultaneously accounted for in the process of decision making, weighting risks and benefits of artificial nutrition and hydration. Considering difficulties in exploring patient’s wishes in advanced dementia, we highlight the importance of advanced care planning, in order to respect the principle of autonomy. Regarding the principle of justice, it is fundamental to guarantee universal access to healthcare, particularly to palliative care. Health professionals are ethically obliged to do everything that is adequate for the patient, but not everything that is clinically available. Conclusion: Decision making regarding artificial nutrition and hydration in dementia patients, requires setting goals of care. Assuming comfort and suffering relief as the main goals, clinical evidence available nowadays does not support these interventions. However, an individualized approach is always required, and palliative care specialists can be of great support helping to solve these ethical dilemmas. |
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Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflectionNão iniciação ou suspensão de alimentação e hidratação artificiais – uma reflexão bioética baseada num caso clínicoIntroduction: Decision about initiating, withdrawing, or withholding artificial nutrition and hydration in patients with advanced dementia is challenging and a frequent ethical dilemma nowadays. Objective: To promote a bioethical reflection about artificial nutrition and hydration in situations of advanced dementia. Materials and methods: Clinical based bioethical analysis of complex issues concerning initiating, withholding, or withdrawing artificial nutrition and hydration, according to the core bioethical principles: beneficence, non-maleficence, autonomy and justice. Results: Beneficence and non-maleficence principles ought to be simultaneously accounted for in the process of decision making, weighting risks and benefits of artificial nutrition and hydration. Considering difficulties in exploring patient’s wishes in advanced dementia, we highlight the importance of advanced care planning, in order to respect the principle of autonomy. Regarding the principle of justice, it is fundamental to guarantee universal access to healthcare, particularly to palliative care. Health professionals are ethically obliged to do everything that is adequate for the patient, but not everything that is clinically available. Conclusion: Decision making regarding artificial nutrition and hydration in dementia patients, requires setting goals of care. Assuming comfort and suffering relief as the main goals, clinical evidence available nowadays does not support these interventions. However, an individualized approach is always required, and palliative care specialists can be of great support helping to solve these ethical dilemmas.Introdução: A decisão sobre iniciação, manutenção ou suspensão de alimentação e hidratação artificiais em doentes com demência avançada é um desafio, configurando um dilema ético frequente na atualidade. Objetivo: Promover uma reflexão bioética sobre a alimentação e hidratação artificiais em situações de demência avançada. Materiais e Métodos: Tendo por base um caso clínico pretende-se desenvolver uma análise bioética do problema complexo da iniciação e suspensão de hidratação e alimentação artificiais, tendo em conta os princípios éticos fundamentais: beneficência, não maleficência, autonomia e justiça. Resultados: Os princípios da beneficência e não maleficência devem ser ponderados de forma articulada na tomada de decisão, pesando riscos e benefícios da alimentação e hidratação artificiais. Tendo em conta as particularidades da demência avançada, com dificuldade na auscultação dos desejos do doente, destaca-se a importância da discussão antecipada de vontades e planos, a fim de que o princípio de autonomia seja respeitado. Quanto ao princípio da justiça, é fundamental garantir o acesso universal aos cuidados de saúde, em particular aos cuidados paliativos. Importa esclarecer que os profissionais de saúde são eticamente obrigados a fazer tudo o que é adequado, mas não tudo o que está clinicamente disponível. Conclusão: A tomada de decisão sobre alimentação e hidratação artificiais na demência avançada obriga a uma definição adequada dos objetivos de cuidados dos doentes. Considerando como principal objetivo a promoção de conforto e minimização do sofrimento, a evidência atualmente disponível favorece a não utilização destes meios. No entanto, um enquadramento individualizado é sempre necessário e a intervenção de equipa especializada em cuidados paliativos tem uma especial importância.Universidade Católica Portuguesa2021-07-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.34632/cadernosdesaude.2021.10219https://doi.org/10.34632/cadernosdesaude.2021.10219Cadernos de Saúde; Vol 13 No 2 (2021); 43-47Cadernos de Saúde; v. 13 n. 2 (2021); 43-472795-43581647-055910.34632/cadernosdesaude.2021.13.2reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revistas.ucp.pt/index.php/cadernosdesaude/article/view/10219https://revistas.ucp.pt/index.php/cadernosdesaude/article/view/10219/10589Direitos de Autor (c) 2021 Filipa Luís Simõeshttp://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessSimões, Filipa LuísSousa, Inês Egídio deCarvalho, Ana Filipa de2023-10-03T15:47:59Zoai:ojs.revistas.ucp.pt:article/10219Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:33:10.516427Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection Não iniciação ou suspensão de alimentação e hidratação artificiais – uma reflexão bioética baseada num caso clínico |
title |
Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection |
spellingShingle |
Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection Simões, Filipa Luís |
title_short |
Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection |
title_full |
Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection |
title_fullStr |
Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection |
title_full_unstemmed |
Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection |
title_sort |
Withholding and withdrawing artificial nutrition and hydration – a case-based bioethical reflection |
author |
Simões, Filipa Luís |
author_facet |
Simões, Filipa Luís Sousa, Inês Egídio de Carvalho, Ana Filipa de |
author_role |
author |
author2 |
Sousa, Inês Egídio de Carvalho, Ana Filipa de |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Simões, Filipa Luís Sousa, Inês Egídio de Carvalho, Ana Filipa de |
description |
Introduction: Decision about initiating, withdrawing, or withholding artificial nutrition and hydration in patients with advanced dementia is challenging and a frequent ethical dilemma nowadays. Objective: To promote a bioethical reflection about artificial nutrition and hydration in situations of advanced dementia. Materials and methods: Clinical based bioethical analysis of complex issues concerning initiating, withholding, or withdrawing artificial nutrition and hydration, according to the core bioethical principles: beneficence, non-maleficence, autonomy and justice. Results: Beneficence and non-maleficence principles ought to be simultaneously accounted for in the process of decision making, weighting risks and benefits of artificial nutrition and hydration. Considering difficulties in exploring patient’s wishes in advanced dementia, we highlight the importance of advanced care planning, in order to respect the principle of autonomy. Regarding the principle of justice, it is fundamental to guarantee universal access to healthcare, particularly to palliative care. Health professionals are ethically obliged to do everything that is adequate for the patient, but not everything that is clinically available. Conclusion: Decision making regarding artificial nutrition and hydration in dementia patients, requires setting goals of care. Assuming comfort and suffering relief as the main goals, clinical evidence available nowadays does not support these interventions. However, an individualized approach is always required, and palliative care specialists can be of great support helping to solve these ethical dilemmas. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-07-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.34632/cadernosdesaude.2021.10219 https://doi.org/10.34632/cadernosdesaude.2021.10219 |
url |
https://doi.org/10.34632/cadernosdesaude.2021.10219 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revistas.ucp.pt/index.php/cadernosdesaude/article/view/10219 https://revistas.ucp.pt/index.php/cadernosdesaude/article/view/10219/10589 |
dc.rights.driver.fl_str_mv |
Direitos de Autor (c) 2021 Filipa Luís Simões http://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Direitos de Autor (c) 2021 Filipa Luís Simões http://creativecommons.org/licenses/by/4.0 |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Católica Portuguesa |
publisher.none.fl_str_mv |
Universidade Católica Portuguesa |
dc.source.none.fl_str_mv |
Cadernos de Saúde; Vol 13 No 2 (2021); 43-47 Cadernos de Saúde; v. 13 n. 2 (2021); 43-47 2795-4358 1647-0559 10.34632/cadernosdesaude.2021.13.2 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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