Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial?

• Autor(a) principal: Brito, Wilson Ferreira
• Data de Publicação: 2022
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/12717
• topic: Decisões Clínicas em Fim de Vida; Fim de Vida; Retenção de Cuidados; Retirada de Cuidados; Retirada de Tratamentos de Suporte de Vida; Sonegação de Tratamentos de Suporte de Vida; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

This systematic review about: withhold, withdrawal, and therapeutic futility is of great importance for everyone working on healthcare and not alone doctors, nurses, or students. The search for individualized care enabling a better treatment is the foundation of modern medicine but it can only be achieved by the critical thinking of the matter at hand. Better professionals with a better understanding of the legal and ethical framework are a must. The main goal of this paper is clearly not to answer questions like “What are the utmost difficulties faced by doctors when deciding the finest management for these patients, from a legal to ethical scope?” or “What are the moral and ethical boundaries of doctors' decisions” or even “Is this treatment beneficial?”. The main purpose of this dissertation is to create a tidal wave of critical thinking about the topic of end-of-life care. Only by learning and formulating critical thinking will we be able to evolve as a society and create the legal framework in which we could, in theory, provide the best health care possible for the patient, loved ones, and the family. To accomplish this dissertation, two databases were used (PubMed and Cochrane Library), the research was limited from 1992 to 2019 to avoid studies related to the Covid-19 pandemic outbreak. The decision to exclude studies during the pandemic time is based on an attempt to stay away from the stress caused by it on ICUs, thus modifying their pattern of action. To navigate PubMed and Cochrane Library, MeSH terms were used, applying Boolean strategy with a combination of “AND’ and “OR” (table 2). The search strategy was not limited to keywords (page xii), often using synonyms or variations of the word or term. The search was limited to publications of peer-reviewed articles published in English, Portuguese, and Spanish. Studies that included pediatric age were excluded. After analyses of the title and abstract, the approved studies went a full analysis as their bibliographies for possible studies of interest. Some of the main authors of the study were contacted via https://researchgate.net/, whenever possible, for additional information. To avoid the risk of information bias, the tool “The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials” (2) was used. Articles were classified as low, high, or uncertain risk. Only low-risk articles were used. It was possible to identify a significant variability concerning the withdrawal of lifesupport treatment in ICUs. This variability exists within units amount their doctors, between regions, countries, and continents, the reason seems to be multifactorial for this result.