Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial?
Autor(a) principal: | |
---|---|
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 |
Resumo: | 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. |
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Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial?Decisões Clínicas em Fim de VidaFim de VidaRetenção de CuidadosRetirada de CuidadosRetirada de Tratamentos de Suporte de VidaSonegação de Tratamentos de Suporte de VidaDomínio/Área Científica::Ciências Médicas::Ciências da Saúde::MedicinaThis 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.Esta Revisão sistemática sobre: reter, retirar e futilidade terapêutica é de grande importância para todos os profissionais de saúde e não apenas médicos, enfermeiros ou estudantes. A procura de cuidados individualizados que permitam um melhor tratamento é a base da medicina moderna, mas só pode ser alcançada com o pensamento crítico que cria uma melhor compreensão do quadro jurídico e ético imprescindíveis para formar melhores profissionais. O principal objetivo deste trabalho claramente não é responder a questões como “Quais são as maiores dificuldades que os médicos enfrentam na decisão da melhor gestão destes doentes, de um âmbito legal e ético?” ou "Quais são as fronteiras morais e éticas das decisões dos médicos" ou mesmo "Este tratamento é benéfico?". O principal objetivo desta dissertação é criar uma onda de pensamento crítico sobre o tema dos cuidados em fim de vida. Só aprendendo e formulando o pensamento crítico poderemos evoluir como sociedade, e seremos capazes de criar o quadro legal em que poderíamos, em teoria, fornecer os melhores cuidados de saúde possíveis para o paciente, entes queridos e a família. Para a realização desta dissertação foram utilizadas duas bases de dados (PubMed e Cochrane Library), a pesquisa foi limitada de 1992 até 2019 de forma a evitar estudos relacionados com a pandemia de Covid-19. A decisão de excluir estudos durante a pandemia baseia-se na tentativa de evitar o stress causado pela mesma nas unidades de cuidados intensivos, assim, modificando o padrão de atuação das mesmas. Para navegar na PubMed e Cochrane Library foram usados termos MeSH aplicando uma estratégia Booleana com combinação de “AND” e OR”(tabela 2). A estratégia de Pesquisa não ficou limitada às palavras-chave (pagina x), frequentemente sendo usados sinónimos ou variações das palavras. A pesquisa foi limitada a publicações de artigos peer-reviewed publicados em inglês, português e espanhol. Foram excluídos estudos em idade pediátrica. Após aprovação do estudo pelo título e abstrato, os mesmos foram analisados na integra tal como as suas bibliografias para possíveis estudos de interesse. Alguns dos autores principais foram contactados através do site https://www.researchgate.net/, sempre que possível, para informação complementar Para evitar o risco de viés de informação foi utilizada a ferramenta “The Cochrane Collaboration’s toll for assessing risk of bias in randomized trials” (2) . Os artigos foram classificados em risco baixo, alto ou incerto. Apenas foram usados artigos com risco baixo. Foi possível identificar uma variabilidade significativa em relação à retirada de tratamento de suporte de vida nas unidades de cuidados intensivos. Essa variabilidade existe dentro da própria unidade, das regiões, países e continentes indicando uma causa multifatorial.Abejas, Abel GarciauBibliorumBrito, Wilson Ferreira2023-01-23T10:03:44Z2022-06-132022-04-222022-06-13T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttp://hdl.handle.net/10400.6/12717TID:203183711enginfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-12-15T09:55:59Zoai:ubibliorum.ubi.pt:10400.6/12717Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T00:52:15.630402Repositório 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 |
Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial? |
title |
Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial? |
spellingShingle |
Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial? Brito, Wilson Ferreira 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 |
title_short |
Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial? |
title_full |
Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial? |
title_fullStr |
Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial? |
title_full_unstemmed |
Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial? |
title_sort |
Withhold, Withdraw, and Futility: When Should Doctors Stop and When Treatment Is No Longer Beneficial? |
author |
Brito, Wilson Ferreira |
author_facet |
Brito, Wilson Ferreira |
author_role |
author |
dc.contributor.none.fl_str_mv |
Abejas, Abel Garcia uBibliorum |
dc.contributor.author.fl_str_mv |
Brito, Wilson Ferreira |
dc.subject.por.fl_str_mv |
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 |
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 |
description |
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. |
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2022 |
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2022-06-13 2022-04-22 2022-06-13T00:00:00Z 2023-01-23T10:03:44Z |
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