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Considerações éticas sobre Sedação Paliativa em Fim de vida – Revisão Sistemática
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Authors
Advisor(s)
Abstract(s)
Introdução: A sedação paliativa constitui uma intervenção clínica essencial no alívio
de sintomas refratários em doentes em fase terminal. No entanto, a sua aplicação é
marcada por uma complexa rede de desafios, desde a delimitação precisa de sintomas
verdadeiramente refratários, até à distinção entre sedação paliativa e práticas como a
eutanásia. A ausência de critérios universalmente aceites, aliada à inexperiência dos
profissionais de saúde, amplifica as incertezas envolvidas nessa decisão.
Objetivos: Explorar as barreiras e dilemas éticos inerentes à decisão de iniciar
sedação paliativa.
Metodologia: Foi realizada uma revisão sistemática com pesquisa nas bases de dados
PubMed/MEDLINE, Web of Science, Science Direct e Scielo. Todos os títulos e
abstracts encontrados foram avaliados sistematicamente. Para a seleção dos estudos
recorreu-se ao diagrama PRISMA. Os estudos considerados pertinentes foram lidos na
íntegra e, posteriormente, confrontados com os critérios de inclusão e exclusão. Foram
ainda utilizados os critérios de Hawker et al para avaliar a qualidade destes artigos.
Resultados: A análise dos 23 artigos incluídos, permitiu a identificação de 17 temas
principais: autonomia do doente, comunicação, perspetiva da família, sedação paliativa
como alternativa à eutanásia, antecipação da morte, perspetiva dos profissionais,
inconsistência nas guidelines, estado de consciência, conhecimento sobre sedação
paliativa, sofrimento não físico, dificuldade em identificar sintomas intoleráveis,
expectativa de vida, princípio do duplo efeito e da proporcionalidade, experiência dos
profissionais e barreiras institucionais, cultura e diferentes práticas entre países.
Discussão/Conclusão: A sedação paliativa envolve desafios éticos, culturais e
emocionais. A autonomia do doente e a comunicação clara e empática são pilares
essenciais para evitar conflitos e angústias. Os profissionais de saúde enfrentam
dilemas éticos, como equilibrar o alívio do sofrimento e evitar a antecipação da morte,
destacando a importância da intenção por detrás da prática. Investir na formação dos
profissionais e promover um diálogo multidisciplinar são passos fundamentais para
decisões mais informadas e humanizadas.
Introduction: Palliative sedation is an essential clinical intervention for relieving refractory symptoms in terminally ill patients. However, its application is marked by a complex network of challenges, from the delimitation of truly refractory symptoms to the delicate distinction between palliative sedation and practices such as euthanasia. The lack of universally accepted criteria, combined with the inexperience of health professionals, amplifies the uncertainties inherent in this decision. Objective: To explore the barriers and ethical dilemmas inherent in the decision to initiate palliative sedation. Methods: A systematic review was carried through research in the PubMed/MEDLINE, Web of Science, Science Direct and Scielo. All tittles and the correspondent abstracts were systematically evaluated. The PRISMA diagram guided the selection of studies. Studies considered relevant were completely read and confronted with the inclusion and exclusion criteria. Hawker et al criteria were used to assess the quality of the studies. Results: The analysis of the 23 articles included allowed the identification of 17 main themes: patient autonomy, communication, family perspective, palliative sedation as an alternative to euthanasia, anticipation of death, perspective of professionals, inconsistency in guidelines, state of consciousness, knowledge about palliative sedation, non-physical suffering, difficulty in identifying intolerable symptoms, life expectancy, principle of double effect and proportionality, experience of professionals and institutional barriers, culture and different practices in different countries. Discussion/Conclusions: Palliative sedation involves significant ethical, cultural and emotional challenges. Patient autonomy and clear and empathetic communication are essential pillars for avoiding conflict and anguish. Health professionals face ethical dilemmas, such as balancing the relief of suffering and avoiding the anticipation of death, highlighting the importance of the intention behind the practice. Investing in the training of professionals and promoting multidisciplinary dialogue are fundamental steps towards more informed and humanized decisions.
Introduction: Palliative sedation is an essential clinical intervention for relieving refractory symptoms in terminally ill patients. However, its application is marked by a complex network of challenges, from the delimitation of truly refractory symptoms to the delicate distinction between palliative sedation and practices such as euthanasia. The lack of universally accepted criteria, combined with the inexperience of health professionals, amplifies the uncertainties inherent in this decision. Objective: To explore the barriers and ethical dilemmas inherent in the decision to initiate palliative sedation. Methods: A systematic review was carried through research in the PubMed/MEDLINE, Web of Science, Science Direct and Scielo. All tittles and the correspondent abstracts were systematically evaluated. The PRISMA diagram guided the selection of studies. Studies considered relevant were completely read and confronted with the inclusion and exclusion criteria. Hawker et al criteria were used to assess the quality of the studies. Results: The analysis of the 23 articles included allowed the identification of 17 main themes: patient autonomy, communication, family perspective, palliative sedation as an alternative to euthanasia, anticipation of death, perspective of professionals, inconsistency in guidelines, state of consciousness, knowledge about palliative sedation, non-physical suffering, difficulty in identifying intolerable symptoms, life expectancy, principle of double effect and proportionality, experience of professionals and institutional barriers, culture and different practices in different countries. Discussion/Conclusions: Palliative sedation involves significant ethical, cultural and emotional challenges. Patient autonomy and clear and empathetic communication are essential pillars for avoiding conflict and anguish. Health professionals face ethical dilemmas, such as balancing the relief of suffering and avoiding the anticipation of death, highlighting the importance of the intention behind the practice. Investing in the training of professionals and promoting multidisciplinary dialogue are fundamental steps towards more informed and humanized decisions.
Description
Keywords
Fim de Vida Sedação Paliativa Tomada de Decisão Médica