Bioethical perspective of the limitation of therapeutic effort in adult terminal patients. Systematic review

Authors

DOI: https://doi.org/10.6018/eglobal.554661
Keywords: end of life, limitation of therapeutic effort, bioethical, palliative care, decision making, terminal patient

Abstract

Introduction: Faced with the ability to maintenance vital functions artificially, new ethical concerns arise among health professionals regarding death. It is been questioned from ethics if the care team should always do everything necessary and possible to prevent the death of a patient.
Objective: to analyze the bioethical aspects of limiting therapeutic effort in end-of-life patients, encourage reflection and contribute to improving end-of-life care.
Method: a narrative and integrative review of the scientific literature was performed by searching for publications in meta-search engines and databases of PubMed, SciELO and the journal of Nursing Ethics. A total of 6,325 studies published since 2018 were identified and a total of 9 articles were included.
Results/Discussion: Issues presented by professionals regarding making-decisions at the end of life, the need to improve training in ethics and aspects related to patients in their last days, palliative care and the limitation of therapeutic effort are described. Only a minority of studies are focused on nursing.
Conclusions: professional's decisions are influenced by values, emotions, beliefs and experiences, which, together with the difficulty that sometimes exists to establish an accurate clinical diagnosis, makes it difficult to limit therapeutic effort. It is therefore necessary to improve training in ethics and knowledge about end-of-life processes from professionals.

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Author Biographies

Ana Belen Sanchez Garcia, Universidad de Murcia

Doctora por la Universidad de Murcia. Profesora asociada académica UM. Enfermera en Reanimación, anestesia y terapia del dolor Hospital General Universitario Reina Sofía de Murcia.

Diego José García Capilla, Universidad de Murcia

Doctor en Filosofía por la Universidad de Murcia. Profesor asociado en la Facultad de Filosofía en la Universidad de Murcia.

References

Betancourt Reyes GL. Un dilema ético actual: ¿Ensañamiento terapéutico o adecuación del esfuerzo terapéutico? Rev medica electron. 2017;39(4):975–86.

García Caballero R, Herreros B, Real De Asúa D, Alonso R, Barrera MM, Castilla V. Limitación del esfuerzo terapéutico en pacientes hospitalizados en el Servicio de Medicina Interna. Rev Calid Asist [Internet]. 2016;31(2):70–5.

Lantigua IF. asistido ¿ cuál es la diferencia ? 2019;

Francisco Fernández Dorado Pau Garro Martínez C. LA ATENCIÓN AL FINAL DE LA VIDA XI Conferencia de Expertos de la SOCMIC 2016.

Mansilla Olivares A, López-Bárcena J, Valenzuela-Gómez-Gallardo F, Rojo-Medina J, Meneses-González F, Vázquez-De Anda GF, et al. National Academy of Medicine of Mexico posture with regard to end-of-life decisions. Gac Mexico. 2019;154(6):628–31.

Sanchiz OR, Pascual LV. Revista de Bioética y Derecho Perspectivas Bioéticas Limitation of life support . Palliative care and end of life in ICU. 2020;(c):81–93.

Vallejo LI, Palacio AM, Marulanda V, Restrepo A, Yepes LA, Valencia NL, et al. Evaluación del conocimiento y práctica de la limitación del esfuerzo terapéutico en personal asistencial de una institución prestadora de servicios de salud para pacientes oncológicos de Medellín, 2018. Pers y Bioética. 2020;24(2):177–87.

Bárzaga Morell S, Estrada García CB, Sánchez Vila HJ, Berdú Saumell Y. Conocimiento y actitudes de los médicos sobre limitación de esfuerzo terapéutico TT - Knowledge and attitudes of physicians about limitation of therapeutic effort. Multimed (Granma) [Internet]. 2019;23(1):131–46.

García Caballero R, Real de Asúa D, García Olmos L, Herreros B. Do internists know what limitation of therapeutic effort means? Rev Clin Esp [Internet]. 2021;221(5):274–8.

Blanco Portillo A, García-Caballero R, Real de Asúa D, Herreros Ruíz-Valdepeñas B. Which are the most prevalent ethical conflicts for Spanish internists? Rev Clínica Española (English Ed. 2021;221(7):393–9.

Alcaraz A. Distanasia, un dilema del personal médico. Rev científica ciencias la salud. 2022;4(2):108–11.

González R. Documento Sobre La Adecuación Del Esfuerzo Terapéutico Área De Salud De León. 2017;

González-Rincón M, Díaz de Herrera-Marchal P, Martínez-Martín ML. The role of the nurse at the end of the life of a critically ill patient. Enferm Intensiva [Internet]. 2019;30(2):78–91.

Yañez-Dabdoub M, Vargas-Celis I. Cuidado humanizado en pacientes con limitación del esfuerzo terapéutico en cuidados intensivos: desafíos para enfermería. Pers y Bioética. 2018;22(1):55–68.

Velarde-García JF, Luengo-González R, González-Hervías R, Cardenete-Reyes C, Álvarez-Embarba B, Palacios-Ceña D. Limitation of therapeutic effort experienced by intensive care nurses. Nurs Ethics. 2018;25(7):867–79.

Stokes F, Zoucha R. Nurses’ Participation in Limited Resuscitation: Gray Areas in End of Life Decision-Making. AJOB Empir Bioeth [Internet]. 2021;12(4):239–52.

Reyes B, Betancourt B. Adecuación del esfuerzo terapéutico: aspectos éticos y legales relacionados con su práctica. Rev Cub Med Int Emerg. 2017;16(1):12–24.

Yuguero O, Esquerda M, Pifarre J. To limit or to adapt the therapeutical effort? Med Clin (Barc) [Internet]. 2019;152(5):e27.

Hernández-Tejedor A, Martín Delgado MC, Cabré Pericas L, Algora Weber A. Limitación del tratamiento de soporte vital en pacientes con ingreso prolongado en UCI. Situación actual en España a la vista del Estudio EPIPUSE. Med Intensiva. 2015;39(7):395–404.

Ferrand E, Lemaire F, Regnier B, Kuteifan K, Badet M, Asfar P, et al. Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions. Am J Respir Crit Care Med. 2003;167(10):1310–5.

Published
01-07-2023
How to Cite
[1]
Gómez Pérez, C. et al. 2023. Bioethical perspective of the limitation of therapeutic effort in adult terminal patients. Systematic review. Global Nursing. 22, 3 (Jul. 2023), 586–619. DOI:https://doi.org/10.6018/eglobal.554661.
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