Advance Care Planning in Brazil

Area of Science:

• Bioethics
• Public Health
• Medical Sociology

Background:

• Brazil's Advance Directives (AD) regulation lacks legal enactment, relying on Federal Medical Council norms.
• Debate often focuses on a transactional approach to AD, overlooking relational models of Advance Care Planning (ACP).
• Palliative care courses are the primary educational context for ACP in Brazil.

Purpose of the Study:

• To analyze the current landscape of Advance Care Planning (ACP) in Brazil.
• To identify barriers and potential risks associated with ACP implementation in the Brazilian context.
• To explore the influence of healthcare culture and inequalities on ACP practices.

Main Methods:

• Qualitative analysis of existing literature and regulatory frameworks concerning AD and ACP in Brazil.
• Discussion of emerging ACP models emphasizing relational aspects.
• Examination of the role of palliative care and healthcare professionals' training.

Main Results:

• ACP education and practice are concentrated within palliative care services, limiting access.
• Conversations about ACP often occur late in disease progression due to limited palliative care access.
• A paternalistic healthcare culture, combined with health inequalities, poses a significant barrier to effective ACP.

Conclusions:

• The current healthcare culture in Brazil presents a major obstacle to widespread ACP adoption.
• There is a significant risk of ACP being misused as a coercive tool against vulnerable populations.
• Addressing health inequalities and promoting shared decision-making education are crucial for ethical ACP implementation.