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La sedación paliativa en pacientes moribundos: "nos volcamos a ella cuando todo lo demás no ha funcionado"
1Program in Medical Ethics and the Division of General Internal Medicine in the Department of Medicine at the University of California San Francisco, USA. bernie@medicine.ucsf.edu
JAMA
|October 13, 2005
Resumen
La sedación paliativa puede aliviar los síntomas graves en pacientes moribundos cuando otros tratamientos fallan. Este enfoque ético requiere una comunicación clara y la documentación de la intención de aliviar el sufrimiento, no acelerar la muerte.
Área de la Ciencia:
- La medicina paliativa es una medicina paliativa.
- Ética médica y ética médica.
Sus antecedentes:
- Los pacientes moribundos pueden experimentar síntomas intratables a pesar de la atención paliativa experta.
- Las dosis altas de opioides para el alivio del dolor pueden conducir a efectos adversos como mioclonus.
Objetivo del estudio:
- Explorar el papel y las consideraciones éticas de la sedación paliativa como último recurso para el manejo de los síntomas.
- Para resaltar la importancia de la doctrina del doble efecto en la justificación de la sedación paliativa.
Principales métodos:
- Ilustración de caso de una paciente con cáncer de mama metastásico que experimenta síntomas refractarios.
- Discusión del marco ético (doctrina del doble efecto) para la sedación paliativa.
- El énfasis en la comunicación y la documentación en la sedación paliativa.
Principales resultados:
- La sedación paliativa, guiada por la doctrina del doble efecto, puede ser una intervención permisible.
- La intención clara de aliviar el sufrimiento, no acelerar la muerte, es crucial.
- El consentimiento del paciente / familia y una comunicación clara entre los equipos de atención son esenciales.
Conclusiones:
- La sedación paliativa es una opción éticamente justificable para los síntomas refractarios en pacientes moribundos.
- Comprender y documentar la intención detrás de la administración de altas dosis de sedantes/opioides es de suma importancia.
- La comunicación abierta aborda los complejos aspectos médicos, éticos y emocionales de la sedación paliativa.
Palabras clave:
La muerte y la eutanasia.
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