Reflexões de profissionais da saúde em relação a pacientes infantis neurológicos crônicos em cuidados paliativos: um olhar da bioética

Abstract

This study reports what health professionals think about using or not high technology on chronic neurological patients in palliative care, from the perspective of bioethics. The purpose was to investigate what, for instance in the case of a cardiac arrest, underlies their actions, what conflicts they experience and what solutions they find in the dynamics of a public hospital which is a local reference in pediatrics. The use of high technology, trying to sustain biological life, seems to just extend suffering when there s nothing else to offer as a possibility for improvement and cure, but, rather, time for applying palliative care. These moments are still considered the responsibility of external assistance, not of the hospital anymore. A field research was performed involving 146 health professionals, such as doctors, nurses, psychologists, psychiatrists, physiotherapists, social workers, a nutritionist and a speech therapist. It was a quantitative/qualitative analysis using the statistical package SPSS and Bardin s content analysis. The analysis referential to support the results was clinical bioethics, preferably from Brazilian authors, inside the cultural perspective of the Judeo-Christian tradition. As a result of the research, we can note that bioethics is still unknown to most people, namely as to reflections and actions in relation to life, death, human dignity in the process of death, interventions and limits, and technological advancements related to patients who have nothing to benefit from them. We discovered attitudes and interventions based just on the guidelines of ethical codes of professional categories, and that the discussions were still very timid and permeated by conflict and fears of disciplinary ethical processes as well as civil jurisdiction. An institutional, specific space for discussion of complex cases is proposed, as well as continuing education of health professionals in relation to current thinking that bioethics brings as an interdisciplinary field of knowledge, involving not only the classic bioethical principles, but more extensive references of analysis, among them the principle of prudence.