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Therapeutic Obstinacy in an Intensive Care Unit: Perspectives from Doctors and Nurses

Posted May 29 2013 6:27pm
It appears that the medical futility debate in Brazil looks much like that in the United States.  I just read this article by Karla Cristiane Oliveira Silva and colleagues called "Therapeutic Obstinacy in an Intensive Care Unit: Perspectives from Doctors and Nurses" (2012 Escola Anna Nery Revista de Enfermagem 16(4): 697-703) (PDF here ).

Here is the abstract:
Therapeutic obstinacy is not a sufficiently studied theme in Brazil, especially on the nursing field. This study aimed to understand the social representations of doctors and nurses, about the excessive investment regarding the terminal patient in an Adult Intensive Care Unit. It is a qualitative, exploratory and descriptive research, founded on Social Representations Theory. Data was collected through focused interviews and participant observation and was interpreted through content analysis. The selection of five nurses and eight doctors to give interviews was carried out for convenience, considering their working shifts. It is possible to conclude that such professionals build their social representations about therapeutic obstinacy, having as a starting point the obstinate requests of the terminal patient's family members to carry out futile measures; difficulties regarding decision making and absence of criteria concerning the limits of investment, as well as the fear of ethical and legal repercussions related to the decisions made.
Here are my favorite excerpts:
If the family is very stubborn, we accept their opinion and do not take a stand. But we know that will end up prolonging the suffering of the patient.
Family members . . . push professionals to invest, unnecessarily in the healing process, the latter in turn, opt for the easy way to please the family instead of working with him on the understanding and acceptance of patient's condition. 
Professionals who joined this research consider the lack of transparency in the Brazilian legislation contributes to the health professionals introduce useless therapies.
The ambiguities of Brazilian law regarding the limits of the therapeutic effort contribute significantly to how doctors and nurses are positioned on the use or not of measures of life support.
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