Antônio Carlos Rodrigues da Cunha

Limitação terapêutica para crianças portadoras de malformações cerebrais graves

Brain malformations may present themselves in different forms, from mild to severe, which can be lethal within a few hours after birth. Based on a systematic review of literature, it was verified that, although theoretically suspending or withholding treatment are ethically similar, in practice, such equivalence is not perceived either by doctors and nursing assistants or by the general population, who tend to more comfortably accept the withholding rather than the withdrawal of treatments. The dialogue with parents is the procedure that legitimizes medical initiatives when proposing therapeutic limitation. In conclusion, severe brain malformations result in an end of life context, in which bioethical principles of palliative care apply and in which the limitation of respiratory support is the main dilemma to be faced in the final moments of patients’ lives.within a few hours after birth. Based on a systematic review of literature, it was verified that, although theoretically suspending or withholding treatment are ethically similar, in practice, such equivalence is not perceived either by doctors and nursing assistants or by the general population, who tend to more comfortably accept the withholding rather than the withdrawal of treatments. The dialogue with parents is the procedure that legitimizes medical initiatives when proposing therapeutic limitation. In conclusion, severe brain malformations result in an end of life context, in which bioethical principles of palliative care apply and in which the limitation of respiratory support is the main dilemma to be faced in the final moments of patients’ lives.

Suspensão de nutrição enteral a pacientes em coma persistente

Withdrawal of enteral nutrition in patients with persistent coma Persistent vegetative state is a clinical condition defined as a long period, from six months to one year, in a coma, which is only possible with the use of medical technology. In some countries, it is lawful for legal guardians to request the suspension of enteral nutrition for these patients, which certainly leads to death within a few days. There is a need for terminology that differentiates between therapeutic limitation, neglect and euthanasia. Therapeutic limitation arises at the moment of acute intercurrences affecting chronic terminal patients, while euthanasia is a request for controlled death. It is concluded, therefore, that the intentional withdrawal of nutritional support for these patients is an act of euthanasia.Persistent vegetative state is a clinical condition defined as a long period, from six months to one year, in a coma, which is only possible with the use of medical technology. In some countries, it is lawful for legal guardians to request the suspension of enteral nutrition for these patients, which certainly leads to death within a few days. There is a need for terminology that differentiates between therapeutic limitation, neglect and euthanasia. Therapeutic limitation arises at the moment of acute intercurrences affecting chronic terminal patients, while euthanasia is a request for controlled death. It is concluded, therefore, that the intentional withdrawal of nutritional support for these patients is an act of euthanasia.

Publicidade de alimentos para crianças e adolescentes: desvelar da perspectiva ética no discurso da autorregulamentação

When it comes to food marketing, children are one of the major targets. Regulatory actions can play a strategic role in health protection. The objective of this research was to characterize the ethical perspective in the discourse against state regulatory actions on food marketing directed at children, aiming to understand the context of the discourses production and how it creates meaning. The methodology adopted was qualitative, with documentary analysis and use of concepts and procedures from Discourse Analysis. The work of Hans Jonas, specifically his Responsibility Principle, and Garrafa and Ports Intervention Bioethics oriented the analysis. The self-regulation discourse analysis showed an ethical perspective in which relations of consumption predominate over the children´s vulnerability. The rhetorical excess is constant, as well as the use of resources like naturalization, untruthfulness, ideological dissimulation and euphemism. An erasure of social conflicts takes place, and an ahistorical perspective is present. The discourse does not align with Jonas´ Responsibility Principle, nor those of Intervention Bioethics. Lastly, the ethical perspective of the discourse represents a double paradox, because it is a business discourse that hides its competitive roots and metamorphoses into an ethical one.Resumo Um dos publicos de maior interesse para a publicidade de alimentos e o infantil. A regulacao da publicidade de alimentos tem papel estrategico na protecao a saude. O objetivo da pesquisa foi caracterizar a perspectiva etica presente no discurso contrario a regulacao pelo Estado, com fins de compreender o contexto de producao e o modo como o discurso gera sentidos. A metodologia adotada foi qualitativa, com analise documental e utilizacao de conceitos e procedimentos da Analise de Discurso. As lentes que pautaram a analise e a discussao foram o pensamento de Hans Jonas e seu Principio Responsabilidade e, de Garrafa e Porto, a Bioetica de Intervencao. A analise do discurso da autorregulamentacao caracterizou uma perspectiva etica em que predominam relacoes de consumo sobre a vulnerabilidade de criancas e adolescentes. E constante o excesso de retorica e recursos de naturalizacao, inverossimilidade, dissimulacao ideologica e eufemizacao. Estao presentes o apagamento de conflitos sociais e a desvalorizacao de perspectivas historicas. O discurso nao se alinha ao principio responsabilidade de Jonas nem aos principios da bioetica de intervencao. A argumentacao apresenta duplo paradoxo, pois a origem empresarial apaga sua raiz competitiva e se metamorfoseia em discurso etico.

Enfoque ético de situaciones de agresión que involucran a pacientes dependientes y a médicos

Resumen es: Con frecuencia los trabajadores del sector de asistencia en salud afrontan el comportamiento agresivo de los pacientes. Cuando esta involucrado un pacien...