Ciro Augusto Floriani

Cuidador do idoso com câncer avançado: um ator vulnerado

Cancer presents high prevalence and mortality rates among elderly Brazilians, and family members provide meaningful care, especially during terminal illness. A literature review focused on the impact for families and the physical, psychological, social, and economic burden for family caregivers of seniors with advanced cancer, as well as related interventions. More studies are needed on family caregivers of elderly with advanced cancer in Brazil in order to develop programs to protect these important social actors.

Atendimento domiciliar ao idoso: problema ou solução?

Home care for the elderly has become an important health care tool in both developed and developing countries. However, several ethical, social, and operational concerns have received insufficient attention, and the Brazilian literature on this theme is limited. Starting with a bibliographic review on home care, this paper takes a bioethical approach to potential problems arising from this growing and important patient care modality. A broader ethical approach is needed to implement home care for the elderly, with policies to protect the patient, family, and caregiver, aimed at improving the quality of this program format.

Cuidados paliativos: interfaces, conflitos e necessidades

The kind of care delivered to patients with advanced and terminal diseases has been under intense debate in the specialized literature. This paper describes and analyzes, on the basis of a bibliographic review, medical care practices at the end of life, with special emphasis to palliative care, a model expanding worldwide. It analyzes, from the perspective of bioethics, some morally relevant aspects involving these practices, that tend to conflict among themselves. Specifically in the field of palliative care the paper emphasizes certain difficulties and challenges involving autonomy, considered one of the cornerstones of good end of life care practices.

Desafios morais e operacionais da inclusão dos cuidados paliativos na rede de atenção básica

Palliative care, a model in end-of-life care, is currently undergoing expansion in Brazil. This article emphasizes the need to implement palliative care in primary health care, with an important role in end-of-life care, especially in areas without specialized palliative-care teams. The article discusses key aspects in the organization of this treatment modality and analyzes how palliative care could and should be implemented within primary health care in Brazil. The article describes several challenges for health teams to provide such care, related to the primary caregiver, inherent ethical conflicts, and human resource allocation.

Routinization and medicalization of palliative care: Losses, gains and challenges

This article investigates some of the criticisms that have been directed at the hospice movement in the process of interaction with the traditional Western healthcare system, such as those relative to its routinization and medicalization. It also aims to review some of the consequences of this process of institutionalisation for the field of end-of-life care: surveillance and control over the process of dying, at the expense of decisions preferably based on the patient and that patients ability to decide how to die, with the loss of wider objectives originally established by the movement, such as unconditional reception for the patient. Based on these criticisms, some considerations are made regarding the moral implications and risks related to this specific mode of action, the hospice way of care.

Cuidados paliativos no domicílio: desafios aos cuidados de crianças dependentes de tecnologia

OBJECTIVES: To conceptualize palliative care and its indications in Pediatrics; to describe the difficulties involved in the delivery of such care at home for technology-dependent children; and to analyze, from a bioethical perspective, the moral dilemmas of palliative care assistance. SOURCES: A literature review of palliative care for technology-dependent children and a bioethical analysis of moral dilemmas. SUMMARY OF THE FINDINGS: There are several obstacles to palliative care for technology-dependent children: structural difficulties at home; social isolation of both children and families; health professionals sense of disbelief regarding this type of care; an excessive number of medical devices at home; uncertainty of a terminal prognosis; physical, emotional, social, material, and financial burden for parents and family; changes in family dynamics to adjust to these children; paternalistic relationship between professionals and family; changes in family roles, with shifts in the caregiver role. CONCLUSIONS: It is essential to outline an agenda based on the premise that the medical apparatus for technology-dependent children will change the landscape of the home, and such a change might become a problem to be faced by all those living together. Based on this assumption, actions performed in a setting other than a health care facility might exert an actual protective effect on children and family, offering support in their several needs and developing a model of care delivery that includes interventions in the different levels of burden on these vulnerated and unprotected individuals.

Casas para os que morrem: a história do desenvolvimento dos hospices modernos

This portrayal of the first modern hospices, established in late Victorian Great Britain, describes the philosophy of that day and the problems faced by these institutions. It looks both at the founding of St. Christophers Hospice, landmark of the birth of the modern hospice movement, and at the continued development of this movement down through today. The movement emerged at a time of growing appreciation for technology, outside the priorities of the British healthcare system, and during a period of major changes in Western societies. The article also describes how Brazils first hospice came into being in Rio de Janeiro in 1944. It concludes with a current overview of the modern hospice movement in Brazil, along with thoughts on the challenges of how hospices fit within the healthcare system.

How might Levinas' concept of the other's priority and Derrida's unconditional hospitality contribute to the philosophy of the modern hospice movement?

Hospitality is commonly referred as one of the meanings of hospes, the Latin word which is also the root of hospice. This article explores the semantics of the word hospice - the seal of identity of modern hospice movement - and attempts to integrate the meaning of hospitality into the modern hospice movement, understood as unconditional reception. Therefore, the article analyzes the concept of unconditional hospitality, developed by Jacques Derrida and that of ethical responsibility proposed by Emmanuel Levinas based on the phenomenological experience of the other. From this point of view, these two concepts tie in with the meaning of hospice, bringing substantial grounding elements to the hospice movement for the construction of a protective ethos.