O enfermeiro diante da obstinação terapêutica: um olhar à luz do referencial bioético da vulnerabilidade

Abstract

The increasing technological development has triggered ethical and bioethical dilemmas like therapeutic obstinacy, a very common situation and almost unknown by labourers from Intensive Therapy Unity / Emergency Room (ITU/ER), especially nurses. The Nursing labourers that work in this environment have a very developed technical expertise and are up to date in technological changes, but the situation is different when considering psychosocial knowledge, which means they have a not so reflexive expertise. This study aimed at understanding the way the ITU/ER nurses feel when facing therapeutic obstinacy under the light of bioethical vulnerability framework; besides, this study aimed also at finding out what these labourers know about the concepts of therapeutic obstinacy and disthanasia, the way they behave when facing therapeutic obstinacy and how they identify their role when living this situation. It is a descriptive academic research made under qualitative approach. Once Comitê de Ética e Pesquisa (Ethics and Research Committee), the Institution and the participants of this research have authorized all the procedures, digital individual interviews recording were made with 14 female nurses, students of postgraduate courses and labourers of ITU/ER for one year or more. The discourse analysis was carried out according to Bardin's framework. From this analysis, two categories could be established: Ignorance in relation to the 'concept' and the 'acting way, which could be divided in five subcategories: unresponsiveness towards doctor's decisions; difficulties when dealing with terminality; negative perception of therapeutic obstinacy; hard feelings towards young patients' terminality; acceptance of their own role towards terminality. The results of this academic research have shown ignorance about the concept of therapeutic obstinacy and disthanasia, which has its influences on nurses' vulnerability when dealing with therapeutic obstinacy, because they feel these situations as situations of terminality, but neither undergraduate nor postgraduate courses they have done have prepared them for terminality, especially when the patient is a child or an adolescent. Thus, these labourers suffer, get distress and become liable to identify these feelings in their patients and families. Moreover, these labourers are not prepared to identify the ambivalence that technological innovation represents; therefore, they have difficulties in determining the necessary boundaries they need to themselves. They admit all the nursery team members must discuss and try to clarify all the procedures due to attend to these patients by giving them common health care procedures in these situations because, although the final decision is under doctors' responsibility, it affects all the nursery team. However, the lack of arguments, caused mainly by ignorance and very little expertise about the issue, associated with some historical Nursing aspects, causes the submissiveness towards doctors' decision, which blocks nurses' autonomy and, besides, determines their vulnerability. In spite of all the questions we have been discussing previously in this research, the nurses admit they must keep patients' pain under control when teminality is going on.. relieve their suffering and keep patients and their families' dignity by giving all of them assistance, according to the Nursing area background and to the palliative aids, which is considered a good method due to avoid therapeutic obstinacy and euthanasia. This research highlights the contents studied during Nursing courses need to be rethought by including ethical and bioethical aspects to make Nursing labourers more skilful when dealing with terminality and, consequently, these labourers would participate more effectively in taking decisions and assisting about- to-die patients and their families.