Twelve Tips for Integrating Bioethics and Palliative Care in Medical Education
DOI:
https://doi.org/10.59679/LAPC20220026Palabras clave:
Palliative Care, Bioethics, Medical Education, Cuidados Paliativos, Bioética, Educação MédicaResumen
It is important to integrate bioethics and palliative care (PC) in addition to providing the appropriate teaching of end-oflife care to future doctors. This article presents an evaluation of the updated literature and thus proposes to integrate the principles of bioethics with PC in medical schools. Accordingly, these 12 tips aim to highlight the necessary key points to help facilitate the teaching of PC and bioethics to medical students. These points are: addressing of bioethical theories according to the context experienced; supporting shared decisions; encouraging the development of a care plan based on beneficence, non-maleficence, and dignity; relieving uncomfortable physical symptoms and the avoidance of dysthanasia; promoting comfort through palliative sedation; understanding vulnerabilities and promoting the patient’s autonomy; taking care of those who care; integrating
spirituality and the respect of religious practices; taking care of family members and informal caregivers; understanding and respecting research participants; developing awareness of medically assisted death and ethical-legal limits; and including PC and bioethics themes in all student experiences related to terminality during medical school.
Citas
Gamondi C, Larkin P, Payne S. Core competencies in palliative care: an EAPC white paper on palliative care education: part 1. Eur J Pall Care. 2013;20(2):86-91.
Gamondi C, Larkin P, Payne S. Core competencies in palliative care: an EAPC white paper on palliative care education: part 2. Eur J Pall Care. 2013;20(3):140-5.
World Health Organization [Internet]. Palliative care: definition of palliative care. Geneva (CH): Cancer; 2020 [cited 2023 Feb 23]. Available from: https://www.who.int/cancer/palliative/definition/en/
Cortina A. Bioethics for the 21st century: building hope. Rev Iberoam Bioét. 2016;1(1):12. https://doi.org/10.14422/rib.i01.y2016.001
Beuchamp TL, Childress JF. Principles of biomedical ethics. 8th ed. Oxford (UK): Oxford University Press; 2019. 512 p.
Stites SD, Rodriguez S, Dudley C, Fiester A. Medical students’ exposure to ethics conflicts in clinical training: implications for timing UME bioethics education. HEC Forum. 2020 Jun;32(2):85-97. https://doi.org/10.1007/s10730-020-09412-w
Langerman A, Cutrer WB, Yakes EA, Meador KG. Embedding ethics education in clinical clerkships by identifying clinical ethics competencies: the vanderbilt experience. HEC Forum. 2020 Jun;32(2):163-74. https://doi.org/10.1007/s10730-020-09410-y
De Panfilis L, Di Leo S, Peruselli C, Ghirotto L, Tanzi S. “I go into crisis when …”: ethics of care and moral dilemmas in palliative care. BMC Palliat Care. 2019 Aug 9;18(1):70. https://doi.org/10.1186/s12904-019-0453-2
Nozick R. Anarchy, state, and utopia. 13th ed. New York (NY): Basic Books; 2013. 372 p.
Mandal J, Ponnambath DK, Parija SC. Utilitarian and deontological ethics in medicine. Trop Parasitol. 2016 Jan-Jun;6(1):5-7. https://doi.org/10.4103/2229-5070.175024
Pelegrino ED, Thomasma DC. For the patient’s good: the restoration of beneficence in health care. Oxford (UK): Oxford University Press; 1988. 256 p.
Torralba F. Antropologia do cuidar. Rio de Janeiro (RJ): Editora Vozes; 2009. 200 p.
Sommovilla J, Kopecky KE, Campbell T. Discussing prognosis and shared decision-making. Surg Clin North Am. 2019 Oct;99(5):849-58. https://doi.org/10.1016/j.suc.2019.06.011
Stiggelbout AM, Pieterse AH, De Haes JC. Shared decision making: concepts, evidence, and practice. Patient Educ Couns. 2015 Oct;98(10):1172-79. https://doi.org/10.1016/j.pec.2015.06.022
Gracia D. Bioética mínima. Madrid (ES): Triacastela; 2019. 185 p.
Noordman J, van Vliet L, Kaunang M, van den Muijsenbergh M, Boland G, van Dulmen S. Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare providers. BMC Palliat Care. 2019 Apr 12;18(1):37. https://doi.org/10.1186/s12904-019-0421-x
Friedman JH. Shared decision making or paternalism? R I Med J. 2016 Aug 1;99(8):8-9.
Swami M, Case AA. Effective palliative care: What is involved? Oncology (Williston Park). 2018 Apr 15;32(4):180-4.
Saracino RM, Rosenfeld B, Breitbart W, Chochinov HM. Psychotherapy at the end of life. Am J Bioeth. 2019 Dec;19(12):19-28. https://doi.org/10.1080/15265161.2019.1674552
Fink HA, Linskens EJ, MacDonald R, Silverman PC, McCarten JR, Talley KMC, et al. Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-Type dementia. Ann Intern Med. 2020 May 19;172(10):656-68. https://doi.org/10.7326/M19-3887
Chochinov MH. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ. 2007 Jul 28;335(7612):184-7. https://doi.org/10.1136/bmj.39244.650926.47
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity and psychotherapeutic considerations in end-of life care. J Palliat Care. 2004 Sep-Nov;20(3):134-42.
Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005 Aug 20;3(24):5520-5. https://doi.org/10.1200/JCO.2005.08.391
Wells G, Youssef E, Winter R, Wright J, Llewellyn C. Medical student confidence in care of the dying and their family: a systematic review. BMJ Support Palliat Care. 2021 Sep;11(3):233-41. https://doi.org/10.1136/bmjspcare-2019-001977
Pessini L, Siqueira JE. Reflexões sobre cuidados a pacientes críticos em final de vida. Rev Bioét. 2019 Jan-Mar;27(1):29-37. https://doi.org/10.1590/1983-80422019271283
Garcia JBS. Euthanasia, disthanasia or orthothanasia? Rev Dor. 2011 Jan-Mar;12(1):3. https://doi.org/10.1590/S1806-00132011000100001
Clark JD, Dudzinski DM. The culture of dysthanasia: attempting CPR in terminally ill children. Pediatrics. 2013 Mar;31(3):572-80. https://doi.org/10.1542/peds.2012-0393
Maltoni M, Scarpi E, Rosati M, Derni S, Fabbri L, Martini F, et al. Palliative pharmacological sedation for terminally ill adults. J Clin Oncol. 2012 Apr 20;30(12):1378-83. https://doi.org/10.1200/ JCO.2011.37.3795
Beller EM, van Driel ML, McGregor L, Truong S, Mitchell G. Palliative pharmacological sedation for terminally ill adults. Cochrane Database Syst Rev. 2015 Jan 2;1(1):CD010206. https://doi.org/10.1002/14651858.CD010206.pub2
Twycross R. Reflections on palliative sedation. Palliat Care. 2019 Jan 27;12:1178224218823511. https://doi.org/10.1177/1178224218823511
Buonanno P, Vargas M, Marra A, Iacovazzo C, Servillo G. Palliative sedation and end of life: lights and shadows. J Am Med Dir Assoc. 2020 Sep;21(9):1359. https://doi.org/10.1016/j.jamda.2020.03.031
Gurschick L, Mayer DK, Hanson LC. Palliative sedation: an analysis of international guidelines and position statements. Am J Hosp Palliat Care. 2015 Sep;32(6):660-71. https://doi.org/10.1177/1049909114533002
Imai K, Morita T, Akechi T, Baba M, Yamaguchi T, Sumi H, et al. The principles of revised clinical guidelines about palliative sedation therapy of the japanese society for palliative medicine. J Palliat Med. 2020 Sep;23(9):1184-90. https://doi.org/10.1089/jpm.2019.0626
Pirôpo US, Damasceno RO, Souza RR, Sena ELS, Yarid SD, Boery RNLS. Interface do testamento vital com a bioética, atuação profissional e autonomia do paciente. Rev Salud Pública. 2018 Jul-Aug;20(4):505-10. https://doi.org/10.15446/rsap.V20n4.65009
Mirarchi FL, Ray M, Cooney T. TRIAD IV: nationwide survey of medical students’ understanding of living wills and DNR orders. J Patient Saf. 2016 Dec;12(4):190-6. https://doi.org/10.1097/PTS.0000000000000083
Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016 Dec 6;316(21):2214-36. https://doi.org/10.1001/jama.2016.17324
Gauer GJC, Franco RS, Zogbi H, Marini PA, Diefenthaeler EC, Cataldo Neto A. Estratégias dos profissionais de saúde para cuidar dos que cuidam. Rev Bioét. 2006;14(2):171-80.
Kearsley JH, Lobb EA. ‘Workshops in healing’ for senior medical students: a 5-year overview and appraisal. Med Humanit. 2014 Dec;40(2):73-9. https://doi.org/10.1136/medhum-2013-010438
Goldberg GR, Weiner J, Fornari A, Pearlman RE, Farina GA. Incorporation of an interprofessional palliative care-ethics experience into a required critical care acting internship. MedEdPORTAL. 2018 Oct 9;14:10760. https://doi.org/10.15766/mep_2374-8265.10760
Dobrowolska B, Mazur E, Pilewska-Kozak A, Dońka K, Kosicka B, Palese A. Predicted difficulties, educational needs, and interest in working in end of life care among nursing and medical students. Nurse Educ Today. 2019 Dec;83:104194. https://doi.org/10.1016/j.nedt.2019.08.012
Puchalski CM, Blatt B, Kogan M, Butler A. Spirituality and health: the development of a field. Acad Med. 2014 Jan;89(1):10-6. https:// doi.org/10.1097/ACM.0000000000000083
Dezorzi LW, Raymundo MM, Goldim JR, de Oliveira CAV. Spirituality in the continuing education of healthcare professionals: an approach to palliative care. Palliat Support Care. 2019 Dec;17(6):662-7. https://doi.org/10.1017/S1478951519000117
Culatto A, Summerton CB. Spirituality and health education: a National Survey of Academic Leaders UK. J Relig Health. 2015 Dec;54(6):2269-75. https://doi.org/10.1007/s10943-014-9974-4
Atkinson HG, Fleenor D, Lerner SM, Poliandro E, Truglio J. Teaching third-year medical students to address patients’ spiritual needs in the surgery/anesthesiology clerkship. MedEdPORTAL. 2018 Dec 14;14:10784. https://doi.org/10.15766/mep_2374-8265.10784
Perpiñá-Galvañ J, Orts-Beneito N, Fernández-Alcántara M, García- Sanjuán S, García-Caro MP, Cabañero-Martínez MJ. Level of Burden and health-related quality of life in caregivers of palliative care patients. Int J Environ Res Public Health. 2019 Nov 29;16(23):4806. https://doi.org/10.3390/ijerph16234806
Lu L, Wang L, Yang X, Feng Q. Zarit Caregiver Burden interview: development, reliability and validity of the Chinese version. Psychiatry Clin Neurosci. 2009 Dec;63(6):730-4. https://doi.org/10.1111/j.1440-1819.2009.02019.x
Zarit SH. Family care and burden at the end of life. CMAJ. 2004 Jun 8;170(12):1811-2. https://doi.org/10.1503/cmaj.1040196 48. Kaasa S, Forbes K. Research in palliative care. In: Cherny NI, Fallon MT, Kaasa S, Portenoy RK, Currow DC, editors. Oxford textbook of palliative medicine. 5th ed. Oxford (UK): Oxford University Press; 2015. p. 1145-54.
Clark J, Gardiner C, Barnes A. International palliative care research in the context of global development: a systematic mapping review. BMJ Support Palliat Care. 2018 Mar;8(1):7‐18. https://doi.org/10.1136/bmjspcare-2015-001008
Quill TE, Ganzini L, Truog RD, Pope TM. Voluntarily stopping eating and drinking among patients with serious advanced illness-clinical, ethical, and legal aspects. JAMA Intern Med. 2018 Jan 1;178(1):123-7. https://doi.org/10.1001/jamainternmed.2017.6307
Gruenewald DA, Vandekieft G. Options of last resort: palliative sedation, physician aid in dying, and voluntary cessation of eating and drinking. Med Clin North Am. 2020 May;104(3):539-60. https://doi.org/10.1016/j.mcna.2020.01.002
Horn R. The right to a self-determined death as expression of the right to freedom of personal development: the German Constitutional Court takes a clear stand on assisted suicide. J Med Ethics. 2020 Jun;46(6):416-7. https://doi.org/10.1136/medethics-2020-106197
Emanuel E. Euthanasia and physician-assisted suicide: focus on the data. Med J Aust. 2017 May 1;206(8):339-40. https://doi.org/10.5694/mja16.00132
Goss AL, Viswanathan VB, DeLisser HM. Not just a specimen: a qualitative study of emotion, morality, and professionalism in one medical school gross anatomy laboratory. Anat Sci Educ. 2019 Jul;12(4):349-59. https://doi.org/10.1002/ase.1868
Crow SM, O’Donoghue D, Vannatta JB, Thompson BM. 2012. Meeting the family: promoting humanism in gross anatomy. Teach Learn Med. 2012;24(1):49-54. https://doi.org/10.1080/10401334.2012.641487
Kaye A, Miranda M, Jones T. The Donor Letter Project: Learning Professionalism and Fostering Empathy in an Anatomy Curriculum. J Med Humanit. 2019 Dec;40(4):607-12. https://doi.org/10.1007/s10912-019-09573-x
Ghosh KS, Kumar A. Building professionalism in human dissection room as a component of hidden curriculum delivery: a systematic review of good practices. Anat Sci Educ. 2019 Mar;12(2):210-21. https://doi.org/10.1002/ase.1836
Boland JW, Barclay S, Gibbins J. Twelve tips for developing palliative care teaching in an undergraduate curriculum for medical students. Med Teach. 2019 Dec;41(12):1359-65. https://doi.org/10.1080/0142159X.2018.1533243
Descargas
Publicado
Versiones
- 2023-10-17 (2)
- 2023-06-29 (1)
Número
Sección
Licencia
Derechos de autor 2023 Latin American Journal of Palliative Care
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
