Juárez-Villegas Luis Enrique, Altamirano-Bustamante Myriam M, Zapata-Tarrés Marta M
Department of Hematology-Oncology, Hospital Infantil de Mexico Federico Gómez, Mexico City, Mexico.
Master and Doctorate Program in Medical and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Front Oncol. 2021 Oct 15;11:739092. doi: 10.3389/fonc.2021.739092. eCollection 2021.
Evidence shows that medical education includes a variety of basic and clinical skills. Ethical and human values are not typically considered in medical school curricula, and this is evident in medical practice in certain scenarios such as decision-making at pediatric cancer patients' end of life.
This study explores a bioethical approach to address complex decision-making at the end of life in children and adolescents with cancer. We are a cross-functional group of scientists from several academic disciplines who conducted a systematic review of the literature using our newly developed meta-bioethical analysis and synthesis of findings. The search was carried out in five databases, resulting in 10 research papers. Following quality screening, seven articles were ultimately selected for further analysis.
Our focus is on the state of the art to better understand the bioethical deliberation at the end of life in pediatric oncology. Here, we report a systematic review that includes (i) classification of the screened articles by the type of decision-making they use, ii) the system values that are at the core of the decision-making at the end of life, and iii) bioethical and ethical discernment queries. We conclude with a discussion regarding the best practices of ethical discernment and decision-making at the end of life.This study highlights the need to develop more research to better understand the influence and origin of these multidimensional factors determining critical decisions that define the quality of life of patients in a highly sensitive moment.
We conclude that personal aspects of the physician define their actions more than knowledge or organized structure. It is thus necessary that pediatric oncologists receive ethics and humanistic education.
有证据表明，医学教育涵盖了各种基础和临床技能。医学院课程通常不考虑伦理和人文价值观，这在某些医疗实践场景中很明显，比如在儿科癌症患者临终时的决策过程中。
本研究探索一种生物伦理学方法，以解决癌症儿童和青少年临终时复杂的决策问题。我们是一个来自多个学术学科的跨职能科学家团队，使用新开发的元生物伦理学分析方法对文献进行了系统综述，并对研究结果进行了综合。检索在五个数据库中进行，共得到10篇研究论文。经过质量筛选，最终选择了7篇文章进行进一步分析。
我们的重点是了解最新情况，以便更好地理解儿科肿瘤学中临终时的生物伦理学审议。在此，我们报告一项系统综述，包括：（i）根据所使用的决策类型对筛选出的文章进行分类；（ii）作为临终决策核心的系统价值观；（iii）生物伦理学和伦理辨别问题。我们最后讨论了临终时伦理辨别和决策的最佳实践。本研究强调需要开展更多研究，以更好地理解这些多维因素的影响和来源，这些因素决定了在一个高度敏感时刻定义患者生活质量的关键决策。
我们得出结论，医生的个人因素比知识或组织结构更能决定他们的行为。因此，儿科肿瘤学家有必要接受伦理学和人文教育。
