Bacoanu Gema, Poroch Vladimir, Aniței Maria-Gabriela, Poroch Mihaela, Froicu Eliza Maria, Pascu Alina Mihaela, Ioan Beatrice Gabriela
2nd Internal Medicine Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania.
Department of Palliative Care, Regional Institute of Oncology, 700483 Iasi, Romania.
Healthcare (Basel). 2024 Aug 10;12(16):1593. doi: 10.3390/healthcare12161593.
End-of-life care raises ethical, moral, legal and economic dilemmas, especially when physicians have to decide whether to initiate or to stop treatments that may be considered disproportionate and futile.
To explore the opinion of health care professionals involved in end-of-life patient care on interventions considered disproportionate and futile at this stage of care, the causes and factors of pressure leading to such situations, and possible solutions to reduce the phenomenon.
The study used an adapted, designed questionnaire intended for health professionals caring for patients at the end of life. The 128 respondents were physicians, nurses, psychologists and social workers who expressed their opinions about therapeutic obstinacy in end-of-life care.
The results of the research highlight the role of the family as a pressure factor, the causes related to the non-acceptance of the prognosis and diagnosis of a terminal condition, fear of death and ignorance of the patient's wishes. Interventions considered disproportionate at the end of life were cardiopulmonary resuscitation, mechanical ventilation, transfusion of blood derivatives, complex diagnostic investigations and the establishment of gastrostomy/jejunostomy in the last days of life.
End-of-life therapeutic obstinacy is a reality in end-of-life care, and healthcare professionals face many ethical challenges in this process. Care decisions must be made together with the patient and their family, respecting the rights, dignity and respect of all parties involved in the process.
临终关怀引发了伦理、道德、法律和经济方面的困境，尤其是当医生必须决定是否开始或停止那些可能被认为不合理且无效的治疗时。
探讨参与临终患者护理的医护人员对在该护理阶段被认为不合理且无效的干预措施、导致此类情况的压力原因和因素，以及减少该现象的可能解决方案的看法。
该研究使用了一份为照顾临终患者的医护人员设计的经过改编的问卷。128名受访者为医生、护士、心理学家和社会工作者，他们对临终关怀中的治疗固执表达了自己的看法。
研究结果突出了家庭作为压力因素的作用，与不接受终末期疾病的预后和诊断、对死亡的恐惧以及对患者意愿的无知相关的原因。在生命末期被认为不合理的干预措施包括心肺复苏、机械通气、血液制品输血、复杂的诊断检查以及在生命最后几天进行胃造口术/空肠造口术。
临终治疗固执是临终关怀中的一个现实情况，医护人员在这个过程中面临许多伦理挑战。护理决策必须与患者及其家人共同做出，尊重该过程中所有相关方的权利、尊严和尊重。
