publicado em 08/05/2013 às 17h32:00
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Ethics in the ICU

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All statements humanities, including all claims of science, are hypothetical, never lose the character of the event. As Descartes thought, in the seventeenth century, we have no absolute certainty that our reality is not a dream, ie the philosophical realism is just a hypothesis also very useful and somehow accepted because it is better than their competitors theories metaphysical. This brief introduction is necessary here to epistemological ethical reflection in our area of ​​science, medicine, especially in relation to work in the medical ICU.

Since our theories and scientific claims are forever hypotheses, consider theoretical error is part of the job of the scientist and physician. Try as we might to avoid them, in our assumptions can always be undetected errors. Our hypotheses diagnostic, prognostic our hypotheses, our hypotheses about the best treatment and the best approach to take, all may contain some error overlooked or not known. Obviously, we believe that a physician should always take the utmost care to avoid all the mistakes already known, this being his first ethical duty in this respect and that he should learn in medical school and the rest of your training and updating. However, a second ethical duty as important as this is always be aware that errors not already known or perceived may be present. And indeed they are, as if science and medicine progress is because they discover and beyond with new hypothetical theories. Only the awareness that there may be errors in our ideas, judgments, opinions and theories makes seek to discover them and they become known, so that the first ethical duty above, to avoid them and fix them, will be met .

The second ethical duty to be aware that we are fallible and can be wrong, because our theories and ideas are fallible, including our moral theories and ideas-and error-prone, is common to all intellectual professions. Lawyers, engineers, politicians and scientists from all areas should cultivate it for training and duty. The importance of this duty is clear when the work involves dealing directly with human lives, as in medicine. One of the consequences of the ethical duty to be aware of our fallibility is terms that totally abandon-effectively eliminate the concept of authority. In medicine, it means that no one can be absolute authority, free of criticism, and should be presented as such, whether in relation to diagnosis, prognosis, treatment and even ethical values. The more delicate in terms of reach and impact to human life are work and decision to be made, this is the second most important duty and he should be more active in the consciousness of all involved.

Ethics is hospitalized in serious condition in the ICU, subjected to medical misconduct, if all the professionals who work there are not fully aware of the ethical duty to recognize his own fallibility intellectual and, therefore, always try to discover their own errors theoretical, scientific and ethical, and avoid them as much as possible in order to benefit the patient. In short, the instrument needs to be self-critical intellectual work of the physician.

There is no denying that all constructions of ideas and judgments that are part of the work of the medical ICU, the more you apply the two ethical duties mentioned above is the formation of judgment that nothing more can be done to treat a patient, that all possible treatments currently on medicine were performed with competence and there is no avoiding death approaching. The best description for a trial like this, however, is not that the patient is in a condition in which death is inevitable, but rather that medicine in your current level of knowledge, it is more likely to treat him and prevent his death. In fact, the history of the progress of medical science shows that is not owned incurable disease or patient, but the current state of the technique, ie, it is not the patient who is definitely with incurable or terminal disease, medicine is not is also able to heal him.

The technical trial of inevitability of death is the most delicate among which may be made in the ICU, it is the opinion of a high impact on human life, about a person who has a whole long and rich history of life, who has dreams and desires , who loves other people and have family and friends who also love it. This is the life of a person, it is imperative to admit, if she herself did not express clearly the opposite, and want to continue living with our professional account for this. It is to be so, so delicate and universal moral and ethical impact that such judgment of technical inevitability of death and also his previous corresponding need in an ICU, the inevitability of technical clinical worsening of the patient, must be submitted to broader and critical scrutiny for errors before being minimally accepted. In fact, like any theory or opinion, such judgments should always be under suspicion intellectual, because only when we put our ideas on suspicion we were interested to discover errors in them. There's nothing more valuable to this human life admitted to the ICU and their families we discover errors in our judgment that is no longer possible to treat it and try to save his life.

The systematic application of this fundamental ethics in medicine, and in almost all intellectual activities, may bump into a bad tradition derived from the myth of the authority of the scientist. The need to preserve the authority aversion leads to the discovery of errors intellectuals and hence the concealment of these errors, sometimes with peer support and people surrounding authoritarian. And in practical activities, the non-consideration of errors in its intellectual phase directly leads to factual errors. In medicine, the ICU, the judgments of technical inevitability of death of patients, this process can generate serious factual errors, including deaths that should not occur if such intellectual errors were discovered and corrected before.

Source: CFM
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Vítor Oliveira    Ethics in the ICU    ICU    Faculty of Medicine    University of São Paulo    Code of Medical Ethics   
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