Ethical principles and dilemmas in the discourse of healthcare practitioners involved with end-of-life care based on the Advanced Directives Document

  • Ana Milena Álvarez Acuña a. Postgraduate in Anesthesiology and Resuscitation, Universidad Industrial de Santander. Bucaramanga, Colombia. b. Bioethics Department, Universidad El Bosque. Bogotá, Colombia. https://orcid.org/0000-0003-4306-4533
  • Julián Camilo Riaño Moreno a. Bioethics, Universidad El Bosque. Bogotá, Colombia. b. School of Medicine, Universidad Cooperativa de Colombia. Villavicencio, Colombia. https://orcid.org/0000-0003-4182-0550
  • Jhonatan López Neira Bioethics Department, Universidad El Bosque. Bogotá, Colombia. https://orcid.org/0000-0002-6903-9419
  • Omar Fernando Gomezese Ribero a. Postgraduate in Anesthesiology and Resuscitation, Universidad Industrial de Santander. Bucaramanga, Colombia. b. Pain Clinic and Palliative Care, Fundación Cardiovascular de Colombia. Floridablanca, Colombia http://orcid.org/0000-0003-4490-7766
Keywords: Ethical dilemmas, Autonomy, Advanced Directives Document, Advanced Directive, Dignity, End-of-life care, Colombia

Abstract

Introduction. The Advanced Directives Document (ADD) is an efficient tool to plan for future medical care in case of a potential loss of autonomy. Ethical dilemmas arise in end-of-life care, including the principle of respect for autonomy and potential beneficence involved in health care, leading to moral distress of practitioners.

Objective. To identify the ethical principles and dilemmas arising from the discourse of healthcare practitioners involved with end-of-life care based on the ADD.  

Methodology. Qualitative study with a hermeneutics approach based on 253 answers to the following exploratory question: Are you willing to respect the ADD of an unconscious patient when you think that the patient may benefit otherwise?  

Results. Most practitioners acknowledge their respect for the ADD as an ethical obligation, whilst a minority consider it a legal right. For the large majority of practitioners, the ethical principles of respect for the ADD are recognized under the ethical theory of liberal individualism. Respect for autonomy is associated with the principle of non-maleficence and the value of human dignity. The principle of beneficence and the quality of life concept were presented as genuine moral dilemmas. A reversible clinical condition, the request for euthanasia, the family and the legibility of anticipated directives were submitted as apparent moral dilemmas.

Conclusions. During the end-of-life decision making process, there are other valid ethical considerations beyond principlism. The dilemmas identified show the ethical complexity healthcare practitioners face based on the ADD.

References

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How to Cite
1.
Álvarez Acuña AM, Riaño Moreno JC, López Neira J, Gomezese Ribero OF. Ethical principles and dilemmas in the discourse of healthcare practitioners involved with end-of-life care based on the Advanced Directives Document . Colomb. J. Anesthesiol. [Internet]. 2022 Jul. 7 [cited 2024 Apr. 17];51(1). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1046

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Published
2022-07-07
How to Cite
1.
Álvarez Acuña AM, Riaño Moreno JC, López Neira J, Gomezese Ribero OF. Ethical principles and dilemmas in the discourse of healthcare practitioners involved with end-of-life care based on the Advanced Directives Document . Colomb. J. Anesthesiol. [Internet]. 2022 Jul. 7 [cited 2024 Apr. 17];51(1). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1046
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