Revista Cubana de Medicina Intensiva y Emergencias. Vol. 17, núm. 1 (2018)

CARTA AL DIRECTOR-EDITOR

 

 

Therapeutic effort limitation a none very lucky term

Limitación del esfuerzo terapéutico un término poco afortunado

 

Gilberto Lázaro Betancourt Reyes1, Gilberto de Jesús Betancourt Betancourt1

Hospital Universitario “Manuel Ascunce Domenech”. Camagüey, Cuba.

Dear Director:

In the last decades, the gigantic scientific-technological progress in the medical sciences, it has represented an extraordinary possibility of progress to the healthcare of the mankind. The technological development is applied to the sick people in excessive and unnecessary procedures of vital support for the maintenance of the vital functions, which only achieve in many of the cases to lengthen the patient's agony and the suffering of its relatives.

It is understood as a vital support treatment (VST): all medical intervention, technique, procedure or medication that it is administered to a patient to retard the moment of the death, be or not this treatment headed toward to the main illness or the causal biological process.1

A worthy death means to consider the terminal and moribund patients as responsible people, with feelings and precise perceptions, to whom necessary material, human and spiritual means should be provided, so the traffic until the death is carried out without suffering, with the necessary support and, accompanied by its relatives.

Everything guided to modify the how, but never the when. Disthanasia (therapeutic obstinacy, or therapeutic savagery): from the Greek word (dis), bad, something not well done, and (thanatos), death. It means the opposite of the euthanasia; that is to say, to retard the coming of the death by all possible means, although there is no hope of cure and although that it means to inflict to the moribund some added sufferings.2 The therapeutic effort limitation is the decision mediated on the non-implementation or the retreat of medical therapies when it won't bear a benefit to the patient.3

The Bioethical Group of the Spanish Society of Intensive Care Medicine has recently proposed the term of adequateness therapeutic effort according to the treatment of vital support, instead the classical term of therapeutic effort limitation, with the intention of highlighting that, in fact, the effort is not limited but only the treatments of vital support.4

For these reasons, some authors prefer to use in their articles the term of adequateness therapeutic effort, when referring to this good clinical practice, to highlight that only those measures of vital support are limited considered as heroic, extraordinary, disproportionated or not appropriated, capable only of prolonging the process of the death in those sick persons that hopelessly must die.4,5

The authors consider necessary to specify that the terms therapeutic effort limitation, limitation of treatments of vital support or adequateness therapeutic effort are used by different authors in the literature reviewed with the same meaning, to refer to the decision of readjusting the medical procedures, diagnostic and therapeutic means, to the patient's real clinical situation, to the evolutionary stage of the illness, in the sense of avoiding futile performances.

Referencias bibliográficas

1. Rincón Roncancio M, Garzón Díaz F. Problemas éticos del retiro o limitación de tratamiento vital en unidades de cuidados intensivos. Revista Latinoamericana de Bioética [Internet]. Jul.-dic. 2015 [citado 26 oct. 2017]; Edición 29. 15 (2):42-51. Disponible en: http://www.umng.edu.co/documents/63968/14057269/03_BIO29_Retiro.pdf.
2. Herreros B, Moreno-Milán B, Pacho-Jiménez E, Real de Asua D, Roa-Castellanos RA, Valenti E. Terminología en bioética clínica. Revista Médica del IMSS [Internet]. 2015 [citado 26 oct. 2017]; 53(6):750-761. Disponible en: http://search.ebscohost.com/login.aspx?direct=true&db=lth&AN=110960654&lang=es&site=ehost-live.
3. Paredes Escobar MC. Limitación del esfuerzo terapéutico en la práctica clínica: Percepciones de profesionales médicos y de enfermería de unidades de pacientes críticos de un hospital público de adultos en la Región Metropolitana. Acta bioética [Internet]. Nov. 2012 [citado 28 oct. 2017]; 18(2):163-171. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S1726-569X2012000200004&nrm=iso.
4. Ara Callizo JR. Adecuación del esfuerzo terapéutico en los pacientes con alteraciones crónicas de la conciencia.EIDON. [Internet]. Dic. 2013 [citado 28 oct. 2017]; (40):25-38. Disponible en: http://revistaeidon.es/index.php/file/getfile/1387468060.eff215fe487a8c2140ee3dcd22a20656.pdf/Adecuacion%20del%20esfuerzo%20terap%C3%A9utico%20
5. Betancourt Reyes GL, Betancourt Betancourt GJ. Los dilemas éticos y los conflictos psicológicos en la adecuación del esfuerzo terapéutico. Rev. Cub. Int Emerg. [Internet]. 2016[citado 28 oct. 2017]; 15 (4): 21–29. Disponible en: http://www.revmie.sld.cu/index.php/mie/article/view/179/pdf_19

1 Hospital Universitario “Manuel Ascunce Domenech”. Camagüey, Cuba.

Los autores declaran no conflicto de interés.

  • Recibido: octubre de 2017
  • Aprobado: noviembre de 2017
  • Publicado: Vol. 17, núm. 1 (2018): enero-marzo

Correspondencia: Gilberto Lázaro Betancourt Reyes. Hospital Universitario “Manuel Ascunce Domenech”. Camagüey, Cuba. E-mail: bbgilbert.cmw@infomed.sld.cu

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