Publication: Revisión bibliográfica sobre la Limitación del Tratamiento de Soporte Vital en Pediatría Oncológica
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2022-05-04
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Abstract
El cáncer supone la primera causa de muerte en la edad pediátrica. El tratamiento de las enfermedades pediátricas ha mejorado considerablemente en los últimos años, pero no siempre ha eliminado el sufrimiento relacionado con la enfermedad. El avance de la tecnología ha permitido la supervivencia de niños con cáncer, pero también ha supuesto, en ocasiones, una prolongación del proceso de muerte, con elevada carga emocional y económica. ¿Realmente la tecnología consigue mantener la vida con una calidad aceptable o solo interfiere con el proceso de muerte y pospone el final? Cada vez se atiende a más niños que necesitan algún tipo de cuidado paliativo y cada vez está más indicada la limitación del tratamiento de soporte vital (LTSV) en aquellas patologías oncológicas en las que los tratamientos son fútiles. En este contexto surgen numerosos conflictos y, por ello, las decisiones que deben tomarse deberían ser tomadas por un equipo interprofesional que pudiese valorar los diferentes puntos de vista. No obstante, la contribución enfermera, de los profesionales que posiblemente más cerca del enfermo han estado, sigue teniendo hoy día escasa relevancia.
Se ha realizado una búsqueda bibliográfica con el objetivo general de valorar el rol de la enfermera en la limitación del tratamiento de soporte vital (LTSV) en la pediatría oncológica, así como de identificar los conflictos éticos que surgen durante la práctica clínica.
Los conflictos éticos identificados en la práctica clínica son los relacionados con la conspiración del silencio, el rechazo al tratamiento, la LTSV en sí y las diferentes medidas de LTSV. Además, es importante la inclusión de las enfermeras en la toma de decisiones por ser quienes antes suelen detectar las situaciones de futilidad.
Cancer is the main cause of death in the pediatric age. Treatment in pediatric diseases has improved considerably over the last years, but that has not always removed disease-related suffering. The advance of technology has allowed the survival of children with cancer, but in some cases it has also involved a futile extension of the death process with both a high emotional and economic impact. Does the new technology really manage to maintain life with acceptable quality or does it just interfere with the death process and postpone the end? More and more children who need palliative care are increasingly being treated and life support treatment (LST) is increasingly indicated in those oncological pathologies where treatments become futile. Ethical conflicts in these cases are almost inevitable and therefore the decisions to be taken in the process of death should be taken by an inter-professional team that could assess the different points of view. However, nurses’ contribution, probably the closest professionals to the patient, still has little relevance today. A bibliographical search has been carried out with the aim of valuing the role of the nurse in life support treatment in paediatric oncology, as well as identifying the ethical conflicts that arise during clinical practice. The ethical conflicts identified in clinical practice are those related to the conspiracy of silence, the rejection of treatment, the LST itself and the different measures of LST. In addition, it is important to include nurses in decision-making because they often detect situations of futility.
Cancer is the main cause of death in the pediatric age. Treatment in pediatric diseases has improved considerably over the last years, but that has not always removed disease-related suffering. The advance of technology has allowed the survival of children with cancer, but in some cases it has also involved a futile extension of the death process with both a high emotional and economic impact. Does the new technology really manage to maintain life with acceptable quality or does it just interfere with the death process and postpone the end? More and more children who need palliative care are increasingly being treated and life support treatment (LST) is increasingly indicated in those oncological pathologies where treatments become futile. Ethical conflicts in these cases are almost inevitable and therefore the decisions to be taken in the process of death should be taken by an inter-professional team that could assess the different points of view. However, nurses’ contribution, probably the closest professionals to the patient, still has little relevance today. A bibliographical search has been carried out with the aim of valuing the role of the nurse in life support treatment in paediatric oncology, as well as identifying the ethical conflicts that arise during clinical practice. The ethical conflicts identified in clinical practice are those related to the conspiracy of silence, the rejection of treatment, the LST itself and the different measures of LST. In addition, it is important to include nurses in decision-making because they often detect situations of futility.