Juliana Dias Reis Pessalacia

By Juliana Dias Reis Pessalacia, Sandra Pinto, Juliana Guimarães Lima Munis, Jacqueline Resende Boaventura and Adriano Menis Ferreira

In order to respect the patient’s right to die at home, with quality and respect, discussions about bioethical problems involving palliative care in the context of primary health care are relevant. Among bioethical problems, communication problems regarding the diagnosis and treatment, the maintenance or discontinuation of futile treatments, the adoption of aggressive and lifelong measures by the emergency mobile service, and the problems involving equal access to care stand out. It is important to emphasize that health systems must incorporate palliative measures in primary care and enable professionals to provide this type of care.

Part of the book: Reflections on Bioethics

By Juliana Guimarães Lima Munis, Juliana Dias Reis Pessalacia, Jacqueline Resende Boaventura, Ana Paula Da Silva, Luciana Ferreira Da Silva, Aires Garcia dos Santos Júnior and Adriano Menis Ferreira

Brazil is a country with great diversity and distinct realities, so there is a proportional challenge and complexity in offering a unified and integrated system which is accessible, of quality, and effective. Population aging and the increased incidence of chronic-degenerative noncommunicable diseases (NCDs) increase the need for palliative care (PC); however, public policies still need to be implemented so that this care encompasses adequate funding, professional training, and guaranteed medication. The first national policy for PC was recently proposed, providing guidelines for the organization of PC, emphasizing the importance of integration between the different levels of care and services in the Brazilian health system (SUS). Nevertheless, the challenges of this policy include the training of professionals, communication in the network, the absence of integrated health information systems, and effective mechanisms to finance this new modality of care.

Part of the book: Palliative Care

By Jacqueline Resende Boaventura, Juliana Dias Reis Pessalacia, Luciana Ferreira Da Silva, Ana Paula Da Silva, Larissa Da Silva Barcelos, Carlos Eduardo Pereira Furlani and Adriano Menis Ferreira

Advance directives (ADs) are understood as the act of deciding what care the patient wants to receive in the period before death. Preserving the patient’s autonomy by choosing his care guarantees human dignity during the process of dying. In Brazil, life expectancy and supportive technologies have increased, leading to growth of the number of terminally ill patients. However, there is still no legislation regulating ADs causing legal uncertainty in health professionals. Nursing professionals have the support of the Federal Nursing Council to respect the ADs, but, because it is an issue little explored, nursing professionals do not feel safe in the use of ADs, and changes in the curricula of the undergraduate courses in nursing are extremely needed, ensuring that patients have their wishes met during the dying process. Thus, this chapter deals with bioethical and legal issues involving ADs and nursing in the Brazilian context, proposing to deepen reflection and criticism on the issue and subsidies for decision-making.

Part of the book: Neuroethics in Principle and Praxis

By Maristela Rodrigues Marinho, Sandra Pinto, Juliana Dias Reis Pessalacia, Priscila Kelly da Silva Neto, Marcela Tavares de Souza and Tatiana Carvalho Reis Martins

This chapter proposes a theoretical reflection on the ethical deliberation process in the allocation of beds and respirators, in the light of the Theory of Health Justice, the Accountability for Reasonableness approach and the principle of health equity of the Brazilian Unified Health System (SUS, as per its Portuguese acronym), before the COVID-19 pandemic in Brazil. The pandemic has become a serious threat to health systems, as installed capacity has been exceeded whether in terms of material resources, equipment, technology and human resources. Thus, according to the theory of Accountability for Reasonableness, a fair and deliberative process aims to ensure resource allocation through limits and constraints (reasonableness), but government responsibility derived from human rights must be considered, allowing for health programming (accountability). Faced with this scenario, where the situation will often require us to make choices, this chapter intends to discuss the assumptions for ethical deliberation, taking into account the context of the act and its foreseeable consequences.

Part of the book: Healthcare Access