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
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