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      The Exercise of Autonomy by Older Cancer Patients in Palliative Care: The Biotechnoscientific and Biopolitical Paradigms and the Bioethics of Protection

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          Abstract

          Toward the end of life, older cancer patients with terminal illness often prefer palliative over life-extending care and also prefer to die at home. However, care planning is not always consistent with patients’ preferences. In this article, discussions will be centered on patients’ autonomy of exercising control over their bodies within the current biotechnoscientific paradigm and in the context of population aging. More specifically, the biopolitical strategy of medicine in the context of hospital-centered health care control and of the frail condition of cancer patients in the intensive care unit will be considered in terms of the bioethics of protection. This ethical principle may provide support to these patients by ensuring that they receive appropriate treatment of pain and other physical, psychosocial, and spiritual problems in an attempt to focus attention on the values of the ill person rather than limiting it to the illness.

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          Most cited references48

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          Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine.

          These recommendations have been developed to improve the care of intensive care unit (ICU) patients during the dying process. The recommendations build on those published in 2003 and highlight recent developments in the field from a U.S. perspective. They do not use an evidence grading system because most of the recommendations are based on ethical and legal principles that are not derived from empirically based evidence. Family-centered care, which emphasizes the importance of the social structure within which patients are embedded, has emerged as a comprehensive ideal for managing end-of-life care in the ICU. ICU clinicians should be competent in all aspects of this care, including the practical and ethical aspects of withdrawing different modalities of life-sustaining treatment and the use of sedatives, analgesics, and nonpharmacologic approaches to easing the suffering of the dying process. Several key ethical concepts play a foundational role in guiding end-of-life care, including the distinctions between withholding and withdrawing treatments, between actions of killing and allowing to die, and between consequences that are intended vs. those that are merely foreseen (the doctrine of double effect). Improved communication with the family has been shown to improve patient care and family outcomes. Other knowledge unique to end-of-life care includes principles for notifying families of a patient's death and compassionate approaches to discussing options for organ donation. End-of-life care continues even after the death of the patient, and ICUs should consider developing comprehensive bereavement programs to support both families and the needs of the clinical staff. Finally, a comprehensive agenda for improving end-of-life care in the ICU has been developed to guide research, quality improvement efforts, and educational curricula. End-of-life care is emerging as a comprehensive area of expertise in the ICU and demands the same high level of knowledge and competence as all other areas of ICU practice.
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            Family Perspectives on Aggressive Cancer Care Near the End of Life.

            Patients with advanced-stage cancer are receiving increasingly aggressive medical care near death, despite growing concerns that this reflects poor-quality care.
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              An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units.

              There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered.
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                Author and article information

                Journal
                Palliat Care
                Palliat Care
                Palliative Care
                SAGE Publications (Sage UK: London, England )
                1178-2242
                2017
                02 February 2017
                : 9
                : 1178224216684831
                Affiliations
                [1 ]Graduate Program in Bioethics, Applied Ethics and Public Health (PPGBIOS), National School of Public Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
                [2 ]Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil
                Author notes
                CORRESPONDING AUTHOR: Márcio Niemeyer-Guimarães, Palliative Care Committee, HFSE-MS. Rua Sacadura Cabral 178, 20.221-903, Sala, 434 Rio de Janeiro / RJ, Brazil. Email: niemarcio@ 123456gmail.com
                Article
                10.1177_1178224216684831
                10.1177/1178224216684831
                5398330
                66a2eb64-b6e7-4e2a-ace2-5cc23e5610d0
                © The Author(s) 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 22 August 2016
                : 24 November 2016
                Categories
                Concise Review

                aged,terminally ill,palliative care,personal autonomy,biotechnoscience,bioethics of protection

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