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2018, Number 4

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Arch Med Fam 2018; 20 (4)

The Smiling at death: fear or desire?

Polesel FV, Craice BMA

Language: Portugués
References: 22
Page: 191-198
PDF size: 196.54 Kb.


ABSTRACT

It is not uncommon to find Palliative Care or cancer patients who wish death. The pain they can feel becomes sometimes total and the medications are not enough for controlling their symptoms, which become so intense or incapacitating that the patients question whether it is worthwhile to continue in their struggle for survival. This questioning is understandable when it comes from a patient in the final stage of life. But and when the patient has a possibility of improvement with the clinical treatment and still requests an euthanasia? How to approach this topic with him or her? Based on the model called narrative-based medicine, we bring a reflection about the narrative of a cancer patient who, despite speaking in a humorous way about the disease itself, hid behind the jokes contradictory feelings: either a very great fear or a desire to die. This reflection also points to the need to adopt a Narrative Ethics in complementation to a Principle-Based Ethics.


REFERENCES

  1. Blasco PG. O médico perante a morte. Revista Brasileira de Cuidados Paliativos. 2009; 2(4): 7-12.

  2. Conselho Federal de Medicina (CFM - Brasil). Código de ética médica. Brasília: Conselho Federal de Medicina; 2010. Disponível em: https://portal.cfm.org.br/images/stories/biblioteca/codigo%20de%20etica%20medica.pdf. Acesso em: 20/07/2018.

  3. Kovács MJ. Bioética nas Questões da Vida e da Morte. Psicologia (USP). 2003; 14(2): 115-67.

  4. De Benedetto MAC, Moreto G, Janaudis MA, Levites MR, Blasco PG. Educando as emoções para uma atuação ética: construindo o profissionalismo médico. Revista Brasileira de Medicina. Edição Especial Oncologia. 2014; 71: 15-24.

  5. McCarthy J. Principlism or narrative ethics: must we choose between them? Med Humanit. 2003; 29(2); 65-71.

  6. Churchill LR. The human experience of dying: the moral primacy of stories over stages. Soundings. 1979; 62: 24-37.

  7. Jones AH. From principles to reflective practice or narrative ethics? In: Carson RA, Burns CR, eds. Philosophy of medicine and bioethics: a twenty-year retrospective and critical appraisal. Dordrecht: Kluwer Academic Publishers; 1997: 193-5.

  8. Stange KC, MillerWL, McWhinney I. Developing the Knowledge Base of Family Practice. Fam Med. 2001; 33(4): 286-97.

  9. Kleinman A, Eisenberg L, Good B. Clinical Lessons from Anthropologic and Cross-cultural Research. Annals of Internal Medicine. 1978; 88: 251-8.

  10. Nobre de Melo AL. Psiquiatria. VI. Rio de Janeiro: Civilização Brasileira; 1979.

  11. Damásio AR. O Erro de Descartes: emoção, razão e cérebro humano. São Paulo: Companhia das Letras; 2000.

  12. Shapiro J. Shapiro J. Does Medical Education Promote Alexithymia? A Call for Attending to the Emotions of Patients and Self in Medical Training. Academic Medicine. 2011; 86(3): 326-32.

  13. De Los Rios R. Quando o Mundo Gira Enamorado. São Paulo: Cultor de Livros: 2017.

  14. Charon R. Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA. 2001; 286(15): 1897-902.

  15. De Benedetto MAC, Blasco PG, Castro A, Carvalho E. Once upon a time… at the Tenth SOBRAMFA International and Academic Meeting, São Paulo, Brazil. Journal for Learning through the Arts. 2006: 2(1): Article 7. Available in: https://sobramfa.com.br/wp-content/uploads/2014/10/2007_mar_once_uppon_a_time.pdf. Acessed in: 11/06/2018.

  16. Carroll R. Find the Words to Say It: The Healing Power of Poetry. Evidence-based Complementary and Alternative Medicine. 2005; 2(2): 161-72.

  17. Smith JM, Stone AA, Hurewitz A; Kael A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. JAMA; 281(14): 1304-9.

  18. Shapiro J, Ross V. Applications of Narrative Theory and Therapy or Practice of Family Medicine. Family Medicine. 2002; 34(2): 96-100.

  19. Frank A. Just Listening: Narrative and Deep Illness. Families, Systems & Health. 1998; 16(3): 197-212.

  20. De Benedetto MAC. O Papel das Narrativas como Recurso Didático na Formação Humanística dos Estudantes de Medicina e Enfermagem. Tese apresentada à Universidade Federal de São Paulo (UNIFESP) – Escola Paulista de Medicina para obtenção do título de doutor em ciências. São Paulo: UNIFESP; 2017. Disponível em: https://drive.google.com/file/d/0Bw2mWMtmLY-lTWVtZndUVmpjc3c/view. Acesso em: 12/07/2018.

  21. Kubbler-Ross E. Sobre a morte e o morrer. Rio de Janeiro: Editora Martins Fontes; 1985.

  22. De Benedetto MAC, Castro AG, Carvalho E, Sanogo R, Blasco PG. From suffering to transcendence: narratives in Palliative Care. Can Fam Physician. 2007; 53(8): 1277–9.




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