End of Life Decisions (EOLD): Defining the Most Important from a Group of Experts in Argentina

De Simone G.1,2, Manzini J.1, Tinant E.1, Tripodoro V.1,2, Grance G.1,2, Rabadán A.1, Gherardi C.1, Maglio I.1, Sluzky L.1, Ceschi R.1, Estévez A.1, López H.1, Butera J.1, Henry E.1, Miranda A.1, Löbbe V.1, Cullen C.1, Salgueiro S.1,2, Martí M.1

(1) Academia Nacional de Medicina, Consejo Académico de Etica en Medicina, Buenos Aires, Argentina, (2) Asociacion Pallium Latinoamérica, Buenos Aires, Argentina

Aim: The working group on EOLD was created in the Council of Medical Ethics - National Academy of Medicine in Buenos Aires, in order to promote education and advice to Argentinean physicians in relation with ethical concerns about EOL care in daily practice. First aim was to focus on main EOLD.

Method: Once EOLD was defined thorough a Delphi process, we developed a survey on main EOLD reported by experts from different professions, making a list of those more frequently considered to be important. 19 experts were invited, all of them accepted to participate in the Delphi and/or survey. EOLD were defined asthose that involved a person whose vital functions are seriously compromised, and they affect (or may affect) personal dignity and integrity, as well as they have an impact on quality,

place or time of dying.

Outcome: A total of 90 EOLD were mentioned and they were classified in 12 categories, following the criteria of OPCARE9 international project which includes experts from 7 countries in Europe and 2 beyond. These categories are: withholding/refusal therapy (includes hydration); place of dying, symptom control, communication, social matters, organization of care, autonomy, other interventions,spirituality, after death, euthanasia and miscellaneous.

When comparing six most frequent categories among the Argentinean group with those of OPCARE9, we find that even when most of the decisions are similar they are ranked differently: withholding/refusal therapy 1st (Argentinean) and 1st (OPCARE), Autonomy 2nd / 7th; organization of care 3rd / 6th; communication 4th / 4th ; place of dying 5th / 2nd; symptom control 6th / 3rd.

We suggest that factors like culture, medical education and resource availability could explain differences in priorities among this Argentinean perspective and other international perspectives like OPCARE9 project. We consider this survey is relevant as a base to promote proper education and research based on own needs on EOLD in the country.

 

Pallium Latinoamérica. Ciencia, alivio y esperanza en el final de la vida.