Health care for terminal patients: between medical practices and religious beliefs

O novo C??digo de ??tica M??dica, que passou a vigorar em 13 de abril de 2010, contempla situa????es cl??nicas irrevers??veis e terminais. Nesses casos ?? indicado ao m??dico evitar a realiza????o de procedimentos diagn??sticos e terap??uticos desnecess??rios, prestando os cuidados paliativos apropriados aos pacientes sob sua responsabilidade. O processo de aprova????o desse texto ?? examinado neste artigo, assim como as transforma????es ocorridas em poucas d??cadas no Brasil, no que tange ?? assist??ncia em sa??de a quadros cl??nicos avaliados como fora de possibilidades terap??uticas de cura ou terminais. Os termos ortotan??sia, distan??sia e eutan??sia, apesar de n??o utilizados no novo c??digo de ??tica m??dica, s??o aqui enfocados, inclusive com o exame dos diferentes posicionamentos de grupos religiosos acerca do processo do morrer. O morrer bem, com dignidade, ou a produ????o de uma morte humanizada, ?? objeto da aten????o de profissionais de cuidados paliativos, que postulam a necessidade de assist??ncia espiritual aos doentes e a seus familiares. A partir de pesquisas com equipes paliativistas e do texto da nova norma de conduta m??dica, s??o debatidos os dilemas que se apresentam, na pr??tica, entre todos os envolvidos no processo do morrer. Por fim, enfoca-se a rela????o m??dico/pacientes/familiares nesta recente modalidade de assist??ncia, uma vez que tal intera????o ?? perpassada por rela????es de poder, nas quais tamb??m se apresentam diferentes valores e cren??as religiosas.The new Brazilian Code of Medical Ethics, which became effective as of April 13, 2010, addresses terminal and irreversible clinical situations. In such cases, doctors are advised to provide appropriate palliative care for patients under their responsibility instead of performing unnecessary diagnostic and therapeutic procedures. The Code???s process of approval is examined in this article, as well as the changes occurred in Brazil within a few decades regarding health care for clinical profiles considered as terminal or out of the therapeutic chances of cure. Although the terms orthothanasia, dysthanasia and euthanasia are not used in the new Code of Medical Ethics, they are addressed in this article together with the different points of view of religious groups on the process of dying. A ???good death???, with dignity, or the production of a umanized death has received the attention of palliative aregivers, who postulate the need to provide spiritual assistance to ill patients and their families. Surveys with palliative care teams and the medical ethics new code???s text are the background for the debate over the dilemmas faced by all those practically involved in the process of dying. Finally, focus is placed on the doctor/patient/family relationship in this recent kind of care, because such interaction is intertwined with power relations, where different values and religious beliefs can be seen