Análisis de la toma de decisiones al final de la vida desde una perspectiva teórica contemporánea
DOI:
https://doi.org/10.18270/rcb.v7i2.1010Keywords:
Atención terminal, atención terminal, Toma de decisiones, toma de decisiones, Procesos mentales, procesos mentales, Creencias, creencias, Muerte, muerte.Abstract
Se realizó. una investigación cualitativa para describir el proceso de decisiones al final de la vida (DFV) bajo el supuesto de que se trata de un fenómeno complejo y dinámico. Con base en entrevistas a profundidad a pacientes, familiares y personal de salud y en fuentes secundarias se analizaron las DFV a partir de teor.as de decisión basadas en el principio de racionalidad limitada. Se encontró. que las DFV exhiben características observadas en los fenómenos complejos como son múltiples componentes fusionados, relaciones variadas, simultaneas, impredecibles, cambiantes y dependientes de las circunstancias. La mayoria de los entrevistados utilizan el método intuitivo para tomar decisiones basándose en rutas de pensamiento cortas: creencias arraigadas, principios, fórmulas y juicios que han demostrado .éxito previamente. Aunque se advierte un discurso de respeto por las elecciones del paciente, existen jerarqu.as instituidas e imaginadas en las que predomina el médico en lugar más alto. El dolor, la disnea y la dependencia progresiva son una fuerte presión para las DFV. También lo es la deficiente atención de los enfermos terminales y sus familias puesto que reduce las opciones a las que el paciente puede tener acceso.
Downloads
References
ANTHIEL, Ryan., et al. Dignity in end-of-life care:
results of a national survey of U.S. physicians. Journal
of Pain Symptom Manage, 44: 331-339, 2012.
ASTROW, Alan & POPP, Beth. The Palliative Care
Information Act in Real Life. New England Journal of
Medicine, 364: 1885-1887, 2011.
BARNATO, Amber., et al. Racial and Ethnic Differences
in Preferences for End-of-Life Treatment. Journal
of General Internal Medicine, 24(6): 695-701, 2009.
BARON, Jonathan. Against bioethics. Massachusett:
Massachusetts Institute of Technology, 2006. 236 p.
BOND, Lyndal & NOLAN, Terry. Making sense of
perceptions of risk of diseases and vaccinations:
a qualitative study combining models of health
beliefs, decision-making and risk perception. MC
Public Health, 11: 943. 2011. [Consultado en Julio
. Disponible desde: http://www.biomedcentral.
com/1471-2458/11/943
BORNSTEIN, Brian & EMLER, Christine. Rationality
in medical decision making: a review of the literature
on doctors’ decision-making biases. Journal of Evaluation
in Clinical Practice, 7: 97-107. 2001.
BOYD, Elizabeth A., et al. “It’s not just what the
doctor tells me:” Factors that influence surrogate
decision-makers’ perceptions of prognosis. Critical
Care Medicine, 38(5): 1243-1396, 2010.
BRETT, Allan & JERSILD, Paul. ‘Inappropriate’
treatment near the end-of-life. Conflict between
religious conviction and clinical judgment. Archives
of Internal Medicine, 163:1645–1649, 2003.
BROWN, Abraham & MOODIE, Crawford. The influence
of tobacco marketing on adolescent smoking
intentions via normative beliefs. Health Education
Research, 24(4): 721-723, 2009.
BUETOW, Stephen; JUTEL, Annemarie & HOARE,
Karen. Shrinking social space in the doctor–modern
patientrelationship: A review of forces for, and implications
of, homologisation. Patient Education and
Counseling, 74(1): 97, 2009.
CHOCHINOV, Harvey, et al. Dignity in the terminally
ill. A cross sectional cohort study. Lancet, 360(9350):
-2030, 2002.
. Burden to others and the terminally
ill. Pain Symptom Manage, 34(5): 463-471, 2007.
CORKE, Charlie., et al. The influence of medical
enduring power of attorney and advance directives
on decision-making by Australian intensive care
doctors. Critical Care Resuscitation, 11: 122-128, 2009.
ELSTER, Jon. Juicios Salomónicos. Limitaciones de la
racionalidad como principio de decisión. Barcelona:
Gedisa, 1999. 228p.
FINLAY, Ilora & SARANGI, Srikant. Medical Discourse:
Communication Skills and Terminally Ill
Patients. Encyclopedia of Language & Linguistics.
Second Edition, pp. 665-674, 2006.
FISCHER, Simon & COLYER, Hazel. Making decisions
about care: what it means for hospice inpatients with
terminal progressive disease. International Journal of
Palliative Nursing, 15(11):548-553, 2009.
GLAVAN, Bradford., et al. Using the Medical Record to
Evaluate the Quality of End-of-Life Care in the Intensive
Care Unit. Critical Care Medicine, 36(4): 1138–1146, 2008.
GOOLD, Susan; WILLIAMS, B. & ARNOLD, R.
Conflicts regarding decisions to limit treatment: A
differential diagnosis. JAMA, 283: 909–914, 2000.
GUO, Kristina. DECIDE: A decision-making model
for more effective decision making by health care
managers. The Health Care Manager, 27(2):118-127,
HANSSON, Sven Ove. Decision theory: a brief
introduction. [En línea] Stockholm: Royal Institute
of Technology (KTH). p.29. [Consultado en Julio
de 2012]. Disponible desde: http://es.scribd.com/
doc/20736431/Decision-Theory-a-Brief-Introduction.
HAYECK, Friederich. La teoría de los fenómenos
complejos [En línea]. Publicado originalmente bajo
el título “The Theory of Complex Phenomena”
en el volumen The Critical Approach to Science
and Philosophy. Essays in Honor of K. R. Popper,
editado por M. Bunge, y publicado por MacMillan
Publishing Co., Inc. (1964). [Consultado en Junio
de 2012]. Disponible en: http://www.hacer.org/pdf/
rev02_hayek.pdf
HERNÁNDEZ, Amparo y VEGA, Román. El Sistema
Colombiano de seguridad social en salud: desigualdad
y exclusión. Gerencia y Políticas de Salud, 1:
-73, 2001.
JANSEN, Sylvia; OTTEN, Wilma & STIGGELBOUT,
Anne. Factors affecting patients’ perceptions of choice
regarding adjuvant chemotherapy for breast cancer.
Breast Cancer Research and Treatment, 99(1):35-45,
KAHNEMAN, Daniel. Mapas de racionalidad limitada:
psicología para una economía conductual. Revista
Asturiana de Economía- RAE N, (28): 181-225, 2003.
KALDJIAN, Lauris; JEKEL, James & FRIEDLAND,
Gerald. End-of-life decisions in HIV-positive patients.
AIDS, 12:103–107,1998.
KEATING, Nancy., et al. Cancer Patients’ Roles in
Treatment Decisions: Do Characteristics of the Decision
Influence Roles? Journal of Clinical Oncology,
: 4364-4370, 2010.
KLEINJAN, Marloes; VAN DEN EIJNDEN, Regina
& ENGELS, Rutger. Adolescent’s rationalizations to
continue smoking: the role of disengagement beliefs
and nicotine dependence in smoking cessation.
Addictive Behaviors 34: 440-445, 2009.
KOENIG, Harold. Health Care and Faith Communities.
How Are They Related?, Journal of General
Internal Medicine, 18(11): 962–963, 2003.
LAPINSKI Maria Knight & RIMAL Rajiv. An Explication
of Social Norms. Communication Theory, 15(2):
-147, 2005.
LAWRENCE, Ryan & CURLIN, Farr. Autonomy,
religion and clinical decisions: findings from a
national physician survey. Journal of Medical Ethics,
: 214-218, 2009.
LYNDAL, Bond & NOLAN, Terry. Making sense of
perceptions of risk of diseases and vaccinations: a
qualitative study combining models of health beliefs,
decision-making and risk perception. BMC Public
Health, 11:943, 2011.
MARTEAU, Therese. Framing of information: Its
influence upon decisions of doctors and patients.
British Journal of Social Psychology, 28(1): 89–94, 1989.
MORIN, Edgar. El Método: Las ideas: Tomo IV.
Madrid: Cátedra, 1992. 135p.
MOSCOVICI, Serge. Social Representations mailing
list postings, 28 Apr - 27 May 1997. [Consultado en
Agosto de 2011]. Disponible desde: http://psyberlink.
flogiston.ru/internet/bits/mosc1.htm
MULLIN, Barbara; MULLIN, Mhari & MULLIN, Robert.
Mhairi’s Dilemma: A study of decision analysis at work.
Judgment and Decision Making (3): 679–689, 2008.
NOZICK, Robert. The nature of rationality. Princeton
NJ: Princeton University Press, 1994. 242 p.
NUSSBAUM, Martha. Paisajes del pensamiento: La
inteligencia de las emociones. Barcelona: Paidos,
896p.
PHELPS, Andrea., et al. Religious Coping and Use
of Intensive Life-Prolonging Care Near Death in
Patients With Advanced Cancer. JAMA, 301(11):
-1147, 2009.
PUGH, Edwin., et al. A profile of the belief system and
attitudes to end-of-life decisions of senior clinicians
working in a National Health Service Hospital in
the United Kingdom. Palliative Medicine, 23(2):158-
, 2009.
QUILL, Timothy E. The ambiguity of clinical intentions.
New England Journal of Medicine, 329(14):1039-
, 1993.
REAL, Kevin & RIMAL, Rajiv. Friends talk to friends
about drinking: exploring the role of peer communication
in the Theory of Normative Social Behavior.
Health Community; 22: 169-180, 2007.
RIMAL Rajiv & LAPINSKI Maria. Why health communication
is important in public health. Bulletin of
World Health Organization, 87(4), página editorial,
RYAN, Ann & Scullion, H. F. Family and staff perceptions
of the role of families in nursing homes.
Journal of Advanced Nursing, 32: 626–634, 2000.
SARMIENTO, María Inés., et al. Problemas y decisiones
al final de la vida en pacientes con enfermedad en
etapa terminal. Salud Pública, 14(1): 116-128, 2012.
. El cuidado paliativo: un recurso para
la atención del paciente con enfermedad terminal.
Salud Bosque: 1(2):23-37, 2011.
SEALE, Clive. The role of doctors’ religious faith and
ethnicity in taking ethically controversial decisions
during end-of-life care. Journal of Medical Ethics,
:677-682, 2010.
. Hastening death in end-of-life care:
a survey of doctors. Social Science and Medicine,
(11):1659-1666, 2009.
SEARLE, John. Rationality in action. Cambridge, MA:
Massachusetst Institute of Technology, 2001. 303p.
SILVESTRI, Gerald., et al. Importance of faith on
medical decisions regarding cancer care. Journal of
Clinical Oncology, 21(7): 1378-1382 , 2003.
SIMON, Herbert A. Naturaleza y límites de la razón
humana. México DF: Fondo de Cultura Económica,
340 p.
SIMÓN, Pablo., et al. Ética y muerte digna: propuesta
de consenso sobre un uso correcto de las palabras.
[Consultado en Agosto 20 de 2012]. Disponible
desde: http://www.eutanasia.ws/hemeroteca/psimonpalabras.
SLOMAN, Steven A. Two Systems of Reasoning. En:
KAHNEMAN, T; GILOVICH, D and GRIFFIN, & K.
D (Edits.) Heuristics and Biases: The psychology of
intuitive judgment. New York: Cambridge University
Press, 2002. 858 p.
SUTTON, Stephen. Health behavior: Psychosocial
theories. Cambridge University. [Consultado en
Octubre 16 de 2012]. Disponible desde: userpage.
fu-berlin.de/~schuez/folien/Sutton.pdf
TAYLOR, David., et al. A review of the use of Health
Belief Model, the Theory of Reasoned Action, the
Theory of Planned Behavior and the Trans Theoretical
Model to study and predict health related behavior
change. National Institute for Health and Clinic
Excellence. The School of Pharmacy University of
London (Draft for consultation 2007). [Consultado
el 10 julio de 2012]. Disponible desde: www.nice.
org.uk/nicemedia/live/11868/44524/44524.pdf
TAYLOR, Lynne. Viewpoint Can We Really Prepare
for Enabling ‘Death with Dignity’? Neurology Today,
(13) 2011. [Consultado en Agosto 5 de 2012].
Disponible desde: http://journals.lww.com/neurotodayonline/
Fulltext/2011/07070/Viewpoint_Can_
We_Really_Prepare_for_Enabling.13.aspx
TAYLOR, Michael. Dealing with Death: Western
Philosophical Perspectives. En: BRYANT, Clifton
(Ed.) Handbook of Death and Dying. Londres: Sage,
pp. 24-34.
THE ECONOMIST INTELLIGENCE UNIT. Dignity
of death: ranking end of life care across the world.
[Consultado el 9 de Septiembre de 2012]. Disponible
desde: http://www.eiu.com/site_info.asp?info_
name=qualityofdeath_lienfoundation&page=noads
THOMPSON, Genevieve & CHOCHINOV, Harvey.
Dignity – based approaches in the care of terminally
ill patientes.Current Opinion Support Palliative Care,
(1): 49-53, 2008.
TVERSKY, Amos & Kahneman, Daniel. Judgment
under uncertainty: heuristics and biases. En D. Kahneman,
P. Slovic, & A. Tversky (Edits.), Judgment
Under Uncertainty: Heuristics and Biases. New York:
Cambridge University Press. 1982. 553p.
VARGAS, Julián y MOLINA, Gloria. Acceso a los
servicios de salud en seis ciudades de Colombia:
limitaciones y consecuencias. Facultad Nacional de
Salud Pública: El escenario para la salud pública desde
la ciencia, 27(2): 121-130, 2009.
WEINFURT, Kevin. Value of high-cost cancer care:
A behavioral science perspective. Journal of Clinical
Oncology, 25: 223-227, 2007.
YOOD, Robert., et al. Patient Decision to Initiate
Therapy for Osteoporosis: The Influence of Knowledge
and Beliefs. Journal of General Internal Medicine
(23)11, 2008.
YOUNG, Amanda & RODRIGUEZ, Kery. The Role
of Narrative in Discussing End-of-Life Care: Eliciting
values and goals from text, context, and subtext.
Health Community, 19(1): 45-59, 2006.
ZIER, Lucas., et al. Doubt and belief in physicians’
ability to prognosticate during critical illness: The
perspective of surrogate decision makers. Critical
Care Medicine 36(8): 2341–2347, 2008.
Downloads
Published
How to Cite
Issue
Section
License
Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial-SinObrasDerivadas 4.0.