O médico frente ao diagnóstico e prognóstico do câncer avançado

Abstract

Biotechnological scientific progress has brought about some misunderstanding between advances and ethical decisions. The relationship physician-patient when facing seriously ill patients has been altered . OBJECTIVE. To evaluate the physician's attitude when facing disclosure to patient, family or both of cancer diagnosis and prognosis including also a bioethical analysis about the conflicts between beneficence, respect for patient autonomy and paternalism. METHODS. Thirty-eight physicians responsible for neoplasic patients in a tertiary hospital were interviewed. The questionnaire was structured in two different parts. The first, with general information about the physicians and the second, with specific questions about diagnosis and prognosis disclosure to the patient, evaluating also the physician's comprehension of beneficence. RESULTS. Although most physicians (97.4%) inform the diagnosis to their patients in cases of fatal diseases, 50.0% rely on the family for support. In cases of fatal prognosis,63.1% tell only the families while 31.6% prefer to tell only the patients. The study showed that physicians misunderstand beneficence and paternalism. CONCLUSION. Physicians normally disclose diagnosis to their patients. When they run out of therapeutic resources, their attitudes become conflicting in relation to the principles of beneficence and autonomy. The number of physicians who believe in paternalism as a form of beneficence is still significant. The paternalistic attitude arises especially when therapeutic resources no longer seem to really solve the problem.