ADVANCE DIRECTIVES: CHALLENGES AND PERSPECTIVES AMONG MULTIDISCIPLINARY HEALTH CARE TEAMS IN BRAZIL

Abstract

Technological advancements in medicine, by prolonging life, have generated complex ethical dilemmas related to finitude, highlighting the need to ensure patient autonomy in the dying process. This chapter, based on a master's dissertation, aims to analyze the perspective of the multidisciplinary healthcare team on Advance Directives (ADs) and Living Wills (LW) in Brazil. The qualitative research employed semi-structured interviews with 21 professionals (nurses, physicians, and psychologists) from a teaching hospital, whose data were subjected to content analysis (Bardin, Minayo). The results revealed four thematic categories: 1) Professionals' understanding of patient autonomy, which, although conceptually clear, faces difficulties in practical application due to a lack of patient information and medicine's curative focus; 2) Professionals' experience with terminally ill patients and family involvement, marked by conflicts between patient and family wishes, with family will often prevailing and late referral to palliative care; 3) The perception of the precarious insertion of ADs in Brazil, due to a lack of guidance, widespread unawareness, absence of robust legal regulation, and professional insecurity; and 4) Professionals' knowledge of Living Wills, which proved incipient and confused, limiting its effective use in clinical practice. It is concluded that the implementation of ADs and LWs requires a profound transformation in the training and continuing education of healthcare professionals, as well as the promotion of open dialogue and a clear legal framework, aiming to guarantee the dignity and respect for patient autonomy at the end of life.