Limitación del esfuerzo terapéutico y cuidados paliativos

The healthcare staff training process has been mainly focused on the preventive, healing, and rehabilitating medicine, constantly with an emphasis on the 'to do' and rarely on the 'stop doing', a necessary consideration for terminal or patients in agony, thus putting itself at risk of incurring the futile handling of medical care. Medical Ethics imposes the moral obligation to implement therapeutic measures when a possibility for healing, surviving or quality of life is available for the patients, but actions should not be taken to prolong the agony of a patient who is inevitably facing death. In this paper reference will be made to the limitation of therapeutic effort (LTE) in adults. The LTE may be categorised as a decision not to implement certain manoeuvres or care procedures, or as a technique to discontinue steps that had already been taken, when these are no longer medically prescribed, and prevent the natural evolution of the disease, thereby creating a disproportion between therapeutic goals and means. Ten items are proposed for the practice of LTE. The LTE shall at all times be bound to the management of palliative care. An explanatory chart is presented, comparing therapeutic effort, life expectancy, limitation of therapeutic effort and palliative care. Six steps are also presented to put therapeutic proportionality judgement into practice. Healing therapy, therapeutic effort, limitation of therapeutic effort and palliative care should be a harmonic ensemble, not a source of conflicts and confusing interpretations of their meaning.