34
Informaciones
Psiquiátricas
2017 - n.º 228
De la medicina se espera que “haga lo
que debe hacer” y que no haga “todo lo
que puede hacer”, adecuando la intensidad
diagnóstica y terapéutica a la fragilidad que
aparece cuando se acerca el fallecimiento.
Las VA surgieron como freno y como guía de
actuación establecida por uno mismo frente
a la intervención médica
1
. Las VA o mejor
aún, una
planificación anticipada de la
asistencia
con actualizaciones periódicas,
deberían dominar la relación asistencial en
el futuro.
Palabras clave:
final de la vida, consenti-
miento informado, autonomía del pacien-
te, voluntades anticipadas, planificación
anticipada de la asistencia sanitaria.
Abstract
In the last decades, the profound and
transformer changes occurred in the wes-
tern societies have also affected the medical
practice. The traditional pyramidal structure
of the medical-patient relation considered
benefactress during the last century, has tur-
ned in a spectacular way into patient auto-
nomy, new and necessary concept to unders-
tand the clinical relationships nowadays.
The principle of autonomy in the sanitary
scene was sustain by the development of
informed consent, that was born as a de-
fense against the abuse of power of some
professionals that carried the paternalism
and the principle of benefit to unacceptable
extremes. Today is well recognized right by
the legislations of all developed countries.
The informed consent and the autonomy
of the patient have become entrenched in
the progressive and intense technification
of medicine. The application of these con-
cepts turns vital in the end of life, where
the environment is especially sensitive be-
cause of the presence of a bigger suffering
and vulnerability.
The advanced directives (AD) come from
the autonomy and the information to find a
planned assistance at the end of life or in
advanced situations, when the patient can-
not express their own wills by their own.
As death, in our society, takes place in a
hospital environment, the AD should help
hospital professionals in the decision pro-
cess at that moment.
Medicine “has to do what it has to do”
not “do anything that can be done”, fitting
diagnose and therapeutic intensity to frailty
that shows up as the end of life approa-
ches. The AD were born as a break and as a
self established guide of practice for medi-
cal intervention
1
. The DA or even better, an
anticipated planning of medical assistance
with periodical updates, should dominate
the medical practice in the future.
Key words:
end of life, informed consent,
patient autonomy, advanced directives, ad-
vance care panning.
Bases de las
Voluntades Anticipadas
1. La Información
La información es base y condición
sine
qua non
para poder tomar decisiones, para
anticiparlas ante un posible entorno de final
de vida. En la actualidad, la información al
paciente está reconocida como un derecho y
regulada la gestión del mismo. Siempre que
exista capacidad suficiente, la información
pertenece al paciente y solo se proporciona
a la persona en la que haya delegado, cuan-
do aquella capacidad no exista.
Elías Díaz-Albo Hermida
