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Essay
a r t i c l e i n f o a b s t r a c t
Article history: Introduction: One could say that disease and fear of death are the key issues that make most
Received 9 August 2011 people seek medical help. However, it is striking to nd that most of the time devoted to
Accepted 2 February 2012 teaching at medical schools focuses on disease while death is simply unspoken. Death as a
real and universal fact is a topic rarely discussed in a doctors-to-be classroom.
Objective: This essay is intended to make the medical reader aware of the fact that in addition
Keywords: to scientic or empirical criteria, there are other valid and enriching perspectives about
Death agony, death and dying; i.e. the philosophical and theological perspective. To that end, the
Disease background is a recently published article in this journal that will be referred to in the next
Philosophy pages.
Physician 2012 Published by Elsevier Espaa, S.L. on behalf of Sociedad Colombiana de
Anestesiologa y Reanimacin.
r e s u m e n
Palabras clave: Introduccin: Podra decirse que la enfermedad y el temor a la muerte son los problemas
Muerte principales que obligan a la mayora de las personas a buscar ayuda mdica. Sin embargo,
Enfermedad sorprende que a la enfermedad se le dedique casi todo el tiempo de la ensenanza en las
Filosofa facultades de medicina y que la muerte se tome simplemente como algo implcito; pocas
Mdico veces el tema de la muerte, como fenmeno real y vivencia universal, es discutido en las
clases para los futuros mdicos.
Objetivo: Por medio de un ensayo de reexin, se pretende motivar al lector mdico de que
adems de criterios cientcos o empricos, existen otras miradas vlidas y enriquecedoras
sobre la agona, la muerte y el morir, como son la mirada losca y teolgica. Para ello
tomamos como base un artculo recientemente publicado en esta revista y del que haremos
alusin ms adelante.
2012 Publicado por Elsevier Espaa, S.L. en nombre de Sociedad Colombiana de
Anestesiologa y Reanimacin.
Please cite this article as: Lpez R. JH, Lpez R. O. Sobre la muerte: a quien pueda interesar. Rev Colomb Anestesiol. 2012;40:1958.
Corresponding author at: CALLE 80 No. 10-43, Bogot, Colombia.
E-mail address: jhlopezr@unal.edu.co (J.H. Lpez R.).
2256-2087/$ see front matter 2012 Published by Elsevier Espaa, S.L. on behalf of Sociedad Colombiana de Anestesiologa y Reanimacin.
Document downloaded from http://www.revcolanest.com.co, day 27/08/2012. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.
This is in contrast with a survey mainly among elderly peo- their daily activities have a tendency to prefer the hospital to
ple who were hospitalized due to cardiopulmonary disease, die.7
asking about where they preferred to die. Almost half of them Nowadays, the doctor must take care of a larger num-
(43%) said that their preferred place was at home, 48% pre- ber of elderly patients and as people age the risk of dying
ferred the hospital and 9% did not have a clear answer. The increases exponentially. If we recall the three basic princi-
choice was determined in the former by the desire to be in ples of bioethics, we then understand that everyone is entitled
a family environment, surrounded by their loved ones and in to medical and palliative care for a dignied life till the
the case of the latter, because they did not want to become last day of their lives (principle of justice); we must provide
a burden to their families or concern about the adequacy of adequate medical care for life quality rather than quantity
care.6 and hence avoid the mistake of therapeutic nihilism (refus-
An Israeli study done in over one thousand people over ing to do the right procedure simply because the patient is
70 years of age, asked directly about their preference for the old), or the mistake of having very elderly patients undergo
place of death. The ndings showed that 70% of the inter- extremely invasive procedures leading to increased costs
viewed preferred dying at home, 23% preferred dying in a and extending the agony rather than relieving suffering
hospital and 5% in a nursing home. When comparing those prior to death (principle of doing good rather than evil).
who preferred dying at home against those who favored insti- Finally, the wishes of the elderly should be respected to
tutionalization, it was signicantly evident that the former choose how, when and where to die (principle of auton-
were married, with solid economic status, lived with some- omy).
one else and their residence was in a rural area. It was also
determined that the elderly who preferred to die at home
suffered from less severe illnesses, experienced less somatic
Conclusion
symptoms and were less disabled as a whole. Furthermore,
those who preferred dying at home expressed greater life sat- Death is a fact inherent to every living creature and partic-
isfaction and experienced less mental health issues than their ularly to us, human beings. While in the animal kingdom
counterparts. In terms of social support, those who preferred the instinct of life preservation makes animals avoid death,
dying at home showed signicant greater trust in their rel- humans exhibit a complex behavior when confronted with
atives and friends and were in more frequent contact with death. Such complex approach to dying includes how we
their loved ones, in contrast with the elderly who preferred would like to die, where and when. If doctors are not pre-
dying somewhere else. The multi-varied analysis showed that pared to address this situation with their patients, certainly
social contact, family trust and housing adjustments were every medical and therapeutic process shall be incom-
statistically signicant factors in the preference to choose plete. This article is an invitation to reect on this topic,
the place of death. Moreover, personality traits such as self- not just as doctors, but also as individuals with a nite
esteem and a sense of control were not predictive of any life.
preference for the place of death. According to the researchers,
their ndings suggest that the elderly are realistic in their pref- Funding
erence when recognizing that a dignied death at home is
mostly dependent on the social support than on their intrinsic
Personal funding.
wishes.
Finally, the authors consider that caring for a loved one who
is about to die is a very demanding task that may result in an Conicts of interest
overwhelming physical and emotional stress. The recommen-
dation that in order to have a larger number of elderly patients
None declared.
dying at home, there is a need for greater support to family
caretakers so that they can improve their skills to cope with
the situation. This may be achieved through specic train- references
ing programs involving volunteers, friends and neighbors, to
help with the chores and the emotional factors inherent to the
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Work Public Health. 2009;24:52742.
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in Flanders. BMC Public Health. 2006;6:178, muerte y factores relacionados en personas mayores de la isla
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