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Letter to the Editor
Futility and palliative psychiatry in mental health: New clinical and ethical challenges
Futilidad y psiquiatría paliativa en salud mental: nuevos desafíos clínicos y éticos
Sergio Ramos Pozón
Escuela de Enfermería, Universidad de Barcelona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The concept of futility is used frequently in the medical field&#46; Although many definitions and approaches have been proposed&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in general&#44; futility refers to the intrinsic relationship between an action and an expected objective&#44; and there are three distinct types&#58; physiological&#44; quantitative and qualitative&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The term futility is accepted in general medicine&#44; but in mental health there are discrepancies&#44; and it is little used&#46; Various articles have recently been published in the literature on its use and&#47;or its legitimacy in this field&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> It has been suggested<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> that the futility judgement in some mental illnesses&#44; such as anorexia nervosa&#44; should be appropriate if there is evidence of poor prognosis&#44; the indicated treatment does not provide an effective therapeutic response&#44; there is progressive physical and psychological deterioration&#44; or there are signs of an inevitable and terminal outcome&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Use of the concept of futility in mental health has not been exempt from criticism and even debate as to whether it is clinically meaningful and ethically and legally justifiable&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Despite the lack of consensus on its legitimacy&#44; the theory that a healthcare professional should not be obliged to offer treatments that are not beneficial or which are inefficient for the patient is usually accepted&#44; but that does not exempt them from dialogue and discussion about therapeutic alternatives&#46; Although there may be a lack of effective treatments for the specific case&#44; this does not invalidate the need to try palliative care&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this context&#44; we have seen the idea of &#8220;palliative psychiatry&#8221;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> gradually being introduced&#44; a concept particularly relevant in anorexia nervosa&#44; schizophrenia and&#47;or borderline personality disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Trachsel et al&#8217;s proposal<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> maintains that this approach improves the quality of life of patients and their families in terms of coping with the problems inherent to mental illness&#46; It is a proposal that affirms life&#44; but which&#44; without wanting to anticipate death&#44; recognises that there may be situations where the condition is incurable&#46; It has a bio-psycho-social and spiritual approach&#44; so it is applicable along with other therapies aimed at prevention&#44; healing&#44; rehabilitation and recovery&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite being widely accepted in literature&#44; critics debate whether an exclusive definition for psychiatry is needed&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Nevertheless&#44; palliative psychiatry in patients with mental health problems has already begun&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and palliative tools are even being developed for people with serious mental illnesses&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This new approach highlights a great respect for people&#44; in that it seeks to introduce the values and preferences of patients &#40;this could even be done by anticipating decisions through an advance directive document or advance care planning<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#41; and their families to improve their quality of life&#46; Therefore&#44; we face a new paradigm&#44; which seeks not only to cure&#44; but also to care for people&#44; but that requires psychiatry to be both critical and reflective&#44; with its foundations and medical praxis&#46; It should therefore be an ethical and clinical imperative to humanise mental healthcare to prevent suffering and futile measures&#44; and to care for incurable patients&#44; and thus seek to provide comfort&#44; psychological support&#44; and inherent respect for dignity&#46;</p></span>"
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ISSN: 25303120
Original language: English
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