Limitation of the therapeutic effort: When less is more

Abstract

The development and proliferation of intensive care units (ICU) and the ability of technology to replace vital functions have added unmeasurable value to medical practice and have changed the way in which culture and science face disease and death. Following progress, new ethical dilemmas arrived: today it is not clear where to draw the line that separates good medical practice and the rational use of technology. Almost always, dignity and life had similar value and, as there were no resources, decisions were based ​​on the principle of dignity, but now resources give more options to sustain life, and in some cases dignity is not under discussion.

Limitation of therapeutic effort (LTE) is to decide on the status and future of the patient to not apply treatments or therapeutic procedures that will provide little benefit about the suffering or agony the patient is experiencing 1. No starting or withdrawing a therapeutic measure to a patient (with or without capacity to decide), is a decision that challenges the health team in front of multiple scenarios and outcomes where both ethical principles of the effectiveness and the efficacy of each medical action prevail. In these situations, there are two poorly understood terms that can affect the decision: "Limitation" and "obstinacy". In any case they not correspond to a literal interpretation of each word. More than limiting, the therapeutic effort (such as energy) must be transformed in an effort to prolong life, to generate an outcome with the least possible suffering. Similarly, referring to "obstinacy" describes a therapeutic effort as a situation that does not fit into the basic principles of the medical profession 2, even though the intention of that act is surely far from intending to infringe them.