Arq. Bras. Cardiol. vol.99 número6 en v99n6a15

Letter to the Editor

Living Wills
Max Grinberg and Graziela Zlotnik Chehaibar
Instituto do Coração – InCor, São Paulo, SP - Brazil

Dear Editor,
Autonomous decisions should be encouraged and young
doctors have been trained to avoid patronizing attitudes
toward their patients. The subject of desire together with
freedom is an old concept in philosophy; mankind has the
sensation of being free during a voluntary act, but one must
consider the involvement of conscious and unconscious
Recently, the Federal Council of Medicine issued
Resolution 1995/2012, which provides for advance directives
of patients’ wills within the concept of orthothanasia, a
subject that has assumptions in the Code of Medical Ethics
and Resolution 1805/2006. It is understood that aggressive
interventions may be not only futile, but also inadequate
in the scenario of end-stage illness and inevitable death in
the short term.
The manifestation on the types of treatment that patients
want from health professionals and caregivers during the end

Living Wills; Right to Die; Bioethics.

stage of life, registered while they still have preserved quality
of life, is known as the Living Will (LW) and already exists in
countries such as Spain, Japan, United States, Portugal and
Uruguay. In Brazil, it is being discussed.
End-stage heart failure in the elderly with heart disease
brings high relevance to the context of discussions on the use
of available methods in cardiology. Therefore, cardiologists
should be interested in the context of LWs.
Considering the likelihood that the new generation of
doctors will have to deal with patients’ Living Wills, we
carried out a study with 32 medical residents from the
Cardiology Program of Instituto do Coração and obtained
the following results: a) 65.3% have some knowledge on
LWs; b) 96.8% believe that the LW will be useful in decisionmaking, c) 96.8% believe that patients will make changes
in the content of their LWs during the course of the illness
d) 84.3% of doctors would unquestioningly respect their
patients’ LWs.
The data reflect not only the young doctors’ respect for the
patients’ right to participate actively in decisions concerning
their own lives, but also showed good acceptance of the LW
as part of the patient’s medical record.

Mailing Address: Max Grinberg •
Rua Manoel Antonio Pinto, 04 / 21ª,Paraisópolis. Postal Code 05663-020, São Paulo, SP - Brazil
Manuscript received September 04, 2012; revised manuscript September 28, 2012; acepted September 28, 2012.




Penalva L. Declaração prévia de vontade do paciente terminal. Rev


Silveira MJ, Kim SY, Langa KM -Advance directives and outcomes of surrogate
decision making before death. N Engl J Med. 2010;362(13):1211-8.


Costa, RD -Autonomia: viver a própria vida e morrer a própria morte.
Cad Saúde Pública. 2006;22(8):1749-54.



Van Wijmen MPS, Pasman HRW, Widdershoven GAM, OnwuteakaPhilipsen BD - What do people want at the end of life, with or without
an advance directive? BMJ Support Palliat Care.2012;2:195.

Teno JM, Gruneir A, Schwartz Z, Nanda A, Wetle T. Association between
advance directives and quality of end-of-life care: a national study. J Am
Geriatr Soc.2007;55(2):189-94.

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