<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2178-4612</journal-id>
<journal-title><![CDATA[Conjectura: Filosofia e Educação]]></journal-title>
<abbrev-journal-title><![CDATA[Conjectura: filos. e Educ.]]></abbrev-journal-title>
<issn>2178-4612</issn>
<publisher>
<publisher-name><![CDATA[Universidade de Caxias do Sul]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2178-46122023000100120</article-id>
<article-id pub-id-type="doi">10.18226/21784612.v28.e023041</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Evolução das perspectivas bioéticas sobre a antecipação do fim da vida]]></article-title>
<article-title xml:lang="en"><![CDATA[Evolution of bioethical perspectives on anticipating the end of life]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Biasoli]]></surname>
<given-names><![CDATA[Luis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fontoura]]></surname>
<given-names><![CDATA[Adriana Alves da]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="A01">
<institution><![CDATA[,Universidade de Caxias do Sul  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="A02">
<institution><![CDATA[,Instituto Brasiliense de Direito Público  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2023</year>
</pub-date>
<volume>28</volume>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://educa.fcc.org.br/scielo.php?script=sci_arttext&amp;pid=S2178-46122023000100120&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://educa.fcc.org.br/scielo.php?script=sci_abstract&amp;pid=S2178-46122023000100120&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://educa.fcc.org.br/scielo.php?script=sci_pdf&amp;pid=S2178-46122023000100120&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo A antecipação do fim da vida sempre foi um tema debatido na história da medicina e da filosofia, ultimamente, outrossim, da bioética. Dado que, hodiernamente, vive-se uma grande evolução no tratamento clínico dos pacientes com diagnóstico de estado vegetativo, decorrente do enorme avanço tecnológico nas áreas da saúde ou médico hospitalares que possibilitaram, cada vez mais, preservar melhor e prolongar mais a vida humana, este artigo objetiva, à luz dos princípios da bioética &#8211; autonomia, beneficência, não-maleficência &#8211;, estudar os possíveis impactos nas mudanças de classificação na literatura médica dos distúrbios crônicos de consciência. Primeiramente, far-se-á uma análise seguindo o método histórico-crítico dos seguintes conceitos: pacientes em estado vegetativo ou síndrome da vigília sem resposta e estado minimamente consciente. Os casos emblemáticos das pacientes Terri Schiavo e Nancy Cruzan são paradigmáticos, para ilustrar como a comunidade médica, por meio de uma reflexão bioética madura e responsável, e usando dos avanços recentes nos diagnósticos clínicos neurológicos, pode ter uma melhor adequação nas decisões e nos juízos ético-morais atinentes à antecipação do fim da vida com respostas mais balizadas na razão e equânimes. Conclui-se, ciente dos limites do artigo, que o progresso da ciência, aliado à tecnologia contemporânea, permite um novo olhar sobre o futuro dos pacientes em estado crítico, sem niilismos obscurantistas. Sabe-se que os princípios da bioética, sem desconsiderar outras fontes, subsidiam, cada vez mais, a reflexão séria e sistemática sobre a antecipação do fim da vida e, sobremaneira, com os avanços das conquistas médicas do século XXI.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract The anticipation of the end of life has always been a debated theme in the history of medicine and philosophy, and lately, also in bioethics. Given that, nowadays, there is a great evolution in the clinical treatment of patients diagnosed with vegetative state, due to the enormous technological advances in the health and medical-hospital areas, which have made it possible to better preserve and prolong human life, this article aims, in the light of bioethical principles &#8211; autonomy, beneficence, non-maleficence &#8211; to study the possible impacts of classification changes in medical literature of chronic disorders of consciousness. Firstly, an analysis will be made following the historicalcritical method of the following concepts: patients in vegetative state or unresponsive wakefulness syndrome and minimally conscious state. The emblematic cases of the patients Terri Schiavo and Nancy Cruzan are paradigmatic, to illustrate how the medical community, by means of a mature and responsible bioethical reflection, and using recent advances in neurological clinical diagnoses can have a better adequacy in the ethicalmoral decisions and judgments regarding the anticipation of the end of life with more reasoned and equanimous responses. It is concluded, aware of the limits of the article, that the progress of science, allied to contemporary technology, allows a new look on the future of critically ill patients, without obscurantist nihilism. It is known that the principles of bioethics, without disregarding other sources, increasingly subsidize the serious and systematic reflection on anticipating the end of life, especially with the advances in medical conquests of the XXI century.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Estado vegetativo]]></kwd>
<kwd lng="pt"><![CDATA[Coma]]></kwd>
<kwd lng="pt"><![CDATA[Bioética]]></kwd>
<kwd lng="pt"><![CDATA[Fim da vida]]></kwd>
<kwd lng="pt"><![CDATA[Terri Schiavo]]></kwd>
<kwd lng="en"><![CDATA[Vegetative state]]></kwd>
<kwd lng="en"><![CDATA[Coma]]></kwd>
<kwd lng="en"><![CDATA[Bioethics]]></kwd>
<kwd lng="en"><![CDATA[End of life]]></kwd>
<kwd lng="en"><![CDATA[Terri Schiavo]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[ADAMS]]></surname>
<given-names><![CDATA[Z. M]]></given-names>
</name>
<name>
<surname><![CDATA[FINS]]></surname>
<given-names><![CDATA[J. J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Historical Origins of the Vegetative State: Received Wisdom and the Utility of the Text]]></article-title>
<source><![CDATA[Journal of the History of the Neurosciences]]></source>
<year>2017</year>
<volume>26</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>140-53</page-range></nlm-citation>
</ref>
<ref id="B2">
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[BEAUCHAMP]]></surname>
<given-names><![CDATA[Tom L.]]></given-names>
</name>
<name>
<surname><![CDATA[CHILDRESS]]></surname>
<given-names><![CDATA[James F.]]></given-names>
</name>
</person-group>
<source><![CDATA[Principles of Biomedical Ethics]]></source>
<year>2001</year>
<edition>5. ed.</edition>
<publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[Oxford University Press]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[CICHELERO]]></surname>
<given-names><![CDATA[César A.]]></given-names>
</name>
<name>
<surname><![CDATA[RECH]]></surname>
<given-names><![CDATA[Moisés João]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bioética: autonomia, dignidade da pessoa humana e reconhecimento]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[BIASOLI]]></surname>
<given-names><![CDATA[Luís Fernando]]></given-names>
</name>
<name>
<surname><![CDATA[CALGARO]]></surname>
<given-names><![CDATA[Cleide]]></given-names>
</name>
</person-group>
<source><![CDATA[Fronteiras da bioética: os reflexos éticos e socioambientais]]></source>
<year>2017</year>
<page-range>74-90</page-range><publisher-loc><![CDATA[Caxias do Sul ]]></publisher-loc>
<publisher-name><![CDATA[Educs]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B4">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[FISHER]]></surname>
<given-names><![CDATA[C. M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The neurological examination of the comatose patient]]></article-title>
<source><![CDATA[Acta Neurol Scan]]></source>
<year>1969</year>
<volume>45</volume>
<numero>36</numero>
<issue>36</issue>
<page-range>1-56</page-range></nlm-citation>
</ref>
<ref id="B5">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[GIACINO]]></surname>
<given-names><![CDATA[J. T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The minimally conscious state. Definition and diagnostic criteria]]></article-title>
<source><![CDATA[Neurology,]]></source>
<year>2002</year>
<volume>58</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>349-53</page-range></nlm-citation>
</ref>
<ref id="B6">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[GOSSERIES]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Role of Neuroimaging Techniques in Establishing Diagnosis, Prognosis and Therapy in Disorders of Consciousness]]></article-title>
<source><![CDATA[The Open Neuroimaging Journal]]></source>
<year>2016</year>
<volume>10</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>52-68</page-range></nlm-citation>
</ref>
<ref id="B7">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[JENNETT]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[PLUM]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Persistent vegetative state after brain damage a syndrome in search of name]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>1972</year>
<volume>229</volume>
<numero>7753</numero>
<issue>7753</issue>
<page-range>734-7</page-range></nlm-citation>
</ref>
<ref id="B8">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[KOEHLER]]></surname>
<given-names><![CDATA[P. J]]></given-names>
</name>
<name>
<surname><![CDATA[WIJDICKS]]></surname>
<given-names><![CDATA[E. F. M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Historical study of coma: looking back through medical and neurological texts]]></article-title>
<source><![CDATA[Brain.]]></source>
<year>2008</year>
<volume>131</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>877-89</page-range></nlm-citation>
</ref>
<ref id="B9">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[KONDZIELLA]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[CHEUNG]]></surname>
<given-names><![CDATA[M. C]]></given-names>
</name>
<name>
<surname><![CDATA[DUTTA]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Public perception of the vegetative state/unresponsive wakefulness syndrome: a crowdsourced study]]></article-title>
<source><![CDATA[Peer J]]></source>
<year>2019</year>
<volume>6</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>65-75</page-range></nlm-citation>
</ref>
<ref id="B10">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[KONDZIELLA]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[European Academy of Neurology Guideline on the Diagnosis of Coma and Other Disorders of Consciousness]]></article-title>
<source><![CDATA[Eur. J. Neurol]]></source>
<year>2020</year>
<volume>27</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>741-56</page-range></nlm-citation>
</ref>
<ref id="B11">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[LAUREYS]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome]]></article-title>
<source><![CDATA[BMC Medicine]]></source>
<year>2010</year>
<volume>1</volume>
<numero>86</numero>
<issue>86</issue>
</nlm-citation>
</ref>
<ref id="B12">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[LAZARIDIS]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Withdrawal of Life-Sustaining Treatments in Perceived Devastating Brain Injury: The Key Role of Uncertainty]]></article-title>
<source><![CDATA[Neurocrit Care]]></source>
<year>2019</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>3-41</page-range></nlm-citation>
</ref>
<ref id="B13">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[LUCE]]></surname>
<given-names><![CDATA[J. M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Chronic Disorders of Consciousness Following Coma. Part Two: Ethical, Legal, and Social Issues]]></article-title>
<source><![CDATA[CHEST]]></source>
<year>2013</year>
<volume>144</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1388-93</page-range></nlm-citation>
</ref>
<ref id="B14">
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[MCCULLAGH]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<source><![CDATA[Conscious in a vegetative state? A critique of the PVS concept]]></source>
<year>2004</year>
<publisher-loc><![CDATA[Dordrecht ]]></publisher-loc>
<publisher-name><![CDATA[Kluwer Academic Publishers]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B15">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[MUELLER]]></surname>
<given-names><![CDATA[P. S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The Terri Schiavo saga: Ethical and legal aspects and implications for clinicians]]></article-title>
<source><![CDATA[Polskie Archiwum Medycyny]]></source>
<year>2009</year>
<volume>119</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>574-80</page-range></nlm-citation>
</ref>
<ref id="B16">
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[PLUM]]></surname>
<given-names><![CDATA[J. B.]]></given-names>
</name>
<name>
<surname><![CDATA[POSNER]]></surname>
<given-names><![CDATA[F.]]></given-names>
</name>
</person-group>
<source><![CDATA[Diagnosis of stupor and coma]]></source>
<year>1966</year>
<edition>2. ed.</edition>
<publisher-loc><![CDATA[Philadelphia ]]></publisher-loc>
<publisher-name><![CDATA[Lippincott Company]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B17">
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[POSNER]]></surname>
<given-names><![CDATA[J. B.]]></given-names>
</name>
</person-group>
<source><![CDATA[Plum and Posner&#8217;s diagnosis of stupor and coma]]></source>
<year>2007</year>
<edition>4. ed</edition>
<publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[Oxford University Press]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B18">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[QJUYOU]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Chronic disorders of consciousness (Review)]]></article-title>
<source><![CDATA[Experimental and Therapeutic Medicine]]></source>
<year>2017</year>
<volume>14</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>1.277-83</page-range></nlm-citation>
</ref>
<ref id="B19">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[QUILL]]></surname>
<given-names><![CDATA[T. E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Terri Schiavo: a tragedy compounded]]></article-title>
<source><![CDATA[The New England Journal of Medicine]]></source>
<year>2005</year>
<volume>352</volume>
<numero>16</numero>
<issue>16</issue>
<page-range>1.630-3</page-range></nlm-citation>
</ref>
<ref id="B20">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[RICHMOND]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Obituary: Fred Plum]]></article-title>
<source><![CDATA[The Lancet]]></source>
<year>2010</year>
<volume>376</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>412</page-range></nlm-citation>
</ref>
<ref id="B21">
<nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[SCHNAKERS]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
<name>
<surname><![CDATA[LAUREYS]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<source><![CDATA[Coma and Disorders of Consciousness]]></source>
<year>2018</year>
<edition>2. ed.</edition>
<publisher-loc><![CDATA[Cham ]]></publisher-loc>
<publisher-name><![CDATA[Springer]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B22">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[SCHANAKERS]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Accuracy of the Vegetative and Minimally Conscious State: Clinical Consensus Versus Standardized Neurobehavioral Assessment]]></article-title>
<source><![CDATA[BMC Neurol]]></source>
<year>2009</year>
<volume>21</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>9-35</page-range></nlm-citation>
</ref>
<ref id="B23">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[SERGI]]></surname>
<given-names><![CDATA[Paola G.]]></given-names>
</name>
<name>
<surname><![CDATA[BILOTTA]]></surname>
<given-names><![CDATA[Federico]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Plum and Posner&#8217;s Diagnosis and Treatment of Stupor and Coma, 5th ed]]></article-title>
<source><![CDATA[Anesthesia &amp; Analgesia]]></source>
<year>2020</year>
<volume>131</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>15-6</page-range></nlm-citation>
</ref>
<ref id="B24">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[THIBAUT]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Therapeutic interventions in patients with prolonged disorders of consciousnes]]></article-title>
<source><![CDATA[Lancet Neurol]]></source>
<year>2019</year>
<volume>18</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>600-14</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
