Preservação da fertilidade da paciente em cuidados oncológicos sob a ótica da Bioética do Cuidado em Saúde
DOI:
https://doi.org/10.37767/2591-3476(2025)02Palabras clave:
Bioética do cuidado, Cuidado centrado no paciente, Cuidados em saúde, Qualidade de vida, Processo decisional, Bioética del cuidado, Cuidado centrado en el paciente, Cuidados en salud, Calidad de vida, Proceso decisional, Bioethics of care, Patient-centred care, Healthcare, Quality of life, Decisionmaking processResumen
O desenvolvimento do câncer afeta os pacientes em outros aspectos de suas vidas e saúde, a exemplo da falência precoce das gônadas e infertilidade. Particularmente as mulheres são altamente impactadas com este efeito resultante do tratamento do câncer, incluso no aspecto emocional e de saúde mental. Assim, é fundamental a proteção da fertilidade da paciente oncológica, observando a Bioética do Cuidado em Saúde. Trata de um estudo de natureza teórica, que se utiliza de uma revisão bibliográfica para a proposição de discussões que fundamentem os aportes teóricos originais sobre a temática. A preservação da fertilidade e o acompanhamento clínico da paciente oncológica têm efeitos positivos, particularmente pelo cuidado focado em fornecer a melhor qualidade de vida após o tratamento. A comunicação empática, acolhedora e compartilhamento decisional são elementos imprescindíveis para amenizar os efeitos do câncer na perspectiva psicoemocional das pacientes. Verifica-se que a literatura ainda carece de discutir sobre a Bioética do Cuidado em Saúde, com enfoque nos efeitos decorrentes do tratamento para a fertilidade do paciente oncológico. Uma abordagem empática deve ser desenvolvida por todos os profissionais de saúde envolvidos, pois o Cuidado Centrado no Paciente assegura a ética e o respeito aos seus direitos.
Referencias
Albuquerque, A. (2022) Críticas ao Principialismo sob a ótica do novo paradigma ético nos cuidados em saúde: o protagonismo do paciente. Red Latinoamericana y del Caribe de Bioética, 1(25).
Albuquerque, A. (2023) Bioética do Cuidado em Saúde: novo método de deliberação ética na prática clínica. Red Latinoamericana y del Caribe de Bioética, 1(27-28).
Albuquerque, A., e Tanure, C. (2023) Healthcare bioethics: A new proposal of ethics for clinical practice. History and Philosophy of Medicine, 5(2), 10.
American Academy of Pediatrics (1995). Informed consent, parental permission, and assent in pediatric practice. Pediatrics, 95, 314–317.
Baek, S. Y., Kim, H. K., Park, S., Yu, J. H., Lee, M. H., Youn, H. J., Kim, H. A., Han, J. H., Choi, J. E., Lee, J. R., Lee, K. H., Chung, S., Chae, H. D., Kim, S., Yoo, S., Hahm, S. K., e Kim, H. J. (2023) Multidisciplinary Shared Decision Making for Fertility Preservation in Young Women With Breast Cancer. Journal of Breast Cancer, 26(6), 582-592. Disponível em: 10.4048/jbc.2023.26.e44.
Basco, D., Campo-Engelstein, L., e Rodriguez, S. (2010). Insuring against infertility: Expanding state infertility mandates to include fertility preservation technology for cancer patients. Journal of Law, Medicine & Ethics, 38, 832–839.
Beauchamp, T. L., e Childress, J.F. (2019) Principles of Biomedical Ethics. 8ª ed. Nova Iorque: Oxford.
Campos, J. R., Rosa-e-Silva, J. C., Carvalho, B. R., Vireque, A. A., Silva-de-Sá, M. F., e Rosa-e-Silva, A. C. (2011). Cryopreservation time does not decrease follicular viability in ovarian tissue frozen for fertility preservation. Clinics, 66(12), 2093-2097.
Carvalho, B. R., e Behrens, R. N. (2009). Direito à informação: Pilar da boa relação médico-paciente e da profilaxia do erro profissional. Prática Hospitalar, 11, 130–132.
Check, J. H., Choe, J. K., Brasile, D., Cohen, R., e Horwath, D. (2012). Comparison of pregnancy rates following frozen embryo transfer according to the reason for freezing: Risk of ovarian hyperstimulation vs inadequate endometrial thickness. Clinical and Experimental Obstetrics & Gynecology, 39(4), 434–435.
Chung, K., Coutifaris, C., Chalian, R., Lin, K., Ratcliffe, S. J., Castelbaum, A. J., Freedman, M. F., e Barnhart, K. (2006). Factors influencing adverse perinatal outcomes in pregnancies achieved through use of in vitro fertilization. Fertil Steril, 86, 1634-1641.
Cobo, A., Kuwayama, M., Pérez, S., Ruiz, A., Pellicer, A., e Remohí, J. (2008). Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method. Fertility and Sterility, 89(6), 1657-1664. https://doi.org/10.1016/j.fertnstert.2007.06.021.
Cooter, R. (2004) Historical Keywords. Bioethics. Disponível em: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(04)17382-0.pdf.
Deepinder, F., e Agarwal, A. (2008). Technical and ethical challenges of fertility preservation in young cancer patients. Reproductive Biomedicine Online, 16(6), 784–791.
Degrazia, D. (2023) Leveraging a Sturdy Norm: How Ethicists Really Argue. Cambridge Quarterly of Healthcare Ethics, 1-11.
Doungkamchan, C., Orwig, K. E. (2021) Recent advances: fertility preservation and fertility restoration options for males and females. Faculty Reviews, 10(55). Disponível em: 10.12703/r/10-55.
Edgar, D. H., Bourne, H., Speirs, A. L., e McBain, J. C. (2000). A quantitative analysis of the impact of cryopreservation on the implantation potential of human early cleavage stage embryos. Human Reproduction, 15(1), 175–179.
ESHRE Guideline Group on Female Fertility Preservation, Anderson, R. A., Amant, F., Braat, D., D'Angelo, A., Lopes, S. M. C. S., Demeestere, I., Dwek, S., Frith, L., Lambertini, M., Maslin, C., Moura-Ramos, M., Nogueira, D., Rodriguez-Wallberg, K., e Vermeulen, N. (2020) ESHRE guideline: female fertility preservation. Human Reproduction Open, 4. Disponível em: https://doi.org/10.1093/hropen/hoaa0.
Ethics Committee of the American Society for Reproductive Medicine. (2019) Fertility preservation and reproduction in patients facing gonadotoxic therapies: an Ethics Committee opinion. Fertility and Sterility, 110(3), 380-386. Disponível em: https://www.asrm.org/globalassets/_asrm/practice-guidance/ethics-opinions/pdf/fertility_preservation_and_reproduction_patients_facing_gonadotoxic_therapy.pdf.
Fasano, G., Moffa, F., Dechène, J., Englert, Y., e Demeestere, I. (2011). Vitrification of in vitro matured oocytes collected from antral follicles at the time of ovarian tissue cryopreservation. Reproductive Biology and Endocrinology, 9(1), 150.
Gracia, C. R., Gracia, J. J. E., e Chen, S. (2010). Ethical dilemmas in oncofertility: An exploration of three clinical scenarios. Cancer Treatment and Research, 156, 195-208.
Green, D. M., Sklar, C. A., Boice Jr., J. D., Mulvihill, J. J., Whitton, J. A., Stovall, M., e Yasui, Y. (2009). Ovarian failure and reproductive outcomes after childhood cancer treatment: Results from the Childhood Cancer Survivor Study. Journal of Clinical Oncology, 27(14), 2374-2381.
Greene, J. (2018) Tribos morais: A tragédia da moralidade do senso comum. São Paulo: Record.
Greenfield, G., Pliskin, J. S., Feder-Bubis, P., Wientroub, S., Davidovitch, N. (2012) Patient-physician relationships in second opinion encounters - The physicians' perspective. Social Science & Medicine, 75(7), 1202-12. Disponível em: 10.1016/j.socscimed.2012.05.026.
Inhorn, M. C., Birenbaum-Carmeli, D., Westphal, L. M., Doyle, J., Gleicher, N., Meirow, D., Raanani, H., Dirnfeld, M., e Patrizio, P. (2018). Medical egg freezing: the importance of a patient-centered approach to fertility preservation. Journal of Assisted Reproduction and Genetics, 35(1), 49-59. Disponível em: 10.1007/s10815-017-1081-5.
Küçük, M. (2012). Fertility preservation for women with malignant diseases: Ethical aspects and risks. Gynecological Endocrinology, 28(10), 937-940. Disponível em: https://doi.org/10.3109/09513590.2012.673893.
Lambertini, M., Peccatori, F.A., Demeestere, I., Amant, F., Wyns, C., Stukenborg, J-B., Paluch-Shimon, S., Halaska, M. J., Uzan, C., Meissner, J., von Wolff, M., Anderson, R. A., e Jordan, K. (2020) Fertility preservation and post-treatment pregnancies in post-pubertal cancer patients: ESMO Clinical Practice Guidelines. Annals of Oncology, 31(12), 1664-1678. Disponível em: https://www.esmo.org/guidelines/guidelines-by-topic/esmo-clinical-practice-guidelines-supportive-and-palliative-care/fertility-preservation-and-post-treatment-pregnancies-in-post-pubertal-cancer-patients.
Larcher, V. (2012). The ethical obligation to preserve fertility in the face of all therapies that might adversely affect it. Archives of Disease in Childhood, 97(9), 767–768. Disponível em: https://doi.org/10.1136/archdischild-2012-302017.
Loren, A. W., Mangu, P. B., Beck, L. N., Brennan, L., Magdalinski, A. J., Partridge, A. H., Quinn, G., Wallace, W. H., e Oktay, K. (2013). Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology, 31(19), 2500-2510. Disponível em: https://doi.org/10.1200/JCO.2013.50.3401.
Michelmann, H. W., e Nayudu, P. (2006). Cryopreservation of human embryos. Cell and Tissue Banking, 7(2), 135–141. Disponível em: https://doi.org/10.1007/s10561-006-9014-1.
MS/SVS/DASIS (2013). Sistema de Informações sobre Nascidos Vivos – SINASC [base de dados]. Departamento de Informática do SUS. Disponível em: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def.
Oktay, K. (2005). Further evidence on the safety and success of ovarian stimulation with letrozole and tamoxifen in breast cancer patients undergoing in vitro fertilization to cryopreserve their embryos for fertility preservation. Journal of Clinical Oncology, 23(16), 3858–3859. Disponível em: https://doi.org/10.1200/JCO.2005.03.0376.
Patrizio, P., e Caplan, A. L. (2010). Ethical issues surrounding fertility preservation in cancer patients. Clinical Obstetrics and Gynecology, 53(4), 717-726. Disponível em: https://doi.org/10.1097/GRF.0b013e3181f7d2d5.
Pawłowski P., Ziętara, K. J., Michalczyk, J., Fryze, M., Buchacz, A., Zaucha-Prażmo, A., Zawitkowska, J., Torres, A., e Samardakiewicz, M. (2023) Fertility Preservation in Children and Adolescents during Oncological Treatment-A Review of Healthcare System Factors and Attitudes of Patients and Their Caregivers. Cancers (Basel), 15(17), 4393. Disponível em: 10.3390/cancers15174393.
PILNICK, Alison. Reconsidering Patient Centred Care. Bingley: Emerald, 2022.
Poirot, C. J., Vacher-Lavenu, M. C., Helardot, P., Guibert, J., Brugières, L., e Jouannet, P. (2002). Human ovarian tissue cryopreservation: Indications and feasibility. Human Reproduction, 17(6), 1447-1452. Disponível em: https://doi.org/10.1093/humrep/17.6.1447.
QUEENSLAND HEALTH. Guide to Informed Decision-making in Health Care. Australia, 2023. Disponível em: https://www.health.qld.gov.au/__data/assets/pdf_file/0019/143074/ic-guide.pdf. Acesso em: jul. 2024.
Rolindo, T. F., Carvalho, B. R., Gomes Sobrinho, D. B., Cuzzi, J. F., Silva, A. A., e Nakagava, H. M. (2013). The child conceived by assisted reproduction techniques: Pre- and perinatal aspects. JBRA Assisted Reproduction, 17(1), 40–43. Disponível em: https://doi.org/10.5935/1678-4375.20130011.
Rowell, E. E., Lautz, T. B., Lai, K., Weidler, E. M., Johnson, E. K., Finlayson, C., e van Leeuwen, K. (2021) The ethics of offering fertility preservation to pediatric patients: A case-based discussion of barriers for clinicians to consider. Seminars in Pediatric Surgery, 30(5), 151095. Disponível em: 10.1016/j.sempedsurg.2021.151095.
Rudick, B., Opper, N., Paulson, R., Bendikson, K., e Chung, K. (2010). The status of oocyte cryopreservation in the United States. Fertility and Sterility, 94(7), 2642-2646. Disponível em: https://doi.org/10.1016/j.fertnstert.2009.10.063.
SEOANE, J. A. (2024) A Rights-Based Theory for Health Justice. In Seoane, J. A. e Vergara, O. (ed.) The Discourse of Biorights. The International Library of Bioethics, v. 109. Germany: Springer.
Shah, D. K., Goldman, E., & Fisseha, S. (2011). Medical, ethical, and legal considerations in fertility preservation. International Journal of Gynecology & Obstetrics, 115(1), 11-15. Disponível em: https://doi.org/10.1016/j.ijgo.2011.04.016.
Silva, A. C. J. S. R., Carvalho, B. R., Silva, J. C. R., e Sá, M. F. S. (2008). Ovarian function preservation after cancer. In M. T. Moorland (ed.). Cancer in female adolescents. Vol. 1. Nova Iorque: Nova Science Publishers. p. 139-153.
Silva, A. C. J. S. R., Silva, J. C. R., Reis, R. M., Tone, L. G., Sá, M. F. S., e Ferriani, R. A. (2007). Gonadal function in adolescent patients submitted to chemotherapy during childhood or during the pubertal period. Journal of Pediatric and Adolescent Gynecology, 20(2), 89-91. Disponível em: https://doi.org/10.1016/j.jpag.2007.02.004.
Stegman, B. J. (2010). Unique ethical and legal implications of fertility preservation research in the pediatric population. Fertility and Sterility, 93(4), 1037-1039. Disponível em: https://doi.org/10.1016/j.fertnstert.2009.03.043.
Tseng, L. M., Lien, P. J., Huang, C. Y., Tsai, Y. F., Chao, T. C., e Huang, S. M. (2021) Developing a Web-Based Shared Decision-Making Tool for Fertility Preservation Among Reproductive-Age Women With Breast Cancer: An Action Research Approach. Journal of Medical Internet Research, 23(3), e24926. Disponível em: 10.2196/24926.
Veacht, R. (2020) Reconciling Lists of Principles in Bioethics. Journal of Medicine and Philosophy, 45, 540-559.
Wang, Y., Anazodo, A., e Logan, S. (2019) Systematic review of fertility preservation patient decision aids for cancer patients. Psychooncology, 28(3), 459-467. Disponível em: 10.1002/pon.4961.
Woodruff, T. K. (2007). The emergence of a new interdiscipline: oncofertility. Cancer Treatment and Research, 138, 3-11. Disponível em: https://doi.org/10.1007/978-0-387-68274-4_1.
World Health Organization (2024). Global cancer burden growing, amidst mounting need for services. Genebra: World Health Organization. Disponível em: https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services.
Publicado
Número
Sección
Licencia
Derechos de autor 2025 Revista Derecho y Salud │Universidad Blas Pascal

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.