End-of-life practices and advance directives: a bioethical analysis based on discussions in the Brazilian Federal Legislative Branch

Salud Colect. 2026 Mar 12;22:e5939. doi: 10.18294/sc.2026.5939.

ABSTRACT

The Brazilian legislative debate on end-of-life practices involves ethical-axiological tensions related to euthanasia, assisted suicide, palliative care, and advance directives, in which divergent conceptions of these practices and of the value of life confront one another, influencing the normative formulation of the dying process. This study analyzes how such tensions are constructed and justified in the discourses of the Federal Legislative Branch, examining the normative meanings and the hierarchy of values attributed to the palliative care framework and to advance directives, as well as their ethical and moral implications. A qualitative documentary study was conducted, guided by a hermeneutic-dialectical approach and grounded in contemporary frameworks of the bioethics of responsibility and everyday bioethics. A total of 193 federal legislative documents (1981-2020) were examined. The analysis yielded two thematic categories: (1) the palliative care framework: meanings and attributions, which reveals the legislative tendency to limit the right to therapeutic refusal; and (2) instruments and mechanisms for the reversal of advance directives, which exposes restrictions on instruments intended to protect autonomy. The findings indicate the predominance of arguments grounded in vital values treated as absolute, to the detriment of personal values such as human dignity, autonomy, and self-determination, which may restrict the right to die with dignity in Brazil.

PMID:42049012 | DOI:10.18294/sc.2026.5939