{"id":119977,"date":"2022-06-23T04:24:11","date_gmt":"2022-06-23T04:24:11","guid":{"rendered":"https:\/\/raed.academy\/?p=119977"},"modified":"2022-06-27T09:40:36","modified_gmt":"2022-06-27T09:40:36","slug":"aspectes-biologics-i-conceptuals-del-proces-de-morir","status":"publish","type":"post","link":"https:\/\/raed.academy\/ca\/aspectes-biologics-i-conceptuals-del-proces-de-morir\/","title":{"rendered":"Aspectes biol\u00f2gics i conceptuals del proc\u00e9s de morir"},"content":{"rendered":"

\"\"August Corominas<\/strong><\/em><\/a>, professor de Fisiologia Humana de la Universitat de M\u00farcia<\/strong> i de la Universitat Aut\u00f2noma de Barcelona<\/strong> i acad\u00e8mic em\u00e8rit i membre del Senat<\/strong> de la Reial Acad\u00e8mia Europea de Doctors-Barcelona 1914<\/strong> (RAED), presenta a la comunitat acad\u00e8mica el seu article “Aspectes biol\u00f2gics i conceptuals del proc\u00e9s de morir”<\/strong>, una reflexi\u00f3 que parteix del curs de doctorat “El proc\u00e9s de morir”<\/strong>, realitzat a l’Hospital Germans Trias i Pujol<\/strong> de Badalona i que ell mateix va impartir al costat d’altres docents.<\/p>\n

La cultura de la mort<\/h2>\n

La mort \u00e9s un fenomen biol\u00f2gic protagonitzat per organismes pluricel\u00b7lulars. La mort \u00e9s l’etapa final de la vida. Estudiem molt la vida, per\u00f2 ignorem o fugim del problema de la mort. Per a la societat actual, la mort \u00e9s una situaci\u00f3 prohibida i vergonyosa: \u00e9s un tab\u00fa. La societat capitalista fuig tant de la q\u00fcesti\u00f3 que fins i tot falta sintonia amb la lentitud del ‘tempus’ natural pel proc\u00e9s de morir. Manca temps per a la reflexi\u00f3 pausada i tranquil\u00b7la. D’altra banda, hi ha un important mercantilisme al voltant de la mort. Morir \u00e9s un proc\u00e9s molt mercantilitzat i molt car. Avui manca cultura de la mort.<\/p>\n

En el proc\u00e9s de morir podem considerar tres aspectes diferents. El primer \u00e9s l’aspecte individual o personal, considerant l’esfera som\u00e0tica, l’esfera ps\u00edquica i l’espiritual o transcendental. El segon aspecte \u00e9s el col\u00b7lectiu o sociosanitari, on interessa assenyalar l’equip sanitari, l’entorn social i l’entorn familiar. El tercer i darrer aspecte seria la institucionalitzaci\u00f3 del proc\u00e9s de morir.<\/p>\n

Estudi del proc\u00e9s de morir<\/h2>\n

Cada cop m\u00e9s, metges, sanitaris i soci\u00f2legs s’estan interessant a estudiar la mort des de diversos punts de vista com el biol\u00f2gic, psicol\u00f2gic, teol\u00f2gic, etnol\u00f2gic i existencial-filos\u00f2fic. Avui a moltes universitats europees s’estan impartint cursos de doctorat, postgrau i m\u00e0ster sobre un problema tan transcendental com \u00e9s el proc\u00e9s de morir.<\/p>\n

Definici\u00f3 de la mort<\/h2>\n

Partim de la hip\u00f2tesi de treball seg\u00fcent: el comen\u00e7ament de la vida \u00e9s a l’organisme hum\u00e0 un fenomen universal i id\u00e8ntic per a tota la humanitat. \u00c9s la fecundaci\u00f3 d’un \u00f2vul per penetraci\u00f3 d’una part d’un espermatozoide. Per aix\u00f2 creiem que encara que els mecanismes intermedis siguin molt variables, el punt final del proc\u00e9s de morir sigui el mateix en tots els humans. Es parla metaf\u00f2ricament dels genets de la mort: c\u00e0ncer, malalties cardiovasculars, accidents cerebrovasculars, dem\u00e8ncies, Alzheimer, sida, agressions… Tenim la hip\u00f2tesi que de qualsevol manera el mecanisme final seria metab\u00f2licament el mateix: entrada massiva de ions de cal\u00e7 dins d’unes estructures de les c\u00e8l\u00b7lules (especialment cerebrals, neurones) que s’anomenen mitocondris. \u00c9s per aix\u00f2 que definim la mort com a proc\u00e9s desadaptatiu (bioqu\u00edmic i biof\u00edsic) catab\u00f2lic, amb tend\u00e8ncia a l’entropia m\u00e0xima, poiquilot\u00e8rmia i destrucci\u00f3 de les bombes de sodi i cal\u00e7 de la membrana amb manca de s\u00edntesi d’ATP; tot aix\u00f2 relacionat amb l’entrada brusca i massiva d’ions de cal\u00e7 a les crestes mitocondrials.<\/p>\n

Aquesta definici\u00f3, que \u00e9s una mica complexa per a alg\u00fa no acostumat a terminologia cient\u00edfica, es podria simplificar dient: manca de fabricaci\u00f3 dins de les c\u00e8l\u00b7lules del combustible (ATP, adenosintrifosfat) necessari per a qualsevol funci\u00f3 (contracci\u00f3 muscular, digesti\u00f3, funci\u00f3 hep\u00e0tica\u2026). Aquesta mancan\u00e7a seria deguda a la destrucci\u00f3 de mitocondris, lloc on es fabrica ATP.<\/p>\n

Verificaci\u00f3 de la mort<\/h2>\n

Una de les preocupacions importants de la humanitat des de fa molts segles \u00e9s establir amb certesa el diagn\u00f2stic de la mort. Des de l’edat mitjana va ser una preocupaci\u00f3 a les epid\u00e8mies de pesta l’enterrament de persones vives. Per aix\u00f2 es va introduir el diagn\u00f2stic de mort mitjan\u00e7ant un mirall i veure si canviava d’aspecte per l’al\u00e8 del suposat cad\u00e0ver. En aquest darrer segle s’emprava el moviment del cor pel diagn\u00f2stic. \u00c9s molt rellevant la verificaci\u00f3 i definir perfectament els signes de la mort.<\/p>\n

Actualment, el problema t\u00e9 una altra connotaci\u00f3, la possibilitat de fer servir (pels trasplantaments) un cad\u00e0ver. L’aprofitament de determinats \u00f2rgans ens obliga, encara m\u00e9s, a poder tenir una certesa total de la mort segons les t\u00e8cniques m\u00e9s modernes (EEG, potencials evocats multimodals, ‘ecodopller’ transcranial, gammagrafia isot\u00f2pica o arteriografia cerebral).<\/p>\n

\"August

Dr. August Corominas<\/p><\/div>\n

Els criteris de la bio\u00e8tica<\/h2>\n

S\u00f3n molts els equips multidisciplinaris que s’han preocupat de donar normes per al diagn\u00f2stic prec\u00eds de la mort. Potser un dels m\u00e9s interessants \u00e9s el del Comit\u00e8 de Mort cerebral de Harvard, que estableix com a punts necessaris la inexist\u00e8ncia dels signes de captaci\u00f3 i resposta a qualsevol est\u00edmul exterior, de reflexos tronco encef\u00e0lics com ara la reacci\u00f3 pupil\u00b7lar, moviments oculars, parpellejos, degluci\u00f3, respiraci\u00f3, i tamb\u00e9 que l’EEG sigui absolutament pla despr\u00e9s de fer l’estudi tres vegades. Avui es considera necessari que el malalt terminal (per exemple estant a l’UVI) no tingui a la sang subst\u00e0ncies com s\u00f3n les benzodiazepines.<\/p>\n

Comentari final<\/h2>\n

El tema de la mort, com a punt final del proc\u00e9s vital, \u00e9s un tema complex que ha estat menyspreat per la societat actual, per\u00f2 en els darrers anys deixa de ser tab\u00fa per convertir-se en un fenomen interessant per als especialistes en bio\u00e8tica i en medicina pal\u00b7liativa. \u00c9s un proc\u00e9s on sempre hem de tenir en compte sis elements: el malalt o moribund, la fam\u00edlia, l’equip sanitari, l’acte de l’\u00e8xitus, el dol i la cerim\u00f2nia de l’enterrament.<\/p>\n","protected":false},"excerpt":{"rendered":"

August Corominas presenta el seu article “Aspectos biol\u00f3gicos y conceptuales del proceso de morir”, reflexi\u00f3 que parteix del seu curs de doctorat<\/p>\n","protected":false},"author":12,"featured_media":104932,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[213],"tags":[],"class_list":["post-119977","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicina-i-cirurgia","et-has-post-format-content","et_post_format-et-post-format-standard"],"yoast_head":"\nAspectes biol\u00f2gics i conceptuals del proc\u00e9s de morir - Reial Acad\u00e8mia Europea de Doctors<\/title>\n<meta name=\"description\" content=\"August Corominas presenta el seu article "Aspectos biol\u00f3gicos y conceptuales del proceso de morir", reflexi\u00f3 que parteix del seu curs de doctorat\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/raed.academy\/ca\/aspectes-biologics-i-conceptuals-del-proces-de-morir\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Aspectes biol\u00f2gics i conceptuals del proc\u00e9s de morir - 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