On November 23, 2013, the Pontifical Council for Health Care Ministry organized the 28th International Conference on the topic: The Church in the service of the elderly and sick, the care for those suffering from neurodegenerative diseases. Those 700 participants from 57 countries, physicians, researchers, volunteers and religious personalities were received in audience by the Holy Father Pope Francis. In his words of encouragement, Pope Francis insisted on the imperative to act only in favor of life, until those who are considered “unproductive” in economic terms will not be marginalized or even eliminated, as the large number of abortions and the spread of the practice of euthanasia shows. The disease, with its variety of afflictions, raised questions for people of all ages. Their answer came off of the concept that they had about the world in which they lived and of the observations made on the powers that govern the world. The spring occurred in the Greek sense of observation and medicine developed independently, as a positive science. That being so, the biblical revelation set aside the scientific aspect of the problem and dealt exclusively with the religious meaning of illness and healing at the level of salvation. In this paper we track: understanding religious binomial healing disease in the light of The Holy Scripture, and we will explain how this position is based on the latest research in the field of bioethics care of people suffering from neuro-degenerative diseases and primary metastatic brain tumors.
Nanotechnology is a field that we often hear of its name nowadays. Altough what we know about it is soo poor, we admire this field of technlogy, moreover some societies even argues that nanotechnology will cause second endustrial revolution. In addition, nanotechnology makes our basic scientific knowledge upside down and is soo powerfull that it is potent in nearly every scientific field. Thereby, it is imposible to say that nanotechnology; which is soo effective on human and human life; will not cause social and ethical outcomes. In general, the definition of nanotechnology is the reconfiguration of nanomaterials by human; there also are different definitions according to the history of nanotechnology and different point of views. First of all, in comparison to the other tehnology fields, what is the cause of excellence of nanotechnology, what human can do is to foresee the advantages and disadvantages of it, what are the roles of developed and developping countries for the progression of nanotechnology, what is the attitude of nanoethics and what is view of global politics to nanotechological research according to international regulations are all the focus of interests of this study. Last but not least, our apprehension capacity of nanotechnology, our style of adoption and evaluation of it and the way that how we locate nanotechnology in our lifes and ethical values are the other focus of interests.
The article presents the statistical results obtained from the investigation conducted into how higher education studies in a specific area - in this case pharmaceutical studies - influence the pharmacist students’ thinking in dealing with a characteristic phenomenon of contemporary society, namely self-medication. Data was collected using a 3-year questionnaire distributed between 2010 and 2013, to a total of 985 students from all the five years of study at the Faculty of Medicine and Pharmacy, University of Oradea, to track the progress after following subject areas, respectively the evolution of opinions about self-medication.
A fundamental condition for proper functioning of the diagnostic and therapeutic process is effective doctor – patient communication which is based on respect for patient’s autonomy and his/her rights. It is essential to point to the important role of transferring medical information to the patient and the influence of the doctor – patient relations on the whole process of treatment, convalescence and rehabilitation. The aim of the paper is to recognise and assess the demand for medical information among patients suffering from breast cancer. Material and methodology: The research was conducted among 120 women diagnosed with breast cancer in the Oncological Surgery Clinic of the Independent Public Research Hospital No. 1 in Lublin, the Oncological Clinic of the Independent Public Research Hospital No. 1 in Lublin and the Rehabilitation Centre with the Rehabilitation Clinic at the Lublin Oncology Centre. The research included women from the “Amazons” Lublin Club of Women after Mastectomy, the “Amazons” Club at the Complex of Specialist Clinics in Ostrowiec Świetokrzyski and the “Amazons” Club in Radom. The research method was the diagnostic survey, the research technique was the authors’ questionnaire and the standardised questionnaire of the Patient’s List of Expectations – PRF created by Peter Salmon and John Quine and adapted by Z. Juczynski. Results of the research were subject to statistical analysis with the use of c 2 test for independence. The relevance of differences among the research results was stated at the level of p≤0.05. Results: The research shows that the demand for medical information among women diagnosed with breast cancer is very high. Respondents want to know all the information concerning the diagnosis, treatment and prognosis (93%). They also expect that the doctor will give them medical information concerning further consequences of cancer and its influence on future health and life (78%). Most of the respondents expect to receive information concerning drugs which should be taken (77%) and the essence of the conducted treatment (93%). Conclusions: The research analysis shows that women diagnosed with breast cancer expect that the doctor will give them reliable and real medical information. Patients want the doctor to present them the probable course of cancer (85%) and all the possible side effects connected with it (89%).
This is a descriptive, observational study based on a documentary analysis of 45 publications on philosophical anthropology and bioethics, in addition to other works that combine both these areas of knowledge. An educational analytical summary (EAS) was used as a resource. The purpose of the study is to compare the characteristics of texts on these two sciences to determine the features a publication should have for teaching the basics of bioethics at postgraduate level, specifically with regard to the philosophical and anthropological content and the most suitable type of publication. We provided several suggestions on how to get the most out of the materials in terms of disseminating content and forming attitudes through, for example, personalized tutoring.
The aim of this paper is to reflect the situation of health legislation alignment in Turkey in its accession process to the European Union and Customs Union Agreement, and to discuss the the EU's health priorities of in parallel with the Turkish ones. The health legislation alignment processes consist of three titles which are: European Union alignment process, the harmonization done in the framework of membership to Council of Europe, and the obligations under the Customs Union Agreement. Significant human resources are required for the adoption of the legislations which make ethically imperative the discussion of whether there is a harmony among the priorities of both parities. Unless this harmony and paralellisim is shown, the human resources appointed for the adoption of health legislation process would not prove their efficiency and effectiveness. In this article, the Customs Union and formal negotiations for full EU membership are included in the phrase "the alignment process to European Union". Council Decisions 1/95 and 2/97 ground on the obligations provided by the Customs Union Agreement. The reference document used to discuss the formal negotiation process for full membership to European Union is the Turkish National Program for the Adoption of the EU Acquis 2008-2013. The legislative obligations of Turkey arising from its membership of the Council of Europe, which has significant contributions to the medical legislation especially in the field of medical ethics, are also included in this article.
Traditional medical practice has changed enormously during the last decades and new responsibilities were imposed on physicians not only to care for patients but to be also health managers. This paper aims at comparing bioethics and business ethics, in their development and approaches to solving ethical dilemmas, with the idea that contemporary medical practice has been brought nearer to business and inevitably has encountered some problems typical for the world of business. Both fields developed rapidly in the second part of the 20th century but while bioethics developed from micro- to macro- business level, ethics moved from macro- to micro-level of ethical problems and reflection. Different philosophical theories are applicable to both fields, but the dominating one in bioethics is the principlism which is not popular in business ethics. Ethical issues in business are often identified by the results of certain business actions while in bioethics we rather reflect on problems “per se”. What seems to be the biggest challenge for bioethics and business ethics nowadays is the transgression of theory to practice - how to enable health professionals and businessmen to see the benefits of ethics in their real work. Certain methodological approaches are applicable to both fields. Beneficence to the patient is still the most important goal of medicine while client’s satisfaction is one of many company’s goals in a highly competitive environment. While we might still find ethical justification in decreasing quality of some products for the sake of company’s survival, in medicine, endangering life and health of the patient on purpose can never be ethically justified.
The concept of the Noosphere may be considered one of the greatest achievements in human history. Humanism today is a weak movement due to the default position when man rejects the notion that his future is preordained by some external agency. The deliberate aspiration in most quarters to solve problems using natural resources rationally and maintaining reasonable stability in the natural environment can be considered one of the successes of modern science. The important issue - morality and ethics; in terms of the noospere this might be called "nooethics" and for the internet, it might be facetiously called "internethics". Animate nature as a system can no longer exist in itself without directing influences. The creation of Nooethics can be considered a strategy for development of ethics and the maintenance of human survival. Nooethics is an ethical component of the development laws of the Noosphere. Information technology creates favourable possibilities for collective human endeavour. Nooethics as the carrier of a moral imperative should occupy a decisive place in solving Noospheral problems. The major question is how to achieve self-identification of personality in a new society, self-realization under conditions of globalization and unification. Nooethics will enable the formulation of a theoretical comprehension of human survival issues.
« Off-label » administration of certain drugs has represented a common practice in medicine in the latest decades. Even if this attitude can be sanctioned with full responsibility transfer to the prescribing doctor, there is no law to punish this kind of practice if, from ethical point of view, the main purpose was to offer the best therapeutic option according to a significantly clinic experience and the patient has been correctly informed and consented about the status of the therapy, risks and advantages. In particular, in ophthalmology, bevacizumab (AVASTIN ® ) is widely used « off-label » since 2005, even though not approved for intravitreal injections, main reasons being similar efficacy and significantly lower costs as compared to approved drugs. In Romania, « off-label » use of bevacizumab has started in 2007 and, until recently, has represented the only chance for patients with certain invalidating eye conditions. Even if, starting this year aflibercept (EYLEA ® ) is officially available, « off-label » treatments with bevacizumab are expected to maintain a significant percentage until the Health Insurance will reimburse, at least in part, much higher costs for using approved drugs. Key Words: « off-label » drugs, bevacizumab, intravitreal use;
The preferential birth assistance is a known and wide spread practice in obstetrics- gynecology clinics from Romania. Specific issues related to its incidence, people who practice it and the ethical and legal considerations are not reported in local literature. The purpose of this study is to evidence, by questioning obstetricians, whether this phenomenon affects their personal life or not. It was found that most physicians surveyed preferred to practice preferential birth assistance (89%), with variations depending on the professional degree. The ethical standards define what is the optimal behavior of the physician accepted thus creating a standard of competence and skill. So, it was considered reporting preferential birth assistance to ethical standards and legal regulations in regard to this matter.
Turkey has experienced the longest hunger strikes and with the maximum participation in the last years. As a result, a total of 140 people died. On September 12, 2012, another hunger strike took place which terminated 68 days later, on November 18, 2012, with no fatalities. The impact of this was devastating as, for the first time, the nation witnessed the participation of children in hunger strikes. Hunger strikes cause physicians to experience serious ethical dilemmas. Moreover, children hunger strikers inevitably deepen these ethical dilemmas even more. The purpose of this article is to make an ethical evaluation of the hunger strike actions in general, aiming to focus on the hunger strikes of children which occurred as a new phenomenon on the ethical, legal and medical grounds.
Scientific studies conducted in recent years regarding patients information have experienced a significant growth and are found as such in a variety of medical subdomains; they observe all the relevant elements related to the quality and clarity of the information received by the patient, the transparency of the public health environment, the manner and method of patients’ self-information, as well as the transformation of the relationship between patient and physician brought by the abundant information present especially in the online environment. The importance and objective of this study are determined by the preliminary investigations undergone by academics and researchers from multidisciplinary fields, comprising legal, ethical, informational, technological, and medical aspects. In a multidisciplinary collaboration with specialists in the technologies of information, medicine, medical and law ethics, we have managed to integrate the pieces of information individually acquired in this project of patient information using the QR code as an alternative and convenient method of accessing the relevant and eloquent information which directly affects the consumer of medical services – namely the patient. By using this type of access to information, we wish to help patients by collecting all the data necessary for documenting them in regard with the legislation in force, as well as the data regarding patient rights and the contents of the ethical and deontological codes of the medical staff, who are required to comply with them in the practice of their medical profession.
Informed consent is a vital document that should be obtained from the patient before performing any manoeuvres, either diagnostic or therapeutic. The principle of informed consent has gained important juridical interpretations and implications; therefore it has a great influence on daily medical practice. It is presented as fundamental ethical norm in major medical codes such as Hippocratic Oath, the Declaration of Geneva and the International Code of Medical Ethics. Most of the equivocal situations and issues in making life-saving decisions are encountered on emergency basis. This paper presents legal and ethical considerations regarding the informed consent for emergency treatment of patients. Medical decisions performed without informed consent must be dictated by the need to save the patient's life, unequivocally and well documented.
The most important general and theoretical horizons regarding bioethics, refers to the ethical theories foundation. We can talk about two general main categories in which we can fall the ethical theories: teleological and deontological. Form the first category we enumerate the Aristotelian perspective or the one developed by J. St. Mill, while the Kantian perspective is exemplary for deontological ethics. According to the teleological perspective a form of human behavior is described as moral or non-moral according to the goals explicitly set. The mere achievement of these goals is a necessary and sufficient condition to qualify as moral actions or people's deeds without taking into account the “intermediate stages” of actions to achieve goals. Deontology, as a general horizon of articulating the ethical theories, believes on the contrary that in every moment of our existence, every action or deed that we accomplish can be described as moral or non-moral according to the ethical principles underlying our behavior. Very important consequences arising from the two general theoretical horizons concerns two different perspectives on “human nature” or what we call as the essence of being human. Starting from this horizon we have the consequentialist and deontological dimensions related to the abortion cases. The bioethical dimension in which we will discuss the issue of abortion involves both dimensions and horizons. The arguments against abortion seem to rely rather in the deontological horizon of Kantian type, while abortion pros seem to rely on consequentialist horizon.
Reflection over our health shows that, although most of the time and to most of us health condition is shaped by our natural attitude towards life [1], health and disease are complex, multi-faceted concepts, covering the biological, psychological, socio-cultural, legal, economic and political dimensions. According to WHO [2], health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. In our attempts to unravel the social theory of health and disease [3], three levels of analysis need to be considered: 1. the first level: the individual lived experience of disease, in which phenomenological and symbolic interactionism apply; 2. the second level - the social construction of disease categories, whereby individuals are classified by professional groups (in this case, Talcott Parsons’ approach on the demands and function of the “sick role” and its implications for doctor-patient relationship and discussion of the social aspects of the institution of medicine as a profession influenced the medical sociology of the 50’s and 60’s) [4]; the third level – refers to healthcare policies over the relationship between the state and other medical organizations. Two approaches are prevailing in the framework of health and disease: the biomedical one and the social construction of health and disease. In contrast to the medical model, which assumes that diseases are universal and invariant to time or place, social constructionists emphasize how the meaning and experience of disease are shaped by the cultural and social systems [5].
Autopsy (necropsy, postmortem examination, autopsy cadaverum) is often marginalized in contemporary medicine, although it remains an important practice with enormous potential to move forwards new medical information and develop clinical practice. Many doctors are not common with autopsy examination and are not sufficiently conscious of the benefits of this procedure not only for the families involved, but also for patients. Standard autopsy should ideally be an critical part of investigating foetal loss, newborn deaths and neonatal deaths without foetal malformations. In many countries where family approval is required, it has been recently recorded a decrease in the number of autopsies. Clinicians and other family doctors requiring family consent for autopsy should consider in advance the options for a full, limited, or step by step post-mortem examination; the problem of tissue sampling and the autopsy value, as well as the possibility that the information obtained has a real benefit for themselves should also be iterated. However, this type of information must be provided in compliance with personal and cultural values of the involved families. Therefore, the role and usefulness of autopsy will be reflected in their public support, and only when the new generation of physicians will realize the importance of the knowledge gained from examining the human body after death, the importance of necropsy for current medicine will be understood.
A psycho-social phenomenon, religion cannot turn aside from conflict generation. On the intrapsychic level, Christian orthodoxy can stir within the individua, a feeling of inadequacy towards what is commonly perceived as right and holy. This includes aspects such as pre- and extramarital sex, the issue of divorce, gender equity, sexual orientation, as well as religious beliefs motivated by cognitive dissonance. At interpersonal level, the absolutist nature of dogmas renders negotiation impossible, leading to conflicts among the various religious groups.
For centuries there was an informal rule not to tell the truth to cancer patients. The paternalistic model of relationships still exists in many societies in relation to the issue of informing the patient.The object of this paper is to study the issue of truth telling to terminally ill patients in Bulgarian hospices.Materials and methods. The study employed a combination of sociological and statistical methods. Self-administered questionnaires were distributed among the personnel and patients' relatives in 17 in-patient, 12 home care hospices and 5 palliative care units. Altogether, 190 health professionals and 216 patients' relatives responded to the questionnaires. The response rates for the personnel and the relatives were 86% and 74.5% respectively.Results. According to the personnel, there were 62.1% autonomous patients in palliative care units, and 23-24% in in-patient and home care hospices. The majority of the patients were familiar with the diagnosis (50.4% in in-patient hospices, 66.7% in home-care hospices, and 78.8% in palliative care units). There was a significant difference in the data obtained by the relatives. Most of the patients were informed by their physician before the hospice admission. 10.2%-18.5% of the patients were informed by the relatives.Conclusion. Following the recent tendencies in favor of respect for autonomy, Bulgarian physicians inform patients and try to build partnerships in most of the therapeutic relations. The issue of truth telling in case of terminally ill patients is still one of the most complex and sensitive situations presenting moral dilemma in clinical practice.
Practical evaluation tools were proposed for the analysis of Chronic Care Model in order to guide the efforts in improving the quality of chronic disease care and to evaluate changes after the adoption of various measures. The study purpose is to conduct a preliminary analysis for adapting, testing and validating one of this instruments - PACIC: Patient Assessment of Chronic Illness Care. The qualitative and quantitative analysis and the survey conducted among people aged over 55 years from Iasi and the surrounding villages, tested the instrument's reliability and content validity, thus completing the first step for validating RO-PACIC: Romanian Older Patient Assessment of Chronic Illness Care. Once adapted, the instrument can be used in further research on different groups of chronic diseases or wider geographical areas.
In the Republic of Moldova, there is a continuous concern of the authorities to develop the emergency medical assistance at all levels. To this end we have proposed a national program on emergency medical assistance development for 2011-2015, a Government planning document, on the medium term, aiming to consolidate and continuously modernize the emergency services, to expand the public access to quality emergency care support services in order to reduce the impact of emergencies on the public health. The national arguments for a better concentration of forces towards ensuring the public emergency care are: high population density, demographic transition and population aging, epidemiological transition with significant change of the morbidity profile and increasing number of non-communicable cardiovascular digestive and respiratory chronic diseases, respectively emergencies caused by their acute exacerbation or decompensation, new public health emergencies as avian and pandemic influenza, recurrence of tuberculosis, increased incidence of injuries and the location of Moldova prone to seismic activity which, together with the risks of droughts, floods, heavy rains and other disasters, make the emergency medical system a clear priority for the Moldovan public health.The project "Regionalization of Paediatric Emergency and Intensive Care services" (REPEMOL) is a complex multidimensional intervention on the Republic of Moldova health system and on the public health. REPEMOL project was initiated in 2008 at the request of the Health Ministry of the Republic of Moldova and submitted to the Swiss Agency for Development and Cooperation, with the aim to increase the effectiveness and efficiency of the paediatric health care system through systemic changes, as response to the Ministry of Health's strategy on the regionalization of health care in the country. Finally, attention should be paid to how the changes occurred in the emergency system are being communicated to all those involved, from policy makers to emergency care professionals and the public, in order to ensure their adherence to changes and hence their support in implementing the proposed measures.
