Medical Deontology Research Articles

Code of Medical Deontology: Challenges and deontological updating

Code of Medical Deontology: Challenges and deontological updating

The new Italian Code of Medical Ethics

The presentation of the new Italian Code of Medical Deontology would require a broad and comparative consideration with the previous text issued by the National Federation of Medical Boards in 1978, to note the points of development in these ten years, in which new problems and new demands have emerged in the world of medical culture and science.

Characteristic Features of Dietary Patterns and Physical Activity among Medical Students

Introduction This paper deals with the investigation of controlled risk factors associated with body weight disorders of young people with overweight and obesity. Authors are convinced that the formation of a conscious attitude to health in youth and early diagnosis of any abnormalities through the dynamic monitoring of adolescents and young people with excess body weight could help in the solution to this problem. Methods Statistical and sociological methods were used during the investigation. 80 students from a medical university participated in this research. In the survey, Google Forms online application were used. The authors followed all the principles of bioethics and medical deontology in conformity with the requirements of the Helsinki Declaration. The questionnaire contained points about the diet, food habits and preferences, socio-economic status of the respondent’s family, the level of their physical activity, knowledge about a healthy lifestyle, and relationships in the group. Results The primary processing of the obtained data was carried out using the methods of descriptive and analytical statistics with the provision of results in the form of relative indicators (Р, %) with an error (m, p). The specificity of the eating behavior of youth was connected with the absence of a food regime, the multiplicity of meals, and the low level of eating culture (lack of a permanent place to eat or eating in front of a computer or TV). Moreover, such habits, like eating before going to bed, eating under stress, or frequently visiting fast food restaurants, were typical for this group of population. A large number of young people were found to be prone to use advertised products. Conclusion Young people’s awareness of healthy nutrition has been found to be insufficient, and the level of physical activity in the studied group as unsatisfactory. Significant features of physical activity associated with maladaptive eating behavior have been observed to be a lack of physical activity on weekdays, absence of morning gymnastics, failure to comply with the norms of rational nutrition in the family, or low level of information about healthy nutrition.

Ultrasound markers of adverse pregnancy outcomes in embryonal period: literature review and own clinical cases

A goal of the review was to search and describe all currently known prenatal ultrasound markers of adverse pregnancy outcomes. The review is instantiated by multiple ultrasound images of own clinical cases. Taking into account the authors wide experience, it is possible to use all of presented ultrasound signs as predictors (markers) of an adverse pregnancy outcome in the early stages. From our point of view, it is reasonable to divide the markers into two groups, “primary markers” and “dynamic markers”. In the case of “Primary markers” revealing on initial ultrasound, it is reasonable to perform control ultrasound in 7–10 days to confirm the viable pregnancy or missed miscarriage. The “Dynamic markers” can be used on control ultrasound, and some of them may be used in shorter dynamic period when there is a need to predict the outcome earlier than 7-10 days. Generally, the review describes 22 early pregnancy ultrasound markers of adverse pregnancy outcome. These are imaging features of the gestational sac, yolk sac, embryo size, embryo heartbeat, and amnion. Early pregnancy ultrasound is not mandatory, but in a real-case scenario, almost all women undergoes ultrasound on early stage of pregnancy in objective or subjective causes. Therefore, in the first days of pregnancy, women should receive a highly professional diagnostic by a physician, able to assess the risks and prognosis of pregnancy outcome. The authors of the review particularly notes that the assessment of ultrasound markers of adverse pregnancy outcomes must be carried out with the strictest adherence to the medical ethics, deontology, and medical privacy.

Realizacja prawa do diagnozy przez lekarza

The subject of the article is a presentation of the concept of the patient’s subjective right to a doctor’s diagnosis.The starting point is a discussion of the clinical diagnostic process currently used in medicine, as well as the clinical decision-making. In the literature, a fairly widely accepted division of clinical diagnostics is used, which breaks diagnostics down into the following elements: subjective examination (interview conducted with the patient or their family), physical examination (determining symptoms using basic methods) and additional examination (using technological advances to determine symptoms, e.g. CT scan). It is indicated that legal provisions do not take into account the abovementioned division, which may cause interpretation difficulties when assessing the possibility of factual guardian consenting to the medical examination. Also, the clinical decision-making stage has been distinguished, which is the basis for the herapeutic decision and, consequently, determines the success of treatment. Next, the patient’s right to information on their health is discussed, which is considered a part of a broader right to information about oneself. Justifications for medical truthfulness are presented as well as an exception to this rule – the so-called therapeutic privilege. Next, the postulated right to diagnosis is discussed, which consists of the following specific rights: the right to form a diagnosis, the right to be informed of a diagnosis, the right to information about the impossibility of a diagnosis, and finally, the right to remain in ignorance. Legal provisions and principles of medical deontology, from which the above law can be derived, are also discussed. The conclusion of the article is that the right to a diagnosis can be justified on the basis of the currently applicable laws and in this respect no legislative initiative is necessary.

Medical ethics and deontology in the work of nurse. Regulations on corporate etiquette. Standard of professional conduct

In the Regulations on the corporate etiquette of middle and junior medical personnel of the State Budgetary Healthcare Institution «Samara Regional Clinical Hospital named after. V. D. Seredavin» reflects such concepts as: etiquette of the appearance of an employee in the workplace, etiquette of behavior of nursing and junior medical personnel in the workplace, etiquette of communication between nursing and junior medical personnel with patients, etiquette of telephone communication of medical personnel. The basis of corporate ethics of nursing and junior medical personnel of the State Budgetary Healthcare Institution «Samara Regional Clinical Hospital named after. V. D. Seredavin» is the Ethical Code of Russian Nurses. It formulates the basic ethical values of the entire sister community of Russia and gives a moral assessment of the most acute ethical conflicts of today.

НОВАЯ СТРАНИЦА В УЧЕБНИКЕ «ИСТОРИИ МЕДИЦИНЫ»: «ДОЛГ» И «ГЕРОИЗМ», КАК ДОМИНАНТНЫЕ ЭТИЧЕСКИЕ КАТЕГОРИИ (НА ПРИМЕРЕ ГЕРОИЗМА РОССИЙСКИХ ВРАЧЕЙ В ЗОНЕ СВО НА УКРАИНЕ)

In education, the task is to create new, relevant textbooks on National history this also applies to textbooks on the "History of Medicine" and "Bioethics". The importance of the basic ethical categories (duty, responsibility, honor, justice, humanism, mercy, compassion) in medical deontology remains important, especially the question of the real implementation of these principles in the daily work of a doctor. The problem has become especially relevant in connection with the implementation of the SVO in Ukraine. Here the ethical categories of "duty" and "heroism" find an organic synthesis. The purpose of the study: To consider the deontological concepts of "duty" and "heroism" in the socio-historical aspect on the examples of the actions of Russian doctors in the SVO zone in Ukraine. New: In this work, for the first time in a scientific article, the principles of "medical duty" and "heroism of doctors" are analyzed based on the specifics of the SVO (Special Military Operation) in Ukraine, the study is based on media materials (TV, Internet, Russian newspapers). Thus, materials are offered for the creation of a new textbook on the "History of Medicine". The research methods used in writing the article: the principle of historicism allows us to consider events in development; - dialectics is a kind of discourse in understanding human behavior in an extreme situation; - hermeneutic analysis, consideration of categories in the context of events; sociological method – the study analyzes modern media. The current socio-political situation has contributed to the manifestation of the best qualities of the doctor's personality in special conditions. So, the biography of an ordinary person-a doctor, in fact, becomes a history textbook! The events in the SVO zone in Ukraine are a new page in National history, including in the history of medicine.

Axiological dimensions of medical deontology in pediatric surgery

The achievements of contemporary medicine, application of advanced technologies and comprehensive therapeutic and diagnostic investigations are not limited to broadening the range of professional opportunities for pediatric surgeons but also require further rationalization of the axiological discourse of medical deontology. Purpose. The article aims at theoretical and methodological substantiation of the axiological principles of medical deontology in pediatric surgery. The theoretical and methodological foundation of the scientific research includes the theory of creative development and self-improvement of an individual, the theory of education and personal development in changing socio-cultural conditions, concepts of humanization of education, conceptual approaches to the general theory of activity and philosophical theories of values. The professional activities of medical workers in pediatric surgery inevitably include the process and result of a deontological dominant, manifested in the profound understanding by the medical experts of their professional and human duties, and in a high moral and ethical responsibility for the quality of their professional activities. Conclusions. Philosophy and axiology constitute the worldview and methodological basis of medical deontology, particularly in surgery. The genesis of knowledge about moral and ethical principles and the professional duty of a pediatric surgeon is presented in the form of a logical chain: philosophy - axiology - deontology - medical deontology - deontology in surgery - deontology in pediatric surgery. The process of forming the deontological competence of medical professionals in pediatric surgery will be successful if the organization of deontological training for future healthcare providers is based on principles of humanism, in compliance with the requirements of the social environment, and implemented in the educational process through a productive mechanism. No conflict of interests was declared by the authors.

Студенты в клинике: этические аспекты

The article is devoted to ethical aspects of bedside training. Education of future specialists in the clinical setting is important to acquire knowledge, skills, professional competencies and to form clinical thinking. Transfer of professional medical experience occurs simultaneous to the development of communication skills which are required to deal with patients, their relatives, colleagues and mentors. It is about comprehension of how the normal standards of medical deontology are implemented in real practice and how important the effective therapeutic alliance is while interacting with the patient. Though bedside training is a long-standing tradition of medical education, the origins of which are associated with the Ancient Greek Healing Practices, it is not always understood and supported by patients and their relatives, and requires students to get more familiar with ethical standards regulating similar education and their behavior within a medical group and institution.

ХАРАКТЕРИСТИКА УРОВНЯ УДОВЛЕТВОРЁННОСТИ ПАЦИЕНТОВ АРХАНГЕЛЬСКОЙ ОБЛАСТИ КАЧЕСТВОМ СТОМАТОЛОГИЧЕСКОЙ ПОМОЩИ

This study was conducted on the basis of a comparative results analysis of a questionnaire survey of patients in the Arkhangelsk region who applied for dental care in state polyclinics and private structures. In the questionnaire, special attention is paid to the issues of assessing the interaction level with nursing staff, as well as the personal qualities of the doctor, which, according to patients, significantly affect the level of final assessment of satisfaction with dental treatment. The average score of the doctor's interaction with the patient was 4,7 ± 0,7. Sociability (81,3%), tact (76,3%), organization (61,2%) and the doctor's ability to listen (55,5%) are the most significant qualities of the doctor that influenced the positive assessment of the interaction quality. Rudeness (42,8%), violation of ethics (42,8%), inability to listen (42,8%) and unwillingness to enter into the patient's position (28,5%) caused unsatisfactory evaluation by patients. Additional recommendations on oral care, selection of individual hygiene products were given to only 70,5% respondents. The results of the survey prove the importance of the dentist personal qualities in the complex interaction of the doctor and patient. Properly structured psychological contact, informing the patient about possible risks and complications, mandatory issuance of additional recommendations increase the level of patient satisfaction with dental treatment, directly affecting the productivity and success of treatment, which are important factors of patient compliance. In order to increase patient satisfaction with dental treatment, it is necessary to conduct additional training in the basics of medical ethics and deontology for medical registrars and X-ray technicians.

СОВРЕМЕННЫЕ ПРОБЛЕМЫ МЕДИЦИНСКОЙ ЭТИКИ И ДЕОНТОЛОГИИ

Due to the rapid development of medicine in various industries, new ethical and deontological problems arise that need to be discussed. Reproductive technologies, genome editing, telemedicine and many other areas are still the subject of public controversy. Medical workers should be able to competently carry out their activities in accordance with ethical and deontological norms. The article discusses the key problems of modern medical ethics and deontology based on the analysis of scientific publications.

Применение этических норм при правовом регулировании труда медицинских работников

Based on the analysis of current legislation and judicial practice the article considers the problems of applica-tion of ethical norms in the legal regulation of medical workers. The author distinguishes general and medical ethics, considering the latter in detail. The article analyzes the relationship between deontology and medical deontology as a ratio of general and particular, and also draws attention to the multiplicity of normative legal sources in which the obligation of medical workers to comply with the norms of professional ethics is estab-lished. Examples from judicial practice are given. The author argues that it is advisable to create regulatory complexes as a combination of substantively related legal and ethical norms, as well as amendments to Art. 350 of the Labor Code of the Russian Federation regarding the non-disclosure of medical confidentiality, which appears to be a key element of medical ethical behavior.

Forced feeding of convicts: problems of theory and practice

The problematic issues of legislative consolidation and application of forced feeding to convicts who refuse to take food in institutions of execution of punishment are considered.
 An analysis of domestic and international legislation in the field of treatment of convicts, prohibition of torture and other cruel, inhuman or degrading treatment and punishment, principles of medical ethics and deontology regarding the admissibility of forced feeding of persons who have declared a hunger strike was carried out.
 Special attention is paid to the analysis of the decisions of the European Court of Human Rights against Ukraine, which found a violation of Article 3 of the Convention on the Protection of Human Rights and Fundamental Freedoms in the context of the treatment of convicts during their forced feeding, which was classified as torture.
 Emphasis has been placed on the fact that the Convention on the Protection of Human Rights and Fundamental Freedoms in itself does not prohibit forced feeding, the purpose of which is to save the life of a specific person who is in custody and who deliberately refuses to eat. At the same time, it has been emphasized the need to comply with the requirements established by the European Court of Human Rights regarding the implementation of this procedure.
 It has been proposed to abandon and prohibit the forced feeding of a mentally healthy and capable person who has declared a hunger strike, contrary to his informed and voluntary refusal, in the form in which it currently exists, replacing it with artificial feeding (supportive therapy) with the express or necessarily implied consent of the person.

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Етика і культура безпеки в медичній практиці

Medical practice is connected with the greatest social values - people's health and life. Its subjects and objects are people with numerous social and biological differences and characteristics. It is obvious that under such circumstances it is impossible to normalize all situations of this practice. Therefore, this involves the wide application of moral laws in health care, supplementing the mechanisms of legal regulation of the relationship between the medical worker and the patient with the norms of medical ethics and deontology. That is why none of the professional communities has at the world, regional and national levels so many conventions, codes, declarations, oaths of a moral and ethical plan, which are an integral part of the regulatory and legal framework of medicine. But ethics and law are not identical. Quite often ethics declare standards of behavior higher than the law. There are known cases where ethics require that doctors not obey laws that require unethical behavior (WMA, 2009). Medical ethics puts the patient and his safety above other criteria for the quality of medical care, above the interests of medical workers. None of these moral and ethical documents bypasses the issue of patient safety, starting with the Hippocratic one: "refraining from causing any harm" and ending with the Code of Ethics of a doctor of Ukraine, which emphasizes that "a doctor must carefully analyze the mistakes made and discuss them with colleagues and guidance for the prevention of similar cases in the clinical practice of other doctors." Patient safety is considered an ethical imperative (Vicki D. Lachman, 2007). This is consistent with the concept of safety culture developed by the IAEA after the accident at the Chernobyl nuclear power plant (IAEA, 1991) to prevent emergency situations in the nuclear power sector. The concept of safety culture is considered as a mechanism for identifying hidden safety deficits and puts its level above the requirements of legislation and regulatory bodies (ILO, 2001). The World Health Organization declared its commitment to safety culture principles in 2005 and called on national health care systems to follow suit. In a recent document, the Global Alliance for Patient Safety (HURST, Samia, et al., 2013) emphasizes the need to consider ethical issues in patient safety research. Considering the above, the concept of safety culture, based on the principles of medical ethics, is at the same time its section in the part related to the formation of a safe hospital environment. Today, many countries have successful experience of using safety culture in medicine, and using it and developing it is an urgent task of the domestic medical community. No conflict of interests was declared by the authors.

Quality in medicine as a deontological requirement

Medical practice has two main dimensions, one scientific and the other human, and in both, the commitment of the doctor is essential. Medical deontology, as a branch of ethics that deals with the duties and obligations of doctors, embodies in the codes of deontology the ethical principles and standards of mandatory compliance. From this point, medical practice should guarantee that patients receive an quality medical care, and to be treated with dignity and respect. In December 2022, the General Council of Official Medical Associations of Spain published a new version of the Spanish Code of Medical Ethics that aims, among other purposes, to standardize medical care of scientific and human quality. Medical practice supported by scientifically-based medicine, lex artis medica, patient safety, professional responsibility, honesty and integrity are some of the aspects that in this updated document of medical ethics frame and define the work of the doctor for a performance of medicine with quality.

Process of elaboration and new issues of the Spanish code of medical deontology 2022

This article describes the elaboration process of the new Spanish Code of Medical Deontology ap- proved by the General Assembly of the General Council of Medical Colleges of Spain in December 2022. The reasons for updating the deontological rules, the works carried out, the principles followed in the development of the Code and the most relevant new rules are described.

Organizational actions to tackle distrust: Building Trust Italy.

According to the italian Code of Medical Deontology, mutual trust and mutual respect for values and rights are the care relationship foundation. To establish reciprocal trust and respect, the communication between care providers and patients must be skilled and appropriate, and the time devoted to communication must be considered time of care. But in Italy, in the last decades costs containment policy in the organizations of the National Health Service critically shortened the time available for care. Today, doctors and other healthcare professionals literally do not have the time to establish appropriate care relationships, and this causes a widespread and increasing distrust of patients and their families in the care system. During Covid-19 pandemic also vaccine hesitancy, defined by experts as a delay in acceptance or refusal of vaccination despite availability of vaccination services, was mainly due to a lack of confidence in care system and in scientific research. Slow Medicine ETS, an italian proactive movement of healthcare professional and citizen, following the example of the initiative “Building Trust” recently activated by the ABIM Foundation in the USA, launched a national initiative aimed to promote and plan concrete actions to restore and consolidate people’s trust in health professionals and organizations, in researchers, in scientific and rational approach to knowledge and in its use for the improvement of health and quality of life. Slow Medicine ETS, still successfully leading and supporting the “Choosing Wisely Italy” project, will be engaged in assembling the national network of the new project “Building Trust Italy”.

Ethical Aspects in Medical Practice: Investigation of Ethical Dilemmas and Principles Related to Medical Practice

Medical ethics or medical deontology is a set of ethical norms and principles of behavior of medical workers in the performance of their professional duties, i.e. deontology provides mainly norms of relationships with the patient. In the medical understanding, deontology is the teaching of legal, professional and moral duties and rules of conduct of a medical worker in relation to a patient. In addition, deontology establishes norms of relationships between medical professionals and relatives of patients, as well as between colleagues in the medical team. The article is a study of ethical aspects related to medical practice. Doctors and other medical professionals face many ethical dilemmas that require making difficult decisions in their daily work. The purpose of this study is to analyze various ethical problems faced by medical professionals and identify the basic ethical principles that help them make decisions in these situations. A medical worker should always remember about the patient, have the ability to conquer and subdue the soul of the patient. The core issues of medical ethics and deontology are the relationship between a medical worker and a patient. The personality and appearance of a medical worker are determined by the economic, political and social conditions of the society in which he works. The paper discusses several ethical dilemmas faced by doctors, such as confidentiality and protection of patients' personal data, principles of fairness and accessibility of medical care, as well as ethical issues that arise when making decisions about consultations, consent to treatment and termination of a patient's life. It also examines the various ethical principles that medical personnel apply to solve these dilemmas, such as the principles of benevolence, non-harm, respect for patient autonomy and justice.

Развитие профессиональной толерантности у студентов-медиков через профессионально-ориентированную обучение иностранным языкам

Global sociocultural transformations in the modern world are associated with expansive digitalisation and its impact on human life. Given the advantages of digital technology development, a number of significant problems arise, in particular, social differentiation, commercialisation of socionomic professions, information consumerism, emotional estrangement due to the virtualisation of communication, a shift in value orientations, replacement of traditional moral norms with their destructive simulacra. There is a clear need for intensification of educational activities in higher education focused on the humanisation of public consciousness, the promotion of social cohesion and the development of the moral backbone of an individual. Hence, it is necessary to refer to the theoretical and methodological foundations of tolerance development in students. The aim of this article is to clarify the concept of professional tolerance of a doctor and describe the strategy of its development in students in the process of foreign language training. Considering the issue of professional education of future doctors, the authors note that the vector of students' spiritual and moral development is determined by the values, attitudes, and norms of medical ethics and deontology. Herewith, the principle of tolerance is of the basic ones since professional medical practice is based on regular interpersonal interaction. The authors define the concept of a doctor's professional tolerance as the willingness to provide patients with high-quality medical care regardless of the heterogeneity of socio-cultural factors and subjective personal aspects. This concept assumes the doctor's tact, empathy, psychological flexibility and poise. The proposed strategy for the development of professional medical tolerance in students via professionally-oriented foreign language training involves the holistic formation of its cognitive, affective and conative components through the educational content and the parity in subject-subject interaction. In the development of the cognitive component, considerable importance is ascribed to supplementing the basic educational materials by authentic content of social and professional orientation. The connecting link of the development of cognitive and affective components is the identification and levelling of stereotypes and prejudices regarding socially significant diseases. The basis for the development of the affective component is pedagogical tolerance, a favourable educational environment, interactive activities at classes, and the facilitation of students' reflection. The development of the conative component of tolerance is directly tied to the development of professional communicative competence of future doctors: the study and development of various speech cliches in the format of interaction with patients; revision of politeness formulas; practicing non-verbal communication means in playing out quasi-professional situations; mastering the speech norms “plain language” and “people-first language”.