Файл: Реферат по теме Этические аспекты работы медицинских специалистов Специальность 31. 02. 04.doc

Частное профессиональное образовательное учреждение

«Северо-Кавказский колледж инновационных технологий»

ЧПОУ «СККИТ»

УТВЕРЖДАЮ Директор ЧПОУ «СККИТ» _______________А.В. Жукова «___»__________2022г.

РЕФЕРАТ

по теме:
Этические аспекты работы медицинских специалистов

Специальность: 31.02.04. Медицинская оптика (углубленная подготовка)

Выполнил: Лебедева Татьяна Анатольевна, студентка 1 курса

Научный руководитель:	Кузьменко В.А., преподаватель ЧПОУ «СККИТ»	____________
Заместитель директора по учебно-методической работе:	Марченко Светлана Владимировна, кандидат экономических наук, доцент	____________
Заместитель директора по воспитательной работе, дополнительному профессиональному образованию, производственному и профессиональному обучению	Макарова Лейла Ильгаровна	____________

Пятигорск 2022

CONTENT

Introduction
This essay is devoted to the topic: "Ethical principles of the medical profession."

The relevance of the choice of the topic of work is explained by the fact that medicine is a unique phenomenon in which the doctor and the patient are subject to mutual psychological influence. The provision of high-quality medical care becomes possible only in the case of properly built moral interaction between the parties. At the same time, the rapid development of medicine and related sciences every day poses new ethical problems for physicians: genetic engineering and reproductive technologies, abortion and euthanasia, the use of stem cells, cosmetic medicine, practice in military conditions, training medical students, conducting clinical experiments on animals, etc. That is, it can be noted that the ethical problems of modern medicine lie in two planes: at the global level in terms of new methods and at the level of patient-doctor communication using already proven methods.

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1. 
   Basic ethical principles in the practice of a medical worker
   

Ethics is the science of morality, which is part of philosophy. At the same time, ethics is also commonly understood as a system of human behavior in relation to other people. Morality and ethics are often used as synonyms in various areas of our lives, but they are especially important in the medical profession. Therefore, in the practice of medical activity, a whole scientific section of deontology has been formed, which studies the rules of behavior of a medical worker in relation to other people and gives a number of fundamental recommendations to doctors.

The first attempts to form the basic ethical principles of the medical profession were made in antiquity. The most striking example is the so-called Hippocratic Oath. It contains nine ethical principles: respect for the mentor, colleagues and students, no harm to the patient, the principle of mercy, that is, the obligatory provision of medical care to all people without exception, the principle of the priority of the patient's interests, respect for life, a negative attitude towards abortion and euthanasia, the rejection of intimate relationship with the patient, the principle of keeping medical secrets and personal self-improvement. According to historians, this document was only edited by Hippocrates (460 - 377 BC) and appeared much earlier - in ancient Egypt. In the ancient Indian treatise on medicine «Charaka-samhita» (I millennium BC), a solemn sermon is given to medical students after graduation. It says that the doctor must take care of the patient's life, even if there is a threat to his life, that information about the patient and his relatives should not be disclosed, and the doctor himself must be neat, healthy, directing all his efforts towards the main goal - treating people.

In ancient Rome, the ideas of medical ethics were perfected by the famous Galen (130 - 200 AD), who, being a follower of Hippocrates, he sharply criticized greed and envy among doctors.

Another equally well-known physician from the East, Avicenna or Ibn Sina (980 - 1037), also created his own code of ethics. In it, Avicenna urged the doctor not only to take a responsible approach to the performance of professional duties, but also to pay great attention to communication, because the doctor’s word also heals. It is impossible to treat the patient rudely, upset him or disturb him. On the contrary, the patient should be encouraged, the reasons for fear should be eliminated, and a favorable psychological atmosphere should be created. At the same time, it is required to select an individual approach to each patient, because. human personality is unique. The healer himself must «... have the eye of a falcon (vigilance), the wisdom of a snake (caution), the heart of a lion (courage) and the hands of a girl (tenderness of mother's hands)».

On the basis of the teachings of Hippocrates, Galen and Avicenna, as well as under the influence of Christian ethics, the deontology of medieval medicine was formed. Later, European medical ethics was supplemented by the principles of humanism, justice, generated by the New Age. In Russia, during the Enlightenment, a special contribution to the development of deontology was made by such medical scientists as D.S. Samoilovich (1744 - 1805) and M.Y. Mudrov (1776 - 1831), who believed that a doctor should not only be disinterested, competent, polite and sincere, but also serve for the benefit of every compatriot. They emphasized that the medical profession is a vocation, very hard work, the purpose of which cannot be only material gain. To illustrate their arguments, scientists cited the example of nurses who voluntarily care for the sick, who show patience and mercy when working with the sick and consider the goal of their work to be moral satisfaction from helping a person.

In the Soviet Union, there was an Oath of a doctor, as a solemn promise to direct all one's strength and knowledge to improve human health, readiness to help at any time and keep medical secrets, improve one's skills and consult with colleagues.

Soviet researchers S.A. Pozdnyakov (1965), and later S.S. Gurevich and A.I. Smolnyakov (1976) identified eight basic ethical principles of the medical profession:

- humanism towards the patient;

- refusal of actions that can worsen human health;

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- providing medical care to all people without exception;

- solidarity of medical workers in relation to each other, the struggle for peace;

- medical secrecy;

- participation in health protection in an indirect way, for example, the fight against environmental pollution;

- refusal to participate in human experiments;

- avoidance of actions that can bring down the honor of a medical worker in the eyes of patients, colleagues and society.

In the Russian Federation, in accordance with the Constitution of the Russian Federation, the Law on the “Basics of Protecting the Health of Citizens”, medical workers, and especially doctors, also take a solemn oath, promising to be merciful, highly moral, patient, to protect people's health in every possible way, helping everyone without exception and discrimination. In addition, Russian doctors are obliged to keep medical secrecy, oppose euthanasia, respect their teachers and colleagues, and improve their professional knowledge and skills. The text of the oath itself is very similar to the Hippocratic oath.

Domestic theorists of medicine agree that the fundamental ethical principles of the modern medical profession are the principle of fulfillment of duties and honesty, the principle of autonomy, no harm, beneficence and justice.

The principle of fulfillment of duties and honesty is perhaps the most ancient, it lies in the fact that a medical worker, firstly, cannot refuse a person medical care under any pretext, and secondly, that the doctor’s activity is not aimed at achieving material benefits, and for the benefit of the patient, the satisfaction of social needs.

At the same time, many actions of a physician cannot be driven into the framework of the law, built according to a certain pattern, therefore the doctor can and should act autonomously, that is, at his own discretion with a certain level of inner freedom that allows him to make the right decision. Only an independent, free doctor, well acquainted with deontology, can respect the patient, colleagues, provide psychological support to patients, provide the necessary information in an accessible form to the patient's relatives. Within the framework of this principle, patients and their relatives also receive more rights, for example, the right to choose their own doctor and to cooperate with him. This principle contradicts the traditional paternalistic model of the relationship «doctor – patient», in which the doctor was seen as a kind of «king and god», who completely guides the patient.

The principle of «do no harm» concerns both the choice of diagnostic method and treatment, prevention and psychological support for the patient. The doctor must ensure the safety of the patient starting from the diagnostic stage, especially when it comes to research methods such as biopsy, endoscopy, etc. After that, he must choose a treatment that would have a minimum of undesirable consequences (taking into account the patient's condition) and contribute to a speedy recovery. Throughout the entire process of treatment, medical workers are required to be patient and respectful towards the patient, to be able to calm and encourage him, to correctly present information so that the patient does not suffer from stress.

Justice in modern deontology is, first of all, ensuring access to medical services for all segments of the population, regardless of their financial situation. It's no secret that in modern Russia most medical services are paid, so doctors are also expected to perform social functions.

Another acute problem of our time is the ethical issues associated with euthanasia, abortion, the announcement of a fatal disease to the patient, animal experiments, and personal position during psychotherapy. And if some of them, for example, euthanasia, which is prohibited in our country, are regulated by law. That other dilemmas - is completely in the sphere of the personal choice of the doctor.

In accordance with the Code of Medical Ethics of the Russian Federation, the main goal of the professional activity of a physician is to save lives and preserve the health of people, to reduce the suffering of terminally ill patients. At the same time, the physician is obliged to bear full responsibility for his decisions and actions. He may conduct a private paid practice, in accordance with the laws, but in making professional decisions he should not be guided by motives for material gain. The ethics committee of the Russian Medical Association monitors the ethics of workers, and especially doctors.

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2. Building relationships between a medical worker and a patient: an ethical aspect

Considering in more depth the ethical code of a domestic doctor, we can see that when he treats a patient, the first and most important ethical principle is the principle “Do no harm!”. The implementation of this principle begins with the fact that the doctor has the right (with the exception of emergency situations) to send the patient to his colleague if he feels that he is not competent enough, or will not be able to establish psychological contact with the patient. When starting to perform duties, the doctor receives the consent of the patient to be treated by him, informs about all the conditions of treatment, including diagnostics. It is also impossible to require a patient to undergo diagnostic procedures without his desire (except in cases of a threat to life). If we are talking about a child or an incapacitated patient, the doctor provides all the information to his parents or guardians. Even the name of the case with an adult incapacitated patient (mental, mental disorders), the doctor should try to establish contact with him as far as possible and explain the essence and necessity of treatment.

When it comes to the treatment of mental illness, the principle of voluntariness must be observed. Treatment without the consent of the patient, as well as the consent of his relatives and guardians, is possible only when calling for emergency medical care (especially if the patient poses a threat to other people), as well as by decision of the judicial authorities. In his work, the psychiatrist must in every possible way resist the anti-psychiatric xenophobic view of society, building his relationship with the patient in such a way that he does not feel isolated. To do this, the doctor must communicate with the patient on an equal footing and inform him of his actions, just as any other medical worker would do. Relatives, and, if necessary, friends and colleagues, the doctor must explain the true nature of the disease, avoiding incorrect expressions and phrases that can lead to stigmatization of the patient (attributing non-existent qualities to him). Over the past decades, the approach to psychiatry has changed in general: today the doctor chooses “sparing” therapy, which may not give a quick and significant therapeutic effect, but will have fewer side effects. Such "safe" care should limit the patient's social opportunities less. In this case, the principle of beneficence, non-harm and autonomy of the patient himself are especially important. That is, the patient has the right, within certain limits, with the loyalty of the doctor, to act independently, and the maximum relief of his suffering should be associated with minimal harm to health. A paternalistic model of interaction with the patient is possible only in the case of a severe disorder, when the patient suffers from psychosis or dementia and, to the extent of his cognitive impairment, does not have the ability to cooperate with medical workers. Assessing his actions and communicating with the patient, the doctor, in accordance with his mental illness, must remain friendly without excessive pessimism and optimism in the treatment prognosis.

The doctor-patient relationship should be based on deep mutual respect. The doctor is required to be courteous and tactful in any situation without excessive interest in the patient's personal life. A medical worker should not allow himself intolerance, rudeness, inattention, anger and irritability. It is also undesirable to dominate the interlocutor, interrupt him, argue, criticize the patient and his relatives, hastily make a decision, treat the patient with prejudice. Therefore, if possible, the physician should prepare mentally for the conversation (it is desirable to constantly improve personal communication skills), approach communication at ease and sincerely. When communicating with a patient, it is important not to be distracted and not to scatter attention, as well as not to distract the patient from the story, to show sympathy, to try to understand the point of view of the interlocutor, to find out the essence of the problem that disturbs the person who applied. After that, put leading questions, following your statements, adhere to the chosen method of communication until the end of treatment, have patience when interacting with the patient's relatives. Everything possible is required of the doctor so that he and the patient enter into a process of cooperation in which the patient himself will be aware of every step taken. All medical information to the patient and relatives is presented in an accessible form in simple language. Each new medical intervention is carried out only with the consent of the patient (written or oral), and the patient himself has the right to read the medical history and other documents.

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The diagnosis, methods of treatment and prognosis are kept in strict medical secrecy, except for cases provided for by law (the patient himself gives consent, at the request of the investigating authorities, in case of a threat, for example, an epidemic of infectious diseases, when other doctors need information to preserve the health and life of the patient). Even after the death of the patient, the doctor does not have the right to disseminate information about him and his family. If a doctor uses the materials of his practice for scientific and pedagogical work, he must maintain the anonymity of patients. If the doctor needs to invade the patient's personal life, then his recommendations should relate purely to the patient's state of health, avoiding other issues if possible. If there is no such need, the doctor must restrain his curiosity. Also, a physician should be extremely tactful in the treatment of specific groups of patients, for example, in dermatovenereology.

It is advisable not to hide information from the patient if it does not harm his health. A particular difficulty faces the doctor when he needs to announce the possibility of a fatal outcome to the patient and his relatives. The doctor must decide whether to inform the patient about this or not. In some cases, for example, in the pathology of the cardiovascular system, such "news" can cause a severe deterioration in the patient's health and premature death. Much also depends on the personality, the patient, his character, worldview, reaction. Perhaps the doctor may resort to informing the patient through relatives who know how best to convey this or that information to the patient. A doctor, regardless of personal views, should not interfere with the patient's right to receive the spiritual support of clergy of various faiths. The doctor himself cannot promote any religious and mystical methods of treatment, alternative medicine. Thus, the principle of the autonomy of a medical worker is realized in action.

When the patient is in a terminal state (a pathology that threatens the brain and other vital organs), the medical worker should not stop trying to save him. He must take all possible measures under the circumstances to alleviate the suffering of the patient. It is impossible to resort to euthanasia, and the decision to disconnect a person from life support devices is made only collectively with the consent of relatives, and also subject to the availability of encephalographic data on the cessation of brain functioning.

Emergency medical care, of course, should be free. To a dying patient, the doctor provides not only medical, but also moral support until the last minute, helping to preserve his human dignity. In the practice of medical activity, there were cases when the right of a doctor who treated a terminally ill person to his inheritance was disputed. With all the moral support and closeness, the doctor should avoid too trusting relationships and not enter into the obligations of the heir of his patient.

If a medical worker realized that he had made a mistake that affected the health of the patient, then he must immediately inform the patient himself, his colleague and the higher health authority, doing everything possible to eliminate the negative consequences for the patient's health. In such a situation, it is especially difficult for a physician to remain calm and polite, but it is impossible otherwise! If the decision concerns special, especially complex methods of treatment, then it is taken only collectively. The doctor has no right to prohibit the patient from consulting other doctors.

Self-promotion of a medical worker or his cooperation with advertising, pharmaceutical, commercial companies is unacceptable. Professional activity is carried out only under his own name.

When it comes to transplantation of human organs and tissues, techniques related to the genome and reproduction of people, medical workers must strictly comply with the legislative norms of domestic and international law and in no case take personal advantage.

In domestic medical practice, it is possible to conduct biomedical research if they can improve the patient's condition, help develop science, and if there is no risk of a threat to human life. In this case, the doctor or a group of doctors receives permission for the study, informs the patient, obtaining his written consent. Tests on pregnant women and their fetuses, on newborns will be excluded. Research involving children is conducted only with parental consent.

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