At the coalface, but on the receiving end.
(9/193)
In dealing with patients the doctor is very often paternalistic. No more so than when the patient is unable to help him--or herself. Modern technology allows people to be kept alive in "intensive care" where they often become an "object" at the centre of proceedings. Fortunately for them, most patients who survive intensive care cannot remember the experience though this does not mean that they were not suffering at the time. There is a strong case for explaining things as much as possible and for making practical procedures as tolerable as possible. The relatives and families of the seriously ill often have great difficulty in understanding what is happening to their loved ones and, in these situations, suffer a great deal of stress and foreboding regarding the ultimate outcome of their illness. The stress on the staff who may become "attached" to their patients often shows through as an indifferent attitude. Peter remembers three out of fourteen days in intensive care and Jane, his wife, remembers the whole experience. Here we tell our stories in the hope that they may help our medical and nursing colleagues to manage better the patients under their care in this situation. (+info)
Frontiers in care: a case of compulsory treatment in AIDS dementia. Case study and commentaries.
(10/193)
A patient with AIDS dementia was confronted and compulsorily prevented from flying out of the country before being admitted against his will to hospital. While finding this on balance justified in the circumstances the commentators raise moral questions about the levels of care in general practice and within the couple's own relationships. (+info)
Would you like to know what is wrong with you? On telling the truth to patients with dementia.
(11/193)
OBJECTIVES: To discover what dementia sufferers feel is wrong with them; what they have been told and by whom, and what they wish to know about their illness. BACKGROUND: Ethical guidelines regarding telling truth appear to be equivocal. Declarations of cognitively intact subjects, attitudes of family members and current psychiatric practice all vary, but no previous research has been published concerning what patients with dementia would in fact like to know about their diagnosis and prognosis. DESIGN: Questionnaire study of the patients' opinions. SETTING: Old Age Psychiatry Service in Worcester. PARTICIPANTS: 30 consecutive patients with dementia. RESULTS: The quality of information received has been poor and many patients have no opportunity to discuss their illness with anybody. Despite that almost half of the participants in this study had adequate insight and a majority declared that they would like to know more about their predicament. CONCLUSIONS: Although many patients would like to know the truth, the rights of those who do not want to know should also be respected. Therefore the diagnosis of dementia should not be routinely disclosed but (just as in other disorders) health care professionals should seek to understand their patients' preferences and act appropriately according to their choice. (+info)
Working with mentally ill homeless persons: should we respect their quest for anonymity?
(12/193)
In recent years, the homeless population has received much attention as authorities attempt to comprehend this phenomenon and offer solutions. When striving to establish a relationship with the homeless person, many problems arise. We encounter this dilemma when respecting the right of the mentally ill to dwell neglected in the streets and simultaneously observe their inability to comprehend provisions such as housing, shelter, medical and mental care which contribute to their human dignity. The polarities of autonomy versus involuntary treatment are highlighted when treating the homeless population. (+info)
Examining consent within the patient-doctor relationship.
(13/193)
The notion of consent which rose to the forefront in biomedical ethics as an attempt to safeguard patients' autonomy, is relatively new. The notion itself requires qualification, for it precludes neither duress nor ignorance. More seriously, I argue here that consent is redundant except in situations where paternalism prevails. Paradoxically, these are the very situations where it may be difficult to uphold or to verify voluntary consent. I suggest that a request-based relationship has the potential to overcome these difficulties. It enhances patients' participation in decision making, requires that the patients remain in command and avoids their subordination. Request is also more conducive to treatments that are representative of patients' own values and perceptions. In practice, what one wants and what one agrees to, often concur. But these are not conceptually identical issues, and they carry important differences of emphasis. (+info)
Medical paternalism and the fetus.
(14/193)
A number of developments in the medical field have changed the debate about the ethics of abortion. These developments include: advances in fetal physiology, the increase in neonatal intensive care and the survival rates of premature infants. This paper discusses the idea of selective termination and the effects that these decisions have on disabled people of today. It presents a critique of the counselling services that are provided for the parents of a disabled fetus and discusses how this is viewed from a social perspective. The article ends with an argument that the mother deserves to be autonomous in the decision of abortion. The easiest and most fair way to develop her autonomy is to consider the relationship between a professional and a mother as an expert-expert relationship. Here both parties are considered experts in diagnostic information, treatment options, possibilities, and their history, family roots, philosophy and way of life, respectively. (+info)
Paternalism versus autonomy: medical opinion and ethical questions in the treatment of defective neonates.(15/193)
The history of confidentiality in medicine: the physician-patient relationship.
(16/193)
The author of this article reviews the history of the confidentiality of medical information relating to patients from its roots in the Hippocratic Oath to the current codes of medical ethics. There has been an important shift in the basis for the demand for confidentiality, from a physician-based commitment to a professional ideal that will improve the physician-patient relationship and thus the physician's therapeutic effectiveness, and replace it with a patientbased right arising from individual autonomy instead of a Hippocratic paternalistic privilege. (+info)