Rules of professional ethics of a medical worker. The doctor-patient relationship. Interaction between nurses

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abstract

Topic: "Ethics and deontology of a medical worker"

Completed by: Larisa Serdyukova

Belgorod 2014

Medical ethics and deontology are features of medical activity based on the mutual trust of the patient and the medical worker, to whom the patient voluntarily entrusts his health, and sometimes his life.

Medical ethics (Greek etohs - custom, disposition, character) as part of general ethics considers the morality of a doctor, including a set of norms of his behavior and morality, a sense of professional duty and honor, conscience and dignity.

Medical ethics also covers certain norms of behavior of a medical worker in everyday life, his culture, philanthropy, physical and moral cleanliness, etc. In general, we can say that ethics is an external manifestation of the inner content of a person.

Medical deontology (Greek deon - due) is understood as the principles of behavior of medical workers aimed at maximizing the benefits of treatment and eliminating the consequences of inadequate medical work. Deontology is part of medical ethics, medical morality.

However, at present, the latest achievements of medical science and technology force us to consider the traditional norms of medical deontology from a slightly different point of view. The former principle "doctor-patient" is replaced by the new "doctor-instrument-patient", and the patient's need for a sensitive and attentive attitude of a medical worker, for his kind word that inspires hope, has not decreased, but has increased even more.

Relevance of the problem

The peculiarity of medical ethics lies in the fact that in it, all norms, principles and assessments are focused on human health, its improvement and preservation. These norms were originally enshrined in the Hippocratic Oath, which became the starting point for the creation of other professional and moral medical codes. The ethical factor has traditionally been of great importance in medicine. More than eighty years ago, by analogy with the medical Hippocratic Oath, the sisterly Oath of Florence Nightingale was created.

Ethical norms and phenomena

In the process of development and formation of professional medical, humanistic, moral principles of the activity of medical workers were clearly formulated.

On this basis, the most generalized concepts of morality or categories were determined, reflecting the moral ties between people and characterizing the attitude of health workers to the subject of their daily activities - a sick and healthy person, to society.

This is how the main categories of medical ethics were formulated and received scientific recognition: duty, conscience, honor and dignity, tact, meaning of life and human happiness. Naturally, all ethical categories are interconnected, mutually complement and reinforce each other. With the development of our ideas and scientific progress in medicine and on this basis - further improvement of methods for examining and treating patients.

It is very important that paramedical workers not only know, but also use the basic requirements of ethical categories in their professional activities and, on their basis, improve the quality of medical care to the population.

Conscience is an ethical category that expresses the highest form of a person's ability to exercise moral self-control, independently formulate moral duties for himself, demand their fulfillment from himself and make self-assessment of his actions. Conscience is an internal awareness of one's professional duty, professional responsibility as a personal duty and personal responsibility.

Honor and dignity are ethical categories that determine the attitude of a person, both to himself and to another person, to society as a whole. In its content, the concept of honor is very close to the concept of "dignity". Both of these categories in a certain way regulate a person's behavior and determine the attitude of others towards him, they are influenced by other categories of ethics, especially duty and conscience, without which there is no personal honor and dignity.

Tact is not an innate quality, but an acquired one; it is brought up from childhood in the social environment where it grows and is formed in the process of social and individual development.

Happiness is a sign that a person has found the personal meaning of life at a particular stage of his life path.

There are two points in ethical phenomena:

1) a personal moment (the autonomy of the individual, his motivation for the rules of moral behavior and moral assessments);

2) an objective, impersonal moment (moral views, values, mores, forms and norms of human relations that have developed in a given culture, social group, community).

The first of the noted points relates to the characteristics of morality, the second - to morality.

A distinctive feature of morality is that it expresses the autonomous position of individuals, their free and independent decision of what is good and evil, duty and conscience in human actions, relationships and affairs. When one speaks of the morality of social groups, communities and society as a whole, one is essentially talking about morality (about group and general social mores, values, views, attitudes, norms and institutions).

Traditional norms and rules of medical deontology

1. Hippocratic model (“do no harm”).

The principles of healing, laid down by the "father of medicine" Hippocrates (460-377 BC), lie at the origins of medical ethics as such. In his famous "Oath", Hippocrates formulated the obligations of the doctor to the patient.

2. Model of Paracelsus (“do good”).

Another model of medical ethics developed in the Middle Ages. Its principles were most clearly stated by Paracelsus (1493-1541). In contrast to the Hippocratic model, when a doctor wins the patient's social trust, in the Paracelsian model, paternalism is of primary importance - the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built.

In the spirit of that time, the relationship between a doctor and a patient is similar to the relationship between a spiritual mentor and a novice, since the concept of pater (Latin - father) in Christianity also applies to God. The whole essence of the relationship between the doctor and the patient is determined by the good deed of the doctor, the good, in turn, has a divine origin, for every Good comes from above, from God.

3. Deontological model (principle of "observance of duty").

This model is based on the principle of "observance of duty" (deontos in Greek means "due"). It is based on the strictest observance of moral prescriptions, compliance with a certain set of rules established by the medical community, society, as well as the doctor's own mind and will for mandatory execution. Each medical specialty has its own "code of honor", non-observance of which is fraught with disciplinary sanctions or even exclusion from the medical class.

4. Bioethics (the principle of "respect for human rights and dignity").

Modern medicine, biology, genetics and relevant biomedical technologies have closely approached the problem of predicting and managing heredity, the problem of life and death of the body, and controlling the functions of the human body at the tissue, cellular and subcellular levels. Some of the problems facing modern society were mentioned at the very beginning of this work. Therefore, the issue of respect for the rights and freedoms of the patient as an individual is more acute than ever, the observance of the patient's rights (the right to choose, the right to information, etc.) is entrusted to ethical committees, which actually made bioethics a public institution.

Moral and professional qualities of a nurse

The role of a nurse in the process of treating a patient, especially in a hospital, cannot be overestimated. Fulfilling doctor's prescriptions, caring for seriously ill patients, carrying out many, sometimes quite complex, manipulations - all this is the direct responsibility of the nursing staff. The nurse also participates in the examination of the patient, preparing him for various surgical interventions, works in the operating room as an anesthetist or operating nurse, monitors the patient in intensive care units and intensive care units. All this places high demands not only on the knowledge and practical skills of a nurse, but also on her moral character, the ability to behave in a team, when communicating with patients and their relatives.

Always and under all circumstances, it must be remembered that a person turns to medical workers for help, due to the fact that a disaster has happened to him, sometimes very serious, which can lead to loss of health, disability, and sometimes life threatening. Only with full sympathy for the patient, with an understanding of his situation, is real contact between him and the medical staff possible, which is so necessary for successful treatment. Sensitivity, moral support, spiritual warmth are needed by the patient no less, and maybe more than drugs. Not for nothing in the recent past nurses called "sisters of mercy": this reflected not only the professional, but also the moral side of their work. Indifferent, unbalanced people, incapable of sympathy for a suffering person, should not be allowed to work in medical institutions. When communicating with the patient, performing manipulations, often unpleasant and painful, the nurse must distract the patient from difficult thoughts, inspire him with vigor and faith in recovery.

Often patients ask nurses about their diagnosis and prognosis. In no case should a patient be told that he has an incurable disease, especially a malignant tumor. As for the forecast, it is always necessary to express firm confidence in a favorable outcome. All information that the nurse gives to the patient must be agreed with the doctor.

BUT)Relationship "nurse - doctor":

Rudeness, disrespectful attitude in communication are unacceptable;

Perform medical appointments in a timely, accurate and professional manner;

Urgently inform the doctor about sudden changes in the patient's condition;

If you have any doubts in the process of fulfilling medical appointments, in a tactful manner, find out all the nuances with the doctor in the absence of the patient.

B)Relationship "nurse - nurse":

Rudeness and disrespectful attitude towards colleagues is unacceptable;

Remarks should be made tactfully and in the absence of the patient;

Experienced nurses should share their experiences with younger ones;

In difficult situations, we must help each other.

AT)Relations "nurse - junior medical staff":

Maintain mutual respect;

Control tactfully, unobtrusively the activities of junior medical staff;

Rudeness, familiarity, arrogance are unacceptable;

It is unacceptable to make comments in the presence of patients and visitors.

Features of communication with sick children

To children of any age, the attitude should be even, benevolent. This rule must be observed from the first days of stay in the hospital.

Medical workers who are directly among children should always take into account the psychological characteristics of patients, their experiences, feelings. Older children, especially girls, are the most sensitive, and in the first days of their stay in the hospital they often become isolated, "withdraw into themselves." For a better understanding of the condition of children, it is important, in addition to clarifying the individual psychological characteristics of the child, to know the situation in the family, the social and position of the parents. All this is necessary for the organization proper care for a sick child in a hospital and its effective treatment.

When communicating with patients, medical workers often experience emotional stress, sometimes caused by the wrong behavior of children, their whims, unreasonable demands of parents, etc. In these cases, it is necessary to remain calm, not to succumb to momentary moods, to be able to suppress irritability and excessive emotionality.

It is also unacceptable to divide children into “good” and “bad”, and even more so to single out “favorites”. Children are unusually sensitive to affection and subtly feel the attitude of adults towards them. The tone of conversation with children should always be even, friendly. All this contributes to the establishment of friendly, trusting relationships between the child and the medical staff and has a positive effect on the patient.

Sensitivity is of great importance when communicating with a child, i.e. trying to understand his feelings. A patient conversation with a child allows you to identify personality traits, a dominant experience, and helps in making a diagnosis. It is necessary not only to formally listen to the complaints of a sick child, but to show warm participation, reacting accordingly to what is heard. The patient calms down, seeing the attitude of the medical worker, and the latter receives Additional information about the child. On the contrary, a harsh or familiar tone in a conversation creates an obstacle to establishing a normal relationship with a sick child.

Caring for a child, in addition to professional training, requires a lot of patience and love for children from a medical worker. It is important to have an idea of the degree of correspondence between the mental and physical development of the child, to know his personal qualities. Frequently ill children early age look more infantile than their more developed healthy peers. A medical worker should be able to compensate children for the absence of parents and relatives. Children under 5 years of age are particularly vulnerable to separation from their parents. However, even children who are painfully experiencing a temporary separation from their parents quickly get used to the new environment and calm down. In this regard, frequent visits to parents in the first days of hospitalization can injure the child's psyche. It is advisable to avoid frequent visits of parents during the period of adaptation (3-5 days). At the end of this period, if for some reason parents or close relatives cannot regularly visit a sick child, the nurse should recommend that they send letters more often, wear parcels so that the child feels care and attention.

The medical worker plays a leading role in creating a favorable psychological environment in a medical institution, reminiscent of a child's home environment (organization of games, watching television programs, etc.). Walks in the fresh air bring children together, and the attention and warm attitude of the medical staff ensure that sick children adapt to new conditions.

Goodwill, unity of style and coherence in work should be maintained in the team of the medical institution, which helps to ensure high level care and treatment of children. The nurse, being among the children and observing their behavior and reactions, must see the individual characteristics of the children, the nature of the relationship, etc. Receiving this important psychological information, the attending physician can also change (optimize) his main treatment tactics in a timely manner, which will contribute to the formation of a healthy psychological atmosphere in the medical institution and increase the efficiency of the treatment process.

The relationship of medical workers with the parents of a sick child

Parents, especially mothers, in most cases have a hard time with a child's illness. And this is understandable: the mother of a seriously ill child is mentally traumatized to one degree or another, and her reactions may be inadequate, since they capture the energetically very powerful sphere of the “maternal instinct”. Therefore, an individual approach to the mother is necessary on the part of all medical workers without exception. Particular attention should be paid to mothers caring for a seriously ill child in a hospital. It is important not only to reassure a woman with words, but also to create the necessary conditions for proper rest, nutrition, to convince her that the child is receiving the right treatment and is in " good hands". The mother must understand the importance and correctness of the manipulations, procedures, etc. prescribed by the doctor and performed by the nurse. And if necessary, you can teach your mother how to perform certain manipulations, such as injections, inhalations, etc.

Most parents treat medical workers with warmth, trust and are grateful to them for their hard work. However, there are also quite “difficult” parents who try to achieve by rudeness and tactless behavior special attention hospital staff to your child. With such parents, medical professionals must show inner restraint and outer calmness, which in itself has a positive effect on ill-bred people.

Great tact is required by the conversation of a medical worker with the parents and relatives of a sick child on the days of visits and receiving parcels. Despite the workload, the health worker should take the time to calmly and leisurely answer all questions. Particular difficulties may arise when parents are trying to find out the diagnosis of the child's disease, to clarify the correctness of the treatment, the appointment of procedures. In these cases, the nurse's conversation with relatives should not go beyond her competence. She has no right to talk about the symptoms and the possible prognosis of the disease. The nurse should politely apologize, plead ignorance, and refer the relatives to the attending physician or head of the department, who has the appropriate competence in these matters.

You should not follow the lead of your parents, strive to fulfill unreasonable demands, for example, stop the injections prescribed by the doctor, change the regimen and diet, etc. This kind of "responsiveness" can only bring harm and has nothing to do with the principles of humane medicine and professional continuity.

In the relationship of medical workers with parents, the form of treatment is of no small importance. When addressing parents, health workers should call them by their first and patronymic names, avoid familiarity and avoid using terms such as “mother” and “dad”.

Contacts of medical workers with parents in children's departments are, as a rule, emotionally intense, close and frequent. The correct tactics of communication between medical personnel and relatives and friends of a sick child creates the proper psychological balance of interpersonal relationships between a medical worker - a sick child - his parents.

Legal and moral standards of responsibility of medical workers

medical deontology moral responsibility

The multifaceted activity of paramedical workers, aimed at preserving and strengthening people's health, is also regulated by legal and moral norms, which are in a certain connection and interaction. This is due to the fact that legislative acts in a socialist society have a deep moral basis.

Consequently, the legal education of medical workers should be combined with moral education and vice versa, moral education should be combined with legal education. Such moral standards as observance of medical secrecy, the obligation to provide emergency medical care to citizens on the road, on the street and other in public places, received in our country consolidation in the Fundamentals of Legislation USSR and union republics on health care.

The following situations, which are often encountered in life, can serve as examples of the close connection between the moral, ethical and legal aspects of the activities of medical workers. If a medical worker strictly observes the requirements of deontology in relations with the patient and relatives, then, despite the possible unfavorable outcome of the disease, the relatives of the deceased come to the defense of the medical worker, because they saw that during the life of the patient everything was done, both from the point of view of professional and and moral and ethical.

On the contrary, a conflict may occur between the relatives of the deceased and the medical worker if the latter violated the requirements of deontology, showed elements of formalism, callousness and disrespect for human dignity in the process of treating the patient.

Thus, those who violated certain moral or legal norms in the course of their labor activity will incur liability, the measure of which will depend on the consequences of the offense.

According to State Committee on antimonopoly policy, the number of violations of the Law "On Protection of Consumer Rights" by medical institutions, organizations for 2000 - 2009. increased by 15.4 times. Positive trends in the struggle for consumer rights often reach their opposite - consumer extremism, when rights are used for unscrupulous purposes to gain benefits.

Many cases of improper provision of medical services become the topics of publications in the media, they receive significant public outcry, which was not the case in previous periods of domestic medicine. The legal basis for civil liability for causing harm in the event of improper provision of medical services is the norms of Chapter 59 of the Civil Code of the Russian Federation "Obligations as a result of causing harm."

Thus, Article 1064 of the Civil Code of the Russian Federation expresses the principle of general tort, according to which the harm caused to the subject of civil law is subject to compensation in full by the person who caused the harm.

Article 1068 of the Civil Code of the Russian Federation provides for the liability of a legal entity for harm caused by a medical worker in the performance of labor obligations (special delict). At the same time, objects and substances that are sources of increased danger are often used in medical activities for diagnosis and treatment. These may include, in particular, x-ray and laser devices, potent drugs, some diagnostic methods, etc. In the event that the legislator certain types medical services to activities that create an increased danger to others, a medical institution, an organization must bear civil liability as owners of a source of increased danger on the basis of Article 1079 of the Civil Code of the Russian Federation.

The actual basis of the responsibility of a medical institution, organization is the harm caused to the life and health of the patient. Responsibility of medical workers may arise from the contract paid provision services in cases of provision of paid medical services (Articles 778 - 783 of the Civil Code of the Russian Federation). Contractual liability for causing harm to life and health during the provision of medical services may provide for a wider range of grounds for its occurrence and the amount of compensation for harm compared to tort liability.

Contractual relations are subject to the Law of the Russian Federation "On Protection of Consumer Rights". So, in case of failure to achieve the planned result of treatment when performing a certain type of medical services, a medical institution, an organization, regardless of their fault, must, at the choice of the patient, either continue treatment free of charge or return the money, and if there is fault, compensate for the moral damage caused (Article 15).

The Civil Code of the Russian Federation provides for the possibility of maximum compensation for losses incurred by victims as a result of harm to life and health, since restoring health lost in such cases can be quite difficult, and sometimes impossible. According to Article 1085 of the Civil Code of the Russian Federation, the wages lost by the injured or part of it, depending on the degree of loss of professional ability to work, are subject to compensation; additional costs caused by damage to health, including medical treatment costs, extra food, purchase of medicines, prosthetics, outside care, sanatorium treatment, purchase Vehicle, vocational training, if the victim needs these types of assistance and is not entitled to receive them free of charge.

In addition, the victim has the right to compensation for moral damage (Article 1100), and in the event of his death, the tortfeasor also bears the costs of burial and in connection with the death of the breadwinner. A prerequisite for liability is the presence of a legally significant (necessary) causal relationship between the doctor's actions and the negative consequences for the patient's health. Sometimes the causality is so obvious that it is easy to establish. It is more difficult to determine the existence of a causal relationship in cases where the result does not immediately follow the wrongful act or when the harm is caused by the action of not one person, but a number of factors and circumstances that complicate the situation. It should be noted that in relation to causing harm in the provision of medical services, it is very difficult to establish a causal relationship, despite its objective nature.

The provision of medical services is a multifaceted process that includes diagnostic, therapeutic, preventive measures, and deviating from the normatively prescribed behavior of a medical worker at any stage of the process can lead to undesirable consequences for the life and health of the patient in the future.

In some cases, with all their experience and knowledge, medical experts can only state the likelihood of the presence or absence of a causal relationship.

To impose civil liability in case of harm, it is necessary to establish the guilt of medical workers. Thus, according to paragraph 2 of Article 1083 of the Civil Code of the Russian Federation, if the gross negligence of the victim himself contributed to the occurrence or increase of harm, depending on the degree of fault of the victim and the harm-doer, the amount of compensation should be reduced (the patient refuses to take medicines, drinks alcohol during treatment with antibacterial drugs, violates the bed rest prescribed by his doctor, hid information about his state of health, which is essential when choosing a method of treatment).

The presence of guilt of the victim in the onset of adverse health consequences must be proved by the tortfeasor, i.e. medical institution, organization. From medical documents, it is possible to obtain information reflecting the course of the patient's treatment, the procedure for prescribing certain procedures, medicines, health status and patient complaints about various stages treatment.

Taking into account the increase in the number of claims from citizens regarding the improper provision of medical services, the problems of the legal liability of medical workers for professional offenses should be given increased attention. The implementation of legal responsibility is achieved through the use of legal means, which allows the influence of law on social relations in the field of medical activity. As you know, not all medical interventions end happily; the patient's recovery. In those cases of adverse outcomes, when it is not necessary to talk about the legitimacy of the actions of a medical worker, there is a need for an objective assessment of the treatment performed and determining the type and degree of responsibility of the medical worker.

The main documents that make up the regulatory framework that determines the property liability of medical workers for the commission of professional offenses are the Civil Code of the Russian Federation, the Law of the Russian Federation "On the Protection of Consumer Rights" (dated January 9, 1996 N 2-FZ), Fundamentals of the legislation of the Russian Federation on health protection citizens (1993). The Law of the Russian Federation "On the Protection of Consumer Rights" regulates the property liability of medical institutions, organizations at the expense of norms on the quality of services, the consumer's right to the safety of services, compensation for moral damage, etc. The property responsibility of medical institutions and organizations implies their greater openness, the reduction in the number of departmental and professional barriers, the equality of patients in the provision of medical services and the strengthening of the legal protection of consumers of medical services.

Currently, the medical community has realized as a real requirement of the time the study of the legal foundations in the field of healthcare. In this regard, it is necessary even from the "student bench" to educate future doctors in a high legal culture and legal awareness. Legal culture and legal awareness can arise on the basis of legal knowledge when a future specialist develops the ability to practically apply legal norms in professional activities, thereby proper legal training of medical workers allows forming a legal culture, responsibility to a person, society and the state. This requires instilling in the medical worker the desire not only for knowledge of the laws and a respectful attitude towards them, but also the ability to apply legal norms in practice.

Currently in medical practice The general trend is that everything large quantity private issues of providing medical services are regulated by law, and are not left to the conscience of the doctor or moral and ethical standards, which is one of the factors of legality in the field of medicine.

Thus, knowledge of health care legislation by medical workers, understanding of their rights, obligations, legal liability for various professional violations, as well as knowledge of the patient's rights form the basis of the legal culture of health workers. Streamlining the legal knowledge of medical personnel will contribute to the most complete provision of public health protection.

Conclusion

The ethical basis of the professional activity of a nurse is humanity and mercy. The most important tasks of the professional activity of a nurse are: comprehensive comprehensive care for patients and alleviation of their suffering; health recovery and rehabilitation; promotion of health and disease prevention. code of ethics provides clear moral guidelines for the professional activities of a nurse, is designed to promote consolidation, increase the prestige and authority of the nursing profession in society, and the development of nursing in Russia.

Bibliography

1. Guseinov A.A., Apresyan R.G. Ethics. M.: 1998.

2. Zelenkova I.L., Belyaeva E.V. Ethics: Tutorial. Mn.: ed. V.M. Skakun, 1995.

3. Fundamentals of ethical knowledge / ed. professor M.N. Rosenko. M.: Ed. "Lan", 1998.

4. Dictionary of ethics. Ed. I.S. Kona. Moscow: Politizdat, 1990.

5. Code of Ethics for Russian nurses (adopted by the Russian Association of Nurses, 1997).

6. Akopov V.I., Maslov E.N. Law in Medicine. M.: Book-service, 2002. 352 p.

7. Aleksandrova O.Yu. Civil liability and its features. M.: ZAO "MTsFER", 2005. S. 167 178.

8. Gerasimenko N.F., Aleksandrova O.Yu., Grigoriev I.Yu. Legislation in the field of protecting the health of citizens. M.: MTsFER, 2005. 320 p.

9. Sergeev Yu.D. Medical law. Educational complex in 3 volumes. M.: GEOTAR-Media, 2008. 777 p.

10. Civil Code of the Russian Federation (as amended on July 29, 2004).

12. Oslopov General care for patients in a medical clinic.

13. "Handbook of a Nurse for Nursing" edited by Academician of the Russian Academy of Medical Sciences N.R. Paleev. Moscow, 1993

14. Ivanyushkin A.Ya. Professional ethics in medicine. M., 1990

15. Code of Ethics for Russian nurses.

16. International Code of Ethics for Nurses.

17. Medicine and law.

18. http://www.medpsy.ru/mprj/archiv_global/2011_4_9/nomer/nomer23.php.

19. http://www.sisterflo.ru/ethics/.

20. http://www.juristlib.ru/book_7444.html.

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Medical ethics is a section of the philosophical discipline of ethics, the object of which is the moral aspects of medicine. Deontology (from the Greek. depn - due) - the doctrine of the problems of morality and ethics, a section of ethics. The term was introduced by Bentham to designate the theory of morality as a science of morality.

Subsequently, science has narrowed down to characterizing the problems of human duty, considering duty as an internal experience of coercion, given ethical values. In an even narrower sense, deontology was designated as a science that specifically studies medical ethics, rules and norms for the interaction of a doctor with colleagues and a patient. deontology medical ethics euthanasia

The main issues of medical deontology are euthanasia, as well as the inevitable death of the patient. The goal of deontology is the preservation of morality and the fight against stress factors in medicine in general.

There is also legal deontology, which is a science that studies the issues of morality and ethics in the field of jurisprudence.

Deontology includes:

1. Issues of observance of medical secrecy

2. Measures of responsibility for the life and health of patients

3. Relationship problems in the medical community

4. Relationship problems with patients and their relatives

5. Rules regarding intimate relations between a doctor and a patient, developed by the Committee on Ethical and Legal Affairs of the American Medical Association:

Intimate contacts between doctor and patient that occur during the period of treatment are immoral;

An intimate relationship with a former patient may be considered unethical in certain situations;

question about intimate relationships between doctor and patient should be included in the training of all healthcare professionals;

Physicians should certainly report violations of medical ethics by their colleagues.

In a narrower sense, medical ethics is understood as a set of moral norms for the professional activities of medical workers. In the latter sense, medical ethics is closely related to medical deontology.

Medical deontology is a set of ethical standards for the performance of their professional duties by health workers. Those. Deontology presupposes predominantly the norms of relationships with the patient. Medical ethics provides for a wider range of problems - the relationship with the patient, health workers among themselves, with the relatives of the patient, healthy people. These two trends are dialectically related.

Understanding medical ethics, morality and deontology

At the beginning of the 19th century, the English philosopher Bentham defined the science of human behavior of any profession with the term "deontology". Each profession has its own deontological norms. Deontology comes from two Greek roots: deon-due, logos-teaching. Thus, surgical deontology is the doctrine of due, these are the rules of conduct for doctors and medical personnel, this is the duty of medical workers to patients. For the first time, the main deontological principle was formulated by Hippocrates: "You should pay attention that everything that is applied is beneficial."

The word "morality" comes from the Latin "togus" and means "temper", "custom". Morality is one of the forms public consciousness, which is a set of norms and rules of behavior characteristic of people of a given society (class). Compliance with moral norms is ensured by the power of social influence, traditions and personal conviction of a person. The term "ethics" is used when they mean the theory of morality, the scientific justification of a particular moral system, a particular understanding of good and evil, duty, conscience and honor, justice, the meaning of life, etc. However, in a number of cases, ethics, like morality, means a system of norms of moral behavior. Consequently, ethics and morality are categories that determine the principles of human behavior in society. Morality as a form of social consciousness and ethics as a theory of morality change in the process of development of society and reflect its class relations and interests.

Despite the difference in class morality characteristic of each type of human society, medical ethics at all times pursues the universal non-class principles of the medical profession, determined by its humane essence - the desire to alleviate suffering and help a sick person. If this primary obligatory basis of healing is absent, it is impossible to speak about observance of moral norms in general. An example of this is the activities of doctors and scientists in Nazi Germany and Japan, who during the Great Patriotic War made many discoveries that mankind still uses today. But as an experimental material, they used living people, as a result of this, by decisions of international courts, their names are consigned to oblivion both as doctors and as scientists - “The Nuremberg Code”, 1947; International court in Khabarovsk, 1948.

There are different views on the essence of medical ethics. Some scientists include in it the relationship of the doctor and the patient, the doctor and society, the doctor's performance of professional and civic duty, others consider it as a theory of medical morality, as a section of the science of moral principles in the activities of a doctor, moral value behavior and actions of the doctor in relation to patients. According to S. S. Gurvich and A. I. Smolnyakov (1976), medical ethics is "a system of principles and scientific concepts about the norms and assessments of regulating the behavior of a doctor, coordinating his actions and the methods of treatment he chooses with the interests of the patient and the requirements of society."

The above definitions, while seeming different, do not differ so much from each other as complement general ideas about medical ethics. Defining the concept of medical ethics as one of the varieties of professional ethics, the philosopher G.I. Tsaregorodtsev believes that it is "a set of principles of regulation and norms of behavior of physicians, due to the peculiarities of their practical activities, position and role in society.

Features of medical ethics and deontology in the surgical department.

Surgery belongs to the field of medicine where the importance of the practical skills of medical personnel is extremely high. All the thoughts and attention of surgeons, operating rooms and ward nurses are concentrated on the operating room, where the main work takes place - a surgical operation. During the operation, the direct contact between medical personnel and the patient practically stops and the process of coordinated interaction between surgeons, anesthesiologists, and paramedical personnel servicing the operating room sharply intensifies.

If in the operating room the leading role is given to surgeons and anesthesiologists, then in the preoperative and especially in the postoperative period, much depends on the attentive and sensitive attitude towards the patient of nurses and junior medical personnel. Many surgeons quite rightly assert that the operation is the beginning surgical treatment, and its outcome is determined by good nursing, i.e., appropriate care in the postoperative period.

Psychological problems include fear of surgery. The patient may be afraid of the operation itself, the suffering associated with it, pain, the consequences of the intervention, doubt its effectiveness, etc. The patient's fears can be learned from his words, conversations with neighbors in the ward. This can be indirectly judged by various vegetative signs: sweating, rapid heartbeat, diarrhea, frequent urination, insomnia, etc. The patient's fear often increases under the influence of "information" that patients who have undergone surgery willingly provide and, as a rule, exaggerate everything that happened to them.

The sister should report her observation of the patient to the attending physician and work out with him the tactics of psychotherapeutic influence. It is advisable to have a conversation with patients who have undergone surgery about the adverse effect of their stories on newly admitted patients who are preparing for surgical treatment. In preparation for surgery, it is very important to establish good contact with the patient, in the course of a conversation, learn about the nature of his fears and concerns in connection with the upcoming operation, reassure, try to change his attitude towards the upcoming stage of treatment. Many patients are afraid of anesthesia, they are afraid of “falling asleep forever”, losing consciousness, giving away their secrets, etc. A number of complex problems also arise after the operation. Some surgical patients with postoperative complications may experience various mental disorders. Surgical intervention and forced bed rest can cause various neurotic disorders. Quite often at patients for 2 - the 3rd day after operation there is a discontent, irritability. Against the background of asthenia, especially if there are complications after the operation, a depressive state may develop. Elderly people in the postoperative period may experience a delirious state with the presence of hallucinations and delusional experiences. Its genesis is complex, predominantly toxic-vascular. Alcoholic delirium often develops in patients suffering from alcoholism in the postoperative period.

It is always advisable for patients with psychosis, if the somatic condition allows, to be transferred to a psychiatrist for observation. Quite often, psychotic states develop in the form of short-term episodes and are easily stopped by the appointment of tranquilizers and antipsychotics. Questions of further treatment should be decided by the attending physician or the doctor on duty, taking into account all the circumstances.

Difficult questions arise when communicating with patients operated on for a malignant neoplasm. They are concerned about their future fate, ask questions whether they have a malignant tumor, whether there were metastases, etc. In a conversation with them, you need to be very careful. It should be explained to the patients that the operation was successful and they are not in danger in the future. With such patients it is necessary to conduct psychotherapeutic conversations.

Patients react heavily to operations to remove individual organs (gastric resection, removal of the mammary gland, amputation of limbs, etc.). Such patients have real difficulties of a social and psychological nature. Patients with a psychopathic personality structure consider their physical defect as a “collapse of later life”, they develop depression with suicidal thoughts and tendencies. Such patients should be constantly monitored by medical personnel.

Modern rules of ethics and deontology

Work in a department or in a hospital must be subject to strict discipline, subordination must be observed, that is, the official subordination of a junior to a senior.

A medical worker in relation to patients must be correct, attentive, and not allow familiarity.

The doctor must be a highly qualified specialist, comprehensively literate. Now patients read medical literature, especially on their illness. The doctor should in such a situation professionally and delicately communicate with the patient. Incorrect actions of doctors or medical personnel, an inadvertently spoken word, tests or medical history that have become available to the patient can lead to a phobia, that is, fear of a particular disease, for example: carcinophobia - fear of cancer.

Deontology refers to the preservation of medical secrecy. In some cases, it is necessary to hide from the patient his true disease, such as cancer.

Maintaining medical secrecy applies not only to doctors, but also to medical staff, students, that is, to all those who are in contact with patients.

There is a rule: "The word heals, but the word can also cripple." Medical secrecy does not extend to the relatives of the patient. The doctor must inform the relatives of the true diagnosis, the patient's condition and prognosis.

Iatrogenicity is closely related to medical deontology - this is a painful condition caused by the activities of a medical worker. If a person is suspicious, psychologically unstable, then it is easy to suggest to him that he has some kind of disease, and this person begins to find various symptoms of an imaginary disease. Therefore, the doctor must convince the patient in the absence of imaginary diseases. Iatrogenic diseases include diseases and injuries resulting from improper actions or treatment of the patient. So, iatrogenic diseases include hepatitis that develops after infusion of infected blood or plasma. Iatrogenic injuries include injuries of internal organs during abdominal operations. This is damage to the spleen during resection of the stomach, the intersection of the common bile duct during cholecystectomy, etc.

Deontology also includes relationships with colleagues. You can not criticize or evaluate the actions of a colleague in the presence of a patient. Remarks to colleagues should be made, if necessary, face to face, without undermining the authority of the doctor. The doctor in his work should not withdraw into himself, the discussion of the cases causing the attending physician should be carried out collegially. The doctor should not shy away from any advice, whether it be from an older or younger one. You should never tell a patient that this consultant is bad if he does not agree with your diagnosis. If disagreements arose during a joint examination with colleagues, it is necessary to discuss them in the intern's room, and then, on the basis of the truth reached in the dispute, it is necessary to communicate the general opinion to the patient in this way: "We discussed and decided ...". When making a diagnosis, determining indications and contraindications, choosing a method of operation, the doctor should consult. It is no coincidence that all future operations are discussed collectively. The same applies to the choice of tactics during manipulations. If during the manipulation the doctor encounters an unforeseen situation, technical difficulties, an anomaly of development, then he should consult, call a senior colleague, if necessary, ask for his participation in the further course of action.

Relations with the middle and junior medical staff should be democratic - they know and hear everything - it is necessary to bring them to their side in terms of maintaining medical secrecy - do not tell either the patient or relatives about the existing disease or pathology, the methods of treatment used, etc. Educate them the correct answer to all questions: “I don’t know anything, ask your doctor.” Moreover, all these issues should not be loudly discussed and issued to anyone. In addition, a sense of duty, responsibility, goodwill should be brought up; given the necessary knowledge and skills.

The tactics of the doctor, his behavior should always be built depending on the nature of the patient, the level of his culture, the severity of the disease, and the characteristics of the psyche. With suspicious patients it is necessary to have patience; all patients need consolation, but at the same time, the doctor's firm confidence in the possibility of a cure. The most important task of the doctor is the need to achieve the trust of the patient and careless word and action not to undermine him in the future. If the patient does not go to the doctor in the future, he does not trust him as a specialist. This is already a sign that this is a “bad” doctor, they are going to a “good” one, even despite the first failure. So, the doctor failed to establish contact and mutual understanding.

The relationship of a doctor with relatives is the most difficult problem of medical deontology. If the disease is common and the treatment is going well, full frankness is acceptable. In the presence of complications, we allow a correct conversation with the next of kin. But it is not at all necessary to tell your husband that you have performed surgery for ectopic pregnancy and the patient in a week will be like a “cucumber” - she will come out sideways to her, especially since her husband was on a business trip for six months.

Conclusion

Ukraine today is drawn into the whirlpool of historical cataclysms. This applies not only to the economic foundations, but also to the morality of the whole people. We are experiencing a profound spiritual revolution. The transition from many restrictions to complete - alas, up to anarchic - freedom is very tempting, but it does not come without serious losses. The pendulum of our ascetic moral foundations with the formally proclaimed equality, brotherhood, freedom, having passed the zero mark, moved into the opposite position of permissiveness, self-interest, cruelty, immorality. Probably, we will pass this test, but so far the revolutionary current has swept away our ideas about good and evil, opposed our almost patriarchal mentality to the thirst for profit, the power of the purest. But at the same time, in this muddy stream, bright new values are more and more firmly indicated: the rights of the individual, the rights of a person who ceases to be just a particle of the whole, but begins to act as a free and self-sufficient quantity.

Along with the unheard of progress in various fields of medicine, its moral and philosophical principle cannot remain unchanged.

The concept of medical ethics and deontology is ambiguous. This is the relationship with the patient, born and based on deep feedback. This is also a counterpoint between the patient and society, relatives, acquaintances, colleagues. It is very important to remember that the doctor has tremendous power over a sick person, because the patient trusts him with his life. This sometimes unlimited power is one of the magical facets of the attractiveness and the greatest responsibility of our profession. For a good person, this is an unlimited space of kindness and compassion, but God forbid such power - to a selfish and evil person!

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Ethics

Ethics studies the relationship of people, their thoughts, feelings and deeds in the light of the categories of goodness, justice, duty, honor, happiness, dignity. The ethics of a doctor is a truly human morality and therefore only a good person can be a doctor.

The moral requirements for people involved in healing were formulated back in the slave-owning society, when there was a division of labor and healing became a profession. FROM ancient times medical activity was highly revered, because it was based on the desire to save a person from suffering, to help him with ailments and injuries.

The most ancient source in which the requirements for a doctor and his rights are formulated is considered to be related to the 18th century. BC. "Laws of Hammurabi", adopted in Babylon. An invaluable role in the history of medicine, including the creation of ethical standards, belongs to Hippocrates.

He owns the axioms: “Where there is love for people, there is love for one’s art”, “Do no harm”, “Physician-philosopher is like God”; he is the creator of the surviving "Oath" that bears his name. Hippocrates for the first time paid attention to the relationship of the doctor with the relatives of the patient, the relationship of doctors. The ethical principles formulated by Hippocrates were further developed in the works of ancient doctors A. Celsus, K. Galen and others.

The doctors of the East (Ibn Sina, Abu Faraja, and others) had a huge influence on the development of medical ethics. It is noteworthy that even in ancient times the problem of the relationship of a doctor to a patient was considered in terms of their cooperation and mutual understanding.

In Russia, advanced Russian scientists have done a lot to promote the humane orientation of medical activity: S.G. Zybelin, D.S. Samoilovich, M.Ya. Mudrov, I.E. Dyadkovsky, S.P. Botkin, zemstvo doctors. Of particular note are the “Sermon on piety and moral qualities of the Hippocratic doctor”, “Sermon on the way to teach and learn practical medicine” by M.Ya. Mudrova and works by N.I. Pirogov, which are an "alloy" of love for their work, high professionalism and care for a sick person. The "holy doctor" F.P. Haaz, whose motto was "Hurry to do good!".

The humanistic orientation of the activities of Russian doctors is comprehensively described in the works of writers-physicians A.P. Chekhov, V.V. Veresaeva and others.

Morality is one of ancient forms social regulation of human behavior and human relationships. A person learns the basic norms of morality in the process of education and perceives following them as his duty. Hegel wrote: “When a person performs this or that moral deed, then by this he is not yet virtuous; he is virtuous only if this mode of behavior is a constant feature of his character.

On this occasion, Mark Twain noted that “we do not use our morality very well on weekdays. By Sunday, it always needs repair.

A morally developed person has a conscience; the ability to independently judge whether his actions correspond to moral norms accepted in society, and is guided by this judgment when choosing his actions. Moral principles are especially necessary for those specialists whose object of communication is people.

Some authors believe that there is no special medical ethics, that there is ethics in general. However, it is wrong to deny the existence of professional ethics. After all, in each specific sphere of social activity, the relations of people are specific.

Each type of work (doctor, lawyer, teacher, artist) leaves a professional imprint on the psychology of people, on their moral relationships. Interesting thoughts about the connection between moral education and the professional division of labor were expressed by Helvetius. He said that in the process of education it is necessary to know "what talents or virtues are characteristic of a person of a particular profession."

Professional ethics should be considered as a specific manifestation of general ethics in the special conditions of a particular activity The subject of professional ethics is also the study of the psycho-emotional features of a specialist, manifested in his relationship with sick people (disabled people) and with his colleagues against the background of certain social conditions.

The peculiarities of the doctor's professional activity determine the fact that in medical ethics there is always a relatively more In any case, more than in the ethical norms that regulate the activities of people of other professions, the universal norms of morality and justice are expressed.

The norms and principles of medical ethics can correctly guide a medical worker in his professional activity only if they are not arbitrary, but scientifically substantiated. This means that various recommendations regarding the behavior of doctors, developed by medical practice, need theoretical reflection.

Medical ethics should be based on a deep understanding of the law of the natural and social life of man. Without a connection with science, moral norms in medicine turn into groundless compassion for a person. The doctor's true compassion for the sick (disabled person) must be based on scientific knowledge. In relation to the patient (disabled), doctors should not behave like inconsolable relatives. According to A.I. Herzen, doctors "can cry in their hearts, take part, but understanding, not tears, is needed to fight the disease." To be humane in relation to sick people (disabled people) is not only a matter of the heart, but also of medical science, of the medical mind.

Some of the failed physicians are so skillfully attuning their behavior to the needs of medical ethics that it is almost impossible to reproach them for not having a vocation for medicine. We are talking about “that coldly businesslike accounting, indifferent attitude to the most acute human tragedies,” wrote the famous Russian surgeon S.S. Yudin, “when behind the guise of so-called professional restraint and restrained courage, they actually hide egoistic insensitivity and moral apathy, moral squalor.”

Lisovsky V.A., Evseev S.P., Golofeevsky V.Yu., Mironenko A.N.

A doctor is one of the most ancient professions, it is a very important and sometimes heroic profession. Doctors are responsible not only for the life and physical health of their patient, but also for his moral health. In order to perform their duties efficiently, only medical knowledge is not enough, so doctors need to know certain rules and norms of communication with the patient.

Medical or medical ethics is a very important part of the professional activity of doctors. It consists of ethical standards, as well as the responsibilities of workers in the medical field. Every doctor must observe medical ethics.

Of course, every medical worker, in addition to professional knowledge, must have such qualities as respect for the patient, the desire to help. This is especially necessary for patients who are having a hard time with their diagnosis, for example, HIV-positive. It is very important to hear words of support not only from close people, but also from the attending physician. It is very important for the patient to be listened to, to know that he is respected and not judged, to receive accessible information. Medical ethics also includes the ability to communicate competently not only with patients, but also with their relatives, they also need to explain everything in an accessible and competent way, and show sympathy. This is especially necessary in situations where a person is given an unfavorable diagnosis (for example, information about positive test for HIV).

Meanwhile, it is worth noting that medical ethics is closely related to the concept of "medical secrecy" (a socio-ethical, medical and legal concept that prohibits the disclosure of data about a person to third parties). The doctor does not have the right to disclose to anyone any information about the diagnosis, disease, state of health of the patient, as well as information about the fact that a person has applied to a medical institution, his personal life and treatment forecasts. Article 13 of Federal Law No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens of the Russian Federation” enshrines the right of a citizen to preserve medical secrecy. If a doctor fails to comply with this right of a citizen, he may be held liable.

Compliance with medical ethics involves the preservation of medical secrecy. Doctors have the right to disclose personal information about the patient and his diagnosis only if it is necessary for his treatment, and if the patient himself has consented to the disclosure of his personal data. In addition, in the event of a court request requiring the disclosure of these data for legal proceedings, or during medical and military examinations.

It is worth noting that not only doctors must observe medical secrecy, but also all those who, on duty, had to find out details about the disease or confidential information about the patient (pharmacists, paramedics, nurses, orderlies, pharmacy pharmacists, etc.).

In modern society, there are a lot of dangerous and incurable diseases, and the doctor should not disclose this information about the patient. Article 61 of Federal Law No. 5487-1 "Fundamentals of the Russian Federation Legislation on the Protection of Citizens' Health" guarantees the right not to disclose information about HIV-positive people, and there is also a list of situations in which disclosure of medical confidentiality is permitted.

Today, medicine has become much more advanced, doctors are widely educated, so patients do not have to worry that someone can find out their personal information. Medical workers are obliged to keep medical secrecy, and the law is on the side of patients in this aspect. Health workers should remember that they are expected to help and support, so it is important for them to be not only good professionals but also patient people.

Rules of professional ethics of a medical worker. The doctor-patient relationship. Interaction between nurses

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Ethics