ABSTRACT
Background: The recognition of ethical problems in medical practice and the potential harmful effects that they may have on patients, underscores the importance of the ethical training of professionals as well as the development of Ethics Committees in Healthcare institutions. However, there is a paucity of national studies about the type of problems faced by professionals and the role of Ethics Committees in hospitals. Aim: To explore the perception about ethical problems in clinical practice of Chilean physicians of different specialties of two public teaching hospitals. Material and Methods: Physicians of both sexes and different specialties working in two teaching hospitals of Metropolitan Santiago, were invited to participate in focus groups of seven to eight participants. They discussed the ethical problems faced during their clinical practice. A content analysis based on the Grounded Theory was performed with the obtained information. Results: Different types of ethical problems could be distinguished according to their content and the actors involved. The data obtained shows that the ethical dimension is present in the daily work of physicians. The evolution of the narrative throughout the interviews corroborated the importance of installing ethical issues and culture in the working routine of health care professionals. Conclusions: Human resources and an adequate institutional environment are required to promote the discussion about ethical issues such as the relationship between physicians and patient, the role of teaching in health care and institutional decisions.
Subject(s)
Humans , Male , Female , Physicians , Health Personnel , Delivery of Health Care , Hospitals, Public , MoralsABSTRACT
La actual pandemia por COVID-19 está generando un impacto sin precedentes en las distintas esferas de la vida, al mismo tiempo que ha puesto en valor la importancia que la disciplina Bioética tiene para el análisis y la deliberación de los desafíos éticos emergentes, previo a la adopción de decisiones razonables y prudentes. Un tema insuficientemente tratado en el curso de esta crisis, cuyos negativos efectos, se consideran, pueden llevar no sólo a interferir los canales de comunicación con la ciudadanía sino a afectar la adherencia esperada de la población a las indicaciones que se necesita que sigan, es la relativa al manejo y comunicación de la información. Asunto especialmente complejo cuando se vive un período de explosión informativa, caracterizada por la Organización Mundial de la Salud como «infodemia¼. Este artículo, reivindicando el imperativo ético y jurídico de actuar responsable en la obtención, uso y difusión de la información que asiste a toda autoridad que desempeña una función social, propone una serie de recomendaciones para alcanzar su efectividad en la práctica.
The current COVID-19 pandemic is producing an unprecedented impact in the different spheres of life, at the same time that it has highlighted the importance that the Bioethics discipline has in analyzing and deliberating of emerging ethical challenges, before making reasonable and prudent decisions. The management and communication of information on this crisis has not been properly addressed, where it is considered that its negative effects may lead not only to interfere with the communication channels with citizens but also affect the expected adherence of the population to the indications that they need to follow. This issue is especially complex when experiencing a period of information explosion, a phenomenon called 'infodemic' by the World Health Organization. This article, claiming the ethical and legal imperative to act responsibly in collecting, using, and disse minating the information that helps any authority that plays a social function, proposes a series of recommendations to achieve its effectiveness in practice.
Subject(s)
Humans , Bioethical Issues , Information Dissemination/ethics , COVID-19 , Bioethics , Communication , Decision Making , Information Dissemination/legislation & jurisprudenceABSTRACT
Current Medical Ethics are based on a model that emphasizes doctor-patient shared decision-making process. Its utmost expression is through the doctrine of informed consent (IC). In this environment there is little empirical data regarding the use of IC among adult patients, and even less in Pediatrics. Objectives: 1) Explore parents' perceptions of their rights, duties, and exercise of autonomy through an evaluation of their expectations of the communication process of IC; 2) Describe common practices and experiences of physicians and nurses as they request IC to parents of hospitalized children. Method and Sampling: Descriptive, exploratory study in three subject groups: a) patient guardians; b) pediatricians; c) physicians and nurses. A common questionnaire was adapted for each group, utilizing open and closed questions, exploring subjects' perceptions of experiences and expectations. Open questions were evaluated for common themes by 2 independent judges. Results: 100 percent of professionals agreed that guardians should be informed of the medical situation of the patient. However, less than half of guardians felt they had received information continuously, showing a gap in desired information and communication difficulties. No guardian mentioned the possibility of participating in medical decision-making. Conclusions: Results allow a data-based discussion regarding professional practices and patient preferences. New challenges arise for health care teams to improve the process of IC incorporating the needs of patients and professionals.
Las actuales declaraciones éticas se basan en un nuevo modelo de relación clínica que enfatiza la deliberación y participación de médico y paciente en la toma de decisiones. Estos elementos poseen su mejor expresión en la doctrina del consentimiento informado. En nuestro medio disponemos de escasos datos empíricos que exploren la puesta en marcha del consentimiento informado en pacientes adultos y menos aún en pediatría. Objetivos: 1) Explorar la percepción de los padres respecto a sus deberes, derechos y ejercicio de su autonomía por medio del análisis de sus expectativas respecto al proceso comunicativo de consentimiento informado; 2) Describir las vivencias y prácticas habituales de médicos y enfermeras en el proceso de ofrecer información y solicitar el consentimiento a los padres de niños hospitalizados. Método y Muestra: Estudio descriptivo, exploratorio, realizado en tres grupos de sujetos: tutores de pacientes, pediatras, médicos y enfermeras. Se aplicó un cuestionario adaptado para cada grupo en estudio, que consta de una sección de preguntas abiertas y una de preguntas cerradas que exploran la percepción de los sujetos en relación a las experiencias vividas y sus expectativas sobre la información a entregar o recibir. Los datos abiertos fueron examinados estableciendo categorías temáticas por 2 jueces independientes. Resultados: El 100 por ciento de los profesionales se mostró de acuerdo en que los tutores deben ser informados de la situación médica del paciente, sin embargo, menos de la mitad de los tutores refiere haber recibido información permanentemente existiendo diferencias entre éstos y profesionales respecto a la información deseada y dificultades en la comunicación. Ninguno de los tutores mencionó la posibilidad de participar en las decisiones médicas. Conclusiones: Los resultados permiten abrir una reflexión empíricamente fundada sobre las prácticas profesionales y preferencias de los pacientes explicitando...
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Communication , Caregivers/psychology , Nurses/psychology , Informed Consent , Physicians/psychology , Ethics , Interpersonal Relations , Pediatrics , Personal Autonomy , Personal Satisfaction , Parents/psychology , Surveys and Questionnaires , Truth DisclosureABSTRACT
Truth telling in medicine is difficult and stressful. Medical training teaches to mitigate pain and suffering, but death and health deterioration causes feelings of frustration among physicians. Physicians tend to conceal bad news to avoid the suffering caused by such adverse information. However, veracity is an integral part of a respectful relationship and is the basis of confidence between patients and health providers. However, confusing truthfulness with a mere exposure of all the available information is an oversimplification of the problem. Therefore the real issue drifts from "how convenient is to communicate the truth" to "how to share the information with my patient" in a setting in which he can express his feeling and thoughts. Communicating the truth is an ethical imperative. The patient has the right to be informed and the physician must provide this information timely and taking into account the capacity, interest and emotional status of the patients. Therefore prudence, warmth and bioethical reasoning are required for a good medical practice.
Subject(s)
Humans , Physician-Patient Relations , Truth Disclosure , Duty to Warn/psychology , Ethics, MedicalABSTRACT
Background: Physician-patient relationship is the basis of clinical practice. In the last decades, the changes in this relationship have influenced the degree of satisfaction of physicians with their practice. Aim: To explore the perception of physicians about changes in physician-patient relationship and its impact in their personal and professional satisfaction. Material and methods: Qualitative study involving 44 physicians from the Metropolitan Region of Chile. Focus groups and semi-structured interviews were used. Results: All physicians mentioned changes on physician-patient reltionship as one of the most important factors that has impact on their satisfaction. The main cause for the deterioration of this relationship is a generalized climate of distrust that leads to frustration and disenchantment with the profession. Conclusions: This feeling is in accordance with other reports showing that patients are progressively acquiring more protagonism in health care decisions. The reconstruction of the bond between patients physicians within these new scenarios is indispensable to improve the degree of satisfaction of both patients and professionals.