Ethical challenges in accessing and providing healthcare for Syrian refugees in Türkiye.

Türkiye hosts approximately 3.6 million Syrian refugees, which accounts for roughly 4.5% of Türkiye's population. This places undeniable pressure on public institutions, particularly on healthcare services. The objective of this study is to document the healthcare structure for Syrian refugees and various challenges faced by Syrians when seeking healthcare and to highlight the ethical concerns emerging from those challenges. To achieve this, we conducted a comprehensive review of several qualitative studies and reports conducted by various organizations and institutions, specifically focusing on health or including a dedicated chapter on health issues, published between 2011 and 2023. Following an extensive analysis of the secondary literature, we classified the challenges into three categories: procedural, cultural, and psychosocial. We argue that each of these challenges is linked to overarching medical ethics concerns. Finally, we propose three possible means to mitigate the challenges Syrians experience in accessing and uptake of healthcare services in Türkiye.

Individuals living with cancer in Turkey and the COVID-19 pandemic / Las personas que viven con cáncer en Turquía y la pandemia de COVID-19 / As pessoas que vivem com câncer na Turquia e a pandemia da COVID-19

Abstract: The aim of this study is to determine the problems faced by individuals living with cancer (ILCs) in accessing health services during the COVID-19 pandemic in Turkey. This qualitative study's sample consisted of 18 volunteer interviewees from 10 cancer-related patient associations in Turkey. Research data were collected by semi-structured interview method. Data collection and analysis were carried out simultaneously. In the sessions where all researchers participated together, the data were coded with a common view, and main and sub-themes were determined. In the analysis of the data the inductive thematic analysis method was applied. Information was gathered under two main themes: compliance with the measures taken and access to health services. Lack of information about nutrition, physical activity, psychological problems, caused by the lockdown and social distance measures taken within the scope of the pandemic should be accepted as problems within the scope of the right of individuals to access health, and additional programs should be prepared to minimize these. Cancer types should be considered in delaying diagnosis, treatment, and controls related to cancer, so that patients are not harmed at least or at all. It is important to ensure that patients do not hesitate to attend diagnosis, treatment, and controls with the anxiety of being infected with COVID-19, both in transportation to health facilities and in terms of preventing transmission in health facilities.

Resumen: El objetivo de este estudio es determinar los problemas a los que se enfrentan las personas que viven con cáncer (ILC) para acceder a los servicios sanitarios durante la pandemia de COVID-19 en Turquía. La muestra consistió en 18 entrevistados voluntarios de 10 asociaciones de pacientes relacionados con el cáncer en Turquía. Los datos de la investigación se recogieron mediante el método de la entrevista semiestructurada. La recogida y el análisis de los datos se llevaron a cabo simultáneamente. En las sesiones los datos se codificaron con una visión común y se determinaron los temas principales y los subtemas. En el análisis de los datos se aplicó el método de análisis temático inductivo. La información se recogió bajo dos temas principales: el cumplimiento de las medidas adoptadas y el acceso a los servicios sanitarios. La falta de información sobre nutrición, actividad física, problemas psicológicos, causados por el encierro y las medidas de distanciamiento social tomadas en el ámbito de la pandemia, deben ser aceptados como problemas dentro del ámbito del derecho de las personas a acceder a la salud, y se deben preparar programas adicionales para minimizarlos. Los tipos de cáncer deben tenerse en cuenta a la hora de retrasar el diagnóstico, el tratamiento y los controles relacionados, para que los pacientes no se vean perjudicados en lo más mínimo. Es importante asegurar que los pacientes no duden en acudir al diagnóstico, tratamiento y controles con la ansiedad de ser infectados con COVID-19, tanto en el transporte a los centros de salud como en la prevención de la transmisión en estos centros.

Resumo: O objetivo deste estudo é determinar os problemas enfrentados pelas pessoas que vivem com câncer (PLWC) no acesso aos serviços de saúde durante a pandemia da COVID-19 na Turquia. A amostra consistiu de 18 respondentes voluntários de 10 associações de pacientes relacionados ao câncer na Turquia. Os dados da pesquisa foram coletados usando o método de entrevista semi-estruturada. A coleta e análise de dados foram realizadas simultaneamente. Nas sessões, os dados foram codificados com uma visão comum e os principais temas e subtemas foram determinados. O método de análise temática indutiva foi aplicado na análise de dados. As informações foram coletadas sob dois temas principais: conformidade com as medidas tomadas e acesso aos serviços de saúde. A falta de informação sobre nutrição, atividade física, problemas psicológicos causados pelo confinamento e medidas de distanciamento social tomadas no contexto da pandemia deve ser aceita como problemas dentro do escopo do direito de acesso à saúde das pessoas, e programas adicionais devem ser preparados para minimizá-los. Os tipos de câncer devem ser levados em consideração ao atrasar o diagnóstico, tratamento e check-ups relacionados, para que os pacientes não fiquem em desvantagem mínima. É importante assegurar que os pacientes não hesitem em ir para diagnóstico, tratamento e check-ups com a ansiedade de serem infectados pela COVID-19, tanto no transporte para instalações de saúde quanto na prevenção da transmissão nessas instalações.

Protecting privacy in mandatory reporting of infectious diseases during the COVID-19 pandemic: perspectives from a developing country.

Mandatory reporting of infectious diseases (MRID) is an essential practice to prevent disease outbreaks. Disease notification is a mandatory procedure for most infectious diseases, even during non-pandemic periods in healthcare. The main rationale behind MRID is the protection of public health. The information and data provided by infectious disease reports are used for many purposes, such as preventing the spread and potential negative impact of infectious diseases, assessing the national and global situation regarding reported diseases, conducting scientific research and planning health policy. In this context, the relevant information benefits public health, health systems and scientific work. Additionally, the follow up and treatment of individuals with infectious diseases is a necessity in certain cases to protect those who cohabit with them. However, these benefits cannot be accepted as unrestricted justifications for MRID, since it is evident that reporting should be conducted within ethical and legal boundaries. MRID should only be devised and implemented with due regard to balancing potential benefits between all individuals, as well as between the individual and the rest of society. Disease notification systems that are not designed with a balancing and harm-reductionist approach may lead to stigmatisation and discrimination. This study aims to investigate the legal framework and ethical issues regarding the reporting of individuals diagnosed with COVID-19 in Turkey-which is a primary example of a developing country.

Examining the ethico-legal aspects of the right to refuse treatment in Turkey.

This paper examines the ethico-legal problems regarding the right to refuse treatment in Turkey's healthcare system. We discuss these problems in the light of a recent case that was directly reported to us. We first summarise the experience of a chronically dependent patient (as recounted by her daughter) and her family during their efforts to refuse treatment and receive palliative care only. This is followed by a summary of the legal framework governing the limits of the right to refuse treatment in Turkey. With the help of this background information on the legal framework, we re-examine the ethico-legal aspects of the case and explain the underlying reasons for the problems the family and the patient experienced. Finally, we conclude that Turkey's legal framework relating to the right to refuse treatment needs to be clarified and amended in accordance with international conventions and fundamental human rights.

Towards a specific approach to education in dental ethics: a proposal for organising the topics of biomedical ethics for dental education.

Understanding dental ethics as a field separate from its much better known counterpart, medical ethics, is a relatively new, but necessary approach in bioethics. This need is particularly felt in dental education and establishing a curriculum specifically for dental ethics is a challenging task. Although certain topics such as informed consent and patient rights can be considered to be of equal importance in both fields, a number of ethical issues in dental practice are only remotely-if at all-relevant for medical practice. Therefore, any sound approach to education in dental ethics has to recognise the unique aspects of dental practice in order to meet the needs of dental students and prepare them for the ethical challenges they may face during their professional practice. With this goal in mind, this paper examines the approach of the authors to dental ethics education and proposes a system to organise the topics of biomedical ethics for dental education. While the authors' perspective is based on their experience in Turkey, the proposed system of classification is not a rigid one; it is open to interpretation in other contexts with different social, cultural and professional expectations. Therefore, the paper also aims to inspire discussion on the development of an ideal dental ethics curriculum at an international level.

Advance directives in Turkey's cultural context: examining the potential benefits for the implementation of patient rights.

Advance directives are not a part of the healthcare service in Turkey. This may be related with the fact that paternalism is common among the healthcare professionals in the country, and patients are not yet integrated in the decision-making process adequately. However, starting from the enactment of the Regulation of Patient Rights in 1998, this situation started to change. While the paternalist tradition still appears to be strong in Turkey, the Ministry of Health has been taking concrete measures in the recent years to ensure that patient rights are implemented in healthcare practice. Therefore, Turkey now seems to be in a transitional period where a move towards a more patient-autonomy centred approach is being supported by the regulatory authorities, as well as the academic circles and the public at large. In the light of this background, this paper aims to examine the potential benefits of advance directives, particularly with regard to their possible effect in the clinical decision-making process of Turkey's context. It will be argued that advance directives, if correctly understood and implemented in the right settings, may be beneficial, particularly for improving communication between patients and healthcare professionals and for implementing of the right to refuse treatment.