Awareness of family physician residents of their roles in disaster health management: a cross-sectional study in Turkey.

AIM: Family physicians are role models for their societies in disaster management and have an important place in it. This study was carried out during the specialty training of the residents, who are currently family physicians fighting against COVID-19 in the field, and was aimed to identify the awareness levels of residents regarding the roles and duties of family physicians before, during, and after disasters and to increase their awareness of disaster medicine and management. BACKGROUND: The duties and responsibilities of a family physician in disasters should be a part of their specialty training. This study has contributed to the limited literature, increased awareness, and opened a new avenue of research for studies to be conducted with family physicians by demonstrating the current situation of family physicians in disaster management. METHODS: This is an observational and descriptive study. The knowledge, experience, opinions, willingness, attitudes of the residents, and the awareness levels of the residents regarding their roles and duties in a disaster were evaluated along with their sociodemographic information. The surveys were applied in the family medicine clinics of the all residents by the interview method (n = 233). FINDINGS: Only 9.2% of the residents stated that they had received training on disaster medicine where they currently work. The knowledge level of the residents on this subject was found as 'Unsure'. In total, 80% of the residents stated that family physicians should have a role in disasters. It was found that 83.3% of the residents had never joined a disaster drill, 94.3% had never participated in making or applying a disaster plan, and 97.7% had never worked in any disaster. CONCLUSION: The residents participating in the study lacked not only information on disaster management but also experience. The residents' willingness to receive training, work voluntarily, significantly question the curriculum, and specialize in disaster medicine were a positive outcome.

Treatment of tuberculosis in Turkey in terms of medical ethics.

Having a history as old as the history of humanity, Tuberculosis (TB) is a serious disease and it is regarded as an important a public health problem not only for its medical aspect but also for its social and ethical aspects. As a result of the discovery of the cure for TB and the improvement of humans' living conditions, the TB problem was believed to be solved and a relaxation in the battle against TB was observed around the world by 1980s. World Health Organization (WHO) declared a state of emergency for the battle against TB in 1993. According to the "Global Tuberculosis Control 2014" which was published by WHO, TB remains one of the world's deadliest communicable diseases. This article argues that tuberculosis is one of the most important neglected topics in medical ethics as regards individual obligations to avoid infecting others, coercive social distancing measures, third-party notification, health workers' duty to treat contagious patients, and justice.The purpose of this article is provide a picture of the current situation of TB treatment in Turkey in terms of medical ethics.

Physicians' attitudes at the end-of-life: a cross-cultural evaluation.

Physician's attitudes towards patients with incurable cancer or at the end-of-life process--treatment of patients, withholding ventilation support, physician-assisted suicide--have changed rapidly in recent years. In cases such as incurable cancer, illnesses in the terminal phase, some neurologic diseases and AIDS, physicians and other health care workers experience dilemmas, arguments and problems on the subjects of whether or not to tell the truth or how to do it, who should inform the patient or his/her guardian, and then, how to give treatment to patients with incurable cancer or withhold ventilation support. All of these issues are affected by the country's' sociocultural and economic structures, the physician's attitudes at the end of life,the medical practice and the form of health structures. In this study our objectives are to assess physicians' views in Turkey regarding the process of the end of life and decision-making, to compare them with views from the USA, Japan and Saudi Arabia and to cristalize a cross-cultural assessment. Our study contains three clinical situations covering the following areas: (1) a patient's right to be informed of incurable cancer, (2) doctor-assisted suicide (3) the conflicting rights of patients, doctors and the family in issues such as refusing ventilatory support or witholding treatment. The four-point Likert Scale was used to mark the responses to the statements. The significant cultural, social and economic differences that exist in health care services between regions in our country affect physician-patient communication and end of life decision-making, as reflected in the process of obtaining informed consent.

The legal grounds regarding clinical trial in Turkey.

The first mention of clinical trials in a legal document occurred in Turkey many years before the Helsinki Declaration or Belmont report; issued in 1926, the Code of Pharmaceutical Products and Preparations No. 1262 law carries the statement: "Experimental drugs can be used in a patient only by his/her permission". Then the other regulation is the Regulation on Medical Deontology, dated 1960, and still in force. Article 10 and 11 of this Regulation address physicians and dentists who are conducting research. After periods of misconducted and ill-designed studies, the modern era of clinical trials began in 1993 with the introduction of the "Drug Research Bylaw". This document was directly influenced by the initial drafts of ICH-GCP Guidelines, and some parts were very similar. This became the main document that regulates the conduct of clinical trials in Turkey. A good clinical practice (GCP) guidelines document was added in 1995. On the other hand, an amendment made to Article 90 of the New Turkish Penal Code No. 5237 of 26 September 2004, which will come into force on 1st April 2005, envisages that in conflicts between international treaties concerning basic rights and freedoms and national laws, priority will be given to the international treaties. Therefore, in Turkish law, international treaties concerning basic rights and freedoms are given precedence as compared with national laws and other regulations. The Article stipulates the conduct of research on conditions such as not violating human well-being and dignity.

Gender, infertility, motherhood, and assisted reproductive technology (ART) in Turkey.

In Turkey, as in many other countries, infertility is generally regarded as a negative phenomenon in a woman's life and is associated with a lot of stigma by society. In other words, female infertility and having a baby using Assisted Reproductive Technologies (ART) have to be taken into consideration with respect to gender motherhood, social factors, religion and law. Yet if a woman chooses to use ART she has to deal with the consequences of her decision, such as being ostracized by society. Other types of procedures in this area, such as sperm and ova donation or surrogate motherhood, are not permitted in law. However; both before and after the development of this techonology, society has been finding its own solutions which are rarely questioned and are still performed This article will discuss what these practices are and try to reach some pragmatic conclusions concerning female infertility, the concept of motherhood and some traditional practices in Turkey.

Bioethics committees and examining consent within the patient-physician relationship in Turkey.

Clinical exercises include questions about a physician's behaviour, decision making process, values, rights and responsibilities, as much as the scientific-technical questions concerning the disease. Some of these questions may be easily answered, for there are well-constructed activity options that have found widespread acceptance regarding what has to be done. However, it is quite difficult to answer the questions with problematic options, or the ones on which a compromised attitude is not present. Patient participation in treatment-related decision-making has been promoted as being ethically and clinically desirable in Western countries. Several studies have indicated that patient participation in decision-making has a positive influence on their health outcomes, thereby increasing patient satisfaction regarding medical care and promoting patient autonomy. Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Turkey, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Turkish people regarding involvement in treatment-related decision-making are limited. In Turkey, to protect the rights of patients, current Govermental requirements mandate that all human biomedical research and medical intervention be accompanied by a consent form that contains the information necessary for an informed decision. In addition, they require that the information provided to the subject or the representative shall be explained in appropriate language. Especially after the new regulations in the Turkish Penal Code, physicians and nurses have started to be more sensitive towards informed consent and have become more conscious about their responsibilities. It has started to be questioned more, and as a result, the problems experienced about patient consent in medical applications created new ethical dilemmas. Informed consent is acknowledged to be the most essential constituent of patient rights today. In this paper, after introducing a general overview of the significance and requirements of informed consent, we will consecutively discuss the decision making and informed consent process, legal arrangements concerning this issue in Turkey, the approaches of physicians and patients towards the topic, and regarding informed consent, we will discuss the responsibilities of hospital ethics committees.

Critique of medical history education in Turkey's medical faculties.

In this article the curricula at the baccalaureate level of 18 medical faculties in our country that have Deontology-Medical Ethics and Medical History departments have been evaluated and classified, looking at the number of hours and topics. Our purpose for this study was, particularly from the aspect of medical history, to compare curricula in departments in which this class is given, to display shared and different directions, and to draw a general framework of medical history education in our country. The study was conducted between March and May 2004.A questionnaire with a total of 12 questions was sent by e-mail or fax to the related departments in the medical faculties. The data that were collected on the questionnaire included a) the year of foundation of the related department and the Medical Faculties that have Deontology-Medical History and Ethics Departments, b) the names of the faculties that have baccalaureate and doctoral programs, c) the number of teaching staff in these faculties, d) the length of medical history and ethics classes and their timing in semesters, e) the stated basic purpose and objectives of medical history classes, f) information about journals related to medical history in our country and g) organized ongoing medical history education. In this study qualitative and quantitative data were evaluated simultaneously, the purpose of medical history classes and the part that these classes play in developing the physicians' identity were assessed together with other results.

Statutory disclosure in article 280 of the Turkish Penal Code.

A new Turkish Penal Code came into effect on 1 June 2005. Article 280 concerns health care workers' failure to report a crime. This article removes the responsibility from health care workers to maintain confidentiality, but also removes patients' right to confidentiality. It provides for up to one year of imprisonment for a health care worker who, while on duty, finds an indication that a crime might have been committed by a patient and who does not inform the responsible authorities about it. This forces the health care worker to divulge the patient's confidential information. A patient who thinks he or she may be accused of a crime may therefore not seek medical help, which is the universal right of every person. The article is therefore contrary to medical ethics, oaths taken by physicians and nurses, and the understanding of patient confidentiality.

Violence against women in Turkey and the role of women physicians.

Violence against women is a serious problem in Turkey. The Women and Ethics Commission of the Turkish Physicians' Association (Ankara Physicians' Chamber) has undertaken significant work to counteract this. This article gives some indications of the sources of violence and discusses its social and health care implications. The Commission is pivotal in the education of women physicians and in heightening awareness of the situation. An outline is given of this work and recommendations are made on how violence against women can be tackled and eliminated.

Emerging health sector problems affecting patient rights in Turkey.

It is accepted throughout the world today that a new approach is needed to health care, one that brings to the forefront the role of economic development. This situation has also increased the importance of the health care sector and health data have begun to take a significant place in countries' development indicators. Health care services as a basic indicator of social and economic development in Turkey, as in the rest of the world, continue to gain in importance. However, there is a significant difference between health indicators for Turkey, which is a candidate for full membership of the European Union, and European Union countries.

Obstetric and gynecologic malpractice in Turkey: incidence, impact, causes and prevention.

The Forensic Medicine Association was established in Turkey by law number 2659 for the purpose of providing expertise in legal cases. In this study the opinions given by the lawcourts and public defenders in the Forensic Medicine Association's First, Second, Third, and Fifth Specialization Divisions between the years 1990 and 2000 (approximately 680,000 files) were examined retrospectively. It was determined from these that there were 636 cases of medical malpractice. In examining the distribution of cases based on specialty branch, it was established that 16.82% (n=107) were in the area of obstetrics and gynecology, 10.69% (n=68) in general surgery, 10.53% in neurology and neurosurgery, and the remaining areas were found to be at lower percentages. It also showed that in recent years there has been an increase in the number of cases claiming medical malpractice in the area of obstetrics and gynecology, and that 58% of the cases (n=62) from 1998 to 2000 were in this area. 96% of the 107 cases that claimed malpractice in the area of obstetrics and gynecology were found to be related to obstetrics and 3.8% (n=4) to gynecology and surgical procedures. In 31% (n=33) of the 107 cases fault was found; all of the cases where medical malpractice was found were in the area of obstetrics and none of the cases related to gynecology were found to have an element of error. Cases that had an element of error were evaluated from the aspect of profession of the health care personnel at fault, areas of fault, places where fault occurred, situations that resulted in death, cause of death, whether or not an autopsy was done, injury that resulted from fault, intervention that was done, and obstetric and gynecologic risk factors that set the stage for claims. Care standards and breach of standards were examined.

The legal and ethical aspects of medical malpractice in Turkey.

The issue of patients' rights is relatively unknown in our country but it is often recalled when an incident of death or disability is suspected as being caused by a physician's error. However patients' rights are being violated thousands of times every day in our country. More than these patients' rights' violations, the essential point is the lack of a mechanism to claim those rights and to complain about the practices which violate them. In our country, patients and their relatives are uninformed, powerless and unprotected against physicians and health organizations, and they typically accept whatever happens to them without complaint. Some of the reasons for this are, presumably, an underdeveloped consciousness of patients' rights, an absence of patient organizations, and insufficient ethical and legal regulations on patients' rights. These deficiencies were diminished somewhat by the "Regulation on Patients' Rights," which was prepared by the Ministry of Health in 1998. Another legal draft law referred to as "Responsibilities Due to Malpractice in Medical Services" has been prepared and is in the process of becoming law. This draft law and the general conditions of the country on this subject are evaluated in this article.

[Clinical drug research from medical ethics and legal perspectives]. / Tip etigi ve tip hukuku açisindan klinik ilaç arastirmalari.

Medical ethics and law in clinical drug research are the two main points that have been discussed in public and medical circles. Conducting drug research on "easily affected and vulnerable groups", such as psychiatric patients, has always been a controversial issue in medicine. How should human subjects be protected, especially psychiatric patients, who are defined as "vulnerable subjects and groups"; what are the ethically and legally justifiable reasons for basing drug research on psychiatric patients; and what can be said about responsibilities in the context of medical ethics and law? Patients who are in the mentioned groups can not be informed clearly about the characteristics of research which they would be involved in. In recent years psychiatric, geriatric, anesthesiology and pediatric patients are defined as "patients who do not have the ability for consent". In this article answers will be given to questions such as why medical ethics is interested in clinical drug research, and what kind of roles should ethics play in drug research. The situation worldwide will be analyzed from a historical approach with regard to laws and regulations concerning drug research. The legal rights of human subjects who have the ability to give informed consent and of those who do not will be discussed and the place of psychiatric patients as human subjects in drug research will be addressed. Some unethical examples and their consequences will be considered and discussed. In this context, a critical evaluation will be made of the situation in Turkey.