RESUMO
Introduction: Official documentation of specialty training provides comprehensive and elaborate criteria to assess residents. These criteria are commonly described in terms of competency roles and entrustable professional activities (EPA's), but they may also implicitly encompass virtues. Virtues are desirable personal qualities that enable a person, in this case, a medical specialist, to make and act on the right decisions. We articulate these virtues and explore the resulting implied ideal of a medical professional. Method: We applied a two-staged virtue ethical content analysis to analyze documents, specific to the Dutch training program of the Ear, Nose, and Throat (ENT) specialty. First, we identified explicit references to virtues. Next, we articulated implicit virtues through interpretation. The results were categorized into cardinal, intellectual, moral, and professional virtues. Results: Thirty virtues were identified in the ENT- training program. Amongst them, practical wisdom, temperance, and commitment. Furthermore, integrity, curiosity, flexibility, attentiveness, trustworthiness and calmness are often implicitly assumed. Notable findings are the emphasis on efficiency and effectiveness. Together, these virtues depict an ideal of a future medical specialist. Conclusion: Our findings suggest that competency-frameworks and EPA's implicitly appeal to virtues and articulate a specific ideal surgeon. Explicit attention for virtue development and discussion of the role and relevance of implied ideal professionals in terms of virtues could further improve specialty training.
Assuntos
Medicina , Cirurgiões , Humanos , Virtudes , Princípios MoraisRESUMO
OBJECTIVES: to explain the practice of wish-fulfilling medicine and how it relates to dentistry. SOURCES: Relevant papers, and reports from authoritative institutions were identified in Pubmed and Google Scholar. RESULTS: Wish-fulfilling medicine refers to services provided by professionals using medical methods in a medical setting to address non-medical wishes of patients. Care-providers, medical industries, and health-insurance companies also contribute to wish-fulfilling in medicine and dentistry. Various concepts of health and illness compounded by blurred borders between health and illness offer an unstable foundation for wish-fulfilling medicine, and growing demands for these services where healthcare resources are limited can displace medically necessary treatments. Moreover, treatments without a medical or a dental necessity, can be harmful and bear the risk of futile or excessive treatments not in patients' long-term interest. Examples in dentistry are found in the field of cosmetic interventions, prosthodontics and orthodontics, where perceptions of small 'deviations' from normality prompt wishes or recommendations for intervention. Ethically, wish-fulfilling services confront the principles of the common morality if the autonomy of a patient is compromised, beneficence is unclear, harm is foreseeable, or distributive justice is compromised. Wish-fulfilling dental treatment can be restricted by legislation if it conflicts with safe, effective and efficient care, or if it interferes with patient's real needs or undermines established professional standards. CONCLUSIONS: The general understanding of wish-fulfilling medicine including its ethical and legal themes is relevant to dentistry. CLINICAL RELEVANCE: Ethical considerations and legislation can guide a dentist to reflect critically on clinical decisions regarding wish-fulfilling dentistry.
Assuntos
Odontologia , Preferência do Paciente , HumanosRESUMO
Wish fulfilling medicine (human enhancement (therapy)) concerns medical treatment without a direct medical need. In traditional medicine, a classical triad applies: 1. after investigation symptoms of illness lead to 2. a diagnosis, followed by 3. a proposal for treatment by the health care provider. In wish fulfilling medicine, the emphasis lies on patient's wishes. Wish fulfilling medicine concerns medical treatment, often at the request of the patient, and should be distinguished from shared decision-making,a form of communication seeking to meet the preferences of the patient and to actively involve the patient in his treatment. In the Netherlands, in accordance with the Healthcare Quality, Complaints and Disputes Act, health care providers have to offer good care at a good level, which is safe, effective, efficient and client-orientated, offered in a timely fashion and geared to the real needs of the client. Good care has to meet professional standards. In this way, fulfilling patients' wishes for treatment without a medical need can be restricted by law.
Assuntos
Odontologia/métodos , Odontologia/normas , Legislação Odontológica , Autonomia Pessoal , Tomada de Decisões , Humanos , Países Baixos , Satisfação do PacienteRESUMO
Wish fulfilling medicine comprises medical procedures applied without a direct medical need. In such procedures, the medical-ethical principles can come under pressure: the autonomy of the patient, when wishes originate from social pressure; beneficence when the (underlying) aim and consequences are unclear; and 'doing no harm', when that appears to be impossible. The principle of justice, too, could come under threat when especially those with a privileged socio-economic background can take advantage of wish fulfilling medicine. Regardless of whether it concerns wish fulfilling medicine or conventional medicine, respect for human dignity and the individual integrity of the patient continue to be paramount. In care ethics and moral ethics, the qualities necessary in a proper caregiver are emphasised, such as caring, compassion, commitment, honesty and personal dedication. Wish fulfilling medicine is the subject of significant ethical debate. Important aspects arising from this debate are that the risks of harm should be limited, human dignity and integrity should be respected, people should genuinely be helped and the principle of justice should be upheld.
Assuntos
Melhoramento Biomédico/ética , Ética Odontológica , Ética Médica , Humanos , Satisfação do Paciente , Autonomia PessoalRESUMO
Wish fulfilling medicine refers to medical procedures applied without a direct medical need. In wish fulfilling medicine, the wish of the patient is dominant, but wish fulfilling medicine is also promoted indirectly by healthcare providers, (pharmaceutical) companies and healthcare insurers. Wish fulfilling medicine often concerns the enhancement of appearance or performance; therefore, wish fulfilling medicine is also referred to as (human) enhancement (therapy). The line between traditional and wish fulfilling medicine is vague: the border between illness and health, normal and abnormal functioning is not sharply defined and is relative to time and place. In the Netherlands, wish fulfilling medicine is not covered in the basic package provided by healthcare insurers and is paid for by the patients themselves. However, 'pay yourself' is not a decisive criterion for wish fulfilling medicine. With new biotechnological developments the domain of wish fulfilling medicine is expanding. Some dental treatments can be considered as wish fulfilling dentistry, for example in the context of cosmetic dentistry, orthodontics, or dental implantology. Although wish fulfilling medical treatments do not cure disease, they can promote health.
