Warum wäre das Opt-out-System zur Organbeschaffung fairer?

The possibility of organ transplantation has created new problems for medical ethics as well as clinical medicine. One of them, organ procurement, is tried to be solved mainly by two systems. Many countries have adopted the ‘optin system’, which aims to raise awareness and make the individuals donate their organs by their own will. The other system, ‘optout’ or ‘presumed consent’, which considers all members of society as potential donors, was adopted by some countries. In this system, individuals should state that they do not wish to donate their organs; otherwise they are considered as donors. By trying to ground our argument with various justifications, we claim that optout system for organ procurement is a fairer option regarding the right to access to healthcare needed, and therefore it should be implemented instead of optin.Mogućnost transplantacije organa je otvorila nove probleme kako u medicinskoj etici tako i u kliničkoj medicini. Jedan od njih, pribavljanje organa, pokušava se riješiti uglavnom pomoću dva sustava. Mnoge države su prihvatile ‘optin’ sustav, koji teži širenju svijesti o problemu i vlastitom izboru pojedinca da donira svoje organe. Drugi sustav, ‘optout’ ili ‘pretpostavljeni pristanak’, u kojem se svi članovi društva smatraju potencijalnim donorima, uveden je u nekolicini zemalja. U tom sustavu, pojedinci trebaju izričito navesti da ne žele donirati svoje organe; u suprotnom se smatraju donorima. U pokušaju utemeljenja našeg argumenta na različitim opravdanjima, tvrdimo da je ‘optout’ sustav pribavljanja organa pravednija opcija, uzimajući u obzir pravo na pristup potrebnoj zdravstvenoj skrbi, te bi stoga treba biti uveden umjesto ‘optin’ sustava.La possibilité de transplantation d’organes a posé de nouveaux problèmes à l’éthique médicale aussi bien qu’à la médecine clinique. Deux systèmes tentent de résoudre l’un de ces problèmes, celui qui concerne l’approvisionnement en organes. Nombre d’États ont adopté le système « optin » qui cherche à répandre la conscience du problème et du choix personnel de l’individu de faire le don de ses organes. Un autre système, appelé « optout » ou « accord tacite », où tous les membres de la société sont considérés comme donateurs potentiels, a été introduit dans certains pays. Dans ce système, les individus doivent indiquer explicitement qu’ils ne souhaitent pas donner leurs organes, faute de quoi ils sont considérés comme donateurs. En essayant de baser notre argumentaire sur les diverses justifications, nous soutenons que le système « optout » est plus juste, compte tenu du droit à l’accès aux soins médicaux nécessaires. Il devrait par conséquent être introduit à la place de « optin ».Die Möglichkeit zur Organtransplantation kreierte neue Probleme für die Medizinethik wie auch für die klinische Medizin. Eines davon, die Organbeschaffung, versucht man hauptsächlich mithilfe zweier Systeme anzugehen. Zahlreiche Staaten haben das ‚OptinSystem’ angenommen, das die Bewusstseinserhöhung sowie Selbstentscheidung der Einzelnen zur Organspende anzielt. Das andere System, das ‚Optout’ bzw. die ‚angenommene Zustimmung’, das sämtliche Gesellschaftsmitglieder als potenzielle Organspender ansieht, wurde von einigen Staaten übernommen. In diesem System sollen Einzelne ausdrücklich erklären, sie wollen keine Organe spenden, anderenfalls werden sie für Organspender gehalten. Indem wir unser Argument auf unterschiedliche Rechtfertigungen zu gründen suchen, behaupten wir, das OptoutSystem zur Organbeschaffung sei eine gerechtere Option in puncto Recht auf Zugang zur notwendigen Gesundheitsfürsorge, und demzufolge solle es anstelle des Optin implementiert werden

Can "presumed consent" justify the duty to treat infectious diseases? An analysis

<p>Abstract</p> <p>Background</p> <p>AIDS, SARS, and the recent epidemics of the avian-flu have all served to remind us the debate over the limits of the moral duty to care. It is important to first consider the question of whether or not the "duty to treat" might be subject to contextual constraints. The purpose of this study was to investigate the opinions and beliefs held by both physicians and dentists regarding the occupational risks of infectious diseases, and to analyze the argument that the notion of "presumed consent" on the part of professionals may be grounds for supporting the duty to treat.</p> <p>Methods</p> <p>For this cross-sectional survey, the study population was selected from among physicians and dentists in Ankara. All of the 373 participants were given a self-administered questionnaire.</p> <p>Results</p> <p>In total, 79.6% of the participants said that they either had some degree of knowledge about the risks when they chose their profession or that they learned of the risks later during their education and training. Of the participants, 5.2% said that they would not have chosen this profession if they had been informed of the risks. It was found that 57% of the participants believed that there is a standard level of risk, and 52% of the participants stated that certain diseases would exceed the level of acceptable risk unless specific protective measures were implemented.</p> <p>Conclusion</p> <p>If we use the presumed consent argument to establish the duty of the HCW to provide care, we are confronted with problems ranging over the difficulty of choosing a profession autonomously, the constant level of uncertainty present in the medical profession, the near-impossibility of being able to evaluate retrospectively whether every individual was informed, and the seemingly inescapable problem that this practice would legitimize, and perhaps even foster, discrimination against patients with certain diseases. Our findings suggest that another problem can be added to the list: one-fifth of the participants in this study either lacked adequate knowledge of the occupational risks when they chose the medical profession or were not sufficiently informed of these risks during their faculty education and training. Furthermore, in terms of the moral duty to provide care, it seems that most HCWs are more concerned about the availability of protective measures than about whether they had been informed of a particular risk beforehand. For all these reasons, the presumed consent argument is not persuasive enough, and cannot be used to justify the duty to provide care. It is therefore more useful to emphasize justifications other than presumed consent when defining the duty of HCWs to provide care, such as the social contract between society and the medical profession and the fact that HCWs have a greater ability to provide medical aid.</p

KONSÜLTASYONLARLA İLGİLİ SORUNLAR VE BİR ÇÖZÜM ÖNERİSİ

Yazının, klinik konsültasyonlarla ilgili sorunların yaygın tartışılmasına yardımcı olacağı ve önerilen yönerge ve formların kısmen de olsa sorunların oluşumunu önleyeceği düşünülmektedir

Halk Sağlığı disiplininin ahlaki değerleri ve ilkeleri

Halk Sağlığı disiplininin birey ve toplumun sağlığını korumayı ve geliştirmeyi amaçladığı, genellikle gerekçesini sorgulamadan kabul edilir. Bununla birlikte, bu kabulün gerekçesini, böyle bir amacın neden değerli olduğunu ifade etmek, Halk Sağlığı uygulamalarına yön vermek ve var olan uygulamaların amaçla ne kadar örtüştüğünü değerlendirmek açısından önemlidir. Bu yazıda, disiplinin var oluş amacının dayandığı değer ve ilkeler temellendirilmekte, ayrıca bu değer ve ilkelerden kalkarak meslek ahlakı kuralları tanımlanması için çağrıda bulunulmaktadır. </p

A follow-up study on the effects of an educational intervention against pharmaceutical promotion.

BackgroundThe promotion strategies of pharmaceutical companies create many problems including irrational prescribing, diminished trust in the patient-physician relationship and unnecessary increases in pharmaceutical costs. Educating prescribers is known to be one of the few potentially effective measures to counteract those impacts. However such educational programs are limited in the literature, and their effectiveness against the effects of hidden curriculum in the long term is unknown. This study aims to evaluate the effectiveness of an education program both in the short term and the long term after the students have been exposed to informal and hidden curriculum and various pharmaceutical promotion methods.MethodsA longitudinal and controlled study was carried out in a school of medicine in Turkey where there are no restrictive policies for pharmaceutical promotion. A survey was applied to 123 students who attended the class throughout the terms of 2011-12, 2012-13, and 2013-14, evaluating the pre-educational status of students' opinions of promotion and any post-educational changes. A follow-up study four years later asked those three cohorts to fill out the same survey to see the possible effects of the clinical environment and various promotion methods. Also, the opinions of all 518 sixth-year students who had not taken the class in those three terms were compared to the educated students.ResultsThe program was significantly effective in the short term in changing students' opinions and attitudes positively towards recognizing companies' discourse and promotion strategies. But in the long term, the education lost its ability to convince students of the importance of not getting financial support for scientific activities from pharmaceutical companies (p:0.006) and carrying out research (pConclusionsThe education program could be used for creating awareness of, increasing skepticism towards, and inculcating disapproval about pharmaceutical promotion practices. However, the effectiveness of the educational intervention is susceptible to erosion after exposure to the informal and hidden curriculum together with exposure to promotion. The impact of role-models, organizational culture, and institutional policies could be important aspects to be addressed for sustaining the effectiveness of such education programs

Halk sağlığı etiği ve meslek ahlakı

Zorunlu bağışıklamadan toplum sağlığını geliştirme programlarına dek pek çok Halk Sağlığı uygulaması çeşitli değer sorunlarının ortaya çıkmasına neden olabilmektedir. Halk Sağlığı Etiği başlığıyla ele alınan bu türden sorunların ülkemizde de tartışılması, özellikle de Halk Sağlığı uzmanlarının gündemine girmesi önemlidir. </span