DEONTOLOGY MEDICAL (Greek deon, deont[os] due, appropriate + logos the doctrine) — set of ethical standards of performance by medics of the professional duties.
- 1 History
- 2 Elements of a medical deontology
- 3 The doctor and the patient
- 4 The doctor and relatives of the patient
- 5 Relationship of health workers
- 6 The deontology and the organization of work of medical institution
- 7 The deontology and scientific tekhnicheky progress
- 8 The deontology in clinical medicine
- 9 The deontology and medical documentation
- 10 A medical secret
- 11 Medical errors
- 12 A deontology in research
D.'s Registration in m in the form of the special doctrine as a part of medicine as science and practice of treatment is caused by its humanistic contents. The purposes of medicine integrally include moral estimates not only because assume ethical standards of relationship of the physician and patient, but also because observance deontol. norms physicians in itself gives therapeutic effect.
The term «deontology» was entered into use of ethics at the beginning of 19 century by the English philosopher Benthamite J. Bentham. However for creative and practical activities of physicians philosophical and ethical motives, as well as attention to psikhol, to features of the physician, patient and their relationship, are characteristic since origin of medicine.
The philosophy regulating a moral appearance of the doctor formed and changed throughout centuries depending on developed in this society of a political system, the social and economic and class relations, level of culture, national, religious traditions etc. Requirements imposed by society during various historical eras to physical, moral and intellectual qualities of the doctor, his professional skill changed respectively and specified. Already the rules of conduct of the doctor understood as ethical standards are in details listed in the Indian code of laws of Manu of «Veda». Considerable influence on medicine of the Ancient East and on professionalnoetichesky representations of her adherents was rendered religious, and later also by philosophical doctrines of that time. So, the Egyptian priests-physicians, widely making use of experience of a national .meditsina and having made great progress in various areas of the specialty, created the atmosphere of mysticism, superstition, mystery around the activity.
In a classical antiquity of medical view were, as a rule, directly connected with philosophical, ethical and social doctrines. An outstanding role in definition of the main problems of medicine both as sciences and as moral activity belongs to the founder of scientific medicine Hippocrates. Hippocrates collection (see) it is devoted not only to private questions of medical practice, but also the problems of all-medical character relating to ideological and philosophical and scientific fundamentals of medicine, humanistic and moral aspects of profession of a physician, standards of behavior of doctors, their relationship with patients and so forth. Sections of the collection «Oath», «Law», «About the Doctor», «About Favorable Behaviour», «About Places in the Person», «About Ancient Medicine» have a direct bearing on problems D. of m. Here Hippocrates managed to formulate a row in essence deontol. the norms having enduring value. In Hippocrates's representation an ideal of the doctor is the doctor wise man: «... Everything that is looked for in wisdom, all this is also in medicine, namely: contempt for money, conscientiousness, modesty, simplicity in clothes, respect, judgment, determination, neatness, abundance of thoughts, knowledge of all that is useful and is necessary for life, disgust for defect, denial of superstitious fear of gods, divine superiority». Hippocrates formulated duties of the doctor in relation to the patient in well-known «Oath»: «Purely also I will uprightly carry out the life and the art... Whatever house I entered, I will enter for advantage of the patient there, being far from all intended, unfair and harmful... What I neither saw or nor heard concerning life human of what should not be disclosed ever, I will hold back that, including similar things a secret...».
In medieval medicine the principles of medical ethics, as well as theoretical fundamentals of medicine, were subordinated to religious and church philosophy and morals and respectively were deprived of actually scientific and all-humane contents. Nevertheless and D.'s norms of m were not alien to medieval doctors. So, they are stated in Salerno code of health (see), and also in Canon of medical science (see) and Ibn-Sina's «Ethics».
In Renaissance humane precepts of great antique physicians gained recognition. The famous doctor and the chemist T. Paracelsus wrote: «Strength of the doctor — in his heart, its work shall be directed god and be lit with natural light and experience; the greatest basis of medicine — love...»
R. Descartes considered that only the medicine can resolve problems most of which of all concern greatness and happiness of mankind.
The principle of a private practice, especially during an era of capitalism and imperialism, put a number of insuperable economic, social and political barriers which extremely complicate work of the advanced doctors of the modern bourgeois world between the patient and the doctor. However N. A. Semashko reasonably noted that «... it would be absolutely unfair and wrong to think that in foreign countries there are no doctors — the original humanists who are perfectly understanding the medical debt and kindly treating patients». These words can be carried also to those representatives of domestic medicine who in the heaviest conditions of pre-revolutionary Russia created the most noble deontol. the traditions apprehended by the Soviet health care. M. Ya. Mudroye learned, «... that doctoring does not consist neither in treatment of a disease, nor in treatment of the reasons — doctoring consists in treatment of the patient».
The great impact on domestic D.'s formation m was exerted by the advanced public figures, humanists, revolutionary democrats A. I. Herzen, D. I. Pisarev, N. G. Chernyshevsky, etc.
The significant role «deontologization» of profession of a physician in our country was played also by territorial medicine. Despite all the objective shortcomings, this system of rendering medical aid to poor segments of the population, unique in the history of medicine, put forward many thousands infinately of the doctors and paramedics betrayed to the business.
What makes now a subject D. of m at the end of 19 century was called as medical ethics. The maintenance of this concept was very indistinct: certain authors included in it the questions relating to the rights of the doctor (dekologiya), to class duties, class etiquette and even to medical policy.
The merit of introduction to practice of the Soviet health care of the term «medical deontology» and disclosures of its contents belongs to H. To N. Petrov. Its main work on this subject «Questions of a Surgical Deontology» was an incitement not only to creation of a number of books, brochures, articles about D. of m, but also laid the foundation for scientific development of all problem in general. H. N. Petrov determined D. by m as «... the doctrine about the principles of behavior of the doctor not for achievement of individual wellbeing and honors, but for the maximum increase in the sum of public usefulness and the maximum elimination of harmful effects of defective medical work». The Soviet D. m as scientific and practical discipline is based on the data of medical psychology, ethics, pedagogics considered from positions of Marxist-Leninist philosophy. The big contribution to theoretical aspects of D. of m was made by I. P. Pavlov's doctrine, Krom by a scientific objective method managed to prove influence of the word as conditioned excitator on the current, an outcome and even different emergence of painful states. V. M. Bekhterev, K. I. Platonov, R. A works. To Luriya, etc., and also further development of the doctrine of I. P. Pavlov exerted a great influence on development of optimum forms of relationship of medical staff with patients, proved use of different types of psychotherapy, promoted development of the doctrine about a yatrogeniya (see. Iatrogenic diseases ).
In the course of development of practical problems D. of m expediency «became clear... to continue their discussion in a section of separate medical specialties» (B. V. Petrovsky). A number of the works devoted deontol is published. to problems in obstetrics, gynecology, surgery, venereology, ophthalmology, oncology, traumatology, psychiatry, phthisiology, a radiology and other areas a wedge, medicine.
An important event in promoting of the principles D. of m among the medical public was convocation in 1969. First all-Union conference on problems D. of m.
The Soviet doctor is the carrier of communistic morals, the patriot of the socialist Homeland, the fighter of the ideological front. Dedicated work for the benefit of society is its sacred duty. Activity of the Soviet doctor is not limited to treatment of patients. It is an active participant of the events for improvement of welfare of workers, safety of their work, normalization of living conditions, the maximum improvement of the environment, broad prevention of diseases held in our country. Interests of business, interests of patients for it above all. According to it the principles of communistic morals imprinted in the Program of the CPSU become leading in professional activity of the doctor, in formation of its moral appearance.
Elements of a medical deontology
the Doctor possesses the leading role in implementation deontol. principles. The behavior of the doctor, his ability to conduct reception, care and completeness of inspection, persuasiveness of the conclusion means. The cultural doctor is a person of high ethical level, sensitive, attentive and careful, sympathetic and tender, benevolent and quiet. M only the doctor who chose the profession on calling can build the activity according to D.'s requirements. The doctor is called to give help to the sick person, to save it from sufferings, to recover his working capacity, to save from death. To love the profession — it means to love the person, to aim to help it, to rejoice to his recovery. Therefore deontol. the requirement to the doctor is his continuous increase in the skill.
The concept «skill of the doctor» cannot be reduced to the sum of techniques. In skill the creative process which is expressed in that form of intellectual work is presented, edges at the doctor the wedge, thinking is called. Need to reveal and analyze the mass of separate data, to choose from them essential to creation of the logical diagnostic scheme, considering at the same time and specific features of the patient, history and conditions of his life, in the shortest possible time to develop the plan to lay down on this basis. tactics — all this most complex intellectual work forms a creative basis of profession of a physician. Klien, thinking assumes the analysis and synthesis of specific data, knowledge of symptomatology, features a wedge, courses of diseases, indications of laboratory and tool methods of a research.
The medical profession is inconceivable without constant replenishment of knowledge. The doctor shall be familiar with the last achievements of medical science, with new methods of researches, with new to lay down. drugs. Improvement of qualification, attention to new scientific achievements, the aspiration to go in step with science are obligatory for the doctor. All actions of the doctor concerning recognition and treatment shall be thought strictly over and evidence-based.
The doctor and the patient
Responsibility for the patient and his health — the main line of a moral duty of the doctor.
Skill of the doctor is a creative process, art of a skillful combination advanced a wedge, thinking with the sensitive attitude towards the patient, with high personal culture of the doctor. A wedge, the thinking of the doctor is an ability not only to quickly generalize and estimate the available data laboratory, tool and other types of an objective research, but also to come into personal contact with the patient. For successful treatment the doctor shall be able to make complete idea not only of a disease in general and its specific manifestations in each case, but also about features of the identity of the diseased. Tactics of the doctor, his behavior always shall be formed depending on character of the patient, level of its culture, disease severity.
For each patient individual approach and individual corrective actions are required. For one people the tender and soft address and especially convincing arguments are required to force them to believe in a possibility of treatment, for others severity and a categoriality of the conclusion there are enough two-three authoritatively pronounced words. That is why a wedge, medicine shall be art, and the doctor (clinical physician) shall possess advanced feeling of a step which creates harmony between it and his patient, based on kindness and respect for the dignity of each other.
The doctor should meet in about tens of the patients different in the cultural level and features of mentality, including suffering from excessive suspiciousness. Therefore it is necessary to have patience to listen to the patient and then methodically to inspect it.
In all cases patients need a consolation. However the doctor shall not try to belittle gravity of a disease. Its task is in convincing the patient of a real possibility of treatment. The fact of visit of the doctor shall facilitate a condition of the patient. Trust to the doctor — one of guarantees of successful treatment. In the course of communication with the patient the doctor shall watch closely always that the blurt not to undermine confidence to himself the patient.
The doctor working in a hospital shall watch very fixedly not only course of disease, but also mood of the patient, his morale. Persistent and long working on by creation favorable to treatment of a situation can be broken by some event, napr, the death of other patient. And again laborious work on recovery of a due situation in chamber and moods of each patient is necessary to the doctor. When treatment or extension of life is possible, the doctor is obliged for creation of the best conditions of treatment tactfully and competently to open for the patient the diagnosis. The exception becomes for patients with malignant tumors, the Crimea report any other diagnosis, napr, «stomach ulcer» instead of «carcinoma of the stomach». The question of whether the patient should tell the truth, with all sharpness arises when the patient refuses operation or is in critical condition. In surgical practice rather often there are situations when both the patient, and his relatives has to be informed on true position and to offer urgent operation, napr, concerning gangrenous appendicitis, perforated stomach ulcer or impassability of intestines. In similar cases explain to relatives of the patient that delay even at several o'clock threatens with death. This task is difficult solvable when operation is offered the patient, at to-rogo the diagnosis of cancer is established. Motives at the majority are identical to failure: they feel well and lay hopes for medicinal treatment. Patients mistakenly believe that with operation they will never be late.
Practice of work convinces that in cases when it is necessary to convince the patient with a malignant tumor to believe in obligation of operation, there is no need to report the true diagnosis. It is necessary to aim to find other rather strong words and arguments. In a slow and heart-to-heart talk, in a statement of achievements of modern medicine, available to understanding of the patient, in assurance that he will be treated by the best specialists, as a rule, it is possible to receive the consent of the patient. It is necessary to develop uniform tactics at doctors of all specialties: if in onkol, establishment offer the patient operation, then other doctors, to the Crimea the patient addresses, shall explain and convince him of need and its urgency.
In cases when it is available irreversible patol, changes, the patient should not tell the truth. Even when the patient cannot be saved, it is impossible to take away from it hopes. And in the last stage of a disease of people continues to believe in rescue. He looks not for the truth, but hope. The patient anyway shall not feel fateful. The doctor shall listen patiently to complaints, to appoint pharmaceuticals and to console — thoughtfully and professionally. The doctor is obliged to resolve in each case an issue of «what» to tell to the patient and «how» to speak. A conversation of the doctor with the patient — art.
The doctor on a bypass should answer any, even the most trifling, a question. The answer shall sound plausibly and convincingly. In process of accumulation of experience in consciousness of the doctor the most successful are postponed and the formulations imposing the patient, logically reasonable answers and explanations, the most convincing words and phrases. Of m demands that the attending physician in the course of observation maintained morale of the patient with any pertinent remark or underlining of positive value even of the most insignificant shift in the state of health. At the same time the blurt of the doctor, his indifferent or irresponsible attitude towards the patient can appear etiol, a factor of an iatrogenic disease.
The doctor and relatives of the patient
the Question of relationship of the doctor and relatives of the patient — one of the least developed and most difficult sections D. of m. If at the patient in the course of treatment shifts to the best, relationship of the doctor with relatives the best and benevolent were outlined all the time. They sometimes worsen if the condition of the patient worsens. If relatives see a doctor concerning the patient, the destiny to-rogo inspires fear, the conversation happens frank, and the doctor, as a rule, has no basis to hide from them gravity of situation. At the same time in a task of the doctor enters to make psychological impact on relatives when intervention of the last can adversely influence a condition of the patient.
When at the patient the diagnosis of cancer is established and it gets in onkol. establishment, the doctor tells the true diagnosis only to the closest relatives, and the others are sent to the informed person.
If at a failure of treatment rules D. of m were followed, relatives of the dead become even defenders of the doctor. At non-compliance with these rules the conflicts between relatives and the doctor arise also at the correct treatment.
Elements of a deontology in activity of an average and junior medical staff. In creation of an optimum situation in to lay down. establishment, high office and professional discipline the doctor is helped by nurses. High culture and neatness, geniality and care, tactfulness and attentiveness, self-control and unselfishness, humanity — the main qualities necessary for the nurse. The nurse shall own well art of the word, in communication with patients and their relatives to observe sense of proportion and a step, to make a maximum of efforts for creation of a situation of trust between the patient and the doctor.
The sister shall not inform either the patient, or his relatives on everything, as for actually disease and the nature of treatment, to observe a medical secret.
In the content of activity of the nurse there were many changes: they manage the difficult medical technique, carry out many responsible manipulations which were allowed to be made only to the doctor until recently. Therefore value of qualification of the nurse and constant improvement of the knowledge by it even more increased.
In creation deontol. situations in stationary department an important role is played by the nurse. Purity of chambers, fresh air, a convenient bed, model patient care — here that minimum of hospital comfort which is created by hands first of all of the nurse. Accurate outward, smartness, the polite and precautionary treatment of patients — requirements which D. the m imposes on the nurse. Work on care of seriously ill patients is especially difficult. The nurse shall wash them several times in day, change bed and underwear, to feed, give to drink. Only the person of big courage, with sympathetic soul can perform such work. «Training of sisters and nurses, their education and formation from them of experts, instilling of the principles of the psychotherapeutic, careful and sparing approach to the patient in them — a paramount task on importance» (B. V. Petrovsky).
Relationship of health workers
the Important problem D. of m is neutralization of some negative sides of differentiation of medicine on specialty. The doctor, certainly, cannot understand all sections of medical activity therefore timely consultations with doctors of other specialty are necessary equally well. If errors of the doctors who were earlier observing the patient are found, then in the presence of the patient to discuss these mistakes absolutely inadmissibly. They should be corrected efficiently, with a big step and, certainly, not at a bed of the patient. A talk of the doctor with the doctor shall be based on mutual respect and mutual assistance always. It is necessary to consider inadmissible critical remarks of the consultant to the attending physician in the presence of the patient or carrying out consultation in the absence of the attending physician. From positions D. of m such statement of business when advise not the patient, but the doctor is correct.
The relations between doctors, sisters and junior medics shall be perfect and be based on absolute mutual trust. Inadmissibly to address sisters on «you» and to do them notes in the presence of the patient. In the opinion of patients it is reduced by the authority to lay down. institutions. Unfriendliness and arrogance of the head, servility and obsequiousness of subordinates exclude a possibility of proofreading and progress in work.
The deontology and the organization of work of medical institution
In to lay down. establishment such situation shall be created, edges as much as possible would spare mentality of patients and generated the atmosphere of trust to the doctor. It is possible to reach it the correct organization of work, high culture of employees both accurate labor and professional discipline. Already the first meeting in registry of policlinic or the accident ward of a hospital shall create the atmosphere of a positive mood of the patient. Both the registrar, and sisters of policlinic shall be interested in mood of patients, do everything possible to reduce waiting time of reception. All situation of an office of the doctor shall promote creative work and dispose to the quiet, intimate story of the patient. It is necessary to establish the immutable rule: during reception and inspection of the patient any hindrances distracting the doctor are inadmissible.
Everything needs to be provided in order that the patient during stay in a hospital had no reason for discontent. The beautiful interior, convenient furniture and art reproductions on a wall, neatness of chambers, fresh air, good sound insulation, a possibility of communication with relatives and friends and use of phone, TV — all this promotes treatment. Timely carrying out researches to lay down. procedures, a strict regulation of hours of a bypass, ensuring silence during an after-dinner and night dream — here those conditions which are positive by patients and promote recovery.
All that negatively influences disease is subject to elimination: it is not necessary to awake patients for cleaning of chambers early in the morning, whisper and a situation of oppressive silence which do not calm shall be rejected, and guard the patient. In time, free from bypasses, the television, radio, dominos, chess, reading newspapers, magazines well influence patients. In good weather it is necessary to allow patients of walk in the fresh air. All situation surrounding patients in to lay down. establishment, shall dispose to optimism and promote recovery of patients.
The deontology and scientific tekhnicheky progress
leads Modern development of the medical equipment, laboratory and tool methods of researches to replacement of direct contacts «the doctor — the patient with» the relations «the doctor — the device — the patient». There is fear that the doctor, trusting in the equipment, ceases to improve the knowledge that technicalization can influence relationship of the doctor and patient and to lead to disturbance optimum psikhol, contact between them. Therefore the high culture of the doctor, a combination developed a wedge of thinking and modern scientific knowledge get emphasized deontol. value. The device shall not zaslonyat identity of the patient. The crucial role in diagnosis shall belong to well collected anamnesis and correctly conducted physical examination.
The deontology in clinical medicine
Radical difference of surgery from all other specialties is need of use of an operative measure, a cut, even faultlessly executed, puts to the patient physical. and mental injury. The inevitable risk element connected with operation does work of the surgeon intense. The surgeon shall take temperament and mood of the patient into account to avoid the standard and a template in the behavior.
N. N. Pirogov calls four conditions for the correct behavior of the surgeon: the first — confidence in recognition of a disease and the patient; the second — to undertake operation in time, having made beneficial moral effect on the patient, to lift his hopes, to eliminate his fear and doubts; the third — not only to perform operation skillfully, but also to manage to prevent complications; the fourth — to carry out the subsequent postoperative treatment with the corresponding leaving that it is sometimes more important than the made operation. A duty of the surgeon long before operation to begin to prepare the patient for the correct behavior in the operating room. It is necessary to overcome two feelings at the patient: fear and pain. The surgical patient always feels fear, manifestations to-rogo sometimes are hidden deeply under various masks — indifference, bravado, etc. To remove fear at the patient, operation is necessary to Krom, it is extremely necessary. Except use of medicamentous means, essential therapeutic means is the warm human word. The conversation with the patient can surpass the strongest sedative drugs in efficiency.
So close attention shall be paid also to removal of pain in small surgery. Disturbance of norms of D. of m is the failure from anesthesia at out-patient operations and researches of the painful centers. It is bad when shout of the patient is suppressed with a hail of the surgeon.
Danger of operation shall not surpass dangers of the disease. In difficult situations when the only recovery aid is operation, remains firm deontol. principle: the surgeon resolves an issue for the benefit of the patient, removing collateral reasons and cares of own reputation on a background.
The doctor - «optimist» presents to the patient any operation as trifling, and «pessimist», on the contrary, emphasizes danger of operation. It is necessary to be guided by the following: the disease is heavier and more dangerous, the bigger deviation from the truth is admissible and it is even obligatory for the doctor informing the patient; the disease is more slight and the forecast is better, the it is less than bases to hide the truth.
Informing the woman in a form, available to it, of essence of a disease, obstetricians and gynecologists shall inspire in optimistic tone in it belief in a happy end of childbirth or diseases. The doctor shall not report the diagnosis, will not be confident in it yet: if the diagnosis is not confirmed, the mental injury done to the woman for a long time leaves a mark.
Many ginek, operations are connected with the subsequent disturbance of menstrual and genital functions. Therefore it is necessary to resolve very seriously an issue of indications to operation and methods of an operative measure, considering not only the immediate results, but also the remote effects.
Though the manager of department makes the individual decision on appointment of the operating surgeon, it is necessary to reckon also with desire of the patient. If for advantage of the patient operation has to be performed on the leading surgeon, he shall call the doctor as the assistant to the electee of the patient. The message on radical removal of a uterus or appendages should be made before an extract of a hospital. In case of impossibility of a child-bearing owing to the inborn or acquired changes of the sexual sphere it is necessary to report about it to the patient. From positions D. of m production small ginekol, operations without anesthesia it is necessary to consider inadmissible.
The major law obstetric and ginekol, departments is such education of personnel when only the attending physician or the manager of department give information on the carried-out treatment and the forecast. The attending physician when the husband of the patient asks about the nature of the made operation gets into extremely difficulties. It is necessary to follow the rule: not to tell the husband of specific volume of the made operation. It is better when the patient tells the husband what operation is performed on it, having chosen for this purpose the most convenient for it option.
The sick child needs special approach of the doctor. In their relationship the leading role is played by emotional influence. At the pediatrician to purely medical to experience and knowledge shall join and pedagogical and consequently, and knowledge of children's psychology. The pediatrician shall learn to come into good contact with children. The atmosphere in child care facility shall be friendly, correspond to behavior and views of children. At inspection, treatment and especially at a preparation for surgery the doctor shall aim not to deceive children, not to tempt them with unrealizable promises. It is necessary that each member of collective created the behavior with the little patient as the relations between mother and the child. To the child cordial heat of people in white dressing gowns helps to get on feet.
The doctor shall not feel sorry for time for explanations with relatives about the state of health of the child and about the possible forecast. At a conversation it is necessary to avoid both elements of excessive optimism, and intimidation. The special attention is required by those families where the only child where children already will not be any more.
Among the population the opinion has distribution that malignant tumors are incurable. That is why the direction in onkol, establishment is perceived by the patient and his relatives so hard and tragicly. Of m obliges the oncologist to force it to believe from first minutes of communication with the cancer patient in a possibility of treatment. It is necessary that the doctor and other medics in a conversation with the patient did not use the word «cancer» and that the patient did not read this word in one of the documents which are handed out to it. It is better to replace the word «cancer» with the words «organic disease» or others which do not guard and is injure the patient.
D.'s problem of m is in that the patients with initial forms of cancer coming to a hospital for radical treatment did not meet patients who have cancer of the same localization, but arriving repeatedly with metastasises, a recurrence etc. From deontol. reasons it is necessary to hospitalize the patients needing only a symptomatic treatment in-tsy the general profile and to treat as treat all patients in a serious condition.
D. contradicts m reference of patients with generalized forms of cancer to «nekurabelny», i.e. not subject to treatment. Use of beam and chemotherapeutic levers allows to receive nek-ry regression of process, to achieve improvement of the general state, remission. Patients sometimes are returned to work. In this improvement big personal merit of the doctor, it deontol. education and orientation. Incurability does not mean a nekurabelnost, and assistance to patients with cancer in the heaviest for them a stage of a disease is one of the main deontol. principles.
In a contradiction with deontol. rules those doctors who dare to predict terms of life onkol, patients enter. Doctors are obliged to undertake all possible measures for extension of life, but not to predict day of approach of death. Such «prophecies» are inherently immoral. Told above completely treats cases not always of justified use of the difficult diagnostic and medical manipulations connected with risk for the patient and a high measure of responsibility for the doctor (an electroshock, an angiography, endoscopic methods of a research, a biopsy of a liver, kidneys etc.).
The deontology and medical documentation
In all cases awareness of the patient on a serious illness aggravates the existing symptoms, reduces efficiency of radical or palliative treatment. It is necessary that the name of a serious illness was not mentioned in the documents which are handed out by the patient. The taken roots practice of issue of analyses to patients of copies on forms in which the typographical font specified normal indicators of any research contradicts rules D. of m and a row wrote down indicators of a research of the most sick. The difference in indicators always injures the patient who in each discrepancy sees threat for health and confirmation of the suspicion which arose at it on existence of a serious illness.
Are not considered with deontol. rules those radiologists who hand out the patient rentgenol, descriptions of the studied body. The structure and function even of normal body in record looks for the unaware patient with a time ominously. With deontol. positions it is necessary to refuse delivery to patients on hands of descriptions rentgenol, pictures. Certainly, rentgenol, the diagnosis shall spare mentality of the patient extremely.
A medical secret
In the capitalist countries the doctor, receiving the royalties for rendering to lay down. the help, it is forced to suppress sometimes these or those facts about the patient even to the detriment of people around. In the socialist countries the doctor is obliged to observe a secret until it does not infringe on interests of society. In article 16 of «Bases of the legislation of USSR and federal republics about health care» it is written down: «Doctors and other health workers have no right to disclose become to them known owing to execution of professional duties of the data on a disease, intimate and family aspects of life of the patient». The doctor and paramedical staff who have an opportunity to get acquainted with medical documentation shall keep in secret not only the data reported by the patient, but also the fact of the disease transferred the patient. It is impossible to mention surnames of the patient in scientific works and in reports, and also to show the photo of the patient, without masking his face.
However the doctor is obliged to inform a dignity immediately. bodies about cases of acute infectious diseases and poisonings, investigating authorities — about murders and severe injuries, one of future spouses about a disease of another. The doctor is obliged to report to heads of institutions about a disease of people whose work is contraindicated in this industry, napr, about epilepsy at the car driver, about some diseases and a carriage of bacilli of the person working at the food enterprise or in child care facility also.
Object of influence of the doctor is the person.
In it deep difference of a profession of the doctor from all other professions. Nobody, except the doctor, should penetrate so deeply into human life with his difficult mental and moral world, experiences. That tension, in Krom constantly proceeds activity of the doctor, and those imperfections of medical science, with to-rymi it is necessary to be considered, create an objective possibility of medical errors. These mistakes especially are explainable if to consider difficult according to contents and difficult work of the doctor on implementation, especially the surgeon, need of urgent acceptance of rational effective measures, sometimes under the most unfavorable conditions. Each doctor, whatever knowledge and experience it had, is not guaranteed against mistakes. Opportunity medical errors (see) is explained by the fact that «the doctor should deal not with the standard material which is easily giving in to assessment and the account, and with the various individualized features of a human body» (I. V. Davydovsky).
Medical errors, including and such which lead to a lethal outcome are always made public in system of bodies of health care. Such mistakes are discussed at medical conferences, at congresses, at meetings scientific about-va doctors, lit in the periodic medical press and lectures in medical in-ta. Monographs are devoted to medical errors. At last, governing bodies of the Ministries of Health issue orders in which the most serious and typical medical errors, the reasons which generated them are analyzed and offers and indications for the prevention of their repetition are provided.
At the same time illumination of medical errors in the general press sharply contradicts D.'s bases of m. This newspaper material is read also by patients in-tsakh. Each patient and his relatives prick up the ears, begin «to comprehend» critically the treatment appointed to it and by that undermine efforts of the doctor in fight against a disease. Among the factors providing the best results of treatment, authority of the doctor, his advantage and morale have crucial importance. This section D. of m demands development.
Contradicts deontol. to the principles availability to the population of popular literature on a serious illness. Promotion of data on prevention of diseases, about bases a dignity is more necessary. cultures, about a balanced diet, about harm of smoking and alcohol, about value and advantage of preventive inspections. This literature shall be counted not on physicians, namely on replenishment of a minimum of medical data at a wide naseleniya*.
A deontology in research
D.'s Requirements of m are of particular importance in research. The deontology of the doctor-researcher is a part of the general D. of m. Testing and approbation with the scientific purpose of vaccines, medical drugs and dosage forms, the diagnostic equipment, new methods of operations, endoscopic and laboratory methods of a research are a part of research.
In Art. 34 of «Bases of the legislation of USSR and federal republics about health care» it is told: «For the benefit of treatment of the patient and from his consent, and — with the consent of their parents, trustees or trustees the doctor can apply the new, evidence-based, but not allowed to general use yet diagnostic methods to the patients who did not reach 16-year age and mentally sick, prevention, treatments and pharmaceuticals. The order of use of the specified diagnostic methods, prevention, treatment and pharmaceuticals is established by the Ministry of Health of the USSR». Those which are not included in the operating State pharmacopeia of the USSR are considered as new medical drugs and were not applied in a wedge, practice.
Primary use in public of new drugs and vaccines is very responsible. With deontol. positions it is necessary after comprehensive check on healthy and sick animals to charge testing in clinic of new drug to the qualified doctors having experience of research.
It is necessary to be guided only by interests of the patient at establishment of indications to difficult and dangerous tool researches, napr, to a puncture biopsy of a liver, a laparoscopy with preliminary imposing of a pneumoperitoneum, to administration of drugs and contrast liquids in a cavity. Of m obliges to use all listed manipulations only when it certainly is shown to this patient, and to subordinate to this principle of a problem of identification of scientific factors or uses of technical innovations.
Pilot studies on prisoners, mentally and seriously ill patients, and also on children, irrespective of the consent of parents are inadmissible. Use with the scientific purpose of burdensome and not quite safe tool researches is possible only at the consent of the studied person and its awareness on a risk degree.
Any new operation demands very detailed theoretical and experimental development then it can be allowed to use only in well equipped clinics and-tsakh.
Need development deontol. governed questions of homotransplantation of bodies and fabrics. These questions are regulated by instructions of M3 of the USSR, according to the Crimea capture of cadaveric material for the medical institutions which are engaged in preparation and preservation of fabrics for transplantation is allowed.
See also Ethics medical .
Bibliography: Bilibin A. F. and Tsaregorodtsev G. I. About clinical thinking (Philosophical deonto a logical sketch), M., 1973, bibliogr.; Wagner E. And., P about with N about in with to and y A. A. and Yagupov P. D. About self-education of the doctor, M., 1971; Vail S. S. Some questions of a medical deontology, L., 1969; Volpert I. E. Psychotherapy, L., 1972, bibliogr.; A. P thunders. Rights, duties and responsibility of health workers, M., 1976, bibliogr.; Davydov S. N. A deontology in obstetrics and gynecology, L., 1968, bibliogr.; Yansky I. Ya. Vrach and the patient (Questions of a medical deontology, ethics and psychotherapy), Kiev, twisted 1964; Kalinin M. I. O health care and medicine, M., 1962; Kassirsky I. A. About doctoring, M., 1970, bibliogr.; Kovanov V. V. Calling, M., 1970; Lisitsyn Yu. P. About theoretical bases of medical ethics and a medical deontology, Zdravookhr. Grew. Federations, No. 1, page 3, 1972; S. D noses. Questions of a deontology in research of the doctor, M., 1975, bibliogr.; First All-Union conference on problems of a medical deontology, Reports, M., 1970; Petrov B. D. A deontology in the history of domestic medicine, Klin, medical, t. 47, No. 7, page 8, 1969; P e of t r about in H. H. Questions of a surgical deontology, L., 1956; Petrovsky B. V. The Soviet health care in 50 years of the USSR, M., 1973; Pies N. I. Questions of life, Diary of the old doctor, Collected works, t. 8, page 69, M., 1962; Pisarev D. I. Main problems of medical ethics and medical deontology, M., 1969, bibliogr.; Chebotaryova E. P. Medical ethics, M., 1970, bibliogr.; Shama-r and P. I N. Medical deontology, medical ethics and scientific and technological revolution, Owls. zdravookhr., No. 6, page 92, 1971; Elstein N. V. Dialogue about medicine, Tallinn, 1975, bibliogr.
A. F. Bilibin, E. A. Wagner, S. B. Korzh.