The main principle of deontology. Features of medical deontology
abstract
Relationships of medical workers with patients and their relatives
abstract
Relationships of medical workers among themselves
Ethicsmedical
parents.
Medical sister and colleagues.
It is impossible to criticize or give an assessment of colleagues in the presence of a patient. Comments to colleagues must be made if necessary, with an eye on the eye, without undermining the authority of the doctor. The doctor in his work should not be closed in itself, the discussion of causing cases causing a doctor should be made collegially. The doctor must not be bored by any advice, whether from the older or younger. One should never speak the patient that this consultant is bad if he does not agree with your diagnosis. If disagreements arose with colleagues with colleagues, it was necessary to discuss them in the ordinal, and then, on the basis of the truth achieved in the dispute, it is necessary to inform the general opinion of the patient exactly as: "We discussed and decided ...". When diagnosing, determining the testimony and contraindications, the choice of the operation method should be consumed. It is not by chance that all future operations are discussed collegially. The same refers to the selection of tactics during manipulations. If, during manipulation, the doctor faces an unforeseen situation, technical difficulties, anomaly of development, he must consult, call the older colleague, if necessary, ask him to participate in the further course of action.
Relationships with medium and younger medical staff should be democratic - they know and hear everything - it is necessary to attract them to their side in terms of preserving medical secrets - not to inform neither the patient nor relatives about the disease or pathology used by treatment methods and others. Epipping them The correct answer to all questions: "I don't know anything, ask the attending physician." Moreover, all these questions should not be loudly discussed and issued to anyone. In addition, a sense of duty, responsibility, goodwill should be brought up; The necessary knowledge and skills are given.
The tactics of the doctor, his behavior should always be built depending on the nature of the patient, the level of its culture, the severity of the disease, the peculiarities of the psyche. With plurality of patients need to be patient; All patients need consolation, but at the same time in the solid confidence of the doctor in the possibility of cure. The most important task of the doctor is the need to achieve the trust of the patient and careless words and not to undermine it in the subsequent. If the patient does not appeal to the doctor in the future, he does not believe him as a specialist. This is already a sign that it is a "bad" doctor, they go to "good", even despite the first failure. So the doctor failed to establish contact and mutual understanding.
The relationship between the doctor with relatives is the most difficult problem of medical deontology. If the disease is ordinary and treatment is well admissible to complete frankness. In the presence of complications, let's say a correct conversation with the nearest relatives. But at all, it is not necessary to inform her husband that you have completed an operation about ectopic pregnancy and the patient in a week will be like a "cucumber" - she will come sideways, especially since the husband has half a year later on a business trip.
Medicalsister and colleagues
In relations with colleagues, a nurse must be honest, fair and decent, recognize and respect their knowledge and experience. A medical sister is obliged to help his knowledge and experience to colleagues by profession, counting on the same assistance on their part, as well as assist other participants in therapeutic process. It should participate in the development of objective criteria for the assessment of nursing activities and strive to ensure that its activities are impartially reviewed and appreciated by colleagues. The nurse must avoid negative statements about the work of colleagues in the presence of patients and their relatives, except in cases of appealing the actions of medical workers. Conquesting authority by discrediting colleagues unethical.
The moral and professional debt of a medical sister is to help the patient to fulfill the treatment program prescribed by the doctor. The high professionalism of the medical sister is the most important moral factor of comrade, collegial relations between the medical sister and the doctor. If the medical sister doubts the feasibility of the medical recommendations of the doctor, it should tactfully discuss this situation first with the doctor himself, and in case of continuing doubt after that, with her supervisory leadership.
Participationin health care
The moral debt of the medical sister as a member of the medical community is to take care of providing accessible and high-quality nursing assistance to the population. The medical sister should actively participate in health care, helping patients to make right choice between state, municipal and private systems Health. The medical sister in the measure of its competence should participate in the development and implementation of collective measures aimed at improving methods to combat diseases, warn patients, authorities and society as a whole on environmental danger, contribute to the organization of rescue services.
Medical deontology
It is necessary to be attentive to all patients, because for any patient his disease is always serious and hard. And therefore, any disregard for the disease or to the patient can lead to the loss of contact with patients necessary in surgical activities. It should be avoided incomprehensible to sick expressions, for example, "the stomach in the form of a hook", the "cross position of the heart", "epithelial cells in the urine", "drip heart", etc., since the patients often begin to think about heavy symptoms, in fact missing diseases. No need to discuss symptoms with patients with sick symptoms, testifying to a favorable course of the disease, when patients with such diseases are nearby, but without these symptoms. All comments should be given only by one person - attending (walled) by a doctor.Thus, one of the most important tasks of surgical deontology - the protection of the psyche of the patient.
In this regard, we consider the unjustified rule for the transfer of information about the diagnosis in a sealed envelope, which is issued to the patients with the presentation of oncologists and other specialists. This should not be done, since such envelopes particularly incite the curiosity of patients.
In no case cannot be discussed with patients with the choice of diagnostic procedures, the nature of the research, treatment tactics, the need for operational interventions, the choice of the anesthesia method, etc. The patient needs to be reported only argued solutions. Doubt - the case of a physician, but not a patient. Sometimes the patient can abandon the disinformation-based operation made from deontological considerations. For example, with a stomach cancer, a patient is often diagnosed with a diagnosis: "ulcer of the stomach". Patient knowing that ulcerative disease can be treated conservatively, refuses the operation. In such cases, it is necessary to convince the patient that the refusal of the operation is dangerous due to the possibility of either already having signs of cancer rebirth of ulcers, because otherwise the principles of deontology are reduced to no, and it is above all the interests of the patient.
It is extremely careful when conversations in transport, elevators, where people who know the patient may be present with telephone conversations with close relatives of the patient, since in the latter case it may be a patient himself. In addition, not all relatives should notice about the true position of the patient. All conversations with the sick and his relatives should lead a gathering doctor or attended.
Medical deontology
Communication with patients requires maximum tact. Inspection of the oral cavity, torso, the extremities of the patient may cause an unfavorable impression from a medical sister, but under no circumstances to be shifted, but in a friendly tone to explain the need to comply with hygiene for a favorable outcome of treatment.Especially important knowledge of deontology in surgery. The mental state of the surgical patient is subject to many tests, and this requires its objective assessment and accounting in individual work with the patient. Surgical patient differs from all other things that he has radical treatment. At the same time, almost all patients are afraid of something: some operations, other - anesthesia, are third - just suffering that can be felt in the process of operation or after it. Patients are usually extremely sensitive to everything negative, every rash word, an act, unfulfilled destination may cause refusal even from the vital operation for them. Thus, the appearance and clothing of medical personnel, the punctual fulfillment of personal hygiene is as important as highly qualified care for seriously ill in the pre-and postoperative period, the skill is painless, gently conduct one or another procedure.
Often you have to hear that the nurse is a doctor's assistant. Does it always have to be a bad performer? If the experienced sister sees the mistakes of the doctor, she should not discuss them with their colleagues, and tactfully and, if necessary, to unnoticate about this to the doctor.
Medical deontology
The word "deontology" means the doctrine of proper (Greek. Deon - due, Logos - word, science, teaching). With regard to medicine under deontology, the principles of medical personnel behavior, aimed at maximizing the usefulness of treatment and eliminating the harmful effects of defective medical work. At the same time, it is important to create a certain psychological climate in the team, where the relationship of medical personnel to the patient has the importance of the relationship between members of the team, regardless of their rank. Deontological rules have developed in various fields of medicine: surgery, obstetrics, oncology, venereology, etc., but they have general principles and, of course, professional differences. Of great importance in the development of deontology was played by the book of the founder of the national oncology N. N. Petrova "Questions of Surgical Deontology" (1945), which marked the beginning of the regulation of professional relationships. Practical deontology is a system of thoughtful, scientifically based behavior and specially designed specific measures of psychological impact on the patient.In deontology as science, much unresolved, sometimes controversial, for example, how in detail the patient should speak about his illness, given the medical literacy of the population, how to explain the patient or his relatives the need to receive a receipt for the operation? etc. There are no ready-made recipes for all occasions and here much depends on the overall culture of the medical worker and from his life experience.
Ethicsmedical
Philosophical discipline studying morality and morality is called ethics.
Professional ethics are the principles of behavior in the process of human professional activity. It is believed that the basic principles of medical ethics formulated hippocrates.
That part of the ethics, the subject of which is the doctrine of a person's debt in front of another person and society as a whole, is called deontology.
Medical deontology is called the doctrine of the proper behavior of medical workers who contribute to the creation of the most favorable environment for the recovery of the patient. The term of medical deontology introduced an outstanding surgeon N.N.Petrov, spreading its principles for medical sisters.
Thus, the theoretical basis of deontology is medical ethics, and deontology, manifested in the actions of medical personnel, is a practical application of medical and ethical principles.
Features of deontology in pediatricsdue to the originality of the children's psyche, as well as the need to contact in work not only with children, but also with theirparents.
Aspects of medical deontology are:
relationships of health workers with patients;
relationships of health workers with patient relatives;
relationships of medical workers among themselves.
The main objectives of the professional activities of the medical sister are: care for patients, facilitating their suffering, restoration and strengthening their health, disease prevention.
To implement these purposes, when fulfilling its functional duties, the medical sister should know and comply with the following basic such ethical principles as humanity and mercy.
The implementation of ethical began in medicine includes:
informing the patient about his rights;
informing the patient about his health
humane attitude towards the patient;
respect for the human dignity of the patient;
preventing moral and physical damage to the patient (no harm);
respect for the patient's right to carry out medical intervention or refusal from it;
respect for the patient's autonomy;
respect for the patient's right to high-quality and timely medical care;
manifestation of careful attitude towards the dying patient (distributional justice);
storage of professional secrets;
maintaining at a high level of their professional competence;
protection of the patient from incompetent medical intervention;
maintaining respect for your profession;
respectful attitude towards your colleagues;
participation in health care.
Medicalsister I.rightspatient
The nurse must be truthful in relation to the patient, to know and respect the patient's rights and in their professional activities to do with these rights.
When applying for medical care and its receipt, the patient has the right to:
1. Respectful and humane attitude from medical and service personnel;
2. Choosing a doctor, taking into account his consent;
3. Examination, treatment and maintenance in conditions corresponding to sanitary and hygienic requirements;
4. Conducting on its request of the Consilium and consultations of other specialists;
5. Facilitation of pain associated with disease and (or) medical intervention, available in ways and means;
6. Preservation by medical professionals of professional secrets;
7. Informed voluntary consent to medical interventions;
8. Refusal to medical intervention;
9. Obtaining information on their rights and responsibilities and the state of its health;
10. Obtaining medical and other services under voluntary health insurance programs;
11. Reimbursement of damage in case of harm to its health when providing medical care;
12. admission to a lawyer or another legal representative to protect his rights;
13. Admission to the patient of the priest or provision of conditions for the departure of religious rites, if it does not violate the inner regulation of the hospital institution.
The moral debt of the medical sister is to inform the patient about his rights. It should inform the patient names and positions participating in his treatment. Considering that the function of informing the patient and his loved ones, most advantage, belongs to the doctor, the medical sister has a moral right to transmit professional information only in coordination with the attending physician.
Humanerelation to the patient, respect for his legal rights
Above all the medical sister should put compassion and respect for the patient's life. She is obliged to respect the patient's right to alleviate suffering to the extent that this allows an existing level of medical knowledge. The debt of the medical worker never participate in the actions against the physical and mental health of people, do not speed up the occurrence of death and not contribute to the suicide of the patient.
Respecthuman dignity of the patient
The medical sister should be constantly ready to provide competent assistance to patients regardless of their age or gender, the nature of the disease, social or financial situation and other differences. Care, the medical sister should take into account the personal needs of the patient, respect his right to participate in planning and conducting treatment. In communicating with patients, you should never forget about the following rules: always carefully listen to the patient, asking the question, always be sure to wait for an answer, to express your thoughts clearly, simply, intelligibly. The manifestations of the arrogance, dismissive relationship or humiliating treatment of the patient are not allowed. When establishing a sequence of medical care to multiple patients, a nurse must be guided only by medical criteria, excluding any discrimination.
Beforeall - not harm
The main ethical principle in medicine is the principle - not harm. Not causing harm, damage to the health of the patient - there is the first duty of each medical worker. Neglecting this duty, depending on the damage to the health of the patient, can be the basis for attracting a medical worker to judicial responsibility.
It is unacceptable to carry out moral or physical damage to the patient neither deliberately nor in negligence, nor because of professional incompetence. The nurse is not entitled to indispensively refer to the actions of third parties seeking to impose such harm to the patient. The actions of the patient care sister, any other medical interventions associated with painful sensations and other temporary negative phenomena are allowed only in its interests. The risk accompanying medical intervention cannot be higher than expected benefits. Making medical interventions, fraught with risk, the medical sister is obliged to provide for safety measures, relieving the patient's threatening and health complications.
Rightpatient agree to medical intervention or refuse him
A very important principle in modern health care is the principle of informed voluntary consent. This principle means that a medical worker should most fully inform the patient and give it optimal advice. Only after that the patient must choose his actions. At the same time, in our country, the law gives the right to the patient to receive all the information. The provision of incomplete information is deception. The nurse must respect the patient's right or his legal representative (when it deals with a child or incapacitated mentally ill) to agree on any medical intervention or refuse him. The nurse must be sure that consent or refusal is given to the patient voluntarily and consciously, that is, without any coercion or deception and with a clear understanding of the nature of the impact on his physical or mental health. The moral and professional debt of a medical sister - to the best of their qualifications to clarify the patient the consequences of the abandon from the medical procedure. The refusal of medical intervention, indicating the possible consequences, is issued in the medical records and is signed by a citizen or his legal representative, as well as a medical worker. If the patient is not able to express his will, the medical sister has the right to carry out urgent medical intervention shown by him, within its competence, based on its own decision.
Rightpatient for high qualityandtimelymedicalhelp(Distributionjustice)
In modern conditions, the principle of distribution fair justice is especially important, which means the obligation to provide and equally available medical care. Unfortunately, distribution injustice especially often occurs when the distribution of expensive drugs used by complex surgery, etc. At the same time, a huge moral damage is caused to the patients, which, due to a number of reasons, are deprived of a one or another type of medical care. A medical sister is obliged to provide a patient with high-quality medical care that meets the principles of humanity and professional standards. It carries moral responsibility for their activities before the patient, colleagues and society. Professional and ethical duty of a medical sister - to provide in the measure of its competence, emergency medical care to any person in need of it.
Medicalsister and dying patient
The medical sister must respect the right of a dying patient to a humane treatment and decent death. The medical sister is obliged to own the necessary knowledge and skills in the field of palliative medical care, which gives a dying patient with the opportunity to end life with the most achievable physical, emotional and spiritual comfort. The first moral and professional duties of a medical sister: prevention and relief of suffering, usually related to the process of dying; Rendering a dying patient and his family of psychological support. Intentional actions of a medical sister in order to stop the life of a dying patient, even at his request, unethical and unacceptable.
Dutystore professional secrecy
The medical sister should be kept secret from third parties to her or who has become known for the fulfillment of professional duties to her: about the fact of treatment for medical care, the patient's health status, the diagnosis, treatment, the forecast of its disease, as well as the patient's personal life, even After the patient dies. It is also not subject to publicity information about physical disabilities, bad habits, property situation, a circle of dating, etc. The purpose of preserving professional secrecy is to prevent possible causing a patient of moral or material damage. The medical sister is obliged to strictly fulfill its functions for protecting confidential information about patients, in whatever form it is neither stored. The medical sister has the right to disclose confidential information about the patient of any third party only with the consent of the patient himself. The right to transfer a nurse to other specialists and medical professionals who provide medical care to the patient, assumes its consent. The nurse has the right to transfer confidential information without the consent of the patient only in the following cases provided for by law:
for the purpose of examining and treating a citizen who is not able to express their will due to his state,
in the threat of the spread of infectious diseases,
at the request of the bodies of the inquiry and investigation, the prosecutor's office and the court in connection with the investigation or legal proceedings,
in case of assistance to a minor under the age of 15 years to inform his parents or legal representatives,
in the presence of grounds to assume that the citizen is harmful to the health of the citizen as a result of unlawful actions.
Professionalcompetence
The medical sister should always support the professional level of its activities. The constant accumulation of special knowledge and skills is the professional debt of a medical sister. It must be competent with the patient's moral and legal rights. Professional competence gives a medical sister moral right to independently make appropriate decisions in extraordinary situations and lead the leadership of junior medical personnel.
Protectionpatient from incompetent medical intervention
A medical sister, faced with illegal, unethical or incompetent medical practice, should become on protecting the interests of the patient. She is obliged to know the legal norms regulating the nursing case, the health care system as a whole and the use of methods traditional medicine, in particular. The moral duty of a medical sister is to actively prevent the practice of dishonest and incompetent colleagues, other persons dealing with dubious medical practice. The medical sister has the right to apply for support to public health authorities, the Association of Medical Sisters, taking measures to protect the patient's interests from dubious medical practice.
Respectto his profession
The medical sister must support the authority and reputation as a nursing profession. It carries personal moral responsibility for maintaining the proper level and improving the standards of nursing. The nurse should critically evaluate the level of their professional training and practical skills and not claim the extent of competence that does not possess. The right and debt of the medical sister is to defend their moral, economic and professional independence. It should abandon the patient's gifts and flattering proposals, if this is based on his desire to achieve a privileged position compared to other patients. The medical sister has the right to accept gratitude from the patient if it is expressed in the form that does not degrading both human dignity, does not contradict the principles of justice and decency and does not violate legal norms. A medical sister should not allow abuse by its professional position and its knowledge. Intimate relationships with the patient are condemned by medical ethics.
However, there are also general rules that should always follow:
a) everyone should know and strictly fulfill their duties;
b) constantly increase its professional level;
c) Teach the comrade what you know;
d) a nurse must be a universal (manipulation, dressing, procedural, etc.);
e) do not forget so-called dirty work.
Deontology Medical (Greek, Deon, Deontos due, proper + logos doctrine) - a set of ethical standards and principles of the behavior of the health worker when performing professional duties, involving the provision of a patient as possible assistance, aimed at eliminating the possibility of harm and conducive to improving the effectiveness of patient treatment and prevention Diseases.
Deontology Medical reflects the humanistic essence of medicine and includes the rules of their professional duties, the principles and forms of relationships with patients, his relatives and loved ones, with colleagues as a result of historical experience. The health worker who meets the requirements of the Deontology Medical, has such qualities as the ability to compassion, willingness to sacrifice its interests and amenities, if necessary for the rescue of life or facilitate the suffering of the patient; tolerance, sensitivity, warning; Striving for improvement professional knowledge; perseverance in helping the patient. The area of \u200b\u200bdeontology of medical problems includes important moral and legal problems, including those related to the responsibility of the health worker for the life and health of the patient, compliance with medical mystery, preventing non-heroed diseases.
At different stages of historical development, moral requirements for representatives of honey. Professions changed in accordance with the characteristics of the ethics of society (see Ethics Medical), but even in ancient medicine they acquired a humanistic orientation. A particularly important role in the definition of moral began honey. Activities belongs to hippocratic. The deontological principles set forth in its "oath" are relevant and now, and they can largely be attributed to activities not only doctors, but also medium-sized health workers. The formation of domestic deontology was influenced by the humanistic ideas of Russian revolutionaries-Democrats A. I. Herzen, N. G. Chernyshevsky, high moral principles of honey. M. Ya. Mudryova, N. I. Pirogova, S. P. Botkin and other prominent Russian clinicians.
As medicine develops, medium-sized health workers are constantly complicated. They work with challenging honey. Appliances, many responsible manipulations perform, which until recently carried out only doctors. In modern conditions for the care of the patient, Feldsher, midwife, nurse must master more and more complex scientific, as well as technical knowledge and skills. In this regard, the qualifications of medium health workers and the rational organization of their activities at a higher professional level are especially important.
The successful implementation of diagnostic and medical measures, quality care per patients is possible only when the whole team honey. Institutions and each member of this team constantly comply with the requirements of deontology. It is necessary to establish contact and trust relationships with patients. This is facilitated by a healthy psychological climate in a medical institution, the atmosphere of attention to the patient, concern for it, the clarity of the implementation of diagnostic and therapeutic procedures, good business, based on mutual respect and trust of the relationship between employees.
Of great importance is the first acquaintance with the patients who came to the reception or entered in the hospital. Invalid formal attitude, indifference to the patient. The adaptation to the hospital setting should not be for a large load for a patient; The medical staff follows from the first hours of staying a patient in a medical institution to surround his concern, ensure its life, to organize a full and timely care. It is very important that not only the medical staff, but also the patient was confident in the readiness of the personnel to the timely and qualified provision of medical care. In the behavior of doctors and nurses, in how drugs and procedures are prescribed and how appointments are made, the patient should see and feel the interest of his fate, responsible attitude towards his health.
When choosing a form of communication with patients, its emotional state, intelligence, education, profession, personality features should be taken into account. It is important to work out the ability to listen to the patient, remove the tension from it during the conversation, eliminate fears, anxiety, to instill confidence in his strength. In a conversation with the patient, it is necessary to monitor not only the content, but also for the form of speech, remember that for the patient is significant and tone, and mimic, and gestures. The nature and focus of conversations can and should vary depending on the period of the disease, the patient's mood. Skillful and cautious penetration into the world of the patient is possible only with a sincere sympathy for his suffering. Therefore, it is unacceptable to trust work with patients with those health workers who mentally outlined, lost the ability to compassion, began to formally relate to the fulfillment of professional duties. Bad, if the object of care and treatment is an impersonal patient, and not a specific human personality. In such cases, the relationship between nurse and patients are official, formal. Non-doubt, special professional knowledge and skills are always important, but they may not be enough in the absence of sensitivity, preventability, attention, goodwill.
The patient, as a rule, easily catches any falsehood when contacting it and is painfully experiencing it. Sympathy, patience, politeness - composite elements good style Nurses work. At the same time, tenderness, the heat in relation to the nurse to the patient should never be intimate character, should not encourage patients to courtship, to unauthorized relationship. The best protection against danger to be incorrectly understood - sincerity and goodwill in the manifestation of attention to the patient.
The nurse must have a neat appearance, be collected, friendly; Inappropriate capriciousness, irritability, as well as complaints of the patient on their difficulty. Gossip, familiarity, which interfere with the normal relations between the sister and the patient are unacceptable.
One of the most important requirements of deontology is to preserve the mystery of the patient. The patient in fear of illness and its possible heavy outcomes is looking for sympathy, frankness, often shares with their nurse with his innermost thoughts, which, like various information about the patient contained in the history of the disease, should not be the property of other people. The need to preserve the secret of information about the patient was noted in the Soviet legislation. The exception concerns only diseases that may pose a threat to society (for example, dissemination of inf. Diseases, severe diseases with violation of visiting drivers); Health workers should officially notify the relevant organizations.
Awareness of a patient about severe disease, as a rule, reduces the effectiveness of treatment. Therefore, in the documents issued by the patient, the name of the serious illness is often not mentioned or the results of the surveys conducted. Complete information in such cases receives one of the close relatives of the patient. The relationship between health workers and relatives of patients is also an important problem of medical deontology. In all cases, they should develop taking into account the interests of the patient.
Compliance with medical ethics and deontology should be at the heart of the activities of any medical institution and penetrate all moments of the doctor's work, nurses, paramedics, etc.
Deontology - The doctrine of the debt, based on the principle of "adherence to debt" (Greek Deon - due + Logos). The term "deontology" is introduced into philosophy I. Bank. Deontology is based on the strictest performance prescriptions of moral order, compliance with some set of rulesestablished by the community, society, as well as their own mind and the will of a person for compulsory execution.
Medical deontology - The doctrine of adequate in medicine, primarily about the professional debt of doctors and all health workers in relation to their patients. In a professional medical environment, the concept of medical deontology is usually used as synonymous with the concept of medical ethics. The term consists in modern medicine "Medical Ethics", and term "Medical Deontology"; At the same time, the term "medical ethics" usually indicates worldview context Principles and norms for doctors and other specialists working in medicine, and the term "Deontology Medical" - on moral norms and standards of medical practice itself. For each medical specialty there is a "Code of Honor", non-compliance with which fraught with disciplinary recovery or even except From medical class.
Basic norms of medical ethics and deontology must be the following:
non-harm patient
justice
truthfulness
competence (specialist of any level)
privacy (non-disclosure of privacy information)
privacy (compliance with medical secrecy)
granting a patient of greatness
compliance with the principles of "autonomy" of the patient
Relationship of the doctor and patient
The leading role in the relationship between the doctor and the patient, as evidenced by numerous works devoted to the study of this problem, have personal and characteristic qualitiesdefining their behavior, motivation of the doctor's activities, the patient's expectations.
The treatment of the patient to the doctor is due desire to get high-quality medical care. When choosing a doctor, he has a certain freedom and is based on the idea of \u200b\u200ban ideal doctor, information about a particular doctor, obtained from various sources, the professional status of a doctor.
An important component of the professional activities of the medical worker is the presence of such quality as empathy - The ability to empathize the interlocutor, to understand his feelings, needs, interests, motivation of actions. During communication with the patient, the doctor arises personal resonance In the form of compassion, the desire to facilitate the suffering of a sick person.
Medical mystery.
Confidentiality - The rate of ethics and rights prohibiting medical professionals to disclose certain information. In one or another, the privacy rate is available in numerous codecs of professional ethics of medical workers, lawyers, psychologists, journalists, etc. This norm applies to all persons who, by virtue of their official or professional position, became owners of this information. The announcement of medical information is permissible only with the open consent of the patient or in cases directly provided by law.
Preservation medical secrecy It is one of the most important issues of medical deontology. By the nature of their activities, the doctor often becomes owners of many biographical, often the most intimate, intimate information about the patient. Currently, the foundations of medical mystery are formed as follows: any doctor should not disclose any information regarding the patient, without his consent, if such are learned during professional communication with patients, and their disclosure can adversely affect the patient. At the same time, the doctor who learned from the patient, self-riskis obliged to fulfill its civic duty and notify the relevant organizations about it
In medical practice there are both direct and indirect violations of medical secrecy. Straight associated with the unscrupulousness of workers, violation of them ethical norms. Indirect may be related to the careless storage of documents, using all kinds of certificates is not for the purpose (transfer to random individuals).
Medical errors:
The concept of "medical errors" usually determine the actions of medical workers, leading to negative consequences in human health or adverse outcomes.
The actions of the doctor associated with adverse effects are usually divided into 3 groups:
accidents
medical errors
professional crimes
Under accidents In medical practice, it is customary to understand the unfavorable outcome of medical intervention, caused by random circumstances, which the doctor could not foresee. In fact, these are mistakes in which the doctor is not to blame.
Under medical errors Understand the mistakes that occurred due to the fault of the medical worker due to the lack of its education or work experience. Usually they are associated with some objective or mitigating circumstances, for example, lack of practical skill, bad conditions for medical care, imperfect research methods, etc.
Under professional crimes Understand the actions of medical professionals, due to negligence, irresponsibility, inaccessible or improper actions of health workers who are in incision with the rules generally accepted in medicine. The difference between medical error and the professional crime consists essentially in the causes and conditions of their occurrence.
Relationships in the medical team.
The relationship of a health worker with their colleagues are an important component of medical deontology, since the atmosphere reigning in the medical team is capable of providing a polar impact, both on patients of a medical institution and its employees.
In the medical team, each employee has its own functions and a circle of responsibilities, the organizational structure is very conservative and traditional, the general requirement is observance of subordination. To maintain a favorable social and psychological climate, medical workers need to be intercrying, benevolent, to be able to provide friendly assistance and not exceed their job responsibilities.
Medical deontology(Greek. deon. - due, logos. - Doctrine) - the doctrine of adequate in medicine, above all, about professional debt, duties and norms of medical workers' behavior.
Along with the moral norms regulating medical activities in general, special norms and standards are recorded in medical deontology and standards in relation to a particular field of medical practice (deontology in surgery, obstetration and gynecology, pediatrics, etc.)
Deontology prescribes a health care person:
Perform your professional duty to patients and society - all your knowledge and ability to direct to strengthen and maintain the health and life of patients;
Conscientiously refer to the fulfillment of their professional duties – provide medical care, respectfully and humanely to treat patients, constantly increase the level of their professional knowledge;
Strive to implement the principles and norms of the medical profession in their practical activities - Do not harm, show compassion, to be fair, keep a medical secret.
Deontology also implies the right of medical professionals to protect their professional honor and dignity.
Modern medical deontology determines:
The moral aspects of the relationship of the doctor - the patient and their specificity in pediatrics, oncology, psychiatry, obstetrics and gynecology, etc.;
Moral aspects of relationship between a doctor and close patient;
Moral aspects of relationships in the medical team (between colleagues, a doctor and medium, junior medical personnel);
Moral aspects of medical errors and systemation;
Patient rights and their regulatory regulation.
Medical Health Errors
One of the ethical norms of medical activities is the recognition by the doctor his professional mistakes and delusions (they are present in the activities of any doctor) and an irreconcilable attitude towards them.
Under a medical error, it is customary to understand the conscientious misconception of a doctor who is based on the imperfection of modern science, ignorance or inability to use the existing knowledge in practice. Not medical errors of the action of a doctor caused by negligence, negligence, ignorance.
To the main reasons for medical errors include:
Objective reasons: imperfection of medical science and practice; the relativity of medical knowledge; the likelihood of an atypical course of the disease in a particular patient caused by the peculiarities of its body; Insufficient equipment of medical institutions with diagnostic equipment, drugs, etc.
Subjective reasons: medical ignorance due to insufficient qualifications, lack of experience and specificity of the doctor's thinking, i.e. its individual ability to accumulate, understand, using medical knowledge; defective inspection and examination of the patient; Refusal of the Council of Colleagues or Consilium or, on the contrary, the desire for the doctor to cover the authority of consultants and others.
All medical errors can be divided into the following groups:
Ø Diagnostic errors;
Ø errors in the choice of method and treatment;
Ø mistakes in the organization of medical care,
Ø Errors in the conduct of medical records.
Diagnostic errors
Diagnostic errors are the most frequent. The formation of a clinical diagnosis is a very complex and multi-component task, the solution of which is based on, on the one hand, on the knowledge of the doctor of etiology, pathogenesis, clinical and pathological manifestations of diseases and pathological processes, on the other hand, registered the individual characteristics of their flow from this particular patient. The most frequent cause of diagnostic errors are objective difficulties, and sometimes the impossibility of early diagnosis of the disease.
Many painful processes have a long-term course with a large-time latent period and almost asymptomatic flow. This refers to malignant neoplasms, chronic poisoning I.T.P.
Serious diagnostic difficulties arise in the lightning course of disease. As mentioned, the objective causes of medical errors can be an atypical course of the disease or combined competing diseases, the severe condition of the patient with insufficient time survey. Significantly makes it difficult to diagnose alcoholic intoxication of the patient, which can mask or pervert the symptoms of the disease or injury.
The causes of diagnostic errors may be underestimated or revaluation of anamnestic data, patient complaints, laboratory and instrumental research methods. However, these reasons cannot be considered as objective, for they rest in the lack of qualifications and the experience of the doctor.
Errors in the choice of method and treatment
These errors are found several times less than diagnostic. In some cases, they are caused by improper or late diagnosis. But, with the right and timely diagnosed diagnosis, errors may occur in treatment, for example, the wrong choice of treatment method in the presence of several possible or incorrect choice of method and volume of operational intervention. It may happen that with timely early treatment and the correct choice of the method of its mistakes in the technique are allowed. This applies, above all, to surgical operations.
Errors in the organization of medical care
The very designation of these errors indicates that their emergence is associated with the wrong or insufficiently thoughtable medical care. The reason for such mistakes is either not enough high professional level of managers of individual health units, or the adverse conditions for the work of some particular medical and prophylactic institution. As a result of errors in the organization of medical and preventive care, medical care is also affected by the provision of medical care, and patients, despite the fact that the doctors of medical institutions, due to the fault of the leaders of which mistakes arise, can quite conscientiously fulfill their duties.
Errors when conducting medical records
These errors can lead to incorrect conclusions in diagnosing diseases, to incorrect solutions of IECE, to insufficiently reasonable rehabilitation activities.
An analysis of all kinds of medical errors plays an important role in their warning, and in improving the qualifications of doctors. This analysis is carried out, in particular, at clinical and anatomical conferences that have become a mandatory and good tradition in our clinics. For the first time they were put into practice prominent pathologists I.V. Davydovsky in 1930, and since 1935, styles are mandatory for all therapeutic institutions.
In the annex to the order of the USSR Ministry of Health of April 4, 1983, the main tasks of clinical and anatomical conferences are formulated by number 375.
They are:
Ø Improving the qualifications of LPU doctors and improving the quality of clinical diagnostics and treatment of patients through joint discussion and analysis of clinical and sectional data.
Ø Detection of causes and sources of errors in diagnosis and treatment at all stages of medical care, as well as identifying deficiencies in the work of auxiliary services (x-ray, laboratory, functional diagnostics, etc.).
Philosophical discipline studying morality and morality is called ethic (from Greek. Ethos - custom, temper). Another term - morality has the same meaning. Because these terms are often used together. The ethics are most often called science, the doctrine of morality and morality.
Professional ethics - These are the principles of behavior in the process of professional activities.
Medical ethics - Part of the common and one of the types of professional ethics. This is the science of moral principles in the activities of physicians. The subject of its research is the psycho-emotional side of the activities of physicians. Medical ethics, in contrast to the right, was formed and existed as a set of unwritten rules. The concepts of medical ethics were developing from ancient times.
In various historical epochs, the peoples of the world existed their ideas about medical ethics related to weight lifestyles, national, religious, cultural and other features. The preserved ancient sources of medical ethics include the laws of ancient Babylon (XVIII century. BC, "Hammurappi laws", which say: "If the doctor makes any serious operation and cause a sick death, then he is punished with a cut-off hand") . Hippocrates, "Father of Medicine", the great doctor of ancient Greece, has repeatedly emphasized the importance for a physician not only the ability to treat, but also strictly follow the requirements of ethical norms. It is believed that it was the hippocrat that formulated the basic principles of medical ethics ("oath", "law", "about doctors", etc.).
The views of the Tajik scientist X-XI centuries were greatly influenced by the development of medical ethics. Physician Ibn Sinna (Avicenna). The main ideas of his teachings are contained in the encyclopedic work "Canon of Medical Science" and the ethics essay.
A well-known role in the development of modern principles of medical ethics was played by the Salern Medical School, which arose in the south of Italy in the IX century. and entered in 1213 to the University of Salern at the Faculty Rights. Representatives of this school were implemented by the humane principles of ancient medicine.
Russian clinicians M.Yu.Mudrov, SG Zabelin, D.Samamolovich, etc., contributed to the development of medical ethics.
For the first time, the concept of "deontology" appeared in the XVIII century. This term suggested the English philosopher and lawyer, the priest I. Banks in his book "Deontology or Science of Morality", which invested in this concept religious and moral content, considering deontology as a doctrine of proper behavior to achieve his goal of each person.
The word "deontology" comes from two Greek words: Deon means proper and logos - doctrine. In domestic medicine, the term "deontology" (the doctrine of the proper behavior of physicians who contribute to the creation of the most favorable environment for the recovery of the patient) introduced an outstanding surgeon of N.N.Petrov, extending the principles of deontology on the activities of nurses.
Consequently, medical deontology is a part of medical ethics, a set of necessary ethical standards and prescriptions for medical professionals in the implementation of professional activities. Deontology studies the moral content of actions and actions of medical personnel in a specific situation. The theoretical basis of deontology is medical ethics, and deontology, manifested in the actions of medical personnel, is a practical application of medical and ethical principles.
Aspects of medical deontology are: the relationship between doctors with patients, relatives of the patient and physicians among themselves.
The basis of relationships is the word that was known in antiquity: "Treat to the word, herbs and a knife," said the ancient healers. Smart, tactful word can be raised the mood of the patient, to instill vigor and hope for recovery and at the same time careless word can be deeply hurting the patient, cause a sharp deterioration in his health. It is important not only what to say, but also, why, where to say, how to react to the one who draws a medical worker: the patient, his relatives, colleagues, etc.
The same thought can be expressed in different ways. The same word people can understand differently, depending on their intelligence, personal qualities, etc. Not only words, but also intonation, facial expression, gestures are of great importance in relationships with patients, his relatives, colleagues. Medic must have a special "sensitivity to man," to own empathia - the ability to compare, put himself in place of the patient. He must be able to understand the patient and his loved ones, be able to listen to the "soul" of the patient, calm and convince. This is a kind of art, and not easy. In a conversation with patients, indifference, passivity, lethargy are unacceptable. The patient should feel that he is correctly understood that a medical worker treats him with sincere interest.
Medic should own speech culture. To speak well, you must first think correctly. A doctor or nurse that "stumbles" on each word, consumes health words and expressions, cause distrust and dislike. Deontological requirements for the culture of the word are that a medical worker should be able to: tell a patient about the illness and its treatment; reassure and encourage the patient, even in the hardest position; use the word as an important factor in psychotherapy; consume the word so that it is evidence of general and medical culture; convince the patient in the need for a particular treatment; patiently silence when this requires the interests of the patient; do not deprive the sick hope of recovery; Welfare in all situations.
In communicating with the patient, we should not forget about the following communication techniques: always carefully listen to the patient; asking a question, be sure to wait for the answer; It is simply impressed, clearly, intelligibly, not to abuse scientific terms; respect the interlocutor, prevent contemptuous facial expressions and gestures; Do not interrupt the patient; encourage the desire to ask questions, responding to them, demonstrate the interest in the opinion of the patient; Keep cool, be patient and tolerant.
Modern models of the relationship between the doctor and the patient. Currently, there are the following types of models of the relationship between the doctor and the patient:
information (scientific, engineering, consumer). The doctor acts as a competent expert professional, collecting and providing information about the disease to the patient himself. At the same time, the patient has complete autonomy, having the right to all information and independently choosing a type of medical care. The patient may be biased, so the task of the doctor is to clarify and bring the patient to the choice of the right decision;
interpretation. The doctor acts as a consultant and adviser. He must figure out the requirements of the patient and assist in choosing treatment. For this, the doctor must interpret, i.e. To interpret information about the state of health, examination and treatment, so that the patient can take the only correct decision. The doctor should not condemn the requirements of the patient. The goal of the doctor is to clarify the requirements of the patient and help make the right choice. This model is similar to information, but implies a closer contact of the doctor and the patient, and not just the supply of the patient with information. Required patient work with the patient. The patient's autonomy with this model is great;
tutorial. The doctor knows the patient well. Everything is solved on the basis of trust and mutual consent. The doctor at this model acts as a friend and teacher. The patient's autonomy is observed, but it is based on the need for precisely this treatment;
paternalist (from Lat. Pater - Father). The doctor acts as a guardian, but at the same time puts the interests of the patient above their own. The doctor persistently recommends the patient the treatment chosen by him. If the patient does not agree, then the last word remains for the doctor. The patient's autonomy with this model is minimal (in the domestic health system, this model is most often used).
Medicism, as the main ethical category. The basic ethical categories of the doctor belongs to the concept of "debt" - a certain range of professional and social obligations in the performance of their duties, which has developed in the process of professional relations.
Duty provides for a qualified and honest fulfillment by each medical worker of their professional duties. Debt performance is inextricably linked with the moral qualities of the personality.
The debt of the medical worker is to exercise humanism and always assist the patient, never participate in the actions against the physical and mental health of people, not to accelerate the occurrence of death.
Inner painting of the disease. The behavior of the physician with the patient depends on the peculiarities of the patient's psyche, which largely determines the so-called inner picture of the disease.
The inner picture of the disease is awareness of the patient of his disease, a holistic representation of a patient about his disease, his psychological assessment of the subjective manifestations of the disease. The peculiarities of the patient's personality (temperament, type of higher nervous activity, character, intelligence, etc.) affect the inner picture of the disease. In the inner picture of the disease distinguish: the sensual level implying painful sensations of the patient; Emotional - responding to the patient on his feelings; Intellectual - knowledge of the disease and its assessment, degree of awareness of the severity and consequences of the disease; Attitude towards disease, motivation to the return of health.
The allocation of these levels is very conditional, but they allow doctors more consciously develop tactics of deontological behavior with patients.
The sensual level is very significant when collecting information (anamnesis) on the manifestations of the disease, the sensations of the patient, which makes it possible to more accurate the diagnosis of the disease.
The emotional level reflects the experiences of the patient of its disease. Naturally, these emotions are negative. Medic should not be indifferent to the experiences of the patient, should show sympathy, be able to raise the patient's mood, to impose hope for a favorable outcome of the disease.
The intellectual level depends on the overall cultural development of the patient, its intelligence. It should be borne in mind that the sick chronicles know there are quite a lot of disease (popular and special literature, conversations with doctors, lectures, etc.). This largely allows doctors to build their relationship with patients on the principles of partnership, without rejecting requests and information that the patient has.
In patients with acute diseases, the intellectual level of the inner painting of the disease below. About his acutely emerged disease, patients tend to know very little, and these knowledge is very superficial. The task of a medical worker with respect to such a patient is that within the limits of the patient necessary and taking into account the state of the patient, to explain the essence of the disease, to tell about the upcoming survey and treatment, i.e., to attract a patient to the joint anticipation of the disease, aim His recovery. Knowledge of the intellectual level of the inner painting of the disease allows you to correctly select the tactics of treatment, psychotherapy, etc.
Therefore, clear ideas about the intellectual level of the inner picture of the disease should be obtained from the first minutes of communication with the patient.
The nature of the attitude towards the disease plays a very big role. Another antiquity doctors knew about it: "Troy - you, the disease and me. If you are with the disease, you will be two, and I will stay alone - you will overpower me. If you are with me, we will have two, the disease will remain alone, we will overcome it "(Abul Farage, Syrian doctor, XIII century). This ancient wisdom shows that in the fight against illness depends on the patient himself, from his assessment of his own illness, the ability of the physicians to attract the patient to their side. The patient's relation to the disease is adequate and inadequate. Adequate attitude towards the disease is distinguished by the awareness of its illness and the recognition of the need to take measures to restore health. Such a patient shows an active partnership in treatment, which contributes to a speedy recovery.
Inadequate attitude towards the disease is more often manifested by several types: alarming - continuous anxiety and imperidity; hypochondriac - focused on subjective sensations; Melancholic - depressure, disbelief in recovery; neurasthenic - reaction by the type of irritable weakness; aggressive-phobic - mbility, based on unlikely concerns; Sensitive - concern the impression that the patient produces on the surrounding; Egocentric - "care" into the disease; Euphoric - a tediment; Anosogly - discarding thoughts about the disease; ergopathic - care from illness to work; Paranoic - confidence that the disease is someone's evil intent; disregardable - underestimation of its condition and appropriate behavior (violation of the prescribed regime, physical and mental overvoltage, ignoring the prescribed treatment, etc.); Utilitarian - the desire to extract material and moral benefits from the disease (without serious grounds, seeks exemption from military service, mitigating punishment for the crime committed, etc.).
Knowledge of the inner painting of the disease helps in establishing deontologically competent communication with patients, in the formation of an adequate relationship of the patient to its disease, which increases the effectiveness of the treatment.
Major ethical principles in medicine. The main ethical principle in medicine is the principle "not harm." This principle was followed by the doctors of the ancient world. So, the hippocrates in the work of the "oath" directly indicates: "I will send the regime of patients to their benefit, according to my forces, refrain from causing any harm and injustice. I will not give anyone asking me a deadly tool and I will not show ways for such an intention. "
Non-harm, damage to the patient's health - is the first duty of each medical worker. Neglecting this duty, depending on the degree of damage to the health of the patient, can be the basis for attracting a medical worker to judicial responsibility. This principle is obligatory, but it allows a certain degree of risk. Some types of treatment are risky for the health of the patient, but this harm is not deliberately applied and it justifies the hope of success in the fight against the disease, especially deadly.
All nations have always had a great importance and has the principle of preserving medical secrecy. Under the medical secret, they understand not subject to publicity about the disease, intimate and family sides of the life of the patient obtained from him or identified in the process of its surveys and treatment. It is also not subject to publicity information about physical disabilities, bad habits, property situation, a circle of dating, etc. In the "Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens", a separate article is devoted to the legal provision of medical secrecy. (See Appendix 2, Section 10, Art. 61). This is stated in the "oath" of the hippocrat: "So that I will not see and did not hear about the life of the human life, I will default, considering such things a mystery ...". In pre-revolutionary Russia, doctors finishing the medical faculty pronounced the so-called "Faculty Promise", which said: "Helping the suffering, I promise to keep the entrusted family secrets and not to use confidence in evil." The purpose of preserving medical mystery is to prevent possible causing a patient of moral or material damage.
Medical mystery should be saved not only by doctors, but also by other medical workers. The medical worker must preserve in secret from third parties a trusted or who has become known due to the fulfillment of professional duties information about the state of the patient's health, diagnosis, treatment, forecast of his disease, as well as the patient's personal life, even after the patient dies.
A medical worker has the right to disclose confidential information about the patient only with the consent of the patient himself. For the disclosure of professional secrecy, the Medic carries a personal moral, and sometimes legal responsibility. In art. 61 "Fundamentals of the Russian Federation on the protection of citizens' health" lists cases in which the provision of information representing a medical secret is allowed without the consent of a citizen or his legal representative (a social worker in order to comply with the interests of his client is obliged to know them):
for the purpose of examining and treating a citizen who is not able to express their will due to its state;
in the threat of the spread of infectious diseases, mass poisoning and lesions;
upon request of the bodies of the inquiry and investigation, the prosecutor's office and the court in connection with the investigation or trial;
in case of assistance to a minor under the age of 15 years to inform his parents or legal representatives;
if there are grounds that suggest that the harm to the health of a citizen is caused by the opposing actions.
The preservation of medical mystery is not only the most important manifestation of moral debt, but also the first duty of the medical worker.
An equally important principle in modern health care is the principle of informed consent (see Ad. 2 "Fundamentals of the Legislation of the Russian Federation on the protection of citizens' health", Section 6, Article 30, 31). This principle means that any medical worker should most fully inform the patient, give it optimal advice. Only after that the patient can choose his actions. In this case, it may happen that his decision will go against the opinion of the physicians. However, compulsory treatment can be carried out only by court decision.
In our country, the law gives the right to the patient receive all the information. The provision of incomplete information is deception. Restrictions are imposed only on obtaining information about other persons. The patient has the right not just listen to the doctor's story, but also to get acquainted with the results of the survey, to obtain any statements and copies of documents. This information may use this information to receive consultations from other specialists. Information is necessary in order for the patient to be based on it, for example, agree to the operation or prefer conservative treatment, etc.
The principle of respect for the patient's autonomy (close to the principle of informed consent) means that the patient himself, independently of the physicians, should decide on the treatment, survey, etc. In this case, the patient has no right to demand a decision for it (if only the patient Not unconscious) so that later do not attract doctors to justice for incorrect treatment.
In modern conditions, the principle of distribution fair justice is especially important, which means the obligation to provide and equally available medical care. In each society, the rules and procedure for providing medical care are established in accordance with its capabilities. Unfortunately, distribution injustice particularly often occurs when the distribution of expensive drugs, the use of complex surgical interventions, etc. At the same time, huge moral damage is caused by the patients, which, due to a number of reasons, are deprived of a one or another type of medical care.
Hippocratic oath. In the "Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens" there is Art. 60 "Klyatva of the doctor." The oath of the doctor is a moral obligation adopted before the state. At the time of the hippocratic, doctors swore before the gods: "I swear by the Appolonian doctor, asclepius. Gigia and Panacea and all the gods and goddess, calling them in witnesses. " The main provisions of the hippocratic oath were later included in numerous ethical codes and instructions of doctors: a ban on causing harm to the patient, respect for life, respect for the personality of the patient, compliance with medical mystery, respect for the profession.
With an oath of hippocratic, the oath of the doctors of the ancient India and the medieval faculty promises, the "faculty promise" of graduates of the medical faculties of the Russian Empire, etc. Graduates of medical universities Russian Federation After receiving a diploma, they bring oath, the text of which contains the above ethical positions.
The Ethical Code of Medical Sister of Russia has been adopted.
Adverse effects on the patient in medicine. A person who has entered into relationships with medicine is often subject to the influence of negative factors - myelogenies. Distinguish the following types of myelogenies:
egogenia - the negative effect of the patient on itself, due, as a rule, by the perception of painful manifestations of the patients themselves;
egrotogneia - the adverse effect of one patient on other patients in the process of their communication, when the patient believes another patient more than a doctor (especially harmful when there is a negative personal basis of who has an impact);
natrogenation (from Greek. Yatros is a doctor and hennao - weighed) - adverse effects on the patient from medical professionals in the process of examination and treatment.
They distinguish the following types of athletic (at the same time, it should be remembered that there may be "dumb" non-ration, which arise as a result of inaction): Yatroxi-hydrogen - psychogenic disorders arising as a consequence of deontological errors of medical workers (incorrect, careless statements or actions); Jatropharmarmaging (or drug ichtrogenation) - adverse effects on the patient in the process of treating medicines, for example side effect medicines, allergic reactions, etc.; yatrophysiogenia (manipulating iatrogenation) - adverse effects on the patient in the survey process (for example, perforation of the esophagus during fibrogastroscopy) or treatment (for example, skin ulcers as a result of radiation therapy), etc.; Combined iatrogenation.
The question of the prevention of nucleation is important for medicine in general, and medical deontology. To solve this issue, it is necessary to increase the culture of medical care at all stages of therapeutic and preventive work, study the peculiarities of experience in patients with their illness, improve professional selection in medium-sized medical schools.
Responsibility of medical workers and institutions. In the "Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens" refers to the responsibility for causing harm to the health of citizens (see Ad. 2, Section 12, Art. 66 ... 69).
Unfortunately, when providing medical care to the patient, there are cases of adverse effects of treatment. These cases are divided into medical errors, accidents, professional offenses.
Under a medical error, the consequences of the conscientious misconception of a doctor without elements of negligence, negligence and professional ignorance are usually understood. Medical errors are usually allowed on objective reasons. Many of medical errors are associated with an insufficient level of knowledge and small experience, some errors depend on the imperfection of research methods, equipment, unusual diseases of the disease in this patient and other reasons. To prevent errors, including cases of non-heroed diseases, a permanent analysis of such cases is needed, an open analysis at various meetings, conferences, etc. It is necessary to find the cause of the error and take all measures in order to prevent this further. Recognition of errors requires good faith, personal courage. "Errors are only errors when you have courage to promise them, but they become a crime when the pride encourages them to hide them," wrote the French surgeon XVIII century. J. L. Pet. It is these qualities that should be formed in the process of training professionals in medical schools. Among the causes of medical errors, the following are distinguished:
the lack of appropriate assistance conditions (the doctor is forced to work in conditions that do not relevant professions), poor material and technical equipment of the medical and prophylactic institution, etc.;
imperfection of medical methods and knowledge (the disease has been studied by medical science incompletely, the error is a consequence of the incompleteness of knowledge of not a given doctor, medicine as a whole);
the insufficient level of professionalism of the doctor without elements of negligence in his actions (the doctor tried to do everything that could, but his knowledge and skills were insufficient for the correct actions).
The negative consequences for the patient can lead: emergency atypoticity of this disease; The exception of the individual characteristics of the patient's body; inappropriate actions of the patient himself, his relatives and other persons (later appeal to medical care, rejection of hospitalization, violation of the treatment regime, refusal of treatment, etc.); Features of the psychophysiological state of the medical worker (illness, extreme degree of overwork, etc.).
Accident is an unfavorable outcome of medical intervention. This result cannot be foreseen and prevented because of objectively emerging random circumstances (although the doctor acts correctly and in full compliance with the medical rules and standards).
Professional offenses (crimes) - negligent or intentional actions of a medical worker who caused the causing harm to the patient's life and health.
Professional violations arise due to the unscrupulousness of the medical worker; unlawful healing, including the use of inappropriate treatment methods, healing in the specialty, according to which the doctor does not have a certificate; The negligence attitude towards professional duties (negligence - non-fulfillment of their professional, official duties or their implementation inappropriately, carelessly).
In the case of professional offenses, it is possible to attract medical worker! In to the administrative, disciplinary, criminal and civil (property) responsibility.
The most dangerous crimes affecting the interests of the patient are:
causing death by negligence due to improper execution by the face of their professional duties;
causing grievous or medium severity of harm to health by negligence, committed due to improper execution by the face of their professional duties;
coercion to the seizure of organs or human tissues for transplantation;
infection of the patient with HIV infection due to improper execution by the face of its professional duties;
illegal abortion production;
unconstruction of the patient's help;
illegal premises in a psychiatric hospital;
violation of privacy with the use of its official position;
illegal issuance or a counterfeit recipes or other documents giving the right to receive narcotic drugs or psychotropic substances;
illegal session of private medical practice or private pharmaceutical activities;
obtaining a bribe;
service forsson.
Compensation of moral damage. Moral harm is expressed in the form of physical or moral suffering associated with incorrect, erroneous treatment or diagnosis. Often, moral suffering brings disclosure of medical mystery. Moral harm is subject to refund. Since there is no clear criteria for moral harm, then its degree determines the court on the basis of the plaintiff's arguments and the defendant.
Features of medical deontology, depending on the disease profile of the patient. Despite the fact that the fundamental
the principles of medical deontology are the same in relation to all patients, regardless of the profile of their diseases, there are certain features of deontology, depending on the disease profile of the patient.
Features of medical deontology in obstetrics and gynecology are due to the following factors:
medical activities in obstetrics and gynecology are inevitably connected with interference in the intimate sphere of the patient's life;
for a woman, health issues related to childbirth are extremely significant, very often they become the main (especially in cases of any gynecological or obstetric pathology);
the mental state of a pregnant woman is often unstable, depending on many factors (relationships to pregnancy in the family, such as the identity of the pregnant, the outcome of previous pregnancies, social factors, etc.), this instability can be expressed by increased anxiety before childbirth (fear of forthcoming suffering, outcome Births, etc.), violation of the behavior of the feminine due to inadequate assessment of the situation (in emotionally unstable women with poor tolerance of pain), a high probability of development in the postpartum period of depression (anxiety, reduced mood up to suicide), etc.
Therefore, it is very important that from the first minutes of the contact of the physician and the patient (especially pregnant) she had the impression that she wants to help. From the first minutes of contact with a woman, it is necessary to correctly appreciate its emotional state. To reduce emotional tensions, you can allow a woman to freely tell about their experiences or switch her attention to other items. Medical workers need to be particularly careful in statements regarding the forecasts of the state of the sexual sphere and the childbearing function of the woman. Often, especially from future single mothers, in relation to medical personnel, irritability, discontent, aggression may occur. But at the same time, medical workers should understand that these negative emotions are not directed to them, but are a consequence of their own problems of such a woman. The main task of physicians in any case is the need to avoid conflicts by "adopting" of these emotions, sympathy, etc. If a woman does not consider it necessary to inform the spouse about the state of his "female" health, then the doctor should not interfere in such cases.
During the treatment of incurable diseases, medical workers must fully support the patient confidence in the prosperous outcome of the disease, inspire an emerging improvement at the slightest favorable symptom, which the patient itself notes.
Especially cautious and tactful should be a medical worker with regard to women with infertility (primary infertility, without pregnancy, pathology in previous births, etc.). It should be tried to inspire confidence in the effectiveness of the treatment of treatment, in the prosperous outcome of pregnancy and childbirth, etc.
Features of deontology in pediatrics are due to the originality of a children's psyche depending on the age of the child. In the process of treating children, medical workers have to deal not only with children, but also with their parents, which complicates deontological tasks.
Children are more impressionable than adult patients, more wounded. The reaction of children to the surrounding environment and new people is more directly very peculiar. Therefore, a medical worker is obliged to learn to understand the features of the children's psyche, be able to enter the child in contact, to earn his confidence, help overcome fear and anxiety (after all, one of the main causes of the negative emotional reactions of the child is the feeling of fear of pain and incomprehensible medical manipulations).
Relationships of health workers with parents of a sick child have no less important, since the child's illness causes great anxiety from the whole family and especially from the mother. The debt of the medical worker to instill confidence that the child and in the absence of parents will be done by everything necessary for recovery.
Among the medical disciplines, psychiatry is the most social. The diagnosis of mental disorder inevitably entails various social limitations of human vital activity, it makes it difficult to social adaptation, distorts the relationship between the patient with the surrounding social environment, etc.
Honors from psychiatry from other medical disciplines is the application to some categories of patients of coercion and even violence without the consent of the patient or even contrary to his desires (a psychiatrist under certain conditions maybe without the consent of the patient to conduct his surveys, to establish mandatory dispensary observation, put in a psychiatric hospital and maintain there Isolation, apply psychotropic drugs, etc.).
A feature of psychiatry is an extremely diverse contingent of patients: some patients due to severe psyche disorders not only can not protect their interests, but they cannot even express them, others (with border mental disorders) in their intellectual development and personal autonomy are not inferior to the doctor Psychiatrist. Psychiatry is designed to defend the interests of society and the patient.
This determines the following features of medical deontology in psychiatry:
professional ethics in psychiatry requires marginal honesty, objectivity and responsibility when concluding a state of mental health;
it is necessary to increase the tolerance of society to persons with mental disabilities, overcome bias in relation to mental illness, regulate social measures against these patients;
limitation of coercion during the provision of psychiatric assistance to the limits determined by the medical necessity, serves as a guarantee of respect for human rights);
psychiatric ethics should strive to achieve the balance of the interests of the patient and society based on the value of the health, life, security and well-being of citizens.
The condition for compliance with these ethical rules is regulatory acts in the field of psychiatry: the Hawaiian Declaration adopted by the World Psychiatric Association in 1977 and recycled in 1983, the principles of medical ethics and annotations to their use in psychiatry ", developed by the American Psychiatric Association in 1873 . And revised in 1981, and others.
In our country, the "Code of Professional Ethics Psychiatrist" was first adopted on April 19, 1994 at the plenum of the Board of the Russian Society of Psychiatrists. Since 1993, psychiatric activities in our country are governed by the Law of the Russian Federation "On psychiatric care and guarantees of citizens' rights with it" (see Appendix 3).
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abstract
Topic: "Ethics and Deontology of the Medical Worker"
Performed: Serdyukova Larisa
Belgorod 2014.
Medical ethics and deontology are features of medical activities based on the mutual trust of the patient and a medical worker, to whom the patient voluntarily entrust his health, and sometimes life.
Medical ethics (Greek Etohs - custom, temper, character) as part of the general ethics considers the issues of the doctor's morality, including the totality of its behavior and morality, the feeling of professional debt and honor, conscience and dignity.
Medical ethics covers certain norms of the behavior of the medical worker in everyday life, its culture, humanity, physical and moral cleanness, etc. In general, it can be said that ethics are an external manifestation of the internal content of a person.
Under medical deontology (Greek. Deon - due) understand the principles of the behavior of medical workers, aimed at maximizing the benefits of treatment and eliminating the consequences of defective medical work. Deontology is part of medical ethics, medical morality.
However, at present, the newest achievements of medical science and technology are forced several from another point of view to consider traditional norms of medical deontology. The former principle of "patient" is replaced by a new "doctor - the device - patient", and the need for a patient in a sensitive and attentive attitude of the medical worker, in his good word, who hesitates hope, has not decreased, and even more increased.
The relevance of the problem
The originality of medical ethics is that in it, all the rules, principles and assessments are focused on human health, its improvement and preservation. These norms were initially enshrined in the hippocratic oath, which became the starting point for creating other professional-moral medical codes. The ethical factor has traditionally important in medicine. More than eighty years ago, by analogy with the medical oath of the Hippocrat, the nursing oath Florence Nestinger was created.
Ethical standards and phenomena
In the process of development and formation of professional medical, humanistic, moral principles of the activities of medical workers were clearly defined.
On this basis, the most generalized concepts of morality or category reflecting moral ties between people were determined and characterizing the attitude of health workers to the subject of their daily activities - the patient and healthy person, to society.
Thus were formulated and received scientific recognition of the main categories of medical ethics: debt, conscience, honor and dignity, tact, meaning of life and happiness of man. Naturally, all ethical categories are interconnected, complement and strengthen each other. As our ideas and scientific progress develop in medicine and on this basis, further improvement of the methods of examination and treatment of patients.
It is very important that the Middle Medical Workers not only knew, but also used the basic requirements of ethical categories in their professional activities and based on them improved the quality of medical care to the population.
Conscience is an ethical category expressing the highest form of personality to carry out moral self-control, independently formulate moral responsibilities for themselves, to require their fulfillment and produce self-esteem of the actions performed. Conscience is an internal awareness of its professional debt, professional responsibility as personal debt and personal responsibility.
Honor and dignity - ethical categories that determine the attitude of a person, both to themselves and to another person, to society as a whole. In its content, the concept of honor is very close to the concept of "dignity". Both of these categories in definitely regulate human behavior and determine the attitude towards him from others, they experience the influence of other categories of ethics, especially debt and conscience, without which there is no personal honor and dignity.
Tact-- This quality is not congenital, but acquired, it is brought up from childhood in that social environment where it grows and is formed in the process of public and individual development.
Happiness is a sign that a person has found a personal meaning of life for some particular stage of his life path.
There are two points in ethical phenomena:
1) Personal moment (the autonomy of the individual, the motivation of the rules of moral behavior and moral estimates);
2) an objective, extravalunal point (established in this culture, social group, the generality of moral views, values, morals, forms and norms of human relations).
The first of the marked moments refers to the characteristic of morality, the second - morality.
A distinctive feature of morality is that it expresses the autonomous position of individuals, their free and independent decision of what is good and evil, debt and conscience in human actions, relationships and affairs. When they talk about the morality of social groups, communities and society as a whole, it is essentially about morality (about group and social innovations, values, views, relations, norms and establishments).
Traditional norms and rules of medical deontology
1. The hypocrat model ("not harm").
The principles of healing laid down by the "Father of Medicine" Hippocrates (460-377 BC), lie at the sources of medical ethics as such. In his famous "oath", Hippocrates formulated the duties of the doctor before the patient.
2. Paracella model ("Do good").
Another model of medical ethics has developed in the Middle Ages. The most clearly its principles were set out by Paracels (1493-1541). Unlike the Hippocrata model, when the doctor conquers the social trust of the patient, in the paracetes model, Patennalism is acquired - emotional and spiritual contact of the doctor with a patient, on the basis of which the entire treatment process is built.
In the spirit of that time, the relationship of the doctor and the patient is similar to the relationship of the spiritual mentor and the novice, as the concept of PATER (Lat. - Father) is distributed in Christianity to God. The whole essence of the relationship of the doctor and the patient is determined by the beneficia of the doctor, in turn, in turn, has a divine origin, because all the benefit comes over, from God.
3. DeonTological model (the principle of "adherence to debt").
The basis of this model is the principle of "adherence to debt" (Deontos in Greater means "due"). It is based on the strictest implementation of the prescriptions of a moral order, compliance with a certain set of rules established by the medical community, society, as well as their own mind and the will of the doctor for compulsory execution. For each medical specialty there is its "Code of Honor", the non-compliance with which is fraught with disciplinary penalties or even an exception from the medical estate.
4. Bioethics (the principle of "respect for the rights and dignity of a person").
Modern medicine, biology, genetics and relevant biomedical technology technologies approached the problem of predicting and managing the heredity, the problem of life and the death of the body, the control of the functions of the human body on the tissue, cellular and sub cell level. Some problems facing modern society were mentioned at the very beginning of this work. Therefore, as soon as the question of compliance with the rights and freedoms of the patient as a person, compliance with the patient's rights (the right to choose, the right to information, etc.) is entrusted to ethical committees who actually made bioethics by the Public Institute.
Moral and Professional Quality Medical Sitters
The role of a medical sister in the process of treating the patient, especially in the hospital, is difficult to overestimate. Implementation of the appointments of the doctor, care for severely ill, carrying out many, sometimes quite complex, manipulations - all this is the direct responsibility of the middle medical staff. The medical sister also participates in the examination of the patient, prepare it for various operational interventions, works in the operating room as anesthesist or operating sister, is observed by the patient in resuscitation and intensive care departments. All this is presented high requirements Not only to the knowledge and practical skills of a medical sister, but also to its moral appearance, the ability to behave in the team, when communicating with patients and their relatives.
Always and under all the circumstances it is necessary to remember that a person appeals to medical professionals for help, due to the fact that the trouble happened to him, sometimes very serious, able to entail the loss of health, ability to work, and sometimes threatening life. Only with full sympathy to the patient, with the understanding of its position, this contact is possible between it and medical personnel, which is so necessary for successful treatment. Durability, moral support, spiritual heat is needed to patient no less, and maybe more than drugs. No wonder in the near past, nurses were called "sisters of mercy": this reflected not only the professional, but also the moral side of their work. Indifferent, unbalanced people who are not able to sympathize with a person who sufferers cannot be allowed to work in medical institutions. When communicating with the patient, performing manipulations, often unpleasant and painful, the nurse must distract the patient from severe thoughts, inspire him the vigor and faith in recovery.
Often patients ask nurses about their diagnosis and forecast. In no case cannot be informed by the patient about the presence of an incurable disease, especially a malignant tumor. As for the forecast, it is always necessary to express firm confidence in a favorable outcome. All information that the medical sister gives the patient must be consistent with the doctor.
BUT)Relationship "Nurse - doctor":
Invalid rudeness, disrespectful relationship in communication;
Perform medical appointments in a timely manner, clearly and professionally;
Urgently inform the doctor about sudden changes in the patient;
In case of doubt, in the process of performing medical purposes in tactful form, find out all the nuances with a doctor in the absence of a patient.
B)Relationship "Nurse - Nurse":
Invalid rudeness and disrespectful attitude towards colleagues;
Comments should be tactfully and in the absence of a patient;
Experienced nurses must share with young experience;
In difficult situations should help each other.
IN)Relationship "Nurse - Junior Medpers":
Comply with mutual respect;
Control tactfully, unobtrusively the activity of the younger medical staff;
Invalidness, familiarity, arrogance;
It is unacceptable to make comments in the presence of patients and visitors.
Features of communication with patients with children
For children of any age, the attitude must be even, benevolent. This rule must be observed from the first days of stay in the hospital.
Medical workers directly among children should always take into account the psychological features of patients, their experiences, feelings. Older children, especially girls, are most sensitive and in the first days of stay in the hospital are often closed, "go to ourselves." For a better understanding of the state of children, it is important, in addition to finding out individual psychological features Child, know the situation in the family, the social and position of parents. All this is necessary to organize the right care of the sick child in the hospital and its effective treatment.
When communicating with patients, health workers often experience emotional tension, sometimes caused by the incorrect behavior of children, their whims, unreasonable requirements of parents, etc. In these cases, it is necessary to maintain peace of mind, do not succumb to the momentary sentiment, be able to suppress irritability and excessive emotionality.
Also unacceptably the division of children on "good" and "bad", and even more so allocate "pets". Children are unusually sensitive to caress and delicately feel the attitude towards them adults. The tone of the conversation with children should always be smooth, friendly. All this contributes to the establishment between the child and medical personnel of benevolent, trusting relationships and has a positive effect on a patient.
Of great importance when communicating with the child has sensitivity, i.e. The desire to understand his experiences. Patient conversation with the child allows you to identify personal features, dominant experience, helps in diagnosis. It is necessary not only to formally listen to the complaints of the sick child, but to show a warm participation, respectively, reacting to the heard. The patient calms down, seeing the attitude of the medical worker, and the latter receives additional information about the child. On the contrary, a sharp or familiar tone in a conversation creates an obstacle to establish a normal relationship with a sick child.
Child care, in addition to vocational training, requires a great patience and love for children from a medical worker. It is important to have an idea of \u200b\u200bthe degree of compliance of the mental and physical development of a child, to know his personal qualities. Often, sick children from early age look more infantile than their more developed healthy peers. Medical worker should be able to compensate for children the absence of parents and loved ones. Especially poorly tolerate separation with parents children under 5 years old. However, even painfully experienced temporary separation from parents, children quickly get used to the new setting, calm down. In this regard, frequent visits to parents in the first days of hospitalization may be injured by the child's psyche. It is advisable during the adaptation period (3-5 days) to prevent frequent visits of parents. At the end of this period, if parents or close relatives, due to some reasons, cannot regularly visit the sick child, the medical sister should recommend them more often to send letters, carry transfer to ensure that the child felt care and attention.
The health worker owns a leading role in creating a favorable psychological situation in a medical institution, reminding the child a home environment (organization of games, television broadcasts, etc.). Fresh-air walks bring together children, and attention and warm attitude of medical personnel ensure the adaptation of patients with children to new conditions.
The team of therapeutic institution should be maintained in the team, the unity of style and coherence in the work, which helps to provide a high level of care and treatment of children. Medical sister, being among the children and watching their behavior and reactions, should see the individual features of children, the nature of relationships, etc. Receiving this important psychological information The attending physician can also be changed in a timely manner (optimizing) its main therapeutic tactics, which will contribute to the formation of a healthy psychological atmosphere of therapeutic institution and an increase in the effectiveness of therapeutic process.
Relationship of medical workers with parents of a sick child
Parents, especially the mother, in most cases are hardly experiencing a child's disease. And this is understandable: the mother of a seriously ill child in one degree or another is mentally injured and its reactions can be inadequate, since they capture an energy-very powerful sphere of "maternal instinct". Therefore, an individual approach to the mother is needed by everyone without exception of medical workers. Special attention should be paid to mothers who care for a seriously ill child in the hospital. It is important not only to calm the woman with words, but also to create the necessary conditions for a full-fledged rest, food, convince her that the child gets the right treatment and is in " good hands" Mother should understand the importance and correctness of the prescribed by the doctor and performed by the medical sister of manipulations, procedures, etc. And if necessary, you can train my mother to perform individual manipulations, such as injections, inhalations, etc.
Most parents relate to medical professionals with warmth, confidence and grateful to them for their hard work. However, there are also pretty "difficult" parents who are trying to rudeness and non -actic behavior to achieve special attention of hospital staff to their child. With such parents, medical workers should show internal restraints and external peace of mind, which in itself has a positive effect on poorly educated people.
Big clock requires a medical worker's conversation with parents and close to the sick child in the days of visits and reception. Despite the workload, the medical worker should find time calmly and leisurely answer all the questions. Special difficulties may occur when parents are trying to find out the diagnosis of child's disease, clarify the correctness of the treatment, the appointment of procedures. In these cases, a medical sister's conversation with relatives should not go beyond its competence. It has no right to talk about symptoms and a possible forecast of the disease. A nurse must politely apologize to refer to ignorance and send relatives to the attending physician or the head of the department, which has appropriate competence on these issues.
You should not go "on the basis of" parents, strive to fulfill unreasonable requirements, for example, to stop the injection prescribed by the doctor, change the mode and diet, etc. This kind of "responsiveness" is capable of bringing only harm and nothing to do with the principles of humane medicine and professional continuity.
In the relationship between health workers with parents, the form of circulation has an important meaning. Turning to the parents, medical professionals should call them named and patronymic, not allowing familiarities and do not use such terms as "Mamasha" and "Dad."
Contacts of medical workers with parents in children's offices, as a rule, emotionally saturated, close and frequent. The correct tactics of communication of medical personnel with relatives and close patients of the child creates a proper psychological balance of interpersonal relationships Medical worker - a sick child is his parents.
Legal and moral standards of responsibility of medical workers
medical Deontology Moral Responsibility
The multifaceted activities of medium-sized medical workers aimed at preserving and strengthening people's health are also regulated by the norms of legal and moral, which are in a certain relationship and interaction. This is due to the fact that legislative acts in the socialist society have a deep moral basis.
Consequently, the legal education of medical workers should be combined with moral and vice versa, moral education should be combined with the legal. Such moral norms as compliance with medical secrecy, the obligation to provide emergency medical care to citizens on the road, on the street and other public places, received in our country to secure in the basics of the Union of the SSR and the Union republics on health care.
Examples of the close relationship of the moral and ethical and legal parties to the activities of medical workers can serve as the following situations that are often found in life. If a medical worker clearly complies with the requirements of deontology in relationships with patients and relatives, then, despite the possible adverse outcome of the disease, the relatives of the deceased are to protect the medical worker, because they have seen that in the life of the patient, everything was done in terms of professional, so and moral-ethical.
On the contrary, there may be conflict between the relatives of the deceased and the medical officer if the latter violated the requirements of deontology, showed elements of formalism, silent and disrespect for human dignity in the treatment of the patient.
Thus, those or other moral or legal norms in the process of his work activity will suffer responsibility, the measure of which will depend on the effects of the offense.
According to the State Committee on Antimonopoly Policy, the number of violations of the law "On Consumer Protection" by medical institutions, organizations for 2000-2009. increased by 15.4 times. Positive trends in the struggle for consumer rights often reach their opposite - consumer extremism, when rights enjoy in unfair purposes to extract benefits.
Many cases of improper medical services are becoming topics of publications in the media, they receive a significant public resonance, which was not in previous periods of domestic medicine. The legal basis of civil liability for causing harm in improper provision of medical services is the norms of chapter 59 of the Civil Code of the Russian Federation "Obligations due to harm."
Thus, Article 1064 of the Civil Code of the Russian Federation expresses the principle of the General Delica, according to which the damage caused to the subject of civil law is subject to compensation in the full person who caused harm.
Article 1068 of the Civil Code of the Russian Federation provides for the responsibility of a legal entity for the harm caused by a medical worker in the performance of labor obligations (Special Delikt). At the same time, subjects and substances are often used in medical activities in diagnosis and treatment, which are sources of increased hazard. These may include, in particular, X-ray and laser devices, potent drugs, some diagnostic methods, etc. If the legislator assists certain types of medical services to activities that creates increased danger to others, the medical institution should carry civil liability as the owners of the source of increased danger on the basis of Article 1079 of the Civil Code of the Russian Federation.
The actual basis of the responsibility of the medical institution, the organization is the harm caused to the patient's life and health. The responsibility of medical workers may flow out of the contract for the provision of a paid service in cases of the provision of paid medical services (Art. Art. 778 - 783 of the Civil Code). Contractual liability for causing harm to life and health in the provision of medical services can provide for a wider range of grounds for its occurrence and compensation for harm compared to the delicate.
The relations of the contractual nature extends the action of the RF Law "On the Protection of Consumer Rights". So, in case of failure to the planned result of the treatment when performing a certain type of medical services, a medical institution, an organization, regardless of their guilt, should, or continue treatment for free, or return the money, and if there is guilt - compensate for the moral damage (Article 15).
The Civil Code of the Russian Federation provides for the possibility of maximum compensation for damages incurred by victims as a result of damage to life and health, as it is difficult to restore health, and sometimes it is impossible. According to Article 1085 of the Civil Code of the Russian Federation, compensation is subject to lost by the victims of earnings or part of it, depending on the degree of loss of professional working capacity; additional costs caused by health damage, including treatment costs, additional nutrition, acquisition of medicines, prosthetics, extraneous care, sanatorium-resort treatment, purchase of vehicles, training, if the victim needs these types of assistance and has no right to their free receipt.
In addition, the victim is entitled to compensate for non-pecuniary damage (Art. 1100), and in the case of his death, the hurt accuracy and in connection with the death of the breadwinner. The prerequisite for the occurrence of responsibility is the presence of a legally significant (necessary) causal relationship between the actions of the doctor and the negative consequences for the patient's health. Sometimes the causal relationship is so obvious that it is easy to install. It is more difficult to determine the presence of a causal connection in cases where the result should not be directly due to the illegal action or when the harm is caused by the action of a non-one person, but a number of factors and circumstances that complicate the situation. It should be noted that in relation to the causality of harm in the provision of medical services to establish a causal relationship, despite the objective nature, it is very difficult.
Medical services are a multidimensional process that includes diagnostic, medical, preventive measures, and deviating from the regulatoryly prescribed behavior of a medical professional at any stage of the process can lead to undesirable consequences for the patient's life and health in the future.
In some cases, with all their experiences and knowledge, medical experts can only state the likelihood of the presence or absence of a causal connection.
To impose civil liability in causing harm to establish the guilt of medical workers. So, according to paragraph 2 of Article 1083 of the Civil Code of the Russian Federation, if the coarse negligence of the victim himself contributed to the emergence or increase of harm, depending on the degree of fault of the victim and the injury damage, the amount of reimbursement should be reduced (the patient refuses to receive drugs, consumes alcohol during the treatment period of antibacterial preparations, violates the presented to him by the medical bed, hid information about the state of his health, which is essential when choosing a treatment method).
The presence of the fault of the victim in the occurrence of adverse consequences for his health should prove the damage causer, i.e. Medical institution, organization. From medical documents it is possible to obtain information reflecting the patient's treatment, the procedure for the appointment of certain procedures, drugs, health status and complaints of the patient at various stages of treatment.
Taking into account the increase in the number of claims for citizens about the improper provision of medical services, the problems of legal responsibility of medical professionals for professional offenses should be paid to increased attention. The implementation of legal liability is achieved through the use of legal means, which allows the impact of the right to public relations in the field of medical activities. As you know, not all medical interventions end safely, i.e. recovery patient. In those cases of adverse outcomes, when it does not have to talk about the legitimacy of the actions of a medical worker, there is a need for an objective assessment of the treatment and determination of the type and degree of responsibility of the medical worker.
The main documents constituting the regulatory framework determining the property responsibility of medical professionals for committing professional offenses are the Civil Code of the Russian Federation, the Russian Law "On Consumer Rights Protection" (dated January 9, 1996 N 2-FZ), the Fundamentals of the Russian Federation on Health Protection Citizens (1993). The Russian Law "On Consumer Protection" regulates the property responsibility of medical institutions, organizations at the expense of the rules on the quality of the service, the rights of the consumer to the security of the service, compensation of moral damage, etc. Property responsibility of medical institutions, organizations implies their greater openness, a decrease in the number of departmental and professional barriers, the equality of patients in the provision of medical services and strengthening the severity of the legal protection of medical services consumers.
Currently, the medical community has realized as a real time requirement to study the legal foundations in the health sector. In this regard, it is necessary to bring up a high legal culture and legal consciousness from the "student bench" in future doctors. Legal culture and legal consciousness may arise on the basis of legal knowledge in the formation of the future specialist of the ability to practice legal norms in professional activities, thereby appropriate legal training of medical workers makes it possible to form legal culture, responsibility to person, society and the state. To do this, we need to instill with the medical worker, the desire not only to the knowledge of laws and respect for them, but also the ability to apply legal norms in practice.
Currently, in medical activities, the general trend is that an increasing number of private issues of medical services are regulated through the right, and not surrendering to the deposit of the doctor or moral and ethical standards, which is one of the factors of legality in the field of medicine.
Thus, knowledge of health workers in the field of health, the idea of \u200b\u200btheir rights, responsibilities, on legal responsibility, coming for various professional violations, as well as the knowledge of the patient's rights is the basis of the legal culture of health workers. The streamlining of legal knowledge of medical personnel will facilitate the most complete ensuring the protection of public health.
Conclusion
The ethical basis of professional activities of the medical sister are humanity and mercy. The most important tasks of the professional activity of the medical sister are: comprehensive comprehensive care for patients and facilitating their suffering; Restoration of health and rehabilitation; Promoting health promotion and disease prevention. The Ethical Code provides clear moral guidelines for the professional activities of the medical sister, is designed to contribute to consolidation, increase prestige and the authority of the nursing profession in society, the development of nursing in Russia.
Bibliography
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