Practising forensic psychiatry: creating awareness amongst psychiatry residents

Forensic psychiatry is still obscure a discipline amongst the practising psychiatrists; so awareness should be created in the young residents pursuing this stream. It is prudent of setting a curriculum for the general psychiatry residents to learn the relevant topics of forensic psychiatry through didactic lectures, seminars, case-discussions and witnessing case proceedings. This topic could enable budding psychiatrists to acquire the skills of the legal aspects of psychiatry. This challenging yet little known branch of medicine can rejuvenate trainee psychiatry residents to specialise further orconduct research activities.     

Ethical dilemmas in pharmacy.

Results of surveys in which pharmacy students and pharmacists responded to ethical dilemmas are discussed. Respondents indicated a high level of concern about patient welfare and patient rights in dilemmas involving conflicts with socio-economic issues, and with peers and physicians. Conflicts that might arise as the roles of pharmacists change and the health-care systems evolve are also discussed.     

Ethical dilemmas in nursing.

Nurses are increasingly realising that they can offer relevant information and participate in decision-making involving ethical issues. However, inter-professional communications are frequently inadequate, and do not permit exchange of opinions. The consequences are often frustrating and upsetting for nurses whose care is affected by others' policies. This paper explores these issues using some clinical examples.     

Ethical dilemmas in clinical genetics.

This paper discusses the results of a survey of medical and paramedical opinion relating to various difficult ethical issues in clinical genetics. These include the confidentiality of the doctor-patient relationship, prenatal diagnosis and termination, and Huntington's chorea. It is suggested that this method provides a useful means of assessing what is ethically acceptable in contemporary society.     

Ethical dilemmas in palliative care: a study in Taiwan

OBJECTIVES: To investigate the incidence and solution of ethical dilemmas in a palliative care unit. DESIGN: Health care workers recorded daily all dilemmas in caring for each patient. SETTING: Palliative care unit of National Taiwan University Hospital in Taiwan. PATIENTS: Two hundred and forty-six consecutive patients with terminal cancer during 1997-8. MAIN MEASUREMENT: Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others. RESULTS: The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%). CONCLUSIONS: The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care.     

Ethical dilemmas in community mental health care

Ethical dilemmas in community mental health care is the focus of this article. The dilemmas are derived from a discussion of the results of a qualitative research project that took place in five countries of the European Union. The different stakeholders are confronted with the following dilemmas: community care versus hospital care (clients); a life with care versus a life without care (informal carers); stimulation of the client toward greater responsibility versus protection against such responsibility (professionals); budgetary control versus financial incentives (policy makers), and respect for the client versus particular private needs (neighbourhood residents). These dilemmas are interpreted against the background of a value based ethical model. This model offers an integral approach to the dilemmas and can be used to determine policy. The dilemmas are discussed here as the result of conflicting values-namely autonomy and privacy, support and safety, justice and participation, and trust and solidarity.     

Ethical dilemmas of brain failure in the elderly

Doctors caring for patients with senile dementia are faced with the dilemma of making treatment decisions for dying, incompetent persons whose lives can be prolonged but not enhanced by modern medical technology. British physician Robertson explores the idea of encouraging elderly people to sign a written declaration of their treatment preferences if afflicted with an incurable dementia. Such a move could help relieve many elderly of their fears of a prolonged, undignified death; encourage physicians to incorporate patients' expressed wishes into treatment decisions; improve the image of geriatric medicine; and clarify public objectives in medical care of the aged.     

124例精神障碍患者暴力行为的司法精神医学鉴定分析

目的:探讨124例精神障碍患者暴力行为的特点及其意义。方法:抽取精神障碍患者中全部暴力行为者124例。调查人口学资料、提请鉴定方、犯罪特征、作案工具、既往有无精神异常史,精神疾病诊断及结论等。结果:1犯罪嫌疑人大多为男性青壮年、汉族、文化程度低、农村人口多等特征;250%案例由家属提请鉴定;3多以各种刀具及铁制农具为凶器,其手段残忍,导致77人死亡,杀人动机不明;4诊断数量在前3位的分别是精神分裂症(导致68人死亡)、心境障碍、人格障碍;5既往有精神障碍者有62人。结论:加强对高危人群的普法教育,积极、科学治疗精神障碍患者。