Clinician integrity and limits to patient autonomy

A 28-year-old man with chronic granulomatous disease developed worsening respiratory status in the setting of chronic bacterial and fungal infections. The attending physician recommended transfer to the intensive care unit (ICU), but the patient declined. The patient understood that the nurses in the ICU have expertise in caring for patients with poor respiratory function. He also understood that he faced an increased risk of dying if he remained on the medical ward. At the same time, the patient was familiar with the nurses on the medical ward and felt comfortable there. Unsure of whether it was appropriate for clinicians to agree to provide less than optimal care for a critically ill patient, the clinicians on the medical ward requested a bioethics consultation. This article reviews the ethical issues that arise when patients ask clinicians to provide less than optimal care. Although it is well established that clinicians ought to respect patient autonomy, that obligation conflicted, in the present case, with the clinicians' sense of professional integrity. Future research on this vital but underexplored topic is needed to determine the extent to which clinicians' professional integrity places limits on the types of patient requests to which they should agree.     

乡村医生学历教育阶段插入护理教学内容方法及教学改革探讨

【】目的：探讨在乡村医生专科学历教育过程中,开展护理学教学最佳的方法;方法：将我院就读的乡村医生分为观察组和对照组两组。观察组学生对教学方法进行改革,如将各门护理学的知识内容化整为零,以临床医学作为教学的主线,根据临床医学的教学情况,插入相应护理学内容,使医学与护理学、各门护理学之间进行有机的组合。并采用TBL教学法进行授课,提高乡村医生学习的积极性和主动性;观察组学生采取传统的方法教学,即各门护理学课程采用LBL教学法独立开展;结果：经过为期1学期的教学改革试验,从乡村医生的学习感受和期末成绩两方面对教学结果进行比较,除“能够自觉按着教学进度进行学习”等几方面比较差异无统计学意义外,其余各项比较,差异均有统计学意义(P<0.05);结论：根据乡村医生实际的学习需求,从组护理学的教学内容和调整教学时间,并采用TBL教学法进行教学改革,教学效果显著。     

Finnish doctors and the realisation of patient autonomy in the context of end of life decision making

Patient autonomy is a fundamental principle in end of life decision making. However, its realisation may take a variety of forms. Discourse analysis was conducted in a qualitative interview study of 19 physicians. The physicians made use of three different discourses, each of which contained a specific understanding of patient autonomy and a physician's proper activities in the context of end of life decision making.     

医患双方视角下医患关系的影响因素研究

为探讨医患关系恶化的心理成因,本研究对湖北和河南洛阳多家医院医患双方双方进行了结构化访谈和问卷调查.研究结果发现(1)医患信任与医患关系呈显著正相关,医患双方的信任感普遍偏低(;2)医护人员的高风险趋避、患者对医生的高期待、医患双方的归因偏差、就医过程中存在的刻板印象等心理因素不利于医患关系的改善.     

Medical restrictions to driving: the awareness of patients and doctors

The study was set up to investigate the awareness of elderly patients and medical doctors of medical restrictions to driving. Separate questionnaires were completed by patients and doctors. All were interviewed face-to-face, without prior warning and their immediate answers were recorded. In total, 150 elderly patients from the acute elderly care wards, rehabilitation wards and day hospital, and 50 doctors (including all grades from consultant to junior house officer) were interviewed. The main outcome measures were numbers of patients currently driving and previously driving; patients' awareness of how their medical condition affected their ability to drive; doctors' spontaneous knowledge of medical conditions which restrict driving, current licensing policy, and restrictions for five specific medical conditions (epilepsy, myocardial infarction, stroke, 5-cm abdominal aortic aneurysm, and diabetes). Only 21 patients were current drivers, and six of these should not have been driving. While 103 perceived themselves eligible to drive, 46 had medical restrictions to driving. Seventeen of the 47 patients who perceived themselves not eligible to drive possibly did not have restrictions to driving. Doctors' knowledge of the current licensing policy and action to be taken if a patient was not eligible to drive was very poor. Knowledge of medical restrictions to driving was scanty, with few doctors giving the correct driving restrictions for the five specific conditions. We recommend that education of doctors regarding medical restrictions to driving should begin at an undergraduate level and be continued throughout their postgraduate career.     

Women doctors in urban general practice: the patients

A large study from a representative sample of general practitioners in Manchester showed that women doctors saw more women patients than men doctors, especially in the childbearing age group. They saw a similar range of diagnoses as men doctors, though they saw more women patients for cervical smears, contraception, and breast disorders. Preventive health care may not be adequately provided for these in practices without a woman partner.     

Exercising restraint: autonomy, welfare and elderly patients.

Despite moves to enhance the autonomy of clients of health care services, the use of a variety of physical restraints on the freedom of movement of frail, elderly patients continues in nursing homes. This paper confronts the use of restraints on two grounds. First, it challenges the assumption that use of restraints is necessary to protect the welfare of frail, elderly patients by drawing on a range of data indicating the limited efficacy of restraints. Secondly, it argues that the duty to respect individual autonomy extends to a duty to respect the autonomy of patients who are elderly, frail and living in nursing homes.     

The autonomy of demented patients: interviews with caregivers.

Tape-recorded semi-structured interviews were conducted with 21 nursing aides and enrolled nurses in the geriatric clinic in Umeå, Sweden. The interviews focused on the difference between the care of demented and non-demented patients and ethical conflicts in dementia care. The results indicate that caregivers have problems in providing the demented patients with opportunities to act autonomously in everyday matters on the ward, mainly due to the difficulty of understanding what the patients wish and the fact that their wishes, when understood, often seem irrational. Measures to provide the demented patients with more opportunities to act autonomously in everyday matters are suggested.     

Women doctors in urban general practice: the doctors

A large study of general practitioners in Manchester showed that women doctors were younger than men doctors, and few were single handed or worked in deprived inner city areas. They had closely similar patterns of care to their male colleagues, and although they worked slightly fewer hours in surgery, they had almost identical consultation times per patient. Women general practitioners were less active in politics and education than men.     

应用沟通技巧构建和谐医患关系的探讨

医患关系是医护人员与患者在医疗过程中产生的特定医治关系,是医疗人际关系的关键.和谐医患关系是构建和谐社会的一部分.近几年采,我国的医患关系日趋紧张,医疗纠纷的发生率逐年上升,医患矛盾日益突出,医护人员感到了前所未有的压力.     

论医疗法律关系的构成

医疗法律关系由主体、客体、内容三要素构成。医疗法律关系的主体是医方和患方。医疗法律关系的客体是医疗行为。医疗法律关系的内容是医患双方的权利和义务。