The role and significance of medical ethics and deontology in the general structure of social regulation of medical activities.

deontology medical ethics responsibility

Medical ethics is a set of norms of behavior and morality of medical workers.

Originality medical ethics is that in it, all norms, principles and assessments are focused on human health, its improvement and preservation. These norms were initially expressed in the Hippocratic Oath, which became the starting point for the creation of other professional and moral medical codes. The ethical factor in medicine has traditionally great importance.

Basic aspects of medical ethics:

* medical worker and society;
* moral qualities and appearance medical worker;
* medical worker and patient;
* medical worker and relatives of the patient;
* medical confidentiality;
* relationships between representatives of medical professions;
* improvement of knowledge;
* ethics of experiment.

The main ethical principle in medicine is the principle - do no harm. Not causing harm or damage to the health of the patient is the primary duty of every medical worker. Neglect of this duty, depending on the damage to the patient’s health, may become the basis for bringing a medical worker to legal liability.

It is unacceptable to cause moral or physical harm to a patient, either intentionally, or through negligence, or due to professional incompetence. A medical professional does not have the right to be indifferent to the actions of third parties seeking to cause such harm to the patient. The actions of a medical worker to care for a patient, any other medical interventions associated with pain and other temporary negative phenomena, are permissible only in his interests. The risk accompanying a medical intervention cannot be greater than the expected benefit. Having carried out medical interventions that are fraught with risk, the medical worker is obliged to provide safety measures to stop complications that threaten the life and health of the patient

A medical worker is obliged to provide medical care that meets the principles of humanity and professional standards, bear moral responsibility, putting compassion, mercy and respect for the patient’s life above all else. In the healthcare field, work morale comes first, since this profession is associated with the most valuable thing on earth - human life. Professionalism is the basis of the medical agreement with society. And this requires that the interests of patients come before the interests of the medical professional. Patients' decisions and concerns should prevail to the extent that they are consistent with ethical practice and do not require the provision of unqualified care.

The profession of a paramedic requires: restraint, the ability to control oneself even in difficult, unforeseen situations. The patient should not show confusion when providing emergency medical care. The patient, in the actions of the average medical worker, should feel calm, confident and professionally able to perform manipulations within the limits of his professional competencies.

Features of medical ethics are:

The principle of mercy, which states: “I will do good to the patient and will not harm him.” Mercy implies a sensitive and attentive attitude towards the patient.

The principle of autonomy requires respect for the individuality of each patient.

The principle of justice requires equal treatment of medical workers and provision of equal care to all patients, regardless of their status. This principle also states that whatever care a health care professional provides to a patient, his actions must not cause harm to the patient.

Empathy and mercy must become the inner content, the core of the medical worker, who must express this through his actions and everyday behavior. The ethical beliefs of a medical worker should be expressed not in loud statements about love for humanity, but in everyday work, primarily through communication with patients, their loved ones, and in relationships with colleagues.

The principle of completeness of medical care implies professional provision of medical care and a professional attitude towards the patient, the use of the entire available arsenal of healthcare to conduct high-quality diagnostics and treatment.

An even attitude towards all patients, consistency in the behavior of medical workers and commitment to fulfilling treatment prescriptions increase the trust of patients in medical workers.

A particular problem in the clinical activities of medical workers is Iatrogenesis- diseases or psychogenic reactions caused by improper behavior of medical workers, as well as their actions (consequences of diagnostic surgical interventions, drug illness, etc.). In the practice of a medical worker, the causes of iatrogenicity can be an excessively detailed conversation with the patient or his relatives, especially containing a description of possible complications, an unfavorable prognosis, or an ineptly conducted health education conversation. In addition, the cause of iatrogenicity may be the provision of medical history and other information to patients. medical documents.

Health care workers should not discuss patient data, their illness, or their personal lives. This is dictated not only by ethical considerations, but also entails legal liability! The core ethical principle of nursing is respect for the life, dignity and rights of the patient. The ethical responsibilities of a nurse in the process of working with a patient are a certain range of actions that are unconditional for fulfillment (for example, respect the patient and his right to self-determination, i.e., revealing his will in relation to something; do no harm; keep his word; cooperate with the patient).

The efficiency of medical workers increases when the patient is treated correctly based on cooperation. A medical worker must strive to be a professionally competent, competent, independent specialist who has the personal characteristics necessary for this work, as well as health. In order to carry out their professional duties, it is very important for medical personnel to maintain their physical and mental health, i.e. dynamic harmony of the individual with the environment, achieved through adaptation. The ethical principle of doing good to another, an action aimed at benefiting another person or community is called beneficence. This is not only goodwill, selflessness, generosity, but also understanding of another person, compassion for him, and participation in his fate.

Ethics―the doctrine of moral norms and rules that determine the relationships of people in the family, society, everyday life and labor activity. Latin word ethics, Greek ethos(custom) - the doctrine of morality, i.e. a system of consistent judgments about the foundations, meaning and purpose of morality. When defining ethics, the words “morality” and “morality” are used.

The term “ethics” was proposed by Aristotle (384–322 BC), who believed “the goal of ethics is not knowledge, but actions; ethics is needed not in order to know what virtue is, but in order to become virtuous, otherwise there would be no use from this science...”

Medical ethics― a set of norms of behavior and morality of medical workers.

In professional medical ethics, the principle of humanism should be considered the starting point.

Humanism- this is a view that considers a person as the highest value, protecting his freedom and all-round development. The term “humanism” arose in the Renaissance, and the idea of humanity (philanthropy) was formed in the middle of the first millennium BC. e. and is found in the Bible, in Homer, in ancient Indian, ancient Chinese, and ancient Greek philosophical sources of the 6th–4th centuries. BC e. During this period, doctors of ancient Greece made an ethical commitment - the “Oath” of Hippocrates (460–377 BC). In Hippocrates, the idea of humanism has specific expressions: “Whatever house I enter, I will enter there for the benefit of the patient... I will direct the regime of the sick to their benefit... refraining from causing any harm and injustice...”. Manifestations of the humanism of Hippocratic ethics include the commandments about medical confidentiality and the value of any human life.

The idea of humanity is embedded in the famous “golden rule of morality”: act towards others as you would like them to act towards you.

Thus, medical humanism in its original meaning affirms human life as the highest value, defines its protection and assistance as the main social function of medicine, which must fulfill this task, guided by scientific knowledge and professional skill.

2. Historical principles and models of medical ethics

For more than 25 centuries, various moral and ethical principles, rules, and recommendations have been formed and replaced each other in European culture, which have accompanied medicine throughout its history. Medical ethics comes in several forms or models.

The Hippocratic model and the principle of “do no harm.”

The moral principles of healing were laid down by the “father of medicine” Hippocrates. In the Oath, Hippocrates formulated the duties of a doctor to the patient and his colleagues in the profession. One of the most important principles is “do no harm.” The Oath states: “I will direct the treatment of the sick to their benefit in accordance with my strength and my understanding, refraining from causing any harm or injustice.” The principle of “do no harm” focuses on the civil creed of the medical profession.

The Hippocratic model contains an initial professional guarantee, which is considered as a condition and basis for the recognition of the medical class not only by society as a whole, but also by every person who trusts a doctor with his life.

The norms and principles of physician behavior, defined by Hippocrates, are filled with content determined by the goals and objectives of healing, regardless of the place and time of their implementation. Having changed somewhat, they are still observed today in one or another ethical document.

An example of a document created on the basis of the “Hippocratic model” is the “Oath of the Doctor of the Republic of Belarus”.

Forms of harm from a doctor:

- harm caused by inaction, failure to provide assistance to those who need it;

- harm caused by negligence or malicious intent, for example, selfish purpose;

― harm caused by incorrect, thoughtless or unskilled actions;

- harm caused by actions objectively necessary in a given situation.

Thus, the principle of “do no harm” must be understood that the harm emanating from the doctor should only be harm that is objectively inevitable and minimal.

The Paracelsian model and the principle of “do good”― a model of medical ethics that developed in the Middle Ages. Its principles were most clearly stated by Paracelsus (Philip Aureolus Theophrastus Bombastus von Hohenheim (1493–1541). This principle is an expansion and continuation of the previous principle.

Paracelsus' principles: “a doctor should think about his patient day and night”; “a doctor does not dare to be a hypocrite, a tormentor, a liar, or a frivolous person, but must be a righteous person”; “the strength of a doctor is in his heart, his work should be illuminated by natural light and experience”; “The greatest foundation of medicine is love.”

Unlike the Hippocratic model, when the doctor wins the social trust of the patient, in the Paracelsian model, paternalism (“pater” is the Latin concept of “father”)—the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built—acquires primary importance. The main moral principle that is formed within the boundaries of this model is the principle of “do good”, goodness or “do love”, beneficence, mercy. Healing is the organized implementation of good.

The principle of “do good” can be conveyed using words such as “mercy”, “charity”, “beneficence”.

Deontological model and the principle of “observance of duty”.

Compliance of a doctor's behavior with certain ethical standards is an essential part of medical ethics. This is its deontological level, or “deontological model.”

The term “deontology” (from the Greek deontos - due) was introduced into Soviet medical science in the 40s of the twentieth century by Professor N. N. Petrov. He used this term to designate a really existing area of medical practice - medical ethics.

The deontological model of medical ethics is a set of “proper” rules corresponding to a particular area of medical practice. An example of such a model is surgical deontology. N. N. Petrov in his work “Issues of surgical deontology” identified the following rules:

- “surgery for patients, not patients for surgery”;

- “do and advise the patient to perform only such an operation that you would agree to under the current circumstances for yourself or for the person closest to you”;

- “for the peace of mind of patients, visits to the surgeon are necessary on the eve of the operation and several times on the very day of the operation, both before and after it”;

- “the ideal of major surgery is to work with a truly complete elimination of not only all physical pain, but also all mental anxiety of the patient”;

― “informing the patient,” which should include mention of the risk, the possibility of infection, and collateral damage.

From the point of view of N.N. Petrov, “informing” should include not so much “adequate information” as a suggestion “about the insignificance of the risk in comparison with the likely benefits of the operation.”

The principle of “compliance with duty” is fundamental to the deontological model. “Complying with duty” means fulfilling certain requirements. An improper act is one that contradicts the requirements presented to the doctor by the medical community, society and his own will and mind. If a person is able to act according to the unconditional requirement of “duty,” then such a person corresponds to his chosen profession; if not, then he must leave this professional community.

Sets of formulated rules of conduct are developed for each medical specialty.

Ethical committees (commissions) ― analytical, advisory, and, in some cases, regulatory bodies of various composition and status, designed to develop moral rules for the functioning of specific research and medical institutions, as well as provide ethical expertise and recommendations on conflict situations emerging in biomedical research and medical practice. Ethics committees are built on an interdisciplinary basis and include, in addition to doctors and biologists, lawyers, psychologists, social workers, experts in the field of medical ethics, patients and their representatives, as well as representatives of the public.

Thus, the theoretical features and moral and ethical principles of each of the listed historical models are real elements of an integral system of professional and ethical knowledge and constitute the value-normative content of professional modern biomedical ethics.

Medical ethics(Latin ethica, from Greek ethice - the study of morality, morality), or medical deontology (Greek deon - duty; the term “deontology” has been widely used in Russian literature in recent years), is a set of ethical standards and principles of behavior of medical workers when performing them of their professional duties.

According to modern ideas, medical ethics includes the following aspects:

Scientific – a section of medical science that studies the ethical and moral aspects of the activities of medical workers;

Practical – an area of medical practice, the tasks of which are the formation and application of ethical norms and rules in professional medical practice.

Any medical worker should have such qualities as compassion, kindness, sensitivity and responsiveness, caring and attentive attitude towards the patient. Ibn Sina also demanded a special approach to the patient: “You should know that each individual person has a special nature inherent to him personally. It is rare or even impossible for anyone to have the same nature as him.” The word is of great importance, which implies not only the culture of speech, but also a sense of tact, the ability to lift the patient’s mood, and not to injure him with a careless statement.

The doctor’s behavior, both from the point of view of his internal aspirations and from the point of view of his external actions, must be motivated by the interests and welfare of the patient. “Whatever house I enter, I will enter there for the benefit of the sick, being far from everything intentional, unrighteous and harmful,” wrote Hippocrates. The practical attitude of a doctor towards a person, initially focused on care, help, support, is certainly the main feature of professional medical ethics. Hippocrates rightly noted the direct relationship between philanthropy and productivity professional activity doctor Philanthropy is not only a fundamental criterion for choosing a profession, but also directly affects the success of medical practice, largely determining the measure of medical art. “Where there is love for people,” wrote Hippocrates, “there is love for one’s art.”

Of particular importance in the medical profession are such universal norms of communication as the ability to respect and listen carefully to the interlocutor, demonstrate interest in the content of the conversation and the patient’s opinion, and correct and accessible construction of speech. The neat appearance of the medical staff is also important: a clean gown and cap, neat replacement shoes, well-groomed hands with short-cut nails. Even in ancient medicine, the doctor told his disciples-followers: “Now leave your passions, anger, greed, madness, vanity, pride, envy, rudeness, buffoonery, falsehood, laziness and all vicious behavior.”

PRIMUMNONNOCERE (lat.) - FIRST OF ALL, DO NO HARM - this statement is the main ethical principle in medicine.

The moral responsibility of a medical worker implies compliance with all principles of medical ethics. Incorrect diagnosis, treatment, and behavior of the doctor and representatives of nursing and junior medical personnel can lead to physical and moral suffering for patients. Such actions of a medical worker as disclosure of medical confidentiality, refusal of medical care, violation of privacy, etc. are unacceptable.

Caring for a patient involves, among other things, also observing certain rules of communication with him. It is important to pay maximum attention to the patient, reassure him, explain the need to adhere to the regimen, take medications regularly, and convince him of the possibility of recovery or improvement of his condition. Great care must be taken when talking with patients, especially those suffering from cancer, who are not usually told the true diagnosis. And today the statement of the great physician of antiquity, the father of medicine, Hippocrates, remains significant: “Surround the patient with love and reasonable consolation, but, most importantly, leave him in the dark of what threatens him.” In some countries, the patient is still informed about the seriousness of the disease, including the possible death (Latin letalis - fatal), based on socio-economic considerations. Thus, in the USA, a patient even has the right to initiate legal proceedings against a doctor who hid the diagnosis of a cancerous tumor from him.

Iatrogenic diseases

Violation of the deontological principles of communication with a patient can lead to the development of so-called iatrogenic diseases (Greek -iatros - doctor, -gepes - generated, arising). Iatrogenic disease (iatrogenics) is a pathological condition of a patient caused by careless statements or actions of a doctor or other medical worker that create in a person the idea that he has a disease or the particular severity of his disease. Inappropriate, wounding and harmful verbal contacts for the patient can lead to various psychogenic iatrogenies.

However, more than 300 years ago, the “English Hippocrates” Thomas Sydenham (1624–1689) emphasized the danger for the patient not only of the actions of a medical worker, which traumatize the patient’s psyche, but also of other possible factors - undesirable consequences of medical manipulations. Therefore, at present, any diseases the occurrence of which is associated with certain actions of medical workers are considered iatrogenic. So, in addition to the psychogenic iatrogeny (iatropsychogeny) described above, there are:

Jatropharmacogenies: a consequence of drug exposure to the patient - for example, side effects of drugs;

Manipulative iatrogenics: adverse effects on the patient during his examination - for example, complications during coronary angiography;

Combined iatrogenies: a consequence of the influence of several factors;

So-called silent iatrogenies are a consequence of the inaction of a medical professional.

Medical secrecy

Deontological issues of patient care also include the need to maintain medical confidentiality. Medical workers do not have the right to disclose information about a patient of a deeply personal, intimate nature. However, this requirement does not apply to situations that pose a danger to other people: sexually transmitted diseases, infectious diseases, infection with the human immunodeficiency virus (HIV), poisoning, etc.

In these cases, health workers are required to immediately inform the relevant organizations of the information received. In order to carry out sanitary and epidemiological measures in the outbreak when an infectious disease, food poisoning or pediculosis is detected, the nurse is obliged to inform the sanitary and epidemiological station by phone within 12 hours from the moment of diagnosis and at the same time send there a completed emergency notification form (form No. 058/u ).

Errors and medical violations

Compliance by a medical worker with moral and ethical standards involves not only fulfilling his duties, but also bearing responsibility for evasion or unprofessional performance of his duties.
"Fundamentals of legislation Russian Federation on the protection of citizens' health" (1993) regulate the legal liability of a medical worker for causing harm to the health of citizens.

Art. 66 – “Grounds for compensation for harm caused to the health of citizens.”

Art. 67 – “Reimbursement of costs for providing medical care to citizens who have suffered from illegal actions.”

Art. 68 – “Responsibility of medical and pharmaceutical workers for violation of the rights of citizens in the field of health protection.”

Art. 69 – “The right of citizens to appeal against the actions of government bodies and officials that infringe on the rights and freedoms of citizens in the field of health care.”

Orthodoxy and medical ethics

Orthodoxy, being historically and logically the first Christian faith, formed the tradition of an ontological understanding of morality, i.e. the deep inclusion of morality in a single and holistic “order of the world.”

That is why in Orthodox moral values, and the first of them - love for God and neighbor - is not only a desirable norm of behavior. This is the principle of being, the law of the “order of the world”, without compliance with which the “connection of times” and meanings disintegrates, one of the links of which is the meaning of human life. The meaning of human life in Christian ethics is directly related to serving one's neighbor.

In this regard, healing is essentially one of the unique human professions, the meaning and purpose of which coincides as closely as possible with “doing good”, with the Christian values of mercy, philanthropy and saving lives. It is no coincidence that the first model of the social institution of health care as an active manifestation of mercy and philanthropy was implemented in Christian monasteries. “Such is the power of mercy: it is immortal, incorruptible and can never perish” (John Chrysostom).

Introduction:

Medical ethics - (Latin ethica, from Greek ethice) - the study of morality, morality), is a section of the philosophical discipline of ethics, the object of study of which is the moral and moral aspects of medicine.

In a narrower sense, medical ethics is understood as a set of moral standards for the professional activities of medical workers. In the latter sense, medical ethics is closely related to medical deontology.

According to modern ideas, medical ethics includes the following aspects:
scientific – a branch of medical science that studies the ethical and moral aspects of the activities of medical workers;
practical – an area of medical practice, the tasks of which are the formation and application of ethical norms and rules in professional medical practice.

Medical deontology (Greek deon – duty) is a set of ethical standards and principles of behavior of medical workers when performing their professional duties.

Excursion into history:

Ancient sources of medical ethics and deontology are the “Laws of Hammurabi” (laws of Ancient Babylon, XVIII century BC), “On the Physician”, “Oath” and “Law” of Hippocrates (V-IV centuries BC), Indian “Book of Life” - “Ayurveda” (V-IV centuries BC). The term “ethics” as “the idea of human morality and morality” was proposed by Aristotle (384-322 BC).
In the Middle Ages, the “Canon of Medical Science” and “Ethics” by Ibn Sina (Avicenna, 10th-11th centuries) appeared.
Jeremy Bentham (English philosopher, lawyer, priest; 1748–1832) introduced the concept of deontology as “...the doctrine of the proper behavior of a person to achieve his goal” (XVIII century).
Russian medicine is “A Word about the piety and moral qualities of the Hippocratic physician” and “A Word about the way to teach and learn practical medicine” by Matvey Yakovlevich Mudrov (1776-1831), “Letters from Heidelberg” and “The Diary of an Old Doctor” by Nikolai Ivanovich Pirogov (1810 -1881).
Nuremberg trial 1947: the verdict against Nazi doctors - the “Nuremberg Code” - postulates not only legal, but also moral principles of medical experiments.
1947 – The World Medical Association was created. Its fundamental actions are the “Declaration of Geneva” - the doctor’s oath (1948), the International Code of Medical Ethics (1949), the “Helsinki Declaration of Human Rights” (1964), the “Helsinki-Tokyo Declaration” (1975), the “International Declaration of Human Rights” (1983).

Medical ethics studies and determines solutions to various problems of interpersonal relationships in three main areas:
medical worker - patient,
medical worker - relatives of the patient,
medical worker - medical worker.

PRIMUM NON NOCERE (lat.) - FIRST OF ALL, DO NO HARM - this statement is the main ethical principle in medicine.

Of particular importance in the medical profession are such universal norms of communication as the ability to respect and listen carefully to the interlocutor, demonstrate interest in the content of the conversation and the patient’s opinion, and correct and accessible construction of speech. The neat appearance of the medical staff is also important: a clean gown and cap, neat replacement shoes, well-groomed hands with short-cut nails. Even in ancient Indian medicine, the doctor told his disciples-followers: “Now leave your passions, anger, greed, madness, vanity, pride, envy, rudeness, buffoonery, falsehood, laziness and all vicious behavior. From now on you will wear your hair and your nails short, dress in red clothes, and lead a pure life.”

It is always necessary to remember that it is unacceptable for a physician to use perfume and cosmetical tools. Strong and pungent odors can cause undesirable reactions: from nervous irritation of the patient and various manifestations of allergies to an acute attack of bronchial asthma.

Violation of the deontological principles of communication with a patient can lead to the development of so-called Iatrogenic diseases (Greek -iatros – doctor, -genes – generated, arising).

Iatrogenic disease (iatrogenic) refers to a pathological condition of a patient caused by careless statements or actions of a doctor or other medical worker, which create in a person the idea that he has some disease or about the special severity of his disease. Inappropriate, hurtful and harmful verbal contacts to the patient can lead to various psychogenic iatrogenies.

Currently, iatrogenic diseases include any diseases the occurrence of which is associated with certain actions of medical workers. So, in addition to the psychogenic iatrogeny (iatropsychogeny) described above, there are:
iatropharmacogeny: a consequence of drug exposure to the patient - for example, side effects of drugs;
manipulation iatrogenics: adverse effects on the patient during his examination - for example, complications during coronary angiography;
combined iatrogenies: a consequence of the influence of several factors;
so-called silent iatrogenies are a consequence of the inaction of a medical professional.

Code of Medical Ethics ( Approved by the All-Russian Pirogov Congress of Doctors on June 7, 1997)
I. Doctor and society

1. The subject of special concern of the state and society is ensuring and preserving the life and health of citizens. Full protection of the health of the people and provision of conditions that allow them to exist and develop with dignity are criteria for the moral policy of the state. In the implementation of this social task, a large role belongs to the doctor, his professional activity and moral position.

2. The main goal of the professional activity of a doctor (practitioner and scientist) is to preserve human life, prevent diseases and restore health, as well as reduce suffering from incurable diseases. The doctor performs his duties following the voice of conscience, guided by the Hippocratic Oath, the principles of humanism and mercy, documents of the world community on ethics, Art. 41 of the Constitution of Russia and the Law of the Russian Federation “On the right of citizens to health care and medical care”.

3. The doctor bears full responsibility for his decisions and actions. To do this, he must systematically improve professionally, remembering that the quality of care provided to patients can never be higher than his knowledge and skills. In his activities, the doctor must use the latest achievements of medical science, known to him and approved for use by the Ministry of Health of the Russian Federation.

4. Motives of material and personal gain should not influence the doctor’s professional decision-making.

5. The doctor should not accept incentives from manufacturers and distributors of medicines for prescribing the medicines they offer.

6. When prescribing medications, a doctor must be strictly guided by medical indications and solely by the interests of the patient.

7. Both in peacetime and in wartime, a doctor must provide medical care to anyone in need, regardless of age, gender, race, nationality, religion, social status, political views, citizenship and other non-medical factors, including financial situation.

8. A doctor must conscientiously fulfill his obligations towards the institution in which he works.

9. Doctors teaching students and young professionals should be an example worthy of emulation by their behavior and attitude towards the performance of their duties.

10. The doctor is obliged to use the means available to him (newspapers, magazines, radio, television, conversations, etc.) to promote a healthy lifestyle, to be an example in observing public and professional ethical standards.

11. A doctor may engage in any other activity if it is compatible with professional independence, does not humiliate the doctor’s dignity and does not harm patients and his medical activities.

12. In accordance with Art. 41 of the Constitution of the Russian Federation, in the conditions of state treatment and preventive institutions, the doctor provides assistance to patients free of charge.

13. Right to private practice doctor is regulated by law.

14. Free treatment of other doctors and their immediate relatives, as well as widows and orphans, is the duty of a Russian doctor and an element of professional morality.

15. The humane goals served by the doctor give him grounds to demand legal protection of his personal dignity, sufficient material support, creating conditions for carrying out professional activities both in peacetime and in wartime.

16. By participating in organizational (provided for by the legislation of the Russian Federation) forms of protest, the doctor is not relieved of the obligation to provide the necessary medical care to patients under his supervision.

17. A doctor is obliged to contribute to medical associations and associations by actively participating in their work, as well as carrying out their instructions.

18. For his medical activities, the doctor, first of all, bears moral responsibility to the patient and the medical community, and for violation of the laws of the Russian Federation - to the court. But the doctor, first of all, must remember that the main judge on his medical path is his own conscience.

19. Monitoring of compliance with medical ethics is carried out by professional associations and the ethical committees (commissions) created under them.

20. The Russian Medical Association and its Ethics Committee (EC) defend and defend in the media, society (state) and in court the honor and dignity of a doctor, if such a decision is made collectively.

II. Doctor and patient

1. The doctor is responsible for the quality of medical care provided to patients. In his work, he must be guided by the laws of the Russian Federation, current regulatory documents for medical practice (medical standards), but within the framework of these regulations, taking into account the characteristics of the disease, choose those methods of prevention, diagnosis and treatment that he considers most effective in each specific case, guided by interests of the patient. If necessary, the doctor is obliged to use the help of his colleagues.

2. A doctor should not expose the patient to unjustified risks, much less use his knowledge for inhumane purposes. When choosing any method of treatment, the doctor must first of all be guided by the commandment “Nonnocere!”

3. Except in cases emergency care When he is obliged to take measures that do not aggravate the patient’s condition, the doctor has the right to refuse to treat the patient if he is sure that there is no necessary mutual trust between him and the patient, if he feels insufficiently competent or does not have the necessary capabilities to carry out treatment. In these and similar cases, the doctor must take all measures to inform the relevant health authority about this and recommend the patient to a competent specialist.

4. The doctor must respect the patient’s right to choose a doctor and participate in decision-making on treatment and preventive measures. The doctor usually obtains the patient's voluntary consent to treatment during a personal conversation with the patient. This consent must be informed; the patient must be informed about the treatment methods, the consequences of their use, in particular about possible complications, and other alternative treatment methods. Carrying out therapeutic and diagnostic measures without the patient’s consent is permitted only in cases of threat to the life and health of the patient and his inability to adequately assess the situation. It is advisable to make decisions in such cases collectively. When treating persons suffering from mental illness, the doctor must be guided by the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens during its provision.” When treating a child, the doctor is obliged to provide full information his parents or guardians, obtain their consent to use a particular treatment method or medicine.

5. The doctor must respect the honor and dignity of the patient, treat him kindly, respect his rights to personal privacy, and understand the concerns of relatives and friends about the patient’s condition, but at the same time he must not interfere in private affairs without sufficient professional reasons. the patient and his family members.

6. If the patient is unable to consciously express his consent, it must be expressed by a legal representative or person who has the permanent care of the patient.

7. The patient has the right to comprehensive information about the state of his health, but he can refuse it or indicate the person to whom the state of his health should be reported. Information may be withheld from the patient if there are reasonable grounds to believe that it could cause serious harm to the patient. However, upon a clearly expressed request by the patient, the doctor is obliged to provide him with complete information. In case of an unfavorable prognosis for the patient, it is necessary to inform him extremely delicately and carefully, leaving hope for prolongation of life, for a possible favorable outcome.

8. At the request of the patient, the doctor should not interfere with the exercise of his right to consultation with another doctor.

10. If a mistake is made or unforeseen complications develop during the treatment process, the doctor is obliged to inform the patient about this, and, if necessary, the health care authority, a senior colleague, and immediately begin actions aimed at correcting the harmful consequences, without waiting for instructions to do so.

11. When selecting patients who require complex preventive, diagnostic and especially therapeutic (for example, organ transplantation, etc.) measures, doctors who are forced to prioritize the provision of care must proceed from strict medical indications and make decisions independently, or better yet, collectively, with the participation of members of the ethical committee (commission).

12. A doctor may practice medicine only under his own surname, without using a pseudonym and without indicating titles, degrees, or titles that have not been officially assigned.

III. Collegiality of doctors

1. Throughout his life, a doctor must maintain respect and a sense of gratitude to the one who taught him the art of healing.

2. The doctor is obliged to protect the honor and noble traditions of the medical community. Doctors should treat each other with respect and kindness.

3. A doctor does not have the right to publicly question the professional qualifications of another doctor or discredit him in any other way. Professional remarks addressed to a colleague must be reasoned, made in a non-offensive form, preferably in a personal conversation, before the medical community is informed about them or the issue is brought up for discussion by the ethics committee (commission). The medical community has a duty to assist the physician in restoring his professional reputation.

4. In difficult clinical cases, experienced doctors should give advice and provide assistance to less experienced colleagues in a correct manner. But only the attending physician bears full responsibility for the treatment process, who has the right to accept or refuse the recommendations of colleagues, guided solely by the interests of the patient.

5. Doctors - heads of scientific and medical institutions are obliged to take care of increasing professional qualifications their fellow subordinates.

6. Doctors are obliged to treat other medical and support staff of the institution with respect, constantly taking care to improve their qualifications.

IV. Medical secrecy

1. Every patient has the right to maintain personal confidentiality, and the doctor, as well as other persons involved in the provision of medical care, is obliged to maintain medical confidentiality even after the death of the patient, as well as the fact of seeking medical help, unless the patient orders otherwise.

2. Secrecy applies to all information obtained during the treatment and treatment of a patient (diagnosis, treatment methods, prognosis, etc.).

3. Medical information about a patient may be disclosed:

o with the express written consent of the patient himself;

o at the motivated request of the bodies of inquiry, investigation, prosecutor’s office and court;

o if keeping the secret significantly threatens the health and life of the patient and (or) other persons (dangerous infectious diseases);

o in the case of involving other specialists in treatment for whom this information is professionally necessary.

4. The doctor must ensure that those involved in the treatment of the patient also maintain professional secrecy.

5. Persons enjoying the right of access to medical information are obliged to keep confidential all information received about the patient.

6. In the process of scientific research, training of students and improvement of doctors, medical confidentiality must be observed. Demonstration of the patient is possible only with his consent.

V. Scientific research and biomedical testing

1. Before starting biomedical research, including testing new medicines, biologically active additives, methods of examination and methods of treatment, the doctor must obtain consent to conduct them from the ethical committee (commission or scientific council) of the institution with approval of the plan (protocol) of the proposed study, in which the goals and ethical aspects, the course of the experiment, possible complications.

2. The subject, after familiarizing himself with the goals, methods, potential benefits and possible risks, must give his explicit written consent to participate in the study, which, at the request of the patient, can be freely denounced by him at any stage.

3. For patients unable to give informed consent to participate in the study, consent must be obtained in writing from a parent or other legal representative - a legally responsible person. Such studies can only be carried out in the interests of saving the life, restoring or maintaining the health of the subject, without causing harm to him, deteriorating his health or the course of an existing disease.

4. Biomedical research on humans may be carried out by doctors in the following cases:

o if they serve to improve the health of patients participating in the experiment;

o if they make a significant contribution to medical science and practice;

o if the results of previous studies and scientific literature do not indicate a risk of complications.

5. Biomedical research on humans must be conducted by scientifically qualified medical researchers under the supervision of competent professionals. Researchers are required to interrupt the trial in cases of signs that are dangerous to the life and health of the subject. Tests on pregnant women, fetuses and newborns are prohibited.

6. Testers are required to insure their liability in case of unintentional harm to the health of the test subjects.

7. In experiments on animals, the doctor-researcher must observe the principles of humanity, alleviating their suffering as far as possible, and strive to reduce the number of experimental animals to the maximum possible extent.

8. After registering copyright for a discovery, invention, etc., the doctor must notify his colleagues about the results of his research through the means of professional information available to him.

9. Doctors, especially leaders of scientific teams, must strictly observe copyright in scientific publications. Inclusion of oneself without sufficient grounds in the team of authors, or withholding the names of persons who actively participated in the research, is a violation of the principles of professional ethics.

VI. Help for terminally ill patients

1. The doctor must make every effort to provide the patient with the necessary medical care under extreme conditions.

2. A doctor should not resort to euthanasia, nor should he involve other persons in its execution, but is obliged to alleviate the suffering of patients in a terminal state by all available, known and permitted methods.

3. The question of stopping resuscitation, especially in cases where there is no encephalographic evidence of complete cessation of brain activity, should, if possible, be decided collectively.

4. The doctor must assist the patient in exercising his right to benefit from spiritual support from a minister of any religious denomination.

VII. Transplantation, reproduction, human genome

1. The actions of a doctor, his moral and ethical orientation during transplantation of human organs and tissues, intervention in the human genome, in reproductive function are determined by the ethical, legal and legislative acts of the Russian Federation, the World Medical Association and the World Health Organization.

2. A doctor should not use these areas of science and practice for personal financial gain.

1. A doctor should not participate in advertising means and methods of prevention, diagnosis, treatment, and especially drugs that are not approved for use by federal health authorities, as well as narcotic drugs, alcohol, and tobacco products.

2. Publications of a medical nature, speeches by doctors at scientific forums, educational activities in the press, radio and television must be ethically impeccable, limited to objective scientific and practical information and not contain elements unfair competition, advertising and self-promotion.

3. The doctor is obliged to report to the Pharmacological State Committee of the Ministry of Health of the Russian Federation or the Federal Center for the Study of Side Effects of Drugs of the Ministry of Health of the Russian Federation about all unknown, unwanted side effects of drugs observed by him.

4. In information events organized with the participation manufacturing companies medicines and medical equipment, the doctor must, first of all, focus on informational purposes and not personally carry out advertising work among patients for the purchase of these funds before their state registration according to established order.

5. In the interests of ensuring the life and health of Russian citizens, a doctor should not promote and use methods and means of an occult, mystical and religious nature for the purposes of prevention and treatment.

IX. Doctor's certificates

A doctor can issue medical certificates only in accordance with current legislative, regulatory, methodological and instructional documents.

This code is valid throughout the Russian Federation and is mandatory for all doctors who are members of the Russian Medical Association, its regional branches (branches), as well as professional associations that have officially recognized the Code of Medical Ethics. A doctor who is not a member of professional associations may personally accept the Code of Medical Ethics and be guided by it in his professional activities.

Violation of medical ethics

A patient came to see a doctor he knew and said:

I came to you so that you could look at the medications prescribed by the doctor and tell me whether they are poisonous and whether I can take them.

Intrigued by this unusual treatment, the doctor asked the patient why he thought that drugs could be poisonous.

“Why,” the patient answered, “a week ago I was at an appointment with doctor N. He prescribed me medications, which I immediately bought at the pharmacy. On the way home, I met another doctor, to whom I showed the medicines I had bought. This doctor looked at them and said: “Do not take these drugs under any circumstances! They are like poison for you." And he prescribed me others. I bought the medications he prescribed, I wanted to take them, but then I thought: if one doctor could prescribe me poisonous medications, then why couldn’t another? That's why I came to you so that you can decide whether you can take them.

Thus, a word launched to discredit another turns into a boomerang and hits its own author. In medical practice there are many very instructive cases of such a boomerang.

An otolaryngologist examined the patient in the presence of students. Pressing his tongue with a spatula and looking into his mouth, he said:

Well well! And who operated on you? Yes, for such a surgical technique, the doctor’s hands should be cut off.

The patient tried to say something, but the doctor did not allow him and began to demonstrate it to the students:

Look how rough the scars are. It was as if a butcher was operating, and not a doctor was operating.

Finally, having had enough of ironizing the “wonder doctor,” he allowed the patient to close his mouth. Then the patient calmly said:

Doctor, it was you who operated on me several years ago.

The doctor, now turning pale, now blushing, began to babble some exculpatory phrases...

An eleven-month-old baby suffered from purulent discharge from his ear for a long time. And the patient’s mother asked the therapist to arrange a consultation with an otolaryngologist professor. The professor saw her, and after consultation she returned to tell the therapist the result.

The professor received me very well, examined the child carefully, said that intensive treatment was necessary, and prescribed a number of medications and procedures. But when he walked out the door, the doctor present at the consultation snorted and said: “And what kind of treatment did he prescribe for you! Better come to me and I will cure your baby.”

A disparaging statement about a colleague, especially in the presence of a patient, is a gross violation of medical ethics, and has always been condemned by doctors and the public. Violations of medical deontology appear somewhat more often in the attitude of older colleagues to younger ones. In teams with a healthy microclimate, a caring attitude towards a junior colleague is observed, and if errors in diagnosis and treatment are identified, then comments are made in a friendly and correct form, best in private and never made in the presence of the patient.

A 40-year-old woman consulted a gynecologist. The doctor, from the first minute of the appointment, gave the impression of an irritated person who treated the patient with disdain, conducted the conversation from a position of superiority, making it clear with all her appearance and demeanor that the patient who came to her for advice and help was illiterate and dark, not understanding anything. in women's health. Thus, an adult, educated, adequate woman, who came to the doctor on a very delicate issue, received in response a spoiled mood and a desire to never contact this specialist again. I admit that a doctor can be a good professional from a purely technical point of view, but where is medical ethics? A doctor, first of all, must be a subtle psychologist and show goodwill towards the patient. Women are encouraged to be attentive to their health, but after meeting the above-mentioned doctor, they may lose any desire to go to a medical facility.

Violation of medical confidentiality. Medical examination in kindergarten.

In the kindergarten, the children's diagnoses were posted for public viewing after examination by an ENT doctor and a neurologist. The lists hung at the entrance to the group.

The nurse was talking in the corridor of the preschool educational institution with the teacher. During the conversation, she talked about “what kinds of diagnoses are now available” - before, they say, children from normal families did not bring lice to the institution. When the teacher asked who this child was, she was given his last name. The children heard the conversation, and the very next day all his classmates teased the boy and refused to communicate with him, although he was already healthy. The child’s parents demanded that the employees be fired and compensated for moral damages.

The patient, born in 1937, has diabetes and recently suffered a third stroke! After the second visit, the therapist said to the patient: “You are doomed and don’t call me or an ambulance again! (I told them not to go to this address!)”

The head physician of the Tobolsk city clinic was brought to administrative responsibility for disclosing medical confidentiality.

An administrative case against the health worker was initiated by the city prosecutor's office based on a statement from a 40-year-old local resident. According to the statement, last fall one of the commercial organizations sent a request to the clinic for information about the treatment of its employee.

The requested data has been transmitted commercial organization chief physician of the clinic. An administrative case was initiated against the offending medical worker. As a result of the consideration of the case in court, the chief doctor was fined 4 thousand rubles.

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Essay

Topic: “Ethics and deontology of a medical worker”

Completed by: Larisa Serdyukova

Belgorod 2014

Medical ethics and deontology are features of medical activity based on mutual trust between the patient and the medical worker, to whom the patient voluntarily entrusts his health, and sometimes his life.

Medical ethics (Greek etohs - custom, custom, character) as part of general ethics considers the moral issues of a doctor, including the set of standards of his behavior and morality, a sense of professional duty and honor, conscience and dignity.

Medical ethics also covers certain norms of behavior of a medical worker in everyday life, his culture, love of humanity, physical and moral cleanliness, etc. In general, we can say that ethics is an external manifestation of a person’s inner content.

Medical deontology (Greek deon - due) is understood as the principles of behavior of medical workers aimed at maximizing the benefits of treatment and eliminating the consequences of inadequate medical work. Deontology is part of medical ethics, medical morality.

However, at present, the latest achievements of medical science and technology force us to consider the traditional norms of medical deontology from a slightly different point of view. The former “doctor-patient” principle is being replaced by the new “doctor-device-patient”, and the patient’s need for the sensitive and attentive attitude of a medical worker, for his kind words that inspire hope, has not decreased, but has increased even more.

Relevance of the problem

The uniqueness of medical ethics lies in the fact that all norms, principles and assessments in it are focused on human health, its improvement and preservation. These norms were initially expressed in the Hippocratic Oath, which became the starting point for the creation of other professional and moral medical codes. The ethical factor is traditionally of great importance in medicine. More than eighty years ago, by analogy with the medical Hippocratic Oath, the sister Oath of Florence Nightingale was created.

Ethical standards and phenomena

In the process of development and formation of professional medicine, the humanistic and moral principles of the activities of medical workers were clearly formulated.

On this basis, the most generalized concepts of morality or categories were determined, reflecting moral ties between people and characterizing the attitude of health workers to the subject of their daily activities - a sick and healthy person, to society.

This is how the main categories of medical ethics were formulated and received scientific recognition: duty, conscience, honor and dignity, tact, the meaning of life and human happiness. Naturally, all ethical categories are interconnected, mutually complement and reinforce each other. As our ideas develop and scientific progress in medicine and on this basis - further improvement of methods of examination and treatment of patients.

It is very important that nursing staff not only know, but also use the basic requirements of ethical categories in their professional activities and, on their basis, improve the quality of medical care to the population.

Conscience is an ethical category that expresses higher form the ability of an individual to exercise moral self-control, independently formulate moral duties for himself, demand that he fulfill them, and make a self-assessment of his actions. Conscience is an internal awareness of one's professional duty, professional responsibility as a personal duty and personal responsibility.

Honor and dignity are ethical categories that determine a person’s attitude, both to himself and to another person, and to society as a whole. In its content, the concept of honor is very close to the concept of “dignity”. Both of these categories regulate a person’s behavior in a certain way and determine the attitude towards him from others; they are influenced by other categories of ethics, especially duty and conscience, without which there is no personal honor and dignity.

Tact is not an innate quality, but an acquired one; it is brought up from childhood in the social environment where it grows and is formed in the process of social and individual development.

Happiness is a sign that a person has found personal meaning in life at some specific stage of his life path.

There are two aspects to ethical phenomena:

1) personal moment (the autonomy of the individual, his motivation for the rules of moral behavior and moral assessments);

2) an objective, extrapersonal moment (the moral views, values, mores, forms and norms of human relations that have developed in a given culture, social group, community).

The first of the noted points relates to the characteristics of morality, the second - morality.

A distinctive feature of morality is that it expresses the autonomous position of individuals, their free and independent decision about what is good and evil, duty and conscience in human actions, relationships and affairs. When they talk about morality social groups, communities and society as a whole, we are essentially talking about morality (about group and general social mores, values, views, relationships, norms and institutions).

Traditional norms and rules of medical deontology

1. Hippocratic model (“do no harm”).

The principles of healing laid down by the “father of medicine” Hippocrates (460-377 BC) lie at the origins of medical ethics as such. In his famous “Oath,” Hippocrates formulated the duties of a doctor to his patient.

2. Paracelsus model (“do good”).

Another model of medical ethics developed in the Middle Ages. Its principles were most clearly outlined by Paracelsus (1493-1541). In contrast to the Hippocratic model, when the doctor wins the social trust of the patient, in the Paracelsian model, paternalism - the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built - acquires primary importance.

In the spirit of that time, the relationship between a doctor and a patient is similar to the relationship between a spiritual mentor and a novice, since the concept of pater (Latin - father) in Christianity extends to God. The whole essence of the relationship between a doctor and a patient is determined by the good deed of the doctor; the good, in turn, is of divine origin, for all Good comes from above, from God.

3. Deontological model (the principle of “observance of duty”).

This model is based on the principle of “observance of duty” (deontos in Greek means “due”). It is based on the strictest adherence to moral requirements, compliance with a certain set of rules established by the medical community, society, as well as the doctor’s own mind and will for mandatory compliance. Each medical specialty has its own “code of honor”, non-compliance with which is fraught with disciplinary action or even exclusion from the medical profession.

4. Bioethics (the principle of “respect for human rights and dignity”).

Modern medicine, biology, genetics and corresponding biomedical technologies have come close to the problem of predicting and managing heredity, the problem of life and death of the body, control of the functions of the human body at the tissue, cellular and subcellular level. Some challenges facing modern society, were mentioned at the very beginning of this work. Therefore, the issue of respecting the rights and freedoms of the patient as an individual is more pressing than ever; compliance with the patient’s rights (the right to choice, the right to information, etc.) is entrusted to ethical committees, which have actually made bioethics a public institution.

Moral and professional qualities of a nurse

The role of the nurse in the process of treating a patient, especially in a hospital, is difficult to overestimate. Carrying out doctor's orders, caring for seriously ill patients, carrying out many, sometimes quite complex, manipulations - all this is the direct responsibility of nursing staff. The nurse also participates in examining the patient, preparing him for various surgical interventions, working in the operating room as an anesthetist or operating nurse, and monitoring the patient in the intensive care unit. All this places high demands not only on the knowledge and practical skills of the nurse, but also on her moral character, ability to behave in a team, when communicating with patients and their relatives.

It is always and under all circumstances necessary to remember that a person turns to medical professionals for help due to the fact that a problem has happened to him, sometimes very serious, capable of causing loss of health, disability, and sometimes life-threatening. Only with full sympathy for the patient, with an understanding of his situation, is real contact possible between him and the medical staff, which is so necessary for successful treatment. The patient needs sensitivity, moral support, and warmth no less, and maybe more, than medications. It is not for nothing that in the recent 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 incapable of empathy for a suffering person should not be allowed to work in medical institutions. When communicating with a patient and performing manipulations, often unpleasant and painful, the nurse must distract the patient from difficult thoughts, instill in him cheerfulness and faith in recovery.

Patients often ask nurses about their diagnosis and prognosis. Under no circumstances should you inform a patient that he has an incurable disease, especially a malignant tumor. As for the prognosis, one must always express firm confidence in a favorable outcome. All information that the nurse gives to the patient must be agreed with the doctor.

A)The nurse-doctor relationship:

Rudeness and disrespectful attitude in communication are unacceptable;

Carry out medical prescriptions in a timely, accurate and professional manner;

Urgently inform the doctor about sudden changes in the patient’s condition;

If you have doubts in the process of carrying out medical prescriptions, tactfully clarify all the nuances with the doctor in the absence of the patient.

B)Nurse-nurse relationships:

Rudeness and disrespect towards colleagues are unacceptable;

Comments should be made tactfully and in the absence of the patient;

Experienced nurses should share their experience with young ones;

IN difficult situations must help each other.

IN)Relationships "nurse - junior medical staff":

Maintain mutual respect;

Monitor tactfully, unobtrusively the activities of junior medical staff;

Rudeness, familiarity, and arrogance are unacceptable;

It is unacceptable to make comments in the presence of patients and visitors.

Features of communication with sick children

The attitude towards children of any age should be equal and friendly. This rule must be followed from the first days of your stay in the hospital.

Medical workers who are directly among children must always take into account the psychological characteristics of patients, their experiences and feelings. Older children, especially girls, are the most sensitive and in the first days of hospital stay they often withdraw and “withdraw into themselves.” To better understand the condition of children, it is important, in addition to finding out the individual psychological characteristics of the child, to know the situation in the family, the social and position of the parents. All this is necessary for the organization proper care for a sick child in a hospital and his effective treatment.

When communicating with patients, medical workers often experience emotional stress, sometimes caused by the incorrect behavior of children, their whims, unreasonable demands of parents, etc. In these cases, it is necessary to remain calm, not to succumb to momentary moods, and to be able to suppress irritability and excessive emotionality.

It is also unacceptable to divide children into “good” and “bad,” and even more so to single out “favorites.” Children are unusually sensitive to affection and subtly sense the attitude of adults towards them. The tone of conversation with children should always be even and friendly. All this contributes to the establishment of friendly, trusting relationships between the child and the medical staff and has a positive impact on the patient.

Sensitivity is of great importance when communicating with a child, i.e. desire to understand his experiences. A patient conversation with a child allows you to identify personal characteristics, dominant experiences, and helps in making a diagnosis. It is necessary not only to formally listen to the complaints of a sick child, but to show warm participation, reacting accordingly to what is 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 harsh or familiar tone in conversation creates an obstacle to establishing a normal relationship with a sick child.

Caring for a child, in addition to professional training, requires a medical worker to have great patience and love for children. It is important to have an idea of the degree of correspondence between the child’s mental and physical development and to know his personal qualities. Often sick children from an early age look more infantile than their more developed healthy peers. A medical worker must be able to compensate children for the absence of parents and loved ones. Children under 5 years of age experience separation from their parents especially poorly. However, even children who are painfully experiencing a temporary separation from their parents quickly get used to the new environment and calm down. In this regard, frequent visits to parents in the first days of hospitalization can traumatize the child’s psyche. It is advisable to avoid frequent visits from parents during the adaptation period (3-5 days). At the end of this period, if parents or close relatives for some reason cannot regularly visit a sick child, the nurse should recommend that they send letters more often and carry packages so that the child feels care and attention.

The medical worker plays a leading role in creating a favorable psychological environment in a medical institution, reminiscent of a child’s home environment (organizing games, watching television, etc.). Walking on fresh air bring children together, and the attention and warm attitude of medical personnel ensure the adaptation of sick children to new conditions.

Goodwill, unity of style and coherence in work should be maintained in the staff of the medical institution, which helps to ensure high level care and treatment of children. The nurse, being among children and observing their behavior and reactions, should see individual characteristics children, the nature of relationships, etc. By receiving this important psychological information, the attending physician can also timely change (optimize) his basic treatment tactics, which will contribute to the formation of a healthy psychological atmosphere in the medical institution and increase the efficiency of the treatment process.

Relationships between medical workers and parents of a sick child

In most cases, parents, especially mothers, have a hard time dealing with their child’s illness. And this is understandable: the mother of a seriously ill child is mentally traumatized to one degree or another and her reactions may be inadequate, since they capture the energetically very powerful sphere of “maternal instinct.” Therefore, an individual approach to the mother is necessary from all medical workers without exception. Particular attention should be paid to mothers caring for a seriously ill child in a hospital. It is important not only to reassure the woman with words, but also to create the necessary conditions for proper rest, nutrition, and to convince her that the child is receiving the correct treatment and is in “ good hands" The mother must understand the importance and correctness of the manipulations, procedures, etc. prescribed by the doctor and performed by the nurse. And if necessary, you can train the mother to perform certain manipulations, for example, injections, inhalations, etc.

Most parents treat health care workers with warmth, trust, and are grateful for their hard work. However, there are also quite “difficult” parents who try, through rudeness and tactless behavior, to get the hospital staff to pay special attention to their child. With such parents, medical workers must show internal restraint and external calm, which in itself has a positive effect on poorly educated people.

Great tact requires a conversation between a medical worker and the parents and relatives of a sick child on the days of visits and receiving packages. Despite the workload, the medical professional should find time to calmly and deliberately answer all questions. Particular difficulties may arise when parents try to find out the diagnosis of the child’s disease, clarify the correctness of the treatment, and the prescription of procedures. In these cases, the nurse’s conversation with relatives should not go beyond her competence. She has no right to talk about the symptoms and possible prognosis of the disease. The nurse should politely apologize, plead ignorance, and refer the relatives to the attending physician or department head who has appropriate competence in these matters.

You should not follow your parents’ lead, try to fulfill unreasonable demands, for example, stop injections prescribed by your doctor, change your regimen and diet, etc. This kind of “responsiveness” can only bring harm and has nothing to do with the principles of humane medicine and professional continuity.

In the relationship between medical workers and parents, the form of address is of no small importance. When addressing parents, medical workers should call them by name and patronymic, avoid familiarity and not use terms such as “mummy” and “daddy.”

Contacts between medical workers and parents in children's departments are usually emotionally intense, close and frequent. The correct tactics of communication between medical personnel and relatives and friends of a sick child creates the proper psychological balance in the interpersonal relationships of the medical worker - the sick child - his parents.

Legal and moral standards responsibility of medical workers

medical deontology moral responsibility

The multifaceted activities of paramedical workers, aimed at preserving and strengthening people's health, are also regulated by legal and moral norms, which are in a certain connection and interaction. This is due to the fact that legislative acts in a socialist society have a deep moral basis.

Consequently, the legal education of medical workers must be combined with moral education, and vice versa, moral education must be combined with legal education. Moral standards such as maintaining medical confidentiality, the obligation to provide emergency medical care to citizens on the road, on the street, and others in public places, have been enshrined in our country in the Fundamentals of Legislation USSR and union republics on healthcare.

Examples of the close connection between the moral, ethical and legal aspects of the activities of medical workers can be the following situations, which often occur in life. If a medical worker clearly complies with the requirements of deontology in relationships with the patient and relatives, then, despite the possible unfavorable outcome of the disease, the relatives of the deceased come to the defense of the medical worker, because they saw that during his lifetime everything was done to the patient, both from a professional and professional point of view. and moral and ethical.

On the contrary, a conflict may occur between the relatives of the deceased and the medical worker if the latter violated the requirements of deontology, showed elements of formalism, callousness and disrespect for human dignity in the process of treating the patient.

Thus, anyone who has violated certain moral or legal norms in the course of his work will bear responsibility, the extent of which will depend on the consequences of the offense.

According to the State Committee for Antimonopoly Policy, the number of violations of the Law "On Protection of Consumer Rights" by medical institutions and organizations for 2000 - 2009. increased by 15.4 times. Positive trends in the fight for consumer rights often reach their opposite - consumer extremism, when rights are used for unscrupulous purposes to extract profit.

Many cases of improper provision of medical services become topics of publications in the media; they receive significant public attention, which was not the case in previous periods of domestic medicine. The legal basis for civil liability for causing harm due to improper provision of medical services is the norms of Chapter 59 of the Civil Code of the Russian Federation “Obligations resulting from causing harm.”

Thus, Article 1064 of the Civil Code of the Russian Federation expresses the principle of a general tort, according to which the harm caused to the subject civil law, is subject to compensation in full by the person who caused the harm.

Article 1068 of the Civil Code of the Russian Federation provides for the liability of a legal entity for harm caused by a medical worker in the performance of labor obligations (special tort). At the same time, in medical activities, during diagnosis and treatment, objects and substances that represent sources of increased danger are often used. These may include, in particular, X-ray and laser devices, potent medications, some diagnostic methods, etc. If the legislator classifies certain types of medical services as activities that create an increased danger to others, the medical institution or organization must bear civil liability as the owner of the source of increased danger on the basis of Article 1079 of the Civil Code of the Russian Federation.

The actual basis for the liability of a medical institution or organization is the harm caused to the life and health of the patient. The liability of medical workers may arise from a contract for the provision of paid services in cases of provision of paid medical services (Articles 778 - 783 of the Civil Code of the Russian Federation). Contractual liability for causing harm to life and health during the provision of medical services may provide for a wider range of grounds for its occurrence and the amount of compensation for harm compared to tortious liability.

Relationships of a contractual nature are subject to the Law of the Russian Federation “On the Protection of Consumer Rights”. Thus, in the event of failure to achieve the planned result of treatment when performing a certain type of medical services, a medical institution or organization, regardless of their fault, must, at the patient’s choice, either continue treatment for free, or return the money, and if there is fault, compensate for the moral damage caused (Article 15).

The Civil Code of the Russian Federation provides for the possibility of maximum compensation for losses incurred by the victim as a result of harm to life and health, since restoring health lost in such cases can be quite difficult, and sometimes impossible. According to Article 1085 of the Civil Code of the Russian Federation, the income lost by the victim or part of it is subject to compensation, depending on the degree of loss of professional ability to work; additional expenses caused by damage to health, including costs of treatment, additional food, purchase of medicines, prosthetics, outside care, sanatorium treatment, purchase of vehicles, vocational training, if the victim needs these types of assistance and is not entitled to receive them free of charge.

In addition, the victim has the right to compensation for moral damage (Article 1100), and in the event of his death, the causer of harm also bears funeral expenses and in connection with the death of the breadwinner. A prerequisite for liability is the presence of a legally significant (necessary) causal connection between the doctor’s actions and the negative consequences for the patient’s health. Sometimes the causal relationship is so obvious that it is easy to establish. It is more difficult to determine the existence of a causal relationship in cases where the result does not directly follow the illegal action or when the harm is caused by the action of not one person, but a number of factors and circumstances that complicate the situation. It should be noted that in relation to harm caused during the provision of medical services, it can be very difficult to establish a causal relationship, despite its objective nature.

The provision of medical services is a multidimensional process, including diagnostic, therapeutic, and preventive measures, and deviating from the normatively prescribed behavior of a medical worker at any stage of the process can lead to undesirable consequences for the life and health of the patient in the future.

In some cases, with all their experience and knowledge, medical experts can only state the probability of the presence or absence of a causal relationship.

To impose civil liability for harm, it is necessary to establish the guilt of medical workers. Thus, according to paragraph 2 of Article 1083 of the Civil Code of the Russian Federation, if the gross negligence of the victim himself contributed to the occurrence or increase of harm, depending on the degree of guilt of the victim and the causer of harm, the amount of compensation should be reduced (the patient refuses to take medications, drinks alcohol during treatment with antibacterial drugs, violates the bed rest prescribed by the doctor, concealed information about the state of his health, which is essential when choosing a treatment method).

The guilt of the victim in the occurrence of adverse consequences for his health must be proven by the causer of the harm, i.e. medical institution, organization. From medical documents it is possible to obtain information reflecting the progress of the patient’s treatment, the procedure for prescribing certain procedures, medications, the patient’s health status and complaints at various stages of treatment.

Taking into account the increase in the number of claims from citizens regarding the inadequate provision of medical services, increased attention should be paid to the problems of legal liability of medical workers for professional offenses. The implementation of legal responsibility is achieved through the use of legal means, which allows the influence of law on public relations in the field of medical activities. As you know, not all medical interventions end well, i.e. recovery of the patient. In cases of unfavorable outcomes when it is not possible to talk about the legality of the actions of a medical worker, there is a need for an objective assessment of the treatment performed and determination of the type and degree of responsibility of the medical worker.

The main documents that make up the legal framework defining the property liability of medical workers for committing professional offenses are the Civil Code of the Russian Federation, the Law of the Russian Federation "On the Protection of Consumer Rights" (dated January 9, 1996 N 2-FZ), Fundamentals of the legislation of the Russian Federation on health protection citizens (1993). The Law of the Russian Federation “On the Protection of Consumer Rights” regulates the property liability of medical institutions and organizations through standards on the quality of services, the consumer’s right to the safety of services, compensation for moral damage, etc. The property responsibility of medical institutions and organizations implies their greater openness, a reduction in the number of departmental and professional barriers, equal rights for patients in the provision of medical services and increased legal protection for consumers of medical services.

Currently, the medical community has recognized the study of the legal framework in the field of healthcare as a real requirement of the time. In this regard, it is necessary to instill in future doctors a high legal culture and legal awareness from the “student bench”. Legal culture and legal awareness can arise on the basis of legal knowledge when developing the skills of a future specialist practical application legal norms in professional activities, thereby proper legal training of medical workers allows for the formation of a legal culture, responsibility to the individual, society and the state. This requires instilling in medical workers the desire not only to know the laws and respect them, but also the ability to apply legal norms in practice.

Currently, the general trend in medical practice is that everyone large quantity private issues of the provision of medical services are regulated by law, and are not left to the doctor’s conscience or moral and ethical standards, which is one of the factors of legality in the field of medicine.

Thus, knowledge by medical workers of legislation in the field of healthcare, an understanding of their rights, responsibilities, legal liability for various professional violations, as well as knowledge of the patient’s rights form the basis of the legal culture of healthcare workers. Streamlining the legal knowledge of medical personnel will contribute to the most complete provision of public health protection.

Conclusion

The ethical basis of the professional activity of a nurse is humanity and mercy. The most important tasks of a nurse’s professional activity are: comprehensive comprehensive care for patients and alleviation of their suffering; health restoration and rehabilitation; promoting health and preventing disease. Code of Ethics provides clear moral guidelines for the professional activity of a nurse and is intended to promote consolidation, increase the prestige and authority of the nursing profession in society, and the development of nursing in Russia.

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