Selim Kadıoğlu

A case study from the perspective of medical ethics: refusal of treatment in an ambulance

This paper will examine a sample case encountered by ambulance staff in the context of the basic principles of medical ethics. An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctors opinion, should be achieved and the patient should be quickly started on an intravenous serum. The patient, however, who has so far kept his silence, objects to the administration of the serum. The day this is taking place is within the month of Ramadan and the patient is fasting. The patient states that he is fasting and that his fast will be broken and his religious practice disrupted in the event that the serum is administered. The ambulance doctor informs him that his condition is life-threatening and that the serum must be administered immediately. The patient now takes a more vehement stand. ‘If I am to die, I want to die while I am fasting. Today is Friday and I have always wanted to die on such a holy day,’ he says. The ambulance physician has little time to decide. How should the patient be treated? Which type of behaviour will create the least erosion of his values?

Attitudes of prehospital emergency care professionals toward refusal of treatment: A regional survey in Turkey

Introduction: Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it. Objective: The objective of this study is to identify emergency health professionals’ views regarding refusal of treatment. Methods: This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10. Ethical considerations: Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary. Results: The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism. Conclusions: This study has found that prehospital emergency health professionals generally respect the patient’s right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach.

Ethical problems in geriatrics: Views of Turkish primary healthcare professionals

Primary healthcare professionals frequently encounter ethical issues in the care of older adults. These issues might particularly appear in the context of “age discrimination”, “respect for autonomy”, “respect for privacy” and “decision‐making competency”. The aims of this study were to determine the frequency rates of various geriatric ethical problems and to evaluate the importance given to these problems in primary healthcare.

A comparison of contribution of informed consent forms with long or short texts with regard to obtaining knowledge by volunteers: A pilot study -

Objective. The objective is to determine which of the two texts giving information about the same issue and one of which id short and one of which is long is more effective in enlightening readers having no pre-knowledge of medical science and whether there is coherence between the scores obtained from the texts. Methods. The sampling of the research planned as experimental is constituted by 66 volunteer female students who are 1st year students at the faculty of agriculture. The group was randomly divided into two and the first group was given the short text and the other one the long text. Then the question from was applied in order to find out how much of the information in the form they learnt. Each true answer given to the questions was scored as 1, and each wrong answer was secored as 0; therefore a total grade was obtained. For data analysis, Mann Whitney-U and t Tests analysis methods have been used. Score averages have been compared using Chi-square statistics and calculated using Odds ratio (OR). Consistency between the average scores of the answers given to short and long forms were evaluated through kapa statistics. Results. 100% of the answers obtained using the long form was above the average, 20% of the answers obtained using the short form was above the average and 80% was below the average. Kappa between the answers in the long and short from was found as 81%. The results obtained from the long form were determined to be seven times better than the short one (OR:7,0). The non-random alignment between responses to the long and short form was found to be 81% (Cohen Kappa: 0.814). When the score average scores obtained from the answers given according to the demographic qualities of the participants, no meaningful relation was found. Conclusions. The long version of the context of informed was found more effective than the short one.