Journal of medical ethics
-
Journal of medical ethics · Feb 2008
Physicians' confidence in discussing do not resuscitate orders with patients and surrogates.
Physicians are often reluctant to discuss "Do Not Resuscitate" (DNR) orders with patients. Although perceived self-efficacy (confidence) is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions. ⋯ We conclude that physicians' confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics.
-
Journal of medical ethics · Feb 2008
Medical education and patients' responsibilities: back to the future?
Medical student learning is dependent on an unwritten agreement between patients and the medical profession, in which students "practise" upon real patients in order that, when they are doctors, those same patients will benefit from the doctors' skills. Given the increasing propensity for patients to refuse to take part in such learning, there is a danger that doctors will qualify without being truly competent. As patients, we must all ask ourselves, when asked to take part in medical teaching: if this student/trainee doesn't learn now, on me and under supervision, how will the person be truly competent next time, when this is for real, and the patient might be me or my loved one? We argue that a new and more explicit agreement is needed, in which the default should be that all patients are willing to help in the education of medical students, while we ensure that all such students are already competent in simulation before first practising upon real patients.
-
Journal of medical ethics · Feb 2008
Clinical photography and patient rights: the need for orthopraxy.
The increasing use of digital image recording devices, whether they are digital cameras or mobile phone cameras, has democratised clinical photography in the UK. However, when non-professional clinical photographers take photographs of patients the issues of consent and confidentiality are either ignored or given scant attention. ⋯ Best practice recognises the need for informed consent and the constraints associated with confidentiality. Against the background of the poverty of the current discourse of these issues, as presented during the Valentine GMC Fitness to Practice hearing, the paper considers the need for orthopraxy in the use of clinical photography.
-
Journal of medical ethics · Feb 2008
International migration of doctors from developing countries: need to follow the Commonwealth Code.
There is an ongoing debate on the migration of doctors, especially psychiatrists, from developing countries. It is argued that these countries, which are already running short of psychiatrists, will further be jeopardized and their health systems will collapse if this migration and subsequent recruitment continue. In this paper the author presents a personal view of the ethics and human rights of this matter. He emphasises the importance of migration of doctors in view of the current situation in developing countries and advises that the Commonwealth Code be followed to address the problem of the shortage of psychiatrists in developing countries and psychiatrists' basic right to avail themselves of the opportunities in the developed world.
-
Journal of medical ethics · Jan 2008
"Allow natural death" versus "do not resuscitate": three words that can change a life.
Physician-written "do not resuscitate" DNR orders elicit negative reactions from stakeholders that may decrease appropriate end-of-life care. The semantic significance of the phrase has led to a proposed replacement of DNR with "allow natural death" (AND). Prior to this investigation, no scientific papers address the impact of such a change. Our results support this proposition due to increased likelihood of endorsement with the term AND.