Folia medica Cracoviensia
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Folia medica Cracoviensia · Jan 1998
Review[Persistent vegetative state: medical, moral, legal and economic aspects].
The classical definition of persistent vegetative state describes patient who is wakeful but not awake, and indicates intact function of the brain stem and no function of brain cortex. The presence and the degree of awareness is most difficult to assess and causes moral and legal controversies concerning the management of persistent vegetative state. ⋯ Differential diagnosis includes coma, brain death, locked-in syndrome and minimally responsive state. The pressure of economical factors (managed care) on medical care makes this problem even more complicated.
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Psychiatry is a discipline which poses particularly sophisticated and subtile requirements from the point of view of professional ethics, as well as general morality, especially when a psychiatrists is a forensic court expert. The necessity of freeing oneself from the temptation to succum to one's distance, and preserve a suitable professional perspectives, with a simultaneous understanding of another human being, often forces the forensic expert to face the toughest and doctor. One also has to bear in mind the specific triple responsibility of the forensic psychiatrists: before the examined person, the confidence in him and whose interests also need to be respected and protected. ⋯ The issue of professional secrets in medicine is discussed in the Code of Medical Ethics (1993) and in Act on the Protection of Mental Health (1995). Finally, the deontological problems of forensic psychiatry and psychology can be analyzed at the most general level, when for instance, totalitarian states abuse institutions whose aim is to bring assistance to people with mental disturbances, for political purposes. Such accusation were never made with relation to Poland.
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At the beginning the author presents the definitions of antipathy, sympathy, empathy and syntony as different types of human interrelations. Then he recalls the kinds of physician-patient relations and discusses the antipathy, especially sympathy and empathy appearing in those relations. At the end the author proves the superiority of empathy over sympathy in the solution of problems of medical practice to the advantage of both the patients and the physicians.