Critically ill patients are vulnerable patient that could not speak for their interests due to their life-threatening condition. Sometimes they should get an invasive treatment in the intensive care unit (ICU) to overcome their fatal and serious illness, which involve pain they do not want. Thus the ethical conflict is common in the ICU and in particular, ethical issues related to the “right to life” or “death” are difficult and complex. Major sources of conflicts are behavioral issues among stakeholders, such as verbal abuse or poor communication between physicians and nurses, and end-of-life care issues including a lack of respect for the patient’s autonomy. These conflicts may cause ICU workers’ physical and mental exhaustion, which often result in threats to patient safety. When healthcare professionals lack knowledge to recognize the ethical implications, ethical conflicts occur frequently. The physicians themselves need to be more sensitive to behavioral conflicts and enable shared decision making in end-of-life care. At the same time, the institutions and administrators should develop their processes to find and resolve common ethical problems in their ICUs.
Vulnerability population cannot protect their interest themselves. Vulnerability in emergency medicine is not different. We assume the factors that influence the patient’s course or patient’s outcome badly. We will discuss three factors of the vulnerability in emergency medicine. Those are the family without relational autonomy, the incompleteness of emergency subrogation payment system, and a lack of decision making capacity. We will describe theory, concepts, systems related factors and then apply them to our case. The factors are not independent. We discuss things to be made up for the autonomy and medical interest of the vulnerable patients that influenced by factors.
The rights of patient in the medicine is emphasized recently, especially the right to be appreciated and the right to get adequate information about the management. Self-determination with the informed consent is the most important factor in the decision. There are several limitations in the process of decision-making for medical treatment in the children. Children usually have not enough capacity for decision. But the children are constantly developing and they have different capacity for the decision on the stage of development. So, health care professionals should seek the best options to reflect the opinions of children in the decision-making. Consent of assent of the children should be based on the capacity of the children. All the decisions are should be for the best benefits of the children. If there are some debate on the decisions, health care professionals should consult to social worker or ask the discussion in th committee for medical ethics.
Psychiatric ethics, which is a field of medical ethics, could show complicated ethical conflicts due to the characteristics of psychiatry such as involuntary treatment. The author described the four basic principles of medical ethics including psychiatric ethics, and organized the clinical cases and theories of various ethical situations that are common in the clinical applications of psychiatry. The four principles of medical ethics are the principle of respect for autonomy, the principle of non-maleficence, the principle of beneficence including paternalism, and the principle of justice. The clinical situations of psychiatry described in this study include ethical problems relevant to restraint and isolation, ethical problems relevant to involuntary hospitalization, confidentiality problem, problems relevant to autonomy and others' benefit, surrogate decision making problem, problems relevant to the diagnosis of psychiatric patients, problems relevant to the relationships with the opposite sex between psychiatric patients, and agreement problem.
The purpose of this study was to clarify educational curriculum in the nursing ethics which is contained human right concept, based on a Delphi study. A Delphi study was conducted in two round with faculty members who teach nursing ethics, clinical research nurse, dean of clinical research center as targeted panelists. Consensus was obtained on 4 chapters 15 items. There were 3 items related to the concepts of research ethics, 2 items related to human rights, 7 items related to nurse’s task in the clinical research, 3 items related to social responsibility. This study was carried out to develop curriculum in nursing research ethics for under graduate level for nursing students. The curriculum is expected to foster the ability to assist and cooperate good research.
After the introduction of private insurance, there have been significant changes in clinical practice patterns. In October 2014, 87 private practitioners from the Chungcheong province participated in our survey (18 on-line, 69 off-line). The survey focused on the positive and/or negative effects of private insurance on clinical environment. The results of our survey show that almost half (47.1%) of private practitioners replied that although private insurance doesn't seem to benefit patients’ health, the majority (90.9%) feel private insurance puts added pressure to their practice. The 79.2% replied that the effect of private insurance on the doctor-patient relationship is negative compared with only 4.6% saying it had a positive effect. The 58.6% replied that private insurance had little or no impact on hospital management and 72.4% replied that private insurance negatively affected objective and conscientious decision making. Overall, 50.6% of our participants replied that the private insurance system was flawed with negative side effects, while 49.4% replied that despite its flaws the private insurance system was bearable. No participants felt the private insurance system was positive and benefited the national insurance system. The 48.2% of participants voiced the need for a governing network between health services, private insurance companies, patients and the government.