Turkiye Klinikleri Journal of Medical Ethics-Law and History

.: RESEARCH
Teşhisin Hastadan Farklı Bir Kişiye Bildirilmesi ve Hekim Sorumluluğu: Nitel Araştırma
Informing a Person Except the Patient About Diagnosis and Physician Responsibility: Qualitative Research
Sevim YAĞIZa, Abdullah YAĞIZb
aİstanbul Üniversitesi İstanbul Tıp Fakültesi, Tıp Tarihi ve Etik ABD, İstanbul, TÜRKİYE
bİstanbul Üniversitesi Diş Hekimliği Fakültesi, Ağız, Diş ve Çene Cerrahisi ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Med Ethics. 2021;29(3):348-56
doi: 10.5336/mdethic.2021-81829
Article Language: TR
ÖZET
Bilgilendirme, hastanın özerkliğine saygının gereği olarak tüm tıbbi süreçlere yerleşmiştir. Bu bağlamda tanı bilgilendirmesi, hastanın gelişecek süreçler hakkında öngörüde bulunmasına, gerekli tedaviyi öğrenmesine olanak sağlar. İyileşme yolunda en uygun stratejiyi seçmesinde aydınlatıcı olur. Bir anlamda tedavi almayı mümkün kılar. Bu çalışmada, gerçek bir olaydan yola çıkarak teşhisin bildirilmesinde karşılaşılabilecek bir yanlışlık ele alınmaktadır. Bebek sahibi, oral skuamöz hücreli karsinom tanısı konulan kadın hastaya teşhis hakkında bilgilendirme yapılmaması vakası anonimleştirilerek sunulmaktadır. Vaka aracılığıyla teşhisi bildirmeme ve hastadan farklı kişiye bildirme tutumunun etik niteliği, Beauchamp ve Childress'ın 'Biyomedikal Etik Prensipleri' yaklaşımı ile normatif açıdan araştırılacaktır. Araştırmada yaklaşımın; hasta özerkliğine saygı, yararlı olma, zarar vermeme ve adalete uygun davranma ilkeleri analizde baz alınmıştır. Hekim tutumunun, temel etik ilkelerle çelişkisinin netlikle görülebilmesi için konu; hekim sorumluluğu, bilgi asimetrisi, anlama yeterliği, savunmasızlık kavramlarıyla kapsamlandırılarak tartışılmıştır. Klinik koşullarda gerçekleşmesi mümkün olabilecek bir yanlışlığın oluşmaması için öneriler sunulmuştur.

Anahtar Kelimeler: Hasta özerkliğine saygı; tanının bildirilmesi; hekim sorumluluğu; bilgi asimetrisi; savunmasızlık
ABSTRACT
Informing is settled in all medical processes as a requirement of respect for patient autonomy. Patient information is accepted as a requirement for respect of his autonomy. Thus, the information about diagnosis enables the patient to predict the future processes and to understand the necessary treatment. It is enlightening in choosing the most appropriate strategy for recovery. In a sense, it makes it possible to accept the treatment. In this study, based on a real event, a mistake that might be encountered in reporting the diagnosis is discussed. The case of a female patient diagnosed with oral squamous cell carcinoma, who has a baby and not being informed about the diagnosis is presented anonymously. The moral status of the attitude of not informing a patient about the diagnosis and reporting it to different person have been normatively investigated with Beauchamp and Childress's 'Principles of Biomedical Ethics approach'. The four principles of the method; respect for patient autonomy, being useful, not harming and protecting justice were used in the analysis. In order to clearly see the contradiction between the physician's attitude and principles of bioethics; the subject was discussed by including the physician responsibility, information asymmetry, comprehension competence, and the concept of vulnerability. At the end, suggestions were presented to prevent this possible error in clinical conditions.

Keywords: Respect for patient autonomy; diagnostic informing; physician responsibility; information asymmetry; vulnerability
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