Eutanasia: una questione di relazione

2007 ◽  
Vol 56 (6) ◽  
Author(s):  
Marianna Gensabella Furnari

L’impostazione classica della questione bioetica dell’eutanasia attraverso il paradigma dei principi conduce a risolvere la questione con un sì, se si privilegia il principio di autonomia, o con un no se si dà il primato al principio dell’indisponibilità della vita. Il saggio muove dalla proposta che sia possibile un altro approccio, basato sull’interazione, suggerita come linea metodica da Warren T. Reich, del paradigma dei principi con gli altri paradigmi della bioetica: l’esperienza, la cura, la virtù. Il primo momento è ripensare l’eutanasia come l’oggetto di una domanda che viene dalla sofferenza e che, come tale, va accolta ed interpretata in un contesto di relazione. A differenza del suicidio, non vi è qui un darsi la morte, ma un domandare la morte all’altro. L’attenzione etica va spostata dal far centro esclusivamente sull’autonomia al focalizzarsi anche e soprattutto sulla relazione, in particolare sulla complessità e le contraddizioni che segnano oggi la relazione tra il paziente e il medico. Anche se chiede una “cura” limite, paradossale che non può essere data, pena la contraddizione e il ribaltamento degli stessi fini della medicina, la domanda di eutanasia non può restare inevasa, ma deve essere accolta, ri-aperta con l’attenzione che il paradigma di cura impone, con l’humanitas che il paradigma di virtù ci consegna. L’attenzione etica all’esperienza di chi domanda la morte diviene il primo momento per trovare una conciliazione tra momenti apparentemente antitetici, come la sacralità e la qualità della vita, per cogliere la complementarità tra diritti apparentemente antitetici come il diritto ad essere lasciati soli e il diritto a non essere lasciati soli, per sostenere insieme la liberazione dal dolore fisico e la liberazione del dolore dell’anima. Spostando il punto di vista dalla libertà alla relazione, il saggio vuole indicare l’impossibilità etica di dire di sì all’eutanasia proprio sul versante della relazione, ponendo al tempo stesso l’accento non solo sulla responsabilità che il dire di sì comporta, ma anche sulle altre responsabilità di cui la domanda di eutanasia ci fa carico: le responsabilità che riguardano la situazione da cui trae origine, e le altre che riguardano ciò che rimane da fare per rispondere alla richiesta di aiuto e di cura che la domanda sottende. Con il movimento proprio dell’etica della cura, il saggio vuole proporre di non risolvere il dilemma in cui la questione bioetica dell’eutanasia sembra costringerci, rinunciando alla vita o alla libertà, ma di provare a ridefinire il contesto da cui il dilemma ha origine, in modo tale che sia possibile tenere insieme vita e libertà. ---------- Classical approach to the problem of the euthanasia, through the paradigm of the principles conducts to solve the matter with a yes, if the principle of autonomy is privileged, or with a no if the primacy is given to the principle of the unavailability of the life. This paper moves from the proposal that another approach is possible, based on the interaction, suggested as methodic line by Warren T. Reich, of the paradigm of the principles with the other paradigms of the bioethics: the experience, the care, the virtue. The first moment is to consider the euthanasia as the object of a question that comes from the suffering and that, as such, it must be welcomed and interpreted in a context of relationship. Unlike the suicide there is not here a killing oneself, but an asking other for death. The ethical attention must be moved from the exclusive center of autonomy to the relationship, particularly on the complexity and the contradictions that mark the physician-patient relationship between today. Even if it asks a limit “care”, paradoxical that cannot be given, or the aims of the medicine itself would be contradicted and overturned, the question of euthanasia cannot stay outstanding, but must be welcomed, opened again with the attention that the paradigm of care imposes, with the humanitas that the paradigm of virtue delivers us. The ethical attention to the experience of whom asks the death it becomes the first moment to find a conciliation among apparently antithetical moments, as the sacredness and the quality of the life, to gather the complementarity among apparently antithetical rights as the right to be left alone and the right not to be left alone, to sustain together the liberation from the physical pain and the liberation from the pain of the soul. Moving the point of view from freedom to relationship the paper wants to point out the ethical impossibility to say yes to the euthanasia just on the side of the relationship, at the same time setting the accent not only on the responsibility that saying yes means, but also on the other responsibilities of which the question of euthanasia ask us: the responsibilities derived by the situation and the others concerning what to answer to the help request and care that the question subtends. In the way proper of the ethics of the care, the paper proposes not to solve the dilemma of the euthanasia abdicating to the life or to the liberty, but trying to redefine the context from which the dilemma has origin, in such way that it is possible to hold together life and liberty.

Author(s):  
Rosella Ciliberti ◽  
Alessandro Bonsignore ◽  
Liliana Lorettu ◽  
Maurizio Secchi ◽  
Michele Minuto ◽  
...  

"Healthcare organization aims to shorten hospitalization times, both to facilitate patient turnover and to avoid the risks of the nosocomial environment. Between March and September 2018, patients that were discharged after hospitalization for scheduled reconstructive breast surgery were given a portable device with the Dr. Link app installed, created to allow real-time communication with physicians. Patients and physicians completed a satisfaction survey on their experience with the use of the device. Analysis shows overall patient satisfaction in terms of improvement in relationships and quality of life. Physicians reported more responsible patient behaviour, better compliance, and earlier treatment of complications. Continuous interactive assistance can improve the discharged patient’s quality of life and therapeutic path. However, the device risks becoming a negative tool if the health care professional has not made the proper initial emotional investment in the relationship, delegating the totality of the therapeutic relationship to the tablet."


1994 ◽  
Vol 3 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Ryuji Ishiwata ◽  
Akio Sakai

In April 1991, a general meeting of the Japanese Medical Conference (called ev 4 years) was held in Kyoto and attracted 32,500 participants, the largest number ever. The theme of the meeting was “Medicine and Health Care in Transition,” and the program Included panel discussions on “How to Promote the Quality of Health Care” and “How Terminal Care Should Be Provided” and symposia on “Diagnosis of Brain Death and Its Problems,” “The Propriety of Organ Transplantation,” and “Brain Death and Organ Transplantation.” These titles reveal not only how medical professionals in Japan perceive the present situatior healthcare but also the Issues that most concern them.


2021 ◽  
Vol 7 (1) ◽  
pp. 37-41
Author(s):  
Hossein Khoshrang ◽  
◽  
Morteza Rahbar Taramsari ◽  
Cyrus Emir Alavi3 ◽  
Robabeh Soleimani ◽  
...  

Background: In patients undergoing Electroconvulsive Therapy (ECT), obtaining written Informed Consent (IC) must be the standard measure before the procedure. The patient must be informed about the risks and benefits of the treatment and alternatives. Objectives: We aimed to investigate the quality of IC obtaining before the ECT course in an academic hospital in the North of Iran. Materials & Methods: This study was conducted at an academic center in the north of Iran during 2018-2019. Firstly the patients’ mental capacity was assessed, and if it was not adequate for giving informed consent, a patient’s relative was interviewed. The collected data were analyzed by SPSS V. 22. The Kolmogorov-Smirnov test was used to evaluate the normality assumption. To compare the mean scores in subgroups, we applied t-test. Results: A total of 259 people enrolled in the survey and were interviewed. Schizophrenia was the main cause of receiving ECT. The Mean±SD score of receiving information was 8.22±3.68 (0-16), understandability of IC 3.03±1.76 (0-6), patients’ voluntary acceptance of the treatment 1.38±0.68 (0-4) and physician-patient relationship 6.11±2.16 (0-12). The total Mean±SD score was 18.05±3.16 (0-38). Conclusion: IC process was not optimal in our center; however, great trust in the physicians was noticeable. The physician-patient relationship had the highest score while the intentional obtaining of informed consent achieved the lowest.


2019 ◽  
Author(s):  
Yousef Semnani ◽  
Arash Ardalan ◽  
Hamid Reza Shahpouri ◽  
fatemeh bastami

Abstract Background The relationship between physician and patient is important topic in medical practice. How a physician dresses and addresses the patients are key factors that contribute to developing a rapport. This study aimed to investigate the psychiatrist's perspectives in order to facilitate an effective communication with patients.Methods This descriptive-analytic study was done on psychiatrists and psychiatric residents through a non-selective and non-randomized sampling method. Data were collected based on a questionnaire. Variables were such as age, sex, duration of practice as a psychiatrist, priority for male psychiatrist dress preference, priority for female psychiatrist dress preferences, priority for choosing a doctor from a gender perspective, priority for being addressed by patients, using the word of the gentleman or lady to address the patients, and the type of verbs and pronouns used by the psychiatrist and the patient during the interview in terms of the total number of verbs and pronouns. Subsequently, eight photographs of male and female physician’s coverage according to the in Iranian culture were shown to the participants and they were asked to choose one.Results A total of 77 psychiatrists participated in this study, of which 45 (58.4%) were male and 32 (41.6%) were female. In case of male psychiatrist’s coverage, 56 (72.7%) participants preferred suits; whereas in case of female psychiatrist’s coverages, 25 (32.5%) participants chose colored mantos and scarves, 22 (28.6%) selected black manteos and head dresses. Sixty three (81.8%) patients believed that the gender of the physician was not important in determining the treating physician. According to the type of addressing the psychiatrist by patients, 71 (92.2%) participants preferred to call the doctor's name followed by surname and 60 (77.9%) psychiatrists wanted patients to use the word "Mr. or Ms.” prior their names. Sixty three (81.8%) psychiatrists stated that it was better to use plural pronouns and verbs in interviewing patients, and 67 (87%) preferred their patients to use plural verbs to address them.Conclusions Psychiatrists’ appearance and the accuracy of the patient-referring type, based on what the physicians believe, along with the characteristics of the patients’ perspectives, help improving physician-patient relationship.


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2060-2060
Author(s):  
Tait D. Shanafelt ◽  
Deborah Bowen ◽  
Chaya Venkat ◽  
Susan L. Slager ◽  
Clive S. Zent ◽  
...  

Abstract Background: Chronic lymphocytic leukemia (CLL) can have a profound effect on the quality of life (QOL) of patients living with the illness. To our knowledge, no studies to date have evaluated the influence of the doctor-patient relationship on patient’s emotional distress or QOL. Methods: We conducted an international, web-based survey of patients with CLL using standardized instruments to evaluate QOL. Additional questions on the survey explored how often patients thought about their disease and evaluated their satisfaction with specific aspects of their relationship with the physician caring for them. Patients were also asked to indicate what phrases their physicians had used to describe/characterize CLL. Results: Between June and October 2006, 1482 patients responded to the survey. The diagnosis of CLL was validated in a randomly selected subset of patients. Over half (55.9%; n=822) of patients reported they thought about their CLL diagnosis daily. Although the proportion of patients who thought about CLL daily decreased with time, two or more years after diagnosis over 50% of patients still thought about their disease every day. When asked to indicate their satisfaction with various aspects of the physician caring for their CLL, more than 90% (n=1340) of patients felt their doctor had a good understanding of how their disease was progressing (i.e., the stage, blood counts, lymph nodes) but only 69% (n=1024) felt their physician had a good understanding of how CLL affected their QOL (anxiety, worry, fatigue, etc.). Similarly, while 90% (n=1324) of patients felt comfortable talking to their doctor about treatment and management of CLL, only 77% (n=1134) felt comfortable talking to their doctor about how CLL affected QOL. Reported satisfaction with their physician in these areas strongly related to patients’ measured emotional and overall QOL on standardized instruments (all p<0.001). This effect on QOL remained (p<0.002) after adjustment for age, extent of co-morbid health conditions, measured fatigue, and treatment status in a regression analysis. Finally, patients were asked to indicate whether the physician caring for them had used specific phrases to describe CLL. Thirty-three percent of patients had been told “CLL is the ‘good’ leukemia,” 24% had been told “don’t worry about your CLL,” and 35% had been told “if you could pick what cancer to have, this is what you would choose.” Overall, 52% of patients had received one or more of these characterizations of CLL by their physician. The emotional and overall QOL were worse among patients who reported their physician had used these phrases to describe CLL (all p≤0.001). This effect on QOL remained after regression analysis (p<0.002). Patients whose physician had used one of these phrases to describe CLL were also less likely to feel their physician understood how CLL was effecting their QOL and to feel comfortable discussing the effects of CLL on their QOL with their physician (all p<0.001). Conclusions: Physicians play an important role helping patients adjust to the physical, intellectual, and emotional challenges of CLL. The effectiveness with which physicians accomplish these tasks appears to impact the QOL of patients with CLL. Additional studies exploring how physicians can best support patients with CLL are needed.


2005 ◽  
Vol 54 (3) ◽  
Author(s):  
Ignacio Carrasco De Paula ◽  
Nunziata Comoretto

Sempre più frequentemente è richiesto al medico di giustificare le proprie decisioni in funzione dei fini e dei valori rilevanti nella medicina. In una medicina realmente centrata sull’uomo, il fine dell’attività medica è nella realizzazione del bene del paziente, mediante un agire adeguato non solo alla salute, ma all’intero essere del paziente, che lo consideri per il valore, infinito, che gli è proprio. Tale concezione antropologica implica, a livello pratico, che non è mai consentita di una persona la discriminazione - trattarla secondo criteri differenti da quelli che derivano dalla sua natura -, la strumentalizzazione - usarla per altri fini, diversi dal bene proprio della stessa - e l’oppressione - agire nei confronti di essa mortificando o tenendo in scarso conto la sua irrinunciabile autonomia e libertà. In una medicina centrata sul paziente il rapporto medico-paziente non è uno strumento dell’attività medica, ma il luogo in cui si realizza l’attività medica. La medicina è il rapporto medico paziente, un rapporto interpersonale, asimmetrico, non definito dalla sola identificazione dei ruoli, ma dall’individuazione di un obiettivo comune. Rapporto medico-paziente non significa dunque semplice “relazione”, ma implica una vera e propria “comunità”, concetto che richiama un’interazione tra le parti, o meglio, una condivisione. Alla base di un buon rapporto medico-paziente, identifichiamo almeno tre fattori: il riconoscimento dell’altro come persona, la costruzione di una vera e appropriata alleanza terapeutica, l’accettazione dei rispettivi ruoli. In conclusione, l’esercizio della professione medica non può prescindere dalla riflessione su quali siano i suoi scopi e, soprattutto, da una concezione antropologica di cosa sia l’uomo perché non ci rapportiamo con il paziente se non in relazione a questo. ---------- More and more frequently physician is required to justify his own decisions in accordance whit the goals and the important values of medicine. In a medicine really centred on patient, the goal of medical activity is the realization of the good of the patient, by acting not only according to health, but whit the whole being of patient, considering him for the value, endless, that is to him really. Such an anthropological conception implicates, to a practical level, that it is never allowed discrimination of the person - to treat him or her according to different criterions than those deriving from his or her nature -, the exploitation - to use him or her for other ends than proper good - and the oppression - to act towards him or her mortifying his or her autonomy and liberty. In a medicine centred on patient, the physician-patient relationship is not a tool of medical activity but the place in which medical activity comes true. The medicine is the physician-patient relationship, a relationship between two persons, asymmetrical, defined not only by the identification of the roles, but by singling out a common objective. Physician-patient relationship doesn’t mean simple relationship, but it implicates a real community, concept that recalls an interaction between the parts, or better, a sharing. At the base of a good physician-patient relationship we identify at least three factors: the recognition of the other as a person, the construction of a true and appropriate therapeutic alliance, the acceptance of the respective roles. In conclusion, the exercise of the medical profession cannot leave the reflection on what its purposes are out of consideration and, above all, an anthropological conception of what the man is because we behave to the patient in conformity with it.


2020 ◽  
Author(s):  
Axler Jean Paul ◽  
Yves Gardy Leonard ◽  
Rebecca Saint Louis ◽  
Jackyvens Camille ◽  
Hans Peter K. Delicat ◽  
...  

AbstractTo discover the relationship model in force between doctor and patient at the Haitian State University Hospital of Haïti (HUEH), a semi-directed survey was conducted among fifty patients. The qualitative analysis of the various interviews showed that patients were generally satisfied with their relationship with doctors. However, opinions are not sharing on their level information whether it is their illness or their therapeutic management; the results also showed that doctors had poor empathy. Hence our conclusion there is an unethical relationship in this institution, where doctors and patients coexist mainly in a “to” relationship and less so in a “between” relationship.


Author(s):  
Jue WANG

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文首先廓清了“醫乃仁術”在傳統儒家思想脈絡裏的含義,並指出從來源上說,它迥異於西方生命倫理學主流,而採取了一種獨特的“不離人倫,親親為本”的視角。然而這種視角使得“醫乃仁術”總是被一種歧義所困擾:它既是一種行善原則,也是一種未顧及自主性原則的行善原則,家長主義的陰影無處不在。“醫乃仁術”的歧義成為中國生命倫理學建設的最大瓶頸。面對這種困境,本文試圖在現代西方生命倫理學話語實踐之外,另闢蹊徑,借助關懷倫理學和美德倫理學的最近研究成果,闡發“醫乃仁術”的合理內涵。This essay addresses the ethical implications of the physician-patient relationship from the Confucian perspective, which holds that the physician must regard the patient as a family member to treat the patient properly. It is well known that there are two primary approaches to moral authority in contemporary Western medical ethics. One is internal, and assumes that the good inherent to medicine is the source of moral authority in medical activities. The other is external, and denies that the ends and ethics of medicine can be determined by typical medical activities. It holds that medical ethics should be based on general moral principles, such as autonomy and justice. However, the Confucian model seems to be at odds with both of these approaches. On the one hand, Confucians do not think that medicine constitutes a self-contained domain of activity with its own ethics; rather, medicine is seen as a continuum of familial relationships and ethics. On the other hand, Confucians also hold that the physician-patient relationship should follow the example of the flexible relationships among family members rather than the rigid general principles of autonomy and justice.The Western model is aimed at action, whereas the Confucian view focuses on personal affective relations. The greatest problem with the Confucian model is its notorious paternalism; that is, it appears to fail to pay sufficient attention to the potential conflict between patient and physician about the good, ignoring the issue of patient autonomy. In the modern Western tradition, the model of the physician-patient relationship is based on two self-sufficient agents (patient and physician) who are united in pursuing a certain good, where each is the final source of what is good for him- or herself. However, the real physician-patient encounter demands a deeper commitment between the two than this model suggests. When entering a physician-patient relationship, what the patient seeks is care from the physician, not autonomy. That is to say, the patient first of all trusts the physician. To earn that trust, it is not enough that the physician treat the patient based only on the principle of autonomy or what the patient requires. Rather, a deep attachment – analogous to a familial relationship – must be developed that can serve as the basis of the encounter between the patient and physician. The Confucian physician-patient model, which is rooted in such a relationship, does not contrast but rather complements its Western counterpart.DOWNLOAD HISTORY | This article has been downloaded 564 times in Digital Commons before migrating into this platform.


1991 ◽  
Vol 29 (1) ◽  
pp. 1-2

It is important to take medicines in the right dose, at the right times, by the right route and in the right way (e.g. with food), and doctors and pharmacists should be able to give the clear advice which patients need. It is the quality of the relationship between the patient and the doctor and pharmacist, including mutual respect and understanding, that will help the patient to follow the recommendations. The term ‘compliance’ is used to describe how well the patient does this, but it is an authoritarian word which denies the patient’s autonomy. Treatment is an activity shared by doctor and patient in which both parties should ‘comply’ with the needs of the other. In this article we therefore use ‘compliance’ only as a technical term.


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