Medical Act and Negligence: Ethical Concerns

To all doctors, Medical ethics must be in support of every medical action. Nowadays, ethics in medicine is an elective topic in college curricula, and therefore, unknown, forgotten or poorly learned in detriment of patient care and their wellbeing. Medical care lacking in ethics generates mistakes derived from lack of skill, negligence or recklessness. These are exacerbated by the lack of training and/or overconfidence, which at first glance can appear to be commonplace and even normal, and thus, resulting in medical malpractice. We must return to humanistic medicine. Combat medical mercantilism at the cost of the patients, and recover the social position that medicine has held with the utmost respect for centuries.

Declaration on patient-oriented healthcare of the Tomsk region

The Declaration on Patient-Oriented Healthcare of theTomsk Region was accepted by the medical and patient communities on August 24, 2018. It was the first document of its kind in Russia. It was created based on several elements: modern international experience in the field of protection of patients’ and medical workers’ rights, particular qualities of Russian legislation, principles of humanistic medicine, and broad analysis of specific complaints from patients of regional public health institutions in the Tomsk region. The reason to create the Declaration was the necessity to build a healthcare system in which both medical staff and patients comply with such principles as mutual respect, choice and responsibility, involvement, accessibility, and openness. The document explains the need for constant adherence to these principles for the effectiveness of treatment, the protection of the individual, professional dignity, and equality.

Between Don Quixote and Hamlet: vicissitudes of contemporary Cultural Psychiatry

Background. Although Cultural Psychiatry (CP) has emerged as a significant discipline and body of knowledge in recent decades, it finds itself in a current intense debate about its identity, its contributions, and its future. Objective. To examine conflictive areas of historical, epistemological, clinical, educational, and research interest in the present and future development of CP. Method. A narrative review of outstanding sources, articles, and textbooks on CP that reflect its current vicissitudes; for each area, adequate quotations of Cervantes’ Don Quixote and Shakespeare’s Hamlet are used. Results. In addition to updating definitions and content, discussions about whether CP is a psychiatric subspecialty, the scope of its diagnostic, clinical and therapeutic applications, evaluation of criticisms and strengths, interactions with other disciplines, as well as reflective speculations about its future, are outlined. Discussion and conclusion. CP is considered the receptacle of many disciplines, the last bastion of humanistic medicine in a globalized world, although its development will always be marked by scholarly debates about contexts, meanings, identities, and competencies regarding its ontological and epistemological components.

Values and Pluralism in Psychiatry

Psychiatry belongs to both science and the humanities, but it has often been more concerned with being evidence based than value based. One consequence has been the unacknowledged acceptance of values prevailing in the culture. Another, despite growing attention to ethical concerns, has been the lack of a clearly articulated set of values with which to approach the complexities of clinical work. Four core values—prevention and treatment of disease, patient centeredness, relief of suffering, and enhancement of functioning—can be seen to emerge from psychiatry’s roots in humanistic medicine. Each of these values needs to be counterbalanced by the others and interpreted from the perspective of the clinician’s and the patient’s spiritual or religious worldview. Together, they offer a rationale for assessing the patient’s disorder, chief concern, and prerequisites for flourishing. In this chapter, three vignettes illustrate the utility of these core values in approaching challenging clinical cases.