Attitude of Health Personnel ; Biomedical Research ; Child ; Ethics, Research ; Humans ; Pediatrics

Attitude to Health ; Civil Defense ; ethics ; Communicable Disease Control ; Communication ; Ethics, Medical ; Freedom ; Health Personnel ; ethics ; Health Planning ; ethics ; Health Priorities ; ethics ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; epidemiology ; Mandatory Programs ; ethics ; Moral Obligations ; Pandemics ; ethics ; Patient Rights ; ethics ; Primary Health Care ; ethics ; Public Health ; ethics ; Public Health Administration ; ethics ; Resource Allocation ; ethics ; Singapore ; Trust

Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.
Analgesics, Opioid ; therapeutic use ; Attitude of Health Personnel ; Death ; Deep Sedation ; ethics ; Ethics, Medical ; Euthanasia ; ethics ; legislation & jurisprudence ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Palliative Care ; ethics ; Personhood ; Philosophy, Medical ; Practice Guidelines as Topic ; Suicide, Assisted ; ethics ; legislation & jurisprudence ; Terminal Care ; ethics ; Unconsciousness

The contents of educational goals and objectives of 32 Korean medical schools, that were listed in the Korean Medical Education Directory for 1994-1995, were analysed to help developing new educationa l goals and objectives. Regarding the professions in which the graduates of medical schools can be engaged, all of the 32 school were aiming at the medical doctor. 34.4% at the medical scientist, 28.1% at the medical educator, and 15.6% at the health administrator. Only 37.5% of the medical schools stated that their educational objective is training the primary physician and 50% of the schools did not specify the level of their graduates as a physician. The proportion of schools which stated that the medical student should learn in three domains of educational objectives, i.e. medical knowledge,clinical skills and attitude were 18.8% and 56.3% of the schools descirbed learning just in two domains of medical knowledge and skills which may reflect underating the importance of attitude. The proportions of knowledge and skills which may reflect underating the importance of attitude. The proportions of schools that stated aquiring the ability of holistic management of patients and self-learning/life long study in their educational objectives were 28.1% and 62.5%, respectively. The proportion of schools that emphasized on the medical ethics and morality was 93.8% and on cultivating human nature was 71.9%. These reflect that a high quality of ethics and morality was 93.8% and on cultivating human nature was 71.9%. These reflect that a high quality of ethics and human nature is required to the medical doctor. The universal and ultimate goal of human society and universities, such as democratic educational ideology, Korean educational ideology, prosperity of human society, promotion of human welfare, and improvement of public health, were included in the educational goals in 43.8% of the schools. As the primary goal of medical schools is the producing primary physicians, it is suggested to include the affective domain(attitude), cultivation of the capacity of self-learning and ability of holistic management of patients in the educational objectives of medical shools.
Administrative Personnel ; Education, Medical ; Ethics ; Ethics, Medical ; Human Characteristics ; Humans ; Learning ; Morals ; Public Health ; Schools, Medical* ; Students, Medical

INTRODUCTIONCommunication between patients and physicians is crucial in the disclosure of cancer diagnosis. Although westernisation of Asian societies has resulted in increased awareness of patient autonomy, the family continues to play an important influencing role in the disclosure process. Therefore, in this study, we aimed to characterise the experience of physicians with the disclosure of cancer diagnosis in a westernised Asian population.

METHODSOncologists at a tertiary hospital were approached to participate in this study. Information pertaining to the extent and approach to disclosure was collated. Logistic regression analysis was performed to characterise factors pertaining to the willingness of physicians to fully disclose a diagnosis of cancer.

RESULTSIn all, 25 oncologists (mean age 38 years; 72% men) responded to the survey. A majority of oncologists disclosed a cancer diagnosis directly to the patient over the first few visits. The main reason behind partial or non-disclosure was family objection. Ordinal logistic regression analysis showed that family resistance was the only significant predictor of reluctance to disclose a cancer diagnosis (p = 0.01).

CONCLUSIONIn this pilot study, contrary to previous reports, we found that oncologists were more likely to disclose a diagnosis of cancer to the patient first, that they do not accede fully to the family's request for non-disclosure and that family resistance was the only significant predictor of reluctance to disclose a diagnosis of cancer.

Adult ; Attitude of Health Personnel ; Cross-Cultural Comparison ; Female ; Humans ; Male ; Medical Oncology ; ethics ; Neoplasms ; diagnosis ; psychology ; Physician-Patient Relations ; ethics ; Singapore ; Surveys and Questionnaires ; Truth Disclosure ; ethics

No abstract available.
Health Personnel/*ethics ; Humans ; Hypnotics and Sedatives/*adverse effects ; Propofol/*adverse effects ; Substance Abuse, Intravenous/*etiology

The intensive care unit (ICU) is the most common place to die. Also, ethical conflicts among stakeholders occur frequently in the ICU. Thus, ICU clinicians should be competent in all aspects for ethical decision-making. Major sources of conflicts are behavioral issues, 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. The ethical conflicts are significantly associated with the job strain and burn-out syndrome of healthcare workers, and consequently, may threaten the quality of care. To improve the quality of care, handling ethical conflicts properly is emerging as a vital and more comprehensive area. The ICU 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.
Administrative Personnel ; Decision Making ; Delivery of Health Care ; Ethics* ; Humans ; Intensive Care Units* ; Terminal Care

Health Personnel ; ethics ; Human Rights ; Humans ; Influenza, Human ; prevention & control ; Pandemics ; Professional Role

Contact monitoring is an essential component of the public health response to a Middle East respiratory syndrome coronavirus outbreak, and is required for an effective quarantine to contain the epidemic. The timeliness of a quarantine is associated with its effectiveness. This paper provides a conceptual framework to describe the process of contact monitoring, and proposes a new measure called the "timely quarantined proportion" as a tool to assess the adequacy of a public health response.
Coronavirus Infections/epidemiology/*prevention & control/transmission ; Disease Outbreaks ; Health Personnel/ethics ; Humans ; Public Health/*ethics/legislation & jurisprudence ; Quarantine ; Republic of Korea/epidemiology

INTRODUCTIONThe medical community in Singapore is faced with a rapidly ageing demographic. This would result in an increase in the interaction between medical professionals and older adults. In anticipation of an increased exposure to elderly patients, we sought to determine the attitudes of our house officers (HO), medical officers (MO) and Registrars towards the elderly.

MATERIALS AND METHODSA descriptive pilot study of junior doctors from the Division of Medicine carried out during a luncheon in the largest tertiary-care public hospital in Singapore. A validated self-administered structured questionnaire using Kogan's Old People (KOP) Scale was used to evaluate attitudes towards older adults and basic demographics and medical educational data were collected.

RESULTSFifty-one questionnaires were completed. The mean KOP score was 114.4, suggesting an overall positive attitude towards older people in this sample. The prevalence of negative attitude was 7.8%. There was no significant difference in attitudes among doctors with different designation, age, marital status, medical school attended, nationality, years in medical practice and living arrangement. Doctors who had previous exposure with a posting in Geriatric Medicine had higher KOP scores but were just out of significance (P = 0.098). Respondents who found treating older people unrewarding had significantly lower KOP score (P <0.001).

CONCLUSIONIn this sample of junior doctors, overall attitudes towards older people as measured by the KOP scale were moderately positive. Exposure to a Geriatric Medicine posting during residency may positively influence a doctor's attitudes towards the older adults.

Adult ; Age Factors ; Aged ; Attitude of Health Personnel ; Female ; Hospitals, Public ; ethics ; Humans ; Male ; Physician-Patient Relations ; ethics ; Singapore ; Surveys and Questionnaires ; Young Adult