Development of medical engineering contributes to patients being able to take their lives with the aid of alleviative attention units. While the development of life-support units is welcomed, there exists such occasions where the use of a life support unit may be questionable. Life support units give hope to the patients ; and progresss their relations outlooks of life and wellness. However, there are some instances when the usage of the life support unit should non be preferred. In that instance, treatments emerge about who will be responsible for the application of these units, and who will make up one’s mind on this. In this regard, the consequences of the questionnaire on this subject presented. The mentality of the module members and the nurses will be evaluated from the position of the ethical and administrational jobs that life back up units can do.
Introduction
Technology and cognition have turned the presentation of the wellness service into a communicational and institutional service that is based on high engineering by excepting it from being an person activity through using new proficient innovations on mass production industry in 18th and nineteenth century and triping information-knowledge age in twentieth century ( 1 ) . This current province led society to present their ain sentiments about the presentation of the wellness service, impacting the wellness community negatively. This consequence took portion both in the quality and the presentation of the wellness service. While engineering and cognition facilitated the passage of wellness cognition into a service and simplified its entree, they besides formed new instances that scrutinize the cognitive and biological characteristics of the human such as biotechnology, psychometries, and sociobiology. There besides emerged new constructs and attacks such as wellness, diseases, decease, and life which are related to the issues that deal with presence of the humanity. Today, there exists a differentiation between engineering and high engineering while high engineering is used for the diagnosing and intervention of the patients ( 1 ) .
The chances that engineering provides to wellness services affect non merely the intercession from the beginning but to the terminal of life. Thereby, it is rather possible to province that it serves for the intercession in the procedure of decease on behalf of the medical specialty. This sort of development evokes the thought of detaining the decease and even bring arounding it merely like a disease. Likewise, the thought of disputing decease and dotage merely like in science- fiction novels has been good accepted. So why are we non accepting this thought in the existent universe?
The developments indicate that the construct of decease might be shaped in conformity with the individual ‘s ain will. Contemporary people prefer a painless decease merely like they opt for likewise a painless life. The complicated relationship between the wellness industry and engineering enabled physicians to work as technicians. In the visible radiation of all these developments, a unit which is important for life and decease – in other words ‘intensive attention units ‘ were established in decision to the factors mentioned above.
In the early twentieth century, the thought of building intensive attention units and life support units along with ventilators and oxygenators was accepted. As for 1930s and 1940s, the thought of set uping intensive attention units was supported and the figure of these units increased. ( 2 ) Between 1948 and 1953, anesthetists had an active portion in intensive attention units. The unreal respiration units were established in 1950 in Europe, in 1960 in USA in Oxford Baltimore and Toronto Universities ( 2,3 ) . The first ventilator was designed by Carl-Gunnar Engstrom in 1950. The volume ventilator of Enstrom was used in 1951 consequently ( 3 ) . As for our state, the first four bed intensive attention unit was established with the aid of Prof.Dr. Cemalettin A-ner and Opt.Dr.RA±za Tezel from HaydarpaAYa Hospital in 1960. In 1990s, life support units were established ( 4 ) .
The intensive attention units serve to assist patients with organ failures in the usage of those variety meats until the variety meats can work usually once more. This procedure includes all of the activities which are necessary for the wellness of the patient ( 5 ) . The physicians and nurses are capable of utilizing unreal respiratory units every bit good as many other devices and engineering which are necessary for the intensive attention units.
In 13.08.2007, Health Ministry of Turkey established “ Standards for Intensive Care Units ” . Today, there exist intensive attention units in every infirmary in every metropolis of Turkey. In developed states, there are besides nurses, psychologists, societal service specializers, physical therapists, and medical moralss specializers every bit good as anesthetists in intensive attention units ( 6,7 ) .
The patients who are treated in intensive attention units are either witting or unconscious patients. They are treated in the units until they are healthy plenty to be treated by ordinary infirmary services. These sorts of patients are treated in intensive attention units and they utilize life support units if their physician considers it necessary. The place of the patients who are treated in intensive attention units and are more likely to be in danger of holding a intellectual bleeding, nephritic failure, encephalon decease, or muscular diseases are at higher hazard than the other intensive attention unit patients ( 6 ) . Therefore, the demand for a life support unit is much more important for such sort of patients. In this instance, the medical and ethical duty of wellness professionals additions ( 7,8 ) .
The duty of a medical squad can be expressed in four captions. The first one is make up one’s minding whether the patient will be kept alive with the aid of life support units or non ; the 2nd one is make up one’s minding whether the patient will be disconnected from a life support unit or non ; the 3rd one is the go oning the application of a life support unit ; and the last 1 is the determination made by neurology, neurosurgery, anaesthesia, or cardiology professionals ; to unplug the life support unit in the instance of patient being encephalon dead ( 9,10,11 ) . There are assorted positions about the proceeding inquiry: “ Does the household or the physician of the patient decide on the disjunction of the life support unit when encephalon decease occurs. Or should both of them decide on this issue? ” The life of a individual who is encephalon dead can be maintained by agencies of high engineering. However resurgence of this patient is impossible. This current province conveys the relationship between relations of the patients and the wellness professionals to a legal and ethical platform.
The developments, applications, and constructs about this issue cause struggle in our state as they have late appeared in our footings ( 12 ) .
Situations such as minimising the life opportunity and/ or diminishing quality of life of the terminal patients who are in demand of life support units ; or the state of affairs in which there is small opportunity for the patients to return to wellness do ethical contradictions. In such instances, medical determinations and ethical challenges should be scrutinized as the medical moralss rules, ethical codifications, and legal ordinances give right to do a determination about the procedure of the disease merely to the physicians other than medical squad. Medical moralss principals and patient rights ordinances province that having informed consent from the patient and including the patient in the disease procedure are considered as the chief rule. This chief rule can non be realized merely when the current province of the patient is non suited for make up one’s minding, apprehension, and showing his sentiments ( 13,14,15 ) . For case the forbearance might be unconscious when s/he is taken to the infirmary, s/he might be a kid, or might be psychologically ill. Inarticulateness and uncommunicativeness of the patient might take to confusion about the cognitive outlook of the patient. Medical moralss rules and patient rights ordinances make relations of the patient along with the medical squad participate in the procedure of doing determination about linking and unpluging life support unit. The lone state of affairs in which the medical squad decides about the state of affairs of the patient is when no 1 can acquire in contact with relations of the patient. In this procedure, the medical squad considers the patient ‘s right to populate, his/her positions about quality of life, understanding on decease determination, and the quality of the decease by taking into consideration the medical rating ( 16 ) .
Euthanasia ; the significance of this word is easy, painless, and a happy decease ; it was used and applied in ancient Greece and Roman times. In seventeenth century, Francis Bacon categorized mercy killing in 2 types. The first 1 is interior mercy killing which prepares the patient ‘s psyche to a peaceable decease with the aid of the priests. The 2nd 1 is exterior mercy killing which means ending the life of a patient who has no opportunity to populate in a painless manner ( 17 ) .
Today euthanasia stands for “ ending the life of a patient who has no opportunity of intervention or with the will of individuals who have the right to make up one’s mind in the name of the patient, doing a determination for the patient ” ( 17 ) . Euthanasia is discussed in three different contexts. The first 1 is active and inactive mercy killing in footings of the physician ‘s committee ; the 2nd 1 is voluntary and nonvoluntary mercy killing in footings of the patient ‘s will ; and the last 1 is direct and indirect mercy killing in footings of the activity ‘s quality ( 17 ) . The construct and application of mercy killing have been discussed about whether it is a human right or non and this issue does non merely include medical justification and application. It besides has ethical and legal sides necessitating an interdisciplinary attack.
Some states defend the thought that people should be free to take the right to decease and accordingly they advocate that euthanasia application should be a legal right. For case ; while Italy decides for the readying of “ biological free will ” , Holland, Belgium, Australia, Oregon province of USA, Sweden and Luxemburg Torahs evaluate demand of decease as a right and license mercy killing lawfully ( 18,19,20 ) .
Medical Ethical motives Principles:
Ethical motives rules enable the connexion with systematic thought that serve for the assujettissement of medical applications ( 16 ) . “ Systematic thought bases for accomplishing an applicapable, consistent, and stable thesis other than the certain replies ” ( 17 ) .
These rules are ; nonmaleficence, beneficence, justness liberty, justness, confidentiality, privateness, and honestness. A medical squad should see the medical moralss rules when they decide about unpluging life support unit. Medical moralss rules are consideration during the whole procedure of the life support units.
The first rule is that if the current state of affairs of the patient does non differ and this procedure does non assist the intervention, unpluging life support unit might be a determination to do. Every individual measure should be applied in the frame of medical moralss rules. The 2nd 1 is that the medical squad should be informed about the patient ‘s outlook of life quality either by the patient himself or relative of the patient due to the medical moralss rules and they should see this information in the procedure of the determination. The 3rd one is that medical squad should inform the patient or relations of the patient about the current province by explicating the fact that life support unit will non assist the patient for rehabilitation. Otherwise relatives of the patients may be disappointed and consequently they may impeach the medical squad essoining the lack of medical attention.
Obstacles among the medical squad, patient, and relations of the patient: The first obstructions are the socio-cultural position, educational degree, attack, and belief. If these differences which cause obstructions are non evaluated and safeguards are non taken, communicating between the medical squad and relations of the patient becomes impossible. As for most of the people, the determinations should be in understanding with the faith. Besides, the patient and relations of the patient may non listen to physicians ‘ address actively due to anxiety, mourning, fright or sorrow so they may non to the full understand the whole duologue. The medical squad should take safeguards for the emotional crisis that relatives of the patient undergo. However the opportunity of common apprehensiveness and consensus lessenings.
The 2nd obstruction is denial of the current state of affairs by relations of the patient. They may non accept the current state of affairs of the patient even if they are told about the state of affairs many times. They may besides hold absurd ideas as if the medical squad is seeking to acquire rid of the patient. In this instance the medical squad should be receptive and patient towards relations of the patient and let for understanding. At the terminal of the procedure, they should be told about the forecast of the disease with the aid of images and booklets and a common determination should be made about the current state of affairs of the patient ( 21 ) .
The 3rd obstruction is turning away of guilt and duty of relations of the patient. They may experience guilty due to the determination they make, so they may non give informed consent. Consequently, they tend to go forth the whole duty of the determination to the medical squad. In this instance, psychological support should be provided to relations of the patient about the procedure of determination.
The 4th obstruction is that relations of the patient and the patient are non independent persons. As the construct of individuality has non improved plenty particularly in folk ( aAYiret ) based communities, active engagement in the determination phase does non be. Peoples who live in East Anatolia and South East Anatolia are used to accepting the thoughts of the people who are accepted as leader in their community. This state of affairs limits a physician ‘s radius of action and the physician is accused of the consequence.
The determination of linking patient to a life support unit ; The medical squad evaluates the lab consequences and physical intervention sing current proficient resources. Consequently they tell the patient and relations of the patient about the benefits of life support unit by having their informed consent. There may be some ethical jobs when the determination is made about the life support unit. One of these jobs is that if a patient does non hold legal competency, the determination of the medical squad or relations of the patient may non match with the patients ‘ position about life and decease ( 12,13 ) .
The medical squad may besides predict about patient ‘s positions from the relations. Appropriate inquiring is indispensable in the procedure of the determination. The medical squad should inquire the inquiry: “ If your patient would be witting, would s/he take to populate under such conditions or terminal his/ her life? ” alternatively of “ What ‘s your determination about the current state of affairs of your patient? ” . This sort of attack directs relations of the patient to believe in patient ‘s places instead than their ain sentiments. The other job is that if patient is non an grownup, should the determination be made by the relations or the patient? Which one should be considered by medical squad in such occasions?
Withdrawal of medical intervention ; This term stands for ending the relation between the patient and life support unit. Holiness of life is indispensable for physicians and they consider intervention as an assignment. The determination about backdown of intervention is a truly difficult determination for physicians. However, if the patient suffers from a coma, nephritic and liver failure or myopathy- in another words patient suffers from incurable disease ( 6 ) , Ministry of Health Organ and Tissue Transplantation Regulations states that if encephalon decease occurs, patient should be disconnected the life support unit. This determination besides contains moral duties besides medical 1s as this determination is important for the life anticipation of the patient. That ‘s why determination procedure should be well-planned as it besides reflects positions of the patient. This kind of information may be obtained from the patient or the relations. If these chances are non available, medical squad prognosticate about the life outlooks of the patient and see this anticipation in the procedure of the determination ( 22 ) .
The determination about backdown of the intervention is different from mercy killing. The anterior purpose is non the decease of patient in backdown of intervention.
Who should make up one’s mind unpluging life support unit? : This is a important inquiry. How should the medical squad, the patient and relations of the patient reply this inquiry? What sort of a function should the medical squad accept in this procedure? The replies of these inquiries should be in the frame of ethical rules.
The medical moralss, deontology statute laws, and patient rights ordinances give importance to enlightenment and blessing of the patient. Medical squad act on behalf of the patient ‘s declaration.
If the patient is witting, the patient should be informed about the hazards and chances of the intervention. The determination should be made in conformity with the free will of the patient.
If the patient is unconscious and there is non a relation of the patient to be informed about, so medical squads make determination about the current province of the patient.
Medical squad should non declare their ain sentiments about the procedure of the determination as they might impact relations ‘ sentiments.
If the patient is unconscious, diagnosing and forecast are evaluated foremost. Necessary information about the patient about his/her outlooks are obtained from the relations and in the visible radiation of this information, a determination about linking or unpluging life support unit is made.
Duty of the determination is shared by the relations and the patient by foregrounding determination of the patient. Patient rights ordinances and deontology statute laws highlights patient ‘s sentiment.
Discussion
On one manus, engineering causes distinction of application of medical trades, on the other manus it causes alterations in the significance of old constructs such as life, unwellness and decease and forms new constructs such as the life support unit, alleviative attention, encephalon decease. So called distinction or multi-directional relation of engineering and medical specialty have been effectual in footings of presentation and care of the medical service. And with the altering consideration, as it was earlier, the function, precedence ; paternalist and dominant function of doctor/ medical staff who took portion in different phases or enlargement of the presentation of the medical service has changed. Doctors/medical staffs give clear medical information about pathogenesis, procedure of the disease, forecast to patient or relations of the patient but the determination is made by patient and physician or relations of the patient and physician. The procedure stems from the necessity that psychosocial and ethic attack demand to be accompanied by biological attack. This attack is associated with importance that doctrine and societal scientific disciplines have bit by bit gained due to the alteration in the construct of scientific discipline. Because biological science based determinations given by medical staff and psychosocial based determinations given by a patient or relation of the patient are evaluated in tandem, a determination approved on a medical, ethical and psychosocial footing is likely to be applied. In this context, life support units which are the topic of this survey as an introducing intervention service besides caused some ethical quandary. However the determination of linking or unpluging life support unit is a medical necessity, nonsubjective cognition acquisition rights, rules, and ordinances are for the patient rights. Consequently, these constructs prevent medical determination. However, the communicating and attack in the context of medical ethic provides all the parties to hold a voice.
There is a meaningful difference between the replies of the physicians and nurses about the inquiries in the research: “ Is that appropriate to unplug with the life support unit of a patient whose encephalon decease has occurred? Is that necessary to hold informed consent of a witting patient before being connected to the life support unit? Do you accept unpluging life support unit of a patient whose encephalon decease has occurred as mercy killing? Can the household of a patient brand a determination about unpluging with life support unit? ” The ground of this difference is thought to be stemmed from the differences of the duties of physicians and nurses in footings of professional tenancies. There seems besides a meaningful difference among physicians, nurses, and the relations of the patient with the stage: “ the determination about disjunction with the life support unit should be given with physician ” . This state of affairs is thought to be a consequence of the instruction and experience differences between wellness professionals and relations of the patient. Another ground of this difference is the thought of disjunction with the life support unit and sacredness of the life is non arguable in the society.
As a consequence, the medical determination given by a physician and cultural, sociological and spiritual based determinations run into on a balanced platform and this platform enables a sort, peaceful, reasonable communicating between the physician and relations of the patient. Such an attitude alienates medical staff from the patients and prevents them from supplying services with a mechanical attack. We all are cognizant that instead than lengthen the life-time of the patient, the most of import aim is the engagement of the patient in the procedure of their status and his/her being content with the procedure.