Background: Midwives are required to make ethical decisions with the support of respective codes of professional ethics which provide a framework for decision making in clinical practice. While each midwife should be ethically aware and sensitive to the ever-changing issues within reproduction, few empirical studies have examined the views of student midwives in relation to reproductive ethical dilemmas. Objective: The aim of this study was to explore midwifery students’ reactions to a number of ethical dilemmas relating to women’s experiences of (...) reproductive decision making. Design: A series of focus groups were conducted with midwifery students who were asked to discuss five culturally significant scenarios including issues of knowledge acquisition regarding methods of family planning, removal or insertion of an intrauterine device, and abortion. Setting: A University in Turkey was the setting for this study. Participants: Purposeful sampling was adopted which resulted in five focus groups with a total of 57 midwifery students. Ethical considerations: The study was reviewed and granted formal ethical approval by an ethical committee at the Faculty of Health Science in Atatürk University. The head of the Faculty of Health Science approved the investigation. The participants received both oral and written information about the study and they gave their consent. Results: Five themes were identified from the analysis of the focus group data related to all five scenarios. These themes were ‘the right to information’, ‘choice and protection’, ‘parental rights and welfare of the women’, ‘make a decision’ and ‘women rights and sexual abuse’. Conclusion: This study has shown that while students respected women’s choice, they also expressed great ambivalence in some situations when personal values conflict with dominant societal beliefs and professional ethics. A focus on ethics education to include human rights is suggested as a means to enable students to explore their own social-value judgements, and as a means to limit the possible development of ethical confusion and moral distress. (shrink)

Families of children with mental health challenges may have been particularly vulnerable to emotional distress during the COVID-19 pandemic. This cross-sectional study surveyed 81 parents of children ages 6–17 years receiving mental health treatment in an outpatient clinic during the pandemic. We sought to characterize the impact of the pandemic on family relationships and parental well-being. Additionally, regression and ANCOVA models examined associations between four potentially protective factors—parents’ psychological resilience, perceived social support, positive family experiences during the pandemic, and (...) children’s use of cognitive or behavioral coping strategies—with family relationships and parental well-being. Findings suggest that families of children with mental health conditions experienced remarkable challenges to family relationships, parental well-being, and parents’ perceived capacity to support their children’s mental health. Nearly 80% of parents reported a negative impact of the pandemic on their own well-being, and 60% reported reduced ability to support their children’s mental health. Simultaneously, protective factors appeared to mitigate the negative impact of the pandemic. Particularly, support within the family and from external sources were associated with better self-reported well-being for parents and their capacity to support their children. Children’s use of coping tools, likely enhanced by mental health treatment, was also positively related to better family relationships and parental ability to support children with mental health challenges. Our findings highlight the need for enhancing supports for families at multiple levels including individual skill-building, family-based/parenting support, and community-based support. (shrink)

This book is a resource for providers and students, integrating germane basic science information with clinical-medicine insights. The goal is to improve primary-care outpatient interactions for physicians, APRNs, and PAs. It is unique, integrating germane basic-science information with clinical-medicine. Unlike other resources that introduce these concepts more distinctly, this book bridges the gap and provides insights for providers and students. Also, there are succinct, yet comprehensive, presentations on managing the more common out-patient problems. The book is designed for primary (...) care providers and students, e.g., physicians, APRNs, and PAs, who desire to improve their patient-education, diagnostic, and treatment skills. The PEARLS are instruments to embellish and emphasize important concepts. The focus of the book is to improve outpatient medicine delivery, and better informed and confident providers are keys to the process. (shrink)

We describe the legal practice of using civil court orders to mandate outpatient mental health treatment for adults with serious mental illness. After briefly placing the practice in historical context, we discuss the traditional clinical rationale and assumptions underlying outpatient commitment and its legal variants, as well as how the predominant and controversial preventive form of outpatient commitment emerged in the U.S. to address limitations of earlier versions of these laws, such as "conditional release." We then consider (...) whether, and under what conditions, outpatient commitment may be ethical, and we provide a conceptual framework for deciding such questions at the policy and individual-case levels. (shrink)

The norms and practices of clinical ethics took form relative to the environment and relationships of hospital care. These practices do not easily translate into the outpatient context because the environment and relational dynamics differ. Yet, as outpatient care becomes the center of health care delivery, the experiences of ethical tension for outpatient clinicians warrant greater responses. Although a substantial body of literature on the nature of the doctor–physician relationship has been developed and could provide theoretical groundwork (...) for an outpatient ethics, this literature is not sufficient to support outpatient caregivers in practical dilemmas. For physicians who are employed by or affiliated with a larger organization, a stronger alliance between clinical ethics and organizational ethics, identity, and mission will promote expansion of ethics resources in outpatient settings and address structural constraints in outpatient clinical care. (shrink)

Refining the model for an emergency department‐based mental health nurse practitioner outpatient service The mental health nurse practitioner (MHNP) role based in the emergency department (ED) has emerged in response to an increase in mental health‐related presentations and subsequent concerns over waiting times, co‐ordination of care and therapeutic intervention. The MHNP role also provides scope for the delivery of specialised primary care. Nursing authors are reporting on nurse‐led outpatient clinics as a method of healthcare delivery that allows (...) for enhanced access to health‐care, particularly following hospital discharge. However, due to a lack of in‐depth substantiation, this mode of service delivery requires more thorough investigation. This study describes the refinement phase undertaken before the implementation and pilot evaluation of a formalised and structured MHNP outpatient service in the ED of a large inner‐city hospital in Sydney, Australia. An expert advisory panel (EAP) consisting of key local informants was convened to provide feedback on and refinement to the proposed model. This related to issues such as target population, structure and process considerations, outcome measures and interface within the overall health service. Findings from the EAP meeting are presented and discussed. The importance of linking methods with the appropriate methodology in evaluating a healthcare program is highlighted. (shrink)

Introduction: Consultation methods differ between medical practitioners depending on the individual setting. However, the central tenet to the doctor–patient relationship is the issue of confidentiality. This prospective survey highlights patient attitudes towards consultation methods in the setting of an ophthalmic outpatient department. Method: Questionnaires were completed by 100 consecutive patients, who had been seen by an ophthalmologist in a single room, which had a joint doctor–patient consultation occurring simultaneously. Results: Each question of all 100 questionnaires was completed. 58% of (...) patients were not concerned about sharing a consultation room with another patient or doctor. However, this did not equate to the 49% of patients who were indifferent to discussing issues in the joint consultation room. The most common factor was the general issue of confidentiality. Discussion: Ensuring total patient confidentiality may be deemed more necessary for certain medical specialties than for others, as seen in the practice of separate medical records in genitourinary medicine, for instance. However, with regard to patient consultations, the same level of confidentiality should be afforded across all specialties, and such factors should be borne in mind when planning outpatient clinics. (shrink)

The association of resilience-related factors with frailty is a recent research topic. Dispositional optimism and context sensitivity are two psychological factors that differently contribute to individual resilience. This study aimed at investigating whether dispositional optimism and context sensitivity might contribute to a multifactorial model of frailty, together with established relevant factors such as cognitive and physical factors. This cross-sectional study involved 141 elderly outpatients aged ≥65 years, who were referred to the Geriatrics and Multidimensional Evaluation Clinic of the University Hospital (...) of Messina. We used the following measures: the Mini-Mental State Examination to screen for global cognitive functioning; 4-m gait speed and handgrip strength to measure physical performance; a 35-item Frailty Index to evaluate patients’ frailty status; the revised Life Orientation Test to gauge dispositional optimism; and the Context Sensitivity Index to measure context sensitivity. We found that LOT-R, CSI, and MMSE were all significantly associated with FI. Gait speed was only marginally associated with FI. The present study showed a novel association of dispositional optimism and context sensitivity with frailty among elderly outpatients. These preliminary findings support a multidimensional approach to frailty in which even peculiar psychological features might provide a significant contribution. (shrink)

In 1972, I created the new field of clinical medical ethics (CME) in the Department of Medicine at the University of Chicago. In my view, CME is an intrinsic part of medicine and is not a branch of bioethics or philosophical ethics or legal ethics. The relationship of patients with medically trained and licensed clinicians is at the very heart of CME. CME must be practiced and applied not by nonclinical bioethicists, but rather by licensed clinicians in their routine, daily (...) encounters with inpatients and outpatients. CME addresses many clinical issues such as truth-telling, informed consent, confidentiality, surrogate decision making, and end-of-life care, while also encouraging personal, humane, and compassionate interactions between experienced clinicians and patients.The goals of CME are to improve patient care and outcomes by helping physicians and other health professionals Clinical Medical Ethics: Its History and Contributions to American Medicine Mark Siegler, Guest Editor identify and respond to clinical-ethical challenges that arise in the ordinary care of patients. As Edmund Pellegrino, Peter A. Singer, and I wrote in the first issue of The Journal of Clinical Ethics, 30 years ago: “The central goal of CME is to improve the quality of patient care by identifying, analyzing, and contributing to the resolution of ethical problems that arise in the routine practice of clinical medicine.” Similar to cardiology and oncology consultations, ethics consultations are a small component of a much larger field, and the process of consultations is certainly not at the core of cardiology or oncology or CME.In this article, I intend to discuss the origins of the field of CME, its goals and methods, the relationship between the broad field of CME and the much narrower practice of ethics consultation, the contributions of the MacLean Center at the University of Chicago in developing the field of CME, and, finally, how CME has improved the practice of medicine in the United States. (shrink)

Clinical neuropsychologists have been working in Germany since the 1980s, and specific training in the discipline has been available since 1993. The qualification currently requires 3 years of practical training, 400 h of theoretical learning, 100 h of supervision, five reports on patients and an oral examination. After its completion, neuropsychologists can work as employees in clinical settings. For a substantial period of time, neuropsychologists working in their own practices faced complex challenges in working with outpatients, whose health insurers did (...) not cover the cost of this treatment. State approval of neuropsychological diagnostic procedures and therapy was achieved in 2011, on the basis of evidence showing the method’s high effectiveness; statutory health insurers therefore now pay out for delivery of these services on an outpatient basis, too. In Germany, neuropsychologists work in all areas of the diagnosis of functional disorders, with children, adolescents, adults and older adults, and carry out treatment. Clinical neuropsychologists provide patients with individualized tools for managing their brain damage, supply exercises and tasks for them to undertake at home, and give input on administrative matters, such as determining the degree of a patient’s disability. Treatment takes place in close collaboration with members of related professions, such as physiotherapists, occupational therapists and speech therapists. Neuropsychologists also work as assessors, investigating, for example, the extent of a patient’s ability to work after sustaining CNS damage or the need for medical retirement. The earnings of clinical neuropsychologists vary widely, currently averaging between €3,000 and €4,000 gross per month for employed neuropsychologists; self-employed neuropsychologists in their own practices can currently bill statutory health insurers for around €100.00 per hour. Despite the generally good working conditions in this discipline, Germany is suffering from a shortage of clinical neuropsychologists. An approximate total of 800 psychologists have completed training in this field, while around 50,000 patients could benefit from neuropsychological treatment every year. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryTor Phern Chern, Associate ConsultantThe case scenario describes a difficult clinical and ethical challenge of a psychiatric patient refusing treatment in the context of a treatment-resistant condition that may be affecting her capacity to refuse treatment.The patient described in the case scenario displayed partial treatment refusal as evidenced by her refusal of ECT and adherence with medication and her voluntary hospital admission. Partial treatment refusal is generally more (...) common than absolute treatment refusal1 and can be sporadic, time-limited, periodic or continuous. It is important for the medical team to clarify which category of treatment refusal this patient’s refusal falls under. These broad categories include the doctor-patient relationship, religion, secondary gain, treatment- or illness-based refusals.2 The proper identification of category of treatment refusal will guide subsequent management.Refusal of treatments may be in response to reality-based transference issues like fear, distrust or pressure from the patient’s family. In this particular case, there is little data about her relationship with her treating psychiatrist, but the lack of a trusting doctor-patient relationship could be a factor for treatment refusal. The treating psychiatrist at the inpatient setting could be different from the patient’s routine outpatient psychiatrist and this could result in the lack of a trusting doctor-patient relationship. The remedy for this would be to develop a trusting relationship between her treating psychiatrist and the patient via understanding the patient’s needs and concerns. A useful adjunct would be to identify someone with whom the patient has a trusting relationship and recruit that person to help develop trust in the doctor-patient relationship. On this point, it is interesting to note that the patient’s family was noted to be highly supportive and influential in previous treatment decisions, agreed [End Page 235] with the treating psychiatrist’s treatment recommendation and yet both the treating psychiatrist and the patient’s family were unable to convince her to accept ECT. One possibility is that the patient may see her family’s support of the treating psychiatrist’s recommendation as one reason to refuse treatment. This possibility warrants deeper explorations of her premorbid underlying cultural and religious beliefs and attitudes towards her family and her perceived role in her community.Religion-based refusals of treatment (e.g. blood transfusions for Jehovah’s Witnesses) are less prominent in psychiatry than in general medicine but may manifest in treatment refusal due to advice from religious leaders on the need for spiritual solutions to the patient’s challenges. Religion-based refusals need to be distinguished from an illness-based refusal but if truly present will require the support of appropriate religious leaders to allow the patient more management options other than spiritual support for her psychiatric disorder. There is no specific information about the patient’s religion and religion-based refusals of ECT are not particularly common so this is unlikely to be a major reason for treatment refusal in this case.Treatment-based refusals of care are related to the specific treatment modality being offered and are often motivated by concerns about the side effects of treatment or past traumas that the treatment elicits. In this particular case, the patient has demonstrated some degree of treatment resistance as evidenced by the relapse of her bipolar disorder despite adherence to medication, and a change in management is certainly warranted. However, a change in medication management may be possible before proceeding to ECT in view of the patient’s acceptance of medication and no clear evidence of violent or disturbed behaviour in the ward. The occasional refusal of food and water is worrying, but if the patient can be coaxed to continue oral nutrition, there is no absolute indication to have ECT for rapid treatment response. Other options that may be acceptable to the patient are to optimise the dosage of current medications, switch medications or add augmenting pharmacological agents before proceeding to ECT. A change in pharmacotherapy must take into account her past treatment response and side effects to individual medications. Psychotherapy may also be considered to augment treatment response before ECT is considered.3Illness-based refusals are the most challenging category and... (shrink)

In mental health policy, a central ethical dilemma concerns involuntary outpatient commitment (OPC), which aims to treat vulnerable individuals with serious mental illness who decline services. The first concern regards whether coercive services undermine the quality of clinical interactions within treatment, particularly as it relates to psychiatric medication use. The second concern is the unexamined role that OPC, and coercive psychiatric programs more broadly, play in the broader landscape of social welfare policy. To examine these concerns, the purpose of (...) this dissertation is to analyze how the management of psychiatric medications in involuntary outpatient services is undergirded by (a) provider and client interpretations of psychiatric medication effects and (b) moral discourses related to coercion and client autonomy. To achieve this aim, I examined data from a team-based ethnography that consisted of 1000 hours of participant observations and 56 semi-structured interviews with 20 clients, 21 providers, and 12 client family members with diverse backgrounds. I analyzed how medication compliance was discussed, monitored, and enforced in an involuntary outpatient program. My analysis demonstrates that medications were interpreted as a technology to control clinical symptoms (clinical control) though, particularly among clients, were also viewed as a method to control client mental experiences, behavioral expression, and autonomy (social control). Providers believed that medications were a necessary component of services (compulsory compliance) and could reduce client vulnerability to violence victimization and perpetration related to clinical symptoms (medicating vulnerability). To address client noncompliance, providers employed several strategies that I categorized as client manipulation. These strategies included providers, family members, and court officials strategizing ways to undermine client autonomy without clients’ knowledge (concealed collusion), deceiving clients into believing that medications were mandated when they were not (performing coercion), and minimizing the role of client consent and preferences in decision-making processes (circumventing consent). These findings demonstrate the pervasive role of manipulation to gain client medication compliance in OPC, which I named institutional coercion. They also highlight that the broader moral justifications for manipulating clients relate to their status as structurally vulnerable in their community settings and a growing relationship between the erosion of the welfare state and psychiatric coercion. (shrink)

Background Compulsory treatments represent a legal means of imposing treatment on an individual, usually with a mental illness, who refuses therapeutic intervention and poses a risk of self-harm or harm to others. Compulsory outpatient treatment in psychiatry, also known as community treatment order, is a modality of involuntary treatment that broadens the therapeutic imposition beyond hospitalization and into the community. Despite its existence in over 75 jurisdictions worldwide, COT is currently one of the most controversial topics in psychiatry, and (...) it presents significant ethical challenges. Nonetheless, the ethical debate regarding compulsory treatment almost always stops at a preclinical level, with the different ethical positions arguing for or against its use, and there is little guidance to support for the individual clinicians to act ethically when making the decision to implement COT. Main body The current body of evidence is not clear about the efficacy of COT. Therefore, despite its application in several countries, evidence favouring the use of COT is controversial and mixed at best. In these unclear circumstances, ethical guidance becomes paramount. This paper provides an ethical analysis of use of COT, considering the principlist framework established by Ross Upshur in 2002 to justify public health interventions during the 2002–2004 severe acute respiratory syndrome outbreak. This paper thoroughly examines the pertinence of using the principles of harm, proportionality, reciprocity, and transparency when considering the initiation of COT. Conclusion Ross Upshur’s principlist model provides a useful reflection tool for justifying the application of COT. This framework may help to inform sounder ethical decisions in clinical psychiatric practice. (shrink)

Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

ObjectiveThis study aimed to better understand the current situation involving work stressors and the coping styles of outpatient and emergency nurses in 29 pediatric specialty hospitals across China. The study analyzed this correlation to provide a reference for the occupational stress management of pediatric nurses.MethodsFrom June to September 2020, 1,457 outpatient and emergency nurses in 29 pediatric specialty hospitals across China were selected as study participants, and a questionnaire survey was conducted using the Basic Information Questionnaire, the Chinese (...) version of the Work Stressor Scale for Nurses, and the Simple Coping Style Scale.ResultsThe assessed stress level of outpatient and emergency nurses in 29 tertiary pediatric specialty hospitals nationwide is lower than the results of the survey of the 2007 domestic norm, p < 0.05. The stressors related to nurses’ expectations, family conflicts, the nature of nursing work, patient factors, and workload were lower compared with the national norm. The positive coping style score on the Simple Coping Style Scale for pediatric outpatient nurses was, and work stressors were positively associated with negative coping styles. Multiple regression analysis showed that the influencing factors of work stressors among pediatric outpatient and emergency nurses correlated with the authorized size, age, working years of nurses, work department, and negative coping styles.ConclusionNegative coping styles were present among pediatric outpatient and emergency nurses and were associated with work stressors. The influencing factors of stressors mainly correlated with the clinical establishment, age, years of employment as a nurse, work department, and negative coping styles. (shrink)

The first aim of the study was to identify when deliberate self-harm behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment. The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. These 46 (...) participants where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early and late responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority ceased their self-harming within the first year, and the average number of weeks was 15.5. Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT. (shrink)

Introduction. The article is devoted to identifying features of spatial placement of health clinics in megacities and assessing the degree of compliance/ deviation with standards of pedestrian accessibility. Methods. The theoretical and methodological basis of the research is scientific ideas in the field of regional economics, spatial and normative analysis. Scientific novelty of the research consists in as- sessing availability and saturation of territories by health clinics, in the context of features of their spatial placement, taking into account (...) the estab- lished regulatory requirements. Results. The place of the megacities of Ural Federal District among the megacities of Russia has been determined according to the conditions affecting availability of health clinics for the population. When carrying out a cartographic analysis of spatial placement of health clinics in Yekaterinburg and Chelyabinsk, district features of the cities studied were established, which made it possible to identify the existing problem areas characterized by an im- balance in the level of infrastructure facilities acces- sibility in relation to the regulatory requirements. The authors show the uneven coverage of clinic service areas, which reduces pedestrian and transport accessibility for citizens when receiving medical services. The features and differences of territorial localization of clinics in the actively built- up areas of Yekaterinburg and Chelyabinsk are revealed. Conclusions. The results obtained can be applied in the framework of determining priorities for implementing spatial transformations of studied territories and the authorities’ decision-making in order to increase medical services availability. (shrink)

This article looks at the relevance of the concept of self-determination to psychiatric patients by studying the existence, importance and manifestations of self-determination. The data were collected by interviewing long-term patients (n = 72) in one mental health care organization, which included a psychiatric hospital and an outpatient department. Self-determination was defined in terms of the right to decision-making, the right to information, the right of consent, the right to refuse treatment, and the right to be heard and taken (...) into account. It was found that, with the exception of the right to refuse and consent, these rights are indeed present in the practice of psychiatric nursing and that they are relevant and important to psychiatric patients. The patients typically gave ethical, practical and legal reasons for a psychiatric patient's right to self-determination. The main reasons why psychiatric patients said they lacked the right to self-determination were illness and staff authority. Recommendations for educational, clinical and methodological implications for the future in nursing are discussed. (shrink)

Many academic medical centers are seeking to attract patients from outside their historical catchment areas for economic and programmatic reasons, and patients are traveling for treatment that is unavailable, of poorer quality, or more expensive at home. Treatment of these patients raises a number of ethical issues including whether they may be given priority in scheduling outpatient follow-up appointments in order to reduce the period of time they are away from home. Granting them priority is potentially unjust because medical (...) treatment is generally allocated based on medical need and resource utilization, and then on a first-come, first-served basis. While it is difficult to compare the opportunity cost of waiting for an appointment to different patients, nonresident patients incur higher expenditures for travel, room, and board than resident patients. Giving them priority in scheduling to reduce these costs may be justifiable. Preferentially scheduling nonresident patients may also indirectly benefit resident patients consistent with Rawls’s difference principle. This potential justification, however, rests on several empirical claims that should be demonstrated. In addition to reducing resident patients’ waiting times, medical centers should not prioritize nonresident patients over resident patients with more urgent medical needs. There is, therefore, a limited and circumscribed justification for prioritizing nonresident patients in scheduling follow-up appointments. (shrink)

The aim of the present investigation was to describe and to classify significant ethical problems encountered by the members of the staff during the daily clinical work at a hospital medical department. A set of definitions was prepared for the purpose, including the definition of a 'significant ethical problem'. During a three month period 426 inpatients and 173 outpatients were admitted. Significant ethical problems were encountered during the management of 106 in-patients (25 per cent) and 9 out-patients (5 per cent). (...) No significant difference was found between the frequency of ethical problems in female and male patients, but a positive correlation was noted between the number of problems and the patients' age. The problem types were classified according to a problem list. The results of this investigation suggest that greater attention must be paid to discussions about ethical problems among doctors and other categories of health personnel and that, among others, medical students ought to be taught the analysis of ethical problems. (shrink)