This paper examines the ethico-legal problems regarding the right to refuse treatment in Turkey's healthcare system. We discuss these problems in the light of a recent case that was directly reported to us. We first summarise the experience of a chronically dependent patient (as recounted by her daughter) and her family during their efforts to refuse treatment and receive palliative care only. This is followed by a summary of the legal framework governing the limits of the right to refuse treatment (...) in Turkey. With the help of this background information on the legal framework, we re-examine the ethico-legal aspects of the case and explain the underlying reasons for the problems the family and the patient experienced. Finally, we conclude that Turkey's legal framework relating to the right to refuse treatment needs to be clarified and amended in accordance with international conventions and fundamental human rights. (shrink)

Advance directives are not a part of the healthcare service in Turkey. This may be related with the fact that paternalism is common among the healthcare professionals in the country, and patients are not yet integrated in the decision-making process adequately. However, starting from the enactment of the Regulation of Patient Rights in 1998, this situation started to change. While the paternalist tradition still appears to be strong in Turkey, the Ministry of Health has been taking concrete measures in the (...) recent years to ensure that patient rights are implemented in healthcare practice. Therefore, Turkey now seems to be in a transitional period where a move towards a more patient-autonomy centred approach is being supported by the regulatory authorities, as well as the academic circles and the public at large. In the light of this background, this paper aims to examine the potential benefits of advance directives, particularly with regard to their possible effect in the clinical decision-making process of Turkey's context. It will be argued that advance directives, if correctly understood and implemented in the right settings, may be beneficial, particularly for improving communication between patients and healthcare professionals and for implementing of the right to refuse treatment. (shrink)

Türkiye hosts approximately 3.6 million Syrian refugees, which accounts for roughly 4.5% of Türkiye's population. This places undeniable pressure on public institutions, particularly on healthcare services. The objective of this study is to document the healthcare structure for Syrian refugees and various challenges faced by Syrians when seeking healthcare and to highlight the ethical concerns emerging from those challenges. To achieve this, we conducted a comprehensive review of several qualitative studies and reports conducted by various organizations and institutions, specifically focusing (...) on health or including a dedicated chapter on health issues, published between 2011 and 2023. Following an extensive analysis of the secondary literature, we classified the challenges into three categories: procedural, cultural, and psychosocial. We argue that each of these challenges is linked to overarching medical ethics concerns. Finally, we propose three possible means to mitigate the challenges Syrians experience in accessing and uptake of healthcare services in Türkiye. (shrink)

In this article, it was aimed to determine the knowledge status of physicians about the forms used in obtaining informed consent and according to these determinations; It is aimed to provide information and suggestions to physicians that will contribute to obtaining consent in accordance with medical law and ethics. Material and Method: A questionnaire was created to determine the knowledge status of the physicians about the titles that should be included in the informed consent form (such as the diagnosis of (...) the patient, the harms, risks, benefits of the intervention, healing process, probability of success), and who should receive informed consent. This questionnaire was delivered to physicians online. The data obtained through the questionnaire were analyzed using the SPSS program. Descriptive statistical analyzes were used in the evaluation of personal information. In the evaluation of the data, frequencies and percentage distributions were taken. The analyzed data were evaluated in terms of compliance with legal regulations and medical ethics. Results: 139 physicians working in a private hospital participated in the survey voluntarily. Approximately 90% of the participants think that the complications that occur as a result of the diagnosis and intervention, approximately 85% of the benefits of the intervention and the problems of the recovery period, about 75% of the consequences of not performing the intervention, about 55% of the probability of success should be included in the form of informed consent.. More than 85% of the participating physicians expressed their opinion to agree with the article about the necessity of obtaining consent by the physician. Discussion and Conclusion: It can be accepted as a positive situation that physicians express their opinions in accordance with medical law about the information that should be included in the informed consent form. However, considering the legal values protected by informed consent, it was suggested to take measures to reduce the rates of disagreement and indecision by emphasizing the views of physicians on disagreement and indecision. (shrink)

Understanding dental ethics as a field separate from its much better known counterpart, medical ethics, is a relatively new, but necessary approach in bioethics. This need is particularly felt in dental education and establishing a curriculum specifically for dental ethics is a challenging task. Although certain topics such as informed consent and patient rights can be considered to be of equal importance in both fields, a number of ethical issues in dental practice are only remotely—if at all—relevant for medical practice. (...) Therefore, any sound approach to education in dental ethics has to recognise the unique aspects of dental practice in order to meet the needs of dental students and prepare them for the ethical challenges they may face during their professional practice. With this goal in mind, this paper examines the approach of the authors to dental ethics education and proposes a system to organise the topics of biomedical ethics for dental education. While the authors' perspective is based on their experience in Turkey, the proposed system of classification is not a rigid one; it is open to interpretation in other contexts with different social, cultural and professional expectations. Therefore, the paper also aims to inspire discussion on the development of an ideal dental ethics curriculum at an international level. (shrink)

INTRODUCTION[|]The practice of medicine has evolved from old approach, in which all decisions for the patient are taken by physician, to a new approach, which includes patients to the medical decision-making process and endorses informed consent of the patients. In addition to healthcare professionals and patients, parents or legal representatives are stakeholders in the informed consent process of children. The knowledge and attitudes of physicians and medical school students about the informed consent period in children are important for the effectiveness (...) of the medical intervention and the biopsychosocial development of children. In this study, it was aimed to understand involvement of medical students and physicians in the informed consent process of children and their level of knowledge on children's rights and their attitudes in daily clinical practice.[¤]METHODS[|]The study is a descriptive study and n = 150 participants, who were randomly selected from senior medical school students working in medical school campus or university hospital and physicians serving pediatric patients, were included to this study. Questionnaires were applied for the measurement of participants' socio-demographic characteristics, education on pediatric patient rights, and legal provisions. The data were evaluated using SPSS 20.00 software.[¤]RESULTS[|]Of participants, 62% (n = 93) were phase 6 medical students, while 29.33% (n = 44) were resident physicians and the rest were faculty members (8.67%; n = 13). The proportion of physicians, who didn't received training on child rights, was 80.7% (n = 46) and statistically significantly higher than medical students (49.45%; n = 45) (p <0.001). However, participants who were not educated about the children's rights stated with higher ratio (44.83%; n=65), that informed consent should be obtained before medical intervention from individuals under 18 years of age, when they are compared to the the participants who received education (20.69%; n=30) (p = 0,019). The majority of participants (59.5%; n = 88) find the intervention in individuals under the age of 18 years in emergencies without consent of legal representatives ethically and legally appropriate (p <0.001). The participants believe that it is ethically and legally appropriate to conduct an intervention on an individual under the age of 18 years without the legal representative (36. 7%; n=54) (p <0.001).[¤]DISCUSSION AND CONCLUSION[|]This study compared the levels of knowledge and attitudes of participants, who were previously trained in or didn't received any training about children's rights and informed consent of children. However, the quality of the training of the participants on children's rights, was not questioned. This study showed that education on children's rights does not significantly increase the level of legal knowledge on children's rights. Having well-designed a subject focused on this theme in medical deontology and ethics education can increase the knowledge levels and improve the attitudes of medical students. This study sheds light on the issues that need to be focused in the medical faculties and the trainings of physicians and showed lack of information and need for development of attitudes regarding children's rights and informed consent in children.[¤]. (shrink)

Mandatory reporting of infectious diseases (MRID) is an essential practice to prevent disease outbreaks. Disease notification is a mandatory procedure for most infectious diseases, even during non-pandemic periods in healthcare. The main rationale behind MRID is the protection of public health. The information and data provided by infectious disease reports are used for many purposes, such as preventing the spread and potential negative impact of infectious diseases, assessing the national and global situation regarding reported diseases, conducting scientific research and planning (...) health policy. In this context, the relevant information benefits public health, health systems and scientific work. Additionally, the follow up and treatment of individuals with infectious diseases is a necessity in certain cases to protect those who cohabit with them. However, these benefits cannot be accepted as unrestricted justifications for MRID, since it is evident that reporting should be conducted within ethical and legal boundaries. MRID should only be devised and implemented with due regard to balancing potential benefits between all individuals, as well as between the individual and the rest of society. Disease notification systems that are not designed with a balancing and harm-reductionist approach may lead to stigmatisation and discrimination. This study aims to investigate the legal framework and ethical issues regarding the reporting of individuals diagnosed with COVID-19 in Turkey—which is a primary example of a developing country. (shrink)

The International Covenant on Economic, Social and Cultural Rights was signed by Turkey in 2000 and has been in force since September 23rd, 2003. For this reason, the Covenant is considered as act of parliament in our domestic law, and unlike the general procedure of application of the law, it can not be alleged to contradict the Constitution (According to Article 90 of the Turkish Constitution). The article 12 of the Covenant defines the right to health and its content. In (...) the article 12 of the Covenant, in its General Comment No. 14 published in 2000, the right to the highest attainable standard of health was interpreted and commented upon. This document contains a detailed description of the right to health, its content, and its obligations to State parties. Although this Comment of the Covenant is not binding, it is a document to which the State parties refer when taking measures related to health services. Every publication and comment on the right to health was based on the General Comment 14 of the Covenant. The Article 12 was reinterpreted by the Covenant on May 2nd, 2016 in the context of rights to sexual and reproductive health. İit has been emphasized that legal, procedural, practical and social barriers limit the access of individuals to full range sexual and reproductive health services. It has also been pointed out that accessibility of sexual and reproductive health services is a distant target for women and girls. Moreover, it has been stated that discrimination that increases exclusion in legislation and practice limits lesbian, gay, bisexual, transgender and intersex (LGBTI) individuals and disabled people'senjoyment of sexual and reproductive health rights. For this reason, it is stated that although commenting on the rights of sexual health and reproductive health is included in 14 comments, it is important to make an interpretation about them. This comment is an interpretation of a binding Convention. Therefore; It is a document that will provide guidance on measures to be taken by States Parties in respect of their rights to sexual health and reproductive health. At the same time, obstacles to discrimination in medical practice bring important approaches in terms of respect for autonomy and respect for private life. In our article, information about the content of the ESKHK's interpretation and possible reflections of this content in the field of medical law and ethics will be given. (shrink)