While ethical issues in medical practice are receiving a great deal of attention these days from professionals within the medical community, relatively little attention has so far been paid to patients perceptions of these ethical issues. For this reason, we performed an on-line survey of patients perspectives on ethical issues. Structured and unstructured questions were posted on a medical information home page (http://www.hospital.co.kr), and information was then collected from 158 respondents. The collected information included the respondents' demographics and data from self-administered questionnaires, which asked patients for their views on abortion, new drug trials, and organ transplantation. The respondents were also asked to describe any personal experiences they had of unethical behaviour in a hospital or a clinic. The collected data shows that the issue that patients regard over-treatment as the most common ethical problem in medical practice. Other frequently mentioned problems are treatment refusal, equality, bribery, sex pre-selection, and artificial abortion. Approximately 48% of the respondents replied that they regarded artificial abortion as murder, and 62% of the respondents answered that selling a person's living organs for transplantation should be allowed. About 77% of respondents were willing to participate in new drug trials if they had fatal diseases, but only 43% would do so if they were in good health. We undertook a qualitative analysis for 58 unstructured answers out of the 158 respondents. We grouped the respondents into two major categories : i) those with perceptions of ethical problems arising from patient-doctor relationships, and ii) those with perceptions of ethical problems arising from health care systems. In the first category, negligent attitudes on the part of doctors was the most frequently reported item, while over-treatment and the abuse of laboratory tests was the second most prevalent item. In the second category, the policy of pay-before-treatment in emergency rooms was the most common complaint. The results of (his study suggest that patients are more concerned with patient-doctor relationships and doctors' communication skills than with other ethical issues in medical practice. Therefore, we believe that these issues ought to occupy a greater portion of the ethical curriculum for medical students.
Recent health care reform initiatives proposed training fewer medical specialists, including psychiatrists, and determining the size and location of training programs via centralized regulatory mechanisms. Facing such potential future developments, the American Association of Directors of Psychiatric Residency Training appointed a Task Force on the Quality of Residency Programs to develop informed recommendations for the field. This paper describes the Task Force's considerations and recommendations concerning how the least damaging and most effective decisions could be made regarding the distribution of residency positions, program size, and the future funding of training stipends. The recommendations emphasize voluntary decisions, feedback from local and regional stakeholders regarding perceived needs and demands for psychiatrists, and Federal or regional funding of postgraduate training stipends that are not primarily tied to providing clinical services.
In August 2000, Korean government implemented a policy to separate the roles of physicians and pharmacists with respect to the prescription and dispensation of medicine. In particular, the policy prohibited physicians from dispensing medicine and prohibited pharmacists from prescribing medicine. Physicians in Korea have been strongly opposed to this policy and have protested its implementation by staging two nation-wide strikes, one immediately prior to the implementation of this policy, and one immediately subsequent to its implementation. These strikes have in turn evoked a hostile response from Korean citizens, who regard the physicians as acting from purely selfish motives. Within this context a debate has been initiated on the ethics of physicians strikes. At the heart of this debate is the following question: Are physicians strikes an ethically acceptable means of protesting government policies? The purpose of this paper is to evaluate the arguments that have been given on both sides of this debate and to show that physicians strikes are justified from a social and professional point of view. In this paper, we consider physicians strikes from the point of view of social ethics, professional ethics, and the four principles governing biomedical ethics. We argue that while such strikes can not be justified by the principles of beneficence, non-maleficence, or patients autonomy, physicians do have social and professional responsibilities to protest government policies that are harmful to society and that physicians, strikes that are carried out with this purpose can be justified by the principle of justice. Since this is the ultimate purpose of the strikes recently carried out by the physicians in Korea, we argue that these strikes are justified from a social and professional point of view. Although the strike is justified according our conditions, physicians should not give up patients lives. During the strikes, physicians never stop providing care in the emergency room, ICU(intensive care unit) and to obstetric patients, and they tried not to delay surgeries of critical cancer patients.
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