Background: Informed consent is the autonomy of the patient who involves decision-making after being informed of and understanding the physician. Objectives: This study sought to investigate and compare patients¡¦ and physicians¡¦ perceptions of informed consent and the factors that influence their viewpoints on informed consent. Methods: The subjects were citizens without medical background and physicians working in four hospitals. Self-structured questionnaire was used to gather information. The physicians were recruited from two medical centers, a regional hospital and a district hospital in Kaohsiung. The data is analyzed by SPSS 14.0 and used descriptive statistics, item analysis, factor analysis, chi-square test, Fisher's exact probability test, t-test, and ANOVA. Results: The response rates were 97% in citizens (n=891) and 79 % in physicians (n=158). As for the concept of informed consent, 55.7% citizens thought that doctor should respect the opinion from the patient and family during the informed consent process. Furthermore, 91.2% the citizens prefer to know the information about their health condition from the physicians rather than from family (8.8%). Regarding the sequence of informing the physical condition, 29.9% citizens also prefer directly from the physician. As for the decision-making process, 55% respondents thought that patient¡¦s own decision is the most important. 52.5% physicians thought that doctor should respect the opinion from both the patient and family and the bad news should be informed by physicians (88.0%) rather than by family. As for the sequence of knowing the bad news, 46.2% physicians preferred to inform family first and inform patient after discussing with family. In decision-making process, 48.7% physicians thought that physician¡¦s opinion was still more important than opinion of patients and family. Further analysis revealed that patients¡¦ gender and the level of family visited hospital have significant difference on the perception of informed consent (p=0.027; p=0.000); gender, age, educational background and living locations also have significant difference on ¡§who to deliver the bad news.¡¨ (p=0.006; p=0.004; p=0.035; p=0.012); Citizens¡¦ age, educational background and career have significant influence on their opinion of informed consent of recently visiting doctor (p=0.014; p=0.006; p=0.001). The variables in the physicians¡¦ background have no relation with the means of informing and decision-making. The gender and position of the physician have significant effect on the opinion of practice of informed consent (p=0.015 and p=0.001). Conclusions: We concluded that the perceptions of informed consent, there was no difference between physicians and citizens; however the citizen chose the patient first, and the physician chose the family first during the process of informed consent. Physicians have better perceptions of informed consent than the common citizens.

Maintaining the proper physician-patient relationship in health care is vital to the well-being of patients, especially when considering end of life decisions such as euthanasia. Because this topic has been in the forefront of media in recent years, there appears to be a need to understand how the relationship between physician and patient works in these practical situations, as well as understand what the most appropriate model of patient care is in regards to maintaining patient autonomy. However, before this can be done this paper will begin with a brief look at the overall permissibility of euthanasia, using the arguments of Dan Brock and Leon Kass. Once the issue of permissibility is discussed, I continue by investigating three main models of patient care presented by Linda and Ezekiel Emanuel: informative, interpretive, and deliberative. Each of these models presents a different view of patient autonomy that changes how the physician and patient interact. By discussing the philosophical requirements of autonomy presented by philosophers such as Harry Frankfurt, Susan Wolf, and Andrea Westlund, I argue that the deliberative model of patient care provides the most sufficient view of autonomy while also protecting the physician-patient relationship and patient well-being.

No description available.

Este estudo teve como proposições: compreender o processo da interação entre profissionais de saúde e usuários estrangeiros nas Unidades Básicas de Saúde (UBS) e Programa Saúde da Família (PSF); conhecer o significado da experiência dos profissionais de saúde ao interagir com os usuários estrangeiros; evidenciar questões bioéticas na experiência de interação entre profissionais e usuários estrangeiros. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada nos Dados, até a codificação axial. A análise dos dados, apresentada como ordenamento conceitual, levou à definição de quatro grandes temas: (1) procurando comunicar-se; (2) percebendo limites; (3) percebendo interação como processo; (4) percebendo perspectivas diferentes. O percurso de interação profissional usuário estrangeiro foi desencadeado a partir de uma escolha: atender a todos indiscriminadamente, tornando possível a aproximação. Perceber ou não no usuário estrangeiro sua dignidade de pessoa humana parece ser determinante na abertura do profissional à interação, na sua disposição a buscar estratégias. / This study had the following objectives: to understand the interaction processes among health professionals and foreign users in the Unidades Básicas de Saúde (UBS) and the Program for Family Health (PSF); to get to know the significance of the health professionals experience as they interact with foreign users; to put in evidence bioetiques issues in the experience of professionals and foreign users interaction.It was used as a theorical referential the Symbolic Interacionism and as methodological reference a Grounded Theory up to an axial coding. Data analysis presented as conceptual ordering, lead to the definition of four great issues: (1) trying to communicate; (2) detecting limits; (3) recognizing interaction as a process; (4) recognizing different perspectives. The route of professional foreign users interaction was developed from one choice: attend everyone (indiscriminately) making approximation possible. To recognize or fail to recognize in the foreign user the dignity of human person seems to be the determining factor for the openness of the professional to the interaction, in his disposition to seek strategies.

Este trabalho volta-se ao estudo das diretivas antecipadas sobre o fim da vida na relação médica no Brasil. Pretende-se verificar a legitimidade bioética e a legitimidade e possibilidade jurídicas da prática das diretivas antecipadas sobre o fim da vida como objetivo central. Busca-se aferir a adequação, bioética e jurídica, das diretivas antecipadas como veículo próprio de autodeterminação da pessoa diante de suas possibilidades existenciais e da formulação de seu projeto de vida e de morte digna. Ademais, especificamente, procura-se determinar a possibilidade jurídica das diretivas antecipadas no Ordenamento brasileiro: a coerência com as garantias constitucionais e a existência de institutos aptos a tal prática. Propõe-se sustentar a legitimação jurídica das diretivas antecipadas no Brasil, indicando possíveis caminhos às soluções interpretativas no plano jurídico, e os efeitos na relação médica a partir, também, das considerações bioéticas. Com essa finalidade, pretende-se averiguar a compatibilidade entre as normas deontológicas de origem bioética e as normas jurídicas de status constitucional de proteção à pessoa humana. A tese também propõe a análise do contexto em que as diretivas antecipadas são utilizadas para (i) problematizar as ideias de capacidade e competência para a prática desse ato de autonomia pessoal, (ii) problematizar sobre como a perspectiva familiar, a perspectiva técnica dos profissionais da saúde e a perspectiva do Poder Judiciário contingenciam a liberdade desse ato e (iii) aferir a eficácia desses atos no espaço clínico e familiar. Para tanto, será empreendido estudo teórico mediante pesquisa bibliográfica e de referências, que levantará as publicações, nacionais e internacionais, sobre os temas da tese. O levantamento bibliográfico compreenderá, preferencialmente, obras sobre filosofia, ética, bioética e direito, que permitam a análise das questões teóricas envolvidas no estudo. O desenvolvimento do trabalho estrutura-se em três capítulos. O primeiro pretende estabelecer as bases conceituais e os fundamentos legais das diretivas antecipadas. O segundo capítulo apresentará a sistematização entre os valores bioéticos e jurídicos que se relacionam a tal prática. O capítulo três apresentará as questões fundamentais pertinentes à validade e eficácia da prática das diretivas antecipadas no Brasil. A partir das premissas construídas ao longo do desenvolvimento, o desfecho da pesquisa pretende reforçar seu argumento central demonstrando, então, a legitimação bioética e a legitimidade e a possibilidade jurídicas das diretivas antecipadas sobre o fim da vida no atual contexto brasileiro.

The aim of this thesis is to study (1) the impact of physicians' locus of control (LOC) on their communication styles in interviews with cancer patients as well as (1) the impact of physicians' LOC on their acquisition of effective communication skills in a communication skills training program. LOC is a generalised belief regarding the extent to which life outcomes are controlled by an individual's actions (“internal” LOC) or by external forces such as luck, fate or other individuals (“external” LOC). (1) Although is it widely recognised that physicians' characteristics could influence their communication styles and may thus interfere with a patient-centred communication, no empirical evidence is currently available. No studies are available on the impact of physicians' LOC on their communication skills. It was hypothesised that physicians with an “external” LOC have a different communication style than physicians with an “internal” LOC. Eighty-one voluntary physicians with a practice in oncology were recorded performing an actual and a simulated interview with a cancer patient as wall as an actual and a simulated interview with a cancer patient and a relative. Physicians' communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Student's t-test. Results show that physicians with “external” LOC give more appropriate information than physicians with “internal” LOC in simulated interviews with a cancer patient (P=0.011) and less premature information than physicians with “internal” LOC in clinical interviews with a cancer patient (P=0.015). Moreover, in actual interviews with a cancer patient and a relative, physicians with an “external” LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an “internal” LOC. In simulated interviews with a cancer patient and a relative, physicians with an “external” LOC used less utterances giving premature information (P=0.031) and used more utterances with a supportive function such as empathy and reassurance (P=0.029) than physicians with an “internal” LOC. (2) Although it is widely recognised that educational interventions may be more effective for people with an “internal” LOC compared to people with an “external” LOC, no study has yet assessed the influence of physicians' LOC on communication skills learning. This study aims to test the hypothesis that, in a communication skills training program, physicians with an “internal” LOC would demonstrate communication skills acquisition to a greater degree than those with an “external” LOC. A non-randomised longitudinal intervention study was conducted between January 1999 and April 2001. Sixty-seven volunteer physicians from private and institutional practice in Belgium participated to a learner-centred, skills-focused, practice-oriented communication skills training program. Communication skills changes were assessed in 2 standardised simulated interviews before and after training (one two-person and one three-person interview). Communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills changes of the upper and lower third of physicians in respect of their scores on this scale were compared using group by time repeated measures of variance. In the two-person and three-person interviews, the increase in open directive questions was more important among physicians with an “internal” LOC compared to physicians with an “external” LOC (P=0.066 and P=0.004 respectively). In the three-person interview, the increase in directive questions (P=0.001), in assessing functions (P=0.002) and in the use of moderate feelings stated explicitly (P=0.011) was more important among physicians with an “internal” LOC compared to physicians with an “external” LOC. Conclusion. These results provide evidence that physicians' LOC can influence their communication styles as well as the efficacy of a communication skills training program. Physicians' awareness of first results constitutes a step towards a tailoring of their communication skills to every patient's and relative's concerns and needs and thus towards a patient-centred communication. The second results support the idea that a psychological characteristic such as "internal" LOC may facilitate communication skills acquisition through physicians' belief that communication with patients may be controlled by physicians themselves.

In the contemporary society, with the disintegration of political authoritarianism and the rise of democratic equality thoughts, as well as the flourishing information and popularity of medical knowledge, patients¡¦ autonomous consciousness and consumerist consciousness thus arise. In this information society, the boundless Internet brings a huge amount of information, and enables the general public to actively enrich themselves with professional medical knowledge, to have a online discussion with others, or to provide online support to each other. Such moves will transform the physician-patient relationship from the traditional ¡§professional led¡¨ interaction to different types of interaction, and hence the relationship between a physician and a patient generally deviates from the social hierarchy system in the past. Medical knowledge is no longer something that the physician can monopolize and enjoy exclusively. Accordingly, several types of physician-patient relationship have been developed. While the information revolution is generally striking the medical profession, in response to the future development and change in the medical field, some assistance should be given to medical students and practitioners to continuously learn new knowledge and new technology, as well as grasp and develop proper communication ability in this rapidly changing information age to build a solid foundation for their future role as a physician. Therefore, it leads to the author¡¦s query about ¡§what competence should a physician possess¡¨ to effectively manage the ¡§new physician-patient relationship management in the information society¡¨ mechanism, which becomes the motivation of making an in-depth study. It is hoped that the literature review and the in-depth interview in this study could help find out the way that physicians and patients ¡§adjust¡¨ to each others in these new types of physician-patient relationship in the information society. Moreover, physicians have to understand that only by improving the effect of their physician-patient relationship management can they create a win-win result under a harmonious physician-patient relationship.

Este trabalho volta-se ao estudo das diretivas antecipadas sobre o fim da vida na relação médica no Brasil. Pretende-se verificar a legitimidade bioética e a legitimidade e possibilidade jurídicas da prática das diretivas antecipadas sobre o fim da vida como objetivo central. Busca-se aferir a adequação, bioética e jurídica, das diretivas antecipadas como veículo próprio de autodeterminação da pessoa diante de suas possibilidades existenciais e da formulação de seu projeto de vida e de morte digna. Ademais, especificamente, procura-se determinar a possibilidade jurídica das diretivas antecipadas no Ordenamento brasileiro: a coerência com as garantias constitucionais e a existência de institutos aptos a tal prática. Propõe-se sustentar a legitimação jurídica das diretivas antecipadas no Brasil, indicando possíveis caminhos às soluções interpretativas no plano jurídico, e os efeitos na relação médica a partir, também, das considerações bioéticas. Com essa finalidade, pretende-se averiguar a compatibilidade entre as normas deontológicas de origem bioética e as normas jurídicas de status constitucional de proteção à pessoa humana. A tese também propõe a análise do contexto em que as diretivas antecipadas são utilizadas para (i) problematizar as ideias de capacidade e competência para a prática desse ato de autonomia pessoal, (ii) problematizar sobre como a perspectiva familiar, a perspectiva técnica dos profissionais da saúde e a perspectiva do Poder Judiciário contingenciam a liberdade desse ato e (iii) aferir a eficácia desses atos no espaço clínico e familiar. Para tanto, será empreendido estudo teórico mediante pesquisa bibliográfica e de referências, que levantará as publicações, nacionais e internacionais, sobre os temas da tese. O levantamento bibliográfico compreenderá, preferencialmente, obras sobre filosofia, ética, bioética e direito, que permitam a análise das questões teóricas envolvidas no estudo. O desenvolvimento do trabalho estrutura-se em três capítulos. O primeiro pretende estabelecer as bases conceituais e os fundamentos legais das diretivas antecipadas. O segundo capítulo apresentará a sistematização entre os valores bioéticos e jurídicos que se relacionam a tal prática. O capítulo três apresentará as questões fundamentais pertinentes à validade e eficácia da prática das diretivas antecipadas no Brasil. A partir das premissas construídas ao longo do desenvolvimento, o desfecho da pesquisa pretende reforçar seu argumento central demonstrando, então, a legitimação bioética e a legitimidade e a possibilidade jurídicas das diretivas antecipadas sobre o fim da vida no atual contexto brasileiro.

Este estudo teve como proposições: compreender o processo da interação entre profissionais de saúde e usuários estrangeiros nas Unidades Básicas de Saúde (UBS) e Programa Saúde da Família (PSF); conhecer o significado da experiência dos profissionais de saúde ao interagir com os usuários estrangeiros; evidenciar questões bioéticas na experiência de interação entre profissionais e usuários estrangeiros. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada nos Dados, até a codificação axial. A análise dos dados, apresentada como ordenamento conceitual, levou à definição de quatro grandes temas: (1) procurando comunicar-se; (2) percebendo limites; (3) percebendo interação como processo; (4) percebendo perspectivas diferentes. O percurso de interação profissional usuário estrangeiro foi desencadeado a partir de uma escolha: atender a todos indiscriminadamente, tornando possível a aproximação. Perceber ou não no usuário estrangeiro sua dignidade de pessoa humana parece ser determinante na abertura do profissional à interação, na sua disposição a buscar estratégias. / This study had the following objectives: to understand the interaction processes among health professionals and foreign users in the Unidades Básicas de Saúde (UBS) and the Program for Family Health (PSF); to get to know the significance of the health professionals experience as they interact with foreign users; to put in evidence bioetiques issues in the experience of professionals and foreign users interaction.It was used as a theorical referential the Symbolic Interacionism and as methodological reference a Grounded Theory up to an axial coding. Data analysis presented as conceptual ordering, lead to the definition of four great issues: (1) trying to communicate; (2) detecting limits; (3) recognizing interaction as a process; (4) recognizing different perspectives. The route of professional foreign users interaction was developed from one choice: attend everyone (indiscriminately) making approximation possible. To recognize or fail to recognize in the foreign user the dignity of human person seems to be the determining factor for the openness of the professional to the interaction, in his disposition to seek strategies.

No description available.