In prominent international documents and professional position papers, confidentiality was recognized as a necessary condition for effective reproductive healthcare of adolescents. Although legally ...guaranteed, it is questionable if the right to confidentiality of adolescents is respected in healthcare practice in Serbia.
To assess primary care physicians' perspectives on the legal right of minors to confidentiality in sexual and reproductive healthcare, as well as their experiences in practice.
Qualitative, semi-structured face-to-face interviews with 12 primary care pediatricians and gynecologists at several municipalities of the city of Belgrade were performed. Interview transcripts were analyzed using qualitative content analysis method.
Most interviewees were aware of their legal obligations and support the general idea of granting adolescents the right to confidentiality. They recognized that the lack of confidentiality assurances prevents adolescents' access to sensitive care. However, physicians expressed concerns regarding medical situations when parents should be notified, which was reflected in their inconsistent respect of said right in actual practice. Several organizational obstacles were emphasized by interviewees, including insufficient number of physicians, time constraints, poor access to gynecological services and vague definitions of legal provisions.
If the aim is for adolescents' right to confidentiality to be consistently respected in practice, primary care physicians need to be systematically educated about legal provisions and given comprehensive clinical guidelines. The general positive attitude towards confidentiality expressed by the primary care physicians implies that a possibility exists to engage them as main advocates for improvements in access to the necessary health care.
Allowing competent children to exercise their right to consent relies largely on healthcare practitioners’ own understanding and attitudes regarding the maturity and decision-making capacity of minor ...patients, particularly in circumstances when professional guidelines for practice do not exist. The aim of this study was to explore Serbian primary care physicians’ a) views and experiences regarding decision-making capacity of adolescents, b) experiences with adolescents’ parents regarding their children’s right to give autonomous consent and c) views on their own role in adolescents’ healthcare. Qualitative semi-structured interviews were conducted in person with twelve pediatricians and gynecologists at eight primary health care institutions at Belgrade (Serbia) from March to May 2016. Qualitative content analysis was used to identify categories in the data. Participants agreed that decision-making capacity is reached at an individual pace, making it difficult to set age boundaries for consent. However, they noted that adolescents’ decision-making capacity can be enhanced by providing appropriate support, by both physicians and parents. Participants described witnessing overprotective behavior in parents, yet highlighted that physicians are well placed to help parents understand the importance of letting their adolescent children participate in decision-making. Since participation in decision-making is considered to be in the best interest of minors, primary care physicians can be important agents in strengthening adolescents’ positions as decision-makers in healthcare. In addition, healthcare workers would benefit from additional training in skills to enhance communication with both adolescents and parents.
Highlights
Adolescents need to be encouraged and assisted in the development of their decisional capacity and autonomy.
Parents need to be educated on the importance of adolescents’ right to participation in health care decision-making.
Cultural values and inter-familial relations need to be taken into account when deciding on the level of children’s autonomy.
Primary care physicians would benefit from additional training in adolescent medicine and skills for communication with both adolescents and parents.
Bioetika je nastala u multikulturnom miljeu kasne/refleksivne modernosti, u SAD-u. Od pojave Bioetike – mosta k budućnosti, Van Rensselaera Pottera, bioetika se u svojoj glavnoj razvojnoj putanji ...kretala od multidisciplinarnog k interdisciplinarnom projektu. Postavlja se pitanje postoji li signifikantna veza izmeÄ‘u njenog ranog multidisciplinarnog karaktera i multikulturalnosti miljea njenog rodnog mjesta? NaÅ¡ odgovor je - vjerojatno da, u najmanju ruku stoga Å¡to oba "multi" korespondiraju sa samom prirodom/logikom Äitavog povijesnog procesa, Äija je suÅ¡tinska karakteristika uvijek bila diferencijacija, to jest transformacija (kako bi to formulirao Herbert Spencer) iz homogenosti u – neodreÄ‘enu, odnosno odreÄ‘enu – heterogenost. TakoÄ‘er je vrlo vjerojatno da postoji uzroÄno-posljediÄni odnos izmeÄ‘u spomenutih dvaju "multi"; heterogenost bioetike bila je, u krajnjoj liniji, posljedica heterogenosti sociokulturnog miljea u kom je nastala. No, postoji (i) znaÄajna razlika izmeÄ‘u ovih dvaju "multi". Pored multikulturnih (manje odreÄ‘enih, odnosno neodreÄ‘enih heterogenih), postoji i koncepcija prema kojoj postoje i interkulturni (odreÄ‘eno heterogeni) miljei. Prema nekim autorima, samo su posljednji autentiÄno ljudski/humani sustavi ljudske meÄ‘uzavisnosti. U postojećem, meÄ‘utim, multikulturnih miljea ima, no interkulturni sustavi joÅ¡ su uvijek tek idealno-tipske konstrukcije (ili utopije). S druge pak strane, bioetika se tijekom posljednjih Äetrdesetak godina razvila (iz multi) u interdisciplinarni projekt, naroÄito u posljednjem desetljeću, unutar koncepta integrativne bioetike. Pitanje koje slijedi jest: ima li bioetika, u svojoj integrativnoj verziji, kapacitet da praktiÄno pridonese (da sada sama postane uzrok) transformacijama multikulturnih u interkulturne sustave ljudske meÄ‘uzavisnosti? I, dalje, ako ima, kako ih možemo upotrijebiti da bismo postigli taj cilj? KonaÄno, koji bi trebao biti prvi korak? Vjerojatno formuliranje jednog Manifesta integrativne bioetike? Pa, uÄinimo to! Â
U ovom radu autori najprije izlažu glavne crte programa (curricula) osnovnih i izbornih predmeta Medicinska sociologija i Medicinska etika, te Uvod u nauku, StanovniÅ¡tvo, ekologija i medicina, ...Istorija medicine, Komunikacija u medicini (I. godina studija) i Bioetika III, Bioetika IV i Bioetika V (III., IV., odnosno V. godina studija) koji su, ultima linea, svi povezani s bioetiÄkom edukacijom na Medicinskom fakultetu SveuÄiliÅ¡ta u Beogradu, bilo kao svojevrsna bioetiÄka propedeutika, bilo kao neposredno bioetiÄko obrazovanje. Nadalje, budući da u nastavnom procesu (osnovnom, ali odnedavno i u okviru poslijediplomskih, dakle, specijalistiÄkih i doktorskih studija) rade na devet predmeta, s preko 2000 studenta tijekom jedne Å¡kolske godine, autori opisuju ambijent u kom je bilo moguće postići takav angažman, te kratku povijest formiranja i razvoja navedenih predmeta. Najzad, s tim u vezi, autori izlažu i ulogu Katedre humanistiÄkih nauka Medicinskoga fakulteta u Beogradu, u Äijim su okvirima, inaÄe, tijekom proteklih godina, ostvareni spomenuti, rekli bismo, radikalni pomaci k na humanistiÄke discipline (na bioetiku, prije svega) orijentiranog edukaciji studenata Medicinskog fakulteta SveuÄiliÅ¡ta u Beogradu.
This paper presents the morally controversial phenomenon of prostitution. As the basis for contemplating the prostitution issue the most important is revealing and understanding its primitive ethical ...root. For understanding its "soul", its essence, also important is comprehending sexual, "elementary thoughts" of mankind, through the relationship between prostitution and religious, social, political and spiritual life, and its nature as a reflection of the sexual-ethical concepts in different epochs and nations. We emphasize the connection between prostitution and psychiatry. Placing a special focus on importance of personality for deciding to become a prostitute, and by pulling it through a moral prism we define prostitution as a new medical situation. In favor of that, we stress the importance of the presence, position and role of psychiatrists within an indispensable multidisciplinary team, which is complementary despite its heterogeneousness, synergistically and simultaneously dealing with psychological, physical and social health-problems of women engaged in prostitution. We propose peer education as a way of promoting healthy and safer behaviors among the subculture of prostitutes, where we see another important role of psychiatrists in selecting/recruiting, training and motivating peer educators among them.
U okviru nastave iz obaveznog predmeta Medicina i druÅ¡tvo (predmet obuhvaća medicinskosocioloÅ¡ki, medicinsko-etiÄki i socijalno-medicinski dio) na prvoj godini osnovnih studija Medicinskog ...fakulteta Univerziteta u Beogradu, 2007., 2008., 2009. i 2012. godine, na prijedlog odgovornog nastavnika prof. dr. Karela Turze, a u suradnji s patronažnom službom Doma zdravlja “Novi Beogradâ€, organizirane su posjete romskim nehigijenskim naseljima2. Cilj ovih posjeta bio je neposredni kontakt studenata s pripadnicima romske populacije, te susret sa zdravstvenim, i Å¡ire, svakodnevnim životnim problemima ljudi koji žive u nehigijenskim naseljima. Na taj naÄin budućim lijeÄnicima omogućeno je da se mnogo prije realnog suoÄavanja s bolesnicima koji su pripadnici romske populacije, suoÄe i s vlastitim predrasudama i stereotipima koji mogu biti smetnja u uspostavljanju kvalitetnog odnosa lijeÄnik - bolesnik. Autori navode neka saznanja o zdravstvenoj zaÅ¡titi i zdravstvenim problemima romske populacije do kojih su doÅ¡li prilikom spomenutih organiziranih posjeta romskim nehigijenskim naseljima. Autori predlažu ovakve i sliÄne organizirane posjete pripadnicima razliÄitih vulnerabilnih skupina kao neizostavni element bioetiÄke edukacije budućih lijeÄnika.
In this paper, the authors intend to give an overview of the institutionalization of bioethics in Serbia. In the first part of the paper the authors are going to briefly elaborate on the meaning of ...the notion of institutionalization and certain important definitions of bioethics, while in the second part of the paper they are going to consider the basic trends regarding the institutionalization of bioethics in Serbia. On the one hand, the institutionalization of bioethics involves the activities of the organizations whose aims are oriented towards the development of bioethics as the multidisciplinary field and, on the other hand, it involves primarily the development of bioethical education within the programs of Serbian academic institutions. In the third part of the paper the authors briefly analyze one of current bioethical issues regarding assisted reproduction as the form of institutionalization of bioethics in Serbia and the necessity of reflection on this issue from different perspectives, not only medical but also juridical, philosophical and sociological perspective. In the conclusion the authors point to the development of the institutionalization of bioethics in Serbia. Adapted from the source document.
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