Ethical principles in public health in Bulgaria

Ethical principles in public health in Bulgaria Yordanka Borissova,M.D. PhD Student Faculty of Public Health Medical University, Sofia, Bulgaria Ethical principles in public health in Bulgaria  Accepting health care as a priority of national political programs, immensely increased the role of medical ethics in health policy making.  Public discussions are focused on the issue of how ethical principles can help forward the creation of health policy and laws in health care.  First of all, practical ethics in medicine and health care has its responsibilities to public heath and public interest. Ethical principles in public health in Bulgaria Main ethical principles which are the basis for ethical evaluation: Ethical principles in public health in Bulgaria  Respect of autonomy  Not maleficence  Beneficence  Usefulness  Justice and honesty Ethical principles in public health in Bulgaria  First of all, autonomy in health care practice is used in taking responsibility at the moment of decision making.  Personal autonomy should be taken in consideration in: -giving an informed consent, -telling the truth, -confidentiality. Ethical principles in public health in Bulgaria  In accordance with contemporary ethics, the patient, as a personality, with his/her doctor’s help, should take part in the process of decision making about diagnostic and therapeutic procedures to be undertaken.  A person with autonomy has freedom to act in accordance with the personal plan, chosen by him/her. Ethical principles in public health in Bulgaria  The process of getting patient’s informed consent is very important.  Principal elements of informed consent : -details of treatment, -benefits, -disadvantages, -alternatives, -documentation Ethical principles in public health in Bulgaria  Those elements encourage the patient to perceive the informed consent as a possibility to achieve with his/her doctor’s help a rational decision about his/her own treatment, being a person with autonomy.  It is an autonomy approval, a permission given to the doctor to start treatment, procedure or examination. Ethical principles in public health in Bulgaria  In the very beginning, the need of informed consent was regarded as a way of reducing the risk and injustice in medical practice.  As a first rate function of informed consent, recently, is regarded: -protection -facilitating individual choice. Ethical principles in public health in Bulgaria How the problem was solved in Bulgaria? Ethical principles in public health in Bulgaria  The start of the health care system reform in Bulgaria/ 01.07.2000/ made patient informed consent a problem of the present day.  After signing the framework contracts between National health insurance fund and hospitals, regulations for obligatory signing patient informed consent were brought into use. Ethical principles in public health in Bulgaria  Legislative measures are only a part of the efforts in achieving true and up to standard patient informed consent .  Greater is the need of acquiring a new medical culture- knowledge and skill, to get an up to standard informed consent by means of positive attitude and realizing the importance of the problem. Ethical principles in public health in Bulgaria  It is not only the vocational training of doctors and medical professionals the way to do it, but purposefully training of society as a whole. Ethical principles in public health in Bulgaria  Health education, as well as making patients familiar with their rights, in particular the informed consent, could be effective if not only medical specialists were engaged, but NGO, organizations defending patient’s rights, newspapers and TV take part in this process, too. Ethical principles in public health in Bulgaria  Another important ethical principle is: NONMALEFICENCE.  It is a principle, associated with the maxim: primum non nocere, "above all, do no harm" Ethical principles in public health in Bulgaria  In terms of medical ethics, the sense of this principle is, first of all to do no harm as a physical damage, pain, disability, death, mental trauma, etc.  In medical practice “do no harm” is not just the obligation not to harm, but to do not expose patients to any risk. Ethical principles in public health in Bulgaria  For this purpose medical professionals have to correspond to some professional, legislative and moral requirements, which include enough knowledge, skills and diligence.  In medicine the principle of being not maleficent is used especially, when taking the decision to conduct or not some kind of treatment. Ethical principles in public health in Bulgaria  For example: -initiate or stop a lifesupporting treatment -chose a standard or alternative treatment -artificial nutrition and application of life sustaining technologies -premeditated or almost stipulated effects Ethical principles provide a moral basis for politics, its ethical frame, and gives favorable conditions for critical analysis of existing healthcare politics, as well. Ethical principles in public health in Bulgaria  New challenges in medicine and healthcare lead to some new priorities: Ethical principles in public health in Bulgaria  Working out ideas for developing public health, based on ethical values  Health as Man’s fundamental right  Active participation of Man, institutions and communities in healthcare and health development Ethical principles in public health in Bulgaria  Form structures and mechanisms for regulation and control of applying new technologies and drugs  Integrating of public health and personal responsibility for health In this connection the training of students in the field of public health gains bigger meaning and value. Ethical principles in public health in Bulgaria  Training of a skilled staff, who are able to respond to new challenges in healthcare is of great importance. Main accents are put on training of students in the field of health prevention, promotion, medical ethics, healthcare economics, health management. Ethical principles in public health in Bulgaria  This is due to creation of new politics in public health, which is prime task in the strategy for development of Bulgarian healthcare.  It is necessary to have health professionals, who skillful at new methods for leading and regulating the processes in healthcare. Ethical principles in public health in Bulgaria  Graduated PH students are wellgrounded specialists, who are ready to meet the challenges of dynamically forming market of health services. Ethical principles in public health in Bulgaria  Creating partnership for health in regional, national and international level is of great importance. Ethical principles in public health in Bulgaria Thank you very much for your attention.