Perceptions of pediatric residents and pediatricians about ethical dilemmas: The case of Turkey.

BACKGROUND: This study determined the knowledge, attitudes, and behaviors of pediatricians and pediatric residents regarding issues of ethics, professional education, clinical ethical principles, and consent they encounter in health service delivery. METHODS: Participants in the study were 134 pediatricians and pediatric residents from three hospitals in Ankara, Turkey. Participants were asked questions regarding their sociodemographic characteristics, their knowledge and views of ethics and ethical education, whether they had ever encountered an ethical problem, their beliefs about obtaining consent from pediatric patients and their families, and case-based questions. All data were collected and evaluated. RESULTS: Of the participants in the study, 82 (61.2%) were residents, 41 (30.6%) were pediatricians, and 11 (8.2%) were faculty lecturers. The data revealed that 10% of the pediatricians and pediatric residents received ethical education, apart from medical ethics/deontology education at medical school, and 90.3% required further education on children and ethical problems. It was determined that 89% of residents and 78% of pediatricians needed help with the ethical problems they encountered during the diagnostic and treatment processes. Overall, 65.7% of the participants stated that the ethical problems they encountered affected the efficiency of health service delivery. It was observed that residents were more affected by ethical issues than pediatricians were. The present study revealed that pediatric residents and pediatricians need ethics education and there is a need to establish ethics counseling centers in hospitals. There is also a need for further studies in pediatrics and ethics.

Views of Women's Sexuality and Violence Against Women in Turkey: A Cross-Sectional Investigation Among University Students.

PURPOSE: This study explored Turkish university students' views of women-related issues--gender roles, sexuality, and violence against women. METHOD: A cross-sectional study was conducted with 605 students--337 females and 268 males--at Ankara University, Turkey. A survey exploring students' views of female sexuality and violence was used. Comparisons of responses were made among groups based on sex, year of study at the university, and field of study at the university. RESULTS: Three relevant findings were found: male students had more traditional, nonegalitarian approaches toward women's issues than female students; educational levels and fields of study did not significantly influence students' views of women; and a small percentage of students approve of violence against women. DISCUSSION: These results show that patriarchal values in Turkish society influence the formation of students' opinions, and university education alone cannot affect everyone's views of gender roles, women's sexuality, and violence against women.

An evaluation of nurses' professional autonomy in Turkey.

BACKGROUND: The development of a profession's autonomy closely relates to that profession's level of autonomy in performing its specific role. For the nursing profession, this key role is nursing care. OBJECTIVES: This study was undertaken to evaluate the professional autonomy of nurses in care provision, from an ethical perspective. RESEARCH DESIGN: A mixed methods approach is employed in this research, which makes use of both quantitative and qualitative methods. The quantitative dimension of this research covers sociodemographic aspects and makes use of the Sociotropy-Autonomy Scale. The qualitative dimension of the research relates to the factors that affect professional autonomy in nursing care. PARTICIPANTS AND RESEARCH CONTEXT: The sample consisted of 30 nurses working in the orthopedics, neurology, or intensive care units of three hospitals. ETHICAL CONSIDERATIONS: Before conducting this research, we received permission from the ethical committee, as well as written permits from all the institutions in which the research was carried out. Informed consent was obtained from all participants. FINDINGS: According to the findings of this study, only 6.7% of the nurses surveyed stated that nurses had professional autonomy; they also stated that professional autonomy in nursing was mostly restricted by the need to be "dependent upon the physician in nursing implementations" and that autonomy in nursing care was mostly limited by a "high number of patients per nurse." DISCUSSION: This study determined that delays in resolving problems with regard to professional autonomy in nursing care in Turkey could be creating many of the professional and ethical problems that nurses face there. CONCLUSION: It is recommended that: individuals choose the nursing profession conscientiously; nurses need to be given professional awareness; their professional organizations need to be strengthened; and plans need to be made to increase research and to accumulate both knowledge and expertise.

The experiences of violence and occupational health risks of sex workers working in brothels in ankara.

OBJECTIVE: The aim of this study was to reveal and discuss occupational health risks, violence against sex workers working in brothels and their working conditions in Ankara. MATERIALS AND METHODS: The study included 138 sex workers. Data were collected at face to face interviews with a questionnaire composed of 40 questions about socio-demographic features, familial characteristics, reasons for becoming a sex worker, experiences of violence and occupational health risks. RESULTS: Twenty-two point five percent of the women were aged 21-30 years and 39.9% were aged 31-40 years. The mean time of education was 5.9±3.5 (0-14) years. Forty-eight point five percent of the women were exposed to physical abuse and 13% of the women had been exposed to sexual abuse in their childhood. Fifty-five point eight percent of the women reported that their clients always used condoms, but 97.1% of the women noted that their clients insisted on not using a condom. Fourteen point five percent and 70.3% of the women were exposed to physical and verbal violence respectively from their clients. Ten point one percent of the women suffered sexual assault while working. CONCLUSION: Sex workers, like other people, should have human rights, all types of violence that they face should be eliminated and the social conditions they are exposed to should be improved. Sexually transmitted diseases, the most important health risk of sex workers, should be considered as occupational diseases in the new regulations.

Gender, infertility, motherhood, and assisted reproductive technology (ART) in Turkey.

In Turkey, as in many other countries, infertility is generally regarded as a negative phenomenon in a woman's life and is associated with a lot of stigma by society. In other words, female infertility and having a baby using Assisted Reproductive Technologies (ART) have to be taken into consideration with respect to gender motherhood, social factors, religion and law. Yet if a woman chooses to use ART she has to deal with the consequences of her decision, such as being ostracized by society. Other types of procedures in this area, such as sperm and ova donation or surrogate motherhood, are not permitted in law. However; both before and after the development of this techonology, society has been finding its own solutions which are rarely questioned and are still performed This article will discuss what these practices are and try to reach some pragmatic conclusions concerning female infertility, the concept of motherhood and some traditional practices in Turkey.

Critique of medical history education in Turkey's medical faculties.

In this article the curricula at the baccalaureate level of 18 medical faculties in our country that have Deontology-Medical Ethics and Medical History departments have been evaluated and classified, looking at the number of hours and topics. Our purpose for this study was, particularly from the aspect of medical history, to compare curricula in departments in which this class is given, to display shared and different directions, and to draw a general framework of medical history education in our country. The study was conducted between March and May 2004.A questionnaire with a total of 12 questions was sent by e-mail or fax to the related departments in the medical faculties. The data that were collected on the questionnaire included a) the year of foundation of the related department and the Medical Faculties that have Deontology-Medical History and Ethics Departments, b) the names of the faculties that have baccalaureate and doctoral programs, c) the number of teaching staff in these faculties, d) the length of medical history and ethics classes and their timing in semesters, e) the stated basic purpose and objectives of medical history classes, f) information about journals related to medical history in our country and g) organized ongoing medical history education. In this study qualitative and quantitative data were evaluated simultaneously, the purpose of medical history classes and the part that these classes play in developing the physicians' identity were assessed together with other results.

Statutory disclosure in article 280 of the Turkish Penal Code.

A new Turkish Penal Code came into effect on 1 June 2005. Article 280 concerns health care workers' failure to report a crime. This article removes the responsibility from health care workers to maintain confidentiality, but also removes patients' right to confidentiality. It provides for up to one year of imprisonment for a health care worker who, while on duty, finds an indication that a crime might have been committed by a patient and who does not inform the responsible authorities about it. This forces the health care worker to divulge the patient's confidential information. A patient who thinks he or she may be accused of a crime may therefore not seek medical help, which is the universal right of every person. The article is therefore contrary to medical ethics, oaths taken by physicians and nurses, and the understanding of patient confidentiality.

Violence against women in Turkey and the role of women physicians.

Violence against women is a serious problem in Turkey. The Women and Ethics Commission of the Turkish Physicians' Association (Ankara Physicians' Chamber) has undertaken significant work to counteract this. This article gives some indications of the sources of violence and discusses its social and health care implications. The Commission is pivotal in the education of women physicians and in heightening awareness of the situation. An outline is given of this work and recommendations are made on how violence against women can be tackled and eliminated.

Fetuses with neural tube defects: ethical approaches and the role of health care professionals in Turkish health care institutions.

Neural tube defects (NTDs) are very serious malformations for the fetus, causing either low life expectancy or a chance of survival only with costly and difficult surgical interventions. In western countries the average prevalence is 1/1000-2000 and in Turkey it is 4/1000. The aim of the study was to characterize ethical approaches at institutional level to the fetus with an NTD and the mother, and the role of health care professionals in four major centers in Turkey. The authors chose perinatology units of four university hospitals and prepared questionnaires for the responsible professionals concerning their own and their institution's ethical approaches to the fetus with an NTD and the mother. The investigation revealed that there were no institutional ethical frameworks or ethics committees available to professional teams in the units. The roles of the health care professionals and their individual decisions and approaches based on ethical principles are described. The ethical decision-making process concerning fetuses with NTDs, examples of institutional approaches to the topic and institutional frameworks, and the role of nurses and other health care professionals are all discussed, based on a literature review. The authors suggest that institutional ethical frameworks, ethics committees, professionals' ethics education and multidisciplinary teamwork should be established for critical situations such as fetuses with an NTD.