Ethical Duties of Nephrologists: When Patients Are Nonadherent to Treatment.

When providing care, nephrologists are subject to various ethical duties. Beyond the Hippocratic notion of doing no harm, nephrologists also have duties to respect their patients' autonomy and dignity, to meet their patients' care goals in the least invasive way, to act impartially, and, ultimately, to do what is (clinically) beneficial for their patients. Juggling these often-conflicting duties can be challenging at the best of times, but can prove especially difficult when patients are not fully adherent to treatment. When a patient's nonadherence begins to cause harm to themselves and/or others, it may be questioned whether discontinuation of care is appropriate. We discuss how nephrologists can meet their ethical duties when faced with nonadherence in patients undergoing hemodialysis, including episodic extreme agitation, poor renal diet, missed hemodialysis sessions, and emergency presentations brought on by nonadherence. Furthermore, we consider the impact of cognitive impairment and provider-family conflict when making care decisions in a nonadherence context, as well as how the coronavirus disease 2019 pandemic might affect responses to nonadherence. Suggestions are provided for ethically informed responses, prioritizing a patient-narrative approach that is attentive to patients' values and preferences, multidisciplinarity, and the use of behavioral contracts and/or technology where appropriate.

[Ethical aspects of teaching of nervous diseases]. / Éticheskie aspekty prepodavaniia nervnykh boleznei.

Ethical aspects of training of physicians are considered. The author highlights the importance of teaching the basic disciplines during the training of the neurologist. An analysis of most frequent mistakes that arise in practical activity as a consequence of overestimation of paraclinical methods of investigation, underestimation of a role of treatment that the patient receives due to other indications is presented. The formation of life attitude of the physician is the extremely important component of teaching process. One should not forget the lessons of history shown examples of physicians that gave their lives to save patients. Also, there are examples of physicians who had violated the fundamental humanitarian principles.