Browsing by Author "Civaner, Murat"

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A proposal for the prevention of ethical problems related to drug promotion: A national network for drug information
(Türkiye Sinir ve Ruh Sağlığı Derneği, 2008-09-01) Civaner, Murat; CİVANER, MUSTAFA MURAT; Uludağ Üniversitesi/Tıp Fakültesi; 0000-0001-5376-3499; S-4188-2019
The promotional activities of pharmaceutical companies are becoming an increasingly hot topic among healthcare workers and the general public. There are many studies in the literature claiming that drug promotion may lead to ethical problems, irrational use of medication, and increased costs, as well as negative effects on the patient-physician relationship and the medical profession. When considering that healthcare workers generally acquire their knowledge from the pharmaceutical industry, the problems mentioned, which are indeed of paramount importante, and the need for effective and sustainable interventions are clearly revealed. Many kinds of interventions have been recommended by various authorities and studies in order to prevent the kinds of problems mentioned above, including training healthcare workers, publishing professional codes to serve as guidelines about which professional values should be protected and how to cope with different situations in relationship to the pharmaceutical industry, or applying the business ethics codes of the pharmaceutical companies. Studies that assessed the effectiveness of different interventions, however revealed that educating healthcare workers about marketing methods and state regulations are the only effective interventions.In this article, after defining the problem, a proposed national network for drug information is to decrease the negative effects of drug promotion and to promote the rational choice of medicines is described. According to the World Health Organization, rational use of medicine is the most effective, safe, applicable/suitable, and, lastly, the most cost effective option. A national network that will gather drug information by compiling evidence-based knowledge Grid taking rational use of medicine measures into account should be established. It should transmit information to oil healthcare workers in a fast, equal, up to date, easily accessible, and free way. The network should also support institutional regulations that aim to limit the promotional activities of pharmaceutical companies.
Can "presumed consent" justify the duty to treat infectious diseases? An analysis
(BMC, 2008-03-06) Arda, Berna; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Etiği Anabilim Dalı.; 0000-0001-5376-3499; S-4188-2019; 24075622600
Background: AIDS, SARS, and the recent epidemics of the avian-flu have all served to remind us the debate over the limits of the moral duty to care. It is important to first consider the question of whether or not the "duty to treat" might be subject to contextual constraints. The purpose of this study was to investigate the opinions and beliefs held by both physicians and dentists regarding the occupational risks of infectious diseases, and to analyze the argument that the notion of "presumed consent" on the part of professionals may be grounds for supporting the duty to treat. Methods: For this cross-sectional survey, the study population was selected from among physicians and dentists in Ankara. All of the 373 participants were given a self-administered questionnaire. Results: In total, 79.6% of the participants said that they either had some degree of knowledge about the risks when they chose their profession or that they learned of the risks later during their education and training. Of the participants, 5.2% said that they would not have chosen this profession if they had been informed of the risks. It was found that 57% of the participants believed that there is a standard level of risk, and 52% of the participants stated that certain diseases would exceed the level of acceptable risk unless specific protective measures were implemented. Conclusion: If we use the presumed consent argument to establish the duty of the HCW to provide care, we are confronted with problems ranging over the difficulty of choosing a profession autonomously, the constant level of uncertainty present in the medical profession, the near-impossibility of being able to evaluate retrospectively whether every individual was informed, and the seemingly inescapable problem that this practice would legitimize, and perhaps even foster, discrimination against patients with certain diseases. Our findings suggest that another problem can be added to the list: one-fifth of the participants in this study either lacked adequate knowledge of the occupational risks when they chose the medical profession or were not sufficiently informed of these risks during their faculty education and training. Furthermore, in terms of the moral duty to provide care, it seems that most HCWs are more concerned about the availability of protective measures than about whether they had been informed of a particular risk beforehand. For all these reasons, the presumed consent argument is not persuasive enough, and cannot be used to justify the duty to provide care. It is therefore more useful to emphasize justifications other than presumed consent when defining the duty of HCWs to provide care, such as the social contract between society and the medical profession and the fact that HCWs have a greater ability to provide medical aid.
Do patients have responsibilities in a free-market system? A personal perspective
(Sage Publications, 2008-03) Arda, Berna; Civaner, Murat; Uludağ Üniversitesi/Tip Fakültesi/Deontoloji Anabilim Dalı.; 24075622600
The current debate that surrounds the issue of patient rights and the transformation of health care, social insurance, and reimbursement systems has put the topic of patient responsibility on both the public and health care sectors' agenda. This climate of debate and transition provides an ideal time to rethink patient responsibilities, together with their underlying rationale, and to determine if they are properly represented when being called 'patient' responsibilities. In this article we analyze the various types of patient responsibilities, identify the underlying motivations behind their creation, and conclude upon their sensibleness and merit. The range of patient responsibilities that have been proposed and implemented can be reclassified and placed into one of four groups, which are more accurate descriptors of the nature of these responsibilities. We suggest that, within the framework of a free-market system, where health care services are provided based on the ability to pay for them, none of these can properly be justified as a patient responsibility.
Exposing nursing students to the marketing methods of pharmaceutical companies
(Sage Publications , 2008-05) Sarıkaya, Özlem; Alıcı, Sevim Ulupınar; Bozkurt, Gülçin; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Deontoloji Anabilim Dalı.; 24075622600
There is a strong association between reliance on the promotional activities of pharmaceutical companies and a generally less appropriate use of prescription drugs. Pharmaceutical companies direct some of their promotion towards health workers who do not have the authority to prescribe medicines, such as nurses in certain countries. The aim of this study was to determine the impact that exposure to the marketing methods of pharmaceutical companies has on judgments made by nursing students about health worker-pharmaceutical company relationships. A cross-sectional survey was carried out with 442 nursing students in Istanbul, Turkey. The exposure of students to the marketing methods of pharmaceutical companies, whether it be indirectly through observation or directly by first-hand experience, increases the probability that students will adopt rationales that underlie affirmative judgments of health worker-pharmaceutical company relationships. Based on the pervasiveness and ability of drug promotion to influence the perceptions of students, it is imperative that attempts be made to reduce its negative impact.
Exposure of medical students to pharmaceutical marketing in primary care settings: Frequent and influential
(Springer, 2009-12) Sarıkaya, Özlem; Vatansever, Kevser; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Deontoloji Anabilim Dalı.; 24075622600
It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician-pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.
"Healthcare-caused harm", instead of "Malpractice"
(Galenos Yayıncılık, 2011-09) Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Etiği Anabilim Dalı.; 0000-0001-5376-3499; S-4188-2019; 24075622600
Malpractice has gained an alarming dimension especially along with the introduction of compulsory professional liability insurance. On the other hand, it is quite difficult to say that malpractice is discussed by considering all responsible determinants. According to individual-focused approach, the error is caused by single individual, so the solution can be achieved by punishing the individual. It is known that this approach does not reduce errors, and adversely affect services due to high compensations and increased insurance premiums. In Turkey, malpractice is simply considered in the customer-seller relationship context, and individual-focused approach is adopted. However, it is well established that this "blame-culture" has negative effects on service provided, social perception of the profession, and job satisfaction. Beside recognizing individual professional responsibilities, basically it should be stressed that declaring healthcare workers as mainly responsible would not be fair. In addition, it violates right to health because of increasing the preventable errors and harms.
Her şey çocuk içindir
(Türk Pediatri Derneği, 2009-12) Ulman, Yeşim Işıl; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Tarihi & Etik Anabilim Dalı.; 24075622600
Recent studies in the history of medicine have shown that the modern healthcare services of reproduction, mother and child health and newborn care date back to the second half of the 19th and to the first decades of the 20th century in Turkey. Institutionalization of the contemporary scientific medicine was in the making at this crucial historical turning point in the country that paved the way for modern healthcare services to become widespread in the society. It is remarkably important to mention, in this striking process, about the achivements of Prof. Dr. Besim Omer Pasha (1861-1940) who opened the first Maternity Hospital (Viladethane) within the School of Medicine in Istanbul in 1894, and conducted the teaching and training of modern obstetrics, gyneacology and midwifery in the School. One of the great many young people he supported in the professional career was Dr. Safiye Ali (1894-1952) who had been the first woman physician in Turkey. Dr. Safiye Ali Krekeller graduated from Würzburg School of Medicine in Germany on Ottoman State's account and turned back to country in 1921. She worked at the Drop of Milk (Süt Damlasi) Houses, the brand new mother and child healthcare clinics at the time which rendered not only curative but also population based preventive medical service. This study aims at introducing briefly the main features of Viladethane and Süt Damlasi by giving emphasis both on their role as pioneering institutions and also on their approach that gave priority to public healthcare in Turkey.
How does the institutional consciousness of bioethics influence determine its agenda?: Medical education
(Ortadogu Yayınları, 2008-10) Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Deontoloji Anabilim Dalı.; 0000-0001-5376-3499; S-4188-2019; 24075622600
In the Encyclopedia of Applied Ethics, bioethics is defined as, "While medical and other healthcare ethics are a major component of bioethics, the latter is now widely acknowledged to extend well beyond healthcare ethics to include not only the ethics of researches in the life sciences but also environmental sciences, ethical issues of sexuality, reproduction, genetics, and population, and various sociopolitical moral issues, including the adverse effects oil people's health of unemployment, poverty, discrimination, crime, war, and torture". Although it is a relatively new discipline, bioethics covers a vast area with contributions from medical ethics, philosophy, sociology etc. Generalizing on various bioethics studies throughout the world, it is possible to see that studies from Western cultures are especially concentrating on certain issues such as euthanasia, beginning of life, genetics, and autonomy. In addition to the similarities, studies originating from other geographical and cultural environments also include ethical problems due to the privatization of national health care systems. In Turkey, studies on bioethics suffer from a lack of disassociation with practical health care services and policies, actual problems of the academia and medical education, and this situation limits the agenda to individual relationships. Raising institutional awareness and defining the context properly seems necessary. in order to expand the agenda and to deal with real problems, One of the most important things to be done is to take into consideration, both in subject selection and ethical analysis, the various, direct and indirect determinants of daily life that effect people's health. This is a necessity, that derives from the definition of bioethics itself.
Olağandışı durumlarda sağlık hizmetleri eğitimi: Mezuniyet öncesi tıp eğitimi için önemli bir gereklilik
(Aves, 2011-09) Vatansever, Kevser; Balcıoğlu, Harun; Yavuz, Cavit Işık; Sarıkaya, Özlem; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Tarihi & Etik Anabilim Dalı.; 24075622600
Gereksinimlerin yerel kaynakların kapasitesini aştığı durumlar” biçiminde tanımlanan olağandışı durumların sıklığı, çeşitliliği ve yıkıcılığı, dünyada ve ülkemizde artış göstermektedir. Sağlık sistemlerinin doğrudan yaşadığı altyapı ve insan gücü kayıplarının yanı sıra toplumun sağlık hizmeti gereksiniminin artması, çok-disiplinli ve gönüllü ekiplerle çalışma zorunluluğu, yerine getirilmesi gereken görevlerin çokluğu ve çeşitliliği gibi sorunlar, durumu daha da karmaşıklaştırmaktadır. Bu sorunlarla baş etmek için en temel araçlardan birisi, sağlık çalışanlarının olağandışı durumlara yönelik olarak eğitilmesidir. Ancak dünyada ve Türkiye’de olağandışı durumlara hazırlıklı olma ve etkili yanıt verme eğitimi açısından çok umutlu bir tablo olduğunu ileri sürmek güçtür. Çok sayıda program uygulanıyor olsa da, programlar çoğunlukla kurumların birbiriyle işbirliği yapmadan düzenlediği, içerik açısından önemli eksikler taşıyan, hedef grup kapsayıcılığı yetersiz ve farklı sektörlerden olağandışı durum çalışanlarının eşgüdümünü desteklemeyen niteliktedir. Bu çalışmada dünyada ve Türkiye’de sağlık alanında olağandışı durum eğitimiyle ilgili durum gözden geçirilmekte ve gereksinimlerin tanımlanması amaçlanmaktadır. Ayrıca bir örnek olarak, mezuniyet öncesi tıp eğitimi için çekirdek yeterlik hedefleri belirlenmekte ve bir program önerisi sunulmaktadır. Program önerisi hazırlanırken, eğitim programlarının etkililiğini güvenceye almak amacıyla önerilen eğitim programı geliştirme basamakları izlenmiştir. Bu amaçla, çeşitli yöntemlerle eğitsel gereksinimler belirlenmiş; olağandışı durum tıbbıyla ilgili temel kaynaklar incelenerek öğrenme hedefleri seçilmiş ve öğrenme hedeflerine uygun öğretme yöntem ve teknikleri kararlaştırılmıştır.
Physician involvement in torture: An ethical perspective
(Springer, 2013-03-01) Siddiqui, Norain A.; Civaner, Murat; Elçi, Ömür Çınar; CİVANER, MUSTAFA MURAT; Uludağ Üniversitesi/Tıp Fakültesi; 0000-0001-5376-3499; S-4188-2019
Evidence proves that physician involvement in torture is widely practiced in society. Despite its status as an illegal act as established by multiple international organizations, mandates are routinely unheeded and feebly enforced. Philosophies condemning and condoning torture are examined as well as physicians' professional responsibilities and the manner in which such varying allegiances can be persuasive. Physician involvement in torture has proven detrimental to the core values of medicine and has tainted the field's commitment to individuals' health and well-being. Only when this complex issue is addressed using a multilevel approach will the moral rehabilitation of medicine begin.
Protests in Turkey, state violence, and how doctors are helping: It's about much more than a park
(BMJ, 2013-06-11) Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Tarihi ve Etik Anabilim Dalı.; 24075622600
Rationing healthcare: Should life-style be used as a criterion?
(Türk Kardiyoloji Derneği, 2010-08) Alpınar, Zümrüt; Örs, Yaman; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Tarihi ve Etik Anabilim Dalı.; 24075622600
Health is considered as important due to its impacts on individuals' lives. Although individual health level is determined partly by the accessibility of the services and their quality, there are many other factors that may influence an individual's health condition, which are mainly social determinants. Since there are many factors that determine health conditions of the individuals, it would be wrong to hold someone totally responsible for her health condition on the basis of her life-style; such as prudency. Indeed, before deciding about whether the patient was prudent or not; first, we have to look at those determinants of health, and investigate whether there is an effective intervention to avoid those determinants. Furthermore, life-styles of the individuals, which are thought to be the personal choices, are just one of the relatively less effective factors that may influence a person's health and also the autonomy of those choices is controversial. In our paper, we will endeavor to develop an argument showing that since health is one of our primary goods that needs to be protected as one of our basic human rights, and since the health status of individuals are not determined only by their personal choices, we claim that it would be unfair to consider accessing healthcare as something removable or limitable based on conditions other than medical criteria.
Sale strategies of pharmaceutical companies in a "pharmerging" country: The problems will not improve if the gaps remain
(Elsevier Ireland, 2012-08) Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Etiği Anabilim Dalı.; 0000-0001-5376-3499; S-4188-2019; 24075622600
Objective: This study aimed to examine the types of sales strategies used by pharmaceutical companies in a "pharmerging" market and to gain insight into the ways of avoiding the negative effects of these strategies. Method: In-depth interviews were conducted with 22 physicians and company employees in the six largest cities of Turkey. The interviews were analyzed using content analysis. Results: Various sales strategies, both legal and illegal, are universally applied. These methods target prescribers, patients, pharmacists, and society in general. Different types of companies, organizations, professionals, and science and ethical principles are used as means. Companies intervene immediately to prevent developments that may decrease sales, and exploit the educational and infrastructural needs. In contrast, physicians are overconfident about the effects of marketing and insufficiently educated on how to cope with the strategies and the drugs on the market, which make them vulnerable. Under these conditions, along with worldwide competition and economic volatility, policies that aim to set frameworks for pharmaceutical relationships have failed. Conclusion: Interventions are crucial, including instituting a national drug policy, minimizing the exposure to marketing, and addressing the educational and infrastructural needs of the prescribers. Without these interventions, gaps will continue to be exploited by companies for their own advantage, and the problems related to marketing will persist.
Should doctors feel able to practise according to their personal values and beliefs
(Wiley, 2012-02-06) Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Etiği Anabilim Dalı.; 0000-0001-5376-3499; S-4188-2019; 24075622600
Uzmanlık eğitiminde tıp etiği
(Türk Kardiyoloji Derneği, 2009-04) Sarıkaya, Özlem; Balcıoğlu, Harun; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Deontoloji Anabilim Dalı.; 24075622600
Tıp etiği eğitimi, uzmanlık eğitimine ilişkin tartışmaların önemli başlıklarından birini oluşturmakta, tıp etiği eğitiminin gerekliliği çeşitli ulusal ve uluslararası metinlerde dile getirilmektedir. Gerek sağlık hizmetlerinin örgütlenme ve finansman modeliyle birlikte hasta-hekim ilişkisi, hekim kimliği ve giderek mesleğin toplumsal yeri ve algılanışının değişiyor olması, gerekse de teknolojik olanaklılıkların artmasıyla ortaya çıkan yeni sorun alanları tıp etiğini güncel kılmaktadır. Günümüzde hekimler, mesleki değerleri korumakta her zamankinden çok zorlanmakta, hızla değişen koşullar yeni ve haklı çıkarılabilen kararlar verilmesini talep edebilmektedir. Hekimlerin mesleki değerleri koruyacak çözümleri bulabilmeleri için mezuniyet öncesinde ve mezuniyet sonrası dönemde özellikle uzmanlık eğitiminde uygun nitelikte tıp etiği eğitimi almaları bu anlamda önemlidir. Bu yazının amacı tıpta uzmanlık eğitiminde tıp etiği eğitiminin yerini gerekçeleriyle dile getirmek ve tıp etiği eğitiminin yapılandırılması için konu başlıkları ve yöntemler önermektir. Bu amaçla uzmanlık öğrencisi hekimlerin mezuniyet öncesi eğitimleri, çalışma koşulları, seçme sınavının özellikleri, nasıl bir ortamda çalışıp eğitim aldıkları gözden geçirilmekte, sonrasında uzmanlık eğitimi ile yetiştirilmesi hedeflenen hekimin özellikleri ve bu hedeflere nasıl bir içerik ve yöntemle ulaşılabileceğinden söz edilmektedir.
Victims of disaster: Can ethical debriefings be of help to care for their suffering?
(Springer, 2017-06) Devisch, Ignaas; Vanheule, Stijn; Deveugele, Myriam; Nola, Iskra; Pype, Peter; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Etiği Anabilim Dalı.; 24075622600
Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties 'medicalised'. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims' narrative and their lived experiences. We will use Paul Ricoeur's phenomenological reflections from 'Suffering is not the same as pain' for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering.
Why would opt-out system for organ procurement be fairer?
(Croatian Philosophical, 2010) Alpınar, Zümrüt Şencan; Örs, Yaman; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Tıp Tarihi ve Etik Anabilim Dalı.; 0000-0001-5376-3499; S-4188-2019; 24075622600
The possibility of organ transplantation has created new problems for medical ethics as well as clinical medicine. One of them, organ procurement, is tried to be solved mainly by two systems. Many countries have adopted the 'opt-in system', which aims to raise awareness and make the individuals donate their organs by their own will. The other system, 'optout' or 'presumed consent', which considers all members of society as potential donors, was adopted by some countries. In this system, individuals should state that they do not wish to donate their organs; otherwise they are considered as donors. By trying to ground our argument with various justifications, we claim that opt-out system for organ procurement is a fairer option regarding the right to access to healthcare needed, and therefore it should be implemented instead of opt-in.