25 KB62 KB24 KB192920262001Pleterski-Rigler, DušicaTrontelj, Joželetnik:70številka:9str. 477-480ISSN:1318-0347COBISSID:13776857URN:URN:NBN:SI:doc-JNXKUPUFslSlovensko zdravniško društvoZdravniški vestnikbolnikiChild advocacyEthics, medicalInformed consentInsanity defensemedicinska etikaMental competencyodločanjePatient complianceKo bolnik ne sodeluje ali ne more sodelovati| When the patient is unwilling or unable to co-operate|Background. Nowadays it is increasingly important for the physician to adequately inform the patient of his or her health situation, explain the options for treatment and obtain his or her consent. This principle is enshrined in the Oviedo Convention, a legal instrument with the power of law. Ethical questions aries when the patient is unwilling or unable to co-operate.Different problems are encountered with adult competent patients, in cases of limited mental capacity or with patients totally unable to consent. In children, the situation differs with age; adolescents opinion mustbe considered as increasingly important in decision making process, commensurate with their ability to understand and make rational choices. Specific ethical dilemmas arise with critically ill patients who refuse medical procedures or are unable to participate in medical decisions. Suicidalattempt cannot be taken to imply valid refusal of medical assistance. Conclusion. In exceptional situations when an appropriate informed consent cannot be obtained, the physician should take his decisions according to his best professional judgement and in the best interest of the patientIzhodišča. Danes je vse pomembnejše, da zdravnik bolniku dovolj dobro pojasni njegovo zdravstveno stanje, mu predstavi možnosti za zdravljenje in si za ukrepanje pridobi njegovo privolitev. To predpisuje tudi Oviedska konvencija, pravni instrument z veljavo zakona. Ob bolniku, ki v medicinskem postopku in pri odločanju ne sodeluje ali ne more sodelovati, se porajajo etična vprašanja. Ta so drugačna pri odraslih, duševno sposobnih bolnikih kot pri manj sposobnih ali nesposobnih bolnikih. Pri otrocih je ravnanje odvisno od starosti; mladoletnikovo voljo je treba upoštevati sorazmerno z njegovo odraslostjo in sposobnostjo, da svoj položaj razume in lahko razumno izbira. Posebne etične dileme se odpirajo ob kritično bolnih, ki zavračajo pomoč ali pri odločanju ne morejo sodelovati. Poskus samomora ne pomeni veljavne zavrnitve zdravniške pomoči. Zaključek. Kadar veljavne privolitve po ustreznempojasnilu ni mogoče dobiti, naj zdravnik ravna po svoji zdravniški vesti in strokovni presoji tako, da bo to v bolnikovo prednostno in najboljšo koristTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo