The arrival of a sick person to a doctor - the event itself is a sacred, which can be compared with the secret confession. Collecting from a sick information for purely medical purposes, the doctor is voluntarily or involuntarily faced with deep personal or even intimate information. The doctor becomes a witness that patients hide even from people close to him.
Instead, patients expect not only professional assistance and compassion from doctors, but also for granted confidentiality. So the daily reality of the medical worker becomes a medical mystery.
The concept of medical mystery
Medical mystery - concept as ancient as medicine itself. For the first time, the principles of the relations of the doctor and the patient were formulated by an ancient Greek physician Hippocratic (460-377. to R.NS.). «What if treatment, as well as without treatment, I see or heard about the life of people from what should not be disclosed, I will default, considering such things to be secret». These are the norms fastened in the omath, the norms became the starting point for creating other professional moral medical codes.
Over time, medical mystery has ceased to be only the concept of moral, she acquired the status of the law. The preservation of medical mystery is guaranteed by law, and legal responsibility is established for its disclosure.
The current concept of medical mystery is recorded in the International Code of Medical Ethics, which has existed since 1949. It says: «The doctor must maintain everything in absolute secret that he knows about his patient, due to the confidence provided to him».
However, by definition of the Russian encyclopedia, «Medical secretary - this is the responsibility of medical professionals not to disclose the information about patients, their intimate and family life known by their profession. Disease information is reported in cases where this requires the interests of public health».
From this definition it follows that not all the secret of the patient is obliged to keep. The doctor should seek to listen to the voice of his own conscience, determining which information may be important not only for a separate patient, but to preserve the life and health of other people. And the doctor takes such a decision, relying not only on his professional knowledge, but also on moral criteria.
Disclosure of medical mystery
Famous Russian doctor and writer in.IN. Veresaev in the book «Notes of the doctor» wrote: «If the preservation of the mystery threatens harm to society or the surrounding patient, then the doctor not only can, but should also break the mystery. However, in each such case, the doctor must be able to give the exact and exhaustive response to the patient and his own conscience, on what basis he violated the sore mystery entrusted to him» (Veresaev B. Collected Works. - M., 1961). The difficulties of the moral plan arise when the doctor is trying to interpret the law from his point of view in which either the interests of society can prevail or the interests of a separate patient.
Extremely acute question of moral choice is set in the context of HIV / AIDS problems. The girl of 15 years has entered the infectious hospital department for preventive examination. HIV-infected girl. Upon admission, she reminded the doctors about the confidentiality of her HIV status. For several days, the girl visits her young man. The girl asks the doctor to tell the guy not her true diagnosis, but the diagnosis «Follicular angina». The surrounding medical staff understands all the responsibility assigned to them: the girl clearly hides its diagnosis, and the young man probably does not recognize that his HIV status can soon be positive or already as a result of their intimate relationships.
Is it possible to say young man about the diagnosis of a girl? How to push it on the idea of the need to be examined on HIV himself?
For a quarter of a century HIV / AIDS from exclusive diseases switched to the discharge of the epidemic. She touched upon all countries and affects human history. Ukraine ranks first in Europe at the rate of infection. In 2006, compared with 2005th, the number of HIV-infected people increased 1.2 times. Officially registered about 73 thousand cases of HIV infection. However, the true number of HIV-infected and AIDS patients significantly exceeds the actual number of registered and can be up to 1.4 percent of the adult population of Ukraine.
Speaking about the problem of HIV / AIDS, it is impossible to limit the epidemic of the disease. According to Lily Heid (magazine editor «HIV / AIDS News», Bulletin of the Information and Resource Center of the International Alliance on HIV / AIDS), the HIV epidemic flourishes exactly in that society, where prejudices reign and ignorance. I spent in 2002 the survey showed the full ignorance of this problem: prevalence, the scale of population coverage, manifestations and even transmission paths. From this another epidemic is born - the epidemic of fear. And the victim of this epidemic is society. While this problem does not apply to us personally, the world is divided into «we» and «they». «We» Frame «them», Referring to the victims, sinners, and sometimes, what sin to hide, almost criminals. The problem of discrimination was the main complexity of the fight against AIDS from the very beginning of the epidemic.
Parents Girls from G. Simferopol died of AIDS, the elderly grandmother led the guardianship, not wanting to give granddaughter to the shelter. Deciding to issue a girl in a kindergarten, the grandmother received a refusal for one mention of the HIV-positive status of a child under the pretext «Lack of seats».
And how no horror treat this occasion when at the dawn of the epidemic in one of the cities of Crimea pregnant woman was forced to give birth in morgue?
Here is the notorious stigma. Stigma (literally - «label», «stigma») - social label that completely changes the attitude towards other people and to himself, forcing us to treat a person only as a carrier of undesirable quality.
Stigma «Show» yourself bico. The external manifestation is an unfair negative attitude towards people living with HIV. The consequence of this is the internal reaction of these sick people in cases of humiliation and discrimination: they avoid testing and hide their status. What, in turn, again enhances the external chattis reaction.
The problem of medical mystery in terms of law
Let's return to the question of medical secret.
In one of the CRH Crimea came information about HIV-infected from the area of this hospital. The Nurse of the Infectious Cabinet signs a document on non-disclosure of the LHV list data (people living with HIV). Looking through the list of HIV-infected, it stumbles on f.AND.O. Groom his niece. The girl does not suspect. Before the wedding there are weeks.
According to Art. 130 Criminal Code of Ukraine, «Intentional (conscious) creation for another person the danger of infection with the human immunodeficiency virus or other incurable disease, life-threatening person» Criminally punished. But what to do aunt? She subscribed to the non-disclosure of the mystery of the diagnosis; The disclosure also leads to criminal liability, according to. 132 Criminal Code.
Each person has the right to personal life and health, freedom and safety. Medical mystery is also a question about human rights. And if we consider a medical secret in such a context, then we are inevitably faced with the conflict of rights.
With a sufficient number of legal regulations, this issue remains unresolved - both at the level of the personal relationship of each individual, and at the level of the state as a whole. When expanding the rights of one population, the rights of others are oppressed.
And what about the medical sphere? Medical workers constitute a group of professional risk of HIV infection. «HIV positive has the full right to tell or not talk about their status... The medical staff must observe the same precautions regardless of whether HIV is infected or not».
It is possible how many years to talk about a significant infecting dose to infect HIV, about precautions and attentiveness, about the perception of all patients as potentially HIV-infected. But the reality is that even one-time gloves in hospitals still lack. And there are cases of professional infection, and not exotic.
So equivalent to the scales? On one - the possibility of infection with a fatal disease, to another - psychological trauma?
There are no lung responses. Can they be?..
A biblical story about Jesus and a woman taken in adultery helps me in my practice. He defended her, accepted and supported - and her heart was revealed to meet him.
Confidence - here is the key that opens grace. BUT «grace towers over the court».
