Turkiye Klinikleri Journal of Medical Ethics-Law and History

.: REVIEW
Down Sendromuna İlişkin Aydınlatılmış Onam Formlarının Etik Bir Değerlendirmesi: Geleneksel Derleme
An Ethical Evaluation of Informed Consent Forms Related with Down Syndrome: Traditional Review
Belkıs BİRDENa
aBaşkent Üniversitesi Tıp Fakültesi, Tıp Tarihi ve Etik ABD, Ankara, Türkiye
Turkiye Klinikleri J Med Ethics. 2023;31(1):77-83
doi: 10.5336/mdethic.2022-92234
Article Language: TR
Full Text
ÖZET
 Türkiye'de son yıllarda yaşanan gelişmelerle hekimler açısından Down sendromu ile ilgili aydınlatılmış onam formları konusunun hukuki ve etik olarak tartışmaya açık olduğu anlaşılmaktadır. Bu konuda hekimlerin Down sendromunu gebelik sürecinde iken tespit edemedikleri ve aydınlatma yükümlülüklerini hukuken usule uygun gerçekleştirmedikleri gerekçesiyle açılan davalar neticesinde yerel mahkemelerin verdikleri kararlar dikkat çekmektedir. Yerel mahkemeler tarafından verilen kararların dayanağını ise Yargıtay kararları oluşturmaktadır. Burada söz konusu olan tıbbi işlem amniyosentezdir. Amniyosentez işlemini yaptıran hastaların değil, yaptırmayanların aydınlatılmış onam formlarında imzalarının olmaması tartışma konusunu oluşturmaktadır. Bununla birlikte hukuki metinlerde aydınlatılmış onam kapsamında, yapılmayan bir tıbbi işlem için hastadan imza alınmasının gerekli olduğuna dair bir ifade bulunmamaktadır. Aydınlatılmış onam, hekim-hasta ilişkisi bağlamında tıp etiği açısından önem taşıyan temel konular arasında yer almaktadır. Tıp alanında ortaya çıkan değer sorunlarını inceleyen tıp etiğinin temel konularından biri olan ilkeci yaklaşım, genel olarak yarar sağlama, zarar vermeme, özerkliğe saygı ve adalet olarak dört ilkeden oluşmaktadır. Özerkliğe saygı ilkesi, aydınlatılmış onamın uygun bir şekilde alınması noktasında önem taşımaktadır. Sağlık profesyonelleri olarak hekimlerin aydınlatma yükümlülükleri konusunda, yargı mercileri tarafından verilen kararlar, hukuki olduğu kadar etik açıdan bir değerlendirme gereksinimi doğurmaktadır. Bu çalışmada, Down sendromuna ilişkin aydınlatılmış onam formları ile ilgili olan temel etik sorun alanları ve bu sorun alanlarına yönelik çözüm yolları tartışılmaktadır.

Anahtar Kelimeler: Down sendromu; aydınlatılmış onam; aydınlatılmış onam formu; etik; tıp etiği
ABSTRACT
 With the developments in Türkiye in recent years, it's understood that the issue of informed consent forms related to Down syndrome is open to legal and ethical discussion for physicians. In this regard, decisions of local courts as a result of cases filed on the grounds that the physicians couldn't determine the Down syndrome during gestation and that they didn't fulfill their obligations to inform legally, draw attention. The basis of the decisions made is the decisions of the Supreme Court. The procedure in question here is amniocentesis. The fact that not the patients who had amniocentesis procedure, but the ones who didn't, didn't have their signatures in the informed consent forms, is the subject of discussion. However, there is no statement in legal texts that it's necessary to obtain a signature from the patient for a procedure that isn't performed. Informed consent is among the main issues that are important in terms of medical ethics in the context of the physician-patient relationship. Principalism, which is one of the main subjects of medical ethics, which examines the value problems that arise in the field of medicine, consists of four principles as beneficence, non maleficence, respect for autonomy and justice. Respect for autonomy is important in terms of obtaining informed consent appropriately. Decisions made by judicial authorities regarding obligations to inform obligations of physicians create a need for ethical as well as legal evaluation. In this study, ethical problems related to informed consent forms about Down syndrome and solutions are discussed.

Keywords: Down syndrome; informed consent; informed consent form; ethics; medical ethics
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