Turkiye Klinikleri Journal of Medical Ethics-Law and History

.: RESEARCH
Medical Students' Perceptions on the Affect of Infectious Disease Outbreaks and Poor Working Conditions on the Duty to Care: A Cross-Sectional Study
Tıp Öğrencilerinin Perspektifinden Bulaşıcı Hastalık Salgınları ve Olumsuz Çalışma Koşullarının Hizmet Sunma Yükümlülüğüne Etkisi: Kesitsel Bir Çalışma
Filiz BULUTa
aDepartment of History of Medicine and Medical Ethics, Bursa Uludağ University Faculty of Medicine, Bursa, TURKIYE
Turkiye Klinikleri J Med Ethics. 2022;30(1):26-34
doi: 10.5336/mdethic.2021-86061
Article Language: EN
Full Text
ABSTRACT
 The existence and limits of the duty to care in certain conditions such as unacceptable working conditions, violence towards healthcare workers, and outbreaks are crucial topics in medical ethics. This study aims to determine the thoughts and reasons of future physicians regarding the limits of the duty to care in infectious diseases and poor working conditions. All 266 sixth-year medical students studying at Bursa Uludağ University School of Medicine were included in this cross-sectional study. Data were gathered by a survey form consisting of 10 questions. The questionnaire had 2 parts: one part with questions on individual characteristics (sex, the reason for choosing the medical school, the opinion on occupational risks, whether the physician was exposed to violence and the opinion about the right to health). The second part focused on participants being asked to state their views on vignettes designed to question whether there is a duty to care. Pearson chi-square test was used for statistical analysis of the data. Half of the participants (55.4%) think that the duty to care does not prevail in the 'physical violence' scenario, while 38.7% in 'extreme fatigue', 37.0% in 'time and quantity pressure', 32.4% in 'lack of equipment', 31.1% in 'verbal violence', and 19.8% in 'outbreaks'. Participants who thought they were responsible during outbreaks stated that the duty to care was still valid significantly less in poor working conditions scenarios (p<0.05). In all scenarios, patient rights were the most favourable justification to serve (28.4%). Outbreaks along with poor working conditions in healthcare can negatively affect the duty to care. Especially during a pandemic, healthcare workers' burnout should be taken into account; their rights should be protected, efficient measures should be taken to prevent violence, to provide the necessary equipment and a positive working environment by the institutions and authorities.

Keywords: Duty to care; communicable diseases; COVID-19; working conditions; medical ethics
ÖZET
 Olumsuz çalışma koşulları, sağlık çalışanlarına yönelik şiddet, salgın hastalıklar gibi bazı durumlarda, bakım yükümlülüğünün varlığı ve sınırları tıp etiğinde önemli bir tartışma konusudur. Bu çalışmanın amacı, geleceğin hekimlerinin bulaşıcı hastalık ve olumsuz çalışma koşullarında hizmet sunma yükümlülüğünün sınırlarına ilişkin düşüncelerini ve gerekçelerini saptamaktır. Kesitsel tipteki bu araştırmaya, Bursa Uludağ Üniversitesi Tıp Fakültesinde öğrenimini sürdüren son sınıf 266 tıp öğrencisinin tamamı dâhil edilmiştir. Veriler, 10 sorudan oluşan bir anket formu ile toplanmıştır. Anket, 2 bölümden oluşmaktadır. Birinci bölüm, demografik sorular içermektedir (cinsiyet, tıp fakültesini seçme nedeni, mesleki riskleri bilme, şiddete maruz kalıp kalmadığı ve sağlık hakkına dair düşüncesi). İkinci bölümde, kurgulanan senaryolara ilişkin katılımcıların hizmet sunma yükümlülüğünün olup olmadığına dair görüşlerini belirtmeleri istenmiştir. Verilerin istatistiksel analizi için Pearson ki-kare testi kullanıldı. Katılımcıların %55,4'ü 'fiziksel şiddet' senaryosunda, %38,7'si 'aşırı yorgunluk', %37,0'ı 'zaman ve sayı baskısı', %32,4'ü 'yetersiz malzeme', %31,1'i 'sözlü şiddet' ve %19,8'i 'bulaşıcı hastalık salgınları' senaryosunda hizmet sunma yükümlülüğünün devam etmediğini düşünmektedir. Bulaşıcı hastalık salgınlarında yükümlü olduklarını düşünen katılımcılar, olumsuz çalışma koşulları senaryolarında hizmet sunma yükümlülüğünün anlamlı derecede daha az olduğunu belirtmişlerdir (p<0,05). Tüm senaryolarda en çok hasta hakları (%28,4) gerekçesi işaretlenmiştir. Sağlık hizmetlerindeki olumsuz çalışma koşullarıyla birlikte bulaşıcı salgınlar, hizmet sunma yükümlülüğünü negatif yönde etkileyebilir. Özellikle bir pandemi döneminde sağlık çalışanlarının tükenmişliği göz önünde bulundurulmalı, sağlık çalışanlarının hakları korunmalı, sağlıkta şiddetin önlenmesi için etkin önlemler alınmalı, kurum ve yetkililer tarafından gerekli ekipman sağlanarak, olumlu bir çalışma ortamı sağlanmalıdır.

Anahtar Kelimeler: Hizmet sunma yükümlülüğü; bulaşıcı hastalıklar; COVID-19; çalışma koşulları; tıp etiği
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