Turkiye Klinikleri Journal of Medical Ethics-Law and History

.: REVIEW
Ölümün Eşiğindeki İkilemler: Ötanazi, Yardımlı İntihar ve Psikiyatri: Geleneksel Derleme
Dilemmas at the Edge of Death: Euthanasia, Assisted Suicide and Psychiatry: Traditional Review
Burak OKUMUŞa
aUşak Eğitim ve Araştırma Hastanesi, Psikiyatri Kliniği, Uşak, Türkiye
Turkiye Klinikleri J Med Ethics. 2024;32(2):123-37
doi: 10.5336/mdethic.2023-99654
Article Language: TR
Full Text
ÖZET
Günümüzde ölümler tipik olarak kademeli fiziksel ve işlevsel bir düşüş döneminden sonra ileri bir yaşta meydana gelmektedir. Bu durum yaşamın son aşamasındaki hastalara yönelik yüksek kaliteli bakımı, XXI. yüzyılın sağlık hizmetlerinin temel zorluklarından birisi hâline getirmektedir. Biyomedikal araştırmalardaki ilerlemeler ve biyoetikte yeni disiplinlerin kurulması yaşam sonu bakımı, ötanazi ve hekim yardımlı intihar konusunda güncel tartışmaları beraberinde getirmektedir. Geçmişten günümüze gelen tartışmalar hâlâ güncelliğini korurken, ötanazi ve hekim yardımlı intihar dünya çapında giderek daha fazla yasallaşmaktadır. Bu tür düzenlemelerin temel amaçları; uygulamaları netliğe kavuşturmak, hekimlere yasal zemini açık bir şekilde sunmak ve hastaları korumaktır. Buna rağmen ölümde tıbbi yardım konusu, paradoksik unsurlar içeren çok boyutlu ciddi tartışmaları gündeme getirerek kamunun dikkatini çekmektedir. Bu uygulamaların evrimi ile ilgili tarihsel yönlerin ve ilgili literatürün araştırılması geçmişten günümüze gelen tartışmaları aydınlatabilir. Bu terimlerin evrimi ve olgularla biçimlenen yasal düzenlemeler, multidisipliner bir yaklaşımın gerekliliğini vurgulamaktadır. Metinde uygulamaların lehindeki ve aleyhindeki yaygın argümanlar literatür verileri ışığında sunulmaktadır. Ayrıca ölümde tıbbi yardım konusunu adli boyutları ve uygulanma biçimleriyle karşılaştırmak klinisyenlere farklı görüşler sunabilir. Derleme ötanazi ve hekim yardımlı intihar uygulamaları sürecinde yer alan ve genellikle ihmal edilen hekimin profesyonel yükümlülükleriyle çelişen gerilimini ortaya koymaktadır. Gözden geçirme, ötanazi ve hekim yardımlı intihar talebinde bulunan hastaların değerlendirilmesinde rol alan psikiyatristlerin ikilem içeren görüşlerinin tartışılmasıyla sona ermektedir.

Anahtar Kelimeler: Ötanazi; yardımlı intihar; psikiyatri; ikilem
ABSTRACT
Death today usually occurs at an advanced age after a gradual physical and functional decline. As a result, the provision of high quality care to patients in the final stages of life is one of the major challenges facing healthcare in the 21st century. Advances in biomedical research and the emergence of new bioethical disciplines have fuelled ongoing debates about end-of-life care, euthanasia and assisted suicide. While the debates of the past remain relevant, euthanasia and assisted suicide are increasingly being legalised around the world. The main aims of such legislation are to clarify practice, to provide clear legal bases for doctors and to protect patients. However, medical assistance in dying attracts public attention by raising serious multidimensional discussions with paradoxical elements. A study of the historical aspects of these practices and the relevant literature can shed light on the debates from the past to the present. The evolution of these notions and the legal regulations shaped by the evidence emphasise the need for a multidisciplinary approach. The text presents common arguments for and against the practices in the context of the literature. In addition, a comparison of the issue of medical assistance in dying with its legal dimensions and application can provide different perspectives for health professionals. The review highlights the often overlooked conflict that physicians face regarding their professional obligations when involved in practices such as euthanasia and assisted suicide. The review concludes with a discussion of the uncertain position of psychiatrists responsible for assessing patients who request euthanasia and assisted suicide.

Keywords: Euthanasia; assisted suicide; psychiatry; dilemma
REFERENCES:
  1. Wolleswinkel-van den Bosch JH, Looman CW, Van Poppel FW, Mackenbach JP. Cause-specific mortality trends in The Netherlands, 1875-1992: a formal analysis of the epidemiologic transition. Int J Epidemiol. 1997;26(4):772-81. [Crossref]  [PubMed] 
  2. van Duin C Garssen J. Bevolkingsprognose 2010-2060: sterkere vergrijzing, langere levensduur. Netherlands: Centraal Bureau voor de Statistiek; 2010. [Link] 
  3. Parker MG, Thorslund M. Health trends in the elderly population: getting better and getting worse. Gerontologist. 2007;47(2):150-8. [Crossref]  [PubMed] 
  4. Veerbeek L. Care and Quality of Life in the Dying Phase: The contribution of the Liverpool Care Pathway for the Dying Patient. Netherlands: Erasmus University Rotterdam; 2008. [Erişim tarihi: 25 Eylül 2023]. [Link] 
  5. Karumathil AA, Tripathi R. Culture and attitudes towards euthanasia: an integrative review. Omega (Westport). 2022;86(2):688-720. [Crossref]  [PubMed] 
  6. Artuk ME, Yenidünya AC. Ötanazi. Prof. Dr. Turhan Tûfan YÜCE'ye Armağan. 1. Baskı. İzmir: Dokuz Eylül Üniversitesi Yayınları; 2001. p.297-319.
  7. Köksal Ç. "Ölümüne karar": ötanazi ["Decision to die": euthanasia]. Sağlık Düşüncesi ve Tıp Kültürü Dergisi. 2009;8. [Link] 
  8. Özkara E. Ötanazide Temel Kavramlar ve Güncel Tartışmalar. 1. Baskı. Ankara: Seçkin Yayıncılık; 2002.
  9. Sağlam İ. Doktor yardımlı intihar ve bu konuyu ele alan düzenlemelere bir örnek olarak, "California hayatı sonlandırma seçeneği yasası"nın değerlendirilmesi [Assisted Suicide and The Evaluation Of "California's end of life option act" which is one of the main examples of regulations dealing with euthanasia]. Journal. 2017;23(3):559-79.
  10. Gruman GJ. Ethics of death and dying: historical perspective. Omega (Westport). 1978-1979;9(3):203-37. [Crossref]  [PubMed] 
  11. Gourevitch D. Suicide among the sick in classical antiquity. Bull Hist Med. 1969;43(6):501-18. [PubMed] 
  12. Miles SH. The Hippocratic Oath and the Ethics of Medicine. 1st ed. New York: Oxford University Press; 2004. [Crossref] 
  13. Picón-Jaimes YA, Lozada-Martinez ID, Orozco-Chinome JE, Montaña-Gómez LM, Bolaño-Romero MP, Moscote-Salazar LR, et al. Euthanasia and assisted suicide: An in-depth review of relevant historical aspects. Ann Med Surg (Lond). 2022;75:103380. [Crossref]  [PubMed]  [PMC] 
  14. Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA. 2016;316(1):79-90. Erratum in: JAMA. 2016;316(12):1319. [Crossref]  [PubMed] 
  15. Philosophica: Enciclopedia filosofica on line [Internet]. ©2012 Pablo Requena Meana y Philosophica: Enciclopedia filosófica on line [Cited: December 3, 2022]. Available from: [Link] 
  16. Bont M, Dorta K, Ceballos J, Randazzo A, Urdaneta-Carruyo E. Eutanasia: Una Visión Histórico - Hermenéutica. Comunidad y Salud. 2007;5(2):34-43. [Link] 
  17. Sabriseilabi S, Williams J. Dimensions of religion and attitudes toward euthanasia. Death Stud. 2022;46(5):1149-56. [Crossref]  [PubMed] 
  18. Bergdolt K. Aspectos actuales e históricos de la eutanasia. Arsmedica. 2016;32(2):199. [Crossref] 
  19. Von Engelhardt D. Euthanasia in between shortening life and aiding death: past experiences, present challenges. Acta Bioethica. 2002;8(1 SE-Original):55-66. [Link] 
  20. Van Der Maas PJ, Van Delden JJ, Pijnenborg L, Looman CW. Euthanasia and other medical decisions concerning the end of life. Lancet. 1991;338(8768):669-74. [Crossref]  [PubMed] 
  21. Consensus report on the ethics of foregoing life-sustaining treatments in the critically ill. Task Force on Ethics of the Society of Critical Care Medicine. Crit Care Med. 1990;18(12):1435-9. [Crossref]  [PubMed] 
  22. Gamsız Bilgin N. Ötanazi: tanım ve tarihçe [Euthanasia: definition and history of euthanasia]. Journal. 2013;3(2):25-31. [Link] 
  23. Artuk ME. Hukukçu gözü ile ötanazi, Ötanazi. Hatemi H, Doğan H, editörler. Medikal Etik, (Doğum, Ölüm Süreçleri ve Yaşamın Anlamı). 1. Baskı. Ankara: Yüce Yayınları; 2001. p.42-60.
  24. Dikmen Y. Yoğun bakımda hastadan desteği çekme ve etik, ötanazi. Hatemi H, Doğan H, editörler. Medikal Etik, (Doğum, Ölüm Süreçleri ve Yaşamın Anlamı). 1. Baskı. Ankara: Yüce Yayınları; 2001. p.35-41.
  25. Akpir K. Yoğun Bakım hastalarında hasta desteği ve devamı ile ilgili kararın verilmesi. Hatemi H, Doğan H, editörler. Medikal Etik, (Doğum, Ölüm Süreçleri ve Yaşamın Anlamı). 1. Baskı. Ankara: Yüce Yayınları; 2001. p.28-34.
  26. Pappas DM. Recent historical perspectives regarding medical euthanasia and physician assisted suicide. Br Med Bull. 1996;52(2):386-93. [Crossref]  [PubMed] 
  27. Brinkman-Stoppelenburg A, Evenblij K, Pasman HRW, van Delden JJM, Onwuteaka-Philipsen BD, van der Heide A. Physicians' and public attitudes toward euthanasia in people with advanced dementia. J Am Geriatr Soc. 2020;68(10):2319-28. [Crossref]  [PubMed]  [PMC] 
  28. Dalfin W, Guymard M, Kieffer P, Kahn JP. Droit à mourir et suicide assisté : état des lieux et analyse critique [The right to die and assisted suicide: Review and critical analysis]. Encephale. 2022;48(2):196-205. French. [Crossref]  [PubMed] 
  29. Rietjens JA, van der Maas PJ, Onwuteaka-Philipsen BD, van Delden JJ, van der Heide A. Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain? J Bioeth Inq. 2009;6(3):271-83. [Crossref]  [PubMed]  [PMC] 
  30. van der Heide A. Assisted suicide and euthanasia. Handb Clin Neurol. 2013;118:181-9. [Crossref]  [PubMed] 
  31. Brody H. Kevorkian and assisted death in the United States. BMJ. 1999;318(7189):953-4. [Crossref]  [PubMed]  [PMC] 
  32. Terzioğlu A. Euthanasie (ötanazi) ve getirdiği etik sorunlar [Euthanasie and the accompanying ehical problems]. Türkiye Klinikleri Tıbbi Etik. 1994;2(1):16-21. [Link] 
  33. Grace J. Curtains for Dr. Death: after assisting 130 suicides since 1990, Jack Kevorkian is found guilty of a murder in Michigan. Time. 1999;153(13):48. [PubMed] 
  34. Pyszczynski T, Greenberg J, Koole S, Solomon S. Experimental existential psychology: coping with the facts of life. In: Fiske S, Gilbert D, Lindzey G, eds. Handbook of Social Psychology. 5th ed. Hoboken, N.J: John Wiley & Sons; 2010. p.724-60. [Crossref]  [PMC] 
  35. van der Heide A, Deliens L, Faisst K, Nilstun T, Norup M, Paci E, et al; EURELD consortium. End-of-life decision-making in six European countries: descriptive study. Lancet. 2003;362(9381):345-50. [Crossref]  [PubMed] 
  36. Vauclair CM, Fischer R, Ferreira MC, Guerra V, Hößler U, Karabati S, et al. What kinds of value motives guide people in their moral attitudes? The role of personal and prescriptive values at the culture level and individual level. Journal of Cross-Cultural Psychology. 2015;46(2):211-28. [Crossref] 
  37. Charatan FB. Oregon's voters approve assisted suicide measure. BMJ. 1994;309(6966):1391. [Crossref]  [PubMed] 
  38. Dyer C. Washington follows Oregon to legalise physician assisted suicide. BMJ. 2008;337:a2480. [Crossref]  [PubMed] 
  39. Oregon Department of Human Services. seventh annual report on Oregon's death with dignity act. Oregon: Department of Human Services; 2005. [Link] 
  40. Kelly BD, McLoughlin DM. Physician-assisted suicide and psychiatry. Psychiatry. 2009;8(7):276-9. [Crossref] 
  41. Steinbrook R. Physician-assisted death--from Oregon to Washington State. N Engl J Med. 2008;359(24):2513-5. [Crossref]  [PubMed] 
  42. Robinson J. Baxter and the return of physician-assisted suicide. Hastings Cent Rep. 2010;40(6):15-7. [Crossref]  [PubMed] 
  43. Groenewoud JH, van der Maas PJ, van der Wal G, Hengeveld MW, Tholen AJ, Schudel WJ, et al. Physician-assisted death in psychiatric practice in the Netherlands. N Engl J Med. 1997;336(25):1795-801. [Crossref]  [PubMed] 
  44. Kelly BD, McLoughlin DM. Euthanasia, assisted suicide and psychiatry: a Pandora's box. Br J Psychiatry. 2002;181:278-9. [Crossref]  [PubMed] 
  45. Schoevers RA, Asmus FP, Van Tilburg W. Physician-assisted suicide in psychiatry: developments in The Netherlands. Psychiatr Serv. 1998;49(11):1475-80. [Crossref]  [PubMed] 
  46. Bosshard G. Euthanasia and law in Europe. In: Griffiths J, Weyers H, Adams M, eds. Switzerland: Hart Publishing, Oxford; 2008. p.463-82.
  47. Hurst SA, Mauron A. Assisted suicide and euthanasia in Switzerland: allowing a role for non-physicians. BMJ. 2003;326(7383):271-3. [Crossref]  [PubMed]  [PMC] 
  48. Chambaere K, Roelands M, Deliens L. Euthanasia for minors in Belgium. JAMA. 2014;312(12):1258. [Crossref]  [PubMed] 
  49. Boehnlein JK. The case against physician assisted suicide. Community Ment Health J. 1999;35(1):5-14. [Crossref]  [PubMed] 
  50. Ganzini L, Leong GB, Fenn DS, Silva JA, Weinstock R. Evaluation of competence to consent to assisted suicide: views of forensic psychiatrists. Am J Psychiatry. 2000;157(4):595-600. [Crossref]  [PubMed] 
  51. Zaubler TS, Sullivan MD. Psychiatry and physician-assisted suicide. Psychiatr Clin North Am. 1996;19(3):413-27. [Crossref]  [PubMed] 
  52. Calati R, Olié E, Dassa D, Gramaglia C, Guillaume S, Madeddu F, et al. Euthanasia and assisted suicide in psychiatric patients: A systematic review of the literature. J Psychiatr Res. 2021;135:153-73. [Crossref]  [PubMed] 
  53. Barraclough B, Bunch J, Nelson B, Sainsbury P. A hundred cases of suicide: clinical aspects. Br J Psychiatry. 1974;125(0):355-73. [Crossref]  [PubMed] 
  54. Gralnick A. Suicide in the psychiatric hospital. Child Psychiatry Hum Dev. 1993;24(1):3-12. [Crossref]  [PubMed] 
  55. Appelbaum PS. Psychiatrists and access to abortion. Hosp Community Psychiatry. 1992;43(10):967-8. [Crossref]  [PubMed] 
  56. Gopal AA. Physician-Assisted Suicide: Considering the Evidence, Existential Distress, and an Emerging Role for Psychiatry. J Am Acad Psychiatry Law. 2015;43(2):183-90. [PubMed] 
  57. Baile WF, DiMaggio JR, Schapira DV, Janofsky JS. The request for assistance in dying. The need for psychiatric consultation. Cancer. 1993;72(9):2786-91. [Crossref]  [PubMed] 
  58. Ganzini L, Lee MA. Psychiatry and assisted suicide in the United States. N Engl J Med. 1997;336(25):1824-6. [Crossref]  [PubMed] 
  59. Massie MJ, Holland J, Glass E. Delirium in terminally ill cancer patients. Am J Psychiatry. 1983;140(8):1048-50. [Crossref]  [PubMed] 
  60. Levene I, Parker M. Prevalence of depression in granted and refused requests for euthanasia and assisted suicide: a systematic review. J Med Ethics. 2011;37(4):205-11. [Crossref]  [PubMed] 
  61. Sullivan MD, Youngner SJ. Depression, competence, and the right to refuse lifesaving medical treatment. Am J Psychiatry. 1994;151(7):971-8. [Crossref]  [PubMed] 
  62. Lo B, Steinbrook R. Beyond the Cruzan case: the U.S. Supreme Court and medical practice. Ann Intern Med. 1991;114(10):895-901. [Crossref]  [PubMed] 
  63. Monacelli F, Martini M, Odetti P, Ciliberti R. Physician assisted suicide and clinical vulnerability: a slippery slope. Clin Ter. 2016;167(5):e92-e5. [PubMed] 
  64. Coleman D. Not dead yet. In: Foley K, Hendin H, eds. The Case Against Assisted Suicide: For the Right to End of Life Care. 1st ed. Baltimore: Johns Hopkins University Press; 2002. p.213-37.
  65. Wortham S. Linguistic anthropology of education. Annual Review of Anthropology. 2008;37(1):849-59. [Crossref] 
  66. Potter J. The psychological slippery slope from physician-assisted death to active euthanasia: a paragon of fallacious reasoning. Med Health Care Philos. 2019;22(2):239-44. [Crossref]  [PubMed] 
  67. Posner RA. Aging and Old Age. 1st ed. Chicago: University of Chicago Press.; 1995.
  68. Parker M. Defending the indefensible? Psychiatry, assisted suicide and human freedom. Int J Law Psychiatry. 2013;36(5-6):485-97. [Crossref]  [PubMed] 
  69. Parker M. Words and reasons: psychiatry and assisted suicide. Aust N Z J Psychiatry. 2012;46(2):80-3. [Crossref]  [PubMed] 
  70. Hewitt J. Rational suicide: philosophical perspectives on schizophrenia. Med Health Care Philos. 2010;13(1):25-31. [Crossref]  [PubMed] 
  71. Verhofstadt M, Thienpont L, Peters GY. When unbearable suffering incites psychiatric patients to request euthanasia: qualitative study. Br J Psychiatry. 2017;211(4):238-45. [Crossref]  [PubMed]  [PMC] 
  72. Blank K, Robison J, Prigerson H, Schwartz HI. Instability of attitudes about euthanasia and physician assisted suicide in depressed older hospitalized patients. Gen Hosp Psychiatry. 2001;23(6):326-32. [Crossref]  [PubMed] 
  73. Vandenberghe J. Physician-Assisted Suicide and Psychiatric Illness. N Engl J Med. 2018;378(10):885-7. [Crossref]  [PubMed] 
  74. Richard-Devantoy S, Berlim MT, Jollant F. A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychol Med. 2014;44(8):1663-73. [Crossref]  [PubMed] 
  75. Nicolini ME, Peteet JR, Donovan GK, Kim SYH. Euthanasia and assisted suicide of persons with psychiatric disorders: the challenge of personality disorders. Psychol Med. 2020;50(4):575-82. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com