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TRUTH TELLING TO TERMINALLY ILL PATIENTS IN BULGARIAN HOSPICES

TRUTH TELLING TO TERMINALLY ILL PATIENTS IN BULGARIAN HOSPICES. SILVIYA ALEKSANDROVA-YANKULOVSKA Medical University of Pleven, Pleven, Bulgaria. OLD DEBATE. ARGUMENTS FOR Respect for autonomy S ettle family and other problems Effective palliative treatment Strengthens relationships

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TRUTH TELLING TO TERMINALLY ILL PATIENTS IN BULGARIAN HOSPICES

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  1. TRUTH TELLING TO TERMINALLY ILL PATIENTS IN BULGARIAN HOSPICES SILVIYA ALEKSANDROVA-YANKULOVSKA Medical University of Pleven, Pleven, Bulgaria

  2. OLD DEBATE ARGUMENTS FOR • Respect for autonomy • Settle family and other problems • Effective palliative treatment • Strengthens relationships • Facilitated communication in the family • Better team work • Better physical condition (anxiety, distress, DNR) ARGUMENTS AGAINST • Depriving from hope • Stress > suicide? • Lack of time for adequate information process • Lack of training • Uncertain prognosis • Difficult and causing stress in health professionals

  3. ETHICAL DOCUMENTS • The Charter on Medical Professionalism (US Accreditation Council for Graduate Medical Education)>openness and honesty in physicians' communication with patients • World Medical Association Declaration on the rights of the patient >“Exceptionally, information may be withheld from the patient when there is good reason to believe that this information would create a serious hazard to his/her life or health”. LEGAL FRAMEWORK • Bulgarian Health Act > no possibility to withhold information

  4. TRADITIONS • Asian and Muslim cultures > family rather than the patient • Western cultures > priority of autonomy However Paternalism still exists!

  5. OBJECT • To study the issue of truth telling to terminally ill patients in Bulgarian hospices. METHODS • Self-administered questionnaire • Personnel and patients’ relatives • 17 in-patient, 12 home care hospices and 5 palliative care units

  6. RESULTS

  7. PATIENTS’ AUTONOMY

  8. PATIENTS’ AWARENESS OF THE DIAGNOSIS (based on data from hospices’ managers and personnel)

  9. PATIENTS’ AWARENESS OF THE DIAGNOSIS (based on data from relatives)

  10. TIME AND SOURCE OF INFORMATION

  11. INVOLVEMENT IN DECISION-MAKING (based on data from hospices’ managers and staff)

  12. CONCLUSION Following the recent tendencies in bioethics in favor of respect for autonomy, Bulgarian physicians inform patients and try to develop partnership in most of the therapeutic relations. The issue of truth telling in case of terminally ill patients, however, is still one of the most complex and sensitive situations presenting moral dilemma in clinical practice. The last amendments in health law closed the door for the possibility not to tell the truth. Does this strict rule make things easier in practice?

  13. THANK YOU FOR YOUR ATTENTION! Contact information: Assoc. Prof. Dr. SilviyaAleksandrova-Yankulovska, MD, PhD, MAS Medical University of Pleven Dean, Faculty of Public Health 1, KlimentOhridski str. 5800 Pleven, Bulgaria silviya_aleksandrova@hotmail.com

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