ETHICAL PROBLEMS IN PATHOLOGY PRACTISE

Aleksada Seafimv, MD, MSci Facult f Medical Scieces, Uivesit f Gce

Delcev Sti, Macedia
1st Macedia Cgess f Patlg it Iteatial Paticiati, At Oid,
Vlume: Bk f Abstacts, Octbe, 12-16, 2011
Objective Idetif te cmm eticaI issues ecuteed i atIg actice
a da-t-da basis ad t give sme guidace tese issues migt be
addessed.
Te iciles f dig Gd ad t dig Ham ae te essece f eve
cde f medical etics. Te dut f medical dcts t tei atiets is t eecise tei
fessial skills i a etical mae ad t bseve te las f cmmuit. Te mst
essetial use is t esue tat atiets tust i te medical fessi is deseved.
Tis is acieved b tectig te atiets ad esuig tat te ae able t btai te
maimum beefits available i medicie. At te same time, medical etics aim t tect
atiets fm te abuse tat ca ccu e e es is i a siti f e.
Te fu geeal iciles i medical etics (esect f autm, -
maleficece, beeficece ad justice) al i te field f Patlg but te ae
clums, because te ae desiged f face-t-face atiet cae. Te idel acceted
statemet Te ealt f m atiet ill be m fist csideati des t al t
atlg, siml because a atlgist des t ave m atiet. Te etical
blems f atlgist lie mail i te cflicts betee mal bligatis t te
essible cliicia (ad te clleagues), t te atiet ad t sciet.
Tee ae 3 mai gus t m atlgists e tei essibilities:
- Patiets
Patlgists ae accutable f te ualit ad itegit f te sevices te
vide.
- Clleagues ad te fessi
Patlgists suld stive t uld te digit ad esect f tei fessis
ad maitai a eutati f est, itegit ad eliabilit. Te suld aim t
ctibute t te advacemet f te fessi b imvig te bd f
scietific kledge, mtig ig stadads f educati ad actice ad
cllabati it clleagues ad te ealt fessials ee ssible.
- Sciet
Patlgists ave a essibilit t ctibute t te geeal ell-beig f
sciet
a situati ee a etical decisi as t be made, a blem aises e t
me etical iciles seem t cflict, ad te difficult lies i te elative eigt t be
attaced t te diffeet iciles, balacig ssible ams agaist beefits. Te
cflict ma aise iti e f te abve iciles suc as autm f D. A vesus
te autm f atiet B. t ma als aise betee iciles, suc as autm f
atiet B vesus beeficece tads atiet B, tads atiets C ad D. Tese
vaius facts ad iciles ma ell be csideed diffeetl b diffeet
atlgists ad diffeet cliicias.
Sme f te etical issues i atlg actice tat must be discussed ae tese
icluded i:
- safe, scietificall accuate ad cmlete istatlgical diagsis i a
easable time fame
- et f tissue samles ad blcks
- saed decisi-makig f atiets
- te atlgist-atlgist elatisi
A safe diagsis
H des edeig a safe diagsis cme ude te uvie f a discussi
etics? Tis is because eve te mst eeieced atlgist is uma, ad cat
claim 100 % accuac f eve diagsis i is e caee. Histatlg is
basicall leaig te laguage f cells, iteetig saes, sizes ad acitectual
attes f tissues iti a give secific cliical ctet. Outside te ld f
atlgists, tee is l a dim udestadig f te tul subjective uaces ative t
tis discilie. Sme cliicias tet d euate a istatlg diagsis it a
matematic fmula vidig edictable ad csistet ases. Te d t ecet
a fleibilit f ite-bseve vaiati i atlg. Suc cliicias must udestad
tat a difficult case is simila t iteetig a semi-abstact k f at. Diffeet ele
lkig at te same ictue cme u it a diffeet ad fte diveget iteetati.
Tis is t t sa tat eve istlg case ses blems. Me ta 85 t 90 e cet
f te k is utie staigtfad ad te eeieced istatlgist ca be
cfidet 95 e cet f te time, me. Heve eve te mst eeieced ca
falte. Tis is mst aaet i te iteetati f bdelie cases, ae diseases,
badl cessed samles, i te absece f cmlete cliical data.
Etical uesti - H ca e esue te submissi f a safe csesus
diagsis i situatis ee te lesi is tul bdelie ae?
Ase build-i cecks t filte ut suc blems. F eamle:
Difficult cases must be utiel evieed it seis it te eets i
deatmetal meetigs. t must be ackledged tat t all atlgists ae
eeieced i all aeas f istlg el suld be sugt e aated.
Rets ivlvig te iis f me ta e es suld be caefull
ded. Te ultimate essibilit f te fial decisi must est it te
atlgist sigs te et.
Fze sectis ad fie eedle asiati ctlg ets must be cmaed
it, ad audited agaist, te fial istatlg ets. lage deatmets,
te atlgist sees te iitial samle suld t, ideall, sig te audit
fial et. Te autmatic auditig seves as a build-i ceck t educe
iaccuacies ad ca als eable a ctiuus teacig cess.
Rets siged b jui staff suld, ideall, be c-siged b sei staff till te
fme eac a level f matuit eeiece.
Rets must be siged cmletel ad cleal. Tis is t just a matte f
fessial ide; it is als bt udet ad fai, t ule ut ambiguit i
teatmet decisis.
Pet f tissues ad blcks?
Te istatlgist as te igt t cess diseased tissue emved duig suge i
a a e/se feels fit t btai diagstic ifmati f futue teaeutic decisis.
Heve, te tissue emais te atiets et. Te et based te samle is a
cfidetial dcumet ic suld be elaed l t te cliicia cceed ad t
te atiet.
Tis ca becme a ctvesial issue i tdas sciet i ic atiets g sig
f dcts iis. Te ma is t ca te tissue samle t seveal diffeet
istatlgists. t is t be eected tat a ctvesial difficult case ma eset
vaiable, eve diveget ets, cfusig te atiet. Neveteless, te atlgist
cat de te atiet te igt t tissues emved f diagstic uses, f
ifmati based tei eamiati. T d s uld be tatamut t malactice.
O te te ad, deatmets i lage istitutis ma ague tat mateial btaied
f diagstic uses suld be sted ad eseved f futue eseac. Tis suld
be de l it te emissi f te atiet fm m te tissue as emved.
Nie ut f 10 atiets ill agee t suc stage, if tei atlgist takes te time t
elai te eed f suc eseac. Heve, if desite tis elaati a atiet
efuses emissi t ave is e tissue sted f eseac, te atlgist as
cice but t ceate.
Saed decisi-makig f atiets
Etical uesti W is essible f a iaiate teatmet decisi?
Patlgists ae essible tissue diagsis ad cliicias ae essible f cliical
diagsis. f e f bt sides f tis euati sets a g diagsis, tat leads t
iaiate teatmet f atiet ad culd esult i u-ecessa eati (ga
emval), uecessa cem- adiati tea, ematue deat b teaeutic
cmlicatis. Tat is te iciles f gd medical etics must be uld b te
atlgist ad b te cliicia.
Etics f te atlgist-atlgist elatisi
Tee ae a umbe f sesitive aeas i istatlg, ic eed t be adled it
cae ad est. Oe suc aea is e a cliicia makes a efeal t a atlgist,
askig im e t evie a fell atlgists ealie diagsis. We a geuie
cage f diagsis is made, te eviee must talk diectl t te fist atlgist ad
elai e/se feels te eed t cage te diagsis. Tug tis is smetimes
misudestd, it is t fai t kee te fist atlgist i te dak. Histatlgists
ave a igt t tei iis. Heve, diveget ctadict diagses ca
ceate csideable aeesi f bt te atiet ad te teatig cliicia.
Smetimes te matte cat be eslved itut a tid eve fut ii. suc
cases, cliicias smetimes cse t believe tat et ic best matces tei
cliical judgemet.
Patlgists ca ad d ld diffeig iis te same diagsis, ad smetimes
te ma eve citicise e ate. Heve, suc discussis suld t g bed
te disageeig aties, ad suld be caied ut i cmlete cfidece. t is uetical
t citicise a fell istatlgist befe te clleagues a cliicia, ad advesel
affects bt te citic ad te citicised. As f te istatlgist eas a atiet
cmlai abut a clleague, e/se suld efai fm listeig t suc cmlaits,
at te ve least, efai fm makig a cmmet tat culd be cstued as
accetace f te citicism.
Pfessial lalt demads udestadig ad mutual esect f es clleagues. A
cage i diagsis ca ccu ve a eid f time. Tis ca ccu i te ga betee
te fze secti ad te fial diagsis, ad als as te disease gesses: me
cliical labat ifmati becmes available, te ictue becmes cleae ad
te diagsis ad gsis becme me aaet. Tis ill ecessitate a caged,
me aiate diagstic label. Wile it ma be embaassig f te fist atlgist,
all f us ecute suc situatis i te cuse f u caees, ad te suld be see
as leaig eeieces. Similal, diagses cage it te use f me secialised
sisticated tests suc as elect micsc, immuct- cemist mlecula
atlg.
At ate level, u fessi deeds saig kledge ad dissemiatig
scietific ifmati. Patlgists suld affiliate temselves it medical scieties ad
scietific meetigs, ad ctibute time, eeg ad meas s tat tese scieties ma
eeset ad uld te ideals f te fessi. Leaig is a life-lg cess, ad
e ca lea fm diffeet ele: e suld t be suised t ea f studets
teacig tei fesss i cfeeces, semias ad kss. Patlgists
feel te k it all ad ave see it all ae dageus. Se late te ae
gig t sig a et ic culd am tei atiets because f tei iabilit t kee
u it te times.
Patlgist-atiet elatisi
Patlgist atiet elatisi is t like a cliicia atiet elatisi. Te
atiet ad te atlgist ave a uusual ctact - a maj life alteig evet ill
ccu based u te defiitive decisi f a amus (faceless) etit, ad te
atiet accets it vlutail itut uesti. Tis is a eamle f blid tust fm te
atiets side. F all te atiet ks te decisi as made b a cmute, because
e/se des t ave face-t-face ctact it is/es atlgist.
Cclusis
Abve ee eseted sme f te etical issues i atlg actice, ic ae
ccuig a da-t-da basis. Patlg as a maj field f uma medicie as t
cml it te iciles f medical etics, as ell as sme te iciles ad ules
tat aise fm te secific k f a atlgist.
Tee is t a atlgist ca claim tat 100 e cet f is/e diagses ae
accuate ad mistakes d ae. Sme mistakes cat d am, but sme ca esult
i a uecessa eati teatmet tat ca seiusl ut te life f a atiet i a
jead, eve ematue deat. Uldig te etical iciles, cstatl
emidig f tese iciles ca make te level f mistakes t a miimum.
Gd etics cmes as muc fm te seac t be etical as it des fm udestadig
etics.
Refeeces
1. Ba DN:Etical Issues ad cliical atlg. Jual f Alied Pils 1992.
2. Meta HS ad Taaevala VJ: Medical la ad etics i Idia. Te Bmba
Samaca Pivate Ltd. Bmba 1. 1963
3. Ci RF: Relatis betee dcts. Issues i Medical Etics 1997; 5 (4): 105-109
4. Pllae M: Te Etical Patlgist lectue slides