Some Deontological Considerations Related to Features of Communication with Patients with Acute Intoxication // Някои деонтологични проблеми, свързани с особеностите на комуникацията с пациенти с остри отравяния
Deontological problems are common in clinical toxicology. This is a current socially-significant topic because of the large number of acute poisonings. The aim of the dissertation is to examine the deontological considerations resulting from the specific characteristics of the communication between a doctor and a patient with an acute intoxication. The main problems are in the area of informed consent for or refusal of treatment and consent for disclosing confidential information to relatives. The main reason is impaired and ineffective doctor-patient communication caused by transient toxic cerebral changes. The risk of communication barriers is highest in acute intoxications with alcohol, medicaments, narcotics, and solvents. Three groups of risks factors are identified: A. Directly related to the intoxication: high incidence of altered mental status; transience and dynamic of the cerebrotoxic syndrome; difficult obtaining of valid informed consent, necessity for coercion in some cases. B. Related to the patients, indirectly to the poisoning: comorbidity, psychoemotional, intellectual, social, etc. C. Related to the medics and the current laws and provisions. Approaches for improving the informed decision-making process in toxicology patients, developed by us, are proposed: 1. A form for dynamic assessment of capacity for communication and for informed consent. 2. A method for validation of informed refusal of treatment using a whole-sentence, handwritten statement as a supplement to the official form. 3. Updating clinical toxicology training.
deontology, acute intoxication, informed consent, informed refusal, risk factor, Токсикология / Toxicology
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