Medicine (Abingdon, England : UK ed.)最新文献

Intentionally terminating life (ITL) is usually assumed to require a doctor to perform it. However, it does not. Two questions have been conflated. First, is it a moral good for society to facilitate people ending their lives, and if so, in what circumstances? And second, how and by whom is it to be done? If ITL becomes a medical responsibility, the profession changes to incorporate a new duty to end some people's lives. This is the most significant moral question in medicine. Because the political movement to legalize assisted suicide and euthanasia is vocal, organized and well-funded, the first question may become redundant soon. The second will then be upon us without due consideration. This article clarifies several ethical confusions that could derail your analysis. You may favour the legalization of ITL without compunction, oppose it in any form, or you may favour ITL but see it as safe only if implemented separate from medicine. Our intention is that you engage with the moral reasoning and not the emotional polemic of this postmodern debate.

The right of an autonomous person to make decisions about their care is central to the practice of medicine. However, we are often faced with situations where someone is unable to make those decisions because of their medical status, mental health or intellectual ability. Here we consider the legal framework for the treatment of individuals who lack the capacity to decide for themselves, and some of the ethical issues that inform how such decisions are made.

Working in partnership with patients is not a new idea but neither is it a simple one. It holds benefits for both the patient and the doctor. Benefits for the treating doctor include better self-care and a reduced risk of burnout. The UK General Medical Council has provided guidelines for practitioners and patients that provide a useful template for personal reflection. There are also formal programmes dedicated to this end.

A patient's personal information can only be disclosed to those involved in their care if consent to such disclosure is given. This consent normally extends implicitly beyond medical staff to other professionals who may also be involved in care. It also commonly includes administrative, secretarial and managerial staff as well as healthcare professionals. This constitutes the duty of confidentiality. In certain specified circumstances, a patient's otherwise confidential information may be disclosed without consent to allow benefits to particular others. The legal position is complex, and while doctors should be familiar with most routine situations (e.g. reporting of certain infectious diseases), advice should always be sought if doubt exists.

Medical ethics is a field of expertise that has developed alongside increasingly powerful technologies that have changed medical practice significantly over the past decades. From artificial ventilation and the possibility of resuscitation after cardiac arrest in the 1960s to the big-data-driven medicine of today, increasingly supported by artificial intelligence (AI), modern medicine is loaded with ethical dilemmas and complex decisions. Four principles, namely respect for autonomy, non-maleficence, beneficence and justice, were identified in the 1970s as guiding concepts of an ethics of biomedicine, the then emerging clinical practice that is informed by biological and physiological evidence from basic research. However, as the cultural and historical context affects the understanding of these principles, their implementation in clinical practice and healthcare is not trivial. Here, we highlight additional principles and values that back up these four core principles in the European context, particularly solidarity, human dignity, pluralism, tolerance, non-discrimination and gender equality. We further summarize how European Union law reflects such principles and values, and refer to existing instruments to support their implementation. Focusing on solidarity, we highlight its understanding in the European context and some challenges for its realization, particularly in the context of using AI in medicine and healthcare.

Clinical uncertainty continues to matter today, causing harm and waste in healthcare. Managing and resolving this through the empirical findings of research are the foundations of modern medicine's successes. Doctors therefore have an ethical duty to help contribute to the identification and resolution of clinical uncertainty through facilitating and contributing to research, a point clearly put in sharp perspective by the recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Ethical codes support this, but endorsement is far from emphatic given its clinical importance and future revisions should urgently address this omission.

Cardiovascular complications are common in poisoned individuals and require prompt attention and intervention. The pathophysiology of the cardiovascular complications depends on the substances involved, which are often unknown. An initial assessment and investigations are key to detecting cardiac disturbances and their cause. Arrhythmias resulting from poisoning in the form of tachycardias and bradycardias are relatively common with some substances such as sympathomimetics or β-adrenoceptor blockers. Changes in electrocardiogram intervals are also common manifestations, not only because of the action of these substances, but also secondary to disturbances of pH or electrolytes. Here we describe an approach to managing patients with exposure to cardiovascular poisoning including clinical assessment, investigations and management.

Self-poisoning accounts for a significant number of attendances to acute services. It can occur at any age. The reasons that lead someone to self-poison are variable and individual. It is often a manifestation of distress. Women are more likely to present, or die, after overdose than men, although men are more likely to die by suicide overall. Self-harm, including self-poisoning, is a strong risk factor and antecedent to suicide. Psychosocial assessment offers an important opportunity to intervene and should be undertaken by a clinician with appropriate training; this should be collaborative where possible and lead to the identification and formulation of relevant risk factors to guide management. The UK National Institute for Health and Care Excellence advises against the use of risk assessment tools and scales and risk stratification, and recommends that the focus of the assessment should be on the person's needs and how to support their immediate and long-term psychological and physical safety.

Poisoning by toxic plants or fungi is not uncommon in the UK. The identity of the suspected toxin is frequently unknown to the patient. Clinicians must be aware of the toxicology, clinical features and treatment of serious and common poisonings to effectively manage such cases.

Colorectal cancer (CRC) is one of the leading causes of cancer deaths worldwide. This article reviews the aetiology and risk factors for CRC and focuses on strategies for prevention and early diagnosis. Prevention involves identifying and optimizing modifiable risk factors through public health awareness. Population screening for CRC is well established in clinical practice and increasing data support it as an effective method for early cancer detection and prevention through polypectomy, although multiple different appropriate faecal tests and endoscopic approaches exist and will be evaluated. Recent changes to UK screening programmes and advances in the understanding of molecular pathways for CRC development are highlighted and their respective roles for cancer prevention discussed. Endoscopic surveillance in the UK is currently offered to high-risk groups including those with multiple high-risk polyps and previous CRC after baseline colonoscopy, with recent changes to UK guidelines highlighted. Endoscopic surveillance is also offered to individuals with a genetic predisposition or long-standing inflammatory bowel disease. Finally, future directions in technology and research for prevention and early diagnosis of CRC, including those aided by artificial intelligence, are explored.