{"id":7315,"date":"2017-03-03T10:18:20","date_gmt":"2017-03-03T10:18:20","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/ethics_manual_latvian.pdf"},"modified":"2017-03-03T10:19:59","modified_gmt":"2017-03-03T10:19:59","slug":"ethics_manual_latvian","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/fr\/ce-que-nous-faisons\/education\/manuel-dethique-medicale\/ethics_manual_latvian\/","title":{"rendered":"ethics_manual_latvian"},"author":2,"comment_status":"open","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"<p class=\"attachment\"><a href='https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/ethics_manual_latvian.pdf'>ethics_manual_latvian<\/a><\/p>\n<p>MEDIC\u012aNAS \u0112TIKAS<br \/>\nrokasgr\u0101mata<br \/>\nPasaules Medic\u012bnas asoci\u0101cija<br \/>\nMedic\u012bnas \u0113tika<br \/>\n\u0113tika<br \/>\nb<br \/>\nMEDIC\u012aNAS \u0112TIKAS<br \/>\nrokasgr\u0101mata<br \/>\nPasaules Medic\u012bnas asoci\u0101cija<br \/>\nII izdevums<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata<br \/>\nMedic\u012bnas students, turot jaundzimu\u0161o<br \/>\n\u00a9 Roger Ball\/CORBIS<br \/>\n3<br \/>\nSATURA R\u0100D\u012aT\u0100JS<br \/>\nPateic\u012bbas&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 5<br \/>\nPriek\u0161v\u0101rds&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 7<br \/>\nIevads &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 9<br \/>\n\u2022 Kas ir medic\u012bnas \u0113tika?<br \/>\n\u2022 K\u0101p\u0113c j\u0101apg\u016bst medic\u012bnas \u0113tika?<br \/>\n\u2022 Medic\u012bnas \u0113tika, \u0101rsta profesion\u0101lisms, cilv\u0113kties\u012bbas un likums<br \/>\n\u2022 Kopsavilkums<br \/>\n1. noda\u013ca. Medic\u012bnas \u0113tikas pamatiez\u012bmes&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 16<br \/>\n\u2022 K\u0101das ir medic\u012bnas \u012bpatn\u012bbas?<br \/>\n\u2022 K\u0101das ir medic\u012bnas \u0113tikas \u012bpatn\u012bbas?<br \/>\n\u2022 Vai medic\u012bnas \u0113tika main\u0101s?<br \/>\n\u2022 Vai medic\u012bnas \u0113tika da\u017e\u0101d\u0101s valst\u012bs ir at\u0161\u0137ir\u012bga?<br \/>\n\u2022 Pasaules Medic\u012bnas asoci\u0101cijas noz\u012bme<br \/>\n\u2022 K\u0101 PMA izlemj, kas ir \u0113tisks?<br \/>\n\u2022 K\u0101 indiv\u012bds izlemj, kas ir \u0113tisks?<br \/>\n\u2022 Kopsavilkums<br \/>\n2. noda\u013ca. \u0100rsti un pacienti&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. 36<br \/>\n\u2022 K\u0101das ir \u0101rsta un pacienta attiec\u012bbu \u012bpatn\u012bbas?<br \/>\n\u2022 Cie\u0146a un vien\u0101da attieksme<br \/>\n\u2022 Sazi\u0146a un piekri\u0161ana<br \/>\n\u2022 L\u0113mumu pie\u0146em\u0161ana r\u012bc\u012bbnesp\u0113j\u012bgu pacientu viet\u0101<br \/>\n\u2022 Kon\ufb01dencialit\u0101te<br \/>\n\u2022 Jaut\u0101jumi, kas saist\u012bti ar dz\u012bves s\u0101kumu<br \/>\n\u2022 Jaut\u0101jumi, kas attiecin\u0101mi uz mu\u017ea nosl\u0113gumu<br \/>\n\u2022 Atgrie\u0161an\u0101s pie gad\u012bjuma anal\u012bzes<br \/>\n3. noda\u013ca. \u0100rsti un sabiedr\u012bba&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 64<br \/>\n\u2022 K\u0101das ir \u0101rsta un sabiedr\u012bbas attiec\u012bbu \u012bpatn\u012bbas?<br \/>\n\u2022 Dubultlojalit\u0101te<br \/>\n\u00a9 2005, 2009, Pasaules Medic\u012bnas asoci\u0101cija<br \/>\nVisas ties\u012bbas pieder PMA. L\u012bdz pat 10 \u0161\u012b dokumenta kopij\u0101m at\u013cauts<br \/>\nizmantot nekomerci\u0101los, personiskos nol\u016bkos, atsaucoties uz ori\u0123i-<br \/>\nn\u0101lo avotu. Jebk\u0101dai citai dokumenta pavairo\u0161anai, saglab\u0101\u0161anai vai<br \/>\nnodo\u0161anai jebk\u0101d\u0101 form\u0101 vai jebk\u0101diem pa\u0146\u0113mieniem nepiecie\u0161ama<br \/>\niepriek\u0161\u0113ja rakstiska at\u013cauja. Piepras\u012bjumu at\u013caujas sa\u0146em\u0161anai adres\u0113t:<br \/>\nThe World Medical Association, B. P. 63, F-01212 Ferney-Voltaire Cedex,<br \/>\nFrance; e-pasts: wma@wma.net; fakss: +33-450-405937.<br \/>\n\u0160\u012b rokasgr\u0101mata ir Pasaules Medic\u012bnas asoci\u0101cijas \u0112tikas strukt\u016brvien\u012b-<br \/>\nbas publik\u0101cija. To uzrakst\u012bjis D\u017eons R. Viljamss (John R. Williams), \u0112tikas<br \/>\nstrukt\u016brvien\u012bbas direktors, PMA. T\u0101s saturs ne vienm\u0113r atspogu\u013co PMA<br \/>\nnost\u0101ju, iz\u0146emot vietas, kur tas ir skaidri un nep\u0101rprotami nor\u0101d\u012bts.<br \/>\nV\u0101ks, dizains un ideja: Tuuli Sauren, Inspirit International Advertising,<br \/>\nBel\u0123ija.<br \/>\nIzstr\u0101de un ideja: World Health Communication Associates, Lielbrit\u0101nija.<br \/>\nFoto: Van Parys Media\/CORBIS<br \/>\nKatalo\u0123iz\u0101cijas inform\u0101cija:<br \/>\nWilliams, John R. (John Reynold), 1942\u2013.<br \/>\nMedical ethics manual.<br \/>\n1. Bio\u0113tika 2. \u00ab\u0100rsts-slimnieks\u00bb attiec\u012bbas \u2014 \u0113tika 3. \u0100rsta loma<br \/>\n4. Biomedic\u012bnisk\u0101 p\u0113tniec\u012bba \u2014 \u0113tika 5. Starpprofesion\u0101l\u0101s attiec\u012bbas<br \/>\n6. Izgl\u012bt\u012bba, medic\u012bnisk\u0101 \u2014 \u0113tika 7. Gad\u012bjumu p\u0101rskati<br \/>\n8. Rokasgr\u0101matas I. Nosaukums<br \/>\nIzdev\u0113js Latvijas \u0100rstu biedr\u012bba, Skolas iela 3, R\u012bg\u0101<br \/>\nTekstu tulkojums un makets sagatavots SIA \u00abNacion\u0101lais apg\u0101ds\u00bb,<br \/>\nHospit\u0101\u013cu iela 55, R\u012bg\u0101<br \/>\nLatvie\u0161u tekstu zin\u0101tniskais redaktors Dr. habil. med. M\u0101ris Balti\u0146\u0161<br \/>\nISBN 92-990028-1-9<br \/>\nISBN 978-9984-26-413-4<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Saturar\u0101d\u012bt\u0101js<br \/>\n4 5<br \/>\nA pielikums. V\u0101rdn\u012bca &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 122<br \/>\nB pielikums. Medic\u012bnas \u0113tikas resursi internet\u0101 &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 125<br \/>\nC pielikums. &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. 127<br \/>\nD pielikums. \u0112tikas m\u0101c\u012b\u0161anas nostiprin\u0101\u0161ana<br \/>\nmedic\u012bnas skol\u0101s &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 129<br \/>\nE pielikums. Papildus gad\u012bjumu izp\u0113te &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 131<br \/>\n\u2022 Resursu sadale<br \/>\n\u2022 Sabiedr\u012bbas vesel\u012bba<br \/>\n\u2022 Glob\u0101l\u0101 vesel\u012bba<br \/>\n\u2022 Atgrie\u0161an\u0101s pie gad\u012bjuma anal\u012bzes<br \/>\n4. noda\u013ca. \u0100rsti un kol\u0113\u0123i &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. 82<br \/>\n\u2022 P\u0101rmai\u0146as \u0101rstu ietekmes sadal\u012bjum\u0101<br \/>\n\u2022 Attiec\u012bbas ar citiem \u0101rstiem, saviem skolot\u0101jiem un studentiem<br \/>\n\u2022 Zi\u0146o\u0161ana par nedro\u0161u vai ne\u0113tisku medic\u012bnas praksi<br \/>\n\u2022 Attiec\u012bbas ar citiem vesel\u012bbas apr\u016bpes speci\u0101listiem<br \/>\n\u2022 Kon\ufb02iktu risin\u0101\u0161ana<br \/>\n\u2022 Atgrie\u0161an\u0101s pie gad\u012bjuma anal\u012bzes<br \/>\n5. noda\u013ca. \u0112tika un medic\u012bnas p\u0113t\u012bjumi&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 96<br \/>\n\u2022 Medic\u012bnisko p\u0113t\u012bjumu noz\u012bme<br \/>\n\u2022 P\u0113t\u012bjumi medic\u012bnas praks\u0113<br \/>\n\u2022 \u0112tikas pras\u012bbas<br \/>\n\u2022 \u0112tikas komitejas apstiprin\u0101jums<br \/>\n\u2022 Zin\u0101tnisk\u0101 v\u0113rt\u012bba<br \/>\n\u2022 Soci\u0101l\u0101 v\u0113rt\u012bba<br \/>\n\u2022 Riski un ieguvumi<br \/>\n\u2022 Inform\u0113t\u0101 piekri\u0161ana<br \/>\n\u2022 Kon\ufb01dencialit\u0101te<br \/>\n\u2022 Attiec\u012bbu kon\ufb02ikti<br \/>\n\u2022 God\u012bga inform\u0113\u0161ana par rezult\u0101tiem<br \/>\n\u2022 Pazi\u0146o\u0161ana<br \/>\n\u2022 Neatrisin\u0101tie jaut\u0101jumi<br \/>\n\u2022 Atgrie\u0161an\u0101s pie gad\u012bjuma anal\u012bzes<br \/>\n6. noda\u013ca. Nosl\u0113gums&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;. 114<br \/>\n\u2022 \u0100rstu atbild\u012bba un privil\u0113\u0123ijas<br \/>\n\u2022 Atbild\u012bba pret sevi<br \/>\n\u2022 Medic\u012bnas \u0113tikas n\u0101kotne<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Saturar\u0101d\u012bt\u0101js<br \/>\n6 7<br \/>\nPRIEK\u0160V\u0100RDS<br \/>\nDr. Delons Hjumans (Delon Human),<br \/>\nPasaules Medic\u012bnas asoci\u0101cijas \u0123ener\u0101lsekret\u0101rs<br \/>\nGr\u016bti notic\u0113t, ka v\u0113l nav izveidota medic\u012bnas studij\u0101m piem\u0113rota<br \/>\nvisp\u0101rpie\u0146emta pamatprogramma medic\u012bnas \u0113tikas apguv\u0113, kaut<br \/>\nmedic\u012bnas \u0113tikas pamatlic\u0113ji, piem\u0113ram, Hipokr\u0101ts, savus darbus<br \/>\nsarakst\u012bju\u0161i jau vair\u0101k nek\u0101 pirms 2000 gadiem. \u0160\u012bs pirm\u0101s PMA ro-<br \/>\nkasgr\u0101matas m\u0113r\u0137is ir aizpild\u012bt \u0161o robu. Ir liels gods nodot j\u016bsu r\u012bc\u012b-<br \/>\nb\u0101 \u0161o rokasgr\u0101matu, kuras s\u0101kums dat\u0113jams ar 51. Pasaules Medic\u012b-<br \/>\nnas asambleju 1999. gad\u0101, kur\u0101 bija pulc\u0113ju\u0161ies \u0101rsti, kas p\u0101rst\u0101v\u0113ja<br \/>\n\u0101rstu biedr\u012bbas no visas pasaules. Taj\u0101 tika nolemts, ka \u00abPasaules<br \/>\nMedic\u012bnas asoci\u0101cija aicina pasaules medic\u012bnas fakult\u0101tes iek\u013caut<br \/>\nstudiju programm\u0101 k\u0101 oblig\u0101tu medic\u012bnas \u0113tiku un cilv\u0113kties\u012bbas\u00bb.<br \/>\nP\u0113c \u0161\u012b l\u0113muma s\u0101k\u0101s darbs, lai izveidotu studentiem un \u0101rstiem no-<br \/>\nder\u012bgus medic\u012bnas \u0113tikas m\u0101c\u012bbu materi\u0101lus, kas balst\u012btos uz PMA<br \/>\nr\u012bc\u012bbpolitikas nost\u0101dn\u0113m, bet pats neb\u016btu politikas veido\u0161anas do-<br \/>\nkuments. \u0160\u012b rokasgr\u0101mata ir PMA \u0112tikas komisijas p\u0101rraudz\u012bta un<br \/>\nkoordin\u0113ta vispus\u012bgu un glob\u0101lu konsult\u0101ciju rezult\u0101t\u0101. PMA v\u0113l\u0113-<br \/>\nj\u0101s \u012bstenot, lai \u0161o publik\u0101ciju k\u0101 atsauces avotu lietotu studenti un<br \/>\n\u0101rsti pasaul\u0113.<br \/>\nM\u016bsdienu vesel\u012bbas apr\u016bp\u0113 ik pa br\u012bdim rodas \u013coti daudz sare\u017e\u0123\u012btu<br \/>\nun daudzpus\u012bgu \u0113tiska rakstura variantu un ne vienm\u0113r \u0101rsti ir pie-<br \/>\ntiekami sagatavoti, lai sp\u0113tu t\u0101s risin\u0101t. \u0160\u012b gr\u0101mata ir apzin\u0101ti iece-<br \/>\nr\u0113ta, lai rosin\u0101tu \u0101rstos p\u0101rdomas par \u0113tiku un veicin\u0101tu t\u0101s iev\u0113ro-<br \/>\n\u0161anu praks\u0113, k\u0101 ar\u012b lai pied\u0101v\u0101tu \u0113tiski pie\u0146emamus risin\u0101jumus. Tas<br \/>\nnav \u00abpareiz\u0101\u00bb un \u00abnepareiz\u0101\u00bb uzskait\u012bjums, bet gan m\u0113\u0123in\u0101jums pa-<br \/>\ndar\u012bt \u0101rsta sirdsapzi\u0146u iej\u016bt\u012bg\u0101ku, jo tie\u0161i uz to gulstas atbild\u012bba par<br \/>\n\u0113tiski pie\u0146emamu un taisn\u012bgu l\u0113mumu pie\u0146em\u0161anu. \u0160im nol\u016bkam<br \/>\nPATEIC\u012aBAS<br \/>\nPasaules Medic\u012bnas asoci\u0101cijas \u0112tikas strukt\u016brvien\u012bba pateicas se-<br \/>\nkojo\u0161\u0101m person\u0101m par pla\u0161ajiem un satur\u012bgajiem koment\u0101riem \u0161\u012bs<br \/>\nrokasgr\u0101matas agr\u0101kajos uzmetumos:<br \/>\nProf. Solly Benatar, University of Cape Town, Dienvid\u0101frika<br \/>\nProf. Kenneth Boyd, University of Edinburgh, Skotija<br \/>\nDr. Annette J.Braunack-Mayer, University of Adelaide, Austr\u0101lija<br \/>\nDr. Robert Carlson, University of Edinburgh, Skotija<br \/>\nMr. Sev Fluss, WMA and CIOMS, Geneva, \u0160veice<br \/>\nProf. Eugenijus Gefenas, University of Vilnius, Lietuva<br \/>\nDr. Delon Human, WMA, Ferney-Voltaire, Francija<br \/>\nDr. Girish Bobby Kapur, George Washington University, Washington,<br \/>\nDC, ASV<br \/>\nProf. Nuala Kenny, Dalhousie University, Halifax, Kan\u0101da<br \/>\nProf. Cheryl Cox Macpherson, St.George\u2019s University, Gren\u0101da<br \/>\nMs. Mareike Moeller, Medizinische Hochschule Hannover, V\u0101cija<br \/>\nProf. Ferenc Oberfrank, Hungarian Academy of Sciences, Budapest,<br \/>\nUng\u0101rija<br \/>\nMr .Atif Rahman, Khyber Medical College, Peshawar, Pakist\u0101na<br \/>\nMr. Mohamed Swailem, Banha Faculty of Medicine, Banha, \u0112\u0123ipte,<br \/>\nun vi\u0146a desmit studentiem par atbalstu pareizas terminolo\u0123ijas iz-<br \/>\nmanto\u0161an\u0101 t\u0101m person\u0101m, kuru dzimt\u0101 valoda nav ang\u013cu valoda.<br \/>\nPMA \u0112tikas strukt\u016brvien\u012bba tiek da\u013c\u0113ji atbalst\u012bta ar Johnson &#038; Johnson<br \/>\nneierobe\u017eotu izgl\u012bt\u012bbas dot\u0101ciju.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Priek\u0161v\u0101rds<br \/>\n8 9<br \/>\nIEVADS<br \/>\nKAS IR MEDIC\u012aNAS \u0112TIKA?<br \/>\nIedom\u0101jieties \u0161\u0101dus medic\u012bniskus gad\u012bjumus, kas var\u0113tu atgad\u012bties<br \/>\ngandr\u012bz jebkur\u0101 valst\u012b:<br \/>\n1. Dr. P., pieredz\u0113jis un prasm\u012bgs \u0137irurgs, ir gandr\u012bz jau beidzis nakts-<br \/>\nde\u017e\u016bru neliel\u0101 viet\u0113j\u0101 slimn\u012bc\u0101. Te k\u0101du \u00a7 meiteni uz slimn\u012bcu<br \/>\natved vi\u0146as m\u0101te, kura nekav\u0113joties dodas prom, sac\u012bdama, ka<br \/>\nvi\u0146ai j\u0101b\u016bt m\u0101j\u0101s pie p\u0101r\u0113jiem b\u0113rniem. Pacientei ir asi\u0146o\u0161ana no<br \/>\nmaksts, un vi\u0146a cie\u0161 lielas s\u0101pes. Dr. P. vi\u0146u izmekl\u0113 un konstat\u0113,<br \/>\nka vi\u0146ai ir spont\u0101ns vai induc\u0113ts aborts. Vi\u0146\u0161 \u0101tri dilat\u0113 dzemdes<br \/>\nkaklu, veic abr\u0101ziju un pasaka medic\u012bnas m\u0101sai, lai apjaut\u0101jas pa-<br \/>\ncientei, vai vi\u0146a var palikt slimn\u012bc\u0101 l\u012bdz br\u012bdim, kad b\u016bs dro\u0161i vi\u0146u<br \/>\nizrakst\u012bt. \u0100rsta mai\u0146a nu ir beigusies, mai\u0146u p\u0101r\u0146emt atn\u0101k Dr. Q.,<br \/>\nun Dr. P. dodas uz m\u0101j\u0101m, neaprun\u0101jies ar pacienti.<br \/>\n2. \u0100rste S. pamaz\u0101m s\u0101k justies aizkaitin\u0101ta, jo pacienti, kas n\u0101k pie<br \/>\nvi\u0146as, vai nu pirms vai p\u0113c \u0161\u012bs viz\u012btes ar to pa\u0161u slim\u012bbu griezu-<br \/>\n\u0161ies pie citiem speci\u0101listiem. Vi\u0146a uzskata, ka \u0161\u0101da r\u012bc\u012bba ir velt\u012b-<br \/>\nga resursu \u0161\u0137ie\u0161ana, k\u0101 ar\u012b nelietder\u012bga pa\u0161iem pacientiem. Vi\u0146a<br \/>\nnolemj pacientiem pateikt, ka turpm\u0101k vairs tos ne\u0101rst\u0113s, ja \u0161o<br \/>\npa\u0161u slim\u012bbu d\u0113\u013c turpin\u0101s apmekl\u0113t ar\u012b citus speci\u0101listus. Vi\u0146a ir<br \/>\nnol\u0113musi v\u0113rsties sav\u0101 medic\u012bnas asoci\u0101cij\u0101, lai piepras\u012btu vald\u012b-<br \/>\nbai nov\u0113rst \u0161\u0101du velt\u012bgu medic\u012bnas resursu \u0161\u0137ie\u0161anu.<br \/>\n3. Dr. C., pils\u0113tas slimn\u012bc\u0101 nesen darb\u0101 nor\u012bkots anesteziologs, ir sa-<br \/>\ntraukts par k\u0101da vado\u0161a \u0137irurga uzved\u012bbu oper\u0101ciju z\u0101l\u0113. \u0136irurgs<br \/>\nizmanto novecoju\u0161as metodes, kas pagarina oper\u0101cijas laiku,<br \/>\npastiprina p\u0113coper\u0101cijas s\u0101pes un paildzina atvese\u013co\u0161anos. Tur-<br \/>\nkl\u0101t \u0161is \u0137irurgs bie\u017ei izsaka nepiedien\u012bgus jokus par pacientiem,<br \/>\nun tas ac\u012bmredzami aizskar asist\u0113jo\u0161\u0101s medic\u012bnas m\u0101sas. B\u016b-<br \/>\ndams visjaun\u0101kais kolekt\u012bva loceklis, vi\u0146\u0161 nev\u0113las kritiz\u0113t \u0137irurgu<br \/>\nj\u016bs gr\u0101mat\u0101 atrad\u012bsit da\u017eu gad\u012bjumu aprakstus, kas veicin\u0101s gan in-<br \/>\ndividu\u0101las \u0113tiska rakstura p\u0101rdomas, gan diskusijas grup\u0101s.<br \/>\nM\u0113s,\u0101rsti,apzin\u0101miest\u0101spriek\u0161roc\u012bbas,komumspaveriesaist\u012b\u0161an\u0101s<br \/>\n\u0101rsta un pacienta attiec\u012bb\u0101s, t\u0101s ir \u012bpa\u0161as attiec\u012bbas, kur\u0101s zin\u0101tnisku<br \/>\natzi\u0146u apmai\u0146a un apr\u016bpe noris viegl\u0101k, ja t\u0101s notiek \u0113tikas un uzti-<br \/>\nc\u0113\u0161an\u0101s gaisotn\u0113. \u0160\u012b gr\u0101mata apskata da\u017e\u0101da veida attiec\u012bbas, kur\u0101s<br \/>\ntiek iesaist\u012bti \u0101rsti, bet centr\u0101l\u0101 vieta alla\u017e ier\u0101d\u0101ma \u0101rsta un pacien-<br \/>\nta attiec\u012bb\u0101m. P\u0113d\u0113jos gados \u0161\u012bs attiec\u012bbas ietekm\u0113 \u0101r\u0113jais spiediens<br \/>\nresursu ierobe\u017eot\u012bbas un citu faktoru d\u0113\u013c, un \u0161\u012b rokasgr\u0101mata skaidri<br \/>\npier\u0101da nepiecie\u0161am\u012bbu ar \u0113tisku r\u012bc\u012bbu stiprin\u0101t \u0161\u012bs saiknes.<br \/>\nVisbeidzot k\u0101ds v\u0101rds par pacienta centr\u0101lo vietu jebkura veida dis-<br \/>\nkusij\u0101s par medic\u012bnas \u0113tikas jaut\u0101jumiem. Vairums medic\u012bnas aso-<br \/>\nci\u0101ciju par savas r\u012bc\u012bbpolitikas nost\u0101dn\u0113s par to, kas ir \u0113tiski, pirmaj\u0101<br \/>\nviet\u0101 jebk\u0101du l\u0113mumu pie\u0146em\u0161an\u0101 par apr\u016bpi izvirz\u012bju\u0161as maksi-<br \/>\nm\u0101lu individu\u0101la pacienta intere\u0161u iev\u0113ro\u0161anu. \u0160\u012b PMA rokasgr\u0101ma-<br \/>\nta attaisnos savu m\u0113r\u0137i tikai tad, ja t\u0101 pal\u012bdz\u0113s medic\u012bnas studen-<br \/>\ntiem un praktiz\u0113jo\u0161iem \u0101rstiem rast lab\u0101k\u0101s atbildes uz daudz\u0101m<br \/>\n\u0113tiska rakstura probl\u0113m\u0101m, ar ko m\u0113s sastopamies ikdienas darb\u0101,<br \/>\nun atrast iesp\u0113jas vislab\u0101k \u012bstenot imperat\u012bvu, ka PACIENTA INTE\uf6ba<br \/>\nRESES LIEKAMAS PIRMAJ\u0100 VIET\u0100.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Ievads<br \/>\n10 11<br \/>\ntie, kuros vienpr\u0101t\u012bba nav pan\u0101kta, vai tie, kuros vis\u0101m alternat\u012bv\u0101m<br \/>\npiem\u012bt k\u0101di tr\u016bkumi (piem\u0113ram, ierobe\u017eoto vesel\u012bbas apr\u016bpes re-<br \/>\nsursu racion\u0101la izmanto\u0161ana).<br \/>\nKas \u012bsti ir \u0113tika, un k\u0101 t\u0101 pal\u012bdz \u0101rstiem tikt ar \u0161\u0101diem jaut\u0101jumiem<br \/>\ngal\u0101? Vienk\u0101r\u0161i run\u0101jot, \u0113tika ir m\u0101c\u012bba par tikum\u012bbu \u2014 r\u016bp\u012bgas un<br \/>\nsistem\u0101tiskas p\u0101rdomas par mor\u0101la rakstura l\u0113mumiem un uzved\u012b-<br \/>\nbu, k\u0101 ar\u012b to anal\u012bze pag\u0101tn\u0113, tagadn\u0113 un n\u0101kotn\u0113. Tikum\u012bba l\u012bdz ar<br \/>\nto apl\u016bko cilv\u0113ku l\u0113mumu pie\u0146em\u0161anas un r\u012bc\u012bbas v\u0113rt\u012bbu dimen-<br \/>\nsiju. M\u0101c\u012bba par tikum\u012bbu sav\u0101 leksik\u0101 ietver t\u0101dus lietv\u0101rdus k\u0101<br \/>\n\u00abties\u012bbas\u00bb, \u00abatbild\u012bba\u00bb, \u00abtikumi\u00bb un \u012bpa\u0161\u012bbas v\u0101rdus \u00abslikts\u00bb (\u00ab\u013cauns\u00bb)<br \/>\nun \u00ablabs\u00bb (\u00abpareizs), \u00abtaisn\u012bgs\u00bb un \u00abne-<br \/>\ntaisn\u012bgs\u00bb. Saska\u0146\u0101 ar \u0161\u012bm de\ufb01n\u012bcij\u0101m<br \/>\n\u0113tikai, pirmk\u0101rt, ir j\u0101aptver zin\u0101\u0161anas,<br \/>\nkam\u0113r mor\u0101les (tikum\u012bbas) pamat\u0101 ir<br \/>\nr\u012bc\u012bba. To cie\u0161\u0101 sasaiste izpau\u017eas t\u0101d\u0113-<br \/>\nj\u0101di, ka \u0113tiska rakstura ba\u017eas nodro\u0161i-<br \/>\nna cilv\u0113kus ar racion\u0101liem krit\u0113rijiem,<br \/>\nk\u0101p\u0113c pie\u0146emt, dr\u012bz\u0101k pie\u0146emt no-<br \/>\nteiktus l\u0113mumus vai r\u012bkoties noteikt\u0101<br \/>\nveid\u0101 nevis sav\u0101d\u0101k.<br \/>\nT\u0101 k\u0101 \u0113tika attiecas uz visiem cilv\u0113ka uzved\u012bbas un l\u0113mumu pie-<br \/>\n\u0146em\u0161anas aspektiem, tad t\u0101s intere\u0161u sf\u0113ra ir pla\u0161a un sare\u017e\u0123\u012bta ar<br \/>\ndaudziem atzarojumiem vai apak\u0161nozar\u0113m. \u0160\u012bs rokasgr\u0101matas ak-<br \/>\ncents galvenok\u0101rt tiek virz\u012bts uz medic\u012bnas \u0113tiku \u2014 \u0113tikas nozari,<br \/>\nkas apl\u016bko mor\u0101las dabas jaut\u0101jumus medic\u012bnas praks\u0113. Medic\u012bnas<br \/>\n\u0113tika ir tuva bio\u0113tikai (biomedic\u012bniskajai \u0113tikai), ta\u010du t\u0101s nav identis-<br \/>\nkas. Kam\u0113r medic\u012bnas \u0113tikas intereses galvenok\u0101rt ir saist\u012btas ar jau-<br \/>\nt\u0101jumiem, kas rodas medic\u012bnas praks\u0113, biomedic\u012bnisk\u0101 \u0113tika ir \u013coti<br \/>\npla\u0161a discipl\u012bna, kas risina mor\u0101les jaut\u0101jumus, kurus rada biolo\u0123ijas<br \/>\ndiscipl\u012bnu att\u012bst\u012bbas process kopum\u0101. Bio\u0113tika at\u0161\u0137iras no medic\u012bnas<br \/>\n\u0113tikas ar\u012b ar to, ka taj\u0101 ne vienm\u0113r nepiecie\u0161ams akcept\u0113t t\u0101s tradi-<br \/>\npersoniski, nedz ar\u012b zi\u0146ot par vi\u0146a uzved\u012bbu attiec\u012bg\u0101m iest\u0101d\u0113m,<br \/>\nta\u010du vi\u0146\u0161 j\u016bt, ka kaut kas ir j\u0101dara, lai situ\u0101ciju uzlabotu.<br \/>\n4. Pie k\u0101das mazpils\u0113tas \u0123imenes \u0101rstes Dr. R. ierodas p\u0113t\u012bjumu l\u012b-<br \/>\ngumorganiz\u0101cijas p\u0101rst\u0101vis un aicina vi\u0146u piedal\u012bties kl\u012bnisk\u0101 p\u0113-<br \/>\nt\u012bjum\u0101 par jauna nestero\u012bd\u0101 pretiekaisuma l\u012bdzek\u013ca lieto\u0161anu os-<br \/>\nteoartr\u012bta \u0101rst\u0113\u0161an\u0101.Vi\u0146ai tiek apsol\u012bta konkr\u0113ta summa par katru<br \/>\npacientu, ko vi\u0146a iesaist\u012bs p\u0113t\u012bjum\u0101. P\u0113t\u012bjumu l\u012bgumorganiz\u0101cijas<br \/>\np\u0101rst\u0101vis vi\u0146u p\u0101rliecina, ka p\u0113t\u012bjuma veik\u0161anai jau ieg\u016btas visas<br \/>\nnepiecie\u0161am\u0101s at\u013caujas, taj\u0101 skait\u0101 ar\u012b no \u0113tikas komitejas. \u0100rste<br \/>\nv\u0113l nekad nav piedal\u012bjusies kl\u012bnisk\u0101 p\u0113t\u012bjum\u0101 un ir \u013coti priec\u012bga<br \/>\npar \u0161\u0101du iesp\u0113ju, kas turkl\u0101t vi\u0146ai garant\u0113 papildu ien\u0101kumus.<br \/>\nVi\u0146a piekr\u012bt piedal\u012bties, tuv\u0101k nepainteres\u0113joties par p\u0113t\u012bjuma zi-<br \/>\nn\u0101tniskajiem vai \u0113tiskajiem aspektiem.<br \/>\nKatrs no min\u0113tajiem gad\u012bjumiem rosina \u0113tiska rakstura p\u0101rdomas.<br \/>\nTie rada jaut\u0101jumus par \u0101rsta uzved\u012bbu un l\u0113mumu pie\u0146em\u0161anu, ne-<br \/>\nvis par zin\u0101tniskiem vai tehniskiem jaut\u0101jumiem, piem\u0113ram, k\u0101 \u0101r-<br \/>\nst\u0113t diab\u0113tu vai veikt divk\u0101r\u0161\u0101 apvada (double bypass) izveido\u0161anas<br \/>\noper\u0101ciju. Tie ir jaut\u0101jumi par v\u0113rt\u012bb\u0101m, ties\u012bb\u0101m un atbild\u012bbu. \u0100rsti<br \/>\nsastopas ar \u0161\u0101diem jaut\u0101jumiem tikpat bie\u017ei k\u0101 ar zin\u0101tniska vai teh-<br \/>\nniska rakstura probl\u0113m\u0101m.<br \/>\nMedic\u012bnas praks\u0113, vienalga, kur\u0101 specialit\u0101t\u0113, uz da\u017eiem jaut\u0101ju-<br \/>\nmiem ir viegl\u0101k atbild\u0113t nek\u0101 uz citiem.Vienk\u0101r\u0161a l\u016bzuma repon\u0113\u0161a-<br \/>\nna vai \u0161uves uzlik\u0161ana uz va\u013c\u0113jas br\u016bces nerad\u012bs nek\u0101das probl\u0113mas<br \/>\n\u0101rstiem, kas ir pieradu\u0161i \u0161\u0101das manipul\u0101cijas veikt. Tom\u0113r da\u017ebr\u012bd<br \/>\nvar rasties \u0161aubas par to, k\u0101 \u0101rst\u0113t atsevi\u0161\u0137as slim\u012bbas, pat \u0161\u0137ietami<br \/>\ntik vienk\u0101r\u0161as k\u0101 tuberkuloze vai hipertensija. T\u0101pat ar\u012b ne visi \u0113tikas<br \/>\njaut\u0101jumi medic\u012bn\u0101 ir vienl\u012bdz viegli atbildami. Uz da\u017eiem atbildes<br \/>\nvar rast sam\u0113r\u0101 \u0101tri, galvenok\u0101rt t\u0101p\u0113c, ka atsevi\u0161\u0137os jaut\u0101jumos<br \/>\nir pan\u0101kta liela vienpr\u0101t\u012bba (konsenss) par r\u012bc\u012bbu noteikt\u0101 situ\u0101cij\u0101<br \/>\n(piem\u0113ram, par to, ka \u0101rstam noteikti j\u0101prasa pacienta at\u013cauja, ja<br \/>\nvi\u0146u grib iesaist\u012bt k\u0101d\u0101 p\u0113t\u012bjum\u0101). Citi jaut\u0101jumi ir sare\u017e\u0123\u012bt\u0101ki, it \u012bpa\u0161i<br \/>\n\u00ab..\u0113tika ir m\u0101c\u012bba par<br \/>\ntikum\u012bbu \u2014 r\u016bp\u012bgas un<br \/>\nsistem\u0101tiskas p\u0101rdomas<br \/>\npar mor\u0101la rakstura<br \/>\nl\u0113mumiem un uzved\u012bbu,<br \/>\nk\u0101 ar\u012b to anal\u012bze pag\u0101tn\u0113,<br \/>\ntagadn\u0113 un n\u0101kotn\u0113.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Ievads<br \/>\n12 13<br \/>\n\u0161o principu iev\u0113ro\u0161ana da\u017e\u0101s noteikt\u0101s<br \/>\nsitu\u0101cij\u0101s bie\u017ei vien ir visai problem\u0101-<br \/>\ntiska, jo \u0101rstiem, pacientiem, vi\u0146u \u0123i-<br \/>\nmenes locek\u013ciem vai citiem vesel\u012bbas<br \/>\napr\u016bpes darbiniekiem var b\u016bt at\u0161\u0137i-<br \/>\nr\u012bgs viedoklis par to, k\u0101 pareiz\u0101k r\u012bko-<br \/>\nties konkr\u0113t\u0101s situ\u0101cij\u0101s. \u0112tikas apguve<br \/>\nsagatavo medic\u012bnas studentus, lai vi\u0146i<br \/>\nsp\u0113tu saskat\u012bt sare\u017e\u0123\u012btas situ\u0101cijas un<br \/>\nt\u0101s risin\u0101t racion\u0101l\u0101 un principi\u0101l\u0101 veid\u0101. T\u0101pat \u0113tika ir svar\u012bga \u0101rstu<br \/>\nmijiedarb\u012bb\u0101 ar sabiedr\u012bbu, vi\u0146u attiec\u012bb\u0101s ar kol\u0113\u0123iem, k\u0101 ar\u012b medi-<br \/>\nc\u012bnisko p\u0113t\u012bjumu veik\u0161an\u0101.<br \/>\nMEDIC\u012aNAS \u0112TIKA, \u0100RSTA PROFESION\u0100LISMS,<br \/>\nCILV\u0112KTIES\u012aBAS UN LIKUMS<br \/>\nK\u0101 var\u0113sit las\u012bt 1. noda\u013c\u0101, medic\u012bnas \u0113tika ir bijusi b\u016btiska medic\u012b-<br \/>\nnas sast\u0101vda\u013ca jau vismaz kop\u0161 Hipokr\u0101ta (grie\u0137u \u0101rsts, kuru uzskata<br \/>\npar medic\u012bnas \u0113tikas pamatlic\u0113ju) laika, V gadsimt\u0101 p.m.\u0113. Tie\u0161i vi\u0146\u0161<br \/>\ndeva priek\u0161statu par medic\u012bnu k\u0101 profesiju, kur\u0101 \u0101rsts dod publis-<br \/>\nku sol\u012bjumu, ka pacienta intereses vi\u0146am b\u016bs svar\u012bg\u0101kas par sav\u0101m<br \/>\n(pla\u0161\u0101k par to 3. noda\u013c\u0101). \u0160aj\u0101 rokasgr\u0101mat\u0101 b\u016bs saskat\u0101ma saikne<br \/>\nstarp \u0113tiku un profesion\u0101lismu.<br \/>\nNesen\u0101 pag\u0101tn\u0113 medic\u012bnas \u0113tiku b\u016btiski ietekm\u0113ja cilv\u0113kties\u012bbu at-<br \/>\nt\u012bst\u012bba. Plur\u0101listisk\u0101 un multikultur\u0101l\u0101 pasaul\u0113, kur\u0101 valda daudzas<br \/>\nat\u0161\u0137ir\u012bgas mor\u0101l\u0101s trad\u012bcijas, pla\u0161a starptautiska l\u012bme\u0146a vieno\u0161an\u0101s<br \/>\npar cilv\u0113kties\u012bb\u0101m var k\u013c\u016bt par t\u0101du medic\u012bnas \u0113tikas pamatu, kas<br \/>\nsp\u0113j p\u0101rvar\u0113t valstu un kult\u016bru robe\u017eas. Turkl\u0101t \u0101rstiem bie\u017ei n\u0101-<br \/>\nkas saskarties ar medic\u012bniska rakstura probl\u0113m\u0101m, kuras radu\u0161\u0101s<br \/>\nt\u0101du cilv\u0113kties\u012bbu p\u0101rk\u0101pumu d\u0113\u013c k\u0101 piespiedu migr\u0101cija vai sp\u012b-<br \/>\ndzin\u0101\u0161ana. Vi\u0146us pla\u0161i skar ar\u012b debates par to, vai vesel\u012bbas apr\u016bpe<br \/>\nir uzskat\u0101ma par vienu no cilv\u0113kties\u012bb\u0101m, jo atbilde uz \u0161o jaut\u0101ju-<br \/>\ncion\u0101l\u0101s v\u0113rt\u012bbas, kuras, k\u0101 to redz\u0113sim 2. noda\u013c\u0101, veido medic\u012bnas<br \/>\n\u0113tikas pamatus.<br \/>\nK\u0101 akad\u0113miskai discipl\u012bnai medic\u012bnas \u0113tikai ir izveidojusies sava<br \/>\nspeci\ufb01ska leksika, kur\u0101 daudzi termini ir aizg\u016bti no \ufb01lozo\ufb01jas. \u0160\u012bs<br \/>\nrokasgr\u0101matas las\u012b\u0161ana neprasa no las\u012bt\u0101ja iepriek\u0161\u0113jas zin\u0101\u0161anas \ufb01-<br \/>\nlozo\ufb01j\u0101, turkl\u0101t visu pamatterminu de\ufb01n\u012bcijas dotas tai viet\u0101 tekst\u0101,<br \/>\nkur termins par\u0101d\u0101s glos\u0101rij\u0101 \u0161\u012bs gr\u0101matas beig\u0101s.<br \/>\nK\u0100P\u0112C J\u0100APG\u016aST MEDIC\u012aNAS \u0112TIKA?<br \/>\n\u00abJa \u0101rsts ir zino\u0161s un pieredz\u0113jis kl\u012bnicists, \u0113tikai nav nek\u0101das noz\u012b-<br \/>\nmes.\u00bb<br \/>\n\u00ab\u0112tiku apg\u016bst \u0123imen\u0113, nevis medic\u012bnas fakult\u0101t\u0113.\u00bb<br \/>\n\u00abMedic\u012bnas \u0113tiku vajag m\u0101c\u012bties, skatoties, k\u0101 r\u012bkojas pieredz\u0113ju\u0161i<br \/>\n\u0101rsti, nevis no gr\u0101mat\u0101m vai lekcij\u0101m.\u00bb<br \/>\n\u00ab\u0112tika ir svar\u012bga, bet m\u016bsu studiju programma jau t\u0101pat ir p\u0101rbl\u012b-<br \/>\nv\u0113ta, un \u0113tikas m\u0101c\u012b\u0161anai taj\u0101 nav vietas.\u00bb<br \/>\nT\u0101s ir tikai da\u017eas atrunas, ar kur\u0101m tiek attaisnots fakts, ka \u0113tikai me-<br \/>\ndic\u012bnas fakult\u0101\u0161u studiju programm\u0101s netiek pie\u0161\u0137irta pietiekami<br \/>\nnoz\u012bm\u012bga vieta. Katrs no \u0161iem argumentiem ir da\u013c\u0113ji, ta\u010du tikai da\u013c\u0113ji<br \/>\npareizs. Pamaz\u0101m medic\u012bnas fakult\u0101tes pasaul\u0113 tom\u0113r s\u0101k saprast,<br \/>\nka ir j\u0101dod studentiem pietiekami daudz laika \u0113tikas apguvei. Veikt<br \/>\n\u0161\u0101das p\u0101rmai\u0146as studiju programm\u0101s t\u0101s uzst\u0101j\u012bgi mudin\u0101ja PMA<br \/>\nun Pasaules Medic\u012bnas izgl\u012bt\u012bbas feder\u0101cijas (World Federation for<br \/>\nMedical Education). (C pielikums)<br \/>\n\u0160\u012b rokasgr\u0101mata skaidri par\u0101d\u012bs \u0113tikas noz\u012bmi medic\u012bnas izgl\u012bt\u012bb\u0101.<br \/>\n\u0112tika ir un vienm\u0113r ir bijusi svar\u012bga medic\u012bnas prakses sast\u0101vda\u013ca.<br \/>\nT\u0101di \u0113tikas principi k\u0101 cie\u0146a pret indiv\u012bdu, inform\u0113ta piekri\u0161ana un<br \/>\nkon\ufb01dencialit\u0101te veido \u0101rsta un pacienta attiec\u012bbu pamatu. Tom\u0113r<br \/>\n\u00ab\u0112tikas apguve sagatavo<br \/>\nmedic\u012bnas studentus,<br \/>\nlai vi\u0146i sp\u0113tu saskat\u012bt<br \/>\nsare\u017e\u0123\u012btas situ\u0101cijas un<br \/>\nt\u0101s risin\u0101t racion\u0101l\u0101 un<br \/>\nprincipi\u0101l\u0101 veid\u0101.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Ievads<br \/>\n14 15<br \/>\nmu konkr\u0113taj\u0101 valst\u012b liel\u0101 m\u0113r\u0101 noteiks, cik pla\u0161am cilv\u0113ku lokam<br \/>\nmedic\u012bnisk\u0101 apr\u016bpe b\u016bs pieejama. \u0160aj\u0101 gr\u0101mat\u0101 cilv\u0113kties\u012bbu jau-<br \/>\nt\u0101jumam ir piev\u0113rsta liela uzman\u012bba, jo tas \u013coti sp\u0113c\u012bgi ietekm\u0113 me-<br \/>\ndic\u012bnas praksi.<br \/>\nMedic\u012bnas \u0113tika ir cie\u0161i saist\u012bta ar likumiem. Vairum\u0101 valstu jau ir<br \/>\npie\u0146emti likumi, kas nosaka, k\u0101 \u0101rstam j\u0101risina \u0113tiskas dabas jau-<br \/>\nt\u0101jumi, kas rodas pacientu apr\u016bpes un medic\u012bnisko p\u0113t\u012bjumu gait\u0101.<br \/>\nTurkl\u0101t katr\u0101 valst\u012b ir licenc\u0113\u0161anas komisijas vai citas p\u0101rraudz\u012bbas<br \/>\niest\u0101des, kas var piem\u0113rot da\u017e\u0101das sankcijas \u0101rstiem, kas neiev\u0113ro<br \/>\n\u0113tikas principus.Tom\u0113r \u0113tika un likums<br \/>\nnav identiski. Visai bie\u017ei \u0113tika pieprasa<br \/>\naugst\u0101kus uzved\u012bbas standartus nek\u0101<br \/>\nlikums, bet da\u017ereiz t\u0101 pieprasa, lai \u0101rsts<br \/>\nneiev\u0113ro likumus, kas pieprasa ne\u0113tis-<br \/>\nku r\u012bc\u012bbu. Turkl\u0101t likumi katr\u0101 valst\u012b ir<br \/>\nat\u0161\u0137ir\u012bgi, kam\u0113r \u0113tika sniedzas p\u0101ri<br \/>\nvalstu robe\u017e\u0101m. \u0160o iemeslu d\u0113\u013c rokas-<br \/>\ngr\u0101mat\u0101 vair\u0101k apskat\u012bta \u0113tika nek\u0101<br \/>\nlikumi.<br \/>\n\u00ab..bie\u017ei \u0113tika pieprasa<br \/>\naugst\u0101kus uzved\u012bbas<br \/>\nstandartus nek\u0101 likums,<br \/>\nbet da\u017ereiz t\u0101 pieprasa, lai<br \/>\n\u0101rsts neiev\u0113ro likumus,<br \/>\nkas pieprasa ne\u0113tisku<br \/>\nr\u012bc\u012bbu.\u00bb<br \/>\nKOPSAVILKUMS<br \/>\nMedic\u012bna ir gan zin\u0101tne, gan m\u0101ksla. Zin\u0101tne balst\u0101s<br \/>\ngalvenok\u0101rt uz to, ko var nov\u0113rot un izm\u0113r\u012bt, un<br \/>\nkompetents \u0101rsts atpaz\u012bst slim\u012bbu simptomus un var<br \/>\npal\u012bdz\u0113t atg\u016bt vesel\u012bbu. Bet zin\u0101tniskajai medic\u012bnai ir savas<br \/>\nrobe\u017eas, sevi\u0161\u0137i run\u0101jot par cilv\u0113ka individualit\u0101ti, kult\u016bru,<br \/>\nreli\u0123iju, br\u012bv\u012bbu, ties\u012bb\u0101m un atbild\u012bbu. Medic\u012bnas m\u0101ksla<br \/>\nietver medic\u012bnas tehnolo\u0123iju piem\u0113ro\u0161anu individu\u0101liem<br \/>\npacientiem, \u0123imen\u0113m un kopien\u0101m, kuras nekad<br \/>\nneb\u016bs vien\u0101das. Kaut gan at\u0161\u0137ir\u012bbas starp indiv\u012bdiem,<br \/>\n\u0123imen\u0113m un kopien\u0101m p\u0113c sava rakstura liel\u0101koties<br \/>\nnav \ufb01ziolo\u0123iskas, t\u0101s ir paman\u0101mas tikai no m\u0101kslas,<br \/>\nhumanit\u0101ro un soci\u0101lo zin\u0101t\u0146u viedok\u013ca, un taj\u0101s \u0113tikai ir<br \/>\nvisai noz\u012bm\u012bga loma. Starp citu, \u0113tika bag\u0101tin\u0101s ar datiem<br \/>\nun ieskatu no citu discipl\u012bnu viedok\u013ca, piem\u0113ram, k\u0101das<br \/>\nkl\u012bniskas situ\u0101cijas teatr\u0101la izsp\u0113le var b\u016bt iespaid\u012bg\u0101ks<br \/>\np\u0101rdz\u012bvojuma un anal\u012bzes stimuls nek\u0101 vienk\u0101r\u0161s<br \/>\ngad\u012bjuma apraksts.<br \/>\n\u0160\u012b rokasgr\u0101mata pied\u0101v\u0101 tikai pamata ievadkursu<br \/>\nmedic\u012bnas \u0113tik\u0101 un da\u017eos t\u0101s noz\u012bm\u012bg\u0101kajos jaut\u0101jumos.<br \/>\nTai b\u016btu j\u0101pamato vajadz\u012bba p\u0113c regul\u0101r\u0101m p\u0101rdom\u0101m<br \/>\npar medic\u012bnas \u0113tisko dimensiju un, jo \u012bpa\u0161i, sp\u0113ju tikt<br \/>\ngal\u0101 ar tiem \u0113tiskas dabas jaut\u0101jumiem, ar kuriem jums<br \/>\nkl\u012bniskaj\u0101 praks\u0113 n\u0101kas saskarties. B pielikum\u0101 ir atrodams<br \/>\nresursu saraksts, kas pal\u012bdz\u0113s jums padzi\u013cin\u0101t<br \/>\nzin\u0101\u0161anas \u0161ai jom\u0101.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Ievads<br \/>\n16 17<br \/>\n1. NODA\u013bA.<br \/>\nMEDIC\u012aNAS \u0112TIKAS PAMATIEZ\u012aMES<br \/>\nM\u0112R\u0136I<br \/>\nP\u0113c \u0161\u012bs noda\u013cas izlas\u012b\u0161anas j\u016bs var\u0113siet:<br \/>\n\u2022 izskaidrot, k\u0101p\u0113c \u0113tika medic\u012bn\u0101 ir tik svar\u012bga;<br \/>\n\u2022 identi\ufb01c\u0113t galvenos medic\u012bnas \u0113tikas avotus;<br \/>\n\u2022 at\u0161\u0137irt da\u017e\u0101das pieejas \u0113tisku l\u0113mumu pie\u0146em\u0161anai, ar\u012b<br \/>\npa\u0161a las\u012bt\u0101ja pieeju.Viena diena fran\u010du visp\u0101r\u012bg\u0101s prakses \u0101rsta dz\u012bv\u0113<br \/>\n\u00a9 Gilles Fonlupt\/CORBIS<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n18 19<br \/>\napd\u0101vin\u0101tus, cent\u012bgus un \u0161im aicin\u0101jumam uztic\u012bgus studentus. Lai<br \/>\nattaisnotu pacientu un studentu cer\u012bbas, ir svar\u012bgi, lai \u0101rsti zin\u0101tu un<br \/>\niemiesotu medic\u012bnas pamatv\u0113rt\u012bbas, jo sevi\u0161\u0137i l\u012bdzciet\u012bbu, kompe-<br \/>\ntenci un autonomiju. \u0160\u012bs v\u0113rt\u012bbas kop\u0101 ar piet\u0101ti pret cilv\u0113ka pamat-<br \/>\nties\u012bb\u0101m veido medic\u012bnas \u0113tikas pamatus.<br \/>\nK\u0100DAS IR MEDIC\u012aNAS \u0112TIKAS \u012aPATN\u012aBAS?<br \/>\nL\u012bdzciet\u012bba, kompetence un autonomija nek\u0101d\u0101 zi\u0146\u0101 nav rakstur\u012b-<br \/>\ngas vien\u012bgi medic\u012bnai.Tom\u0113r no \u0101rstiem m\u0113dz sagaid\u012bt, ka vi\u0146iem \u0161\u012bs<br \/>\n\u012bpa\u0161\u012bbas piem\u012bt liel\u0101k\u0101 m\u0113r\u0101 nek\u0101 daudzu citu profesiju p\u0101rst\u0101vjiem<br \/>\nun ka vi\u0146i t\u0101d\u0113j\u0101di kalpo par piem\u0113ru citiem.<br \/>\nL\u012bdzciet\u012bba, kuru var\u0113tu de\ufb01n\u0113t k\u0101 sapratni un r\u016bpes par otra cil-<br \/>\nv\u0113ka cie\u0161an\u0101m, ir \u013coti b\u016btiska \u0101rsta prakses sast\u0101vda\u013ca. Lai risin\u0101tu<br \/>\npacienta probl\u0113mas, \u0101rstam j\u0101sp\u0113j identi\ufb01c\u0113t simptomus, ko pa-<br \/>\ncients izj\u016bt, un c\u0113lo\u0146us, kas tos izraisa, k\u0101 ar\u012b j\u0101pal\u012bdz pacientam at-<br \/>\ng\u016bt vesel\u012bbu. Pacienta atvese\u013co\u0161an\u0101s noris sekm\u012bg\u0101k, ja vi\u0146\u0161 j\u016bt, ka<br \/>\n\u0101rsts saprot vi\u0146a ba\u017eas un patiesi v\u0113las \u0101rst\u0113t vi\u0146u, nevis tikai vi\u0146a<br \/>\nslim\u012bbu.<br \/>\nNo \u0101rstiem tiek gan pras\u012bts, gan ar\u012b sagaid\u012bts augsts kompetences<br \/>\nl\u012bmenis. T\u0101s tr\u016bkums var novest pie pacienta n\u0101ves vai cit\u0101m sma-<br \/>\ng\u0101m sek\u0101m. Lai ieg\u016btu nepiecie\u0161amo kompetenci, \u0101rstiem ilgus<br \/>\ngadus j\u0101m\u0101c\u0101s, turkl\u0101t, \u0146emot v\u0113r\u0101 medic\u012bnas zin\u0101\u0161anu straujo<br \/>\nizaugsmi, nepiecie\u0161ams nep\u0101rtraukti uztur\u0113t savu kompetences<br \/>\nl\u012bmeni. Turkl\u0101t t\u0101s nav tikai teor\u0113tiskas zin\u0101\u0161anas vai praktiskas ie-<br \/>\nma\u0146as, bet ar\u012b \u0113tiskas atzi\u0146as, iema\u0146as un attieksme, jo p\u0101rmai\u0146as<br \/>\nmedic\u012bnas praks\u0113, k\u0101 ar\u012b t\u0101s soci\u0101laj\u0101 un politiskaj\u0101 kontekst\u0101 izvirza<br \/>\narvien jaunus \u0113tiska rakstura jaut\u0101jumus.<br \/>\nAutonomija jeb pa\u0161noteik\u0161an\u0101s ir medic\u012bnas pamatv\u0113rt\u012bba, kas<br \/>\np\u0113d\u0113jos gados ir main\u012bjusies visvair\u0101k. Individu\u0101li praktiz\u0113jo\u0161iem<br \/>\nK\u0100DAS IR MEDIC\u012aNAS \u012aPATN\u012aBAS?<br \/>\nLiekas, ka cilv\u0113ces rakst\u012bt\u0101s v\u0113stures laik\u0101 un pasaul\u0113, \u0101rsta esam\u012bbai<br \/>\nvienm\u0113r ir tikusi pie\u0161\u0137irta \u012bpa\u0161a noz\u012bm\u012bba. Cilv\u0113ki dodas pie \u0101rsta, lai<br \/>\nsa\u0146emtu pal\u012bdz\u012bbu visneatliekam\u0101ko vajadz\u012bbu gad\u012bjum\u0101 \u2014 rem-<br \/>\nd\u0113tu s\u0101pes un cie\u0161anas, atjaunotu vesel\u012bbu un labsaj\u016btu. Vi\u0146i \u013cauj<br \/>\n\u0101rstiem sevi apskat\u012bt, aizskart un veikt manipul\u0101cijas ar jebkuru \u0137er-<br \/>\nme\u0146a da\u013cu, neizsl\u0113dzot pat visint\u012bm\u0101k\u0101s. Vi\u0146i to dara, jo tic, ka \u0101rsts<br \/>\npiln\u012bb\u0101 r\u012bkojas pacienta interes\u0113s.<br \/>\n\u0100rstu statuss da\u017e\u0101d\u0101s valst\u012bs un pat<br \/>\nvienas valsts robe\u017e\u0101s m\u0113dz b\u016bt at\u0161\u0137i-<br \/>\nr\u012bgs. P\u0113d\u0113j\u0101 laik\u0101 \u0161\u0137iet, ka vi\u0146u statuss<br \/>\nkopum\u0101 s\u0101k pasliktin\u0101ties. Daudzi \u0101r-<br \/>\nsti uzskata, ka vi\u0146i vairs nebauda t\u0101du<br \/>\ncie\u0146u k\u0101 agr\u0101k. Da\u017e\u0101s valst\u012bs vesel\u012bbas apr\u016bpes p\u0101rraudz\u012bba no \u0101rs-<br \/>\ntiem pak\u0101peniski non\u0101kusi profesion\u0101lu administratoru un birokr\u0101-<br \/>\ntu rok\u0101s, turkl\u0101t da\u017ei no vi\u0146iem \u0101rstus uzskata nevis par partneriem,<br \/>\nbet dr\u012bz\u0101k gan par trauc\u0113kli vesel\u012bbas apr\u016bpes reformas \u012bsteno\u0161an\u0101.<br \/>\nPacienti, kas agr\u0101k bez ierun\u0101m pie\u0146\u0113ma \u0101rsta nor\u0101d\u012bjumus, tagad<br \/>\nl\u016bdz \u0101rstiem pamatot savus ieteikumus, ja tie at\u0161\u0137iras no pado-<br \/>\nmiem, kas g\u016bti no cit\u0101m \u0101rstniec\u012bbas person\u0101m vai no interneta.<br \/>\nDa\u017eas proced\u016bras, kas agr\u0101k ietilpa tikai \u0101rstu kompetenc\u0113, m\u016bsdie-<br \/>\nn\u0101s veic medic\u012bnas tehni\u0137i, medic\u012bnas m\u0101sas vai citas personas ar<br \/>\nspecializ\u0113tu medic\u012bnisko izgl\u012bt\u012bbu1<br \/>\n.<br \/>\nPar sp\u012bti \u0161\u012bm p\u0101rmai\u0146\u0101m, kas apdraud<br \/>\n\u0101rstustatusu,medic\u012bnuk\u0101profesijuv\u0113l<br \/>\njoproj\u0101m augstu v\u0113rt\u0113 slimie cilv\u0113ki,<br \/>\nkam nepiecie\u0161ami vi\u0146u pakalpojumi.<br \/>\nT\u0101 joproj\u0101m turpina piesaist\u012bt daudzus<br \/>\n1. \u0160ai gad\u012bjum\u0101 ang\u013cu paramedics vai fran\u010du personnel paramedical ir apko-<br \/>\npojo\u0161a grupa, kurai latviski nav viena visaptvero\u0161a nosaukuma, t\u0101d\u0113\u013c tas<br \/>\nj\u0101atveido apraksto\u0161i (\u0161eit un turpm\u0101k parindes piez\u012bmju autors ir tulkojuma<br \/>\nzin\u0101tniskais redaktors M\u0101ris Balti\u0146\u0161).<br \/>\n\u00abDaudzi \u0101rsti uzskata, ka<br \/>\nvi\u0146i vairs nebauda t\u0101du<br \/>\ncie\u0146u k\u0101 agr\u0101k.\u00bb<br \/>\n\u00abLai attaisnotu pacientu<br \/>\nun studentu cer\u012bbas, ir<br \/>\nsvar\u012bgi, lai \u0101rsti zin\u0101tu<br \/>\nun iemiesotu medic\u012bnas<br \/>\npamatv\u0113rt\u012bbas..\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n20 21<br \/>\nizgl\u012bt\u012bbas un prakses standartus. \u0160aj\u0101 rokasgr\u0101mat\u0101 m\u0113s redz\u0113sim,<br \/>\nk\u0101 \u0161ai zi\u0146\u0101 situ\u0101cija daudz\u0101s valst\u012bs ir main\u012bjusies, vald\u012bb\u0101m vai cit\u0101m<br \/>\np\u0101rvaldes strukt\u016br\u0101m uz\u0146emoties kontroli p\u0101r \u0101rstiem. Par sp\u012bti tam<br \/>\n\u0101rsti joproj\u0101m augstu v\u0113rt\u0113 savu kl\u012bnisko un profesion\u0101lo autonomi-<br \/>\nju un p\u0113c iesp\u0113jas cen\u0161as to saglab\u0101t.Vienlaikus vis\u0101 pasaul\u0113 vismaz<br \/>\nda\u013c\u0101 \u0101rstu visp\u0101r\u0113ju izpratni un atbalstu guvusi pacienta autonomi-<br \/>\njas ideja taj\u0101 noz\u012bm\u0113, ka tikai pacientam j\u0101b\u016bt tam, kur\u0161 pie\u0146em gala<br \/>\nl\u0113mumu par jaut\u0101jumiem, kas tie\u0161i skar vi\u0146u pa\u0161u. \u0160aj\u0101 rokasgr\u0101ma-<br \/>\nt\u0101 tiks apl\u016bkoti da\u017ei piem\u0113ri par kon\ufb02iktiem starp \u0101rsta autonomiju<br \/>\nun pacienta autonomijas iev\u0113ro\u0161anu.<br \/>\nBez \u0161\u012bm sav\u0101m trim pamatv\u0113rt\u012bb\u0101m medic\u012bnas \u0113tika no visp\u0101r\u012bg\u0101s<br \/>\n\u0113tikas, kas piem\u0113rojama visiem, at\u0161\u0137iras ar\u012b ar to, ka t\u0101 tiek publiski<br \/>\napliecin\u0101ta ar zv\u0113restu, piem\u0113ram, Pasaules Medic\u012bnas Asoci\u0101cijas<br \/>\n(PMA) \u017den\u0113vas deklar\u0101ciju un\/vai k\u0101du citu kodeksu. Da\u017e\u0101d\u0101s val-<br \/>\nst\u012bs un pat vienas valsts ietvaros zv\u0113resti un kodeksi m\u0113dz b\u016bt at-<br \/>\n\u0161\u0137ir\u012bgi, bet tiem ir vair\u0101kas kop\u012bgas iez\u012bmes, iek\u013caujot sol\u012bjumus, ka<br \/>\npacientu intereses \u0101rsts tur\u0113s augst\u0101k par sav\u0101m, ka nediskrimin\u0113s<br \/>\npacientus to rases, reli\u0123ijas vai citas cilv\u0113kties\u012bb\u0101s noteiktas paz\u012b-<br \/>\nmes d\u0113\u013c, ka vi\u0146\u0161 aizsarg\u0101s pacientu inform\u0101cijas kon\ufb01dencialit\u0101ti un<br \/>\nsniegs neatliekamo pal\u012bdz\u012bbu ikvienam, kam t\u0101 nepiecie\u0161ama.<br \/>\nKUR\u0160 IZLEMJ, KAS IR \u0112TISKS?<br \/>\n\u0112tika ir daudz\u0161\u0137aut\u0146aina. Atsevi\u0161\u0137i indiv\u012bdi nereti nesp\u0113j vienoties<br \/>\npar to, kas ir labs un kas \u2014 slikts, un, pat ja vi\u0146i ar\u012b par kaut ko vieno-<br \/>\njas, tad vi\u0146i to var dar\u012bt at\u0161\u0137ir\u012bgu apsv\u0113rumu d\u0113\u013c. Da\u017e\u0101s sabiedr\u012bb\u0101s<br \/>\n\u0161\u0101das domstarp\u012bbas tiek uzskat\u012btas par norm\u0101l\u0101m, un \u013coti liela no-<br \/>\nz\u012bme tiek pie\u0161\u0137irta indiv\u012bda br\u012bv\u012bbai r\u012bkoties p\u0113c saviem ieskatiem,<br \/>\nja vien vi\u0146\u0161 nep\u0101rk\u0101pj citu cilv\u0113ku ties\u012bbas. Tradicion\u0101l\u0101k orient\u0113-<br \/>\nt\u0101 sabiedr\u012bb\u0101 turpretim \u0113tika nereti k\u013c\u016bst par pla\u0161\u0101kas vieno\u0161an\u0101s<br \/>\nobjektu un v\u0113rojams liel\u0101ks soci\u0101ls spiediens, kas reiz\u0113m sak\u0146ojas<br \/>\nlikumos, lai indiv\u012bdi dotu priek\u0161roku noteikta veida r\u012bc\u012bbai, nevis k\u0101-<br \/>\n\u0101rstiem l\u012bdz \u0161im bijusi iesp\u0113ja baud\u012bt visai lielu kl\u012bnisko autonomiju,<br \/>\npie\u0146emot l\u0113mumus par to, k\u0101 vi\u0146u pacienti \u0101rst\u0113jami. Turkl\u0101t \u0101rsti<br \/>\nk\u0101 profesion\u0101la grupa kopum\u0101 var\u0113ja piln\u012bgi br\u012bvi noteikt medic\u012bnas<br \/>\nPASAULES MEDIC\u012aNAS ASOCI\u0100CIJAS<br \/>\n\u017dEN\u0112VAS DEKLAR\u0100CIJA<br \/>\nAtz\u012bstot mani par medi\u0137a profesijas p\u0101rst\u0101vi,<br \/>\nES svin\u012bgi ap\u0146emos velt\u012bt savu dz\u012bvi, lai kalpotu cilv\u0113cei,<br \/>\nES cien\u012b\u0161u un b\u016b\u0161u pateic\u012bgs saviem skolot\u0101jiem,<br \/>\nES str\u0101d\u0101\u0161u sav\u0101 profesij\u0101 ar sirdsapzi\u0146u un godu,<br \/>\nMANA pacienta vesel\u012bba man b\u016bs galvenais,<br \/>\nES cien\u012b\u0161u nosl\u0113pumus, kas man uztic\u0113ti, pat p\u0113c pacienta<br \/>\nn\u0101ves,<br \/>\nES visiem sp\u0113kiem saglab\u0101\u0161u medi\u0137a profesijas godu un c\u0113-<br \/>\nl\u0101s trad\u012bcijas,<br \/>\nMANI kol\u0113\u0123i b\u016bs mani br\u0101\u013ci un m\u0101sas,<br \/>\nES ne\u013cau\u0161u pacienta vecumam, slim\u012bbai vai invalidit\u0101tei, ti-<br \/>\nc\u012bbai, etniskajai pieder\u012bbai, dzimumam, taut\u012bbai, politiskajai<br \/>\npieder\u012bbai, rasei, seksu\u0101lajai orient\u0101cijai, soci\u0101lajam st\u0101vok-<br \/>\nlim vai k\u0101dam citam faktoram nost\u0101ties starp manu pien\u0101-<br \/>\nkumu un pacientu,<br \/>\nES saglab\u0101\u0161u visliel\u0101ko cie\u0146u pret cilv\u0113ka dz\u012bv\u012bbu, pat esot<br \/>\napdraud\u0113ts,<br \/>\nES nelieto\u0161u savas medic\u012bnas zin\u0101\u0161anas, lai p\u0101rk\u0101ptu cilv\u0113k-<br \/>\nties\u012bbas un pilso\u0146u ties\u012bbas,<br \/>\nES dodu \u0161os sol\u012bjumus svin\u012bgi, br\u012bvpr\u0101t\u012bgi un ar godu.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n22 23<br \/>\nTom\u0113r nekad nav bijis t\u0101, ka \u0101rstiem b\u016btu pie\u0161\u0137irtas absol\u016btas privi-<br \/>\nl\u0113\u0123ijas pa\u0161iem noteikt savus \u0113tikas standartus. L\u016bk, da\u017ei piem\u0113ri:<br \/>\n\u2022 \u0100rstiem vienm\u0113r tiek piem\u0113roti visp\u0101r\u012bgie valsts likumi, un da\u017ereiz<br \/>\nvi\u0146us var sod\u012bt, ja r\u012bkojas pret\u0113ji \u0161o likumu norm\u0101m;<br \/>\n\u2022 Da\u017eas medic\u012bnas organiz\u0101cijas sp\u0113c\u012bgi ietekm\u0113 reli\u0123isk\u0101s doktr\u012b-<br \/>\nnas, kuras bez medic\u012bnas \u0113tikas norm\u0101m, kas ir saisto\u0161as visiem<br \/>\n\u0101rstiem, uzliek saviem biedriem v\u0113l papildu pien\u0101kumus;<br \/>\n\u2022 Da\u017e\u0101s valst\u012bs to organiz\u0101ciju, kuras ir pilnvarotas noteikt \u0101rstu<br \/>\nuzved\u012bbas standartus un kontrol\u0113t to iev\u0113ro\u0161anu, biedru vid\u016b ir<br \/>\ndaudz \u00abne\u0101rstu\u00bb.<br \/>\n\u0100rstu biedr\u012bbu \u0113tisk\u0101s direkt\u012bvas ir visp\u0101r\u012bgas, un taj\u0101s, protams, nav<br \/>\napl\u016bkotas visas situ\u0101cijas, ar k\u0101d\u0101m \u0101rsti var\u0113tu sastapties ikdienas<br \/>\nprofesion\u0101laj\u0101 darb\u012bb\u0101. Vairum\u0101 gad\u012bjumu \u0101rstam pa\u0161am j\u0101izlemj,<br \/>\nkas ir labs un kas ne, bet \u0161\u0101d\u0101 l\u0113mumu pie\u0146em\u0161anas br\u012bd\u012b ir visai<br \/>\nlietder\u012bgi zin\u0101t, k\u0101 l\u012bdz\u012bg\u0101 situ\u0101cij\u0101 r\u012b-<br \/>\nkotos citi kol\u0113\u0123i. Medic\u012bnas \u0113tikas ko-<br \/>\ndeksi atspogu\u013co visp\u0101r\u012bgu vienpr\u0101t\u012bbu,<br \/>\nk\u0101 \u0101rstam b\u016btu j\u0101r\u012bkojas un \u0161ie notei-<br \/>\nkumi ir j\u0101iev\u0113ro, ja vien nav pietiekami<br \/>\nb\u016btisku iemeslu r\u012bkoties cit\u0101di.<br \/>\nVAI MEDIC\u012aNAS \u0112TIKA MAIN\u0100S?<br \/>\nGadu gait\u0101 medic\u012bnas \u0113tika tom\u0113r ir main\u012bjusies. V\u0113l pavisam ne-<br \/>\nsen \u0101rstam bija pien\u0101kums un ties\u012bbas br\u012bvi lemt par pacienta \u0101rs-<br \/>\nt\u0113\u0161anas kursu un nek\u0101du pras\u012bbu par pacienta inform\u0113\u0161anu nebija.<br \/>\nTurpretim PMA \u00abPacientu ties\u012bbu deklar\u0101cijas\u00bb 1995. gada versija<br \/>\ns\u0101kas ar \u0161\u0101du apgalvojumu: \u00abP\u0113d\u0113j\u0101 laik\u0101 attiec\u012bbas starp \u0101rstiem,<br \/>\npacientiem un sabiedr\u012bbu kopum\u0101 ir b\u016btiski main\u012bju\u0161\u0101s. Kaut gan<br \/>\n\u0101rstam vienm\u0113r j\u0101r\u012bkojas saska\u0146\u0101 ar savu sirdsapzi\u0146u un vienm\u0113r \u2014<br \/>\ndai citai. \u0160aj\u0101s sabiedr\u012bb\u0101s noteico\u0161o lomu \u0113tiskas uzved\u012bbas izv\u0113l\u0113<br \/>\nnosaka kult\u016bras \u012bpatn\u012bbas un reli\u0123ija.<br \/>\nDa\u017e\u0101d\u0101s sabiedr\u012bb\u0101s, reiz\u0113m vien\u0101 un taj\u0101 pa\u0161\u0101 sabiedr\u012bb\u0101, atbilde<br \/>\nuz jaut\u0101jumu, kur\u0161 izlemj, kas visp\u0101r ir \u0113tisks, var b\u016bt at\u0161\u0137ir\u012bga. Libe-<br \/>\nr\u0101l\u0101k\u0101s sabiedr\u012bb\u0101s indiv\u012bdam tiek pie\u0161\u0137irta liela izv\u0113les un r\u012bc\u012bbas<br \/>\nbr\u012bv\u012bba, ta\u010du visticam\u0101k to ietekm\u0113s draugi, \u0123imene, reli\u0123ija, pla\u0161-<br \/>\nsazi\u0146as l\u012bdzek\u013ci un citi \u0101r\u0113ji avoti. Savuk\u0101rt tradicion\u0101l\u0101k orient\u0113t\u0101s<br \/>\nsabiedr\u012bb\u0101s b\u016btisk\u0101ka noz\u012bme \u0113tisku principu noteik\u0161an\u0101 ir \u0123imenei<br \/>\nun cil\u0161u vec\u0101kajiem, reli\u0123iskaj\u0101m autorit\u0101t\u0113m un politiskajiem l\u012bde-<br \/>\nriem, nevis atsevi\u0161\u0137am indiv\u012bdam.<br \/>\nPar sp\u012bti \u0161\u012bm at\u0161\u0137ir\u012bb\u0101m vairums cilv\u0113ku sp\u0113j vienoties par da\u017eiem<br \/>\nkop\u012bgiem \u0113tikas pamatprincipiem, proti, cilv\u0113ka pamatties\u012bbas ir<br \/>\nnoteiktas ANO Visp\u0101r\u0113j\u0101 cilv\u0113kties\u012bbu deklar\u0101cij\u0101 (United Nations<br \/>\nUniversal Declaration of Human Rights) un citos atz\u012btos un o\ufb01ci\u0101li<br \/>\npie\u0146emtos dokumentos. Par vissvar\u012bg\u0101kaj\u0101m cilv\u0113kties\u012bb\u0101m no me-<br \/>\ndic\u012bnas \u0113tikas viedok\u013ca uzskat\u0101mas ties\u012bbas uz dz\u012bv\u012bbu, br\u012bv\u012bba no<br \/>\ndiskrimin\u0101cijas, k\u0101 ar\u012b no sp\u012bdzin\u0101\u0161anas un cietsird\u012bgas, nehum\u0101nas<br \/>\nun pazemojo\u0161as attieksmes, uzskatu un v\u0101rda br\u012bv\u012bba, vien\u0101das tie-<br \/>\ns\u012bbas uz sabiedrisko pakalpojumu pieejam\u012bbu valst\u012b un ties\u012bbas uz<br \/>\nmedic\u012bnisk\u0101s apr\u016bpes pieejam\u012bbu.<br \/>\nUz jaut\u0101jumu \u00abKur\u0161 izlemj, kas ir \u0113tisks un kas \u2014 ne?\u00bb \u0101rstu atbil-<br \/>\nde v\u0113l pavisam nesen bija nedaudz cit\u0101da nek\u0101 p\u0101r\u0113jiem cilv\u0113kiem.<br \/>\nGadsimtu gait\u0101 \u0101rstu vid\u0113 izveidoj\u0101s savi uzved\u012bbas standarti \u0113tikas<br \/>\nkodeksu un deklar\u0101ciju veid\u0101, kas bija j\u0101iev\u0113ro profesion\u0101l\u0101s gru-<br \/>\npas locek\u013ciem. Pasaules l\u012bmen\u012b PMA ir noteikusi pla\u0161as un visp\u0101r\u012bgas<br \/>\n\u0113tiska rakstura nost\u0101dnes, kas nosaka \u0101rstu uzved\u012bbas standartus<br \/>\nneatkar\u012bgi no t\u0101, kur tie dz\u012bvo un praktiz\u0113.Vairum\u0101 valstu, varb\u016bt pat<br \/>\nit vis\u0101s valst\u012bs, \u0101rstu biedr\u012bbas ir atbild\u012bgas par \u0161o standartu att\u012bst\u012b\u0161a-<br \/>\nnu un ievie\u0161anu. Atkar\u012bb\u0101 no attiec\u012bg\u0101s valsts pieejas medic\u012bnas tie-<br \/>\nsiskajam regul\u0113jumam \u0161ie standarti var ieg\u016bt ties\u012bbu aktu statusu.<br \/>\n\u00ab..\u0161\u0101d\u0101 l\u0113mumu<br \/>\npie\u0146em\u0161anas br\u012bd\u012b ir visai<br \/>\nlietder\u012bgi zin\u0101t, k\u0101 l\u012bdz\u012bg\u0101<br \/>\nsitu\u0101cij\u0101 r\u012bkotos citi<br \/>\nkol\u0113\u0123i.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n24 25<br \/>\nMedic\u012bnas zin\u0101tnes un tehnolo\u0123iju izaugsme ir izrais\u012bjusi virkni<br \/>\n\u0113tiska rakstura jaut\u0101jumu, uz kuriem tradicion\u0101l\u0101 medic\u012bnas \u0113tika<br \/>\nnesp\u0113j rast atbildes. M\u0101ksl\u012bg\u0101 apaug\u013co\u0161ana, \u0123en\u0113tika un vesel\u012bbas<br \/>\ndatu informatiz\u0113\u0161ana, k\u0101 ar\u012b dz\u012bv\u012bbas uztur\u0113\u0161anas un paildzin\u0101\u0161anas<br \/>\ntehnolo\u0123ijas \u2014 tas viss prasa \u0101rstu l\u012bdzdal\u012bbu un atkar\u012bb\u0101 no t\u0101, k\u0101<br \/>\nt\u0101s piem\u0113ro praks\u0113, var nest pacientam ne vien lielu labumu, bet<br \/>\nar\u012b potenci\u0101lu kait\u0113jumu. Lai pal\u012bdz\u0113tu \u0101rstiem izlemt, vai visp\u0101r un<br \/>\nk\u0101dos apst\u0101k\u013cos \u0161\u0101das darb\u012bbas veikt, \u0101rstu biedr\u012bb\u0101m j\u0101piem\u0113ro<br \/>\nda\u017e\u0101da rakstura situ\u0101cijas anal\u012bzes metodes, lai gan vienk\u0101r\u0161i var\u0113ja<br \/>\natsaukties uz eso\u0161ajiem medic\u012bnas \u0113tikas kodeksiem.<br \/>\nPar sp\u012bti \u0161\u012bm krasaj\u0101m p\u0101rmai\u0146\u0101m medic\u012bnas \u0113tik\u0101 \u0101rstu vid\u016b valda<br \/>\nvienpr\u0101t\u012bba, ka medic\u012bnas pamatv\u0113rt\u012bbas un \u0113tiskie principi nav gro-<br \/>\nz\u0101mi, vismaz tiem nevajadz\u0113tu main\u012bties. T\u0101 k\u0101 cilv\u0113ks b\u016bs pak\u013cauts<br \/>\nda\u017e\u0101d\u0101m slim\u012bb\u0101m, vienm\u0113r b\u016bs vajadz\u012bga l\u012bdzciet\u012bga, kompetenta<br \/>\nun autonoma \u0101rsta pal\u012bdz\u012bba.<br \/>\nVAI MEDIC\u012aNAS \u0112TIKA DA\u017d\u0100D\u0100S VALST\u012aS IR AT\u0160\u0136IR\u012aGA?<br \/>\nT\u0101pat k\u0101 medic\u012bnas \u0113tika var main\u012bties un ar\u012b main\u0101s laika gait\u0101,<br \/>\natt\u012bstoties medic\u012bnas zin\u0101tnei un tehnolo\u0123ij\u0101m, k\u0101 ar\u012b mainoties<br \/>\nsoci\u0101l\u0101m v\u0113rt\u012bb\u0101m, t\u0101 atkar\u012bb\u0101 no \u0161iem pa\u0161iem faktoriem var b\u016bt<br \/>\nat\u0161\u0137ir\u012bga da\u017e\u0101d\u0101s valst\u012bs. Piem\u0113ram, eitan\u0101zijas jaut\u0101jum\u0101 da\u017e\u0101du<br \/>\nvalstu \u0101rstu biedr\u012bb\u0101m ir krasi at\u0161\u0137ir\u012bgi viedok\u013ci. Vienas to piln\u012bb\u0101<br \/>\nnoliedz, citas ie\u0146em neitr\u0101lu poz\u012bciju, bet vismaz viena \u2014 Karalis-<br \/>\nk\u0101 N\u012bderlandes \u0100rstu biedr\u012bba \u2014 noteiktos apst\u0101k\u013cos to atz\u012bst. T\u0101-<br \/>\npat jaut\u0101jum\u0101 par vesel\u012bbas apr\u016bpes pieejam\u012bbu da\u017eu valstu \u0101rstu<br \/>\nbiedr\u012bbas atbalsta visu pilso\u0146u vienl\u012bdz\u012bbas principu, kam\u0113r citas<br \/>\npie\u013cauj sam\u0113r\u0101 lielu nevienl\u012bdz\u012bbu. Da\u017e\u0101s valst\u012bs ir liela interese par<br \/>\nmedic\u012bnas \u0113tikas probl\u0113m\u0101m saist\u012bb\u0101 ar jaun\u0101ko medic\u012bnas tehno-<br \/>\nlo\u0123iju lietojumu, turpretim cit\u0101s, kur t\u0101s nav pieejamas, \u0161\u0101da vei-<br \/>\nda probl\u0113mas nerodas. Daudz\u0101s valst\u012bs \u0101rsti j\u016btas dro\u0161i, ka vald\u012bba<br \/>\nvi\u0146u darb\u0101 neiejauksies un nespied\u012bs pie\u0146emt ne\u0113tiskus l\u0113mumus,<br \/>\npacienta interes\u0113s, vi\u0146am taj\u0101 pa\u0161\u0101 laik\u0101 j\u0101nodro\u0161ina ar\u012b pacienta<br \/>\nautonomija un taisn\u012bgums.\u00bb \u0160obr\u012bd daudzi uzskata, ka vi\u0146i pa\u0161i sev<br \/>\nir vesel\u012bbas apr\u016bpes sniedz\u0113ji, \u0101rstam atv\u0113lot vien\u012bgi konsultanta vai<br \/>\nizgl\u012btot\u0101ja lomu. Lai ar\u012b \u0161\u0101ds redz\u0113jums par pa\u0161apr\u016bpi k\u0101 vesel\u012bbas<br \/>\napr\u016bpes n\u0101kotni nepavisam nav visp\u0101rin\u0101ms, tom\u0113r \u0161\u0101da v\u0113lme<br \/>\nturpina pieaugt un ir simptom\u0101tiska \u0101rsta un pacienta attiec\u012bbu<br \/>\np\u0101rmai\u0146u tendence, kas uzliek \u0101rstam cit\u0101dus \u0113tiskos pien\u0101kumus<br \/>\nnek\u0101 bija iepriek\u0161.<br \/>\nV\u0113l pavisam nesen \u0101rsti uzskat\u012bja, ka vi\u0146i ir atbild\u012bgi tikai sevis, savu<br \/>\nkol\u0113\u0123u, vai \u2014 tic\u012bgie \u2014 Dieva priek\u0161\u0101. M\u016bsdien\u0101s \u0101rstiem bez atbil-<br \/>\nd\u012bbas par saviem pacientiem ir j\u0101uz\u0146emas ar\u012b papildu atbild\u012bba \u2014<br \/>\nvi\u0146iem j\u0101r\u0113\u0137in\u0101s ar tre\u0161\u0101s puses, k\u0101, piem\u0113ram, slimn\u012bcas vai vese-<br \/>\nl\u012bbas apr\u016bpes organiz\u0113t\u0101ju1<br \/>\n, da\u017e\u0101du<br \/>\nlicenz\u0113\u0161anas komisiju un p\u0101rraudz\u012bbas<br \/>\niest\u0101\u017eu viedokli, ar\u012b ar atbild\u012bbu tiesas<br \/>\npriek\u0161\u0101. \u0160\u012bs da\u017e\u0101d\u0101s atbild\u012bbas nereti<br \/>\nnon\u0101k pretrun\u0101 cita ar citu, k\u0101 tas b\u016bs<br \/>\nredzams tre\u0161aj\u0101 noda\u013c\u0101 diskusij\u0101 par<br \/>\ndubultlojalit\u0101ti.<br \/>\nAr\u012b cit\u0101s jom\u0101s medic\u012bnas \u0113tika ir main\u012bjusies. V\u0113l pavisam nesen<br \/>\n\u0113tikas kodeksi noliedza abortus, bet tagad vairum\u0101 valstu daudzos<br \/>\ngad\u012bjumos \u0101rstu attieksme pret tiem ir visai ieciet\u012bga. Ja tradicion\u0101-<br \/>\nlaj\u0101 medic\u012bnas \u0113tik\u0101 \u0101rsta atbild\u012bba galvenok\u0101rt bija saist\u012bta ar in-<br \/>\ndividu\u0101lu pacientu, tagad valda uzskats, ka \u0101rstam j\u0101\u0146em v\u0113r\u0101 ar\u012b<br \/>\nsabiedr\u012bbas vajadz\u012bbas, piem\u0113ram, izlietojot ierobe\u017eotos vesel\u012bbas<br \/>\napr\u016bpes resursus.<br \/>\n1. Terminam, kas lietots kodeksa ang\u013cu tekst\u0101 managed healthcare organizati-<br \/>\nons vai fran\u010du administrations de soins de sant\u00e9, nav tie\u0161as atbilsmes latvie\u0161u<br \/>\nvalod\u0101, jo \u0161\u0101ds vesel\u012bbas apr\u016bpes apdro\u0161in\u0101\u0161anas un organiz\u0101cijas veids uz-<br \/>\nskat\u0101ms par speci\ufb01sku ASV eksist\u0113jo\u0161u par\u0101d\u012bbu, kam vairum\u0101 valstu analoga<br \/>\nnav. T\u0101d\u0113\u013c latviski \u0161eit izv\u0113l\u0113ts visp\u0101r\u012bgs termins.<br \/>\n\u00ab\u0160\u012bs da\u017e\u0101d\u0101s atbild\u012bbas<br \/>\nnereti non\u0101k pretrun\u0101 cita<br \/>\nar citu..\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n26 27<br \/>\nka nek\u0101 pirmie divi dokumenti, jo tikai 1964. gad\u0101 \u0161\u012bs vadl\u012bnijas<br \/>\ntika pie\u0146emtas Helsinku deklar\u0101cij\u0101 (Declaration of Helsinki). Ar\u012b \u0161is<br \/>\ndokuments ir ticis vair\u0101kk\u0101rt p\u0101rstr\u0101d\u0101ts un labots, p\u0113d\u0113jo reizi \u2014<br \/>\n2000. gad\u0101.<br \/>\nPapildus \u0161\u012bm \u0113tikas pamatatzi\u0146\u0101m PMA ir pie\u0146\u0113musi r\u012bc\u012bbpolitikas<br \/>\npamatnost\u0101dnes par vair\u0101k nek\u0101 simts jaut\u0101jumiem. Vairum\u0101 gad\u012b-<br \/>\njumu tie bija \u0113tiskas dabas, tom\u0113r da\u017ei<br \/>\nno tiem sk\u0101ra soci\u0101lmedic\u012bnisku te-<br \/>\nmatiku, ieskaitot medic\u012bnisko izgl\u012bt\u012bbu<br \/>\nun vesel\u012bbas apr\u016bpes sist\u0113mas. Katru<br \/>\ngadu PMA \u0122ener\u0101laj\u0101 asamblej\u0101 tiek<br \/>\nlaboti un papildin\u0101ti da\u017ei jau eso\u0161ie<br \/>\ndokumenti, k\u0101 ar\u012b pie\u0146emti jauni.<br \/>\nK\u0100 PMA IZLEMJ, KAS IR \u0112TISKS?<br \/>\nSasniegt starptautisku vienpr\u0101t\u012bbu pretrun\u012bgos \u0113tiskas dabas jaut\u0101-<br \/>\njumos nav viegls uzdevums pat t\u0101d\u0101 sam\u0113r\u0101 viendab\u012bg\u0101 grup\u0101 k\u0101<br \/>\n\u0101rsti. Lai pie\u0146emtu l\u0113mumu par katra \u0113tiskas dabas jaut\u0101juma izlem-<br \/>\n\u0161anu vai eso\u0161o nost\u0101d\u0146u p\u0101rstr\u0101d\u0101\u0161anu, PMA \u0122ener\u0101laj\u0101 asamblej\u0101<br \/>\ntam j\u0101nodro\u0161ina konsenss ar vismaz 75% balsu atbalstu. Priek\u0161no-<br \/>\nsac\u012bjums, lai sasniegtu tik lielu vienpr\u0101t\u012bbu, ir pla\u0161as konsult\u0101cijas<br \/>\npar konkr\u0113to \u0113tikas pamatnost\u0101d\u0146u projektu, r\u016bp\u012bgi ieklausoties<br \/>\nPMA Medic\u012bnas \u0113tikas komitejas koment\u0101ros vai da\u017ek\u0101rt ar\u012b attie-<br \/>\nc\u012bg\u0101s probl\u0113mas anal\u012bzes ieteikumos, ko dod speci\u0101li izp\u0113tei izvei-<br \/>\ndota darba grupa un, turpm\u0101k p\u0101rstr\u0101-<br \/>\nd\u0101jot projektu, un bie\u017ei vien turpinot<br \/>\natk\u0101rtotas konsult\u0101cijas. \u0160is process<br \/>\natkar\u012bb\u0101 no jaut\u0101juma aktualit\u0101tes var<br \/>\nb\u016bt \u013coti laikietilp\u012bgs un sare\u017e\u0123\u012bts. Pie-<br \/>\nm\u0113ram, p\u0113d\u0113j\u0101 Helsinku deklar\u0101cijas<br \/>\np\u0101rstr\u0101d\u0101\u0161ana tika uzs\u0101kta 1997. gada<br \/>\nturpret\u012b cit\u0101s zem\u0113s \u0101rstiem ir sam\u0113r\u0101 gr\u016bti iev\u0113rot \u0113tikas kodek-<br \/>\nsu, piem\u0113ram, nodro\u0161in\u0101t pacientu kon\ufb01dencialit\u0101ti, saduroties ar<br \/>\npolicijas vai armijas pras\u012bb\u0101m sniegt zi\u0146as par \u00abaizdom\u012bgiem\u00bb ie-<br \/>\nvainojumiem.<br \/>\nLai ar\u012b \u0161\u012bs at\u0161\u0137ir\u012bbas \u0161\u0137iet \u013coti b\u016btiskas, tom\u0113r l\u012bdz\u012bg\u0101 ir daudz vair\u0101k.<br \/>\nPasaul\u0113 \u0101rstiem ir daudz kas kop\u012bgs, un, kad tie apvienojas t\u0101d\u0101s or-<br \/>\nganiz\u0101cij\u0101s k\u0101 PMA, parasti sp\u0113j vienoties par kop\u012bgu viedokli pret-<br \/>\nrun\u012bgos \u0113tiskos jaut\u0101jumos, kaut ar\u012b bie\u017ei tas prasa garas debates<br \/>\nun diskusijas. T\u0101das fundament\u0101las pamatv\u0113rt\u012bbas k\u0101 l\u012bdzciet\u012bba,<br \/>\nkompetence un autonomija kop\u0101 ar \u0101rsta pieredzi un prasm\u0113m par<br \/>\nvisiem medic\u012bnas un vesel\u012bbas apr\u016bpes aspektiem rada kop\u012bgu b\u0101zi<br \/>\nmedic\u012bnas \u0113tikas jaut\u0101jumu anal\u012bzei un rod risin\u0101jumu, kas ir visla-<br \/>\nb\u0101kie gan individu\u0101liem pacientiem un pilso\u0146iem, gan ar\u012b atbilst<br \/>\nkop\u012bg\u0101m sabiedr\u012bbas vesel\u012bbas interes\u0113m.<br \/>\nPASAULES MEDIC\u012aNAS ASOCI\u0100CIJAS NOZ\u012aME<br \/>\nK\u0101 vien\u012bg\u0101 starptautisk\u0101 organiz\u0101cija, kas p\u0101rst\u0101v visus \u0101rstus neat-<br \/>\nkar\u012bgi no to taut\u012bbas vai specialit\u0101tes, PMA ir ap\u0146\u0113musies iedibin\u0101t<br \/>\nvisp\u0101r\u0113jas, pasaul\u0113 piem\u0113rojamas medic\u012bnas \u0113tikas pamatnormas.<br \/>\nJau no pa\u0161a darb\u012bbas s\u0101kuma (1947) t\u0101 ir str\u0101d\u0101jusi, lai neatk\u0101rto-<br \/>\ntos t\u0101du ne\u0113tisku \u0101rstu r\u012bc\u012bbu, k\u0101da tika \u012bstenota nacistiskaj\u0101 V\u0101cij\u0101<br \/>\nun citur. PMA pirmais uzdevums bija piel\u0101got Hipokr\u0101ta zv\u0113restu<br \/>\nXX gadsimta vajadz\u012bb\u0101m, t\u0101p\u0113c tapa \u017den\u0113vas deklar\u0101cija (Decla-<br \/>\nration of Geneva), kas tika pie\u0146emta PMA 2. \u0122ener\u0101laj\u0101 asamblej\u0101<br \/>\n1948. gad\u0101. T\u0101 ir vair\u0101kk\u0101rt p\u0101rstr\u0101d\u0101ta, p\u0113d\u0113jo reizi \u2014 1994. gad\u0101.<br \/>\nOtrais uzdevums bija izveidot Starptautisko medic\u012bnas \u0113tikas ko-<br \/>\ndeksu (International Code of Medical Ethics), kuru pie\u0146\u0113ma 3. \u0122e-<br \/>\nner\u0101laj\u0101 asamblej\u0101 1949. gad\u0101. Tas tika p\u0101rstr\u0101d\u0101ts 1968. un 1983.<br \/>\ngad\u0101, un ar\u012b \u0161obr\u012bd risin\u0101s darbs pie k\u0101rt\u0113j\u0101s kodeksa redakcijas.<br \/>\nN\u0101kamais uzdevums, kur\u0101 iesaist\u012bj\u0101s PMA, bija \u0113tisku vadl\u012bniju iz-<br \/>\nstr\u0101de par p\u0113t\u012bjumiem ar cilv\u0113kiem. Tas aiz\u0146\u0113ma daudz vair\u0101k lai-<br \/>\n\u00ab..PMA ir ap\u0146\u0113musies<br \/>\niedibin\u0101t visp\u0101r\u0113jas,<br \/>\npasaul\u0113 piem\u0113rojamas<br \/>\nmedic\u012bnas \u0113tikas<br \/>\npamatnormas.\u00bb<br \/>\n\u00abSasniegt starptautisku<br \/>\nvienpr\u0101t\u012bbu pretrun\u012bgos<br \/>\n\u0113tiskas dabas jaut\u0101jumos<br \/>\nnav viegls uzdevums..\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n28 29<br \/>\n\u017ei vien medic\u012bnas praks\u0113 izvirz\u0101s t\u0101di<br \/>\n\u0113tiskas dabas jaut\u0101jumi, uz kuriem<br \/>\nneviena medic\u012bnisk\u0101 asoci\u0101cija nepie-<br \/>\nd\u0101v\u0101 gatavus ieteikumus. J\u0101\u0146em v\u0113r\u0101,<br \/>\nka tie\u0161i indiv\u012bdi pa\u0161i ir atbild\u012bgi par sa-<br \/>\nviem \u0113tiskas dabas l\u0113mumiem un to<br \/>\npiem\u0113ro\u0161anu.<br \/>\nIesp\u0113jamas da\u017e\u0101das pieejas t\u0101diem \u0113tiska rakstura jaut\u0101jumiem<br \/>\nk\u0101 konkr\u0113to gad\u012bjumu anal\u012bzei, kuri izkl\u0101st\u012bti \u0161\u012bs rokasgr\u0101matas s\u0101-<br \/>\nkum\u0101. Nosac\u012bti t\u0101s var iedal\u012bt div\u0101s liel\u0101s kategorij\u0101s: racion\u0101l\u0101s un<br \/>\nneracion\u0101las. Svar\u012bgi saprast, ka v\u0101rds \u00abneracion\u0101ls\u00bb \u0161aj\u0101 gad\u012bjum\u0101<br \/>\nnav lietots ar noz\u012bmi iracion\u0101ls, ar to glu\u017ei vienk\u0101r\u0161i saprot to, kas at-<br \/>\n\u0161\u0137iras no sistem\u0101tiskas un p\u0101rdom\u0101tas pr\u0101ta izmanto\u0161anas l\u0113muma<br \/>\npie\u0146em\u0161an\u0101.<br \/>\nNeracion\u0101l\u0101s pieejas:<br \/>\n\u2022 Paklaus\u012bba ir ierasts \u0113tisku l\u0113mumu pie\u0146em\u0161anas veids, it \u012bpa\u0161i<br \/>\nb\u0113rniem un tiem, kas str\u0101d\u0101 autorit\u0101ra rakstura instit\u016bcij\u0101s (pie-<br \/>\nm\u0113ram, armij\u0101, policij\u0101, reli\u0123isk\u0101s organiz\u0101cij\u0101s, daudzos uz\u0146\u0113-<br \/>\nmumos). Tikumiska uzved\u012bba tad noz\u012bm\u0113 tikai seko\u0161anu noteiku-<br \/>\nmiem vai nor\u0101d\u012bjumiem, kurus dod tie, kam dele\u0123\u0113ta vara, neat-<br \/>\nkar\u012bgi no t\u0101, vai indiv\u012bds tiem piekr\u012bt vai ne.<br \/>\n\u2022 Atdarin\u0101\u0161ana ir l\u012bdz\u012bga paklaus\u012bbai tai zi\u0146\u0101, ka bez ierun\u0101m tiek<br \/>\npie\u0146emts cita cilv\u0113ka, atdarin\u0101m\u0101s personas, spriedums. Tikumis-<br \/>\nka r\u012bc\u012bba t\u0101d\u0113j\u0101di ir seko\u0161ana atdarin\u0101majai personai. Iesp\u0113jams,<br \/>\n\u0161is ir visizplat\u012bt\u0101kais medic\u012bnas \u0113tikas apg\u016b\u0161anas veids, topo\u0161a-<br \/>\njiem \u0101rstiem m\u0101coties no pieredz\u0113 bag\u0101tiem kol\u0113\u0123iem \u2014 v\u0113rojot<br \/>\nvi\u0146us darb\u012bb\u0101 un apg\u016bstot vi\u0146u v\u0113rt\u012bbu sist\u0113mu.<br \/>\ns\u0101kum\u0101, bet pabeigta \u2014 tikai 2000. gada oktobr\u012b. Un ar\u012b tad vair\u0101ki<br \/>\njaut\u0101jumi palika neizskat\u012bti un nodoti Medic\u012bnas \u0113tikas komitejai un<br \/>\ndarba grup\u0101m jaut\u0101jumu preciz\u0113\u0161anai.<br \/>\nPareiza procesa norise ir svar\u012bga, bet t\u0101 ne vienm\u0113r garant\u0113 labu<br \/>\nrezult\u0101tu. Pie\u0146emot l\u0113mumus par \u0113tiskas dabas probl\u0113m\u0101m, PMA<br \/>\nbalst\u0101s uz sen\u0101m medic\u012bnas \u0113tikas trad\u012bcij\u0101m, kuras atspogu\u013cojas<br \/>\njau agr\u0101k pie\u0146emtaj\u0101s \u0113tikas pamatnost\u0101dn\u0113s.T\u0101pat t\u0101 \u0146em v\u0113r\u0101 ar\u012b<br \/>\ncitu pu\u0161u uzskatus par konkr\u0113to jaut\u0101jumu \u2014 gan valstu un starp-<br \/>\ntautisko organiz\u0101ciju o\ufb01ci\u0101lo nost\u0101ju, gan ar\u012b \u0113tikas jaut\u0101jumos pie-<br \/>\nredz\u0113ju\u0161u speci\u0101listu individu\u0101lo vie-<br \/>\ndokli. Da\u017eos jaut\u0101jumos, piem\u0113ram,<br \/>\npar inform\u0113to piekri\u0161anu, v\u0113rojama<br \/>\nvair\u0101kuma vienpr\u0101t\u012bba ar PMA, savu-<br \/>\nk\u0101rt citos, piem\u0113ram, par individu\u0101lo<br \/>\nmedic\u012bnisko datu kon\ufb01dencialit\u0101ti,<br \/>\n\u0101rstu viedoklis akt\u012bvi j\u0101aizst\u0101v pret val-<br \/>\nd\u012bbas, vesel\u012bbas apr\u016bpes sist\u0113mas or-<br \/>\nganizatoru un\/vai komercuz\u0146\u0113mumu<br \/>\npras\u012bb\u0101m. Pamatiez\u012bme, kas raksturo<br \/>\nPMA konceptu\u0101lo pieeju \u0113tikas jaut\u0101jumiem, ir priorit\u0101r\u0101s noz\u012bmes<br \/>\npie\u0161\u0137ir\u0161ana individu\u0101lam pacientam vai p\u0113t\u012bjuma dal\u012bbniekam. Cit\u0113-<br \/>\njot \u017den\u0113vas deklar\u0101ciju, \u0101rsts sola: \u00abPacienta vesel\u012bba man ir pirmaj\u0101<br \/>\nviet\u0101\u00bb. Helsinku deklar\u0101cij\u0101 formul\u0113ts: \u00abVeicot medic\u012bniskus p\u0113t\u012bju-<br \/>\nmus ar cilv\u0113kiem, pirmk\u0101rt, j\u0101\u0146em v\u0113r\u0101 konkr\u0113t\u0101 cilv\u0113ka labkl\u0101j\u012bba,<br \/>\nnevis zin\u0101tnes un sabiedr\u012bbas intereses\u00bb.<br \/>\nK\u0100 INDIV\u012aDS IZLEMJ, KAS IR \u0112TISKS?<br \/>\n\u0100rstiem un medic\u012bnas studentiem medic\u012bnas \u0113tika neaprobe\u017eojas<br \/>\nar vienk\u0101r\u0161u PMA vai citu \u0101rstu organiz\u0101ciju ieteikumu iev\u0113ro\u0161anu.<br \/>\n\u0160ie ieteikumi bie\u017ei vien ir visp\u0101r\u012bgi, un katram pa\u0161am j\u0101nov\u0113rt\u0113 ra-<br \/>\ndusies situ\u0101cija un j\u0101saprot, vai tos var piem\u0113rot vai ne. Turkl\u0101t bie-<br \/>\n\u00abDa\u017eos jaut\u0101jumos, ..<br \/>\n\u0101rstu viedoklis akt\u012bvi<br \/>\nj\u0101aizst\u0101v pret vald\u012bbas,<br \/>\nvesel\u012bbas apr\u016bpes sist\u0113mas<br \/>\norganizatoru un\/vai<br \/>\nkomercuz\u0146\u0113mumu<br \/>\npras\u012bb\u0101m.\u00bb<br \/>\n\u00abJ\u0101\u0146em v\u0113r\u0101, ka tie\u0161i<br \/>\nindiv\u012bdi pa\u0161i ir atbild\u012bgi<br \/>\npar saviem \u0113tiskas<br \/>\ndabas l\u0113mumiem un to<br \/>\npiem\u0113ro\u0161anu.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n30 31<br \/>\npirms interes\u0113jas par racion\u0101laj\u0101m pieej\u0101m. T\u0101s ir \u010detras: deontolo-<br \/>\n\u0123ija, konsekvent\u0101lisms, principi\u0101lisms un tikumu \u0113tika.<br \/>\n\u2022 Deontolo\u0123ija r\u016bp\u0113jas par labi pamatotu likumu mekl\u0113\u0161anu, kas<br \/>\nvar\u0113tu kalpot par pamatu mor\u0101la rakstura l\u0113mumu pie\u0146em\u0161anai.<br \/>\nLabs piem\u0113rs ir atzi\u0146a \u00abpret visiem cilv\u0113kiem izturies vien\u0101di\u00bb. T\u0101s<br \/>\npamats var b\u016bt reli\u0123isks (visas Dieva rad\u012bt\u0101s cilv\u0113cisk\u0101s b\u016btnes ir<br \/>\nvienl\u012bdz\u012bgas) vai nereli\u0123isks (visi cilv\u0113ki ir gandr\u012bz vienu un to pa\u0161u<br \/>\ng\u0113nu nes\u0113ji). Kad likumi ir ieviesti, atliek tos piem\u0113rot da\u017e\u0101d\u0101s<br \/>\nkonkr\u0113t\u0101s situ\u0101cij\u0101s, un te jau rodas vieta domstarp\u012bb\u0101m par to,<br \/>\nko \u012bsti likumi no mums pieprasa (piem\u0113ram, vai likums par citas<br \/>\ncilv\u0113c\u012bgas b\u016btnes non\u0101v\u0113\u0161anas nepie\u013caujam\u012bbu aizliedz ar\u012b abortu<br \/>\nvai n\u0101vessodu).<br \/>\n\u2022 Konsekvent\u0101lisms \u0113tisko l\u0113mumu pie\u0146em\u0161anu balsta uz da\u017e\u0101-<br \/>\ndu seku un iesp\u0113jamo galarezult\u0101tu anal\u012bzi. Pareiza r\u012bc\u012bba nedod<br \/>\nvislab\u0101kos gala rezult\u0101tus. Protams, ar\u012b te iesp\u0113jamas domstarp\u012b-<br \/>\nbas par to, kas tad ir uzskat\u0101ms par labu gala rezult\u0101tu. Viens no<br \/>\nlab\u0101k zin\u0101majiem konsekvent\u0101lisma paveidiem \u2014 utilit\u0101risms \u2014<br \/>\njau nosaukum\u0101 ietver t\u0101du m\u0113ru k\u0101 lietder\u012bbu, to de\ufb01n\u0113jot k\u0101 ie-<br \/>\nsp\u0113ju \u00abpan\u0101kt iesp\u0113jami liel\u0101ku labumu iesp\u0113jami liel\u0101kai cilv\u0113ku<br \/>\ngrupai\u00bb. Citi gala rezult\u0101tu raksturlielumi, ko m\u0113dz lietot vesel\u012bbas<br \/>\napr\u016bpes l\u0113mumu pie\u0146em\u0161an\u0101, ir izmaksu efektivit\u0101te un dz\u012bves<br \/>\nkvalit\u0101te, kuru izsaka ar \u2014 QALY (quality-adjusted life-years, p\u0113c<br \/>\nkvalit\u0101tes standartiz\u0113tie m\u016b\u017ea gadi) vai ar DALY (disability-adjus-<br \/>\nted life-years, p\u0113c nesp\u0113jas standartiz\u0113tie m\u016b\u017ea gadi). Konsek-<br \/>\nvent\u0101lisma piekrit\u0113ji neizmanto p\u0101r\u0101k daudz principu \u2014 tos ir<br \/>\ntik gr\u016bti identi\ufb01c\u0113t, sak\u0101rtot priorit\u0101r\u0101 sec\u012bb\u0101 un piem\u0113rot dz\u012bv\u0113,<br \/>\nt\u0101pat bie\u017ei vien vi\u0146i ne\u0146em v\u0113r\u0101, ko tad \u012bsti noz\u012bm\u0113 mor\u0101la rakstu-<br \/>\nra l\u0113mumu pie\u0146em\u0161anas pamats, proti, gala rezult\u0101ti. \u0160\u012b nosac\u012bt\u0101<br \/>\natteik\u0161an\u0101s no principiem var rad\u012bt iespaidu par \u00abm\u0113r\u0137is attaisno<br \/>\nl\u012bdzek\u013cus\u00bb, t\u0101d\u0113\u013c, piem\u0113ram, lai sasniegtu k\u0101du soci\u0101lu m\u0113r\u0137i, var<br \/>\nneiev\u0113rot individu\u0101l\u0101s cilv\u0113kties\u012bbas.<br \/>\n\u2022 Izj\u016btas vai v\u0113lmes \u2014 subjekt\u012bva pieeja mor\u0101las dabas l\u0113mumu<br \/>\npie\u0146em\u0161anai un uzved\u012bbai. Pareizs ir tas, ko izj\u016bt par pareizu vai<br \/>\nkas apmierina k\u0101da v\u0113lmes, savuk\u0101rt tas, ko izj\u016bt par nepareizu<br \/>\nvai kas \u0161\u0101das v\u0113lmes nepiepilda, ir nepareizs. Tikumiskas uzve-<br \/>\nd\u012bbas m\u0113rs mekl\u0113jams katr\u0101 indiv\u012bd\u0101, un, protams, tas b\u016bs krasi<br \/>\nat\u0161\u0137ir\u012bgs ne vien da\u017e\u0101diem indiv\u012bdiem, bet pat vienam un tam pa-<br \/>\n\u0161am cilv\u0113kam da\u017e\u0101dos laika posmos.<br \/>\n\u2022 Intu\u012bcija ir s\u0101kotn\u0113j\u0101 uztvere (saj\u016btu impulss), k\u0101 konkr\u0113t\u0101 situ-<br \/>\n\u0101cij\u0101 vajadz\u0113tu r\u012bkoties. T\u0101 ir l\u012bdz\u012bga jau min\u0113taj\u0101m izj\u016bt\u0101m vai<br \/>\nv\u0113lm\u0113m,un ar\u012b t\u0101 ir piln\u012bgi subjekt\u012bva, tom\u0113r intu\u012bcija dr\u012bz\u0101k sais-<br \/>\nt\u0101ma ar pr\u0101tu, nevis ar gribu. Sal\u012bdzin\u0101jum\u0101 ar paklaus\u012bbu, atdari-<br \/>\nn\u0101\u0161anu un izj\u016bt\u0101m vai v\u0113lm\u0113m t\u0101 zin\u0101m\u0101 m\u0113r\u0101 jau ir tuv\u0101ka racio-<br \/>\nn\u0101lai \u0113tisku l\u0113mumu pie\u0146em\u0161anai. Tom\u0113r t\u0101 nav ne sistem\u0101tiska,<br \/>\nne p\u0101rdom\u0101ta, un l\u0113mumu pie\u0146em\u0161ana balst\u0101s uz acumirkl\u012bgu<br \/>\niek\u0161\u0113jo saj\u016btu impulsu. T\u0101pat k\u0101 iepriek\u0161\u0113j\u0101 pieeja, ar\u012b \u0161\u012b ir indivi-<br \/>\ndu\u0101la un b\u016bs krasi at\u0161\u0137ir\u012bga ne vien da\u017e\u0101diem indiv\u012bdiem, bet pat<br \/>\nvienam un tam pa\u0161am cilv\u0113kam da\u017e\u0101dos laika posmos.<br \/>\n\u2022 Ieradums ir \u013coti efekt\u012bva l\u0113mumu pie\u0146em\u0161anas metode, jo nav<br \/>\nnepiecie\u0161ams atk\u0101rtot sistem\u0101tisku l\u0113mumu pie\u0146em\u0161anas proce-<br \/>\nsu ik reizes, kad rodas k\u0101ds \u0113tiskas dabas jaut\u0101jums, kas l\u012bdz\u012bgs jau<br \/>\nreiz biju\u0161am. Tom\u0113r ir gan slikti (piem\u0113ram, melo\u0161ana), gan labi<br \/>\nieradumi (piem\u0113ram, paties\u012bbas teik\u0161ana), turkl\u0101t \u0161\u0137ietami l\u012bdz\u012b-<br \/>\ngas situ\u0101cijas reiz\u0113m pieprasa \u013coti at\u0161\u0137ir\u012bgus l\u0113mumus. Lai ar\u012b cik<br \/>\nieradums b\u016btu der\u012bgs, piln\u012bgi uz to pa\u013cauties nevar.<br \/>\nRacion\u0101l\u0101s pieejas:<br \/>\nT\u0101 k\u0101 \u0113tika ir tikumiskas r\u012bc\u012bbas jaut\u0101jumu izp\u0113te studiju discipl\u012bna,<br \/>\nt\u0101, protams, paz\u012bst un pie\u0146em, ka \u0113tiskas dabas uzved\u012bb\u0101 un l\u0113mu-<br \/>\nmu pie\u0146em\u0161an\u0101 domin\u0113 \u0161\u012bs neracion\u0101l\u0101s pieejas. Tom\u0113r \u0113tika vis-<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n32 33<br \/>\nun m\u0113\u0123in\u0101t tos piem\u0113rot pla\u0161\u0101k. L\u012bdz ar to vajadz\u0113tu izzin\u0101t ar\u012b citu<br \/>\nalternat\u012bvu l\u0113mumu iesp\u0113jam\u0101s sekas un izv\u0113l\u0113ties, kuras liekas v\u0113-<br \/>\nlam\u0101k\u0101s. Visbeidzot n\u0101ktos nodro\u0161in\u0101t, lai \u0161\u0101da l\u0113muma pie\u0146\u0113m\u0113ja<br \/>\nun \u012bstenot\u0101ja patiesi b\u016btu apbr\u012bnas v\u0113rta. \u0160is process ietvertu \u0161\u0101dus<br \/>\npas\u0101kumus:<br \/>\n1. Noteikt, vai apskat\u0101majam jaut\u0101jumam piem\u012bt \u0113tisks rak-<br \/>\nsturs.<br \/>\n2. Konsult\u0101cijas ar autoritat\u012bviem avotiem \u2014 s\u0101kot ar medi-<br \/>\nc\u012bnisko asoci\u0101ciju \u0113tikas kodeksiem un r\u012bc\u012bbpolitikas doku-<br \/>\nmentiem un beidzot ar cien\u012bjamiem kol\u0113\u0123iem, lai izzin\u0101tu,<br \/>\nk\u0101 citi \u0101rsti risin\u0101tu \u0161o probl\u0113mu.<br \/>\n3. Apsv\u0113rt alternat\u012bvus risin\u0101jumus no \u0161o principu viedok\u013ca,<br \/>\nkas ir atbilsto\u0161i tajos ietvertajai v\u0113rt\u012bbu sist\u0113mai un iesp\u0113ja-<br \/>\nmaj\u0101m sek\u0101m.<br \/>\n4. Apspriest pied\u0101v\u0101to risin\u0101jumu ar cilv\u0113kiem, kurus tas var\u0113-<br \/>\ntu skart.<br \/>\n5. Izdar\u012bt l\u0113mumu un r\u012bkoties saska\u0146\u0101 ar to, respekt\u0113jot citas<br \/>\niesaist\u012bt\u0101s personas.<br \/>\n6. Nov\u0113rt\u0113t savu l\u0113mumu un b\u016bt gatavam n\u0101kotn\u0113 r\u012bkoties ci-<br \/>\nt\u0101di.<br \/>\n\u2022 Principi\u0101lisms, k\u0101 jau pats nosaukums to r\u0101da, l\u0113mumu pie\u0146em-<br \/>\n\u0161anas pamat\u0101 izvirza \u0113tiskus principus. Tie tiek piem\u0113roti da\u017e\u0101-<br \/>\nd\u0101m situ\u0101cij\u0101m, lai noteiktu, k\u0101 pareizi b\u016btu j\u0101r\u012bkojas, \u0146emot v\u0113r\u0101<br \/>\ngan likumus, gan iesp\u0113jam\u0101s r\u012bc\u012bbas sekas. P\u0113d\u0113j\u0101 laik\u0101 diskusij\u0101s<br \/>\npar da\u017e\u0101diem \u0113tiskas dabas jaut\u0101jumiem \u0161\u012b pieeja ir bijusi \u0101rk\u0101rt\u012b-<br \/>\ngi ietekm\u012bga, jo sevi\u0161\u0137i ASV. Diskusij\u0101s tika identi\ufb01c\u0113ti \u010detri vissva-<br \/>\nr\u012bg\u0101kie medic\u012bnas praks\u0113 piem\u0113rojamie principi \u0113tiska rakstura<br \/>\nl\u0113mumu pie\u0146em\u0161an\u0101: autonomijas respekt\u0113\u0161ana, dar\u012bt labu, ne-<br \/>\nkait\u0113t un taisn\u012bgums. Racion\u0101l\u0101 l\u0113mumu pie\u0146em\u0161an\u0101 principiem<br \/>\nir \u013coti svar\u012bga noz\u012bme. Tom\u0113r \u0161o \u010detru principu izv\u0113le un sarindo-<br \/>\n\u0161ana priorit\u0101r\u0101 sec\u012bb\u0101, s\u0101kot ar autonomiju, ir rietumu liber\u0101l\u0101s<br \/>\nkult\u016bras ietekme, nevis k\u0101da univers\u0101la principa atspogu\u013cojums.<br \/>\nTurkl\u0101t \u0161ie \u010detri principi noteikt\u0101s situ\u0101cij\u0101s var non\u0101kt pretrun\u0101<br \/>\ncits ar citu, t\u0101d\u0113\u013c vajadz\u012bgi noteikti krit\u0113riji vai metodes, kas \u013cautu<br \/>\n\u0161\u0101dus principu kon\ufb02iktus risin\u0101t.<br \/>\n\u2022 Tikumu \u0113tika vair\u0101k interes\u0113jas par l\u0113muma pie\u0146\u0113m\u0113ju raksturu<br \/>\nun to, k\u0101 raksturs izpau\u017eas vi\u0146a uzved\u012bb\u0101, nevis par pa\u0161u l\u0113mumu<br \/>\npie\u0146em\u0161anu. Tikumi ir izcilu mor\u0101lu \u012bpa\u0161\u012bbu kopums. K\u0101 jau ie-<br \/>\npriek\u0161 min\u0113ts, viens no svar\u012bg\u0101kajiem \u0101rsta tikumiem ir l\u012bdzciet\u012bba.<br \/>\nCiti tikumi iemieso god\u012bgumu, apdom\u012bbu un savas misijas apzi\u0146u.<br \/>\n\u0100rsti, kam \u0161\u0101di tikumi piem\u012bt, visticam\u0101k, pie\u0146ems ar\u012b pareizus l\u0113-<br \/>\nmumus un sp\u0113s tos pareizi \u012bstenot dz\u012bv\u0113. Tom\u0113r pat augsti tikum\u012b-<br \/>\ngi cilv\u0113ki m\u0113dz b\u016bt nedro\u0161i par to, k\u0101 r\u012bkoties noteikt\u0101s situ\u0101cij\u0101s,<br \/>\nun nav pasarg\u0101ti no aplamu l\u0113mumu pie\u0146em\u0161anas.<br \/>\nNeviena no \u0161\u012bm pieej\u0101m, k\u0101 ar\u012b jebkura cita, kas var\u0113tu tikt ieteik-<br \/>\nta, nevar pretend\u0113t uz visp\u0101r\u0113ju piekri\u0161anu. Indiv\u012bdi un vi\u0146u mot\u012bvi,<br \/>\ndodot priek\u0161roku racion\u0101lai vai neracion\u0101lai \u0113tiska rakstura l\u0113mu-<br \/>\nmu pie\u0146em\u0161anai, ir at\u0161\u0137ir\u012bgi. Tas ir izskaidrojams ar to, ka katrai no<br \/>\n\u0161\u012bm pieej\u0101m ir stipr\u0101s un v\u0101j\u0101s puses. Iesp\u0113jams, ka visu \u010detru pieeju<br \/>\nkombin\u0101cija, kas aptvertu visas lab\u0101k\u0101s \u012bpa\u0161\u012bbas, b\u016btu optim\u0101lais ra-<br \/>\ncion\u0101lu \u0113tisku l\u0113mumu pie\u0146em\u0161anas veids. Tad vajadz\u0113tu noskaid-<br \/>\nrot, kuri likumi un principi ir vispiem\u0113rot\u0101kie konkr\u0113taj\u0101 situ\u0101cij\u0101,<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n34 35<br \/>\nKOPSAVILKUMS<br \/>\n\u0160\u012b noda\u013ca nosac\u012bti sagatavoja las\u012bt\u0101ju tam, par ko<br \/>\nuzzin\u0101s n\u0101kamaj\u0101s noda\u013c\u0101s. Kad ir runa par speci\ufb01skiem<br \/>\nmedic\u012bnas \u0113tikas jaut\u0101jumiem, tad labi atcer\u0113ties, ka<br \/>\nlaika gait\u0101 \u0101rsti ar daudziem l\u012bdz\u012bgiem ir jau sastapu\u0161ies<br \/>\nun vi\u0146u uzkr\u0101t\u0101 pieredze un zin\u0101\u0161anas \u0161odien var b\u016bt<br \/>\n\u013coti noder\u012bgas. PMA un citas \u0101rstu organiz\u0101cijas turpina<br \/>\n\u0161o trad\u012bciju un sniedz \u0101rstiem noder\u012bgus \u0113tiskas dabas<br \/>\nieteikumus. Tom\u0113r, neraugoties uz sam\u0113r\u0101 lielo \u0101rstu<br \/>\nvienpr\u0101t\u012bbu \u0113tikas jaut\u0101jumos, konkr\u0113tos gad\u012bjumos<br \/>\natsevi\u0161\u0137i cilv\u0113ki var nepiekrist un ar\u012b nepiekr\u012bt vair\u0101kuma<br \/>\nviedoklim. V\u0113l jo vair\u0101k, \u0101rstu viedoklis var krasi at\u0161\u0137irties<br \/>\nno pacientu vai citu vesel\u012bbas apr\u016bpes sniedz\u0113ju<br \/>\nuzskatiem. Pirmais solis ce\u013c\u0101 uz \u0113tiska rakstura kon\ufb02iktu<br \/>\nrisin\u0101\u0161anu b\u016btu visiem \u0101rstiem skaidri apzin\u0101ties, ka<br \/>\npast\u0101v da\u017e\u0101das pieejas l\u0113mumu pie\u0146em\u0161an\u0101 par \u0113tiskas<br \/>\ndabas jaut\u0101jumiem, proti, nevis tikai t\u0101, kuru saredz<br \/>\nvi\u0146i pa\u0161i, bet ar\u012b citu iesaist\u012bto personu at\u0161\u0137ir\u012bg\u0101 pieeja.<br \/>\nTas pal\u012bdz\u0113s ar\u012b vi\u0146iem izv\u0113l\u0113ties vispareiz\u0101ko r\u012bc\u012bbu un<br \/>\nizskaidrot savus l\u0113mumus citiem.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Medic\u012bnas\u0113tikaspamatiez\u012bmes<br \/>\n36 37<br \/>\n2. NODA\u013bA.<br \/>\n\u0100RSTI UN PACIENTI<br \/>\nM\u0112R\u0136I<br \/>\nP\u0113c \u0161\u012bs noda\u013cas izlas\u012b\u0161anas j\u016bs var\u0113siet:<br \/>\n\u2022 izskaidrot, k\u0101p\u0113c visi pacienti ir peln\u012bju\u0161i cie\u0146u un<br \/>\nvien\u0101du attieksmi;<br \/>\n\u2022 noteikt b\u016btisk\u0101kos inform\u0113t\u0101s piekri\u0161anas elementus;<br \/>\n\u2022 izskaidrot, k\u0101 b\u016btu j\u0101pie\u0146em medic\u012bniski l\u0113mumi to<br \/>\npacientu viet\u0101, kas pa\u0161i nav sp\u0113j\u012bgi tos pie\u0146emt;<br \/>\n\u2022 izskaidrot pacienta datu kon\ufb01dencialit\u0101tes pamatojumu<br \/>\nun apzin\u0101ties likum\u0101 paredz\u0113tos iz\u0146\u0113mumus;<br \/>\n\u2022 apzin\u0101ties svar\u012bg\u0101k\u0101s \u0113tisk\u0101s probl\u0113mas, kas sastopamas<br \/>\ndz\u012bves s\u0101kum\u0101 un m\u016b\u017ea beig\u0101s;<br \/>\n\u2022 apkopot argumentus par un pret eitan\u0101ziju vai<br \/>\npal\u012bdz\u0113to pa\u0161n\u0101v\u012bbu1<br \/>\n, k\u0101 ar\u012b at\u0161\u0137ir\u012bbu starp \u0161o r\u012bc\u012bbu un<br \/>\npaliat\u012bvo apr\u016bpi vai attur\u0113\u0161anos no \u0101rst\u0113\u0161anas.<br \/>\n1. Latvie\u0161u valod\u0101 v\u0113l nav iedibin\u0101ts labs terminolo\u0123isks ekvivalents, kas<br \/>\nvisprec\u012bz\u0101k atbilstu ang\u013cu assisted suicide vai fran\u010du suicide assist\u00e9. \u0160eit<br \/>\nlietotais termins \u00abpal\u012bdz\u0113t\u0101 pa\u0161n\u0101v\u012bba\u00bb uzskat\u0101ms par ieteikumu, tom\u0113r<br \/>\ntas lab\u0101k atspogu\u013co b\u016bt\u012bbu nek\u0101 burtisks p\u0101rc\u0113lums \u00abasist\u0113t\u0101 pa\u0161n\u0101v\u012bba\u00bb,<br \/>\nkas latvie\u0161u valod\u0101 noz\u012bm\u0113tu tie\u0161u \u0101rsta kl\u0101tb\u016btni pa\u0161n\u0101v\u012bbas br\u012bd\u012b.L\u012bdzj\u016bt\u012bgs \u0101rsts<br \/>\n\u00a9 Jose Luis Pelaez, Inc.\/CORBIS<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n38 39<br \/>\nr\u0113t pacienta kon\ufb01dencialit\u0101ti laikmet\u0101, kad visi medic\u012bniskie dati<br \/>\ntiek uzglab\u0101ti elektronisk\u0101 form\u0101t\u0101 un kad tiek ieviesta p\u0101rvald\u012bt\u0101<br \/>\nvesel\u012bbas apr\u016bpe1<br \/>\n, k\u0101 ar\u012b pien\u0101kums saglab\u0101t dz\u012bv\u012bbu tad, kad vi\u0146am<br \/>\nl\u016bdz pasteidzin\u0101t n\u0101ves iest\u0101\u0161anos.<br \/>\n\u0160aj\u0101 noda\u013c\u0101 tiks apskat\u012btas se\u0161as t\u0113mas, kas \u0101rsta ikdienas praks\u0113<br \/>\nrada \u012bpa\u0161as probl\u0113mas: cie\u0146a un vien\u0101da attieksme; sazi\u0146a un pie-<br \/>\nkri\u0161ana; l\u0113mumu pie\u0146em\u0161ana r\u012bc\u012bbne-<br \/>\nsp\u0113j\u012bgu pacientu viet\u0101; kon\ufb01denciali-<br \/>\nt\u0101te; dz\u012bves s\u0101kuma un beigu prob-<br \/>\nl\u0113mjaut\u0101jumi.<br \/>\nCIE\u0145A UN VIEN\u0100DA ATTIEKSME<br \/>\nUzskats, ka visi cilv\u0113ki ir peln\u012bju\u0161i cie\u0146u un vien\u0101du attieksmi, radies<br \/>\nnesen. Vairum\u0101 sabiedr\u012bbu cie\u0146as tr\u016bkums un nevien\u0101da attiek-<br \/>\nsme pret indiv\u012bdiem vai cilv\u0113ku grup\u0101m tika uzskat\u012bta par norm\u0101lu<br \/>\nun dabisku. Viena no t\u0101s praktiskaj\u0101m izpausm\u0113m bija verdz\u012bba,<br \/>\nkuru Eiropas valstu kolonij\u0101s un ASV atc\u0113la tikai XIX gadsimt\u0101, bet<br \/>\nda\u017e\u0101s pasaules da\u013c\u0101s t\u0101 past\u0101v joproj\u0101m. V\u0113l v\u0113l\u0101k tika izbeigta<br \/>\ndiskrimin\u0101cija pret kr\u0101sainajiem iedz\u012bvot\u0101jiem, piem\u0113ram, Dien-<br \/>\nvid\u0101frik\u0101. Vairum\u0101 pasaules valstu sievietes v\u0113l joproj\u0101m sastopas<br \/>\nar nepietiekamu cie\u0146u un nevien\u0101du attieksmi. Pla\u0161i izplat\u012bta ir<br \/>\nar\u012b diskrimin\u0101cija vecuma, nesp\u0113jas vai seksu\u0101l\u0101s orient\u0101cijas d\u0113\u013c.<br \/>\nT\u0101d\u0113\u013c skaidri redzams, ka pras\u012bbai p\u0113c vien\u0101das attieksmes pret vi-<br \/>\nsiem uz zemes m\u012bto\u0161iem cilv\u0113kiem, v\u0113l joproj\u0101m n\u0101kas sadurties<br \/>\nar lielu pretest\u012bbu.<br \/>\nCilv\u0113ces pak\u0101peniska piev\u0113r\u0161an\u0101s atzi\u0146ai, ka visi cilv\u0113ki ir vienl\u012bdz\u012b-<br \/>\ngi, aizs\u0101k\u0101s XVII un XVIII gadsimt\u0101 Eirop\u0101 un Zieme\u013camerik\u0101, bet t\u0101<br \/>\nir aktu\u0101la ar\u012b m\u016bsdien\u0101s. To ievad\u012bja divas pretrun\u012bgas ideolo\u0123ijas:<br \/>\n1. \u0160ai gad\u012bjum\u0101 termins managed care vai gestion des soins lietots \u0161aur\u0101kaj\u0101<br \/>\nnoz\u012bm\u0113 k\u0101 apr\u016bpe, kuras nodro\u0161in\u0101t\u0101ji ap\u0146emas gan to \ufb01nans\u0113t, gan ar\u012b pa\u0161i<br \/>\nsamekl\u0113t iesp\u0113jami l\u0113t\u0101ko t\u0101s veic\u0113ju.<br \/>\nK\u0100DAS IR \u0100RSTA UN PACIENTA ATTIEC\u012aBU \u012aPATN\u012aBAS?<br \/>\n\u0100rsta un pacienta attiec\u012bbas ir medic\u012bnas prakses un t\u0101d\u0113j\u0101di ar\u012b me-<br \/>\ndic\u012bnas \u0113tikas st\u016brakmens. K\u0101 iepriek\u0161 min\u0113ts, \u017den\u0113vas deklar\u0101cija<br \/>\nno \u0101rsta prasa, ka \u00abmana pacienta vesel\u012bba man b\u016bs vissvar\u012bg\u0101kais<br \/>\napsv\u0113rums\u00bb, un Starptautiskais medic\u012bnas \u0113tikas kodekss nosaka,<br \/>\nka \u00ab\u0101rstam j\u0101izr\u0101da piln\u012bga lojalit\u0101te pacientam un j\u0101liek liet\u0101 visas<br \/>\nsavas zin\u0101\u0161anas\u00bb. K\u0101 tika uzsv\u0113rts jau pirmaj\u0101 noda\u013c\u0101, tradicion\u0101l\u0101s<br \/>\n\u0101rsta un pacienta patern\u0101l\u0101s attiec\u012bbas, kur\u0101s \u0101rsts pie\u0146em l\u0113mumu,<br \/>\nbet pacients tam pak\u013caujas, p\u0113d\u0113jo gadu laik\u0101 tiku\u0161as bie\u017ei noraid\u012b-<br \/>\ntas \u2014 gan no \u0113tisk\u0101, gan tiesisk\u0101 viedok\u013ca. Tom\u0113r daudzi pacienti<br \/>\nnesp\u0113j vai nev\u0113las pie\u0146emt l\u0113mumus par savu medic\u012bnisko apr\u016bpi,<br \/>\nt\u0101d\u0113\u013c bie\u017ei vien pacientu autonomija ir visai ap\u0161aub\u0101ma.<br \/>\nTikpat ap\u0161aub\u0101mi ir ar\u012b citi \u0101rsta un pacienta attiec\u012bbu aspekti, pie-<br \/>\nm\u0113ram, \u0101rsta pien\u0101kums iev\u0113rot profesion\u0101lo nosl\u0113pumu un uztu-<br \/>\n\u00ab..mana pacienta vesel\u012bba<br \/>\nman b\u016bs vissvar\u012bg\u0101kais<br \/>\napsv\u0113rums..\u00bb<br \/>\n1. GAD\u012aJUMA APRAKSTS<br \/>\nDr. P., pieredz\u0113jis un prasm\u012bgs \u0137irurgs, ir gandr\u012bz jau<br \/>\nbeidzis naktsmai\u0146u neliel\u0101 viet\u0113j\u0101 slimn\u012bc\u0101. Te k\u0101du jaunu<br \/>\nmeiteni uz slimn\u012bcu atved vi\u0146as m\u0101te, kura nekav\u0113joties<br \/>\ndodas prom, sac\u012bdama, ka vi\u0146ai j\u0101b\u016bt m\u0101j\u0101s pie p\u0101r\u0113jiem<br \/>\nb\u0113rniem. Pacientei ir asi\u0146o\u0161ana no maksts, un vi\u0146a cie\u0161<br \/>\nlielas s\u0101pes. Dr. P. vi\u0146u izmekl\u0113 un konstat\u0113, ka vi\u0146ai ir<br \/>\nspont\u0101ns vai induc\u0113ts aborts. Vi\u0146\u0161 \u0101tri dilat\u0113 dzemdes<br \/>\nkaklu, veic abr\u0101ziju un pasaka medic\u012bnas m\u0101sai, lai<br \/>\napjaut\u0101jas pacientei, vai vi\u0146a var palikt slimn\u012bc\u0101 l\u012bdz<br \/>\nbr\u012bdim, kad b\u016bs dro\u0161i vi\u0146u izrakst\u012bt. \u0100rsta mai\u0146a nu ir<br \/>\nbeigusies, to p\u0101r\u0146em Dr. Q., un Dr. P. dodas uz m\u0101j\u0101m,<br \/>\nneaprun\u0101jies ar pacienti.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n40 41<br \/>\ndz\u012bbas iest\u0101des, ir vislab\u0101kais l\u012bdzeklis, kas nov\u0113r\u0161 cilv\u0113kties\u012bbu p\u0101r-<br \/>\nk\u0101pumus.<br \/>\nPat, ja \u0101rsti iev\u0113ro cie\u0146as un vienl\u012bdz\u012bbas principus, atlasot pacien-<br \/>\ntus, vi\u0146iem ir iesp\u0113jams tos p\u0101rk\u0101pt \u0101rst\u0113\u0161anas veidu izv\u0113l\u0113 vai at-<br \/>\ntieksm\u0113 pret pacientu. \u0160o probl\u0113mu labi ilustr\u0113 noda\u013cas s\u0101kum\u0101<br \/>\napl\u016bkotais piem\u0113rs. K\u0101 min\u0113ts 1. noda\u013c\u0101, \u0101rsta l\u012bdzciet\u012bba ir viena no<br \/>\nsvar\u012bg\u0101kaj\u0101m medic\u012bnas pamatv\u0113rt\u012bb\u0101m un t\u0101 ir \u012bpa\u0161i b\u016btiska labu<br \/>\nterapeitisko attiec\u012bbu izveid\u0113. L\u012bdzciet\u012bba ir balst\u012bta uz pacienta cie-<br \/>\n\u0146as un v\u0113rt\u012bbu sist\u0113mas iev\u0113ro\u0161anu, bet t\u0101 neaprobe\u017eojas tikai ar<br \/>\n\u0161iem principiem, bet izprot un r\u0113\u0137in\u0101s ar\u012b ar pacienta ievainojam\u012bbu,<br \/>\nsaskaroties ar slim\u012bbu un\/vai nesp\u0113ju. Ja pacients jut\u012bs \u0101rsta l\u012bdzcie-<br \/>\nt\u012bbu, vi\u0146\u0161 dr\u012bz\u0101k notic\u0113s, ka \u0101rsts r\u012bkojas t\u0101 interes\u0113s, un \u0161\u012b uztic\u012bba<br \/>\nvar dot labus rezult\u0101tus atvese\u013co\u0161an\u0101s proces\u0101.<br \/>\n\u0160\u0101da uztic\u0113\u0161an\u0101s, kas ir tik \u013coti b\u016btiska \u0101rsta un pacienta attiec\u012bb\u0101s,<br \/>\nparasti tiek interpret\u0113ta t\u0101d\u0101 noz\u012bm\u0113, ka \u0101rstam nevajadz\u0113tu atst\u0101t<br \/>\npacientu bez apr\u016bpes, ja vi\u0146\u0161 reiz ap\u0146\u0113mies to veikt. PMA Starptau-<br \/>\ntiskais Medic\u012bnas \u0112tikas Kodekss nor\u0101-<br \/>\nda, ka vien\u012bgais \u0101rsta un pacienta at-<br \/>\ntiec\u012bbu p\u0101rtrauk\u0161anas iemesls var\u0113tu<br \/>\nb\u016bt pacienta pras\u012bba p\u0113c konsult\u0101cijas<br \/>\npie cita \u0101rsta ar cit\u0101d\u0101m zin\u0101\u0161an\u0101m:<br \/>\n\u00ab\u0100rstam j\u0101izr\u0101da piln\u012bga lojalit\u0101te pa-<br \/>\ncientam un j\u0101liek liet\u0101 visas savas zin\u0101-<br \/>\n\u0161anas. Kad izmekl\u0113\u0161ana vai \u0101rst\u0113\u0161ana<br \/>\np\u0101rsniedz \u0101rsta zin\u0101\u0161anu iesp\u0113ju robe-<br \/>\n\u017eas, vi\u0146am j\u0101pieaicina cits \u0101rsts, kam ir<br \/>\nnepiecie\u0161am\u0101s sp\u0113jas.\u00bb<br \/>\nTom\u0113r ir pietiekami daudz citu iemeslu, k\u0101p\u0113c \u0101rsts grib\u0113tu p\u0101r-<br \/>\ntraukt attiec\u012bbas ar pacientu, piem\u0113ram, \u0101rsta p\u0101rcel\u0161an\u0101s uz citu<br \/>\nvietu vai prakses izbeig\u0161ana, pacienta nesp\u0113ja vai nev\u0113l\u0113\u0161an\u0101s<br \/>\nmaks\u0101t par \u0101rsta pakalpojumiem, abpus\u0113ja nepatika starp \u0101rstu un<br \/>\njauna izpratne par krist\u012bgo tic\u012bbu un pret kristiet\u012bbu v\u0113rsts racion\u0101-<br \/>\nlisms. Pirm\u0101 iedvesmoja Amerikas revol\u016bciju un Ties\u012bbu hartas tap-<br \/>\n\u0161anu, bet otr\u0101 \u2014 Lielo Fran\u010du revol\u016bciju un ar to saist\u012bt\u0101s politisk\u0101s<br \/>\np\u0101rmai\u0146as. \u0160o divu ietekmju rezult\u0101t\u0101 pak\u0101peniski iedibin\u0101j\u0101s de-<br \/>\nmokr\u0101tijas principi un s\u0101k\u0101s to izplat\u012b\u0161an\u0101s pasaul\u0113. T\u0101 balst\u012bj\u0101s uz<br \/>\ntic\u012bbu par visu v\u012brie\u0161u (daudz v\u0113l\u0101k ar\u012b sievie\u0161u) politisko vienl\u012bdz\u012bbu<br \/>\nun no t\u0101s izrieto\u0161aj\u0101m ties\u012bb\u0101m izv\u0113l\u0113ties tos, kas \u012bstenos p\u0101rvaldi.<br \/>\n20. gadsimt\u0101 liela uzman\u012bba cilv\u0113kties\u012bbu kontekst\u0101 tika piev\u0113rsta<br \/>\nvienl\u012bdz\u012bbai. Viens no jaundibin\u0101t\u0101s Apvienoto N\u0101ciju Organiz\u0101ci-<br \/>\njas pirmajiem veikumiem bija Visp\u0101r\u012bg\u0101s Cilv\u0113kties\u012bbu deklar\u0101cijas<br \/>\n(Universal Declaration of Human Rights) izstr\u0101d\u0101\u0161ana 1948. gad\u0101.<br \/>\nT\u0101s 1. pant\u0101 teikts: \u00abVisi cilv\u0113ki ir piedzimu\u0161i br\u012bvi un vienl\u012bdz\u012bgi cie\u0146\u0101<br \/>\nun ties\u012bb\u0101s\u00bb. Daudzas citas valstu un starptautisk\u0101s organiz\u0101cijas ir<br \/>\npie\u0146\u0113mu\u0161as da\u017e\u0101dus dokumentus par ties\u012bb\u0101m, t\u0101s attiecinot uz<br \/>\nvisiem cilv\u0113kiem, k\u0101das valsts pilso\u0146iem vai noteikt\u0101m \u013cau\u017eu gru-<br \/>\np\u0101m (b\u0113rnu ties\u012bbas, pacientu ties\u012bbas, pat\u0113r\u0113t\u0101ju ties\u012bbas). Lai \u012bste-<br \/>\nnotu \u0161aj\u0101s deklar\u0101cij\u0101s noteikto ties\u012bbu iev\u0113ro\u0161anu, tika izveidotas<br \/>\nar\u012b daudzas organiz\u0101cijas. Diem\u017e\u0113l daudz\u0101s valst\u012bs cilv\u0113kties\u012bbas v\u0113l<br \/>\njoproj\u0101m netiek iev\u0113rotas.<br \/>\nGadu gait\u0101 medic\u012bnas profesijas p\u0101rst\u0101vji ir paudu\u0161i nedaudz pret-<br \/>\nrun\u012bgus viedok\u013cus par vienl\u012bdz\u012bbu un pacientu ties\u012bb\u0101m. No vienas<br \/>\npuses, \u0101rsti ir ap\u0146\u0113mu\u0161ies, ka \u00abvecums, slim\u012bba vai nesp\u0113ja, tic\u012bba,<br \/>\netnisk\u0101 pieder\u012bba, dzimums, valstspieder\u012bba, politisk\u0101 p\u0101rliec\u012bba,<br \/>\nrase, seksu\u0101l\u0101 orient\u0101cija vai soci\u0101lais statuss neietekm\u0113s manus<br \/>\npien\u0101kumus pret pacientu\u00bb (\u017den\u0113vas deklar\u0101cija). Taj\u0101 pa\u0161\u0101 laik\u0101<br \/>\n\u0101rsti ir piepras\u012bju\u0161i sev ties\u012bbas atteikties pie\u0146emt pacientu, iz\u0146emot<br \/>\nneatliekamus gad\u012bjumus. Par \u0161\u0101das atteik\u0161anas likum\u012bgo pamatu<br \/>\nvar kalpot piln\u012bga slodze darba viet\u0101, atbilsto\u0161as izgl\u012bt\u012bbas vai spe-<br \/>\ncializ\u0101cijas tr\u016bkums, tom\u0113r, ja ar\u012b \u0101rstam nav nek\u0101da attaisnojuma,<br \/>\nvi\u0146\u0161 viegli var \u012bstenot diskrimin\u0101ciju un neb\u012bties par sauk\u0161anu pie<br \/>\natbild\u012bbas. \u0100rsta sirdsapzi\u0146a, nevis likums vai disciplin\u0101r\u0101s p\u0101rrau-<br \/>\n\u00ab..\u0101rsts grib\u0113tu p\u0101rtraukt<br \/>\nattiec\u012bbas ar pacientu..<br \/>\nVi\u0146am j\u0101b\u016bt gatavam<br \/>\npamatot \u0161\u0101du l\u0113mumu gan<br \/>\nsev, gan pacientam, gan<br \/>\nar\u012b, ja nepiecie\u0161ams, k\u0101dai<br \/>\ntre\u0161ajai pusei.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n42 43<br \/>\nteikti nek\u0101di iz\u0146\u0113mumi pacientiem ar infekcijas slim\u012bb\u0101m, t\u0101d\u0113\u013c tiek<br \/>\nuzskat\u012bts, ka \u0101rsta pien\u0101kums ir nodro\u0161in\u0101t vien\u0101du apr\u016bpi. PMA<br \/>\nnost\u0101dn\u0113s par \u0101rstu profesion\u0101lo atbild\u012bbu, \u0101rst\u0113jot AIDS pacientus<br \/>\n(Statement on the Professional Responsibility of Physicians in Treating<br \/>\nAIDS Patients), \u0161\u012b doma izteikta t\u0101:<br \/>\n\u00abAIDS slimniekiem ir ties\u012bbas sa-<br \/>\n\u0146emt atbilsto\u0161u medic\u012bnisku apr\u016bpi,<br \/>\npar\u0101dot l\u012bdzciet\u012bbu un respekt\u0113jot<br \/>\nvi\u0146u pa\u0161cie\u0146u. \u0100rstam nav mor\u0101lu<br \/>\nties\u012bbu atteikties \u0101rst\u0113t pacientu,<br \/>\nkura pa\u0161reiz\u0113j\u0101 slim\u012bba ietilpst \u0101rsta<br \/>\nkompetenc\u0113, tikai t\u0101p\u0113c vien, ka pa-<br \/>\ncients ir seropozit\u012bvs.<br \/>\nMedic\u012bnas \u0113tika nepie\u013cauj noteiktu pacientu grupu diskrimin\u0101-<br \/>\nciju t\u0101d\u0113\u013c vien, ka vi\u0146i ir seropozit\u012bvi. Personai, kas slimo ar AIDS,<br \/>\nnepiecie\u0161ama kompetenta un l\u012bdzciet\u012bga attieksme. \u0100rstam,<br \/>\nkur\u0161 nesp\u0113j nodro\u0161in\u0101t nepiecie\u0161amo apr\u016bpi, ko pieprasa AIDS<br \/>\nslimnieki, j\u0101nos\u016bta vi\u0146i pie atbilsto\u0161a speci\u0101lista vai uz iest\u0101di,<br \/>\nkas ir apr\u012bkota, lai nodro\u0161in\u0101tu \u0161\u0101dus pakalpojumiem. Bet l\u012bdz<br \/>\ntam br\u012bdim \u0101rstam p\u0113c lab\u0101k\u0101s sirdsapzi\u0146as j\u0101r\u016bp\u0113jas par pa-<br \/>\ncientu.\u00bb<br \/>\n\u0100rsta un pacienta attiec\u012bbu person\u012bg\u0101 daba var izrais\u012bt seksu\u0101lu val-<br \/>\ndzin\u0101jumu. Tradicion\u0101l\u0101s medic\u012bnas \u0113tikas galvenais likums ir, ka<br \/>\n\u0161\u0101dam k\u0101rdin\u0101jumam j\u0101turas pret\u012b. Hipokr\u0101ta zv\u0113rest\u0101 iek\u013cauts \u0161\u0101ds<br \/>\nsol\u012bjums: \u00abLai kur\u0101 m\u0101j\u0101 es neieietu, es ieie\u0161u taj\u0101, lai nestu labumu<br \/>\nslimajiem, un attur\u0113\u0161os no katras apzin\u0101tas \u013caunpr\u0101t\u012bbas vai kr\u0101p-<br \/>\n\u0161anas, sevi\u0161\u0137i no sievie\u0161u vai v\u012brie\u0161u, k\u0101 br\u012bvo, t\u0101 vergu pavedin\u0101\u0161a-<br \/>\nnas1<br \/>\n.\u00bb P\u0113d\u0113jos gados daudzas medic\u012bnas asoci\u0101cijas ir atjaunin\u0101ju-<br \/>\n\u0161as un aktualiz\u0113ju\u0161as tie\u0161i \u0161o \u0101rsta un vi\u0146a pacienta dzimumattiec\u012b-<br \/>\n1. \u0160eit izmantots profesora K. Rudz\u012b\u0161a v\u0101rdn\u012bc\u0101 dotais Hipokr\u0101ta zv\u0113resta<br \/>\ntulkojums.<br \/>\npacientu, pacienta atteik\u0161an\u0101s iev\u0113rot \u0101rsta nor\u0101d\u012bjumus. \u0160ie iemes-<br \/>\nli var b\u016bt gan tiesiski pamatoti, gan ar\u012b non\u0101kt pretrun\u0101 ar \u0113tikas<br \/>\nprincipiem. Apsverot \u0161\u0101du l\u0113mumu, \u0101rstam vajadz\u0113tu izp\u0113t\u012bt \u0112tikas<br \/>\nkodeksu un citus atbilsto\u0161us ieteikumus, k\u0101 ar\u012b uzman\u012bgi izprast sa-<br \/>\nvus mot\u012bvus. Vi\u0146am j\u0101b\u016bt gatavam pamatot \u0161\u0101du l\u0113mumu gan sev,<br \/>\ngan pacientam, gan ar\u012b, ja nepiecie\u0161ams, k\u0101dai tre\u0161ajai pusei. Ja mo-<br \/>\nt\u012bvs ir tiesiski pamatots, \u0101rstam b\u016btu j\u0101pal\u012bdz pacientam atrast citu<br \/>\npraktiz\u0113jo\u0161u \u0101rstu, kuru vi\u0146\u0161 uzskata par kompetent\u0101ko vai, ja tas<br \/>\nnav iesp\u0113jams, izsniedz pacientam izzi\u0146u par \u0101rst\u0113\u0161anas p\u0101rtrauk-<br \/>\n\u0161anu, lai pacients var\u0113tu atrast citu medic\u012bnisk\u0101s apr\u016bpes sniedz\u0113ju.<br \/>\nJa mot\u012bvs nav pamatots, piem\u0113ram, rasu aizspriedumi, \u0101rstam b\u016btu<br \/>\nj\u0101tiek gal\u0101 ar \u0161o probl\u0113mu.<br \/>\nDaudziem \u0101rstiem, it \u012bpa\u0161i tiem, kas str\u0101d\u0101 sabiedriskaj\u0101 sektor\u0101, ne-<br \/>\nmaz nav iesp\u0113jas izv\u0113l\u0113ties savus pacientus. Da\u017ei pacienti ir agres\u012bvi<br \/>\nun apdraud \u0101rsta dro\u0161\u012bbu. Citu iztur\u0113\u0161an\u0101s ir klaji antisoci\u0101la, un vi\u0146u<br \/>\nuzved\u012bbu da\u017ebr\u012bd var uzskat\u012bt vienk\u0101r\u0161i par pret\u012bgu. Vai \u0161ie pacienti<br \/>\nir zaud\u0113ju\u0161i ties\u012bbas uz cie\u0146u un vien\u0101du attieksmi, vai no \u0101rstiem<br \/>\npatiesi j\u0101prasa papildu p\u016bles, bie\u017ei vien pat heroiska r\u012bc\u012bba, lai no-<br \/>\ndibin\u0101tu un uztur\u0113tu terapeitiskas attiec\u012bbas ar \u0161\u0101diem pacientiem?<br \/>\nVi\u0146u kl\u0101tb\u016btn\u0113 \u0101rstiem j\u0101balans\u0113 starp vi\u0146am pak\u013caut\u0101 person\u0101la<br \/>\ndro\u0161\u012bbu un labkl\u0101j\u012bbu un savu pien\u0101kumu sekm\u0113t pacientu labkl\u0101-<br \/>\nj\u012bbu. \u0100rstiem j\u0101mekl\u0113 veidi, k\u0101 apmierin\u0101t abus pien\u0101kumus. Ja tas<br \/>\nnav iesp\u0113jams, \u0101rstiem j\u0101m\u0113\u0123ina nodro\u0161in\u0101t \u0161iem pacientiem cita<br \/>\nveida apr\u016bpi.<br \/>\nV\u0113l cits nopietns p\u0101rbaud\u012bjums cie\u0146as un vien\u0101das attieksmes prin-<br \/>\ncipa iev\u0113ro\u0161an\u0101 ir infekciozu pacientu apr\u016bpe. Visbie\u017e\u0101k tas attiecas<br \/>\nuz HIV\/AIDS \u2014 ne tikai t\u0101p\u0113c, ka t\u0101 ir smaga, dz\u012bv\u012bbai b\u012bstama slim\u012b-<br \/>\nba, bet ar\u012b t\u0101p\u0113c, ka t\u0101 bie\u017ei k\u013c\u016bst par soci\u0101lu aizspriedumu objek-<br \/>\ntu. Turkl\u0101t ir daudz citu smagu infekciju, no kur\u0101m da\u017eas ir viegl\u0101k<br \/>\np\u0101rnesamas un b\u012bstam\u0101kas medic\u012bnas person\u0101lam nek\u0101 HIV\/AIDS.<br \/>\nDa\u017ei \u0101rsti atsak\u0101s veikt invaz\u012bvas proced\u016bras HIV\/AIDS slimniekiem<br \/>\nbail\u0113s, ka pa\u0161i var\u0113tu in\ufb01c\u0113ties. Medic\u012bnas \u0113tikas kodeksos nav no-<br \/>\n\u00abPersonai, kas slimo<br \/>\nar AIDS, nepiecie\u0161ama<br \/>\nkompetenta un l\u012bdzciet\u012bga<br \/>\nattieksme.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n44 45<br \/>\nLaba sazi\u0146a starp \u0101rstu un pacientu ir svar\u012bgs inform\u0113tas piekri\u0161anas<br \/>\npriek\u0161nosac\u012bjums. Laik\u0101, kad medic\u012bnisko patern\u0101lismu uzl\u016bkoja par<br \/>\nnorm\u0101lu par\u0101d\u012bbu, sazi\u0146a bija relat\u012bvi vienk\u0101r\u0161\u0101ka, t\u0101 sast\u0101v\u0113ja no<br \/>\n\u0101rsta nor\u0101d\u012bjumiem pacientam par to vai citu \u0101rst\u0113\u0161anu. M\u016bsdien\u0101s<br \/>\nsazi\u0146a no \u0101rstiem prasa daudz vair\u0101k. Vi\u0146iem j\u0101sniedz pacientam<br \/>\nvisa inform\u0101cija, kas nepiecie\u0161ama, lai pie\u0146emtu l\u0113mumu. Tas noz\u012b-<br \/>\nm\u0113, ka vi\u0146iem j\u0101prot izskaidrot vienk\u0101r\u0161\u0101 valod\u0101 sare\u017e\u0123\u012btu slim\u012bbas<br \/>\ndiagnostikas gaitu un prognozi, k\u0101 ar\u012b \u0101rst\u0113\u0161anas principus. Vi\u0146iem<br \/>\nj\u0101sp\u0113j apstiprin\u0101t vai labot inform\u0101ciju, ko pacients guvis no citiem<br \/>\navotiem (no cita \u0101rsta, preses, interneta), nodro\u0161in\u0101t, ka pacients<br \/>\nizprot savu iesp\u0113jamo \u0101rst\u0113\u0161anas metodes izv\u0113li, jo \u012bpa\u0161i t\u0101s priek\u0161-<br \/>\nroc\u012bbas un tr\u016bkumus, atbild\u0113t uz jebkuru iesp\u0113jamo jaut\u0101jumu, kas<br \/>\npacientam var\u0113tu rasties, un saprast vi\u0146a l\u0113mumu, lai k\u0101ds tas ar\u012b<br \/>\nneb\u016btu, un, ja iesp\u0113jams, ar\u012b \u0161\u0101da l\u0113muma iemeslus. Daudziem cil-<br \/>\nv\u0113kiem nav dabas dotu labas sazi\u0146as sp\u0113ju, vi\u0146iem t\u0101s ir j\u0101att\u012bsta un<br \/>\nj\u0101izkopj apzin\u0101tu un atk\u0101rtotu p\u016bli\u0146u rezult\u0101t\u0101.<br \/>\nDivi galvenie \u0101rsta un pacienta sazi\u0146as \u0161\u0137\u0113r\u0161\u013ci ir valodas un kult\u016bras<br \/>\nat\u0161\u0137ir\u012bbas. Ja \u0101rsts un pacients nerun\u0101 vien\u0101 valod\u0101, nepiecie\u0161ams<br \/>\ntulks. Diem\u017e\u0113l ne vienm\u0113r atrodams kvali\ufb01c\u0113ts tulks, t\u0101p\u0113c \u0101rstam<br \/>\nj\u0101atrod labs iesp\u0113jamais kandid\u0101ts \u0161im darbam. Kult\u016bra ir daudz<br \/>\npla\u0161\u0101ka par valodu un izraisa papildu sazi\u0146as gr\u016bt\u012bbas. At\u0161\u0137ir\u012bgas<br \/>\nizpratnes d\u0113\u013c, ko da\u017e\u0101das kult\u016bras sniedz par slim\u012bbas dabu un c\u0113lo-<br \/>\n\u0146iem, pacienti var neizprast diagnozi un \u0101rst\u0113\u0161anas iesp\u0113jas, ko \u0101rsts<br \/>\npied\u0101v\u0101. \u0160\u0101dos apst\u0101k\u013cos \u0101rstam j\u0101dara viss iesp\u0113jamais, lai noteiktu<br \/>\npacienta izpratnes l\u012bmeni par vesel\u012bbas un \u0101rst\u0113\u0161anas jaut\u0101jumiem<br \/>\nun vislab\u0101kaj\u0101 iesp\u0113jamaj\u0101 veid\u0101 j\u0101sniedz vi\u0146am padomi.<br \/>\nJa \u0101rsts sekm\u012bgi sniedzis visu inform\u0101ciju par diagnozi, prognozi un<br \/>\n\u0101rst\u0113\u0161anas iesp\u0113j\u0101m, pacientam ir iesp\u0113jas izdar\u012bt inform\u0113tu pie-<br \/>\nkri\u0161anu par jaut\u0101jumu, kas ticis uzdots. Lai ar\u012b termins \u00abpiekri\u0161ana\u00bb<br \/>\nbu aizliegumu. Iemesli ir tie pa\u0161i, kas pirms 2500 gadiem. Pacienti ir<br \/>\nviegli ievainojami un uzticas, ka sa\u0146ems no \u0101rsta labu apr\u016bpi. Vi\u0146i<br \/>\nvar\u0113tu nepretoties \u0101rsta seksu\u0101l\u0101s tuvo\u0161an\u0101s m\u0113\u0123in\u0101jumiem bai-<br \/>\nl\u0113s, ka t\u0101d\u0113j\u0101di vi\u0146i nesa\u0146ems nepiecie\u0161amo \u0101rst\u0113\u0161anu. V\u0113l vair\u0101k,<br \/>\nemocion\u0101la attieksme pret pacientu var\u0113tu negat\u012bvi ietekm\u0113t \u0101rsta<br \/>\nprofesion\u0101lo darb\u012bbu.<br \/>\nP\u0113d\u0113jais iemesls attiecas ar\u012b uz gad\u012bjumiem, kad \u0101rsts \u0101rst\u0113 savus<br \/>\n\u0123imenes locek\u013cus, no k\u0101 daudzi medic\u012bnas \u0113tikas kodeksi katego-<br \/>\nrisk\u0101 veid\u0101 cen\u0161as attur\u0113t. Tom\u0113r \u0161\u012b, t\u0101pat k\u0101 daudzu citu, \u0113tikas<br \/>\nkodeksu ieteikumu piem\u0113ro\u0161ana noteiktos apst\u0101k\u013cos var main\u012bties.<br \/>\nPiem\u0113ram, lo\u0123iski, ka mazapdz\u012bvot\u0101s viet\u0101s, kur ir tikai viens \u0101rsts,<br \/>\nvi\u0146\u0161 apr\u016bp\u0113s ar\u012b savus \u0123imenes locek\u013cus, it sevi\u0161\u0137i jau neatliekamos<br \/>\ngad\u012bjumos.<br \/>\nSAZI\u0145A UN PIEKRI\u0160ANA<br \/>\nInform\u0113ta piekri\u0161ana (informed consent) ir viens no galvenajiem<br \/>\nm\u016bsdienu medic\u012bnas \u0113tikas pamatj\u0113dzieniem. Pacientu ties\u012bbas<br \/>\nlemt par vesel\u012bbas apr\u016bpi, kas skar vi\u0146us, atz\u012bst vis\u0101 pasaul\u0113, nosakot<br \/>\nto likumos un pau\u017eot \u0113tikas kodeksos. PMA Pacientu ties\u012bbu dekla-<br \/>\nr\u0101cij\u0101 teikts:<br \/>\n\u00abPacientam ir pa\u0161noteik\u0161an\u0101s ties\u012bbas, proti, ties\u012bbas br\u012bvi pie-<br \/>\n\u0146emt l\u0113mumus, kas saist\u012bti ar vi\u0146u pa\u0161u. \u0100rsts inform\u0113 pacientu<br \/>\npar l\u0113muma sek\u0101m. R\u012bc\u012bbsp\u0113j\u012bgam pieaugu\u0161am pacientam ir<br \/>\nties\u012bbas piekrist vai atteikties no jebkura veida diagnostiskas vai<br \/>\n\u0101rstnieciskas manipul\u0101cijas. Pacientam ir ties\u012bbas sa\u0146emt visu<br \/>\nnepiecie\u0161amo inform\u0101ciju, lai \u0161o l\u0113mumu pie\u0146emtu. Pacientam<br \/>\nir skaidri j\u0101izprot jebkura izmekl\u0113juma vai manipul\u0101cijas m\u0113r-<br \/>\n\u0137is, iesp\u0113jamie sasniedzamie rezult\u0101ti un sekas, kas iest\u0101sies, ja<br \/>\nvi\u0146\u0161 piekri\u0161anu nedos.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n46 47<br \/>\n\u2022 Gad\u012bjumos, kad inform\u0101cijas izpau\u0161ana var kait\u0113t pacientam tra-<br \/>\ndicion\u0101li tiek piesaukts \u00abterapeitisk\u0101s privil\u0113\u0123ijas\u00bb j\u0113dziens. Tas at-<br \/>\n\u013cauj \u0101rstiem neizpaust medic\u012bniska rakstura inform\u0101ciju, kas var\u0113-<br \/>\ntu nodar\u012bt \ufb01zisku, psihisku un emocion\u0101lu kait\u0113jumu pacientam,<br \/>\npiem\u0113ram, ja pacients, uzzinot ne\u0101rst\u0113jamas slim\u012bbas diagnozi,<br \/>\nvar\u0113tu izdar\u012bt pa\u0161n\u0101v\u012bbu. \u0160\u012b privil\u0113\u0123ija var nest daudz s\u0101pju, t\u0101p\u0113c<br \/>\n\u0101rstiem t\u0101 b\u016btu j\u0101piem\u0113ro tikai iz\u0146\u0113muma situ\u0101cij\u0101s. Vi\u0146iem b\u016btu<br \/>\nj\u0101s\u0101k ar cer\u012bbu, ka visi pacienti sp\u0113j samierin\u0101ties ar faktiem un ka<br \/>\ninform\u0101cijas neizpau\u0161ana b\u016btu j\u0101atst\u0101j vien\u012bgi gad\u012bjumiem, kad ir<br \/>\npiln\u012bga p\u0101rliec\u012bba, ka inform\u0101cijas izpau\u0161ana nes\u012bs vair\u0101k \u013caunu-<br \/>\nma.<br \/>\nDa\u017e\u0101s kult\u016br\u0101s bie\u017ei vien tiek uzskat\u012bts, ka \u0101rsta pien\u0101kums nodro\u0161i-<br \/>\nn\u0101t pacientu ar inform\u0101ciju nav sp\u0113k\u0101, ja pacientam ir diagnostic\u0113ta<br \/>\nne\u0101rst\u0113jama slim\u012bba. Tas ir uzskats, ka \u0161\u0101da inform\u0101cija var novest<br \/>\npacientu l\u012bdz izmisumam un padar\u012btu vi\u0146a p\u0113d\u0113j\u0101s dienas no\u017e\u0113lo-<br \/>\njam\u0101kas nek\u0101 tad, ja b\u016btu kaut neliela cer\u012bba uz izvese\u013co\u0161anos. Pa-<br \/>\nsaul\u0113 nav nekas neparasts, kad radinieki vienojas ar \u0101rstiem neteikt<br \/>\nslimajam cilv\u0113kam, ka vi\u0146\u0161 mirst. \u0100rstiem j\u0101b\u016bt \u013coti uzman\u012bgiem ar<br \/>\nkult\u016bras \u012bpatn\u012bb\u0101m un person\u012bgajiem faktoriem, it \u012bpa\u0161i, ja ir j\u0101pa-<br \/>\nsaka sliktas zi\u0146as, piem\u0113ram, dr\u012bza n\u0101ve. Pacienta ties\u012bbas uz infor-<br \/>\nm\u0113tu piekri\u0161anu aizvien pla\u0161\u0101k atz\u012bst vis\u0101 pasaul\u0113, un \u0101rsta pirmais<br \/>\npien\u0101kums ir pal\u012bdz\u0113t \u012bstenot \u0161\u012bs ties\u012bbas.<br \/>\nPieaugot tendencei vesel\u012bbas apr\u016bpi uztvert k\u0101 pat\u0113ri\u0146a produktu<br \/>\nun k\u013c\u016bstot pacientiem par pat\u0113r\u0113t\u0101jiem, pacienti un vi\u0146u \u0123imenes<br \/>\nnereti prasa pieeju t\u0101diem medic\u012bniskajiem pakalpojumiem, kas<br \/>\np\u0113c \u0101rsta dom\u0101m vi\u0146am nav atbilsto\u0161i, s\u0101kot no antibiotik\u0101m vul-<br \/>\ng\u0101ras v\u012brusslim\u012bbas gad\u012bjum\u0101 un beidzot ar pras\u012bb\u0101m p\u0113c intens\u012b-<br \/>\nvas \u0101rst\u0113\u0161anas kl\u012bnisk\u0101s n\u0101ves gad\u012bjum\u0101 un daudzsolo\u0161\u0101m, bet v\u0113l<br \/>\nnep\u0101rbaud\u012bt\u0101m \u0137irur\u0123isk\u0101m oper\u0101cij\u0101m un medikamentiem. Da\u017ei<br \/>\npacienti izvirza \u00abties\u012bbas\u00bb uz visiem medic\u012bnas pakalpojumiem, kas<br \/>\nvi\u0146iem \u0161\u0137iet piem\u0113roti un vajadz\u012bgi, un bie\u017ei vien \u0101rsti v\u0113las b\u016bt p\u0101-<br \/>\nnoz\u012bm\u0113 \u0101rst\u0113\u0161anas akcept\u0113\u0161anu, infor-<br \/>\nm\u0113ta piekri\u0161ana1<br \/>\ntikpat labi ir attieci-<br \/>\nn\u0101ma gan uz \u0101rst\u0113\u0161anas noraid\u012b\u0161anu<br \/>\nvisp\u0101r, gan uz k\u0101da alternat\u012bva \u0101rst\u0113-<br \/>\n\u0161anas veida izv\u0113li. R\u012bc\u012bbsp\u0113j\u012bgiem pa-<br \/>\ncientiem ir ties\u012bbas atteikties no \u0101rst\u0113-<br \/>\n\u0161anas pat tad, ja \u0161\u0101ds atteikums var\u0113tu<br \/>\nrad\u012bt nesp\u0113u vai n\u0101vi.<br \/>\nPiekri\u0161anas apliecin\u0101jumi var b\u016bt tie\u0161i vai netie\u0161i (nojau\u0161ami). Tie\u0161u<br \/>\npiekri\u0161anu var izteikt mutiski vai rakstiski. Netie\u0161a t\u0101 ir gad\u012bjumos,<br \/>\nkad pacients ar savu uzved\u012bbu apliecina v\u0113lmi pak\u013cauties noteikt\u0101m<br \/>\nmanipul\u0101cij\u0101m vai sa\u0146emt \u0101rst\u0113\u0161anu. Piem\u0113ram, netie\u0161i at\u013cauju durt<br \/>\nv\u0113n\u0101 var izr\u0101d\u012bt, pastiepjot roku. Tom\u0113r gad\u012bjumos, kad \u0101rst\u0113\u0161ana ir<br \/>\nriskant\u0101ka vai saist\u012bta ar nopietn\u0101ku diskomfortu, vajadz\u0113tu ieg\u016bt<br \/>\ntie\u0161u piekri\u0161anu.<br \/>\nIr divi iz\u0146\u0113mumi, kad netiek piepras\u012bta piekri\u0161ana no r\u012bc\u012bbsp\u0113j\u012bgiem<br \/>\npacientiem:<br \/>\n\u2022 Situ\u0101cijas, kad pacienti br\u012bvpr\u0101t\u012bgi nodot l\u0113muma pie\u0146em\u0161anas<br \/>\nties\u012bbas \u0101rstam vai tre\u0161ajai pusei. Piem\u0113ram, jaut\u0101juma sare\u017e\u0123\u012bt\u012b-<br \/>\nbas d\u0113\u013c vai t\u0101p\u0113c, ka pacients vienk\u0101r\u0161i uzticas \u0101rstam. Pacients<br \/>\nvar \u0101rstam pateikt: \u00abDariet to, kas jums \u0161\u0137iet vispareiz\u0101kais.\u00bb \u0100r-<br \/>\nstam nevajadz\u0113tu dedz\u012bgi uzreiz \u0161im pied\u0101v\u0101jumam paklaus\u012bt, bet<br \/>\nvismaz pamatvilcienos b\u016btu j\u0101inform\u0113 pacients par \u0101rst\u0113\u0161anas ie-<br \/>\nsp\u0113j\u0101m un j\u0101iedro\u0161ina pa\u0161am pie\u0146emt l\u0113mumus. Ja ar\u012b p\u0113c \u0161\u0101da<br \/>\naicin\u0101juma pacients tom\u0113r paliek pie sava, \u0101rstam tas j\u0101pie\u0146em<br \/>\nun j\u0101r\u012bkojas pacienta interes\u0113s.<br \/>\n1. L\u012bdztekus latviskajam terminam inform\u0113ta piekri\u0161ana (informed consent)<br \/>\nar to pa\u0161u noz\u012bmi tiek lietots, kaut nedaudz ret\u0101k, ar\u012b termins \u00abapzin\u0101ta<br \/>\npiekri\u0161ana\u00bb.<br \/>\n\u00abR\u012bc\u012bbsp\u0113j\u012bgiem<br \/>\npacientiem ir ties\u012bbas<br \/>\natteikties no \u0101rst\u0113\u0161anas<br \/>\npat tad, ja \u0161\u0101ds atteikums<br \/>\nvar\u0113tu rad\u012bt nesp\u0113ju vai<br \/>\nn\u0101vi.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n48 49<br \/>\nT\u0101pat vi\u0146am j\u0101b\u016bt br\u012bvam atteikt \u0101rst\u0113\u0161anu, kas nenestu pacientam<br \/>\nnek\u0101du labumu, kaut gan neb\u016btu ar\u012b kait\u0113jo\u0161a, jo nevajadz\u0113tu \u0146emt<br \/>\nv\u0113r\u0101 tikai placebo efektu. Ja probl\u0113mai ir ierobe\u017eoti resursi, tad \u0101r-<br \/>\nstam b\u016btu j\u0101v\u0113r\u0161 to personu uzman\u012bba, kas ir atbild\u012bgi par resursu<br \/>\nsadali.<br \/>\nL\u0112MUMU PIE\u0145EM\u0160ANA R\u012aC\u012aBNESP\u0112J\u012aGU PACIENTU VIET\u0100<br \/>\nDaudzi pacienti, piem\u0113ram, mazi b\u0113rni, pacienti ar psihiskiem vai<br \/>\nneirolo\u0123iskiem trauc\u0113jumiem vai personas, kas ir bezsama\u0146\u0101 vai<br \/>\nkom\u0101, nesp\u0113j pa\u0161i pie\u0146emt l\u0113mumus par savu \u0101rst\u0113\u0161anu. \u0160\u0101diem pa-<br \/>\ncientiem nepiecie\u0161ams tiesiski pilnvarots p\u0101rst\u0101vis (tas var b\u016bt \u0101rsts<br \/>\nvai k\u0101ds tuvinieks), kas ir ties\u012bgs personas viet\u0101 pie\u0146emt l\u0113mumus<br \/>\npar \u0101rst\u0113\u0161anu. \u0112tiskas pretrunas var rasties ar \u0161\u0101du pilnvarotu perso-<br \/>\nnu noteik\u0161anu un vi\u0146u l\u0113mumu pie\u0146em\u0161anas izv\u0113les krit\u0113rijiem.<br \/>\nKad domin\u0113ja medic\u012bniskais patern\u0101lisms, \u0101rsts tika uzskat\u012bts par<br \/>\npiem\u0113rot\u0101ko personu, kas pie\u0146\u0113ma l\u0113mumus par r\u012bc\u012bbnesp\u0113j\u012bgu<br \/>\npacientu apr\u016bpes gaitu. \u0100rsti var\u0113ja sazin\u0101ties ar pacienta \u0123imeni,<br \/>\nta\u010du gala l\u0113mumu pie\u0146\u0113ma vi\u0146i. Pamaz\u0101m \u0101rsts \u0161o pilnvarojumu ir<br \/>\nzaud\u0113jis, jo daudz\u0101s valst\u012bs pacientiem ir iesp\u0113ja likum\u0101 paredz\u0113t\u0101<br \/>\nk\u0101rt\u012bb\u0101 noteikt pilnvaroto personu, kas vi\u0146a viet\u0101 sp\u0113tu pie\u0146emt<br \/>\npacienta interes\u0113m atbilsto\u0161us l\u0113mumus gad\u012bjumos, ja vi\u0146\u0161 pats<br \/>\nto nesp\u0113tu. Turkl\u0101t da\u017e\u0101s valst\u012bs pilnvarot\u0101s personas tiek noteik-<br \/>\ntas dilsto\u0161\u0101 sec\u012bb\u0101 (piem\u0113ram, laul\u0101tais, pieaugu\u0161i b\u0113rni, br\u0101lis,<br \/>\nm\u0101sa u. c.). \u0100rsts gala l\u0113mumu pie\u0146em tikai gad\u012bjumos, ja pilnva-<br \/>\nrot\u0101 persona nav atrodama, k\u0101 tas bie\u017ei gad\u0101s kritisk\u0101s situ\u0101cij\u0101s.<br \/>\nPMA Pacientu ties\u012bbu deklar\u0101cija nosaka, k\u0101di ir \u0101rsta pien\u0101kumi \u0161\u0101-<br \/>\ndos gad\u012bjumos:<br \/>\n\u00abJa pacients ir bezsama\u0146\u0101 vai citu iemeslu d\u0113\u013c nesp\u0113j paust<br \/>\nsavu gribu, piekri\u0161ana, ja iesp\u0113jams, j\u0101ieg\u016bst no tiesisk\u0101 ce\u013c\u0101<br \/>\npilnvarotas personas. Ja \u0161\u012b persona nav pieejama, bet ak\u016bta<br \/>\nr\u0101k izpal\u012bdz\u012bgi, lai gan apzin\u0101s, ka no medic\u012bnas viedok\u013ca konkr\u0113tais<br \/>\npakalpojums neuzlabos pacienta vesel\u012bbas st\u0101vokli. \u012apa\u0161i nopietna<br \/>\n\u0161\u012b probl\u0113ma ir tad, kad resursi ir stingri ierobe\u017eoti, un, kam\u0113r \u012bpa\u0161iem<br \/>\npacientiem \u0161o \u0101rst\u0113\u0161anu veic \u00abvelt\u012bgi\u00bb un \u00abnedziedino\u0161i\u00bb, citi paliek<br \/>\nne\u0101rst\u0113ti.<br \/>\nV\u0101rdus \u00abvelt\u012bgi un nedziedino\u0161i medic\u012bniskie pakalpojumi\u00bb b\u016btu j\u0101-<br \/>\nsaprot \u0161\u0101di. Da\u017eos gad\u012bjumos \u0101rsts var noteikt, ka \u0101rst\u0113\u0161ana no me-<br \/>\ndic\u012bnisk\u0101 viedok\u013ca ir piln\u012bgi bezj\u0113dz\u012bga vai nelietder\u012bga, jo t\u0101 neno-<br \/>\ndro\u0161in\u0101s ne st\u0101vok\u013ca uzlabo\u0161anos, ne atvese\u013co\u0161anos, k\u0101 ar\u012b pacients<br \/>\nneg\u016bs nek\u0101du uzlabojumu. Citos gad\u012bjumos \u0101rst\u0113\u0161anas lietder\u012bgu-<br \/>\nmu un t\u0101s lietojumu var noteikt, tikai balstoties uz pacienta subjek-<br \/>\nt\u012bvaj\u0101m atsauksm\u0113m par savu labsaj\u016btu. Atbilsto\u0161i pamatlikumam<br \/>\npacientu noteikti j\u0101iesaista \u0101rst\u0113\u0161anas<br \/>\nnelietder\u012bguma noteik\u0161anas proces\u0101.<br \/>\nTikai da\u017eos retos gad\u012bjumos \u0161\u0101das dis-<br \/>\nkusijas var\u0113tu neatbilst pacienta inte-<br \/>\nres\u0113m. \u0100rstam nek\u0101d\u0101 zi\u0146\u0101 nav pien\u0101-<br \/>\nkums pied\u0101v\u0101t pacientam velt\u012bgu vai<br \/>\nnedziedino\u0161u \u0101rst\u0113\u0161anu.<br \/>\nInform\u0113tas piekri\u0161anas princips iemieso pacienta ties\u012bbas izv\u0113l\u0113ties<br \/>\nk\u0101du no \u0101rsta pied\u0101v\u0101taj\u0101m \u0101rst\u0113\u0161anas metod\u0113m. K\u0101das ir pacien-<br \/>\nta un pieder\u012bgo ties\u012bbas uz pakalpojumiem, ko \u0101rsts nepied\u0101v\u0101, tas<br \/>\nm\u016bsu dien\u0101s k\u013cuvis par b\u016btisku pretrun\u012bgu \u0113tikas, ties\u012bbu un sabied-<br \/>\nr\u012bbas politikas jaut\u0101jumu. Kam\u0113r tiek nogaid\u012bts, lai par \u0161iem jaut\u0101ju-<br \/>\nmiem izlemtu vald\u012bba, vesel\u012bbas apdro\u0161in\u0101\u0161ana, uz\u0146\u0113mumi un\/vai<br \/>\nprofesion\u0101l\u0101s organiz\u0101cijas, katram<br \/>\n\u0101rstam individu\u0101li n\u0101kas izlemt \u2014 pie-<br \/>\nkrist pacientu l\u016bgumiem par nevaja-<br \/>\ndz\u012bgu \u0101rst\u0113\u0161anu vai ne. Tom\u0113r \u0101rstam<br \/>\n\u0161\u0101ds l\u016bgums noteikti j\u0101noraida, ja vi\u0146\u0161<br \/>\nir p\u0101rliecin\u0101ts, ka \u0101rst\u0113\u0161ana nodar\u012bs<br \/>\nliel\u0101ku kait\u0113jumu nek\u0101 dos labumu.<br \/>\n\u00ab\u0100rstam nek\u0101d\u0101 zi\u0146\u0101<br \/>\nnav pien\u0101kums pied\u0101v\u0101t<br \/>\npacientam velt\u012bgu vai<br \/>\nnedziedino\u0161u \u0101rst\u0113\u0161anu.\u00bb<br \/>\nK\u0101das ir pacienta un<br \/>\npieder\u012bgo ties\u012bbas uz<br \/>\npakalpojumiem, ko \u0101rsts<br \/>\nnepied\u0101v\u0101?<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n50 51<br \/>\nm\u0101li iepriek\u0161\u0113ja r\u012bkojuma veid\u0101 vai izteikts iepriek\u0161. Ja pacienta iz-<br \/>\nv\u0113le nav zin\u0101ma, l\u0113mums j\u0101pie\u0146em atbalsto\u0161i pacienta interes\u0113m,<br \/>\n\u0146emot v\u0113r\u0101 \u0161\u0101dus aspektus: a) pacienta diagnozi un prognozes;<br \/>\nb) zin\u0101m\u0101 pacienta v\u0113rt\u012bbu sist\u0113mu; c) inform\u0101ciju, kas ieg\u016bta no<br \/>\npacienta radiniekiem, kuri var\u0113tu pal\u012bdz\u0113t noteikt pacienta intere-<br \/>\nses; d) pacienta kult\u016bras un reli\u0123ijas aspektus, kas var\u0113tu ietekm\u0113t<br \/>\nl\u0113mumu par \u0101rst\u0113\u0161anas kursu. \u0160is veids ir daudz nenoteikt\u0101ks nek\u0101<br \/>\ntad, ja pacients b\u016btu devis konkr\u0113tus nor\u0101d\u012bjumus, ta\u010du tas dod<br \/>\niesp\u0113ju pilnvarotajam l\u0113muma pie\u0146\u0113m\u0113jam apl\u016bkot probl\u0113mu no<br \/>\nda\u017e\u0101d\u0101m izv\u0113les iesp\u0113j\u0101m un secin\u0101t, k\u0101 pacients \u0161\u0101d\u0101 situ\u0101cij\u0101 va-<br \/>\nr\u0113tu r\u012bkoties.<br \/>\nIr gr\u016bti nov\u0113rt\u0113t pacienta sp\u0113ju pie\u0146emt medic\u012bniska rakstura l\u0113-<br \/>\nmumus, sevi\u0161\u0137i jauniem cilv\u0113kiem vai t\u0101diem, kuru dom\u0101\u0161anas<br \/>\nsp\u0113jas ir ietekm\u0113jusi k\u0101da ak\u016bta vai hroniska slim\u012bba. \u0160\u012b persona<br \/>\nvar pie\u0146emt visp\u0101r\u012bgus l\u0113mumus, kas attiecas uz da\u017eiem ikdienas<br \/>\ndz\u012bves aspektiem, bet ne par citiem, turkl\u0101t spriestsp\u0113ja m\u0113dz b\u016bt<br \/>\nmain\u012bga \u2014 da\u017e\u0101dos diennakts br\u012b\u017eos personai var b\u016bt skaidrs sa-<br \/>\npr\u0101ts un orient\u0113\u0161an\u0101s sp\u0113jas, bet citos \u2014 ne. Lai ar\u012b \u0161\u0101di pacienti<br \/>\nno likuma viedok\u013ca var neb\u016bt r\u012bc\u012bbsp\u0113j\u012bgi, vi\u0146u izv\u0113le j\u0101\u0146em v\u0113r\u0101,<br \/>\nkad tiek pie\u0146emts l\u0113mums, kas vi\u0146us skar. Pacientu ties\u012bbu dekla-<br \/>\nr\u0101cij\u0101 pausta \u0161\u0101da nost\u0101dne: \u00abJa pa-<br \/>\ncients ir nepilngad\u012bgs vai cit\u0101d\u0101 veid\u0101<br \/>\nno likuma viedok\u013ca r\u012bc\u012bbnesp\u0113j\u012bgs,<br \/>\npiekri\u0161anu dod likuma noteikt\u0101 k\u0101rt\u012b-<br \/>\nb\u0101 izv\u0113l\u0113t\u0101 persona. Tom\u0113r ar\u012b tad pa-<br \/>\ncientam j\u0101b\u016bt maksim\u0101li iesaist\u012btam<br \/>\nl\u0113muma pie\u0146em\u0161anas proces\u0101, cik<br \/>\nvien vi\u0146a gar\u012bg\u0101s un \ufb01zisk\u0101s sp\u0113jas to<br \/>\nat\u013cauj.\u00bb<br \/>\nNereti pacienti nesp\u0113j pie\u0146emt sapr\u0101t\u012bgus un labi izsv\u0113rtus l\u0113mu-<br \/>\nmus slim\u012bbas izrais\u012bt\u0101 diskomforta un apjukuma d\u0113\u013c. Tom\u0113r vi\u0146i var<br \/>\nizr\u0101d\u012bt noraido\u0161u attieksmi pret k\u0101du noteiktu manipul\u0101ciju, pie-<br \/>\nmedic\u012bnisk\u0101 iejauk\u0161an\u0101s ir absol\u016bti nepiecie\u0161ama, ir j\u0101pie\u0146em,<br \/>\nka pacients pats devis piekri\u0161anu, ja vien nav nep\u0101rprotami<br \/>\nskaidrs, ka tas nerun\u0101 pretim pacienta iepriek\u0161 izteikt\u0101m v\u0113l-<br \/>\nm\u0113m un p\u0101rliec\u012bbai.\u00bb<br \/>\nProbl\u0113mas rodas tad, ja par pilnvarotaj\u0101m person\u0101m uzdodas vair\u0101-<br \/>\nki cilv\u0113ki, piem\u0113ram, da\u017e\u0101di \u0123imenes locek\u013ci, un viedok\u013cu at\u0161\u0137ir\u012bbas<br \/>\nd\u0113\u013c nesp\u0113j vienoties par kop\u012bgu l\u0113mumu vai ar\u012b visiem ir vienots vie-<br \/>\ndoklis, kas p\u0113c \u0101rsta dom\u0101m var\u0113tu neatbilst pacienta interes\u0113m.<br \/>\n\u0160\u0101d\u0101 situ\u0101cij\u0101 \u0101rsts vispirms var\u0113tu uz\u0146emties t\u0101du k\u0101 starpnieka<br \/>\nfunkciju, bet, ja nesaska\u0146as turpin\u0101s, probl\u0113ma j\u0101risina cit\u0101d\u0101 ce\u013c\u0101,<br \/>\npiem\u0113ram, izlemjot vec\u0101kajam \u0123imenes loceklis vai balsojot. Ja ra-<br \/>\ndu\u0161\u0101s \u013coti nopietnas domstarp\u012bbas starp \u0101rstu un pilnvarotajiem<br \/>\nl\u0113mumu pie\u0146\u0113m\u0113jiem, tad padoms rodams Pacientu ties\u012bbu dekla-<br \/>\nr\u0101cij\u0101: \u00abJa pacienta pilnvarot\u0101 persona aizliedz \u0101rstam \u012bstenot \u0101rst\u0113-<br \/>\n\u0161anu, kas p\u0113c \u0101rsta dom\u0101m b\u016btu pacientam vislab\u0101k\u0101 un piem\u0113ro-<br \/>\nt\u0101k\u0101, \u0101rstam \u0161is l\u0113mums b\u016btu j\u0101apstr\u012bd atbilsto\u0161\u0101s tiesu iest\u0101d\u0113s vai<br \/>\ncit\u0101s pilnvarot\u0101s instanc\u0113s.\u00bb<br \/>\nL\u012bdz\u012bgi k\u0101 iepriek\u0161\u0113j\u0101 apak\u0161noda\u013c\u0101 par pacienta inform\u0113tu piekri-<br \/>\n\u0161anu, ar\u012b gad\u012bjumos, kad pacientu p\u0101rst\u0101v radi vai citas pilnvaro-<br \/>\ntas personas, j\u0101piem\u0113ro t\u0101da darb\u012bbas proced\u016bra it k\u0101 l\u0113mumu<br \/>\npie\u0146emtu pacients pats. \u0100rstam j\u0101sp\u0113j sniegt \u0161iem aizvietotajiem<br \/>\nl\u0113mumu pie\u0146\u0113m\u0113jiem visa l\u0113muma izdar\u012b\u0161anai nepiecie\u0161am\u0101 in-<br \/>\nform\u0101cija. Tas ietver skaidrojumus vienk\u0101r\u0161\u0101 valod\u0101 par sare\u017e\u0123\u012bto<br \/>\ndiagnozi, prognozi un \u0101rst\u0113\u0161anas veidiem, \u012bpa\u0161i p\u0101rliecinoties, vai<br \/>\nl\u0113muma pie\u0146\u0113m\u0113js izpratis \u0101rst\u0113\u0161anas iesp\u0113jas, ieskaitot katras me-<br \/>\ntodes priek\u0161roc\u012bbas un tr\u016bkumus, atbildes uz katru radu\u0161os jaut\u0101ju-<br \/>\nmu un izpratne par jebk\u0101du \u0161o personu l\u0113mumu un, ja iesp\u0113jams,<br \/>\nar\u012b t\u0101 mot\u012bviem.<br \/>\nGalvenais krit\u0113rijs, ko piem\u0113rot, lai pie\u0146emtu \u0101rstnieciska rakstura<br \/>\nl\u0113mumu par r\u012bc\u012bbnesp\u0113j\u012bgu pacientu \u0101rst\u0113\u0161anu, ir pa\u0161a pacienta<br \/>\nizv\u0113les iev\u0113ro\u0161ana, ja vien t\u0101 ir zin\u0101ma. Tas var\u0113tu b\u016bt pausts for-<br \/>\n\u00ab..pacientam j\u0101b\u016bt<br \/>\nmaksim\u0101li iesaist\u012btam<br \/>\nl\u0113muma pie\u0146em\u0161anas<br \/>\nproces\u0101, cik vien vi\u0146a<br \/>\ngar\u012bg\u0101s un fizisk\u0101s sp\u0113jas<br \/>\nto at\u013cauj.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n52 53<br \/>\nviss, ko vi\u0146\u0161 zina par savu pacientu pat<br \/>\np\u0113c vi\u0146a n\u0101ves\u00bb. Turpretim da\u017ei \u0113tikas<br \/>\nkodeksi noraida \u0161\u0101du absol\u016bto pieeju<br \/>\nkon\ufb01dencialit\u0101tei. Fakts, ka da\u017eos ga-<br \/>\nd\u012bjumos atk\u0101p\u0161an\u0101s no profesion\u0101l\u0101<br \/>\nnosl\u0113puma principa ir iesp\u0113jama, pra-<br \/>\nsa t\u0101l\u0101kus skaidrojumus par kon\ufb01dencialit\u0101tes ideju.<br \/>\nAugstu v\u0113rt\u012bbu kon\ufb01dencialit\u0101tei pie\u0161\u0137ir tr\u012bs principi: autonomija,<br \/>\ncie\u0146a pret citiem un uztic\u0113\u0161an\u0101s. Autonomija saist\u0101s ar kon\ufb01den-<br \/>\ncialit\u0101ti t\u0101d\u0113j\u0101di, ka personiska rakstura inform\u0101cija attiecas tikai uz<br \/>\npacientu un ka to nedr\u012bkst izpaust cit\u0101m person\u0101m bez vi\u0146a piekri-<br \/>\n\u0161anas. Ja indiv\u012bds atkl\u0101j personiska rakstura inform\u0101ciju k\u0101dam ci-<br \/>\ntam, piem\u0113ram, \u0101rstam vai medic\u012bnas m\u0101sai, vai ja inform\u0101cija par\u0101-<br \/>\nd\u0101s k\u0101du izmekl\u0113jumu laik\u0101, tiem, kas to uzzina, t\u0101 j\u0101tur slepen\u012bb\u0101,<br \/>\nkam\u0113r vien pacients nav at\u013c\u0101vis to izpaust.<br \/>\nKon\ufb01dencialit\u0101te ir svar\u012bga ar\u012b t\u0101p\u0113c, ka jebkur\u0161 cilv\u0113ks ir peln\u012bjis cie-<br \/>\n\u0146u. Svar\u012bgs veids, k\u0101 to izr\u0101d\u012bt, ir saglab\u0101t vi\u0146a priv\u0101tumu. Medic\u012bnas<br \/>\niest\u0101d\u0113 priv\u0101tums bie\u017ei vien tiek ierobe\u017eots, ta\u010du tas v\u0113l vair\u0101k liek<br \/>\nattur\u0113ties no nevajadz\u012bgas iejauk\u0161an\u0101s personas priv\u0101taj\u0101 dz\u012bv\u0113. T\u0101<br \/>\nk\u0101 katram cilv\u0113kam ir cit\u0101da izpratne par priv\u0101tumu, t\u0101d\u0113\u013c nevaram<br \/>\npie\u0146emt, ka visi v\u0113las, lai pret vi\u0146iem iztur\u0113tos piln\u012bgi vien\u0101di. Ir \u013coti<br \/>\nr\u016bp\u012bgi j\u0101izprot, kuru inform\u0101ciju pacients v\u0113las patur\u0113t nosl\u0113pum\u0101<br \/>\nun kuru \u2014 \u013caut atkl\u0101t citiem.<br \/>\nUztic\u0113\u0161an\u0101s ir b\u016btiska \u0101rsta un pacienta attiec\u012bbu sast\u0101vda\u013ca. Lai sa-<br \/>\n\u0146emtu medic\u012bnisku apr\u016bpi, pacientiem n\u0101kas \u0101rstiem un citiem cil-<br \/>\nv\u0113kiem, kuri vi\u0146am ir glu\u017ei sve\u0161i, atkl\u0101t personiska rakstura inform\u0101-<br \/>\nciju, bet vi\u0146\u0161 nev\u0113las, lai citi to uzzina. Pacientam ir dibin\u0101ts iemesls,<br \/>\nlai var\u0113tu uztic\u0113ties \u0101rstiem un cit\u0101m person\u0101m, kas vi\u0146u apr\u016bp\u0113,<br \/>\nka vi\u0146i neaizpaud\u012bs \u0161o inform\u0101ciju. Uztic\u0113\u0161an\u0101s pamat\u0101 ir \u0113tiskas un<br \/>\ntiesiskas normas, kas vesel\u012bbas apr\u016bpes veic\u0113jiem j\u0101iev\u0113ro. Ja pa-<br \/>\ncients nav p\u0101rliecin\u0101ts, ka sniegt\u0101s zi\u0146as nepaliks nosl\u0113pums, vi\u0146\u0161<br \/>\nm\u0113ram, past\u0101v\u012bg\u0101 intravenoz\u0101 katetra ievad\u012b\u0161anu. \u0160\u0101dos gad\u012bjumos<br \/>\nnepiekri\u0161anas izpausmes j\u0101uztver \u013coti nopietni pat tad, ja tas b\u016btiski<br \/>\niespaidos \u0101rst\u0113\u0161anas m\u0113r\u0137u sasnieg\u0161anu.<br \/>\nPacienti ar psihiskiem un neirolo\u0123iskiem trauc\u0113jumiem, par kuriem<br \/>\nnolemts, ka vi\u0146i var apdraud\u0113t pa\u0161i sevi vai apk\u0101rt\u0113jos, izvirza \u012bpa\u0161i<br \/>\nsare\u017e\u0123\u012btas \u0113tiskas probl\u0113mas. Ir svar\u012bgi iev\u0113rot vi\u0146u cilv\u0113kties\u012bbas,<br \/>\n\u012bpa\u0161i ties\u012bbas uz br\u012bv\u012bbu. Taj\u0101 pa\u0161\u0101 laik\u0101 vi\u0146us var ar\u012b ievietot slimn\u012b-<br \/>\nc\u0101 vai \u0101rst\u0113t pret pa\u0161u gribu, lai pasarg\u0101tu no kait\u0113juma gan pa\u0161us<br \/>\npacientus, gan apk\u0101rt\u0113jos. Var saskat\u012bt at\u0161\u0137ir\u012bbu starp piespiedu ie-<br \/>\nvieto\u0161anu slimn\u012bc\u0101 un piespiedu \u0101rst\u0113\u0161anu. Da\u017eu pacientu aizst\u0101vji<br \/>\napliecina pacienta ties\u012bbas atteikties no \u0101rst\u0113\u0161anas pat tad, ja tas<br \/>\nnoved pie piespiedu ievieto\u0161anas slimn\u012bc\u0101. Pamatots iemesls, lai<br \/>\natteiktos no t\u0101s, var b\u016bt nepat\u012bkama pieredze ar agr\u0101k veiktu \u0101r-<br \/>\nst\u0113\u0161anu, piem\u0113ram, nopietnas psihotropo medikamentu blaknes.<br \/>\nPie\u0146emot l\u0113mumu par \u0161\u0101du pacientu ievieto\u0161anu slimn\u012bc\u0101, \u0101rstam<br \/>\nj\u0101b\u016bt p\u0101rliecin\u0101tam, ka pacients sev un citiem rada re\u0101lus draudus,<br \/>\nnevis tikai sag\u0101d\u0101 apgr\u016btin\u0101jumus. \u0100rstiem b\u016btu j\u0101izzina pacienta<br \/>\nizv\u0113le par \u0101rst\u0113\u0161anu un \u0161\u0101das izv\u0113les iemesli \u2014 pat ja beigu beig\u0101s<br \/>\nt\u0101 nevar tikt apmierin\u0101ta.<br \/>\nKONFIDENCIALIT\u0100TE<br \/>\nJau kop\u0161 Hipokr\u0101ta laikiem par vienu no medic\u012bnas \u0113tikas st\u016brakme-<br \/>\n\u0146iem uzskata \u0101rsta pien\u0101kumu nodro\u0161in\u0101t pacienta sniegt\u0101s infor-<br \/>\nm\u0101cijas kon\ufb01dencialit\u0101ti. Hipokr\u0101ta zv\u0113rest\u0101 teikts: \u00abNeko no t\u0101, ko<br \/>\nes, piekopdams sava amata praksi, redz\u0113\u0161u vai dzird\u0113\u0161u par cilv\u0113ku<br \/>\nsadz\u012bv\u0113 t\u0101du, kas nav izpau\u017eams, es neizpaud\u012b\u0161u, apzin\u0101damies, ka<br \/>\ntas j\u0101tur slepen\u012bb\u0101.\u00bb<br \/>\n\u0160is zv\u0113rests, t\u0101pat k\u0101 citas jaun\u0101kas zv\u0113restu versijas, nepie\u013cauj ne-<br \/>\nk\u0101dus iz\u0146\u0113mumus no \u0161\u012b likuma. Piem\u0113ram, PMA Starptautiskais Me-<br \/>\ndic\u012bnas \u0113tikas kodekss uzsver, ka \u00ab\u0101rstam j\u0101patur piln\u012bg\u0101 nosl\u0113pum\u0101<br \/>\n\u00ab..\u0101rstam j\u0101patur piln\u012bg\u0101<br \/>\nnosl\u0113pum\u0101 viss, ko vi\u0146\u0161<br \/>\nzina par savu pacientu pat<br \/>\np\u0113c vi\u0146a n\u0101ves\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n54 55<br \/>\nvalod\u0101s, vajadz\u012bgs tulks, kas atvieglotu dialogu. Gad\u012bjumos, kad<br \/>\npacienti pa\u0161i nesp\u0113j pie\u0146emt medic\u012bniska rakstura l\u0113mumus, infor-<br \/>\nm\u0101cija par pacientu ir j\u0101sniedz person\u0101m, kas ir ties\u012bgas pie\u0146emt l\u0113-<br \/>\nmumu pacienta viet\u0101. Pacienta n\u0101ves gad\u012bjum\u0101 \u0101rsts parasti sniedz<br \/>\ninform\u0101ciju \u0123imenes locek\u013ciem par n\u0101ves c\u0113loni. \u0160\u012bs ir attaisnojamas<br \/>\natk\u0101pes no kon\ufb01dencialit\u0101tes principa, ta\u010du t\u0101s uzskat\u0101mas par iz-<br \/>\n\u0146\u0113mumu. Tiem, kam bijusi pieeja kon\ufb01denci\u0101lai inform\u0101cijai, ir ar to<br \/>\nj\u0101r\u012bkojas \u013coti piesardz\u012bgi un to dr\u012bkst izpaust tikai pacienta interes\u0113s<br \/>\np\u0113c iesp\u0113jas \u0161auram personu lokam. Kad vien iesp\u0113jams, par \u0161\u0101d\u0101m<br \/>\natk\u0101p\u0113m j\u0101inform\u0113 pacients.<br \/>\nV\u0113l viens pie\u0146emams profesion\u0101l\u0101<br \/>\nnosl\u0113puma p\u0101rk\u0101p\u0161anas iemesls ir pa-<br \/>\nk\u013cau\u0161an\u0101s likuma pras\u012bb\u0101m. Daudz\u0101s<br \/>\njurisdikcij\u0101s ir ties\u012bbu normas, kas pie-<br \/>\nprasa oblig\u0101tu inform\u0101cijas snieg\u0161anu<br \/>\npar pacientiem, kas sirgst ar noteikt\u0101m<br \/>\nslim\u012bb\u0101m,parperson\u0101m,kurasuzskata<br \/>\npar nesp\u0113j\u012bg\u0101m vad\u012bt transportl\u012bdzek-<br \/>\nli vai gad\u012bjumos, kad ir aizdomas par<br \/>\nvardarb\u012bbu pret b\u0113rniem. \u0100rstiem j\u0101b\u016bt uzman\u012bgiem gad\u012bjumos,<br \/>\nkad likums pieprasa sniegt zi\u0146as par pacientu vi\u0146a darba vietai. To-<br \/>\nm\u0113r likuma pras\u012bbas reiz\u0113m var non\u0101kt pretrun\u0101s ar cilv\u0113kties\u012bb\u0101m,<br \/>\nkas ir medic\u012bnas \u0113tikas pamats. Turkl\u0101t \u0101rstam katr\u0101 \u0161\u0101d\u0101 gad\u012bjum\u0101<br \/>\nkritiski j\u0101izv\u0113rt\u0113 ar\u012b likuma pras\u012bbas un j\u0101p\u0101rliecin\u0101s, k\u0101das inform\u0101-<br \/>\ncijas izpau\u0161ana ir attaisnojama.<br \/>\nKad \u0101rsts ir p\u0101rliecin\u0101ts, ka no likuma viedok\u013ca piepras\u012bt\u0101 medic\u012b-<br \/>\nniska rakstura inform\u0101cijas izpau\u0161ana ir attaisnojama, pirms tas ir<br \/>\nnoticis, vi\u0146am tas b\u016btu j\u0101p\u0101rrun\u0101 ar pacientu, lai nodro\u0161in\u0101tu sa-<br \/>\ndarb\u012bbu. Piem\u0113ram, b\u016bs lab\u0101k, ja pacients, kur\u0161 tiek tur\u0113ts aizdom\u0101s<br \/>\npar vardarb\u012bbu pret b\u0113rniem, \u0101rsta kl\u0101tb\u016btn\u0113 piezvana b\u0113rnu ties\u012b-<br \/>\nbu sarg\u0101jo\u0161\u0101m instit\u016bcij\u0101m un piesak\u0101s pats vai ar\u012b \u2014 \u0101rsts ieg\u016bst<br \/>\npacienta piekri\u0161anu, pirms zi\u0146ojums non\u0101k o\ufb01ci\u0101l\u0101s instanc\u0113s. \u0160\u0101da<br \/>\n\u0101rstam neuztic\u0113sies un nepiecie\u0161amo inform\u0101ciju nesniegs. Tas sa-<br \/>\nvuk\u0101rt trauc\u0113s \u0101rstiem veikt efekt\u012bvu \u0101rst\u0113\u0161anu vai sasniegt iecer\u0113-<br \/>\ntos sabiedr\u012bbas vesel\u012bbas m\u0113r\u0137us.<br \/>\nPMA Pacienta ties\u012bbu deklar\u0101cij\u0101 par pacienta ties\u012bb\u0101m uz kon\ufb01den-<br \/>\ncialit\u0101ti ir teikts:<br \/>\n\u2022 \u00abVisa veida inform\u0101cijai par pacienta vesel\u012bbas st\u0101vokli, medi-<br \/>\nc\u012bniska rakstura apst\u0101k\u013ciem, diagnozi, prognozi un \u0101rst\u0113\u0161anu,<br \/>\nk\u0101 ar\u012b citai personiska rakstura inform\u0101cijai j\u0101paliek kon\ufb01den-<br \/>\nci\u0101lai pat p\u0113c pacienta n\u0101ves. Iz\u0146\u0113mums ir pacienta p\u0113cn\u0101c\u0113-<br \/>\nji, kuriem var\u0113tu b\u016bt piek\u013cuve tai inform\u0101cijai, kas \u013cautu apzi-<br \/>\nn\u0101ties savus vesel\u012bbas riskus.<br \/>\n\u2022 Kon\ufb01denci\u0101la rakstura inform\u0101ciju dr\u012bkst izpausta tikai tad,<br \/>\nja pacients ir devis skaidru piekri\u0161anu vai ja tas skaidri ir no-<br \/>\nteikts likum\u0101. Citiem vesel\u012bbas apr\u016bpes speci\u0101listiem to dr\u012bkst<br \/>\nizpaust tikai tik daudz, cik katram nepiecie\u0161ams zin\u0101t, ja vien<br \/>\npacients nav devis nep\u0101rprotamu piekri\u0161anu.<br \/>\n\u2022 Visiem identi\ufb01c\u0113tiem pacienta datiem j\u0101b\u016bt aizsarg\u0101tiem.<br \/>\nDatu aizsardz\u012bbai j\u0101b\u016bt atbilsto\u0161ai tam, k\u0101d\u0101 form\u0101t\u0101 \u0161ie dati<br \/>\ntiek uzglab\u0101ti. Aizsarg\u0101tiem j\u0101b\u016bt ar\u012b cilv\u0113ku cilmes biolo\u0123is-<br \/>\nkajiem materi\u0101liem, no kuriem \u0161\u0101dus datus var ieg\u016bt.\u00bb<br \/>\n\u0160aj\u0101 deklar\u0101cij\u0101 nor\u0101d\u012bts, ka past\u0101v ar\u012b iz\u0146\u0113mumi no stingraj\u0101m<br \/>\nkon\ufb01dencialit\u0101tes principa pras\u012bb\u0101m. Da\u017ei no tiem nerada tikpat k\u0101<br \/>\nnek\u0101das probl\u0113mas, turpretim citi \u0101rstiem izvirza nopietnus \u0113tiskus<br \/>\njaut\u0101jumus.<br \/>\nDaudz\u0101s vesel\u012bbas apr\u016bpes iest\u0101d\u0113s kon\ufb01dencialit\u0101tes neiev\u0113ro-<br \/>\n\u0161ana ir bie\u017ea par\u0101d\u012bba. Daudziem cilv\u0113kiem \u2014 \u0101rstiem, medic\u012bnas<br \/>\nm\u0101s\u0101m, laboratorijas speci\u0101listiem u. c. \u2014 vajadz\u012bga pieeja pacienta<br \/>\ndatiem, lai nodro\u0161in\u0101tu adekv\u0101tu apr\u016bpi, bet studentiem, lai apg\u016btu<br \/>\npraktisko medic\u012bnu. Ja pacients un apr\u016bpes person\u0101ls run\u0101 da\u017e\u0101d\u0101s<br \/>\n\u00ab..\u0101rstam katr\u0101 \u0161\u0101d\u0101<br \/>\ngad\u012bjum\u0101 kritiski j\u0101izv\u0113rt\u0113<br \/>\nar\u012b likuma pras\u012bbas un<br \/>\nj\u0101p\u0101rliecin\u0101s, k\u0101das<br \/>\ninform\u0101cijas izpau\u0161ana ir<br \/>\nattaisnojama.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n56 57<br \/>\nattaisnojama, ja pacients pats nev\u0113las br\u012bdin\u0101t t\u0101s par risku. \u0160\u0101da<br \/>\nrakstura inform\u0101cijas izpau\u0161ana pie\u013caujama \u0161\u0101dos apst\u0101k\u013cos: part-<br \/>\nneris ir pak\u013cauts riskam in\ufb01c\u0113ties ar HIV un vi\u0146am nav citas iesp\u0113jas<br \/>\nto uzzin\u0101t; pacients ir atteicies inform\u0113t savu dzimumpartneri; pa-<br \/>\ncients ir noraid\u012bjis \u0101rsta pied\u0101v\u0101jumu pazi\u0146ot to partnerim pacienta<br \/>\nv\u0101rd\u0101, turkl\u0101t \u0101rsts ir br\u012bdin\u0101jis pacientu par savu nodomu izpaust<br \/>\n\u0161o inform\u0101ciju partnerim.<br \/>\nAizdom\u0101s tur\u0113to personu un noties\u0101tu noziedznieku medic\u012bnisk\u0101<br \/>\napr\u016bpe rada \u012bpa\u0161as gr\u016bt\u012bbas kon\ufb01dencialit\u0101tes nodro\u0161in\u0101\u0161an\u0101. Lai<br \/>\nar\u012b \u0101rstiem, kas apr\u016bp\u0113 ieslodz\u012btos, ir ierobe\u017eota neatkar\u012bba, vi\u0146iem<br \/>\nj\u0101dara viss iesp\u0113jamais, lai nodro\u0161in\u0101tu t\u0101du pa\u0161u apr\u016bpi, k\u0101du sa-<br \/>\n\u0146em citi pacienti. Sevi\u0161\u0137i vi\u0146iem b\u016btu j\u0101iev\u0113ro kon\ufb01dencialit\u0101te, lai<br \/>\nneizpaustu zi\u0146as par vesel\u012bbas st\u0101vokli ieslodz\u012bjuma vietas adminis-<br \/>\ntr\u0101cijai bez iepriek\u0161\u0113jas pacienta piekri\u0161anas.<br \/>\nJAUT\u0100JUMI, KAS SAIST\u012aTI AR DZ\u012aVES S\u0100KUMU<br \/>\nDaudzi svar\u012bgi medic\u012bnas \u0113tikas jaut\u0101jumi attiecas tie\u0161i uz cilv\u0113ka<br \/>\ndz\u012bves s\u0101kumu. Rokasgr\u0101matas ierobe\u017eotais apjoms ne\u013cauj \u0161os jau-<br \/>\nt\u0101jumus apskat\u012bt detaliz\u0113ti, ta\u010du ir v\u0113rts tos vismaz min\u0113t saraksta<br \/>\nveid\u0101, lai izprastu \u0113tiskas dabas jaut\u0101jumus un tos ar\u012b risin\u0101tu.<br \/>\n\u2022 Kontracepcija \u2014 fakts, ka pasaul\u0113 arvien pla\u0161\u0101k atz\u012bst sievietes<br \/>\nties\u012bbas kontrol\u0113t savu augl\u012bbu, proti, izsarg\u0101ties no nev\u0113lamas<br \/>\ngr\u016btniec\u012bbas, neatbr\u012bvo \u0101rstus no pien\u0101kuma par \u0161o t\u0113mu risin\u0101t<br \/>\nsare\u017e\u0123\u012btus \u0113tiskus jaut\u0101jumus, piem\u0113ram, mazgad\u012bgo pras\u012bbas<br \/>\np\u0113c kontracepcijas un da\u017e\u0101do kontracepcijas meto\u017eu risku iz-<br \/>\nskaidro\u0161ana.<br \/>\n\u2022 M\u0101ksl\u012bg\u0101 apaug\u013co\u0161ana \u2014 p\u0101riem (un indiv\u012bdiem), kas nevar ie-<br \/>\n\u0146emt b\u0113rnu dabisk\u0101 ce\u013c\u0101, ir pieejami vair\u0101ki m\u0101ksl\u012bg\u0101s apaug\u013co\u0161a-<br \/>\nnas veidi \u2014 m\u0101ksl\u012bg\u0101 aps\u0113klo\u0161ana, in vitro fertiliz\u0101cija un embrija<br \/>\nimplant\u0101cija dzemd\u0113, kas pieejami liel\u0101kaj\u0101s kl\u012bnik\u0101s. Cits iesp\u0113-<br \/>\npieeja sagatavo turpm\u0101k\u0101s darb\u012bbas. Tom\u0113r, ja sadarb\u012bba nav iesp\u0113-<br \/>\njama un \u0101rstam ir iemesls aizdom\u0101m, ka kav\u0113\u0161an\u0101s var rad\u012bt smagu<br \/>\nkait\u0113jumu k\u0101dam b\u0113rnam, \u0101rsta pien\u0101kums ir nekav\u0113joties zi\u0146ot<br \/>\nb\u0113rnu ties\u012bbu sarg\u0101jo\u0161\u0101m instit\u016bcij\u0101m un tikai p\u0113c tam inform\u0113t pa-<br \/>\ncientu, ka tas ir izdar\u012bts.<br \/>\nPapildus likuma noteiktaj\u0101m atk\u0101p\u0113m no kon\ufb01dencialit\u0101tes princi-<br \/>\npa \u0101rstam ir \u0113tisks pien\u0101kums sniegt \u0161o kon\ufb01denci\u0101lo inform\u0101ciju<br \/>\ncitiem, kurus pacients var\u0113tu apdraud\u0113t. Ir divas situ\u0101cijas, kur\u0101s<br \/>\ntas var\u0113tu notikt: ja pacients psihiatram saka, ka gatavojas k\u0101dam<br \/>\nnodar\u012bt ko \u013caunu, un ja \u0101rsts ir p\u0101rliecin\u0101ts, ka HIV pozit\u012bvs pacients<br \/>\nbez aizsargl\u012bdzek\u013ciem turpina seksu\u0101las attiec\u012bbas ar savu laul\u0101to vai<br \/>\ncitiem partneriem.<br \/>\nGad\u012bjumi, kad likums nepieprasa atk\u0101p\u0161anos no kon\ufb01dencialit\u0101tes<br \/>\nprincipa, bet t\u0101 ir pamatota, ir \u0161\u0101di: ja prognoz\u0113jamais kait\u0113jums ir<br \/>\ndraudo\u0161s, nenov\u0113r\u0161ams, nopietns un neatgriezenisks, tad inform\u0101-<br \/>\ncija j\u0101izpau\u017e, kaut ar\u012b pacients \u0101rstam nav \u013c\u0101vis to dar\u012bt, bet nezi-<br \/>\n\u0146o\u0161ana var rad\u012bt liel\u0101ku kait\u0113jumu. Lai noteiktu \u0161\u0101du sagaid\u0101mo un<br \/>\nprognoz\u0113jamo kait\u0113jumu nopietn\u012bbu, \u0101rstam j\u0101nov\u0113rt\u0113 un j\u0101sal\u012b-<br \/>\ndzina kait\u0113juma ra\u0161an\u0101s iesp\u0113ju un nopietn\u012bbu. \u0160aubu gad\u012bjumos<br \/>\n\u0101rstam b\u016btu j\u0101mekl\u0113 eksperta padoms.<br \/>\nKad \u0101rsts ir noteicis, ka vi\u0146a pien\u0101kums br\u012bdin\u0101t par briesm\u0101m at-<br \/>\ntaisno inform\u0101cijas izpau\u0161anu, ir j\u0101pie\u0146em divi l\u0113mumu. Kam tas<br \/>\nb\u016btu j\u0101pazi\u0146o? Cik daudz nepiecie\u0161ams pateikt? Izpaustajai infor-<br \/>\nm\u0101cijai vajadz\u0113tu satur\u0113t tikai iesp\u0113jam\u0101 kait\u0113juma nov\u0113r\u0161anai ne-<br \/>\npiecie\u0161am\u0101s zi\u0146as. B\u016btu j\u0101r\u012bkojas sapr\u0101t\u012bgi, lai mazin\u0101tu kait\u0113jumu<br \/>\nun apdraud\u0113jumu pacientam, ko var\u0113tu rad\u012bt inform\u0101cijas izpau\u0161a-<br \/>\nna. B\u016btu labi, ja \u0101rsts br\u012bdin\u0101tu pacientu, ka p\u0101rk\u0101ps kon\ufb01dencialit\u0101-<br \/>\ntes principu pacienta un citu potenci\u0101lo upuru aizsardz\u012bbai. Iesp\u0113ju<br \/>\nrobe\u017e\u0101s j\u0101m\u0113\u0123ina pan\u0101kt pacienta sadarb\u012bbu.<br \/>\nHIV pozit\u012bva pacienta gad\u012bjum\u0101 inform\u0101cijas izpau\u0161ana laul\u0101tajam<br \/>\nvai pa\u0161reiz\u0113jam seksu\u0101lajam partnerim nav ne\u0113tiska un t\u0101 ir pat<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n58 59<br \/>\nJAUT\u0100JUMI, KAS ATTIECIN\u0100MI UZ M\u016a\u017dA NOSL\u0112GUMU<br \/>\nJaut\u0101jumi, kas attiecin\u0101mi uz m\u016b\u017ea nogali, ir mirsto\u0161u pacientu<br \/>\ndz\u012bv\u012bbas paildzin\u0101\u0161anas m\u0113\u0123in\u0101jumi ar da\u017e\u0101du eksperiment\u0101lu<br \/>\ntehnolo\u0123iju, piem\u0113ram, dz\u012bvnieku org\u0101nu implant\u0101ciju, pal\u012bdz\u012bbu,<br \/>\ncentieni priek\u0161laikus p\u0101rtraukt dz\u012bv\u012bbu eitan\u0101zijas un medic\u012bniski<br \/>\npal\u012bdz\u0113tas pa\u0161n\u0101v\u012bbas ce\u013c\u0101. Starp \u0161\u012bm div\u0101m gal\u0113j\u012bb\u0101m ir daudz jau-<br \/>\nt\u0101jumu par potenci\u0101lo dz\u012bv\u012bbas pagarin\u0101\u0161anas l\u012bdzek\u013cu uzs\u0101k\u0161anu<br \/>\nvai to p\u0101rtrauk\u0161anu, termin\u0101lu pacientu apr\u016bpi un iepriek\u0161 paustu<br \/>\nnor\u0101d\u012bjumu piem\u0113ro\u0161anu un to lietder\u012bgumu.<br \/>\nDivi jaut\u0101jumi, eitan\u0101zija un pal\u012bdz\u0113ta pa\u0161n\u0101v\u012bba, pelna \u012bpa\u0161u iev\u0113-<br \/>\nr\u012bbu:<br \/>\n\u2022 Eitan\u0101zija ir apzin\u0101ta un pl\u0101nota r\u012bc\u012bba, kas nep\u0101rprotami<br \/>\nv\u0113rsta uz k\u0101das personas dz\u012bv\u012bbas p\u0101rtrauk\u0161anu.Tai rakstur\u012bgi<br \/>\n\u0161\u0101di momenti: indiv\u012bds ir r\u012bc\u012bbsp\u0113j\u012bgs, pie apzi\u0146as eso\u0161s cil-<br \/>\nv\u0113ks, kas ir ne\u0101rst\u0113jami slims un kur\u0161 labpr\u0101t\u012bgi l\u016bdz, lai vi\u0146a<br \/>\ndz\u012bv\u012bba tiktu izbeigta; \u0161\u012bs darb\u012bbas \u012bstenot\u0101js, zinot par pa-<br \/>\ncienta vesel\u012bbas st\u0101vokli un vi\u0146a v\u0113lmi nomirt, veic darb\u012bbas,<br \/>\nkuru pamatuzdevums ir dz\u012bv\u012bbas p\u0101rtrauk\u0161ana. \u0160\u0101da r\u012bc\u012bba<br \/>\ntiek veikta aiz l\u012bdzciet\u012bbas un nedod t\u0101s \u012bstenot\u0101jam nek\u0101du<br \/>\npersonisku labumu.<br \/>\n\u2022 Pal\u012bdz\u0113ta pa\u0161n\u0101v\u012bba aptver apzin\u0101ti un ar nodomu pacien-<br \/>\ntam sniegt paskaidrojumus par nepiecie\u0161amaj\u0101m zin\u0101\u0161an\u0101m<br \/>\nun l\u012bdzek\u013ciem, lai var\u0113tu izdar\u012bt pa\u0161n\u0101v\u012bbu, ieskaitot padomus<br \/>\npar let\u0101lo z\u0101\u013cu dev\u0101m, k\u0101 ar\u012b \u0161\u0101du medikamentu let\u0101lu devu<br \/>\nparakst\u012b\u0161ana vai izsnieg\u0161ana.<br \/>\nKaut gan eitan\u0101ziju un pal\u012bdz\u0113to pa\u0161n\u0101v\u012bbu bie\u017ei uzskata par mor\u0101-<br \/>\nl\u0101 zi\u0146\u0101 l\u012bdzv\u0113rt\u012bg\u0101m, skaidri saskat\u0101mas praktiskas un da\u017e\u0101s valst\u012bs<br \/>\nar\u012b tiesiskas at\u0161\u0137ir\u012bbas.<br \/>\njams risin\u0101jums ir ar\u012b gr\u016btniec\u012bbas izn\u0113s\u0101t\u0101jas (surog\u0101tm\u0101tes) pie-<br \/>\nsaiste. Tom\u0113r \u0161aj\u0101s metod\u0113s no indiv\u012bda vai sabiedr\u012bbas viedok\u013ca<br \/>\nrodas savas probl\u0113mas.<br \/>\n\u2022 Prenat\u0101lais \u0123en\u0113tiskais skr\u012bnings \u2014 m\u016bsdien\u0101s ir iesp\u0113-<br \/>\njams veikt \u0123en\u0113tiskos izmekl\u0113jumus, kas \u013cauj noteikt da\u017eas<br \/>\n\u0123en\u0113tiskas embrija vai aug\u013ca anom\u0101lijas un preciz\u0113t t\u0101 dzi-<br \/>\nmumu. Balstoties uz izmekl\u0113jumu rezult\u0101tiem, reiz\u0113m n\u0101kas<br \/>\npie\u0146emt l\u0113mumu par gr\u016btniec\u012bbas turpin\u0101\u0161anu vai p\u0101rtrauk-<br \/>\n\u0161anu. \u0100rstiem vajadz\u0113tu sp\u0113t noteikt, kur\u0161 ir vispiem\u0113rot\u0101kais<br \/>\ngr\u016btniec\u012bbas laiks \u0161\u0101du p\u0101rbau\u017eu veik\u0161anai, k\u0101 ar\u012b izskaidrot<br \/>\nieg\u016btos rezult\u0101tus pacientiem.<br \/>\n\u2022 Aborts \u2014 \u0161is ilgu laiku ir viens no pretrun\u012bg\u0101kajiem medi-<br \/>\nc\u012bnas \u0113tikas jaut\u0101jumiem gan \u0101rstiem, gan sabiedr\u012bbai. PMA<br \/>\nNost\u0101dnes par terapeitisku abortu (Statement on Therapeuti-<br \/>\ncAbortion) atz\u012bst \u0161o viedok\u013cu un tic\u012bbu da\u017e\u0101d\u012bbu un nosl\u0113dz<br \/>\np\u0101rskatu ar v\u0101rdiem, ka \u00abtas ir individu\u0101l\u0101s p\u0101rliec\u012bbas un<br \/>\nsirdsapzi\u0146as jaut\u0101jums, un tas j\u0101respekt\u0113\u00bb.<br \/>\n\u2022 Jaundzimu\u0161ie, kuru prognoz\u0113jam\u0101 dz\u012bvotsp\u0113ja ir krasi<br \/>\nierobe\u017eota \u2014 da\u017eiem jaundzimu\u0161ajiem da\u017e\u0101du iedzimtu<br \/>\nanom\u0101liju un priek\u0161laic\u012bgas dzim\u0161anas d\u0113\u013c iesp\u0113jas izdz\u012bvot<br \/>\nir \u013coti niec\u012bgas. Bie\u017ei vien j\u0101izdara smaga izv\u0113le \u2014 pagarin\u0101t<br \/>\ndz\u012bvi vai \u013caut vi\u0146iem nomirt.<br \/>\n\u2022 Ar p\u0113t\u012bjumiem saist\u012btie jaut\u0101jumi \u2014 ar \u0161o j\u0113dzienu saprot<br \/>\nrezerves embriju rad\u012b\u0161anu vai lieko (virsnormas) embriju izlie-<br \/>\nto\u0161anu, ja tie nav vajadz\u012bgi reprodukt\u012bviem m\u0113r\u0137iem, lai \u0101rst-<br \/>\nnieciskos nol\u016bkos ieg\u016btu cilmes \u0161\u016bnas, p\u0113t\u012btu jaunas repro-<br \/>\ndukt\u012bv\u0101s medic\u012bnas metodes un veiktu p\u0113t\u012bjumus ar cilv\u0113ka<br \/>\nembrijiem.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n60 61<br \/>\nbeig\u0101s. Paliat\u012bv\u0101s apr\u016bpes pacientiem<br \/>\nuzman\u012bba j\u0101velta vienam aspektam,<br \/>\nproti, s\u0101pju remd\u0113\u0161anai. Visiem \u0101rs-<br \/>\ntiem, kas r\u016bp\u0113jas par mirsto\u0161iem pa-<br \/>\ncientiem, j\u0101p\u0101rliecin\u0101s, ka vi\u0146iem ir<br \/>\natbilsto\u0161as zin\u0101\u0161anas \u0161aj\u0101 jom\u0101 vai<br \/>\nka nepiecie\u0161am\u012bbas gad\u012bjum\u0101 vi\u0146iem<br \/>\nkonsult\u0101cijas var sniegt pieredz\u0113ju\u0161i<br \/>\npaliat\u012bv\u0101s apr\u016bpes speci\u0101listi. \u0100rstiem nevajadz\u0113tu atteikties no mir-<br \/>\nsto\u0161iem pacientiem, bet turpin\u0101t l\u012bdzciet\u012bbas pilnu apr\u016bpi ar\u012b tad, ja<br \/>\nakt\u012bva \u0101rst\u0113\u0161ana vairs nav iesp\u0113jama.<br \/>\nN\u0101ves tuvo\u0161an\u0101s izvirza pacientiem, vi\u0146a pilnvarotajiem l\u0113mumu<br \/>\npie\u0146\u0113m\u0113jiem un \u0101rstiem v\u0113l daudz \u0113tiska rakstura probl\u0113mu. Dz\u012b-<br \/>\nv\u012bbas paildzin\u0101\u0161ana ar tehnolo\u0123iju un z\u0101\u013cu pal\u012bdz\u012bbu, resuscit\u0101ci-<br \/>\njas veik\u0161ana, radiolo\u0123iskie izmekl\u0113jumi un intens\u012bv\u0101 terapija prasa<br \/>\nskaidru l\u0113mumu, kad \u0161\u012bs darb\u012bbas uzs\u0101kamas un kad \u2014 p\u0101rtrauca-<br \/>\nmas, ja t\u0101s ir nesekm\u012bgas.<br \/>\nK\u0101 iepriek\u0161 min\u0113ts apak\u0161noda\u013c\u0101 par sazi\u0146u un piekri\u0161anu, pacien-<br \/>\ntam ir ties\u012bbas atteikties no \u0101rst\u0113\u0161anas pat tad, ja vi\u0146a l\u0113muma rezul-<br \/>\nt\u0101t\u0101 var iest\u0101ties n\u0101ve. Cilv\u0113ku attieksme pret n\u0101vi ir krasi at\u0161\u0137ir\u012bga.<br \/>\nDa\u017ei dar\u012bs visu, lai m\u016b\u017eu p\u0113c iesp\u0113jas paildzin\u0101tu neatkar\u012bgi no t\u0101,<br \/>\ncik ilgi un cik stipras s\u0101pes vi\u0146iem n\u0101ktos ciest, citi savuk\u0101rt izv\u0113las<br \/>\ndr\u012bz\u0101k mirt, jo atsak\u0101s no visai vienk\u0101r\u0161as \u0101rst\u0113\u0161anas, kas pasarg\u0101tu<br \/>\nvi\u0146u dz\u012bv\u012bbu, piem\u0113ram, no antibiotik\u0101m bakteri\u0101l\u0101s pneimonijas<br \/>\ngad\u012bjum\u0101. Ja \u0101rsts ir dar\u012bjis visu, lai sniegtu pacientam piln\u012bgu infor-<br \/>\nm\u0101ciju par pieejamo \u0101rst\u0113\u0161anu un to iesp\u0113jamaj\u0101m sekm\u0113m, vi\u0146am<br \/>\nj\u0101respekt\u0113 pacienta l\u0113mums par jebkura \u0101rst\u0113\u0161anas veida uzs\u0101k\u0161a-<br \/>\nnu vai turpin\u0101\u0161anu.<br \/>\nLiel\u0101kas gr\u016bt\u012bbas ir, lai pie\u0146emtu l\u0113mumu par m\u016b\u017ea nobeigumu r\u012b-<br \/>\nc\u012bbnesp\u0113j\u012bgiem pacientiem, dz\u012bves p\u0101rtrauk\u0161anu. Ja pacients skaidri<br \/>\npaudis savu gribu jau agr\u0101k iepriek\u0161\u0113ja r\u012bkojuma veid\u0101, tad l\u0113mums<br \/>\nSaska\u0146\u0101 ar \u0161\u012bm de\ufb01n\u012bcij\u0101m no eitan\u0101zijas un pal\u012bdz\u0113tas pa\u0161n\u0101v\u012bbas<br \/>\nb\u016btu j\u0101no\u0161\u0137ir nelietder\u012bgas, resursu iz\u0161\u0137\u0113rd\u0113jo\u0161as un negrib\u0113tas<br \/>\n\u0101rst\u0113\u0161anas p\u0101rtrauk\u0161anu vai attur\u0113\u0161anos no t\u0101s, k\u0101 ar\u012b l\u012bdzciet\u012bgas<br \/>\npaliat\u012bv\u0101s apr\u016bpes nodro\u0161in\u0101\u0161anu, pat ja to \u012bsteno\u0161ana sa\u012bsina<br \/>\nm\u016b\u017eu.<br \/>\nPacienti parasti pieprasa eitan\u0101ziju un pal\u012bdz\u0113tu pa\u0161n\u0101v\u012bbu, lai iz-<br \/>\nvair\u012btos no liel\u0101m s\u0101p\u0113m vai cit\u0101m cie\u0161an\u0101m, kuras vi\u0146i uzskata par<br \/>\nnepanesam\u0101m. Vi\u0146i lab\u0101k v\u0113las mirt, nek\u0101 turpina dz\u012bvot \u0161\u0101dos aps-<br \/>\nt\u0101k\u013cos. Turkl\u0101t daudzi pacienti bie\u017ei vien uzskata, ka vi\u0146iem ir ties\u012b-<br \/>\nbas mirt, ja t\u0101da ir vi\u0146u izv\u0113le, un ka vi\u0146iem ir pat ties\u012bbas uz k\u0101da<br \/>\npal\u012bdz\u012bbu \u0161\u0101d\u0101 br\u012bd\u012b.T\u0101 k\u0101 \u0101rstam ir gan medic\u012bniskas zin\u0101\u0161anas, gan<br \/>\npiek\u013cuve z\u0101l\u0113m, kas nodro\u0161in\u0101tu \u0101tru un nes\u0101p\u012bgu n\u0101vi, vi\u0146us m\u0113dz<br \/>\nuzskat\u012bt par vispiem\u0113rot\u0101ko l\u012bdzekli n\u0101ves nodro\u0161in\u0101\u0161anai.<br \/>\nSaprotamu iemeslu d\u0113\u013c \u0101rsti atsak\u0101s pild\u012bt \u0161\u0101dus pacientu l\u016bgumus,<br \/>\njo vairum\u0101 valstu eitan\u0101zija un\/vai pal\u012bdz\u0113t\u0101 pa\u0161n\u0101v\u012bba ir nelikum\u012bga<br \/>\nun daudzos medic\u012bnas \u0113tikas kodeksos ar\u012b aizliegta. \u0160is aizliegums<br \/>\nir da\u013ca Hipokr\u0101ta zv\u0113resta, un tas atk\u0101rtoti uzsv\u0113rts PMA Deklar\u0101cij\u0101<br \/>\npar eitan\u0101ziju (Declaration of Euthanasia):<br \/>\n\u00abEitan\u0101zija, t\u012b\u0161a pacienta dz\u012bv\u012bbas p\u0101rtrauk\u0161ana, ir ne\u0113tiska, pat<br \/>\nja pacients vai tuvi vi\u0146a radinieki to ir l\u016bgu\u0161i. Tas nekav\u0113 \u0101rstu<br \/>\niev\u0113rot pacienta v\u0113lmi \u013caut turpin\u0101ties dabiskam n\u0101ves proce-<br \/>\nsam ne\u0101rst\u0113jamas slim\u012bbas termin\u0101laj\u0101 stadij\u0101. \u00bb<br \/>\nAtteikums \u012bstenot eitan\u0101ziju un\/vai pal\u012bdz\u0113to pa\u0161n\u0101v\u012bbu nenoz\u012bm\u0113,<br \/>\nka \u0101rsts neko nevar dar\u012bt, lai atvieglotu pacienta cie\u0161anas dz\u012bv\u012bbu<br \/>\napdraudo\u0161as slim\u012bbas p\u0113d\u0113j\u0101 stadij\u0101, kad nek\u0101das akt\u012bvas \u0101rst\u0113\u0161a-<br \/>\nnas metodes vairs nav piem\u0113rojamas. P\u0113d\u0113jos gados b\u016btiski uzla-<br \/>\nbojusies pacientu paliat\u012bv\u0101 apr\u016bpe, nodro\u0161inot s\u0101pju remdin\u0101\u0161anu,<br \/>\ncie\u0161anu mazin\u0101\u0161anu un dz\u012bves kvalit\u0101tes uzlabo\u0161anu. Paliat\u012bv\u0101 ap-<br \/>\nr\u016bpe ir piem\u0113rota visu vecumu cilv\u0113kiem \u2014 s\u0101kot no maziem b\u0113r-<br \/>\nniem, kas slimo ar v\u0113zi, un beidzot ar veciem cilv\u0113kiem pa\u0161\u0101s m\u016b\u017ea<br \/>\n\u00ab..\u0101rstiem nevajadz\u0113tu<br \/>\natteikties no mirsto\u0161iem<br \/>\npacientiem, bet turpin\u0101t<br \/>\nl\u012bdzciet\u012bbas pilnu apr\u016bpi<br \/>\nar\u012b tad, ja akt\u012bva \u0101rst\u0113\u0161ana<br \/>\nvairs nav iesp\u0113jama.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n62 63<br \/>\nir vienk\u0101r\u0161\u0101ks, lai gan ar\u012b tas bie\u017ei vien ir nenoteikts un noteikti j\u0101-<br \/>\nizskata pacienta paties\u0101 st\u0101vok\u013ca kontekst\u0101. Ja pacients nav skaidri<br \/>\npaudis savu gribu, pilnvarotajam l\u0113muma pie\u0146\u0113m\u0113jam j\u0101izdara pa-<br \/>\ncienta interes\u0113m atbilsto\u0161s l\u0113mums par turpm\u0101ko \u0101rst\u0113\u0161anu.<br \/>\nATGRIE\u0160AN\u0100S PIE GAD\u012aJUMA ANAL\u012aZES<br \/>\nSaska\u0146\u0101 ar \u0161aj\u0101 noda\u013c\u0101 apskat\u012bto \u0101rsta un pacienta<br \/>\nattiec\u012bbu anal\u012bzi Dr. P. uzved\u012bba bija neatbilsto\u0161a vair\u0101ku<br \/>\napsv\u0113rumu d\u0113\u013c:<br \/>\n1) sazi\u0146a \u2014 vi\u0146\u0161 pat nepap\u016bl\u0113j\u0101s aprun\u0101ties ar pacienti<br \/>\nvai m\u0101ti par vi\u0146as vesel\u012bbas st\u0101vok\u013ca c\u0113lo\u0146iem, \u0101rst\u0113\u0161anas<br \/>\nmetodes izv\u0113li un vi\u0146as iesp\u0113j\u0101m palikt slimn\u012bc\u0101 l\u012bdz<br \/>\natvese\u013co\u0161an\u0101s br\u012bdim;<br \/>\n2) piekri\u0161ana \u2014 vi\u0146\u0161 neieguva inform\u0113tu pacientes<br \/>\npiekri\u0161anu \u0101rst\u0113\u0161anai;<br \/>\n3) l\u012bdzj\u016bt\u012bba \u2014 ak\u016bt\u0101 st\u0101vokl\u012b vi\u0146\u0161 pacientei neizr\u0101d\u012bja<br \/>\nnek\u0101du l\u012bdzj\u016bt\u012bbu. Iesp\u0113jams, ka \u0137irur\u0123isko \u0101rst\u0113\u0161anu vi\u0146\u0161<br \/>\npaveica augst\u0101 l\u012bmen\u012b un mai\u0146as beig\u0101s bija noguris, ta\u010du<br \/>\ntas neattaisno \u0113tikas principu neiev\u0113ro\u0161anu.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunpacienti<br \/>\n64 65<br \/>\n3. NODA\u013bA.<br \/>\n\u0100RSTI UN SABIEDR\u012aBA<br \/>\nM\u0112R\u0136I<br \/>\nP\u0113c \u0161\u012bs noda\u013cas izlas\u012b\u0161anas j\u016bs var\u0113siet:<br \/>\n\u2022 izprast neatbilst\u012bbu starp \u0101rsta pien\u0101kumiem pret<br \/>\npacientu un pret sabiedr\u012bbu un identi\ufb01c\u0113t \u0161o kon\ufb02iktu<br \/>\niemeslus;<br \/>\n\u2022 identi\ufb01c\u0113t un tikt gal\u0101 ar \u0113tikas jaut\u0101jumiem, kas saist\u012bti<br \/>\nar ierobe\u017eoto vesel\u012bbas apr\u016bpes resursu izlietojumu;<br \/>\n\u2022 izprast \u0101rsta atbild\u012bbu par sabiedr\u012bbas vesel\u012bbu un<br \/>\nglob\u0101lo vesel\u012bbu.Aci pret aci ar AIDS<br \/>\n\u00a9 Gideon Mendei\/CORBIS<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n66 67<br \/>\nprivil\u0113\u0123ijas, ieskaitot ekskluz\u012bvu atbild\u012bbu par noteiktu pakalpoju-<br \/>\nmu nodro\u0161in\u0101\u0161anu un augstu pa\u0161regul\u0101cijas pak\u0101pi, pret\u012b sa\u0146emot<br \/>\nprofesijas p\u0101rst\u0101vju piekri\u0161anu lietot<br \/>\n\u0161\u012bs privil\u0113\u0123ijas vispirms citu, tikai p\u0113c<br \/>\ntam \u2014 sav\u0101 lab\u0101.<br \/>\nM\u016bsdien\u0101s vair\u0101k nek\u0101 jebkad medi-<br \/>\nc\u012bna ir dr\u012bz\u0101k soci\u0101la, nevis individu\u0101la<br \/>\ndarb\u012bba. Darbo\u0161anos taj\u0101 liel\u0101 m\u0113r\u0101<br \/>\nietekm\u0113 vald\u012bba, da\u017e\u0101das korporat\u012bvas<br \/>\norganiz\u0101cijas un \ufb01nans\u0113jums. T\u0101 balst\u0101s uz publiski vai priv\u0101ti veik-<br \/>\ntiem medic\u012bniskiem p\u0113t\u012bjumiem un r\u016bpniecisk\u0101m izstr\u0101d\u0113m, kas<br \/>\nnodro\u0161ina medic\u012bnu gan ar zin\u0101\u0161anu b\u0101zi, gan \u0101rst\u0113\u0161anas iesp\u0113j\u0101m.<br \/>\nMedic\u012bna \u0101rst\u0113 slim\u012bbas, kam dr\u012bz\u0101k ir soci\u0101la, ne biolo\u0123iska cilme.<br \/>\nMedic\u012bnas \u0113tikas hipokr\u0101tisk\u0101 trad\u012bcija sniedz pavisam maz nor\u0101d\u012b-<br \/>\njumu par \u0101rsta un sabiedr\u012bbas attiec\u012bb\u0101m. Papildinot to, m\u016bsdienu<br \/>\nmedic\u012bnas \u0113tika piev\u0113r\u0161as \u0161im jaut\u0101jumam, kas tie\u0161i izriet no \u0101rsta<br \/>\nun pacienta attiec\u012bbu probl\u0113m\u0101m un pied\u0101v\u0101 krit\u0113rijus un metodes,<br \/>\nkas pal\u012bdz\u0113tu \u0161\u0101das probl\u0113mas risin\u0101t.<br \/>\nRun\u0101jot par medic\u012bnas soci\u0101lo raksturu, neizb\u0113gami rodas jaut\u0101-<br \/>\njums \u2014 kas ir sabiedr\u012bba? Rokasgr\u0101mat\u0101 ar terminu \u00absabiedr\u012bba\u00bb<br \/>\ndom\u0101ti j\u0113dzieni \u00abkopiena\u00bb vai \u00abvalsts\u00bb. Tas nav sinon\u012bms v\u0101rdam<br \/>\nvald\u012bba, jo tai gan b\u016btu j\u0101p\u0101rst\u0101v sabiedr\u012bbas intereses, bet tas bie\u017ei<br \/>\nvien nenotiek, un, pat ja t\u0101 notiek, tad darbojas sabiedr\u012bbas d\u0113\u013c, ne-<br \/>\nvis k\u0101 sabiedr\u012bbas da\u013ca.<br \/>\n\u0100rstu attiec\u012bbas ar sabiedr\u012bbu ir da\u017e\u0101das. T\u0101 k\u0101 sabiedr\u012bba un \ufb01zis-<br \/>\nk\u0101 vide ir \u013coti b\u016btiski vesel\u012bbas faktori, tad gan \u0101rstu profesijai, gan<br \/>\nkatram \u0101rstam individu\u0101li ir b\u016btiska noz\u012bme sabiedr\u012bbas vesel\u012bb\u0101,<br \/>\nvesel\u012bbas izgl\u012bt\u012bb\u0101, vides aizsardz\u012bb\u0101, ties\u012bbu normu izstr\u0101d\u0113, kas<br \/>\nskar kopienas vesel\u012bbu un labkl\u0101j\u012bbu, k\u0101 ar\u012b liec\u012bbu snieg\u0161an\u0101 tiesas<br \/>\npriek\u0161\u0101.<br \/>\nK\u0100DAS IR \u0100RSTA UN SABIEDR\u012aBAS ATTIEC\u012aBU \u012aPATN\u012aBAS?<br \/>\nMedic\u012bna ir profesija. V\u0101rdam \u00abprofesija\u00bb ir divas skaidri no\u0161\u0137iramas,<br \/>\nbet sam\u0113r\u0101 cie\u0161i saist\u012btas noz\u012bmes: 1) nodarbo\u0161an\u0101s, kam rakstur\u012bga<br \/>\nziedo\u0161an\u0101s citu labumam, augsti mor\u0101les standarti, zin\u0101\u0161anas un<br \/>\nprasmes, k\u0101 ar\u012b augsta l\u012bme\u0146a autonomija; 2) visi indiv\u012bdi, kas str\u0101d\u0101<br \/>\n\u0161aj\u0101 darb\u012bbas jom\u0101. \u00ab\u0100rstu profesija\u00bb t\u0101tad var noz\u012bm\u0113t gan medic\u012b-<br \/>\nnas praksi, gan visu \u0101rstu kopumu.<br \/>\n\u0100rsta profesija neaprobe\u017eojas tikai ar attiec\u012bb\u0101m starp \u0101rstu un pa-<br \/>\ncientu, kas jau apskat\u012btas 2. noda\u013c\u0101, vai \u0101rsta attiec\u012bb\u0101m ar kol\u0113\u0123iem<br \/>\nun citu vesel\u012bbas apr\u016bpes profesiju darbiniekiem, kas tiks apl\u016bko-<br \/>\ntas 4. noda\u013ca. T\u0101s aptver ar\u012b \u0101rsta attiec\u012bbas ar sabiedr\u012bbu. \u0160\u0101s var<br \/>\nraksturot k\u0101 \u00absoci\u0101lu l\u012bgumu\u00bb, kur sabiedr\u012bba garant\u0113 profesijas<br \/>\n\u00abM\u016bsdien\u0101s vair\u0101k nek\u0101<br \/>\njebkad medic\u012bna ir dr\u012bz\u0101k<br \/>\nsoci\u0101la, nevis individu\u0101la<br \/>\ndarb\u012bba.\u00bb<br \/>\n2. GAD\u012aJUMA APRAKSTS<br \/>\n\u0100rste S. pamaz\u0101m s\u0101k justies aizkaitin\u0101ta, jo pacienti,<br \/>\nkas n\u0101k pie vi\u0146as, vai nu pirms vai p\u0113c \u0161\u012bs viz\u012btes ar to<br \/>\npa\u0161u slim\u012bbu griezu\u0161ies pie citiem speci\u0101listiem. Vi\u0146a<br \/>\nuzskata, ka \u0161\u0101da r\u012bc\u012bba ir velt\u012bga resursu \u0161\u0137ie\u0161ana, k\u0101 ar\u012b<br \/>\nnelietder\u012bga pa\u0161iem pacientiem. Vi\u0146a nolemj pacientiem<br \/>\npateikt, ka turpm\u0101k vairs tos ne\u0101rst\u0113s, ja \u0161o pa\u0161u slim\u012bbu<br \/>\nd\u0113\u013c turpin\u0101s apmekl\u0113t ar\u012b citus speci\u0101listus. Vi\u0146a ir<br \/>\nnol\u0113musi v\u0113rsties sav\u0101 medic\u012bnas asoci\u0101cij\u0101, lai piepras\u012btu<br \/>\nvald\u012bbai nov\u0113rst \u0161\u0101du velt\u012bgu medic\u012bnas resursu \u0161\u0137ie\u0161anu.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n68 69<br \/>\n\u0160\u012b spektra vien\u0101 gal\u0101 ir oblig\u0101ta pras\u012bba zi\u0146ot par pacientiem, kas<br \/>\nslimo ar noteikt\u0101m slim\u012bb\u0101m, kuras, piem\u0113ram, ne\u013cauj vad\u012bt trans-<br \/>\nportl\u012bdzekli vai par gad\u012bjumiem, ja ir aizdomas par varm\u0101c\u012bbu pret<br \/>\nb\u0113rniem. \u0100rstam vajadz\u0113tu \u0161\u012bs pras\u012bbas pild\u012bt, ta\u010du ar\u012b pacients par<br \/>\nto b\u016btu j\u0101inform\u0113.<br \/>\nOtr\u0101 spektra gal\u0101 ir policijas vai armijas r\u012bkojumi vai pav\u0113les iesais-<br \/>\nt\u012bties procesos, kas p\u0101rk\u0101pj cilv\u0113ka pamatties\u012bbas, piem\u0113ram, sp\u012b-<br \/>\ndzin\u0101\u0161an\u0101. 2003. gada rezol\u016bcij\u0101 par \u0101rstu atbild\u012bbu apzin\u0101tas sp\u012b-<br \/>\ndzin\u0101\u0161anas vai ne\u017e\u0113l\u012bgas, nehum\u0101nas vai pazemojo\u0161as iztur\u0113\u0161an\u0101s<br \/>\ngad\u012bjumu atkl\u0101\u0161anu, kuros vi\u0146i piedal\u012bju\u0161ies (Resolution on the Res-<br \/>\nponsibility of Physicians in the Denuinciation of Acts of Torture or Cruel<br \/>\nor Inhuman or Degrading Treatment of which They are Aware), PMA<br \/>\ndod \u012bpa\u0161as nor\u0101des tiem \u0101rstiem, kas non\u0101k \u0161\u0101d\u0101 situ\u0101cij\u0101. Tom\u0113r<br \/>\n\u0101rstiem maksim\u0101li b\u016btu j\u0101sarg\u0101 profesion\u0101l\u0101 neatkar\u012bba, lai r\u012bkotos<br \/>\npacienta interes\u0113s un iev\u0113rotu \u0113tikas<br \/>\npamatpras\u012bbas inform\u0113tas piekri\u0161anas<br \/>\nun kon\ufb01dencialit\u0101tes jaut\u0101jumos. Kat-<br \/>\nram \u0161o pras\u012bbu p\u0101rk\u0101pumam, ja t\u0101ds ir<br \/>\nj\u0101izdara, ir j\u0101b\u016bt pamatotam un j\u0101dara<br \/>\nzin\u0101ms pacientam. \u0100rstam b\u016btu j\u0101zi-<br \/>\n\u0146o attiec\u012bgaj\u0101m instit\u016bcij\u0101m par katru<br \/>\nneattaisnojamas iejauk\u0161an\u0101s gad\u012bju-<br \/>\nmu apr\u016bpes proces\u0101, ja vi\u0146u pacientu<br \/>\nties\u012bbas netiek iev\u0113rotas, jo \u012bpa\u0161i, ja tas<br \/>\nattiecas uz gad\u012bjumiem, kad tiek p\u0101r-<br \/>\nk\u0101ptas cilv\u0113ka pamatties\u012bbas. Ja insti-<br \/>\nt\u016bcijas nerea\u0123\u0113, tad pal\u012bdz\u012bba j\u0101mekl\u0113<br \/>\nvalsts medic\u012bnas asoci\u0101cij\u0101, PMA vai cilv\u0113kties\u012bbas sarg\u0101jo\u0161\u0101s orga-<br \/>\nniz\u0101cij\u0101s.<br \/>\nKaut kur pel\u0113k\u0101s joslas vid\u016b atrodas da\u017eas p\u0101rvald\u012btas vesel\u012bbas<br \/>\napr\u016bpes programmas, kas ierobe\u017eo \u0101rstu kl\u012bnisko autonomiju no-<br \/>\nteikt, k\u0101 vi\u0146u pacienti \u0101rst\u0113jami. Lai ar\u012b \u0161\u0101das programmas parasti<br \/>\nPMA Pacientu ties\u012bbu deklar\u0101cij\u0101 teikts: \u00abJa likumdev\u0113ja vara, vald\u012b-<br \/>\nba vai k\u0101da cita p\u0101rvaldes instit\u016bcija neatz\u012bst pacientu ties\u012bbas, \u0101rs-<br \/>\ntiem ir j\u0101\u012bsteno atbilsto\u0161i pas\u0101kumi, lai t\u0101s tiktu atjaunotas un iev\u0113-<br \/>\nrotas.\u00bb \u0100rstam ar\u012b j\u0101uz\u0146emas b\u016btiska loma sabiedr\u012bbas r\u012bc\u012bb\u0101 eso\u0161o<br \/>\nierobe\u017eoto vesel\u012bbas apr\u016bpes resursu sadal\u0113, t\u0101d\u0113\u013c da\u017ek\u0101rt vi\u0146iem<br \/>\nir pien\u0101kums nov\u0113rst pacientu piek\u013cuvi pakalpojumiem, uz kuriem<br \/>\nvi\u0146iem nav nek\u0101du ties\u012bbu. \u0160\u012bs atbild\u012bbas \u012bsteno\u0161ana var izrais\u012bt \u0113tis-<br \/>\nkus kon\ufb02iktus, it \u012bpa\u0161i tad, ja sabiedr\u012bbas intereses non\u0101k kon\ufb02ikt\u0101 ar<br \/>\nk\u0101da individu\u0101la pacienta interes\u0113m.<br \/>\nDUBULTLOJALIT\u0100TE<br \/>\nJa \u0101rstam ir pien\u0101kumi un atbild\u012bba gan pret pacientu, gan pret<br \/>\ntre\u0161o pusi un ja \u0161ie pien\u0101kumi un atbild\u012bba nav savienojami, \u0101rsts<br \/>\nnon\u0101k \u00abdubultlojalit\u0101tes\u00bb situ\u0101cij\u0101. Tre\u0161\u0101 puse, kas prasa no \u0101rsta<br \/>\nlojalit\u0101ti, ir vald\u012bba, darba dev\u0113ji (piem\u0113ram, slimn\u012bca vai vesel\u012bbas<br \/>\napr\u016bpes sist\u0113ma), apdro\u0161in\u0101t\u0101ji, milit\u0101ro strukt\u016bru amatpersonas,<br \/>\npolicija, ieslodz\u012bjuma vietu administr\u0101cija un \u0123imenes locek\u013ci. Lai<br \/>\nar\u012b PMA Starptautiskais medic\u012bnas \u0113tikas kodekss pau\u017e, ka \u00ab\u0101rstam<br \/>\nj\u0101b\u016bt piln\u012bgi loj\u0101lam pret savu pacien-<br \/>\ntu\u00bb, ir atsevi\u0161\u0137as situ\u0101cijas, kad citu<br \/>\nintereses \u0101rsts var izvirz\u012bt augst\u0101k par<br \/>\npacienta interes\u0113m. \u0112tiska probl\u0113ma<br \/>\nrodas, ja j\u0101izlemj, kad un k\u0101 aizst\u0101v\u0113t<br \/>\npacientu no iesp\u0113jama tre\u0161\u0101s puses<br \/>\np\u0101rst\u0101vju spiediena.<br \/>\nDubultlojalit\u0101tes situ\u0101cijas ir k\u0101 skala, kuras vien\u0101 gal\u0101 priek\u0161ro-<br \/>\nka dodama sabiedr\u012bbas interes\u0113m, otr\u0101 \u2014 situ\u0101cijas, kur\u0101s daudz<br \/>\nsvar\u012bg\u0101kas ir pacienta intereses. Pa vidu starp t\u0101m ir pla\u0161a pel\u0113k\u0101<br \/>\njosla, kur vajadz\u012bgs detaliz\u0113ts nov\u0113rt\u0113jums, lai pie\u0146emtu lab\u0101ko l\u0113-<br \/>\nmumu.<br \/>\n\u00ab..ir atsevi\u0161\u0137as situ\u0101cijas,<br \/>\nkad citu intereses \u0101rsts<br \/>\nvar izvirz\u012bt augst\u0101k par<br \/>\npacienta interes\u0113m.\u00bb<br \/>\n\u00ab\u0100rstam b\u016btu j\u0101zi\u0146o<br \/>\nattiec\u012bgaj\u0101m instit\u016bcij\u0101m<br \/>\npar katru neattaisnojamas<br \/>\niejauk\u0161an\u0101s gad\u012bjumu<br \/>\napr\u016bpes proces\u0101, ja vi\u0146u<br \/>\npacientu ties\u012bbas netiek<br \/>\niev\u0113rotas, jo \u012bpa\u0161i, ja tas<br \/>\nattiecas uz gad\u012bjumiem,<br \/>\nkad tiek p\u0101rk\u0101ptas cilv\u0113ka<br \/>\npamatties\u012bbas.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n70 71<br \/>\nRESURSU SADALE<br \/>\nPasaules valst\u012bs, ieskaitot visbag\u0101t\u0101k\u0101s, ir v\u0113rojama plata, stabili au-<br \/>\ngo\u0161a plaisa starp vajadz\u012bb\u0101m p\u0113c vesel\u012bbas apr\u016bpes pakalpojumiem<br \/>\nun pieejamajiem resursiem, kas \u013cauj tos nodro\u0161in\u0101t. T\u0101s esam\u012bba<br \/>\npieprasa racion\u0101lu resursu sadali. Vesel\u012bbas apr\u016bpes norm\u0113\u0161ana jeb,<br \/>\nk\u0101 to bie\u017e\u0101k d\u0113v\u0113, resursu sadale ir iesp\u0113jama trijos l\u012bme\u0146os:<br \/>\n\u2022 augst\u0101kaj\u0101 l\u012bmen\u012b (makrol\u012bmen\u012b) vald\u012bba nosaka gan vesel\u012b-<br \/>\nbas apr\u016bpei pie\u0161\u0137iramo bud\u017eetu, gan to, kuri vesel\u012bbas apr\u016bpes<br \/>\npakalpojumi tiks sniegti bez maksas un par kuriem b\u016bs j\u0101maks\u0101<br \/>\npacientiem pa\u0161iem vai vi\u0146u vesel\u012bbas apdro\u0161in\u0101t\u0101jiem; cik daudz<br \/>\ntiks pie\u0161\u0137irts \u0101rstu, medic\u012bnas m\u0101su un citu vesel\u012bbas apr\u016bpes dar-<br \/>\nbinieku atalgojumam, k\u0101das b\u016bs slimn\u012bcu un citu instit\u016bciju uz-<br \/>\ntur\u0113\u0161anas iek\u0101rtu izmanto\u0161anas izmaksas, cik naudas paredz\u0113ts<br \/>\np\u0113t\u012bjumiem, medic\u012bnas darbinieku izgl\u012bto\u0161anai un \u012bpa\u0161u slim\u012bbu,<br \/>\npiem\u0113ram, tuberkulozes, AIDS u. c. \u0101rst\u0113\u0161anai utt.<br \/>\n\u2022 institucion\u0101laj\u0101 l\u012bmen\u012b (mezol\u012bmen\u012b), ar ko saprot slimn\u012bcas, kl\u012b-<br \/>\nnikas, vesel\u012bbas apr\u016bpes centrus u. c. iest\u0101des, to vad\u012bba sadala<br \/>\nsavus resursus un nolemj, k\u0101dus pakalpojumus nodro\u0161in\u0101t; cik<br \/>\ndaudz t\u0113r\u0113t person\u0101lam, apr\u012bkojumam, apsardzei, citiem uztur\u0113-<br \/>\n\u0161anas izdevumiem, darb\u012bbas papla\u0161in\u0101\u0161anai u. t. t.<br \/>\n\u2022 individu\u0101laj\u0101 jeb pacienta l\u012bmen\u012b (mikrol\u012bmen\u012b) vesel\u012bbas ap-<br \/>\nr\u016bpes veic\u0113ji, it \u012bpa\u0161i \u0101rsti, nolemj, k\u0101di izmekl\u0113jumi b\u016btu nepie-<br \/>\ncie\u0161ami; vai nepiecie\u0161ams nos\u016bt\u012bt pacientu pie cita \u0101rsta vai uz<br \/>\nslimn\u012bcu; vai nepiecie\u0161ams k\u0101ds ori\u0123in\u0101lra\u017eot\u0101ja medikaments<br \/>\n\u0123en\u0113risku z\u0101\u013cu viet\u0101. Apr\u0113\u0137ini liecina, ka \u0101rsti ir atbild\u012bgi par vis-<br \/>\nmaz 80% vesel\u012bbas apr\u016bpes resursu pat\u0113ri\u0146u, un, vi\u0146iem v\u0113l jop-<br \/>\nroj\u0101m ir iev\u0113rojama ietekme, lai noteiktu, ar k\u0101diem resursiem<br \/>\npacienti tiks nodro\u0161in\u0101ti.<br \/>\nVisos l\u012bme\u0146os pie\u0146emtie l\u0113mumi satur b\u016btiskus \u0113tikas elementus, jo<br \/>\nbalst\u012bti uz v\u0113rt\u012bb\u0101m, un tiem var b\u016bt b\u016btiska ietekme k\u0101 uz indiv\u012bda,<br \/>\nnenon\u0101k pretrun\u0101 ar pacientu interes\u0113m, tom\u0113r t\u0101s ir iesp\u0113jamas,<br \/>\nun \u0101rstiem b\u016btu uzman\u012bgi j\u0101apsver, vai \u0161\u0101d\u0101s programm\u0101s var pie-<br \/>\ndal\u012bties. Ja nav citu iesp\u0113ju, piem\u0113ram, citu alternat\u012bvu programmu<br \/>\nnemaz nav, vi\u0146iem b\u016btu ener\u0123iski j\u0101iest\u0101jas par savu pacientu in-<br \/>\nteres\u0113m.<br \/>\nTipiska dubultlojalit\u0101tes situ\u0101cija, ar ko \u0101rsts ikdien\u0101 saskaras, ir<br \/>\niesp\u0113jams vai past\u0101vo\u0161s intere\u0161u kon\ufb02ikts starp pacientu un\/vai<br \/>\nsabiedr\u012bbu, no vienas puses, un starp k\u0101du komerci\u0101la rakstura uz-<br \/>\n\u0146\u0113mumu, no otras puses. Farm\u0101cijas \ufb01rmas, medic\u012bnas tehnolo\u0123iju<br \/>\nra\u017eot\u0101ji un citas ar medic\u012bnu saist\u012btas komercstrukt\u016bras bie\u017ei vien<br \/>\n\u0101rstiem pied\u0101v\u0101 d\u0101vanas vai citus labumus, s\u0101kot no iesp\u0113jas segt<br \/>\nce\u013ca un viesn\u012bcas izdevumus k\u0101d\u0101 izgl\u012btojo\u0161\u0101 pas\u0101kum\u0101 l\u012bdz pat<br \/>\nd\u0101snai atl\u012bdz\u012bbai par kl\u012bniskiem p\u0113t\u012bjumiem (skat. 5. noda\u013cu). \u0160\u0101da<br \/>\nlielo ra\u017eot\u0101juz\u0146\u0113mumu d\u0101snuma iemesls ir v\u0113lme sekm\u0113t, lai \u0101rsts<br \/>\nparakst\u012btu saviem pacientiem attiec\u012bg\u0101s \ufb01rmas medikamentus vai<br \/>\ncitus produktus, kas ne vienm\u0113r ir lab\u0101kais risin\u0101jums un bie\u017ei vien<br \/>\npat paaugstina vesel\u012bbas apr\u016bpes izmaksas. PMA 2004. gada no-<br \/>\nst\u0101dn\u0113s par saist\u012bb\u0101m starp \u0101rstiem un komercuz\u0146\u0113mumiem (Sta-<br \/>\ntement Concerning the Relationship be-<br \/>\ntween Physicians and Commercial En-<br \/>\nterprises) sniedz \u0101rstiem nor\u0101d\u012bjumus,<br \/>\nk\u0101 r\u012bkoties l\u012bdz\u012bg\u0101s situ\u0101cij\u0101s, turkl\u0101t<br \/>\ndaudzu valstu medic\u012bnas asoci\u0101cij\u0101m<br \/>\nir izstr\u0101d\u0101tas savas vadl\u012bnijas. \u0112tikas<br \/>\npamatprincips \u0161aj\u0101s vadl\u012bnij\u0101s ir, ka<br \/>\n\u0101rstam j\u0101atrisina \u0161\u0101da veida kon\ufb02ikts<br \/>\nt\u0101, lai pacienta intereses aizvien g\u016btu<br \/>\np\u0101rsvaru p\u0101r \u0101rsta interes\u0113m.<br \/>\n\u00ab..\u0101rstam j\u0101atrisina \u0161\u0101da<br \/>\nveida konflikts t\u0101, lai<br \/>\npacienta intereses aizvien<br \/>\ng\u016btu p\u0101rsvaru p\u0101r \u0101rsta<br \/>\ninteres\u0113m.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n72 73<br \/>\nja pacienti t\u0101s pieprasa. Antibiotiku<br \/>\np\u0101rm\u0113r\u012bga lieto\u0161ana ir viens no uzska-<br \/>\nt\u0101miem piem\u0113riem, kad \u0161\u0101da r\u012bc\u012bba<br \/>\nir gan iz\u0161\u0137\u0113rd\u012bga, gan kait\u0113jo\u0161a. Dau-<br \/>\ndzas ikdien\u0101 izmantotas \u0101rst\u0113\u0161anas<br \/>\nmetodes kl\u012bniskos p\u0113t\u012bjumos izr\u0101d\u012bj\u0101s<br \/>\nneefekt\u012bvas, \u0101rst\u0113jot t\u0101s slim\u012bbas, kuru<br \/>\ngad\u012bjum\u0101 t\u0101s parasti m\u0113dz lietot. Dau-<br \/>\ndzos gad\u012bjumos ir pieejamas kl\u012bnisk\u0101s<br \/>\nprakses vadl\u012bnijas, kas pal\u012bdz at\u0161\u0137irt<br \/>\nefekt\u012bvu \u0101rst\u0113\u0161anu no neefekt\u012bvas. \u0100rstiem b\u016btu j\u0101iepaz\u012bstas ar \u0161\u012bm<br \/>\nvadl\u012bnij\u0101m, lai taup\u012btu resursus, lai nodro\u0161in\u0101tu lab\u0101ko \u0101rst\u0113\u0161anu sa-<br \/>\nviem pacientiem.<br \/>\nSare\u017e\u0123\u012bts l\u0113mums, kas daudziem \u0101rstiem bie\u017ei vien j\u0101pie\u0146em, ir iz-<br \/>\nv\u0113le starp diviem vai vair\u0101k pacientiem, kas pretend\u0113 uz vienu ie-<br \/>\nrobe\u017eotas pieejam\u012bbas resursu (\u0101rst\u0113\u0161anas metodi), piem\u0113ram, par<br \/>\nneatliekam\u0101s pal\u012bdz\u012bbas noda\u013cas person\u0101la uzraudz\u012bbu, vien\u012bgo atli-<br \/>\nku\u0161o gultu intens\u012bv\u0101s terapijas noda\u013c\u0101, transplant\u0101cijai pieejamiem<br \/>\norg\u0101niem, sare\u017e\u0123\u012btiem radiolo\u0123iskiem izmekl\u0113jumiem un atsevi\u0161-<br \/>\n\u0137iem, \u013coti d\u0101rgiem medikamentiem. \u0100rstiem, kas kontrol\u0113 \u0161o resur-<br \/>\nsu izlietojumu, ir j\u0101izlemj, kuriem pacientiem tie b\u016bs pieejami un<br \/>\nkuriem \u2014 b\u016bs liegti, labi apzinoties, ka l\u0113muma rezult\u0101t\u0101 pacienti,<br \/>\nkas tos nesa\u0146ems, tiks pak\u013cauti cie\u0161an\u0101m un pat n\u0101vei.<br \/>\nDa\u017eiem \u0101rstiem \u0161\u0101ds papildu intere\u0161u kon\ufb02ikts v\u0113l vair\u0101k pastipri-<br \/>\nn\u0101s t\u0101d\u0113\u013c, ka akt\u012bvi piedal\u0101s visp\u0101r\u012bg\u0101s resursu sadales politik\u0101, kas<br \/>\ntie\u0161i skar ar\u012b vi\u0146u pacientus. \u0160is kon\ufb02ikts bie\u017ei vien nov\u0113rojams slim-<br \/>\nn\u012bc\u0101s vai cit\u0101s iest\u0101d\u0113s, kur\u0101s \u0101rsts ie\u0146em administrat\u012bvu amatu vai ir<br \/>\niesaist\u012bts komitej\u0101s, kur \u0161\u0101du politiku iesaka vai pat nosaka r\u012bkojuma<br \/>\nveid\u0101. Lai ar\u012b daudzi \u0101rsti m\u0113\u0123ina no\u0161\u0137irt darb\u012bbu \u0161\u0101d\u0101s komitej\u0101s<br \/>\nno savas pamatdarb\u012bbas, atrodas ar\u012b t\u0101di, kas paman\u0101s izmantot si-<br \/>\ntu\u0101ciju sev un saviem pacientiem par labu pat tad, ja citiem nepie-<br \/>\ncie\u0161am\u012bba ir liel\u0101ka.<br \/>\nt\u0101 ar\u012b uz kopienas vesel\u012bbu un labkl\u0101j\u012bbu. Lai ar\u012b \u0101rstus skar l\u0113mumi,<br \/>\nkas tiek pie\u0146emti visos l\u012bme\u0146os, vi\u0146i vistie\u0161\u0101k ir iesaist\u012bti mikrol\u012bme-<br \/>\nn\u012b. Da\u017eus \u0161\u012b l\u012bme\u0146a aspektus apl\u016bkosim turpm\u0101k.<br \/>\nK\u0101 iepriek\u0161 min\u0113ts, \u0101rstam tradicion\u0101li vispirms j\u0101r\u016bp\u0113jas par pa-<br \/>\ncientu interes\u0113m, neveltot \u012bpa\u0161u v\u0113r\u012bbu citu vajadz\u012bb\u0101m. \u0100rstu pri-<br \/>\nm\u0101r\u0101s \u0113tikas v\u0113rt\u012bbas \u2014 l\u012bdzciet\u012bba, kompetence un autonomija \u2014<br \/>\ntika v\u0113rstas uz vi\u0146u individu\u0101lo pacientu vajadz\u012bbu apmierin\u0101\u0161anu.<br \/>\n\u0160\u012b individu\u0101l\u0101 pieeja medic\u012bnas \u0113tikas jaut\u0101jumiem saglab\u0101j\u0101s ar\u012b<br \/>\np\u0113c p\u0101rejas no \u0101rsta patern\u0101lisma uz pacienta autonomiju, kuras<br \/>\ngad\u012bjum\u0101 individu\u0101la pacienta griba k\u013cuva par galveno krit\u0113riju, lai<br \/>\npie\u0146emtu l\u0113mumu, k\u0101dus medic\u012bniskos resursus (pakalpojumus)<br \/>\nvi\u0146\u0161 sa\u0146ems. Krietni nesen\u0101 pag\u0101tn\u0113 k\u0101da cita v\u0113rt\u012bba, proti, taisn\u012b-<br \/>\ngums, ir k\u013cuvusi par noz\u012bm\u012bgu faktoru,<br \/>\nkas iespaido medic\u012bnisku l\u0113mumu pie-<br \/>\n\u0146em\u0161anas procesu. \u0160\u012b v\u0113rt\u012bba nosaka,<br \/>\nka resursu sadal\u0113 j\u0101iev\u0113ro vair\u0101k soci-<br \/>\n\u0101li orient\u0113ta pieeja, jo t\u0101 liek \u0146emt v\u0113r\u0101<br \/>\nar\u012b citu pacientu intereses. Saska\u0146\u0101 ar<br \/>\nto \u0101rsti ir atbild\u012bgi ne vien par saviem<br \/>\nindividu\u0101lajiem pacientiem, bet zin\u0101m\u0101<br \/>\nm\u0113r\u0101 ar\u012b par citiem.<br \/>\n\u0160\u012b jaun\u0101 izpratne par \u0101rstu noz\u012bmi resursu sadal\u0113 ir izteikta daudzu<br \/>\nvalstu medic\u012bnas asoci\u0101ciju \u0113tikas kodeksos, k\u0101 ar\u012b PMA Pacienta tie-<br \/>\ns\u012bbu deklar\u0101cij\u0101, kas nosaka: \u00abApst\u0101k\u013cos, kad vair\u0101kiem pacientiem<br \/>\nnepiecie\u0161ama k\u0101da \u012bpa\u0161a \u0101rst\u0113\u0161anas metode, kuras pieejam\u012bba ir<br \/>\nierobe\u017eota, visiem \u0161\u012bs grupas pacientiem ir ties\u012bbas pras\u012bt, lai pie-<br \/>\nm\u0113rot\u0101 atlases proced\u016bra \u0101rst\u0113\u0161anas sa\u0146em\u0161anai b\u016btu god\u012bga. \u0160ai<br \/>\nizv\u0113lei j\u0101notiek atbilsto\u0161i medic\u012bniskiem krit\u0113rijiem un nav pie\u013cauja-<br \/>\nma diskrimin\u0101cija.\u00bb<br \/>\nViens no l\u012bdzek\u013ciem, k\u0101 \u0101rsts var \u012bstenot atbild\u012bbu par resursu sadali,<br \/>\nir izvair\u012b\u0161an\u0101s no iz\u0161\u0137\u0113rd\u012bg\u0101m un neefekt\u012bv\u0101m manipul\u0101cij\u0101m, pat<br \/>\n\u00ab..\u0101rsti ir atbild\u012bgi<br \/>\nne vien par saviem<br \/>\nindividu\u0101lajiem<br \/>\npacientiem, bet zin\u0101m\u0101<br \/>\nm\u0113r\u0101 ar\u012b par citiem.\u00bb<br \/>\n\u00abViens no l\u012bdzek\u013ciem,<br \/>\nk\u0101 \u0101rsts var \u012bstenot<br \/>\natbild\u012bbu par resursu<br \/>\nsadali, ir izvair\u012b\u0161an\u0101s<br \/>\nno iz\u0161\u0137\u0113rd\u012bg\u0101m<br \/>\nun neefekt\u012bv\u0101m<br \/>\nmanipul\u0101cij\u0101m, pat ja<br \/>\npacienti t\u0101s pieprasa.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n74 75<br \/>\nResursu sadales proces\u0101 \u0101rstiem ne tikai j\u0101uztur l\u012bdzsvars starp l\u012bdz-<br \/>\nciet\u012bbas un taisn\u012bguma principiem, bet ar\u012b j\u0101izlemj, kura no pieej\u0101m<br \/>\nir vispiem\u0113rot\u0101k\u0101 konkr\u0113taj\u0101 situ\u0101cij\u0101. Ir vair\u0101kas pieejas, proti:<br \/>\nliber\u0101l\u0101 (libertarian) \u2014 resursu sadale notiek saska\u0146\u0101 ar tirgus prin-<br \/>\ncipiem (personiska izv\u0113le, ko nosaka sp\u0113ja un v\u0113lme maks\u0101t; ierobe-<br \/>\n\u017eota soci\u0101l\u0101 pal\u012bdz\u012bba tr\u016bc\u012bgajiem);<br \/>\nutilit\u0101r\u0101 (utilitarian) \u2014 resursi j\u0101sadala t\u0101, lai tiktu \u012bstenots uz vi-<br \/>\nsiem attiecin\u0101mais maksim\u0101l\u0101 guvuma princips;<br \/>\negalit\u0101r\u0101 (egalitarian) \u2014 stingra resursu sadale tikai p\u0113c nepiecie-<br \/>\n\u0161am\u012bbas;<br \/>\nsan\u0113jo\u0161\u0101 (restorative) \u2014 resursu sadale tiek veikta par labu nelab-<br \/>\nv\u0113l\u012bg\u0101m iedz\u012bvot\u0101ju grup\u0101m vai nabadz\u012bgiem re\u0123ioniem.<br \/>\nJau min\u0113ts, ka \u0101rsti pamaz\u0101m s\u0101k atk\u0101pties no tradicion\u0101l\u0101s indi-<br \/>\nvidu\u0101listisk\u0101s medic\u012bnas \u0113tikas, kas nosac\u012bti var\u0113tu veicin\u0101t liber\u0101lo<br \/>\npieeju resursu sadal\u0113, pie\u0146emot t\u0101s viet\u0101 vair\u0101k soci\u0101li orient\u0113tu<br \/>\nizpratni par vi\u0146u noz\u012bmi. Kaut gan ar\u012b liber\u0101l\u0101 pieeja parasti tiek no-<br \/>\nraid\u012bta, medic\u012bnas \u0113tikas speci\u0101listi nav sp\u0113ju\u0161i rast vienpr\u0101t\u012bbu par<br \/>\nto, kura no pieej\u0101m ir p\u0101r\u0101ka. Katra no t\u0101m sniedz krasi at\u0161\u0137ir\u012bgus<br \/>\nrezult\u0101tus, ja t\u0101s piem\u0113ro iepriek\u0161 min\u0113taj\u0101s situ\u0101cij\u0101s, piem\u0113ram,<br \/>\nk\u0101di izmekl\u0113jumi nepiecie\u0161ami; vai ir nepiecie\u0161ama cita \u0101rsta kon-<br \/>\nsult\u0101cija; vai pacients b\u016btu j\u0101hospitaliz\u0113; vai ir nepiecie\u0161ams k\u0101ds<br \/>\nori\u0123in\u0101lra\u017eot\u0101ja medikaments vai pietiek ar \u0123en\u0113riskaj\u0101m z\u0101l\u0113m;<br \/>\nkam pien\u0101kas transplant\u0113jamais org\u0101ns utt. Piem\u0113ram, utilit\u0101r\u0101 pie-<br \/>\neja individu\u0101li praktiz\u0113jo\u0161am \u0101rstam ir \u013coti gr\u016bti realiz\u0113jama, jo t\u0101<br \/>\nprasa padzi\u013cin\u0101tu da\u017e\u0101du \u0101rst\u0113\u0161anas meto\u017eu galarezult\u0101tu anal\u012bzi,<br \/>\nte nepietiek tikai ar \u0161\u012b \u0101rsta pacientiem, bet j\u0101\u0146em v\u0113r\u0101 ar\u012b citi cilv\u0113-<br \/>\nki. Izv\u0113le starp p\u0101r\u0113j\u0101m div\u0101m (vai trim, ja iek\u013cauj ar\u012b liber\u0101lo pieeju)<br \/>\nb\u016bs atkar\u012bga no pa\u0161a \u0101rsta tikumisk\u0101s<br \/>\napzi\u0146as un soci\u0101lpolitisk\u0101s vides, kur\u0101<br \/>\n\u0101rsts darbojas. Piem\u0113ram, ASV liber\u0101l\u0101<br \/>\npieeja ir popul\u0101r\u0101ka par cit\u0101m, turpre-<br \/>\ntim citas valstis, piem\u0113ram, Zviedrija,<br \/>\nizce\u013cas ar egalit\u0101ru poz\u012bciju, savuk\u0101rt<br \/>\nv\u0113l da\u017e\u0101s valst\u012bs, piem\u0113ram, Dienvid\u0101-<br \/>\nfrikas Republik\u0101, tiek izm\u0113\u0123in\u0101ta san\u0113jo\u0161\u0101 pieeja. Daudzi vesel\u012bbas<br \/>\npl\u0101not\u0101ji populariz\u0113 utilit\u0101ro pieeju. Lai gan ir savstarp\u0113jas at\u0161\u0137ir\u012b-<br \/>\nbas, da\u017e\u0101du valstu vesel\u012bbas sist\u0113m\u0101s bie\u017ei vien l\u012bdz\u0101s past\u0101v divas<br \/>\nvai vair\u0101k izpratnes par taisn\u012bguma principu, un \u0101rsti var izv\u0113l\u0113ties<br \/>\nsavas prakses nosac\u012bjumus (piem\u0113ram, priv\u0101ta vai publiska), kas at-<br \/>\nbilst pa\u0161u izpratnei par resursu sadales metod\u0113m.<br \/>\nLai ar\u012b k\u0101da b\u016btu \u0101rstu noz\u012bme eso\u0161o vesel\u012bbas apr\u016bpes resursu sa-<br \/>\ndal\u0113, vi\u0146iem ir j\u0101uz\u0146emas atbild\u012bba par<br \/>\nto palielin\u0101\u0161anu viet\u0101s, kur tie ir nepie-<br \/>\ntiekami, lai pacientu vajadz\u012bbas tiktu<br \/>\napmierin\u0101tas. Tas prasa \u0101rstu kopdar-<br \/>\nb\u012bbu gan profesion\u0101l\u0101 asoci\u0101cij\u0101, gan<br \/>\np\u0101rliecinot l\u0113mumu pie\u0146\u0113m\u0113jus vald\u012b-<br \/>\nb\u0101 un cit\u0101s atbild\u012bg\u0101s instit\u016bcij\u0101s par<br \/>\npaties\u0101m vajadz\u012bb\u0101m p\u0113c medic\u012bnas<br \/>\nresursiem un iesp\u0113j\u0101m t\u0101s apmierin\u0101t<br \/>\ngan valsts, gan glob\u0101l\u0101 l\u012bmen\u012b.<br \/>\nSABIEDR\u012aBAS VESEL\u012aBA<br \/>\nXX gadsimta medic\u012bna ir p\u0101rdz\u012bvojusi neveiksm\u012bgo iedal\u012bjumu starp<br \/>\n\u00absabiedr\u012bbas vesel\u012bbu\u00bb un cita veida vesel\u012bbas apr\u016bpi (\u00abpriv\u0101to\u00bb vai<br \/>\n\u00abindividu\u0101lo\u00bb vesel\u012bbu). Neveiksm\u012bgs tas ir t\u0101d\u0113\u013c, ka, k\u0101 jau min\u0113ts,<br \/>\n\u00abIzv\u0113le .. b\u016bs atkar\u012bga no<br \/>\npa\u0161a \u0101rsta tikumisk\u0101s<br \/>\napzi\u0146as un soci\u0101lpolitisk\u0101s<br \/>\nvides, kur\u0101 \u0101rsts<br \/>\ndarbojas.\u00bb<br \/>\n\u00abLai ar\u012b k\u0101da b\u016btu \u0101rstu<br \/>\nnoz\u012bme eso\u0161o vesel\u012bbas<br \/>\napr\u016bpes resursu sadal\u0113,<br \/>\nvi\u0146iem ir j\u0101uz\u0146emas<br \/>\natbild\u012bba par to<br \/>\npalielin\u0101\u0161anu viet\u0101s, kur<br \/>\ntie ir nepietiekami, lai<br \/>\npacientu vajadz\u012bbas tiktu<br \/>\napmierin\u0101tas.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n76 77<br \/>\nsabiedr\u012bba sast\u0101v no indiv\u012bdiem un ir pas\u0101kumi, kas tiek \u012bstenoti, lai<br \/>\naizsarg\u0101tu un stiprin\u0101tu sabiedr\u012bbas.<br \/>\nP\u0101rpratumus rada ar\u012b tas, ka j\u0113dzienu \u00absabiedr\u012bbas vesel\u012bba\u00bb nere-<br \/>\nti saprot k\u0101 \u00absabiedr\u012bbas \ufb01nans\u0113tu vesel\u012bbas apr\u016bpi\u00bb (tas ir, vesel\u012b-<br \/>\nbas apr\u016bpe, kuru \ufb01nans\u0113 no valsts ien\u0101kumiem nodok\u013cu veid\u0101 vai<br \/>\nar oblig\u0101tas visaptvero\u0161as apdro\u0161in\u0101\u0161anas sist\u0113mas pal\u012bdz\u012bbu). Tad<br \/>\nto pretstata j\u0113dzienam \u00abpriv\u0101ti \ufb01nans\u0113ta vesel\u012bbas apr\u016bpe\u00bb (tas ir,<br \/>\nvesel\u012bbas apr\u016bpe, par kuru maks\u0101 indiv\u012bds pats vai ar priv\u0101t\u0101s vesel\u012b-<br \/>\nbas apdro\u0161in\u0101\u0161anas pal\u012bdz\u012bbu, bet t\u0101 parasti nav visiem pieejama).<br \/>\nAr terminu \u00absabiedr\u012bbas vesel\u012bba\u00bb, rokasgr\u0101mat\u0101 tiek dom\u0101ta gan<br \/>\niedz\u012bvot\u0101ju (popul\u0101cijas) vesel\u012bba kopum\u0101, gan ar\u012b medic\u012bnas spe-<br \/>\ncialit\u0101te, kas apl\u016bko vesel\u012bbas jaut\u0101jumus nevis no indiv\u012bdu, bet no<br \/>\nvisas popul\u0101cijas viedok\u013ca. Pasaul\u0113<br \/>\ntr\u016bkst speci\u0101listu, kas ieteiktu un aiz-<br \/>\nst\u0101v\u0113tu t\u0101du soci\u0101lo politiku, kas veici-<br \/>\nn\u0101tu labu vesel\u012bbu popul\u0101ciju un vien-<br \/>\nlaikus iesaist\u012btos aktivit\u0101t\u0113s, lai aizst\u0101-<br \/>\nv\u0113tu sabiedr\u012bbu no lip\u012bg\u0101m slim\u012bb\u0101m<br \/>\nun citiem vesel\u012bbas riskiem. Sabiedr\u012b-<br \/>\nbas vesel\u012bbas prakses (da\u017ereiz to d\u0113v\u0113 ar\u012b par \u00absabiedr\u012bbas vesel\u012bbas<br \/>\nmedic\u012bnu\u00bb vai \u00abkopienu medic\u012bnu\u00bb) zin\u0101tniskos pamatus galveno-<br \/>\nk\u0101rt veido epidemiolo\u0123ija, kas p\u0113t\u012b slim\u012bbu un vesel\u012bbas sadal\u012bjumu<br \/>\nietekm\u0113jo\u0161os faktorus popul\u0101cij\u0101. Da\u017ei \u0101rsti ieg\u016bst papildizgl\u012bt\u012bbu,<br \/>\nlai padzi\u013cin\u0101tu savas zin\u0101\u0161anas un k\u013c\u016btu par epidemiologiem. Lai nu<br \/>\nk\u0101 \u2014 visiem \u0101rstiem j\u0101izprot soci\u0101lie un vides faktori, kas ietekm\u0113<br \/>\nvi\u0146u pacientu vesel\u012bbu. PMA Nost\u0101dn\u0113s par vesel\u012bbas veicin\u0101\u0161anu<br \/>\n(Statement of Health Promotion) teikts: \u00abPraktiz\u0113jo\u0161iem \u0101rstiem un<br \/>\nvi\u0146u profesion\u0101laj\u0101m asoci\u0101cij\u0101m ir \u0113tisks pien\u0101kums un profesio-<br \/>\nn\u0101la atbild\u012bba vienm\u0113r r\u012bkoties saska\u0146\u0101 ar savu pacientu interes\u0113m<br \/>\nun papla\u0161in\u0101t savu atbild\u012bbu ar r\u016bp\u0113m par sabiedr\u012bbas vesel\u012bbu, ie-<br \/>\nsaistoties t\u0101s uzlabo\u0161an\u0101.\u00bb<br \/>\nSabiedr\u012bbas vesel\u012bbas pas\u0101kumi, piem\u0113ram, vakcin\u0113\u0161anas kampa-<br \/>\n\u0146as vai neatliekami pas\u0101kumi lip\u012bgo slim\u012bbu apkaro\u0161an\u0101 ir svar\u012bgi<br \/>\nfaktori individu\u0101l\u0101s vesel\u012bbas nodro\u0161in\u0101\u0161an\u0101, bet soci\u0101lie faktori,<br \/>\npiem\u0113ram, m\u0101jok\u013ci, uzturs un nodarbin\u0101t\u012bba, ir tikpat noz\u012bm\u012bgi. \u0100rsti<br \/>\n\u013coti reti ir sp\u0113j\u012bgi c\u012bn\u012bties ar individu\u0101lo pacientu slim\u012bbu soci\u0101lajiem<br \/>\nc\u0113lo\u0146iem, tom\u0113r vi\u0146i var nos\u016bt\u012bt pacientu p\u0113c pal\u012bdz\u012bbas pie visiem<br \/>\niesp\u0113jamiemsoci\u0101lajiemdienestiem.Tom\u0113rnetie\u0161i\u0101rstivardotsavu<br \/>\nartavu \u0161o probl\u0113mu ilgtermi\u0146a risin\u0101jumam, piedaloties sabiedr\u012bbas<br \/>\nizgl\u012bto\u0161anas pas\u0101kumos, nov\u0113rojot un zi\u0146ojot par videi nodar\u012bto kai-<br \/>\nt\u0113jumu, kas var izrais\u012bt slim\u012bbas, identi\ufb01c\u0113jot un publiskojot datus<br \/>\npar vesel\u012bbai nelabv\u0113l\u012bgiem faktoriem, piem\u0113ram, varm\u0101c\u012bbas un<br \/>\nvardarb\u012bbas esam\u012bbu, iest\u0101joties par sabiedr\u012bbas vesel\u012bbas dienestu<br \/>\ndarb\u012bbas uzlabojumiem.<br \/>\nTom\u0113r da\u017ereiz sabiedr\u012bbas vesel\u012bbas intereses var non\u0101kt kon\ufb02ikt\u0101<br \/>\nar individu\u0101lu pacientu interes\u0113m, piem\u0113ram, tad, ja vakcin\u0101cija iz-<br \/>\nraisa nev\u0113lamu reakciju, jo t\u0101, protams, var ne\u013caut indiv\u012bdam nodot<br \/>\nslim\u012bbu t\u0101l\u0101k, bet nepasarg\u0101s no t\u0101s pa\u0161u vakcin\u0113to; pret b\u0113rniem<br \/>\nun veciem cilv\u0113kiem v\u0113rstas vardarb\u012bbas gad\u012bjumu uzskaite; ja no-<br \/>\nteikta darb\u012bba, piem\u0113ram, automa\u0161\u012bnas vai lidapar\u0101ta vad\u012b\u0161ana, var<br \/>\nb\u016bt b\u012bstama ne tikai pa\u0161am, bet ar\u012b citiem. \u0160ie ir jau min\u0113t\u0101s dubult-<br \/>\nlojalit\u0101tes piem\u0113ri. Lai risin\u0101tu \u0161\u0101das un l\u012bdz\u012bgas situ\u0101cijas, ir izstr\u0101-<br \/>\nd\u0101ta proced\u016bra, kas tuv\u0101k apskat\u012bta rokasgr\u0101matas otr\u0101s noda\u013cas<br \/>\napak\u0161noda\u013c\u0101 \u00abKon\ufb01dencialit\u0101te\u00bb. \u0100rstiem j\u0101m\u0113\u0123ina rast veids, k\u0101<br \/>\nmazin\u0101t kait\u0113jumu, kuru sabiedr\u012bbas vesel\u012bbas pras\u012bbu iev\u0113ro\u0161anas<br \/>\nd\u0113\u013c var\u0113tu ciest individu\u0101li pacienti. Piem\u0113ram, kad ir nepiecie\u0161ams<br \/>\nzi\u0146ot par k\u0101du konkr\u0113tu pacientu, vi\u0146a kon\ufb01dencialit\u0101tei j\u0101b\u016bt tik<br \/>\nliel\u0101 m\u0113r\u0101 nodro\u0161in\u0101tai, cik vien to pie\u013cauj tiesisko pras\u012bbu iev\u0113ro-<br \/>\n\u0161ana.<br \/>\nCits indiv\u012bda un sabiedr\u012bbas intere\u0161u kon\ufb02ikta veids par\u0101d\u0101s tad, ja<br \/>\nindividu\u0101ls pacients \u0101rstiem l\u016bdz pal\u012bdz\u012bbu, lai ieg\u016btu k\u0101du labumu,<br \/>\nkas vi\u0146am nepien\u0101kas, piem\u0113ram, apdro\u0161in\u0101\u0161anas maks\u0101jumu vai<br \/>\nslim\u012bbas atva\u013cin\u0101jumu. \u0100rstiem ir dele\u0123\u0113tas pilnvaras apliecin\u0101t, vai<br \/>\n\u00ab..visiem \u0101rstiem j\u0101izprot<br \/>\nsoci\u0101lie un vides faktori,<br \/>\nkas ietekm\u0113 vi\u0146u pacientu<br \/>\nvesel\u012bbu.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n78 79<br \/>\npacientu st\u0101voklis no medic\u012bnisk\u0101 viedok\u013ca atbilst nosac\u012bjumiem,<br \/>\nkas vi\u0146iem \u013cautu \u0161os labumus ieg\u016bt. Da\u017ei \u0101rsti nev\u0113las noraid\u012bt pa-<br \/>\ncientu l\u016bgumus, kas neatbilst lietas apst\u0101k\u013ciem, tom\u0113r vi\u0146iem vaja-<br \/>\ndz\u0113tu pal\u012bdz\u0113t pacientiem atrast citus pabalstu ieg\u016b\u0161anas veidus,<br \/>\nkuri neprasa ne\u0113tisku r\u012bc\u012bbu.<br \/>\nGLOB\u0100L\u0100 VESEL\u012aBA<br \/>\nIzpratne par \u0101rstu atbild\u012bbu pret sabiedr\u012bbu, kur\u0101 vi\u0146i dz\u012bvo, gadu<br \/>\ngait\u0101 ir augusi l\u012bdz atbild\u012bbai par glob\u0101lo vesel\u012bbu. \u0160is termins ir de-<br \/>\n\ufb01n\u0113ts k\u0101 vesel\u012bbas probl\u0113mjaut\u0101jumi un r\u016bpes, kas p\u0101rsniedz nacio-<br \/>\nn\u0101l\u0101s robe\u017eas. Tos var ietekm\u0113t citu valstu apst\u0101k\u013ci un pieredze, un<br \/>\ntie vislab\u0101k ir risin\u0101mi ar savstarp\u0113ju pal\u012bdz\u012bbu. Glob\u0101l\u0101 vesel\u012bba ir<br \/>\ndaudz pla\u0161\u0101kas kust\u012bbas, proti, globaliz\u0101cijas, sast\u0101vda\u013ca. Globaliz\u0101-<br \/>\ncija ietver inform\u0101cijas apmai\u0146u, tirdzniec\u012bbu, politiku, t\u016brismu un<br \/>\ndaudzas jomas, kas saist\u012btas ar cilv\u0113ku darb\u012bbu.<br \/>\nGlobaliz\u0101cijas pamats ir atzi\u0146a, ka indi-<br \/>\nv\u012bdu un sabiedr\u012bbas savstarp\u0113j\u0101 atkar\u012b-<br \/>\nba turpina pieaugt. Saist\u012bb\u0101 ar cilv\u0113ku<br \/>\nvesel\u012bbu to skaidri pier\u0101d\u012bja da\u017eu slim\u012b-<br \/>\nbu, piem\u0113ram, gribas vai SARS, strauj\u0101<br \/>\nizplat\u012b\u0161an\u0101s. \u0160\u0101du epid\u0113miju kontrolei<br \/>\nnepiecie\u0161ama starptautiska sadarb\u012bba.<br \/>\nK\u0101da \u0101rsta nolaid\u012bba vai nesp\u0113ja atkl\u0101t<br \/>\nun \u0101rst\u0113t \u0161\u0101du \u013coti lip\u012bgu slim\u012bbu vien\u0101 valst\u012b var izrais\u012bt graujo\u0161as<br \/>\nsekas ar\u012b citu valstu pacientiem. \u0160\u012b iemesla d\u0113\u013c \u0101rstu \u0113tiskie pien\u0101-<br \/>\nkumi sniedzas t\u0101l\u0101k par vi\u0146u individu\u0101lajiem pacientiem, t\u0101l\u0101k par<br \/>\nkopien\u0101m vai valst\u012bm.<br \/>\n\u0160\u0101ds glob\u0101ls vesel\u012bbas apskats rada aizvien pieaugo\u0161u p\u0101rliec\u012bbu, ka<br \/>\npasaul\u0113 v\u0113rojama virkne b\u016btisku at\u0161\u0137ir\u012bbu starp vesel\u012bbas apr\u016bpes<br \/>\nsist\u0113m\u0101m. Lai gan notiek v\u0113rien\u012bgas kampa\u0146as c\u012b\u0146\u0101 pret priek\u0161laic\u012b-<br \/>\ngas n\u0101ves gad\u012bjumiem un smag\u0101m krop\u013cojo\u0161\u0101m slim\u012bb\u0101m nabadz\u012b-<br \/>\ng\u0101s valst\u012bs (kuru izskau\u0161an\u0101 ir sasniegti lieliski rezult\u0101ti, piem\u0113ram,<br \/>\nbaku un, cerams, ar\u012b poliomiel\u012bta gad\u012bjum\u0101), plaisa starp vesel\u012bbas<br \/>\napr\u016bpes l\u012bmeni valst\u012bs ar augstiem un zemiem ien\u0101kumiem arvien<br \/>\npapla\u0161in\u0101s. Da\u013c\u0113ji tas ir HIV\/AIDS d\u0113\u013c, kas \u012bpa\u0161i graujo\u0161i skar nabadz\u012b-<br \/>\ng\u0101s valstis, bet vismaz da\u013c\u0113ji ar\u012b t\u0101p\u0113c, ka t\u0101s nesp\u0113j atv\u0113l\u0113t pietieka-<br \/>\nmi daudz l\u012bdzek\u013cu vesel\u012bbas apr\u016bpei, k\u0101 tas p\u0113d\u0113jos gadu desmitos ir<br \/>\nnoticis citur pasaul\u0113. Lai ar\u012b nabadz\u012bbas iemesli bie\u017ei vien ir politiski<br \/>\nun ekonomiski un ir sp\u0113c\u012bg\u0101ki par \u0101rstiem vai vi\u0146u asoci\u0101ciju ietekmi<br \/>\nvai kontroli, \u0101rstiem tom\u0113r ir j\u0101str\u0101d\u0101 ar nabadz\u012bbas rezult\u0101tu \u2014 slik-<br \/>\ntu vesel\u012bbas st\u0101vokli. Nabadz\u012bg\u0101s valst\u012bs \u0101rstiem ir pavisam nedaudz<br \/>\nresursu, ko pied\u0101v\u0101t pacientiem, un ar\u012b tad vienm\u0113r j\u0101dom\u0101, k\u0101 \u0161os<br \/>\nresursus sadal\u012bt p\u0113c iesp\u0113jas taisn\u012bgi. Ar\u012b vid\u0113ji un augsti att\u012bst\u012bt\u0101s<br \/>\nvalst\u012bs vi\u0146i saskaras ar pacientiem, ko tie\u0161i sk\u0101rusi globaliz\u0101cija, pie-<br \/>\nm\u0113ram, b\u0113g\u013ci vai t\u0101di pacienti, kam ne vienm\u0113r ir pieejami tie pa\u0161i<br \/>\nmedic\u012bnas pakalpojumi, kas pien\u0101kas attiec\u012bg\u0101s valsts pilso\u0146iem.<br \/>\nV\u0113l viena globaliz\u0101cijas iez\u012bme ir vesel\u012bbas apr\u016bpes profesion\u0101\u013cu, ie-<br \/>\nskaitot \u0101rstu, starptautisk\u0101 mobilit\u0101te. \u0100rstu aizpl\u016b\u0161ana no att\u012bst\u012bbas<br \/>\nvalst\u012bm uz industrializ\u0113taj\u0101m ir liels ieguvums gan \u0101rstiem, gan val-<br \/>\nst\u012bm, kur\u0101s vi\u0146i ierodas, toties t\u0101 valsts, kuru vi\u0146i atst\u0101j, paliek zaud\u0113-<br \/>\nt\u0101jos. PMA dokument\u0101 \u2014 \u0112tikas vadl\u012bnijas starptautiskai \u0101rstu dar-<br \/>\nb\u0101 iek\u0101rto\u0161anai (Ethical Guidelines for the International Recruitment<br \/>\nof Physicians) \u2014 deklar\u0113ja, ka nevajadz\u0113tu likt \u0161\u0137\u0113r\u0161\u013cus \u0101rstiem, kas<br \/>\ndodas prom no savas valsts vai pa\u0161reiz\u0113j\u0101s m\u012btnes zemes uz k\u0101du<br \/>\ncitu, lai mekl\u0113tu karjeras iesp\u0113jas. Tom\u0113r \u0161is dokuments aicina katru<br \/>\nvalsti dar\u012bt visu iesp\u0113jamo, lai sagatavotu un izgl\u012btotu atbilsto\u0161\u0101m<br \/>\nvajadz\u012bb\u0101m un resursiem nepiecie\u0161amo \u0101rstu skaitu, k\u0101 ar\u012b nepa-<br \/>\n\u013cautos uz \u0101rstu imigr\u0101ciju no cit\u0101m valst\u012bm, lai nodro\u0161in\u0101tu savas<br \/>\nvajadz\u012bbas.<br \/>\nIndustrializ\u0113to valstu \u0101rstiem izveidoju\u0161\u0101s ilgsto\u0161as trad\u012bcijas, k\u0101 zi-<br \/>\nn\u0101\u0161anas un prasmes nodot att\u012bst\u012bbas valstu kol\u0113\u0123iem. \u0160im procesam<br \/>\niesp\u0113jamas da\u017e\u0101das formas: neatliekam\u0101s medic\u012bnisk\u0101s pal\u012bdz\u012bbas<br \/>\n\u00abK\u0101da \u0101rsta nolaid\u012bba vai<br \/>\nnesp\u0113ja atkl\u0101t un \u0101rst\u0113t<br \/>\n\u0161\u0101du \u013coti lip\u012bgu slim\u012bbu<br \/>\nvien\u0101 valst\u012b var izrais\u012bt<br \/>\ngraujo\u0161as sekas ar\u012b citu<br \/>\nvalstu pacientiem\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n80 81<br \/>\nsnieg\u0161ana, ko koordin\u0113 t\u0101das organiz\u0101cijas k\u0101 Sarkan\u0101 Krusta un<br \/>\nSarkan\u0101Pusm\u0113nessbiedr\u012bbasvai\u00a0\u00bb\u0100rstibezrobe\u017e\u0101m\u00a0\u00bb(M\u00e9decinssans<br \/>\nFronti\u00e8res); \u012bslaic\u012bgas \u0137irur\u0123isk\u0101s pal\u012bdz\u012bbas kampa\u0146as kataraktas vai<br \/>\nauksl\u0113ju \u0161\u0137eltnes oper\u0101ciju veik\u0161anai; doc\u0113t\u0101ju vieso\u0161an\u0101s medic\u012b-<br \/>\nnas augstskol\u0101s; \u012bslaic\u012bgi vai ilgsto\u0161i p\u0113tniec\u012bbas projekti; apg\u0101de ar<br \/>\nmedikamentiem vai medic\u012bnas iek\u0101rt\u0101m u. c. \u0160\u0101das programmas<br \/>\nraksturo globaliz\u0101cijas pozit\u012bvos aspektus un vismaz da\u013c\u0113ji kompen-<br \/>\ns\u0113 \u0101rstu aizpl\u016b\u0161anu no nabadz\u012bgaj\u0101m valst\u012bm uz bag\u0101t\u0101kaj\u0101m.<br \/>\nATGRIE\u0160AN\u0100S PIE GAD\u012aJUMA ANAL\u012aZES<br \/>\nSaska\u0146\u0101 ar \u0161aj\u0101 noda\u013c\u0101 analiz\u0113taj\u0101m \u0101rsta un sabiedr\u012bbas<br \/>\nattiec\u012bb\u0101m ir saprotama Dr. S. cen\u0161an\u0101s pan\u0101kt<br \/>\nsabiedr\u012bbas ietekmi uz vi\u0146as pacientu uzved\u012bbu. Pat, ja<br \/>\nkonsult\u0101cijas pie citiem vesel\u012bbas apr\u016bpes sniedz\u0113jiem<br \/>\nneietilpst taj\u0101 apr\u016bpes sist\u0113m\u0101, kur\u0101 str\u0101d\u0101 Dr. S. un nav<br \/>\nsaist\u012btas ar izdevumiem, kurus \ufb01nans\u0113 sabiedr\u012bba kopum\u0101,<br \/>\ntad \u0161ie pacienti velti pat\u0113r\u0113 \u0161\u012bs \u0101rstes laiku, ko vi\u0146a var\u0113tu<br \/>\nvelt\u012bt citiem pacientiem. Tom\u0113r \u0101rstiem \u0161\u0101d\u0101s situ\u0101cij\u0101s<br \/>\nj\u0101b\u016bt \u013coti piesardz\u012bgiem. Daudzu un da\u017e\u0101du iemeslu d\u0113\u013c<br \/>\npacienti ne vienm\u0113r sp\u0113j pie\u0146emt racion\u0101lus l\u0113mumus,<br \/>\nun vi\u0146iem var b\u016bt nepiecie\u0161ams laiks un papildu<br \/>\nmedic\u012bnisk\u0101 izgl\u012bt\u012bba, lai saprastu, kas ir vislab\u0101kais vi\u0146iem<br \/>\npa\u0161iem un citiem. Dr. S. ir taisn\u012bba ar\u012b par sazin\u0101\u0161anos ar<br \/>\nsavu medic\u012bnas asoci\u0101ciju, lai risin\u0101tu \u0161o probl\u0113mu, jo t\u0101<br \/>\nskar ne tikai vi\u0146u un konkr\u0113tos pacientus, bet tikpat liel\u0101<br \/>\nm\u0113r\u0101 ar\u012b citus \u0101rstus un to pacientus.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunsabiedr\u012bba<br \/>\n82 83<br \/>\n4. NODA\u013bA.<br \/>\n\u0100RSTI UN KOL\u0112\u0122I<br \/>\nM\u0112R\u0136I<br \/>\nP\u0113c \u0161\u012bs noda\u013cas izlas\u012b\u0161anas j\u016bs var\u0113siet:<br \/>\n\u2022 raksturot, k\u0101 \u0101rstiem citam pret citu b\u016btu j\u0101izturas;<br \/>\n\u2022 pamatot zi\u0146o\u0161anu par ne\u0113tisku kol\u0113\u0123u r\u012bc\u012bbu;<br \/>\n\u2022 identi\ufb01c\u0113t galvenos \u0113tikas principus sadarb\u012bb\u0101 ar cit\u0101m<br \/>\nperson\u0101m pacienta apr\u016bpes laik\u0101;<br \/>\n\u2022 izskaidrot, k\u0101 risin\u0101t kon\ufb02iktus ar citiem vesel\u012bbas<br \/>\napr\u016bpes sniedz\u0113jiem.Medic\u012bnas komanda, apsprie\u017eot probl\u0113mu<br \/>\n\u00a9 Pete Saloutos\/CORBIS<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunkol\u0113\u0123i<br \/>\n84 85<br \/>\nP\u0100RMAI\u0145AS \u0100RSTU IETEKMES SADAL\u012aJUM\u0100<br \/>\n\u0100rsts ir t\u0101 profesija, kas tradicion\u0101li<br \/>\ndarbojas gan iek\u0161\u0113ji, gan \u0101r\u0113ji \u0101rk\u0101rt\u012bgi<br \/>\nhierarhisk\u0101 varas sadal\u012bjuma strukt\u016br\u0101.<br \/>\nProfesij\u0101 iek\u0161\u0113ji ir tr\u012bs hierarhijas veidi,<br \/>\nkas savstarp\u0113ji da\u013c\u0113ji p\u0101rkl\u0101jas: pirm\u0101<br \/>\nir medic\u012bnas specialit\u0101\u0161u hierarhija, jo<br \/>\nda\u017eas specialit\u0101tes m\u0113dz uzskat\u012bt par<br \/>\npresti\u017e\u0101k\u0101m un t\u0101s ir lab\u0101k apmaks\u0101tas par cit\u0101m; otr\u0101 hierarhija<br \/>\nveidojas specialit\u0101tes iek\u0161ien\u0113, jo akad\u0113miskajiem m\u0101c\u012bbsp\u0113kiem ir<br \/>\nliel\u0101ka ietekme nek\u0101 tiem, kas str\u0101d\u0101 praktisku darbu priv\u0101tpraks\u0113<br \/>\nvai publisk\u0101 vesel\u012bbas apr\u016bpes iest\u0101d\u0113; savuk\u0101rt tre\u0161\u0101 hierarhija ir<br \/>\nsaist\u012bta ar konkr\u0113tu pacientu apr\u016bpi, jo prim\u0101r\u0101s apr\u016bpes speci\u0101lists<br \/>\natrodas hierarhijas piram\u012bdas aug\u0161\u0101, toties citi \u0101rsti neatkar\u012bgi no<br \/>\nvi\u0146u pieredzes vai zin\u0101\u0161an\u0101m darbojas tikai k\u0101 konsultanti, ja vien<br \/>\npacients nav piln\u012bb\u0101 nodots vi\u0146u apr\u016bp\u0113. \u0100r\u0113j\u0101s vesel\u012bbas apr\u016bpes<br \/>\nveic\u0113ju hierarhijas aug\u0161gal\u0101 \u2014 virs m\u0101s\u0101m un citiem vesel\u012bbas ap-<br \/>\nr\u016bpes speci\u0101listiem \u2014 vienm\u0113r ir biju\u0161i \u0101rsti.<br \/>\n\u0160aj\u0101 noda\u013c\u0101 tiks apskat\u012bti \u0113tiski jaut\u0101jumi, kas rodas ab\u0101s \u2014 gan<br \/>\niek\u0161\u0113j\u0101, gan \u0101r\u0113j\u0101 \u2014 hierarhiskaj\u0101s sist\u0113m\u0101s. Da\u017ei jaut\u0101jumi ab\u0101m<br \/>\nhierarhij\u0101m ir kop\u012bgi, citi atrodami tikai vien\u0101 vai otr\u0101 no t\u0101m. Dau-<br \/>\ndzi no tiem ir visai jauni, jo radu\u0161ies neseno medic\u012bnas un vesel\u012b-<br \/>\nbas apr\u016bpes p\u0101rmai\u0146u rezult\u0101t\u0101. \u0160ie jaut\u0101jumi ir liels p\u0101rbaud\u012bjums<br \/>\nklasiskajam ietekmes sadal\u012bjumam medic\u012bn\u0101, t\u0101d\u0113\u013c nepiecie\u0161ams \u012bss<br \/>\np\u0101rskats par notiku\u0161aj\u0101m p\u0101rmai\u0146\u0101m.<br \/>\nL\u012bdz ar straujo zin\u0101tnes atzi\u0146u izaugsmi un to lieto\u0161anu kl\u012bnisk\u0101,<br \/>\nmedic\u012bna ir k\u013cuvusi sare\u017e\u0123\u012bt\u0101ka. Individu\u0101li \u0101rsti nesp\u0113j b\u016bt lietpra-<br \/>\nt\u0113ji par vis\u0101m pacientu slim\u012bb\u0101m un to iesp\u0113jamo \u0101rst\u0113\u0161anu, t\u0101d\u0113\u013c<br \/>\nvi\u0146iem bie\u017ei vien nepiecie\u0161ama citu specialit\u0101\u0161u \u0101rstu vai citu ve-<br \/>\nsel\u012bbas apr\u016bpes profesiju p\u0101rst\u0101vju, piem\u0113ram, medic\u012bnas m\u0101su,<br \/>\nfarmaceitu, \ufb01zioterapeitu, laboratorisk\u0101s diagnostikas speci\u0101listu,<br \/>\nsoci\u0101lo darbinieku un daudzu citu, pal\u012bdz\u012bba. \u0100rstiem b\u016btu j\u0101zina,<br \/>\nk\u0101 ieg\u016bt tr\u016bksto\u0161\u0101s prasmes, kas nepiecie\u0161amas, lai apr\u016bp\u0113tu savus<br \/>\npacientus.<br \/>\nK\u0101 jau run\u0101ts 2. noda\u013c\u0101, medic\u012bniskais patern\u0101lisms pak\u0101peniski<br \/>\nsaira, jo arvien liel\u0101kas ties\u012bbas (un v\u0113lmi pa\u0161iem pie\u0146emt b\u016btiskus<br \/>\nmedic\u012bniskus l\u0113mumus) ieguva pacienti. T\u0101 rezult\u0101t\u0101 kooperat\u012bvais<br \/>\nl\u0113mumu pie\u0146em\u0161anas modelis ir aiz-<br \/>\nst\u0101jis autorit\u0101ro, kas bija rakstur\u012bgs<br \/>\ntradicion\u0101lajam medic\u012bnas patern\u0101-<br \/>\nlismam. T\u0101ds process notiek ar\u012b \u0101rstu<br \/>\nun citu vesel\u012bbas apr\u016bpes profesiju<br \/>\nsavstarp\u0113j\u0101s attiec\u012bb\u0101s. Citu apr\u016bpes<br \/>\nprofesiju p\u0101rst\u0101vji vairs negrib pak\u013cau-<br \/>\nties \u0101rstu r\u012bkojumiem, ja nezina to mo-<br \/>\nt\u012bvus. Vi\u0146i sevi uzskata par profesion\u0101\u013ciem, kam ar\u012b pret pacientiem<br \/>\nir speci\ufb01ska \u0113tiska atbild\u012bba; ja vi\u0146u uztvere par \u0161o atbild\u012bbu non\u0101k<br \/>\n\u00ab\u0100rsts ir t\u0101 profesija, kas<br \/>\ntradicion\u0101li darbojas..<br \/>\n\u0101rk\u0101rt\u012bgi hierarhisk\u0101 varas<br \/>\nsadal\u012bjuma strukt\u016br\u0101.\u00bb<br \/>\n\u00ab..kooperat\u012bvais l\u0113mumu<br \/>\npie\u0146em\u0161anas modelis<br \/>\nir aizst\u0101jis autorit\u0101ro,<br \/>\nkas bija rakstur\u012bgs<br \/>\ntradicion\u0101lajam medic\u012bnas<br \/>\npatern\u0101lismam.\u00bb<br \/>\n3. GAD\u012aJUMA APRAKSTS<br \/>\nDr. C., nesen darb\u0101 pils\u0113tas slimn\u012bc\u0101 nor\u012bkots<br \/>\nanesteziologs, ir satraukts par k\u0101da iev\u0113rojama \u0137irurga<br \/>\nuzved\u012bbu oper\u0101ciju z\u0101l\u0113. Vi\u0146\u0161 izmanto novecoju\u0161as<br \/>\nmetodes, kas pagarina oper\u0101cijas laiku, pastiprina<br \/>\np\u0113coper\u0101cijas s\u0101pes un paildzina atvese\u013co\u0161anos.<br \/>\nTurkl\u0101t \u0161is \u0137irurgs bie\u017ei izsaka nepiedien\u012bgus jokus par<br \/>\npacientiem, un tas ac\u012bmredzami aizskar asist\u0113jo\u0161\u0101s<br \/>\nmedic\u012bnas m\u0101sas. B\u016bdams visjaun\u0101kais kolekt\u012bva loceklis,<br \/>\nvi\u0146\u0161 nev\u0113las kritiz\u0113t \u0137irurgu person\u012bgi, nedz ar\u012b zi\u0146ot par<br \/>\nvi\u0146a uzved\u012bbu attiec\u012bg\u0101m iest\u0101d\u0113m, ta\u010du vi\u0146\u0161 j\u016bt, ka kaut<br \/>\nkas ir j\u0101dara, lai situ\u0101ciju uzlabotu.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunkol\u0113\u0123i<br \/>\n86 87<br \/>\nkon\ufb02ikt\u0101 ar \u0101rsta r\u012bkojumiem, vi\u0146i uzskata, ka j\u0101uzdod papildu jau-<br \/>\nt\u0101jumi vai pat j\u0101apstr\u012bd \u0101rsta r\u012bkojumi. Hierarhiskais modelis neat-<br \/>\nst\u0101j vietu pat \u0161aub\u0101m par to, kur\u0161 kon\ufb02ikta gad\u012bjum\u0101 b\u016bs situ\u0101cijas<br \/>\nnoteic\u0113js, turpretim kooperat\u012bvais modelis paver iesp\u0113jas diskut\u0113t<br \/>\npar piem\u0113rot\u0101ko pacienta apr\u016bpi.<br \/>\nT\u0101di uzlabojumi k\u0101 \u0161ie maina \u00absp\u0113les noteikumus\u00bb \u0101rstu attiec\u012bb\u0101s<br \/>\nar citiem kol\u0113\u0123iem un p\u0101r\u0113jiem vesel\u012bbas apr\u016bpes speci\u0101listiem.<br \/>\n\u0160aj\u0101 noda\u013c\u0101 turpm\u0101k apskat\u012bsim da\u017eus problem\u0101tiskus \u0161o attiec\u012bbu<br \/>\naspektus un ieteiksim da\u017eus risin\u0101jumu veidus.<br \/>\nATTIEC\u012aBAS AR CITIEM \u0100RSTIEM, SAVIEM SKOLOT\u0100JIEM<br \/>\nUN STUDENTIEM<br \/>\nNo \u0101rstiem alla\u017e ir tikusi sagaid\u012bta \u012bpa\u0161a attieksme citam pret citu,<br \/>\nk\u0101 vienas profesijas p\u0101rst\u0101vjiem vi\u0146iem b\u016btu j\u0101izturas k\u0101 \u0123imenes<br \/>\nlocek\u013ciem, nevis k\u0101 sve\u0161iniekiem vai pat k\u0101 draugiem. PMA \u017den\u0113vas<br \/>\ndeklar\u0101cij\u0101 ir sol\u012bjums: \u00abMani kol\u0113\u0123i man b\u016bs k\u0101 m\u0101sas un br\u0101\u013ci\u00bb. \u0160\u012bs<br \/>\npras\u012bbas izpratne da\u017e\u0101d\u0101s valst\u012bs un da\u017e\u0101dos laikos ir bijusi at\u0161\u0137ir\u012bga.<br \/>\nPiem\u0113ram, kad \u00abmaksa par konkr\u0113tu pakalpojumu\u00bb bija galvenais<br \/>\nvai pat vien\u012bgais \u0101rsta atalgojuma veids, past\u0101v\u0113ja stingri iev\u0113rots<br \/>\nnerakst\u012bts \u00abprofesion\u0101l\u0101s piekl\u0101j\u012bbas\u00bb (professional courtesy) likums,<br \/>\nka no saviem kol\u0113\u0123iem \u0101rsts samaksu par \u0101rst\u0113\u0161anu nepras\u012bja. Val-<br \/>\nst\u012bs, kur pav\u0113r\u0101s iesp\u0113ja sa\u0146emt atl\u012bdz\u012bbu no tre\u0161\u0101s puses, \u0161\u012b prakse<br \/>\npak\u0101peniski izzuda.<br \/>\nL\u012bdztekus pozit\u012bvaj\u0101m pras\u012bb\u0101m iztur\u0113ties ar cie\u0146u pret kol\u0113\u0123iem<br \/>\nun sadarboties ar tiem, lai kop\u012bgi p\u0113c iesp\u0113jas uzlabotu pacienta<br \/>\napr\u016bpi, PMA Starptautiskais medic\u012bnas \u0113tikas kodekss satur divus<br \/>\nierobe\u017eojo\u0161us \u0101rstu attiec\u012bbu nosac\u012bjumus: 1) maks\u0101t vai sa\u0146emt<br \/>\nmaks\u0101jumus un citus ieguvumus, lai nos\u016bt\u012btu pacientu pie k\u0101da<br \/>\nsava kol\u0113\u0123a vai pats to sa\u0146emtu no citiem; 2) p\u0101rvilin\u0101t kol\u0113\u0123a pa-<br \/>\ncientus. Tre\u0161ais pien\u0101kums \u2014 zi\u0146ot par ne\u0113tisku vai nekompetentu<br \/>\nkol\u0113\u0123a r\u012bc\u012bbu \u2014 ir apskat\u012bts nedaudz v\u0113l\u0101k.<br \/>\nHipokr\u0101tiskaj\u0101 medic\u012bnas \u0113tik\u0101 \u0101rstiem bija j\u0101izr\u0101da \u012bpa\u0161a cie\u0146a pret<br \/>\nsaviem skolot\u0101jiem. \u017den\u0113vas deklar\u0101cija to uzsver \u0161\u0101di: \u00abEs izr\u0101d\u012b\u0161u<br \/>\nsaviem skolot\u0101jiem cie\u0146u un pateic\u012bbu, k\u0101da tiem pien\u0101kas\u00bb. Kaut<br \/>\ngan \u0161odien medic\u012bnas studiju proces\u0101 ir iesaist\u012bti daudzi skolot\u0101ji<br \/>\npretstat\u0101 seno laiku \u00abviens pret vienu\u00bb attiec\u012bb\u0101m, \u0161\u012b principa iev\u0113-<br \/>\nro\u0161ana v\u0113l joproj\u0101m ir katra \u0101rsta goda lieta un pateic\u012bba par to, ka<br \/>\nskolot\u0101js bie\u017ei vien nesa\u0146\u0113ma nek\u0101du atl\u012bdz\u012bbu par m\u0101c\u012bb\u0101m. Me-<br \/>\ndic\u012bnas studenti un citi \u0161\u012bs profesijas apguv\u0113ji ir pateic\u012bbu par\u0101d\u0101<br \/>\nsaviem pasniedz\u0113jiem, jo bez tiem medic\u012bnas studijas b\u016btu tikai<br \/>\npa\u0161m\u0101c\u012bba.<br \/>\nPasniedz\u0113jiem ir pien\u0101kums pret stu-<br \/>\ndentiem iztur\u0113ties ar cie\u0146u un r\u0101d\u012bt<br \/>\nizcilu piem\u0113ru attiec\u012bb\u0101s ar pacien-<br \/>\ntiem. \u0160is t\u0101 sauktais apsl\u0113ptais m\u0101c\u012b-<br \/>\nbu pl\u0101ns (hidden curriculum) medic\u012b-<br \/>\nnas izgl\u012bt\u012bb\u0101, kuru par\u0101da praktiz\u0113jo\u0161i<br \/>\n\u0101rsti, ir daudz iedarb\u012bg\u0101ks par tie\u0161i<br \/>\ndoc\u0113to medic\u012bnas \u0113tikas studiju kur-<br \/>\nsu, un, ja ar\u012b rodas kon\ufb02ikts starp \u0113tikas pras\u012bb\u0101m un vi\u0146a skolo-<br \/>\nt\u0101ja attieksmi un uzved\u012bbu, students dr\u012bz\u0101k sekos sava skolot\u0101ja<br \/>\npiem\u0113ram.<br \/>\nSkolot\u0101jiem ir \u012bpa\u0161s pien\u0101kums neiesaist\u012bt studentus ne\u0113tisk\u0101s dar-<br \/>\nb\u012bb\u0101s. \u0160\u0101das darb\u012bbas, par kur\u0101m rakst\u012bts medic\u012bnas \u017eurn\u0101los, ir,<br \/>\npiem\u0113ram, pacientu inform\u0113tas piekri\u0161anas ieg\u016b\u0161ana ar medic\u012bnas<br \/>\nstudentu pal\u012bdz\u012bbu situ\u0101cij\u0101s, kad to dr\u012bkst\u0113tu pras\u012bt tikai kvali\ufb01c\u0113ta<br \/>\n\u0101rstniec\u012bbas persona, maz\u0101 iegur\u0146a izmekl\u0113\u0161ana bez iepriek\u0161\u0113jas<br \/>\npiekri\u0161anas anestez\u0113tam vai nupat miru\u0161am pacientam, vai pras\u012bba<br \/>\nbez uzraudz\u012bbas izdar\u012bt k\u0101das kaut visai vienk\u0101r\u0161as manipul\u0101cijas k\u0101<br \/>\nintravenozu injekciju, ja to veik\u0161anai studentam v\u0113l nav nepiecie-<br \/>\n\u0161amo zin\u0101\u0161anu. Paturot pr\u0101t\u0101 nevienl\u012bdz\u012bgo varas sadal\u012bjumu starp<br \/>\nskolot\u0101ju un studentiem un ar to saist\u012bto studentu nev\u0113l\u0113\u0161anos uz-<br \/>\ndot jaut\u0101jumus vai atteikties \u0161\u0101du manipul\u0101ciju veikt, skolot\u0101jam<br \/>\n\u00ab..skolot\u0101jiem ir<br \/>\npien\u0101kums pret saviem<br \/>\nstudentiem iztur\u0113ties<br \/>\nar cie\u0146u un r\u0101d\u012bt izcilu<br \/>\npiem\u0113ru attiec\u012bb\u0101s ar<br \/>\npacientiem.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunkol\u0113\u0123i<br \/>\n88 89<br \/>\nj\u0101p\u0101rliecina studenti, ka vi\u0146\u0161 neprasa<br \/>\nstudentiem r\u012bkoties pretrun\u0101 ar \u0113tikas<br \/>\nprincipiem. Daudz\u0101s medic\u012bnas augst-<br \/>\nskol\u0101s darbojas studentu p\u0101rst\u0101vji vai<br \/>\nmedic\u012bnas studentu asoci\u0101cijas, kur\u0101m<br \/>\nvi\u0146i var izteikt savas ba\u017eas par \u0113tiskas<br \/>\ndabas probl\u0113m\u0101m medic\u012bniskaj\u0101 izgl\u012b-<br \/>\nt\u012bb\u0101. Studentiem, kas ir nor\u016bp\u0113ju\u0161ies<br \/>\npar \u0113tikas normu iev\u0113ro\u0161anu studij\u0101s<br \/>\nj\u0101b\u016bt nodro\u0161in\u0101tai pieejai atbild\u012bg\u0101m<br \/>\norganiz\u0101cij\u0101m, kam vi\u0146i var dro\u0161i paust savas ba\u017eas bez bail\u0113m, ka<br \/>\nvi\u0146us nod\u0113v\u0113s par zi\u0146u pienes\u0113jiem jeb denunciatoriem, k\u0101 ar\u012b vi-<br \/>\n\u0146iem j\u0101sa\u0146em nepiecie\u0161amais atbalsts, ja t\u0101ds b\u016btu vajadz\u012bgs un ja<br \/>\njaut\u0101jums tiktu risin\u0101ts form\u0101l\u0101 ce\u013c\u0101.<br \/>\nSavuk\u0101rt ar\u012b no studentiem k\u0101 no topo\u0161ajiem \u0101rstiem tiek pras\u012bta<br \/>\naugsti \u0113tiska uzved\u012bba. Pret saviem studiju biedriem vi\u0146iem j\u0101iztu-<br \/>\nras k\u0101 pret kol\u0113\u0123iem un j\u0101b\u016bt vienm\u0113r gataviem pal\u012bdz\u0113t, ja nepie-<br \/>\ncie\u0161ams, ieskaitot aizr\u0101d\u012bjumus par neprofesion\u0101lu uzved\u012bbu. T\u0101pat<br \/>\nvi\u0146iem piln\u012bb\u0101 j\u0101velta savs laiks t\u0101du kop\u012bgu pien\u0101kumu veik\u0161anai<br \/>\nk\u0101 akad\u0113misko saist\u012bbu izpilde un l\u012bdzdal\u012bba de\u017e\u016br\u0101s.<br \/>\nZI\u0145O\u0160ANA PAR NEDRO\u0160U VAI NE\u0112TISKU MEDIC\u012aNAS PRAKSI<br \/>\nMedic\u012bna alla\u017e ir lepojusies ar saviem profesion\u0101l\u0101s pa\u0161regul\u0101cijas<br \/>\nmeh\u0101nismiem. Apmai\u0146\u0101 pret privil\u0113\u0123ij\u0101m, ko \u0101rstu profesija sa-<br \/>\n\u0146em no sabiedr\u012bbas, un uztic\u012bbu, ko konkr\u0113tiem \u0101rstiem d\u0101v\u0101 vi\u0146u<br \/>\npacienti, \u0161aj\u0101 profesij\u0101 ir noteikti augsti uzved\u012bbas standarti un iz-<br \/>\nstr\u0101d\u0101tas disciplin\u0101ras proced\u016bras, lai izmekl\u0113tu neatbilsto\u0161as uz-<br \/>\nved\u012bbas gad\u012bjumus un, ja nepiecie\u0161ams, sod\u012btu p\u0101rk\u0101p\u0113jus. Tom\u0113r<br \/>\nbie\u017ei vien \u0161\u012b pa\u0161regul\u0113jo\u0161\u0101 sist\u0113ma nedarbojas, un p\u0113d\u0113jos gados ir<br \/>\nieviestas da\u017e\u0101das p\u0101rmai\u0146as, lai palielin\u0101tu profesijas atbild\u012bgumu,<br \/>\npiem\u0113ram, iek\u013caujot kontrol\u0113jo\u0161o instit\u016bciju sast\u0101v\u0101 ar\u012b \u00abne\u0101rstus\u00bb<br \/>\n(lajus). Galven\u0101 pras\u012bba sekm\u012bgas pa\u0161regul\u0101cijas \u012bsteno\u0161anai nep\u0101r-<br \/>\nprotami ir \u0101rstu atbalsts \u0161iem principiem un vi\u0146u v\u0113lme atkl\u0101t ned-<br \/>\nro\u0161u un ne\u0113tisku medic\u012bnas praksi un tos nov\u0113rst.<br \/>\n\u0112tikas kodeksos ir uzsv\u0113rts pien\u0101kums zi\u0146ot par kol\u0113\u0123a nekom-<br \/>\npetenci, nodar\u012bto kait\u0113jumu vai amatp\u0101rk\u0101pumu. Piem\u0113ram, PMA<br \/>\nStarptautiskaj\u0101 medic\u012bnas \u0113tikas kodeks\u0101 teikts: \u00ab\u0100rsts .. cent\u012bsies<br \/>\natmaskot kol\u0113\u0123us, kuriem tr\u016bkst atbilsto\u0161u rakstura \u012bpa\u0161\u012bbu vai<br \/>\nkompetences, vai kuri iesaist\u0101s kr\u0101p\u0161an\u0101 vai maldin\u0101\u0161an\u0101.\u00bb Tom\u0113r<br \/>\n\u0161\u012b principa piem\u0113ro\u0161ana tikai retumis ir vienk\u0101r\u0161a. No vienas puses,<br \/>\ndoma par kol\u0113\u0123a reput\u0101cijas iedrag\u0101\u0161anu \u0101rstam var\u0113tu ien\u0101kt pr\u0101-<br \/>\nt\u0101 ar\u012b zemisku personisku mot\u012bvu, piem\u0113ram, skaud\u012bbas d\u0113\u013c vai aiz<br \/>\natrieb\u012bbas par k\u0101du sen\u0101ku aizvainojumu. \u0100rsts var\u0113tu ar\u012b nenodot<br \/>\nsavu kol\u0113\u0123i, piem\u0113ram, simp\u0101tiju vai draudz\u012bbas d\u0113\u013c (\u00abTas tikpat<br \/>\nlabi var\u0113ju b\u016bt ar\u012b es\u00bb). Turkl\u0101t pazi\u0146o\u0161anas sekas var b\u016bt \u013coti ne-<br \/>\nizdev\u012bgas pa\u0161am zi\u0146ojuma iesniedz\u0113jam, kuram n\u0101ksies sastapties<br \/>\nar piln\u012bgi dro\u0161u nos\u016bdz\u0113t\u0101 kol\u0113\u0123a un, visai ticams, ar\u012b citu kol\u0113\u0123u<br \/>\nnaid\u012bgumu.<br \/>\nLai ar\u012b iesp\u0113jami \u0161\u0137\u0113r\u0161\u013ci, zi\u0146o\u0161ana par p\u0101rk\u0101pumiem ir katra \u0101rsta<br \/>\nprofesion\u0101ls pien\u0101kums. Vi\u0146i ir ne tikai atbild\u012bgi par profesijas la-<br \/>\nb\u0101s slavas uztur\u0113\u0161anu, bet bie\u017ei vien ir<br \/>\nvien\u012bgie, kas sp\u0113j konstat\u0113t nekompe-<br \/>\ntenci, kait\u0113jumu vai amatp\u0101rk\u0101pumu.<br \/>\nTurkl\u0101t norm\u0101l\u0101s situ\u0101cij\u0101s zi\u0146o\u0161ana<br \/>\npar kol\u0113\u0123i ir p\u0113d\u0113jais l\u012bdzeklis p\u0113c tam,<br \/>\nkad izm\u0113\u0123in\u0101ti alternat\u012bvie risin\u0101jumi<br \/>\nun tie izr\u0101d\u012bju\u0161ies nesekm\u012bgi. Pirmais<br \/>\npas\u0101kums var\u0113tu b\u016bt m\u0113\u0123in\u0101jums sa-<br \/>\nzin\u0101ties ar kol\u0113\u0123i un teikt, ka j\u016bs vi\u0146a<br \/>\nr\u012bc\u012bbu v\u0113rt\u0113jat k\u0101 nedro\u0161u vai ne\u0113tisku. Ja probl\u0113mu iesp\u0113jams at-<br \/>\nrisin\u0101t \u0161aj\u0101 l\u012bmen\u012b, nav nepiecie\u0161am\u012bbas doties t\u0101l\u0101k. Ja ne \u2014 n\u0101-<br \/>\nkamais pas\u0101kums var\u0113tu b\u016bt saruna ar j\u016bsu un\/vai p\u0101rk\u0101pumu iz-<br \/>\ndar\u012bju\u0161\u0101 kol\u0113\u0123a tie\u0161o priek\u0161nieku un l\u0113muma atst\u0101\u0161ana vi\u0146a zi\u0146\u0101.<br \/>\n\u00ab..studentiem, kas ir<br \/>\nnor\u016bp\u0113ju\u0161ies par \u0113tikas<br \/>\nnormu iev\u0113ro\u0161anu studij\u0101s<br \/>\nj\u0101b\u016bt nodro\u0161in\u0101tai pieejai<br \/>\natbild\u012bg\u0101m organiz\u0101cij\u0101m,<br \/>\nkam vi\u0146i var dro\u0161i paust<br \/>\nsavas ba\u017eas.\u00bb<br \/>\n\u00ab..zi\u0146o\u0161ana par kol\u0113\u0123i<br \/>\nir p\u0113d\u0113jais l\u012bdzeklis p\u0113c<br \/>\ntam, kad izm\u0113\u0123in\u0101ti<br \/>\nalternat\u012bvie risin\u0101jumi<br \/>\nun tie izr\u0101d\u012bju\u0161ies<br \/>\nnesekm\u012bgi.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunkol\u0113\u0123i<br \/>\n90 91<br \/>\nJa \u0161\u012b taktika nav iesp\u0113jama vai nedod rezult\u0101tus, tad nepiecie\u0161ams<br \/>\n\u0137erties pie gal\u0113j\u0101 l\u012bdzek\u013ca un inform\u0113t disciplin\u0101ro instit\u016bciju.<br \/>\nATTIEC\u012aBAS AR CITIEM VESEL\u012aBAS APR\u016aPES SPECI\u0100LISTIEM<br \/>\nOtr\u0101 noda\u013ca par \u0101rsta attiec\u012bb\u0101m ar pacientiem s\u0101k\u0101s ar diskusiju par<br \/>\ncie\u0146as un vien\u0101das attieksmes noz\u012bmi \u0101rsta un pacienta attiec\u012bb\u0101s.<br \/>\n\u0160iem principiem ir tikpat liela noz\u012bme ar\u012b \u0101rsta un vi\u0146a l\u012bdzstr\u0101dnie-<br \/>\nku attiec\u012bbu veido\u0161an\u0101. \u017den\u0113vas deklar\u0101cij\u0101 noteikts diskrimin\u0101cijas<br \/>\naizliegums \u00abvecuma, vesel\u012bbas st\u0101vok\u013ca, tic\u012bbas, etnisk\u0101s pieder\u012bbas,<br \/>\ndzimuma, nacionalit\u0101tes, politiskajiem uzskatiem, rases, seksu\u0101l\u0101s<br \/>\norient\u0101cijas vai soci\u0101l\u0101 statusa\u00bb d\u0113\u013c, un \u0161ie principi ir saisto\u0161i \u0101rstiem<br \/>\nsaskar\u0113 ar cit\u0101m person\u0101m, ar kuriem vi\u0146i sadarbojas pacientu ap-<br \/>\nr\u016bp\u0113 neatkar\u012bgi no to un citas profesion\u0101l\u0101s darb\u012bbas.<br \/>\n\u00abNediskrimin\u0101cija\u00bb ir pas\u012bva attiec\u012bbu forma. Cie\u0146a jau noz\u012bm\u0113 kaut<br \/>\nko daudz pozit\u012bv\u0101ku un akt\u012bv\u0101ku. Cie\u0146pilna attieksme pret citiem<br \/>\nvesel\u012bbas apr\u016bpes sniedz\u0113jiem \u2014 \u0101rstiem, medic\u012bnas m\u0101s\u0101m un pa-<br \/>\nl\u012bgperson\u0101lu \u2014 nor\u0101da uz to, ka vi\u0146u prasmes un pieredze tiek no-<br \/>\nv\u0113rt\u0113ta t\u0101d\u0101 m\u0113r\u0101, cik vien vi\u0146u kompetence \u013cauj dot ieguld\u012bjumu<br \/>\npacientu apr\u016bp\u0113. Vesel\u012bbas apr\u016bpes sniedz\u0113ju m\u0101c\u012bbu ilgums un<br \/>\nizgl\u012bt\u012bbas l\u012bmenis ir \u013coti at\u0161\u0137ir\u012bgs, tom\u0113r k\u0101 cilv\u0113ki vi\u0146i ir vienl\u012bdz\u012bgi<br \/>\nun tos vieno r\u016bpes par pacientu labkl\u0101j\u012bbu.<br \/>\nT\u0101pat k\u0101 attiec\u012bb\u0101s ar pacientiem, ir pamatoti iemesli, k\u0101p\u0113c b\u016btu<br \/>\nj\u0101atturas vai j\u0101p\u0101rtrauc p\u0101r\u0101k tuvas attiec\u012bbas starp \u0101rstu un citu ve-<br \/>\nsel\u012bbas apr\u016bpes sniedz\u0113jiem.Tas var\u0113tu b\u016bt saist\u012bts ar neuztic\u0113\u0161anos<br \/>\ncitu personu sp\u0113j\u0101m vai god\u012bgumam, k\u0101 ar\u012b rad\u012bt pamatu nopietnai<br \/>\nraksturu nesader\u012bbai. Prasme no\u0161\u0137irt \u0161os mot\u012bvus no citiem maz\u0101k<br \/>\nb\u016btiskiem prasa no \u0101rsta augsti att\u012bst\u012btu \u0113tisku r\u012bc\u012bbu.<br \/>\nSADARB\u012aBA<br \/>\nMedic\u012bna vienlaikus ir gan dzi\u013ci individu\u0101listiska, gan ar\u012b augsta<br \/>\nl\u012bme\u0146a sadarb\u012bbas profesija. No vienas puses, \u0101rsti ir pieder\u012bgi \u00absa-<br \/>\nviem\u00bb pacientiem.Tas ir nepiecie\u0161ams t\u0101d\u0113\u013c, ka individu\u0101las \u0101rsta un<br \/>\npacienta attiec\u012bbas ir lab\u0101kais veids, lai nodro\u0161in\u0101tu pacienta paz\u012b\u0161a-<br \/>\nnu un \u0101rst\u0113\u0161anas procesa nep\u0101rtraukt\u012bbu, kas \u013cauj pan\u0101kt sekm\u012bgu<br \/>\nslim\u012bbu pro\ufb01laksi un \u0101rst\u0113\u0161anu. Pacienta piesaist\u012b\u0161ana dod labumu,<br \/>\nvismaz \ufb01nansi\u0101lu, ar\u012b \u0101rstam. Taj\u0101 pa\u0161\u0101 laik\u0101, k\u0101 jau min\u0113ts, medic\u012b-<br \/>\nna ir k\u013cuvusi \u013coti sare\u017e\u0123\u012bta un speci\ufb01ska, t\u0101d\u0113\u013c nepiecie\u0161ama cie\u0161a<br \/>\nsadarb\u012bba starp da\u017e\u0101diem speci\u0101listiem ar at\u0161\u0137ir\u012bg\u0101m zin\u0101\u0161an\u0101m un<br \/>\nprasm\u0113m. \u0160\u012b pretruna starp individu\u0101lismu un sadarb\u012bbu m\u016bsdien\u0101s<br \/>\nk\u013cuvusi par atk\u0101rtoti apl\u016bkojamu medic\u012bnas \u0113tikas t\u0113mu.<br \/>\nMedic\u012bnisk\u0101 patern\u0101lisma v\u0101jin\u0101\u0161an\u0101s<br \/>\nir izgaisin\u0101jusi uzskatu, ka vi\u0146a pa-<br \/>\ncienti ir \u0101rsta \u012bpa\u0161ums. Tradicion\u0101l\u0101s<br \/>\npacienta ties\u012bbas pras\u012bt otra speci\u0101-<br \/>\nlista viedokli nu ir papla\u0161in\u0101ju\u0161\u0101s l\u012bdz<br \/>\niesp\u0113jai sa\u0146emt citu vesel\u012bbas apr\u016bpes<br \/>\nsniedz\u0113ju pakalpojumus, kas var\u0113tu<br \/>\nlab\u0101k apmierin\u0101t pacienta vajadz\u012bbas. Saska\u0146\u0101 ar PMA Pacientu tie-<br \/>\ns\u012bbu deklar\u0101ciju \u00ab\u0101rstam ir pien\u0101kums pacienta \u0101rst\u0113\u0161anas proces\u0101<br \/>\nsadarboties ar citiem vesel\u012bbas apr\u016bpes sniedz\u0113jiem\u00bb. Turkl\u0101t \u0101rsti<br \/>\nno izmaksu sadal\u012b\u0161anas nedr\u012bkst g\u016bt papildu pe\u013c\u0146u.<br \/>\n\u0160os \u0101rsta \u00ab\u012bpa\u0161nieciskuma\u00bb ierobe\u017eojumus, kas attiecas uz pacien-<br \/>\ntiem, b\u016btu j\u0101l\u012bdzsvaro citiem pas\u0101kumiem, kas aizsarg\u0101tu \u0101rsta un<br \/>\npacienta attiec\u012bbu priorit\u0101ti. Piem\u0113ram, laik\u0101, kad pacients atrodas<br \/>\nslimn\u012bc\u0101, ja vi\u0146a \u0101rst\u0113\u0161anu veic vair\u0101ki \u0101rsti, tad vienam no vi\u0146iem<br \/>\nj\u0101uz\u0146emas apr\u016bpes koordin\u0113\u0161ana, k\u0101 ar\u012b j\u0101inform\u0113 pacients par \u0101rs-<br \/>\nt\u0113\u0161anas gaitu un j\u0101pal\u012bdz pacientam pie\u0146emt l\u0113mumus.<br \/>\n\u00abMedic\u012bnisk\u0101<br \/>\npatern\u0101lisma v\u0101jin\u0101\u0161an\u0101s<br \/>\nir izgaisin\u0101jusi uzskatu,<br \/>\nka vi\u0146a pacienti ir \u0101rsta<br \/>\n\u012bpa\u0161ums.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunkol\u0113\u0123i<br \/>\n92 93<br \/>\nJa \u0101rstu savstarp\u0113j\u0101s attiec\u012bbas sam\u0113r\u0101 skaidri nosaka da\u017e\u0101di labi<br \/>\nformul\u0113ti un akcept\u0113ti noteikumi, tad t\u0101s citiem vesel\u012bbas apr\u016bpes<br \/>\ndarbiniekiem ir nep\u0101rtrauktu p\u0101rmai\u0146u stadij\u0101 un past\u0101v visai at-<br \/>\n\u0161\u0137ir\u012bgi viedok\u013ci, k\u0101d\u0101m t\u0101m vajadz\u0113tu b\u016bt. K\u0101 jau min\u0113ts, daudzas<br \/>\nmedic\u012bnas m\u0101sas, farmaceiti, \ufb01zioterapeiti un citi apr\u016bpes profe-<br \/>\nsion\u0101\u013ci uzskata, ka sav\u0101 jom\u0101 vi\u0146i ir kompetent\u0101ki par \u0101rstiem un<br \/>\nneredz nek\u0101du pamatu, k\u0101p\u0113c lai pret vi\u0146iem neiztur\u0113tos tie\u0161i t\u0101-<br \/>\npat k\u0101 pret \u0101rstiem. Vi\u0146i iest\u0101jas par komandas pieeju pacientu ap-<br \/>\nr\u016bpei, kur\u0101 ikviena speci\u0101lista darbs pelna vienl\u012bdz\u012bgu uzman\u012bbu,<br \/>\nun vi\u0146i j\u016bt atbild\u012bbu pret pacientu, nevis pret \u0101rstu. Taj\u0101 pa\u0161\u0101 laik\u0101<br \/>\ndaudzi \u0101rsti uzskata, ka \u0161aj\u0101 komandas darb\u0101 tom\u0113r j\u0101b\u016bt vienai<br \/>\natbild\u012bgai personai un \u0101rsti izgl\u012bt\u012bbas un pieredzes d\u0113\u013c \u0161ai lomai at-<br \/>\nbilst vislab\u0101k.<br \/>\nLai ar\u012b da\u017ei \u0101rsti var\u0113tu pretoties \u0161\u012bm p\u0101rmai\u0146\u0101m, kas zin\u0101m\u0101 m\u0113r\u0101<br \/>\ngrauj vi\u0146u tradicion\u0101lo, gandr\u012bz absol\u016bto vienpersonisko autorit\u0101ti,<br \/>\nizskat\u0101s, ka vi\u0146iem tom\u0113r n\u0101ksies akcept\u0113t situ\u0101ciju, kur\u0101 paredz\u0113-<br \/>\ntas liel\u0101kas iesp\u0113jas pacientiem un citiem vesel\u012bbas apr\u016bpes snie-<br \/>\ndz\u0113jiem pla\u0161\u0101k iesaist\u012bties l\u0113mumu pie\u0146em\u0161anas proces\u0101. \u0100rstiem<br \/>\nb\u016bs j\u0101iem\u0101c\u0101s pamatot savas rekomend\u0101cijas un p\u0101rliecin\u0101t citus,<br \/>\nlai vi\u0146i t\u0101s pie\u0146emtu. Papildus \u0161\u012bm sazi\u0146as prasm\u0113m \u0101rstam b\u016bs ar\u012b<br \/>\nj\u0101prot risin\u0101t kon\ufb02iktus starp da\u017e\u0101diem vesel\u012bbas apr\u016bpes sniedz\u0113-<br \/>\njiem, ja pacienta apr\u016bpes proces\u0101 t\u0101di rad\u012bsies.<br \/>\n\u012apa\u0161s p\u0101rbaud\u012bjums sadarb\u012bbai pacienta intere\u0161u aizst\u0101v\u012bbas v\u0101rd\u0101<br \/>\nir vi\u0146a izv\u0113le v\u0113rsties p\u0113c pal\u012bdz\u012bbas pie tradicion\u0101l\u0101s vai alterna-<br \/>\nt\u012bv\u0101s medic\u012bnas p\u0101rst\u0101vjiem jeb dziedniekiem. Vi\u0146i sniedz pado-<br \/>\nmus daudziem pacientiem \u0100frik\u0101 un \u0100zij\u0101, un \u0161\u012b ietekme pieaug<br \/>\nar\u012b Eirop\u0101 un Amerik\u0101. Lai ar\u012b ir uzskats, ka abas pieejas (zin\u0101tnisk\u0101<br \/>\nmedic\u012bna un dziedniec\u012bba) tikai papildina viena otru, bie\u017ei vien t\u0101s<br \/>\nnon\u0101k kon\ufb02ikt\u0101. T\u0101 k\u0101 vismaz da\u017e\u0101m netradicion\u0101l\u0101s medic\u012bnas un<br \/>\ndziedniec\u012bbas metod\u0113m ir terapeitisks efekts un pacienti t\u0101s mek-<br \/>\nl\u0113, \u0101rstiem b\u016btu j\u0101atrod veidi, k\u0101 sadarboties ar dziedniekiem. \u0160\u012bs<br \/>\nsadarb\u012bbas formas da\u017e\u0101d\u0101s valst\u012bs un da\u017e\u0101d\u0101s specialit\u0101t\u0113s var b\u016bt<br \/>\ndaudzveid\u012bgas, bet vienm\u0113r te pirmaj\u0101 viet\u0101 b\u016btu j\u0101liek pacienta<br \/>\nintereses un labkl\u0101j\u012bba.<br \/>\nKONFLIKTU RISIN\u0100\u0160ANA<br \/>\nLai ar\u012b \u0101rsti var iesaist\u012bties da\u017e\u0101da veida kon\ufb02iktos ar citiem \u0101rstiem<br \/>\nun vesel\u012bbas apr\u016bpes sniedz\u0113jiem, piem\u0113ram, par jaut\u0101jumiem, kas<br \/>\nsaist\u012bti ar administrat\u012bv\u0101s k\u0101rt\u012bbas iev\u0113ro\u0161anu vai darba samaksu, \u0161ai<br \/>\np\u0101rskat\u0101 galven\u0101 v\u0113r\u012bba velt\u012bta kon-<br \/>\n\ufb02iktiem par pacientu apr\u016bpi. Ide\u0101l\u0101<br \/>\ngad\u012bjum\u0101 pacienta apr\u016bpes l\u0113mumi<br \/>\natspogu\u013co vieno\u0161anos starp pacien-<br \/>\ntu, \u0101rstu un cit\u0101m iesaist\u012btaj\u0101m per-<br \/>\nson\u0101m. Tom\u0113r nedro\u0161\u012bba un da\u017e\u0101die<br \/>\nviedok\u013ci var izrais\u012bt nesapra\u0161anos par<br \/>\napr\u016bpes m\u0113r\u0137iem vai l\u012bdzek\u013ciem to sa-<br \/>\nsnieg\u0161anai. Vienpr\u0101t\u012bba var\u0113tu b\u016bt gr\u016bti sasniedzama ar\u012b ierobe\u017eotu<br \/>\nvesel\u012bbas apr\u016bpes resursu vai darba organiz\u0101cijas d\u0113\u013c.<br \/>\nDomstarp\u012bbas starp vesel\u012bbas apr\u016bpes sniedz\u0113jiem par \u0101rst\u0113\u0161anas<br \/>\nm\u0113r\u0137iem vai to sasnieg\u0161anas l\u012bdzek\u013ciem vajadz\u0113tu atrisin\u0101t apr\u016bpes<br \/>\nkomandai, neietekm\u0113jot vi\u0146u attiec\u012bbas ar pacientu. Domstarp\u012bbas,<br \/>\nkas radu\u0161\u0101s starp vesel\u012bbas apr\u016bpes sniedz\u0113jiem un administr\u0101ci-<br \/>\nju, piem\u0113ram, par resursu sadali, b\u016btu j\u0101risina noda\u013c\u0101 vai iest\u0101d\u0113,<br \/>\nbet t\u0101s nek\u0101d\u0101 zi\u0146\u0101 nevajadz\u0113tu apspriest pacienta kl\u0101tb\u016btn\u0113. T\u0101<br \/>\nk\u0101 abu veidu kon\ufb02iktiem piem\u012bt \u0113tisks raksturs, tad to risin\u0101jumu<br \/>\nvar\u0113tu viegl\u0101k sasniegt, uzklausot \u0113tikas komisijas vai k\u0101da \u0113tikas<br \/>\nkonsultanta padomus, ja t\u0101di ir pieejami.<br \/>\n\u00ab..nedro\u0161\u012bba un da\u017e\u0101die<br \/>\nviedok\u013ci var izrais\u012bt<br \/>\nnesapra\u0161anos par apr\u016bpes<br \/>\nm\u0113r\u0137iem vai l\u012bdzek\u013ciem to<br \/>\nsasnieg\u0161anai.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunkol\u0113\u0123i<br \/>\n94 95<br \/>\n\u0160ie ieteikumi var\u0113tu b\u016bt noder\u012bgi kon\ufb02iktu risin\u0101\u0161an\u0101:<br \/>\n\u2022 Kon\ufb02ikts j\u0101risina p\u0113c iesp\u0113jas neform\u0101li, piem\u0113ram, tie\u0161as<br \/>\nkon\ufb02ikt\u0113jo\u0161o personu vieno\u0161anas rezult\u0101t\u0101, p\u0101rejot pie for-<br \/>\nm\u0101l\u0101k\u0101m proced\u016br\u0101m tikai tad, ja neform\u0101li pas\u0101kumi izr\u0101-<br \/>\nd\u012bju\u0161ies nesekm\u012bgi;<br \/>\n\u2022 Katrai iesaist\u012btajai personai j\u0101b\u016bt ties\u012bgai paust viedokli, kuru<br \/>\ntad ar pilnu cie\u0146u j\u0101nov\u0113rt\u0113;<br \/>\n\u2022 Pacienta vai vi\u0146a pilnvarot\u0101s l\u0113mumu pie\u0146\u0113m\u0113jas personas<br \/>\ninform\u0113tajai piekri\u0161anai par \u0101rst\u0113\u0161anas procesu j\u0101b\u016bt prim\u0101-<br \/>\nrajam apsv\u0113rumam kon\ufb02iktu risin\u0101\u0161an\u0101;<br \/>\n\u2022 Ja str\u012bd\u0101 tiek skartas pacientam pied\u0101v\u0101jam\u0101s \u0101rst\u0113\u0161anas ie-<br \/>\nsp\u0113jas, tad priek\u0161roka dodama pla\u0161\u0101kajam iesp\u0113ju spektram.<br \/>\nJa t\u0101s nav pieejamas resursu ierobe\u017eot\u012bbas d\u0113\u013c, ir glu\u017ei norm\u0101-<br \/>\nli, ka par to inform\u0113 pacientu;<br \/>\n\u2022 Ja p\u0113c sapr\u0101t\u012bgiem p\u016bli\u0146iem neform\u0101l\u0101 dialog\u0101 nav iesp\u0113jams<br \/>\nvienoties vai rast kompromisu, j\u0101akcept\u0113 par l\u0113muma pie-<br \/>\n\u0146em\u0161anu atbild\u012bg\u0101s personas viedoklis. Ja tas nav \u012bsti skaidrs<br \/>\nvai tiek ap\u0161aub\u012bts, kuram dele\u0123\u0113ta atbild\u012bba par l\u0113mumu, tad<br \/>\nj\u0101mekl\u0113 vidut\u0101ja, \u0161\u0137\u012br\u0113jtiesas vai tiesas pal\u012bdz\u012bba.<br \/>\nJa vesel\u012bbas apr\u016bpes sniedz\u0113js profesion\u0101la sprieduma vai mor\u0101lu<br \/>\napsv\u0113rumu d\u0113\u013c nav vienispr\u0101tis ar vair\u0101kuma pie\u0146emto l\u0113mumu,<br \/>\nvi\u0146\u0161 dr\u012bkst atteikties no turpm\u0101kas piedal\u012b\u0161an\u0101s atbilsto\u0161i l\u0113mumam<br \/>\nuzs\u0101ktaj\u0101 apr\u016bpes proces\u0101, p\u0101rliecinoties, ka apr\u016bp\u0113jamai personai<br \/>\nnetiks rad\u012bts kait\u0113juma risks vai t\u0101 nepaliks bez apr\u016bpes.<br \/>\nATGRIE\u0160AN\u0100S PIE GAD\u012aJUMA ANAL\u012aZES<br \/>\nDr. C. satraukumam par iev\u0113rojam\u0101 \u0137irurga r\u012bc\u012bbu<br \/>\noper\u0101ciju z\u0101l\u0113 ir objekt\u012bvs pamats. Vi\u0146\u0161 ne tikai apdraud<br \/>\npacienta vesel\u012bbu, bet ar\u012b izr\u0101da necie\u0146u gan pret<br \/>\npacientu, gan pret kol\u0113\u0123iem. Dr. C. \u0113tisks pien\u0101kums ir<br \/>\nneatst\u0101t \u0161\u0101du uzved\u012bbu bez iev\u0113r\u012bbas un kaut ko dar\u012bt, lai<br \/>\nsitu\u0101ciju uzlabotu. Pirmais solis b\u016btu vec\u0101k\u0101 kol\u0113\u0123a r\u012bc\u012bbas<br \/>\nneatbalst\u012b\u0161ana, piem\u0113ram, nesmejoties par vi\u0146a jokiem.<br \/>\nJa vi\u0146\u0161 dom\u0101, ka vienk\u0101r\u0161a aprun\u0101\u0161an\u0101s ar \u0161o \u0137irurgu<br \/>\nvar\u0113tu b\u016bt efekt\u012bva, vajadz\u0113tu aicin\u0101t kol\u0113\u0123i uz sarunu.<br \/>\nJa ne \u2014 vi\u0146\u0161 var doties pie slimn\u012bcas vad\u012bbas. Ja vad\u012bba<br \/>\natsak\u0101s \u0161o probl\u0113mu risin\u0101t, jaunajam \u0101rstam ir ties\u012bbas<br \/>\nv\u0113rsties atbilst\u012bg\u0101s \u0101rstu serti\ufb01c\u0113\u0161anas organiz\u0101cij\u0101s un<br \/>\npiepras\u012bt lietas izmekl\u0113\u0161anu.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0100rstiunkol\u0113\u0123i<br \/>\n96 97<br \/>\n5. NODA\u013bA.<br \/>\n\u0112TIKA UN MEDIC\u012aNISKIE P\u0112T\u012aJUMI<br \/>\nM\u0112R\u0136I<br \/>\nP\u0113c \u0161\u012bs noda\u013cas izlas\u012b\u0161anas j\u016bs var\u0113siet:<br \/>\n\u2022 identi\ufb01c\u0113t galvenos p\u0113t\u012bjumu veik\u0161anas \u0113tiskos<br \/>\nprincipus;<br \/>\n\u2022 zin\u0101siet, k\u0101 rast l\u012bdzsvaru starp p\u0113t\u012bjumiem un kl\u012bnisko<br \/>\napr\u016bpi;<br \/>\n\u2022 apmierin\u0101t \u0113tikas komiteju pras\u012bbas.Miega slim\u012bba atgrie\u017eas<br \/>\n\u00a9 Robert Patric\/CORBIS SYGMA<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n98 99<br \/>\nMEDIC\u012aNISKO P\u0112T\u012aJUMU NOZ\u012aME<br \/>\nMedic\u012bna nav eksakta zin\u0101tne t\u0101d\u0101 izpratn\u0113 k\u0101 matem\u0101tika vai \ufb01-<br \/>\nzika. To veido vair\u0101k vai maz\u0101k visp\u0101r\u012bgu principu kopums, kas vai-<br \/>\nrum\u0101 gad\u012bjumu ir efekt\u012bvi, tom\u0113r katrs pacients ir at\u0161\u0137ir\u012bgs, t\u0101d\u0113\u013c<br \/>\niesp\u0113jams, ka tas, kas der 90% cilv\u0113ku,<br \/>\nvar neder\u0113t p\u0101r\u0113jiem 10%. \u0160\u012bs b\u016btisk\u0101s<br \/>\n\u012bpa\u0161\u012bbas d\u0113\u013c medic\u012bnai ir eksperimen-<br \/>\nt\u0101ls raksturs. Pat vispla\u0161\u0101k atz\u012bt\u0101s \u0101rs-<br \/>\nt\u0113\u0161anas metodes ir kontrol\u0113jamas un<br \/>\np\u0101rv\u0113rt\u0113jamas, lai noteiktu to piem\u0113rot\u012bbu gan noteikt\u0101m pacientu<br \/>\ngrup\u0101m, gan visiem pacientiem kopum\u0101. T\u0101 ir viena no medic\u012bnisko<br \/>\np\u0113t\u012bjumu funkcij\u0101m.<br \/>\nOtra, iesp\u0113jams lab\u0101k zin\u0101ma, funkcija ir jaunu \u0101rst\u0113\u0161anas meto\u017eu,<br \/>\n\u012bpa\u0161i medikamentu, medic\u012bnas iek\u0101rtu un \u0137irur\u0123isk\u0101s \u0101rst\u0113\u0161anas,<br \/>\natt\u012bst\u012b\u0161ana. P\u0113d\u0113jos 50 gados \u0161aj\u0101 jom\u0101 sasniegts iev\u0113rojams prog-<br \/>\nress, un m\u016bsdien\u0101s vienlaikus tiek veikts vair\u0101k da\u017e\u0101du medic\u012bnisko<br \/>\np\u0113t\u012bjumu k\u0101 jebkad agr\u0101k. Medic\u012bnas zin\u0101tne joproj\u0101m mekl\u0113 ar\u012b at-<br \/>\nbildes uz daudziem neatbild\u0113tiem jaut\u0101jumiem par cilv\u0113ka \u0137erme\u0146a<br \/>\nfunkcij\u0101m, gan zin\u0101mu, gan jaunu slim\u012bbu c\u0113lo\u0146iem un lab\u0101kaj\u0101m to<br \/>\npro\ufb01lakses vai \u0101rst\u0113\u0161anas metod\u0113m. Medic\u012bniskie p\u0113t\u012bjumi ir vien\u012b-<br \/>\ngais veids, k\u0101 ieg\u016bt atbildes uz \u0161iem jaut\u0101jumiem.<br \/>\nTurkl\u0101t, lai lab\u0101k izprastu cilv\u0113ka \ufb01ziolo\u0123iju, medic\u012bnas p\u0113tniec\u012bb\u0101<br \/>\nliela uzman\u012bba tiek piev\u0113rsta daudziem citiem cilv\u0113ku vesel\u012bbu ie-<br \/>\ntekm\u0113jo\u0161iem faktoriem \u2014 t\u0101diem k\u0101 slim\u012bbu izplat\u012bbai (epidemio-<br \/>\nlo\u0123ija), vesel\u012bbas apr\u016bpes \ufb01nans\u0113\u0161anai, organiz\u0101cijai un praksei<br \/>\n(vesel\u012bbas apr\u016bpes sist\u0113mu izp\u0113te), vesel\u012bbas soci\u0101lajiem un kult\u016b-<br \/>\nras aspektiem (medic\u012bnas sociolo\u0123ija un antropolo\u0123ija), tiesiskiem<br \/>\naspektiem (tiesu medic\u012bna) un \u0113tikai (medic\u012bnas \u0113tika). Da\u017e\u0101das<br \/>\nvalsts un nevalstiskas organiz\u0101cijas, it \u012bpa\u0161i speci\u0101li fondi, arvien vai-<br \/>\nr\u0101k interes\u0113jas par \u0161iem medic\u012bnas p\u0113t\u012bjumu veidiem, un daudzas<br \/>\nvesel\u012bbas apr\u016bpes \ufb01nans\u0113\u0161anas organiz\u0101cijas ir izveidoju\u0161as \u012bpa\u0161as<br \/>\nprogrammas ne\ufb01ziolo\u0123isku medic\u012bnas p\u0113t\u012bjumu atbalst\u012b\u0161anai.<br \/>\nP\u0112T\u012aJUMI MEDIC\u012aNAS PRAKS\u0112<br \/>\nVisi \u0101rsti praks\u0113 izmanto jaun\u0101ko p\u0113t\u012bjumu rezult\u0101tus. Lai uztur\u0113tu<br \/>\nsavu kompetenci, \u0101rstiem j\u0101seko l\u012bdzi<br \/>\njaun\u0101kajiem sasniegumiem, iesaisto-<br \/>\nties medic\u012bnas t\u0101l\u0101kizgl\u012bt\u012bbas vai pro-<br \/>\nfesion\u0101l\u0101s izaugsmes programm\u0101s,<br \/>\nlasot medic\u012bnas \u017eurn\u0101lus un daloties<br \/>\npieredz\u0113 ar zino\u0161iem kol\u0113\u0123iem. Pat<br \/>\ntad, ja vi\u0146i neiesaist\u0101s p\u0113tniec\u012bb\u0101,<br \/>\n\u0101rstiem j\u0101sp\u0113j interpret\u0113t p\u0113t\u012bjumos<br \/>\n4. GAD\u012aJUMA APRAKSTS<br \/>\nPie k\u0101das mazpils\u0113tas \u0123imenes \u0101rstes ierodas p\u0113t\u012bjumu<br \/>\nl\u012bgumorganiz\u0101cijas p\u0101rst\u0101vis un aicina vi\u0146u piedal\u012bties<br \/>\nkl\u012bnisk\u0101 p\u0113t\u012bjum\u0101 par jauna nestero\u012bd\u0101 pretiekaisuma<br \/>\nl\u012bdzek\u013ca lieto\u0161anu osteoartr\u012bta \u0101rst\u0113\u0161an\u0101. Vi\u0146ai tiek<br \/>\napsol\u012bta konkr\u0113ta summa par katru pacientu, ko vi\u0146a<br \/>\niesaist\u012bs p\u0113t\u012bjum\u0101. P\u0113t\u012bjumu l\u012bgumorganiz\u0101cijas p\u0101rst\u0101vis<br \/>\nvi\u0146u p\u0101rliecina, ka p\u0113t\u012bjuma veik\u0161anai jau ieg\u016btas<br \/>\nvisas nepiecie\u0161am\u0101s at\u013caujas, taj\u0101 skait\u0101 ar\u012b no \u0113tikas<br \/>\nkomitejas. \u0100rste v\u0113l nekad nav piedal\u012bjusies kl\u012bnisk\u0101<br \/>\np\u0113t\u012bjum\u0101 un ir \u013coti priec\u012bga par \u0161\u0101du iesp\u0113ju, kas turkl\u0101t<br \/>\nvi\u0146ai garant\u0113 papildu ien\u0101kumus. Vi\u0146a piekr\u012bt piedal\u012bties,<br \/>\ntuv\u0101k nepainteres\u0113joties par p\u0113t\u012bjuma zin\u0101tniskajiem vai<br \/>\n\u0113tiskajiem aspektiem.<br \/>\n\u00ab\u0160\u012bs b\u016btisk\u0101s \u012bpa\u0161\u012bbas<br \/>\nd\u0113\u013c medic\u012bnai ir<br \/>\neksperiment\u0101ls raksturs.\u00bb<br \/>\n\u00abPat tad, ja vi\u0146i neiesaist\u0101s<br \/>\np\u0113tniec\u012bb\u0101, \u0101rstiem j\u0101sp\u0113j<br \/>\ninterpret\u0113t p\u0113t\u012bjumos<br \/>\nieg\u016btie rezult\u0101ti un<br \/>\ntos piem\u0113rot pacientu<br \/>\n\u0101rst\u0113\u0161an\u0101.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n100 101<br \/>\nieg\u016btie rezult\u0101ti un tos piem\u0113rot pacientu \u0101rst\u0113\u0161an\u0101. T\u0101d\u0113\u013c pamat-<br \/>\nzin\u0101\u0161anas par p\u0113tniec\u012bbas metod\u0113m ir neat\u0146emama labas kl\u012bnisk\u0101s<br \/>\nprakses sast\u0101vda\u013ca.Vislab\u0101kais veids, k\u0101 ieg\u016bt \u0161\u012bs zin\u0101\u0161anas, ir pieda-<br \/>\nl\u012bties k\u0101d\u0101 p\u0113tniec\u012bbas projekt\u0101 vai nu k\u0101 medic\u012bnas studentam, vai<br \/>\nv\u0113l\u0101k \u2014 t\u0101l\u0101kizgl\u012bt\u012bb\u0101.<br \/>\nVisierast\u0101k\u0101 p\u0113t\u012bjumu metode, ar kuru saskaras praktiz\u0113jo\u0161ie \u0101rsti,<br \/>\nir kl\u012bniskie p\u0113t\u012bjumi. Pirms k\u0101da jauna medikamenta re\u0123istr\u0101cijas,<br \/>\nko veic pilnvarota valsts iest\u0101de, ar to tiek veikti daudzi savstarp\u0113ji<br \/>\nsaist\u012bti p\u0113t\u012bjumi, lai noteiktu medikamenta dro\u0161umu un efektivit\u0101ti.<br \/>\nProcess s\u0101kas ar laboratoriskiem p\u0113t\u012bjumiem, kam seko medika-<br \/>\nmenta izp\u0113te uz dz\u012bvniekiem. Ja \u0161ie p\u0113t\u012bjumi liekas perspekt\u012bvi, seko<br \/>\nturpm\u0101kie \u010detri darb\u012bbas posmi jeb f\u0101zes:<br \/>\n\u2022 pirmaj\u0101 f\u0101z\u0113 \u2014 parasti tiek iesaist\u012bts neliels skaits br\u012bvpr\u0101t\u012bgo,<br \/>\nkam bie\u017ei vien par dal\u012bbu \u0161\u0101d\u0101 p\u0113t\u012bjum\u0101 maks\u0101; vi\u0146i lieto medika-<br \/>\nmentu, lai noteiktu, k\u0101da deva ir nepiecie\u0161ama, lai tas sp\u0113tu atst\u0101t<br \/>\nnoteiktu iespaidu uz cilv\u0113ka \u0137ermeni, noteiktu medikamenta uz-<br \/>\ns\u016bk\u0161anos un sadal\u012bjumu organism\u0101 un spriestu, vai tas neizraisa<br \/>\nk\u0101dus toksiskus vai kait\u012bgus efektus.<br \/>\n\u2022 otraj\u0101 f\u0101z\u0113 \u2014 medikamentu lieto neliels skaits pacientu, kas sirgst<br \/>\nar to slim\u012bbu, kuru iecer\u0113ts \u0101rst\u0113t ar jauno medikamentu. \u0160\u012bs f\u0101-<br \/>\nzes m\u0113r\u0137is ir noteikt, vai medikamentam tie\u0161\u0101m piem\u012bt eventu\u0101l\u0101<br \/>\nv\u0113lam\u0101 ietekme un vai tas nerada k\u0101das nev\u0113lamas blakuspar\u0101-<br \/>\nd\u012bbas.<br \/>\n\u2022 tre\u0161aj\u0101 f\u0101z\u0113 ietilpst kl\u012bniski p\u0113t\u012bjumi, kuru laik\u0101 medikamentu lieto<br \/>\ndaudzi pacientu, turkl\u0101t tas tiek sal\u012bdzin\u0101ts ar k\u0101du citu jau praks\u0113<br \/>\nlietotu medikamentu vai placebo. Ja vien iesp\u0113jams, \u0161ie p\u0113t\u012bjumi ir<br \/>\n\u00abdubultakli\u00bb (dubultmask\u0113ti), proti, nedz p\u0113t\u012bjuma pacienti, nedz<br \/>\nar\u012b vi\u0146u \u0101rst\u0113jo\u0161ie \u0101rsti nezina, kur\u0161 kuru sa\u0146em medikamentu (vai<br \/>\nplacebo).<br \/>\n\u2022 ceturt\u0101 f\u0101ze tiek \u012bstenota p\u0113c tam, kad medikaments ir re\u0123istr\u0113ts<br \/>\nun laists tirg\u016b. Pirmos gadus tiek organiz\u0113ti v\u0113rota medikamenta<br \/>\nietekme, it \u012bpa\u0161i, vai tas neizraisa k\u0101dus iepriek\u0161\u0113jos p\u0113t\u012bjumos ne-<br \/>\npaman\u012btus blakusefektus.T\u0101pat ar\u012b z\u0101\u013cu ra\u017eo\u0161anas \ufb01rmas interes\u0113-<br \/>\njas, k\u0101das ir atsauksmes no \u0101rstiem, kas \u0161o medikamentu izraksta,<br \/>\nun pacientiem, kas to lieto.<br \/>\nP\u0113d\u0113jos gados nov\u0113rotais straujais p\u0113t\u012bjumu skaita pieaugums ra-<br \/>\nd\u012bjis nepiecie\u0161am\u012bbu atrast un tajos iesaist\u012bt arvien liel\u0101ku pacientu<br \/>\nskaitu, lai apmierin\u0101tu p\u0113t\u012bjumiem izvirz\u012bt\u0101s statistikas pras\u012bbas. Par<br \/>\np\u0113t\u012bjumu \u012bsteno\u0161anu atbild\u012bgajiem individu\u0101lajiem \u0101rstiem vai z\u0101\u013cu<br \/>\nra\u017eo\u0161anas \ufb01rm\u0101m arvien bie\u017e\u0101k n\u0101kas pa\u013cauties uz daudziem \u0101rs-<br \/>\ntiem da\u017e\u0101d\u0101s valst\u012bs, lai iesaistu vi\u0146u pacientus p\u0113t\u012bjumos.<br \/>\nLai ar\u012b \u0161\u0101da dal\u012bba p\u0113t\u012bjumos \u0101rstam ir neatsverama pieredze, ir<br \/>\nda\u017eas potenci\u0101las probl\u0113mas, kuras b\u016btu j\u0101pamana un no kur\u0101m<br \/>\nb\u016btu j\u0101cen\u0161as izvair\u012bties. Pirmk\u0101rt, \u0101rsta un pacienta attiec\u012bbas at-<br \/>\n\u0161\u0137iras no p\u0113tnieka un p\u0113t\u012bjuma dal\u012bbnieka attiec\u012bb\u0101m, pat ja \u0101rsts<br \/>\nun p\u0113tnieks ir viena un t\u0101 pati perso-<br \/>\nna. \u0100rstam galvenais ir atbild\u012bba par<br \/>\npacienta labkl\u0101j\u012bbu, turpretim p\u0113tnie-<br \/>\nkam atbild\u012bba svar\u012bg\u0101k ir jaunu zin\u0101-<br \/>\n\u0161anu ieg\u016b\u0161ana, kaut gan \u0161is process<br \/>\nvar\u0113tu gan labv\u0113l\u012bgi, gan nelabv\u0113l\u012bgi<br \/>\nietekm\u0113t p\u0113t\u012bjuma dal\u012bbnieka vesel\u012bbu un labkl\u0101j\u012bbu. T\u0101d\u0113j\u0101di te<br \/>\niesp\u0113jams potenci\u0101ls antagonisms starp ab\u0101m lom\u0101m. Ja tas no-<br \/>\ntiek, tad \u0101rsta noz\u012bmei j\u0101b\u016bt noteico\u0161ai. K\u0101 tas izpau\u017eas praks\u0113, to<br \/>\napskat\u012bsim v\u0113l\u0101k.<br \/>\nOtra potenci\u0101l\u0101 probl\u0113ma, kas saist\u0101s ar abu \u0161o lomu apvieno\u0161anu,<br \/>\nir intere\u0161u kon\ufb02ikts. Medic\u012bniskie p\u0113t\u012bjumi ir \u013coti labi apmaks\u0101ta uz-<br \/>\n\u0146\u0113m\u0113jdarb\u012bba, un \u0101rstiem par piedal\u012b\u0161anos \u0161\u0101dos p\u0113t\u012bjumos bie\u017ei<br \/>\nvien tiek pied\u0101v\u0101ta iev\u0113rojama atl\u012bdz\u012bba. Tie var b\u016bt gan maks\u0101jumi<br \/>\n\u00ab..\u0101rsta un pacienta<br \/>\nattiec\u012bbas at\u0161\u0137iras no<br \/>\np\u0113tnieka un p\u0113t\u012bjuma<br \/>\ndal\u012bbnieka attiec\u012bb\u0101m\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n102 103<br \/>\nskaidr\u0101 naud\u0101 par katru iesaist\u012bto pacientu, gan ar\u012b cita veida labu-<br \/>\nmi, piem\u0113ram, dators p\u0113t\u012bjuma datu apstr\u0101dei vai iel\u016bgumi uz kon-<br \/>\nferenc\u0113m, kur\u0101s tiek apspriesti p\u0113t\u012bjumu rezult\u0101ti, un l\u012bdzautor\u012bba<br \/>\npublik\u0101cij\u0101s par p\u0113t\u012bjumu rezult\u0101tiem. \u0100rsta ieinteres\u0113t\u012bba par \u0161iem<br \/>\nlabumiem reiz\u0113m nav apvienojama ar pien\u0101kumu nodro\u0161in\u0101t pa-<br \/>\ncientam lab\u0101ko apr\u016bpi. T\u0101pat t\u0101 var non\u0101kt kon\ufb02ikt\u0101 ar pacienta tie-<br \/>\ns\u012bb\u0101m sa\u0146emt visu nepiecie\u0161amo inform\u0101ciju, lai izdar\u012btu inform\u0113tu<br \/>\nl\u0113mumu par piedal\u012b\u0161anos vai nepiedal\u012b\u0161anos p\u0113t\u012bjum\u0101.<br \/>\n\u0160\u012bs probl\u0113mas ir p\u0101rvaramas. \u0100rsta \u0113tikas v\u0113rt\u012bbas \u2014 l\u012bdzciet\u012bba,<br \/>\nkompetence, autonomija \u2014 tikpat labi attiecas ar\u012b uz p\u0113tniekiem,<br \/>\nt\u0101d\u0113\u013c ka starp ab\u0101m lom\u0101m nep\u0101rvarama antagonisma nav. Ja \u0101rsti<br \/>\nizprot un iev\u0113ro p\u0113t\u012bjumu \u0113tikas pamatlikumus, vi\u0146iem nevajadz\u0113-<br \/>\ntu b\u016bt gr\u016bti veidot dal\u012bbu p\u0113t\u012bjumos k\u0101 noz\u012bm\u012bgu kl\u012bnisk\u0101s prakses<br \/>\nsast\u0101vda\u013cu.<br \/>\n\u0112TIKAS PRAS\u012aBAS<br \/>\nP\u0113t\u012bjumu veik\u0161anas \u0113tiskie pamatprincipi m\u016bsdien\u0101s ir \u013coti labi<br \/>\nizstr\u0101d\u0101ti. Tom\u0113r vienm\u0113r tas t\u0101 nav bijis. Daudzi izcili XIX un XX<br \/>\ngadsimta p\u0113tnieki \u012bstenoja eksperimentus ar pacientiem, tos ne-<br \/>\ninform\u0113jot un neuztraucoties par vi\u0146u labkl\u0101j\u012bbu. Lai gan jau XX<br \/>\ngadsimta s\u0101kum\u0101 tika izstr\u0101d\u0101tas da\u017eas deklar\u0101cijas par p\u0113t\u012bjumu<br \/>\n\u0113tikas principiem, tom\u0113r t\u0101s neattur\u0113ja \u0101rstus nacistiskaj\u0101 V\u0101cij\u0101 un<br \/>\ncit\u0101s valst\u012bs no p\u0113t\u012bjumiem ar cilv\u0113kiem, kas rupji p\u0101rk\u0101pa cilv\u0113ku<br \/>\npamatties\u012bbas. P\u0113c Otr\u0101 pasaules kara da\u017ei no \u0161iem \u0101rstiem tika<br \/>\nsaukti pie atbild\u012bbas un noties\u0101ti Nirnbergas kara tribun\u0101l\u0101. Sprie-<br \/>\nduma pamats ir paz\u012bstams k\u0101 Nirnbergas kodekss, kas ir kalpojis<br \/>\npar vienu no modern\u0101s p\u0113tniec\u012bbas \u0113tikas pamatdokumentiem.<br \/>\nPie desmit \u0161\u012b kodeksa principiem pieder ar\u012b pras\u012bba par br\u012bvpr\u0101t\u012bgu<br \/>\npacienta dal\u012bbu p\u0113t\u012bjum\u0101.<br \/>\nPMA tika dibin\u0101ta 1947. gad\u0101, \u2014 gad\u0101, kad tika izstr\u0101d\u0101ts Nirnber-<br \/>\ngas kodekss. Apzinoties savu atbild\u012bbu par medic\u012bnas \u0113tikas p\u0101r-<br \/>\nk\u0101pumiem pirms Otr\u0101 pasaules kara un t\u0101 laik\u0101, PMA dibin\u0101t\u0101ji ne-<br \/>\nkav\u0113joties dar\u012bja visu, lai nodro\u0161in\u0101tu, ka \u0101rsti vismaz apzin\u0101s savus<br \/>\n\u0113tiskos pien\u0101kumus. P\u0113c da\u017eiem probl\u0113mas izp\u0113tes gadiem, 1954.<br \/>\ngad\u0101, PMA pie\u0146\u0113ma virkni dokumentu, ko paz\u012bst k\u0101 Principus<br \/>\ntiem, kas iesaist\u0101s p\u0113t\u012bjumos un eksperimentos (Principles for<br \/>\nThoseinResearchandExperimentation).Turpm\u0101kos desmit gados \u0161is<br \/>\ndokuments tika p\u0101rstr\u0101d\u0101ts un beidzot 1964. gad\u0101 tika pie\u0146emts k\u0101<br \/>\nHelsinku deklar\u0101cija (Declaration of Helsinki). P\u0113c tam t\u0101 tika p\u0101r-<br \/>\nstr\u0101d\u0101ta 1975., 1983., 1989., 1996. un 2000. gad\u0101. Helsinku deklar\u0101-<br \/>\ncija ir koncentr\u0113ts \u0113tikas kopsavilkums. P\u0113d\u0113jos gados ir izstr\u0101d\u0101ti<br \/>\nciti, detaliz\u0113t\u0101ki dokumenti gan par p\u0113t\u012bjumu \u0113tikas visp\u0101r\u012bgos jau-<br \/>\nt\u0101jumos, piem\u0113ram, Starptautisko medic\u012bnas zin\u0101t\u0146u organiz\u0101ciju<br \/>\npadomes (Council for International Organizations of Medical Scien-<br \/>\nces, CIOMS) dokuments Starptautiskas \u0113tisk\u0101s vadl\u012bnijas bio-<br \/>\nmedic\u012bniskos p\u0113t\u012bjumos, kuros iesaist\u012bti cilv\u0113ki (International<br \/>\nEthical Guidelines for Biomedical Research Involving Human Subjects),<br \/>\ntas tika sagatavots 1993., bet p\u0101rstr\u0101d\u0101ts 2002. gad\u0101, gan ar\u012b par p\u0113-<br \/>\nt\u012bjumu \u0113tikas speci\ufb01skos jaut\u0101jumos, (piem\u0113ram, Nuf\u012bldas Bio\u0113tikas<br \/>\npadomes (Nu\ufb03eld Council on Bioethics) dokuments \u0113tik\u0101 Vesel\u012bbas<br \/>\napr\u016bpe jaunatt\u012bst\u012bbas valst\u012bm (The Ethics of Research Related to Heal-<br \/>\nthcare in Developing Countries), kas apstiprin\u0101ts 2002. gad\u0101).<br \/>\nLai ar\u012b \u0161iem dokumentiem ir da\u017e\u0101ds skatupunkts, apjoms un auto-<br \/>\nri, tie visi ir vienispr\u0101tis par \u0113tikas pamatprincipiem p\u0113t\u012bjumos. \u0160ie<br \/>\nprincipi ir iestr\u0101d\u0101ti daudzu valstu likumos un noteikumos un starp-<br \/>\ntautisku organiz\u0101ciju dokumentos, ieskaitot t\u0101s organiz\u0101cijas, kas ir<br \/>\ntie\u0161i saist\u012btas ar jaunu medic\u012bnas iek\u0101rtu un medikamentu p\u0101rbaudi.<br \/>\nL\u016bk, \u012bss \u0161o principu uzskait\u012bjums, kas galvenok\u0101rt \u0146emts no Helsinku<br \/>\ndeklar\u0101cijas.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n104 105<br \/>\n\u0112tikas komitejas apstiprin\u0101jums<br \/>\nHelsinku deklar\u0101cijas 13. un 14. paragr\u0101fs izvirza nosac\u012bjumu, ka<br \/>\nkatra p\u0113t\u012bjuma, kur\u0101 tiks iesaist\u012bti cilv\u0113ki, uzs\u0101k\u0161ana j\u0101izskata un j\u0101-<br \/>\napstiprina neatkar\u012bgai \u0113tikas komitejai. Lai ieg\u016btu apstiprin\u0101jumu,<br \/>\np\u0113tniekiem j\u0101sp\u0113j izskaidrot p\u0113t\u012bjuma m\u0113r\u0137is un metodolo\u0123ija; j\u0101-<br \/>\npar\u0101da, k\u0101 tiks iesaist\u012bti p\u0113t\u012bjuma dal\u012bbnieki, k\u0101 tiks pan\u0101kta vi\u0146u<br \/>\npiekri\u0161ana un k\u0101 tiks nodro\u0161in\u0101ta vi\u0146u<br \/>\nkon\ufb01dencialit\u0101te; j\u0101inform\u0113, k\u0101 p\u0113-<br \/>\nt\u012bjums tiek \ufb01nans\u0113ts; j\u0101atkl\u0101j visi po-<br \/>\ntenci\u0101lie p\u0113t\u012bjuma \u012bstenot\u0101ju intere\u0161u<br \/>\nkon\ufb02ikti. \u0112tikas komiteja var projektu<br \/>\napstiprin\u0101t, piepras\u012bt veikt da\u017eus gro-<br \/>\nz\u012bjumus pirms t\u0101 uzs\u0101k\u0161anas vai ar\u012b to<br \/>\nnoraid\u012bt. Daudzas komitejas ir noz\u012bm\u012b-<br \/>\ngas ar\u012b eso\u0161o projektu \u012bsteno\u0161anas p\u0101rraudz\u012bb\u0101, lai p\u0101rliecin\u0101tos, ka<br \/>\np\u0113tnieki izpilda savus pien\u0101kumus, un, ja nepiecie\u0161ams, aptur\u0113tu<br \/>\nprojektu nopietnu, nev\u0113lamu notikumu d\u0113\u013c.<br \/>\nIemesls,k\u0101p\u0113c\u0161\u0101ds\u0113tikaskomitejasapstiprin\u0101jumsirnepiecie\u0161ams,<br \/>\nir tas, ka ne p\u0113tnieki, ne ar\u012b p\u0113t\u012bjuma dal\u012bbnieki ne vienm\u0113r ir pietie-<br \/>\nkami zino\u0161i vai objekt\u012bvi, lai noteiktu, vai projekts no zin\u0101tnisk\u0101 un<br \/>\n\u0113tisk\u0101 viedok\u013ca ir pie\u0146emams. P\u0113tniekiem ir j\u0101pier\u0101da neatkar\u012bgai<br \/>\nekspertu komitejai, ka projekts ir v\u0113rt\u012bgs, ka vi\u0146i ir pietiekami kom-<br \/>\npetenti, lai to \u012bstenotu, un ka tiks iev\u0113roti visi iesp\u0113jamie pas\u0101kumi,<br \/>\nlai potenci\u0101liem p\u0113t\u012bjuma dal\u012bbniekiem netiktu nodar\u012bts kait\u0113jums.<br \/>\nViens neatrisin\u0101ts jaut\u0101jums \u0161aj\u0101 situ\u0101cij\u0101 tom\u0113r paliek. Proti, vai tad,<br \/>\nja projekts tiek \u012bstenots vair\u0101kos centros, pietiek ar vienas komitejas<br \/>\nvienu apstiprin\u0101jumu, vai tom\u0113r vajadz\u0113tu g\u016bt apstiprin\u0101jumu no<br \/>\nkatras re\u0123ion\u0101l\u0101s komitejas. Ja p\u0113t\u012bjumu centri atrodas da\u017e\u0101d\u0101s val-<br \/>\nst\u012bs, tad apstiprin\u0101jums vajadz\u012bgs no katras valsts \u0113tikas komitejas.<br \/>\nZin\u0101tnisk\u0101 v\u0113rt\u012bba<br \/>\nHelsinku deklar\u0101cijas 11. paragr\u0101fs pieprasa, ka medic\u012bniskiem p\u0113-<br \/>\nt\u012bjumiem, kuros tiek iesaist\u012bti cilv\u0113ki, j\u0101b\u016bt zin\u0101tniski pamatotiem.<br \/>\n\u0160\u012b pras\u012bba izvirz\u012bta t\u0101d\u0113\u013c, lai noraid\u012btu<br \/>\nprojektus, kas nesola sekmes, piem\u0113-<br \/>\nram, neatbilsto\u0161as metodolo\u0123ijas d\u0113\u013c,<br \/>\nvai t\u0101dus, kuros visticam\u0101k tiks ieg\u016bti<br \/>\ntrivi\u0101li rezult\u0101ti, pat ja tie b\u016bs sekm\u012bgi.<br \/>\nJa pacienti tiek l\u016bgti iesaist\u012bties p\u0113t\u012bju-<br \/>\nmu projekt\u0101, kaut gan t\u0101 risks b\u016btu minim\u0101ls, ir j\u0101b\u016bt p\u0101rliec\u012bbai un<br \/>\npier\u0101d\u012bjumiem, ka sagaid\u0101mie rezult\u0101ti b\u016bs noz\u012bm\u012bgi zin\u0101tnes att\u012bs-<br \/>\nt\u012bb\u0101.<br \/>\nLai nodro\u0161in\u0101tu zin\u0101tnisko v\u0113rt\u012bbu, 11. paragr\u0101fs v\u0113l pieprasa, lai<br \/>\nprojekts ir balst\u012bts uz literat\u016br\u0101 atrodamu datu apkopojumu par<br \/>\np\u0113t\u0101mo probl\u0113mu, iepriek\u0161\u0113jiem laboratoriskiem p\u0113t\u012bjumiem un,<br \/>\nja iesp\u0113jams, ar\u012b izm\u0113\u0123in\u0101jumiem ar dz\u012bvniekiem, t\u0101s kop\u0101 \u013cauj sa-<br \/>\ngaid\u012bt, ka paredzam\u0101 metode b\u016bs efekt\u012bva ar\u012b cilv\u0113kiem. Ar\u012b p\u0113t\u012bju-<br \/>\nmiem ar dz\u012bvniekiem j\u0101saskan ar \u0113tikas vadl\u012bnij\u0101m, kas pieprasa l\u012bdz<br \/>\nminimumam samazin\u0101t izmantoto dz\u012bvnieku skaitu un pasarg\u0101t tos<br \/>\nno nevajadz\u012bg\u0101m s\u0101p\u0113m. 15. paragr\u0101f\u0101 pievienots papildu nosac\u012b-<br \/>\njums \u2014 tikai zin\u0101tniski kvali\ufb01c\u0113tas personas dr\u012bkst veikt p\u0113t\u012bjumus<br \/>\nar cilv\u0113kiem. Pirms \u0113tikas komisija apstiprina projektu, tai j\u0101b\u016bt p\u0101r-<br \/>\nliecin\u0101tai, ka visas \u0161\u012bs pras\u012bbas tiek pild\u012btas.<br \/>\nSoci\u0101l\u0101 v\u0113rt\u012bba<br \/>\nViena no pretrun\u012bg\u0101kaj\u0101m pras\u012bb\u0101m<br \/>\nmedic\u012bnas p\u0113t\u012bjumos ir t\u0101, lai projekts<br \/>\ndotu savu ieguld\u012bjumu visas sabied-<br \/>\nr\u012bbas labkl\u0101j\u012bb\u0101. Agr\u0101k bija visp\u0101rpie-<br \/>\n\u0146emts, ka zin\u0101tnes sasniegumi bija<br \/>\n\u00ab..katra p\u0113t\u012bjuma, kur\u0101<br \/>\ntiks iesaist\u012bti cilv\u0113ki,<br \/>\nuzs\u0101k\u0161ana j\u0101izskata un<br \/>\nj\u0101apstiprina neatkar\u012bgai<br \/>\n\u0113tikas komitejai.\u00bb<br \/>\n\u00ab..medic\u012bniskiem<br \/>\np\u0113t\u012bjumiem, kuros tiek<br \/>\niesaist\u012bti cilv\u0113ki, j\u0101b\u016bt<br \/>\nzin\u0101tniski pamatotiem.\u00bb<br \/>\n\u00ab..soci\u0101l\u0101 v\u0113rt\u012bba ir k\u013cuvusi<br \/>\npar b\u016btisku krit\u0113riju, lai<br \/>\npie\u0146emtu l\u0113mumu par<br \/>\nprojekta finans\u0113\u0161anu.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n106 107<br \/>\nv\u0113rt\u012bba pa\u0161i par sevi un tiem nevajadz\u0113ja nek\u0101dus papildu attais-<br \/>\nnojumus. Ta\u010du m\u016bsdien\u0101s, kad resursu pieejam\u012bba medic\u012bnas p\u0113t-<br \/>\nniec\u012bbai aizvien strauj\u0101k atpaliek no vajadz\u012bb\u0101m, soci\u0101l\u0101 v\u0113rt\u012bba ir<br \/>\nk\u013cuvusi par b\u016btisku krit\u0113riju, lai pie\u0146emtu l\u0113mumu par projekta \ufb01-<br \/>\nnans\u0113\u0161anu.<br \/>\nHelsinku deklar\u0101cijas 18. un 19. pants skaidri izsaka atbalstu soci\u0101l\u0101s<br \/>\nv\u0113rt\u012bbas krit\u0113rija piem\u0113ro\u0161anai, izv\u0113rt\u0113jot p\u0113t\u012bjuma nepiecie\u0161am\u012bbu.<br \/>\nSkaidriem un saprotamiem projekta m\u0113r\u0137iem \u2014 gan zin\u0101tniskiem,<br \/>\ngan soci\u0101liem \u2014 j\u0101b\u016bt p\u0101rliecino\u0161\u0101kiem par risku un kait\u0113jumu, kas<br \/>\nvar\u0113tu rasties p\u0113t\u012bjuma dal\u012bbniekiem. V\u0113l vair\u0101k \u2014 sabiedr\u012bbai, kur\u0101<br \/>\np\u0113t\u012bjums tiek veikts, vajadz\u0113tu g\u016bt no t\u0101 rezult\u0101tiem k\u0101du labumu.<br \/>\n\u012apa\u0161i noz\u012bm\u012bgi tas ir valst\u012bs, kur ir iesp\u0113jama negod\u012bga r\u012bc\u012bba pret<br \/>\nbr\u012bvpr\u0101t\u012bgajiem, kas p\u0113t\u012bjuma laik\u0101 uz\u0146emas lielu risku un ne\u0113rt\u012bbas,<br \/>\nbet galu gal\u0101 labumu no p\u0113t\u012bjuma rezult\u0101tiem g\u016bst vien\u012bgi pacienti<br \/>\nkaut kur citur.<br \/>\nIzv\u0113rt\u0113t p\u0113t\u012bjuma projekta soci\u0101lo v\u0113rt\u012bbu ir gr\u016bt\u0101k nek\u0101 zin\u0101tnisko,<br \/>\ntom\u0113r tas nav iemesls, lai esam\u012bbu ignor\u0113tu. P\u0113tniekiem un \u0113tikas<br \/>\nkomitejas locek\u013ciem ir j\u0101b\u016bt p\u0101rliecin\u0101tiem, ka pacienti netiek pa-<br \/>\nk\u013cauti izmekl\u0113jumiem, kuriem nav nek\u0101da lietder\u012bga soci\u0101l\u0101 m\u0113r\u0137a.<br \/>\nPret\u0113ja r\u012bc\u012bba nelietder\u012bgi iz\u0161\u0137\u0113rd\u0113tu v\u0113rt\u012bgos medic\u012bnas resursus un<br \/>\nv\u0101jin\u0101tu medic\u012bnas p\u0113t\u012bjumu \u2014 b\u016btiska cilv\u0113ces labkl\u0101j\u012bbas un vese-<br \/>\nl\u012bbas faktora \u2014 reput\u0101ciju.<br \/>\nRiski un ieguvumi<br \/>\nKad ir noteikts p\u0113t\u012bjuma projekta zin\u0101tnisk\u0101 un soci\u0101l\u0101 v\u0113rt\u012bba, p\u0113t-<br \/>\nniekam j\u0101pier\u0101da, ka iesp\u0113jamie riski, kuriem tiks pak\u013cauti p\u0113t\u012bjuma<br \/>\ndal\u012bbnieki, nav nesapr\u0101t\u012bgi vai neproporcion\u0101li sagaid\u0101majam gu-<br \/>\nvumam no p\u0113t\u012bjuma rezult\u0101tiem, kurus, iesp\u0113jams, p\u0113t\u012bjuma dal\u012bb-<br \/>\nnieki pa\u0161i pat neizbaud\u012bs. Risks ir iesp\u0113jamais kait\u0113jums (nev\u0113lams<br \/>\ngalarezult\u0101ts), kas var\u0113tu rasties. Tam ir divi komponenti: 1) iesp\u0113-<br \/>\njam\u012bba, ka kait\u0113jums tiks nodar\u012bts (no<br \/>\n\u013coti mazticamas l\u012bdz \u013coti ticamai); 2)<br \/>\nnodar\u012bt\u0101 kait\u0113juma smagums (no tri-<br \/>\nvi\u0101la maznoz\u012bm\u012bga st\u0101vok\u013ca l\u012bdz palie-<br \/>\nko\u0161ai nesp\u0113jai vai pat n\u0101vei). Labam<br \/>\np\u0113tniec\u012bbas projektam probl\u0113mas<br \/>\nnerad\u012bs \u013coti mazticams nenoz\u012bm\u012bga<br \/>\nkait\u0113juma risks. Turpret\u012b otr\u0101 spektra<br \/>\ngal\u0101, kur b\u016bs ar\u012b \u013coti ticams nopietna<br \/>\nkait\u0113juma risks, projekts b\u016bs nepie-<br \/>\n\u0146emams, ja vien p\u0113t\u012bjums nav vien\u012bg\u0101<br \/>\ncer\u012bba uz \u0101rst\u0113\u0161anu nedziedin\u0101mi sli-<br \/>\nmiem pacientiem. Starp \u0161\u012bm div\u0101m gal\u0113j\u012bb\u0101m Helsinku deklar\u0101cijas<br \/>\n17. paragr\u0101f\u0101 ir pras\u012bts, lai p\u0113tnieki adekv\u0101ti izv\u0113rt\u0113 riskus un g\u016bst<br \/>\np\u0101rliec\u012bbu, ka vi\u0146i sp\u0113s tos kontrol\u0113t. Ja riska lielums ir piln\u012bgi ne-<br \/>\nzin\u0101ms, p\u0113t\u012bjumu nevajadz\u0113tu uzs\u0101kt l\u012bdz br\u012bdim, kam\u0113r nav ieg\u016bti<br \/>\nticami dati, piem\u0113ram, no laboratoriskiem p\u0113t\u012bjumiem vai eksperi-<br \/>\nmentiem ar dz\u012bvniekiem.<br \/>\nInform\u0113t\u0101 piekri\u0161ana<br \/>\nNirnbergas kodeksa pirmais princips<br \/>\npausts \u0161\u0101diem v\u0101rdiem: \u00abCilv\u0113ka br\u012bv-<br \/>\npr\u0101t\u012bga piekri\u0161ana ir absol\u016bti nepie-<br \/>\ncie\u0161ama\u00bb. \u0160im principam pievieno-<br \/>\ntais izskaidrojo\u0161ais pants kop\u0101 ar v\u0113l<br \/>\ndaudziem citiem nosac\u012bjumiem pieprasa, ka p\u0113t\u012bjuma dal\u012bbniekam<br \/>\n\u00abb\u016btu j\u0101b\u016bt pietiekam\u0101m zin\u0101\u0161an\u0101m un izpratnei par p\u0113t\u012bjuma b\u016b-<br \/>\nt\u012bbu, lai vi\u0146\u0161 sp\u0113tu pie\u0146emt sapr\u0101t\u012bgu un inform\u0113tu l\u0113mumu\u00bb.<br \/>\nHelsinku deklar\u0101cija ir padzi\u013cin\u0101ts skaidrojums par inform\u0113to piekri-<br \/>\n\u0161anu. 22. pants preciz\u0113, kas \u012bsti p\u0113t\u012bjuma dal\u012bbniekiem b\u016btu j\u0101zina,<br \/>\nlai sp\u0113tu pie\u0146emt inform\u0113tu l\u0113mumu par dal\u012bbu p\u0113t\u012bjum\u0101. 23. pants<br \/>\n\u00abJa riska lielums ir piln\u012bgi<br \/>\nnezin\u0101ms, p\u0113t\u012bjumu<br \/>\nnevajadz\u0113tu uzs\u0101kt l\u012bdz<br \/>\nbr\u012bdim, kam\u0113r nav ieg\u016bti<br \/>\nticami dati, piem\u0113ram,<br \/>\nno laboratoriskiem<br \/>\np\u0113t\u012bjumiem vai<br \/>\neksperimentiem ar<br \/>\ndz\u012bvniekiem.\u00bb<br \/>\n\u00abCilv\u0113ka br\u012bvpr\u0101t\u012bga<br \/>\npiekri\u0161ana ir absol\u016bti<br \/>\nnepiecie\u0161ama.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n108 109<br \/>\nbr\u012bdina par iesp\u0113jamu spiediena izdar\u012b\u0161anu uz person\u0101m, lai vi\u0146i<br \/>\npiedal\u012btos p\u0113t\u012bjum\u0101, jo tas noz\u012bm\u0113, ka \u0161\u0101dos apst\u0101k\u013cos dal\u012bba pro-<br \/>\njekt\u0101 neb\u016btu glu\u017ei br\u012bvpr\u0101t\u012bga. 24. un 26. pant\u0101 ir runa par p\u0113t\u012bjuma<br \/>\ndal\u012bbniekiem, kas pa\u0161i nesp\u0113j pie\u0146emt l\u0113mumus (mazgad\u012bgi b\u0113rni,<br \/>\npacienti ar smagiem gar\u012bgiem trauc\u0113jumiem, bezsama\u0146\u0101 eso\u0161i pa-<br \/>\ncienti). Iev\u0113rojot \u012bpa\u0161i stingrus nosac\u012bjumus, ar\u012b vi\u0146i tom\u0113r atsevi\u0161-<br \/>\n\u0137os gad\u012bjumos var k\u013c\u016bt par p\u0113t\u012bjuma dal\u012bbniekiem.<br \/>\nK\u0101 visi citi \u0113tiska rakstura dokumenti, ar\u012b Helsinku deklar\u0101cija ie-<br \/>\nsaka p\u0113t\u012bjuma dal\u012bbnieka br\u012bvpr\u0101t\u012bgo piekri\u0161anu \ufb01ks\u0113t rakstiski \u2014<br \/>\nparakst\u012bt \u00abpiekri\u0161anas formu\u00bb (22. pants). Daudzas \u0113tikas komitejas<br \/>\np\u0113tniekiem pieprasa uzr\u0101d\u012bt \u00abpiekri\u0161anas formas, kuras vi\u0146i pl\u0101-<br \/>\nnoju\u0161i lietot \u0161aj\u0101 p\u0113t\u012bjum\u0101\u00bb. Da\u017e\u0101s valst\u012bs \u0161\u012bs formas jau ir k\u013cuvu-<br \/>\n\u0161as tik garas un detaliz\u0113tas, ka vairs nesp\u0113j pild\u012bt savu tie\u0161o funk-<br \/>\nciju \u2014 inform\u0113t dal\u012bbnieku par p\u0113t\u012bjumu, kur\u0101 piedal\u012bsies. Jebkur\u0101<br \/>\ngad\u012bjum\u0101 \u0161is inform\u0113t\u0101s piekri\u0161anas ieg\u016b\u0161anas process nes\u0101kas<br \/>\nun ar\u012b nebeidzas ar formas parakst\u012b\u0161anu. Taj\u0101 j\u0101ietver ar\u012b mutisks<br \/>\nizsme\u013co\u0161s skaidrojums par projektu un visu, ko dal\u012bba taj\u0101 var\u0113tu<br \/>\nnoz\u012bm\u0113t katram dal\u012bbniekam. T\u0101pat projekta dal\u012bbniekiem j\u0101b\u016bt in-<br \/>\nform\u0113tiem, ka jebkur\u0101 br\u012bd\u012b vi\u0146i dr\u012bkst atsaukt savu piekri\u0161anu, pat<br \/>\ntad, ja projekts jau ir uzs\u0101kts, bez jebk\u0101das atrieb\u012bbas no p\u0113tnieku<br \/>\nvai \u0101rstu puses un bez jebk\u0101diem \u0161\u0137\u0113r\u0161\u013ciem turpm\u0101k sa\u0146emt vese-<br \/>\nl\u012bbas apr\u016bpi.<br \/>\nKon\ufb01dencialit\u0101te<br \/>\nT\u0101pat k\u0101 kl\u012bniskajiem pacientiem, ar\u012b p\u0113t\u012bjumu dal\u012bbniekiem ir tie-<br \/>\ns\u012bbas uz vi\u0146u vesel\u012bbas st\u0101vok\u013ca datu kon\ufb01dencialit\u0101ti. Tom\u0113r p\u0113t\u012b-<br \/>\njuma proces\u0101 \u0161ad tad ir nepiecie\u0161ama<br \/>\nzi\u0146u izpau\u0161ana citiem, ieskaitot zi-<br \/>\nn\u0101tniskos darbiniekus, da\u017ereiz \u2014 pat<br \/>\nsabiedr\u012bbu. Lai pasarg\u0101tu dal\u012bbnieka<br \/>\npriv\u0101tumu, p\u0113tniekiem j\u0101garant\u0113, ka<br \/>\ninform\u0101cija par vi\u0146a vesel\u012bbas st\u0101vokli tiks izmantota tikai p\u0113t\u012bjuma<br \/>\nvajadz\u012bb\u0101m, tas savuk\u0101rt pieprasa, lai jau pirms p\u0113t\u012bjuma veik\u0161anas<br \/>\ndal\u012bbnieki b\u016btu inform\u0113ti par to, k\u0101 tiks izlietota inform\u0101cija par<br \/>\nvi\u0146u vesel\u012bbas st\u0101vokli. Galvenais, ka inform\u0101cijai j\u0101b\u016bt neidenti\ufb01-<br \/>\nc\u0113jamai, k\u0101 ar\u012b dro\u0161i uzglab\u0101tai un nodotai t\u0101l\u0101k. Nor\u0101d\u012bjumi par \u0161o<br \/>\nt\u0113mu atrodami PMA deklar\u0101cij\u0101 parVesel\u012bbas datub\u0101zu uztur\u0113\u0161anas<br \/>\n\u0113tiskajiem apsv\u0113rumiem (Declaration on Ethical Considerations Re-<br \/>\ngarding Health Databases).<br \/>\nAttiec\u012bbu kon\ufb02ikti<br \/>\nJau min\u0113ts \u0161aj\u0101 noda\u013c\u0101, ka \u0101rsta un pacienta attiec\u012bbas ir cit\u0101das<br \/>\nnek\u0101 p\u0113tnieka un p\u0113t\u012bjuma dal\u012bbnieka attiec\u012bbas, pat ja \u0101rsts un p\u0113t-<br \/>\nnieks ir viena un t\u0101 pati persona. Helsinku deklar\u0101cijas 28. pants no-<br \/>\nsaka, ka \u0161\u0101dos gad\u012bjumos svar\u012bg\u0101ka ir \u0101rsta noz\u012bme. Tas noz\u012bm\u0113, ka<br \/>\n\u0101rstam b\u016btu j\u0101iesaka pacientam nepiedal\u012bties projekt\u0101, ja jau eso\u0161\u0101<br \/>\n\u0101rst\u0113\u0161ana ir sekm\u012bga, bet p\u0113t\u0101m\u0101 metode prasa nejau\u0161u pacienta<br \/>\niedal\u012b\u0161anu grup\u0101s, kas sa\u0146ems da\u017e\u0101das \u0101rst\u0113\u0161anas metodes un\/vai<br \/>\nplacebo. \u0100rsts var l\u016bgt ar\u012b pacientu piedal\u012bties p\u0113t\u012bjum\u0101, ja vi\u0146\u0161 sa-<br \/>\nska\u0146\u0101 ar zin\u0101tniski pamatotiem apsv\u0113rumiem nav p\u0101rliecin\u0101ts, ka<br \/>\neso\u0161\u0101 \u0101rst\u0113\u0161anas metode ir piem\u0113rot\u0101ka par p\u0113t\u012bjum\u0101 apl\u016bkojamo<br \/>\n\u0101rst\u0113\u0161anu vai pat tikai par placebo.<br \/>\nGod\u012bga inform\u0113\u0161ana par rezult\u0101tiem<br \/>\nLai ar\u012b ne vienm\u0113r ir nepiecie\u0161ams<br \/>\nprec\u012bzs p\u0113t\u012bjuma rezult\u0101tu atspogu-<br \/>\n\u013cojums, tom\u0113r ir palielin\u0101jusies nego-<br \/>\nd\u012bga p\u0113t\u012bjumu rezult\u0101tu public\u0113\u0161ana.<br \/>\n\u0160\u012b probl\u0113ma sev\u012b ietver pla\u0123i\u0101tismu,<br \/>\ndatu falsi\ufb01c\u0113\u0161anu, publik\u0101cijas un \u00abd\u0101vin\u0101tu\u00bb autor\u012bbu. No \u0161\u0101das<br \/>\nprakses labumu var g\u016bt p\u0113tnieks, vismaz l\u012bdz br\u012bdim, kam\u0113r p\u0101rk\u0101-<br \/>\n\u00ab..p\u0113t\u012bjumu dal\u012bbniekiem<br \/>\nir ties\u012bbas uz vi\u0146u<br \/>\nvesel\u012bbas st\u0101vok\u013ca datu<br \/>\nkonfidencialit\u0101ti.\u00bb<br \/>\n\u00ab..ir palielin\u0101jusies<br \/>\nnegod\u012bga p\u0113t\u012bjumu<br \/>\nrezult\u0101tu public\u0113\u0161ana.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n110 111<br \/>\npumi netiek atkl\u0101ti, ta\u010du t\u0101 var nodar\u012bt lielu \u013caunumu pacientiem,<br \/>\nkas, iesp\u0113jams, b\u016bs sa\u0146\u0113mu\u0161i aplamu \u0101rst\u0113\u0161anu atbilsto\u0161i neprec\u012b-<br \/>\nzai vai maldino\u0161ai inform\u0101cijai p\u0113t\u012bjumu p\u0101rskatos, k\u0101 ar\u012b citi p\u0113t-<br \/>\nnieki, kas velti iz\u0161\u0137ie\u017e laiku un resursus, pa\u013caujoties uz \u0161iem p\u0113t\u012b-<br \/>\njumiem.<br \/>\nZi\u0146o\u0161ana<br \/>\nLai nov\u0113rstu ne\u0113tisku p\u0113t\u012bjumu ra\u0161anos vai atmaskotu jau notiku\u0161us<br \/>\ngad\u012bjumus, ikvienam, kam ir zin\u0101ms par \u0161\u0101d\u0101m darb\u012bb\u0101m, ir pien\u0101-<br \/>\nkums par t\u0101m zi\u0146ot atbilst\u012bg\u0101m iest\u0101d\u0113m. Diem\u017e\u0113l ne vienm\u0113r \u0161\u0101da<br \/>\nzi\u0146o\u0161ana tiek nov\u0113rt\u0113ta vai \u012bstenota, un zi\u0146ot\u0101ji bie\u017ei vien tiek sod\u012bti<br \/>\nvai atstumti no darba, l\u012bdzko vi\u0146i m\u0113\u0123ina atmaskot nelikum\u012bbas. Pa-<br \/>\nmaz\u0101m gan attieksme pret \u00abzi\u0146ot\u0101jiem\u00bb s\u0101k main\u012bties, jo gan vald\u012b-<br \/>\nba, gan medic\u012bnas zin\u0101tnieki uzskata par nepiecie\u0161amu pie\u0137ert un<br \/>\nsod\u012bt negod\u012bgus p\u0113tniekus, un s\u0101k pat atbilsto\u0161i nov\u0113rt\u0113t zi\u0146ot\u0101ja<br \/>\nnoz\u012bmi, lai sasniegtu \u0161o m\u0113r\u0137i.<br \/>\nBie\u017ei vien p\u0113t\u012bjumu grupas jaun\u0101kajiem dal\u012bbniekiem, piem\u0113ram,<br \/>\nmedic\u012bnas studentiem, ir \u013coti gr\u016bti rea\u0123\u0113t uz aizdom\u012bgu vai ne\u0113tisku<br \/>\nr\u012bc\u012bbu p\u0113t\u012bjum\u0101, jo vi\u0146i var\u0113tu justies nepietiekami kvali\ufb01c\u0113ti, lai v\u0113r-<br \/>\nt\u0113tu vec\u0101ko p\u0113tnieku darb\u012bbu. T\u0101pat, visticam\u0101k, ka studenti tiktu<br \/>\npar to sod\u012bti, ja vi\u0146i s\u0101ktu run\u0101t. Vi\u0146i tom\u0113r var\u0113tu atteikties pieda-<br \/>\nl\u012bties darb\u012bb\u0101s, ko uzskata par ne\u0113tisk\u0101m, piem\u0113ram, melo\u0161ana pa-<br \/>\ncientiem vai p\u0113t\u012bjuma datu safabric\u0113\u0161ana. Ja vi\u0146i \u0161\u0101dus gad\u012bjumus<br \/>\nnov\u0113ro, b\u016btu j\u0101dara viss, lai tie\u0161i vai anon\u012bmi br\u012bdin\u0101tu atbild\u012bg\u0101s<br \/>\niest\u0101des.<br \/>\nNeatrisin\u0101ti jaut\u0101jumi<br \/>\nNe visos p\u0113t\u012bjumu aspektos ir pan\u0101kta \u0113tiska vienpr\u0101t\u012bba. T\u0101 k\u0101<br \/>\nmedic\u012bna turpina att\u012bst\u012bties, tad t\u0101d\u0101s jom\u0101s k\u0101 \u0123en\u0113tika, augst\u0101k\u0101<br \/>\nnervu darb\u012bba, org\u0101nu un audu transplant\u0101cija rodas arvien jauni<br \/>\nun jauni jaut\u0101jumi par lietoto tehniku un meto\u017eu, k\u0101 ar\u012b \u0101rst\u0113\u0161anas<br \/>\niesp\u0113ju atbilst\u012bbu \u0113tikas pras\u012bb\u0101m.Turkl\u0101t uz \u0161iem jaut\u0101jumiem nav<br \/>\ngatavu atbil\u017eu.V\u0113l vair\u0101k \u2014 ir da\u017ei jau sen\u0101k radu\u0161ies jaut\u0101jumi, par<br \/>\nkuriem v\u0113l joproj\u0101m ir \u0113tiska rakstura<br \/>\npretrunas, piem\u0113ram, k\u0101dos apst\u0101k-<br \/>\n\u013cos medic\u012bniskos p\u0113t\u012bjumos b\u016btu j\u0101-<br \/>\niek\u013cauj grupa, kas sa\u0146ems placebo, un<br \/>\nk\u0101da turpm\u0101k\u0101 \u0101rst\u0113\u0161ana b\u016btu j\u0101nod-<br \/>\nro\u0161ina p\u0113t\u012bjuma dal\u012bbniekiem. Fakts,<br \/>\nka pasaul\u0113 tikai 10% medic\u012bniskajiem<br \/>\np\u0113t\u012bjumiem pie\u0161\u0137irto l\u012bdzek\u013cu tiek<br \/>\nizt\u0113r\u0113ti to slim\u012bbu izp\u0113tei, kas ietek-<br \/>\nm\u0113 90% pasaules iedz\u012bvot\u0101ju, ir \u013coti problem\u0101tisks un neatrisin\u0101ts<br \/>\n\u0113tikas jaut\u0101jums. Kad p\u0113tnieki veic p\u0113t\u012bjumus re\u0123ionos, kur medi-<br \/>\nc\u012bniskie resursi ir \u013coti ierobe\u017eoti, vi\u0146i saskaras ar probl\u0113m\u0101m, kas<br \/>\nrodas da\u017e\u0101do \u0113tisko uzskatu un kult\u016bras at\u0161\u0137ir\u012bbu d\u0113\u013c. \u0160ie jaut\u0101jumi<br \/>\nir risin\u0101mi turpm\u0101kas anal\u012bzes un diskusiju ce\u013c\u0101, l\u012bdz tiek sasniegta<br \/>\nvienpr\u0101t\u012bba.<br \/>\nLai ar\u012b ir \u0161\u012bs potenci\u0101l\u0101s probl\u0113mas, medic\u012bniskie p\u0113t\u012bjumi ir v\u0113rt\u012bga<br \/>\nun neatsverama pieredze gan \u0101rstiem, gan medic\u012bnas studentiem,<br \/>\ngan ar\u012b p\u0113t\u012bjumu dal\u012bbniekiem. Starp citu, ar\u012b \u0101rstiem un studentiem<br \/>\npa\u0161iem b\u016btu j\u0101apsver dal\u012bba \u0161\u0101dos p\u0113t\u012bjumos k\u0101 dal\u012bbniekiem, lai<br \/>\nvi\u0146i var\u0113tu izbaud\u012bt p\u0113tnieka un p\u0113t\u012bjuma dal\u012bbnieka attiec\u012bbas.<br \/>\n\u00ab..pasaul\u0113 tikai 10%<br \/>\nmedic\u012bniskajiem<br \/>\np\u0113t\u012bjumiem pie\u0161\u0137irto<br \/>\nl\u012bdzek\u013cu tiek izt\u0113r\u0113ti<br \/>\nto slim\u012bbu izp\u0113tei, kas<br \/>\nietekm\u0113 90% pasaules<br \/>\niedz\u012bvot\u0101ju..\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n112 113<br \/>\nATGRIE\u0160AN\u0100S PIE GAD\u012aJUMA ANAL\u012aZES<br \/>\nDr. R. nevajadz\u0113ja tik strauji pie\u0146emt pied\u0101v\u0101jumu.<br \/>\nVispirms b\u016btu vair\u0101k j\u0101uzzina par \u0161o projektu un<br \/>\nj\u0101p\u0101rliecin\u0101s, vai tas tie\u0161\u0101m atbilst p\u0113tniec\u012bbas \u0113tikas<br \/>\npras\u012bb\u0101m. Vi\u0146ai bija j\u0101pieprasa, lai par\u0101da protokolu,<br \/>\nkas tika iesniegts \u0113tikas komitej\u0101, un iesp\u0113jamos \u0113tikas<br \/>\nkomitejas koment\u0101rus vai nosac\u012bjumus par to. Vi\u0146a<br \/>\ndr\u012bkst\u0113tu piedal\u012bties tikai t\u0101dos projektos, kas atbilst<br \/>\ndarb\u012bbas jomai, turkl\u0101t b\u016btu j\u0101p\u0101rliecin\u0101s ar\u012b par projekta<br \/>\nzin\u0101tnisko un soci\u0101lo v\u0113rt\u012bbu. Ja vi\u0146a nav p\u0101rliecin\u0101ta par<br \/>\nsavu sp\u0113ju pien\u0101c\u012bgi izv\u0113rt\u0113t p\u0113t\u012bjumu, b\u016btu j\u0101cen\u0161as<br \/>\nnoskaidrot liel\u0101kos centros str\u0101d\u0101jo\u0161u kol\u0113\u0123u viedokli.<br \/>\nJ\u0101p\u0101rliecin\u0101s, ka vi\u0146a r\u012bkojas savu pacientu interes\u0113s<br \/>\nun ka tiks iesaist\u012bti tikai tie pacienti, kam nevar kait\u0113t<br \/>\neso\u0161\u0101s terapijas nomai\u0146a ar p\u0113t\u0101mo medikamentu vai<br \/>\nplacebo. Vi\u0146ai j\u0101prot saviem pacientiem izskaidrot visas<br \/>\nalternat\u012bvas, lai tie sp\u0113tu pie\u0146emt piln\u012bb\u0101 inform\u0113tu<br \/>\npiekri\u0161anu par dal\u012bbu izp\u0113tes projekt\u0101 vai attur\u0113\u0161anos<br \/>\nno t\u0101. Vi\u0146ai nevajadz\u0113tu piekrist iesaist\u012bt noteiktu<br \/>\npacientu skaitu, jo tad var n\u0101kties ietekm\u0113t pacientus,<br \/>\nun tas, iesp\u0113jams, nesaskan\u0113tu ar pacientu interes\u0113m.<br \/>\n\u0100rstei b\u016btu r\u016bp\u012bgi j\u0101nov\u0113ro p\u0113t\u012bjuma pacienti un j\u0101b\u016bt<br \/>\ngatavai \u0101tri, operat\u012bvi un profesion\u0101li nov\u0113rst negaid\u012btus,<br \/>\nnev\u0113lamus notikumus. Visbeidzot p\u0113c p\u0113t\u012bjuma vi\u0146ai<br \/>\nar pacientiem b\u016btu j\u0101p\u0101rrun\u0101 t\u0101 rezult\u0101ti, tikko tie b\u016bs<br \/>\npieejami.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014\u0112tikaunmedic\u012bniskiep\u0113t\u012bjumi<br \/>\n114 115<br \/>\n6. NODA\u013bA.<br \/>\nNOSL\u0112GUMS<br \/>\nV\u012brs, k\u0101pjot sl\u012bp\u0101 kaln\u0101<br \/>\n\u00a9 Don Mason\/CORBIS<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Nosl\u0113gums<br \/>\n116 117<br \/>\n\u0100RSTU ATBILD\u012aBA UN PRIVIL\u0112\u0122IJAS<br \/>\n\u0160\u012b rokasgr\u0101mata galveno uzman\u012bbu velta \u0101rsta atbild\u012bbai un pien\u0101-<br \/>\nkumiem, kas paties\u012bb\u0101 ar\u012b ir medic\u012bnas \u0113tikas b\u016bt\u012bba. Tom\u0113r, t\u0101pat<br \/>\nk\u0101 citiem cilv\u0113kiem, \u0101rstiem bez pien\u0101kumiem ir ar\u012b ties\u012bbas, un<br \/>\nmedic\u012bnas \u0113tika neb\u016btu piln\u012bga, ja t\u0101<br \/>\nnepateiktu, k\u0101du attieksmi \u0101rsti v\u0113l\u0113-<br \/>\ntos sagaid\u012bt no citiem \u2014 pacientiem,<br \/>\nsabiedr\u012bbas un kol\u0113\u0123iem. \u0160\u012b medic\u012bnas<br \/>\n\u0113tikas perspekt\u012bva ir k\u013cuvusi \u012bpa\u0161i no-<br \/>\nz\u012bm\u012bga, jo daudz\u0101s valst\u012bs \u0101rsti praks\u0113<br \/>\npiedz\u012bvo milzu vil\u0161anos \u2014 resursi ir ierobe\u017eoti, vesel\u012bbas apr\u016bpi<br \/>\nregul\u0113 vald\u012bba un\/vai korporat\u012bvu organiz\u0101ciju s\u012bkman\u012bgi r\u012bkojumi,<br \/>\npar\u0101d\u0101s daudzi sensacion\u0101li pazi\u0146ojumi pla\u0161sazi\u0146as l\u012bdzek\u013cos par<br \/>\nk\u013c\u016bd\u0101m un ne\u0113tisku \u0101rstu r\u012bc\u012bbu, pacienti un citi vesel\u012bbas apr\u016bpes<br \/>\nsniedz\u0113ji ap\u0161auba \u0101rstu autorit\u0101ti un prasmes.<br \/>\nJau agr\u0101k medic\u012bnas \u0113tik\u0101 tika apskat\u012btas gan \u0101rsta ties\u012bbas, gan<br \/>\nvi\u0146a pien\u0101kumi. Piem\u0113ram, Amerikas Medic\u012bnas asoci\u0101cijas ko-<br \/>\ndeksa (American Medical Association\u2019s Code) 1847. gada versij\u0101<br \/>\niek\u013cautas sada\u013cas par pacientu un sabiedr\u012bbas pien\u0101kumiem pret<br \/>\n\u0101rsta profesiju. Vairums \u0161o pien\u0101kumu ir novecoju\u0161i, piem\u0113ram,<br \/>\n\u00ab\u0101rsta nor\u0101d\u012bjumiem pacientam j\u0101pak\u013caujas piln\u012bb\u0101, \u0101tri un bez<br \/>\n\u0161aub\u012b\u0161an\u0101s\u00bb. Tom\u0113r joproj\u0101m sp\u0113k\u0101 ir apgalvojums, ka \u00absabiedr\u012b-<br \/>\nbai vajadz\u0113tu paust \u0101rstiem savu atzin\u012bgo v\u0113rt\u0113jumu (un) .. katr\u0101<br \/>\niesp\u0113jam\u0101 veid\u0101 sniegt iedro\u0161in\u0101jumu un atbalst\u012bt iesp\u0113jas apg\u016bt<br \/>\nmedic\u012bnisku izgl\u012bt\u012bbu..\u00bb. T\u0101 viet\u0101, lai p\u0101rstr\u0101d\u0101tu un uzlabotu \u0161\u012bs<br \/>\nsada\u013cas, Amerikas Medic\u012bnas asoci\u0101cija ir t\u0101s visp\u0101r izsv\u012btrojusi no<br \/>\nkodeksa.<br \/>\nGadiem ejot, PMA ir pie\u0146\u0113musi vair\u0101kas politikas nost\u0101dnes par<br \/>\n\u0101rstu ties\u012bb\u0101m un ar\u012b citu, it \u012bpa\u0161i vald\u012bbu, pien\u0101kumiem \u0161o ties\u012bbu<br \/>\niev\u0113ro\u0161an\u0101:<br \/>\n\u2022 1984. gada Nost\u0101dnes par br\u012bv\u012bbu apmekl\u0113t medic\u012bniska<br \/>\nrakstura san\u0101ksmes (Statement on Freedom to Attend Medical<br \/>\nMeetings) pau\u017e, ka \u00abnek\u0101diem ierobe\u017eojumiem nevajadz\u0113tu ka-<br \/>\nv\u0113t \u0101rstus apmekl\u0113t medic\u012bniska rakstura san\u0101ksmes, lai ar\u012b kur t\u0101s<br \/>\nnotiktu\u00bb;<br \/>\n\u2022 1986. gada Deklar\u0101cija par \u0101rstu neatkar\u012bbu un profesion\u0101lo<br \/>\nbr\u012bv\u012bbu (Declaration on Physician Independence and Professional<br \/>\nFreedom) apgalvo: \u00ab\u0100rstiem j\u0101pie\u0161\u0137ir profesion\u0101l\u0101 br\u012bv\u012bba, lai vi\u0146i<br \/>\nbez iejauk\u0161an\u0101s var\u0113tu veikt pacientu apr\u016bpi\u00bb un \u00ab\u0101rstiem j\u0101pie-<br \/>\n\u0161\u0137ir profesion\u0101lo br\u012bv\u012bbu, lai \u0101rsts p\u0101rst\u0101v\u0113tu un aizst\u0101v\u0113tu pacien-<br \/>\ntu vesel\u012bbas vajadz\u012bbas pret visiem, kas v\u0113l\u0113tos liegt vai ierobe\u017eot<br \/>\nnepiecie\u0161amo apr\u016bpi slim\u0101m vai ievainot\u0101m person\u0101m\u00bb;<br \/>\n\u2022 1995. gada Nost\u0101dnes par profesion\u0101lo atbild\u012bbu un medic\u012b-<br \/>\nnisk\u0101s apr\u016bpes standartiem (Statement on Professional Respon-<br \/>\nsibility for Standards of Medical Care) deklar\u0113, ka \u00abjebkur\u0101 spriedu-<br \/>\nm\u0101 par \u0101rsta profesion\u0101lo uzved\u012bbu vai pien\u0101kumu izpildi j\u0101iek\u013cauj<br \/>\nt\u0101du kol\u0113\u0123u sniegts v\u0113rt\u0113jums, kuru izgl\u012bt\u012bba un pieredze \u013cauj iz-<br \/>\nprast apskat\u0101mo medic\u012bnisko probl\u0113mu sare\u017e\u0123\u012bt\u012bbu\u00bb. \u0160\u012bs pa\u0161as no-<br \/>\nst\u0101dnes nosoda \u00abjebk\u0101das ar pacientu s\u016bdz\u012bb\u0101m saist\u012btas darb\u012bbas<br \/>\nvai kompens\u0101ciju izmaksu pacientiem, ja t\u0101s netiek pamatotas ar<br \/>\ntaisn\u012bgu \u0101rsta r\u012bc\u012bbas un pie\u013caut\u0101s nolaid\u012bbas anal\u012bzi atbilsto\u0161i citu<br \/>\n\u0101rstu profesion\u0101lajam v\u0113rt\u0113jumam (peer review).\u00bb<br \/>\n\u2022 1997. gada Atbalsta deklar\u0101cija \u0101rstiem, kas atsak\u0101s jebk\u0101-<br \/>\nd\u0101 veid\u0101 piedal\u012bties sp\u012bdzin\u0101\u0161an\u0101s vai cita veida cietsird\u012b-<br \/>\ng\u0101s, nehum\u0101n\u0101s vai pazemojo\u0161\u0101s darb\u012bb\u0101s vai br\u012bdina par<br \/>\nt\u0101m (Declaration Concerning Support for Medical Doctors Refusing<br \/>\nto Participate in, or to Condone, the Use of Torture or Other Forms of<br \/>\nCruel, Inhuman or Degrading Treatment) uzliek PMA par pien\u0101ku-<br \/>\nmu \u00ab[PMA] atbalst\u012bt un aizst\u0101v\u0113t, k\u0101 ar\u012b aicin\u0101t valstu medic\u012bnas<br \/>\nasoci\u0101cijas atbalst\u012bt un aizst\u0101v\u0113t \u0101rstus, kas atsak\u0101s iesaist\u012bties<br \/>\n\u0161\u0101d\u0101 nehum\u0101n\u0101 r\u012bc\u012bb\u0101 vai kas str\u0101d\u0101, lai \u0101rst\u0113tu un rehabilit\u0113tu t\u0101s<br \/>\n\u00ab..t\u0101pat k\u0101 citiem<br \/>\ncilv\u0113kiem, \u0101rstiem ir ar\u012b<br \/>\nties\u012bbas..\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Nosl\u0113gums<br \/>\n118 119<br \/>\nupurus, k\u0101 ar\u012b nodro\u0161in\u0101t augst\u0101ko \u0113tikas principu iev\u0113ro\u0161anu, ie-<br \/>\nskaitot medic\u012bnisko kon\ufb01dencialit\u0101ti&#8230;\u00bb<br \/>\n\u2022 2003. gada Nost\u0101dnes par \u0113tikas vadl\u012bnij\u0101m starptautiskai<br \/>\n\u0101rstu darb\u0101k\u0101rto\u0161anai (Statement on Ethical Guidelines for the<br \/>\nInternational Recruitment of Physicians) aicina katru valsti \u00abiesp\u0113ju<br \/>\nrobe\u017e\u0101s dar\u012bt visu, lai \u0101rsti paliktu str\u0101d\u0101t sav\u0101 profesij\u0101 un v\u0113lams<br \/>\nar\u012b valst\u012b, nodro\u0161inot vi\u0146us ar nepiecie\u0161amo atbalstu, lai vi\u0146i va-<br \/>\nr\u0113tu sasniegt savus personiskos un profesion\u0101los m\u0113r\u0137us, \u0146emot<br \/>\nv\u0113r\u0101 valsts vajadz\u012bbas un resursus\u00bb un nodro\u0161in\u0101t, lai \u00abattieksme<br \/>\npret \u0101rstiem, kas past\u0101v\u012bgi vai uz laiku str\u0101d\u0101 valst\u012b, kas nav vi\u0146u<br \/>\ndzimtene, b\u016btu t\u0101da pati k\u0101 pret citiem \u0161\u012bs valsts \u0101rstiem (piem\u0113-<br \/>\nram, vienl\u012bdz\u012bgas karjeras iesp\u0113jas, vienl\u012bdz\u012bgs atalgojums par to<br \/>\npa\u0161u darbu)\u00bb.<br \/>\nJau min\u0113to draudu un gr\u016bt\u012bbu d\u0113\u013c<br \/>\n\u0161\u0101da aizst\u0101v\u012bba \u0101rstiem ir nepiecie-<br \/>\n\u0161ama, tikpat svar\u012bgi ir reiz\u0113m \u0101rstiem<br \/>\natg\u0101din\u0101t par privil\u0113\u0123ij\u0101m, k\u0101das vi\u0146i<br \/>\nbauda. Daudzu valstu sabiedr\u012bbas ap-<br \/>\ntauju dati past\u0101v\u012bgi liecina, ka \u0101rsti ir<br \/>\nviena no profesion\u0101laj\u0101m grup\u0101m, kas bauda visliel\u0101ko uztic\u012bbu un<br \/>\ncie\u0146u. Parasti vi\u0146i sa\u0146em liel\u0101ku atalgojumu par vid\u0113jo darba algu<br \/>\n(da\u017e\u0101s valst\u012bs pat iev\u0113rojami liel\u0101ku).V\u0113l joproj\u0101m vi\u0146iem ir dota pla-<br \/>\n\u0161a kl\u012bnisk\u0101 autonomija, gan vairs ne tik liela k\u0101 agr\u0101k. Daudzi \u0101rsti,<br \/>\npiedaloties p\u0113t\u012bjumos, ir iesaist\u012bti aizraujo\u0161\u0101 jaunu zin\u0101\u0161anu ieguves<br \/>\nproces\u0101. Vissvar\u012bg\u0101kais, vi\u0146i sp\u0113j sniegt individu\u0101liem pacientiem,<br \/>\nk\u0101 ar\u012b visai sabiedr\u012bbai, nenov\u0113rt\u0113jamus pakalpojumus, it sevi\u0161\u0137i<br \/>\ntiem, kas ir mazaizsarg\u0101ti (vulnerabli) un kam tas visvair\u0101k ir nepie-<br \/>\ncie\u0161ams. Ir tikai da\u017eas profesijas, kas sp\u0113j sniegt liel\u0101ku gandar\u012bjumu<br \/>\npar medic\u012bnu, ja \u0146em v\u0113r\u0101 labumu, ko \u0101rsts sp\u0113j \u2014 remd\u0113t s\u0101pes<br \/>\nun cie\u0161anas, iz\u0101rst\u0113t slim\u012bbas un nodro\u0161in\u0101t atbalstu mirsto\u0161ajiem.<br \/>\n\u0112tisko pien\u0101kumu iev\u0113ro\u0161ana ir visai zema cena, ko \u0101rsti maks\u0101 par<br \/>\nsav\u0101m privil\u0113\u0123ij\u0101m.<br \/>\nATBILD\u012aBA PRET SEVI<br \/>\nRokasgr\u0101mata atspogu\u013co \u0101rsta pie-<br \/>\nn\u0101kumus pret citiem \u2014 pacientiem,<br \/>\nsabiedr\u012bbu, kol\u0113\u0123iem (ieskaitot citus<br \/>\nvesel\u012bbas apr\u016bpes profesion\u0101\u013cus). To-<br \/>\nm\u0113r \u0101rsti bie\u017ei vien aizmirst, ka vi\u0146i ir<br \/>\natbild\u012bgi ar\u012b pret savi un sav\u0101m \u0123ime-<br \/>\nn\u0113m. Daudz\u0101s pasaules da\u013c\u0101s \u0101rsta darbs prasa piln\u012bgu ziedo\u0161anos<br \/>\nmedic\u012bnai, aizmirstot par pa\u0161a vesel\u012bbu un labkl\u0101j\u012bbu. 60\u201480 stun-<br \/>\ndu darba ned\u0113\u013ca nav nekas neparasts, un atva\u013cin\u0101jumi ir uzskat\u012b-<br \/>\nti par nevajadz\u012bgu grezn\u012bbu. Lai ar\u012b daudziem \u0101rstiem \u0161\u0101da darba<br \/>\nslodze \u0161\u0137iet pie\u0146emama, tas skar vi\u0146u \u0123imenes. Daudzi \u0101rsti \u013coti<br \/>\ncie\u0161 no \u0161\u0101da darba tempa, kura rezult\u0101ts ir virkne negat\u012bvu par\u0101-<br \/>\nd\u012bbu \u2014 no hroniska noguruma l\u012bdz pat psihotropu vielu lieto\u0161anai<br \/>\nun pa\u0161n\u0101v\u012bbai. \u0160\u0101di \u0101rsti rada briesmas pacientiem, jo nogurums ir<br \/>\nnopietns medic\u012bnisku neveiksmju (k\u013c\u016bdu) ra\u0161an\u0101s faktors.<br \/>\nLai pan\u0101ktu pacientu dro\u0161\u012bbu, k\u0101 ar\u012b \u0101rstu vid\u016b veicin\u0101tu vesel\u012bg\u0101ku<br \/>\ndz\u012bvesveidu, daudzas valstis ir noteiku\u0161as \u0101rstu un rezidentu darba<br \/>\nlaika un mai\u0146as garuma ierobe\u017eojumus. Da\u017eas medic\u012bnisk\u0101s izgl\u012b-<br \/>\nt\u012bbas iest\u0101des ir padar\u012bju\u0161as viegl\u0101ku studiju p\u0101rtrauk\u0161anas proce-<br \/>\nsu sieviet\u0113m \u0123imenes apst\u0101k\u013cu d\u0113\u013c. Lai ar\u012b \u0161ie pas\u0101kumi pie\u0146emti<br \/>\nr\u016bp\u0113s par \u0101rstu labkl\u0101j\u012bbu, individu\u0101l\u0101 atbild\u012bba gulstas uz katru<br \/>\natsevi\u0161\u0137i. L\u012bdz\u0101s t\u0101diem vesel\u012bbai kait\u012bgiem faktoriem k\u0101 sm\u0113\u0137\u0113-<br \/>\n\u0161ana, psihotropu vielu lieto\u0161ana un p\u0101rslodze \u0101rstam b\u016btu j\u0101sarg\u0101<br \/>\nun j\u0101uzlabo vesel\u012bba, identi\ufb01c\u0113jot stresa faktorus profesion\u0101laj\u0101 un<br \/>\npriv\u0101taj\u0101 dz\u012bv\u0113, k\u0101 ar\u012b att\u012bstot un piem\u0113rojot atbilsto\u0161as metodes,<br \/>\nlai to p\u0101rvar\u0113tu. Ja tas neizdodas, ir j\u0101mekl\u0113 kol\u0113\u0123u un citu kvali-<br \/>\n\ufb01c\u0113tu speci\u0101listu pal\u012bdz\u012bba personisko probl\u0113mu risin\u0101\u0161anai, pre-<br \/>\nt\u0113j\u0101 gad\u012bjum\u0101 t\u0101s var negat\u012bvi ietekm\u0113t attiec\u012bbas ar pacientiem,<br \/>\nsabiedr\u012bbu un kol\u0113\u0123iem.<br \/>\n\u00ab..svar\u012bgi ir reiz\u0113m \u0101rstiem<br \/>\natg\u0101din\u0101t par privil\u0113\u0123ij\u0101m,<br \/>\nk\u0101das vi\u0146i bauda\u00bb<br \/>\n\u00ab..\u0101rsti bie\u017ei vien aizmirst,<br \/>\nka vi\u0146i ir atbild\u012bgi ar\u012b pret<br \/>\nsavi un sav\u0101m \u0123imen\u0113m.\u00bb<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Nosl\u0113gums<br \/>\n120 121<br \/>\nMEDIC\u012aNAS \u0112TIKAS N\u0100KOTNE<br \/>\n\u0160aj\u0101 rokasgr\u0101mat\u0101 apskat\u012bts medic\u012bnas \u0113tikas pa\u0161reiz\u0113jais st\u0101voklis,<br \/>\npapildinot to ar daudz\u0101m atsauc\u0113m uz pag\u0101tni. Ta\u010du tagadne ir j\u0113-<br \/>\ndziens, kas nemit\u012bgi aizsl\u012bd proj\u0101m, t\u0101d\u0113\u013c svar\u012bgi ir paredz\u0113t n\u0101kotni,<br \/>\njanegribamatpaliktnolaikmetapras\u012bb\u0101m.Medic\u012bnas\u0113tikasn\u0101kotne<br \/>\nliel\u0101 m\u0113r\u0101 b\u016bs atkar\u012bga no medic\u012bnas n\u0101kotnes. XXI gadsimta s\u0101ku-<br \/>\nm\u0101 medic\u012bna piedz\u012bvo \u013coti strauju att\u012bst\u012bbu un ir visai gr\u016bti paredz\u0113t,<br \/>\nk\u0101da b\u016bs medic\u012bnas prakse tad, kad \u0161odienas pirm\u0101 gada medic\u012bnas<br \/>\nstudents pabeigs savu izgl\u012bt\u012bbu. T\u0101pat nav iesp\u0113jams ar\u012b paredz\u0113t,<br \/>\nk\u0101das p\u0101rmai\u0146as v\u0113l sagaid\u0101mas l\u012bdz br\u012bdim, kad vi\u0146iem b\u016bs laiks<br \/>\ndoties pensij\u0101. Nav teikts, ka n\u0101kotne b\u016bs lab\u0101ka par tagadni, jo v\u0113-<br \/>\nrojama pla\u0161a ekonomisk\u0101 un politisk\u0101 nestabilit\u0101te, vides noplicin\u0101-<br \/>\n\u0161ana, HIV\/AIDS un citu potenci\u0101lu epid\u0113miju izplat\u012b\u0161an\u0101s. Kaut ar\u012b<br \/>\nm\u0113s varam cer\u0113t, ka medic\u012bnas progresa pied\u0101v\u0101tais guvums t\u0101pat<br \/>\nsasniegs visas valstis un ka sastapt\u0101s \u0113tisk\u0101s probl\u0113mas tur b\u016bs tie\u0161i<br \/>\nt\u0101das pa\u0161as, k\u0101das \u0161obr\u012bd risina att\u012bst\u012bt\u0101s valstis, bet j\u0101apzin\u0101s, ka<br \/>\nvar notikt glu\u017ei pret\u0113jais \u2014 valst\u012bs, kur tagad ir augsts labkl\u0101j\u012bbas<br \/>\nl\u012bmenis, situ\u0101cija var krasi pasliktin\u0101ties un non\u0101kt l\u012bdz st\u0101voklim, ka<br \/>\n\u0101rstiem j\u0101sastopas ar tropisko slim\u012bbu epid\u0113mij\u0101m un lielu medic\u012b-<br \/>\nnas l\u012bdzek\u013cu de\ufb01c\u012btu.<br \/>\nT\u0101 k\u0101 n\u0101kotne ir tik neparedzama, svar\u012bgi, lai medic\u012bnas \u0113tika b\u016btu<br \/>\nelast\u012bga un atv\u0113rta p\u0101rmai\u0146\u0101m, k\u0101 tas jau labu laiku ar\u012b notiek. To-<br \/>\nm\u0113r varam cer\u0113t, ka t\u0101s pamatv\u0113rt\u012bbas, it sevi\u0161\u0137i l\u012bdzciet\u012bba, kom-<br \/>\npetence, autonomija, r\u016bpes par cilv\u0113ka pamatties\u012bbu iev\u0113ro\u0161anu<br \/>\nun ziedo\u0161an\u0101s profesijai, paliks nemain\u012bgas. Lai ar\u012b k\u0101das p\u0101rmai\u0146as<br \/>\nmedic\u012bn\u0101 nestu soci\u0101lie, politiskie un ekonomiskie faktori, vienm\u0113r<br \/>\nb\u016bs slimi cilv\u0113ki, kurus, ja iesp\u0113jams, vajadz\u0113s iz\u0101rst\u0113t un apr\u016bp\u0113t.<br \/>\n\u0100rsti tradicion\u0101li alla\u017e ir nodro\u0161in\u0101ju\u0161i \u0161os pakalpojumus, vienlaic\u012bgi<br \/>\nr\u016bp\u0113joties ar\u012b par vesel\u012bbas veicin\u0101\u0161anu, slim\u012bbu pro\ufb01laksi un vese-<br \/>\nl\u012bbas apr\u016bpes sist\u0113mas p\u0101rvald\u012b\u0161anu. \u0160o darb\u012bbu \u012bpatsvars n\u0101kotn\u0113<br \/>\nvar\u0113tu main\u012bties, bet \u0101rsti \u0161ajos procesos vienm\u0113r ie\u0146ems svar\u012bgu<br \/>\nnoz\u012bmi un turpin\u0101s sekot l\u012bdzi jaunin\u0101jumiem medic\u012bnas \u0113tik\u0101, t\u0101pat<br \/>\nk\u0101 vi\u0146i to dara par citiem medic\u012bnas aspektiem.<br \/>\n\u0160is ir rokasgr\u0101matas nobeigums, ta\u010du las\u012bt\u0101jam tas ir tikai viens<br \/>\nsolis visa m\u016b\u017ea garum\u0101, lai iedzi\u013cin\u0101tos medic\u012bnas \u0113tik\u0101. Jau ieva-<br \/>\nd\u0101 min\u0113ts, ka rokasgr\u0101mata sniedz tikai ieskatu medic\u012bnas \u0113tik\u0101 un<br \/>\napskata tikai da\u017eus centr\u0101los aspektus. T\u0101s nol\u016bks ir sniegt jums<br \/>\npriek\u0161statu un veicin\u0101t p\u0101rdomas par medic\u012bnas \u0113tisko dimensiju,<br \/>\nun r\u0113\u0137in\u0101ties ar to, k\u0101 ar\u012b sp\u0113t risin\u0101t \u0113tisk\u0101s dabas jaut\u0101jumus, ar ko<br \/>\nsastapsities praks\u0113. B pielikum\u0101 min\u0113tie resursi jums pal\u012bdz\u0113s padzi-<br \/>\n\u013cin\u0101t zin\u0101\u0161anas \u0161aj\u0101 jom\u0101.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014Nosl\u0113gums<br \/>\n122 123<br \/>\nPIELIKUMS A \uf6bc V\u0100RDN\u012aCA<br \/>\nAizst\u0101v\u0113t \u2014 (darb. v.) run\u0101t vai r\u012bkoties citas personas vai grupas v\u0101rd\u0101;<br \/>\n(lietv. aizst\u0101vis) k\u0101ds, kas \u0161\u0101di r\u012bkojas. \u0100rsti darbojas k\u0101 savu pacientu<br \/>\naizst\u0101vji, kad j\u0101run\u0101 ar vald\u012bbas vai vesel\u012bbas apdro\u0161in\u0101\u0161anas ier\u0113d\u0146iem,<br \/>\nlai ieg\u016btu pakalpojumus, kas nepiecie\u0161ami pacientam.<br \/>\nAnesteziologs \u2014 anaesthetist, anaesthesiologist. Abus \u0161os terminus lieto<br \/>\nda\u017e\u0101d\u0101s valst\u012bs.<br \/>\n\u0100rsts \u2014 indiv\u012bds, kas ir kvali\ufb01c\u0113ts praktiz\u0113t medic\u012bnu. Da\u017e\u0101s valst\u012bs \u0101rsti<br \/>\ntiek at\u0161\u0137irti no \u0137irurgiem un termins \u00abdoktors\u00bb tiek lietots, lai apz\u012bm\u0113tu<br \/>\ntos abus. Ta\u010du terminu \u00abdoktors\u00bb attiecina uz citu vesel\u012bbas profesiju<br \/>\np\u0101rst\u0101vjiem, k\u0101, piem\u0113ram, stomatologiem un veterin\u0101r\u0101rstiem, k\u0101 ar\u012b<br \/>\ntiem, kas ieguvu\u0161i doktora gr\u0101du. Termins \u00abmedic\u012bnas doktors\u00bb ir prec\u012b-<br \/>\nz\u0101ks, bet netiek pla\u0161i lietots. Pasaules Medic\u012bnas asoci\u0101cija un \u0161\u012b rokas-<br \/>\ngr\u0101mata attiecina terminu \u00ab\u0101rsts\u00bb uz visiem, kas ir kvali\ufb01c\u0113ti praktiz\u0113t<br \/>\nmedic\u012bn\u0101, ne\u0146emot v\u0113r\u0101 to specialit\u0101ti.<br \/>\nAtbild\u012bgs \u2014 b\u016bt atbild\u012bgam par kaut ko k\u0101dam (piem., darbinieki ir at-<br \/>\nbild\u012bgi par savu darbu darba dev\u0113jam). Atbild\u012bba noz\u012bm\u0113 b\u016bt gatavam<br \/>\npaskaidrot izdar\u012bto vai neizdar\u012bto.<br \/>\nBio\u0113tika\/biomedic\u012bnas \u0113tika \u2014 divi l\u012bdzv\u0113rt\u012bgi termini, kas apz\u012bm\u0113 m\u0101-<br \/>\nc\u012bbu par medic\u012bnas, vesel\u012bbas apr\u016bpes un biolo\u0123isko zin\u0101t\u0146u \u0113tiska-<br \/>\nj\u0101m probl\u0113m\u0101m. Tai ir \u010detras galven\u0101s apak\u0161grupas: kl\u012bnisk\u0101 \u0113tika,<br \/>\nkas apl\u016bko pacientu apr\u016bpes probl\u0113mas (\u0161\u012bs rokasgr\u0101matas 2. noda\u013ca);<br \/>\np\u0113tniec\u012bbas \u0113tika, kas apl\u016bko cilv\u0113ku aizsardz\u012bbu vesel\u012bbas apr\u016bpes<br \/>\np\u0113t\u012bjumos (\u0161\u012bs rokasgr\u0101matas 5. noda\u013ca); profesion\u0101l\u0101 \u0113tika, kas apl\u016b-<br \/>\nko \u0101rstu un citu vesel\u012bbas apr\u016bpes profesiju p\u0101rst\u0101vju konkr\u0113tos pien\u0101-<br \/>\nkumus un atbild\u012bbu (medic\u012bnas \u0113tika ir viens no profesion\u0101l\u0101s \u0113tikas<br \/>\nveidiem); un sabiedrisk\u0101s politikas \u0113tika, kas apl\u016bko noteikumus,<br \/>\nk\u0101 ar\u012b formul\u0113jumus un interpret\u0101cijas likumos, kas saist\u012bti ar bio\u0113tikas<br \/>\nprobl\u0113m\u0101m.<br \/>\nHierarhija \u2014 akur\u0101ts cilv\u0113ku izvietojums, \u0146emot v\u0113r\u0101 to noz\u012bm\u012bbas pa-<br \/>\nk\u0101pi no augst\u0101k\u0101 uz zem\u0101ko. Hierarhisks ir \u012bpa\u0161\u012bbas v\u0101rds, kas raksturo<br \/>\n\u0161\u0101du izvietojumu. Termins hierarhija ar\u012b tiek attiecin\u0101ts uz organiz\u0101cijas<br \/>\naugst\u0101k\u0101 l\u012bme\u0146a vad\u012bt\u0101jiem.<br \/>\nIepriek\u0161\u0113ja direkt\u012bva \u2014 pazi\u0146ojums, parasti rakstveid\u0101, kas nosaka, k\u0101<br \/>\npersona v\u0113las, lai pret vi\u0146u izturas vai neizturas, kad t\u0101 vairs nesp\u0113s pati<br \/>\npie\u0146emt l\u0113mumus (piem., ja persona ir bezsama\u0146\u0101 vai pl\u0101npr\u0101t\u012bga). Tas<br \/>\nir viens no n\u0101kotnes apr\u016bpes pl\u0101no\u0161anas veidiem, otrs veids \u2014 izv\u0113-<br \/>\nl\u0113ties k\u0101du, kas pie\u0146emtu l\u0113mumus \u0161\u012bs personas viet\u0101 t\u0101d\u0101s situ\u0101cij\u0101s.<br \/>\nDa\u017e\u0101s valst\u012bs ir likumdo\u0161ana, kas attiecin\u0101ma uz iepriek\u0161\u0113j\u0101m direkt\u012b-<br \/>\nv\u0101m.<br \/>\nKonsenss (uzskatu vienpr\u0101t\u012bba) \u2014 visp\u0101r\u0113ja, bet ne oblig\u0101ti vienbals\u012bga,<br \/>\nvieno\u0161an\u0101s.<br \/>\nLabdar\u012bba \u2014 \u00abdar\u012bt labu\u00bb. No \u0101rstiem tiek gaid\u012bts, ka tie r\u012bkosies pacien-<br \/>\nta interes\u0113s.<br \/>\nNekait\u0113t (non-male\ufb01cence) \u2014 \u00abnedar\u012bt sliktu\u00bb. \u0100rstiem un medic\u012bnas<br \/>\np\u0113tniekiem ir j\u0101izvair\u0101s no kait\u0113juma nodar\u012b\u0161anas pacientiem vai p\u0113-<br \/>\nt\u012bjuma subjektiem.<br \/>\nNov\u0113rt\u0113t \u2014 (darb.v.) uzskat\u012bt kaut ko par \u013coti svar\u012bgu; v\u0113rt\u012bba (lietv.) kaut<br \/>\nkas, kas tiek uzskat\u012bts par \u013coti svar\u012bgu.<br \/>\nPaliat\u012bv\u0101 apr\u016bpe \u2014 pacienta, kur\u0161 var\u0113tu nomirt sam\u0113r\u0101 tuv\u0101 n\u0101kotn\u0113<br \/>\nno nopietnas, nedziedin\u0101mas slim\u012bbas, apr\u016bpes metode, kas tiek kon-<br \/>\ncentr\u0113ta uz pacienta dz\u012bves kvalit\u0101ti, it \u012bpa\u0161i s\u0101pju kontroli.T\u0101 var tikt no-<br \/>\ndro\u0161in\u0101ta slimn\u012bc\u0101s, speci\u0101l\u0101s slimn\u012bc\u0101s n\u0101ves slimniekiem vai pacienta<br \/>\nm\u0101j\u0101s.<br \/>\nPla\u0123i\u0101tisms \u2014 negod\u012bga r\u012bc\u012bba, kad persona kop\u0113 k\u0101da cita darbu, pie-<br \/>\nm\u0113ram, da\u013cu vai visu public\u0113to rakstu, un uzdod to par savu darbu (tas<br \/>\nir, nenor\u0101dot t\u0101 avotu).<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014PielikumsA<br \/>\n124 125<br \/>\nPl\u0101nveida vesel\u012bbas apr\u016bpe \u2014 organizatoriska pieeja vesel\u012bbas apr\u016bpei,<br \/>\nkad vald\u012bbas, korpor\u0101cijas vai apdro\u0161in\u0101\u0161anas komp\u0101nijas nolemj, k\u0101di<br \/>\npakalpojumi tiks pied\u0101v\u0101ti, kas tos pied\u0101v\u0101s (\u0101rsti speci\u0101listi, praktiz\u0113-<br \/>\njo\u0161i \u0101rsti, slimnieku kop\u0113ji, citi vesel\u012bbas apr\u016bpes profesion\u0101\u013ci utt.), kur<br \/>\ntos pied\u0101v\u0101s (kl\u012bnik\u0101s, slimn\u012bc\u0101s, pacienta m\u0101j\u0101s utt.), un citi ar \u0161o nozari<br \/>\nsaist\u012bti jaut\u0101jumi.<br \/>\nPlur\u0101listisks \u2014 t\u0101ds, kam ir vair\u0101kas vai daudzas da\u017e\u0101das iez\u012bmes vai me-<br \/>\ntodes; pret\u0113js vienveid\u012bgam.<br \/>\nPozit\u012bva \u012bpa\u0161\u012bba \u2014 laba cilv\u0113ku \u012bpa\u0161\u012bba rakstur\u0101 un uzved\u012bb\u0101. Da\u017eas po-<br \/>\nzit\u012bv\u0101s \u012bpa\u0161\u012bbas ir svar\u012bgas konkr\u0113t\u0101m cilv\u0113ku grup\u0101m, piem\u0113ram, l\u012bdzj\u016b-<br \/>\nt\u012bba \u0101rstiem, drosme ugunsdz\u0113s\u0113jiem, god\u012bgums lieciniekiem utt.<br \/>\nRacion\u0101ls \u2014 balst\u012bts uz cilv\u0113ka sp\u0113ju b\u016bt sapr\u0101t\u012bgam, tas ir, b\u016bt sp\u0113j\u012b-<br \/>\ngam apsv\u0113rt k\u0101das r\u012bc\u012bbas pozit\u012bvo un negat\u012bvo pusi un pie\u0146emt l\u0113mu-<br \/>\nmu, kura alternat\u012bva ir lab\u0101ka.<br \/>\nSludin\u0101t (profess) \u2014 publiski pazi\u0146ot p\u0101rliec\u012bbu vai sol\u012bjumu. Tas ir pa-<br \/>\nmat\u0101 terminiem \u00abprofesija\u00bb, \u00abprofesion\u0101ls\u00bb un \u00abprofesion\u0101lisms\u00bb.<br \/>\nSurog\u0101ta vai aizst\u0101j\u0113ja gr\u016btniec\u012bba \u2014 gr\u016btniec\u012bbas veids, kur\u0101 sieviete ir<br \/>\npiekritusi izn\u0113s\u0101t b\u0113rnu un p\u0113c dzim\u0161anas to atdot citam indiv\u012bdam vai<br \/>\np\u0101rim, kuri liel\u0101kaj\u0101 da\u013c\u0101 gad\u012bjumu ir devu\u0161i vai nu spermu (m\u0101ksl\u012bg\u0101s<br \/>\napaug\u013co\u0161anas veid\u0101), vai embriju (apaug\u013co\u0161anas m\u0113\u0123en\u0113 un embrija<br \/>\np\u0101rst\u0101d\u012b\u0161anas veid\u0101).<br \/>\nTaisn\u012bgums \u2014 taisn\u012bga iztur\u0113\u0161an\u0101s pret indiv\u012bdiem un grup\u0101m. K\u0101 3. no-<br \/>\nda\u013c\u0101 ir izcelts, ir da\u017e\u0101das izpratnes par to, kas ir taisn\u012bga iztur\u0113\u0161an\u0101s ve-<br \/>\nsel\u012bbas apr\u016bp\u0113.<br \/>\nZi\u0146ot\u0101js \u2014 k\u0101ds, kas zi\u0146o varas iest\u0101d\u0113m vai sabiedr\u012bbai par indiv\u012bdu vai<br \/>\norganiz\u0101ciju neleg\u0101lo vai ne\u0113tisko r\u012bc\u012bbu.<br \/>\nPIELIKUMS B \uf6bc MEDIC\u012aNAS \u0112TIKAS RESURSI INTERNET\u0100<br \/>\nPasaules Medic\u012bnas asoci\u0101cijas pamatnost\u0101d\u0146u rokasgr\u0101mata<br \/>\n(www.wma.net\/e\/policy\/handbook.htm) \u2014 satur pilnu tekstu par PMA<br \/>\npamatnost\u0101dn\u0113m (angliski, franciski un sp\u0101niski)<br \/>\nPasaules Medic\u012bnas asoci\u0101cijas \u0113tikas strukt\u016brvien\u012bba<br \/>\n(www.wma.net) \u2014 ietver \u0161\u0101das sada\u013cas:<br \/>\n\u2022 m\u0113ne\u0161a izdevums;<br \/>\n\u2022 PMA pas\u0101kumi \u0113tikas veicin\u0101\u0161an\u0101;<br \/>\n\u2022 PMA \u0113tikas pamatnost\u0101dnes, taj\u0101 skait\u0101 t\u0101s, kas tiek izstr\u0101d\u0101tas<br \/>\nvai p\u0101rskat\u012btas;<br \/>\n\u2022 Helsinku deklar\u0101cija, v\u0113sture un \u0161\u0101 br\u012b\u017ea statuss;<br \/>\n\u2022 PMA \u0113tikas resursi;<br \/>\n\u2022 medic\u012bnas \u0113tikas organiz\u0101cijas, taj\u0101 skait\u0101 to \u0113tikas kodeksi;<br \/>\n\u2022 pazi\u0146ojumi par konferenc\u0113m;<br \/>\n\u2022 izgl\u012bt\u012bba medic\u012bnas \u0113tik\u0101;<br \/>\n\u2022 \u0113tika un cilv\u0113kties\u012bbas;<br \/>\n\u2022 \u0113tika un profesionalit\u0101te medic\u012bn\u0101.<br \/>\nDz\u012bves s\u0101kuma jaut\u0101jumi<br \/>\nCilv\u0113ku klon\u0113\u0161ana \u2014 www.who.int\/ethics\/topics\/cloning\/en\/<br \/>\nPal\u012bdz\u012bba reprodukcijas jaut\u0101jumos \u2014<br \/>\nwww.who.int\/reproductive-health\/infertility\/report_content.htm<br \/>\nDz\u012bves beigu jaut\u0101jumi<br \/>\nAvoti \u2014 www.nih.gov\/sigs\/bioethics\/endo\ufb02ife.html<br \/>\nPaliat\u012bv\u0101s un dz\u012bves beigu apr\u016bpes izgl\u012bt\u012bba \u2014<br \/>\nwww.hospicecare.com\/Ethics\/ethics.htm<br \/>\nEitan\u0101zijas pretinieki \u2014 www.euthanasia.com<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014PielikumsB<br \/>\n126 127<br \/>\nHIV\/AIDS<br \/>\nUNAIDS \u2014 www.unaids.org\/en\/PolicyAndPractice\/default.asp<br \/>\nAttiec\u012bbas ar tirdzniec\u012bbas uz\u0146\u0113mumiem<br \/>\nIzgl\u012btojo\u0161i avoti \u2014 www.epec.net\/EPEC\/webpages\/index.cfm<br \/>\nP\u0113t\u012bjumi, kuros iesaist\u012bti cilv\u0113ki<br \/>\nVadl\u012bnijas un avoti \u2014 www.who.int\/ethics\/research\/en\/<br \/>\nSabiedr\u012bbas vesel\u012bbas H\u0101rvardas skola, \u0113tikas jaut\u0101jumi starptautiskaj\u0101<br \/>\nvesel\u012bbas p\u0113t\u012bjumu kurs\u0101 \u2014 www.hsph.harvard.edu\/bioethics\/<br \/>\nIzgl\u012bto\u0161ana un avoti par p\u0113t\u012bjumu \u0113tisko nov\u0113rt\u0113jumu \u2014<br \/>\nwww.trree.org\/site\/en_home.phtml<br \/>\nPIELIKUMS C<br \/>\nPASAULES MEDIC\u012aNAS ASOCI\u0100CIJA<br \/>\nRezol\u016bcija par medic\u012bnas \u0113tikas un cilv\u0113kties\u012bbu iek\u013cau\u0161anu<br \/>\nmedic\u012bnas skolu m\u0101c\u012bbu programm\u0101s vis\u0101 pasaul\u0113<br \/>\n(Pie\u0146emta 51. Pasaules Medic\u012bnas asamblej\u0101, Telaviv\u0101, Izra\u0113l\u0101,<br \/>\n1999. gada oktobr\u012b)<br \/>\n1. \u0145emot v\u0113r\u0101, ka medic\u012bnas \u0113tika un cilv\u0113kties\u012bbas ir b\u016btiska medic\u012bnas<br \/>\nprofesijas kult\u016bras un darba sast\u0101vda\u013ca, un<br \/>\n2. \u0145emot v\u0113r\u0101, ka medic\u012bnas \u0113tika un cilv\u0113kties\u012bbas ir b\u016btiska Pasaules<br \/>\nMedic\u012bnas asoci\u0101cijas v\u0113stures, strukt\u016bras un darb\u012bbas m\u0113r\u0137a sast\u0101v-<br \/>\nda\u013ca,<br \/>\n3. Ar \u0161o tiek nolemts, ka PMA ap\u0146emas stingri rekomend\u0113t medic\u012bnas<br \/>\nskol\u0101m vis\u0101 pasaul\u0113 iek\u013caut medic\u012bnas \u0113tiku un cilv\u0113kties\u012bbas k\u0101 obli-<br \/>\ng\u0101to priek\u0161metu vi\u0146u m\u0101c\u012bbu programm\u0101s.<br \/>\nMEDIC\u012aNAS IZGL\u012aT\u012aBAS PASAULES FEDER\u0100CIJA (MIPF)<br \/>\nVisp\u0101rpie\u0146emtie standarti par kvalit\u0101tes uzlabo\u0161anu \u2014 Medic\u012bnas<br \/>\npamata izgl\u012bt\u012bba (www2.sund.ku.dk\/wfme\/)<br \/>\n\u0160ie standarti, kuri b\u016btu j\u0101iev\u0113ro vis\u0101m medic\u012bnas skol\u0101m, iek\u013cauj \u0161\u0101das<br \/>\nrekomend\u0101cijas par medic\u012bnas \u0113tiku:<br \/>\n1. Izgl\u012bt\u012bbas l\u012bmenis, pabeidzot skolu<br \/>\nMedic\u012bnas skolai ir j\u0101nosaka kompetences (tai skait\u0101 zin\u0101\u0161anas un sa-<br \/>\npratni medic\u012bnas \u0113tikas jom\u0101) kuras studenti p\u0113c diploma ieg\u016b\u0161anas<br \/>\nvar\u0113tu demonstr\u0113t turpm\u0101kaj\u0101 apm\u0101c\u012bbu proces\u0101 un darb\u0101 vesel\u012bbas<br \/>\napr\u016bpes jom\u0101.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014PielikumsC<br \/>\n128 129<br \/>\n2. M\u0101c\u012bbu programma \u2014 Medic\u012bnas \u0113tika<br \/>\nMedic\u012bnas skolai m\u0101c\u012bbu programm\u0101s ir j\u0101nosaka un j\u0101iek\u013cauj devums<br \/>\nmedic\u012bnas \u0113tik\u0101, kas veicina efekt\u012bvu komunik\u0101ciju, kl\u012bnisko l\u0113mumu<br \/>\npie\u0146em\u0161anu un \u0113tisko jaut\u0101jumu risin\u0101\u0161anu.<br \/>\n3. M\u0101c\u012bbu programma \u2014 Kl\u012bnisk\u0101s zin\u0101\u0161anas un prasmes<br \/>\nKl\u012bnisk\u0101s prasmes iek\u013cauj v\u0113stures zin\u0101\u0161anas, komunik\u0101cijas un perso-<br \/>\nn\u0101la vad\u012bbas prasmes.<br \/>\nPiedal\u012b\u0161an\u0101s pacientu apr\u016bp\u0113 var\u0113tu iek\u013caut komandas darbu ar cit\u0101m<br \/>\nvesel\u012bbas apr\u016bpes profesij\u0101m.<br \/>\n4. Izgl\u012btojo\u0161ie avoti \u2014 P\u0113tniec\u012bba<br \/>\nMijiedarb\u012bbai starp p\u0113tniec\u012bbas darbu un m\u0101c\u012bb\u0101m vajadz\u0113tu iedro-<br \/>\n\u0161in\u0101t un sagatavot studentus iesaist\u012bties medic\u012bnas p\u0113tniec\u012bb\u0101 un t\u0101s<br \/>\natt\u012bst\u012bb\u0101.<br \/>\nPIELIKUMS D \u2014 \u0112TIKAS M\u0100C\u012a\u0160ANAS NOSTIPRIN\u0100\u0160ANA<br \/>\nMEDIC\u012aNAS SKOL\u0100S<br \/>\nDa\u017e\u0101s medic\u012bnas skol\u0101s \u0113tiku m\u0101ca \u013coti maz, taj\u0101 pa\u0161\u0101 laik\u0101 cit\u0101s ir \u013coti<br \/>\natt\u012bst\u012btas programmas.Tom\u0113r pat p\u0113d\u0113j\u0101s no min\u0113taj\u0101m, vienm\u0113r ir vie-<br \/>\nta uzlabojumiem. T\u0101s ir darb\u012bbas, kuras var inici\u0113t ikviens, vienalga vai<br \/>\ntas ir medic\u012bnas students vai pasniedz\u0113js, kur\u0161 v\u0113las stiprin\u0101t medic\u012bnas<br \/>\n\u0113tikas apm\u0101c\u012bbas sav\u0101 iest\u0101d\u0113.<br \/>\n1. J\u0101iepaz\u012bstas ar l\u0113mumu pie\u0146\u0113m\u0113jiem iest\u0101d\u0113<br \/>\n\u2022 Dek\u0101nu<br \/>\n\u2022 M\u0101c\u012bbu programmas veidot\u0101jiem<br \/>\n\u2022 Fakult\u0101tes padomi<br \/>\n\u2022 Ietekm\u012bgiem pasniedz\u0113jiem<br \/>\n2. J\u0101mekl\u0113 atbalsts ar\u012b no citiem<br \/>\n\u2022 Studentiem<br \/>\n\u2022 Pasniedz\u0113jiem<br \/>\n\u2022 Galvenajiem administratoriem<br \/>\n\u2022 Nacion\u0101laj\u0101m medic\u012bnas asoci\u0101cij\u0101m<br \/>\n\u2022 Nacion\u0101laj\u0101m \u0101rstu darb\u012bbu regul\u0113jo\u0161\u0101m instit\u016bcij\u0101m<br \/>\n3. Izmantot sp\u0113c\u012bgus argumentus<br \/>\n\u2022 Rezol\u016bcija par medic\u012bnas \u0113tikas un cilv\u0113kties\u012bbu iek\u013cau\u0161anu medic\u012b-<br \/>\nnas skolu m\u0101c\u012bbu programm\u0101s vis\u0101 pasaul\u0113<br \/>\n\u2022 Visp\u0101rpie\u0146emtie standarti par kvalit\u0101tes uzlabo\u0161anu \u2014 Medic\u012bnas<br \/>\npamata izgl\u012bt\u012bba<br \/>\n\u2022 Citu medic\u012bnas skolu piem\u0113ri<br \/>\n\u2022 \u0112tikas pras\u012bbas p\u0113tniec\u012bb\u0101<br \/>\n\u2022 Paredz\u0113t pretargumentus (piem\u0113ram, p\u0101rs\u0101tin\u0101ta m\u0101c\u012bbu prog-<br \/>\nramma)<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014PielikumsD<br \/>\n130 131<br \/>\n4. Pied\u0101v\u0101t pal\u012bdz\u012bbu<br \/>\n\u2022 Sniegt pied\u0101v\u0101jumus saist\u012bb\u0101 ar strukt\u016bru, saturu, pasniedz\u0113ju<br \/>\nun studentu iesp\u0113j\u0101m (sal\u012bdzin\u0101jumam, PMA \u0112tikas strukt\u016brvien\u012bbas<br \/>\nm\u0101jas lapa par medic\u012bnas \u0113tikas izgl\u012bt\u012bbas avotiem:<br \/>\nhttps:\/\/www.wma.net\/e\/ethicsunit\/education.htm<br \/>\n\u2022 Sasaist\u012bties ar cit\u0101m medic\u012bnas \u0113tikas programm\u0101m, PMA, utt.<br \/>\n5. Nodro\u0161in\u0101t nep\u0101rtraukt\u012bbu<br \/>\n\u2022 Iest\u0101ties par past\u0101v\u012bgu medic\u012bnas \u0113tikas komiteju<br \/>\n\u2022 Piesaist\u012bt jaun\u0101kus studentus<br \/>\n\u2022 Piesaist\u012bt papildus pasniedz\u0113jus<br \/>\n\u2022 P\u0101rliecin\u0101t jaunos doc\u0113t\u0101jus un galvenos administratorus.<br \/>\nPADOMS PAR KONTRACEPCIJU<br \/>\nPUSAUDZIM<br \/>\nS\u0101ra ir 15 gadus veca. Vi\u0146a dz\u012bvo pils\u0113t\u0101, kur izvaro\u0161ana<br \/>\nk\u013c\u016bst par arvien bie\u017e\u0101ku par\u0101d\u012bbu. Vi\u0146a ierodas J\u016bsu<br \/>\nkl\u012bnik\u0101 p\u0113c receptes or\u0101lajai kontracepcijai, kas pasarg\u0101tu<br \/>\nvi\u0146u no gr\u016btniec\u012bbas gad\u012bjum\u0101, ja vi\u0146a k\u013c\u016btu par<br \/>\nseksu\u0101la uzbrukuma upuri. Gr\u016btniec\u012bba ierobe\u017eotu vi\u0146as<br \/>\nizgl\u012bto\u0161an\u0101s iesp\u0113ju, un vi\u0146ai b\u016btu sare\u017e\u0123\u012bti atrast v\u012bru.<br \/>\nS\u0101ra Jums st\u0101sta, ka vi\u0146a negrib, lai vi\u0146as vec\u0101ki zin\u0101tu,<br \/>\nka vi\u0146a lieto kontracepcijas l\u012bdzek\u013cus, jo vi\u0146i dom\u0101tu, ka<br \/>\nS\u0101ra gras\u0101s uzs\u0101kt seksu\u0101las attiec\u012bbas ar draugu. J\u016bs esat<br \/>\naizdom\u012bgs attiec\u012bb\u0101 uz S\u0101ras mot\u012bviem, bet J\u016bs apbr\u012bnojat<br \/>\nvi\u0146as ap\u0146em\u0161anos izvair\u012bties no gr\u016btniec\u012bbas. J\u016bs iesak\u0101t<br \/>\nvi\u0146ai atn\u0101kt uz kl\u012bniku ar vec\u0101kiem, lai visp\u0101r\u012bgi aprun\u0101tos<br \/>\npar \u0161o t\u0113mu. P\u0113c trim dien\u0101m S\u0101ra atgrie\u017eas viena un<br \/>\nst\u0101sta, ka vi\u0146a ir m\u0113\u0123in\u0101jusi run\u0101t ar vec\u0101kiem, bet vi\u0146i<br \/>\natteiku\u0161ies to apspriest. K\u0101 Jums tagad j\u0101r\u012bkojas?<br \/>\nPIELIKUMS E \uf6bc PAPILDUS GAD\u012aJUMU IZP\u0112TE<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014PielikumsE<br \/>\n132 133<br \/>\n* Ieteica Dr. D\u017eeralds Neicke un Mareike Mellere, Hanoveres<br \/>\nMedic\u012bnas augstskola, V\u0101cija<br \/>\nHIV INFEKCIJA<br \/>\nS. kungs ir prec\u0113jies un ir divu skolas vecuma b\u0113rnu t\u0113vs.<br \/>\nVi\u0146\u0161 tiek \u0101rst\u0113ts J\u016bsu kl\u012bnik\u0101 no reta pneimonijas paveida,<br \/>\nkas bie\u017ei tiek saist\u012bts ar AIDS.<br \/>\nVi\u0146a asins testa rezult\u0101ti uzr\u0101da, ka vi\u0146\u0161 patie\u0161\u0101m ir HIV<br \/>\npozit\u012bvs. S. kungs teic, ka vi\u0146\u0161 pats gribot izlemt, vai<br \/>\nun kad vi\u0146\u0161 pateiks sievai par infekciju. J\u016bs nor\u0101d\u0101t, ka<br \/>\ntas var\u0113tu gl\u0101bt dz\u012bv\u012bbu vi\u0146a sievai, pasarg\u0101jot to no<br \/>\ninfekcijas. Turkl\u0101t b\u016btu svar\u012bgi, ka ar\u012b vi\u0146a veic HIV testu.<br \/>\nPozit\u012bva testa rezult\u0101ta gad\u012bjum\u0101 vi\u0146ai b\u016btu iesp\u0113ja dzert<br \/>\nz\u0101les, lai pal\u0113nin\u0101tu slim\u012bbas uzliesmojumu, t\u0101d\u0113j\u0101di<br \/>\npagarinot vi\u0146ai dz\u012bvi. P\u0113c 6 ned\u0113\u013c\u0101m S. kungs ierodas<br \/>\nJ\u016bsu kl\u012bnik\u0101 uz kontroles p\u0101rbaudi. Uz J\u016bsu jaut\u0101jumu<br \/>\nvi\u0146\u0161 atbild, ka joproj\u0101m neesot inform\u0113jis savu sievu. Vi\u0146\u0161<br \/>\nnegrib, lai vi\u0146a uzzin\u0101tu par S. kunga homoseksu\u0101lajiem<br \/>\nsakariem, jo baid\u0101s, ka t\u0101s b\u016btu vi\u0146u attiec\u012bbu beigas un<br \/>\n\u0123imene izjuktu. Bet, lai pasarg\u0101tu sievu, vi\u0146iem ir tikai<br \/>\n\u201edro\u0161s sekss\u201d. K\u0101 \u0101rst\u0113jo\u0161ais \u0101rsts J\u016bs apsverat, vai Jums<br \/>\npret\u0113ji S. kunga gribai b\u016btu jainform\u0113 S. kundze par vi\u0146as<br \/>\nv\u012bra saslim\u0161anu, lai vi\u0146ai tiktu dota iesp\u0113ja s\u0101kt \u0101rst\u0113\u0161anos,<br \/>\nja t\u0101da nepiecie\u0161ama.<br \/>\nPRIEK\u0160LAIC\u012aGI DZIMIS B\u0112RNS*<br \/>\nMaksis piedzima gr\u016btniec\u012bbas 23. ned\u0113\u013c\u0101. Vi\u0146\u0161 tiek<br \/>\nm\u0101ksl\u012bgi elpin\u0101ts, jo vi\u0146a plau\u0161as ir v\u0113l neatt\u012bst\u012bju\u0161\u0101s.<br \/>\nTurkl\u0101t, vi\u0146\u0161 cie\u0161 no galvas smadze\u0146u asi\u0146o\u0161anas, jo vi\u0146a<br \/>\nasinsvadu audi ir nestabili. Maz ticams, ka vi\u0146\u0161 izdz\u012bvos<br \/>\nilg\u0101k par n\u0101kamaj\u0101m p\u0101ris ned\u0113\u013c\u0101m. Ja vi\u0146\u0161 izdz\u012bvos,<br \/>\ntad, iesp\u0113jams, vi\u0146am b\u016bs gan \ufb01ziskie, gan psihiskie<br \/>\ntrauc\u0113jumi.<br \/>\nMak\u0161a st\u0101voklis pasliktin\u0101s, kad vi\u0146am att\u012bst\u0101s nopietna<br \/>\nzarnu infekcija. Past\u0101v iesp\u0113ja iz\u0146emt skarto zarnu da\u013cu<br \/>\noper\u0101cijas ce\u013c\u0101, kas saglab\u0101tu z\u0113nam mazu iesp\u0113ju<br \/>\nizdz\u012bvot. Ta\u010du Mak\u0161a vec\u0101ki nedod savu piekri\u0161anu<br \/>\noper\u0101cijai, jo negrib, lai Maksis ciestu v\u0113l vair\u0101k, un vi\u0146i<br \/>\nsaprot, ka b\u0113rna dz\u012bves kvalit\u0101te nekad neb\u016bs laba. K\u0101<br \/>\n\u0101rst\u0113jo\u0161ais \u0101rsts J\u016bs uzskat\u0101t, ka oper\u0101cija ir nepiecie\u0161ama,<br \/>\nun dom\u0101jat, k\u0101 tikt gal\u0101 ar vec\u0101ku atteikumu.<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014PielikumsE<br \/>\n134 135<br \/>\n\u0100RST\u0112JOT IESLODZ\u012aTO<br \/>\nK\u0101 da\u013cu no J\u016bsu medi\u0137a pien\u0101kumiem J\u016bs vienu dienu<br \/>\ndiv\u0101s ned\u0113\u013c\u0101s velt\u0101t tuvum\u0101 eso\u0161\u0101 cietuma iem\u012btnieku<br \/>\napskatei. Vakar J\u016bs \u0101rst\u0113j\u0101t ieslodz\u012bto, kuram bija daudzi<br \/>\nnobr\u0101zumi uz sejas un \u0137erme\u0146a. Kad J\u016bs pajaut\u0101j\u0101t, kas<br \/>\nizrais\u012bjis \u0161os ievainojumus, pacients atbild\u0113ja, ka vi\u0146am<br \/>\npratin\u0101\u0161anas laik\u0101 uzbrucis cietuma person\u0101ls, kad vi\u0146\u0161<br \/>\natteicies atbild\u0113t uz jaut\u0101jumiem. Lai gan \u0161is ir pirmais<br \/>\n\u0161\u0101ds gad\u012bjums J\u016bsu praks\u0113, J\u016bs esat dzird\u0113jis no kol\u0113\u0123iem<br \/>\npar l\u012bdz\u012bgiem gad\u012bjumiem. J\u016bs esat p\u0101rliecin\u0101ts, ka Jums<br \/>\nkaut kas j\u0101dara, bet pacients atsak\u0101s \u013caut Jums atkl\u0101t<br \/>\ninform\u0101ciju par sevi, jo baid\u0101s no cietuma p\u0101rvaldes<br \/>\natrieb\u012bbas. Turkl\u0101t J\u016bs neesat p\u0101rliecin\u0101ts, ka ieslodz\u012btais<br \/>\nJums teicis paties\u012bbu; cietumsargs, kas vi\u0146u pie Jums<br \/>\natveda, teica, ka ieslodz\u012btais k\u0101vies ar citu ieslodz\u012bto.<br \/>\nJums ir labas attiec\u012bbas ar cietuma person\u0101lu, un J\u016bs<br \/>\nnegribat t\u0101m kait\u0113t, izsakot nepier\u0101d\u012btus apvainojumus<br \/>\npar \u013caunpr\u0101t\u012bgu iztur\u0113\u0161anos pret ieslodz\u012btajiem. K\u0101 Jums<br \/>\nr\u012bkoties?<br \/>\nL\u0112MUMS PAR DZ\u012aVES IZBEIG\u0160ANU<br \/>\nK\u0101da 80-gad\u012bga sieviete ir uz\u0146emta J\u016bsu slimn\u012bc\u0101 no<br \/>\npansion\u0101ta, lai \u0101rst\u0113tu pneimoniju. Vi\u0146a ir v\u0101rga un sirgst<br \/>\nar vieglu pl\u0101npr\u0101t\u012bbu. J\u016bs veiksm\u012bgi iz\u0101rst\u0113jat pneimoniju,<br \/>\nbet, pirms vi\u0146a tiek izrakst\u012bta atpaka\u013c uz pansion\u0101tu,<br \/>\nvi\u0146a p\u0101rcie\u0161 trieku, kas paraliz\u0113 \u0137erme\u0146a labo pusi, k\u0101<br \/>\nrezult\u0101t\u0101 sieviete nesp\u0113j sevi pabarot pati. Vi\u0146ai tiek<br \/>\nievad\u012bta zonde, kas rada diskomfortu, un p\u0113c vair\u0101kiem<br \/>\npacientes m\u0113gin\u0101jumiem izvilkt to ar kreiso roku,<br \/>\nmin\u0113t\u0101 roka tiek sasieta. Vi\u0146a nav sp\u0113j\u012bga izteikt ar\u012b savas<br \/>\nv\u0113lmes. B\u0113rnu vai citu radinieku mekl\u0113jumi, kas pal\u012bdz\u0113tu<br \/>\npie\u0146emt l\u0113mumus par vi\u0146as \u0101rst\u0113\u0161anu, ir neveiksm\u012bgi. P\u0113c<br \/>\nvair\u0101k\u0101m dien\u0101m J\u016bs secin\u0101t, ka vi\u0146as st\u0101vokli neizdosies<br \/>\nuzlabot un ka vien\u012bgais veids, k\u0101 atvieglot pacientes<br \/>\nst\u0101vokli, ir sekojo\u0161s: dot nomierino\u0161us l\u012bdzek\u013cus vai ar\u012b<br \/>\niz\u0146emt zondi un \u013caut vi\u0146ai nomirt. K\u0101 Jums r\u012bkoties?<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata\u2014PielikumsE<br \/>\n137<br \/>\nGAD\u012aJUMU P\u0112T\u012aJUMU KOLEKCIJAS<br \/>\nUNESCO profes\u016bras (UNESCO Chair) gad\u012bjumu p\u0113t\u012bjumi bio\u0113tik\u0101 \u2014<br \/>\nhttp:\/\/research.haifa.ac.il\/~medlaw\/<br \/>\nLielbrit\u0101nijas KL\u012aNISK\u0100S \u0112TIKAS T\u012aKLA (UK Clinical Ethics Network)<br \/>\ngad\u012bjumu p\u0113t\u012bjumi \u2014 www.ethics-network.org.uk\/case-studies<br \/>\nH\u0101rvardas Sabiedr\u012bbas vesel\u012bbas skolas (Harward School of Public<br \/>\nHealth) gad\u012bjumu izp\u0113te \u2014 www.hsph.harvard.edu\/research\/<br \/>\nbioethics\/cases\/<br \/>\nMedic\u012bnas students, turot jaundzimu\u0161o<br \/>\n\u00a9 Roger Ball\/CORBIS<br \/>\nVec\u0101ka gada g\u0101juma sieviete,<br \/>\nsa\u0146emot \u0101rsta konsult\u0101ciju<br \/>\n\u00a9 Peter M. Fisher\/CORBIS<br \/>\nMedic\u012bnas\u0113tikasrokasgr\u0101mata<br \/>\nPMA ir balss, kas p\u0101rst\u0101v \u0101rstus vis\u0101 pasaul\u0113, neatkar\u012bgi no<br \/>\nvi\u0146u specialit\u0101tes, atra\u0161an\u0101s vietas vai prakses veida. PMA<br \/>\nmisija ir kalpot cilv\u0113kiem, cen\u0161oties sasniegt visaugst\u0101kos<br \/>\niesp\u0113jamos standartus medic\u012bnas apr\u016bp\u0113, \u0113tik\u0101, zin\u0101tn\u0113,<br \/>\nizgl\u012bt\u012bb\u0101 un ar vesel\u012bbu saist\u012btaj\u0101s cilv\u0113kties\u012bb\u0101s visiem cil-<br \/>\nv\u0113kiem.<br \/>\nPMA \u0112tikas komiteja tika izveidota 2003. gad\u0101, lai koor-<br \/>\ndin\u0113tu politikas att\u012bst\u012bbu un izplat\u012btu PMA \u0113tikas pas\u0101ku-<br \/>\nmus tr\u012bs jom\u0101s: sakaru veido\u0161an\u0101 ar cit\u0101m starptautisk\u0101m<br \/>\n\u0113tikas jom\u0101 str\u0101d\u0101jo\u0161\u0101m organiz\u0101cij\u0101m; PMA aktivit\u0101\u0161u<br \/>\nveicin\u0101\u0161ana ar konferen\u010du un PMA m\u0101jas lapas starpnie-<br \/>\nc\u012bbu; jaunu \u0113tikas t\u0101l\u0101kizgl\u012bt\u012bbas materi\u0101lu, t\u0101du k\u0101 \u0161\u012b ro-<br \/>\nkasgr\u0101mata, veido\u0161ana.<br \/>\nPasaules Medic\u012bnas asoci\u0101cija<br \/>\nB. P. 63, 01212 Ferney-Voltaire Cedex, Francija<br \/>\ne-pasts wma@wma.net fax (+33) 450 40 59 37<br \/>\nwww.wma.net<br \/>\nISBN 92-990028-1-9<br \/>\nISBN 978-9984-26-413-4<\/p>\n"},"caption":{"rendered":"<p>ethics_manual_latvian MEDIC\u012aNAS \u0112TIKAS rokasgr\u0101mata Pasaules Medic\u012bnas asoci\u0101cija Medic\u012bnas \u0113tika \u0113tika b MEDIC\u012aNAS \u0112TIKAS rokasgr\u0101mata Pasaules Medic\u012bnas asoci\u0101cija II izdevums Medic\u012bnas\u0113tikasrokasgr\u0101mata Medic\u012bnas students, turot jaundzimu\u0161o \u00a9 Roger Ball\/CORBIS 3 SATURA R\u0100D\u012aT\u0100JS Pateic\u012bbas&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 5 Priek\u0161v\u0101rds&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 7 Ievads &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 9 \u2022 Kas ir medic\u012bnas \u0113tika? \u2022 K\u0101p\u0113c j\u0101apg\u016bst medic\u012bnas \u0113tika? \u2022 Medic\u012bnas \u0113tika, \u0101rsta profesion\u0101lisms, cilv\u0113kties\u012bbas un likums [&hellip;]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":682,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/ethics_manual_latvian.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/7315"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=7315"}]}}