J of IMAB. 2012; 18(3):308-311
DEONTOLOGICAL PROBLEMS OF CLINICAL TOXICOLOGY IN BULGARIA, CONNECTED TO COMMUNICATION DIFFICULTIES, DURING THE DECADE 2000-2010
Marieta Yovcheva
Clinic of Intensive Treatment of Acute Intoxications and Toxoallergy, Naval Hospital – Varna, Military Medical Academy – Sofia, Bulgaria.

ABSTRACT:
The specificity of clinical toxicology has always raised many deontological, medico ethical and legal problems, mainly connected to communication barriers, leading to distortion or total disappearance of the ability of the intoxicated patient to perceive and process the received information about his state and necessity of treatment, to agree or refuse medical help, to permit announcing data about his case. During the decade 2000-2010 significant changes in Health law, minor decrees and Medical Ethic Codes have been done, solving partially some of these questions. The new conceptions and conditions aroused new problems, connected with the intoxicated patient’s autonomy, right to information, confidentiality, etc. The necessity of some adaptation of the official formulary of informed consent for clinical toxicology is discussed with accent on the dynamics of the process rather than on one-moment decision.  A requirement of informed refusal by a whole sentence, free text, hand written by the patient, instead of simple signature is recommended. Current analysis and discussions of the deontological questions of toxicology are important.

Key words: deontology, clinical toxicology, communication, consciоusness, competent, information, autonomy, duress, access, law.

- Download FULL TEXT /PDF 522 KB/
Please cite this article as: Yovcheva M. Deontological Problems of Clinical Toxicology in Bulgaria, Connected to Communication Difficulties, during the Decade 2000-2010. J of IMAB. 2012; 18(3):308-311. doi: 10.5272/jimab.2012183.308.

REFERENCES:
1. Monov Al., Clinical Toxicology, vol. I and II, Venel, Sofia, 1995. [in Bulgarian]
2. Radanov St. Medical Deontology. Siela. 2005. p. 83-140; p. 162-240. [in Bulgarian]
3. Zinovieva D. Medical Law. Sofia. 2004. P. 23-29; p. 151-168; p. 223-231; p. 264-269. [in Bulgarian]
4. Law of Health. Prom. SG 70/10 Aug 2004. In force from 1st of January 2005. [in Bulgarian]
5. Vodenicharov C, S. Popova, Medical Ethics. Sofia. 2003. p. 55-169. [in Bulgarian]
6. Dimitrova S. The Informed Consent in Medical Practice. Alfamarket. Stara Zagora. 2003. p. 6-47. [in Bulgarian]
7. Lisaev P. Medical Deontology and Medical Law. Pleven. 2008. [in Bulgarian]
8. Donchev P. Medical Law and Deontology. Medicina i fizkultura. Sofia. 1992. p. 7-77; p. 129-142. [in Bulgarian]
9. Iovcheva M, Asparuhova M, Markova S. A Therapeutical Compulsion in Cases of Acute Selfpoisonings – Some Contemporary Deontological Problems. J of IMAB - Godishen sbornik (nauchni trudove). 1999, 5(2):224-225. [in Bulgarian]
10. Stoev V. Clinical Communication. Softtrade. 2011. [in Bulgarian]
11. Parker J, Coeira E. Improving Clinical Communication. A View from Psychology. J Am Med Inform Assoc. 2000 Sep-Oct;7(5):453-461. [PubMed] [CrossRef]
12. Simpson M, Buckman R, Stewart M, Maguire P, Lipkin M, Novack D, et al. Doctor-patient communication: the Toronto consensus statement. BMJ. 1991 Nov 30; 303(6814):1385-1387. [PubMed]