Journal - International Society for the History of Islamic Medicine

A MEDICAL ETHICS PERSPECTIVE TO LAWS IN
PUBLIC HEALTH IN TURKEY
stigmatize them. We know that the isolation and
quarantine restrict freedom. Individuals, families,
even entire communities may be identified and stigmatized,
isolated, or quarantine and shunned by their
neighbors.
Identifying and isolating cases is an accepted feature
of communicable disease control, held to be necessary
to protect the population. The need to protect
society has been recognized as a higher imperative
than the rights of an individual patient or contact.
When smallpox, cholera, polio, typhoid, diphtheria
and other contagious diseases were prevalent, few
people questioned the actions of public health authorities
who notified and isolated patients and quarantined
contacts, often severely infringing the freedom
and dignity of entire families.
According to 52-102. articles of the Turkish Law
of Protection of Health, immunization campaigns
are compulsory for necessary persons. Here, public
health doctor should explain this condition to identifying
persons as empathic. So, the beneficence of the
society is very important in Turkey. Moreover, one
duty of all who conduct immunization campaigns is
to ensure that everybody is aware of the risks as well
as having the benefits clearly explained to them; in
short, informed consent is essential. This is very
important when children are not admitted to school
without evidence of immunization; that is, when
immunization is mandatory rather than voluntary.
Today, in Turkey, risk-benefit calculations are
required for all forms of mass medication. The possibility
of adverse effects or idiosyncratic reaction
always exists. Opposition to fluoridation of drinking
water is based in part on the unfounded fear that fluoride
can cause cancer or some other dread disease.
Epidemiologic analysis shows no association
between fluoridation and cancer. Opposition to fluoridation
is more a political than a public health issue,
in which the catch-phrase of the antifluoridation
movement, “keep the water pure”, is difficult to
rebut. Another political argument is that fluoridation
is a paternalistic measure, imposed on the population
whether they like it or not. According to the ethical
principle of respect for autonomy, individuals in a
free society should have the right to choose for themselves
whether they want to drink fluoridated water.
JISHIM 2004, 3
Ayþegül DEMÝRHAN ERDEMÝR
Responsible adults can choose, but for infants and
small children, fluoridated drink water makes the difference
between healthy and carious teeth. Applying
the ethical principle of beneficence, public health
officials argue that infants and small children should
receive fluoride to ensure that their dental enamel can
resist cariogenic bacteria.
Proponents of computerized medical record storage
and retrieval systems assert that computerize
records are more secure than paper records, but if
unauthorized access does occur, many people’s privacy,
not just one person’s, can be violated. Moreover,
computers can “crash” and a whole library of records
may be lost or become inaccessible (4,5).
Applying the principle of beneficence, it is desirable
not only to maintain data files of health-related
information, but to expand them; available ideas as
well as available information should be used for the
common good. Statistical analysis of health-related
information has been so convincingly demonstrated
to be in the public interest that there is no rational
argument against continuing on our present course
and further expanding the scope of these activities.
This argument applies with particular force to the use
of linked medical records, potentially the most powerful
method of studying diseases that are rare or
have long incubation times, or both (6,7,8).
Health workers have an ethical duty to protect the
confidentiality of the records that they use.
Irresponsible disclosure of confidential details that
can harm individuals is not only unethical but can
arouse public opinion against collection and use of
such material. Properly used, health statistics and the
records from which they are derived do not invade
individual privacy (9,10,11). According to the
Turkish Law of Patients’ Rights with the date of
1998, the patient has the right of privacy (12).
The process and procedures for obtaining
informed consent should be clearly understood by all
health workers. The process consists of transfer of
information and understanding of its significance to
subjects of medical interventions, followed by
explicit consent of the subjects (or responsible proxies)
to take part in the intervention (13). According to
the Turkish Law of Patients’ Rights, the informed
35