Journal - International Society for the History of Islamic Medicine

Ayþegül DEMÝRHAN ERDEMÝR A MEDICAL ETHICS PERSPECTIVE TO LAWS IN
PUBLIC HEALTH IN TURKEY
consent of persons is necessary in many areas of public
health.
Health promotion is the process of enabling people
to increase control over and improve their health.
Health advocates regard it as a step toward
autonomous decision-making for people who were
formerly passive recipients of public health measures
like purifying drinking water, mass vaccination programs,
dietary additives, tuberculin tests, and other
routine public health interventions (14).
What could be more beneficent than spreading
information about risks to health and actions that can
be taken to reduce these risks? Health education
encourages all to take greater responsibility for their
own health (15). Economic interests in communities
dependent on the alcohol and tobacco industries, it is
argued, also must be considered when deciding how
to deal with public health problems associated with
tobacco and alcohol use and abuse. These are complex
economic, political and ethical questions. The
ethical principles here are beneficence and justice
(16). According to the Turkish Law of the Control
of Narcotic Matters with the date of 1928, the prevention
of tobacco and alcohol use and abuse is necessary.
Here, beneficence of community is very
important from the point of the medical ethics.
National population policies range from encouragement
of couples to have or refrain from having
children (often with related laws on access to and use
of contraceptives) to vaguely visualized policies
implied by the appearance in newspapers and
women’s magazines of articles on birth control that
contain statements about the efficacy of contraceptive
methods (17). According to the Turkish Law of
Family Planning with the date of 1983, curettage
can be applied up to the 10th week with the desire of
woman. Birth control drugs and apparatus can be
used with the prescription of physician.
In a free society, public health workers have an
ethical duty to consider each patient or client as an
individual with her own unique life situation, problems,
and requests - not as a “case” to whom the official
policies necessarily apply. The aspirations of
women and couples to have or refrain from having
children are powerful and very personal (18). Staff
members of family planning clinics have an ethical
duty to offer advice and treatment, and an equally
important duty not to enforce their own or official
views on individual clients in Turkey.
Public health is inherently concerned with social
justice, with fair and equitable distribution of
resources to protect, preserve and restore health.
Public health workers therefore frequently become
advocates for health care systems that provide access
to needed services without economic or other barriers.
The principles of equity and justice go further.
The allocation of health care budgets is often based
on political or emotional grounds and on the ability
of eloquent spokespersons for high-technology diagnostic
and therapeutic services to promote these
interests. Funds sometimes are allocated for expensive
equipment and devices, while much - needed
public health services such as water purification
plans is need of renovation or logistic support for
immunization programs, go without funds. It is an
ethical imperative for public health workers to be as
aggressive as circumstances require in obtaining an
equitable share of resources and funds for public
health services (19-21). Law of Socialization of
Health Services with the date of 1961 provides that
every citizen make use of social services equally.
Justice principle is provided with this law. Health dispensaries
provide health service for everybody.
Beneficence is the dominant ethical principle of
public health in Turkey. The aim of public health
services ought to be to enlighten people about risks to
health and to assist people in gaining greater control
over environmental, social and other conditions that
influence their own health. We have an ethical duty to
work with people, empowering them, doing whatever
may be necessary to promote better health-doing
things with, not to, people (22). However, it is beneficent
for public health workers to strive for economic,
environmental, social and political conditions that
will maximize good health.
Reactions to human immunodeficiency virus
(HIV) disease have been different. It is important to
protect the privacy of HIV-positive persons and to
safeguard the confidentiality of their medical records
to minimize the risk of disclosing information that
could harm them or members of their families.
36 JISHIM 2004, 3