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Review: Giovanni Maio, Essays in Medical Ethics: Plea for a Medicine of Prudence. die of disease or in an accident (viii). The volume has eight chapters.
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At the same time, it demonstrates by exam- ple that in a globalised world,epidemics not only have the potential to wipe out entire populations, but also that they do not stop at national borders, nor are they confined to certain continents. We must work to de- velop effective global strategies to ensure that viruses can be contained early going forward. These strategies must incorporate elements of prevention, as well as rapid re- sponse facilities.

The Ebola outbreak made it clear that vac- cines, a sensible tool for combating epidem- ics,were initially not developed by the phar- maceutical industry because the market was not deemed profitable enough.

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Although there are promising trials in progress, there is still no approved vaccine available. The World Medical Association and the CPME have demanded that adequate funding fi- nally be made available for immunization programmes and for vaccine research and development. The Declaration of Helsinki can and must serve as the basis for these de- velopments.

Legal and Ethical Aspects of Medicine – Confidentiality: By Nelson Chan M.D.

But this call from the Europe- an and global medical communities should not be limited to research focused on Ebola vaccines. As a matter of principle, if there is a lack of incentives for conducting research and if the development of diagnostic tests, therapies and vaccines is not being pursued rigorously, governments are called upon to take effective measures in this regard, start- ing with providing access to adequate finan- cial resources.

Above and beyond research into vaccines, the international community and, in partic- ular,the industrialised world are called upon to provide the resources needed to develop the appropriate infrastructure to ensure the early containment of epidemics. The administration also plans to organise a team of physicians and other medical personnel that could be deployed anywhere in the world within three to five days, and to provide additional medi- cal supplies, like field hospitals and mobile laboratories.

However, a breakthrough will only be possible if the G7 countries agree to coordinate their activities effectively on an international level and to commit sufficient financial resources. Frank Ulrich Montgomery Global Epidemics. Even if all emission of greenhouse gas is stopped now, it would still be difficult to completely pre- vent global warming. Health needs to be given the greatest pri- ority in efforts to minimize climate change.

The discus- sion was initiated by presentations meant to shed light on the domestic and inter- national aspects of battling global epidem- ics. He reported on practical measures taken to stem the disease, which included educating the population and in- creasing public awareness about infectious disease and safe burials, as well as efforts to strengthen countries affected by epidem- ics.

From the perspective of an interna- tional non-governmental organisation, it is also essential to address what is needed to protect and safeguard medical and non- medical personnel and their employment rights during their deployment abroad. Following this talk, Prof.

Gottschalk addressed options for re- gional, national and European crisis inter- vention, as well as the limits of each. He also presented early warning and response systems for monitoring and controlling the spread of communicable diseases and options for improving risk and crisis com- munication. The level of engagement with which the parliament of the German medical profes- sion dealt with this issue and formulated political demands through a very lively discussion is noteworthy.

In the battle against global epidemics like Ebola, the th German Medical Assembly called for Germany, Europe and the international community to promote the research of in- fectious disease and the development and implementation of diagnostic tests, thera- pies and vaccines.

The parliament of physi- cians also called upon drug manufacturers to conduct targeted research, even at low profit margins, in order to develop the per- tinent drugs and vaccines. Financial resources to combat epidemics and to rebuild healthcare systems and pub- lic life in the wake of an epidemic should be allocated to the affected countries in the form of a fund, according to the Medi- cal Assembly.

The Medi- cal Assembly also demanded essential pro- tection for medical and non-medical per- sonnel during their deployment abroad, as well as approved leaves of absence and job security for physicians who volunteer to participate in aid missions. The Medical Assembly also called upon the German federal government to establish a state-funded and organised medical relief organisation to provide emergency medical relief with specially trained health profes- sionals in crisis areas. This would make it possible for doctors and other health profes- sionals to be deployed faster by simplifying the process of obtaining approved leaves of absence from their employers and provid- ing social protection.

The Ebola epidemic in West Africa demonstrated that the systems in place for gathering the appropriate medi- cal personnel to engage in crisis situations were inadequate. According to the Medical Assembly, a state-organised medical relief organisation must be created to work with non-governmental organisations to facilitate prompt delivery of healthcare in crisis areas.

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These, in turn, have effects on the health, safety, and liveli- hoods of people-especially the poor. We have already seen previews of the health impact that lies ahead if extreme weather events continue to increase. Heat waves like the one that hit Chicago in , killing some people and hospi- talized thousands, and the European heat wave, killing 21, to 35, people in five countries, are becoming more com- mon. But even more subtle, gradual climatic change can still harm human health.

El- evated carbon dioxide levels promote the growth and sporulation of some soil fungi, and diesel particles help deliver these aero- allergens deeper into our alveoli and present them to immune cells along the way. Mosquitoes, which can carry many diseases, are very sensitive to temperature changes. Extremely wet weather may bring its own share of ills. Floods are frequently followed by dis- ease clusters. These are only a few examples of what is in store. The impact of climate change comes in many shapes and sizes from not only damage from increase in harmful substances or chemicals in the air but also the increase in prevalence of various contagious diseases, which are all major public health challenges.

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In particular, the detrimental effects of cli- mate change on health are far more serious among the more vulnerable population such as children, the elderly and people in less developed countries. WMA has continuously expressed its con- cern over the health impact by climate change, and has worked to raise awareness regarding the benefits of putting health in the center of the climate change agenda. The main activity of the Environmental Caucus is sharing global trends and con- ference information regarding environ- ment and identifying common topics of interest and to discuss follow-up measures.

It encourages free exchange of opinions by adopting an informal setting. Major themes discussed at the Environmental Caucus with regards to the direction of future WMA activities include the role of physicians and of constituent members in greenhouse gas reduction, promoting re- search on the health co-benefits of coun- tering climate change and expansion of green hospitals and clinics.

At the last meeting of the Environmental Caucus held in Oslo, Norway, during the th Council Session of WMA, partici- pants all agreed on the importance of form- ing a coordinated voice representing the entire medical community in anticipation of COP 21 and shared ideas about what we can do. The discussion can be summarized into the following approaches: 1. Recognition of co-benefits of dealing with health issues in climate action 2.

Active media coverages and journal ex- poses 4. Collaboration with other professional organizations and NGOs on joint ini- tiatives on the issue 5. Promoting awareness of members on green policies for daily operation of health facilities. Much is at stake as COP21 approaches,and hopes are high that we will be able to de- liver our voices effectively so that COP21 will find a meaningful framework to pre- vent and resolve health problems caused by climate change.

College of Medicine E-mail: dshin5 yuhs. The physician also has a duty of care to their patients and should keep their medical re- cords secret within applicable national laws. A narrative approach encom- passes an open awareness of health and dis- ease within a storied structure from which the meaning and purpose in both an illness and the experience of recovery emerge.

A story is re- counted in a complicated narrative of illness told in words,silences,gestures,physical ob- servations,overlain not only by the objective findings but also with the fears, hopes and implications associated with it [2]. The narration is a therapeutic central act be- cause to find the words to contain the disorder and its attendant worries gives shape to and control over the uncertainties of the illness.

As the physician listens to the patient, he or she follows the narrative thread of the story in all its existential, cultural, familial, biological, social, psychological and spiritual dimensions. Why is this happening to me? And what will be the result? If the physician cannot perform these narra- tive tasks,the patient might not tell the whole story, might not ask the most frightening questions, and might not feel heard [6].

The resultant diagnostic workup might be unfocused and therefore more expensive than need be,the correct diagnosis might be missed,the clinical care might be marked by noncompliance and the search for another opinion, and the therapeutic relationship might be shallow and ineffective. The nar- rative is absorbing. It engages the listening physician and invites an interpretation. Too often a computer generated form is completed with the minimum of narra- tive followed by a cursory clinical examina- tion and a huge array of expensive investiga- tions from which a diagnosis is expected to emerge.

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A person centered approach Those starting out on a medical career may need a format to act as guidance. The per- son centered Integrated Diagnostic model is being developed and refined to meet this need. It proposes the whole person in con- text as the Centre and goal of clinical care and public health [10]. This encourages a more flexible and conversational style. It is only through this open style interactive conversation and questioning the physician sorts, extracts, subtracts and adds informa- tion into a meaningful format.

There is then a tendency to move to gather more specific information to exclude other possibilities and confirm the presumptive diagnosis. The danger is that at this stage other pertinent information may not be given by the patient or sought by the physician. Some physicians may avoid eliciting multiple concerns due to the fear of extending the encounter when time is limited. Repeated invita- tions to express additional concerns early in the consultation may enhance the efficiency of the interview by decreasing late-arising concerns,allowing the physician and patient to prioritize problems at the outset, to make the best use of their time and minimize im- plicit assumptions of what the patient wants to discuss.

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Patients may defer emotionally laden topics until the trustworthiness of the physician is better known or until the physi- cian brings up the topic [11]. Agenda setting is a teachable and learnable skill that deserves emphasis and reinforcement. A few verbal affective remarks can be ef- fective and this is not necessarily time con- suming [12]: In one study it took only 38 seconds to make a difference! These points have been defined as fundamental for effective patient- physician communication.

Affective communication may have the power to elicit beneficial effects in clinical encounters as it enables patients to adjust better to the emotional and cognitive im- pact of medical information [14].