In order to prepare bioethics and clinical ethics courses for clinicians in Turkey, we needed to know the attitudes of physicians when placed in ethically difficult care situations. We presented four cases to 207 physicians who are members of the Physicians' Association in Kocaeli, Turkey. Depending on the decisions they made in each case, we determined whether they were aware of the ethical aspects of the cases and the principles they chose as a basis for their decisions. We aimed to gain information about their ethical tendencies and moral sensitivity. A small number of physicians stated that they would 'show respect for a patient's living will' in the first case, but more stated that they would 'let the patient refuse the treatment' in the second. In the third case, where medical confidentiality was the significant ethical issue, most of the physicians said that they would act in order to maintain confidentiality. For the last case, more than half the physicians chose to 'tell the truth' to the patient. The paternalism shown in the doctors' decisions on the first two cases was no longer observed in those made for the last two cases. We concluded that the physicians who participated in our study have low sensitivity to living wills (or advance directives) and patients refusing treatment. However, when issues of medical confidentiality and truth-telling are concerned, they take care to protect the autonomy of the individual an are relatively more aware of the ethical aspects of these cases.

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Decapitation of bodies is a rare event in the civilian setting and is reported to account for approximately 0.1 % of medico-legal autopsies. Suicidal decapitation is a very rare method of self-destruction. In suicidal decapitation, the favored method is the one involving trains. Other encountered methods are decapitation in suicidal hanging, vehicle-assisted ligature suicide. Though being encountered rarely decapitation by guillotine was also reported. In this retrospective study, in order to depict characteristic features of deaths with decapitation, we presented the findings of fatalities with decapitation over a 10-year period in a medico-legal autopsy series in Istanbul, Turkey. A total of 36270 forensic autopsies were performed over the period of the study and in 19 cases, the bodies were found to be decapitated (0.05 %). The age range of decapitated bodies was 18 to 71 years (average 39,1 years), with a male to female ratio of 13/6. There was only one case of suicide and the way used for suicide was a mechanism like guillotine. In this case, a guillotine-like device designed by male victim had been used for deliberately decapitating the body. The age of the suicide case was 41 years. There was no female suicide case. There were 13 deaths of accidental origin. 6 vehicle crashes and 7 train-pedestrian accidents. The age range of individuals died in accidents was 26 to 68 years (average 36.8 years) with a male to female ratio of 11/2. During the study period the number of the homicide cases with decapitation was 5. The age range of homicide cases was 18 to 71 years (average, 45.2 years), with a male to female ratio of ¼. There were multiple traumas in other body parts of the bodies of homicide cases together with decapitation. In majority of homicide cases, multiple stab wounds were detected. Decapitation level of vertebrae was at the level of 3-4 cervical vertebrae in 9 cases and different levels at cervical region in other cases.

Medical malpractice has attracted the attention of people and the media all over the world. In Turkey, malpractice cases are tried according to both criminal and civil law. Nurses and midwives in Turkey fulfill important duties in the distribution of health services. The aim of this study was to reveal the legal procedures followed in malpractice allegations and malpractice lawsuits in which nurses and midwives were named as defendants. We reviewed 59 nursing and midwifery lawsuits reported to the Higher Health Council between 1993 and 1998. Health professionals were held liable in 59% of the lawsuits. Midwives had the highest percentage of malpractice liability (52%), followed by physicians (29%) and nurses (19%). To reduce potential liability, nurse education should be improved, a nursing malpractice law should be enacted, and instructions for nursing procedures should be formulated.

BACKGROUNDMedical malpractice claims in Turkey have increased. We evaluated the problem by describing medical malpractice cases assessed by the Higher Health Council between 1993 and 1998. Our recommendations should help to improve care and decrease medical malpractice claims.METHODSWe reviewed 997 medical malpractice cases reported to the Higher Health Council between 1993 and 1998 and examined the decisions made by the Higher Health Council. We collected data on demographic characteristics, such as the type of the institution where the defendants worked, type of medical malpractice, and medical outcome.RESULTSThere were 997 medical malpractice cases reported to the Higher Health Council in the six years between 1993 and 1998. The Higher Health Council decided that 47.7% of the physicians were liable. Malpractice cases were mostly seen in state hospitals (42.4%). Fifty-nine percent of the cases resulted in death. Among actions that led to malpractice lawsuits against all health care workers, including physicians, the most common were negligence, inappropriate treatment, and diagnostic failure.CONCLUSIONWe think it is necessary to revise the health system and working conditions in hospitals and to develop clinical practice guidelines. We are of the opinion that an emphasis on the use of diagnosis and therapy protocols, standards, post-graduation education, clear and informed patient consent, and improved communication with patients will drastically decrease medical malpractice claims.