Chapter 8: Iatrogenesis, Placebo, Euthansia & Informed

• Iatrogenesis


  Any effect on a patient's state caused by the actions or the lack of action of the medical professionals involved in their care
• Types of Iatrogenesis


  • Medical iatrogenesis
  • Social and cultural iatrogenesis
• Medical iatrogenesis


  Harmful consequences on the health and well-being of a patient as a result of consciously or unconsciously performed medical procedures, as well as omitted ones
• Examples of medical iatrogenesis

  • Medical errors
  • Antibiotic resistance
  • Nosocomial infections
  • Side effects from drug or surgical interventions, as well as drug interactions
  • Omitted diagnostic or therapeutic procedures due to ignorance or fatigue of the medical staff
  • Inappropriate or untimely provision of information to the patient regarding their health state
  • Carrying out unnecessary therapeutic procedures for profit
• Social and cultural iatrogenesis

  Over-medicalization of everyday life due to the introduction of medical product advertisements in various media, leading to increased self-treatment and use of over-the-counter medicines instead of natural remedies
• Placebo


  Any positive effect on the health of a patient when using an inactive substance
• Nocebo


  Negative effects on a patient's health when using an ineffective substance
• Informed consent


  Consent given voluntarily after familiarization with certain information
• Obligatory elements of valid informed consent


  • Provision of complete information about the necessity, benefits and risks of the applied medical procedure
  • The patient's ability to understand the meaning and consequences of the procedure being performed
  • Voluntariness
• Every person has the right to refuse a medical procedure, even if it is life-saving, by signing an Informed Non-consent
• Euthanasia


  The possibility of a terminally suffering patient to choose to accelerate and alleviate the process of complete and irreversible cessation of life processes with the help of medication, usually with the aim of ending the death agony in severe terminal diseases
• Types of euthanasia


  • Active: application of a substance terminating the vital functions of the individual
  • Passive: withdrawal of life-sustaining treatment
• Types of euthanasia based on consent

  • Voluntary-the person provides informed consent
  • Non-voluntary cases of passive euthanasia when a patient is unconscious and the decision should be made by their legal representatives
  • Involuntary-when the person does not provide informed consent because they are not aware of what is happening
• The decision to perform euthanasia is not made by the patient alone, but requires a complex assessment by a Committee, including various specialists and a psychologist and a psychiatrist as well
• There are quite a few religious dogmas preventing euthanasia, as in almost all known religions, suicide is considered a sin, and assisted suicide is no exception
• Animal model experiments


  • Later developed and evaluated on various patients
  • Establishes presence of complex of symptoms and syndromes similar in different medical conditions
• Patients with different diagnoses and severity of symptoms lose appetite, strength, ambition, interest in the environment, their weight reduces, and this even reflects on their outlook
• General adaptation syndrome


  Syndrome described by Selye, later called "Stress Syndrome"
• Selye's theory


  • Based on triad: hypertrophy of adrenal gland, hypotrophy of thymus and immune system, and gastrointestinal problems
  • Evoked same behavioural response in animals when applied to different stimuli (chemical, physical, biological)
  • Reflects a state of "reaction to alarm", which is nonspecific and observed with different triggering conditions and stimuli
• Stress


  Nonspecific reaction of the body to various stimuli, directed towards it
• General adaptation syndrome


  • Involves three main reacting organs: adrenal, thymolymphatic and gastrointestinal
  • Passes through three main stages: reaction to alarm, state of resistance, and stage of exhaustion or decompensation
  • Considered adaptive, as it develops in response to stress factors to maintain homeostasis
• Alarm response


  1. Activation of hypothalamus leads to stimulation of autonomic nervous system

  2. Initial decrease in homeostasis, reduction in sympathetic activity, decrease in muscle tone, hypotension, and hypothermia

  3. Affects blood sugar, lipid profile, white blood cells, amino acids

  4. Characterized by "fight or flight" response, with stimulation of sympathetic nervous system and adrenal gland release of catecholamines
• Stage of resistance


  1. Activation, maintenance of high functioning to overcome stressful factor

  2. Attempt to change organ/system function to find balance between organism and stressor
• Stage of exhaustion


  Disruption of homeostasis, gradual disruption of functions in all organs and systems, absence of recovery, leading to death
• Stress should be considered as positive and negative, depending on cognitive appraisal and whether it is sought or unwanted
• Eustress


  Positive stress from exciting and challenging situations, motivating personal growth
• Negative stress


  Harmful stress from uncontrollable situations, chronic restlessness, or inability to cope, leading to fatigue, anxiety, and other negative effects
• Paracelsus' formulation: "It is not the poison that envenom, but the dose"
• Positive stress


  Exciting and challenging situations that can be motivating and help in personal growth
• Positive stress


  • Provides the opportunity to learn new skills, acquire knowledge, and achieve goals
• Negative stress


  Harmful stress that arises from uncontrollable situations, chronic restlessness or inability to cope with demands
• Negative stress


  • Can lead to fatigue, anxiety and other negative effects on well-being
• Paracelsus' formulation


  The dose distinguishes poison from medicine
• Stress that can be endured by the organism

  Positive effect (cure) or negative effect (poison)
• Stress must be managed and controlled to ensure it has a constructive effect, not a destructive one
• Eustress


  Positive aspects of stress that can achieve growth
• Distress


  Negative stress that must be kept under control
• Neuroplasticity


  • Ability of the brain to reorganize by forming new neuronal connections throughout life in response to upbringing, learning, experience, and changes in the environment
• Eustress


  Stimulates neuroplasticity through engaging and challenging experiences
• Positive stress


  Improves attention, perception of new material, and memory, building adaptation and resilience