Bilim sosyolojisi ve bilim tarihi içerisinde araştırmacıların sıklıkla tartıştığı konulardan birisi de bilimin, toplum, ideolojiler ve dinler ile olan ilişkisidir. Bu tartışmaların içeriği, genellikle felsefi, siyasi ideolojiler ve dini inançlar üzerinde otorite sahibi kişi ya da kurumların, bilimi kullanarak toplumu manipüle etmesi, bilimin saygınlık imajının zedelenmesi ve toplum nezdinde bilim karşıtı görüşlerin ortaya çıkması gibi hususlarla ilgilidir. Bundan da öte bu problem alanları, daha özel olarak bilim ve din arasında bir uyumun ya da çatışmanın olup olmayacağı gibi, felsefi olduğu kadar, (...) sosyolojik izaha muhtaç bir konuyla da yakından ilintilidir. (shrink)

BackgroundAssessment of capacity to consent to treatment is an important legal and ethical issue in daily medical practice. In this study we carefully evaluated the capacity to consent to treatment in patients admitted to an acute medical ward using an assessment by members of the medical team, the specific Silberfeld's score, the MMSE and an assessment by a senior psychiatrist.MethodsOver a 3 month period, 195 consecutive patients of an internal medicine ward in a university hospital were included and their capacity (...) to consent was evaluated within 72 hours of admission.ResultsAmong the 195 patients, 38 were incapable of consenting to treatment (unconscious patients or severe cognitive impairment) and 14 were considered as incapable of consenting by the psychiatrist (prevalence of incapacity to consent of 26.7%). Agreement between the psychiatrist's evaluation and the Silberfeld questionnaire was poor (sensitivity 35.7%, specificity 91.6%). Experienced clinicians showed a higher agreement (sensitivity 57.1%, specificity 96.5%). A decision shared by residents, chief residents and nurses was the best predictor for agreement with the psychiatric assessment (sensitivity 78.6%, specificity 94.3%).ConclusionPrevalence of incapacity to consent to treatment in patients admitted to an acute internal medicine ward is high. While the standardized Silberfeld questionnaire and the MMSE are not appropriate for the evaluation of the capacity to consent in this setting, an assessment by the multidisciplinary medical team concurs with the evaluation by a senior psychiatrist. (shrink)