Israel Medical Association Journal

Background: In Israel a general code of ethics exists for physicians, drafted by the Israel Medical Association. The question arises whether psychiatrists require a separate set of ethical guidelines.

Objectives: To examine the positions of Israeli psychiatrists with regard to ethics in general and professional ethics in particular, and to explore opinions regarding a code of ethics or ethical guidelines for psychiatry. 

Methods: A specially designed questionnaire was compiled and completed by psychiatrists recruited for the study. 

Results: Most participants reported low levels of perceived knowledge regarding ethics, professional ethics, and the general code of ethics. Older and more experienced professionals reported a higher level of knowledge. Most psychiatrists agreed or strongly agreed with the need for a distinct code of ethics/ethical guidelines for psychiatrists. This support was significantly higher among both psychiatrists under 50 years and residents. 

Conclusions: Our findings suggest that the existing code of ethics and position papers may not be sufficient, indicating a potential need to develop and implement a process to create the ethical code itself. In addition, the findings highlight the importance of ethics education, suggesting that the need for a code of ethics is more urgent in the early stages of professional training, as younger professionals may be more exposed to advanced media technology. While some may fear that a distinct code of ethics will distance psychiatry from modern medicine, others assert that the profession combines aspects from the humanities and social sciences that require a unique sort of management and thus this profession requires a distinct code of ethics.

 

Background: While many are familiar with postpartum depression, the phenomenon of postpartum post-traumatic stress disorder (PTSD) is less well known and investigated. Objectives: To assess the prevalence of postpartum PTSD in a cohort of women in Israel, and to examine factors affecting its development.

Methods: Eighty-nine women completed several ratings immediately after delivery and one month later. The factors examined related to the pregnancy, childbirth expectations, and delivery. Rating scales comprised evaluations of attachment, personality, PTSD, and demographic variables.

Results: The prevalence of post-partum PTSD was 3.4% (complete PTSD), 7.9% nearly complete PTSD, and 25.9% significant partial disorder. Women who developed PTSD symptoms had a higher prevalence of "traumatic" previous childbirth, with subsequent depression and anxiety. They also reported more medical complications and “mental crises” during pregnancy as well as anticipating more childbirth pain and fear. Instrumental or cesarean deliveries were not associated with PTSD. Most of the women who developed PTSD symptoms delivered vaginally but received fewer analgesics with stronger reported pain. Women with PTSD reported more discomfort with the undressed state, stronger feelings of danger, and higher rates of not wanting more children.

Conclusions: The study results indicate a) the importance of inquiring about previous pregnancy and birthing experiences, b) the need to identify at-risk populations, and c) increased awareness of the disorder. The importance of addressing anticipatory concerns of pain prior to delivery and of respecting the woman’s dignity and minimizing the undressed state during childbirth should not be underestimated. A short questionnaire following childbirth may enable rapid identification of symptoms relevant to PTSD.
 

Background: Religiosity has been examined as a mechanism of stress management. Since many studies have shown a high rate of psychological morbidity among medical students during different stages of training, it is important to investigate whether religiosity may serve as a protective factor.

Objectives: To assess the association between religiosity and depression or anxiety in a sample of medical students and to compare the results with a matched sample of students from other fields of study.

Methods: This cross-sectional study examined a sample of Tel Aviv University medical students and compared them with students in other faculties at the same university for any association between religiosity and depression or anxiety. The subjects completed the Beck Depression Inventory, the Beck Anxiety Inventory, a modified religiosity inventory, and a demographic and psychosocial variables inventory.

Results: Findings did not show a significant association between religiosity and depression or anxiety in the general sample (n=119). A positive significant correlation between religiosity and anxiety was found among medical students, with 29.4% of them reporting anxiety and 25.2% depression. While high rates of depression and anxiety were reported by students in the first to third years (pre-clinical years), there was a decrease in depression and anxiety in the fourth to sixth years (clinical years). However, higher anxiety and depression scores were noted among controls as compared to medical students.

Conclusions: In contrast to another recent investigation, a negative correlation between religion and depression/anxiety does not necessarily exist. An association between religiosity and mental health could have many theoretical and practical implications and requires further investigation. Similar to previous studies, the rates of depression and anxiety among Israeli medical students were comparable with those of other countries. These rates are considered higher than those in the general population and emphasize the importance of alertness to mental health issues among students, especially during the early study years.
 

There are isolated cases of physicians who murdered their patients. However, never had a single physician personally supervised the mass murder of hundreds of thousands of individuals, until Dr. Irmfried Eberl. Commander of the Nazi death camp Treblinka, he killed both the ill and those he considered "a disease to his nation." At age 32 Dr. Eberl established Treblinka, where he was responsible for the killing of approximately 280,000 individuals within a few weeks. The position of camp commandant was earned following his success as head of two psychiatric hospitals in Germany where he coordinated the murder of thousands of mentally ill Jews and non-Jews within the context of the euthanasia program. However, few in medicine have heard of him or the harm he caused to the ethical practice of the profession and to human rights.

The biblical story of Samson may be understood at various levels and from different perspectives. Since the story of Samson in the Bible is sketchily drawn, the interpretations of the narrative are numerous. One version, according to David Grossman, a contemporary writer and liberal Israeli political activist, regards Samson critically, viewing him as a tormented individual who opts to end his life in order to end his suffering. Another version is that of Ze’ev Jabotinsky, a twentieth century author and nationalistic Jewish political activist, who regards Samson as a heroic figure exemplifying the ultimate Jewish hero who killed himself to help his people. While suicide is considered a tragic event, viewed as the outcome of an unstable state of mind from a psychopathological point of view, and a controversial issue in Judaism (as in other religions), there is value in examining how each of these authors explains the act. Since the personal and political opinions of the authors influenced their interpretations, the discussion will briefly expound on their biographies. A comparison between their two versions of the narrative will be made. A word of caution is introduced regarding the merits and demerits of artistic and creative analysis of the biblical narrative.

Eponyms are titles of medical disorders named for individuals who originally described the condition. They also help us remember and identify the disorder. Medicine is replete with them, and changing them or eradicating them, for whatever reason, is not simple. But when there is a moral issue involved – for example, the research conducted under overwhelming unethical conditions – we believe it wrong to perpetuate and thus “reward” the memory of the individual for whom the disorder is named. The name of a syndrome should thus be discontinued if described by an individual whose research used extreme or who was involved in atrocities against humanity. Ethical considerations should be introduced into medical nosology just as they exist in patient care and research. This article details a group of notable eponyms, the names of which are associated with overt crimes of the medical community during the Nazi era, and provides alternative medical nomenclature. In addition, examples are provided of eponyms named after Nazi era victims, eponyms of those who protested such injustices, and eponyms of those who had to flee discrimination and death. These should be remembered and even strengthened, as opposed to those of the perpetrators, which should be obliterated. Since the greatest accolade a physician can earn is praise from his colleagues as expressed in an eponym entrenched in one's name, the medical profession should remove any honor given to physicians involved in crimes to humanity.