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12 Cambridge Q. Healthcare Ethics 279 (2003)
End-of-Life Care in Turkey

handle is hein.journals/cqhe12 and id is 285 raw text is: Special Section: Bioethics Now: International Voices 2003 End-of Life Care in Turkey N. YASEMIN OGUZ, STEVEN H. MILES, NUKET BUKEN, and MURAT CIVANER Most physicians confront the moral and technical challenges of treating persons who are coming to the natural end of their lives. At the level of the health system, this issue becomes a more pressing area for reform as premature death decreases and more people live a full life span. Well-developed countries and international organizations such as the World Health Organization (WHO) and the Organisation of Economic Cooperation and Development (OECD) have made recommendations for improving healthcare problems in aging societies.1-3 Turkey belongs to the WHO and the OECD. This article describes end-of-life healthcare in Turkey, the design of the healthcare system to meet this need, challenges that should be addressed, and solutions that would be appropriate to Turkish culture and resources. The People and Healthcare System of Turkey Turkey provides primary, secondary, and tertiary healthcare. The healthcare system in Turkey is based in local primary, outpatient healthcare centers. About 5,785 of these have physicians, and midwives run about 11,738 smaller rural units.4 The Ministry of Labor and Social Security has established an additional system of local clinics for workers. Collectively, this primary healthcare system focuses on preventing infectious disease and on treating acute and chronic disease. Secondary healthcare is structured around state hospitals, with a national insurance system for workers and their dependents managing its own state hospitals. University hospitals are the tertiary healthcare facilities. The healthcare system has evolved since the founding of the Turkish Repub- lic in 1923 and the socialization of healthcare in 1961. During the early years of the Republic, the highest priority was fighting infectious diseases, especially malaria, tuberculosis, trachoma, smallpox, and leprosy. Government efforts to reduce these diseases were very successful.5 With time, however, attention waned and malaria and tuberculosis increased in prevalence to again become a focus of concern.6 In 1961, Turkey socialized its healthcare system to focus on preventing disease, promoting health, and providing treatment and rehabilita- tion.7 This legislation was intended to make multidisciplinary health services available and accessible in every part of the country. This policy defined health as physical, psychological, and social well-being, which is very similar to the WHO's Declaration of Alma-Ata that was adopted 17 years later.8 There were many difficulties in implementing this reform. More emphasis was put on treating disease rather than on preventing illness. Patients and Cambridge Quarterly of Healthcare Ethics (2003), 12, 279-284. Printed in the USA. Copyright © 2003 Cambridge University Press 0963-1801/03 $16.00 279

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