saqarTvelos eqimis qcevis wesebi

`rac unda mdidari qveyana unda iyos bunebiT, Tu iq Cemida Seni, ese igi kacTa ufleba da movaleoba, ZneladgasarCevia da ar aris sayovelTaod gansazRvruli cxadadda ucilod, iq xalxis warmateba da keTildReoba, TuyoveldRe ukan ar iwevs, Seferxebuli xom aris da aris.~ilia WavWavaZe`cxovreba da kanoni~, gazeTi `iveria~ 1877 w.3

Sesavalisamoqalaqo sazogadoebis Camoyalibebis, progresisa dakeTildReobis winapirobaa yvela sferoSi, maT Soris, jandacvissistemaSi, kanonis uzenaesoba, adamianis uflebebis pativiscema,adamianebs Soris urTierTobis eTikuri normebisa da qcevis wesebisdacva.saeqimo saqmianobis warmatebulad da Rirseulad warmarTvis,samedicino momsaxurebis adekvaturi xarisxis uzrunvelyofissafuZveli, garda samedicino codnisa da unar-Cvvebisa, ariskanonmdeblobaSi asaxuli normebis, sayovelTaod aRiarebulieTikuri principebis da qcevis wesebis codna da gamoyeneba. amisaTviski aucilebelia saxelmZRvanelo, romelSic pacientTan, mis ojaxiswevrebTan da axloblebTan, kolegebTan, studentebTan,rezidentebTan, agreTve, masobrivi informaciis saSualebebis,samarTaldamcavi organoebis, industriis warmomadgenlebTan da a.S.urTierTobis principebi, wesebi iqneba asaxuli.swored zemoxsenebuliT ganisazRvreba winamdebare `saqarTveloseqimis qcevis wesebis” saWiroeba; saxeldobr, man xeli unda Seuwyos:• pacientis interesebis uzenaesobis dacvas eqimis profesiulisaqmianobisas;• komunikaciis unar-Cvevebis optimalur doneze standartizaciaseqimebs Soris;• swori gadawyvetilebis miRebas im SemTxvevebSi, rodesac eqimisamarTlebrivi da eTikuri dilemis winaSe aRmoCndeba xolme –pacientisaTvis e.w. `cudi ambebis~ (mag., fataluri daavadebisdiagnozi) Setyobineba, patimrebTan urTierToba, sicocxlisSemanarCunebeli mkurnalobis Sewyveta, tvinis sikvdiliskonstataciis Semdeg samoqmedo strategiis gansazRvra darealizacia, adamianis organoebis aReba da gadanergva damravali sxva.4

`saqarTvelos eqimis qcevis wesebis” momzadebis Sesaxeb gaformdamemorandumi moxseniebul programasa da Semdeg arasamTavroboorganizaciebs Soris: `saqarTvelos bioeTikisa da jandacvis sferossamarTlebrivi sakiTxebis Semswavleli sazogadoeba~, `saqarTvelosojaxis eqimTa asociacia~, `saqarTvelos saojaxo medicinisprofesionalTa kavSiri~ da `saqarTvelos eqimTa asociacia~.CamoTvlili organizaciebis warmomadgenelTagan Seiqmna samuSaojgufi Semdegi SemadgenlobiT: givi javaSvili (jgufis xelmZRvaneli;saqarTvelos bioeTikis da janmrTelobis dacvis samarTlebrivisakiTxebis Semswavleli sazogadoeba), guram kiknaZe (saqarTvelosojaxis eqimTa asociacia), irina qarosaniZe da Tamar gabunia(saqarTvelos saojaxo medicinis profesionalTa kavSiri), revazTaTaraZe da giorgi wilosani (saqarTvelos eqimTa asociacia).`saqarTvelos eqimis qcevis wesebze” muSaoba dasrulda 2010 wlisdekemberSi. 2011 wlis ianvridan daiwyo `saqarTvelos eqimis qceviswesebis~ farTo sazogadoebrivi ganxilva.`saqarTvelos eqimis qcevis wesebi” momzadda zemoT CamoTvliliorganizaciebis warmomadgenlebis keTili nebis safuZvelze, raimeanazRaurebis gareSe.* * *6

1. zogadi nawili:1.1. `saqarTvelos eqimis qcevis wesebis~ mizani`saqarTvelos eqimis qcevis wesebis~ mizania xeli SeuwyossaqarTveloSi eqimis profesiuli saqmianobis SesabamisobassayovelTaod aRiarebul profesiul, eTikur da samarTlebrivnormebTan, rac uzrunvelyofs:• samedicino momsaxurebis xarisxis amaRlebas;• pacientebis usafrTxoebas;• eqimsa da pacients Soris urTierTndobisa daTanamSromlobisaTvis keTilganwyobili garemos damkvidrebas;• eqimis avtoritetis zrdas.1.2. visTvis aris gamiznuli `saqarTvelos eqimis qcevis wesebi~`saqarTvelos eqimis qcevis wesebi” gamiznulia saqarTveloSimomuSave eqimebisa da yvela pirisaTvis, romlebic eqimis funqciasasruleben – rezidentebi, doqtorantebi, studentebi.amasTan, sasurvelia, rom `saqarTvelos eqimis qcevis wesebiT”ixelmZRvanelon jandacvis sxva profesionalebmac (mag., eqTnebi);Tumca, am ukanasknelTa profesiul saqmianobas, SesaZloa,awesrigebdes maTi specialobisTvis SemuSavebuli qcevis normebi.`saqarTvelos eqimis qcevis wesebi” gankuTvnilia farTosazogadoebisTvisac, romelmac, sasurvelia, kargad icodes, rasunda moelodes eqimisagan.1.3. `saqarTvelos eqimis qcevis wesebis~ safuZvlebi`saqarTvelos eqimis qcevis wesebi” efuZneba saerTaSorisodaRiarebul da qveyanaSi damkvidrebul faseulobebs daSexedulebebs pacientTan damokidebulebis, janmrTelobis dacvis,adamianis uflebebisa da eqimis profesiuli saqmianobissferoebSi. imavdroulad, is gamomdinareobs `saqarTvelos eqimiseTikis kodeqsidan~, romelic gansazRvravs saqarTveloSi eqimisprofesiuli saqmianobis fundamentur eTikur principebs.7

`saqarTvelos eqimis qcevis wesebSi” asaxulia qvemoTCamoTvlil erovnul da saerTaSoriso, savaldebulo Tudeklaraciuli bunebis dokumentebSi mocemuli debulebebi,romelic eqimis profesiuli saqmianobis samarTlebriv da eTikurregulacias isaxavs miznad:a) saqarTvelos kanonebi `saeqimo saqmianobis Sesaxeb~ (2001 w.),`pacientis uflebebis Sesaxeb~ (2000 w.) da `janmrTelobis dacvisSesaxeb~ (1997 w.), agreTve, kanonebi, romlebic jandacvisspecifikur dargebs awesrigebs, mag.: kanonebi `sazogadoebrivijanmrTelobis Sesaxeb~ (2007 w.), `aiv infeqcia/Sidsis Sesaxeb~(2009 w.), `fsiqiatriuli daxmarebis Sesaxeb~ (2006 w.) `adamianisorganoebis gadanergvis Sesaxeb” (200 w.) da sxv.b) evropis sabWos samarTlebrivi instrumentebijanmrTelobis dacvis, biomedicinisa da adamianis uflebebissferoSi, maT Soris konvencia `adamianis uflebebisa dabiomedicinis Sesaxeb~ (1997 w.) da misi damatebiTi oqmebi;g) jandacvis msoflio organizaciis deklaracia `evropaSipacientTa uflebebisaTvis xelSewyobis Sesaxeb~ (1994 w.);d) gaerTianebuli erebis saganmanaTleblo, samecniero dakulturis organizaciis (`iuneskos”) `sayovelTao deklaraciabioeTikisa da adamianis uflebebis Sesaxeb~ (2005 w.),gaerTianebuli erebis organizaciis `samedicino eTikisprincipebi~ (1982 w.);e) msoflio samedicino asociaciis `samedicino eTikissaerTaSoriso kodeqsi~ (1949 w.) da deklaraciebi, maT Soris,Jenevis, lisabonis, helsinikis, tokios, hamburgis da sxva.8

eqimi yovel Rones xmarobs, rom win aRudges winamdebare`saqarTvelos eqimis qcevis wesebSi” asaxuli principebisa daeTikuri normebis sawinaaRmdego moqmedebisaken mowodebas.1.4.4 profesiuli kompetenciaeqimi yovel Rones xmarobs mocemuli specialobisTvisqveynaSi aRiarebuli profesiuli kompetenciis (codna, unar-Cvevebi da damokidebuleba) mopovebisa da SenarCunebisaTvis,eqimi Tavis saqmianobas warmarTavs aRniSnuli kompetenciisfarglebSi.amasTan, eqimi cdilobs uari Tqvas iseT samedicinomomsaxurebaze, romelic, misi azriT, mocemul momentSi aresadageba mis codnas da unar-Cvevebs, miuxedavad imisa, rommomsaxurebis es saxe Seesabameba mis specialobas.1.4.5 kanonmdeblobis codnis da dacvis aucileblobaeqimi kargad icnobs da icavs qveyanaSi arsebulkanonmdeblobas, romelic mis profesiul saqmianobasaregulirebs. amasTan, eqimi cdilobs xeli SeuwyoskanonmdeblobaSi asaxuli im normebis Secvlas da daxvewas,romelic, eqimis azriT, ewinaaRmdegeba pacientisa dasazogadoebis janmrTelobis interesebs, xels uSlis eqims,daicvas profesiuli da eTikuri standartebi.1.4.6 profesiis prestiJiprofesiis Rirsebisa da prestiJis dacva eqimis saqmianobisaucilebeli Semadgenelia. is, upirveles yovlisa, miiRwevakeTilsindisieri profesiuli saqmianobiT, eTikuri daprofesiuli standartebis ganuxreli dacviT, sxva eqimebTankolegialuri damokidebulebiT, pacientisa da sazogadoebisjanmrTelobis interesebze gulwrfeli zrunviT.10

2. kerZo nawili2.1. eqimis damokidebuleba pacientTan profesiuli movaleobisaRsrulebisaseqimis upirvelesi sazrunavia pacienti – adamiani, romeliceqims mimarTavs janmrTelobis problemis gamo. eqimi yovelTvisunda iTvaliswinebdes, rom mas saqme aqvs ara mxoloddaavadebasTan, aramed pirovnebasTan, romelsac sakuTarifaseulobebi, Sexedulebebi da molodini aqvs, Taviseburadganicdis da aRiqvams avadmyofobas.warmatebuli saeqimo saqmianobis aucilebeli winapirobaaeqimsa da pacients Soris urTierTgagebis, urTierTndobisa daurTierTpativiscemis atmosferos Camoyalibeba, partnioruliurTierTobis damyareba.2.1.1 pacientis avtonomiis pativiscemapacientis, rogorc pirovnebis, pativiscema aucilebladgulisxmobs misi azris, Sexedulebebisa da arCevanisgaTvaliswinebas, rac pacientis avtonomiis aRiarebas niSnavs.pativi eciT pacientis avtonomias – pacientis uflebas,miiRos informirebuli gadawyvetileba misTvis samedicinodaxmarebis gawevis Taobaze.2.1.2 Tanabari da samarTliani damokidebulebaTanabari da samarTliani damokidebuleba pacientis mimarTgulisxmobs, erTi mxriv, yovelgvari diskriminaciis gamoricxvas,xolo, meore mxriv, pacientis individualuri saWiroebebisgaTvaliswinebas.dauSvebelia eqimis mier pacientis diskriminaciawarmomavlobis, socialuri mdgomareobis, aRmsareblobis,msoflmxedvelobis, daavadebis an sxva raime niSnis gamo.amasTan, pacientisTvis samedicino daxmarebis gawevisasgaiTvaliswineT misi individualuri saWiroebebi, rogorcjanmrTelobasTan, ise religiur, eTnikur, fsiqologiur,socialur Tu sxva pirovnul maxasiaTeblebTan dakavSirebuli.11

2.1.3 informaciis miwodeba2.1.3.1 informaciis miwodeba pacientisaTvispacients ufleba aqvs misTvis gasageb enaze da misTvisgasagebi formiT miiRos obieqturi, sruli, drouli informaciasakuTari janmrTelobis mdgomareobis Sesaxeb.hkiTxeT pacients, surs Tu ara sakuTari janmrTelobismdgomareobis Sesaxeb sruli informaciis miReba. survilisSemTxvevaSi, miawodeT pacients misTvis gasagebi formiTamomwuravi, obieqturi da drouli informacia:• samedicino gamokvlevebis Sedegebis, diagnozisa daprognozis, SeTavazebuli prevenciuli, sadiagnozo,samkurnalo Tu sareabilitacio RonisZiebebis, agreTve, maTiTanmxlebi riskisa da SesaZlo efeqtianobis Sesaxeb;• zemoxsenebuli SeTavazebuli RonisZiebebis alternatiulivariantebis, maTi Tanmxlebi riskisa da SesaZloefeqtianobis Sesaxeb;• samedicino momsaxurebasTan dakavSirebuli finansurisakiTxebis, samedicino dawesebulebis resursebisa daSinaganawesis Taobaze;• Tqveni (mkurnali eqimis) vinaobisa da kompetenciis Sesaxeb.pacientis informirebisas gaiTvaliswineT misi aRqmis unari,nu gamoiyenebT samedicino terminebs. darwmundiT, rom manjerovnad gaigo da Seafasa Tqvens mier miwodebuli informacia.Tu pacienti arasrulwlovania, ixelmZRvaneleT TavSi `2.2.1arasrulwlovnebi~ asaxuli rCevebiT.Tu pacients gadawyvetilebis miRebis unari SezRuduli aqvsfsiqikuri daavadebis gamo, ixelmZRvaneleT rCevebiT, romlebicmocemulia TavSi `2.2.5 eqimi da fsiqikuri daavadebis mqonepacientebi, romlebsac SezRuduli aqvT gadawyvetilebis miRebisunari~.12

Tu pacienti uars ambobs informaciis miRebaze, dahyeviT misnebas da hkiTxeT, vis SeiZleba miawodoT informacia (naTesavi,kanonieri warmomadgeneli; ix. Tavi `2.1.3.2 informaciis miwodebapacientis axloblisTvis an kanonieri warmomadgenlisTvis~).amasTan, im SemTxvevaSi, Tu pacienti uars ambobs informaciismiRebaze, magram informaciis miuwodeblobam SeiZleba zianimiayenos Tavad pacientis an mesame piris janmrTelobas, romlisvinaobac cnobilia, maSin Tqven mainc unda miawodoT pacientsinformacia.Tu pacienti gTxovT samedicino Canawerebis gacnobas,daubrkoleblad mieciT mas amisi SesaZlebloba.roca pacientma ar icis saxelmwifo da/an eqimisTvis gasagebiena, ixelmZRvaneleT kanonmdeblobiT da dawesebulebisSinaganawesiT, romelic gansazRvravs Tarjimnis mowvevisa daanazRaurebis wess.Tu Tqven grZnobT, rom enobrivi barieris gamo ar SegiZliaTsrulyofili informaciis moZieba, gaagzavneT pacienti sxvaeqimTan, romelic SeZlebs moxseniebuli dabrkolebis daZlevas.aRniSnulis SeuZleblobis SemTxvevaSi, pacientis janmrTelobisinteresebidan gamomdinare, uari TqviT samedicino momsaxurebaze,kanonmdeblobiT daSvebul SemTxvevebSi (ix. Tavi `2.1.13 eqimisuari samedicino momsaxurebis gawevaze~).Tu Tqven gaqvT safuZveli ivaraudoT, rom janmrTelobismdgomareobis Sesaxeb informaciis miwodebam SeiZleba uaryofiTigavlena iqonios pacientis mdgomareobaze:• SezRudeT informaciis moculoba an saerTod nu miawodebTinformacias;• zemoT miTiTebul gadawyvetilebas individualurad numiiRebT; aucileblad SeajereT is Tqveni dawesebulebiseTikis komisiasTan an, misi ararsebobis SemTxvevaSi, TqvenskolegasTan;13

• rogorc erT, ise meore zemoxsenebul SemTxvevaSi pacientissamedicino dokumentaciaSi werilobiT daasabuTeTinformaciis armiwodebis an SezRudvis saWiroeba dagadawyvetileba; agreTve, daafiqsireT samedicino eTikiskomisiis an kolegis Tanxmoba;• Tu pacienti daJinebiT moiTxovs misTvis sruli informaciismiwodebas, maT Soris samedicino Canawerebis gacnobas, Tqven,miuxedavad zemoT moxseniebuli garemoebisa, valdebulixarT, mas sruli informacia miawodoT.2.1.3.2 informaciis miwodeba pacientis axloblisTvis an kanonieriwarmomadgenlisTvis• qmedunariani pacientis janmrTelobis Sesaxeb informacia miskanonier warmomadgenels an naTesavs miawodeT mxolod imSemTxvevaSi, Tu Tqven amis Taobaze pacientisgan TanxmobamiiReT. amasTan, pacientma Tavad unda daasaxelos im pirisvinaoba, romelsac informacias miawodebT;• Tu pacienti qmeduunaroa an ar aqvs gacnobierebuligadawyvetilebis miRebis unari, informacia miawodeTpacientis kanonier warmomadgenels an naTesavs.2.1.4 informirebuli Tanxmoba, pacientis gadawyvetilebis pativiscemainformirebuli Tanxmoba samedicino Carevis aucilebelipirobaa; is uzrunvelyofs samedicino Carevis Sesaxebgadawyvetilebis miRebaSi pacientis Tanamonawileobas.pacientis informirebuli Tanxmoba ama Tu im samedicinoCarevaze gulisxmobs misi Tanxmobis miRebas mxolod mas Semdeg,rac pacients detalurad ganemarta:• ra saxis Carevaa ganzraxuli;• ratom sWirdeba pacients es Careva;• rogoria ganzraxuli Carevis mosalodneli Sedegi, radiskomforti, garTulebebi aris SesaZlebeli, rogoriariski pacientis janmrTelobisa da sicocxlisTvis;• ra Sedegi SeiZleba mohyves ganzraxul Carevaze uaris Tqmas;14

• ganzraxuli Carevis ra alternativebi arsebobs, ramdenadxelmisawvdomia es Carevebi teritoriulad, finansurad; raupiratesoba an nakli aqvs maT, ganzraxul CarevasTanSedarebiT.zemoT miTiTebuli informaciis miwodebisas esaubreTpacients misTvis gasagebi eniT, samedicino terminebisgamoyenebis gareSe, ise, rom man kargad gaigos da Seafasosmiwodebuli informacia.informirebuli Tanxmobis aucilebeli pirobaa pacientisqmedunarianoba da gacnobierebuli gadawyvetilebis miRebisunari. Tu pacienti qmeduunaroa an moklebulia gacnobierebuligadawyvetilebis miRebis unars, ixelmZRvaneleT rekomendaciebiT,romlebic asaxulia TavebSi `2.2.1 arasrulwlovnebi~ da `2.2.5eqimi da fsiqikuri daavadebis mqone pacientebi, romlebsacSezRuduli aqvT gadawyvetilebis miRebis unari~.amasTan, gaiTvaliswineT, rom:• pacientis Tanxmoba samedicino Carevaze unda iyosTavisufali 1 ;• saqarTvelos kanonmdebloba zogierTi samedicinoCarevisaTvis aucileblad miiCnevs werilobiT informirebulTanxmobas 2 .werilobiTi informirebuli Tanxmoba aucilebeliaqirurgiuli operaciebis, sxva invaziuri da maRal riskTandakavSirebuli procedurebis SemTxvevaSi (mag., sxivuri Terapia,qimioTerapia, genetikuri testireba da sxva). amasTan, SegiZliaT,Tqveni Sexedulebisamebr, nebismier SemTxvevaSi miiRoTpacientisagan werilobiTi informirebuli Tanxmoba.1Tavisufali Tanxmoba – Tanxmoba, miRebuli yovelgvari zewolis, zegavlenis(fsiqologiuri, finansuri da sxv.) gareSe.2 saqarTvelos kanoni `saeqimo saqmianobis Sesaxeb ~, muxli 44.115

2.1.4.1 pacientis uari samedicino momsaxurebis gawevazepacients SeuZlia uari Tqvas nebismier samedicino Carevaze.kanoni krZalavs qmedunariani da gacnobierebuli gadawyvetilebisunaris mqone pacientis nebis winaaRmdeg raime samedicino Carevas.roca pacienti uars acxadebs samedicino momsaxurebaze, amaTu im samedicino Carevaze, darwmundiT, rom pacients kargadesmis am Carevis mizani, mniSvneloba, mosalodneli sargebloba dariski, misi (samedicino Carevis) arCatarebis mosalodneliSedegebi; meore mxriv, kargad SeafaseT pacientis miergacnobierebuli gadawyvetilebis miRebis unari. am ukanaskneliskritikuli Sefaseba gansakuTrebiT mniSvnelovania, roca pacientiuars ambobs misi janmrTelobisa da sicocxlisaTvismniSvnelovan Carevaze.roca samedicino momsaxurebaze uars acxadebs pacientiganukurnebeli daavadebis terminaluri stadiiT, ixelmZRvaneleTrekomendaciebiT, romlebic asaxulia TavSi `2.2.5 pacientiganukurnebeli daavadebis terminalur stadiaze, paliatiurimzrunveloba, tkivilis marTva~.2.1.4.2 pacientis winaswar gacxadebuli nebasaqarTvelos kanonmdeblobiT moqlaqes SeuZlia winaswarwerilobiT gamoxatos neba misTvis samedicino momsaxurebisgawevis Sesaxeb im SemTxvevebSi, roca is ver SeZlebs sakuTarinebis gamoxatvas (mag., aRmoCndeba komur mdgomareobaSi).saqarTveloSi jerjerobiT ar arsebobs pacientebis winaswargacxadebuli nebis registri. amitom, zemoaRniSnulis SesaxebhkiTxeT pacientis ojaxis wevrebs, axloblebs. aseTi werilobiTidokumentis arsebobis SemTxvevaSi, gaiTvaliswineT pacientissurvili misTvis samedicino momsaxurebis gawevis Sesaxeb, magramgaxsovdeT, rom aseTi neba ar SeiZleba exebodes sicocxlisSemanarCunebeli mkurnalobis Sewyvetas an arCatarebas, garda imSemTxvevebisa, roca pacients aqvs fataluri an mZime invalidobisgamomwvevi daavadeba.16

2.1.5 informaciis konfidencialurobapacientis janmrTelobis mdgomareobisa da piradi cxovrebisSesaxeb informacia konfidencialuria. Tqven ar unda gaamJRavnoTis arc pacientis sicocxleSi da arc misi sikvdilis Semdeg.dauSvebelia konfidencialuri informaciis gamJRavnebamasobrivi informaciis saSualebebis warmomadgenlebisaTvis.konfidencialuri informaciis gamJRavneba SeiZleba, Tu:• pacienti Tanaxmaa, rom misi janmrTelobis mdgomareobisa Tupiradi cxovrebis Sesaxeb informacia gadaeces sxva pirs anpirebs;• informaciis gaumJRavnebloba safrTxes uqmnis mesame piris(romlis vinaobac cnobilia) janmrTelobas an/da sicocxles;• informacia miewodeba samedicino momsaxurebaSi CarTul sxvasamedicino personals;• Tqven gaqvT dasabuTebuli eWvi savaldebulo aRricxvasdaqvemdebarebuli daavadebis arsebobaze;• informacias, werilobiTi momarTvis safuZvelze, iTxovssasamarTlo an prokuraturis organoebi;• es gaTvaliswinebulia Sesabamisi kanonmdeblobiT.rogorc zemoT aris miTiTebuli, pacientis Sesaxebkonfidencialuri informacia kolegas gauziareT mxolod maSin,Tu igi CarTulia pacientisaTvis samedicino daxmarebaSi;magaliTad, rodesac kolegasTan agzavniT pacients an kolegaraRac etapze ukve monawileobda pacientisaTvis samedicinomomsaxurebaSi, agreTve, yvela sxva SemTxvevaSi, roca TvliT, rommisi rCeva mniSvnelovania konkretuli pacientis samedicinoproblemis marTvisaTvis.amasTan, aRniSnul SemTxvevebSi, kolegasTan pirispir Tusatelefono saubrisas, darwmundiT, rom aravin gismenT (mag., arxarT sxvaTa garemocvaSi). aseve, gaufrTxildiT samedicinoCanawerebs, faqsiT Tu eleqtronuli fostiT miRebul17

informacias, konsultantebis Canawerebs da uzrunvelyaviT maTidacva ise, rom isini ar iyos xelmisawvdomi SemTxveviTipirebisTvis.nuravis gaumJRavnebT informacias pacientis ojaxuricxovrebis intimuri detalebis Sesaxeb, pacientis sikvdilisSemdegac ki.2.1.6 pirad cxovrebaSi CaurevlobapacientisaTvis mniSvnelovania, rom ambulatoriasa TusaavadmyofoSi hqondes garkveulwilad izolirebuli, daculigaremo da samedicino momsaxurebis miRebisas `moridebuli iyosucxo Tvals~.pativi eciT pacientis am survils; Sesabamisad, konsultaciasan ama Tu im samedicino proceduras nuravis daaswrebT, garda imSemTxvevebisa, roca pacienti Tavad iTxovs amas (axlobeli,ojaxis wevri da sxv.) an Tu TvliT, rom aucilebelia sxvasamedicino personalis, studentebis an rezidentebis daswreba damonawileoba. yvela SemTxvevaSi pacients acnobeT, vin da ratomaris mowveuli da miiReT misgan Tanxmoba.zogjer erTi-erTze saubari da pacientis gasinjvaizolirebul garemoSi SeuZlebelia samedicino dawesebulebaSiarsebuli pirobebis gamo – mravalsawoliani palata, intensiuriTerapiis ganyofileba. aseT SemTxvevaSi SeecadeT, maqsimaluraduzrunvelyoT pacientisaTvis komfortuli garemo (mag., Sirmisgamoyeneba); am dros pacients esaubreT SeZlebisdagvaradxmadabla, ise, rom Tqveni saubari mxolod misTvis iyos gasagoni.2.1.7 pacientis monawileoba studentebis, rezidentebis, eqimebisswavlebasa da mzadebaSipacientis monawileoba studentebis, rezidentebis, eqimebisswavlebasa da mzadebaSi samedicino praqtikis aucilebeliTanamdevi procesia.ganumarteT pacients, risTvis aris saWiro studentebis,rezidentebis da/an sxva eqimebis daswreba pacientis fizikurigasinjvisas, romelime samedicino proceduris (qirurgiuli18

Carevis CaTvliT) an sxvaTa mier Catarebulipacientis Tanxmoba am SemTxvevebSi aucilebelia.konsultaciisas.SeecadeT, rom xsenebulTa daswrebam minimaluri diskomfortiSeuqmnas pacients. proceduris damTavrebisas madlobagadauxadeT mas keTili nebisaTvis.Tu pacienti qmeduunaroa an SezRuduli aqvs qmedunarianoba,an moklebulia gacnobierebuli gadawyvetilebis miRebis unars,werilobiTi informirebuli Tanxmoba unda miiRoT pacientisnaTesavisgan an axloblisagan.swavlebis mizniT (leqcia, seminari, SemTxvevis garCeva da a.S.)pacientis janmrTelobis mdgomareobis amsaxveli dokumentaciisgamoyenebisas monacemebi warmoadgineT ise, rom SeuZlebeli iqnespirovnebis identificireba.2.1.8 holistikuri midgoma: pacientTan urTierTobisbiofsiqosocialuri modelipacientis janmrTelobasTan dakavSirebuli problemebis (anubiosamedicino problemebis) gadaWrisas gaiTvaliswineT pacientisfsiqologiuri maxasiaTeblebi da im socialuri garemosTaviseburebebi, romelSic pacienti cxovrobs (ojaxi, samsaxurida a.S.).moxseniebuli mniSvnelovani winapirobaa Tqvenirekomendaciebis rigianad Sesasruleblad da, aqedan gamomdinare,efeqturi samedicino momsaxurebisaTvis, pacientiskmayofilebisaTvis. SeecadeT pasuxi miiRoT kiTxvebze:• rogoria daavadebis pacientiseuli aRqma da gancda? rogorafasebs pacienti Tavis janmrTelobas da daavadebas? xom araqvs gadaWarbebuli SiSi, SfoTva an zerelad xom araRiqvams Tavis problemebs?• rogor zrunavs sakuTar janmrTelobaze? ras moeliseqimisagan da jandacvis sistemisgan?• ramdenad SeTavsebadia Tqveni rekomendaciebi:19

o pacientis qceviT maxasiaTeblebTan (organizebuloba,akuratuloba, Cvevebi, tradiciebi da a.S.)?o mis mikrosocialur garemosTan (ojaxis wevrebi, maTidamokidebuleba pacientisadmi, sacxovrebeli pirobebi,vin hyavs gverdiT, vin SeiZleba daexmaros eqimisdaniSnulebis da rCevebis SesrulebaSi)?• ramdenad xelmisawvdomia misTvis (finansurad,teritoriulad, teqnikurad da sxv.) Tqvens mierrekomendebuli prevenciuli, sadiagnozo, samkurnalo Tusareabilitacio RonisZiebebi?zemoxsenebul kiTxvebze pasuxebis gaTvaliswinebagagiadvilebT pacientisaTvis misaRebi da Sesrulebadirekomendaciebis Camoyalibebas, pacientis CarTvasgadawyvetilebis miRebisa da misi realizaciis procesSi.2.1.9 eqimi – komunikaciis eqspertipacientze orientirebuli, efeqturi komunikaciagulisxmobs pacientisadmi gulwrfeli TanagrZnobis, Tanadgomisgamoxatvas, Ria, gaxsnil, gulisxmier, zrdilobian urTierTobasmisi ndobis mosapoveblad.eqimi pacientTan misalmebisa da gamomSvidobebis dros iqcevaise, rogorc es miRebulia zogadad sazogadoebaSi, amave dros,konkretuli pacientis individualuri maxasiaTeblebisgaTvaliswinebiT. es, upirveles yovlisa, gulisxmobs wamodgomasmigebebisa da gamomSvidobebis dros.mieciT pacients saubris dro da saSualeba; acadeT, sruladgamoxatos Tavisi azri, gancda daavadebis Taobaze, SfoTvebi damolodini; reagirebis gareSe nu datovebT pacientis emocias.esaubreT pacients mkafiod da misTvis gasagebi eniT, SeafaseTramdenad aRiqvams is Tqvens naTqvams.ecadeT, CamouyaliboT pacients motivacia cxovrebis nirisSesacvlelad, samkurnalo sqemis guldasmiT Sesasruleblad,sakuTar janmrTelobaze zrunvisaTvis.20

konsultaciis procesSi nu iqnebiT dakavebuli samedicinoCanawerebis warmoebiT. ecadeT, gqondeT TvaliT kontaqti (uyureTpacients); saWiroebisamebr, isargebleT araverbalurikomunikaciis sxva meTodebiT (eqimis poza, manZili eqimsa dapacients Soris da sxv.). gaxsovdeT, rom `araverbalurigzavnilebis” gamoyeneba xSirad ufro metad moqmedebs pacientze,vidre sityva.2.1.10 eqimi rogorc pacientis maswavlebelipacientisaTvis aRmoCenili samedicino daxmarebis erT-erTimniSvnelovani nawilia pacientis ganaTleba mis janmrTelobasTandakavSirebul (daavadebaTa prevencia, mkurnaloba, reabilitacia)sakiTxebSi. pacientis ganaTleba xels uwyobs Tqvensa dapacients Soris TanamSromlobis – e.w. `Terapiuli aliansis”Camoyalibebas. is aucilebeli winapirobaa imisaTvis, rom pacientidaavadebis marTvis monawile gaxdes da ar darCes mxolod eqimismiTiTebebis brmad da usityvod Semsruleblad; moxseniebulimniSvnelovanwilad aris samedicino momsaxurebis efeqturobissafuZveli.yovelTvis ganumarteT pacients misi roli sakuTarijanmrTelobis SenarCunebasa da gaumjobesebaSi; ra undagaakeTos, ratom unda Seasrulos Tqveni rekomendaciebi.moxseniebuls didi mniSvneloba aqvs pacientisaTvis motivaciisSeqmnisaTvis.SeecadeT, Tqveni rekomendaciebi iyos konkretuli,pacientisaTvis gasagebi da Sesrulebadi.amasTan, pacientisaTvis informaciis miwodebisas cxovrebisjansaRi wesis Taobaze gaiTvaliswineT is iSviaTi SemTxvevebic,roca pacientma Tqveni rCeva SeiZleba pirad cxovrebaSi CarevadaRiqvas. sxva SemTxvevaSi moxseniebuli informacia misTvis ama Tuim mavne CveviT ganpirobebuli daavadebis aRmocenebis SiSisgaCenis da sulieri simSvidis darRvevis mizezi SeiZleba gaxdes(iatrogenia). am dros janmrTeli adamiani sakuTar sxeulSiiwyebs safrTxis niSnebis Ziebas. aseT SemTxvevebSi SeecadeT21

daarwmunoT pacienti, rom mas arafers umalavT da Tqveni mizaniamxolod cxovrebis jansaRi wesis propaganda da misivejanmrTelobis dacva.igive garemoebebia gasaTvaliswinebeli avTvisebianis simsivnisskriningis Sesaxeb rekomendaciebis micemisas.2.1.11 eqimi da rTuli pacientirTuli pacientis damaxasiaTebelia disforiuli depresia,mometebuli SfoTva an agresiuloba.sirTule SeiZleba dakavSirebuli iyos fsiqiatriulproblemasTan, personologiur, qceviT TaviseburebebTan.imavdroulad, pacientTan urTierTobis siZnele Tavad eqimisgamoucdelobiT, komunikaciis unar-Cvevebisa da moulodnel daaraadekvatur reaqciebTan gamklavebis unaris arasrulyofilebiTSeiZleba iqnes ganpirobebuli; agreTve, eqimis gadatvirTulobiT,daRlilobiT da sxva pirovnuli garemoebebiT. udavo mniSvnelobaaqvs jandacvis sistemis naklovanebebsac; am ukanaskneliTgamowveuli ukmayofileba pacients eqimze gadaaqvs, rac arTulebspacientsa da eqims Soris urTierTobas. sistemasTandakavSirebuli naklovanebebi gulisxmobs eqimis zedmiwevniTgadatvirTvas, cvlilebebs jandacvis dafinansebaSi, sadazRvevopaketiT Tu sxva ram mizeziT ganpirobebul vizitebis arasakmarissixSires. moxseniebuli aryevs eqimis avtoritets.guldasmiT SeafaseT rTuli pacienti fsiqopaTologiisaRmosaCenad. dasaxmareblad moixmeT kolegebi. specifikurisakomunikacio teqnika da pacientis SeZlebisdagvaradmaqsimaluri CarTuloba procesSi aumjobesebs urTierTobas.rTul pacientTan urTierTobisas:• mouxmeT kolegas, erTad gansajeT situacia; Tu saWirodCaTvliT, daixmareT fsiqoTerapevti;• gamohyaviT aseTi pacientis vizitisaTvis Cveulebrivze metidro;22

• saTanadod daafiqsireT sirTulis komponentebi samedicinodokumentaciaSi; aucileblad aRnusxeT sirTuleebisdaZlevis Tqveneuli mcdelobebi, maTi Sedegianoba TuuSedegoba.2.1.12 momsaxurebis uwyvetoba, momsaxurebaSi sxva personalis CarTvasamedicino momsaxurebis uwyvetoba gulisxmobs aucilebeliprevenciuli, sadiagnozo, samkurnalo Tu sareabilitacioRonisZiebebis Seuferxebel ganxorcielebas, rogorc erTisamedicino dawesebulebis farglebSi erTi an ramdenimemedicinis muSakis mier, aseve, sxva dawesebulebebSi sxvadasxvaspecialistebis koordinirebuli TanamSromlobis safuZvelze.Tqveni SesaZleblobebis farglebSi, yvela Rone ixmareTmomsaxurebis wyvetis gamomwvevi SesaZlo mizezebis (finansuri,organizaciuli, pirovnuli da a.S.) aRmosafxvrelad.Tu samedicino momsaxurebis uwyvetobis uzrunvelsayofadsaWirod migaCniaT sxva samedicino personalis CarTvamomsaxurebis procesSi:a) ganumarteT pacients, ratom aris saWiro sxva samedicinopersonalis CarTva;b) miawodeT pacients mkafio, misTvis gasagebi informaciaaucilebeli samedicino momsaxurebis Sesaxeb – ragamokvlevebi, konsultaciebi, samkurnalo, prevenciuli Tusareabilitacio RonisZiebebia misTvis aucilebeli da ravadebSi; daixmareT pacientis axloblebi (amisTvis pacientisTanxmobaa saWiro), Tu varaudobT, rom es xels Seuwyobspacientis mier zemoxsenebuli informaciis srulfasovnadaRqmas da Sefasebas;g) awarmoeT mkafio samedicino Canawerebi (samedicino baraTi,sakonsultacio furceli, daskvnebi, cnobebi, amonawerebi dasxv.), organizebuli, sistemuri saxiT, ise, rom maTi moZiebada gacnoba advili iyos kolegebisTvis;23

d) SeecadeT daukavSirdeT kolegas (Tu is sxva dawesebulebaSimuSaobs), romelic CarTulia an unda CaerTos Tqvenipacientis samedicino momsaxurebaSi. yvela SemTxvevaSiwerilobiT ganumarteT kolegas pacientis gagzavnis mizanida janmrTelobis problemis arsi;e) roca pacients iRebT sxva eqimis momarTviT, romelSicmiTiTebulia konsultaciis mizani, SeecadeT sakonsultaciobaraTSi mkafiod asaxoT miznis Sesabamisi informacia,agreTve, yvela monacemi, romelic, Tqveni azriT,sayuradReboa pacientis janmrTelobisaTvis;v) Tu raime mizezis gamo ar gaqvT pacientisaTvis samedicinomomsaxurebis gawevis da/an misi uwyvetobis uzrunvelyofisSesaZlebloba, auxseniT mas, vis da rogor SeuZlia mimarTos.amasTan, uzrunvelyaviT kolegisaTvis (vinc, savaraudod,pacients samedicino momsaxurebas gauwevs) samedicinoCanawerebis xelmisawvdomoba;z) dauSvebelia raime sazRauris an sxva sargeblis moTxovna anmiReba im eqimisgan, an eqimis funqciis Semsruleblisgan,romlis CarTva pacientis momsaxurebis procesSi TqvenganizraxeT;sxva samedicino personalis momsaxurebaSi CarTvis formebia:• delegireba;• referali;• gadabareba.delegireba gulisxmobs:a) kolegisTvis Txovnas, gauwios pacients Tqvens miergansazRvruli, TqvenTan SeTanxmebuli samedicino momsaxureba.delegirebis adekvaturobisaTvis, momsaxurebis xarisxisa daSedegisaTvis pasuxismgebloba Tqven gekisrebaT, TumcaRa gaweulimomsaxurebis (manipulacia an sxva raime qmedeba) xarisxisaTvis daSedegisaTvis pasuxs agebs ganmaxorcielebelic;24

) eqimis funqciis SemsrulebelisaTvis (studenti, rezidenti)Txovnas gauwios pacients Tqvens mier gansazRvruli, TqvenTanSeTanxmebuli samedicino momsaxureba. delegirebisadekvaturobisaTvis, momsaxurebis xarisxisa da SedegisaTvispasuxismgebloba Tqven gekisrebaT.referali gulisxmobs sxva eqimisTvis da/an samedicinodawesebulebisTvis pacientis gagzavnas garkveuli mizniT dagarkveuli droiT (roca ar gagaCniaT saTanado resursi, marTvascildeba Tqveni profesiuli kompetenciis farglebs da sxv.),pacientis janmrTelobis problemis marTvisaTvispasuxismgeblobis nawilobriv an mTlianad gadacemiT.gadabareba gulisxmobs pacientis janmrTelobis problemismarTvisTvis pasuximgeblobis srulad gadacemas sxvaprofesionalisaTvis.yvela zemoxsenebul SemTxvevaSi:• kolegas Tu samedicino dawesebulebas sruli informaciaunda miawodoT pacientis janmrTelobis mdgomareobisa damisTvis ukve gaweuli samedicino momsaxurebis Sesaxeb;• darwmunebuli unda iyoT, rom saWiro momsaxurebaganxorcieldeba momsaxurebis gasawevad aucilebeli droisganmavlobaSi;• unda gqondeT dasabuTebuli varaudi, rom uzrunvelyofiliiqneba momsaxurebis usafrTxoeba da xarisxi.2.1.13 eqimis uari samedicino momsaxurebis gawevaze, samedicinomomsaxurebis SewyvetayovelTvis, roca uars ambobT an wyvetT samedicinomomsaxurebas, Tuki es SesaZlebelia, acnobeT pacients(saWiroebisas, mis kanonier warmomadgenels an naTesavs)samedicino momsaxurebis gawevaze uaris Tqmis an dawyebulisamedicino momsaxurebis Sewyvetis mizezi.25

2.1.13.1 eqimis profesiul kompetenciasTan da resursebisukmarisobasTan dakavSirebuli uarisamedicino momsaxurebis dawyebamde kritikulad SeafaseTTqveni profesiuli kompetencia, Tqvens xelT arsebuli resursebida uari TqviT momsaxurebaze, Tu:• is scildeba Tqveni specialobis farglebs an SeesabamebaTqvens specialobas, magram ar eTanadeba Tqvens codnas daunar-Cvevebs;• adekvaturi momsaxurebisa da xarisxis uzrunvelyofisaTvisaucilebeli pirobebi da/an resursebi ar gagaCniaT.zemoaRniSnuli ar exeba pacientisaTvis gadaudebelisamedicino daxmarebis gawevas (ix. Tavi `2.3 gadaudebelisamedicino momsaxureba~).profesiuli kompetenciis, agreTve, Sesabamisi pirobebisa daresursebis ukmarisobis gamo pacientisaTvis samedicinomomsaxurebis gawevaze uaris Tqmis an momsaxurebis SewyvetisSemTxvevaSi urCieT pacients, vis, sad da rogor unda mimarTosmisTvis saWiro samedicino momsaxurebis misaRebad, agreTve,uzrunvelyaviT pacientis janmrTelobis Sesaxeb Tqvens xelTarsebuli informaciis xelmisawvdomoba sxva samedicinopersonalisaTvis, romelic gauwevs pacients momsaxurebas;amasTan, ixelmZRvaneleT TavSi `2.1.12 momsaxurebis uwyvetoba,momsaxurebaSi sxva personalis CarTva~ asaxuli rekomendaciebiT.2.1.13.2 samedicino da eTikur kriteriumebTan an akrZalvasTandakavSirebuli uariuari TqviT samedicino Carevaze:• romelic kanonmdeblobiT akrZalulia;• romlis Catareba samedicino kriteriumebiTgaumarTlebelia da/an ar Seesabameba eTikur normebs,miuxedavad imisa, vin gTxovT aseTi Carevis ganxorcielebas.2.1.13.3 eqimis usafrTxoebasTan dakavSirebuli uariTqven SegiZliaT uari TqvaT pacientis samedicinomomsaxurebaze an SewyvitoT ukve dawyebuli samedicino26

momsaxureba, Tu momsaxurebis dros Tqvens sicocxles realurisafrTxe Seeqmna (mag. xanZari, eleqtrotravmis an afeTqebissaSiSroeba da sxv.).amasTan, Tqveni SesaZleblobebis farglebSi, SeecadeT,uzrunvelyoT pacientisaTvis samedicino daxmarebis gasawevadsaWiro pirobebi; amisaTvis dauyovnebliv daukavSirdiT dagamoiZaxeT Sesabamisi samsaxurebi (saxanZro-samaSvelo samsaxuri,policia da a.S.). pacients daxmareba aRmouCineT, rogorc ki amisiSesaZlebloba mogecemaT.2.1.13.4 eqimis moralur SexedulebebTan dakavSirebuli uariTqven SegiZliaT uari TqvaT samedicino Carevaze, rocaaRniSnuli samedicino Careva kanonmdeblobiT daSvebulia, magramewinaaRmdegeba Tqvens moralur faseulobebs.zemoaRniSnuli ar exeba pacientisaTvis gadaudebelisamedicino daxmarebis gawevas (ix. Tavi `2.3 gadaudebelisamedicino momsaxureba~).Tu Tqven, Tqveni moraluri Sexedulebebis gamo, saerToduars ambobT ama Tu im samedicino Carevis ganxorcielebaze, amisSesaxeb winaswar acnobeT dawesebulebis xelmZRvanels,saWiroebisas, sadazRvevo kompanias da/an jandacvis marTvisadgilobriv struqturas da Tqvens pacientebs.2.1.13.5 samedicino momsaxurebis Sewyveta da pacientTanprofesiuli urTierTobis dasruleba pacientis qcevis gamozogjer pacientis qcevis gamo (agresiuloba, Zaladoba,qurdoba, araadekvaturi qmedeba) SeuZlebeli xdeba pacientTanprofesiuli urTierTobis gagrZeleba da misTvis samedicinomomsaxurebis gaweva.sanam pacientTan profesiuli urTierTobis gawyvetis Sesaxebgadawyvetilebas miiRebdeT, SeecadeT normaluri komunikaciisaRdgenas, hkiTxeT rCeva kolegas, xelmZRvanels; amasTan,ixelmZRvaneleT rekomendaciebiT, romlebic asaxulia TavSi `2.1.11eqimi da rTuli pacienti~.27

pacientTan profesiuli urTierTobis dasrulebis Sesaxebgadawyvetileba kargad daasabuTeT; acnobeT pacients aRniSnulisSesaxeb, umjobesia werilobiT, urTierTobis dasrulebismizezebis aRniSvniT.acnobeT pacients, sad SeuZlia samedicino momsaxurebisgagrZeleba da uzrunvelyaviT pacientis janmrTelobis SesaxebTqvens xelT arsebuli informaciis (upirveles yovlisa,samedicino Canawerebis) xelmisawvdomoba im samedicinopersonalisaTvis, romelic gaagrZelebs pacientis samedicinomomsaxurebas; amasTan, ixelmZRvaneleT TavSi `2.1.12 momsaxurebisuwyvetoba, momsaxurebaSi sxva personalis CarTva~ asaxulirekomendaciebiT.2.2. eqimi da sazogadoebis daucveli, mowyvladi nawili2.2.1 arasrulwlovnebiarasrulwlovani pacientis SemTxvevaSi gadawyvetilebismimRebia mSobeli an meurve/kanonieri wamomadgeneli. Sesabamisad,maTi Tanxmobis misaRebad Tqven unda imoqmedoT ise, rogorcmoqmedebT pacientisgan Tanxmobis miRebis SemTxvevaSi (ix. Tavi`2.1.4 informirebuli Tanxmoba, pacientis gadawyvetilebispativiscema~). imavdroulad, SeecadeT, arasrulwlovani, misiasakis, gonebrivi ganviTarebis Sesabamisad, gadawyvetilebismiRebisas Tanamonawiled gaxadoT da gaiTvaliswinoT misi azrisamedicino Carevaze.zemoxsenebulidan gamomdinare, arasrulwlovnebTanurTierToba damatebiT moTxovnebs uyenebs eqims. es imiTiaganpirobebuli, rom xSirad rTulia balansis dacva qvemoTCamoTvlil sam komponents Soris:• arasrulwlovnis interesebi da molodini, mis SegrZnebebida emociebi;• arasrulwlovnis mSoblis an kanonieri warmomadgenlisinteresebi da molodini, mis SegrZnebebi da emociebi;28

• eqimis mier gansazRvruli saWiroebebi da Sesabamisigadawyvetilebebi ama Tu im samedicino Carevis Taobaze.gaiTvaliswineT, rom xSirad is, rasac mozrdilebisamarTlianad afaseben, rogorc adekvaturi gadawyvetilebisamsaxvel qmedebas (samedicino Carevis saxiT), bavSvisTvis mxolodZaladobaa, Tu is saTanadod ar aris amisTvis momzadebuli.zemoT moxseniebuli winaaRmdegobebis dasaZlevadarasrulwlovans SeuqmeniT uSfoTveli da naklebaddamTrgunveli garemo, pativiscemiT moepyariT, guldasmiT dakeTilganwyobilad mousmineT mas, stimuli mieciT, dagisvaTkiTxvebi; SeecadeT, amomwuravad upasuxoT kiTxvebze, agrZnobineT,rom misi azri TqvenTvis mniSvnelovania. gadawyvetilebismiRebisas, SeZlebisdagvarad, gaiTvaliswineT misi azri,daarwmuneT is, rom angariSs uwevT mis mosazrebebs, survilebsda molodins.mozardTan (e.w. `TineijerTan~) urTierTobisas SeecadeT, romdrois garkveuli monakveTi marto dahyoT masTan, mSoblisgareSe. SesaZloa, is ufro metad gendoT da gagimxiloT misTvisintimuri informacia. imavdroulad, am informaciis safuZvelzegadawyvetilebis miRebisas gaiTvaliswineT mSoblebis azri. imSemTxvevaSi, Tu mSoblis/kanonieri warmomadgenlisgadawyvetileba safrTxes uqmnis arasrulwlovnis sicocxlesda/an janmrTelobas, wvrilad moiZieT mSoblis/kanonieriwarmomadgenlis mier arasrulwlovnisTvis daxmarebis aRmoCenazeuaris Tqmis mizezi (mag., finansuri, aRmsareblobiTi da sxv.),detalurad ganumarteT mSobels/kanonier warmoadgenelsdaxmarebaze uaris Tqmis mosalodneli Sedegebi da isic, romTqven gaqvT kanoniT moniWebuli ufleba, miuxedavadmSoblis/kanonieri warmomadgenlis uarisa, bavSvs daxmarebaaRmouCinoT, Tu es aucilebelia bavSvis sicocxlis gadasarCenad.zemoT miTiTebul situaciaSi, Tu aucilebelia gadaudebelidaxmareba, imoqmedeT arasrulwlovnis interesebis Sesabamisad.29

mSoblebis/kanonieri warmomadgenlis winaaRmdegobisSemTxvevaSi, arasrulwlovnis sicocxlis gadasarCenad mimarTeTsamarTladamcav organoebs (sapatrulo policias).Tu gadaudebeli daxmareba ar aris aucilebeli da droiTmens, mimarTeT kolegebs, Tqveni dawesebulebis eTikiskomitets, administracias, uflebadamcvel organizaciebs,socialur samsaxurebs, sasamarTlos. sasamarTlosgadawyvetileba Sesasruleblad savaldebuloa rogorc bavSvismSoblisa Tu kanonieri warmomadgenlisTvis, ise eqimisTvis.2.2.2 braldebulebi da msjavrdebulebibraldebulebTan da msjavrdebulebTan Tqveni profesiuli,rogorc pirdapiri, ise arapirdapiri, urTierTobis erTaderTimizani unda iyos maTi janmrTelobis Sefaseba, dacva dagaumjobeseba.moxseniebul pirTaTvis samedicino daxmarebis gawevisasSeecadeT, kanonmdeblobiT gansazRvrul farglebSi, maTifizikuri da fsiqikuri janmrTelobis dacva, Rirsebisa daavtonomiis pativiscema uzrunvelyoT imave xarisxiTa da wesebiT,rogorc im adamianebisa, romlebic ar arian braldebulebi anmsjavrdebulebi.arasodes gamoiyenoT Tqveni codna da unar–Cvevebi iseTiqmedebebisaTvis, ramac SeiZleba uaryofiTad imoqmedosbraldebulisa da msjavrdebulis janmrTelobaze, Seuqmnas masnebismieri saxis diskomforti. amasTan, gadawyvetilebis miRebisas,angariSi gauwieT sxvaTa, braldebulebisa Tu msjavrdebulebis,agreTve, momsaxure personalis usafrTxoebas.2.2.2.1 moSimSile braldebuli da msjavrdebuliSimSilobis gamocxadeba braldebulis da msjavrdebulisuflebaa.wvrilad ganumarteT pirs sakvebis miRebis Sewyvetismosalodneli Sedegebi, darwmundiT, rom mas Seswevs30

gacnobierebuli gadawyvetilebis miRebis,adekvaturi Sefasebis unari.SimSilobis Sedegebisdaskvnebs moxseniebulis Taobaze nu gamoitanTerTpirovnulad, aucileblad mouxmeT kolegas. Tu TqvendarwmundiT, rom pacienti adekvaturad afasebs SimSilobismosalodnel Sedegebs, samedicino daxmareba gauwieT mxolodmisi TanxmobiT. nu SeecdebiT mis iZulebiT xelovnur kvebas;ganumarteT mas, rom ugono mdgomareobis dadgomis SemTxvevaSiTqven, miuxedavad mis mier winaswar gacxadebuli nebisa, itovebTuflebas, gamoiyenoT yvela saSualeba, maT Soris xelovnurikveba, misi janmrTelobis SesanarCuneblad da/an sicocxlisgadasarCenad. aseT SemTxvevaSi gadawyvetilebis miRebisasixelmZRvaneleT mxolod samedicino kriteriumebiT.2.2.3 orsuli, mSobiare da meZuZuri dedaorsulisTvis ama Tu im samedicino Carevis Taobazegadawyvetilebis miRebisas gaiTvaliswineT am Carevis nayofzezemoqmedebis SesaZlebloba.Sesabamisad, orsuls, samedicino Carevis Sesaxebgadawyvetilebis miRebamde, miawodeT sruli, obieqturi dadrouli informacia ganzraxuli Carevis nayofze SesaZlopirdapiri an iribi mavne zemoqmedebis Sesaxeb. gadawyvetilebaorsulma unda miiRos.hkiTxeT orsuls, xom ar surs mSobiarobis dros gverdiTiyolios meuRle an sxva misTvis sasurveli piri. survilisSemTxvevaSi, mieciT mas amisi SesaZlebloba.mSobiare qalisTvis samedicino daxmareba imave pirobebiTunda ganxorcieldes, rac aRwerilia TavSi `2.1.4 informirebuliTanxmoba, pacientis gadawyvetilebis pativiscema~. nayofisjanmrTelobisTvis saWiro samedicino momsaxurebis Taobazegadawyvetilebas mSobiare Rebulobs.Tu saWiroa iseTi samedicino momsaxureba, romelicaucilebelia cocxali nayofis dabadebisaTvis da, amave dros,31

minimaluri riskis matarebelia mSobiaris janmrTelobisa dasicocxlisaTvis, magram mSobiare uars ambobs am momsaxurebaze,ganumarteT mas momsaxurebis arCatarebis mosalodneli Sedegebi;xazi gausviT im garemoebas, rom aseT SemTxvevaSi kanonmdeblobagaZlevT momsaxurebis Catarebis uflebas.SeecadeT, rom melogine qalma gverdiT iyolios axalSobilida sakuTari Sexedulebisamebr kvebos is, Tu amis SesaZleblobasiZleva dedisa da bavSvis janmrTeloba.wvrilad ganumarteT melogines, ra sargebeli moaqvs ZuZuTikvebas bavSvisaTvis da Tavad misTvis. SeecadeT, daarwmunoT isZuZuTi kvebis upiratesobaSi, garda im uiSviaTesi SemTxvevebisa,rodesac ZuZuTi kveba SeuZlebelia an ukunaCvenebia an dedis, anbavSvisTvis.2.2.4 eqimi da fsiqikuri daavadebis mqone pacientebi, romlebsacSezRuduli aqvT gadawyvetilebis miRebis unarifsiqikuri daavadebis gamo gacnobierebuli gadawyvetilebisunaris SezRudvis mqone pacientisaTvis samedicinomomsaxurebamde Tanxmoba miiReT pacientis kanonieriwarmomadgenlisagan an, misi ararsebobis SemTxvevaSi,naTesavisagan.Tanxmobis miRebamde pacientis kanonier warmomadgenels annaTesavs miawodeT TavSi `2.1.3 informaciis miwodeba~ asaxuliinformacia.amasTan, gaxsovdeT, rom aRqmisa da gagebis unarisgaTvaliswinebiT, aucilebelia aseTi pacientebis informirebamaTi janmrTelobis mdgomareobisa da saWiro samedicinomomsaxurebis Sesaxeb2.2.5 pacienti ganukurnebeli daavadebis terminalur stadiaze,paliatiuri mzrunveloba, tkivilis marTvaganukurnebeli daavadebis terminalur stadiaSi myofipacienti gansakuTrebul mzrunvelobasa da movlas saWiroebs.aRniSnuli moicavs pacientis simptomebis efeqtur marTvas,pacientisa da misi ojaxis fsiqologiur mxardaWeras.32

pacienti informirebuli unda iyos misi daavadebis Sesaxeb,garda iSviaTi gamonaklisebisa (ix. qveTavi `2.1.3 informaciismiwodeba~). amasTan, fataluri diagnozis Sesaxeb informaciismiwodebisas gaiTvaliswineT pacientis pirovnuli maxasiaTeblebi,misi informirebulobis done (ra icis Tavisi daavadebis Sesaxeb)da survili, miiRos an ar miiRos sruli informacia;saWiroebisas da pacientis Tanxmobis SemTxvevaSi konsultaciaSiCarTeT ojaxis wevrebi. informaciis miwodebis Semdeg pacientsuTxariT da agrZnobineT, rom samedicino momsaxurebis gawevagrZeldeba da yvelafers gaakeTebT mis dasaxmareblad.arsebobs gamocdilebaze dafuZnebuli rekomendaciebipacientisaTvis e.w. `cudi ambebis~ (maT Soris fataluridiagnozis) miwodebis Sesaxeb. gaecaniT maT da SeecadeT,Sesaferis SemTxvevebSi gamoyenoT.ganukurnebeli daavadebis terminalur stadiaSi pacientissimptomebis (maT Soris tkivilis) marTva, misi movla dafsiqologiuri mxardaWera saTanado momzadebas, gamocdilebasada unar-Cvevebs saWiroebs. Tu aseTi gamocdileba da unar-CvevebigakliaT, pacientis movlaSi CarTeT Sesabamisi dargisspecialistebi (paliatiuri mzrunvelobis profesionalebi).SeecadeT, daavadebis terminalur stadiaze myofi pacientismovlaSi CarToT ojaxis wevrebic. pacientis survilisamebr, xeliSuwyveT pacientTan misi ojaxis wevrebis yofnas. daexmareTpacientis ojaxis wevrebs fsiqologiuri barieris gadalaxvaSi,romelic maT xels uSlis momakvdavi axloblis gverdze yofnasada masze zrunvaSi.Tu daavadebis terminalur stadiaze myofi pacienti uarsacxadebs samedicino momsaxurebaze, romelic pacients vergankurnavs, magram garkveuli xniT gaaxangrZlivebs missicocxles, darwmundiT, realurad ra surs pacients. SesTavazeTpacients ojaxis wevrebTan erTad gasaubreba. miawodeT massaTanado ganmartebebi. SeafaseT, rogor imarTeba pacientissimptomebi (tkivili, Rebineba, Sekruloba, slokini da a.S.), radgan33

mkurnalobaze uaris safuZveli SeiZleba simptomebisaraadekvaturi marTva iyos.Tu pacients aqvs gadawyvetilebis miRebis unari da,miuxedavad simptomebis adekvaturi marTvisa da Sesabamisiganmartebebis miwodebisa, uars acxadebs samedicinomomsaxurebaze, moerideT misi nebis winaaRmdeg samedicinoCarevas, Tundac es sicocxlis SemanarCunebeli mkurnaloba iyos.amasTan, auxseniT pacientis ojaxis wevrebs, rom ar gaqvTsamedicino Carevis ufleba qmedunariani da gacnobierebuligadwyvetilebis unaris mqone pacientis nebis winaaRmdeg.2.2.6 evTanazia, eqimis daxmarebiT suicidiarasodes ar miiRoT monawileoba evTanaziaSi, racgulisxmobs pacientis Txovnis/moTxovnis safuZvelze pacientissikvdilis daCqarebas raime manipulaciis ganxorcielebis gziT.arasodes ar daexmaroT pacients Tavis mokvlaSi (mag., armisceT wamali da ar aswavloT misi gamoyeneba Tavis mokvlismizniT).zemoaRniSnuli qmedebebi araeTikuria, kanoniT ikrZaleba daisjeba sisxlis samarTlis kanonmdeblobiT.2.3. gadaudebeli samedicino momsaxurebaTqvens samuSao adgilze pacientisaTvis gadaudebelisamedicino momsaxurebisas ganaxorcieleT yvela saWiro CarevaTqveni SesaZleblobis farglebSi.arasamuSao adgilze, roca pacienti saWiroebs gadaudebeldaxmarebas, SeecadeT, SesaZleblobis farglebSi, gauwioT massamedicino daxmareba, Tuki iq ar imyofeba Sesabamisi profesiulikompetenciis eqimi an aseTi eqimi daxmarebis survils ar iCens.kanonmdebloba avaldebulebs eqims daxmarebas arasamuSaoadgilze im SemTxvevebSi, roca Careva gadaudeblad aris saWiro.pacientis janmrTelobasTan da Tqvens mier gaweulsamedicino daxmarebasTan dakavSirebuli informacia miawodeTeqims, romelic gaagrZelebs pacientisaTvis samedicino34

momsaxurebis gawevas (mag., saswrafo daxmrebis da/an saavadmyofosgadaudebeli daxmarebis ganyofilebis eqimi).arasamuSao adgilze gadaudebeli daxmarebis gawevisasdauSvebelia raime sazRauris moTxovna.iseTi garemoebebis arsebobisas, roca pacientisaTvisgadaudebeli samedicino daxmarebis gaweva safrTxes uqmnisTqvens sicocxles, ixelmZRvaneleT rekomendaciebiT, romlebicasaxulia TavSi `2.1.13.3 eqimis usafrTxoebasTan dakavSirebuliuari~.2.4. adamianis organoebisa da qsovilebis gadanergvagaxsovdeT, rom donoris mier organos gacemazegadawyvetileba (Tanxmoba an uari) Tavisufali da nebayoflobiTiunda iyos. es niSnavs, rom donori gadawyvetilebis miRebisasTavisufalia yovelgvari zewolisagan. Tu adamiani Tanaxmaagasces organo sxvisTvis gadasanergad garkveuli sargebelismiRebis pirobiT (materialuri daintereseba, gaWirvebiTganpirobebuli finansuri imperativi) an raime sxva garemoebisgamo (fsiqologiuri zewola, samsaxurebrivi interesebi,msjavrdebulisaTvis sasjelis Semsubuqebis dapireba da a.S.),aseTi gadawyvetileba ar SeiZleba CaiTvalos Tavisuflad, xoloTanxmoba nebayoflobiTad. amrigad, `nebayoflobiTi Tanxmoba~~Tavisufali Tanxmobis~ sinonimia. zewolis pirobebSi miRebuli`Tanxmoba~ ukanonoa.adamianis organoebis gadanergvis procesSi monawileobisas,Tu gaqvT eWvi, rom organos gacemis Taobaze donorisgadawyvetileba ar aris misi Tavisufali nebis gamomxatveli, armiiRoT monawileoba transplantaciis procesSi.adamianis organoebiT vaWroba isjeba kanoniT.2.5. tvinis sikvdiliTavis tvinis sikvdilis kriteriumebi da diagnozisgaformebis procedura kanonmdeblobiT aris gansazRvruli.35

zustad daicaviT dadgenili samarTlebrivi normebi. nebismiermauzustobam fataluri Sedegi SeiZleba ganapirobos.2.6. eqimis moqmedeba resursebis ukmarisobisasresursebis ukmarisobis SemTxvevaSi:a) miawodeT pacients sruli informacia:• ra saxis momsaxureba sWirdeba mas da ris gamoa SeuZlebelioptimaluri momsaxurebis gaweva;• ra saxis momsaxurebis gawevaa SesaZlebeli TqvensdawesebulebaSi da TqvenTvis cnobil sxva dawesebulebebSi;• pacientisaTvis saWiro momsaxurebis dafinansebis raSesaZleblobebi arsebobs rogorc saxelmwifo, ise kerZo anarasamTavrobo seqtorSi;• sad SeuZlia pacients miiRos misTvis saWiro damatebiTiinformacia zemoT moxseniebuli sakiTxebis Sesaxeb;b) maqsimalurad gamoiyeneT Tqvens xelT arsebuli informaciada resursebi pacientis sakeTildReod;g) agreTve, ixelmZRvaneleT rekomendaciebiT, romlebic asaxuliaTavSi `2.9.2 momsaxurebis xelmisawvdomobisaTvis zrunva~.2.7. eqimi da pacientis axloblebi, ojaxis wevrebidaamyareT kargi urTierToba pacientis ojaxis wevrebTan daaxloblebTan. iyaviT maT mimarT gulisxmieri, gamoavlineTTanadgoma, daarwmuneT, rom TanaugrZnobT.Tu qmedunarianma pacientma mogcaT ufleba, gamonaxeT dropacientis ojaxis wevrebTan/axloblebTan sasaubrod pacientisdaavadebis, mkurnalobisa da prognozis Sesaxeb. xazi gausviT maTrols, mniSvnelobas pacientis movlasa da mkurnalobaSi,SeZlebisdagvarad CarTeT isini, Tanamonawiled gaixadeTpacientis movla-patronobaSi, mis moralur-fsiqologiurmxardaWeraSi. daarwmuneT ojaxis wevrebi da axloblebi, rom,36

pacientis garda, Tqvenc gWirdebaT maTi daxmareba, Tanadgoma.SeecadeT, moipovoT maTi keTilganwyoba.Tu Tqven, qmedunariani pacientis Tanxmobis SemTxvevaSi,miawodeT zemoT moxseniebuli informacia pacientis ojaxiswevrs/axlobels, aucileblad detalurad asaxeT es samedicinodokumentaciaSi. igive gaakeTeT im SemTxvevebSi, roca pacientiqmeduunaroa.kargad gaerkvieT, ras moelian pacientis ojaxis wevrebiTqvengan; SeecadeT, rom molodini realisturi iyos daiTvaliswinebdes yvela sirTules, agreTve moulodnelobebs,rac samedicino momsaxurebas axlavs. iyaviT gulwrfeli,nurasodes daumalavT simarTles, raoden mwarec unda iyos igi(cxadia, amisaTvis aucilebelia qmedunariani da gacnobierebuligadawyvetilebis unaris mqone pacientis Tanxmoba). gaxsovdeTisic, rom maTi keTilganwyoba Tqvens mimarT, SesaZloa,gagrZeldes mxolod manam, sanam samedicino momsaxurebaSedegiania an, rogorc minimum, pacientis mdgomareobis gauaresebaar aRiniSneba. sakuTari molodinis gaumarTleblobisas,obieqturi faqtorebiT (daavadebis sirTule, inkurabeluroba,dagvianebuli SemTxveva da a.S.) ganpirobebuli warumatebelisamedicino momsaxurebisas, miT umetes, pacientis mdgomareobisdamZimebis an misi gardacvalebisas, maTi keTilganwyoba adviladSeiZleba Seicvalos negatiuri damokidebulebiT,agresiulobiTac ki, ganurCevlad imisa, riTi iyo zemoxsenebuligamowveuli – eqimis nakliT Tu sxva obieqturi garemoebebiT.2.7.1 pacientis ojaxis wevrebi samedicino dawesebulebaSisamedicino dawesebulebaSi (saavadmyofo, ambulatoriuliklinika) pacientisaTvis samedicino momsaxurebis gawevisasxSirad pacientis survilia, rom mis gverdiT imyofebodes misiojaxis wevri (wevrebi) an sxva pirebi, romlebTanac pacientsaxlo urTierToba aqvs. zogjer, roca pacients ar aqvs survilisgamoxatvis SesaZlebloba/unari (mcirewlovani bavSvi, fsiqikuridaavadebis mqone piri, ugono mdgomareobaSi myofi pacienti),37

pacientis gverdiT yofnis survils misi ojaxis wevrebi anaxloblebi gamoxataven.arsebobs mtkicebulebebi, rom:a) ojaxis wevrebis gverdiT yofna exmareba pacients, is Tavsufro komfortulad grZnobs;b) axloblebis gverdiT yofnis Sedegad mcirdeba ojaxiswevrebis eWvebi samedicino momsaxurebis xarisxis Sesaxeb,mcirdeba ojaxis wevrebis wuxili da SiSi imis Taobaze, Tura mdgomareobaSia maTi axlobeli; amasTan, pacientisojaxis wevrebs ukmayofildebaT pacientTan axlos yofnisda misi daxmarebis survili; pacientis gardacvalebisSemTxvevaSi, ojaxis wevrebs SedarebiT umsubuqdebaTstresuli mdgomareoba da gloviT gamowveuli wuxili;g) ojaxis wevrebis pacientis gverdiT yofna ar uSlis xelssamedicino momsaxurebas, ar auaresebs gamosavlebs dauaryofiTad ar moqmedebs ojaxis wevrebis fsiqologiurmdgomareobaze.SeecadeT, xeli SeuwyoT pacientis axloblebis pacientisgverdiT yofnas, iSviaTi gamonaklisebis garda, roca pacientisojaxis wevrebis daswrebam SeiZleba xeli SeuSalospacientisaTvis adekvaturi samedicino daxmarebis gawevas andiskomforti Seuqmnas sxva pacientebs.iTanamSromleT dawesebulebis sxva personalTan daadministraciis warmomadgenlebTan dawesebulebaSi pacientisaxloblebis yofnis Taobaze mkafio wesebis SesamuSaveblad.miawodeT informacia am wesebis Sesaxeb pacientebis ojaxiswevrebs da axloblebs.2.7.2 urTierToba ojaxis wevrebTan pacientis sikvdilis SemTxvevaSipacientis sikvdilis Semdeg gamoiCineT yuradReba misiaxloblebis mimarT. ojaxis wevrebs, romelnic pacientissikvdilis mowmeni gaxdnen, uxSiresad Tavad sWirdebaT daxmareba.uTanagrZneT maT, SeZlebisdagvarad wvrilad ganumarteT38

sikvdilis mizezebi. daarwmuneT isini Tqvens gulwrfel wuxilSi.gaxsovdeT, rom zogjer axloblis sikvdiliT gamowveuli SokisSemdeg `damnaSavis” Zieba iwyeba. xSirad ojaxis wevrebi,miuxedavad imisa, rom sikvdilis Tavidan acileba SeuZlebeliiyo, sakuTar Tavs da/an jandacvis profesionalebs Tu mTlianadsistemas adanaSauleben. auxseniT rom am SemTxvevaSi `damnaSave~aravin aris, rom sikvdilis Tavidan acileba SeuZlebeli iyo.arsebobs gamocdilebaze dafuZnebuli rekomendaciebigardacvlili pacientis ojaxis wevrebTan da axloblebTanurTierTobis Sesaxeb, gaecaniT maT da SeecadeT, gamoyenoTSesaferis SemTxvevebSi.2.8. eqimi da kolegebisaeqimo saqmianobis prestiJis dacvis upirvelesi winapirobapacientis interesebis ganuxrelad dacvaa. amasTan erTad,kolegebs Soris urTierTpativiscemis atmosferos damkvidrebadidad uwyobs xels saeqimo saqmianobis prestiJis amaRlebas.2.8.1 kolegis pacientiTu Tqven mogmarTaT pacientma, romelsac manamde sxva eqimimeTvalyureobda imave problemis gamo, nu daiSurebT ZalixmevasimisaTvis, rom Tavad pacientma an misma axlobelma saqmis kursSiCaayenon moxseniebuli eqimi momxdaris Sesaxeb. aseT SemTxvevaSi,Tu saWirod CaTvliT diagnozis, mkurnalobis an samedicinoCarevis Taobaze adre sxva eqimis mier miRebuli gadawyvetilebisSecvlas, SeecadeT, rom pacients es informacia ise miawodoT,rom mas ar gauCndes ukmayofileba im eqimis mimarT, romelic masmanamde meTvalyureobda. Tu Tqvens mier ganzraxuli cvlilebadiagnostikasa Tu mkurnalobaSi arsebiTia, SeecadeT, pacientisTanxmobiT, Tavad daukavSirdeT moxseniebul eqims da mouTxroTTqveni gadawyvetilebis Sesaxeb; SeZlebisdagvarad, masTan erTadSeecadoT rogorc Zveli, ise axali gadawyvetilebebis gansjas.zemoxsenebuli aucilebelia im SemTxvevaSi, Tu eqimebi erTsamedicino dawesebulebaSi muSaoben, sasurvelia – Tusxvadasxva dawesebulebebSi arian dasaqmebuli.39

nurasodes etyviT pacients uars samedicino momsaxurebazeimis gamo, rom manamde mas sxva eqimi mkurnalobda.nurasodes SeecdebiT kolegis pacientis `gadabirebas”.sakuTari Tavis qeba iseve miuRebelia, rogorc sxva eqimze augisTqma.Tu Tqvens dawesebulebaSi momuSave kolega, raime mizezisgamo, ver axerxebs pacientis samedicino momsaxurebas, yvela RoneixmareT, rom pacientis interesebs ziani ar miadges; SeenacvleTkolegas Tqven Tavad an saqmis kursSi CaayeneT sxva kolegebi, ise,rom uzrunvelyoT pacientisaTvis saWiro samedicinomomsaxurebis uwyvetoba.2.8.2 konsiliuminu daaswrebT konsiliumze pacients, pacientis axlobels ankanonier wamomadgenels. winaswar SeuTanxmeT pacients, vis undamiewodos informacia konsiliumis gadawyvetilebis Sesaxeb –Tavad mas, Tu mis axlobels an kanonier wamomadgenels.gadawyvetilebis Sesaxeb informaciis mimwodeblad gamohyaviTerT-erTi kolega konsiliumis monawileTagan.Tu konsiliumis mimdinareobisas azrTa sxvadasxvaobaaRiniSna, SeecadeT konsensusis miRwevas an gansazRvreT,damatebiT ra unda gakeTdes imisaTvis, rom erTiani azriCamoyalibdes.konsiliumis damTavrebis Semdeg pacients (an mis axlobels,kanonier warmomadgenels) piruTvnelad miawodeT informaciaazrTa sxvadasxvaobis Sesaxeb, wvrilad ganumarteT is obieqturigaremoebebi, ramac drois mocemul monakveTSi SeuZlebeli gaxadasaboloo azris Camoyalibeba. ganumarteT, ra gzebi daisaxaerTiani gadawyvetilebis misaRebad. mdgomareobis marTvisramdenime SesaZlo gzis arsebobisas pacients an mis axlobels(kanonier warmomadgenels) informacia alternativebis SesaxebkonsiliumSi monawileTa saerTo mosazrebis saxiT miawodeT.agreTve, acnobeT konsiliumis monawileTa erTiani rekomendaciaam alternativebis Taobaze. aseT SemTxvevaSi saboloo40

gadawyvetilebas pacienti iRebs. erideT konkretulimosazrebebis avtorebis dasaxelebas, Tu amas kategoriulad armoiTxovs pacienti an romelime mosazrebis avtori.konsiliumis oqmSი srulad asaxeT gansxvavebulimosazrebebic da isic, razec konsiliumis monawileebiSeTanxmdnen.2.8.3 kolegis mowvevakargad gaicnobiereT Tqveni SesaZleblobebis/kompetenciebisfarglebi sakuTar specialobaSi. nurasodes mogeridebaT imisiaRiareba, rom specialobis garkveuli sferoebSi Tqvensrulyofili codna da/an unar-Cvevebi ar gaqvT. aseT SemTxvevebSimoiwvieT kolega, romelic ukeT daexmareba pacients. amasTan,ecadeT Tqveni profesiuli naklis Sevsebas uwyveti profesiuliganviTarebis sistemaSi monawileobis gziT.2.8.4 kolegis saqmianobis Sefasebakolegis saqmianobis sityvierad an werilobiT SefasebisasiyaviT keTilsindisieri da obieqturi. sxvisi saeqimo saqmianobis,gansakuTrebiT saeqimo Secdomis, Sefasebisas Tqvens miergamoTqmuli mosazrebebi mxolod faqtebs unda eyrdnobodes daaraviTar SemTxvevaSi hipoTezebs, daSvebebs.yovelTvis gaiTvaliswineT da angariSi gauwieT garemos,romelSic eqims gadawyvetilebis miReba mouxda; saxeldobr,gansajeT, mxedvelobaSi miiReT is obieqturi faqtorebi, romelTaarsebobac maRali albaTobiT ganapirobebs saeqimo Secdomas.kolegis naklze Tu Secdomaze saubari dasaSvebia mxolodprofesionalTa wreSi. gansjis mizani unda iyos kolegisprofesiuli donis amaRlebis stimulireba, mis mier gaweulisamedicino momsaxurebis xarisxis gaumjobeseba. nebismier sxvagaremoSi kolegis saqmianobis augad moxsenieba arRvevs kolegebsSoris urTierTpativiscemis atmosferos, cudad moqmedebs saeqimosaqmianobis prestiJze sazogadoebaSi.41

dauSvebelia konkretuli kolegis Secdomebis gansjamasobrivi informaciis saSualebebiT.2.8.5 zrunva kolegis profesiul kompetenciazeTu Tqven amCnevT nakls kolegis codnaSi, mis profesiulunar-CvevebSi, konfidencialurad da piruTvnelad miuTiTeT masamis Sesaxeb; Tqveni SesaZleblobis farglebSi, daexmareT naklisgamosworebaSi.2.8.6 kolegis janmrTelobaze zrunvaTu kolegam mogmarTaT sakuTari janmrTelobis mdgomareobisgamo, SeecadeT, maqsimalurad SeumsubuqoT mas saWiromomsaxurebis miRebasTan dakavSirebuli finansuri daorganizaciuli problemebi.2.9. eqimi da sazogadoeba2.9.1 mosaxleobaSi cxovrebis jansaRi wesis damkvidrebisaTvisxelSewyobaZalismevas nu daiSurebT Tqvens pacientebs Soris, agreTve,zogadad mosaxleobaSi, cxovrebis jansaRi wesisdamkvidrebisaTvis, prevenciuli RonisZiebebisganxorcielebisaTvis, mosaxleobis ganaTlebisaTvisjanmrTelobasTan dakavSirebul sakiTxebSi.amave dros, Tqven Tavad unda iZleodeT cxovrebis jansaRiwesis magaliTs. upirveles yovlisa es exeba iseT mavne Cvevebs,rogoricaa Tambaqos weva, alkoholis Warbi moxmareba da misT.2.9.2 momsaxurebis xelmisawvdomobisaTvis zrunvaTqveni SesaZleblobebis farglebSi izruneT imisaTvis, rom:• gadamxdeli (saxelmwifo, sadazRvevo kompania) adekvaturadfaravdes momsaxurebas;• gadamxdelis (saxelmwifo, sadazRvevo kompania) mierpacientisaTvis SeTavazebuli momsaxurebebis nusxaSeZlebisdagvarad sruli iyos.42

2.9.3 eqimis profesiisadmi ndobis damkvidrebasaeqimo profesiisadmi ndobis damkvidrebis upirvelesiwinapirobaa Tavad eqimis saqmianobis Sesabamisoba qveyanaSiaRiarebul profesiul da eTikur standartebTan. es gulisxmobs:• pacientis interesebis uzenaesobis aRiarebas;• sakuTari da kolegebis profesiuli SesaZleblobebissworad Sefasebas;• codnisa da unar-Cvevebis ganuwyvetel srulyofas;• kolegebTan erToblivi saqmianobiT momsaxurebis SesaZlosaukeTeso xarisxis uzrunvelyofas.SeecadeT, xeli SeuwyoT mosaxleobaSi medicinisSesaZleblobebze realuri warmodgenebis Camoyalibebas; nuSeecdebiT, nu SeuwyobT xels sazogadoebaSi iseTi molodinisdamkvidrebas, romlis ganxorcielebac SeuZlebelia. es exebarogorc teqnologiur (sadiagnozo, samkurnalo Tu sxv.)siaxleebs, ise mTlianad jandacvis sistemis SesaZleblobebs.sistemis prioritetebis sazogadoebis TanamonawileobiTgansazRvra, maTi saTanadod dasabuTeba xels uwyobssazogadoebaSi jandacvis sistemisadmi, eqimis profesiisadmindobis damkvidrebas.2.10. eqimi da masobrivi informaciis saSualebebimasobrivi informaciis saSualebebTan TanamSromloba eqimssaSualebas aZlevs sazogadoebis yuradReba gaamaxvilosmosaxleobis janmrTelobisa da misi dacvis mniSvnelovanaspeqtebze, maT Soris:• cxovrebis jansaR wessa da daavadebaTa prevenciaze;• janmrTelobis sxvadasxva problemis marTvaSi pacientisrolze;• samedicino momsaxurebis xelmisawvdomobis problemaze.SeecadeT iTanamSromloT masobrivi informaciissaSualebebTan zemoxsenebul sakiTxebze.43

amasTan, ar gamoiyenoT masobrivi informaciis saSualebebisakuTari upiratesobis warmoCenisaTvis sxva eqimebisa Tusamedicino dawesebulebebis saqmianobasTan Sedarebis gziT.masobrivi informaciis saSualebebisaTvis informaciismiwodebisas ar daasaxeloT konkretuli pacientis vinaoba, argaTqvaT pacientebis Sesaxeb TqvenTvis cnobili konfidencialuriinformacia, Tuki amis Sesaxeb winaswar ar gaqvT miRebulipacientis da/an misi kanonieri warmomadgenelis Tanxmoba (ix. Tavi`2.1.5 informaciis konfidencialuroba~).ar dauSvaT pacientebis video- da fotogadaReba, Tu miRebuliar gaqvT pacientis da/an misi kanonieri warmomadgenlis Tanxmoba.2.11. eqimi da TviTmkurnaloba, eqimis mier sakuTari ojaxiswevrebis mkurnalobanu umkurnalebT sakuTar Tavs, Tqveni ojaxis wevrebs, Zalianaxloblebs. gaxsovdeT, rom aseT SemTxvevebSi maRalia imisialbaToba, rom Tqvens mier miRebuli gadawyvetileba obieqturi,xolo gaweuli daxmarebis xarisxi adekvaturi ar iqneba.am wesidan gamonaklisi dasaSvebia mxolod im SemTxvevaSi, Tusamedicino momsaxurebis gaweva gadaudeblad aris saWiro da/ansxva eqimis moZieba SeuZlebelia.2.12. eqimi da industriawinamdebare dokumentSi termini `industria” gulisxmobssamewarmeo (komerciul, mogebaze orientirebul) iuridiul pirs,romlis nawarmi/produqti gamoiyeneba jandacvis sferoSi.aseTebia:• farmacevtuli industria;• bioteqnologiuri industria;• bavSvTa xelovnuri sakvebis mwarmoebeli industria;• parenteraluri kvebis produqtebis mwarmoebeli industria;• samedicino xelsawyoebis mwarmoebeli industria.44

janmrTelobis dacvis sferos TanamSromloba industriasTansasargebloa pacientisTvis, eqimisTvis da mTlianadsazogadoebisaTvis. imavdroulad, industriis miznebi, zogjer, areTanadeba jandacvis sistemis prioritetebs, xolo eqimebis`gulis monadirebis” meTodebi, zogjer, scildeba samedicinoeTikis farglebs.industriasTan urTierTobisas yvela SemTxvevaSi guldasmiTgansazRvreT, gaweuli daxmarebis sanacvlod (sponsorobisaTvis)ras iTxovs Tqvengan industriis warmomadgeneli. mxolod amisSemdeg miiReT gadawyvetileba daxmarebis gamoyenebis Sesaxeb.samedicino dawesebulebaSi, sasurvelia, industriasTanurTierTobisTvis gamoiyos piri, romelic pasuxismgebeli iqnebaam urTierTobis adekvaturobis uzrunvelyofaze. es funqciaSeiZleba ikisros eTikis komitetma, romelic SeimuSavebssaTanado rekomendaciebs. es rekomendaciebi da maTiCamoyalibebis safuZveli cnobili unda iyos dawesebulebispersonalisaTvis.kerZo/individualuri praqtikis SemTxvevaSi industriasTanurTierTobisas gaiTvaliswineT Semdegi rekomendaciebi:• industriis mier warmoebuli produqtis gavrcelebisaTvisxelSewyobis pirobiT ar miiRoT industriiswarmomadgenlebisagan sazRauri an saCuqari, maT Soris, raimeproduqti (wamali, samedicino xelsawyo, xelovnuri sakvebida sxv.) an sponsoroba (nebismieri formiT);• dauSvebelia industriis ama Tu im produqtis (wamali,samedicino xelsawyo, xelovnuri sakvebi da sxv.) sareklamofurclebis, gancxadebebis gavrcelebaSi eqimis monawileoba;• pacientisTvis wamlis SerCevisas, receptis gamowerisasixelmZRvaneleT mxolod pacientis interesebiT; nurasodesgamowerT wamals farmacevtuli kompaniis logoTi moniSnulreceptis blankze;45

• guldasmiT gansajeT industriis winadadeba sponsorobagauwios samecniero konferenciebze, sxvadasxva SexvedrebzeTqvens daswrebas, saganmanaTleblo RonisZiebebSimonawileobas (mgzavrobis, sastumros xarjebi,monawileobisaTvis Sesatani Tanxis anazRaureba da sxv.);• kompensaciis miReba momsaxurebisTvis, romelic gaewiaindustrias, gamWvirvale unda iyos; mis Sesaxeb acnobeTdamqiravebels da, saWiroebis SemTxvevaSi, pacients;• Tu Tqven dakavSirebuli xarT farmacevtul kompaniasTan damonawileobT klinikuri praqtikis erovnuli rekomendaciis(gaidlainis) momzadebaSi, aucileblad acnobebT amis Sesaxebkolegebs, romlebTan erTadac amzadebT zemoxsenebuls.2.13. eqimi da dazRvevis sistemakargad gaerkvieT janmrTelobis dacvis arsebul sistemaSi,sadazRvevo pirobebSi. miawodeT pacients sruli informacia imisTaobaze, ra momsaxurebis miReba SeuZlia mas sadazRvevopolisiT, ra gamonaklisebia daSvebuli sadazRvevoxelSekrulebiT.yovelTvis ecadeT, racionalurad gamoiyenoT samedicinomomsaxurebisaTvis sadazRvevo kompaniebis mier gamoyofili Tanxa.amasTan, SeecadeT, ar misceT saSualeba dazRvevis sistemasimoqmedos medicinaSi arsebuli profesiuli da eTikuristandartebis, pacientis janmrTelobis interesebis sazianod.2.14. saCuqari eqimsuangaroba da samarTlianoba eqimis pacientis mimarTganwyobis ZiriTadi ganmsazRvrelia. profesiuli saqmianobisassargeblis miRebis principiT nurasodes imoqmedebT.eqimisTvis saCuqris mirTmeva medicinis Tanamdevi tradiciaa. erTSemTxvevaSi saCuqari gulwrfeli madlierebis gamoxatulebaa(sikeTiT sikeTis gadaxda), meore SemTxvevaSi qvelmoqmedebaa, sxvaSemTxvevaSi mas eqimze gavlenis moxdenis (raRac privilegiebismopovebis) survili udevs safuZvlad. eqims SeiZleba gauWirdes46

garkveva – ra motiviT xelmZRvanelobs pacienti – altruizmiT dagulwrfeli madlierebis grZnobiT, Tu pragmatuli mosazrebebiT.es gairkveva xolme pacientsa da eqims Soris urTierTobisSemdgom etapebze. mTavaria, rom saCuqarma ar imoqmedos Tqvensganwyobaze pacientis mimarT, misTvis gaweuli samedicinomomsaxurebis xarisxze. amasTan, gaxsovdeT, rom Tu pacientis mierTqvenTvis saCuqris morTmevis mizania samedicino momsaxurebisasraRac upiratesobebis miRebaa, saCuqris miReba dauSvebelia.2.15. eqimis saqmianobis TviTreklamanu SeecdebiT, sityvierad Tu werilobiT, Tqvensupiratesobaze saubars kolegebisa da sxva samedicinodawesebulebebis saqmianobis dakninebis xarjze.amasTan, SegiZliaT, sazogadoebas sxvadasxva formiTmiawodoT mkafio informacia Tqvens mier SeTavazebulisamedicino daxmarebis Sesaxeb. es ukanaskneli SeiZleba Seicavdesmomsaxurebis saxeebis detalur CamonaTvals, gamoyenebulmeTodebs, agreTve, Tqveni kvalifikaciis amsaxvel masalas(saxelmwifo sertifikatis flobas ama Tu im specialobasa TusubspecialobaSi, gamocdilebis damadasturebel faqtebs).2.16. eqimis urTierToba damqiravebelTan, SromiTi xelSekrulebayuradRebiT gaecaniT damqiravebelTan SromiT xelSekrulebas.xelSekruleba unda asaxavdes mxareTa valdebulebebs,daqiravebulis mier Sesasrulebuli samuSaos aRwerilobas,saxelSekrulebo vadas vadis dasawyisisa da dasasrulisCvenebiT. miaqcieT yuradReba, rom xelSekrulebaSi asaxuli iyosadekvaturi Sromis anazRaureba, samuSao garemos adekvaturobisaucilebloba. xelSekrulebaSi SeiZleba Sevides damatebiTipirobebic, kanonmdeblobiT gaTvaliswinebulisagan gansxvavebuli,magram damatebiTma pirobebma ar SeiZleba SezRudos angaauaresos kanoniT dadgenili moTxovnebi. saxeldobr, TuSromiTi xelSekrulebis pirobebi, Sromis kodeqsSi asaxulnormebTan SedarebiT, auareseben daqiravebulis mdgomareobas,aseTi normebi baTilia.47

damqiravebeli valdebulia Seasrulos rogorckanonmdeblobiT gansazRvruli pirobebi, aseve is piroba,romelic damatebiT Sevida xelSekrulebaSi. amave dros,damqiravebels ufleba aqvs muSakisaTvis sakuTari saxsrebisxarjze daadginos kanonmdeblobasTan SedarebiT damatebiTiSromiTi da socialuri SeRavaTebi.2.17. samedicino momsaxurebis xarisxi da pacientis usafrTxoebasamedicino momsaxurebis xarisxi da pacientis usafrTxoebaeqimis upirvelesi sazrunavia. xsenebulis uzrunvelyofisaTvisgamudmebiT izruneT sakuTari codnisa da unar-CvevebissrulyofisaTvis. amave dros, gaiTvaliswineT, rom momsaxurebisxarisxi da usafrTxoeba ar aris damokidebuli mxolod Tqvenscodnaze, gamocdilebasa da unar-Cvevebze. samedicinomomsaxurebis gamosavals da pacientis kmayofilebas mravalifaqtori ganapirobebs, saxeldobr: sxva samedicino personalisprofesiuli done, anazRaurebis adekvaturoba, samuSao garemo,dawesebulebis Sinaganawesi, aRWurviloba, samedicinomomsaxurebis danergili standartebi, dawesebulebaSimomsaxurebis xarisxisa da pacientTa usafrTxoebisuzrunvelyofis formalizebuli sistemis arseboba, samedicinopersonalsa da dawesebulebis xelmZRvanelobas SorisurTierTobis Taviseburebebi, saeqimo saqmianobis qveyanaSiarsebuli maregulirebeli garemo da sxv.2.17.1 samedicino momsaxurebis xarisxisa da pacientTa usafrTxoebisuzrunvelyofaSi monawileobanu daiSurebT Zalisxmevas Tqvens dawesebulebaSimomsaxurebis xarisxisa da pacientTa usafrTxoebisuzrunvelyofis sistemis CamoyalibebisTvis. aqtiuri monawileobamiiReT am sistemis funqcionirebaSi, SeZlebisdagvarad, xeliSeuwyveT kolegebs masSi CarTvisaTvis. zemoxsenebuligulisxmobs:• dawesebulebis Sida konsiliumebis organizebas da maTSimonawileobas;48

• klinikur-paTologiuri konferenciebis Catarebas da maTSimonawileobas;• klinikuri praqtikis gaidlainebisa da protokolebisadaptaciasa da danergvaSi monawileobas, maT gamoyenebasyoveldRiur saqmianobaSi;• Sida da gare auditis sistemis danergvas da masSimonawileobas;• uwyveti profesiuli ganviTarebis sistemaSi monawileobas;• kolegebis saqmianobis konstruqciul, keTilganwyobilkritikas, maT mier gamoTqmul SeniSvnebze Tqvenskonstuqciul reaqcias;• gardacvlili pacientebis samedicino dokumentaciisganxilvaSi monawileobas;• jandacvis sistemis, saeqimo saqmianobis maregulirebeliaqtebis SemuSavebasa da ganxilvaSi monawileobas; ukvearsebul maregulirebel aqtebSi naklis gamovlenisas maTisrulyofis mcdelobas saxelisuflo organoebis,profesiuli asociaciebis, pacientTa organizaciebisCarTviT.2.17.2 samuSao garemoadekvaturi samuSao garemo da adekvaturi anazRaureba eqimiskanonmdeblobiT gaTvaliswinebuli uflebebia. dawesebulebisxelmZRvaneloba/damqiravebeli valdebulia izrunos rogorcerTis, ise meoris srulyofaze. saWiroebis SemTxvevaSi, numogeridebaT amis Taobaze maTTvis Sexseneba.zemoT Tqmuli srulad exeba dawesebulebaSi resursebisdeficitsac, ramac SeiZleba xeli SeuSalos adekvaturixarisxisa da pacientisaTvis usafrTxo samedicino momsaxurebas.werilobiT miawodeT dawesebulebis xelmZRvanels/damsaqmebels saTanado informacia, saWiroebis SemTxvevaSiCarTeT saxelisuflo organoebi, profesiuli asociaciebi,pacientTa uflebebis damcavi organizaciebi. gaxsovdeT, rom49

zemoxsenebuli garemoebebisas pacientisaTvis zianismiyenebisaTvis pasuximgebloba, SesaZloa, Tqven dagekisroT.2.18. samedicino dokumentaciis warmoebaguldasmiT SeavseT pacientis samedicino dokumentacia.aucileblad SeitaneT pacientis saidentifikacio monacemebi,sruli informacia daavadebis diagnozis, mkurnalobis,mimdinareobis, gamosavlis Taobaze. ama Tu im Carevis(sadiagnozo, samkurnalo da a.S.) Sesaxeb gadawyvetilebisamsaxvel CanawerSi detalurad, adekvaturad asaxeTgadawyvetilebis miRebis safuZveli, agreTve, informacia,romelic pacients (an mis kanonier warmomadgenels/axlobels)miewoda Carevis Sesaxeb; mkafiod gadmoeciT moxseniebulTaTanxmoba an uari. kanoniT gansazRvrul SemTxvevebSiaucilebelia, pacientma an , misma kanonierma warmomadgenelmaTanxmoba xelis moweriT daadasturos (ix. Tavi `2.1.4informirebuli Tanxmoba, pacientis gadawyvetilebispativiscema~).diagnozTan Tu mkurnalobasTan dakavSirebiT raime eWvisarsebobisas /daafiqsireT dokumentaciaSi eWvis safuZveli da isRonisZiebebi, rac aucilebelia am eWvis gasaqarwyleblad andasadastureblad.Tu Tqveni rekomendaciis Sesruleba obieqturi garemoebebisgamo SeuZlebelia, miuTiTeT dokumentaciaSi mizezebze, SesaZlogavlenaze daavadebis mimdinareobasa da gamosavalze. aRwereT isRonisZiebebi, romlebic rekomendaciis SesrulebisTvisganaxorcieleT. saWiroebisas, mimarTeT dawesebulebisxelmZRvanelobas, eTikis komitets.samedicino dokumentaciaSi asaxuli informaciakonfidencialuria, misi gamJRavneba SeiZleba mxolod kanoniTgaTvaliswinebul SemTxvevebSi.Tu samedicino dokumentaciaSi raime Secdomaa daSvebuli,gaasworeT is. mcdari informaciis Secvlisas an arasruli50

informaciis Sevsebisas nu waSliT Zvel Canawerebs. aucilebladmiuTiTeT Secdomis mizezi (mag., gvian SegatyobinaT pacientma anmisma axlobelma/kanonierma warmomadgenelma, gvian miiReTsadiagnozo kvlevis Sedegebi da sxv.) da ise SeitaneT axaliinformacia.gaxsovdeT, rom samedicino Canawerebi SeiZleba gamoyenebuliiqnes samedicino momsaxurebis xarisxis analizisTvis (mag.,auditis sistema) misi gaumjobesebis mizniT, swavlebisTvis,samecniero kvlevisTvis. gaiTvaliswineT is garemoebac, romsamedicino Canawerebi, SesaZloa, gamoyenebuli iqnessamarTaldamcavi organoebis, sasamarTlos mier, rogorcmtkicebuleba. amasTan, samarTaldamcavi organoebi, bunebrivia,xelmZRvaneloben mxolod dokumentaciaSi asaxuli faqtebiT.amitomac, detalurad asaxeT dokumentaciaSi nebismieri garemoebaTu faqti dakavSirebuli Tavad pacientTan an misaxloblebTan/ojaxis wevrebTan, maTi fsiqologiurimaxasiaTeblebi, maT Soris urTierTobis Taviseburebebi, racxels uSlis adekvatur samedicino momsaxurebas; yuradRebagaamaxvileT sxva xelSemSlel garemoebebzec (mag., ama Tu imsadiagnozo Tu samkurnalo meTodis gamoyenebis SeuZlebloba),ramac daabrkola samedicino momsaxurebis adekvaturadganxorcieleba, im RonisZiebebzec, romelsac Tqven mimarTeT amnaklis aRmosafxvrelad.Tu pacientis janmrTelobis mdgomareobis Sesaxeb cnobasgascemT ucxo enaze, pasuxismgebloba informaciisadekvaturobaze Tqven gekisrebaT.2.19. eqimis moqmedeba, roca samedicino momsaxurebawarumatebeli aRmoCndebasamedicino momsaxurebis warumateblobis SemTxvevaSi pacients(mis axlobels, kanonier warmomadgenels) detalurad ganumarteTmisi mizezebi. ganmartebebis micemamde gaiazreT da dagegmeTsaubris qarga, moemzadeT mosalodnel SekiTxvebze pasuxisgasacemad, SeZlebisdagvarad, gaiTvaliswineT msmenelis51

mosalodneli reaqcia. saubari CaatareT mSvid, komfortulgaremoSi. daarwmuneT msmeneli, rom Tqven gulwrfeladTanaugrZnobT mas.warumatebeli samedicino momsaxureba aucileblad undagaxdes TqvenTvis sakuTari profesiuli saqmianobis SefasebissafuZveli. eZieT sakuTari nakli, ramac, SesaZloa, ganapirobawarumatebloba. izruneT am naklis aRmofxvraze.2.20. eqimis moqmedeba saeqimo Secdomis daSvebisassaeqimo profesia maRali riskis matarebeli urTulesiprofesiaa. Tqven arasodes xarT dazRveuli profesiuliSecdomisgan. es ukanaskneli SeiZleba ganpirobebuli iqnesTqvengan sruliad damoukidebeli faqtorebiT –aRWurvilobis/resursebis, medikamentebis an damxmaresaSualebebis ukmarisobiT, samuSao garemos arasrulfasovnebiT.amave dros, Secdomis mizezi SeiZleba gaxdes Tavad Tqvenicodnis ukmarisobა an unar-Cvevebis arasaTanado done.Tu samedicino Secdoma kolegebis wreSi ganixileba, maTTanerTad SeecadeT, gansazRvroT Tqvens mier daSvebuli Secdomismizezebi da, imavdroulad, dasaxoT gzebi momavalSi msgavsiSecdomis Tavidan asacileblad. wynarad moismineT dagaaanalizeT kolegebis SeniSvnebi; gaxsovdeT, rom koleebiswreSi sakuTari Secdomis gulwrfeli aRiareba da gansjaprofesionalizmis maRal doneze miuTiTebs.sxvisi Secdomis Sefasebisas yovelTvis gaiTvaliswineT, romsaeqimo Secdoma niSnavs, rom konkretuli eqimisTvis SeuZlebeligaxda mocemul situaciaSi sakuTari qmedebis an umoqmedobisSedegebis gaTvaliswineba an Tavidan acileba. piruTvnelad,magram keTilganwyobilad gansazRvreT Secdomis savaraudodganmapirobebeli garemoebebi. amasTan, garda subieqturifaqtorebisa (eqimis codna, gamocdileba, unar-Cvevebi),aucileblad gaaanalizeT is garemo, romelSic eqims uxdebodasaqmianoba, SeafaseT, aseT garemoSi iyo Tu ara SesaZlebeliswori gadawyvetilebis miReba.52

2.21. momCivani pacientisamedicino momsaxureba, Tundac absoluturad adekvaturi,yovelTvis efeqturi ar aris, rac SeiZleba saCivris safuZveligaxdes. aseT SemTxvevaSi (roca gamoricxulia saeqimo Secdoma)ganumarteT pacients, rom uefeqtobis mizezi medicinisarasrulyofilebaa da ara Tqveni nakli. saCivris mizezi,zemoxsenebulis garda, SeiZleba Tavad pacientis pirovnulimaxasiaTeblebic iyos (ix. qveTavi 2.1.11 `rTuli pacienti”) anmomsaxurebis organizaciuli mxaris arasrulyofileba (didxansmouxda lodini, gundis wevri – sxva specialisti, eqTani,damlagebeli da a.S. – ar iyo koreqtuli mis mimarT) da sxvamravali.xSirad pacientis saCivari momsaxurebaSi arsebuli naklisdafiqsirebis mniSvnelovani saSualebaa. amitomac yuradRebiTmousmineT momCivan pacients, nu SeawyvetinebT saubars, acaleTmas bolomde da srulad gamoxatos ukmayofilebis mizezi daSeecadeT gaiTavisoT is. nu mogeridebaT mobodiSebis, esukanaskneli ar niSnavs Tqveni Secdomis an bralis aRiarebas; isgagebisa da tolerantobis gamovlenis saukeTeso gzaa. Tuukmayofileba momsaxurebis organizaciul problemebTan arisdakavSirebuli, madloba gadauxadeT mas imisaTvis, rom saqmiskursSi CagayenaT, daarwmuneT, rom Tqven seriozulad aRiqvamTmis mier danaxul nakls, dahpirdiT, rom es aRar ganmeordeba arcmis da arc sxva pacientebis mimarT. ganumarteT, ra zomebsmiiRebT amisaTvis. amasTan, iyaviT gulwrfeli, nu dahpirdebiTimas, rasac ver SeasrulebT.pacientis Civilma araviTari gavlena ar unda moaxdinosmisTvis samedicino momsaxurebis xelmisawvdomobaze da/anxarisxze.2.22. eqimi da samarTaldamcavi organoebi, sxva saxelmwifodawesebulebebisamarTaldamcavi organoebis an sxva saxelmwifodawesebulebebis momarTviT Catarebuli eqspertizis SemTxvevebSi53

iyaviT obieqturi, piruTvneli. aucileblad gaiTvaliswineTgaremo, romelSic eqims uxdeboda gadawyvetilebis miReba,pacientisa an/da misi axloblebis (kanonieri warmomadgenlis)fsiqologiuri maxasiaTeblebi, socialuri, kulturuliTaviseburebebi; iyo Tu ara SesaZlebeli da Tu iyo, ramdenadsakmarisi dro hqonda eqims pacientTan (mis axlobelTan/kanonierwarmomadgenelTan) Terapiuli aliansis CamoyalibebisaTvis.daskvnebis gakeTebisas Tqveni orientiri nu iqneba saSualostatistikuri maCveneblebi, literaturul monacemebzedamyarebuli mosazrebebi. klinikuri praqtikis gaidlainiTa daprotokoliT gaTvaliswinebuli rekomendaciebis eqimisqmedebebTan Sejerebisas aucileblad gaiTvaliswineT maTirealizaciis SesaZlebloba im konkretul garemoSi da imkonkretul pacientTan. aseve, gaiTvaliswineT rekomendaciebi,romlebic asaxulia TavSi `2.20 eqimis moqmedeba saeqimo SecdomisdaSvebisas~.2.23. sakuTar profesiul kompetenciaze zrunva, uwyvetiprofesiuli ganviTarebaadekvaturi, profesiuli da eTikuri standartebis Sesabamisisamedicino momsaxurebisaTvis aucilebelia sakuTari codnisa daunar-Cvevebis gamudmebiT ganaxleba da srulyofa. es procesiTqveni profesiuli saqmianobis dawyebisas unda iRebdes dasabamsda grZeldebodes manam, sanam Tqven dakavebuli xarT saeqimosaqmianobiT. nurasodes irwmunebT, rom Tqveni saqmianobasrulyofilia. mxolod sakuTari gamocdileba da dagrovebulicodna, marTalia, mniSvnelovania, magram raRac etapze (axaliteqnologiebi, axali medikamentebi, mkurnalobis axali meTodebida sxv.) arasakmarisi xdeba medicinis miRwevebis Sesabamisisamedicino momsaxurebis uzrunvelyofisaTvis.2.24. eqimi da axali teqnologiebiaxali teqnologiebis gamoyenebisas `iCqareT nela”.darwmundiT, rom arsebobs mtkicebulebebi maTi gamoyenebissargeblianobis Sesaxeb; gansajeT, ra siZneleebs Segiqmnian axali54

teqnologiebis gamoyenebis gzaze manamde damkvidrebulitradiciebi da midgomebi. teqnologiis gamoyenebamde gaiareTsaTanado mzadebis kursi. uTxariT pacients, ra gamocdilebagaqvT am teqnologiis gamoyenebaSi da mxolod amis Semdeg miiReTmisi informirebuli Tanxmoba proceduris Catarebaze.axali wamlis gamoyenebamde moiZieT mtkicebulebebi misiefeqturobis Sesaxeb.darwmundiT, rom wamali registrirebulia qveyanaSi(daSvebulia saqarTvelos bazarze) da mxolod amis SemdeggamouwereT pacients.amasTan, rodesac es aucilebelia pacientisjanmrTelobisaTvis, SegiZliaT pacients urCioT nebismieridauregistrirebeli wamlis gamoyenebac. aseT SemTxvevebSiacnobeT pacients, rom kanonmdeblobiT daSvebulia calkeulipacientis saWiroebisaTvis arakomerciuli mizniT wamlebisSemotana `saqarTvelos bazarze daSvebis reJimis~ gverdis avliT 3 .2.25. eqimi da telemedicinatelemedicinis gamoyenebiT miRebuli konsultaciissafuZvelze pacientisaTvis rekomendaciis micemisas misiganxorcielebis Sedegze pasuxismgebloba Tqven gekisrebaT.pacientis moTxovniT, monacemebi misi janmrTelobismdgomareobisa da piradi cxovrebis Sesaxeb SeiZleba gadaicespacientis vinaobis dasaxelebis gareSe.2.26. eqimi mkvlevaribiosamedicino kvleva aucilebelia medicinisganviTarebisaTvis da efeqturi prevenciuli, sadiagnozo,samkurnalo Tu sareabilitacio meTodebis SemuSavebisaTvis.xeli SeuwyveT mkvlevarebs, romlebic kvlevas gegmaven TqvensdawesebulebaSi da TanamSromlobas SemogTavazeben. amasTan,yovelTvis gaiTvaliswineT kvlevis subieqtis usafrTxoebisa da3 saqarTvelos kanoni `wamlisa da farmacevtuli saqmianobis Sesaxeb~, muxli 11 13 .55

uflebebis dacvis aucilebloba. pacientis usafrTxoeba dajanmrTeloba upiratesia kvlevis miznebTan SedarebiT.kvlevaSi monawileobaze da/an kvlevaSi Tqveni pacientebisCarTvaze Tanxmoba ganacxadeT mxolod maSin, Tu kvlevis gegmadamtkicebulia Sesabamisi eTikis komitetis mier. aRniSnulSidasarwmuneblad sTxoveT mTavar mkvlevars, rom warmogidginoTeTikis komitetis daskvna.kvlevaSi pacientebis CarTvamde:• guldasmiT waikiTxeT kvlevis gegma da informirebuliTanxmobis forma;• dawvrilebiT gaecaniT kvlevis miznebs, meTodebs, kvlevissubieqtis SerCevis gzebs. gaarkvieT, ra sargebloba SeiZlebamoitanos kvlevis Sedegebma zogadad, agreTve, rasargebloba SeiZleba hqondes mas Tqveni pacientebisTvis anTqveni pacientebis mdgomareobaSi myofi sxva pirebisTvis;gaarkvieT, ra riski axlavs kvlevas, ra diskomfortsSeiZleba ganicdides kvlevis subieqti (pacienti) kvlevaSimonawileobisas.Tu pacientis Tanxmobis miReba kvlevaSi monawileobaze TqvengevalebaT, Tqven unda:• gaacnoT pacients kvlevis mizani, mosalodneli sargebelipiradad misTvis, agreTve mis mdgomareobaSi myofi sxvapirebisaTvis; darwmundeT, rom pacients ar aqvsgadaWarbebuli, usafuZvlo molodini kvlevaSi monawileobissargeblianobis Sesaxeb;• miawodoT informacia pacients kvlevaSi monawileobasTandakavSirebuli riskisa da diskomfortis Sesaxeb;• misceT pacients werilobiTi informirebuli Tanxmobisforma, romelic Seicavs dawvrilebiT informacias kvlevisSesaxeb da misceT mas dro da saSualeba, gaecnos aRniSnulformas;56

• sTxovoT pacients, rom dagisvaT kiTxvebi misTvis sainteresosakiTxebze mas Semdeg, rac igi gaecnoba informirebuliTanxmobis formaSi asaxul informacias. SeecadeT upasuxoTmis kiTxvebs martivi, gasagebi eniT; darwmundiT, rompacientma gaigo misTvis saintereso yvela sakiTxi;• mkafiod acnoboT pacients, rom mas ufleba aqvs uari TqvaskvlevaSi CarTvaze, agreTve, nebismier etapze ganacxadosuari ukve dawyebul kvlevaSi monawileobaze da gamoeTiSosmas;• aseve mkafiod acnoboT pacients, rom uari kvlevaSiCarTvaze an ukve dawyebuli kvlevidan gamoTiSva araviTargavlenas ar moaxdens misTvis saWiro samedicinomomsaxurebis gawevaze;• misceT pacients dro gadawyvetilebis misaRebad kvlevaSimonawileobis Taobaze;• daafiqsiroT informirebuli Tanxmobis formaze pacientisada Tqveni, rogorc mkvlevaris, xelmowera mxolod masSemdeg, rac darwmundebiT, rom pacientma, rogorc kvlevissubieqtma, aRiqva yvela mniSvnelovani informacia kvlevaSimonawileobasTan dakavSirebiT da rom misi TanxmobaTavisufalia yovelgvari zegavlenisagan.kvlevis mimdinareobisas:• yuradReba miaqcieT, rom gamoyenebuli kvlevis meTodebizedmiwevniT emTxveodes kvlevis gegmaSi asaxulmeTodologias;• uzrunvelyaviT pacientis Sesaxeb arsebuli monacemebiskonfidencialuroba kvlevis gegmaSi asaxuli meTodologiisSesabamisad.• SeafaseT pacientis janmrTelobis mdgomareoba kvlevaSimonawileobasTan dakavSirebuli SesaZlo riskisa dadiskomfortis gaTvaliswinebiT. gaxsovdeT, rom, rogorczemoT ukve iyo aRniSnuli, pacientis usafrTxoeba da57

janmrTeloba upiratesia kvlevis miznebTan SedarebiT,raoden mniSvnelovanic ar unda iyos es ukanaskneli.• kvlevis procesSi wamoWrili nebismieri gauTvaliswinebeligaremoebebis warmoqmnisas dauyovnebliv acnobeT mTavarmkvlevars, romelic valdebulia amis Sesaxeb acnobosSesabamis eTikis komitets, agreTve, kanonmdeblobiTa dakvlevis gegmiT gaTvaliswinebul struqturebsa da pirebs.• daicaviT obieqturoba da miRebuli monacemebi daafiqsireTzustad, rogoric ar unda iyos is (sasurveli Tuarasasurveli mkvlevarTa jgufisaTvis an sponsorisTvis).2.27. eqimi maswavlebelipedagogiuri saqmianoba xels uwyobs Tavad eqimis profesiulganviTarebas. Tu mogecaT SesaZlebloba, nurasodes ityviT uarsstudentebis, rezidentebis, eqimebis ganswavlaSi da mzadebaSimonawileobaze. saqmianobis efeqturobisaTvis kargad gaiTaviseTmozrdilTa swavlebis meTodologia da unar-Cvevebi.58

3. saqarTvelos eqimis qcevis wesebis danergva`saqarTvelos eqimis qcevis wesebSi” asaxuli rekomendaciebisgamoyeneba nebayoflobiTia.amasTan, imis gaTvaliswinebiT, rom `saqarTvelos eqimis qceviswesebi” efuZneba moqmed kanonmdeblobas da aRiarebul eTikurstandartebs, am wesebis gamoyeneba eqims daexmareba usafrTxo,Tanamedrove eTikuri standartebis Sesabamisi samedicinopraqtikis warmarTvaSi. qcevis wesebis dacva saSualebas miscemseqims, erTi mxriv, sul mcire, Tavi aaridos kanonmdeblobasTankonfliqts, xolo meore mxriv, mudmivad aamaRlos mis miergaweuli samedicino momsaxurebis xarisxi da gazardospacientebis kmayofileba.`saqarTvelos eqimis qcevis wesebis” danergvis ZiriTadi gzaaam wesebis oficialuri aRiareba eqimTa dargobrivi asociaciebismier. wesebis aRiarebiT asociacia mouwodebs sakuTar wevrebs,ixelmZRvanelon `saqarTvelos eqimis qcevis wesebiT”.eqimTa asoicaciebs da maT mier Seqmnil sxvadasxvastruqturebs SeuZliaT ixelmZRvanelon `saqarTvelos eqimisqcevis wesebiT” eqimis mier gaweuli samedicino momsaxurebisxarisxis Sefasebisas, uwyveti samedicino ganaTlebissaWiroebebis, miznebisa da amocanebis gansazRvrisas da a.S.3.1. `saqarTvelos eqimis qcevis wesebis” aRiareba dargobriviasociaciebis mier`saqarTvelos eqimis qcevis wesebs” aqvs danarTi –`deklaracia `saqarTvelos eqimis qcevis wesebis” aRiarebisSesaxeb~. aRniSnul deklaraciaze xelis moweriT eqimTadargobrivi asociaciebi adastureben qcevis wesebis aRiarebas.`deklaracia `saqarTvelos eqimis qcevis wesebis” aRiarebisSesaxeb~ inaxeba saqarTvelos eqimTa asociaciaSi.eqimTa dargobrivi asociaciebis mier `saqarTvelos eqimisqcevis wesebis” aRiareba Semdegnairad xdeba:59

• `saqarTvelos eqimis qcevis wesebis” aRiarebis msurvelieqimTa dargobrivi asociaciis xelmZRvaneli `saqarTveloseqimTa asociaciaSi~ waradgens Sesabamis gancxadebas,romelsac Tan daerTveba dargobrivi asociaciis xelmZRvaneliorganos gadawyvetilebis amsaxveli dokumenti (damowmebuliamonaweri sxdomis oqmidan, sadac miTiTebulia, rom sxdomammiiRo gadawyvetileba, dargobrivma asociaciam aRiaros`saqarTvelos eqimis qcevis wesebi”).• gancxadebis warmodgenis Semdeg dargobrivi asociaciisxelmZRvaneli xels awers `deklaracias `saqarTvelos eqimisqcevis wesebis” aRiarebis Sesaxeb~, riTic adasturebs`saqarTvelos eqimis qcevis wesebis” aRiarebas. xelmoweraunda damowmdes dargobrivi asociaciis beWdiT.• `saqarTvelos eqimis qcevis wesebis” aRiareba SeuZliasaqarTveloSi registrirebul nebismier eqimTa dargobrivasociacias, nebismier dros.• eqimTa dargobriv asociacias, romelic miuerTda qceviswesebs, SeuZlia nebismier dros gaauqmos xelmowera,risTvisac `saqarTvelos eqimTa asociaciaSi~ waradgensSesabamis gancxadebas.• `saqarTvelos eqimTa asociacia~ mudmivad aaxlebs imdargobrivi asociaciebis nusxas, romlebmac aRiaressaqarTvelos eqimis qcevis wesebi da inaxavs dargobriviasociaciebis mier wardgenil gancxadebebsa da TandarTuldokumentacias.60