Warning Signs of Dementia: Dementia, a Collection of Symptoms

In the medical world, dementia is somewhat of a mystery. Are you aware of the warning signs collectively labeled as dementia?

What is dementia?   

Dictionary.com defines dementia as being “severe impairment or loss of intellectual capacity and personality integration, due to the loss of, or damage of neurons in the brain.” It also suggests that dementia is equivalent to “madness” or “being out of one’s mind”.

In the past, the word senility described a patient who was losing his or her mind. Senile has become an obsolete word. It is seldom, if ever, used in medical circles or health care scenarios today. The word, madness is also obsolete with a current trend towards the use of the word dementia. Another word used in the past, is demented. This has had both mental and spiritual implications, in terms of a patient regarded as being demon possessed.

Be aware that dementia is not Alzheimer’s disease, although the collective symptoms regarded as dementia, may be associated with it.

With this in mind, what are the warning signs of dementia?

Understanding that dementia as a collection of symptoms, rather than as a disease entity as such, is very important because these symptoms are the warning signs.

Note that the degree of severity of the symptoms suggesting dementia and the mental faculties that are involved depend upon which part of the brain is affected. There is a problem with basic, brain function and thus, the cognitive areas of the brain are involved. This means that the thinking, judgment and behavior of a patient demonstrating the collection of symptoms regarded as dementia, may be abnormal. Memory and language are often part of this scenario, as these may be or may become increasingly impaired over time. If so, this will become more and more evident.

There is a fine line between Alzheimer’s disease and dementia, because when one’s mind and memory are both affected, one’s reality becomes increasingly unclear or indistinct. It may be difficult for a patient to define his or her own reality.

Appropriate communication is one way to recognize a patient is mentally sound, stable and healthy. Inappropriate communication should raise concern immediately. Is there evidence of increasing memory loss or perhaps the possibility of a more serious, underlying problem?

Does the patient appear to be oriented or confused with respect to time and place? Does he or she know his or her name and address? An ongoing medical investigation will help to determine the extent and severity of this kind of a problem. Because dementia is not a disease entity as such, but rather the collection of symptoms associated with confusion and disorientation, document the symptoms carefully.    

What makes dementia difficult to diagnose at times, is the reality that other disease entities can also demonstrate similar symptoms. For example, severe heart problems, diabetes, kidney disease, abuse of alcohol, nicotine and other substances, may be underlying factors that display similar symptoms.

Whenever a patient’s circulation is impaired as in severe heart disease or stroke activity, there may be dementia-like symptoms. This is also true in cases of severe malnutrition, vitamin and mineral deficiency or other serious illnesses, including different kinds of mental illness. For example, schizophrenia may manifest itself in terms of confusion and disorientation. Differential diagnosis is required to determine the root or cause of the confusion and disorientation.

When should one become alarmed?

Repeated, dramatic and sudden shifts in a patient’s behavior, mood and personality indicate the need for ongoing medical assessment.

Symptoms rarely occur alone. Increasing language impairment or the inability to carry out normal tasks associated with day-to-day living, may prove to be important warning signs. Forgetfulness, in conjunction with life style activities, constant losing or misplacing of important items or the continual repetition of words and phrases, suggests imminent, pending or actual deprivation of mental faculties. Demonstrating the inability to think properly, suggests further investigation may be necessary.

Underlying disease entities and the causes of symptoms collectively regarded as dementia, will become increasingly evident. It may be possible to treat some of the symptoms that appear to present dementia in a patient, depending upon the degree of progression of the disease entity.  

How long should one wait before becoming concerned? One must suggest that the patient needs an immediate assessment, diagnosis and treatment of his or her symptoms. The safety of the patient may be in question. This may also include the safety of others. Is the patient in early or later stages of the symptoms of dementia? This can only be determined with an ongoing assessment.

If you discover what you consider warning symptoms of dementia in a patient, document them accurately as to date, time, place and circumstances. Report the symptoms to a medical professional. Do not hesitate to act, as you may save the patient’s life or that of someone else.

Knowing the warning signs collectively regarded as dementia, is important for everyone because in the future, dementia may become a far more serious problem than anyone realizes at this time.

Tips for Caring for Someone With Alzheimer's/Dementia: Nursing Care Tips for a Patient with Alzheimer's/Dementia

How does one care for a patient diagnosed with Alzheimer’s/dementia? 

With Alzheimer’s disease, there is mild to severe memory loss, that gradually increases and affects the way a patient functions, on a day-to-day basis. Coupled with increasing, cognitive impairment, leading towards the collective symptoms of dementia, there may be evidence of varying degrees of the loss of touch with reality.

At times, it may be difficult to separate the symptoms of Alzheimer’s disease, from the symptoms of dementia. Being aware of this is important, particularly in terms of patient care.

Here are some nursing care tips for a patient diagnosed with Alzheimer’s/ dementia.

First, always identify your patient correctly, as there may be partial or complete loss of self-identity on the part of the patient.

Memory loss, confusion and disorientation result in the loss of a patient's identity. He or she may not know, recognize or be able to give you his or her name. This might also include his or her date and place of birth, social insurance or social security number. He or she may not respond to the name that you use to identify him or her.  

Speak to the patient directly, always using his or her correct name in order to continue to re-familiarize the patient with his or her correct identity.        

Check the patient’s identification bracelet carefully, before administering any medications or treatments. If you do not know this patient and there is no identification bracelet on him or her, find someone, preferably a professional medical person or a family member, who can identify this patient correctly. Make certain that he or she has appropriate identification to avoid the recurrence of this kind of a scenario, in the future.        

This patient may appear to be confused with regard to both time and place. He or she may not be comfortable with his or her surroundings, particularly if they are relatively new. The patient may show evidence of feeling displaced or lost, even in an environment that he or she should recognize. Document all increasing evidence of memory loss, confusion or disorientation.

Note that Alzheimer’s disease coupled with dementia can result in extremely aggressive behavior, even though the patient usually appears to be non-aggressive. Document all evidence of increasing aggression. 

Fear or paranoia may surface at any time and be manifest in terms of aggressive words or actions, on the part of the patient. Unexpected or inappropriate behavior may occur. Document aggression and inappropriate behavior, as these may become recurrent patterns of behavior. 

Always speak to the patient politely, gently and kindly, as he or she may still comprehend what you are saying, even though he or she is not able to respond to it verbally. Document whatever indicates the patient does not comprehend what you are doing or saying.  

Patient safety, as well as the safety of others, is extremely important. The patient may need one-on-one care. The use of restraints may be necessary in order to protect the patient, as well as others. This patient may require medication or admission into a medical care facility or unit where he or she cannot harm family members or other patients.

A patient with Alzheimer’s disease, coupled with symptoms of dementia, may not recognize family members, at various times. This can depend upon the extent of the disease process, as well as the patient’s previous contact with family members. He or she may relate better to one person than to another.

The patient may continually try to escape from his or her surroundings or try to go home, even when he or she is in his or her own home. Memories of places where he or she has lived previously, even in earlier decades, may surface.

The patient may not always be able to complete his or her own personal care and may require varying degrees of assistance with the normal activities of daily living. This can include basics of patient care including meals, dressing, bathing and hair care. Do not ridicule or make fun of the patient, regardless of what he or she does.

Keep the patient clean, comfortable and warm. Note that the need for ongoing assistance will probably increase over time, as the disease progresses further. Be aware that no two patients will have exactly the same symptoms.

If it becomes necessary, feed the patient carefully, as he or she may choke on food or drinks. This has to do with possible, ongoing stroke activity and the loss of the ability to swallow properly. Offer only small amounts of foods and fluids, if difficulty swallowing is apparent. Document and report all evidence of this.

Fear or suspicion may surface with regard to medications, food or drinks, particularly something that is new or different. Do not force a patient to eat or drink. Offer that same food or drink later. Document the patient’s response to it, at that time.    

Speak softly and quietly to this patient. Be firm, but kind and gentle, at all times. Remember that a smile or a pat on the patient’s hand or back, can go a long way towards keeping the peace.

Note that this patient may repeatedly lose or misplace his or her glasses, dentures and other personal belongings. He or she may hide things in unusual or unexpected places. The patient may take or steal personal property that belongs to others, thinking that these items are his or hers, so make certain that the personal property of patients is identifiable. 

Try not to argue or fight with this patient, as this will only increase his or her aggressive tendencies.  Abuse of patients is never acceptable.    

Listen carefully to this patient, as he or she may try to tell you things that are important to him or her, even though he or she may not be able to speak properly. Note whether the patient is able to hear or see properly. He or she may lie to cover up memory loss.

Find appropriate, interesting and fun things that the patient can do, at various stages of this disease and reward him or her appropriately, for trying to do them.

Find entertainment that the patient enjoys, as a happy patient is much easier to take care of. Many patients enjoy listening to quiet, classical music or watching family-oriented movies. Avoid television programs that may be upsetting to the patient.

With these nursing care tips in mind, know that looking after a patient with Alzheimer’s dementia is often a challenge. It can become easier if one recognizes the reality that this patient will respond to loving, kind and compassionate nursing care administered in a positive way, even during the later stages of his or her disease.

The Final Decision: Should Medical Advice Trump Parental Rights?

Ideally, the question, should medical advice trump parental rights, is answered in the affirmative. At the same time, the use of the word trump might concern some parents or others, particularly if they feel that trump is not the most appropriate word to use. This can happen when the word trump appears heavy-handed or offensive to them.

Medical advice should take precedence over parental rights when the life of a child is at stake. A qualified medical professional offers sound advice, directed toward healing, health and wholeness. It is also life-oriented. The doctor will be knowledgeable, skilled and trained from a medical perspective. He or she will be able to direct parents to someone who has a higher level of expertise, if necessary. In many life-threatening situations, patients must take their child or children to see other professional medical consultants in order to receive the correct medical care, medications or treatments.     

Medical advice is something that every parent has to seek for his or her children, at one time or another. No doctor has the answer for every possible, medical problem. At times, there are no easy answers for medical problems that concern children and they need to see pediatricians or other child care specialists. While no parent has to accept all of the medical advice given by any particular doctor, it is generally wiser to allow medical advice from qualified medical professionals to take precedence over parental rights.

It is important to encourage parents to find family doctors who they trust with the health care of their children. This becomes even more important at critical times in their children’s lives. Having children’s medical records with one doctor, if possible, is vital in case of an emergency, as this can save time, as well as the lives of the children in question.   

Parents love their children and want what is best for them, so do doctors and other medical professionals. Parents who choose to work together as a team, along with qualified medical professionals, in terms of the care of their children, are much more likely to achieve success, than those who do not..

Parents need to receive current medical information from medical professionals, particularly in our era, which is one in which almost anyone can obtain data from the Internet. Finding other sources of medical information than those offered by professional medical people is always a possibility, as information changes daily. Ideally, parents should consult their children’s doctors about this kind of information, if that happens.

With regard to children, the final decision about accepting medical advice is in the hands of the parents. There are times when doctors have to make a decision, particularly if they cannot reach the parents. 

Sometimes, when parental decisions are questionable from a medical perspective and court decisions are necessary. Intervention with appropriate emergency medical measures may save the life of a child. .     

Here is another thought for parents to consider, with regard to the use of the word trump. Trump can also suggest outrank. In other words, the advice given and decision made by medical professionals is superior, wiser or more appropriate in terms of saving the life of a child. Within this context, medical advice should trump parental rights.     

The Risk of Releasing Patient Information on the Internet

The risk of releasing patient information on the Internet is always high regardless of whether the patient information originates from a medical or health care professional, or from a patient and his or her family. The transfer and release of medical records or documents of various kinds can come about through medical or health care facilities.

In medical and health care facilities, there may be few, if any, patient consent forms with regard to the release of patient information on the Internet. The same is true regarding rules and regulations about the release of patient information on the Internet. Do they exist? Over time, this will become an increasingly, serious area of concern with regard to doctor-patient confidentiality.

At this time, there should be some actively, enforced rules and regulations about the use of the Internet, with regard to the release of patient information. Is it possible to enforce them? The feasibility of implementing this may be questionable, at best.

Patient data, obtained by doctors and other medical and health care professionals, becomes information entered into computer files in medical and health care facilities. It happens continually all around the globe, as medical records take on various forms of documents and a wide variety of files, transferred from person to person, as well as from place to place, via the Internet.

Should patients allow the release of their information on the Internet? Can patients prevent this, if they choose not to allow it to happen?

One might suggest that only a patient, in conjunction with his or her family, should make the final decision about the release of his or her information on the Internet. That decision should be under the guidance of a patient’s medical or health care professional. When it comes to a question of patient preference, there will be those who allow this to happen, while there will be others, who object strongly. There may also be those, who do not wish to take a stand, in either direction.

It becomes an area of serious concern, when one sees patient information released on the Internet, by family members or close friends. This should always be discouraged, particularly in terms of social networking, as information can quickly fall into the wrong hands. At the same time, it happens every day.

Should medical or health care professionals release patient information on the Internet?

This question may raise controversy because medical and health care professionals use the Internet on a regular basis and thus, there is no easy answer to this question, at this time. There are instances when releasing patient information via the Internet could endanger the life of a patient. This includes data transferred by medical or health care professionals, to the facilities they use for patient care.

Patients are in a vulnerable position and preventing exploitation of them is important. The protection of patients is a concern to all medical and health care professionals. The unauthorized disclosure of their information is never acceptable.

Weighing the advantages versus the disadvantages, is it worth the risk to release patient information on the Internet?

At times, this may become a decision made only as the necessity arises. In other words, what one might decide is acceptable at one time, might not be a wise decision, in a different situation. Saving a patient’s life might indicate that the risk taken, is or has been worth it. If a human life is lost for any reason, data transfer on the Internet, might become an area with serious legal implications. For example, a doctor might require immediate information, like the medical history or blood type of a patient, in order to save his or her life, after a patient experiences an accident with an injury. If the patient’s life is lost, the release of information on the Internet may be subject to severe scrutiny. Remember that there are times, when those who take emergency measures to save patient’s lives are subject to severe criticism.

Text messaging on the Internet might appear to be the most effective and fastest method of communication at times, for instance, in a hospital emergency. At other times, the best option might be voice mail or e-mail. Note that at the same time, the doctor or other health care professional could place his or her own license at risk, by using any method of electronic communication.   

There are definitely both pros and cons with regard to releasing patient information on the Internet. At times, it may be necessary to weigh one side of the issue, against the other. There may be times, when it appears that there are no other possible options.

Release of patient information is essentially a moral, ethical and legal concern for doctors and other medical and health care professionals. The risk of releasing patient information on the Internet cannot and should not ever be under-estimated, as this kind of a scenario can quickly escalate into a serious moral, ethical and legal issue for any doctors, other medical and health professionals, patients and their families.

Medical facilities may also be liable if patient information appears on the Internet, in a manner that is not appropriate or professional. For example, a man in a medical facility has dementia and his children, as well as others, are engaged in a legal dispute about his estate. A doctor or health care person from the medical facility may be entering into regular dialogue via e-mail with a family member, about the patient’s mental health status.

What are the future implications of this communication in terms of the pending court case, particularly if the dialogue becomes less than professional, at times?    

While this may not prove to be a good scenario, at times, there are advantages to releasing essential patient information on the Internet. There are an increasing number of medical and health care professionals who use the Internet for medical records including short and long-term data storage. Many medical and health care facilities do the same thing. Data transfer via the Internet, is ongoing, all around the world. The reasons for this include time, space and convenience. There is a minimum amount of time and space involved in the transference of patient data, via the Internet. Patient records can be very large and are often difficult to store and thus, compressing data on files saves both time and space. Since medical and health care professionals have access to computers and other electronic devices, transferring them becomes a matter of convenience.     

Professionalism is the most important factor to consider in the release of patient information.

Patient confidentiality is important to doctors and other health care professionals. Part of being professional, involves maintaining a high level of confidentiality. Patient information that is on the Internet may no longer be confidential once it has become accessible to others. Medical and health care professions teach the importance of patient confidentiality. This is a trust relationship and that trust should not be broken.  

There is the always the possibility of human error on the Internet, as well as the reality of serious computer issues that can result from human error. While computers appear to be relatively safe and reliable, at least for the most part, computer crashes occur regularly, often at the hands of incompetent individuals. Malicious, computer hackers may try to obtain patient data files. One must understand that the margin of human error is relatively high.

Security or the lack thereof, becomes extremely important with regard to patient information. While computers may appear to be relatively secure, there is always the chance that these computer systems can break down. Server problems happen and important files disappear, sometimes quickly. They may not be retrievable. Firewalls frequently break down. Back up files may be available at times, but not always.     

There is also the question of increasing identity theft. Obtaining access to patient information or their medical records, is only one way  that someone engaged in identity theft can steal the identity of another person, so proper precautions must be taken.

In conclusion, one must suggest that the release of patient information on the Internet is of serious concern to medical and health care professionals, even though the Internet is widely used as a communication tool, at this time. This should continue to be an area of serious concern to doctors and other health care professionals, as well as to patients and their families. The risk factor involved in releasing patient information on the Internet is high and there will always be the possibility of potential problems. Medical and health care professionals, as well as patients and their families, must be alert to this potential danger.

Obesity: A Growing Health Concern Globally

The obesity epidemic is real.

If one walks down the street, particularly in the western world, it immediately becomes apparent that the problem of obesity is a growing, health concern. This is not merely attributable to hype or media hype, personal or mass opinion, or merely a figment of someone’s vivid imagination. There are a large percentage of people, who are overweight or even grossly overweight, all around the globe.

One might argue that because of the media, there is increased awareness of the growing obesity epidemic. There are also medical records documenting evidence that shows the problem of obesity is reaching epidemic proportions, in many different parts of the world.

In order to understand the obesity epidemic, it is important to know what obesity is. It is also necessary to understand how this is determined, as well as what a concern of epidemic proportion signifies for humankind.

One might ask how it is possible to determine if there really is an obesity epidemic. Is it identifiable from a medical, scientific perspective?

To explain this more fully, there are three words that must be understood, namely obesity, epidemic and 

body mass index. 

What is obesity?

“Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or health problems. (1) 

When one argues that obesity is of epidemic proportion globally, it is important to understand how an epidemic is determined and why it becomes an area of medical concern. 

What is an epidemic?

Normally, one would of an epidemic in terms of being the spread of a disease process or an infection. Thus, since obesity is not an infection, there are people who prefer not to refer to the problem of obesity, as an epidemic. At no point in time, has it ever been determined that obesity has any relationship to infection. At the same time, the obesity problem continues to expand its global horizons, rapidly.

Allegorically speaking, one might suggest that the problem of obesity is growing, in a manner similar to the spread of a disease or an infection. In other words, as it spreads, it touches, changes and endangers the lives of many people in certain areas, at the same time. It also affects their health in an adverse manner.

Within this context and under the following definition of epidemic, one might suggest that obesity is a real epidemic or at the very least, a global health concern of epidemic proportion: “A rapid spread, growth or development.” (2)

To assert that an obesity epidemic is real, it is important to understand how body mass index is determined from a scientific, medical and health care perspective. 

What is body mass index?

“Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 kg/m2 and 30 kg/m2, and obese when it is greater than 30 kg/m2."  (3)

Globally, medical and health care professionals, determine body mass index for their patients. This often includes large numbers of people living in different areas, sometimes in remote areas of the world. This information researched further, determines the numbers of people whose lives are ultimately affected. That is when the reality of obesity as an epidemic or a global health concern of epidemic proportion, becomes evident.

On this basis, the obesity epidemic is real and yes, people everywhere, should be concerned and seek medical guidance and directives with regard to obesity. The good news is that the problem of obesity can be resolved.

1. http://en.wikipedia.org/wiki/Obesity

2. http://www.answers.com/topic/epidemic

3. http://en.wikipedia.org/wiki/Obesity

Human Rights: Privacy, Trust and Confidentiality

"Should patient information be published on the Internet?":

This question should be answered with a firm no, by patients and other family members, as well as by medical and health care professionals, in order to protect them.

Three major areas of concern should be addressed in this question, namely human rights (and more specifically, the right to privacy), trust and confidentiality.

Human rights

Each person has basic human rights and these include the right to personal privacy.

Note the following quotation:

“Privacy is a fundamental human right recognized in the UN Declaration of Human Rights, the International Convenant on Civil and Political Rights and in many other international and regional treaties. Privacy underpins human dignity and other key values such as freedom of association and freedom of speech. It has become one of the most important human rights issues of the modern age. The publication of this report reflects the growing importance, diversity and complexity of this fundamental right.” (1)

One might ask, is it a violation of human rights (and more specifically a person’s privacy), when patient information is posted on the Internet? One must argue that it is.

Does it make a difference who releases the information?

Should a patient post his or her own patient information on the Internet, in conjunction with his or her own family members? Doing so may affect the lives of others and impinge upon their human rights.

Can a patient or a patient’s family violate his or her own human rights? Perhaps unknowingly or even knowingly, this is possible. In turn, this might reflect further, on the human rights of others.

Should patient information be posted on the Internet, by medical or other health care professionals?

Medical and health care professionals do not post any patient information on the Internet, particularly when a consent in writing, has not been obtained from the patient and/or the patient’s family.  

Trust  

“The typical definition of trust follows the general intuition about trust and contains such elements as: the willingness of one party (trustor) to be vulnerable to the actions of another party (trustee); reasonable expectation (confidence) of the trustor that the trustee will behave in a way beneficial to the trustor; risk of harm to the trustor if the trustee will not behave accordingly; and the absence of trustor's enforcement or control over actions performed by the trustee. Trust can be naturally attributed to relationships between people. It can be demonstrated that humans have a natural disposition to trust and to judge trustworthiness that can be traced to the neurobiological structure and activity of a human brain…” (2) 

Patients and their families establish an element of trust, based upon personal integrity, in their relationship with others.

Should that trust ever be broken?

Ideally, this kind of a trust relationship should never be broken through the posting of patient information on the Internet.

There is the element of trust established between a doctor and his or her patients, another trust that should not be broken. To post patient information on the Internet, without the consent of a patient and his or her family, would be a violation of that trust.

Confidentiality

Many people are not aware of what is involved in terms of confidentiality issues and concerns, when patient information is posted on the Internet.

Consider the following three definitions of confidentiality:

“…the principle in medical ethics that the information a patient reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party.” (3)

“The ethical principle or legal right that a physician or other health professional will hold secret all information relating to a patient, unless the patient gives consent permitting disclosure.” (4)

“…secrecy relating to information. All clinical data have a degree of confidentiality, the level varying with the information and the circumstances.” (5)

Confidentiality, where it concerns a patient and his or her family members, is something that becomes an individual or a family matter, but the importance of it should never be underestimated.

Confidentiality is always a major concern for all medical and health care professionals. This is a basic tenet of their training, practice and professional conduct.

Thus, being aware that human rights, (specifically those of personal privacy), trust and confidentiality are vital in terms of a person’s medical and health status, patient information should not be posted on the Internet by a patient, or his or her family members.

It is even more important when it comes to medical and health care professionals.

1. http://gilc.org/privacy/survey/intro.html

2. http://en.wikipedia.org/wiki/Trust_(social_sciences)

3. http://medical-dictionary.thefreedictionary.com/confidentiality

4. Ibid.

5. Ibid.

Understanding the Difference Between Legal, Moral and Ethical Issues: Ongoing Research in Evaluation and Reassessment

To understand the difference between legal, moral and ethical issues, particularly as they concern the practice of medicine, it is important to distinguish between these three realms of inquiry.

While it is possible to simplify this to some extent, at the same time, one must be aware that each of these realms is broad in scope. In other words, there is on-going research, re-evaluation and re-assessment in each of these areas, during every era and thus, their horizons are continually expanding.    

Legal issues pertain to the law.

We each have a basic understanding of the law, as well as how it concerns us as individuals, couples, families, communities and countries. At times, we look at this from an international perspective. Established laws should not be broken. If or when, they are broken, there may be repercussions, which may include severe punishment. Of course, the interpretation of the law and the enforcement thereof, always presents a certain degree of difficulty, in every part of the world and in every realm of inquiry, including that related to the medical world.

Moral issues involve the concept of right and wrong in terms of a person’s conscience and behavior.

From a western perspective, Christians understand the divine Law or the Ten Commandments in the Old Testament of the Bible, to be the foundation of the moral system. In the New Testament, “the love of God and one another”, sets a broader, moral standard for humankind, based upon the concept of divine love and forgiveness.  

Of course, there are different standards of morality all around the world. These are generally in conjunction with various religious systems and beliefs. Most countries have moral teachings, as well as moral leaders, who instruct and guide their people. Moral issues can be of an individual or collective nature, even in the medical realm of inquiry.

Ethical issues relate to the basic principles that govern individuals or groups. 

In terms of medical ethics, this is the basis for the establishment of guidelines regarding principles and practice, in the realm of medicine. At times, there can be a fine line between legal, moral and ethical issues. This is also true when it comes to medical practice. One must accept the reality that the horizons of legal, moral and ethical issues are continually expanding their horizons in every part of the world.

That also means what the western world regards as legal, moral and ethical may come under severe scrutiny and criticism from people who live in different parts of the world. At the same time, their principles and practice may come under our scrutiny and criticism. This holds true in the realm of medicine.

Global standardization of legal, moral and ethical issues is often difficult to achieve. It becomes even more complex, as the medical realm continues to expand its scientific horizons.   

One must suggest that legal, moral and ethical issues in medical practice are always in process, to some degree. In other words, because these areas are continually subject to new research, ongoing re-evaluation or re-assessment, this results in on-going expansion of their horizons, individually and collectively.

Patients, their families, as well as doctors and other health care professionals everywhere, deal with medical issues that have legal, moral and ethical aspects. It is important to understand how they are unique and yet inter-related, in the medical world.