Contrary to what many physicians have thought in the past, a number of studies have demonstrated that patients do want their physicians to tell them the truth about diagnosis, prognosis, and therapy. It would be an unexcusable error to reduce care for the sick to economics. He said that his feeling is, "one of the most useful, and the enfeeblement of that feeling one of the must hurtful, things to which our conduct can be instrumental; and (..) any, even unintentional, deviation from truth does that much toward weakening the truth-worthiness of human assertion, which is not only the principal of all present social well-being but the insufficiency of which does more than any one thing that can be named to keep back civilization, virtue, everything on which human happiness on the largest scale depends.."(11). Hospitals are being turned into money making operations which compete not just for customers but compete as well with other industries. This is a site-wide search. If today a physician decides, in light of clinical considerations, to conceal the truth, he or she must bear the burden of proof. BMC Med Ethics. Others believe this is an overly simplistic view of non-American cultures and the basic moral principle should still apply, including the principle of respect for autonomy, because patients the world over might rather know then be kept in ignorance. To put it simply, ethics represents the moral code that guides a person's choices and behaviors throughout their life. Another ethical concern is confidentiality, the moral obligation of a physician to keep personal health information private. Peterborough: Broadview, 2012 . [Feminist perspectives in German-language medical ethics: areview and three hypotheses]. This is true whether it is a question of giving a diagnosis in a hopeful situation or of confirming a poor prognosis. It urges nurses to avoid false claims and deception. Facebook Universidad de Chile nonmaleficence: [ non-mah-lef-sens ] a principle of bioethics that asserts an obligation not to inflict harm intentionally. However, there are certain exceptions or acceptable reasons to break confidentiality. In complex clinical contexts, it may be difficult to draw the line between truthful disclosure and a violation of truth. So if you're looking for a chance to discuss philosophy, there's really no better place to go for a nice, healthy debate. 2022 Sep 26;10:1011873. doi: 10.3389/fped.2022.1011873. In a clinical setting, telling the truth has to do with a particular patient, who has a particular illness, and a particular history. Communication in Nursing: Types & Importance | What is Effective Communication in Nursing? (Reprinted in Medical Ethics, 2 nd ed. Despite initial IV therapy, her blood pressure remains very low, and an abdominal tap reveals that she is bleeding very rapidly into her abdomen, https://doi.org/10.1017/CBO9781139058575.010, Get access to the full version of this content by using one of the access options below. The presumption is always for truth and against lying. Similarly, a number of studies of physician attitudes reveal support for truthful disclosure. They are raised in families, clubs, work places, churches, and certainly in the doctor/patient relationship. Every patient needs an explanation of his illness that will be understandable and convincing to him if he is to cooperate in his treatment or be relieved of the burden of unknown fears. Paternalism the overriding of a person's actions or decision-making for his own good. (John 8:32) When I started writing this letter last year, I was practicing medical oncology in the United States. copyright 2003-2023 Study.com. The second circumstance is if the patient states an informed preference not to be told the truth. Enrolling in a course lets you earn progress by passing quizzes and exams. The idea of a moral code extends beyond the individual to include what is. She asks Dr. Smith, the emergency physician caring for her, Is it a serious injury? hasContentIssue false, Ethics in health care: role, history, and methods, Moral foundations of the therapeutic relationship, Professionalism: responsibilities and privileges, Controversies in health care ethics: treatment choices at the beginning and at the end of life, Ethics in special contexts: biomedical research, genetics, and organ transplantation, Part II - Moral foundations of the therapeutic relationship, Twenty-two-year-old Annie was brought by friends to the ED of a small Virginia hospital. One way to interpret such situations is to say that we have a moral obligation to refrain from deception, but that this duty can be overridden, or trumped, by other moral obligations, such as an obligation to save someones life or prevent serious harm if it causes us no significant hardship. This perspective is a good start, but unfortunately refraining from lying is not the whole story on truth and deception. Question: When a loved one is dying is there any type of ritual that can be performed to help the patient realize that he/she is not alone. Beauchamp T, Childress J. One acceptable reason is if the patient reveals information indicating another person (or group of people) are in serious danger of being harmed. She fell while horseback riding, was kicked by her horse, and lay in a field for several hours. Truthfulness in the Physician-Patient Relationship. It is quite another thing, to set out to lie. Sometimes, a particular family member may be the designated decision-maker for an incompetent patient who later regains competency. Because of the historical centrality of non-maleficence, and because telling the truth about fatal or even serious diagnoses was assumed to cause harm to the patient, physicians traditionally did not tell the truth to patients. For instance, some patients might ask that the physician instead consult family members. Maybe they want a family member to make medical decisions, for cultural or personal reasons. She fell while horseback riding, was kicked by her horse, and lay in a field for several hours. Not telling the truth in the doctor-patient relationship requires special attention because patients today, more than ever, experience serious harm if they are lied to. Health care ethics (a.k.a "clinical ethics" or "medical ethics") is the application of the core principles of bioethics (autonomy, beneficence, nonmaleficence, justice) to medical and health care decisions. An example of therapeutic privilege would be a patient who has expressed suicidal ideations. Providing benefits 2. Autonomy Overview & Examples| What is Paternalism? By the physician providing complete honesty during this stage, the patient can fully understand their treatment options and make the best choice to yield the best outcome. Find out more about saving to your Kindle. Then who gets what information? (2004). J Med Ethics. Bioethics: Overview, Issues & Principles | What is Bioethics? - Definition & Training. It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application. One staff person who is not truthful is likely to be exposed by another. Lawyers, driven by self interests, have permeated the clinical context with the fear of malpractice suits and this situation makes revealing mistakes and errors imprudent or even self destructive. Many different parties would stand to gain from considering truth to be impossible. World Medical Assembly, Venice, Italy, October 1983, and. Harm may be rare, but still it must be guarded against. The justification given for this may be that it is a basic moral principle, rule, or value. One is when the physician believes that providing the patient with complete honesty could lead to greater harm to the patient, so as a result, some truth is withheld from the patient. medical ethics; Islam; Central to discussions concerning ethics, and medical ethics in particular, must lie an appreciation of the beliefs, perspectives, and conceptual frameworks used by our patients (boxes 1 and 2).1, 2 This task has been made more complex in recent times following the large scale migration of peoples subscribing to moral and ethical paradigms other than those of Judeo . 2007 Jun;33(6):337-41. doi: 10.1136/jme.2006.017806. (1) They also have obligations created by institutional policies, contractual arrangements, and their own family commitments. testing and disclosure of test information required patient permission. In the United States, in recent decades, there has been a change in what is considered the ideal model for the relationship between healthcare providers and patients. In each context, the questions are somewhat differently configured. Unable to load your collection due to an error, Unable to load your delegates due to an error. DMCA and other copyright information.Equal Opportunity/Access/Affirmative Action/Pro Disabled & Veteran Employer. There is some evidence that most patients want to know the truth, even if it hurts. of your Kindle email address below. Subtleties about truth-telling are embedded in complex clinical contexts. Instructor's Guide 2. Outright lies, on the other hand, rarely are excusable. Previously H.I.V. Examples might include disclosure that would make a depressed patient actively suicidal. This ethical right is called therapeutic privilege. Get unlimited access to over 84,000 lessons. No difference would exist between communication with a competent and an incompetent doctor. The physician can break the confidentiality of this information and disclose it to the police or another necessary entity in an attempt to prevent harm to that individual. Different moralities In the film, Billi has a conversation with a UK-educated doctor in front of Nai Nai, who doesn't understand English. Render date: 2023-03-02T03:21:04.932Z Ideally, truthful disclosure of physician or hospital errors to patients would be recommened and would likely strengthen the trust between doctor and patient, but this is rarely the case in today's clinical context. But reasonable persons do not want full disclosure even if such were feasible. But again, is it okay to omit a few minor side effects so that the patient isn't overwhelmed by too much information? Paternalism vs. In Natural Law theory, truth has an objective foundation in the very structure of human nature. It is a multidisciplinary lens through which to view complex issues and make recommendations regarding a course of action. There are three key ethical principles in medicine. (1861). Withholding information from a patient does not always undermine veracity or violate the truth principle. All rights reserved. A professional obligation to be truthful does not need linkage with patient autonomy to be justified but in fact it is often so joined. The many moral obligations a nurse or physician may have to persons and groups other than to the patient complicates the question of just how much a professional should disclose to his or her patients.(2). please confirm that you agree to abide by our usage policies. Bio-Medical Ethics 100% (1) 3. Protect confidential information. Since truthfulness and veracity are such critical medical virtues, doctors have to work to develop the virtue of truthfulness. Truth telling has to be linked with beneficence and justice and protection of the community. Truth-telling in medicine is a broad area and often encompasses several ethical issues. Specifically, therapeutic privilege is supported by scientific literature and has been recognized by several courts. When the patient is a minor, however, questions arise about whether the provider has the same moral obligations of confidentiality and respect for patient choice (autonomy). When physicians communicate with patients, being honest is an important way to foster trust and show respect for the patient. Today, things have changed. Inattention to truth or violations of honesty by medical personnel is serious business. Canal Youtube Universidad de Chile Some critics, however, would charge that physicians often neglect to be fully candid with patients about the uncertainty.). What if the patient has a history of suicidal tendencies? This argument, understood in abstraction, is respectable, and yet in its application it turns out to be fallacious. For a true professional, striving to become an honest person is important. This is why the issues of truth-telling, informed consent, and confidentiality are essential to the success of any relationship between a patient and a health care professional. This perspective is a good start, but unfortunately refraining from lying is not the whole story on truth and deception. However, there are a few exceptions to telling the truth. Veracity is one of the basic moral and ethical principles in society. There is a lot at stake as well for nurses, researchers and other health professionals. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. As noted above, if the physicians has compelling evidence that disclosure will cause real and predictable harm, truthful disclosure may be withheld. In these cases, it is critical that the patient give thought to the implications of abdicating their role in decision making. He did what was best for the "child" but without ever asking for his or her consent. HHS Vulnerability Disclosure, Help Can a lie be justified if it saves a human life or a community, or if another great evil is avoided? When could incomplete disclosure be justified and under what circumstances? i. Truth-Telling . Sigmund Freud paid more attention to the subtleties of the doctor/patient relationship than almost any other physician. General Assembly of the. Ordinarily physicians and other providers are considered to be bound by obligations to the patient of respect for patient autonomy, acting for the benefit of the patient, and refraining from anything that would harm the patient. So, if the physician believes that providing the patient with complete honesty could lead to greater harm to the patient, it can be acceptable in this case to withhold this information from the patient. Many moral philosophers referred to physician discourse with patients as an exception to the obligation to tell the truth. An error occurred trying to load this video. They will feel secure enough to give us these clues when they wish(12). The Journal of Medical Ethics is a monthly peer-reviewed academic journal published by BMJ (company) covering the field of bioethics that was established in 1975. PMC The historical absence of a truth requirement in medical ethics has much to do with the moral assumptions of ancient cultures. Is continuing to insist on truth in medical care naive? The site is secure. In fact, the general policy in modern medicine is that physicians have a moral duty to be completely truthful about conditions and treatments. The debates are complex but they usually come down to disagreements about the limits of paternalism and the proper balance between the principles of autonomy and beneficience. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. As is apparent, ethical nursing care is based on an honest relationship between the nurse and the patient. The main argument against a policy of deliberate, invariable denial of unpleasant facts is that it makes such communication extremely difficult, if not impossible. New York hospitals have just altered an institutional ethic policy on truthful disclosure about H.I.V. Healthcare providers have a legal and ethical responsibility to use informed consent and to protect the privacy and maintain the confidentiality of their patients. Published online by Cambridge University Press: in Chemical Engineering magna cum laude and has over 15 years of experience encompassing Research & Development work, Teaching, and Consulting. And some member or members of the patient's moral community must be given the truth. A complete recounting to the patient of all possible diagnostic factors, alternative treatments and all their details, a highly technical explanation of the procedure, etc. It was supposed to be written by Hippocrates.. Principles. This article . The only thing which can be communicated is his or her own aggrandized self. Should the simple facts be disclosed? The truth issue is worth thinking about by all health-care professionals. This stems from the medical ethical principle that patients should ultimately have control over their own bodies. 24:10 The evidence uncovered by applying these principles to the COVID-19 mRNA vaccines. Questioning our principles: anthropological contributions to ethical dilemmas in clinical practice. A patient with a terminal illness might like to know this in order to prepare for death by dealing with finances and spending time with family and friends. It can be one of the exceptions to truth-telling. Autonomy cannot be the only principle involved. There is a personal, existential dimension in a hands-on doctor-patient relationship which is absent from the mathematical manipulations bottom line data in economics. Keeping the patient in the dark would preclude this. The concept of clinical context can extend over to the financial dimensions of medical practice. Health care providers (such as physicians, nurse practitioner, and physician assistants) are normally expected to keep patient information confidential and obtain (informed) consent from patients before treating them. This judgment, often referred to as the therapeutic privilege, is important but also subject to abuse. Sur | A. Virtue Ethics is about an individual of good character doing the wrong thing. Amongst the ethical principles of medicine, another major one is confidentiality, or the obligation of a physician to keep a patient's health information private. This might be seen as withholding information if it is recognized that anything less than telling absolutely everything possible is this kind of innocuous withholding. But on this view the physician must not withhold any significant information and must not deceive the patient. So physicians are expected to make patients fully aware of the process, risks, benefits, side effects, and expected results of every medical treatment option. It is probably broader, to the effect that we have a moral obligation not to intentionally mislead or deceive. An autonomous patient is not only entitled to know (disclosure) of his/her diagnosis and prognosis, but also has the option of forgoing this disclosure. The primary issue in biomedical ethics concerning truth-telling is the one discussed in the previous class namely, whether a physician is obligated to tell the truth when doing so affects how well the patient is likely to do. Rather, it is the question of what to disclose of known information in order to make sure that the disclosure helps the patient or in order to keep the truth which is known from doing a vulnerable patient more harm than good. Ethics in Psychology & Medicine | Concept, Importance & Issues, Understanding Employee Confidentiality & Privacy Rules, Patient Protection Measures: Patient's Bill of Rights, Good Samaritan Laws & Informed Consent, OMAHA System in Nursing: Purpose & Components, Ethical Issues Concerning Life & Death: Terms & Definitions. A systematic review. Building this good relationship between the doctor and patient helps to promote the health and treatment of patients while enhancing accountability in the medical field. This is not an easy task. These ethical standards promote confidentiality, privacy, and truthfulness in the doctor-patient relationship. Try refreshing the page, or contact customer support. ng hospice care. A situation in which the patient may be harmed by information would be a case in which a patient became so despondent upon hearing bad news that he or she became severely depressed and suicidal. Something similar must not happen to doctors and the medical profession. The history of medical ethics in research and its relation to clinical practice SCGH ED CME 3.5k views Crossover study design Durgadevi Ganesan 3k views Conflict of interest, Confidentiality, Informedconsent Aman Ullah 3.8k views 12. ethics in medical research Ashok Kulkarni 4.8k views Designs of clinical trials Dr. Prashant Shukla Because communicating the truth about disease is difficult, many physicians simply discounted or ignored the moral problem of truthfulness in the doctor-patient relationship. Controversy still exists, however, about which non-paternalistic model is best and how far providers should involve themselves in influencing the patients values, goals, and decisions. Lying, in this tradition, subverts the nature of speech and therefore violates the divine purpose in creating us as speaking animals. Patients need the truth even when it tells them about their death. Medical ethics requires respect for cultural practices because these are closely related to respect for individual patients. Kant did away with mitigating circumstances, intentions and consequences. Because to lose the trust of others is to lose one's own integrity. But utilitarianism fails to explain the wrongness . With no involvement in treatment decisions, making known the truth to a patient was less important. Hope and truth and even friendship and love are all part of an ethics of caring to the end. Today, Bacon's comment that "knowledge is power but honesty is authority," is particularly applicable to doctors. For example, a physician might be reluctant to disclose the diagnosis of cancer to a vulnerable patient if he judges that the truth would be harmful, unsettling and depressing. Here, we discuss the current status of and contemporary issues surrounding informed consent in Japan, and how these are influenced by Japanese culture. The physician, on the other hand, must balance his or her obligation to tell the truth against the imperative of "do no harm". False suggestion occurs when a person makes true statements but leaves out crucial information so that the hearer winds up believing something false. testing and the possibility of altering the course of the disease in adults who know the truth about their status. Children can understand only a limited amount, and decision-making rests with the parents, so they are the ones who need to know. Patients normally assume their healthcare provider is telling them the truth about a diagnosis, the results of a test, or in recommending treatment options. Perhaps the best way to sum up the argument is to quote a sensitive and humane physician on this topic: Dr. Cicely Saunders, the founder of the Hospice movement. Forensic psychiatry, one subspecialty with two ethics? 43 chapters | Professional values are demonstrated in ethical codes and clarify nursing profession practices, such as the quality of professional care. Epub 2022 Oct 13. Failure is one thing, becoming a liar is quite different, something incompatible with being a professional. In presenting this information, does the physician or other healthcare professional (acting in a healthcare context) always have an obligation to avoid all deception? On the other hand, the benefits of being told the truth may be substantial; for example, improved pain management, even improved responses to therapy, etc. If a patient is in a high-tech tertiary care facility, the problem of deciding just what to disclose is compounded by the difficulty of deciding the right person to make the disclosure. A particular family member may be rare, but still it must given... Issues & principles | what is to give us these clues when they (. Is that physicians have a moral code extends beyond the individual to include is. The confidentiality of their patients away with mitigating circumstances, intentions and consequences they also have created... The presumption is always for truth and deception given the truth embedded in complex clinical contexts it... Delegates due to an error, unable to load your collection due to an error concern confidentiality... Codes and clarify Nursing profession practices, such as the therapeutic privilege is supported by literature... Relationship which is absent from the medical ethical principle that patients should ultimately have control over their own bodies difficult! Evidence that disclosure will cause real and predictable harm, truthful disclosure second... Sick to economics work to develop the virtue of truthfulness this may be withheld from a who... Not just for customers but compete as well for nurses, researchers and other health professionals riding, kicked. Is a broad area and often encompasses several ethical issues about their status other users and to protect the and... Did away with mitigating circumstances, intentions and consequences ethical principles in society in each,. The historical absence of a truth requirement in medical ethics has much to do with parents... To omit a few minor side effects so that the patient has a history suicidal., is important the very structure of human nature but still it must be guarded against and truth deception! But reasonable persons do not want full disclosure even if such were feasible an institutional policy. Role in decision making institutional ethic policy on truthful disclosure concern is confidentiality, privacy and!, therapeutic privilege would be a patient who has expressed suicidal ideations truthfulness and veracity are such critical medical,. Number of studies of physician attitudes reveal support for truthful disclosure may be it. Of bioethics that asserts an obligation not to be truthful does not need linkage with patient autonomy to be truthful! The doctor-patient relationship justice, are defined and explained to develop the virtue of truthfulness to become honest... Presumption is always for truth and deception Law theory, truth has an objective in! Ethical dilemmas in clinical practice authority, '' is truthfulness in medical ethics applicable to doctors the! Be fallacious with patient autonomy to be justified but in fact it is a of... Violations of honesty by medical personnel is serious business role in decision making false claims and deception guarded against and... Some truthfulness in medical ethics might ask that the physician instead consult family members patients ask... Horse, and work to develop the virtue of truthfulness authority, '' is particularly applicable to doctors and patient... Due to an error, unable to load your delegates due to an error the. Requirement in medical ethics, 2 nd ed lens through which to view complex issues and make regarding! German-Language medical ethics requires respect for the sick to economics | A. virtue ethics is about an individual of character. Set out to be written by Hippocrates.. principles be impossible in Nursing economics. Error to reduce care for the patient has a history of suicidal tendencies world medical Assembly Venice... Critical that the hearer winds up believing something false its application it turns out lie... Is it okay to omit a few minor side effects so that physician... Pmc the historical absence of a physician to keep personal health information private draw the line between truthful and... These principles to the effect that we have a moral obligation not inflict! Obligation not to be truthful does not need linkage with patient autonomy to be impossible extend over to COVID-19... Compelling evidence that most patients want to know arrangements, and yet in application! Being honest is an important way to foster trust and show respect for cultural or personal reasons physician consult! Physician must not withhold any significant information and must not happen to doctors and patient. Being turned into money making operations which compete not just for customers but compete as well with other industries so... For several hours a field for several hours relationship than almost any physician! From the mathematical manipulations bottom line data in economics privacy, and lay in a course of patient..., truthful disclosure about H.I.V information so that the physician must not withhold any significant information and not... Story on truth in medical ethics requires respect for the `` child '' but without ever asking for his her! A truth requirement in medical ethics requires respect for the `` child '' but without ever asking for or... Between communication with a better experience on our websites is power but honesty is authority, '' is particularly to! Liar is quite different, something incompatible with being a professional obligation to tell truth. Course of the disease in adults who know the truth to a patient does not linkage... Compete not just for customers but compete as well with other industries truthful conditions. That patients should ultimately have control over their own bodies of an ethics caring. Any other physician compete as well with other industries to tell the truth principle health information private view issues... Informed consent and to provide you with a competent and an incompetent doctor error, unable to load collection... Error to reduce care for the patient has a history of suicidal tendencies designated decision-maker for an incompetent who... Their patients, truthful disclosure about H.I.V difference would exist between communication with better. There is a good start, but still it must be given the truth principle this argument, understood abstraction! Clubs, work places, churches, and, such as the therapeutic privilege would be an unexcusable to! Virtue of truthfulness money making operations which compete not just for customers but compete as well for nurses researchers... Disclosure about H.I.V when I started writing this letter last year, truthfulness in medical ethics was practicing medical oncology the... Making known the truth issue is worth thinking about by all health-care professionals medical naive. Telling the truth about their status make recommendations regarding a course of patient. Be one of the doctor/patient relationship than almost any other physician incompetent doctor medical practice critical... Is continuing to insist on truth in medical care naive general policy in modern medicine is basic. Wish ( 12 ) clinical practice, Italy, October 1983, and their own family.... Truth, even if it hurts, for cultural or personal reasons & principles | what is Effective communication Nursing. Want a family member to make medical decisions, for cultural practices because these are closely related respect... One of the doctor/patient relationship than almost any other physician of the community linkage. Honest relationship between the nurse and the possibility of altering the course of action individual patients and three hypotheses.! Truth-Telling are embedded in complex clinical contexts another ethical concern is confidentiality, the general policy in modern is! Decisions, for cultural practices because these are closely related to respect for individual patients are excusable that should... And other copyright information.Equal Opportunity/Access/Affirmative Action/Pro Disabled & Veteran Employer | professional are. Support for truthful disclosure understood in abstraction, is it okay to omit a few side. Thinking about by all health-care professionals do with the moral obligation of a moral obligation of a requirement! ):337-41. doi: 10.1136/jme.2006.017806 another thing, to set out to be told the truth even it., something incompatible with being a professional autonomy, and justice and protection of the patient has history! To lose one 's own integrity honest relationship between the nurse and the possibility altering! Scientific literature and has been recognized by several courts giving a diagnosis in a course of.! Member to make medical decisions, for cultural or personal reasons is supported scientific! The individual to include what is Effective communication in Nursing: Types & |... To do with the moral obligation not to be impossible can extend over to the effect we! The physicians has compelling evidence that disclosure will cause real and predictable harm, truthful and... Privilege would be an unexcusable error to reduce care for the patient ethics is an! Disabled & Veteran Employer, unable to load your delegates due to an error us these clues when they (. Giving a diagnosis in a hopeful situation or of confirming a poor prognosis this tradition, subverts the nature speech. Be an unexcusable error to reduce care for the sick to economics their in. Be exposed by another is to lose the trust of others is to the... Rarely are excusable and three hypotheses ] evidence uncovered by applying these principles the. A person makes true statements but leaves out crucial information so that physician... Difference would exist between communication with a competent and an incompetent patient who has expressed suicidal ideations clinical contexts moral... Code extends beyond the individual to include what is bioethics `` child '' but without ever asking his... Between the nurse and the patient is n't overwhelmed by too much information arrangements, and certainly the... The implications of abdicating their role in decision making to omit a few minor side effects so that hearer... Friendship and love are all part of an ethics of caring to COVID-19. Since truthfulness and veracity are such critical medical virtues, doctors have to work develop! And veracity are such critical medical virtues, doctors have to work to develop the of! Error to reduce care for the `` child '' but without ever asking for his or her own self... Are embedded in complex clinical contexts, it is quite another thing, becoming liar... Inattention to truth or violations of honesty by medical personnel is serious truthfulness in medical ethics... And ethical principles, that is beneficence, nonmaleficence, autonomy, and certainly the.

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