[How to provide meaningful primary care to patients with an addiction?] / Wat is zinvolle eerstelijnszorg aan verslaafde patiënten?

Offering meaningful care to patients with an addiction is not always easy. This also holds true for general physicians. In this article we provide a legal and practical framework for general physicians on how to provide meaningful care for this group of patients. Various interventions are described. In case meaningful care does not seem to be an option, then the general physician has to draw his conclusions.

[Is agression a valid reason to end the therapeutic relationship with a patient?] / Is agressie een reden om de behandelrelatie met een patiënt te beëindigen?

It regularly occurs that a physicians is abused by a patient. For physicians this may be a reason to consider to end the relationship with such patients, particularly if patients become violent. But is this permitted? The Dutch law and professional standards restrict physicians from doing so, unless there are 'serious reasons' to do so and only after having investigated all possibilities to restore the treatment relationship, including a discussion with the patient. We argue that these restrictions are too strict. Physicians should be able the end the relationship with patients that fail to respect the physical or mental integrity of physicians or their colleagues.

[Who is allowed to attend a multidisciplinary team meeting?] / Wie mogen er deelnemen aan een patiëntbespreking?

Healthcare providers regularly discuss the situation of a patient and his or her care needs with colleagues. This in an effort to compare experiences and provide in a coordinated way high quality care to patients. These multidisciplinary meetings are sometimes also attended by healthcare professionals that do not themselves have a treatment relation with the patient, such as medical students and junior doctors for learning purposes. This raises the question whether it is allowed for non-treating professionals to attend these meetings without the prior informed consent of the patient. We argue that the attendance on non-treating professionals is in accordance with the rules of the General Data Protection Regulation and the Dutch Act on Patients' Rights provided that they are bound by the duty of confidentiality.

[Am I entitled to inform my patient about a mistake of my predecessor?] / Mag ik mijn patiënt informeren over een fout van mijn voorganger?

A physician may suspect that another physician has made a medical mistake without informing the patient about this. Under Dutch law the treating physician is entitled to inform the patient about his concerns. This is, however, not a legal or professional obligation. Under Dutch law, the duty to inform a patient about mistakes rests upon the responsible health care provider. Whether the current treating physician decides to inform the patient, with or without previously contacting his or her predecessor, depends on all relevant factors.

[Choosing for euthanasia in advanced dementia; an analysis of the decisions by the Supreme Court]. / Euthanasie bij gevorderde dementie.

For many yearsthere has been confusion in the Netherlands about the question of whether doctors are entitled to end the life of incompetent patients with advanced dementia. The euthanasia control commission, the disciplinary courts and the penal court all answered this question differently after a doctor had performed euthanasia on a 74-year-old woman with advanced dementia and an advance directive made at an earlier stage. On 21 April 2020 the Supreme Court provided clarity, at least to a certain extent. This contribution presents an analysis of the decisions made by the Supreme Court and their implications for self-chosen death in patients with advanced dementia.

[Prospective parents with a mental impairment: is prior competency testing in this group of people who wish to have children justified?] / Wensouders met een verstandelijke beperking.

Doctors can decide to subject individuals who wish to become parents to a test to analyse their parental competence. From a legal perspective there is no justification to subject only those individuals with a mental impairment to such a test. In fact, it could be argued that all potential parents should undergo such a test, but due to the impact this would have on the healthcare system that is simply not feasible.

[The Psychiatric Hospitals (Compulsory Admissions) Act ceases to exist; what does this mean for treating physicians and patients?] / De Wet Bopz houdt op te bestaan; wat betekent dat voor behandelend artsen en patiënten?

The Psychiatric Hospitals (Compulsory Admissions) Act, Wet BOPZ in Dutch, will be replaced by two new laws as of 1 January 2020. This has many implications for patients as well as the physicians treating them. The new laws are emphasising treatment rather than admission. They also provide for more forms of treatment at home. However, there are several practical and fundamental sticking points and issues of coordination between the two laws.

[The right to sexual health and the role of doctors]. / Recht op seksuele gezondheid en de rol van de arts.

Sexual health is an internationally recognised human right, imposing obligations on States to promote the aspirations enshrined in this right. However, from a legal and ethical perspective, the right to sexual health also creates duties for doctors to protect, respect and - where possible - fulfil. By means of a number of scenarios, we discuss how doctors should react to these situations. The responsibility of doctors concerning the sexual health of patients goes further than many would assume, but also has clear restrictions.

[Legally capable care refuser has rights as well as responsibilities]. / Wilsbekwame zorgmijder heeft rechten én plichten.

It is hard to determine how a doctor should act when a patient with a somatic condition refuses medical care. The Dutch law obliges a doctor to inform a patient about his condition and the possible treatment options. This includes an effort to reach out and make contact with the patient. But how far should a doctor's responsibility reach when a patient refuses contact? We point out that refusal of medical care can also be seen in the light of a patient's autonomy. We thereby propose that falling ill gives responsibilities to a patient too, which include making the effort to seek medical care and cooperate with treatment.

[Palliative sedation - because it's what the patient wants? Pronouncement of Disciplinary Court cause of great confusion]. / Palliatieve sedatie ­ omdat de patiënt dat wil?

The Medical Disciplinary Court of The Hague recently imposed an official warning on two physicians who did not yield to the pressure exerted by a 102-year-old patient and her family to start palliative sedation. This decision not only restricts the directing role of physicians with respect to the end-of-life phase, but is also inconsistent with the guideline from the Royal Dutch Medical Association (KNMG) on palliative sedation.

[Reducing problematic sickness absence: of importance to every general practitioner]. / Terugdringen van stagnerend arbeidsverzuim.

Problematic sickness absence is an issue that concerns not only occupational health physicians, but all physicians. More collaboration between occupational health and treating physicians, plus improved alignment of symptom treatment and reintegration counselling, can help avoid long-term sickness absence of employees. Achieving this goal presupposes mutual knowledge of each other's professions. Medical practice guidelines are a tool par excellence to share knowledge and bring this into practice. Treating physicians should not refrain from posing work-related and return-to-work questions, even if the overall responsibility lies with the occupational health physicians in terms of reintegration efforts. The patient's interest should be the leading principle for all physicians involved. This means not only provision of good care, aimed at patient recovery, but also adequate reintegration in the labour market. Occupational health physicians, general practitioners and consultant specialists should share this common goal.

[Implant registry and patient data; physician needs to be aware of privacy laws]. / Implantatenregister en patiëntengegevens; arts moet zich bewust zijn van privacyregels.

In 2015 a national implant registry (LIR) was established in the Netherlands. The aim of this registry is to enable the quick identification of patients with implants that subsequently cause problems. To this end, the controller of the registry collects patient data from hospitals and individual physicians. The privacy laws apply to the LIR and the disclosing hospitals and physicians. Both the controller of the registry and those who submit data to it should be aware of these laws, particularly in view of the high administrative penalties that have recently been imposed on breaches of the laws on privacy and the risk of liability claims.

[Why the Royal Dutch Medical Association does not blindly follow the euthanasia review committees]. / Waarom de KNMG de toetsingscommissies niet lijdzaam volgt.

The provisions of the Dutch Termination of Life on Request and Assisted Suicide Act are not always as clear as were originally hoped for. This also holds true with respect to the provision on the role of an advance directive in a case where the patient is no longer able to express his or her will. Euthanasia Review Committees now tend to interpret this provision broadly, although not always in a consistent way. The Royal Dutch Medical Association has its own responsibility in interpreting this provision in a way consistent with the professional standard.

Patients' rights and access to health care.

During the last fifteen years, an increasing number of European countries have adopted laws or other legal instruments respecting and protecting the rights of patients. This reflects the progressive recognition of the inherent dignity and equal and inalienable rights of all (potential) users of the health care system. At the same time, however, a growing number of persons seem to encounter difficulties in accessing health care. This raises the question to what extent patients' rights should also include entitlements to health care services.

Genetics, data protection and non-discrimination: some reflections from an international human rights law perspective.

As a result of progress in medical research genetic traits can increasingly be used as predictive factors and selection criteria. This calls into question the appropriateness, validity and legitimacy of genetic traits as (co-)determinants in decision-making processes. This paper confines itself to examining the implications of genetics on the right to privacy--notably data protection--and the right not to be discriminated against.