How health care professionals confront and solve ethical dilemmas - a tale of two countries: Slovenia and Croatia.

AIM: To assess the differences in the way how Slovenian and Croatian health care professionals (HCPs) confront ethical dilemmas and perceive the role of hospital ethics committees (HECs). METHODS: This cross-sectional, survey-based study involved HCPs from three Slovenian and five Croatian university medical centers (UMC). The final sample sizes were 308 (244 or 79.2% women) for Slovenia and 485 (398 or 82.1% women) for Croatia. RESULTS: Compared with Croatian physicians, Slovenian physicians reported a higher share of ethical dilemmas regarding waiting periods for diagnostics or treatment, suboptimal working conditions due to interpersonal relationships in the ward, and end-of-life treatment withdrawal, and a lower share regarding access to palliative care and patient information protection. Compared with Croatian nurses, Slovenian nurses reported a lower share of ethical dilemmas regarding the distribution of limited resources, recognizing the patient's best interests, and access to palliative care. Compared with Croatian other HCPs, Slovenian other HCPs reported a lower burden of ethical dilemmas regarding waiting periods for diagnostics or treatment, distribution of limited resources, and access to palliative care. When encountering an ethical dilemma, all HCPs in both countries would first consult their colleagues. Slovenian and Croatian HCPs recognized the importance of the HECs to a similar extent, but viewed their role differently. CONCLUSION: Croatian and Slovenian HCPs are confronted with different ethical dilemmas and perceive the role of HECs differently.

The first nationwide study on facing and solving ethical dilemmas among healthcare professionals in Slovenia.

BACKGROUND: Healthcare professionals (HCPs), patients and families are often faced with ethical dilemmas. The role of healthcare ethics committees (HECs) is to offer support in these situations. AIM: The primary objective was to study how often HCPs encounter ethical dilemmas. The secondary objective was to identify the main types of ethical dilemmas encountered and how HCPs solve them. SUBJECTS AND METHODS: We conducted a cross-sectional, survey-based study among HCPs in 14 Slovenian hospitals. A questionnaire was designed and validated by HCPs who were selected by proportional stratified sampling. Data collection took place between April 2015 and April 2016. RESULTS: The final sample size was n = 485 (385 or 79.4%, female). The response rates for HCPs working in secondary and tertiary level institutions were 45% and 51%, respectively. Three hundred and forty (70.4%) of 485 HCPs (very) frequently encountered ethical dilemmas. Frequent ethical dilemmas were waiting periods for diagnostics or treatment, suboptimal working conditions due to poor interpersonal relations on the ward, preserving patients' dignity, and relations between HCPs and patients. Physicians and nurses working in secondary level institutions, compared to their colleagues working in tertiary level institutions, more frequently encountered ethical dilemmas with respect to preserving patients' dignity, protecting patients' information, and relations between HCPs and patients. In terms of solutions, all HCPs most frequently discussed ethical dilemmas with co-workers (colleagues), and with the head of the department. According to HCPs, the most important role of HECs is staff education, followed by improving communication, and reviewing difficult ethical cases. CONCLUSIONS: Waiting periods for diagnostics and treatment and suboptimal working conditions due to poor interpersonal relations are considered to be among the most important ethical issues by HCPs in Slovenian hospitals. The most important role of HECs is staff education, improving communication, and reviewing difficult ethical cases.

Accommodaton of constitutional due process rights within the new patients' rights legislation in Slovenia.

The Constitutional Court of the Republic of Slovenia issued several decisions concerning the protection of patients' rights (e.g. decisions on involuntary commitment, on access to health care, on rights related to obligatory and voluntary health insurance). Consequently, the Parliament renewed Health Legislation by the enactment of the Patients' Rights Act (February 2008) and of the Mental Health Act (July 2008). Both bills enshrine a charter of patients' rights that may be considered as concretization of several human rights that are protected by the Constitution. The discussion is focused on the due process rights (e.g. equal protection of rights, right to judicial protection, right to legal remedies, legal guarantees in proceedings related to deprivation of personal liberty) that were in particular addressed by the Court. The results demonstrate that their effective implementation was one of the most important demands that the Legislature had to accommodate when enacting new bills.

The Slovenian Mental Health Act de lege ferenda.

This article analyzes the case-law of the Constitutional Court of the Republic of Slovenia relating to the protection of mentally ill persons. In case No. U-I-60/03 the Constitutional Court declared that the provisions of Arts. 70 to 81 of the Non-litigious Civil Procedure Act (a Chapter on involuntary Commitment to the closed wards of psychiatric hospitals) are not in conformity with the Constitution. As an interim measure the Constitutional Court instructed the regular Courts (in the procedure for the involuntary commitment of persons to a mental institution) to ensure the following: an ex officio counsel must be appointed for an involuntarily committed person upon the commencement of proceedings; and the notification of detention that the authorised mental institution is obliged to submit to the court must contain reasons substantiating the necessity of detention. The Legislature's intention is to enact a special Law (Mental Health Act) that will not only deal with the procedural questions, but also with all other constitutional and statutory rights and freedoms of the mentally ill patients. It should also deal with other forms of institutional and non-institutional care for mentally ill persons. The author discusses the Ombudsman's control over the rights and freedoms of involuntary committed in-patients. Finally, the author discusses some of the most problematic issues of the Slovenian Mental Health Actde lege ferenda.