Polish Abortion Legal Framework after the Judgment of the Constitutional Court of 22 October 2020 in case no. K 1/20: Impact on Doctors.

In 2020, the rules governing the practice of abortion in Poland were narrowed and became some of the strictest in Europe. These new rules were the result of the Constitutional Court's oral announcement of its judgment in case K 1/20, making abortion for embryo-pathological reasons illegal. Thus, terminations of pregnancy in cases where prenatal tests and other medical findings indicated a high risk of a severe and irreversible damage to the foetus, or an incurable life-threatening ailment of the foetus, which in 2018 accounted for approximately 98% of all abortions in Poland, were declared illegal. In the Constitutional Court's written opinion, however, the court included a statement that may constitute a basis for broader interpretation, namely, that reasons of an embryo-pathological nature, insofar as they pose a threat to the life or health of the pregnant woman, may constitute a basis for legal termination of a pregnancy on the grounds of "the mother's well-being." But it is not clear in the Court's opinion how many doctors (and of what specialties) should make the relevant evaluation that would constitute sufficient legal justification for a decision to perform a legal abortion, thereby mitigating the risk of facing legal liability for terminating a pregnancy. For these reasons, doctors are likely to bear the burden that should have been placed on the legislators, who are, after all, obliged to consistently and exhaustively consider all the factual situations that are bound to happen in medical practice. Such factual situations should be addressed by thoughtful legislation instead of subjecting physicians to potentially unorthodox or free interpretation of laws falling short of meeting the actual needs of their patients.

The profession of psycho-oncologist in Poland as an example of inadequate legal regulation in the area of health care. / Zawód psychoonkologa w Polsce jako przyklad niewlasciwej regulacji prawnej w obszarze ochrony zdrowia.

The profession of psycho-oncologist in Poland is not sufficiently regulated by law. The issue is further complicated by the fact that this profession has not been classified by the legislature in the group of medical professions, but only in the group of allied health professions. Currently, according to the Regulation of the Minister of Health on guaranteed services in the field of hospital treatment, a psycho-oncologist is a person with higher medical education, i.e. a graduate of a medical university, for example a doctor or a nurse, who has fulfilled the additional condition of completing postgraduate studies in psycho-oncology. It is thus clear that the legal definition of the profession of a psycho-oncologist remaining in force is inconsistent with the regulation of this profession in force since 2018, resulting from the announcement of the same minister in the Polish Qualifications Framework (PQF - Polska Rama Kwalifikacji, abbrev. PRK). This is because the PQF limits the group of persons who may obtain a qualification in the area of psycho-oncological diagnosis and treatment to psychologists and psychiatrists only, thus limiting the group of persons authorised to practise the profession of a psycho-oncologist. An additional legal problem results from significant differences in the nature of the professions of a medical doctor and psychologist, due to the fact that the Act on the Profession of a Psychologist does not apply in practice, despite remaining in force formally. Thus, a psychologist who practises the profession of a psycho-oncologist, might additionally be a subject to the lack of legal regulation of their "foundation profession", for example due to the fact that it is impossible for a psychologist to obtain a licence to practise their profession, as there is no body to grant them such a licence. Finally, it should not be overlooked that, in addition to the two contradictory regulations of the profession of a psycho-oncologist mentioned above (Regulation of the Minister of Health and the PQF), there also exists a third path to obtain the so-called psycho-oncologist certificate, awarded by the Polish Psycho-oncology Society (Polskie Towarzystwo Psychoonkologiczne - PTPO). At present, persons certified via this path, who include, apart from psychologists and doctors, also representatives of other professions, such as nurses or clergy employed in hospices, will in the majority of cases not be able to formally practise the profession, because the legislature has not provided for the recognition of certificates issued by the PTPO as equivalent to obtaining a psycho-oncological qualification in the context of the above-mentioned regulations.

NOS2 Polymorphism in Aspect of Left and Right-Sided Colorectal Cancer.

Background: The NOS2 gene polymorphism rs2297518 is associated with an increased level of NO, which could contribute to colorectal cancer (CRC) development. We hypothesized that the potential influence of the NOS2 gene polymorphism on cancer development may vary between right-sided and left-sided colon cancers, and rectal cancers. The aim of this study was to determine the rs2297518 polymorphism influence on colorectal cancer development with regard to tumor localization. Methods: This case-control study included 199 patients with CRC and 120 controls. The qPCR endpoint genotyping was conducted using the TaqMan® genotyping assay. Results: This study revealed significant differences in tumor characteristic and in the minor alelle A frequency in the NOS2 genotype between colorectal cancers with different localizations. The mucinous adenocarcinoma was diagnosed significantly more often in right-sided cancers than in left-sided (30.6% vs. 10.9%, p = 0.009) and rectal cancers (30.6% vs. 7.1%, p = 0.0003). The minor allele A of the NOS2 genotype was observed more frequently in right-sided cancers than in left-sided cancers (44.9% vs. 23.1%, p = 0.0137) and more frequently in rectal cancers than in left-sided cancers (40.0% vs. 23.1%, p = 0.0285). Conclusions: In conclusion, the results support the hypothesis that the SNP rs2297518 of the NOS2 gene influences colorectal cancer development with regard to tumor localization.

The internment of patients undergoing treatment for alcohol addiction as a result of a specific interpretation of legal provisions by some judicial authorities. / Internowanie pacjentów leczacych sie odwykowo jako skutek okreslonej wykladni przepisów prawa przez niektóre organy wymiaru sprawiedliwosci.

In the Polish legal system, each medical procedure requires patient's consent. Exemptions from the obligation to obtain such a consent are limited by the legislator to exceptional situations, i.e., when the delay caused by the procedure for obtaining consent would pose a threat to patient's life, serious injury, or serious health impairment. Undergoing addiction treatment is also voluntary. Exceptions to this principle are stipulated by a legal act. People who abuse alcohol and therefore break down family life, demoralize minors, avoid the obligation to meet the needs of their families, or systematically disturb peace or public order, may be obliged to undergo addiction treatment in an inpatient or outpatient treatment centre on condition that they are addicted to alcohol. A patient who fails to report to the medical entity designated by the court to execute the decision on the obligation to undertake addiction treatment may be brought to this entity by the police. In the context of the obligation to obtain a consent for treatment by a person against whom a court decision containing an obligation in this respect has been issued, there are discrepancies in the application of law provisions. In some medical entities, this results in the forced continuation of addiction treatment by a given patient in hospital, as discharge from the hospital depends on a court order issued in this regard, not on the consent of the patient himself/herself. In other medical entities, patients are not admitted for treatment due to the lack of such a consent, despite the court's obligation in this respect. The article confirms that a specific practice of applying the law, which downgrades the role of the patient's consent in the therapeutic process, has negative consequences for the effectiveness of the therapy.

Association between Glutathione S-Transferases Gene Variants and COVID-19 Severity in Previously Vaccinated and Unvaccinated Polish Patients with Confirmed SARS-CoV-2 Infection.

As the outcome of COVID-19 is associated with oxidative stress, it is highly probable that polymorphisms of genes related to oxidative stress were associated with susceptibility and severity of COVID-19. The aim of the study was to assess the association of glutathione S-transferases (GSTs) gene polymorphisms with COVID-19 severity in previously vaccinated and unvaccinated Polish patients with confirmed SARS-CoV-2 infection. A total of 92 not vaccinated and 84 vaccinated patients hospitalized due to COVID-19 were included. The WHO COVID-19 Clinical Progression Scale was used to assess COVID-19 severity. GSTs genetic polymorphisms were assessed by appropriate PCR methods. Univariable and multivariable analyses were performed, including logistic regression analysis. GSTP1 Ile/Val genotype was found to be associated with a higher risk of developing a severe form of the disease in the population of vaccinated patients with COVID-19 (OR: 2.75; p = 0.0398). No significant association was observed for any of the assessed GST genotypes with COVID-19 disease severity in unvaccinated patients with COVID-19. In this group of patients, BMI > 25 and serum glucose level > 99 mg% statistically significantly increased the odds towards more severe COVID-19. Our results may contribute to further understanding of risk factors of severe COVID-19 and selecting patients in need of strategies focusing on oxidative stress.

Obligation Is Not a Compulsion-The Quality of the Law and the Effectiveness and Safety of Vaccination against COVID-19.

In December 2021, the Minister of Health in Poland announced via Twitter that vaccination was not compulsory. Such a message from a public authority, who was to a significant extent responsible for organising the process of preventing and combating the infections caused by the SARS-CoV-2 pandemic, appeared to have a negative impact on the public perception of the role of vaccination in combating this disease. The impossibility of directly enforcing vaccination, in the sense that there is no legal basis for its compulsory administration, should not weaken the sense of obligation towards a socially necessary attitude of vaccination as a means of protecting the population against the disease; this should be promoted by public authorities. An auxiliary role in shaping this type of message should be played by the law of appropriate quality, regulating the rules related to vaccination in a way that encourages citizens' trust in the state and the law.