[The ethical, legislative and regulatory basis of therapeutic education]. / Les fondements éthiques, législatifs et réglementaires de l'éducation thérapeutique.

Beyond its interest in the field of public health and the political aspect with the "Hospital, patients, health and territories" law, therapeutic education now occupies an important place in nursing care. This new nursing culture provides another clinical approach for the nurse and a real means of learning for the patient in the framework of a support and guidance plan drawn up together.

Medical treatment and patient decisional power: the Italian state of the art.

Therapy dissent and refusal are the situations most debated in the medical profession, that lead to various interpretations with regards to life and health, and even more in case of death risk. In the last decades, the medical treatment consent matter has become such an interesting and central issue that it has considerably modified the doctor-patient relationship. In particular, thanks to a fecund discussion on doctrine and case law, the informed consent became an autonomy act through which the patient exercises his/her personal health right. There are two international provisions that deserve to be mentioned for the matter: article no. 3 of the Charter of Fundamental Rights of the European Union, adopted in Nice on December 7, 2000, and the Oviedo Convention of April 4, 1997, which Italy passed under article no. 145, March 28, 2001. Both laws are symptomatic for the growing attention toward the person's self-determination, and for the impossibility to perform treatment in absence of personal, informed, recent and at any time revocable consent of the person concerned. Actually, these different and opposite ways of thinking correspond to a variable attitude of the case law that, in absence of a clear legislation regarding this matter, induces a deep insecurity in the physician's act on the one hand, and, does not allow the patient to totally avail him/herself of the self-determination principle on the other hand, particularly regarding the will and choices on health care.

Do physicians care about patient choice?

A new policy (patient choice) was introduced in Sweden in the early 1990s to give patients the right to choose their healthcare providers, however, evaluations show that few patients exercise this right. This paper analyses physicians' roles in putting the patient choice policy into effect. To examine attitudes, knowledge and behaviour among physicians, a questionnaire was sent to 960 physicians in one of the most populous counties in Sweden. The results show that the physicians approve of the policy, yet only a minority state that they regularly help patients to choose healthcare providers by giving them information and letting them choose where they will be referred. Instead, referrals are mostly based on medical grounds; the patient's wish to choose a specific provider is considered less important. In summary, we found that more than a decade after the policy was introduced, only a minority of physicians act according to the political intention. This could be one explanation for why many patients still do not exercise their right to choose a hospital.

[The right to health versus entitlement to loving care and attention. The model project "gemeinsam gesund werden"]. / Recht auf Gesundheit, Anrecht auf fürsorgliche Behandlung. Das Modellprojekt "gemeinsam gesund werden".

The following paper describes a model project (currently in the trial phase at one clinic) focussing on empathetic communication within the family as an essential part of the treatment of mothers suffering from breast cancer and their children in order to activate the mother's self-healing powers and at the same time to prevent the children being traumatised as a consequence of the mother's illness.

[Patient self-determination - the beneficiaries of medicine and their rights]. / Selbstbestimmte Patienten? - Die Nutzniesser der Medizin und ihre Rechte

Respect for patient autonomy is one of the major ethical goals of modern medicine. Therefore, it is important to analyse whether the organisational structure of the German health care system impedes the realisation of patient self-determination. It will be shown by means of historical and ethical analysis that the nature of the doctor-patient relationship as well as other factors in the organisation of modern medicine systematically undermine patient autonomy. If individual responsibility in the health care setting is to be strengthened, patients' influence on public health decision-making processes, too, has to be advanced. The paper shows from a patient perspective where this could be the case.

Transfusion-free treatment of Jehovah's Witnesses: respecting the autonomous patient's rights.

Do six million Jehovah's Witnesses mean what they say? Muramoto's not-so-subtle proposition is that they don't, because of a system of control akin to the Orwellian "thought police". My response is that the fast developing cooperative relationship between our worldwide community and the medical profession as a whole, and the proven record of that community's steadfast integrity in relation to their Christian principles is the evidence that we do! I seek to highlight the inaccuracy of information, which Muramoto admits came largely from dis-enchanted ex-members, by quoting "established" medical ethical opinion that refusal of blood transfusions must be respected as evidence of patient autonomy. Personal experience of my work on hospital liaison committees for Jehovah's Witnesses is reviewed and I endeavour to prove that our view of blood, and its association with life, goes to the very core of the human psyche. Lastly I suggest that faith transcends rationality. Human beings are more than just minds! Our deep moral sense and consciousness that our dignity is diminished by living our lives solely on the "self interest" principle, lies at the heart of true personal autonomy. Maybe it's a case of "two men looking through the same bars: one seeing mud, the other stars".

The risk of transfusion-associated AIDS: offering patients an active role in their care.

This article explores the duty of health care providers to inform patients of the risk of contracting AIDS through blood transfusions that may be necessitated by surgery or other forms of medical treatment. Although the quantitative risk of receiving HIV-contaminated blood in a transfusion is small, the qualitative risk is of a magnitude requiring complete disclosure if a patient's consent to treatment is to be considered adequately informed. Recent litigation confirms the importance of providing patients with the information needed to adequately assess the risks and benefits of proposed treatments that might involve a transfusion and reveals the need to offer the opportunity, where permissible, for autologous and directed donations. A comprehensive program embodying these concerns improves the quality of patient care and reduces exposure to liability for transfusions with contaminated blood.