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1.
S D Med ; 73(1): 22-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32135048

RESUMO

"Privilege" vs. "Right" in healthcare is a failed political binary because it has divided the nation. The "my privilege" end of this false choice has been damaging, shifting the burden to the patient and away from the physician. It is medicine's historic privilege to care for any human but obligation has waned being plagued by opportunism. Also, what we have a right to or are privileged to receive is undefined. Past premises for the privilege are untrue, based on Health = medical care. Present assessments of the privilege are unfair, deeming American medicine a sickness. Future solutions for the privilege are untenable, if "equality" is the goal. The framework for healthcare's obligation-to-give already surrounds us, emerging from the American Revolution with its idea of individual dignity as to priority, checks and balances as to protection and Federalism as to improvement. American medicine has followed this idea albeit misused and unfulfilled. The null hypothesis of this debate must be fairly tested - that American medicine is the worst form of healthcare delivery - except for all the rest. Both Big Business and Big Politics in healthcare have become ends unto themselves and therefore neither can solve the privilege question nor bear the weight of our obligation-to-give. The patient-as-obligation must be our aim.


Assuntos
Médicos , Assistência à Saúde , Humanos , Direitos do Paciente , Política , Estados Unidos
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 220-224, 2020 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-32192298

RESUMO

As an emerging treatment method, watch and wait (W&W) strategy is not the standard treatment for rectal cancer patients but recommended by some guidelines. The legal risk of W&W is that once the medical behavior fails to achieve the desired effect, the patient may think that it is because of the wrong choice of treatment plan and delay of radical resection, thus causing medical dispute. As for the above legal risks, medical personnel should fulfill higher obligations when carrying out W&W strategy after neoadjuvant treatment for rectal cancer, including confirming that the treatment method has relatively reliable evidence-based medical evidence, fully implementing the information obligation and obtaining informed consent of the patient, and formulating standardized treatment procedures to ensure the standardization of medical behavior. At the same time, through patient education and communication, patients are aware of and coordinate with the efforts made by medical staff to improve patients' outcomes and quality of life, so as to understand the possible benefits and risks of this treatment strategy, as well as the efficacy and damage of complying with conventional treatment, and make final decision together with the medical staff.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Consenso , Humanos , Recidiva Local de Neoplasia , Direitos do Paciente , Qualidade de Vida , Neoplasias Retais/terapia , Conduta Expectante
3.
Enferm. clín. (Ed. impr.) ; 30(1): 16-22, ene.-feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-186279

RESUMO

Objetivo: Analizar el grado de conocimiento y la actitud sobre las voluntades anticipadas de las enfermeras que trabajan en 3 hospitales del Servizo Galego de Saúde (España). Método: Estudio descriptivo, transversal, multicéntrico. Se realizó un muestreo estratificado a enfermeras de los complejos hospitalarios Universitarios de Ourense, Ferrol y Vigo. Se calculó un tamaño muestral de 239 individuos. La recogida de los datos se realizó durante el primer semestre de 2018 mediante un cuestionario validado autocumplimentado («Cuestionario de conocimientos y actitudes de los profesionales sanitarios en el proceso de declaración de voluntades vitales»). Resultados: Participaron un total de 262 enfermeras. Un 50% cree que los profesionales sanitarios están obligados a informar sobre las voluntades anticipadas. Un 2% considera que tiene suficiente información sobre el tema, y así lo demuestran en las preguntas de conocimientos, donde entre un 61-93% fallan en las preguntas relacionadas con la documentación, uso y aspectos legales de las mismas. Un 84% considera que tiene la obligación de respetar los valores y creencias de los pacientes y un 89% que los pacientes tienen derecho a recibir y decidir sobre la atención idónea. Un 13% considera que los pacientes no están bien informados sobre voluntades anticipadas, y un 83% recomendaría a sus pacientes crónicos la realización del documento de voluntades anticipadas. Conclusiones: Las enfermeras tienen un gran desconocimiento sobre los aspectos legales y el uso de las voluntades anticipadas, lo que les hace sentirse poco capaces para informar a sus pacientes sobre las mismas. A pesar de la falta de conocimiento, su actitud es positiva y la mayoría manifiesta que las recomendaría a sus pacientes


Objective: To analyse the level of knowledge and attitudes concerning living wills of nurses working in 3 hospitals of Servizo Galego de Saúde (Spain). Method: Descriptive, cross-sectional, multi-centre study. Stratified sampling was carried out with nurses from the University Hospital Complexes of Ourense, Ferrol and Vigo. A sample size of 239 individuals was calculated. The data was collected during the first semester of 2018 using a validated self-administered questionnaire («Cuestionario de conocimientos y actitudes de los profesionales sanitarios en el proceso de declaración de voluntades vitales»). Results: A total of 262 nurses participated. Fifty percent believe that health professionals are obliged to inform about living wills. Two percent consider that they have enough information on the subject, and this is demonstrated in the knowledge questions, where between 61%-93% fail in the questions related to the documentation, use, and their legal aspects. Eighty-four percent consider that they have the obligation to uphold the values and beliefs of patients, and 89% that patients have the right to receive and decide on the right care. Thirteen percent consider that patients are not well informed about living wills, and 83% would recommend to chronic patients that they complete a living will. Conclusions: Nurses have a great lack of knowledge about the legal aspects and the use of living wills, which makes them feel unable to inform their patients about them. Despite of the lack of knowledge, their attitude is positive and most of them state that they would recommend them to their patients


Assuntos
Humanos , Adesão a Diretivas Antecipadas/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Recursos Humanos de Enfermagem , Direitos do Paciente , Coleta de Dados , Hospitalização , Inquéritos e Questionários , Análise de Dados
5.
Rev Med Suisse ; 16(681): 307-309, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049451

RESUMO

Switzerland has a high rate of legal measures of constraint by international standard. Beside the incorporation of legal, medical and economic elements, the physician may be asked on what it means to be a care giver and to be free, because his decision could private his patient of a fundamental human right. The deprivation of freedom for purposes of assistance is helpful in some clinical situations but remains a controversial issue. We have to do our due diligence when assessing the patient, notably his capacity of discernment, and discuss with him and his relatives other treatments without legal constraint. The advance directives and the joint plan of crisis should be tools to increase patients' autonomy and to decrease the coercive measures.


Assuntos
Coerção , Tomada de Decisões , Hospitais Psiquiátricos , Direitos do Paciente/legislação & jurisprudência , Diretivas Antecipadas , Humanos , Transferência de Pacientes/legislação & jurisprudência , Médicos/psicologia , Suíça
6.
Wiad Lek ; 72(11 cz 1): 2161-2166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860865

RESUMO

OBJECTIVE: Introduction: Legal liability for medical negligence should contribute to the protection of patients' rights to life and health. At the same time, unreasonably strict sanctions against physicians should be analyzed much closely. More balanced model of such liability requires serious in-depth research. The aim of the article is to stimulate discussion about the necessity to improve the criminal legislation and judicial practice of criminal liability execution. PATIENTS AND METHODS: Materials and methods: This study is based on the analysis of international law, WHO documents, jurdicial practice and statistics, criminal and medical law legal doctrine (29 laws and papers, 97 court judgments were analyzed). Dialectical, comparative, analytic, synthetic and system analysis research methods were used, also for interpretation purposes. CONCLUSION: Conclusions: An effective legal mechanism should ensure the timeliness and thoroughness of the investigation and prosecution of each case of medical negligence to prevent the recurrence of such consequences in the future. Legal liability (civil, disciplinary or criminal) for medical negligence is a necessary part of this mechanism. The inevitability of criminal punishment rather than its severity should be recognized as a core for the medical negligence prevention concept. That's why the long-term imprisonment for medical negligence as a form of punishment should be recognized as socially unreasonable, it cannot improve the protection of patients' life and health but leads to significant negative social complications instead.


Assuntos
Imperícia , Direito Penal , Humanos , Responsabilidade Legal , Direitos do Paciente
8.
Georgian Med News ; (294): 156-165, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687970

RESUMO

The present article aims to provide a comprehensive review of the legal basis for and special features of indemnification for damages inflicted by maiming and other personal injuries including death, in particular, due to the doctor's treatment or the denial of medical care. The fulfilment of the aim involved critical analysis of civil legislation of Ukraine, with regard to indemnification for damages inflicted by maiming and other personal injuries including death. It also employs the legal framework governing out-of-court and in-court settlement of disputes with regard to inflicting personal injury to patients due to the provision of medical assistance or failure to provide medical assistance and some aspects of the assessment of damages to be awarded to the injured patient. In order to identify common trends relating to court decisions on damages in personal injury and wrongful death cases in the healthcare setting, 8 decisions made by domestic national courts of Ukraine as well as 17 decisions made by the European Court of Human Rights were considered. The present research employed the comparative legal research method, the integrated system-wide approach, the method of , the inductive method, the method of modelling , etc. Based on the conducted research, both out-of-court and in-court ways of the settlement of disputes with regard to inflicting personal injury to patients due to the provision of medical assistance or failure to provide medical assistance were identified as well as and some aspects of the assessment of the amount of compensation for damages to be awarded to the injured patient. The article provides a critical description of the reasons for liability of healthcare facilities or private doctors for causing maiming or other personal injuries including death to patients as well as the special features of this liability in criminal proceedings. It also outlines common tendencies of making decisions on personal injury cases involving the healthcare sector by the European Court of Human Rights. The article examines the role and special features of forensic medical examination as a sound basis for determining the fact of causing a personal injury.


Assuntos
Compensação e Reparação , Direitos Humanos , Legislação Médica , Responsabilidade Legal , Imperícia , Direitos do Paciente , Humanos , Ucrânia
9.
Georgian Med News ; (294): 165-171, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687971

RESUMO

The article explores the issue of human rights protection in the field of health care by the Constitutional Court of Ukraine. The decisions of the Constitutional Court of Ukraine in the case of K. G. Ustimenko (1997), the case of paid medical services (1998), the case of free medical care (2002), the case of judicial control over the hospitalization of incapacitated persons into psychiatric institute are analyzed (2016), as well as the new legislation of Ukraine in the light of radical reform in the healthcare sector. Attention is drawn to the principle of friendly attitude to international law, constitutional complaint, legal positions of the Constitutional Court of Ukraine in the above-mentioned cases and the prospect of their application into the development of new legislation of Ukraine in the context of radical reform of the health care system of Ukraine. It is emphasized that the legal positions of the Constitutional Court of Ukraine, with regard of peculiarities of the national legislature, can serve as a source of inspiration for the courts of other countries. The purpose of the article is to specify the role and place of the Constitutional Court of Ukraine in the system of judicial protection of human and citizen rights, to determine the prospects of applying the legal positions of the Constitutional Court of Ukraine within the development of new legislation of Ukraine in the light of radical reform of the health care system. The object of the study is the social relations that arise during protection of human rights in the field of health care by the Constitutional Court of Ukraine. The methodological basis of the research are general and special methods of scientific knowledge (formal-logical method, comparative-legal, structural-logical). As a result of the conducted research, the role and place of the Constitutional Court of Ukraine in the system of judicial protection of human and citizen rights, the role of the decisions of the Constitutional Court of Ukraine in the case of K. G. Ustimenko, the case of paid medical services, the case of free medical care, the case of judicial control over hospitalization of incapacitated persons into psychiatric institution in the formation and development of domestic constitutional proceedings are defined. It is emphasized that the introduction of the constitutional complaint concept (institution) contributed to the improvement of the national mechanism of human rights protection in the field of health care. Conflicts of constitutional regulation of the human right to free medical care have been identified, and proposals have been worked out regarding possible ways and methods to eliminate them.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Direitos Humanos , Direitos do Paciente , Instalações de Saúde , Hospitalização , Humanos , Ucrânia
11.
BMC Health Serv Res ; 19(1): 722, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638984

RESUMO

BACKGROUND: Thai massage is a highly gendered and culturally specific occupation. Many female Thai masseuses migrate to Norway as marriage migrants and as such are entitled to the same public healthcare as Norwegian citizens. Additionally, anyone who is not fluent in Norwegian is entitled to have an interpreter provided by the public healthcare system. Norway and most other countries aspire to universal health coverage, but certain immigrant populations continue to experience difficulties accessing appropriate healthcare. This study examined healthcare access among Thai migrant masseuses in Oslo. METHODS: Guided by access to healthcare theory, we conducted a qualitative exploratory study in 2018 with Thai women working as masseuses in Oslo, Norway. Through semi-structured in-depth interviews with 14 Thai women, we explored access to healthcare, health system navigation and care experiences. We analyzed the data using thematic analysis and grouped the information into themes relevant to healthcare access. RESULTS: Participants did not perceive that their occupation limited their access to healthcare. Most of the barriers participants experienced when accessing care were related to persistent language challenges. Women who presented at healthcare facilities with their Norwegian spouse were rarely offered interpreters, despite their husband's limited capacity to translate effectively. Cultural values inhibit women from demanding the interpretation services to which they are entitled. In seeking healthcare, women sought information about health services from their Thai network and relied on family members, friends and contacts to act as informal interpreters. Some addressed their healthcare needs through self-treatment using imported medication or sought healthcare abroad. CONCLUSIONS: Despite having the same entitlements to public healthcare as Norwegian citizens, Thai migrants experience difficulties accessing healthcare due to pervasive language barriers. A significant gap exists between the official policy that professional interpreters should be provided and the reality experienced by study participants. To improve communication and equitable access to healthcare for Thai immigrant women in Norway, health personnel should offer professional interpreters and not rely on Norwegian spouses to translate. Use of community health workers and outreach through Thai networks, may also improve Thai immigrants' knowledge and ability to navigate the Norwegian healthcare system.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Emigrantes e Imigrantes , Acesso aos Serviços de Saúde/estatística & dados numéricos , Massagem , Ocupações , Adulto , Barreiras de Comunicação , Feminino , Humanos , Noruega/epidemiologia , Direitos do Paciente , Pesquisa Qualitativa , Tailândia
13.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570361

RESUMO

A 28-year-old woman suffered a traffic accident resulting in severe head injuries with deleterious prognosis. Diagnostics further revealed a hitherto unknown pregnancy, at suspected week 9. Based on the patient's wish to donate organs, brain death protocol confirmed irreversible loss of brain function. Yet, vital pregnancy rendered organ transplantation impossible. Multiple ethical and legal issues arose, from invalidation of established legal care after brain death to the delivery of a healthy child after trauma and long-term critical care. After medicolegal and ethical counselling, pregnancy was sustained, and the goal of organ donation postponed. Critical care focused on foetal homeostasis. At 30+4 weeks, a viable girl was born via assisted vaginal delivery. Postpartal organ donation resulted in heart, kidney and pancreas transplantation. The case emphasises the medical, legal and ethical challenges to combine two apparently diametrical goals: the successful full-term pregnancy and the fulfilment of a patient's wish to donate organs.


Assuntos
Morte Encefálica , Viabilidade Fetal/fisiologia , Cuidados para Prolongar a Vida/ética , Doadores Vivos/ética , Mães , Defesa do Paciente/ética , Cuidado Pré-Natal/ética , Obtenção de Tecidos e Órgãos/ética , Adulto , Diretivas Antecipadas , Aconselhamento , Cuidados Críticos , Feminino , Humanos , Cuidados para Prolongar a Vida/métodos , Direitos do Paciente/ética , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/métodos
15.
Cien Saude Colet ; 24(10): 3663-3672, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31576996

RESUMO

This paper focuses on the life experiences of children with chronic disease, a group whose invisibility involves particular challenges in their relationship with professionals in important life contexts, such as family, school and hospital. The study includes two complementary phases: i) Phase 1, composed of 15 interviews with parents, education and health professionals and two focus group discussions with children, and children and their mothers; and ii) Phase 2, which included self-report questionnaires administered to parents (n = 152) and children with chronic disease (n = 176). Based on a mixed methodology, this study combines quantitative and qualitative methods assuming that plural approaches allow for a deeper understanding of the life conditions of children with chronic disease and their families. The results reinforce the reproduction of social stereotypes and the tendency to focus on the individual ability to solve problems, which still remain to be circumscribed to the people's chronic disease sphere. Moreover, this paper reveals the central role that inclusive contexts have on children's wellbeing.


Assuntos
Bem-Estar da Criança/psicologia , Doença Crônica/psicologia , Pais/psicologia , Direitos do Paciente , Adolescente , Criança , Feminino , Grupos Focais , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Inquéritos e Questionários
17.
J Leg Med ; 39(3): 247-261, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626574

RESUMO

This article reviews the U.S. Food and Drug Administration (FDA) regulation of generic medications-specifically, the use of bioequivalence to compare generic and brand prescriptions. New or "brand" drugs are subjected to extensive review by the FDA before they can be marketed to the public. Generics, which are posited to be identical to brands, are subject to a less extensive review process and must prove only that the generic is the "bioequivalent" (BE) of the brand drug. Generic medications are important because they comprise almost 80% of prescriptions filled in the United States and cost 80% to 85% less than brand drugs, playing a crucial role in patients' access to cost-effective treatments. However, there is dissension about whether they can be interchanged with brand drugs without any consequences for the patient, especially for Narrow Therapeutic Index (NTI) drugs, which have precise dosage requirements. The regulatory designation of bioequivalence also has implications for doctor-patient relationships, patient outcomes, and patient legal rights. This article aims to establish that there is insufficient evidence to conclude whether using bioequivalence is adequate to determine whether two drugs can be considered equivalent given the medical and legal implications that flow from deeming two drugs equivalent.


Assuntos
Medicamentos Genéricos/normas , Equivalência Terapêutica , United States Food and Drug Administration/legislação & jurisprudência , Medicamentos Genéricos/farmacocinética , Direitos do Paciente , Preparações Farmacêuticas/classificação , Guias de Prática Clínica como Assunto , Índice Terapêutico do Medicamento , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration/normas
18.
Z Gerontol Geriatr ; 52(Suppl 4): 243-248, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31602507

RESUMO

The use of freedom-depriving measures (physical and medicinal restraints) in people with cognitive impairment or dementia in clinical care settings is of ongoing importance. At the same time, these coercive measures are not only heavily debated but also in most cases ethically questionable from the perspective of the ethics of human dignity. Usually, the ethical evaluation of freedom-depriving measures follows classical paradigms of medical ethics, such as the Principles of Biomedical Ethics by Beauchamp and Childress. To enrich the debate at this point, the ethical category of embodiment ("Leiblichkeit" ) is introduced and discussed after a short summary of the ethical problem at hand. The phenomenon of the living body that has received increasingly more attention in several sciences since the proclaimed "corporeal turn" enables new perspectives towards human dignity, freedom and deprivation of freedom: freedom-depriving measures do not take place in an invisible realm of ideas but are directly applied to the psychophysical unity that is the living body of a person. Thus, freedom-depriving measures are an intervention into the bodily autonomy of the human being and the personal freedom that is manifested in the living body. The concept of the living body ("Leib") that is applied here, signifies more than just a physical object and is especially apt to capture the (inter)subjective dimension that has to be taken into account here. Finally, it will have to be investigated whether the use of medicinal restraints represents an especially serious interference into the sphere of human embodiment. Once introduced into the debate on freedom-depriving measures in clinical care, the category of embodiment can warrant decisive new emphases.


Assuntos
Cuidados Críticos/ética , Demência/terapia , Liberdade , Direitos do Paciente/ética , Autonomia Pessoal , Respeito , Cuidados Críticos/psicologia , Tomada de Decisões , Ética Médica , Humanos
19.
Lakartidningen ; 1162019 Oct 15.
Artigo em Sueco | MEDLINE | ID: mdl-31613375

RESUMO

This article highlights a special subtype of this dilemma, in which the patient requests a treatment that the physician judges to be substandard. Reasons for and against providing substandard treatment in the name of patient autonomy are presented and discussed. It is suggested that physicians carefully consider the risk of crowding out of other patients if substandard treatment is provided.


Assuntos
Necessidades e Demandas de Serviços de Saúde/ética , Preferência do Paciente , Qualidade da Assistência à Saúde/ética , Beneficência , Ética Médica , Prioridades em Saúde , Humanos , Participação do Paciente , Direitos do Paciente , Autonomia Pessoal , Papel do Médico
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