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3.
Obstet Gynecol ; 136(5): 1036-1039, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030860

RESUMO

The population of women within carceral systems is growing rapidly. A portion of these individuals are pregnant and will deliver while incarcerated. Although shackling laws for pregnant persons have improved, incarcerated patients are forced to labor without the support of anyone but a carceral officer and their medical staff. We believe access to continuous labor support is critical for all pregnant persons. Carceral systems and their affiliated hospitals have the opportunity to change policies to reflect that continuous labor support is a basic human right and should be permitted for incarcerated pregnant persons in labor, either through a doula program or a selected person of choice.


Assuntos
Parto Obstétrico/ética , Trabalho de Parto/psicologia , Direitos do Paciente/legislação & jurisprudência , Assistência Perinatal/ética , Prisioneiros/psicologia , Entorno do Parto , Parto Obstétrico/legislação & jurisprudência , Feminino , Humanos , Assistência Perinatal/legislação & jurisprudência , Gravidez , Prisioneiros/legislação & jurisprudência
4.
Soins Psychiatr ; 41(328): 19-22, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33039086

RESUMO

The act of 5 July 2011 pertaining to the rights and the protection of persons under psychiatric care presents the possibility for compulsory care, without the need for full hospitalisation. Patients can be cared for through partial hospitalisation (day hospital and part-time therapeutic clinic) or in a medical-psychological centre. Treatments and all care are detailed in a care programme. This programme is sent, like all certificates, to the regional health agency and the prefecture in the case of psychiatric care by decision of the State representative, or to the hospital director for psychiatric care at the request of a third party. We propose two clinical vignettes.


Assuntos
Assistência Ambulatorial , Transtornos Mentais/terapia , Hospital Dia , Humanos , Direitos do Paciente/legislação & jurisprudência
5.
Cuad Bioet ; 31(102): 167-182, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910670

RESUMO

In this paper present, from a bioethical perspective, a reflection on how to reconcile efforts to combat the COVID-19 pandemic with the safeguard of human rights. To do this, I develop three points. First, the regulatory framework that justifies the restriction or suspension of rights in the face of serious threats to public health. Second, the declarations of the international bioethics committees on the way in which human rights should be protected during public health crisis. And third, a review of the main rights threatened both by the public health crisis and by the means adopted to combat it. Before going into each of these points, I offer a preliminary note to clarify certain legal concepts and underline the need to overcome disjunctive approaches in considering human rights.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis/legislação & jurisprudência , Direitos Humanos/ética , Pandemias/prevenção & controle , Saúde Pública/ética , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Comissão de Ética , União Europeia , Liberdade , Recursos em Saúde/ética , Recursos em Saúde/provisão & distribuição , Acesso aos Serviços de Saúde/ética , Direitos Humanos/legislação & jurisprudência , Humanos , Pandemias/ética , Pandemias/legislação & jurisprudência , Direitos do Paciente/ética , Direitos do Paciente/legislação & jurisprudência , Autonomia Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Saúde Pública/legislação & jurisprudência , Quarentena/ética , Quarentena/legislação & jurisprudência , Sujeitos da Pesquisa , Alocação de Recursos/ética , Espanha , UNESCO
6.
Clin Ter ; 171(5): e401-e406, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32901782

RESUMO

INTRODUCTION: The study in question starts from a general analysis of Law n. 219/2017 and then to deepen the patient's right to self-determination, which is exercised through the expression of an informed consent to medical therapy. The analysis refers in particular to the patient's decision-making autonomy, the professional autonomy of the doctor and his consequent responsibility. MATERIALS AND METHODS: This study examines the art. 5 of the Law n. 219/2017, where the Legislator has defined the theme of shared planning of care. The authors compare the Advance Treatment Provisions (Article 4 - Law No. 219/2017) and the Shared Care Planning, to then examine the emerging relationship of care between doctor and patient. RESULT: The relationship of care must be related to the patient's willingness to decide on his future and to the technical and scientific information that the doctor is required to give. CONCLUSION: In conclusion, the Authors highlight the innovative content of the shared care plan, emphasizing the importance for a patient suffering from a chronic and progressive disease to be actively involved in formulating their own therapeutic plan.


Assuntos
Consentimento Livre e Esclarecido/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Humanos , Itália , Administração dos Cuidados ao Paciente , Participação do Paciente , Autonomia Pessoal
7.
Mayo Clin Proc ; 95(8): 1732-1739, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32753147

RESUMO

In 2018, the American Academy of Neurology, the American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research published a systematic evidence-based review and an associated practice guideline for improved assessment, treatment, and rehabilitation of patients with disorders of consciousness. Patients with disorders of consciousness include individuals in the vegetative and minimally conscious states, as well as others with covert consciousness and cognitive motor dissociation. These landmark publications (concurrently published in Neurology and Archives of Physical Medicine and Rehabilitation) supplant the 1994 New England Journal of Medicine Multi-Society Task Force report on the vegetative state and the 2002 criteria establishing minimally conscious states. The guideline re-designates the permanent vegetative state as chronic. In our article, we consider the legal and ethical implications of the practice guideline for clinical practice and explain the vulnerability of these patients who suffer from high rates of misdiagnosis, inadequate medical surveillance, undertreatment of pain, inadequate rehabilitation, and segregation in chronic care. We argue that these deficiencies in medical care are inconsistent with our growing appreciation of the dynamic nature of these brain states and an emerging standard of care as articulated by the national guideline. These deficiencies also violate domestic and international disability law. To substantiate this latter claim, we apply disability law to this population, focusing on key Americans with Disabilities Act mandates, the relevance of the 1999 Supreme Court, Olmstead v. L.C., and the utility of Olmstead enforcement actions to integrate the care of these individuals into the medical mainstream.


Assuntos
Transtornos da Consciência/diagnóstico , Pessoas com Deficiência/legislação & jurisprudência , Transtornos da Consciência/terapia , Consenso , Erros de Diagnóstico/legislação & jurisprudência , Avaliação da Deficiência , Humanos , Direitos do Paciente/legislação & jurisprudência , Estado Vegetativo Persistente/diagnóstico , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Estados Unidos
9.
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
10.
Bull World Health Organ ; 98(1): 52-58, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902962

RESUMO

The United Nations Convention on the Rights of Persons with Disabilities requires a paradigm shift from a medical model of disability to a social model that emphasizes overcoming the barriers to equality created by attitudes, laws, government policies and the social, economic and political environment. The approach adopted by the social model recognizes that people with psychosocial disabilities have the same right to take decisions and make choices as other people, particularly regarding treatment, and have the right to equal recognition before the law. Consequently, direct or supported decision-making should be the norm and there should be no substitute decision-making. Although recent mental health laws in some countries have attempted to realize a rights-based approach to decision-making by reducing coercion, implementing the Convention on the Rights of Persons with Disabilities can be challenging because it requires continuous refinement and the development of alternatives to coercion. This article reviews the impact historical trends and current mental health frameworks have had on the rights affected by the practice of involuntary treatment and describes some legal and organizational initiatives that have been undertaken to promote noncoercive services and supported decision-making. The evidence and examples presented could provide the foundation for developing a context-appropriate approach to implementing supported decision-making in mental health care.


Assuntos
Tomada de Decisões , Serviços de Saúde Mental/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Coerção , Serviços Comunitários de Saúde Mental/organização & administração , História do Século XX , História do Século XXI , Humanos , Tratamento Psiquiátrico Involuntário/história , Tratamento Psiquiátrico Involuntário/legislação & jurisprudência , Serviços de Saúde Mental/história , Aceitação pelo Paciente de Cuidados de Saúde , Direitos do Paciente/história , Apoio Social
11.
Neurology ; 94(7): 306-310, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-31969466

RESUMO

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.


Assuntos
Atenção à Saúde/ética , Pessoas com Deficiência , Acidente Vascular Cerebral/terapia , Temas Bioéticos , Tomada de Decisão Clínica/ética , Ensaios Clínicos como Assunto , Atenção à Saúde/legislação & jurisprudência , Pessoas com Deficiência/legislação & jurisprudência , Pessoas com Deficiência/reabilitação , Disparidades em Assistência à Saúde , Humanos , Direitos do Paciente/ética , Direitos do Paciente/legislação & jurisprudência
12.
Gac. sanit. (Barc., Ed. impr.) ; 34(supl.1): 76-80, ene. 2020.
Artigo em Espanhol | IBECS | ID: ibc-201183

RESUMO

Tras la aprobación de la Constitución ha habido importantes avances en el estatuto jurídico del paciente en general y del paciente mental en particular. Sin embargo, la regulación de los derechos del paciente mental ha sido menos detallada y más incompleta. Existen en esta materia importantes carencias, al ser la regulación existente mínima, sin tener en cuenta los más relevantes instrumentos internacionales de referencia. Con la aprobación de la Convención de Nueva York se han producido importantes reformas legales respecto a las personas con discapacidad. No ha sucedido lo mismo con los enfermos mentales. En esta materia existe un considerable retraso en la adaptación de nuestro ordenamiento jurídico a la Convención. Y además se plantean importantes problemas para su implementación, al cambiar el modelo asistencial tradicional (rehabilitador) por el modelo social y al utilizarse en la Convención conceptos (así, capacidad jurídica) no coincidentes con otros propios de la tradición legislativa española. La interpretación que de la Convención ha llevado a cabo el Comité de Derechos de las Personas con Discapacidad añade dificultades para la homologación de nuestro ordenamiento a la Convención. Con este panorama es evidente que quedan pendientes muchos retos para abordar en el futuro, y para ello es preciso el establecimiento de un previo diálogo racional


After the approval of the Constitution there have been major improvements on the juridical status of the patient in general and specifically of the mental kind. Nevertheless the regulation of the rights regarding the mental patients has been less thorough. Consequently there are significant deficiencies regarding this matter, being the existing regulations minimal, those which do not take on account the most relevant international reference tools. With the approval of the New York Convention major legal reforms have been introduced regarding the sensory and physically handicapped. However not the same has happened with the case of those with mental conditions. On this subject exists a sizable delay on the adaptation of our juridical application to this Convention. Furthermore major problems arise for its implementation. This changes the traditional assistance model (towards rehabilitation) for the social model and uses new concepts brought by the Convention (legal capacity) which do not coincide with other ones characteristic of the Spanish legislative tradition. The interpretation of the Convention done by the Committee on the Rights of Persons with Disabilities adds difficulties to validate our regulation to the Convention. With all this in mind it is clear to see that there are many challenges to take on the future, being necessary for this the implementation of a previous rational dialogue


Assuntos
Humanos , Direitos do Paciente/legislação & jurisprudência , Assistência à Saúde Mental , Transtornos Mentais/epidemiologia , Pessoas com Deficiência Mental/legislação & jurisprudência , Deficiência Intelectual/terapia , Espanha/epidemiologia , Pessoas Mentalmente Doentes/legislação & jurisprudência , Serviços de Saúde Mental/legislação & jurisprudência
13.
Gac. sanit. (Barc., Ed. impr.) ; 34(supl.1): 81-86, ene. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-201184

RESUMO

La transición legislativa e ideológica producida en los últimos años en España ha favorecido el desarrollo del modelo comunitario de atención a la salud mental. No obstante, aún persiste una fuerte resistencia a la inclusión de abordajes comunitarios en la atención de las personas con problemas de salud mental y a la implementación de una atención y unos cuidados integrados de enfoque salutogénico. El propósito del siguiente artículo es describir la evolución del modelo comunitario de atención a la salud mental en el sistema nacional de salud español y evaluar su estado actual. Inicialmente se realizó una revisión de los planes y estrategias de salud mental nacional publicados y luego se evaluaron tomando como referencia el Documento de consenso sobre los principios fundamentales y elementos clave de la salud mental comunitaria, que establece los criterios de valoración de la calidad de la atención comunitaria. Ante la falta de planes o estrategias actualizados, se incluyeron informes y recomendaciones internacionales. Los resultados se agruparon en: 1) perspectiva social, en la que se evidencia la controversia sobre la capacidad de las personas usuarias para tomar decisiones a pesar del reconocimiento de sus derechos como agentes morales autónomos; 2) perspectiva de la centralidad de las personas usuarias de los servicios de atención a la salud mental, en la que se plasma la resistencia a la implementación de una atención y unos cuidados comunitarios integrados; y 3) perspectiva profesional en relación con la efectividad de las intervenciones y la red comunitaria de principios de atención, que señala la necesidad de transformar las instituciones para realizar intervenciones comunitarias en salud mental basadas en la evidencia y de manera intersectorial, integral, integrada e integradora


The legislative and ideological transition produced in recent years in Spain has favoured the implementation of the community model of mental health care. However, there is still strong resistance to the inclusion of community approaches in the care of people with mental health problems and to the implementation of integrated care and attention with a salutogenic approach. The purpose of the following report is to describe the evolution of the community model of mental health care in the Spanish National Health System and to assess its current status. Initially, a review of the published national mental health plans and strategies was carried out. Subsequently, the evaluation was carried out taking as reference the Consensus Document on the Fundamental Principles and Key Elements of Community Mental Health, which establishes the criteria for evaluating the quality of community care. In the absence of updated plans or strategies, international reports and recommendations were included. The results were grouped into: 1) social perspective, where the controversy about the capacity of the users to make decisions despite the recognition of their rights as autonomous moral agents is evident; 2) perspective of the centrality of the users of mental health care services, where the resistance to the implementation of integrated community care and attention is expressed; and 3) professional perspective in relation to the effectiveness of the interventions and the community network of care principles, which highlights the need to transform the institutions to carry out community interventions in mental health based on evidence and in an intersectoral, comprehensive, integrated and integrating manner


Assuntos
Humanos , Centros Comunitários de Saúde Mental/organização & administração , Assistência à Saúde Mental , Transtornos Mentais/epidemiologia , Espanha/epidemiologia , Modelos Organizacionais , Assistência Centrada no Paciente/organização & administração , Psiquiatria Comunitária/organização & administração , Direitos do Paciente/legislação & jurisprudência
15.
BMJ Support Palliat Care ; 10(2): e14, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28438759

RESUMO

OBJECTIVES: To examine palliative care clinicians' level of knowledge of the law regarding the use of the Deprivation of Liberty Safeguards (DoLS). METHODS: Regional postal survey of palliative care clinicians working in hospices in the East of England, undertaken in April 2015. Clinicians' level of knowledge was assessed by their response to 7 factual questions. Data regarding self-reported levels of confidence in applying the Safeguards was collected, alongside information regarding the number of times they had used DoLS in practice. A free-text section invited additional comments from participants. RESULTS: There were 47 responses from 14 different organisations; a response rate of 68%. Respondents included consultants, specialty and associate specialists, registrars, nurses and social workers. Higher self-reported confidence and training in the use of DoLS was associated with higher factual knowledge. Consultants had the highest level of knowledge, training and experience. Doctors of other grades, nurses and social workers recorded less knowledge and experience and scored lower in the knowledge sections. The free-text comments revealed difficulty applying the Safeguards in practice, particularly among the consultant responses, based around several themes: insufficient guidance on how to use the Safeguards, process after death, uncertainty as to relevance to palliative care and delays in assessments. CONCLUSIONS: Clinicians working in palliative care have good levels of knowledge of the DoLS. Despite this concerns were raised, particularly by consultants; uncertainty as to when they should be used and the relevance of the Safeguards in clinical practice. Further guidance should be given to clinicians working in this specialty to ensure that clinical practice is both lawful and in the patients' best interests.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cuidados Paliativos na Terminalidade da Vida/psicologia , Cuidados Paliativos/psicologia , Direitos do Paciente/legislação & jurisprudência , Médicos/psicologia , Adulto , Inglaterra , Feminino , Cuidados Paliativos na Terminalidade da Vida/legislação & jurisprudência , Hospitais para Doentes Terminais , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/legislação & jurisprudência , Inquéritos e Questionários
16.
Nurs Ethics ; 27(1): 289-300, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31088205

RESUMO

BACKGROUND: Nurses providing 24-h care for the primary caregiver role have a number of significant roles to play in potential problems or conflicts associated with patient privacy and confidentiality. RESEARCH OBJECTIVES: The objective of the study is to determine the prevailing attitudes towards gossip and the patient privacy practices of nurses working in paediatric units. RESEARCH DESIGN: A descriptive and cross-sectional design was used. A Descriptive Characteristics Form, a Gossip and Rumour Attitude Scale and a Patient Privacy Scale were used to collect data. PARTICIPANTS AND RESEARCH CONTEXT: A total of 112 paediatric nurses working in Turkey were included in the study. The response rate was 79.43%. ETHICAL CONSIDERATIONS: Permission to conduct the study was obtained from the university's ethics committee. The participants were informed of the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them. FINDINGS: It was observed that nurses who had a higher education level, who were educated about patient privacy and who had read the patient rights regulations were more concerned about patient privacy. Negative correlations were found between the attitudes towards gossiping and the average scores on the patient confidentiality scale. Nurses who negatively defined gossip were more concerned about patient confidentiality. DISCUSSION: Privacy is important for securing and protecting the personal, physical and psychological things that are important and special for patients. It is argued that obstacles to maintaining the privacy of hospitalized children and adolescents are a tolerant attitude towards gossiping, a lack of education about patient privacy and insufficient information about patient's rights regulations and the Convention on the Rights of the Child. CONCLUSION: A nurse's knowledge about the provision of patient confidentiality affects their privacy practices. For this reason, regular training sessions are recommended in hospitals.


Assuntos
Atitude do Pessoal de Saúde , Confidencialidade , Enfermeiras Pediátricas/psicologia , Direitos do Paciente/ética , Direitos do Paciente/legislação & jurisprudência , Privacidade , Estudos Transversais , Humanos , Turquia
17.
Clin Cancer Res ; 26(2): 340-343, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31666248

RESUMO

Patients with cancer who have exhausted standard treatments often seek access to investigational drugs. Often, however, such access is unavailable, due to either the unavailability of a trial, lack of an open recruiting spot on the trial, even when the trial itself is open, or the inability of the patient to meet one or more trial eligibility criteria. In such settings patients often seek access to investigational agents outside of a trial. The federal "Right to Try" legislation was passed to create an additional avenue, different from the FDA's Expanded Access, or "Compassionate Use" Program, through which patients might obtain access to investigational drugs. A year after this legislation was signed into law, there remains both a limited awareness of it and a substantial degree of misunderstanding on the part of those who are aware of it. The law creates an avenue to greatly facilitate off-study administration when patient, physician, and the manufacturer are all in agreement regarding the off study use of an eligible investigational agent. The law does not, however, empower a patient to impose a demand on either a provider or a drug manufacturer, nor does it require any entity to provide financial coverage for the drug. Eligible drugs are those which are not approved by the FDA for any indication, have completed a phase I trial, have an ongoing pivotal trial, and have an active registration plan. We review the specific law with commentary on its implications for improved access to investigational drugs outside of clinical trials.


Assuntos
Aprovação de Drogas/legislação & jurisprudência , Drogas em Investigação/uso terapêutico , Neoplasias/tratamento farmacológico , Direitos do Paciente/legislação & jurisprudência , Terapias em Estudo/ética , Humanos , Estados Unidos , United States Food and Drug Administration
18.
Rev. derecho genoma hum ; (51): 61-76, jul.-dic. 2019.
Artigo em Inglês | IBECS | ID: ibc-192372

RESUMO

On December 27, 2018, Law No. 13,787 was enacted in Brazil, regulating the electronic health record and establishing rules for its digitization and use. While already in force, the new Law refers to the General Data Protection Law - LGPD (Law No. 13,709 of August, 14, 2018, as amended by Law No. 13,853 of July 08, 2019), which will only come into effect in August 2020. In analyzing the documentary dimension of the right to health in the Brazilian regulation, this text proposes to analyze two issues: Could the electronic health record mean risk of leakage or misuse of patients' data in violation of their rights of personality? If the information is online, how could it be prevented from being accessed out of clinical objectives thus constituting a violation of the patient's personality rights?


El 27 de diciembre de 2018 se promulgó en Brasil la Ley Núm. 13.787, que regula la historia clínica electrónica y establece normas para su digitalización y uso. Si bien ya está vigente, la nueva Ley se refiere a la Ley General de Protección de Datos - LGPD (Ley Núm. 13.709 de 14 de agosto de 2018, modificada por la Ley Núm. 13.853 del 8 de julio de 2019), que sólo entrará en vigor en agosto de 2020. Al analizar la dimensión documental del derecho a la salud en la regulación brasileña, este trabajo propone analizar dos cuestiones: ¿Podría el historial médico electrónico significar un riesgo de uso indebido de los datos de los pacientes en violación de sus derechos de personalidad? Si la información está en línea, ¿cómo se puede evitar que se acceda a ella desde objetivos clínicos, lo que constituye una violación de los derechos de la personalidad del paciente?


Assuntos
Humanos , Sistemas Computadorizados de Registros Médicos/ética , Sistemas Computadorizados de Registros Médicos/legislação & jurisprudência , Direitos do Paciente/ética , Direitos do Paciente/legislação & jurisprudência , Privacidade/legislação & jurisprudência , Brasil
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