Equal access to healthcare in national legislations: how do Croatia, Germany, Poland, and Slovenia counteract discrimination in healthcare?

BACKGROUND: The aim of the study was a comparative analysis of legislative measures against discrimination in healthcare on the grounds of a) race and ethnicity, b) religion and belief, and c) gender identity and sexual orientation in Croatia, Germany, Poland and Slovenia. METHODS: We conducted a search for documents in national legal databases and reviewed legal commentaries, scientific literature and official reports of equality bodies. We integrated a comparative method with text analysis and the critical interpretive approach. The documents were examined in their original languages: Croatian, German, Polish, and Slovenian. RESULTS: All examined states prohibit discrimination and guarantee the right to healthcare on the constitutional level. However, there are significant differences among them on the statutory level, regarding both anti-discriminatory legal measures and other legislation affecting access to healthcare for groups of diverse race or ethnicity, religion or belief, sexual orientation or gender identity. Croatia and Slovenia show the most comprehensive legislation concerning non-discrimination in healthcare in comparison to Germany and even more Poland. Except for Slovenia, explicit provisions protecting equal access for members of the abovementioned groups are insufficiently represented in healthcare legislation. CONCLUSIONS: The study identified legislative barriers to access to healthcare for persons of diverse race or ethnicity, religion or belief, sexual orientation or gender identity in Croatia, Germany, Poland and Slovenia. The discrepancies in the level of implementation of anti-discriminatory measures among these states show that there is a need for comprehensive EU-wide regulations, which would implement the principle of equal treatment in the specific context of healthcare. General anti-discrimination regulations should be strengthened by inclusion of anti-discrimination provisions directly into national legislation relating specifically to the area of healthcare.

Saints and "Possession": A Case Review Bordering Ethnopsychiatry and Cultural Diversity.

The migrations of modern times have exposed psychiatrists and other medical experts to elements from other cultures which have to be recognised and discerned from pathology. In the present paper, we offer an overview of both historical and modern witnessings of various kinds of "possession", with shedding light on the whole process of diagnostics-taking into account all aspects that make a person as an individual: with particular emphasis on origin, lifestyle, moral values, and ethical norms what is sometimes easily associable with culture-bound phenomena, and sometimes overstepping the border of clinical disturbance, to maximise the possibility of recovery.

Social diversity and access to healthcare in Europe: how does European Union's legislation prevent from discrimination in healthcare?

BACKGROUND: Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief. METHOD AND MATERIALS: For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research topic. Our search covered documents that were in force between 13 December 2007 and 31 July 2019. RESULTS: Generally, the EU legal system prohibits discrimination on grounds of religion or belief, racial or ethnic origin, sex, and sexual orientation. However, with regard to the issue of non-discrimination in access to healthcare EU secondary law provides protection against discrimination only on the grounds of racial or ethnic origin and sex. The issue of discrimination in healthcare on the grounds of religion or belief, gender identity and sexual orientation is not specifically addressed under EU secondary law. DISCUSSION: The absence of regulations regarding non-discrimination in the EU secondary law in the area of healthcare may result from the division of competences between the European Union and the Member States. Reluctance of the Member States to adopt comprehensive antidiscrimination regulations leads to a situation, in which protection in access to healthcare primarily depends on national regulations. CONCLUSIONS: Our study shows that EU antidiscriminatory law with regard to access to healthcare is fragmentary. Prohibition of discrimination of the level of European binding law does not fully encompass all aspects of social diversity.

THE BEGINNINGS OF KIDNEY TRANSPLANTATION IN SOUTH-EAST EUROPE.

Organ transplantation is one of the most important medical achievements of the 20th century. Kidney transplantation is the most efficient method of renal replacement therapy. The first successful kidney transplantation in human was performed in 1954 in Boston, USA. In former Yugoslavia, the first kidney transplantation was performed on April 16, 1970 in Ljubljana, Slovenia, and second one on January 30, 1971 in Rijeka, Croatia. In both cases, the mother donated kidney to the son. In the article, we describe the prerequisite conditions for this operation, the characteristics of first patients, and the impact of transplantation program on the development of the hospitals and medical schools.

Science as religion: when science becomes (too) irrational.

Science is expected to be objective: however, since practiced and produced by humans, it has to reflect human flows - prejudices, stubbornness, malice, and the tendency to be misused. No wonder an excellent scientist like John Eccles proclaimed science to be among the most personal activities he had known. By analysing a few examples from the history of science (in particular the intellectual development of Van Rensselaer Potter, the American onco-biochemist and bioethics pioneer), as well as the current trend of the evidence-based approach, the present paper will try to demonstrate that denying, distrusting, and opposing science for the sake of religion, as seen so many times in human history, has significant similarities to the overestimation of science we more often encounter in our times.

Historical and Social Evolution of the Healers' Charisma.

This study aims to explore the relation between charisma and healing and how the concept of charisma evolved within medical profession over time. The development of medical profession from shamans to modern medical doctors, the gradual transition from ritual to physical healing, the relation between the physician and common people, and the transition from personal to professional charisma are presented in a medico-historical context. The article concludes that there is an indisputable link between the phenomenon of charisma and healing. Healers have often been considered among the most significant charismatic figures in their societies. With time physicians have lost their personal charisma and replaced it by a stable professional charisma. Today, the growing involvement of patients in healing and demystification of the medical profession is diminishing the charisma of the physicians, although medical profession still retains qualities found in classic charismatics and with it also some authority over patients.

Miraculous healings of paralysis: a preliminary study on sources.

The aim of the present paper has been to explore the medieval evidence on miraculous healings of paralysis and to confront it with modern medical knowledge. Paralysis has been selected as a model for such a study and St. Bernardino of Siena (1380-1444) as a model of a saintly healer. Analyzed were the primary sources and modern literature. Paralysis was found to be among the most frequent diseases in medieval miracle reports, including the healings by St. Bernardino. According to the hypothesis offered in the paper, the majority of medieval cases of "miraculously healed paralysis" was of conversive origin.

Chapitre 4. Is it time for a plant bioethics?

As early as 1926, Fritz Jahr suggested the broadening of Kant’s Categorical Imperative onto all living beings. And while, at that time, Jahr’s animal ethics could have been built upon Ignaz Bregenzer and other scientifically accepted sources, Jahr’s ideas on plant ethics must have relied only on more poetical and philosophical conjectures, like the ones by Richard Wagner, Hans Christian Andersen, or Eduard von Hartmann. Today, we have accummulated certain knowledge about plant physiology, proving the complexity of plant cognition and feeling. Ten years ago, the “Rheinauer Theses on the Rights of Plants” once again provoked discussion, eventually supported by Monica Gagliano, Stefano Mancuso, and other biologists advocating the redefinition of human relation toward plants. In the present paper, we intend to review those arguments, but also to examine whether our ethics should be based upon our knowledge only.

The eco-ethical contribution of Menico Torchio - a forgotten pioneer of European Bioethics.

BACKGROUND: In 1926, Fritz Jahr described bio-ethics (German: bio-ethik) as "the assumption of moral obligations not only towards humans, but towards all forms of life." Jahr summarized his philosophy by declaring, "Respect every living being on principle as an end in itself and treat it, if possible, as such!." Bioethics was thus originally an ethical system concerned with the "problems of interference with other living beings… and generally everything related to the balance of the ecosystem" according to the 1978 Encyclopedia of Bioethics. This definition was predicated on the work of Fritz Jahr, Menico Torchio, and Van Rensselaer Potter. METHODS: In order to proceed with depthful analysis of the origin and major bioethical flare up, we will use critical analysis of existing literature, followed by a study trip to relevant bioethical localities (collecting photo and other documentations regarding Menico Torchio). RESULTS: While Jahr and Potter are typically given intellectual credit for developing the field of bioethics, the eco-ethical contributions of Menico Torchio have been forgotten.This article will first trace the origins of "bioethics" - now commonly bifurcated into "biomedical ethics" and "environmental bioethics." The former was developed by Tom Beauchamp from the Philosophy Department and James Childress of the Religious Studies department at Georgetown University and is based on principlism, with a narrow focus on medical settings. The latter addresses the environmental impact of the medical industry and climate change health hazards. Second, we will present a panorama of Torchio's significant intellectual contribution to bioethics. Menico Torchio's concept of bioethics synthesized work of both Jahr and Potter, advocating "the need to expand our ethical obligations and embrace the most developed groups of animals, not only physically but also psychologically." Third, we will reflect on the lasting legacy of "bioethics" on biomedical and environmental bioethics today. Thematic elements such as interconnectedness of planetary health and human health, dedication to living in harmony with nature, and emphasis on systems and symbiosis remain unchanged from the legacy of Tochio onward. CONCLUSION: Our conclusion will underscore the necessity of understanding the connections between planetary, environmental, and human health.

Diversity awareness, diversity competency and access to healthcare for minority groups: perspectives of healthcare professionals in Croatia, Germany, Poland, and Slovenia.

Introduction: Due to cultural, language, or legal barriers, members of social minority groups face challenges in access to healthcare. Equality of healthcare provision can be achieved through raised diversity awareness and diversity competency of healthcare professionals. The aim of this research was to explore the experiences and attitudes of healthcare professionals toward the issue of social diversity and equal access to healthcare in Croatia, Germany, Poland, and Slovenia. Methods: The data reported come from semi-structured interviews with n = 39 healthcare professionals. The interviews were analyzed using the methods of content analysis and thematic analysis. Results: Respondents in all four countries acknowledged that socioeconomic factors and membership in a minority group have an impact on access to healthcare services, but its scope varies depending on the country. Underfunding of healthcare, language barriers, inadequate cultural training or lack of interpersonal competencies, and lack of institutional support were presented as major challenges in the provision of diversity-responsive healthcare. The majority of interviewees did not perceive direct systemic exclusion of minority groups; however, they reported cases of individual discrimination through the presence of homophobia or racism. Discussion: To improve the situation, systemic interventions are needed that encompass all levels of healthcare systems - from policies to addressing existing challenges at the healthcare facility level to improving the attitudes and skills of individual healthcare providers.

Antituberculosis consortium founded in Rijeka (Croatia): implementation of public health measures between 1924-1945.

Between two World Wars the city of Rijeka was a port and industrial town whose infrastructure failed to provide adequate living conditions for numerous workers and their families. Insufficient organization of the health care system, poor living conditions-especially among the poor, low hygienic standards combined with a large number of transitory citizens made city and its citizens vulnerable to tuberculosis. Between 1924-1945 Rijeka was a part of the Kingdom of Italy. Therefore, the fight against tuberculosis was organised according to Italian public health plan and laws. In 1925, Antituberculosis consortium was founded in order to organise and coordinate antituberculosis activities in the city region. Despite its ambitious administrative measures it was unsuccessful in the field: Rijeka had a high mortality and morbidity rate due to tuberculosis. This article is based on unpublished archival material.

Organization of the "Marine Colony" for children with tuberculosis in Rijeka (Croatia): entanglement between medicine and politics.

Tuberculosis was a major public health concern in the beginning of the 20th century. Since medications were not available at the time, therapy in general was based on health education, healing effects of climate, nutrition and rest. The Marine Colony was founded in 1924 in Rijeka, a city with turbulent political history, by the Antitubercular Consortium which was part of a planned program for the fight against tuberculosis on a national level in the whole of Italy. The Colony in Rijeka, Croatia specialised in care of children with clinical tuberculosis or under greater risk of developing disease. This article gives an overview of the medical treatment provided for children in Colony, as well as pointing out the political-agenda at that period.

UVOD U MEDICINU I POVIJEST MEDICINE

Zagreb: Skolska knjiga, 2021.; 271 stranica; Kazalo pojmova i mena; Popis slika (84); Literatura na kraju svakog poglavlja Prikaz knjige

Caring for Transgender People in Healthcare: A Qualitative Study with Hospital Staff in Croatia.

Transgender and gender-diverse people have greater health risks due to increased social stress and face a disadvantaged position in the healthcare system as a result of the stigma associated with their gender identity. Due to the lack of research in Croatia on the position of transgender people in the healthcare system, this research was intended to supplement the knowledge about the experiences of hospital staff in the Croatian healthcare system when caring for patients with transgender identities. Qualitative research was conducted using an interview method. The participants (n = 10) were healthcare managers or hospital care team members. The collected data were processed through thematic analysis. The results show that some participants had had no encounters with transgender patients and those who had described them as unproblematic or had only encountered them at a level of basic healthcare. They also described how they perceive transgender people and their life circumstances. The participants described how they envision potential encounters with this group of patients and what they consider necessary to improve the position of this group within the healthcare system. In the discussion part of the article, we assess the need for additional training regarding hospital staff, especially in terms of diversity competence, and for an increase in the visibility of transgender patients.

The Labin Region, an ecologically vulnerable geographical area in Croatia: Mortality characteristics in an area polluted by industrial over a 40-year period.

The history of the Labin region in Croatia includes intensive industrial development with repercussions of pollution on environment and health. Assuming that prolonged exposure to polluted environments causes qualitative changes in mortality, the aim was to analyse the mortality characteristics of the population of the Labin Region for the 1968-2008 period based on data from the Croatian Bureau of Statistics. Public health and social opportunities in this geographical area carry a long-term burden of exposure to an industrial polluted environment with outcomes expressed by mortality or/and morbidity in the population. This study includes data on 11,903 deaths, most of which due to diseases of the circulatory, respiratory and digestive systems as well as neoplasms. In the third and fourth decade of the study period, a group of neoplasms showed significant increases, while the increase in respiratory diseases were more gradual. The female population died mostly from diseases of the circulatory and endocrine system as well as neoplasms, while the male population mainly died from diseases of the digestive system and external causes. This research provides guidelines that could create better public health, raising the quality of life and contribute to a future environmental protection in local communities by targeted policies.

Fritz Jahr: the invention of bioethics and beyond.

Since the discovery of his work in 1997, Fritz Jahr (1895-1953) has slowly become recognized as the author of the term and concept of bioethics. Jahr's ideas on bioethics were partly different from those shaped by Van Rensselaer Potter in the 1970s and, therefore, might be helpful for the further reform and broadening of modern bioethics. In this article, the authors elucidate ideas from lesser-known works by Jahr, especially those considering animal protection and teaching.

Chapter 6. Informed consent in Croatia today: bioethical and legal aspects.

After obtaining political independence in the early 1990s, Croatia started to regulate numerous social sectors and issues, including health care. More intensive European integration efforts in the late 1990s, provided a new moment for the 1997 Europen Convention on Human Rights and Biomedicine, followed in 2004 by the first national Act on the Protection of Patients' Rights. Today, the introduction of the right to co-decison making can be seen as a step forward and a milestone in patients' rights regulation in Croatia.However, such a claim has to face some reconsiderations, mainly due to formal (mis)understanding of the 2004 Act and the lack of its understanding by its users, both patients and physicians. If at some time the co-decision right did serve as an impetus to bioethics in Croatia, more than 10 years later, it faces deficiences due to a lack of the legal support.In this article, we follow the period after the passing of the first Act on the Protection of Patients' Rights in 2004, trying to elucidate pros and cons of the Act, including its contribution to the development of bioethics in Croatia, but also legal omissions of its implementation.

Chapter 5. Specific role of lawyers and the legal perspective in the development of Integrative Bioethics in Croatia.

Athough, first forms of legal provisions concerning medical research in Croatia (ex Yugoslavia) came into force during 1970s (regulating work of "commissions for drugs"), more vivid presence and impact of law within bioethics can be traced in the 1990s. Beside the new Law on Health Protection (1997) - articles 51 and 52 requiring the establishment of ethics committees and regulating the framework of their duties, the introduction and the success of the law occured as a consequence of political changes and international opening, influencing education, research, health and social policies. Later progression of the legal discipline within bioethics can be noticed not only with respect to the work of prominent legal experts, but also the main tide of Croatian bioethics, particularly the Integrative Bioethics of Ante Covic.The aim of this paper is to detect the main representatives of legal perspective and discipline within modern bioethical trends in Croatia, as well as to clarify some of the many intriguing mutal influences.

HALF A CENTURY OF DEBT: SIME VLAHOVIC (1932­1977) AND IMMUNOLOGICAL PREPARATION OF THE FIRST KIDNEY TRANSPLANTATION IN CROATIA / POLUSTOLJETNI DUG: SIME VLAHOVIC (1932. ­ 1977.) I IMUNOLOSKA PRIPREMA PRVE TRANSPLANTACIJE BUBREGA U HRVATSKOJ

Despite some earlier significant discoveries and widespread vaccination successful practices, the history of understanding immunological mechanisms is actually relatively short and associated only with the second half of the 20th century when, among other things, the laws of activation of these mechanisms are crucial for transplantation medicine. Among the first experts in Croatia who turned to these topics was Sime Vlahovic. Born in Split, he graduated and received his PhD in Zagreb. He worked on the problems of transplant immunology from 1963 to 1965 at the eminent centers in the United States. He was the head of the Rijeka Department of Physiology at the Faculty of Medicine from 1965 to 1977, since 1976 as a full professor. He was the winner of the Ruder Boskovic award and many others, but his crucial contribution to the medical heritage of Rijeka and Croatia is certainly less known. Based on family archives and memories, this work will attempt to at least partially correct that gap. Thanks to the immunological preparation of Sime Vlahovic, as well as, of course, a large team led by surgeon Vinko Franciskovic, in January 1971, the first kidney transplant was performed in Croatia from a living relative (mother to son), a year later from a cadaver, and in the decades following that, an experimental liver and pancreas transplant program has been developed in Rijeka. Today, we can only speculate about the intriguing directions of the development of the Rijeka Transplant and Immunology School, which would have been led by Sime Vlahovic, had he not passed away at the age of less than 45.