The issue of causality in the suits for damages The subject of this thesis is the issue of causality in disputes relating to compensation for damage to health. Causation is a considerably miscellaneous institute, therefore, this paper deals with various aspects of this topic and its context. The writing focuses on cases in which damage was caused to health through providing health services, as this legal field is characterized by many specifics from other areas of liability. Firstly, the thesis aims at explanation of the concept of causation, its importance and development not only in law but also in other areas of human activity. Subsequently, the attention is focused on the significance of causation in law; after theories of causation are compared, its substantial features are described in comparison to the other elements of liability. Consequently, the work concentrates on processes through which the causal link is determined, on the selection of relevant causes and consequences and the relationship between them in cases involving their plurality. It does not forget to mention the importance of causation in the context of strict liability, particularly in its specific cases relating to the provision of health services. The core of this work is the issue of causation in disputes in which the...

This dissertation focuses on the issue of health care provision without the consent of a patient within the system of intensive care provision. Situations when its possible to hospitalize a patient without his or her consent are defined in § 38 ZZS (Health Services and Terms and Conditions of Health Service Provision Act as amended). In the intensive care unit we are very often faced with patients that need to be urgently treated without their consent. Also very frequently a treatment is provided to patients that are under the influence of addictive substances therefore are dangerous to themselves and to others. Health of these patients is damaged and even their lives are at risk. A treatment without a patient's consent is debatable from the ethical point of view. A conflict occurs between the fundamental ethical principles (benefit principle and principle of autonomy) because it is not entirely clear which one of the two principles should be prioritize during the treatment. Work and moral obligation of every medical personnel is to provide a medical treatment in accordance with the law and ethical principles. A theoretical part of the paper is dedicated to the legal and ethical sides of the examined issue. The empirical part of the paper is dedicated to the research. A qualitative analysis of...

L’approche statique de la notion d’acquéreur, retenue par le Code civil, a été remise en cause par la professionnalisation des vendeurs, suite au renouvellement des méthodes de vente et à la complexification des biens. Au stade de la formation du contrat de vente, l’équilibre postulé par le droit commun s’est progressivement affaibli pour donner naissance à des rapports déséquilibrés entre l’acquéreur et le vendeur. Pour remédier à cette situation, les normes contemporaines, d’inspiration consumériste, ont adopté une approche dynamique de la notion en établissant différentes catégories d’acquéreurs, en vue de leur permettre d’exprimer un consentement réfléchi et éclairé. Les enjeux, théoriques et pratiques, d’une étude confrontant l’acquéreur aux règles de la formation du contrat de vente ont pour objet de déterminer si l’évolution législative a permis de rétablir l’équilibre. L’immixtion du droit de la consommation dans le droit de la vente met en œuvre un dispositif protecteur du consentement de l’acquéreur. Ainsi, les normes consuméristes restaurent-elles l’équilibre pour tous les rapports ? Les règles protectrices du consentement, n’étant pas exclusivement attachée à la qualité de l’acquéreur, autorisent-elles le retour à l’équilibre ou au contraire, donnent-elles naissance à de nouvelles situations déséquilibrées ? La réponse à cette interrogation nécessite d’analyser les dispositions organisant le contrat de vente mais, également, celles relatives au contrat de prêt. Le financement de l’acquisition est, généralement, lié à la conclusion de la vente. / The static approach of the idea of buyer, chosen by the Civil Code, has been challenged by the professionalization of the buyer, following the renewal of sales techniques and the fact that the goods are becoming more complex. On the level of the making of the sales contract, the balance implied by the common-law has gradually weakened to generate unbalanced relationships between the buyer and the seller. To solve this, the contemporary standards based on consumerism have adopted a dynamic approach of the notion by distinguishing different categories of buyers, in order to give them the opportunity to express a well-thought and informed consent. The major issues, both theoretical and practical, of a study which confronts the buyer to the rules of the making of a sales contract, are to determine if the legal evolution allowed to reestablish the balance. The interference of the consumption right in the sales right generates a protective system of the buyer's consent. Can the consumerist standards restore the balance at all levels? Do the protective rules of consent, not being exclusively attached to the quality/ nature of the buyer, allow a way back to the original balance or on the contrary, do they give birth to new unbalanced situations? The answer to this question requires to analyze the rules which organize the sales contract and those connected to the rental contract too. The acquisition financing is currently connected to the sealing of the sale. The diversity of these rules requires to deal with them under the light of the protection of the buyer's consent, in order to allow him to give a well-thought and informed consent.

O consentimento informado consiste em um processo capaz de informar o participante de pesquisa sobre as intervenções médicas previstas a serem aplicadas no decorrer do estudo e faz com que este participe ativamente no processo de tomada de decisão. O Termo de Consentimento Livre e Esclarecido (TCLE) caracteriza-se por ser um documento explicativo, de forma escrita, no qual são abordadas informações referentes ao projeto de pesquisa, com o objetivo de garantir a voluntariedade do indivíduo. A qualidade do TCLE em pesquisa clínica é determinada pelo grau de compreensão que os participantes desenvolvem durante o processo de consentimento informado. O objetivo deste estudo consiste em avaliar o processo de consentimento dos participantes de pesquisa clínica. Trata-se de um estudo híbrido, com coleta prospectiva. Para o seu desenvolvimento dividiu-se nas seguintes fases: Elaboração e validação do formulário, Treinamento da Equipe de Entrevistadores, Estudo Piloto, Coleta de Dados e Avaliação da Legibilidade dos TCLEs. Foi realizada análise descritiva dos dados e comparação entre as variáveis por meio de análises univariadas. Dos 70 participantes que compuseram a amostra, 83% eram mulheres, a média de idade foi de 46,7 anos (S ±13.99 anos), 55,7% eram brancos, 45,75% casados, 52,9% analfabetos ou com ensino fundamental, 49,3% economicamente ativos e renda média de 1496,2 reais. Dos participantes, 35,7% desconheciam o tipo de estudo que participavam 38,6% não sabiam contar sobre a pesquisa que participavam, 64,7% não receberam informações referentes a outros tipos de tratamento, 62,7% não tinham informações sobre indenização, 66,2% não leram todo o TCLE antes de assinar, 86,8% relataram que o documento foi fácil de ser lido, 62,2% acharam o documento longo. Após o cálculo do ILFK dos 12 TCLEs analisados, 100% apresentaram valor de 0 a 30, considerado como leitura muito difícil. É de suma importância incentivar o desenvolvimento de estudos nacionais que avaliem a percepção dos participantes de pesquisa quanto aos seus direitos e a criação de instrumentos que possibilitem essa verificação na população brasileira / Informed consent consists a process that is able to inform, the research participant, of the planned medical interventions to be apply during the course of the study, and actively participate in the decision-making process. The Informed Consent Form (ICF) characterized by being an explanatory document, in written form, in which information about the research project is addressed, with the purpose of guaranteeing the individual\'s willingness. The quality of ICF in clinical research determined by the degree of understanding that participants develop during the informed consent process. The objective of this study is to evaluate the consent process of clinical research participants. It is a hybrid study, with prospective collection. For its development, it divided into the following phases: Elaboration and validation of the form, Training of the Team of Interviewers, Pilot Study, Data Collection and Evaluation of the Readability of ICF. A descriptive analysis of the data and a comparison between the variables performed using univariate analyses. Of the 70 participants, 83% were women, mean age was 46,7 years (S ± 13.99 years), 55,7% were white, 45,75% married, 52,9% illiterate or basic education, 49,3% economically active and average income of 1496,2 Reais. Of the participants, 35,7% didn\'t know the type of study they participated in, 38,6% didn\'t know about the research they participated, 64,7% didn\'t receive information regarding other types of treatment, 62,7% didn\'t have information about compensation, 66,2% didn\'t read the entire ICF before signing, 86,8% reported that the document was easy to read, 62,2% found the document long. After the ILFK calculation of the 12 ICF analysed, 100% presented values from 0 to 30, considered as very difficult reading. It is extremely important to encourage the development of national studies that evaluate the perception of research participants regarding their rights and the creation of instruments that enable such verification in the Brazilian population

Introdução: A episiotomia é intervenção instituída rotineiramente no Brasil, a partir da hospitalização do parto, em meados do século XX. Tida como facilitadora do parto no período expulsivo, vem sendo questionada pelas evidências científicas. Comprovou-se que a intervenção não impede lacerações importantes, incontinência urinária, dispareunia ou disfunções sexuais, e é associada a mais dor pós-parto e a complicações da episiorrafia. No Brasil, há médicos que fazem o procedimento rotineiramente, enquanto outros a praticam de modo seletivo ou, mais raramente, nunca o fazem. Este estudo buscou compreender o processo por meio do qual tais profissionais aprenderam e iniciaram sua prática, se esta foi revista, e as razões do posicionamento técnico e ético quanto ao procedimento, na atualidade. Objetivos: descrever e analisar o processo vivenciado pelos médicos obstetras, e que os levou ao posicionamento com relação à prática da episiotomia, tendo em vista sua formação, sua prática, o posicionamento de seus pares e o ambiente institucional. Método: Trata-se de estudo qualitativo, com análise temática a partir do referencial de gênero. A população de estudo foi composta por 12 médicos(as) obstetras que atendiam partos pela via vaginal, obedecendo ao método snowball. Os dados foram obtidos por meio de entrevistas norteadas por questões semiestruturadas. Resultados: A educação médica, no recorte da episiotomia, dá-se em escalonamento hierárquico, sem que o aluno aprenda por meio de professor, mas entre alunos, do mais graduado para o menos graduado. Transmite-se a insegurança técnica e o impedimento de questionar as indicações, a segurança do procedimento ou lesões decorrentes. Não se discute a autonomia da paciente, os direitos reprodutivos, o direito à integridade corporal ou a real informação para o consentimento. Vários entrevistados relatam dificuldades para deixar de praticar a episiotomia, o que resulta de pressão exercida pelos pares, pela corporação e pela instituição em que atende. Conclusões: É imprescindível a reforma na educação médica, para que professores, atualizados com as evidências científicas, transmitam as técnicas de modo adequado às taxas preconizadas internacionalmente. Sugerese alterar a didática e conteúdo de disciplina que discuta bioética, tornando-a mais conectada com a prática e a ética médica, além de contextualizar a lei vigente. Conclui-se, enfim, pela necessidade de exigir a justificativa em prontuário para a intervenção, a anotação de toda episiotomia realizada e de toda lesão espontânea, além da aplicação de ferramentas de segurança da paciente, adotando uma assistência que promova a integridade genital no parto. / Introduction: Episiotomy is an intervention routinely established in Brazil, from birth hospitalization, in mid-twentieth. Considered as a facilitative intervention in the expulsive stage of birth, it has been questioned by scientific evidences. It was concluded that the intervention does not prevent main lacerations, urinary incontinence, either dyspareunia or sexual dysfunction, and is related to after-birth pain and complications developed from episiorrhaphy. In Brazil, there are physicians that perform it routinely, while some perform it selectively or never use it. This ressearch aimed to understand the way those professionals learned and started their practice, if it has been reviewed, and the reasons for their technical and ethic positioning about the intervention, nowadays. Objective: Describe and analyze the process experienced by obstetricians, and what took them to their positioning regarding to episiotomy practice, in terms of their professional education, their practice, their peers positioning and institutional environment. Method: This is a qualitative study, with thematic analysis, based on gender references. The study population was composed by 12 obstetricians, who attended vaginal births, following snowball method. Data were obtained by interviews guided by semi-structured questions. Results: The medical education, on episiotomy, occurs in a hierarchical scheduling, and the student doesnt learn through a teacher, but through a more graduate student, resulting on technical uncertainty and the impossibility to question indications, the procedure safety or resulting injuries. Patient autonomy, reproductive rights, body integrity or information to the consent are not questioned. Many physician finds it difficult to stop practicing episiotomy, because of intense pressure from peers, corporative and institution. Conclusions: Some changes are essential in medical education, so that teachers, updated on scientific evidences, transmit the techniques adequately to the internationally recommended rates. It is suggested to change teaching and disciplines that discuss bioethics, making it more connected with the practice and medical ethics, and contextualize it to the current law. It follows, finally, the need to require physicians to justify interventions in medical charts, the annotation of all performed episiotomy and all spontaneous lacerations, as well as applying patient safety tools, adopting an assistance that promotes genital integrity at birth.

Introdução: A episiotomia é intervenção instituída rotineiramente no Brasil, a partir da hospitalização do parto, em meados do século XX. Tida como facilitadora do parto no período expulsivo, vem sendo questionada pelas evidências científicas. Comprovou-se que a intervenção não impede lacerações importantes, incontinência urinária, dispareunia ou disfunções sexuais, e é associada a mais dor pós-parto e a complicações da episiorrafia. No Brasil, há médicos que fazem o procedimento rotineiramente, enquanto outros a praticam de modo seletivo ou, mais raramente, nunca o fazem. Este estudo buscou compreender o processo por meio do qual tais profissionais aprenderam e iniciaram sua prática, se esta foi revista, e as razões do posicionamento técnico e ético quanto ao procedimento, na atualidade. Objetivos: descrever e analisar o processo vivenciado pelos médicos obstetras, e que os levou ao posicionamento com relação à prática da episiotomia, tendo em vista sua formação, sua prática, o posicionamento de seus pares e o ambiente institucional. Método: Trata-se de estudo qualitativo, com análise temática a partir do referencial de gênero. A população de estudo foi composta por 12 médicos(as) obstetras que atendiam partos pela via vaginal, obedecendo ao método snowball. Os dados foram obtidos por meio de entrevistas norteadas por questões semiestruturadas. Resultados: A educação médica, no recorte da episiotomia, dá-se em escalonamento hierárquico, sem que o aluno aprenda por meio de professor, mas entre alunos, do mais graduado para o menos graduado. Transmite-se a insegurança técnica e o impedimento de questionar as indicações, a segurança do procedimento ou lesões decorrentes. Não se discute a autonomia da paciente, os direitos reprodutivos, o direito à integridade corporal ou a real informação para o consentimento. Vários entrevistados relatam dificuldades para deixar de praticar a episiotomia, o que resulta de pressão exercida pelos pares, pela corporação e pela instituição em que atende. Conclusões: É imprescindível a reforma na educação médica, para que professores, atualizados com as evidências científicas, transmitam as técnicas de modo adequado às taxas preconizadas internacionalmente. Sugerese alterar a didática e conteúdo de disciplina que discuta bioética, tornando-a mais conectada com a prática e a ética médica, além de contextualizar a lei vigente. Conclui-se, enfim, pela necessidade de exigir a justificativa em prontuário para a intervenção, a anotação de toda episiotomia realizada e de toda lesão espontânea, além da aplicação de ferramentas de segurança da paciente, adotando uma assistência que promova a integridade genital no parto. / Introduction: Episiotomy is an intervention routinely established in Brazil, from birth hospitalization, in mid-twentieth. Considered as a facilitative intervention in the expulsive stage of birth, it has been questioned by scientific evidences. It was concluded that the intervention does not prevent main lacerations, urinary incontinence, either dyspareunia or sexual dysfunction, and is related to after-birth pain and complications developed from episiorrhaphy. In Brazil, there are physicians that perform it routinely, while some perform it selectively or never use it. This ressearch aimed to understand the way those professionals learned and started their practice, if it has been reviewed, and the reasons for their technical and ethic positioning about the intervention, nowadays. Objective: Describe and analyze the process experienced by obstetricians, and what took them to their positioning regarding to episiotomy practice, in terms of their professional education, their practice, their peers positioning and institutional environment. Method: This is a qualitative study, with thematic analysis, based on gender references. The study population was composed by 12 obstetricians, who attended vaginal births, following snowball method. Data were obtained by interviews guided by semi-structured questions. Results: The medical education, on episiotomy, occurs in a hierarchical scheduling, and the student doesnt learn through a teacher, but through a more graduate student, resulting on technical uncertainty and the impossibility to question indications, the procedure safety or resulting injuries. Patient autonomy, reproductive rights, body integrity or information to the consent are not questioned. Many physician finds it difficult to stop practicing episiotomy, because of intense pressure from peers, corporative and institution. Conclusions: Some changes are essential in medical education, so that teachers, updated on scientific evidences, transmit the techniques adequately to the internationally recommended rates. It is suggested to change teaching and disciplines that discuss bioethics, making it more connected with the practice and medical ethics, and contextualize it to the current law. It follows, finally, the need to require physicians to justify interventions in medical charts, the annotation of all performed episiotomy and all spontaneous lacerations, as well as applying patient safety tools, adopting an assistance that promotes genital integrity at birth.

In this thesis, I argue that the interdependence between personal identity and practical concerns is overstated. In paradigmatic places where philosophers and common sense suggest that personal identity constrains how we should reason and care, or vice versa, the two spheres are in fact neutral to each other. I defend this claim by considering four specific cases. First, a rough characterization of the distinction between the complex and the simple view is that the former takes personal identity to consist in other relations, whereas the latter does not. I argue that the extreme claim according to which the complex view fails to give reasons for future-directed concern can be resisted. We maintain forward-looking attitudes and projects not because someone will be us, but because we relate to future selves in other, more important ways. Second, I argue that intuitions in a range of popular imaginary cases are contaminated by practical concerns whose relevance for personal identity is far from straightforward. Third, I argue that on a closer look, the complex versus simple distinction is confused. It thus cannot be what grounds differences in judgements on what matters. Debates about personal identity should be framed in terms of better understood notions. Finally, I argue that it is not a constraint on rational transformative choice that decision-maker and transforming individual are identical. Moreover, whether we are deciding for ourselves or for others - the importance of informed consent for transformative treatments is not diminished by the decision-maker's failure to projectively imagine the outcomes.

Made available in DSpace on 2016-04-27T13:10:23Z (GMT). No. of bitstreams: 1 Adilson Peron.pdf: 1186813 bytes, checksum: 5ebb7419e0360630b3d63cef39acfe9f (MD5) Previous issue date: 2014-02-12 / Introduction: Cholelithiasis is very prevalent surgical disease, with approximately 60,000 admissions per year in the Unified Health System in Brazil (Sistema Único de Saúde - SUS). Is often asymptomatic or oligosymptomatic and major complications arise from the migration of calculi to biliary low tract. Despite these complications are severe and life threatening, many patients refuse surgical treatment. Objectives: To understand the reasons why individuals with cholelithiasis refuse cholecystectomy before complications inherent to the presence of gallstones in the bile duct and pancreatitis occur. Methods: To investigate the justifications for refusing to submit to surgery we performed individual interviews according to a predetermined script. In these interviews, we evaluate the degree of knowledge of individuals about the disease and its complications and the reasons for the refusal of surgical treatment. We interviewed 20 individuals with cholelithiasis who refused or postponed surgical treatment without a plausible reason. In these interviews, we apply the thematic analysis (MINAYO, 2006). Results: The majority of participants has good knowledge of their disease and its possible complications, were well oriented and had the right surgical indications by their physicians. The refusal for surgery is based primarily on negative experiences of themselves or family members with surgery, including anesthesia; unexplained fears of surgery and, some, cannot specify the reason for the denial or prefer to get the risk and wait for complications to then have to solve them compulsorily. Conclusions: The reasons for the refusal to surgical resolution of cholelithiasis are diverse, but are closely related to personal negative surgical experiences or related persons or complex problems of psychological nature that must be adequately addressed by the surgeon and other qualified professionals. Our study has the proposal of an informed consent that brings all the information about the surgery, its preoperative and postoperative risks, as well as figures with friendly format intended to inform and to help the patients in their decisions / Introdução: A colelitíase é uma doença de resolução cirúrgica muito prevalente, com aproximadamente 60.000 internações por ano no SUS. Muitas vezes é assintomática ou oligossintomática e as principais complicações advêm da migração dos cálculos para as vias biliares baixas. Apesar das complicações serem graves e com risco de morte, muitos pacientes se recusam ao tratamento cirúrgico. Objetivos: Entender as razões pelas quais os indivíduos com colelitíase recusam a colecistectomia antes que ocorram complicações inerentes à presença de cálculos na vesícula, nas vias biliares e a possível pancreatite. Métodos: Para conhecer as justificativas da recusa à cirurgia realizamos entrevistas individuais segundo um roteiro de perguntas pré-determinadas. Nestas entrevistas procuramos avaliar o grau de conhecimento dos indivíduos sobre a doença e suas complicações e as razões para a recusa do tratamento cirúrgico. Entrevistamos 20 indivíduos portadores de colelitíase que se recusavam ou adiavam sem uma justificativa plausível o tratamento cirúrgico. A estas entrevistas aplicamos a análise temática (Minayo, 2006). Resultados: A grande maioria dos entrevistados tem bom conhecimento de sua doença, das possíveis complicações, foram bem orientados e tiveram a indicação cirúrgica pelos seus médicos assistentes. A recusa para a cirurgia foi baseada (principalmente) em experiências negativas próprias ou de familiares com o ato cirúrgico, incluindo aí a anestesia; medos inexplicáveis do ato cirúrgico e alguns não conseguiram especificar a razão para a recusa, preferiram correr o risco e esperar pelas complicações para então ter que resolvê-las. Conclusões: As razões para a recusa à resolução cirúrgica da colelitíase são diversas, mas estão intimamente ligadas às experiências cirúrgicas negativas pessoais ou de pessoas relacionadas ou a complexos problemas de natureza psicológicas que devem ser adequadamente abordados pelo cirurgião e por outros profissionais habilitados. Nosso estudo faz a proposta de um termo de consentimento livre e esclarecido que traz todas as informações sobre a cirurgia, seus riscos pré e pós-operatório assim como figuras com formato amigável que pretendem informar e ajudar o paciente na sua decisão.

<p>There is a growing interplay of competing realities facing the international community in the general areas of innovation, technological advancement and overall economic development. The highly industrialised wealthy nations, largely located on the Northern hemisphere are on the one hand undoubtedly at the forefront in global research, technology and infrastructure development. The developing and least developed countries on the other hand are mostly situated on the Southern hemisphere. They are not as wealthy or technologically advanced as their&nbsp / Northern counterparts, but are naturally endowed with unique variations of plant, animal and micro-organism species occurring in natural ecosystems, as well as the traditional knowledge on&nbsp / how to use these unique species. This knowledge has been adjudged to be responsible for the sustainable maintenance of the earth&rsquo / s biodiversity. Increasing exploitation of biodiversity,&nbsp / spurred on by the competing realities identified above, has left the earth in a present state of alarm with respect to the uncontrolled loss of biodiversity. The traditional knowledge of local&nbsp / peoples has significantly offered leads to research institutes from the North in developing major advancements in drugs, cosmetics and agriculture. Little or no compensation has however been seen to go back to the indigenous&nbsp / communities and countries that provide resources, and indicate various possibilities through their traditional knowledge to the use of such resources. Efforts by some biodiversity rich countries to&nbsp / ddress this trend through legislation developed in accordance with the principles of the Convention on Biological Diversity have been frustrated due to the inability to enforce their domestic laws outside their borders. Theft of genetic resources and its associated traditional knowledge&nbsp / from such countries has therefore remained a major challenge. Against this backdrop, and on the&nbsp / insistence of biodiversity-rich developing countries, an international regime on access and benefit sharing was negotiated and its final text adopted in 2010. This international regime is as&nbsp / contained in the Nagoya Protocol. This research sets out to examine whether the Nagoya Protocol offers a final solution to the protection of traditional knowledge associated with biodiversity in&nbsp / biodiverse countries. It further examines the importance of domestic legislation in achieving the objectives of the Protocol. The research has been tailored to African biodiverse countries, and&nbsp / seeks these answers within the context of Africa.<br /> &nbsp / </p>

University of Macau / Faculty of Law