Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2006. / Source: Dissertation Abstracts International, Volume: 67-07, Section: A, page: 2478. Adviser: Reginald J. Alston. Includes bibliographical references (leaves 123-130) Available on microfilm from Pro Quest Information and Learning.

Étudier l’animal en droit permet de mettre en lumière les difficultés du droit à refléter tant sa réalité biologique que l’évolution de sa perception sociale. L’animal bouleverse les agencements traditionnels du droit, les catégories juridiques, y compris lorsqu’il est élevé par l’homme dans l’une des perspectives les plus utilitaristes qui soit : l’alimentation. L’analyse des règles de droit relatives à la santé de l’animal d’élevage a été conçue dans l’optique de déterminer si ces règles visent à satisfaire un intérêt « animalitaire ». Saisir les modalités de l’appréhension de la santé de cet animal par les règles de droit a permis de constater que, d’une part, ces règles voient leur emprise sur sa santé élargie et que, d’autre part, les sources de ces règles se sont étendues pour s’inscrire dans des organisations à vocation économique reflétant in fine son instrumentalisation par l’homme. C’est dans ce cadre que peut être mis en évidence un dualisme dans l’appréhension de l’animal à travers les règles de droit relatives à sa santé ; dualisme qui comporte, en germe, toute l’ambivalence de la question animale en droit. Saisi à la fois comme membre d’une collectivité et à la fois comme individu, l’animal d’élevage voit néanmoins la protection de sa santé soumise à la satisfaction d’intérêts anthropocentriques / Studying the animal under a legal perspective enables to highlight the issues faced by law to reflect not only its biological reality but also the evolution of its social perception. The animal disrupts the traditional legal layouts, legal categories, included when it is bred by man to achieve one of its most utilitarian goals: food. The analysis of the legislation relating to the health of the farmed animal has been designed with the intention to determine whether or not those rules aim to satisfy an “animalitarian” interest. Determining the terms under which animal health is apprehended by law has enabled to observe that, on the one hand, those rules enlarge their grip on their health and, on the other hand, the sources of those rules have been extended in order to fall within organizations with economic purpose, reflecting in fine its instrumentalization by man. In this framework, a dualism can be highlighted in the way the animal is apprehended through the legislation relating to its health. This dualism comprises the seeds of the whole ambivalence of the question of the animal in law. Caught altogether as a member of a collectivity and as an individual, the farmed animal nevertheless sees the protection of its health subject to the satisfaction of anthropocentric interests

La recherche sur les cellules souches, enjeux d'une future médecine régénérative, est emblématique à la fois des opportunités liées au progrès scientifique et des nouvelles questions que ce progrès pose à la société. Recherche sur l'embryon humain, clonage thérapeutique, clonage reproductif sont autant de sujets au coeur d'une actualité brûlante.Quels sont les enjeux scientifiques, éthiques, économiques et juridiques de ces recherches ? En quête d’un équilibre entre le respect de la dignité de l'être humain et la liberté de la recherche, malgré la disparité des pratiques et des législations nationales, l'Europe est devenue le cadre du développement d'un nouveau corpus juridique. Cette étude se propose de montrer de quelle manière la controverse autour de la recherche sur les cellules souches s’intègre «dans une aventure politique européenne» dans laquelle se trouvent impliqués individus, institutions et autorités publiques, engagés dans un processus de «décision ouverte». S’inscrivant dans une perspective comparative, pluridisciplinaire et transdisciplinaire, ce travail a comme objectif de montrer l’évolution et le fonctionnement du droit européen de la bioéthique et surtout de dévoiler le processus qui a amené à l’adoption des règles dans ce domaine. L’importance de cette nouvelle branche du droit pour l’Europe, appelée à répondre aux nouveaux défis scientifiques, économiques et de société, est ainsi mise en évidence. / Research on stem cells, challenges for of a future regenerative medicine, is emblematic of the opportunities related to scientific progress and the new questions that it implies for society. Research on human embryo, therapeutic cloning and reproductive cloning are burning issues.What are scientific, ethical, economic and legal aspects of this research at stake? Looking for a balance between the respect of the dignity of the human being and the freedom of research, in spite of the disparity of national practices and legislations, Europe became the framework for the development of a new legal corpus. This study aims at showing how the controversy related to research on stem cells come within “a European political adventure” in which individuals, institutions and public authorities, engaged in a process of “open decision”, are implied. In a comparative, multidisciplinary and trans-disciplinary perspective, this work has the objective to highlight the evolution and functioning of the European law of bioethics and especially to reveal the process which brought to the adoption of European rules in this field. The importance of this new sector of law for Europe, called to face the new scientific, economic and society challenges, is also emphasized.

Abstract : Rare diseases are debilitating conditions often leading to severe clinical manifestations for affected patients. Orphan drugs have been developed to treat these rare diseases affecting a small number of individuals. Incentives in the legal framework aimed to recoup the research and development cost of orphan drugs for pharmaceutical companies have been implemented in the United States and the European Union. At the present time, Canada is still lacking a legal and policy framework for orphan drugs. Several problems at the federal and provincial levels remain: lack of research funds for rare diseases, discrepancies on orphan drug policies between provinces, difficulties to access and reimburse these high price drugs. Recommendations and measures are proposed, such as a pan-Canadian (national) scientific committee to establish evidence-based guidelines for patients to access orphan drugs uniformly in all provinces with a disease specific registry, a formal agreement for a centralized Canadian public funding reimbursement procedure, and increasing the role of “guardian” for prices by the Patented Medicines Review Board in Canada. These recommendations and measures will be beneficial for the implementation of a policy framework for orphan drugs in Canada. / Résumé : Les maladies rares sont des maladies sérieuses pouvant causer des manifestations cliniques sévères chez les patients atteints. Les médicaments orphelins ont été développés pour le traitement de ces maladies rares qui touchent un petit nombre d’individus. Un cadre légal permettant des incitatifs pour les compagnies pharmaceutiques aux États-Unis et au niveau de l’Union Européenne a favorisé la recherche et le développement desdits médicaments. Présentement, il n’existe pas de cadre juridique et de politiques spécifiques au Canada entourant les médicaments orphelins. Ceci a mené à plusieurs problèmes tant au niveau fédéral que provincial dont: un manque de support financier consacré à la recherche pour les maladies rares, des disparités entre les provinces concernant les politiques pour les médicaments orphelins, des difficultés d’accès et de remboursement desdits médicaments dont les coûts sont élevés. Des recommandations et mesures sont proposées, telles l’implantation d’un comité scientifique pancanadien (national) afin d’établir des lignes directrices fondées sur des données probantes pour faciliter un accès uniforme aux médicaments orphelins pour les patients, y compris un registre spécifique élaboré pour chaque maladie, établir une entente formelle centralisée pour tout le Canada pour un financement public de remboursement des médicaments orphelins, augmenter le rôle de « gardien » des prix par le Conseil d’examen du prix des médicaments brevetés au Canada. Ces recommandations et mesures serviront à l’implantation d’un cadre de politiques pour les médicaments orphelins au Canada.

A Comissão Intergestores Bipartite (CIB) foi instituída pela Norma Operacional Básica 01/93 e responde pelos aspectos operacionais do Sistema Único de Saúde (SUS). É um espaço de negociação e pactuação entre gestores municipais e estaduais, promovendo a integração dos diferentes sistemas municipais de saúde sob coordenação do governo estadual. As normas expedidas pela CIB, na forma de resoluções, têm natureza jurídica de direitos-meio, isto é, estabelecem os procedimentos específicos para realização do direito à saúde, permitindo que todos os potenciais destinatários destas normas possam conhecer, aderir, criticar ou mesmo judicializá-las. O poder normativo da CIB decorre da previsão legislativa expressa para regular os aspectos operacionais do SUS e da legitimidade democrática, exercida diretamente pelo cidadão, ou através dos Conselho Estadual de Saúde (CES). As normas que emanam deste fórum deliberativo devem ser respeitas por integrarem o ordenamento jurídico e cumprirem sua função de instrumentalização normativa do SUS. Nesse sentido, o objetivo desta pesquisa foi discutir o poder normativos da CIB e a efetividade de suas normas, a partir do paradigma do discurso do direito. Realizamos uma análise documental, a partir das resoluções e das atas da CIB, para compreender sua dinâmica discurso-deliberativa e caracterizá-la, ou não, como um espaço de gênese democrática de direitos. Identificamos e classificamos as propostas aprovadas quanto à correspondência com as resoluções do CES, quanto ao conteúdo, à forma de aprovação à dinâmica da discussão das propostas aprovadas que resultaram em resoluções. Foi possível perceber que há um grande potencial democrático na CIB, um potencial que precisa ser explorado. Mas há também fragilidades e contradições na dinâmica das discussões no interior da Intergestores. Há indício de uma institucionalização que mina o potencial democrático-discursivo e se fecha à participação e controle social. Em tempos de uma democracia e de um sistema jurídico em crise de legitimidade, espaços como a CIB devem cada vez mais se abrir para a participação popular, estimulando uma radicalização democrática, construindo instrumentos de participação da sociedade civil e de abertura às novas formas de expressão da democracia participativa, que escapa às formas institucionais tradicionais / The Intermanager Bipartite Commission (IBC) was instituted by the Basic Operational Norm 01/93 and responds for the operational aspects of the Unified Health System (UHS). It is a forum for negotiation and pactuation between municipal and state managers, promoting the integration of the various municipal health systems coordinated by the state government. The norms issued by the IBC in the form of resolutions , have the nature of procedural rights, in other words, establish specific procedures for fulfill the right to health , allowing all potential receivers of these norms to acknowledge, support, criticize or even challenge them in court. The normative power of the ICB results from express legal prevision to regulate the operational aspects of the UHS, and its democratic legitimacy is the result of the control exercised directly by citizens or through the State Council of Health (SCH). The norms that emanate from the ICB should recognize as a part of the legal order and fulfill its operational goal inside the legal health system. Accordingly, the objective of this research was to discuss the normative power of the IBC and the effectiveness of its resolutions, under the paradigm of the discourse theory of law. The methodology was fulfilled through the documentary analysis of the resolutions and discussions of IBC, to understand its deliberative and discursive dynamics to characterize it, or not, as a forum for democratic genesis of rights. We identify and rank the proposals approved as its correspondence with the resolutions of the SCH, as its the content, its approval procedures, and the dynamics of the discussion to approve proposals that resulted in resolutions. We observed that there is a great democratic potential in IBC, a potential that needs to be explored. But there are also weaknesses and contradictions in the dynamics of the discussions within the Intermanager. There is evidence of a potential institutionalization that undermines democratic discourse and closes the IBC to social participation and control. In times of a democracy and a legal system in a crisis of legitimacy, spaces like the IBC must increasingly open to popular participation, encouraging democratic radicalization, building instruments for civil society to participate and openness to the new forms of expression of democracy, which escapes the traditional institutional forms

O objetivo do trabalho consiste em verificar e analisar, no âmbito do Município de São Paulo, a eficácia do artigo 129, II, da Constituição Federal, que, combinado ao art.197, atribui ao Ministério Público a função institucional de zelar pelo efetivo respeito ao direito à saúde por parte dos Poderes Públicos e dos serviços de relevância pública. Analisaram-se a estrutura e o funcionamento institucionais no período compreendido entre 1988 e 1996, por meio de levantamento documental, acompanhamento de demandas e entrevistas. O primeiro capítulo procura justificar a escolha e importância do tema e enuncia os conceitos adotados de eficácia, função institucional e relevância pública, alicerces da pesquisa. O segundo capítulo descreve a execução da coleta de dados, independentemente da análise de seu conteúdo, apresentada no terceiro capítulo. Conclui-se pelo avanço institucional em direção ao cumprimento da norma enfocada, cuja eficácia, entretanto, ainda não se alcançou integralmente. / The purpose of this study was to analyse and verify, in the scope of São Paulo City, the effectiveness of art.129, II, of the Federal Constitution, which, combined with art.197, assigns to Public Attorneys the institutional function of ensuring the proper application of health laws by the Public Powers and services of public relevance. The institutional structure and functioning in the period between 1988 and 1996 were analysed through documental survey, follow-up of demands and personal interviews. The first chapter aims at justifying the importance of the theme, defining such concepts of efficacy, institutional role and public relevance as underlie the research. In the second chapter, the process of data collection is described, irrespective of content analysis, which will be the object of the third chapter. The conclusion is that some institutional advancement has been achieved towards better application of the rule at issue, without, however, having attained its entire effectiveness.

The process of acquiring informed consents from patients belongs to one of the everyday activities of hospital personnel. The duty of submitting informed consent forms to patients is mostly in competence of the doctors. Nurses, however, are present during the entirety of patients' medical care and should be acquainted with all aspects of the informed consent. The process of acquiring the informed consents from patients admitted to intensive care unit (hereinafter ICU) is connected with a multitude of difficulties. The method of statistical analysis of data acquired by the questionnaire construction method was used for this quantitative research. 99 respondents participated in the questionnaire construction. The research took place within one hospital at chosen ICUs. The main goal of this thesis is to evaluate the process of acquiring informed consents from patients from the point of view of nurses and to identify the main issues connected with signing of informed consents. The results of the research show that patients are adequately informed by their physicians before signing the informed consents. Poor medical condition of patients admitted to ICUs may be seen as one of the main issues during the signing of informed consents. The research further shows that 50% of patients don't read the text of...

Submitted by RAFAEL MONTEIRO TEIXEIRA null (rafamtmt@hotmail.com) on 2017-03-22T13:12:41Z No. of bitstreams: 1 Direitos e Garantias da Pessoa Atingida pela Hanseníase.pdf: 1635730 bytes, checksum: d08080beef5d209bdb5e47f2c97605d2 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-03-23T13:13:18Z (GMT) No. of bitstreams: 1 teixeira_rm_me_bot.pdf: 1635730 bytes, checksum: d08080beef5d209bdb5e47f2c97605d2 (MD5) / Made available in DSpace on 2017-03-23T13:13:18Z (GMT). No. of bitstreams: 1 teixeira_rm_me_bot.pdf: 1635730 bytes, checksum: d08080beef5d209bdb5e47f2c97605d2 (MD5) Previous issue date: 2017-02-21 / A hanseníase é uma doença crônica infecciosa, de evolução lenta, que se manifesta sobretudo mediante sinais e sintomas dermatológicos, tais como lesões na pele e nervos, especialmente nos olhos, mãos e pés cujo agente etiológico é o Mycobacterium leprae. A doença é considerada um grande problema de saúde pública, devido a sua magnitude e alto poder incapacitante. O reconhecimento precoce e o tratamento oportuno são elementos chave para cessar a transmissão prevenindo incapacidades. A assistência integral à pessoa com hanseníase requer a organização de equipes multidisciplinares da rede pública de serviços do Sistema Único de Saúde (SUS), da atenção básica à média e alta complexidade, de acordo com a necessidade de cada caso e com os princípios de equidade e integralidade. Diante desse cenário, compete ao Estado nos termos do artigo 1°, III e do artigo 5° da Constituição Federal de 1988 disponibilizar ferramentas para que o cidadão tenha condições de subsistir com dignidade, assegurando meios de efetivação dos seus direitos. Diante do exposto, este estudo tem por objetivo descrever os direitos da pessoa atingida pela hanseníase com vistas a oferecer aos profissionais da saúde ferramentas para que estes possam informar e orientar a existência e o acesso a esses direitos. É um estudo quantitativo, que foi realizado no ambulatório de referência de hanseníase do Hospital das Clínicas - UNESP em Botucatu/SP e também nas unidades de saúde das cidades que compõem o Polo Cuesta.Participaram do estudo profissionais da área da saúde que trabalham no ambulatório de hanseníase e profissionais que trabalham nas unidades de saúde das cidades que integram o pólo cuesta diretamente ligados ao atendimento das pessoas atingidas pela hanseníase que aceitaram a participar do estudo assinando o termo de Consentimento livre e Esclarecido. Também participaram das pesquisas pessoas atingidas pela hanseníase maiores de 18 anos que aceitaram a participar do estudo assinando o termo de Consentimento livre e Esclarecido. Os dados foram coletados mediante questionário realizado e aplicado pelo pesquisador. A amostra foi composta por 31 pessoas atingidas pela hanseníase e 26 profissionais da saúde diretamente ligados ao atendimento dessas pessoas. Quanto a categorização das pessoas atingidas verificou-se o predomínio de pessoas do sexo masculino, quanto a idade a amostra demonstra que as pessoas atingidas pela hanseníase estão em idade economicamente ativa. De acordo com o estado civil mostra o predomínio de pessoas casadas ou vivendo em união estável. Quanto ao perfil demográfico dos profissionais de saúde nas unidades estudadas observou-se uma prevalência de mulheres, com idade mediana de 34 anos, são profissionais médicos e enfermeiros em sua maioria. Com relação ao conhecimento da pessoa atingida pela hanseníase sobre os direitos decorrentes da doença o estudo revela o prevalente desconhecimento acerca dos direitos que o portador de hanseníase possui e observa-se que, frequentemente, os pacientes não são orientados quanto aos seus direitos.Com relação ao conhecimento dos profissionais diretamente ligados ao atendimento da pessoa atingida pela hanseníase acerca dos direitos legais desse paciente, verifica-se pela análise dos dados que a prevalência é de profissionais que, quando questionados de forma geral, não conhecem os direitos da pessoa atingida pela hanseníase e mesmo os que conhecem não orientam seus pacientes a exercitar esses direitos. Já quando os questionamentos foram pontuais acerca de direitos específicos os profissionais demonstram maior conhecimento, no entanto o percentual de profissionais que orientam é relativamente baixo. Os direitos questionados foram tratamento gratuito, ao ter suas informações mantidas em sigilo, reabilitação em todos os níveis terapêuticos, recebimento gratuito de órtese e prótese, pleitear de forma administrativa ou judicial, quando necessário, auxílio doença, aposentadoria por invalidez e benefício assistencial. O que se verifica na literatura é a descrição pormenorizada da doença, suas manifestações clínicas, formas de tratamento e prevenção, no entanto, é extremamente escassa com relação à descrição e divulgação dos direitos legais da pessoa atingida pela hanseníase. Do mesmo modo verificou-se a escassez de artigos relacionados ao conhecimento dos profissionais da saúde ligados ao atendimento de pessoas com hanseníase acerca dos direitos legais aplicáveis a essa situação, razão pela qual o presente estudo descreve de forma não exaustiva quais são esses direitos e os mecanismos para seu exercício.Este estudo resultou na elaboração de uma cartilha que contempla de forma simples e objetiva informações acerca da hanseníase e dos direitos e garantias assegurados à pessoa atingida, permitindo assim a disseminação desse conhecimento. / Leprosy (etiological agent Mycobacterium leprae) is a chronic infectious disease of slow growth, manifesting itself mostly through dermatological signs and symptoms, such as skin and nerve lesions particularly on the eyes, hands and feet. The disease is regarded as a major public health problem due to its magnitude and high incapacitating power. Early detection and timely treatment are key elements in stopping transmission thus preventing incapacities. Comprehensive healthcare assistance for Leprosy sufferers requires the organization of multidisciplinary teams across the national healthcare service network of Brazil (SUS), from basic to mid and highly complex care, in accordance with the necessities of each case and based on equity and integrality principles. It is therefore, the role of the State as per the terms under Article 1°, III and Article 5° of the 1988 Constitution of the Federative Republic of Brazil, to provide the citizen with tools to allow subsistence with dignity by ensuring ways in which to implement their rights. In view of the aforementioned, this study aims to describe the rights of the person affected by Leprosy, in order to offer health professionals tools to guide and inform about the existence and access to these rights. It is a quantitative study that was conducted at the Reference Centre for Leprosy at the Hospital das Clínicas (São Paulo State University – UNESP- Medical School’s Clinical Hospital) in Botucatu/SP, as well as health care units in the cities that make up the “Polo Cuesta” (Cuesta Tourist Pole, a tourism consortium non-profit association of twelve municipalities in the state of São Paulo). Taking part in the study were health professionals, all providing direct assistance to those affected by Leprosy, working on the health care units in the cities that make up the “Polo Cuesta” and those working at the Reference Centre for Leprosy, as well as people affected by Leprosy, over 18 years of age only, all of whom have agreed to participate by signing the Informed Consent Form. The data was collected through a questionnaire created and administered by the researcher. The sample was composed by 31 people affected by Leprosy and 26 health professionals directly linked to assisting these people. As for the categorization of the people affected by Leprosy, the sample shows the predominance of males, it also demonstrates that people affected by Leprosy are of an economically active age. In terms of marital status, it presents a predominance of people either married or in a stable union. As per the demographic profile of the health professionals from the studied unities, a prevalence of women with an average age of 34 years old was noted, most of them professional doctors and nurses. In relation to the knowledge of the rights derived from the disease by the person affected by Leprosy, the study reveals a prevalent unfamiliarity about their own rights and it has been observed that quite frequently, the patients are not guided in relation to their rights. In terms of the knowledge held by the professionals directly linked to those affected by Leprosy about the legal rights of said patient, it was verified by data analysis that most professionals when questioned, in general, have no knowledge of the rights a person affected by Leprosy is entitled to, and even when they are aware, they do not guide their patients to exercise their rights. On the other hand, when clearly questioned about specific rights, the professionals demonstrated wider knowledge. However, the percentage of professionals that guided their patients was relatively low. The specific rights in question were free treatment, having their information confidentially kept, rehabilitation on all therapeutic levels, receipt of orthosis and prosthesis free of charge, administrative or judicial plead, when necessary, for disability aid, retirement due to disability and benefits program. What is seen in the literature is the detailed description of the disease, its clinical manifestations, forms of treatment and prevention, however it is extremely scarce in relation to the description and disclosure of the legal rights of the person affected by Leprosy. Likewise, there was a shortage of articles relating to health professionals who assist Leprosy sufferers and their knowledge of the legal rights applicable to this situation, which is why the present study describes in a non-exhaustive way, what these rights are and the mechanisms for their exercise. This study resulted in the elaboration of a booklet that provides information in a simple and objective way, about Leprosy and the rights and guarantees assured to the affected person, thus allowing for the dissemination of this knowledge.

A Comissão Intergestores Bipartite (CIB) foi instituída pela Norma Operacional Básica 01/93 e responde pelos aspectos operacionais do Sistema Único de Saúde (SUS). É um espaço de negociação e pactuação entre gestores municipais e estaduais, promovendo a integração dos diferentes sistemas municipais de saúde sob coordenação do governo estadual. As normas expedidas pela CIB, na forma de resoluções, têm natureza jurídica de direitos-meio, isto é, estabelecem os procedimentos específicos para realização do direito à saúde, permitindo que todos os potenciais destinatários destas normas possam conhecer, aderir, criticar ou mesmo judicializá-las. O poder normativo da CIB decorre da previsão legislativa expressa para regular os aspectos operacionais do SUS e da legitimidade democrática, exercida diretamente pelo cidadão, ou através dos Conselho Estadual de Saúde (CES). As normas que emanam deste fórum deliberativo devem ser respeitas por integrarem o ordenamento jurídico e cumprirem sua função de instrumentalização normativa do SUS. Nesse sentido, o objetivo desta pesquisa foi discutir o poder normativos da CIB e a efetividade de suas normas, a partir do paradigma do discurso do direito. Realizamos uma análise documental, a partir das resoluções e das atas da CIB, para compreender sua dinâmica discurso-deliberativa e caracterizá-la, ou não, como um espaço de gênese democrática de direitos. Identificamos e classificamos as propostas aprovadas quanto à correspondência com as resoluções do CES, quanto ao conteúdo, à forma de aprovação à dinâmica da discussão das propostas aprovadas que resultaram em resoluções. Foi possível perceber que há um grande potencial democrático na CIB, um potencial que precisa ser explorado. Mas há também fragilidades e contradições na dinâmica das discussões no interior da Intergestores. Há indício de uma institucionalização que mina o potencial democrático-discursivo e se fecha à participação e controle social. Em tempos de uma democracia e de um sistema jurídico em crise de legitimidade, espaços como a CIB devem cada vez mais se abrir para a participação popular, estimulando uma radicalização democrática, construindo instrumentos de participação da sociedade civil e de abertura às novas formas de expressão da democracia participativa, que escapa às formas institucionais tradicionais / The Intermanager Bipartite Commission (IBC) was instituted by the Basic Operational Norm 01/93 and responds for the operational aspects of the Unified Health System (UHS). It is a forum for negotiation and pactuation between municipal and state managers, promoting the integration of the various municipal health systems coordinated by the state government. The norms issued by the IBC in the form of resolutions , have the nature of procedural rights, in other words, establish specific procedures for fulfill the right to health , allowing all potential receivers of these norms to acknowledge, support, criticize or even challenge them in court. The normative power of the ICB results from express legal prevision to regulate the operational aspects of the UHS, and its democratic legitimacy is the result of the control exercised directly by citizens or through the State Council of Health (SCH). The norms that emanate from the ICB should recognize as a part of the legal order and fulfill its operational goal inside the legal health system. Accordingly, the objective of this research was to discuss the normative power of the IBC and the effectiveness of its resolutions, under the paradigm of the discourse theory of law. The methodology was fulfilled through the documentary analysis of the resolutions and discussions of IBC, to understand its deliberative and discursive dynamics to characterize it, or not, as a forum for democratic genesis of rights. We identify and rank the proposals approved as its correspondence with the resolutions of the SCH, as its the content, its approval procedures, and the dynamics of the discussion to approve proposals that resulted in resolutions. We observed that there is a great democratic potential in IBC, a potential that needs to be explored. But there are also weaknesses and contradictions in the dynamics of the discussions within the Intermanager. There is evidence of a potential institutionalization that undermines democratic discourse and closes the IBC to social participation and control. In times of a democracy and a legal system in a crisis of legitimacy, spaces like the IBC must increasingly open to popular participation, encouraging democratic radicalization, building instruments for civil society to participate and openness to the new forms of expression of democracy, which escapes the traditional institutional forms

O objetivo do trabalho consiste em verificar e analisar, no âmbito do Município de São Paulo, a eficácia do artigo 129, II, da Constituição Federal, que, combinado ao art.197, atribui ao Ministério Público a função institucional de zelar pelo efetivo respeito ao direito à saúde por parte dos Poderes Públicos e dos serviços de relevância pública. Analisaram-se a estrutura e o funcionamento institucionais no período compreendido entre 1988 e 1996, por meio de levantamento documental, acompanhamento de demandas e entrevistas. O primeiro capítulo procura justificar a escolha e importância do tema e enuncia os conceitos adotados de eficácia, função institucional e relevância pública, alicerces da pesquisa. O segundo capítulo descreve a execução da coleta de dados, independentemente da análise de seu conteúdo, apresentada no terceiro capítulo. Conclui-se pelo avanço institucional em direção ao cumprimento da norma enfocada, cuja eficácia, entretanto, ainda não se alcançou integralmente. / The purpose of this study was to analyse and verify, in the scope of São Paulo City, the effectiveness of art.129, II, of the Federal Constitution, which, combined with art.197, assigns to Public Attorneys the institutional function of ensuring the proper application of health laws by the Public Powers and services of public relevance. The institutional structure and functioning in the period between 1988 and 1996 were analysed through documental survey, follow-up of demands and personal interviews. The first chapter aims at justifying the importance of the theme, defining such concepts of efficacy, institutional role and public relevance as underlie the research. In the second chapter, the process of data collection is described, irrespective of content analysis, which will be the object of the third chapter. The conclusion is that some institutional advancement has been achieved towards better application of the rule at issue, without, however, having attained its entire effectiveness.