The unprecedented growth of the aging population in Tennessee is a significant demographic trend that highlights the necessity for healthcare policy that tackles end-of-life issues. This study examined the perceived quality of end-of-life healthcare in Tennessee, areas that are in need of improvement, policies that have the potential to influence improvements, and the role of politics in end-of-life healthcare policy. It also assessed the support for end-of-life healthcare policy that would advance quality of care and expand end-of-life choices for Tennesseans, while evaluating the policy-making process that legislators employ. For this study, data were collected using semi-structured, in-depth interviews with an open interview guide. These interviews were conducted in a two-tiered format. Tier 1 included ten leading experts in various areas of end-of-life healthcare and aging in Tennessee. Tier 2 included nine legislators who were members of the health committees of either the Tennessee House of Representatives or the Tennessee Senate. Qualitative data were organized into numerous categories, and an initial phase of open coding was completed. From this phase of coding, emergent themes and focuses were discovered. This was followed by focused coding on all nineteen interviews using coding software to organize subtleties. Findings of the Tier 1 interviews indicated that there are many areas of end-of-life healthcare that need improvement including increased funding, expanded caregiver support, improved doctor-patient communication, and increased use of advance directives. Emergent themes included the influence of money, having difficult conversations, the stigma of death and dying, and supporting the caregiver. Tier 2 findings highlighted the motivations behind voting decisions and the level of awareness legislators have in areas of end-of-life healthcare policy. Both tiers also explored the support and opposition of physician-assisted death. The findings of this dissertation are intended to inform health professionals and state legislators. The data gathered through this exploratory research and the knowledge gained will lead to a greater understanding of end-of-life healthcare in Tennessee, and what needs to be done to improve its quality. This will allow individuals and families faced with end-of-life decisions to navigate the process with expanded options, access, and support.

[pt] Esta pesquisa se propõe a reescrever a história do direito à saúde desde a perspectiva da saúde da população negra enquanto campo em construção. Partimos do pressuposto de que as doenças e os agravos em saúde que acometem a população negra resultam, em grande parte, do racismo que não reconhece e invisibiliza os corpos negros. Neste sentido, o trabalho discute a saúde da população negra desde a História do Direito e é influenciada pela Lei número 10.639/2003, que institui a obrigatoriedade do ensino de cultura afro-brasileira e africana nos diferentes níveis e modalidades de ensino. Discute alguns aspectos da luta pelo direito à saúde na Assembleia Nacional Constituinte e advogamos a necessidade de enegrecimento do Direito Sanitário. Demonstramos algumas singularidades que marcam o processo de constituição do campo da saúde da população negra e, por fim, apresentamos o percurso de elaboração da Política Nacional de Saúde Integral da População Negra. O objetivo deste trabalho consiste em problematizar a ausência de pesquisas sobre saúde da população negra no Direito, mais especificamente no Direito Sanitário e na História do Direito. / [en] This research proposes to rewrite the history of the right to health from the perspective of the health of the black population as a field under construction. We assume that the diseases and health problems that affect the black population are largely the result of racism that does not recognize and make black bodies invisible. In this sense, the work discusses the health of the black population since the History of Law and is influenced by Law no. 10,639 / 2003, which establishes the obligation to teach Afro-Brazilian and African culture at different levels and modes of education. It discusses some aspects of the struggle for the right to health in the National Constituent Assembly and we advocate the need for blackening of the Health Law. We demonstrate some singularities that mark the process of constitution of the health field of the black population and, finally, we present the route of elaboration of the National Policy for Integral Health of the Black Population. The objective of this work is to problematize the absence of research on health of the black population in Law, more specifically in Health Law and in the History of Law.

Mental health treatment in state prisons is revealed to be highly variable, under-funded, and systematically inadequate. Existing literature exposes this injustice but fails to provide a comprehensive proposal for reform. This paper attempts to fill that gap, outlining a cost-effective, evidence-based treatment proposal, directly addressing the deficits in care revealed through analysis of our current system. In addition, this paper provides historical overviews of the prison system and mental health treatment, utilizing theoretical perspectives to contextualize this proposal in the present state of affairs. Lastly, the evidence is provided to emphasize the potential economic and social benefits of improving mental health treatment in state prisons. Significant findings suggest a clear financial, legal, and moral incentive for states to address this issue, while the proposal provides a viable method of doing so.

Healthcare fraud is a major problem within the healthcare industry. The study examined medical fraud, its laws, and punishments on federal and state levels. It compared medical fraud to non-fraud crimes done in the healthcare industry. This comparison will be done on a state level. The study attempted to analyze the severity of fraud against non-fraud and that doctors would commit fraud offenses more often than non-fraud offenses.

Within the Surinamese jurisdiction the Constitution grants women the right to health and imposes a legal duty on the state to facilitate the realization of this right. Also treaty law, in particular, the ICESCR article 12 and the CEDAW article 12 grant women the right to the highest attainable standard of health and the right to non-discriminatory access to healthcare. But due to the criminal law applicable to abortion women lack non-discriminatory access to reproductive healthcare and therefore do not enjoy the highest attainable standard of pregnancy related health. Despite its decision not to enforce the abortion prohibiting criminal laws, Suriname remains in a state of failure to comply with its legal duties as imposed by the Constitution and treaty law. This, due to the state’s reluctance to repeal the criminal laws on abortion and its failure to enact effective health regulations to facilitate women in need of an abortion.

Within the Surinamese jurisdiction the Constitution grants women the right to health and imposes a legal duty on the state to facilitate the realization of this right. Also treaty law, in particular, the ICESCR article 12 and the CEDAW article 12 grant women the right to the highest attainable standard of health and the right to non-discriminatory access to healthcare. But due to the criminal law applicable to abortion women lack non-discriminatory access to reproductive healthcare and therefore do not enjoy the highest attainable standard of pregnancy related health. Despite its decision not to enforce the abortion prohibiting criminal laws, Suriname remains in a state of failure to comply with its legal duties as imposed by the Constitution and treaty law. This, due to the state’s reluctance to repeal the criminal laws on abortion and its failure to enact effective health regulations to facilitate women in need of an abortion.

This study was designed to evaluate the quality of informed consent practiced by healthcare professionals in South Africa using an empirical quantitative methodology combined with medicolegal analysis to produce an interdisciplinary thesis on bioethics and medical law. Informed consent is an ethical and legal doctrine derived from the principle of respect for autonomy, whereas the rights to bodily integrity, privacy and human dignity are constitutionally protected in South Africa. The National Health Act 61 of 2003 codified requirements for informed consent by stipulating that healthcare providers must inform healthcare users about diagnosis, risks, benefits, treatment options, and the right of refusal, while taking into consideration users language and literacy levels. However, African communities are inherently challenged by problems of poverty, poor education, power asymmetry, and unfamiliarity with libertarian rights-based autonomy, which could affect informed consent practice. An empirical study was conducted at randomly selected public hospitals in EThekwini metropolitan municipality involving 927 participants; comprising 168 medical doctors, 355 professional nurses, and 404 patients. The study showed that healthcare professionals had limited knowledge regarding ethical and legal requirements for informed consent, and were partially compliant with current informed consent regulations. Barriers to informed consent identified were language, poor education, workload, and lack of interpreters. Most patients attending public hospitals were indigent, but preferred full information disclosure, and a shift from informed to shared-healthcare decision-making. The study recommends that a corps of trained interpreters should be introduced at public hospitals. This will improve providerpatient communications and minimize workloads, increase job satisfaction, and the overall quality of healthcare service delivery. Analysis of recent South African case law on informed consent revealed vacillations between the “reasonable doctor” and “prudent patient” standards of information disclosure which are inconsistent with the jurisprudence from comparative foreign common law jurisdictions. Therefore, South African court judgments on informed consent ought to be re-evaluated to establish a uniform standard of information disclosure consistent with international jurisprudence, current legislation, and constitutional protections relating to human dignity and security of the person. / Jurisprudence / LL. D.

The purpose of this thesis is to prove the existence of the right to adequate healthcare through a critical analysis of the law of obligations, constitutional law and international law framed in the wider focal point of South African medical law. The Constitution only makes provision for the right to access to health care. Conclusively this thesis will have to establish a link between a minimum standard in health care and the Constitution. It is submitted that the most efficacious method of establishing this link is with the duty of care, which is intrinsically linked to the doctor-patient relationship. If a critical analysis of the doctor-patient relationship can establish a clear link between the duty of care and state liability then such a link can successfully be applied to the Constitution. If this link is transposed onto the Constitution, a critical evaluation of the rights in the Bill of Rights will then reveal the most applicable right that can house the right to an adequate standard of health care. Such an analysis is only part of the solution however. In order to make this right effective, the international body of medical laws must be critically analysed and juxtaposed against this adequate standard. This carries the dual purpose of adding normative content as well as determining the current state of South Africa’s obligations under international human rights law, and to what extent those obligations have been discharged. Finally, and most significantly, the right to adequate healthcare, as it was forged in the international legal analysis, will be transposed onto the current South African jurisprudence of socio-economic rights. This practical application will then be reflected onto the new National Health Care Insurance to show conclusively that the current governmental approach of effecting health care is wholly inoperable and will ultimately result in significant harm and extensive human rights violations. This is based on the government only considering access to health care sufficient to discharge its duties and being totally incapable of effectively managing its resources. The core outcome for this thesis is to prove the existence of the right to adequate healthcare. Secondary outcomes are tracing the history of medicine to illustrate the creation and evolution of the doctor-patient relationship, a critical analysis of the application of medical ethics to South African law of obligations, a critical analysis of the Constitution and its fundamentals, an exhaustive evaluation of South Africa’s duties and accomplishments under its international obligations and effectively applying the right to adequate healthcare which is diametrically opposed to the current course South Africa is taking to provide health care. / Dissertation (LLM)--University of Pretoria, 2012. / Public Law / unrestricted

Cotutelle France-Québec / La médiation présente un fort potentiel dans la régulation des rapports entre patients et professionnels de santé et de nombreux bénéfices dans le domaine de la santé lequel se prête aisément à la mise en œuvre des modes amiables de règlement des différends. L’utilisation marginale de la médiation en santé invite alors à considérer les facteurs juridiques susceptibles de l’expliquer. Ce travail visait donc à déterminer, le cadre juridique optimal susceptible de favoriser le recours – ou promouvoir le développement – de la médiation extrajudiciaire dans les différends nés de la relation de soin. L’hypothèse étant que la faible efficacité incitative des législations applicables à la médiation en santé représente un facteur dissuasif à son utilisation, cette efficacité étant tributaire du degré d’adaptation de ces législations à la nature spécifique des différends en santé. Le travail s’appuie sur une analyse comparative franco-québécoise, le Québec et la France étant tous deux au diapason s’agissant d’encourager le recours à la médiation. Un cadre d’analyse pour juger de l’adéquation des législations québécoise et française applicables à la médiation en santé aux différends nés de la relation de soin a d’abord été dégagé de l’étude de la singularité de ces différends. La comparaison des corpus juridiques québécois et français a ensuite montré des différences dans l’appréhension de la médiation mais également des similarités notamment s’agissant des difficultés concernant son implantation dans le champ de la santé. Les démarches faites pour les surmonter à la fois se rejoignent et diffèrent puisqu’elles dépendent de deux paramètres : assurer un environnement favorable au recours et structurer les conditions de la fonction de médiation. Ainsi, l’environnement juridique, à la fois conceptuel et axé sur l’information, l’accompagnement et l’accessibilité des justiciables, et la formation des acteurs de la médiation en santé sont donc cruciaux pour son avenir dans le champ de la santé. En prenant appui sur les forces des cadres juridiques québécois et français, le modèle de référence de la médiation en santé proposé s’inscrit, d’abord, dans un cadre global plus large visant à insuffler une véritable culture de médiation. Ensuite, il repose sur une approche pragmatique et donc sur une conception de la médiation en santé « hybride » qui se détache de la définition communément adoptée par la doctrine. Ce cadre de référence propose de renouveler le champ d’application de la médiation par une approche centrée sur le concept de qualité et de sécurité de soins. Le potentiel de la médiation dans l’amélioration de la qualité et de la sécurité de soins est sûrement l’élément clé qui fonde la spécificité de cette médiation et sur lequel il conviendrait de davantage insister en tant que finalité explicite de cette médiation. La médiation en santé pourrait ainsi bénéficier d’un ancrage pérenne et s’insérer plus aisément dans le répertoire des pratiques institutionnelles. Par ailleurs, en tant qu’instrument au service de l’amélioration de la qualité de soins et de prévention des erreurs médicales, la médiation n’est plus seulement un instrument « curatif » de gestion de crise. Elle offre plutôt un panel d’options permettant de répondre à l’extrême diversité des besoins des parties au différend né de la relation de soin. Au travers de cette étude, nous montrons in fine l’existence d’un besoin accru de médiation au sein des deux systèmes de santé et de quelle manière le droit peut constituer un moteur essentiel pour promouvoir un certain modèle de médiation en santé et favoriser ou non son recours. / Mediation has great potential in the regulation of relations between patients and health professionals and many benefits in the health field, which lends itself easily to the implementation of alternative dispute resolution methods. The marginal use of mediation in the health field invites us to consider the legal factors that could explain it. The aim of this work was therefore to determine the optimal legal framework likely to encourage the use - or promote the development - of extrajudicial mediation in disputes arising from the care relationship. The hypothesis being that the low incentive efficiency of the legislations applicable to mediation in health represents a dissuasive factor to its use, this effectiveness being dependent on the degree of adaptation of these legislations to the specific nature of the disputes in health. The work is based on a comparative Franco-Quebec analysis, with both Quebec and France being in tune in terms of encouraging the use of mediation. An analytical framework for judging the adequacy of the Quebec and French legislation applicable to mediation in the health sector to disputes arising from the health care relationship was first identified by studying the singularity of these disputes. The comparison of the Quebec and French legal corpora then showed differences in the apprehension of mediation but also similarities, in particular with regard to the difficulties concerning its implementation in the health field. The steps taken to overcome them are both similar and different since they depend on two parameters: ensuring an environment favourable to recourse and structuring the conditions of the mediation function. Thus, the legal environment, both conceptual and focused on information, support and accessibility of litigants, and the training of the actors of mediation in health are crucial for its future in the health field. By building on the strengths of the Quebec and French legal frameworks, the proposed reference model for mediation in health is, first, part of a broader global framework aimed at instilling a true mediation culture. Secondly, it is based on a pragmatic approach and therefore on a conception of « hybrid » mediation in health care that is different from the definition commonly adopted by the doctrine. This reference framework proposes to renew the field of application of mediation by an approach centred on the concept of quality and safety of care. The potential of mediation in the improvement of the quality and safety of care is surely the key element that founds the specificity of this mediation and on which it would be advisable to insist more as an explicit purpose of this mediation. Mediation in health care could thus benefit from a perennial anchoring and be more easily inserted in the repertoire of institutional practices. Moreover, as an instrument for improving the quality of care and preventing medical errors, mediation is no longer just a "curative" instrument for crisis management. Rather, it offers a range of options to meet the extremely diverse needs of the parties to the dispute arising from the care relationship. Through this study, we show in fine the existence of an increased need for mediation within the two health systems and how the law can constitute an essential driving force to promote a certain model of mediation in health and to promote or not its recourse.

À partir de la notion de projet parental, nous souhaitons déconstruire, en droit, l'assignation des femmes aux questions reproductives. En effet, le corpus juridique relatif à la reproduction participe à la perpétuation des stéréotypes de genre et en particulier, ceux liés à la division sexuée du travail. Le projet parental est une notion qui a émergé avec les techniques reproductives. Pour autant, l'analyse du cadre relatif aux techniques de PMA montre de quelle manière celui-ci renforce les stéréotypes de genre. Les conditions d'accès aux méthodes de PMA sont empreintes de naturalisme et une comparaison entre le droit français et le droit suisse montre le caractère construit de ces références constantes à la nature. L'établissement du lien de la filiation renforce le cadre naturaliste : d'un côté, la filiation est établie pour les projets parentaux réalisés dans le cadre légal selon les règles du droit commun et renforce la différenciation des fondements à la filiation selon le sexe du parent ; de l'autre, les projets parentaux qui s'écartent du cadre naturaliste sont relégués aux marges du droit de la filiation, même s'ils doivent aujourd'hui être reconnus sous la pression du législateur en matière de PMA et de la CEDH concernant la GPA. En dépit de l'état actuel du droit, la notion de projet parental pourrait promouvoir au sein du droit de la reproduction l'égalité entre les sexes et la liberté reproductive. En prenant appui sur le principe d'égalité entre les sexes et la liberté reproductive nous proposons de faire évoluer le droit de la reproduction, afin qu'il y ait davantage d'autonomie et d'égalité, tant en matière de filiation que d'accès aux actes médicaux non thérapeutiques en matière de reproduction que sont l'IVG, la contraception, la stérilisation et la PMA. Nous préconisons en particulier de modifier le droit commun de la filiation en y intégrant les techniques de PMA et en faisant de la volonté le fondement principal de l'établissement de la filiation. La promotion de l'autonomie reproductive lors de la mise en œuvre des droits reproductifs se traduit par un renforcement des droits des usagers du système de santé en matière de reproduction. À travers l'exemple du droit de la reproduction, nous montrons in fine de quelle manière le droit peut contribuer à favoriser au sein de la société l'autonomie des individus et l'égalité entre les sexes. / Starting from the concept of "parental project", we aim to deconstruct the traditional roles of women in reproductive matters from a legal standpoint. Gender stereotypes, especially those related to gendered division of labour, are indeed sustained by the current reproductive legal framework. The parental project is a concept introduced by law regulating the new reproductive technologies and yet, the analysis of legal aspects of medically assisted reproduction (MAR) stresses how gender stereotypes are in fact strengthened. The legal criteria to access MAR methods are defined based on Nature and comparing French and Swiss legal frameworks shows there are no fixed rules and thus, that references to Nature are not unbiased. Moreover, when it comes to rules of filiation, the naturalistic framework is further reinforced: on the one hand, when the parental project is carried out within the legal framework, filiation is established based on general law, corroborating the gendered legal basis of filiation; on the other hand, parental projects outside of the naturalistic framework are marginalized, and if nowadays filiation should also be recognized for children born in such conditions, it is only because of legal and jurisprudential developments. In spite of this, we think that the concept of "parental project" should promote, within the legal framework of reproduction, both gender equality and reproductive autonomy. Based on the principle of sex-equality and reproductive autonomy, our proposals aim to change dispositions regarding filiation and reproductive medical acts so that they could improve gender equality and reproductive autonomy. In particular, MAR should be addressed by the general law of filiation in order to make of will the main basis of parentage. Likewise, promoting autonomy in reproductive medical acts cannot proceed without rights of the health care users. Finally this research in reproductive law could be seen as a striking example of how law could foster gender equality and individual autonomy in society.