Thesis (M.Phil.)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: AIDS is the most important threat to world health. Recent years have seen a dramatic spread of HIVand AIDS in South Africa. Health education directed at modifying risk behaviour appears to be the only way in which the disease can be contained. Controlling AIDS is not only by controlling the virus, but also involves tackling social, economic and political issues and putting AIDS into the broader context of sexuality and gender roles. This requires a broader understanding of this aspect of HIV-AIDS ranging from population dynamics, through to research on individual behaviour and its socio-economic impact; so that we can dispel the myths and rumours that surround AIDS and answer searching questions that will be asked by the community. In South Africa, HIV-AIDS remains a stigmatized disease. There have been calls from courageous and influential people for those who are living with HIV-AIDS to be open about their status and to destigmatise the disease. Institutions too have been drawn into the controversy about whether to remain silent or speak out. Southern African Anglican bishops, as well as some politicians declared their intention to undergo testing for HIV status in order to sensitise the public to the seriousness of the epidemic. Were AIDS not regarded as intolerable, the entire issue of confidentiality would fall away. Calls to destigmatise the disease through openness cannot stand alone. Government must put effective treatment programmes in place. In the absence of treatment, AIDS may represent only frustration and hopelessness to those who test positive; and fear, danger and resultant animosity to those who are HIV negative. The text is in four chapters. Chapter 1 focuses on confidentiality as an important principle in the management of disease. In HIV -AIDS, confidentiality is a more sensitive issue as AIDS is particularly viewed as a social stigma, accompanied by discrimination and harassment. The chapter also addresses HIV infection, transmission, counseling and screemng. Chapter 2 deals with the principles of biomedical ethics namely, autonomy, to enable the patient to determine his/her course of treatment; informed consent, designed to protect the interests of patients from exploitation and harm, and encourage health professionals to act responsibly; beneficence and nonmaleficence, to protect the welfare of others; and justice, to ensure access to health care for all. It also highlights the aspects of and limitations to confidentiality. Chapter 3 discusses broadly the ethical dilemmas pertammg to professional-patient relationships, women and HIV-AIDS, religion, prisoners and employer-employee relationships. When the AIDS epidemic started, very few people suffered from the disease, and the disease was treated with great caution and confidentiality. Today, AIDS is a pandemic and emphasis should shift from the ethic of autonomy and confidentiality, to a social ethic, which emphasizes the responsibility of minimizing the risk of spread of infection. The chapter also examines the role of the Department of Health, the participation of health professional bodies and the legal aspects relating to confidentiality in HIV-AIDS. Chapter 4 attempts to construct an argument to destigmatise HIV-AIDS by arguing the responsibility of the government to make sufficient resources available for the treatment and control of the pandemic. Health professionals are challenged to engage their expertise and skills in the service of the sick with dignity and respect. The community is encouraged to support the drive towards controlling the spread of HIV infection and enable people living with AIDS to disclose their status without fear of harassment. / AFRIKAANSE OPSOMMING: Vigs is die gevaarlikste bedreiging van wéreldgesondheid. Die afgelope paar jaar het 'n dramatiese verspreiding van mv en VIGS in Suid-Afrika plaasgevind. Gesondheidsopvoeding wat gemik is op die verandering van risiko-gedrag is skynbaar die enigste metode wat die siekte kan beheer. Die kontrolering van VIGS is nie net die kontrolering van die virus nie, maar dit betref ook herbesinning oor sosiale, ekonomiese en politiese en geslagsrolle. Dit vereis 'n omvattender verstaan van hierdie aspek van HIV-VIGS, wat strek vanaf van bevolkingspatrone tot by die navorsing oor individuele gedrag en die sosio-ekonomiese impak van 19. So kan ons hopelik help om die mites rondom VIGS te besweer. In Suid-Afrika bly mV-VIGS 'n gestigmatiseerde siekte. Daar rus 'n veranbtwoordelikheid op invloedryke mense wat met mV-VIGS leef en wat as rolmodelle sou kon dien, om hul mv -status te openbaar en sodoeonde te help om die siekte te destigmatiseer. Instansies is ook by hierdie twispunt betrek om vas te stelof die mense moet praat of swyg. Suider-Afrikaanse Anglikaanse Biskoppe, asook somige politici het hulle intensies aangekondig om die mv -toets te ondergaan om sodoende die publiek te help opvoed oor die gevaar van hierdie epidemie. Oproepe om die siekte te destigmatiseer deur openbaarheid kan nie in isolasie funksioneer nie. Die staat moet effektiewe kuratiewe en voorkomingsprogramme hier rondom loods en kontinueer. In die afwesigheid van 'n geneesmiddel, sal VIGS slegs frustrasie, hopeloosheid, en vrees skep by diegene wat positief getoets is, sowel as vyandigheid onder diegene wat nie mv positief is nie. Die teks het vier hoofstukke. Hoofstuk 1 fokus op vertroulikheid as 'n belangrike beginsel in die bestuur van die siekte. In mV-VIGS is vertroulikheid 'n meer sensitiewe beginsel aangesien VIGS in die besonder as 'n sosiale skandvlek, aangevreet deur diskriminasie, gesien word. Die hoofstuk bespreek ook mv -infeksie, transmissie, raadgewing en toetsing. Hoofstuk 2 gaan oor die beginsels van die biomediese etiek, naamlik, outonomie, waaronder ingeligte toetstemming, ontwerp om die belange van die pasiente te beskerm teen eksploitasie en gevaar: om gesondheids professionele aan te moedig om hulle op 'n verantwoordelike manier te gedra. Ander beginsels is goedwilligheid en niekwaadwiligheid om die welsyn van ander te beskerm, asook geregtigheid, om toegang tot gesondheidshulp vir almal te verseker. Dit beklemtoon ook die aspekte verwant aan beperkinge tot vertroulikheid. Hoofstuk 3 bespreek breedweg die etiese dilemmas met betrekking tot die verhouding tussen pasiënye en professionele gesondheidswerkers, vrouens en mV-VIGS, godsdiens, gevangenes en werkgewer-werker verhoudings. Toe die VIGS-epidemie begin het, het min mense aan die siekte gely, en die siekte is met groot sorg en vertroulikheid behandel. Vandag is VIGS 'n pandemie en die klem moet geskuif word vanaf outonomie en vetrouilikheid na 'n sosiale etos wat verantwoordlikheid en die vermindering van die risiko van die verspreiding van die infeksie beklemtoon. Die hoofstuk kyk ook na die rolle van gesondheidsdepartmente, deelname van gesondheids professionele organisasies en die juridiese aspekte met betrekking tot vertroulikheid van HIV-VIGS. Hoofstuk 4 poog om 'n argument te ontwikkel wat daartoe sou kon bydra dat HIV-VIGS gedestigmatiseer sal word. Klem word gelê op die verabtwoordelikheid van die staat om soveel moontlike bronne beskikbaar te stel vir die behandeling van en beheer oor hierdie pandemie. Gesondheids professionele word uitgedaag om hulle deskundigheid en bekwaamheid in die diens van die siekes met waardigheid en respek te gebruik. Die gemeenskap word aangemoedig om die poging tot die beheer van die verspreiding van die HIV -infeksie te ondersteun en om die mense wat met VIGS leef in staat te stelom hul status sonder die dreigement van stigmatisering bekend te maak.

The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.

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Responsibility of the doctor in criminal law and the circumstances under which it is possible to carry out medical procedures without the threat of legal punishment is a topic that has been, is and will be always up to date. It is a complex set of problems, which includes aspects of moral, medical and legal. In my thesis I focused on relationship between doctor's proffession and legal aspects of his work according to criminal law. Its goal is to describe the issue of the practice of medicine and circumstances of justification in terms of legislation in the Czech Republic. The thesis consists of three chapters. The first chapter provides an introduction to the problem and the reasons that led me to choose this topic work. The second chapter is devoted to criminal liability and is divided into two parts. The first contains the general conditions that are necessary for criminal liability of doctors. The second part contains the typical and most common possible crimes that may physician in the exercise of their profession commit. The third and most extensive chapter has focused on description of the circumstances of justification. The chapter is divided into four parts. Firstly it deals with self-defense and legitimate use of weapons that are not too common in the medical environment. Then I focus on...

Request for termination of life in Benelux countries from the perspective of civil law The master's thesis is about euthanasia which is known as one of the most controversial and discussed topic in the world of law and medicine, especially termination of life on request. The aim of this work is to innovatively interduce unique legislation of termination of life on request in Benelux countries from the perspective of civil law because I am convinced of its importance despite being overshadowed by the meaning of criminal perspective. In a first chapter the terminology, definition and theory dividing will be explained. The other terms which are connected with the things above are the content of this part as well. The human rights related to euthanasia are discussed in next part of this work. Benelux countries have their own euthanasia enactment - this is what third chapter is about. Next part shows in-depth analysis of due care criteria which are countained in second chapter of Termination of life on request and Assisted Suicide Act. Fulfilment of these is one of criterias needed for impunity of the executor of termination of life on request. Fifth chapter is a key part of this work for civil law perspective because of legal requirements for request itself. It also describes related institutes -...

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...

Cette thèse traite de la révision automatique des connaissances contenues dans les systèmes fonctionnant par exploration informée d'arbres d'états. Ces systèmes, de par leur performance, sont employés dans de nombreux domaines applicatifs. En particulier, des travaux ont proposés d’utiliser cette approche dans le cadre de l'automatisation de la généralisation de données géographiques. La généralisation de données géographique s'intéresse à la dérivation, à partir de données géographiques détaillées, de données moins détaillées adaptées à un besoin particulier (e.g. changement d'échelle). Son automatisation, enjeu majeur pour les agences cartographiques telles que l'Institut Géographique National (IGN), est particulièrement complexe. Les performances des systèmes basés sur l’exploration informée d'arbres d'états sont directement dépendantes de la qualité de leurs connaissances (heuristiques). Or, la définition et la mise à jour de ces dernières s'avèrent généralement fastidieuses. Dans le cadre de cette thèse, nous proposons une approche de révision hors ligne des connaissances basée sur le traçage du système et sur l'analyse de ces traces. Ces traces sont ainsi utilisées par un module de révision qui est chargé d'explorer l'espace des connaissances possibles et d'en modifier en conséquence les connaissances du système. Des outils de diagnostic en ligne de la qualité des connaissances permettent de déterminer quand déclencher le processus de révision hors ligne des connaissances. Pour chaque méthode et approche que nous présentons, une mise en oeuvre est détaillée et expérimentée dans le cadre de l'automatisation de la généralisation de données géographiques / This work deals with automatic knowledge revision in systems based on an informed tree search strategy. Because of their efficiency, these systems are used in numerous fields. In particular, some literature work uses this approach for the automation of geographic data generalisation. Geographic data generalisation is the process that derives data adapted to specific needs (e.g. map scale) from too detailed geographic data. Its automation, which is a major issue for national mapping agencies like Institut Géographique National (IGN), is particularly complex. The performances of systems based on informed tree search are directly dependant on their knowledge (heuristics) quality. Unfortunately, most of the time, knowledge definition and update are fastidious. In this work, we propose an offline knowledge revision approach based on the system logging and on the analysis of these logs. Thus, the logs are used by a revision module which is in charge of the system knowledge revision by knowledge space exploration. Tools for online knowledge quality diagnosis allow to determine when the offline knowledge process should be activated. For each method and each approach presented, an implementation is proposed in the context of geographic data generalisation

I tested two pairs of captive chimpanzees (Pan troglodytes) in the informed forager paradigm: a subordinate saw the location of hidden bait, and then searched with a naïve dominant. This paradigm has tested what subjects know about others' states of knowledge, but my focus was to determine how subjects used different movement types and different gaze types to modify their competitive tactics. In particular, I investigated whether chimpanzees follow opponents' gaze to gain information. Learning more about how primates use visual information to predict others' behaviour can shed light on the continuing debate over to what degree apes possess theory of mind capacities. Previous published studies in this paradigm included narratives of ignorant competitors exploiting informed subjects by following their movement and gaze, and informed subjects avoided this exploitation by walking away from hidden food. The subordinate's behaviour can be considered tactical deception, which is a good place to seek strong evidence of second-order intentionality. Analyses with descriptive statistics, however, fail to capture the complexity of these interactions, which range from single decision-making points to larger patterns of following and misleading. I introduced a novel method of statistical analysis, cross correlations, that enabled me to examine behavioural patterns quantitatively that previous authors have only been able to describe in narrative form. Though previous studies on chimpanzees' understanding of gaze found that they were unable to use (human-given) gaze cues to locate hidden food, the subjects I tested followed their conspecific opponent's gaze, and used information gained from the gaze interaction to modify their own movement towards the hidden bait. Dominants adjusted their physical following of the subordinates as the interaction progressed, which reflected their changed states of knowledge. Subordinates used their movement and gaze differentially to manipulate dominants' behaviour, by withholding information and by recruiting towards a less-preferred bait.

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