This thesis sets out to examine the place of patient choice in English health care, primarily within the National Health Service and in relationship to English law with regard to (a) informed consents and information and risk disclosure, and (b) confidentiality and privacy in relation to the access to and management of patient information. The analysis in underpinned with a limited review of the associations between choice and respect for individual autonomy. Health policy rhetoric has been laden with references to pro-patient choice in recent years and yet this research re-affirms that in law (still) it is the negative patient choice that carries weight in matters of consent to treatment. There is (still) no place for real demand. Similarly, in individual medical information access and management there is no sanction for demand, even negative patient choice is bounded. In both aspects of health care the ‘choices’ are (rightly) limited and can hardly constitute choice as the consumer-patient might see it. What the three papers contribute is the recognition that restrictions in patient choice are necessary; to be supported and for some individuals should be even more fettered than that of the general public in the interest of that general public. The papers examine the language of choice and find it lacking in transparency, with the reality dissociated from patient engagement, information dissemination and shared decision making; so compromising trust. If the health care system is to genuinely respect the individual autonomy of the capable adult and not utilise choice language as covert method of policy implementation, the language of what is on offer and why, the reasons for information acquisition and use and why, needs to be part of the patient-practitioner discussion as well as clarified in policy.

Informed consent can be considered, without any doubt, as a central issue in current bioethics and in medical law. The modern relationship between physician and patient has completely changed. Informed consent has dominated the theoretical discussions since the 1970s. Its importance is essential for both medical research and clinical practice. This work focuses mainly on clinical practice, on the relationship between a doctor (or more generally a healthcare professional) and a patient. The institute of informed consent has evolved similarly in medical ethics as well as in the medical law, but there are some significant differences. One of the basic issues of this work is to distinguish both positions and point out differences between legal and ethical aspects of this institute. The thesis sees the fundamental differences in the different purposes of both two key normative systems, in their function, in the values they represented and in the principles they emphasized. While trust and mutuality are essential to informed consent in ethics, the legal institute reflects more the protection of the subjects, especially the protection against abuse, thus providing legal certainty especially for the patient. The ethical level is primarily to ensure respect for the other person so that he or she is...

The impressive growth of antidiscrimination law in liberal democracies in the past few decades belies the inadequacy of the normative bases on which it has been sought to be justified. Popular ideals such as rationality, equality and dignity have been unsuccessful in providing a coherent liberal framework for the fundamental aspects of the practice of antidiscrimination law. In this thesis, I have argued that a unified normative framework comprising autonomy and dignity-as-autonomy does a markedly better job of justifying the most fundamental aspects of these laws. The ideal of personal autonomy is understood here as a principle that seeks to guarantee an adequate range of valuable options to individuals. Dignity-as-autonomy is understood to be an expressive norm, which forbids certain persons from expressing contempt for the autonomy of another. These ideals have different forms: autonomy is a non-action-regarding principle, while dignity-as-autonomy is action-regarding. They are also distinct substantively: it is often possible to violate one of them without affecting the other. When these ideals make incompatible demands, I argue that those made by autonomy should prevail. Mandating positive action and reasonable accommodation on the one hand, and prohibiting indirect discrimination and harassment on the other, are essential features of a model of antidiscrimination law based on this framework. Further, under this framework, antidiscrimination law is not vulnerable to objections such as ‘levelling down’ and responds well to claims of discrimination on ‘intersectional grounds’. Furthermore, it is not essential to find an ‘appropriate comparator’ in order to prove discrimination. This model also explains when, and under what conditions, can some forms of discrimination be ‘justified’. Finally, on an autonomy-based model, antidiscrimination law is only one of several complementary tools that should be employed to protect and promote personal autonomy.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2015-12-07T14:14:13Z No. of bitstreams: 1 arquivototal.pdf: 630551 bytes, checksum: a248f59e81f913b9601f38a16f8226cd (MD5) / Made available in DSpace on 2015-12-07T14:14:13Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 630551 bytes, checksum: a248f59e81f913b9601f38a16f8226cd (MD5) Previous issue date: 2015-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This dissertation deals with the fundamentals of cosmopolitan right in Immanuel Kant’s philosophical thought. As, for Kant, without cosmopolitan law to guarantee peace among nations, it is not possible to guarantee rights even among individuals, and without a guarantee of the rights among individuals, there is no exercise of freedom, Kant’s interest in cosmopolitanism reveals itself linked to the project of the Enlightenment, a project he exposes in his booklet Answer the Question: What is Enlightenment? Grounding on concepts as freedom, legality, right, justice – which, according to Kant, have their foundations a priori on human reason, being therefore recognized as such by all human race – we will approach Kant’s analyses on a concept of right able to ensure endurable peace, founded in the cosmopolitan law. This research will follow Kant’s analyses of the connections between his concept of morals – to which Enlightenment’s project of freedom is bounded – and the problem of history and cosmopolitanism in his works on political philosophy and philosophy of law. In this course, we will be dealing with important concepts of Kant's philosophy of morals, on which are based his concepts relative to law, such as autonomy, heteronomy, freedom of the will, coercion, morality and legality. These concepts will give us elements to understand the bridge from the law among individuals within the state to the establishment of a universal right, or cosmopolitan law, among the nations, a bridge that should reveal what Kant means by his concept of progress of mankind defined as moral progress. / Esta dissertação trata dos fundamentos do direito cosmopolita no pensamento de Immanuel Kant. Na medida em que, para Kant, sem um direito cosmopolita que garanta a paz entre as nações, não é possível a garantia nem mesmo dos direitos entre os indivíduos no interior dos Estados e, sem a garantia de direitos entre os indivíduos, não há exercício da liberdade, o interesse de Kant no cosmopolitismo revela-se vinculado ao projeto do Esclarecimento, que ele expõe em seu opúsculo Resposta à Pergunta: que é Esclarecimento? Com base nos conceitos de liberdade, legalidade, direito, justiça – que segundo Kant têm seus fundamentos a priori na razão humana, sendo por isso reconhecidos como tais por todo o gênero humano – vamos abordar as análises de Kant referentes a um direito que torne possível uma paz duradoura, fundada num direito cosmopolita. Esta pesquisa seguirá as análises de Kant do vínculo entre o conceito de moral – no qual o projeto de liberdade do Esclarecimento se insere – e o problema da história e do cosmopolitismo em seus trabalhos sobre filosofia política e filosofia do direito. Nesse percurso, vamos examinar conceitos importantes da reflexão kantiana sobre a moral, que estão na base de sua concepção do direito, tais como, autonomia, heteronomia, liberdade da vontade, coação, moralidade e legalidade. Esses conceitos irão nos dar elementos para entender a passagem do direito entre os indivíduos no interior dos Estados à instituição de um direito universal, ou cosmopolita, entre as nações, passagem que vai configurar o que Kant entende por progresso da humanidade como progresso moral e jurídico.

L’ordonnance du 23 mars 2006 a réformé le droit des sûretés en France et introduit un gage sans dépossession inspiré du security interest américain dans l’objectif d’améliorer l’efficacité de la matière. L’amélioration est visible mais peut encore être approfondie. En premier lieu, la prépondérance de l’autonomie de la volonté dans la constitution et le régime du gage sans dépossession traduit son détachement progressif de la matière réelle. En effet, le droit du créancier bénéficiaire a pour objet plus la valeur du contenu de l’assiette affectée que son incarnation matérielle. Ainsi, il faut, d’une part, autoriser l’évolution du contenu matériel de l’assiette de constitution pour admettre que l’assiette de réalisation ne soit pas constituée des mêmes biens mais représente toujours la même valeur affectée. D’autre part, il faut reconnaître l’opposabilité du droit de rétention fictif aux procédures d’insolvabilité. En second lieu, le détachement de la sûreté de son objet réel et la prévalence de l’autonomie de la volonté doivent se prolonger en droit international privé. Ainsi, il convient d’admettre l’abandon de la compétence de la lex rei sitae, source de difficultés liées à la nature mobilière du bien grevé, et de reconnaître la compétence de la lex contractus, tirée de la prépondérance de la source conventionnelle de la sûreté.Ainsi, tant l’adaptation de la sûreté permise par la place laissée la volonté des parties, que la possibilité de circulation transfrontalière offerte par la reconnaissance des sûretés étrangères, font du gage sans dépossession une sûreté plus efficace aussi bien en droit interne qu’au niveau international. / On March 23rd 2006, the French reform of security law introduced the « gage sans dépossession », inspired by the security interest of the Article 9 of the U.C.C. from the United- States, in order to improve the efficiency of security law in France. The enhancement is undeniable and yet but there remains room for improvement.First of all, the increased autonomy given to parties when creating and ruling a security results in its detachment from the scope of personal property. Indeed, the creditor is more entitled to the value of the collateral rather than to the good itself. Therefore, the physical content of the collateral should be allowed to change physically as long as collateral remains of same value. On the other hand, the creditor’s fictive right of retention must be enforceable against insolvency proceedings. Secondly, both the detachment of the security from its physical collateral and the preponderance of parties’ autonomy must be taken into account in international private law. Should a matter of choice of law arise, the security should be governed not by lex rei sitae, given the issues raised when applied to movable goods, but by lex contractus, on account of the contractual source of the security. As a result of its adaptability enabled by autonomy, and as a result of the ability to move the security over borders and still be enforceable, the French “gage sans dépossession” appears to be more efficient both in France and on an international level.