M.Sc. (Med. (Bioethics and Health Law)), Faculty of Health Sciences, University of the Witwatersrand, 2008. / The research aims to establish whether processes around the consideration and execution of the living will help enhance the doctor-patient relationship. Studies have shown that the living will is not used frequently, and that the doctor-patient relationship is often deficient. The research explores the two primary topics – the living will, and the doctor-patient relationship – separately. Each primary topic is approached via a consideration of the relevant literature, and each is then analyzed from a theoretical–ethical point of view. A synthesis of these separate investigations is presented. This synthesis concludes that the living will can help enhance the doctor-patient relationship.

1998 Dozier Award Winner / It is widely recognized that the role of the physician has undergone dramatic changes in the last century changes which have serous implications for the patient-physician relationship. This is an ethnographic study examining how certain changes in the role and abilities of biomedical physicians have affected patient attitudes and expectations about end-of-life care. In-home interviews were conducted with eighteen persons age fifty-five and older, including a sample of Hemlock Society members. Results indicate a broad spectrum of end-of-life concerns including capacity, autonomy, pain, and burden to loved ones. Most participants reported a reluctance to begin a discussion of death or future deteriorating capacity with their physicians. Instead, when conversations about death were reported, they had been largely limited to the scenarios of catastrophic illness (e.g., hospitalization, ventilator, etc.) and the Living Will. While this discussion does not overlook the utility of the Living Will, it proposes that reliance on this document for preparing patients for end-of-life care is inadequate.

v anglickém jazyce: The aim of the thesis is to provide description of nursing and medical aspects and offer ethical and legal context concerning the issue of living will. The body of the thesis is divided into theoretical section and practical section. The theoretical section deals with the issue of living will from the nursing and medical point of view with characterization of several serious conditions in intensive care such as apalic syndrome, terminal state etc. The chapter on legal aspects of living will defines the term 'lege artis', 'do not resuscitate - DNR', and characterizes the matter of decision making in the case of serious and terminal states. The chapter on ethical perspective discusses the process of dying and the Christian point of view on the issue of dying. The practical section processes the results of a survey based on 104 non-professional respondents and their replies to a provided questionnaire. The research section analyzes the level of knowledge which non-professional population has of the issue of living will. The closing discussion evaluates the confirmation of established hypotheses and provides practical suggestions. Keywords: living will, dying, ethic, resuscitation, terminal state.

End of life and changes in medical bioethicsThe issue of the end of life includes —necessarily— an analysis of human dignity in its social and legal dimension as a parameter and value of the cultural history of countries and societies. The vagueness of this term has created, in particular, many difficulties in the effort to define its boundaries. In particular, the use of human dignity to understand the dynamics of the end of life faces the issue of medical paternalism and theory of informed consent in the doctor-patient relationship. / El tema del final de la vida incluye —necesariamente— unanálisis de la dignidad humana en su dimensión social y jurídica, como parámetro y valor de la historia cultural de los países y de las sociedades. La indeterminación de este concepto ha creado, en lo concreto, muchas dificultades en el esfuerzo de concretar sus confines. En particular, el uso de la dignidad humana para comprender las dinámicas del fin de la vida enfrenta el tema del paternalismo médico y la teoría del consentimiento informado en larelación médico-paciente.

The aim of this thesis is a detailed description and analysis of the institute advance directives/previously expressed wishes in the Czech Republic in comparison with the Australian legislation. This thesis deals with the Queenland's legislation and the legislation of the Northern Territory. The methods used in this thesis are analyzes of legal norms and comparison of specific law regulations. Introductory chapters are focused on the principle of patient's autonomy in the Czech Republic legislation and on the protection of the person's integrity. The thesis covers not only the rules contained in the Act. No. 89/2012 Coll., the Civil Code, but also mentions rules in the Act. No. 40/1964 Coll., the Civil Code. The next chapter is focused on different patient's rights, such as the right to life and be healthy, the right to self-determination and the right to dignity. In the second part, the author focuses on the institute of advance directives/previously expressed wishes. First within the international legal framework. This chapter also underlines negative opinions about advance directives/previously expressed wishes and points out the benefits of their use in practice. Next the author focuses on the Czech legal regulations. The author does not mention only the Health Services Act, but also not...

Die vorliegende Arbeit befasst sich mit der Kenntnis über Patientenverfügungen sowie deren Akzeptanz und dem Vorhandensein dieser Vorsorgedokumente innerhalb eines Studienkollektives von Senioren in Leipziger Alten- und Pflegeheimen. Der Gegenstand der Patientenverfügung selbst wird, unter Berücksichtigung soziodemographischer, persönlicher sowie gesundheitlicher Aspekte, evaluiert. Außerdem werden Standpunkte der Heimbewohner wie beispielsweise die Bereitschaft zu lebensverlängernden Therapien sowie zu Reanimationsmaßnahmen hinterfragt. Vor dem Hintergrund der Ergebnisse werden Lösungsmöglichkeiten diskutiert, welche die Grenze zwischen medizinisch-technisch Möglichen und ethisch Vertretbarem bezüglich der Entscheidungen am Lebensende regulieren können.

Living will is a multidisciplinary, ethical-law problem. When applied a legally competent patient as a lay person orders the medical staff as professionals how to treat him or her in case of him/her not being able, temporarily or permanently, to give an informed permission with a treatment or alternatively refuse such treatment. A patient has a right to express his/her wishes concerning a future health care for him/her-self in a time when he/she is no longer capable to decide on his/her own. The living will is a particular kind of an informed consent or decline targeted towards a future event which is to an extent uncertain. The presented thesis consists of two parts which are additionally divided into three chapters. The major aim of the first part is to give a comprehensive explanation of the Living will's position in the legal system of the Czech Republic. This part also analyses the relation of the modification embedded in the the Act on Health Services and Conditions of Their Provision and the Civil Code. The second part consists of two chapters: "The Living will's reflection in the intensive and palliative care" and " Care limitations, the Living will and a the legal responsibility of a medical doctor". It deals with the use of the Living will in intensive medicine and palliative care. These...

Purpose: There is a lack of discussion regarding end-of-life care planning which results in low advanced directive execution (AD) rates. This can lead to decision making by family, friends, and the health care team on behalf of patients whose end-of-life care wishes are unknown. The purpose of this study was to determine the effectiveness of an educational intervention in the work setting to increase end-of-life discussions and the execution of advanced directives. Methods: A descriptive design was used in an occupational workplace setting at a local bottling company after appropriate IRB approval was obtained. An educational intervention based on the Five Wishes document was presented in an occupational health setting covering all shifts and employment categories. A pre-program questionnaire measured a lack of knowledge and understanding of end-of-life planning and advanced directives. A post-program questionnaire measured the increase in knowledge and understanding of end-of-life planning and advanced directives. A focus group was conducted with audio recording to describe personal experiences. The quantitative analysis used statistical procedures to describe and synthesize data and content analysis was conducted on the focus group data. Results: A sample of 78 participants was used to gather the quantitative data. Of the total participants, an overwhelming majority were male with ethnic backgrounds evenly represented. Most of the participants either were married and either were drivers, salespeople, or warehouse workers. More participants indicated no religious affiliation than any other affiliation, and the majority of participants indicated that they had a high school diploma. When questioned about their 1) knowledge of advanced directives, 2) whether or not they would consider executing an advanced directive, 3) whether or not they were likely to discuss end-of-life care with other, 4) whether they would be comfortable having someone make end-of-life decisions on their behalf, and 5) whether or not they believed that advanced directives were important, the majority of participants indicated that they strongly agreed or agreed. However, none of the participants had executed an advanced directive. Only 10.3% of participants had ever discussed AD's with a healthcare provider. When the same participants were asked the same questions after the education portion of the study, data analysis of the pre- and post-program questionnaire mean scores, revealed a significant increase in scores on questions 1,2 and 3 (p > .05), and no significant increase on question 4 and 5 (p > .05). The implication of these findings suggest that an education intervention program in a workplace setting significantly increases end-of-life discussions and advanced directive execution rates. The Jones model of end-of-life education intervention and interpretation of the study are presented. Limitations of the study, as well as implications for nursing professionals and health care providers that will improve patient outcomes are presented. Discussion/Implication: The study shows that workplace education regarding Advanced Directives can lead to increase end-of-life discussions and increase advanced directive execution rates. Therefore, this education program at a worksite merits further research and may serve as a model program for other worksite settings.

Am 1. September 2009 wurde das 3. Gesetz zur Änderung des Betreuungsrechts erlassen. Seitdem ist die Einhaltung von Patientenverfügungen rechtlich bindend. Ärztliche Beratung zur Patientenverfügung wird empfohlen, ist aber keine Gültigkeitsvoraussetzung. Es wurde eine Studie durchgeführt, in der Ärztinnen und Ärzte dazu befragt wurden, in welchem Ausmaß zur Patientenverfügung beraten wird, wie die Qualität der Beratung beurteilt wird, welchen Stellenwert ärztliche Beratung zur Patientenverfügung hat und wie die Finanzierung ärztlicher Beratung beurteilt wird. Es wurde deutlich, dass die Patientenverfügung als Instrument durchaus anerkannt ist. Die befragten Ärztinnen und Ärzte schätzen ihre Beratungskompetenz hoch ein. Trotzdem wird Fortbildung gewünscht. Offizielle Empfehlungen und Standards zur ärztlichen Beratung wären sehr sinnvoll. Die Frage der Finanzierung sollte dringend abschließend geklärt werden. Eine zumindest anteilige Übernahme der Beratungskosten durch die Solidargemeinschaft wird vom Großteil der Befragten gefordert. In diesem Rahmen wäre auch eine eigene Abrechnungsziffer für Beratungsgespräche sinnvoll.

Criminal law issues related to Advance directives Abstract The aim of this thesis is to describe the recent institute of Advance directives in the Czech legal system and to analyze criminal law issues related with it's aplication. The focus is on medical workers which can get into jeopardy of criminal liability by respecting the Advance directives. Furthermore in this thesis are compared the legislations of Czech republic and the Australian state Queensland conserning Advance directives. Also, key rullings of Australian courts and other common law courts related to the aplicaton of Advance directives are described in this thesis. Descreption methods were aplied to describe each institute and terms close to it, analyzing methods to analyze liability of medical workers and comparative methods to compare the Czech and Queensland legislations. The thesis is divided into seven chapters and many subchapters. The first chapter is dedicated to the institute of Advance directives, to it's definition, history and to the legislations it is based in. The second chapter describes fundamental human rights related to Advance directives. These are the Right to Life, Right to dignity and the Right to self- determination. Every one of these rights is closely described and a subchapter deals with their collisions. The third...