As organizações de saúde, instituições de ensino, pesquisadores e profissionais têm investido em mecanismos que visam aperfeiçoar a assistência integral à saúde ofertada aos pacientes. Todavia, a assistência pode estar sujeita a falhas que podem acarretar danos indesejados aos pacientes, familiares e profissionais, além de prejuízos ao sistema de saúde. Acionar o Poder Judiciário é um dos mecanismos adotados para reparar o dano causado. Nos últimos anos, no Brasil, especialmente a partir de 2003, observa-se um crescimento das demandas judiciais relacionadas aos serviços prestados pelos profissionais da saúde, reflexo das mudanças ocorridas na sociedade e da ampliação dos direitos sociais e fundamentais. Justifica-se, assim, um estudo retrospectivo de casos julgados, com análise da jurisprudência do Superior Tribunal de Justiça (STJ), no período de 2003 a 2013, acerca das ações judiciais movidas em face dos profissionais de saúde e instituições de saúde no âmbito público e privado. Realizada analise quantitativa e qualitativa do conteúdo dos discursos dos Ministros do STJ sobre o tema erro médico, aplicando o método do Discurso do Sujeito Coletivo (DSC). O estudo das decisões proferidas contribuiu para a compreensão dos assuntos que têm predomínio na jurisprudência do STJ sobre o erro médico. O trabalho identificou o sexo feminino como o mais vulnerável aos supostos erros médicos e as especialidades médicas diretamente relacionadas com a saúde feminina como a mais acionadas judicialmente. Ginecologia/Obstetrícia (27,08%), Ortopedia (12,5%) e Cirurgia Plástica (10,42%) foram, respectivamente, as especialidades mais demandadas. Em conclusão, o estudo traz subsídio para as organizações de saúde identificarem possíveis áreas estratégicas de atuação, no sentido de implementarem ações para reduzir a probabilidade de erros médicos, identificando mecanismos eficientes para o acompanhamento e a racionalização de possíveis falhas e para atuarem, preventivamente, nas práticas de gestão visando reduzir danos aos pacientes, diminuir custos decorrentes das indenizações, possibilitando, uma prestação de serviço de saúde de maior excelência, qualificado e seguro no sistema único e no sistema suplementar de saúde. / Healthcare organizations, educational institutions, researchers and healthcare professionals have invested in mechanisms to improve the integral medical assistance offered to patients, but these assistance could have failures that may result in injury to patients, family members, and damage to system. One of the mechanisms to repair the damage is to claim to the Judiciary. In Brazil, especially since 2003, there has been an increase the lawsuit number related to medical malpractice, reflecting the changes in society and the expansion of social and fundamental rights. This is a retrospective study of judged cases by the Superior Court of Justice, in the period from 2003 to 2013, regarding the lawsuits against healthcare professionals and institutions in the public and private practice. Performed quantitative and qualitative analysis of the Superior Court of Justice Ministers speeches content, using the collective subject discourse method. Analyze of decisions contributed to understanding of the predominated issues in the malpractice lawsuit. The study identified the women as the most vulnerable to medical errors and medical specialties directly related to women\'s health as the most driven in court. Gynecology/Obstetrics (27.08%), Orthopedics (12.5%) and Plastic Surgery (10.42%) were, respectively, the most demanded specialties. In conclusion, the study provides subsidy for healthcare organizations identify potential areas of action to implement strategies to reduce the likelihood of injury to patients, decreasing costs and medical malpractice.

Medical negligence is a growing concern within South Africa.1 The medical environment has great potential for conflict, because even the best trained physicians can commit errors that result in medical disabilities and sometimes in death.2 The conflicts that follow from these errors are mostly fuelled by emotions and they can become very expensive and time-consuming to settle using the litigation process.3 There is a growing recognition that alternative dispute resolution (ADR) systems in healthcare may alleviate some of the financial and psychological burdens on doctors and patients involved in medical negligence disputes. Mediation is a method of ADR that is flexible and it permits the parties to the dispute to have control over the resolution. A typical medical negligence dispute is driven by intensely emotional factors on the part of injured patients. Victims are not merely seeking financial compensation but they are also looking to understand the circumstances that brought on the event at hand. They want closure. A huge issue with regard to medical negligence litigation is the manner in which the claims are resolved. Litigation provides injured patients and caregivers with a traditional platform for addressing medical negligence claims. However, due to many reasons, this system seems not to be adequate for dealing with disputes arising from alleged medical negligence. Mediation offers a promising solution to the problems surrounding redress of medical negligence disputes. / Jurisprudence / LL. M.

Seguro y Responsabilidad Patrimonial de la Administración presenta un detallado estudio del derecho de seguros y de la responsabilidad de la Administración Pública por las acciones y omisiones de funcionarios en la prestación de servicios públicos. Su objetivo es ilustrar cómo el seguro trabaja en el ámbito de la Administración Pública. La tesis se divide en tres partes y combina la exposición con el análisis crítico. En la primera parte, la tesis analiza brevemente el contrato de seguro y proporciona argumentos económicos para defender que el seguro es socialmente más beneficioso en Administraciones Públicas pequeñas que en Administraciones totalmente solventes. En la segunda parte, la tesis doctoral proporciona soluciones a los problemas que surgen entre la Ley de Contrato de Seguro y la regulación de la responsabilidad patrimonial de la Administración Pública. Finalmente, examinamos estas soluciones en un particular contexto: el seguro de responsabilidad civil por mala praxis médica que proporciona protección en el caso de que actos negligentes den lugar a algún daño o lesión a los pacientes en el ámbito de la Administración Pública. / Seguro y Responsabilidad Patrimonial de la Administración presents a detailed examination of the law of insurance and the Liability of Public Administration for the actions and omissions of civil servants in the provision of public services. Its objective is to illustrate how insurance works in the Public Administration. The thesis is divided into three parts and combines exposition with critical analysis. In the first part, the thesis briefly analyzes the insurance contract and provides economic arguments that the insurance is more socially beneficial in small Public Administrations than completely solvent Administrations. In the second section, the doctoral thesis provides solutions to the problems between Spanish law of insurance contracts and the regulation of Liability of Public Administration. Finally, we examine these solutions in a particular context: the medical malpractice liability insurance that provides protection in case of acts of malpractice that result in harm or injury to patients in the Public Administration.

隨著近年醫療糾紛日益增加，民刑事訴訟程序冗長，醫病雙方長時間煎熬，醫病關係日益惡化，導致防禦性醫療盛行。本研究從醫療責任切入，討論醫療爭議及現行處理途徑與方式，現行醫療責任保險之發展，簡介外國醫療責任保險概況。探討我國實施強制醫療責任保險之可能性。 本研究試圖以多階層醫療風險處理模式，以達有效處理醫療糾紛事件之目的。該模式將建立強制醫療責任保險以提供基本補償及簡化賠償機制，推動醫療機構責任保險以行政手段加強民眾保障，限定賠償金額避免高風險急重症專科無人從事，提倡醫師專業責任保險分散風險，引進醫事審議仲裁機制縮短醫療糾紛審查及賠償程序。 期以多面向分層處理醫療糾紛及其賠償問題，建構安全的醫療制度，避免防衛性醫療的盛行及司法資源的浪費。 / With the growing number of medical malpractice cases and the lengthy process of both civil and criminal litigation procedures in recent years, the torture has been agonizing and worsening the relationship between physicians and patients. The very situation results in the prevalence of defensive medical treatment. This research deals with the problem from the viewpoint of medical liability, discusses the current methods of handling medical disputes and explores the development of current medical liability insurance. An overview of the situation in other countries is presented to investigate the possibility of implementing mandatory medical liability insurance in Taiwan. This research attempts to establish a multi-level mode to effectively resolve medical risks. This mode will contribute to a lot of functions including enforcing mandatory medical liability insurance, supporting a fundamental compensation and simplifying the process of damages claiming. Furthermore, the mode will also serve to promote the medical liability insurance of medical institutions and in turn enhance the protection for the common public with administrative measures. In addition, the mode intends to restrict the upper limit of damages in order to remedy the serious phenomenon that no doctors are willing to practice in the high-risk medical departments, which is expected to distribute the medical risk of all the doctors. It will also introduce a medical arbitration mechanism to shorten and accelerate the procedure of medical reviewing and damages claiming in handling medical malpractice cases. We hope, with the establishment of such a multi-level mode, a sound and wholesome medical system can be constructed and the overflowing defensive medical treatment and waste of judicial resources can be avoided.

Cancer is regarded as a global disease and one of the leading killer diseases in the world. The reason why cancer is so widespread and often misunderstood stems from multiple factors, namely, the lack of knowledge about cancer, unfair discrimination of persons living with cancer, inadequate or inappropriate treatment provided to patients, the stigma attached to cancer, misdiagnosis and late diagnosis of persons living with cancer, as well as the inadequate provision of screening programs to detect cancer at an early stage. The combination of these issues raises alarming medico-legal problems that merit further attention. The thesis will explore the origin, nature, philosophical and clinical aspects pertaining to cancer, as well as legal issues related to cancer and oncology. The study will conclude with recommendations aimed at mitigating and addressing the shortcomings that exist in the medico-legal framework. The study will also draw on a legal comparison of relevant South African, English and American laws and regulations. Since this thesis entails focussing on medico-legal principles, the study will draw on aspects of medical law, labour law, law of contract, law of delict, constitutional law and criminal law. / Private Law / LL. D.

Using hauntology as a linchpin, this dissertation explores the undertheorized connection between intersex and disability. Building on important feminist research in the fields of intersex, queer, disability, crip, and hauntology studies, I ask, how do we understand and reconcile the contested meanings, responses to, and effects of intersex? Intersex is “a perpetually shifting phantasm” (Holmes 2002: 175), yet intersex is typically represented and treated as innate disorder, disability, or disease by medical professionals. That said, many intersex people appear to distance from disability. By engaging intersex studies with feminist disability and crip theories, however, I demonstrate that an intersex politic and intersex studies must be rooted in a disability politic and disability studies. Through a feminist disability and crip lens, I conduct a textual and critical discourse analysis of three case studies of interphobic violence or, what I term, “compulsory dyadism,” meaning the instituted cultural mandate that people cannot have intersex traits or house the “spectre of intersex” (Sparrow 2013: 29); such a spectre must be exorcised. The three case studies include nonconsensual medical interventions, sport sex testing, and employing reproductive technologies to select against intersex variations. My analyses of these case studies produce three important observations. First, intersex is presently and effectively being integrated into conventional notions of disability; second, ableist logics underpin interphobic violence; and third, compulsory dyadism is intertwined with, or is an iteration of, compulsory able-bodiedness. In recognizing this interconnection, theorizing intersex and disability together is not merely beneficial, doing so is necessary. Ultimately, my dissertation interrogates and extends questions of the ever-shifting categorization of body-minds, culturally mandated ways of being, and (the haunting effects of) pathologization. I apply pressure to the academic field of intersex studies as well as intersex activist and advocate communities to center disability in discussions concerning intersex human rights and interphobia.