Thesis (M. Phil.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 212-241).

Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Faculty of Nursing. Title from pdf file main screen (viewed on November 15, 2009). Includes bibliographical references.

Le débat entre éthique de la sacralité de la vie et éthique de la qualité de la vie se trouve au centre des discours bioéthiques (en particulier ceux en langue anglaise) depuis une quarantaine d'années. La sacralité de la vie est généralement considérée comme une éthique ancienne dont les origines remonteraient aux traditions judéo-chrétienne et hippocratique. L'éthique de la qualité de la vie, quant à elle, est souvent présentée comme une éthique moderne, née consécutivement au développement scientifique et technique qui a marqué le domaine médical depuis soixante ans. La différence entre les deux éthiques consisterait alors dans le fait que chacune d'entre elles attribuerait une valeur distincte à la vie humaine. De là découleraient des considérations morales divergentes sur certaines pratiques : euthanasie, avortement, interruption des traitements, etc. L'abondance de la littérature sur le sujet et la récurrence de l'usage des deux expressions n'empêchent pas que la portée et la signification de ces éthiques restent confuses. Cela est particulièrement évident dans les débats publics, et notamment à l’occasion de cas fortement médiatisés. Qu'entend-on par vie (humaine) ? Par sacralité ? Et par qualité ? Même au sein des « camps » apparemment bien définis, ces questions ne reçoivent pas toujours la même réponse.La présente thèse s'interroge sur la pertinence de l'opposition plus haut présentée au moyen d'une approche généalogique et d'une méthode archéologique. Elle se questionne d'abord sur l'idée commune de la sacralité de la vie et en repère les provenances multiples et hétérogènes. Celles-ci sont ensuite relues en contexte, en s'intéressant aux conditions dans lesquelles l'expression a été mobilisée, ainsi qu'aux discours qui s'y sont opposés. Ce cadre permet de porter un regard neuf sur l'apparition du débat entre éthique de la sacralité de la vie et éthique de la qualité de la vie, ainsi que sur son émergence et sa reconfiguration au sein de la bioéthique. L'enjeu est ici de fournir de nouvelles clés pour penser autrement le débat contemporain. / The debate between the sanctity of life ethic and the quality of life ethic has been at the core of bioethical discussions (especially those in English) for forty years. It is generally considered that the sanctity of life is an ancient ethic which belongs to the Judeo-Christian and to the Hippocratic traditions. The quality of life, for its part, is commonly understood as a modern ethic which was born with the scientific and technological development of the medical field started sixty years ago. It is then stated that the difference between the sanctity of life ethic and the quality of life ethic depends on the value that each ethic assigns to human life. A moral judgment about subjects as abortion, euthanasia, the withholding and withdrawal of life support, and so on, is supposed to result from this value. The literature on the subject is abundant, and the expressions “sanctity of life” and quality of life” are often used, but the meaning and the scope of these ethics remain sometimes unclear. This fact becomes more evident in the public debates, especially in the well-known cases. What (human) life, sanctity (of life), and quality (of life) mean? These questions rarely receive the same answer.The purpose of this thesis is to investigate the validity of the opposition between the sanctity of life ethic and the quality of life ethic with a genealogical approach and an archaeological method. The common idea of the sanctity of life is, first, analyzed to find its multiple and heterogeneous “descents” [provenances]. These “descends”, then, are put into context, focusing on the conditions in which the expression “sanctity of life” was mobilized, and on the discourses that opposed to it. This framework, finally, allows to bring a fresh look at the advent of the debate between sanctity of life ethic and quality of life ethic, as well as at its emergence and reconfiguration in bioethics. The challenge is to provide new keys for thinking differently the contemporary debate.

Law / LL.M.

O objeto de estudo da presente dissertação - negligência informacional médica - situa-se na esfera da responsabilidade civil médica, restringindo-se o escopo à esfera privada, que é compreendida majoritariamente, tanto pela doutrina como pela jurisprudência, como uma relação de consumo. A pesquisa empírica levanta as decisões do Superior Tribunal de Justiça STJ em seu site na internet. A partir da filtragem lexical, é constituído um corpus constituído de oito julgados analisados a partir do eixo epistêmico da Análise Crítica do Discurso ACD. Para tanto a revisão de literatura busca na dogmática jurídica suporte para compreender a responsabilidade civil médica pela violação do dever de informar. Estuda-se a natureza e o conteúdo da obrigação médica, além de analisar o direito subjetivo do consumidor à informação, bem como o dever de informar do médico contido em seu Código de Ética Médica. Investiga-se a importância do Termo de Consentimento Informado TCI para a concreta autonomia e escolha livre e consciente do pacienteconsumidor. A análise qualitativa do corpus viabilizou a caracterização da violação do dever de informar médico como uma negligência informacional / The object of this dissertation - informational medical negligence - locates itself in the sphere of medical liability, restricting the scope at the private sector, where is mostly understood, both by doctrine and case law, as a consumer relationship. The empirical research raises the decisions of the Superior Court of Justice - STJ from their website. From the lexical filtering, is constituted a corpus consisting of eight judgments, analyzed from the epistemic axis of Critical Discourse Analysis - ACD. The literature review seeks dogmatic support to understand the medical liability for violating the duty to inform. It studies the nature and content of medical obligation, and then analyzes the subjective right of consumers to information and the duty to inform of the physician contained in its Code of Medical Ethics. Investigates the importance of Informed Consent - TCI to concrete autonomy and free and conscious choice of the patient-consumer. The qualitative analysis of the corpus enabled the characterization of the violation of the physician‟s duty to inform as a informational negligence

The Council of Australian Therapeutic Advisory Groups (CATAG) (2013) define a Pharmaceutical and Therapeutics Committee (PTC) as a ‘multi-disciplinary team committee with a commitment to the overall governance of the medicines management system in health service organizations to ensure the judicious, appropriate, safe, effective and cost-effective use of medicines’. The multi-disciplinary team includes the health care providers, who are actively participating in the health care systems, such as doctors, pharmacists, nurses, administrators, finance officers, quality improvement managers and other staff members who participate in the medicine use processes according to their knowledge and skills. The major role of this committee is to evaluate and promote rational drug use by health care providers and consumers. In addition, this committee is responsible for developing systems and strategies to prevent adverse medicine reactions and medication errors, enhance rational prescribing and dispensing, provide educational activities and ensure the use of quality and cost-effective medicines. This is a cross-sectional study that was aimed at exploring the structure, activities and functions of public sector institutional Pharmaceutical and Therapeutics Committees (PTC) in the Eastern Cape (EC) Province in South Africa (SA). The primary objectives of the study were to (i) investigate and describe the structure, functions and the activities of the institutional PTCs, and (ii) explore and describe the perception of PTC secretariats on the functionality of the institutional PTCs. A purpose-designed questionnaire including both quantitative and qualitative aspects adapted from other international studies was piloted prior to being used for data collection. The secretariats of the institutional PTCs were requested to complete the questionnaire. Data were analysed using descriptive statistics for the quantitative aspects and thematic analysis for the qualitative component of the questionnaire. Data collection commenced after approval by the relevant ethics committees had been granted. The findings of the study reflected that the majority of the PTCs in the EC province, SA are district/sub-district PTCs which are a cluster of a number of health care institutions in close proximity. The PTC members were appointed by the executive authority as recommended by the literature and other guiding documents. As expected the nurses were dominant as the members of the PTCs in these district/sub-district PTCs. The secretariats were the pharmacists where pharmacists were available and chairperson were doctors. These findings correspond to the recommendations by the National Department of Health PTC policy (2015) and the studies conducted in other countries. A number of PTCs had sub-committees formed e.g. ABC analysis review committee, medicine utilization evaluation (MUE) committee and pharmacovigilance committee to optimise their functionality. Out of 15 PTCs only five PTCs with sub-committees reported functions and interventions, establishment of policies and SOPs. The rest had no outcomes or interventions reported. Poor production of policies and SOPs was observed which differs from other countries’ PTCs. The focus of sub-committees in other countries is the development of formulary and policies related to medicine use. These findings pose a question regarding the functionality and effectiveness of the existing institutional PTCs in the province. In addition, the basic documents that are required to run the PTC were unavailable in a number of PTCs. Barriers to the functionality of PTCs were reported i) Lack of pharmacists and training in PTCs. ii) The rural nature of the EC province and iii) Unavailability of resources including lack of re-imbursement of personal costs. These findings reveal that budget allocation for institutional PTCs is crucial for their functionality. It can be concluded that in the EC province the institutional PTCs which are active and effective are low in number and do not cover all geographical areas. Secondly there is a need for training and educating the PTC members on the role of the PTC members, role of sub-committees, development of policies, SOPs and the basic documents for the functionality of the committee. It is also important that during training the monitoring and evaluation of the effectiveness of the committee is emphasised. Therefore, the choice of the PTC objectives should be measurable as they can assist as indicators of effectiveness. Support by the executive authority has been observed.

Bakgrund: När en patient drabbas av hjärtstopp ingår det i allmänsjuksköterskans uppgifter att påbörja HLR för att försöka rädda patientens liv. På allmän vårdavdelning används mer avancerad behandling, så kallad S-HLR. En hjärtstoppsituation kan upplevas skrämmande för sjuksköterskan eftersom hen sannolikt behöver gå från en mer lugn till en akut situation. Det kan kännas påfrestande men kunskap och erfarenhet hjälper hen att agera. Behandlingen av hjärtstopp utförs i team tillsammans med flera professioner vilket innebär att det är viktigt med ett väl fungerande teamarbete. Syfte: Syftet med studien var att undersöka allmänsjuksköterskors upplevelser av att vårda vid ett hjärtstopp på vårdavdelningar. Metod: Som metod valdes en kvalitativ intervjustudie där resultatet baserades på sju semistrukturerade intervjuer. Intervjuerna transkriberades och analyserades sedan med en kvalitativ innehållsanalys som besvarade syftet för studien. Resultat: Resultatet visade på att det fanns fyra kategorier som bidrog till upplevelsen av hjärtstopp; ”Kunskap om hjärtstopp” där vikten av utbildning, rutiner och erfarenhet påtalades. ”När hjärtstopp pågår” som innefattar första reaktionen, HLR-situationen och att avbryta HLR. ”Att arbeta i team” bestående av samarbete, trygghet och verktyg för teamet. Slutligen ”Bearbetning efter hjärtstopp” som handlade om debriefing, uppföljning och uppfattning om hjärtstopp. Alla dessa områden bildade tillsammans en uppfattning av hjärtstopp. Slutsats: Hjärtstoppsvård är en påfrestande situation som sjuksköterskan minns länge och det är därför viktigt att avdelningarna arbetar med samtliga kategorier som framkommit i resultatet för att stödja och underlätta för de sjuksköterskor som engageras vid ett hjärtstopp på en vårdavdelning. / Background: When a patient has a cardiac arrest, it is included in the RN's duties to start CPR in order to try to save the patient's life. In the general nursing ward, more advanced treatment, so-called hospital CPR, is used. A cardiac arrest can be daunting for the nurse because they probably need to shift from a calm situation to an emergency situation. It may feel stressful, but knowledge and experience helps the RN to act. The treatment of cardiac arrest is performed in teams with several professions which means that it is important to have a good teamwork. Aim: The aim of the study was to investigate the RN’s experiences of caring for a cardiac arrest occurring at nursing wards. Method: As a method, a qualitative interview study was chosen, based on seven semi- structured interviews. The interviews were transcribed and then analyzed with a qualitative content analysis that suited the aim of the study. Result: The result showed that there were four categories that contributed to the experience of cardiac arrest; "Knowledge of cardiac arrest", emphasizing the importance of education, routines and experience. "When cardiac arrest is in progress" that includes the first response, CPR situation, and termination of CPR. "Working in team" consisting of cooperation, safety and instruments for teamwork. Finally, "Processing after cardiac arrest" that involved debriefing, follow-up and perception of cardiac arrest. All of these areas together formed an idea of ​​cardiac arrest. Conclusion: Cardiac arrest is an urgent situation that the nurse remembers for a long time, and it is therefore important that the wards work with all categories identified in the results to support and facilitate the nurses engaged in a cardiac arrest in a nursing ward.

Introduktion: Operationssjuksköterskor har begränsade möjligheter till att möta patienten och studier fokuserar huvudsakligen på den intraoperativa vården. Operationssjuksköterska möter patienten ett kort ögonblick strax innan operationen och oftast tillsammans med övriga i operationsteamet. Syfte: Syftet var att beskriva operationssjuksköterskans erfarenheter av möten med patienten under den perioperativa vårdprocessen. Metod: Studien var en kvalitativ intervjustudie. Totalt genomfördes sex intervjuer med operationssjuksköterskor med minst tre års yrkeserfarenhet, verksamma vid ett sjukhus i mellersta Sverige. Data analyserades med kvalitativ innehållsanalys. Resultat: I analysen framkom tre kategorier med tillhörande underkategorier som beskrev operationssjuksköterskans möte med patienten inom perioperativ vård: Etablera en första kontakt - ge sig till känna, skapa en vårdrelation, att göra patienten delaktig i vården; Att säkerställa patientens vård - att förhindra att patienten utsätts för skador, ha möjlighet att kunna utvärdera genomförda omvårdnadsåtgärder; Att bevara patientens integritet – viljan att göra gott. Slutsats: I mötet med patienten skapas en vårdrelation, vilket medför att patienten blir delaktig i vården och operationssjuksköterskan ges möjlighet att kunna planera, genomföra och utvärdera genomförda omvårdnadsåtgärder, vilket bidrar till utveckling av patientens vård och operationssjuksköterskans kompetens. / Introduction: Operating theatre nurses have limited opportunities to meet the patient and studies focuses mainly on the intraoperative care. Operating theatre nurse meets the patient briefly just before the surgery together with other members of the surgical team. Aim: The aim of the study was to describe operating theatre nurse´s experiences of meeting with the patient during the perioperative nursing process.Method: The study was a qualitative interview study. In total six interviews with operating theatre nurses with at least three years of professional experience and were working at a hospital in central Sweden. The data was analysed through a content analysis. Results: The analysis revealed three categories with associated subcategories that described the operating theatre nurses´ meeting with the patient in the perioperative care: To establish a first contact – to make themselves known, to create a care relationship, making the patient involved in care; To ensure patient care – to prevent patient exposure to injuries, having the opportunity to evaluate the implemented care measures; To preserve patient privacy – wanting to do good. Conclusion: In the meeting with the patient a care relationship is created, which makes the patient involved in the care and the operating theatre nurse is given the opportunity to plan, to implement and to evaluate the implemented care measures, which contributes to the development of the patient´s care and the operating theatre nurse´s competence.

Cette étude se propose d’introduire auprès du lectorat français, dans la mesure de nos moyens et de notre axe problématique, l’œuvre encore méconnue de Viktor von Weizsäcker (1886-1957), susceptible pourtant de figurer dans la lignée des penseurs et praticiens inspirés par la phénoménologie, au même titre que Ludwig Binswanger dans le domaine de la psychiatrie. En effet, si les concepts forgés par l’auteur dépaysent et déroutent parfois le lecteur – mais aussi le surprennent et l’enhardissent –, ce dernier ne sera toutefois pas sans remarquer la présence, profondément inscrite dans la trame du texte, d’un fil rouge, celui de la démarche phénoménologique même : à savoir la tâche de remettre en lumière inlassablement le sujet, sans cesse occulté par le monde des objets. À rebours de toute réification, la médecine psychosomatique de Weizsäcker découvre que chaque maladie est chargée de sens, et en tire les conséquences théoriques sur la nature du corps humain, et par extension de la matière toute entière. Nous voulons déterminer si la pensée de Weizsäcker peut nous permettre de fonder en raison la thèse de la conscience corporelle, c’est-à-dire de la nature conscience du corps, et par extension, de la matière. Cette idée serait porteuse d’une nouvelle lecture du monde, réconciliatrice et bienfaisante. / This study intends to introduce the French lectors to the opus of Viktor von Weizsäcker (1186-1957), in the limit of our capacities and of our own problematical axis. While still largely unknown, he is yet one of the thinker and practitioner who has been inspired by phenomenology, like for instance Ludwig Binswanger in the psychiatrical aera. Indeed, if the concepts forged by the author can surprise the lector - as well as they can stimulate him - one can note however the presence of a common thread, deeply inscribed in the text itself, that is, the very phenomenological way of thinking or the unremitting task of questionning the subject by freeing it from the world of objects. Against any reification, the psychosomatical medicine of Viktor von Weizsäcker reveals that each disease is full of meanings, and concludes from there to the real nature of human body, as well as to the real nature of matter itself. We would like to etablish whether the thinking of Weizsäcker can allow us to ground the thesis of the bodily consciousness – namely, of the conscious nature of the body, and then, of the conscious nature of matter. This idea would bear a new lecture of the world, bringing reconciliation and goodness.

Introduction: Licensed medical personnel (henceforth LMP) experience ethical problems related to undertaking care duties in combat zones. When employed in the Armed Forces they are always under the command of tactical officers (henceforth TOs). Aim: The overall aim was to explore everyday ethical problems experienced by military medical personnel, focusing on licensed medical personnel in combat zones from a descriptive and normative perspective. A further aim was to explore leadership challenges in leading licensed medical personnel. Methods: For the research descriptive, explorative (inductive and abductive) and normative designs were used. Data collection was undertaken by using different methods. Altogether 12 physicians, 15 registered nurses, seven combat lifesavers and 15 tactical officers were individually interviewed. The participants were selected by strategic (I), purposive (II) and theoretical sampling (III). The interviews were analyzed by using qualitative content analysis. Study III used classic grounded theory and study IV was a normative analysis of an ethical problem based on the idea of a wide reflective equilibrium. Results: We found that LMP experience ethical problems related to dual loyalty when serving in combat zones. They give reasons for undertaking, or not, military duties that can be seen as combat duties. Sometimes they have restricted reasons for undertaking these military duties. Furthermore, LMP are under the command of TOs who found it challenging when leading LMP, since TOs have to unify LMP in the unit. The unifying makes it difficult since LMP experience dual loyalty. Conclusions: LMP experience dual loyalty in combat zones. The reason maybe that humanitarian law and the medical ethical codes are not clear-cut or explicit about how to be interpreted around these everyday ethical problems in internal military operations. In order to fit in todays context humanitarian law needs to be revised. Furthermore, LMP need further training in parallel with reflections on ethical problems in order to adapt to the combat zones of today.