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...

La thèse présentée est intitulée « Le principe d’autonomie de la volonté de la patiente enceinte avant l’accouchement: Modèle de communication hospitalière ». Le travail de recherche est essentiellement méthodologique. Il comporte également une partie d’étude empirique, des enquêtes sous forme de témoignages auprès de plus de 500 patientes ayant subi une IVG en Europe. Il contribue à un thème de recherche important, la mise en place des mécanismes juridiques nécessaires à l’évolution des stratégies de santé publique du droit à l’IVG. La thèse est structurée en deux grandes parties : I. La consécration de l’autonomie de la femme lors d’une grossesse indésirée II. Les atteintes à l’autonomie de la femme lors d’une grossesse indésirée (modèle de communication) Ce découpage met en évidence le développement juridique autour de la remise en cause de la procédure d’accès à l’IVG par un éclairage de l’autonomie de la patiente. La première partie est divisée en deux titres qui présentent le respect de l’autonomie et le recueil du consentement. Le travail de recherche se construit par une analyse des données nécessaires pour évaluer les impacts du consentement perverti par le profane et le milieu médical dans lequel il s’inscrit. La deuxième partie propose deux titres qui présentent la responsabilité médicale et l’effet relatif des responsabilités quant à l’autonomie de la femme enceinte, permettant d’analyser les limites à la détermination de la patiente, le préjudice subi de la perte d’autonomie et les inégalités qui découlent des traitements différents selon les législations en vigueur. Malgré l’impossibilité de conclure à priori sur l’autonomie du processus de décision médicale, des solutions juridiques sont néanmoins proposées dans le dernier chapitre : il s’agit d’une étude de cas pour le renforcement juridique du consentement de la patiente (2019) menée aux Hôpitaux de Genève (HUG) en Suisse permettant, notamment, une déconstruction du principe de « libre-choix » de la patiente. Loin d’entrer dans une logique critique et antinomique pro-IVG, la thèse propose d’analyser les failles procédurales (le paradoxe de la responsabilité médicale) dans une étude nourrie de réflexions juridiques sur la notion d’autonomie et le statut de la femme lors de la décision IVG. / The thesis presented is entitled "The principle of autonomy of will of the pregnant patient before giving birth : a hospital communication model. The research work is essentially methodological. It also includes a part of empirical study, surveys in the form of testimonies with more than 500 patients having undergone a VTP care, in the 3 European countries determined in the study, in France, Poland and Switzerland. It contributes to an important research theme, the establishment of the legal mechanisms necessary for the evolution of public health strategies of the VTP right. The thesis is structured in two main parts : I. The recognition of women's autonomy when deciding on the use of the VTP care. II. Violations of women's autonomy when deciding on the use of the VTP care (hospital communication model). This division highlights the legal development around the questioning of the procedure of access to the VTP care by a lighting of the autonomy of the patient. The first part is divided into two titles that show respect for autonomy and the collection of consent. The research work is constructed by an analysis of the data needed to evaluate the impact of perverted consent by the lay person and the medical community in which he is enrolled. The second part proposes two titles that present the special medical responsibility and the relative effect of responsibilities on the autonomy of the pregnant woman, allowing to analyze the limits to the determination of the patient, the harm suffered from the loss of autonomy and the inequalities that result from different treatments according to the legislation in force. Despite the impossibility of concluding a priori on the autonomy of the medical decision-making process, legal solutions are nevertheless proposed in the last chapter : it is a case study for the legal strengthening of the patient's consent (2018) conducted at the Geneva Hospitals (HUG) in Switzerland allowing, in particular, a deconstruction of the principle of "free choice" of the patient. Far from entering a critical and antinomic pro-VTP logic, the thesis proposes to analyze the procedural flaws (the paradox of medical responsibility) in a study nourished by legal reflections on the notion of autonomy and the status of women during the decision IVG.

Although current professional and public opinion support the right of the client to make an informed decision about entering and continuing in a psychotherapy or counseling relationship, research studying the effects of informed consent on client behaviors and attitudes in the medical, research, and mental health fields has resulted in equivocal findings. This study looked at the effects of an informed consent procedure on client behaviors and attitudes in a pro-life pregnancy counseling center where the center's primary goal is to reduce the number of abortion decisions among clients. Thirty of the center's clients (Experimental Group) were given an Informed Consent Sheet that explicitly stated the center's policies, procedures, and goals while another 30 clients {Control Group) were exposed to the center's regular procedures which did not include this Informed Consent Sheet. Results of subsequently administered questionnaires showed that there were no differences between groups regarding their stated intention to abort a potential pregnancy, nor were there any differences between groups on their attitudes toward their counselors and their counseling experience, in general.

Thesis (MPhil (Philosophy))--University of Stellenbosch, 2009. / ABSTRACT: The European Enlightenment secured man’s freedom from doctrinal thought. Scientific progress and technological innovation flourished in the 18th Century, radically changing the lives of all. Man’s mastery and transformation of his environment was matched by revolutionary political reform, resulting in the dissolution of empire and the transfer of power into the hands of the people. Social transformation saw the city-states of pre-modern man supplanted by a globalized community whose existence grew from time and space distantiation facilitated by the new technologies and the development of symbolic forms. These sweeping social, political and ideological changes of the 18th Century fostered the belief that man’s transformative authority was indeed his to command. Man believed he had a right to self-governance and to autonomous decision-making. Kant described moral autonomy as the freedom men have to show rational accountability for their actions and he saw in men a dignity beyond all price because of this moral autonomy. Personal autonomy is seen as the expression of the free will of individuals and is justifiably constrained by the need to respect the interests and agency of others. The principle of autonomy, in the context of medical practice, was not clearly articulated until the early 20th century. Prior to this, the ethical practice of medicine relied upon the beneficent intentions of the practitioners. The limits to patient autonomy have been delineated largely by issues of social justice based upon the need to share scarce resources fairly among members of society. However, autonomy remains a dominant principle and is most clearly exemplified by the process of informed consent obtained prior to any medical intervention. This thesis provides a conceptual analysis of autonomy in the context of informed consent. Following this, several different clinical scenarios are examined for evidence of justifiable limitations to patient autonomy. Each scenario is examined in the light of different moral theories including deontology, utilitarianism, communitarianism and principlist ethical reasoning. Kantian ethical reasoning is found to be resilient in rejecting any limitation to the autonomy principle whereas each of the other theories allow greater scope for morally-justified curtailment of individual autonomy. The thesis concludes with reflection on post-modern society in which the radicalization of what began with the European Enlightenment sees the transformation of pre-modern society into a global community in which epistemological certainty is no longer available. In this environment, the emerging emphasis on global responsibility requires ethical accountability, not only when individuals secure transactions between one another but also between individuals and unknown communities of men and women of current and future generations. The thesis concludes that patient autonomy is justifiably limited in South African medical practice because of issues related to social justice but that the impact of the new genetic technologies and post-modernity itself may in future set new limits to individual patient autonomy. / OPSOMMING: Die Europese Verligting het die mensdom bevry van verstarde, dogmatiese denke. Wetenskaplike en tegnologiese ontwikkelinge het tydens the 18de Eeu die lewens van almal radikaal verander. Die mens se bemeestering en transformasie van sy omgewing het gepaard gegaan met revolusionêre politieke hervormings wat gelei het tot die ontbinding van tradisionele politieke ryke en die oordrag van mag aan die mens. Sosiale transformasie het veroorsaak dat die politieke ordeninge van voor-moderne mense deur ‘n globale gemeenskap vervang is wat ontstaan het as gevolg van onder meer die ontkoppeling van tyd en plek (Giddens), en wat deur nuwe tegnologiese ontwikkelings en die ontstaan van simboliese vorms moontlik gemaak is. Hierdie uitgebreide ontwikkelinge het die idee laat ontstaan dat niks vir die 18de Eeuse mens onmoontlik is nie. Die mens het geglo dat hy ‘n reg het op self-bestuur en outonome besluite. Kant het die morele outonomie van die mens beskou as sy vryheid om verantwoordlikheid te neem vir sy eie rasioneel-begronde handelinge en verder het hy ‘n besondere waardigheid in die mens geïdentifiseer vanweë sy morele outonomie. Omdat ‘n mens hierdie eienskap besit, beskik hy oor ‘n hoër waardigheid as alle alle ander lewensvorme. Persoonlike outonomie is die uitoefenimg van die vrye wil van die individu en word om geregverdigde redes beperk deur die regte van ander mense. Die beginsel van outonomie met verwysing na mediese etiek het nie voor die begin van die 20ste eeu prominent geword nie. Voor hierdie tyd het mediese etiek staatgemaak op die goeie voorneme van die praktisyn. Die grense van individuele outonomie word nou bepaal deur die noodsaak van sosiale geregtigheid. Al is dit die geval, bly die beginsel van outonomie die belangrikste beginsel in die etiese debat en word meestal gesien as ‘n deel van die proses van ingeligte toestemming. Hierdie tesis verskaf ‘n omvattende ontleding van outonomie met betrekking tot ingeligte toestemming. Daarna word verskillende kliniese gevalle beskryf en ontleed, en verskeie etiese teorieë gebruik om die wyse waarop pasiënt outonomie reverdigbaar ingekort behoort te word, te bespreek. Die teorie van Kant is in staat om enige inkorting van outonomie in alle gevalle the weerstaan. Elkeen van die ander teorieë verskaf redes waarom die outonomie van individuele pasiënte legitiem ingekort mag word. Hierdie werk sluit af met besinning oor die post-moderne gemeenskap wat ‘n globale samelewing moet aanvaar sowel as die ontoereikenheid van enige kenteoretiese sekerheid. Die ontwikkelende verantwoordelikheid vir die totale mensdom in hierdie wêreld veroorsaak dat individue nie meer slegs moet besluit oor die morele verhouding met sy medemens nie, maar ook oor sy verhouding met mense van gemeenskappe wat geskei is in tyd en ruimte, insluitend sy verhouding met die mense van toekomstige generasies. Hierdie werk sluit af met die gevolgtrekking dat pasiënt outonomie regverdigbaar beperk word in die Suid Afrikaanse mediese praktyk deur die noodsaaklikheid van sosiale geregtigheid. Die verwagte impak van nuwe genetiese tegnologieë en die ontwikkeling van ‘n post-moderne gemeenskap mag nuwe beperkings bring vir pasiënt outonomie.

The selected aspects of the legal relationship of doctor, parents and minor patient - the criminal aspects. (Abstract) This paper discusses various legal aspects of the relationship, which may arise between a minor patient, his parents and his doctor (or other appropriate health professional). The most important general rule holds good also in the Czech healthcare law. The general rule says that any interference with bodily integrity, and therefore each therapeutic medical intervention, can take place only with the consent of the patient. To be eligible to make such an agreement is a crucial legal capacity according to the arrangements of the Czech Civil Code. If someone is not eligible in this way about himself decide to grant consent to an intervention, it must be done by his legal guardian. In the case of minors it is usually intended by both parents. The most important regulation of the legal issues that arise in the care of the patient is found in Act No. 20/1966 Coll. Health Care. However from the perspective of the Convention on Human Rights and Biomedicine this regulation appears to be somewhat outdated and patients and physicians (as well as other medical staff) find the law like overly complex, unintelligible and therefore unsuitable for their use. Unfortunately this law should help and serve...

Informed consent is a basic institution of health services. This work aims at comparison of the basic components of informed consent in the Czech and English law. The beginning is dedicated to the development and the current relationship between patient and doctor. The traditional paternalistic approach that was prevailing until recently in the health care will be examined more in detail. Furthermore, the work deals with the concept of informed consent as such. The components of the informed consent will be specified as well as the form of the informed consent. Disclosure of the risks and other information must precede for the informed consent to be valid and the consent also have to meet the requirements of legal actions. Text will also focus on informed consent of the minors. Finally, an advance decision will be examined including its conditions of validity. Powered by TCPDF (www.tcpdf.org)

The aim of this thesis is to describe Czech approach towards pecuniary compensation in connection with immaterial damage arising from providing medical care. Protection of patient's personality rights and eventually that of his relatives is stressed out. Over the last few decades, the issue of compensation for immaterial harm has become more significant, whereas the same could be said about the role of patient in the system of providing medical care. Regarding the fact that there is currently a period of recodification of Czech private law, it is opportunity to have hindsight of where theory, respectively judicial practice, has reached regarding immaterial damage compensations. Therewithal, it is necessary to try to describe and analyze new laws and compare them with the current laws and evaluate their positive and possible negative approaches. This thesis is divided into five chapters. The first one is an introduction and it is divided into three parts. The first one deals with the issue of medical-legal disputes, the second one focuses on the issue of sources of law and the third one on questions arising from protection of personality rights. The second chapter straightly deals with the issue of immaterial satisfaction according to the Civil Code of 1964 and discusses its purpose and questions...

Using mainly quantitative methods of evaluation, as well as patient comment assessment, this study evaluated whether changing the current informed consent process for labor epidural analgesia to a longer, more informational process resulted in a more satisfied patient. Satisfaction with the labor epidural informed consent process was evaluated using a questionnaire that was mailed and also available online. Half of the patient population was given a written labor epidural risk/benefit document at their 36-week obstetric check up. All patients received the standard informed consent. Survey responses were evaluated based on three independent variables dealing with the modality, timing, amount of informed consent information and one dependent variable, whether the patient's expectations of the epidural were met, which is equated with satisfaction. Patients in this study clearly indicated that they want detailed risk/benefit information on epidural analgesia earlier in their pregnancy. A meaningfully larger percentage of patients who received the written risk/benefit document were satisfied with the epidural process as compared to those who did not receive the document.

Dans le cadre de l’exercice de ses activités professionnelles, le médecin développe avec ses interlocuteurs des liens d’intérêts susceptibles d’influencer ses décisions et la manière dont il pratique la médecine. Ces influences peuvent s’avérer bénéfiques lorsqu’elles lui permettent de perfectionner ses connaissances et ses compétences. Toutefois, lorsqu’elles sont contraires à l’intérêt supérieur des patients, ces influences sont constitutives d’un conflit d’intérêts que le droit médical se fait un devoir d’encadrer avec plus ou moins de succès. Par ailleurs, les autorités institutionnelles sanitaires et les acteurs de la relation médicale sont également à l’origine de la production des normes de droit souple, a priori sans valeur coercitive, que le droit va faire sienne et intégrer à la norme juridique. Ainsi, les autorités éthiques, sanitaires et scientifiques, mais également les acteurs de la relation de soin et leurs représentants influencent la norme juridique médicale. L’étude du droit médical démontre, en résumé, une ambivalence de la matière à l’égard des influences exercées par les acteurs du système de santé sur la pratique de la médecine et sur les sources des normes qui l’encadre. / During the exercise of his professional activities, physician develops with his interlocutors links of interests likely to influence his decisions and the way he practices medicine. These influences can be beneficial when they allow him to perfect his knowledge and skills. However, when they are contrary to the best interests of patients, these influences constitute a conflict of interest that medical law try to manage with more or less success. In addition, the health institutional authorities and the actors of the medical relationship are also produce soft laws, without coercive value, that the law will adopt and integrate them into the legal norm. Thus, the ethical, health and scientific authorities, but also the actors of care relationships and their representatives influence medical law. In short, the study of medical law shows an ambivalence of the subject with regard to the influences exerted by the actors of the health system on the practice of medicine and on the sources of the norms that frame it.

Introduction: Little guidance is given to health professionals over how to deal with HIV disclosure complexities in the biomedical setting. Given the paucity of related research in this context, there is also little consideration of the actual effect of HIV disclosure in a given context. Social constructionist theory is an important contribution to disclosure research because it shifts the focus from a biomedical perspective to one that incorporates an individual's experience with HIV infection in a specific context. The task of this study was to develop substantive theory, with the aim of providing a theoretical framework for public health and health care practitioners to better understand HIV disclosure dynamics in the PMTCT setting. Methods: This was a qualitative study which explored the experience of disclosure amongst HIV positive pregnant women in the PMTCT context. Between 5 June – 31 November 2008, a total of 62 participants were recruited from two urban-based PMTCT programmes located within the eThekwini District, KwaZulu-Natal, South Africa. Results: Participants disclosed to two main groups: sexual partners, and family/others. Structural and relationship network factors shaped transmission risk behaviour, subsequent disclosure behaviour and outcomes. The circumstances which placed participants at risk for HIV acquisition also affected the likelihood of disclosure and health behaviour change. HIV and pregnancy diagnoses often occurred concurrently which profoundly impacted on participant's social identities and disclosure behaviour. Current HIV testing protocols within PMTCT settings often recommend disclosure to sexual partners under the assumption that couples will engage in safer behaviours, yet findings from this study indicate that this assumption should be challenged. Discussion: The study findings are synthesized in a conceptual model which offers substantive new theory over the concepts and interrelated factors that were identified to shape HIV disclosure and outcomes in the PMTCT context. The model identifies the following domains: 1) social networks and social support; 2) identity; 3) risk behaviour; 4) HIV and pregnancy diagnoses; and 5) HIV disclosure process to partners and others. Recommendations: Assumed pathways to risk reduction and HIV prevention need to be relooked and reconsidered. The conceptual model provides a proposed framework for future research, intervention design and implementation planning in the PMTCT setting. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.