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The purpose of my thesis is to analyse criminal aspects of the relationship between a doctor and an patient. The reason for my research is that I think this topic does not recive enough attention in Czech republic as it deserves. The thesis is composed of five chapters, each of them dealing with different aspects of doctors criminal lability. I dedicated m attention only to doctors criminal lability, not to the criminal liability of patient. Chapter One is introductory and defines basic terminology used in the thesis as types of lability, basic aspects of relatinship between doctor and patient, medical experiment, specific aspects of criminal lability in medicine and another terminology which is often used in medical law. The chapter is devided in nine parts. Chapter Two is dedicated to crimes which are usually committed by doctors practising their profession. The chapter is divided five parts, using the same system and order as in czech Penal Code. Chapter Three is subdivided in two parts. Part one is dedicated to euthanasia and legal problems which are united with euthanasia. Chapter three examines relevant czech legislation and problems in czech legislation united with euthanasia. This part of chapter also deals with advantages and disadvantages of euthanasia. Part two is dedicated to assisted...

The discipline of orthopaedic surgery is a fast growing surgical specialty directed at the diagnosis and management of disorders of the musculoskeletal system e.g. acute trauma, fractured or dislocated joints, elective reconstructive surgery as well as related research. The standard of care in orthopaedic surgery treatment reflects the status of its evolution and what is currently available in terms of the knowledge, surgical expertise, orthopaedic implant materials, and equipment. It is the duty of the orthopaedic surgeon to live up to the promise as best he or she can to heal when it is possible to heal and to provide the level of care expected that transcends simple surgical expertise and bio-technological intervention. The informed consent process is an often neglected but vital component of the standard of care which has to satisfy prescribed ethical and legal requirements. This research is focused on how to heighten the awareness of, and to encourage engagement within the orthopaedic surgery fraternity with the informed consent process. If the informed consent is given more recognition within this group, it will benefit the potentially vulnerable orthopaedic patient, protect the orthopaedic surgeon against litigation, and importantly, contribute to the ethical imperatives bound in a doctor-patient relationship. For this research, a vast search of the available local and international literature has been perused and my finding is that the application of Ethics and recognition of the informed consent concept within the medical community in general is gathering momentum and it must be both supported and internalized by those in orthopaedic surgical practice.

Résumé. En partant d’une description des nombreux changements de la pratique médicale depuis quelques décennies, la thèse étudie divers aspects constitutifs du malaise du médecin. L’accroissement de la puissance médicale qu’a permis la technoscience est analysée et remise dans un contexte plus large où les technologies de l’information ont une grande place. L’augmentation considérable des connaissances pose un problème de maîtrise de la science médicale. La multiplicité des observations fait qu’il y a discordance de certaines d’entre elles avec les théories médicales largement acceptées. De cette manière, le gain d’efficacité est associé à une perte de la cohérence du discours médical. Le rôle du médecin disparaît derrière la technique, qui semble pouvoir, seule, rendre tous les progrès accessibles. Le médecin devient alors un simple distributeur de services et, à ce titre, développe parfois des offres de pratiques sans fondement, voire dangereuses. Le pouvoir du médecin est évoqué, et se ramène in fine à la fourniture d’un diagnostic et d’une explication de sa maladie au patient. Le rôle des explications particulières que donne le médecin au malade est exploré à la lumière d’une conception narrative et évolutive de la vie humaine. Le rôle du médecin apparaît alors comme d’aider le patient à réécrire a posteriori le fil d’une histoire qui apparaît initialement comme interrompue par la maladie. Le rôle social de maintien de l’ordre de la pratique médicale est alors évoqué. Ensuite, par une approche descriptive du phénomène religieux, on montre que la médecine du XXIe siècle a les caractéristiques d’un tel phénomène. Entités extrahumaines, mythes, rites, tabous, prétention à bâtir une morale, accompagnement de la vie et de la mort, miracles, promesse de salut, temples, officiants sont identifiés dans la médecine « classique » contemporaine. Seule la fonction de divination de l’avenir d’un homme précis est devenue brumeuse, la technoscience permettant régulièrement du « tout ou rien » là où auparavant un pronostic précis (et souvent défavorable) pouvait être affirmé. L’hypothèse que la médecine est devenue une religion du XXIe siècle est confrontée à des textes de S. Freud, M. Gauchet et P. Boyer. Non seulement ces textes n’invalident pas l’hypothèse, mais la renforcent même. Il apparaît que le fonctionnement de l’esprit humain favorise l’éclosion de religions et donc la prise de voile de la médecine. La dynamique générale de la démocratisation de la société montre que la médecine est une forme de religion non seulement compatible avec une société démocratique, mais est peut-être une des formes accomplies de celle-ci, où chaque individu écrit lui-même sa propre histoire. Le danger qu’il y a, pour le patient comme pour le médecin, si ce dernier accepte de jouer un rôle de prêtre, est ensuite développé. Enfin, la remise dans le cadre plus général de l’existence humaine, l’évocation de la dimension de révolte de la médecine, de son essentielle incomplétude, l’acceptation d’une cohérence imparfaite permettent au médecin de retrouver des sources de joie afin de, peut-être, ne tomber ni dans un désinvestissement blasé, ni dans un cynisme blessant. Summary From a description of the many changes medical practice has undergone for a few decades, the work goes on to study many sides of the modern doctor’s malaise. The gain of power made possible by technoscience is put on a larger stage where information technologies play a major role. The abundance of knowledge makes health literacy more difficult. the great number of observations makes discrepancies with general theories more frequent. The gain in power is associated with a loss of coherence of the medical speech. The doctor’s role vanishes behind technology that seems to be the only access to all medical progresses. Doctors becomes mere service providers and go on to offer unvalidated or even harmful services on the market. Modern medical power resumes into the explanations and diagnosis given to the patient. The role of medical explanations is explored through an evolutive and narrative vision of human life. The duty of the doctors then appears to allow a new narration of the self that bridges the gap disease introduced into the patient’s life. The role of medicine in maintaining social order is mentioned. Through a sociological approach of the religious phenomenon, one can see that XXIst century medicine is such a phenomenon. Medicine knows of extrahuman entities, myths, rites, taboos, miracles, temples; priests are present in modern mainstream medicine. Some want to derive objective moral values from medicine, and it brings companionship to man from birth to death. The only departure from old religions was the weakened ability to predict the future of an individual patient: for some diseases for which survival was known to be very poor, the possibilities are now long-term survival with cure, or early death from the treatment. The hypothesis that medicine is a religion is confronted to texts from Freud S., Gauchet M. and Boyer P. Not only do they not invalidate the hypothesis, but they bring enrichment to it. Brain/mind dynamics is such that the appearance of religions is frequent, and makes the transformation of medicine into a religion easier. Society’s democratisation confronted to religion’s history shows that medicine is the most compatible form of religion within a truly democratic society, where each individual writes his own story. To become a priest brings some dangers for the patient, but also for the doctor. These dangers are discussed. This discussion is put into the larger context of human life. The revolt dimension of medicine is discussed, as is its never-ending task. Their acceptance, as that of a lack of total logical coherence can open the possibility for the doctor to enjoy his work, without being neither unfeeling nor cynical.

The patient-doctor relationship (PDR) as perceived by the patient is an important concept in primary care and psychotherapy. The PDR Questionnaire (PDRQ-9) provides a brief measure of the therapeutic aspects of the PDR in primary care. We assessed the internal and external validity of the German version of the PDRQ-9 in a representative crosssectional German population survey that included 2,275 persons aged$14 years who reported consulting with a primary care physician (PCP). The acceptance of the German version of this questionnaire was good. Confirmatory factor analysis demonstrated that the PRDQ-9 was unidimensional. The internal reliability (Cronbach’s a) of the total score was .95. The corrected item-total correlations were$.94. The mean satisfaction index of persons with a probable depressive disorder was lower than that of persons without a probable depressive disorder, indicating good discriminative concurrent criterion validity. The correlation coefficient between satisfaction with PDR and satisfaction with pain therapy was r = .51 in 489 persons who reported chronic pain, indicating good convergent validity. Despite the limitation of low variance in the PDRQ- 9 total scores, the results indicate that the German version of the PDRQ-9 is a brief questionnaire with good psychometric properties to assess German patients’ perceived therapeutic alliance with PCPs in public health research.

The patient-doctor relationship (PDR) as perceived by the patient is an important concept in primary care and psychotherapy. The PDR Questionnaire (PDRQ-9) provides a brief measure of the therapeutic aspects of the PDR in primary care. We assessed the internal and external validity of the German version of the PDRQ-9 in a representative crosssectional German population survey that included 2,275 persons aged$14 years who reported consulting with a primary care physician (PCP). The acceptance of the German version of this questionnaire was good. Confirmatory factor analysis demonstrated that the PRDQ-9 was unidimensional. The internal reliability (Cronbach’s a) of the total score was .95. The corrected item-total correlations were$.94. The mean satisfaction index of persons with a probable depressive disorder was lower than that of persons without a probable depressive disorder, indicating good discriminative concurrent criterion validity. The correlation coefficient between satisfaction with PDR and satisfaction with pain therapy was r = .51 in 489 persons who reported chronic pain, indicating good convergent validity. Despite the limitation of low variance in the PDRQ- 9 total scores, the results indicate that the German version of the PDRQ-9 is a brief questionnaire with good psychometric properties to assess German patients’ perceived therapeutic alliance with PCPs in public health research.

Ett stort antal patienter söker information på Internet för att fatta olika beslut ochförbereda sig för olika procedurer. Syftet med denna studie var att belysa hälsoochsjukvårdsinformation på Internet. Metoden var en litteraturstudie baserad på11 vetenskapliga artiklar. Resultatet visar att validerade utbildnings- ochinformationsprogram på Internet kan bidra till förbättring av patienternasegenvård. Det framkommer att dialogen mellan Internet informerade patienter ochprofessionen har ändrats. Internet anses generellt vara en resurs och stöd, menpatienterna kan uppleva det svårt att finna och förstå hälso- ochsjukvårdsinformation. Brister i kvalitén på vissa webbsidor som handlar om olikahälso- och sjukdomstillstånd förekommer. Kvalitetskontroller av webbsidor börgöras. Konklusion: Hälsoinformation på Internet har kommit för att stanna. Ominformationen har hög kvalitet och utformningen av Internetsidan möterpatienternas behov kan detta leda till att patienterna blir mer aktiva ochvälinformerade. Därmed får de mer makt och bättre resultat av sin egenvård. / A large number of patients are seeking information on the Internet to makedifferent decisions and prepare for various processes. The purpose of this studywas to highlight health information on the Internet. The method was based on aliterature review of 11 scientific articles. The result show that validated trainingand information programs on the Internet can contribute to the improvement ofpatients´ self-care. It appears that the dialogue between the Internet informedpatients and the profession has changed. The Internet is generally considered to bea resource and support, but patients can experience it difficult to find andunderstand health information. Deficiencies in the quality of some Web pagesrelated to various health and medical conditions exist. Quality controls on Webpages should be done. Conclusion: Health information on the Internet has come tostay. If the information is of high quality and the design of the Internet page meetpatients ' needs, this can lead to patients becoming more active and wellinformed.Thus, they get more power and better results from their self-care.

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In un contesto in cui il coinvolgimento e la partecipazione dei consumatori/clienti di prestazioni sanitarie è oggi più che mai all’ordine del giorno, il concetto di “patient engagement” si è sempre più imposto nella letteratura scientifica e manageriale come call to action in risposta alle sfide epidemiologiche – legate all’aumento della cronicità – ed economiche – connesse all’aumento dei costi sanitari e alla riduzione delle risorse disponibili - a cui i sistemi sanitari contemporanei devono necessariamente rispondere per evitare il collasso. Per ciò, a fronte di una letteratura sul tema ancora parziale e frammentata, definire il concetto di “patient engagement” e le sue implicazioni a vari livelli diviene cruciale per passare da una dichiarazione di intenti ad una concreta strategia di azioni volte a promuoverlo. Alla luce di queste premesse, il progetto di ricerca ambisce a rispondere ad una necessità fondativa sia da un punto di vista teroico che empirico di questo concetto e ad evidenziare possibili linee di sviluppo e ricadute applicative per una rinnovata professionalizzazione dei clinici che devono oggi riadattare le proprie pratiche professionali e ripensare alla propria identità in funzione di un paziente sempre più attivo e partecipe rispetto alle scelte legate alla gestione della propria salute. / The expectancy of patient living with chronic disease has improved significantly in the recent years due to advances in medical sciences. To address the burden of this growing demand of care, patient engagement is considered crucial as it contributes to improve health outcomes and control healthcare costs. However, many gaps still exist for its implementation starting from the lack of a shared definition and shared guidelines for medical practice based on the direct patients' care experience. In the light of this premises this dissertation will propose a sequential research design generally aimed at improving the knowledge and understanding of patient engagement and its implications for the medical practice and professionalism. To answer the overall aim of this thesis both literature reviews and qualitative methodology were used. Chapter 1 was aimed to set scene and give the readers an overview of the global cultural and societal scenario that justifies the need to deal with the topic of patient engagement. Chapter 2 and 3 consist in in-depth literature reviews aimed at shading light on the concepts featuring the participatory medicine movement and, more specifically, the one of patient engagement. An in-depth qualitative study according to the grounded theory principles was conducted and reported in chapter 4 and was aimed at deepening the heart failure patient’s perspective towards engagement in their care in order to build and experience-based model of this phenomenon. The last two chapters, based on the insights emerged from both the literature analysis and the grounded theory study, were aimed at discussing the implications of patient engagement for the clinical decision making process (chapter 5), and for training health professionals in patient engagement strategies and improving the effectiveness of their communication and relational habits with this aim (chapter 6).

L’idée qui traverse l’ensemble de la thèse est la possibilité de la rencontre de deux mouvements : Psichiatria democratica et la psychothérapie institutionnelle, de deux psychiatres Basaglia et Tosquelles, rencontre entre médecin et patient ; rencontre entre patient psychotique et le monde, monde étant compris comme la société mais aussi le groupe de soin.La réflexion est basée sur des points « d’accrochage » entre différents discours : psychanalytique, historique, sociologique, philosophique ou phénoménologique à travers un axe central : celui de la relation possible entre médecin et patient au-delà d’une logique institutionnelle close. La pratique de la rencontre, à travers leurs protagonistes : opérateurs, usagers, patients etc… Ne peut, de fait, être comprise qu’à travers les concepts qui la fondent : l’inconscient, le transfert, la pulsion, etc. Elle est, comme on l’entendra ici, un rencontre transférentielle lieu de relations interpersonnelles qui doivent savoir s’adapter à la singularité de chacun. / The main theory of the thesis is the possibility of two psychiatrical movements meeting at a crossroad: Italian "psichiatria democratica" and French "psychothérapie institutionnelle". In the study their two founders, the psychiatrists Basaglia and Tosquelles are compared as well as the relation between psychiatrist and patient and patient and world (as society but also as group of care). The observation is focused on common grounds among different disciplines, psychoanalytic, historical, sociological, philosophical and phenomenological, over a central axis: the relationship between physician and patient outside the logic of closed institutional clinics. The setting of this intellectual encounter of operators, users and patients can only be understood through the concepts that underlie it: the unconscious, the transfer, the impulse. Lastly our “encounter” is, as we'll understand it here, a transferential encounter. It is a network of interpersonal relations that must adapt to each other actor’s singularity and individuality.