Thesis (Ph.D.)--Duquesne University, 2006. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 485-518) and index.

Thesis (Ph.D.)--Victoria University (Melbourne, Vic.), 2008. / Includes bibliographical references.

Thesis (Ed.D.)--Duquesne University, 2007. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 96-107).

The aim of this thesis is to describe and evaluate legislation concerning the informed consent in the Czech legal system and propose its changes de lege ferenda. The thesis also comprises many comparisons between the Czech legislation and the foreign legislation. The first five chapters of this thesis deal with sources of legislation, informed consent as such along with information of patients as a necessary prerequisite for giving of the consent, other topics are refusal of medical care by patients and the so called advance decisions. Apart from this theoretical part the thesis also includes a practical part. The aim of this practical part is to explore implementation of legislation concerning informed consent in the everyday practice of hospitals and subsequently to compare this practice with the requirements of law. This survey was carried out by means of questionnaires, which were submitted to doctors relating theirs experience with using of informed consents in their medical practice. The purpose of this practical part is also to find out the experience and opinions of recipients of medical services, i. e. the patients, concerning different issues connected with the informed consent, also by means of the questionnaire method. Last but not least the thesis mentions many problems which are...

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)

Source: Masters Abstracts International, Volume: 46-05, page: 2674. Adviser: Carl Hacker. Includes bibliographical references.

Résumé : L’objectif de ce travail est d’étudier ce qui amène une personne malade à formuler un refus de traitement, à partir d’une triple approche. Celle du patient et de ses proches, celle des professionnels confrontés à ce refus, celle d’un groupe de réflexion éthique, pluri professionnel, rassemblant des représentants des sciences humaines, ainsi que des « citoyens ordinaires » non professionnels de santé, apportant le regard de la cité. Chercher le sens d’un refus consiste à analyser et décrypter une volonté de la personne que quelque chose se produise ou ne se produise pas, et correspond à la dialectique du don et de l’acceptation du soin. Refuser un traitement n’est pas refuser un soin. Les situations de refus constituent un champ de réflexion sur nos comportements, individuels et collectifs, nos doutes, nos incertitudes ainsi que sur des valeurs en conflit. Ce travail étudie la complexité des problèmes rencontrés à ce sujet en pratique clinique quotidienne, pour en approfondir le questionnement dans l’interaction qui se joue entre les différents acteurs. Il montre aussi l’importance des méthodes de travail à mettre en place pour favoriser l’éthique du dialogue. Face aux choix auxquels sont confrontés ceux qui assument la responsabilité de la décision, la question se pose de savoir vers quelles ressources se tourner pour favoriser la réflexion éthique, évitant l’arbitraire des convictions personnelles. / Abstract : The objective of this work is to study what brings a sick person to formulate a refusal of treatment, based on a three-pronged approach. One of the patient and his relatives, one of professionals faced with this refusal, and one of a multi-professional ethics reflection group, bringing together representatives of humanities and social sciences, as well as “ordinary citizens”, bringing the outside eye of the city. Looking for the meaning of a refusal consists of analyzing and decoding a willingness of the person that something happens or does not happen, and corresponds to the dialectic of the gift and acceptance of the care. To refuse a treatment doesn’t mean refusing care. Situations of refusal pave the way for reflection about our individual and collective behavior, our doubts, our uncertainties as well as conflicting values. This work explores the complexity of such problems encountered in daily clinical practice, in order to deepen the questioning about the interaction played between the different actors. It also shows how important it is to working methods that promote the ethics of dialogue. Considering the choices faced by those who assume the responsibility for the decision, the question arises of which resources to use to promote ethical reflection, avoiding the arbitrary nature of personal convictions.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-04, page: 2059. Adviser: Ross Shegog. Includes bibliographical references.

Contexte : Qu’ils soient parlementaires, sociétaux ou judiciaires, les débats actuels relatifs à la fin de vie font ressortir de vives préoccupations sociales, éthiques et politiques en France et dans le monde. L’affaire « Vincent LAMBERT » illustre parfaitement les enjeux de situations médicales à la frontière de la vie et de la mort et montre ainsi les limites de l’encadrement législatif des situations de fin de vie. Les rebondissements juridictionnels successifs intervenus dans cette affaire font observer à quel point la prise de décision médicale est complexe, tiraillée entre les volontés, parfois opposées, du patient, de ses proches, voire des professionnels de santé. Objectif : L’objectif de notre recherche était d’identifier les barrières rencontrées lors de la prise de décision médicale devant mettre en œuvre un refus anticipé de traitement. Il convenait de répondre à la question suivante : un refus de soins anticipé est-il une décision impossible ? Méthodes : La première partie des travaux présentés a consisté à recueillir l’avis et évaluer les connaissances des patients et de leurs accompagnants sur les moyens qui permettent à un patient d’exprimer sa volonté par anticipation. La deuxième partie a consisté dans l’identification des critères d’efficacité et d’inefficacité des directives anticipées à travers une analyse de la littérature scientifique et une recherche en droit comparé. La troisième partie présente les difficultés rencontrées dans la mise en œuvre des décisions de limitation et d’arrêt des traitements sur les plans pratique et judiciaire. Conclusion : L’ensemble des questions soulevées au cours de cette recherche suggère la nécessité de développer, en France, des mécanismes efficients d’expression anticipée de la volonté des patients et de promouvoir leur diffusion. Les personnes désirant rédiger des directives anticipées devraient pouvoir avoir accès à un dispositif garantissant le respect et l’effectivité de leur droit à refuser un traitement. Une personne dans l’incapacité d’exprimer sa volonté devrait pouvoir exercer les mêmes droits de refuser un traitement et de voir ce choix respecté qu’une personne capable de s’exprimer. / Context: The current debates concerning the end of life deal with legal, judicial and social issues. What is clear is they all highlight some serious social, ethical and political concerns in France and in the world. The case « Vincent Lambert » shows exactly the difficulties of medical situations between the life and the death of patients, which puts in evidence the limits of the legal framework. Indeed, several judicial reversals happened in this case and illustrate well how difficult it is to make a right medical decision when the patient, their relatives and medical staff have conflicting views. Objective: The objective of our research was to identify which are the difficulties when medical staff has to make a decision applying an anticipated refusal of treatment. As a consequence, the challenge was to answer the following question: is an anticipated refusal of treatment an impossible decision? Methods: Our work was divided into three parts. The first part aimed at asking patients’ opinions as well as assessing their knowledge of the different ways to express their will in advance. Then, the second part had to determine which criteria ensure a good application of advance directives. This study was based on an analysis of the scientific literature and a work in Comparative Law. In the end, the third part presents both practical and judicial problems regarding the application of a decision whose the goal is to withhold and withdraw a life-sustaining treatment Conclusion: This research has raised several issues and it draws our attention on the need to devise effective ways to give an anticipated consent about the end of life. If people want to write advance directives, they should have the possibility to do so and make sure their right to refuse a treatment is respected. In addition, even though someone is unable to give their consent because of their condition or disease, they should be able to use the same right to refuse a treatment and should be sure their decision is respected.

Le droit à la liberté de pensée, de conscience et de religion expressément reconnu à l’enfant par l’article 14 de la Convention internationale de New York adoptée en 1989 soulève de nombreuses questions. En raison de l’état de dépendance de l’enfant et de sa vulnérabilité, l’exercice de cette liberté apparaît particulièrement fragilisée. Les droits de l’enfant sont en effet menacés de toute part, tant par l’autorité publique, que par sa famille, ou par des tiers, voire par l’enfant lui-même. Les parents tout en étant les premiers protecteurs et les premiers « guides spirituels » de l’enfant pourront parallèlement représenter les premiers obstacles à l’exercice de sa liberté religieuse pleine et entière suscitant un conflit entre droits parentaux et droits de l’enfant. L’État s’érige d’ailleurs en protecteur lorsque ses parents lui font courir un risque au nom même de leurs convictions religieuses. Le juge pourra aussi connaître de conflits familiaux provoqués par un désaccord religieux. Garant de l’ordre public, l’État sera parfois amené à limiter la liberté religieuse de l’enfant et de ses parents en mettant en avant la primauté d’un intérêt social tel la sauvegarde du principe de laïcité. Il apparaît donc nécessaire de considérer la question de la liberté religieuse de l’enfant à la fois dans la sphère familiale et plus largement dans la société en nous interrogeant notamment quant à l’effectivité réelle du droit de liberté religieuse de l’enfant. Comme pour tout sujet touchant aux droits de l’enfant, la recherche de l’équilibre entre liberté et protection s’inscrit sur un chemin difficile dont témoigne l’étude du droit de l’enfant à la liberté religieuse. / The right to freedom of thought, conscience and religion expressly granted to the child under article 14 of the Convention on the Rights of the Child adopted in 1989 raises many questions. Regarding his particular dependence and vulnerability, the exercise of this liberty by the child appears particularly weaken. Children’s rights are indeed threatened from all quarters, so much by public authority as by their family or by third parties, if not by the child himself. Parents, while being his first protectors and first “spiritual guides”, can also represent the first obstacle to the full exercise of the child’s freedom of religion, therefore raising a conflict between parental and children’s rights. It is to be noticed that the State establishes itselfs as the protector of the child whenever parents endanger him even in the name of religious beliefs. The judge might also intervene within family conflicts resulting from religious disagreements. Ensuring public order as well, the State will in some cases subject child’s and parents’ freedom of religion to limitations deemed necessary in regard to the primacy of a particular social interest such as the protection of secularism. It seems therefore essential to consider the question of the child’s religious freedom within the family sphere as well as, to a larger extent, within society, while questioning the effectivity of the right of the child to religious freedom. As for any subject relating to children’s rights, the search for balance between freedom and protection is engaged on a difficult path as evidenced by this study on the right of the child to religious freedom.