On observe des disparités importantes en matière de santé entre les Autochtones et les non-Autochtones au Canada. Ces inégalités démontrent l’importance d’agir afin de décoloniser les systèmes de santé canadiens et nous amène à nous demander si une approche fondée sur les droits pourrait constituer une solution efficace pour améliorer la situation. Ce mémoire vise donc à déterminer s’il existe, dans le contexte juridique canadien, un droit autochtone à la santé qui permettrait aux peuples autochtones de présenter leurs revendications et d’assurer l’imputabilité des gouvernements canadiens. Pour y répondre, nous analysons d’abord les disparités en matière de santé à partir des données épidémiologiques disponibles et de la théorie des déterminants fondamentaux de la santé. Nous procédons ensuite à une analyse du droit constitutionnel canadien et du droit international afin de déterminer la mesure dans laquelle ils pourraient servir à la revendication d’un droit à la santé par les peuples autochtones dans le contexte juridique national. Ce mémoire délimite quatre fondements juridiques potentiels rattachés à l’article 35 de la Loi constitutionnelle de 1982 qui pourraient fonder un droit autochtone à la santé : 1) le droit à l’autonomie gouvernementale; 2) les droits issus de traités; 3) les droits ancestraux spécifiques; et 4) les droits ancestraux génériques fondés sur la normativité internationale. Une approche fondée sur les développements jurisprudentiels récents en matière de droit de la personne favorise aussi une compréhension approfondie de l’étendue des obligations des gouvernements canadiens envers les peuples autochtones en matière de santé. Cela nous mène à conclure que le droit canadien ne permet pas d’établir l’existence d’un droit à la santé absolu pour les Autochtones, mais qu’un tel droit peut néanmoins exister sous certaines formes plus spécifiques qui répondent au besoin de prévisibilité du droit. / There are significant health disparities between Aboriginal and non-Aboriginal peoples in Canada. These inequalities highlight the importance of decolonizing Canadian health care systems and lead us to wonder whether a rights-based approach could constitute an effective solution to improve the situation. This thesis therefore aims to determine whether there exists, in the Canadian legal context, an Aboriginal right to health that would allow Aboriginal peoples to articulate their claims and ensure the accountability of Canadian governments. To answer this, we first analyze health disparities based on available epidemiological data and the theory of fundamental determinants of health. We then proceed to an analysis of Canadian constitutional law and international law to determine the extent to which they could be used for the assertion of a right to health by Indigenous peoples in the national legal context. This thesis delineates four potential legal bases flowing from section 35 of the Constitution Act, 1982, that could serve as a basis for argument in support of an existing Aboriginal right to health: 1) self-government rights; 2) treaty rights; 3) specific Aboriginal rights; and 4) generic Aboriginal rights based on international normativity. An approach grounded in recent human rights case law developments also serves to foster greater understanding of the extent of Canadian governments' obligations towards Indigenous peoples with respect to health. This analysis leads us to conclude that Canadian law do not support the existence of an unlimited right to health for Aboriginal peoples, but that such rights can nevertheless exist in more specific forms that respect the need for legal predictability.

There are thousands of desperate people globally who need a kidney for transplantation. The number of people who require a kidney transplant continues to escalate faster than the number of kidneys available for a transplant. The aim of this dissertation is to examine and analyse the judicial framework pertaining to kidney transplants in South Africa. The examination is conducted within the framework of the South African Constitution and the National Health Act 61 of 2003. The specific focus of this dissertation is to determine whether the payment of kidney donors could be regarded as constitutionally acceptable. A comparative study is undertaken, with Singapore and Iran as a background against which recommendations for the South African regulatory framework are made. The most important finding is that people should at least be granted the choice whether they would prefer to receive payment for their kidney donations or not. / Jurisprudence / LL.M.

Medical expenses refer to all medical and related expenditure reasonably incurred in respect of bodily injuries sustained. This then constitutes the primary loss in incidences of bodily injuries. However, it is accepted that bodily injuries infringe in the main the non-patrimonial aspects of the individual’s bodily integrity which is a personality right. Notwithstanding this trite provision of our law, the dissertation contends that medical expenses as a head of damages is inherently patrimonial. In essence, the true nature of medical expenses as a loss that ultimately affects both the patrimonial and non-patrimonial interests of the individual, is considered. Furthermore, the dissertation analyses the assessment and quantification mechanisms in our law, and makes a comparative study with the corresponding positions in England and Australia. The intended outcome of this dissertation is to provide clear guidelines for the award of damages, particularly where future loss is involved. / Private Law / LLM

INTRODUÇÃO: Esta tese trata da discussão em torno às perguntas necessárias para compor uma agenda política estratégica da reforma hospitalar brasileira. Buscou-se construir argumentos sobre a relevância de abordar nessas perguntas a grande insuficiência da oferta de leitos hospitalares, como indicador da falta de resposta oportuna em volume e qualidade para materializar a resposta às necessidades da população e garantir os direitos humanos e sociais à saúde, conforme os preceitos constitucionais de 1988. MÉTODOS: O estudo adotou um enfoque desde a perspectiva de política de saúde, o que nos remete ao debate sobre processo e poder, destacando os ciclos de formulação e implementação de políticas, a hierarquização desses debates como de política estratégica (High Politics) ou setorial (Low Politics) e as condições requeridas em termos de atores e espaços de decisão a considerar. Realizou-se a revisão da experiência internacional para identificar as referências do número e perfil de leitos requeridos para atender populações nacionais em seus territórios e também foram resgatados os parâmetros adotados no Brasil desde o Estado Novo. Para a análise da oferta hospitalar entre 2005 e 2014, foram utilizados os dados secundários extraídos do Cadastro Nacional de Estabelecimentos em Saúde - CNES, do Sistema de Informações Ambulatoriais e Hospitalares - SIA / SIH, da Agencia Nacional de Saúde Suplementar - ANS e do Instituto Brasileiro de Geografia e Estatística - IBGE. RESULTADOS: 1. O número e tipo de leitos necessários e o número, porte, tipo e características sistêmicas dos serviços hospitalares que os abrigariam, são temas que se consideraram relevantes para compor as perguntas para a agenda estratégica em debate. 2. A análise da política do período 2004 a 2014 permite identificar a fragmentação e descontinuidade das ações mesmo obtendo resultados pontuais de melhora, mas afastando-se da promessa estratégica de algumas agendas ensaiadas no período. 3. Ganhou destaque a diminuição continuada do estoque geral de leitos e de leitos para o SUS, alcançando níveis muito inferiores a qualquer parâmetro comparativo de outros sistemas universais de saúde, particularmente quando adotou-se o critério de leitos efetivos para examinar a oferta de leitos e seu desempenho. Na Saúde Suplementar houve aumento de leitos, porém queda no número por mil assegurados dado o crescimento das coberturas hospitalares no período. CONCLUSÕES: A crise persistente de acesso hospitalar constitui razão para construir uma agenda estratégica para a reforma hospitalar brasileira. Ao buscar o caminho para elevar o tema da crise hospitalar a um tratamento de alta política, foram mapeados: o conteúdo de política hospitalar dos planos estaduais de saúde, documentos técnicos estaduais e organogramas de coordenação da atenção hospitalar estadual, examinando-se a possibilidade dos governos estaduais liderarem no processo de regionalização a construção de uma agenda política estratégica estadual e nacional, fortalecendo o diálogo entre os entes federados, incluindo seus próprios prestadores e os prestadores não estatais particularmente os filantrópicos, além de estender o diálogo com o corpo médico e os usuários entendidos como cidadãos sujeitos de direitos. Para alicerçar este caminho possível se apresenta o processo de elaboração participativa de planos diretores de redes e hospitais por estados e suas regiões, como forma de construção de comunidades epistêmicas e suas projeções para a sustentação de uma agenda para a alta política, orientada a alcançar 4 leitos por 1000 habitantes em 20 anos de esforço sustentado / INTRODUCTION: This thesis addresses the debate on the questions that should be part of a strategic political agenda of the Brazilian hospital reform. The purpose is to develop arguments on the relevance that such questions should approach the huge insufficient supply of hospital beds, as an indicator of the lack of timely answer, in number and quality, to materialize people\'s needs, and therefore to guarantee the human and social rights to health, according to the 1988 constitutional principles. METHODS: This study adopts the approach from the health policy perspective, referring us to debates on process and power, and outlining the cycles of policy formulation and implementation, as well as the classification of these debates as strategic policy (High Politics) or sectorial policy (Low Politics), and the required conditions in terms of actors and decision-making spaces. A review of international experience was carried out to identify data on number and types of hospital beds necessary to attend national populations in their territories; moreover a review of the parameters adopted in Brazil since President Vargas\' dictatorship, known as the New State (1937-1945), was also carried out. For the analysis of the hospital supply between 2005 and 2014, we used secondary data drawn from the National Health Facilities Register - CNES, both the Ambulatory and Hospital Information Systems - SIA / SIH, National Regulatory Agency for Private Health Insurance and Plans - ANS, and Brazilian Institute of Geography and Statistics - IBGE. RESULTS: 1. The topics considered relevant to set the issues for the strategic agenda are: number and type of necessary beds; and number, size, type and systemic characteristics of the hospital services that would provide the beds. 2. The political analysis of the period between 2004 and 2014 allows us to identify fragmentation and discontinuity of actions, limited improvement, and failure to fulfil the strategic promise of some agendas that were tried out during that time frame. 3. The on-going decrease in the total number of national hospital beds and at the Unified Health System (SUS) is outlined, showing much lower levels than any comparative parameter of other universal national health systems, particularly when considering effective beds in the analysis of beds\' supply and its performance. In Private Health, there has been an increase in beds, but also a decrease in the number per 1,000 insureds in view of the increase in the insurance coverings in that period. We refer the persistent crisis of the hospital access as the reason to build a strategic agenda for the Brazilian hospital reform. CONCLUSIONS: In our effort to find a path that could elevate the hospital crisis\' topic to be addressed as a high politics, we delineated the content of hospital policy in Brazilian States\' health plans, technical documents, and organization charts of their hospital care coordination; considering the possibility of States\' governments lead, in the regionalization process, the development of both state and national strategic political agenda; as well as strengthen dialogue among the federated entities and the non-state providers, especially the philanthropic ones; and also extend the dialogue with medical professionals and service users who should be regarded as citizens-subjects endowed with rights. To pave this possible path we indicate the process of participative development of director plans of hospitals networks for the States and their regions, as a mean of developing epistemic communities and their projections to the sustainability of an agenda for high politics aimed to achieve 4 beds for 1,000 inhabitants in 20 years of sustained effort

Medical expenses refer to all medical and related expenditure reasonably incurred in respect of bodily injuries sustained. This then constitutes the primary loss in incidences of bodily injuries. However, it is accepted that bodily injuries infringe in the main the non-patrimonial aspects of the individual’s bodily integrity which is a personality right. Notwithstanding this trite provision of our law, the dissertation contends that medical expenses as a head of damages is inherently patrimonial. In essence, the true nature of medical expenses as a loss that ultimately affects both the patrimonial and non-patrimonial interests of the individual, is considered. Furthermore, the dissertation analyses the assessment and quantification mechanisms in our law, and makes a comparative study with the corresponding positions in England and Australia. The intended outcome of this dissertation is to provide clear guidelines for the award of damages, particularly where future loss is involved. / Private Law / LLM

INTRODUÇÃO: Esta tese trata da discussão em torno às perguntas necessárias para compor uma agenda política estratégica da reforma hospitalar brasileira. Buscou-se construir argumentos sobre a relevância de abordar nessas perguntas a grande insuficiência da oferta de leitos hospitalares, como indicador da falta de resposta oportuna em volume e qualidade para materializar a resposta às necessidades da população e garantir os direitos humanos e sociais à saúde, conforme os preceitos constitucionais de 1988. MÉTODOS: O estudo adotou um enfoque desde a perspectiva de política de saúde, o que nos remete ao debate sobre processo e poder, destacando os ciclos de formulação e implementação de políticas, a hierarquização desses debates como de política estratégica (High Politics) ou setorial (Low Politics) e as condições requeridas em termos de atores e espaços de decisão a considerar. Realizou-se a revisão da experiência internacional para identificar as referências do número e perfil de leitos requeridos para atender populações nacionais em seus territórios e também foram resgatados os parâmetros adotados no Brasil desde o Estado Novo. Para a análise da oferta hospitalar entre 2005 e 2014, foram utilizados os dados secundários extraídos do Cadastro Nacional de Estabelecimentos em Saúde - CNES, do Sistema de Informações Ambulatoriais e Hospitalares - SIA / SIH, da Agencia Nacional de Saúde Suplementar - ANS e do Instituto Brasileiro de Geografia e Estatística - IBGE. RESULTADOS: 1. O número e tipo de leitos necessários e o número, porte, tipo e características sistêmicas dos serviços hospitalares que os abrigariam, são temas que se consideraram relevantes para compor as perguntas para a agenda estratégica em debate. 2. A análise da política do período 2004 a 2014 permite identificar a fragmentação e descontinuidade das ações mesmo obtendo resultados pontuais de melhora, mas afastando-se da promessa estratégica de algumas agendas ensaiadas no período. 3. Ganhou destaque a diminuição continuada do estoque geral de leitos e de leitos para o SUS, alcançando níveis muito inferiores a qualquer parâmetro comparativo de outros sistemas universais de saúde, particularmente quando adotou-se o critério de leitos efetivos para examinar a oferta de leitos e seu desempenho. Na Saúde Suplementar houve aumento de leitos, porém queda no número por mil assegurados dado o crescimento das coberturas hospitalares no período. CONCLUSÕES: A crise persistente de acesso hospitalar constitui razão para construir uma agenda estratégica para a reforma hospitalar brasileira. Ao buscar o caminho para elevar o tema da crise hospitalar a um tratamento de alta política, foram mapeados: o conteúdo de política hospitalar dos planos estaduais de saúde, documentos técnicos estaduais e organogramas de coordenação da atenção hospitalar estadual, examinando-se a possibilidade dos governos estaduais liderarem no processo de regionalização a construção de uma agenda política estratégica estadual e nacional, fortalecendo o diálogo entre os entes federados, incluindo seus próprios prestadores e os prestadores não estatais particularmente os filantrópicos, além de estender o diálogo com o corpo médico e os usuários entendidos como cidadãos sujeitos de direitos. Para alicerçar este caminho possível se apresenta o processo de elaboração participativa de planos diretores de redes e hospitais por estados e suas regiões, como forma de construção de comunidades epistêmicas e suas projeções para a sustentação de uma agenda para a alta política, orientada a alcançar 4 leitos por 1000 habitantes em 20 anos de esforço sustentado / INTRODUCTION: This thesis addresses the debate on the questions that should be part of a strategic political agenda of the Brazilian hospital reform. The purpose is to develop arguments on the relevance that such questions should approach the huge insufficient supply of hospital beds, as an indicator of the lack of timely answer, in number and quality, to materialize people\'s needs, and therefore to guarantee the human and social rights to health, according to the 1988 constitutional principles. METHODS: This study adopts the approach from the health policy perspective, referring us to debates on process and power, and outlining the cycles of policy formulation and implementation, as well as the classification of these debates as strategic policy (High Politics) or sectorial policy (Low Politics), and the required conditions in terms of actors and decision-making spaces. A review of international experience was carried out to identify data on number and types of hospital beds necessary to attend national populations in their territories; moreover a review of the parameters adopted in Brazil since President Vargas\' dictatorship, known as the New State (1937-1945), was also carried out. For the analysis of the hospital supply between 2005 and 2014, we used secondary data drawn from the National Health Facilities Register - CNES, both the Ambulatory and Hospital Information Systems - SIA / SIH, National Regulatory Agency for Private Health Insurance and Plans - ANS, and Brazilian Institute of Geography and Statistics - IBGE. RESULTS: 1. The topics considered relevant to set the issues for the strategic agenda are: number and type of necessary beds; and number, size, type and systemic characteristics of the hospital services that would provide the beds. 2. The political analysis of the period between 2004 and 2014 allows us to identify fragmentation and discontinuity of actions, limited improvement, and failure to fulfil the strategic promise of some agendas that were tried out during that time frame. 3. The on-going decrease in the total number of national hospital beds and at the Unified Health System (SUS) is outlined, showing much lower levels than any comparative parameter of other universal national health systems, particularly when considering effective beds in the analysis of beds\' supply and its performance. In Private Health, there has been an increase in beds, but also a decrease in the number per 1,000 insureds in view of the increase in the insurance coverings in that period. We refer the persistent crisis of the hospital access as the reason to build a strategic agenda for the Brazilian hospital reform. CONCLUSIONS: In our effort to find a path that could elevate the hospital crisis\' topic to be addressed as a high politics, we delineated the content of hospital policy in Brazilian States\' health plans, technical documents, and organization charts of their hospital care coordination; considering the possibility of States\' governments lead, in the regionalization process, the development of both state and national strategic political agenda; as well as strengthen dialogue among the federated entities and the non-state providers, especially the philanthropic ones; and also extend the dialogue with medical professionals and service users who should be regarded as citizens-subjects endowed with rights. To pave this possible path we indicate the process of participative development of director plans of hospitals networks for the States and their regions, as a mean of developing epistemic communities and their projections to the sustainability of an agenda for high politics aimed to achieve 4 beds for 1,000 inhabitants in 20 years of sustained effort

There are thousands of desperate people globally who need a kidney for transplantation. The number of people who require a kidney transplant continues to escalate faster than the number of kidneys available for a transplant. The aim of this dissertation is to examine and analyse the judicial framework pertaining to kidney transplants in South Africa. The examination is conducted within the framework of the South African Constitution and the National Health Act 61 of 2003. The specific focus of this dissertation is to determine whether the payment of kidney donors could be regarded as constitutionally acceptable. A comparative study is undertaken, with Singapore and Iran as a background against which recommendations for the South African regulatory framework are made. The most important finding is that people should at least be granted the choice whether they would prefer to receive payment for their kidney donations or not. / Jurisprudence / LL.M.