The subject of this thesis is one very important relationship of health care - the doctor- patient-relationship. During a recent decades a big attention was paid to this theme both on international and czech field. In the Czech Republic the doctor-patient-relationship went through the essential change, when instantly changed from a paternalistic relationship to a partnership. Many legal changes followed this change finishing it by accepting the Act on Healthcare Services which for example describes rights and duties of subjects of this relationship. The first part is dedicated to a doctor-patient-relationship itself. Its history and evolution, placement in a legal system, legal form. One part is dedicated to an ethic aspect of doctor-patient-relationship. The second part discusses about rights and duties of both participants of this relationship. Specifically, rights determined by the Act on Healthcare Services. The third part is dedicated to detailed analysis of some basic patient's rigths and the doctor's duties characterizing doctor-patient-relationship in its current form. These are informed consent, where I describe, why it is needed. I was concerned about its requisites, possibility to abandon informed consent, to informed dissent including its form while a short look on an issue of...

Introdução: O avanço tecnológico da medicina, sem dúvida trouxe aspectos positivos ao homem como salvar vidas. Em contrapartida, tem contribuído de forma desmedida para o prolongamento dessas, o que tem gerado diversos questionamentos do ponto de vista bioético principalmente na área da Terapia Intensiva. Ambiente esse, que com frequência se depara com pacientes em fase de terminalidade da vida e com perda da capacidade de exercício da autonomia. Objetivos: Avaliar o posicionamento dos médicos que atuam em Unidades de Terapia Intensiva (UTIs) diante de diretivas antecipadas de vontade (DAV) de pacientes e como objetivos específicos, avaliar o conhecimento e valores associados às DAV; identificar possíveis fatores que possam interferir na tomada de decisão; avaliar o desenvolvimento psicológico-moral destes médicos como meio de verificar a capacidade de tomada de decisão e comparar estas características, entre os médicos que atuam em Belém do Pará e em Porto Alegre. Métodos: Estudo transversal de base populacional, envolvendo UTIs de seis hospitais públicos, cinco no Pará e um no Rio Grande do Sul. Dois instrumentos foram utilizados para a coleta dos dados, um questionário autopreenchido composto por dados sociodemográficos e características dos profissionais, questões relacionadas ao tema e quatro diferentes cenários clínicos apresentados para avaliar o posicionamento dos médicos. O segundo instrumento buscou avaliar o desenvolvimento psicológico-moral dos profissionais. Os dados foram avaliados de forma quantitativa e qualitativa. Resultados: Os 115 participantes da pesquisa apresentaram uma média de idade de 40,59±9,06 anos. A maioria relatou prática religiosa (54,8%) com associação estatisticamente significativa entre os grupos estudados (p<0,001), em Belém 76,4% dos médicos praticavam uma religião e em Porto Alegre 35%, predominando a religião católica. Dentre os participantes, a maioria tinha mais de 10 anos de formado (66,9%), o mesmo se observando com o tempo de atuação em UTI (50,4%). Dentre esses, a maioria era Intensivista (63,5%). Três associações significativas foram observadas em relação às especialidades: a titulação em Medicina Intensiva, se associou com Porto Alegre (P<0,001) e a Cirurgia Geral (P<0,001) e ausência de titulação especializada (P<0,005) com Belém. Quanto ao desenvolvimento psicológico-moral, observou-se quatro estágios: conformista (2,5%), consciencioso (44,1%), autônomo (44,1%) e integrado (6,8%). Quanto ao conhecimento sobre DAV, a maioria dos participantes (83,5%) afirmou conhecer. Com relação à utilização desse instrumento, (80,9%) foi favorável, seguido dos que talvez utilizasse (14,8%) e não utilizaria (4,3%), com associação significativa entre os grupos (P=0,013), evidenciando-se, resposta "sim" para Porto Alegre e "não" para Belém. A principal justificativa para a utilização das DAV foi a autonomia (67,7%). Entre os participantes que talvez utilizasse esse documento, a justificativa foi que, esse poderia limitar a decisão (29,3%). Na necessidade de uma legislação específica, a maioria dos médicos foi favorável (88,7%), havendo uma associação estatisticamente significativa (P=0,045), entre os grupos, com Belém, se associando a uma posição mais legalista. A justificativa mais utilizada para uma legislação foi o amparo legal (53,9%). Em caso de legislação específica a maioria dos médicos (81,7%) acataria a DAV. No primeiro cenário, a maioria dos médicos (94,0%) levaria em consideração a vontade do paciente em diferentes níveis, havendo uma associação significativa entre os grupos (P=0,004). No segundo cenário, 80,0% considerou a vontade do paciente determinante. No terceiro, (96,5%) levaria em consideração a vontade do paciente em diferentes graus, com destaque (71,3%) para a vontade do paciente ser determinante, com associação significativa entre os grupos (P=0,003). No quarto cenário, a maioria dos médicos (86,1%) também levaria em consideração a vontade do paciente em diferentes graus, com associação significativa (P=0,001) entre os grupos. Quanto à justificativa para implantar ou não implantar terapêutica fútil, (83,5%) consideraram ambas justificáveis, com significância estatística entre os grupos (P=0,001). Quanto aos fatores que influenciam a tomada de decisão, os mais frequentes foram, os aspectos éticos (94,8%), legais (88,7%), morais (73,9%), técnicos (67,0%) e aspectos religiosos do paciente (52,2%). Conclusão: É possível concluir que os médicos participantes deste estudo conhecem e utilizariam as diretivas antecipadas de vontade, mas reconhecem a necessidade de ter um amparo legal específico para esta questão. Os dados gerados neste estudo, evidenciam que os médicos valorizam a vontade dos pacientes e buscam realizar decisões compartilhadas. Além disto, fica evidente a influencia regional nos fatores associados ao processo de tomada de decisão. / Introduction: Technological advancements in the medical field have undoubtedly brought forth positive aspects to man such as saving lives. On the other hand, these advancements have contributed fearlessly to prolong these lives raising a great deal of questioning from a bioethical viewpoint mainly in the area of Intensive Therapy. Such area frequently deals with patients in the end of life and some who has lost the capacity to exercise autonomy. Objectives: to evaluate the opinion of physicians who work at Intensive Care Units (ICUs) regarding advance directives (AD) of patients and as specific objectives to evaluate the knowledge and values associated to AD; identify possible factors that can interfere with decision making process; evaluate the psychological-moral development of these physicians as a means to exam their capacity to make decision and compare these features between physicians who work in Belém do Pará and in Porto Alegre. Method: This is a transversal study based on population involving ICUs of six public hospitals five in Pará and one in Rio Grande do Sul. Two tools were used in data collection process, a self-completed questionnaire composed of social demographic data and features of the professional, questions related to the theme and four different settings were presented to evaluate the position of the physicians. The second tool sought to assess the psychological-moral development of the professionals. The data were assessed in terms of quantity and quality. Results: The 115 participants in the research were between de 26 a 63 years old, with mean age 40,59±9,06. Most of them reported some kind of religious practice (54,8%) showing significant statistic association between the groups evaluated (p<0,001), in Belém 76,4% of the physicians had some religious practice and in Porto Alegre 35%, Catholicism predominating. Amongst the participants most of them had been graduated for more than 10 years (66,9%), the same was seen regarding time of activity at ICU (50,4%). Most of these were Intensive Care Physicians (63,5%). Three significant associations were perceived in relations to the specialties: entitling in Intensive Medicine associated to Porto Alegre (P<0,001) and General Surgery (P<0,001) and the lack of specialized entitling (P<0,005) to Belém. Regarding to psychological-moral development, four stages were observed: conformist (2,5%), conscientious (44,1%), autonomous (44,1%) and integrated (6,8%). In regard to knowledge of AD, most of the participants (83,5%) claimed to know it. In relation to the use of this tool (80,9%) was favorable, followed by those who would maybe use it (14,8%) and those who would not use it (4,3%), showing significant association between the groups (P=0,013), evidencing the answer "yes" for Porto Alegre and "no" for Belém. The main justification for the use of AD was the autonomy (67,7%). Among the participants who would maybe use such document, the justification was that it could hinder the decision (29,3%). As for the necessity of specific legislation, most of the physicians were favorable (88,7%) revealing a significant statistic association (P=0,045) between the groups, where Belém associated to a more legalistic position. The most common justification for legislation was legal support (53,9%). In case of specific legislation most of the physicians (81,7%) would comply with the AD. In the first setting, most of the physicians (94,0%) would take into account the will of the patient in different levels revealing a significant association between the groups (P=0,004). In the second setting 80,0% considered the patient’s will as determinant. In the third (96,5%) would consider the patient’s will in different degrees highlighting (71,3%) the patient’s will as determinant, with significant association between the groups (P=0,003). In the fourth setting, most of the physicians (86,1%) would also consider the patient’s will in different degrees with significant association (P=0,001) between the groups. As regards the justification to introduce or not futile therapy (83,5%) considered both justifiable showing significant statistic between the groups (P=0,001). Related to the factors that influence decision making, the most frequent were ethical (94,8%), legal (88,7%), moral (73,9%), technical (67,0%) and the religious aspects of the patient (52,2%). Conclusion: It is possible to conclude that the physicians participating in this study know and would use advance directives, but they recognize the need of specific legal support in this matter. Data resulting from this study reveal that physicians value the will of the patient and seek to make shared decisions. Furthermore, the regional influence is evident in the factors related to decision making process.

O ensino de Jornalismo é objeto freqüente de reflexão, principalmente no que diz respeito à aquisição e compreensão de ferramentas e conhecimentos necessários para a formação de um profissional com múltiplas habilidades e competências. A implantação dos Projetos Experimentais no currículo da Habilitação Jornalismo nos cursos de Comunicação Social no Brasil ocorreu em 12 de abril de 1978, recebendo posteriormente, a partir da Resolução do CFE nº 002/84, o tratamento de disciplina regida por normas específicas de acordo com os projetos pedagógicos das instituições de ensino superior. A pesquisa investiga o papel exercido pelos Projetos Experimentais em universidades paulistas, que possibilitam, por meio de diferentes experiências adotadas, a vivência, a aquisição e o domínio de técnicas importantes da produção jornalística para a formação ética e profissional dos graduandos em Jornalismo. Por meio de estudo de casos múltiplos e tendo como referência principal as Diretrizes Curriculares Nacionais dos cursos de Comunicação Social (Parecer CNE/CES nº 492/2001), verifica-se que os Projetos Experimentais têm importante papel no exercício de cidadania frente aos desafios e responsabilidades da profissão, especialmente quanto à contribuição para a sociedade, à formação do bem comum e à consciência do papel do Jornalismo na realidade. / The education of Journalism is a frequent object of reflection, mainly in what concerns the acquisition and understanding of tools and necessary knowledge for the formation of a professional with multiple skills and abilities. The implementation of the Experimental Projects in the curriculum of the competence Journalism in the courses of Social Communication in Brazil occurred on April 12, 1978, receiving subsequently, from the Resolution of the CFE number 002/84, the handling of discipline governed by specific standards according to the pedagogical projects of the institutions of higher education. The research investigates the paper exerted by the Experimental Projects in universities of the state of São Paulo that enable through different adopted experiences, the knowledge, the acquisition and the domain of important techniques of the journalistic output for the ethical and professional formation of the graduating students in Journalism. Through multiple case studies and having as main reference the National Curricular Directives of the courses of Social Communication (CNE/CES Study number 492/2001), are verified that the Experimental Projects have important paper in the exercise of citizenship facing the challenges and responsibilities of the profession, specially as regards the contribution for the society, to the formation of the welfare and to the conscience of the paper of the Journalism nowadays.

Introdução As Diretivas Antecipadas de Vontade, também denominadas Testamento Vital constituem um documento com o registro expresso do desejo de um cidadão de recusar tratamento, caso venha a sofrer de alguma enfermidade terminal. Dessa forma, busca desconstruir uma cultura centrada no paternalismo que reduz o indivíduo doente a um paciente que deve aguardar, resignado e submissamente, que deliberações acerca de sua vida sejam tomadas por outros, sem que possa se manifestar ou decidir, autonomamente, como quer ser tratado ou que tipo de práticas de intervenção está disposto a aceitar. Objetivo - O presente trabalho objetivou conhecer a representação do Testamento Vital para os enfermeiros que atuam na assistência à pacientes em situação de terminalidade. Método - Trata-se de pesquisa de natureza qualitativa realizada com quinze enfermeiros que atuam na assistência à pacientes terminais, por meio de entrevistas norteadas pela seguinte questão Fale a respeito do Testamento Vital. Após a aprovação do Comitê de Ética em Pesquisa, houve a obtenção dos depoimentos que foram analisados de acordo com o método do Discurso do Sujeito Coletivo com fundamentação na Teoria das Representações Sociais de Serge Moscovici. Resultados - A pesquisa identificou três categorias que compõem o Discurso do Sujeito Coletivo: o enfermeiro frente às diretivas antecipadas de vontade; o enfermeiro frente à família contrária à vontade do paciente e o enfermeiro frente ao médico contrário à vontade do paciente. Conclusão - O testamento vital representa, na perspectiva dos enfermeiros, a autonomia e o direito do paciente pelas decisões nas situações de terminalidade que devem ser compartilhadas com seus familiares e profissionais de saúde. Não obstante, o enfermeiro pode vivenciar conflitos éticos nas situações em que o desejo manifestado por meio desse documento não é respeitado por familiares e/ou médicos. Diante dessa situação, o enfermeiro pode perceber a própria ação como limitada e sentir-se frustrado com a impossibidade de atender o desejo do paciente. / Introduction: Advance Directives also known as the Living Will Declaration constitute a manifestation of will by means of a document written by a person fully healthy of his mental faculties in order to dispose of the care, treatment and procedures that whether or not he or she wants to be submitted in case of a disease that is beyond therapeutic possibilities and incapable of manifesting his or her will freely. Objective - To know the representation of Living Will Declaration for nurses who work with terminally ill patients. Method - This is a qualitative research carried out with fifteen nurses who work in the care of terminal patients, through interviews guided by the following question \"Talk about the Living Will Declaration\". After the approval of the Committee of Ethics in Research, the interviews were obtained, which were analyzed according to the Collective Subject Discourse method based on Serge Moscovici\'s Theory of Social Representations. Results - The research identified three categories that make up the Discourse of the Collective Subject: \"the nurse in front of the advance directives \"; \"The nurse facing the family contrary to the will of the patient\" and \"the nurse facing the doctor contrary to the will of the patient\". Conclusion - The living will declaration represents, from the perspective of nurses, the autonomy and the right of the patient for decisions in terminal situations that should be shared with family members and health professionals. Nonetheless, nurses may experience ethical conflicts in situations where the desire expressed through this document is not respected by family members and / or doctors. Faced with this situation, the nurse can perceive the action as limited and feel frustrated with the impossibility of fulfilling the patient\'s desire.

When Sweden first implemented Natura 2000 in 1995, it was done in a hurry and not all the information from the European Commission was interpreted as it was intended. The fact is that it took a long time for the authorities in Sweden to really understand Natura 2000 and its potential. The big break came in 2000 when the Swedish environmental Code was changed to match the regulations of Natura 2000. This created problems for already planned projects in Sweden that now had to follow the new rules. The implementation also provided the environmentalist management to advance at the expense of the spatial planning in a struggle about the governance over the landscape. In this thesis the Natura 2000 network is described as an instrument and compared to other nature protections in Sweden. The thesis also gives a description on how Natura 2000 is built up and how it was and is implemented in Sweden. The Environmentalist paradigm and planning paradigm are described and presented in the case studies Tre Toppar and Botniabanan. The development of the two cases is also described to get a picture of how differently they were managed and how different they turned out in the end. / Examination name of the thesis: Natura 2000- The implementation and the Use in Sweden, Case study of Botniabanan and Tre Toppar. Johan Johansson Gomér: +46703089306 Erika Wärneryd: +46735070737

Ireland is facing a great challenge in meeting renewable energy requirements, where due to past circumstances and decisions, the nation state is now heavily dependent on imported fossil fuels. Given the contribution of these imported fossil fuels to global climate change, price instability and supply insecurity, Ireland is under a pressing need to face up to the dilemma of an unsustainably fueled economy. This thesis explores how the EU policy process is helping Ireland to achieve the goals it has set with the EU and how these are being incorporated into the drivers of wind power development in Ireland. This research sought to uncover the dynamic of this relationship - the goodness of fit - through an assessment of three mechanisms of change, namely: Discourses, Directives and Finances, which were drawn on from the theoretical approach of Europeanisation. By doing a combined assessment of these three channels and their influence, this thesis provides a greater understanding of the ways in which the development of wind power in Ireland is influenced by the EU level. The thesis finishes with a concluding discussion on the importance of the national level in this process, as well as the importance of social and community engagement, which despite being previously seen as important, has to date largely manifested as a tokenistic gesture in Ireland. This thesis reasserts it as a common and crucial thread of the renewable energy transition that continuously arose as being pre-eminent during this study.

Civil Liability in the Case of Disrespecting a Patient's Advance Directives The aim of this thesis is to analyse and describe the problematic of Civil Liability in the specific case of disrespecting a patient's advance directives by a medical. The institute of Advance Directives was first introduced in the Czech law by the Convention on Human Rights and Biomedicine in 2001 and later by the Law No. 372/2011 Coll., Act on Health Care Provision. Thought the Advance Directives cannot be considered as a new institute in the Czech law, it is hardly ever used in practice. There is no judicature and practical knowledge on the topic of civil liability in this case, and the insecurity causes that doctors do not feel like willing to respect the exceptionally occurring advance directives, because they fear the criminal liability they think that could arise if they did not provide the health care necessary for saving life of their patient. This thesis is trying to highline the importance of a patient's will. Meanwhile, it is pointing to the fact that even saving a patient's life can cause legal liability of a doctor. The thesis is primarily analysing and describing such liability within the general provisions on liability in the Czech Law and is also trying to give an insight to the problematic of potential...

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This thesis focuses on the area of register and account of long-term material possession according to accounting legislative and American accounting US GAAP. The main goal of this thesis is to analyze current situation of register and account in selected company. The main solution is proposition of internal directive. All suggested solutions emerge from completed analysis.

The certification of systems in the medical domain aims to ensure that a system is acceptably safein order to bear the CE mark. Such process is exhaustive, expensive, time-consuming and safety-critical.Medical devices shall be re-certified under Medical Device Regulations. The first de-facto platform for re-certification is delivered by AMASS project. This thesis is expected to fill the specific gap: evaluate the compliance re-certification efficiency of the platform in the medical domain during the re-certification effort required as a consequence of a change in the normative space. Due to the lack of demonstrations in this safety-critical domain, the standard for medical devices, ISO 14971 with its versions and the Notified Bodies Recommendation Group (NBRG) Consensus paper are considered. There are several differences among them, in terms of the normative part and the fact whether they are international or only applicable in Europe. The evaluation will be conducted on acase study and the research has followed best practicing in case study design/execution. The focus is on two changes. The first change in the normative space is represented by the introduction of the EU directives (EU Medical Device Directives (MDDs): 90/385/EEC, 93/42/EEC, and 98/79/EC.) in relation to ISO 14971:2007, which required the introduction of ISO 14971:2012 (which applies only to manufacturers placing devices on the market in Europe). The second change is represented by the introduction of ISO 14971:2019, an international standard. Through the tool-chain (EPF Composer-BVR Tool), the families of standards and processes are modeled. The reuse of components is assessed through the application of selected metrics creating the measurement framework.The aim is to increase evidence according to the usefulness of the tool-chain in other domains. This master thesis will contribute with a case study evaluation of the tool-chain (a subset of the platform), considering cross-jurisdictional challenges. This work could represent the starting point for an evaluation where not only reference-processes are considered, but also the processes actually modelled in industrial settings.