Une évolution récente de la loi a rendu les directives opposables juridiquement et ainsi plus « contraignantes » pour les équipes médicales. Or dans la pratique des soins palliatifs, les soignants sont souvent confrontés à un refus des patients de se prononcer sur un choix anticipé concernant les décisions de fin de vie. À travers une étude qualitative par entretiens semi dirigés et une analyse textuelle du discours de 12 patients en situation palliative et 10 de leurs proches, nous avons étudié les freins et des leviers à la rédaction des directives anticipées chez ces patients. Au-delà du passage à l’écrit, c’est l’élaboration des DA elles-mêmes qui semble difficile chez ces patients. L’impossibilité d’imaginer, de conceptualiser le temps du mourir, bien que le pronostic soit connu, conduit à une incapacité à rédiger des DA. Un des enjeux de ces DA au-delà de leur rédaction, serait de les utiliser comme un médium de communication entre patients ou futurs patients et équipe médicale. Le partage d’une éventuelle décision concernant la fin de vie avec les proches ainsi qu’avec les équipes médicales, apparait comme indispensable. Ces échanges s’inscrivent dans un processus dynamique tenant compte de la temporalité du patient mais aussi des étapes évolutives de la pathologie, garantissant ainsi une meilleure adéquation entre situation vécue et DA. Les DA sous la forme de documents écrits ne sont pas conformes aux souhaits des patients et des proches que nous avons interrogés. La notion de discussions anticipées et d’« advance care planning » associant l’entourage, semble être plus approprié aux attentes des patients en situation palliative. Pour les proches, des discussions anticipées régulières en dehors de tout contexte médical pathologique paraissent un moyen adapté au recueil de leurs souhaits et valeurs. D’un acte individuel de rédaction, reflet de l’expression de l’autonomie de l’individu, nous devrions tendre vers une approche plus systémique. / An evolution of the law is undertaken in order to make advance directives judiciously enforceable and thus made more binding for the medical teams. However, in the practice of palliative cares, the nursing teams are often confronted to a refusal from the patients when they have to make an anticipated choice concerning the end of their life. Through a qualitative study by semi-directed interviews and a textual analysis of the speech of 12 patients in palliative situation and 10 of their relatives, we studied the brakes and levers in the drafting of advance directives in these patients. Beyond the transition to writing of directives, it is the elaboration of the ADs itself that is seemingly difficult for patients in a palliative situation. The impossibility of imagining or conceptualizing the time of death, although the prognosis is known, leads to an inability to write ADs. One of the challenges of these ADs, beyond their actual writing, would be to use them as a communication medium between patients or future patients and the medical team.The sharing of a possible end-of-life decision with relatives as well as with the medical teams, appears essential. These exchanges are part of a dynamic process taking into account the temporality of the patient but also the various evolutionary stages of the disease thus ensuring a better match between an experienced situation and ADs. ADs in the form of written documents do not conform to the wishes of the patients and relatives we interviewed.For relatives, regular early discussions outside of any pathological medical context seem to be a suitable way of collecting their wishes and values. The notion of anticipatory discussions and « advance care planning » associating the entourage, would appear to be more in line with the expectations of patients in a palliative situation. From an individual act of writing, reflecting the expression of autonomy of the individual, we should tend towards a more systemic approach.

An advance directive is an instruction made by a competent person about his or her preferred health care choices, should the person become incapable to make treatment decisions. Legal recognition of advance directives has developed over the last half century in response to medical advances that can prolong the life of a patient who is no longer sentient, and who has decided to forego some or all treatment under such circumstances. Two types of directive have emerged in the law: an instructional directive, in which a person sets out treatment choices, and a proxy directive, which enables the person to appoint a proxy to make treatment decisions. Development of the law has been impeded by fear that advance directives diminish regard for the sanctity of life and potentially authorize euthanasia or assisted suicide. In Canada, this fear explains the continued existence of outdated criminal law prohibitions and contributes to provincial advance directive legislation that is disharmonized and restrictive, in some provinces limiting personal choice about the type of advance directive that can be made. The British Columbia Representation Agreement Act (RAA)1 is an example of such restrictive legislation. The RAA imposes onerous execution requirements, is unduly complex and restricts choice of planning instrument. Respect for patient autonomy requires that health care providers honour patients' prospective treatment preferences. Capable persons must have ready access to a choice of health care planning instruments which can be easily executed. B.C. should implement advance directive legislation that meets the needs and respects the autonomy of B.C. citizens. The Criminal Code must be amended to eliminate physicians' concern about potential criminal liability for following an advance directive. Advance directive legislation across Canada should be harmonized. Finally, health care providers should receive training on effective ways to communicate with patients about end-of-life treatment decisions to ensure that patients' health care choices are known and respected. / Law, Peter A. Allard School of / Graduate

published_or_final_version / Community Medicine / Master / Master of Public Health

No description available.

Background: Numerous studies demonstrate benefits of using advance care planning (ACP) in the general practice setting. Despite this, providers do not regularly initiate ACP and only one third of Americans have completed an advance directive (AD). This number is even lower among ethnic and minority groups. Community health center (CHC) providers have the opportunity to improve the quality of end-of-life (EOL) care and reduce healthcare disparities affecting medically underserved populations, yet no research has been conducted to identify CHC providers' practices, knowledge and attitudes towards ACP. Addressing this query may assist researchers in identifying optimal strategies for improving ACP delivery in this setting, ultimately leading to improved quality of EOL care for the populations served. Purpose: The study purpose was to assess Arizona CHC providers' practices, knowledge and attitudes towards ACP. Setting: The study setting was federally qualified community health centers located in urban and rural sites throughout Arizona. Participants: Study participants (N = 38) were predominantly middle-aged females practicing for an average of 13 years. 60% of providers were Master's or Doctor of Nursing Practice (DNP) prepared providers while 40% were Doctor of Medicine (MD) or Doctor of Osteopathy (MD). Methods: This study used a descriptive correlational quantitative research design. The "EOL Decision Making Survey" instrument was adapted into an electronic survey and distributed to 514 physician and non-physician CHC providers. Data analysis was performed using PASS and SPSS statistical software. Results: This sample of Arizona CHC providers was reasonably knowledgeable about Arizona state law and clinical application of ACP. Physician providers had greater knowledge and greater confidence in their answers related to Arizona state law compared to non-physician providers. Participants were largely comfortable with counseling patients in ACP and exhibited mostly positive attitudes toward ACP. Older respondents with greater years' experience tended to have greater knowledge of the clinical application of ACP as well as greater positive attitudes towards ACP. Providers with greater years' experience tended to have greater comfort in counseling patients in ACP. Despite these positive findings, routine initiation of ACP in this setting was low (44%). Conclusions: Though Arizona CHC providers have reasonable knowledge related to ACP, are comfortable with counseling patients in ACP and have positive attitudes towards ACP, less than half routinely initiate ACP conversations with their patients. Though more research is needed to validate these findings, targeted educational interventions and process changes may help improve ACP delivery rates in this setting.

Le droit de l’Union européenne emprunte fréquemment aux techniques élaborées et perfectionnées par la science des conflits de lois. Le droit dérivé en général, vecteur de l’intégration juridique des États membres, est la source d’un nombre croissant de dispositions de droit international privé. Les directives européennes, en particulier, exploitent les différentes méthodes de droit international privé façonnées de longue date par les droits nationaux. Les instruments conflictuels y sont placés au service de la construction européenne et voient ainsi leur finalité séculaire redéfinie. Ce sont donc tant les objectifs que les origines des règles touchant aux conflits de lois qui sont modifiés dans le contexte européen. Les contraintes propres aux directives, ces normes à deux niveaux, sont autant de facteurs susceptibles de perturber le fonctionnement des mécanismes de droit international privé. La présente étude se propose d’expliquer l’influence des directives sur le conflit de lois à travers le prisme des méthodes du droit international privé. Elle tend à montrer qu’un double mouvement d’influence réciproque caractérise les relations entre ces textes et ces méthodes. La réception des méthodes traditionnelles par les directives provoque une série de perturbations susceptibles de renouveler leur analyse classique. Inversement, des procédés nouveaux, issus de la construction du marché intérieur et présents au sein des directives, enrichissent la théorie du droit international privé. Cette analyse permet de mettre en lumière la diversité des méthodes de droit international privé contenues dans les directives européennes. / European Union law frequently utilizes from techniques elaborated and continuously improved by the conflict of laws science. Secondary law in general, vector of the legal integration of Member states is the source of an increasing number of private international law measures. In particular, European directives leverage the various methods of private international law designed by the respective national laws a long time ago. In these specific norms, conflicts resolution instruments are repositioned to serve the objective of European construction and therefore have their secular purpose redefined. Thus, both the objectives and the origins of rules relative to the conflict of laws are altered in the European context. As two level laws, directives have specific constraints, which can disrupt how private international law mechanisms operate. The present study aims at explaining the influence of the directives on the conflict of laws from the private international law methods standpoint. It tends to show that these texts and methods operate in a reciprocal influence model. The integration of the traditional methods into directives causes a series of disturbances which can renew their classic analysis. Inversely, new processes stemming from the construction of the internal market and present within the directive are likely to enhance private international law theory. This analysis sheds light on the diversity of private international law methods embedded in European directives.

Title of thesis: Actual problems of criminal liability in medical treatment in connection with advance directives Abstract The main aim of this thesis is to analyze the topic of advance directives, recent institute in Czech legislation, its problems and mainly criminal liability in medical treatment, which is not summarized complexly in Czech professional literature. This thesis is composed of seven chapters, which are divided into sections and subsections. Chapter One is introductory and is dedicated to moral rights of a patient, which provide the basic starting points of this thesis. The chapter is subdivided into two parts. Part One describes evolution of rights of patients and part Two presents right to life, right to self-determination and finally right to protection of human dignity. Chapter Two analyzes advance directives. This chapter is subdivided into five sections. The basic characteristic is processed with respect to legislation, particular types, issues and critical aspects of advance directives. Chapter Three discusses the legal liability in healthcare. Chapter is divided into four sections; each is devoted to one of the civil, labor, administrative and disciplinary liability. Chapter Three is related to the following chapter, which deals with criminal liability and represents, with respect to...

The aim of this thesis is a detailed description and analysis of the institute advance directives/previously expressed wishes in the Czech Republic in comparison with the Australian legislation. This thesis deals with the Queenland's legislation and the legislation of the Northern Territory. The methods used in this thesis are analyzes of legal norms and comparison of specific law regulations. Introductory chapters are focused on the principle of patient's autonomy in the Czech Republic legislation and on the protection of the person's integrity. The thesis covers not only the rules contained in the Act. No. 89/2012 Coll., the Civil Code, but also mentions rules in the Act. No. 40/1964 Coll., the Civil Code. The next chapter is focused on different patient's rights, such as the right to life and be healthy, the right to self-determination and the right to dignity. In the second part, the author focuses on the institute of advance directives/previously expressed wishes. First within the international legal framework. This chapter also underlines negative opinions about advance directives/previously expressed wishes and points out the benefits of their use in practice. Next the author focuses on the Czech legal regulations. The author does not mention only the Health Services Act, but also not...

The aim of my work is to describe and analyze the European and German consumer protection law, especially the implementation of selected consumer protection directives into German law. Main part of this work deal with the following EU Directives: Directive 1999/44/EC on certain aspects of the sale of consumer goods and associated guarantees, Directive 93/13/EEC on unfair terms in consumer contracts, Directive 85/577/EEC to protect the consumer in respect of contracts negotiated away from business premise and the Directive 97/7/EC on the protection of consumers in respect of distance contracts. I've also tried to analyze the German legal regulations and found out the differences and similarities between the German and Czech consumer protection law. My work contains 9 chapters: First chapter defines the basic terms of the consumer protection law like a consumer and a supplier. It deals also with the judicature of the European Court of Justice and German legal regulations and judicature, which extend the consumer's protection to another subjects. Second and third chapter describe the primary and secondary EU consumer law, competence of the EU, consumer law basics included in the primary law and list of secondary legal acts, which regulate the field of consumer protection. Fourth chapter contains the...

The master's thesis focuses on one aspect of public procurement law in the Czech Republic. Specifically, it provides with thorough interpretation of the Czech legal regulation of conditions allowing for using negotiated procedure with prior notice or negotiated procedure without prior notice to award a public tender. In order to achieve such purpose, the thesis uses information from the 137/2006 Coll., Public Procurement Act, as amended, available doctrinal literature and case law of the Office for the Protection of Competition, Czech courts and the European Court of Justice. The interpretation is performed to compare the Czech regulation with the one contained in relevant European directives (2004/17/EC, 2004/18/EC and 2009/81/EC). After interpretation of these directives focused majorly on differences from the Czech law, the thesis provides conclusions about correctness of transposition of the directives into Czech legal system, which is the core of its focus.