Thesis "A NEW CONCEPT OF HEALTH CARE IN THE CZECH REPUBLIC IN RELATION TO PUBLIC ADMINISTRATION "deals with health care in the Czech Republic. In the most economically developed countries health care is becoming a part of their health care policy. The diploma thesis reflects the health reform efforts in recent years of economic reality in the Czech Republic. The state acts as a guarantor, whose task is to regulate health care, establish legal and economic rules and thereby to ensure availability. Focus of the thesis is analytical and descriptive. The introductory chapter describes the health systems, the second focuses on the legal framework and then the third on the demographic and health status of the population. The focus of the work is in the fourth chapter, this chapter describes the economics of health policy, financing of individual groups, the fifth drug policy. Consistency of health care associated with the Czech Republic's accession to the EU, its principals and strategies are presented in the final chapter

Une question nouvelle anime aujourd’hui la littérature médicale : faut-il prendre soin de la dimension spirituelle des patients atteints de maladies graves ? Alors que de nombreux chercheurs font consensus en faveur de l’intégration de la spiritualité dans le soin et que des modèles d’intervention spécifiques sont développés dans différents hôpitaux, d’importantes réserves éthiques et épistémologiques doivent être formulées. Cette thèse de doctorat en éthique médicale et en sciences des religions procède de manière critique à l’analyse de ce phénomène tel qu’il prend forme plus particulièrement en cancérologie depuis une vingtaine d’années. Nous avons mis en évidence que l’avis des patients n’était jamais pris en compte pour justifier la nécessité de prendre soin de la spiritualité ; or, nous pensons que leur implication est indispensable pour délimiter les missions du soin. Cela nous a amené à la question de recherche suivante : pour quelles raisons les patients atteints de cancer au pronostic péjoratif souhaiteraient-ils que l’hôpital public français s’ouvre à la question spirituelle ? Pour y répondre, nous avons interrogé vingt patients aux prises avec un cancer au pronostic péjoratif, suivis dans des hôpitaux publics français, par le biais d’entretiens semi-directifs. Les résultats montrent qu’ils n’attendent pas de l’hôpital un soin en matière de spiritualité. Par contre, ils expriment le besoin d’être reconnus comme des êtres à part entière et non, uniquement, comme des patients. Ces données nous invitent ainsi à penser l’intégration de la spiritualité dans l’hôpital davantage sur le registre de la reconnaissance que sur celui du soin. / A new question has arisen in the medical literature recently: must spirituality be included as a specific dimension in the care system? If several scholars arrive at a consensus in favour of this integration, considerable ethical and epistemological worries have to be expressed. This thesis in medical ethics and religious studies critically analyses this phenomenon, more specifically in the context of oncology. Our main concern is to discuss the different arguments given in medical literature justifying the necessity to develop spiritual care. In doing so, we discovered that the patients’ point of view is never taken into account, posing the question: for which reasons patients with advanced cancer would (or would not) expect spiritual care from the hospital? In response, we interviewed 20 patients undergoing treatment in a French hospital, using a semi directive methodology. Results show that patients do not expect spiritual care from the hospital but wish to be recognised as human beings and not only as “patients”. Data invites us to consider the integration of spirituality in the hospital through an ethic of recognition as opposed to an ethic of care.

Qu’est-ce qui légitime un discours éthique ? Se distingue-t-il des autres discours ? Pouvons-nous nous entendre sur un tel sujet ? Voilà quelques questions choisies auxquelles nous allons tenter de répondre. Notre étude se nourrit des réflexions de Ludwig Wittgenstein. La position de ce dernier concernant l’éthique présente plusieurs aspects de ce thème. Pendant une période de son parcours intellectuel, elle apparaît à la fois fondamentale et taboue, alors que dans une autre, elle trouve une place dans le discours, mais s’évanouit dans un certain relativisme. En disposant une trame où l’éthique s’enchevêtre, le discours se révèle un médium crucial. Au sein de cet espace, notre enquête déterminera la cohérence de la relation entre l’éthique et la signification. En scrutant un type de discours particulier (l’éthique médicale), nous confronterons ultimement l’apport wittgensteinien sur cette question. Il nous sera alors envisageable de pointer la possibilité d’une cohérence de l’éthique au sein du langage. / What legitimizes an ethical speech? Does it distinguish itself from other speeches? Can we agree on such subject? Here are some selected questions which we will try to answer. Our study is nourished by Ludwig Wittgenstein thoughts. The latter’s position concerning the ethics presents several aspects of this thematic. For a period of his intellectual journey, it seems fundamental and taboo and for another one, it finds a place in the speech, but falls into certain relativism. By setting a background where the ethics is entwined, the speech appears as a crucial medium. Within this space, our investigation will determine the coherence of the relation between ethics and meaning. By scrutinizing a particular speech type (medical ethics), we shall confront ultimately the wittgensteinian contribution on this question. It will then be possible for us to point the possibility of a coherence of the ethics within the language.

The casuistical manner of dealing with ethical issues goes as far as to the antiquity, and afterwards it was considerably developed in Christianity. Nevertheless from the half of the 17th century it was criticized because of abusing and due to the supposedly "unscientific" character and subsequently it has been abandoned. The ridiculous criticism of Blaise Pascal in his "Provincial Letters" has presented the casuistry as a way in which it is possible to justify almost any behaviour and this evaluation has remained up to the present day. In the same era the mathematization of natural sciences has led to impressive successes and the similar mathematical exactness was expected also in other fields of the human knowledge. Also ethics was concerned with seeking such abstract general principles, which were supposed to describe, cover and explain the whole field of morality. The value of casuistry was seen only as an illustration of such principles in an individual case. In my diploma thesis I attempted to rehabilitate the casuistry as an ethical method. I discussed the book of American authors Albert R. Johnes and Stephen Toulin "The Abuse of Casuistry" from the year 1988. The presentation of this publication is one of purposes of my thesis. Then I examined the casuistry as an ethical method in cases of...

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Indiana University-Purdue University Indianapolis (IUPUI) / For the past 2,000 years, the medical and philosophical communities have been unable to formulate a clear conception of function. Yet, I argue that this debate has become of central importance to Western bioethics due to the role the concept of function plays within emerging health care justice models, and more broadly, within the debate surrounding universal health care in the United States. My thesis focuses on the relationship between species function and health care justice. Specifically, my position is that any workable formulation of just health care that is justified from a Rawlsian or politically liberal perspective must utilize conceptions of normal species function that are as neutral and stable as possible. I conclude by showing that Larry Wright’s evolutionarily-based teleological account of function is the most neutral and stable account of function within the philosophical canon, and utilize two case studies – idiopathic short stature and obesity – to help illustrate the applicability of Wright’s account to liberal health care justice formulations.

Bakgrund: Äldre patienter med nedsatt beslutsbeslutsförmåga har svårare att ta självständiga beslut, och har svårare att vara delaktiga i sin egen sjukvård. Självbestämmande anses vara en förutsättning för ett gott liv, och en rättighet för alla patienter i dagens sjukvård. Att tillgodose äldre patienters självbestämmande i ambulanssjukvården kan ibland vara utmanande, och vid nedsatt beslutsförmåga ställer det ökade krav på ambulanspersonalen. Syfte: Syftet med studien var att beskriva ambulanspersonalens erfarenheter av självbestämmande hos äldre patienter med nedsatt beslutsförmåga. Metod: En kvalitativ intervjustudie med induktiv ansats. Deltagarna rekryterades genom ett strategiskt urval, och data analyserades med en kvalitativ innehållsanalys. Resultat: Resultatet resulterade i fyra teman; "strategier för att bedöma äldre patienters möjlighet till självbestämmande", "tillvägagångssätt för att främja äldre patienters självbestämmande", "utmaningar för att tillgodose äldre patienters självbestämmande" och "situationer där äldre patienters självbestämmande fråntas". Slutsats: Nedsatt beslutsförmåga innebar ökade utmaningar för att bedöma äldre patienters förmåga till självbestämmande. Utmaningarna handlade om att balansera medicinsk bedömningen mot patienters självbestämmande, där det beroende på situation kunde tillämpas både ett pliktetiskt och konsekvensetiskt synsätt. För att det i framtiden ska bli enklare att tillgodose äldre patienters självbestämmande, efterfrågas bättre anpassade riktlinjer och utökade resurser. Tidigare forskning visar också att det krävs en ökad etisk medvetenhet hos ambulanspersonal för att bättre kunna bemöta äldre patienters vårdbehov i framtiden.

While ethical codes have been established for practitioners, there is a possibility that dual loyalty affects occupational medical practitioners’ (OMPs) decisions in determining fitness status of employees. Literature indicates dual loyalty of OMPs leads to ethical dilemmas. The study’s main objective is to determine if dual loyalty participates in OMPs’ decisions and influences OMPs to breach medical ethics required in their profession, resulting in employees unfairly losing their jobs. The study interrogates literature review on dual loyalty and adopts a multi-layered approach focussing on the Constitution; relevant Acts and guidelines; case law and ethical principles. Case studies from the Medical Inspector’s archives are interrogated to determine the influence dual loyalty has on OMPs’ decision-making. Case law indicates that conflict of interest is the source of dual loyalty. Occupational medical practitioners have fiduciary duties and need to serve the best interests of the employees. From case studies discussed, the study shows that OMPs are affected by dual loyalty and tend to disregard medical ethics. They may be conflicted when making decisions concerning employees’ fitness to work, especially when individualised assessments are not conducted. A guideline addressing ethical obligations and human rights should be drafted for OMPs, guiding them on dealing with dual loyalty. Employers will need awareness training in various institutions so that OMPs are supported and encouraged to have sound medical ethics. This will promote best practice in doctor-patient relationships, avoiding dual loyalty dilemmas. / Mini Dissertation (MPhil)--University of Pretoria, 2019. / Public Law / MPhil / Unrestricted

There is a perceived soft skills problem within the medical assistant program (MAP) at a 2-year technical college in the Midwestern United States. Soft skills refer to relational skills such as practicing self-management, communicating with various groups, adapting to change, negotiating, and resolving conflict. The purposes of this intrinsic case study were to (a) understand the perspectives of faculty, staff, and leadership regarding students' soft skills ability within the study MAP and (b) identify important soft skills needed in the workplace. An integrative conceptual framework that drew upon vocational and organizational theories was used as a theoretical framework for the study. Fourteen participants, comprised of program faculty, program leadership, and staff members from local healthcare clinics, participated in open-ended interviews. Documents were also collected, including the college mission, class syllabi, and attendance records. The interview transcripts and documents were analyzed through Creswell's 6-step process of data preparation/organization, data sorting, developing description codes, narration/visual representation of findings, reflective interpretation of results, and finding validation strategies. Findings confirmed a perceived need for soft skills instruction in communication skills, professionalism, work ethic, interpersonal skills, and good judgement. Positive social change could occur from the organization improving students' workplace success through a deeper understanding of these needed soft skills. Further, MAP students at the study site would be better positioned to provide an increased quality of patient care.

Lung cancer is the leading cause of cancer mortality in the United States, especially among African Americans, who have the lowest survival rate from this disease among all racial/ethnic groups. The aim of this qualitative study was to investigate how family support and religion/faith influence patients' decisions about seeking treatment for lung cancer. This study was guided by the medical decision-making model and used a phenomenological approach. Data were collected from male and female lung cancer patients (n = 15) who were being treated in a thoracic and cardiovascular surgery clinic in Greensboro, North Carolina using semi-structured interviews. All participants were between the ages of 18 and 75 years and spoke English, and were questioned how they made their decisions about seeking lung cancer treatment. The main themes were patients' lack of knowledge about the disease, treatment, and the length of time to live; patients' financial anxieties; the role of faith, prayer, and religion related to treatment decision-making; confidence in the physician for medical advice; and the role of emotional and financial support from family, including the church family. The study findings provide valuable information that can be used by medical and public health professionals in helping patients make medical decisions for lung cancer treatment. Further, these findings have considerable social change merits because they provide needed information about how African American patients evaluate seeking treatment for lung cancer, which can be used to develop decision-making aids and to help better facilitate communication between health care providers and patients.