The Concept of the Patient’s Autonomy: From the Vaults of Civil Law

The concept of patient’s rights itself was fairly known before the last four or five decades, and medical malpractice of all kinds made the aggrieved party to seek redress at a court; but no special legislation, apart from rare exceptions, has ever existed to anchor the patient’s rights before the late 20th century. In the civil law tradition of the 20th century, especially its earlier decades, doctors could be held criminally or civilly liable for a wide variety of malpractice, including unauthorised medical intervention or divulgation of patient’s information, though such provisions did not develop actual rights, were quite general in their nature, and were individually assessed by the courts in each case. Within in the gradual change in the doctrines of medical law, the term “autonomy”, shaping the patient’s right to decide what medical interventions could or could not be performed upon his body, intervened into the existing legal scholarship, which was later augmented with various issues, such as access to medical records of the patient, refusal of blood transfusion, participation in medical experiments, deciding upon end-of-life situations or relating to various reproductive law considerations, not always permitted by national law. Many of these rights are much older than the concept of patient’s autonomy themselves, and have developed in the case law which itself has originated from lawsuits against doctors and hospitals for acts, being nearly obscure in the existing legal doctrine, such as unauthorised medical experiments. The given paper is aimed to discuss the academic development and overall gist of the patient’s right to autonomy, as well as some of its early interpretations in civil law doctrine. Keywords: patient’s rights, medical malpractice, theory of law, medical law, patient autonomy, civil law.

Сriminal Law Protection of the Autonomy of Patients in Ukraine. Part 1

<p>The article aims to analyze the phenomenon of “patient’s autonomy” as an object of criminal law protection. Patients’ autonomy is one of the most important rights. Respect for it is one of the factors ensuring the correct treatment process. The article is divided into two parts. In this part, the authors analyze the legal acts of Ukraine, which regulate the process of providing medical services and guarantee patients’ right to autonomy. The authors discuss, i.a., the issue of the patient’s consent to medical interventions or the right to information about his or her state of health. They also point to statistics on offences committed by medical staff members in connection with their professional activities. Furthermore, they point out that the problem of violation of patient’s autonomy should be looked at not only from the legal but also from the social point of view. This applies to the patient–medical relationship, in which the doctor plays a leading role. Moreover, the content of these relations lies not only on the professional but also on the bioethical level.</p>

НАВИЧКИ КЛІНІЧНОГО СПІЛКУВАННЯ У ПРОФЕСІЙНІЙ ДІЯЛЬНОСТІ ЛІКАРЯ

The article considers some aspects of clinical communication between a doctor and a patient. The doctor’s profession inherently faces an indispensable requirement to possess a high level of communicative competence, because whatever the development of medical science and technology, the real help to patients is provided by a doctor. In this regard, various aspects of communication between doctors and patients are constantly in the focus of interest in natural and humanitarian spheres of research, as evidenced by numerous scientific studies of domestic and foreign scientists. The research is interdisciplinary and covers a range of issues related to medical psychology and medical pedagogy, medical ethics and deontology, sociology and sociolinguistics. The authors emphasize that in a patient-centered approach, the skills of clinical communication belong to basic clinical abilities, which minimize factors that can negatively affect the doctor’s success, promoting patient satisfaction with medical care and improving their psycho-emotional state, patient compliance, increasing the effectiveness of diagnosis, treatment, disease prevention, and palliative care. It is observed that the skills of clinical communication are complex and are manifested by the ability to choose appropriate tactics of communication with patients and their relatives, to create a trusting atmosphere and a comfortable psychological environment for the patient; possession of nonverbal and paraverbal components of communication; the ability to conduct educational work with the patient to maintain a healthy lifestyle and give up bad habits; the ability to maintain and encourage patient’s autonomy, prove information about possible complications; persuade the patient to comply; the ability to avoid conflicts or act adequately in a conflict situation with patients. The conclusions state that the skills of clinical communication should be formed from the first steps at a medical university, consolidating them during the entire period of study at the undergraduate and postgraduate stages, as well as refining them in the future through non-formal and informal education.

Quandaries of Autonomy and Empowerment in Evidence-Based Nursing Care

Empowerment and evidence-based practice represent two influential principles in nursing care: that decision-making should be based upon the patient’s autonomous choice, and the most up-to-date research findings, respectively. In this article, patient empowerment is taken to imply a transfer of control and power from the nurse to the patient through communication and care and acknowledging the patient’s perspectives and values. Empowerment-based nursing may thus be central to enhancing a patient’s autonomy. Evidence-based nursing combines up-to-date research findings, the nurse’s clinical expertise and the patient’s preferences. This article concerns some of the potential conflicts these principles may give rise to in everyday deliberations in nursing care. It is argued that patient empowerment and autonomy potentially both have paternalistic connotations. It is also questioned whether an increased emphasis on patient empowerment and autonomy may lead to a risk of diminished professional autonomy.

Transitions in Palliative and End-of-Life Care

In palliative and end-of-life care, people with serious illness and their families experience a number of transitions—in functional status, physical location, cognitive abilities, and goals of care. This chapter focuses on care transitions in location and treatment preferences and discusses some pitfalls of transitions, along with telemedicine as a palliative care tool to reduce the burden of transitions. Medication reconciliation between sites of care and interprofessional coordination of care among various clinicians and teams are important elements of safe, effective care transitions. Respecting a patient’s autonomy while optimizing safety can be a challenge, and care decisions in times of transition should be person centered, holistic, and compassionate.

EUTHANASIA: AIMING TO KILL WITH A COUNTER FULL OF OPTIONS?

Euthanasia or assisted suicide has been a matter of contention for many years with various types of euthanasia including voluntary, non-voluntary, involuntary, active and passive euthanasia being argued for around the world. This article highlights the types of euthanasia while analyzing the ethical, legal, economical and spiritual dilemmas surrounding them. It also compares euthanasia laws of countries around the world with the Indian stand taken by the Supreme Court in legalizing passive euthanasia. There exists a ne line between life and death. It is the duty of a medical practitioner to assess these situations critically while preserving a patient's autonomy. To deny a person the right to end their life with dignity is equivalent to depriving them of a meaningful existence.

Exploring the Relationship between Shared Decision-Making, Patient-Centered Medicine, and Evidence-Based Medicine

Shared decision-making is a possible link between the best of patient-centered medicine and evidence-based medicine. This article seeks to describe the link between them. It discusses to what extent the integration of such perspectives is successful in assuring respect for the patient’s autonomy. From the evidence herein, we conclude that if the doctor–patient relationship and communication are strengthened to cover all issues relevant to the patient’s health and values, is it possible for him or her to achieve more autonomous decisions by this linkage of shared decision-making and patient-centered medicine? Summary: Shared decision-making is a possible link between the best of patient-centered medicine and evidence-based medicine. This article seeks to describe the link between them.

A Decade of Wishes-Changes in Maternal Preference of the Mode of Delivery among Polish Women over the Last Decade

Background and Objectives: The maternal preference of mode of delivery is an important problem in respect of patient’s autonomy and shared decision-making. The objective of the study was to obtain information about women’s preferences of the mode of delivery and knowledge about the cesarean section and its’ consequences. Materials and Methods: The study was based on a survey filled in by 1175 women in 2010 and 1033 women in 2020. Respondents were asked about their preference of mode of delivery, possible factors influencing their decision and their knowledge about risks and benefits of cesarean section. Results: There was a significant increase in the rate of women who declared cesarean section as their preferred mode of delivery, from 43.97% in 2010 to 56.03% in 2020 (p < 0.05). In 2010 26.51% of women thought that choice of mode of delivery should be their autonomic decision, 46.36% preferred decision-sharing with their obstetrician, 25.64% thought that cesarean section should be performed for medical indications only (respectively 34.86%, 44.45% and 19.38% in 2020). Conclusions: There has been a significant increase in the rate of Polish women who prefer cesarean delivery over the last decade, as well as in the rate of women who consider the mode of delivery as their autonomic decision.

Nurse-sensitive outcomes in district nursing care: A Delphi study

Objectives To determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses’ scope and domain of practice and that are influenced by nursing inputs and interventions. Design A Delphi study following the RAND/UCLA Appropriateness Method with two rounds of data collection. Setting District nursing care in the community care setting in the Netherlands. Participants Experts with current or recent clinical experience as district nurses as well as expertise in research, teaching, practice, or policy in the area of district nursing. Main outcome measures Experts assessed potential nurse-sensitive outcomes for their sensitivity to nursing care by scoring the relevance of each outcome and the ability of the outcome to be influenced by nursing care (influenceability). The relevance and influenceability of each outcome were scored on a nine-point Likert scale. A group median of 7 to 9 indicated that the outcome was assessed as relevant and/or influenceable. To measure agreement among experts, the disagreement index was used, with a score of <1 indicating agreement. Results In Delphi round two, 11 experts assessed 46 outcomes. In total, 26 outcomes (56.5%) were assessed as nurse-sensitive. The nurse-sensitive outcomes with the highest median scores for both relevance and influenceability were the patient’s autonomy, the patient’s ability to make decisions regarding the provision of care, the patient’s satisfaction with delivered district nursing care, the quality of dying and death, and the compliance of the patient with needed care. Conclusions This study determined 26 nurse-sensitive outcomes for district nursing care for community-living older people based on the collective opinion of experts in district nursing care. This insight could guide the development of quality indicators for district nursing care. Further research is needed to operationalise the outcomes and to determine which outcomes are relevant for specific subgroups.