Professional Ethics Relationship with Patient’s Rights Charter Observance among Nurses and Midwives

Introduction: Respect for patients’ rights and observance of professional ethics standards improves medical services that will have an essential role in promoting patients’ health. Objective: This study aimed to determine the relationship between awareness of patient’s rights charter and professional ethics with patient’s rights charter observance. Materials and Methods: This analytical correlational study was performed on 285 staff members (196 nurses and 85 midwives) working in 2 hospitals affiliated to Alborz University of Medical Sciences, Iran, and 2 social security hospitals. They were selected using a stratified random sampling method. The study data were collected using the sociodemographic characteristics questionnaire, awareness and observance of the patient’s rights, and professional ethics charter questionnaires. Descriptive statistics and inferential statistics, including the independent t-test, Pearson correlation, Chi-square tests, and multivariate linear regression, were used for data analysis. Results: The Mean±SD ages of nurses and midwives were 36.2±8.3 and 37.5±7.9 years, respectively. The results also showed an association of professional ethics and awareness of patient’s rights charter with patient’s rights charter observance in both nurses (P=0.0001) and midwives (P=0.0001). Based on multivariate linear regression analysis, there were relationships between gender (B=-0.3; 95%CI; -2.0, 2.0; P=0.000), work experience (B=-0.6; 95%CI; -4.0, 3.0; P=0.000), marital and employment status (B=-3.2; 95%CI; -6.0, -0.0; P=0.045), in nurses and between job position (B=9.5; 95%CI; 5.4, 13.5; P=0.000), interest to work (B=-7.9; 95%CI; -11.5, -4.3; P=0.000), and income status (B=6.3; 95%CI; 3.3, 9.2; P=0.000), in midwives with Observance of the Charter of Patient Rights. Conclusion: It is possible to improve compliance with the charter of patient’s rights and its dimensions by strengthening the knowledge of nurses and midwives in this area and their professional ethics, which results in patient satisfaction in this area.

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.

The patient's order as a separate manifestation of his will

The article analyzes the issues of the patient's will in medical relations, it is proved that it is due to the expression of will to the proposed treatment (consent or refusal) that the patient is a full active participant in this relationship. However, his inability to express his will, temporary or irreversible, caused by the development of the disease, the peculiarity of its course may be an obstacle to determining his real desire for future treatment, medical intervention and jeopardize the violation or inability to exercise the patient's right to consent or refuse medical intervention. To avoid this, there is a certain legal institution in the legislation of a number of countries around the world, through which it is possible to plan your treatment in advance, to refuse it, in case of inability to do so in the future. In some legal systems, this institution has different names - "wishes made earlier", "medical will", "patient's will", "power of attorney to make decisions on health care", "patient orders" and so on. The paper analyzes the content of this institute, considers the views of scholars on it, made a comparative analysis with the legal construction of the "testament" and concluded that there are significant differences between these constructions, which makes it impossible, from the author's point of view, to call this will "testament". . It is proposed to consider such a will as one of the patient's rights - "patient order", which is made in writing by an adult - the patient, regardless of the type and stage of the disease in case of possible future inability to consent to medical examination, intervention or treatment. The patient has at his disposal not only his will for the future (list of medical procedures that are allowed to be performed in relation to his health, which are not), but also the case when it can be used (for example, coma, autonomic state). It is impossible to conclude it through a representative, because in this case the will of the patient is unknown. This order is executed by proxies (relatives, close persons, representatives, doctors, etc.). Despite the fact that in Ukraine today this legal institution is absent, the main directions of recoding of civil legislation indicate the possibility of its appearance in the updated legislation

RAZLOZI KOJI OPRAVDAVAJU OTKRIVANjE PROFESIONALNE TAJNE LEKARA

Medical practice and care has always included the duty of doctors to protect patients' confidiental information. However, this duty is not absolute. The subject of this paper is to identify the situations in which doctors are not bound by doctor - patient privilege, that is what are the exclusions in Serbian law that allow doctors to disclose patients’ confidential information. Considering current legal and ethical regulations related to this matter, the author analyzes each of the indetified reasons which justify disclosing doctor - patient confidential information. They are: the written consent of the patient or his legal representative; the need to protect a higher interest than the patient’s right to privacy and confidentiality of medical information; legal obligation to disclose certain information from the patient’s medical records; the court order. Assessing whether and to what extent the conditions have been met to apply each of these reasons for exclusion, the author of this paper findings that their introduction is justified and well balanced with the protection of other patient’s rights, the rights of third persons and the need to protect public health. In the concluding remarks, the author underlines that the method and extent of disclosing doctor - patient confidential information must be done for adequate purposes in order to protect patients’ confidential information in the best possible manner.

Advancing the agenda for people-centred accountability of the private healthcare sector

The thematic track on accountability of the private and corporate healthcare sectors during the Community of Practitioners for Accountability and Social Action in Health (COPASAH) Global Symposium aimed to analyse the emergence of the global trend of commercialisation of health systems, and the transition of healthcare from being a public good to a marketable commodity, at the cost of publicly funded healthcare in developing countries. It examined the implications of the lack of state regulation and oversight which has enabled the profit driven private healthcare sector to exploit vulnerable people through overcharging, malpractices and violations of patient’s rights. Finally, the session addressed challenges in advocacy of patients’ rights and showcased effective campaign strategies used by health activists in different countries to promote accountability of the private healthcare sector. Putting together learnings and insights from this track will help in contributing towards a powerful global counter-narrative, while providing activists with the tools to create awareness and engage with this critical issue.

PROTECTING PATIENT’S RIGHTS IN A POST-TRADITIONAL LEGAL SYSTEM: COMPARING LATVIAN AND JAPANESE MEDICAL JURISPRUDENCE

Litigation concerning the violation of patient’s rights, which are associated with informed consent, confidentiality, right to information and medical records, as well as occasionally with end-of-life decision- making are quite frequent in common law and civil law jurisdictions, and has lasted for over a century in issues concerning malpractice, or unauthorized medical interventions and breaches of medical confidentiality. However, what could we say about medical law-related litigation in Japan? Technically, the legal system of Japan is a civil law one, but is practically post-traditional, which is reflected in extreme paternalism in healthcare and patient-physician relationships, which could be observed before the recent decades and which still has some impact on the modern Japanese medical law, despite the number of medical law-related litigation is becoming more frequent nowadays. The Japanese legislation does not have a specific “patient’s rights law” in contrast to European states, and most of the principles relating to medical malpractice derive from case law – the practice of the Supreme Court and of the lower courts. Each of the decisions strongly depends upon the factual circumstances, and the post-traditional features of the legal system may have some impact on it.

Van patiëntenrechten naar patiëntenwaarden

From patients' rights to patients' values In 2022, the Patient’s Rights Act will be 20 years old. This Act has created a permanent recognition of the central position of the patient and his autonomy within the Belgian healthcare system. The Act did undergo some limited changes, but generally remained the same. Nevertheless, the evolution of the healthcare reveals new points of interest and demands attention to so-called patient values, namely quality, care innovation and patient participation. These patient values also reflect the critics formulated on the Patient’s Rights Act. The Belgian patient’s rights framework today consists of a number of other regulations besides the Patient’s Rights Act itself. All these regulations currently form a diffuse patient’s rights framework. In order to guarantee the central position of patient’s rights in our health care system for the next 20 years, a new approach of patient’s rights protection through the patient values is suggested in this article, focusing on quality, care innovation and patient participation and based on the existing legal patient’s rights framework.

PROBLEMS IN THE LEGAL REGULATION OF THE PROVISION OF HEALTH SERVICES: RIGHTS AND OBLIGATIONS OF THE PATIENT

The paper analyzes the patient's legal status as a key figure in the provision of health services, identifies and qualifies his rights and obligations, reveals the specifics of some legal opportunities for consumers of health services. The purpose of the paper is a comprehensive analysis of the patient’s rights and obligations under the contract for the provision of medical services. Methods: the authors use empirical methods of comparison, description, interpretation and theoretical methods of formal and dialectical logic. Special scientific methods are used: legal-dogmatic and the method of interpreting legal norms. Results: the authors conclude that it is necessary to develop a clear and complete conceptual apparatus; they propose to expand and structure the list of rights by strengthening their informational component, to detail the set of patient's obligations, and to adjust the norms on the patient's voluntary informed consent to medical intervention. The role of insurers in the medical field in helping patients to realize their legal opportunities is highlighted.

-Score-Based Secure Biomedical Model for Effective Skin Lesion Segmentation Over eHealth Cloud

This study aims to process the private medical data over eHealth cloud platform. The current pandemic situation, caused by Covid19 has made us to realize the importance of automatic remotely operated independent services, such as cloud. However, the cloud servers are developed and maintained by third parties, and may access user’s data for certain benefits. Considering these problems, we propose a specialized method such that the patient’s rights and changes in medical treatment can be preserved. The problem arising due to Melanoma skin cancer is carefully considered and a privacy-preserving cloud-based approach is proposed to achieve effective skin lesion segmentation. The work is accomplished by the development of a Z -score-based local color correction method to differentiate image pixels from ambiguity, resulting the segmentation quality to be highly improved. On the other hand, the privacy is assured by partially order homomorphic Permutation Ordered Binary (POB) number system and image permutation. Experiments are performed over publicly available images from the ISIC 2016 and 2017 challenges, as well as PH dataset, where the proposed approach is found to achieve significant results over the encrypted images (known as encrypted domain), as compared to the existing schemes in the plain domain (unencrypted images). We also compare the results with the winners of the ISBI 2016 and 2017 challenges, and show that the proposed approach achieves a very close result with them, even after processing test images in the encrypted domain. Security of the proposed approach is analyzed using a challenge-response game model.