Medicine and law
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The authors describe models for the approach to demand-orientated and demand-driven health care as experienced in the Netherlands. The practical operation of the scheme is discussed including implications for financing and other aspects of regulation. The paper concludes that at present a demand-orientated system is feasible, but changes of a fundamental nature would be necessary to institute a successful operation of demand-driven health care, at least in the country the subject of this study.
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One of the most difficult issues doctors face is a conflict between their professional duties. Such a conflict may arise when doctors know that information has implications not only for patients but also for family members but their duty of confidentiality prevents them from disclosing it. A comparative analysis of English and Israeli medical law reveals that the doctors' duty is based on two principles: a liberal perception of patient autonomy and an overriding utilitarian principle of prevention of harm. ⋯ This approach perceives confidentiality and privacy as embracing the family unit, based on the view that close relatives are not entirely outside the private sphere of the individual but rather are integral to his or her identity. Thus, to the utilitarian mechanism available in medical law this approach adds a social criterion: The effect any decision (to disclose or not to disclose) will have on the familial relationship and on the dynamics of the particular family. This will provide a more flexible and workable alternative for doctors to resolve familial tensions over access to genetic information.