Medicine and law
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In terms of South African legislation, all health research on human participants must be submitted to an accredited research ethics committee for independent ethics review. Health research covers a broad spectrum of research, including clinical trials. ⋯ Special attention is given to the conduct of clinical trials. In conclusion, it is submitted that the National Health Act, the Draft Regulations Relating to Research on Human Subjects, and two sets of ethical guidelines adopted by the Department of Health provide a much needed and coherent ethical-legal framework for research in South Africa.
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Having access to high-quality healthcare is a priority issue for European citizens and is recognised by the Charter of Fundamental Rights of the EU. The right to healthcare also encompasses situations where patients travel from one EU Member State to another and receive treatment there. This paper will explore the contradictory relation between the competence of EU Member States to regulate their health systems on their own, on the one hand, and free movement of services in the European Union, on the other hand. It will discuss the consequences of the decisions of the European Court of Justice in this field and the provisions of the Proposal for a Directive on Patients' Rights in Cross-Border Healthcare, especially in the light of opening up of EU Member States' healthcare markets, the need to control national healthcare expenditures and to protect the welfare state and the population of the host state.
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Nowadays, health care institutions develop policies on how to deal with medical decisions concerning the patients' end-of-life stage (hereafter: "end-of-life decision policies" or "ELD-policies"). This evolution is not only noticeable in hospitals, but also in nursing homes, residential facilities for the disabled and home care services. However, these policies raise several legal issues. ⋯ Due to many differences in form and content, their legal value is difficult to define. Nevertheless, institutional ELD-policies are only enforceable on physicians after incorporation into a binding agreement and without violation of their (deontological and/or legal) right to professional autonomy. Patients (or their legal representatives) can never obligate physicians or health care institutions to comply with institutional ELD-policies, unless enforceable patients' rights are violated.
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The right to conscientious objection is founded on human rights to act according to individuals' religious and other conscience. Domestic and international human rights laws recognize such entitlements. Healthcare providers cannot be discriminated against, for instance in employment, on the basis of their beliefs. ⋯ The reconciliation of patients' rights to care and providers' rights of conscientious objection is in the duty of objectors in good faith to refer their patients to reasonably accessible providers who are known not to object. Conscientious objection is unethical when healthcare practitioners treat patients only as means to their own spiritual ends. Practitioners who would place their own spiritual or other interests above their patients' healthcare interests have a conflict of interest, which is unethical if not appropriately declared.
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Historical Article
Medicine and the Holocaust--lessons for present and future physicians.
German medicine, under National Socialism, was broadly complicit in the conceptualization and promulgation of the Nazi social and racial policies, and as such, played an integral and pertinent role in the Nazi implementation of the tragedies during the Holocaust. Much of contemporary ethics can be seen as a response to the abuses of this era. ⋯ Ethical challenges, other than those relating to human experimentation, which have continuing relevance were not addressed at Nuremberg and shall be presented in this paper. Organized efforts to educate about the ethos of medicine in this historical context should be imperative for all medical students and students of other healthcare professions.