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Biomedical subjects

H Nys

Publications and source records attributed to H Nys.

13 recordsLinked to original sources
PubMed2006

Impact of cost containment measures on medical liability.

RATIONALE: Owing to the growing health care expenditure and the need to improve efficiency, public authorities have since the 1980s changed their policy with respect to health care. Financial pressures encouraged them to investigate methods to control health care costs. One recent method is the enactment of cost containment measures based on clinical practice guidelines (CPGs) that provide financial or administrative sanctions. AIMS AND OBJECTIVES: This article describes the legal value of CPGs, the evolution towards cost containment measures based on CPGs, and finally the legal value of these new cost containment measures. It questions whether these measures may have an impact on the medical liability rules and it wants to open the debate on the legal value of these measures based vis-à-vis the professional autonomy of the physician and patients' rights on quality care. METHODS: The research for this article is based on a comparative analysis of the legal literature and jurisprudence of a number of legal systems. RESULTS AND CONCLUSIONS: The article concludes that, as a result of the rising costs, it becomes increasingly difficult for a physician to balance his duty to take care on the one hand and his duty to control costs on the other. Maintaining a high standard of care towards patients becomes difficult. Consequently, one wonders whether the law should then allow the standard of care to be adjusted according to the available means. Until now, courts in a fault based system have not been willing to accept such an adjustment of the standard of care, but it might well be possible that this attitude will change in case of no-fault compensation systems.

Belgium↗
PubMed2006

Presymptomatic and predictive genetic testing in minors: a systematic review of guidelines and position papers.

The objective of this study is to review ethical and clinical guidelines and position papers concerning the presymptomatic and predictive genetic testing of minors. The databases Medline, Philosopher's Index, Biological Abstracts, Web of Science and Google Scholar were searched using keywords relating to the presymptomatic and predictive testing of children. We also searched the websites of the national bioethics committees indexed on the websites of World Health Organization (WHO) and the German Reference Centre for Ethics in the Life Sciences, the websites of the Human Genetics Societies of various nations indexed on the website of the International Federation of Human Genetics Societies and related links and the national medical associations indexed on the website of the World Medical Association. We retrieved 27 different papers dealing with guidelines or position papers that fulfilled our search criteria. They encompassed the period 1991-2005 and originated from 31 different organizations. The main justification for presymptomatic and predictive genetic testing was the direct benefit to the minor through either medical intervention or preventive measures. If there were no urgent medical reasons, all guidelines recommend postponing testing until the child could consent to testing as a competent adolescent or as an adult. Ambiguity existed for childhood-onset disorders for which preventive or therapeutic measures are not available and for the timing of testing for childhood-onset disorders. Although the guidelines covering presymptomatic and predictive genetic testing of minors agree strongly that medical benefit is the main justification for testing, a lack of consensus remains in the case of childhood-onset disorders for which preventive or therapeutic measures are not available.

Age Factors↗
PubMed2000

Professional autonomy in Belgium.

The Belgian health care system has a few features that may have contributed to the rising costs of health care: patients' free choice of physicians, large clinical freedom of physicians, essentially a fee-for-service remuneration for medical specialists in which the fees are agreed between insurance funds and physicians. The increased medical consumption and costs have prompted the state and insurance companies to take measures that limit the professional autonomy of the physicians. Access to medical education, free until 1997, is now restricted. The medical profession is organized in the Order of Physicians that has established a code of professional ethics that has moral but not legal force. So far, there is no special legislation for the patient-physician relationship, though laws on specitic issues like organ transplantation contain duties for physicians. In recent years a debate is taking place on patients' rights, of which informed consent is central and gaining importance in medico-legal publications. An analysis of (ethical and legal) regulations concerning the withholding or withdrawal of treatment by physicians demonstrate that the profession still enjoys a large clinical autonomy, though due discussion with the patient has become more explicitly required. The respect for professional autonomy is not primarily due to any formal power that the Order of Physicians would have, but is rather grounded in the generally high quality of the patient-physician relationship that in ethical terms is considered essentially as a confidence relationship rather than a contractual relationship.

Belgium↗
PubMed1999

Sterilisation of incompetent mentally handicapped persons: a model for decision making.

Doctors are regularly confronted with requests for sterilisation of mentally handicapped people who cannot give consent for themselves. They ought to act in a medical vacuum because there doesn't exist a consensus about a model for decision making on this matter. In this article a model for decision making is proposed, based on a review of the literature and our own research data. We have attempted to select and classify certain factors which could enable us to arrive at an ethically justifiable method of making a medical decision. In doing so we distinguish two major criteria: heredity and parenting competence, and six minor criteria: conception risk, IQ, age, personality, medical aspects and prognosis and finally support and guidance for the mentally handicapped person. The major criteria give rise to a "situation of necessity". In this situation the physician is confronted with a conflict of values and interests. The minor criteria are of an entirely different ethical order. They can only be considered once the major criteria have created a "situation of necessity". Ultimately it comes down to deciding whether the benefits of sterilisation outweigh the drawbacks and whether the means are appropriate to the end, where efficient contraception is the end and irreversible sterilisation is the means.

Adolescent↗
PubMed1996

Recommendations for European health data protection legislation.

In year 1 of the SEISMED project, the Katholieke Universiteit Leuven coordinated the inventory and analysis of medical personal data protection legislation in Europe. A report on legal issues of medical data protection legislation in Europe was written by the Vrije Universiteit Amsterdam, the Centre National pour la Recherche Scientifique (Paris) and the University College Dublin. This report served as a basis for a second important legal deliverable, i.e. the Health Informatics Deontology Code. In this third and final report, we take into account the results of the other two legal reports and we formulate recommendations for the national and European legislator. This report analyses critically the upcoming privacy directive. We propose several recommendations which should be taken into account by the European and national legislator. We focused quite extensively on the use of medical data for research purposes. We had several reasons to do this. One of them is the fact that the use of medical data for research purposes is very popular, in particular now the health care sector is becoming more and more 'standardized' by using computers, networksystems and telematics. Legislation is therefore needed. Moreover, the use of medical data for research purposes involves the transfer of data from one Member State to another. Therefore, a harmonized legislation is really needed. We hope that the recommendations we propose, will be taken into consideration by the European legislator.

Computer Security↗
PubMed1993

Therapeutic use of human organs and tissues under Belgian law.

In 1986 the Belgian Parliament adopted a law on the removal and transplantation of organs and tissues. Five years later, it has become clear that this law needs to be revised. The main difficulties relate to the distinction between the removal of organs for therapeutic and experimental use, which has proved to be unadministrable; the rules regulating the removal of organs from living minors; the definition of and criteria for determining death and the involvement of relatives in the decision to remove organs from dead donors. This article proposes alternative solutions, keeping in mind the need for harmonized rules on the removal of organs in a broad European perspective.

Adult↗
PubMed1988

Psychosurgery and personality--some legal considerations.

The practice of psychosurgery is subjected to different rules, sometimes written, often unwritten, in the different jurisdictions. No commonly accepted definition on what psychosurgery exactly is has been given by the national legislatures. Some legislatures have simply outlawed psychosurgery; some have no specific rules; others have provided a stable legal basis to it, while protecting the patient (informed consent; review committees; second opinions).

Belgium↗
PubMed1984

For-profit hospitals: do they have a place in Europe?

This article examines the legislative and administrative approach to for-profit hospitals in the 10 member states of the European Community. When considering the hospital legislation of these states one can see that in some Hospital Acts a distinction had been made between for-profit and not-for-profit hospitals. However, there seem to be no clear legal criteria on which this distinction has been based. It is very questionable indeed whether it is at all possible to legally distinguish for-profit and not-for-profit hospitals. The legislative approaches towards for-profit hospitals in the E.E.C. vary from legal prohibition (Greece) to a neutral non-interventional attitude (Federal Republic of Germany, and Ireland). In between those two approaches lie indirect prohibition (Belgium, the Netherlands), regulation through legislation and ethical codes, rhetorical neglect (Italy), cooperation (France) and complete assimilation (Denmark).

Europe↗
PubMedDate not supplied

Human rights: implications for patients and staff.

Originating from wider declarations of fundamental human rights, individual human rights in the field of health care, also called patients' rights, have been elaborated, developed and implemented by most international organisations, including the European Union and the World Health Organisation. The Council of Europe is however, particularly prominent in its work in the field of human rights, having drawn up a number of vital international treaties, among them and most importantly the Convention on Human Rights and Biomedicine, which strengthens internationally the legal position of the patient and the research subject in setting a minimum level of protection in respect of individual human rights and health and is binding upon the member states that have ratified it. Nonetheless, it needs to be examined to see if the European Union would be a better alternative to regulate these patients' rights.

Codes of Ethics↗