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Nieleczniczy środek zabezpieczający umieszczenia w ośrodku terapii osobowości – szpitalu psychiatrycznym

Author(s): Lech K. Paprzycki / Language(s): Polish Issue: 4/2012

The study concerns the draft amendment of the Executive Penal Code of 1997 (adding the stipulation in article 83a) and detailed amendment of the Act of 1994 on the protection of mental health, submitted by the Minister of Justice and leading to the establishment of ‘centers for personality therapy’ which enjoy the status of a psychiatric hospital. Careful analysis leads to the conclusion that the proposed solution was not well designed and, what is more, inconsistent. The draft amendments to these two legal acts were criticized by medical as well as legal circles.

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Stosowanie technik wspomaganej medycznie prokreacji w celach niewyłącznie rodzicielskich. Problem „dziecka-lekarstwa”

Author(s): Joanna Haberko / Language(s): Polish Issue: 4/2012

Reproductive medicine is a branch of science which is developing in a highly intensive and extremely rapid manner, while these developments are far from receiving unanimous moral and legal approval. The techniques of medically assisted procreation are applied in numerous instances of unintentional infertility of human couples. As techniques of medical treatment theyshould correspond with the requirements of current medical knowledge and be applied in conformity with the current state of medical knowledge and standards of conduct in the treatment of infertility. The subject of this paper is to a certain extent related to the limits of this medical obligation.Polish law does not provide any detailed solutions in the field of the application of medically assisted procreation techniques, both as regards the standards of conduct and theadmissibility of undergoing ‘infertility treatment’for a purpose which is actually not medicinal. The lack of grounds and detailed principles governing the standards of the profession in Polish law generates a risk of the instrumental use of the latest achievements of medical technology. Onthe one hand, the legislator does not take a stand as regards the admissibility of the applicationof medically assisted procreation for other than exclusively parental purposes. The decision concerningthis admissibility is left to the due diligence, assessment and conscience of a doctor approached by a couple wishing (or even demanding) that a child is created in order to save its illsiblings. At the same time, the legislator appears to set the limits for the admissibility of usingbone marrow and hematopoietic cells of peripheral blood for the sake of one’s siblings. The factof establishing these limits, and the fact that the legislator does not leave this matter to the decision of parents and doctor, is praiseworthy. There are still doubts, however, stirred by the possibility of exceeding these limits when using blood cells obtained for siblings, or the lack ofsanctions when acting despite the objections of the minor to have his/her bone marrow harvested.The legal protection of the limits for the admissibility of obtaining material from onechild to treat another is vested in courts and their decisions, made in accordance with the principleof the child’s interest. It is of course difficult to design general solutions, but it seems that thecourt should be very particular when examining the admissibility of harvesting when a minor has not consented to have his/her bone marrow harvested; the same thing applies in the situationwhere hematopoietic cells are harvested when a minor is not given an opportunity to takea stand.

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Jaki jest status prawny bloczka parafinowego jako dokumentu medycznego?

Author(s): Krzysztof W. Zieliński,Adam Zieliński / Language(s): Polish Issue: 4/2012

The paper presents the legal circumstances of human tissue samples collected for diagnostic purposes which, in the opinion of the authors, become a kind of medical document, following their embedding in paraffin, and histological and cytological preparations. Potential problemsare indicated that may emerge when introducing legal regulations for pathomorphological tissuearchives.

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Odpowiedzialność zawodowa lekarzy w okresie II Rzeczypospolitej

Author(s): Krzysztof Kordel,Piotr Kordel / Language(s): Polish Issue: 4/2012

The article presents the law regulating the proceedings in cases involving professional liability of doctors in the Second Polish Republic. Professional liability of physicians was regulated bythe Acts on the Chambers of Physicians passed in 1921 and in 1934 and Statutory Instrument of the Minister of Social Security issued in 1936. The professional liability of dentists was regulated by the Act on the Chamber of Dental Practitioners passed in 1938 and by Statutory Instrument of the Minister of Health issued in 1946.

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Odpowiedzialność dyscyplinarna lekarza za zaniechanie udzielenia pomocy

Author(s): Piotr F. Piesiewicz / Language(s): Polish Issue: 4/2012

The subject of this paper concerns the duty of a doctor to help a person whose life and health arein danger. The author approaches the problem both from the perspective of the principles of professionalethics, such as the Code of Medical Ethics, and statutory regulations, i.e. the law of December 5, 1996 on the professions of physician and dentist, the law of December 2, 2009 onmedical chambers, the law of April 15, 2011 on medical activity, and the law on the CriminalCode of June 6, 1997. Describing these regulations, on the one hand the author outlines the limitations of doctors’right to refuse to begin treatment or not to treat a patient, on the other hand, hepoints to the obligation, or actually the duty of a doctor, to help another human being whose lifeor health is in danger.

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Wątpliwości dotyczące zgody pacjenta na świadczenia medyczne – wybrane problemy praktyki szpitala klinicznego

Author(s): Monika Urbaniak,Szczepan Cofta / Language(s): Polish Issue: 4/2012

The practice of a physician working for a clinical hospital frequently involves providing treatmentin emergencies. Decisions are often taken under pressure of time, and under the risk of possible difficulties in determining whether the patient’s consent for the application of a given diagnostic measure or treatment has been obtained or not. There emerge doubts related to the issueof the patient’s consent to further treatment. The paper makes a detailed legal analysis of fiveactual situations that took place in the Clinical Hospital of Poznan University of Medical Sciences. These cases concern treatments provided, resorting to the institution of applying surrogate consent, due to the specific conditions of medical intervention.

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Odpowiedzialność z tytułu zaistnienia zdarzenia medycznego. Kilka uwag na temat nowej regulacji z ustawy o prawach pacjenta i Rzeczniku Praw Pacjenta

Author(s): Bartosz Kuczyński / Language(s): Polish Issue: 4/2012

The objective of the paper is to describe the issues of liability for medical occurrences. The descriptionis accompanied by remarks on the new regulations in the Act on patient’s rights and Commissioner for the Patient. The paper shows that while introducing a new system to compensate for medical harm, the legislator has not foreseen certain adverse consequences related tothe possibility of compensation being claimed by authorized bodies, resulting from their legalstatus. Nevertheless, the solutions introduced with respect to medical occurrences are highly innovative within the Polish legal system. They aim to simplify the enforcement of claims resultingfrom a medical occurrence that took place in the course of providing a health treatment in a hospital,as stipulated in the Act on medical activity. The system exclusively concerns those patients who were provided with treatment in a hospital.

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Dopuszczalność eutanazji

Author(s): Katarzyna Golusińska / Language(s): Polish Issue: 4/2012

The issue of euthanasia involves an extensive repertoire of problems, ranging from the lack of a coherent definition, through to terminological chaos, to a lack of uniform solutions. Differences in the opinions of advocates and opponents of euthanasia, caused by different outlooks or religious views, result in confusion and the impossibility to reach consensus as concerns the application of euthanasia and criminal liability. Additionally, the progress of modern medicine and related sciences has resulted in the legal regulations, particularly those concerning euthanasia, becoming obsolete. This paper attempts to order this chaos and presents selected legal regulations. It indicates that despite differing legal solutions, the global tendency is to liberalize the regulations on euthanasia. Analyzing different regulations, one can conclude that a model that fulfills the will of the patient, that is his/her right to a dignified death, and guarantees that thefeatures of homicide are not met, has been adopted in Switzerland. These regulations provide for the conscious and voluntary taking of a pharmaceutical, leading to the termination of life processes. In the opinion of the author, the multitude of religious and other views, and the diversity of regulations leads to a clear inability to develop a consensus in this matter.

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Higiena dla społeczeństwa obywatelskiego

Author(s): Leszek Bartkowiak / Language(s): Polish Issue: 4/2012

The paper presents the thesis that, despite its progressing specialization, modern hygiene hasa significant educational and promotional role in shaping social awareness and advancing civilsociety. Therefore, the idea of hygiene as a socio-medical discipline, the characteristics of civic society and the factors that can be supported by the tasks of hygiene are discussed. It is assumed that hygiene should be a part of civil culture, which is understood as a set of approved values, beliefs, attitudes and models of behavior required if an individual and a society are to function efficiently. The advancement of civil culture is assumed to be conditioned on knowledge and education, including health education. The paper presents the view that hygiene can prevent dogmatic thinking, which poses a threat to civil society. Hygiene, understood as a practical implementationof health directives, should make apparent all the ideological constructs of health, the shared values and interests which provoke citizens to joint action.

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Błąd sztuki lekarskiej

Author(s): Elżbieta Jęczmionka / Language(s): Polish Issue: 4/2012

The purpose of the text is to introduce the concept of ‘error in the art of medicine’. The analysis presents a subjective and objective approach to this concept as well as opinions that question the concepts of ‘error’ and ‘art’. It is also demonstrated that a precise and short definition of a medical error is not easy, which is why there are many definitions. The view is adopted that a medical error is constituted by conduct defying commonly accepted principles of medical knowledge, which may involve engaging in or abandoning an activity against long-standing, generally accepted principles of medical knowledge. Additionally, medical error involves activity that is harmful to a patient, and the performance, or non-performance of an activity with harmful results that could have been avoided by applying the basic principles of medical knowledge.

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Reklama produktów leczniczych a dopuszczalność przyjmowania korzyści przez lekarzy

Author(s): Michał Puk / Language(s): Polish Issue: 4/2012

The purpose of this article is to present the current legal regulations in Poland concerning advertising medicinal product and acceptability of taking material and personal profits by physicians bound up with pharmaceutical industry. On the basis of recent sociological studies of the pharmaceutical sector in Poland, an analysis of the provisions of the act of Pharmaceutical law, that define the concept of advertising of medicinal products and define the boundaries of permissible gaining benefits by doctors was carried. Afterwards, basing on criminal regulation containedin above-mentioned act and criminal code, topic of the criminal responsibility of physicians dependent on pharmaceutical company was discussed. The issue of professional responsibility, on the basis of act of Law on Chambers of Physicians and Code of Medical Ethics, was also concerned. The analysis was made using studies and commentary of representatives of the scientific doctrine. The final conclusion is the necessity to establish more strict regulations aimed at protecting independence of doctors.

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Analyzing conversations between Polish patients and doctors: a sketch of methodology and some initial results

Author(s): Matylda Weidner / Language(s): Polish Issue: 4/2012

This paper presents a brief methodological sketch of conversation analysis, a qualitative methodof analyzing spoken materials and demonstrates the usability of this method for analyzing conversations between doctors and patients in the context of Polish healthcare. In what follows I first outline the basic assumptions of conversation analysis that are of particular relevance for this paper. Next, I provide a brief illustration of the kind of insights that conversation analytic examination of interactional materials can offer. Accordingly, I focus on particular type of action– questions, and look at two particular dimensions of question delivery formats in Polish medical communication. In the remainder of the paper I review a number of past and present studies on medical communication and conclude with some general observations on the relevance of analyzing the organization of individual doctor–patient encounters for the overall study of medical communication.

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Przegląd orzecznictwa Naczelnego Sądu Lekarskiego z 2011 r.

Author(s): Jędrzej Skrzypczak / Language(s): Polish Issue: 4/2012

As in the case of other verdicts by the judiciary, the decisions of medical courts by principle do not constitute legal precedents in our legal system. In other words, they do not establish a new legalstandard and only present a practical interpretation of individual legal provisions. In the case of medical courts the situation tends to be slightly more complicated, given the content of article 76 of the Code of Medical Ethics. By virtue of this regulation, in the cases not provided forby the Code of Medical Ethics, one should follow the principles expressed in the legal decisions of medical courts, among other things. The opinions and arguments of the Supreme MedicalCourt are significant, as in conformity with article 90 of the Act of December 2, 2009 on legal chambers, the Supreme Medical Court is a court of appeals from the decisions of regional medical courts. The current Act provides for the possibility stipulated in article 84, saying that when a penalty referred to in article 83, section 1, items 4–7 is adjudged, a medical court can decide to publish its legal decision in the bulletin of the regional medical chamber where the defendant is a member. Nevertheless, medical courts apply this regulation infrequently. Therefore, the need to publish selected decisions of the Supreme Medical Court seems unquestionable, and the present paper tries to perform this task, albeit only partially. The paper presents selected justifications ofthe legal decisions issued by the Supreme Medical Court in 2011. This presentation serves the exclusive purpose of presenting the issue and is not intended to brand individuals or entities (DistrictMedical Courts and District Commissioners of Professional Responsibility) taking part in the proceedings. While the justifications of the verdicts issued by the Supreme Medical Court do not contain their arguments, the author of the paper took it upon himself to emphasize the most crucial aspects of the described justifications.

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Ramy prawne wykonywania zawodów medycznych we włoskim systemie ochrony zdrowia

Author(s): Monika Urbaniak / Language(s): Polish Issue: 4/2012

In Italy, healthcare professions can be performed by persons with a title recognized by the Italian state. Performing a healthcare profession means providing medical, preventive, diagnostic or rehabilitation services. In addition, individuals who have been granted the right to perform a healthcare profession abroad are admitted to such professions once their diploma has been recognized by the ministry of health. The paper describes medical professions in the Italian healthcare system. The description is divided into basic healthcare professions (pharmacist, surgeon,dentist (odontoiatra), veterinarian and psychologist-psychotherapist) and other professions (dealing with rehabilitation, technical and paramedic professions, and technical andpreventive professions). The professions described in more detail include those providing basicmedical care: nurse, surgeon or pharmacist. The paper also discusses the issue of civil liability of physicians and other medical staff.

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Sprawozdanie z działalności Naczelnego Sądu Lekarskiego w 2011 r.

Author(s): Wojciech Łącki / Language(s): Polish Issue: 4/2012

Two years after the Act on medical chambers of December 2, 2009 came into force, it has become possible to make some comparisons of medical courts functioning under the new regulations. The amendments to the regulations have not resulted in an increased number of cases, which isclearly observable both in regional courts and in the Supreme Court. Compared to 2010, there has been a significant increase in the number of appeals made by complainants. This is mostlikely the result of the fact that the complainant is almost always represented by professional attorneys who fully protect his/her interests. The same tendency has not been observed with respect to overturned verdicts, whose number has not increased and which is mainly connected with thestrict principles by which they are submitted, including a quite significant, and compulsory, court fee. The number of appeals made by the Supreme Screener for Professional Liability is negligible. In both instances the most frequent penalties encompass admonitions and reprimands. There are few fines and bans to hold managerial functions. A considerable proportion of verdicts involve acquittals. A new range of penalties is slowly ‘catching on’. Another step on the path towards its more comprehensive application should involve the screeners suggesting the type of penalty for the alleged professional offence in the application for punishment they submit. This would make it possible to codify penalties in relation to the severity of the act committed. The analysis of medical specializations that are most often the subject of applications for punishment shows that they have not changed, and are dominated by surgery, closely followed by internal medicine, obstetrics and gynecology. Specializations involving surgical treatment have beenand will continue to be high risk specializations

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Transplantacja płuc

Author(s): Wojciech Dyszkiewicz / Language(s): Polish Issue: 3/2011

Transplantology of the chest organs (heart, lungs) faces difficult issues nowadays. On the onehand it is not possible to perform the procedure in all patients awaiting the transplantation. On the other – quality of life after the operation, particularly lung transplantation, leaves much to be desired (numerous complications and astronomical treatment cost). The current activities of the scientists and the medical practitioners are therefore directed at developing more effective, while less invasive, measures of prevention, monitoring and treatment of patients experiencing transplant rejection. The future of transplantology will be decided not so much by surgical techniques, well mastered at present, but by the ability to either overcome the long-lasting process o fallograft rejection or else to successfully modify xenotransplant genotype, lest it is recognised by the recipient’s organism as a foreign body. The successful introduction of the latter procedure would mean a significant progress in transplantology, through a marked increase in the numberof donors. It would also end the discussion on ethical and legal aspects concerning organ transplantation. Preparations for lung transplantation in Greater-Poland area are continuing since 2006. The necessary training of the surgical teams at the Thoraco- and Cardiosurgery Departments was completed and the surgical infrastructure at the No. 1 University Hospital fully prepared. Then the Ministry of Health was asked for an accreditation for the Cardiosurgery Department of the Cardio-Thoracosurgery Chair, University of Medical Sciences in Poznan, in the field of lung transplantation. After the Accreditation Commission’s inspections the relevant approval was obtained in 2009. However, the Centre has not, so far, become operational, chiefly due to the insufficient number of potential lung transplant recipients in our area.

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Pozyskiwanie komórek krwiotwórczych w teorii i praktyce

Author(s): Ewa Speichert-Mądra,Krzysztof Olbromski / Language(s): Polish Issue: 3/2011

Transplantations of haematopoietic cells are universally accepted in treatment of primarily proliferative diseases of haematopoietic system as well as metabolic and immunological diseases, and many others. Stem cells are still being collected from bone marrow but increasingly also from peripheral blood, preceded by mobilisation of these cells. The use of stem cells taken from cord blood shows a great promise as well. Due to a great diversity among HLA-antigens the possibility of finding a matching, unrelated donor of stem cells depends on the existence and close collaboration of world-wide registers of unrelated bone marrow and cord blood donors. The more examined and registered potential bonemarrow donors, the greater chances of saving another life. The Act of 17. July, 2009 – amending the Act on collection, storing and transplantation of cells, tissues and organs – standardises in detail the principles of providing bone marrow donors in Poland, and the task assigned to the Central Register of Unrelated Donors of Bone Marrow and Cord Blood (Poltransplant, CRNDSiKP). The Act imposes finding of potential bone marrow donors on Centres of Bone marrow Donors, and then reporting them to the Poltransplant Register. The latter, acting by the Organisational-Coordinating Centre for Transplantation, will transfer the data to Bone Marrow Donor Worldwide (BMDW).

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Powstanie programu transplantacji serca w Poznaniu

Author(s): Marek Jemielity / Language(s): Polish Issue: 3/2011

In May, 2009, the Ministry of Health authorised the Cardio-surgery Department in one of the university hospitals in Poznan, led by Prof. Marek Jemielity, to activate the Heart Transplantation Programme. This decision enabled the preparations for the first such procedure in a Poznan centre. The article depicts the implementation of the project.

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Przeszczepianie nerek

Author(s): Maciej Głyda / Language(s): Polish Issue: 3/2011

Renal transplantation is, beside peritoneal dialysis and haemodialysis, an accepted method of renal replacement therapy, in patients with terminal renal failure. The first successful renal transplantation between monozygotic twins was performed by dr. J. Murray in Boston, 50 years ago. The first such procedure in Poland, also successful, was carried out in Warsaw in 1966. The article presents medical and legal regulations associated with transplantation of this organ.

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Stacja dializ jako model do dyskusji nad rozwiązaniami systemowymi w ochronie zdrowia w Polsce

Author(s): Teresa Dryl-Rydzyńska / Language(s): Polish Issue: 3/2011

The article presents the current dialysis therapy model in Poland. Organisation and financing of dialysis services are discussed, particularly those stemming from system solutions in the Polish health care. Changes intended to improve the quality and effectiveness of therapy involving dialysis are also suggested. As mentioned above, model solutions in this field may be applied in the whole health care system in this country.

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