Result card
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Do laws/ binding rules require appropriate processes or resources to guarantee equal access to Abdominal Aorta Aneurysm Screening ?
Authors: Pseudo108 Pseudo108
Internal reviewers: Pseudo99 Pseudo99
There are several regulations on the EU and international levels that secure equal access to healthcare in Europe. {33–39} This legislation implies that, in addition to the screening programme (for asymptomatic people in a risk group), usual care (ultrasound examination) is provided for all other people who present with suspicious symptoms.
Special problems in the case of AAA screening
Gender selection
Is it, according to the legal rules of equal access, appropriate to define risk groups for only one gender group (i.e. men aged 64+)?
States Parties {40}shall take all appropriate measures to eliminate discrimination against women in the field of healthcare.{41}
The paper of Perlin 2010 {51} “concludes that we must rigorously apply therapeutic jurisprudence principles to these issues” ( Anm.: relationship between therapeutic jurisprudence (TJ) and the role of criminal defense lawyers in insanity and incompetency-to-stand-trial (IST) cases), “so as to strip away sanist behavior, pretextual reasoning and teleological decision making from the criminal competency and responsibility processes, so as to enable us to confront the pretextual use of social science data in an open and meaningful way. This gambit would also allow us to address—in a more successful way than has ever yet been done—the problems raised by the omnipresence of ineffective counsel in cases involving defendants with mental disabilities.”
Especially in the field of e-health “It is essential to discuss, among others, aspects relating to safety and confidentiality; professional accountability; technical standards relating to digital recording, storage, and transmission of clinical data; copyright; authorization from professional regulatory bodies; and licensing for the remote practice of medicine.”(Rezende 2010) {52}
Because quality is based on education (within the medical profession), physicians' laws alone define legally the principles of medical handling. To assure the quality (i.e. special quality criteria) within a screening process the details can/should be ruled by contracts.
Responsibility:
About neonatal screening Loeber 2008 {53} states several legal aspects from a Singapore (legal) point of view: “no screening programme where such a programme should be (UN Convention for the right of the child); neonate(s) not screened for conditions within the established programme; no consent when it should have been given; error(s) in sampling, analysis, reporting; no follow-up available, error(s) in confirmatory diagnostics and treatment; irregular storage of dried blood spot specimen. Legal issues can be solved easily when responsibilities of parties concerned have been established and documented.”
Prisoners
According to the Council of Europe Committee of Ministers Recommendation (2006)2 of the Committee of Ministers to member states on the European Prison Rules, Part III {42} Health and medical services in prison shall be organised in close relation with the general health administration of the community or nation. (40.1) Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation (40.3).
Does that mean, screening is included? Yes. And if screening is included in this interpretation, is voluntary participation guaranteed? Do they (prisoners) have any choice? This should be the case (legally). Because ultrasound examination of the abdomen does not cause pain, or touch dignity, there should not be any problem. The patients' rights of prisoners are protected separately. {43}
Regionalism
It can be assumed that ultrasound could be provided even in very rural areas, but what about the consequences in the case of a positive result? Is it possible to ensure that people living far from a heart centre are not discriminated against in any way (e.g. by transport costs, waiting times)?
What about equality of services among EU citizens? Health for EU citizens working part time in a country other than their home country and emergency healthcare during holidays is clearly regulated {44}. As a part of the continuing coordination of the systems of social security in the EU {45} an existing EU guideline on patients' rights to cross-border healthcare {46} must be implemented on national levels by 25 October 2013.
Higher age
The selected population for AAA screening should be people (men) aged 64 or more. Can it be assured that within this age group no selection in favour of the younger and against the older members of the group takes place? Can it be legally assured that there is no age discrimination (medically) that is argued on the grounds of the severity of treatment risks (too old for heart surgery, already in nursing home care...).
The limits of healthcare should be implemented as a balance between the right of access and the patient's rights to human dignity, to life, and to their personal integrity, the prohibition of torture and inhuman or degrading treatment or punishment; and respect for private and family life. {47}
Quality:
"The most common allegation among family medicine closed claims was diagnostic error, and the most prevalent diagnosis was acute myocardial infarction, which represented 24.1% of closed claims with diagnostic errors". (Flannery 2010) {48} “Aortic aneurysms and dissections, although relatively infrequent as clinical events, represent a substantial MPL risk because of the high percentage of paid claims (30%) and the very high average indemnity payment of $417,298.”(in USA, Anm.) (Oetgen 2010) {49}.
The question for screening is: should the quality level of screening (the diagnostic ability of the provider) be secured legally?
The World Medical Association Declaration on the Rights of the Patient {50} includes the right to medical care of good quality, and there are several patient rights that implement the issue of quality. But is quality claimable?
References
PROPOSITION DE LOI relative à l'euthanasie volontaire; http://www.senat.fr/leg/ppl10-031.html
La loi belge relative à l'euthanasie; http://www.ginsburgh.net/textes/Fin_che_si_compia.pdf
L'euthanasie et l'assistance au suicide | Loi du 16 mars 2009. Sommaire.
Sommaire. Préface. 6. Questions/réponses sur la loi sur l'euthanasie. 9 et l' assistance; http://www.legilux.public.lu/leg/a/archives/2009/0046/a046.pdf
40 States Parties are countries which have adhered to the World Heritage Convention. http://whc.unesco.org/en/statesparties
41 Convention on the Elimination of all Forms of Discrimination against Women; Article 12; http://www.childinfo.org/files/childmarriage_cedaw.pdf
42 https://wcd.coe.int/ViewDoc.jsp?id=955747
43 Recommendation No. R(98) 71 of the Committee of Ministers to Member States concerning the ethical and organisational aspects of health care in prison; https://wcd.coe.int/com.instranet.InstraServlet?command=com.instranet.CmdBlobGet&InstranetImage=530914&SecMode=1&DocId=463258&Usage=2
44 Council Regulations (EC) No 1408/71of 14 June on the application of social security schemes to employed persons, to self-employed persons and to members of their families moving within the Community; especially Art. 22A; http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CONSLEG:1971R1408:20060428:en:PDF
45 Regulations (EEC) No 1408/71 from 14th June 1971; http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CONSLEG:1971R1408:20070102:EN:PDF
No 547/72 from 21st March 1972; http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:1997:176:0001:0016:en:PDF
No 883/2004, http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2004:166:0001:0123:en:PDF
No 988/2009; http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32009R0988:en:NOT
46 DIRECTIVE 2011/24/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 9 March 2011 on the application of patients' rights in cross-border healthcare http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:088:0045:0065:EN:PDF
47 Charter of Fundamental Rights of the European Union (2007/C 303/01); Articles 1 - 4; 7,8; http://eur-lex.europa.eu/en/treaties/dat/32007X1214/htm/C2007303EN.01000101.htm
48 Flannery FT ; Parikh PD ; Oetgen WJ. Characteristics of medical professional liability claims in patients treated by family medicine physicians. J Am Board Fam Med. 2010 Nov-Dec;23(6):753-61.
49 Oetgen WJ ; Parikh PD ; Cacchione JG ; Casale PN ; Dove JT ; Harold JG ; Hindle BL ; Maglaras M ; Rodgers GP ; Wright JS Characteristics of medical professional liability claims in patients with cardiovascular diseases. Am J Cardiol. 2010 Mar 1;105(5):745-52.
50 WMA Declaration of Lisbon on the Rights of the Patient, Adopted by the 34th World Medical Assembly, Lisbon, Portugal, September/October 1981 and amended by the 47th WMA General Assembly, Bali, Indonesia, September 1995 and editorially revised by the 171st WMA Council Session, Santiago, Chile, October 2005;http://www.wma.net/en/30publications/10policies/l4/
51 Perlin ML. "Too stubborn to ever be governed by enforced insanity": Some therapeutic jurisprudence dilemmas in the representation of criminal defendants in incompetency and insanity cases. Int J Law Psychiatry. 2010 Nov-Dec;33(5-6):475-81. Epub 2010 Oct 14.
52 Rezende EJ ; Melo Mdo C ; Tavares EC ; Santos Ade F ; Souza C. [Ethics and eHealth: reflections for a safe practice]. Rev Panam Salud Publica. 2010 Jul;28(1):58-65.
53 Loeber JG. Legal issues in neonatal screening. Ann Acad Med Singapore. 2008 Dec;37(12 Suppl):92-2.
Commission communication on Action against Cancer: European Partnership
European Parliament resolution of 6 May 2010 on the Commission communication on
Action Against Cancer: European Partnership (2009/2103(INI)); I 39
http://www.europarl.europa.eu/RegData/seance_pleniere/textes_adoptes/definitif/2010/05-06/0152/P7_TA(2010)0152_EN.pdf
Commission communication on Action against Cancer: European Partnership
European Parliament resolution of 6 May 2010 on the Commission communication on
Action Against Cancer: European Partnership (2009/2103(INI)); I 39
http://www.europarl.europa.eu/RegData/seance_pleniere/textes_adoptes/definitif/2010/05-06/0152/P7_TA(2010)0152_EN.pdf Abs 57
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