ABSTRACT
Abstract Objective Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide. Methods This is a review of the literature published in the 21st century on commercial surrogacy. Results A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers. Conclusion Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.
Resumo Objetivo A gestação de substituição é o processo no qual uma mulher engravida e entrega um bebê a outra pessoa ou casal, conhecidos como pais pretendidos. Quando as gestantes são pagas, isto é conhecido como gestação de substituição comercial. O objetivo do presente trabalho é rever os aspectos legais, éticos, sociais e culturais da gestação de substituição comercial, bem como o panorama atual em todo o mundo. Métodos Trata-se de uma revisão da literatura publicada no século XXI sobre a gestação de substituição comercial. Resultados Um total de 248 artigos foi incluído nesta revisão. A demanda por tratamentos com gestação de substituição por mulheres sem útero ou com distúrbios uterinos importantes, homens solteiros e casais masculinos está aumentando constantemente em todo o mundo. Este tratamento reprodutivo tem dilemas éticos importantes. Além disso, a legislação é amplamente adiada em todo o mundo e está em constante mudança. Portanto, os pacientes procuram cada vez mais por tratamentos no exterior, o que pode levar a importantes problemas legais entre países com leis diferentes. A gestação de substituição comercial é praticada em vários países, na maioria dos quais não há legislação específica. Alguns países tomaram medidas restritivas contra esta técnica por causa de relatos de exploração destas mulheres. Conclusão A gestação de substituição comercial é uma prática comum, apesar de importantes dilemas éticos e legais. Como consequência de diversas legislações nacionais, os pacientes frequentemente recorrem a programas de gestação de substituição comercial internacionais. Atualmente, não existe um contexto jurídico internacional padrão e esta prática permanece em grande parte não regulamentada.
Subject(s)
Humans , Female , Pregnancy , Bioethics , Fertilization in Vitro , Legislation, MedicalABSTRACT
Background: Teenage pregnancy is a psychosocial and multifactorial problem described as a lack of exercise of rights in sexual and reproductive health. There are important aspects in the doctor-patient relationship and confidentiality that directly affect the continuity and quality of care. There are controversies in the laws relating to the provision of contraception and confidentiality, and those that protect the sexual indemnity, especially in adolescents under 14 years. Aim: To describe the implications of the legal framework for professional midwives in the care of adolescents younger than 14 years in sexual and reproductive health. Material and Methods: In-depth interviews were conducted to 13 female and 2 male midwives working at Primary Health Care Centers in the Metropolitan Region. Results: The attention of adolescents younger than 14 years in sexual and reproductive health involves medical-legal issues for health professionals. All professionals recognize that mandatory reporting sexual activity is a complex situation. All professionals notify pregnancies. In relation to the delivery of contraception, clinical care is problematic since professionals should take shelter from a legal standpoint. Conclusions: The medical-legal context of pregnant women under 14 years of age care generates a context of uncertainty and fear for professionals and becomes a source of conflict and insecurity in the exercise of the profession.
Subject(s)
Humans , Male , Female , Pregnancy , Adolescent , Adult , Middle Aged , Pregnancy in Adolescence/prevention & control , Professional-Patient Relations , Reproductive Health/legislation & jurisprudence , Midwifery/legislation & jurisprudence , Primary Health Care/legislation & jurisprudence , Chile , Interviews as Topic , Surveys and Questionnaires , Confidentiality , Qualitative Research , Reproductive Health/education , Legislation, MedicalABSTRACT
Background: There are legal regulations about sexual and reproductive rights of adolescents. However, this legal framework (LF) may have contradictory elements: there are laws assuring confidentiality and access to contraception at any age but there are other laws that consider any sexual contact with an adolescent younger than 14 a sexual assault, whose report to the legal authorities in mandatory. Aim: To explore the knowledge and clinical practice of primary health care (PHC) providers regarding prevention of teenage pregnancy. Material and Methods: Qualitative study collecting data using semi-structured interviews made to midwives and directors of PHC centers. Analysis of the data was based on Grounded Theory. Results: There is a differentiated clinical care for pregnancy prevention among adolescents if they are over 14 years old. This is due to the LF, specifically to the sexual crimes law (19,927) and the law about regulation of the fertility (20,418). The differences affect health care, access and counseling about contraception and confidentiality. Healthcare of teenagers under the age of 14 is perceived as problematic for providers, due to the possible legal implications. Conclusions: The LF causes insecurity on health care providers and derives in a differentiated clinical approach according to the patient´s age. This is a barrier to provide timely and confidential access to counseling and contraception.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Pregnancy in Adolescence/prevention & control , Primary Health Care , Health Knowledge, Attitudes, Practice , Legislation, Medical , Physician Executives , Chile , Interviews as Topic , Qualitative ResearchABSTRACT
Background: The frequency and features of malpractice lawsuits against dentists in Chile are not well known. Aim: To determine the magnitude and frequency of professional liability claims against dentists. Material and Methods: A retrospective analysis of the Medical Liability Unit of the Legal Medical Service of Chile database. This public organization deals with most professional liability claims in Chile. Results: Between 2007 and 2012, 3,990 expert opinions about liability of health care professionals were requested. Odontology was the fifth specialty most commonly sued and dentists, the second most frequently sued professionals. Sixty nine percent of cases originated in private clinics, which is coincident with a higher frequency of dentists working in private practice. Most petitioners were adult women and most claims originated from surgical interventions and infections. In 35% of claims against dentists, a violation of Lex Artis was confirmed, compared with 9% of all expert opinions that generated in the unit. Conclusions: Claims against dentists are more common than previously thought and these professionals should adopt preventive measures to avoid them.
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Prostatic Neoplasms/pathology , Prostatic Neoplasms/radiotherapy , Radiotherapy, Adjuvant/statistics & numerical data , Black or African American/statistics & numerical data , Age Factors , Comorbidity , Databases, Factual , Income , Logistic Models , Neoplasm Grading , Neoplasm Staging , Prostatectomy/methods , Prostatic Neoplasms/surgery , Radiotherapy, Adjuvant , Residence Characteristics , Risk Assessment , Risk Factors , United States/epidemiologyABSTRACT
Este trabajo analiza los discursos del médico higienista argentino Leopoldo Bard a partir de tres publicaciones que realizó entre 1923 y 1933 sobre toxicomanías. Las mismas condensan los debates en torno al papel del Estado, de las políticas públicas nacionales, regionales y, particularmente, la influencia norteamericana en Argentina a través de su figura. Las medidas legislativas y políticas de la época, de indudable corte represivo, fueron significativas para los avances del Estado en la esfera privada, la creciente importancia de los cuerpos profesionales en la definición de fronteras materiales y simbólicas sobre lo socialmente aceptable, incluyendo lo relativo al consumo de drogas. También se destacan los múltiples propósitos que parecen satisfacer estas políticas: en el plano local habilitan otras formas de represión de los conflictos derivados de la inmigración mientras que, en el internacional, complacen a los requerimientos norteamericanos.
This paper analyzes the discourses of Argentine doctor and public health professional Leopoldo Bard using three texts on drug abuse published between 1923 and 1933. These texts embody the debates of the time regarding the role of the State, public policies at the national and regional level and, particularly, the US influence in Argentina exerted through the figure of Dr. Bard. The legislative measures and policies of that time, undoubtedly of a repressive character, were key in the State's advances into the private sphere and in the increasing importance of professional organizations in the definition of the material and symbolic borders of the socially acceptable, including those related to drug use. The multiple purposes these policies seem to satisfy are also highlighted: at the local level they enable other forms of repressing conflicts arising from immigration, while at the international level they appease US requirements.
Subject(s)
History, 20th Century , Humans , Drug and Narcotic Control/legislation & jurisprudence , Illicit Drugs/legislation & jurisprudence , Argentina , Drug and Narcotic Control/history , Illicit Drugs/historyABSTRACT
Nas últimas décadas, houve um crescimento das implicações em sociedade do erro médico, assunto em que se entrelaçam Medicina e Direito. Este estudo procurou conhecer a percepção de estudantes de Medicina e Direito sobre erro médico, avaliando nível de interesse e informação, e a necessidade de abordar o tema na graduação e como ela ocorre para cada área, na sua ótica. Estudo observacional descritivo transversal foi realizado na Universidade Federal de Juiz de Fora (MG) em 2008 com 185 alunos de Medicina e 119 de Direito. 88,7 por cento dos alunos de Medicina (MED) e 92,4 por cento de Direito (DIR) referiram conhecimento sobre erro médico. O interesse se dá por ser um tema muito discutido atualmente. Os alunos consideram necessária sua abordagem na graduação (97,8 por cento MED e 94,9 por cento DIR). É importante discutir um tema tão atual na graduação de Medicina e de Direito pela contribuição que pode ser oferecida para diminuir o ciclo vicioso de erros, iatrogenias e processos jurídicos, além de possibilitar uma reflexão acerca do papel da educação médica na construção ética de novos profissionais.
Recent decades have witnessed an increase in the societal implications of medical error, a subject in which Medicine and Law intertwine. This study focused on medical error from the perspective of medical students and law students, assessing their level of interest and information and the need to discuss the topic during undergraduate education and how it occurs in each field, in their view. A cross-sectional, descriptive, observational study was conducted at the Federal University in Juiz de Fora, Minas Gerais State, in 2008 with 185 medical students and 119 law students. 88.7 percent of the medical students and 92.4 percent of the law students reported knowledge of medical error. The interest was due to the fact that medical error is currently a widely discussed issue. The students thought the issue should be addressed in their undergraduate education (97.8 percent of medical students and 94.9 percent of law students). It is important to discuss such a current issue in undergraduate education in both medicine and law, because of the potential for decreasing the vicious circle of errors, iatrogenesis, and law suits, in addition to fostering reflection on the role of medical education in the ethical training of young professionals.