On the Possible Ethical Risks and Corresponding Prevention Paths of ChatGPT in the Medical Field / 中国医学伦理学

With the continuous development of artificial intelligence technology, ChatGPT, as an emerging natural language processing technology, although there is currently no mature application mode, its application prospects in the medical field are becoming increasingly broad. However, its application also faces some possible ethical risks and challenges, including personal privacy data leakage, discrimination and bias in machine algorithms, difficulty in defining responsibility, inexplicability of algorithms, and lack of supervision and so on. It is necessary to strengthen the training of relevant personnel, guide public opinion to pay attention to risks, focus on algorithm validation standards, emphasize multi-party cooperation and co-governance, strengthen medical ethics research, as well as deepen regulatory supervision and standardization construction to solve the above problems.

Reclamações fundamentadas de âmbito odontológico no PROCON do estado da Paraíba / Grounded dental complaints in PROCON of the state of Paraíba

Introdução: A relação entre pacientes e profissionais, vista como contratação de prestação serviços, em conjunto com o advento do Código de Defesa do Consumidor, traz como consequência o maior conhecimento sobre direitos por parte dos consumidores, os quais passaram, com mais frequência, a reclamar e a buscar ressarcimentos pelos possíveis danos causados. Objetivo: Analisar as reclamações fundamentadas de âmbito odontológico obtidas do PROCON da Paraíba. Material e Métodos: Estudo observacional documental, com universo composto de todos os processos de reclamações fundamentadas oriundos dos relatórios disponibilizados, através do Sistema Nacional de Informações de Defesa do Consumidor, pelo PROCON da Paraíba, sendo a amostra representada pelas reclamações de âmbito odontológico entre 2015 e 2021, as quais foram analisadas de forma descritiva. Resultados: Foram registradas 13.893 reclamações fundamentadas, sendo 66 de âmbito odontológico (0,47%); o ano com maior percentual encontrado foi o de 2020 (0,73%); das reclamações de âmbito odontológico, houve maior frequência de casos relacionados aos planos odontológicos (66,66%), seguidos das clínicas ou consultórios odontológicos (31,81%), restando apenas uma reclamação registrada na categoria cirurgiões-dentistas (1,51%); os principais motivos relatados foram problemas com o Serviço de Atendimento ao Consumidor (SAC), cobrança indevida ou não autorizada e publicidade enganosa; e houve predominância de atendimentos às reivindicações. Conclusão: Não houve constância de crescimento das reclamações de âmbito odontológico obtidas do PROCON/PB entre os anos de 2015 a 2021, os planos odontológicos constituíram seu maior alvo, tendo como principal motivo a reclamação contra o SAC

Introduction: The relationship between patients and professionals, seen as contracting services, together with the advent of the Consumer Protection Code, brings as a consequence greater knowledge about rights on the part of consumers, who have more often claim and seek compensation for possible damages caused. Objective: To analyze substantiated dental complaints obtained from PROCON in Paraíba. Material and Methods: Observational documentary study, with a universe composed of all substantiated complaints processes arising from the reports made available, through the National Consumer Protection Information System, by PROCON of Paraíba, with the sample represented by dental complaints between 2015 and 2021, which were analyzed in a descriptive way. Results: 13,893 substantiated complaints were registered, of which 66 were related to dentistry (0.47%); the year with the highest percentage found was 2020 (0.73%); of dental complaints, there was a higher frequency of cases related to dental plans (66.66%), followed by dental clinics or offices (31.81%), leaving only one complaint registered in the dental surgeons category (1.51% ); the main reasons reported were problems with the Customer Service (SAC), improper or unauthorized billing and misleading advertising; and there was a predominance of requests for assistance. Conclusion: There was no constant growth in dental complaints obtained from PROCON/PB between the years 2015 to 2021, dental plans were its biggest target, with the main reason being the complaint against the SAC

Definition of legal concept of pharmaceutical care and its legal liability / 中国药房

OBJECTIVE To pro vide so lutions for the appli cation of legal liability caused by the confusion of the concept of pharmaceutical care. METHODS Literature research and comparative method were adopted to clarify the legal concept of pharmaceutical care ，analyze the civil and administrative liabilities arising from different forms of pharmaceutical care ，and standardize the new responsibilities of pharmacists in pharmaceutical care. RESULTS & CONCLUSIONS The legal concept of pharmaceutical care has the function of judgement standard. Only such behaviors can belong to pharmacists ’liability under legal regulation，which are based on mutual agreements ，ensure the public medication safety and optimize patient treatment effect through the application of pharmaceutical expertise related to drug treatment. Under this definition ，the civil liability of pharmaceutical care needs to distinguish the professional degree of pharmaceutical care in different situations ，so as to establish a typed civil liability system and provide different levels of protection for patients ；regarding administrative liability ，it is necessary to improve the pharmaceutical regulatory system with the dual core of the Drug Administration Law and the Pharmacist Law from the perspective of liability integration.

Proteção jurídica dos profissionais de saúde envolvidos no atendimento em contexto da pandemia da COVID-19 / Legal protection of health professionals involved in care in the context of the COVID-19 pandemic / Protección jurídica de los profesionales sanitarios involucrados en la atención en el contexto de la pandemia COVID-19

A COVID-19 é a primeira crise contemporânea de saúde pública com potencial para sobrecarregar o sistema público de saúde mundial. A assistência à saúde é um recurso da sociedade compartilhada e, portanto, os princípios éticos que orientam seu racionamento exigem que serviços, medicamentos e equipamentos sejam aplicados onde forem mais eficazes, o que prioriza os pacientes com maior probabilidade de se beneficiar do tratamento. Os prestadores de serviços de saúde tomam decisões racionais com recursos escassos e merecem uma liberdade considerável para as suas deliberações de boa-fé, guiadas por estruturas éticas estabelecidas. O padrão de atendimento adequadamente aplicado sofre modulação em sua aplicação, o que requer uma mitigação da responsabilidade civil médica dentro de certos parâmetros objetivos. A lógica normativa é fundamentada no princípio da reciprocidade. Quando a sociedade pede que alguns de seus membros corram grandes riscos pessoais ao servir os interesses do público, é razoável esperar que a sociedade assuma algumas responsabilidades por eles em troca dos riscos assumidos. É apropriado que os formuladores de políticas públicas articulem padrões de atendimento especiais para desastres em massa, como a COVID-19. O objetivo do artigo é identificar como, no Brasil, Portugal e Espanha, a objetiva alteração das circunstâncias impôs a adequação da análise judicial de padrões de conduta profissionais a um panorama de calamidade.

COVID-19 is the first contemporary public health crisis with the potential to overwhelm the public health system worldwide. Health care is a resource of the shared society and, therefore, the ethical principles that guide its rationing require that services, medicines and equipment be applied where they are most effective, which prioritizes patients most likely to benefit from treatment. Health service providers make rational decisions with scarce resources, and deserve considerable freedom for their deliberations in good faith guided by established ethical structures. The standard of care properly applied is modulated in its application, which requires a mitigation of medical liability within certain objective parameters. The normative logic is based on the principle of reciprocity. When society asks some of its members to take great personal risks in serving the interests of the public, it is reasonable to expect society to take some responsibility for themin exchange for the risks taken. It is appropriate for public policy makers to articulate special care standards for mass disasters, such as COVID-19. The objective of the article is to identify how in Brazil, Portugal and Spain, the change in circumstances imposed the adequacy of the judicial analysis of professional standards of conduct to a panorama of calamity.

COVID-19 es la primera crisis de salud pública contemporánea con el potencial de abrumar al sistema de salud pública en todo el mundo. La atención de la salud es un recurso de la sociedad compartida y, por tanto, los principios éticos que orientan su racionamiento exigen que los servicios, medicamentos y equipos se apliquen donde sean más efectivos, lo que prioriza a los pacientes con mayor probabilidad de beneficiarse del tratamiento. Los proveedores de servicios de salud toman decisiones racionales con recursos escasos y merecen una libertad considerable para sus deliberaciones de buena fe guiadas por estructuras éticas establecidas. El estándar de atención aplicado correctamente se modula en su aplicación, lo que requiere una mitigación de la responsabilidad médica dentro de ciertos parámetros objetivos. La lógica normativa se basa en el principio de reciprocidad. Cuando la sociedad pide a algunos de sus miembros que asuman grandes riesgos personales para servir a los intereses del público, es razonable esperar que la sociedad asuma alguna responsabilidad por ellos a cambio de los riesgos asumidos. Es apropiado que los formuladores de políticas públicas articulen estándares de atención especial para desastres masivos, como la COVID-19. El objetivo del artículo es identificar cómo en Brasil, Portugal y España, el cambio objetivo de circunstancias impuso la adecuación del análisis judicial de los estándares de conducta profesional a un panorama de calamidad.

Legal Application and Perfection of Drug Administrative Detention / 中国药学杂志

OBJECTIVE: To normalize new institution of administrative detention in revised Drug Administration Law. METHODS: Starting with concept and character of administrative detention in drug administration, by comparing with other forms of detention, situation and flaws of current implementation of administrative detention procedure was analyzed. RESULTS: Ideas and suggestions regarding legislation and procedural norm of administrative detention in drug administration were put forward. CONCLUSION: Administrative detention as a form of administrative penalty is added for the first time in legal liability part of revised Drug Administration Law. For behaviors which seriously violate Drug Administration Law and yet do not constitute crimes, public security authorities may apply penalties of restricting personal freedom for a short period of time. In order to effectively implement this new legal requirements and safeguard good order of drug administration, it is necessary to construct sound and detailed procedural norms.

Violation of children's and adolescents' rights ­ the profile of a southern state in Brazil

The rights of children and adolescents are provided by law and it is the duty of the State, family and society to care for them. Health and education professionals are responsible for reporting suspected or confirmed cases of rights violation. This study aimed to investigate the prevalence and qualification of violation of children's and adolescents' rights in the State of Paraná between 2009 and 2014. A descriptive and observational quantitative study was carried out based on the records of the Child Protective Services in Paraná, accessed through the Information System for Childhood and Adolescence (SIPIA). A total of 129.123 violations of rights were found. Among those cases, the right to familiar and communitarian companionship stands out with the greatest number of violations, followed by the right to education, culture, sports and leisure. Mothers were found to be the main aggressors, followed by fathers, and sexual violence/abuse was the most prevalent type of violence. In conclusion, there was a significant amount of violation of children's and adolescents' rights in the State of Paraná during the period covered by this research, and it has increased over the years. Besides, we found out that there is a predisposition of gender and age group for each variable analyzed.

Tipos penais e sua ocorrência no exercício profissional de enfermagem: análise de processos ético-disciplinares / Criminal types and their occurrence in professional nursing practice: analysis of ethical and disciplinary processes

Introdução: A infração ética envolvendo tipos penais, viola normas éticas, deveres profissionais e a própria essência da profissão, porém os fatos possuem forte relação com as escolhas valorativas dos profissionais envolvidos. Este estudo abordou infrações cometidas pelos profissionais de enfermagem consideradas tipos penais nos processos éticos julgados pelo COREN-SP nos anos de 2012 e 2013. Objetivos: Identificar, classificar e descrever as ocorrências envolvendo tipos penais nos processos éticos julgados pelo COREN-SP no período de 2012 e 2013; analisar os depoimentos dos profissionais condenados pela prática de tipos penais e identificar a existência de fatores desencadeadores da atitude do profissional. Métodos: Estudo documental de abordagem quanti-qualitativa, a partir de dados de 399 profissionais julgados pelo COREN-SP no período mencionado. A partir dos critérios estabelecidos foram selecionados 13 processos que preenchiam os requisitos de institucionalização da denúncia, cujos profissionais foram condenados por infrações éticas consideradas tipos penais. A partir da identificação das unidades temáticas nos depoimentos dos profissionais, foram construídas categorias analíticas que emergiram dos discursos. Assim, optou-se pelo referencial teórico-filosófico da Teoria Tridimensional do Direito e da Deliberação Moral. Resultados: O estudo quantitativo abrangeu 399 profissionais julgados e forneceu dados para a composição de um primeiro retrato dos tipos penais na enfermagem com a identificação de 169 profissionais em processos relacionados a tipos penais. Os profissionais de nível médio foram os mais envolvidos (71%), sendo a categoria dos Auxiliares de Enfermagem mais evidenciada (49,1%). Detectou-se maior evidência de profissionais do sexo feminino (67,5%), bem como iniciantes no exercício profissional formados no máximo há 5 anos (43,2%), na faixa etária de 31 a 40 anos (38,7%). No que tange às ocorrências propriamente ditas, a maioria foi de natureza procedimental com resultado óbito ou lesão corporal. Em relação às ocorrências de natureza atitudinal, o exercício ilegal de profissão teve maior incidência, seguida de falsificação de documento. Os casos de negligência apresentaram maior incidência de óbito e lesão corporal. Como desfecho dos julgamentos, 63,3% dos profissionais envolvidos foram considerados culpados e a penalidade mais aplicada foi advertência (21,5%). Foram identificados e classificados os tipos penais encontrados, seguindo o critério estabelecido pelo CPB e apresentada a síntese de cada processo a partir da metodologia proposta por Schneider. A partir dos depoimentos dos profissionais foram formuladas sete categorias analíticas. Discussão: Observou-se, nos depoimentos, a importância da análise do caso concreto, a partir dos fatos, normas e deveres infringidos e os valores envolvidos, pois da mesma forma que alguns manifestaram arrependimento e conhecimento do ato ilícito, outros não manifestaram pesar pela prática do ato lesivo praticado, com discurso de negação, autoridade ou perseguição. Foram identificados fatores relacionados a condições de trabalho, financeiros e psicológicos e/ou sociais, como influenciadores da valoração do profissional. Conclusão: O estudo possibilitou o alcance dos objetivos delineados, bem como a relevância da análise deliberativa nas infrações éticas cometidas por profissionais de enfermagem. Ademais, denota-se a importância do investimento em educação, melhores condições de trabalho e reconhecimento dos profissionais dessa área, visando a diminuição de ilícitos éticos considerados tipos penais.

Introduction: Ethical infraction involving criminal types violates ethical norms, professional duties and the very essence of the profession, but the facts have a strong relationship with the valorative choices of the involved. This study addressed infractions committed by nursing professional considered criminal types in the ethical processes judged by COREN-SP in the years 2012 and 2013. Objectives: Identify, classify and describe the occurrences involving criminal types in the ethical processes judged by COREN-SP in the 2012-2013 period; analyze the testimonies of professionals convicted of the practice of criminal types and identify the existence of factors that trigger the professionals attitude. Methodology: Documentary study with a quantitative-qualitative approach, based on data from 399 professionals judge by COREN-SP in the period mentioned. From the established criteria, 13 processes were selected that fulfilled the requirements for institutionalizing the complaint, whose professionals were convicted of ethical offenses considered criminal types. From the identification of thematic units in the testimonies of the professionals, analytical categories that emerged from the speeches were constructed. Thus, we opted for the theoretical-philosophical framework of three-dimensional theory of law and moral deliberation. Results: The quantitative study covered 399 judged professionals and provided data for the composition of a first portrait of criminal types in nursing with the identification of 169 professionals in processes related to criminal types. Mid-level professionals were the most involved (71%), with the category of Nursing assistants being the most evident (49,1%). There was greater evidence of female professionals (67,5%), as well as newcomers trained at the most 5 years ago (43,2%), in the age group of 31 to 49 years (38,7%). With regard to the occurrences themselves, most are of a procedural nature with result of death or bodily injury. Regarding occurrences of an attitudinal nature, the illegal exercise of profession had a higher incidence, followed by document forgery. Negligence cases had a higher incidence of death and personal injury. As the outcome of the trials, 63,3% of the professionals involved were found guilty and the most applied penalty was a warning (21,5%). The criminal types found were identified and classified, following the criteria established by the CPB and the synthesis of each process was presented based on the methodology proposed by Schneider. From the professionals testimonies, seven analytical categories were formulated. Discussion: It was observed in the testimonies; the importance of analyzing the specific case, based on the facts, rules and duties violated and the values involved, because just as some expressed regret and knowledge of the illegal act, others did not express regret for the practice of the harmful act practiced, with a speech of denial, authority or persecution. Factors related to working conditions, financial and psychological and/or social were identified as influencing the professionals valuation. Conclusion: The study made it possible to achieve the objectives outlined, as well as the relevance of deliberative analysis in ethical infractions committed by nursing professionals. In addition, the importance of investing in education, better working conditions are recognition of professionals in this area is delayed, aiming at reducing of ethics illegal considered criminal types.

Odontologia legal: avaliação dos currículos dos cursos de graduação das faculdades de Minas Gerais / Forensic dentistry: curriculum evaluation of the graduation courses from Minas Gerais Universities

Introdução: O ensino da disciplina de Odontologia Legal nos cursos de graduação em Odontologia é extremamente importante na formação acadêmica. Por isso, em 2014, a Associação Brasileira de Odontologia Legal (ABOL) criou diretrizes de apoio ao ensino da disciplina no Brasil, orientando as Instituições de Ensino Superior (IES) a conduzir esta ciência nas grades curriculares. Objetivo: Esta pesquisa visou descrever como a disciplina de Odontologia Legal está sendo ofertada, nas IES do Estado de Minas Gerais, a fim de verificar se as diretrizes da ABOL estão sendo implementadas. Metodologia: Estudo descritivo de análise documental, realizado no ano de 2018. Para coleta de dados, acessaram-se os sites de todas IES de MG na busca dos documentos: projeto político pedagógico, matriz curricular e ementário. A partir desses documentos, identificaram-se quantas disciplinas da área de Odontologia Legal são ofertadas, o período de oferta das disciplinas, a carga horária, o momento do curso em que é ofertada e a nomenclatura das disciplinas. Resultados: No total, 33 (100%) IES ofertam disciplinas da área de Odontologia Legal em seu currículo. Dessas, apenas duas (6,2%) instituições ofertam disciplinas em momentos distintos, priorizando a disciplina de Ética antes das práticas clínicas e a disciplina de Odontologia Legal no final da graduação. Com relação à carga horária mínima, 11 (33,33%) instituições ofertam a disciplina com 60 horas. Conclusão: A maioria das IES de MG ainda não adequou seus currículos as diretrizes sugeridas pela ABOL.

Introduction: The teaching of Legal Dentistry is extremely important in academic training. That is why, in 2014, the Brazilian Association of Legal Dentistry (ABOL) created guidelines to support the instruction of this subject in Brazil, orienting the Higher Education Institutions (IES) to conduct this science in curricular grades. Objective: This research aimed to describe how the discipline of Legal Dentistry is being offered at the IES of the State of Minas Gerais, in order to verify if the ABOL guidelines are being implemented. Methodology: Descriptive study of documentary analysis, accomplished in the year of 2018. For the collection of data, all the MG's IES websites were accessed in the searching for the following documents: political pedagogical project, curriculum and the course syllabus. From these documents, it was identified how many subject in the Legal Dentistry area were offered and the name that they hold. Results: In total, 33 (100%) IES offer subjects in the Legal Dentistry area in their curriculum. Between those, only two (6,2%) institutions offer the subject in distinct moments, prioritizing Ethics as a subject before the clinical practices and Legal Dentistry at the end of the course. Concerning the minimum workload, 11 (33,33%) of the institutions offer 60 hours. Conclusion: Most of the MG's IES have not yet adjusted their curriculum to the ABOL's suggested guidelines.

Correlação entre reclamações de consumidores e ações judiciais por falhas na prestação de serviços odontológicos no estado de São Paulo, Brasil / Correlation between consumer complaints and lawsuits for failures in dental services, São Paulo state, Brazil

A responsabilidade dos cirurgiões-dentistas tem como principais enfoques os direitos e as obrigações destes profissionais. O objetivo do trabalho foi realizar a associação entre os cirurgiões-dentistas e/ou as empresas que prestam serviços odontológicos que tiveram seus nomes apontados em sites especializados em reclamações e, a partir desses nomes reclamados, buscar as demandas judiciais no Estado de São Paulo. A amostra foi composta por processos disponíveis no site do Tribunal de Justiça de São Paulo. Os nomes de 175 cirurgiões-dentistas e/ou empresas odontológicas foram coletados a partir de sites especializados em reclamações utilizando termos relacionados à Odontologia. Os resultados mostraram que, a partir dos 175 nomes encontrados, havia 313 processos constando esses nomes como parte requerida em processos judiciais. O ano com maior ocorrência dos casos foram 2011 e 2012. A maioria das ações foi promovida por pessoas do sexo feminino (62%) e os planos odontológicos constituem o principal alvo dos processos. Com relação ao "tipo de ação" referente ao fator motivador dos processos analisados, os "danos morais", "danos materiais e morais", "danos materiais", seguido de "contrato" e "obrigação" foram os termos mais encontrados. Os valores pleiteados, quando divulgados, foram bastante variados, com uma média correspondendo a um montante de R$ 27.349,54. Pode-se concluir que houve associação entre os nomes que estavam sendo reclamados nos sites brasileiros especializados em reclamação de consumidores e as demandas judiciais no Estado de São Paulo.

The main topic of Dentistry responsibility is the professional´s rights and obligations. This study aimed to verify the association between dentists and/or dental companies´ names presents in specific complaints websites, and with these names look for lawsuits using the online database of the São Paulo State Court. The sample was com posed by lawsuits from these websites. The 175 dentists and/or dental companies´ names were collected using keywords about Dentistry. The results showed that 175 names were found in complaints websites and after the search using these names in database of the São Paulo State Court were found 313 lawsuits against the professional and companies found. The majority of cases occurred in the years 2011 and 2012. The most lawsuits were filed by women (62%) and the dental companies were the lawsuits´main target. About the lawsuit "nature" an "topic" concerning the reason to start the lawsuit the studied shows that "moral damage", "moral and material damage", "material damage", and "contract" and "obligation" were the principal terms found. The requested compensation values were varied, and the mean value was R$ 27,349.54 (in Brazilian reais). It was concluded that there is association between the names found in specific complaints websites and the lawsuits database of the São Paulo State Court.

Anti-medical violence legislation: international experience and inspirations for China / 中华医院管理杂志

Traditional mindset in anti-medical violence legislation tends to divert the responsibility to prevent medical violence to the party of the lowest costs, a design of obvious loopholes in reducing medical violence occurrence. By combining the legal liability and penalty adjustment to counter medical violence crimes, the US, Australia and South Korea are trying to match the private cost of victims and its social cost with the punishment of crime law. In this sense, China should highlight the nature of public safety of medical service, zero tolerance report and optimal punishment to medical violence crimes. This approach can take place of the existing incentive mechanism featuring violent conflicts, being conducive to building a safe and harmonious doctor-patient relationship.

O papel do cirurgião-dentista no diagnóstico precoce da leucemia e sua responsabilidade ética e legal ­ revisão de literatura / The role of the dentist in the early diagnosis of leukemia and his ethical and legal responsibility - literature review

O cirurgião-dentista tem papel fundamental no diagnóstico precoce das leucemias, pois sinais ou sintomas podem ocorrer na boca, sendo mais comum nas fases agudas da doença, e mais frequentes na leucemia monocítica. A leucemia é uma doença que pode levar o paciente ao óbito em pouco tempo e os pacientes geralmente procuram o dentista acreditando serem doenças de origem local. O objetivo deste artigo é abordar as características odontológicas passíveis de identificação precoce da leucemia e discutir a responsabilidade ética e legal do cirurgião-dentista frente aos aspectos éticos e legais. Para tanto, foi realizado levantamento bibliográfico sobre a parte clínica do tema, bem como normativas e legislação correlatas. Conclui-se que é dever do cirurgião-dentista o conhecimento do diagnóstico de doenças e alterações que se manifestam na cavidade oral, bem como a correta interpretação do resultado de exames complementares, como o hemograma, pois este profissional pode responder legal e eticamente por falhas no diagnóstico e tratamento de pacientes com leucemia.

The dentist has a key role in the early diagnosis of leukemias, since signs or symptoms may occur in the mouth, being more common in the acute stages of the disease, and more frequent in monocytic leukemia. Leukemia is a disease that can take the patient to death in a short time and patients usually look for the dentist believing that they are diseases of local origin. The objective of this article is to discuss the dental characteristics that can be identified early in the leukemia and to discuss the ethical and legal responsibility of the dentist regarding ethical and legal aspects. For that, a review of literature was carried out on the clinical part of the topic, as well as normative and related legislation. It is concluded that it is the duty of the dentist to know the diagnosis of diseases and alterations that manifest in the oral cavity, as well as the correct interpretation of the result of complementary tests, such as the hemogram, since this professional can answer legally and ethically for failures in diagnosis and treatment of patients with leukemia.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes

OBJECTIVES: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. MATERIALS AND METHODS: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. RESULTS: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. CONCLUSION: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes

OBJECTIVES: Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. MATERIALS AND METHODS: We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. RESULTS: Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. CONCLUSION: This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

World Health Organization and the search for accountability: a critical analysis of the new framework of engagement with non-state actors / A Organização Mundial da Saúde e a procura da responsabilização: uma análise crítica da estrutura de colaboração com intervenientes não estatais / La Organización Mundial de la Salud y la búsqueda de la rendición de cuentas: un análisis crítico del nuevo marco de colaboración con los actores no estatales

The article probes the origins and content of the Framework of Engagement with Non-State Actors (FENSA) of the World Health Organization (WHO), approved on May 28, 2016, at the 69th World Health Assembly, which established different rules of collaboration to four categories of actors: nongovernmental organizations (NGOs), private sector entities, philanthropic foundations, and academic institutions. Applying the findings of International Legal Theory and based on extensive documentary research, we sought to determine whether FENSA is an appropriate accountability mechanism according to four functions of accountability: constitutional, democratic, epistemic, and populist. The article concludes that there is a risk of the prevalence of the populist function at the expense of the accountability potential that could result from the better use of the other three accountability functions.

O artigo investiga as origens e o conteúdo da Estrutura de Colaboração com Intervenientes Não Estatais (FENSA, em inglês) da Organização Mundial da Saúde (OMS), aprovada em 28 de maio de 2016 pela 69ª Assembleia Mundial da Saúde, e que define regras distintas para quatro categorias de atores: organizações não governamentais (ONGs), entidades do setor privado, fundações filantrópicas e instituições acadêmicas. O estudo aplicou os achados da Teoria do Direito Internacional e recorreu a uma extensa pesquisa documental para determinar se a FENSA é um mecanismo apropriado de accountability de acordo com quatro funções de responsabilização: constitucional, democrática, epistêmica e populista. O artigo conclui que há um risco de prevalência da função populista com detrimento do potencial de accountability pelo uso melhor das outras três funções de accountability.

El artículo examina los orígenes y el contenido del Marco de Colaboración con Actores no Estatales (FENSA, en inglés) de la Organización Mundial de la Salud (OMS), aprobado el 28 de mayo de 2016 en la 69ª Asamblea Mundial de la Salud, que estableció diferentes reglas de colaboración para cuatro categorías de actores: organizaciones no gubernamentales (ONG), entidades del sector privado, fundaciones filantrópicas e instituciones académicas. Aplicando los hallazgos de la Teoría Legal Internacional y basándonos en una extensa investigación documental, buscamos determinar si FENSA es un mecanismo apropiado de rendición de cuentas según cuatro funciones de rendición de cuentas: constitucional, democrática, epistémica y populista. El artículo concluye que existe el riesgo de que la función populista se mantenga a expensas del potencial de rendición de cuentas que podría derivarse del mejor uso de las otras tres funciones de rendición de cuentas.

Research on Palliative Care Legislation in China / 中国医学伦理学

The Economists Intelligence Unit pointed out that the global ranking of Chinese people's death quality index falls behind and once again causes people's attention and discussion of death and related legal issues.Palliative Care can make people go to death as far as possible with dignity,ready and calm.So it is gradually being concerned,and the importance of legislation related to it is also becoming increasing.Palliative Care has emerged in our country,but because of the lack of legislative regulation,relatives of patients and medical staff are at risk being accounted for legal liability.Through the analysis of the legitimacy and feasibility of palliative care,this paper put forward some suggestions of relevant legislation and current corresponding countermeasures;it should clarify the legal validity of living will signed by patients,strengthen the supervision in the implementation process and exempt responsibility of relevant personal.

A importância do preenchimento adequado dos prontuários para evitar processos em Odontologia / The importance of the appropriate completion of dental records to avoid lawsuits in Dentistry

Objetivo: Realizar uma revisão na literatura, buscando orientar os profissionais e graduandos em odontologia para a elaboração dos documentos clínicos que compõem o prontuário odontológico do paciente evitando processos. Material e Métodos: A partir de uma elaboração adequada, foram realizados anamnese, exame clínico, plano de tratamento, evolução e intercorrências, contrato de prestação de serviços, confecção de atestados, receitas odontológicas, bem como o consentimento livre e informado e o arquivamento de exames complementares. Foi feita uma revisão da literatura nas principais bases de dados em saúde (Lilacs, Pubmed e Scielo) utilizando como palavras chaves: "prática profissional", "responsabilidade legal" e "ética odontológica", entre os anos de 1996 e 2014, nos idiomas português, inglês e espanhol. Também foram consultados livros da Biblioteca da Universidade Estadual de Feira de Santana (UEFS). Conclusão: É necessário estabelecer uma relação de confiança e amizade durante todo o tratamento, sempre informando e sendo transparente nas ações, além de manter um exame clínico detalhado, um prontuário atualizado e organizado de forma que não comprometa sua validade sob o aspecto legal.(AU)

Aim: This study aimed to review the literature, seeking to guide professionals and students in dentistry for the preparation of clinical documents that make up patient dental records in an attempt to avoid lawsuits. Methods: This study starts with the analysis of an appropriate preparation, interview, clinical examination, treatment plan, evolution and complications, service contract, preparation of certificates, and dental revenues, as well as the free and informed consent form and the archiving of laboratory tests. A literature review in the main health databases was carried out (Lilacs, Pubmed and Scielo), using as keywords "professional practice", "liability", and "dental ethics", between 1996 and 2014 in Portuguese, English, and Spanish. Books from the Library of the State University of Feira de Santana (UEFS) were also consulted. Conclusion: It is necessary to establish a relationship of trust and friendship throughout the treatment, always informing and being transparent in one's actions, as well as to maintain a detailed clinical examination and an updated and organized dental record in such a way that it does not compromise the validity of the records from a legal standpoint.(AU)

Failures in dental prosthesis: dentists perception of the involved legal aspects / Insucessos em prótese dental: percepção dos cirurgiões-dentistas quanto aos aspectos odontolegais envolvidos

This aim of this study was to verify the level of knowledge of prosthodontics specialists from the city of Porto Alegre, Rio Grande do Sul State, concerning the failures of prosthetic works, and to provide a reflection on the type of responsibility assumed by the prosthodontist during the dental treatment. This was a descriptive cross-sectional study with a non-probabilistic sample, conducted through questionnaires with closed and open questions. The data was analyzed using the Fisher's Exact Test (p value < or = 0.005). The sample consisted of 143 questionnaires. The statistical analysis evidenced that the dentists with up to 15 years of professional practice assign the responsibility of failures most often to the laboratory (p = 0.001) and to the patient (p = 0.021), but over the years this trend is reversed. The prosthodontists included in the study proved to have an adequate knowledge of issues that pervade the failures in the prosthodontics specialty. In relation to the parameters of the professional responsibility, it is necessary to consider the type of duty assumed by the prosthodontist as for the responsibility of means.

O objetivo deste estudo foi verificar o grau de conhecimento do CD especialista em prótese dentária da cidade de Porto Alegre/RS sobre aspectos relacionados aos insucessos de trabalhos protéticos, bem como propor uma reflexão sobre o tipo de obrigação assumida pelos protesistas durante o tratamento odontológico. Tratou-se de um estudo transversal descritivo, com amostra não probabilística de indivíduos realizada por meio de questionários, nos quais constavam questões fechadas e abertas. A análise dos dados foi realizada utilizando-se o Teste Exato de Fischer (sendo p < ou = 0,005). A amostra foi composta de 143 questionários. O estudo estatístico mostrou quando interpretado em relação ao tempo de exercício profissional, que até os primeiros 15 anos de formado o profissional tem o entendimento de que os erros advêm mais frequentemente do laboratório (p = 0,001) e dos pacientes (p = 0,021), invertendo esta tendência com o passar dos anos. Os protesistas componentes da amostra mostraram ter um conhecimento adequado das questões relacionadas aos aspectos que permeiam os insucessos na especialidade de prótese. Ao considerarmos os parâmetros da responsabilidade profissional, deve-se considerar o tipo de obrigação assumida pelos protesistas como responsabilidade de meio.

Training residents in the prevention of legal disputes

Unlike medical students, doctors-in-training (residents) are physicians who can legally provide medical treatment with a medical doctor's license obtained from Korea the Ministry of Health and Welfare, and thus they are liable for the care they provide. Therefore, residents need to be aware of the legal and risks they facing in medical practice and ensure that they have the ability to deal with such risks. Legal responsibilities of residents can be examined from three perspectives: the relationships between patients and doctors, the relationships between doctors and medical officials, and the Korean health and welfare system. With regard to the relationships between patients and doctors, the legal responsibilities of doctors-in-training span a diverse range of liability for explanation (informed consent), malpractice, medical records, prohibition on revealing medical secrets, emergency medical treatment, treatment for the opposite sex, and other basic responsibilities. They will be liable for any damage caused under Article 268 of the Criminal Code, which addresses the crime of professional negligence resulting in injury or in death, and Article 750 of the Civil Code, which addresses torts liability, and above and beyond them of legal liability in general. With regard to the relationships between doctors and medical officials, the legal responsibilities can be classified into two types of relationships. One is between a doctor and a senior doctor, and the other is between a doctor and a doctor from a different medical specialization. it there is miscommunication between two or more doctors, it could lead to poor outcomes for patients. Regarding the health and welfare system, the issuance of medical licenses and the duty of notification are the most important legal responsibilities. The system's treatment of residents require special caution as issuance of falsified medical licenses has caused serious social problems. Laws that state the various notification duties allow no exceptions even for the residents. Residints should therefore understand the basic notification duties involved in cases of accidental death, child abuse, and etc. and prepare for contingencies.

Ethical and legal considerations on professional liability of the orthodontist

INTRODUCTION: After the enactment of Law 8078, of September 11, 1990, the Consumers Defense Code implied important alterations in Brazil's legal scenario, providing a greater balance in the relationship between consumers and service providers. From this law, dental surgeons came to establish a consumer relationship with their clients. OBJECTIVE: Due to the ethical and legal issues against the dental professionals, this work makes general considerations about the nature of the dentist´s obligation in services, specifically in Orthodontics. CONCLUSION: The responsibility of the professional shall be restricted to predictable risks and undertaken obligations. When the professional warns the client in a correct, clear and express manner, it will lower the chances of being later charged.

INTRODUÇÃO: após a promulgação da Lei nº. 8.078, de 11 de setembro de 1990, o Código de Defesa do Consumidor provocou importantes alterações no cenário jurídico brasileiro, proporcionando um maior equilíbrio nas relações estabelecidas entre os consumidores e os fornecedores de produtos e serviços. A partir dessa lei, os cirurgiões-dentistas passaram a estabelecer com seus pacientes uma relação de consumo. OBJETIVO: tecer considerações sobre a natureza obrigacional do cirurgião-dentista especialista em Ortodontia. CONCLUSÃO: a responsabilidade do contratado será compreendida entre os riscos previsíveis e as obrigações assumidas. Quando o profissional alerta de forma correta, clara e expressa, diminuem-se as chances de serem posteriormente cobrados.

Responsabilidad médica del psiquiatra / Medical Liability of the Psychiatrist

Este artículo de reflexión presenta aspectos relevantes de la figura jurídica de la responsabilidad médica enfocada a la práctica profesional, con base en el análisis de aspectos relevantes de la legislación colombiana. Se exponen algunos temas en conflicto y se enuncian aspectos jurídicos relacionados. Se discuten la responsabilidad del psiquiatra y las diversas situaciones a las que este se ve expuesto. También se discuten algunas medidas de protección para una adecuada relación médico-paciente.

This article discusses some relevant issues on the legal implications of medical liability focusing on the professional practice of medicine, based on the analysis of key aspects under the Colombian legislation. Some conflicting topics are considered with particular reference to related legal aspects. The responsibility of the psychiatrist and the various situations he/ she is exposed to are discussed, in addition to some protective measures for an adequate doctor - patient relationship.