Статті в журналах з теми "Medical laws and legislation – moral and ethical aspects"

Introduction. Moral, ethical, and professional deontological rules have a substantial impact on the social relations of legal regulation regarding liability for abuses and violations of citizens’ rights – people taking medication – patients as part of the health care system. The identification of the place and role of moral norms, ethics, and professional deontology, their quality as specific non-traditional primary sources in the development of the health care system, and the sub-branch of pharmaceutical law in the Republic of Moldova were the focus of the present study. Material and methods. The secondary descriptive synthesis study of normative-legal acts as primary specific non-traditional sources, viewed through the lens of the protection of the rights of the consumer of medicines, the patient – the ultimate beneficiary of the social relations in the field of health care – spanned the years 1991 to 2021. The most relevant sources subject to analysis are the Constitution of the Republic of Moldova, the Code of Ethics for doctors and pharmacists in the Republic of Moldova, laws, and sub-legislative acts, etc. The study is based on the use of several recognized techniques and methods of analysis: systemic approach, synthesis, logical-legal deduction, content and comparative analysis, etc. Results. Both the literature and recognized authors state that respect for moral, ethical, bioethical, and professional deontological norms in the field of health care has always been highly appreciated in society, which has led to the recognition of the nobility of medical and pharmaceutical activity. The results presented in this paper have made it possible to highlight aspects that recommend that the investigation of the role of legal regulation in medical and pharmaceutical activities also question the place and role of moral, ethical, and bioethical norms, as they generally have the same thematic orientation and influence on law, legislation, the practice of applying the law, and vice versa. Conclusions. The accomplished study allowed the identification of the dialectical and organic unity between moral, ethical, bioethical, and deontological sources with the rules of law - the moral-legal foundation of medico-pharmaceutical law. The consolidation of legal and moral norms demonstrates the structuring of the sub-branch of medico-pharmaceutical law. The analysis of the normative-legal acts in the Republic of Moldova confirms both the functionality of the „moral-ethics-deontology-law” system and the importance given to the protection of the rights of the consumer of medicines, the patient, as the ultimate beneficiary of social relations in the field of health care.

Confidentiality is a central bioethical principle governing the provider–patient relationship. Dating back to Hippocrates, new laws have interpreted it for the age of precision medicine and electronic medical records. This is where the discussion of privacy and technology often ends in the scientific health literature when Internet-related technologies have made privacy a much more complex challenge with broad psychological and clinical implications. Beyond the recognised moral duty to protect patients’ health information, clinicians should now advocate a basic right to privacy as a means to safeguard psychological health. The article reviews empirical research into the functions of privacy, the implications for psychological development and the resigned sentiment taking hold regarding the ability to control personal data. The article concludes with a call for legislative, educational and research steps to readjust the equilibrium between the individual and ‘Big Data’.

The article covers the study of some aspects of protecting the intellectual property rights in the areas of biology, medicine and pharmacy including biotechnological inventions. The rapid progress of science and technology, the generation and accumulation of knowledge, the possibilities to process large amounts of various data further stimulate the development of all social areas and unprecedentedly contribute to the emergence of innovations, in particular in the area of biotechnology. Intellectual property rights have a direct impact on the progress of medical and biological research, but increasingly require coordination with the ethical and moral principles of the society regarding the patentability of inventions in biology, medicine and pharmacy.The article analyzes the modern trends in the protection of intellectual property rights to biotechnology inventions at an international level, and forecasts the likely subsequent development in legal protection of intellectual property rights in the areas of biology, medicine and pharmacy in view of the ever increasing ethical and law controversies of medical and biological research in some areas, the emergence of big data, use of artificial intelligence, etc.The national legislation refers to the term «biotechnology» in the Law of Ukraine «On Environmental Protection», while not giving any legal definition of “biotechnology” in any laws. The Ukrainian intellectual property and health care legislation require reformation to get properly updated to respond to the ongoing challenges. There is a whole layer of gaps regarding the legal regulation of using biotechnology in Ukraine, and this extends to all areas where biotechnology is actually integrated. The use of biotechnology in biology, medicine and pharmacy requires a systemic and multi-aspect study in order to develop the appropriate legal norms.To ensure the stability of the pharmaceutical market, which is focused on the national manufacturer, it is necessary to create the proper conditions for the development of a high-tech research environment in Ukraine. It is necessary to improve nationallegislation in the field of biobanking and the legal regime of human biological material for the purpose of using it in research.

Almost at the onset of surrogacy as a method of ART, it has been attracting the attention of society as the way to fulfill the issue of high priority – procreation and family. Surrogacy has become one of the main research objects of bioethics that studies the ethical and moral aspects of the use of new biological and medical technologies. The main issue of this article is the identification and comparative analysis of the features of the legal regulation of the method of surrogacy in Ukraine and other countries. The particular importance lies in specifying those prohibitions and restrictions, who they are applied to, and how they relate to the human right to procreation. The comparison to the laws of other countries that have a better legal surrogacy regulation will take place. The theoretical and practical significance of the work is reflected in the fact that the results can be used in the further theoretical development of the legal issues related to surrogacy as one of the methods of human assisted reproduction. The research made it possible to find out the basic terms that are used in the legal regulation of surrogacy. In the course of the research, it was found out that legal regulation of the use of the ART methods in the word, including surrogacy, varies depending on the jurisdiction. Each country has their laws. Nowadays it is possible to divide legal regulation of the use of the surrogacy method into four basic legal regimes: – regime of permission; – regime of restriction; – regime of complete prohibition (in any form); – regime of uncertainty. Ukrainian legislation is considered to be very liberal in relation to surrogacy. Major types of surrogacy, including commercial surrogacy, are permitted and widely used. Moreover, in Ukraine, legislation does not allow traditional surrogacy, and also does not allow couples who do not have a registered marriage, single people, and same-sex couples, to use this method. It should also be borne in mind that the method of surrogacy can only be used for medical reasons. In Ukraine, taking into account the peculiarities of notarization, agreements (contracts) on commercial surrogacy should be preferably signed by a notary. However, in the legislative norms there is no direct reference to the notarized form of such an agreement.The obtained research results indicate that Ukrainian surrogacy legal regulation is lacking a special law and thus remains fragmented. According to the author, only through the adoption of a special law in Ukraine, it will be possible to make proper legal regulation of basic reproductive human rights, including the application of the method of surrogacy, the peculiarities of concluding surrogacy agreements, post-mortem human reproduction and delayed parenthood.

Mandatory vaccination laws require children to be vaccinated against certain communicable diseases to attend school. These laws also provide exemptions to school vaccination requirements. All states exempt children from vaccination requirements for medical reasons, and most states also provide an exemption for religious and/or other personal reasons. Seven states include an educational component in their religious or philosophical exemption process, requiring that parents receive information regarding the benefits of vaccination and the risks of not being vaccinated. Of these seven states, five require that information regarding the social benefits of vaccination will be provided to parents. This type of legislation is part of an overall trend to tighten the vac- cine exemption process, which is reflected in the vaccination laws of an increasing number of states. Tightening the vaccine exemption process through the addition of administrative requirements has been proven to decrease exemption rates. But this is not the focus of this Article. Instead, the Article focuses on one aspect of the educational component of the legislation—educating parents regarding the social benefits of vaccines. The Article explores the nature of the obligation to be educated regarding the social benefits of vaccines and the potential influence of this legislation on parents’ vaccination decision making. I claim that this legislation should be conceptualized and under- stood through the concept of solidarity. Following this conclusion, I will explore the potential effects of solidarity legislation on parents’ vaccination behavior. For this purpose, two aspects of the legislation will be addressed. First, I will discuss the language included in these laws, which explicitly declare that vaccines have social benefits. I will explore the expressive functions of this language and their potential influence on parental attitudes, beliefs, and behaviors. I will continue by addressing the educational process that this legislation requires. Addressing this aspect of the legislation, I will examine whether providing parents information regarding the social benefits of vaccines through educational encounters is expected to increase their motivation to vaccinate their child.

Background: Ambulance professionals often address conflicts between ethical values. As individuals’ values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles in Spain and Sweden. Methods: The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. Ethical considerations: This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals’ moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally – especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

Background: Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress. Objectives: To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology. Research design: In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups. Participants and research context: Healthcare professionals at all paediatric oncology centres in Sweden were invited to participate. A total of 278 healthcare professionals participated. The response rate was 89%. Ethical considerations: In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey. Findings: The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants. Discussion: Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings. Conclusion: The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care.

Medical practice is connected with the greatest social values - people's health and life. Its subjects and objects are people with numerous social and biological differences and characteristics. It is obvious that under such circumstances it is impossible to normalize all situations of this practice. Therefore, this involves the wide application of moral laws in health care, supplementing the mechanisms of legal regulation of the relationship between the medical worker and the patient with the norms of medical ethics and deontology. That is why none of the professional communities has at the world, regional and national levels so many conventions, codes, declarations, oaths of a moral and ethical plan, which are an integral part of the regulatory and legal framework of medicine. But ethics and law are not identical. Quite often ethics declare standards of behavior higher than the law. There are known cases where ethics require that doctors not obey laws that require unethical behavior (WMA, 2009). Medical ethics puts the patient and his safety above other criteria for the quality of medical care, above the interests of medical workers. None of these moral and ethical documents bypasses the issue of patient safety, starting with the Hippocratic one: "refraining from causing any harm" and ending with the Code of Ethics of a doctor of Ukraine, which emphasizes that "a doctor must carefully analyze the mistakes made and discuss them with colleagues and guidance for the prevention of similar cases in the clinical practice of other doctors." Patient safety is considered an ethical imperative (Vicki D. Lachman, 2007). This is consistent with the concept of safety culture developed by the IAEA after the accident at the Chernobyl nuclear power plant (IAEA, 1991) to prevent emergency situations in the nuclear power sector. The concept of safety culture is considered as a mechanism for identifying hidden safety deficits and puts its level above the requirements of legislation and regulatory bodies (ILO, 2001). The World Health Organization declared its commitment to safety culture principles in 2005 and called on national health care systems to follow suit. In a recent document, the Global Alliance for Patient Safety (HURST, Samia, et al., 2013) emphasizes the need to consider ethical issues in patient safety research. Considering the above, the concept of safety culture, based on the principles of medical ethics, is at the same time its section in the part related to the formation of a safe hospital environment. Today, many countries have successful experience of using safety culture in medicine, and using it and developing it is an urgent task of the domestic medical community. No conflict of interests was declared by the authors.

The article examines the issues of glocalization and regulation of communicative interaction based on the material of the speech act of defamation. It is shown that countries, when legislating public relations in this area, proceed from the interests dictated by their own information security policy. Using the example of some post-Soviet states, which historically have common sources of law, evidence is presented of the refusal of states to unify legal norms in the field of regulating public communication activity: the speech act of defamation as an illegal and criminally punishable act is excluded from the legislation of Estonia; in Azerbaijan, Latvia, Lithuania, Tajikistan it does not have the status of a serious crime, unlike The Republic of Belarus and the Russian Federation. However, this approach does not exclude the emergence of problems, primarily of a methodological nature. As an actual example, fragments of Belarusian legislation are analyzed, which reveal a terminological lacuna in understanding the categories of honor, dignity and business reputation as a triad of intangible subject rights, the attempt on which is realized through a speech act of defamation. The relevance of the legal linguistic interpretation of the designated content of the concepts is substantiated: honor as moral and ethical qualities of a person in the assessment of others; the introverted phenomenon of dignity as a social self-esteem of a person; business reputation as a set of professional and/or service qualities of a person. Based on the material of the Belarusian legislation, a meaningful detailing of the signs of the implementation of a speech act of defamation is given according to the parameters 1) factual nature, 2) object composition, 3) type of information and 4) channel of information dissemination.

The global market for commercial surrogacy is growing at a significant pace. Every year, thousands of wom- en agree, for a fee, to bear a child for another woman. As a result, thousands of children are born conceived by one woman, but claimed by another. The central argument of this article is that surrogacy should be ap- proached as a complex commercial, ethical, legal relationship. At the moment, there is an active international trade in uterus, sperm and eggs. There are rapidly advancing medical technologies that have undoubtedly in- creased both the demand for surrogacy services and the supply from surrogate mothers. But the fundamentals of the market rule governing surrogate motherhood, norms, laws are developing much more slowly. Some states, such as the USA, France, Germany, Austria regulate issues related to surrogacy mainly in the form of a ban; other states create the most liberal legislation, such as India, Russia, Kazakhstan. In the article, the au- thor concluded that he divided the ethical and moral issues of surrogacy into two camps of all countries in the world: supporters and opponents who compare it with the slavery of women. The necessity of establishing se- curity measures to ensure that there will be no exploitation of women in a difficult financial situation in this transaction is justified.

Overview Objective: The aim of this research is to present our experiences with the surgical treatment of gynecological patients among Jehovah’s Witnesses. Moreover, the medical, moral, and ethical problems in this regard have been highlighted. Methods: 75 Jehovah’s Witnesses patients were operated on for various benign and malignant gynecological diseases between 2007 and 2018. All of these patients were operated on according to the rules of blood-sparing surgery. Results: The operations were assessed according to the dia­gnosis, mode of surgery, estimated blood loss, and disease outcome. Excessive blood loss did not occur during any of these operations, and the estimated blood loss for the same procedure was 10 to 550 mL. Conclusion: Jehovah’s Witnesses gynecological patients is a group of high-risk patients because they refuse to undergo blood transfusion. Nevertheless, the principles of blood-sparing surgery should be applied to not only Jehovah’s Witnesses patients but also to all patients in general. Even if a blood transfusion is the last resort to solve issues pertaining to excessive blood loss during complicated operations, the said procedure always carries certain risks. Therefore, blood transfusion should be performed only on rare occasions. Jehovah’s Witnesses patients categorically refuse blood transfusion even if it is the only way to save one’s life. Even though the legislation of the Czech Republic deals with this problem, there are other moral and ethical aspects that need to be addressed in this regard. Keywords: bloodless surgery – Gynecologic surgery – Jehovah’s Witnesses – legislation – moral and ethical problems

Whether adopted voluntarily or imposed through legislation, Corporate Social Responsibility (CSR) has an impact on existing laws. This article examines the relationship between CSR and compliance with corporate tax in Tanzania. It is observed that, while on the one hand, ethical and moral aspects of CSR should help to improve tax compliance in a particular jurisdiction on the other hand, adoption of CSR may come with corporate tax benefits to the companies. However, given the wide range of activities of the state which are financed by tax revenue, the article emphasizes on the need to include an item on corporate tax compliance in CSR reports. Also, it calls for deliberate efforts by the state to improve and prioritize provision of public as well as social services. Such measures will reduce reliance on CSR programmes in the provision of public and social services, aspects, which raise issues of legitimacy in a democratic state. Key Words: CSR and corporate tax, corporate tax law, income tax law, social welfare, public welfare, allowable deductions.

Euthanasia is commonly performed in veterinary medicine to humanely induce the death of an animal when its quality of life is affected by pain or chronic degenerative diseases. The choice of euthanasia is a bilateral decision that represents a challenge for both the veterinarian and the owner of the animal due to the close emotional human–animal bond. Currently, there is legislation that can orient veterinarians concerning euthanasia and the causes that would justify this resolution. However, it is still controversial, and deciding it as the last available resort requires considering it from a medical, legal, and moral perspective. Therefore, this review aims to explore the ethical and legal implications of euthanasia in canine patients. It will analyze the reason that can justify euthanasia in animals with pain or terminal and chronic degenerative diseases, highlighting the importance of effective communication, ethical knowledge, and consideration of euthanasia as a multimodal resolution.

This article aims to demonstrates some facets of the current state of legal regulation and ethical problems of application of new medical technologies in reproduction, therapy and genetic modification of humans, plants and animals through the prism of intellectual property rights protection and based on: the materials of a number of normative acts (laws, ministerial Regulations) of one of the BRICS countries - South Africe. In this format, based on analytical reflections over information taken from sources and literature from the list of sources and literature, as well as a number of legal provisions driven to life by the existence and application of such technologies and new knowledge; opinions, ideas and ethical and legal discussions, the article analyzes the provisions of South Africa's approaches that create patterns of application of new medical technologies, the potential and ethical and legal basis for such development, taking into account the current views of the doctrine and legislation. The relevance of this research is due to the fact that a number of approaches to legislation and ethical approaches under study are new and could not be considered in studies of an earlier period. Thus, this study serves to fill this gap. The author's results are presented in the light of the identified state interest within the framework of the liberal model of the relationship between law and bioethics in delineating the boundaries of permissible (notpermissible) use of new medical technologies in the field of reproduction and treatment of human, genetic modification of humans, animals and plants not only from the perspective of legal and ethical constraints, permissions and prohibitions but the implementation of the provisions of applicable South African legislation on the intellectual property rights protection, which, due to its examination request system, can not guarantee that the patented product - the result of genetic modification - can be freely used in South Africa with regard to the restrictions and prohibitions established by 2003 Act and relevant Regulations No. 175, 177, 180. The theoretical and practical significance of the results obtained is determined by the fact that Russian readers will be provided with up-to-date scientific information about the state of Indian legislation and doctrine, and other ideas in the field under study, which in practical terms will contribute to understanding the gap (or lack thereof) in the achievements in this field of Russian and foreign researchers and practitioners in terms of their implications at the level of practice and legislation.

The ‘SLICE’ model for Structured Learning in Clinical Ethics provides a template to help medical professionals identify their own “moral compass” to provide guidance in complex ethical areas. The model has five domains – Conscience, Compliance, Concurrence, Conversation and Conversion. The use of ‘SLICE’ model as a tool for ethics education has been described in various undergraduate and postgraduate settings. These include teaching ethical aspects of transplantation; legislation for undergraduates and consent in paediatric anaesthesia. Its use as tool for teaching reflective ethical practice has been recently described demonstrating the potential of the SLICE model for supporting appraisal and professional development. In this article, we explore the suitability of the SLICE model to provide a general framework encompassing all the requirements for Ethical Clinical practice in anaesthesia. Good Medical Practice guidance produced by the General Medical Council and guidance provided jointly by the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland is used as the foundation for developing this framework. The Good Practice Guide for anaesthetic departments provides a solid ethical frame work for interpreting and applying Good Medical Practice guidance by the General Medical Council. Tools such as the SLICE model complement the guides produced by the professional organisations by providing a choice of different methods to facilitate education, decision making and reflective practice.

The COVID-19 pandemic has greatly affected all spheres of life, including biomedical research. The ethical regulation of clinical trials has a long history in international and domestic practice. An efficient infrastructure of international and national legislation has been created. At the same time, there are features of the organization of ethical review of clinical trials that arise under the restrictions associated with COVID-19. Healthcare of all countries is faced with the need to develop new approaches caused by the speed of the spread of the disease, its severe consequences for the life and health of people, the excessive burden on the medical worker, not only physical, but also psychological, including those associated with ethical problems. The purpose of this research was to study and analyze the experience of ethical review of clinical trials in the context of the COVID-19 epidemic, its regulatory framework in international and domestic practice. For high-quality and lawful conduct of clinical trials in Russia in the context of the COVID-19 epidemic, appropriate conditions were created, namely, a vertical base: the central ethical committee of the Ministry of Health of the Russian Federation local ethical committees based in clinical institutions and research centers. They are provided with sufficient and high-quality legal support in the form of laws of the Russian Federation, country standards and by-laws. The work of local ethics committees is built in accordance with strict ethical international and domestic standards. Standard operating procedures implemented in local ethics committees provide for all the nuances of situations, including those implemented using modern telecommunication technologies and other end-to-end information technologies. Even if many restrictions are imposed, biomedical research must continue, and accordingly, it must be carried out under the strict control and monitoring of research ethics committees. The article presents an overview of legal sources, an analysis of the main approaches in domestic and foreign literature, taking into account historical retrospective.

Human organ transplantation technology in the past drugs can not overcome the disease has a chance to be cured, to save the organ damage of the terminally ill patients so that they restore health and even regain life, is a great medical technology for the benefit of mankind. At present, our country, like other countries in the world, is making full use of this medical technology to benefit the people. However, this technology not only brings benefits to the people and society, but also brings us ethical, moral, legal and other problems. However about organ transplantation in our country legislation still exist deficiencies, in order to protect the life and health of the people, maintain normal medical order, harmony, promote the benign development of the medical career, to ensure the maximum play to the value of organ transplant technology, crack down on exposed in the process of all kinds of crime, our country should be human organ transplant to develop more perfect criminal law, To fill the inadequacies of the existing laws.

The rapid development and achievements of science and technology provides people to improve their lives. Over the past 10 years, genetic researches have grown significantly. Today they are the subject of debate not only by doctors, lawyers, but also theologians. Currently, legislation of countries in Middle East regulates genomics and genetic research differently. Countries are having orient towards religion and therefore pay more attention in these countries to the ethical regulators of Islam besides only legal regulation of genomics (humans, animals, plants, i.e. all living things). Ethical standards are gradually becoming legal norms. In some countries of the Middle East, there are draft laws on the legal regulation of genetics; in some countries given attention in the legal acts of executive authorities in genomics sphere, and in some, have been developed local acts of leading medical centers. A number of eastern countries are also highlighted, in the legislation of which some aspects of the legal regulation of genetic research act as legislative novels. In the most economically developed Middle Eastern countries, genetics is one of the priority programs of the state, in particular, there are national strategic programs for the development of countries already use of modern methods of genome sequencing, bioinformatics, and validation methods. Many Middle Eastern countries have ratified international acts in genetic research and on issues related to their regulation. In addition, Islamic states have developed an independent concept of genomics regulation, taking into account the attitudes of the fundamental sources of Islamic law. Based on the read material of the article, the reader learns about the legal, ethical and legal regulation in the field of genomics of Middle Eastern Islamic states.

AbstractIn this paper, we examine the qualitative moral impact of machine learning-based clinical decision support systems in the process of medical diagnosis. To date, discussions about machine learning in this context have focused on problems that can be measured and assessed quantitatively, such as by estimating the extent of potential harm or calculating incurred risks. We maintain that such discussions neglect the qualitative moral impact of these technologies. Drawing on the philosophical approaches of technomoral change and technological mediation theory, which explore the interplay between technologies and morality, we present an analysis of concerns related to the adoption of machine learning-aided medical diagnosis. We analyze anticipated moral issues that machine learning systems pose for different stakeholders, such as bias and opacity in the way that models are trained to produce diagnoses, changes to how health care providers, patients, and developers understand their roles and professions, and challenges to existing forms of medical legislation. Albeit preliminary in nature, the insights offered by the technomoral change and the technological mediation approaches expand and enrich the current discussion about machine learning in diagnostic practices, bringing distinct and currently underexplored areas of concern to the forefront. These insights can contribute to a more encompassing and better informed decision-making process when adapting machine learning techniques to medical diagnosis, while acknowledging the interests of multiple stakeholders and the active role that technologies play in generating, perpetuating, and modifying ethical concerns in health care.

Introduction: The main priorities of the implemented health policies in the Republic of Bulgaria are directly aimed at preserving and improving the health of the population, providing equal access of patients to modern and efficient healthcare, promptness and quality, in compliance with the normative requirements of the offered health service. In this sense, the focus of these health policies is to prioritize prevention and prophylaxis of early diagnosis of diseases. It is much more reasonable to prevent the disease or to manage it at an early stage than to slow down the treatment until the pathological processes develop into severe or irreversible complications. Aim: The aim of this systematic review is to investigate the effectiveness of existing legal acts governing the implementation of a common health policy in the field of health promotion and prevention. Another aim is to localize regulatory gaps and make relevant optimization suggestions. Materials and methods: The analysis of this systematic review is based on a thorough review of the existing regulatory framework (statutory and regulative legislation, case law, European practice) that concerns public health. Articles focused directly on the issues of medical screening and public health in a national and global perspective have been studied.Results: Two major legal acts, two regulations and strategies of the World Health Organization are considered. Suggestions for optimization of the control activity of the administrative bodies in the sector are presented. Conclusions: From the analysis done, proposals for optimization of the existing legal framework in the sector of health-care were made. The proposals were made based on the results of the analysis of w8orld trends regarding the methodology for state funding of medical screening for early diagnosis of diseases. The issue in question is up to date and raises issues related to legislative regulation, moral, ethical and deontological principles to which the medical profession adheres, as well as the health policy that is followed by the Ministry of Health in this aspect.

The problem of securing and protecting the citizens rights for the medical care delivery in the existing legislation is one of the most relevant in the modern Russian law. In domestic legislation the right to health and medical care is primarily enshrined in the Constitution of the Russian Federation. For example, the article 41 establishes the right to get free medical care in accordance with the state guarantees program of free medical care delivery to citizens, and to receive paid medical and other services. However, there are some peculiarities and problems of these rights implementation in minor patients. This article is devoted to the analysis of this problem certain aspects. In particular, it raises questions on the patient’s right to get information about his/her health status, enshrined in the Fundamentals (article 19) and the Law of the Russian Federation «On Protection of Consumers’ Rights of 07.02.1992». Quite controversial is the situation when the legal representatives of a minor under the age of 15 years strongly refuse medical intervention and hospital insists on it. Considering the features of the right ofminors to confidentiality, it should be noted that providing the information constituting patient’s confidentiality to legal representatives is not stipulated by the national medical legislation standards in case of minors over 15 years old. However, it should be taken into account that in case of harm infliction to a minor or unlawful interference with the minor’s health, the latters not having full legal capacity, are not able to protect themselves. Also in the current legislation in the field of donation and transplantation the problem of the minors lifetime donation regulation remains unsolved. In summary, it should be noted that, despite the relative development of the legislation on the minor patients rights, in reality unusual situations that create psychological, moral and ethical problems for doctors occur quite often.

The article, being offered, emphasizes the modern conditions of legislation in Ukraine on issues of health care. Presents the doctors survey results about level of their knowledge in the sphere of medical law. 610 respondents from 9 regions of Ukraine took part in the survey. The survey results indicate insufficient of doctors knowledge’s in the sphere of medical law at all stages of vocational training. Were identified difficulties in working with normative legal acts regulating medical practice, in particular due to their number and lack of systematization. Also, it was found that 100% of respondents would like to attend a medical law course, and examine the rights and responsibilities of health professionals, the legal protection of doctors, the legal aspects of the interaction between physicians and patients, health legislation, patients' rights and responsibilities. Was made the analysis of legal relations between entities in the sphere of health care as to issues, related to indemnification of harm, caused by handicap, other health injury or death of natural person in terms of Civil Code of Ukraine and practice of civil law proceeding. Article justifies the expediency of creating the Medical Code of Ukraine, that will systematize of national legislation in the sphere of health care through its codification and establishment of basic document – Medical Code of Ukraine – will assist to improvement in level of legal culture at doctors, improvement in their positive responsibility, consolidation of moral ethical values and high professional landmarks among medical men that will assist to improvement in quality of rendering the medical aid to population for reinforcement and preservation of the highest social value – human life and health.

The application of artificial intelligence (AI) in modern society has an increasingly significant impact on various aspects of life, including the field of legislation. Singapore is recognized as one of the leading countries in the development and use of AI, so its legislative practice in this field is a relevant topic for the research.The purpose of this article is to examine Singapore’s legislative practice regarding the use of artificial intelligence and its impact on society. The article aims to identify the main legislative acts and initiatives governing the use of AI in Singapore, as well as to analyze their effectiveness and impact on the country’s society and business environment.The article will analyze the laws and regulations related to the use of AI in such areas as computer vision, autonomous vehicles, financial services, medicine, and others. Special attention will be paid to the ethical aspects of the use of AI and measures taken to ensure transparency, security and protection of human rights.The research will include analysis of practical examples of AI applications in Singapore, such as CCTV, automated financial solutions and medical technology. The positive aspects of the use of AI, such as improved efficiency, accuracy and availability of services, as well as the potential risks.This article also examines Singapore’s legislative practice regarding the use of artificial intelligence and its impact on society and business. Recognized as a global leader in innovation and technological development, Singapore places significant role on regulating the use of AI to ensure ethical, safe and responsible use of this technology.The article analyzes key aspects of Singapore’s AI-related legal framework, including the Personal Data Act, the Personal Data Protection Act and the Cybersecurity Act. These laws aim to ensure the protection of human rights to privacy, control over the use of their personal data and ensure cyber security in the context of AI.Additionally, the article examines the specific requirements and standards that are set for specific industries where AI is used, such as financial services, medicine, and autonomous vehicles. Singapore is focusing on developing detailed directives and guidelines for the use of AI in these sectors to ensure high standards of safety and quality.In addition, the article highlights the importance of the ethical use of AI in Singapore.

Autonomous vehicles (AVs) will revolutionize mobility in the future. However, accidents will still happen and it will affect the practices of today’s tort laws. This work discusses all those aspects which should be considered in order to find out who is liable, i.e., an operator, owner, manufacturer, government entity, software provider, network provider, original equipment manufacturer (OEM), etc., as traditional tort rules will not help to find out the liability in case of an AV accident. The work comprehensively discusses different liabilities ranging from legal, civil, operator, criminal, moral, product, insurance, etc., to find out who is liable in case of an AV accident, as compared to the existing literature which generally discusses one or two aspects only. The work also presents the current state of legislation and discusses legal challenges to the lawmakers, insurance companies, consumer, and manufacturers, etc. The future mobility models and different scenarios of AV accidents have also been discussed in terms of legal liability and third party insurance claims. The role of regulatory bodies and different challenges has also been discussed along with recommendations. Finally, the work also proposes a new novel liability attribute model with a particular focus on ethical issues. The research proposes that liability should be attributed in such a way that it benefits everyone and everybody feels justified in case of an AV accident. The research also concludes that product liability will be the major issue in terms of insurance issues and the manufacturer should be held liable for product failure unless other evidence favors the manufacturer.

Problem setting. The article highlights problematic issues related to academic responsibility for violations of academic integrity of participants in the educational process. Attention is drawn to the fact that a significant shortcoming of the Laws of Ukraine «On Education» and «On Higher Education» is the absence of such definitions as «academic responsibility», «types of academic responsibility», «academic misconduct», which significantly complicates the bringing to academic responsibility of pedagogical , scientific-pedagogical and scientific workers of educational institutions and students of education in practice. Analysis of recent researches and publications. A. Artyukhova, V. Zinchenko, Y. Kalinovsky, M. Ozhevan, O. Tytska, O. Chumak and others scientists have addressed the issue of academic integrity in their works. The scientific conclusions and approaches to the vision of these scholars are an important basis for our study. Target of the research is to study and comprehend the problematic issues of bringing to academic liability for violation of academic integrity of participants in the educational process. Article’s main body. Based on the analysis of current legislation, the author formulates a definition of the term “academic liability” and establishes its place in the general system of legal liability. The author’s definition of the term «academic responsibility» is proposed: this is a type of legal responsibility that arises for the violation of the academic integrity of pedagogical, scientific-pedagogical and scientific employees of educational institutions, students of education in scientific institutions and educational institutions and entails negative consequences of state influence in case of committing them of an academic offense. A critical assessment of the list of violations of academic integrity is given. It is noted that in the current educational legislation there is no differentiation of violations related to the training of highly qualified personnel (master’s students, doctoral students, etc.). Attention is drawn to the fact that the Law of Ukraine «On Education» establishes a list of violations of academic integrity, in which offenses that are completely different in terms of the degree of social damage, for example, self-plagiarism and bribery, are placed in the same row/ The author established that the Law of Ukraine «On Higher Education» contains a list of sanctions for violation of academic integrity not for all participants of the educational process, but only for pedagogical, scientific-pedagogical and scientific employees of educational institutions and students of education. Amendments to the current legislation regarding the clear definition of objective criteria for the selection of the type of academic responsibility for a specific violation of academic integrity are proposed. Conclusions and prospects for the development. It was concluded that academic responsibility is a multi-meaning concept, in particular, a type of social, corporate, moral-ethical, legal responsibility, is a type of state coercion. It is proposed to harmonize the provisions of the educational legislation with the Code of Criminal Procedure of Ukraine, the Civil Code of Ukraine, the Criminal Code of Ukraine and other laws, which will regulate the types and measures of punishment for violating academic integrity. It is proved that academic responsibility can be legal (civil, labor, administrative, criminal), social, moral and ethical, corporate responsibility. Thus, academic responsibility intersects with legal responsibility. The need to establish the definition of the concept of «academic responsibility» at the legislative level and to regulate in detail all procedural aspects of bringing the participants of the educational process to academic responsibility is argued.

Keywords: medical research, ethical aspects of research, patient rights, as the objectof research, informed consent In the article, the author conducted a study of medical research with human participation, analyzed the legislation of Ukraine and international documents and found that there is no unified conceptof «medical research», but uses different terms, such as biomedical experiment, clinicaltrial, clinical trials, etc. The legal acts of Ukraine provide for a variety of terms, but dothey all mean the same concept. It would be appropriate to enshrine at the level of thelaw the concept of broad meaning «medical research», which would include such types as:«medical and biological experiments», «clinical trials» and so on. Referring to internationalinstruments on the search for the concept of «medical research» also revealed differencesin the conceptual understanding of the concept of «medical research». Instead, itwas found that all the legal acts analyzed in the article stipulate that medical examinationswith human participation, as the object of research, begin only after the person hasgiven voluntary informed consent to conduct research on him.The procedure for conducting medical examinations with the participation of a personas an object of study in all legal documents referred to in the article provides for themandatory voluntary consent of the person who is the object of research. Article 10, paragraph2, of the Convention for the Protection of Human Rights and Dignity of Biologyand Medicine: The Convention on Human Rights and Biomedicine guarantees everyonethe right to access any information collected about their health. However, the desire ofindividuals not to receive such information must also be respected. The rights of patientsduring medical research, as the object of research, including the study of their biologicalmaterial and data, regardless of the country in which they live and where medical researchtakes place, national laws must guarantee ethical standards at the highest levelof medical research and ensure strong legal basis for future medical research. The socialfunction of the state is the vocation to protect the researcher and the subjects.

Developments in science and technology have, among other things, challenged the family. Human values, which change in step with this technological progress, have faced many legal, moral and ethical dilemmas which await answers from the science on bioethics. We are in such a situation when we discuss about many advances in contemporary and national family law, including new forms of family reproduction that differ from a natural process of child conceiving. The authors in this paper bring comparative aspects of biomedical and family legislation of the Republic of North Macedonia and Republic of Kosovo. Among other things, they emphasize that given the traditional and biological model of the family in our society, new reproductive forms are a very reserved topic in the family and biomedical field, but it awakens a curiosity of discussions on ethics, philosophy and legal regulation of reproduction of human beings in both countries. The numerous stereotypes that prevail in the society of both countries regarding the application of artificial reproduction technology methods are contrary to many legal and medical justifications for couples who do not have the opportunity to become parents in a biological (natural) way. Therefore, the purpose of the authors is to provide accurate and grounded information through this text about the legal framework and medical options available to all persons who wish to exercise their reproductive right to establish a family.

The main legal ways to the socio-political regulation of sexual services (prostitution) in different countries are considered. The main problems facing the society of each state in the field of regulation of prostitutes activity, their so-called �curatores� and clients. The participation of the state in identifying and solving the problems of the sex industry are defined. It is determined that an important role in the legalization of prostitution is played not only by the legal but also by the moral and ethical aspects, which have a lot of limits in every society. Four models of prostitution regulation that exist in different countries of the world are analyzed. It is substantiated that not every model in itself is effective and is optimal for implementation. It depends of the legal system, level of consolidation of society and position of the government on this issue. Criminal liability for pimping, which exists in Ukraine, is only a small positive step in the fight against illegal profits related to the exploitation (voluntary or forced) of another person's body. The negative point in this area is the lack of social, medical and legal protection of prostitutes, as their clients are also at risk. So, the legalization on of the sexual services is necessary for our state, but it must be preceded by a series of successive authority�s steps: public dialogue on different public platforms, changes in legislation and government administrative decisions.

“[A] murder prosecution is a poor way to design an ethical and moral code for doctors,” observed the California Court of Appeal in 1983. Yet, physicians who have chosen to help terminally ill patients to commit suicide have trespassed on illegal ground. When skilled medical care fails to relieve the pain of terminally ill patients, some people believe that physicians may assist in these suicides. Others reject any kind of physician involvement. The debate on assisted suiczide and active euthanasia has focused on whether these acts can ever be acceptable. We propose to shift the debate to a less divisive issue: whether a caring physician who provides a suffering and ill patient with a prescription for a lethal dose of medication should be prosecuted as a felon. Even assisted suicide's opponents may object to such criminal prosecution. We propose to modify existing criminal laws to give physicians who assist their terminally ill patients in suicide, under carefully defined circumstances, a legal defense against criminal charges.

The article analyses the foundations and principles of global bioethics in the European ethical, legal and philosophical contexts. An analysis of European bioethics shows that there are at least three modern models of European bioethics: bioethics as metaethics; bioethics as biolaw; bioethics as applied biomedical ethics. European bioethics originates in the global bioethics of V.R. Potter and F. Jahr, and encompasses not only moral issues of medicine and public health, but also global environmental and social problems. In this context, the convergence of the natural and the human is seen as a rehabilitation of practical philosophy, a further study and development of the principles of practical reason, understood by analogy with the objective laws of nature. The study of constitutions, legislative and legal regulations of European countries has revealed a variety of bioethical principles in the field of biomedicine. However, at the level of legislation in biomedicine, there is a certain influence of the American model of bioethics, biomedical ethics, which is manifested in the principlism methodology and the weak connection between medical and environmental issues. Global bioethics in the European context is characterized by an intensification of bioethical reflection, social relationships and legislative activity in biomedicine within pan-European structures, such as the European Council and the European Union. The defining feature of global bioethics as a phenomenon of European culture and ethos is that its principles can be “activated” only as a semantic and logical integrity. Bioethical principles serve as a kind of harmonising factor of European biopolitics.

The legal aspects of formation and development if integral competence of local council deputies are analyzed in the article.There has been defined the concept of "integral competence of local council deputies such as knowledge, skills, capacities, and sometimes - other important qualities, ways and methods of their implementation into the activities of the local council deputies which are necessary for the successful and responsible fulfillment of their tasks and responsibilities. It has been determined that the profile of integral (pro-active, business-like) competence of local council deputies in Ukraine includes law-making, administrative and jurisdictional (organizational, executive, administrative, coordinative), control and supervisory, informational and analytical; economic (budgetary and planning, etc.), value-oriented (moral and ethical), social and psychological with communicative and consulting competences. The profile is designed mainly for the creative type of activity. The necessity to develop knowledge, skills and capacities of local council deputies to solve urgent problems of local self-government related to decentralization reform has been substantiated.It has been proved that the local council deputy must be highly professional in his/her field, capable to control changes, develop leadership skills, take risks, meet challenges of today. It has been emphasized necessary to provide continuous professional training to local council deputies for their mobility, prompt and effective response to the challenges of society in the context of development the paradigm shift within the state administration and local self-government.It is concluded that ensuring the effective activity of a local council deputy depends directly on his level of integral competence increasing through the vocational training. Leadership is an important component of integral competence. Leadership features include open-mindness and responsibility for self-actualization. The legal bases of formation and development of integral competence of the local councils deputies. There has been investigated defined by the Constitution of Ukraine, laws of Ukraine "On local self-government in Ukraine", "On the status of the local councils deputies " - concerning the content of the profile of integrative competence of local councils deputies in Ukraine, based on the distinguishing of empowerment and competences of the local self-government body; legislation defining the strategy and main directions of the further development of life-long adult education in Ukraine by means of formal, non-formal and informal education, namely: the National Doctrine of Education Development, the National Strategy for Education Development in Ukraine until 2021, the National Qualifications Framework, the laws of Ukraine “On Professional Development of Employees”, “On Employment of the Population”, “On Higher Education”, “On Education”. It is proved that the existing system of vocational training, based on European standards of education development, plays a key role in the process of the integral competence formation for the local councils deputies, and insurance of their continuous professional training. The have been analyzed the legal foundations of the vocational training system for the local councils deputies, which are defined by the Concept of reforming the system of vocational training for civil servants, heads of local state administrations, their senior deputies and deputies, local self-government officials and of local councils deputies under the date of December 1, 2017 No. 974-p , the plan of actiors for its implementation, as well as the corresponding Regulations on the vocational training system.

The article examines the discourse of «decommunisation» in a public plane of the modern Ukrainian information space. Its rhetorical dominant is represented by the communication strategies of the supporters and opponents of the package of «historical» laws adopted by the Verkhovna Rada of Ukraine on April 9, 2015.The author of the article has reproduced the chronical development of discourse «decommunisation» within the national concept of «historical memory».European practice of condemnation of communist crimes was analyzed; factual material representing the international dialogue discussion Ukrainian decommunisation process was involved. Special attention is given to the issue of decommunisation of the media sector, it was emphasised on the controversial aspects of interpretation of legislation «purification» from the Soviet Communist symbols. Functional explications of discourse «decommunisation» in the media were studied, in particular within the event content, social content of the problem, subject-content argumentation and contextualization in international, legal, moral and ethical plane, mythologizing the narrative. On the basis of factual material the basic meaning of the public topics of the analyzed discourse flow was revealed, it was indicated on its dependence of the communication purpose of the speeches. Infographic representation of the component «decommunisation» in the media has been analyzed, including the frequency of use of official symbols and their substantive relevance. It was revealed that the information occasion and the intensity of publications within the discourse is caused not only by the event content, but also by the methodological source (Calendar of decommunisation), developed by the Ukrainian Institute of National Memory. The reasoning patterns of the texts were analyzed and it was found that the strategy of «responsible contextualization» contributes to the formation of the constructive dialogue. It was indicated on the necessity of attraction of qualitative component of communicative media strategies, including the use of critical narratives. The author has focused on the ambivalent influence of the discourse on the design of public opinion, the set of public representations which, depending on the purpose of communication, contributes to the formation conventional meanings, the effect of «normalization» and manipulation.

The article examines basic human rights. Among the fundamental and inalienable human rights is the right to life. Yes, Art. 27 of the Constitution of Ukraine guarantees everyone an inalienable right to life. It states that no one can be arbitrarily deprived of life. The duty of the state is to protect human life. This right is closely related to human health. It is emphasized that human life depends on the state of its health. Often health is a major component for conservation and prolonged life. Accordingly, organ transplantation, as a way of saving life, is especially important, and therefore the problems of transplanting organs and tissues are drawn by scientists, and not only from the medical sphere. Transplantation of organs and tissues of the human body is one of the most promising and at the same time quite in demand of modern medicine, which has made it possible to treat a number of serious diseases. Transplantation of organs and tissues, as a means of real assistance to patients who need it, has a number of characteristic features that distinguish this method from other medicinal effects. This is due to the presence of a donor-a person who in most cases does not require medical care, as well as problems of moral and ethical and general legal content. These circumstances substantiate the importance and need to regulate public relations in the field of transplantology. It is emphasized that the analysis of the norms in force in this area shows that many issues of transplantation of organs and tissues are either not regulated at all or need to improve legal regulation. The legal aspects of the problem of organ and tissue transplantation are extremely relevant. That is why transplantology as a science of transplanting organs and (or) tissues of a person should be based on the law, which is based on the protection of fundamental rights, freedoms and human dignity of every citizen. From the point of view of ethics, the problem of transplantology differs significantly depending on whether it is about the sampling of organs and tissues for transplanting organs in a living person or from the body of the dead. Solving these ethical problems depends largely on the state of legislation in the state, including constitutional ones. Key words: human rights, right to life, right to health, somatic rights, transplantation, recipient, donor, legal regulation of donation, health care, human body, human body tissues.

Nowadays changes’ vector related to the information and technological novelties presently shifts: from technical, economic and legal fields - to the socio-cultural dimension. Following the production sectors, other areas of life became the objects of conscious and deliberate innovative activities, that allow us to fix the transition towards an innovative model of social and cultural development, and the corresponding increase in the value of Intellectual Property institutions in today’s post-industrial world. This is why the innovation has become one of the main types of nowadays practical activity with intellectual or creative content, and it’s perceived as an essential precondition for further civilized development. The intellectual property may be considered as a specific kind of original information, objectified in appropriate form. The core of any intellectual property object is innovation. The latter may even be understood as its inner substance. And the knowledge should be esteemed as a prelude to innovative or creative process. In the article, the main attention was focused on the dialectics of development of our Information reality that is changing gradually, but inevitably. The most controversial point is to keep the balance between the principle of Freedom of information (including free Internet, independent mass-media, privacy on the Web, anonymous sources for press and journalism activity), on the one hand, and the principle of informational safety and public security (i.e. the possibility of state power to resist an external informational aggression, to block disinformation attempts, to prevent manipulations with information that may be really dangerous or harmful to the society in different aspects), on the other hand. The general vision of today’s Information space evolution is expressed as an ambiguous process, which implies both the advantages and disadvantages of this new kind of reality. Eventually, this means the existence of the dark side of mentioned processes, and the bright one. It all depends on how people will actually use these technological tools. That’s why the state should always remain the sentinel of this fragile balance between the Freedom of Information in all possible ways, and the Censorship that may be expressed in soft or hard forms. The other matter is an Intellectual Property protection mechanism in this new information reality, including international and local legislation, judicial practice, as well as mental, moral and ethical, sociocultural, economic and even geopolitical aspects of IP protection. Everyone should respect the related Laws, and individual commercial & noncommercial rights of authors or possessors. But, simultaneously, this realm of social-economic and legal relations - called "intellectual property" - should be reconsidered deeply, as technological and sociocultural conditions have changed substantially. That’s why we consider the current global IP protection system as the olden one. It must be modernized, and this modernization should be definitely commenced by its liberalization.

Visum et Repertum (VeR) is in the form of a written statement made by doctors who have to take an oath of office, based on things seen and discovered upon examination of the dead or wounded allegedly caused by a criminal act. KUHAP does not mention the term visum et repertum, but KUHAP is one of the legal bases in making VeR. VeR is not only needed in criminal case examination but also civil cases in some instances. The exact cause of a person's death can be related to events in criminal law as well as civil law as in the claim insurance or determination of heirs related to the distribution of inheritance rights. Given the urgency of VeR as one of the evidence used before court proceedings, in making VeR, there is a potential for abuse of power by doctors by making VeR not based on actual examination results. Such abuse of authority by doctors has violated the moral and ethical aspects which override the values of truth and justice. Therefore, the problems in this article focus on what is the authority of doctors in administering Visum et Repertum and what is the legal responsibility for the abuse of doctor's authority in making Visum et Repertum. The results of the discussion indicated that: doctors have the authority to, among others: accept victims sent by investigators; request a letter requesting a statement of VeR; a specialist can only carry out medical examination of the victim; signing of the VeR statement following the applicable laws and regulations, and delivery of completed evidence may only be submitted to the investigator accompanied by an official report. Making VeR unlawfully is not clearly explained in the Criminal Procedure Code. However, the use of VeR against the law occurs when VeR becomes an instrument of action against the law as formulated in the norms of every criminal act. Therefore, it is a form of legal responsibility for doctors who abuse their authority regarding VeR can be pursued through 4 (four) types of sanctions, including administrative sanctions, civil sanctions, criminal sanctions, and medical discipline sanctions.

Objective: The objective of this study is to investigate Brazilian legislation, Dworkin's studies and feminist critical theory regarding abortion with the aim of understanding how feminisms can generate criticism of Brazilian legal regulation and Dworkin's conclusions on the topic. Theoretical Framework: In this topic, the main concepts and theories that underpin the research are presented. Feminist critical theories and Dworkinian theory stand out, providing a solid basis for understanding the context of the investigation. Method: The methodology adopted for this research comprises the hypothetical-deductive method and data collection was carried out through bibliographical documentary research, notably from research sources consisting of scientific articles, books, periodicals and collections. Results and Discussion: The results obtained revealed that (i) different feminisms contribute to confronting sexist oppression; (ii) by guaranteeing the material equality of people, the Federal Constitution is feminist and the acts of the three Powers should be revised accordingly; (iii) the decriminalization of abortion in the first trimester of pregnancy will be decided by the Federal Supreme Court in ADPF 442, but there is a favorable understanding in HC 124/306; (iv) Dworkin's interpretive theory proposes Law as integrity and analyzes abortion from the American context, when the Supreme Court presented a permissive precedent; (v) Dworkin understood abortion as a collective issue because it involves collective values ​​and the intrinsic good of life, which is of state interest, which would justify the State demanding certain responsibilities via regulation; (vi) Dworkin criticizes the author of radical feminism and cites the author of femininity feminism, which is widely criticized for the idealization of motherhood and for enabling sexist aspects; (vii) for the Law, abortion is not a religious, moral or ethical discussion, it does not require consideration between the community's religious rights and other rights, but it is a choice of the pregnant woman and its regulation depends on scientific medical criteria. In the discussion section, these results are contextualized in light of the theoretical framework, highlighting the implications and relationships identified. Possible discrepancies and limitations of the study are also considered in this section. Research Implications: The practical and theoretical implications of this research are discussed, providing insights into how the results can be applied or influence practices in the field of criminal law. These implications could include the (de)criminalization of abortion. Originality/Value: This study contributes to the literature by approaching a critical view of abortion for Dworkinian theory from feminisms. The relevance and value of this research are evidenced by its questioning of some Dworkinian moral assumptions about abortion.

As you know, the principles of academic culture and integrity in the current state of university education in Ukraine are often simply perceived as an abstract, but necessary for the European integration of education postulate. Codes of ethics and regulations on combating academic plagiarism are created on the basis of recommendations of the Ministry of Education and Science, regulate the activities of employees and students in the context of prevention and detection of falsifications, violations of academic integrity, including academic plagiarism. The establishment of the principles of academic culture and integrity in educational institutions is a necessary prerequisite for building a strong civic culture in society. Expert evaluation of scientific papers, including anti-plagiarism, in our opinion is an important prerequisite for the adequacy of complex scientific topics and objectifies the overall assessment of the quality of presentation of research results, including dissertations,monographs, manuals, articles and abstracts. The aim of the work was to improve measures to combat academic dishonesty and plagiarismbased on the analysis of current legislation, orders and regulations of Danylo Halytskyi Lviv National Medical University, creation and implementation of a new discipline for PhD students to acquire the necessary knowledge, skills and abilities. based on the topics of meaningful modules, created taking into account the experience of examination of scientific and educational works. In total for the three-year period (2018-2020) 5992 inspections were carried out and violations of academic integrity were confirmed in 611 works, which was the reason for their rejection. Algorithmic logical functional sequence of anti-plagiarism examination of dissertations and abstracts with analysis of the percentage of uniqueness of the text by the method of shingles with optimized settings was used to conduct the initial examination of dissertations to detect academic plagiarism. Deep search parameters and deep verification by Unichek, Plagiarism Detector Pro v. 1092”, etc. with further maternity check and establishment of the percentage of uniqueness of the text by the freely accessible program “AdvegoPlagiatus”. Based on the analysisof the causes, trends and spread of academic plagiarism in the university community for applicants and graduate students was created and implemented the discipline “Information support, academic integrity and research ethics” which is aimed at gaining analytical competencies, flexible skills “soft skills”. necessary during the planning and implementation of dissertation research and ensuring adequate communication in the scientific community. It consists of three content modules “Academic Integrity and Anti-Plagiarism”, “Scientific Ethics”, “Information Technology and Patent and Literary Support of Research Papers”. Lectures, seminars and topics of independent work are aimed at acquiring analytical competencies, flexible skills “soft skills” needed during the planning and implementation of dissertation research and ensuring adequate communication in the scientific community, the formation of graduate students’ theoretical knowledge and practical skills and skills in compliance with ethical and moral and legal principles in the planning and implementation of scientific research with human participation and with the use of laboratory animals, obtaining by graduate students and applicants knowledge of research activities and acquisition of skills of independent research, features of patent research and preparation of reporting documentation. Postgraduate students acquire knowledge of current legislation on academic integrity and anti-plagiarism; ethical aspects of scientist behavior and communication; research planning, organization and tactics strategies; liability for breach of academic integrity; basics of statistical conclusion, counteraction to conflicts of interest, elimination of risk factors and errors in ensuring academic integrity, which determines the social and professional mobility of research and teaching staff, promotes diversification of higher education, increasing the value of scientific knowledge and professional experience. Prospects for further research are to improve algorithms for detecting academic plagiarism and scientific falsifications, optimizing measures to prevent anddetect manifestations of academic dishonesty.

The sphere of reproductive rights is still beyond the scope of a thorough legal analysis, and it is not given due attention in the legal literature. This may be due to the fact that the concept of reproductive rights is new to Ukrainian law and has not yet found its proper place in the general system of law. There is a lack of scientific development in the issue of protection of the rights of the child to birth, trafficking in human beings for the purpose of exploiting surrogate mothers or children born as a result of surrogate motherhood, etc. The purpose of the study is to analyze the legislative, doctrinal and moral aspects of reproductive rights and to identify effective legal measures to improve the legal regulation of surrogate motherhood in Ukraine and the proper legal protection of the child before and after birth. Experimenting with human gene material as a conception in vitro turns children into a commodity. There is an artificial situation in which wealthy men will hire women to provide contracting services to their offspring. It is difficult to disagree that in surrogate motherhood, as in any business, personal financial gain dominates. So, from this point of view, surrogacy is a kind of market and business. The conception of the child is not a right, but an opportunity that is not given to all, but surrogate motherhood turns the child into an "object of economic agreement and contract, a kind of ordering of goods." The child cannot be considered as an object of property. It is unacceptable to consider the practice of surrogacy as ethical. In addition, forced commercial surrogate motherhood falls within the definition of trafficking in human beings. The issue of reproductive technology must be addressed in such a way that the child born as a result of surrogate motherhood does not fall prey to further exploitation. The author concluded that in many countries with a licensing or altruistic regime, many aspects of the use of assisted reproductive technologies and surrogate motherhood remain unregulated. There is no clear understanding of all the principles and standards governing the use of assisted reproductive technologies and surrogacy agreements. In general, the legislation lacks sufficient standards and provisions to protect the rights of parties to surrogacy agreements. The most controversial issues are the rights of the surrogate mother, the expectant parents and the children born as a result of the surrogate motherhood. At the present stage, legal adaptation of society to the development of medicine in the field of reproductive technologies has not yet taken place in Ukraine. Cases such as the birth of several children by surrogate mothers, births of a child with developmental disabilities, birth of a dead child or miscarriage, the need for an artificial interruption of pregnancy according to the medical opinion of doctors, the termination of marriage by genetic parents, the death of one or both parents. Keywords: reproductive rights, surrogacy motherhood, legal regulation, legal protection, embryo, child rights, family, surrogacy agreement.

The interest in political crime has been growing in the Polish doctrine of penal law and criminology of the 1980's. In 1982, the Institute of Penal Law of Warsaw university organized a conference dealing with the problems of political crime and the status of political prisoners. In 1984, the works of J. Kubiak and S. Hoc were published, with those of T. Szymanowski and S. Popławski to follow during the next two years. In 1986, articles by Z. Ciepiński and S. Pawela appeared in the organ of the Academy’s of Internal Affairs Institute of Law, and the Learned Society for Penal Law devoted one of its 1987 session to the problems of political crime. The present paper formulates and develops the main threads of the lectures delivered in 1982 and 1987 by the present authors. Accepting the opinions of O. Kirchheimer and S. Schafer, classical in a sense, as to the extreme complexity of political crime and the impossibility of formulating a universal criterion basing on which such crime might be distinguished, we give an outline of the chief elements of that interesting social phenomenon. The oldest Roman legal constructions of proditio and perduellio were transformed during the period of empire into crimen leasae maiestatis, an institution that was to persist for centuries to come in the shape of offences against state or the ruler. The origins of the modern history of political crime as a separate legal category date back to the end of the 18th century and the changes brought about by the French Revolution. In the early half of the 19th century, France and Belgium were the first to grant to political offences a privileged status among prohibited acts, introducing the competence of assizes, a separate system of penalties, and abolishing death penalty towards political offenders; this also took place in several other European countries. The privilege of political offences was based mainly on their distinct motives and their perpetrators personality traits. The 19th-century optimism and romanticism of approach towards political crime paled in the late half of the century as the surge of anarchistic and revolutionary movements grew. The legal status of a political offender started to worsen; the great 20th-century dictatorships were tragic to their real and supposed antagonists, treated with particular severity so as to terrify the citizens. In about two centuries of modern history, the legal category of political offence went through all possible extremes: now the time has come to reconsider it. A general, universal and timeless definition of political offence does not seem possible, even the most extreme of its forms being relativistic. Offenders called by some ,,terrorists’’ are ,,fighters for liberty’’ in the eyes of others. On the other hand, state terror is sometimes given the neutral name of ,,special operation’’ or ,,new policy’’. Last of all, one might also say quoting the extreme section of radical criminology that there is a political entanglement to all offences, administration of justice being an instrument of politics. Also the opposite is sometimes contended, namely, that political crime does not exist at all, enemies of the system being common criminals or madmen. There is also a marked trend to exclude terrorism, war crimes, and genocide from the discussed definition. In international law, the notion of political crime is purely functional: the separate states base on it when refusing extradition and granting political asylum. As regards the internal penal legislation, some states only distinguish political offence as a legal notion. There are in the doctrine of penal law three basic methods of defining that notion. According to the objective approach, the kind good being assaulted constitutes the essence of political crime: thus the group of such acts is restricted to direct attempts against the state's basic political interests only. According to the second conception, the subjective one political crime is any prohibited act committed for political motives or to political end. The third, mixed theory consists in taking both these aspects into account: the interest protected by law and the perpetrator's ideological motivation or aims which cannot be recognized as censurable. Additionally, the preponderance or domination theory allows for a punishable act to be recognized as a political offence if political elements prove to have predominated in the given circumstances, aims, and motives. Robert Merton's was the most successful attempt to characterize a political (nonconformist) offender. Contrary to the common offender, his political counterpart 1) makes no effort whatever to hide his infringement of norms he repudiates or questions as to their legal validity; 2) he wants to replace the norms he considers wrong with other norms based on a different moral foundation; 3) his aims are completely or largely disinterested; 4) he is commonly perceived as quite different a person than a common offender. If we broaden the notion of ,,nonconformist" by adding adjectives like ,,religious" and ,,ethical" to it, we bring it closer to that of ,,convictional criminal" used by Schafer and of ,,prisoner of conscience" used by the Amnesty International. The radical trends in sociology and criminology of the recent decades brought an important element to change the aproach to political crime: an opinion is promoted that the state itself is the main source of that crime as it may use every possible legal norm and institution to fight its opponents. As opposed to the two countries where the conception of political criminals separate status was born, France and Belgium - discussed particularly broadly by the authors of lectures - the United States repudiate in their law and law courts decisions the existence of political crime. Instead, there is ,,civil disobedience'' which, together with the specifically American constitutional mechanisms, constitutes an instrument of the struggle for the protection of civil rights and liberties. The fact is stressed in the legal and criminological literature that a refusal to recognize the political character of acts that deserve such recognition contributes to the discredit of administration of justice as the establishment's political instrument. At the same time, various methods of illegal ,,neutralization" of political opponents are brought to light, including the so-called dirty tricks of the FBI and the different forms of abuse of authority by the CIA. In Great Britain, there is according to the official standpoint no political crime in the light of penal law. But the problem itself does exist in practice which is evidenced among others by the quest - a feverish one at times - after the measure to control the difficulties resulting from it; among such measures, there are administrative acts or on appropriate interpretation of the existing regulations, e.g. rules of imprisonment. The doctrine of penal law and criminology do not seem too interested in the discussed problem; its treatment by L. Radzinowicz and R. Hood is no doubt an exception, particularly if we consider the fates of the activists of the three socio-political movements before World War I: Chartists who fought for workmen’s rights, Fenians who demanded the grant of rights to the Irish, and suffragists. Despite the fact that the problem is only treated in its historical aspect, materials of immediate interest can be drawn from its analysis. In the Federal Republic of Germany, political crime lacks a separate status: yet a growth in the interest in such crime can be observed. This was particularly true in the seventies and was due to the activities of terrorist groups and to students protests. Also G. Radbruch’s conception of ,,convictional criminal’’ plays a certain part there, among intellectuals with leftist tendencies above all. Also in that country, the discussion grows especially important about the relation between the powerful and the powerless. Another significant point is H. J. Schneider’s demand for the problems of political crime to be granted a privileged position in criminological research. Considering the aspects of that crime in their broad interpretation, Schneider found it possible to include both terrorism and genocide in his discussion; thus, for the first time ever, a profound treatment of Nazi crimes was included in the West-German criminology. In Poland, after the country regained independence in 1918, several different laws were in force for over ten years concerning political crime and prisoners, in a difficult internal situation. In 1931, uniform rules of imprisonment entered into force which provided for no mitigation for political prisoners. The penalty of arrest, introduced by the 1932 penal code admittedly included certain elements of the status of a political prisoner, but the opposition’s struggle for its proper formulation went on till the outbreak of World War II. After the war, ,,counter-revolutionaries’’ and ,,traitors of the nation’’ were treated with utmost severity. This situation in which political opponents were so treated on a mass scale ended with the fall of Stalinism. The recent Polish discussion about the notion and status of political prisoner dates from the events of 1980-1981. Many were not aware at that time that there had been in the 1970’s in Poland a partial legal regulation of the special status of persons defined as perpetrators of political offences. It followed from the fact that Poland ratified in 1958 the ILO Convention No. 105 and that in consequence, the Minister of Justice issued an appropriate order. In the provisions of the decree (issued on the imposition of martial law on December 13, 1981) on remittal and forgiveness of certain offences, those ,,committed for political reasons’’ were mentioned amond others. Thus the lawyers could argue that the notion of political offence was know to the legislator, the only problem consisting in providing a more detailed legal regulation of that sphere. But the authorities chose a different solution. At the beginning, those convicted of the sc-called ,non-criminal" acts were granted an actual (and not legal) status of political prisoners. Later on, most of such persons were released from prison by the terms of the succeeding amnesty acts. in 1986, the Act on ,,decriminalization'' transferred the competence to decide in most of those cases to misdemeanour courts. The interest in the problems of political crime, increased since 1982, still persists in the circles of the Polish doctrine of penal law and criminology. There is a general trend to give that notion a broader interpretation as compared with the present doctrine of penal law which practically limits its range to offences against the state's basic political and economic interests only. We believe the Polish doctrine of penal law; criminology and legislation in Poland now face at least three basic questions: 1) whether to introduce into the law a special status of political offenders and prisoners in its traditional construction; 2) whether to recognize similarly a privileged legal situation of a larger group of ,,ideological nonconformists" mentioned by the ILO Convention No. 105;3) whether and to what extent to include in the notion of political offence the prohibited acts committed by state functionaries while exercising authority.

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed.

Photo ID 129550055 © Katarzyna Bialasiewicz | Dreamstime.com ABSTRACT It has been 26 years since medical aid in dying (“MAiD”) was first legalized in Oregon, and today, about 20 percent of people in the US live in jurisdictions that permit MAiD. The New York State legislature is currently considering a bill that would permit Medical Aid in Dying for terminally ill patients in certain defined circumstances. Those states now benefit from decades of experience, evidence, and reporting from MAiD jurisdictions. This demonstrates that legislation can simultaneously grant terminally ill citizens the civil right to access MAiD while also aggressively protecting all patients from coercion, manipulation, and harm. Given the copious evidence gathered in the past decades, concerns about abuse can no longer be credited as grounds for opposing the passage of legislation that is demonstrably both effective and safe. INTRODUCTION It has been 26 years since medical aid in dying (“MAiD”) was first legalized in Oregon,[1] and today, about 20 percent of people in the US live in jurisdictions that permit MAiD.[2] Other jurisdictions, including New York, are actively considering adopting MAiD laws. Those states now benefit from decades of experience, evidence, and reporting from MAiD jurisdictions, demonstrating that legislation can permit MAiD while also aggressively protecting all patients from coercion, manipulation, and harm. The data should allay the concerns of those who oppose MAiD due to the risk of abuse, coercion, and a hypothetical slippery slope. We, as a society, as clinicians, and as ethicists, must remain vigilant and prevent abuse of MAiD, given the potential risks in the community and in congregate care settings and the risk of patient exploitation by family members. However, given the copious evidence, concerns about abuse do not justify opposition to legislation that is effective and safe. I. New York’s MAiD Bill The New York State legislature is currently considering a bill that would permit MAiD for terminally ill patients in defined circumstances.[3] The bill applies only to adults with a terminal illness or condition that is “incurable and irreversible” and “will, within reasonable medical judgment, produce death within six months.” The bill contains numerous protective requirements: MAiD requests can only be made by the patient themself; requests cannot be made by healthcare agents, surrogates, or anyone else; MAiD requests must be made both orally and in writing to the patient’s attending physician; No person is eligible for MAiD solely because of age or disability; The patient’s attending physician must determine the patient has a qualifying terminal illness, has decision-making capacity, and has made a voluntary, informed decision to request MAiD, in the absence of coercion; These determinations must be confirmed by a second consulting physician in writing; If the attending physician has any concern that the patient may not have decision-making capacity, the patient must be referred to a mental health professional; The attending physician has additional duties to the patient, including ensuring the decision is informed, by discussing the patient’s condition and prognosis; discussing the MAiD process, and treatment alternatives like palliative and hospice care; offering referrals to other appropriate treatment, like palliative and hospice care; and educating the patient that their request can be rescinded at any time and offering them an opportunity to do so; The written request must be witnessed by at least two adults who cannot be (i) related to the patient, (ii) entitled to any portion of the patient’s estate, (iii) employed by a healthcare facility where the patient is receiving treatment or residing, (iv) or the attending physician, consulting physician, or mental health professional determining decision-making capacity; and MAiD medication must be self-administered by the patient, and it must be voluntarily ingested.[4] ARGUMENTS FOR AND AGAINST MAiD II. No Evidence of Abuse of Existing MAiD Laws MAiD supporters and critics alike have a concern about the abuse of MAiD. For this reason, MAiD laws throughout the US incorporate strict eligibility criteria and protective procedural requirements. For instance, patients are eligible only if they are terminally ill with six months or less to live, more than one physician must be involved, and requests must be witnessed (by individuals unrelated to the patient who will not profit from the patient’s estate). MAiD requests have been closely examined in the 27 years since Oregon became the first state to legalize the practice. The results show that these compassionate and protective measures have worked. There have been no documented or substantiated incidents of MAiD abuse since Oregon became the first to implement a MAiD law in 1997.[5] In 2019, the executive director of Disability Rights Oregon (DRO), an organization mandated by federal law to investigate complaints of abuse or neglect of people with disabilities, reported that DRO has never received a complaint that a person with disabilities was coerced into obtaining a prescription for MAiD drugs.[6] A recent study of aggregated data from all nine of the US jurisdictions with publicly available MAiD records from 1998 to 2002 found that 95.6 percent of those who died by MAiD were non-Hispanic white individuals, and 53.1 percent were male.[7] 72.2 percent of these individuals had at least some college education, 74 percent had a cancer diagnosis, and the median age of MAiD death was 74 years old. Only 11 percent of patients were uninsured. MAiD users tend to be white, older, educated, diagnosed with cancer, and insured. Fears that MAiD would overwhelmingly be used by (or on) the poor, the uninsured, the uneducated, or racial and ethnic minorities have not materialized. This data has actually raised a converse concern: that MAiD may, inequitably, not be readily available to less privileged populations or those with a diagnosis other than cancer.[8] Opponents of MAiD may argue that the recent relaxation of certain legal restrictions in some jurisdictions is evidence that the slippery slope to unrestricted euthanasia has begun. This is a mischaracterization. Certain restrictions have been adjusted. For instance, Oregon and Vermont removed the residency restriction that previously excluded non-residents from eligibility.[9] Both states changed the residency requirement due to lawsuits challenging the constitutionality of requiring residence.[10] New Jersey’s law will likely change soon, as well.[11] Initial MAiD laws were drafted to be highly restrictive out of concern about unintended and unforeseeable consequences. Given the gravity of the subject, decades ago, it was better to err on the side of caution, even if that meant excluding from eligibility people who ought to, ethically or legally, be included. Now, with nearly 30 years of experience and data, we can better determine which requirements are necessary to appropriately protect patients, clinicians, and society. Restrictions proven to be unnecessary can now be modified. The core purposes of MAiD laws and the rights and protections they provide are not changing. Rather, a few aspects of the regulations are being adjusted so they are not more restrictive than necessary to achieve their purpose. The ever-growing body of evidence that MAiD laws can adequately protect against abuse and the mythic slippery slope has assured many that their fears will not materialize.[12] For example, NYU bioethicist Arthur Caplan was once a vigorous opponent of MAiD. He worried that MAiD laws would lead to the abuse of the poor, uninsured, and disabled in service of cost-saving or the convenience of others. [13] But, after closely following the empirical evidence from MAiD early-adopters, Oregon and Washington, Caplan changed his mind. In 2018, he argued in favor of the NY MAiD bill before the New York State Assembly Standing Committee on Health.[14] Discussing his review of evidence from these states, Caplan stated: I found no cause for my concerns, none with respect to the slippery slope. There isn’t solid evidence of coercion or duplicity being exercised with respect to people who choose assistance in dying in either state. The police, government officials, families of those who have chosen to use the legislation and the general citizenry find no causes or basis for changing the laws due to abuse or misapplication . . . These slippery slope arguments are just not true . . . there is no current factual support for this slippery slope argument that vulnerable individuals are at risk for being coerced into using the law.[15] Decades of evidence has shown that legislation can simultaneously grant terminally ill patients access to MAiD while also protecting against coercion and abuse. In the face of this evidence, continuing to deny access to MAiD because of hypothetical abuse is unjust and unethical. III. Views of Opponents are Neither Grounded in Fact nor Consistent with Current End-of-Life Practices a. Risk of coercion One common argument heard today from some disability advocates who oppose MAiD goes something like this: Everybody who would qualify for and use MAiD is (or will become) a disabled person, so MAiD only kills people with disabilities. The most common reasons people choose to end their lives via MAiD are disability issues, like loss of autonomy, less ability to engage in activities, and loss of dignity. They argue that, instead of making it easier for disabled people to die, we should make sure that proper services and support exist so that disabled people do not choose to die. Such disability-rights-based arguments tend to assert that to avoid abuse, we must prohibit MAiD altogether. They argue that legalizing MAiD will inexorably lead to abuse and coercion, and disabled people will be pressured into suicide. Some even argue that MAiD laws are the first step to euthanasia, noting the path in other jurisdictions.[16] As an initial matter, people with disabilities deserve adequate support and services, and these are not always available to them. People with disabilities have faced tremendous discrimination in the healthcare system and have been historically prevented from accessing proper care and asserting their autonomy. Ensuring that all can access adequate end-of-life care, like palliative or hospice care, is an ongoing battle that ought not be abandoned. But fighting for adequate end-of-life care and legalizing MAiD are not mutually exclusive. In Oregon, 90 percent of those who access MAiD are enrolled in hospice and states with MAiD laws tend to have better access to palliative care than states without.[17] MAiD proponents seek only to add another choice for the dying, not to diminish any other options. This is reflected in the text of New York’s pending bill, which explicitly requires patient education and referrals to appropriate end-of-life services, like palliative care and hospice.[18] No one has openly argued that society should hold terminally ill patients hostage in order to obtain broader support and funding for palliative care, but that is the practical effect. Beyond the need for supportive services and proper access to the full range of end-of-life care options, the disability argument fails. First, the assertion that MAiD laws will be abused and disabled people will be coerced into suicide is not grounded in fact. To the contrary, real-life evidence gathered in over two decades of legal MAiD has shown no documented or substantiated incidents of abuse, as discussed above.[19] The slippery slope has simply not materialized. Advocates for people with disabilities who are opposed to MAiD have not clearly articulated exactly who is vulnerable to being coerced into obtaining a MAiD prescription or even how such coercion could logistically occur. Most people with disabilities are not vulnerable to MAiD abuse, as they do not have a qualifying terminal illness or lack decisional capacity due to a developmental disability and are therefore not eligible. MAiD opponents appear to be claiming that all those who qualify for MAiD are vulnerable and seek protection from MAiD laws. But this would include many of the people that, over the past decades, have aggressively and publicly advocated for access to MAiD – terminally ill people, like Brittany Maynard,[20] many of whom lobbied hard for the passage of MAiD laws while knowing that they themselves would die before the laws passed. Opponents of MAiD from a segment of the disability rights community are telling individuals who they claim, without permission, as members of the MAiD opposition community, that they must all endure unimaginable suffering without a MAiD option because they must be protected from theoretical coercive harm. People with disabilities should be allowed to make their own choices. No one, not even the most well-meaning advocate, should be allowed to obstruct a patient’s end-of-life choices – those choices belong to the patient alone. b. Argument That the Demand for MAID is a Result of Poor Disability Services Second, the argument that terminally ill patients would decline MAiD if only they had better disability services or support is disingenuous to the extent that it ignores the fact that people choosing MAiD are actively dying. No provision of supportive services can change this. And it is perfectly reasonable for someone who knows that they will die in less than six months to want some control over the manner of their death and to avoid the deterioration, indignity, and suffering that could come with it. The argument construes a MAiD death as a choice to die rather than live with a disability. But individuals choosing MAiD are not choosing death – death is coming and coming quickly. MAiD simply offers some control over this reality, giving patients an option that is safe, certain, and painless. Certainly, supportive hospice services should be available for these individuals. But there is no evidence demonstrating that any amount of service would eliminate the need and desire for the MAiD option. c. Inconsistent Positions on MAID and Other Ending Life Care Options: Palliative Sedation and VSED MAiD opponents who are concerned about abuse and coercion often hold inconsistent views on other currently available ending life care options.[21] For example, some argue that palliative sedation[22] renders MAiD unnecessary and does not present the same ethical problems.[23] However, whereas MAiD can only be chosen by the patient themself (and the patient must have decision-making capacity), the same is not true for palliative sedation. Palliative sedation, a valuable modality of end-of-life care, does not have to be initiated by the patient. If the patient is deemed not to have decision-making capacity to make that decision, their healthcare proxy can decide to initiate the process and continue it until the patient dies. Individuals other than patients often choose to begin palliative sedation and continue it to its inevitable conclusion. And because palliative sedation does not require enabling legislation, none of the protective safeguards incorporated in MAiD legislation are available to protect those who receive palliative sedation. Some may try to differentiate between palliative sedation and MAiD by saying that once started, palliative sedation can always be discontinued – it need not end in the patient’s death. This is true, but the very process of palliative sedation will inevitably make the patient insensible or unconscious or otherwise unable to exercise a choice to stop sedation. With MAiD, the patient must self-administer and ingest the medication on their own, with death following quickly. The patient can choose to forgo MAID up until the very moment of self-administration. Considering MAiD’s procedural safeguards, including that only the patient may choose and administer MAiD, MAiD patients are offered more protection from potential abuse than patients who receive palliative sedation. While some have vocally opposed MAiD for decades, there has not been similar opposition to the option of voluntarily stopping eating and drinking (VSED). With VSED, adults with decision-making capacity make a voluntary decision to refuse nutrition and hydration to die more quickly. People choosing VSED are, essentially, making the same choice that people choosing MAiD do. But VSED is a less predictable process that takes much longer to complete. Unfortunately, the process also carries a risk of unpleasant side-effects, though proper care can help mitigate them. Additionally, the practice of VSED is not constrained by statutorily defined protective measures, as is the case with MAiD – one does not even need to have a terminal illness to choose VSED.[24] It is logically inconsistent for those who oppose MAiD because of the perceived potential of abuse to hold different views about VSED.[25] If malevolent actors can unethically pressure or coerce patients into MAiD, they can also coerce them to stop eating and drinking. As with palliative sedation, it could be argued that an important difference is that VSED can be stopped, unlike MAiD. This argument fails clinically and ethically. As with palliative sedation, the VSED process eventually results in the patient losing consciousness and decision-making capacity. The patient generally becomes unarousable for a period that could last for days or even weeks. For this reason, it is crucial for VSED patients to express their choice in writing (or preferably in video recording)[26] to ensure that they will not be given nutrition or hydration when they are no longer able to enforce their refusal (or if they begin asking for nutrition or hydration). Therefore, there is a period in which the patient cannot decide to end the process, just as with palliative sedation. To the extent that someone is so concerned with potential abuse of MAiD that they seek to ban it but have not expressed similar concerns with VSED, these positions are inconsistent. At a NYS Bar Association-sponsored conference on MAiD in 2019, David Hoffman asked a MAiD opponent whether, “as someone who is looking out for the interests of a segment of the disability population,” she supports palliative sedation and VSED.”[27] Kathryn Carroll, who represented the Center for Disability Rights (“CDR”), confirmed that CDR did not oppose palliative sedation and did not offer a position on VSED. She noted the subtle difference in intention: I don’t believe the Center for Disability Rights has taken issue with palliative sedation. And my understanding is that there is a key difference between palliative sedation and assisted suicide, particularly in that palliative sedation, the point is not to bring about the death of the person, but to relieve the pain that they are experiencing. And so the death is more of a side effect rather than the intended outcome.[28] During the questioning, she provided no explanation as to why the potential for abuse would be different among palliative sedation, VSED, and MAiD.[29] The other MAiD opponent on the panel, Dennis Vacco, of Vacco v. Quill[30] fame, interjected but could not explain any ethically significant difference between VSED and MAiD. Instead, he focused solely on palliative sedation, stating that the relevant difference is that palliative sedation can be stopped: . . . treating the pain including what you referred to as terminal sedation, is not moral and legally and ethnically the same as physician-assisted suicide . . . The fact of the matter is – the difference is you can terminate that treatment, and it’s the permanent aspect of physician-assisted suicide that goes back to what I said 20 minutes ago. You can’t put the bright line anyplace else other than where it is.[31] But, as discussed above, that difference is of little import, given that palliative sedation results in patients without the ability or capacity to make the choice to stop treatment. Vacco then reverted to his concerns about the potential for coercion and the elusive slippery slope, referencing his primary argument that the only way to ensure there is no abuse of a MAiD law is not to have one at all: The bright line that is created by the law in the state of New York, which makes physician-assisted suicide a manslaughter in the second-degree, or assisting suicide by anybody, manslaughter in the second degree . . . is unfortunately the only place that line can be. That line should not move further toward accommodation. And we see here in the context of . . . all of the so-called protections in the statute. With every protection that is not prohibition, with every protection, you raise the possibility of abuse. You raise the possibility with every protection.[32] Neither Vacco nor Carroll addressed the fact that many common practices today can be the result of coerced decisions. These practices have none of the safeguards contained in MAiD legislation. As another panelist, David Leven, stated: consider that people who want to have life-sustaining treatment withdrawn, whether it’s a ventilator or feeding tube, they can also be coerced by family members. That can happen even more often, of course, because that process takes place more and more often, and there are none of the safeguards that we’re talking about here . . . there are risks involved in any process which might result in a hastened death. But there seems to be very little risk involved with medical aid in dying based on the experience in 40 years and the nine states which now permit medical aid in dying.[33] There is an inescapable inconsistency within the disability argument: one cannot logically be so concerned about the abuse of legalized access to MAiD to justify opposing all MAiD legislation while simultaneously supporting options like palliative sedation or VSED as abuse-free alternatives. d. Argument Against Speaking for a Community with Diverse Views Finally, while some disability advocates opposing MAiD will claim terminally ill patients as part of their community, they have no right or authorization to speak for the extremely heterogeneous group of terminally ill patients or the disability community[34] as a whole. The disability community is not homogenous; while some members oppose MAiD, others support it.[35] Recent polling indicates that MAiD may have broad support across the disability community.[36] e. MAiD Opponents Hold the Rights of the Terminally Ill Subordinate to Their Personal Morality and Unsubstantiated Theoretical Concerns The argument that does not get much attention, the one that is the simplest and perhaps even the most compelling, is that all killing is wrong, and the government ought not to be in the business of enabling it. That is certainly a compelling religious and moral argument against individuals engaging in any form of acts that result in ending a human life. But such an ethical or theological position does not dictate that individuals who hold different views on personal morality should be precluded by the state from accessing the most safe, certain, and painless means of addressing an invariably terminal illness. Arguments like the one described above by Vacco (that the only way to completely avoid potential MAiD abuse is to prohibit MAiD) are essentially claiming that the safest thing to do is to subordinate the suffering of the terminally ill to avoid the more subtle task of balancing the interests of two different groups of New York state citizens. But surely, that is the role of the legislature every day. And we should expect no less from the legislature on this issue. The best way to ensure no one dies in car accidents is to prohibit driving. But instead of doing so, we implement safety regulations (like speed limits) to balance the right to travel with the right of everyone else not to be killed in the process. Evidence demonstrates that MAiD legislation can also strike a balance between the rights of the terminally ill and the need to prevent harm. It is not justifiable to support a blanket prohibition of MAiD. CONCLUSION Opponents of MAiD have had decades to cite problematic case studies or formulate a compelling moral argument against it that is grounded in data rather than an assertion of their personal morality. Plainly, no one on either side of the MAiD legislative discussion wants to see anyone subjected to involuntary euthanasia or coerced into MAiD as a better alternative to palliative care when such a plan of care is a viable alternative to “ending life care.” However, enough time has passed, and the risk of coercion has been given sufficient study and debate that we can now conclude, as a society, that the rights of the terminally ill and the rights of persons committed to living their best and longest life with a disability are wholly compatible. It is time for the legislature to strike the appropriate balance and give the terminally ill a well-regulated, responsible pathway to obtaining medication that can relieve their suffering in a manner that is safe, certain, and painless. - [1] Oregon’s Death with Dignity Act, Oregon Health Authority, https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/index.aspx [2] Elissa Kozlov et al., Aggregating 23 Years of Data on Medical Aid in Dying in the United States, 70 Journal of the American Geriatrics Society 3040 (2022). https://doi.org/10.1111/jgs.17925 [3] Medical Aid in Dying Act, A.995-A, N.Y. St. Assemb. (2023), available at https://legislation.nysenate.gov/pdf/bills/2023/A995A; see also, Medical Aid in Dying Act, S.2445-A, N.Y. St. Senate (2023), available at https://legislation.nysenate.gov/pdf/bills/2023/S2445A. [4] Id. [5] Ronald A. Lindsay, Oregon’s Experience: Evaluating the Record, 9 The American Journal of Bioethics 19 (2009), https://doi.org/10.1080/15265160802654137; Christopher A. Riddle, Medical Aid in Dying: The Case of Disability, in New Directions in the Ethics of Assisted Suicide and Euthanasia 234 (Michael Cholbi & Jukka Varelius eds., 2nd ed. 2023), https://doi.org/10.1007/978-3-031-25315-7; Health Law Section: Duties, Rights & the Law at the End of Life (2019), NY ST. BAR ASSOC. (Nov. 8, 2019), https://nysba.org/products/health-law-section-duties-rights-the-law-at-the-end-of-life-2019/; Medical Aid in Dying: Hearing on A.2383-A Before the New York State Assembly Standing Committee on Health (2018) (testimony of Arthur Caplan), transcript available at https://nystateassembly.granicus.com/DocumentViewer.php?file=nystateassembly_bc5bd4afc9fd8b9021781bc9e35e15ae.pdf&view=1; Fact: Medical Aid in Dying Laws Work to Protect Patients. (n.d.). Compassion & Choices. Retrieved September 5, 2023, from https://compassionandchoices.org/resource/fact-medical-aid-in-dying-laws-work-to-protect-patients; Frequently Asked Questions. (2021, December 7). Death With Dignity. https://deathwithdignity.org/resources/faqs/. [6] Bob Joondeph, Letter from Disability Rights Oregon (DRO), Compassion & Choices (Feb. 14, 2019), https://www.compassionandchoices.org/docs/default-source/default-document-library/disability-rights-oregon-dwd-letter-2-14-19.pdf. [7] Elissa Kozlov et al., Aggregating 23 Years of Data on Medical Aid in Dying in the United States, 70 Journal of the American Geriatrics Society 3040 (2022). https://doi.org/10.1111/jgs.17925 [8] Id. [9] Medical Aid in Dying: Act 39: Patient Choice and Control at the End of Life, Vermont Ethics Network, https://vtethicsnetwork.org/palliative-and-end-of-life-care/medical-aid-in-dying-act-39 (last visited Sept. 21, 2023). [10] Gideonse v. Brown, No. 3:21-cv-01568-AC (D. Or.); Bluestein v. Scott, No. 2:22-cv-00160 (D. Vt.). [11] Govatos v. Murphy, No. 2:23-cv-12601(D.N.J.). [12] Medical associations, historically opponents of MAiD, have begun adopting neutral positions, reflecting changing attitudes of the medical community. E.g., California Medical Association removes opposition to physician aid in dying bill, California Medical Association (May 20, 2015), https://www.cmadocs.org/newsroom/news/view/ArticleId/27210/California-Medical-Association-removes-opposition-to-physician-aid-in-dying-bill; Board directs CMS to develop and distribute “End-of-Life Act” education to members, Colorado Medical Society (November 22, 2016), https://www.cms.org/articles/board-directs-cms-to-develop-and-distribute-end-of-life-act-education-to-me; Vermont Medical Society Policy on End-of-life-Care, Vermont Medical Society (2017), https://vtmd.org/client_media/files/vms_resolutions/2017End-of-Life-Care.pdf (last accessed Sept. 21, 2023); but see Physician-Assisted Suicide, AMA Code of Ethics, https://code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide. (5.7 provides opinion opposing MAiD; opinion 1.1.7 provides opinion on conscientious objection.); The American Medical Association could vote to change its stance on medical aid in dying, Death with Dignity (Nov. 10, 2023), https://deathwithdignity.org/news/2023/11/ama-could-vote-to-change-stance-on-maid/ (Update notes that the AMA did not change its stance from opposed to neutral at its November 2023 interim meeting in Baltimore, but referred the resolutions for further study). [13] Medical Aid in Dying: Hearing on A.2383-A Before the New York State Assembly Standing Committee on Health (2018) (testimony of Arthur Caplan), transcript available at https://nystateassembly.granicus.com/DocumentViewer.php?file=nystateassembly_bc5bd4afc9fd8b9021781bc9e35e15ae.pdf&view=1. [14] Id. [15] Id. [16] Id. (noting the laws in Netherlands, Belgium and Canada.); see also National Council on Disability, The danger of assisted suicide laws: Part of the Bioethics and Disability series (2019). https://ncd.gov/sites/default/files/NCD_Assisted_Suicide_Report_508.pdf. [17] Sean Riley & Ben Sarbey, The unexamined benefits of the expansive legalization of medical assistance-in-dying, 19 J. Bioethical Inquiry 4, 663 (2022) (citing Oregon Health Authority Center for Health Statistics, Oregon Death with Dignity Act: 2018 Data Summary (2019), https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf and R. Sean Morrison, et al., America’s care of serious illness: A state-by-state report card on access to palliative care in our nation’s hospitals, 14 J. Palliat. Med. 10, 1094–1096 (2011)). [18] Medical Aid in Dying Act, A.995-A, N.Y. St. Assembly. (2023), available at https://legislation.nysenate.gov/pdf/bills/2023/A995A [19] See also, Ben Colburn, Disability‐based Arguments against Assisted Dying Laws, 36 Bioethics 680 (2022) (cataloging research in multiple countries and concluding that “there is no evidence that assisted dying laws have a disproportionate effect on people with disabilities”). https://doi.org/10.1111/bioe.13036 [20] Eyder Peralta, As Planned, Right-To-Die Advocate Brittany Maynard Ends Her Life, NPR (Apr. 3, 2014), https://www.npr.org/sections/thetwo-way/2014/11/03/361094919/as-planned-right-to-die-advocate-brittany-maynard-ends-her-life (Activist Brittany Maynard moved to Oregon after she was diagnosed with a malignant brain tumor, because her home state did not permit MAiD at the time). [21] Ending life care is defined as the final stage of the end-of-life care continuum, where the patient chooses to end their life as a means to end their suffering or unacceptable quality of life. [22] Palliative sedation is defined as “the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life,” and it carries a risk of hastening death. Molly L. Olsen, Keith M. Swetz & Paul S. Mueller, Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments, 85 Mayo Clin Proc 949 (2010). https://doi.org/10.4065/mcp.2010.0201 [23] E.g. Disability Rights Toolkit for Advocacy Against Legalization of Assisted Suicide, Not Dead Yet, https://notdeadyet.org/disability-rights-toolkit-for-advocacy-against-legalization-of-assisted-suicide (last visited Dec. 8, 2023) (describing palliative sedation as “a legal solution to any remaining painful and uncomfortable deaths; one that does not raise the very serious hazards of legalizing assisted suicide”); Testimony of CDR’s Kathryn Carroll, Esq. Opposing NY Assisted Suicide Bill A2383A, Not Dead Yet (Apr. 23, 2018), https://notdeadyet.org/testimony-of-cdrs-kathryn-carroll-esq-opposing-ny-assisted-suicide-bill-a2383a. [24] Voluntarily Stopping Eating and Drinking: A Compassionate, Widely-Available Option for Hastening Death, (Timothy E. Quill et al. eds., 2021). https://doi.org/10.1093/med/9780190080730.001.0001 [25] This is not to say that MAiD and VSED are ethically identical. Different writers have articulated various reasons why MAiD and VSED are meaningfully different and meaningfully similar. Here we distinguish the potential for abuse, as this is the argument that persists among MAiD opponents, For a broader discussion on the ethics of VSED and how it compares to MAiD, see Voluntarily Stopping Eating and Drinking: A Compassionate, Widely-Available Option for Hastening Death, (Timothy E. Quill et al. eds., 2021). https://doi.org/10.1093/med/9780190080730.001.0001 [26] Id.; see also David N. Hoffman and Judy Schwarz, Can Patients Choose to Stop Eating–Even If They Have Dementia–and Can Health Care Facilities Get Paid for Taking Care of Them? Ethics and Reimbursement at the End of Life (Am. Health L. Ass’n Conf. on Long Term Care and the Law 2020). [27] Health Law Section: Duties, Rights & the Law at the End of Life (2019), NY St. Bar Assoc. (Nov. 8, 2019), https://nysba.org/products/health-law-section-duties-rights-the-law-at-the-end-of-life-2019/. [28] Id. [29] CDR still does not appear to have articulated a position on VSED. CDR is a major and vocal opponent of MAiD legislation in NY with considerable resources (they state their projected 2010 budget was approximately $29,000,000). About Us, Center for Disability Rights, https://cdrnys.org/about/. [30] Vacco v. Quill, 521 U.S. 793 (1997) (holding that there is no equal protection violation when N.Y. law criminalized assisted-suicide but permitted removal of life-support systems). [31] Health Law Section: Duties, Rights & the Law at the End of Life (2019), supra note 5. [32] Id. [33] Id. [34] Ben Colburn, Disability‐based Arguments against Assisted Dying Laws, 36 Bioethics 680 (2022) (providing evidence that “that people with disabilities, and disability rights organizations, have diverse views on the question of whether assisted dying should be legal”). https://doi.org/10.1111/bioe.13036 [35] Us for Autonomy, https://www.usforautonomy.org (last visited Sep 10, 2023); see also, Kathryn L. Tucker, Building Bridges Between the Civil Rights Movements of People with Disabilities and Those with Terminal Illness, 78 U. of Pitt. L. Rev. 329 (2017) (collecting and describing amici participation by disability advocates supporting end-of-life liberty). https://doi.org/10.5195/lawreview.2017.473 [36] E.g., USA/National Public Opinion Survey, Susquehanna Polling & Research, Inc. (Feb. 2023),https://d31hzlhk6di2h5.cloudfront.net/20230307/2e/9e/21/14/d37db7887f3f349202ae6f31/Raben_Crosstabulation_Report_2023.FINAL%20(1).pdf ).

Herseyet alhave outlined a proposed ethical framework for assessing abortion policies that locates the effect of government legislation between the provider and the patient, emphasising its influence on interactions between them. They claim that their framework offers an alternative to the personal moral claims that lie behind legislation restricting abortion access. However, they fail to observe that their own understanding of reproductive justice and the principles of medical ethics are similarly predicated on their individual moral beliefs. Consequently, the conclusions obtained from their framework are also derived from their individual beliefs, and have no claim to being objective.

Most states have adopted conscience clauses since the Roe v. Wade paradigm in the 1970s; however, not all clauses are respective to pharmacists. The purpose of this report is to quantify the presence of conscientious objection among US states with respect to pharmacist’s right to refuse to dispense. Fifty Boards of Pharmacy administrative codes were consulted for review. If Web sites were ambiguous or undeterminable, E-mail requests were sent on active legislation per National Association of Boards of Pharmacy contact information. Eleven states have conscience clauses present in their pharmacy administrative code—nearly double than last published in 2006. Requirements vary throughout the states including drug-specific limitations, requirement in writing, or notification in advance. Some states alternatively require duty to dispense. Less than one-fourth of United States boards of pharmacy provide a conscience clause or similar intended language in laws or policies. Within those states, pharmacists have a right to refuse to perform certain services based on religious, ethical, or moral objections. Imprecise language throughout the nation allows the rights to vary widely.

About 6% of women in the world live in countries that ban all abortions, and 34% in countries that only allow abortion to preserve maternal life or health. In the USA, over the last decades—even before Dobbs v. Jackson Women’s Health Organization overturned the federal right to abortion—various states have sought to restrict abortion access. Often times, this legislation has been advanced based on legislators’ personal moral values. At the bedside, in contrast, provision of abortion care should adhere to the normative principles of medical ethics and reproductive justice, centreing patients and their individual reproductive intentions and desires. Abortion regulations, through their influence on patients and providers, may facilitate or impede such ethical care at the bedside. In this paper, we present a framework to model how abortion legislation should fit into the patient–provider relationship and to clarify the dynamics by which legislation may affect healthcare encounters. Our proposed framework serves as a tool to analyse the ethical impact of abortion regulations. We propose a model for assessing abortion policies based not on legislators’ or advocates’ individual moral claims, but on the shared, normative framework of clinical medical ethics. Through contrasting case studies, we demonstrate how a robust normative ethical framework can recentre patients and their reproductive needs. Our model is one way to account for—and safeguard—patients’ diverse viewpoints and needs in the development of abortion policy, and it can serve to ground narratives for advocacy by healthcare workers and their professional organisations.

Many state laws specify procedures for determining surrogate or proxy decision-makers for end-of-life care in the absence of an advance directive, living will, or other designation. Some laws also set forth criteria that the decision-maker must follow when making medical decisions for an incapacitated patient and determining whether to withdraw life-sustaining treatment. This article provides analysis of a medical ethics case on the question of how to address family allegations that the proxy decision-maker suffers from dementia and is unable to make decisions for the patient. Cases such as this involve interwoven legal and ethical considerations including: how to address concerns that the proxy is making questionable or unreasonable decisions, how to evaluate the proxy's decisional capacity, strategies for enhancing communication, and standards for removing a proxy. This article suggests that “surrogacy ladders” in state law serve not only as a procedural mechanism, but also protect important ethical values such as tiers of moral authority for decision-making, relational autonomy, and privacy.

Abstract Background The Constitutional Court of South Korea declared that an abortion ban was unconstitutional on April 11, 2019. The National Health Care System will provide abortion care across the country as a formal medical service. Conscientious objection is an issue raised during the construction of legal reforms. Methods One hundred sixty-seven perioperative nurses responded to the survey questionnaire. Nurses’ perception about conscientious objection, support of legislation regarding conscientious objection, and intention to object were measured. Logistic regression was used to explore the factors associated with support of the legislation and the intention to conscientiously object. Results Only 28.8% of the responding nurses were aware of health care professionals’ conscientious objection. The majority (68.7%) felt that patients’ rights should be prioritized over health care professionals’ conscientious objection. On the other hand, 45.8% supported the legislation on conscientious objection to abortion, and 42.5% indicated a willingness to refuse to participate in an abortion case if conscientious objection was permitted. Religion, awareness of conscientious objection, and prioritizing of nurses’ right to conscientious objection were significantly associated with supporting the legislation. Moreover, religion and prioritizing nurses' rights were significantly associated with the intention to conscientiously object. Conclusions This study provides information necessary for further discussion of nurses’ conscientious objection. Nursing leaders, researchers, and educators should appeal to nurses and involve them in making policies that balance a women's right to non-discrimination and to receiving appropriate care with nurses' rights to maintain their moral integrity without compromising their professional obligation.

According to the traditional Judeo-Christian moral and ethical standards, which conceive of sex in purely functional terms, i.e., for the purpose of procreation only. Now days the legislation criminalizing consensual oral and anal sex is outdated and has no place in modern society. By criminalizing private, consensual same-sex conduct, some countries in the world’s penal laws serves as the weapon for police abuse; detaining and questioning, extortion, harassment, forced sex, payment of hush money; and perpetuates negative and discriminatory beliefs towards same-sex relations and sexuality minorities. This sodomy laws thus creates a class of vulnerable people that is continually victimized and directly affected by the provision as well as sexuality minorities. The inalienable component of right to life, the pursuit of happiness encompassed within the concepts of privacy, human dignity, individual autonomy and the human need for an intimate personal sphere require that privacy dignity claim concerning private, consensual, sexual relations are also afforded protection within the ambit of the said fundamental right to life and liberty. There is almost unanimous medical and psychiatric opinion that homosexuality is not a disease or a disorder and is just another expression of human sexuality.

Objective To develop an ethically, legally, and clinically appropriate ventilator allocation policy for AdventHealth Tampa and AdventHealth Carrollwood in Tampa, Florida, which could be enacted swiftly during the Covid-19 pandemic. Methods During Spring 2020, a subcommittee of the Medical Ethics Committee established consensus on the fundamental principles of the policy, then built on existing ethical, legal, and clinical guidance. Results The plan was finalized in May 2020. The plan triages patients based on exclusion criteria (imminent mortality), prognosis and expected benefit of ventilation (using the Sequential Organ Failure Assessment), and change in prognosis over time. Decisions are made by committee in order to minimize moral distress among individual patient care providers. Conclusions Due to international concerns about healthcare resource shortages during the Covid-19 pandemic, hospitals need allocation policies informed by the crisis standard of care, the hospital’s ethical duty to plan for an emergency, and federal civil rights laws Policy Implications: This type of policy can serve as a model for other institutions to develop crisis standards of care resource allocation policies, which are a necessary component of disaster planning.

Abstract Background When rationing health care, a commonly held view among ethicists is that there is no ethical difference between withdrawing or withholding medical treatments. In reality, this view does not generally seem to be supported by practicians nor in legislation practices, by for example adding a ‘grandfather clause’ when rejecting a new treatment for lacking cost-effectiveness. Due to this discrepancy, our objective was to explore physicians’ and patient organization representatives’ experiences- and perceptions of withdrawing and withholding treatments in rationing situations of relative scarcity. Methods Fourteen semi-structured interviews were conducted in Sweden with physicians and patient organization representatives, thematic analysis was used. Results Participants commonly express internally inconsistent views regarding if withdrawing or withholding medical treatments should be deemed as ethically equivalent. Participants express that in terms of patients’ need for treatment (e.g., the treatment’s effectiveness and the patient’s medical condition) withholding and withdrawing should be deemed ethically equivalent. However, in terms of prognostic differences, and the patient-physician relation and communication, there is a clear discrepancy which carry a moral significance and ultimately makes withdrawing psychologically difficult for both physicians and patients, and politically difficult for policy makers. Conclusions We conclude that the distinction between withdrawing and withholding treatment as unified concepts is a simplification of a more complex situation, where different factors related differently to these two concepts. Following this, possible policy solutions are discussed for how to resolve this experienced moral difference by practitioners and ease withdrawing treatments due to health care rationing. Such solutions could be to have agreements between the physician and patient about potential future treatment withdrawals, to evaluate the treatment’s effect, and to provide guidelines on a national level.

Patient autonomy is one of the four pillars of modern medical ethics. In some cases, however, its value is not absolute and autonomy may be overridden by sufficiently important matters of public interest. Coroner’s autopsies represent an example of when the wishes of the deceased and their family may come in conflict with the benefits of knowledge gained from understanding the cause of death. Current legislation governing coroner’s autopsies relies on the assumption of their obvious public benefit, hence consent for them need not be sought. This interpretation has attracted controversy, as exemplified by the case of Rotsztein vs HM Senior Coroner and a recent study questioning the prevalent use of invasive autopsy. However, this issue has received little recent attention in ethical literature. In this essay, the ethical nature of coroner’s autopsies in cases of natural deaths with unexplained causes is examined as a balance between patient autonomy and the value of knowledge gained from them. This is done by analysing a case which under current legislation warrants coroner’s autopsy, however, its ethical justification remains contentious. This discussion is expanded by discussion of non-invasive alternatives and comparison to another situation which balances individual autonomy with public benefits—organ donation. The conclusion of this analysis is a moral middle ground in which objection to invasive autopsy could be respected once issues of overriding public interest are excluded, or at least non-invasive alternatives should be considered, with coroners left responsible for demonstrating specific public needs that could override objection.