Rafał Patryn

Vaccinations-Between free will and coercion.

ABSTRACT Dynamically changing social situation associated with migrations, increasing freedom rights, popularity of anti-vaccine movements and the resulting from that decrease in herd immunity, forces the medical society and the governments of various countries to reflect on the attitude toward vaccinations. Issues of freedoms and self-determination frequently do not accept any medical coercion in case of prophylactic vaccinations, however, recent waves of epidemics revealed that there is a necessity for undertaking strict legal actions to encourage vaccinations. After analyzing various legal approaches toward vaccinations we believe that personal coercion in case of vaccination refusal has too far reaching sanctions and propose the possibility of balancing the right to autonomy and the medical coercion. We postulate that vaccination refusal should be equivalent with covering frequently high medical costs in case of infection, The threat of financing medical treatment should influence the decision making process of those opposing vaccinations simultaneously respecting their rights not too get vaccinated.

Current state of corneal transplants in Poland

Avitabile T, Castiglione F & Bonfiglio V (2010): Transconjunctival sutureless 25gauge versus 20-gauge standard vitrectomy: correlation between corneal topography and ultrasound biomicroscopy measurements of sclerotomy sites. Cornea 29: 19–25. Christensen UC, Kroyer K, Sander B, Larsen M, Henning V, Villumsen J & la Cour M (2009): Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial. Br J Ophthalmol 93: 1005–1015. Emanuelli A, Garcia-Gonzalez JM, Berrocal MH & Flynn HW Jr (2012): Minimal refractive change induced by sutureless 23and 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging 43: 94–96. Hamoudi H & La Cour M (2013): Refractive changes after vitrectomy and phacovitrectomy for macular hole and epiretinal membrane. J Cataract Refract Surg 39: 942–947. Hamoudi H, Kofod M & La Cour M (2013): Refractive change after vitrectomy for epiretinal membrane in pseudophakic eyes. Acta Ophthalmol 91: 434–436.

Vaccination refusal. Autonomy and permitted coercion

Abstract The article presents vaccination obligation in relation to the existing or newly enacted legislation. Mass vaccinations and a wave of criticism they cause, forces us to reflect on the limits of medical intervention in the human body and the boundaries granted to individual’s freedom and autonomy. This problem is universal and exists mainly in countries without mandatory vaccinations. Analyzing recent years, it must be underlined that a process in some legislatures has been introduced to enforce various forms of vaccination coercion. Although, refusing vaccinations has been treated liberally, the last wave of epidemics in the United States and Europe forced the creation of a different approach. Gradually in the USA, a duty (not a ‘coercion’) of vaccination is being enforced. Occurring epidemics, (e.g. measles) and dangers resulting from them, force authorities to violate the principle of autonomy and restrict individuals’ freedoms regarding their own body. The article presents legal solutions relating to vaccinations in the United States and Europe i.e. administrative decisions imposing vaccinations, solutions conditioning social existence and financial penalties for not complying with this obligation and proposes a solution based on financial liability that will balance out patients’ autonomy and public security.

Epidemiology and the legal basis for corneal transplants in Poland

The article aims at presenting a legal basis for corneal transplantation — the most frequently conducted transplantation procedure in Poland. Applicable rules and regulations concerning transplantation can be found in the Cell, Tissue, and Organ Recovery, Storage, and Transplantation Act of July 1, 2005 and the Regulation of the Minister of Health of December 4, 2009 on detailed conditions of removal, preservation, and transplantation of cells, tissues, and organs. However, the scope and content of the above legislation does not directly refer to corneal transplantation, neither in concept nor description, which may lead to certain misinterpretations and ambiguity of information as to the adopted rules of corneal removal, transplantation and the existing formal solutions (documentation, or rules for obtaining consent). The article refers to a very important legal principle — omnia sunt interpretanda — which in practice obliges the description and proper interpretation of the legal rules pertaining in this content to such procedures. In terms of legalisation it is possible to find only norms concerning the possibility of obtaining and transplanting corneas, entities which can conduct such procedures (after obtaining the consent of the Ministry of Health), and information on the scope of the so-called presumed consent that is one of the basic legal mechanisms allowing tissue procurement from deceased donors. The summary is a synthetic and comprehensive presentation of current knowledge and the legal situation of corneal transplantation, which can prove useful in an appropriate interpretation of legal standards regarding such procedures.

Decisions on the type and range of care services for the purposes of court proceedings

Abstract Article 4, (1) Act of 15 July 2011 on the Professions of Nurse and Midwife specifies that the profession of a nurse encompasses providing health services. Point 6 specifies the kind and scope of attendance benefits, both for the patient and the care provider. It needs emphasizing that there is a statutory possibility of determining these benefits by nurses, understood as an opportunity to express a professional opinion related to specialized professional activities. This very study will both present and discuss an opinion that was created as a reference to the quoted article. The opinion is related to the scope, types and methods of performing nursing activities for the patient-plaintiff looking to receive a compensation from a healthcare entity. The document created during the process was used by the general court in the pending civil proceeding. The description that was created took the form of an established standard of care. It defines the specificity, tasks and the amount of time that every nurse needs to spend caring for a patient who is bed-bound. The opinion was created to be used during court proceedings and can be applied to similar cases. This may establish it as a source of medical knowledge in case of recommended and desired scope care exercised by nurses, physiotherapists and paramedics.

Biobanks and consent with a terminal clause

To the Editor: We have read with great interest the article “A Systematic Literature Review of Individuals’ Perspectives on Broad Consent and Data Sharing in the United States,” by Garrison et al.1 We believe that the emergence of biobanks requires an introduction of appropriate legal and ethical norms for their functioning. One of the basic and primary requirements for the storage and usage of the genetic material is donor’s consent. The issue of consent has already been broadly debated and is analyzed in Garrison and colleagues’ article; however, we would like to stress a matter that seems to be underestimated and even unnoticed in terms of consent: time restrictions. Time restrictions, to a great extent, organize and clarify the already existing legal principles and may ultimately prove crucial in the functioning of biobanks as one of the factors affecting willingness to give consent for genetic research. Various models of consent function in the legislature (e.g., implied, proxy, authorized, dynamic), but none, including the basic broad consent for biobank research, indicates time limitations.2 We believe that consent (independent of the type) should always include a time aspect—in this case, information on how long the genetic material will be stored and what will happen to the material after the established time passes. Lack of such a provision in the consent form is equivalent to providing incomplete information. Additionally, because it is difficult to predict what will be allowed and possible in the distant future, donors are uncertain of possible future applications and benefits (e.g., being entitled to property rights in case of commercial use of the genetic material). The absence of precise solutions regarding the terminal application of stored genetic material may lead to the disrespect of the donors’ subjectivity, misinterpretation of the rules governing storage of the genetic material, and possible claims statements. Failure to determine the storage time causes the donor to lack information about the following:

Letter to the Editor: Medicolegal Sidebar: Informed Consent in the Information Age

To the Editor, We read with interest the Medicolegal Sidebar column on obtaining informed consent in the information age. We agree with the legal doctrine of informed consent, where a doctor must provide enough information to help the patient make enlightened healthcare choices. Yet physicians frequently omit certain steps in obtaining informed consent. For instance, they often provide insufficient information on harms and risks, do not check if patients understand the provided information, or even ask the nursing staff to obtain the consent for them. Consequently, the patients’ outlook or expectations regarding a treatment method may be distorted. We have a proposal for improving the process. We would emphasize the importance of how consent is obtained (either on a video, recorded, or in writing). By doing so, we would place more responsibility on the physician and his or her obligation of providing the necessary information and receiving a valid, effective, and informed consent from the patient. It is the physician’s job to confirm that the patient comprehends what has been presented. But taking into consideration a patient who is going through an emotional breakdown caused by a progressive disease, it is difficult to expect him or her to make treatment choices based on reading intricate and extensive forms, analyzing words and phrases, or asking questions. Here, the question of whether the patient is actually capable of making such a decision comes into play. In many cases, the patient is not informed even though, from a medical perspective, the patient has the capacity to make a decision. The burden of this process should be placed on the physician, who is legally obliged to provide the patient with information and answer any questions or doubts. Only after everything is clear to the patient does the physician have the right to ask for consent, to which the patient can agree or disagree. We understand that this proposal requiring a written, audio, or video recording of the information “transaction” between the physician and the patient places an additional burden on the physician. But we feel strongly that by doing so, the physician will be obtaining consent from a more-informed patient.