CI Ingles 2023-2024 PDF

• the cause of these conflicts or claims of patients against the professional are they are many and varied ….diverse: • 1-. The right of patients • 2-.the rights of the health professional • 3-. the relationships between ethics and the law 4-The coexistence between public health system and private h...

• the cause of these conflicts or claims of patients against the professional are they are many and varied ….diverse: • 1-. The right of patients • 2-.the rights of the health professional • 3-. the relationships between ethics and the law 4-The coexistence between public health system and private health • 4-.The differentiation between legal and illegal benefits and Among the illegal ones, those that are a health crime….different with dad praxis • sometimes the health professional …dentist physiotherapist odontologist ..LIVES difficult situations to solve with ethical problems and legal problems: • sometimes the legal solution and the ethical solution IS NOT SIMILAR…NO …coincide, • FOR EXAMPLE: • the ethics may be less permissive than the law, for example in the case of abortion: • we can consider abortion is amoral…. YOU ARE again abortion …and the law allows abortion:…. in these example in which ethics is less permissive than abortion there is a a right of the health professional: • right of conscientious objection of or conscience of the health professional • THE HEALTH PROFESSIONAL can claim that: • In the right to conscientious objection, the health professional can refuse to carry out certain legal health practices • • the relationships between health professionals, the health center and patients can generate or exist conflicts and criminal or civil responsibilities • It is necessary ANALYZED OR STUDY THE CAUSES AND THE ORIGIN OF THESE CONCLICTS • Despite scientific and technological advances in the diagnosis and treatment of diseases, the percentage of complaints due to malpractice has increased dramatically in recent years. • Do Professionals make more mistakes now than before?????....No This does not mean that THE SANITARY professionals MAKE more mistakes or, in other words, that they cause more damage Increase in claims occurs because the rights of patients have been increased and for other causes that we will study now • EX: but also in the field of a possible health activity results, the patient could claim when the agreed result is not obtained EVEN, IN THOSE SITUATIONS IN WHICH there is good practice or correct sanitary technique. • due to reckless actions, but rather that this is due to Increase in claims occurs because such as: • Increase in claims occurs because Increase in claims occurs because • conscience OBJECTION: • the health professional can refuse to carry out a legal health practice that he considers amoral • it must be clarified that not all health PRAxis generate the right to conscientious objection.. • IN SPAIN ONLY IN abortion if it is allowed, however … • the pharmacists”, CHEMIST” claimed the right to conscientious objection to not (sell)supplying the morning-after pill or postcoital pill …because they considered it to be abortive, the Supreme Court has considered that this right could not be claimed because….. • the pharmacy is a private establishment that provides a public pharmaceutical service The responsibility of the healthcare professional appears when there is a bad technique and when the rights of patients are not respect • -.The responsibility to compensate the patient can arise even if there is good technic Why?? • The health professional must carry out a correct sanitary technique and ... also respect the rights of patients . • The obligation to compensate the patient may appear even when there is good tecnics • In Spain there is a long list of patient rights that generate or imply a large number of obligations on healthcare professionals and, even on entities or institutions that provide healthcare. •Autonomy of the patient informed consent power to decide paternalistic protective system of autonomy will.. the decision The change that the health system TEN YEARS AGO, WE CAN OBSERV: • essentially paternalistic system: • (in which the professional made decisions that are now attributed to the patient), • Now we can Observe appreciate a system based on the patient's power to decide (principle of autonomy). • The health system in Spain has changed: • it has gone from an essentially protective paternalistic …to a system to a system in which the patient has a leading position • It has gone from a protectionist system to a system of autonomy of the will: • we currently have a system in which the patient plays a leading role we currently have a system where the patient has a great role he old axiom was: • "Everything for the patient, but without the patient" It has lost prominence, in such a way that the current health system focuses its attention on protecting the patient's decision, which must be preceded by information that requires conditions whose nonobservance generates the obligation to compensate despite the fact that there is good health technique. • Indeed, in effect, • One of the main rights of patients in is the right to be informed in a legal way that is required by law: For this reason, it is necessary for health professionals to know: • It is necessary to answer about the following questions: Because Informed consent in Spain has many requirements: • 1-.-How old must the patient be to give valid consent?? • –What is the health majority age? • what happens with the patient with dementia….minor???? -.How old must the patient be to be able to receive health information and … give consent to be treated?• 2-.and what is the legal form in which the patient can give this consent??: • 3-.Content: the patient must be informed about: What is the content….extent of the information we give the patient???? How much information should be given to the patient • There is a minimum content of information that must be provided to the patientrbal or written form??? Another origin ….cause or element that has influenced the increase in claims for health damages • The cause or element that there is noise in the increase in claims • in Spain there are Legal health benefits)sanitary treatment) and illegal health benefits… • within the legal health benefits we must know that there are some that are treatment financed by the public health National Health System and others that are not financed by SNS • within the illegal benefits we have to know that there are some that constitute malpractice but not a crime punishable by imprisonment and health benefits are very serious or are considered very serious from the legal point of view that it is the socalled health crimes financed cost free for patient ???? Legal no financed…who bears the cost of healthcare and pharmaceutical services??? who pays assumes the obligation to pay ????? bad praxis…no prison • Illegal • • s Sanitary crimen legal • variety of legal and illegal health benefits or treatments financed by public health • • • • not financed some….. illegal practices in Spain that can be carried out abroad….. in countries where that health practice is legal …surrogacy: in which a Spaniard can contract a surrogacy in a country where this practice is legal with certain requirements and achieve legal effects in Spain, that is, to be able to register their child in the Civil Registry with their surnames legal no financed total or financed with some requirement::growth hormone:I n growth hormone if it is financed by the public outlet but with certain requirements it is required that there be a report from the Commission on growth hormone and the Commission on rare diseases indicating that this hormone will be and will have effects of growth in the patient Illegal • definition of malpractice and definition of sanitary crime malpractice does not carry a prison sentence, however the sanitary crime has a prison sentence the question is : • who decides when we are facing a sanitary crime?????? • in Spain is the Penal Code (there`s written text with the level of Organic Law that is approved by an absolute majority … • the Penal Code describes what behaviors are or constitute a crime::penalty or prison sentence • ………outside of the Penal Code there is no crime………… • that decides which sanitary practices are legal and which sanitary proxies are illegal crimen(sanction punishment deprivation of liberty :prison) as a summary and mainly anticipating sanitary crimes are murder, homicide, and miscarriage, crime of disclosure of secrets, omission duty of relief and manipulation the judge therefore cannot consider criminal an activity that is not described in the Penal Code Malpractice DIFFERENTSANITARY CRIMES Inside illegal practices we must distinguish malpractice from crimes or health crimes:Malpractice supposes not respecting the lex artis ad HoC . the lex artis aD HOC: good technic and…respect patient right supposes the set of duties that the health professional must observe, while ……………………… health crimes can carry a prison sentence This is what is called loss of opportunity, you can perform(make) a good physiotherapeutic technique, dentistry, medical, pharmacology, but if you do not respect the right of the patient, for example, to be informed, he can be sentenced for what is called loss of opportunity, jurisprudence establishes that there is loss of the opportunity on the part of the patient when you do not inform him of all the possible , it is risks of each therapeutic alternative necessary to inform the patient of the therapeutic alternatives and of the risks, advantages and disadvantages of each alternative of health treatment or each alternative …..will be obligation to pay if………….. is an alternative risks occurs…. even with good practice with good technique the obligation to compensate is generated for: what is called loss of opportunity if you had informed me of the risk maybe I would not have chosen that therapeutic alternative • called loss of opportunity, • There are adverse risks that can occur even if there is good I have Sanitas if I do not report these risks the obligation to compensate is generated The sanitary crime is a bad practice that the Penal Code considers more serious and therefore punishes it with a prison sentence or limiting the rights of the author of the crime WHO DECIDE ?? Who decides when an action is a health crime.......? The Penal Code describes which actions or which sanitary practices are SANITARY CRIME….. therefore the judge must apply the Penal Code …The Judge cannot punish a certain sanitary aCTION as a crime if the Penal Code does not establish it in this way …f For example:……….the judge cannot punish abortion as a crime if the Spanish Penal Code does not consider abortion as a crime another circumstance to take into account is: -All this becomes a little more complicated when, --in the study of illegal sanitary practices, the so-called sanitary crimes must be analyzed (crime of intrusion, disclosure of Secrets, euthanasia, surrogacy, serious injuries ...). that make --it essential to study new Jurisprudential criteria. -To the described health care context, we must add the existence of health services (treatments) that, despite being illegal in Spain (even criminal). Spanish citizens can hire or receive them in countries where these treatments are legal AND , NOT ONLY can be carried out in THIS country AND despite THIS TREATMENTS can have civil effects in Spain. -This currently occurs in the so-called surrogacy ,( despite being illegal in Spain), a Spanish citizen can hire it in a country where it is legalized and get legal effects of filiation in Spain and even Social Security rights, such as rest by maternity that is recognized, even Spanish single-parent families (intended parents) who bring a baby to Spain by surrogacy and manage to register it in the Spanish Civil Registry as a legal child for all legal purposes. another circumstance to take into account is: -All this becomes a little more complicated when, --in the study of illegal sanitary practices, the so-called sanitary crimes must be analyzed (crime of intrusion, disclosure of Secrets, euthanasia, surrogacy, serious injuries ...). that make --it essential to study new Jurisprudential criteria. -To the described health care context, we must add the existence of health services (treatments) that, despite being illegal in Spain (even criminal). Spanish citizens can hire or receive them in countries where these treatments are legal AND , NOT ONLY can be carried out in THIS country AND despite THIS TREATMENTS can have civil effects in Spain. -This currently occurs in the so-called surrogacy ,( despite being illegal in Spain), a Spanish citizen can hire it in a country where it is legalized and get legal effects of filiation in Spain and even Social Security rights, such as rest by maternity that is recognized, even Spanish single-parent families (intended parents) who bring a baby to Spain by surrogacy and manage to register it in the Spanish Civil Registry as a legal child for all legal purposes. •Free…. Paid????? • Our normative System -legal Sistem- of Health Legislation not only describes the LEGAL (and ILLEGAL) SANITARY PRAXIS, but, within the socalled legal, we must analyze the existing differentiation between those that are financed by the National Health System (free) and those that must be paid by the patient. Within the legal sanitary treatment -health benefits-, it is necessary to analyze and distinguish between: • In the Spanish health system, it is necessary to analyze and differentiate(differentiate analyze and study) between • The public health system: • -free treatments (in which the patient does not have the obligation to pay a price) • -- free of charge (free of payment //pay no price))for the patient. • --entity that pays(COSTED FINANCED THE TREATMENTS) is the state or autonomous assume the cost or expense and the private health system • -• that are not financed or paid for by the public health system • .-Coexistence between the public health system and private SANITARY system:THE BENEFITS OR SANITARY TREATMEN OR HEALTH TREATMENTS • • • • • • CAN BE LEGAL ILLEGAL: SUBROGATED GESTATION: LEGAL EFFECTS IN SPAIN ARE RECOGNIZED / WHEN A SPANISH HIRES A WINTER FOR RENT IN A COUNTRY WHERE IS LEGAL // LEGALS WITH CERTAIN REQUIREMENTS WITHIN THE TREATMENTS WITHIN THE LEGALS MAY BE FINANCED BY PUBLIC HEALTH OR CITIZENS………….PARTIALLY FREE • This generates the need for us to know, albeit in a basic way, what is called the portfolio of benefits financed by the Spanish Public Health System and, those called: • "Reimbursement of health expenses". • These are characterized by the need generated in the patient who must resort to private healthcare when there are certain circumstances such as: • Unjustified denial and / or vital urgency •Requirements •CI • CI INTIMITY CONFIDENCIALITY • CONCEPT • BASIS/THE CAUSE: WHY? PROTECTS THE FACULTY TO DECIDE OF THE PATIENT/ IT IS PROTECTED SHAPE • HISTORICAL BACKGROUND • APPLIES IN PUBLIC HEALTH AND PRIVATE HEALTH • ESCEPTIONS: • COMPULSORY SANITARY TREATMENT • VITAL URGENCY • THERAPEUTIC PRIVILEGE • The previous instructions --PRIOR INSTRUCTIONS • ADVANCED WILL-- LIVING WILL • the patient has the right to receive adequate healthcare information before undergoing (or receive) health treatment: receive medical treatment. • receive healthcare • The obligation is not only the doctor: • every professional who is going to apply a health treatment to the patient: • The obligation must be observed, not only by the doctor, but by any professional who is going to apply a health treatment to the patient: • physiotherapists, pharmacist, nurse or dentist, podiatrist Informed consent is part of the right of every patient to receive adequate information about a medical action in order to be able to decide freely whether to submit to it or not. • This procedure is carried out with respect for the dignity of people, the autonomy of the will and privacy, and it is considered the axis of the doctorpatient relationship. In this post we will explain what this informed consent consists of and how to obtain it signed easily, quickly and legally. .- TEM 1 LESSON 1 Definition of informed consent • .-as a general rule: indicate the way in which the patient can validly give consent’’’ What is the age of majority? • What is the person who can represent the patient with dementia? • parents always give consent for their children??? • living will concept • Can you ask for euthanasia in the living will? •PORQUE?????? WHY???? • 3.-IT CAN BE APPRECIATED TO GENERATE RESPONSIBILITY TO BE PRODUCED they can generate responsibility(RESPONSIBILITY MAY BE GENERATED EVEN IF THERE IS GOOD HEALTH TECHNIQUE (MEDICAL PHYSIOTHERAPEUTIC…)DENTISTRY despite the fact that the technique applied or used by the healthcare professional is correct to the advances of the technique use • YOU HAVE TO STUDY THE ORIGIN. THE CONSEQUENCES AND SOLUTIONS OF THESE CONFLICTS.-origin(CAUSE)and resolution of conflicts • the large amount of patient rights/THE GREAT AMOUNT OF PATIENTS 'RIGHTS : 5.-different ways CLAIM about malpractice • the relationships between health professionals, the health center and patients can generate or exist conflicts that generate criminal responsibilities(CLAIMS) jail sentence) civil or administrative (with possible sentences to pay compensation C I Definition of informed consent •1.-DEFINITION 2.-DIFFERENT possibilities 3.UNDERSTANDABLE DEFINITION informed consent • The right (obligation of the health professional) that the patient has to be informed of: • your diagnosis • pathology • possible treatment alternatives • risks advantages and disadvantages of each therapeutic alternative BE INFORMED IN UNDERSTANDABLE TERMS THAT THE PATIENT UNDERSTANDS • BE INFORMED IN UNDERSTANDABLE TERMS • THAT THE PATIENT UNDERSTAND Way---form---shape in which the patient requests consent and receive the information: • Generally, the verbal or oral form is sufficient. • but writing is required in: • notorious risks • invasive procedure • REAL CASE CONSULTATION OF TRAUMATOLOGY URGENCY: • 77-YEAR PATIENT ATTENDS TRAUMATOLOGY CONSULTATION • 2.-IT IS TREATED OF CHRONIC PATIENT WITH SERIOUS CARDIAC PATHOLOGY • 3.-THE DOCTOR DIAGNOSTICS HIP BREAK • 4.- THE DOCTOR DECIDES THAT IT IS VERY RISKY—dangerous-TO OPERATE • .-5.- THE PATIENT HAS A PERCENTAGE OF 90 PERCENT TO DIE IN THE SURGERY • 6.- THE TRAUMATOLOGY DECIDES NOT TO OPERATE AND INDICATES TO SAVE REST—in bed-• 7.- DURING THE CONSULTATION IS NOT PRESENT YOUR CHILD • 8.- THE PACIENT SON EXPRESSES HIS DESIRE TO GO TO ACCOMPANY THE CONSULTATION TO HIS FATHER • 9.- THE DOCTOR SAID: • THE PATIENT ENTER ONLY • ALTERNATIVES • 1.- OPERATE WITH SURGERY OR NOT OPERATE • 2.-THE SURGERY CAN BE: 1.a .- WITH A NAIL, BUT IT IS NECESSARY THAT THE BONE HAS A GOOD BLOOD CIRCULATION (BLOOD) • 1.b .- WITH A HIP PROSTHESIS: THIS WEIGHTS MORE AND THE REHABILITATION WILL BE SLOWER AND NEEDS MORE EFFORT) •REAL CASE CONSULTATION OF TRAUMATOLOGY URGENCY: • HOW DID THE HEALTH PROFESSIONAL HAVE(GIVE) TO INFORM THE PATIENT? HOW ??--• IN WHICH FORM SHOULD THE PATIENT BE INFORMED? SHOULD BE INFORMED? • WHO HAS TO INFORM AND LISTEN? • WHAT HAPPENS IF THE PATIENT IS UNDER 16 YEARS OLD? • WHAT HAPPENS IF IT IS 12 YEARS OLD AND THE FATHERS DO NOT WANT A TRANSFUSION IF IT IS NECESSARY. • IT IS ADVISABLE THAT THE PATIENT ENTERS THE CONSULTATION ONLY (WITHOUT THE COMPANION ?? WHO CAN BE INFORMED VALIDLY IF THE PATIENT DOESN'T UNDERSTAND ... DOES NOT UNDERSTAND ... HAS DEMENTYA ... OR?? WHO CAN BE INFORMED VALIDLY IF THE PATIENT DOESN'T UNDERSTAND ... DOES NOT UNDERSTAND ... HAS DEMENTYA ... OR IS LESS?? ALLEGED OR LINKED????? .-BEFORE THE LAW SAYED THAT THE PATIENT MUST BE INFORMED TO THE ALLEGADA-PERSON ALLEGED related TO THE PATIENT WHO CAN BE INFORMED VALIDLY IF THE PATIENT DOESN'T UNDERSTAND ... DOES NOT UNDERSTAND ... HAS DEMENTYA ... OR IS LESS?? ALLEGED OR LINKED????? .-BEFORE THE LAW SAYED THAT THE PATIENT MUST BE INFORMED TO THE ALLEGADAPERSON related ALLEGED TO THE PATIENT -THIS SEEMS TO MEAN THAT both(the pacient and the person who can recivet the information Member of the same family… ….-it seems that: the patient and the person who can receive the information must belong to the same family (are parent)… … are from the same family… …IT SEEMS THAT BETWEEN THE PATIENT AND THE PERSON WHO RECEIVES THE INFORMATION, SHOULD EXIST(must be) a LINK OR FAMILY RELATIONSHIP (belong to the same family. .-this makes it difficult to observe this duty to inform this was or was difficult to inform the patient • therefore now the law speaks or says (use the expression or word: • person linked to the patient…. No necessary FAMILY LINK… (CONSANGUINEO O POR AFINIDAD .... POLITICAL FAMILY. RELATIONSHIP WITH THE CONSANGUINEOS OF THE Wife HUSBAND • Any PERSON who GOING WITH THE PATIENT: MOTHER FATHER MOTHER SON DAUGHTER ...person who accompanies.. escort • …the patient ... who takes care of him ... or person who works in the residence where he lives…kindergarten:minor who gets (sickget)sick…feel bad • all this in such a way that the patient has the right ABOUT DIFFERENT possibilities: • 1.-give up being informed: In this case: do you have the right to be treated like ?? who decides ?? 2.-refuse to treat • decide not to be treated: in this case the refusal to treat must be in writing • 3.-may decide to treat • and ... how to treat : THE FORM…CHOOSE THE TREATMEN.. • This does not mean (does not mean) that informed consent is a protective blanket for the professional: to protect you from any kind of responsibility: • if properly informed and informed/if the patient is informed in legal form only/ • , the responsibility is eliminated when/ the risk (foreseeableprovoid- but unavoidable) occurs: • it is possible/ may happen …but unavoidable …even ... even though there is good Praxis • ….if there is good praxis Only if the risk is foreseeable (it is known that it may occur despite / even / if there is good praxis: it is unavoidable • / the professional cannot prevent it from happening: • If this risk or adverse effect may occur even though if there is good technique / practice is necessary inform • when we face an avoidable risk with a good practice, the responsibility is generated even if (despite) this risk has been reported • • • • why????? for what the Supreme Court calls: Loss of opportunity: if you had informed(give me all the information) me of all the alternatives and risks ... maybe I would have chosen the way to treat me differently: I would have chosen I would have decided another treatment • the first sentence occurred in relation to vasectomy surgery • vasectomy surgery has a percentage of 0.4 of spontaneous recanalization and male return to fertility • if that possible recanalization is not reported and ... • the couple gets pregnant because the recanalization is generated .... • the obligation to indemnify for: • moral damage from unwanted pregnancy • baby education expenses • when the patient can validly give consent?? WHAT IS THE AGE REQUIRED • How old can you consent? at what age??? which is what is called a mature minor??If the child has enough judgment?? • with twelve years must be heard?? Once the minor has been heard, it occurs when the minor's health wishes are different from those of the parents (or legal representatives? ability to understand. HEALTH DESIRE • THE TREATMENT CHOSEN BY PARENTS ARE DIFFERENT TO THE DESIRES OF THE MINOR • It is necessary to be 16 years old • (12 ??? • with twelve years the patient must be heard: • different opinions about de treatment • The owner of the right to information ?? • 18:living reproduction techniques --abortion --vital testament / DONATE ORGANS WHEN THE DONOR IS A LIVING PERSON •the parents do not own the child's health life • Minor and incapacitated: • • • • • .-The parents do not own the child's health life .-Fiscal Ministry is responsible for: protection of minors and of those legally incapacitated If the health professional perceives that the minor has a contrary or different sanitary desire from the parents and ... considers that the decision of the parents is not the best for the minor, it may transfer to the court that after hearing the prosecutor and requesting the reports necessary will decide what it is better for the child • A real case: • minor who wants to abort and his stepfather refuses • in the end it was shown that the father abused the child • He had sex with the child against his will • sterilize with minors with psychic limitations down syndrome • • • • • • practical assumption: mother whose husband leaves her .- has a daughter with down syndrome. .-the girl to acquire the age of pubertd .- has sexual promiscuity the mother goes to her gynecologist requesting sterilization of her daughter • .-The gynecologist says that the safest practice is tubal ligation. • Questions: • .- If the father seems: can claim against the gynecologist why causes ?? //…Distinguish two cases. father who has parental authority .- father who lacks parental authority • solution: • parental authority in Spain means having the legal representation of the enormous ... acting in his name ... • It is different from the guard and custody of living or with the parent • in Spain the different thing is shared custody • half share in half • half on the mother and the other half with the father: half the time with the mother and the other half with the father • they must live nearby for the judge to recognize her crime of mutilation: Cause loss of the functionality of an organ: • the doctor was condemned not because of consent, since the father did not have parental authority • but he was convicted in criminal proceedings for a crime of mutilation ... based on the sentence .. the sterilization of minors or those legally incapacitated is carried out with judicial authorization license a) Inform the patient about the characteristics of the intervention to be practiced, its risks, advantages and disadvantages, prognosis and treatment alternatives b) Transmit the information to the patient in understandable terms and well in advance. c) PROCURING IS CONVENIENT //IN writing FORM, in the medical record, that informed consent has been given, (since in case of being sued, it must be the professional who must prove that he has duly informed the patient). IF PATIENT CLAIM AGAINT THE PROFFESIONAL WHO HAVE THE OBLIGATION TO PROVE THAT YOU HAVE INFORMED?? • MINOR MATURE CAPACITY OF COMPREHENSION / sufficient maturity ability to comprehend • DEMENTIA: who gives consent for the patient with dementia?? • by the patient with demencia/ DEMENTIA OR PSYCHIATRIC PATHOLOGY the consent of the person related to the patient • person linked to the patient • FOR THIS REASON THE HEALTHCARE PROFESSIONAL SHOULD KNOW: • WHAT REQUIREMENTS MUST THE PATIENT MEET TO BE ABLE TO PROVIDE THE CONSENT VALIDLY: • MAJORITY OF AGE NECESSARY • PROBLEM OF MINOR MATURE • PATIENT WITH DEMENTIA •in Spain you have to distinguish the disability with the psychiatric pathology and dementia •Limits or exception: to CI: • Life emergency //vital urgency •Mandatory health treatment •Therapeutic privilege •Limits or exception: to CI: •Mandatory health treatments •Vital urgency •Therapeutic privilege • Mandatory health treatments: • they are those in which one acts against the will of the patient: • All of them require judicial authorization: • forced feeding • blood transfusion in witnesses of jehova • public health problems: such as tuberculosis. • Forced feeding may be from prisoners or patients with anorexia and even anyone who goes on a hunger strike • Blood transfusion in witnesses of jehova .-gehova's witnesses think they do not go to paradise if they receive blood from another person .-There are two rights that have been observed: the right to the life of the child and the right to religious freedom of parents .-in Spain both are fundamental rights if he respects religious freedom, the health professional can be sentenced for homicide for the death of the minor if he respects the right to life, he can be condemned to turn off –pay- compensation for violating religious freedom •blood transfusion in gehova witnesses • tratamientos sanitarios obligatorios en Ébola difteria o tuberculosis: es un problema de salud publica • en España el paciente tiene derecho a no tratarse • a renunciar al tratamiento en este caso si esta en el hospital pide el alta voluntaria ( por escrito y se va) • pero puede contagiar. • si se le retiene en contra de su voluntad puede denunciar, reclamar por un delito de coacciones • si se le retienen en contra de su voluntad puede alegar decir que se le ha causado lesiones al retenerle: arañados ,romper hueso... • si se va puede contagiar y aparece la responsabilidad respecto de la personas contagiadas 22 71 • tratamientos sanitarios obligatorios en ebola difteria o tuberculosis: es un problema de salud publica • en España el paciente tiene derecho a no tratarse • a renunciar al tratamiento en este caso si esta en el hospital pide el alta voluntaria ( por escrito y se va) • pero puede contagiar. • si se le retiene en contra de su voluntad puede denunciar, reclamar por un delito de coacciones • si se le retienen en contra de su voluntad puede alegar decir que se le ha causado lesiones al retenerle: arañados ,romper hueso... • si se va puede contagiar y aparece la responsabilidad respecto de la personas contagiadas 22 72 sanitary treatment obligatory by reason for causes of public health obligatory sanitary treatments in ebola diphtheria or tuberculosis: it is a problem of public health patients can give up – refuse--, treatment and ask for voluntary discharge (always in writing) and leave the hospital in Spain the patient has the right not to be treated • to waive treatment in this case if he is in the hospital he asks for voluntary discharge (in writing and he leaves) • but it can infect. • If you are held against your will, you can denounce, claim for a crime of coercion • if he is held against his will, he can claim to have caused injuries by holding him: scratching, breaking bones ... • if it goes away, it can be contagious and the responsibility for contagious people appears 22 73 • there are two rights • On the one hand, the patient's right to renounce to treat for another right of all citizens to be protected against a public health problem But if you act against the patient and he is detained he can denounce by coercion or even by injury: Retention against his will retains immobilizes so that it does not leave the hospital and can infect 22 74 • there are two rights • On the one hand, the patient's right to renounce to treat for another right of all citizens to be protected against a public health problem But if you act against the patient and he is detained he can denounce by coercion or even by injury retains immobilizes so that it does not leave the hospital and can infect 22 75 •Living will • It is the document they can grant to make • The living will must be registered in the Register of Prior Instructions of your Autonomous Community, under the Ministry of Health. • In addition, there is a National Registry of Prior Instructions (RNIP), where all the documents submitted by the regional registries are deposited. • Documento en el que una persona capaz y libre( 18 años ) manifiesta los tratamientos sanitar4ios que desea que se le aplique n o, que no se le aplique en un futuro en el que no pueda presta validamente el consentimiento por: • Que este en coma o insconsciente • O tenga alterada sus facultades mentales …demencia … • posibilidad de dejar decidido cuáles serán los cuidados recibidos en el final de la vida.… • O… • Sobre el destino de su cuerpo o de sus órganos. • quién es el representante autorizado para ayudar a interpretar, en su caso, las instrucciones contenidas en el documento y para tomar las decisiones que corresponda, cuando no se hayan previsto. • Document in which a capable and free person (18 years old) shows the sanitary treatments that he wishes to be applied to, that does not apply to him in a future in which he cannot validly give consent for: • That is in a coma or unconscious • Or have your mental faculties altered ... dementia ... • possibility to leave decided what will be the care received at the end of life ... • OR… • On the fate of his body or his organs. • who is the authorized representative to help interpret, where appropriate, the instructions contained in the document and to make the corresponding decisions, when they have not been foreseen • El testamento vital se debe inscribir en el Registro de Instrucciones Previas de tu Comunidad Autónoma, dependiente de la Consejería de Sanidad. • Además, existe un Registro Nacional de Instrucciones Previas (RNIP), donde se depositan todos los documentos remitidos por los registros autonómicos. • 1. Who can do it and what is the living will for? • 2. What can it contain? • 3. Ways to carry out a living will • 4. Differences between autonomous communities in relation to the living will • 5. Can it be modified or canceled? •Ways to carry out a living will According to the autonomous community, there are several ways to carry out the Advance Will Document. In summary, they are: before a notary, in the registry, or with three witnesses. In the registry This formula will allow health personnel to have your last wishes practically immediately to register it. You can do it by going to a Health registry of your autonomous community and delivering the document containing the instructions. The official who registers it will attest to it. Notary •Before three witnesses • The document must be signed by three people (witnesses), two of them, cannot be relatives or have an economic relationship with the person. Can it be modified or canceled? • You'll always be in time to change your mind. The document can be modified or canceled when the user wants to.