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Biomedical subjects

J K Gevers

Publications and source records attributed to J K Gevers.

At least 19 recordsLinked to original sources
PubMed2001

[Evaluation of the Dutch Medical Treatment Act (WGBO)].

Five years after its implementation, the Dutch Medical Treatment Act, which regulates the doctor patient contract, was evaluated in an extensive study. This act regulates (a) the right of patients to be informed and to give consent and (b) how to deal with confidential patient data. The main outcome from this study is that, in general, physicians are aware of the most important patient rights laid down in the Act and that compliance with these is mostly satisfactory. Nevertheless, the implementation can still be improved in several areas, notably the application of the more abstract provisions of the Act in everyday practice. It is recommended that measures be taken in the education and further training of health professionals and that guidelines are developed that detail how to deal with the rights of a patient in specific situations.

Confidentiality↗
PubMed2000

[Mixing of medical and scientific responsibilities is undesirable].

Should the medical responsibility to provide good care and the societal responsibility to allocate scarce resources remain separated or be brought together? Bonneux takes the latter position. Guidelines would offer an appropriate tool for this: the consensus groups developing them can at the same time take into account medical knowledge and a just distribution of resources. There are arguments against this view: consensus groups do not have the status and legitimation to take allocative decisions. Such decisions should be made at the political level, the more so since they affect individual entitlements to care under health insurance legislation. If cost effectiveness plays a dominant role in their development, guidelines can no longer be regarded as a true reflection of the professional standard of care. Finally, doctors cannot and should not be exempted from legal liability on the sole ground that they act in accordance with a guideline.

Cost-Benefit Analysis↗
PubMed2000

[Assistance in hunger strikes: legal guidelines].

Hunger strikes raise ethical and legal issues, in addition to societal and medical ones. The World Medical Association adopted resolutions in 1975 (Declaration of Tokyo) and 1991 (Declaration of Malta) in which respect for the decision to refuse food was confirmed. A survey of the relevant international and national standards shows that in the Netherlands law and policy are more supportive of respect for food refusal (and against forced feeding) than would seem to be the case at the international level. However, respect for the decision of the hunger striker requires that it is well-considered, informed, and free from group coercion. The existence of an unambiguous legal framework will not save the advising physician from difficult dilemmas which will in particular occur in case of a protracted hunger strike. In anticipation of expected loss of judgement capacities in protracted hunger strikers it is advisable that the wishes of the striker and the professional policy that the physician will adopt are written down. In case of hunger strike legal standards cannot fully replace psychological insight, professional ethics and conscience, however.

Civil Rights↗
PubMed1999

[Medical decisions, cost considerations and clinical practice guidelines; comments from the legal point of view].

Physicians are expected to take into account the cost of medical decisions. From a legal point of view, this need not to be problematic as long as it does not detract from good care. A controversial issue is whether a doctor may offer a less effective treatment than would be possible, because of financial constraints. At present, the courts in the Netherlands would seem to leave only marginal room for that, although they do not require a maximization of care. This means that clinical practice guidelines cannot be based, at least not to an unlimited extent; on cost-effectiveness, if they are to retain their professional character. If this restriction is not respected and cost-effectiveness based guidelines are not distinguished from professional ones, a likely result is confusion over their legal status and over the professional duties and liability of physicians.

Cost-Benefit Analysis↗
PubMed1999

[Alternative therapies after enactment of the Individual Health Care Professionals Act (Wet BIG)].

Alternative therapies, i.e. methods of treatment which cannot be considered to form part of the regular medical professional standard, are practised not only by alternative practitioners, but to some extent by qualified physicians, also. The Individual Health Care Professionals Act recently enacted in the Netherlands concerns the freedom to practise this complementary medicine. Whereas for physicians the decisions of the disciplinary courts will remain the determining factor, the new law--recognising the right and responsibility of individuals to seek health care wherever they wish--provides more room for alternative practitioners. This does not imply that the law does no longer protect the public from irresponsible forms of alternative medicine. However, it remains to be seen whether the instruments provided by the law to repress such practices are sufficient.

Complementary Therapies↗
PubMed1998

[Medical decisions made by teams: carefulness and responsibility].

To a growing extent, medical decision making takes place in the context of a team. Where multidisciplinary cooperation is necessary and the decisions to be taken are complex and consequential (in particular at the beginning and the end of life) joint decision making is considered an essential requirement of careful medical practice. From a legal point of view, this raises the question who is accountable for such decisions. Basically, accountability (and the liability that may result from it) will stay with the individual participants, and in particular with the first responsible, attending physician. In this respect, decision making in such situations is not basically different from other, more informal consultation structures (such as regular case reviews at department level) which are current practice in many health care institutions. Finally, if joint decision making is required, it should be clear in advance how decisions are to be arrived at in the team.

Decision Making↗
PubMed1998

[The dentist as communicator: the law].

Communication with the patient in dentistry: what the law requires. What does the law require with respect to the communication of dentists with their patients? The answer is first of all to be found in the Act on the medical contract, which is incorporated in the Dutch Civil Code, and applies also to dentistry. In this article, that act is discussed with a view to dental practice. Particular attention is given to the content and extent of the duty to provide information, and to the liability of the dentist who acts negligently on this point.

Communication↗
PubMed1997

[Communication between treating physician and occupational physician in the management of absenteeism].

In case of an employee's absenteeism, both the treating physician and the company doctor possess relevant medical information. With a view to reducing absenteeism, exchange of data is considered important. Provision of data requires the consent of the patient/employee. If the latter is informed of the purpose for which the data are requested and of how they will be used, medical professional secrecy is not violated. In order to enhance the exchange of data between treating physician and company doctor, without bypassing the requirement of consent or cancelling the division between treatment and checking, the treating physician should be permitted to provide more information than just the data asked for in specific questions. This however requires the development of guidelines for careful consultation.

Absenteeism↗
PubMed1995

Response of the law to developments in genetics.

In this article, first of all the potential role of the law with regard to complex developments like those in genetics is examined; a distinction is made between substantive law (for example prohibitions) and procedural law (for example licensing systems), and between statutory and voluntary regulation. In Europe, in particular the parliament of the European Union has called for legislation. Although several European countries have prepared legislation relating to particular aspects (for instance embryo research, genetic screening, use of genetic tests in employment and insurance), in general the response would seem cautious. When legislation is envisaged the outcome of the lawmaking process is not always predictable because of moral pluralism and political pressures. Legislating in this field is hard also for other reasons, such as the pace of development and the difficulty to assess the social consequences of developments. Other problems are the similarity or difference between genetic information and conventional medical information, and the fact that the developments in genetics lay bare more general deficiencies in the social system. With regard to many developments, the response of the law in the immediate future should be to monitor rather than to ban; where possible, self-regulation should be preferred over statutory regulation, and general laws over genetic specific laws. An international level, common principles should be adopted to serve as a framework for national legislation. Nevertheless, in some areas legislation may already be needed: in particular where genetic technologies or their results are being applied outside the regular health care setting, for instance in the form of population screening or testing for insurance purposes.

Embryo, Mammalian↗
PubMed1992

Legislation on euthanasia: recent developments in The Netherlands.

Recently, new developments took place in the Dutch debate on the legislation of euthanasia. After a brief account of that debate, the article discusses a new government proposal for legislation in this field, which was submitted to the Dutch parliament in November 1991. This proposal relates not only to euthanasia but also to some other medical decisions concerning the end of life. The author concludes that, for several reasons, it is unsatisfactory.

Euthanasia↗
PubMed1992

Genetic testing and insurance.

To what extent should insurance companies be allowed to collect genetic data on persons seeking insurance cover? This question has evoked public debate in the Netherlands. In March 1990 a temporary agreement was reached between insurers and the government. This article discusses the arguments underlying this agreement and in particular the question whether genetic information should have the same status under the law as other medical information.

Advisory Committees↗