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Pregled bibliografske jedinice broj: 343073

Ethics Committees in Croatia


Borovečki, Ana
Ethics Committees in Croatia, 2007., doktorska disertacija, Medicinski fakultet, Nijmegen, Nizozemska


CROSBI ID: 343073 Za ispravke kontaktirajte CROSBI podršku putem web obrasca

Naslov
Ethics Committees in Croatia

Autori
Borovečki, Ana

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, doktorska disertacija

Fakultet
Medicinski fakultet

Mjesto
Nijmegen, Nizozemska

Datum
4.9

Godina
2007

Stranica
125

Mentor
Ten Have Henk ; Orešković Stjepan

Ključne riječi
ethics committes; Croatia

Sažetak
In this thesis the work of ethics committees in Croatia is being investigated for the first time. The 1997 Law on Health Protection introduced legal standards for the establishment of the so-called “ mixed” type of ethics committees in healthcare institutions. Our study aims to examine whether this top-down approach of ethics committee implementation was the right approach for Croatia and what the consequences of this approach were for the work and formation of Croatian ethics committees. The investigation is focused on the types of committees, the functions they perform in their everyday work, their membership structure. Special emphasis has been placed on the analysis of ethics committees in healthcare institutions, especially hospitals, in Croatia. Data was collected using questionnaires. Chapter 1 provides a general background on the history, development and different types of ethics committees worldwide. It addresses specific characteristics of the Croatian situation in regard to ethics and ethics committees. The aim of the thesis is presented. Chapter 2 gives an overview of the situation and development regarding ethical issues in medicine in the European countries in tranisiton. Chapter 3 gives an overview of the situation and development regarding ethical issues in Croatian medicine. In Croatia, the subject of medical ethics, or bioethics, was introduced into the curriculum at the medical schools of the Universities of Rijeka and Zagreb in the early 1990s. Today, bioethics education has become a basic part of undergraduate medical education not only in Rijeka and Zagreb but also in Osijek. In 1997 legal provisions for the establishment of ethics committees in healthcare institutions were provided by the Law on Health Protection. In 2001 the National Bioethics Committee of the Government of the Republic of Croatia was founded. However, some issues have been a continuing source of legal and ethical problems. In future, improvements can be made in this area. We conclude that developments regarding ethics issues in medicine are well on track in Croatia, but a lot of work remains to be done, especially on the educational and legal levels. Chapter 4 presents the first of the three surveys into the work of Croatian ethics committees described in this thesis. This first exploration was undertaken in 2002/2003 by the National Ethics Committee for Medicine of the Government of the Republic of Croatia. In Croatia, ethics committees are legally required in all healthcare institutions by the Law on Health Protection. A cross-sectional survey of healthcare institutions (excluding pharmacies and home care institutions) was undertaken to identify all the ethics committees six years after the implementation of the Law on Health Protection. This first survey studied the structure, functions and legal provisions as well as the different types of ethics committees in Croatian healthcare institutions. The data was obtained from the replies of the committees to a circular letter and a questionnaire distributed by the National Bioethics Committee. The results show that 46% of the healthcare institutions in Croatia (excluding pharmacies and home care institutions) have ethics committees. 89% of the ethics committees have 5 members, 3 of whom are from medical professions and 2 from other fields. 49% of those committees stated that their main function is the analysis of research protocols. Only a small fraction of those ethics committees sent in standing orders, working guidelines or other documents that are connected with their work. Although there are legal provisions for ethics committees in healthcare institutions in Croatia, there is evidence of discrepancies between what happens in practice as opposed to what is required by the Law on Health Protection, suggesting the need for a revision of the law. There is also a need for creating separate networks of HECs and IRBs in Croatia. In comparison with other countries, the development of ethics committees in Croatia demonstrates some similarities with other transitional societies in Europe. Chapter 5 deals with the education of ethics committee members in Croatia. It presents the first educational workshop ever for members of ethics committees in healthcare institutions, held in Zagreb in 2003, together with the survey that was performed during this workshop. The objective of this survey was to study the knowledge and attitudes of hospital ethics committee members who attended the first workshop for ethics committees in Croatia (all of them came from hospital ethics committees). This survey was a pilot-study project with the purpose to test a specially designed questionnaire and highlight the main problems and issues in the work of hospital committees. It took the form of a before/after cross-sectional study using a self-administered questionnaire specially developed for this purpose. The main outcome measurements were the knowledge and attitudes of the participants before and after the workshop, and the everyday functioning of hospital ethics committees. The majority of the respondents came from committees with at least 5 members (at least two physicians). The majority of the ethics committees were elected by the governing bodies of their hospitals. Most committees were founded after the implementation on the Law on Health Protection in 1997. The membership structure (3 physicians + 2 members from other fields) and functions were copied from these legal provisions. Analysis of research protocols was the main part of their work (in 56 cases), thus neglecting the other functions important for a hospital ethics committee: education, case analysis, guidelines formation. The level of knowledge of the members was average, but not sufficient for the complicated tasks that they were supposed to perform in their everyday work. However, it was significantly higher after the workshop. The majority of respondents felt that their knowledge should be improved by additional education. Their views on certain issues and bioethical dilemmas displayed a high level of paternalism and over-protectiveness of their patients, and that did not change after the workshop. The data presented provides some impressions on the current situation in Croatia regarding the knowledge and attitudes of the members of hospital ethics committees. A bureaucratic pattern of the development of the committees was observed. Furthermore, concerns are raised about the knowledge levels of members of hospital ethics committees. More effort needs to be made to use education as a possible factor in improving the quality of their work. The findings regarding the everyday work of the committees were consistent with the findings of the 2002/2003 study of the National Bioethics Committee for Medicine in the Republic of Croatia. Chapter 6 presents an in-depth analysis of the work of hospital ethics committees in Croatia. A specially designed questionnaire was used for this purpose. This was the third survey performed into the work of ethics committees in Croatia. The objective of the survey was to study the work and membership structure of hospital ethics committees in Croatia. It was a cross-sectional study using a self-administered questionnaire specially developed for this purpose. The questionnaire was sent by mail to all members of ethics committees in Croatian hospitals. The response rate by mail was 60%. The main outcome measurements were the knowledge and attitudes of the participants as well as the everyday functioning of hospital ethics committees. The results show that the structure and composition of the hospital ethics committees are highly legalistic and formal. Most of them were formed after 1997, in the wake of the introduction of legal provisions for ethics committees in Croatia. In the majority of cases, the number of members and their occupation were an exact replica of the structure of the committees required by the law (3 physicians + 2 members of other professions, of whom lawyers and theologians were the most likely candidates for membership). As in previous surveys, our data also show that the main task of the ethics committees in hospitals was an analysis of research protocols, thus neglecting the other functions important for a hospital ethics committee: education, case analysis, guidelines formation. The level of knowledge of the members was average, but not sufficient for the complicated tasks that they were supposed to perform in their everyday work. Their views on certain issues and bioethical dilemmas displayed a high level of paternalism and over-protectiveness of their patients. The majority of the members who participated in our survey were 50 years and older with, in most cases, no formal education in the field of bioethics. Chapter 7 comprises the evaluation of the results of the three previously described surveys in this thesis. The aim was to analyse the structural ethics issues observed in the work of ethics committees in Croatia. On the basis of bioethics literature discussed in Chapter 1 and experiences from other countries, the findings regarding ethics committees in Croatia are critically examined. The findings show that in the European countries in transition, like Croatia, the healthcare system has a bureaucratic climate and approach. Ethics committees in such a climate are bureaucratically constituted entities whose functions mainly comprise the analysing of research protocols. The members of hospital ethics committees tend to have insufficient knowledge of ethical issues as well as a paternalistic approach. Ignoring human relationships and treating patients insufficiently as persons can strain both the providers and users of healthcare, creating unresolved issues and tensions as well as ethical problems. Chapter 8 gives an overview of worldwide experiences in hospital ethics committees’ education with the description of current problems and approaches. Croatian situation of ethics committees’ education is also discussed. Possible solutions and approaches in ethics committees’ education for transitional societies with special emphasis on Croatian healthcare system are discussed. Chapter 9 concludes the thesis with a discussion on the findings obtained from the previously described studies. It also provides recommendations for further improvement of the work of ethics committees in Croatia. Possible changes in policies and legal frameworks are also discussed.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti



POVEZANOST RADA


Projekti:
108-1080317-0296 - POLOŽAJ PACIJENATA U SUSTAVU ZDRAVSTVA REPUBLIKE HRVATSKE – NORMATIVNO I STVARNO (Babić-Bosanac, Sanja, MZOS ) ( POIROT)

Ustanove:
Medicinski fakultet, Zagreb

Profili:

Avatar Url Ana Borovečki (autor)

Avatar Url Stjepan Orešković (mentor)

Poveznice na cjeloviti tekst rada:

Pristup cjelovitom tekstu rada

Citiraj ovu publikaciju:

Borovečki, Ana
Ethics Committees in Croatia, 2007., doktorska disertacija, Medicinski fakultet, Nijmegen, Nizozemska
Borovečki, A. (2007) 'Ethics Committees in Croatia', doktorska disertacija, Medicinski fakultet, Nijmegen, Nizozemska.
@phdthesis{phdthesis, author = {Borove\v{c}ki, Ana}, year = {2007}, pages = {125}, keywords = {ethics committes, Croatia}, title = {Ethics Committees in Croatia}, keyword = {ethics committes, Croatia}, publisherplace = {Nijmegen, Nizozemska} }
@phdthesis{phdthesis, author = {Borove\v{c}ki, Ana}, year = {2007}, pages = {125}, keywords = {ethics committes, Croatia}, title = {Ethics Committees in Croatia}, keyword = {ethics committes, Croatia}, publisherplace = {Nijmegen, Nizozemska} }




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