Publications


ORIGINAL RESEARCH

Robert Doričić, Marcin Orzechowski, Marianne Nowak, Ivana Tutić Grokša, Katarzyna Bielińska, Anna Chowaniec, Mojca Ramšak, Paweł Łuków, Amir Muzur, Zvonka Zupanič-Slavec, Florian Steger: Diversity Competency and Access to Healthcare in Hospitals in Croatia, Germany, Poland, and Slovenia. International Journal of Environmental Research and Public Health (2021) 18: 11847. https://doi.org/10.3390/ijerph182211847

Diversity competency is an approach for improving access to healthcare for members of minority groups. It includes a commitment to institutional policies and practices aimed at the improvement of the relationship between patients and healthcare professionals. The aim of this research is to investigate whether and how such a commitment is included in internal documents of hospitals in Croatia, Germany, Poland, and Slovenia. Using the methods of documentary research and thematic analysis we examined internal documents received from hospitals in these countries. In all four countries, the documents concentrate on general statements prohibiting discrimination with regard to healthcare provision. Specific regulations concerning ethnicity and culture focus on the issue of language barriers. With regard to religious practices, the documents from Croatia, Poland, and Slovenia focus on dominant religious groups. Observance of other religious practices and customs is rarely addressed. Healthcare needs of patients with non-heteronormative sexual orientation, intersexual, and transgender patients are explicitly addressed in only a few internal documents. Diversity competency policies are not comprehensively implemented in hospital internal regulations in hospitals under investigation. There is a need for the development and implementation of comprehensive policies in hospitals aiming at the specific needs of minority groups.


ORIGINAL RESEARCH

Fabian-Alexander Tietze, Marcin Orzechowski, Marianne Nowak, Florian Steger: Access to healthcare for minors: An ethical analysis of judgments of the European Court of Human Rights. Healthcare (2021) 9: 1361. https://doi.org/10.3390/healthcare9101361

The right to non-discriminatory access to healthcare is anchored in the European Convention on Human Rights and other international treaties or guidelines. Since its ratification, the European Convention on Human Rights was made binding in all Member States of the Council of Europe and is interpreted by the European Court of Human Rights (ECtHR). Despite its legal recognition, discrimination in healthcare provision has repeatedly been an issue of medicoethical and political consideration. In this context, minors are particularly in danger of being deprived of this fundamental right. The aim of this study is to analyze the current state of the ECtHR jurisdiction on challenges in accessing healthcare for minor patients. We conducted a systematic search of judgments by the ECtHR using the keywords “healthcare” and “child”. We performed descriptive statistics and qualitative thematic analysis. Our search resulted in n = 66 judgments, which were all screened. Access to healthcare for minors played a role in n = 21 judgments, which involved applications against n = 13 countries. We formed five, partially overlapping categories, which represent recurring themes regarding the research topic. These themes are governance failure (n = 11), the status of refugee, asylum seeker or migrant (n = 5), parental home (n = 5), maternity and birth (n = 4) and others (n = 2). The normative framework of the ECtHR’s jurisprudence illustrates intersections between social, legal and medicoethical aspects of minors’ discrimination in the healthcare system. It emphasizes the particular vulnerability of children, who require exceptional protection. Inadequate access to healthcare manifests itself in specific situations, such as in the context of migration or staying in public institutions. Healthcare professionals need to be sensitized for such discrimination mechanisms, as they are often at the forefront of encountering structural discrimination in the healthcare system.


ORIGINAL RESEARCH

Marcin Orzechowski, Moritz E. Wigand, Marianne Nowak, Thomas Becker, Florian Steger: Post-traumatic stress disorder, human rights and access to healthcare: An analysis of judgments of the European Court of Human Rights from an ethical perspective. European Journal of Psychotraumatology (2021) 12: 1930704. https://doi.org/10.1080/20008198.2021.1930704

Background: Human rights violations such as torture are associated with a high risk of post-traumatic stress disorder (PTSD). The judgements of the European Court of Human Rights (ECtHR) include a normative perspective on PTSD and address central ethical questions.

Objective: To help bridge the gap between the psycho-medical and the legal discourse on human rights violations and to illustrate their medico-ethical implications by systematically assessing and categorizing all judgements by the ECtHR dealing with PTSD.

Method: The ECtHR database was searched for ‘post-traumatic stress disorder’. A descriptive statistic was performed on the Articles of the European Convention on Human Rights involved and violations to these articles. In a qualitative analysis, the judgements were thematically grouped.

Results: The search yielded n = 103 judgements, of which n = 90 were included. There were mostly violations of Article 3 (prohibition of torture), Article 8 (Right to respect for private and family life) and Article 6 (Right to a fair trial). PTSD in these judgements is normatively discussed with regards to ethical, social and political themes such as inadequate access to healthcare, especially in prison, matters of asylum, expulsion and extradition, protection of minorities and minors, as well as rights and duties of traumatized witnesses.

Conclusion: PTSD plays a central role in a large number of ECtHR judgements. Our results show that PTSD as a medical diagnosis also encompasses legal, ethical, social, and political dimensions. This knowledge is essential for healthcare professionals working with traumatized persons, but can also be relevant for political decision-makers.


ORIGINAL RESEARCH

Marcin Orzechowski, Marianne Nowak, Katarzyna Bielińska, Anna Chowaniec, Robert Doričić, Mojca Ramšak, Paweł Łuków, Amir Muzur, Zvonka Zupanič-Slavec and Florian Steger: Social diversity and access to healthcare in Europe: how does European Union’s legislation prevent from discrimination in healthcare? BMC Public Health (2020) 20:1399. https://doi.org/10.1186/s12889-020-09494-8

Background: Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief.

Method and materials: For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research topic. Our search covered documents that were in force between 13 December 2007 and 31 July 2019.

Results: Generally, the EU legal system prohibits discrimination on grounds of religion or belief, racial or ethnic origin, sex, and sexual orientation. However, with regard to the issue of non-discrimination in access to healthcare EU secondary law provides protection against discrimination only on the grounds of racial or ethnic origin and sex. The issue of discrimination in healthcare on the grounds of religion or belief, gender identity and sexual orientation is not specifically addressed under EU secondary law.

Discussion: The absence of regulations regarding non-discrimination in the EU secondary law in the area of healthcare may result from the division of competences between the European Union and the Member States. Reluctance of the Member States to adopt comprehensive antidiscrimination regulations leads to a situation, in which protection in access to healthcare primarily depends on national regulations. Conclusions: Our study shows that EU antidiscriminatory law with regard to access to healthcare is fragmentary. Prohibition of discrimination of the level of European binding law does not fully encompass all aspects of social diversity.

 


ORIGINAL RESEARCH

Moritz E Wigand, Marcin Orzechowski, Marianne Nowak, Thomas Becker, Florian Steger: Schizophrenia, human rights and access to health care: A systematic search and review of judgements by the European Court of Human Rights. International Journal of Social Psychiatry (2020). https://doi.org/10.1177%2F0020764020942797

Background: Persons with schizophrenia are vulnerable regarding human rights violations.

Aims: The aim of this research is to systematically analyse judgements by the European Court of Human Rights (ECtHR) involving persons with schizophrenia.

Methods: A systematic search of judgements by the ECtHR, using the search term ‘schizophrenia’. Descriptive statistics and a qualitative thematic analysis were performed.

Results: A total of n = 105 judgements were included, originating in n = 29 countries. Article 5 (Right to liberty and security) of the European Convention on Human Rights was ruled by the ECtHR to have been violated in 45.7% of judgements, Article 3 (Prohibition of torture) in 20.0% and Article 8 (Right to respect for private and family life) in 19.0%. Relevant themes were inadequate access to mental health care, especially in prisons and during police operations, involuntary confinement, detention and ill-treatment as a risk factor for psychosis, the right to family life versus the rights of others, extradition/expulsion and protection of other persons’ human rights against violent behaviour by persons with schizophrenia.

Discussion: Persons with schizophrenia often do not receive adequate treatment and are especially vulnerable in prisons, where ill-treatment can be an additional risk factor. They can have both offender and victim status. The judgements suggest that the ECtHR has a balanced view on involuntary confinement. National legislation and internal hospital guidelines should be written in a manner to help minimise human rights violations against persons with schizophrenia.

 


CONFERENCE REPORT

Robert Doričić, Marcin Orzechowski and Marianne Nowak: International Conference Healthcare as a Public Space: Social Integration and Social Diversity in the Context of Access to Healthcare in Europe. European Journal of Bioethics 11 (2020), pp. 283-286.

The conference report provides an overview of the various presentations, as well as insights and discussions that transpired during the First International Conference organized within the framework of the project.

The full text of the report can be accessed here.


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