Hasil untuk "Medical legislation"

Andrea Calvo, María Pellisé, Alfonso Muriel et al.

Background Colorectal polypectomy plays a crucial role in reducing mortality from colorectal cancer. Postpolypectomy bleeding is the most common adverse event. Current European guidelines recommend a temporary suspension of anticoagulation for polypectomy, despite the lack of high-quality evidence supporting this practice. Recent data challenge this approach, suggesting that polypectomy without discontinuing anticoagulation is not only safe but may also reduce the incidence of thromboembolic events.Methods and analysis This multicentre, prospective randomised, endoscopist-blinded, investigator-initiated, non-inferiority clinical trial aims to compare the safety of temporary interruption versus maintenance of anticoagulation during polypectomy for colorectal lesions. A total of 481 patients on oral anticoagulant treatment (either vitamin K antagonists or direct oral anticoagulants), and scheduled for an elective colonoscopy for any indication, will be randomised in a 1:1 ratio to each group. Colonoscopy and polypectomy procedures will be conducted by experienced endoscopists at 11 Spanish hospitals. The primary outcome is clinically significant postpolypectomy haemorrhage, while the secondary outcomes involve evaluating the risk of thromboembolic events and other procedural-related variables. Non-inferiority will be assessed in the per-protocol population using an adjusted absolute risk difference margin of 10%.Ethics and dissemination The study protocol was initially approved by the Medical Ethics Committee of Hospital Clínico San Carlos, Madrid, Spain (approval number: 24/330-EC_M). According to Spanish legislation on clinical trials, approval by a single CEIm is sufficient for multicentre studies and is recognised by all participating centres. The decision of the approving ethics committee is therefore applicable to all study sites. All participants will provide written informed consent prior to enrolment.The results of this study will be disseminated through publication in a peer-reviewed scientific journal and presentation at relevant national and international gastroenterology and endoscopy conferences.Trial registration number NCT07185295.

Dianfan WANG, Zongming ZHANG, Hui SHI

Australia is the first Western country to recognize the legal status of traditional Chinese medicine by legislation. In the process of legalization of traditional Chinese medicine, Australia went through three stages: an early period of disorder, a period of regeneration and consolidation, and a formal legislation period, which created a precedent for the overall legislation of traditional Chinese medicine. Institutionally, traditional Chinese medicine legislation in Australia has been supported by the national government, in terms of content, it reflects parity between traditional Chinese medicine and acupuncture, as well as between traditional Chinese medicine and Western medicine, procedurally, it has become increasingly standardized and systematized. The legislative process and characteristics of traditional Chinese medicine in Australia indicate that advancing legalization requires the leadership of the national government, relies on institutional organizations to ensure implementation, and establishes overall legislative objectives. Simultaneously, corresponding measures should be taken in light of the differences in national systems and legal frameworks to promote the legislative process of traditional Chinese medicine, providing a reference for its integration into the mainstream Western medical system.

A.I. Subbot, K.O. Kalachenkova, V.V. Berch et al.

Background. The digitalization of healthcare, the rapid expansion of mobile applications and integrated mHealth platforms, as well as the increasing use of artificial intelligence, are reshaping the ways reproductive data are collected, processed, and shared. These data belong to the most sensitive categories of medical information, and their leakage or improper use undermines privacy, violates medical secrecy, creates risks of discrimination and stigmatization, and directly affects the realization of reproductive rights. In the Ukrainian context, these challenges are intensified by fragmented legal regulation, insufficient development of public policy in digital health, and a generally low level of awareness in the field of reproductive rights. Objective of the study: to conduct an interdisciplinary analysis of the existential challenges posed by digitalization for the confidentiality of information related to human reproductive health. Materials and methods. The methodological framework combines dialectical, ethical-normative, phenomenological and complementary approaches with comparative-legal, statistical, and doctrinal methods. The empirical component is based on an online survey (n = 643) assessing public trust in mechanisms protecting confidential information in the field of reproductive health. The regulatory analysis covered the General Data Protection Regulation (GDPR), Convention 108+, Ukrainian legislation, and international standards. Results. The findings indicate that reproductive data are perceived as the most vulnerable to risks associated with digital processing. Users of digital services for fertility or menstrual cycle tracking demonstrated significantly higher levels of concern regarding potential data breaches. Statistically significant associations were revealed between anxiety related to data leakage and behavioral decisions, particularly the tendency to postpone medical consultations. Key challenges were identified, including commercial profiling, unfair data collection practices, algorithmic discrimination, re-identification of genetic data, system vulnerabilities, and insufficient alignment of national regulation with GDPR and Convention 108+. The study also revealed gaps in Ukrainian health law, such as the absence of a distinct category of reproductive data, inadequate technical security standards, and unregulated cross-border data transfers. Conclusions. The results confirm the need to develop an integrated legal policy aimed at strengthening privacy and medical secrecy in the context of digitalization. Priority steps include: defining reproductive data as a separate protected category; harmonizing national regulation with GDPR and Convention 108+; implementing unified technical security standards for mHealth platforms; creating a legal framework for the use of artificial intelligence in reproductive medicine; reinforcing mechanisms of informed consent; and improving public awareness of reproductive rights.

A. V. Kubyshkin, O. S. Grin, T. O. Shilyuk

Objective: to formulate recommendations and proposals for improving legislation in the field of protection of genomic and genetic information, including those obtained as a result of medical diagnostics.Materials and methods. We analyzed 18 regulatory legal acts, including 4 international, 3 acts of foreign states, 11 domestic legislation and judicial practice in the area under study. In addition, scientific works on this topic were analyzed. In the course of the study, we used the formal-logical, dogmatic, comparative method and axiological approaches.Results. We formulated the concepts of genomic and genetic information and demonstrated differences between these concepts. We showed topical issues of information protection, identified problems in the field of legal regulation of relevant relations, formulated recommendations and proposals for improving legal regulation.Conclusion. Based on performed research results, we recommend: 1. To incorporate in the legislation of the Russian Federation the principle that would allow the use of genetic information for further research depending on certain cases using a criteria-based approach, when such use should meet important public interests, for example, contributes to developing methods for the treatment of serious and socially significant diseases. 2. Regulate relations in the field of obtaining consent for research of biological material for scientific purposes (for example, within the framework of the Federal Law "On Personal Data"). 3. To define in Federal Law No. 86-FZ of July 5, 1996 "On State Regulation in the Field of Genetic Engineering Activities" the cases that require ethical examination in order to comply with the principle of safety of clinical trials of gene diagnostic methods, as well as in other cases. 4. Medical organizations shall ensure compliance with the rules of professional ethics in terms of data confidentiality, carry out their depersonalization, notify patients in writing about compliance with such a regime and, as a result, provide guarantees for the protection of information about patients, as well as about their relatives.

Jiri Berger, Jan Bruthans, Jiří Kofránek

BackgroundIt is very difficult to find a consensus that will be accepted by most players when creating health care legislation. The Czech electronic prescription system was launched in 2011 and new functions were introduced in 2018. To ensure that these functions will not conflict with any other existing law, a process modeling tool based on the patent “Method and system for automated requirements modeling” was used successfully in the Czech Republic for the first time. ObjectiveThe aim of this project was to develop another successful application of process modeling to add COVID-19 vaccination records to the existing electronic prescription system. MethodsThe method employed was based on the mathematical theory of hierarchical state diagrams and process models. In the first step, sketches that record the results of informal discussions, interviews, meetings, and workshops were prepared. Subsequently, the architecture containing the main participants and their high-level interactions was drafted. Finally, detailed process diagrams were drawn. Each semiresult was discussed with all involved team members and stakeholders to incorporate all comments. By repeating this procedure, individual topics were gradually resolved and the areas of discussion were narrowed down until reaching complete agreement. ResultsThis method proved to be faster, clearer, and significantly simpler than other methods. Owing to the use of graphic tools and symbols, the risk of errors, inaccuracies, and misunderstandings was significantly reduced. The outcome was used as an annex to the bill in the legislative process. One of the main benefits of this approach is gaining a higher level of understanding for all parties involved (ie, legislators, the medical community, patient organizations, and information technology professionals). The process architecture model in a form of a graphic scheme has proven to be a valuable communication platform and facilitated negotiation between stakeholders. Moreover, this model helped to avoid several inconsistencies that appeared during workshops and discussions. Our method worked successfully even when participants were from different knowledge areas. ConclusionsThe vaccination record process model was drafted in 3 weeks and it took a total of 2 months to pass the bill. In comparison, the initial introduction of the electronic prescription system using conventional legislative methods took over 1 year, involving immediate creation of a text with legislative intent, followed by paragraph-by-section wording of the legislation that was commented on directly. These steps are repeated over and over, as any change in any part of the text has to be checked and rechecked within the entire document. Compared with conventional methods, we have shown that using our method for the process of modification of legislation related to such a complex issue as the integration of COVID-19 vaccination into an electronic prescription model significantly simplifies the preparation of a legislative standard.

Felicia Maya, Budi Sarwo, Daniel Budi Wibowo

In principle, laws and regulations have regulated the working relationship between doctors and hospitals in the implementation of health services, but in the field it is often found that there are many models of legal relations between doctors in hospitals which, when examined more deeply, are found to be incompatible with existing legislation. In addition, the doctor's relationship with the hospital which is not stated in a clear agreement and legal relationship, often creates disagreements between hospital management and doctors, especially when there are demands for compensation or other responsibilities demanded by third parties for the services of doctors at home. sick. This study raises issues that are also the purpose of writing, namely the legal basis for the occurrence of work agreements and the implementation of legal relationships that occur between doctors and hospitals as well as patterns of effective legal responsibility for doctors in hospitals. This research includes empirical legal research that is descriptive analytical using primary and secondary data types. The analysis is carried out by connecting relevant theories, namely applicable laws and regulations, hospital legal theories and positive law enforcement practices related to the problems in the research. From the results of the study, it was concluded that the working relationship between doctors and hospitals was bound in a work agreement which contained the legal responsibilities of each party.

John Dinelli

Photo by Cecilie Johnsen on Unsplash INTRODUCTION Across the country, states are enacting legislation that curtails LGBTQ+ rights and liberties.[1] In March 2021, Arkansas enacted Senate Bill 289, titled the Medical Ethics and Diversity Act (the “Act”).[2] The Act permits medical practitioners, healthcare institutions, and insurance companies to refuse to treat, or, in the case of insurance companies, to cover, a non-critically ill person if treating the individual violates their religious or personal beliefs. Though masked as protecting religious liberties, the Act discriminates against LGBTQ+ patients. While the Act purports to protect different types of healthcare workers, I frame my discussion of the Act to discuss the physician’s obligations given the changes to Arkansas law.  Even if legally permissible, I believe virtuous physicians do not consider patients’ sexual orientation or gender identity when deciding whether to treat them. I will explain why a virtuous physician would never conscientiously object to treating a patient based on the patient’s sexual orientation or gender identity, even if allowed, like in Arkansas. Conscientious objection based on sexual orientation or gender identity, even if permitted under state law, is always unvirtuous. l.     Senate Bill 289 and the LGBTQ+ Patient On March 29, 2021, Governor Hutchinson adopted the Act by signing Senate Bill 289 into Arkansas state law. To protect a “right of conscience” in health care, the Act invokes traditions of the United States and the Hippocratic Oath, stating: [t]he right of conscience was central to the founding of the United States, has been deeply rooted in the history and tradition of the United States for centuries, and has been central to the practice of medicine through the Hippocratic Oath for millennia. As used in the Act, conscience means “religious, moral, or ethical beliefs.” The Act protects medical practitioners, healthcare institutions, or healthcare payors when they act from their conscience and extends this protection to include the following: (1) the right not to participate in a healthcare service that violates his, her, or its conscience; (2) no requirement to participate in a healthcare service that violates his, her, or its conscience; and (3) no civil, criminal, or administrative liability for declining to participate in a healthcare service that violates his, her, or its conscience. The Act limits which services physicians can refuse to perform: it permits conscientious objection only if the patient requires non-emergency care. Under Arkansas state law, an emergency is defined as an “immediate threat to the life or health of a patient.”[3] Before the Act, conscientious objection was limited in medical practice in the United States. The American Medical Association’s (“AMA”) Code of Medical Ethics states physicians can act as moral agents. The AMA’s code supports conscientious objection if it is based on a   moral objection to a treatment rather than discrimination against patients.[4] From the Church Amendments to the Affordable Care Act,  federal law has protected practitioners’ rights to object to participating in treatments contrary to their religious or moral beliefs, such as abortions, sterilization, euthanasia, or physician-assisted suicide.[5] However, the language of these laws emphasizes treatment-based objection; the laws protect healthcare workers who are unwilling to participate in medical practices based on a moral objection to a treatment. In addition, the laws specifically name procedures like sterilization, euthanasia, or physician-assisted suicide as permissible grounds for objection. The Act extends physicians’ rights to conscientious objection by removing the treatment-specific language. In Arkansas, the broad language of the law could permit conscientious objection based on a patient’s LGBTQ+ identity because it does not limit objections based on type of treatments. The Act broadened conscientious objection in Arkansas to include treatment-based and patient-based objections.  ll.     Virtue Ethics Virtue ethics is an ethical framework that focuses on the character of the individual performing actions during the individual’s life and career. In Nicomachean Ethics, Aristotle writes that virtue is a state of being, such as a courageous or amiable person, rather than a system for ethical action selection.[6] Society understands these virtues as falling at the mean—or between— a deficiency and an excess. For example, the virtue of courage lies between the deficiency of cowardness and excess of rashness, never in abundance or excess. A virtuous person exemplifies the virtues required of the person’s role and performs the required functions well. Aristotle writes, “[w]e become just by doing just actions, temperate by doing temperate actions, brave by doing brave actions.” In this way, we must live our virtues to become virtuous. A.     The Virtuous Physician The virtuous physician exemplifies virtue and practices medicine in congruence with medicine’s ethos. Since an individual can practice and learn virtue, it provides a unique ethical framework to distinguish between the virtuous or “good” physician and the unvirtuous or “bad” physician. Aristotle writes that life’s virtues are courage, temperance, generosity, magnificence, magnanimity, mildness, amiability, truthfulness, wit, and shame.[7] Individuals possessing these traits are virtuous, but virtuous physicians must also demonstrate traits integral to their professional duties. A virtuous physician’s qualities include empathetic listening, emotional sensitivity, and respect for patients. These additional qualities create trust and comfort patients.[8] Also, the virtuous physician exemplifies trustworthiness, integrity, discernment, compassion, patience, and conscientiousness.[9] Others even include theological virtues such as faith, hope, and charity as important characteristics in a physician’s practice.[10] While not an exhaustive list of the values that compose a virtuous physician, these standards are the basic requirements for physician to exemplify virtue and perform the job’s functions well. One may argue that theological virtues like faith, hope, and charity support the conscientious objection because physicians are virtuous when they are faithful, or loyal to their religious beliefs. However, this argument fails to consider the four principles of medical ethics. Using conscientious objection to withhold care from even non-critically ill patients can cause harm that is physical and emotional. A physician cannot act virtuously and simultaneously undermine non-malfeasance and beneficence. The virtuous physician must also practice medicine in congruence with medicine’s ethos, acting for the patient’s benefit and taking a patient-centered approach. The patient’s benefit has multiple elements, such as the medically defined good outcome, the patient’s definition of a good outcome, what is dignifying to the patient, and what is considered universally good.[11] If a physician acts against a patient’s good or the physician does not exemplify virtue in their own life, the physician would be considered unvirtuous.  B.     Unvirtuous Conscientious Objection Through the Act Conscientious objection is a debated topic. Some argue that physicians’ values should not influence the care they provide.[12] In addition, the legalization of conscientious objection is seen by some to violate medicine’s central ethos of caring for the patient.[13] Others do not view conscientious objection as wholly wrong. Despite the debate over the role of conscientious objection in the physician’s practice, conscientious objection based on a patient’s LGBTQ+ identity under the Act is unvirtuous. The Act extends the understood norm of treatment-based objections to objections based on any component of health care, including a patient’s LGBTQ+ identity. This patient-based objection is discriminatory and unrelated to the patient’s requested medical service which may conflict with the physician’s morals.[14]  A virtuous physician would never refuse to treat a patient based on the patient’s race, color, religion, sex, sexual orientation, gender identity, or national origin. Refusing to treat a patient because of the patient’s LGBTQ+ identity is unvirtuous because it defies a physician’s duty, is discriminatory, and displays a lack of respect for patients, amiability, and compassion. Even if permitted under the Act, a virtuous physician must never object to treating a patient based on the patient’s sexual orientation or gender identity. One may argue a physician can be virtuous while conscientiously objecting if the physician clearly communicates all limitations and refers the patient to another medical provider. This is the American College of Obstetricians and Gynecologists’ view.[15]  Under this view, physicians maintain respect for themselves as agents but ultimately provide proper care for the patient, even if their hands do not perform the service. However, to be virtuous, this objection must never be discriminatory. Even with prerequisites, objection based on gender identity and sexual orientation is discriminatory and indicates deficiencies in the physician’s virtue. The simple act of objection can cause psychological pain to a patient. LGBTQ+-based discrimination and rejection causes unnecessary physiological harm like anxiety, depression, and suicidal ideations, whereas social acceptance increases feelings of self-esteem.[16] The virtuous physician would never cause pain to the patient, as this violates the principle of non-maleficence. Regardless of actions taken before or after the objection, a physician is unvirtuous when the physician inflicts pain on a patient by conscientiously objecting to treating the patient based on LGBTQ+ status. CONCLUSION        To avoid discrimination, a physician must have a valid reason for employing conscientious objection. The Medical Ethics and Diversity Act extends physicians’ rights from treatment-based objection to patient-based objection. Arkansas’s LGBTQ+ community is at risk of suffering from discriminatory healthcare practices. The physician who objects based on LGBTQ+ identity is unvirtuous because the physician’s action causes psychological harm to the patient, displays deficiencies in virtues, and opposes the central ethos of medicine. - [1] For examples of Senators and State Representatives passing laws affecting LGBTQ+ rights to protect religious liberties and fairness, see ACLU. (2021). Legislation Affecting LGBTQ Rights Across the Country 2021. https://www.aclu.org/legislation-affecting-lgbtq-rights-across-country-2021 [2] Medical Ethics and Diversity Act, Ark. Acts 462 §§17-80-501-06 (2021). https://www.arkleg.state.ar.us/Acts/FTPDocument?path=%2FACTS%2F2021R%2FPublic%2F&file=462.pdf&ddBienniumSession=2021%2F2021R [3] Emergency Medical Care Act, Ark. A.C.A. § 20-9-309 [4] AMA. (n.d.) Physician Exercise of Conscience. https://www.ama-assn.org/delivering-care/ethics/physician-exercise-conscience [5] U.S. Department of Health and Human Services (2021). Your Conscience Rights. https://www.hhs.gov/conscience/conscience-protections/index.html [6] Aristotle. (1999). Nicomachean Ethics. (Irwin, 2nd ed.). Hackett Publishing Company, Inc. [7]Aristotle. (1999). Nicomachean Ethics. (Irwin, 2nd ed.). Hackett Publishing Company, Inc. [8] Bain, L. E. (2018). Revisiting the need for virtue in medical practice: a reflection upon the teaching of Edmund Pellegrino. Philosophy, Ethics, and Humanities in Medicine, 13(1), 4. https://doi.org/10.1186/s13010-018-0057-0 [9] Gardiner, P. (2003). A virtue ethics approach to moral dilemmas in medicine. Journal of Medical Ethics, 29(5), 297-302. https://doi.org/10.1136/jme.29.5.297 [10] Toon, P. D. (1999). Towards a philosophy of general practice: a study of the virtuous practitioner. Occasional Paper Royal College of General Practitioners, (78), iii-vii, 1-69. [11] Shelp, E. E. E., & Pellegrino, D. (1985). The Virtuous Physician and the Ethics of Medicine Virtue and medicine explorations in the character of medicine, 17, 237-255. [12] Savulescu, J. (2006). Conscientious objection in medicine. BMJ, 332(7536), 294-297. https://doi.org/10.1136/bmj.332.7536.294 [13] Stahl, R. Y., & Emanuel, E. J. (2017). Physicians, Not Conscripts - Conscientious Objection in Health Care. New England Journal of Medicine, 376(14), 1380-1385. https://doi.org/10.1056/NEJMsb1612472 [14] Reis-Dennis, S., & Brummett, A. L. (2021). Are conscientious objectors morally obligated to refer? Journal of Medical Ethics, medethics-2020-107025. https://doi.org/10.1136/medethics-2020-107025 [15] ACOG. The limits of conscientious refusal in Reproductive Medicine. (n.d.). Retrieved September 12, 2022, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2007/11/the-limits-of-conscientious-refusal-in-reproductive-medicine [16] Meanley, S., Flores, D. D., Listerud, L., Chang, C. J., Feinstein, B. A., & Watson, R. J. (2021). The interplay of familial warmth and LGBTQ+ specific family rejection on LGBTQ+ adolescents' self-esteem. Journal of Adolescent Health, 93, 40-52. https://doi.org/10.1016/j.adolescence.2021.10.002 ;  Ruben, M. A., Livingston, N. A., Berke, D. S., Matza, A. R., & Shipherd, J. C. (2019). Lesbian, Gay, Bisexual, and Transgender Veterans' Experiences of Discrimination in Health Care and Their Relation to Health Outcomes: A Pilot Study Examining the Moderating Role of Provider Communication. Health Equity, 3(1), 480-488. https://doi.org/10.1089/heq.2019.0069. ; Sutter, M., & Perrin, P. B. (2016). Discrimination, mental health, and suicidal ideation among LGBTQ people of color. Journal of Counseling Psychology, 63(1), 98-105. https://doi.org/10.1037/cou0000126

M. Swanson

N. Woznitza, International Society Of Radiographers And Radiolo, The European Federation Of Radiographer Societies

Radiographers and radiological technologists are the interface between imaging technology and patients. As medical imaging and radiotherapy experts, radiographers and radiological technologists are professionally accountable for patients’ physical and psychological wellbeing, immediately prior to, during and following imaging investigations or therapy procedures. Radiographers and radiological technologists take an active role in justification and optimisation of medical imaging and radiotherapeutic procedures, and have a critical position and vital role in the radiation safety of patients, carers and relatives in accordance with the “As Low As Reasonably Practicable (ALARP)” principle and relevant legislation.1 Recent developments have seen increasing integration of complex machine learning algorithms and artificially intelligent systems (AI) within medical safety, equipment operation, image review and treatment planning processes.2e4 Adoption of AI in medical imaging and radiation therapy requires radiographers and radiological technologists to adapt their imaging and treatment practices to ensure new technology is being implemented, used and regulated appropriately, based on high quality research evidence, maximising benefits to their patients.5e8 Changes in practice must be underpinned by appropriate education and training, both for the existing workforce and also curriculum development for the future workforce at European Qualifications Framework (EQF) Levels 6 (Bachelors) and 7 (Masters).

D. Shaw, W. Norman

Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political, and policy events before and since decriminalization. We assess implications for clinical care, health service and systems decisions, health policy, and the epidemiology of abortion in the absence of criminal legislation. As the criminal abortion law was struck down, dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.

Chori Diah Astuti, Suherman Suherman, Arrisman Arrisman

Health is a primary right of every individual and must be guaranteed by the state; therefore, the state has regulated the health of its citizens as stipulated in the 1945 Constitution Article 28 Section 3 which is further regulated in law No. 40 Year 2004 concerning the national social security system. One of the concerns of the government is that many Indonesians who have reached the age of 50-60 years who experience vision problems due to cloudy eye lense or cataract. The government concern is can be seen from their attention on health problems by passing Minister of Health Regulation No. 29 Year 2016. Concerning with eye Health Care Services at the Health Care Amanities and the Director of Health Service Security on Health (SSAH) passed a regulationNo. 2 Year 2018 concering with cataract service security service.The Method Used in this study is a normative juridical method, using secondary data consisting of primary, secondary and tertiary legal materials. The end purpose of this study is to get clarity about the legal protection of patients against health services by the Health amenities and SSAH or BPJS with the existence of restrictions on cataract surgery and to find out the claim procedures concerning with this restriction.

Carolina Kuntardjo

Telemedisin in Indonesia was known a few years ago but unfortunately did not make progress in its implementation. As technology developed during the Industrial Revolution 4.0 era, Indonesia returned to pay attention to the telemedicine system. One manifestation is the enactment of Minister of Health Regulation No. 20 of 2019 concerning the Implementation of Telemedicine Between Health Service Facilities. In the preamble of this Permenkes, it appears that the spirit of doing telemedicine is in order to bring health services closer and improve the quality of health services in health facilities in remote areas that prioritize patient interests and safety. Despite the fact that telemedicine currently available in Indonesia is more personal between doctors and patients. Of course, this can be considered to violate existing regulations, because there are no rules that frame them. In addition to the benefits derived from telemedicine because health services for remote areas are increasingly affordable and faster, there are still many obstacles in terms of ethics and law. In legal matters, the lack of rules that frame the implementation of telemedicine can jeopardize the position of doctors in the event of a medical dispute. In terms of ethics, there are still a number of things that are not in accordance with the principles of bioethics, namely beneficence, non-maleficence, autonomy, and justice. It is feared that the doctor-patient relationship will fade in telemedicine. The doctor's professional standard is also the case, because a doctor may not be able to conduct a direct examination of patients. There are still many obstacles in the implementation of telemedicine that this should be a challenge for the Indonesian government through the Ministry of Health to pay more attention and make clearer rules to frame the implementation of telemedicine in Indonesia.

E. A. Zakharova, T. M. Sorokina, E. A. Yudina

Introduction: modernization of Russian education is the central task of Russian educational policy. One of its distinctive features is the transition from the teaching and educational to the scientific and educational process, which allows the introduction of students' research work into it. A feature of the work of a practicing physician is the ability to analyze his own activities from a scientific point of view, knowledge and ability to work with methods of clinical research. Based on this, changes were made to the legislation, and in accordance with the Federal Standards2016 in the specialty of “Medicine”, a graduate who has mastered the program in his specialty should have professional competences that, along with competences in the field of medical activity, include competencies in research activities. Also, in accordance with the Federal Law of 21.11.2011 No. 323-FZ “Concerning the Basics of Citizen Health Protection in the Russian Federation”, a new system of continuous medical and pharmaceutical education was introduced, being aimed at continuous improvement of professional knowledge and skills throughout the entire working period of medical workers as well as the acquisition in practice of new professional skills.Psychological readiness of students for professional activity is a question that has been discussed by the scientific community for quite a long period of time. The structure of this construct has also been repeatedly discussed by many authors, but there is no consensus on this issue. The article presents the points of views of various scientists on the problem of readiness for research activities. The structure is proposed, which is a synthesis of several components: motivational, operational, and reflexive-evaluative ones. Many scientists studied this issue both Russian and foreign ones (L.S. Vygotsky, E.P. Ilyin, A.N. Leontyev, A.N. Poddyakov, E.A. Shashenkova, Zier K. Rosenberg I.E., Dantas J.B., Ley T.J., Rosenberg I.E., Solomon S.S., Tom S.C. et al.) Special attention is paid to the motivational component of psychological readiness for the research activities of future doctors. The problem of the necessity to develop this component is being actualized.Materials and methods: 76 students of the 1st course of the medical and pediatric faculties of thePrivolzhskyResearchMedicalUniversity were randomly selected for this study. The study was carried out in 3 stages: diagnostic, training, final diagnostic. At the initial and final stages 2 diagnostic procedures were used. The first one is the methodics for diagnosing the motives of students' learning activities according to A.A. Rean and V.A. Yakunin modified by N.Ts. Badmaeva. In this method, there are seven grading scales: scale 1 "Communicative motives"; scale 2 “Motives for avoiding failure”; scale 3 "Motives of prestige"; scale 4 "Professional motives"; scale 5 "Motives for creative self-realization"; scale 6 "Educational and cognitive motives"; scale 7 "Social motives". 2) Methods of studying the motivation of learning in the university by T.I. Ilyin ". The method presents three scales: “the acquisition of knowledge” (the desire to acquire knowledge, curiosity); “Mastering a profession” (striving to master professional knowledge and form professionally important qualities); "Obtaining a diploma" (the desire to acquire a diploma in the formal assimilation of knowledge, the desire to find workarounds for exams and tests).The results of the study: statistical results before and after the training in the framework of English language classes at the medical university demonstrate changes in the motivational field of students.Discussion and conclusions: the implementation of a collective training program in foreign language classes with the aim of the motivational component development to research activities of students at a medical university can be considered as an effective tool for the development of psychological readiness for further professional medical activity. It emphasizes the need for an integrated approach to solving this problem.

Daniel G. Aaron, M. Siegel

K. Mattocks, M. Mengeling, Anne G. Sadler et al.

U. Musazzi, Valentina Marini, A. Casiraghi et al.

H. Michtalik, H. Yeh, P. Pronovost et al.

M. Laughon, Debbie Avant, N. Tripathi et al.

M. Jakovljevic

S. Clarke, J. Rockett, D. Sloane et al.