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When something goes wrong in healthcare, it is important that patients are informed in an open and honest manner. This dissertation focuses on the question: what is the role of law when something goes wrong in health care? To answer this question, research was conducted in three domains: action research with Dutch hospitals that want to become more open and practice being open in a better way; quantitative questionnaire research into the impact of medical disciplinary procedures on doctors who received a disciplinary measure, and traditional legal research into openness and the settlement of complaints and claims under the Quality, Complaints and Disputes in Health Care Act (Wkkgz). This study shows that openness requires policy, such as assistance for patients and support for care providers. At the institutional level, it is important to strive for a just culture, in which open discussion and learning from mistakes is the norm. The law appears to have adverse side effects in all three domains. The organisation of openness in hospitals is compartmentalised in procedures that make it difficult to pay attention to the full range of needs of the people involved; medical disciplinary law has a negative impact on the professional practice of defendants and rarely leads to learning; in principle, the Wkkgz has the potential to improve the settlement of both complaints and claims. Restorative justice, as a legal perspective on the principles of a just culture, has been explored as a way of realising that potential. Reflecting on these findings in a broader sense, it appears that the problems described here are not an isolated phenomenon. What can be learned from this dissertation is that when solving problems, it is important to strive for participation of those who are affected; in this dissertation patients and caregivers. In line with the principles of a just culture, restorative justice has been studied as a legal perspective for the settlement of incidents. The challenge this dissertation poses is how a restorative response after a medical incident can be organized concretely. Three methods were used in this thesis: action research, quantitative questionnaire research, traditional legal literature and case law research. As such, this dissertation is in line with the development towards a more empirical approach to law. Action research in particular offers potential for (legal) scholars who want to contribute to the improvement of an undesirable situation. The legal method does not lose its added value in this approach; on the contrary, it is one of the methods that action researchers will need in order to understand and change a problem in its entirety.

When something goes wrong in healthcare, it is important that patients are informed in an open and honest manner. This dissertation focuses on the question: what is the role of law when something goes wrong in health care? To answer this question, research was conducted in three domains: action research with Dutch hospitals that want to become more open and practice being open in a better way; quantitative questionnaire research into the impact of medical disciplinary procedures on doctors who received a disciplinary measure, and traditional legal research into openness and the settlement of complaints and claims under the Quality, Complaints and Disputes in Health Care Act (Wkkgz). This study shows that openness requires policy, such as assistance for patients and support for care providers. At the institutional level, it is important to strive for a just culture, in which open discussion and learning from mistakes is the norm. The law appears to have adverse side effects in all three domains. The organisation of openness in hospitals is compartmentalised in procedures that make it difficult to pay attention to the full range of needs of the people involved; medical disciplinary law has a negative impact on the professional practice of defendants and rarely leads to learning; in principle, the Wkkgz has the potential to improve the settlement of both complaints and claims. Restorative justice, as a legal perspective on the principles of a just culture, has been explored as a way of realising that potential. Reflecting on these findings in a broader sense, it appears that the problems described here are not an isolated phenomenon. What can be learned from this dissertation is that when solving problems, it is important to strive for participation of those who are affected; in this dissertation patients and caregivers. In line with the principles of a just culture, restorative justice has been studied as a legal perspective for the settlement of incidents. The challenge this dissertation poses is how a restorative response after a medical incident can be organized concretely. Three methods were used in this thesis: action research, quantitative questionnaire research, traditional legal literature and case law research. As such, this dissertation is in line with the development towards a more empirical approach to law. Action research in particular offers potential for (legal) scholars who want to contribute to the improvement of an undesirable situation. The legal method does not lose its added value in this approach; on the contrary, it is one of the methods that action researchers will need in order to understand and change a problem in its entirety.

This doctoral thesis examines the following main research question: To what extent can Dutch medical liability law be said to have the intended effect of influencing behaviour? This thesis attempts to answer this main question in three parts: the legal framework, existing empirical research, and new empirical research, consisting of a quantitative study (questionnaires) and a qualitative study (interviews). Civil medical liability law, medical disciplinary law and medical criminal law form the legal framework for this study. A study of the literature, case law and parliamentary documents reveal that, in all three areas of the law, prevention can be defined as a key objective. In this, a distinction can be drawn between general prevention and special prevention. The objectives of general and special prevention are based on two important assumptions. Firstly, that healthcare providers are aware of the norms that apply to them. Secondly, that the areas of law described are premised on a ‘positive’ influence on behaviour. In other words, the effect on behaviour is such that it ensures that people observe the prescribed norms. In that sense, therefore, they should never act in a defensive manner. These two assumptions form the main theme of the empirical section of the thesis. The question of the extent to which doctors know about medical liability law is of relevance to the first assumption described above. The limited research that is available follows the same basic line: although healthcare providers often have a general awareness of the norms that apply, the more specific the norms become, the less familiar they are with them. The empirical research for this thesis, also reflects this basic line. Doctors who completed the questionnaires generally appear perfectly capable of gauging whether there has been a breach of the norm (according to the court) in cases presented to them. However, there does seem to be a strong degree of uncertainty. The interviews show that most respondents understand the general elements of the various areas of law, but do not have a more detailed awareness of medical liability law. The issue of whether doctors act defensively because of their fear of medical liability law is of relevance to the second assumption described above. The existing empirical studies show a varied picture. In general, most perception studies tend to conclude that defensive behaviour occurs to a significant extent, whereas the studies using hard data often fail to identify any strong link between liability and behaviour. In studies that apply a combination of methods, there are signs that doctors have a tendency to overestimate the liability risks that apply to them. There are also indications that a limited knowledge of the law results in an increase in defensive behaviour. The empirical study for this thesis builds on these findings. The questionnaires show that there is a link between a person's assessment of the risk of being found to have breached the norms and the extent to which defensive behaviour is reported. This link means that a ‘correct’ assessment of the risk is associated with less defensive behaviour. In this light, the uncertainty noted above with regard to the exact definition of applicable norms becomes problematical, as does the fact that this uncertainty can be exacerbated by the significant role played by open norms in medical liability law. The information described above leads one to the observation that Dutch medical liability law achieves the intended effect of influencing behaviour to a limited extent only.

Tom Vander Beken en Vincent Eechaudt zetten op een zeer heldere manier de tuchtregeling voor gedetineerden uiteen. Eerst worden de bronnen van het penitentiair tuchtrecht uiteengezet, waarna de algemene bepalingen inzake tucht in de Basiswet worden besproken. De tuchtrechtelijke inbreuken en sancties komen uitgebreid aan bod. Wat de sancties betreft, betekent de tuchtregeling van de Basiswet een grondige stap voorwaarts: de tuchtrechtelijke sancties zijn limitatief opgelijst, wat een breuk met het verleden inhoudt. Vander Beken en Eechaudt overlopen uitgebreid de algemene en bijzondere tuchtsancties, ze staan stil bij de opsluiting in een strafcel, de afzondering in de aan de gedetineerde toegewezen verblijfsruimte, de toemeting van tuchtsancties en de tuchtprocedure. Ze staan ook stil bij tucht voor geïnterneerden en onderstrepen de noodzaak van een aparte interne rechtspositie voor deze kwetsbare groep.

De Wet op de beroepen in de individuele gezondheidszorg (Wet BIG) verscheen op 11 november 1993 in het Staatsblad1 en is daarna gefaseerd in werking getreden. Doel van de wet was het bevorderen en bewaken van de kwaliteit van de beroepsuitoefening en de bescherming van het publiek tegen ondeskundig en onzorgvuldig handelen in de gezondheidszorg. Daarbij had de wetgever gezocht naar een evenwicht tussen de bescherming van patiënten en burgers en de keuzevrijheid van patiënten en burgers.2 Anders dan de belangrijkste voorganger van deze wet, de Wet uitoefening geneeskunst, die door de Wet BIG werd vervangen, verbiedt de wet niet het uitoefenen van een geneeskundig beroep door anderen dan daartoe regulier opgeleide en goed gekwalificeerde zorgverleners. Het staat de burger in het kader van de zorg vrij om qua zorg te zoeken wat hem past en de wet heeft aldus een geheel open horizon. Ter bewaking van de kwaliteit staat tegenover deze ruime buitengrens als een kwaliteitskern een regeling van aan geregistreerde beroepsbeoefenaren voorbehouden geneeskundige handelingen (art. 36 Wet BIG), noodzakelijkerwijs gecombineerd met een stelsel van titelbescherming van de basisberoepen, zodat duidelijk is welke personen als beroepsbeoefenaren deze voorbehouden handelingen mogen verrichten (art. 3 Wet BIG).

De voorbije 15 jaar werd de interne rechtspositie van de gedetineerde binnen het penitentiair tuchtrecht versterkt. Zo werden in 2011, na meerdere wetswijzigingen, de bepalingen met betrekking tot het penitentiair tuchtrecht uit de basiswet grotendeels van kracht. Dit leidde onder andere tot: - de invoering van een limitatieve lijst van tuchtinbreuken en tuchtsancties - het uitwerken van een formele tuchtprocedure waarbij de gedetineerde een steeds actievere rol speelt - een complexer tuchtregime waarbij een toenemend aantal actoren betrokken zijn en waarbij de initiële voorschriften verder werden ontwikkeld via wetgeving, beleidsdocumenten en jurisprudentie De praktijkgerichte studienamiddag geeft daarom meer inzicht in het huidige penitentiair tuchtrecht. Binnen welk rechtskader kan het penitentiair personeel manoeuvreren? Welke rechten en plichten hebben de gedetineerden? Hoe kan de advocaat een gedegen verdediging voeren? Tijdens de presentaties zal geput worden uit de diverse rechtsbronnen die het penitentiair tuchtrecht vormgeven, waaronder de basiswet en de relevante koninklijke besluiten, het algemeen reglement van de strafinrichtingen, de algemene rechtsbeginselen, verschillende beleidsdocumenten en de recente nationale en internationale jurisprudentie omtrent het onderwerp. Zo krijgt u inzicht in de meest voorkomende fouten in de tuchtprocedure. Ook zal er een antwoord geboden worden op de verschillende vraagstukken die de aanwezigen naar voren brengen. Deze vorming is ideaal voor advocaten, magistraten, het gevangeniswezen (directeurs – hoofdcipiers - …), Liga voor mensenrechten, FOD Justitie, de Centrale Toezichtsraad Gevangeniswezen, … die up-to-date willen zijn en blijven inzake penitentiair tuchtrecht.

Promotor doctoraat betreffende het militair tuchtrecht