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- Herausgeber: OBART
- Kategorie: Geisteswissenschaft
- Sprache: Englisch
- Veröffentlichungsjahr: 2023
There are no Sundays or holidays. There is no rest for those who have assumed the responsibility of caring for a family member in a serious and chronic condition (examples are not lacking: AIDS, cancer, Alzheimer's, serious psychiatric pathologies,...) even though there are times when other people replace them in this absorbing task. The caregiver is that person who, although he does not belong to the healthcare world or has been trained as such, is responsible for the care of the dependent patient at home. The existence of the informal caregiver (according to the definition of the World Health Organization) is fundamental in our society, but it is not without risks. On many occasions, throughout the disease process, the caregiver feels that he is running out of strength to carry on.
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Carmen Plano
Libro inglés mayores
Table of contents
Qualities to look for in a caregiverelderly
Qualities to look for in a caregiverelderly
INDEX
INTRODUCTION
TOPIC 1. Health knowledge
SUBJECT 2. Responsibility
TOPIC 3. Capacity to react to emergencies
UNIT 4. Patience
UNIT 5. Empathy
SUBJECT 6. Flexibility
SUBJECT 7. Good presence
UNIT 8. Physical force
SUBJECT 9. Motivation
UNIT 10. Assertiveness
DEVELOPMENT
INTRODUCTION
A good caregiver must have knowledge of health care and know how to react to emergency situations, but above all be patient and empathetic. Going to medical appointments with them, keeping an eye on their meals and medication, cleaning their house, accompanying them and stimulating them... Not everyone has time to care for their elderly relatives, and they need to resort to the assistance of a caregiver. What do you have to pay attention to so as not to make a mistake in the choice? Taking care of an elderly person is exhausting work, which requires high doses of affection and patience, as well as minimal knowledge in health care, responsibility and the ability to react to emergency situations.As they get older, many need care and attention that their family cannot or does not always know how to give them, so finding a caregiver becomes the ideal solution for some of their elderly relatives. There are several options that can be used:
individuals. The services of these caregivers are generally known by "word of mouth" among relatives and acquaintances. The references in this case are very close and can be verified, so it is a very widespread option.
Companies. There are more and more companies dedicated to providing caregivers to families who need this service. They have professionals who, in addition to having "knowledge in geriatrics or nursing, are very empathetic and have extensive experience."
Volunteers. The Spanish Association against Cancer, Cáritas or the Obra Social of some companies are very present in the field of palliative care and care for the sick elderly, with volunteers. They are not a solution to cover a wide time slot, nor for all cases, but they can be a relief and reduce the hours that a caregiver must be paid, knowing that the family member will be well cared for. To find out if you can take advantage of one of these options, the most effective thing is to contact these associations and present your specific case.
To search for —and find— the right caregiver, it is essential to take into account the physical and mental state of the elderly and their needs. It is not the same to help clean the house and take a walk, than having to clean, treat and feed a bedridden person or attend toelderly with some cognitive impairment. When caring for a person, in addition, "their values, customs, beliefs and preferences must be respected, respecting and promoting their autonomy and avoiding situations of overprotection". The physical and mental state of the elderly, his needs and character are essential when looking for a caregiver. Thus, the degree of dependency, the hours that need to be cared for and —very importantly— the character of the elderly should be essential issues when addressing the search for a caregiver. Whichever option is chosen, it is necessary to clearly explain to the contracted person what services will be required of him and his degree of responsibility in caring for the elderly.
When looking for a caregiver for an elderly person, rushing works against you. It is never convenient to rush, and before hiring a person to take care of your family member, it is important to have references, whether we use a company or a private caregiver. The best thing to do is that they always come backed by previous satisfactory experiences. A trial period is essential to see the connection between the caregiver and the elderly and to check other qualities. Do you think you have the perfect candidate after having had a personal interview? It is the decisive moment: introduce the elderly and the caregiver. It is convenient to establish a trial period, which is where you can really see if there is a connection between the two (if the old man's mental abilities are not diminished). "It is one of the fundamental aspects for the relationship to come to fruition." In addition, during the trial period you will be able to check if the old man is clean, hydrated, relaxed, etc.; conditions that will help you make a decision. How much can these services cost? The fork is very wide, although they are not cheap services for a medium-income family, since they oscillate between 800 and 1,500 euros per month, being more expensive in large capitals than in small towns. The average rate for a caregiver is 20 euros per hour (two hours a day would cost around 800 euros per month). If the caregiver works as an intern (lives in the house and works from Monday to Friday), the minimum they charge is around 700-800 euros per month, to which is added their maintenance and accommodation. In addition, the worker's Social Security must be paid. If you decide to use the services of a caregiver to care for your elderly relatives, Whether through a company or an individual, there is another important issue: you must sign a contract. It must clearly show the details of the employer and employee, the amount to be paid for the services rendered, as well as the hours or days of work and, if possible, specify their functions.
It is not always possible to turn to a caregiver outside the family. In fact, "care is provided mostly in the unpaid family environment, in up to three quarters of the cases." If you have no choice but to care for your elderly relative, you should bear in mind that it is not a transitory situation (and you do not know how long you will have to be), "it is essential to train, plan and prepare to be able to carry out their function in the best conditions ”. In this way, the quality of care for the person in a situation of dependency and its continuity are guaranteed, avoiding unwanted institutionalizations.
There are no Sundays or holidays. There is no rest for those who have assumed the responsibility of caring for a family member in a serious and chronic condition (examples are not lacking: AIDS, cancer, Alzheimer's, serious psychiatric pathologies,...) even though there are times when other people replace them in this absorbing task. The activity is always present in the mind of the caregiver, and can end up becoming an obsession. The main problem affects the patient, but also those who care for them day and night suffer the consequences of a serious or incurable disease. It is a situation that occurs and that the family will face. And, in the end, time, domestic and social relationships, leisure, personal emotionality and the entire life of the assistant will revolve around the needs that this father, mother,center of your routine. The helper, no matter how much self-sacrifice, human compassion and dedication to the patient is provided, can end up feeling suffocated and trapped by feelings that are difficult to control. Among them, the frustration of an apparently wasted effort: the patient does not improve or his health even deteriorates.
The awareness that a path of no return is being traveled and the confirmation of the patient's hopelessness turn the situation into a journey bristling with difficulties, and, in some cases, devoid of stimuli. To this emotional scenario must be added the physical fatigue that the multiplicity of roles in which the caregiver unfolds, to continue attending -in addition to the constant requests of the patient- the tasks of their daily life.
If at the end of the day (you never know if work will end at midnight or if you will have to get up in the middle of the night) the assistant is asked how he is, the most likely answer will be: "tired, very tired, I prefer not to think, I What I would like is to sleep” (these tasks, among us, are normally performed by women; hence, the feminine).
When the situation lasts for months or years, or its end becomes unpredictable, it can generate imbalances and family tensions. It is a stressful panorama, and it is convenient both not to get carried away by the emotion that permanent contact with the patient arouses and not to fall into total dedication, physical and mental, to the patient.
The objective is twofold: that the caregiver does not fall victim to illness or depression, and that they keep their forces in balance, in order to be more effective in caring for the loved one, who requires us so much in the last phase of their life.
A new and unknown situation.
The first is realism. We cannot start from the “I can with everything”, whatever our character or the effort and hours to invest. We do not believe ourselves to be essential or think that without our collaboration the outcome will be imminent or in more painful circumstances. "They don't know how to do it and they hurt him" or "with me he is calmer and feels safer" or "what he wants is to be with me, because he knows he is more cared for" are impractical statements. The caregiver, with his exclusive and absorbing dedication, will only get exhausted and frustrated. He will not be able to prevent there being moments in which the patient suffers or in which he even tyrannizes him. In addition, this radical position causes feelings of guilt, when the assistant has to resort to the help of other people.
Nor should they fall into the victimhood of “I can't take it anymore, if this continues like this, it's taking me by storm, I'm nervous,” without doing anything to solve problems that are beginning to do serious harm to the caregiver.
Let's be honest and realistic.
Let's allow ourselves to feel the fear of death, but let's not allow it to block or paralyze us. The assumption of death serves to help us be cautious, responsible and loving in our lives.
The patient reminds us every minute that life has an end, and that it is inescapable. If we learn to live with our fear and talk about death naturally, we will give way to that discomfort that causes tension and rigidity when spending our days with seriously chronically ill patients.
In the face of sadness, serenity.
Settling in negativity, in hopelessness, when taking care of one of these patients on a daily basis, is an easy thing, almost natural. It is appropriate to look calmly at this stage, which has three aspects: that of the caregiver himself, that of his family, and that of the person whom it has been decided to assist. For our forces to be effective and to satisfactorily care for the patient, the caregiver's mood has to be positive, because it depends on him and his serenity when making the decisions that arise in the relationship with the patient that we feel at peace with ourselves regarding the acquired purpose: that coexistence enjoys a climate of communication.
And that, given the irreversibility of the disease, so much dedication has its positive side: the strengthening of family solidarity ties. And, of course, that the help to the sick is a true accompaniment in what is expected to be his final stretch. The caregiver must help himself to feel the illusion of living, every moment of his life. Thus he will be able to transmit joy and serenity to the patient. Loving words, kisses and caresses should not be missing towards this: they will fill the memory of our behavior with that sick person.
It may be useful for us to remember some guidelines that help the caregiver of a seriously ill chronically or incurably ill to maintain a good physical-emotional balance:
Distribute time: every day (apart from the work of caring for the sick) let us have some time for ourselves and another for family or social life.
Dedicate, more than ever, time and pampering to our partner and children.
The world and life go on. Let's try to maintain relationships with friends, even if we have to space them out. The phone works too.
Take a walk or exercise, at least for half an hour a day.
Go from time to time to shows (theatre, cinema, music), museums, …
Hire the help of professionals, so that, at least from time to time, they spend the night with the patient. Or ask for help from family or friends, to replace us.
Do not neglect food or rest. Tired or sad we will not do our job well. The patient will notice. He needs help, but also conversation and good vibes.
The patient, in addition to basic care - feeding, cleaning and medicalization - requires tranquility and a lot of affection. We will offer you our calm and accompanying words. And, together with them, caresses and kisses, exponents of our closeness and love.
We will maintain a good physical and emotional condition. Our life has undergone changes, but I am still the protagonist of it: I try to ensure that my work, hobbies, care and relationships with loved ones are disrupted as little as possible.
One of the experiences that plunges us into a new phase of our lives is becoming grandmothers or grandfathers, a vital moment for which we are not always prepared and to which not everyone accesses in the same way.
Some people experience a kind of sensation of decrepitude and involution, while other people feel with the new status a rebirth of dormant illusions.
Assuming that we are grandmothers and grandfathers
It is about recognizing oneself in the new status, and one must be aware that the following will intervene in this.
The way to internalize and accept the new role in the family.
The resolution of the internal conflict between the desire and the fear of already having grandchildren. The desire to be a grandfather is related to the opportunity to enjoy with the children of the children, remembering, but not imitating, one's own motherhood or fatherhood. Fear comes from the evidence that one is older than then.
The state of health, the ability to articulate movements, visual and hearing acuity, is not the same.
How previous life cycles were lived. It is often said that one ages as one has lived. The way to be a grandmother or grandfather will depend on how you lived your childhood, on how you were a child yourself and how you were a grandson. The relationship with their own grandparents is remembered, and it is imitated or improved. Of course, it also influences how adulthood has been lived and how one is, and left, father and mother.
How the current life cycle is being lived. Until not long ago, becoming a grandfather or grandmother in itself marked the entrance into the third age or old age. Today, as a consequence of the increase in life expectancy and quality, and due to the new stimuli of the society in which we live, it is not the same as being old. There are grandmothers and grandfathers who are living fully at work, socially or with family, and having grandchildren has not turned them into "old" misfits and useless.
How the family can help grandparents fulfill their role
Promoting your independence. Grandparents want to have time for their things, useless as they may seem to the rest of the family. They also need their space. If they are comfortable in their house, there is no reason to force them to move to another. It is one thing to invite with insistence and affection, another very different to impose the criteria of the children.
/imgs/20040501/interiormente02.jpgAllow them to act as grandparents with their grandchildren. For them it is "the second chance" to do with their grandchildren what they did not do with their children. It is good to turn a blind eye when they "spoil" the grandchildren by granting them some reasonable whim and sporadically.
It is convenient to treat them as adults. Sometimes they are treated like children with the excuse that since they are older they become childish and "dotty". We must avoid becoming educators of grandparents.
Respect their flaws as they have done before with ours. Family life is much easier when you are flexible with the behavior of its members.
Being grateful to them and teaching the grandchildren to be so. We must not forget that we are 'dwarfs on the shoulders of giants' and that if we are more, have more or are better prepared, it is largely thanks to them.
It is important to listen to them and respect their ways of thinking, even if they do not coincide with that of the younger generation in the family. It is not true that "any time in the past was better", nor is it true that everything today is absolutely extraordinary or infallible.
Dwarfs on the shoulders of giants
Being a grandfather or grandmother is a unique opportunity for many positive experiences to emerge. New ways of living together can be learned between the three generations that have emerged within the family itself. You can take advantage of the opportunity that your grandchildren give to be in contact with other ways of living, with other knowledge, with other points of view that enrich the elderly if they are open to changes and new ways of life. That is why it is so important that, as long as the hustle and bustle of today's life allows us, family gatherings are organized with any excuse to be together and enjoy the pleasure of seeing, hearing and feeling each other. The best tribute that can be done to grandparents is to offer them the pleasure of sitting at a table with their children and grandchildren. In this scenario, the results of personal stories often full of efforts and difficulties are reflected. It is really satisfying to be able to offer grandparents the chance to prove that their lives have been worth living.
Attitudes that grandparents and grandmothers should cultivate
Retain your own independence, if possible. Regardless of their age, grandmother and grandfather have the right and need to enjoy their own spacevital, to have time for their hobbies, friendships or to project, if they feel like it, new affective relationships. They do not have to agree to become a permanent “babysitter” grandmother or grandfather.
Respect the educational guidelines that your children propose to your grandchildren, even if you do not fully agree with them.
Do not disavow the parents in front of the grandchildren, even if in private they can express their discrepancies. The opinions of grandparents are always a useful reference for parents, but it will be the parents who ultimately decide how to educate their children.
Being a grandfather is the opportunity to establish a privileged relationship with the grandchildren that perhaps could not be had with the children. It is the occasion to playfully live with them, gratifying them, but without going overboard, and asking themselves if their parents would agree to allow it. Limits must be set so that the grandchildren do not become tyrants.
Take advantage of any moment to transmit experiences and memories. There is no need to fear being heavy. Older people have the past as their heritage and "grandfather's battles" even if they are repeated over and over again -because older people do not usually keep track of the number of times they say things- are the memory that will remain impregnated in the minds of the grandchildren. Above all, the affection, illusion and nostalgia with which the memories were transmitted will remain.
Grandparents can complete the education carried out by parents, but never replace it. This is a risk that is run today, given that current circumstances force in many cases that grandparents or grandmothers take care of their grandchildren for many hours.
Treatment to ensure the health of the sick person also depends on their own involvement and ability to participate in therapeutic decision-making. The sick, less patient and more active
The sick person deposits his trust and hope in medical knowledge. But the patient is far from being a passive subject in the recovery process. He can, and it is advisable that he does, demand personalized treatment, a better health-patient relationship, adequate and correct information, as well as the possibility of participating in decisions about his health. Concepts such as continuous improvement, quality or excellence, already established in other areas of society, are emerging as benchmarks for the management systems of healthcare organizations.
new roles
Until a few years ago, the traditional model of the doctor-patient relationship was based on a paternalistic model: the doctor, after listening to and recognizing the patient, issued the diagnosis and established a treatment. He knew what was best for the patient and he passively consented, barely receiving information about the different therapeutic alternatives with their advantages and disadvantages. in this typeIn the relationship, the patient was nothing more than a passive element who had little to say and rarely dared to question the opinion of the professional.
This model has been disappearing in recent decades and the doctor-patient relationship has been transformed. The evolution of social relationships, the rise of individual rights and the accessibility to a great deal of information have encouraged the patient to increasingly assume a co-protagonist role in their health care and in decision-making. when you need treatment.
However, for this new role to develop satisfactorily, certain conditions must be met. The first is the guarantee of the quality of the information accessed or provided to the patient. Law 41/2002 on Patient Autonomy provides in its article 4.3 that "the doctor responsible for the patient guarantees compliance with his right to information and the professionals who attend him during the care process or apply a specific technique or procedure they will also be responsible for informing you.” It must be taken into account that not only the doctor is involved in care, but also the rest of the health personnel who participate in the process: nurses, physiotherapists, assistants or social workers, among others. When multiple parties are involved,
Along these lines, the General Health Law establishes the physician's obligation to inform the patient, and Law 41/2002 on Patient Autonomy introduces the figure of the responsible physician, that is, the one who coordinates the information and care: "every patient You must be informed by your responsible doctor before obtaining written consent, also guaranteeing your right to complete information”.
However, and despite the important protection provided by the current legal framework - Article 43 of the Spanish Constitution of 1978, General Health Law of 1986, Basic Law 41/2002 Regulating Patient Autonomy and Rights and Obligations in the field of Information and Clinical Documentation, and those that the autonomous communities have established for their respective territories- an evaluation of their knowledge by users or their effectiveness in daily clinical practice is not contemplated. This aspect is basic, since if an individual does not know her rights and obligations, he will not be able to participate in making decisions about his treatment, diagnosis, etc.
Information requirements
The information also raises other important questions. Until recently, medical professionals held the hegemony over health-related information. Now, health information, which invades the press and, in particular, the Internet, is growing exponentially -although its reliability is sometimes questionable- and is available to almost everyone: 19.6% of Internet queries that are carried out in Spain and focus on issues relatedwith health and it is increasingly common for patients to consult their doctors about issues that they have first read on the Internet. All of this configures a new reality in which health professionals act as advisers on access and quality of available health information, an activity that requires adapting consultation times.
Precisely, the lack of time to care for patients is the most important drawback for this ideal model of "shared decision-making" to develop successfully in daily clinical practice. For this reason, the written information and informed consent document is usually used almost exclusively, although some studies suggest that the content of many of these documents is deficient. Therefore, and despite the legal initiatives that seek to promote the right to information and patient autonomy, the minimum objectives are far from being achieved.
Greater involvement
On a higher rung is the implication and participation of the citizen in the decisions of sectoral policies in health and health services. Experts, associations and international organizations such as the Organization for Economic Cooperation and Development (OECD), the World Health Organization (WHO) and the Council of Europe have drawn up a series of recommendations on the participation of citizens and patients in the decision-making process in health systems. The need to redesign them to adapt to the new reality is clear and the participation of citizens in this process is one of the best indicators for the patient's health to improve from all points of view.
The Spanish Constitution of 1978
Title I. Fundamental rights and duties
Third chapter. Of the guiding principles of social and economic policy
Article 43
1. The right to health protection is recognized.
2. It is the responsibility of the public powers to organize and protect public health through preventive measures and the necessary benefits and services. The law will establish the rights and duties of everyone in this regard.
3. The public powers will promote health education, physical education and sport. They also encourage the proper use of leisure.
precedents
The closest thing to a precedent in terms of health protection in Spanish constitutionalism is found in article 46.2 of the 1931 Constitution, according to which "the social legislation (of the Republic) will regulate the cases of health insurance. .", with no references to sports practice or the use of leisure.
Elaboration of the precept
Article 43 did not have a troubled development process. On the contrary, it barely underwent changes from the first draft of the Constitutional Draft to the version approved by the Constitutional Commission of the Senate, which would already be the final one.
Comparative Law
Article 32 of the Italian Constitution of 1947 establishes that "The Republic protects health as a fundamental right of the individual and guarantees free medical treatment for the indigent. No one can be forced to a specific health treatment except by provision of the law, the which in no case may violate the limits imposed by respect for the human person".
A) HEALTH
Introduction
The Spanish Constitution of 1978, in its article 43, recognizes the right to health protection, entrusting the public powers ("generic concept that includes all those entities (and their bodies) that exercise an imperial power, derived from sovereignty of the State and proceeding, consequently, through a more or less long mediation, of the people themselves" STC 35/1983, of May 11) organize and protect public health through preventive measures and benefits and necessary services. In its article 41, of undoubted thematic connection with the commented article, the Constitution establishes that the public powers will maintain a public Social Security regime for all citizens, which guarantees sufficient assistance and social benefits in situations of need. In turn, article 42.1.
Finally, title VIII of the constitutional text designs a territorial organization of the State that makes possible the assumption by the Autonomous Communities of competences in matters of health (art. 148.1.21.ª), reserving for the latter foreign health, the regulation of bases and general coordination of health and legislation on pharmaceutical products (art. 149.1.16.ª). Under the protection of the constitutional provisions and the respective Statutes of Autonomy, all the Autonomous Communities have gradually assumed powers in matters of health. This process was completed with a stable financing model, through the approval of Law 21/2001, of December 27,it is also necessary to consider the modifications introduced in said financing system by laws 22 and 23 of 2009, the complementary organic law 3/2009 and, more recently, by Organic Law 6/2015, of June 12, modifying the Law Organic 8/1980, of September 22, of financing of the Autonomous Communities.
At the level of the European Union, art. 4.2.f) of the Treaty on the Functioning of the European Union defines "common security issues in the field of public health" as shared competence between the Union and the Member States, and in its art. 6.a) attributes to the EU competence to support, coordinate or complement the action of the Member States in terms of protection and improvement of human health. In his art. 9 establishes that in the definition and execution of its policies and actions, the Union will take into account the requirements related to the protection of human health. The art. 36 allows prohibitions or restrictions on imports, exports or transit justified for reasons of public order, public morality and security, protection of the health and life of people and animals, and arts. 45 and 52 also allow restrictions on free movement and establishment for reasons of public health. The art. 114 calls for an approximation of the laws of the Member States in the field of health.
But essentially, the law of the Union regarding the protection of health is contained in Title XIV of the TFUE, which is headed "public health" (art. 168). It is a transversal competence, since the commitment is proclaimed that when defining and executing all the policies and actions of the Union, a high level of protection of human health is guaranteed, and cooperation and coordination between the States is promoted Member States in this area Even though it is a competence that is complementary to the action of the Member States, the ordinary legislative procedure (co-decision) is established so that the Union can issue regulations that address common security problems in this area, in relation to :
a) measures that establish high levels of quality and safety of organs and substances of human origin, as well as blood and blood derivatives; these measures shall not prevent any Member State from maintaining or introducing more stringent protection measures;b) measures in the veterinary and phytosanitary fields that have as their direct objective the protection of public health;c) measures that establish high standards of quality and safety of medicines and health products.
The European Parliament and the Council, also in accordance with the ordinary legislative procedure and after consulting the Economic and Social Committee and the Committee of the Regions, may also adopt incentive measures designed to protect and improve human health and, in particular, to combat against cross-border pandemics, measures relating to the surveillance of serious cross-border threats to health, alerting in the event of such threats and combating them, as well as measures directly aimed at protecting public health in terms of concerning tobacco and excessive alcohol consumption, excluding any harmonization of the laws and regulations of the Member States. The Council, at the proposal of the Commission, may also adopt recommendations to fulfill these purposes.
In any event, Union action in the field of public health shall respect the responsibilities of the Member States as regards the definition of theirhealth policy, as well as the organization and provision of health services and medical care.
Legislation
1. Law 14/1986, of April 25, General Health, constitutes the reference standard in this area, insofar as it establishes the structure and operation of the public health system, oriented primarily to the promotion of health and disease prevention. According to its article 1, its object consists of the general regulation of all actions that make it possible to make effective the right to health protection recognized in article 43 and concordant of the Constitution. The law has the status of basic norm, in the sense of article 149.1.16.ª of the Constitution, and is applicable throughout the national territory.
2. Holders of the rights to health protection and health care are:
a) all Spaniards and foreign citizens who have established their residence in the national territory, andb) Non-resident foreigners in Spain, as well as Spaniards outside the national territory, who will have this right guaranteed in the manner established by international laws and agreements.
In accordance with constitutional jurisprudence (SSTC 236/2007 and 139/2016, of July 21), the right to health protection and health care, as a legal configuration right, is capable of being modulated and, therefore, limited in its application to foreigners by current regulations, which will be examined later.
3. Everyone is recognized, with respect to the different public health administrations, a series of rights (art. 10), such as respect for personality, dignity and privacy, non-discrimination, information, confidentiality , to the assignment of a doctor, to participate in health activities, or to use claim channels and suggestions, among others, and also establishes a series of obligations (art. 11) , such as complying with the general prescriptions of health nature, common to the entire population, or take responsibility for the proper use of the benefits offered by the health system. At this point it is necessary to mention the important Law 41/2002, of November 14, basic regulation of patient autonomy and rights and obligations in terms of clinical information and documentation, which completes the provisions that the General Health Law states as general principles. This law reinforces and gives special treatment to the patient's right to autonomy, and pays special attention to prior instructions, which contemplate the patient's previously expressed wishes within the scope of informed consent. Regarding the right to information, as a right of the citizen when he demands health care, this has been the object in recent years of various clarifications and extensions by laws and provisions of different types and ranges. Thus, Organic Law 15/1999, of December 13, on the Protection of Personal Data, qualifies data relating to the health of citizens as specially protected data, establishing a particularly rigorous regime for obtaining it,
4. According to the General Health Law, the public powers will guide their health spending policies in order to correct health inequalities and guarantee equal access to public health services throughout the Spanish territory, according to the provisions of articles 9.2 and 158.1. of the Constitution (art.12). The rules ofuse of health services will be the same for everyone, regardless of the condition in which they are accessed (art.16)
5. Foreign health and international health relations and agreements are the exclusive competence of the State (art. 38). The Autonomous Communities will exercise the powers assumed in the Statutes and those that the State transfers to them or, where appropriate, delegates to them (art. 41). The decisions and public actions provided for in the Law that have not been expressly reserved to the State will be understood to be attributed to the Autonomous Communities (art. 41.2)
6. All structures and public services at the service of health will be integrated into the National Health System, a set of Health Services of the State Administration and the Health Services of the Autonomous Communities in the terms established in the Law ( art. 44), which has as fundamental characteristics:
a) the extension of its services to the entire populationb) the adequate organization to provide comprehensive health carec) the coordination and, where appropriate, the integration of all public health resources in a single device.d) financing through resources from the Public Administrations, contributions and fees for the provision of certain services.e) the provision of comprehensive health care, seeking high levels of quality duly evaluated and controlled. (art. 46)
7. In each Autonomous Community, a health service will be established, made up of all the centers, services and establishments of the Community itself, Provincial Councils and Town Halls and any other intra-community territorial Administrations, which will be managed under the responsibility of the respective Autonomous Community. (art. 50)
8. The Autonomous Communities will delimit and establish in their territory demarcations called health areas, which are the fundamental structures of the health system, responsible for the unitary management of the centers and establishments of the health service of the Autonomous Community in their territorial demarcation and the benefits and health programs to be developed by them (art. 56)
9. The State and the Autonomous Communities will approve health plans within the scope of their respective powers and may establish joint health plans (arts. 70 and 71)
10. The financing of the healthcare provided will be charged to:
a) social contributionsb) State transfersc) fees for the provision of certain servicesd) contributions from the Autonomous Communities and Local Corporationse) ceded state taxes (Law 21/2001)
11. The right to free exercise of the health professions is recognized, in accordance with the provisions of articles 35 and 36 of the Constitution (art. 88). At this point, it is necessary to cite Law 44/2003, of November 21, on the organization of health professions, which aims to regulate the basic aspects of qualified health professions in regard to their exercise on their own or foreign, to the general structure of the training of professionals, to the professional development of these and their participation in the planning and management of thehealth professions. The provisions of the law are applicable both if the profession is practiced in the public health services and in the field of private health. Law 55/2003, of December 16, on the Framework Statute of statutory health service personnel, must also be taken into account, the purpose of which is to establish the regulatory bases for the special civil service relationship of statutory health service personnel. that make up the National Health System, through the Framework Statute of said personnel. Finally, and in the same way, the General Health Law recognizes the freedom of business in the health sector, in accordance with article 38 of the Constitution (art. 89) and the possibility for public health administrations, in the field of their respective powers,
12. It corresponds, according to the law, to the State Health Administration, to assess the sanitary suitability of medicines and other sanitary products and articles, both to authorize their circulation and use and to control their quality (art. 95). At this point it should be remembered once again that in 2002 the process of decentralization of health care in the National Health System culminated, so that all the Autonomous Communities have assumed the functions that they had been performing and the services that the National Institute of Health had been providing. Health, including pharmaceutical benefits. This includes medicines and health products, as well as the set of actions aimed at ensuring that patients receive and use them appropriately and with the necessary information for their correct use and at the lowest possible cost.
As regards the regulations on this matter, Law 29/2006, of July 26, sought, like Law 25/1990, of December 20, on Medicines, repealed by it, to provide Spanish society of an institutional instrument that would allow drug-related problems to be addressed by all the social agents involved in their management, from the perspective of improving health care.
The continuous succession of regulations that have completed or modified, with different scope, Law 29/2006, among others those aimed at containing pharmaceutical spending in a context of economic crisis, made it advisable to prepare a single text that included, duly harmonized , all applicable provisions within the scope of said law. To this end, the revised text of the Law on guarantees and rational use of medicines and health products, approved by Royal Legislative Decree 1/2015, of July 24, repeals the 2006 law, except for certain final provisions.
The current Law regulates, in the field of powers that correspond to the State:
a) all aspects related to medicines for human use and medical devices;b) the actions of natural or legal persons as they intervene in industrial or commercial circulation and in the prescription or dispensing of medicines and health products;c) the criteria and general requirements applicable to veterinary medicines; andd) cosmetics and personal care products.
The Law pays special attention to the regime of guarantees, both those of a general nature provided for in Title I (supply and dispensation, independence, defenseof public health or transparency), such as those specifically predicable of medicines for human use and veterinary medicines, regulated respectively in chapters II and III of Title II. Title III regulates the investigation of medicines for human use and Title IV establishes the guarantees required in the manufacture and distribution of medicines, including the mandatory authorizations and administrative control, which is exercised by the Spanish Agency for Medicines and Health Products. Titles V and VI foresee, respectively, the sanitary guarantees of the foreign trade of medicines and the records of pharmaceutical laboratories and manufacturers, importers or distributors of active ingredients. The regime relating to the rational use of medicines for human use is established in Title VII and public financing of medicines and health products is included in Title VIII. Finally, the Law closes with the titles related to the sanctioning regime, the cessation action and the applicable rates.
13. In another order of issues, with regard to pharmacies, considered as health establishments (STC 109/2003, of July 5 and 181/2014, of November 6, among others), the General Law of Health provides that they will be subject to health planning in the terms established by the special legislation on medicines and pharmacy (art. 103.3). In compliance with this provision, Law 16/1997, of April 25, regulating the services of pharmacies, which has its origin in Royal Decree-Law 11/1996, proposed to adapt the regulations governing the sector ( in force since 1978) to new needs and improve pharmaceutical care for the population, through a series of measures such as:
