Turkiye Klinikleri Journal of Medical Ethics-Law and History

.: REVIEW
SMA Tarama, Tanı ve Tedavisinde Karşılaşılan Etik Sorunlar, Sağlık Politikalarında Yükselen Popülizm ve Medyanın Etkisi: Sistematik Derleme
Ethical Problems Faced in SMA Screening, Diagnosis and Treatment, Rising Populism in Health Policy and Impact of the Media: Systematic Review
Gülten DİNÇa , Mehmet Gökhan AKINb , Zeynep ERATb
aİstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Tıp Tarihi ve Etik ABD, İstanbul, Türkiye
bİstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, İstanbul, Türkiye
Turkiye Klinikleri J Med Ethics. 2024;32(1):64-75
doi: 10.5336/mdethic.2023-99285
Article Language: TR
Full Text
ÖZET
 Spinal musküler atrofi (SMA), ilerleyici ve kalıtsal bir motor nöron hastalığıdır. Beş tipi olan hastalığın günümüzde kesin bir tedavisi yoktur. Güncel tedaviler hastalığın ilerleyişini yavaşlatıp hastaların yaşam süresini uzatsa ve yaşam kalitesini iyileştirebilse de tedavilere ilişkin birçok sosyal ve etik problem ortaya çıkabilir. Ortaya çıkan bu problemler arasında; tedavinin çok yüksek olan maliyeti, tedavi sürecinde dijital ve konvansiyonel (geleneksel) medyanın gücünden yararlanma olanaklarındaki eşitsizlikler, kaynakların adil olmayan dağılımı ve SMA'ya ilişkin sağlık politikalarında yükselen popülizm sayılabilir. Bununla beraber SMA hastalığına ilişkin etik problemler sadece tedavi ile sınırlı değildir. Tanı ve tarama testlerindeki yetersizlikler, hastaların palyatif bakım ve yaşam sonu desteğine ihtiyaç duyabilmesi, hastaların ve ailelerin aydınlatılmış onamlarının alınması, yasa ve yönetmeliklerin uygulanmasındaki güçlükler ve bu gibi birçok konu da etik açıdan tartışmalıdır. Tüm bunlara ek olarak söz konusu etik problemlerin ana öznesini çoğu zaman; savunmasız bir hasta grubunun yani bakıma muhtaç çocukların oluşturduğu gerçeği bu etik problemleri daha da karmaşık hâle getirmektedir. Ancak SMA'nın oldukça geniş bir yelpazede birçok etik probleme neden olmasına karşın hastalığı tıp etiği açısından irdeleyen yeterli sayıda kaynak bulunmamaktadır. Bu nedenle makalede özellikle ülkemiz açısından; hastalığın tarama, tanı ve tedavisi sırasında ortaya çıkabilecek etik sorunlar ile birlikte sağlık politikaları ve hastalıkla ilgili popülizmde medyanın etkisi gözden geçirilecektir.

Anahtar Kelimeler: SMA; etik; tıbbi kitle fonlaması; sağlık politikaları; medya etkisi
ABSTRACT
 Spinal muscular atrophy (SMA) is a progressive and inherited motor neuron disease. The disease has five types and currently there is no definitive treatment for the disease. Although current treatments can slow the progress of disease, prolong patient's life span and improve quality of life; they can lead to many social and ethical problems. These problems include; extremely high treatment costs, inequalities in utilization of digital and conventional (traditional) media power during the course of treatment, unfair distribution of resources and rising populism in health policies regarding SMA. Furthermore, ethical problems relating to SMA are not limited only to its treatment. Many issues such as imperfections in the diagnosis and screening tests, patients' need for palliative care and end-of-life support, obtaining informed consent of patients and families, and difficulties in the execution of laws and regulations are also ethically controversial. Additionally, the fact that the main subject of aforementioned ethical problems caused by a vulnerable patient population; children in need of nursing care most of the time, makes these ethical problems even more complex. Although SMA causes a wide range of ethical problems, there is no sufficient number of resource examining the disease under the scope of medical ethics. Therefore, in this article, we will examine the ethical problems that may arise during the course of screening, diagnosis and treatment of the disease, especially in Türkiye, as well as the impact of the media on health policies and populism related to the disease.

Keywords: SMA; ethics; medical crowdfunding; health policies; media influence
REFERENCES:
  1. Nanette C, Joyce DO. Spinal muscular atrophy. In: Nelson MR, ed. Pediatrics; Rehabilitation Medicine Quick Reference. 2nd ed. New York: Demos Medical; 2011. p.206-7.
  2. Burr P, Reddivari AKR. Spinal Muscle Atrophy. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [PubMed] 
  3. Bofanova NS, Eliseeva AR, Onchina VS. Sovremennye printsipy terapii patsientov so spinal'nymi myshechnymi atrofiyami [Modern principles of therapy for patients with spinal muscular atrophy]. Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(3):34-40. Russian. [Crossref]  [PubMed] 
  4. CADTH. Pharmacoeconomic Review Report: Nusinersen (Spinraza): (Biogen Canada Inc.): Indication: Treatment of patients with 5q SMA [Internet]. Appendix 1, Cost Comparison. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2018. Cited: May 5, 2023. Available from: [Link] 
  5. Ogbonmide T, Rathore R, Rangrej SB, Hutchinson S, Lewis M, Ojilere S, et al. Gene therapy for spinal muscular atrophy (SMA): a review of current challenges and safety considerations for onasemnogene abeparvovec (Zolgensma). Cureus. 2023;15(3):e36197. [Crossref]  [PubMed]  [PMC] 
  6. Mahajan R. Onasemnogene abeparvovec for spinal muscular atrophy: the costlier drug ever. Int J Appl Basic Med Res. 2019;9(3):127-8. [Crossref]  [PubMed]  [PMC] 
  7. Baranello G, Darras BT, Day JW, Deconinck N, Klein A, Masson R, et al; FIREFISH Working Group. Risdiplam in type 1 spinal muscular atrophy. N Engl J Med. 2021;384(10):915-23. [Crossref]  [PubMed] 
  8. Markati T, Fisher G, Ramdas S, Servais L. Risdiplam: an investigational survival motor neuron 2 (SMN2) splicing modifier for spinal muscular atrophy (SMA). Expert Opin Investig Drugs. 2022;31(5):451-61. [Crossref]  [PubMed] 
  9. CADTH. CADTH Reimbursement Recommendation; Risdiplam (Evrysdi). Canadian Journal of Health Technologies. 2021;1(8):1-15 [Crossref] 
  10. Mercuri E, Finkel RS, Muntoni F, Wirth B, Montes J, Main M, et al; SMA Care Group. Diagnosis and management of spinal muscular atrophy: Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscul Disord. 2018;28(2):103-15. [PubMed] 
  11. Butchbach ME. Copy number variations in the survival motor neuron genes: implications for spinal muscular atrophy and other neurodegenerative diseases. Front Mol Biosci. 2016;3:7. [Crossref]  [PubMed]  [PMC] 
  12. Verhaart IEC, Robertson A, Wilson IJ, Aartsma-Rus A, Cameron S, Jones CC, et al. Prevalence, incidence and carrier frequency of 5q-linked spinal muscular atrophy - a literature review. Orphanet J Rare Dis. 2017;12(1):124. [Crossref]  [PubMed]  [PMC] 
  13. Prior TW; Professional Practice and Guidelines Committee. Carrier screening for spinal muscular atrophy. Genet Med. 2008;10(11):840-2. [Crossref]  [PubMed]  [PMC] 
  14. Özdemir Y, Arısoy R, Semiz A, Şanlıkan F, Akar G, Çağ M. Carrier frequency of spinal muscular atrophy in Turkish population. Perinatal Journal 2022;30(1):57-60. [Crossref] 
  15. Demir N, Ceylaner S. Spinal Müsküler Atrofi (SMA) bilgilendirme belgesi (Perinatoloji uzmanları için). Maternal-Fetal Tıp ve Perinatoloji Derneği. 2019. Erişim tarihi: 2 Mayıs 2023. Erişim linki: [Link] 
  16. Boardman FK, Young PJ, Griffiths FE. Impairment experiences, identity and attitudes towards genetic screening: the views of people with spinal muscular atrophy. J Genet Couns. 2018;27(1):69-84. [Crossref]  [PubMed]  [PMC] 
  17. T.C Sağlık Bakanlığı [İnternet]. © 2023 Halk Sağlığı Genel Müdürlüğü [Erişim tarihi: 10 Ekim 2022]. Evlilik Öncesi Spinal Musküler Atrofi (SMA) Taşıyıcı Tarama Programı. Erişim linki: [Link] 
  18. Resmî Gazete (11.8.2021/31565) Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinde Değişiklik Yapılamasına Dair Tebliğ; 2021. [Erişim tarihi: 11 Haziran 2023]. Erişim linki: [Link] 
  19. T.C Sağlık Bakanlığı [İnternet]. © 2023 Halk Sağlığı Genel Müdürlüğü [Erişim tarihi: 10 Ekim 2022]. Yenidoğan Metabolik ve Endokrin Hastalık Tarama Programı (NTP). Erişim linki: [Link] 
  20. T.C Sağlık Bakanlığı [İnternet] © 2023 Halk Sağlığı Genel Müdürlüğü [Erişim tarihi: 10 Ekim 2022]. Evlilik Öncesi Spinal Musküler Atrofi (SMA) Taşıyıcı Tarama Programı. Erişim linki: [Link] 
  21. Marseille E, Kahn JG. Utilitarianism and the ethical foundations of cost-effectiveness analysis in resource allocation for global health. Philos Ethics Humanit Med. 2019;14(1):5. [Crossref]  [PubMed]  [PMC] 
  22. Cookson R, McCabe C, Tsuchiya A. Public healthcare resource allocation and the Rule of Rescue. J Med Ethics. 2008;34(7):540-4. [Crossref]  [PubMed] 
  23. Jonsen AR. Bentham in a box: technology assessment and health care allocation. Law Med Health Care. 1986;14(3-4):172-4. [Crossref]  [PubMed] 
  24. Aydın E. Tarihsel ve güncel yönden tıp etiği [Historical and current medical ethics]. Erdem, İnsan ve Toplum Bilimleri Dergisi Etik Özel Sayısı. 2005;44:83-102. [Crossref] 
  25. Resmî Gazete (5.7.2017/30115) Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinde Değişiklik Yapılmasına Dair Tebliğ; 2017. [Erişim tarihi: 25 Mart 2023]. Erişim linki: [Link] 
  26. Resmî Gazete (1.2.2019/30673) Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinde Değişiklik Yapılmasına Dair Tebliğ; 2019. [Erişim tarihi: 25 Mart 2023]. Erişim linki: [Link] 
  27. Resmî Gazete (20.8.2020/31219) Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinde Değişiklik Yapılmasına Dair Tebliğ; 2019. [Erişim tarihi: 25 Mart 2023]. Erişim linki: [Link] 
  28. Resmî Gazete (2.2022/31744) Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinde Değişiklik Yapılmasına Dair Tebliğ; 2022. [Erişim tarihi: 25 Mart 2023]. Erişim linki: [Link] 
  29. SMA Bilim Kurulu toplantısına ilişkin açıklama (09.01.2021) [İnternet]. © T.C. Sağlık Bakanlığı (Erişim tarihi: 26 Eylül 2022). Erişim linki: [Link] 
  30. SMA Bilim Kurulu toplantısına ilişkin açıklama 31.01.2023. © T.C. Sağlık Bakanlığı. (Erişim tarihi: 23 Mart 2023). Erişim linki: [Link] 
  31. Nusinersen TA588 Variation 2_16 January 2022. Contract Variation Agreement No.2 Cited: December 22, 2022. Available from: [Link] 
  32. Min-jun J. SMA patients call for improving reimbursement standards for Spinraza. Korea Biomedical Review. April 21, 2023. [Cited: October 15, 2023]. Available from: [Link] 
  33. Min-jun J. SMA patients protest inconsistent reimbursement standards for Spinraza. Korea Biomedical Review. May 19, 2023. [Cited: October 15, 2023]. Available from: [Link] 
  34. Bilgili E, Ecevit E. Sağlık hizmetleri piyasasında asimetrik bilgiye bağlı problemler ve çözüm önerileri [Problems based on asymmetric information in healthcare market and resolutions]. Hacettepe Sağlık İdaresi Dergisi. 2008;11(2):201-28 [Link] 
  35. Harris J. Micro-allocation: deciding between patients. In: Kuhse H, Singer P, eds. A Companion to Bioethics. 1st ed. Oxford: Blackwell Publishers; 2001. p.293-305. [Crossref] 
  36. World Health Organization. WHO methods and data sources for global burden of disease estimates 2000-2019. Geneva: World Health Organization; 2020. [Link] 
  37. Chabrol B, Desguerre I. Ethical aspects in the care of a child with infantile spinal muscular atrophy (SMA). Arch Pediatr. 2020;27(7S):7S50-7S53. [Crossref]  [PubMed] 
  38. Hully M, Barnerias C, Chabalier D, Le Guen S, Germa V, Deladriere E, et al. Palliative care in SMA type 1: a prospective multicenter french study based on parents' reports. Front Pediatr. 2020;8:4. [Crossref]  [PubMed]  [PMC] 
  39. Ersoy N. Yaşamın sonuyla ilgili etik konular: I. Demirhan Erdemir A, Öncel Ö, Aksoy Ş, editörler. Çağdaş Tıp Etiği. 1. Baskı. İstanbul: Nobel Tıp Kitabevleri; 2003. p.328-89.
  40. Young MJ, Scheinberg E. The rise of crowdfunding for medical care: promises and perils. JAMA. 2017;317(16):1623-4. [Crossref]  [PubMed] 
  41. Kubheka BZ. Bioethics and the use of social media for medical crowdfunding. BMC Med Ethics. 2020;21(1):96. [Crossref]  [PubMed]  [PMC] 
  42. Snyder J. Crowdfunding for Medical care: ethical issues in an emerging health care funding practice. Hastings Cent Rep. 2016;46(6):36-42. [Crossref]  [PubMed] 
  43. CTV News [Internet]. © 2023 Bell Media [Cited: Jun 11, 2023]. 'Disgusting' scammer uses B.C. teen's cancer story to solicit donations. Available from: [Link] 
  44. Carollo K. Are Cancer Fraudsters Desperate or Psychopathic. ABC News. Aug 12, 2010. [Cited: June 11, 2023]. Available from: [Link] 
  45. DHA. Fotoğraf da valilik izni de sahte: Sosyal medyada 'hasta çocuk' dolandırıcılığı. CNN Türk. 18.03.2022. [Erişim tarihi: 11 Haziran 2023]. Erişim linki: [Crossref] 
  46. SMA'lı çocuğun adıyla dolandırıcılık yapan adam serbest bırakıldı. BirGün. 12.08.2022. [Erişim tarihi: 11 Haziran 2023]. Erişim linki: [Link] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com