[The legal awareness of medical workers in the system of medical care quality management].

PubMed

Khodakova, O V; Shil'nikova, N F

2012-01-01

The article presents the results of comprehensive study of the level of legal awareness of medical workers. The knowledge of physicians, paramedical personnel and health administrators concerning the rights of patients was assessed. The role of factor of legal awareness in the system of medical care quality management was analyzed. The effective system of measures of development of legal competence of medical personnel was marked out.

Developments in legal and medical practice regarding the unborn child and the need to expand prenatal legal protection.

PubMed

Dorscheidt, Jozef H H M

2010-12-01

Developments in legal and medical practice in the Netherlands give rise to questions regarding the legal position of the unborn child. This article provides an overview of these developments and argues--in view of developments in other countries--that current Dutch legislation regarding the unborn child is not up to date. In effect, the article challenges the idea that the actual legal protection of the unborn child under positive Dutch law can be considered proportionate, even sufficient. To support this view the author will show that abortion is not the only matter in which clarity as to the legal protection of the viable unborn child is required. This signalisation provides good cause to reconsider the Dutch perspective on the matter, thus offering a point of reference to countries with a similar interpretation of what constitutes an appropriate legal protection of the unborn child.

Reefer madness: legal & moral issues surrounding the medical prescription of marijuana.

PubMed

Barnes, R E

2000-01-01

California, Arizona, and several other states have recently legalized medical marijuana. My goal in this paper is to demonstrate that even if one grants the opponents of legalization many of their contentious assumptions, the federal government is still obligated to take several specific steps toward the legalization of medical marijuana. I defend this claim against a variety of objections, including the claims: that marijuana is unsafe, that marijuana cannot be adequately tested or produced as a drug, that the availability of synthetic THC makes marijuana superfluous, and especially that legalizing medical marijuana will increase recreational use by 'sending the wrong message.' I then go on to argue that given the intransigent position of the federal government on this issue, state governments are justified in unilaterally legalizing medical marijuana as an act of civil disobedience. A large portion of this paper consists of an extensive response to the objection that legalizing medical marijuana will 'send the wrong message'--which I take to be the primary impediment to legalization. This objection basically claims that the consequences of withholding legalization (especially preventing increased recreational use) are superior to those of legalizing medical marijuana. I argue that legalization is justified even if one were to grant both that the harms of legalization outweighed its benefits and that utilitarianism is true. This requires a subtle and somewhat extended discussion of utilitarian moral and political theory.

Pilot study of medical-legal partnership to address social and legal needs of patients.

PubMed

Weintraub, Dana; Rodgers, Melissa A; Botcheva, Luba; Loeb, Anna; Knight, Rachael; Ortega, Karina; Heymach, Brooke; Sandel, Megan; Huffman, Lynne

2010-05-01

As a preliminary investigation of the effectiveness of medical-legal partnership in pediatrics, we conducted a 36-month prospective cohort study of the impact of clinic- and hospital-based legal services. We hypothesized that integration of legal services into pediatric settings would increase families' awareness of and access to legal and social services, decrease barriers to health care for children, and improve child health. Health care providers referred families with legal or social needs to the Peninsula Family Advocacy Program (FAP). Fifty four families completed both baseline and six-month follow-up assessments. Comparison of follow-up with baseline demonstrated significantly increased proportions of families who utilized food and income supports and significantly decreased proportions of families avoiding health care due to lack of health insurance or concerns about cost. Two-thirds of respondents reported improved child health and well-being. This study suggests that adding an attorney to the medical team increases awareness of and access to social and legal services.

Competency and capacity: the legal and medical interface.

PubMed

Purser, Kelly; Magner, Eilis S; Madison, Jeanne

2009-05-01

The loss of legal competency, in the context of wills, enduring powers of attorney and advance directives, presents a challenge to individual autonomy. Both legal and medical practitioners have roles to play in determining when, and if, to infringe upon a person's sovereignty in order to provide for their protection. However, there is some evidence that inter-professional discussions are characterised by tension. Medical expertise is necessary to assess physical and mental capacity, but the legal concern is with competency, two distinct terms. It is argued here that cooperation between the legal and medical professions is essential in this area of practice. This article attempts to promote discussion of this objective by proposing therapeutic jurisprudence as a theoretical framework in which to reassess competency determinations, by reviewing the institutional structure and by suggesting that the adoption of a common and consistent terminology is essential.

Medical Cannabis in Arizona: Patient Characteristics, Perceptions, and Impressions of Medical Cannabis Legalization.

PubMed

Troutt, William D; DiDonato, Matthew D

2015-01-01

Many advances have been made toward understanding the benefits of medical cannabis. However, less is known about medical cannabis patients themselves. Prior research has uncovered many important patient characteristics, but most of that work has been conducted with participants in California, who may not represent medical cannabis patients throughout the United States. Furthermore, it is unknown if medical cannabis legalization, which typically imposes strict regulations on cannabis cultivation and sale, impacts patients' experiences acquiring and using cannabis. The goal of this study was to address these limitations by (1) examining the characteristics, perceptions, and behaviors of medical cannabis patients in Arizona; and (2) questioning participants with a history of cannabis use regarding their experiences with cannabis before and after legalization. Patients in Arizona share many characteristics with those in California, but also key differences, such as average age and degree of cannabis consumption. Participants also had positive perceptions of the effect of medical cannabis legalization, reporting that feelings of safety and awareness were higher after legalization compared to before. The results are discussed in relation to evidence from patients in other states and in terms of their potential policy implications.

Legal Care as Part of Health Care: The Benefits of Medical-Legal Partnership.

PubMed

Murphy, Johnna S; Lawton, Ellen M; Sandel, Megan

2015-10-01

Many of the social determinants of health are rooted in legal problems. Medical-legal partnerships (MLPs) have the potential to positively change clinical systems. This change can be accomplished by integrating legal staff into health care clinics to educate staff and residents on social determinants of health and their legal origins. When the MLP team works directly with patients to identify and address legal needs that improve health outcomes, and incorporate legal insights and solutions into health care practice where the patient population is overwhelmingly impacted by social conditions, outcomes are beneficial to children and families. Copyright © 2015 Elsevier Inc. All rights reserved.

Interprofessional Medical-Legal Education of Medical Students: Assessing the Benefits for Addressing Social Determinants of Health.

PubMed

Pettignano, Robert; Bliss, Lisa; McLaren, Susan; Caley, Sylvia

2017-09-01

Screening tools exist to help identify patient issues related to social determinants of health (SDH), but solutions to many of these problems remain elusive to health care providers as they require legal solutions. Interprofessional medical-legal education is essential to optimizing health care delivery. In 2011, the authors implemented a four-session didactic interprofessional curriculum on medical-legal practice for third-year medical students at Morehouse School of Medicine. This program, also attended by law students, focused on interprofessional collaboration to address client/patient SDH issues and health-harming legal needs. In 2011-2014, the medical students participated in pre- and postintervention surveys designed to determine their awareness of SDH's impact on health as well as their attitudes toward screening for SDH issues and incorporating resources, including a legal resource, to address them. Mean ratings were compared between pre- and postintervention respondent cohorts using independent-sample t tests. Of the 222 medical students who participated in the program, 102 (46%) completed the preintervention survey and 100 (45%) completed the postintervention survey. Postintervention survey results indicated that students self-reported an increased likelihood to screen patients for SDH issues and an increased likelihood to refer patients to a legal resource (P < .001). Incorporating interprofessional medical-legal education into undergraduate medical education may result in an increased likelihood to screen patients for SDH and to refer patients with legal needs to a legal resource. In the future, an additional evaluation to assess the curriculum's long-term impact will be administered prior to graduation.

The changing purpose of mental health law: From medicalism to legalism to new legalism.

PubMed

Brown, Jennifer

2016-01-01

The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally. Copyright © 2016 Elsevier Ltd. All rights reserved.

Medical marijuana: legal considerations.

PubMed

Schouten, J T

1999-01-01

In 1998, Washington State passed a law, Initiative 692 (I-692), that gives individuals who are charged with possession of marijuana for medical purposes a possible affirmative defense. The law lets these individuals provide a note from their doctor or a copy of their medical records stating they have a condition that may benefit from the use of marijuana. I-692 does not legalize the medical use of marijuana and does not affect Federal law, which makes obtaining, possessing, and growing marijuana illegal. The Washington law limits the amount of marijuana a patient can possess to a 60-day supply and defines the conditions for which medical marijuana may be used. These conditions include HIV, cancer, multiple sclerosis, and epilepsy.

Sexual Abuse of the Mentally Retarded Patient: Medical and Legal Analysis for the Primary Care Physician

PubMed Central

Morano, Jamie P.

2001-01-01

The primary care physician has a vital role in documenting and preventing sexual abuse among the mentally retarded populations in our community. Since the current national trend is to integrate citizens with mental retardation into the community away from institutionalized care, it is essential that all physicians have a basic understanding of the unique medical and legal ramifications of their clinical diagnoses. As the legal arena is currently revising laws concerning rights of sexual consent among the mentally retarded, it is essential that determinations of mental competency follow national standards in order to delineate clearly any instance of sexual abuse. Clinical documentation of sexual abuse and sexually transmitted disease is an important part of a routine examination since many such individuals are indeed sexually active. Legal codes adjudicating sexual abuse cases of the mentally retarded often offer scant protection and vague terminology. Thus, medical documentation and physician competency rulings form a solid foundation for future work toward legal recourse for the abused. PMID:15014610

Legal Issues for the Medical Director.

PubMed

Trulove, William G

2015-09-04

The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles-nephrology practice and the leadership of a dialysis clinic-may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment. Copyright © 2015 by the American Society of Nephrology.

Legal Issues for the Medical Director

PubMed Central

2015-01-01

The nephrologist serving as medical director of a dialysis clinic must understand that the role of director is not simply an extension of being a good nephrologist. The two roles—nephrology practice and the leadership of a dialysis clinic—may be filled by a single person. However, each role contains unique tasks, requiring specific skill sets, and each role comes with inherent, associated legal risks. The medical director assumes a new level of responsibility and accountability defined by contractual obligations to the dialysis provider and by state and federal regulations. Hence, a medical director is accountable not only for providing standard-of-care treatment to his or her private practice patients dialyzed at the clinic but also for maintaining the safety of the dialysis clinic patient population and staff. Accordingly, a nephrologist serving in the role of medical director faces distinct legal risks beyond typical professional liability concerns. The medical director must also be mindful of regulatory compliance, unique avenues to licensure board complaints, and implications of careless communication habits. A thoughtful and prepared medical director can mitigate these risk exposures by understanding the sources of these challenges: contractual obligations, pertinent regulatory responsibilities, and the modern electronic communications environment. PMID:25492255

Medical-Legal Partnerships At Veterans Affairs Medical Centers Improved Housing And Psychosocial Outcomes For Vets.

PubMed

Tsai, Jack; Middleton, Margaret; Villegas, Jennifer; Johnson, Cindy; Retkin, Randye; Seidman, Alison; Sherman, Scott; Rosenheck, Robert A

2017-12-01

Medical-legal partnerships-collaborations between legal professionals and health care providers that help patients address civil legal problems that can affect health and well-being-have been implemented at several Veterans Affairs (VA) medical centers to serve homeless and low-income veterans with mental illness. We describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York in the period 2014-16. The partnerships served 950 veterans, who collectively had 1,384 legal issues; on average, the issues took 5.4 hours' worth of legal services to resolve. The most common problems were related to VA benefits, housing, family issues, and consumer issues. Among a subsample of 148 veterans who were followed for one year, we observed significant improvements in housing, income, and mental health. Veterans who received more partnership services showed greater improvements in housing and mental health than those who received fewer services, and those who achieved their predefined legal goals showed greater improvements in housing status and community integration than those who did not. Medical-legal partnerships represent an opportunity to expand cross-sector, community-based partnerships in the VA health care system to address social determinants of mental health.

[Psychiatric medication as restraint: between autonomy and protection, is there place for a legal framework?].

PubMed

Bernheim, Emmanuelle

2010-01-01

The use of chemical restraint has been regulated for the past ten years in Quebec. However, clinical, ethical and legal issues, sometimes contradictory, have not really been considered during the legislative process leading to consolidation in its current form. The author supports that, because of the absence of consent and the effects of medication, a specific legal framework to the use of medication is necessary in a context of unplanned intervention to protect both patients and medical staff. This framework would prescribe good practice, take into account the non-medical aspects of consent to care and formalize the practice as an exception to the rule. In addition, the symbolism of law, through which social solidarity can be expressed, must not be underestimated.

[Prescribing medication in 2013: legal aspects].

PubMed

Berland-Benhaïm, C; Bartoli, C; Karsenty, G; Piercecchi-Marti, M-D

2013-11-01

To describe the legal framework of medicine prescription in France in 2013. With the assistance of lawyer and forensic pathologist, consultation (legifrance.gouv.fr), analysis, summary of French laws and rules surrounding drugs prescriptions to humans for medical purpose. Free medicine prescription is an essential feature of a doctor's action. To prescribe involve his responsibility at 3 levels: deontological, civilian and penal. Aim of the rules of medicine prescription is to preserve patient's safety and health. Doctors are encouraged to refer to recommendations and peer-reviewed publication every time the prescriptions go out of the case planned by law. Knowledge and respect of medicine prescription legal rules is essential for a good quality practice. Medical societies have a major role to improve medicine use among practitioners. Copyright © 2013. Published by Elsevier Masson SAS.

Medical Marijuana Legalization and Co-use in Adult Cigarette Smokers.

PubMed

Wang, Julie B; Cataldo, Janine K

2016-03-01

We examined effects of long-term medical marijuana legalization on cigarette co-use in a sample of adults. We conducted secondary analysis using data from the 2014 US Tobacco Attitudes and Beliefs Survey, which consisted of cigarette smokers, aged ≥ 45 years (N = 506). Participants were categorized by their state residence, where medical marijuana was (1) illegal, (2) legalized < 10 years, and (3) legalized ≥ 10 years. The Web-based survey assessed participants' marijuana use, beliefs and attitudes on marijuana, and nicotine dependence using Fagerstrom Tolerance for Nicotine Dependence (FTND) and Hooked on Nicotine Checklist (HONC) scores. In cigarette smokers aged ≥ 45 years, long-term legalization of medical marijuana was associated with stable positive increases in marijuana use prevalence (ever in a lifetime) (p = .005) and frequency (number of days in past 30 days) (unadjusted p = .005; adjusted p = .08). Those who reported marijuana co-use had greater FTND and HONC scores after adjusting for covariates (p = .05). These preliminary findings warrant further examination of the potential impact of long-term legalization of medical marijuana on greater cigarette and marijuana co-use in adults and higher nicotine dependence among co-users at the population level.

Medical-Legal Partnerships: A Healing Collaboration.

PubMed

Wick, Caroline J; Wick, Jeannette Y

2018-02-01

Medical providers know that there are some conditions they can't treat because the condition is caused or exacerbated by social conditions and are known as "social determinants of health." ThIs classic example-a patient has asthma, lives in a moldor cockroach-infested apartment, has no resources to move, and has a landlord who refuses to clean or exterminate bugs- exemplifies why patients need legal advocates to improve their health. This article discusses medical-legal partnerships (MLPs), models in which medical providers refer patients to attorneys to represent them to resolve such problems. MLPs recognize social determinants of health and foster collaboration between attorneys and health care providers. Originally developed to advocate for children, many MLPs now focus on the vulnerable elderly, individuals at the end of life, and veterans. As these collaborations grow, it's important to spread the word among health care providers and to engage all collaborators. Today, more than 300 MLPs across the nation have documented remarkable achievements. The authors hope that in the future, pharmacists will become MLP team members and help patients address many of their medication-related problems.

[Legal quality criteria of expert opinions in liability for medical malpractice].

PubMed

Neu, Johann

2017-09-01

In litigation regarding to liability for medical malpractice the court itself for lack of medical expert knowledge cannot judge a claimed error in treatment. That applies too for the question if there is causation between the error in treatment and claimed damage to patient's health. In this respect, the court is dependent on a medical expert and is bound to his assessment, unless there is no quality deficit in respect of medical and/or legal criteria. The more the medical expert knows the legal background of physician's liability for medical malpractice, the less is the risk of legal quality deficits in his expert opinion and thereby also of judicial errors by court. Georg Thieme Verlag KG Stuttgart · New York.

Medical and legal considerations in managing patients with musculoskeletal tumors.

PubMed

Morris, Carol D; Bal, B Sonny; D'Elia, Elizabeth M; Benevenia, Joseph

2014-01-01

At some point in their careers, many orthopaedic surgeons will have to navigate the legal system as it pertains to medical malpractice. An orthopaedic surgeon will find it helpful to review information on the basic legal elements of medical malpractice law along with suggestions on how he or she can assist the legal defense team if a lawsuit is filed. Surgeons who face litigation within the context of managing patients with musculoskeletal tumors should be aware of the common pitfalls in managing these patients. Knowledge of complementary strategies can provide good patient care and reduce legal risks when caring for patients with musculoskeletal neoplasms.

Survey on Views and Knowledge of House Officers on Medical-Legal Issues.

ERIC Educational Resources Information Center

Beninger, Paul R.; And Others

1985-01-01

House medical staff of the University of California, Davis, Medical Center were administered a questionnaire to determine their knowledge of relevant medical-legal principles. Responses from 111 house staff indicated that pediatrics, physical medicine, and rehabilitation staff confronted more medical-legal issues than pathology staff. (SW)

[Legal aspects of delegation and reorganisation of medical services in the psychiatric field].

PubMed

Jordan, Wolfgang; Adler, Lothar; Bleich, Stefan; Cohrs, Stefan; von Einsiedel, Regina; Falkai, Peter; Grosskopf, Volker; Hauth, Iris; Steiner, Johann

2011-11-01

Current psychiatric-psychotherapeutic in-patient care takes place in an area of tension between increasing treatment requirements and the persistent lack of qualified staff. The optimisation of the diagnostic-therapeutic procedures in a clinic helps to reduce existing care deficits or to generate resources for future developments. The subject of delegation and substitution of medical services is considered in this context. Inadequate knowledge of the legal situation on the part of the decision makers impairs the indispensable trustful cooperation among the professions and adds to the uncertainty of all those concerned. The present paper outlines the legal, organisational and health policy aspects of delegation and the reorganisation of medical activities in the field of psychiatry. © Georg Thieme Verlag KG Stuttgart · New York.

Medical Marijuana Legalization and Co-use in Adult Cigarette Smokers

PubMed Central

Wang, Julie B.; Cataldo, Janine K.

2016-01-01

Objectives We examined effects of long-term medical marijuana legalization on cigarette co-use in a sample of adults. Methods We conducted secondary analysis using data from the 2014 US Tobacco Attitudes and Beliefs Survey, which consisted of cigarette smokers, aged ≥ 45 years (N = 506). Participants were categorized by their state residence, where medical marijuana was (1) illegal, (2) legalized < 10 years, and (3) legalized ≥ 10 years. The Web-based survey assessed participants’ marijuana use, beliefs and attitudes on marijuana, and nicotine dependence using Fagerstrom Tolerance for Nicotine Dependence (FTND) and Hooked on Nicotine Checklist (HONC) scores. Results In cigarette smokers aged ≥ 45 years, long-term legalization of medical marijuana was associated with stable positive increases in marijuana use prevalence (ever in a lifetime) (p = .005) and frequency (number of days in past 30 days) (unadjusted p = .005; adjusted p = .08). Those who reported marijuana co-use had greater FTND and HONC scores after adjusting for covariates (p = .05). Conclusions These preliminary findings warrant further examination of the potential impact of long-term legalization of medical marijuana on greater cigarette and marijuana co-use in adults and higher nicotine dependence among co-users at the population level. PMID:26931752

Antiprogestin drugs: ethical, legal and medical issues.

PubMed

Cook, R J; Grimes, D A

1992-01-01

RU 486 allows women the choice of a medical rather than a surgical abortion, and, for most women, the choice is one of procedure, not of whether to have an abortion. Issues surrounding RU 486 were explored in an American Society of Law and Medicine conference in December 1991 entitled "Antiprogestin Drugs: Ethical, Legal and Medical Issues." An introduction to 14 conference papers provides an overview of the proceedings. Baulieu, the father of RU 486, described updated developments in its use and the medically supervised method of abortion. Bygdeman and Swahn presented their work in Sweden on combining RU 486 with a prostaglandin to make abortion more effective. They suggested that the drug may be an attractive postovulation contraceptive. Greenslad et al. discussed service delivery aspects of the use of RU 486. Holt considered the implications of use of the drug in low-resource settings. A survey of obstetricians and gynecologists, presented by Heilig, indicates that 22% more physicians would perform a medical abortion. Patient perspectives were addressed by David, who stated that measuring acceptability of an abortion technique is difficult; women have historically used whatever method is available. A collaborative research project in India and Cuba on why women chose certain methods was reported by Winikoff et al. (90% of women would choose medical abortion if faced with the choice again). Berer analyzed French data on women's perspectives on medical vs. surgical abortion. The question of adolescent use of the drug was considered by Senderowitz, who lamented the lack of data on the subject and described what is known about adolescent pregnancy. Macklin proposed a framework for ethical analysis and used facts to address ethical questions. Weinstein provided another ethical framework, to analyze whether pharmacists have a right to refuse to provide abortifacient drugs. Buc approached the subject from a legal point of view and concluded that, whereas legal problems

Legal issues in medical informatics: a bird's eye view.

PubMed

Laske, C

1996-01-01

The present paper is the result of a study investigating the legal issues, problems and obstacles which have arisen as a result of the R&D projects financed by the AIM Program 1991-94. Two parallel lines of investigation were adopted in this study. First of all, a questionnaire was sent to all project partners listed in the AIM 93 Report, with the objective of collecting information on the legal questions with which the individual projects were confronted in the course of their R&D work. This allowed for an initial mapping out of the legal aspects relevant in the field of medical informatics. Secondly, the actual projects were studied as to their legal content and in particular those which included a legal workpackage. This allowed for an assessment of further legal questions, some of which had as yet perhaps not been perceived as such. The present paper deals with five key aspects, describing the nature of the issues and the relevant law and case law or legal vacuum as it may be. It must be emphasised that, as pointed out in the title, this study offers an overview of the legal issues debate in medical informatics and is somewhat exploratory in nature. It is not intended to offer a critical analysis of existing picces of legislation or case law. This would call for more fundamental legal research. Instead the study restricts itself to a general description of existing legal principles and their relevance in the health care sector. As the reader will gather from this paper, legally speaking information technology is still a relatively new entity in the health care sector, which means that legal research and any resulting recommendations may have a real impact on the future course of the law in this field.

[Medical expert assessment in criminal processes from the legal viewpoint].

PubMed

Ulsenheimer, K

1996-11-01

In the area of medical professional blunder, the medical expert witness is the one participant in a trial whose statement is practically decisive for the court or the prosecutor. Legally, the responsibility remains naturally in the legal hand as the expert witness is only the assistant of the judge. The most important demands on the expert witness are strict objectiveness including towards the colleague, no independent inquiries or interrogations, comprehensive processing of the expert assessment, readiness to revise a written expert assessment according to better knowledge or new facts, independence from the client, no legal comments, clarity of language and intellectual honesty.

The Terri Schiavo case: legal, ethical, and medical perspectives.

PubMed

Perry, Joshua E; Churchill, Larry R; Kirshner, Howard S

2005-11-15

Although tragic, the plight of Terri Schiavo provides a valuable case study. The conflicts and misunderstandings surrounding her situation offer important lessons in medicine, law, and ethics. Despite media saturation and intense public interest, widespread confusion lingers regarding the diagnosis of persistent vegetative state, the judicial processes involved, and the appropriateness of the ethical framework used by those entrusted with Terri Schiavo's care. First, the authors review the current medical understanding of persistent vegetative state, including the requirements for patient examination, the differential diagnosis, and the practice guidelines of the American Academy of Neurology regarding artificial nutrition and hydration for patients with this diagnosis. Second, they examine the legal history, including the 2000 trial, the 2002 evidentiary hearing, and the subsequent appeals. The authors argue that the law did not fail Terri Schiavo, but produced the highest-quality evidence and provided the most judicial review of any end-of-life guardianship case in U.S. history. Third, they review alternative ethical frameworks for understanding the Terri Schiavo case and contend that the principle of respect for autonomy is paramount in this case and in similar cases. Far from being unusual, the manner in which Terri Schiavo's case was reviewed and the basis for the decision reflect a broad medical, legal, and ethical consensus. Greater clarity regarding the persistent vegetative state, less apprehension of the presumed mysteries of legal proceedings, and greater appreciation of the ethical principles at work are the chief benefits obtained from studying this provocative case.

Optimizing the health impacts of civil legal aid interventions: the public health framework of medical-legal partnerships.

PubMed

Lawton, Ellen; Tyler, Elizabeth Tobin

2013-07-01

Research documents the significance of the social determinants of health - the social and environmental conditions in which people live, work and play. A critical foundation of these social and environmental conditions are laws and regulations, which construct the environments in which individuals and populations live, influencing how and when people face disease. Increasingly, healthcare providers, public health professionals and lawyers concerned with social determinants are joining forces to form Medical-Legal Partnerships (MLPs) which offer a preventive approach to address the complex social, legal and systemic problems that affect the health of vulnerable populations. Now in more than 500 health and legal institutions across the country, including Rhode Island, MLP is a healthcare delivery model that integrates legal assistance as a vital component of healthcare. This article explores the many benefits of the MLP model for improving patient health, transforming medical and legal practice and institutions and generating policy changes that specifically address health disparities and social determinants.

[Internet presence in surgical departments in Germany. II. Legal bases of medical Internet presence].

PubMed

Schenk, C; Nimmerfroh, O; Mugomba, G; Dabidian, R; Glaser, F

2001-09-01

In recent years, the Internet has generally been growing throughout the world, and physicians have taken to the Web as well. Besides its use for medical data research, physicians and hospitals are increasingly discovering the Internet as a vehicle for the presentation of their scope of practice. In this regard, the legal frameworks in Germany are strictly regulated. This article presents current legal standards and consequences to be faced when the law on prohibited advertising is broken. Included are references to specific laws concerning Internet pages.

Medical-Legal Partnership: Collaborating with Lawyers to Identify and Address Health Disparities

PubMed Central

Cohen, Ellen; Fullerton, Danya Fortess; Retkin, Randye; Weintraub, Dana; Tames, Pamela; Brandfield, Julie

2010-01-01

Introduction Medical-legal partnerships (MLPs) bring together medical professionals and lawyers to address social causes of health disparities, including access to adequate food, housing and income. Setting Eighty-one MLPs offer legal services for patients whose basic needs are not being met. Program Description Besides providing legal help to patients and working on policy advocacy, MLPs educate residents (29 residency programs), health care providers (160 clinics and hospitals) and medical students (25 medical schools) about how social conditions affect health and screening for unmet basic needs, and how these needs can often be impacted by enforcing federal and state laws. These curricula include medical school courses, noon conferences, advocacy electives and CME courses. Program Evaluation Four example programs are described in this paper. Established MLPs have changed knowledge (MLP | Boston—97% reported screening for two unmet needs), attitudes (Stanford reported reduced concern about making patients “nervous” with legal questions from 38% to 21%) and behavior (NY LegalHealth reported increasing resident referrals from 15% to 54%) after trainings. One developing MLP found doctors experienced difficulty addressing social issues (NJ LAMP—67% of residents felt uncomfortable). Discussion MLPs train residents, students and other health care providers to tackle socially caused health disparities. PMID:20352508

Personality, gender and medico-legal matters in medical practice.

PubMed

Nash, Louise; Daly, Michele; Johnson, Maree; Coulston, Carissa; Tennant, Chris; van Ekert, Elizabeth; Walter, Garry; Willcock, Simon; Walton, Merrilyn

2009-02-01

The aim of this paper was to explore the relationship between the personality traits of Australian General Practitioners (GPs) and their gender, work practice arrangements, and history of medico-legal matters. A cross-sectional self report survey was mailed to 1239 GPs. There were 566 respondents (45.7% response rate to survey). The survey assessed personality traits (using the Eysenck Personality Questionnaire), demographic and practice information, and history of medico-legal matters with any medical defence organization. The number and type of medico-legal matters was also extracted from the UNITED Medical Protection database. Male respondents had significantly higher psychoticism scores than females (p<0.001), and females had significantly higher neuroticism scores than males (p<0.01), as in community samples. However, for GPs who worked more than 48 hours per week, there were no gender differences in personality trait scores. Solo practitioners and non-solo practitioners did not differ on personality scores. Proceduralists and non-proceduralists did not differ on personality scores. However, a higher proportion of proceduralists experienced a medico-legal matter than non-proceduralists (p<0.001). There was a positive correlation between extraversion scores and doctors who attended peer review (p<0.001). There was no difference in the numbers of medico-legal matters for doctors who attended peer review. Males who self reported a medico-legal matter had higher neuroticism scores than the males who did not report medico-legal matters. This was not the case for females. For males, this pattern was not replicated when considering data from UNITED. The known demographic and practice factors that differ for doctors having a medico-legal matter are replicated here--being male, a proceduralist and working longer hours. There is not a consistent pattern regarding personality traits and medico-legal matters.

Sexual harassment in the medical profession: legal and ethical responsibilities.

PubMed

Mathews, Ben; Bismark, Marie M

2015-08-17

Sexual harassment of women in medicine has become a subject of national debate after a senior female surgeon stated that if a woman complained of unwanted advances her career would be jeopardised, and subsequent reports suggest that sexual harassment is a serious problem in the medical profession. Sexual harassment of women in the medical profession by their colleagues presents substantial legal, ethical and cultural questions for the profession. Women have enforceable legal rights to gender equality and freedom from sexual harassment in the workplace. Both individual offenders and employers face significant legal consequences for sexual harassment in every Australian state and territory, and individual medical practitioners and employers need to understand their legal and ethical rights and responsibilities in this context. An individual offender may be personally liable for criminal offences, and for breaching anti-discrimination legislation, duties owed in civil law, professional standards and codes of conduct. An employer may be liable for breaching anti-discrimination legislation, workplace safety laws, duties owed in contract law, and a duty of care owed to the employee. Employers, professional colleges and associations, and regulators should use this national debate as an opportunity to improve gender equality and professional culture in medicine; individuals and employers have clear legal and ethical obligations to minimise sexual harassment to the greatest extent possible.

Cross-border issues in the development of medical tourism in Malaysia: legal challenges and opportunities.

PubMed

Nemie, Puteri; Kassim, Jahn

2009-08-01

Strategically located at the crossroads of Asia, Malaysia has become one of the key players in the fast-growing and lucrative market for health care services in Asia. Medical travel across international boundaries has been made possible through affordable airfares and the favourable exchange rates of the Malaysian ringgit has contributed to the rise of the "medical tourism phenomenon" where medical travel is combined with visiting popular tourist destinations in Malaysia. Further, competitive medical fees and modern medical facilities have also made Malaysia a popular destination for medical tourists. Nevertheless, the increased number of foreign patients has opened up possibilities of Malaysian health care providers being subjected to malpractice claims and triggering a myriad of cross-border legal issues. Presently, there is no internationally accepted legal framework to regulate medical tourism and issues of legal redress in relation to unsatisfactory provision of treatment across international boundaries. The economic benefits of medical tourism must be based upon a solid legal regulatory framework and strong ethical standards as well as upon high-quality medical and health care services. It is therefore important to assess the existing legal framework affecting the development of medical tourism in Malaysia in order to explore the gaps, deficiencies and possibilities for legal and regulatory reform.

[The awareness of pediatricians about ethical legal issues of medical care provision].

PubMed

Polunina, N V; Shmelev, I A; Konovalov, O A

2016-01-01

The implementation of rights of under-age patients in medical institutions in many ways depends on level of awareness of pediatricians about availability and mechanisms of legal guarantees provided to them by law and hence depends quality of medical care of children population. The study was carried out to analyze opinions of pediatricians about issues of implementation of rights of patients. The results are presented concerning sociological survey of 261 pediatricians of the Samarskaia oblast. The study established inadequate awareness of respondents about ethical legal issues of medicine and rate of application of knowledge about legal acts in practical activity. The awareness was higher among pediatricians of younger age with duration of professional work lesser than 10 years. This phenomenon is explained by inclusion of courses of biomedical ethics and medical law in educational programs of medical educational institutions during last decade. The direct dependence is established between awareness of pediatricians about issues of bioethics and the level of their qualification. The most of the respondents consider that the have sufficient level of knowledge about rights of children-patients and their parents related to reservation of medical secrecy, consent or refuse of parents to medical intervention and receiving full information about child's health. The overwhelming majority of pediatricians, independently of professional category and duration of service, provided this right implementing modern informational and collegiate model of interaction with parents of ill child and informed that always obtained their consent about medical care. However, such rights of children were limited by framework of child's health and ability for apprehending information about one's health and prospective medical intervention. All respondents participated in survey insisted that they never disclosed medical secrecy. The development of legal literacy of pediatricians by

Pain and suffering: a legal and medical lexicon for the 21st century.

PubMed

Hirshberg, Richard M

2012-09-01

Defining "suffering and pain" from both legal and medical perspectives is essential in understanding how misinterpretations, confusion and misconceptions can occur through "impressions" of events by uninvolved observers of these basic human sensations. Subjective interpretations of an individual's pain/narrative by professionals can lead to collisions in the courtroom and be a cause for clinical ambivalence in the physician's office. The phenomenon of cognitive, affective experiences with acute, chronic, and emotional pain and its association with "suffering" will be discussed. Contemporary experimental results in neuroscience and advances in clinical medical research attempting to explain how varied expressions of pain in man may have evolved, can be more carefully evaluated, and possibly visualized and measured, will be reviewed. The neurobiological impact of empathy and compassion derived from an individual's narrative and self-reporting of pain and suffering upon the psyches of physicians, juries and otherwise dispassionate observers will be discussed. The purpose of this discussion is to emphasize the importance of considering the complexities embodied in any decision-making process, legal or medical, involving the phenomenon of human perceptions and responses to pain. The data discussed are based on a comprehensive search and review of past and current pertinent literature attempting to explain and decipher man's expressions of pain and suffering in its legal, societal, clinical and scientific ramifications.

Medical-legal partnerships: the role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural settings.

PubMed

Speldewinde, Christopher A; Parsons, Ian

2015-01-01

Medical-legal partnerships (MLP) are a model in which medical and legal practitioners are co-located and work together to support the health and wellbeing of individuals by identifying and resolving legal issues that impact patients' health and wellbeing. The aim of this article is to analyse the benefits of this model, which has proliferated in the USA, and its applicability in the context of rural and remote Australia. This review was undertaken with three research questions in mind: What is an MLP? Is service provision for individuals with mental health concerns being adequately addressed by current service models particularly in the rural context? Are MLPs a service delivery channel that would benefit individuals experiencing mental health issues? The combined searches from all EBSCO Host databases resulted in 462 citations. This search aggregated academic journals, newspapers, book reviews, magazines and trade publications. After several reviews 38 papers were selected for the final review based on their relevance to this review question: How do MLPs support mental health providers and legal service providers in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural Australia? There is considerable merit in pursuing the development of MLPs in rural and remote Australia particularly as individuals living in rural and remote areas have far fewer opportunities to access support services than those people living in regional and metropolitan locations. MLPS are important channels of service delivery to assist in early invention of legal problems that can exacerbate mental health problems.

The Impact of Legal Medicine Education on Medical Students' Attitudes toward Law.

ERIC Educational Resources Information Center

LeBlang, Theodore R.; And Others

1985-01-01

Physicians' negative attitudes toward law and the legal system derive from the lack of understanding of basic legal principles relating to medical practice. The impact of required curriculum programing in legal medicine at Southern Illinois University School of Medicine is assessed. (Author/MLW)

Duty to disclose in medical genetics: a legal perspective.

PubMed

Pelias, M Z

1991-06-01

As technical knowledge and public information in medical genetics continue to expand, the geneticist may expect to be held responsible for informing patients and clients about new developments in research and diagnosis. The long legal evolution of the physician's duty to disclose, and more recent findings of a physician's duty to recall former patients to inform them about newly discovered risks of treatment, indicate that medical geneticists may have a duty to disclose both current and future information about conditions that are or could be inherited. Recent case law supports findings of professional liability for both present and future disclosure, even in the absence of an active physician-patient relationship. The requirement of candid and complete disclosure will affect the counseling approach in testing for deleterious genes and in providing medical treatment for minors with hereditary diseases. Finding a duty to recall may impose further professional burdens on the geneticist to reach beyond the immediate counseling arena and to recontact patients, perhaps years after their initial visit to genetics clinic.

The Medicalization and Legalization of Child Abuse.

ERIC Educational Resources Information Center

Newberger, Eli H.; Bourne, Richard

The authors propose that theoretical confusion and clinical inadequacy regarding child abuse is due, in part, from medical and legal ambiguity concerning child abuse and from dilemmas surrounding social policy and the professional response toward families and children. The dilemmas of social policy (family autonomy versus coercive intervention)…

Ethical and legal aspects in medically assisted human reproduction in Romania.

PubMed

Ioan, Beatrice; Astarastoae, Vasile

2008-01-01

Up to the present, there have not been any specific norms regarding medically assisted human reproduction in Romanian legislation. Due to this situation the general legislation regarding medical assistance (law no. 95/2006, regarding the Reform in Health Care System), the Penal and Civil law and the provisions of the Code of Deontology of the Romanian College of Physicians are applied to the field of medically assisted human reproduction. By analysing the ethical and legal conflicts regarding medically assisted human reproduction in Romania, some characteristics cannot be set apart because they derive from religious, cultural and socio-economic aspects. In this article the authors identify the development stages of medically assisted human reproduction in Romania, beginning from these characteristics and insisting upon the failure of the legal system in this specific field. The authors consider that the law regarding medically assisted human reproduction cannot be effective because it did not take into account the ethical and cultural aspects that might appear. Furthermore, in this framework of the legal process, no public debate involving the representatives of civil society was undertaken although the Council of Europe Oviedo Convention approved by our country according to law no. 17/2001 stipulated exactly this working method.

Integrating Social Workers into Medical-Legal Partnerships: Comprehensive Problem Solving for Patients

ERIC Educational Resources Information Center

Colvin, Jeffrey David; Nelson, Brooke; Cronin, Katie

2012-01-01

Medical-legal partnerships (MLPs) integrate legal services into the health care setting to resolve legal issues that have a negative impact on patient health. These partnerships between attorneys and health care professionals have traditionally focused on physicians. Despite early success and expansion of the MLP model, the literature is only…

Key Considerations for an Economic and Legal Framework Facilitating Medical Travel

PubMed Central

Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

2016-01-01

Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel. PMID:27066467

Key Considerations for an Economic and Legal Framework Facilitating Medical Travel.

PubMed

Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

2016-01-01

Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel.

[Guidelines on medically assisted reproduction: legal issues and professional liability].

PubMed

Molinelli, A; Motroni Gherardi, S M; Picchioni, D M; Ventura, F

2007-08-01

The authors analyze the legal and medico-legal issues deriving from the recent Law No. 40 of February 19, 2004 concerning the Medically Assisted Reproduction. In particular, they analyze the contrasting points between the dispositions of Law No. 40/2004 and those of Law No. 194/1978 on the voluntary interruption of pregnancy, and they analyze the guidelines about the procedures and the techniques of the Medically Assisted Reproduction, issued by the Ministry of Health with D.M. of July 21, 2004. The Guidelines, as well as some sentences of several courts, lead to some reflections also about the consent and the professional liability, in particular considering the various moments of the medical action, from the first interview to the carrying out of the assisted reproduction techniques.

Legal perceptions and medical decision making.

PubMed

Kapp, Marshall B; Lo, Bernard

1986-01-01

Medicine and law are more closely intertwined than ever before, particularly regarding issues of life-sustaining treatment for the elderly. The legal system's potential as a positive force in medical decision making has been limited by pervasive misperceptions by physicians of its processes and role. Identifying these myths and misperceptions is a first step toward a more effective partnership of medicine and law on behalf of the dying or demented patient.

Inbound medical tourism to Barbados: a qualitative examination of local lawyers' prospective legal and regulatory concerns.

PubMed

Crooks, Valorie A; Cohen, I Glenn; Adams, Krystyna; Whitmore, Rebecca; Morgan, Jeffrey

2015-07-28

Enabled by globalizing processes such as trade liberalization, medical tourism is a practice that involves patients' intentional travel to privately obtain medical care in another country. Empirical legal research on this issue is limited and seldom based on the perspectives of destination countries receiving medical tourists. We consulted with diverse lawyers from across Barbados to explore their views on the prospective legal and regulatory implications of the developing medical tourism industry in the country. We held a focus group in February 2014 in Barbados with lawyers from across the country. Nine lawyers with diverse legal backgrounds participated. Focus group moderators summarized the study objective and engaged participants in identifying the local implications of medical tourism and the anticipated legal and regulatory concerns. The focus group was transcribed verbatim and analyzed thematically. Five dominant legal and regulatory themes were identified through analysis: (1) liability; (2) immigration law; (3) physician licensing; (4) corporate ownership; and (5) reputational protection. Two predominant legal and ethical concerns associated with medical tourism in Barbados were raised by participants and are reflected in the literature: the ability of medical tourists to recover medical malpractice for adverse events; and the effects of medical tourism on access to health care in the destination country. However, the participants also identified several topics that have received much less attention in the legal and ethical literature. Overall this analysis reveals that lawyers, at least in Barbados, have an important role to play in the medical tourism sector beyond litigation - particularly in transactional and gatekeeper capacities. It remains to be seen whether these findings are specific to the ecology of Barbados or can be extrapolated to the legal climate of other medical tourism destination countries.

Legal and medical aspects of body dysmorphic disorder.

PubMed

Nachshoni, Tali; Kotler, Moshe

2007-12-01

Body Dysmorphic Disorder (BDD), a preoccupation with an imagined defect in physical appearance has a rich clinical history, but officially appeared with diagnostic criteria only in the DSM-III-R classification system. Prevalence of BDD in plastic and cosmetic dermatology ranges between 7-15% due to the obsession with imagined imperfections. The emotional "defect" causes dissatisfaction with nonpsychiatric medical procedures, and often recourse into legal action. We present a case study of BDD developing after cosmetic surgery and debate whether this is an actual possibility and the legal consequences of this possibility. We question whether surgery was a traumatic event and its relationship to the patient's premorbid "eggshell personality". The difficulty in determining causation of psychiatric disorders for the purpose of deciding issues of compensation is discussed. A practical algorithm is offered in order to avoid litigation and to maintain the legitimate medical ideal of "first do no harm".

Exploring UK medical and social work students' legal literacy: comparisons, contrasts and implications.

PubMed

Preston-Shoot, Michael; McKimm, Judy

2013-05-01

To ensure acceptable practice standards both doctors and social workers should draw on relevant legal rules when reaching professional judgements concerning, for instance, children requiring protection, people with severe mental distress and adults at risk, information sharing, consent to intervention and service user involvement in their care and treatment. Many practitioners use the law to maintain high standards of professionalism. However, research has uncovered limited awareness of legal rules and poor standards of health and social care. Academic benchmarks and practice requirements for health and social care professions centrally position legal knowledge for secure decision-making. Model curricula exist. However, the outcomes of the taught curriculum on students' confidence in their legal knowledge and skills have been relatively overlooked. This article introduces the concept of legal literacy, a distillation of knowledge, understanding, skills and values that enables practitioners to connect relevant legal rules with their professional practice, to appreciate the roles and duties of other practitioners and to communicate effectively across organisational boundaries. It presents the outcomes for a 2006-2009 study of 1154 UK medical and 638 social work students of their law learning for practice, response rates of 46% and 68%. Significant differences were found between medical and social work students' attitudes towards the law, and in their self-ratings of legal knowledge and skills. Confidence levels were low and anxiety high, especially among medical students, although law teaching had some positive outcomes on knowledge and skill development. Social work and medical students associated different themes with the law, the latter especially foregrounding ethics, negligence and liability, which could affect inter-professional working. Students are not fully prepared for legally literate practice, with a consequent need to review the time allocated for, and

Rape as a legal indication for abortion: implications and consequences of the medical examination requirement.

PubMed

Teklehaimanot, K I; Smith, C Hord

2004-01-01

A number of countries adopt abortion laws recognizing rape as a legal ground for access to safe abortion service. As rape is a crime, these abortion laws carry with them criminal and health care elements that in turn result in the involvement of legal and medical expertise. The most common objective of the laws should be providing safe abortion services to women survivors of rape. Depending on purposes of a given abortion law, the laws usually require women to undergo a medical examination to qualify for a legal abortion. Some abortion laws are so vague as to result in uncertainties regarding the steps health personnel must follow in conducting medical examination. Another group of abortion laws do not leave room for regulation and remain too rigid to respond to changing socio-economic circumstances. Still others require medical examination as a prerequisite for abortion. As a result, a number of abortion laws remain on the books. The paper attempts to analyze legal and practical issues related to medical examination in rape cases.

The emergence of the silent witness: the legal and medical reception of X-rays in the USA.

PubMed

Golan, Tal

2004-08-01

The late 19th-century discovery of X-rays befuddled not only the scientific world but also the medical and legal worlds. The possibility of looking into the human body as if through an open window challenged the time-honored medical monopoly over the inner cavities of the human body. Likewise, the possibility of visualizing objects unavailable to the naked eye challenged the established legal theories and practices of illustration and proof. This paper describes the reactions to those challenges by the medical and the legal professions in the USA. The two professions are treated as connected social institutions, producing ongoing negotiations through which legal doctrines affect medicine no less than scientific discoveries and medical applications affect the law. This joint analysis rewards us with a rich story about an early and overlooked chapter in X-ray history on the professionalization of radiology, the origins of defensive medicine, and the evolution of the legal theory and practice of visual evidence.

[Current issues in legal cases of compensation for healthcare malpractice].

PubMed

Heiner, Tamás; Barzó, Tímea

2014-09-21

dogmatic and practical problems related to this topic. Another important area of current analysis is the institution of injury fees, which replaced the reimbursement of non-pecuniary damages. The mere fact of infringement allows setting injury fees. Taking into consideration the current resources in staff and equipment available in healthcare, this regulation may promote claims for injury fees impartial. Consequently, courts will have to apply other criteria when judgment in 'trivial cases', which might not require legal assessment, is delivered.

76 FR 54004 - Agency Information Collection (Report of Medical, Legal, and Other Expenses Incident to Recovery...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

... of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death) Activity under OMB... INFORMATION: Title: Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death, VA... government agency for personal injury or death. Such award is considered as countable income; however...

Medical marijuana: legal issues for physicians, others.

PubMed

Mirken, B

1996-12-20

California's and Arizona's pro marijuana for medical use initiatives possess practical problems, particularly those regarding possible dangers to physicians who recommend use of cannabis. Doctors, regardless of safeguards placed in the State initiatives, may still face Federal charges and criminal liability according to the California Medical Association (CMA). The CMA believes the safest course for doctors to take is to not recommend marijuana at all, and health care providers are being cautious. No one knows whether Federal authorities will aggressively enforce the law against doctors or others, however, the government appears to be proceeding from the notion that such initiatives are a national strategy to legalize drugs. It appears that, for public relations reasons, prosecution efforts may be limited to distributors that may include buyers' clubs. Congress may also draft a Federal bill aimed at effectively nullifying the two initiatives. Californians for Medical Rights, the organization that sponsored Proposition 215, is working on strategies to protect doctors.

Public Health Effects of Medical Marijuana Legalization in Colorado.

PubMed

Davis, Jonathan M; Mendelson, Bruce; Berkes, Jay J; Suleta, Katie; Corsi, Karen F; Booth, Robert E

2016-03-01

The public health consequences of the legalization of marijuana, whether for medical or recreational purposes, are little understood. Despite this, numerous states are considering medical or recreational legalization. In the context of abrupt changes in marijuana policy in 2009 in Colorado, the authors sought to investigate corresponding changes in marijuana-related public health indicators. This observational, ecologic study used an interrupted time-series analysis to identify changes in public health indicators potentially related to broad policy changes that occurred in 2009. This was records-based research from the state of Colorado and Denver metropolitan area. Data were collected to examine frequency and trends of marijuana-related outcomes in hospital discharges and poison center calls between time periods before and after 2009 and adjusted for population. Analyses were conducted in 2014. Hospital discharges coded as marijuana-dependent increased 1% per month (95% CI=0.8, 1.1, p<0.001) from 2007 to 2013. A change in trend was detected in poison center calls mentioning marijuana (p<0.01). After 2009, poison center calls increased 0.8% per month (95% CI=0.2, 1.4, p<0.01). Poison center calls also increased 56% (95% CI=49%, 63%, p<0.001) in the period following the policy change. Further, there was one hospital discharge coded as dependent for every 3,159 (95% CI=2465, 3853, p<0.001) medical marijuana registrant applications. The abrupt nature of these changes suggests public health effects related to broad policy changes associated with marijuana. This report may be used to assist in policy decisions regarding the short-term public health effects of marijuana legalization. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Rape Survivors' Agency within the Legal and Medical Systems

ERIC Educational Resources Information Center

Greeson, Megan R.; Campbell, Rebecca

2011-01-01

Many rape survivors seek help from the legal and medical systems post-assault. Previous studies have examined how social system personnel treat survivors, but less attention has been paid to how survivors attempt to shape their interactions with these systems. The purpose of this qualitative study was to examine rape survivors' agency--the active…

Legal Medicine in Medical Schools: A Survey of the State of the Art.

ERIC Educational Resources Information Center

Grumet, Barbara Ruhe

1979-01-01

Results of a survey of American medical schools indicate that there is considerable interest in legal medicine and that while 40 percent of the schools require students to complete some course work in legal medicine, the curricula vary considerably among the schools. Topics most frequently covered are informed consent and malpractice. (Author/JMD)

Legal and ethical issues in neuroimaging research: human subjects protection, medical privacy, and the public communication of research results.

PubMed

Kulynych, Jennifer

2002-12-01

Humans subjects research entails significant legal and ethical obligations. Neuroimaging researchers must be familiar with the requirements of human subjects protection, including evolving standards for the protection of privacy and the disclosure of risk in "non-therapeutic" research. Techniques for creating veridical surface renderings from volumetric anatomical imaging data raise new privacy concerns, particularly under the federal medical privacy regulation. Additionally, neuroimaging researchers must consider their obligation to communicate research results responsibly. The emerging field of neuroethics should strive to raise awareness of these issues and to involve neuroimaging researchers in the legal, ethical, and policy debates that currently surround human subjects research.

Legal aspects of administrating antipsychotic medications to jail and prison inmates.

PubMed

Dlugacz, Henry; Wimmer, Christopher

2013-01-01

The administration of antipsychotic medications to jail and prison inmates involves two related components: conducting the informed consent process in a coercive environment and, where consent is not obtained, forcible administration of medication if needed. In the United States, both involve common law, statutory, and constitutional principles. Obtaining informed consent in correctional institutions is complicated. Patients in correctional institutions lack access to alternate sources of information, and depend on the correctional system completely - a system which they may distrust. This may influence the patient's view of the administering physician. Where consent cannot be obtained, forcible administration may be legally permissible for two primary reasons: to restore a criminal defendant to competency in order to stand trial and to ameliorate severe symptoms of mental disability, particularly when they threaten the safety of self, others, or in some instances, property. The interests at stake for the individual and the government, and the legal standards developed to balance these interests, differ between the two situations. When considering challenges to forcible medication of inmates serving a prison sentence, the United States Supreme Court has treated the interest of the institution in maintaining security as paramount. By contrast, when considering challenges to forcible medication of pretrial detainees, the Court's concern for the fair trial rights guaranteed by the Sixth Amendment has seemingly led it to moderate its emphasis on security. However, this distinction is not stable and may in fact be breaking down, as the recent case of Jared Loughner demonstrates. This article discusses the various federal, state, and international legal standards applicable to both informed consent and forcible medication, and their implementation in the correctional setting, focusing on issues related to the United States. Copyright © 2013 Elsevier Ltd. All rights

Psychotropics without borders: ethics and legal implications of internet-based access to psychiatric medications.

PubMed

Klein, Carolina A

2011-01-01

Medical practitioners are revisiting many of the ethics and the legal implications surrounding the clinical frameworks within which we operate. In today's world, distinguishing between virtual and physical reality continues to be increasingly difficult. The physician may be found grappling with the decision of whether to continue to treat a patient who may be obtaining psychotropic medications through the Internet. This article approaches some of the clinical and legal implications and the ethics regarding the availability of prescription psychotropics over the Internet.

“Extra Oomph:” Addressing Housing Disparities through Medical Legal Partnership Interventions

PubMed Central

Hernández, Diana

2016-01-01

Low-income households face common and chronic housing problems that have known health risks and legal remedies. The Medical Legal Partnership (MLP) program presents a unique opportunity to address housing problems and improve patient health through legal assistance offered in clinical settings. Drawn from in-depth interviews with 72 patients, this study investigated the outcomes of MLP interventions and compares results to similarly disadvantaged participants with no access to MLP services. Results indicate that participants in the MLP group were more likely to achieve adequate, affordable and stable housing than those in the comparison group. Study findings suggest that providing access to legal services in the healthcare setting can effectively address widespread health disparities rooted in problematic housing. Implications for policy and scalability are discussed with the conclusion that MLPs can shift professionals’ consciousness as they work to improve housing and health trajectories for indigent groups using legal approaches. PMID:27867247

Medical malpractice: a case study in medical and legal decision making.

PubMed Central

Piccirillo, M.; Graf, G. J.

1989-01-01

The conference was organized in part to dispel some of the misinformation that interferes with cooperative efforts of attorneys and physicians to redress the malpractice situation. During discussion of the hypothetical case, participants identified how medical decision-making responsibilities were allocated among health care providers caring for the patient. Panel members suggested ways in which medical decision making might be affected by non-medical factors such as third-party reimbursement (e.g., selection of inpatient or outpatient setting, the opportunity to discuss issues related to informed consent prior to the day of a procedure) and potential malpractice litigation (e.g., documentation in charts, use of diagnostic procedures). The characterization of decision-making roles and responsibilities differed somewhat for purposes of malpractice litigation; that is, which caregivers might be named as defendants. Panel members reconstructed the development of the medical incident into a legal case. Plaintiff's attorney commented that it is often a hospital employee who advises the family to consult an attorney and described some of the constraints on information gathering (e.g., the rule of "discovery" requiring that suit be filed before defendants can be forced to give statements about what happened, insurance contract provisions prohibiting physicians from talking without legal counsel present to persons who indicate that they plan to file suit). He also briefly explained the rationale for the contingency fee arrangement in these cases. Describing the role of the medical expert witness and the need to review the medical record, he outlined the process of deciding whether to pursue a malpractice case. In making this decision, plaintiff's attorney evaluates the facts to identify issues in the case, to determine if there are deviations from the standard of care, and to try to predict jury reaction. If a suit is filed, defense attorneys employed by the hospital

Legal Briefing: Adult Orphans and the Unbefriended: Making Medical Decisions for Unrepresented Patients without Surrogates.

PubMed

Pope, Thaddeus Mason

2015-01-01

This issue's "Legal Briefing" column covers recent legal developments involving medical decision making for incapacitated patients who have no available legally authorized surrogate decision maker. These individuals are frequently referred to either as "adult orphans" or as "unbefriended," "isolated," or "unrepresented" patients. The challenges involved in obtaining consent for medical treatment on behalf of these individuals have been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the "single greatest category of problems" encountered in bioethics consultation. In 2012, JCE published a comprehensive review of the available mechanisms by which to make medical decisions for the unbefriended. The purpose of this "Legal Briefing" is to update the 2012 study. Accordingly, this "Legal Briefing" collects and describes significant legal developments from only the past three years. My basic assessment has not changed. "Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform." Most facilities are "muddling through on an ad hoc basis." But the situation is not wholly negative. There have been a number of promising new initiatives. I group these developments into the following seven categories: 1. Increased Attention and Discussion 2. Prevention through Better Advance Care Planning 3. Prevention through Expanded Default Surrogate Lists 4. Statutorily Authorized Intramural Mechanisms 5. California Litigation Challenging the Team Approach 6. Public Guardianship 7. Improving Existing Guardianship Processes. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Medical confidentiality versus disclosure: Ethical and legal dilemmas.

PubMed

Agyapong, V I O; Kirrane, R; Bangaru, R

2009-02-01

A case is described of a fifty year old single man who made disclosures about criminal sexual practices during a psychiatric assessment. In common practice with other professional men, a doctor is under a duty not to disclose, without the consent of his patient, information which he has gained in his professional capacity other than in exceptional circumstances. We discuss the ethical and legal considerations surrounding issues of medical confidentiality and the dilemma that sometimes face clinicians, when they feel obliged, in the public interest, to disclose information they have gained in confidence. Breach of confidences can have deleterious consequences; particularly for the doctor-patient relationship, but failure to disclose in some situations could have serious implications for the well-being of the wider society. Doctors should be aware of the basic principles of confidentiality and the ethical and legal framework around which they are built.

Does the medical diagnosis of occupational asthma coincide with the legal diagnosis?

PubMed

Çelebi Sözener, Zeynep; Aydın, Ömür; Demirel, Yavuz Selim; Soyyiğit, Şadan; Çerçi, Pamir; Kendirlinan, Reşat; Bavbek, Sevim; Çelik, Gülfem Elif; Misirligil, Zeynep; Sin, Betül Ayşe; Keleşoğlu, Arif; Mungan, Dilşad

2017-11-01

The incidence of occupational asthma (OA) is increasing worldwide. In this study, we first aimed to document the rate of diagnosis of OA among patients who were referred to our clinic from the Social Security Institution and the factors that affected diagnosis; secondly, we aimed to assess the consistency of the medical and legal diagnoses. The study involved 132 consecutive patients who were referred to our clinic for the evaluation of OA between 2010 and 2015. Detailed workplace history, the tools used in the diagnosis such as peak expiratory flow (PEF) monitoring and bronchial provocation tests, and the final medical diagnosis were recorded from case files. Asthma was diagnosed in 75% (n = 99) of the patients. Among them, 22.2% were diagnosed as having OA. The diagnosis was confirmed by serial PEF measurements, non-specific bronchial hyperreactivity assessment or both of the tests both at work and off-work periods. OA diagnosis was mostly established in active workers (72.7%). The legal diagnosis period was completed in 54.5% of these 22 patients, and 50% (n = 11) were officially diagnosed as having OA with a 91.6% concordance with medical diagnosis. This study verifies the importance of diagnosing asthma correctly as a first step in the evaluation of OA. Diagnostic tests other than specific provocation tests could be preferential in patients who still work in the same field. We believe that cooperation with the patient's occupational physician and adequate recognition of the work environment will improve the consistency of legal and medical diagnoses.

Medical advances in transsexualism and the legal implications.

PubMed

Harish, Dasari; Sharma, B R

2003-03-01

Transsexualism is a condition wherein an individual's psychological gender is the opposite of his or her anatomic sex. The general belief now among behavioral scientists and physicians is that it is an identifiable and incapacitating disease, which can be diagnosed and successfully treated by reassignment surgery in carefully selected patients. Although many advances have been made in the reassignment surgery techniques, phalloplasty still remains a major challenge; to date, no ideal technique has been developed. The new gender created by the reassignment surgery has, in turn, led to many legal complications for postoperative transsexuals because states and the judiciary have not recognized the new gender. However, with wider acceptance of transsexuals by society, this outlook has changed for the better, with many states amending their laws in accordance with the advances in medical sciences. But in many developed and the developing countries, transsexuals are not given a legal identity, thereby adding to their agonies and miseries.

Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence

PubMed Central

Cerdá, Magdalena; Wall, Melanie; Keyes, Katherine M; Galea, Sandro; Hasin, Deborah

2011-01-01

Background Marijuana is the most frequently used illicit substance in the United States. Little is known of the role that macro-level factors, including community norms and laws related to substance use, play in determining marijuana use, abuse and dependence. We tested the relationship between state-level legalization of medical marijuana and marijuana use, abuse, and dependence. Methods We used the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national survey of adults aged 18+ (n=34,653). Selected analyses were replicated using the National Survey on Drug Use and Health (NSDUH), a yearly survey of ~68,000 individuals aged 12+. We measured past-year cannabis use and DSM-IV abuse/dependence. Results In NESARC, residents of states with medical marijuana laws had higher odds of marijuana use (OR: 1.92; 95% CI: 1.49-2.47) and marijuana abuse/dependence (OR: 1.81; 95% CI: 1.22-2.67) than residents of states without such laws. Marijuana abuse/dependence was not more prevalent among marijuana users in these states (OR: 1.03; 95% CI: 0.67-1.60), suggesting that the higher risk for marijuana abuse/dependence in these states was accounted for by higher rates of use. In NSDUH, states that legalized medical marijuana also had higher rates of marijuana use. Conclusions States that legalized medical marijuana had higher rates of marijuana use. Future research needs to examine whether the association is causal, or is due to an underlying common cause, such as community norms supportive of the legalization of medical marijuana and of marijuana use. PMID:22099393

[The legal status of medical students during practical training in hospitals (author's transl)].

PubMed

Liebhardt, E; Spann, W; Marx, B

1977-10-21

The most important change in the qualification regulations in force at the present time is the provision for the practical training of medical students, which occurs not only in university hospitals but also in "teaching hospitals" outside the university. The realization of the practical year is problematic according to the actual conditions because of the difficulties and financial investment necessarily associated with it. Furthermore, the legal status of the students during the practical activities differes from that of earlier medical assistants, because according to the present law the legal provisions for employment and social insurance such as the determination of division of labour, working hours and remuneration and also for third party and accident insurance do not apply.

Medical safety in boxing: administrative, ethical, legislative, and legal considerations.

PubMed

Schwartz, Michael B

2009-10-01

The roles and responsibilities of the ringside physician are complex and have evolved into a unique specialty in sport medicine. In addition to the medical aspects of ringside medicine, the doctor is now responsible for many administrative, ethical, and legal considerations. This article reviews and details the numerous roles the ringside physician plays in the sport of boxing.

Ireland and medical research with minors: some medico-legal aspects.

PubMed

Sheikh, Asim A

2008-07-01

The practice of medical research with minors in Ireland consist of practices pertaining to therapeutic and non-therapeutic medical research. Clinical trials (a category of therapeutic research), is governed by legislation. However, any other therapeutic research (non-clinical trials research) and non-therapeutic research, e.g. observational medical research such as a longitudinal study of children or non-therapeutic research such as blood sample collection for analysis of cause of disease, are unregulated by legislation. This, article will outline and describe some of the medico-legal issues involved in both types of research and will comment on matters such as what national law exists, how the directive on good clinical practice has been implemented, what guidelines, if any, exist.

Towards a European code of medical ethics. Ethical and legal issues.

PubMed

Patuzzo, Sara; Pulice, Elisabetta

2017-01-01

The feasibility of a common European code of medical ethics is discussed, with consideration and evaluation of the difficulties such a project is going to face, from both the legal and ethical points of view. On the one hand, the analysis will underline the limits of a common European code of medical ethics as an instrument for harmonising national professional rules in the European context; on the other hand, we will highlight some of the potentials of this project, which could be increased and strengthened through a proper rulemaking process and through adequate and careful choice of content. We will also stress specific elements and devices that should be taken into consideration during the establishment of the code, from both procedural and content perspectives. Regarding methodological issues, the limits and potentialities of a common European code of medical ethics will be analysed from an ethical point of view and then from a legal perspective. The aim of this paper is to clarify the framework for the potential but controversial role of the code in the European context, showing the difficulties in enforcing and harmonising national ethical rules into a European code of medical ethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The duty of care: an update. Current legal principles.

PubMed

Fullbrook, Suzanne

2005-02-01

The author had a twofold purpose in writing this article: firstly to inform readers of the current legal principles that inform the duty of care, and secondly to discuss these principles with reference to two recent cases. Practitioners giving consideration to these issues will be assisted in their professional decision-making processes.

Evolving medical service in the information age: a legal analysis of applying telemedicine programs in Taiwan.

PubMed

Wu, Hsing-Hao

2008-12-01

In the face of the information age, Internet and telecommunication technologies have been widely applied in various settings. These innovational technologies have been used in the areas of e-commerce, long distance learning programs, entertainment, e-government, and so on. In recent years, the evolution of Internet technology is also pervading the health care industry. This dramatic trend may significantly alter traditional medical practice as well as the means of delivery of health care. The idea of telemedicine is to use modern information technology as a means or platform to deliver health care service in remote areas and to manage medical information in digitalized forms. The progress of developing telemedicine, however, is rather slow. The main reason for this slow progress is not technological but rather legal. Health care providers are reluctant to promote this innovation in medical service mainly due to uncertain legal consequences and ethical concerns. Although there are many legal challenges surrounding telemedicine, this note will examine major legal issues including licensure, malpractice liability, and privacy protection. Furthermore, I will discuss the potential of applying telemedicine programs in Taiwan's National Health Insurance Program (hereinafter referred to as NHI).

[Delegation of medical responsibilities to non-medical personnel. Options and limits from a legal viewpoint].

PubMed

Ulsenheimer, K

2009-11-01

Increasing specialization and growing mechanization in medicine have strongly supported the transfer of originally medical responsibilities to non-medical personnel. The enormous pressure of costs as a result of limited financial resources in the health system make the delegation of previously medical functions to cheaper non-medical ancillary staff expedient and the sometimes obvious lack of physicians also gains importance by the delegation of many activities away from medical staff. In the German health system there is no legal norm which clearly and definitively describes the field of activity of a medical doctor. Fundamental for a reform of the areas of responsibility between physicians and non-medical personnel is a terminological differentiation between instruction-dependent, subordinate, non-independent assistance and the delegation of medical responsibilities which are transferred to non-medical personnel for independent and self-determined completion under the supervision and control of a physician. The inclination towards risk of medical activities, the need of protection of the patient and the intellectual prerequisites required for carrying out the necessary measures define the limitations for the delegation of medical responsibilities to non-medical ancillary staff. These criteria demarcate by expert assessment the exclusively medical field of activity in a sufficiently exact and convincing manner.

[Delegation of medical responsibilities to non-medical personnel. Options and limits from a legal viewpoint].

PubMed

Ulsenheimer, K

2009-05-01

Increasing specialization and growing mechanization in medicine have strongly supported the transfer of originally medical responsibilities to non-medical personnel. The enormous pressure of costs as a result of limited financial resources in the health system make the delegation of previously medical functions to cheaper non-medical ancillary staff expedient and the sometimes obvious lack of physicians also gains importance by the delegation of many activities away from medical staff. In the German health system there is no legal norm which clearly and definitively describes the field of activity of a medical doctor. Fundamental for a reform of the areas of responsibility between physicians and non-medical personnel is a terminological differentiation between instruction-dependent, subordinate, non-independent assistance and the delegation of medical responsibilities which are transferred to non-medical personnel for independent and self-determined completion under the supervision and control of a physician. The inclination towards risk of medical activities, the need of protection of the patient and the intellectual prerequisites required for carrying out the necessary measures define the limitations for the delegation of medical responsibilities to non-medical ancillary staff. These criteria demarcate by expert assessment the exclusively medical field of activity in a sufficiently exact and convincing manner.

Medical negligence. An overview of legal theory and neurosurgical practice: duty of care.

PubMed

Todd, Nicholas V

2014-04-01

A working knowledge of the legal principles of medical negligence is helpful to neurosurgeons. It helps them to act in a "reasonable, responsible and logical" manner, that is a practice that is consistent with the surgical practice of their peers. This article will review and explain the relevant medical law in relation to duty of care with illustrative neurosurgical cases.

Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia.

PubMed

Fetters, Tamara; Samandari, Ghazaleh; Djemo, Patrick; Vwallika, Bellington; Mupeta, Stephen

2017-02-16

Although abortion is technically legal in Zambia, the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document 2 years of implementation. An intervention between the Ministry of Health, University Teaching Hospital and the international organization Ipas, was established to introduce medical abortion and to address the lack of understanding and implementation of the country's abortion law. An implementation science model was used to evaluate effectiveness and glean lessons for other countries about bringing safe and legal abortion services to scale. The intervention involved the provision of Comprehensive Abortion Care services in 28 public health facilities in Zambia for a 2 year period, August 2009 to September 2011. The study focused on three main areas: building health worker capacity in public facilities and introducing medical abortion, working with pharmacists to provide improved information on medical abortion, and community engagement and mobilization to increase knowledge of abortion services and rights through stronger health system and community partnerships. After 2 years, 25 of 28 sites provided abortion services, caring for more than 13,000 women during the intervention. For the first time, abortion was decentralized, 19% of all abortion care was performed in health centers. At the end of the intervention, all providing facilities had managers supportive of continuing legal abortion services. When asked about the impact of medical abortion provision, a number of providers reported that medical abortion improved their ability to provide affordable safe abortion. In neighboring pharmacies only 19% of mystery clients visiting them were offered misoprostol for purchase at baseline, this increased to 47

Application of legal principles and medical ethics: multifetal pregnancy and fetal reduction

PubMed Central

Cheong, May Anne; Tay, Catherine Swee Kian

2014-01-01

In the management of complex medical cases such as a multifetal pregnancy, knowledge of the ethical and legal implications is important, alongside having competent medical skills. This article reviews these principles and applies them to scenarios of multifetal pregnancy and fetal reduction. Such a discussion is not solely theoretical, but is also relevant to clinical practice. The importance of topics such as bioethical principles and informed consent are also herein addressed. PMID:25017403

Organ donation after cardiac death: legal and ethical justifications for antemortem interventions.

PubMed

Richards, Bernadette; Rogers, Wendy A

2007-08-06

Organ donation after cardiac death increases organ availability, but raises several legal and ethical issues, including consent. Medical interventions for people who are unconscious usually require guardian consent and must meet patients' best-interests standards. Antemortem procedures can improve the success of organ transplant after cardiac death, but do not serve the patient's medical interests, and it is contentious whether consent for antemortem interventions is legal under current Australian guardianship legislation. We argue that consent decisions should take patients' wishes as well as their medical interests into account. Antemortem interventions are ethically and legally justified if the interventions are not harmful and the person concerned wished to be an organ donor.

[Participation of forensic medical experts in the examination at the place of occurrence: fundamental legal principles and organizational aspects].

PubMed

Kachina, N N

2013-01-01

Discussed in this paper are fundamental legal principles and organizational aspects of the participation of forensic medical experts in the examination of the corpses at the place of occurrence. A detailed analysis of the current departmental and sectoral regulations governing the activities of specialists in the field of forensic medicine was performed The analysis demonstrated their positive and negative aspects. These findings were used to develop concrete recommendations for further improvement of these documents.

Physicians' explanatory behaviours and legal liability in decided medical malpractice litigation cases in Japan.

PubMed

Hamasaki, Tomoko; Hagihara, Akihito

2011-04-21

A physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability. We analysed legal decisions of medical malpractice cases between 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed. When the physician's explanation was given before treatment or surgery (p = 0.006), when it was relevant or specific (p = 0.000), and when the patient's consent was obtained (p = 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment. These findings may be useful in improving physician-patient communication in the medical setting.

Physicians' explanatory behaviours and legal liability in decided medical malpractice litigation cases in Japan

PubMed Central

2011-01-01

Background A physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability. Methods We analysed legal decisions of medical malpractice cases between 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed. Results When the physician's explanation was given before treatment or surgery (p = 0.006), when it was relevant or specific (p = 0.000), and when the patient's consent was obtained (p = 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment. Conclusion These findings may be useful in improving physician-patient communication in the medical setting. PMID:21510891

[Harm related to medical device use - legal and organisational risks].

PubMed

Hölscher, U M

2014-12-01

The effectiveness of the risk management systems established by medical device manufacturers and health-care facilities is clearly mitigated by European and national legal provisions. Laws, regulations and authorities prevent the systematic exchange of much safety-relevant information. The obligation to report adverse events is suspended for many relevant risks associated with medical device use. Reporting into the vigilance system is of little avail for users. Reporting even may endanger the information provider. The federal fragmentation of the German vigilance system poses a risk for patients. Risk management in health-care facilities without risk policy is dangerously incomplete. © Georg Thieme Verlag KG Stuttgart · New York.

Legal regulation of the production and trade of medical devices and medical equipment in the EU and US: experience for Ukraine.

PubMed

Pashkov, Vitalii; Kotvitska, Alla; Harkusha, Andrii

2017-01-01

The need for effective legal regulation of production and sale of medical products in Ukraine due to its social effect is obvious and requires a high level of clarity. The experience of more advanced countries in this area, given the way chosen by Ukraine to harmonize our laws with EU legislation, is certainly could be a useful source of information. The urgency of issues need further intensification of national legal reforms. Some key points on concept of legal regulation of abovementioned sphere is a base of this study. Legislation of Ukraine, European Union, United States of America, Guidelines, developed by European Commission & Food and Drug Administration's (FDA), recommendations represented by international voluntary group and scientific works. This article is based on dialectical, comparative, analytic, synthetic and comprehensive research methods. This study provide a possibility to state that main difference of regulatory systems in EU and US is that the legal framework of the EU is more flexible. This flexibility is grounded on main principle that only basic quality requirements for medical devices is defined by legislative acts however more detailed requirements are defined in standards, technical regulations, specifications, which are discretionary in nature. Contractors are free to choose any technical solution that provides compliance with the essential requirements, they can choose among different conformity assessment procedures and between accredited conformity assessment bodies to which they want to apply. The contractors themselves is interested to pass the conformity assessment procedure and have the right to put a conformity mark on their medical device because it will give them a real competitive advantage. In contrast, US State regulatory system provides strict control over business entities and law act establishes the quality requirements of medical products. The only body that can authorize the introduction of medical products and perform

Training the 21st-Century Health Care Team: Maximizing Interprofessional Education Through Medical-Legal Partnership.

PubMed

Tobin-Tyler, Elizabeth; Teitelbaum, Joel

2016-06-01

For too long, many stakeholders in the health care delivery system have ignored the extent to which social determinants of health (SDH) are inextricably woven into and affect individual and population health. The health care system is undergoing a relatively rapid transformation, which has included in part an increasing recognition of SDH's effects. This recognition, in turn, has led to renewed calls for changing the way that physicians are trained and has accelerated medical education curricular reforms. This Perspective focuses on one such innovative method of team-based care and the opportunities for its integration into medical education: medical-legal partnership, a health care delivery model that embeds civil legal services into the spectrum of health care services provided to low-income or otherwise vulnerable patients and communities.

Peri-viable birth: legal considerations.

PubMed

Sayeed, Sadath A

2014-02-01

Peri-viable birth raises an array of complex moral and legal concerns. This article discusses the problem with defining viability, touches on its relationship to abortion jurisprudence, and analyzes a few interesting normative implications of current medical practice at the time of peri-viable birth. Copyright © 2014 Elsevier Inc. All rights reserved.

Public opinion and medical cannabis policies: examining the role of underlying beliefs and national medical cannabis policies.

PubMed

Sznitman, Sharon R; Bretteville-Jensen, Anne Line

2015-10-14

Debate about medical cannabis legalization are typically informed by three beliefs: (1) cannabis has medical effects, (2) medical cannabis is addictive and (3) medical cannabis legalization leads to increased used of cannabis for recreational purposes (spillover effects). We examined how strongly these beliefs are associated with public support for medical cannabis legalization and whether this association differs across divergent medical cannabis policy regimes. Robust regression analysis was used to analyse data derived from two nationally representative samples of adults participating in comparable cross-sectional online surveys in one country where medical cannabis smoking is illegal (Norway, n = 2175, 51 % male) and in one country where medical cannabis smoking is legal (Israel, n = 648, 49 % male). The belief that cannabis has medical benefits was more strongly related to support for medical cannabis legalization than were beliefs about addiction and spillover effects. While the support for medical cannabis legalization was stronger in Israel than in Norway (78 vs. 51 %, p < 0.01), the belief variables had, in general, more impact on the policy stand in Norway. The belief that cannabis has medical benefits is particularly salient for support for medical cannabis legalization. It is possible that the recent surge in evidence supporting the medical benefits of cannabis will increase the belief about medical benefits of cannabis in the general population which may in turn increase public support for medical cannabis legalization. Results also suggest that once medical cannabis is legalized, factors beyond cannabis-specific beliefs will increasingly influence medical cannabis legalization support. These conclusions are, however, only suggestive as the current study is based on cross-sectional data. Hopefully, future research will be able to capitalize on changes in medical cannabis policies and conduct longitudinal studies that enable an

Medical and legal point of view for low-vision patients.

PubMed

Bogdănici, Camelia-Margareta; Bogdănici, Ştefan Tudor; Săndulache, Diana Elena; Diaconu, Carmen-Mariana

2018-01-01

The aim of the study was to highlight the medical and legal difficulties in framing low-vision patients for certification. We performed a retrospective observational study conducted from January 2013 to January 2016, on 63 patients with the mean age of 16.37±3.34 years, evaluated at the Ophthalmology Clinic from "Sf. Spiridon" Hospital, Iași, in order to release a medical certificate required at the Expertise Board. The clinical parameters observed were visual acuity (VA) with correction, objective refraction (in Spherical Equivalent - SEq), intraocular pressure, slit lamp examination of the anterior pole, fundus examination, orthoptic eye exam, and ocular ultrasonography (in selected cases). The main causes for the decreased visual acuity found are refractive or strabic amblyopia determined by: high myopia (28.57%), esotropia (19.04%), astigmatism (17.46); congenital diseases - congenital nystagmus (12.69%), congenital cataract (7.93%), microphthalmia (7.93%); acquired diseases - retinopathy of prematurity (9.52%), optic nerve atrophy (7.93%), bandelette keratopathy (6.34); ocular trauma (7.93%). In 52.38% of the cases for the RE and 53.96% of the cases for the LE, decreased visual acuity was caused by an irreversible condition and could not be improved. Patients come every year for reevaluation in order to receive the medical certificate required at the Expertise Board. Evaluating the patient for a certificate for visual impairment is a time consuming process due to the high number of investigations necessary and, sometimes, difficult collaboration with the patient with associated general pathology. It also requires knowledge of frequently changing legislation to complete legal forms for patients with visual impairment. A medical certificate may now be issued with a validity of up to four years, given that certain diseases are irreversible and visual functional status does not change over time.

[The notion of occupational skin disease. Medical and legal aspects].

PubMed

Elsner, P; Schliemann, S

2015-03-01

The different definitions of skin disease in medicine and in law are frequently confusing for dermatologists. While a skin disease may be defined medically referring to the definition of health by the WHO as a pathological condition of the skin leading to a disruption of the physical, mental and social well-being of the individual, legal definitions vary depending on the field of insurance law that is referred to. In the law of private health insurance, a skin disease is defined as an anomalous condition of the skin requiring medical treatment that exists independently of the subjective judgement of the insured person and needs to be objectively confirmed by a medical evaluation. In contrast, in the law of the social health insurance, the Federal Court of Social Justice defines disease as irregular physical or mental condition, deviating from the perception of a healthy human being that requires medical treatment or leads to inability to work. Substantial bodily disfigurement may be regarded as an irregular physical condition. In the law of the statutory accident insurance, occupational skin diseases are defined under clause 5101 of the occupational disease regulation as serious or repeatedly relapsing skin diseases that have forced a person to refrain from any work activities causal for the development, the aggravation or the recurrence of the disease. The Federal Court of Social Justice interprets the term "skin disease" from the protective purpose of the law, i.e. the protection against the economic and health consequences of the exposure to harmful agents and a thereby forced change of profession. This broad interpretation of the term "skin disease" leads to the recognition of diseases of the conjunctiva of the eye or diseases of the blood vessels of the skin due to cold damage as skin diseases according to clause 5101. For the correct treatment and possibly notification of occupational skin diseases in collaboration with various insurance carriers

Medication-Related Practice Roles: An Ethical and Legal Primer for School Psychologists

ERIC Educational Resources Information Center

Shahidullah, Jeffrey D.

2014-01-01

Given the prevalence of school-age children and adolescents who are prescribed with and are taking psychotropic medications, a critical issue that school psychologists may likely encounter in contemporary practice is providing both quality and continuity of care to these students in the context of relevant legal and ethical parameters. With a…

The relationship between medical ethics and the legal system in Italy: food for thought.

PubMed

Petrini, Carlo; Ricciardi, Walter

2016-01-01

Relations between ethics in general - and medical ethics in particular - and legal systems are complex and have been extensively examined in the literature. The topic is important not only for ethicists and jurists, but also for members of the public, who benefit from the services offered by the professions. While the Italian Institute of Health does not claim to propose new avenues for exploration of the relations between ethics and legal systems, it offers some food for thought in the ongoing debate.

[Giving medico-legal opinions in cases with suspicion of medical mistake. part 2. Expert evidence in cases with suspicion of medical mistake - expectations, possibilities, threats…].

PubMed

Chowaniec, Czesław; Chowaniec, Małgorzata; Wilk, Mateusz

Problems of medical mistake and therapeutic failure are inextricably linked with realization of medical services. In recent years, mostly by the media and increasing demanding attitude, a rapid increase of initiated cases opened by judicial body in conjunction with medical mistake made by medical staff is observed. Making medico-legal opinions is not easy task and often face many difficulties. These consist of lacks in medical documentation, time rigor, formal tightening and need to create team that consist of both forensic medicine specialist and clinicians, who together shall write complex medico-legal opinion. This article touches the essence of the opinion-making problem in the aspect of medical mistake. It shows specifics of the role of forensic medicine specialist, his challenges and difficulties in creating opinions. The article confronts real possibilities of court experts with expectations of judicial body, outlining new challenges and dangers which court experts have to face.

From Bolam-Bolitho to Modified-Montgomery - A Paradigm Shift in the Legal Standard of Determining Medical Negligence in Singapore.

PubMed

Neo, Han Yee

2017-09-01

In a recent landmark litigation, the Singapore Court of Appeal introduced a new legal standard for determining medical negligence with regards to information disclosure - the Modified-Montgomery test. This new test fundamentally shifts the legal position concerning the standard of care expected of a doctor when he dispenses medical advice. Previously, a doctor is expected to disclose what a "reasonable physician" would tell his patient. Now, a doctor must disclose "all material risks" that a "reasonable patient" would want to know under his unique circumstances. Patient-centred communication is no longer an aspirational ideal but has become a legal mandate. Manpower, administrative, logistic and medical educational reforms should start now, so as to support the average physician transit from the era of the Bolam-Bolitho, to that of the Modified-Montgomery.

The identity, legal status and origin of the Roman army's medical staff in the imperial age.

PubMed

Bader, Pascal

2014-01-01

More than a hundred epigraphic documents on different writing materials refer to medical staff in the Roman army. This paper focuses on the identity, legal status and origin of the Roman army medical staff--a topic which until now has hardly been studied. Various titles were conferred to a large number of medical staff in every unit of the Roman army; the doctors (medici) were the most numerous and had different ranks and status. The onomastic study of the inscriptions reveals a large proportion of Roman citizens in the military medical service. Most of them are ingenui with a Latin name, but freedmen with a Greek origin are frequently attested, though less so than among civilian doctors. These results dispel some misconceptions such as the Greek origin of most military doctors, which can be explained by the legal requirements of the recruitment into the Roman army.

How Does Iranian's Legal System Protect Human Vulnerability and Personal Integrity in Medical Research?

PubMed Central

Karoubi, Mohammad Taghi; Akhondi, Mohammad Mehdi

2011-01-01

The astonishing advance of medical science in recent decades has had endless advantages for humans, including improved level of health, prevention of disease and advances in treatment. These advances depend to a great extent on conducting continuous research. However, besides its enormous advantages, the sole interest of medical science undermines the principles of respect for human vulnerability and personal integrity, in both positive and negative approaches. The positive approach refers to the people who participate in research and practice, while the negative approach refers to people who are deprived of research and practice. The authors of this work, based on legal or moral grounds try to analyse the tension between the principle of respect for human vulnerability and personal integrity and the interest of medical science. Undoubtedly, in applying scientific knowledge and medical practice human vulnerability should be taken into account. In this regard, especially vulnerable individuals and groups should be protected and the personal integrity of such individuals respected. In the light of the merits of Islamic law, this paper is designed to examine the significance of the principles of human vulnerability and personal integrity in medical research by studying the international documents as formalised by UNESCO in order to explore the place of these principles in the Iranian legal system. PMID:23408269

Accommodating the medical use of marijuana: surveying the differing legal approaches in Australia, the United States and Canada.

PubMed

Bogdanoski, Tony

2010-02-01

While the scientific and medical communities continue to be divided on the therapeutic benefits and risks of cannabis use, anecdotal evidence from medical users themselves suggests that using cannabis is indeed improving their quality of life by alleviating their pain and discomfort. Notwithstanding the benefits anecdotally claimed by these medical users and the existence of some scientific studies confirming their claims, criminal drug laws in all Australian and most United States jurisdictions continue to prohibit the possession, cultivation and supply of cannabis even for medical purposes. However, in contrast to Australia and most parts of the United States, the medical use of cannabis has been legal in Canada for about a decade. This article reviews these differing legal and regulatory approaches to accommodating the medical use of cannabis (namely, marijuana) as well as some of the challenges involved in legalising it for medical purposes.

Medical Error Disclosure and Patient Safety: Legal Aspects

PubMed Central

Guillod, Olivier

2013-01-01

Reducing the number of preventable adverse events has become a public health issue. The paper discusses in which ways the law can contribute to that goal, especially by encouraging a culture of safety among healthcare professionals. It assesses the need or the usefulness to pass so-called disclosure laws and apology laws, to adopt mandatory but strictly confidential Critical Incidents Reporting Systems in hospitals, to change the fault-based system of medical liability or to amend the rules on criminal liability. The paper eventually calls for adding the law to the present agenda of patient safety. Significance for public health The extent of preventable adverse events and the correlative need to improve patient safety are recognized today as a public health issue. In order to lower the toll associated with preventable adverse events, the former culture of professionalism (based on the premise that a good physician doesn’t make mistakes) must be replaced by a culture of safety, which requires a multi-pronged approach that includes all the main stakeholders within the healthcare system. A number of legal reforms could help in prompting such a change. This contribution stresses the need to include legal aspects when trying to find appropriate responses to public health issues. PMID:25170502

Recommendations for teaching upon sensitive topics in forensic and legal medicine in the context of medical education pedagogy.

PubMed

Kennedy, Kieran M; Scriver, Stacey

2016-11-01

Undergraduate medical curricula typically include forensic and legal medicine topics that are of a highly sensitive nature. Examples include suicide, child abuse, domestic and sexual violence. It is likely that some students will have direct or indirect experience of these issues which are prevalent in society. Those students are vulnerable to vicarious harm from partaking in their medical education. Even students with no direct or indirect experience of these issues may be vulnerable to vicarious trauma, particularly students who are especially empathetic to cases presented. Despite these risks, instruction relating to these topics is necessary to ensure the competencies of graduating doctors to respond appropriately to cases they encounter during their professional careers. However, risk can be minimised by a well-designed and thoughtfully delivered educational programme. We provide recommendations for the successful inclusion of sensitive forensic and legal medicine topics in undergraduate medical curricula. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Legal, Social, Ethical, and Medical Perspectives on the Care of the Statutory Rape Adolescent in the Emergency Department.

PubMed

Tsai, Shiu-Lin; Acosta, Elvira; Cardenas, Toni; Sigall, Jeremy K; Van Geem, Kevin

2017-07-01

Rapes involving adolescents who present to the emergency department (ED) are fraught with ethical and legal complexities and are often emotionally turbulent for patients, their families, and medical providers. Management requires a thoughtful approach from multiple standpoints, including legal, psychosocial, ethical, and medical ones. However, there is no standardized sexual assault education for emergency medicine residents, and management practices vary widely. 1,2 We present a hypothetical statutory rape case based on real cases that occurred in New York City and bring together the perspectives of an attorney on the legal parameters, two social workers on the psychosocial issues, an ethicist on the moral considerations, and a pediatric emergency physician-who is also a sexual assault forensic examiner-on the medical treatments. We aim to provide a framework for physicians to navigate issues of patient-physician privilege involving minors, privacy rules, and mandatory reporting laws. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Learning from the legal history of billing for medical fees.

PubMed

Hall, Mark A; Schneider, Carl E

2008-08-01

When patients pay for care out-of-pocket, physicians must balance their professional obligations to serve with the commercial demands of medical practice. Consumer-directed health care makes this problem newly pressing, but law and ethics have thought for millennia about how doctors should bill patients. At various points in European history, the law restricted doctors' ability to bill for their services, but this legal aversion to commercializing medicine did not take root in the American colonies. Rather, US law has always treated selling medical services the way it treats other sales. Yet doctors acted differently in a crucial way. Driven by the economics of medical practice before the spread of health insurance, doctors charged patients according to what they thought each patient could afford. The use of sliding fee scales persisted until widespread health insurance drove a standardization of fees. CURRENT PRACTICE: Today, encouraged by Medicare rules and managed care discounts, providers use a perverse form of a sliding scale that charges the most to patients who can afford the least. Primary care physicians typically charge uninsured patients one third to one half more than they receive from insurers for basic office or hospital visits, and markups are substantially higher (2 to 2.5 times) for high-tech tests and specialists' invasive procedures. Ethical and professional principles might require providers to return to discounting fees for patients in straitened circumstances, but imposing such a duty formally (by law or by ethical code) on doctors would be harder both in principle and in practice than to impose such a duty on hospitals. Still, professional ethics should encourage physicians to give patients in economic trouble at least the benefit of the lowest rate they accept from an established payer.

Learning from the Legal History of Billing for Medical Fees

PubMed Central

Schneider, Carl E.

2008-01-01

INTRODUCTION When patients pay for care out-of-pocket, physicians must balance their professional obligations to serve with the commercial demands of medical practice. Consumer-directed health care makes this problem newly pressing, but law and ethics have thought for millennia about how doctors should bill patients. Historical Background At various points in European history, the law restricted doctors’ ability to bill for their services, but this legal aversion to commercializing medicine did not take root in the American colonies. Rather, US law has always treated selling medical services the way it treats other sales. Yet doctors acted differently in a crucial way. Driven by the economics of medical practice before the spread of health insurance, doctors charged patients according to what they thought each patient could afford. The use of sliding fee scales persisted until widespread health insurance drove a standardization of fees. Current Practice Today, encouraged by Medicare rules and managed care discounts, providers use a perverse form of a sliding scale that charges the most to patients who can afford the least. Primary care physicians typically charge uninsured patients one third to one half more than they receive from insurers for basic office or hospital visits, and markups are substantially higher (2 to 2.5 times) for high-tech tests and specialists’ invasive procedures. CONCLUSION Ethical and professional principles might require providers to return to discounting fees for patients in straitened circumstances, but imposing such a duty formally (by law or by ethical code) on doctors would be harder both in principle and in practice than to impose such a duty on hospitals. Still, professional ethics should encourage physicians to give patients in economic trouble at least the benefit of the lowest rate they accept from an established payer. PMID:18414955

Marijuana Use Among Patients With Glaucoma in a City With Legalized Medical Marijuana Use.

PubMed

Belyea, David A; Alhabshan, Rashed; Del Rio-Gonzalez, Ana Maria; Chadha, Nisha; Lamba, Tania; Golshani, Cyrus; Merchant, Kunal; Passi, Neena; Dan, Jacob A

2016-03-01

Previous research has shown several limitations associated with the use of marijuana as a treatment for glaucoma. However, little is known regarding patients' perceptions toward using marijuana for glaucoma and their intentions to use this therapeutic alternative. To identify factors among patients with glaucoma that could lead to intentions to use marijuana for treatment. This cross-sectional survey study of 204 patients with glaucoma or suspected to have glaucoma was conducted at an academic-based glaucoma clinic in Washington, DC, between February 1 and July 31, 2013. Patients completed a self-administered survey assessing demographics, perceived severity of glaucoma, prior knowledge about marijuana use in glaucoma, past marijuana use, perceptions toward marijuana use (legality, systemic adverse effects, safety and effectiveness, and false beliefs), satisfaction with current glaucoma management, relevance of treatment costs, and intentions to use marijuana for glaucoma. Medical records were reviewed for disease severity. Data analysis was conducted from September 1, 2013, to September 30, 2015. The main outcome was patients' intentions to use marijuana for glaucoma. Multiple linear regression analysis was conducted to identify factors associated with patients' intentions to use marijuana for glaucoma. Of the 334 patients who were invited to participate in the study, 204 (61.1%) completed the survey. About half the participants were women (104 [51.0]%), and 82 (40.2%) were white. Regression analysis of 204 respondents indicated that perceptions of legality of marijuana use (β, 0.378; 95% CI, 0.205 to 0.444; P < .001), false beliefs regarding marijuana (β, 0.323; 95% CI, 0.236 to 0.504; P < .001), satisfaction with current glaucoma care (β, -0.222; 95% CI, -0.362 to -0.128; P < .001), and relevance of marijuana and glaucoma treatment costs (β, 0.127; 95% CI, 0.008 to 0.210; P = .04) were significantly associated with intentions to use marijuana for glaucoma

The impact of marijuana policies on youth: clinical, research, and legal update.

PubMed

Ammerman, Seth; Ryan, Sheryl; Adelman, William P

2015-03-01

This technical report updates the 2004 American Academy of Pediatrics technical report on the legalization of marijuana. Current epidemiology of marijuana use is presented, as are definitions and biology of marijuana compounds, side effects of marijuana use, and effects of use on adolescent brain development. Issues concerning medical marijuana specifically are also addressed. Concerning legalization of marijuana, 4 different approaches in the United States are discussed: legalization of marijuana solely for medical purposes, decriminalization of recreational use of marijuana, legalization of recreational use of marijuana, and criminal prosecution of recreational (and medical) use of marijuana. These approaches are compared, and the latest available data are presented to aid in forming public policy. The effects on youth of criminal penalties for marijuana use and possession are also addressed, as are the effects or potential effects of the other 3 policy approaches on adolescent marijuana use. Recommendations are included in the accompanying policy statement. Copyright © 2015 by the American Academy of Pediatrics.

Insulin Administration in Catholic Schools: A New Look at Legal and Medical Issues

ERIC Educational Resources Information Center

Huggins, Mike

2015-01-01

Anecdotal evidence indicates that more students with type 1 diabetes are enrolling in Catholic schools across the United States. Meeting the medical needs of these students appears to be a significant challenge--legally and logistically--for many Catholic schools. District officials, school leaders, and school staff need support to understand the…

10 CFR 712.14 - Medical assessment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... abuse of legal drugs or other substances, as identified by self-reporting or by medical or psychological... use disorder, use of illegal drugs, or the abuse of legal drugs or other substances, must undergo an... psychiatric evaluations, a review of current legal drug use, and any other relevant information. This...

The implementation of medical monitoring programs following potentially hazardous exposures: a medico-legal perspective.

PubMed

Vearrier, David; Greenberg, Michael I

2017-11-01

Clinical toxicologists may be called upon to determine the appropriateness of medical monitoring following documented or purported exposures to toxicants in the occupational, environmental, and medical settings. We searched the MEDLINE database using the Ovid ® search engine for the following terms cross-referenced to the MeSH database: ("occupational exposures" OR "environmental exposures") AND ("physiologic monitoring" OR "population surveillance"). The titles and abstracts of the resulted articles were reviewed for relevance. We expanded our search to include non-peer-reviewed publications and gray literature and resources using the same terms as utilized in the MEDLINE search. There were a total of 48 relevant peer-reviewed and non-peer-reviewed publications. Publications excluded contained no information relevant to medical monitoring following potentially harmful toxicologic exposures, discussed only worker screening/surveillance and/or population biomonitoring, contained redundant information, or were superseded by more recent information. Approaches to medical monitoring: A consensus exists in the peer-reviewed medical literature, legal literature, and government publications that for medical monitoring to be a beneficial public health activity, careful consideration must be given to potential benefits and harms of the program. Characteristics of the exposure, the adverse human health effect, the screening test, and the natural history of the disease are important in determining whether an exposed population will reap a net benefit or harm from a proposed monitoring program. Broader interpretations of medical monitoring: Some have argued that medical monitoring programs should not be limited to exposure-related outcomes but should duplicate general preventive medicine efforts to improve public health outcomes although an overall reduction of morbidity, mortality and disability by modifying correctable risk factors and disease conditions. This broader

What is legal medicine--are legal and forensic medicine the same?

PubMed

Beran, Roy G

2010-04-01

Some consider the terms "forensic" and "legal" medicine to be synonymous but this is counter to the title of the Faculty of Forensic and Legal Medicine or the dual strands for progression to fellowship of the Australian College of Legal Medicine. The paper examines a very brief historical background to legal medicine and develops a definition of the strands thereof, namely legal and forensic medicine. It demonstrates that the two are different components of the application of medical knowledge upon the legal system. Legal medicine has greater relevance to civil and tort law, impacting upon patient care, whereas forensic medicine relates to criminal law and damage to, or by, patients.

Analysis - what is legal medicine?

PubMed

Beran, Roy G

2008-04-01

Legal medicine addresses the interface between medicine and law in health care. The Australian College of Legal Medicine (ACLM) established itself as the peak body in legal and forensic medicine in Australia. It helped establish the Expert Witness Institute of Australia (EWIA), the legal medicine programme at Griffith University and contributes to government enquiries. Public health, disability assessment, competing priorities of privacy verses notification and determination of fitness for a host of pursuits are aspects of legal medicine. Complementing the EWIA, the ACLM runs training programmes emphasising legal medicine skills additional to clinical practice, advocating clinical relevance. Assessment of athletes' fitness and ensuring that prohibited substances are not inadvertently prescribed represent a growing area of legal medicine. Ethical consideration of health care should respect legal medicine principles rather than armchair commentary. International conventions must be respected by legal medicine and dictate physicians' obligations. The NSW courts imposed a duty to provide emergency medical care. Migration and communicable diseases are aspects of legal medicine. Police surgeons provide a face to legal medicine (which incorporates forensic medicine) underpinning its public perception of specialty recognition. Legal medicine deserves its place as a medical specialty in its own right.

Inclusion of Medical-Legal Issues in Entry-Level Occupational and Physical Therapy Curricula.

ERIC Educational Resources Information Center

Ekelman, Beth A.; Goodman, Glenn; Dal Bello-Haas, Vanina

2000-01-01

Directors of 47 occupational therapy (OT) and 65 physical therapy (PT) accredited entry-level programs responded to a survey by indicating their support for inclusion of medical-legal issues in the curriculum. Only 40% of OT and 52% of PT directors believed lawyers should deliver instruction; most felt their faculty were qualified to teach these…

[Factors forming opnion on marijuana legalization in Poland among group of students from medical and technical college faculty].

PubMed

Suwała, Małgorzata; Gerstenkorn, Andrzej; Szewczyk, Anna

2015-01-01

Marijuana is the most popular illegal drug in the world. In 2010 17.6% of polish adult population (age 15-64) and 37.3% of youth (age 17-18) declared use of marijuana at least once in their lifetime. Recent years in Poland brought back public discussion regarding decriminalization and legalization of marijuana. The main goal of the study was to reveal the opinion about legalization of marijuana in Poland among students of medical and technical faculty in correlation with chosen socio-demographic factors, college major, attitude to tobacco smoking, use of drugs and religious practice. Study included 230 students (110 from Medical University of Lodz and 120 from Technical University of Lodz). Women consisted on 56.1% of surveyed and men on 43.9%. Study used audit survey as a research method. Results. 40.4% of students considered marijuana as "soft" drug and in majority (65.7%) are convinced that it is not addictive. The main part of studied group (83%) claimed that marijuana is easily accessible in Poland. The majority of the group (38.75%) was against marijuana legalization, a little bit less (35.2%) approved its legalization in Poland and 26.1% had no opinion. Type of college faculty had not been detected as a factor influencing support for legalization. Important factors influencing positive opinion on legalization was: living in the city, tobacco smoking, socializing with legalization supporters, lack of regular religious practice, drug use. CONCLUSION. Young people's diversified opinion regarding legalization of marijuana in Poland should encourage further discussion. Educational and preventive activities within different social groups are necessary to form a conscious opinion on legalization of marijuana in Poland based on the knowledge of actual scientific facts.

Legal and regulatory responses to innovative treatment.

PubMed

Chan, Tracey Evans

2013-01-01

Developments in medical technology, healthcare delivery, and commercial interests in medicine have increased both the potential for conflicts of interest on the part of physicians, and doubts over the sufficiency of patient autonomy as a justification for administering innovative therapy. The legal and regulatory treatment of innovative therapy is therefore an important question, on which there is a current lack of consensus on a number of issues. This paper discusses recent developments in Singapore and uses them as a springboard to flesh out basic regulatory issues that arise from the deployment of innovative treatment: the distinction between innovative treatment and clinical research, the adequacy of the current post hoc scrutiny of innovative therapy under existing legal principles and the need for further specialised regulatory oversight.

[Prevention of medico-legal conflicts in medical practice].

PubMed

Minossi, José Guilherme

2009-02-01

Generally, medico-legal conflicts which occur in surgical and medical practice are a source of worry for both the medical profession and the society as a whole, because on one hand, they could cause high emotional stress for doctors, and on the other hand, patients could be rejected. Once consolidated, defensive medicine increases treatment costs and the doctor-patient relationship could transform into a tragedy. There are many causes for this, including non-treatment factors, such as an unsupported and disorganized health system, lack of participation from society and the doctor in improving this system, the training machine which launches a large number of young unprepared doctors to practice in this noble profession, along with a lack of continuing training, as there are few public or private institutions providing preparation, or further medical training. The related treatment factors are generally, a deficient doctor-patient relationship, poor work condition, power abuse by the doctor, a lack of clear agreement, and poor medical record keeping. These conflicts cannot be solved by simple creating legislation, or by denying the existence of medical error, which occurs at higher frequency than the actual conflicts. It is very important to improve the doctor-patient relationship because an effective fraternal relationship reduces the chance of a judicial demand. The doctor still needs to fully understand his/her conduct obligations and mainly to avoid power abuse. Doctors must also professionally link themselves with politicians who fight for the individual's rights against the system. Society must also understand that health is not just an issue exclusive for doctors, and people must fight to improve living conditions. Society must seriously show its frustration with the increasing disparity between scientific possibilities and actual wellbeing. The training machine needs immediate profound changes to produce professionals with the highest qualifications equipped

Legal Rights of Asbestos Exposure Victims. A Practical Legal Guide for People With Breathing and Other Medical Problems, Possibly Resulting from Exposure to Asbestos.

ERIC Educational Resources Information Center

Silberfeld, Roman M.; Hecht, Richard L.

This practical legal guide for people with breathing and other medical problems, possibly resulting from exposure to asbestos, provides 19 questions and detailed answers about Asbestosis and other diseases resulting from asbestos exposure. Included is information concerning symptoms, difficulty of diagnosis, necessity of a detailed…

[Legal framework of data protection : current requirements in Germany and requirements in planned European Union regulations].

PubMed

Schütze, B

2013-05-01

The federal system in Germany necessitates that in addition to federal laws, country and church-specific legislations must also be considered during the evaluation of relevant legal stipulations concerning data protection. Furthermore, there are also special legal regulations for hospitals in almost every federal state which are governed by the principle of subsidiarity: special legal regulations are to be preferentially used, so that findings from one federal state are difficult to transfer to another federal state.Patient data may only be used and processed without legal regulations with informed consent of the patient. The use of patient data for purposes of quality assurance, research and further education of students and doctors is possible under the present laws according to a positive weighting of interests. Patient data can also be exchanged via online services for the purposes of patient care; however, informed consent of the patient for medical online services is almost always unavoidable.

Medical and legal problems in intermediate intensive units.

PubMed

Gherson, G

1994-12-01

Due to a lack of legislation on the subject (the only data concerns the standard of hospital personnel in the Ministerial Decree (DM) of 13th September 1988), the medical and legal problems are concerned, in the first instance, with defining the type of unit, the context within which it can be placed and the eventual access to essential services and minimum equipment. With regard to responsibility, bearing in mind that the medical team of the intermediary unit (as with all other hospital teams) is employed by the public National Health Service, medical malpractice can be associated with lack of equipment and an inadequate public health service, which is often the cause. If penal responsibility is strictly personal (art. 27 of the Constitution) the civil relationship is, on the one hand, a relationship between the administration and the patient (the physician as employee must give his services within the Health Service and does not have an official personal relationship with the patient) so the Hospital organisation has a contractual type of civil responsibility whereas the employed doctors have an extra-contractual responsibility with different obligations. These responsibilities, which are also determined by the functions of the physician within the USL Health Service (DPR n. 761/1979), can also include control of non-medical staff, control of the equipment, specific training of personnel, etc. Problems concerning the admission of patients to the intermediate unit must also be taken into account (precise evaluation of the indications and of the type of patient to be admitted, refusal of patients in such a condition as to require intensive care or invasive techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Outsourcing medical data analyses: can technology overcome legal, privacy, and confidentiality issues?

PubMed

Brumen, Bostjan; Heričko, Marjan; Sevčnikar, Andrej; Završnik, Jernej; Hölbl, Marko

2013-12-16

Medical data are gold mines for deriving the knowledge that could change the course of a single patient's life or even the health of the entire population. A data analyst needs to have full access to relevant data, but full access may be denied by privacy and confidentiality of medical data legal regulations, especially when the data analyst is not affiliated with the data owner. Our first objective was to analyze the privacy and confidentiality issues and the associated regulations pertaining to medical data, and to identify technologies to properly address these issues. Our second objective was to develop a procedure to protect medical data in such a way that the outsourced analyst would be capable of doing analyses on protected data and the results would be comparable, if not the same, as if they had been done on the original data. Specifically, our hypothesis was there would not be a difference between the outsourced decision trees built on encrypted data and the ones built on original data. Using formal definitions, we developed an algorithm to protect medical data for outsourced analyses. The algorithm was applied to publicly available datasets (N=30) from the medical and life sciences fields. The analyses were performed on the original and the protected datasets and the results of the analyses were compared. Bootstrapped paired t tests for 2 dependent samples were used to test whether the mean differences in size, number of leaves, and the accuracy of the original and the encrypted decision trees were significantly different. The decision trees built on encrypted data were virtually the same as those built on original data. Out of 30 datasets, 100% of the trees had identical accuracy. The size of a tree and the number of leaves was different only once (1/30, 3%, P=.19). The proposed algorithm encrypts a file with plain text medical data into an encrypted file with the data protected in such a way that external data analyses are still possible. The results

Outsourcing Medical Data Analyses: Can Technology Overcome Legal, Privacy, and Confidentiality Issues?

PubMed Central

2013-01-01

Background Medical data are gold mines for deriving the knowledge that could change the course of a single patient’s life or even the health of the entire population. A data analyst needs to have full access to relevant data, but full access may be denied by privacy and confidentiality of medical data legal regulations, especially when the data analyst is not affiliated with the data owner. Objective Our first objective was to analyze the privacy and confidentiality issues and the associated regulations pertaining to medical data, and to identify technologies to properly address these issues. Our second objective was to develop a procedure to protect medical data in such a way that the outsourced analyst would be capable of doing analyses on protected data and the results would be comparable, if not the same, as if they had been done on the original data. Specifically, our hypothesis was there would not be a difference between the outsourced decision trees built on encrypted data and the ones built on original data. Methods Using formal definitions, we developed an algorithm to protect medical data for outsourced analyses. The algorithm was applied to publicly available datasets (N=30) from the medical and life sciences fields. The analyses were performed on the original and the protected datasets and the results of the analyses were compared. Bootstrapped paired t tests for 2 dependent samples were used to test whether the mean differences in size, number of leaves, and the accuracy of the original and the encrypted decision trees were significantly different. Results The decision trees built on encrypted data were virtually the same as those built on original data. Out of 30 datasets, 100% of the trees had identical accuracy. The size of a tree and the number of leaves was different only once (1/30, 3%, P=.19). Conclusions The proposed algorithm encrypts a file with plain text medical data into an encrypted file with the data protected in such a way that

The current status of medical malpractice countersuits.

PubMed

Sokol, D J

1985-01-01

The dramatic growth of medical malpractice litigation in recent decades has contributed significantly to an overall increase in health care costs in this country. Although lawmakers, physicians, and other responsible citizens have proposed numerous solutions in an effort to curb the crisis, these proposals have generally been ineffective. In this Article the Author endorses countersuits as the most appropriate response to frivolous medical malpractice actions. The Author also suggests that contingent fee systems, coupled with the economic motivation of private insurers to settle claims quickly, provide incentive for plaintiffs to initiate frivolous claims. This Article analyzes the general legal approaches available for countersuits, emphasizing recent successful actions based on malicious prosecution and abuse of process, and proposes more widespread use of these approaches.

Sleep-Related Violence and Sexual Behavior in Sleep: A Systematic Review of Medical-Legal Case Reports

PubMed Central

Ingravallo, Francesca; Poli, Francesca; Gilmore, Emma V.; Pizza, Fabio; Vignatelli, Luca; Schenck, Carlos H.; Plazzi, Giuseppe

2014-01-01

Objective: To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS). Search Methods: We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles. Selection Criteria: Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided. Data Extraction and Analysis: Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed. Results: Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant's sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case. Conclusion: SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority. Citation: Ingravallo F, Poli F, Gilmore EV, Pizza F, Vignatelli L, Schenck CH, Plazzi G. Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports. J Clin Sleep Med 2014;10(8):927-935. PMID:25126042

Study on the Application Mode and Legal Protection of Green Materials in Medical-Nursing Combined Building

NASA Astrophysics Data System (ADS)

Zhiyong, Xian

2017-09-01

In the context of green development, green materials are the future trend of Medical-Nursing Combined building. This paper summarizes the concept and types of green building materials. Then, on the basis of existing research, it constructs the green material system framework of Medical-Nursing Combined building, puts forward the application mode of green building materials, and studies the policy and legal protection of green material application.

[Individual rights vs public health in the fight against contagious diseases: proposals to improve the current legal framework].

PubMed

Salamero Teixidó, Laura

2016-11-01

The public health protection constitutional mandate requires public powers to protect the population from contagious diseases. This requires a legal framework that both protects public health effectively and respects individual rights and freedoms that could be undermined by the public administrations. This article analyses, from a legal perspective, the current legal framework regulating the adoption of health measures to protect public health against contagious diseases. It argues that current regulations generate legal uncertainty on the basis of the wide range of discretionary powers they give to the public administration and the lack of provisions for limiting these powers. As a result, the guarantee mechanisms (primarily judicial consent) only weakly protect the rights and freedoms of the citizens affected by health measures. To conclude, the article proposes several amendments to improve public health regulations related to contagious diseases. The purpose is to render a legal framework that offers more legal certainty, in which it is possible to protect individual rights and freedoms when measures are adopted, without sacrificing the effective protection of public health. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

[Coercive procedures in forensic psychiatry : Current treatment practice in forensic psychiatric hospitals from a medical ethics perspective].

PubMed

Jakovljević, A-K; Wiesemann, C

2016-07-01

In 2011 the legal foundations of coercive treatment in German forensic psychiatric clinics were declared to be unconstitutional. In the present study we analyzed the frequency of coercive procedures in forensic psychiatric hospitals before and after 2011, the consequences for medical care as well as the ethical assessments by attending chief physicians. By a questionnaire-based survey of views of attending chief physicians in forensic psychiatric clinics in 2013, data on the current state of patient care were collected and analyzed from an ethical perspective. These were compared with treatment data from a large forensic psychiatric clinic collected over the period 2007-2013. Even after 2011 coercive forms of treatment were applied in forensic psychiatric hospitals. In practice, there is a high degree of legal uncertainty regarding the limits of coercive treatment. Of all patients treated in forensic psychiatric clinics in 2012, on average 13 % had been in isolation at least once, approximately 3 % had been treated under fixation at least once and 2.2 % had been subjected to coercive medical treatment at least once. From an ethical perspective an open debate about the practice of coercive treatment is urgently required. Legal regulations, ethical guidelines and treatment standards have to be developed for the special situation of patient care in forensic psychiatric hospitals.

Assessing potential legal responses to medical ghostwriting: effectiveness and constitutionality

PubMed Central

Chen, Chung-Lin

2018-01-01

Abstract Pharmaceutical companies are extensively involved in shaping medical knowledge to market their products to physicians and consumers. Specialized planning is undertaken to produce scientific articles driven by commercial interests. Rather than the listed authors, hidden analysts and publication management firms hired by pharmaceutical companies are often responsible for the content of scientific articles. Such ghostwriting practices raise serious concerns regarding the integrity of knowledge and thus demand urgent attention. This paper analyses the strategies of legal regulation on medical ghostwriting and their comparative advantages and disadvantages. Many of regulatory proposals suffer from a lack of effectiveness, whereas others are subject to constitutional concerns. The analysis in this paper offers insights into framing adequate regulation; it supports the strategy for reforming the structure of information production while calling for cautiousness in shaping its regulatory outline. In addition, this paper contributes to the analysis of First Amendment jurisprudence, suggesting that the judiciary should allow a certain amount of leeway for political branches to develop effective regulation PMID:29707217

Evaluation of the quality of medical certificates in the context of the opening of a measure of legal protection for adults over 60 years of age.

PubMed

Arcese, Guillaume; Drunat, Olivier; Arbault, Sylvie; Gonthier, Régis

2017-06-01

In France between 700,000 and 800,000 people will be covered by legal protection. The opening of any measure is conditioned by a detailed medical certificate. It is drawn up by a doctor registered on the list drawn up by the public prosecutor. No specific training is required. A single piece of legislation frames the content of the certificates. We therefore investigated whether the medical certificates currently produced were in compliance with the code of civil procedure. 111 medical certificates collected and anonymized by the tribunal d'instance of Saint-Étienne, from 4 January to 3 April 2016. The certificates concerned applications for the opening of legal protection for adults over 60 years of age. 57% of detailed medical certificates satisfied the requirements of article 1219 of the code of civil procedure, with no difference between requests for curatorship and guardianship. 76% of adults had cognitive impairment, 14% had a psychiatric disability, and 10% had a functional disability. 72% medical certificates proposed a guardianship measure, 21% a reinforced curatorship and 7% a simple curatorship. The circumstances justifying the opening of a measure of protection and the way of life of the adult were respectively found in 32% and 83% of the certificates. In 49% of the cases, the doctors dispensed the majority of hearing with the judge and the right to vote was retained in 10% of the adults subject to a guardianship application. The study showed a deficiency in the application of article 1219 of the code of civil procedure but also in the information that was requested. The drafting of the detailed medical certificate requires specific medical and legal knowledge. This raises the question of the training of doctors on the list of public prosecutors. Like the medical assessment carried out in the context of the assessment of bodily injury, the detailed medical certificate must become a real expertise carried out by doctors trained in this exercise.

The Use of Medical Marijuana in Cancer.

PubMed

Birdsall, Shauna M; Birdsall, Timothy C; Tims, Lucas A

2016-07-01

The use of medical marijuana in cancer care presents a dilemma for both patients and physicians. The scientific evidence is evolving, yet much of the known information is still insufficient to adequately inform patients as to risks and benefits. In addition, evidence-based dosing and administration information on medical marijuana is lacking. Medical marijuana is now legal, on some level, in 24 states plus the District of Columbia, yet is not legal on the federal level. This review addresses the current state of the research, including potential indications, risks and adverse effects, preliminary data on anticancer effects, as well as legal and quality issues. A summary of the clinical trials underway on medical marijuana in the oncology setting is discussed.

Urethral catheters and medical malpractice: a legal database review from 1965 to 2015.

PubMed

Awad, Mohannad A; Osterberg, E Charles; Chang, Helena; Gaither, Thomas W; Alwaal, Amjad; Fox, Ryan; Breyer, Benjamin N

2016-10-01

Urethral catheters (UCs) are commonly used in medicine and are associated with complications such as urinary tract infections (UTIs) and trauma. Given UC complications and their ubiquitous usage in healthcare, there is a potential for liability risk. We aim to explore litigation involving UC-related complications. The LexisNexis legal database was queried for all state and federal cases from January 1965 through October 2015 using the terms "urethral catheter" or "Foley catheter" in combination with "medical malpractice", "negligence", "medical error", and "trauma". Each case was reviewed for reported medical characteristics and legal aspects, including the outcome of the case. Our search yielded 29 cases. Urologists were the most common providers cited as defendants (21%), all of whom were successful in their defense. The most common malpractice claim was for traumatic insertion (48%). Pain was the most common type of damage claimed by plaintiffs (28%), followed by UTI (24%). Nineteen (66%) cases favored defendants, while 10 (34%) cases favored the plaintiffs, of which 2 (7%) were settled out of the court. In settled cases, the mean settlement received by plaintiffs was $55,750 (range, $25,000-$86,500). The mean award to plaintiffs for cases determined by the court was $112,991 (range, $4,000-$325,000). Despite widespread usage of UC over a 50-year period, lawsuits centered on UC misuse are rare at the state and federal court levels. Of litigated cases, urologists are commonly involved yet have successful defenses.

Legalized abortion: a public health success story.

PubMed

Kelly, M

1999-06-01

60% of more than 2000 women surveyed by the Picker Institute who underwent induced abortion procedures rated the quality of their care as excellent. Another third reported their care as being either very good or good. The survey also found that the quality of abortion care is comparable to other outpatient surgery. However, the high quality of care women receive from abortion providers is lost in the hostile anti-abortion climate created by threatening protesters outside of clinics and the murder of 7 clinic workers and physicians who performed abortions. Abortion opponents fail to acknowledge that legal abortion is a medical procedure which protects women's health and saves their lives. Before abortion was legalized in the US, countless women were either rendered unable to reproduce or died from abortion-related complications. Efforts to outlaw abortion persist despite it being widely recognized by medical experts as one of the most safe medical procedures currently performed in the US. When state legislatures target abortion providers with unduly strict regulations, abortion becomes prohibitively expensive and difficult to obtain.

Legal assessment of current situation on orphan patients in Lithuania.

PubMed

Spokiene, Indre

2008-01-01

After Lithuania joined the European Union, the Regulation (EC) No. 141/2000 on orphan medicinal products and Commission Regulation (EC) No. 847/2000 came into force as part of national legislation. Member States must adopt specific measures to increase knowledge on rare diseases and to improve their detection, diagnosis, and treatment. The aim of this article was to present and to assess the current legal situation on orphan patients and their treatment in Lithuania, to identify legislation gaps, and to propose some ideas how to facilitate the solution of the existing problems in this field. For this purpose, European Union and Lithuanian legal documents on rare medicinal products are examined using a comparative method. With reference to inventory of Member States' incentives for rare diseases in national level, the most important issues, which orphan patients face to in Lithuania, are singled out. In Lithuania, the situation of orphan patients in terms of protection of patient rights is insufficiently determined. The access to effective health care services or approved therapies in some cases is restricted. Working relationships between genetic services and various clinical specialists as well as with those in primary care are not legally determined; the number of clinical trials aimed at orphan medicinal products is low. These results suggest a need for awareness raising among Lithuanian Government, health care specialists, patient organizations about the importance to improve practical implementation of European Union legislation and progressive experience of some European countries in this field.

[Complications after laser hair removal: the standpoint of a dermatological legal expert regarding liability].

PubMed

Bayle, P; Saval, F; Rougé, D; Telmon, N

2015-03-01

Laser hair removal is widely used, including outside medical settings. Potential complications, notably burns, may engage the operator's liability. In this case, investigations by medical experts are frequently requested. We describe 6 expert examinations carried out by the same legal dermatology expert between 2012 and 2014. They concerned burns of varying severity caused by laser hair removal procedures carried out by a doctor, a physiotherapist and 4 beauticians. Laser hair removal is carried out in many beauty centres, although in France it is restricted by law to medical use. This practice is thus currently the subject of legal and economic controversy. The analysis of 6 medical expert investigations of accidents involving laser hair removal illustrates the various types of fault in which the operator's liability may be engaged and it also serves to redefine the legal framework of this act within the realm of aesthetic medicine. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

76 FR 34812 - Proposed Information Collection (Report of Medical, Legal, and Other Expenses Incident to...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-14

... of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death) Activity; Comment... Expenses Incident to Recovery for Injury or Death, VA Form 21-8416b. OMB Control Number: 2900-0545. Type of... report compensation awarded by another entity or government agency for personal injury or death. Such...

A time to step in: legal mechanisms for protecting those with declining capacity.

PubMed

Arias, Jalayne J

2013-01-01

Current estimates approximate that the population over sixty-five years of age will increase from 40 million in 2010 to 72.1 million by 2030. As society ages, the number of elderly with cognitive deficits that impair decision-making abilities will also increase. This will place additional burdens on families and probate courts seeking to balance individual autonomy with necessary protections. A legal determination of incompetency is a prerequisite to a judicial order appointing a guardianship or other protective mechanism. The current legal-medical model for competency determinations fails to reflect the complexities of declining capacity in an aging population. A global structure for competency determinations leaves a critical gap between competent and incompetent. The gap between competence and incompetence not only raises concerns about how to classify those that fall between the two, but also highlights the lack of legal protections for those within the gap. A revised model is needed to provide protections to individuals who do not yet meet the threshold for incompetence but require additional protections for their personal or financial welfare. This Article provides an unprecedented examination of the legal model for determining competence through a comparison of the medical model for evaluating capacity. While a number of legal scholars have examined the appointment and oversight of guardians, fewer articles have critically examined the process by which individuals are declared incompetent. This Article presents a comprehensive overview of competency and clinical capacity determination procedures, legal mechanisms available to protect individuals with declining capacity, and policy recommendations for improving legal protections in light of inefficiencies related to legal competency determinations.

The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. law.

PubMed

Mead, Alice

2017-05-01

In the United States, federal and state laws regarding the medical use of cannabis and cannabinoids are in conflict and have led to confusion among patients, caregivers, and healthcare providers. Currently, cannabis is legal for medical purposes in 50% of the states, and another seventeen states allow products that are high in cannabidiol (CBD) and low in THC (tetrahydrocannabinol) for medical use. Many of these artisanal products are sold in dispensaries or over the internet. However, none of these products has been approved by the Food and Drug Administration (FDA). Understanding how federal laws apply to clinical research and practice can be challenging, and the complexity of these laws has resulted in particular confusion regarding the legal status of CBD. This paper provides an up-to-date overview (as of August 2016) of the legal aspects of cannabis and cannabidiol, including cultivation, manufacture, distribution, and use for medical purposes. This article is part of a Special Issue title, Cannabinoids and Epilepsy. Copyright © 2017 The Author. Published by Elsevier Inc. All rights reserved.

Consumers devise drug cost-cutting measures: medical and legal issues to consider.

PubMed

Ganguli, Gouranga

2003-01-01

Health care costs in general, and prescription drug costs in particular, are rapidly rising. Between 1996 and 2007 the average annual per capita health care cost is projected to increase from dollar 3,781 to dollar 7,100. [AQ1] The single leading component of health care cost is the cost of prescription drugs (currently 10% of total health care spending, projected to become 18% in 2008). The average cost per drug increased 40% during the 1993-1998 period. Forty-one million Americans have no health insurance, and those who have, have inadequate prescription drug coverage. [AQ2] To cope with this situation, many consumers are trying to economize by doing without the prescriptions or the appropriate doses, buying generics or medicines from Canada or Mexico, or splitting pills of higher doses to take advantage of the pricing policy of drug manufacturers. Some of these approaches are medically and/or legally acceptable, while some are dubious. Most adversely affected are the seniors and poor; for certain groups of seniors prescription drugs account for 30% of their health care spending. The problem must receive prompt concerted attention from consumers, insurers, pharmaceutical companies, and lawmakers before it gets out of hand.

Medical practice and legal background of decisions for severely ill newborn infants: viewpoints from seven European countries.

PubMed

Sauer, P J J; Dorscheidt, J H H M; Verhagen, A A E; Hubben, J H

2013-02-01

To comparing attitudes towards end-of-life (EOL) decisions in newborn infants between seven European countries. One paediatrician and one lawyer from seven European countries were invited to attend a conference to discuss the practice of EOL decisions in newborn infants and the legal aspects involved. All paediatricians/neonatologists indicated that the best interest of the child should be the leading principle in all decisions. However, especially when discussing cases, important differences in attitude became apparent, although there are no significant differences between the involved countries with regard to national legal frameworks. Important differences in attitude towards neonatal EOL decisions between European countries exist, but they cannot be explained solely by medical or legal reasons. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

Urethral catheters and medical malpractice: a legal database review from 1965 to 2015

PubMed Central

Osterberg, E. Charles; Chang, Helena; Gaither, Thomas W.; Alwaal, Amjad; Fox, Ryan; Breyer, Benjamin N.

2016-01-01

Background Urethral catheters (UCs) are commonly used in medicine and are associated with complications such as urinary tract infections (UTIs) and trauma. Given UC complications and their ubiquitous usage in healthcare, there is a potential for liability risk. We aim to explore litigation involving UC-related complications. Methods The LexisNexis legal database was queried for all state and federal cases from January 1965 through October 2015 using the terms “urethral catheter” or “Foley catheter” in combination with “medical malpractice”, “negligence”, “medical error”, and “trauma”. Each case was reviewed for reported medical characteristics and legal aspects, including the outcome of the case. Results Our search yielded 29 cases. Urologists were the most common providers cited as defendants (21%), all of whom were successful in their defense. The most common malpractice claim was for traumatic insertion (48%). Pain was the most common type of damage claimed by plaintiffs (28%), followed by UTI (24%). Nineteen (66%) cases favored defendants, while 10 (34%) cases favored the plaintiffs, of which 2 (7%) were settled out of the court. In settled cases, the mean settlement received by plaintiffs was $55,750 (range, $25,000–$86,500). The mean award to plaintiffs for cases determined by the court was $112,991 (range, $4,000–$325,000). Conclusions Despite widespread usage of UC over a 50-year period, lawsuits centered on UC misuse are rare at the state and federal court levels. Of litigated cases, urologists are commonly involved yet have successful defenses. PMID:27785434

Medical, social, and legal implications of treating nausea and vomiting of pregnancy.

PubMed

Brent, Robert

2002-05-01

This article will deal with medical, social, and legal implications of treating nausea and vomiting of pregnancy (NVP). Clinical problems occur when the symptoms become exaggerated and result in debilitation, dehydration, and hospitalization. The treatment of NVP in its early stages has the implication that it will prevent the more serious complications, including hospitalization. Therapeutic modalities discussed in this conference that have been used or are being tested are primarily symptomatic treatments (antihistamines, Bendectin (Merrell Dow; Cincinatti, Ohio), phenothiazines, hypnosis, accupressure, relaxation behavioral modification, audiogenic feedback training, newer medications, diet, and nutritional support). Bendectin is probably the most studied medication with regard to its reproductive effects, and the studies clearly demonstrate that therapeutic doses of Bendectin have no measurable reproductive risks to the mother or the fetus. In spite of Bendectin's record of safety, numerous nonmeritorious congenital malformation lawsuits were filed and went to trial, and that junk science was presented at these trials. The Bendectin era focused our attention on the area of nonmeritorious litigation and junk science, which could have an effect on any new or less well-studied therapies, because such a high percentage of women are treated for NVP. Because 3% of the offspring will be affected with birth defects, the potential for litigation is immense. The solutions are (1) for legal problems, the medical community should focus their attention on junk scientists and their junk science, over which physicians should have some authority, and (2) for the treatment problem, it would seem most logical that a major research effort should be directed toward brain receptors that are involved in these physiologic effects. Furthermore, it would be imperative to study the array of molecules, both natural and manufactured, that can interact with these receptors for the

Affirmative Action in Medical Education: A Legal Perspective.

ERIC Educational Resources Information Center

Helms, Lelia B.; Helms, Charles M.

1998-01-01

Describes history of legal theory behind affirmative action, with examples from case law and Department of Education regulations, identifying legal pitfalls in admissions and financial aid, including categorization of students by race, racially disproportionate financial aid awards after accounting for need, racially disproportionate scholarship…

Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana.

PubMed

Richmond, Melissa K; Pampel, Fred C; Rivera, Laura S; Broderick, Kerryann B; Reimann, Brie; Fischer, Leigh

2015-01-01

With increasing use of state legalized medical marijuana across the country, health care providers need accurate information on patterns of marijuana and other substance use for patients with access to medical marijuana. This study compared frequency and severity of marijuana use, and use of other substances, for patients with and without state legal access to medical marijuana. Data were collected from 2,030 patients who screened positive for marijuana use when seeking health care services in a large, urban safety-net medical center. Patients were screened as part of a federally funded screening, brief intervention, and referral to treatment (SBIRT) initiative. Patients were asked at screening whether they had a state-issued medical marijuana card and about risky use of tobacco, alcohol, and other illicit substances. A total of 17.4% of marijuana users had a medical marijuana card. Patients with cards had higher frequency of marijuana use and were more likely to screen at moderate than low or high risk from marijuana use. Patients with cards also had lower use of other substances than patients without cards. Findings can inform health care providers of both the specific risks of frequent, long-term use and the more limited risks of other substance use faced by legal medical marijuana users.

Management of the Jehovah’s Witness in Obstetrics and Gynecology: A Comprehensive Medical, Ethical and Legal Approach

PubMed Central

Zeybek, Burak; Childress, Andrew; Kilic, Gokhan S.; Phelps, John; Pacheco, Luis; Carter, Michele; Borahay, Mostafa A.

2016-01-01

Importance Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah’s Witness patients in obstetrics and gynecology, most of them are case reports and a comprehensive review about these patients including ethico-legal perspective is lacking. Objective This review outlines the medical, ethical and legal implications of management of Jehovah’s Witness patients in obstetrical and gynecological settings. Evidence Acquisition A search of published literature using Pubmed, Ovid Medline, EMBASE and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion and ethical/legal considerations in Jehovah’s Witness patients. Results Early diagnosis of anemia and immediate initiation of therapy is essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as anti-hepcidin antibodies and hemoglobin based oxygen carriers. Options to decrease blood loss include anti-fibrinolytics, desmopressin, recombinant Factor VII and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches. Conclusion and Relevance All obstetricians and gynecologists should be familiar with alternatives and ‘less invasive’ options for patients who refuse blood transfusions. Target Audience Obstetricians and gynecologists, family physicians PMID:27526872

Are psychiatrists affecting the legal process by answering legal questions?

PubMed

Hardie, Timothy; Elcock, Susan; Mackay, R D

2008-01-01

Psychiatrists are often asked to answer legal questions. The extent to which they answer strictly legal rather than medical matters is not known. To investigate how strongly psychiatrists in England and Wales express opinions on one legal question - that of diminished responsibility in respect of a murder charge, and how this is related to outcome in court. METHOD Our data were extracted from psychiatric reports and case files supplied by the then Department of Constitutional Affairs (now the Ministry of Justice) on cases heard in the Crown Courts between 1 January 1997 and 31 December 2001 in which the defence of diminished responsibility had been raised. The cases had been selected by the Law Commission in their earlier review of partial defences to murder. We devised a reliable system of rating the presence/absence and strength of expression of a legal opinion in the medical reports. We tested the data for relationship between nature and strength of opinion and progression to trial and verdict. RESULTS Psychiatric reports were available on 143 of 156 cases in which diminished responsibility was considered. They yielded 338 opinions on at least one aspect of diminished responsibility. In 110 (93%) of the 118 cases in which there was a diminished verdict, this was made without trial and, therefore, without reference to a jury. In only eight (27%) out of the 30 cases that went to trial, was a diminished responsibility verdict made. Half of the reports (169) gave a clear opinion on diminished responsibility, a third (121) invited the court to draw a particular conclusion and only 11% (36) provided relevant evidence without answering the legal questions. When there was an opinion or an invitation to make a finding on the legal question, a trial was less likely. A trial was also less likely if reports agreed on what the verdict should be. CONCLUSIONS Psychiatrists frequently answer the legal question of diminished responsibility. The judiciary and medical experts

Medical Marijuana Legalization and Marijuana Use Among Youth in Oregon.

PubMed

Paschall, Mallie J; Grube, Joel W; Biglan, Anthony

2017-06-01

While the legalization of marijuana for medical and recreational use has raised concerns about potential influences on marijuana use and beliefs among youth, few empirical studies have addressed this issue. We examined the association between medical marijuana patients and licensed growers per 1000 population in 32 Oregon counties from 2006 to 2015, and marijuana use among youth over the same period. We obtained data on registered medical marijuana patients and licensed growers from the Oregon Medical Marijuana Program and we obtained data on youth marijuana use, perceived parental disapproval, and demographic characteristics from the Oregon Healthy Teens Survey. Across 32 Oregon counties, the mean rate of marijuana patients per 1000 population increased from 2.9 in 2006 to 18.3 in 2015, whereas the grower rate increased from 3.8 to 11.9. Results of multi-level analyses indicated significant positive associations between rates of marijuana patients and growers per 1000 population and the prevalence of past 30-day marijuana use, controlling for youth demographic characteristics. The marijuana patient and grower rates were also inversely associated with parental disapproval of marijuana use, which decreased from 2006 to 2015 and acted as a mediator. These findings suggest that a greater number of registered marijuana patients and growers per 1000 population in Oregon counties was associated with a higher prevalence of marijuana use among youth from 2006 to 2015, and that this relationship was partially attributable to perceived norms favorable towards marijuana use.

Impact of E-Cigarette Minimum Legal Sale Age Laws on Current Cigarette Smoking.

PubMed

Dutra, Lauren M; Glantz, Stanton A; Arrazola, René A; King, Brian A

2018-05-01

The purpose of this study was to use individual-level data to examine the relationship between e-cigarette minimum legal sale age (MLSA) laws and cigarette smoking among U.S. adolescents, adjusting for e-cigarette use. In 2016 and 2017, we regressed (logistic) current (past 30-day) cigarette smoking (from 2009-2014 National Youth Tobacco Surveys [NYTS]) on lagged (laws enacted each year counted for the following year) and unlagged (laws enacted January-June counted for that year) state e-cigarette MLSA laws prohibiting sales to youth aged <18 or <19 years (depending on the state). Models were adjusted for year and individual- (e-cigarette and other tobacco use, sex, race/ethnicity, and age) and state-level (smoke-free laws, cigarette taxes, medical marijuana legalization, income, and unemployment) covariates. Cigarette smoking was not significantly associated with lagged MLSA laws after adjusting for year (odds ratio [OR] = .87, 95% confidence interval [CI]: .73-1.03; p = .10) and covariates (OR = .85, .69-1.03; p = .10). Unlagged laws were significantly and negatively associated with cigarette smoking (OR = .84, .71-.98, p = .02), but not after adjusting for covariates (OR = .84, .70-1.01, p = .07). E-cigarette and other tobacco use, sex, race/ethnicity, age, and smoke-free laws were associated with cigarette smoking (p <.05). Results unadjusted for e-cigarette use and other tobacco use yielded a significant negative association between e-cigarette MLSA laws and cigarette smoking (lagged: OR = .78, .64-.93, p = .01; unlagged: OR = .80, .68-.95, p = .01). After adjusting for covariates, state e-cigarette MLSA laws did not affect youth cigarette smoking. Unadjusted for e-cigarette and other tobacco use, these laws were associated with lower cigarette smoking. Copyright © 2017 The Society for Adolescent Health and Medicine. All rights reserved.

Maintaining a legal status for filmless archived digital medical images

NASA Astrophysics Data System (ADS)

Shani, Uri

2001-08-01

Most medical images today are generated digitally before exposure on film. In hospitals that employ Picture Archiving and Communication Systems (PACS), the images are also stored and managed digitally. Indeed, film copies of images are still used at large, but the new generation of filmless hospitals tend to minimize the production of films unless deem necessary, or required by the patients or third parties. There are basically two main reasons for working with films in 'filmless' hospitals. One is that in fact, these are 'less film' hospitals due to the film-oriented environment where they operate. Environment which has not yet entered the PACS and DICOM era; Neither in operation, nor in intercommunication. The other reason is that films are needed for legal purposes as a sole indicator to the medical image evidence used during diagnosis. PACS offer numerous advantages, but a high entry cost which can be balanced with the savings in films production and handling. However, as long as films are mandatory, they do not help to lower the inhibitory cost of PACS, and the use of films prevails.

The complex legal and ethical issues related to generic medications. Viral hepatitis: a case study.

PubMed

Danta, M; Ghinea, N

2017-04-01

The economic impact of medications is significant, with many countries unable to afford the essential medicines listed by the WHO. Generic medications are one strategy to address this issue. Generic medications are similar to but not the same as originator medications. They have a significant cost advantage because they do not require the background research and development studies to support registration. Consequently, they are gaining increased market share in both the developed and developing world. Many new medications are now licensed to generic manufacturers in the developing world. As a result, it is possible for patients to bypass regulatory and cost barriers by importing medications directly from generic producers. Importation of the novel hepatitis C direct-acting antiviral therapy into Australia before it was registered in the country is an illustrative case study. This review will characterise generic medications and some of the legal and ethical issues around their utilisation, focusing on the relevant players, including pharma, government, patients and doctors.

An Interdisciplinary Seminar on Legal Issues in Medicine.

ERIC Educational Resources Information Center

Moore, Dale L.

1989-01-01

A seminar on legal issues in medicine brings together medical (obstetrics/gynecology) and law students to promote mutual understanding of the legal and medical realms, their effects on each other, and the potential for cooperation. (MSE)

The medical practice of euthanasia in Belgium and The Netherlands: legal notification, control and evaluation procedures.

PubMed

Smets, Tinne; Bilsen, Johan; Cohen, Joachim; Rurup, Mette L; De Keyser, Els; Deliens, Luc

2009-05-01

To describe and compare current legal procedures for notifying, controlling and evaluating (NCE-procedures) euthanasia in Belgium and the Netherlands, and to discuss the implications for a safe and controllable euthanasia practice. We systematically studied and compared official documents relating to the Belgian and the Dutch NCE-procedures for euthanasia. In both countries, physicians are required to notify their cases to a review Committee, stimulating them to safeguard the quality of their euthanasia practice and to make societal control over the practice of euthanasia possible. However, the procedures in both countries differ. The main differences are that the Dutch notification and control procedures are more elaborate and transparent than the Belgian, and that the Belgian procedures are primarily anonymous, whereas the Dutch are not. Societal evaluation is made in both countries through the Committees' summary reports to Parliament. Transparent procedures like the Dutch may better facilitate societal control. Informing physicians about the law and the due care requirements for euthanasia, and systematic feedback about their medical actions are both pivotal to achieving efficient societal control and engendering the level of care needed when performing such far-reaching medical acts.

Latin American women’s experiences with medical abortion in settings where abortion is legally restricted

PubMed Central

2012-01-01

Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe. Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used. Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades. This article summarizes the findings of a literature review on women’s experiences with medical abortion in Latin American countries where voluntary abortion is illegal. Women’s personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1) a medically supervised abortion in a clandestine clinic or 2) complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support. Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it might not be effective, and

[Judicial and medical/legal aspects of the responsibility of workers appointed to carry out first aid].

PubMed

Caprioli, L C; Ciavarella, M; Sacco, A

2005-01-01

One of the innovations introduced by law 626/94 [the Italian law on occupational health and safety of workers] is the obligation of the employer to designate workers responsible for first aid. To identify and discuss the duties, the role and the medical and legal responsibility of workers appointed to carry out first aid measures. Analysis of legislation and current practice concerning medical and legal responsibility in first aid procedures. The worker appointed to carry out first aid measures is, by virtue of his appointment, obliged to take action. Therefore, he could commit an illegitimate act both by "acting" and by "omitting" to carry out a duty that is his responsibility. In the first case the worker could be accused of committing an unpremeditated criminal offence when his actions involve negligence, imprudence, inexperience or violation of regulations concerning his duties. A "serious criminal offence" is committed when the most elementary rules of diligence, prudence and skill are violated; the offence is "slight" when negligence, imprudence or inexperience are involved in particularly complex situations. The reference parameter for inexperience is not a first aid volunteer, nor a member of the public, but a worker designated to carry out first aid possessing "average" attitudes, training and ability. Briefly, a guilty error by the appointed worker consists of the following: i) the professional conduct of the operator was clearly wrong, serious and unjustifiable; ii) the operator clearly omitted doing his/her duty; iii) the consequence of the error is physical personal damage. The observations made clearly illustrate the delicacy of the tasks of the worker appointed to carry out first aid measures. Essential elements for minimizing wrong and/or negligent conduct are appropriate choice of the designated workers and their adequate training.

Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial.

PubMed

Sege, Robert; Preer, Genevieve; Morton, Samantha J; Cabral, Howard; Morakinyo, Oluwatomisin; Lee, Vonne; Abreu, Catarina; De Vos, Edward; Kaplan-Sanoff, Margot

2015-07-01

Changes in health care delivery create opportunities to improve systems to better meet the needs of low-income families while achieving quality benchmarks. Families of healthy newborns receiving primary care at a single large urban safety-net hospital participated. Intervention families were randomly assigned a family specialist who provided support until the 6-month routine health care visit. The Developmental Understanding and Legal Collaboration for Everyone (DULCE) intervention is based on the Strengthening Families approach and incorporated components of the Healthy Steps and Medical-Legal Partnership models. Medical record reviews determined use of preventive and emergency care. Surveys conducted at baseline, postintervention (6 months), and follow-up (12 months) were used to determine hardship and attainment of concrete supports. Three hundred thirty families participated in the study. At baseline, 73% of families reported economic hardships. Intervention parents had an average of 14 contacts with the family specialist, and 5 hours of total contact time. Intervention infants were more likely to have completed their 6-month immunization schedule by age 7 months (77% vs 63%, P < .005) and by 8 months (88% vs 77%, P < .01). Intervention infants were more likely to have 5 or more routine preventive care visits by age 1 year (78% vs 67%, P < .01) and were less likely to have visited the emergency department by age 6 months (37% vs 49.7%, P < .03). The DULCE intervention accelerated access to concrete resources (P = .029). Assignment to the Project DULCE intervention led to improvements in preventive health care delivery and utilization and accelerated access to concrete supports among low-income families. Copyright © 2015 by the American Academy of Pediatrics.

Advance directives in the UK: legal, ethical, and practical considerations for doctors.

PubMed

Kessel, A S; Meran, J

1998-05-01

In the United Kingdom (UK), advance directives have recently received considerable attention from professional and voluntary organizations as well as medical journals and the media. However, despite such exposure, many doctors remain uncertain of the importance or relevance of advance directives with regard to their own clinical practice. This paper addresses these uncertainties by first explaining what advance directives are and then describing the current legal status of such directives in the UK. Examination of the cases underpinning this status reveals several key elements: competence, information, anticipation, applicability, and freedom from duress. Each is discussed. Although this paper focuses on legal issues, it is important that medical law does not dominate medical ethics. Accordingly, the paper also discusses some important philosophical and sociological considerations that have remained largely unexplored in the medical press. Finally, the paper deals with practical matters, including how the general practitioner might be involved.

Medical innovation laws: an unnecessary innovation.

PubMed

Richards, Bernadette

2016-06-01

Objective This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. What is known about the topic? Over recent months, there has been a great deal of discussion surrounding the law in the context of medical innovation. This was driven by the attempts in the UK to introduce specific laws in the Medical Innovation Bill. The general subject matter - negligence and the expected standard of care in the provision of treatment - is very well understood, but not in cases where the treatment can be described as innovative. The general rhetoric in both the UK and Australia around the Medical Innovation Bill demonstrates a lack of understanding of the position of the law with regards to innovative treatment. What does this paper add? This paper adds clarity to the debate. It presents the law and explains the manner in which the law can operate around innovative treatment. The paper asserts that medical innovation is both supported and encouraged by existing legal principles. What are the implications for practitioners? The paper presents an argument that can guide the policy position

Medical tourism.

PubMed

Leggat, Peter

2015-01-01

Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment. This article provides an outline of the current research around medical tourism, especially its impact on Australians. Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad.

[Legal consequences in cases of child abuse].

PubMed

Clauß, D; Richter, C; Klohs, G; Heide, S

2013-09-01

Medical child protection includes besides interdisciplinary diagnostics and treatment of physical and psychological symptoms also a discussion that looks at the ensuing legal consequences.This study analyses 21 criminally investigated cases of suspected child abuse from a 2 year study period and compares severity of injury to legal outcome.7 of those 21 criminal proceedings were already dropped by the prosecution and never went to trial. 4 of the 8 cases that led to a trial ended with a conviction. In all of the 4 cases that resulted in an acquittal the judges had been convinced that the child had been abused but found themselves unable to exactly identify the perpetrator. Our study's cases did not show a positive correlation between severity of injury and legal outcome.Diagnosing and treating children and minors within the context of medical child protection should always also include the ques-tion of possible legal consequences. The judicial process in cases of serious child abuse requires high medical expertise. Such expertise particularly includes the ability to determine the time of injury as exactly as possible and to provide precise written documentation of any medical findings. However, our study also shows that medical assessment is only one of many aspects in the legal response to child abuse. © Georg Thieme Verlag KG Stuttgart · New York.

Current Illinois Legal Issues. Second Edition.

ERIC Educational Resources Information Center

Kopecky, Frank J., Ed.; Wilkin, Rebecca S., Ed.

Designed as supplementary reading in American government or social studies courses, this compilation of articles is intended to help students gain a better understanding of the judiciary's role in the Illinois legal system. The first of three sections contains articles about judges and the court system. The second section examines the criminal…

Assisted suicide: Models of legal regulation in selected European countries and the case law of the European Court of Human Rights.

PubMed

Grosse, Claudia; Grosse, Alexandra

2015-10-01

This paper presents three different models of the legal regulation of assisted suicide in European countries. First, the current legal regime governing assisted suicide in the Netherlands is described where both euthanasia and assisted suicide have been legalised. This section also includes some empirical data on euthanasia and assisted-suicide practices in the Netherlands, as well as a comparison with the current legal legislation in Belgium and Luxembourg. Next, Switzerland is presented as a country where euthanasia is punishable by law but assisted suicide is legally allowed, provided it is not carried out with selfish motives. This section also focuses on the assisted-suicide-related case law of the Swiss Federal Supreme Court and the European Court of Human Rights. Last, the current legal situation regarding assisted suicide in Austria and Germany is described. While the Austrian Penal Code explicitly prohibits assisted suicide, assistance with suicide is not specifically regulated by the German Penal Code. However, medical doctors are not allowed to assist suicides according to the professional codes of conduct drawn up by the German medical associations under the supervision of the health authorities. © The Author(s) 2014.

[Legal relevance of guidelines : Contextualization exemplified by international recommendations for treatment of inguinal hernia in adults].

PubMed

Weyhe, D; Uslar, V N; Mählmeyer, C; Oehlers, H

2018-06-21

Guidelines aim to standardize treatment concepts based on evidence from the literature and may thus be viewed as collegial support; however, there is a lack of clarity about the legal relevance and legal validity of international guidelines compared to the Association of the Scientific Medical Societies in Germany (AWMF) recommendations. A literature search was conducted on German AWMF guidelines and on international guidelines for inguinal hernia in adults. Differences in the structure of the guidelines were analyzed and legal terms, such as the medical standard, the Patients' Rights Act and the current legal literature are defined and commented on with respect to guideline-compliant treatment. Since 2003 a total of 15 guidelines and recommendations for the treatment of inguinal hernia have been published. There are no AWMF guidelines on one of the procedures most frequently performed in Germany. Among the relevant judgments and laws passed from 1994 onwards, § 630 of the German Civil Code (BGB) passed in 2013 seems to be particularly significant, since it standardizes the term "medical standard" and explicitly allows values falling short of the standard after clarification. From a legal point of view, the basic prerequisites for medical treatment are patient consent and intervention education. In principle, a non-guideline-compliant treatment procedure can be agreed. The patient must be informed about the treatment options that are relevant to the medical standard, the procedure must be indicated according to the medical standard and the operation must be performed in accordance with the national medical specialist standard. Thus, international guidelines cannot a priori claim to be followed unobserved and are therefore not legally comparable to the German S3 guidelines of the AWMF. It is strongly advised to expressly point out and explicitly explain anything falling short of the standard, individual healing attempts and so-called outsider methods.

[Towards a new Tunisian Medical Code of Deontology].

PubMed

Aissaoui, Abir; Haj Salem, Nidhal; Chadly, Ali

2010-06-01

The Medical Code of Deontology is a legal text including the physician's duties towards his patients, colleagues, auxiliaries and the community. Considering the scientific, legal and social changes, the deontology code should be revised periodically. The first Tunisian Medical Code of Deontology (TMCD) was promulgated in 1973 and abrogated in 1993 by the new Code. This version has never been reviewed and does not seem to fit the current conditions of medical practice. The TMCD does not contain texts referring to information given to the patient, pain control, palliative care and management of the end of life as well as protection of medical data. Furthermore, the TMCD does not include rules related to tissues and organs transplantation and medical assisted human reproduction in accordance with Tunisian legal texts. We aim in this paper at analyzing the insufficiencies of the TMCD and suggesting modifications in order to update it.

Marijuana Legalization: Impact on Physicians and Public Health.

PubMed

Wilkinson, Samuel T; Yarnell, Stephanie; Radhakrishnan, Rajiv; Ball, Samuel A; D'Souza, Deepak Cyril

2016-01-01

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health.

[Medical-legal conduct with individuals in judicial or police custody].

PubMed

Medallo Muñiz, Jordi; Martín-Fumadó, Carles; Nuno Vieira, Duarte

2014-03-01

The problems involved in caring for individuals in custody, as well as deaths that occur during custody, are relevant aspects of legal and forensic medicine in terms of the possible criminal, civil and administrative responsibility of health professionals and/or public or private institutions that might hold individuals in custody and deprived of freedom. The rule of law should ensure that these cases comply with state law and international agreements and treaties related to human rights and the special treatment of individuals deprived of freedom in hospitals or detention centers. Of particular mention is the medical-forensic activity regarding deaths associated with the use of control holds and/or restraint during the detention of individuals by members of the armed forces or law enforcement or in healthcare centers by safety and healthcare personnel. In these cases, both the immediate healthcare treatment subsequent to the events and the medical-forensic study should be particularly careful. These situations, which are often high profile, cause social alarm and involve judicial actions that can result in especially severe liabilities. Copyright © 2014 Elsevier España, S.L. All rights reserved.

Legal briefing: informed consent in the clinical context.

PubMed

Pope, Thaddeus Mason; Hexum, Melinda

2014-01-01

This issue's "Legal Briefing" column covers recent legal developments involving informed consent.1 We covered this topic in previous articles in The Journal of Clinical Ethics.2 But an updated discussion is warranted. First, informed consent remains a central and critically important issue in clinical ethics. Second, there have been numerous significant legal changes over the past year. We categorize recent legal developments into the following 13 categories: (1) Medical Malpractice Liability, (2) Medical Malpractice Liability in Wisconsin, (3) Medical Malpractice Liability in Novel Situations, (4) Enforcement by Criminal Prosecutors, (5) Enforcement by State Medical Boards, (6) Enforcement through Anti-Discrimination Laws, (7) Statutorily Mandated Disclosures Related to End-of-Life Counseling, (8) Statutorily Mandated Disclosures Related to Aid in Dying, (9) Statutorily Mandated Disclosures Related to Abortion, (10) Statutorily Mandated Disclosures Related to Telemedicine, (11) Statutorily Mandated Disclosures Related to Other Interventions, (12) Statutorily Mandated Gag and Censorship Laws, (13) Informed Consent in the Research Context. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

Medical emergencies in children of orthodox Jehovah's Witness families: Three recent legal cases, ethical issues and proposals for management.

PubMed

Guichon, Juliet; Mitchell, Ian

2006-12-01

Three recent Canadian legal cases have dealt with the proposed blood transfusion of adolescent members of Jehovah's Witness (JW) families. In each case, the court permitted transfusions if medically necessary. Much critical analysis of the issue of forced treatment of decisionally competent adolescents focuses exclusively on competence and questions why mature minors may not decide for themselves. The authors argue that a focus on decision-making competence alone is too narrow. Before one may legally give or refuse consent to medical treatment, three conditions must be met: competence, adequate information and lack of coercion. In striving to find agreement on medical treatment, physicians, patients and JW family members seek and, in fact, often achieve mutual understanding and cooperation. Coercion by actual or threatened shunning and excommunication can occur, and these factors may affect adolescent decision-making. In this context, a court order authorizing medical treatment can, therefore, be seen as enhancing patient freedom. The authors suggest that, in addition to fulfilling existing statutory duties to report a child in need of protection, health care professionals caring for acute patients of JW families should actively look for evidence that the patient has accurate medical information and is acting without coercion. The authors also explore suggestions on how to deal with the unusual complexities of such cases.

Marijuana Legalization: Impact on Physicians and Public Health

PubMed Central

Wilkinson, Samuel T.; Yarnell, Stephanie; Radhakrishnan, Rajiv; Ball, Samuel A.; D'Souza, Deepak Cyril

2016-01-01

Marijuana is becoming legal in an increasing number of states for both medical and recreational use. Considerable controversy exists regarding the public health impact of these changes. The evidence for the legitimate medical use of marijuana or cannabinoids is limited to a few indications, notably HIV/AIDS cachexia, nausea/vomiting related to chemotherapy, neuropathic pain, and spasticity in multiple sclerosis. Although cannabinoids show therapeutic promise in other areas, robust clinical evidence is still lacking. The relationship between legalization and prevalence is still unknown. Although states where marijuana use is legal have higher rates of use than nonlegal states, these higher rates were generally found even prior to legalization. As states continue to proceed with legalization for both medical and recreational use, certain public health issues have become increasingly relevant, including the effects of acute marijuana intoxication on driving abilities, unintentional ingestion of marijuana products by children, the relationship between marijuana and opioid use, and whether there will be an increase in health problems related to marijuana use, such as dependence/addiction, psychosis, and pulmonary disorders. In light of this rapidly shifting legal landscape, more research is urgently needed to better understand the impact of legalization on public health. PMID:26515984

[Medical Devices Law for pain therapists].

PubMed

Regner, M; Sabatowski, R

2016-08-01

Medical Devices Law is a relatively new legal system, which has replaced the Medical Devices Regulations still well-known in Germany. German Medical Devices Law is based on European directives, which are, in turn, incorporated into national law by the Medical Devices Act. The Medical Devices Act is a framework law and covers a number of regulations that address specific topics within Medical Devices Law. In turn, in individual regulations, reference is made to guidelines, recommendations, etc. from other sources that provide detailed technical information on specific topics. Medical Devices Law is a very complex legal system, which needs to be permanently observed due to constant updating and adjustment. In the current article, the design and the structure of the system will be described, but special emphasis will be laid on important problem areas that need to be considered when applying and operating medical products, in this case by pain therapists in particular.

Level of awareness about legalization of abortion in Nepal: a study at Nepal Medical College Teaching Hospital.

PubMed

Tuladhar, H; Risal, A

2010-06-01

World Health Organization (WHO) estimates that about 25.0% of all pregnancies worldwide end in induced abortion, approximately 50 million each year. More than half of these abortions are performed under unsafe conditions resulting in high maternal mortality ratio specially in developing countries like Nepal. Abortion was legalized under specified conditions in March 2002 in Nepal. But still a large proportion of population are unaware of the legalization and the conditions under which it is permitted. Legal reform alone cannot reduce abortion related deaths in our country. This study was undertaken with the main objective to study the level of awareness about legalization of abortion in women attending gyne out patients department of Nepal Medical College Teaching Hospital (NMCTH), which will give a baseline knowledge for further dissemination and advocacy about abortion law. Total 200 women participated in the study. Overall 133 (66.5%) women said they were aware of legalization of abortion in Nepal. Women of age group 20-34 years, urban residents, service holders, Brahmin/Chhetri caste and with higher education were more aware about it. Majority (92.0%) of the women received information from the media. Detail knowledge about legal conditions under which abortion can be performed specially in second trimester was found to be poor. Large proportion (71.0%) of the women were still unaware of the availability of comprehensive abortion care services at our hospital, which is being provided since last seven years. Public education and advocacy campaigns are crucial to create awareness about the new legislation and availability of services. Unless the advocacy and awareness campaign reaches women, they are not likely to benefit from the legal reform and services.

Assessing the public health impacts of legalizing recreational cannabis use in the USA.

PubMed

Hall, W; Weier, M

2015-06-01

A major challenge in assessing the public health impact of legalizing cannabis use in Colorado and Washington State is the absence of any experience with legal cannabis markets. The Netherlands created a de facto legalized cannabis market for recreational use, but policy analysts disagree about how it has affected rates of cannabis use. Some US states have created de facto legal supply of cannabis for medical use. So far this policy does not appear to have increased cannabis use or cannabis-related harm. Given experience with more liberal alcohol policies, the legalization of recreational cannabis use is likely to increase use among current users. It is also likely that legalization will increase the number of new users among young adults but it remains uncertain how many may be recruited, within what time frame, among which groups within the population, and how many of these new users will become regular users. © 2015 American Society for Clinical Pharmacology and Therapeutics.

A Student Selected Component (or Special Study Module) in Forensic and Legal Medicine: Design, delivery, assessment and evaluation of an optional module as an addition to the medical undergraduate core curriculum.

PubMed

Kennedy, Kieran M; Wilkinson, Andrew

2018-01-01

The General Medical Council (United Kingdom) advocates development of non-core curriculum Student Selected Components and their inclusion in all undergraduate medical school curricula. This article describes a rationale for the design, delivery, assessment and evaluation of Student Selected Components in Forensic and Legal Medicine. Reference is made to the available evidence based literature pertinent to the delivery of undergraduate medical education in the subject area. A Student Selected Component represents an opportunity to highlight the importance of the legal aspects of medical practice, to raise the profile of the discipline of Forensic and Legal Medicine amongst undergraduate medical students and to introduce students to the possibility of a future career in the area. The authors refer to their experiences of design, delivery, assessment and evaluation of Student Selected Components in Forensic and Legal Medicine at their respective Universities in the Republic of Ireland (Galway) and in the United Kingdom (Oxford). Copyright © 2017. Published by Elsevier Ltd.

The Americans with Disabilities Act and Family and Medical Leave Act: Legal Requirements, Negotiations and Policy Considerations.

ERIC Educational Resources Information Center

Juengart, Laurie S.

The Americans with Disabilities Act (ADA) and Family and Medical Leave Act (FMLA) are two major pieces of social legislation that impact private and public employers, including school districts. Public school employers must have thorough awareness of the legal requirements of both laws and must analyze the ways in which those requirements…

Legal features of the drug advertising.

PubMed

Pashkov, Vitalii M; Olefir, Andrii A; Bytyak, Oleksiy Y

In the article discribed current trends of advertising in the pharmaceutical market and foreign experience of legal regulation of these relations. As for the advertising of medicines identified it's symptoms, types, basic rules and prohibitions. Modern pharmaceutical companies can not successfully carry out economic activities without advertising. Besides we can mention some fundamental changes in society (information overload, universal access to internet, social media, freedom of movement of goods, labor and finance), also self-medication becomes more popular. At the same time, the number of deaths after improper and uncontrolled use of drugs ranks fifth in the world among the causes of death. Investigate current trends of advertising on the pharmaceutical market, find advertising signs, basic restrictions and prohibitions on advertising of medicines, as well as foreign experience of legal regulation of these relations. Despite the fact that pharmaceutical advertising were studied by such scholars as M. Abraham, L. Bradley, C. Dunn, J. Donoh'yu, D. Castro, M. Lipski, K. Taylor and others, number of issues related features of drug advertising, remained without proper theoretical studies. Based on the analysis can come to the conclusion that advertising of medicinal products are the subject of special attention from the state. Drugs, unlike other products, are a group of specialized consumer products. Risks increase when patients under the influence of «aggressive» advertising resort to self-medication. If a complete ban on advertising of medicines is inappropriate, you should set stricter requirements for the content of advertising and product placement rules. That is, in the national legislation to implement regulatory requirements of Directive 2001/83 / EC. Legal regulation of drug advertising can be improved by such legal means: - should provide for a mechanism of public control over the observance of ethical standards in the advertising of medicinal products

Structural and legal implications of e-health.

PubMed

Terry, N P

2000-01-01

Web and attendant e-Commerce phenomena are irretrievably at odds with the traditional structure and hence legal regulation of health delivery. E-Health delivers healthcare information, diagnosis, treatment, care, and prescribing of drugs in a nonlinear, nonhierarchical manner that encourages patients to "enter" the system at an infinite number of points, thus defying current regulatory constructs. Similarly, e-Commerce fundamentals such as disintermediation and disaggregation result in medical information being delivered through unfamiliar channels, creating immensely difficult questions for health lawyers.

Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports.

PubMed

Ingravallo, Francesca; Poli, Francesca; Gilmore, Emma V; Pizza, Fabio; Vignatelli, Luca; Schenck, Carlos H; Plazzi, Giuseppe

2014-08-15

To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS). We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles. Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided. Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed. Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant's sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case. SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority.

What emergency physicians should know about informed consent: legal scenarios, cases, and caveats.

PubMed

Moore, Gregory P; Moffett, Peter M; Fider, Cyril; Moore, Malia J

2014-08-01

The basic concept of obtaining informed consent is familiar to emergency physicians, and many consider themselves well versed on the topic; however, lack of obtaining proper informed consent is a frequent source of lawsuits. The legal definitions and nuances of informed consent might surprise even the most experienced physician. This article will detail the historical legal evolution of the concept of informed consent. It will also report defining and recent court cases that illustrate the current medical-legal status of informed consent. Special scenarios, caveats, and documentation recommendations are discussed. After reading this article the emergency physician will know how to practice and document the appropriate aspects of informed consent in emergency medicine, as well as understand available legal defenses if a lawsuit should arise. © 2014 by the Society for Academic Emergency Medicine.

Variation in Acceptable Child Discipline Practices by Child Age: Perceptions of Community Norms by Medical and Legal Professionals

PubMed Central

Block, Stephanie D.; Poplin, Ashlee Burgess; Wang, Eric; Widaman, Keith F.; Runyan, Desmond K.

2016-01-01

Mandated child abuse reporters may judge specific disciplinary practices as unacceptable for young children, whereas child law professionals arbitrating allegations may be less inclusive. Do the views of these groups diverge, by child age, regarding physical discipline? Judgments of community norms across a wide range of children’s ages were obtained from 380 medical and legal professionals. Because the Parent-Child Conflict Tactics Scale (PC-CTS) can be used to assess the epidemiology of child disciplinary behaviors and as a proxy to examine the incidence or prevalence of child abuse, the disciplinary practices described on the PC-CTS were presented as triggers for questions. Significant child age effects were found for disciplinary practices classified as “harsh.” The consistencies between legal and medical professionals were striking. Both groups reflected changes in United States norms, as non-physical approaches were the most approved. We conclude that instruments estimating the prevalence of child maltreatment by parent-report should consider modifying how specific disciplinary practices are classified. PMID:27117603

The impact of marijuana policies on youth: clinical, research, and legal update.

PubMed

2015-03-01

This policy statement is an update of the American Academy of Pediatrics policy statement "Legalization of Marijuana: Potential Impact on Youth," published in 2004. Pediatricians have special expertise in the care of children and adolescents and may be called on to advise legislators about the potential impact of changes in the legal status of marijuana on adolescents. Parents also may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical and nonmedical purposes or to decriminalize the possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization. The accompanying technical report reviews what is currently known about the relationships of marijuana use with health and the developing brain and the legal status of marijuana and adolescents' use of marijuana to better understand how change in legal status might influence the degree of marijuana use by adolescents in the future. Copyright © 2015 by the American Academy of Pediatrics.

Tuskegee redux: Evolution of legal mandates for human experimentation

PubMed Central

Levine, Robert S.; Williams, Jamila C.; Kilbourne, Barbara A.; Juarez, Paul D.

2013-01-01

Human health experiments systematically expose people to conditions beyond the boundaries of medical evidence. Such experiments have included legal-medical collaboration, exemplified in the US by the PHS Syphilis Study (Tuskegee). That medical experiment was legal, conforming to segregationist protocols and specific legislative authorization which excluded a selected group of African Americans from any medical protection from syphilis. Subsequent corrective action outlawed unethical medical experiments but did not address other forms of collaboration, including PHS submission to laws which may have placed African American women at increased risk from AIDS and breast cancer. Today, anti-lobbying law makes it a felony for PHS workers to openly question legally anointed suspension of medical evidence. African Americans and other vulnerable populations may thereby face excess risks -- not only from cancer, but also from motor vehicle crashes, firearm assault, end stage renal disease and other problems -- with PHS workers as silent partners. PMID:23124504

Relay kidney transplantation in Korea--legal, ethical and medical aspects.

PubMed

Park, Jong-Hyun; Park, Joong-Won; Koo, Young-Mo; Kim, Jang Han

2004-07-01

Living kidney transplantations constitute the majority of kidney transplantations in Korea. Recently, relay kidney transplantation, which is a modified form of both 'exchange transplantation' and 'living anonymous donation', has become at issue. After a living anonymous donor makes the initial donation, the next donor, who is related to the first recipient, makes the second donation; the third donor, who is related to the second recipient, makes the third donation; and so on. In relay kidney transplantation, organ trafficking, coercion of donation, assessment order, breach of agreement, and recipient burden should be evaluated with respect to ethical, legal and medical considerations. Despite these problems, a non-governmental body, the Korean Organ and Tissue Donor Program, has been promoting relay kidney transplantations to address the shortage of cadaveric kidney donations. Acceptance of the method of relay kidney transplantation requires the institution of supplementary measures to minimize the related problems.

The Legal Doctrine on 'Limitation of Liability' in the Precedent Analysis on Plastic Surgery Medical Malpractice Lawsuits.

PubMed

Park, Bo Young; Pak, Ji-Hyun; Hong, Seung-Eun; Kang, So Ra

2015-12-01

This study intended to review the precedents on plastic surgery medical malpractice lawsuits in lower-court trials, classify the reasons of 'limitation of liability' by type, and suggest a standard in the acknowledgement of limitation of liability ratio. The 30 lower-court's rulings on the cases bearing the medical negligence of the defendants acknowledged the liability ratio of the defendants between 30% and 100%. Ten cases ruled that the defendants were wholly responsible for the negligence or malpractice, while 20 cases acknowledged the limitation of liability principle. In the determination of damage compensation amount, the court considered the cause of the victim side, which contributed in the occurrence of the damage. The court also believed that it is against the idea of fairness to have the assailant pay the whole compensation, even there is no victim-side cause such as previous illness or physical constitution of the patient, and applies the legal doctrine on limitation of liability, which is an independent damage compensation adjustment system. Most of the rulings also limited the ratio of responsibility to certain extent. When considering that the legal doctrine on limitation of liability which supports concrete validity for the fair sharing of damage, the tangible classification of causes of limitation of liability suggested in this study would be a useful tool in forecasting the ruling of a plastic surgery medical malpractice lawsuit.

The Legal Doctrine on 'Limitation of Liability' in the Precedent Analysis on Plastic Surgery Medical Malpractice Lawsuits

PubMed Central

Kang, So Ra

2015-01-01

This study intended to review the precedents on plastic surgery medical malpractice lawsuits in lower-court trials, classify the reasons of 'limitation of liability' by type, and suggest a standard in the acknowledgement of limitation of liability ratio. The 30 lower-court's rulings on the cases bearing the medical negligence of the defendants acknowledged the liability ratio of the defendants between 30% and 100%. Ten cases ruled that the defendants were wholly responsible for the negligence or malpractice, while 20 cases acknowledged the limitation of liability principle. In the determination of damage compensation amount, the court considered the cause of the victim side, which contributed in the occurrence of the damage. The court also believed that it is against the idea of fairness to have the assailant pay the whole compensation, even there is no victim-side cause such as previous illness or physical constitution of the patient, and applies the legal doctrine on limitation of liability, which is an independent damage compensation adjustment system. Most of the rulings also limited the ratio of responsibility to certain extent. When considering that the legal doctrine on limitation of liability which supports concrete validity for the fair sharing of damage, the tangible classification of causes of limitation of liability suggested in this study would be a useful tool in forecasting the ruling of a plastic surgery medical malpractice lawsuit. PMID:26713045

Legal responsibilities of physicians when making participation decisions in athletes with cardiac disorders: Do guidelines provide a solid legal footing?

PubMed

Panhuyzen-Goedkoop, Nicole M; Smeets, Joep L R M

2014-08-01

Safe sports participation involves protecting athletes from injury and life-threatening situations. Preparticipation cardiovascular screening (PPS) in athletes is intended to prevent exercise-related sudden cardiac death by medical management of athletes at risk, which may include disqualification from sports participation. The screening physician relies on current guidelines and expert recommendations for management and decision-making. There is concern about false-positive screening results and wrongly grounding an athlete. Similarly, there is a concern about false-negative screening results and athletes participating with potentially lethal disorders. Who is legally responsible if an athlete suddenly dies after a proper PPS resulting in low risk? Several consensus documents based on expert opinion describe only a few lines on legal responsibilities in eligibility screening and disqualification decision-making in athletes. This article discusses legal responsibilities and concerns in eligibility decision-making for physicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Tuskegee redux: evolution of legal mandates for human experimentation.

PubMed

Levine, Robert S; Williams, Jamila C; Kilbourne, Barbara A; Juarez, Paul D

2012-11-01

Human health experiments systematically expose people to conditions beyond the boundaries of medical evidence. Such experiments have included legal-medical collaboration, exemplified in the U.S. by the Public Health Service (PHS) Syphilis Study (Tuskegee). That medical experiment was legal, conforming to segregationist protocols and specific legislative authorization which excluded a selected group of African Americans from any medical protection from syphilis. Subsequent corrective action outlawed unethical medical experiments but did not address other forms of collaboration, including PHS submission to laws which may have placed African American women at increased risk from AIDS and breast cancer. Today, anti-lobbying law makes it a felony for PHS workers to openly challenge legally anointed suspension of medical evidence. African Americans and other vulnerable populations may thereby face excess risks-not only from cancer, but also from motor vehicle crashes, firearm assault, end stage renal disease, and other problems-with PHS workers as silent partners.

Medical information and the right to privacy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Drell, D.

1994-06-01

This report is a compilation of submitted abstracts of papers presented at the DOE-supported workshop on medical information and the right to privacy held at the National Academy of Sciences in Washington, DC, on June 9 and 10, 1994. The aim of this meeting is to provide a forum to discuss the legal, ethical and practical issues related to the computerization and use of medical data, as well as the potential impact the use of these data may have on an individual`s privacy. Topical areas include an overview of the Federal and legal requirements to collect medical data, historical experiencesmore » with worker screening programs, currently available medical surveillance technologies (both biomedical and computer technologies) and their limitations. In addition, an-depth assessment of the needs and interests of a wide spectrum of parties as they relate to the use of medical data from both a legal and privacy perspective is provided. The needs of the individual, the public (e.g., blood and tissue banks), private enterprises (e.g., industry and insurance carriers), and the government (e.g., FBI) are discussed. Finally, the practical and legal issues relating to the use of computers to carry, store and transmit this information are also examined. The abstracts are presented in the intended order of presentation as indicated in the agenda for the meeting.« less

Medical futility decisions and physicians' legal defensiveness: the impact of anticipated conflict on thresholds for end-of-life treatment.

PubMed

Swanson, J W; McCrary, S V

1996-01-01

Does legal defensiveness significantly influence physicians' assessments of medical futility, in ways that may adversely affect the rights of patients and their family members to make their own health care decisions at the end of life? This exploratory study addresses that question with attitudinal data from a survey of 301 physicians practicing in academic medical centers in Texas. The majority of respondents indicated that the probability of success defining futile treatment should hypothetically be lower for patients with potential to benefit more from life-sustaining medical intervention (e.g. typically patients who are sentient), and higher for patients with less potential to benefit (e.g. patients in a persistent vegetative state). That is to say, physicians normally perceive longer odds to be worth pursuing for greater potential gain - a position that seems logically consonant with patients' rational self-interest. However, physicians with an attitude of extreme legal defensiveness did not fit this pattern. Rather, they tended to define futility in a manner that would maximize the physician's latitude to justifiably oppose patient preferences for end-of-life treatment abatement. These findings suggest that some physicians assume an adversarial position in their consideration of medical futility issues - an attitude that anticipates conflict with terminally-ill patients or their surrogates. The analysis presented here is not definitive, but at least raises the question of whether some physicians may inappropriately use their prerogative over medical futility as a means to guard their professional autonomy against perceived threats.

[Current legal framework conditions for running and utilization of biobanks. Part 2: data protection and informed consent].

PubMed

Haier, J

2013-10-01

Informed consent of donors of biomaterials represents an essential pillar of legal conformity of business organizations even for biobanks. For the assessment of self-determination of donors and freedom of research for users of biobanks there is a general consensus on the necessity for a social and individual agreement for the participation of donors in research projects. However, demands are often made for which the legal implementation is at least contentious and can be considered as excessive and biased. In part 2 of this review series the current legal foundation of data protection and informed consent is summarized on the basis of normative and ethical principles. With respect to appropriation of data and biosamples it can be deduced that by conformation to corresponding framework conditions the informed consent of donors in particular can be constructed independent of the project.

Munchausen syndrome by proxy in Mexican children: medical, social, psychological and legal aspects.

PubMed

Trejo-Hernández, Jorge; Loredo-Abdalá, Arturo; Orozco-Garibay, José Manuel

2011-01-01

The Munchausen Syndrome by Proxy (MSP), is considered as an unusual less frequent variety of child abuse (CA). In this type of abuse the perpetrators purposely provide factitious information, tamper with specimens or actually induce an illness in a child. Nowadays, it is a clinical entity described in pediatrics as more frequently than before. Despite the fact of its presence worldwide, there are still problems in order to get an appropriate diagnostic. It is also difficult to handle both the clinical and legal aspects in various countries. Make our academic fellows aware of various pediatric, psychological, social and legal aspects of a series of cases attended at the Clínica de Atención Integral al Niño Maltratado from Instituto Nacional de Pediatría (CAINM-INP), Mexico [Integral Clinic of Attention for Abused Children, at National Institute of Pediatrics, Mexico]. From a series of 25 cases, 18 minors of age were considered with this syndrome since we found that they shared medical, psychological, social and legal characteristics. 18 minors of age belonged to 14 families. 4 of those families had two affected children each one. These affected children were girls 13/18, predominant in children under six years in 10/18. Syndrome expression was distributed as follows: fever from a non determined origin, seizures, chronic diarrhea, hematuria, and probable sexual abuse. 14 children were hospitalized. In all cases, the aggressor was the mother. The psychological evaluation of six perpetrators revealed psychotic, histrionic, and compulsive-obsessive traits. The socio-economic condition was low in 50% of the cases. A legal demand was posed for seven patients in which all the children remained under the custody of the mother. In Mexico, reports of CA have increased within the last years according to experience. Some complex forms as MSP require the participation of an interdisciplinary team for both diagnosis and integral attention.

[Passive euthanasia in clinical practice--the medical decision reflected in the legal position].

PubMed

Möller, T; Grabensee, B; Frister, H

2008-05-01

Doctors are often confronted with end-of-life decisions. When deciding on the withdrawal of medical treatment physicians have to consider the legal position. This study was done to evaluated how far doctors at the university medical center in Düsseldorf had acted in conformity with the established case law in Germany. Between April and August 2006 doctors at the university medical center in Düsseldorf filled in a standardized questionnaire about the decisions they had taken to withdraw life-support treatment. 128 of a total of 512 doctors questioned replied (25 %; 32,8 % females and 67,2 % males) . The survey showed that the judicial decision (that it is not necessary to provide treatment if life-support measures are not indicated) is largely determined by non-medical criteria. The clinical decision by doctors depended mainly on his personal opinion. Furthermore the survey showed that only a few doctors made use of the - lawful - option to withdraw medical treatment when this was not indicated. Finally the survey revealed that, in case of conflict between indication and perceived patients' wishes, the vast majority of doctors behaved in contravention of the decisions established by case law. There is the need to discuss what non-medical issues should be taken into account when determining the indication of withdrawal of life-support measures. The results also highlighted the uncertainties that exist regarding a doctor's decisions about it. Not only should legislation clarify whether "passive euthanasia" is allowed, but it would also be useful to delegate end-of-life decisions to a review board.

Severe neurological impairment: legal aspects of decisions to reduce care.

PubMed

Beresford, H R

1984-05-01

Decisions to reduce care for patients with severe neurological impairment may raise legal questions. The laws of most states now authorize physicians to stop care for those who have suffered irreversible cessation of all functions of the brain ("brain death"). Where state law is not explicit, it is nevertheless probably lawful to regard brain death as death for legal purposes so long as currently accepted criteria are satisfied. Several courts have ruled that it is lawful to reduce care for patients in vegetative states, but have prescribed differing standards and procedures for implementing such decisions. The issue of whether parents can authorize physicians to reduce care for neurologically impaired children is the focus of current litigation. Implicit in this litigation is the question of how severe neurological impairment must be before parents and physicians may lawfully agree to reduce care. For severely impaired but not vegetative adults, there is some legal authority to justify certain decisions to reduce care. The issue of whether withholding feeding from a severely demented patient with life-threatening medical problems constitutes criminal behavior is now being considered by a state supreme court.

Teaching legal competencies through an individualized elective in medicine and law.

PubMed

Kapp, Marshall B

2016-10-14

Medical education, including education intended to prepare future physicians to care to older individuals, should include development and implementation of competencies relating to a physician's ability to understand and interact with the legal environment and legal actors who will affect the practice of medicine. The wisdom of integrating legal knowledge into the medical curriculum has been documented, and literature discusses the content and methods of teaching medical students and residents about law and the legal system. This article describes one unique but replicable, pedagogical approach to preparing future physicians to thrive in their inevitably interprofessional careers as they fulfill the fiduciary responsibilities that lie at the heart of their therapeutic and advocacy relationships with older patients.

[Abortion: towards worldwide legalization].

PubMed

1998-09-01

A table showing the current status of abortion in the world based on two recent and detailed studies is presented. Countries are categorized according to whether they totally prohibit abortion, permit it to save the mother's life, permit it to preserve her physical health or mental health, permit it for maternal socioeconomic reasons, or provide it at the mother's request. The countries are grouped into 5 geographic areas: America and the Caribbean; Central Asia, Middle East, and North Africa; East and South Asia and the Pacific; Europe; sub-Saharan Africa. The trend toward liberalization of laws is clear. The development of abortion laws is moving in the direction of complete legalization, that is, the creation of health norms that facilitate abortion for all women, with guarantees of medical safety. There are still countries that move to restrict access to abortion, and in a few cases, such as Colombia and Poland, legalization and prohibition have alternated depending on the social and political circumstances of the moment. In the past 12 years, 28 countries liberalized their laws in some way, while 4 countries with close ties to the Vatican restricted or prohibited access.

[Legal repercussions of Clinical Ethics Committees reports].

PubMed

Couceiro V, Azucena; Beca I, Juan Pablo

2006-04-01

Clinical Ethics Committees and Research Ethics Committees have their own specific roles. The Clinical Ethics Committee's pronouncements have an advisory function, whereas Research Ethics Committees' decisions are binding. This article analyzes the legal impact of the Clinical Ethics Committees' reports. Legal and medical reasoning share the same practical nature. Both can have several correct answers to the same situation. Clinical Ethics Committees deliberate about these alternatives and analyze the involved values. Their conclusions are non-compulsory recommendations. They do not replace nor diminish the doctor's personal responsibility. Even though the Clinical Ethics Committees' reports are not binding, they constitute a sort of "expert's opinion", expressed by qualified professionals, who assume their own professional responsibility as advisors. The members' behavior is necessarily subject to constitutional and legal regulations. When judges review the Clinical Ethics Committee's reports, they must realize that their nature is advisory, and also consider them an essential element to reduce the gap between the medical and legal fields. In this way, the problem of increasingly transforming medicine into a legal issue can be prevented.

HTA and its legal issues: a framework for identifying legal issues in health technology assessment.

PubMed

Widrig, Daniel; Tag, Brigitte

2014-12-01

Legal analysis can highlight important issues that are relevant when deciding whether a medical technology should be implemented or reimbursed. Literature and studies show that even though the law is an acknowledged part of health technology assessment (HTA), legal issues are rarely considered in practice. One reason for this may be the lack of knowledge about the diversity of legal issues that are relevant for HTA. Therefore, this contribution aims primarily to identify and then explain the relevant legal issues in HTA. This study offers a framework for identifying the legal issues in HTAs in different jurisdictions and provides a basis for further research. After extensive literature search, the authors review Swiss health law to identify legal issues that are relevant to HTA. The authors then categorize these legal issues using a framework with an inside and outside perspective. Finally, they explain a selection of these legal issues with several examples. This study reveals numerous legal issues that are relevant for HTA and underlines the necessity of incorporating legal analysis in HTAs. The suggested perspectival framework in this study provides a basis to structure the legal analysis. The identified legal issues are relevant in other countries and the perspectival framework is transferable to other jurisdictions. The article underlines the importance of in-depth discussion about the role of law in HTA. It provides a structured overview of the legal issues in HTA and suggests a development of more concrete instruments toward a standardized legal technology assessment.

Use of the dead body in healthcare and medical training: mapping and balancing the legal rights and values.

PubMed

Herrmann, Janne Rothmar

2011-05-01

By exploring the central legal principles and issues regarding usage of the dead body in healthcare and especially in medical training, this article aims at drawing some general conclusions on the legal status of the dead body and the protection of the deceased's integrity, dignity and autonomy. The article demonstrates that the use of the cadaveric body for scientific and educational purposes involves a redrawing of the traditional boundaries between the decent and the indecent, making these acts acceptable that would otherwise be regarded as assaults on the sanctity of bodily boundaries. This is made possible by the fact that the underlying principle of dignity is not perceived to be of an absolute nature when applicable to deceased persons.

Psychopathic disorder: a category mistake? A legal response to Colin Holmes.

PubMed Central

Mackay, I

1991-01-01

Holmes is concerned with a conflict between law and medicine about the problem of psychopathy, in particular as it relates to homicide. He looks for a consistent set of legal principles based on a variety of medical concepts and in doing so criticises the court for its commonsense approach, its disregard for medical evidence and for employing lay notions of responsibility and illness. This commentary explores how Holmes's notions fit into existing legal rules and explains how the court seeks the assistance of medical evidence when looking at the evidence as a whole to enable it to decide upon issues of defence, which involve legal and not medical concepts. PMID:1870087

Ethical and legal framework and regulation for off-label use: European perspective.

PubMed

Lenk, Christian; Duttge, Gunnar

2014-01-01

For more than 20 years the off-label use of drugs has been an essential part of the ethical and legal considerations regarding the international regulation of drug licensing. Despite a number of regulatory initiatives in the European Union, there seems to remain a largely unsatisfactory situation following a number of critical descriptions and statements from actors in the field. The present article gives an overview of the ethical and legal framework and developments in European countries and identifies existing problems and possible pathways for solutions in this important regulatory area. In addition to the presentation of the ethical and legal foundations, some attention is given to criticisms from medical practitioners to the current handling of off-label drug use. The review also focuses on the situation confronted by patients and physicians when off-label prescriptions are necessary. Through legal descriptions from a number of countries, possible solutions for future discussion of European health care policy are selected and explained.

[Medical legal issues associated with the evaluation of herniated discs in seafarers to merchant ships].

PubMed

Onofri, E; Salesi, M; Massoni, F; Rosati, M V; Ricci, S

2012-01-01

"Seafarer" means person employed with any job on board a ship offshore, whether publicly or privately, excluding ships of war. Day by day a seafarer is forced to confront a reality in constant motion and live in environments that require awkward movements, and restricting the normal mobility of the person. In order to verify the frequency of herniated discs in this particular category of workers, given the recent introduction of INAIL tabulated diseases, a study was conducted on a sample of seafarers. Data analysis showed that 48.3% of the seafarers of the sample has herniated lumbar disc, and 34.5% of these duties in the deck, and 65.5% of the machine. The study of sample, varied as to age and task being performed, supports the assertion that the individual risk factors, especially age and obesity, are not strongly implicated in the genesis of disk herniation suffered by seafarers while the work factors (vibrations) play a more significant role in the onset of this disease. This consideration is part of a context, that of legal medical evaluation and in particular the causal relationship, which currently seems rather lacking in terms of literature and scientific production.

["Is there a doctor on board?" - legal aspects of medical care in emergency situations during spare time].

PubMed

Lindner, Christina; Lindner, Gregor; Exadaktylos, Aristomenis K

2013-12-11

Medical emergencies on international flights are not uncommon. In these situations the question often arises whether physicians are obliged to render first aid and whether omission leads to legal consequences. The general obligation to aid those in need applies to everyone, not only to physicians. Evading this duty makes liable to prosecution for omittance of defence of a third person in line with Art. 128 of the Swiss Penal Code, punishable by custodial sentence up to three years or an equivalent punitive fine. Vocational and professional law extend the duty to aid for physicians to urgent cases. Although resulting from the performance of a legal obligation, malpractice occurred in the course of first aid can lead to claims for compensation - even from foreign patients, and that according to their own domestic law.

Improving the Care of Youth With Type 1 Diabetes With a Novel Medical-Legal Community Intervention: The Diabetes Community Care Ambassador Program.

PubMed

Malik, Faisal S; Yi-Frazier, Joyce P; Taplin, Craig E; Roth, Christian L; Whitlock, Kathryn B; Howard, Waylon; Pihoker, Catherine

2018-04-01

Purpose The purpose of this study was to examine the feasibility and efficacy of the Diabetes Community Care Ambassador (DCCA) Program, a novel medical-legal community intervention designed to support high-risk youth with type 1 diabetes. Methods Study eligibility criteria: ages 3-19 years, A1C ≥8.5% (≥69 mmol/mol) and/or recent diabetic ketoacidosis hospitalization, type 1 diabetes duration ≥1 year, and English- or Spanish-speaking. Eighty-nine youth and their caregivers participated in the 9- to 12-month intervention, which included diabetes education and support through 3 home visits, 1 to 2 school visits, and phone support from a lay health worker, as well as legal support from a medical-legal partnership attorney. Feasibility was assessed; change in A1C was compared in a linear mixed model. Results Of the 89 DCCA Program participants, 80% completed the program, with the majority of participants rating their DCCA favorably. Sixty-two percent reported ≥1 unmet legal need, of whom 29% accepted legal counsel. Youth enrolled in the DCCA Program demonstrated an improvement in glycemic control as their mean A1C decreased from 9.71% (83 mmol/mol) at the start of the program to 9.40% (79 mmol/mol) at the end of the intervention period ( P = .03). Participants with public health insurance experienced the greatest differential A1C reduction (9.79% to 9.11%, 83 mmol/mol to 76 mmol/mol). Conclusions The DCCA Program represents a promising intervention for improving care of high-risk youth with type 1 diabetes. A significant proportion of caregivers of youth reported having an unmet legal need. Participants remained highly engaged and demonstrated improved glycemic control, particularly youth with public health insurance.

How to write a medico-legal report.

PubMed

Bird, Sara

2014-11-01

The preparation and provision of medico-legal reports by the treating doctor is an inevitable but sometimes unwelcome part of general practice. This article outlines the steps involved in preparing a 'good' medico-legal report, including some of the common pitfalls to avoid. General practitioners play an important role in providing medico-legal reports about their patients for a wide variety of purposes. A medico-legal report may be seen by a diverse, non-medical audience. Once prepared, the report may be used as evidence in court proceedings and subjected to close scrutiny. A structured and comprehensive medico-legal report may minimise the chances of having to give evidence in court.

[Euthanasia and other decisions at the end of life (Proposal for a more transparent terminology and some thoughts on the legal framework of medical treatment)].

PubMed

Vadász, Gábor

2010-10-24

Indication of euthanasia is only one of several medical decisions at the end of life. Precise definition of this topic related to the clinical events happening around the sick-bed is not complete in the legal and medical literature. The present review attempts to classify the different end of life events with the aim of clarifying which of these do not belong to the concept of passive euthanasia. Euthanasia is not a legal category. The everyday expressions of active and passive euthanasia are simplifications, which cover actions of different purposes. Use of these in medical and legal literature can be confusing and misleading. We differentiate decisions at the end of life on basis of their purpose. Based on the definition and category of the Hungarian Doctors' Chamber, euthanasia is the act or the lack of action in order to mercifully shorten or end the life of a suffering fellow-man to help him. Concepts of active, passive and forced euthanasia are defined. The terms of indirect and intermediate euthanasia are not used in order to avoid misunderstanding. Help and participation of non-professionals in the implementation cannot be completely excluded from the concept of euthanasia, and we believe euthanasia is not merely related to doctors. We outline those medical decisions at the end of life which do not belong to the category of passive euthanasia, namely: withdrawal of ineffective and life sustaining treatments, letting go of the patient, contra-indication of therapy escalation, use of palliative therapy, pain-relieving treatment, compromise medicine, consideration of reanimation and choosing cost-effective therapy. We touch upon the subject of the living will, why it cannot be applied, and its relation to active and passive euthanasia. With reference to the legal regulation of life saving and life sustaining treatment, we deal with the expected spirit of medical legislation.

[Involuntary commitment of the psychiatric patient: legal regulations and critical aspects].

PubMed

Ibáñez Bernáldez, M; Casado Blanco, M

2018-03-01

Traditionally, medical care received by psychiatric patients involved their separation from the society through their isolation in closed institutions, thereby setting a stigmatising trend on the sick, and by extension on mental illness, a practice that somehow has remained until now. The profound changes in the field of psychiatry have been important and are reflected in the therapeutic field, as well as in the legislative one, and have contributed to establish changes concerning the social opinion about psychiatric patients. The purpose of this article is to review, from the critical perspective, the current legislative framework concerning the situation of involuntary psychiatric commitment as a therapeutic measure in the psychiatric patient, as well as the legal medical practice which indicates the lack of legal skills and ethical and professional conduct arising in the field of primary care. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Same-Sex Couples: Legal Complexities

ERIC Educational Resources Information Center

Oswald, Ramona Faith; Kuvalanka, Katherine A.

2008-01-01

In this article, the authors present a typology for organizing our current knowledge regarding same-sex couples in the United States who have and have not established legal ties between partners. This framework is complemented by a discussion of key rulings that define what is legally possible as well as the introduction of "legal consciousness,"…

Forensic Medicine in South Africa: Associations between Medical Practice and Legal Case Progression and Outcomes in Female Murders

PubMed Central

Abrahams, Naeemah; Jewkes, Rachel; Martin, Lorna J.; Mathews, Shanaaz

2011-01-01

Background Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. Methods We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. Findings In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16–2.20), weapon recovered 1.36 (95% CI:0.58–2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14–3.00). None of the forensic medical activities increased the likelihood of a conviction. Conclusion The findings raise important questions about the role of forensic medicine in these cases. PMID:22194868

Forensic medicine in South Africa: associations between medical practice and legal case progression and outcomes in female murders.

PubMed

Abrahams, Naeemah; Jewkes, Rachel; Martin, Lorna J; Mathews, Shanaaz

2011-01-01

Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16-2.20), weapon recovered 1.36 (95% CI:0.58-2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14-3.00). None of the forensic medical activities increased the likelihood of a conviction. The findings raise important questions about the role of forensic medicine in these cases.

THE LIABILITY FORMS OF THE MEDICAL PERSONNEL.

PubMed

Bărcan, Cristian

2015-01-01

Current legislation, namely Law no. 95/2006 on healthcare reform in the medical malpractice domain stipulates that medical staff can be held accountable in the following forms: disciplinary liability, administrative liability, civil liability and criminal liability. Each form of legal liability presents its features, aspects that are found mainly in the procedural rules. However, the differences between the various legal forms of liability are not met only in the procedural rules but also in their effects and consequences. It is necessary to know what the procedure for disciplinary responsibility, administrative liability, civil liability, or criminal liability is. In addition to the differentiation determined by the consequences that may arise from the different forms of legal liability, it is important to know the competent authorities to investigate a case further and the solutions which various public institutions can take regarding the medical staff. Depending on the type of legal liability, authorities have a specialized authority. If the Disciplinary Committee is encountered at the College of Physicians, it may not intervene in cases before the monitoring and competence for malpractice cases Committee. The latter two committees cannot intervene directly in the legal assessment of civil or criminal cases, as no criminal investigation authorities cannot intervene in strictly civilian cases. Therefore, the importance of knowing the competent institutions is imperative.

Cannabis, pesticides and conflicting laws: the dilemma for legalized States and implications for public health.

PubMed

Stone, Dave

2014-08-01

State laws on the legalization of medical and recreational cannabis are rapidly evolving. Similar to other crops, cannabis is susceptible to multiple pests during cultivation. Growers have an economic incentive to produce large yields and high quality plants, and may resort to pesticides to achieve these outcomes. Currently, there are no pesticides registered for cannabis in the United States, given its illegal status by the federal government. This discrepancy creates a regulatory vacuum and dilemma for States with legal medical and recreational cannabis that seek to balance lawful compliance with pesticides and worker or public health. Pesticide use presents occupational safety issues that can be mitigated through established worker protection measures. The absence of approved products for cannabis may result in consumer exposures to otherwise more hazardous pesticides or higher residue levels. While many legal and scientific hurdles exist to register conventional pesticides for use on cannabis, legalized States have explored other opportunities to leverage the present regulatory infrastructure. Stakeholder engagement and outreach to the cannabis industry from credible sources could mitigate pesticide misuse and harm. Copyright © 2014 Elsevier Inc. All rights reserved.

Disciplinary and Legal Actions Against Dermatologists in Canada.

PubMed

Nasseri, Eiman

2016-01-01

Dermatologists face a litany of professional and legal risks in practice. To review cases of disciplinary and legal action against dermatologists in Canada. The Canadian Medical Protective Association, all 10 provincial medical colleges, and the Canadian Legal Information Institute were contacted to obtain data on legal or disciplinary action taken against dermatologists in their records. A literature review was performed regarding litigation against dermatologists in other countries. Six dermatologists in Canada faced disciplinary action in the last 5 to 30 years. Seven dermatologists and 5 other specialists in Canada faced lawsuits relating to dermatology in the last 1 to 144 years. Procedures and therapy are the most frequently sources of lawsuits against dermatologists both at home and abroad. Dermatologists need to remain vigilant to avoid disciplinary action and lawsuits from their increasing and varied interactions with patients. © The Author(s) 2015.

[Legal aspects and the treatment procedure of gender dysphoria in Hungary].

PubMed

Kórász, Krisztián

2015-07-26

The legal process of gender transition in Hungary had previously been more developed as in most European countries, as the law enabled transsexual people to change their name and gender before or without a medical treatment, which was unique at the time. Over the years, however, lots of European countries developed legal frameworks and accepted international standards of care for the treatment of gender dysphoria that Hungary did not follow. Currently in Hungary there is no consistent legal framework of gender transition, there is no official regulation or guidelines regarding gender transition process, no institution with the obligation to accommodate the process, and there is no nominated specialist in the state health care system whose remit included dealing with transsexual patients. The information on gender transition options both to the professionals and to the patients is limited and incoherent. This paper reviews the legal aspects and clinical management process of gender dysphoria in Hungary. Some issues regarding the Hungarian practice and possible solutions based on examples from the United Kingdom are addressed within the paper.

Ethical and legal issues in caring for asylum seekers and refugees in the UK.

PubMed

Hamill, M; McDonald, L; Brook, G; Murphy, S

2004-11-01

Inward migration to the UK remains topical and controversial as numbers continue to increase. Many immigrants have specific health care needs and may shoulder a large burden of infectious disease. Imposition of legal constraints can have a huge impact on the medical care afforded to immigrants. Currently UK policy is to treat, free of charge and with NHS resources, those who fulfil specific criteria. However an increasing number are being asked to pay for their treatment. Many health care professionals are confused as to current legal restrictions and require guidance on the associated ethical issues. We concentrate on provision of care to HIV positive individuals and use cases to illustrate some of the issues. However these issues are equally pertinent to practitioners in all branches of medicine.

[Medical, ethical and legal issues in cryopreservation of human embryos].

PubMed

Beca, Juan Pablo; Lecaros, Alberto; González, Patricio; Sanhueza, Pablo; Mandakovic, Borislava

2014-07-01

Embryo cryopreservation improves efficiency and security of assisted reproduction techniques. Nonetheless, it can be questionable, so it must be justified from technical, legal and ethical points of view. This article analyses these perspectives. Embryo cryopreservation maximizes the probability of pregnancy, avoids new ovary stimulations and reduces the occurrence of multiple gestations. There is consensus that the in vitro embryo deserves legal protection by its own, although not as a newborn. Very few countries prohibit embryo cryopreservation based on the legal duty to protect human life since fecundation. Those countries that allow it, privilege women's reproductive rights. In Chile and in Latin America, no laws have been promulgated to regulate human assisted reproduction. The moral status of the embryo depends on how it is considered. Some believe it is a potential person while others think it is just a group of cells, but all recognize that it requires some kind of respect and protection. There is lack of information about the number of frozen embryos and their final destination. As a conclusion the authors propose that women or couples should have the right to decide autonomously, while institutions ought to be clear in their regulations. And the legislation must establish the legal status of the embryo before its implantation, the couples' rights and the regulation of the embryo cryopreservation. Personal, institutional or legal decisions must assume a concept about the moral status of the human embryo and try to avoid their destruction or indefinite storage.

Clean dealing. Legal considerations for buy/sell agreements.

PubMed

Johnson, Bruce A

2002-01-01

Buy/sell agreements for medical practices relate as much to governance and power as to dollars and cents. A practice should consider strategic, financial and legal issues in the buy/sell arrangement and express them in the group's legal documents.

Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study

PubMed Central

Marchant, Gary E.; Scheckel, Kathryn; Campos-Outcalt, Doug

2016-01-01

Precis As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system’s expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. PMID:27256135

Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study.

PubMed

Marchant, Gary E; Scheckel, Kathryn; Campos-Outcalt, Doug

2016-03-01

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. © 2016 American Society of Law, Medicine & Ethics.

Medicine beyond borders: the legal and ethical challenges.

PubMed

Kassim, Puteri Nemie J

2009-09-01

The ease and affordability of international travel has contributed to the rapid growth of the healthcare industry where people from all around the world are traveling to other countries to obtain medical, dental, and surgical care while at the same time touring, vacationing and fully experiencing the attractions of the countries that they are visiting. A combination of many factors has led to the recent increase in popularity of medical tourism such as exorbitant costs of healthcare in industrialized nations, favorable currency exchange rates in the global economy, rapidly improving technology in many countries of the world and most importantly proven safety of healthcare in selected foreign nations. Nevertheless, the development of medical tourism has certainly awakened many ethical and legal issues, which must be addressed. Issues pertaining to malpractice, consumer protection, organ trafficking, alternative medicine and telemedicine need comprehensive legal regulatory framework to govern them. Ethical issues are also been raised by the promotion of medical tourism in particular those pertaining to doctor and patient relationship. A future, where medical law is subsumed into various legal and ethical dimensions, poses serious challenges for the practice and ethics of medicine.

Death with Dignity: A Tripartite Legal Response

ERIC Educational Resources Information Center

Leblang, Theodore Raymond

1978-01-01

This article provides a descriptive overview of the legal problems that attend medical treatment of the terminally ill patient as well as a careful analysis of the legal vehicles that have been offered in response to these problems--the living will, the antidysthanasia contract, and right to die legislation. (Author)

Medical marijuana: medical necessity versus political agenda.

PubMed

Clark, Peter A; Capuzzi, Kevin; Fick, Cameron

2011-12-01

Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government's stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights.

Medical marijuana: Medical necessity versus political agenda

PubMed Central

Clark, Peter A.; Capuzzi, Kevin; Fick, Cameron

2011-01-01

Summary Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government’s stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights. PMID:22129912

Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

PubMed

Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

2015-02-01

The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

The Legalization of Higher Education

ERIC Educational Resources Information Center

Badke, Lara K.

2017-01-01

A complete discussion of intellectual property (IP), faculty rights, and the public good requires a thorough framing of higher education's legal context, from which the rise of legalistic criteria (or legalization) and current IP regime have grown.

The right to information and their exceptions in medical practices in the Iranian legal system.

PubMed

Sheykh-Talimi, Maysam; Shariati-Nasab, Sadegh; Zare, Mohammad Kazem; Omani-Samani, Reza

2016-01-01

The right to information Act was implemented in the Iranian legal system through accession of the Merida Convention ensuring the right to information as a fundamental right for the public. One significant aspects of this subject is the ratification of the "Disclosure and Access to Information Act" by which it is recognized as a right of all Persian individuals and citizens to access state-held information in Iran administration. The Iranian legislature, with regard to the role of access to information and its significance, clarified the scope, permitted subjects of access, and exceptions of the right to state-held information. In this essay, we will discuss the legal aspects and scope of ensuring access to medical information in the Iranian statutes and their exceptions. It is argued that the Iranian legislation ensures the principle of maximum disclosure, while sensitive subjects', specially classified and private information, are exempted. Therefore, the related rules in Iran's statutes not only do not threaten patient's information, but also protect them by criminalizing the breaching of the mentioned right.

[LEGAL REGULATION OF TRANSPLANTOLOGY AT THE PRESENT STAGE: UKRAINIAN ISSUE AND EXPERIENCE OF FOREIGN STATES].

PubMed

Sovgyria, O

2018-03-01

The objective of the research is to analyze the legal regulation in the transplantology field at the present stage in Ukraine. To address identified challenges, the author investigates the foreign countries experience and suggests ways of improving certain mechanism for legal regulation in the field of organ transplantation and anatomical materials. The empiric material of the study included a wide range of legal instruments regulating this sphere of legal relationships, information regarding the problems of their application, statistics, expert analysis of Ukrainian and foreign researchers. Methodological mechanism of current research includes such methods: systematic, logical and formal, structural-functional, comparative. The research found that the most world's successful model for the organization of transplantation is in Spain. Additionally, the criteria for the reception of such a model are singled out as well as certain aspects of their application in Ukraine are analyzed. Particularly, the most important criteria are: universal and general territorial proliferation of national health systems; relevant economic resources (special attention is paid to the fact that transplantation is not a medicine of luxury, and an adequate compensation to hospitals for transplantation operations should serve as a main economic aspect); an adequate and necessary number of doctors and nurses; the availability of advanced technical options for medical mechanical ventilation (air conditioning of dead bodies). The research led to the following overall findings. Due to the rapid development of medical and biological sciences, there is an urgent need on further investigation of legal, moral and ethical, general medical aspects of transplantation with subsequent proposals for improving legislation in the field of human organs transplantation and other anatomical materials. At the same time, development of appropriate legislation by complex groups of cross-disciplinary specialists

Legal principles of confidentiality and other public interests: Part 1.

PubMed

Fullbrook, Suzanne

The principles of confidentiality are of paramount importance to nurses and all health professionals. This is explicitly so as the Common Law recognizes confidentiality and supports its importance. However, current practice must take cognizance of the realities of 21st century healthcare delivery - we live in an age of electronic data that is potentially very difficult to keep secret. New rules, protocols and guidelines are being formulated, and regulatory bodies such as the Nursing and Midwifery Council (NMC) reflect such rules in their codes of professional conduct. There is, however, a debate that is suggesting that the rules that relate to confidentiality may need to expand or even bend a little as innovate ways of obtaining, storing, utilizing and communicating data continue to occupy the minds of government and those who formulate legal principles (British Medical Association, 2005). This series of three articles will explore these issues. The first part is a review of case law that explores the fundamental legal principles that underpin confidentiality. The second will concentrate on a review of the guidelines that are to be found in professional regulatory documentation - the NMC and the General Medical Council as they relate to the legal principles. The third and last part will review and reflect on issues that relate expressly to the implementation of electronic patient records, with a review of appropriate statutory legislation and principles of common law.

Relationship between Prior Legal Involvement and Current Crisis for Adults with Intellectual Disability

ERIC Educational Resources Information Center

Lunsky, Yona; Raina, Poonam; Jones, Jessica

2012-01-01

Background: Individuals with intellectual disability (ID) and legal involvement are a unique population with complex needs. To date, there has been limited research exploring the demographic and clinical profiles of individuals with ID and legal involvement that are in crisis and how they differ to individuals with ID without legal involvement.…

Is there any legal and scientific basis for classifying electronic cigarettes as medications?

PubMed

Farsalinos, Konstantinos E; Stimson, Gerry V

2014-05-01

The rapid growth in the use of electronic cigarettes has been accompanied by substantial discussions by governments, international organisations, consumers and public health experts about how they might be regulated. In the European Union they are currently regulated under consumer legislation but new legislation will regulate them under the Tobacco Products Directive. However, several countries have sought to regulate them under medicines regulations. These claims have been successfully challenged in 6 court cases in European states. Under European legislation a product may be deemed to be a medicine by function if it is used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis. It is a medicine by presentation if it is presented (e.g. by a manufacturer or distributor) as having properties for treating or preventing disease in human beings. We assess the legal and scientific basis for the claim that electronic cigarettes should be regulated as medicines. We conclude that they are neither medicine by function nor necessarily by presentation The main reason for their existence is as a harm reduction product in which the liking for and/or dependence on nicotine is maintained, and adoption of use is as a substitute for smoking and not as a smoking cessation product. In reality, they are used as consumer products providing pleasure to the user. They are not used to treat nicotine addiction or other disease, but to enable continued use of nicotine. Their use is adjusted individually by each consumer according to his or her perceived pleasure and satisfaction. Gaps in current regulation regarding safety and quality can be met by tailored regulations. Copyright © 2014 Elsevier B.V. All rights reserved.

Examining the debate on the use of medical marijuana.

PubMed

DuPont, R L

1999-01-01

The opium poppy and the coca leaf offer useful perspectives on the current controversies over medical marijuana. In both cases, purified synthetic analogues of biologically active components of ancient folk remedies have become medical mainstays without undermining efforts to reduce nonmedical drug use. A decade ago, a campaign strove to legalize heroin for the compassionate treatment of pain in terminally ill patients. Like the current campaign to legalize medical marijuana, many well-meaning people supported this effort. The campaign for medical heroin was stopped by science when double-blind studies showed that heroin offered no benefits over the standard opioid analgesics in the treatment of severe cancer pain. Scientific medicine requires purified chemicals in carefully controlled doses without contaminating toxic substances. That a doctor would one day write a prescription for leaves to be burned is unimaginable. The Controlled Substances Act and international treaties limit the use of abused drugs or medicines. In contrast to smoked marijuana, specific chemicals in marijuana or, more likely, synthetic analogues, may prove to be of benefit to some patients with specific illnesses. Most opponents of medical use of smoked marijuana are not hostile to the medical use of purified synthetic analogues or even synthetic tetrahydrocannabinol (THC), which has been available in the United States for prescription by any licensed doctor since 1985. In contrast, most supporters of smoked marijuana are hostile to the use of purified chemicals from marijuana, insisting that only smoked marijuana leaves be used as "medicine," revealing clearly that their motivation is not scientific medicine but the back door legalization of marijuana.

Medications and breast-feeding: Current concepts.

PubMed

Nice, Frank J; Luo, Amy C

2012-01-01

To describe the various factors that come into play when a breast-feeding mother is taking medications, including use of prescription drugs, over-the-counter medications, recreational drugs, galactogogues, and herbal remedies and to provide a framework used for counseling breast-feeding women. Community and hospital pharmacy and health care settings. Consultative services provided to breast-feeding mothers who had been prescribed or were using medications. Use of pharmacokinetic factors, maternal and child factors, a list of questions to ask breast-feeding mothers, and a stepwise approach to counsel breast-feeding mothers on the compatibility of using medications while breast-feeding. By positive intervention of pharmacists and health care providers, up to 1 million breast-feeding mothers, who must use medications, can continue to breast-feed while taking medications. Objectively weighing the benefits of drugs and breast-feeding versus the risks of drugs and not breast-feeding, in most cases, allows for pharmacists to give current and practical advice to mothers and other health professionals who counsel mothers.

Geriatrics and the Legal System.

PubMed

Yarnell, Stephanie C; Kirwin, Paul D; Zonana, Howard V

2017-06-01

Correctional systems, already struggling to meet the basic and functional requirements of older prisoners, will be further challenged by the increasing medical and psychiatric needs of this population. Mental health and general medical care for older adults requires specific on-site or consultation expertise in geriatric medicine and psychiatry, as well as potential changes in infrastructure, both of which may be prohibitively expensive. However, compassionate and effective treatment of older prisoners requires that prison and legal systems facilitate this expert care. To address this situation, strategic revisions of the criminal justice system are needed to alleviate prison overcrowding and consequent inadequate medical care for inmates, especially the elder ones. The unique, age-related demands of this older population predict an increased need for forensic psychiatrists with a thorough knowledge and expertise in geriatrics, as more forensic psychiatric evaluations will be needed before trial in both civil and criminal cases, during incarceration, and at the time of parole. In this article, we review the current state of elder inmates in correctional institutions and advocate for increased geriatric training for forensic psychiatrists in anticipation of this growing need. © 2017 American Academy of Psychiatry and the Law.

Driving and legal status of Spanish opioid-dependent patients.

PubMed

Roncero, Carlos; Álvarez, F Javier; Barral, Carmen; Gómez-Baeza, Susana; Gonzalvo, Begoña; Rodríguez-Cintas, Laia; Brugal, M Teresa; Jacas, Carlos; Romaguera, Anna; Casas, Miguel

2013-06-03

Opioid dependent patients have legal problems, driving violations and accidents more frequently than the general population. We have hypothesized that those patients currently driving may have better legal outcomes than those who do not possess a valid driving license. With this aim we have analyzed the information gathered in the PROTEUS study regarding the legal and driving statuses and assessed the possible association between them. The PROTEUS study was an observational, cross-sectional, descriptive, multicenter nationwide representative study, conducted in Spanish healthcare centers for opioid dependent patients. The driving and legal statuses of a population of opioid dependent patients ≥ 18 years and enrolled in Opioid Agonist Therapy treatment centers in Spain, were assessed using a short specific questionnaire and the EuropASI questionnaire to highlight distinct individual clinical needs. 621 patients were evaluable (84% men, 24.5% active workers). 321 patients (52%) drove on a regular basis. Nineteen percent of patients had some problem with the criminal justice system. There was a significant difference (p = 0.0433) in status, according to the criminal justice system, between patients who drove on a regular basis and those who did not, with a higher percentage of patients with non-pending charges among usual drivers. Regular drivers showed fewer legal problems than non-regular drivers, with the exception of those related to driving (driving violations and drunk driving). Driving is a good prognostic factor for the social integration of the patients and policies should be implemented to enable these patients to drive safely under medical authorization. The legal description will be useful to assess treatment efficacy.

Liability versus innovation: the legal case for regenerative medicine.

PubMed

Keren-Paz, Tsachi; El Haj, Alicia J

2014-10-01

Medical innovation occupies a position somewhere between standard practice and clinical research, but innovation is primarily intended to benefit an individual patient where standard treatment fails. Medical innovations in the area of regenerative medicine have the potential to completely transform medical practice, but rely upon some major revision to the nature of treatments beyond drug-based therapies. There is considerable investment in scientific and clinical research, but further attention could be paid to legal barriers to medical innovation imposed by the threat of medical malpractice. We survey in this article the legal framework for making determinations of medical malpractice in general, and highlight the issues specific to innovative treatments. In essence, liability could be imposed for failing to adequately inform the patient about the innovative nature of the suggested therapy or based on the fact that the risks outweighed the benefits. As for the latter, we examine whether liability is likely to be based merely on deviating from existing practice or on an examination on the merits of the treatments' risks and benefits. The facts that some risks are unforeseeable and some benefits are external to the patient complicate negligence determinations. The first fact relates to the problem of judging adverse events in hindsight; the second, to the obligation to make decisions based on the patient's best interest and avoid conflict of interests. In addition, we evaluate the relationship between the obligations to secure the patient's informed consent and to avoid clinical negligence. We identify the need for further research to examine the significance of the putative anti-innovation bias that current liability regimen has, and to examine whether a move to strict liability might avoid such bias, while being fair to patients who contribute for the advancement of medical knowledge by participating in innovative therapies.

Physician-assisted suicide: the legal slippery slope.

PubMed

Walker, R M

2001-01-01

In Oregon, physicians can prescribe lethal amounts of medication only if requested by competent, terminally ill patients. However, the possibility of extending the practice to patients who lack decisional capacity exists. This paper examines why the legal extension of physician-assisted suicide (PAS) to incapacitated patients is possible, and perhaps likely. The author reviews several pivotal court cases that have served to define the distinctions and legalities among "right-to-die" cases and the various forms of euthanasia and PAS. Significant public support exists for legalizing PAS and voluntary euthanasia in the United States. The only defenses against sliding from PAS to voluntary euthanasia are adhering to traditional physician morality that stands against it and keeping the issue of voluntary euthanasia legally framed as homicide. However, if voluntary euthanasia evolves euphemistically as a medical choice issue, then the possibility of its legalization exists. If courts allow PAS to be framed as a basic personal right akin to the right to refuse treatment, and if they rely on right-to-die case precedents, then they will likely extend PAS to voluntary euthanasia and nonvoluntary euthanasia. This would be done by extending the right to PAS to incapacitated patients, who may or may not have expressed a choice for PAS prior to incapacity.

Medical Rights of Minors: Some Answered and Unanswered Legal Questions.

ERIC Educational Resources Information Center

Talbutt, Lou

1980-01-01

Because school counselors work with minors they must keep up with current laws, as well as state and local school policies. Special caution is needed concerning medical rights of minors and parental consent in dealing with student pregnancy, abortion, drug abuse, and child abuse. (JAC)

Interprofessional Legal Practitioners: The Case of the M.D.-LL.B.

ERIC Educational Resources Information Center

Schneller, Eugene Stewart

1975-01-01

Careers and problems encountered by the large majority of M.D.-LL.B's who practice legal medicine are examined. The author argues that the legal profession must strive to create institutionalized career lines so that interprofessional medical-legal practice is a well-founded career choice. (JT)

Review of the Italian current legislation on research biobanking activities on the eve of the participation of national biobanks’ network in the legal consortium BBMRI-ERIC.

PubMed

Calzolari, Alessia; Napolitano, Mariarosaria; Bravo, Elena

2013-04-01

The ethical-legal framework of research biobanking activities is still scarcely defined in Italy, and this constitutes a major obstacle to exploit the potential benefits of existing bioresource patrimony at the national and international levels. Biobanking and Biomolecular Resources Research Infrastructure (BBMRI), which aims to become a major interface between biological samples and data and top-level biological and medical research, is undertaking the crucial transformation to the ERIC (European Research Infrastructure Consortium) legal entity. In this scenario, there is a need to address the national legal and ethical concerns that are strictly correlated with the use of human biosources in research across European countries participating (and not) in BBMRI. In this perspective, this article aims to review the legal framework applying to research biobanking in Italy, including both "soft" nonbinding instruments and binding regulations. Since ethical and societal aspects impact biobanking research activities, the article discusses both the critical ethical and legal open issues that need to be implemented at the national level.

Legal rights to safe abortion: knowledge and attitude of women in North-West Ethiopia toward the current Ethiopian abortion law.

PubMed

Muzeyen, R; Ayichiluhm, M; Manyazewal, T

2017-07-01

To assess women's knowledge and attitude toward Ethiopian current abortion law. A quantitative, community-based cross-sectional survey. Women of reproductive age in three selected lower districts in Bahir Dar, North-West Ethiopia, were included. Multi-stage simple random sampling and simple random sampling were used to select the districts and respondents, respectively. Data were collected using a structured questionnaire comprising questions related to knowledge and attitude toward legal status of abortion and cases where abortion is currently allowed by law in Ethiopia. Descriptive statistics were used to summarize the data and multivariable logistic regression computed to assess the magnitude and significance of associations. Of 845 eligible women selected, 774 (92%) consented to participate and completed the interview. A total of 512 (66%) women were aware of the legal status of the Ethiopian abortion law and their primary sources of information were electronic media such as television and radio (43%) followed by healthcare providers (38.7%). Among women with awareness of the law, 293 (57.2%) were poor in knowledge, 188 (36.7%) fairly knowledgeable, and 31 (6.1%) good in knowledge about the cases where abortion is allowed by law. Of the total 774 women included, 438 (56.5%) hold liberal and 336 (43.5%) conservative attitude toward legalization of abortion. In the multivariable logistic regression, age had a significant association with knowledge, whereas occupation had a significant association with attitude toward the law. Women who had poor knowledge toward the law were more likely to have conservative attitude toward the law (adjusted odds ratio, 0.40; 95% confidence interval, 0.23-0.61). Though the Ethiopian criminal code legalized abortion under certain circumstances since 2005, a significant number of women knew little about the law and several protested legalization of abortion. Countries such as Ethiopia with high maternal mortality records need to lift

Legal consequences of standard setting for competitive athletes with cardiovascular abnormalities.

PubMed

Weistart, J C

1985-12-01

This paper addresses the issue of whether establishing consensus standards for the treatment of particular medical conditions increases a physician's exposure to legal liability. The conclusion reached is that the legal effects of standard setting, rather than representing a significant threat of liability, should be seen as beneficial to the medical profession. A fundamental point is that the legal test for liability is entirely dependent on the medical profession's definition of what constitutes adequate care. The law incorporates the standard of care defined by the medical profession and does not impose an external norm. In the absence of formally stated standards, the process of defining relevant medical criteria will involve a great deal of uncertainty. Outcomes of legal contests will be affected by such extraneous factors as the relative experience of the lawyers involved, their access to knowledgeable expert witnesses, and their strategic decisions made with respect to tactics and procedures. Establishment of formal standards has the salutory effect of limiting the influence of these factors and thus reducing the randomness of the results reached. Formal standards also have the advantage of being easily replicated in unrelated proceedings and thereby contribute to the development of a consistent, evenly applied rule of liability. Finally, even if formal standards are either more, or less, progressive than the actual state of medical practice, there is relatively little risk that they will produce untoward results.

Driving and legal status of Spanish opioid-dependent patients

PubMed Central

2013-01-01

Background Opioid dependent patients have legal problems, driving violations and accidents more frequently than the general population. We have hypothesized that those patients currently driving may have better legal outcomes than those who do not possess a valid driving license. With this aim we have analyzed the information gathered in the PROTEUS study regarding the legal and driving statuses and assessed the possible association between them. The PROTEUS study was an observational, cross-sectional, descriptive, multicenter nationwide representative study, conducted in Spanish healthcare centers for opioid dependent patients. Findings The driving and legal statuses of a population of opioid dependent patients ≥18 years and enrolled in Opioid Agonist Therapy treatment centers in Spain, were assessed using a short specific questionnaire and the EuropASI questionnaire to highlight distinct individual clinical needs. 621 patients were evaluable (84% men, 24.5% active workers). 321 patients (52%) drove on a regular basis. Nineteen percent of patients had some problem with the criminal justice system. There was a significant difference (p = 0.0433) in status, according to the criminal justice system, between patients who drove on a regular basis and those who did not, with a higher percentage of patients with non-pending charges among usual drivers. Conclusions Regular drivers showed fewer legal problems than non-regular drivers, with the exception of those related to driving (driving violations and drunk driving). Driving is a good prognostic factor for the social integration of the patients and policies should be implemented to enable these patients to drive safely under medical authorization. The legal description will be useful to assess treatment efficacy. PMID:23731546

Legalizing a market for cannabis for pleasure: Colorado, Washington, Uruguay and beyond.

PubMed

Room, Robin

2014-03-01

Colorado, Washington state and Uruguay are currently designing legal non-medical markets for cannabis. These clearly contravene the 1961 and 1988 drug conventions; options for what may happen next are discussed. The current provisions in the three regulatory schemes are summarized. From a public health perspective, the emphasis should be on holding down consumption with regulatory measures, but the public health agenda does not seem to be a strong consideration in the implementation of the US schemes, and they are paying little attention to what can be learned from the history of alcohol and tobacco regulation. While alternative paths to a cannabis market under the conventions are noted, the legalization initiatives underline the need to revise the drug conventions, making prohibition of domestic markets an optional matter. Such changes would also ease the path for including alcohol under the conventions, which would be an important step forward in global health. © 2013 Society for the Study of Addiction.

Women’s status in the Polish Society in light of legal regulations till year 2015

PubMed

Wróbel–Harmas, Monika; Rachuta, Krzysztof

Gender equality and women’s rights are the subjects of ongoing discussions in societies all over the world. Women, more often than men, are likely to become victims of gender-based violence. The studies carried out in Europe show that only the every second woman is aware of gender-based legal regulations in her country, 19% cannot recognise any support service, and what is particularly important for the health care system – 87% would like their medical doctor to ask patients with physical injuries about potential violence experienced. The Paper aims at presenting the women’s status in the Polish society in light of current legal regulations implemented to guarantee equal treatment of both genders in every walk of life, which then reflects in the society’s physical and emotional health condition. The Authors analysed the current legal regulations in Poland with the aim to draw a preliminary evaluation of the women’s status in Poland as far as the realisation of the Third Millennium Development Goal within the UN Millennium Project Promote Gender Equality and Empower Women is concerned. The basic tool to combat violence in Poland is so-called the Blue Cards system. Till 2015 the Polish current law protected the women’s rights to a great extent. However, many issues were not covered by legal regulations, and in a great number of cases, women’s rights were practically not respected. Consequently, despite resolutions and international conventions ratified by Poland in order to legally protect women’s rights, they still remain a partially solved issue.

Controlling Legal Risk for Effective Hospital Management

PubMed Central

Park, Hyun Jun; Cho, Duk Young; Park, Yong Sug; Kim, Sun Wook; Park, Jae-Hong

2016-01-01

Purpose To analyze the types of medical malpractice, medical errors, and medical disputes in a university hospital for the proposal of countermeasures that maximize the efficiency of hospital management, medical departments, and healthcare providers. Materials and Methods This study retrospectively reviewed and analyzed 55 closed civil lawsuits among 64 medical lawsuit cases carried out in Pusan National University Hospital from January 2000 to April 2013 using medical records, petitions, briefs, and data from the Medical Dispute Mediation Committee. Results Of 55 civil lawsuits, men were the main plaintiffs in 31 cases (56.4%). The average period from medical malpractice to malpractice proceeding was 16.5 months (range, 1 month to 6.4 years), and the average period from malpractice proceeding to the disposition of a lawsuit was 21.7 months (range, 1 month to 4 years and 11 months). Conclusions Hospitals can effectively manage their legal risks by implementing a systematic medical system, eliminating risk factors in administrative service, educating all hospital employees on preventative strategies, and improving customer service. Furthermore, efforts should be made to establish standard coping strategies to manage medical disputes and malpractice lawsuits, operate alternative dispute resolution methods including the Medical Dispute Mediation Committee, create a compliance support center, deploy a specialized workforce including improved legal services for employees, and specialize the management-level tasks of the hospital. PMID:27169130

Epilepsy: legal discrimination from negative to positive.

PubMed

Mani, K S

1997-01-01

Indian law equates epilepsy with temporary insanity and also prohibits a legally valid marriage for a person with epilepsy with inherent risk of divorce. This absurd law, unique to India and possibly Brazil, must be excised in toto. Repeated petitions, by the Indian Epilepsy Association, to the Federal Government, have resulted in only vague assurances and alternate methods are under consideration. There are no legal impediments to education or work. Strict regulations against driving have yielded place to lax rules wherein a person can drive a vehicle, even after a recent fit, provided he gets a certificate from any registered medical practitioner. The nascent medical insurance specifically excludes epilepsy from its ambit. The cost of anti-epileptic drugs includes a 40% tax akin to Value Added Tax in the West. We must consider the impact of these legal impediments on the social fabric of the individual in his/her milieu and vis-a-vis priorities in national development.

Legal Standards for Brain Death and Undue Influence in Euthanasia Laws.

PubMed

Pope, Thaddeus Mason; Okninski, Michaela E

2016-06-01

A major appellate court decision from the United States seriously questions the legal sufficiency of prevailing medical criteria for the determination of death by neurological criteria. There may be a mismatch between legal and medical standards for brain death, requiring the amendment of either or both. In South Australia, a Bill seeks to establish a legal right for a defined category of persons suffering unbearably to request voluntary euthanasia. However, an essential criterion of a voluntary decision is that it is not tainted by undue influence, and this Bill falls short of providing adequate guidance to assess for undue influence.

Legal and ethical issues in research

PubMed Central

Yip, Camille; Han, Nian-Lin Reena; Sng, Ban Leong

2016-01-01

Legal and ethical issues form an important component of modern research, related to the subject and researcher. This article seeks to briefly review the various international guidelines and regulations that exist on issues related to informed consent, confidentiality, providing incentives and various forms of research misconduct. Relevant original publications (The Declaration of Helsinki, Belmont Report, Council for International Organisations of Medical Sciences/World Health Organisation International Guidelines for Biomedical Research Involving Human Subjects, World Association of Medical Editors Recommendations on Publication Ethics Policies, International Committee of Medical Journal Editors, CoSE White Paper, International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use-Good Clinical Practice) form the literature that are relevant to the ethical and legal aspects of conducting research that researchers should abide by when conducting translational and clinical research. Researchers should note the major international guidelines and regional differences in legislation. Hence, specific ethical advice should be sought at local Ethics Review Committees. PMID:27729698

Legal and ethical issues in research.

PubMed

Yip, Camille; Han, Nian-Lin Reena; Sng, Ban Leong

2016-09-01

Legal and ethical issues form an important component of modern research, related to the subject and researcher. This article seeks to briefly review the various international guidelines and regulations that exist on issues related to informed consent, confidentiality, providing incentives and various forms of research misconduct. Relevant original publications (The Declaration of Helsinki, Belmont Report, Council for International Organisations of Medical Sciences/World Health Organisation International Guidelines for Biomedical Research Involving Human Subjects, World Association of Medical Editors Recommendations on Publication Ethics Policies, International Committee of Medical Journal Editors, CoSE White Paper, International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use-Good Clinical Practice) form the literature that are relevant to the ethical and legal aspects of conducting research that researchers should abide by when conducting translational and clinical research. Researchers should note the major international guidelines and regional differences in legislation. Hence, specific ethical advice should be sought at local Ethics Review Committees.

The interface of legal and esthetic considerations

Treesearch

Richard C. Smardon

1979-01-01

This paper is an overview of development of legal/policy factors affecting visual resource management. Review of major legal issues, court cases, laws and administrative decisionmaking reveals that the "action" regarding legal and aesthetic issues is currently in the public arena as managed by administrative agencies. Analysis of key court cases reveals that...

Medical marijuana

MedlinePlus

... this page: //medlineplus.gov/ency/patientinstructions/000899.htm Medical marijuana To use the sharing features on this page, ... have legalized marijuana for medical use. How Does Medical Marijuana Work? Medical marijuana may be: Smoked Vaporized Eaten ...

Dementia and legal competency.

PubMed

Filaković, Pavo; Erić, Anamarija Petek; Mihanović, Mate; Glavina, Trpimir; Molnar, Sven

2011-06-01

execution, language difficulties, loosing perception of time and space, changes in mood and behaviour, personality alterations, loss of interests and initiative). Towards more accurate determination of legal competency the psychometric tests are being used. The appliance of these tests must be guided with basic question during evaluation: "For what is or is not he/she capable?" In prediction of possible dementia development, the modern diagnostic procedures are used as help for potentially demented individuals in order to plan own affairs and by oneself determine future guardian. This ensures the maximal respect and protection of rights among persons with dementia in order to independently manage life one step ahead of progressive illness. Finally, it is to be distinguished medical concept of legal capacity which is universal and judicial concept which is restricted by rules of national legal system differing from country to country.

Explore and experience: mobile augmented reality for medical training.

PubMed

Albrecht, Urs-Vito; Noll, Christoph; von Jan, Ute

2013-01-01

In medicine, especially in basic education, it may sometimes be inappropriate to integrate real patients into classes due to ethical issues that must be avoided. Nevertheless, the quality of medical education may suffer without the use of real cases. This is especially true of medical specialties such as legal medicine: survivors of a crime are already subjected to procedures that constitute a severe emotional burden and may cause additional distress even without the added presence of students. Using augmented reality based applications may alleviate this ethical dilemma by giving students the possibility to practice the necessary skills based on virtual but nevertheless almost realistic cases. The app "mARble®" that is presented in this paper follows this approach. The currently available learning module for legal medicine gives users an opportunity to learn about various wound patterns by virtually overlaying them on their own skin and is applicable in different learning settings. Preliminary evaluation results covering learning efficiency and emotional components of the learning process are promising. Content modules for other medical specialtiesare currently under construction.

42 CFR 35.12 - Solicitation of legal business prohibited.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Solicitation of legal business prohibited. 35.12 Section 35.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.12 Solicitation of legal business...

42 CFR 35.12 - Solicitation of legal business prohibited.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Solicitation of legal business prohibited. 35.12 Section 35.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.12 Solicitation of legal business...

42 CFR 35.12 - Solicitation of legal business prohibited.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Solicitation of legal business prohibited. 35.12 Section 35.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.12 Solicitation of legal business...

42 CFR 35.12 - Solicitation of legal business prohibited.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Solicitation of legal business prohibited. 35.12 Section 35.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.12 Solicitation of legal business...

42 CFR 35.12 - Solicitation of legal business prohibited.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Solicitation of legal business prohibited. 35.12 Section 35.12 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.12 Solicitation of legal business...

Have the Answers to Common Legal Questions Concerning Nutrition Support Changed Over the Past Decade? 10 Questions for 10 Years.

PubMed

Barrocas, Albert; Cohen, Michael L

2016-06-01

Clinical nutrition specialists (CNSs) are often confronted with technological, ethical, and legal questions, that is, what can be done technologically, what should be done ethically, and what must be done legally, which conflict at times. The conflict represents a "troubling trichotomy" as discussed in the lead article of this issue of Nutrition in Clinical Practice (NCP). During Clinical Nutrition Week in 2006, a symposium covering these 3 topics was presented, and later that year, an article covering the same topic was published in NCP In this article, we revisit several legal questions/issues that were raised 10 years ago and discuss current answers and approaches. Some of the answers remain unchanged. Other answers have been modified by additional legislation, court decisions, or regulations. In addition, new questions/issues have arisen. Some of the most common questions regarding nutrition support involve the following: liability, informed consent, medical decisional incapacity vs legal competence, advance directive specificity, surrogate decision making, physician orders for life-sustaining treatment and electronic medical orders for life-sustaining treatment, legal definition of death, patient vs family decision making, the noncompliant patient, and elder abuse obligations. In the current healthcare environment, these questions and issues are best addressed via a transdisciplinary team that focuses on function rather than form. The CNS can play a pivotal role in dealing with these challenges by applying the acronym ACT: being Accountable and Communicating with all stakeholders while actively participating as an integral part of the transdisciplinary Team. © 2016 American Society for Parenteral and Enteral Nutrition.

Physicians-in-training are not prepared to prescribe medical marijuana.

PubMed

Evanoff, Anastasia B; Quan, Tiffany; Dufault, Carolyn; Awad, Michael; Bierut, Laura Jean

2017-11-01

While medical marijuana use is legal in more than half of U.S. states, evidence is limited about the preparation of physicians-in-training to prescribe medical marijuana. We asked whether current medical school and graduate medical educational training prepare physicians to prescribe medical marijuana. We conducted a national survey of U.S. medical school curriculum deans, a similar survey of residents and fellows at Washington University in St. Louis, and a query of the Association of American Medical Colleges (AAMC) Curriculum Inventory database for keywords associated with medical marijuana. Surveys were obtained from 101 curriculum deans, and 258 residents and fellows. 145 schools were included in the curriculum search. The majority of deans (66.7%) reported that their graduates were not at all prepared to prescribe medical marijuana, and 25.0% reported that their graduates were not at all prepared to answer questions about medical marijuana. The vast majority of residents and fellows (89.5%) felt not at all prepared to prescribe medical marijuana, while 35.3% felt not at all prepared to answer questions, and 84.9% reported receiving no education in medical school or residency on medical marijuana. Finally, only 9% of medical school curriculums document in the AAMC Curriculum Inventory database content on medical marijuana. Our study highlights a fundamental mismatch between the state-level legalization of medical marijuana and the lack of preparation of physicians-in-training to prescribe it. With even more states on the cusp of legalizing medical marijuana, physician training should adapt to encompass this new reality of medical practice. Copyright © 2017 Elsevier B.V. All rights reserved.

[Temporary disability and its legal implications].

PubMed

Martin-Fumadó, Carles; Martí Amengual, Gabriel; Puig Bausili, Lluïsa; Arimany-Manso, Josep

2014-03-01

Temporary disability is the condition that workers face when, as the result of illness (common or professional) or accident (work-related or not), they are temporarily prevented from performing their work and require health care. The management of temporary disability is a medical act that involves (in addition to a complex clinical assessment) obvious social, occupational and financial connotations and requires continuing medical follow-up from doctors, as well as responses to medical-legal conflicts. The regulatory framework on the subject is extensive in the Spanish setting and highly diverse in the European setting. Beyond the regulatory framework, the repercussions of temporary disability are self-evident at all levels. Although determining temporary disability is a common medical act for practicing physicians, it is not exempt from risks or difficulties arising from the assessment itself and the characteristics of practicing medical care. Established medical-legal conflicts include the processing of health data and the requirements for transferring information related to workers' temporary disability to their company's medical services. The interest and usefulness demonstrated by the data obtained from forensic medicine for public health require the incorporation of these data into general healthcare information, as it could be essential to the surveillance of worker health. The recommendations established by medical societies, as good practice guidelines, are especially useful in this type of conflict. Copyright © 2014 Elsevier España, S.L. All rights reserved.

[Analysis of barriers and legal-ethical opportunities for disclosure and apology for medical errors in Spain].

PubMed

Giraldo, Priscila; Corbella, Josep; Rodrigo, Carmen; Comas, Mercè; Sala, Maria; Castells, Xavier

2016-01-01

To identify opportunities for disclosing information on medical errors in Spain and issuing an apology, as well as legal-ethical barriers. A cross-sectional study was conducted through a questionnaire sent to health law and bioethics experts (n=46). A total of 39 experts (84.7%) responded that health providers should always disclose adverse events and 38 experts (82.6%) were in favour of issuing an apology. Thirty experts (65.2%) reported that disclosure of errors would not lead to professional liability. The main opportunity for increasing disclosure was by enhancing trust in the physician-patient relationship and the main barrier was fear of the outcomes of disclosing medical errors. There is a broad agreement on the lack of liability following disclosure/apology on adverse events and the need to develop a strategy for disclosure among support for physicians. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

[Abortion in Colombia. Medical, legal and socioeconomic aspects].

PubMed

Umaña, A O

1973-01-01

Abortion is a social problem and criminal sanctions are very ineffective in limiting it and are seldom applied (133 legal actions vs. 65,600 cases of induced abortion in 1965). Abortion is a social disease, as are prostitution, juvenile delinquency, drug abuse, and so far has been an insoluble problem. Colombian laws should be modified to reflect reality. Sex education must be emphasized, because ignorance is one of the main causes of abortion. Leniency should be applied toward women who cooperate with the authorities in identifying the person who performed an abortion. Legalization of abortion and enforcement of strict laws against it are considered as possible solutions, but both are rejected. The former is regarded as morally unacceptable and as imposing an excessive burden on scarce health services, the latter as even worse, imposing an equivalent burden on the court system, without s olving either health or social problems. The best and probably only solution is to improve education in family planning, to promote knowledge and motivation to enable the population to make sound and responsible decisions.

Minimally legally invasive dentistry.

PubMed

Lam, R

2014-12-01

One disadvantage of the rapid advances in modern dentistry is that treatment options have never been more varied or confusing. Compounded by a more educated population greatly assisted by online information in an increasingly litigious society, a major concern in recent times is increased litigation against health practitioners. The manner in which courts handle disputes is ambiguous and what is considered fair or just may not be reflected in the judicial process. Although legal decisions in Australia follow a doctrine of precedent, the law is not static and is often reflected by community sentiment. In medical litigation, this has seen the rejection of the Bolam principle with a preference towards greater patient rights. Recent court decisions may change the practice of dentistry and it is important that the clinician is not caught unaware. The aim of this article is to discuss legal issues that are pertinent to the practice of modern dentistry through an analysis of legal cases that have shaped health law. Through these discussions, the importance of continuing professional development, professional association and informed consent will be realized as a means to limit the legal complications of dental practice. © 2014 Australian Dental Association.

e-Learning strategies in occupational legal medicine based on problem solving through "CASUS" system.

PubMed

Martínez-Jarreta, B; Monsó, E; Gascón, S; Casalod, Y; Abecia, E; Kolb, S; Reichert, J; Radon, K

2009-04-01

The use of online teaching tools facilitate the incorporation of self-learning methods. With a view to encouraging convergence in teaching tools and methods in Occupational Legal Medicine, an initiative was set up within the classes of Legal and Forensic Medicine at Saragossa University, as part of the EU funded NetWoRM project, which has been led since 1999 by Ludwig-Maximilians-Universität in Munich (Germany). The interest of medical students in Occupational Legal Medicine has so far been low and in addition different aspects complicate the teaching of Occupational Legal Medicine at medical schools: One reason for the low interest is the limited availability of bedside teaching, one of the students' most favourite and effective way to learn. The reason for that is that most medical schools with occupational departments only have outpatient clinics. "Interesting" patients who be need for educational purposes are therefore only available for a limited part of the day. However, in order to recognize and prevent occupational disorders each medical student and physician needs profound clinical knowledge in Occupational Legal Medicine. This project has proven to be highly efficient in permitting the creation and validation of teaching tools which cover and improve the traditional training of the Occupational Legal Medicine programme imparted in the degree of Medicine.

[Medical confidentiality for minors].

PubMed

Peyrebrune, Cécile; Génot-Pok, Isabelle

2009-12-20

The new statutory provisions on the care of minors have given a legal framework for primary healthcare professionals. They clarify the rights of minors and their general application to improve the quality of the healthcare system. They are valuable and relevant tools for general practitioners in their day to day practice, and they help improve the medical care of minors, currently considered as a real public health problem.

Euthanasia: Some Legal Considerations

ERIC Educational Resources Information Center

Koza, Pamela

1976-01-01

Several sections of the Criminal Code of Canada which are relevant to the issue of euthanasia are discussed. In addition, the value placed on the sanctity of life by the law, the failure to recognize motive in cases of euthanasia, and disparate legal and medical definitions of death are also considered. (Author)

Study of the Types of Domestic Violence Committed Against Women Referred to the Legal Medical Organization in Urmia - Iran.

PubMed

Aghakhani, Nader; Sharif Nia, Hamid; Moosavi, Ehsan; Eftekhari, Ali; Zarei, Abbas; Bahrami, Nasim; Nikoonejad, Ali Reza

2015-12-01

Today, domestic violence against women is a growing epidemic that can be observed in many countries. This study was carried out to determine the types of domestic violence against women who were referred to the Legal Medical Organization of Iran in Urmia, Iran in 2012. The descriptive survey included demographic information, abuse screening, and items regarding partner involvement. Data was gathered using face-to-face structured interviews. The study population included 300, women 18 years of age or older, and data was collected about their demographic characteristics and the types of domestic violence they experienced. SPSS software version 16 was used for the analyses. The majority of participants were in the 25 - 30 age group, and 83% of them were battered by their husbands in various ways. No significant relationships were observed between violence and unemployment, increasing age, and home ownership. The prevalence of abuse reported by women in this population suggests that many women that are referred to the Legal Medical Organization of Iran may have a history of abuse. Abused women may have different reasons for seeking a divorce. If routine screening for abuse is included in counseling, health providers will have the opportunity to develop a safety plan and initiate appropriate referrals.

Good cop, bad cop: federal prosecution of state-legalized medical marijuana use after United States v. Lopez.

PubMed

Newbern, A E

2000-10-01

The Supreme Court's recent decisions in United States v. Lopez and United States v. Morrison articulate a vision of federalism under which Congress's regulatory authority under the Commerce Clause is severely limited in favor of returning traditional areas of state concern, particularly criminal law enforcement, to local or state control. The Court's decisions in these cases coincide with ballot initiatives legalizing the medical use of marijuana garnering a majority of the vote in California, Arizona, Alaska, Colorado, Nevada, Oregon, Washington, Maine, and Washington D.C. Those who use marijuana for medical purposes under sanction of state law, however, still face the threat of federal prosecution under the Controlled Substances Act. Medical marijuana proponents have traditionally, and unsuccessfully, contested federal prosecution using individual rights arguments under theories of equal protection or substantive due process. This Comment argues that after Lopez and Morrison, the federal government's authority to regulate intrastate use of marijuana for medicinal purposes is not the foregone conclusion it once was. The author suggests that proponents of medical marijuana use should invoke the federalism arguments of Lopez and Morrison and argue for state legislative independence from the federal government on this issue.

Compromised External Validity: Federally Produced Cannabis Does Not Reflect Legal Markets

PubMed Central

Vergara, Daniela; Bidwell, L. Cinnamon; Gaudino, Reggie; Torres, Anthony; Du, Gary; Ruthenburg, Travis C.; deCesare, Kymron; Land, Donald P.; Hutchison, Kent E.; Kane, Nolan C.

2017-01-01

As the most widely used illicit drug worldwide, and as a source of numerous under-studied pharmacologically-active compounds, a precise understanding of variability in psychological and physiological effects of Cannabis varieties is essential. The National Institute on Drug Abuse (NIDA) is designated as the sole legal producer of Cannabis for use in US research studies. We sought to compare the chemical profiles of Cannabis varieties that are available to consumers in states that have state-legalized use versus what is available to researchers interested in studying the plant and its effects. Our results demonstrate that the federally-produced Cannabis has significantly less variety and lower concentrations of cannabinoids than are observed in state-legal U.S. dispensaries. Most dramatically, NIDA’s varieties contain only 27% of the THC levels and as much as 11–23 times the Cannabinol (CBN) content compared to what is available in the state-legal markets. Research restricted to using the current range of federally-produced Cannabis thus may yield limited insights into the chemical, biological and pharmacological properties, and medical potential of material that is available in the state markets. Investigation is urgently needed on the full diversity of Cannabis chemotypes known to be available to the public. PMID:28422145

Social media in the health-care setting: benefits but also a minefield of compliance and other legal issues.

PubMed

Moses, Richard E; McNeese, Libra G; Feld, Lauren D; Feld, Andrew D

2014-08-01

Throughout the past 20 years, the rising use of social media has revolutionized health care as well as other businesses. It allows large groups of people to create and share information, ideas, and experiences through online communications, and develop social and professional contacts easily and inexpensively. Our Gastroenterology organizations, among others, have embraced this technology. Although the health-care benefits may be many, social media must be viewed through a legal lens, recognizing the accompanying burdens of compliance, ethical, and litigation issues. Theories of liability and risk continue to evolve as does the technology. Social media usage within the medical community is fraught with potential legal issues, requiring remedial responses to meet patients' needs and comply with current laws, while not exposing physicians to medical malpractice and other tort risks.

Current Situation of Medication Adherence in Hypertension.

PubMed

Vrijens, Bernard; Antoniou, Sotiris; Burnier, Michel; de la Sierra, Alejandro; Volpe, Massimo

2017-01-01

Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and associated with increased risks of coronary and cerebrovascular events. Whilst there has been a gradual trend toward improved control of hypertension, the number of patients with blood pressure values above goal has remained constant. This has both personal and economic consequences. Medication adherence is a multifaceted issue and consists of three components: initiation, implementation, and persistence. A combination of methods is recommended to measure adherence, with electronic monitoring and drug measurement being the most accurate. Pill burden, resulting from free combinations of blood pressure lowering treatments, makes the daily routine of medication taking complex, which can be a barrier to optimal adherence. Single-pill fixed-dose combinations simplify the habit of medication taking and improve medication adherence. Re-packing of medication is also being utilized as a method of improving adherence. This paper presents the outcomes of discussions by a European group of experts on the current situation of medication adherence in hypertension.

Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy

PubMed Central

Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan

2013-01-01

In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation – ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and

Protected health information on social networking sites: ethical and legal considerations.

PubMed

Thompson, Lindsay A; Black, Erik; Duff, W Patrick; Paradise Black, Nicole; Saliba, Heidi; Dawson, Kara

2011-01-19

setting of medical mission trips. Trainees need to learn to equate standards of patient privacy in all medical contexts using both legal and ethical arguments to maintain the highest professional principles. We propose three practical guidelines. First, there should be a legal resource for physicians traveling on medical mission trips such as an online list of local laws, or a telephone legal contact. Second, institutions that organize medical mission trips should plan an ethics seminar prior the departure on any trip since the legal and ethical implications may not be intuitive. Finally, at minimum, traveling physicians should apply the strictest legal precedent to any situation.

Protected Health Information on Social Networking Sites: Ethical and Legal Considerations

PubMed Central

2011-01-01

privacy, they only seem to make this lapse in the setting of medical mission trips. Trainees need to learn to equate standards of patient privacy in all medical contexts using both legal and ethical arguments to maintain the highest professional principles. We propose three practical guidelines. First, there should be a legal resource for physicians traveling on medical mission trips such as an online list of local laws, or a telephone legal contact. Second, institutions that organize medical mission trips should plan an ethics seminar prior the departure on any trip since the legal and ethical implications may not be intuitive. Finally, at minimum, traveling physicians should apply the strictest legal precedent to any situation. PMID:21247862

[Valid liability law in surgery. Principles of legal requirements and clinical benchmarks exemplified by visceral surgery].

PubMed

Theuer, D; Dillschneider, J; Mieth, M; Büchler, M W

2012-01-01

The spectacular increase in liability processes in the field of surgery and in particular in visceral surgery, necessitates an objectification of the conflict between surgical medical professionals and medico-legal institutions, firms of solicitors and courts. Out of court settlements assisted by expert opinion commissions of the Medical Council can avoid many legal conflicts. For improvement of the legal standpoint of a defendant medical professional an unambiguous, extensive and detailed documentation of medical examination findings, the indications for the planned operative intervention, extensive and detailed documentation on disclosure and informed consent of the patient for the planned operative intervention, an extensive, detailed careful and responsibly guided report of the operation as well as a systematic, orderly well-planned postoperative complication management are necessary to counter the accusation of an organizational failure of medical professionals and the accused hospital. The mutual building of confidence between surgical medical professionals and legal institutions is safeguarded by a comprehensive documentation and an unambiguous description and formulation of the medical discharge report on termination of inpatient treatment.

Review: the legal duty of care for nurses and other health professionals.

PubMed

Young, Andy

2009-11-01

To explore the nature and extent of the legal duty of care in relation to contemporary healthcare practice. The paper seeks to re-frame and update the legal duty of care for clinical nursing practice in the 21st century, taking into account collaborative and partnership working in healthcare practice. Doctrinal legal 'approach'. 'Black letter' legal research methodology used for data collection and analysis. Literature search using Westlaw and LexisNexis database(s) to identify recent common law decisions. There has been a perceptible doctrinal shift away from paternalism and toward patient empowerment and autonomy in the last decade. This has implications for nurses and other healthcare professionals in terms of consenting patients and acting reasonably to ensure quality patient care. A number of experienced nurses are currently assuming extended roles and some are completing medical tasks, traditionally allocated to doctors. These specialist practitioners must remember that additional responsibility invariably means increased professional risk and accountability. Therefore, it is essential that those engaging in advanced nursing practice, fully understand the nature and reach of their professional duty of care and the significance of statutory and common law developments. Nurses and other healthcare professionals must update their clinical skills and practice within a legal framework and to certain standards. The cases cited and discussed are relevant to all branches of nursing and indeed to all health professions.

Medical entrepreneurism: the current opportunity in America.

PubMed

Lexa, Frank James

2004-10-01

This article discusses both the current climate for entrepreneurial activity in the fields of biotechnology, health care services, and medical devices as well as key ideas in the process of successful innovation. Basic issues related to the nature of new medical ventures and its importance in the U.S. economy are discussed. A stepwise overview of the process of innovation is provided, starting from the initial idea, through the early and middle stages of growth, and on to an initial public offering or other alternative harvest strategy. The roles of financing sources in generating health care entrepreneurial activity are explored, and the advantages and disadvantages of each are discussed. The article focuses on venture capital investment because of its pivotal role in high-profile successes; however, alternative forms of financing are also covered as appropriate to each stage. In addition, critical nonfinancial issues that affect the success of new enterprises, such as intellectual property protection and the creation of management teams for young companies, are also covered. The magnitude of current investment in the domestic biomedical field is addressed, and future prospects for American medical innovation are briefly discussed.

[The legal status of blood's therapeutic products and consequences].

PubMed

Thibert, J-B

2016-05-01

The first testimonies of humanity show a constant: blood was always surrounded with a sacred fascination. For years, it was not useful to define a legal status for blood, but healthy crisis, medical practices, had led to answer this question in a context of legal protection of human dignity and rights. Actually, the legal frame is moving and to know those statuses is helpful for a better understanding of the changes. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Current status of teaching on spirituality in UK medical schools.

PubMed

Neely, David; Minford, Eunice J

2008-02-01

To investigate the current status of teaching on spirituality in medicine in UK medical schools and to establish if and how medical schools are preparing future doctors to identify patients' spiritual needs. We carried out a national questionnaire survey using a 2-part questionnaire. Section A contained questions relating to the quantity of teaching on spirituality and the topics covered. Section B contained questions relating to teaching on alternative health practices. Medical educators from each of the 32 medical schools in the UK were invited to participate. A response rate of 53% (n = 17) was achieved. A total of 59% (n = 10) of respondents stated that there is teaching on spirituality in medicine in their curricula. On extrapolation, at least 31% and a maximum of 78% of UK medical schools currently provide some form of teaching on spirituality. Of the respondents that teach spirituality, 50% (n = 5) stated that their schools include compulsory teaching on spirituality in medicine, 80% (n = 8) include optional components, and 88% stated that teaching on complementary and alternative medicine is included in the curriculum. Although 59% (n = 10) of respondent medical schools (the actual UK figure lies between 31% and 78%) currently provide some form of teaching on spirituality, there is significant room for improvement. There is little uniformity between medical schools with regard to content, form, amount or type of staff member delivering the teaching. It would be beneficial to introduce a standardised curriculum on spirituality across all UK medical schools.

[The fiscal position of medical specialists].

PubMed

Stevens, S; Moors, M

2013-01-01

Independent medical specialists in the Netherlands are treated as entrepreneurs for tax purposes and therefore enjoy tax benefits. A change in the legal relationship between medical specialists and hospitals is foreseen in 2015. Independent medical specialists will then no longer be considered to be entrepreneurs. This could negatively affect their tax position. The Dutch government has adopted a policy aimed at controlling expenses arising from medical specialists' fees. According to this policy, the formation of regional practices or mega-practices of specialists will be discouraged. In contrast, the current fiscal legislation encourages medical specialists to incorporate their practice into regional practices or mega-practices or to become shareholders of their hospitals. It has been proposed that fiscal benefits be linked to certain aspects of entrepreneurship, such as investing in medical equipment or employing medical personnel.

Implications of marijuana legalization for adolescent substance use.

PubMed

Hopfer, Christian

2014-01-01

Marijuana that is legally available for adults has multiple implications for adolescent substance use. One potential effect that legalization may have is an increase in adolescent use to due increased availability, greater social acceptance, and possibly lower prices. Legalization may also facilitate the introduction of new formulations of marijuana (edible, vaporized) and with potentially higher potencies. It is unknown what adolescent consumption patterns will be if marijuana is widely available and marketed in different forms, or what effects different patterns of adolescent use will have on cognition, the development of marijuana use disorders, school performance, and the development of psychotic illnesses. Also unclear is whether adolescent users will be experiencing higher levels of tetrahydrocannabinol (THC) compared with previous generations of users due to higher potencies. Although previous studies of the effects of adolescent marijuana use provide some guidance for current policy and public health recommendations, many new studies will be needed that answer questions in the context of use within a legal adult environment. Claims that marijuana has medicinal benefits create additional challenges for adolescent prevention efforts, as they contrast with messages of its harmfulness. Prevention and treatment approaches will need to address perceptions of the safety of marijuana, claims of its medicinal use, and consider family-wide effects as older siblings and parents may increasingly openly consume and advocate for marijuana use. Guidance for primary care physicians will be needed regarded screening and counseling. Widespread legalization and acceptance of marijuana implies that as law enforcement approaches for marijuana control decline, public health, medical, and scientific efforts to understand and reduce negative consequences of adolescent marijuana use need to be substantially increased to levels commensurate with those efforts for tobacco and alcohol.

Physicians' communication skills with patients and legal liability in decided medical malpractice litigation cases in Japan

PubMed Central

Hamasaki, Tomoko; Takehara, Tadamichi; Hagihara, Akihito

2008-01-01

Background In medical malpractice litigations in recent years in Japan, it is notable that the growing number of medical litigation cases includes the issue of a doctor's explanation to the patient as a pivotal point. The objective of this study was to identify factors of physicians' communication skills with patients, as related to their legal liability, and differences in doctors' communication skills with patients by the type of medical facility. Methods Decisions of medical malpractice litigation cases between 1988 and 2005 in Japan, the pivotal issue of which was a physician's explanation, were analyzed in the study. The content of each decision was summarized using the study variables (information about the patient, doctor, manner of the doctor's explanation, and subsequent litigation), and a database comprising the content of each decision (N = 100) was constructed. In order to evaluate an association between doctors' communication skills with patients and the outcome of the litigation, the analysis was performed based on the outcome of litigation or the type of medical facility. Results The ratio of acknowledged physician liability by court decision was lower in cases in which the doctor's explanation occurred before treatment or surgery (p = 0.013). The ratio of acknowledged physician liability by court decision was higher in cases of elective or non-urgent treatment (p = 0.046). The ratio of acknowledged physician liability by court decision was higher in clinics than in hospital groups (p = 0.036). Conclusion These findings are beneficial for the prevention of medical disputes and improvement of patient-physician communication. PMID:18652700

Physicians' communication skills with patients and legal liability in decided medical malpractice litigation cases in Japan.

PubMed

Hamasaki, Tomoko; Takehara, Tadamichi; Hagihara, Akihito

2008-07-25

In medical malpractice litigations in recent years in Japan, it is notable that the growing number of medical litigation cases includes the issue of a doctor's explanation to the patient as a pivotal point. The objective of this study was to identify factors of physicians' communication skills with patients, as related to their legal liability, and differences in doctors' communication skills with patients by the type of medical facility. Decisions of medical malpractice litigation cases between 1988 and 2005 in Japan, the pivotal issue of which was a physician's explanation, were analyzed in the study. The content of each decision was summarized using the study variables (information about the patient, doctor, manner of the doctor's explanation, and subsequent litigation), and a database comprising the content of each decision (N = 100) was constructed. In order to evaluate an association between doctors' communication skills with patients and the outcome of the litigation, the analysis was performed based on the outcome of litigation or the type of medical facility. The ratio of acknowledged physician liability by court decision was lower in cases in which the doctor's explanation occurred before treatment or surgery (p = 0.013). The ratio of acknowledged physician liability by court decision was higher in cases of elective or non-urgent treatment (p = 0.046). The ratio of acknowledged physician liability by court decision was higher in clinics than in hospital groups (p = 0.036). These findings are beneficial for the prevention of medical disputes and improvement of patient-physician communication.

The necessity of repeated assessment of imaging studies contained in medical records in medico-legal opinions.

PubMed

Borowska-Solonynko, A

The paper presents two case reports of living victims, in which imaging studies of the chest conducted at a medical facility were an essential part of the medico-legal opinion. The first case was that of a young male hospitalized due to CT evidence of bilateral rib fractions, who claimed to have been assaulted by police officers. The other case was that of a six week old baby hospitalized due to chest X-ray evidence of right hand side rib fractions. The chest X-ray was performed due to one bruise found on the baby's forehead and two small bruises on the back, which gave rise to suspicions of child abuse. In both cases, expert witnesses in radiology definitively excluded the presence of any fractures. These cases indicate that a new assessment of imaging studies contained in medical records is needed. Expert opinions based solely on the description of imaging studies may result in grave consequences.

The Restorative Role of Apology in Resolving Medical Disputes: Lessons From Chinese Legal Culture.

PubMed

Lin, Nuannuan

2015-12-01

This article is the first exploration of the Chinese notion of apology from a comparative legal perspective. By reviewing the significance of apology in the context of Chinese culture, the article presents a three-dimensional structure of apology that, in contrast to the understanding the research community now has, defines acknowledgement of fault, admission of responsibility, and offer of reparation as three essential elements of an apology. It is the combination of these three elements that enables apology to serve as a form of reparation. The article further places the three-dimensional apology in the context of the Chinese concept of "the relations of humanity," arguing that an apology accompanying admission of fault and responsibility may help to restore the harmony of relations and, by so doing, resolve medical disputes positively.

Informed consent: a socio-legal study.

PubMed

Rathor, M Y; Rani, Mohammad Fauzi Abdul; Shah, Azarisman Mohammad; Akter, Sheikh Fariuddin

2011-12-01

Informed consent [IC] is a recognized socio-legal obligation for the medical profession. The doctrine of IC involves the law, which aims to ensure the lawfulness of health assistance and tends to reflect the concept of autonomy of the person requiring and requesting medical and/or surgical treatment. Recent changes in the health care delivery system and the complex sociological settings, in which it is practiced, have resulted in an increase in judicial activity and medical negligence lawsuits for physicians. While IC is a well-established practice, it often fails to meet its stated purpose. In the common law, the standard of medical care to disclose risks has been laid down by the Bolam test- a familiar concept to most physicians, but it has been challenged recently in many jurisdictions. This paper aims to discuss some important judgments in cases of alleged medical negligence so as to familiarize doctors regarding their socio-legal obligations. We also propose to discuss some factors that influence the quality of IC in clinical practice. Literature review. The law of medical consent has been undergoing changes in recent years. Case law appears to be evolving towards a more patient centered standard of disclosure. Patient's expectations are higher and they are aware of the power of exercising their rights. Failure to obtain IC is one of the common allegations in medical malpractice suits. The medical professionals need to change their mindset and avoid claims of negligence by providing information that is "reasonable" in the eyes of the court.

‘Legal high’ associated Wallenberg syndrome

PubMed Central

Arora, Alok; Kumar, Anil; Raza, Muhammad Naeem

2013-01-01

‘Legal highs’ are substances of synthetic or natural origin having psychotropic properties. ‘Legal highs’ are often new and, in many cases, the actual chemical ingredients in a branded product can be changed without notifications and the risks are unpredictable. Acute recreational drug toxicity is a common reason for presentation to both hospital and prehospital medical services. It appears that, generally, the pattern of toxicity associated with ‘legal highs’ is broadly similar to that seen with classical stimulant recreational drugs such as cocaine, MDMA (3,4 methylenedioxy-N-methyl amphetamine) and amphetamine. Lack of clear literature pertaining to their chemical properties, pharmacology and toxicology makes an evaluation of their effects difficult. We describe a unique case in which consumption of such a substance led to hospital admission and a diagnosis of ‘lateral medullary stroke’ or ‘Wallenberg syndrome’. We believe that this is the first described case of a ‘legal high’ intake linked to a posterior circulation stroke. PMID:23709150

[Deceased organ donors, legal regulations governing diagnosis of brain death, overview of donors and liver transplants in the Czech Republic].

PubMed

Pokorná, E

2013-08-01

The key restriction of transplantation medicine globally, as well as in the Czech Republic, concerns the lack of organs. The number of deceased donors, and thus the availability of organ transplants, has been stagnating in our country. The paper describes current legal regulations governing the dia-gnosis of brain death and primary legal and medical criteria for the contraindication of the deceased for organ explantation, gives an overview of the number of liver transplants, age structure, and diagnosis resulting in brain death of the deceased liver donors in the Czech Republic.

Challenges of access to medicine and the responsibility of pharmaceutical companies: a legal perspective.

PubMed

Ahmadiani, Saeed; Nikfar, Shekoufeh

2016-05-04

The right to health as a basic human right- and access to medicine as a part of it- have been a matter of attention for several decades. Also the responsibilities of different parties- particularly pharmaceutical companies- in realization of this right has been emphasized by World Health Organization. This is while many companies find no incentive for research and development of medicines related to rare diseases. Also some legal structures such as "patent agreements" clearly cause huge difficulties for access to medicine in many countries. High prices of brand medicine and no legal production of generics can increase the catastrophic costs- as well as morbidity-mortality of medication in lower income countries. Here we evidently review the current challenges in access to medicine and critically assess its legal roots. How societies/governors can make the pharmaceutical companies responsible is also discussed to have a look on possible future and actions that policy makers- in local or global level- can take.

[Legal aspects of transplant and donation].

PubMed

Teijeira, R

2006-01-01

The Spanish model of organ and tissue donation enjoys great prestige in the world medical sphere and has been the object of study and imitation in different countries. Part of this success is due to the fact that since the year 1979 different legal norms have been enacted that have regulated and facilitated donation. The current legislation on the donation and transplant of organs and tissues is based on the principles of the gratuity and confidentiality of the donation, indicating the need for facilitating the formation of organisations at the level of the autonomous communities and at the national level. It also contains the requisites for donation of both live donors and deceased donors, establishing the norms for certification of death due to cardiorespiratory arrest and due to the irreversible cease of brain functions.

The current status of medical marijuana in the United States.

PubMed

McKenna, Gerald J

2014-04-01

Medical marijuana is currently a controversial issue in medicine. There are strong pro and con opinions but relatively little scientific data on which to base medical decisions. The unfortunate scheduling of marijuana in class I has limited research and only serves to fuel the controversy. This article will review the history of laws to regulate drugs in the United States in the 20th century to provide context for the current status of medical marijuana. It will include the rationale for opposing medical marijuana laws and the problem of the Schedule I inclusion of marijuana as well as other drugs. It will examine the problems associated with smoking raw marijuana and review other routes of administration. Finally, it examines the inadvisability of medicine's promotion of smoked marijuana.

Benefit in liver transplantation: a survey among medical staff, patients, medical students and non-medical university staff and students.

PubMed

Englschalk, Christine; Eser, Daniela; Jox, Ralf J; Gerbes, Alexander; Frey, Lorenz; Dubay, Derek A; Angele, Martin; Stangl, Manfred; Meiser, Bruno; Werner, Jens; Guba, Markus

2018-02-12

The allocation of any scarce health care resource, especially a lifesaving resource, can create profound ethical and legal challenges. Liver transplant allocation currently is based upon urgency, a sickest-first approach, and does not utilize capacity to benefit. While urgency can be described reasonably well with the MELD system, benefit encompasses multiple dimensions of patients' well-being. Currently, the balance between both principles is ill-defined. This survey with 502 participants examines how urgency and benefit are weighted by different stakeholders (medical staff, patients on the liver transplant list or already transplanted, medical students and non-medical university staff and students). Liver transplant patients favored the sickest-first allocation, although all other groups tended to favor benefit. Criteria of a successful transplantation were a minimum survival of at least 1 year and recovery of functional status to being ambulatory and capable of all self-care (ECOG 2). An individual delisting decision was accepted when the 1-year survival probability would fall below 50%. Benefit was found to be a critical variable that may also trigger the willingness to donate organs. The strong interest of stakeholder for successful liver transplants is inadequately translated into current allocation rules.

Genetic testing: medico-legal issues.

PubMed

Bird, Sara

2014-07-01

The availability and frequency of genetic testing is increasing. Genetic testing poses some unique ethical and legal issues for medical practitioners because of the potential to identify genetic variants that carry implications for the risk of disease in the future for the patient and their relatives. The regulatory framework within which genetic testing is provided in Australia is also changing. This article examines some medico-legal issues associated with genetic testing that general practitioners (GPs) are likely encounter in their practices. There is inevitable involvement of the GP in the long term care of a patient (and possibly their family) following genetic testing, regardless of whether or not the GP has ordered the testing. Cases are presented to illustrate some of the medico-legal issues that may arise from direct-to-consumer genetic testing, information disclosure to genetic relatives and requests for parentage testing.

Legalizing and Regulating Marijuana in Canada: Review of Potential Economic, Social, and Health Impacts.

PubMed

Hajizadeh, Mohammad

2016-05-25

Notwithstanding a century of prohibition, marijuana is the most widely used illicit substance in Canada. Due to the growing public acceptance of recreational marijuana use and ineffectiveness of the existing control system in Canada, the issue surrounding legalizing this illicit drug has received considerable public and political attentions in recent years. Consequently, the newly elected Liberal Government has formally announced that Canada will introduce legislation in the spring of 2017 to start legalizing and regulating marijuana. This editorial aims to provide a brief overview on potential economic, social, and public health impacts of legal marijuana in Canada. The legalization could increase tax revenue through the taxation levied on marijuana products and could also allow the Government to save citizens' tax dollars currently being spent on prohibition enforcement. Moreover, legalization could also remove the criminal element from marijuana market and reduce the size of Canada's black market and its consequences for the society. Nevertheless, it may also lead to some public health problems, including increasing in the uptake of the drug, accidents and injuries. The legalization should be accompanied with comprehensive strategies to keep the drug out of the hands of minors while increasing awareness and knowledge on harmful effects of the drug. In order to get better insights on how to develop an appropriate framework to legalize marijuana, Canada should closely watch the development in the neighboring country, the United States, where some of its states viz, Colorado, Oregon, Washington, and Alaska have already legalized recreational use of marijuana. © 2016 by Kerman University of Medical Sciences.

Special Forces Medical Sergeants' perceptions and beliefs regarding their current medical sustainment program: implications for the field.

PubMed

Wilson, Ramey L; DeZee, Kent J

2014-01-01

Special Forces Medical Sergeants (SFMS) are trained to provide trauma and medical care in support of military operations and diplomatic missions throughout the world with indirect physician oversight. This study assessed their perceptions of the current program designed to sustain their medical skills. An Internet-based survey was developed using the constructs of the Theory of Reasoned Action/Planned Behavior and validated through survey best practices. Of the 334 respondents, 92.8% had deployed at least once as an SFMS. Respondents reported spending 4 hours per week sustaining their medical skills and were highly confident that they could perform their duties on a no-notice deployment. On a 5-point, Likert-type response scale, SFMS felt that only slight change is needed to the Special Operations Medical Skills Sustainment Course (mean: 2.17; standard deviation [SD]: 1.05), while moderate change is needed to the Medical Proficiency Training (mean: 2.82; SD: 1.21) and nontrauma modules (mean: 3.02; SD: 1.22). Respondents desire a medical sustainment program that is provided by subject matter experts, involves actual patient care, incorporates new technology, uses hands-on simulation, and is always available. SFMS are challenged to sustain their medical skills in the current operational environment, and barriers to medical training should be minimized to facilitate sustainment training. Changes to the current medical sustainment program should incorporate operator-level perspectives to ensure acceptability and utility but must be balanced with organizational realities. Improving the medical sustainment program will prepare SFMS for the challenges of future missions. 2014.

Marijuana Legalization and Parents’ Attitudes, Use, and Parenting in Washington State

PubMed Central

Kosterman, Rick; Bailey, Jennifer A.; Guttmannova, Katarina; Jones, Tiffany M.; Eisenberg, Nicole; Hill, Karl G.; Hawkins, J. David

2016-01-01

Purpose The recent legalization of non-medical marijuana use in several US states has unknown implications for those who are actively parenting. This study examined parents’ reactions to marijuana legalization and changes in attitudes and behaviors over time. Methods Data were from a gender-balanced, ethnically diverse sample of 395 parents in Washington State who were participating in the longitudinal Seattle Social Development Project. Participants were interviewed 15 times between 1985 (age 10) and 2014 (age 39). Adult non-medical marijuana use was legalized in Washington in 2012 and retail outlets opened in 2014. Results Results showed (a) one third of parents incorrectly believed the legal age of non-medical marijuana use to be 18; (b) significant increase in approval of adult marijuana use and decrease in perceived harm of regular use; (c) wide opposition to teen use and use around one’s children; and (d) substantial increases in frequency of use and marijuana use disorder among parents who used. Conclusions Despite increased acceptance and frequency of adult use, parents remain widely opposed to teen use but need facts and strategies for talking with their children about marijuana. PMID:27523977

Increasing Access to Dental and Medical Care by Allowing Greater Flexibility in Scope of Practice

PubMed Central

Hoffmann, Diane; Rowthorn, Virginia

2015-01-01

In recent years, advocates for increasing access to medical and oral health care have argued for expanding the scope of practice of dentists and physicians. Although this idea may have merit, significant legal and other barriers stand in the way of allowing dentists to do more primary health care, physicians to do more oral health care, and both professions to collaborate. State practice acts, standards of care, and professional school curricula all support the historical separation between the 2 professions. Current laws do not contemplate working across professional boundaries, leaving providers who try vulnerable to legal penalties. Here we examine the legal, regulatory, and training barriers to dental and medical professionals performing services outside their traditional scope of practice. PMID:26180970

Legal and ethical issues in robotic surgery.

PubMed

Mavroforou, A; Michalodimitrakis, E; Hatzitheo-Filou, C; Giannoukas, A

2010-02-01

With the rapid introduction of revolutionary technologies in surgical practice, such as computer-enhanced robotic surgery, the complexity in various aspects, including medical, legal and ethical, will increase exponentially. Our aim was to highlight important legal and ethical implications emerged from the application of robotic surgery. Search of the pertinent medical and legal literature. Robotic surgery may open new avenues in the near future in surgical practice. However, in robotic surgery, special training and experience along with high quality assessment are required in order to provide normal conscientious care and state-of-the-art treatment. While the legal basis for professional liability remains exactly the same, litigation with the use of robotic surgery may be complex. In case of an undesirable outcome, in addition to physician and hospital, the manufacturer of the robotic system may be sued. In respect to ethical issues in robotic surgery, equipment safety and reliability, provision of adequate information, and maintenance of confidentiality are all of paramount importance. Also, the cost of robotic surgery and the lack of such systems in most of the public hospitals may restrict the majority from the benefits offered by the new technology. While surgical robotics will have a significant impact on surgical practice, it presents challenges so much in the realm of law and ethics as of medicine and health care.

International medical law and its impact on the ukrainian health care legislation.

PubMed

Pashkov, Vitalii; Udovyka, Larysa; Dichko, Hanna

2018-01-01

Introduction: The Ukrainian state has an urgent necessity of rapid search for essentially new legal and organizational forms of the healthcare system, reform of the legal regulation of healthcare services provision. In the context of European integration, the advancement of the medical industry reform is closely related to consideration of international standards and norms of health care. The aim: To study the impact of international medical law on the Ukrainian health care legislation. Materials and methods: International and Ukrainian regulations and documents on health care were used in the research. System and structural, functional and legal comparative methods as well as systematization, analysis and synthesis were determinative in the research process. Review: Systematization of international documents on health care was made. The major problems in the Ukrainian health care legislation were determined in terms of their conformity with the international legislative norms. The expediency of the Medical Code adoption was grounded and its structure was defined. Conclusions: Most health care international acts are ratified by Ukraine and their provisions are implemented in the legislation. Simultaneously, there is a row of problems, which hinder the Ukrainian health care development and place obstacles in the way of European integration. To remove these obstacles, it is expedient to create a codified act - the Medical Code, which would systematize the provisions of the current medical laws and regulations and fill in the existing gaps in the legal regulation of health care.

Current ethical and legal issues in health-related direct-to-consumer genetic testing.

PubMed

Niemiec, Emilia; Kalokairinou, Louiza; Howard, Heidi Carmen

2017-09-01

A variety of health-related genetic testing is currently advertized directly to consumers. This article provides a timely overview of direct-to-consumer genetic testing (DTC GT) and salient ethical issues, as well as an analysis of the impact of the recently adopted regulation on in vitro diagnostic medical devices on DTC GT. DTC GT companies currently employ new testing approaches, report on a wide spectrum of conditions and target new groups of consumers. Such activities raise ethical issues including the questionable analytic and clinical validity of tests, the adequacy of informed consent, potentially misleading advertizing, testing in children, research uses and commercialization of genomic data. The recently adopted regulation on in vitro diagnostic medical devices may limit the offers of predisposition DTC GT in the EU market.

Monitoring ethical, legal, and social issues in developing population genetic databases.

PubMed

Austin, Melissa A; Harding, Sarah E; McElroy, Courtney E

2003-01-01

To characterize ethical, legal, and social issues unique to population genetic database research and to determine the relevance of international recommendations and guidelines for addressing these issues in the development of "genebank" projects globally. Building on our previous description of eight international genebanks, we conducted a comprehensive electronic search and literature review of relevant publications and consulted national and international documents applicable to genebank research. We identified and characterized five categories of ethical, legal, and social issues unique to genebank development: sponsorship and benefit-sharing, neutrality and regulatory power of ethics committees, public engagement, consent, and data protection. We illustrate these issues with examples from specific genebanks. Not all of the issues are addressed in current international guidelines, many of which are nonspecific and unenforceable. The trend of genebank development promises to provide new discoveries to the field of medical science and to greatly improve public health. However, there is a growing need for more explicit, enforceable, and coordinated international guidelines relevant to the development and implementation of genebanks. By comparing ethical, legal and social issues as they arise in genebanks, researchers can better evaluate how to best use these projects to improve public health while protecting participating populations.

[The issues of legal support of municipal public health].

PubMed

2011-01-01

The issues of legal regulation of municipal health care system are discussed. It is demonstrated that the Federal legislation unjustifiably restricts the powers of municipal public health. This situation impacts the provision of accessible and qualified medical care to population and financing of municipal public health. The necessity of further development of legal regulation of health promotion on municipal level is postulated.

The impact of the legalization of recreational marijuana on college students.

PubMed

Jones, Jacob; Nicole Jones, K; Peil, Jenny

2018-02-01

In January of 2014 the Regulate Marijuana like Alcohol Act or, Amendment 64, went into effect in Colorado. Even though it was the first state to enact recreational legalization, attitudes towards marijuana use have been changing for decades. Prompted by medical marijuana legalization, studies have found mixed results in regards to the impact that legalization has on frequency of use and abuse. With college students having the highest rates of use in the United States (U.S.), whether legal or not, it was important to explore the impact that legalization has on this population. In the current study, rates of marijuana and alcohol use in college students before and after recreational legalization were explored. Data was collected in four waves from October 2013 to March 2015, to be able to determine the trends in marijuana and alcohol use, and relationship between the substances. In addition, grade point average was measured as a possible consequence of marijuana use. We found the frequency of marijuana use in Colorado college students is much higher than the national average t(94445)=24.424, p<0.001, especially the percentage of daily or almost daily users, t(2191)=10.373, p<0.001. There were significant differences between the marijuana non-users and the once a week or more often but not daily marijuana users in grade point average, F(6, 227)=2.935, p<0.001. In addition, it seems that the relationship between alcohol and marijuana use in general is decreasing since the passing of Amendment 64, but not among the binge drinkers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Medical negligence: Indian legal perspective.

PubMed

Agrawal, Amit

2016-10-01

A basic knowledge of how judicial forums deal with the cases relating to medical negligence is of absolute necessity for doctors. The need for such knowledge is more now than before in light of higher premium being placed by the Indian forums on the value of human life and suffering, and perhaps rightly so. Judicial forums, while seeking to identify delinquents and delinquency in the cases of medical negligence, actually aim at striking a careful balance between the autonomy of a doctor to make judgments and the rights of a patient to be dealt with fairly. In the process of adjudication, the judicial forums tend to give sufficient leeway to doctors and expressly recognize the complexity of the human body, inexactness of medical science, the inherent subjectivity of the process, genuine scope for error of judgment, and the importance of the autonomy of the doctors. The law does not prescribe the limits of high standards that can be adopted but only the minimum standard below which the patients cannot be dealt with. Judicial forums have also signaled an increased need of the doctors to engage with the patients during treatment, especially when the line of treatment is contested, has serious side effects and alternative treatments exist.

The standard of care and conflicts at the end of life in critical care: lessons from medical-legal crossroads and the role of a quasi-judicial tribunal in decision-making.

PubMed

Hawryluck, Laura; Sibbald, Robert; Chidwick, Paula

2013-12-01

The goals of this qualitative study were to review the last 7 years of end of life legal decisions within the critical care field to explore how medical benefit is defined and by whom and the role of the standard of care (SoC) in conflict resolution. A public online, non-profit database of the Federation of Law Societies of Canada was searched for relevant Consent and Capacity Board decisions from 2003 to 2012. In total, 1486 cases were collected, and purposive sampling identified a total of 29 decisions regarding use of life-sustaining treatments at end of life. Using modified grounded theory, decisions were read and analyzed from a central SoC concept to understand definitions of benefit, rationales for case adjudication, and repercussions of legal recourse in conflict resolution. Medical benefit was clearly defined, and its role in determining SoC, transparent. Perceptions of variability in SoC were enhanced by physicians in intractable conflicts seeking legal validation by framing SoC issues as "best interest" determinations. The results reveal some key problems in recourse to the Consent and Capacity Board for clinicians, patients and substitute decision makers in such conflict situations. This study can help improve decision-making by debunking myth of variability in determinations of medical benefit and the standards of care at end of life and reveal the pitfalls of legal recourse in resolving intractable conflicts. © 2013.

A review of legal framework applicable for the management of healthcare waste and current management practices in Ethiopia.

PubMed

Haylamicheal, Israel Deneke; Desalegne, Solomon Akalu

2012-06-01

The management of healthcare waste (HCW) requires special attention due to the risk posed by the presence of hazardous waste. The first step towards this is the issuance of national legislation complemented by policy documents, regulations and technical guidelines. In Ethiopia there is no specific legislation for healthcare waste management (HCWM). However, there are various legislations which may provide a legal framework for the management of HCW. This review assesses the various legislations that are relevant to HCWM. It also looks into the institutional arrangements put in place and waste management practices that prevail in the country. It was found that, although the existing legislations have provisions that may provide a legal framework for the management of HCW in Ethiopia, they are not comprehensive and lack specificity in terms of defining hazardous HCW and its categories; in indicating legal obligations of healthcare facilities (HCFs) in handling, transporting, treating and disposing HCW, and record keeping and reporting. There is overlapping of mandates and lackof co-ordination among various government institutions that are responsible for HCWM. The HCWM practices also do not conform to the principles of waste management in general and HCWM in particular. Thus, to better manage HCW in Ethiopia, a specific and comprehensive legislation and policy document on HCWM with clear designation of responsibilities to various stakeholders should be issued immediately. Moreover, training and awareness raising activities on proper HCWM should be undertaken targeting medical staffs, HCF administrators, waste handlers, policy and decision makers and the general public.

Medical marijuana laws and suicides by gender and age.

PubMed

Anderson, D Mark; Rees, Daniel I; Sabia, Joseph J

2014-12-01

We estimated the association between legalizing medical marijuana and suicides. We obtained state-level suicide data from the National Vital Statistics System's Mortality Detail Files for 1990-2007. We used regression analysis to examine the association between medical marijuana legalization and suicides per 100 000 population. After adjustment for economic conditions, state policies, and state-specific linear time trends, the association between legalizing medical marijuana and suicides was not statistically significant at the .05 level. However, legalization was associated with a 10.8% (95% confidence interval [CI] = -17.1%, -3.7%) and 9.4% (95% CI = -16.1%, -2.4%) reduction in the suicide rate of men aged 20 through 29 years and 30 through 39 years, respectively. Estimates for females were less precise and sensitive to model specification. Suicides among men aged 20 through 39 years fell after medical marijuana legalization compared with those in states that did not legalize. The negative relationship between legalization and suicides among young men is consistent with the hypothesis that marijuana can be used to cope with stressful life events. However, this relationship may be explained by alcohol consumption. The mechanism through which legalizing medical marijuana reduces suicides among young men remains a topic for future study.

Organ transplantation: legal, ethical and islamic perspective in Nigeria.

PubMed

Bakari, Abubakar A; Abbo Jimeta, Umar S; Abubakar, Mohammed A; Alhassan, Sani U; Nwankwo, Emeka A

2012-07-01

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in

Organ Transplantation: Legal, Ethical and Islamic Perspective in Nigeria

PubMed Central

Bakari, Abubakar A; Abbo Jimeta, Umar S; Abubakar, Mohammed A; Alhassan, Sani U; Nwankwo, Emeka A

2012-01-01

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in

Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users.

PubMed

Bonn-Miller, Marcel O; Boden, Matthew Tyler; Bucossi, Meggan M; Babson, Kimberly A

2014-01-01

Little research has investigated the demographic and symptom profile of medical cannabis users in states in the USA that have legalized cannabis use. In the present cross-sectional study, we investigated the demographic profile of 217 adults currently receiving medical cannabis, as well as differences in problematic use and perceived helpfulness in terms of (i) symptoms of psychological disorders and pain, and (ii) motives for use. Findings indicated that medical cannabis users (i) use and perceive cannabis to be beneficial for multiple conditions, some for which cannabis is not specifically prescribed or allowed at the state level; and (ii) report similar rates of disordered use as compared with population estimates among regular users. Furthermore, problematic cannabis use was predicted by several symptoms of psychological disorders (e.g. depression) and a variety of use motives (e.g. coping), while cannabis was reported as particularly helpful among those with several psychological symptoms (e.g. traumatic intrusions), as well as those reporting use for social anxiety reasons. Results are discussed in terms of future directions for research given the current debates regarding legalization of cannabis for medical purposes and, more generally, the lack of empirical data to inform such debates.

Legal briefing: conscience clauses and conscientious refusal.

PubMed

Pope, Thaddeus Mason

2010-01-01

This issue's "Legal Briefing" column covers legal developments pertaining to conscience clauses and conscientious refusal. Not only has this topic been the subject of recent articles in this journal, but it has also been the subject of numerous public and professional discussions. Over the past several months, conscientious refusal disputes have had an unusually high profile not only in courthouses, but also in legislative and regulatory halls across the United States. Healthcare providers' own moral beliefs have been obstructing and are expected to increasingly obstruct patients' access to medical services. For example, some providers, on ethical or moral grounds, have denied: (1) sterilization procedures to pregnant patients, (2) pain medications in end-of-life situations, and (3) information about emergency contraception to rape victims. On the other hand, many healthcare providers have been forced to provide medical treatment that is inconsistent with their moral beliefs. There are two fundamental types of conscientious objection laws. First, there are laws that permit healthcare workers to refuse providing - on ethical, moral, or religious grounds healthcare services that they might otherwise have a legal or employer-mandated obligation to provide. Second, there are laws directed at forcing healthcare workers to provide services to which they might have ethical, moral, or religious objections. Both types of laws are rarely comprehensive, but instead target: (1) certain types of healthcare providers, (2) specific categories of healthcare services, (3) specific patient circumstances, and (4) certain conditions under which a right or obligation is triggered. For the sake of clarity, I have grouped recent legal developments concerning conscientious refusal into eight categories: 1. Abortion: right to refuse 2. Abortion: duty to provide 3. Contraception: right to refuse 4. Contraception: duty to provide 5. Sterilization: right to refuse 6. Fertility, HIV, vaccines

Domestic violence survivors and their experiences during legal process.

PubMed

Özçakar, Nilgün; Yeşiltepe, Gözde; Karaman, Gökçe; Ergönen, Akça Toprak

2016-05-01

Many victims of domestic violence do not seek recourse to the needed medical and legal services. The aim of this study was to determine the difficulties faced by and experiences of female survivors of domestic violence during their medical and legal proceedings. We designed our study using a qualitative approach to understand the experiences of survivors during the legal process as well as their feelings and attitudes towards domestic violence through in-depth interviews. The data obtained from the participants were analyzed and synthesized using a thematic analysis procedure. Most of our participants reported different types of domestic violence, citing feelings of fear and loneliness during these experiences. They reported feeling dissatisfied with their complaints being ignored by the police and the perpetrators remaining unpunished. They complained of the complex procedures and negligence of staff in health-care centers such as hospitals, and they reported being shifted to several different places. We believe that an assessment of such female survivors in terms of specific standards set by specialists will help make improvements to the legal process. Education programs should be organized for professionals dealing with survivors of domestic violence. Special health-care services with fast proceedings must be established in health-care centers. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

[Giving medico-legal opinions in cases with suspicion of medical mistake.part 1. between medicine and justice.

PubMed

Chowaniec, Czesław; Chowaniec, Małgorzata; Wilk, Mateusz

2017-01-01

Creating medico-legal opinion is a sophisticated investigative, analytical, decision-making and creative process. Forensic medicine specialist in cooperation with clinical medicine consultants, on the basis of evidence analysis, which was gathered during procedures and contained in the acts has to create an objective and essential opinion. This opinion is a vital, very important and irreplaceable proof in every case. Judicial body consults with forensic medicine specialist or specialists if there are circumstances for settlement of which there is a need of classified informations - art. 193 of Penalty Code. Forensic medicine specialists face many difficulties which may have effect on quality, positiveness of opinion, compliance with the deadline, increasing expectancy of judicial body or sides. It is very difficult to find clinical specialists which except their clinical knowledge have basic knowledge about law, the role and duties of an court expert. In this article we discuss creating-opinion problems, role and position of court expert in confrontation with expectations of judicial body and the Justice with particular emphasis on medical mistakes and assessment of medical proceedings. We show the complexity of creating of medical opinions, especially these institutional.

Bilingual Encounters: Spanish-English Medical and Legal Dialogues. A Practical Resource for Educators and Students of Interpreting. Interpreting and Translation Publications Series, No. 1.

ERIC Educational Resources Information Center

Hale, Sandra

Thirty-eight dialogues are presented, each illustrating a common, real-life interpreting situation involving medical and/or legal issues and terminology. Each involves both Spanish and English languages, and the situations are specific to New South Wales, Australia. They are designed to be used as a resource in teaching interpreting. The…

[Teenage pregnancies, legal aspects].

PubMed

Rogue, Fanny

2016-01-01

Minor girls are legally considered as incapable, under the authority of their parents. Difficulties can arise when a minor becomes pregnant. The law takes account of this situation: under certain conditions, she can decide by herself to undertake certain actions, medical or otherwise, without the consent of her parents. These include access to contraception, abortion or anonymous birth. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Exploring Legal Restrictions, Regulatory Reform, and Geographic Disparities in Abortion Access in Thailand.

PubMed

Arnott, Grady; Sheehy, Grace; Chinthakanan, Orawee; Foster, Angel M

2017-06-01

Despite decades of advocacy among Thai governmental and nongovernmental actors to remove abortion from the country's 1957 Criminal Code, this medically necessary service remains significantly legally restricted. In 2005, in the most recent regulatory reform to date, the Thai Medical Council established regulatory measures to allow a degree of physician interpretation within the confines of the existing law. Drawing on findings from a review of institutional policies and legislative materials, key informant interviews, and informal discussions with health service providers, government representatives, and nonprofit stakeholders, this article explores how legal reforms and health policies have shaped the abortion landscape in Thailand and influenced geographic disparities in availability and accessibility. Notwithstanding a strong medical community and the recent introduction of mifepristone for medication abortion (also known as medical abortion), the narrow interpretation of the regulatory criteria by physicians further entrenches these disparities. This article examines the causes of subnational disparities, focusing on the northern provinces and the western periphery of Thailand, and explores strategies to improve access to abortion in this legally restricted setting.

Exploring Legal Restrictions, Regulatory Reform, and Geographic Disparities in Abortion Access in Thailand

PubMed Central

Arnott, Grady; Sheehy, Grace; Chinthakanan, Orawee; Foster, Angel M.

2017-01-01

Abstract Despite decades of advocacy among Thai governmental and nongovernmental actors to remove abortion from the country’s 1957 Criminal Code, this medically necessary service remains significantly legally restricted. In 2005, in the most recent regulatory reform to date, the Thai Medical Council established regulatory measures to allow a degree of physician interpretation within the confines of the existing law. Drawing on findings from a review of institutional policies and legislative materials, key informant interviews, and informal discussions with health service providers, government representatives, and nonprofit stakeholders, this article explores how legal reforms and health policies have shaped the abortion landscape in Thailand and influenced geographic disparities in availability and accessibility. Notwithstanding a strong medical community and the recent introduction of mifepristone for medication abortion (also known as medical abortion), the narrow interpretation of the regulatory criteria by physicians further entrenches these disparities. This article examines the causes of subnational disparities, focusing on the northern provinces and the western periphery of Thailand, and explores strategies to improve access to abortion in this legally restricted setting. PMID:28630551

Current Trends in Electronic Medication Reminders for Self Care.

PubMed

Fang, Kerry Y; Maeder, Anthony J; Bjering, Heidi

2016-01-01

Poor adherence to medication can lead to negative health outcomes and increased financial burdens. We present a literature review on electronic medication reminders used for medication adherence in self care settings, to identify current and possible future trends. A structured PubMed search based on extracted MeSH terms provided a total of 45 publications which were identified as most relevant. Three main categories of electronic solutions were identified: mobile phone reminders, in-home electronic reminder devices, and portable reminder devices.

[Euthanasia: medications and medical procedures].

PubMed

Lossignol, D

2008-09-01

The Belgian law relative to euthanasia has been published in 2002. A physician is allowed to help a patient with intractable suffering (physical or psychological). Legal conditions are clear. However, nothing is said about medical procedures or medications to be used. The present paper will present specific clinical situations at the end of life, practical procedures and medications. A special focus is made on psychological impact of euthanasia.

The Legal Doctrine on the Liability of Physicians in Medical Malpractice Lawsuits Involving Complex Regional Pain Syndrome.

PubMed

Shin, SuHwan; Jang, Seung Gyeong; Min, KyeongTae; Lee, Won; Kim, So Yoon

2018-02-26

Complex regional pain syndrome (CRPS) involves severe pain and it is difficult to identify the exact cause or pathogenesis. Therefore, there are controversies regarding legal issues related to the establishment of damage in medical malpractice lawsuits involving CRPS. This study aimed to analyze malpractice lawsuits involving CRPS, which occurred after the disputed medical treatment, to provide information on the courts' opinion and characteristics of the cases. This study analyzed 23 lawsuit judgments involving CRPS that were sentenced from 2005 to 2015. A total of 12 of the 23 cases were partially ruled in favor of the plaintiff. The average amount (KRW) claimed was 470,638,385 ± 860,634,092 (21,000,000 to 4,020,000,000), and that awarded was 72,906,843 ± 53,389,367 (15,000,000 to 181,080,803). Sixteen of the 23 cases had CRPS type I. In 11 of 23 cases, the site of the pain was located in the lower limb and in 14 cases there was no presence of trauma or event prior to medical treatment. Nerve injury was the most frequent reason for taking responsibility in compensating damage in malpractice cases involving CRPS. Physicians should consider various possibilities of such complications in medical practices. It is important to identify and improve areas which need to be improved for patient safety through analyzing the lawsuit judgment cases. © 2018 The Korean Academy of Medical Sciences.

Non-normative bodies, rationality, and legal personhood.

PubMed

Travis, Mitchell

2014-01-01

This article questions how legal personhood is constructed by law. Elective amputation is used as a way of interrogating the institutional, material, and discursive relations that combine in order to suspend legal personhood. Elective amputation is introduced in terms of medical and psychological explanations. Additionally, the perspective of self-identified elective amputees who choose to share their stories through online blogs is utilised to gain a narrative sense of how these individuals understand and engage with law. In particular, the areas of disability, sexuality, and rationality are used to exemplify law's continuing commitment to normative embodiment as grounds for ascribing legal personhood. © The Author [2014]. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

Legal, cultural and ethical considerations on the informing of the cancer patient: a perspective from Greece.

PubMed

Kousathana, L; Kousathana, F; Karamanou, M; Kousoulis, A A

2013-01-01

To discuss the current official legal position of the Greek Council and the official international statement on the subject, as well as the emerging cultural and moral aspects on the issue of informing the cancer patient. Perusal of national and international legal and ethics sources, under a multidisciplinary perspective. According to the Council of State of Greece the violation of informing the patient by the physician constitutes urban liability and disciplinary offence. The Greek Code of Medical Ethics declares that the physician is obliged to inform his patient about his health and respect the desire of the patient who decides not to be informed. The UNESCO declaration does not seem to clarify the subject. In Greece, physicians have the tendency to tell the truth more often today than in the past, reflecting the global tendency, although the majority still discloses the truth to the next of kin. The difference in the tactics of informing in several nations reflects huge cultural, social, economic and religious differences in each society. Well informed and knowledgeable health-care and legal professionals, alongside with patients and ethical directors, should sit at the same table in order to productively discuss the most sensitive matters of the contemporary medical practice.

Assisted reproduction involving gestational surrogacy: an analysis of the medical, psychosocial and legal issues: experience from a large surrogacy program.

PubMed

Dar, Shir; Lazer, Tal; Swanson, Sonja; Silverman, Jan; Wasser, Cindy; Moskovtsev, Sergey I; Sojecki, Agata; Librach, Clifford L

2015-02-01

What are the medical, psychosocial and legal aspects of gestational surrogacy (GS), including pregnancy outcomes and complications, in a large series? Meticulous multidisciplinary teamwork, involving medical, legal and psychosocial input for both the intended parent(s) (IP) and the gestational carrier (GC), is critical to achieve a successful GS program. Small case series have described pregnancy rates of 17-50% for GS. There are no large case series and the medical, legal and psychological aspects of GS have not been addressed in most of these studies. To our knowledge, this is the largest reported GS case series. A retrospective cohort study was performed. Data were collected from 333 consecutive GC cycles between 1998 and 2012. There were 178 pregnancies achieved out of 333 stimulation cycles, including fresh and frozen transfers. The indications for a GC were divided into two groups. Those who have 'failed to carry', included women with recurrent implantation failure (RIF), recurrent pregnancy loss (RPL) and previous poor pregnancy outcome (n = 96; 132 cycles, pregnancy rate 50.0%). The second group consisted of those who 'cannot carry' including those with severe Asherman's syndrome, uterine malformations/uterine agenesis and maternal medical diseases (n = 108, 139 cycles, pregnancy rate 54.0%). A third group, of same-sex male couples and single men, were analyzed separately (n = 52, 62 cycles, pregnancy rate 59.7%). In 49.2% of cycles, autologous oocytes were used and 50.8% of cycles involved donor oocytes. The 'failed to carry' group consisted of 96 patients who underwent 132 cycles at a mean age of 40.3 years. There were 66 pregnancies (50.0%) with 17 miscarriages (25.8%) and 46 confirmed births (34.8%). The 'cannot carry pregnancy' group consisted of 108 patients who underwent 139 cycles at a mean age of 35.9 years. There were 75 pregnancies (54.0%) with 15 miscarriages (20.0%) and 56 confirmed births (40.3%). The pregnancy, miscarriage and live birth

Early Impacts of Marijuana Legalization: An Evaluation of Prices in Colorado and Washington

PubMed Central

Hunt, Priscillia; Pacula, Rosalie Liccardo

2017-01-01

Following the legalization and regulation of marijuana for recreational purposes in states with medical markets, policymakers and researchers are in need of empirical evidence related to how, and how fast, supply and demand have changed over time. Because prices constitute an indication of how suppliers and consumers respond to policy changes, we used a difference-indifference approach to capitalize on the timing of policy implementation and to identify the effects of legalization on marijuana prices four to five months after markets opened. We used a unique longitudinal survey of self-reported prices and a web-scraped dataset of dispensary prices advertised online in three U.S. states that had legalized medical marijuana, and which later legalized recreational marijuana as well. Results indicate there were no effects on the prices paid for medical or recreational marijuana among state-representative samples of residents within the short four- to five-month window following legalization. However, there were differences in how much people paid if they obtained marijuana for recreational purposes from a recreational store. Further analyses of advertised prices confirmed this result, but also demonstrated heterogeneous responses in prices across types of commonly advertised strains; prices either did not change or they increased depending on the strain type. A key implication of our findings is that there are both supply and demand responses at work in the opening of legalized markets, suggesting that evaluations of immediate effects may not accurately reflect the long run impact of legalization on marijuana consumption. PMID:28456861

Safeguarding patient privacy in electronic healthcare in the USA: the legal view.

PubMed

Walsh, Diana; Passerini, Katia; Varshney, Upkar; Fjermestad, Jerry

2008-01-01

The conflict between the sweeping power of technology to access and assemble personal information and the ongoing concern about our privacy and security is ever increasing. While we gradually need higher electronic access to medical information, issues relating to patient privacy and reducing vulnerability to security breaches surmount. In this paper, we take a legal perspective and examine the existing patchwork of laws and obligations governing health information in the USA. The study finds that as Electronic Medical Records (EMRs) increase in scope and dissemination, privacy protections gradually decrease due to the shortcomings in the legal system. The contributions of this paper are (1) an overview of the legal EMR issues in the USA, and (2) the identification of the unresolved legal issues and how these will escalate when health information is transmitted over wireless networks. More specifically, the paper discusses federal and state government regulations such as the Electronic Communications Privacy Act, the Health Insurance Portability and Accountability Act (HIPAA) and judicial intervention. Based on the legal overview, the unresolved challenges are identified and suggestions for future research are included.

[Acute scrotal pain in childhood: legal pitfalls].

PubMed

Bader, Pia; Hugemann, Christoph; Frohneberg, Detlef

2017-12-01

Acute scrotal pain in childhood is an emergency.Sudden scrotal pain may be caused by a variety of diseases. Therefore, it is important to carefully consider the specific medical history and possible differential diagnoses in each case for fast and decisive action (e. g. in case of testicular torsion). As minors lack the capacity for consent, it is absolutely necessary to obtain consent from their legal guardian. However, obtaining consent in the available time frame can cause organisational challenges in an acute emergency, which may lead to situations in the daily routine where a therapeutic decision needs to be taken (including surgery) without legal security based on consent by the guardian. In some cases, the child's consent also needs to be taken into account, depending on its age and development.For the physician and surgeon in charge, the legal evaluation of the case at hand and therewith the obtainment of legal security are of great significance. © Georg Thieme Verlag KG Stuttgart · New York.

Ethical and legal perspectives on the medical practitioners use of social media.

PubMed

Kubheka, Brenda

2017-04-25

Use of social media has increased exponentially throughout the world. Social media provides a platform for building social and professional relationships that can be used by all, including healthcare professionals. Alongside the benefits of creating networks and spreading information wider and faster than is possible with traditional communication channels, however, it presents ethical and legal challenges. For health professionals, it poses a threat to confidentiality and privacy owed to patients, colleagues and employers. It is vital for health professionals to acknowledge that the same ethical and legal standards apply both online and offline, and that they are accountable to professional bodies and the law for their online activities. This article seeks to explore the ethical and legal pitfalls facing health professionals using social media platforms. Importantly, it seeks to create awareness about the cyberpsychology phenomenon called the 'online disinhibition effect', responsible for lowering restraint during online activities.

Attitudes to legalizing cannabis use.

PubMed

Williams, Jenny; van Ours, Jan C; Grossman, Michael

2016-09-01

In this paper, we investigate the relationship between cannabis use and attitudes to legalizing the use of cannabis. Predictions from theory provide a means of learning about the roles of information, self interest and regret in explaining differences in attitudes to legalization between those who currently use, those who have used in the past and those who have never used. Our empirical investigation suggests that users have a greater awareness of cannabis not being as harmful as abstainers think it is. This may explain why individuals are more inclined to be in favor of legalizing cannabis once they have used it themselves. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Sex differences in medico-legal action against doctors: a systematic review and meta-analysis.

PubMed

Unwin, Emily; Woolf, Katherine; Wadlow, Clare; Potts, Henry W W; Dacre, Jane

2015-08-13

The relationship between male sex and poor performance in doctors remains unclear, with high profile studies showing conflicting results. Nevertheless, it is an important first step towards understanding the causes of poor performance in doctors. This article aims to establish the robustness of the association between male sex and poor performance in doctors, internationally and over time. The electronic databases MEDLINE, EMBASE, and PsycINFO were searched from inception to January 2015. Backward and forward citation searching was performed. Journals that yielded the majority of the eligible articles and journals in the medical education field were electronically searched, along with the conference and poster abstracts from two of the largest international medical education conferences. Studies reporting original data, written in English or French, examining the association between sex and medico-legal action against doctors were included. Two reviewers independently extracted study characteristics and outcome data from the full texts of the studies meeting the eligibility criteria. Study quality was assessed using the Newcastle-Ottawa scale. A random effect meta-analysis model was used to summarize and assess the effect of doctors' sex on medico-legal action. Extracted outcomes included disciplinary action by a medical regulatory board, malpractice experience, referral to a medical regulatory body, complaints received by a healthcare complaints body, criminal cases, and medico-legal matter with a medical defence organisation. Overall, 32 reports examining the association between doctors' sex and medico-legal action were included in the systematic review (n=4,054,551), of which 27 found that male doctors were more likely to have experienced medico-legal action. 19 reports were included in the meta-analysis (n=3,794,486, including 20,666 cases). Results showed male doctors had nearly two and a half times the odds of being subject to medico-legal action than female

Legal Briefing: Medicare Coverage of Advance Care Planning.

PubMed

Pope, Thaddeus Mason

2015-01-01

This issue's "Legal Briefing" column covers the recent decision by the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of advance care planning, beginning 1 January 2016. Since 2009, most "Legal Briefings" in this journal have covered a wide gamut of judicial, legislative, and regulatory developments concerning a particular topic in clinical ethics. In contrast, this "Legal Briefing" is more narrowly focused on one single legal development. This concentration on Medicare coverage of advance care planning seems warranted. Advance care planning is a frequent subject of articles in JCE. After all, it has long been seen as an important, albeit only partial, solution to a significant range of big problems in clinical ethics. These problems range from medical futility disputes to decision making for incapacitated patients who have no available legally authorized surrogate. Consequently, expanded Medicare coverage of advance care planning is a potentially seismic development. It may materially reduce both the frequency and severity of key problems in clinical ethics. Since the sociological, medical, and ethical literature on advance care planning is voluminous, I will not even summarize it here. Instead, I focus on Medicare coverage. I proceed, chronologically, in six stages: 1. Prior Medicare Coverage of Advance Care Planning 2. Proposed Expanded Medicare Coverage in 2015 3. Proposed Expanded Medicare Coverage in 2016 4. The Final Rule Expanding Medicare Coverage in 2016 5. Remaining Issues for CMS to Address in 2017 6. Pending Federal Legislation. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Breakdowns in communication of radiological findings: an ethical and medico-legal conundrum

PubMed Central

Murphy, Daniel R.; Singh, Hardeep

2016-01-01

Communication problems in diagnostic testing have increased in both number and importance in recent years. The medical and legal impact of failure of communication is dramatic. Over the past decades, the courts have expanded and strengthened the duty imposed on radiologists to timely communicate radiologic abnormalities to referring physicians and perhaps the patients themselves in certain situations. The need to communicate these findings goes beyond strict legal requirements: there is a moral imperative as well. The Code of Medical Ethics of the American Medical Association points out that “Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties.” Thus, from the perspective of the law, radiologists are required to communicate important unexpected findings to referring physicians in a timely fashion, or alternatively to the patients themselves. From a moral perspective, radiologists should want to effect such communications. Practice standards, moral values, and ethical statements from professional medical societies call for full disclosure of medical errors to patients affected by them. Surveys of radiologists and non-radiologic physicians reveal that only few would divulge all aspects of the error to the patient. In order to encourage physicians to disclose errors to patients and assist in protecting them in some manner if malpractice litigation follows, more than 35 states have passed laws that do not allow a physician’s admission of an error and apologetic statements to be revealed in the courtroom. Whether such disclosure increases or decreases the likelihood of a medical malpractice lawsuit is unclear, but ethical and moral considerations enjoin physicians to disclose errors and offer apologies. PMID:27006891

20 CFR 725.512 - Support of legally dependent spouse, child, or parent.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Provisions § 725.512 Support of legally dependent spouse, child, or parent. If current maintenance needs of a... the legally dependent spouse, a legally dependent child, or a legally dependent parent of the... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Support of legally dependent spouse, child...

20 CFR 725.512 - Support of legally dependent spouse, child, or parent.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Provisions § 725.512 Support of legally dependent spouse, child, or parent. If current maintenance needs of a... the legally dependent spouse, a legally dependent child, or a legally dependent parent of the... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Support of legally dependent spouse, child...

20 CFR 725.512 - Support of legally dependent spouse, child, or parent.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Provisions § 725.512 Support of legally dependent spouse, child, or parent. If current maintenance needs of a... the legally dependent spouse, a legally dependent child, or a legally dependent parent of the... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Support of legally dependent spouse, child...

20 CFR 725.512 - Support of legally dependent spouse, child, or parent.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Provisions § 725.512 Support of legally dependent spouse, child, or parent. If current maintenance needs of a... the legally dependent spouse, a legally dependent child, or a legally dependent parent of the... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Support of legally dependent spouse, child...

State medical marijuana laws: understanding the laws and their limitations.

PubMed

Pacula, Rosalie Liccardo; Chriqui, Jamie F; Reichmann, Deborah A; Terry-McElrath, Yvonne M

2002-01-01

Significant attention has been given to the debate regarding allowances for medical marijuana use since the 1996 California and Arizona ballot initiatives. State medical marijuana allowances, however, have existed since the mid-1970s. Much of the current debate stems from confusion about the various ways states approach the issue. In this paper, we present original legal research on current state medical marijuana laws identifying four different ways states statutorily enable the medical use of marijuana. We discuss the tension these approaches have with federal law as well as their implications regarding real access for patients. In addition, we present information on how a small number of states are trying to deal with the issue of access within the context of their medical marijuana laws, and discuss the implication of various supply approaches on the enforcement of other state marijuana laws.

Informed consent: clinical and legal issues in family practice.

PubMed

Searight, H R; Barbarash, R A

1994-04-01

While patient informed consent is an important clinical and legal dimension of specialty medical care, many important issues arise in primary care. Family physicians are in a unique position to implement informed consent discussions in the ethical spirit in which the doctrine was intended. Because of their long-term relationships with patients and sensitivity to psychosocial issues, family physicians can engage patients in collaborative health care decision making. Primary care physicians are optimally suited to assess patients' understanding of medical information and their competence. Instead of viewing the informed consent process simply as a necessary legal requirement, it should be a method for educating patients and allowing them to participate in their health care decision making.

Current and future medical treatments for patients with acromegaly.

PubMed

Maffezzoni, Filippo; Formenti, Anna Maria; Mazziotti, Gherardo; Frara, Stefano; Giustina, Andrea

2016-08-01

Acromegaly is a relatively rare condition of growth hormone (GH) excess associated with significant morbidity and, when left untreated, high mortality. Therapy for acromegaly is targeted at decreasing GH and insulin-like growth hormone 1 levels, ameliorating patients' symptoms and decreasing any local compressive effects of the pituitary adenoma. The therapeutic options for acromegaly include surgery, medical therapies (such as dopamine agonists, somatostatin receptor ligands and the GH receptor antagonist pegvisomant) and radiotherapy. However, despite all these treatments option, approximately 50% of patients are not adequately controlled. In this paper, the authors discuss: 1) efficacy and safety of current medical therapy 2) the efficacy and safety of the new multireceptor-targeted somatostatin ligand pasireotide 3) medical treatments currently under clinical investigation (oral octreotide, ITF2984, ATL1103), and 4) preliminary data on the use of new injectable and transdermal/transmucosal formulations of octreotide. This expert opinion supports the need for new therapeutic agents and modalities for patients with acromegaly.

Breaching confidentiality: medical mandatory reporting laws in Iran

PubMed Central

Milanifar, Alireza; Larijani, Bagher; Paykarzadeh, Parvaneh; Ashtari, Golanna; Mehdi Akhondi, Mohammad

2014-01-01

Medical ethics is a realm where four important subjects of philosophy, medicine, theology and law are covered. Physicians and philosophers cooperation in this area will have great efficiency in the respective ethical rules formation. In addition to respect the autonomy of the patient, physician’s obligation is to ensure that the medical intervention has benefit for the patient and the harm is minimal. There is an obvious conflict between duty of confidentiality and duty of mandatory reporting. Professional confidentiality is one of the basic components in building a constant physician-patient relationship which nowadays, beside the novelty, it is the subject of discussion. Legal obligation of confidentiality is not absolute. In physician-patient relationship, keeping patient’s secrets and maintaining confidentiality is a legal and ethical duty, and disclosure of such secrets is mainly through specific statutes. Thus, there are a number of situations where breach of confidentiality is permitted in different legal systems. One of the situations where breaching confidentiality is permitted is the medical mandatory reporting to the relevant authority which is in accordance with many countries’ legal systems. Some situations are considered in many countries legal systems’ such as notification of births and deaths, infectious diseases, child abuse, sport and relevant events, medical errors, drug side effects and dangerous pregnancies. In this paper, we will examine and discuss medical mandatory reporting and its ethical and legal aspects in the judicial and legal system of Iran and few other countries. Finally we will suggest making Medical Mandatory Reporting Law in Iran. PMID:25512832

Breaching confidentiality: medical mandatory reporting laws in Iran.

PubMed

Milanifar, Alireza; Larijani, Bagher; Paykarzadeh, Parvaneh; Ashtari, Golanna; Mehdi Akhondi, Mohammad

2014-01-01

Medical ethics is a realm where four important subjects of philosophy, medicine, theology and law are covered. Physicians and philosophers cooperation in this area will have great efficiency in the respective ethical rules formation. In addition to respect the autonomy of the patient, physician's obligation is to ensure that the medical intervention has benefit for the patient and the harm is minimal. There is an obvious conflict between duty of confidentiality and duty of mandatory reporting. Professional confidentiality is one of the basic components in building a constant physician-patient relationship which nowadays, beside the novelty, it is the subject of discussion. Legal obligation of confidentiality is not absolute. In physician-patient relationship, keeping patient's secrets and maintaining confidentiality is a legal and ethical duty, and disclosure of such secrets is mainly through specific statutes. Thus, there are a number of situations where breach of confidentiality is permitted in different legal systems. One of the situations where breaching confidentiality is permitted is the medical mandatory reporting to the relevant authority which is in accordance with many countries' legal systems. Some situations are considered in many countries legal systems' such as notification of births and deaths, infectious diseases, child abuse, sport and relevant events, medical errors, drug side effects and dangerous pregnancies. In this paper, we will examine and discuss medical mandatory reporting and its ethical and legal aspects in the judicial and legal system of Iran and few other countries. Finally we will suggest making Medical Mandatory Reporting Law in Iran.

[Legal decisions on access to medicines in Pernambuco, Northeastern Brazil].

PubMed

Stamford, Artur; Cavalcanti, Maísa

2012-10-01

To analyze decisions from the legal system concerning the population's access to medicines within the Brazilian Public Health System through judicial channels, with regard to decision-making criteria and possible political and economic pressure. This was a descriptive retrospective study on documents with a quantitative and qualitative approach. Data were gathered from the State of Pernambuco Superintendency for Pharmaceutical Care, and the data sources used were 105 lawsuits and administrative reports between January and June 2009. It was ascertained which medications have a patent or patent request in the database of the Brazilian Patent Office (INPI), in order to identify the frequency with which patents feature in lawsuits. The data obtained were classified according to Anatomical and Therapeutic Chemical System. To analyze the judicial decisions, the theory of autopoietic social systems was used. There were lawsuits involving 134 medications, with an estimated value of R$ 4.5 million for attending the treatments requested. 70.9% of the medications had a patent or a patent request and they were concentrated in three therapeutic classes: antineoplastic and immunomodulating agents; digestive tract and metabolism; and sensory organs. Six central ideas within judges' decision-making criteria were identified (the federal constitution and medical prescriptions), along with pressure between the legal, economic and political systems concerning access to medications. The analysis on judicial decisions based on the theory of autopoietic social systems made it possible to identify mutual stimulation (dependency) between the legal system and other social systems in relation to the issue of citizens' access to medications. This dependency was represented by the federal constitution and intellectual property. The federal constitution and medical prescription were identified as decision-making criteria in lawsuits. Intellectual property represented possible political and

Perspectives on medicine adherence in service users and carers with experience of legally sanctioned detention and medication: a qualitative study.

PubMed

Gault, Iris; Gallagher, Ann; Chambers, Mary

2013-01-01

To explore and analyze perceptions of service users and caregivers on adherence and nonadherence to medication in a mental health care context. Mental health medication adherence is considered problematic and legal coercion exists in many countries. This was a qualitative study aiming to explore perceptions of medication adherence from the perspective of the service user (and their caregiver, where possible). Eighteen mental health service users (and six caregivers) with histories of medication nonadherence and repeated compulsory admission were recruited from voluntary sector support groups in England. Data were collected between 2008 and 2010. Using qualitative coding techniques, the study analyzed interview and focus group data from service users, previously subjected to compulsory medication under mental health law, or their caregivers. The process of medication adherence or nonadherence is encapsulated in an explanatory narrative. This narrative constitutes participants' struggle to negotiate acceptable and effective routes through variable quality of care. Results indicated that service users and caregivers eventually accepted the reality of their own mental illness and their need for safety and treatment. They perceived the behavior of professionals as key in their recovery process. Professionals could be enabling or disabling with regard to adherence to medication. This study investigated service user and caregiver perceptions of medication adherence and compulsory treatment. Participants described a process perceived as variable and potentially doubly faceted. The behavior of professionals was seen as crucial in collaborative decision making on medication adherence.

Experiencing abortion rights in India through issues of autonomy and legality: A few controversies.

PubMed

Patel, Tulsi

2018-06-01

Abortion laws in India, like other laws, are premised on the 1861 British Penal Code. The Medical Termination of Pregnancy Act was passed in 1971 to circumvent the criminality clause around abortion. Yet the law continues to render invisible women's right to choose. Legal procedures have often hindered in permitting abortion, resulting in the death of a mother or the foetus. Despite the latest techno-medical advances, the laws have remained stagnant or rather restrictive, complicated further by selective female foetus abortions. Legal resistance to abortion-seeking after 20 weeks gestation adversely affects women, depriving them of autonomy of choice. In this paper, raising important gender, health and ethical issues are illustrated through a recent legal case in India. Feminist campaigns against the legal mindset in India are emerging.

Nursing Homes as Teaching Institutions: Legal Issues.

ERIC Educational Resources Information Center

Kapp, Marshall B.

1984-01-01

Discusses the trend toward affiliation of nursing homes with educational programs as clinical teaching institutions for medical, nursing, and allied health students. Reviews potential ethical and legal issues for the nursing home administrator, professional staff member, educator, and student, including informed consent, supervisory…

[Withdrawal of artificial nutrition and hydration in severe stroke: medical, legal and ethical considerations].

PubMed

Tannier, C; Crozier, S; Zuber, M; Constantinides, Y; Delezie, E; Gisquet, E; Grignoli, N; Lamy, C; Louvet, F; Pinel, J-F

2015-02-01

In the majority of cases, severe stroke is accompanied by difficulty in swallowing and an altered state of consciousness requiring artificial nutrition and hydration. Because of their artificial nature, nutrition and hydration are considered by law as treatment rather basic care. Withdrawal of these treatments is dictated by the refusal of unreasonable obstinacy enshrined in law and is justified by the risk of severe disability and very poor quality of life. It is usually the last among other withholding and withdrawal decisions which have already been made during the long course of the disease. Reaching a collegial consensus on a controversial decision such as artificial nutrition and hydration withdrawal is a difficult and complex process. The reluctance for such decisions is mainly due to the symbolic value of food and hydration, to the fear of "dying badly" while suffering from hunger and thirst, and to the difficult distinction between this medical act and euthanasia. The only way to overcome such reluctance is to ensure flawless accompaniment, associating sedation and appropriate comfort care with a clear explanation (with relatives but also caregivers) of the rationale and implications of this type of decision. All teams dealing with this type of situation must have thoroughly thought through the medical, legal and ethical considerations involved in making this difficult decision. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

20 CFR 725.512 - Support of legally dependent spouse, child, or parent.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., or parent. 725.512 Section 725.512 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION... Provisions § 725.512 Support of legally dependent spouse, child, or parent. If current maintenance needs of a... the legally dependent spouse, a legally dependent child, or a legally dependent parent of the...

[Tyramine and serotonin syndromes. Pharmacological, medical and legal remarks].

PubMed

Toro-Martínez, Esteban

2005-01-01

The tyramine syndrome and the serotonin syndrome are a complex of signs and symptoms that are thought to be largely attributable to drug - drug interactions or drug - food interactions that enhances norepinephrine o serotonin activity. This article reviews: pharmacological basis of those syndromes; clinical features; forbidden foods, drug-drug interactions, and treatment options. Finally a set of legal recommendations are proposed to avoid liability litigations.

You're it! How to psychologically survive an internal investigation, disciplinary proceeding, or legal action in the police, fire, medical, mental health, legal, or emergency services professions.

PubMed

Miller, Laurence

2009-01-01

Rightly or wrongly, law enforcement, public safety, medical, mental health, legal, and emergency services professionals may have to face internal investigation, disciplinary measures, license suspension, criminal prosecution, civil lawsuits, and/or personal life disruption related to actions taken in the course of their work. This article describes the main categories of misconduct--or simply mistakes--that can cause different types of professionals to be investigated, charged, prosecuted, and/or sued. It next discusses the kinds of psychological reactions commonly seen in workers who face these kinds of proceedings. Finally, the article offers a set of practical psychological coping strategies and procedural recommendations for dealing with the stresses of an investigation, administrative action, or litigation, and for mitigating their effects on one's life and career.

Marijuana-Perinatal and Legal Issues With Use During Pregnancy.

PubMed

Krening, Cynthia; Hanson, Keri

Although still illegal at the federal level, marijuana has been legalized for medical and/or recreational use in 29 states, causing a dynamically changing legal and social landscape. While the legalization of marijuana at the state level provides criminal protection for use by adults, there remain civil legal implications for families brought about by mandated reporting laws. Mandated reporting requirements have not been updated to account for the movement toward legalization, risking overload of community child protection resources. There is little evidence to inform development of guidelines and protocols for screening, educating, testing of mothers and newborns, and reporting. There are perinatal issues in this evolving environment as well. Discriminatory testing, length of time the drug remains in the system, potential for compromised provider-patient relationships, inconsistent education and referrals, breastfeeding during marijuana use, punitive or legal interventions that may have a negative psychosocial impact on a new family, and the risk for development of community standards of care based on opinion rather than science are just a few of the issues realized after marijuana legalization. These legal and perinatal issues are discussed in detail, along with considerations for practice and policy in caring for cannabis-exposed pregnant women and newborns.

Negligence and the legal standard of care: what is 'reasonable' conduct?

PubMed

Miola, José

Medical negligence has become a big issue for medical practitioners. Fear of the law, and of litigation, has led to claims of defensive medical practice among doctors and nurses. At the heart of this lies the legal definition of the standard of care, where the law seeks to determine when conduct is 'reasonable' (and thus not negligent), or 'unreasonable' (and thus a breach of the legal duty of care and potentially negligent). In this article the author clarifies what the law means by 'reasonableness' with respect to nurses, drawing on both the law and the NMC Code. Furthermore, the article shall demonstrate that the law is not something to be fearful of but, rather, demands a standard no higher than that of the NMC.

Physician alert: the legal risks associated with 'on-call' duties in the USA.

PubMed

Paterick, Zachary R; Patel, Nachiket J; Paterick, Timothy Edward

2018-06-13

On-call physicians encounter a diverse aggregate of interfaces with sundry persons concerning patient care that may surface potential legal peril. The duties and obligations of an on-call physician, who must act as a fiduciary to all patients, create a myriad of circumstances where there is a risk of falling prey to legal ambiguities. The understanding of the doctor-patient relationship, the obligations of physicians under the Emergency Medical Treatment and Labor Act, the meaning of medical informed consent and the elements of negligence will help physicians avoid the legal risk associated with the various encounters of being on call. After introducing the legal concepts, we will explore the interactions that may put physicians at legal risk and outline how to mitigate that risk. Being on call is time consuming and arduous. While on call, physicians have a duty to act morally and ethically in the best interest of the patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Legal challenges in neurological practice.

PubMed

Jayalakshmi, Sita; Vooturi, Sudhindra

2016-10-01

Clinical neuroscience has made tremendous advances over the last century. Neurology as a discipline is still considered challenging and at times risky due to the natural history and progressive course of few of the neurological diseases. Encouragingly, the patient and their caregivers are now increasingly willing to be actively involved in making decisions. The patients' relationship with the doctor is a reflection of the society. A society that is orienting itself toward "rating" and "feedback" has made this doctor-patient relationship, a consumer-service provider relationship. This perhaps is due to commercialization of health that usually accompanies globalization. Moreover, a rapid influx of information from potential erroneous sources such as the Internet has also made patient and caregivers not being hesitant to taking legal course in the case of adverse events during treatment or simply because of dissatisfaction. The purpose of the legal process initiated by patients with neurological ailments is more often to compensate for the income lost, physical and psychological anguish that accompanies disease and its treatment, and to fund treatment or rehabilitation requirements. However, it is not clearly established if monetary benefits acquired lead to better opportunities for recovery of the patient. The consumer protection act and commercialization of medical services may well have an adverse effect on the doctor and patient relationship. Hence, there is a great need for all medical professionals to mutually complement and update each other. This review examines legal (litigation) processes with special interest on medicolegal system in patients with neurological ailments and the challenges faced by the neurologist during day-to-day clinical practice.

[Medical tourism and travel - an interdisciplinary approach].

PubMed

Freyer, W; Kim, B-S

2014-01-01

Medical tourism (or medical travel, international patient service, cross-border or global health care) is a new current phenomenon with increasing relevance for the two disciplines of medicine and tourism. Both sides hope to improve their reputation and image, as well as to increase their revenues and rate of employment; furthermore, they want to provide better care and service for patients and tourists: Medical tourism can close the gap of the health care system at home, providing better quality, quicker access and cheaper procedures abroad, also with treatments, not - legally - available in the sending country. For the tourism sector it broadens the variety of tourism products and supply of the host country and combines medical treatments and recovery with an attractive stay in a tourism destination for patients and their companions. But in spite of all popularity of this new type of tourism and treatment, there is quite a lack of theory and academic analysis. This article outlines the status quo of scientific research both from a medical and tourism point of view. This interdisciplinary method of approach is based mainly on a state-of-the art review of the current literature. There is a great need for more scientific research in the field of medical tourism, based on the common knowledge of both disciplines tourism and medicine. First there is neither an internationally agreed definition nor a common methodology for data collection. So the real impact of touristic and medical services both for the source and for the receiving countries is un-known and imprecise. Second the internal processes of the health system have to be adapted to the needs of international patients, e. g., medical fee schedule, billing, language, inter-cultural qualifications of the staff. Moreover the whole service chain has to be taken into account, especially the pre- and post-processes, which mostly start or end abroad. Here quality standards as well as accreditations are current

[Meta-legal paradigms of nanomedicine].

PubMed

Pérez Alvarez, Salvador

2012-01-01

Nanomedicine is the Nanotechnology applied in the field of Medicine. Nanomedicine includes a wide range of technologies applied to devices, materials, medical procedures and treatment modalities are being developed, in some cases, through the convergence of living and nonliving materials. The developments in this scientific field are the prelude of a new era in health where Nanotechnology will provide, in a short period of time, substantial benefits for the general welfare and health of people with serious and incurable diseases using other more traditional medical treatments. This is, in brief, the object of this research that has been focused in the study of the ethical-legal paradigms that should inform the developments and expectations generated by medical applications of Nanotechnology.

How a Lumbar Diskectomy Influenced Medical Malpractice and the Landscape of Health Care.

PubMed

Yang, Brian W; Bi, Wenya Linda; Smith, Timothy R; Brewster, Ryan; Gormley, William B; Dunn, Ian F; Laws, Edward R

2016-02-01

Jeff Chandler was one of Hollywood's top leading men in the 1950s and 1960s. In 1961, at the peak of his career, Chandler died of complications following an aortic-iliac injury during a routine lumbar diskectomy. The subsequent public outcry and malpractice suit resulted in an unprecedented settlement award. Chandler's lawsuit marked a pivotal time in the evolution of medical malpractice and monetary awards. Before 1960, malpractice legal claims were rare, with little impact on the practice of medicine. Chandler's award, however, dwarfed the average malpractice verdict for its time and would influence the relationship between medicine and the legal world. This case helped issue a radical increase in total expenditure on medical liability insurance, frequency of successful claims, average numbers of neurosurgical malpractice suits, and financial award sizes. The trend ensuing from this time has continued to the contemporary era. To link Chandler's case to the current malpractice climate, we highlight the relationship of the case with 3 factors comprising the legal argument for the perpetuation of medical malpractice: 1) contingency fees, 2) citizen juries, and 3) the nature of tort law. This case illustrates an inflection point in American medical malpractice expenditure increases beginning in the 1960s to a current estimated $55.6 billion. As we investigate ways to provide value in health care, it is important to consider the historical factors that have influenced the status quo when seeking strategies to reform the malpractice system on both sides of the value equation: quality and cost. Copyright © 2016 Elsevier Inc. All rights reserved.

Mental health among currently enrolled medical students in Germany.

PubMed

Wege, N; Muth, T; Li, J; Angerer, P

2016-03-01

The study identifies the prevalence of common mental disorders according to the patient health questionnaire (PHQ) and the use of psychotropic substances in a sample of currently enrolled medical students. A cross-sectional survey with a self-administrated questionnaire. All newly enrolled medical students at the University of Dusseldorf, with study beginning either in 2012 or 2013, respectively, were invited to participate. The evaluation was based on 590 completed questionnaires. Mental health outcomes were measured by the PHQ, including major depression, other depressive symptoms (subthreshold depression), anxiety, panic disorders and psychosomatic complaints. Moreover, information about psychotropic substances use (including medication) was obtained. Multiple logistic regression analysis was used to estimate associations between sociodemographic and socio-economic factors and mental health outcomes. The prevalence rates, measured by the PHQ, were 4.7% for major depression, 5.8% for other depressive symptoms, 4.4% for anxiety, 1.9% for panic disorders, and 15.7% for psychosomatic complaints. These prevalence rates were higher than those reported in the general population, but lower than in medical students in the course of medical training. In all, 10.7% of the students reported regular psychotropic substance use: 5.1% of students used medication 'to calm down,' 4.6% 'to improve their sleep,' 4.4% 'to elevate mood,' and 3.1% 'to improve cognitive performance.' In the fully adjusted model, expected financial difficulties were significantly associated with poor mental health (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.31-3.48), psychosomatic symptoms (OR:1.85; 95% CI: 1.11-3.09) and psychotropic substances use (OR: 2.68; 95% CI: 1.51-4.75). The high rates of mental disorders among currently enrolled medical students call for the promotion of mental health, with a special emphasis on vulnerable groups. Copyright © 2016 The Royal Society for Public

Cold atmospheric pressure plasma for treatment of chronic wounds: drug or medical device?

PubMed

Kramer, A; Conway, B R; Meissner, K; Scholz, F; Rauch, B H; Moroder, A; Ehlers, A; Meixner, A J; Heidecke, C-D; Partecke, L I; Kietzmann, M; Assadian, O

2017-08-02

The use of cold atmospheric pressure plasma (CAPP) as a new therapeutic option to aid the healing of chronic wounds appears promising. Currently, uncertainty exists regarding their classification as medical device or medical drug. Because the classification of CAPP has medical, legal, and economic consequences as well as implications for the level of preclinical and clinical testing, the correct classification is not an academic exercise, but an ethical need. A multidisciplinary team of physicians, surgeons, pharmacists, physicists and lawyers has analysed the physical and technical characteristics as well as legal conditions of the biological action of CAPP. It was concluded that the mode of action of the locally generated CAPP, with its main active components being different radicals, is pharmacological and not physical in nature. Depending on the intended use, CAPP should be classified as a drug, which is generated by use of a medical device directly at the point of therapeutic application.

Preimplantation diagnosis to create 'saviour siblings': a critical discussion of the current and future legal frameworks in South Africa.

PubMed

Strode, Ann; Soni, Sheetal

2011-12-14

Pre-implantation genetic diagnosis (PGD) is a technology used in conjunction with in vitro fertilisation to screen embryos for genetic conditions prior to transfer. It was initially developed to screen mutations for severe, irreversible, genetic conditions. Currently, PGD makes it possible to select against more than 100 different genetic conditions. It has been proposed as a method for creating a tissue-matched child who can in turn serve as a compatible stem cell donor to save a sick sibling in need of a stem cell transplant. The advantage of this method is that it provides genetic information before implantation of an embryo into the womb, making it possible to ensure that only tissue-matched embryos are transferred to the uterus. A couple can therefore avoid the difficult choice of either terminating the pregnancy at a later point if the fetus is not a match, or extending their family again in the hope that their next child will be tissue compatible. Many people have expressed disapproval of the use of PGD for this purpose, and it is associated with many conflicting interests including religion, ethics as well as legal regulation. In order to manage these issues some jurisdictions have created legal frameworks to regulate the use of this technology. Many of these are modelled on the UK's Human Fertilisation and Embryology Authority and its guardian legislation. This paper critiques the current and future South African legal framework to establish whether it is able to adequately regulate the use of PGD as well as guard against misuse of the technology. It concludes that changes are required to the future framework in order to ensure that it regulates the circumstances in which PGD may occur and that the Minister of Health should act expediently in finalising draft regulations which will regulate PGD in the future.

Teaching law in medical schools: first, reflect.

PubMed

Campbell, Amy T

2012-01-01

Law is now routinely included in the medical school curriculum, often incorporated into bioethics and/or practice of medicine coursework. There seems to lack, however, a systematic understanding of what works in terms of getting across an effective depth and breadth of legal knowledge for medical students - or what such would even look like. Moreover, and more critically, while some literature addresses these what, when, how, and who questions, a more fundamental question is left unanswered: why teach law in medical school? This article suggests a process to reveal a more consensual understanding of this latter question. The author highlights findings and recommendations of some of the leading literature to date related to teaching law in medical schools, and also recent U.K. projects addressing legal teaching in medical schools. Reflecting on these materials and activities, the author suggests that we take a "pause" before we argue for more or different legal topics within the medical curriculum. Before we alter the curricula for more and/or different "law," first, it is critical to have a meaningful, stakeholder-driven, consensus-seeking discussion of the goals of legal education: why do we think it matters that medical students learn about "the law"? © 2012 American Society of Law, Medicine & Ethics, Inc.

[Legal secrecy: abortion in Puerto Rico from 1937 to 1970].

PubMed

Marchand-Arias, R E

1998-03-01

The essay discusses abortion in Puerto Rico from 1937 to 1970, concentrating in its legal status as well as its social practice. The research documents the contradictions between the legality of the procedure and a social practice characterized by secrecy. The essay discusses the role of the Clergy Consultation Service on Abortion in promoting the legal practice of absortion in Puerto Rico. It also discusses the ambivalent role of medical doctors who, despite being legally authorized to perform abortions to protect the life and health of women, refused to perform the procedure arguing abortion was illegal. The essay concludes with a brief discussion on perceptions of illegality regarding abortion, emphasizing the contradictions between the practice of abortion and that of sterilization in Puerto Rico.

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 2. Equipment, Safe Driving Practices, Legal Aspects, Controlling the Situation, Action Evaluation Conference. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This student manual, the second in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains five sections that cover the following course content: ambulance equipment, safe driving practices for emergency vehicle drivers, legal aspects of the EMT's job, how to maintain control at an accident scene…

Forensic psychiatry in India current status and future development.

PubMed

Shah, L P

1999-07-01

Forensic psychiatry is a developing superspeciality in India and other SAARC countries. After a brief historical review, the paper describes the current status of forensic psychiatry in India and compares it with the development in this field in Europe and America. It takes the stock of current scenario in three different areas viz., i) legal and clinical ii) teaching and training and Hi) research. It deliberates on need for teaching this subject at the undergraduate and the postgraduate medical and legal courses and necessity of full time consultants devoted to the practice of forensic psychiatry. It focuses on the recent developments in the field of forensic psychiatry like enactment of Narcotic and Psychotropic Substance Act (1985), Mental Health Act (1987), Juvenile Justice Act (1989), Act for the Disabled (1994) and the Consumer Protection Act (1986). The paper also recommends some strategies for teaching, training, research and future developments in this field.

Medical examiner/death investigator training requirements in state medical examiner systems.

PubMed

Prahlow, J A; Lantz, P E

1995-01-01

Comprehensive and properly performed investigation of suspicious, unusual, unnatural, and various natural deaths is necessary to maintain the health, safety, and well-being of society as a whole. Adequate investigation requires the combined efforts and cooperation of law-enforcement and other public-service agencies, medical professionals, and those within the forensic community. As such, the "death investigator" plays a crucial role in the investigation process. These front-line investigators, whether they be coroners, medical examiners, physicians, other medical professionals, or lay-people, are required to make important decisions which have far-reaching consequences on how death investigation cases proceed. Death investigation practices vary greatly among medico-legal jurisdictions. A recent publication has categorized state death investigation systems by type of system. In an attempt to better delineate death investigation practices with specific regard to investigators' training and continuing education requirements, we surveyed the 20 systems categorized as state medical examiner systems and the five states with combined state medical examiner and county coroner/medical examiner systems. We present our findings and make recommendations which address the attributes and deficiencies of current death investigation practices.

20 CFR 410.587 - Support of legally dependent spouse, child, or parent.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Support of legally dependent spouse, child, or parent. If current maintenance needs of a beneficiary are... dependent spouse, a legally dependent child, or a legally dependent parent of the beneficiary. [37 FR 20651... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Support of legally dependent spouse, child...

[Euthanasia: legal comparison in selected European countries].

PubMed

Doležal, Adam

2018-01-01

This article deals with the subject of euthanasia (all its forms) and other end-of-life decisions, such as assisted suicide, withdrawing and whithholding life-sustaining treatments. Among other things, the article will also deal with the issue of the offense of Homicide by the Victims Request. Based on an empirical historical method, the article compares the various selected legal orders. From this analysis, it draws some conclusions that have an impact on ethical discourse. First of all, the terminology is defined in the article, which is very important in this area. Further, German law is being analysed, with emphasis on Nazi Germany. On that basis, the so-called reductio ad Hitlerum argument is rejected. Research continues and is followed by another states, the Netherlands, Belgium and Switzerland. By analysing them, the following ethical arguments used in euthanasia debates are examined: the argument of a slippery slope and the argument of respect for autonomy. Finally, the judgment of the European Court of Human Rights in the Pretty case is also analysed. On this case, we can demonstrate, how insufficient is argument of human dignity. The last part is dedicated to the Czech Republic and its legal order. Firstly, it focuses on the history of the legal regulation of euthanasia, but the main part deals with the current legal situation. In addition to the recent state of affairs, the bill of Death with dignity act is also being examined. At the end of the article it is pointed out that the Czech regulation is insufficient and changes are necessary. However, the proposed bill of Death with dignity act is not the right way to follow. Rather, it may be wise to adopt an amendment to the Penal Code that would introduce the offense of Homicide by the Victims Request.Key words: assisted suicide - euthanasia - Homicide by the Victims Request - medical futility - withdrawing and whithholding life-sustaining treatment.

Support for Marijuana Legalization and Predictors of Intentions to Use Marijuana More Often in Response to Legalization Among U.S. Young Adults.

PubMed

Cohn, Amy M; Johnson, Amanda L; Rose, Shyanika W; Rath, Jessica M; Villanti, Andrea C

2017-01-28

As of 2015, more than half of U.S. states have legalized, medicalized, or decriminalized marijuana. This study examined the prevalence and correlates of support for marijuana legalization in a national sample of young adults and the intention to use marijuana more frequently if it were legalized. Data were from Wave 7 (weighted N = 3532) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18-34. We assessed demographics, past 30-day substance (alcohol, tobacco, marijuana, other drug use), depression and anxiety, social smoking, marijuana harm perceptions (relative to cigarettes), and state-level marijuana policies as correlates of support for marijuana legalization and intentions to use marijuana more often if it were legalized. Multivariable models of correlates of support for legalization and intentions to use marijuana were conducted separately for the full sample and for nonmarijuana users. Weighted estimates showed that 39% of the full sample and 9% of nonmarijuana users supported marijuana legalization. Multivariable models showed that lower marijuana harm perceptions and lifetime and past 30-day tobacco use were common predictors of support for marijuana legalization and intentions to use marijuana among non-users of marijuana. Conclusions/Importance: Over a third of the sample supported marijuana legalization. Tobacco use and perceptions that marijuana is less harmful than cigarettes were robust risk correlates of support for marijuana legalization and intentions to use more frequently among nonusers. Public health campaigns should target these factors to deter marijuana-related harm in susceptible young adults.

Current Legal Trends Regarding Abortions for Minors: A Dilemma for Counselors.

ERIC Educational Resources Information Center

Talbutt, Lou Culler

1983-01-01

Reviews court cases dealing with abortion and the counselor's legal responsibility to both the student and parents. Provides practical recommendations on abortion counseling with minors and suggests that counselors urge minors to discuss abortion plans with parents. Counselor should consider local mores and be knowledgeable about appropriate…

Employment Issues in Higher Education: A Legal Compendium.

ERIC Educational Resources Information Center

Sagan, Jean S., Ed.; Rebel, Thomas P., Ed.

This volume contains 32 articles and sample documents treating legal issues in higher education employment focusing on major issues arising in a non-unionized setting. The first of six sections contains seven articles on the employment relationship in general that touch on current legal trends in employee selection procedures, employment…

Should performance-enhancing drugs in sport be legalized under medical supervision?

PubMed

Wiesing, Urban

2011-02-01

This review examines the question of whether performance-enhancing drugs should be permitted in sport under the control of physicians, and evaluates the expected outcomes of such a scenario. Such a change in regulation would need to be tightly controlled because of the risks involved. The results of legalizing performance-enhancing drugs in competitive sport would be either unhelpful or negative, and the unwanted aspects of doping control would not disappear. Athletes, including children and adolescents who wanted to pursue competitive sports, would be forced to take additional, avoidable health risks. The 'natural lottery' of athletic talents would be compensated for only partially by use of performance-enhancing agents. It would also be complemented by another 'natural lottery' of variable responses to doping measures, combined with the inventiveness of doping doctors. There would be no gain in 'justice' (i.e. fairer results that reflected efforts made) for athletes as a result of legalizing doping. Legalization would not reduce restrictions on athletes' freedom; the control effort would remain the same, if not increased. Extremely complicated international regulations would have to be adopted. The game of the 'tortoise and the hare' between doping athletes and inspectors would remain because prohibited but not identifiable practices could still provide additional benefits from use of permissible drugs. Audience mistrust, particularly toward athletes who achieved outstanding feats, would remain because it would still be possible that these athletes were reliant on illegal doping practices. Doping entails exposing the athletes to avoidable risks that do not need to be taken to increase the appeal of a sport. Most importantly, the function of sport as a role model would definitely be damaged. It is not necessary to clarify the question of what constitutes the 'spirit of sport' and whether this may be changed. From a practical point of view, a legalization of

Weaponisation of Space - Some Legal Considerations

NASA Astrophysics Data System (ADS)

Jolly, C.

2002-01-01

This paper will examine a current national initiative from the United States of America to achieve greater national security through the `weaponisation' of extra-atmospheric space. We will propose a synthesis of the current international legal framework pertaining to military activities in space. Based on the analysis of the legal regime and on some current national and regional political initiatives, we will make some practical recommendations to prevent an arms race in space. Civil remote sensing, telecommunications, and launchers launch vehicle technologies have all benefited from a military heritage. They are dual use technologies, in other words, technologies that have both military and civilian applications. In fact, space has always been militarised, ever since the first satellites were put in orbit for reconnaissance missions. But recently, some national policies and technological advances are making the militarisation of space less `discrete'. Military assets from different countries are already stationed in orbit (e.g. reconnaissance and navigation satellites), but they might soon be joined by new `space weapons' with lethal strike capabilities. Currently, in the United States, military and civilian space activities are being closely intertwined. A typical example is the call of the NASA Administrator Sean O'Keefe, a former Secretary of the Navy, for closer cooperation on research and development between NASA and the Department of Defense. Concerning plans to station weapons in space, the American Air Force Space Command issued, in February 2000, its `Strategic Master Plan for FY02 and Beyond'. It states that the United States "...future Air Force Space Command capabilities will enable a fully integrated Aerospace Force to rapidly engage military forces worldwide. [...] Full spectrum dominance in the space medium will be achieved through total space situational awareness, protection of friendly space assets, prevention of unauthorized use of those assets

Compensation for subjects of medical research: the moral rights of patients and the power of research ethics committees.

PubMed Central

Guest, S

1997-01-01

Awareness of the morally significant distinction between research and innovative therapy reveals serious gaps in the legal provision for compensation in the UK for injured subjects of medical research. Major problems are limitations inherent in negligence actions and a culture that emphasises indemnifying researchers before compensating victims. Medical research morally requires compensation on a no-fault basis even where there is proper consent on the part of the research subject. In particular, for drug research, there is insufficient provision in the current patient guidelines of the Association of the British Pharmaceutical Industry, since they make "no legal commitment" to paying compensation for injury to patient subjects. There is a need for the provision of both adequate insurance and contractual arrangements for making payments. The solution is for Local Research Ethics Committees (LRECs) to make use of their power to withhold approval of medical research where compensation is not legally enforceable. PMID:9220333

Patient Perspectives of Medical Confidentiality

PubMed Central

Sankar, Pamela; Mora, Susan; Merz, Jon F; Jones, Nora L

2003-01-01

OBJECTIVE To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer-reviewed journal articles reporting original research on patients' confidentiality views and conduct were included. MAIN RESULTS Many patients are unaware of or misunderstand their legal or ethical right to medical confidentiality protections, which leads them to both over- and underestimate confidentiality protections. The possibility that medical information might be revealed, intentionally or not, to acquaintances in a clinic or other social community troubles patients as much as information release to insurers or employers. A significant minority of patients distrust confidentiality protections, leading some to report that they delay or forgo medical care. If doubtful that confidentiality will be upheld, patients will act independently to protect information. CONCLUSIONS Our review found a wider variety of understandings and beliefs about medical confidentiality among patients than are often indicated in the writings of practitioners or legal experts. As medical confidentiality regulations evolve, these differences need to be recognized and accounted for in interactions between practitioners and patients. PMID:12911650

Innovative Legal Approaches to Address Obesity

PubMed Central

Pomeranz, Jennifer L; Teret, Stephen P; Sugarman, Stephen D; Rutkow, Lainie; Brownell, Kelly D

2009-01-01

Context: The law is a powerful public health tool with considerable potential to address the obesity issue. Scientific advances, gaps in the current regulatory environment, and new ways of conceptualizing rights and responsibilities offer a foundation for legal innovation. Methods: This article connects developments in public health and nutrition with legal advances to define promising avenues for preventing obesity through the application of the law. Findings: Two sets of approaches are defined: (1) direct application of the law to factors known to contribute to obesity and (2) original and innovative legal solutions that address the weak regulatory stance of government and the ineffectiveness of existing policies used to control obesity. Specific legal strategies are discussed for limiting children's food marketing, confronting the potential addictive properties of food, compelling industry speech, increasing government speech, regulating conduct, using tort litigation, applying nuisance law as a litigation strategy, and considering performance-based regulation as an alternative to typical regulatory actions. Finally, preemption is an overriding issue and can play both a facilitative and a hindering role in obesity policy. Conclusions: Legal solutions are immediately available to the government to address obesity and should be considered at the federal, state, and local levels. New and innovative legal solutions represent opportunities to take the law in creative directions and to link legal, nutrition, and public health communities in constructive ways. PMID:19298420

Integrating legal liabilities in nanomanufacturing risk management.

PubMed

Mohan, Mayank; Trump, Benjamin D; Bates, Matthew E; Monica, John C; Linkov, Igor

2012-08-07

Among other things, the wide-scale development and use of nanomaterials is expected to produce costly regulatory and civil liabilities for nanomanufacturers due to lingering uncertainties, unanticipated effects, and potential toxicity. The life-cycle environmental, health, and safety (EHS) risks of nanomaterials are currently being studied, but the corresponding legal risks have not been systematically addressed. With the aid of a systematic approach that holistically evaluates and accounts for uncertainties about the inherent properties of nanomaterials, it is possible to provide an order of magnitude estimate of liability risks from regulatory and litigious sources based on current knowledge. In this work, we present a conceptual framework for integrating estimated legal liabilities with EHS risks across nanomaterial life-cycle stages using empirical knowledge in the field, scientific and legal judgment, probabilistic risk assessment, and multicriteria decision analysis. Such estimates will provide investors and operators with a basis to compare different technologies and practices and will also inform regulatory and legislative bodies in determining standards that balance risks with technical advancement. We illustrate the framework through the hypothetical case of a manufacturer of nanoscale titanium dioxide and use the resulting expected legal costs to evaluate alternative risk-management actions.

Claims about Medical Malpractices Resulting in Maternal and Perinatal Mortality Referred to Iranian Legal Medicine Organization During 2011–2012

PubMed Central

Taghizadeh, Ziba; Pourbakhtiar, Maryam; Ghadipasha, Masoud; Soltani, Kamran; Azimi, Khadijeh

2017-01-01

Background: Obstetricians, gynecologists, and midwives are the most common specialists of the medical sciences group against whom medical malpractices are claimed, many of which are avoidable and preventable. Therefore, the present study was conducted to investigate the causes of claims regarding medical malpractices resulting in maternal and perinatal mortality. Materials and Methods: A descriptive cross-sectional study was conducted and 7616 claims of medical malpractices in the field of obstetrics, gynecology, and midwifery that were referred from all 31 provinces to the central commission of legal medicine were studied during 2011–2012. Therefore, the present research is a national inclusive study covering all the provinces across Iran. To collect information from the transcript of medical malpractices cases, a researcher-made checklist was used, and the collected data were analyzed. Results: The results of the present study showed that among all the medical malpractice claims regarding pregnancy and childbirth (42.24%), the majority concerned perinatal death (71.82%) and maternal death (28.16%). Conclusions: Medical malpractice complaints are increasing; although, most of these claims are preventable. To achieve this aim, it is necessary for obstetricians, gynecologists, and midwives to try to reduce the complaints by paying more attention to the signs and symptoms of diseases, performing all the diagnostic and therapeutic measures according to the scientific criteria, and fully document patients' records. In addition, patients' acquaintance with the importance of measurements and examinations, before and during pregnancy care and even after childbirth is crucial. PMID:28904542

The degree of certainty in brain death: probability in clinical and Islamic legal discourse.

PubMed

Qazi, Faisal; Ewell, Joshua C; Munawar, Ayla; Asrar, Usman; Khan, Nadir

2013-04-01

The University of Michigan conference "Where Religion, Policy, and Bioethics Meet: An Interdisciplinary Conference on Islamic Bioethics and End-of-Life Care" in April 2011 addressed the issue of brain death as the prototype for a discourse that would reflect the emergence of Islamic bioethics as a formal field of study. In considering the issue of brain death, various Muslim legal experts have raised concerns over the lack of certainty in the scientific criteria as applied to the definition and diagnosis of brain death by the medical community. In contrast, the medical community at large has not required absolute certainty in its process, but has sought to eliminate doubt through cumulative diagnostic modalities and supportive scientific evidence. This has recently become a principal model, with increased interest in data analysis and evidence-based medicine with the intent to analyze and ultimately improve outcomes. Islamic law has also long employed a systematic methodology with the goal of eliminating doubt from rulings regarding the question of certainty. While ample criticism of the scientific criteria of brain death (Harvard criteria) by traditional legal sources now exists, an analysis of the legal process in assessing brain death, geared toward informing the clinician's perspective on the issue, is lacking. In this article, we explore the role of certainty in the diagnostic modalities used to establish diagnoses of brain death in current medical practice. We further examine the Islamic jurisprudential approach vis-à-vis the concept of certainty (yaqīn). Finally, we contrast the two at times divergent philosophies and consider what each perspective may contribute to the global discourse on brain death, understanding that the interdependence that exists between the theological, juridical, ethical, and medical/scientific fields necessitates an open discussion and active collaboration between all parties. We hope that this article serves to continue the

Early Impacts of Marijuana Legalization: An Evaluation of Prices in Colorado and Washington.

PubMed

Hunt, Priscillia; Pacula, Rosalie Liccardo

2017-06-01

Following the legalization and regulation of marijuana for recreational purposes in states with medical markets, policymakers and researchers seek empirical evidence on how, and how fast, supply and demand changed over time. Prices are an indication of how suppliers and consumers respond to policy changes, so this study uses a difference-in-difference approach to exploit the timing of policy implementation and identify the impacts on marijuana prices 4-5 months after markets opened. This study uses unique longitudinal survey data of prices paid by consumers and a web-scraped dataset of dispensary prices advertised online for three U.S. medical marijuana states that all eventually legalized recreational marijuana. Results indicate there were no impacts on the prices paid for medical or recreational marijuana by state-representative residents within the short 4- to 5-months window following legalization. However, there were differences in how much people paid if they obtained marijuana for recreational purposes from a recreational store. Further analysis of advertised prices confirms this result, but further demonstrates heterogeneous responses in prices across types of commonly advertised strains; prices either did not change or increased depending on the strain type. A key implication of our findings is that there are both supply and demand responses at work in the opening of legalized markets, suggesting that evaluations of immediate effects may not accurately reflect the long run impact of legalization on consumption.

28 CFR 543.11 - Legal research and preparation of legal documents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Legal research and preparation of legal... INSTITUTIONAL MANAGEMENT LEGAL MATTERS Inmate Legal Activities § 543.11 Legal research and preparation of legal... program or work assignment), to do legal research and to prepare legal documents. Where practical, the...

28 CFR 543.11 - Legal research and preparation of legal documents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Legal research and preparation of legal... INSTITUTIONAL MANAGEMENT LEGAL MATTERS Inmate Legal Activities § 543.11 Legal research and preparation of legal... program or work assignment), to do legal research and to prepare legal documents. Where practical, the...

28 CFR 543.11 - Legal research and preparation of legal documents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Legal research and preparation of legal... INSTITUTIONAL MANAGEMENT LEGAL MATTERS Inmate Legal Activities § 543.11 Legal research and preparation of legal... program or work assignment), to do legal research and to prepare legal documents. Where practical, the...

28 CFR 543.11 - Legal research and preparation of legal documents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Legal research and preparation of legal... INSTITUTIONAL MANAGEMENT LEGAL MATTERS Inmate Legal Activities § 543.11 Legal research and preparation of legal... program or work assignment), to do legal research and to prepare legal documents. Where practical, the...

28 CFR 543.11 - Legal research and preparation of legal documents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Legal research and preparation of legal... INSTITUTIONAL MANAGEMENT LEGAL MATTERS Inmate Legal Activities § 543.11 Legal research and preparation of legal... program or work assignment), to do legal research and to prepare legal documents. Where practical, the...

Mobile health applications: the patchwork of legal and liability issues suggests strategies to improve oversight.

PubMed

Yang, Y Tony; Silverman, Ross D

2014-02-01

Mobile health (mHealth) technology has facilitated the transition of care beyond the traditional hospital setting to the homes of patients. Yet few studies have evaluated the legal implications of the expansion of mHealth applications, or "apps." Such apps are affected by a patchwork of policies related to medical licensure, privacy and security protection, and malpractice liability. For example, the privacy protections of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may apply to only some uses of the apps. Similarly, it is not clear what a doctor's malpractice liability would be if he or she injured a patient as the result of inaccurate information supplied by the patient's self-monitoring health app. This article examines the legal issues related to the oversight of health apps, discusses current federal regulations, and suggests strategies to improve the oversight of these apps.

Legal implications of premenstrual syndrome: a Canadian perspective.

PubMed Central

Meehan, E; MacRae, K

1986-01-01

A summary of the symptoms, prevalence and history of premenstrual syndrome (PMS) is presented. The legal implications of PMS, particularly its use as a defence in criminal prosecutions and as an implicit factor in specific offences, are discussed by means of an analysis of Canadian legal cases, with reference to those in England and the United States. The authors offer suggestions on how physicians can make use of PMS in a courtroom more reliable. They conclude that PMS is unlikely to become a substantive criminal defence until the medical community more fully recognizes its significance. Although the role of PMS as a mitigating factor in sentencing may be illogical, the courts now recognize the syndrome in a legally and practically important manner. Images p602-a PMID:3756691

Lessons learned after three years of legalized, recreational marijuana: The Colorado experience.

PubMed

Ghosh, Tista S; Vigil, Daniel I; Maffey, Ali; Tolliver, Rickey; Van Dyke, Mike; Kattari, Leonardo; Krug, Heather; Reed, Jack K; Wolk, Larry

2017-11-01

In November 2012 Colorado voters approved legalized recreational marijuana. On January 1, 2014 Colorado became the first state to allow legal sales of non-medical marijuana for adults over the age of 21. Since that time, the state has been monitoring potential impacts on population health. In this paper we present lessons learned in the first three years following legal sales of recreational marijuana. These lessons pertain to health behaviors and health outcomes, as well as to health policy issues. Our intent is to share these lessons with other states as they face the prospect of recreational marijuana legalization. Copyright © 2017 Elsevier Inc. All rights reserved.

Legal Services: The Army Legal Assistance Program

DTIC Science & Technology

1996-02-21

Army Regulation 27–3 Legal Services The Army Legal Assistance Program Headquarters Department of the Army Washington, DC 21 February 1996 REPORT...1996 to xx-xx-1996 4. TITLE AND SUBTITLE The Army Legal Assistance Program Unclassified 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT...Z39.18 SUMMARY of CHANGE AR 27–3 The Army Legal Assistance Program This change 2 corrects the title page of this regulation. This change 2-- o Corrects

Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy.

PubMed

Harper, Joyce; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo J; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan

2014-08-01

How has the interface between genetics and assisted reproduction technology (ART) evolved since 2005? The interface between ART and genetics has become more entwined as we increase our understanding about the genetics of infertility and we are able to perform more comprehensive genetic testing. In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and ART and published an extended background paper, recommendations and two Editorials. An interdisciplinary workshop was held, involving representatives of both professional societies and experts from the European Union Eurogentest2 Coordination Action Project. In March 2012, a group of experts from the European Society of Human Genetics, the European Society of Human Reproduction and Embryology and the EuroGentest2 Coordination Action Project met to discuss developments at the interface between clinical genetics and ART. As more genetic causes of reproductive failure are now recognized and an increasing number of patients undergo testing of their genome prior to conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and PGD may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from RCTs to substantiate that the technique is both effective and efficient. Whole genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving, but still remains very

Assessing the public health impact of cannabis legalization in Canada: core outcome indicators towards an 'index' for monitoring and evaluation.

PubMed

Fischer, Benedikt; Russell, Cayley; Rehm, Jürgen; Leece, Pamela

2018-05-30

The legalization of non-medical cannabis use and supply is impending in Canada. This constitutes a major policy change with the declared objective of improving public health outcomes, which requires rigorous monitoring and evaluation. While numerous different aspects associated with legalization will be examined, a focused perspective is required for effective policy evaluation purposes. To these ends, we have identified a set of 10 core indicators associated with cannabis-related risk/harm outcomes-based on current best evidence-that are expected to measure the primary impacts of legalization on public health outcomes. We briefly review these indicators, and their respective data availability in Canada. As ideally an integrated outcome assessment of cannabis legalization's impact on public health will be available, we further propose options to merge the individual indicators into an integrated, weighted 'index', considering their expected relative impact for public health. One possible approach to undertake this is 'multi-criteria decision analysis' as a method to weight the relative indicator impact on public health; alternative approaches are proposed. The integrated 'public health index' for cannabis legalization will allow for scientifically comprehensive, while focused, monitoring and evaluation of the effects of legalization in Canada for the benefits of science and evidence-based policy alike.

Simulation of leakage current measurement on medical devices using helmholtz coil configuration with different current flow

NASA Astrophysics Data System (ADS)

Sutanto, E.; Chandra, F.; Dinata, R.

2017-05-01

Leakage current measurement which can follow IEC standard for medical device is one of many challenges to be answered. The IEC 60601-1 has defined that the limit for a leakage current for Medical Device can be as low as 10 µA and as high as 500 µA, depending on which type of contact (applied part) connected to the patient. Most people are using ELCB (Earth-leakage circuit breaker) for safety purpose as this is the most common and available safety device in market. One type of ELCB devices is RCD (Residual Current Device) and this RCD type can measure the leakage current directly. This work will show the possibility on how Helmholtz Coil Configuration can be made to be like the RCD. The possibility is explored by comparing the magnetic field formula from each device, then it proceeds with a simulation using software EJS (Easy Java Simulation). The simulation will make sure the concept of magnetic field current cancellation follows the RCD concept. Finally, the possibility of increasing the measurement’s sensitivity is also analyzed. The sensitivity is needed to see the possibility on reaching the minimum leakage current limit defined by IEC, 0.01mA.

Legal Preparedness

PubMed Central

Courtney, Brooke; Hodge, James G.; Toner, Eric S.; Roxland, Beth E.; Penn, Matthew S.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Christian, Michael D.; Powell, Tia

2015-01-01

contribute to protecting hospitals and practitioners who act in good faith from liability. Finally, to address anticipated staffing shortages during severe and prolonged disasters and pandemics, governments should develop approaches to formally expand the availability of qualified health-care workers, such as through using official foreign medical teams. CONCLUSIONS As a fundamental element of health-care and public health emergency planning and preparedness, the law underlies critical aspects of disaster and pandemic responses. Effective responses require comprehensive advance planning efforts that include assessments of complex legal issues and authorities. Recent disasters have shown that although law is a critical response tool, it can also be used to hold health-care stakeholders who fail to appropriately plan for or respond to disasters and pandemics accountable for resulting patient or staff harm. Claims of liability from harms allegedly suffered during disasters and pandemics cannot be avoided altogether. However, appropriate planning and legal protections can help facilitate sound, consistent decision-making and support response participation among health-care entities and practitioners. PMID:25144203

Research with Pregnant Women: New Insights on Legal Decision-Making

PubMed Central

Mastroianni, Anna C.; Henry, Leslie Meltzer; Robinson, David; Bailey, Theodore; Faden, Ruth R.; Little, Margaret O.; Lyerly, Anne Drapkin

2017-01-01

Although pregnant women rely on medical interventions to treat and prevent a wide variety of health conditions, they are frequently excluded or underrepresented in clinical research. The resulting dearth of pregnancy-specific evidence to guide clinical decisionmaking routinely exposes pregnant women, and their future offspring, to risk of uncertain harms for uncertain benefits. The two legal factors regularly cited as obstacles to such research are the federal regulatory scheme and fear of liability. This article reveals a far more nuanced and complex view of the legal context. First, legal professionals may—at any time from product conception to marketing—influence decisions about research with pregnant women. Second, factors not previously articulated in the literature may prompt legal professionals to slow or halt such research. They include: financial interests, regulatory ambiguity, obstacles to risk management, and site-specific laws unrelated to research. Any efforts to promote the ethical inclusion of pregnant women in research must acknowledge the role of legal decisionmakers and address their professional concerns. PMID:28543423

FORENSIC PSYCHIATRY IN INDIA CURRENT STATUS AND FUTURE DEVELOPMENT

PubMed Central

Shah, L.P.

1999-01-01

Forensic psychiatry is a developing superspeciality in India and other SAARC countries. After a brief historical review, the paper describes the current status of forensic psychiatry in India and compares it with the development in this field in Europe and America. It takes the stock of current scenario in three different areas viz., i) legal and clinical ii) teaching and training and Hi) research. It deliberates on need for teaching this subject at the undergraduate and the postgraduate medical and legal courses and necessity of full time consultants devoted to the practice of forensic psychiatry. It focuses on the recent developments in the field of forensic psychiatry like enactment of Narcotic and Psychotropic Substance Act (1985), Mental Health Act (1987), Juvenile Justice Act (1989), Act for the Disabled (1994) and the Consumer Protection Act (1986). The paper also recommends some strategies for teaching, training, research and future developments in this field. PMID:21455388

Munchausen's syndrome: a medico-legal dilemma.

PubMed

Mydlo, J H; Macchia, R J; Kanter, J L

1997-07-01

In his or her life-long career, the physician will eventually encounter a patient with factitious disorder, or Munchausen's syndrome. We discuss two patients complaining of renal colic that were identified as having Munchausen's syndrome. We review the literature to identify certain aspects of the disease and to discuss the medical and legal implications for the treating physician and hospital.

[Responsibilities of physicians in legal practice with emphasis on civil law].

PubMed

Veselić, Ivica

2007-01-01

Medical doctors and lawyers respectively are very often directed to cooperate in many different ways. It is worth informing the medical doctors in a simple and understandable way of a newer and more recent practice of the term of responsibility and its usage in legal practice. Placing subjective or objective medical doctors' responsibility arises a considerable doubt in practice. Author's opinion is that the legal practice should keep the subjective responsibility because it is precisely the subjective responsibility that has a supremacy over the objective one. He is, of course, taking into consideration the honorable medical profession which shouldn't professionally constraint the doctors in doing their honorable work by confronting them with ethical and professional dilemma about whether they would be burdened with criminal or civil responsibility, and all that on the assumption of lege artis. The author has himself searched and checked the archive and Internet records of 200 court rulings of the Municipal Court in Zagreb and the District Court in Zagreb. He also searched Internet records of the Supreme Court of the Republic of Croatia both for the civil law responsibility as for the criminal law one. The figures shown in this work are appriximate and they are to be used as guidelines and support for indentifying and solving problems both in medical as in legal practice. After checking the court rulings of the Municipal Court in Zagreb the author has noted that the mistakes most frequently occur in the field of diagnostics and additional health care (42%), in performing a surgery and post-operative complications (43%) and in the field of ginecology (15%). With the developpement of medicine and technology the risks and medical mistakes are ever growing. However, maybe one simple conversation between a doctor and a patient before and after providing medical services would solve many of the dilemmas and reduce the unreasonable expectations.

First HIV legal precedent in Kyrgyzstan: breach of medical privacy.

PubMed

Iriskulbekov, Erik; Balybaeva, Asylgul

2007-12-01

A recent court case of a breach of the privacy rights of a person living with HIV/AIDS in Kyrgyzstan is the first of its kind in Central Asia, write Erik Iriskulbekov and Asylgul Balybaeva. ADILET, the NGO that brought the case to court, is one of only a few NGOs in Central Asia that provide legal assistance related to HIV and AIDS.

End-of-life decisions in Malaysia: Adequacies of ethical codes and developing legal standards.

PubMed

Kassim, Puteri Nemie Jahn; Alias, Fadhlina

2015-06-01

End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.

The medical responsibility: current view from the Council of Physicians side.

PubMed

Squifflet, J P

2003-04-01

The medical responsibility has been clearly defined in the Royal Decree no. 78 dated November 11, 1967 concerning the medical practice. Moreover, several articles from the Ethical Code (Code de Déontologie) have clarified some social and economical responsibilities in the medical practice (articles 99 to 103) and the quality of patient care (article 36). The National Council has also published at least 31 advises facing the daily reality and the growing insecurity. That atmosphere is coming from the jurisprudence, the increasing responsibility insurance fees, the obligation of results instead of means, and the project of patient rights law. That project is currently dissociated from other projects such as an update on the medical responsibility and/or the no fault indemnity. Therefore, there is a current need for developing written patient information and using informed consent forms for risky surgical procedures. Before recognizing the no fault concept with indemnity, it is necessary to review the coverage of the responsibility insurance, educate the medical doctors in the no fault concept, study the mode of compensation for therapeutic hazards and differentiate the objective and subjective parts of the patient's chart.

Legal aspects of satellite teleconferencing

NASA Technical Reports Server (NTRS)

Smith, D. D.

1971-01-01

The application of satellite communications for teleconferencing purposes is discussed. The legal framework within which such a system or series of systems could be developed is considered. The analysis is based on: (1) satellite teleconferencing regulation, (2) the options available for such a system, (3) regulatory alternatives, and (4) ownership and management aspects. The system is designed to provide a capability for professional education, remote medical diagnosis, business conferences, and computer techniques.

Political and medical views on medical marijuana and its future.

PubMed

Rubens, Muni

2014-01-01

The policies, laws, politics, public opinions, and scientific inferences of medical marijuana are rapidly changing as the debate on medical use of marijuana has always been political, rather than scientific. Federal law has barred the use of medical marijuana though 18 state governments and Washington, DC, support the medical use of marijuana. Unfortunately, not many studies exist on medical marijuana to back these laws and policies. The judiciary, on the other hand, has elicited a diverse response to medical marijuana through its rulings over several decades. Some rulings favored the federal government's opinion, and others supported the larger public view and many state governments with legalized medical marijuana. Public opinion on legalizing medical marijuana has always favored the use of medical marijuana. The movement of scientific knowledge of medical marijuana follows an erratic, discontinuous pathway. The future place of medical marijuana in U.S. society remains unknown. The three forces-scientific knowledge, social-political acceptance, and laws-play a role in the direction that medical marijuana takes in society. Overcoming political-social forces requires a concerted effort from the scientific community and political leaders. The results of scientific research must guide the decisions for laws and medical use of marijuana. This article aims to trace the political dilemma and contradictory views shared by federal and state governments and predict the future of medical marijuana by tracing the past history of medical marijuana with its bumpy pathway in the social-political arena.

Medical marijuana and the developing role of the pharmacist.

PubMed

Seamon, Matthew J; Fass, Jennifer A; Maniscalco-Feichtl, Maria; Abu-Shraie, Nada A

2007-05-15

The pharmacology, therapeutic uses, safety, drug-drug interactions, and drug-disease interactions of medical marijuana are reviewed, and the legal issues related to its use and the implications of medical marijuana for the pharmacist are presented. Marijuana contains more than 460 active chemicals and over 60 unique cannabinoids. The legal landscape surrounding marijuana is surprisingly complex and unsettled. In the United States, 11 states and several municipalities have legalized medical marijuana. Another state provides legislation that allows patients to claim a defense of medical necessity. Nevertheless, patients using medical marijuana may never interact with a pharmacist. Marijuana is a Schedule I controlled substance and its use is illegal under federal law. Marijuana has a number of purported therapeutic uses with a broad range of supporting evidence. There are five general indications for medical marijuana: (1) severe nausea and vomiting associated with cancer chemotherapy or other causes, (2) weight loss associated with debilitating illnesses, including HIV infection and cancer, (3) spasticity secondary to neurologic diseases, such as multiple sclerosis, (4) pain syndromes, and (5) other uses, such as for glaucoma. Marijuana is associated with adverse psychiatric, cardiovascular, respiratory, and immunologic events. Moreover, marijuana may interact with a number of prescription drugs and concomitant disease states. Several states have legalized the use of marijuana for chronic and debilitating medication conditions. Pharmacists need to understand the complex legal framework surrounding this issue so that they can protect themselves and better serve their patients.

Legal interfaces in telemedicine technology.

PubMed

Lott, C M

1996-05-01

Telemedicine, an emerging technology which seeks to use advanced telecommunications equipment to enhance medical care, is progressing rapidly in the Department of Defense health care delivery system. This paper recommends that a cautious, preventive law approach be simultaneously initiated to ensure that the technology does not abridge patients' rights to confidentiality or security of medical records, and that agreement on practice parameters be developed. Seven interfaces, in the areas of informed consent, physician liability, non-physician liability, costs, practice parameters, physician-patient relationships, and ergonomics, are discussed in the context of telemedicine. The author recommends that telemedicine pioneers include the legal community's early input in the application of telemedicine technology to help avoid needless litigation.

‘This Is Real Misery’: Experiences of Women Denied Legal Abortion in Tunisia

PubMed Central

Hajri, Selma; Raifman, Sarah; Gerdts, Caitlin; Baum, Sarah; Foster, Diana Greene

2015-01-01

Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff. PMID:26684189

[Attitudes on euthanasia and medical advance directives].

PubMed

van Oorschot, B; Lipp, V; Tietze, A; Nickel, N; Simon, A

2005-02-11

With regard to medical decisions and measures at the end of life, the values and attitudes of those concerned are crucial. However, they have hardly been taken into account so far in German empirical studies on euthanasia and medical advance directives. Between October 2003 and May 2004, a mail survey of a representative group of internists, anaesthetists and general practitioners from Bavaria, Westphalia-Lippe and Thuringia was conducted. Of 1,557 mailed questionnaires 727 were returned (rate of returns: 46 %). The survey showed, high of appreciation for medical advance directives and, at the same, time scepticism regarding surrogate decision-making by legal guardians and authorized representatives. Furthermore, the survey revealed a considerable amount of uncertainty in the physicians about the application of certain measures at the end of life to the different forms of euthanasia. In practice, many physicians do not comprehend the juridical differentiation between (illegal) active and (legal) passive or indirect euthanasia. In training and further education more scope should be given to the reflection of medical decisions at the end of life. At the same time, the usual, partly counterintuitive legal definitions should be brought more into line with medical decision making, while taking into account developments in English speaking areas. A transdisciplinary discourse is indispensable for the development of medical ethical and legal justifications suitable as guidance for action.

Aspects of dento/medico-legal report writing.

PubMed

Wood, Geoff D

2014-03-01

This paper offers some guidance on aspects of dento/medico-legal report writing, citing anonymized examples from the author's caseload for clarification of the points made, and also serves to illustrate that sometimes not everything is as straightforward as it may initially appear. It provides reference to the current Civil Procedure Rules in England and Wales and its relevance in report writing. To provide guidance on aspects of dento/medico-legal report writing.

The legal and ethical aspects of telemedicine. 1: Confidentiality and the patient's rights of access.

PubMed

Stanberry, B

1997-01-01

This paper reviews the principle of confidentiality and the rights of access by patients to their medical records. Confidentiality has been germane to the ethics of medical practice since the time of Hippocrates but the nature of the legal obligation of confidence does not have such a clear pedigree. The introduction of cross-border telemedical consultations presents a very real danger to maintaining the confidentiality of medical data. While both the common law and statute law can be used to prevent the unauthorized interception and disclosure of medical data and protect the patient's rights of access and ownership in the UK, it is the harmonization regime of the European Union that will bring comprehensive regulation and legal clarity to the protection of patients' rights within an increasingly international medical 'super-specialty'.

The legal system, the U.S. Forest Service, and human-caused wildfires.

Treesearch

Linda R. Donoghue; Donna M. Paananen

1984-01-01

Presents an overview of the American legal system; describes the relations and interactions between the Forest Service and legal system components and processes; discusses how individuals enter, move through, and leave the legal system; and describes the current status of Forest Service law enforcement efforts directed at wildfire violations.

Legal aspects of E-HEALTH.