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State passes physician-aided suicide; now asks, 'What have we done'?

It's hard to tell whether we're hearing a collective sigh of relief or the catching of one's breath as Oregon's Death with Dignity Act was passed but put on hold. Regardless, the show's not over, although the devil in the details is starting to emerge. Many are calling the vote a "wake-up call," although it appears that opposing messages are being heard. Moreover, the distinction between physician-aided suicide and euthanasia are becoming ever more blurred.

Attitude of Health Personnel↗

Contemporary challenges for Catholic healthcare.

In this article, Father Morrisey uses a legal approach to analyze the challenges facing Catholic healthcare in a time of rapid change, drawing his observations from his work with Catholic healthcare institutions both in Canada and in the United States.

Canada↗

Donaldson v. Van de Kamp: cryonics, assisted suicide, and the challenges of medical science.

In recent years, advances in medical science have left the legal community with a wide array of social, ethical, and legal problems previously unimaginable. Historically, legislative and judicial responses to these advances lagged behind the rapid pace of such developments. The gap between the scientist's question, "Can we do it?," and the lawyer's question, "Should/may we do it?'" is most evident in the field of cryonics, with its technique of cryonic, or cryogenic, suspension. In cryonic suspension, a legally dead but biologically viable person is preserved at an extremely low temperature until advances in medical science make it possible to revive the person and implement an effective cure. The terminally ill patient who wishes to benefit from such treatment is faced with the dilemma that present life must be ceased with hope of future recovery. As a result, the process challenges our traditional notions of death and the prospects of immortality while raising a host of concomitant legal dilemmas. Some facets of this dilemma are exemplified by Donaldson v. Van de Kamp. In Donaldson, Thomas A. Donaldson sought the declaration of a constitutional right to premortem cryonic suspension of his body and the assistance of others in achieving that state. Donaldson, a forty-six-year-old mathematician and computer software scientist, suffers from a malignant brain tumor that was diagnosed by his physicians in 1988. This tumor is inoperable and continues to grow and invade his brain tissue. Donaldson's condition will gradually deteriorate into a persistent vegetative state and will ultimately result in death. Physicians predict his probable death by August 1993. Donaldson petitioned the California courts, seeking a declaration that he had a constitutional right to achieve cryonic suspension before his natural death. His doctors believe that if Donaldson waits until his natural death to be suspended, future reanimation will be futile because the tumor will have destroyed his brain. In addition, Donaldson's doctors sought an injunction against criminal prosecution for their participation in the suspension, because Donaldson, once suspended, would be considered "dead" under California law. Donaldson and his doctors built their novel argument upon the recent right-to-die cases in which the courts recognized a patient's right to have life-sustaining medical treatment withdrawn. Donaldson argued that his right to privacy and self-determination is paramount to any state interest in maintaining life. Thus, according to Donaldson, balancing the state's reasons to end--or "interrupt," as cryonics enthusiasts would have it--his own life was not necessary. The trial court dismissed the complaint for failure to state a cause of action, and Donaldson appealed to the California Court of Appeals. Because the cryonic process would necessarily involve physician-assisted death, or the aiding, advising, or encouraging of another to commit suicide, the appellate court affirmed the ruling of the trial court, holding that Donaldson did not have a constitutional right to assisted death. Additionally, in light of Donaldson's First Amendment challenge to the statute, the court upheld the criminal statute prohibiting the aiding, advising, or encouraging of another to commit suicide. This Note briefly discusses the process of cryonic suspension and explores the holding of Donaldson in light of the underlying rationale of the California right-to-die cases. Considering the contradictory state and individual interests balanced in the right-to-die cases, this Note concludes that, under a similar balancing test, premortem cryonic suspension could be permitted under certain circumstances; however, the right to premortem cryonic suspension may be more effectively recognized through legislation.

California↗

Medical records and privacy: empirical effects of legislation.

OBJECTIVE: To determine the effects of state legislation requiring patient informed consent prior to medical record abstraction by external researchers for a specific study. DATA SOURCES/STUDY SETTING: Informed consent responses obtained from November 1997 through April 1998 from members of a Minnesota-based IPA model health plan. STUDY DESIGN: Descriptive case study of consent to gain access to medical records for a pharmaco-epidemiologic study of seizures associated with use of a pain medication that was conducted as part of the FDA's post-marketing safety surveillance program to evaluate adverse events associated with approved drugs. DATA COLLECTION: The informed consent process approved by an institutional review board consisted of three phases: (1) a letter from the health plan's medical director requesting participation, (2) a second mailing to nonrespondents, and (3) a follow-up telephone call to nonrespondents. PRINCIPAL FINDINGS: Of 140 Minnesota health plan members asked to participate in the medical records study, 52 percent (73) responded and 19 percent (26) returned a signed consent form authorizing access to their records for the study. For 132 study subjects enrolled in five other health plans in states where study-specific consent was not required, health care providers granted access to patient medical records for 93 percent (123) of the members. CONCLUSION: Legislation requiring patient informed consent to gain access to medical records for a specific research study was associated with low participation and increased time to complete that observational study. Efforts to protect patient privacy may come into conflict with the ability to produce timely and valid research to safeguard and improve public health.

Cohort Studies↗

Civil commitment of the mentally ill: an overview.

This article discusses historical themes that led to the civil commitment reforms of the sixties and seventies. The changes in the substantive criteria for commitment are analyzed and critiqued. The author believes that the present criteria tend to focus so specifically on various external indicia of mental illness that they render commitment difficult for many seriously ill patients. An alternative commitment scheme is discussed.

Commitment of Persons with Psychiatric Disorders↗

Empirical Dimensions of Discrimination Against Disabled People.

Where at one time professionals viewed disability as a condition inherent in a person, there now is widespread acceptance that, in large measure, disability is a social construct with roots in societal attitudes. Specifically, the case has been made by disabled people that they are the victims of discrimination. This paper reviews some of the empirical evidence of discriminatory practices in the areas of: access to education; meaningful participation in the labor force; and, physical and sexual assault. There is ample evidence of discriminatory practices in education and employment which further disadvantage disabled people. Disabled people receive less education and are much less likely to find a job than are non-disabled people and are much more vulnerable than the non-disabled to sexual or physical assault. Promoting and protecting the rights and dignity of disabled people will require a combination of legal approaches, attention to the concrete realities of disability and societal barriers, and changes in the perception of and societal attitudes towards disabled people.

Journal Article↗

Genetic information and genetic discrimination how medical records vitiate legal protection. A comparative analysis of international legislation and policies.

This study compares currently enacted and pending legislation and policies concerning genetic information and genetic discrimination in Europe and the USA. The emergence of a multi-disciplinary scientific field comprising genetically-related areas and the discovery of new genetic factors have improved our ability to predict genetic risks associated with illness. Early detection and preventive healthcare thus hold promise for improving public health, but much remains unknown about the actual risks deriving from genetic testing. Positive (not-normal) test results may give little certainty of the actual severity of a disease. Genetic information could thus be used for social stigmatization and genetic discrimination. Western laws have been enacted in a context of unknown potential risks and benefits, and an increased number of regulatory initiatives is to be expected. Yet, there is currently no comprehensive US or European legal approach concerning genetic information and genetic discrimination and, despite legislation thus far enacted, the protection of individuals remains uncertain, and this could have a negative impact on attitudes to genetic testing, with important consequences for public health strategies to prevent disease.

Confidentiality↗

The physician as a health care proxy.

Many states prohibit patients from appointing their physicians as health care proxies, fearing paternalism and conflict of interest. But the potential for conflict is not unique to physicians, and patients may have compelling reasons to prefer that their doctor make decisions on their behalf. Managing potential conflicts serves patients better than denying them the right to choose who will make health care decisions for them when they are no longer competent.

Authoritarianism↗

Ethics and aims of cosmetic surgery: a contribution from an analysis of claims after minor damage.

MAIN OBJECTIVES: Cosmetic surgery raises the ethical problem of the balance of risks and benefits of an operation the benefit of which is psychological and difficult to evaluate. The aim of this study is to improve the understanding of the factors that influence an unsatisfactory outcome. In this context, we have analyzed complaints from patients the alleged damage to whom proved to be ultimately non-existent or minimal. METHODS: Review of the case notes of 20 patients who had sought damages through the French judicial system for minimal or non-existent alleged damage. Data were collected in 1999. FINDINGS: We found fifteen complaints of insufficient results, two for cause and effect relations with pathologies without any connection, and three for lack of information. 5 patients received compensation, the rest having been ruled out of court. The gender ratio (17 F/3 M), the average age (38 years old), the distribution of the operations and the socio-professional categories reflect the characteristics of a standard cosmetic surgery population. The average period of time between an operation and a complaint was 4.3 years (SD = 4.2). Among the medical histories we found two cases of depression, one treatment "for the nerves", one suicide attempt, and two cases of alcoholism without possible interpretation in the framework of this study. In six cases, the surgeon's qualification was not appropriate to the type of operation. The unprofessional conduct of colleagues had an influence on the effect of the procedure as an independent factor. CONCLUSION: These results call for more responsibility from professionals and encourage the undertaking of prospective complementary studies in order to evaluate more precisely the balance of risks and benefits.

Adult↗