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Charting a course through difficult legislative waters: tribunal decisions on life-sustaining measures.

Since the enactment in Queensland of the Powers of Attorney Act 1998 (Qld) and the Guardianship and Administration Act 2000 (Qld), a decision can be made to withhold or withdraw life-sustaining medical treatment from an adult who lacks capacity to make such decisions for herself or himself. The Guardianship and Administration Tribunal of Queensland has been asked to consider the law in relation to these decisions on a number of occasions since the legislation was passed. This article explores the relevant provisions of these statutes and some of the difficulties that arise from how they are currently drafted. It also examines how the Guardianship and Administration Tribunal has dealt with applications to withhold or withdraw life-sustaining measures, and suggests a course that might avoid some of the difficulties that are inherent in Queensland's legislative regime.

Adult↗

Advance health directives.

Case histories are based on actual medical negligence claims or medicolegal referrals, however, certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. The aim of this article is to outline the legislative framework in relation to advance health directives and enduring powers of attorney or guardianship, with a particular focus on the medical and legal issues of relevance with respect to an assessment of mental capacity.

Advance Directives↗

Life and death choices after Cruzan: case law and standards of professional conduct.

Medical practitioners often feel obligated to use all available procedures to sustain patients' lives. A review of case law indicates, however, that practitioners who abate treatment that is contrary to people's known preferences or current best interests act legally and in accordance with the highest professional standards. In the case of Nancy Cruzan, the Supreme Court delegated to the states the determination whether to respect the rights of nonautonomous patients to die with dignity. States should enact creative laws to encourage families and physicians to discuss final care, and assist people in making clear and simple statements about their preferences.

Advance Directives↗

Medico-legal and ethical problems associated with treatment of children born with congenital malformations.

Recent advances in medicine and biomedical science have brought in their wake a whole array of moral, ethical and medico-legal problems. For eg, in relation to the withholding or withdrawal of treatment of neonates born with congenital malformations. While the technology to treat and thus to artificially prolong life is available, the related question of whether or not to do so and in what circumstances has to be considered. There is a paucity of cases in the courts. However, some useful principles can be drawn from a number of cases in the UK. The search for clearer legal and moral criteria has become more urgent. A way ahead appears to lie in the formation of Hospital Review Committees or some such mechanism which would enable the most appropriate decision to be taken in any one case bearing in mind the complex ethical and medico-legal issues involved.

Abnormalities, Multiple↗

Consent to treatment: application to performing arts medicine.

Because treatment outcomes may have an effect on performing artists' livelihood, physicians should involve these patients in the treatment planning phase by obtaining informed consent. Treatment without consent is a battery. Physicians have several available lines of defense against an allegation of failure to obtain informed consent, including reasonable documentation of treatment plan discussions with patients; the "so what!" defense, which states that the patient would have agreed to treatment despite the risks; and the "unduly alarming" defense, which contends that based on past experience with a particular patient, proper disclosure would cause undue emotional distress. Alert compliance with the laws governing consent for treatment and sound medical judgment are every physicians' legal, ethical, and moral duty.

Humans↗

The nurse educator and the legal implications.

This paper considers the liability of the nurse educator in her professional work. It begins by exploring the law for liability in giving negligent instructions and advice and the possibility of being liable for harm caused to a patient as a result of negligent teaching. The possibility of being liable if an incompetent student becomes registered and causes harm is also discussed. Liability for giving references on students is also considered and differences in outcomes between true but unsupportive references as against false but supportive ones are analysed.

Education, Nursing↗

Legal issues in ambulatory surgery.

Professional liability is an issue of increasing concern to all health care practitioners. The components that constitute professional liability are discussed. Issues that safeguard and define nursing practice are explored from the ambulatory setting perspective.

Ambulatory Surgical Procedures↗

Law for the nurse manager. Legal update--1996, part 2.

Traditional liability issues such as falls and medication errors continue to be a concern for nurses. Researchers predict that more than 770,000 hospital patients will experience an adverse drug event each year; almost half are preventable.

Humans↗

[Legal evaluation of bone tumors].

Three topics are of major importance in the legal evaluation of bone tumors: The questions of medical liability, of causality and of medical evaluation. Concerning medical liability, the legal consequences of proven cases of malpractice are stressed. A causal connection between an accused trauma and the occurrence of a malignant bone tumor can be denied in nearly all circumstances. Due to the well known occurrence of a secondary sarcoma, the irradiation of a benign bone tumor or tumorlike lesion is strongly disfavored. In cases of medical evaluation, patients with malignant bone tumors should be judged by the same criteria as patients with any other diseases and impairments.

Bone Neoplasms↗