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PubMed1995

Using science to influence the Supreme Court on the right to refuse treatment: amicus curiae briefs in Washington v. Harper.

The Supreme Court's use of empirical behavioral science data has grown dramatically in the 40 years since Brown v. Board of Education. Most of these data are submitted in amicus curiae (friend of the court) briefs submitted by parties with an interest in the outcome of the significant mental health law cases coming before the court. The increasing use of such briefs raises important questions. Is there evidence that the court is actually influenced by such briefs? Can scientific/professional organizations present scientific data objectively in a clearly adversarial document? A review of the nine amicus briefs filed in Washington v. Harper, a right to refuse treatment case, and a comparison of the Court's opinion with that of the dissent demonstrate that both the majority and the dissent refer to arguments contained in the briefs, incorporate elements of these arguments, and occasionally paraphrase references cited in the briefs. It remains unclear whether the Court uses such arguments to formulate opinions or to justify them. A comparison of the briefs presented by the American Psychological Association and the American Psychiatric Association highlights the challenge to scientific objectivity inherent in participation in the amicus process.

Antipsychotic Agents↗
PubMed1995

Sanctions against sexual abuse of patients by doctors: sex differences in attitudes among young family physicians.

OBJECTIVE: To explore attitudes of new-to-practice certified family physicians in Ontario concerning sanctions against sexual abuse of patients by physicians and to assess the importance of concern about accusations of sexual abuse in influencing clinical decisions. DESIGN: Qualitative study and cross-sectional survey. SETTING: Ontario. PARTICIPANTS: Focus groups: 34 physicians who completed family medicine residency training between 1984 and 1989 participated in seven focus groups between June and October 1992. SURVEY: all certificants of the College of Family Physicians of Canada who received certification between 1989 and 1991 and were currently practising in Ontario. Of the 564 eligible physicians 395 (184 men and 211 women) responded, for an overall response rate of 70.0%. The response rates among the male and female physicians were 70.5% and 69.6% respectively. OUTCOME MEASURES: Physicians' attitudes toward restricting physical examinations done by physicians to same-sex patients, mandatory reporting of sexual impropriety and loss of licence in cases of sexual violation and the perceived importance of concern about accusations of sexual abuse as an influence on clinical decisions. RESULTS: During the focus groups male physicians in particular expressed concerns about the effect on their practice patterns of the current climate regarding sexual abuse of patients. Female physicians were less concerned about possible accusations of sexual abuse but expressed concerns regarding possible sexualization of the clinical encounter by male patients. In the survey equal proportions of men (163 [93.7%]) and women (191 [92.3%]) disagreed with restricting examinations to same-sex patients. The women were more likely than the men to agree that all suspected cases of sexual impropriety committed by other physicians should be reported (121 [58.7%] v. 86 [50.0%]), whereas the men were more likely to disagree (48 [27.9%] v. 32 [15.5%]) (p = 0.008). The women were also more likely than the men to agree that physicians should lose their licence permanently if they were found guilty of sexual violation (125 [62.2%] v. 73 [43.5%]), whereas the men were more likely to disagree (61 [36.3%] v. 37 [18.4%]) (p < 0.001). Almost half of the men (80 [46.5%]) but only 28 women (14.1%) reported that concerns about accusations of sexual abuse were of importance in their clinical decisions (p < 0.001). CONCLUSIONS: Young female family physicians practising in Ontario are much more likely than their male counterparts to endorse permanent loss of licence for physicians who sexually abuse patients and are significantly less concerned about accusations against themselves. Neither sex endorses only same-sex examinations by physicians. Educational approaches to protect patients while ensuring that appropriate care continues to be delivered are essential.

Attitude↗
PubMed1993

Involuntary medication of patients who are incompetent to stand trial: a descriptive study of the New York experience with judicial review.

The United States Supreme Court, in the recent case of Riggins v. Nevada, extended its examination of the issue of involuntary treatment with antipsychotic medication to the mentally disabled facing criminal trial. A criminal defendant who is "incompetent to stand trial" cannot be subjected to trial. Many such persons are committed to hospitals to be treated and rendered "competent to stand trial," and some of these patients refuse medication. The involuntary administration of antipsychotic medication to such patients raises important and unique medical and moral questions. This highly controversial issue has been understudied. We report here on the first study of persons committed to a state hospital in order to be rendered competent to stand trial who refuse antipsychotic medication and for whom judicial review is requested to allow involuntary treatment, and in which results are given specifically for these subjects. This is a retrospective study to determine the characteristics of such cases and aspects of their outcome in the hospital. We reviewed all cases (N = 68) of application for treatment over objection, filed since the inception in 1986 of the new laws and regulations requiring judicial review through 1990, among patients in the two facilities that receive over 95 percent of all indicted felony offenders in New York State who are incompetent to stand trial. Tentative conclusions are formulated based on the findings that, according to clinical reports, no patient gave only rational reasons for medication refusal, clinicians always indicated the clinical appropriateness of the proposed treatment, judges apparently never found that someone who is "incompetent to stand trial" is "competent" to refuse medication, 93 percent of patients treated involuntarily had a good clinical response, and 87 percent of patients treated involuntarily were restored to "competency to stand trial."

Adult↗
PubMed1994

'Ageism' and right to die litigation.

This study examines 88 reported judicial decisions involving adult patients and decisions about life-prolonging medical treatments. The patient's age by itself does not appear to be a factor influencing findings of mental competency or incompetency or findings of the appropriateness or inappropriateness of abating life-prolonging medical treatments. Neither can an explicit ageist bias be extracted from an analysis of the text of judicial decisions in this arena. Various potential explanations for the lack of apparent ageist bias are suggested.

Adult↗
PubMed1993

Breaking confidentiality survey.

Several Israeli laws require therapists to violate confidentiality. Psychiatrists, clinical psychologists and social workers were asked about their decisions to break confidentiality concerning information revealed in psychotherapy. No differences were found in confidentiality between private practice and public services. No differences were found between the three professional groups. Many therapists claim they do not report sensitive information revealed in psychotherapy, and prefer dealing with the information in therapy. Therapists were less inclined to break confidentiality about past (as opposed to present) sexual abuse. Therapists were less inclined to break confidentiality when sexual abuse was revealed in psychotherapy by the abuser than when revealed by the victim.

Adolescent↗
PubMed1993

Alcohol: the clinician's role in evaluating legal responsibility.

Alcohol-related misconduct poses a challenge for society, the legal system, and the medical profession. The debate is centered on alcohol abuse and the determination of responsibility for misbehavior. In assessing responsibility, the legal system often requests the expertise of the medical professional. The knowledgeable clinician can contribute to the just resolution of complex medico-legal cases. The best contribution considers medical facts in relation to the evolution of legal thinking. This article explores the historical, social, and legal approaches to alcohol-related misconduct. The article concludes with a discussion of a model clinical assessment.

Alcoholism↗
PubMed1993

In re T.A.C.P.

Explore the source record for details and available documents.

Anencephaly↗
PubMed1993

In re Ray.

Explore the source record for details and available documents.

Enteral Nutrition↗
PubMed1993

Screening services in civil commitment of the mentally ill: an attempt to balance individual liberties with needs for treatment.

Screening services are a central feature of New Jersey's new civil commitment law. This law, more commonly referred to as the screening law, exemplifies a nationwide trend in civil commitment legislation, attempting to balance liberty interests and the need to treat the mentally ill. Screening services, designated as the preferred process of entry into involuntary hospitalization, were expected to prevent unnecessary commitment and to provide community mental health services. When deemed necessary, commitment in local general hospitals rather than in state mental hospitals was to occur. This paper reports results of a study of screening centers that were already in operation in New Jersey prior to the implementation of the new law. It assesses the function of screening services and their potential impact on the commitment process in light of the objectives of the law. Data were obtained from in-depth interviews with key informants from the screening centers as well as from their environment, and from statistical reports on hospitalizations in state hospitals, admissions to screening centers, and admissions to psychiatric inpatient units of general hospitals. Analysis suggests that without more resources for alternative community facilities, screening services cannot achieve their objectives and the new reform may not live up to expectations. Shortage of alternatives to hospitalization and lack of incentives to develop and use them appeared to be counterproductive to achieving the objectives of the law. The availability of screening service and psychiatric units in general hospitals for involuntary hospitalization, on one hand, and the lack of alternatives in the community, on the other, may actually lead to inappropriate commitments and an increase in the number of civil commitments. Furthermore, findings indicated that screeners encouraged hospitalization readily even if other, less restrictive environments could have been pursued. Screening centers may become "gate openers" instead of playing their expected role as "gate keepers."

Commitment of Persons with Psychiatric Disorders↗