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Consumer Product Safety↗

[Legal problems in obstetrics. On the "liability of the expert witness"].

There has been a depressing increase in claims for damages and associated civil code and legal code proceedings in medicine in general (as the term "defensive medicine" illustrates) that exercises considerable influence on medical activities in obstetrics, not always to the benefit of the patients. In what manner and to what extent the expert can and must influence legal decisions, is demonstrated by means of a few examples such as management of parturition in case of breech presentation, causal assessment of psychomotoric retardation in postnatal life and the management of dystocia in shoulder presentation. If judges and attorneys are blamed-as is often the case-one should always also consider the significance of expertising activities. Typical errors occurring during expert assessment are pointed out. This shows the high degree of responsibility that has to be shouldered by the expert when he advises judges and/or attorneys. Expertising activities should be directed to a greater measure than in recent years, at delivering expertises restricted to the factual situation without involving emotions. This would at the same time reduce the influence of judges, attorneys and lawyers on our medical activities, an influence that has recently been much deplored.

Birth Weight↗

The duty to counsel: reviewing a decade of litigation.

Twenty-three legal cases from the 1980s were studied. The allegation in each of these cases was that the defendant pharmacist should have done something more than correctly process a prescription to prevent harm to the patient from drug use. Four theoretical models of pharmacist legal responsibility are considered: (1) the policy-analysis model, (2) the professional-standards model, (3) the consumer-expectation model, and (4) the power model. It is concluded that the power model, based on superior knowledge and reasonable foreseeability of harm, best defines the pharmacist's legal responsibility, consistent with established legal precedents.

Humans↗

The suicide prevention contract: clinical, legal, and risk management issues.

In the managed care era, mental health professionals increasingly rely upon suicide prevention contracts in the management of patients at suicide risk. Although asking a patient if he or she is suicidal and obtaining a written or oral contract against suicide can be useful, these measures by themselves are insufficient. "No harm" contracts cannot take the place of formal suicide risk assessments. Obtaining a suicide prevention contract from the patient tends to be an event whereas suicide risk assessment is a process. The suicide prevention contract is not a legal document that will exculpate the clinician from malpractice liability if the patient commits suicide. The contract against self-harm is only as good as the underlying soundness of the therapeutic alliance. The risks and benefits of suicide prevention contracts must be clearly understood.

Humans↗