In Matter of Spring. 21 Dec 1979.
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This article looks at the newly-issued JCAHO standards and their increased focus on patient safety in performance standards for healthcare organizations. As part of these standards, hospitals are required to inform patients of outcomes of care, including unanticipated outcomes. This article examines this requirement and suggests varying interpretations of it. After looking at the current legal and ethical standards requiring disclosure of errors or negligent acts, the article suggests that hospitals are faced with many difficulties in implementing the standard. Specifically, the article argues that more details are necessary regarding what events must be reported and what hospitals are required to do when members of the medical staff refuse to inform patients of medical error.
This article discusses the complex legal and operational issues related to the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) unanticipated outcomes disclosure standard. The author examines case law on the discoverability of hospital quality improvement efforts and information submitted to the JCAHO, and considers whether submitting this information to JCAHO amounts to a waiver of privilege. The author concludes disclosure of an unanticipated outcome should not give rise to a waiver if the hospital and physician are careful in making the disclosure.
They have needs, and because they live within a welfare state, these needs confer entitlements--rights--to the resources of people like me. Their needs and their entitlements establish a silent relation between us. As we stand together in line at the post office, while they cash their pension cheques, some tiny portion of my income is transferred into their pockets through the numberless capillaries of the state. The mediated quality of our relationship seems necessary to both of us. They are dependent on the state, not upon me, and we are both glad of it.... My responsibilities towards them are mediated through a vast division of labour.... When they can't go on, an ambulance will take them to the hospital, and when they die, a nurse will be there to listen to the ebbing of their breath. It is this solidarity among strangers, this transformation through the division of labour of needs into rights and rights into care that gives us whatever fragile basis we have for saying that we live in a moral community.
HOLDING: In the accelerating rush to judgment that occurred here, a series of legal errors and missteps following a preliminary hearing compounded what was already an excruciatingly difficult and complex situation. The record strongly suggests that no one involved in the protective proceeding had ever communicated directly with baby AMB's parents and only the testifying doctor had ever seen AMB, an infant with life-threatening disabilities. Thus, a duly enacted statutory process designed to protect individual rights, to allow the intelligent exercise of these rights, and to assure balanced and considered decision making became, instead, the opposite. There was such a relentless disregard for basic principles of law that in its opinion, the Michigan Court of Appeals attempted to assure that this tragedy is never repeated in that state.
HELD: There is no right to euthanasia within the constitutional right of privacy. Recognition of such a right to euthanasia would impermissibly expand the right of privacy and thus place the issue outside the arenas of public debate and legislative action. Such a holding would also involve the judiciary in deciding questions that are simply beyond its capacity. There is no principled basis for the court to legalize euthanasia.
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Due to the possibility of storing gametes and pre-embryos, conflicts over the use of pre-embryos and post mortem insemination have found their way into the courts. Case law allows parties to conclude an agreement as to the destination of their pre-embryos in case of divorce or death. These agreements shall be presumed binding. However, if the agreement leads to forced procreation, this will not be allowed. If there is no agreement, or no agreement that can be enforced, the Davis rule will be applied: the right to procreate and the right to avoid procreation will be balanced against each other. If post mortem procreation is not prohibited, the role of a third party, i.e. the doctors or the future child, should also be taken into account.
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