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PubMed1984

Informed consent in Canada: an empirical study.

The case of Reibl v. Hughes has significantly altered the law regarding informed consent in Canada. It might be expected, therefore, that its impact on the Canadian medical profession would be significant. However, in the first study to examine the practice of Canadian doctors in this respect, Professor Robertson concludes that the profession is largely unaware of either the decision or its importance. Further, the study examines doctors' current perceptions and opinions on the disclosure of risks to patients and the results, among others, raise serious questions regarding both the awareness and reception of important legal rulings.

Attitude of Health Personnel↗
PubMed1998

Legalization of assisted suicide. A pilot study of gerontological nurses.

1. Legalization of physician-assisted suicide poses serious challenges to the Code for Nurses of the ANA, particularly in the areas of self-determination and autonomy versus sanctity of life. 2. Nurses in this pilot study were divided in their support of legalization of physician-assisted suicide for all ages (46 in favor, 54 opposed) but showed stronger support for legalization when applied to the elderly (58 in favor, 42 opposed). 3. No demographic variables realized statistical significance toward attitudes on the legalization of physician-assisted suicide or its legalization as applied to the elderly. 4. While supported conceptually, the actual practice of physician-assisted suicide was not supported by many who were in favor of legalization of physician-assisted suicide.

Adult↗
PubMed1993

The law and AIDS: issues and objectives (a comparative approach).

What are the proclaimed and actual objectives of the legal measures various governments have adopted to deal with the AIDS pandemic? What political and social issues are involved? Are public health regulations compatible with human rights? Does the fight against AIDS justify discrimination and repression? Will AIDS, given the social and legal reactions to it, undermine the progress of our civilization? 'May I see nothing but humanity in the person who suffers'--Maimonides.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Professional liability (malpractice) coverage of humanist scholars functioning as clinical medical ethicists.

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way the function as clinical ethicists.

Consultants↗
PubMed2000

The capacity of people with a 'mental disability' to make a health care decision.

BACKGROUND: Based on the developing clinical and legal literature, and using the framework adopted in draft legislation, capacity to make a valid decision about a clinically required blood test was investigated in three groups of people with a 'mental disability' (i.e. mental illness (chronic schizophrenia), 'learning disability' ('mental retardation', or intellectual or developmental disability), or, dementia) and a fourth, comparison group. METHODS: The three 'mental disability' groups (N = 20 in the 'learning disability' group, N = 21 in each of the other two groups) were recruited through the relevant local clinical services; and through a phlebotomy clinic for the 'general population' comparison group (N = 20). The decision-making task was progressively simplified by presenting the relevant information as separate elements and modifying the assessment of capacity so that responding became gradually less dependent on expressive verbal ability. RESULTS: Compared with the 'general population' group, capacity to make the particular decision was significantly more impaired in the 'learning disability' and 'dementia' groups. Importantly, however, it was not more impaired among the 'mental illness' group. All the groups benefited as the decision-making task was simplified, but at different stages. In each of the 'mental disability' groups, one participant benefited only when responding did not require any expensive verbal ability. CONCLUSIONS: Consistent with current views, capacity reflected an interaction between the decision-maker and the demands of the decision-making task. The findings have implications for the way in which decisions about health care interventions are sought from people with a 'mental disability'. The methodology may be extended to assess capacity to make other legally-significant decisions.

Adolescent↗
PubMed1990

Researching the effects of confidentiality law on patients' self-disclosures.

We hypothesized that conflicting research findings on the effects that confidentiality laws have on patients' self-disclosure reflect the fact that privacy is important only to some patients in some circumstances. Instead of asking whether privacy is always important, we posed the following question: What factors determine whether privacy is important? With 42 outpatients we found that self-disclosures about sensitive issues (e.g., child abuse, drug abuse) during intake were determined partly by how legally informed patients were and partly by how relevant and consequential the law was to their cases.

Confidentiality↗
PubMed2004

Abortion in Islamic countries--legal and religious aspects.

The debate over abortion is still controversial as ever. As one of every four people in the world is of the Muslim religion, it is important to learn more about the Islamic point of view toward this dilemma in medical ethics. The first part of this paper gives a general view of the sources of Islamic law and discusses modern developments in Islamic medical ethics regarding abortion. The second part focuses on the legal aspects of abortion in different Islamic states, dealing with the need to supply solutions to women who for different reasons wish to abort and at the same time enact laws that would not contradict Islamic principles. A study of three Muslim states (Egypt, Kuwait and Tunisia) demonstrates three different approaches toward legalizing abortion--a conservative approach, a more lenient approach, and a liberal one--all within Islamic oriented states. This leads to a conclusion that a more liberal attitude regarding abortion is possible in Islamic states, as long as traditional principles are taken into account.

Abortion, Induced↗
PubMed2003

Refusal of treatment during pregnancy.

A survey of maternal-fetal medicine fellowship directors in the 1980s found that many supported coercive treatment of pregnant women for the sake of their potential children. To examine whether legal, social, and medical developments since then have led to changes in practice or attitudes about this issue, we surveyed current directors of maternal-fetal medicine fellowship programs. Our data show that the number of requests for court orders in such cases has declined, but some practioners and judges still support them. In this article we offer an update on pertinent legal rulings, describe the method and results of our study, and discuss ethical aspects of the issue.

Civil Rights↗
PubMed1992

Why the gap? Practice and policy in civil commitment hearings.

The failure of civil commitment procedures to meet statutory requirements is one of the more reliable findings in the applied social sciences. Most states now require specific legal procedures and behavioral standards for involuntary hospitalization. Nonetheless, empirical studies have demonstrated that commitment hearings are rarely adversarial and clinical concerns continue to take precedence over legal issues. These findings are analyzed in the context of three related issues: the grounds for commitment that are used in civil commitment hearings, the particular difficulties of recommitment hearings, and the shortcomings of the national policy of deinstitutionalization. The authors conclude that a primary cause of the gap between legal standards and actual practice is the absence of viable, less restrictive alternatives to inpatient treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

The Adults with Incapacity (Scotland) Act--Who knows? Who cares?

UNLABELLED: The Adults with Incapacity (Scotland) Act 2000 provides new guidelines on obtaining consent for adults who are incapable of providing informed consent. This article surveys current practice of health workers when obtaining consent from such individuals, and the results are compared to the Incapacity Act and local guidelines. The survey results suggest that practice of the guidelines is variable and often legally inadequate. AIMS: To quantify awareness and practical application of the Adults with Incapacity (Scotland) Act in surgical wards in a central Glasgow teaching hospital, 2 years after the Act's introduction. METHODS: An interviewer led anonymous questionnaire was presented to all degree educated staff encountered on random visits to acute and elective surgical and orthopaedic wards in a split site teaching hospital. RESULTS: 17 out of 50 staff approached (34%) had not heard of the Adults with Incapacity Act. There was a significantly higher level of awareness amongst staff based on acute wards (85%) when compared with those from elective wards (54%) (p < 0.05, chi-square) There was a complete absence offormal training in using the Act and knowledge was sometimes inaccurate or incorrect. Most staff that had heard of the Act could suggest causes of incapacity, but some included physical disability. There was a persistence of the belief that a relative can consentfor an incapable adult patient, and this was expressed by some of the staff despite knowledge of the Act. CONCLUSIONS: This study shows that a significant number of ward staff have no knowledge of the Act; and understanding is variable amongst staff who have heard of it. The Adults with Incapacity (Scotland) Act 2000 is a unique piece of legislation to protect the interests of incapable patients, and doctors treating them; but is of no use if medical and nursing staff are unaware of its existence.

Adult↗
PubMed2001

Physicians' attitudes towards patients' rights legislation.

Patients' rights laws, bills and charters aim at delineating the patient-physician relationship in regard to consent to medical treatment, confidentiality and related issues. The need to shape such an intimate relationship by way of legislation seems anomalous to some, but imperative to others. We present for the first time an insight into Israeli physicians' attitudes towards Israel's patients' rights laws, in a changing medical and socio-legal environment. The research results suggest that physicians are reluctant to participate in the implementation of such laws, demonstrated by the level of their misunderstanding of the law's norms and regulations, and subjective attitudes and perceptions. In order to ensure the medical community's participation in augmenting patients' rights, efforts should focus on improved legal and ethical education, enhanced cooperation of professional associations and joint action with legislators to assure a productive composition of these important acts.

Attitude of Health Personnel↗
PubMed1992

Treatment decisions for terminally ill patients: physicians' legal defensiveness and knowledge of medical law.

In this study, we investigated physicians' attitudes, knowledge, and reported practices regarding the effects of perceived legal constraints on the abatement of life-sustaining treatment from patients who are clearly dying. A factor in assessing these issues is the concept of defensive medicine -- that is the perception that doctors are being forced to order every possible laboratory test and second opinion, or to continue providing non-beneficial life-sustaining treatment, solely to protect themselves from future legal claims. This perception appears widespread among practicing physicians. However, we believe that defensive medicine represents only part of a complex constellation of factors that comprise physicians' reluctance to abate treatment. This phenomenon encompasses medical, legal, social, psychological, and spiritual factors interacting in ways that are not fully understood. We remain cognizant of the potential impact of all these factors. For purposes of this article, however, we have chosen to focus on legal and psychological aspects of physicians' reluctance to abate treatment and the corresponding ethical implications.

Attitude↗