Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Legal Approach”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed2001

The prevalence and correlates of capacity to consent to a geriatric psychiatry admission.

In the UK the recent House of Lords ruling on the Bournewood case provided a statutory basis for admitting patients into psychiatric beds who lack the capacity to consent, but do not dissent, without recourse to detention under the Mental Health Act. A study to ascertain the prevalence and correlates of the lack of capacity to consent to geriatric psychiatry inpatient admission was undertaken. All consecutive acute inpatient admissions to a geriatric psychiatry unit over a six-month period were examined by an independent research psychiatrist (SM). Data on demography, diagnosis, severity of cognitive impairment, insight, the SM's assessment of capacity to consent to the admission and the consultant psychiatrists' assessment of the capacity to consent to the admission were ascertained. The overall prevalence of lack of capacity to consent to geriatric psychiatry inpatient admission was 48%. It was associated with a diagnosis of dementia, increased severity of cognitive impairment, reduced insight and detention under the Mental Health Act. The kappa concordance between SM's and the consultant psychiatrist's assessment of capacity was modest at 0.6. These findings require replication in a larger multi-centre study, perhaps using standardised instruments to measure capacity. A large number of psychiatric patients are informally admitted despite lacking the capacity to consent to the admission because they do not dissent. These patients do not enjoy the safeguards available under the Mental Health Act.

Aged↗
PubMed2005

Pediatric do-not-attempt-resuscitation orders and public schools: a national assessment of policies and laws.

Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored.

Adolescent↗
PubMedDate not supplied

Research subject advocate: a new protector of research participants.

In 2001, the National Center for Research Resources (NCRR) directed the 78 General Clinical Research Centers (GCRC) to develop a Research Subject Advocate (RSA) position. The RSA would report directly to the Principal Investigator (PI) of each GCRC and assure compliance of studies conducted on the GCRC with federal regulations and policies. Seven RSAs agreed to be interviewed about their new role. Website documents, electronic correspondence, and presentations at the first annual national meeting of RSAs were scrutinized using discursive analysis to shed light on this new organizational form and its potential for increased protection of human research participants. The RSA role actualizes the ethical principles of respect for persons, justice, and beneficence that are the foundation of the protection of research participants. The results also reveal the regulatory, institutional, collegial, and personal resources and barriers that assist the RSA in the successful implementation of the RSA role. In addition, issues important to the RSAs are described.

Clinical Trials as Topic↗
PubMed2000

What is the role of procedural justice in civil commitment?

OBJECTIVE: To determine best practice management strategies in the clinical application of civil commitment. METHOD: All relevant literature on the topics of 'civil commitment', 'coercion' and 'procedural justice' were located on MEDLINE and PsychLIT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings. RESULTS: Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice. CONCLUSIONS: Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.

Advance Directives↗
PubMed2004

The precautionary principle, toxicological science, and European-U.S. scientific cooperation.

Although it is an ages old concept, the precautionary principle is only a few decades old as a formal expression of a philosophy guiding protection of the environment and of human health. The emergence of the precautionary principle in the European Community and its relatively slower acceptance in the United States reflects differences in underlying social, cultural, and legal approaches to environmental and public health protection. Unfortunately, this poorly defined principle in some of its manifestations can lead to a loss of the toxicological scientific base that is necessary for short-term and long-term protection of the environment and public health. Examples of problems caused by using the precautionary principle include trade barriers erected by the European Community, and the loss of the impetus to develop understanding of the toxicity of hazardous air pollutants due to precautionary aspects of the 1990 U.S. Clean Air Act amendments. There are other U.S.-European differences in the organization and funding of science that are threatening the legacy of Herbert Remmer which was built on close trans-Atlantic scientific cooperation to the benefit of all.

Animals↗
PubMed2002

A comparison of state advance directive documents.

PURPOSE: Advance directive (AD) documents are based on state-specific statutes and vary in terms of content. These differences can create confusion and inconsistencies resulting in a possible failure to honor the health care wishes of people who execute health care documents for one state and receive health care in another state. The purpose of this study was to compare similarities and differences in the content of state AD documents. DESIGN AND METHODS: AD documents for 50 states and the District of Columbia posted on the Partnership for Caring website were reviewed. States and regions of the country were compared for type or types of documents used and issues included in AD documents. RESULTS: Three states had statutory living will documents only; however, these states did allow for appointment of a health care agent for limited end-of-life decisions. Three states had statutory durable power of attorney for health care documents only, 32 had both statutory living will and durable power of attorney for health care documents, and 13 had statutory forms which combine both types of directive in one document (advance health care directives). Of 8 identified key issues, those addressed by at least 90% of states were designation of a proxy, personal instructions for care, general life-sustaining measures, and terminal illness. When document types were compared, advance health care directive documents included more of the key issues than did living will or durable power of attorney for health care documents (p <.001). IMPLICATIONS: This variability suggests a need for national dialogue to standardize some provisions of AD documents.

Advance Directives↗
PubMed1985

Parental discretion and children's rights: background and implications for medical decision-making.

This paper argues that liberal tenets that justify intervention to promote the welfare of an incompetent do not suffice as a basis for analyzing parent-child relationships, and that this inadequacy is the basis for many of the problems that arise when thinking about the state's role in resolving family conflicts, particularly when monitoring parental discretion in medical decision-making on behalf of a child. The state may be limited by the best interest criterion when dealing with children, but parents are not. The state's relation with the child is formal while the parental relation is intimate, having its own goals and purposes. While the liberal canons insist on the incompetent one's best interest, parents are permitted to compromise the child's interest for ends related to these familial goals and purposes. Parents decisions should be supervened, in general, only if it can be shown that no responsible mode of thinking warrants such treatment of a child.

Adult↗
PubMed2002

Informed consent in functional endoscopic sinus surgery.

OBJECTIVES: Functional endoscopic sinus surgery (FESS) is one of the more common procedures performed by otolaryngologists. Before performing FESS, surgeons are obligated to discuss the procedure and its risks through the process of informed patient consent. The study identifies current practices in informed consent for FESS and formulates guidelines for informed consent for FESS. STUDY DESIGN: Survey. METHODS: Surveys were sent to 1000 American Academy of Otolaryngology-Head and Neck Surgery members in the United States. Surveys inquired about current informed consent practices related to FESS. RESULTS: Three hundred forty-six surveys were returned. Nearly 60% of respondents thought that 1% incidence of a complication warrants a discussion with patients. The percentage of respondents who discuss specific risks were as follows: bleeding, 96.7%; infection, 84.8%; cerebrospinal fluid leak, 99.1%; orbital injury, 96.7%; smell changes, 40.2%; cerebrovascular accident, 17.9%; myocardial infarction, 81%; and death, 28.0%. CONCLUSIONS: The study suggests that there is variability in specific informed consent practices for FESS among otolaryngologists. It also suggests that the incidence or severity of a complication does not necessarily correlate with whether or not it is mentioned during the informed consent process. The authors think that practicing otolaryngologists may be able to use this information to improve their consent practices.

Cross-Sectional Studies↗
PubMed2005

Notices of Privacy Practices: a survey of the Health Insurance Portability and Accountability Act of 1996 documents presented to patients at US hospitals.

BACKGROUND: Federal regulation requires hospitals to present patients with a Notice of Privacy Practices (NPP) that contains all stipulated content items, is readable by patients, and posted on institutional web sites. OBJECTIVE: The objective of this study was to determine whether the NPP texts contain the required content, if readability is influenced by local literacy rates, and if readability or the presentation of NPP texts in other languages is influenced by local rates of English proficiency. RESEARCH DESIGN: The authors conducted a cross-sectional study of the web sites of 115 hospitals selected from the US News and World Report list: Best Hospitals in America. MEASURES: English NPP texts were evaluated for 18 content items and readability using the Flesch-Kincaid scale, which assigns the minimal grade level required to read a text (range, 0-16). RESULTS: NPP texts were available for all hospitals (115 of 115). A Spanish-language NPP was available for 25% (29 of 115). All content items were evident in 76% (87 of 115) of hospitals' NPP texts. The average grade-level readability of NPP text was 12.3 (95% confidence interval, 12.0-12.7). Readability was not associated with the rate of local literacy (P = 0.07). Hospitals with a lower local rate of English proficiency had NPP texts that were more difficult to read (P = 0.03) and did not present NPP texts in other languages more frequently (P = 0.15). CONCLUSIONS: Although NPP texts typically cover the stipulated content, they are written beyond the reading capacity of the majority of American adults. Explicit federal guidance is needed to help privacy lawyers draft NPP texts that are both comprehensive and comprehensible. The goals of the Health Insurance Portability and Accountability Act of 1996 Privacy Rule cannot be met with NPP texts patients cannot decipher.

Analysis of Variance↗
PubMed2004

Health Insurance Portability Accountability Act (HIPAA) regulations: effect on medical record research.

OBJECTIVE: To evaluate the effect of impending HIPAA regulations on Applications for Exemptions from Institutional Review Board (IRB) approval. SUMMARY BACKGROUND DATA: HIPAA was implemented to reduce potential for misuse of personal information and restricts access to medical records by insurers, employers, and clinical researchers. We hypothesized that HIPAA regulations adversely impact medical records research. METHODS: The UW-Madison Human Subjects Committee database was accessed to evaluate success and delays in processing Applications for Exemption between September 1999 and March 2003. The number of protocols submitted, number of required revisions, and number considered nonexempt (requiring full IRB review) were determined. RESULTS: Prior to 2000, applications for medical records research were rare (11 applications in 1999-2000). In anticipation of the implementation of HIPAA regulations, a new application process was instituted in 2001. During that year, 92 of 103 were approved by an expedited process with few requiring full IRB approval. In 2002 to 2003, submissions increased to 199 and approval without revision dropped to 59% (P < 0.0001) as the number requiring revision (25%) and full IRB approval (16%) increased significantly (P < 0.0001 and P < 0.05, respectively). Of the 31 requiring full IRB approval, 7 were pursued while 24 (77%) were abandoned. CONCLUSION: HIPAA appears to inhibit medical record and database research. Ethical considerations in healthcare research are paramount, but current HIPAA implementation strategies increase workload for HSC and researchers, and increase the dropout rate for proposed studies when investigators are unable or unwilling to meet the regulatory requirements. It is unclear whether or to what degree the new requirements add to protection of privacy. Studies designed to investigate the costs and effects on quantity and/or quality of research should be prospectively implemented.

Biomedical Research↗
PubMed2002

Psychiatric examinations on handcuffed convicts in Brazil: ethical concerns.

Psychiatric examinations in official institutions of the Brazilian government include examinations of individual convicts--some of whom are highly dangerous--carried out by court decision. These individuals are taken handcuffed under police escort from penitentiaries to the examination site. In most Brazilian states, medical examiners or experts adopt the basic procedure of asking the police officers to remove the handcuffs from the convict for the examination to be carried out. This article analyzes, from the bioethical standpoint, the behavior of 49 forensic psychiatrists in eight Brazilian states in relation to procedures adopted as protection measures against any possible danger posed by their examinees. In the context of a developing country, where sophisticated protection means are not available, the practice of keeping convicts handcuffed during such examinations is compared to other measures and more advisable alternatives are discussed from the ethical standpoint. Considering the dilemma between showing minimum respect for the autonomy of examinees and ensuring the security of examiners, the need to adopt equitable procedures based on the recognition of the different needs of examiners and examinees is addressed.

Attitude of Health Personnel↗
PubMed2003

End-of-life issues as perceived by Lebanese judges.

OBJECTIVES: to assess the attitudes of judges in Beirut, Lebanon, regarding end-of-life issues such as assisted suicide and withholding or withdrawing life-sustaining treatment. SUBJECTS AND METHODS: 85% of all currently acting and in-training judges and public prosecutors in Beirut (N=135) were surveyed using a mailed questionnaire that assessed attitudes toward intervention in five hypothetical cases. The associations of attitudes, on a scale from least to most 'sympathetic' toward assisting those who desire to end their lives, were measured by a variety of personal, social and professional variables. RESULTS: younger individuals, and those who have not yet been formally appointed as judges, were significantly more sympathetic to withdrawal or withholding of life-sustaining devices when patients or their proxies requested it, and more in support of assisted suicide. Gender, religious denomination, religious practice, and personal experience with prolonged illness leading to death among close friends or family, were generally not significant predictors of respondents' attitudes. Years of experience as a judge correlated strongly with age and may have contributed to its predictive effect. DISCUSSION AND CONCLUSIONS: a relatively more sympathetic attitude among younger judges, many of them women, and among trainees, may reflect a historical evolution in younger age-groups in Lebanon today. A survey of opinions in the public may help reach a more conclusive understanding in this regard. In any case, judges in Lebanon will remain important partners in the debate, as they will continue to be the final interpreters of the letter of the law in end-of-life issues.

Age Factors↗
PubMed1995

Dying in dignity: the pros and cons of assisted suicide.

This paper describes the historical background and the current situation regarding the practice of assisted suicide in The Netherlands. It outlines and discusses what is considered to be the 'golden standard' of conduct for doctors and other health professionals in this area, it describes experiences with the application of this standard and discusses some of the major pitfalls involved. It also describes the results of several empirical studies on the attitudes of the general public, and the nature and magnitude of the practice of assisted suicide in the country. It is concluded that although perfect application of the 'Dutch Protocol' encourages and supports careful and responsible professional conduct regarding assisted suicide and provides satisfactory safeguards both for the patients involved, (potential) survivors and society as a whole, there are many cases where the desired perfection is far from feasible, hence assistance with suicide remains very hazardous. It is also concluded, however, that health care policy makers, as well as professionals, should confront the issue of assisted suicide, since, as the historical development in The Netherlands has shown, repression and denial implicates the worst of all possible scenarios, and does not contribute at all to the primordial goals of a humane health care system: the alleviation of suffering and the prevention of premature death.

History, 20th Century↗