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PubMed1999

An Orwellian scenario: court ordered caesarean section and women's autonomy.

Between 1992 and 1996, a small number of women in the UK were forced by the courts to undergo caesarean section against their expressed refusal. Analysis of the reported cases reveals the blanket assumption of maternal incompetence and the widespread use of thinly veiled coercion. Such attitudes and practices are themselves frequently compounded by inadequate communication. Medical discretion in such problematic cases seems to err on the side of safety and so appears to favour the life of the fetus over maternal autonomy. Despite current policy's placement of the pregnant woman at the centre of maternity care, obstetricians' concerns appear to lie more with the unborn fetus. In other words, there seems to be a point at which the value of fetal life begins to outweigh, not so much the life of the woman, but her right to self-determination, her plans and her choices. While it is important to acknowledge that these court ordered caesareans represent an unusual extreme within contemporary maternity care in this country, that they have happened brings into sharp relief some of the stereotypical assumptions about women. These are assumptions that underlie much of current medical practice and may compromise or disempower women in other ways during their experience of pregnancy and labour. Using the first and last of the six reported cases as contextual illustrations, this article focuses on the complex interplay of processes that have brought the medical profession to a position in which their own self-conviction and determination to do what they believe is best for their patients has resulted in gross denial of women's autonomy and the use of the law to override pregnant women's refusal of consent.

Advance Care Planning↗
PubMed1994

Controlling resurgent tuberculosis: public health agencies, public policy, and law.

The reappearance of tuberculosis as a serious public health threat points up the fallacy of the widely held assumption that medical science had conquered the communicable diseases that were once leading causes of morbidity and mortality. In devising a strategy to prevent the spread of TB, public policymakers must adapt traditional TB control measures to reflect the current problem. Such a strategy can and should include the appropriate use of governmental coercion to compel observance of public health TB control measures. Public health approaches to control of human immunodeficiency virus, with their emphasis on the voluntary cooperation of those infected and at high risk for infection, are not a model for effective TB control. Additional resources, while needed, will not alone enable public health agencies to bring TB and other communicable diseases under control. In the present debate over health care reform, little attention has been paid to the importance of public health agencies in protecting the public health. The resurgence of TB is a warning of the consequences of neglecting public health agencies and ignoring the socioeconomic problems that underlie it and other communicable diseases.

Antitubercular Agents↗
PubMed2002

Will physician unions improve health system performance?

In the public debate over the extension of collective bargaining rights to independent physicians, union proponents' primary argument has been that patients would benefit from allowing physicians to bargain collectively with health plans. This article examines the likely effects of physician unions on the U.S. health care system. Specifically considered are likely effects on economic efficiency, quality, access, and cost. Under none of these criteria are physician unions likely to improve health system performance, particularly when compared with available alternative strategies for dealing with problems identified by union proponents.

American Medical Association↗
PubMed2002

The role of group interest, identity, and stigma in determining mental health policy preferences.

Public attitudes toward mental health present an interesting puzzle. While mental health is one aspect of general health and well-being, it receives less support for government spending increases than does health care. One explanation lies with the stigma that is attached to mental illness. This stigma produces more negative attitudes on policy issues related to persons with mental illness such as government spending for mental health. However, group identification, as defined by personal experience or a family member who has experienced a mental illness, may have a strong effect on these attitudes. Using data from the 1996 General Social Survey's module on mental health. I examine this and other hypotheses and find evidence that group identification increases the likelihood of increased support for government spending for mental health. These robust findings exist even in quantitative models, which include politically relevant variables and measure identification with mental illness in two different ways. These findings suggest that mental health is policy for the few because those most supportive of government spending increases are persons who share the common identity of experiencing mental illness.

Attitude to Health↗
PubMedDate not supplied

Medical interventions during pregnancy and childbirth.

The right of the medical profession to intervene during childbirth, contrary to the wishes of the patient, has been the subject of considerable legal debate during the 1990s. However, recent judicial comment in R vs Louize Collins and others [1998] seems to have reached a clear conclusion on the rights of the pregnant woman, and also the steps that can be taken to treat when a pregnant woman has refused intervention.

Child Advocacy↗
PubMedDate not supplied

Confidentiality. 14: Powers of the police and access to information.

Staff nurse Paula Rose was on duty in the accident and emergency (A&E) department early one Sunday morning when a police constable came in asking for details of any patient who had been brought in and for whom there was evidence of a fall from height. The constable explained that a girl had been assaulted and raped while in her bedroom by an assailant who came in through the window. Her screams brought help, but he made his escape from the window and she believed that he had fallen and may have suffered fractures or bruises.

Confidentiality↗
PubMedDate not supplied

Giving medicinal information to mentally capacitated patients.

Roy was advised that a new drug which had just come on the market would assist his chronic depression. He was not given any further information, but after taking it for a few days found that it had a strong effect on his personality and he became aggressive and violent. As a consequence of a fight at work he lost his job and now claims that had he known of these effects he would not have taken the new drug.

Drug Therapy↗
PubMedDate not supplied

Rights to information access under the Data Protection Act.

A patient has a legal right to access personal information held by health professionals on the basis of statutory provisions, such as the Data Protection Act 1998 and the regulations made under that Act, the Access to Health Reports Act 1988 (which is considered in a later article), and also on the basis of the common law, i.e. judge made or case law. Neither legal rights, however, give the patient an absolute right, but are qualified.

Computer Security↗
PubMedDate not supplied

The law regarding health records of the deceased in the UK.

Case Scenario: Following the death in hospital of a patient, John, a dispute has arisen over his will and the allocation of his property. He married twice and had a son from each marriage who have never got on well with each other. In his will he left his terraced house to the son, Bruce, who most frequently visited him at home and in hospital. The other son, Ben, however, feels that Bruce exerted undue influence upon the father and that the property should have been equally divided between the two of them in the absence of any other relatives. He also believes that his father lacked the necessary mental capacity when he made his will and, therefore, the will is also invalid on those grounds. Ben is seeking to access his father's health records to try and establish the mental state of his father at the time he made the will. He has applied to see the records. Will he be able to access them?

Access to Information↗
PubMed1990

Patient 'dumping' post-COBRA.

To gauge the impact of the new federal patient transfer provisions following the federal Combined Budget Reconciliation Act of 1985 (COBRA), we monitored all emergency interhospital transfers to a public hospital emergency department in the Memphis, Tennessee area during three identical time periods: June 1 to August 31 of 1986, 1987, and 1988. A high number of transfers in the summer of 1986 diminished only slightly in summer 1987 (following implementation of COBRA). Far greater reductions occurred in summer 1988, when overcrowding forced our hospital to refuse most transfers. In contrast to changes in hospital policy, COBRA alone had little effect in this area.

Emergency Service, Hospital↗
PubMed1997

The impact of parental consent on the HIV testing of minors.

OBJECTIVES: This investigation assessed change in use of human immunodeficiency virus (HIV) testing by minors after removal of the parental consent requirement in Connecticut. METHODS: HIV counseling and testing records for 13- to 17-year-olds who accessed publicly funded testing sites were analyzed. RESULTS: The number of visits increased by 44% from the 12-month period before the statutory change (n = 656) to the 12-month period thereafter (n = 965). The number of HIV tests increased twofold. Visits and tests of high-risk minors tripled. CONCLUSIONS: Minors should have the right to consent to HIV testing.

Adolescent↗
PubMed1993

Ethics, profit and patients: when pharmaceutical companies sponsor medical meetings.

A series of dynamic changes underway in Washington could transform the manner in which physicians learn of new pharmaceutical therapies. The potential impact of these changes is likely to significantly affect the manner in which physicians learn about and prescribe medications for years to come; the ultimate effect on patient care has yet to be measured, however.

Attitude of Health Personnel↗