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Physician reporting of impaired drivers: a new trend in state law?

The State of Oregon recently enacted legislation that increases physician responsibility for reporting medically at-risk drivers. The legislation comes at a time when the public is closely scrutinizing the question of the elderly and driving and the role of physicians in the reporting of potentially dangerous drivers. The evolution of Oregon's law is somewhat unique and offers an opportunity to examine what perhaps is to come in other states. The law broadened the role of the physician in assessment and reporting of impaired drivers. It also opened the door for new tort, that of "negligent failure to report," before input from physicians and other health care providers led to important revisions in the final statute. Physicians must look to current statutes to guide the legislative process in their own states, so that new law aimed at maintaining safe highways also preserves the physician-patient relationship and allows for a collaborative assessment of driving skill in the physician's office.

Accidents, Traffic↗

Sell v. U.S.: involuntary medication to restore trial competency--a workable standard?

Competency to Stand Trial (CST) evaluations are common in the U.S. criminal justice system. Of those defendants found Incompetent to Stand Trial (IST), psychotic disorders are the most common diagnoses, and active psychotic symptoms are strongly correlated with impairments in trial-related abilities. If a defendant is rendered IST because of psychosis, restoration will be unlikely without antipsychotic medication. Last term, in Sell v. U.S., the U.S. Supreme Court dealt with medication refusal in the context of competency restoration. The Court held that involuntary medication, under certain circumstances, is appropriate. This article includes a review of earlier relevant legal decisions and an analysis and discussion of the Sell decision.

Antipsychotic Agents↗

Court-ordered obstetrical intervention and the rights of a pregnant woman.

Cases of court-ordered obstetrical interventions are not common but have caused great controversy in the United States, Canada and Britain. At stake for the pregnant woman is her right to have autonomy over her body and control over the medical treatment that she receives. However, with growing medical knowledge of the fetal condition, there is a case to suggest that the fetus should have some rights in cases where the decision of the pregnant woman to refuse treatment would cause severe harm to the fetus. The article argues that though the case against intervention is extremely strong, court-ordered obstetrical interventions should still be possible in extreme cases.

Australia↗

Fiduciary disclosure of medical mistakes: the duty to promptly notify patients of adverse health care events.

Fiduciary obligations are imposed by the common law to ensure that a person occupying a societal role with a high potential for the manipulation of vulnerable persons exercises utmost good faith. Australian law has recognised that the doctor-patient relationship, while not wholly fiduciary, has fiduciary aspects. Amongst such duties are those prohibiting sexual or financial abuse of patients or disclosure without express authority of confidential information. One important consequence of attaching such fiduciary duties to the doctor-patient relationship is that the onus of proof falls not upon the vulnerable party (the patient), but upon the doctor (to disprove the allegation). Another is that consent cannot be pleaded as an absolute defence. In this article the authors advocate that the law should now accept that the fiduciary obligations of the doctor-patient relationship extend to creating a legal duty that any adverse health care event be promptly reported to the patient involved. The reasons for creating such a presumption, as well as its elements and exceptions, are explained.

Australia↗

Consent and the individual detained in custody.

It has been acknowledged that autonomy is one of the prima facie principles in modern medical practice and integral to the interchange between doctor and patient even if that meeting does not fulfil the normal criteria for a consultation. The lead having been taken by other jurisdictions, the General Medical Council, the UK national regulatory body for doctors, has now acknowledged the concept of informed consent that was first espoused in cases such as Rogers v. Whitaker. In regard to the concept of informed consent, there are three pertinent issues that the Forensic Physician should consider in deciding upon the adequacy of this: Did that person have capacity in the eyes of the law? The Forensic Physician may be asked to examine individuals whose age span ranges from the newly born to the elderly and there will be potential conflict of interest between parent and child or elderly people and their carers. Even if adequate information was imparted, did a person under the (significant) influence of alcohol or drugs understand the likely implications that would flow from their decision? Was the individual concerned given appropriate information beforehand--in other words, was the consent truly informed? Was the consent given voluntarily? Voluntariness is probably the most significant ethical worry likely to confront the doctor, particularly when examining an individual for fitness to be detained or fitness to be interviewed, both categories of which make up the main work load in this sub-specialty. The thorny ethical dilemmas faced in this specialty are considered and how the professional standard originally defined in Hunter v Hanley and re-iterated in the Bolam test (with subsequent modification in Bolitho) affect the way in which the clinician deals with the problems is likely to face.

Forensic Medicine↗

Oregon v. Ashcroft.

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Drug and Narcotic Control↗