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At least 19 recordsLinked to original sources
PubMed1992

Informed consent: medical-legal update for the practitioner on recent judicial opinions applying state laws.

Physicians, in general, and surgeons, in particular, need to be aware that there is no universally applicable definition of informed consent. This paper provides a framework for understanding current, commonly accepted legal approaches and trends. State codes, state cases, and federal cases were searched manually and with the Westlaw and Lexis data bases for states with both informed consent statutes and judicial decisions interpreting those laws. Statutory definitions, where present, may be general or detailed. Legal standards for informed consent disclosure are usually either professionally based or objective. Standards for informed consent causation have been either subjective, objective, or modified-objective. Often, a physician must breech both the disclosure and the causation standards to be legally liable. Results of individual cases depend on the legislative and judicial standards adopted. Physicians need to be conversant with the general approaches to informed consent so they may better understand the applicable standards for their own jurisdictions.

Humans↗
PubMed1975

Medicolegal implications of medical records.

The problem of ownership and possession of patient's medical records has been reviewed. The apparent fallacies in the presently accepted legal doctrines regarding ownership of the patient's records by health care providers have been submitted. The legal approaches and tactics available to implement the accessibility and availability of his records to the patient have been reviewed. The problems incident to the employment of statutory enactments as a means of putting the patient's record in his possession have been considered. The various legal theories that could conceivably be utilized in establishing this right on a case-to-case basis in the courts have been presented. The medicolegal implications relating to medical records have been discussed.

Confidentiality↗
PubMed1990

Effect of New York State's do-not-resuscitate legislation on in-hospital cardiopulmonary resuscitation practice.

PURPOSE: On April 1, 1988, New York State enacted legislation governing the withholding of cardiopulmonary resuscitation (CPR). Suggestions that the mandated protocol for withholding CPR is too cumbersome and will result in an increase in CPR attempts led us to study the effect of the new law on in-hospital resuscitation practice. PATIENTS AND METHODS: We retrospectively reviewed the charts of 245 adult in-patients at a county teaching hospital who died during three-month periods before and after the law took effect. RESULTS: There was a statistically nonsignificant decline in the frequency of CPR attempts at the time of death, from 59 (50%) of 119 patients in 1987 to 57 (45%) of 126 patients in 1988. Use of explicit written "do-not-resuscitate" (DNR) orders increased significantly from 13 (22%) of 60 patients who died without CPR in 1987 to 64 (93%) of 69 patients in 1988. Patient and family involvement in decisions to withhold CPR was common before the law and did not change significantly. CONCLUSION: Although changing the way DNR decisions are documented, the legislation resulted in no significant change either in the frequency of CPR or in the degree to which patients are involved in these decisions.

Adult↗
PubMedDate not supplied

Nationwide practices for screening and reporting prenatal cocaine abuse: a survey of teaching programs.

Questionnaires surveying policies and opinions about prenatal cocaine abuse were sent to training programs nationwide. Eighty-one pediatric and 81 obstetric programs from 42 states responded. Although respondents favored routinely screening all patients by maternal history (81%) and by urine toxicology (36%), only 64% and 8%, respectively, reported these as established policy. Physicians reporting higher regional prenatal cocaine abuse rates more commonly favored universal perinatal screening (p = .009), but established policies were similar regardless of local prevalence (p = .19). Fifty-two percent of respondents were unaware of their state's requirements for reporting prenatal cocaine abuse. While most physicians favored interventions such as voluntary drug rehabilitation (64%) and family support services (64%), some physicians favored foster care placement for the infants (28%) and involuntary drug rehabilitation (31%). Only 3% felt that criminal prosecution of the mother was appropriate. Policies for managing prenatal cocaine abuse often did not reflect physicians' opinions. A multidisciplinary medical, social, and legal approach is needed to develop effective management policies.

Cocaine↗
PubMed1990

Baby Doe regulations and medical judgment.

The potential for conflict between social policy and medical judgment can be examined in relation to the 'Baby Doe' regulations issued by the U.S. Federal Government in 1984. These regulations identify the circumstances in which medical treatment may be withheld from handicapped infants. This article reports on a national survey of perinatal social workers which compared their responses to the answers of physicians to similar questions published earlier. These social workers failed to express a conflict between sound medical judgment and the federal regulations when confronted with three hypothetical cases. The same was true in the published study of physicians but that data was erroneously interpreted as providing evidence of a conflict between medical judgment and federal regulations. On some general opinion statements, the social workers were similar to physicians in their criticism of these regulations but on others they were equivocal. While the majority of responses of social workers to other questions about these regulations was rather similar to the responses of physicians, the social workers were found to be more inclined than physicians to express the view that these regulations were needed to protect the rights of handicapped infants and the view that the physician's practice had been changed as a result of these regulations.

Ethics, Medical↗
PubMed1978

Physician responsibility for the cost of unnecessary medical services.

Most diagnostic and therapeutic services are ordered by physicians, but physicians practicing under fee-for-service conditions have few incentives to contain the costs of medical care. Without such incentives, effective cost control through mechanisms such as Professional Standards Review Organizations have been disappointing. Several legal approaches might be used to increase physicians' responsibility for the cost of unnecessary services--expansion of tort law, implied contact, redesign of insurance mechanisms, equitable estoppel and informed consent. However, increasing physician responsibility will require uniform but flexible definitions of medical necessity, reliable means for predeterming the need for services and effective penalties or incentives. We propose a peer-review system that would incorporate the sharing of financial risk among physician, hospital, insurer and patient in the fee-for-service sector.

Costs and Cost Analysis↗
PubMed1991

Refusal of tube feeding as seen from a patient advocacy organization: a comparison with landmark court cases.

OBJECTIVE: To determine how closely high court decisions regarding tube feeding are a reflection of the situations that occur in the general population. DESIGN: A retrospective review was conducted of memos recording inquiries made to the Society for the Right to Die (SRD), a patient advocacy organization. Characteristics of clients were compared to characteristics of individuals considered in landmark "right-to-die tube feeding cases during the same period of time. RESULTS: Information from 116 memos of inquiries made from 1985 through mid-1990 was compared to 20 court cases, and significant differences were identified. The average age of the SRD clients was 77.6 (+/- 18.4) years compared to 55.1 (+/- 22.8) years for the court cases (P less than 0.001). Of the clients, 79% were 70 years of age or older and 28% were 90 or older; in contrast, 7 (35%) of subjects in the court cases were 70 years of age or older, and none was over 90 (P less than 0.001). In addition, whereas 14 (70%) of the court cases dealt with individuals in a persistent vegetative state, only 17 (15%) of SRD clients carried that diagnosis (P less than 0.001), with the remainder suffering from dementia, various stages of coma, or a variety of other debilitating disorders. The sex distribution, year of inquiry or year of court decision, and geographic distribution were similar. Some states were overrepresented in both groups. CONCLUSION: High court cases may inadequately reflect the majority of situations that arise on a day-to-day basis. Elderly individuals, in particular those who are not in a persistent vegetative state, are significantly underrepresented.

Aged↗
PubMed1991

The dilemma of civil rights versus the right to treatment: questionable involuntary admissions to a mental hospital.

Admission to a close ward was analyzed at the Department of Psychiatry, University of Oulu using 888 patients and their 1861 assessment and treatment episodes. Of all referrals for involuntary assessment (n = 237, 12.7% of all episodes) a total of 44 (2.4%) used "questionable" juridical criteria: the final diagnosis was not psychosis. In the follow-up, the admission of the questionable patients was mainly considered a clinical necessity, and at least one third of them were diagnosed as being psychotic and 2 committed suicide. An elevated probability of belonging to the questionable group was seen among patients in their first treatment episode, with minimal professional education, female sex, short treatment time, or residence in a rural area. The result suggests that some inequality existed between women and men, less and more educated and residents of urban and rural areas. The results also reflect conflict between the ethics and clinical practice of involuntary commitment, and the phrasing of the law, especially its diagnostic limitation to psychotic states only.

Adult↗