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PubMedDate not supplied

[Nurses' professional responsibility].

As managed care relevance is growing, several old issues related to personal institutional responsibility are increasing among practitioners. Therefore, as a professional figure a nurse bases his/her job on a mix of personal knowledge and skills along with training, and he/she is responsible for giving advice in line with professional care standards. In addition, he/she is in charge of the treatment pattern agreed with the patient. However, nursing is a much more complex job, which leads professional figures facing the controversial issue of combining institutional responsibility and nursing professional tasks and duties daily. As far as nursing institutional responsibility is concerned, different view points or approaches can be applied to investigate it. The most common one is the legal approach, yet this is not the most appropriate one. Therefore, our professional background is mainly based on a management prospective rather than a legal one; dealing with the issue legally would lead, essentially, to a summary of laws and regulations without any kind of argumentative discussion. Consequently, this study aimed to analyze nurses' institutional responsibility by approaching the issue from an innovative human resources management prospective; therefore, defining the gap between nursing institutional responsibility and its tasks.

Italy↗
PubMed1994

Digital archives and communication highways in health care require a second look at the legal framework of the seventies.

The present state of the art and the state of practice regarding legal aspects of medical informatics are reported. Examples are taken from networking, archiving, and virtual reality. It is derived that the data protection concepts of the seventies are covering only some legal aspects of the application scene today and in the future. Thus a far wider legal approach is necessary. It can only be mastered if engineers and lawyers discuss future trends and derive together a new legal framework for medical computer systems in the late nineties. As computers will be everywhere from childhood to death the key issue is not to just protect an individual but to positively frame an information society.

Computer Communication Networks↗
PubMedDate not supplied

[Current problems in reforming of dental care services].

Orientation to priority utilization of economic and medical legal approaches to reformation of dental service is an obligatory condition for effective solution of the problems of Russian dentistry. The priority tasks are: creation of economic and legal models of a dental profession and improvement of its normative and legal basis; development and realization of general Russian and regional programs of transformation of state dental centers into other than state ones and privatization of dental institutions; practical reformation of economic mechanisms of dental service; development of methods for state regulation of dental activities during the transition period; determination of directions and choice of social measures to modify dentistry service; creation of a system of guarantee of high quality of dental care; improvement of legally-based professional protection of dentists.

Dental Care↗
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↗
PubMed2006

Implications of the Schiavo case for understanding family caregiving issues at the end of life.

The case of Mrs. Terri Schiavo illustrates common themes in family caregiving at the end of life but is distinctive from most family caregiving situations in other ways. As occurred in Mrs. Schiavo's case, family members do act as both caregivers and decisionmakers for their loved ones at the end of life, often without the benefit of written advance directives. Family stress and conflict may result, yet seldom lead to court proceedings, legislative intervention, and media coverage as occurred in the Schiavo case. The importance of informal conflict resolution and the limitations of adversarial legal approaches are discussed.

Adult↗
PubMed2003

Does trauma trigger multiple sclerosis? 2: A medicolegal view.

Set against the scientific debate in multiple sclerosis are a number of medicolegal cases in which the scientific evidence has been examined in the context of specific events. It is instructive to understand something of the legal approach to cause and association, and to consider this in relation to individual cases.

Adult↗
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↗
PubMed2002

Treating acute anaemia in a Jehovah's Witness in Israel: an innovative approach to a medical and legal challenge.

A person's right to control his or her own body, expressed through the concept of informed consent to medical treatment, has gained worldwide acceptance. Nevertheless, this right may conflict with the state's interest in preserving life in cases where patients refuse treatment in medical emergencies. This paper examines the management of treating acute anaemia in a Jehovah's Witness in Israel who refused blood transfusion on religious grounds. The medical and legal ramifications are discussed in light of the Israeli Patients' Rights Law of 1996. This law established statutory ethics committees which may, under defined conditions of emergency or threat to life, approve treatment against the patient's will. This power, previously vested in the courts, should be used only in extreme circumstances while, in general, patients' wishes and beliefs must be respected. Sensitivity to the legal and ethical aspects involved deserves greater emphasis in medical school curricula.

Acute Disease↗
PubMed2000

People for sale: the need for a multidisciplinary approach towards human trafficking.

The article addresses the question of how to develop appropriate measures to tackle trafficking in women, based on the findings of a study of trafficking between the Philippines and Belgium. It argues that there is no easy or unidimensional solution to human trafficking, since it is influenced by a complex set of factors, often working in combination with one another. It concludes that control measures alone cannot stop the flow of trafficking in women and that a legal approach which relies solely on one type of legislation would be too narrow. An effective strategy must combine and balance punitive measures with protection of human rights, stricter border control and the removal of the root causes of irregular movements. Measures must be agreed and coordinated between origin, transit and receiving countries.

Asia↗
PubMed2006

Female child sexual abuse within the family in a Hungarian County.

BACKGROUND: The aim of the study was to analyze the characteristics of intrafamiliar female child sexual abuse and to explore common features that may be utilized as targets for possible methods of prevention. We also described the medical and legal approaches to handling child neglect. METHODS: This was a descriptive, cross-sectional study on 52 sexually abused girls under the age of 18 at the Department of Obstetrics and Gynecology, Medical and Health Science Center of Debrecen. We prospectively recorded the data of all cases. Intrafamiliar events were defined if the victim and perpetrator belonged to the same family. Legal outcomes were also recorded. RESULTS: During the 16-year period, 209 cases of sexual abuse were seen in our clinic, 52 of them had been involved in child sexual abuse within the family. This accounts for 25% of adolescent cases. Eighty-six percent of the victims were pupils, 50% of them were between 11 and 14 years of age. The perpetrator was the victim's father in 44%, and the stepfather in 40%. There was a slight difference between the type of abuse among the pre- and postpubertal group of victims, but statistically it was not significant. The abuse occurred on multiple occasions in 52%. The occurrence rate of assault was the highest in the summer season (58%), mostly in the afternoon (42%) and it took place almost exclusively at home (98%). The mother accompanied the victim in 38% of the cases and the police in 40%. Vaginal penetration was the type of abuse in 75%, and sexual perversion in 25%. Six victims were physically injured, the presence of sperm could be confirmed on vulvovaginal smears in 2 cases. One pregnancy conceived. Nine cases were reported to the police and as a result of legal proceedings, 5 perpetrators have been sentenced. CONCLUSION: The majority of crimes take place within the family and are disclosed after multiple episodes. The small proportion of reported sexual assaults is the consequence of the lack of harmony between the Hungarian conditions of emergency care and the criminal law. Prevention calls for attention at all levels of child education, observation at off-school times, early involvement of health professionals, applying standardized medical guidelines and the modification of jurisdiction.

Adolescent↗
PubMed2001

Abraham Lincoln's suit against a medical imposter who assaulted his client.

In 1851, A. Lincoln, Esquire represented Edward Jones who charged in a law suit that his attending physician had assaulted him. Jones, also a lawyer, had sharply questioned Dr. Joseph S. Maus about his claims of attendance and graduation from Philadelphia's Jefferson Medical College, an allopathic medical school. Jones claimed that Maus became enraged at his persistent questioning and attacked him. In turn, Maus denied the allegation. He said that he was merely defending himself from Jones' blows with a large cane. Lincoln's legal approach was to argue about the state of medical education and whether Maus had really graduated from Jefferson Medical College. Acting as a peacemaker, he finally arranged to settle the dispute between Jones and Maus out of court.

Education, Medical↗
PubMed1996

Salt Enrichment of Municipal Sewage: New Prevention Approaches in Israel

Wastewater irrigation is an environmentally sound wastewater disposal practice, but sewage is more saline than the supplied fresh water and the salts are recycled together with the water. Salts have negative environmental effects on crops, soils, and groundwater. There are no inexpensive ways to remove the salts once they enter sewage, and the prevention of sewage salt enrichment is the most immediately available solution. The body of initiatives presently structured by the Ministry of the Environment of Israel are herein described, with the aim to contribute to the search for a long-term solution of salinity problems in arid countries. The new initiatives are based on: (1) search for new technologies to reduce salt consumption and discharge into sewage; (2) different technologies to cope with different situations; (3) raising the awareness of the public and industry on the environmental implications of salinity pollution; and (4) an elastic legal approach expressed through new state-of-the-art regulations. The main contributor to the salinity of sewage in Israel is the water-softening process followed by the meat koshering process. Some of the adopted technical solutions are: the discharge of the brine into the sea, the substitution of sodium by potassium salts in the ion-exchangers, the construction of centralized systems for the supply of soft water in industrial areas, the precipitation of Ca and Mg in the effluents from ion-exchangers and recycling of the NaCl solution, a reduction of the discharge of salts by the meat koshering process, and new membrane technology for salt recovery.

Journal Article↗
PubMedDate not supplied

A new attack on smoking using an old-time remedy.

This article first will explain the reasons behind and goals of state recoupment actions against the major cigarette manufacturers, their lobbying arm and trade association, and their public relations firms (collectively referred to as the "tobacco industry") for the recovery of Medicaid and other indigent care expenditures on smoking-related illnesses. These are, primarily, to relieve the heavy financial burden on state treasuries and to stop the tobacco industry from targeting children in advertising and promotions. To put this new legal approach in perspective, the article presents a brief historical background to the tobacco industry's litigation strategy: to wear down opponents through delay and intimidation, to cast doubt on science, and to wrongfully invoke the attorney-client privilege against disclosure of incriminating evidence. Next authors discuss the states' strategy: each filing one suit seeking equitable remedies under theories of restitution/unjust enrichment, indemnity, public nuisance, and injunctive relief to protect the interests of minors, instead of maintaining thousands of product liability claims on behalf of individual smokers. This will be followed by a critique of the industry's response to state actions: political attacks against attorneys general and trial lawyers and charges that the lawsuits would hurt business as well as a variety of legal challenges, including an imaginative but risky defense that if smoking indeed causes disease and attendant health care expenditures, then the tobacco industry ought to be given a credit against those expenditures for the taxes generated by its business and the "savings" which inure to the states from the premature deaths of smokers (the cost of geriatric care, for example). The article will wrap up by impressing on health officials and other readers what is at stake in these actions and what their success or failure will mean for the Medicaid program.

Adult↗
PubMed2003

[End-of-life decision-making process].

Since time immemorial the attitude toward the dying patient has been one of the most difficult issues in medical ethics. The diversity of philosophical, religious, social and legal approaches does not enable one to reach a universal consensus to solve the many problems involved in end-of-life decisions. Within the health care system in Israel there is currently no consensual practice concerning the dying patient. Moreover, there is no published information on the actual decision-making processes within hospitals, hospices and geriatric facilities in Israel concerning the dying patient. A group of investigators in Shaare Zedek Medical Center in Jerusalem recently performed a prospective study to explore the decision-making process concerning DNR orders within this hospital. The results of this study demonstrated that the terminally-ill patients never take part in the decision-making process, they are never consulted about their wishes, and there is no effort to discover their previous wishes concerning their treatment at the terminal stages. Moreover, in many instances even the family was not consulted and did not take part in the decision-making process. In a significant minority, the final decision of a DNR order was undertaken by a single physician. This approach represents an extreme form of unethical paternalism, and it requires an urgent societal intervention to establish an ethically sound decision-making process. Recently, a national committee ("Steinberg Committee") formulated a widely agreed upon legislative proposal organizing all the fundamental and practical issues related to the dying patient. This proposal is based upon a balance between opposing values such as autonomy, life, quality-of-life, beneficence, non-maleficence and "slippery-slope" concerns. It relates to various treatment modalities, such as resuscitation, ventilation, dialysis, medication and sustenance. It establishes a clear position on euthanasia, physician-assisted suicide, withdrawing treatment and withholding treatment. It establishes a hierarchy of decision-making agents, and it validates advanced medical directives. It also promotes a legally-binding requirement of modern palliative care.

Attitude to Death↗
PubMed2005

Characteristics of female child sexual abuse in Hungary between 1986 and 2001: a longitudinal, prospective study.

OBJECTIVE: To summarize the characteristics of female child sexual abuse and to explore common features that may be utilized as targets for possible methods of prevention. DESIGN: Prospective, longitudinal study. SETTING: A Hungarian county, University of Debrecen. PARTICIPANTS: Between 1986 and 2001, 209 girls under the age of 18 who had been exposed to sexual abuse visited the Department of Adolescent Gynecology. METHODS: We prospectively collected data illustrating the characteristics of all cases. Events in which victim and perpetrator were members of the same family were recorded as intrafamilial. Subsequent legal procedures were also evaluated. MAIN OUTCOME MEASURES: We describe the medical and legal approaches to handling child neglect. RESULTS: Seventy-five percent of the victims were students, and 47% of them were between 11 and 14 years of age. The perpetrator was familiar to the victim in 66% of the cases, and a stranger in 34%. Fifty-two (25%) perpetrators were members of the victims' families. In 11% of cases, the perpetrator was the victim's father and in 10%, her stepfather. The abuse had occurred on multiple occasions in 21%. The occurrence rate of assault was highest in the summer season (59%). Thirty-nine percent of victims were accompanied by their mothers when they attended the clinic and 43%, by police. officers. Vaginal penetration was the type of abuse in 80%, and sexual perversion in 20%. Sixty-six victims were physically injured, and in 38 cases the presence of sperm was confirmed in vulvo-vaginal smears. One pregnancy occurred as the result of the abuse. In all, 127 cases were reported to the police; 56 of the perpetrators were sentenced as a result of legal proceedings. CONCLUSION: A high proportion of female child sexual abuse takes place within the family and is revealed only after multiple episodes. The low reported prevalence of sexual assault is the consequence of the lack of cooperation between the emergency services in Hungary and the Hungarian criminal law. Prevention requires vigilance in out-of-school times, child education, early involvement of healthcare professionals, and adjustment of the administration of justice.

Adolescent↗
PubMed1994

Prevalence of advance directives and do-not-resuscitate orders in community nursing facilities.

OBJECTIVE: To determine the prevalence of advance directives and do-not-resuscitate (DNR) orders in nursing homes and to measure the effect of the Patient Self-Determination Act (PSDA) and patient characteristics on these prevalences. DESIGN: Cross-sectional study. SETTING: Eight rural community nursing facilities. PARTICIPANTS: Six hundred forty-one records of nursing home residents (total census of eight facilities). RESULTS: The mean age of the residents was 82.6 years and 75% were women. Thirty-seven percent were judged to have decisional capacity. Less than one third of the records revealed an advance directive (standard living will, 11.5%; other written directive, 11.1%; durable power of attorney for health care, 12%). Thirty-six percent had DNR orders. Residents with advance directives were older than those without them. Those residents with advance directives were more likely to have been admitted to the nursing home after the enactment of the PSDA (25.1% before vs 37.9% after enactment; P < .0001). There was substantial variation among facilities in both prevalences. Written rationales for DNR orders were found in only 40% of records. CONCLUSION: Enactment of the PSDA reflects increased interest in documentation of advance directives. However, in many nursing facilities, the prevalence of advance directives and DNR orders is relatively low. A greater commitment will be required by providers, residents, and their proxies if we are to change this reality.

Advance Directives↗