What medical school did you graduate from? Judicial prescribing of medical treatments

There is much in the literature concerning conflicts between clinicians and the law over who should make decisions in a legal context, such as involuntary hospitalization or patients' competency to make treatment decisions. There is little, however, about judges' trying to impose specific treatment decisions on clinicians. This article addresses that situation and the problems such orders cause.     

Would responsible medical lawyers lose their patients?

This essay presents an analytic approach to understanding patients' responsibilities. Prompted by arguments in Margaret Brazier's article 'Do No Harm--Do Patients Have Responsibilities Too?', the paper demonstrates how medical lawyers can attempt to answer the questions Brazier raises, particularly regarding the translation of ethical responsibilities into legal ones. It suggests that the expansive nature of medical law as a discipline renders increasingly unhelpful the paradigm 'autonomous patients' found in a narrowly understood medical ethics. The great variety of contexts in which analysis takes place--some more, and some less 'medical'--implies a need in each case to presume that there might be radical variation in the responsibilities (legal and ethical) of different patients. It is therefore argued that instead of a one-size-fits-all paradigm of 'patients', always possessive of the same rights and freedoms, medical lawyers must be prepared to conduct analysis around more particular, nuanced concepts of the patient, and ultimately in a frame of legal and political rather than moral theory.     

Is medical care different? Old questions, new answers

This paper examines whether changes in medical markets may be making them more like other markets. The emergence of HMOs and other managed care systems appears to have increased the consumer's potential ability to make better comparative judgments about the price and quality of medical care, and also seems to have made medical care more like other goods. However, the evidence that medical care is a "reputation good" suggests that it is, in this respect, different from other goods. Finally, the social concerns about medical care use necessarily make medical care different.     

What do NHS staff learn from training on the Mental Capacity Act (2005)?

Purpose. Many studies have reported that professionals have a limited understanding of mental capacity issues. Implementation (in England and Wales) of the Mental Capacity Act (MCA) (2005) presents a challenge to services. The aim of this study was to evaluate the extent to which National Health Service (NHS) staff benefited from attending MCA training courses. Methods. Participants were assessed before and after MCA training using a structured interview, which included three scenarios describing mental capacity dilemmas, four vignettes addressing the role of the Independent Mental Capacity Advocate (IMCA), and 16 true–false items. Results. Interview performance improved post‐training, but this could be largely ascribed to an increased awareness of mental capacity issues, with minimal improvements in the knowledge that would be needed to undertake the assessments. Nine areas were identified where there remained significant gaps in participants’ knowledge post‐training. Participants with experience of dealing with mental capacity issues performed better than those without. Conclusions. The results suggest that methods other than formal training events may be needed to prepare health staff to implement new legislation.     

Building from the ground up: exploring forensic mental health staff’s relationships with patients

Recovery-orientated care is becoming generally accepted as the best practice, and continued development in the ways it is practiced is necessary to ensure improvement of ongoing care. Forensic patients often experience double stigmatization (the dual stigma of mental illness and offending behaviour) and during admission to hospital may lose touch with their community supports. While working through their personal recovery, patients develop therapeutic relationships with their multidisciplinary team members. When positive, these relationships can enhance a patient’s recovery. Clinical staff members participated in 88 in-depth interviews, which were transcribed, reviewed, and analysed using thematic analysis. From analysing the data, main themes and subthemes emerged related to staff’s perceptions of therapeutic relationships. When developing relationships, staff need to overcome receptiveness issues by increasing trust through understanding their preconceptions, reducing stigma, sharing innocuous stories, and giving patients the time they need. The key pillar underpinning all traits ascribed to patients and staff is collaboration and approaching treatment protocols with a social approach is essential to enhancing recovery. Staff shared a holistic view of recovery that incorporated the benefits of positive relationships and the need to create a sense of home within the institution.     

Anna Mikhaĭlovna Smyslova--the first Russian woman forensic medical expert

This article describes in brief the life and the work of the first Russian female forensic medical expert, Anna Mikhailovna Smyslova, based on the analysis of the materials available from the Central State Historical Archive, Sankt-Peterburg, and a number of publications in the-prerevolutionary editions.     

The struggle over retiree medical benefits: who's on top?

Over the past decade, there has been an explosion of litigation addressing an employer's right to unilaterally amend or terminate medical benefits provided to retirees. The sheer volume of these cases and the variety of facts and legal theories have combined to obscure the patterns and trends that actually are emerging from this litigation. This article will describe the context of the struggle over retiree benefits and discuss those leading decisions in which the federal courts of appeals have established their rules for deciding retiree benefits cases.     

Is there an acceptable answer to rising medical malpractice premiums?

This article explores the key issues involved in the attempts at reform of the present medical malpractice system. Investigating the effects that federal tort reform legislation would have on physicians, patients, lawyers, and the medical malpractice insurers, Dr. Gunnar succinctly outlines the issues surrounding the present "crisis in healthcare" and explores the separate interests involved. The article examines the economic forces influencing the medical malpractice insurance industry, reviews previous tort reform, and predicts the future of federal tort reform legislation. Dr. Gunnar concludes by proposing alternatives for malpractice reform.