‘Cashing In’ on curiosity and spectacle: the forensic patient and news media

Health and social care professionals are gatekeepers to, and custodians of, confidential service user information. In the United Kingdom (UK), police investigations have unveiled cases of payments being made to public service officials by journalists in return for service user information. The purpose of this discussion is to investigate such cases in the context of high-security forensic care. This paper provides a discussion drawing upon two UK-based case studies of prosecutions of public service workers relating to the sale of confidential information. The analysis presented here illuminates upon the salient and connected issues at work that have led to the transgression of legal obligations and professional responsibilities/principles of confidentiality. A fuller reading of the context in which these transgressions occur, and motivations that exist, may well serve to inform policy, training, guidance or vigilance in relation to the preserving of service user information in the future.     

论医疗事故罪的主观方面

本文从医务人员的注意义务、注意能力以及法学理论与司法实践的冲突三个角度论述了医疗事故罪的主观方面。对医务人员诊疗中注意义务及其程度的制定标准应当综合考量多种因素 ;在认定医务人员的注意能力时 ,应采用客观说 ;并建议在医疗事故罪的主观定性方面 ,应以危害结果的发生不违背行为人的本意作为区分故意与过失的界限     

Work-related stress in Australia: The effects of legislative interventions and the cost of treatment

The Australian Institute of Health and Welfare data published in 2002 shows a continued rise in health care costs to the Australian community due to the growing number of people diagnosed with mental health disorders. Those mental health disorders may originate from a number of sources, including work and non-work-related factors. The so called work-related stress claims in all Australian jurisdictions are the most expensive form of workers compensation claim. In the most part this is due to the lengthy period of absence (duration) and complicated medical care which are characteristic of these claims. In Australia, in the last decade, attempts have been made to reduce the costs of compensable stress-related claims by imposing special legislative thresholds on such claims. This ‘back end’ approach to cost reduction has resulted in an array of legislative formula designed to exclude work-related stress claims. This article surveys the various legislative provisions dealing with work-related stress claims in Australia and provides an analysis of their effectiveness. A range of options are presented as alternatives to the exclusion of particular forms of work-related stress claims. The use of a corporate citizenship approach to the prevention and management of stress claims is also discussed as a proactive alternative to occupational safety and health legislative provisions and the workers compensation legislative exclusions.     

The conflict between the ethics of th individual and the ethics governing public health: practical sustainability of health care in jeopardy?

The "health rights movement" has reconstructed the clinical relationship between health care workers and patients by simultaneously demanding more from traditional medical care and challenging the perceived power differential between doctors and patients by rejecting the paternalistic medical model in favour of an individual patients' rights model. However, the growth in individual expectations of a right to health care creates a potential conflict with the ethics that prioritise public health and guide the rationing of its limited financial and human capital resources. This, in turn, creates a practical dilemma which requires public health institutions to become service orientated while sacrificing their integral role in training and educating the medical workforce and potentially compromising the practical sustainable delivery of public health in Australia. However, the law can play a role in resolving this conflict through legislation, regulations, codes, administrative law and common law in an effort to ensure the quality and future sustainability of public health in Australia.     

Planning for incapacity by people with bipolar disorder under the Mental Capacity Act 2005

The Mental Capacity Act 2005 provides a variety of legal mechanisms for people to plan for periods of incapacity for decisions relating to personal care, medical treatment, and financial matters. Little research has however been done to determine the degree to which these are actually implemented, and the approach to such advance planning by service users and professionals. This paper looks at the use of advance planning by people with bipolar disorder, using qualitative and quantitative surveys both of people with bipolar disorder and psychiatrists. The study finds that the mechanisms are under-used in this group, despite official policy in support of them, largely because of a lack of knowledge about them among service users, and there is considerable confusion among service users and professionals alike as to how the mechanisms operate. Recording is at best inconsistent, raising questions as to whether the mechanisms will be followed.     

Access to health care: what a difference shades of color make

Professor Majette's timely article examines an age-old problem: the effect of race and ethnicity on a patient's receipt of health care. Her article analyzes some of the major health care access issues, with a focus on barriers confronting African Americans, Asians, Hispanics, and Native Americans. Some of the barriers include inability to pay, cultural insensitivity, a shortage of health care providers, and discrimination. She also examines some of the unsuccessful legal solutions and remedies designed to eliminate these barriers. Given the complexity of the access barriers encountered by people of color, Professor Majette concludes that only an interdisciplinary approach can eliminate them. Her proposed approach requires business, legal, and medical professionals to collaborate in developing a health care system that meets the needs of aracially and ethnically diverse population.     

我国医疗损害责任中医务人员注意义务的标准

医务人员的注意义务是衡量其在医疗活动中是否存在过失的前提，我国即将实施的《侵权责任法》对医务人员的注意义务的标准未作详尽规定，本文通过比较普通法系国家和日本相关的规定，从而指出我国医务人员的注意义务的标准。     

Workers with Disabilities Between Legal Changes and Persisting Exclusion: How Contradictory Rights Shape Legal Mobilization

It has become commonplace within disability sociolegal scholarship to argue that, in the last 30 years, a new legal and policy approach to disability has emerged, leading to a paradigm shift from a social protection framework to an antidiscrimination model. Some authors have stressed, however, that the new model has not fully replaced the older social protection approach. Yet little is still known about how the coexistence of these different models impacts on the everyday experience of disability in the workplace and on potential legal mobilization. Based on interviews with workers with disabilities who mobilized the law to obtain reasonable accommodation in Belgium combined with an analysis of evolving Belgian legal schemes relating to disability, this article explores how interactions between social, labor, and antidiscrimination rights shape legal mobilization of persons with disabilities in the workplace. We find that individual's initial self‐identification as workers or persons with disabilities influences how they frame their claim and the kind of legal norms they refer to in a first stage but that both their identification and their rights consciousness evolve and change through the course of legal mobilization as they interact with various professionals and navigate between the different concepts and rights available in current law.     

Quality of health care and the role of relationships: bridging the medico-legal divide

This Article focuses on an often overlooked barrier to efforts to enhance the quality of health care: the relationship crisis that currently exists between physicians and patients. This state of affairs has resulted from the divide between the medical and legal worlds. The medical arena has understandably tended to view the doctor-patient relationship as a purely medical issue, ignoring the law's impact in generating and sustaining problematic relationship patterns. The legal world has yet to fully recognize this state of affairs, and the law's role in its evolution and persistence. We offer a relational approach to health-care law as a means of bridging the divide between the two disciplines. In the malpractice context, this would entail adopting a no-fault compensation scheme, which is committed to strengthening collaborative doctor-patient relations, enhancing patient safety and systemic learning, while providing adequate compensation.     

The Loosening of Professional Boundaries and Restructuring: The Implications for Nursing and Medicine in Ontario, Canada

This paper suggests that the combination of health care restructuring, legislation expanding, and redefining a regulated health profession in Ontario, Canada, has reduced medical dominance and increased managerial dominance of health care professionals. The paper focuses on nurses and doctors, and examines the effects of the Regulated Health Professions Act and the changes occurring within the health care system on their political, clinical, and economic autonomy. It argues that there has been a redistribution of power in the health care sector and suggests that the present autonomy of health care professionals is limited, and may be limited even further as the technical side of health care is prioritized over the indeterminate side.     

Algorhythm of making forensic medical expert examinations by medical documents in obstetric-gynecological practice

Most of the suits brought against medical professionals concern obstetricians-gynecologists. The experienced clinicians take part in commissions of experts to certify validity of diagnosis, treatment, operations, manipulations. Current state of obstetric-gynecological expertise is characterized. Algorithm of making obstetric-gynecological examinations is proposed. Criteria on forensic-medical assessment of medical care conducted in comparison with current standards of this care are formulated.     

Conscientious objection in reproductive health care: Analysis of Pichon and Sajous v. France

This article explores the issue of conscientious objection invoked by health professionals in the reproductive and sexual health care context and its impact on women's ability to access health services. The right to exercise conscientious objection has been recognized by many international and European scholars as being derived from the right to freedom of thought, conscience and religion. It is not, however, an absolute right. When the exercise of conscientious objection conflicts with other human rights and fundamental freedoms, a balance must be struck between the right to conscientious objection and other affected rights such as the right to respect for private life, the right to equality and non-discrimination, and the right to receive and impart information. Particularly in the reproductive health care context, states that allow health professionals to exercise conscientious objection must accommodate this in such a way that its exercise does not compromise women's access to health services. This article analyses the European Court of Human Rights' decision on admissibility in Pichon and Sajous v. France (2001) and argues that a balancing approach should be applied in cases of conscientious objection in the sexual and reproductive health care context.     

美国成年病人放弃治疗机制对于中国的启示

美国倡导清醒有自决能力的成年人用预先指示的方式表明自己在丧失自决能力时的医疗选择。预先指示主要分为生前遗嘱和持续性医疗授权书两种形式。美国联邦和各州有相对完善的法律制度,规定预先指示的形式内容及预先指示不存在时能为病人作出决定的人群和权限。医院也会有程序指南为医务工作者提供指导原则。中国可借鉴美国经验在转变大众对于死亡的观念、尊重病人自主权、出台相应法律法规、行业指南、增强医务工作者的沟通技巧和人文关怀等方面作出积极改变,完善放弃治疗的程序,满足病人要求,解决医务工作者的两难困境。     

Inmate sues the Correctional Service of Canada

This article summarizes a lawsuit commenced recently in the Ontario Superior Court of Justice by an HIV-positive inmate in the federal penitentiary system against the Correctional Service of Canada (CSC). This action is an important part of the ongoing struggle to hold government and public officials accountable for failing to address the HIV/AIDS crisis in prisons. The suit contends that CSC must be held liable for the seroconversion of an inmate while in CSC's care and custody, and that it must also be held liable for the alleged negligent provision of medical care to HIV-positive inmates.     

Waiver of the two-year home country physical presence requirement for certain foreign medical graduates--INS. Interim rule with request for comments

This rule amends the Immigration and Naturalization Service (Service) regulations by allowing certain foreign medical graduates who entered the United States in J-1 status, or who acquired J-1 status after arrival in the United States, to obtain a waiver of the 2-year home country residence and physical presence requirement under section 212(e)(iii) of the Immigration and Nationality Act (Act) pursuant to a request by a State Department of Public Health, or its equivalent. The waiver is intended to permit these foreign medical graduates to work at a health care facility in an area designated by the Secretary, Health and Human Services (HHS), as having a shortage of health care professionals ("HHS-designated shortage area"). This interim rule also contains provisions which will permit these foreign medical graduates to change their nonimmigrant status in the United States from J-1 exchange visitor to H-1B specialty occupation worker.     

Mental health outreach and street policing in the downtown of a large French city

ContextMarseille, the second largest city in France, has a large population of homeless persons. A mental health outreach team was created in 2005 as a response to high rates of mental illness among this group. In a national political context where security is a government priority, a new central police station was created in Marseille in 2006 to address robberies, violence and illegal traffic in the downtown area of the city. While not directly related to such crimes, police also are responsible for public safety or behavioral issues related to the presence of individuals who are homeless in this area.ObjectiveThis report on a two-year pilot study (2009–2011) addresses collaborative work between a mental health outreach team and the police department responding to the clinical needs of persons who are homeless with serious psychiatric disorders. It also describes the homeless persons' interactions with, and perceptions of the presence of, police and mental health professionals on the streets.MethodsInvestigators adopted a mixed-methods approach. Data were collected on 40 interactions using brief standardized report for each interaction. Focus groups were conducted with police officers, outreach team members, peer workers, and service users. Minutes of partnership meetings between police officers and outreach workers also served as a source of qualitative data.ResultsOutreach workers initiated just over half (n = 21) of the encounters (n = 40) between police and outreach workers. Interactions mainly involved persons with psychosis (77%), the vast majority (80%) of which involved persons in an acute phase of psychosis. Two key themes that emerged from data analysis included the violent nature of life on the streets and the high percentage of ethnic minorities among subjects of the interactions. In addition, it was found that the practices of the outreach workers are sometimes similar to those of the police, especially when outreach workers use coercive methods. “Users” (homeless persons) described police as sometimes using less coercion than the outreach team, and noted that they were more fearful of psychiatrists than police.ConclusionFormal initiatives between mental health outreach teams and police departments involve some common street practices. This study demonstrates the potential for closer working relationships between the two parties to help persons who are homeless with mental illnesses receive needed care, and to reduce inappropriate coercion including involuntary hospitalization and arrests.     

US Judge: inadequate medical care for HIV-positive prisoners is a violation of rights

A federal judge in the United States has determined that Alabama prison officials violated HIV-positive prisoners' constitutional rights and that poor medical care caused HIV-positive prisoners to die early.     

Health professional-patient confidentiality: does the law really matter?

Confidentiality is often tested in the health professional-patient relationship, particularly given that both the law and ethics permit disclosure of confidential information in the public interest. This column outlines the results of an Australian Research Council project indicating that mental health professionals may place more weight on their ethical responsibilities relating to confidentiality than what the law requires. The outcomes of the project, which used both questionnaires and focus group discussions, suggests that there is some confusion as to legal requirements in this area and that many mental health professionals rely on ethical frameworks to justify disclosure even where there is no legal requirement to do so. It is suggested that ethics training for health professionals should be of primary importance to ensure responsible decision-making in this area.     

Autoerotic asphyxial death initially misinterpreted as suicide and a review of the literature.

Death during autoerotic activities is of special concern to law enforcement officials, medical examiners, the family of the decedent, and society in general. As in the probing of any violent demise, accurate identification, management, and preservation of all physical evidence; complete photographic documentation of the scene and the body; reconstruction of the scene; and interviews with the family and acquaintances (psychological autopsy) are mandatory for proper study, evaluation, and interpretation of the case. Because of a lack of knowledge on the part of many people, including professionals, about these activities and the fact that many autoerotic fatalities share common characteristics with suicide and homicide, these cases are often misinterpreted. The authors present a case of autoerotic accidental asphyxial death which was initially misinterpreted as suicide.     

Error Rates in Forensic Child Sexual Abuse Evaluations

When mental health, medical, and social work professionals and paraprofessionals make false positive or false negative errors in their judgments about the validity of allegations of child sexual abuse, the consequences can be catastrophic for the affected children and adults. Because of the high stakes, practitioners, legal decision makers, and policy makers should have some idea of the magnitude and variability of error rates in this domain. A novel approach was used to estimate individual error rates for 110 professionals (psychologists, physicians, social workers, and others) who conduct or participate in forensic child sexual abuse evaluations. The median estimated false positive and false negative error rates were 0.18 and 0.36, respectively. Estimated error rates varied markedly from one participant to the next. For example, the false positive error rate estimates ranged from 0.00 to 0.83. These estimates are based on participants’ self-reported substantiation rates and on their subjective frequency distributions for the probability of truth for the abuse allegations they evaluate.