The conflict of understanding the genetic make-up of man and his knowledge of it

The rapid development within the research of the human genome offers a great potential with regard to the diagnosis of genetic diseases but it also bears dangers of misuse. The starting point for avoiding these dangers is the autonomy of the individual, i.e. that the information about his genetic constitution should only be ascertained with his explicit consent. It is the duty of law to protect the individual and his relatives - who might also be concerned - without undermining the right to self-determination. Furthermore, it is discussed whether genetic tests should be limited to "health purposes" only. The problem of this limitation, however, is to define the term "health purposes" particularly when the criterion of "quality of life" is also taken into consideration. In order to assure a responsible handling of the genetic data, genetic analysis and especially the counselling of the subject should be reserved to the medical profession, since only a real understanding of the individual's genetic constitution with all risks and chances will enable him to make an informed and self-determined decision.     

Invisible hand or fatherly hand? Problems of paternalism in the New Perspective on health

This article examines the charge that the "New Perspective" on health (as exemplified by the Lalonde Report in Canada, by Prevention and Health in the United Kingdom) represents an abandonment of liberal principles in favor of a collectivist and paternalistic role for the state. It looks first at the problems confronting modern health policy, and at the reasoning behind the New Perspective's approach. It then explores whether and how the charge of paternalism applies to that approach, and just what such a charge implies. The article concludes with a discussion of the "liberal paternalist" viewpoint towards health policy, a viewpoint that combines respect for individual liberty with an interest in taking effective public action to improve the health status of modern populations.     

The mental health service crisis of neoliberalism -- an antipodean perspective

Major transformations in forms of governance of the liberal state have been wrought over the course of the last century, including the rise of neoliberalism and 'new public management.' Mental health too has witnessed change, with pharmacological treatment displacing residential care, a shift to community-based services, mainstreaming with general health care, and greater reliance on civil society institutions such as the family or markets. This article considers whether mental health law, and its court/tribunal 'gatekeepers' have kept pace with those changes. It argues that the focus of the liberal project needs to shift to measures which will better guarantee access to mental health services, and keep a more watchful eye on both 'hidden' coercion of people on community treatment orders, and passive neglect of human need.     

Posttraumatic Stress Disorder’s Traumatic Stressor Criterion: History, Controversy, and Clinical and Legal Implications

This paper discusses posttraumatic stress disorder’s (PTSD) traumatic stressor criterion (Criterion A) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The history of the stressor criterion is detailed, including how it has changed over time in successive versions of the DSM. We discuss controversy over the stressor criterion, regarding arguments about whether it is too conservative or too liberal. Studies comparing Criterion A and non-Criterion A events in their association with PTSD are discussed, including the finding across studies that non-Criterion A events are just as (or more) likely to result in PTSD. Potential explanations to account for this finding are discussed, including presentation of solutions to Criterion A’s limitations. Finally, legal implications for Criterion A in evaluating individuals presenting with PTSD in civil and criminal cases are discussed.     

Health and Efficiency: Community Law and National Health Systems in the Light of Müller-Fauré

In Müller-Fauré the Court of Justice has made clear that restricting patients to receiving medical services from their domestic health systems is often contrary to EC Treaty rules on the free movement of services, particularly where the treatment is not in-patient. The patient should generally be able to go abroad for treatment at the expense of their national health authority. This has structural and financial repercussions for health care systems in several Member States, including the United Kingdom, whose systems are premised upon captive patients. It also has broader implications for welfare harmonisation and provision in the European Union. Exceptions are possible, where the implications for the national health system would be very serious, but Müller-Fauré indicates that the Court will not allow national courts or authorities to rely on these too freely.     

Obligation to advise of options for treatment--medical doctors and complementary and alternative medicine practitioners

An important aspect of health professional's duty of care is to advise patients of the available options of treatment so that the patient can choose the form of treatment that suits her or his requirements. As CAM becomes more evidence-based and accepted, medical doctors need to consider the extent to which they should provide patients with information about those types of treatments. If a CAM treatment option is evidence-based, there is a strong argument that medical doctors should advise of this option for treatment to satisfy their duty. CAM practitioners should also provide details of options for treatment within their own modality but are not obliged to advise of medical options.     

Chapter 1: The Subject and Functions of Forensic Psychiatry

Forensic psychiatry is a science closely associated with philosophy and the legal and medical disciplines. It is inseparable from general psychiatry, but has its own particular functions. Forensic psychiatry, conceived as a branch of Soviet public health, is at the service of Soviet justice and is a contributing factor in — and, indeed, has as one of its chief tasks — the consolidation of socialist legality. In evaluating the mental condition of the accused in a criminal case, forensic psychiatrists must not only diagnose mental illness and treat the patient: they must also determine the extent to which the existing medical disorders affect the individual's ability to account for and govern his actions. In an examination of a convicted person, his ability to serve out his sentence is weighed. In determining a person's competence in a civil action, his "capacity to conduct his affairs rationally" is ascertained.     

论马克思早期的自由观

自由是人类固有的权利.实现自由从来都是人类的理想.正因为自由是一种普遍精神,内在地具有自主性、客观性、能动性、选择性、历史性,以及自发地从事认识、实践和发明创造的性质,具有社会道德和多元价值的含义,因此马克思终生酷爱自由,憎恨剥夺人民群众自由权利的行为,把全部身心都奉献给无产阶级解放事业,以使人类获得真正自由的本性.     

医疗过失鉴定需遵循的原则

医疗纠纷解决中的核心问题是医疗过失的技术鉴定问题,在鉴定实务中,确立判定医疗过失的原则,则是此核心中的核心。本文旨在探讨＂医疗过失评判的基本原则＂,以期规范和指导相关鉴定工作。作者认为,这些原则应包括：（1）遵循＂专业性判断＂的原则;（2）以＂注意义务作为医疗过失判断基准＂的原则;（3）以＂是否尽到与当时的医疗水平相应的诊疗义务＂为审查原则;（4）对＂医疗紧急处置行为的宽泛性＂原则;（5）＂告知-知情-同意＂的原则;（6）＂并发症的审查＂原则;（7）＂医疗意外的免责＂原则等。     

Why Tolerate Conscience?

In Why Tolerate Religion?, Brian Leiter argues against the special legal status of religion, claiming that religion should not be the only ground for exemptions to the law and that this form of protection should be, in principle, available for the claims of secular conscience as well. However, in the last chapter of his book, he objects to a universal regime of exemptions for both religious and secular claims of conscience, highlighting the practical and moral flaws associated with it. We believe that Leiter identifies a genuine and important contemporary legal and philosophical problem. We find much to admire in his reasoning. However, we raise questions about two claims that are crucial for his argument. The first claim is that it is not religion as such, but conscience that deserves toleration and respect. The second claim is that respect for religion and conscience demands ‘principled toleration’ but does not entail stronger policies of legal exemptions. Against the first claim, we argue that Leiter does not successfully distinguish religious belief from secular conscience and morality; and he does not explain why secular conscience (which shares many of religious conscience’s epistemic features) deserves respect. Against the second claim, we argue that the most promising theories of legal exemptions are not classical theories of liberal toleration.     

论强制医疗启动程序决定主体

强制医疗制度是国家医疗保健制度的有机组成部分,强制医疗有广义与狭义之分。狭义的强制医疗,如实施危害行为的精神病患者、甲类传染病患者等;广义的强制医疗,包括预防接种、指定医保单位就医等。强制医疗程序启动的决定主体必须是国家赋予相应权力的机关,其他任何单位不具有这样的权力,因而无权决定强制医疗程序启动。强制医疗主体的确定取决于强制医疗对象的危害程度、广度及时间等因素。     

生命预嘱制度建构初探简

生命预嘱（Living Will）是人们事先也就是在健康或意识清楚时签署的,说明在不可治愈的伤病末期或临终时要或不要哪种医疗护理的指示文件。生命预嘱尊重患者的医疗自主权,强调了医护人员和患者及家属之间在医疗工作中的合作关系,是医学领域中必要的创新。事实上,由于种种原因,在中国临终放弃治疗已经相当普遍,但对临终患者是否可以预立生命预嘱,告诉医护人员他是否想要手术,插管进食或使用呼吸机来维持生命,我国法律尚无此类规定。由于缺少相关法律制度对医师的行为进行有效的保护和约束,临床实践中医师对临终患者的处理做出决策相当困难。就死亡过程而言,社会提出了明确要求,法律就应当认真对待。本文通过介绍国内外的生命预嘱立法及其实践情况,了解实践中生命预嘱在我国的存在空间,探讨我国未来生命预嘱的立法思路,为我国未来生命预嘱的主要制度的构建略尽绵薄之力。     

由谁来行使知情同意的权利:患者还是家属?

知情同意权是患者的一项基本权利,但是在我国目前的医疗实务中,该项权利却普遍地由患者的家属予以行使。本文围绕应当由谁来行使“有同意能力的患者”的知情同意权这一问题,由现行法的态度出发,从正反两个角度论证了应当由患者本人行使其知情同意权的观点。     

Tolerance and Liberal Justice

Tolerance, the mere “putting up” with disapproved behaviour and practices, is often considered a too negative and passive engagement with difference in the liberal constitutional state. In response, liberal thinkers have either discarded tolerance, or assimilated it to the moral and legal precepts of liberal justice. In contradistinction to these approaches I argue that there is something distinctive and valuable about tolerance that should not be undermined by more ambitious, rights‐based models of social cooperation. I develop a conception of tolerance as a complementary principle and an interim value that is neither incompatible with, nor reducible to, rights‐based liberalism. Tolerance represents a particular, non‐communitarian expression of the general dictum that the liberal state, having released its citizens into liberty, rests on social presuppositions it cannot itself guarantee.     

Choosing to limit choice: Self-binding directives in Dutch mental health care

In certain cases of chronic mental illness (for example bipolar disorder) a self-binding directive or Ulysses contract may be a helpful intervention to prevent harm to the person him- or herself and/or others. By choosing such an arrangement, the patient can indicate when and how mental health professionals may intervene against his or her will and provide indicated care which may lead to an improvement of the patient's mental condition. In the Netherlands, since 2008 the Compulsory Admissions Act has been amended and now includes a paragraph on self-binding. Starting from the Dutch debate and statutory regulation of self-binding in mental health care, a number of issues with broader relevance are discussed, particularly as these pertain to the legal regulation and juridification of self-binding. It is argued that too many detailed rules are a threat to increasing patient empowerment.     

Plato and the origin of mental health

This essay examines the history of the concept of mental health. Its origin can be traced to Plato, who argued that immorality is to the soul what disease is to the body. The purpose of this argument was to answer those who thought that morality is a set of social conventions, and in that sense, is contrary to nature. Plato responded by turning to those who made a systematic study of nature – the medical writers of his day – and claiming that if proper balance is needed to maintain a healthy body, the same is true of the soul. Thus the natural state of the soul is one in which the various parts agree on which should rule. This does not mean that Plato sought to excuse immoral behavior by treating it as a medical condition, only that he regarded immoral behavior as contrary to nature and thus treatable. Although later attempts to define mental health are not as rigid as Plato's, it is remarkable how many of his insights are still applicable, in particular the claim that morality and mental health, though not identical, are nonetheless linked. A case in point is the experience of wanting something but not liking the fact that you want it. Plato regarded internal conflict of this sort as a paradigm case of psychic dysfunction. I argue that we can regard it as either a moral failing or a mental one.     

诉讼证据合法性问题辨析

案件事实只能通过证据来认定.证据事实可能与真实的事实有出入,只是案件事实的假象.较之于其它本质属性,诉讼证据的合法性的主要功能是为诉讼证据的认识提供检验标准,来确定证据事实的法律效力.它不是证据自身的物理属性而是外在的关系属性,它不属于证据的真实性问题而属于有效性问题.诉讼证据合法性体现了立法者对证据的标准的认识,具有主观性和历史性.在现代社会里,论证是认定证据的有效性的检验标准,因而,诉讼证据合法性问题便主要是通过建立具有理想的论证方式来增强诉讼证据的效力,促进合法性与其它属性的真正统一.     

Health Status of Incarcerated Adolescents: Implications for Juvenile Justice Decision Making

Adolescents arriving in detention often bring with them significant medical, dental, and psychological problems. These issues have important implications for courts that must decide the best disposition for offending youths. Appropriate treatment benefits the individual by enhancing his/her well‐being and improving his/her chances of successful rehabilitation. Society also benefits by avoiding the higher cost of caring for neglected conditions later in life. A comprehensive health care program for detention facilities involves establishing standardized procedures that address both common adolescent problems plus those more peculiar to detainees. Health care professionals working in a correctional setting have unique duties such as clearing youths for boot camp, monitoring injuries, dealing with resistant patients, monitoring for safe activities, and planning aftercare for youths who may face impediments to accessing care such as poor motivation and poverty. Research concerning issues specific to the needs of incarcerated youths remains infrequent and should be undertaken by health care providers. This article provides an overview of medical issues confronting juvenile offenders that should be considered when a juvenile becomes involved in the juvenile justice system.     

论医疗损害鉴定制度——对《侵权责任法（草案）》（二次审议稿）第七章的建议

医疗损害鉴定及其鉴定结论是决定医疗纠纷案件责任认定和赔偿标准的关键环节。对医疗损害鉴定应当采用司法鉴定程序,以解决司法实务中存在的医疗事故技术鉴定和医疗过错司法鉴定二元化状况。建议正在制定的《侵权责任法》建立统一的医疗损害鉴定制度,并作出授权性立法,为制定专门的《医疗损害鉴定规则》提供法律依据。只有明确规定医疗损害鉴定制度,才能有效解决医疗损害赔偿法律适用二元化问题。这对切实保护医惠双方的合法权益,依法公正解决医疗损害赔偿案件,构建和谐的医患关系具有重要的意义。     

医疗事故损害赔偿问题研究(1)(山西大学2004届法律硕士研究生毕业论文)

本文以《医疗事故条例》与民事法律、法规及司法解释的冲突为切入点,首先从医疗事故的构成要件着手分析,将医疗事故界定为“医疗机构及其工作人员在医疗活动中,违反医疗卫生法律、行政法规、部门规章和诊疗护理规范、常规,过错造成患者人身损害的事故”,拓宽了医疗事故的范围,并在此基础上着重强调医疗机构的谨慎注意义务,缩小了医疗事故的免责事由。其次,经过分析认为医疗事故损害赔偿责任的性质是侵权责任与违约责任的竞合,在实践中应根据当事人意思自治原则区别对待,适用不同的归责原则,同时指出了赔偿范围与标准以及医疗事故鉴定的不足,批驳了“不属于医疗事故的,不承担赔偿责任”的错误观点,论证了惩罚性赔偿原则在医疗事故损害赔偿纠纷中适用的可行性,提出了医疗事故网上鉴定的设想。最后为了强化对患者的司法救济,分散医疗机构的风险,消化医疗机构的损失,平衡医患双方的利益冲突,构筑完整的医疗事故损害赔偿体系,对医疗责任保险的保险范围、除外责任提出了自己的看法,同时提出医事法律应借鉴其他法律的相关规定,对医疗责任保险做出强制投保规定的设想。