Ethical concerns expressed by forensic psychiatrists

A survey was made of American Academy of Forensic Sciences (AAFS) forensic psychiatrists to evaluate whether there is concern among them about potential ethical problems in criminal justice work. Of the respondents, 93.8% had encountered such problems. The main concerns indicated were about those psychiatrists who become a "hired gun," become an advocate, do not give an honest opinion, or have problems with confidentiality. The need for ethical guidelines and further debate about ethical issues is presented.     

Perceptions of ethical problems by forensic psychiatrists

A survey was undertaken of the opinions of two groups of forensic psychiatrists to determine their views regarding forensic ethical issues. Although AAPL has made significant strides for our profession by adopting ethical guidelines, some important issues have not yet been addressed, as revealed by our survey. Included were items heretofore considered too "controversial" for incorporation into guidelines, as well as items from the APA ethical framework. All APA items were evaluated as addressing ethical problems. The majority of respondents also viewed most of the "controversial" items as confronting relevant ethical problems, thereby suggesting their inclusion, in some form, in the profession's guidelines. They also appeared to favor retention of many traditional medical ethical values when functioning as a forensic psychiatrist. Clear selective discrimination existed among differing death penalty facets. Since AAPL at present does not wish to conduct its own ethics hearings, the AAPL guidelines as well as the items supported in this paper's survey would best be translated into a form consistent with the APA framework. In this way, AAPL's guidelines and also the new suggested items could readily be coordinated within the APA framework and could play a role in the APA local district branch enforcement process.     

On the state of the budgetary funding of government forensic medical expert institutions in the Russian Federation

The data on the budgetary funding of state-owned forensic medical bureaus in the Russian Federation for the period from 2005 to 2008 were collected and analysed. The results of the overall estimation and parameters characterizing the level of funding of these expert facilities are presented. Selected state forensic medical bureaus have been ranked based on the level of their financial support.     

Risk assessment of sexual offenders in German forensic institutions

BACKGROUND: The assessment of recidivism in sexual offenders is an urgent topic for forensic psychiatry in Germany. The call for useful predictive measures is therefore getting louder. AIMS: The present study analyses which criteria are employed by therapists in forensic hospitals to assess the dangerousness of sexual offenders. Of particular interest is whether the criteria listed in presently known prediction scores as decisive are actually used in decision-making in current forensic psychiatric practice. METHOD: Data are collected in a prospective prediction study funded by the German Research Association. RESULTS: The results reveal that therapists employ mainly clinical and less historical criteria, thus indicating substantial differences from currently known prediction scores and results of other studies. CONCLUSIONS: That therapists base their prediction of dangerousness primarily on clinical variables reveals a substantial error that has to be remedied. Further research on the extent of relevance of clinical variables is needed.     

Opinions by AAPL forensic psychiatrists on controversial ethical guidelines: a survey.

A survey was conducted of a sample of AAPL members to determine their opinions on the inclusion of controversial ethical guidelines for forensic psychiatry. Members appear to appreciate the need to consider traditional Hippocratic values as at least one consideration in their functioning as forensic psychiatrists. They appear to balance their duties to an evaluee with duties to society and the legal system and to appreciate the responsibilities of multiple agency. Support was shown for interpreting ambiguities in AAPL's current guidelines in the directions indicated by most of this survey's proposed guidelines.     

Current issues in state mental health forensic programs

The major current issues facing state and local forensic mental health programs are presented in this paper. Debates over forensic patients' rights and the insanity defense are discussed, together with many administrative problems such as the pros and cons of correctional versus mental health system program control and payment incentives for treatment. The authors cite the differing goals of correctional and mental health systems, i.e., security and treatment, as reasons for difficulties in developing needed collaboration. Guidelines are suggested to address such important issues as mixing civil with criminal patients, developing units for special populations, defining patients who can respond to treatment, and follow-up after discharge.     

Management of forensic psychiatry patients who refuse medication--two scenarios

An Ohio federal court set Wyatt-type standards for treatment rights of forensic psychiatry patients and ordered legal due process-type hospital hearings to protect patients from what the court considers harmful clinical practices. Experience with this legal method for management of patients who refuse medication is examined for its impact on staff and patient care. Under legal pressure Ohio has built new regional forensic psychiatry hospitals. In one, spurred by legal activism, the prevalence of patients refusing medication has become pandemic. In its typical 16-bed ward, when 2 or more patients refuse medication, danger escalates rapidly for patients and staff. The method adopted to manage these situations is to assess the emergency of danger to patient or others, and if warranted to administer medication despite objections. This emergency management is dramatic in improving patient behavior and defusing milieu tensions. The psychiatrist ordering emergency management, however, faces challenges from several quarters--patient advocates, outside patients' rights legal advocates, and the commissioner of mental health. The clinically managed process contrasts markedly also with the legally imposed one in its impact on the personal and professional integrity of the responsible psychiatrist. Both scenarios illustrate the task yet remaining--integration of the clinical and legal concerns into a multisystem resolution of diverse interests, values, ethics, and rights.     

Can dentists recognize their own work? The forensic implications

After 10 months, 71.4% of a group of dental students were able to recognize amalgam restorations that they had placed in the mouths of manikins. After 24 months, 57.1% of the group were able to recognize their work again. In contrast, only 5.5% of a second group of students, who did not have the interim viewing at 10 months, could recognize their work at 24 months. These results suggest that, with time, dental operators lose the ability to recognize their work but that this ability is prolonged by interim observations of the work. This study underscores the need for dentists to chart and record accurately any artifacts introduced into the patient's mouth, as well as any features that would make the patient unique upon forensic examination.     

The Medicare approach: political choice and American institutions

The most significant health reform in American history was the passage of Medicare in 1965, but this was an accomplishment born of defeat. Medicare was designed and understood by its early promoters as an approach to health reform, not simply as a discrete program for a distinct target population. Although Medicare incrementalism has tended to be shunted aside when the opportunities for health reform are most promising, the final years of the Johnson administration reveal previously underappreciated efforts to expand Medicare eligibility to large new population groups and offer insights into the continuing potential of Medicare incrementalism in our own time.     

The organized subdural blood clot in forensic case work - a case report

The medico-legal assessment of a subdural haematoma (recent or organized) usually requires some information regarding its cause. Quite often, especially in the absence of a known history of trauma, minor head injuries, which are no longer verifiable, are simply assumed to be the most likely causes. Considering the fact that a subdural haematoma could also be non-traumatic, e.g. in haemorrhagic disorders, cardiac conditions with persistent passive hyperaemia, true inflammatory and degenerative processes of the dura, etc., the medico-legal implication of a possible head injury would require the exclusion of such non-traumatic conditions capable of causing subdural bleeding. In this respect, the case of a 92-year-old man, who suffered from cerebral sclerosis with occasional episodes of confusion and agitation, is briefly discussed. He was reported to have fallen from his bed, was hospitalized and died 2 days later. A head injury was suspected. At autopsy, no skull fractures and no obvious bruises were discovered. Fresh bilateral temporal subdural haematomas were found. These appeared consistent with a suspected head injury sustained as a result of a fall. Fairly large partly organized adherent subdural clots in the parieto-occipital region completely remote from and unconnected with the fresh bitemporal haematomas were also found. Based on the gross pathology and the histology, an attempt is made to assess the possible cause of the organized clots. Some of the findings indicated a possible non-traumatic origin, a consideration which is likely to affect the forensic implications.     

胸背部外伤致持续性植物状态案例分析

在现有的法医学文献中,多将持续性植物状态（persistent vegetative state,PVS）作为颅脑损伤的并发症进行介绍。但在法医学鉴定实践中,非颅脑损伤所致的PVS并非少见。另一方面,目前通用的法医学鉴定标准中,只有《道路交通事故受伤人员评定》将PVS明确列为评残条文,并归入“颅脑、脊髓及周围神经损伤致”项内。由于上述两方面原因,PVS、特别是非颅脑损伤所致PVS的损伤程度、伤残等级的评定均成为鉴定难点。在实际检案中．可以结合PVS的病因和病理机制、临床表现及法医学检查特点加以综合分析,进而作出损伤程度、伤残等级的评定。     

Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients

Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research.     

Dementing diseases among elderly persons who suffered fatal accidents: a forensic autopsy study

The demographics and forensic autopsy findings of 125 elderly persons were analyzed to identify the risk factors of fatal accidents among elderly and to develop preventive measures to minimize such events. Cliniconeuropathologic dementing diseases were diagnosed in 13 of the 69 accidental death but only 1 of the 56 nonaccidental death cases, indicating that dementing diseases are associated with accidental deaths of elderly in forensic autopsy populations and suggesting that interventions for preventing fatal accidents should focus on elderly persons with dementia. Blood alcohol was only detected in persons without dementia, indicating that dementing diseases and drunkenness are not coexisting factors for fatal accidents among elderly. Living alone might increase the risk of mortalities associated with accidental injuries because of the absence of a caregiver at the scene and delayed medical help. The majority of fatal accidents occurred outdoors, emphasizing the need for interventions to reduce environmental hazards such as those related to traffic, open water, and cold weather. Increased public awareness of accident risks and preventive interventions will reduce accidental deaths among community-dwelling elderly people.     

Legal regulation and management of fee for services in the state expert institutions

With due regard for the economic situation in regions, differences in the material-technical and personnel provision of each forensic-medical bureau (FMB), paying capacity of local residents and for other factors, a method for estimating the cost of forensic medical services was elaborated and offered for use. The formula of cost estimation for rendered services allow for basic wages (BW) and bonuses, sick-list and vacation payments, overhead charges (including FMB wear-and-tear), and BW assignment to off-budget funds (which constitute, in total, the self-cost of services) as well as the planned profit and road taxes.     

试析构建“和谐社会”进程中农民工犯罪问题

城市农民工是城市中的特殊群体。一直以来,由于受制度歧视,社会保障机制不完善等原因的影响,加之自身素质低下,造成了城市农民工的犯罪活动频繁发生,危害了安定的社会秩序,侵害了公民的人身和财产权益,激化了社会矛盾,增添了社会不稳定、不和谐的因素。因此,本文从构建和谐社会的视角着笔,重点分析了当前农民工犯罪的现状及产生原因,并就如何在新的形势下解决农民工犯罪问题提出了自己的看法和观点。