Surrogate decision-making for incompetent elderly patients: the role of informal representatives

Informal or unofficial representation refers to the practice (more common in some European jurisdictions than in others), that persons not designed by a court or by the patient himself, make medical decisions on the patient's behalf in case of their incompetence. If the law provides for this, it is usually next of kin (spouse, children, brothers and sisters, etc.) who are allowed to act in such a capacity. Informal representation raises several questions. Are family members always familiar with what their relative would have wished, ready to take responsibility, and not too much reigned by their emotions? The basic legal concern is whether there are sufficient procedural and other safeguards to protect the incompetent patient from representatives who do not serve their best interests. In addressing these issues, after a brief survey of the law in the Netherlands as compared with that in Belgium, Germany and England/Wales, we will argue that informal representation as such is not at variance with international and European standards. However, an 'informal' approach to surrogate decision-making should always go together with sufficient protection of the incompetent patient, including procedural safeguards with regard to the decision that the patient is incompetent, limits to the decision-making power of informal representatives and effective forms of conflict resolution.     

Fatal intravenous injection of potassium in hospitalized patients

We describe 4 cases of fatal intravenous injection of potassium in the hospital setting. These cases illustrate the subtlety of findings in such deaths and remind the forensic pathologist to consider this type of event in sudden, unexpected death of hospitalized patients.     

Medical decision-making for incapacitated elders: A "therapeutic interests" standard

Some older individuals lack sufficient present cognitive and/or emotional ability to make and express autonomous decisions personally. In those situations, health-care providers routinely turn to available formal or informal surrogates who often must apply the best interests standard in making decisions for the incapacitated person. This article contends that defining the best interests standard of surrogate decision-making for older adults in terms of optimal or ideal choices (truly the patient's "best" interests) frequently sets out an unrealizable goal for surrogates to satisfy. Instead, a decision-making standard based on the incapacitated person's "therapeutic" interests is more realistic and hence more honest to adopt and apply from legal, ethical, and medical perspectives.     

Disclosure of medical information to the surrogate of a patient who lacks decision-making capacity. Final rule

This document amends Department of Veterans Affairs (VA) regulations to reflect changes made by section 504 of the Caregivers and Veterans Omnibus Health Services Act of 2010. Section 504 authorizes a VA practitioner, when the practitioner deems it necessary to ensure an informed medical decision, to share certain, otherwise protected medical information with the representative of a patient who lacks decision-making capacity. This rulemaking amends VA regulations consistent with this new authority.     

精神障碍者民事行为能力两分法的理论依据

目前,随着我国经济和社会的发展,人们参与的民事活动日渐增多,而各种民事诉讼活动也随着人们法制观念的提高以及法律制度的完善而逐渐增多.因此,诉讼中涉及的民事活动当事人的民事行为能力的司法精神病鉴定也愈来愈多.加之,我国加入WTO组织,国际交流日益增多,国际间民事纠纷亦增多,民事行为能力的司法精神病学鉴定的重要性将愈发突出. 但我国此类鉴定仍处于初始阶段,在实际工作中还存在如行为能力的"二分法"等许多问题和难点,有必要进行深入探讨以进一步完善之.     

精神障碍者民事行为能力两分法的理论依据

目前 ,随着我国经济和社会的发展 ,人们参与的民事活动日渐增多 ,而各种民事诉讼活动也随着人们法制观念的提高以及法律制度的完善而逐渐增多。因此 ,诉讼中涉及的民事活动当事人的民事行为能力的司法精神病鉴定也愈来愈多。加之 ,我国加入ＷＴＯ组织 ,国际交流日益增多 ,国际间民事纠纷亦增多 ,民事行为能力的司法精神病学鉴定的重要性将愈发突出。但我国此类鉴定仍处于初始阶段 ,在实际工作中还存在如行为能力的“二分法”等许多问题和难点 ,有必要进行深入探讨以进一步完善之。与刑事责任能力的划分类似 ,精神障碍者的民事行为能力也存在…     

精神发育迟滞患者辨认能力的影响因素研究

目的　探讨司法鉴定中精神发育迟滞 (MR)患者辨认能力的影响因素。方法　对 86例MR司法鉴定资料进行判别分析 ,选出影响辨认能力的判别因子 ,并建立判别方程 ,进行组内回代检验。结果　经判别分析 ,有 5个因素被选入 :个性特征、诊断分组、是否伴有癫痫及其他精神病性症状、作案类型、作案动机 ,组内回代检验不同程度辨认能力的判断正确率分别为 :有完全辨认能力 93 8%、有部分辨认能力73 4 %、无辨认能力 1 0 0 %,总判断正确率为 89 0 %。结论　MR患者作案时辨认能力受多种因素的影响 ,否认了“单纯以诊断分级判断辨认能力”的观点。     

精神发育迟滞患者辨认能力的影响因素研究

目的 探讨司法鉴定中精神发育迟滞（ＭＲ）患者辨认能力的影响因素。方法 对８６例ＭＲ司法鉴定资料进行判别分析,影响辨认能力的判别因子,并建立判别方程进行组内回代检验。结果 经判别分析,有５个因素被选入;个性特性、诊断分组、是否伴有癫痫及其他精神病性症状、作案类型、作案动机,组内回代检验不同程度辨认能力的判断正确率分别为：有完全辨认能力９３．８％、有部分辨认能力７３．４％、无辨认能力１００％,总判断正     

The structure of medical malpractice decision-making in Japan

The article summarises the problems in the medical malpractice litigation systems in the United Kingdom and Japan, demonstrating the similarities and identifying the length of time between initiating an action and its decision and other factors responsible for lengthy litigation. Based on analysis of decisions of medical malpractice cases between 1986 and 1998 in Japan, the functioning of the Japanese medical malpractice litigation system is discussed. Lengthy litigation is shown to be correlated with outcome and implies that the Japanese medical dispute resolution mechanism favours those who can endure lengthy litigation, namely the defendants, who are physicians or hospitals. In view of the similarities between the two systems, it is likely that the same bias--that the wealthier party in the litigation is more likely to win the case--also occurs in medical malpractice litigation in the United Kingdom and Australia.