The ethical implications of prospective payment and corporate medical practice: A research agenda

The major trends in the growth of prospective payment and the corporatization of medical practice in the United States are examined. In particular, the ethical implications of these changes in the context of the multiple system goals of access, cost containment, and quality are considered. Considerable concern is being expressed that with the dominant emphasis on cost containment, the principles of access and quality might be compromised. This paper formulates a research agenda to address this question, based on a review and synthesis of empirical evidence and hypotheses about the probable or actual impact of these changes on the multiple health system goals. A basic premise is that ethical judgments should be grounded in empirical evidence about what actually is or will be.     

The thin line between legitimate and criminal enterprises: subsidy frauds in the European Community

This paper describes and analyses a large fraud against the financial interests of the European Community (EC). On the basis of this case and our interviews with officials in five EC countries, we highlight structural impediments to the control of such frauds, draw parallels with other research on organisational crime and suggest that the distinction between organised crime and white-collar crime be abandoned in favour of an enterprise model of crime. We conclude by pointing out that legal changes and strict controls alone cannot substantially reduce the huge potential for EC frauds, especially in view of the abolition of EC's internal borders in 1993. Antifraud policies must also address the underlying structural factors.     

Walking the line: Specialized and standard probation officer perspectives on supervising probationers with serious mental illnesses

Specialized probation programs were developed to more effectively address the unique needs of probationers with serious mental illnesses. Probation officers are tasked with serving both law enforcement and rehabilitative functions, and officers play an important gatekeeper function in helping probationers with serious mental illnesses avoid long incarceration sentences. The purpose of this paper was to explore specialized and standard probation officers' work in supervising probationers with serious mental illnesses. Twenty-one probation officers (11 specialized and 10 standard) participated in semi-structured interviews. Qualitative analyses examined: 1 — beliefs on the relationship between mental illness and crime; 2 — purpose of specialized and standard probation units; and 3 — approaches to supervising probationers with serious mental illnesses. Implications for developing more effective probation supervision programs are discussed.     

Bridging the gap between academia and practice: Perspectives from two large-scale and niche research projects in Canada

There is a recognized disconnect in priority and synergy between academic and practitioners in forensic science. In this work, we personally reflect on our experiences in conducting research studies that directly involve academic and practitioner stakeholders. We believe, amongst others, that this “gap” can be mitigated through regular and productive communication. We also emphasize the need to create stronger and national research strategies which identifies the current and pressing needs of enforcement officials in order to bring these needs directly to academia. As part of this, researchers should actively seek to make sure what they study will be relevant within the discipline. Our reflection is geared on direct feedback from an entomological study in large scale sampling of blowflies and workshops in bloodstain pattern analysis using a forensic blood substitute.     

The legal status of clinical and ethics policies, codes, and guidelines in medical practice and research

This article examines the legal status of "soft law" in the fields of medicine and medical research. Many areas of clinical practice and research involve complex and rapidly changing issues for which the law provides no guidance. Instead, guidance for physicians and researchers comes from what has often been called "soft law"--non-legislative, non-regulatory sources, such as ethics policy statements, codes, and guidelines from professional or quasi-governmental bodies. This article traces the evolution of these "soft law" instruments: how they are created, how they are adopted within the professional community, and how they become accepted by the courts. It studies the relationship between soft law instruments and the courts. It includes an examination of the approaches to judicial analysis used by the courts in theory and in practice. The authors then examine the jurisprudence to see how courts will adopt professional norms as the legal standard of care in some circumstances and not others. They consider the legal concerns and ethical issues surrounding the weight attached to professional practices and norms in law. The authors demonstrate how practices and policies that guide professional conduct may ultimately bear weight as norms recognizable and enforceable within the legal sphere.     

Self-neglect: adaptation of a clinical tool to the practice of the medical examiner

Self-neglect is the inability or unwillingness to provide for oneself the goods and services needed to live safely and independently. It is the most common allegation reported to Adult Protective Services agencies throughout the United States. Unfortunately, it seems that most medical examiners and their teams are not trained appropriately on self-neglect and forget to ask pertinent questions and document relevant observations. The most important aspect of self-neglect for the medical examiner is to recognize the diagnosis to avoid confusion with other forms of elder abuse, particularly neglect from a third party. In this context, a self-neglect scale could be a useful tool to assist the death investigation team. In the clinical field, a self-neglect severity scale was developed by the Consortium for Research in Elder Self-Neglect of Texas. It is here proposed that a self-neglect severity scale for medical examiners should be developed, to assist the investigative team in assessing these common cases. This scale is developed by modifying the clinical scale to adapt it to the particular needs of death investigation. This scale can help the medical examiner and his team in approaching these deaths in a systematic and comprehensive way.     

Ireland and medical research with minors: some medico-legal aspects

The practice of medical research with minors in Ireland consist of practices pertaining to therapeutic and non-therapeutic medical research. Clinical trials (a category of therapeutic research), is governed by legislation. However, any other therapeutic research (non-clinical trials research) and non-therapeutic research, e.g. observational medical research such as a longitudinal study of children or non-therapeutic research such as blood sample collection for analysis of cause of disease, are unregulated by legislation. This, article will outline and describe some of the medico-legal issues involved in both types of research and will comment on matters such as what national law exists, how the directive on good clinical practice has been implemented, what guidelines, if any, exist.     

对一起复杂性非法行医案件查处问题探讨

通过对K市某"生命养护中心"监督检查中发现的一起不同时段、不同违法主体开展非法行医的复杂案件的介绍,对案件调查取证、执法程序和法律适用进行全面评析,总结此类案件查处中的争议和不足.在国家全民大健康背景下,随着《基本医疗卫生与健康促进法》的出台,就未来如何有效打击和遏制非法行医活动等问题进行探讨.