Error Reduction, Patient Safety and Institutional Ethics Committees

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. In this paper, the author endeavors to fill the gap. As noted in the Hastings Center's recent report, "Promoting Patient Safety," the occurrence of medical error involves complex web of multiple factors. Human misstep is certainly one such factor, but not the only one. This paper builds on the Hastings Center's report in arguing that institutional ethics committees ought to play an integral role in the transformation of a "culture of blame" to a "culture of safety" in healthcare delivery.     

Conflict Between Doctor and Patient

"The belief that doctors can act on behalf of patients denies the existence of inevitable conflict." Jay Katz¹     

Medical Device Regulation and Nanotechnologies: Determining the Role of Patient Safety Concerns in Policymaking

Balancing acceptable risks and early release of products for new treatments in patient care with the rights of patients and the rights of stakeholders—device makers and regulators—is a complex task. With the rapid technological innovations of the last two decades, providing a balanced voice to all participants is essential, but a sense of urgency depends on which side of the aisle one is sitting: on the side of patients, surgeons, regulators, and device makers; or that of providers and scientific advisors. A review of the medical device political economy suggests why patient safety concerns are or should be kept alive throughout the entire regulatory cycle from clinical evaluation and premarket checks to their final use in a huge variety of clinical settings around the globe. The key issue for nano‐enhanced devices now is whether the uncertainties and perceived risks can be reduced through more stringent regulatory requirements and proactive measures without stifling innovation and development of new treatments for patients.     

War Stories and Occupying Soldiers: A Narrative Approach to Understanding Police Culture and Community Conflict

Narrative theory and methods are gradually finding a place in the study of crime and its control. However vibrant narrative criminology has been to this point, narrative scholars have somewhat ignored policing, both in terms of the language and grammar of individual officers and the cultural life of the institution itself. In this article, we elaborate the importance of storytelling in the (re)production of contemporary police culture and the broader police power. While storytelling as cultural production is, of course, not the sole purview of police, they are uniquely positioned to shape the broad social, cultural and political imaginaries of crime and the realities of crime control and community interactions. Therefore, in paying close attention to the narratives of police and the cultural work accomplished through storytelling, we gain insight into the production and maintenance of police authority and culture.     

Frontline Safety: Understanding the Workplace as a Site of Regulatory Engagement

The concept of frontline safety encapsulates an approach to occupational health and safety that emphasizes the “other side of the regulatory relationship”—the ways in which safety culture, individual responsibility, organizational citizenship, trust, and compliance are interpreted and experienced at the local level. By exploring theoretical tensions concerning the most appropriate way of conceptualizing and framing frontline regulatory engagement, we can better identify the ways in which conceptions of individuals (as rational, responsible, economic actors) are constructed and maintained through workplace interactions and decision making as part of the fulfillment of the ideological and constitutive needs of neoliberal labor markets.     

美国医疗差错的概念、定义与特征本

医疗差错已经是一个全世界的问题。越是现代化的国家 ,这一问题就显得越为严重 ,在美国因医疗差错导致患者死亡已占死因的第 8位。在我国 ,一直习惯使用医疗事故的概念 ,而医疗事故又在《刑法》里有明确的罪责。随着中国经济日益与世界接轨 ,法律制度中的一些概念性问题也在逐步朝向国际统一方向发展。因此 ,对于医疗差错的明确统一定义 ,就显得十分很重要。本文主要介绍美国法律方面的相关规定。一、医疗差错是当今的世界性问题1999年 ,美国医学研究所 (ＩＯＭ ,ｔｈｅＩｎｓｔｉｔｕｔｅｏｆＭｅｄｉｃｉｎｅ )估计 ,每年有 980 0 0人死于…     

美国医疗差错的概念、定义与特征本

医疗差错已经是一个全世界的问题。越是现代化的国家，这一问题就显得越为严重，在美国 因医疗差错导致患者死亡已占死因的第8位。在我国，一直习惯使用医疗事故的概念，而医 疗事故又在《刑法》里有明确的罪责。随着中国经济日益与世界接轨，法律制度中的一些 概 念性问题也在逐步朝向国际统一方向发展。因此，对于医疗差错的明确统一定义，就显 得十 分很重要。本文主要介绍美国法律方面的相关规定。     

Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice

Clinical evidence suggests that many patients undergo surgery that they would decline if fully informed. Failure to communicate the relevant risks, benefits, and alternatives of a procedure violates medical ethics and wastes medical resources. Integrating shared decision-making, a method of communication between provider and patient, into medical decisions can satisfy physicians' ethical obligations and reduce unwanted procedures. This article proposes a three-step process for implementing a nationwide practice of shared decision-making: (1) create model integration programs; (2) provide legal incentives to ease the transition; and (3) incorporate shared decision-making into medical necessity determinations.     

浅论澳门与内地食品安全法律冲突及其解决机制

澳门与内地在食品安全标准制度、食品安全公众参与制度、食品安全监管体制方面都有较大法律冲突。对此,应秉承＂食品安全至上＂的最高理念,以构建食品安全统一实体法规范、在共同参与的国际公约框架内和构建澳门与内地长效食品安全监管合作机制为主,解决食品安全法冲突。     

论医疗过失损害赔偿责任的适当限制规则

医疗过失损害赔偿责任与一般的人身损害赔偿责任不同，具有一定的特殊性，因此，应当确立医疗损害赔偿适当限制规则。具体的限制方法：应当限制精神损害抚慰金的赔偿数额、应当对医疗过失引起的财产损害赔偿运用原因力规则合理确定、应当特别强调定期金赔偿在医疗过失损害赔偿中的适用和应当借鉴排除间接来源规则，在医疗过失损害赔偿中实行损益相抵规则。     

Analysis of Bone Healing in a Postoperative Patient: Skeletal Evidence of Medical Neglect and Human Rights Violations

This study highlights complexities associated with postsurgical trauma interpretation of a 76‐year‐old female patient from a psychiatric institution in Mexico. The skeletal analysis identified complications from an unsuccessful surgical operation for an intertrochanteric fracture of the femur. An improperly placed surgical plate resulted in nonunion due to limited contact between fracture margins. However, it is unclear whether this resulted from surgical complications, ineffective postoperative care, or from the decedent's limited ability to follow postoperative care instructions. Additionally, failure of the plate resulted in degenerative changes to the acetabulum. These complications, associated with degenerative changes to upper limb joints, suggest significant mobility issues. The pattern of antemortem trauma and contextual information support a conclusion of postoperative medical neglect, a documented problem in psychiatric institutions in Latin America. This study provides insight into the relevance of detailed trauma assessment of skeletal remains in cases where neglect and human rights violations are suspected.