A paradigm shift for ethics committees and case consultation: a modest proposal

In conclusion, the expert-consultation model of ethics consultation is deeply imbedded in modern health care. The paradigm of consultant as expert rather than as community-enabler shapes the expectations and behaviors of healthcare personnel and institutions. This paradigm has also shaped the early stages of HEC development and ethics case consultation. It is time to shift paradigms and adopt one that derives more from the nature of ethics than from the nature of scientific medicine: the role of HECs should be to enable key professionals to carry out the ethical dimensions of patient care. When the HEC does review cases, it should be with the purpose of improving the institution, not of resolving individual cases. One consequence of this is that there will be more individual case reviews than before, but the function, emphasis, agents and locations will shift substantially. A second consequence is that the HEC will function more as an agent of social change by helping to harness the institution's resources. We judge both of these to be a welcome evolution in healthcare ethics.     

Defederalizing Medicaid: fair to the poor, fair to taxpayers?

This paper explores the access and equity implications to the poor and taxpayers of further defederalizing Medicaid program administration. New data on enrollees and tax incidence indicates little horizontal, let alone vertical, equity in the system. Styles of cost control are also examined, showing a systematic bias towards providers and taxpayers at the expense of the poor in penurious states.     

The right to a fair trial as a conceptual framework for digital evidence rules in criminal investigations

Digital evidence and digital forensics have a significant impact on criminal investigation. This requires an examination if the fair trial principle remains sound in the new domain.In this paper the right to a fair trial in Art. 6 ECHR and its interpretation in case law is analysed in order to clarify its connection to evidence law and its specific application to the investigation stage of criminal proceedings. It is argued that the principle implicitly enshrines a framework for the development of universal evidence rules . Derived are two-groups of evidence rules: equality of arms based and presumption of innocence based. For each group specific challenges in the digital investigation are outlined and discussed in the context of a new governance model for digital evidence.     

Photojournalism, fair use and fair dealing

A Massachusetts decision applying the US fair use principlesto unlicensed broadcasts of news photographs highlights thespecial protection given to news photographs, but not news videos,under UK copyright law.     

Sudden death due to right ventricular cardiomyopathy

A 21-year-old man died suddenly at a small party. He had had no clinical signs of cardiac disease except for a slightly abnormal electrocardiogram (occasional premature ventricular contractions) since he was 15 years of age. Autopsy examination revealed cardiomegaly (469 g), with right atrial and ventricular dilatation. The right ventricular myocardium was massively replaced with adipose tissue, and there was one isolated fatty lesion in the right side of the ventricular septum. There were no congenital malformations such as a septal defect or valvular deformity. Histologically, muscular fibers remaining in the right ventricular wall showed neither degenerative nor inflammatory changes. An isolated lesion of the ventricular septum consisted of almost complete replacement of the muscle bundles with adipose tissue. Such a pathologic condition has recently been termed right ventricular cardiomyopathy. Postmortem examination is necessary to make a definite diagnosis of the disease, because in most adult cases of the disease, sudden death occurs before there have been any critical signs.