Monitoring doctors' clinical competence: a Queensland focus

The medical profession is held accountable in numerous ways, many of which are concerned with clinical competence. However, while Australia's State medical boards are statutorily charged with protecting the public from incompetent practice, they have never instituted programs aimed at maintaining the standards of all practitioners. The article describes recent legislative changes and developments in undergraduate medical education, which aim to increase physicians' accountability in relation to competence, and compares developments in Queensland and other States with those in the United Kingdom, Quebec and New Zealand. The investigation of clinical incompetence as currently undertaken by the Medical Board of Queensland should, and will, be adopted in other States. However, responding to incompetence is necessarily piecemeal, and the article further argues that the States should develop inclusive revalidation strategies. Both the community and leading voices within the profession are demanding greater commitment to a self-regulation culture that is more transparent and has sharper teeth.     

精神病人合同能力鉴定的相关问题

为了探讨精神病人合同能力鉴定的相关理论,解决合同能力鉴定中鉴定标准混乱的问题,对合同能力鉴定的法律基础、标准、民事行为能力与民事权利能力的区别, 民事行为能力的广义、狭义区分进行了论述.提出合同能力鉴定的核心问题是意思表示的真实性,主张将合同能力分为有、无两级,强调合同能力的分级与民事行为能力的等级存在区别.并提出合同能力鉴定的程式为:首先判定其行为能力,有行为能力相应具有合同能力, 无行为能力即无合同能力,限制民事行为者,应根据年龄、智力、精神健康状况、生活关联度,再分为有合同能力、无合同能力.     

受审能力探析

受审能力是被告人接受法庭审判的能力。我国对受审能力的研究还处于起步阶段，立法上还有许多空白之处。本文从评定标准、提起、确认与法律后果等方面对受审能力进行了探讨。     

Therapists' obligations to report their patients' criminal acts

The law governing the obligation of therapists to report their patients' previous criminal acts was reviewed. Most often, discussions of this subject fall under the general category of "misprison of a felony," that is, the presumed general obligation of all citizens to report felonies that come to their attention. Review of federal law revealed that the courts have consistently interpreted the federal misprision statute as requiring active concealment of a crime, not a mere failure to report, in order to convict for the offense. State law is more diverse. Only one state has a general misprison statute labeled as such, and several states have recently repealed such statutes. The strong trend in states without statutes is to reject misprison as a common law crime, because of its incompatibility with modern notions of justice. Most states, however, have limited reporting statutes, such as for child abuse or gunshot wounds, that impose similar obligations. Therapists' reporting of past crimes may be affected by clinical and ethical concerns, as well as by obligations to protect future victims. In almost all jurisdictions, however, the fear of prosecution for failure to report a past crime should not be a factor in deciding on a course of action.     

谈自主开发创新能力

任何社会活动都依赖于人的参与，建设创新型国家这一重大历史任务更需要创新型人才来做其重要的载体。本文以人才学原理为基础对其进行分析，阐述了创新型人才自我培养的方式和方法，以使人们在日常生活中找到一条自主开发创新能力的途径。     

受审能力探析

受审能力是被告人接受法庭审判的能力。我国对受审能力的研究还处于起步阶段,立法上还有许多空白之处。本文从评定标准、提起、确认与法律后果等方面对受审能力进行了探讨。     

Developmental trends in adolescents' psychological and legal competence to consent to abortion

United States Supreme Court has affirmed the right of states to require parental consent or notice from minors seeking abortion. We examine an underlying presumption that minors are not competent to consent to abortion. Participants (N=75 age 13–21, seeking a pregnancy test at a women's medical clinic) completed an interview that was audiotaped and scored on four cognitive and volitional criteria of legal competence. Competence was compared in three age groups (≤15; 16–17; 18–21) for participants who considered abortion and for those who did not. Adolescents age 16–17 and adolescents ≤15, who considered abortion, appeared as competent as legal adults; only≤15-year-old adolescents who did not consider abortion appeared less competent. Regression analysis was used to identify psychosocial predictors of competence. Results challenge the presumption that minors are not competent. An alternate policy based upon informed consent and empowerment of minors as decision makers is proposed.     

Defining a clinically useful model for assessing competence to consent to treatment

Burdened with the responsibility of making an initial assessment of their patients' capacity to make treatment decisions, clinicians need a sound clinical assessment model. Drawing on ethical, legal, and clinical sources, the author reviews the appropriateness of existing models and standards and describes why each fails the needs of the clinician. The patient's ability to form a therapeutic alliance is shown to be a valid assessment model for defining a treatment decision-making ability threshold because it adheres to widely accepted ethical and legal standards. Using threshold because it adheres to widely accepted ethical and legal standards. Using this model to set a threshold for the decision to bring cases to the attention of a court or administrative body, the therapist arrives at a satisfactory balance between competent treatment, patient autonomy, and judicially mandated due process imperatives while providing a forum for patient education and assessment of the clinician's technical skill. Explanations of case examples illustrate the use of the therapeutic alliance for this purpose in a variety of clinical situations. Specific recommendations are made on what may be represented to court in cases in which the patient's competence appears to fall below this treatment threshold.     

The use of multiple informants to assess children's maltreatment experiences

Most researchers rely exclusively on the reports of protective service workers to determine children's abuse history. In this report, information about children's maltreatment experiences is obtained from protective service workers and three supplementary sources of data: parents, medical records, and clinical observations. Fifty-six children from 34 families receiving protective services for verified reports of physical abuse, neglect, sexual abuse, and/or emotional maltreatment participated in the study, with most children known to have experienced more than one type of abuse. The supplementary data provided important information about the range and severity of children's maltreatment experiences. Review of the parent and medical record data led to identification of 28 children who had additional types of maltreatment experiences that were not reported by their protective services workers—nine cases of physical abuse, two cases of neglect, five cases of sexual abuse, and 12 cases of emotional maltreatment. Supplementary data also revealed information about incidents of specific types of abuse that were more severe than those reported by the children's protective service workers in an additional 24 cases. A method was devised to synthesize information provided from the different sources of data examined in this report to derive 0–4 point ratings of four categories of maltreatment experiences: (1) physical abuse, (3) neglect, (3) sexual abuse, and (4) emotional maltreatment. The Kappa reliability coefficients for each of these scales were .88, .73, .83, and .90, respectively. Data demonstrating the relationship between these maltreatment ratings and various indices of the children's socioemotional and cognitive functioning were also presented to provide preliminary support for the validity of these scales. The findings from this study suggest that multiple sources of data should be examined in order to obtain accurate assessments of children's maltreatment experiences, and that independent raters can synthesize discrepant data to obtain reliable and valid estimates of children's abuse history. Clinical and methodological issues relevant to the improved assessment of children's maltreatment experiences are also discussed.     

Fatal suicidal crossbow injury--the ability to act

We report a case of a 58-year-old man who committed suicide using a modern crossbow. The victim shot himself in the chest with a conical field-tip arrow from close proximity. We first presumed that this was a case of homicide committed with a firearm. We were, however, subsequently proved wrong. The reasons for the primary statement were as follows: the external morphology of the entrance wound being typical of a firearm discharged from long distance; the perforation found on the victim's clothing; the absence of the firearm at the place of death; the absence of the arrow in the wound. All of these reasons forced us initially to conclude that the case was one of homicide. In the reported case, the man, after having been shot with an arrow, was further able to act, even though the abdominal aorta and liver were seriously injured. While the arrow was in the wound, the injuries may not have led to massive bleeding because of incomplete tamponade of the defects by the arrow shaft. Pulling the arrow out of the victim's wound track initiated massive bleeding. Despite all these injuries, the man was capable of pulling the bow string again and reloading the crossbow with the arrow used in the first attempt. This case demonstrates that forensic investigations into crossbow injuries can be very difficult, especially when the bolt has been removed from the body.     

Using resolution calculations to assess changes in capillary electrophoresis run parameters

Capillary electrophoresis is widely used in the forensic community for the analysis of Short Tandem Repeat DNA. The CE system used in most forensic laboratories allows the user to modify standard operational protocols to accommodate some samples that fall outside of interpretational guidelines. We have made operational changes and monitored system resolution and the ability of the software to identify alleles as a result of these modifications. Increased amount of amplified product in the injection preparation, lengthened injection times or repeated injections of the same sample were all investigated along with variations in run voltages. Certain protocol modifications offer some advantages to the analysis of STRs and may allow the analyst to avoid extraction of additional portions of crime scene samples to achieve interpretable results.