Ethics and the Physician-Patient Relationship

Book Reviews in This Article:
Getting Rid of Patients: Contradictions in the Socialization of Physicians . By Terry Mizrahi
Physicians and Social Change . By John Colombotos and Corinne Kirchner
Changing Values in Medicine . Edited by Eric J. Cassell and Mark Siegler
Professional Ethics and Primary Care Medicine: Beyond Dilemmas and Decorum . By Harmon L. Smith and Larry R. Churchill
Physician—Patient Decision-Making: A Study in Medical Ethics . By Douglas N. Walton
With Dignity: The Search for Medicare and Medicaid . By Sheri I. David
The Dismissal of Students with Mental Disorders. Legal Issues, Policy Considerations, and Alternative Responses .
Courtroom Toxicology . By Marshall Houts, Randall C. Baselt, and Robert H. Cravey     

Mentally disordered offenders in Sweden.

This article reviews the laws in Sweden concerning mentally disordered offenders. It also contains some figures on the relationship between mentally disordered offenders and other offenders sentenced to prison. The rules in Sweden are very different from other countries in that the responsibility concept has been abolished and thus there is no acquittal on a psychiatric basis.     

Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland--monitoring early changes in HIV-seropositivity among risk groups and average population.

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.     

Dissecting intramural haematoma of the coronary artery with intimal tears.

A dissecting intramural haematoma of the coronary artery is an infrequent cause of sudden and unexpected death. Most cases are women and in a significant number of these women, the haematoma occurred at term to 80 days postpartum. Because the intimal rupture and communication with the lumen were not found in most of the cases, the site of rupture has been considered to be a vasa vasorum. The authors report on a case of one woman who was at a later postpartum period (106 days). The microscopic finding of the dissected coronary artery revealed two intimal tears in a section. The case showed that the dissecting intramural haematoma of the coronary artery is caused not only by the rupture of the vasa vasorum but also by the rupture of the intima.     

Identification based on medical findings

1. The indications such as the place of finding, the identification of clothes or other personal items, represent only the first step towards the identification of a corpse. 2. An identification based on medical data, other than dental, is often possible, more often than it is believed. 3. The forensic pathologist plays a double role in the case of such an identification: a) in the phase of the inquiry, he must contact the investigators and the families to explain his wishes and the different possibilities of identification. b) he must use the gathered information in the appropriate way. 4. It would be desirable to compose some statistical tables of the various medical elements useful for the identification (mutilations, surgical operations, etc...). We present six cases of identification in our practice.     

Inmates: Who occupies our jails?

The purpose of this investigation was to identify inmate personal and demographic data that may be used to further define or profile persons with a greater likelihood of being at risk for serving a jail sentence. This study was explorative. The survey administration was similar in format to that conducted by the U.S. Department of Justice. Chaplains were used as survey proctors. Pilot studies were conducted to determine the suitability of survey content. Surveys consisted of 172 items. Subjects included four hundred inmates: males comprised 88.75 percent of the sample, Caucasians 58.25 percent, Blacks 37 percent, Hispanics 3.25 percent and other 1.5 percent of the sample. Respondents ranged in age from 15 to 64 years with an average age of 30.3 years. Less than two percent of the contacted inmates refused participation in the survey. Results are presented for demographic data, select legal/criminal data, select drug and alcohol use data, employment data, health, parent/family data, education data, social data, and “other”.     

THE MPA CAPSTONE EXPERIENCE: FHE ESSENCE OF ANALYSIS IS SURPRISE

A final course, or project is a standard requirement in Master of Public Administration (MPA) programs. This requirement is intended to permit the student to demonstrate advanced ability in the discipline. This article examines one such course at Florida State University. The course included readings, exercises, oral presentations, and a written report. This author assesses the merits and drawbacks of the course as well as notes the unintended consequences that resulted. In concluding the article, the author makes several recommendations for future courses based on the experiences gained in the Florida state model.     

The Whole-Brain Concept of Death Remains Optimum Public Policy

"Brain death," the determination of human death by showing the irreversible loss of all clinical functions of the brain, has become a worldwide practice. A biophilosophical account of brain death requires four sequential tasks: (1) agreeing on the paradigm of death, a set of preconditions that frame the discussion; (2) determining the definition of death by making explicit the consensual concept of death; (3) determining the criterion of death that proves the definition has been fulfilled by being both necessary and sufficient for death; and (4) determining the tests of death for physicians to employ at the patient's bedside to demonstrate that the criterion of death has been fulfilled. The best definition of death is "the cessation of functioning of the organism as a whole." The whole-brain criterion is the only criterion that is both necessary and sufficient for death. Brain death tests are used only in the unusual case in which a patient's ventilation is being supported. Brain death critics have identified weaknesses in its formulation. But despite its shortcomings, the whole-brain death formulation comprises a concept and public policy that make intuitive and practical sense and that has been well accepted by many societies.