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.     

Public health and vulnerable groups

Editors' Introduction

Public health and vulnerable groups     

The cost of regulation in a decentralized context: the case of the Spanish regions

The impact of regulation on productivity is an issue that has attracted increasing interest in recent decades, as some scholars have argued that the proliferation of red tape may be the cause of slower growth rates in some western economies. Regulation (and other public instruments) has significant effects that may be either benign or harmful. Justified and well designed regulation protects consumers from potentially unsafe products, limits pollution, enhances workplace safety and contributes to public health and safety, as well as a more productive and fair society. However, an overabundance of rules or badly designed regulation can cause confusion and delay, impose unreasonable compliance costs in terms of capital investment, labour and official paperwork, retard innovation, lower productivity and, accidentally, distort incentives for private initiative. The objective of this paper is to examine the possible impact of regulatory activity in the Spanish regions over the past decade (1989–2001) on growth and productivity.     

Fiscal Federalism, European Stability Pact, and Municipal Investment Finance: A Microdata Analysis of Spanish Municipalities

In countries where subnational governments control a large partof the public finances, the central government's ability tokeep its commitment to the European Union's Stability and GrowthPact can be a difficult matter. European rules demand that theoverall budget be balanced over the medium term; applying thisrule at subcentral level may unduly reduce capital outlays andlocal budgetary autonomy. This article examines the possibleimpact of budgetary stability legislation on the capital expenditureof Spanish municipalities. The empirical findings suggest thatthe new budgetary stability framework will oblige municipalitiesto (i) limit their investments, (ii) raise the tax burden, or(iii) reduce the funds allocated to other budget items. We believethe Spanish municipal experience is generalizable to other federalcountries in Europe that are facing hard budget constraintsand high earmarked grants.     

Neurocysticercosis

Neurocysticercosis results when the ingested eggs of the pork tapeworm, Taenia solium, hatch into larval forms that penetrate the gut wall, disseminate hematogenously, and then encyst in the brain. The subsequent symptoms and associated morbidity are variable. Worldwide, cysticercosis is the most common parasitic disease affecting the central nervous system, but it is not a common autopsy finding in the United States. Neurocysticercosis may be an incidental finding, a contributing cause of death, or the underlying cause of death. It is also important for the forensic pathologist to be aware of the possibility of neurocysticercosis in the autopsy population for purposes of epidemiology studies and infection control. The authors use cases of neurocysticercosis found at autopsy at their institution to give examples of each scenario and to review the clinical and pathologic features of this parasitic disease.     

The Influence of Evidence on Animal Cruelty Prosecution and Case Outcomes: Results of a Survey

Two hundred prosecuting attorneys completed a survey concerning priorities in taking on animal cruelty cases and the factors that help or hinder prosecuting such cases. Respondents commented on the priority given such cases. Questions also addressed specific kinds of evidence that had been used to decide whether to take on a cruelty case and were used in court. Results showed that prosecutors most frequently relied upon “traditional” sources of evidence, including detailed medical and crime scene reports and good quality photographic evidence. Other sources of forensic evidence such as DNA, computer forensics, forensic accounting, blood, and trace evidence were rarely employed. Veterinary forensic evidence, including forensic necropsies and detailed medical reports, was viewed as an important factor by a majority of prosecutors in deciding whether to accept a case for prosecution and in achieving a successful outcome, but a need for additional training for investigators was indicated.     

Functioning strategies of the research groups' leaders in the context of funding and policy instabilities☆

We explore the strategies implemented by Research Groups' Leaders while coping with unstable contexts, characterized by incoherence and lack of coordination among different policy discourses and instruments, and scarce resources. We focus on a country where these conditions are present: Colombia. In doing so, we study two cases, one in nanotechnology and another one in biomedical engineering. Interviews, focus groups and workshops allowed us to identify and validate strategies grouped in four popular sayings, proper to local idiosyncrasy, highlighting the role of home institutions and principal investigators in facing such situations with resilience and resourcefulness, and even taking advantage of them. We find that Research Groups' Leaders use strategies such as: adapting, balancing agendas and funding sources, networking, and taking advantage of the support programs available at their home institution to continue functioning. These are setting the ground for a further survey which could pretend some generalization. However, policymakers could consider these findings when defining policy instruments or for assessing their effectiveness or impacts.