Recent developments in medicine and law

This article addresses important developments in the field of medicine and the law during the last year and highlights some of the significant areas of law affecting health care providers that should be considered. Actions against health care providers may include challenges to peer review immunity, allegations concerning the practice of medicine across state lines without a license, and even accusations of wrongfully assisting a patient to commit suicide. These areas are addressed in turn by this article. Finally, antitrust developments over the last year are briefly addressed as an emerging area of concern for providers forming complex practice networks in today's health care arena.     

Dreams and Nightmares: Practical and Ethical Issues for Patients and Physicians Using Personal Health Records

Electronic health records for patients, personal health records (PHRs), have become increasingly popular among policy makers and purchasers, but uptake among patients and physicians has been relatively slow. PHRs have varying uses that might make them more or less appealing to different stakeholders. The three core uses for PHRs — promoting communication, data use, and patient responsibility — each raises a set of potential practical and financial dilemmas. But some ethical concerns are also at play, some of which are rarely recognized as values-based barriers to the use of PHRs. Recognizing these ethical issues, and addressing them explicitly in PHR design and policy making, would help PHRs to achieve their promise.     

Three Patterns of Domestic Violence in Households: Single Victimization,Repeat Victimization,and Co-occurring Victimization

Using National Crime Victimization Survey data (1992–2004), this study analyzed the effects of household variables, victim characteristics, and incident characteristics on three household family violence patterns (single victimization, repeat victimization and co-occurrence). Eighty percent of family violence households experienced one victimization; 15% experienced repeat victimization; 5% experienced co-occurrence. The total number of people in the household was positively related to multiple violent victimization households, especially co-occurrence households. Victims with less than a high school education (compared to victims with a high school education) had significantly higher odds of living in a co-occurrence household versus a repeat victimization household. Victims who experienced threatened attacks compared to completed attacks with no injury had higher odds of living in single victimization or repeat victimization households but had lower odds of living in co-occurrence households. Respondents victimized by ex-spouses, parents/stepparents, siblings, and other relatives had consistently higher odds of living in co-occurrence households versus repeat victimization households compared to those victimized by spouses.     

Assessing the Debate, Assessing the Damage: Transatlantic Relations after Bush

Transatlantic relations during the Bush administration sank to the lowest point in the post-war period following the invasion of Iraq in 2003. This article provides an analysis of both the current state of that relationship and the academic debate which accompanies it. Arguments over the impact of various factors are analysed to determine the extent of transatlantic divergence. Thus, demographic change in America and Europe, divergence of political values between Europe and America, power differences, post-war geopolitical realignments, European integration and American unilateralism and exceptionalism are all analysed and evaluated. While some of these arguments presented are challenged, the article argues that the process of constructing separate European and American identities from within the transatlantic community is the single most significant contemporary challenge to transatlantic relations.     

Reinventing Amtrak: The politics of survival

This article argues that Amtrak's design as a “quasi-public, for-profit” corporation was seriously flawed from its beginnings. The corporation was isolated from America's private railroads, and isolated from trust-funding financial mechanisms that supported highways, airports, and mass transit. It depended on powerful Democratic congressional patrons and labor union support for protection from Republican executive budget cuts. But these allies pushed Amtrak into running far more costly service than was good for its bottom line. The corporation was already engaged in an internal reorganization designed to bring it closer to its customers, when the Republican victory in the 1994 congressional election launched an external effort to reorient and restructure Amtrak. There are three possible outcomes of the two-sided reinvention process: status quo and continued slow decline; partnership based on new relationships between Amtrak, federal and state governments, and the private sector; and privatization which might still require substantial public expenditures for some time. Synchronizing the opportunities created by both the internal and the external reinvention efforts is the key to whether Amtrak can emerge as a viable and valuable provider of rail transportation in the 21st century.     

The Sooner the Better: The Arguments for the Use of Extended Welfare Assessment Grids in Animal Welfare Cases

Animals are protected under national animal welfare legislation, against intentional acts of cruelty and a failure to act, resulting in neglect and causing an animal to suffer. The Royal Society for the Prevention of Cruelty to Animals (RSPCA) bears the responsibility of investigating and prosecuting the majority of animal welfare offences in England and Wales. In recent years, how they operate has been criticised, and it has been debated whether they should be able to bring private prosecutions, and what their role should actually be. This criticism calls for a change in the way in which the RSPCA approach cases of animal welfare, to strengthen their continuing role in ensuring positive animal welfare is achieved and, where not, prosecuted. This paper outlines the need for a new approach and how it can be managed. Honess and Wolfensohn (Altern Lab Anim 38:205, 2010) have developed an Extended Welfare Assessment Grid (EWAG), a visualisation mapping tool of welfare impact, which has been useful for assessing the welfare of animals used in laboratories. This tool has proven so useful, veterinarians are now using it in veterinary hospitals to help assess whether an animal is likely to further deteriorate, due to disease and illness, and to show any short-term welfare impact on the animal (Williams in UFAW conference, Newcastle upon Tyne, 2018). This paper will explore the potential for the EWAG to be adapted to assess the welfare of animals when owners are not meeting the welfare needs of their companion animals. RSPCA can use it to support their assessments of the current welfare of an animal under a person’s ownership and whether the animal’s welfare will deteriorate should they remain under that ownership. The EWAG will be a useful tool for those working in animal welfare, such as the RSPCA, to help organisations to intervene earlier, work in partnership with an owner, and support their claims of a risk to animal welfare.