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     

Toxicological findings in a death involving dextromethorphan and terfenadine.

A case of fatal self-poisoning with dextromethorphan, an antitussive, and terfanadine, an antihistamine H1, is reported. Both drugs were quantified in several postmortem tissues and fluids using capillary gas chromatography coupled to mass spectrometry. Results are discussed in the light of the existing literature.     

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.     

Small business innovation,research, and development

Historically, small businesses have been the innovation engine of the United States, with significantly more than half of the new technologies and products coming from small enterprises. In 1992, there were more than 21 million small businesses with fewer than 500 employees each in the United States, including 4.5 million small corporations, 1.6 million partnerships, and 15.1 million sole proprietorships. Although most small businesses have considerably fewer than 100 employees, they employ more than half the private U.S. work force, contribute more than half of all sales in the country, and are responsible for over half of the private sector's products. From 1976 to 1990, small firms also generated 65% of the net new jobs. From 1988 to 1990, all of the net new jobs in the U.S. economy were created by small firms. Indeed, small business is really big business in the United States.     

Global economic developments: A view from Switzerland

In a free market world economy now characterized by a strong trend towards integrated economic areas dominated by North America, Western Europe and the Pacific, effective cooperation is the key to sustained success. Mr. Lautenberg is a diplomat, whose career has been strongly oriented on bilateral and multilateral economic matters (Poland, FRG; GATT, EFTA, CSCE). Between 1970 and 1974, Mr. Lautenberg, who holds a degree in political sciences from the University of Lausanne, led various research programs at the General Staff of the Department of Defense.     

Are disturbed and normal adolescents equally competent to make decisions about mental health treatments?

This study uses a structured vignette procedure to assess competency to make treatment decisions in two groups of adolescents, one at risk for institutional placement and the other a matched community sample. Scores on Factual Understanding (the ability to recall facts), Inferential Understanding (the ability to make inferences about those facts), and Reasoning (the ability to weigh risks and benefits of various treatment options and to make choices based on that reasoning) were compared. Results showed that while at-risk adolescents and their community, counterparts did not differ in their factual and inferential understanding abilities, the at-risk adolescents did significantly less well than the community adolescents in reasoning. This difference could not be fully explained by differences in verbal IQ. Girls, no matter what their risk status, scored higher than boys on the Reasoning scale. Implications for legal policies concerning adolescents are discussed.