Assessment of physician-assisted death by members of the public prosecution in The Netherlands.
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OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. (+info)
Legal aspects of clinical ethics committees.
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In an increasingly litigious society where ritual demands for accountability and "taking responsibility" are now commonplace, it is not surprising that members of clinical ethics committees (CECs) are becoming more aware of their potential legal liability. Yet the vulnerability of committee members to legal action is difficult to assess with any certainty. This is because the CECs which have been set up in the UK are--if the American experience is followed--likely to vary significantly in terms of their functions, procedures, composition, structures and authority. As a consequence it is difficult to generalize about the legal implications. Nevertheless, despite these difficulties this article will outline the broad legal principles governing the potential liability of committee members. It will also consider the relationship between CECs and the courts. It begins, however, with a brief analysis of the relationship between ethics and law in committee deliberations, and in particular of the role of law and legal expertise on CECs. (+info)
The rise of nursing home litigation: findings from a national survey of attorneys.
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Lawsuits against nursing homes are a relatively recent phenomenon. Despite a growing sense of alarm among policymakers, little is known about these lawsuits' scale, dynamics, or outcomes. To describe these characteristics, we conducted a Web-based survey of attorneys nationwide who bring and defend this litigation. Our respondents and their firms were involved in 4,677 and 8,256 claims, respectively, in 2001; more than half of these claims were in Florida and Texas. The costs of nursing home litigation are substantial, both in the aggregate and per claim, especially in states where the litigation is most prevalent. These findings elevate concerns about quality of nursing home care and indicate that litigation diverts resources from resident care, which may fuel quality problems. (+info)
The need for scientists and judges to work together: regarding a new European network.
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Is it always true to say that science is, by definition, universal whilst laws and the courts which apply them are a classic state and national expression? Yes and no. In recent years a new scenario has opened all over the world. Courts intervene more and more in disputes on matters related to scientific procedures in the biological field. In doing so the courts' decisions are affected by scientific issues and ways of reasoning and, on the other hand, affect the scientific field and its way of reasoning. While the old matter of bioethics was still alive and while judges were improving their skill in dealing with hard matters, like refusal of medical treatments, abortion, euthanasia et cetera, a new challenge appeared on the horizon, the challenge of biological sciences, and especially of the most troubled field of human genetics. A completely new awareness is developing among judges that they belong to an international judiciary community, as informal as it is real. Such a community is, even at an embryonic stage, sufficiently universal to be able to come together with the international scientific community. The authors maintain we are in urgent need for new interaction between judges and scientists and of new international means in the light of such cooperation. Judges and jurists need to become better acquainted with scientific questions and learn to exchange ideas with scientists. They also need to set themselves against the latters' conceptual systems and be willing to put their own up for discussion. A European Network for Life Sciences, Health and the Courts is taking its first steps, and judges and scientists are working side by side to tackle the new challenges. The provisional headquarters are located at the University of Pavia (I), Laboratorio di Biologia dello Sviluppo and Collegio Ghislieri (e-mail: [email protected]). ENLSC activity is inspired by the following idea: to be against science is as much antiscientific as to be acritically pro-science. (+info)
Patent issues in drug development: perspectives of a pharmaceutical scientist-attorney.
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The major purpose of this article is to emphasize the need for pharmaceutical scientists to have a better understanding of patent fundamentals. This need is illustrated by analyses of key scientific and legal issues that arose during recent patent infringement cases involving Prozac, Prilosec, and Buspar. Economic incentives for drug discovery and development clash with societal needs for low-cost pharmaceuticals in the United States and all over the world. The Hatch-Waxman Act of 1984 was enacted to promote public health by balancing the interests of brand name and generic companies. Patent protection, which provides a monopoly for a limited time, is aimed to provide such incentives. Creation of patents requires the interaction between scientists and lawyers, an endeavor made difficult by the differing intellectual spheres of their respective disciplines. Therefore, in the first place, a thorough understanding of patent fundamentals among pharmaceutical scientists will help them work more efficiently with patent attorneys. Second, it will enable them to appreciate the strengths and weaknesses of individual patents, which is critical in developing strategies amidst the ongoing patent tug-of-war between brand-name and generic companies. (+info)
Claims, errors, and compensation payments in medical malpractice litigation.
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BACKGROUND: In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation--claims that lack evidence of injury, substandard care, or both--is common and costly. METHODS: Trained physicians reviewed a random sample of 1452 closed malpractice claims from five liability insurers to determine whether a medical injury had occurred and, if so, whether it was due to medical error. We analyzed the prevalence, characteristics, litigation outcomes, and costs of claims that lacked evidence of error. RESULTS: For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent did not involve errors. Most of the claims that were not associated with errors (370 of 515 [72 percent]) or injuries (31 of 37 [84 percent]) did not result in compensation; most that involved injuries due to error did (653 of 889 [73 percent]). Payment of claims not involving errors occurred less frequently than did the converse form of inaccuracy--nonpayment of claims associated with errors. When claims not involving errors were compensated, payments were significantly lower on average than were payments for claims involving errors (313,205 dollars vs. 521,560 dollars, P=0.004). Overall, claims not involving errors accounted for 13 to 16 percent of the system's total monetary costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts). Claims involving errors accounted for 78 percent of total administrative costs. CONCLUSIONS: Claims that lack evidence of error are not uncommon, but most are denied compensation. The vast majority of expenditures go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant. (+info)
HIPAA notice of privacy practices used in U.S. dental schools: factors related to readability or lack thereof.
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The Health Insurance Portability and Accountability Act of 1996 requires Notices of Privacy Practices (NPP) in plain (clear, concise, and easily understood) language. The objectives of this study were to test the readability of U.S. dental school NPPs; examine factors relating to readability; and develop a plain language NPP supplement. Readability statistics were Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL). Social capital measures of potential resources available to people in a civil society (e.g., perceived trust, perceived reciprocity, and per capita voluntary organization membership) along with lawyers per capita for each state were examined for potential relationships with readability levels. One-sample t-tests assessed plain language (FRE=60, FKGL=8), and analyses of variance compared groups. Spearman rank correlations (r(s)) compared social capital to readability. A plain language NPP supplement was developed. All fifty-six U.S. dental school NPPs were obtained (100 percent response). Forty-eight of fifty-six schools (86 percent) had website NPPs. FRE and FKGL were significantly more complex than plain language, overall (both p<0.0001, 95% CIs: FRE=37.6, 40.5; FKGL=11.2, 11.8) and by region (all p<0.014). Readability did not differ by region. Social capital measures moderately related to readability (0.18 < or = |r(s)| < or =0.39) with reciprocity being most related (FRE r(s)=0.36, FKGL r(s)=-0.39). U.S. dental school NPPs are more complex than "plain language." (+info)
Do doctors vote?
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BACKGROUND: Organizational leaders and scholars have issued calls for the medical profession to refocus its efforts on fulfilling the core tenets of professionalism. A key element of professionalism is participation in community affairs. OBJECTIVE: To measure physician voting rates as an indicator of civic participation. DESIGN: Cross-sectional survey of a subgroup of physicians from a nationally representative household survey of civilian, noninstitutionalized adult citizens. PARTICIPANTS: A total of 350,870 participants in the Current Population Survey (CPS) November Voter Supplement from 1996-2002, including 1,274 physicians and 1,886 lawyers; 414,989 participants in the CPS survey from 1976-1982, including 2,033 health professionals. MEASUREMENTS: Multivariate logistic regression models were used to compare adjusted physician voting rates in the 1996-2002 congressional and presidential elections with those of lawyers and the general population and to compare voting rates of health professionals in 1996-2002 with those in 1976-1992. RESULTS: After multivariate adjustment for characteristics known to be associated with voting rates, physicians were less likely to vote than the general population in 1998 (odds ratio 0.76; 95% confidence interval [CI] 0.59-0.99), 2000 (odds ratio 0.64; 95% CI 0.44-0.93), and 2002 (odds ratio 0.62; 95% CI 0.48-0.80) but not 1996 (odds ratio 0.83; 95% CI 0.59-1.17). Lawyers voted at higher rates than the general population and doctors in all four elections (P < .001). The pooled adjusted odds ratio for physician voting across the four elections was 0.70 (CI 0.61-0.81). No substantial changes in voting rates for health professionals were observed between 1976-1982 and 1996-2002. CONCLUSIONS: Physicians have lower adjusted voting rates than lawyers and the general population, suggesting reduced civic participation. (+info)