Medical practice: defendants and prisoners.
It is argued in this paper that a doctor cannot serve two masters. The work of the prison medical officer is examined and it is shown that his dual allegiance to the state and to those individuals who are under his care results in activities which largely favour the former. The World Health Organisation prescribes a system of health ethics which indicates, in qualitative terms, the responsibility of each state for health provisions. In contrast, the World Medical Association acts as both promulgator and guardian of a code of medical ethics which determines the responsibilities of the doctor to his patient. In the historical sense medical practitioners have always emphasized the sanctity of the relationship with their patients and the doctor's role as an expert witness is shown to have centered around this bond. The development of medical services in prisons has focused more on the partnership between doctor and institution. Imprisonment in itself could be seen as prejudicial to health as are disciplinary methods which are more obviously detrimental. The involvement of medical practitioners in such procedures is discussed in the light of their role as the prisoner's personal physician. (+info)
The case for a statutory 'definition of death'.
Karen Quinlan, the American girl who has lain in deep coma for many months, is still 'alive', that is to say, her heart is still beating and brain death has not occurred. However, several other cases have raised difficult issues about the time of death. Dr Skegg argues that there is a case for a legal definition of death enshrined in statutory form. He suggests that many of the objections to a statutory provision on death are misplaced, and that a statute concerning the occurrence of death could remove all doubts in the minds of both doctors and public as to whether a 'beating heart cadaver' was dead or alive for legal purposes. (+info)
The case of disability in the family: impact on health care utilization and expenditures for nondisabled members.
Families with a disabled member undergo heightened emotional and financial stress, which can arise from caring for the person with one or more disabilities over the life course or at the end of life. Because health care resources are strained by the needs of the disabled family member, nondisabled members are often limited in health care access and utilization when they are most in need of care. This analysis uses the National Medical Expenditure Survey to describe families with disabled members, based on multiple definitions of disability, and to examine health care utilization and expenditures by nondisabled family members. Indications of higher use of medical care by adult, nondisabled members of such families support the frequent reports in the literature of stress occurring in these situations. The signals of a household rationing effect for families near and at poverty levels should alert policy makers to consider the needs of the whole family when creating or modifying assistance programs. (+info)
Organ transplantation--then and now.
The last 25 years have seen amazing progress in transplantation--from the development of techniques for immunosuppression to methods for organ removal and preservation. Our distinguished authors focus on these developments and discuss how the momentum seen during the last quarter century can be accelerated. (+info)
Body piercing medical concerns with cutting-edge fashion.
OBJECTIVE: To review the current information on medical complications, psychological implications, and legislative issues related to body piercing, a largely unregulated industry in the United States. METHODS: We conducted a MEDLINE search of English language articles from 1966 until May 1998 using the search terms "body piercing" and "ear piercing." Bibliographies of these references were reviewed for additional citations. We also conducted an Internet search for "body piercing" on the World Wide Web. MAIN RESULTS: In this manuscript, we review the available body piercing literature. We conclude that body piercing is an increasingly common practice in the United States, that this practice carries substantial risk of morbidity, and that most body piercing in the United States is being performed by unlicensed, unregulated individuals. Primary care physicians are seeing growing numbers of patients with body pierces. Practitioners must be able to recognize, treat, and counsel patients on body piercing complications and be alert to associated psychological conditions in patients who undergo body piercing. (+info)
Clinical and legal significance of fragmentation of bullets in relation to size of wounds: retrospective analysis.
OBJECTIVE: To examine the relation between fragmentation of bullets and size of wounds clinically and in the context of the Hague Declaration of 1899. DESIGN: Retrospective analysis of prospectively collected data on hospital admissions. SETTING: Hospitals of the International Committee of the Red Cross. SUBJECTS: 5215 people wounded by bullets in armed conflicts (5933 wounds). MAIN OUTCOME MEASURES: Grade of wound computed from the Red Cross wound classification and presence of bullet fragments on radiography. RESULTS: Of the 347 wounds with fragmentation of bullets, 251 (72%) were large wounds (grade 2 or 3)-that is, those with a clinically detectable cavity. Of the 5586 wounds without fragmentation of bullets, 2915 (52.1%) were large wounds. Only 7.9% (251/3166) of large wounds were associated with fragmentation of bullets. CONCLUSIONS: Fragmentation of bullets is associated with large wounds, but most large wounds do not contain bullet fragments. In addition, bullet fragments may occur in wounds that are not defined as large. Fragmentation of bullets is neither a necessary nor sufficient cause of large wounds, and surgeons should not diagnose extensive tissue damage because of the presence of fragments on radiography. Such findings also do not necessarily represent the use of bullets which contravene the law of war. Future legislation should take into account not only the construction of bullets but also their potential to transfer energy to the human body. (+info)
Appropriate use of psychotropic drugs in nursing homes.
The Omnibus Budget Reconciliation Act (OBRA) of 1987 limited the use of psychotropic medications in residents of long-term care facilities. Updates of OBRA guidelines have liberalized some dosing restrictions, but documentation of necessity and periodic trials of medication withdrawal are still emphasized. Antidepressant drugs are typically underutilized in nursing homes. Tricyclic antidepressants have many side effects and thus are not preferred medications in elderly patients. Anxiety and insomnia are common problems in the institutionalized elderly. If behavioral measures are not successful, antidepressant medications with shorter half-lives may avoid drug accumulation, which can lead to excessive sedation, cognitive impairment and an increased risk for falls. In the elderly, antipsychotic medications can cause serious side effects, such as extrapyramidal symptoms and tardive dyskinesia. Newer antipsychotic drugs are less often associated with these side effects, but they should be used only for specific diagnoses and when behavioral and environmental measures are unsuccessful. (+info)