Medicine and law
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Market forces have been introduced in the health care systems of many European countries. Fundamental to the introduction of the market was the need to distinguish between the roles of purchaser and provider. In this article the authors have analyzed the consequences of contracting and the purchaser-provider split from both a legal and organizational perspective. ⋯ Including the legal and organizational dimension into these economically oriented models, these models can also be used for analyzing recent trends and developments. A four-country analysis indicates trends towards convergence of health care systems and both decentralization and integration in the systems. The future roles of both managers and lawyers working in health care need to be further defined.
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National and international variations in clinical practice, study methodologies, and data collection make the estimation of patient deaths attributable in some measure to anaesthesia a difficult task. Such rates have undoubtedly significantly declined, a tribute, in large part, to the work of groups such as the International Committee for the Prevention of Anaesthetic Mortality and Morbidity, the Anesthesia Patient Safety Foundation and the Australian Patient Safety Foundation. There is, however, internationally, still a significant risk of mortality associated with anaesthesia which is distinct from that related to any relevant surgery or intercurrent disease. ⋯ In an age where the global provision of health services and equipment may be increasingly dominated, under trade-promoting international agreements, by a few trans-national corporations, and where technology facilitates dissemination of medical data, a unified, worldwide approach to the investigation and prevention of anaesthetic mortality appears both rational and urgent. The benefits of an investigatory system, focused on subsequent safety rather than present liability and standardized through International Conventions, are well established in the air transport industry. We urge the involvement of persons with political and legal expertise in the development of an International Convention for the Investigation and Prevention of Anaesthetic Mortality.
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This paper examines the present law in England and Wales concerning the sterilisation of women who are unable to give valid consent to medical treatment. In particular, it considers why sterilisation is frequently presented as the only meaningful reproductive choice that can be made by or on behalf of women with learning disabilities. ⋯ Furthermore, the best interests of the adult patient are determined by reference to the 'Bolam' test. This paper questions whether the Bolam test is the appropriate mechanism for determining the patient's best interests, having particular regard to the Australian model of decision-making for the intellectually impaired.
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The burdens of life with treatment may outweigh the benefits. Under which set of circumstances and to what extent a neonate should receive medical intervention is a difficult ethical issue involving principles and cultural aspects which may be in conflict. The nature of the disease, the risks involved in treatment or non-treatment, the degree to which therapy will extend life, the discomfort associated with therapy, the anticipated quality of life, the wishes of surrogates, and national cultural mores are the important considerations in determination of the neonate's best interest in order to arrive at ethically defensible decisions. These decisions are not necessarily cross-culturally uniform.