Medicine and law
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The issue of children's rights has become very prominent over the past few decades during which attempts were being made to formulate an international agreement about the person status of children world-wide. These attempts have brought together and formalised a trend that has evolved over at least 400 years to broaden and develop society's understanding and acceptance of children as unique, necessary valuable societal assets. ⋯ Definitions and descriptions of various types of children's rights are given as well as the arguments posed for and against. Finally the various proposals and motivations for the inclusion of certain types of children's rights as they presently occur in the 1989 UN Convention on the Rights of the Child are noted and discussed.
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This paper reviews the rationale for cardiopulmonary resuscitation (CPR) and a "Do Not Resuscitate" order (DNR). It includes the confusion surrounding consent and related treatments; implications and misunderstandings for care givers, patients and families; efficacy; value; unilateral DNRs; and discomfort on the part of physicians to discuss patients' preferences early in treatment. CPR and DNR challenge accepted definitions of beneficence and force us to consider the immediate as well as the long-term value and benefit to patients and families, the concept of futility, and our view of the good. ⋯ Patients' medical status and prognosis may mitigate the wisdom of attempting to resuscitate. This paper reviews the principles of best interest and substitute judgment, it provides suggestions to frame and facilitate conversations about DNR related to the larger treatment goals and plans among physicians, nurses, patients, and families. Policies and forms developed at institutions are reviewed to identify mechanisms for improving the process and special circumstances such as the operating room.
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Informed consent for research in psychiatry raises a number of ethical and legal issues. To illustrate some of the ethical problems involved, in particular issues of patient competence and proxy consent, as well as the motives of patients to become research participants, as an example the case of so-called medication-free research in schizophrenia is discussed. ⋯ In case of substituted consent it is shown that proxy decision makers may fail to protect the interests of incompetent patients in research. Finally, researchers ought to be aware that research subjects may be motivated to participate in research because they may mistakenly believe that the research project is designed to benefit them directly.