Medicine and law
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On 17 September 2004 New Zealand created a multidisciplinary Health Practitioners Disciplinary Tribunal. The new Tribunal hears disciplinary charges laid against all registered health professionals in New Zealand. It is believed the New Zealand Health Practitioners Disciplinary Tribunal is the only organisation of its kind functioning at the moment There are 19 categories of health professionals registered in New Zealand who may be subject to the Tribunal's jurisdiction. This paper will: Describe the rationale for the establishment of a single Tribunal to hear disciplinary charges against all registered health professionals; Explain the structure of the new organisation; Examine the procedures followed by the Tribunal; Assess the likely impact of the Tribunal on the regulation of health professional standards in New Zealand.
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When the desires of a patient are unknown or cannot be ascertained, cardio-pulmonary resuscitation (CPR) is the default procedure. Explicit, Do Not Resuscitate (DNR), orders are required to prevent implementation of CPR. We studied the response of general medical internists in specific clinical situations demanding consideration of DNR orders and respect for patient preferences; their current practice regarding slow codes and participation in CPR attempts considered futile provide information as to how often they discuss DNR issues with patients or families. ⋯ Only 55% agreed to do the same for a competent patient who specifically requested that CPR be withheld in the event of a cardiopulmonary arrest (p<0.05). 77% reported to have performed CPR, at least three times, in situations where they expected no benefit. 59% affirmed that their team had performed a partial CPR (slow code) at least once. Only 28% discussed the subject of DNR with patients or family more than 5 times a year. Paternalism, disregard for patients' preferences and poor communication skills influence normative behaviour in end-of-life decision-making.
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In the Netherlands the total number of liability claims per year is about 2500, 100 of which are taken to court. Over the years these figures appear to be rather constant. ⋯ Is it the improvement of the patients' possibility to recover? Is the main goal to put a stop to the progress of increasing costs of liability claims? Is saving doctors from the threat of being sued the main issue? Or is there a problem of the insurance companies that has to be solved? No-fault compensation is not a panacea. In the end improving the liability system may turn out to be a better solution.
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The UK's Human Fertilisation and Embryology Authority (hereafter the HFEA) is a regulatory body facing growing pressures and difficulties. Like any regulatory body, it faces the challenge of regulating with sufficient expertise, legitimacy, and contemporaneity. This challenge is, however, exacerbated by the fact that it seeks to regulate some of the most controversial and rapidly changing technologies of our time. ⋯ In addition to the multitude of cases brought against it, the HFEA's actions recently led a House of Commons Select Committee to pointedly declare that "democracy is not served by unelected quangos (quasi-autonomous non-governmental organizations) taking decisions on behalf of Parliament". While endorsing the general need to review the legislation under which the HFEA operates (the Human Fertilisation and Embryology Act 1990), this paper will argue that the HFEA was correct in interpreting its jurisdiction to encompass the technique used to produce Dolly the sheep. This paper thereby defends the key feature of the approach of the House of Lords in the recent case of R (Bruno Quintavalle on behalf of the ProLife Alliance) v Secretary of State for Health [2003] UKHL 13.
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The United States may or may not be facing a "malpractice crisis" which can result in a loss of quality of medical care in certain specialties by virtue of non-performance or the exiting of certain physicians from certain high-risk specialties due to increases in premiums. Various studies have been performed by various governmental agencies on a federal level in the United States. The Department of Legal Medicine, part of the Armed Forces Institute of Pathology, began collecting veteran's affairs medical malpractice claims data and extracting information from the analysis from medical records and associated documents. ⋯ Subsequent to that report, several other reports have been issued including a report on medical malpractice insurance generated by the General Accounting Office in 2003, some ten years later. More recently, a report of medical malpractice having implications on rising premiums on and access to health care generated by the General Accounting Office was released in August of 2003. This paper will demonstrate areas of concern with regard to the area of medical malpractice as well as incidence of medical malpractice and claims upon the insurance industry, medical specialties and the impact upon the community generally in the United States.