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Corns C. Investigating Investigation Powers under the Health Practitioner Regulation National Law. J Law Med 2023; 30:673-689. [PMID: 38332601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Investigators and inspectors appointed under the Australia Health Practitioner Regulation National Law play important roles by gathering and assessing evidence used in disciplinary proceedings and/or criminal prosecutions. In performing these roles, investigators and inspectors exercise "police-like" powers including coercive questioning and entry onto private property with or without a search warrant. The investigation process can add additional stress and anxiety for health practitioners who are subject to disciplinary proceedings. It is difficult for an aggrieved party to challenge the lawfulness of the exercise of an investigation power in a tribunal as tribunals lack jurisdiction to rule on the legality of an investigation power or the admissibility of evidence. This article explores the range of powers possessed by investigators and inspectors under the National Law and a number of issues relating to the exercise of those powers.
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Affiliation(s)
- Chris Corns
- Adjunct Professor School of Law La Trobe University
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Gostin LO, Parmet WE, Rosenbaum S. The US Supreme Court's Rulings on Large Business and Health Care Worker Vaccine Mandates: Ramifications for the COVID-19 Response and the Future of Federal Public Health Protection. JAMA 2022; 327:713-714. [PMID: 35061000 DOI: 10.1001/jama.2022.0852] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
| | - Wendy E Parmet
- Northeastern University School of Law, Boston, Massachusetts
| | - Sara Rosenbaum
- Milken Institute School of Public Health, George Washington University, Washington, DC
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3
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Sokol D. Why mandatory vaccination for healthcare workers should not be scrapped. BMJ 2022; 376:o206. [PMID: 35074894 DOI: 10.1136/bmj.o206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McDevitt D, McDevitt M. A Primer on the Good Samaritan Act. J Christ Nurs 2021; 38:28-31. [PMID: 33284214 DOI: 10.1097/cnj.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article explores the various legal and ethical facets for healthcare professionals to consider in order to avoid legal liability when rendering aid in an emergency. A general overview of Good Samaritan legislation enacted throughout the United States is discussed along with varying levels of assistance required or protected by law in selected states. Moral considerations for Christian nurses are addressed.
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Affiliation(s)
- Lara Shemtob
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Mark Ferris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kaveh Asanati
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Geerts JM, Kinnair D, Taheri P, Abraham A, Ahn J, Atun R, Barberia L, Best NJ, Dandona R, Dhahri AA, Emilsson L, Free JR, Gardam M, Geerts WH, Ihekweazu C, Johnson S, Kooijman A, Lafontaine AT, Leshem E, Lidstone-Jones C, Loh E, Lyons O, Neel KAF, Nyasulu PS, Razum O, Sabourin H, Schleifer Taylor J, Sharifi H, Stergiopoulos V, Sutton B, Wu Z, Bilodeau M. Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic: A Consensus Statement. JAMA Netw Open 2021; 4:e2120295. [PMID: 34236416 DOI: 10.1001/jamanetworkopen.2021.20295] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. OBJECTIVE To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. EVIDENCE REVIEW A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. FINDINGS The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. CONCLUSIONS AND RELEVANCE Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.
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Affiliation(s)
- Jaason M Geerts
- Research and Leadership Development, Canadian College of Health Leaders, Ottawa, Ontario, Canada
- Bayes Business School, University of London, London, United Kingdom
| | - Donna Kinnair
- Royal College of Nursing, Marylebone, London, United Kingdom
| | - Paul Taheri
- Yale School of Medicine, New Haven, Connecticut
| | - Ajit Abraham
- Barts Health NHS Trust, Royal Hospital, London, United Kingdom
- Staff College: Leadership in Healthcare, London, United Kingdom
| | - Joonmo Ahn
- Department of Public Administration, Korea University, Seoul, Republic of Korea
| | - Rifat Atun
- Global Health Systems, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Lorena Barberia
- Department of Political Science, University of São Paulo, São Paulo, Brazil
- Solidarity Research Network for Public Policies and Society, Observatorio COVID-19 Brazil
| | - Nigel J Best
- United Nations Mission in South Sudan, UN House, Juba, South Sudan
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Louise Emilsson
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Värmland, Sweden
- Medicine and Health, Örebro University, Örebro, Sweden
| | - Julian R Free
- University of Lincoln, Brayford Pool, Lincoln, United Kingdom
| | - Michael Gardam
- Chief Executive Officer, Health PEI, Charlottetown, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - William H Geerts
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Shanthi Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Kooijman
- World Health Organization Patients for Patient Safety, Geneva, Switzerland
- Patients for Patient Safety Canada, Edmonton, Alberta, Canada
| | - Alika T Lafontaine
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
- Canadian Medical Association, First Nations Health Authority, Indigenous Physicians Association of Canada, West Vancouver, British Columbia, Canada
| | - Eyal Leshem
- Institute for Travel and Tropical Medicine, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Erwin Loh
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
- St Vincent's Health Australia, East Melbourne, Australia
| | - Oscar Lyons
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | | | - Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Department of Global Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Oliver Razum
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Hélène Sabourin
- Canadian Association of Occupational Therapists, Nepean, Ontario, Canada
- Organizations for Health Action, Ottawa, Ontario, Canada
| | - Jackie Schleifer Taylor
- London Health Sciences Centre, London, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brett Sutton
- Department of Health, Melbourne, Victoria, Australia
- Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Zunyou Wu
- China Center for Disease Control and Prevention, Beijing, China
- Division of HIV Prevention, National Center for AIDS/STD Control and Prevention, Beijing, China
- Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles
| | - Marc Bilodeau
- Surgeon General, Canadian Armed Forces, Ottawa, Ontario, Canada
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Came H, Kidd J, Heke D, McCreanor T. Te Tiriti o Waitangi compliance in regulated health practitioner competency documents in Aotearoa. N Z Med J 2021; 134:35-43. [PMID: 34012139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Within Aotearoa (New Zealand) there are systemic health inequities between Māori (the Indigenous people of Aotearoa) and other New Zealanders. These inequities are enabled in part by the failure of the health providers, policy and practitioners to fulfil treaty obligations to Māori as outlined in our foundational document, te Tiriti o Waitangi (te Tiriti). Regulated health professionals have the potential to play a central role in upholding te Tiriti and addressing inequities. Competency documents define health professionals' scope of practice and inform curriculum in health faculties. In this novel study, we critically examine 18 regulated health practitioners' competency documents, which were sourced from the websites of their respective professional bodies. The competencies were reviewed using an adapted criterion from Critical te Tiriti Analysis, a five-phase analysis process, to determine their compliance with te Tiriti. There was considerable variation in the quality of the competency documents reviewed. Most were not te Tiriti compliant. We identified a range of alternative competencies that could strengthen te Tiriti engagement. They focussed on (i) the importance of whanaungatanga (the active making of relationships with Māori), (ii) non-Māori consciously becoming an ally with Māori in the pursuit of racial justice and (iii) actively engaging in decolonisation or power-sharing. In the context of Aotearoa, competency documents need to be te Tiriti compliant to fulfil treaty obligations and policy expectations about health equity. An adapted version of Critical te Tiriti Analysis might be useful for those interested in racial justice who want to review health competencies in other colonial settings.
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Affiliation(s)
- Heather Came
- Head of Department - Public Health, Faculty of Health and Environmental Sciences, Auckland University of Technology
| | - Jacquie Kidd
- Associate Professor Jacquie Kidd, Faculty of Health and Environmental Sciences, Auckland University of Technology
| | - Deborah Heke
- PhD Candidate, Taupua Waiora Centre for Maori Health Research, Faculty of Health and Environmental Sciences
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Hordowicz M, Klimkiewicz A, Jarosz J, Wysocka M, Jastrzębska M. Knowledge, attitudes, and prescribing patterns of cannabis and cannabinoid-containing medicines among European healthcare workers: a systematic literature review. Drug Alcohol Depend 2021; 221:108652. [PMID: 33667785 DOI: 10.1016/j.drugalcdep.2021.108652] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/20/2021] [Accepted: 02/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Since the introduction of the National Medical Cannabis Programme in The Netherlands, many other countries in Europe have made medical cannabis (MC) and cannabis-based medicines (CBMs) available. However, each of them has implemented a unique legal framework and reimbursement strategy for these products. Therefore, it is vital to study healthcare professionals' knowledge level (HCP) and HCPs in-training regarding both medical uses and indications and understand their safety concerns and potential barriers for MC use in clinical practice. METHODS A comprehensive, systematic literature review was performed using PubMed/MEDLINE, EMBASE, and Google Scholar databases, as well as PsychINFO. Grey literature was also included. Due to the high diversity in the questionnaires used in the studies, a narrative synthesis was performed. RESULTS From 6995 studies retrieved, ten studies, all of them being quantitative survey-based studies, were included in the review. In most studies, the majority of participants were in favor of MC and CBMs use for medical reasons. Other common findings were: the necessity to provide additional training regarding medical applications of cannabinoids, lack of awareness about the legal status of and regulations regarding MC among both certified physicians, as well as prospective doctors and students of other medicals sciences (e.g., nursing, pharmacy). CONCLUSIONS For most European countries, we could not identify any studies evaluating HCPs' knowledge and attitudes towards medicinal cannabis. Therefore, similar investigations are highly encouraged. Available evidence demonstrates a need to provide medical training to the HCPs in Europe regarding medical applications of cannabinoids.
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Affiliation(s)
| | | | - Jerzy Jarosz
- Hospice of St. Christopher in Warsaw, Warsaw, Poland
| | - Maria Wysocka
- Hospice of St. Christopher in Warsaw, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland; Nowowiejski Hospital in Warsaw, Warsaw, Poland
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Cheung IW, Silva DS, Miller KJ, Michalak EE, Goldsmith CH. A qualitative study of clinicians' perspectives on independent rights advice for involuntary psychiatric patients in British Columbia, Canada. PLoS One 2021; 16:e0247268. [PMID: 33735273 PMCID: PMC7971454 DOI: 10.1371/journal.pone.0247268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In British Columbia (BC), Canada, clinicians are responsible for giving involuntary psychiatric patients rights information upon admission. Yet an investigation by the BC Office of the Ombudsperson found that clinicians are not always fulfilling this responsibility. The Ombudsperson recommended that the provincial government fund an independent body to give rights advice to patients. METHODS To understand how clinicians feel about this recommendation, focus groups of clinicians who may give psychiatric patients rights information (n = 81) were conducted in Vancouver, BC, to probe their attitudes toward independent rights advisors. The focus group transcripts were thematically analyzed. RESULTS Most clinicians believe that giving rights information is within their scope of practice, although some acknowledge that it poses a conflict of interest when the patient wishes to challenge the treatment team's decisions. Participants' chief concerns about an independent rights-advice service were that (a) patients may experience a delay in receiving their rights information, (b) integrating rights advisors into the workflow would complicate an already chaotic admission process, and (c) more patients would be counselled to challenge their hospitalization, leading to an increased administrative workload for clinical staff. However, many participants believed that independent rights advisors would be a positive addition to the admission process, both allowing clinicians to focus on treatment and serving as a source of rights-related information. CONCLUSIONS Participants were generally amenable to an independent rights-advice service, suggesting that the introduction of rights advisors need not result in an adversarial relationship between treatment team and patient, as opponents of the proposal fear. Clearly distinguishing between basic rights information and in-depth rights advice could address several of the clinicians' concerns about the role that independent rights advisors would play in the involuntary admission process. Clinicians' and other stakeholders' concerns should be considered as the province develops its rights-advice service.
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Affiliation(s)
- Iva W. Cheung
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Diego S. Silva
- Sydney Health Ethics, Sydney School of Public Health, Sydney, NSW, Australia
| | - Kimberly J. Miller
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Erin E. Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Nikolić B. Applicability of European Union Competition Law to Health Care Providers: The Dividing Line between Economic and Noneconomic Activities. J Health Polit Policy Law 2021; 46:49-70. [PMID: 33085957 DOI: 10.1215/03616878-8706603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ever-increasing health spending, which, according to future projections, continues to outpace economic growth, will further endanger the financial sustainability of health systems. In a quest to improve the efficacy and efficiency of the health system and thus strengthen its financial sustainability, member states are employing market-based mechanisms to finance, manage, and provide health care. However, the introduction of elements of competition is constrained by the application of EU competition law, which raises significant concerns regarding the applicability of competition law and its limits in the field of health care. Due to the lack of a clear definition in EU legislation, the applicability and scope of competition law are determined on a case-by-case basis, which reveals an inconsistent approach by the European Commission and the CJEU regarding the application of competition law to health care providers and has created legal uncertainty. The aim of this article is to analyze relevant decisions by the commission and the CJEU case law in the pursuit of "boundaries" that may trigger the applicability of competition law with regard to health care providers. Based on the findings of the analysis, the article proposes a set of principles or guidelines for determining whether a health care provider should be considered as an undertaking and, as such, subject to EU competition law.
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Sokol T. The Effect of EU Integration on Health Care in Central and Eastern Europe. J Health Polit Policy Law 2021; 46:147-175. [PMID: 33085963 DOI: 10.1215/03616878-8706651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The effect of EU policy and its legal framework on health care in CEE member states has been complex. In relation to health care access and financial sustainability, it has been detrimental in certain parts of CEE. This has primarily been the result of economic/fiscal governance instruments of the EU and free-movement rules facilitating outflows of health care professionals. Although there has been a general improvement in access to health care since accession to the EU, the instruments the EU has used to handle the economic crisis have somewhat offset this improvement. Additionally, outflow of health care professionals has resulted in retention strategies such as salary increases and investments in medical infrastructure in some CEE member states, increasing the standard of health care. Still, differences between East and West in terms of important health indicators continue to exist, and EU instruments aimed at compensating this generally lack power to provide meaningful solutions. It seems more solidarity between member states is the only way to increase legitimacy of the European integration in CEE member states and thus prevent them from feeling as outsiders within the EU. Without such a development, CEE countries will continue to lag behind other parts of the Union.
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van de Gronden JW, Guy M. The role of EU competition law in health care and the 'undertaking' concept. Health Econ Policy Law 2021; 16:76-89. [PMID: 32349857 DOI: 10.1017/s1744133120000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Part of the controversy surrounding competition and health care stems from the complexity connected with delineating the applicability of competition law - encompassing both the provisions governing anticompetitive agreements and abuse of dominance and the state-aid rules. Cases determined at the European Union (EU) level within the past 30 years have developed a broad framework, and notable trends have emerged - for example, a distinction between health care providers and managing bodies (purchasers). The former have been subject to an 'abstract' test and the latter to a more sophisticated 'concrete' test. In this paper, we chart the development of the EU courts' approach to developing the 'undertaking' concept in health care and examine the current EU competition law framework with a view to identifying future directions. van de Gronden has recently identified a 'three-prong' test of exemption from competition law in connection with the recent CEPPB case: firstly, where the supply of services is predominantly dependent upon public financing; secondly, the public funding aims to achieve a public interest goal and thirdly, the activities concerned are closely related to this public interest goal. We examine this test in a health care context, drawing on our findings regarding Dutch competition reforms.
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Affiliation(s)
| | - Mary Guy
- Lecturer in Law, Lancaster Law School, Lancaster University, Lancaster, UK
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Oliva A, Caputo M, Grassi S, Vetrugno G, Marazza M, Ponzanelli G, Cauda R, Scambia G, Forti G, Bellantone R, Pascali VL. Liability of Health Care Professionals and Institutions During COVID-19 Pandemic in Italy: Symposium Proceedings and Position Statement. J Patient Saf 2020; 16:e299-e302. [PMID: 32941344 PMCID: PMC7678349 DOI: 10.1097/pts.0000000000000793] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND On May 12, 2020, a symposium titled "Liability of healthcare professionals and institutions during COVID-19 pandemic" was held in Italy with the participation of national experts in malpractice law, hospital management, legal medicine, and clinical risk management. The symposium's rationale was the highly likely inflation of criminal and civil proceedings concerning alleged errors committed by health care professionals and decision makers during the COVID-19 pandemic. Its aim was to identify and discuss the main issues of legal and medicolegal interest and thus to find solid solutions in the spirit of preparedness planning. METHODS There were 5 main points of discussion: (A) how to judge errors committed during the pandemic because of the application of protocols and therapies based on no or weak evidence of efficacy, (B) whether hospital managers can be considered liable for infected health care professionals who were not given adequate personal protective equipment, (C) whether health care professionals and institutions can be considered liable for cases of infected inpatients who claim that the infection was transmitted in a hospital setting, (D) whether health care institutions and hospital managers can be considered liable for the hotspots in long-term care facilities/care homes, and (E) whether health care institutions and hospital managers can be considered liable for the worsening of chronic diseases. RESULTS AND CONCLUSION Limitation of the liability to the cases of gross negligence (with an explicit definition of this term), a no-fault system with statal indemnities for infected cases, and a rigorous methodology for the expert witnesses were proposed as key interventions for successfully facing future proceedings.
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Affiliation(s)
- Antonio Oliva
- From the Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome
| | - Matteo Caputo
- Section of Criminal Law, Department of Juridical Science, Università Cattolica del Sacro Cuore, Milan
| | - Simone Grassi
- From the Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome
| | - Giuseppe Vetrugno
- Unit of Risk Management, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Marco Marazza
- Labor Law, Department of Health of Woman and Child and Public Health, Università Cattolica del Sacro Cuore, Rome
| | - Giulio Ponzanelli
- Section of Civil Law, Department of Juridical Science, Università Cattolica del Sacro Cuore, Milan
| | - Roberto Cauda
- Section of Infectious Diseases, Department of Healthcare Surveillance and Bioethics, Università Cattolica del Sacro Cuore
| | - Giovanni Scambia
- Section of Gynecology and Obstetrics, Department of Health of Woman and Child and Public Health, Università Cattolica del Sacro Cuore, Rome
| | - Gabrio Forti
- Section of Criminal Law, Department of Juridical Science, Università Cattolica del Sacro Cuore, Milan
- Alta Scuola “Federico Stella” sulla Giustizia Penale, Università Cattolica del Sacro Cuore, Milan
| | - Rocco Bellantone
- Medicine and Surgery Faculty, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo L. Pascali
- From the Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome
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16
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Affiliation(s)
- Eli M Cahan
- From the Stanford University School of Medicine, Stanford, CA, and New York University School of Medicine, New York (E.M.C.); the MAVEN Project, San Francisco (L.B.L.); and Harvard Medical School, Boston (W.W.C.)
| | - Lisa B Levine
- From the Stanford University School of Medicine, Stanford, CA, and New York University School of Medicine, New York (E.M.C.); the MAVEN Project, San Francisco (L.B.L.); and Harvard Medical School, Boston (W.W.C.)
| | - William W Chin
- From the Stanford University School of Medicine, Stanford, CA, and New York University School of Medicine, New York (E.M.C.); the MAVEN Project, San Francisco (L.B.L.); and Harvard Medical School, Boston (W.W.C.)
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Pinto-Sietsma SJ, Zwinderman AH, Oude Ophuis T. [Medical disciplinary boards punish more often and more severely; an observational study of 10 years of medical disciplinary law]. Ned Tijdschr Geneeskd 2020; 164:D4587. [PMID: 32940979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine if the medical disciplinary law in the Netherlands is becoming tougher. DESIGN Observational study. METHOD We read the annual reports of the Dutch Disciplinary Committees for the Healthcare Sector 2007-2017, and registered the numbers of disciplinary cases and those cases upheld, the measures imposed and the degree of consistency in the event of an appeal. Over 400 medical disciplinary cases were reviewed in more detail. Based on these cases, we determined those variables that increase or decrease the likelihood of conviction, such as the gender of the defendants, the region in which the disciplinary case was heard, and if objective norms and professional practice guidelines had been used in arriving at the verdict. RESULTS Each year a disciplinary case is brought against an average of 0.4% of all health care providers - mainly physicians (an average of approximately 1400 disciplinary cases each year). One-third of all disciplinary cases were dealt with in court and about half of them were upheld. Over time, the number of disciplinary cases has increased (36%), as has the percentage of cases that are upheld (27%). Additionally, heavier measures were more often imposed and the degree of consistency between the initial ruling and the ruling on appeal also increased (56%). Those factors that increased the likelihood of a case being upheld were: being a physician of male gender, the disciplinary case being heard in The Hague or Eindhoven, and the non-implementation of an objective norm or professional practice guideline in arriving at the verdict. CONCLUSION Since 2007 the Dutch medical disciplinary boards have been punishing more often and more severely. This may be because the subjective demands made on health care professionals have changed. Arriving at an opinion subjectively is not a problem when it comes to verifying compliance with standards of due care. However, if this method is used to determine the penalty, the health care system will become defensive - and this will not improve the quality of care.
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Affiliation(s)
- S J Pinto-Sietsma
- Amsterdam UMC, locatie AMC, afd. Klinische epidemiologie, Biostatistiek en Bio-informatica, Amsterdam (tevens: afd. Vasculaire Geneeskunde)
- Contact: S.J. Pinto-Sietsma
| | - A H Zwinderman
- Amsterdam UMC, locatie AMC, afd. Klinische epidemiologie, Biostatistiek en Bio-informatica, Amsterdam
| | - T Oude Ophuis
- Canisius Wilhelmina Ziekenhuis, afd. Cardiologie, Nijmegen (tevens: Universiteit van Amsterdam)
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Farrell AM, Alghrani A, Kazarian M. Gross Negligence Manslaughter in Healthcare: Time for a Restorative Justice Approach? Med Law Rev 2020; 28:526-548. [PMID: 32462185 DOI: 10.1093/medlaw/fwaa013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article explores the merits of employing a restorative justice approach in cases of gross negligence manslaughter involving healthcare professionals, in line with the recent policy turn towards developing a just culture in addressing episodes of healthcare malpractice within the National Health Service in England. It is argued that redress for victims and rehabilitation of offenders should operate as key values, underpinning the adoption of a restorative justice approach in such cases. It would also be vital that a structured pathway was designed that established suitable protocols and safeguards for both victims and offenders taking account of problematic issues such as the informality of the process, power asymmetries between parties, and the context in which the offence took place. Taking all such matters into account, we propose that consideration be given to establishing a pilot involving the use of restorative justice in cases of gross negligence manslaughter involving healthcare professionals, which would be subject to judicial and stakeholder oversight to ensure transparency and accountability, which in turn could inform future policy options.
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Affiliation(s)
| | - Amel Alghrani
- School of Law and Social Justice, University of Liverpool, UK
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19
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Abstract
Conscientious objection refers to refusal by a health care provider (HCP) to provide certain treatments, including the standard of care, to a patient based upon the provider's personal, ethical, or religious beliefs. Federal and state rules regarding conscientious objection have expanded the scope of legal protections that HCPs and institutions can invoke in support of refusal. Opponents of these rules argue that allowing refusal of care deprives patients of care that conforms to professionally established guidelines, contradicts long-standing principles related to informed consent, interferes with the ability of health care facilities to provide safe and efficient care, and leaves the patient without means of redress for injury. Proponents respond that such rules are necessary to preserve the moral integrity of providers, including institutions. Although refusal rules are most often associated with abortion, some HCPs have cited moral concerns regarding contraception, sterilization, prevention/treatment of sexually transmitted infections, transition-related care for transgender individuals, medication-assisted treatment of substance use disorders, the use of artificial reproductive technologies, and patient preferences for end-of-life care. Evidence suggests that the burden of conscientious refusal falls disproportionately on vulnerable populations, and legitimate concern exists that moral disagreement is merely pretext for discrimination. A careful balance must be struck between the defending the conscience rights of HCPs and the civil rights of patients.
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Affiliation(s)
- Eileen K Fry-Bowers
- Hahn School of Nursing and Health Science, Betty and Bob Beyster Institute for Nursing Research, Advanced Practice and Simulation, University of San Diego
- School of Nursing, George Washington University
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20
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Abstract
In 2015, the Supreme Court in Montgomery v Lanarkshire Health Board handed down a landmark decision on informed consent to medical treatment, heralding a legal shift to a more patient-centred approach. Montgomery, and the extensive commentary that has followed, focuses on 'adult persons of sound mind'. Cave and Purshouse consider the potential claims that may flow from a failure to adequately inform children. They argue that the relevance of the best interests test blurs the boundaries between negligence and battery. Limitations on children's rights to make treatment decisions for themselves impact on their potential to claim in negligence for non-disclosure and, conversely, enhance the potential relevance of the tort of battery. In paediatric cases, Montgomery raises expectations that the law is currently ill-equipped to satisfy. Tort law provides a legal incentive to disclose relevant information to children but limits the availability of a remedy.
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Affiliation(s)
- Emma Cave
- Durham Law School, Palatine Centre, Durham University, Durham DH1 3LE, UK
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21
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Holloway L. COVID-19: Has the Standard of Care Changed and Are Providers Immune from Liability? Mo Med 2020; 117:199-201. [PMID: 32636544 PMCID: PMC7302037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Lorinda Holloway
- Partner in the Austin, Texas, office of Husch Blackwell. She represents a full spectrum of health care providers in government investigations and in all manner of litigation, including medical malpractice
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22
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Underwood PY, Wyatt KD, Greaney C, Derauf C, Uribe RA, Colaiano JM, Hellmich TR. Mobile Point-of-Care Medical Photography: Legal Considerations for Health Care Providers. J Leg Med 2020; 40:247-263. [PMID: 33137276 DOI: 10.1080/01947648.2020.1816234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/09/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
Medical photographs have been used for decades to document clinical findings. The ease with which medical photographs can be captured and integrated into the electronic health record (EHR) has increased as digital cameras obviated the need for the film development process. Today, cameras integrated into smartphones allow for high-resolution images to be instantly uploaded and integrated into the EHR. With major EHR vendors offering mobile smartphone applications for the conduct of point-of-care medical photography, health care providers and institutions need to be aware of legal questions that arise in the conduct of medical photography. Namely, (1) what are the requirements for consent when taking medical photographs, and how may photographs be used after consent is obtained, (2) are medical photographs admissible as evidence in court, and (3) how should a provider respond to a request by a patient or parent requesting that a photograph be deleted from the medical record? Herein, we review relevant laws and legal cases in the context of accepted standards of medical practice pertaining to point-of-care medical photography. This review is intended to aid health care providers and institutions seeking to develop or revise policies regarding using a mobile application at their clinical practice.
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23
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Affiliation(s)
- Sara Gerke
- The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
| | - Serena Yeung
- Department of Biomedical Data Science, and the Clinical Excellence Research Center, Stanford University, Stanford, California
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24
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Frogner BK, Fraher EP, Spetz J, Pittman P, Moore J, Beck AJ, Armstrong D, Buerhaus PI. Modernizing Scope-of-Practice Regulations - Time to Prioritize Patients. N Engl J Med 2020; 382:591-593. [PMID: 32053296 DOI: 10.1056/nejmp1911077] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bianca K Frogner
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Erin P Fraher
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Joanne Spetz
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Patricia Pittman
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Jean Moore
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Angela J Beck
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - David Armstrong
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Peter I Buerhaus
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
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25
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Richards NK, Crockett E, Morley CP, Levandowski BA. Young women's reproductive health conversations: Roles of maternal figures and clinical practices. PLoS One 2020; 15:e0228142. [PMID: 31971983 PMCID: PMC6977719 DOI: 10.1371/journal.pone.0228142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/08/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the role of clinical providers and mothers on young women's ability to have confidential, candid reproductive health conversations with their providers. METHODS We conducted 14 focus groups with 48 women aged 15-28 years (n = 9), and 32 reproductive healthcare workers (n = 5). Focus groups were audio recorded and transcribed. Data were analyzed using inductive coding and thematic analyses. We examined findings through the lens of paternalism, a theory that illustrates adults' role in children's autonomy and wellbeing. RESULTS Mothers have a substantial impact on young women's health values, knowledge, and empowerment. Young women reported bringing information from their mothers into patient-provider health discussions. Clinical best practices included intermingled components of office policies, state laws, and clinical guidelines, which supported health workers' actions to have confidential conversations. There were variations in how health workers engaged young women in a confidential conversation within the exam room. CONCLUSIONS Both young women and health workers benefit from situations in which health workers firmly ask the parent to leave the exam room for a private conversation with the patient. Young women reported this improves their comfort in asking the questions they need to make the best decision for themselves. Clinic leadership needs to ensure that confidentiality surrounding young women's reproductive health is uniform throughout their practice and integrated into patient flow.
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Affiliation(s)
- Nicole K. Richards
- Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Christopher P. Morley
- Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Psychiatry, Upstate University Hospital, Syracuse, New York, United States of America
| | - Brooke A. Levandowski
- Department of Family Medicine, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, United States of America
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26
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Pattanite MA, Carrigg PF. New Jersey Employment Law Update for the Medical Professional Employer. MD Advis 2020; 13:13-18. [PMID: 32101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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27
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Frentzel E, Jump RLP, Archbald-Pannone L, Nace DA, Schweon SJ, Gaur S, Naqvi F, Pandya N, Mercer W. Recommendations for Mandatory Influenza Vaccinations for Health Care Personnel From AMDA's Infection Advisory Subcommittee. J Am Med Dir Assoc 2020; 21:25-28.e2. [PMID: 31888863 PMCID: PMC6996022 DOI: 10.1016/j.jamda.2019.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/24/2022]
Abstract
Preventing influenza infections is a national health priority, particularly among geriatric and adults with frailty who reside in post-acute and long-term care (PALTC) settings. Older adults account for more than 70% of deaths from influenza, a reflection of decreased vaccine effectiveness in that age group. Annually vaccinating health care personnel (HCP) working with these patients against influenza is critical to reducing influenza morbidity and mortality among patients. PALTC HCP have the lowest influenza vaccination rate when compared to HCP in other settings. The Advisory Committee on Immunization Practices recommends that all HCP receive an annual influenza vaccination, including those who do not have direct patient care responsibilities. Here, we discuss the importance of influenza vaccination for HCP, detail recommendations for influenza vaccination practice and procedures for PALTC settings, and offer support to PALTC settings and their staff on influenza vaccinations.
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Affiliation(s)
- Elizabeth Frentzel
- Essential Hospitals Institute of the America's Essential Hospitals, Washington, DC.
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center, Specialty Care Center of Innovation and Division of Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Laurie Archbald-Pannone
- General Medicine, Geriatrics and Palliative Care, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - David A Nace
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Swati Gaur
- Northeast Georgia Health System, Division of Postacute Long Term Care, Gainesville, GA
| | | | - Naushira Pandya
- Department of Geriatrics, Nova Southeastern University, Fort Lauderdale, FL
| | - William Mercer
- Wheeling Ohio County Health Department and Peterson Rehabilitation and Geriatric Hospital, Wheeling, WV
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28
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Grzanka PR, DeVore EN, Frantell KA, Miles JR, Spengler ES. Conscience clauses and sexual and gender minority mental health care: A case study. J Couns Psychol 2019; 67:551-567. [PMID: 31789537 DOI: 10.1037/cou0000396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tennessee is one of the first states in the United States to have a law that enables counselors and therapists in independent practice to deny services to any client based on the practitioner's "sincerely held principles." This so-called "conscience clause" represents a critical moment in professional psychology, in which mental health care providers are on the frontlines of cultural and legal debates about religious freedom. Though the law's language is ambiguous, it was widely perceived to target sexual and gender minority (SGM) individuals. We interviewed 20 SGM people living in Tennessee to understand their experiences with mental health care in the state and their perceptions of the law. Our participants perceive the law as fundamentally discriminatory, though they overwhelmingly conceptualize the conscience clause as legalizing discrimination toward members of all stigmatized groups-not just SGM individuals. They described individual and societal consequences for the law, including an understanding of the conscience clause as harmful above and beyond any individual discrimination event it may engender. We situate these findings amid the research on structural stigma and suggest that counseling psychologists become actively engaged in combatting conscience clauses, which appear to have profound consequences on mental health care engagement, particularly for populations vulnerable to discrimination. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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29
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Wells R, Abo-Hilal M, Steel Z, Hunt C, Plested B, Hassan M, Lawsin C. Community readiness in the Syrian refugee community in Jordan: A rapid ecological assessment tool to build psychosocial service capacity. Am J Orthopsychiatry 2019; 90:212-222. [PMID: 31414849 DOI: 10.1037/ort0000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The knowledge of Syrian psychosocial activists in displaced communities is an invaluable resource for developing an ecological understanding of community needs and attitudes. This may elucidate the structural challenges of displacement to be addressed in psychosocial interventions. During Phase 1 of the study, we employed the community readiness model-a tool to assess community climate, needs, and resources-to determine community capacity-building needs. Eight Syrian key informants were interviewed in Amman, Jordan (December 2013 to January 2014). Community readiness scores were calculated. Thematic analysis explored community identified needs. During Phase 2, a focus group was conducted with 11 local psychosocial workers in Amman (September 2016) employing Phase 1 findings to develop a local capacity-building intervention. For the Phase 1 results, community attitudes toward mental health were reported to be rapidly changing. However, continued stigma, lack of knowledge of service availability, and insufficient number of services were noted as barriers to care. Sense of civic engagement and cultural knowledge of local psychosocial actors were noted as significant strengths. However, lack of access to work rights and technical supervision were identified as contributing to burnout, undermining the sustainability of local, grassroots initiatives. A need for training in clinical interventions, along with ongoing supervision, was identified. For the Phase 2 results, local psychologists elected to receive training in culturally adapted cognitive behavior therapy and operational capacity building. The cultural and contextual knowledge of Syrian community members are invaluable. Unfortunately, failure to provide these professionals with basic work rights and technical support have undermined the sustainability of their endeavors. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Ruth Wells
- Clinical Psychology Unit, School of Psychology, University of Sydney
| | | | - Zachary Steel
- Trauma and Mental Health Unit, School of Psychiatry, University of New South Wales
| | - Caroline Hunt
- Clinical Psychology Unit, School of Psychology, University of Sydney
| | | | | | - Catalina Lawsin
- Department of Behavioral Sciences, Rush University Medical Centre
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30
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Abstract
Australian medical professionals whose patients undertake assisted reproductive treatment abroad face a conflict: to try to provide optimal and on-going care for their patient at the same time as ensuring compliance with Australian legal, ethical, and professional rules which proscribe as unsafe or unethical key aspects of such treatment. A major suggestion from literature on medical travel is that risks to the patient can be mitigated through the involvement of the local professional. However, the force of legal regulation and ethical guidance in Australia strenuously directs clinicians away from involvement in overseas reproductive treatment. This article reports on 37 interviews with Australians travelling abroad for surrogacy, egg donation, and embryo donation, reflecting on patients' experiences with Australian medical professionals both before and after they travelled. Patient reports demonstrate a fragmented and bewildering medical landscape in Australia, in which the ability to access domestic care and expertise varied markedly depending upon the kind of treatment patients were seeking abroad, and the mode of practice of the Australian doctor. Doctors practicing within licensed IVF clinics were notably more constrained than those outside such a setting. Patients seeking egg donation were offered information and received a wide range of diagnostic and preparatory treatments, while those seeking surrogacy were shunned, chided and offered limited (and sometimes covert) assistance. While recent changes to national ethical guidance improve clarity on information giving, the ethical and legal propriety of Australian medical professionals providing diagnostic or preparatory treatment for cross border reproduction remains uncertain.
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Kirby J. Balancing competing interests and obligations in mental health-care practice and policy. Bioethics 2019; 33:699-707. [PMID: 30887536 DOI: 10.1111/bioe.12575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 12/04/2018] [Accepted: 12/22/2018] [Indexed: 06/09/2023]
Abstract
It is often challenging for mental health-care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health-care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care-related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on legal precedents, there is a gap in decision-making support in other mental health-care domains. This article proposes that a set of targeted, decision-making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization).
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Affiliation(s)
- Jeffrey Kirby
- Department of Bioethics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Smith Y, Colletta L. Intensive oversight of youth residential treatment: Staff perspectives on the New York State Justice Center for the Protection of People with Special Needs. Child Abuse Negl 2019; 91:52-62. [PMID: 30831533 DOI: 10.1016/j.chiabu.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/14/2018] [Accepted: 02/03/2019] [Indexed: 06/09/2023]
Abstract
Youth care workers in U.S. residential treatment centers (RTCs) provide 24-h care to youth whose significant psychosocial needs cannot be managed in a less restrictive setting. They have sometimes abused or neglected youth in their care. This study investigates staff perspectives on a new form of intensive oversight developed in New York State to prevent maltreatment of youth in care facilities. It asks: How does intensive oversight and investigation mandated by a state-run agency for the protection of people in care affect residential youth care workers in RTCs? Derived from a 15-month ethnographic study of an RTC serving a child welfare population conducted in 2015 and 2016, these results suggest that intensive oversight may have unanticipated consequences for RTCs, the youth care workforce, and youth in care. Consistent with other studies of regulation and surveillance in risk societies, participants reported that fear of prolonged and intimidating investigations, false allegations, and unavoidable violations of policy negatively affected their practice and contributed to staff turnover. Organizational consequences included serious staffing challenges and increased costs of overtime and administrative management of compliance. Some participants suggested that the form of intensive oversight studied here may have reduced the quality of care received by youth by disrupting therapeutic relationships, causing youth to be cared for by unfamiliar workers, and compelling workers to act defensively to prevent allegations rather than in the best interest of youth. We suggest that, under conditions of intensive oversight, youth care workers, like their clients, should be considered an at risk population whose well being is essential for the provision of high quality care. We conclude with modest recommendations to organizations and jurisdictions using or considering intensive oversight practices to protect the rights and safety of youth in RTCs.
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Affiliation(s)
- Yvonne Smith
- Syracuse University, School of Social Work, United States.
| | - Lex Colletta
- Syracuse University, School of Social Work, United States
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Cerminara KL. Therapeutic jurisprudence's future in health law: Bringing the patient back into the picture. Int J Law Psychiatry 2019; 63:56-62. [PMID: 29980335 DOI: 10.1016/j.ijlp.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/24/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
More than 25 years ago, Professors David Wexler and Bruce Winick envisioned broad application of therapeutic jurisprudence (TJ), an interdisciplinary theory of law suggesting that legislatures, regulators, and judges consider the extent to which their decisions impact the psychological well-being of those upon whom the law acts. TJ most obviously plays a significant role in mental health and criminal law, where it originated, but Wexler and Winick long ago opined that TJ could be useful in a wide variety of other disciplines as well. Indeed, TJ has expanded exponentially in application over the years. Yet, although Wexler and Winick originally suggested that health law was an "obvious" field in which it could expand, application of TJ in that discipline has been less robust than one might have expected. This article will examine the extent to which TJ has been applied in health law other than mental health law, categorize the areas of health law in which it has been applied, and suggest future paths for expansive application in this most obvious of areas.
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Affiliation(s)
- Kathy L Cerminara
- Nova Southeastern University Shepard Broad College of Law, 3305 College Avenue, Ft. Lauderdale, FL 33314, USA.
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Legemaate J. [Amendments of medical disciplinary law]. Ned Tijdschr Geneeskd 2019; 163:D3589. [PMID: 30638007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the first half of 2019, the Dutch medical disciplinary law will be amended. Changes include court fees to be paid by people filing complaints, the introduction of an information officer and the possibility to order a health professional to stop his activities during disciplinary proceedings. Some of these amendments are mainly intended to prevent 'complaints of minor importance' from being filed with the disciplinary court.
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Affiliation(s)
- Johan Legemaate
- Amsterdam UMC, locatie AMC, afd. Sociale Geneeskunde: prof.mr. J. Legemaate, gezondheidsjurist
- Contact: J. Legemaate
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Appelo M. [Changes of little consequence]. Ned Tijdschr Geneeskd 2019; 163:D3628. [PMID: 30638005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this article, I explain why the amendments to Dutch disciplinary law, as summarised by Professor Johan Legemaate, are absolutely insufficient to obtain the central goal of this law: improving the quality of professional health care. Dutch disciplinary law is inflexible and creates an atmosphere of anxiety and repression in which positive developments are impossible. This is why this law should be subjected to a comprehensive and fundamental revision.
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Scurria S, Asmundo A, Gualniera P. Cross-Country Comparative Analysis of Legislation and Court Rulings in Wrongful Birth Actions. J Leg Med 2019; 39:35-53. [PMID: 31141455 DOI: 10.1080/01947648.2019.1596851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/03/2019] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
Negligent conduct by health care providers can result in medical malpractice injury sustained by parents denied their right to decide whether and when to have children. In this review of the international medicolegal literature, the authors present a comparative analysis of the law of medical negligence in this context and a discussion of the grounds for compensable injury resulting from medical error. The discussion is focused on the legal provisions for compensable injury awarded to the plaintiff (expectant mother, parents of the born child, and born child) and the types of injury various legal systems recognize in such cases. The aim of this article is to provide medical malpractice investigators and legal professionals with an overview of the birth cases.
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Vergallo GM, Gulino M, di Luca A, Rinaldi R. Limitation of professional medical liability in case of emergency medical treatment according to the joint criminal divisions of the Supreme Court of Cassazione. Ann Ital Chir 2019; 90:485-490. [PMID: 31929172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Judgement no. 8770 released on February 22, 2018 by the joint criminal divisions of the Supreme Court of Cassazione innovatively established that emergency medical conditions represent "problem of special complexity" and, therefore, it is mandatory to apply art. 2236 of the Italian Civil Code. This article provides that health care professional may be convicted only in case of willful misconduct or gross negligence. The authors analyze the jurisprudential evolution of all those elements that are fundamental to assess health care professional liability: a) special complexity of the performance b) relation between imprudence and carelessness c) conditions that may make the healthcare liability gross. The principles approved by the joint criminal division within the above mentioned judgment significantly expand special complexity cases' range and, therefore, the corresponding liability's limitation range is extended. Due to the solidity of the reasons on which it is based, this sentence could permanently influence the orientation of the Courts and, therefore, dramatically diminish the risk of professional liability for healthcare staff. There is, however, a lack of clarity in the practical applications of the distinction between unskillfulness, on the one hand, and imprudence and negligence on the other. This event risks to nullify the usefulness of the joint criminal divisions' intervention. In fact, if the Court considers the health care professional behavior to be imprudent or negligent (rather than unskilled), no limitation of liability can be applied. KEY WORDS: Carelessness, Criminal and civil medical liability limitation, Emergency medical treatments, Gross negligence, Problems of special complexity, Unskillfulness, imprudence.
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Yuksekdag Y. The right to exit and skilled labour emigration: Ethical considerations for compulsory health service programmes. Dev World Bioeth 2018; 19:169-179. [PMID: 30548442 DOI: 10.1111/dewb.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/09/2018] [Accepted: 09/20/2018] [Indexed: 12/01/2022]
Abstract
Compulsory (health) service contracts have recently received considerable attention in the normative literature. The service contracts are considered and offered as a permissible and liberal alternative to emigration restrictions if individuals relinquish their right to exit via contract in exchange for the state-funded tertiary education. To that end, the recent normative literature on the service programmes has particularly focused on discussing the circumstances or conditions in which the contracts should be signed, so that they are morally binding on the part of the skilled workers. However, little attention is devoted to the relevance of the right to exit for the debate on compulsory service programmes. In this paper, I argue that even if the service contracts are voluntary, and thus the would-be medical students voluntarily relinquish their right to exit, the reasons behind the right should be taken into account for the contracts to be morally valid. A clear understanding of the right to exit is a must in order not to breach its basic components and for the service contracts to be morally binding. To that end, I provide two accounts of the reasons to value the right to exit by presenting Patti Lenard's discussion of the right to exit and by reconstructing James Griffin's account of human rights. I conclude by offering brief ethical considerations for compulsory health service programmes grounded in the reasons to value the right to exit.
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Ahmed AM, Kabbash IA, Hassan NM, Radwan NM. Assessing of policies and practices for occupational exposure to blood-borne viral infections in Tanta University Hospitals, Egypt. Environ Sci Pollut Res Int 2018; 25:30747-30754. [PMID: 27718116 DOI: 10.1007/s11356-016-7730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
Abstract
One of the best ways to investigate and improve the effectiveness of polices for prevention and control of infections is through systematic and rigorous evaluation of the structural, functional, and practical elements of these polices. To assess the policies for managing occupational exposure to blood-borne viral infections in Tanta University Hospitals. A cross-sectional survey was carried out. A checklist was used to collect data related to the hospital policy regarding occupational exposure to blood-borne viral infections which was filled by direct personal interviews with the members of infection control (IC) committee of Tanta University Hospitals where the percentage of those in compliance with specific occupational management policies were reported. All studied participants reported lack of access to written infection control manual and only 14.3 % reported that infection control policies and procedures are updated yearly. Only 32.5 % of studied healthcare workers (HCWs) were not aware by the availability of a needle injury clinic. Only 28.6 % of the members of IC committee reported that pre-placement screening of HCWs for baseline blood tests for HBV, HCV, or HIV was conducted; however, periodic screening for these infections was not conducted as reported by all of the members. Among the members of IC committee, 57.1 % recorded availability of post-exposure evaluation. Only 42.8 % of the members of IC committee reported ensuring HCWs' confidentiality when reporting their exposure incidents. Both exposure management policies and practices were not aligning with the national guidelines.
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Affiliation(s)
- Asmaa Mohammad Ahmed
- Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ibrahim Ali Kabbash
- Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Nadira Mansour Hassan
- Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Nashwa Mohammad Radwan
- Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Reiss DR, Dubal VB. Influenza Mandates and Religious Accommodation: Avoiding Legal Pitfalls. J Law Med Ethics 2018; 46:756-762. [PMID: 30336078 DOI: 10.1177/1073110518804237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Influenza mandates in health care institutions are recommended by professional associations as an effective way to prevent the contraction of influenza by patients from health care workers. Health care institutions with such mandates must operate within civil rights frameworks. A recent set of cases against health care institutions with influenza mandates reveals the liabilities posed by federal law that protects employees from religious discrimination. This article examines this legal framework and draws important lessons from this litigation for health care institutions. We argue counterintuitively that providing religious exemptions from influenza mandates may expose health care institutions to more liability than not providing a formal exemption.
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Affiliation(s)
- Dorit Rubinstein Reiss
- Dorit Rubinstein Reiss, LL.B., Ph.D., is a Professor of Law at the University of California, Hastings College of the Law who specializes in law and policy related to vaccines. V.B. Dubal, J.D., Ph.D., is an Associate Professor of Law at the University of California, Hastings College of the Law who specializes in employment law and employment discrimination, and researches the intersection of work law and social change
| | - V B Dubal
- Dorit Rubinstein Reiss, LL.B., Ph.D., is a Professor of Law at the University of California, Hastings College of the Law who specializes in law and policy related to vaccines. V.B. Dubal, J.D., Ph.D., is an Associate Professor of Law at the University of California, Hastings College of the Law who specializes in employment law and employment discrimination, and researches the intersection of work law and social change
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Parmet WE. Beyond Employer-Mandates: Improving Influenza Vaccination Rates among Health Care Workers. J Law Med Ethics 2018; 46:763-765. [PMID: 30336083 DOI: 10.1177/1073110518804238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Wendy E Parmet
- Wendy E. Parmet, J.D., is the Matthews Distinguished University Professor of Law and Director, Center for Health Policy and Law; Professor of Public Policy and Urban Affairs, Northeastern University School of Public Policy and Urban Affairs
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Turale S. A moral and humanitarian imperative: the protection of health workers in war and conflict. Int Nurs Rev 2018; 65:307-308. [PMID: 30132857 DOI: 10.1111/inr.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Julia Raifman
- Both authors are with the Boston University School of Public Health, Boston, MA
| | - Sandro Galea
- Both authors are with the Boston University School of Public Health, Boston, MA
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Artz L, Meer T, Aschman G. Legal duties, professional obligations or notional guidelines? Screening, treatment and referral of domestic violence cases in primary health care settings in South Africa. Afr J Prim Health Care Fam Med 2018; 10:e1-e7. [PMID: 29943618 PMCID: PMC6018123 DOI: 10.4102/phcfm.v10i1.1724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Since 2013, approximately 4400 women have been murdered by their partners in South Africa. This is five times higher than the per capita global average. Domestic violence is known to be cyclical, endemic and frequently involves multiple victims. It also becomes progressively more dangerous over time and may lead to fatalities. In 2012, the Health Professions Council of South Africa released a domestic violence protocol for emergency service providers. This protocol, or screening guidelines, includes assessing future risk to domestic violence, providing physical and psychosocial care, documentation of evidence of abuse and informing patients of their rights and the services available to them. The extent to which these guidelines have been circulated and implemented, particularly by general health care practitioners (HCPs), is unknown. AIM We review international treaties to which South Africa is a signatory, as well as national legislation and policies that reinforce the right to care for victims of domestic violence, to delineate the implication of these laws and policies for HCPs. METHOD We reviewed literature and analysed national and international legislation and policies. RESULTS The 'norms' contained in existing guidelines and currently practiced in an ad hoc manner are not only compatible with existing statutory duties of HCPs but are in fact a natural extension of them. CONCLUSION Proactive interventions such as the use of guidelines for working with victims of domestic violence enable suspected cases of domestic violence to be systematically identified, appropriately managed, properly referred, and should be adopted by all South African HCPs.
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Affiliation(s)
- Lillian Artz
- Gender, Health and Justice Research Unit, Division of Forensic Pathology, Faculty of Health Sciences, University of Cape Town.
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Fujioka JK, Mirza RM, McDonald PL, Klinger CA. Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers' Perspectives. J Pain Symptom Manage 2018; 55:1564-1576.e9. [PMID: 29477968 DOI: 10.1016/j.jpainsymman.2018.02.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
RESEARCH AIMS With the growing interest in Medical Assistance in Dying (MAiD), understanding health care professionals' roles and experiences in handling requests is necessary to evaluate the quality, consistency, and efficacy of current practices. This scoping review sought to map the existing literature on health care providers' perspectives of their involvement in MAiD. METHODS A scoping review was conducted to address the following: 1) What are the roles of diverse health care professionals in the provision of MAiD? and 2) What professional challenges arise when confronted with MAiD requests? A literature search in electronic databases and gray literature sources was performed. Articles were screened, and a thematic content analysis synthesized key findings. RESULTS After evaluating 1715 citations and 148 full-text papers, 33 articles were included. Perspectives of nurses (n = 10), physicians (n = 7), mental health providers (n = 7), pharmacists (n = 4), social workers (n = 3), and medical examiners (n = 1) were explored. Professional roles included consulting/supporting patients and/or other staff members with requests, assessing eligibility, administering/dispensing the lethal drugs, providing aftercare to bereaved relatives, and regulatory oversight. Challenges included lack of clear guidelines/protocols, role ambiguity, evaluating capacity/consent, conscientious objection, and lack of interprofessional collaboration. CONCLUSION Evidence from various jurisdictions highlighted a need for clear guidelines and protocols that define each profession's role, scope of practice, and legal boundaries for MAiD. Comprehensive models of care that incorporate multidisciplinary teams alongside improved clinician education may be effective to support MAiD implementation. Little is known about health care providers' perspectives in handling requests, especially outside physician practice and nursing.
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Affiliation(s)
- Jamie K Fujioka
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada.
| | - Raza M Mirza
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
| | - P Lynn McDonald
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
| | - Christopher A Klinger
- Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; National Initiative for the Care of the Elderly, Toronto, Ontario, Canada
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Dhaliwal U. 'Reasonable accommodation' for medical professionals with congenital colour vision deficiency. Natl Med J India 2018; 31:65-66. [PMID: 30829218 DOI: 10.4103/0970-258x.253161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Upreet Dhaliwal
- Formerly Department of Ophthalmology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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Jain S, Jain H. Mandatory reporting of sexual offences in Indian legislation: An ethical dilemma for medical professionals. Natl Med J India 2018; 31:125-126. [PMID: 30829239 DOI: 10.4103/0970-258x.253159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Shobhit Jain
- Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Harjeet Jain
- Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Wiesener S, Salamonsen A, Fønnebø V. Which risk understandings can be derived from the current disharmonized regulation of complementary and alternative medicine in Europe? BMC Complement Altern Med 2018; 18:11. [PMID: 29321023 PMCID: PMC5763613 DOI: 10.1186/s12906-017-2073-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many European citizens are seeking complementary and alternative medicine (CAM). These treatments are regulated very differently in the EU/EFTA countries. This may demonstrate differences in how risk associated with the use of CAM is perceived. Since most CAM treatments are practiced fairly similarly across Europe, differing risk understandings may influence patient safety for European CAM users. The overall aim of this article is thus to contribute to an overview and awareness of possible differing risk understandings in the field of CAM at a policymaking/structural level in Europe. METHODS The study is a re-analysis of data collected in the CAMbrella EU FP7 document and interview study on the regulation of CAM in 39 European countries. The 12 CAM modalities included in the CAMbrella study were ranked with regard to assumed risk potential depending on the number of countries limiting its practice to regulated professions. The 39 countries were ranked according to how many of the included CAM modalities they limit to be practiced by regulated professions. RESULTS Twelve of 39 countries generally understand the included CAM treatments to represent "high risk", 20 countries "low risk", while the remaining 7 countries understand CAM treatments as carrying "very little or no risk". The CAM modalities seen as carrying a risk high enough to warrant professional regulation in the highest number of countries are chiropractic, acupuncture, massage, homeopathy and osteopathy. The countries understanding most of the CAM modalities in the study as potentially high-risk treatments are with two exceptions (Portugal and Belgium) all concentrated in the southeastern region of Europe. CONCLUSION The variation in regulation of CAM may represent a substantial lack of common risk understandings between health policymakers in Europe. We think the discrepancies in regulation are to a considerable degree also based on factors unrelated to patient risk. We argue that it is important for patient safety that policy makers across Europe address this confusing situation. This could be done by applying the WHO patient safety definitions and EU's policy to facilitate access to "safe and high-quality healthcare", and regulate CAM accordingly.
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Affiliation(s)
- Solveig Wiesener
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Anita Salamonsen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU North), Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Vinjar Fønnebø
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
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Echols B. "Heal Thyself."—An Argument for Granting Asylum to Healthcare Workers Persecuted During the 2014 West African Ebola Crisis. SMU Law Rev 2018; 71:1153-1179. [PMID: 30648831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article argues for a change in United States asylum policy at a time when change is needed most. Those seeking asylum must prove that they fear persecution in their home country based on one of five protected categories and that their government is the persecutor or is unable to control the actions of the persecutors. Multiple articles have recognized that the "particular social group" is the most difficult category of asylum seeker to analyze. Not only do the standards for particular social groups (PSGs) vary among circuit courts, but judicial consistency is lacking. This article focuses on a particular PSG, healthcare workers from recently Ebola-stricken West Africa. During the 2014 Ebola crisis, these healthcare workers faced discrimination and violence due to their association with western medicine. Hospitals were frequently threatened and ransacked. Multiple accounts of violence against local and international healthcare workers were recorded by Doctors Against Borders, the Centers for Disease Control, and the international media. However, because of the inconsistencies in asylum law and the ever-present political influence in what originates as a humanitarian process, it is unlikely for these PSGs to be found asylum-eligible. This highlights the need for a more consistent and humanitarian-based asylum policy with less political influence.
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