Legal Rights Of Patients Research Articles

A pilot study on the global practice of informed consent in paediatric dentistry.

Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment-and has specific relevance with SDF/ SF treatments. The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared. Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the "best interest" of the patient. It is recommended that it is clarified globally when a dentist may act in the "best interest" of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.

Legal rights of patients in Saudi Arabia

Legal rights of patients in Saudi Arabia

Risk assessment and its influencing factors of involuntary admission in patients with mental disorders in Shanghai, China.

The 'risk criterion' for involuntary admission (IA) has been adopted by Mental Health Law of the People's Republic of China since 2013. How the new legal regulation influences daily practices in psychiatric institutes are still unclear. The present study sought to explore the application of risk criterion in IA cases; especially risk assessed by psychiatrists at admission and its influencing factors. Socio-demographic and clinical data including risk assessment for admission of 3,529 involuntary admitted patients from two typical hospitals in Shanghai from 2013 to 2014 were consecutively collected. Personal information of psychiatrists who made admission assessment was collected separately. Among the 3,529 cases, 1,890 (53.6%) were admitted because of actual harmful behaviors to self or others, while 1,639 (46.4%) were admitted with some kinds of risk, but 265 (7.5%) were admitted without any records on risk assessment checklists. Patients who were unemployed, of younger age, single status, diagnosed with schizophrenia were more likely to be admitted without any records on the checklist. Male gender, older age, and lower professional title are influencing factors that psychiatrists made no risk assessment records. The vast majority (92.5%) of risk assessment in IA patients were qualified in our study. In order to protect the legal rights of patients better, operational and reasonable procedures of risk assessment should be developed, such include more detailed rules to IA, systematic training of psychiatrists on IA assessment, mechanism improving doctor-patient relationship, and alternative mental health services for patients and so on.

Generalizable items of quantitative and qualitative cornerstones for personnel requirement of physicians in anesthesia.

Anesthesiologists perform a broad spectrum of tasks. However, in many countries, there is no legal basis for personnel staffing of physicians in anesthesia. Also, the German diagnosis related groups system for refunding does not deliver such a basis. Thus, in 2006 a new calculation base for the personnel requirement that included an Excel calculation sheet was introduced by the German Board of Anesthesiologists (BDA) and the German Society of Anesthesiology and Intensive Care Medicine (DGAI), and updated in 2009 and 2015. Oriented primarily to organizational needs, in 2015, BDA/DGAI defined quantitative and qualitative cornerstones for personnel requirement of physicians in anesthesia, especially reflecting recent laws governing physician’s working conditions and competence in the field of anesthesia, as well as demands of strengthened legal rights of patients, patient care and safety. We present a workload-oriented model, integrating core working hours, shift work or standby duty, quality of care, efficiency of processes, legal, educational, controlling, local, organizational and economic aspects for calculating personnel demands. Auxiliary tables enable physicians to calculate personnel demands due to differing employee workload, non-patient oriented tasks and reimbursement of full-equivalents due to parental leave, prohibition of employment, or long-term illness. After 10 years of experience with the first calculation tool, we report the generalizable key aspects and items of a necessary calculation tool which may help physicians to justify realistic workload-oriented personnel staffing demands in anesthesia. A modular, flexible nature of a calculation tool should allow adaption to the respective legal and organizational demands of different countries.

Occupational skin diseases from 1997 to 2004 at the Department of Dermatology, University Hospital of Northern Norway (UNN): an investigation into the course and treatment of occupational skin disease 10–15 years after first consultations with a dermatologist

ObjectivesWe investigate the impact of occupational skin disease consultations among outpatients at the Dermatological Department, University Hospital, Northern Norway.Study designFrom 1997 until 2004, 386 patients with occupational skin disease were examined and given advice on skin care, skin disease treatment, skin protection in further work, and on the legal rights of patients with this disease. Ten to fifteen years later, we wanted to look at these patients in terms of their work situation, the current status of their disease, the help they received from the labour offices, and their subjective quality of life.Material and methodsIn the autumn of 2011 until the spring of 2012, a number of the patients examined in the period from 1997 to 2004 were selected and sent a questionnaire, which they were asked to answer and return, regarding their work situation and the progress and current status of their occupational disease.ResultsA total of 153 (77%) patients answered the questionnaire; 71% of these patients were still in work, and further 15% had old-age retired, 13% were working until then; 16% had retired early because of disability; 54% had changed jobs because of their occupational skin disease; 86% of the patients indicated that the skin disease had improved since our previous investigation.ConclusionsOur investigation into patients with occupational skin disease documented that the majority of patients who had received professional dermatological consultation and intervention offers were still in the labour market and had good control of their skin disease 10–15 years later. We discovered that 71% of the patients were still employed. 13% had remained in work until they became old age pensioners. Only 16% dropped out of work because of disability. These high percentages may indicate that our intervention has contributed positively to patients’ work conditions and the course of their skin disease.

The compliant court — Procedural fairness and social control in compulsory community care

Compulsory community care (CCC) was introduced in Sweden in 2008. This article investigates all written court decisions regarding CCC over a 6month period in 2009 (N=541). The purpose is to examine how the legal rights of patients are protected and what forms of social control patients are subjected to.51% of CCC patients are women and 84% are being treated for a psychosis-related disorder. In the court decisions, only 9% of patients are described as dangerous to themselves, while 18% are regarded a danger to others. The most common special provisions that patients are subjected to are medication (79%) and a requirement that they must maintain contact with either community mental health services (51%) or social services (27%).In the decisions, both the courts and court-appointed psychiatrists agree with treating psychiatrists in 99% of cases. Decisions lack transparency and clarity, and it is often impossible to understand the conclusions of the courts. There is considerable variation between regional courts as regards the provisions to which patients are subjected and the delegation of decision-making to psychiatrists. This means that decisions fail to demonstrate clarity, transparency, consistency and impartiality, and thus fail to meet established standards of procedural fairness.Surveillance techniques of social control are more common than techniques based on therapy or sanctions. Because of the unique role of medication, social control is primarily imposed on a physical dimension, as opposed to temporal and spatial forms.The article concludes that patients are at risk of being subjected to new forms of social control of an unclear nature without proper legal protection.

AMA Code of Medical Ethics' Opinions on Discussing Patients with Third Parties

Opinion 5.04 - Communications Media: Standards of Professional Responsibility Physicians are ethically and legally required to protect the personal privacy and other legal rights of patients. When information concerning a specific patient is requested by the media, the physician must obtain the consent of the patient or an authorized representative before releasing such information. The physician may release only the authorized information or that which is public knowledge. The patient-physician relationship and its confidential nature must be maintained.

The American medical liability system: An alliance between legal and medical professionals can promote patient safety and be cost effective

Objective: The aim of this paper is to evaluate a hypothesis premised on the idea that if medical leaders in the United States support an unfettered access for patients injured by medical error to the American civil justice system, that approach would improve patient safety and be cost effective. Method: An analysis of the relevant legal and medical literature. Results: Medical liability in the American civil justice system derived from traditional tort law is based on accountability. Reforms applied to medical liability cases urged by healthcare providers limit and in some cases eliminate legal rights of patients injured by healthcare error which rights exist for all others in non-medical cases. Yet medical liability cases have promoted a culture of safety. Information learned from medical liability cases has been used to make care safer with a reduced incidence of adverse outcomes and lower costs. A just culture of safety can limit provider emotional stress. Using the external pressures to reduce the incidence of law suits and promoting ethical mandates to be safer and disclose the truth can promote provider satisfaction. Conclusions: An alliance between legal and medical professionals on the common ground of respect for the due process legal rights of patients in the American system of justice and the need for accountability can make care safer and can be cost effective.

Civil liability for mistakes in the treatment of patients and notification in German law on patients' rights

This paper contains an introduction, four separate parts and the conclusion. In the introduction was first exposed patients' rights in Germany before their codification, and then we talk about general characteristics and objectives of the political and legal rights of patients. The first part of paper is dedicated to the treatment contract and his place in the German Civil Code, that set by the legislature. This is about typical contractual obligations of its parties and special responsibilities of doctors to patients. The second part relates to the peculiar duty of doctors to inform patients about their own and others' mistakes in treatment. The third part includes responsibility for mistakes in patient care. Starting from the premise that the mistake is a negative deviation from the medical standard, the author talks about the concept of medical standards and the principle of freedom to choose the method of treatment, and what treatment means. The fourth section deals with the burden of proof for liability for negligent medical treatment and informing the patient. There is, in fact, a word of facilitating evidence in favor of the patient, as it has found and developed jurisprudence, and now these benefits translated into the legal standard which is particularly noticeable feature of the German health medical law. The author concludes that the German law on patients' rights has a special meaning for patients, doctors and lawyers in Serbia. The special attention is drawn to its provisions regarding the treatment contract, which the legislator settled in the Civil Code. They encourage reflection on whether the contract of treatment has the place in the future Serbian Civil Code which is preparations are underway. In addition, special attention is given to the provisions of the new German law which obliges the doctors to inform the patient of his and someone else's mistakes in treatment, as well as provisions on the burden of proof in lawsuits against doctors. The author states that Germany is the only one, so far, the country in Europe that legislators in the form of these rules means to maintain a balance of interests between doctors and patients. For those who are not ready to go down that path, this could be at least an ideal to be strived for.

Knowledge about patients’ rights among professionals in public health care in Finland

The legal rights of patients include civil rights for patients and the duties of healthcare professionals. Knowledge of legislation and the ability to put juridical norms into practice are among the main aspects of professionals. The aim of the study was to describe the level of healthcare professionals' knowledge about patients' legal rights and to describe background variables associated with the knowledge. The legal rights are based on the Finnish Act on the Status and Rights of Patients. The data were collected from healthcare professionals (nurses and physicians) in public health care in Finland (recruited N = 290, responded n = 191) with a questionnaire designed for the study. The response rate was 66%. The data were analysed statistically. Healthcare professionals were partially familiar with patients' legal rights. The right to good health care, treatment and access to care and right to self-determination were the best-known areas. The respondents lacked knowledge on the right to information and the right to use the services of patient ombudsman. Based on self-evaluation, half of the respondents thought that they had weak knowledge of the legislation on patients' rights. However, they perceived knowledge about patients' rights as being important. There was no correlation between respondents' self-evaluated knowledge and actual scoring on the knowledge test. These results implicate a need for further education aimed at healthcare professionals and development of professional training about patients' legal rights.

Health care reform: the differential diagnosis

Economic and political experts appear to agree that the US health care system is a horrible mess, and there is no consensus as to how to fix it. The differential diagnosis is that our health care system: (a) is dying because of hopelessly opposed political parties and greedy insurance companies or (b) has a treatable illness. I believe that the illness is treatable, if we adhere to several guiding principles. These include (a) universal access to compassionate health care, (b) improved health care through scientific advances, and (c) reduced administrative and legal costs. Establishing these three goals, and introducing a series of changes designed to achieve them, can result in meaningful health care reform. Goal number one: universal, compassionate coverage. The first goal should be the easiest to achieve. Initially, through a combination of private and public options, everybody should have some form of health insurance. I believe that the ultimate goal should be a single-payer system, but that need not be the first step toward universal coverage. Achieving universal health insurance today would require the government to provide coverage for that portion of the 15% in the United States who are currently uninsured and cannot afford health insurance and to make health insurance a requirement for those who can afford it. The reality is that everybody now has access to health care, but the uninsured primarily use the most expensive forms of health care (e.g., the emergency room), boosting the costs. Cost savings from regulating physician income and from administrative and tort reform could be used to pay for universal coverage. A bigger challenge is training the primary care providers who will be required in a new, more efficient health care system. This will require increased efforts by US medical schools to recruit and train primary care providers. To promote preventive care, all insurers should be required to refund a portion of insurance costs to patients who undergo their annual physical examinations. The discussion about health care has to refocus on how to provide access for all to a physician who is well trained and cares about patients and who works in a system that is humane and no longer treats patients and physicians like commodities. Goal number two: scientific advances in medical knowledge. America has the best biomedical research infrastructure in the world. However, this great national treasure is fragile and must be continually supported in order to develop new, more effective and affordable diagnostics and therapies. Sustained increases in support for biomedical research are an essential component of health care reform. Goal number three: reducing costs. Any discussion of meaningful health care reform has to include improvements in diagnosis and effectiveness of health care delivery achieved using electronic medical records. The costs of implementing electronic patient records should be shared among the medical schools, as a single format would meet the needs of all. Similarly, as a first step toward a single-payer plan, all insurance providers should be required to use the same form, which would largely be filled out automatically using the electronic record. This would drastically reduce administrative costs associated with insurance and billing. Additional cost savings could be achieved by meaningful tort reform that protects the legal rights of patients but reduces frivolous lawsuits. This could be facilitated by an enhanced system of case review by experts, prior to initiating costly legal proceedings. Further cost regulation should include compensating all physicians with salaries, which would remove incentives for unnecessary procedures. The diagnosis is clear: our health care system is in critical condition. However, its strengths include the world’s best systems for training health care providers and biomedical researchers. The quality and effectiveness of the administrative components of our health care system must be improved so that they enhance the health of the patient, rather than destroy it.

Pharmacist conscience clauses and access to oral contraceptives

The introduction of conscience clauses after the 1973 US Supreme Court decision in Roe v. Wade allowed physicians and nurses to opt out of medical procedures, particularly abortions, to which...

Enhancing Communication in Dental Clinics with Linguistically Different Patients

The United States is becoming substantially more diverse in its citizenry, with numerous racial and ethnic cultural groups and immigrants living and working in this country. In addition, there has been an increase in the number of languages other than English spoken in homes, as well as an increase in the number of individuals with limited English-speaking abilities. Given the emerging racial, ethnic, and cultural trends in U.S. society, it is important that dental students as future practitioners have knowledge of interpreter services, working with professionally trained interpreters, and the legal responsibilities and requirements of interpretation. The purposes of this study were to 1) describe the role of interpreters in dental health care settings; 2) identify challenges they face; and 3) propose approaches and strategies to improve communication between dental students as future practitioners and non-English-speaking patients. Data were collected through a series of individual in-depth, face-to-face interviews using a semi-structured open-question format and email communications with three key informants who were purposefully selected to participate in this study based on their comprehensive knowledge and experience as interpreters. The qualitative analysis revealed themes or stories related to the following areas of this study: 1) the role of professional interpreters in dental and other health care settings; 2) challenges faced by interpreters and providers working with patients with limited English-speaking ability; and 3) strategies and approaches used to improve communication and address challenges. By understanding the unique interpreting needs of non- or limited English-speaking patients, dental students have an opportunity to broaden their cultural competency skills. Dental schools have an obligation to ensure that students, faculty, and staff know and understand the legal rights of patients and health care providers to communicate effectively when using an interpreter, although having a professionally trained interpreter working in a facility does not end the cultural learning processes needed in a multicultural society.

Walking a mile in their shoes... Symbolic interactionism for families living with severe mental illness.

1. With deinstitutionalization and changes in legal rights of patients, care of patients with severe mental illness has shifted from a hospital-based to a community-centered system. 2. Families often serve as an extension of the mental health system, providing important case management functions such as assessment, monitoring, crisis management, and advocacy. 3. Symbolic interactionism provides a framework for understanding the role of meaning in individual and family responses to the disruption of life that results from severe mental illness.

The United Nations principles for the protection of people with mental illness: Applications and limitations

People detained as involuntary patients in psychiatric hospitals often live in a harrowing and different reality: beset by alien voices, frightening visions and wild swings in mood. In the past however, their tragedy was often compounded by the unnecessary deprivation of their dignity and freedom. Recognising this, governments here and in other parts of the western world enacted new ‘rights’ related legislation during the 1980s. This legislation was a significant advance. It secured the legal rights of patients in hospital. But, unfortunately, it appears that it has done little to enhance their social and material needs either in hospital or the wider community. In these respects, their tragedy remains constant and needs urgently to be addressed. In this article, I will survey the legal reforms with a particular focus on the interaction between the United Nations Principles for the Protection of Persons with Mental Illness and Victoria's Mental Health Act 1986. I will then explore some limits to the legal...

Private Reform of Tort-Law Dogma: Market Opportunities and Legal Obstacles

At this point, the focus of the symposium shifts away from possible legislative reforms of malpractice law in order to consider whether some relief from malpractice problems might be obtainable through private action-that is, through private contracts altering the responsibilities of health care providers and the legal rights of patients.1 The first thesis to be presented here, in opening this subject, is that the idea of private reform in the area of medical malpractice squares nicely both with recent developments in national health policy and with recent changes in the health care industry itself. It will also be contended that the legal system, to the extent that it is unreceptive to contractual variations of its rules governing medical accidents, is out of touch with recent developments and needs to have its premises reexamined. The observations here support the view that tort law must recede from a dogmatic regulatory role in which it alone specifies rights arising out of the provider/patient relationship and should recognize that private agreements altering its prescriptions may benefit everyone appropriately concernedeveryone, that is, except malpractice lawyers. An examination of the implications of recent health sector developments for malpractice reform should be helpful to several audiences. Those who focus their attention primarily on liability issues are apt to be only generally aware of what is happening in health policy and in the health care marketplace

Malpractice: A Guide to the Legal Rights of Patients and Doctors

Dr Flaster states in his dedication that it is his hope that his book may bring about better mutual understanding and benefit both parties. I doubt that this objective will be obtained. While most of the observations made are true, and while those who read the book will agree with the author that he has adequately described the reasons for the increasing number of lawsuits by patients against medical care providers, no patient will be dissuaded from pursuing an action, nor will a physician change his methods of practice or his relationships with his patients. The reasons why patients sue and the author's emphasis on the patientdoctor relationship are not without proper foundation. The patient who reads the book will say, See, I told you so. The physician will agree with its comments, but generally will deny that he falls into any but the most favorable category of practicing physicians.

Book ReviewMalpractice: A guide to the legal rights of patients and doctors

Book ReviewMalpractice: A guide to the legal rights of patients and doctors

Law and the Mental Health Professions: Friction at the Interface

When much acute psychiatric care was transferred from mental hospitals to general hospitals in the late 1950s and 1960s—largely due to electroconvulsive treatments and to chemotherapy—and when true community mental health centers developed by the mid-1960s to provide ambulatory care and crisis intervention, psychiatric treatment became more successful than ever before. At this juncture lawyers and judges began to regulate meaningfully the public practice of psychiatry. Beginning with the articulation of legal rights of patients, a series of cases spelled out gradually narrowing limits, within which patients could be involuntarily hospitalized. Procedural safeguards analogous to those in civil administration hearings and close to the standards for criminal trials were articulated. Phrases like "least restrictive environment" set the stage for progressive deinstitutionalization of patients. It was almost as though courts were playing the role of a modern-day Pinel and releasing the mentally ill from their chains. All this did not come

Ethical and legal considerations in high risk studies of schizophrenia.

The domains of the legal and mental health systems have long been Interrelated; today their joint concerns seem focused on the broad Issues of ethics and morals. Over the past several years, there has been a crescendo/ng Involvement of the legal system In mental health Issues; Informed consent, confidentiality, right to treatment, and legal rights of patients have been brought Into sharp relief by court cases and/or new regulations. No area In which these two domains overlap Is more perplexing than one Involving children. For example, what are the legal riahts and responsibilities of children? When are children able to make decisions in their own behalf? If they are deemed unable to decide for themselves, who should? How are they to be protected from being subjected to possibly harmful procedures, and at the same time assured that they will not be denied new treatments of potential value? Although this is only a partial listing of troubling ethical quandaries regarding the treatment of children, it can easily be seen that similar questions can be raised with regard to adults as well. Professor Curran's summary of an Intensive review of the legal, ethical, and moral implications of intervention undertaken with children thought to be vulnerable to psychopathology In later life Is presented here, in part, to serve as a stimulus for Bulletin readers to air their views, experiences, and problems with the entire spectrum of legal, ethical, and moral issues that confront mental health workers today. We invite your comments and will publish a representative sampling of material received. Preference will be given to letters that provide data documenting views, experiences, and problems.—The Editors.