Medical Jurisprudence Commons^™

Pregnancy Denied, Pregnancy Rejected In Stephanie Daley, Susan Ayres, Prema Manjunath

Susan Ayres

This article offers a reading of Hilary Brougher’s film Stephanie Daley (2006), in which a teen is accused of murdering her newborn (neonaticide). Brougher depicts a “phenomenology of unwanted pregnancy” and an example of therapeutic jurisprudence. Part One examines Brougher’s treatment of the “shadow side of pregnancy,” and highlights barriers to the empathetic treatment of neonaticide. Part Two emphasizes the process of therapeutic jurisprudence as experienced by the two main characters. Brougher’s film provides a social narrative and phenomenology that may influence laws and legal responses and enlarge social understanding of unwanted pregnancy.

The Politics Of Abortion, Janine Brodie, Shelley Gavigan, Jane Jenson

Shelley A. M. Gavigan

The United States and Ireland are not the only places where the abortion rights debate currently exists. This book represents the collaboration of three established scholars (two political scientists and one lawyer) to document and analyze the abortion saga in Canada from the legalization of therapeutic abortions in 1969 to the debates over new legislation in 1990. Through the integration of political, legislative, and constitutional dimensions of the issue, this work examines the evolution of abortion policy in Canada.

Clinical Jurisprudence: Could Thorough Documentation Have Changed The Outcome Of This Trial?, Joseph Sanfilippo, Steven Smith, Shirley Pruitt

STEVEN R SMITH

A patient sued her gynecologist on the grounds that, because an originally planned BSO was not performed, she was fearful of developing ovarian cancer in the future. Preoperative documentation was “sketchy”at best and did not reflect the preoperative discussion and options presented to the patient. There was no documentation of anyone accompanying the patient at the preoperative office visit. The case went to trial. What’s the verdict?

Life And Death Decision-Making: Judges V. Legislators As Sources Of Law In Bioethics, Charles Baron

Charles H. Baron

In some situations, courts may be better sources of new law than legislatures. Some support for this proposition is provided by the performance of American courts in the development of law regarding the “right to die.” When confronted with the problems presented by mid-Twentieth Century technological advances in prolonging human life, American legislators were slow to act. It was the state common law courts, beginning with Quinlan in 1976, that took primary responsibility for gradually crafting new legal principles that excepted withdrawal of life-prolonging treatment from the application of general laws dealing with homicide and suicide. These courts, like the …

The Dialogue Between Biomedicine And Law In An “Intraamerican Transnational Perspective”, Charles Baron

Charles H. Baron

No abstract provided.

The Concept Of Person In The Law, Charles Baron

Charles H. Baron

The focus of the abortion debate in the United States tends to be on whether and at what stage a fetus is a person. I believe this tendency has been unfortunate and counterproductive. Instead of advancing dialogue between opposing sides, such a focus seems to have stunted it, leaving advocates in the sort of “I did not!” – “You did too!” impasse we remember from childhood. Also reminiscent of that childhood scene has been the vain attempt to break the impasse by appeal to a higher authority. Thus, the pro-choice forces hoped they had proved the pro-life forces “wrong” by …

Medical Paternalism And The Rule Of Law: A Reply To Dr. Relman, Charles Baron

Charles H. Baron

In this Article, Professor Baron challenges the position taken recently by Dr. Arnold Relman in this journal that the 1977 Saikewicz decision of the Supreme Judicial Court of Massachusetts was incorrect in calling for routine judicial resolution of decisions whether to provide life-prolonging treatment to terminally ill incompetent patients. First, Professor Baron argues that Dr. Relman's position that doctors should make such decisions is based upon an outmoded, paternalistic view of the doctor-patient relationship. Second, he points out the importance of guaranteeing to such decisions the special qualities of process which characterize decision making by courts and which are not …

Medical Malpractice Reform Measures And Their Effects, Robert Leflar

Robert B Leflar

New rules and methods for medical injury dispute resolution have been launched in New Hampshire and New York, and demonstration projects are underway elsewhere. This article describes major medical malpractice reforms undertaken and proposed in recent years. Reforms are classified as (1) liability-limiting initiatives favoring health-care providers; (2) procedural innovations promoted as improving dispute resolution processes, such as patient compensation funds, “sorry” laws, disclosure and early offer laws, health courts, and safe harbor laws; and (3) major conceptual reforms to move liability away from physicians to hospitals or administrative no-fault compensation systems. Empirical evidence about the practical effects of already-implemented …

Association Between Work-Family Conflict And Musculoskeletal Pain Among Hospital Patient Care Workers, Seung-Sup Kim, Cassandra Okechukwu, Orfeu Buxton, Jack Dennerlein, Leslie Boden, Dean Hashimoto, Glorian Sorenson

Dean M. Hashimoto

Background

A growing body of evidence suggests that work–family conflict is an important risk factor for workers' health and well-being. The goal of this study is to examine association between work–family conflict and musculoskeletal pain among hospital patient care workers.

Methods

We analyzed a cross-sectional survey of 1,119 hospital patient care workers in 105 units in two urban, academic hospitals. Work–family conflict was measured by 5-item Work–Family Conflict Scale questionnaire. Multilevel logistic regression was applied to examine associations between work–family conflict and self-reported musculoskeletal pain in the past 3 months, adjusting for covariates including work-related psychosocial factors and physical work …

Barriers To Use Of Workers' Compensation For Patient Care At Massachusetts Community Health Centers, Lenore Azaroff, Letitia Davis, Robert Naparstek, Dean Hashimoto, James Laing, David Wegman

Dean M. Hashimoto

Objectives

To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC). Data Sources/Study Setting

Leadership of CHCs in Massachusetts. Study Design

We used purposeful snowball sampling of CHC leaders for in-depth exploration of reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of all CHCs in Massachusetts. Data Collection/Extraction Methods

Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated. Principal Findings

Few CHCs formally discourage use …

Lessons From Personhood’S Defeat: Abortion Restrictions And Side Effects On Women’S Health, Maya Manian

Maya Manian

State personhood laws pose a puzzle. These laws would establish fertilized eggs as persons and, by doing so, would ban all abortions. Many states have consistently supported laws restricting abortion care. Yet, thus far no personhood laws have passed. Why? This Article offers a possible explanation and draws lessons from that explanation for understanding and resisting abortion restrictions more broadly. I suggest that voters’ recognition of the implications of personhood legislation for health issues other than abortion may have led to personhood’s defeat. In other words, opponents of personhood proposals appear to have successfully reconnected abortion to pregnancy care, contraception, …

Longer-Term Use Of Opioids, Dongchung Wang, Dean Hashimoto, Kathryn Mueller

Dean M. Hashimoto

With opioid misuse a top public health problem in the United States, this study examined longer-term use of narcotics in 21 states and how often recommended treatment guidelines for monitoring injured workers with longer-term use were followed by physicians. The information provided will help public officials identify means to strengthen the design or implementation of public policies related to narcotic use, and help payors target efforts to better manage the use of narcotics while providing appropriate care to injured workers and reducing unnecessary risks to patients and unnecessary costs to employers. The study is based on nearly 300,000 workers' compensation …

Occupational Injuries For Consecutive And Cumulative Shifts Among Hospital Registered Nurses And Patient Care Asscoiates: A Case-Control Study, Karen Hopcia, Jack Dennerlein, Dean Hashimoto, Terry Orechia, Glorian Sorensen

Dean M. Hashimoto

Nontraditional work shifts for hospital registered nurses and patient care associates and associated injuries were examined through a case-control study. Inpatient care requires that many staff work nontraditional shifts, including nights and 12-hour shifts, but some characteristics remain unexplored, especially consecutive shifts. A total of 502 cases (injured workers) were matched to single controls based on their hospital, unit type, job type, gender, and age (± 5 years). Conditional logistic regression was used for the analysis, controlling for weekly hours scheduled. For both, consecutive shifts of 2 or more days and some various cumulative shifts over a week and month …

Ancillary Joint Ventures And The Unanswered Questions After Revenue Ruling 2004-51

Gabriel O Aitsebaomo

Ever since the Internal Revenue Service (the "Service") issued Revenue Ruling 98-15… in which it emphasized "control" as a critical factor in determining whether a tax-exempt hospital that enters into a whole-hospital joint venture with a for-profit entity would continue to maintain its tax-exemption, practitioners and scholars alike have sought guidance from the Service regarding whether such "control" would also be required of an exempt organization that enters into an "ancillary joint venture" with a for-profit entity. In response, the Service issued Revenue Ruling 2004-51 on May 6, 2004.

… In Revenue Ruling 2004-51, the Service enunciated that a tax-exempt …

Relationship Of Sleep Deficiency To Perceived Pain And Functional Limitations In Hospital Patient Care Workers, Orfeu Buxton, Karen Hopcia, Grace Sembajwe, James Porter, Jack Dennerlein, Christopher Kenwood, Anne Stoddard, Dean Hashimoto, Glorian Sorensen

Dean M. Hashimoto

Objective: Health care workers are at high risk of developing musculoskeletal symptoms and pain. This study tested the hypothesis that sleep deficiency is associated with pain, functional limitations, and physical limitations that interfere with work. Methods: Hospital patient care workers completed a survey (79% response rate) including measures of health, sociodemographic, and workplace factors. Associations of sleep deficiency with pain, work interference due to this pain, and functional limitations were determined. Results: Of 1572 respondents (90% women; mean age, 41 years), 57% reported sleep deficiency, 73% pain in last 3 months, 33% work interference, and 18% functional limitation. Sleep deficiency …

Musculoskeletal Pain And Psychological Distress In Hospital Patient Care Workers, Sijn Reme, Jack Dennerlein, Dean Hashimoto, Glorian Sorenson

Dean M. Hashimoto

Purpose

The aim of the study was to assess the association of psychological distress and musculoskeletal pain, how it is related to pain interference with work and multiple pain areas, and potential differences between the different pain areas in hospital patient care workers.

Methods

Data were collected from a cross-sectional survey of patient care workers (n = 1,572) from two large hospitals.

Results

Patient care workers with musculoskeletal pain reported significantly more psychological distress than those without pain. Psychological distress was significantly related to pain interference with work, even after adjusting for pain and demographics (OR = 1.05; CI = …

Occupational Injuries Among Nurses And Aides In A Hospital Setting, Leslie Boden, Grace Sembajwe, Torill Tveito, Dean Hashimoto, Karen Hopcia, Christopher Kenwood, Anne Stoddard, Glorian Sorenson

Dean M. Hashimoto

Background

Patient care workers in acute care hospitals are at high risk of injury. Recent studies have quantified risks and demonstrated a higher risk for aides than for nurses. However, no detailed studies to date have used OSHA injury definitions to allow for better comparability across studies.

Methods

We linked records from human resources and occupational health services databases at two large academic hospitals for nurses (n = 5,991) and aides (n = 1,543) in patient care units. Crude rates, rate ratios, and confidence intervals were calculated for injuries involving no days away and those involving at least 1 day …

The Role Of The Work Context In Multiple Wellness Outcomes For Hospital Patient Care Workers, Dean Hashimoto, Glorian Sorensen, Anne Stoddard, Sonia Stoffel, Orfeu Buxton, Grace Sembajwe, Jack Dennerlien, Karen Hopcia

Dean M. Hashimoto

Objective: To examine the relationships among low back pain (LBP), inadequate physical activity, and sleep deficiency among patient care workers, and of these outcomes to work context.

Methods: A cross-sectional survey of patient care workers (N = 1572, response rate = 79%).

Results: A total of 53% reported LBP, 46%, inadequate physical activity, and 59%, sleep deficiency. Inadequate physical activity and sleep deficiency were associated (P = 0.02), but LBP was not significantly related to either. Increased risk of LBP was significantly related to job demands, harassment at work, decreased supervisor support, and job title. Inadequate physical activity was significantly …

A Theory Of Discipline For Professional Misconduct, Nadia Sawicki

Nadia N. Sawicki

State medical boards derive their licensure and disciplinary authority from the police powers reserved to the states under the 10th Amendment. Though it is clear that public health, safety, and welfare are well-served by the educational and examination requirements uniformly imposed upon medical professionals, many medical practice acts also authorize discipline for professional misconduct that does not directly implicate clinical competence or patient safety - for example, being convicted of a felony or a crime of moral turpitude, failing to comply with a child support order, providing expert opinion to a court without reasonable investigation, ordering unnecessary laboratory tests, engaging …

Compliance With Advance Directives: Wrongful Living And Tort Law Incentives, Holly Lynch, Michele Mathes, Nadia Sawicki

Nadia N. Sawicki

Modern ethical and legal norms generally require that deference be accorded to patients' decisions regarding treatment, including decisions to refuse life-sustaining care, even when patients no longer have the capacity to communicate those decisions to their physicians. Advance directives were developed as a means by which a patient's autonomy regarding medical care might survive such incapacity. Unfortunately, preserving patient autonomy at the end of life has been no simple task. First, it has been difficult to persuade patients to prepare for incapacity by making their wishes known. Second, even when they have done so, there is a distinct possibility that …

Baby Doe Cases: Compromise And Moral Dilemma, Phoebe Haddon

Phoebe A. Haddon

No abstract provided.

The Regulation Of Medical Malpractice In Japan, Robert Leflar

Robert B Leflar

How Japanese legal and social institutions handle medical errors is little known outside Japan. For almost all of the 20th century, a paternalistic paradigm prevailed. Characteristics of the legal environment affecting Japanese medicine included few attorneys handling medical cases, low litigation rates, long delays, predictable damage awards, and low-cost malpractice insurance. However, transparency principles have gained traction and public concern over medical errors has intensified. Recent legal developments include courts' adoption of a less deferential standard of informed consent; increases in the numbers of malpractice claims and of practicing attorneys; more efficient claims handling by specialist judges and speedier trials; …

Interstate Variations In Medical Practice Patterns For Low Back Conditions, Dean Hashimoto, Dongchun Wang, Kathryn Mueller, Sharon Belton, Xiaoping Zho

Dean M. Hashimoto

No abstract provided.

Eyes Wide Shut: Erasing Women's Experience, From The Clinic To The Courtroom, Marybeth Herald, Ellen Waldman

Marybeth Herald

n his decade long exploration of female sexuality, Sigmund Freud professed to be on a mission to answer the elusive question, what do women want. Unfortunately, the 19th century psychiatrist was unable to separate that question from the one he ultimately answered, What do men want women to want? In some sense, Freud's inquiries provide an apt metaphor for the medical professions' stance toward female experience. When confronted with the difference presented by the female body as well as women's unique life experience, the medical field has responded with approaches that range from bemusement to hostility to intense indifference.

Although …

Life And Death Decision-Making: Judges V. Legislators As Sources Of Law In Bioethics, Charles Baron

Charles H. Baron

In some situations, courts may be better sources of new law than legislatures. Some support for this proposition is provided by the performance of American courts in the development of law regarding the “right to die.” When confronted with the problems presented by mid-Twentieth Century technological advances in prolonging human life, American legislators were slow to act. It was the state common law courts, beginning with Quinlan in 1976, that took primary responsibility for gradually crafting new legal principles that excepted withdrawal of life-prolonging treatment from the application of general laws dealing with homicide and suicide. These courts, like the …

The Proposed Patients' Bill Of Rights: The Case Of The Missing Equal Protection Clause, Dean Hashimoto

Dean M. Hashimoto

Congress is considering passing a patients' bill of rights. The proposed reform provides for appeals of disagreements between managed care organizations and patients over treatment decisions and also ensures access to specialists and emergency rooms. These reforms place a heavy emphasis on regulating managed care groups by assigning due process rights to patients of privately funded health plans. This article offers a vision of an alternative reform based on principles of both equality and due process. Empirical research demonstrates that although managed care systems appear to provide roughly adequate health care for the general public, they may not be providing …

A Model State Act To Authorize And Regulate Physician-Assisted Suicide, Charles Baron, Clyde Bergstresser, Dan Brock, Garrick Cole, Nancy Dorfman, Judith Johnson, Lowell Schnipper, James Vorenberg, Sidney Wanzer

Charles H. Baron

Despite laws in many states prohibiting assisted suicide, an unknown but significant number of people each year commit suicide with the aid of a physician. In recent years, the phenomenon of physician-assisted suicide has attracted greater attention as physicians have openly risked prosecution to shed light on the subject, advocates have raised a series of legal challenges to laws banning assisted suicide, and a federal judge has struck down the nation's first statute allowing physicians to assist patients in suicide. In this Article, nine authors from the fields of law, medicine, philosophy and economics propose a comprehensive statute to permit …

Fetal Research: The Question In The States, Charles Baron

Charles H. Baron

This article is based on a paper delivered at the Third National Symposium on Genetics and the Law in Boston, April 1984.

The Concept Of Person In The Law, Charles Baron

Charles H. Baron

The focus of the abortion debate in the United States tends to be on whether and at what stage a fetus is a person. I believe this tendency has been unfortunate and counterproductive. Instead of advancing dialogue between opposing sides, such a focus seems to have stunted it, leaving advocates in the sort of “I did not!” – “You did too!” impasse we remember from childhood. Also reminiscent of that childhood scene has been the vain attempt to break the impasse by appeal to a higher authority. Thus, the pro-choice forces hoped they had proved the pro-life forces “wrong” by …

Licensure Of Health Care Professionals: The Consumer's Case For Abolition, Charles Baron

Charles H. Baron

While state medical licensure laws ostensibly are intended to promote worthwhile goals, such as the maintenance of high standards in health care delivery, this Article argues that these laws in practice are detrimental to consumers. The Article takes the position that licensure contributes to high medical care costs and stifles competition, innovation and consumer autonomy. It concludes that delicensure would expand the range of health services available to consumers and reduce patient dependency, and that these developments would tend to make medical practice more satisfying to consumers and providers of health care services.