Although medicolegal challenges to the use of neurologic criteria to declare death in the USA have been well-described, the management of court cases in the United Kingdom about objections to the use of neurologic criteria to declare death has not been explored in the bioethics or medical literature. This article (1) reviews conceptual, medical and legal differences between death by neurologic criteria (DNC) in the United Kingdom and the rest of the world to contextualize medicolegal challenges to DNC; (...) (2) summarizes highly publicized legal cases related to DNC in the United Kingdom, including the nuanced 2022 case of Archie Battersbee, who was transiently considered dead by neurologic criteria, but ultimately determined to be in a vegetative state/unresponsive-wakeful state; and (3) provides an overview of ethical issues raised by medicolegal challenges to DNC in the United Kingdom and a comparison to the management of these challenges in the USA. (shrink)

Ariane Lewis reviewed medicolegal challenges to Death by Neurologic Criteria (DNC) in the United Kingdom in order to identify and discuss the ethical issues raised (Lewis 2024). Here I briefly clar...

The relation between moral philosophy and moral practice is itself philosophically controversial. nor is there any one determinate formula through which to express the relations between the basic principles of morality and of rationality itself. the concepts of the moral and the political are both 'essentially contestable' and so too is the nature of their relations; that is, their analysis is itself of moral and political import. nevertheless, in periods of overall stability, this contestability may hardly be apparent. all this, (...) and its connection with philosophy's fundamental commitment to questioning and self-awareness has a deep significance for moral (and political) education. (shrink)

In _Bioethics in Context_, Gary Jones and Joseph DeMarco connect ethical theory, medicine, and the law, guiding readers toward a practical and legally grounded understanding of key issues in health-care ethics. This book is uniquely up-to-date in its discussion of health-care law and unpacks the complex web of American policies, including the Patient Protection and Affordable Care Act. Useful case studies and examples are embedded throughout, and a companion website offers a thorough, curated database of relevant legal precedents as (...) well as additional case studies and other resources. (shrink)

In 2014, the American Academy of Pediatrics published its policy statement on contraception for adolescents, which provides, in effect, a mandate to temporarily sterilize all adolescents with long-acting reversible contraceptives for five to ten years. The author reviews the AAP guidelines and their effects on Catholic adolescents, their families, and adolescent health care providers. He then discusses medicolegal issues raised by the policy, outlines Catholic strategies for combating it, and proposes a diocese-based physician-led program for teaching and counseling (...) elementary and high school students. (shrink)

The Italian parliament passed the law on assisted reproduction after a heated debate. The promulgation of this law (Law 40/2004) is the end point of a long and troubled journey that has seen many bills come and go, all of which have failed. The law consists of a whole set of regulations that will have a great impact on health and on society in general. The law is against many of the technical practices of assisted reproduction; several such practices are (...) banned. This paper outlines ethical and medicolegal issues arising in connection with the law. The law states that no more than three embryos must be created at any one time and all the embryos created must be transferred together even if the couple does not need all the embryos. Embryo cryopreservation is also forbidden, as is assisted reproductive technology (ART), which uses a third party in any way, and the screening of embryos for genetic defects. (shrink)

The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. This is an authoritative and much-needed introduction to and defence of the concept of reproductive health, which though internationally endorsed, is still contested. The authors are leading authorities on reproductive medicine, women's health, human rights, medical law, and bioethics. They integrate their disciplines to provide an accessible but comprehensive picture. They analyse 15 cases from different countries (...) and cultures, and explore options for resolution. The aim is to equip readers to fashion solutions in their own health care circumstances, compatibly with ethical, legal and human rights principles. (shrink)

George Annas serves a critical function as an incisive commentator on the interactions between law and medicine and law and public health. Along with Alex Capron, Dena Davis, Rebecca Dresser, and Larry GostinProfessor Annas analyses legal aspects of a spectrum of medicolegal issues both in a forum and in a manner that makes them accessible and understandable to a broad community of healthcare providers. His latest book, SomeChoice, continues that valuable tradition. The bulk of the volume (17 out (...) of 22 chapters) is drawn from essays originally published as the feature of the NewEnglandJournalofMedicine. The topics include such staples of patients' rights debate as the boundaries of informed consent, authorization of medical experiments, and physician-assisted suicide. A treat is the inclusion of less frequently covered issues, such as access to health information concerning presidential candidates and constitutional bounds of limits on cigarette advertising. (shrink)

George Annas serves a critical function as an incisive commentator on the interactions between law and medicine and law and public health. Along with Alex Capron, Dena Davis, Rebecca Dresser, and Larry Gostin—to pinpoint a few—Professor Annas analyses legal aspects of a spectrum of medicolegal issues both in a forum and in a manner that makes them accessible and understandable to a broad community of healthcare providers. His latest book, Some Choice, continues that valuable tradition. The bulk of (...) the volume is drawn from essays originally published as the “Legal Issues in Medicine” feature of the New England Journal of Medicine. The topics include such staples of patients' rights debate as the boundaries of informed consent, authorization of medical experiments, and physician-assisted suicide. A treat is the inclusion of less frequently covered issues, such as access to health information concerning presidential candidates and constitutional bounds of limits on cigarette advertising. (shrink)

In a special issue of this journal, a range of authors addressed the critical problem of difference in bioethics. To what extent do class, culture, ethnicity, and race affect the ethical decisions that patients and professionals must make in a medical context? Those arguing for an understanding of cultural influences in bioethical decisionmakingtypically argue from the perspective of individual case studies to demonstrate the importance of these social constructs. Others, like Erika Blacksher, however, worry that this approach will obscure the (...) uniqueness of individual decisionmakng patterns, allowing all persons of a single group to be aggregated as if their class, cultural construct, or religious affiliation were the single motive element in their medicolegal decisionmaking. There is, she cautions, a risk of misuse if a professional care provider reflexively assumes individual patient or surrogate reactions on the basis of ethnicity or culture. (shrink)

Background In an increasingly globalized world, legal protocols related to health care that are both effective and culturally sensitive are paramount in providing excellent quality of care as well as protection for physicians tasked with decision making. Here, we analyze the current medicolegal status of brain death diagnosis with regard to end-of-life care in Japan, China, and South Korea from the perspectives of front-line health care workers. Main body Japan has legally wrestled with the concept of brain death for (...) decades. An inability to declare brain death without consent from family coupled with cultural expectations of family involvement in medical care is mirrored in other Confucian-based cultures and may complicate care for patients from these countries when traveling or working overseas. Within Japan, China, and South Korea, medicolegal shortcomings in the diagnosis of brain death act as a great source of stress for physicians and expose them to potential public and legal scorn. Here, we detail the medicolegal status of brain death diagnosis within Japan and compare it to China and South Korea to find common ground and elucidate the impact of legal ambiguity on health care workers. Conclusion The Confucian cultural foundation of multiple Asian countries raises common issues of family involvement with diagnosis and cultural considerations that must be met. Leveraging public education systems may increase awareness of brain death issues and lead to evolving laws that clarify such end-of-life issues while protecting physicians from sociocultural backlash. (shrink)

As clinicians, this case1 raises both personal and professional challenges. A key issue is who carries legal parental responsibility for the difficult decisions that may be required around life-sustaining care in baby T. Medicolegally, we understand that the surrogate mother holds legal parental responsibility for baby T until this can be transferred to the intended parents.2 But this process can take many months to complete, after the birth of baby. As M is now critically ill and unable to engage in (...) any discussion around the care of her baby, who becomes the legal guardian of the baby, for complex decision making that involves either reorientation of care away from intensive care with the inevitable consequence of death in this extremely premature baby, or continuing this life-sustaining treatment with a high likelihood for major neonatal morbidity and longer term disability? Does it pass onto one of the IPs as the genetic father, or does this responsibility fall on the neonatal consultant managing the baby in intensive care? And if an antenatal surrogacy agreement had existed, is it legally binding for inclusion of the IPs perspectives in the decision-making, especially if our medical decision making turns out to be at discord with the beliefs and wishes of the IPs for baby T? Box 1 ### Current surrogacy proceedings in the UK.2 6–8 The Law Commission UK5 is currently reviewing the decision on whether legal parenthood to intended parents can be effected immediately at the time of birth of the baby. Parental orders. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Basic Resources in Bioethics*Mary Carrington Coutts (bio)OrganizationsKennedy Institute of Ethics Georgetown University Washington, DC 20057 National Reference Center for Bioethics Literature 800-MED-ETHX or 202-687-3885The Hastings Center 255 Elm Road Briarcliff Manor, NY 10510 914-762-8500Society for Health and Human Values 6728 Old McLean Village Drive McLean, VA 22101 703-556-9222NOTE: There are numerous organizations in the United States and abroad that deal with bioethical issues. For a more comprehensive listing (...) of those organizations, see:American Hospital Association. Directory of Biomedical Ethics Organizations. Chicago: American Hospital Association, 1989.National Reference Center for Bioethics Literature. International Directory of Bioethics Organizations edited by Robert Iosco. Washington, DC: Georgetown University, 1986.Encyclopedia and DictionaryDictionary of Medical Ethics. Edited by A.S. Duncan, G.R. Dunstan, and R.B. Welborn. New rev. ed. New York: Crossroad, 1981. [End Page 75]Encyclopedia of Bioethics. Edited by Warren T. Reich. 4 vols. New York: Macmillan-Free Press, 1978; or 1982 reprint in 2 volumes available to members of the Kennedy Institute of Ethics through the membership office, 202-687-8099.Online DatabaseBioethicsline. Produced by the Kennedy Institute of Ethics for the National Library of Medicine. Searchable through the MEDLARS system. Focuses on questions of ethics and public policy in the fields of health care and biomedical research. Searches available upon request to the National Reference Center for Bioethics Literature. For information on securing a personal access code from the National Library of Medicine, call 800-638-8480.BibliographiesBibliography of Bioethics. Edited by LeRoy Walters and Tamar Joy Kahn. Washington, DC: Kennedy Institute of Ethics, Georgetown University. Issued annually since 1975. Corresponds to the BIOETHICSLINE database. Provides references to resources on ethical and public policy issues in medicine and biomedical research. Includes abstracts; arranged by broad subject categories.Ethics in Nursing. Edited by Terry Pence. 2nd ed. New York: National League for Nursing, 1986. An annotated bibliography of nursing ethics. Includes author and subject indexes.Goldstein, Doris M. Bioethics: A Guide to Information Sources. Detroit: Gale Research, 1982. A selected, annotated bibliography to the literature of bioethics.The Hastings Center's Bibliography of Ethics, Biomedicine and Professional Responsibility. Compiled by the staff of the Hastings Center. Frederick, MD: University Publications of America, 1984.Medical Ethics: An Annotated Bibliography. Edited by Mark Siegler, Peter A. Singer and David L. Schiedermayer. Philadelphia: American College of Physicians, 1988.Current Awareness ServicesNOTE: Several journals have sections where they highlight new publications. See, for example, the "In The Literature" section of the Hastings Center Report, or the "Medicolegal Reference Shelf" section of Law, Medicine and Health Care. Other services include:BioLaw. Edited by James F. Childress and Ruth D. Gaare. Frederick, MD: [End Page 76] University Publications of America, 1983 to present. Annual with bimonthly updates. (Previous title: Bioethics Reporter.) A compendium of articles and legal documents on ethical and legal issues in medicine, health care administration and human experimentation. Includes the text of important legal decisions in the Resources section.New Titles in Bioethics. Edited by Luanda Fitch Huttlinger. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. Published monthly 1975-1989; quarterly 1990—present. List of acquisitions by the National Reference Center for Bioethics Literature. Organized by subject categories. Includes ordering information for difficult-to-find items. Annual cumulation available.Scope Notes Series. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. A series of issue briefs including annotated bibliographies on the following popular bioethical topics:No 1. Dangerousness, September 1982, 5 p.No 2. Living Wills and Durable Powers of Attorney: Advance Directive Legislation and Issues, Revised February 1990, 15 p.No 3. Ethics Committees in Hospitals, Revised June 1989, 12 p.No 4. Diagnosis Related Groups and the Prospective Payment System, June 1984, 11 p.No 5. Baby Fae, January 1985, 19 p.No 6. Surrogate Mothers, Revised January 1988, 12 p.No 7. Withholding or Withdrawing Nutrition or Hydration, Revised September 1988, 12 p.No 8. AIDS: Law, Ethics and Public Policy, April 1988, 12 p.No 9. Bioethics Audiovisuals 1982 to Present, September 1988, 12 p.No 10. Ethical Issues in... (shrink)

Oleoresin capsicum (OC) is a substance contained in capsicum peppers that produces a range of physiological responses in mammals, including inflammation and respiratory constriction. It is also the active ingredient in the most widely used chemical munition in the United States. OC-based pepper sprays are now issued to police officers by nearly every law enforcement agency in the country. Police use of pepper spray is supported by an ostensibly evidence-based consensus that OC exposure presents no significant risk of lethal injury. (...) This essay examines the peculiar durability of that nonlethality consensus in the face of mounting contradictory evidence. It traces the trajectory of European science that links race and capsaicin sensitivity from colonization to slavery to the twentieth century, while also narrating the emergence of OC-based pepper spray as a distinct and highly desirable category of police weapon. It concludes by exposing medicolegal death examination practices that continually rehabilitate the nonlethality consensus by naturalizing deaths caused by or linked to OC exposure. (shrink)

As guidelines for neonatal resuscitation evolve from a growing evidence base, clinicians must ensure that practice is closely aligned with the available evidence, based on methodologically sound and ethically conducted research. This paper reviews ethical, legal and risk-management issues arising during the design of a quality-assurance project to make video recordings of neonatal resuscitations after high-risk deliveries. The issues, which affect patients, researchers, staff and the hospital at large, include the following: 1) Informed consent for research involving emergency (...) procedures is often not possible, for lack of time to provide sufficient information. The mental capacity of the subject or parent may be compromised by the impending emergency, and freedom of choice is threatened by the time pressure to consent. 2) Video recording of the inevitable medical errors raises issues of whether participating staff may be identifiable and accountable, affecting their willingness to participate in such research. The approach to staff participation and identification is reviewed. 3) The use of video data for education threatens the privacy of research subjects. The ethics of maintaining privacy is balanced with the ethics of using the data to improve practice of resuscitation. 4) The research subjects (patients, or the staff whose performance is being monitored) must be defined. 5) There are legal and ethical aspects of management and ownership of data. 6) The role of the Human Research Ethics Committee in protecting the research subject and possibly the medicolegal interests of the hospital is discussed. This paper reviews the literature and discusses the issues. (shrink)

Recently, there have been a number of lawsuits in the United States in which families objected to performance of apnoea testing for determination of brain death. The courts reached conflicting determinations in these cases. We discuss the medicolegal complications associated with apnoea testing that are highlighted by these cases and our position that the decision to perform apnoea testing should be made by clinicians, not families, judges, or juries.

sirAccording to the Swedish Immigration Board , about 26,500 people per year have applied for asylum in Sweden during the last decade. Experiences from Denmark show that up to 20% of those who seek asylum have been subjected to torture or severe ill-treatment in their home countries.1 Since 1992, most of these applicants have been examined at the Centre for Torture and Trauma survivors in Stockholm.2 The findings are described in medicolegal certificates submitted to the immigration authorities.The present study (...) was primarily aimed at analysing the relationship between the medicolegal certificates and the chances of obtaining asylum in 52 randomly selected CTD cases from the years 1994-96. The medicolegal certificates were classified according to extent of compatibility between testimony …. (shrink)

In “An Overview of Ethical Challenges Raised by Medicolegal Challenges to Death by Neurologic Criteria in the United Kingdom and a Comparison to Management of these Challenges in the USA,” Ariane L...

The problem of mental existence is a multidimensional subject that is related to many issues with its ontological and epistemological aspects. Both philosophers and theologians have addressed this problem from different perspectives and have discussed it among themselves. These discussions have produced some evidence and criticisms about mental existence in terms of acceptance and rejection. In these discussions, which are also associated with different issues, the use of information about maʿdūm, particularly as evidence of mental existence, also helped (...) pinpoint the source of the knowledge about maʿdūm. The fact that maʿdūm is the subject of knowledge is often a matter of consensus among theologians if some exceptions are disregarded. Particularly due to the extension of the subject of kalām to the known, it is a matter accepted by the scholars that maʿdūm can be known, whether it is mumkin (possible) or mumtani‘ (impossible). Therefore, the issue of where the information about it is located has emerged as an extension of the discussions on mental existence. In this context, in terms of epistemological theories they adopted, both theologians and philosophers have questioned the epistemological and ontological location of the knowledge of such concepts as ma'dūm, which hardly exist in the objective world but can be reasoned out or judged or imagined, and they have tried to determine the source of this knowledge. As a result of this effort, they have recognized that the source of knowledge about maʿdūm can be explained in two ways: the mind and outside world. In response to theologians, who claimed that the place of knowledge about maʿdūm is the mind, it has been claimed that the place of this knowledge is not the mind but the outside world. No consensus has been reached among those who claimed that the information was outside; some claimed that this information was in Plato's ideas, while others claimed that it was in the active mind. On the other hand, there has been no disagreement among those who considered the source of knowledge about maʿdūm as the mind. Based on this perspective, the present study tried to identify the source and place of information about maʿdūm, with a particular reference to the later kalām period, based on the evidence put forward to prove mental existence and the criticisms against such evidence. As a part of these discussions, the disputing parties were specified and the criticisms of the opponents towards each other were also included. This is because the nature of these criticisms is critical as such criticisms are capable of revealing the opinions of those who have opposing views about the source of knowledge of maʿdūm. The scope of the present study was limited to al-Rāzī and some later theologians as it was Fakhr al-Dīn al-Rāzī, who brought mental existence up for discussion as a specific point of debate. Therefore, in the present study, the famous theological texts that are highly representative of mental existence in the late kalām period and prominent commentaries written on these basic texts were preferred. (shrink)

In Sahan et al ’s article,1 they present the ethical challenges faced by clinical laboratory scientists in genetic medicine, including labour allocation and responsibility, interpretation and accuracy of results with new technologies, and the need for better standardisation and ethical consistency. At the same time, they also propose a potential solution to the aforementioned challenges: ethical preparedness(EP). Along with their vivid case discussions and insightful analysis, I would like to propose two more points that are worth further examination and discussion (...) to aid stakeholders in better comprehending the ethical issues that clinical laboratory scientists face in the practice of genetic medicine. The case 1 reported by Sahan et al raises concerns about who should be responsible for tracking families or individuals with genetic results, particularly in the absence of mainstream services to track future risks. However, this should not be a factor influencing the decision to inform gene carriers. If there is a clear division of responsibilities in current practice, clinical laboratory scientists can report detected gene carriers without psychological burden. However, the decision to report gene carriers should be based on who is being served when clinical laboratory scientists face genetic problems in clinical practice and who is being considered when …. (shrink)

As Vetter says, we are at the “beginning of the debate, not the end” (2015: 300) when it comes to evaluating her potentiality-based account of metaphysical modality. This paper contributes to this developing debate by highlighting three problems for Vetter’s account. Specifically, I begin (§1) by articulating some relevant details of Vetter’s potentiality-based view. This leads to the first issue (§2), concerning unclarity in the idea of degrees of potentiality. Similarly, the second issue (§3) raises trouble for Vetter’s proposed individuation (...) conditions for potentialities. Finally, the third issue (§4) is about apparently unmanifestable intrinsic potentialities, and suggests that there might be some deeper problems with anchoring metaphysical possibilities in concrete objects. More generally, though the issues detailed here are problematic, I do not take them to be fatal. However, they do show that, at minimum, further clarification of Vetter’s potentiality view is required. As Vetter says, we are at the “beginning of the debate, not the end” (2015: 300) when it comes to evaluating her potentiality-based account of metaphysical modality. This paper contributes to this developing debate by highlighting three problems for Vetter’s account. Specifically, I begin (§1) by articulating some relevant details of Vetter’s potentiality-based view. This leads to the first issue (§2), concerning unclarity in the idea of degrees of potentiality. Similarly, the second issue (§3) raises trouble for Vetter’s proposed individuation conditions for potentialities. Finally, the third issue (§4) is about apparently unmanifestable intrinsic potentialities, and suggests that there might be some deeper problems with anchoring metaphysical possibilities in concrete objects. More generally, though the issues detailed here are problematic, I do not take them to be fatal. However, they do show that, at minimum, further clarification of Vetter’s potentiality view is required. (shrink)