Asunto(s)
Servicios Médicos de Urgencia , Testimonio de Experto , Testimonio de Experto/ética , Testimonio de Experto/legislación & jurisprudencia , Humanos , Servicios Médicos de Urgencia/ética , Servicios Médicos de Urgencia/legislación & jurisprudencia , Servicios Médicos de Urgencia/normas , Estados Unidos , Mala Praxis/legislación & jurisprudenciaAsunto(s)
Toma de Decisiones Clínicas/ética , Pólipos del Colon/patología , Neoplasias Colorrectales/diagnóstico , Algoritmos , Colectomía/ética , Colectomía/métodos , Pólipos del Colon/cirugía , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Manejo de la Enfermedad , Resección Endoscópica de la Mucosa/ética , Resección Endoscópica de la Mucosa/métodos , Testimonio de Experto/ética , Humanos , Comunicación Interdisciplinaria , Márgenes de Escisión , Medición de Riesgo , Espera Vigilante/ética , Espera Vigilante/métodosRESUMEN
OBJECTIVE: To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. DESIGN: Systematic review. ELIGIBILITY CRITERIA: Studies that compared the association between conflicts of interest and favourable recommendations of drugs or devices (eg, recommending a drug) in clinical guidelines, advisory committee reports, opinion pieces (eg, editorials), or narrative reviews. DATA SOURCES: PubMed, Embase, Cochrane Methodology Register (from inception to February 2020), reference lists, Web of Science, and grey literature. DATA EXTRACTION AND ANALYSIS: Two authors independently extracted data and assessed the methodological quality of the studies. Pooled relative risks and 95% confidence intervals were estimated using random effects models (relative risk >1 indicates that documents with conflicts of interest more often had favourable recommendations than documents with no conflicts of interest). Financial and non-financial conflicts of interest were analysed separately, and the four types of documents were analysed separately (preplanned) and combined (post hoc). RESULTS: 21 studies that analysed 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews were included. Unpublished data were received for 11 studies (eight full datasets and three summary datasets). 15 studies showed risk of confounding because the compared documents could differ in factors other than conflicts of interest (eg, different drugs used for different populations). The relative risk for associations between financial conflicts of interest and favourable recommendations for clinical guidelines was 1.26 (95% confidence interval 0.93 to 1.69; four studies of 86 clinical guidelines), for advisory committee reports was 1.20 (0.99 to 1.45; four studies of 629 advisory committee reports), for opinion pieces was 2.62 (0.91 to 7.55; four studies of 284 opinion pieces), and for narrative reviews was 1.20 (0.97 to 1.49; four studies of 457 narrative reviews). An analysis of all four types of documents combined supported these findings (1.26, 1.09 to 1.44). In one study that investigated specialty interests, the association between including radiologists as authors of guidelines and recommending routine breast cancer was: relative risk 2.10, 95% confidence interval 0.92 to 4.77; 12 clinical guidelines). CONCLUSIONS: We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. Limitations of this review were risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest influence recommendations. SYSTEMATIC REVIEW REGISTRATION: Cochrane Methodology Review Protocol MR000040.
Asunto(s)
Comités Consultivos/ética , Conflicto de Intereses , Testimonio de Experto/ética , Guías de Práctica Clínica como Asunto , Literatura de Revisión como Asunto , Sesgo , Conflicto de Intereses/economía , Humanos , Apoyo a la Investigación como Asunto/éticaAsunto(s)
Investigación Biomédica , Infecciones por Coronavirus , Testimonio de Experto , Pandemias , Neumonía Viral , Salud Pública , Betacoronavirus , Investigación Biomédica/ética , Investigación Biomédica/normas , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Medicina de Emergencia Basada en la Evidencia , Testimonio de Experto/ética , Testimonio de Experto/normas , Política de Salud , Humanos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Formulación de Políticas , Profesionalismo/normas , Salud Pública/ética , Salud Pública/métodos , Salud Pública/normas , SARS-CoV-2 , Responsabilidad SocialRESUMEN
Medico-legal psychiatry is the field of forensic psychiatry that consists of reporting to criminal, civil and administrative authorities and testifying in courts of law. As a forensic science, medico-legal psychiatry is based on the principle of impartiality. However, the notion of impartiality is not clearly defined and can be understood in many different ways. The purpose of this study was to explore the meaning that expert psychiatrists attribute to this notion. Members of the forensic sections of the World Psychiatric Association, the European Psychiatric Association and the American Academy of Psychiatry and the Law were surveyed by e-mail using a vignette and a questionnaire. One hundred and thirty-one responses were received. When commenting on the case presented in the vignette, a large majority of respondents considered that the personal moral convictions of the doctor were the main factor likely to cast doubt on the impartiality of the expert, followed by past personal experience and the fact that the expert was the treating doctor of the examinee. In the answers to the questionnaire, 54% of participants considered that the question of impartiality was similar in both the inquisitorial and adversarial systems. Impartiality was considered by most participants as both an ethical and a legal concept. The main factors considered as likely to affect the impartiality of an expert were past personal experience, personal beliefs and perceptions, and the fact that the expert was the treating doctor of the examinee. Training in forensic psychiatry and past professional experience were considered to be the most important factors that could enhance the impartiality of an expert. When asked about their own definition, 70% of respondents defined impartiality as a choice specific to the expert, and 27% of participants defined impartiality as a result of external factors. The term 'objectivity' was used in 30% of responses. Results revealed a rather unified view of the issue of impartiality by medico-legal psychiatrists, irrespective of their country and practice conditions. The notions of honesty and striving for objectivity, which are emphasized in several guidelines of forensic psychiatry associations, were cited by many participants. Impartiality appears to be considered as a coherent concept in both normative and consequentialist ethics and represents a useful reference in the practice of medico-legal psychiatry.
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Testimonio de Experto/ética , Psiquiatría Forense/ética , Adulto , Anciano , Anciano de 80 o más Años , Ética Médica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , ConfianzaRESUMEN
The goal of this paper is to discuss scientific integrity, consumerism, conflicts of interest, and transparency within the context of forensic science. Forensic scientists play crucial roles within the legal system and are constantly under various pressures when performing analytical work, generating reports based on their analyses, or testifying to the content of these reports. Maintaining the scientific integrity of these actions is paramount to supporting a functional legal system and the practice of good science. Our goal is to discuss the importance of scientific integrity as well as the factors it may compromise, so that forensic practitioners may be better equipped to recognize and avoid conflicts of interest when they arise. In this discussion we define terms, concepts, and professional relationships as well as present three case studies to contextualize these ideas.
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Conflicto de Intereses , Ética Profesional , Ciencias Forenses/ética , Ciencias Forenses/legislación & jurisprudencia , Ciencias Forenses/normas , Práctica Profesional/ética , Testimonio de Experto/ética , Guías como Asunto , HumanosRESUMEN
Any physician who has authored an Independent Medical Evaluation or medical record review can and should anticipate being called as an expert witness (EW). Litigants rely on EW testimony in most civil cases. The most common areas in which EWs participate and provide opinions and testimony are workers' compensation, personal injury, and medical malpractice. This report will become part of the discovery process, the process by which a party to a lawsuit can obtain information from another party or other entities involved in the lawsuit.
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Testimonio de Experto/legislación & jurisprudencia , Médicos/legislación & jurisprudencia , Conflicto de Intereses/legislación & jurisprudencia , Testimonio de Experto/ética , Humanos , Rol del Médico , Médicos/ética , Profesionalismo/legislación & jurisprudenciaRESUMEN
Expert witnesses have a special place in court, bringing their knowledge and skills in the form of opinion evidence to educate the court. This allows the fact-finder to make legal decisions more effectively. Although experts are often allowed a role in civil and criminal matters, this brings certain risks to the court process. Admissibility of expert witness testimony in Canada has generally paralleled American law, including the standards enunciated in Daubert v Merrell Dow Pharmaceutical, Inc. (1993). Recently, there has been a series of decisions in Canadian law that has focused on the role of the expert witness in the court. Although only having precedence in Canada, these cases highlight important legal principles that all expert witnesses must navigate, regardless of their jurisdiction. We review these significant cases to assist forensic psychiatrists in recognizing and professionally navigating potential pitfalls in giving expert opinions.
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Testimonio de Experto/legislación & jurisprudencia , Psiquiatría Forense/legislación & jurisprudencia , Rol Judicial , Sesgo , Canadá , Testimonio de Experto/ética , Testimonio de Experto/normas , Historia del Siglo XX , Humanos , Responsabilidad Legal/historiaAsunto(s)
Testimonio de Experto/legislación & jurisprudencia , Mala Praxis/legislación & jurisprudencia , Neonatólogos/ética , Neonatología/legislación & jurisprudencia , Actitud del Personal de Salud , Comprensión , Testimonio de Experto/ética , Humanos , Jurisprudencia , Neonatólogos/legislación & jurisprudencia , Estados UnidosRESUMEN
Ethics guidelines recommend that forensic mental health professionals begin in-person assessments by explaining the nature and purpose of the examination. To learn whether evaluees have understood and can give consent, forensic practitioners may ask evaluees to paraphrase the explanation. This article explores how a forensic evaluee's disclosure response (DR) reveals substantive information relevant to the purposes of a forensic examination. We examined archival data from 255 reports on competence to stand trial (CST) that a Midwest public sector hospital had previously submitted to courts. We classified each evaluee's DR at one of three levels: DR = yes (accurate paraphrasing), DR = no (inability to paraphrase or provide a relevant response), or DR = other (an intermediate level implying a less-than-accurate response). None of the 28 DR = no evaluees was CST, and only 7 (17%) of the 48 DR = other evaluees were CST. Thus, a CST evaluee who cannot paraphrase an examiner's explanation is likely to be incompetent to stand trial, and an examiner would need to adduce a strong argument to support any opinion to the contrary.
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Criminales/psicología , Revelación/ética , Testimonio de Experto/ética , Psiquiatría Forense/ética , Competencia Mental/legislación & jurisprudencia , Derecho Penal/normas , Psicología Criminal/legislación & jurisprudencia , Revelación/legislación & jurisprudencia , Testimonio de Experto/legislación & jurisprudencia , Psiquiatría Forense/legislación & jurisprudencia , Humanos , Trastornos MentalesRESUMEN
Among the strengths of forensic psychiatry as a profession is its ability to support lively discussion of critical questions, such as how to characterize its own essence and whether it belongs to the practice of medicine. The American Academy of Psychiatry and the Law is fortunate that Michael Norko has taken the occasion of his presidential address to describe in depth the results of the advanced stage of his probing on a truly spiritual level the fundamental place of compassion in the practice of forensic psychiatry. In so doing, he casts inevitable light on the seamless connections binding forensic psychiatry and medicine, particularly the importance for both of practicing compassion in our search for truth.
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Derecho Penal/ética , Ética Profesional , Psiquiatría Forense/ética , Ética Médica , Testimonio de Experto/ética , Humanos , Revelación de la Verdad/éticaRESUMEN
Science and its practice always had a subtext, subject to influence by scientists', funders', and other innovation actors' values and assumptions. The recent emergence of post-truth, authoritarian and populist penchants, in both developed and developing countries, has further blurred the already fluid boundaries between material scientific facts and their social construction/shaping by scientific subtext, human values, powers, and hegemony. While there are certain checks, balances, and oversight mechanisms for publication ethics, other pillars of science communication, most notably, scientific conferences and their governance, are ill prepared for post-truth science. Worrisomely, the proliferation of spam conferences is a major cause for concern for integrative biology and postgenomic science. The current gaps in conference ethics are important beyond science communication because conferences help build legitimacy of emerging technologies and frontiers of science and, thus, bestows upon the organizers, funders, enlisted scientific advisors, speakers, among others, power, which in turn needs to be checked. Denis Diderot (1713-1784), a prominent intellectual during the Enlightenment period, has aptly observed that the very act of organizing brings about power, influence, and control. If the subtext of conference practices is left unchecked, it can pave the way for hegemony, and yet more volatile and violent authoritarian governance systems in science and society. This begs for innovative solutions to increase accountability, resilience, and capacity of technology experts and scientists to discern and decode the subtext in science and its communication in the current post-truth world. We propose that the existing undergraduate and graduate programs in life and physical sciences and medicine could be redesigned to include a rotation for exposure to and training in political science. Such innovative PhD+ programs straddling technical and political science scholarship would best equip future students and citizens to grasp and respond to subtext and embedded opaque value and power systems in scientific practices in an increasingly post-truth world. Political science scholarship unpacks the inner workings, subtext, and power dynamics in science and society. Thus, knowledge of political science competency is akin to molecular biology in life sciences. Both make the invisible (e.g., cell biology versus subtext of knowledge) visible. The ability to read subtext in science and claims of post-truth knowledge is a new and essential form of societal literacy in 21st century science and integrative biology.
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Congresos como Asunto/ética , Ciencia/ética , Educación/tendencias , Testimonio de Experto/ética , Humanos , Invenciones/éticaRESUMEN
People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.