A legal perspective on athlete screening and disqualification.

Physicians participate in the screening, routine medical supervision, and disqualification of student-athletes. In doing so, they should understand that eligibility/disqualification decisions inevitably have associated liability issues. It is the responsibility of physicians to take the lead role in the student-athlete medical assessment process to allow for optimum safety in sports programmes. The first duty of the physician is to protect the health and well-being of the student-athlete. However, because there is potential liability associated with the screening/disqualification process, physicians are wise to develop sound and reasonable strategies that are in strict compliance with the standard of care. This article focusses on cardiac screening and disqualification for participation in sports.

Consent and privacy in pharmacogenetic testing.

The clinical use of pharmacogenetic drugs will require that a sample of a patient's DNA be tested before a drug is prescribed. Although pharmacogenetic tests pose fewer risks than genetic tests for disease mutations, they might still reveal personal information that could be used adversely to a patient's interests. Informed consent and privacy of pharmacogenetic test results may be essential in most clinical uses of pharmacogenetic drugs.

Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach.

Traffic accidents involving children and adolescents present complex challenges from both the medico-legal and orthopedic standpoints. Despite the implementation of road traffic safety laws, pediatric road traffic injuries continue to be a significant contributor to mortality rates, physical harm, and hospitalization on a global scale. For children and young people, automobile accidents are considered to be the primary culprit of mortality in developed nations. Even in highly developed nations, trauma is a significant factor in infant mortality. Each age category, from childhood to young adulthood, has its fracture patterns, as their skeletons are considerably different from those of adults. The consequences of traffic accidents extend beyond the immediate physical trauma. The medico-legal aspects surrounding these incidents add another layer of complexity, as legal repercussions may affect the responsible adult or parent, particularly in cases involving child fatalities. To effectively address traffic accidents in children and adolescents, a comprehensive approach is necessary. This approach should involve not only medical professionals but also legal experts and policymakers. Collaboration between orthopedic specialists, medico-legal professionals, law enforcement agencies, and relevant government bodies can facilitate the development and implementation of strategies aimed at prevention, education, the enforcement of traffic laws, and improved infrastructure. By addressing both the medical and legal aspects, it is possible to enhance road safety for children and adolescents, reducing the incidence of injuries and their associated long-term consequences. In this review, we aimed to summarize traffic accidents in children and adolescents from a complex orthopedic and medico-legal approach.

Current Epidemiological Trends of Pediatric Traffic Accidents at a Romanian Clinical Hospital.

BACKGROUND: Pediatric road traffic accidents (RTAs) have a substantial impact on the worldwide youth population, resulting in a considerable burden of disability. According to the World Health Organization's (WHO) Global Status Report on Road Safety, around 1.35 million children die each year in RTAs around the world, having a big effect on health and financial costs. Today's high-income countries like the Netherlands have experienced a decrease in the incidence of fatal traffic accidents (TAs) in children compared to countries with higher-than-average scores, including Romania, where roughly one out of every two minor deaths was a pedestrian; however, there is a lack of comprehensive and up-to-date epidemiological data on non-fatal TAs regarding pediatric patients. The objective of this study is to perform a thorough examination of the epidemiological aspects of Tas in pediatric patients admitted to the Emergency Department (ED) of "St. Mary's" Emergency Clinical Hospital for Children in Iasi, Romania. MATERIALS AND METHODS: A descriptive retrospective research study was conducted at the "St. Mary's" Emergency Clinical Hospital for Children in Iasi, Romania, from January 2015 to December 2022. The research population includes all pediatric trauma patients that were between the age range of 1 month and 18 years who were treated by the trauma department. A total of 358 cases met the inclusion criteria and fulfilled fulfilled fulfilled. Data concerning variables such as accident incidents, types of injuries, and length of hospitalization have been gathered. RESULTS: The average age of the patients was 11.43 ± 4.07 years, with patients of both sexes, the representation of the male sex being 78.5%. The incidence occurred during the summer, representing 15.3% in June. Of the patients admitted to the ED, 55.5% (n = 196) did not require surgery. Most of the patients spent from a minimum of one day to a maximum of 28 days in the hospital, with an average of 8.50 hospital days. The most common injuries were fractures (n = 221), and the most frequent anatomical region affected was the upper limbs (n = 55.2%). CONCLUSION: While the literature on fatal TA cases shows a declining trend, there is a lack of up-to-date information on non-fatal TAs involving children. The results of our study suggest that there is a high incidence of pediatric TAs due to the scale of "St. Mary's" Emergency Clinical Hospital for Children, from Iasi, which provides medical services to a considerable number of patients coming from both rural and urban areas of the seven counties of Moldova region, in Romania.

Children by choice: reproductive technologies and the boundaries of personal autonomy.

Unlike other countries that regulate assisted reproduction, the US has largely left this field to the domain of professional self-regulation and market preferences. The reason lies both in the confused jurisprudence of reproductive liberty and the paralysing effect of the abortion debate on US politics. The debate surrounding cloning, however, has galvanized both activists and the government to revisit the question of regulation, and recent cases in the US Supreme Court suggest that if the political will to regulate this field is found, governmental authority to intervene in areas such as pre-implantation diagnosis, gamete donation and surrogacy might well be upheld, even in the face of constitutional challenges.

Legal issues in genomic medicine.

Society has entered uncharted territory regarding how, when and where genetic information can be used. This article discusses the major issues raised by increased access to genomic information, which will ultimately be resolved by legislation or the courts.

Changes in abortions and births and the Texas parental notification law.

BACKGROUND: On January 1, 2000, Texas began enforcement of a law that requires physicians to notify a parent of a minor child seeking an abortion at least 48 hours before the procedure. METHODS: We assessed changes in the rates in Texas of abortions and births (events per 1000 age-specific population) before enforcement of the parental notification law (1998 to 1999) and after enforcement (2000 to 2002). We did this by comparing the rate changes among minors 15 to 17 years of age at the time of conception (i.e., those who were subject to the law) with those of teens 18 years of age at the time of conception (i.e., those who were not subject to the law). RESULTS: After enforcement of the law, abortion rates fell by 11 percent among 15-year-olds (rate ratio, 0.89; 95 percent confidence interval, 0.83 to 0.94), 20 percent among 16-year-olds (rate ratio, 0.80; 95 percent confidence interval, 0.76 to 0.85), and 16 percent among 17-year-olds (rate ratio 0.84; 95 percent confidence interval, 0.80 to 0.87), relative to the rates among 18-year-olds. Among the subgroup of minors 17.50 to 17.74 years of age at the time of conception (who would have been subject to the parental notification law in early pregnancy), birth rates rose by 4 percent relative to those of teens 18.00 to 18.24 years of age (rate ratio, 1.04; 95 percent confidence interval, 1.00 to 1.08). The adjusted odds ratio for having an abortion after 12 weeks' gestation among minors 17.50 to 17.74 years of age as compared with 18-year-olds was 1.34 (95 percent confidence interval, 1.10 to 1.62). CONCLUSIONS: The Texas parental notification law was associated with a decline in abortion rates among minors from 15 to 17 years of age. It was also associated with increased birth rates and rates of abortion during the second trimester among a subgroup of minors who were 17.50 to 17.74 years of age at the time of conception.

Genetic testing. Families sue hospital, scientist for control of Canavan gene.

A successful partnership between parents and a scientist to combat a deadly genetic disease has dissolved into a bitter legal battle over the commercial tests used to identify people with dangerous mutations in their genes. The lawsuit, filed on 30 October in Chicago federal court, is the latest dispute in the growing controversy over who controls and who benefits from human genetics research.

Two fertilized eggs stir global furor.

KIE: An Australian case involving a wealthy couple, Mario and Elsa Rios, who died without arranging for the disposition of two of the woman's fertilized ova in frozen storage has renewed debate over the legal and moral aspects of in vitro fertilization. Experts doubt that the zygotes are still viable, but questions have been raised about their legal status, their inheritance rights, and the possibility of implanting them in the womb of a surrogate mother. Disposition of unused fertilized eggs in the United States is currently governed by informal guidelines, although a public consensus on the issues raised by new and future reproductive technologies has not been attained.^ieng

Federal court strikes down Baby Doe rules.

KIE: As the result of a suit brought by the American Medical Association and five other medical organizations, a federal district court judge has struck down the February 1984 version of the Department of Health and Human Services' "Baby Doe" regulations. It was the second time a court had denied the government's claim that federal statutes forbidding discrimination against the handicapped give it the authority to intervene in treatment decisions concerning handicapped newborns. At the time of the ruling, no complaints about the care of any infant had been handled by DHHS under the provisions of this latest set of regulations.^ieng

"Baby Doe" squad adviser says HHS was insensitive.

KIE: The Department of Health and Human Services has been accused of "insensitive and arbitrary" behavior while investigating a possible violation of its "Baby Doe" regulations by a Rochester, N.Y., hospital. Dr. Frederick Wirth, a Virginia neonatologist who had agreed to advise DHHS teams on the care of handicapped newborns, was sent to Rochester without special authority to review patients' records in New York. DHHS personnel were already at the hospital, examining medical records without permission of the parents. Wirth left, and later told Science that DHHS had exposed him to legal action and violated patient privacy rights.^ieng

FDA draws criticism on prenatal test.

KIE: A report is provided on the controversial decision by the Food and Drug Administration on 17 June to approve the wider use of diagnostic kits for the detection of fetal neural tube defects. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics are among the critics who favor tighter restrictions on use of the kits, which measure levels of alpha-fetoprotein in serum samples taken from expectant mothers, on the grounds that false positive results are common, necessitating careful quality control monitoring of physicians, manufacturers, and laboratories performing the test.^ieng

"Baby Doe" regs thrown out by court.

KIE: On April 14, 1983, federal district court judge Gerhard Gesell overturned, as "arbitrary and capricious," a Department of Health and Human Services regulation that required hospitals to post notices concerning the illegality of denying life-saving care to handicapped infants and encouraged anyone with knowledge of such a case to report it to HHS via a telephone hotline. This article reviews the evolution and implementation of the HHS regulation, the legal challenge to it, and the judge's ruling.^ieng

Biotechnology as an intellectual property.

Recent advances in biotechnology have created many public policy and legal issues, one of the most significant of which is the treatment of biotechnological industrial products, particularly under the patent system. Patents represent one of several types of intellectual property; their ownership confers the right to exclude others from benefitting from the tangible products of a proprietary subject matter. Intellectual property law and its protections will play a major role in the rate at which biotechnology develops in the United States. In this article biotechnological intellectual property issues are reviewed in the context of their underlying legal requirements. The implications of other factors, such as international competition, research funding, and gene ownership, are also considered.

KIE: Legal ownership of industrial products of biomedical research is discussed as a question of intellectual property rights. Attention is focused on the major role played by the U.S. patent system in establishing such rights, as illustrated by the case of products of recombinant DNA research. Trade secret, copyright, and trademark protections are also considered, as are policy issues such as international competition in the development of biomedical technologies and financing arrangements.

Larger public sector role sought on biotech.

KIE: Increasing opposition to field tests of genetically altered organisms is causing the biotechnology industry to look to some form of government regulation as a way to calm the public's fears. Industry leaders are concerned that future developments will be subject to costly legal delays unless an efficient regulatory system is in place, although neither the federal government nor industry has been able to determine what standards are needed or what classes of products should be regulated. The two biotechnology trade associations have begun to work on their positions, regulatory legislation has been introduced in Congress, and the roles of the Environmental Protection Agency and the Department of Agriculture are about to be defined. There is a divergence of opinion about federally-supported intermediate test facilities, which some industry spokesmen believe would be unnecessary.^ieng

Organ shortage clouds new transplant era.

KIE: Technical advances and new drugs that prevent rejection of transplanted tissue are revolutionizing organ transplantation, but the current shortage of donated organs is expected to worsen. The reasons for this shortage and possible solutions to the problem are discussed briefly, and the ethical and legal implications of salvaging organs from brain-dead patients are mentioned. Presumed consent laws, already in force in several European countries, would drastically increase the number of available organs, but American ethicists are divided over a policy permitting automatic use of organs unless a person has left explicit instructions to the contrary.^ieng

Public health. Surveillance and privacy.

Surveillance is the radar of public health. It has provided the foundation for public health planning, intervention, and prevention. Important ethical issues regarding privacy--the extent to which name-based reporting violates the trust and assumptions made about how personal medical information will be treated--are raised by public health surveillance. This policy forum looks at the contexts of differing responses from the public health communities and general public to surveillance efforts.

Laboratory animals. Researchers pained by effort to define distress precisely.

The U.S. Department of Agriculture requested comments earlier this year to help it decide whether to adopt a formal definition of "distress" as part of its responsibilities under the Animal Welfare Act. But the 2600 pieces of advice it received during a 4-month period that ended earlier this month suggest that its job won't be easy. The comments highlight a deep split between animal activists, who see the potential new regulations as a step toward eliminating all painful procedures, and most researchers, who say that the present system is working well and that no major changes are needed.

Legal rights and duties in the AIDS epidemic.

This article provides an overview of some major areas of legal concern in which the AIDS epidemic is having an impact. The rights of infected individuals to testing, treatment, and confidentiality are reviewed, and emphasis is given to their claims to nondiscrimination regarding access to health care, employment, housing, education, insurance, and related interests. Infected persons' duties to contain transmission of AIDS are outlined under principles of criminal and civil law, including liability for provision of contaminated blood products. Uninfected people's general rights to protection are considered, and health professionals' and authorities' rights and duties are given more detailed attention. In conclusion, some legal developments outside the United States are reviewed.

Cell biology. Stem cell scorecard.

As researchers continue to explore the potential uses of stem cells obtained from a variety of sources (see main text), governments around the world are grappling with whether to allow research on stem cells derived from human embryos. Governments are cautious yet increasingly open to the new research, which may eventually yield treatments for a variety of diseases from Parkinson's to diabetes.