Guidelines for the ethical use of neuroimages in medical testimony: report of a multidisciplinary consensus conference.

SUMMARY: With rapid advances in neuroimaging technology, there is growing concern over potential misuse of neuroradiologic imaging data in legal matters. On December 7 and 8, 2012, a multidisciplinary consensus conference, Use and Abuse of Neuroimaging in the Courtroom, was held at Emory University in Atlanta, Georgia. Through this interactive forum, a highly select group of experts-including neuroradiologists, neurologists, forensic psychiatrists, neuropsychologists, neuroscientists, legal scholars, imaging statisticians, judges, practicing attorneys, and neuroethicists-discussed the complex issues involved in the use of neuroimaging data entered into legal evidence and for associated expert testimony. The specific contexts of criminal cases, child abuse, and head trauma were especially considered. The purpose of the conference was to inform the development of guidelines on expert testimony for the American Society of Neuroradiology and to provide principles for courts on the ethical use of neuroimaging data as evidence. This report summarizes the conference and resulting recommendations.

Qualitative outcome assessment of a medical ethics program for clinical clerkships: a pilot study.

This study assessed the usefulness of an open-ended case analysis test instrument for evaluating the effects of a 1-year ethics course on medical students' decision-making skills. Through case-oriented seminars in gynecology, internal medicine, obstetrics, pediatrics, psychiatry, and surgery, third-year medical students were taught a structured analytic framework for analyzing clinical ethical problems stressing the interactive relationships among medical indications, patient preferences, quality of life, and contextual (social, legal, economic) matters. At precourse, the students were given a test case and asked to provide a line of reasoning for their clinical decisions. At postcourse, the students were given the same case. Content analysis of pre- and postcourse responses of a random student sample revealed increases in student awareness in the following areas: 1) consideration of informed consent, 2) professional liability, 3) physician-assisted suicide, and 4) resource utilization. With some modifications, open-ended case analysis holds promise for evaluating medical ethics courses. The authors make recommendations for future research in evaluating the true impact of clinical ethics courses in medical education.

Changing attitudes about end-of-life decision making of medical students during third-year clinical clerkships.

To better define the learning objectives of ethics curricula and evaluate changes in medical students' attitudes about end-of-life decision making, enrolled students (N = 96) of a pilot medical ethics program were surveyed at the beginning and end of their third-year clinical clerkship about their experiences and attitudes about end-of-life decision making. At the end of their clinical clerkship year, the majority of students had participated in end-of-life decisions, prioritized patient autonomy and quality-of-life issues, were concerned about legal liability, were polarized over issues such as physician-assisted suicide, and gained confidence in their ethical decision-making ability. To train future physicians such that clinical practice is consistent with ethical guidelines and legislation on end-of-life care, medical ethics curricula should focus on symptom relief, clarification of legal issues, and resolution of conflicts between personal beliefs and public opinion about such issues as physician-assisted suicide. Appropriate role-modeling and mentoring by residents and attending physicians should also be emphasized.

Clinically significant abnormalities in postreduction radiographs after anterior shoulder dislocation.

STUDY OBJECTIVE: To determine the incidence of clinically significant fractures or other abnormalities seen on postreduction shoulder radiographs which were not seen on postreduction should radiographs which were not seen on the prereduction films obtained for anterior shoulder dislocations. METHODS: Retrospective chart review of 131 patients who presented with a total of 175 anterior shoulder dislocations to the emergency department of an urban, university-affiliated, Level 1 Trauma Center with an emergency medicine residency program. All patients had complete medical records, radiographs before and after reduction, and no fractures reported on the prereduction films. RESULTS: There were three avulsion fractures (1.7%; 95% confidence interval [CI], 0% to 4.5%) detected on postreduction radiographs. In all three cases, a radiologist who was blinded to the original interpretations and the purpose of the study also noted the fractures on the prereduction films, although these fractures were not detected on the original interpretations. There were 14 new Hill-Sachs deformities (8%; 95% CI, 4% to 12%). In one case (.6%; 95% CI, 0% to 2.8%), the postreduction radiograph demonstrated a persistent dislocation, which was subsequently reduced in the ED. This was the only postreduction finding that altered acute management. CONCLUSION: Postreduction radiographs rarely reveal any clinically significant abnormality after an anterior shoulder dislocation has been reduced. Emergency physicians and orthopedic surgeons should question whether the time and expense of obtaining routine postreduction films in the ED for anterior shoulder dislocations is justified. A prospective study is needed to validate our findings.

The changing nature of neonatal ethics in practice.

This article overviews the current practice of neonatal care ethics. Tracing the evolving nature of neonatal care over the last few decades, the author reviews Rhoden's categories of approaches to neonatal care and raises questions about the nature of responsibility in neonatal decision making. The role of the parent or guardian and the importance of communication is explored. Current neonatal outcome studies are reviewed in considering what "best interests" means for the newborn. The article concludes by reviewing several issues raised by current court cases that may point to the future of ethical decision making in neonatal care.