[Autonomy and patient prisoners]. / Autonomía y pacientes reclusos.

The authors study a recent Spanish High Court decision declaring liability on the Administration's part for the death of an inmate in a prison hospital. We analyse the Court's decision using legal, ethical, medical and social perspectives. The conclusions are that: 1. the Administration has no legitimate right to force a prisoner to take medical treatment, except in circumstances in which there is a grave and definite risk to the patient's life, or when the patient lacks capacity or when there is the risk of harm to the health of third parties; 2. That in the case of health decision making that might affect a patient, the Court has mounted a frontal attack on the autonomy of patients in prison; 3. That from a medical point of view the decision is discriminatory since it does not apply the same standards of measurement to all chronic illnesses that might be found in the prison context; 4. That it is inapplicable in daily practice due to the fact that its strictness of application would seriously affect the already highly fragile ordered coexistence that exists in a prison.

Autonomía y pacientes reclusos / Autonomy and patient prisoners

Los autores estudian una reciente sentencia de la Sala 3ª del Tribunal Supremo en la que se declara la responsabilidad patrimonial de la Administración por la muerte de un paciente preso. Se analizan los argumentos de la Sala desde una perspectiva jurídica, ética, médica y social. Concluyen que: 1: la Administración no está legitimada para imponer tratamientos médicos a los reclusos, salvo que medie riesgo grave y cierto para su vida, incapacidad para decidir o riesgo para la salud de terceros; 2: que la sentencia supone un ataque frontal a la autonomía de los pacientes presos en la toma de decisiones sanitarias que les afecten; 3: que desde un punto de vista médico es discriminatoria, ya que no mide por el mismo rasero a todas las enfermedades crónicas que se pueden dar en prisión y 4: que resulta inasumible en la práctica diaria, porque su estricta aplicación alteraría considerablemente la ya de por sí frágil ordenada convivencia en un centro penitenciario

The authors study a recent Spanish High Court decision declaring liability on the Administration’s part for the death of an inmate in a prison hospital. We analyse the Court’s decision using legal, ethical, medical and social perspectives. The conclusions are that: 1. the Administration has no legitimate right to force a prisoner to take medical treatment, except in circumstances in which there is a grave and definite risk to the patient’s life, or when the patient lacks capacity or when there is the risk of harm to the health of third parties; 2. That in the case of health decision making that might affect a patient, the Court has mounted a frontal attack on the autonomy of patients in prison; 3. That from a medical point of view the decision is discriminatory since it does not apply the same standards of measurement to all chronic illnesses that might be found in the prison context; 4. That it is inapplicable in daily practice due to the fact that its strictness of application would seriously affect the already highly fragile ordered coexistence that exists in a prison

Problemas médico-legales del consumo de drogas / No disponible

Los trastornos derivados del consumo de alcohol y drogas son causa de múltiples problemas en diferentes ámbitos del Derecho, siendo necesario para su resolución que Jueces y Tribunales dispongan de un informe pericial que valore el estado del paciente y que les permita conocer la situación real, para acorde con ello dictar una resolución motivada. Para la valoración psicopatológica proponemos atender a 2 criterios: uno médico basado en los síntomas y signos clínicos, la gravedad de cuadro y el momento de inicio del mismo en relación con los hechos de trascendencia jurídica, y otro médico legal, que relaciona los hechos con el estado del paciente partiendo de un análisis estructural de sus funciones cognitivas y volitivas y del estudio de la gravedad de la adicción. Dada la frecuencia con la que las conductas adictivas coexisten con otras patologías psiquiátricas, proponemos un estudio completo recurriendo a métodos prospectivos (seguimiento del paciente), retrospectivos (basado en autoinformes referidos a periodos de tiempo concretos) y objetivos (análisis y distintas pruebas de laboratorio) para el correcto diagnóstico diferencial entre los trastornos inducidos por drogas y otros trastornos psiquiátricos. Para la valoración pronostica, proponemos estudiar los elementos que pueden influir en el éxito o el fracaso de la asistencia médica o psicosocial del problema, atendiendo básicamente a: 1) los factores que motivan el consumo, 2) los motivos que motivan la solicitud de ayuda para abandonar el consumo, y 3) viabilidad del plan Terapéutico propuesto (AU)

The dysfunctions derived from the consumption of alcohol and drugs are the cause of multiple problems in different spheres of Law. To resolve them, judges and tribunals require an expert report assessing the condition of the patient enabling them to ascertain the real situation prior to reaching a decision. For the psychopathological evaluation we propose 2 criteria, one medical based on the clinical symptoms and signs, the seriousness of the case and the commencement of the same in relation to the facts of the legal case in question, and another legal- medical one which lists the facts with the medical condition of the patient on the basis of a structural analysis of his/her cognitive and volitive functions and a study of the seriousness of the addiction. Given the frequency with which addictive behaviours coexist with other psychiatric pathologies, we propose a complete study based on prospective methods (patient followups), retrospectives (based on self-reports referring to specific periods) and objectives (analysis and different laboratory tests) for the correct differential diagnosis between dysfunctions induced by drugs and other psychiatric dysfunctions. Lastly and for the evaluation for the prognosis, we propose to study the elements that can influence the success or the failure of the medical or psychosocial attention to the problem, basically: 1) the factors that motivate the consumption, 2) the reasons that motivate the request for assistance in giving up consumption, and 3) viability of the proposed therapeutic plan (AU)