Patient experiences using public and private insurance coverage for abortion in Illinois: Implementation successes and remaining gaps.

CONTEXT: Insurance coverage for abortion in states where care remains legal can alleviate financial burdens for patients and increase access. Recent policy changes in Illinois required Medicaid and some private insurance plans to cover abortion care. This study explores policy implementation from the perspectives of patients using their insurance to obtain early abortion care. METHODOLOGY: Between July 2021 and February 2022, we interviewed Illinois residents who recently sought abortion care at ≤11 weeks of pregnancy. We also interviewed nine key informants with experience providing or billing for abortion or supporting insurance policy implementation in Illinois. We coded interview transcripts in Dedoose and developed code summaries to identify salient themes across interviews. RESULTS: Most participants insured by Illinois Medicaid or eligible for enrollment received full coverage for their abortions; most with private insurance did not and faced challenges learning about coverage status. Some opted not to use insurance, often citing privacy concerns. Participants who benefited from abortion coverage expressed relief, gave examples of other financial challenges they could prioritize, and described feeling in control of their abortion experience. Those without coverage described feeling stressed, uncertain, and constrained in their decision-making. CONCLUSION: When abortion was fully covered by insurance, it reduced financial burdens and enhanced reproductive autonomy. Illinois Medicaid policy-with seamless enrollment options and appropriate reimbursement rates-offers a model for improving abortion access in other states. Further investigation is needed to determine compliance among private insurance companies and increase transparency.

Debate: Involuntary treatment and detention are a necessary part of mental health care for children and young people.

People of all ages are subject to involuntary psychiatric detention and treatment worldwide but there is current discussion about whether this complies with modern human rights law. The use of involuntary psychiatric hospitalisation among children and young people has largely eschewed research and policy interest to date. In this debate section, we hear from people with experience of child mental health services in the UK, USA and low- and middle-income countries about their views on the use of involuntary treatment in young people.

Expert Recommendations from the AEDV on Legal Aspects Surrounding the Management of Sexually Transmitted Diseases. / Recomendaciones de expertos de la AEDV sobre los aspectos legales en el manejo de las infecciones de transmisión sexual.

The incidence of sexually transmitted diseases has been on the rise in our setting for decades. These infections represent not only an individual problem, but also a problem of public health. Therefore, the management of STDs involves reducing community incidence, which means that common issues in the clinical practice such as failure to attend may become a more complex problem, which adds to the difficult and delicate task of locating sexual contacts that would benefit from screening and the appropriate treatment. On the other hand, STDs have direct legal implications in cases of underage patients, or suspected sexual assault. Therefore, the correct handling of these scenarios requires knowledge of the legal framework that regulates them. Dermatologists are clinically trained and prepared to deal with these conditions. Nonetheless, the legal issues involved are often difficult to solve. This document stands as a simple reference guide to help solve the main legal issues we may encounter in a consultation when dealing with STDs.

Child torture victimization: Review of criminal statutes and medico-legal issues.

A renowned group of pediatricians and an attorney with expertise in child abuse matters proposed a medical definition of intrafamilial child torture perpetrated by a caretaker in a landmark 2014 publication in the health sciences literature. Representing one of the most widely cited publications on non-politically motivated child torture to date, this medical definition encompassing physical abuse, psychological abuse, deprivation, and neglect characterizing child torture has been broadly recognized and accepted by multidisciplinary professionals across medical, child welfare, and criminal justice sectors. While the medical community's efforts aimed to compel legislative changes, including adoption of explicit torture-specific statutes that would enable criminal justice system responses reflective of abuse severity, subsequent legal analyses have revealed tremendous variability in criminal investigations, prosecution, sentencing, and case outcomes. In this discussion piece, medico-legal issues relevant to intrafamilial child torture case prosecution are reviewed. The impact of the established medical definition on jurisdictional legal approaches and unique case challenges related to longitudinal nature of abuse, frequent psychological injury, and victim-perpetrator dynamics are explored in depth. Utilizing available legal research platforms, investigative information, health sciences literature, and prosecutor self-report, existing child torture statutes and case outcomes were compared with focus on perpetrator, victim, socio-environmental, and community influence on legal outcome. Prosecutorial challenges facing jurisdictions lacking child torture statutes are discussed with emphasis placed on the critical role played by the medical community to support diagnosis of physical and emotional impacts to the child. Finally, the process by which states can establish a jurisdictional torture statute are suggested.

The Labyrinthine Journey: Unveiling Obstacles in addressing Mental Health Challenges in Prisons and its Confluence with Medico-Legal and Pharmacological Perspectives.

This paper delves into the intricate realm of mental health issues within prisons including other correctional facilities, the intersectionality with legal and medical aspects, and the potential of pharmacology as a viable treatment modality. The prevalence and diverse array of mental disorders among incarcerated individuals are thoroughly examined, underscoring the imperative for all-encompassing interventions. The legal structure, hurdles encountered in delivering mental healthcare, and the indispensability of interdisciplinary cooperation are scrutinized. Furthermore, the effectiveness and moral implications of pharmaceutical interventions in correctional environments are deliberated upon. Conclusive suggestions are put forth to enhance mental healthcare provisions in prisons. The research paper endeavors to penetrate the labyrinthine complexities of mental health predicaments within correctional institutions, with a specific emphasis on the convergence of medico-legal facets and the plausible impact of pharmacological interventions. The study strives to elucidate the intricate nature of mental health challenges among incarcerated populations, considering the intricate interplay of socio-cultural, environmental, and psychological factors that contribute to their pervasiveness. By delving into these interconnected dimensions, the research aims to unlock prospective remedies capable of efficaciously meeting the mental health requisites of incarcerated individuals.

Debate: The experience of involuntary psychiatric hospitalisation for children and young people.

Involuntary treatment has been reported to be traumatic, stigmatising and frightening, as well as sometimes lifesaving. However, there has been little research into the experiences of people who have been hospitalised involuntarily prior to the age of 18. A greater understanding of this may help us to make changes which could improve the experience of involuntary psychiatric treatment for children and young people. Lizzie Mitchell is an expert by experience who was admitted to a psychiatric hospital in England under the Mental Health Act (MHA) when she was 16 years old. Here, in discussion with Susan Walker, a child and adolescent psychiatrist, Lizzie reflects on her own experiences alongside wider reflections around the involuntary hospitalisation of young people, including the potential short and long-term impact on mental health, education, friendships, family and identity.

The Evolving Complexities of MAID Care in Canada From a Nursing Perspective.

Medical Assistance in Dying (MAID) legislation has evolved rapidly in Canada with significant impacts on nursing practice. The purpose of this paper is to describe evolving complexities in legislative context and practice standards that influence the experiences nurse practitioners and registered nurses have with MAID. Qualitative interviews were conducted with 25 registered nurses and 10 nurse practitioners from diverse contexts across Canada. Participants described their practices and considerations when discussing MAID as part of advance care planning; their use of, and challenges with, waivers of consent; their practice considerations in negotiating the complexities of clients for whom death is not reasonably foreseeable; and their moral wrestling with the inclusion of MAID for persons whose sole underlying medical condition is mental illness. Findings illustrate the moral complexities inherent in the evolving legislation and the importance of robust health and social care systems to the legal and ethical implementation of MAID in Canada.

Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit.

End-of-life care (EOLC) exemplifies the joint mission of intensive and palliative care (PC) in their human-centeredness. The explosion of technological advances in medicine must be balanced with the culture of holistic care. Inevitably, it brings together the science and the art of medicine in their full expression. High-quality EOLC in the ICU is grounded in evidence, ethical principles, and professionalism within the framework of the Law. Expert professional statements over the last two decades in India were developed while the law was evolving. Recent landmark Supreme Court judgments have necessitated a review of the clinical pathway for EOLC outlined in the previous statements. Much empirical and interventional evidence has accumulated since the position statement in 2014. This iteration of the joint Indian Society of Critical Care Medicine-Indian Association of Palliative Care (ISCCM-IAPC) Position Statement for EOLC combines contemporary evidence, ethics, and law for decision support by the bedside in Indian ICUs. How to cite this article: Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, et al. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024;28(3):200-250.

The influence of fears of perceived legal consequences on general practitioners' practice in relation to defensive medicine - a cross-sectional survey in Germany.

BACKGROUND: Medical decisions are influenced by a variety of factors also by legal requirements and feelings of uncertainty, which results in the term defensive medicine. The aim of the study was to evaluate the influence of fears of perceived legal consequences on the practice of defensive medicine from the perspective of German general practitioners (GPs). METHODS: A cross-sectional study was performed from April to May 2022. GPs were invited via an e-mail newsletter of the Institute for Continuing Education in Family Medicine in the German Association of General Practitioners and via an online platform of the German College of General Practitioners and Family Physicians. The evaluation of legal fears, the general assessment of defensive medicine and reasons for and the frequency of defensive medical measures were surveyed in this study. Beside descriptive analyses, a stepwise linear regression analysis was used to explore potential associations between for the primary outcome variable 'fears of legal consequences' on the practice of defensive medicine. RESULTS: 413 general practitioners with an average age of 50 years (51% female) responded. The majority rated their fears of legal consequences as low to average whereas for almost a third (27%, n = 113) the fears were strong to very strong. Regarding legal fears, the physician-patient-relationship played a fairly to very large role for 48% (n = 198) of the respondents. One third estimated the probability of being sued civilly in the next 10 years as rather high to very high. 47% (n = 193) of the participants assumed that the risk of being sued could mostly to very much be reduced by defensive medicine. Legal self-protection was for 38% of the responders (n = 157) quite frequently to very frequently a reason for acting defensively. Consequently, half of the respondents stated that they performed unnecessary laboratory tests at least once per week and 40% indicated that they referred patients for radiological diagnostics without medical indication once per month. CONCLUSIONS: As legal fears have an influence on medical practice and legal self-protection being a frequent reason for defensive behaviour, understanding and knowledge of the law should be improved by legal education at university and further training of post-graduate trainees and practicing physicians should be implemented. Additionally, a more in-depth enlightenment of society about the phenomenon of Protective and Defensive Medicine and its consequences could be a possibility to decrease the perceived fears of legal consequences on the physicians' side.

Legal issues in digital oral health: a scoping review.

BACKGROUND: This scoping review aims to systematically and critically describe the numerous legal challenges brought about by the utilization of digital oral health in the delivery of oral healthcare. METHODS: A systematic search was conducted. The following electronic databases were reviewed from inception up to March 2023: MEDLINE, Embase, Scopus, and LILACS. The search included any scientific document and paper in English, Spanish, or Portuguese on legal issues raised using digital health in oral healthcare delivery. Two reviewers conducted the selection process and data extraction. Legal issues raised concerning the adoption of digital health technology were analysed using the modified Mars' framework. RESULTS: Seventeen studies were included. Most of the documents identified and covered generic aspects of delivering digital oral healthcare (n = 11) without explicitly referring to any dental specialty. The most mentioned legal issues were data security (n = 15); liability and malpractice (n = 14); consent (n = 12); and confidentiality (n = 12). To a lower extent, patient-practitioner relationship (n = 11); and license and jurisdiction (n = 11) were also covered. These were followed by privacy of information (n = 10); adequacy of records (n = 9); and e-referrals (n = 8). On the other hand, fewer studies commented on social media use (n = 3), authentication (n = 2); or e-prescriptions (n = 2). Before implementing any digital health solution, practitioners need to be aware of the many legal issues that the introduction of these technologies involves, be clear where the responsibility lies, and apply extreme caution in following national guidelines. Current literature concentrates on a few well-known legal issues. Issues around authentication, use of social media, and e-prescriptions received less attention.

Ethical and legal implications of gene editing in plant breeding: a systematic literature review. / åŸºå› ç¼–è¾‘åœ¨æ¤ç‰©è‚²ç§ä¸­çš„é“å¾·å’Œæ³•å¾‹å½±å“ï¼šä¸€é¡¹ç³»ç»Ÿæ€§æ–‡çŒ®ç»¼è¿°.

Biotechnology policies and regulations must be revised and updated to reflect the most recent advances in plant-breeding technology. New Plant Breeding Techniques (NPBT) such as gene editing have been applied to address the myriad of challenges in plant breeding, while the use of NPBT as emerging biotechnological tools raises legal and ethical concerns. This study aims to highlight how gene editing is operationalized in the existing literature and examine the critical issues of ethical and legal issues of gene editing for plant breeding. We carried out a systematic literature review (SLR) to provide the current states of ethical and legal discourses surrounding this topic. We also identified critical research priority areas and policy gaps that must be addressed when designing the future governance of gene editing in plant breeding.

Family issues and custodial mothers' quest for justice: Evidence from Colombia.

Access to justice is limited for many worldwide. Although prior research generally recognizes the legal needs and barriers faced by women, less is known about mothers. This study examined the legal needs of mothers in different family configurations and the actions they took in response to these needs through the lens of help-seeking theories. We used unique data from the 2016 Colombian Quality of Life Survey (QLS) to produce descriptive statistics on the legal needs of mothers in two-parent families and custodial mothers. We then conducted multivariate analyses to examine the factors associated with having a family issue and seeking institutional help. Custodial mothers were more likely than mothers in two-parent families to have reported any legal need, and to report a family legal issue. The most frequent legal issues related to the family were issues with child support, custody, and/or visitation. The most frequent action taken to resolve issues was through an institutional actor. Among custodial mothers, single, younger mothers and mothers with more children were more likely to experience family legal issues, but they were not the ones seeking institutional help-those mothers were often more socioeconomically advantaged. That more socioeconomically disadvantaged mothers are more likely to experience a family legal issue but less likely to seek institutional help, the most frequent route to action, calls for research that examines the barriers faced by these mothers and policies to improve their access to justice.

Who Cares About Me? The Need of the Hour is to Improve Awareness and Quality of End-of-life Care Practices in Indian Intensive Care Units.

How to cite this article: Singh U, Maurya I, Gurjar M. Who Cares About Me? The Need of the Hour is to Improve Awareness and Quality of End-of-life Care Practices in Indian Intensive Care Units. Indian J Crit Care Med 2023;27(8):523-525.

Questioning What We Thought We Knew: Commentary on Leonhard's Performance Validity Assessment Articles.

Neuropsychologists have long understood that valid examinee performance is needed in order to understand the constructs of interest that are at the heart of clinical and forensic evaluations. The assessment of performance validity has evolved over time, from very rudimentary and subjective clinical impressions of examinee task engagement to psychometrically based, multi-method, algorithm-driven, and consensus-informed approaches. Christoph Leonhard has further advanced that evolution in a meaningful way, forcing us to reconsider much of what we thought we knew about the psychometric assessment of performance validity. Although a structured, systematic, and objective approach to validity assessment is necessary, Leonhard has brought to our attention some significant concerns that need to be addressed. This commentary describes professional, ethical, and legal implications of Leonhard's articles. Through an ongoing process of examining, revising, and improving our methods and procedures, we will be better positioned to provide services of value to those we serve. Leonhard has provided an opportunity for us to do just that.

Ethical and legal implications of gene editing in plant breeding: a systematic literature review. / åŸºå› ç¼–è¾‘åœ¨æ¤ç‰©è‚²ç§ä¸­çš„é“å¾·å’Œæ³•å¾‹å½±å“ï¼šä¸€é¡¹ç³»ç»Ÿæ€§æ–‡çŒ®ç»¼è¿°.

Biotechnology policies and regulations must be revised and updated to reflect the most recent advances in plant-breeding technology. New Plant Breeding Techniques (NPBT) such as gene editing have been applied to address the myriad of challenges in plant breeding, while the use of NPBT as emerging biotechnological tools raises legal and ethical concerns. This study aims to highlight how gene editing is operationalized in the existing literature and examine the critical issues of ethical and legal issues of gene editing for plant breeding. We carried out a systematic literature review (SLR) to provide the current states of ethical and legal discourses surrounding this topic. We also identified critical research priority areas and policy gaps that must be addressed when designing the future governance of gene editing in plant breeding.

Effect of Supplemental Regional Anesthesia on the Complication and Readmission Rate of Patients After Elective Foot and Ankle Surgery.

BACKGROUND: The purpose of this study is to define the effect of facility type (inpatient vs outpatient) for the use of supplemental regional anesthesia (SRA), and SRA's effect on complications, readmissions, operation time, and length of hospital stay after elective foot and ankle surgery. METHODS: We performed a retrospective review to identify a large cohort of adult patients who underwent elective foot and ankle surgery between 2006 and 2020 from the American College of Surgeons National Surgical Quality Improvement Program database. We fit log-binomial generalized linear models to estimate risk ratios for general anesthesia (GA) with SRA versus GA alone, and linear regression models to estimate the effect of GA with SRA on the average total hospital length of stay (in days) and operation time (in minutes); we also performed inverse propensity scores. RESULTS: We found that there is no statistical difference in the rate of readmissions (P = .081) between patients under GA alone versus GA with SRA. In the propensity score analysis, patients who underwent midfoot/forefoot surgery had 3.85 times the risk of complications under GA with SRA compared with GA alone (P = .045). Also, patients who received GA with SRA had a longer unadjusted operative duration (102.22 minutes) when compared with patients who received GA alone (93.84 minutes) (P < .001). However, patients who received GA alone had a longer unadjusted hospital length of stay (0.88 days) when compared with patients who received GA with SRA (0.70 days) (P = .006). CONCLUSION: This study found that, when compared with GA alone, GA with SRA leads to a statistically significant increased operative time but a shorter hospital stay without significantly increasing readmissions and only increasing the risk of complications for midfoot/forefoot surgery within 30 days postoperatively for elective foot and ankle surgery. LEVEL OF EVIDENCE: Level III.

Ethical decision-making in the administration of 'as required' antipsychotics to people with dementia in care homes.

Antipsychotic medicines are often prescribed 'as required' to manage behavioural and psychological symptoms of dementia, despite evidence that these medicines have little benefit for people with dementia and have numerous adverse side effects, including sedation. It is the nurse's role to decide if and when to administer antipsychotic medicines that have been prescribed on an as required basis. This decision-making is underpinned by complex ethical considerations such as mental capacity, chemical restraint, quality of life and autonomy. Adopting a person-centred approach and considering the ethics, guidelines and legislation related to such decisions can support nurses to act in patients' best interests. This article uses two ethical frameworks - the four principles of biomedical ethics and the 'four quadrants' approach - to examine this complex issue and to demonstrate their use in the context of ethical decision-making in nursing practice.

Antitrust as a Guardrail for Socially Responsible Neurotechnology Design.

The neurotechnology sector is likely to develop under pressure towards commercialized, nonmedical products and may also undergo market consolidation. This possibility raises ethical, social, and policy concerns about the future responsibility of neurotechnology innovators and companies for high-consequence design decisions. Present-day internet technology firms furnish an instructive example of the problems that arise when providers of communicative technologies become too big for accountability. As a guardrail against the emergence of similar problems, concerned neurotechnologists may wish to draw inspiration from antitrust law and direct efforts, where appropriate, against undue consolidation in the commercial neurotechnology market.