Ethical aspects of age estimation for forensic purposes in Saudi Arabia / Aspectos éticos de la estimación de la edad para propósitos forenses en Arabia Saudita / Aspectos éticos da estimativa de idade para propósitos forenses na Arábia Saudita

Abstract: In forensic and legal contexts, an assessment of skeletal maturation is required to predict the chronological age in certain circumstances in which the chronological age is undocumented or unable to be proven. Carrying such medical examinations will always pose an ethical concern, especially in cases of assessing sexual maturity as well as examinations involving ionizing radiation. The cultural and religious barriers are also discussed concerning the ethical standards set in Saudi Arabia. Several ethical issues concerning age estimation examinations including issues related to consent forms, privacy, and radiation hazards have been documented. While ethical issues regarding radiation hazards are more likely to be overcome by introducing other imaging modalities without radiation hazards, ethics related to consent forms and privacy are still to be improved.

Resumen: En contextos forenses y legales, se requiere la evaluación de la maduración del esqueleto para predecir la edad cronológica en ciertas circunstancias en que la edad cronológica no está documentada o no es posible de probar. Realizar tales exámenes médicos siempre significa una preocupación ética, especialmente en casos de evaluación de madurez sexual así como en exámenes que involucran radiaciones ionizantes. Se discuten también las barreras culturales y religiosas relacionadas con el contexto de estándares éticos en Arabia Saudita. Entre los varios temas éticos relacionados con la estimación de la edad, se documentan temas relacionados con los formularios de consentimiento, privacidad y riesgos de radiación. Mientras que los temas éticos relacionados con riesgos de radiación pueden ser resueltos al introducir otras modalidades de examen sin radiación, los problemas éticos relacionados con los formularios de consentimiento y privacidad todavía necesitan mejorarse.

Resumo: Em contextos forenses e legais, uma avaliação de maturação esquelética é requerida para predizer a idade cronológica em certas circunstâncias nas quais a idade cronológica não é documentada ou impossível de ser provada. Conduzir tais exames médicos sempre irá suscitar uma preocupação ética, especialmente em casos para avaliar maturidade sexual bem como exames envolvendo radiação ionizante. As barreiras culturais e religiosas também são discutidas no que diz respeito a padrões éticos estabelecidos na Arábia Saudita. Diversos aspectos éticos concernentes a exames de estimativa de idade incluindo aspectos relacionados a formulários de consentimento, privacidade e risco de radiação foram documentados. Ao passo que aspectos éticos que dizem respeito a risco de radiação serem mais provavelmente superáveis pela introdução de outras modalidades de exames de imagem sem risco de radiação, a ética relacionada a formulários de consentimento e privacidade ainda estão por serem melhorados.

A statewide elder mistreatment virtual assessment program: Legal, ethical, and practical issues.

Telecommunication assisted forensic assessments of capacity and mistreatment by geriatricians with expertise in elder abuse and self-neglect are helping to meet the demand for such forensic services for Adult Protective Services (APS) clients in remote and underserved areas of Texas. The use of synchronous audiovisual assisted interviews instead of in-person interviews with clients to provide capacity assessments has become more important with the arrival of the COVID-19 pandemic. There is growing interest in establishing similar programs in other states using geriatrician faculty from medical schools to serve the clients of their state Adult Protective Services agencies. The arrangement between APS and the geriatricians at McGovern Medical School in Houston, Texas is novel. The structure of the arrangement is important for the success of the program. Legal, ethical, and practical considerations are discussed in this article, including approaches to the Health Insurance Portability and Accountability Act, physician liability, state law, and resource limitations. It is hoped that sharing how one such collaboration has addressed these important issues will suggest approaches for the structuring of similar programs.

The dignity of the human corpse in forensic medicine.

Working with the dead is a very specific kind of work. Although a dignified handling of the corpses is demanded by the legislator and by the general public, neither the legal status of the corpse is undisputed nor is it obvious what a dignified handling of the deceased should consist of. In our hypothesis generating pilot study, we asked which concrete considerations are involved in daily practice of forensic specialists. We used an online questionnaire (invitations via e-mail) consisting of questions with single choice, multiple choice, and free text entries. The answers to single or multiple choice questions were displayed in pivot tables. The data was thus summarized, viewed, descriptively analyzed, and displayed together with the free text answers. 84.54% of the physicians and 100% of the autopsy assistants stated that considerations concerning the dignity of the deceased should play a role in daily autopsy practice. 45.87% stated that the conditions surrounding the autopsy need improvement to be ethically suitable. The analysis of the survey's results was based on Robert Audi's ethics, according to which three aspects need to be lightened in order to evaluate the conduct of a person morally: the actions, the motivation, and the way in which the actions are carried out. This systematization helps to identify the need for improvement and to make the vague demands for a dignified handling of corpses more concrete.

Análisis de la confección de los certificados de asistencia de primera intención del lesionado. Matanzas 2015 / Analysis of the preparation of the first intention assistance certificates of the injured party. Matanzas 2015

Resumen Dentro de las actuaciones medicolegales de mayor trascendencia en el delito de lesiones se encuentra la asistencia de primera intención del lesionado con la correspondiente certificación médica inicial. La confección en Cuba del certificado de asistencia de primera intención de un lesionado dista mucho de ser la adecuada, comprobado por diversos trabajos de autores nacionales y extranjeros. La presente investigación tiene como objetivo el análisis de la confección de los certificados de este tipo, realizados en el municipio de Matanzas, Cuba, en el año 2015 para lo cual se utilizaron variables como la descripción anatómica de las lesiones y el pronóstico medicolegal. Para el análisis de los resultados se utilizaron métodos estadísticos como valores porcentuales y tablas de frecuencia. Los resultados obtenidos arrojaron como conclusiones que el desconocimiento de la clasificación de las lesiones según el código penal, las dificultades en la descripción anatómica y en el pronóstico médico legal de las lesiones constituyen las principales deficiencias detectadas.

Abstract Among the most important medical legal actions in the crime of injuries is the first intention assistance of the injured party with the corresponding initial medical certification. The preparation in Cuba of the certificate of first intention assistance of an injured person is far from being adequate, proven by various works by national and foreign authors. The objective of this research is to analyze the preparation of certificates of this type, carried out in the municipality of Matanzas, Cuba, in 2015, for which variables such as the anatomical description of the injuries and the medical-legal prognosis were used. . For the analysis of the results, statistical methods such as percentage values and frequency tables were used. The results obtained yielded as conclusions that the ignorance of the classification of injuries according to the penal code, the difficulties in the anatomical description and in the legal medical prognosis of the injuries constitute the main deficiencies detected.

[Forensic implications of humane self-chosen death in the Netherlands]. / Zelfgekozen levenseinde: een forensisch dilemma.

Euthanasia is legal in the Netherlands. Nevertheless, some individuals decide to plan their self-chosen death without the help of a physician. 'Right-to-die' organisations provide advice about humane deaths, which include voluntary refusal of food and fluids, the helium method and use of a lethal overdose of medication. It is known that suicides are sometimes influenced by the media and internet. Since 2013, 'right-to-die' organisations have informed individuals about the use of a deadly barbiturate overdose and the helium method. A rise in suicides resulting from these methods has subsequently been observed in the Netherlands. Suicides are recorded as deaths resulting from unnatural causes and are therefore investigated by a forensic physician, forensic investigator and tactical investigator. Investigation should determine the cause of death and rule out a staged crime, 'criminal' assisted suicide or an accident.

For Victims of Fatal Child Abuse, Who Has the Right to Consent to Organ Donation?

In rare circumstances, children who have suffered traumatic brain injury from child abuse are declared dead by neurologic criteria and are eligible to donate organs. When the parents are the suspected abusers, there can be confusion about who has the legal right to authorize organ donation. Furthermore, organ donation may interfere with the collection of forensic evidence that is necessary to evaluate the abuse. Under those circumstances, particularly in the context of a child homicide investigation, the goals of organ donation and collection and preservation of critical forensic evidence may seem mutually exclusive. In this Ethics Rounds, we discuss such a case and suggest ways to resolve the apparent conflicts between the desire to procure organs for donation and the need to thoroughly evaluate the evidence of abuse.

Caracterización de la responsabilidad profesional medica, Dirección de Medicina Forense de Tegucigalpa / Characterization of complaints of medical professional responsibility, issued by Dirección de Medicina Forense in Tegucigalpa

Justificación:Las fallas relacionadas a la actuación profesional, impactan negativamente a los pacientes e incluso pueden conducirlos a la muerte. Las denuncias constituyen un mecanismo por el que los pacientes o sus familiares expresan insatisfacción, y cuando se analizan, sistemáticamente, no solo desde la perspectiva legal, constituyen una oportunidad de mejora continua. Objetivo:Caracterizar las denuncias por responsabilidad profesional médica dictaminadas en la Dirección de Medicina Forense de Tegucigalpa. Metodología:Se realizó un estudio descriptivo de 89 denuncias por responsabilidad profesional médica, entre el 2010 y el 2015 dictaminadas en la Dirección de Medicina Forense de Tegucigalpa, siendo las variables de estudio: De las víctimas: edad, sexo, escolaridad. De los denunciantes: edad, sexo, motivo de la denuncia, relación con la víctima, procedencia. Del denunciado: Edad, sexo, centro donde laboraba, tiempo de laborar y especialidad ejercida. Resultados:El 5,61% de las denuncias correspondieron a casos de responsabilidad profesional médica, 20% de las cuales fueron por desconocimiento inexcusable y 80% por omisión de cuidados. Ginecobstetricia fue la especialidad más denunciada con el 30%. Los médicos más denunciados (77,6%) trabajaban en una institución pública, y el conflicto en la relación médico-paciente fue la causa de denuncia más frecuente (40.4%). Conclusión:Los médicos del sexomasculino, cercanos a los 50 años de edad y con más de 15 años de experiencia, que laboraban encentros públicos y que ejercían las especialidadesde Ginecobstetricia, OrtopediayCirugía General, fueron los más denunciados; entre los motivos más frecuentes dedenuncia se citaron losconflictos en la relación médico-paciente-familiar, la inconformidad en el diagnóstico y falta de ética profesional de otros profesionales con comentarios adversos hacia sus colegas o las instituciones...(AU)

Sexual Assault Examination of the Unconscious Patient: A Legal, Ethical and Professional Grey-area for the Forensic Physician.

When treating unconscious patients believed to have been victims of sexual assault, forensic physicians must decide whether to conduct physical examinations in order to collect evidence while patients are unconscious and cannot consent. The choice is urgent: potential evidence may be lost before the patient regains the ability to consent. The physician's choice affects not only the patient's bodily integrity, but also their ability to pursue criminal and potentially civil justice remedies if they were assaulted. This article bases its discussion on one such real-life situation. It first examines ethical models relevant to deciding whether to take evidence and finds that no one approach produces morally satisfactory outcomes in every case. It then examines the legal framework guiding these decisions, finding that while collecting evidence without consent may well be permissible under New South Wales (NSW) legislation, relevant guidelines disallow it, placing physicians in a legal grey-area. The article concludes with practical recommendations to address these ethical, professional and legal challenges.

Muerte de un producto de la concepción. ¿Aborto ilícito o asesinato? / Death of a product of conception. Illegal abortion or murder?

Introducción: Cuando ocurre la muerte del resultado de la concepción, con la realización de la necropsia médico-legal se deben precisar aspectos importantes que definirán las conductas a seguir con los presuntos responsables de un delito. Para ello es necesario precisar si existió vida extrauterina o no, que le dará a este resultado, la definición de persona, según lo establecido en la legislación civil. Objetivo: Establecer el posible tipo de delito y enmarcar la posibilidad de que se trate de un aborto ilícito o un asesinato, además de precisar las causas y circunstancias en que la muerte se produjo. Presentación del caso: Se trata de un cadáver resultado de la concepción que fue hallado en una vivienda, dentro de un envoltorio, junto a la placenta y el cordón umbilical, cuya madre había mantenido su embarazo oculto. Durante el acto de la necropsia se demostró que era un producto viable que había presentado vida extrauterina. Conclusiones: Se presenta un caso poco frecuente en la práctica forense. Se determinó que se trataba de una recién nacida, por haber presentado vida extrauterina, cuyas causas de muerte estuvieron en relación con un traumatismo craneoencefálico(AU)

Introduction: When the death of a product of conception occurs, important aspects resulting from the completion of the medico-legal necropsy that define the behaviors to be followed with those presumed responsible for a crime must be specified. To achieve this, it is necessary to establish whether extrauterine life existed or not, which will give the definition of person to the mentioned product, as it is established in the civil legislation. Objective: To establish the possible type of crime and consider the possibility of an illegal abortion or a murder, as well as to specify the causes and circumstances in which the death occurred. Case Presentation: A corpse that was considered a product of conception was found in a dwelling house, wrapped up next to the placenta and the umbilical cord. The mother had kept a hidden pregnancy. During the act of performing a necropsy, it was demonstrated that it was a viable product that had had extrauterine life. Conclusions: A rare and unusual case is presented in forensic practice. It was determined that she was a newborn baby girl because she had had extrauterine life, whose causes of death were related to a traumatic brain injury(AU)

El martillo de las brujas al caso Belén / From Hammer of Witches to Belen's case / Del martell de les bruixes al cas Belén

El presente texto parte de la existencia de una íntima relación entre el modo de definir lo ilícito y el procedimiento que se establece para su persecución. Desde esa perspectiva, analiza las previsiones del Malleus Maleficarum ("Martillo de las Brujas") para la tortura de una mujer acusada de brujería. Luego explora las continuidades entre el Malleus y el proceso penal del caso "Belén", con referencias al uso del lenguaje en la doctrina jurídica argentina en referencia al abuso sexual y otros delitos. Por último, plantea interrogantes en cuanto a los significados subyacentes de la punición del aborto que aun rige en la Argentina

The present article originates in the existence of an intimate relationship between the way in which crime is defined, and the procedure prescribed for its prosecution. From this perspective, it begins with an analysis of the guidelines provided in the Malleus Maleficarum ("Hammer of Witches") for the torture of a woman charged with witchcraft. Then, it explores the connections between the content of the Malleus and the criminal prosecution of "Belen's case", focusing on the use of language in Argentinian doctrine about sexual abuse and other crimes. Finally, it poses questions about the underlying significances meanings in the prosecution of abortion, which still prevails in Argentinian current law

Aquest article parteix de l'existència d'una íntima relació entre la manera de definir l'il·lícit penal i el procediment que s'estableix per a la seva persecució. Des d'aquesta perspectiva, s’hi analitza les previsions del Malleus Maleficarum ("Martell de les Bruixes") per a la tortura d'una dona acusada de bruixeria. A continuació, s’hi estudia la continuïtat entre el Malleus i el procés penal del cas Belén, amb referències a l'ús del llenguatge en la doctrina jurídica argentina sobre l'abús sexual i altres delictes. Finalment, s’hi plantegen diferents interrogants en quant al significat subjacent a la punició de l'avortament que regeix a l'Argentina

[The logical analysis of the notion of 'medical error']. / Logicheskii analiz poniatiia 'meditsinskaia oshibka'.

The objective of the present study was the logical analysis of the notions of 'medical error' and 'doctor's error' based on the consideration of the statutory and regulatory enactments published in the available literature. This article continues a series of thematic reports by the author concerning the application of the logical laws for the purpose of both the practical work of forensic medical experts and the use of specific notions in the expert conclusions, normative legal acts, scientific works of the experts and the lawyers.

Guía de Principios Éticos de la Red Iberoamericana de Instituciones de Medicina Legal y Ciencias Forenses / Ethical Principles Guidelines Iberoamerican Network of Legal Medicine and Forensic Sciences Institutions / Guia de Princípios Éticos da Rede Ibero-americana de Medicina Legal e Ciências Forenses

La Red Iberoamericana de Instituciones de Medicina Legal y Ciencias Forenses, organización que integra el Comité Internacional Cruz Roja, acordó una Guía de Principios Éticos. Sus objetivos son establecer una base mínima consensual sobre los aspectos éticos del trabajo de la Medicina Legal y las Ciencias Forenses en el contexto regional, así como ofrecer un marco axiológico de referencia para las instituciones y los profesionales forenses. Los nueve principios desarrollados en la Guía giran en torno a la obligación del respeto y promoción de los derechos humanos, la calidad técnica del trabajo, la necesaria formación en Medicina Legal y Ciencias Forenses, el trabajo en equipo respetando los perfiles disciplinares, la independencia técnica, los posibles conflictos de interés, los conflictos deontológicos cuando se actúa bajo dependencia, la confidencialidad y el consentimiento informado. Las Guías asumen también los principios consagrados en diversos documentos internacionales y en los códigos de ética nacionales. En Uruguay, el documento fue aprobado por la Facultad de Medicina y el Consejo Directivo Central de la Universidad de la República dispuso su más amplia difusión entre todos los servicios, especialmente a aquellos que participan en actividades forenses. (AU)

The Ibero American Network of Legal Medicine Institutions and Forensic Sciences, an organization that is part of the Red Cross International Committee agreed on a Guide of ethical principles with the purpose of a minimum agreed platform on ethical aspects in connection with professional practice in Legal Medicine and Forensic Sciences within the regional context. Likewise, it aims to provide an axiological framework for both forensic institutions and professionals. The nine principles agreed upon deal with the obligation to respect and promote human rights, the technical quality of work, need for training in Legal Medicine and Forensic Sciences, teamwork respecting disciplinary profiles, technical independence, potential conflicts of interest and deontological conflicts when acting under a certain rule, confidentiality and informed consent. The guide also undertakes the principles contemplated on several international documents and in the national codes of ethics. In Uruguay the document was approved by the School of Medicine and the Board of the University of the Republic decided for it to be communicated among all services, especially among those which take part in forensic activities. (AU)

A Rede Ibero-americana de Instituições de Medicina Legal e Ciências Forenses, organização integrante do Comitê Internacional Cruz Roja, elaborou um Guia de Princípios Éticos. Seus objetivos são estabelecer uma base mínima de consenso sobre os aspectos éticos do trabalho da Medicina Legal e das Ciências Forenses no contexto regional, bem como oferecer um ponto axiológico de referencia para as instituições e profissionais forenses. Os nove princípios descritos no Guia foram desenvolvidos considerando a obrigação ao respeito e a promoção dos direitos humanos, a qualidade técnica do trabalho, a necessária formação em Medicina Legal e Ciências Forenses, o trabalho em equipe respeitando os perfis das diferentes disciplinas, a independência técnica, os possíveis conflitos de interesse, os conflitos deontológicos quando se age em condições de dependência, a confidencialidade e o consentimento informado. O Guia assume também os princípios consagrados em diversos documentos internacionais e nos códigos de ética nacionais. No Uruguai, o documento foi aprovado pela Facultad de Medicina e o Consejo Directivo Central da Universidad de la República determinou que fosse amplamente difundido entre todos os serviços e departamentos, especialmente a aqueles que participam em atividades forenses. (AU)

La mala educación: la violación sistemática del secreto médico en Argentina / Bad education: systematic violation of medical confidentiality in Argentina / La mala educació: la violació sistemàtica del secret mèdic a Argentina

La violación del secreto médico es una transgresión a un deber moral y un ilícito penal en la República Argentina. Sin embargo, se registran demasiados casos en la jurisprudencia local, en que el personal médico viola el secreto para formular denuncias penales contra sus pacientes. Casos que habitualmente son anulados por los tribunales superiores, pero permiten someter a las víctimas a severos casos de violencia institucional durante su trámite en los tribunales inferiores. Sostengo que este fenómeno es la consecuencia de severas deficiencias en la educación médica, que persisten hasta la actualidad y que, por consiguiente, deben desplegarse acciones destinadas a corregir esta conducta ilícita en la educación universitaria

Violation of medical confidentiality is not only a moral transgression but also a criminal offence according to Argentinian law. However, there are too many cases in local jurisprudence where physicians breach confidentiality to file criminal charges against their patients. These cases are usually dismissed by appeal courts, but allow lesser courts to exert some degree of institutional violence over their victims. I claim that this phenomenon is the consequence of severe deficiencies in medical education, both historical and current, and therefore, I appeal to the local educational community to take actions in order to correct this medical misconduct

La violació del secret mèdic és una transgressió a un deure moral i un il·lícit penal a la República Argentina. No obstant això, es produeixen excessius casos en la jurisprudència local en què el personal mèdic viola el secret amb la finalitat de presentar denúncies penals contra els seus pacients. Són casos que habitualment són anul·lats pels tribunals superiors, però que permeten sotmetre a les víctimes a situacions de violència institucional greu durant el seu tràmit en els tribunals inferiors. Aquest fenomen és la conseqüència de deficiències importants en l'educació mèdica, que persisteixen fins l'actualitat i que, per tant, s'han de dur a terme accions a fi de corregir aquesta conducta il·lícita en l'educació universitària

Radiología médico-legal: un dilema ético para el técnico en radiología / Medical-legal radiology: an ethical dilemma for radiology technician / Radiologia médico-legal: um dilema ético para o técnico de Radiologia

Resumen: Las exploraciones radiológicas médico-legales incluyen exposiciones médicas a radiaciones que se realizan por orden judicial a una persona que no está enferma. El técnico o tecnólogo médico en radiología tiene el deber de minimizar las dosis a pacientes y a la población en su conjunto; por ello, realizar este tipo de exploraciones entra en conflicto con las máximas de la protección radiológica y de su código ético. Presentamos un estudio de revisión donde se analiza si estas prácticas médicas son contrarias a la ética profesional del técnico en radiología.

Abstract: The medico-legal, radiological examinations include those medical exposures to radiation conducted by court order a person who is not sick. The radiologic technologist has a duty to minimize the dose to patients and the population as a whole, therefore, make this type of exploration conflicts with the maximum of Radiation Protection and its ethical code. We present a review study where we analyze whether these medical practices are contrary to professional ethics of the Radiologic technologist.

Resumo: As explorações radiológicas médico-legais incluem aquelas exposições médicas a radiações que se realizam por ordem judicial a uma pessoa que não está doente. O técnico ou tecnólogo médico em radiologia tem o dever de minimizar a dose para os pacientes e a população como um todo; portanto, realizar este tipo de exploração entra em conflito com os princípios da proteção radiológica e de seu código de ética. Apresentamos um estudo de revisão no qual analisamos se estas práticas médicas são contrárias à ética profissional do técnico em radiologia.

[About the role of subjective factors in forensic expertise]. / O roli sub''ektivnykh faktorov v sudebnoi ekspertize.

The article examines the influence of subjective factors on the activities of a forensic expert. It is noted that to improve the objectivity and reliability of the findings of forensic experts is necessary to strictly observe the presumption of innocence, to develop guidelines for certain types of expertise, production of which is not carried out in the state forensic institutions, as well as carry out some other organizational and methodical activities.

Forensic uses of research biobanks: should donors be informed?

Occasional reports in the literature suggest that biological samples collected and stored for scientific research are sometimes accessed and used for a variety of forensic purposes. However, donors are almost never informed about this possibility. In this paper we argue that the possibility of forensic access may constitute a relevant consideration at least to some potential research subjects in deciding whether to participate in research. We make the suggestion that if some type of forensic access to research collections is likely to be perceived by the subjects as a reason against donating their biological materials, there are good ethical reasons to make this type of access impossible or at least severely restricted. We also provide an ethical argument for the claim that, if a total ban on this type of forensic access cannot be achieved, potential research subjects should be informed about the extent to which this type of forensic access is possible.

Variable Classification of Drug-Intoxication Suicides across US States: A Partial Artifact of Forensics?

BACKGROUND: The 21st-century epidemic of pharmaceutical and other drug-intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice. OBJECTIVE: To evaluate whether observed variation in the relative magnitude of drug-intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system. METHODS: This was a national, state-based, ecological study of 111,583 drug-intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) drug-intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008-2010, and derived from NCHS's Multiple Cause-of-Death public use files. RESULTS: Across states, the proportion of drug-intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined drug-intoxication death rates and corresponding suicide rates (Spearman's rho = 0.38; p<0.01). Citation of 1 or more specific drugs on the death certificate was positively associated with the relative odds of a state classifying a nonhomicide drug-intoxication death as suicide rather than accident or undetermined, adjusting for region and type of state death investigation system (odds ratio, 1.062; 95% CI,1.016-1.110). Region, too, was a significant predictor. Relative to the South, a 10% increase in drug citation was associated with 43% (95% CI,11%-83%), 41% (95% CI,7%-85%), and 33% (95% CI,1%-76%) higher odds of a suicide classification in the West, Midwest, and Northeast, respectively. CONCLUSION: Large interstate variation in the relative magnitude of nonhomicide drug-intoxication deaths classified as suicide by medical examiners and coroners in the US appears partially an artifact of geographic region and degree of toxicological assessment in the case ascertainment process. Etiologic understanding and prevention of drug-induced suicides and other drug-intoxication deaths first require rigorous standardization involving accurate concepts, definitions, and case ascertainment.

Ética en donación de órganos: una alianza rentable / Ethics in organ donation: a symbiotic partnership

Los trasplantes de órganos son un gran avance de la medicina contemporánea. Sin embargo, para poder seguir creciendo y llegar a la autosuficiencia, es preciso que las actuaciones de los profesionales sanitarios tengan máximos estándares éticos. Solo así, con la población que confía en sus instituciones y en sus profesionales, se podrán atender las crecientes necesidades de trasplantes. Los conflictos éticos con la determinación de la muerte, la utilización de órganos de donantes con criterios expandidos, el trasplante con donantes vivos o por la asignación de órganos, deben poder resolverse atendiendo a protocolos que, permanentemente actualizados, permitan acreditar que la equidad, la beneficencia, la autonomía y la no maleficencia han sido contempladas en caso de conflictos. Si se hace bien, la capacidad teórica de donación alcanzará máximos, ya que la confianza entre población y profesionales sanitarios será óptima (AU)

Organ transplants represent extraordinary progress of modern medicine. However, in order to grow and become self-sufficient, it is necessary that the actions of health professionals have highest ethical standards. When people trust their institutions and their professionals, they will meet the needs of transplants. Ethical conflicts with the determination of death, the use of organs from expanded criteria donors, transplantation with living donors or organ allocation, should be able to be resolved with updated protocols, allowing establish that equity, autonomy, beneficence and justice, have been referred to in case of conflicts. If done well, improvements in donation will reach highs as trust between population and health professionals will be optimal (AU)