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3.
BMC Med Ethics ; 23(1): 16, 2022 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-35246129

RESUMO

BACKGROUND: Defensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians' ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour. METHODS: A qualitative interview study investigated the views and experiences of physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in 'Choosing Wisely' initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change. RESULTS: All participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians' perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians' desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences. CONCLUSIONS: The findings call for strengthening knowledge and skills, for example, to improve clinicians' understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care.


Assuntos
Medicina Defensiva , Médicos , Austrália , Medo , Humanos , Advogados , Médicos/psicologia , Pesquisa Qualitativa
4.
J Law Med Ethics ; 50(1): 157-168, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35243986

RESUMO

Attorneys regularly prepare advance healthcare directives for their clients. However, attorneys, lacking medical knowledge, are often considered ill-equipped to prepare such documents. While recognizing and respecting the fact that advance healthcare directives pertain to decisions about medical care, this article proposes that attorneys who prepare advance healthcare directives nevertheless provide a valuable service.


Assuntos
Diretivas Antecipadas , Advogados , Atenção à Saúde , Dissidências e Disputas , Humanos , Respeito
5.
BMC Health Serv Res ; 22(1): 210, 2022 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-35172814

RESUMO

BACKGROUND: Medical legal partnerships provide an opportunity to help address various social determinants of health; however, the traditional practice of screening patients during clinical encounters is limited by the capacity of busy clinicians. Our medical legal partnership utilized care coordinators trained by the legal service attorneys to screen patients outside of clinical encounters for health harming legal needs. The goal of our study was to demonstrate that our novel model could successfully identify and refer patients of a safety-net healthcare system to appropriate legal services. METHODS: We conducted a mixed methods evaluation of the program. Data was collected during the implementation period of the program from March 2017 to August 2018. Operational data collected included number of patients screened, number of referrals to the legal partner, source and reason for referrals. Return on investment was calculated by subtracting program costs from the total reimbursement to the health system from clients' insurance benefits secured through legal services. RESULTS: During the 18-month study, 29,268 patients were screened by care coordinators for health harming legal needs, with 492 patients (1.7%) referred for legal assistance. Of the 133 cases closed in 2017, all clients were invited to participate in a telephone interview; 63 pre-consented to contact, 33 were successfully contacted and 23 completed the interview. The majority (57%) reported a satisfactory resolution of their legal barrier to health. This was accompanied by an improvement in self-reported health with a decrease of patients reporting less than optimal health from 16 (89%) prior to intervention to 8 (44%) after intervention [risk ratio (95% confidence interval): 0.20 (0.04, 0.91)]. Patients also reported improvements in general well-being for themselves and their family. The healthcare system recorded a 263% return on investment. CONCLUSIONS: In our medical legal partnership, screening for health harming legal needs by care coordinators outside of a clinical encounter allowed for efficient screening in a high risk population. The legal services intervention was associated with improvements in self-reported health and family well-being when compared to previous models. The return on investment was substantial.


Assuntos
Atenção à Saúde , Serviços Jurídicos , Humanos , Advogados , Programas de Rastreamento , Encaminhamento e Consulta
6.
J Cancer Surviv ; 16(1): 165-182, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35107800

RESUMO

PURPOSE: Given the training and experience of lawyers, we assumed that a study of lawyers' willingness to disclose disability in the workplace would provide an example of the actions of a group knowledgeable about disability law. The current study accounts for the effect of visibility of disability, onset and type of disability, and whether the lawyer has made an accommodation request. We also investigate the role of other individual characteristics, such as sexual orientation, gender identity, race/ethnicity, age, and job-related characteristics, in willingness to disclose. METHODS: We use data from the first phase of a longitudinal national survey of lawyers in the USA to estimate the odds of disclosing disability to co-workers, management, and clients using proportional odds models. RESULTS: Lawyers with less visible disabilities, those with mental health disabilities, and those who work for smaller organizations have lower odds of disclosing to co-workers, management, and clients as compared to their counterparts. Attorneys who have requested accommodations are more willing to disclose as compared to those who have not, but only to co-workers and management. Women are less likely than men to disclose to management and clients. However, gender is not a significant determinant of disclosure to co-workers. Older attorneys are more likely to disclose to clients, whereas attorneys with children are less likely to disclose to co-workers. Lastly, lower perceived prejudice and the presence of co-workers with disabilities are associated with higher disclosure scores, but not for all groups. CONCLUSIONS: Individuals who acquired a disability at a relatively early point in life and those with more visible disabilities are more likely to disclose. However, such willingness is affected by the intersection of disability with other individual and firm-level characteristics. IMPLICATIONS FOR CANCER SURVIVORS: The findings imply that those with less visible disabilities and with health conditions acquired later in life are less likely to disclose. The relevance of the findings is heightened by the altered work conditions and demands imposed by the COVID-19 pandemic for cancer survivors.


Assuntos
COVID-19 , Pessoas com Deficiência , Neoplasias , Minorias Sexuais e de Gênero , Criança , Diversidade Cultural , Revelação , Feminino , Identidade de Gênero , Humanos , Advogados , Masculino , Pandemias , SARS-CoV-2
7.
Hist Psychol ; 25(2): 143-169, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34726443

RESUMO

The history of the psychology of eyewitness testimony cannot be adequately understood without taking the respective legal systems, that is inquisitorial versus adversarial system, into account. Across all periods, questions regarding the accuracy of testimony, its suggestibility, and intentional distortions in false accusations become apparent. We describe the history of the experimental psychology of testimony in Germany from the beginning of the 20th century until the time after the second world war. Louis William Stern and Otto Lipmann conceived and established a broad conception of Aussagepsychologie (psychology of report), attracting the collaboration of lawyers, pedagogues, and scholars from other disciplines to conduct laboratory and staged event experiments. They were successful in institutionalizing psychology and law by organizing interdisciplinary conferences, founding a journal, and testifying as experts in court. When appearing as experts, they encountered strong rivalry from psychiatrists. We also sketch some of the problems psychologists in Germany faced during the second world war. In our discussion, we stress the importance of legal, contextual, and sociocultural factors affecting both research outcomes and expert testimony, which appear to be parallel to present-day concerns. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Prova Pericial , Psiquiatria , Alemanha , História do Século XX , Humanos , Aplicação da Lei , Advogados , Psicologia
8.
Ethn Health ; 27(2): 453-462, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32126801

RESUMO

OBJECTIVES: Given the ethnic/racial disparities in end-of-life care, this study aimed to describe and identify factors affecting engagement in three types of advance care planning including informal talk, living will, and durable power of attorney for health care among ethnic/racial minority older adults. Living will refers to any written instruction about medical treatments at the end-of-life while durable power of attorney for health care allows someone to make a health care decision when an individual is incapable of making a reasoned decision. DESIGN: We used a subset of racial/ethnic minority groups drawn from the second wave of the National Health Aging and Trends Survey (n = 543) collected in 2012. RESULTS: The descriptive result showed that informal talk (60%) happened most followed by durable power of attorney for health care (30%) and living will (26.5%) completion. Multivariate logistic regression analyses found that higher education and lower preference toward life-sustaining treatment were associated with engagement in all three types of advance care planning. Having multimorbidity and U.S. born were associated with having informal talk. Non-Hispanic others were more likely to have informal talk and complete durable power of attoreny for health care to compared to Blacks. Furthermore, married older adults were more likely to complete living wills compared to those separated/divorced or never married. CONCLUSIONS: Our findings about different factors affecting engagement in advance care planning indicate that we may need targeted approaches to promote each type of advance care planning for ethnic/racial minority older adults.


Assuntos
Planejamento Antecipado de Cuidados , Testamentos Quanto à Vida , Diretivas Antecipadas , Idoso , Atenção à Saúde , Humanos , Advogados , Grupos Minoritários , Prevalência
9.
J Law Med ; 29(1): 156-172, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35362285

RESUMO

Legal services can play a critical role in facilitating claimant access to entitlements and shaping claimant experiences and outcomes in compensation settings. However, much remains unknown about claimants' goals in engaging legal services, experiences of using legal services, and satisfaction with legal advisers. Drawing on semi-structured interviews with claimants in the road traffic injury compensation scheme in the State of Victoria, Australia, this article identified that most claimants engaged legal services to access entitlements when they struggled to do so alone. Claimants often had little understanding of the activities performed by their lawyers: despite this, most viewed legal service use as valuable or worthwhile in terms of outcomes achieved. Claimants' experiences and levels of satisfaction were coloured by the quantity and quality of communication between themselves and their legal representatives. The findings highlight opportunities for schemes, lawyers, and legal profession regulators to increase the responsiveness of services to claimants' needs.


Assuntos
Advogados , Humanos , Vitória
10.
J Occup Environ Med ; 63(12): e871-e882, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34860207

RESUMO

OBJECTIVES: Two studies were conducted to determine whether mindfulness meditation could be an effective tool for improving well-being among legal professionals-a population plagued by high rates of depression, anxiety, and stress. METHODS: Study 1. Legal professionals completed questionnaires before and after an 8-week mindfulness program. Study 2. Lawyers were randomly assigned to either an experimental or waitlist condition. Questionnaires were administered at the beginning of the study and after experimental participants had completed a 30-day intervention. RESULTS: Study 1. Participants reported significant improvements in mood, resilience, trait mindfulness, stress, anxiety, and depression over time. Study 2. Post-intervention, experimental participants reported better mood, lower levels of stress, and higher levels of non-reactivity and observing than waitlist participants. CONCLUSIONS: Mindfulness and meditation may effectively improve well-being among legal professionals.


Assuntos
Meditação , Atenção Plena , Ansiedade/prevenção & controle , Depressão/prevenção & controle , Humanos , Advogados , Autorrelato , Estresse Psicológico/prevenção & controle
11.
J Health Care Poor Underserved ; 32(4): 1720-1733, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34803038

RESUMO

Medical-legal partnerships (MLP) address legal needs that contribute to health inequities. Health providers express discomfort accessing legal services and a desire for greater training, however best practices remain unclear. METHODS: We conducted a scoping literature review and interviews with key informants to identify essential components of MLP training and best practices in MLP training. RESULTS: Twenty-one articles out of an initial 1,247 met criteria. Most learners were medical (11; 52%) or law (13; 62%) students or residents (12; 57%). Training was primarily led by lawyers (18; 86%). Educational approaches included didactics (15; 71%). Content was focused on skill-acquisition (18; 86%). Most training was presented as stand-alone (5; 24%) courses. Essential skills included issuespotting, adaptability, and trauma-informed care. CONCLUSION: Medical-legal partnerships make use of varied perspectives to address unmet legal needs. This review helped identify best practices in training and a need for future study on evaluation. Future research should explore how best to evaluate the effectiveness of MLP training.


Assuntos
Educação Interprofissional , Determinantes Sociais da Saúde , Humanos , Advogados
12.
Prog Community Health Partnersh ; 15(2): 203-216, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248064

RESUMO

THE PROBLEM: Marginalized populations experience health-harming legal needs-barriers to good health that require legal advocacy to overcome. Medical-legal partnerships (MLPs) embed lawyers into the healthcare team to resolve these issues, but identifying patients with health-harming legal needs is complex, and screening practices vary across MLPs.Purpose of Article: Academic and community partners who collaborate in an MLP at a school-based health center (SBHC) share their process of co-creating a two-stage legal check-up for adolescents. KEY POINTS: Screening adolescents for health-harming legal needs is challenging. It took ongoing collaboration to refine the process to fit the needs of adolescents and meet the partners' goals. CONCLUSION: Social determinants of health play a significant role in health disparities, and there is a need for innovative solutions to screen and address these in vulnerable populations. Other partners can learn from our experiences to co-create their own approach to addressing health-harming legal needs.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Advogados , Adolescente , Humanos , Pobreza , Instituições Acadêmicas , Populações Vulneráveis
13.
Am J Law Med ; 47(1): 88-90, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34247672

RESUMO

Diversity and Inclusion in the American Legal Profession: Discrimination and Bias Reported by Lawyers with Disabilities and Lawyers Who Identify as LGBTQ+ ("Blanck et al.") is an incredibly careful, thoughtful, and powerful article, and may and should lead to changes in the stigma, bias, and discrimination landscape in the legal profession.1.


Assuntos
Pessoas com Deficiência , Advogados , Humanos , Estados Unidos
14.
Am J Law Med ; 47(1): 63-70, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34247673

RESUMO

The past decade has seen numerous positive developments in both legal and policy protections for those who identify as lesbian, gay, bisexual, trans, or queer ("LGBTQ+"). Progress in this area has been decidedly uneven, however, and significant barriers still exist which thwart the full legal and societal acceptance of LGBTQ+ individuals. Unfortunately, as the groundbreaking study by Peter Blanck, Fitore Hyseni, and Fatma Altunkol Wise shows, LGBTQ+ identifying lawyers, especially those with intersectional identities, continue to experience discrimination and bias in their workplaces.1.


Assuntos
Advogados , Minorias Sexuais e de Gênero , Feminino , Humanos , Comportamento Sexual , Local de Trabalho
15.
Am J Law Med ; 47(1): 91-99, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34247675

RESUMO

Haley Moss was diagnosed with autism at age three. At the time, her parents were told that achievements such as obtaining a driver's license, graduating from high school, or even making friends were unlikely. Even after she proved the experts wrong and gained acceptance to law school, Moss saw continued challenges for students with disabilities. "I remember in my first year of law school, there was a blind student in my section, but she did not return for the second semester-and I wondered why," she told us.1 "Law school is not always as accessible as it could be for people with disabilities."2 But those people are essential to the functioning of our legal system, she added: "We need all types of minds to get all kinds of jobs done."3.


Assuntos
Pessoas com Deficiência , Advogados , Feminino , Humanos , Licenciamento
17.
Am J Law Med ; 47(1): 9-61, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34247678

RESUMO

PURPOSE: This article is part of an ongoing body of investigation examining the experiences of lawyers with diverse and multiple minority identities, with particular focus on lawyers with disabilities; lawyers who identify as lesbian, gay, bisexual, transgender, and queer ("LGBTQ+" as an overarching term); and lawyers with minority identities associated with race and ethnicity, gender, and age. The focus of this article is on discrimination and bias in their workplaces as reported by the lawyers experiencing it. METHODS: We employ survey data from the first phase of this investigation, gathered from the survey responses of 3590 lawyers located across all states in the United States and working in most types and sizes of legal venues. The data were collected between 2018 and 2019, before the 2020 pandemic. We estimate differences across three categories of discrimination reported-subtle-only discrimination, overt-only discrimination, and both subtle and overt discrimination. We estimate the nature and magnitude of associations among individual and organizational variables, and we use multinomial logistic regression to illustrate relative risks of reports of discrimination for intersecting identities. RESULTS: As compared to non-disabled lawyers, lawyers with disabilities show a higher likelihood of reporting both subtle and overt discrimination versus no discrimination. Similarly, lawyers who identify as lesbian, gay, bisexual, and queer ("LGBQ") show a higher likelihood of reporting both subtle and overtdiscrimination, and subtle-only discrimination, as compared to lawyers who identify as straight/heterosexual. Women lawyers and lawyers of color are more likely to report all three types of discrimination. In general, younger lawyers are more likely to report subtle-only discrimination when compared to older lawyers. Lawyers working at a private firm are less likely to report all types of discrimination, while working for a larger organization is associated with a higher relative risk of reporting subtle-only discrimination versus no discrimination. CONCLUSIONS: The current study represents a next, incremental step for better understanding non-monochromatic and intersectional aspects of individual identity in the legal profession. The findings illustrate that primary individual and multiple minority identities, as identified by disability, sexual orientation, gender, race/ethnicity, and age, are associated with reports of discrimination and bias in the legal workplace.


Assuntos
Pessoas com Deficiência/psicologia , Emprego , Advogados/psicologia , Preconceito , Minorias Sexuais e de Gênero/psicologia , Discriminação Social , Local de Trabalho , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Identidade de Gênero , Humanos , Advogados/estatística & dados numéricos , Masculino , Probabilidade , Minorias Sexuais e de Gênero/estatística & dados numéricos , Inclusão Social , Estigma Social , Inquéritos e Questionários , Estados Unidos
18.
Psych J ; 10(5): 707-731, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34137498

RESUMO

Past investigations have consistently demonstrated the robust stereotype-consistent effect in the circumstance of source memory but not always in item memory, including the case of professional stereotype. However, it remains unclear whether the effect still occurs in professional stereotype when considering the attributes of negative (or bad) or positive (or good); besides, it has not been concerned about how does warning work in remembering the professional stereotypical stimuli. The current experiments aimed to address these issues by adopting descriptive sentences as stimuli, which were related or unrelated to doctors and lawyers, and with different professional moral valences (negative, neutral, or positive). Item memory and source memory were tested successively. Experiment 1 without the explicit warning confirmed the reliable stereotype-consistent effect solely in source memory; the modulation of professional morality on memory behaved differently between doctor and lawyer, that is, negativity bias versus positivity bias. When giving an explicit warning (Experiment 2), the stereotype-consistent effect attenuated in the lawyer case, and the occurrence of negativity bias was sensitive to the memory task. Thus, our findings further reinforce the dual-process model; both professional morality and warning work in memory of professional stereotype, depending upon the nature of the profession, the concerned memory task, and also the presence of warning. Implications are made for future research to consider more perspectives.


Assuntos
Advogados , Memória Episódica , Humanos , Princípios Morais
19.
Law Hum Behav ; 45(2): 81-96, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34110871

RESUMO

OBJECTIVE: COVID-19 has impacted many facets of daily life and the legal system is no exception. Legal scholars have hypothesized that the effects of the pandemic may contribute to more coercive plea bargains (Cannon, 2020; Johnson, 2020). In this study, we explored defense attorneys' perceptions of whether and how the plea process has changed during the COVID-19 pandemic. HYPOTHESES: This study was exploratory, and we made no a priori hypotheses. METHOD: We surveyed 93 practicing United States defense attorneys about their perceptions of whether and how the pandemic has affected court procedures, plea-bargaining and prosecutorial behavior, and defendant decision-making. We conducted semistructured follow-up interviews with 13 defense attorneys to help contextualize the survey responses. RESULTS: The majority of defense attorneys (81%, n = 76) reported that the plea process had changed during the COVID-19 pandemic, and that they experienced difficulty contacting and communicating with their clients, especially those who were detained. Two thirds of defense attorneys (n = 42) who said the plea process had changed thought that prosecutors were offering more lenient deals. One third of defense attorneys with detained clients (n = 23) reported having had clients plead guilty due to COVID-19 related conditions who might not have under normal circumstances. CONCLUSIONS: The majority of defense attorneys reported that the COVID-19 pandemic has impacted their ability to access and advise clients, and they believed that leverage in plea negotiations had shifted further to individual prosecutors. At the same time, the attorneys reported that prosecutors were offering more lenient deals, painting a complex picture of the plea negotiation process during the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
COVID-19 , Direito Penal , Tomada de Decisões , Advogados/psicologia , Negociação , Humanos , Epidemiologia Legal , Inquéritos e Questionários , Estados Unidos/epidemiologia
20.
Law Hum Behav ; 45(2): 112-123, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34110873

RESUMO

OBJECTIVES: Research on plea bargaining is increasing, yet much of this work examines how the process unfolds in adult court. Plea bargaining in juvenile court has several notable differences such as parental involvement. Including parents throughout the adjudicatory process is encouraged but ultimately left up to the attorney. Research has not explored whether attorneys include parents in plea bargain discussions with their clients. The present study examined parental involvement in the juvenile plea bargain process. HYPOTHESES: We did not have any formal a priori hypotheses for this exploratory study. METHOD: The first author conducted qualitative interviews with eighteen defense attorneys from the juvenile division of a public defender's office on the East Coast where we discussed their most recent case that resulted in a plea bargain. RESULTS: Parents were included in plea negotiations and hearings. Attorneys described seeking parental input because parents may be impacted by the terms of the plea and because the court often seeks parental approval. During hearings, parents offered input regarding their child's ability to plea, the disposition plan, and whether they support their child's decision to plead guilty. CONCLUSIONS: Pleas might impact parents, so it may be impractical to overlook their interests. However, parent and child interests may conflict, and parents often lack understanding of their children's rights and pleading generally. Therefore, attorneys must not only advocate for their clients, but also educate and manage parents' interests both inside and outside the courtroom. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Direito Penal/métodos , Tomada de Decisões , Delinquência Juvenil , Advogados/psicologia , Negociação , Pais , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Papel (figurativo)
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