Medical certificates attesting fitness to drive

Few if any sanctions have been imposed on doctors for inappropriate certification of fitness to drive. This paper reviews a recent Tribunal decision on inappropriate certification of fitness to drive. This paper reviews the facts of the case of Medical Board of Australia v Andrew and discusses the legal implications for doctors who certify patients as fit to drive. The paper offers a necessary and timely warning that the Medical Board sought harsh sanctions, more severe than were imposed by the Tribunal, but that the Tribunal also felt compelled to impose ‘general deterrence’ to prevent inappropriate certification. The paper emphasises the need for scrupulous attention to detail and an absolute need for circumspection when assessing patients who claim to be seizure free, or who minimise impairment from a range of other conditions, insisting on clearance to be able to drive     

Valeur juridique des recommandations de bonne pratique : cas de l’hormonothérapie des cancers du sein

On April 27th 2011, the French Supreme Administrative Court (Conseil d’État) granted the Recommendations for Good Practice set out by the French National Authority for Health (Haute Autorité de santé - [HAS]) a legal status, considering that they “must be regarded as (…) decisions which may be subject to an action for annulment”. The judge came to this conclusion through a quasi-syllogistic reasoning. Firstly, the French Code of Medical Ethics requires physicians to care for their patients in accordance with established scientific knowledge. Secondly, the HAS recommendations recall in particular this established scientific knowledge. Treating patients according to established scientific knowledge requires then that physicians follow the HAS recommendations. While the case at bar does not directly involve liability for medical malpractice – since the applicant only sought to have an HAS recommendation declared void – it is nonetheless necessary to examine the impact of this ruling for health professionals. Indeed, this decision raises a number of concerns for everyday medical practice. Guidelines concerning the endocrine treatment of hormonodependant breast cancers are plentiful. In January 2010, the HAS and the French National Institute for Cancer (Institut national du cancer) issued a “Guide for long-term illnesses – Breast cancer” (Guide ALD - Cancer du sein). In addition to these nation-wide guidelines, the Regional Networks for Cancer (réseaux régionaux de cancérologie) issued their own recommendations. Other guidelines are also set out in the framework of consensus conferences, such as the Nice Saint-Paul-de-Vence (France) and St. Gallen (Switzerland) conferences. In the United States, the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO), and in Europe, the European Society of Medical Oncology (ESMO) make recommendations as well. Therefore, the HAS recommendations are hardly the sole source of information for physicians and these documents sometimes contradict each other. Besides, these can quickly become obsolete, what still limits their relevance. Nevertheless, in the judge's mind, there is no place for conflicting interpretations; scientific knowledge must be consistent, homogeneous and objective. However, the reality is quite the opposite. This simplistic vision shared by judges does not seem to grasp the complexity of everyday medical practice. After a critical reading of the Conseil d’État judgment, we shall consider the potential issues and concerns raised by this ruling in medical practice using the example of hormone therapy for breast cancer patients.     

Drugs on the Internet,Part V: Absinthe,Return of the Emerald Mask

Absinthe, a famous liquor of the 19th century, has become immensely popular with its return to legality and mass marketing and drug culture enhancement of its purported unique effects. The electronic world of the Internet has greatly expedited the extent and depth of societal knowledge about the allure of the green fairy, absinthe. An extensive number of websites exists, representing 22 categories of topics about or using the word absinthe. Recent research has dispelled many myths about absinthe and its effects, yet beliefs about its magical powers persist, thus maintaining its reputation as an extraordinary experience within a bohemian lifestyle.     

药品缺陷侵权法律问题与对策研究——以权利救济为视角

目的 解决药品缺陷侵权的权利救济问题，保障用药患者的合法权利。方法 梳理药品缺陷侵权的立法现状与权利救济现状，分析中国药品缺陷侵权权利救济存在的问题，并针对问题提出相应的解决措施。结果 药品缺陷侵权的相关立法不完善，权利救济案件数量少且成功率低，权利救济现实情况堪忧。药品缺陷概念缺失与认定标准不明确、侵权归责原则不明、举证责任分配不合理、救济途径单一以及药品缺陷认定困难是药品缺陷侵权在权利救济方面存在的现实问题。结论 药品缺陷侵权的权利救济问题不容忽视，必须通过明确药品缺陷概念与认定标准、完善药品缺陷的归责原则立法、拓宽救济途径、完善药品鉴定制度以及建立、健全多元救济体系等措施，对药品缺陷侵权问题加以规制，从而提高药品服务的质量，保证用药安全。     

Checking and Balancing New Zealand's Mental Health Review Tribunal: Perspectives of Forensic Patients

The aim of the study was to examine perspectives of forensic patients who applied for Mental Health Review Tribunal (MHRT) hearings regarding their compulsory detention in New Zealand. Ten participants were identified; semistructured interviews were completed; and a thematic analysis was performed. The participants described variable understanding of the process and scope of the MHRT. They explained why they applied for hearings, including to resolve disputes with clinicians regarding aspects of their care and the desire to expedite examination of their compulsory status. In some instances, the participants described feelings of distress and powerlessness regarding the process and outcome of the hearings. They also discussed the impact of the process upon the therapeutic relationships with their treatment teams. It emerged as important for patients to understand the limited functions of the MHRT. Written and other accessible forms of information may be helpful in this regard. For participants, the application process and hearing had variable value and utility, although some participants reported that the MHRT afforded them dignity because they had the right to challenge their compulsory detention.     

Tipping the Scales: How Defendant Body Type May Result in Eyewitness Biases

Body type is often overlooked as a basis for discrimination and has rarely been examined in legal contexts. The present research examined the role of body type on eyewitness line-up misidentification. Participants watched a video of a violent crime or theft and were asked to select the defendant out of a suspect-absent line-up. The lineup included digitally altered photos displaying muscular, normal weight, and overweight defendants. Muscular defendants were most likely to be mistakenly selected out of the simultaneous line-up, and overweight defendants were least likely to be selected. These results indicate that body type may be a biasing factor in comparative eyewitness evaluations.     

A Legal Approach to Cancer Epidemiology in Public Health

The Public Health Act encompasses scientific research and law enforcement as causes, distributions, and preventive factors for diseases and injuries of a particular population. Today, the Public Health Law is growing into a field that expects to cultivate and utilize lawful practitioners who can apply specialized legal skills in health policy development and public health performance. The multidisciplinary approach of the Public Health Act integrates the legal and scientific elements of the field and the workforce, characterized by a more dynamic understanding of the health impact of legislation and the rapid deployment of effective policies. Thus, legal health interventions that manage and treat diverse populations need to be evaluated more rigorously and quickly. In addition, funding for policy surveillance and other legislation and policy mapping needs to be more sophisticated to maximize utility and avoid duplication. This study investigated legal interventions to manage and treat various groups of populations for health and discussed the necessity of public health laws.     

When Artificial Intelligence Models Surpass Physician Performance: Medical Malpractice Liability in an Era of Advanced Artificial Intelligence

It seems inevitable that diagnostic and recommender artificial intelligence models will ultimately reach a point when they outperform human clinicians. Just as antibiotics displaced a host of medicinals for treating infections, the superior performance of such models will force their adoption. This article contemplates certain ethical and legal implications bearing on that adoption, especially because they involve a clinician’s exposure to allegations of malpractice. The article discusses four relevant considerations: (1) the imperative of using explainable artificial intelligence models in clinical care, (2) specific strategies for diminishing liability when a clinician agrees or disagrees with a model’s findings or recommendations but the patient nevertheless experiences a poor outcome, (3) relieving liability through legislation or regulation, and (4) comprehending such models as “persons” and therefore as potential defendants in legal proceedings. We conclude with observations on clinician–vendor relationships and argue that, although advanced artificial intelligence models have not yet arrived, clinicians must begin considering their implications now.     

Characterization and in vitro phase I microsomal metabolism of designer benzodiazepines: An update comprising flunitrazolam,norflurazepam, and 4'‐chlorodiazepam (Ro5–4864)

The number of newly appearing benzodiazepine derivatives on the new psychoactive substances (NPS) drug market has increased over the last couple of years totaling 23 ‘designer benzodiazepines’ monitored at the end of 2017 by the European Monitoring Centre for Drugs and Drug Addiction. In the present study, three benzodiazepines [flunitrazolam, norflurazepam, and 4′‐chlorodiazepam (Ro5–4864)] offered as ‘research chemicals' on the Internet were characterized and their main in vitro phase I metabolites tentatively identified after incubation with pooled human liver microsomes. For all compounds, the structural formula declared by the vendor was confirmed by gas chromatography?mass spectrometry (GC–MS), liquid chromatography?tandem mass spectrometry (LC MS/MS), liquid chromatography?quadrupole time of flight?mass spectrometry (LC?QTOF?MS) analysis and nuclear magnetic resonance (NMR) spectroscopy. The metabolic steps of flunitrazolam were monohydroxylation, dihydroxylation, and reduction of the nitro function. The detected in vitro phase I metabolites of norflurazepam were hydroxynorflurazepam and dihydroxynorflurazepam. 4’‐Chlorodiazepam biotransformation consisted of N‐dealkylation and hydroxylation. It has to be noted that 4′‐chlorodiazepam and its metabolites show almost identical LC–MS/MS fragmentation patterns to diclazepam and its metabolites (delorazepam, lormetazepam, and lorazepam), making a sufficient chromatographic separation inevitable. Sale of norflurazepam, the metabolite of the prescribed benzodiazepines flurazepam and fludiazepam, presents the risk of incorrect interpretation of analytical findings.     

Mycobacterium Chimaera: Clinical and medico-legal considerations starting from a case of sudden acoustic damage

Mycobacterium Chimaera is a microorganism that can cause nosocomial infections particularly in patients undergoing cardiac surgery. The specific case presented herein shows an original clinical presentation of the infection: sudden unilateral deafness as a result of septic embolization. Medico-legal experts appointed by the court in a civil liability dispute analyzed the case and submitted their expert opinion. This article analyzes the peculiar and innovative aspect of professional liability that can be attributed to the healthcare facility and the manufacturer of the equipment used in the operating room from a medical-legal point of view.