医院感染管理中涉及的法律问题及应对研究

目的调研医护人员对医院感染相关内容的认知,提高法律意识,采取有效措施,防范医疗纠纷的发生。方法采用调查问卷方式,对2016年3月-5月医院500名医护人员进行调查,重点了解对医院感染概念、相关法律法规、患者知情权和隐私权、可能会引发医疗纠纷的相关因素,如建筑布局、消毒隔离措施、侵入性操作、手卫生、环境物品清洁消毒、医疗废物处置、病历书写记录等的知晓程度。结果 100%调查对象知道院感概念,大部分医护人员不熟悉相关法律法规,认为院感不会引起纠纷,只属于高危因素,其中,对建筑布局分区以及患者的知情权和隐私权可能会引起医院感染相关纠纷的认识最为薄弱。结论加强医院感染相关法律、法规培训,利用管理工具,建立多部门协作机制,提高执行力,特别是对重点科室、重点环节的管理,从而有效降低医院感染发生,避免可能引发的纠纷以及法律风险。     

Substance abuse and control in the United States: ethical and legal issues.

In 1986, the United States began to wage its most recent War on Drugs. This has involved establishing various policies and making investments to implement these policies and approaches. In general, the U.S. has taken a tough-guy stand to drug abuse and control that emphasizes punishment, restriction, and 'social warfare', as opposed to a public health oriented position. Current policy reflects a 'quick fix' solution to a complex problem, which may partially explain its failure and why we appear to be losing the War on Drugs. In this review I summarize the current debates and controversies surrounding drug abuse in the U.S. regarding the extent of the drug problem, the need for drug control, prevention efforts, legalization controversy, workplace strategies, treatment dilemmas, and maternal drug abuse. I argue that a radically different approach must be taken that is grounded in public health methods and an appreciation of the larger social context in which drug abuse occurs. We must look for a long-term solution to this complex problem that is integrated into society, and which is certainly resistant to the current quick fix approaches.     

Brain death: medical and legal issues

Irreversible cessation of brain function has become a widely accepted criterion of death. Case law, state statutes, and medical opinion, backed by clinical studies, all support the use of brain death criteria as a means of determining death. Current state statutes are in need of some uniformity, as 12 different statutory approaches to brain death are currently in use. Brain death should not be confused with the still unresolved issue of termination of life support to terminally ill, mentally incompetent patients, or those who are comatose yet do not meet brain death criteria.     

Ethical and legal issues in the control of drug abuse and drug trafficking: the Nigerian case.

This paper presents a general review of drug law and policy in Nigeria beginning with the international attempts to control the traffic in liquor during the pre-colonial and colonial periods. The paper assesses the impact of penal policy on trafficking and use of illicit drugs at different stages in the transformation of Nigeria from a colonial outpost to an independent nation. One persistent feature of drug control mechanisms in Nigeria has been the emphasis on the reduction of supply with the imposition of harsh though inconsistent punishment including, at one time, the death penalty for trafficking. Consequently, initiatives aimed at demand reduction through education, treatment and rehabilitation have been neglected. One reason for this is that, to a great extent, drug control strategy in modern Nigeria has been a response to international demands; another is that they were formulated under military regimes with an overriding concern for law and order. Other features of the Nigerian drug problem are presented and the need for the reform of current laws is stressed. It is argued that an enduring solution lies in the implementation of a comprehensive but clearly defined policy aimed both at the control of supply and reduction of demand. While the state has the duty and the right to protect its citizens from drug-related harm, it is an ethical imperative to institute control measures which do no harm to the citizens they are meant to protect.     

Contaminated land liability issues: legal perspective.

Until recently, companies that contaminated land faced little prospect of being prosecuted or having claims made against them for any personal injuries or property damage arising from the contamination. Most companies would have considered it to be inconceivable that they could be required to clean up contamination resulting from an historic disposal, particularly if the disposal had been neither negligent nor unlawful. Current environmental law differs significantly, however, from the law which existed even 10 years ago. This paper examines liabilities arising from contaminated land. First, it discusses the new contaminated land regime and a parallel regime to remediate sites that are contaminated with radioactive substances. Second, it discusses remediation liabilities for water pollution. Such liabilities may well involve the remediation of contaminated land when groundwater is polluted. Finally, the paper examines liabilities for property damage and personal injuries arising from contamination by radioactive substances.     

Xenotransplantation and public health: identifying the legal issues.

The debate over the acceptability of clinical trials for xenotransplantation has focussed primarily on analyses of: 1) the medical benefits that might accrue to individual patients in need of organ replacement therapy; 2) the risk of introducing new infectious disease(s) into the population; and 3) the ability of public safety measures to minimize that risk. It is now generally accepted that if we are to proceed with xenobiotechnology, sufficient public safety measures must first be adopted. Despite the growing consensus as to the indispensability of scientific safeguards, few authors have questioned the ability of current or novel legal frameworks to sustain and enforce such safeguards. A legal analysis of the public health concerns must be incorporated into the debate if we are to ensure a thorough and responsible decision-making process.     

Wrongful birth and wrongful conception: the legal and moral issues

This is a summary review of the various legal, moral and policy issues that have contributed to changes in the courts' enactment of legislation on wrongful-birth and wrongful-conception suits in the United States. Both cases represent the Supreme Court's recognition of personal injury claims by parents who have received inadequate medical care that has led to the birth of an imparied or unplanned child. In wrongful-birth cases, the parents assert that if they had received proper genetic counseling or testing, the child's birth could have been avoided. Parents involved in litigation of this type argue that the doctor's negligence prevented them from making such decisions, and that they should be compensated for the financial hardships and emotional suffering they experience as a result of his mistake. In such claims, the physician is charged with malpractice, an aspect of the law of torts which gives the injured party the right to seek financial compensation for that injury. Generally, state courts have allowed parents to recover the costs of medical care and of training and treatment for the handicapped child. Similarly, state courts now routinely recognize the wrongful-conception claims of parents who seek damages from a doctor or pharmacist after the birth of a healthy but unplanned child, born as a result of a failed sterilization or abortion. The recognition of wrongful-birth claims is closely linked to the legalization of abortion and the refinement of diagnostic tests, e.g., amniocentesis, that can detect many genetic diseases before birth. Such legislation is due to changes i opinion since 1967 and was strongly reinforced by the Supreme Court's concurrent decisions that it is a couples' constitutional right to decide whether or not to have a child and whether or not to use contraceptives to prevent conception. The major controversy today in this type of claims is over the amount of damages the parents may recover. Some states have passed legislation barring such claims due to the influence of right-to-life groups. They contend that such barring legislation is necessary to protect doctors who are morally opposed to abortion from having to provide information that might lead to such a practice. Pro-life proponents also argue that the recognition of such claims compels doctors to seek out and abort imperfect fetuses to avoid possible financial liability, and that human life no matter how severely handicapped, or unwanted, should be valued and protected.     

SARS遭遇法律问题

在防治“非典”过程中，不断出台一系列法律法规及规范性文件，无疑依法防非的强有力的法律武器，但仍有一些问值得探讨。这些问题主要反映在医疗救治过程中的民事律纠纷与组织抗”非典”过程中的行政法律关系上。     

Children as organ donors: legal rights and ethical issues

As the number of children in need of organ transplants increases as a result of medical advances, so does the demand for organs that can be used in transplantation. In the face of compelling medical need, prospective donors as well as prospective recipients are subject to strong pressures. Social workers can play a large role in protecting the rights and interests of both groups of young clients.     

The anencephalic newborn: medical/legal and bioethical issues

Anencephaly, a severe congenital malformation, is frequently associated with other malformations not involving the central nervous system. Diagnosis is usually antenatal and expectation of life is very short. This article reviews noted cases reported in the past two decades, examines bioethical opinions, as well as ethical and medico-legal questions in relation to current Italian law, including medical professional responsibility and the 'slippery slope' of issues concerning the anencephalic newborn as organ donor.