The purpose of the investigation was to examine the utilization of the Danish legislation concerning access to case records by means of a prospective registration and questionnaire. During the investigation-period (1.3.1987-29.02.1988) 50 requests were made of which only one was refused for a limited period. The patients requesting to read their records differed from the total population of hospitalized patients as regards diagnosis as significantly more schizofrenic and fewer patients with diagnoses of drug abuse, were found. One of the 32 patients who actually read their records became more psychotic afterwards and two patients stated that they had become agitated. However, 15 patients felt calmer and 29 patients (90.6%) stated that the purpose of requesting access to their records had been fulfilled. The overall impression is that the law, which came into effect 1.1.1987, has functioned adequately although a more restrictive attitude would perhaps have reduced the negative influence on the psychotic conditions observed in three patients.
During 1987, all requests for access to case records at the Psychiatric Hospital in Vordingborg were registered prospectively. Fifty-nine patients made a total of 69 requests for access to case records. The total time used by the staff in connection with the requests was 51 hours and 47 minutes. Of all the patients admitted to the hospital in 1987 only 3.7% asked for access to case records. No serious problems in relation to this were registered. There was a significant tendency for the younger patients, the patients with non-psychotic disorders, and especially patients with borderline disorders to ask for access to their records more frequently.
The Community Care Access Centre (CCAC) of Waterloo Region, in partnership with a number of other social service agencies, designed and implemented a restorative justice model applicable to older adults who have been abused by an individual in a position of trust. The project was very successful in building partnerships, as many community agencies came together to deal with the problem of elder abuse. The program also raised the profile of elder abuse in the community. However, despite intensive efforts, referrals to the restorative justice program were quite low. Because of this, the program moved to a new organizational model, the Elder Abuse Response Team (EART), which has retained the guiding philosophy of restorative justice but has broadened the mandate. The team has evolved into a conflict management system that has multiple points of entry for cases and multiple options for dealing with elder abuse. The team has developed a broad range of community partners who can facilitate referrals to the EART and also can help to provide an individualized response to each case. The transition to the EART has been successful, and the number of referrals has increased significantly.
The exercise of compulsory powers for the protection of society against the spread of infectious diseases may impose severe restrictions on individual liberty. The law should therefore enable public health officials to strike the proper balance between public health and individual rights. An overview of the infectious diseases control legislation of five European countries (Germany, Switzerland, England, Sweden and the Netherlands) shows outdated medical approaches to infectious diseases, deficiencies in substantive statutory criteria and a lack of suitable procedural protection. The law has to be modified not only to fit current epidemiological insights, but also to give full weight to evolving individual rights.
One of the most difficult problems facing physicians is how to approach proxy decisions made on behalf of congenitally incompetent patients. The author considers two recent court cases that attempt to provide guidelines: Re Stephen Dawson, which opts for a substituted-judgement approach, and Eve v. Mrs E.) which injoins best-interests considerations. The author explores the impact of Eve v. Mrs. E. as superseding Re Stephen Dawson, considers its ethical implications and attempts to clarify the best-interests criterion by sketching some guidelines for its interpretation. In so doing, he tries to reconcile the two decisions by laying bare their common underlying ethical rationale. The author concludes by pointing out some ethically questionable implications of Eve v. Mrs. E. in the area of allocation of health care resources.
Notes
Cites: Can Med Assoc J. 1983 Oct 15;129(8):815-86225505
Cites: Health Law Can. 1980 Autumn;1(3):49-5210309454
