Boundaries, Blackmail, And Double Binds: A Pattern Observed In Malpractice Consultation.

Abstract

A scenario common to several boundary violation/sexual misconduct cases is reviewed and discussed. Common features include an articulate patient whose high functionality concealed more primitive dynamics that arose in the therapy; boundary problems, often on an “attempted rescue” basis; and eventual litigation in some form. The patient's high functioning appeared to cause the therapists to underestimate the severity of the patients' disturbances. Drawing on forensic experience, the author analyses the cases and suggests risk management approaches.

In malpractice prevention and risk management consultation, boundary questions are a very common concern among consultees. Such questions account for a considerable portion of legal and ethics-related difficulties for clinicians. The subject has been extensively discussed in the professional literature (see, for example, Refs. 1–10).

Over time, a particular pattern has emerged that seems to pose repeated problems and create familiar pitfalls for the therapists involved. This review lays out the pattern and indicates...

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Boundary Crossings and Violations in Clinical Settings

Abstract

Principles of beneficence, autonomy, and nonmaleficence, compassion along with fiduciary partnership are the core concepts in the doctor-patient relationship in therapeutic settings. There are varieties of reasons for boundary problems. Physicians ignorance, exploitative character, emotional vulnerability moral weakness and similar factors may pave the way for boundary issues resulting in nonsexual or sexual boundary crossings and violations.

INTRODUCTION

Physicians are held in great esteem and respect by the society. It is the duty of the medical personnel to discharge their duties toward the billions of suffering from physical or psychological disorders, with a sense of commitment and without damaging the values of ethics. The behavior of the physicians toward their clients must be consistent in all aspects with the norms of the society and culture they live. Physicians are bound to abide by Hippocratic Oath. The Hippocratic Oath is an oath historically taken by doctors swearing to practice medicine ethically.[1]...

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Determination Of Time Since Deposition Of Blood Stains

Introduction

DNA analysis has revolutionized the field of Forensic Science by allowing for unambiguous identification of the person from whom a biological sample has been obtained. DNA provides a spatial link between a suspect and a crime scene or other location relative to a crime investigation. In many instances, this information is sufficient for conviction of the perpetrator of a crime. The limitation of traditional DNA, however, is that it provides no information on when the biological material was deposited. It only indicates that, some time in the past, the person visited the scene, it could have been months or years before the material was collected. Temporal linkage between the biological material and the commission of a crime is especially important in situations involving victims and suspects with close personal ties. In these instances, finding biological material from the suspect in the home or other pertinent location associated with the victim is not unexpected....

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The Management Of Stab Wounds To The Back.

Abstract

The management of stab wounds to the back is controversial. There are certain clear indications for exploratory laparotomy, but most cases require a diagnostic workup and a period of observation. In this article, different diagnostic modalities are presented, including local wound exploration, diagnostic peritoneal lavage, abdominal computed tomography (CT) scan, triple-contrast abdominal CT scan, and intravenous pyelography (IVP). Recommendations for management are given, with emphasis on abdominal CT scan and observation.

Management of stab wounds of the back and flank.

Abstract

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries.

See Also: : Management Of Stab Wounds Of The Back And Flank.

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Following Blood Trails: A SAR Perspective

Authors „ Unless otherwise noted, this presentation is based upon the research and field work of Mark Gleason and C. Steve Frye. The presentation was created by Mark Gleason.

„Both are members of the Virginia-based Search and Rescue Tracking Institute (www.sarti.us). „ This presentation may be used by others for educational purposes, with proper credit given to the authors or referenced sources.

Credits and Thanks

„Photographs on slides 19-22 are used with the expressed permission of Joe Slemko, of J. Slemko Forensic Consulting. email: jslemko@bloodspatter.com; website: www.bloodspatter.com

„Poke Week photograph from Kevin Brewer. Information regarding the properties of blood, wounds, and blood clotting was obtained, in part, from discussions with Dr. K. Miller, Search and Rescue Tracking Institute. „ Information regarding types of wounds and resulting blood trails are from the work of Tyron J. Cunningham from his 2004 publication entitled, “Scout Craft and Scout Tracking...

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Pharmacology of Neuromuscular Blocking Drugs

Abstract

Neuromuscular blocking drugs (NMBDs) have become an established part of anaesthetic practice since Griffith and Johnson in Montreal first described the use of curare to facilitate muscle relaxation in a healthy man undergoing an appendicectomy in 1942....

Depolarizing NMBDs

Mechanism of action

Depolarizing drugs are agonists at ACh receptors. Succinylcholine is the only depolarizing NMBD in clinical use. It is effectively two ACh molecules joined through the acetate methyl groups. The two quaternary ammonium radicals bind to the two α-subunits of one nicotinic receptor, and depolarization occurs. When voltage-sensitive sodium channels sense membrane depolarization (as a result of activation of the ACh receptors), they first open (Fig. 1A(b)) and thereafter close and become inactivated (Fig. 1A(c)). The membrane potential must be reset before the sodium channels can be reactivated (Fig. 1A(a)). This is a very rapid process with ACh (1 ms), as it is hydrolysed by acetylcholinesterase (AChE) within the synaptic cleft...

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Calculating Consequences:The Utilitarian Approach to Ethics

Emagine that the U.S. Central Intelligence Agency gets wind of a plot to set off a dirty bomb in a major American city. Agents capture a suspect who, they believe, has information about where the bomb is planted. Is it permissible for them to torture the suspect into revealing the bomb's whereabouts? Can the dignity of one individual be violated in order to save many others?

Greatest Balance of Goods Over Harms

If you answered yes, you were probably using a form of moral reasoning called "utilitarianism." Stripped down to its essentials, utilitarianism is a moral principle that holds that the morally right course of action in any situation is the one that produces the greatest balance of benefits over harms for everyone affected. So long as a course of action produces maximum benefits for everyone, utilitarianism does not care whether the benefits are produced by lies, manipulation, or coercion....

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The Talking Dead: 4 Observations About the Dying Declaration Exception Based on the Advisory Committee’s Notes

Federal Rule of Evidence 804(b)(2) provides an exception to the rule against hearsay

In a prosecution for homicide or in a civil case, [for] a statement that the declarant, while believing the declarant’s death to be imminent, made about its cause or circumstances.

Working off of my post from yesterday about dying declarations being admissible for ("The defendant didn't do it") and against ("The defendant didn't do it"), I wanted to take a look at the Advisory Committee's Note to Rule 804.

In that Note, we first have the Committee in part justifying the former testimony exception by reference to the dying declaration exception:

Falknor concluded that, if a dying declaration untested by cross-examination is constitutionally admissible, former testimony tested by the cross-examination of one similarly situated does not offend against confrontation....The constitutional acceptability of dying declarations has often been conceded.

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Unreliable Admissions To Homicide. A Case Of Misdiagnosis Of Amnesia And Misuse Of Abreaction Technique.

Abstract

BACKGROUND The past decade has witnessed a recognition that unsafe criminal convictions may be occasioned by unreliable confessions.

AIMS To present a case which illustrates the dangers of using abreaction interview techniques in a legal context and demonstrate the relevance of the memory distrust syndrome to an unsafe confession to murder.

METHOD We under took a detailed assessment of a person appealing against his original murder conviction, 'the appellant', and a careful scrutiny of all the relevant papers in the case.

RESULTS The appellant served 25 years in prison before his conviction was quashed as 'unsafe' on the basis of fresh psychological and psychiatric evidence.

CONCLUSIONS Amnesia for an offence had been misdiagnosed, and the use of repeated abreaction interviews had further confused both the appellant and the original court. At the Appeal Court, the advice was that the man had experienced a form of source amnesia which resulted in an unreliable confession.

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The Sudden Murderer A Comparative Analysis

Abstract

In this study, the “sudden murderer” is defined as a person who, without having been involved in any previous serious aggressive antisocial acts, suddenly, unlawfully, and intentionally kills (or makes a serious attempt to kill) another human being. The murder is “sudden” in the sense that it appears to be a single, isolated, unexpected episode of violent, impulsive acting-out behavior behavior which is never well thought out, behavior which has no obvious purpose or hope for personal advantage or profit foreseeable as a result. Of 153 criminal offenders referred for psychiatric evaluation between July 1, 1956, and Dec. 30, 1957, to the Social Maladjustment Study Unit at the Malcolm Bliss Mental Health Center in St Louis,* 13 could be called “sudden murderers” by this definition. Although in this group of patients the crime as a function of the personality of the patient concerned proved most...

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The Role Of Stabbing And Slashing In Knife Combat

You’ve got to know your weapon because your survival would depend on it. In knife fighting, you’ve got to know what damage a blade can do to the human anatomy.

Stabbing and slashing are the two fundamental ways of inflicting trauma with a knife. This is evident in the basic principle of Filipino knife fighting that says, “In every thrust there is a slash and in every slash there is a thrust.”

Stab wounds are considered more lethal than slash wounds because of the greater possibility of internal organ damage. Considering the application of force and the positioning of the weapon, stabbing has a greater chance of puncturing a vital organ than slashing. But the latter can be deadly too if it severed an artery.

Death by either stab wound or slash wound is often caused by shock. This kind of shock is different from emotional state of shock. “Hypovolemic shock...

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A New Look at Bloodstains Is Changing Forensics

The rolling pin is traditionally seen as a woman's tool. She can use it to roll out dough -- or to smash her husband's skull.

 The latter tends to be rather bloody, so it's no surprise that the seemingly harmless kitchen utensil is part of the equipment at Germany's only institute specializing in bloodstain pattern analysis, where it's stored between blood-splattered pieces of paper.

The lab uses very little high-tech and modern equipment. Inside the old barn in Usingen, a town in the western German state of Hesse, the creative chaos of a workshop prevails. Much of the equipment seems to have come directly from a hardware store.

Dr. Silke Brodbeck, the director of the institute, turns out not to be a morbid forensic scientist but a tidy and introspective woman. Brodbeck regularly assembles medical experts and criminologists in the barn for demonstrations in the art of interpreting bloodstains and blood...

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Documenting Bloodstain Patterns Through Roadmapping

An accurate and methodical technique for documenting bloodstain patterns is invaluable in crime scene analysis.

As the old adage goes, “a picture is worth a thousand words.” However, in the field of crime scene investigation this saying should be changed to “a properly taken picture is worth a thousand words.” Never is this more true than when documenting bloodstain patterns at a scene. Proper documentation of a crime scene, and bloodstains specifically, verifies the integrity of the scene and the evidence within it; provides quality presentations for subsequent courtroom testimony; and allows for outside analysis by other experts.1 The fundamental goal of documenting bloodstain patterns is to accurately depict the patterns as you found them. This is accomplished through note taking, sketching, and photography. Additionally, videotaping may be helpful depending on the scene, but it should never replace photography.

Let’s first address note taking. Your notes should...

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Intimate Partner Homicide Methods In Heterosexual, Gay, And Lesbian Relationships

Abstract

Previous research indicates that the killing method used in homicides may reflect the motivation of the offender and qualities of the victim-offender relationship. The effect of gender and sexual orientation of intimate partner homicide offenders (N = 51,007) was examined with respect to the brutality of killing methods. Guided by previous research and theory, it was hypothesized that homicide brutality will vary with the offender's sexual orientation and gender, such that the percentage of killings coded as brutal will be higher for (a) gay and lesbian relative to heterosexual relations, (b) men relative to women, (c) gay relative to heterosexual men, and (d) lesbian relative to heterosexual women. The rates of intimate partner homicide were also hypothesized to vary with the gender of the partners, such that (a) homicide rates will be higher in gay relative to heterosexual and lesbian couples and (b) homicide rates will be lowest in lesbian couples....

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When Turnabout Is Fair Play: Character Evidence and Self Defense in Homicide and Assault Cases

INTRODUCTION

Debbie, a call girl, agrees to meet a new customer, Victor, at the Shady Acres Motel for dancing and a massage.

They retire to a motel room, but once there, Victor demands an entirely different act from Debbie, one in which she does not want to participate. Debbie gathers her belongings and tries to leave, but Victor escalates his demands by becoming aggressive.

He blocks the doorway, grabs Debbie’s blouse, and attempts to pull her towards him. She slaps him and scratches his cheek, causing him to break his grip on her blouse. He threatens to break her neck. She screams and retreats from him. He grabs a chair and swings it at her, barely missing her head. Debbie retreats again, this time to a corner of the room, across the bed from Victor. In a panic, she rummages through her purse and finds the switchblade sh

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The Scapegoat Identity

One of the most important of personal assessments we can give to ourselves, and one which will pretty quickly tell us whether or not OK are living authentically is answering this question: What thought or emotion runs me?  What emotion or thought gets me to do things I don't even want to do? 

Is it guilt?  Does guilt come around fairly frequently telling me that IF I don't do X, Y, or Z I am going to have to contend with horrible feelings of guilt later?  Do I  hang out with people I don't want to hang out with, do and say things I don't want to do and say-because I fear that if I don't I will feel guilty later?  Do I feel like I might be thought of as a "bad" person or, worse yet, a "selfish" person if I don't do that thing the guilt is urging me to do? ...

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