Don’t Lie But Don’t Tell The Whole Truth: The Therapeutic Privilege – Is It Ever Justified?

Summary

This position paper will show that withholding information from a competent patient is a violation of the doctor's role as a fiduciary and is not ever justified. As a fiduciary, the doctor's relationship with his or her patient must be one of candour since it will be impossible for the patient to trust the doctor without regular candid information regarding the patient's condition and its outcome. Although the use of the therapeutic privilege has been recognized by several courts and is supported by scientific literature, I will explore why withholding information from a competent patient is a violation of the doctor's role as a fiduciary and as such is not legally or ethically defensible.

While some courts have recognized the therapeutic privilege as a way of promoting patient wellbeing and respecting the Hippocratic dictum of “primum non nocere” {or first do no harm},

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Doctor’s Views On Disclosing Or Withholding Information On Low Risks Of Complication

Abstract

Background

More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.

Objective

To report doctors' views on whether to disclose or withhold information on low risks of complications.

Methods

In a qualitative study design, 37 respondents (gastroenterologists and gynaecologists or obstetricians) were included. Focus group interviews were held with 22 respondents and individual in‐depth interviews with 15.

Results

Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a...‐.

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Homeless Youth: Defining The Problem And The Population

Current studies suggest that the primary cause of youth homelessness is family dysfunction in the form of parental neglect, physical or sexual abuse, family substance abuse and family violence.

The term “runaway and homeless youth” encompasses individuals with varied life trajectories and reasons for finding their way to RHY programs and shelters.

Homeless youth are typically defined as unaccompanied youth ages 12 and older (up to age 17, 21, or 24) who are without family support and who are living in shelters, on the streets, in cars or vacant buildings, or who are “coach surfing” or living in other unstable circumstances.

The National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART), conducted by the Office of Juvenile Justice and Delinquency Prevention in the U.S. Department of Justice, is one of the best sources of data on this vulnerable population....

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Substance Abuse Disorders Among Homeless and Runaway Adolescents

Abstract

This paper presents lifetime and 12-month prevalence rates and comorbidity data for substance abuse disorders among homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males and 241 females) homeless and runaway adolescents aged 16 to 19 years (mean age = 17.4 year, SD = 1.05). The data were collected by full-time interviewers on the streets and in shelters in eight Midwestern cities of various populations. About two thirds (60.5%) of the runaways met lifetime criteria for at least one of three substance disorders (alcohol abuse, alcohol dependence, drug abuse), and nearly one half (48.1%) met 12-month criteria for at least one of the disorders. Nearly all of the adolescents (93%) who met criteria for a substance disorder met criteria for at least one other Introduction...

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My Wife Died After Giving Birth

When Judah Schiller talks about how he met his wife, Galit, his voice gets soft. "I was 25 at the time and scuba diving in the Red Sea," the executive vice president of Saatchi & Saatchi S reminisces. "You can imagine: pillows, campfire, the beautiful water, the brown hues of the desert. I was sitting there trying to charm these two very lovely French models, and Galit sat down a few pillows away from us. She was a very pretty woman, and I could tell she was kind of eavesdropping, so I invited her to join the conversation."

The models left, and the couple watched the sun set over the Sinai Mountains, beginning a charmed courtship that resulted in their 1998 marriage. Shortly afterward, they settled in San Francisco, where their first son, Tomer, was born in 1999. In 2002, they had their daughter, Naomi....

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Long-Term Effects of the Death of a Child on Parents’ Adjustment in Midlife

Abstract

The death of a child is a traumatic event that can have long-term effects on the lives of parents. This study examined bereaved parents of deceased children (infancy to age 34) and comparison parents with similar backgrounds (n = 428 per group) identified in the Wisconsin Longitudinal Study. An average of 18.05 years following the death, when parents were age 53, bereaved parents reported more depressive symptoms, poorer well-being, and more health problems and were more likely to have experienced a depressive episode and marital disruption than were comparison parents. Recovery from grief was associated with having a sense of life purpose and having additional children but was unrelated to the cause of death or the amount of time since the death. The results point to the need for detection and intervention to help those parents who are experiencing lasting grief...

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Why Do Men Predominately Think Death Threats Or Threats Of Violence Are Protected By Free Speech?

Firstly, it has been found that the majority of the time women make up half of internet hate mobs (gender equity at last) and can be the most vitriolic in their vile vituperations.

As for why people think death threats or threats of violence are acceptable then they probably are just ignorant of the law or don’t care.

I am not sure what the ask classes as a death threats but things like ‘I wish/think/hope/pray that you die’, you ought to be beaten up’ etc are not threats, just the (sometimes justified) expression of desire to see the recipient hurt. These comprise the majority of the cancer known as the comments section and as they do not state credible intent to commit violence or incitement to violence are protected under freedom of speech. ...

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The Forensic Nurse as a Death Investigator

In the United States, responsibility for death investigation lies with either the coroner or the medical examiner. A coroner is an elected official who, in some jurisdictions, has no specific educational requirements. A Medical Examiner is generally an appointed physician with training in forensic pathology. There are currently 11 Coroner states, 22 Medical Examiner states, and 18 states that employ some combination of both.

Every state/county has different needs and resources, and every state/county may run death investigations with a different approach. What matters is that every effort be made to ensure a thorough, accurate, and timely investigation. A faulty cause of death determination can significantly impact surviving family members, agencies responsible for planning public health policy, civil or criminal action, and even public safety.  Some deaths may occur as a result of a criminal event, but every death is a medical event....

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Choices to Make Before Death

Seriously ill people and their families may feel swept along by the fatal illness and the various treatments, as if they have no control over the events. Some people seem to prefer this sense of having no control because it relieves them of the responsibility of deciding what should be done. Other people prefer to determine all aspects of their care, sometimes even including the specifics of their funeral and burial.

Honest, open communication between patients and doctors about preferences for care at the end of life helps to ensure the best possible quality of life during a fatal illness. The doctors provide a candid assessment of the likely benefits of end-of-life treatments and their disadvantages, including effects on quality of life. People express what they do and do not want to experience. People have the chance to...

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Marriage and Happiness: 18 Long-Term Studies

What happens to your happiness and satisfaction with your life in the years following a potentially major life event such as getting married or divorced or having a child or becoming unemployed? Social scientists have been doing a lot of research on that question.

What’s Wrong with Most Research on Marriage and Marital Status

More social scientists are beginning to realize what should have been obvious all along – we can’t just compare, say, people who are currently married to people who are not married, at one point in time, to understand the implications of getting married. If the currently-married people differ from the other people – in happiness, for example – we cannot conclude that they are different because they are married.

People who are married and people who are not married may differ in all sorts of other ways...

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The Marriage Prospects of Women Already Sealed

There is a kind of meme in the Church to the effect that women who have already been sealed to a husband in the temple, but then are widowed or divorced, have seriously diminished marriage prospects due to the fact that they are not available to be sealed to another man in the here and now.

I am curious about this. Maybe it reflects a lack of faith on my part, but I have a hard time imagining myself being swayed against interest in a particular woman for that reason. I’m not sure it would even occur to me to worry about such a thing.

Questions:

1. Have any of you witnessed this phenomenon? Any stories you would like to share?

2. Assuming this is a real phenomenon, what do you think about it? Is it justified on...

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Jurisdiction over Interstate Felony Murder

Suppose a felony committed in one state results in a death in another state and the alleged perpetrator is prosecuted for homicide under the felony-murder rule. The law is not settled as to which state or states may exercise jurisdiction over the crime. Only three states have confronted this issue, and the courts involved relied on differing rationales to reach disparate conclusions. Despite the narrowness of the problem posed, its resolution raises!arger questions as to the analysis appropriate for deciding questions of jurisdiction over interstate crime generally.

This comment examines current approaches to jurisdiction over interstate crime and demonstrates that their failure to provide satisfactory solutions for interstate felony murders is the result of their inadequate analyses of the state interests served by anassertion of jurisdiction. The comment will analyze...

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Death From Propofol: Accident, Suicide, Or Murder?

Abstract

A 24-yr-old woman was found dead in her home from apparent propofol "toxicity." Her blood level of propofol was 4.3 microg/mL. She had no history of drug abuse and no evidence of such behavior at autopsy. The medical examiner and police investigators felt that she died from probable homicide. Attention was focused on a male registered nurse acquaintance, who had acquired propofol and other drugs in the course of his regular duties in a surgical intensive care unit. This is the first reported case of murder with propofol.

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Advertising Facilities for Murder.

What would be thought of a newspaper which had a section of its advertising columns specially devoted to giving publicity to establishments devoted to the training of juvenile thieves, to the puffing of the newest and most effective implements of burglary, and to the announcement of the whereabouts of "cracksmen" and pickpockets who wished to secure coadjutors in crime? Can it to possible that the chastity of woman and the lives of babes are of less account than a few ounces of precious metal, or a roll of greenbacks? The law watches narrowly over every attempt which imperils the safety of the latter, and utterly disregards a wide spread conspiracy against the former. Public opinion would be shocked at the coolness of- an advertisement from a professional thief, and the newspaper which admitted it would certainly be looked after by the Police. But both the public and the Police appear to be perfectly callous about the offenses of newspapers which insert the lying notices Of men and women whose profession, if it means anything at all, means; murder made...

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Libericide And Infanticide: Socio-demographic, Clinical And Criminological Characteristics

Introduction / Objective

Although it is well-known that infanticide (murder of child< 1year) is typically for young women and libericide (murder of child≥1year) for older melancholic women, comprehensive differences between these two kinds of murderers remain little-known. Our objective was to describe their demographic, clinical and criminological differences.

Method

We collected 41 psychiatric expert examinations in criminal cases of child murder between 2000 and 2005 and compared, after sex-matching, those responsible for infanticide (n=16) and libericide (n=25).

Results

Compared to perpetrators of infanticide, subjects responsible for libericide were older (24 and 33 respectively, p=0.012), and had a psychiatric history (35% versus 71%, p=0.005) and convictions for violence towards others (6% versus 29%, p=0.022). A the time of the crime, 77% of libericide perpetrators were suffering from a psychotic, depressive, cognitive or personality disorders while only 53% of perpetrators of infanticide were ill (p=0.024). Although...

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