The Boundaries of “Good Behavior” and Judicial Competence: Exploring Responsibilities and Authority Limitations of Cognitive Specialists in the Regulation of Incapacitated Judges

Both law and medicine rely on self-regulation and codes of professionalism to ensure duties are performed in a competent, ethical manner. Unlike physicians, however, judges are lawyers themselves, so judicial oversight is also self-regulation. As previous literature has highlighted, the hesitation to report a cognitively-compromised judge has resulted in an “opensecret” amongst lawyers who face numerous conflicts of interest.Through a case study involving a senior judge with severe cognitive impairment, this article considers the unique ethical dilemmas that cognitive specialists may encounter when navigating duties to patient, society, and the medical profession, without clear legal guidance.Systemic self-regulatory inadequacies in the legal profession are addressed, as well as challenges that arise when trying to preserve the trust and dignity of an incapacitated patient who must fulfill special duties to society.Ultimately, because of their unique neurological expertise and impartial assessments, we submit that allowing cognitive specialists to submit their assessments to an internal judiciary board may act as an additional check and balance to ensure the fair and competent administration of justice.

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The Aging Physician

Principles of Medical Professionalism ◽

10.1093/med/9780197506226.003.0015 ◽

2021 ◽

pp. 259-274

Author(s):

Gia Merlo

Keyword(s):

Cognitive Impairment ◽

Financial Literacy ◽

Cognitive Abilities ◽

Successful Aging ◽

Medical Profession ◽

Current System ◽

Self Regulation ◽

Optimal Solution ◽

Mandatory Retirement

After decades of working in the medical field, physicians have gathered an extensive knowledge of human pathology as well as effective courses of treatment for illnesses. However, aging may also bring about cognitive deterioration, which may compromise the quality of care physicians provide to their patients. In 2015, 23 percent of physicians were above the age of 65. An estimated 25,000 to 50,000 active physicians are expected to suffer from mild cognitive impairment and up to 25,000 from dementia. Currently, physicians are not held to a mandatory retirement age and are not subject to oversight of their cognitive abilities and physical health as they age. However, the current system of self-regulation for cognitive impairment is insufficient for protecting patient safety; on the other hand, mandatory retirement or screening of aging physicians may be ethically or legally problematic. An optimal solution would balance the safety of patients and the dignity of aging physicians. It is likely to be multipronged and multifactorial, involving multiple screening steps and continued development to assess the quality of validation. Adoption of healthy lifestyle practices and financial literacy, as well as providing opportunities for retired physicians to stay involved with the medical profession, may encourage successful aging among physicians and ease the transition to retirement.

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Research on Starvation in the Warsaw Ghetto – Ethical Problems

Zagłada Żydów. Studia i Materiały ◽

10.32927/zzsim.141 ◽

2010 ◽

pp. 439-450

Author(s):

Marta Janczewska

Keyword(s):

Research Team ◽

Ethical Dilemmas ◽

Medical Profession ◽

Research Work ◽

Special Kind ◽

Scientific Discipline ◽

Medical Treatments ◽

Warsaw Ghetto ◽

Dying Patients ◽

To Receive

Research team of physicians and lab technicians under Izrael Milejkowski’s direction undertook the effort to carry out a series of clinical and biochemical experiments on patients dying of starvation in the Warsaw ghetto so as to receive the fullest possible picture of hunger disease. The research was carried out according to all the rigors of strict scientific discipline, and the authors during their work on academic articles, published it after the war entitled: „Starvation disease: hunger research carried out in the Warsaw ghetto in 1942,” according to their own words, they “supplemented the gap in accordance with the progress of knowledge.” The article is devoted to the reflections over ethical dilemmas of the research team, who were forced in their work to perform numerous medical treatments of experimental nature on extremely exhausted patients. The ill, according to Dr Fajgenblat’s words,“demonstrated negativism toward the research and treatment, which extremely hindered the work, and sometimes even frustrated it.” The article attempts to look at the monumental research work of the Warsaw ghetto doctors as a special kind of response of the medical profession to the feeling of helplessness to the dying patients. The article analyzes the situation of Warsaw ghetto doctors, who undertook the research without support of any outer authority, which could settle their possible ethical dilemmas (Polish deontological codes, European discussions on the conditions of the admissibility of medical research on patients, etc.).

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Analysis of Functional and Cognitive Impairment in Institutionalized Individuals with Movement Disorders

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530319666190311104247 ◽

2019 ◽

Vol 19 (7) ◽

pp. 1022-1031 ◽

Cited By ~ 2

Author(s):

Paula D. Cebrián ◽

Omar Cauli

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Cognitive Performance ◽

Functional Impairment ◽

Movement Disorders ◽

Neurological Disorders ◽

Daily Living ◽

Severe Cognitive Impairment

Background: Many neurological disorders lead to institutionalization and can be accompanied in their advanced stages by functional impairment, and progressive loss of mobility, and cognitive alterations. Objective: We analyzed the relationship between functional impairment and cognitive performance and its related subdomains in individuals with Parkinson’s disease, Alzheimer’s disease accompanied by motor dysfunction, and with other neurological disorders characterized by both motor and cognitive problems. Methods: All participants lived in nursing homes (Valencia, Spain) and underwent cognitive evaluation with the Mini-Mental State Examination; functional assessment of independence in activities of daily living using the Barthel score and Katz index; and assessment of mobility with the elderly mobility scale. Results: The mean age of the subjects was 82.8 ± 0.6 years, 47% of the sample included individuals with Parkinson’s disease, and 48 % of the sample presented severe cognitive impairment. Direct significant relationships were found between the level of cognitive impairment and functional capacity (p < 0.01) and mobility (p < 0.05). Among the different domains, memory impairment was not associated with altered activities of daily living or mobility. The functional impairment and the risk of severe cognitive impairment were significantly (p<0.05) higher in female compared to male patients. Among comorbidities, overweight/obesity and diabetes were significantly (p < 0.05) associated with poor cognitive performance in those individuals with mild/moderate cognitive impairment. Conclusion: In institutionalized individuals with movement disorders there is an association between functional and cognitive impairment. Reduction of over-weight and proper control of diabetes may represent novel targets for improving cognitive function at such early stages.

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