Cushing Oration, 1988: Law and medicine: conflict or collaboration?

1988 ◽  
Vol 69 (3) ◽  
pp. 319-325 ◽  
Author(s):  
Brian Dickson
Keyword(s):  
Informed Consent ◽  
Medical Profession ◽  
Standard Of Care ◽  
Ethical Values ◽  
Common Goal ◽  
Content Type ◽  
Legal Rules ◽  
Fair Compensation ◽  
The Common ◽  
Fine Print

✓ Doctors and lawyers share the common goal of pursuit of the welfare of the patient and client. Even where litigation brings physicians into conflict with the law, collaboration must be our guide. The standard of care is defined by reference to the expertise of the medical profession. The need for informed consent is based upon the moral and ethical values our professions share. In assessing fair compensation, legal rules are shaped by the need to make the lives of the injured and disabled bearable, again an ethical value we hold in common. The nature of our day-to-day tasks and the methods we employ may be different, but we must never lose sight of the fact that the interests of society can only be met if we work closely together.

Coagulopathy with the use of hetastarch in the treatment of vasospasm

1995 ◽  
Vol 82 (1) ◽  
pp. 44-47 ◽  
Author(s):  
Eric R. Trumble ◽  
J. Paul Muizelaar ◽  
John S. Myseros ◽  
Sung C. Choi ◽  
Brian B. Warren
Keyword(s):  
Volume Expansion ◽  
Clinical Symptoms ◽  
Standard Of Care ◽  
The Other ◽  
Appropriate Use ◽  
Content Type ◽  
Prevention And Treatment ◽  
Plasma Protein Fraction ◽  
Clinically Significant ◽  
Fine Print

✓ The use of colloid agents to achieve hypervolemia in the prevention and treatment of postsubarachnoid hemorrhage (post-SAH) vasospasm is included in the standard of care at many institutions. Risk profiles are necessary to ensure appropriate use of these agents. In a series of 85 patients with recent aneurysmal SAH, 26 developed clinical symptoms of vasospasm. Fourteen of the 26 were treated with hetastarch for volume expansion while the other 12 received plasma protein fraction (PPF). Clinically significant bleeding pathologies were noted in six patients who received hetastarch as a continuous intravenous infusion. Hetastarch increased partial thromboplastin time from a mean of 23.9 seconds to a mean of 33.1 seconds (p < 0.001) in all patients who received infusions of this agent, while no effect was noted in the 12 patients who received PPF infusions. No other coagulation parameters were altered. This study shows an increase in coagulopathy with the use of hetastarch as compared with the use of PPF for the treatment of postaneurysmal vasospasm.

Legal Rules for Recovery

2001 ◽  
Author(s):  
Jessica W. Berg ◽  
Paul S. Appelbaum ◽  
Charles W. Lidz ◽  
Lisa S. Parker
Keyword(s):  
Informed Consent ◽  
Legal Theory ◽  
Medical Profession ◽  
Physician Behavior ◽  
Medical Decision ◽  
Legal Doctrine ◽  
Legal Rules ◽  
Judicial Remedy ◽  
The Law ◽  
Injured Patients

This chapter deals with the legal theory and procedural framework under which patients can obtain redress for their injuries resulting from treatment administered in the absence of informed consent. The evolution of the legal doctrine was driven by the demands of patients for redress for injuries, and more attention has been given by courts and legislatures to the questions of when and how compensation might be obtained than to providing guidance for clinicians. In some important respects, the distinction between the law as it applies to the physician engaged in medical decision making with a patient and the law as it applies to that same patient who later seeks compensation in the courts is an artificial one. Insofar as the spirit of informed consent is not embraced voluntarily by the medical profession, but is adhered to in large part to avoid the likely consequences of failure to observe the legal rules, physician behavior will be shaped not only by the rules themselves but also by the way they are enforced. If, for example, the rules governing the means of redress were complex, time-consuming, and unlikely to yield the desired compensation, few injured patients would pursue a judicial remedy. As a result, physicians would eventually realize that adverse consequences were unlikely to follow from a failure to observe the relevant rules and, except to the extent that they had accepted the ethical theory of informed consent, their adherence to the doctrine would crumble. Some critics of the present system contend that this has already happened (see Chapter 7). On the other hand, rules that make recovery easier and more certain would be likely to encourage compliance with the requirements for informed consent. Differential emphasis by the courts on particular kinds of lapses by clinicians might also shape their actions accordingly. For example, the courts’ focus on risk information has led many physicians to tailor disclosure to emphasize risks. Thus, the issues addressed in this chapter, although framed in legal terminology, are important (some would argue crucial) determinants of the ultimate impact of informed consent.

Medicine through untinted glasses

1976 ◽  
Vol 45 (4) ◽  
pp. 369-375
Author(s):  
Roger O. Egeberg
Keyword(s):  
State Government ◽  
Medical Profession ◽  
Content Type ◽  
The Public ◽  
Medical Programs ◽  
Fine Print

✓ The 1976 Cushing orator takes a critical look at federal medical programs today, and at the health desires and needs of the public. He outlines the possible future roles of federal and state government and of the medical profession itself.

Cervical radiculopathy, entrapment neuropathy, and thoracic outlet syndrome: how to differentiate?

2004 ◽  
Vol 1 (2) ◽  
pp. 179-187 ◽  
Author(s):  
John E. McGillicuddy
Keyword(s):  
Older Patients ◽  
Thoracic Outlet Syndrome ◽  
Cervical Radiculopathy ◽  
Sensory Loss ◽  
Neuralgic Amyotrophy ◽  
Content Type ◽  
Arm Pain ◽  
Entrapment Neuropathies ◽  
The Common ◽  
Fine Print

✓ The common diagnoses of cervical radiculopathy and upper-extremity entrapment neuropathies can at times be difficult to differentiate. Additionally, thoracic outlet syndrome is often diagnosed when, in fact, the problem is radiculopathy or neuropathy. Another source of confusion, especially in older patients, is neuralgic amyotrophy, brachial plexitis, or the Parsonage—Turner syndrome. The differential diagnosis of unilateral arm pain, weakness, and/or sensory loss includes all of these problems. The clinical and electrodiagnostic features of each are discussed as an aid to distinguishing between these common and similar entities.

The Future of Informed Consent in British Common Law

1999 ◽  
Vol 6 (3) ◽  
pp. 235-248 ◽  
Author(s):  
Keyword(s):  
Human Rights ◽  
United Kingdom ◽  
Informed Consent ◽  
Medical Profession ◽  
Common Law ◽  
European Convention ◽  
The United Kingdom ◽  
The Future ◽  
The Common ◽  
The Law

AbstractWithin the common law world, the use of the term informed consent implies the American doctrine. Informed consent as a doctrine is not part of the law in the United Kingdom. However, it is possible to predict a way forward in disclosure cases yet to be heard in the courts of the United Kingdom. These predictions are based on current developments in the common law in the United Kingdom as well as those in Canada and Australia, on the European convention on Human Rights and Biomedicine and on trends within the medical profession itself in the light of the Bolam test.

Obliteration of experimental aneurysms in dogs with isobutyl-cyanoacrylate

1984 ◽  
Vol 61 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Gerard M. Debrun ◽  
Vassilis Varsos ◽  
Theodore M. Liszczak ◽  
Kenneth R. Davis ◽  
Roberto S. Heros ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Direct Vision ◽  
Content Type ◽  
Femoral Catheterization ◽  
The Common ◽  
Carotid Aneurysms ◽  
Fine Print

✓ Experimental cervical carotid aneurysms in dogs are obliterated with isobutyl-cyanoacrylate (IBCA) injected under direct vision into the aneurysm. Reflux of IBCA into the artery was prevented by inflating either a latex or a Silastic balloon in the carotid artery at the level of the neck of the aneurysm. This balloon was introduced through a catheter advanced into the common carotid artery by femoral catheterization. The Silastic balloon was found to be much more effective than the latex balloon in preventing spillage of IBCA into the lumen.

Experimental induction of cerebral aneurysms in monkeys

1987 ◽  
Vol 67 (6) ◽  
pp. 903-905 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Choegon Kim ◽  
Haruhiko Kikuchi ◽  
Masayuki Kojima ◽  
Yoo Kang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Experimental Hypertension ◽  
Content Type ◽  
Experimental Induction ◽  
The Common ◽  
The Brain ◽  
Fine Print

✓ Saccular cerebral aneurysms were successfully induced in two monkeys treated with ligation of the common carotid artery, experimental hypertension, and β-aminopropionitrile feeding. The cerebral aneurysms developed on the large arteries at the base of the brain, such as the anterior communicating artery and the internal carotid artery at the origin of the posterior communicating artery. Because of the similarity of the monkey to man as a species, the present results strongly suggest the significance of postnatal aggravating factors in the development of cerebral aneurysms in man.

Atypical fibromuscular hyperplasia

1981 ◽  
Vol 54 (5) ◽  
pp. 685-689 ◽  
Author(s):  
Fremont P. Wirth ◽  
William A. Miller ◽  
A. Preston Russell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Content Type ◽  
First Report ◽  
Fourth Report ◽  
Fibromuscular Hyperplasia ◽  
The Common ◽  
Fine Print

✓ Two cases of atypical fibromuscular hyperplasia of the internal carotid artery (ICA) are reported. These cases are unique because the changes involve the intima of the vessels without involvement of medial structures as seen in the more common form of fibromuscular hyperplasia. Case 1 is only the fourth report of a symptomatic fibromuscular stenosis at the origin of the ICA. Case 2 is the first report of fibromuscular hyperplasia involving the common carotid artery. Changes similar to those in Case 2 (an elongated area of tubular fibromuscular stenosis) have been reported in the ICA. These atypical or intimal forms of fibromuscular hyperplasia appear to be more common in males and blacks, and may be more often unilateral as well.

Microsurgical anatomy of the extracranial—extradural origin of the posterior inferior cerebellar artery

1999 ◽  
Vol 91 (4) ◽  
pp. 645-652 ◽  
Author(s):  
Andrew D. Fine ◽  
Alberto Cardoso ◽  
Albert L. Rhoton
Keyword(s):  
Soft Tissue ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
The Third ◽  
Cerebellar Artery ◽  
The Common ◽  
Bone Anomalies ◽  
Fine Print

Object. The authors describe the microsurgical anatomy of the posterior inferior cerebellar artery (PICA) with an extradural origin and discuss its importance as a common variation.Methods. The microsurgical anatomy of paired PICAs with an extradural origin were examined.Conclusions. Five to 20% of PICAs have an extradural origin. In the case described, both PICAs arose extradurally from the third segment of the vertebral artery (VA). Both origins were less than 1 cm proximal to the site at which the VA penetrated the dura, and neither PICA gave rise to extradural branches. Extradurally, the PICAs coursed parallel to the VA and the C-1 nerve and the three structures penetrated the dura together. Intradurally, the PICAs remained lateral and posterior to the brainstem, whereas, in the common PICA configuration, the first segment of the PICA courses anterior to the medulla. Neither PICA sent branches to the anterior brainstem, which is commonly found in PICAs with an intradural origin. There were no soft-tissue or bone anomalies.

Invading meningiomas of the sphenoid ridge

1980 ◽  
Vol 53 (5) ◽  
pp. 587-599 ◽  
Author(s):  
Joël Bonnal ◽  
André Thibaut ◽  
Jacques Brotchi ◽  
Jacques Born
Keyword(s):  
Histological Study ◽  
Sella Turcica ◽  
Lateral Part ◽  
Insertion Point ◽  
Content Type ◽  
The Common ◽  
Frontal Lobe Syndrome ◽  
Sphenoid Ridge ◽  
Fine Print

✓ The authors report a series of 34 meningiomas of the sphenoid ridge. Eight tumors were totally removed uneventfully: two from the middle sphenoid ridge and six from the pterion or Sylvian point. Five tumors were not operated on because of their extensions or the patient's age. Twenty-one tumors raised serious surgical problems, resulting in a classification into three groups: deep or clinoidal, invading beyond the sphenoid wings, and a combination of both. Histological study of the hyperostotic bone showed meningiomatous cells in the bone in 12 of 13 cases so examined. Surgical limitations included invasion of the cavernous sinus (15 cases), of the dura mater of the sella turcica (seven cases), of the lateral part of the sphenoid body at the insertion point of the ala magna (seven cases), and of the common tendinous annulus of Zinn in the orbit (five cases), and basilar extracranial extension, particularly in the pterygomaxillary fossa (three cases). Following extensive removal, there were no early recurrences and three late recurrences (9 years and more). In 13 cases with a follow-up period of 1 to 8 years, there were no clinical recurrences. In only two cases was the meningioma totally removed. There were three postoperative deaths, two cases of hemiparesis with aphasia and epilepsy, one case with a frontal lobe syndrome, and nine with slight oculomotor, visual, or esthetic sequelae.

Sign in / Sign up

Export Citation Format

Share Document