Consequences of untreated rheumatoid arthritis in an uncompliant patient.

This article describes a clinical case of rheumatoid arthritis, actively "untreated" for several decades in an incompetent patient. The absence of basic therapy led to severe deformities of the limbs, movement restrictions, scleritis, and AA-amyloidosis.

The Profile of the Mentally Incompetent Patient of the Local Health Unit of Guarda, Portugal

Forensic psychiatry, as a specific branch of psychiatry, is the medical science that approaches mental illness and its relation with law enforcement. In this regard, medicine and justice converge in the contact with individuals that, due to the alleged assumption of acting under the effects of a psychiatric disease, have a disturbing behaviour and infringe the laws of Society. The objective of this research project, which has a retrospective nature, is to delineate the profile of the mentally incompetent patients of the Local Health Unit of Guarda, Portugal, resorting to the reports of mental faculty's examinations of, at least, 30 individuals. With this methodology, we will be able to study the characteristics of selected individuals who have committed some sort of criminal offences but are not subject to prosecution, namely with regard to the specific personal and family data, psychiatric background, diagnostic formulations, applied legal concepts, among others. Statistical analysis was carried out using the Microsoft Excel tool. The main goal of the study is to provide to the Psychiatry Department of the Local Health Unit of Guarda an analytical instrument that characterizes the respective mentally incompetent population and may, essentially, contribute positively to the contextualization and accomplishment of the future assessments on mental faculties of the individuals who are involved in judicial proceedings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Surrogate Decision-making for Incompetent Elderly Patients: The Role of Informal Representatives

Informal or unofficial representation refers to the practice (more common in some European jurisdictions than in others), that persons not designed by a court or by the patient himself, make medical decisions on the patient’s behalf in case of their incompetence. If the law provides for this, it is usually next of kin (spouse, children, brothers and sisters, etc.) who are allowed to act in such a capacity. Informal representation raises several questions. Are family members always familiar with what their relative would have wished, ready to take responsibility, and not too much reigned by their emotions? The basic legal concern is whether there are sufficient procedural and other safeguards to protect the incompetent patient from representatives who do not serve their best interests. In addressing these issues, after a brief survey of the law in the Netherlands as compared with that in Belgium, Germany and England/Wales, we will argue that informal representation as such is not at variance with international and European standards. However, an ‘informal’ approach to surrogate decision-making should always go together with sufficient protection of the incompetent patient, including procedural safeguards with regard to the decision that the patient is incompetent, limits to the decision-making power of informal representatives and effective forms of conflict resolution.

End-of-Life Care in Israel—The Dying Patient Law, 2005

After years of political stalemate on the issue of end-of life medical care in Israel, the Knesset enacted the Dying Patient Law in 2005. This Article argues that the new law manifests a paradigm shift in the normative framework regulating end-of-life treatment in Israel, from a patient right approach based on the principle of autonomy, to a physician duty approach based on the principle of the sanctity of life. In so doing the law created a complex web of formal procedural rules and culturally unique legal artifices, which amount to a maze of medicolegal technocracy. The technocratic maze conceals substantive restrictions on rights to patient autonomy which had been recognized in the former case law in relation to the withholding and withdrawal of medical treatment. In particular, under the new law, the request of a competent patient to withdraw artificial respiration may not be respected, and the advance directives of an incompetent patient to withhold artificial nutrition are of no effect. Beyond a question of constitutionality, the Article suggests that the underlying approach of the law to death and dying is an unskillful response to the challenges that have arisen from life extending technology.