Medicine and law
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This paper examines briefly the rights and vulnerabilities of children and young people. It brings together themes relative to respect for individuals, maintaining trust and competence to make valid decisions. ⋯ It looks at the criteria for "best interests" judgements. Also, the role of the doctor is considered in regard to the whole family.
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The issue of children's rights has become very prominent over the past few decades during which attempts were being made to formulate an international agreement about the person status of children world-wide. These attempts have brought together and formalised a trend that has evolved over at least 400 years to broaden and develop society's understanding and acceptance of children as unique, necessary valuable societal assets. ⋯ Definitions and descriptions of various types of children's rights are given as well as the arguments posed for and against. Finally the various proposals and motivations for the inclusion of certain types of children's rights as they presently occur in the 1989 UN Convention on the Rights of the Child are noted and discussed.
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This paper reviews the rationale for cardiopulmonary resuscitation (CPR) and a "Do Not Resuscitate" order (DNR). It includes the confusion surrounding consent and related treatments; implications and misunderstandings for care givers, patients and families; efficacy; value; unilateral DNRs; and discomfort on the part of physicians to discuss patients' preferences early in treatment. CPR and DNR challenge accepted definitions of beneficence and force us to consider the immediate as well as the long-term value and benefit to patients and families, the concept of futility, and our view of the good. ⋯ Patients' medical status and prognosis may mitigate the wisdom of attempting to resuscitate. This paper reviews the principles of best interest and substitute judgment, it provides suggestions to frame and facilitate conversations about DNR related to the larger treatment goals and plans among physicians, nurses, patients, and families. Policies and forms developed at institutions are reviewed to identify mechanisms for improving the process and special circumstances such as the operating room.
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Medical students, overwhelmed by new information, rarely appreciate patients' complaints beyond their biomedical aspects. To encourage students to think more comprehensively about patients, I initiated a biweekly series of seminars in medical humanities at the Duke University School of Medicine. ⋯ The humanities inculcate a tolerance for ambiguity, provide a basis for the reconciliation of competing values, and foster the ability to discern the narrative thread in the setting of illness. The paper highlights the elements of the lecture series and suggests how it helps cultivate a core competency of medical education: learning to engage in the dialogue that grounds the doctor-patient relationship.
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Although several international and regional human rights instruments, including the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights, give explicit recognition to a broad right to health, this right, at present, offers little real protection to interests in individual and community health, including reproductive and sexual health. This is so, the author argues, because the mechanisms now in place for supervision and enforcement of this and other "social human rights" are extremely weak. In these circumstances, better protection is available indirectly, through enforcement of certain "classical human rights," such as the right to life, the right to be free from inhuman and degrading treatment, and the right to found a family, that contribute to--and depend upon--realisation of a right to health.