Advance medical directives

Article Abstract:

Although society, medical associations, ethicists, and many interested individuals believe that patients have the right to refuse life-sustaining care, problems can arise in actual cases. A typical problematic situation is one where the patient is no longer competent to state his wishes and may never have stated them while still competent. Two mechanisms now exist whereby a person can specify how treatment decisions should be made with respect to artificial life support. These are through written directions (a living will), or through appointment of a proxy who will make health care decisions. The Committee on Medicolegal Problems of the American Medical Association recently issued a report on these two options and an expanded version of the report is discussed. Living will laws now exist in 41 states. People can describe the kinds of life support they would accept. One drawback is the existence of situations not covered in the living will. A proxy may be provided for by a living will or by a 'durable power of attorney', which empowers a family member or friend to act as the principal's agent. An ordinary power of attorney is usually legally inadequate in these cases. A 1988 survey by the American Medical Association showed that 56 percent of adults had discussed treatment preferences with family members, but only 15 percent had filled out a living will. Physicians can initiate discussions about such issues and provide information to patients. This should be done before the onset of disease or illness, since even young, healthy patients can be affected. Many Americans will face decisions about the removal of life-sustaining care and preparedness is the only way to ensure that people's wishes will be carried out. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Advance directives (Medicine), Right to refuse treatment, Right to die, Treatment refusal, Living wills

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Genetic screening by employers

Article Abstract:

The human genome project involves the detailed analysis of an estimated 100,000 human genes and has future applications for the detection of genetic diseases and predispositions. However, the possibility that the newly acquired genetic information could be misused is of concern. For example, an employer could discriminate against individuals who have a genetic predisposition for certain diseases such as alcoholism, Alzheimer's disease, or coronary artery disease. Guidelines for employer-initiated testing have been developed in the Disabilities Act, which is to be passed by Congress this year. The Act prohibits employment discrimination against those who are disabled, but it only applies to employers who receive federal funding and have at least 15 employees. Employers will be prohibited from discriminating on the basis of a person's disability if the disability does not interfere with the person's ability to perform the essential functions of the job. The Disabilities Act will forbid the use of medical tests to detect disabilities in employees, unless the testing would provide information about the person's ability to perform job-related functions. Medical tests of job applicants will be forbidden entirely before a job offer is made. The Disabilities Act will also protect those who are at risk of disease. It is suggested that routine testing of a person's ability to function in a safety-sensitive job may be more reliable than genetic testing, which can be imprecise. (Consumer Summary produced by Reliance Medical Information, Inc.)

Disability evaluation, Genetic screening, Genetic testing, Employment tests

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Corporal punishment in the schools

Article Abstract:

Corporal punishment of students is still legal in more than half the states in the US. Children are the only citizens who can be beaten with impunity, and this probably arises from the belief that children are the property of others rather than human beings who have rights. Corporal punishment of students has been banned in many other countries, and the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association have advocated a ban in the US. A bill pending in Congress would withhold funding from public schools that permit corporal punishment. According to federal records, there were one million reports of corporal punishment in the US during the 1986-1987 academic year, but this is probably an underestimate. Research has shown that physical punishment is not always effective, and may teach children that violence is an acceptable way of solving problems. Teachers can change their students' behavior by praising good behavior, exhibiting proper behavior, using detentions, loss of privilege and verbal reprimands, and treating their students with respect.

Reports, Crimes against, Students, American Medical Association, School discipline, Corporal punishment

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