The Role of Health Care Professionals in Breaking Bad News about Death: the Perspectives of Doctors, Nurses and Social Workers

Background: The way a death is notified to family members has a long-term effect on their coping with their loss. The words caregivers use and the sentiments they express can stay with their hearers for the rest of theirlife. Aims: To study the views of three caregivers groups—doctors, nurses and social workers—as to their role in breaking a death news in an ED.Methods: One hundred and fifteen health care professionals participated in the research (51 nurses, 38 doctors and 26 social workers). They completed a 72-item questionnaire comprising behaviour descriptions, attitudes and statements. Content validation of the questionnaire was conducted by the help of experts group, and the internal reliability, measures in all its parts was 0.78 on average (α = 0.78).Results: Doctors gave a higher score than the other groups to their responsibility for breaking bad news (p<0.005) and to the content of the information they provide. Social workers scored the mental support given the family significantly higher than doctors and nurses did (p<0.000). Nurses scored the instrumental support given(tissues, water to drink) significantly higher than doctors and social workers (p<0.000). Breaking bad news caused social workers more mental distress than it did either doctors or nurses. All three groups gave a high score to the emotional exhaustion, sadness and identification this task caused them. Nurses felt more fear at theprospect of a notifying a death and made more effort to escape the task.Conclusions: The findings of the study will help develop performance guidelines for notifying a death and provide input for simulation and other training workshops

Quadratic and Near-Quadratic Lower Bounds for the CONGEST Model

We present the first super-linear lower bounds for natural graph problems in the CONGEST model, answering a long-standing open question. Specifically, we show that any exact computation of a minimum vertex cover or a maximum independent set requires a near-quadratic number of rounds in the CONGEST model, as well as any algorithm for computing the chromatic number of the graph. We further show that such strong lower bounds are not limited to NP-hard problems, by showing two simple graph problems in P which require a quadratic and near-quadratic number of rounds. Finally, we address the problem of computing an exact solution to weighted all-pairs-shortest-paths (APSP), which arguably may be considered as a candidate for having a super-linear lower bound. We show a simple linear lower bound for this problem, which implies a separation between the weighted and unweighted cases, since the latter is known to have a sub-linear complexity. We also formally prove that the standard Alice-Bob framework is incapable of providing a super-linear lower bound for exact weighted APSP, whose complexity remains an intriguing open question

The Sparsest Additive Spanner via Multiple Weighted BFS Trees

Spanners are fundamental graph structures that sparsify graphs at the cost of small stretch. In particular, in recent years, many sequential algorithms constructing additive all-pairs spanners were designed, providing very sparse small-stretch subgraphs. Remarkably, it was then shown that the known (+6)-spanner constructions are essentially the sparsest possible, that is, larger additive stretch cannot guarantee a sparser spanner, which brought the stretch-sparsity trade-off to its limit. Distributed constructions of spanners are also abundant. However, for additive spanners, while there were algorithms constructing (+2) and (+4)-all-pairs spanners, the sparsest case of (+6)-spanners remained elusive. We remedy this by designing a new sequential algorithm for constructing a (+6)-spanner with the essentially-optimal sparsity of O~(n^{4/3}) edges. We then show a distributed implementation of our algorithm, answering an open problem in [Keren Censor{-}Hillel et al., 2016]. A main ingredient in our distributed algorithm is an efficient construction of multiple weighted BFS trees. A weighted BFS tree is a BFS tree in a weighted graph, that consists of the lightest among all shortest paths from the root to each node. We present a distributed algorithm in the CONGEST model, that constructs multiple weighted BFS trees in |S|+D-1 rounds, where S is the set of sources and D is the diameter of the network graph

No-fault (strict liability) for injuries from innovative treatments: fairness or also efficiency?

Innovative treatments (ITs) have a distinct SIROT pattern: they often show, and are expected to show, significantly improved results over time. Of the four IT categories discussed, two stand out: SIROT treatments which are currently not in the patient's best interest (BI) but will become superior treatment over time (category 3), and treatments which are already arguably BI but will clearly become the superior option as they improve with time (category 2). There is a strong fairness argument to compensate patients injured from ITs because their injury led to improved knowledge benefitting future patients. By analogy to private necessity, IT patients should be considered ‘rescuers’ entitled to costs reimbursement, since future patients receive an incontrovertible benefit inextricably linked to their loss. Crucially, category 2 patients also deserve compensation, notwithstanding that their treatment was BI. From an efficiency perspective, patients should avoid only irresponsible ITs (category 4) but they are not well-placed to identify such treatments. Patients’ incentives to submit to ITs are no worse, and perhaps slightly improve under strict liability (SL): SL might incentivise patients to undergo a treatment whose prospect as BI is in doubt but is likely to be SIROT. Finally, while under SL (but not negligence) category 2 cases yield liability, which may deter physicians from offering ITs, reputation loss under SL is lessened, so physicians’ incentives may improve (and they also have strong non-legal incentives to offer ITs)

Regulating innovative treatments: information, risk allocation and redress

This special issue features papers culminating from a six seminar ESRC series ‘Liability versus innovation: Unpacking Key Connections,’ convened between December 2015 and September 2017 at Keele, QUT (Brisbane, Australia) and Durham universities.11 See: ‘Liability v Innovation: Unpacking Key Connections, An ESRC Seminar Series’. The support of ESRC towards this research is acknowledged. The seminar series was conceived in response to perceptions of scientists and clinicians that, despite the pro innovation rhetoric in Government policy documents,the threat of malpractice liability might stifle innovative treatment (IT). Such perceptions are supported by two related claims common in medico-legal literature – that the threat of legal liability following adverse outcomes causes defensive medicine, and that the threat of legal liability stifles innovation. The extent of these problems remains disputed. In particular, the Bolam-Bolitho test of clinical negligence in England – which excludes liability for clinical decisions accepted as proper by a responsible body of skilled medical peers unless such practice is illogical – is arguably problematic in terms of incentives to engage in IT. An IT is by definition less likely to accord with accepted practice. So, while policy-makers encourage and pay considerable lip service to innovation, tort law might give the opposite incentive to clinicians. Or so goes the argument

Gender injustice in compensating injury to autonomy in English and Singaporean negligence law

The extent to which English law remedies injury to autonomy (ITA) as a stand-alone actionable damage in negligence is disputed. In this article I argue that the remedy available is not only partial and inconsistent (Keren-Paz in Med Law Rev, 2018) but also gendered and discriminatory against women. I first situate the argument within the broader feminist critique of tort law as failing to appropriately remedy gendered harms, and of law more broadly as undervaluing women’s interest in reproductive autonomy. I then show by reference to English remedies law’s first principles how imposed motherhood cases—Rees v Darlington and its predecessor McFarlane v Tayside Health Board—result in gender injustice when compared with other autonomy cases such as Chester v Afshar and Yearworth v North Bristol NHS Trust: A minor gender-neutral ITA is better remedied than the significant gendered harm of imposing motherhood on the claimant; men’s reproductive autonomy is protected to a greater extent than women’s; women’s reproductive autonomy is protected by an exceptional, derisory award. Worst of all, courts refuse to recognise imposed motherhood as detriment; and the deemed, mansplained, nonpecuniary joys of motherhood are used to offset pecuniary upkeep costs, forcing the claimant into a position she sought to avoid and thus further undermining her autonomy. The recent Singaporean case ACB v Thomson Medical Pte Ltd, awarding compensation for undermining the claimant’s genetic affinity in an IVF wrong-sperm-mix-up demonstrates some improvement in comparison to English law, and some shared gender injustices in the context of reproductive autonomy. ACB’s analysis is oblivious to the nature of reproductive autonomy harm as gendered; and prioritises the father’s interest in having genetic affinity with the baby over a woman’s interest in not having motherhood imposed upon her