Malpractice Claims and Ethical Issues in Prison Health Care Related to Consent and Confidentiality

Respecting the consent and confidentiality of a patient is an underlying element in establishing the patient’s trust in the physician and, implicitly, obtaining the patient’s compliance. In particular, cases of inmate patients require increased attention in order to fulfill this goal against a background of institutional interferences, which, in certain situations, may endanger the autonomy of the physician and their respect for the inmate’s dignity. The purpose of this article is to depict the characteristics of consent and confidentiality in a prison environment, in special cases, such as hunger strikes, violent acts, HIV testing, COVID-19 measures, and drug use, bringing into focus the physician and the inmate in the context of the particular situation where the target is disciplining someone in order for them to conform to social and juridical norms. Respecting the dignity of the inmate patient requires an adequate approach of informed consent and confidentiality, depending on each case, considering the potential unspoken aspects of the inmate’s account, which can be key elements in obtaining their compliance and avoiding malpractice claims

Medical–Legal and Psychosocial Considerations on Parental Alienation as a Form of Child Abuse: A Brief Review

Parental alienation, an entity situated at the limit of psychiatry, sociology, and justice, still represents a controversial concept despite the legal dispositions that take it into account. The scope of this paper is to consider the relationship between parent and child, and child abuse from a psychosocial perspective, as well as to depict parental alienation, considered a form of child abuse, without omitting contradictory arguments which are also based on prudence in the minor’s interest, turning the attention to parental estrangement. Although parental alienation is not a psychiatric diagnosis per se and neither is parental estrangement, recognizing the difference between them is vital to adequately manage the situation at the time of establishing custody

An Ethical Analysis Regarding the COVID-19 Pandemic Impact on Oral Healthcare in Patients with Mental Disorders

During the COVID-19 pandemic, restrictive measures were imposed that significantly impacted the healthcare system in general, and the dental healthcare system in particular. The literature cites a possible association between mental and oral health, as psychiatric patients have decreased awareness of their oral health and, therefore, poor dental status. Moreover, several studies have found a positive association between SARS-CoV-2 infection and oral health conditions, as well as between SARS-CoV-2 infection and mental health status. This context generated multiple ethical dilemmas in the case of persons with mental health disorders who require dental treatment because they are more vulnerable in this respect. This article aims to analyze the ethical issues in dental care for patients with mental disorders concerning the COVID-19 restrictive measures. The ethical aspects involved here are the basic principles of bioethics and the related elements of accessibility, equity, consent, and confidentiality

Perceptions of Dental Medicine Students on Equity within Healthcare Systems in Romania: A Pilot Study

The scope of this paper is to evaluate the opinion of future dentists on equity within healthcare systems from a social and medical perspective. Material and methods: We conducted an observational study based on a survey among year five students from the “Carol Davila” Faculty of Dental Medicine Bucharest using an online questionnaire composed of graded answers to 14 statements on the theme of equity within healthcare systems before taking this course. Results: The questionnaire was sent to 300 students, of whom 151 (50.3%) responded; 79.47% of these were female and 20.53% were male; 9.3% had a rural background and 90.7% had an urban background. The majority of respondents expressed strong agreement that equity in public healthcare and acknowledging disadvantaged populations was important. The majority of students also strongly agreed that inequity came about from a lack of accessibility to medical care, lack of financial resources, and the absence of a second medical opinion. There were no statistically significant differences specific to the gender and background environment of the respondents. Conclusions: The notion of equity is known to future dentists. However, contextual clarifications of the concept itself and its adequate quantification are necessary

From Monastic Benevolence to Medical Beneficence: The Inception of Medical Ethics in Wallachia and Moldavia before the Second Half of the 19th Century

In Middle Ages, in Moldavia and Wallachia, the healthcare system was almost non-existent, medical practice being the attribute of old women, midwives, charmers, and later monastic personnel. The first elements of medical ethics are identifiable in written texts from the 17th century, associated with a process of laicization of medicine and the appearance of the first combined civil and penal codes (Vasile Lupu’s Law from 1646 and Matei Basarab’s Law from 1652). In the next 150 years, elements of medical ethics were rarely identified, usually in legal regulations, personal letters, or literary works. Starting with the end of the 18th century, associated with the emergence of the position of public physician, detailed regulations regarding the healthcare system associated with an increased number of ethical norms began to emerge. The purpose of this article is to increase awareness to an international audience about the history of Romanian medical deontology and the roots of concepts appertaining to medical ethics in the territories of Moldavia and Wallachia

Particularities of Offenders Imprisoned for Domestic Violence from Social and Psychiatric Medical–Legal Perspectives

Background and Objectives: It is known that there may be an interconditionality between social status, personality disorders, and aggressive behavior. This study aimed to analyze the social and psychiatric diagnosis characteristics in subjects imprisoned for domestic violence acts compared to other types of aggressive behaviors. Materials and Methods: We performed a retrospective study using psychiatric medical–legal reports at the National Institute of Legal Medicine “Mina Minovici” Bucharest from 2016 to 2020. Results: We included 234 cases in our analysis, from which 132 (56%) were domestic violence offenders (DVO), and 102 (44%) were violence offenders imprisoned for other aggressions (OVO). Overall, DVOs were older than OVOs (43.0 +/− 14.7 vs. 36.1 +/− 16.6 years-old). In both study groups, most subjects were men, but the DVO group had more women than the OVO group: 23 cases (17%) and 3 cases (3%), respectively. In 14 cases (11%), previous criminal records were found from the DVO and 31 (30%) from the OVO group. Significantly fewer DVO were chronic psychoactive substance users: 83 (63%) in the DVO group versus 78 (86%) in the OVO group. Significantly more DVO had suicidal tendencies 26 (20%) compared to OVO 9 (9%). DVO subjects had significantly less often unsocialized conduct disorder or antisocial personality disorder compared to the OVO group. Conclusions: We found that DVO, compared to the OVO, were more numerous, older, less abusive, with a less frequent history of psychoactive substance abuse and addictions, and were less frequently indifferent to the committed acts

Physician-Patient Relationship in Current Cosmetic Surgery Demands More than Mere Respect for Patient Autonomy—Is It Time for the Anti-Paternalistic Model?

The ethical framework of cosmetic surgery is distinct from the one associated with clinical medicine. This distinctiveness has led to significant difficulties in conceptualizing the physician-patient relationship (PPR), as most models have been developed specifically for the latter. The purpose of this article is to show that the PPR in cosmetic surgery can be better described through a distinct approach that we name the anti-paternalistic model of the PPR, and we will briefly present the differences between it and autonomy-based models. We will analyze the principle of non-interference, the variable degree of autonomy of both the patient and the physician within this relationship, the handling of the relevant information, the principle of beneficence as satisfaction, the difficulties regarding the informed consent, the algorithm allowing for the refusal of the procedure, and children-related issues. Based on this analysis, we will show that an anti-paternalistic model of the PPR is preferable to an autonomy-based one, as it allows for better clarification of the underlying ethical issues involved in cosmetic surgery

Particularities of Offenders Imprisoned for Domestic Violence from Social and Psychiatric Medical–Legal Perspectives

Background and Objectives: It is known that there may be an interconditionality between social status, personality disorders, and aggressive behavior. This study aimed to analyze the social and psychiatric diagnosis characteristics in subjects imprisoned for domestic violence acts compared to other types of aggressive behaviors. Materials and Methods: We performed a retrospective study using psychiatric medical–legal reports at the National Institute of Legal Medicine “Mina Minovici” Bucharest from 2016 to 2020. Results: We included 234 cases in our analysis, from which 132 (56%) were domestic violence offenders (DVO), and 102 (44%) were violence offenders imprisoned for other aggressions (OVO). Overall, DVOs were older than OVOs (43.0 +/− 14.7 vs. 36.1 +/− 16.6 years-old). In both study groups, most subjects were men, but the DVO group had more women than the OVO group: 23 cases (17%) and 3 cases (3%), respectively. In 14 cases (11%), previous criminal records were found from the DVO and 31 (30%) from the OVO group. Significantly fewer DVO were chronic psychoactive substance users: 83 (63%) in the DVO group versus 78 (86%) in the OVO group. Significantly more DVO had suicidal tendencies 26 (20%) compared to OVO 9 (9%). DVO subjects had significantly less often unsocialized conduct disorder or antisocial personality disorder compared to the OVO group. Conclusions: We found that DVO, compared to the OVO, were more numerous, older, less abusive, with a less frequent history of psychoactive substance abuse and addictions, and were less frequently indifferent to the committed acts

Ethical implications of developing RNA-based therapies for cardiovascular disorders

The awareness concerning RNA-based therapies was boosted significantly after the successful development of COVID-19 vaccines. However, they can potentially lead to significant advances in other areas of medicine, such as oncology or chronic diseases. In recent years, there has been an exponential increase in the number of RNA-based therapies that were evaluated as potential treatments for cardiovascular disorders. One of the areas that was not explicitly assessed about these therapies is represented by their overall ethical framework. Some studies evaluate ethical issues of RNA-based treatments in general or targeting specific disorders (especially neurodegenerative) or interventions for developing RNA-based vaccines. Much less information is available regarding the ethical issues associated with developing these therapeutic strategies for cardiovascular disorders, which is the main aim of this study. We will focus our analysis on three main topics: risk-benefit analysis (including the management of public awareness about these technologies), and justice (in both research and clinical medicine)