Issues in Law & Medicine最新文献

Purpose: To evaluate the global research on school-based comprehensive sex education (CSE) by applying rigorous and meaningful criteria to outcomes of credible studies in order to identify evidence of real program effectiveness.

Methods: We examined 120 studies of school-based sex education contained in the reviews of research sponsored by three authoritative agencies: the United Nations Educational, Scientific and Cultural Organization, the U.S. federal Teen Pregnancy Prevention Program, and the Centers for Disease Control and Prevention. Their reviews screened more than 600 hundred studies and accepted only those that reached a threshold of adequate scientific rigor. These included 60 U.S. studies and 43 non-U.S. studies of school-based CSE plus 17 U.S. studies of school-based abstinence education (AE). We evaluated these studies for evidence of effectiveness using criteria grounded in the science of prevention research: sustained positive impact (at least 12 months post-program), on a key protective indicator (abstinence, condom use-especially consistent use, pregnancy, or STDs), for the main (targeted) teenage population, and without negative/harmful program effects.

Results: Worldwide, six out of 103 school-based CSE studies (U.S. and non-U.S. combined) showed main effects on a key protective indicator, sustained at least 12 months post-program, excluding programs that also had negative effects. Sixteen studies found harmful CSE impacts. Looking just at the U.S., of the 60 school-based CSE studies, three found sustained main effects on a key protective indicator (excluding programs with negative effects) and seven studies found harmful impact. For the 17 AE studies in the U.S., seven showed sustained protective main effects and one study showed harmful effects.

Conclusions: Some of the strongest, most current school-based CSE studies worldwide show very little evidence of real program effectiveness. In the U.S., the evidence, though limited, appeared somewhat better for abstinence education.

In the U.S., legal abortion is considered extremely safe, and abortion-related mortality is reported to be far lower than mortality associated with term childbirth. Yet, the voluntary nature of abortion complication reporting and ideological selection biases obscure the poor quality of the data used to support these assumptions. Worldwide, the World Health Organization reports that illegal abortion is extremely unsafe, killing and injuring vast numbers of women yearly. They advocate for the liberalization of abortion laws so that women can access safer abortions. Yet, their calculations are based largely on subjective opinions from a limited number of health care providers, with little objective verification from external sources. The limitations in the data should prompt calls for improved studies and more objective estimates of complications and deaths resulting from abortion, both legal and illegal.

Bernard A. Nathanson (1926-2011), was a professionally well-recognized and successful New York obstetrician and gynecologist. An avowed atheist as a young man through his middle age, Nathanson was a co-founder of the National Association for the Repeal of Abortion Laws, whose activities are credited with hastening the liberalization of abortion law in New York State. Intent on increasing the accessibility and promoting the acceptance of abortion on demand, Dr. Nathanson taught and published journal articles on the operative techniques and on the results from large numbers of these procures. During his tenure as director of the largest abortion clinic in the Western World, Nathanson presided over 60,000 abortions, and he performed more than 1,500 in his own practice. His studies of embryology and evidence from emerging technologies to monitor and examine intrauterine fetal development led Nathanson to question the morality of voluntarily interrupting pregnancy, thence to rejecting abortion procedures from his own clinical practice altogether, and eventually to become involved in anti-abortion, pro-life activities. An influential writer, speaker and film maker, these experiences and witnessing the love and prayer of other pro-life supporters turned Nathanson to notions of God, and finally reading and personal prayer guided him from secular atheism to Christianity.

Fetal pain is a hot topic of debate, but not amongst the neonatologists who daily treat premature babies. The uncontroversial medical standard of care for this population's treatment includes avoiding, minimizing, or intentionally treating pain, and this standard has evolved due to the data of multiple lines of research. While it is true that unsettled debate over how to best define "pain" continues, this debate does not change the fact that premature babies' outcomes are better when what seems to be painful stimuli is removed or treated. Thus there is an uncomfortable paradox between the current standard of care for neonatologists, and what remains legal for obstetricians to do to the same patient. While this article is not an all-inclusive literature review, it is a brief presentation of the information that informs current neonatal practice but does not equally inform national law.

The Perinatal Revolution is an exciting and rapidly developing field of medicine that aims to treat and possibly cure disease in the prenatal period, and thereby to improve health across the lifespan of the child. Here we describe an overview of the perinatal field, with specific emphasis on current therapies and interventions for specific fetal problems, such as myelomeningocele and congenital diaphragmatic hernia. Advances in perinatal medicine have resulted in increased survival rates and improvements in morbidity and mortality for premature neonates. Novel innovations in screening and genetic diagnosis, as well as future prospects in cell-based therapies, tissue engineering, gene therapy, and artificial womb are significantly expanding the field and are discussed. Ethical, regulatory and policy concerns closely linked to clinical practice and public awareness are also highlighted as the Perinatal Revolution continues to unfold through research, genetic, medical and surgical advances.

Israeli and French Governments passed Body Image Laws that require models to have a minimum BMI or be of a healthy weight and if an image was modified to make the model appear thinner, it must have a warning. Are these laws merely symbolic, to focus a spotlight on this issue, or can they too have an impact? This article analyses some of the criticisms of the Body Image Laws by applying existing evidence from health research. Ultimately, it argues that there are many flaws with the Body Image Laws and that such a law should not be passed in Australia.

In this article the authors examine the legality of human body transplantation under the current state of medical knowledge. The article first analyzes under what conditions an experimental medical procedure may be legitimately performed under international and national law. Then it examines the legal requirements for prior ethics approval and considers the possible civil and criminal liability claims and disciplinary sanctions that may arise if such a procedure would fail. Subsequently, it applies this analysis to investigate whether body transplants would currently be legally allowed. The authors conclude that it is very unlikely that prior ethics approval would be obtained, and emphasize that physicians are likely to be found liable for medical malpractice if body transplantation is performed. If body transplantation results in the death of the patient, the physicians involved would run a considerable risk of being held criminally liable for negligent homicide. The participating physicians also risk severe disciplinary sanctions for professional misconduct, with a real possibility that they will be suspended or even banned from medical practice for life.