"Rectal Feeding"-Unethical Medical Officer Participation at CIA Secret Interrogation Facilities.

This Viewpoint discusses recently released information regarding the practice of "rectal feeding" among detainees at Guantanamo Bay and Central Intelligence Agency (CIA) secret prisons.

Concussion management in United States college sports: compliance with National Collegiate Athletic Association concussion policy and areas for improvement.

BACKGROUND: In 2010, the National Collegiate Athletic Association (NCAA) adopted its Concussion Policy and Legislation, which applies to more than 450,000 collegiate athletes annually. To date, there has been no examination of school-level compliance with the NCAA Concussion Policy. PURPOSE: To examine whether stakeholders at NCAA schools report that their school has a concussion management plan and whether existing plans are consistent with the NCAA policy. Also examined were stakeholders' perceptions regarding concussion management at their institution and possible areas for improvement. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Surveys were sent by e-mail to coaches, sports medicine clinicians, and compliance administrators at all 1066 NCAA member institutions. Surveys asked population-specific questions about institutional concussion management. Individuals (N=2880) from 907 unique schools participated in this survey. RESULTS: Most respondents (n=2607; 92.7%) indicated their school had a concussion management plan. Most schools had all (82.1%) or some (15.2%) respondents indicate a concussion management plan was present. When asked to indicate all individuals who could have final responsibility for returning athletes to play after a concussion, 83.4% selected team doctor, 72.8% athletic trainer, 31.0% specialist physician, 6.8% coach, and 6.6% athlete. Most respondents (76.1%) indicated that their institution had a process for annual athlete concussion education; 91.2% required athletes to acknowledge their responsibility to report concussion symptoms. Nearly all respondents (98.8%) thought their school's concussion management plan protected athletes "well" or "very well." Top categories suggested for improvement included better coach education (39.7%), increasing sports medicine staffing (37.2%), and better athlete education (35.2%). CONCLUSION: Although a large majority of respondents indicated that their school has a concussion management plan, improvement is needed. Compliance with specified components (eg, annual athlete education) lags behind the presence of the plan itself, and stakeholders had suggestions for areas in which improvements are needed. Increasing scientific evidence supporting the seriousness of concussion underscores the need for the NCAA to use its regulatory capabilities to ensure that athletes' brains are safe.

Jacobson v Massachusetts: it's not your great-great-grandfather's public health law.

Jacobson v Massachusetts, a 1905 US Supreme Court decision, raised questions about the power of state government to protect the public's health and the Constitution's protection of personal liberty. We examined conceptions about state power and personal liberty in Jacobson and later cases that expanded, superseded, or even ignored those ideas. Public health and constitutional law have evolved to better protect both health and human rights. States' sovereign power to make laws of all kinds has not changed in the past century. What has changed is the Court's recognition of the importance of individual liberty and how it limits that power. Preserving the public's health in the 21st century requires preserving respect for personal liberty.

Nontherapeutic research with children: Grimes v Kennedy Krieger Institute.

Research with young children raises difficult issues of law and ethics. A recent Maryland case, Grimes v Kennedy Krieger Institute, Inc, appears to impose restrictive rules on research with children when the subjects are put at risk but cannot derive direct benefit from their involvement in the research project. This case exemplifies the tension that exists between the goal of science to increase knowledge and the protection of the rights and welfare of nonconsenting research subjects. While some language in the opinion may be difficult to understand or apply, for the most part the case reflects the problems other courts and ethicists have had in delineating the role of children in "nontherapeutic" research.

Case vignette: Niki goes to school -- autonomy, control, and psychiatric hospitalization.

The following is a description of a case and a discussion by professionals of the ethical issues raised. Niki turned 18 years old just 3 months ago. She is a freshman student at Central State University, where her father is also a faculty member. Niki has been residing in her parents' home. On Monday afternoon, Niki arrives at the college health service asking for a walk-in appointment. An intake evaluation reveals that she is showing signs of anorexia nervosa and is having suicidal ideation. A decision is made to refer Niki for admission to a local psychiatric facility. She agrees to accept a voluntary admission but advises the staff at both the health center and the hospital that she does not want her parents to know where she is. By Monday evening, Niki's family is very anxious regarding her whereabouts and is telephoning everyone they can think of to try to locate her. Although staff members have been urging Niki to allow them to inform her family of her admission to the hospital, she is still refusing to authorize such disclosure. What should the professionals involved in the case do or say if they are contacted by the parents? What are the parameters of confidentiality in cases of children who are living at home but have attained the age of legal majority?