Current and emerging legal issues in critical care.

Antitrust, access to care, and accountability are but three areas of law directly affecting the provision of critical care services. As the country continues to wrestle with increased health care costs, the expanding needs posed by an aging population and problems such as the AIDS epidemic, and whether or not to adopt some form of national health insurance, the legal system will continue to interact with the health care delivery system. Providers of critical care services are in the forefront of advances in medicine and are in the middle of the political, economic, and policy debates about the shaping of the health care system. They must not allow themselves to be caught at the end of rapid changes in the legal system. Critical care providers must take a leadership role in helping shape the forces that will be the major legal issues in years to come. If providers do not like lawyers and bureaucrats telling them how to provide patient care, they must seize the initiative in shaping defined standards of care. If providers do not like to be forced into providing "useless" or "unnecessary" care, they must be more honest in discussing care options with patients, families, and the media. If they do not like being told for how long to hospitalize a patient, they must be more responsible in making decisions to admit, transfer, or discharge a patient. Lawyers have been quite happy to step into what has long been perceived as a vacuum of leadership among medical care providers, and will continue to do so as long as there is uncertainty and lack of consensus about what constitutes appropriate medical care.

Legal medicine in medical schools: a survey of the state of the art.

American medical colleges are showing increased interest in acquainting their students with legal aspects of the practice of medicine. However, little is known about the role of legal medicine in the medical school curriculum. During the summer of 1978 the author sent a questionnaire to all U.S. medical schools. The 86% response rate suggests considerable interest in the subject matter. The results of the survey indicate that while 40% of the schools require their students to complete some course work in legal medicine, the curricula vary considerably among the schools. The topics most frequently covered are informed consent and malpractice.

Homicide and community-based psychiatry.

The authors studied the records of all persons convicted of homicide or found not guilty by reason of insanity during the uears 1963 through 1975, 6 years before and after the opening of the community-based psychiatric facility, in Albany County, New York. Using the Fisher Exact Probability Test, a statistically significant increase was found for those found not guilty by reason of insanity (p = .041) and those with a history of mental illness found guilty (p = .036). Other factors, including age of the perpetrator, use of alcohol, and relationship to the victim, were also examined. The authors caution against sweeping indictments of community-based psychiatry and urge that the study be repeated elsewhere.