Subject(s)
Ethics, Medical , Medical Records , Physician-Patient Relations , Germany , Humans , Truth DisclosureABSTRACT
For the determination of legal limits in the care of seriously impaired newborns no real or presumed decisions of the patient are at hand. An autonomy of the patient (such as informed consent/refusal) does not exist nor do individual signs that would allow assumptions about the newborn's will. Also, decisions of the legal guardians are not binding if they are directed against the child's interests. Judgements based on arguments that consider social and psychological facts must be rejected as well as considerations about the rightfulness of an abortion on eugenic grounds. Solely general legal principles and norms can serve as a guideline for the determination of such limits: "life" as the most precious value guaranteed by constitution, the ban of the killing of any human being as a criminal act, the physicians general objectives that are based on professional ethics and affect law. From this can be deducted: Any obligation of the physician ends with the cerebral death of the patient. The obligation to prolong life ceases with: irreversible coma, or if necessary operations would result in such coma, or if life that befits a human being can never be secured without the help of mechanical ventilation, or if survival would constantly require new serious operations, or if imminent death could only be postponed for a short period of time.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Abnormalities, Multiple/surgery , Ethics, Medical , Euthanasia, Passive/legislation & jurisprudence , Infant, Premature, Diseases/surgery , Legal Guardians , Refusal to Treat/legislation & jurisprudence , Brain Death/legislation & jurisprudence , Humans , Infant, Newborn , Quality of LifeABSTRACT
X-ray films of the skeleton obtained after trauma in 1,386 children and adolescents (until the end of their 18th year) were analysed retrospectively. Among a total of 2,006 examinations 354 fractures were diagnosed, an average diagnostic yield of 17.2%. Classifying the results by skeletal region, X-ray films of the skull were the most frequently requested examination (29.7%), but fractures were diagnosed in only 2.2%. On the other hand, X-rays of the lower arm provided the highest fracture yield, at 54.9%, followed by the shoulder with 47.7%.- In view of the large discrepancy between clinical suspicion and radiological confirmation of fractures, X-ray examinations should be undertaken in case of trivial injuries in children only if strictly indicated. Although the doctor is legally bound to detailed documentation of each case, this does not necessarily imply that he must perform an X-ray.
Subject(s)
Radiology/legislation & jurisprudence , Wounds and Injuries/diagnostic imaging , Adolescent , Age Factors , Child , Child, Preschool , Evaluation Studies as Topic , Fractures, Bone/diagnostic imaging , Germany , Humans , Infant , Radiography/adverse effects , Risk Factors , Skull Fractures/diagnostic imagingABSTRACT
Pregnancies in patients with Addison's disease and Diabetes mellitus are rarely observed. A case of pregnancy in such patient is reported. The course of pregnancy and the fetal development show, that pregnancy can be finished without great problems, if there is therapeutical full compensation of metabolic derangement by hydrocortisone and insulin. There are less complications due to Addison's disease than to Diabetes mellitus. Thus the management of delivery should be the same as in isolated Diabetes mellitus.
