Judging in the genomic era: judges' genetic knowledge, confidence and need for training.

Genetic information is increasingly used in many contexts, including health, insurance, policing and sentencing-with numerous potential benefits and risks. Protecting from the related risks requires updates to laws and procedures by justice systems. These updates depend to a large extent on what the key stakeholders-the judiciary-know and think about the use of genetic information. This study used a battery of 25 genetic knowledge items to collect data from 73 supreme court judges from the same country (Romania) on their knowledge of genetic information. Their responses were compared with those of two other groups: lawyers (but not judges; N = 94) and non-lawyers (N = 116) from the same country. The data were collected at approximately the same time from the three groups. The judges' results were also compared to the results obtained from a general population data collection (N = 5310). The results showed that: (1) judges had overall better knowledge of genetics than the other groups, but their knowledge was uneven across different genetic concepts; (2) judges were overall more confident in their knowledge than the other two groups, but their confidence was quite low; and (3) the correlation between knowledge and confidence was moderate for judges, weak for lawyers and not significant for non-lawyers. Finally, 100% of the judges agreed that information on gene-environment processes should be included in judges' training. Increasing genetic expertise of the justice stakeholders is an important step towards achieving adequate legal protection against genetic data misuse.

Thinking Outside the Silos: Information Sharing in Medical-Legal Partnerships.

Medical-legal partnerships (MLPs) allow providers to address patients' health-harming legal needs through partnerships with lawyers. MLPs are most successful in addressing the complex needs of vulnerable populations when clinicians, social workers, and other care team members regularly communicate with the MLP lawyer. Privacy laws and professional rules of conduct governing patient/client confidentiality, however, potentially hinder this exchange of patient-client information. MLP attorneys may be reluctant to share relevant information about a client with the medical partner for fear that doing so would breach client confidentiality or result in an ill-advised waiver of attorney-client privilege. Similarly, privacy concerns may lead providers to limit MLP attorneys' access to patients' medical information.Drawing on the real-world experiences of MLP professionals, this article explores whether legal and ethical obligations impede the sharing of patient-client information between MLPs' medical and legal partners. Our research indicates that at present patient/client confidentiality rules generally do not pose a significant barrier to doing so. However, current legal and professional standards may frustrate emerging advanced care coordination models that pair MLPs with care teams that comprehensively address a broad range of social, economic, and behavioral health needs. We therefore recommend continued monitoring and discussion of the issue.

Effect of Lawyer-Submitted Reports on Signals of Disproportional Reporting in the Food and Drug Administration's Adverse Event Reporting System.

INTRODUCTION: Lawyer-submitted reports may have unintended consequences on safety signal detection in spontaneous adverse event reporting systems. OBJECTIVE: Our objective was to assess the impact of lawyer-submitted reports primarily for one adverse event (AE) on the ability to detect a signal of disproportional reporting for another AE for the same drug in the US FDA Adverse Event Reporting System (FAERS). METHODS: FAERS reports from January 2004 to September 2015 were used to estimate yearly cumulative proportional reporting ratios (PRRs) for three known drug-AE pairs-isotretinoin-birth defects, atorvastatin-rhabdomyolysis, and rosuvastatin-rhabdomyolysis-with and without lawyer-submitted reports. Isotretinoin and atorvastatin have been the subject of high-profile tort litigation regarding other AEs. A lower bound of the 95% confidence interval (CI) of one or more based on three or more reports defined a signal. RESULTS: Cumulative PRRs met signaling criteria in all analyses. For isotretinoin, lawyer-submitted reports increased PRRs for birth defects before 2008, with the largest increase in 2006 (2.9 [95% CI 2.4-3.5] to 3.3 [95% CI 2.8-3.9]); lawyer-submitted reports decreased PRRs for birth defects after 2011, with the largest decrease in 2013 (2.2 [95% CI 2.0-2.5] to 1.9 [95% CI 1.7-2.1]). For atorvastatin, lawyer-submitted reports reduced PRRs for rhabdomyolysis after 2013, with the largest decrease in 2015 (18.0 [95% CI 17.1-19.1] to 15.4 [95% CI 14.5-16.2]). Lawyer-submitted reports had little impact on PRRs for rosuvastatin and rhabdomyolysis. CONCLUSIONS: Inclusion of lawyer-submitted reports in FAERS did not meaningfully distort known safety signals for two drugs subject to high-profile tort litigation for other AEs.

[Development of a Tool for Training and Evaluation of the Competencies in Occupational Mental Health Necessary for Labor and Social Security Attorneys].

Labor and Social Security Attorneys (LSSAs) advise their clients about occupational mental health, but the competencies necessary in this field are not clear to them. We standardized the necessary competencies as a counseling guide for LSSAs, and we also designed a related discussion training program. These competencies were summarized in a brainstorming session at a research conference comprised of physicians, an occupational health nurse, LSSAs, an instructional design expert, and a management consultant, and then a training program (lasting 9 hours 30 minutes) was developed. Nineteen trainees who were introduced by members of the research conference collectively completed a seven-question written test, both before and after the training, in order to assess its effectiveness. Sixteen trainees who completed the training were surveyed, with a recovery rate of 100%. The necessary competencies that they identified were: information about circular notices from the Ministry of Health, Labor and Welfare; behavior such as the gathering of information; and dealing with the reinstatement of employees. The scores were subjected to the Wilcoxon signed-rank test in order to evaluate the training, and the answers from the pre-training were compared with those from the post-training. A significant difference (P < 0.05) was seen for each question. These results show the effectiveness of the developed training program for the learning of the competencies necessary for LSSAs.

Attorney Questions Predict Jury-eligible Adult Assessments of Attorneys, Child Witnesses, and Defendant Guilt.

Children are often the primary source of evidence in maltreatment cases, particularly cases of child sexual abuse, and may be asked to testify in court. Although best-practice protocols for interviewing children suggest that interviewers ask open-ended questions to elicit detailed responses from children, during in-court testimony, attorneys tend to rely on closed-ended questions that elicit simple (often "yes" or "no") responses (e.g., Andrews, Lamb, & Lyon, ; Klemfuss, Quas, & Lyon, ). How then are jurors making decisions about children's credibility and ultimately the case outcome? The present study examined the effect of two attorney-specific factors (e.g., temporal structure and questioning phase) on mock jurors' perceptions of attorney performance, child witness credibility, storyline clarity, and defendant guilt. Participants were randomly assigned to read a trial excerpt from one of eight conditions and were then asked to evaluate the attorney, child witness, and the case. Selected excerpts were from criminal court case transcripts and contained either high attorney temporal structure (e.g., use of temporal markers) or low temporal structure (e.g., frequent topic switching), involved direct or cross-examination, and represented cases resulting in a conviction or acquittal. Child responses were kept consistent across all excerpts. Results showed that participants perceived the attorney's performance and child's credibility more favorably and thought the storyline was clearer when attorneys provided high rather than low temporal structure and when the excerpt contained direct rather than cross-examination. Participants who read a direct rather than cross-examination excerpt were also more likely to think the defendant was guilty. The study highlights the impact of attorney questioning style on mock jurors' perceptions. Copyright © 2016 John Wiley & Sons, Ltd.

How good are future lawyers in judging the accuracy of reminiscent details? The estimation-observation gap in real eyewitness accounts / Habilidad de los futuros abogados para valorar la precisión de detalles evocados. La brecha entre estimación y observación en el relato real de testigos oculares

Research has shown a discrepancy between estimated and actually observed accuracy of reminiscent details in eyewitness accounts. This estimation-observation gap is of particular relevance with regard to the evaluation of eyewitnesses’ accounts in the legal context. To date it has only been demonstrated in non-naturalistic settings, however. In addition, it is not known whether this gap extends to other tasks routinely employed in real-world trials, for instance person-identification tasks. In this study, law students witnessed a staged event and were asked to either recall the event and perform a person identification task or estimate the accuracy of the others’ performance. Additionally, external estimations were obtained from students who had not witnessed the event, but received a written summary instead. The estimation-observation gap was replicated for reminiscent details under naturalistic encoding conditions. This gap was more pronounced when compared to forgotten details, but not significantly so when compared to consistent details. In contrast, accuracy on the person-identification task was not consistently underestimated. The results are discussed in light of their implications for real-world trials and future research (AU)

La investigación ha revelado que hay diferencias entre la precisión estimada y la observada realmente en los detalles evocados en los relatos de testigos oculares. La brecha entre estimación y observación es especialmente importante en la evaluación de los relatos de testigos oculares en el contexto legal. Sin embargo, hasta la fecha solo se ha demostrado en contextos no naturales. Además, no se sabe si esta brecha es extensible a otras tareas habituales en pruebas en el mundo real, como las de identificación de personas. En este estudio, estudiantes de Derecho presenciaron un montaje y se les pidió que lo recordaran y llevaran a cabo una tarea de identificación de personas o bien que estimaran la precisión de la actuación de los demás. Además se obtuvieron estimaciones externas de los estudiantes que no habían presenciado el montaje, recibiendo un resumen escrito en su lugar. La brecha entre estimación y observación se replicó para detalles evocados en condiciones de codificación naturales. La brecha era más pronunciada cuando se comparaban con detalles olvidados, aunque no significativa cuando se comparaban con detalles congruentes. Por el contrario, no fue infravalorada de un modo coherente la precisión de la tarea de identificación de personas. Se comentan los resultados desde el punto de vista de sus implicaciones para los ensayos en el mundo real y la investigación futura (AU)

Older persons and compromised decisional capacity: the role of public policy in defining and developing core professional competencies.

Issues frequently arise concerning the cognitive and emotional ability of older individuals to make certain legally significant decisions. In confronting these issues, the professional involvement of both attorneys and physicians (and other health care professionals), acting both individually and collaboratively, is desirable. This article describes the possible contributions of public policy in developing, through fostering innovations in medical and legal education, core competencies for physicians and attorneys that are essential to improving interprofessional collaboration on behalf of older individuals suspected of being compromised in their ability to make certain significant decisions. Additionally, ideas are suggested to address certain aspects of the current policy environment that may inhibit attorneys and physicians from optimal interprofessional interaction in this sphere.

Enduring powers of attorney: promoting attorneys' accountability as substitute decision makers.

AIM: The misuse and abuse of Enduring Powers of Attorney (EPAs) by attorneys, particularly in relation to financial decision-making, is a growing concern. This paper explores the opportunities to enhance accountability of attorneys at the time of the execution of the document in Queensland. METHOD: A four-stage multi-method design comprised a critical reference group; semi-structured interviews with 32 principals or potential principals, attorneys and witnesses; two focus groups with service providers and a state-wide survey of 76 principals, attorneys and witnesses. RESULTS: Across all methods and user groups, understanding the role and obligations of the attorney in an EPA was consistently identified as problematic. CONCLUSIONS: Promoting accountability and understanding can be addressed by greater attention to the role of the attorney in the forms/ guidelines and in the structure and witnessing of the forms, increased direction about record keeping and access to appropriate advice and support.

Medical malpractice lawsuits and the value of skilled and diverse legal counsel.

Medical malpractice claims against dermatologists and dermapathologists arise mostly out of claims for negligence--when a patient claims a provider owed a duty to a patient, breached that duty, and caused damages to the patient. When a health care provider files a claim with his or her insurance company, the insurance company will usually retain and pay an attorney for the health care provider. It is important to understand the role the attorney retained by the insurance company plays to evaluate whether a health care provider should seek the advice of independent or "personal" counsel.

Medical-legal partnership: collaborating with lawyers to identify and address health disparities.

INTRODUCTION: Medical-legal partnerships (MLPs) bring together medical professionals and lawyers to address social causes of health disparities, including access to adequate food, housing and income. SETTING: Eighty-one MLPs offer legal services for patients whose basic needs are not being met. PROGRAM DESCRIPTION: Besides providing legal help to patients and working on policy advocacy, MLPs educate residents (29 residency programs), health care providers (160 clinics and hospitals) and medical students (25 medical schools) about how social conditions affect health and screening for unmet basic needs, and how these needs can often be impacted by enforcing federal and state laws. These curricula include medical school courses, noon conferences, advocacy electives and CME courses. PROGRAM EVALUATION: Four example programs are described in this paper. Established MLPs have changed knowledge (MLP | Boston-97% reported screening for two unmet needs), attitudes (Stanford reported reduced concern about making patients "nervous" with legal questions from 38% to 21%) and behavior (NY LegalHealth reported increasing resident referrals from 15% to 54%) after trainings. One developing MLP found doctors experienced difficulty addressing social issues (NJ LAMP-67% of residents felt uncomfortable). DISCUSSION: MLPs train residents, students and other health care providers to tackle socially caused health disparities.

Tobacco industry lawyers as "disease vectors".

OBJECTIVE: Despite their obligation to do so, tobacco companies often failed to conduct product safety research or, when research was conducted, failed to disseminate the results to the medical community and to the public. The tobacco company lawyers' role in these actions was investigated with a focus on their involvement in company scientific research, claims of attorney-client privilege and work-product cover, document concealment, and litigation tactics. METHODS: Searches of previously secret internal tobacco industry documents located at Tobacco Documents Online. Additional searches included court transcripts, legal cases and articles obtained through Westlaw, PubMed, and the internet. RESULTS: Tobacco company lawyers have been involved in activities having little or nothing to do with the practice of law, including gauging and attempting to influence company scientists' beliefs, vetting in-house scientific research, and instructing in-house scientists not to publish potentially damaging results. Additionally, company lawyers have taken steps to manufacture attorney-client privilege and work-product cover to assist their clients in protecting sensitive documents from disclosure, have been involved in the concealment of such documents, and have employed litigation tactics that have largely prevented successful lawsuits against their client companies. CONCLUSIONS: Tobacco related diseases have proliferated partly because of tobacco company lawyers. Their tactics have impeded the flow of information about the dangers of smoking to the public and the medical community. Additionally, their extravagantly aggressive litigation tactics have pushed many plaintiffs into dropping their cases before trial, thus reducing the opportunities for changes to be made to company policy in favour of public health. Stricter professional oversight is needed to ensure that this trend does not continue.

The professional responsibility of lawyers: emotional competence, multiculturalism and ethics.

Traditional legal education and the Socratic method it utilises are by and large successful at training lawyers to think, reason and analyse. The cultivation of lawyers' intrapersonal and interpersonal skills, however, has been, at best, neglected by the profession. All lawyers, like all human beings, are emotional. Emotions affect who they are and how they practise law, whether or not they are conscious of them. As emotions cannot be removed from the practice of law, it is essential that lawyers learn to understand and manage their emotions, as well as learn to be attuned to their clients' emotional lives. Ignorance of concepts such as countertransference, denial and unconscious bias adversely impact the lawyer-client relationship. Lawyers who understand basic psychological principles and behaviours, who are aware of their own psychological makeup, understand their cultural perspective and recognise and credit their clients' differences, will enhance their effectiveness as counsellors. The client whose lawyer has these competencies will enjoy a therapeutically superior counselling or representational experience. The neglect of either the lawyer's or the client's emotional life threatens to sabotage the lawyer's ability, and thus professional responsibility, to render competent and impartial legal advice. Through drawing parallels to the training and practice in other counselling disciplines and relationships, this article argues that psychological-mindedness and multicultural competence are essential elements of ethically responsible legal representation.