W.L.J.M. Duijst

Trafficking in Human Beings for the Purpose of Organ Removal and the Ethical and Legal Obligations of Healthcare Providers.

Abstract Physicians and other health care professionals seem well placed to play a role in the monitoring and, perhaps, in the curtailment of the trafficking in human beings for the purpose of organ removal. They serve as important sources of information for patients and may have access to information that can be used to gain a greater understanding of organ trafficking networks. However, well-established legal and ethical obligations owed to their patients can create challenging policy tensions that can make it difficult to implement policy action at the level of the physician/patient. In this article, we explore the role—and legal and ethical obligations—of physicians at 3 key stages of patient interaction: the information phase, the pretransplant phase, and the posttransplant phase. Although policy challenges remain, physicians can still play a vital role by, for example, providing patients with a frank disclosure of the relevant risks and harms associated with the illegal organ trade and an honest account of the physicians own moral objections. They can also report colleagues involved in the illegal trade to an appropriate regulatory authority. Existing legal and ethical obligations likely prohibit physicians from reporting patients who have received an illegal organ. However, given the potential benefits that may accrue from the collection of more information about the illegal transactions, this is an area where legal reform should be considered.

Women refusing standard obstetric care: Maternal-fetal conflict or doctor-patient conflict?

Evidence based guidelines can help healthcare practitioners to provide better and more cost effective care for the average patient with a specific medical problem [1]. During the past 15 years, the Cochrane Collaboration, NICE, and many other national and international organizations have provided obstetric medicine with a wealth of new evidence based guidelines. However, more protocolized care also means less room for personalized medicine. Not all patients have the same perception of risk as medical staff [2] and some attach more importance to avoiding a certain intervention (for instance caesarean section) than to incurring a small increase in risk of perinatal morbidity or mortality. One of the consequences of the plethora of protocols in obstetric medicine could be a real or perceived increase in the number of patients who wish to go outside the standard of care. No quantitative surveys on this subject have been done to date, so exact numbers are not available. Much is still unclear among professionals about the rights of a pregnant woman, those of her fetus, and the legal position of a healthcare provider who is willing to assist a woman who wants to give birth outside the standard protocol. The debate is as yet unresolved whether the law can or indeed should intervene in situations where the woman’s decision seems to put the fetus’s life at risk. This is often described by obstetricians as a maternal-fetal conflict. In this paper we will provide some insight into the legal and ethical context surrounding women’s rights in childbirth and the issues mentioned above. We will also review some professional organizations’ statements on these issues. Legal measures against pregnant women in literature.

Lost and found: The identification process of human bodies recovered from the North Sea

Files of the Dutch bureau of missing persons at the North Sea (BVPN) were investigated to analyse the process that led to identification of human bodies recovered from the North Sea between 1980 and 2013. Of the 94 cases that were analysed 41.5% was identified by the family, 23.4% by the use of DNA and 17% by the use of the dental status. The linking pin for the identification was the place where the body was found (14.9%), the general appearance (12.8%), jewellery (11.6%) and media attention (9.6%). In only a few cases the DNA or fingerprint database was used for identification. When a person is not reported missing the identification is problematic because of the lack of antemortem data. National and international databases of people who have gone missing, can help solve this problem.

Kroniek rechtspraak strafrecht

SamenvattingIn deze kroniek zijn de bekende thema’s van het gezondheidsstrafrecht, zoals beroepsgeheim, dood door schuld, hiv, alternatieve genezers en handelen rond het levenseinde weer aanwezig. Uitspraken die in juridische zin opzienbarend waren zijn er het afgelopen jaar niet geweest, wel uitspraken die gezien hun ‘exotische’ karakter of de maatschappelijke relevantie de aandacht van de media trokken.

Evaluation of postmortem biochemical markers: Completeness of data and assessment of implication in the field

Throughout the years an increase has been observed in research output on biochemical markers for determining the postmortem interval (PMI). However, to date, a complete overview is missing on the results of postmortem biochemical markers (PBMs) for PMI estimation. In this paper, literature was reviewed in order to identify the knowledge lacunae of PBM research from a practical point of view. A three-step approach was undertaken in order to achieve the set goal. Literature was collected, the PBMs were evaluated for completeness by means of a scorings index based on set criteria, and PBMs were subsequently evaluated in light of the Daubert &Frye criteria for scientific evidence in court. Seven PBMs were found to be well investigated, from which potassium had the highest completion score. However, none of these PBMs could be qualified as suitable for court evidence. Further, this study revealed that the majority of PBMs (94%) is not well investigated. Consequently, these PBMs did not meet Daubert &Frye criteria. In order to improve the assessment for use of PBMs as evidence in court regarding PMI estimation, PBMs should be investigated more thoroughly and data should be made readily available.

The correlation between the Aquatic Decomposition Score (ADS) and the post-mortem submersion interval measured in Accumulated Degree Days (ADD) in bodies recovered from fresh water

The Aquatic Decomposition Score (ADS) made by van Daalen et al., was developed to approximate the Post-Mortem Submersion Interval (PMSI) in bodies recovered in salt water. Since the decomposition process in salt water differs from the process in fresh water due to salinity, the temperature, and the depth of the water, we wanted to investigate whether there is a correlation between the ADS and the PMSI and if the ADS can be used to make an estimation of the PMSI in bodies recovered from fresh water. For the latter, the PMSI was measured using Accumulated Degree Days (ADD). In our study we included seventy-six human remains found outdoors in fresh water. Their decomposition was measured using the ADS. A strong correlation was found between the ADS and the PMSI. Also, it was found that the ADS can significantly estimate the ADD. Despite the more varied circumstances under which bodies in fresh water are found when compared to those found in salt water, the ADS can be used to measure the decomposition and accurately estimate the ADD, and thus the PMSI. More research is needed to validate our method and make a prediction model with smaller confidence intervals.

Temperature estimations of heated bone: a questionnaire-based study of accuracy and precision of interpretation of bone colour by forensic and physical anthropologists

The colour of thermally altered bone, recovered from archaeological and forensic contexts, is related to the temperature(s) to which it was exposed. As it is heated bone changes in colour from ivory white, to brown and black, to different shades of grey and chalky white. It should be possible to estimate exposure temperature based on visually observable changes in colour. In forensic casework the temperature that human remains have been subjected to can reveal information about the existence and nature of foul play. Therefore, it is important to understand the accuracy and precision of visual methods of temperature estimation. Twenty-eight forensic and/or physical anthropologists estimated the temperature that fourteen bone samples had been subjected to based only on their colour via an online questionnaire. Bone samples shown in the questionnaire ranged from unheated to having been heated at 1200°C. Respondents were given two options to base their estimates on, resulting in a multiple response analysis. The results suggest it is difficult to identify the correct temperature range based solely on colour. Most respondents felt confident enough to opt for a single option, which may have contributed to a relatively high number of incorrect estimates. Low accuracy and precision were found for most of the temperature ranges, especially in the lower and middle categories. This study demonstrates that caution should be taken in the reliance upon temperature estimates of thermally induced colour changes in bone and the need for further research and improved methods.

Deaths under the responsibility of the Dutch police: Lessons to be learned

The European Convention on Human Rights requires states to protect the life of detainees and to investigate police custody deaths. Investigations into these deaths are not only necessary in the individual case but can also be important in preventing future deaths. Examination of multiple police custody deaths over a number of years provides the possibility to determine risk factors and to establish preventive measures for avoiding future deaths. A descriptive study was therefore performed on 78 case files relating to police custody deaths in the Netherlands in 2005–2010. The main findings of this study are that half of the calamities occurred during the relatively short period of apprehension and transport by the police. The consumption of drugs and/or alcohol seems to be an important factor in fatal medical emergencies occurring under the responsibility of the police.

Verklaring van overlijden

SamenvattingDuijst W. Verklaring van overlijden. Huisarts Wet 2015;58(8):432-4. Huisartsen worden geregeld geconfronteerd met een overlijden van een voor hen min of meer bekende patiënt. Het verzoek aan de huisarts is dan om de schouw te verrichten en de verklaring van overlijden in te vullen. Dit artikel gaat in op de lijkschouw en de verklaring van overlijden. Aan welke eisen moeten huisartsen voldoen voordat ze de verklaring van overlijden kunnen invullen? De voorwaarden voor professioneel handelen rondom het afhandelen van een overlijden komen aan de orde.AbstractDuijst W. Certification of death. Huisarts Wet 2015;58(8):432-4. When a patient dies, general practitioners are often asked to carry out the physical examination and to confirm that death has occurred. This article describes the postmortem examination and certification of death. What requirements must GPs satisfy before they can issue a death certificate? Aspects of professional practice when dealing with a death are discussed.

Suicide in detention in the light of the human rights convention

The European Court of Human Rights has derived several obligations from the European Convention for the Protection of Human Rights and Fundamental Freedoms with regard to suicide prevention among detainees and the investigation after a suicide has occurred in detention. We performed a study on case files on suicides in detention. In this article, we present a part of the results of this study in the light of the requirements arising from the European Convention.