Showing papers on "Directive published in 1991"
TL;DR: Advance directives as part of a comprehensive approach such as that provided by the Medical Directive are desired by most people, require physician initiative, and can be achieved during a regular office visit.
Abstract: Background. Advance directives for medical care and the designation of proxy decision makers to guide medical care after a patient has become incompetent have been widely advocated but little studied. We investigated the attitudes of patients toward planning, perceived barriers to such planning, treatment preferences in four hypothetical scenarios, and the feasibility of using a particular document (the Medical Directive) in the outpatient setting to specify advance directives. Methods. We surveyed 405 outpatients of 30 primary care physicians at Massachusetts General Hospital and 102 members of the general public in Boston and asked them as part of the survey to complete the Medical Directive. Results. Advance directives were desired by 93 percent of the outpatients and 89 percent of the members of the general public (P>0.2). Both the young and the healthy subgroups expressed at least as much interest in planning as those older than 65 and those in fair-to-poor health. Of the perceived barriers ...
759 citations
TL;DR: The Patient Self-Determination Act takes effect on December 1,1991, and requires hospitals, nursing homes, and hospices to advise patients on admission of their right to accept or refuse medical care and to execute an advance directive.
Abstract: DESPITE widespread acknowledgment of the need for individuals to draft living wills, durable powers of attorney, or other advance directives, few Americans have done so. To encourage patients to complete advance directives, Congress enacted the Patient Self-Determination Act (hereafter "the Act") last October. The Act takes effect on December 1,1991, and requires hospitals, nursing homes, and hospices to advise patients on admission of their right to accept or refuse medical care and to execute an advance directive. Managed care organizations and home health care agencies must provide the same information to each of their members on members' enrollment. Provider organizations will also be required to (1) document whether patients have advance directives, (2) implement advance directive policies, and (3) educate their staffs and communities about advance directives. Compliance with the Act is a condition for Medicare and Medicaid reimbursement and is tied to institutional
204 citations
TL;DR: It is suggested that institutions develop treatment policies for situations in which the wishes of patients who lack decisional capacity are not known, and these policies should be designed to promote the patients' best interests.
Abstract: Living wills and other advance directives currently play a limited role in medical decision making. A new federal law, the Patient Self-Determination Act, will require health care providers in hospitals, nursing homes, and other facilities to inquire about the presence of advance directives, to record patient preferences in the medical record, and to develop institutional policies regarding the implementation of these directives. Unfortunately, the law does little to promote discussion or preparation of advance directives before hospitalization. Additional efforts to promote the use of advance directives can take place in the outpatient medical care system, in attorneys' offices, or through health insurers. Because most people have not yet prepared an advance directive, we suggest that institutions develop treatment policies for situations in which the wishes of patients who lack decisional capacity are not known. These policies should be designed to promote the patients' best interests, as defined by the consensus of the institutions' staff and members of the surrounding community.
187 citations
TL;DR: A model advance directive is proposed which seeks to keep the merits of the original Medical Directive yet modify it according to empirical data on its use by patients.
Abstract: Despite wide popularity and numerous state statutes, living wills have been previously little used. Now the Patient Self Determination Act promises to close the gap. The medical world is obliged to move fast in an attempt to provide good advance planning to patients and to avert the possible negative outcomes of poor advance planning. A good document has the potential to stimulate good doctor-patient discussion and good planning. A model advance directive is proposed which seeks to keep the merits of the original Medical Directive yet modify it according to empirical data on its use by patients. The remodelled directive still provides an instructional section, a durable power of attorney section, a values statement section, and an organ donation section in addition to the illness scenarios section, much as in the Medical Directive. In the illness scenarios section, however, the Health Care Directive makes use of a wider range of scenarios that may be particularly relevant to the elderly or chronically ill and an intervention selection system that includes statements about goals of treatment.
40 citations
Book•
31 Aug 1991
TL;DR: It is often difficult to make sense of advance directives, and the author documents the reasons why, which eliminate both over-reliance on legalities and the use of directives as trump cards in a game of power that is often conducted at the bedside of gravely ill, incompetent patients.
Abstract: Advance directives - such as living wills and health care proxies - are documents intended to declare and preserve the health care choices of patients if they become unable to make their own decisions. This book provides a comprehensive overview of advance directives and clear, practical directions for writing and interpreting them. Nancy M.P. King provides a legal, philosophical, and historical analysis of the moral and legal force of advance directives. She explains the types and models of advance directives currently in use and offers guidelines for individuals seeking to write, read, and use directives to promote individuals' health care choices within the laws of their own states. King emphasizes that advance directives are not orders given by patients to their doctors; instead, they are documents that invite conversation between doctors and patients about health care decisions of great importance. The purpose of advance directives is to support patients' health care choices, and the book promotes a thoughtful use of advance directives that is best calculated to achieve that purpose, whatever form individual advance directives may take. This new edition has been updated to reflect the many changes in advance directive statutes since 1991, including expanded discussions of health care proxy statutes, the impact of the Patient Self-Determination Act and the Supreme Court's Cruzan decision. King also has extended her analysis of the implications for advance directives of managed care, resource allocation, resource scarcity, and the debate over futile treatment at the end of life. "Making Sense of Advance Directives" is a valuable handbook for patients, health care providers and administrators, patient counselors, lawyers, policymakers, and any individual interested in advance directives.
33 citations
TL;DR: There are several reasons for special doubts about whether an advance directive accurately reflects what the patient would have wanted, and advance directives are often framed with implicit assumptions about the conditions in which the directive will be applied.
Abstract: When, if ever, should a patient's advance directive not be followed? Since it is widely accepted that a competent patient's treatment choice must be respected, and an advance directive can reasonably be understood as the treatment choice of a patient while still competent, some believe that informed, voluntary advance directives should always be followed. However, there are several reasons for special doubts about whether an advance directive accurately reflects what the patient would have wanted. Uncertainty as to how closely an advance directive reflects what a patient actually would want may arise from any of several sources. Advance directives typically require individuals to predict what they would want well in advance of the use of the directive in treatment decisionmaking, and so treatment choices in advance directives often inevitably are less well informed than competent patients' contemporaneous choices. For example, new, highly beneficial treatment may have been developed of which the patient was unaware; or if the directive is very old there may be evidence that the patient's wishes about treatment have changed. Also, advance directives must often be formulated without knowing what it will be like to experience the radically different conditions in which later treatment choices must be made. Further, advance directives are often formulated in somewhat vague or general terms, which inevitably leaves significant discretion in applying them to later treatment choices and, in turn, uncertainty about whether they have been correctly interpreted. Moreover, when competent patients make choices that appear to be seriously in conflict with their well-being or settled preferences and values, these choices will typically be questioned, explored, and even opposed by their physicians, family members, and others who care for them to insure that the patients fully understand the nature and implications of their choices, and that the choices are what they "really" want. Directives executed by no longer competent patients obviously cannot be similarly clarified. Finally, advance directives are often framed with implicit assumptions about the conditions in which the directive will be applied. For example, an advance directive declining CPR may be intended by the patient to apply to circumstances where her overall condition has so deteriorated that she is virtually certain not to survive the attempt. The patient may not have meant her directive to apply, however, should a cardiac arrest be caused by a medical procedure or in reaction to a drug, and in circumstances where CPR is highly likely to succeed and to leave the patient unimpaired. In the second kind of case in which an advance directive might be trumped, what the individual executing the directive really wanted need not be in doubt. Instead, the issue is the moral authority of that individual's advance directive to determine the patient's treatment. That authority can be called into question when the directive appears to be seriously in conflict with important interests of the present patient or the patient has suffered such profound cognitive changes-for example, being now in a persistent vegetative state or severely demented-that there are doubts whether personal identity is maintained between the person who executed the advance directive and the present patient. The strongest cases of this sort for trumping advance directives will be when both these conditions obtain, with directives requesting either the forgoing of treatment or maximally aggressive treatment. …
31 citations
TL;DR: A pilot study on risk information needs was conducted at two Seveso sites in Italy in order to begin to resolve some of the problems involved in the provision of public information and to suggest appropriate guidelines as mentioned in this paper.
Abstract: In 1982 the Council of the European Communities issued a Directive on the Major Accident Hazards of Certain Industrial Activities, commonly known as the Seveso Directive. Besides other requirements, the Directive specifies that members of the public liable to be affected by a major accident from certain industrial activities must be informed of safety measures and how they should behave in the event of an accident. The Directive was subsequently amended in an extensive way. Upon the transposition of the Seveso Directive and its amendments into national legislations, the 12 European Member States are faced with the task of "appropriately and effectively" informing the public about major accident hazards. Delays are observed throughout the community, both in transposing the Directives and implementing public information. A pilot study on "Risk Information Needs" was commissioned and carried out at two Seveso sites in Italy in order to begin to resolve some of the problems involved in the provision of public information and to suggest appropriate guidelines. One hundred subjects answered an experimental protocol designed to assess their "information needs." This article presents the theoretical background, the pragmatic aims, and the design of the study. It also summarizes its most relevant findings and suggests some recommendations for the provision of information to the public. Language: en
30 citations
Journal Article•
21 citations
TL;DR: In this article, the authors describe the legal aspects of oral change orders or directives, and provide basic criteria for an owner, contract administrator, or contractor to determine if an oral directive is valid, entitling the contractor to additional compensation.
Abstract: This paper describes the legal aspects of oral change orders or directives. It provides basic criteria for an owner, contract administrator, or contractor to determine if an oral directive is valid, entitling the contractor to additional compensation. The criteria are based on common law rules extracted from a review of more than 70 appellate court cases. The rules provide that for an oral directive to be valid, there must be no statutes requiring a written change, the owner must have knowledge of the work, and he must know that the contractor is expecting compensation for the additional work. A promise to pay cannot be rescinded. Other aspects discussed include proper or apparent authority and waiver. The case law review revealed substantial consistency in the application of these rules, and no discernible differences were found between the public and private sectors. The rules are arranged in an easy‐to‐follow flowchart, and numerous case citations are included. Recommended practices are also included.
14 citations
Posted Content•
TL;DR: The European Community (EC) Council Directive Coordinating Regulations on Insider Dealing as discussed by the authors is a model act that must be implemented by national legislation in all the member states of the European Community.
Abstract: The European Community (EC), as part of its mandate under the Treaty of Rome to create a single internal market by 1992, has enacted an EC-wide prohibition on insider trading. The EC’s “Council Directive Coordinating Regulations on Insider Dealing” is a mandatory model act setting forth the minimal regulatory prohibition that must be implemented by national legislation in all EC member states. The directive prohibits two defined groups of persons, referred to as primary and secondary insiders, from taking advantage of nonpublic, price-sensitive information relating to issuers or their securities; it prohibits primary insiders from disclosing that information to others; and it mandates prompt public disclosure of all price-sensitive information by firms whose securities are publicly traded in a regulated market. It is intended to level the playing field for market participants and to promote investor confidence in the newly integrated securities markets of the member states. However, the EC does not fully succeed in these purposes. The directive merely assists the EC in its promotion of a dangerous imagery of regulation: the directive’s denunciation of insider trading conveys the false impression of a comprehensively-regulated marketplace. Given the historical complacency toward insider trading against which this directive was implemented, the Insider Trading Directive faces a set of widely-held attitudes that likely will prove resistant to behavioral modification.This article focuses first on the legislative background of the Insider Trading Directive, from its origins in the European Code of Conduct to the several drafts from which it emerged. Then, it examines the doctrinal basis underlying the directive’s adoption. After discussing the directive’s legislative development, the article provides a detailed analysis of the directive’s substantive prohibitions on trading and tipping, with particular emphasis on the definitions of “insider information” and “primary” and “secondary insiders.” The analysis also focuses on the other elements of, as well as the various exclusions from, the trading and tipping offenses. Then, the issues of penalties, enforcement and multistate cooperation are addressed. Finally, the article reiterates the primary strength of the directive, as well as its deficiencies, as the EC continues its quest for a harmonized securities regime for the common market.
13 citations
Book•
01 Jan 1991
TL;DR: An outline of the work of the Community to date can be found in this paper, where the first and second council directives mergers and divisions the fourth and seventh directives -individual company accounts and consolidated accounts the eighth directive on the approval of auditors
Abstract: An outline of the work of the Community to date the first and second council directives mergers and divisions the fourth and seventh directives - individual company accounts and consolidated accounts the eighth directive on the approval of auditors the draft fifth and Vredling directives miscellaneous draft directives supranational instruments mutual recognition.
Book•
19 Dec 1991
TL;DR: The proposed Directive contrasted: United States and Japan the international perspective and other European countries.
Abstract: Before the Directive: proposal for a Council Directive public debate and the legislation process. Commentary and practitioner's guide: Article 1 - object of protection Article 2 - authorship of computer programs Article 3 - beneficiaries of protection Article 4 - restricted Acts Article 5 - exceptions to restricted Acts Article 6 - decompilation Article 7 - special measures of protection Article 8 - term of protection Article 9 - continued application of legal provisions Article 10 - final provisions. Position in Member states. The Directive contrasted: United States and Japan the international perspective and other European countries. Appendices: Proposed Directive Commission's amended text communication to Parliament Council Directive.
TL;DR: In this paper, the impact of an EEC pollution control directive on the profits of the firms in the chlor-alkali industry is examined and various definitions of equal treatment are developed and it is argued that knowledge of the relationship between discharges and various methods of abatement is crucial to an investigation of the extent to which the directive meets the equity criteria.
TL;DR: Emergency physicians have the opportunity to assist their patients in advance by disseminating advance directives to those who have contact with the emergency department: patients, family members, friends, health care workers, emergency medical services personnel, and police.
TL;DR: Most states now have statutes on treatment directives, commonly called "living wills." Often, however, these statutes only cover patients who are terminally ill at the time the treatment choice is to be effectuated, and they may contain substantive limitations, such as a seeming prohibition on the use of treatment directives to refuse artificial nutrition and hydration as discussed by the authors.
Abstract: Most states now have statutes on treatment directives, commonly called "living wills." Often, however, these statutes only cover patients who are terminally ill at the time the treatment choice is to be effectuated. They may also prescribe a certain form to be followed in drafting a treatment directive. Further, they may contain substantive limitations, such as a seeming prohibition on the use of treatment directives to refuse artificial nutrition and hydration. All of these restrictions have led many health care professionals, administrators, and even lawyers wrongly to maintain that a directive broader than the statute is without legal effect. They make the common mistake of believing that once the legislature has recognized one means of protecting individual rights, there are no other means. They misconstrue every other effort to express treatment preferences as if it were a ball hit out of bounds. In fact, any expression of treatment preferences has legal effect. A directive broader than the state statute is not out of bounds. Health care professionals are obligated to pay careful attention to such directives. But to see why, you have to understand something about the relationship of the statutory rights provided by state legislatures, the additional common-law rights recognized by judges, and die rights provided by the state and federal constitutions. Patients have all three. Statutes on advance directives vary from state to state, but they generally provide a combination of carrots and sticks to induce health care professionals to honor a patient's written treatment preferences. The most important carrot they hold out is civil and criminal immunity to professionals who act in good-faith reliance on a patient's directive in forgoing life-sustaining treatment. With that kind of guarantee, there is no excuse for overriding the patient's preferences. Thus, state statutes create a protective umbrella, a zone in which patient preferences are protected by a system of incentives directed at health care professionals and institutions. However, that is by no means the entire domain of protected rights. It is a piece of the playing field, not the whole ballpark. A number of state statutes actually acknowledge this. They state that the rights provided by the statute in no way reduce other rights the patient may have. In other words, the statute adds to the patient's rights deriving from common law and constitutional law; it does not reduce those rights. So what are these other nonstatutory rights? judges have long since recognized that patients have a common-law right to be free of unwanted bodily invasion. This is the basis of die legal obligation to obtain a patient's informed consent before performing invasive procedures. In case after case, judges have declared that patients have a common-law right to refuse unwanted life-sustaining treatment. That right is not confined to the terminally ill, and applies to the refusal of all life-sustaining treatment modalities including artificial nutrition and hydration. Nor does a patient even need to express the refusal in writing. Oral expressions of preference may be effective as well. There are similar constitutional rights. A majority of the Supreme Court acknowledged in the 1990 Cruzan case that the federal Constitution protects the right of competent patients to refuse any life-sustaining treatment including nutrition and hydration. A number of state courts have said so as well. In addition, state courts have found relevant protections in their state constitutions. …
01 Jan 1991
01 Jan 1991
01 Jan 1991
TL;DR: In this article, a comparison of the scope of consolidation required by the 7th EEC Directive, IAS 27 and the newly published Belgian Royal Decree is presented, which gives us a better insight as to how future legislation might develop.
Abstract: This paper focuses on a comparison of the scope of consolidation required by the 7th EEC Directive, IAS 27 and the newly published Belgian Royal Decree. Through such a comparison, we can judge the consistency of and deviation in the legislation of Belgium, EEC Member States and the IAS Members. We also discuss some of the contemporary issues of consolidation such as effective control, true and fair view, incentives to consolidate voluntarily and the possibility of the success of the Directive implementations. The discussion gives us a better insight as to how future legislation might develop.
01 Mar 1991
TL;DR: In 1984, the Chairman and Chief Executive Officer of the McDonnell Douglas Corporation in St. Louis, Missouri, directed that each of the company's major components establish a competitive intelligence organization to improve its understanding of the competition as discussed by the authors.
Abstract: In October 1984, the Chairman and Chief Executive Officer of the McDonnell Douglas Corporation in St. Louis, Missouri, directed that each of the company's major components establish a competitive intelligence organization to improve its understanding of the competition. One premise behind this directive was that an assessment of the competition in the marketplace was essential, and that the company's current informal methods of competitive‐intelligence gathering were inadequate. Another premise was that only ethical and legal data‐gathering techniques were to be used, especially since there was so much information available from a wide variety of public sources. The directive specified that the overall process must be action oriented with a focus on analysis, assessment, and communication.
TL;DR: In this article, the authors deal with the multi-faceted prob lems involved in the effective communication of such information and discuss the requirements for pub lic information within the general scope of risk communication.
Abstract: Following a number of chemical accidents, in 1982 the Council of the Euro pean Communities issued a directive, commonly known as the "Seveso direc tive", on major accident hazards of certain industrial activities. Among other requirements, the legislator provides for the dissemination of information about safety measures and emergency behaviour to members of the public liable to be affected by a major accident. The paper deals with the multi-faceted prob lems involved in the effective communication of such information. It starts with a brief account of the European Communities' main bodies and opera tions ; then it focuses on the Seveso directive and its implementation in the member states. Subsequently it discusses the directive's requirements for pub lic information within the general scope of risk communication, drawing also on some empirical research studies. Finally, it describes in some detail a pilot study on risk information needs carried out in Italy in 1989.
Book•
01 Jan 1991
01 Jan 1991
TL;DR: In this paper, the problems of environmental impacts in road planning are discussed as described in the study "Environmental Impacts Assessment According to the European Directive in the Road Economy Sphere" (Ljubljana, June 1990).
Abstract: The article discusses the problems of environmental impacts in road planning as described in the study "Environmental Impacts Assessment According to the European Directive in the Road Economy Sphere" (Ljubljana, June 1990). It describes environmental requirements according to the European directive 85/337/EEC from 1985. Basic characteristics have been determined according to respective foreign experiences, definitions and objectives.
01 Jan 1991
TL;DR: The post-Seveso Directive as mentioned in this paper requires that the public likely to be affected by an accident must be informed of safety measures and of the correct behavior to adopt in the event of an accident.
Abstract: In 1976 in Seveso, Italy, an accident occurred at a chemical plant in which the toxic substance dioxin was emitted into the environment. Although the damage from this accident remains uncertain, an important revelation was that serious information deficiencies existed, not only at the Seveso site, but about hazardous sites generally. Consultations therefore were started in the European Community (EC) to arrive at European guidelines aimed at reducing the chances of hazards materialising, and regulating the way government and public should be notified of those hazards, of safety measures, and of emergency arrangements. On June 24, 1982, the so-called post-Seveso Directive was issued (Council of the European Communities, 1982). The deadline for implementation was January, 1st, 1985. The Directive requires amongst other things that the public likely to be affected by an accident must be informed of safety measures and of the correct behavior to adopt in the event of an accident.
01 Jan 1991
TL;DR: Emergency physicians should anticipate that the law will provide not only benefits, but also some burdens, and it is the specialty's responsibility to gather empirical data that can guide the use of advance directives in emergency departments.
Abstract: On December 1, 1991, a new federal law designed to increase public use of advance directives takes effect. After that date, health care facilities must provide written information about advance directives to all adult patients. This information must describe (1) the patient's rights to make medical care decisions under state statutes and case law, and (2) how patients can secure these rights within the scope of the provider's policies. The law also requires that institutions educate their staffs and the communities about advance directives and document the existence of any advance directive in the patient's medical record. The new federal law will benefit American society, U.S. health care, and the practice of emergency medicine. However, emergency physicians should anticipate that the law will provide not only benefits, but also some burdens. Many institutions will expect emergency department personnel to disseminate and explain the required information, and annotate the medical record. It is the specialty's responsibility to gather empirical data that can guide the use of advance directives in emergency departments.
01 Jan 1991
TL;DR: In this article, the situation in the Netherlands with respect to Article 8 of the Directive is reviewed, and the information contained in this chapter has been accumulated through interviews with local and provincial authorities and representatives of industry.
Abstract: Following the accident in Seveso, Italy (see chapter 1) consultations were started at EC level to arrive at European guidelines for reducing chances of the occurrence of hazards, and directing the way government and the public should be informed. This chapter reviews the situation in the Netherlands with respect to Article 8 of the Directive. The information contained in this chapter has been accumulated through interviews with local and provincial authorities and representatives of industry.1 About one hundred sites will fall under the directive, of which about one-third are situated in the Rijnmond area. This figure gives some idea about the potential impact of the Seveso directive in the Netherlands.
TL;DR: The Finnish Product Liability Act as mentioned in this paper is based on the EEC Directive on Products Liability from 1985 and it does not contain any threshold for damage to property corresponding to the threshold in art. 9 of the Directive.
Abstract: The paper describes some features of the new Finnish Products Liability Act. The Act is mainly based on the EEC Directive on Products Liability from 1985. In implementing the directive, Finland has chosen a maximalist approach. Development risks as well as damages caused by primary agricultural products are covered by the Products Liability Act. In addition to this, the Finnish Act does not contain any threshold for damage to property corresponding to the threshold in art. 9 of the Directive. Damages caused by pharmaceuticals are compensated through a special semi-voluntary collective insurance scheme, covering both development risks and even some damage due to non-defective products. In the paper some arguments for these solutions are presented. The perspectives concerning the possibilities to retain these special features of Finnish law if Finland joins the European Economic Area are also touched upon.
Book•
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01 Jan 1991
TL;DR: The regulations: the EEIG the European Company Statute as mentioned in this paper, and company law directives: Fourth and Seventh Directives Directives on disclosure of significant shareholdings Eleventh Directive Twelfth Directive Proposal for a Fifth Directive draft proposal for a Ninth Directive Tenth Directive on cross-border mergers.
Abstract: Part 1 The regulations: the EEIG the European Company Statute. Part 2 Company law directives: Fourth and Seventh Directives Directives on disclosure of significant shareholdings Eleventh Directive Twelfth Directive proposal for a Fifth Directive draft proposal for a Ninth Directive Tenth Directive on cross-border mergers. Part 3 Security Regulation: Public Offers Directive Investment Services Directive insider dealing proposal for a Thirteenth Directive on takeovers barriers to takeover initiatives. Part 4 Insolvency: European Insovenct Initiatives proposals for and EC bankrutcy convention. Part 5 Competition and latest developments: mefgers regulation tax provisions proposal for money laundering Directive proposal for informing and consulting employees.