Ethical, Legal and Forensic Issues regarding Vulnerable Populations

Topic Information

Dear Colleagues,

The term “vulnerable population” refers to those who are incapable of protecting their own interests, or in other words, those who require the utmost care, specific ancillary considerations and augmented protections in research. Vulnerable populations may be divided into three main domains: a) the physical domain—mothers and infants at high risk, the chronically ill, the disabled and persons with HIV/acquired immunodeficiency syndrome; b) the psychological domain—people with chronic mental conditions, such as schizophrenia, bipolar disorder, major depression, attention-deficit/hyperactivity disorder, or a history of alcohol and/or substance abuse; and c) the social domain—people living in abusive families, the homeless, immigrants, refugees, prisoners, LGBTQ people and several other minorities (gypsies, indigenous populations, etc.).

The health care of the above-mentioned populations presents several ethical, forensic, and legal challenges. In this respect, this Topic aims to enable the exchange and development of knowledge and expertise on crucial matters regarding vulnerable populations such as human rights (capacity, confidentiality, and consent), research ethics, medical negligence, abuse and exploitation, sexual assault, mortality, violence, crime, bodily harm, torture, deaths under custody, etc.  

Groups from all specialties and fields are encouraged to submit original research, short reports, reviews, commentaries, and case reports/case studies that provide new insights into the above-related issues. We look forward to receiving your contributions.

Prof. Dr. Stavroula Papadodima
Dr. Flora Bacopoulou
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Forensic Sciences forensicsci	-	1.7	2021	40.2 Days	CHF 1000
Healthcare healthcare	2.4	3.5	2013	20.5 Days	CHF 2700
Journal of Clinical Medicine jcm	3.0	5.7	2012	17.3 Days	CHF 2600
Journal of Personalized Medicine jpm	3.0	4.1	2011	16.7 Days	CHF 2600

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Published Papers (7 papers)

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12 pages, 457 KiB  

Open AccessReview

Dental Identification System in Public Health: Innovations and Ethical Challenges: A Narrative Review

by Gabriele Napoletano, Alessandra Putrino, Enrico Marinelli, Simona Zaami and Lina De Paola

Healthcare 2024, 12(18), 1828; https://doi.org/10.3390/healthcare12181828 - 13 Sep 2024

Viewed by 799

Abstract

Dental identification systems (DISs) encompass various techniques used for forensic identification, serving as alternatives or complements to genetic methods. Technologies such as microchip implants, prosthetic inscriptions, microSD cards, and identification plaques have been proposed to address limitations in comparative methods, offering streamlined processes [...] Read more.

Dental identification systems (DISs) encompass various techniques used for forensic identification, serving as alternatives or complements to genetic methods. Technologies such as microchip implants, prosthetic inscriptions, microSD cards, and identification plaques have been proposed to address limitations in comparative methods, offering streamlined processes for forensic experts. This study reviews current and potential DIS implementations, emphasizing cost-effectiveness and community benefits. Literature analysis from PubMed (2008–2024) yielded 17 relevant articles on implantable DISs, enabling direct subject identification via teeth or prostheses. The integration of DIS aims to enhance accuracy and speed in personal profiling and legal identification, promoting technology transfer in dentistry. It will be necessary to develop strict privacy regulations to protect patient data and establish ethical guidelines for their use. The study’s aim is to highlight that the universal adoption of DISs could mitigate healthcare disputes and facilitate data exchange in clinical settings, which is particularly beneficial for vulnerable populations. Full article

(This article belongs to the Topic Ethical, Legal and Forensic Issues regarding Vulnerable Populations)

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8 pages, 213 KiB  

Open AccessArticle

Novel Approaches Needed: An Experimental Study with an Alternative to Mechanical Restraint

by Tilman Steinert, Bernd Maierhofer, Peter Schmid and Sophie Hirsch

Healthcare 2024, 12(16), 1658; https://doi.org/10.3390/healthcare12161658 - 20 Aug 2024

Viewed by 772

Abstract

Despite many calls to reduce or eliminate the use of mechanical restraint, it is still widely used in many countries. Studies using patient interviews have a very clear message: Patients experience mechanical restraint as the most humiliating intervention. There seems to be a [...] Read more.

Despite many calls to reduce or eliminate the use of mechanical restraint, it is still widely used in many countries. Studies using patient interviews have a very clear message: Patients experience mechanical restraint as the most humiliating intervention. There seems to be a lack of alternatives for violent patients if all other approaches to prevent the use of coercion have failed. We developed a method using 30 kg bags, originally designed for fitness purposes, to be attached to a patient’s wrist or ankle under 1:1 supervision. The method was tested with 10 experienced nurses and de-escalation trainers. A video was made and presented to six outpatients who had previously experienced mechanical restraint. All participants were interviewed. Transcribed interviews were analysed using qualitative content analysis. All participants approved of the method as a milder and less humiliating alternative to mechanical restraint. The nurses’ main concerns were the risk of falls and the use of the bags as weapons. The latter could be controlled by using an additional bag. Patients were generally positive, especially if there was a history of abuse. The method should be further developed to replace at least some mechanical restraints. As with all ‘milder means’, care should be taken to really replace restraint and not to introduce additional coercion. Full article

(This article belongs to the Topic Ethical, Legal and Forensic Issues regarding Vulnerable Populations)

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13 pages, 449 KiB  

Open AccessArticle

Psychological Factors Influencing Attitudes towards Euthanasia, Assisted Suicide and Palliative Care among Medical Students and Doctors in Training

by Maria Forycka, Magdalena Liberacka-Dwojak, Wojciech Leppert, Paweł Suchecki, Natalia Suchecka and Bartłomiej Ast

Healthcare 2024, 12(8), 833; https://doi.org/10.3390/healthcare12080833 - 15 Apr 2024

Viewed by 1919

Abstract

Background: This study aimed to analyse the attitudes of medical students, Polish and classical philology students and trainee doctors towards the legalisation and practice of euthanasia and assisted suicide, to explore their beliefs about palliative care and to identify the cognitive, behavioural and [...] Read more.

Background: This study aimed to analyse the attitudes of medical students, Polish and classical philology students and trainee doctors towards the legalisation and practice of euthanasia and assisted suicide, to explore their beliefs about palliative care and to identify the cognitive, behavioural and emotional factors influencing these attitudes. Methods: An anonymous 22-question survey was sent by email to 670 participants, who comprised students of medicine, students of Polish and classical philology and trainee physicians. Results: Out of the 670 people invited to the survey, 313 (46.72%) responded; 215 (68.69%) and 112 (35.80%) participants supported the legalisation of euthanasia and assisted suicide, respectively. No differences were found between the respondent groups studied. The respondents’ attitudes were influenced by religion, place of residence and professed values in the doctor–patient relationship. Among the medical students and trainee doctors surveyed, the declared willingness to perform euthanasia was lower, with 90 (43.7%) people, than the support for its legalisation, with 135 (65.5%) people. Significantly higher support for palliative care was expressed by fifth- and sixth-year medical students and trainee doctors, with 88 respondents (89.89%), less support was expressed by first- and fourth-year medical students, with 74 respondents (68.5%), and the lowest support was observed among Polish and classical philology students, with 63 respondents (58.9%). Conclusions: The legalisation of euthanasia and assisted suicide was supported by more than two-thirds and one-third of all the respondents, respectively, with the majority of medical students and trainee doctors surveyed expressing uncertainty or lack of readiness towards their practice. More than 70% of all the respondents showed a positive opinion towards palliative care, with the lowest support being among Polish and classical philology students. Full article

(This article belongs to the Topic Ethical, Legal and Forensic Issues regarding Vulnerable Populations)

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13 pages, 288 KiB  

Open AccessArticle

‘Fleeing’ as a Strategy for Navigating Resistance in Patient Encounters within Forensic Care

by Lars Hammarström, Ove Hellzén and Siri Andreassen Devik

Healthcare 2023, 11(21), 2890; https://doi.org/10.3390/healthcare11212890 - 2 Nov 2023

Viewed by 1307

Abstract

The aim of this study was to describe the phenomenon of “fleeing the encounter when facing resistance” as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers [...] Read more.

The aim of this study was to describe the phenomenon of “fleeing the encounter when facing resistance” as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one’s emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers’ self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient’s lifeworld but also their own. Full article

(This article belongs to the Topic Ethical, Legal and Forensic Issues regarding Vulnerable Populations)
(This article belongs to the Section Forensic Medicine)

17 pages, 638 KiB  

Open AccessArticle

Ethical and Forensic Issues in the Medico-Legal and Psychological Assessment of Women Asylum Seekers

by Valeria Tullio, Corinne La Spina, Daniela Guadagnino, Giuseppe Davide Albano, Stefania Zerbo and Antonina Argo

Healthcare 2023, 11(17), 2381; https://doi.org/10.3390/healthcare11172381 - 24 Aug 2023

Cited by 2 | Viewed by 1653

Abstract

Asylum-seeking migrants represent a vulnerable segment of the population, and among them, women constitute an even more vulnerable group. Most of these women and girls have been exposed to threats, coercion, and violence of many kinds, including rape, forced prostitution, harassment, sexual slavery, [...] Read more.

Asylum-seeking migrants represent a vulnerable segment of the population, and among them, women constitute an even more vulnerable group. Most of these women and girls have been exposed to threats, coercion, and violence of many kinds, including rape, forced prostitution, harassment, sexual slavery, forced marriage and pregnancy, female genital mutilation/excision, and/or other violations of their rights (e.g., deprivation of education, prohibition to work, etc.). The perpetrators of the violence from which they flee are often their own families, partners, and even institutional figures who should be in charge of their protection (such as police officers). In the process for the acceptance/rejection of an asylum application, the forensic and psychological certification can make the difference between successful and unsuccessful applications, as it can support the credibility of the asylum seeker through an assessment of the degree of compatibility between the story told and the diagnostic and forensic evidence. This is why constant and renewed reflection on the ethical, forensic, and methodological issues surrounding medico-legal and psychological certification is essential. This article aims to propose some reflections on these issues, starting from the experience of the inward healthcare service dedicated to Migrant Victims of Maltreatment, Torture, and Female Genital Mutilation operating since 2018 at the Institute of Forensic Medicine of the University Hospital of Palermo. Full article

(This article belongs to the Topic Ethical, Legal and Forensic Issues regarding Vulnerable Populations)
(This article belongs to the Section Forensic Medicine)

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10 pages, 291 KiB  

Open AccessArticle

Characterization of Domestic Violence among Patients Consulting a French Psychiatric Emergency Department

by Laetitia Leveque, Stavroula Papadodima, Ryan Toutin, Mathieu Fraigneau, Eric Baccino and Laurent Martrille

Healthcare 2023, 11(6), 832; https://doi.org/10.3390/healthcare11060832 - 12 Mar 2023

Viewed by 1705

Abstract

The aim of the present study was to identify the prevalence of domestic violence among patients attending a French psychiatric emergency department and its association with psychiatric disorders. This retrospective study was performed, including all patients examined in the psychiatric emergency department of [...] Read more.

The aim of the present study was to identify the prevalence of domestic violence among patients attending a French psychiatric emergency department and its association with psychiatric disorders. This retrospective study was performed, including all patients examined in the psychiatric emergency department of the Lapeyronie University Hospital of Montpellier (France) in the daytime from 1 July 2021 to 31 October 2021. A total of 152 patients were eligible during this study period. The prevalence of domestic violence was 38.2% (n = 58) overall. The percentage of female victims of domestic violence was higher than that of male victims (47.6% vs. 17.0%, p < 0.001). Among the 58 victims of domestic violence, 20.7% reported psychological abuse, 17.2% physical abuse, 3.4% sexual abuse, and 58.6% multiple forms of abuse. The risk of suicide attempt and anxiety disorder among the female patients was associated with domestic violence (p = 0.006, OR = 7.24, and p = 0.010, OR = 0.16). Our study showed that the psychiatric population should be identified as a population at risk for domestic violence, especially when the patient is female and suffers from anxiety disorders or if she has performed a previous suicide attempt. Full article

(This article belongs to the Topic Ethical, Legal and Forensic Issues regarding Vulnerable Populations)
(This article belongs to the Section Forensic Medicine)

11 pages, 241 KiB  

Open AccessArticle

Decisions of Greek Courts Securing the Right of Parent–Child Communication and Their Determinants

by Andreas-Nikolaos Koukoulis, Maria Tsellou, Vasiliki Rougkala, Flora Bacopoulou and Stavroula Papadodima

Healthcare 2022, 10(12), 2522; https://doi.org/10.3390/healthcare10122522 - 13 Dec 2022

Viewed by 1571

Abstract

Background: There is an increasing awareness that a child’s separation from one parent after the divorce places the child’s development and well-being at risk. The aim of this study was to determine how Greek courts deal with the cases of parental prevention of [...] Read more.

Background: There is an increasing awareness that a child’s separation from one parent after the divorce places the child’s development and well-being at risk. The aim of this study was to determine how Greek courts deal with the cases of parental prevention of communication with their children and which factors affect the judicial decisions. Methods: The Greek legal databases “NOMOS” and “Isokratis” were searched, and associations between judicial decisions, as well as communication prevention ways, and several parameters, were assessed. Results/Conclusions: A total of 50 parental communication prevention law cases were retrieved for the time period from 1992 to 2019. Results showed that mothers were more frequently alleged to interfere with father–child communication. Both direct and indirect methods of interfering with communication were followed. In cases of a single child, the method of indirect interference was more frequently followed. Judicial decisions were unaffected by the age and gender of the child, the gender of the parent preventing the communication, the number of children, the gender of the child and whether the child is the same gender as the preventing or prevented parent, the way of prevention, and the reference to parental alienation. Full article

(This article belongs to the Topic Ethical, Legal and Forensic Issues regarding Vulnerable Populations)
(This article belongs to the Section Forensic Medicine)

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