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7 * Medical-Legal Disclosure of Suffering The issue of suffering in contemporary medical practice is of considerable concern. Legally, the law regards pain and suffering as one and the same entity, and proof of suffering is found in the realm of psychological illness. Some clinicians fear that acknowledging suffering as separate from pain will result in insurance adjusters denying legitimate claims for fiscal compensation to those individuals who require considerable assistance after traumatic injuries. Against this argument is the definition of suffering as a perception of threat to idea of self and personhood. Accepting this definition does not negate the results of impairment or disabilities as determined by quantitative and qualitative measures of abilities and opportunities (quality-of-life scales) or impact-of-illness measures. Acknowledging suffering, as defined above, simply takes the experience out of the realm and stigma of psychological illness and places it within the context of cause and effect. In medical legal cases, the patient may be entitled to fiscal compensation because idea of self and personhood are adversely affected due to traumatic events. Further, suffering, as defined above, would most likely not have occurred if the impairments had not led to disability or chronic illness. Many health professionals and their patients do not realize that the prime concern of insurance companies is to be sure that monies are awarded in accordance with rules and regulations determined by formal legal agreements and the duty of the law is to uphold these rules when disputes occur. Often patients and clinicians believe that the purpose of the law in personal injury disputes is to determine the rightness or wrongness of an event or the goodness or badness of the people involved. Consequently, ignorance of the purpose of the law may result in failure to understand the impact of health care providers’ careless or inappropriate note taking and inappropriate and incomplete problem identification in determining the degree of assistance required by patients. Failure of health care providers to understand the basic tenets of the law in relationship to suffering may result in poor treatment outcomes and an increase in patient suffering. The purpose of this chapter is to present a brief introduction to the history of the law and a description of how rules and regulations are made. The focus of this chapter also raises questions about: (a) the difference between medical and legal definitions of suffering, (b) similarities between medical and legal discourse and suffering and the loss of personal autonomy, (c) the justification for loss of personal power in legal and medical discourse, (d) ethical considerations in ­ medical 90 Suffering: What Man Has Made of Man and legal discourse, and (e) cultural implications in pluralistic multicultural societies and the impact on suffering. In this section it is argued that it is the ethical responsibility of all health care practitioners to be familiar with basic tenets of the law as it relates to patient suffering . Issues relating to law and professional misconduct are beyond the scope of this discussion. For purposes of clarification, examples of legal discourse are taken from the British, U.S., and Canadian legal systems because both the U.S. and Canadian systems have evolved from the British system. The need for health care providers to understand the basic principles of the legal systems of their own countries is a global medical responsibility. A Brief History of the Law and Its Impact on Contemporary Health Care Delivery Sometimes, patients experience a great deal of distress when legal judgments appear to violate laws of natural reason and perceptions of justice. If health care providers can provide patients with brief explanations of how, throughout the centuries , there were many difficulties encountered in determining the relationship between the law and individuals, patients may be less likely to feel victimized and abandoned. The law arises from the needs of society and may be based on religious or social customs (1–3). In ancient times (500 b.c.), Greek laws were such that claims were made against manufacturers, bank officials, or accountants. Crimes involved murder, robbery, and slander. Initially, murder was a crime against a family, but later became a crime against the state. Generally, the notion of justice is based on ideas of morality and fairness. Health care providers who are not aware of the history of the law may not realize that justice was originally based on ownership of property and possessions. In the language of modern society, justice and fairness relate to monetary gain. The needs of...

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