Inconceivable? Deducting the costs of fertility treatment

This Article considers whether infertile taxpayers can deduct their fertility treatment costs as medical expenses under Internal Revenue Code section 213 and whether they should be able to deduct them. Internal Revenue Code section 213 defines medical expenses as "amounts paid-for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." This definition is interpreted by reference to a baseline of normal biological functioning, which includes reproductive functioning. Most people conceive and bear children without having to incur expenses for fertility treatment. Expenses incurred to approximate the baseline of normal reproductive health are deductible, even if the taxpayer winds up better off, with a child, after the fertility treatment. The medical profession recognizes that infertility is a disease or condition. Infertility is a loss, just as a broken leg is a loss. Fertility treatment costs are thus medical expenses under section 213. In addition, given the existence of the medical expense deduction, taxpayers should be able to deduct the cost of fertility treatments, including IVF, egg donor, and surrogate procedures, under either an "ability-to-pay" or consequentialist normative approach. Reproduction is extremely important to most people. In addition, allowing taxpayers to deduct the costs of fertility treatment will encourage infertile taxpayers to elect the most effective treatment option and reduce the rate of risky multifetal pregnancies. This Article concludes that fertility treatment costs are deductible as medical expenses under current law and should be deductible as medical expenses.     

How voluntary must treatment of addicted patients be?

As for each medical treatment the principle of voluntariness also applies to the therapy of drug addicts. Indeed, under current drug influence or in an acute withdrawal situation a free will decision could not be possible. Also an excessive drug consumption over a longer period of time can lead to a severe personality disturbances. But from an--unreasonable--drug abuse one cannot conclude a general inability for making decisions of free will. For this reason the expressed will of the drug addict remains decisive. This applies also to juvenile addicts. Besides, one has to call in the parents as legal representatives. In case of consent to the therapy one should not be very exacting on the internal therapy readiness). It can also be awoken within the course of therapy (therapy to the therapy readiness). In case of a briefing in a withdrawal or penal institution a readiness to therapy is not required. But then there is only a state-obligation to offer therapies; for the single therapeutic measure the right of self-determination of the drug addict is further on valid.     

Punishment or therapy? The ethics of sexual offending treatment

Abstract

The claim that sex offender treatment is a form of punishment and as such cannot be covered by traditional ethical codes is a controversial one. It challenges the ethical basis of current practice and compels clinicians to rethink the work they do with sex offenders. In this paper I comment on Bill Glaser's defence of that idea in a challenging and timely paper and David Prescott and Jill Leveson's rejection of his claims. First, I consider briefly the nature of both punishment and treatment and outline Glaser's argument and Prescott and Levenson's rejoinder. I then investigate what a comprehensive argument for either position should look like and finish with a few comments on each paper.     

Dosage of treatment to sexual offenders: are we overprescribing?

A sample of 337 offenders who received treatment in a variety of sex offender treatment programs in the Ontario region of Correctional Service Canada between 1993 and 1998 were divided based on the highest intensity sex offender programming that they received (low, moderate, and high). The three groups were compared with reference to a variety of actuarial risk assessment measures, criminogenic factors, and the number and type of treatment programs completed. It was hypothesized that the high-intensity group would have more criminogenic risk factors, higher actuarial scores, and participate in more treatment programs than both the moderate- and low-intensity groups. The results indicate that in general, the hypotheses were supported. Nonetheless, the results suggest that the low-intensity group may be receiving too much sex offender-specific treatment.     

The impact of sex offender’s interpersonal style,treatment readiness and the therapeutic alliance on treatment gain

The impact of internal responsivity factors and therapeutic process variables on intra-individual within-treatment gain in sex offenders has received little empirical attention. This study examined how (1) internal responsivity factors, including treatment readiness and interpersonal style, and (2) therapy process variables, including the therapeutic alliance and the presence of ruptures in the therapeutic relationship, impacted intra-individual within-treatment gain. Participants comprised 71 sex offenders who participated in group-based sex offender treatment programmes in prison or the community. Results showed that offender hostile-dominance and the affective and interpersonal characteristics of psychopathy, as measured by the Psychopathy Checklist: Screening Version Factor 1 score, negatively impacted treatment gain. Pre-treatment readiness, client ratings of the therapeutic alliance and whether or not there were ruptures in the therapeutic relationship had no association with within-treatment gain. The strength of the therapeutic alliance later in treatment did not moderate the relationship between offender interpersonal style, or psychopathy, and treatment gain.     

Repetition or reparation? An exploratory study of the relationship schemas of child molesters in treatment

This exploratory study examined the relationship patterns of child abusers in treatment by comparing interactions involving the therapist with those involving a parent. Twenty participants were included in the study. The participants' relationship patterns were assessed using the core conflictual relationship theme (CCRT) method. Core schemas were found in interactions involving the therapist and a parent. The two CCRTs found in interactions with parents were often motivated by a desire for closeness or intimacy, to which the parent reacted with rejection or domination. The participants then felt disappointed, depressed, and unreceptive. In relationship episodes involving the therapist, a similar desire for closeness was answered with help and cooperation from the therapist, hence leading the participants to feel self-controlled and self-confident. Furthermore, the therapist's criticism and opposition was often experienced as an indication of care and acceptance.     

Evaluation of structured cognitive–behavioural treatment programmes in reducing criminal recidivism

This paper reports the outcome of a 17-month follow-up of structured, community-based, offence-focused, intervention programmes designed to reduce rates of re-conviction amongst adjudicated offenders under probation supervision. Three separate programmes were examined, all derived from a cognitive social learning model of risk factors for repeated involvement in crime. Using a quasi-experimental design, the study compared male offenders who had completed programmes (n = 215) with a non-completion group (n = 181), a group allocated to programmes but who had not commenced them (n = 339), and a control sample (n = 194) not allocated to the programmes. Outcome data analysis employed (a) an “intent to treat” between-group comparison, (b) “treatment received” methodology. In order to take account of selection bias, data were further analysed using instrumental variables and propensity scores; results suggested a possible treatment effect for moderate and higher-risk cases. Factors influencing different interpretations of these findings were considered.

Angels of mercy? The legal and professional implications of withdrawal of life-sustaining treatment by nurses in England and Wales

In circumstances where life-sustaining treatment appears merely to be drawing out the inevitable, it is usual practice for the healthcare team to withdraw aggressive life-sustaining measures, once agreement is reached with the patient and their family. Common law gives doctors several defences to allegations of criminality or malpractice in taking the key actions that withdraw treatment and result in the patient's death; however, the legal defensibility of nurses undertaking this role has not been explored. In the absence of a specific body of law related to nurses taking the actions that withdraw life-sustaining treatment, I discuss the probable legal response by considering parallel cases. Examining some of the circumstances in which doctors are allowed to take life, I argue that the legal dispensation by which doctors are permitted to perform these tasks rests largely on their identity as doctors rather than any distinctive feature of their activities themselves. This uniqueness means that medical law for nurses is quite distinct from that for doctors. While it may nevertheless give nurses practical exemption from the legal consequences of their actions in withdrawal, it depends upon a judicial view that nurses are instruments of doctors. This judicial position is at odds with nurses' professional responsibilities, which envisage them as independent professionals who are liable for their own actions, inviting potentially adverse consequences from their professional registrar.     

The positive effects of cognitive–behavioral programs for offenders: A meta-analysis of factors associated with effective treatment

A meta-analysis of 58 experimental and quasi-experimental studies of the effects of cognitive-behavioral therapy (CBT) on the recidivism of adult and juvenile offenders confirmed prior positive findings and explored a range of potential moderators to identify factors associated with variation in treatment effects. With method variables controlled, the factors independently associated with larger recidivism reductions were treatment of higher risk offenders, high quality treatment implementation, and a CBT program that included anger control and interpersonal problem solving but not victim impact or behavior modification components. With these factors accounted for, there was no difference in the effectiveness of different brand name CBT programs or generic forms of CBT.

A preliminary assessment of the effect of PreCR™ DNA repair treatment on mixture ratios in two person mixtures

In this study, DNA extracted from known buccal samples was combined into two component mixture samples. These were subjected to UV exposure prior to their amplification with the Promega PowerPlex® 16HS amplification kit, and subsequent capillary electrophoresis on the ABI 3130xl instrument. Damaged samples were subjected to enzymatic repair treatment and retested to assess the amount of repair. Data showed that there is fidelity associated with the application with profile concordance after its use, and a corresponding increase in the amount of recovered alleles post damage. Results also showed changes in the stochastic relationship between mixture components that appear to be induced by the repair process itself. The mixture ratios of DNA samples were altered from an approximate original 1:3 ratio, to a ratio of 1:2 or greater. This variation can have a significant effect regarding the ability to reliably de-convolute DNA mixtures that have been subjected to the repair process.     

Prisons’ condition and treatment of prisoners in Nigeria: towards genuine reformation of prisoners or a violation of prisoners’ rights?

This study examines the conditions of prisons and the treatment of prisoners in Nigeria. The purpose of this examination is to determine compliance with the benchmarks for the treatment of prisoners and ascertain if prisoners’ rights against ill-treatment are safeguarded. The study uses relevant laws, as well as published and unpublished reports, in order to paint a coherent picture of the conditions of prisons and the treatment of prisoners in Nigeria. This article comes to the conclusion that prisons in Nigeria are not operating satisfactorily according to their statutory duties, and instead of functioning as rehabilitation centres they end up contributing to human rights violation.     

Treated sex offenders as “paraprofessional” co-workers in the treatment of the sex offender

This paper will briefly review the utilization of the paraprofessional in a community-based sex offender treatment programme in Merseyside, UK. The paraprofessionals are treated paedophiles in the role of treatment co-facilitators. Further thoughts on the role dynamic, training issues and supervision are discussed. This is an example of service-user involvement in practice.