Assessment of competency for execution? A guide for mental health professionals

Assessment of competency for execution presents two compelling ethical questions for mental health professionals: whether clinicians can ethically provide such assessment, and if so, how it should be done in order to maximize quality and minimize ethical conflict. In this article we address the issue of whether to participate and, if so, how. The question of whether to participate is discussed by summarizing the arguments for and against participation and offering guidelines for making a decision. The question of how to proceed is discussed in two contexts: preadjudication (before a formal decision about competency) and postadjudication (following a determination of "incompetent" and transfer of the offender to another facility for treatment and further assessment). Finally, recommendations are made regarding research that would improve the quality of execution competency assessments.     

Cyprus: Federation Under International Safeguards

Constitutional engineering to overcome ethnoregional cleavagesis being put to a severe test on Cyprus, where Greek and Turkishcommunities haltingly endeavor to salvage a divided state Threeyears after independence in 1960, the attempt to govern throughfunctional federalism ended in civil war. Intervention by Greeceand Turkey in 1974 resulted in a de facto partitioning of therepublic into two ethnically homogeneous areas. Under UnitedNations auspices, communal elites bargain for a consociationalsettlement, balancing national autonomy and individual rights.The solution requires international safeguards guaranteeinga new constitution and providing for "free cities" under a bicommunaladministration. Failure of the international community to actwill lead to a partitionist solution as manifested by a growingacceptance of Turkish Cypriot statehood.     

Identification of a red "fiber": chironomid larvae

During preliminary examination of the body of a homicide victim, a peculiar red "fiber" was noticed and recovered. Initially believing this to be a carpet fiber, the item was subjected to fiber analysis. It was found to be a short coiled particle not like any known natural or synthetic fabric fiber. Subsequent examinations determined this "fiber" to be the larva of a common freshwater midge (Diptera; Chironomidae). Chironomid larvae have been observed on other bodies recovered from freshwater environments. Entomological studies of this organism have led to the conclusion that the presence of chironomid larvae indicates submersion of the body.     

Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.     

Injuries of the large arteries of the brain and vital reactions. An electron microscopy study

In 90 forensic autopsies (Craniocerebral injury, gunshot, stabbing, blow, strangulation, etc.), semithin sections of great arteries were prepared from around 770 Epon blocks and checked for vital reactions at the mural and intimal ruptures. In 21 cases in which death had occurred immediately or soon after the trauma, with three exceptions, there was a subsequent electron microscopic investigation. In all six mural ruptures and in five of ten intimal ruptures, thrombocyte aggregates were found at the rupture margins. In five intimal ruptures, the possibility of the occurrence of preparations injuries had to be considered. In five cases, the results of the histological study were negative. The success rate is limited in principle in such a screening test since there are technical difficulties in preparing serial sections on long vessels. Death was rapid and the thrombocytes were observed to adhere to the injured wall sites immediately after the trauma. The "thrombocyte sign" is thus of substantial importance as the earliest local vital reaction. In two control cases (strangulation), thrombocyte aggregates were found at intimal ruptures of the basilar artery, which were regarded as the results of stretching via the vertebral arteries during attacks to the neck. The healing processes of intimal ruptures and traumatic medial necrosis in incomplete ruptures occurring later in life are discussed. Even if a cadaver is a few days old, the histological findings at the level of the thrombocytes can be evaluated.     

Reviews

Rajan Menon, Soviet Power and the Third World. New Haven and London: Yale University Press, 1986, ix + 261 pp. £18.50.

Georgi Arbatov, Cold War or Detente? The Soviet Viewpoint. London: Zed Books, 1983. xviii + 219 pp. £16.95, $30.00 h/b; £4.95, $8.95 p/b.

Jonathan Steele, World Power: Soviet Foreign Policy under Brezhnev and Andropov. London: Michael Joseph, 1983, xii + 287 pp. £14.95.

Imre Vincze, The International Payments and Monetary System in the Integration of the Socialist Countries, The Hague: Martinus Nijhoff, 1984, ix + 185 pp. £20.50, $32.00.

M. M. Kostecki ed. The Soviet Impact on Commodity Markets, London: Macmillan, 1984, xl + 271 pp. £25.00.

Gerhard Fink ed. East‐West Economic Relations Now and in the Future: Die Ost‐West‐Wirtschaftsbeziehungen heute und morgen, Vienna: Springer‐Verlag, 1985, 100 pp. DM 34,00.

András Köves, The CMEA Countries in the World Economy: Turning Inwards or Turning Outwards, Budapest, Akadémiai Kiadó, 1985, 248 pp. £18.25.

Ger P. van den Berg, The Soviet System of Justice: Figures and Policy, Martinus Nijhoff, Dordrecht, Boston, Lancaster (series Law in Eastern Europe No. 29) 1985, xiii + 374 pp incl appendices, indices and references, £56.95, $71.50.

Eugene Huskey, Russian Lawyers and the Soviet State. The Origins and Development of the Soviet Bar, 1917–1939. Princeton: Princeton University Press, 1986, xii + 247 pp. £19.00.

David Lane, Labour and Employment in the USSR. Brighton: Wheatsheaf Books (distributed by Harvester Press), 1986, 280 pp. £28.50.

Martin McCauley and Stephen Carter, eds. Leadership and Succession in the Soviet Union, Eastern Europe and China. London: Macmillan, 1986, xiii + 256 pp. £27.50 h/b, £8.95 p/b.

Leslie Holmes, Politics in the Communist World. Oxford: Oxford University Press, 1986, xi + 457 pp. £25–00 h/b, £9.95 p/b.

Peter Kenez, The Birth of the Propaganda State: Soviet Methods of Mass Mobilization, 1917–1929. Cambridge: Cambridge University Press, 1985. xi + 308 pp. £27.50, $39.50 h/b, £9.95, $12.95 p/b.

Joseph J. Collins, The Soviet Invasion of Afghanistan: a Study in the Use of Force in Soviet Foreign Policy. Lexington, Mass.: Lexington Books, 1986, xv + 197 pp. £22.50, $31.25.

Leszek Buszynski, Soviet Foreign Policy and Southeast Asia. London: Croom Helm, 1986, 303 pp. £25.00.

William J. Kelly, Hugh L. Shaffer and I. Kenneth Thompson, Energy Research and Development in the USSR: Preparations for the Twenty‐First Century. Durham, North Carolina: Duke University Press, 1986, xvi + 417 pp. £62.50.

Gregory D. Andrusz, Housing and Urban Development in the USSR, London: Macmillan in association with CREES, University of Birmingham, 1985, xix + 354 pp. £30.00.

Jane Ellis, The Russian Orthodox Church: a Contemporary History, London & Sydney: Croom Helm, 1986. 531 pp. £27.50.

Edward Acton, Russia: The Present and the Past, London and New York: Longman, 1986, xiii + 342 pp. £17.50 h/b, £8.95 p/b.

Robert Service, Lenin: A Political Life. Vol. 1. The Strengths of Contradiction. London: Macmillan, 1985, x + 246 pp. £25.00.

Abbott Gleason, Peter Kenez and Richard Stites, eds., Bolshevik Culture. Experiment and Order in the Russian Revolution. Bloomington: Indiana University Press, 1985, xii + 304 pp., $27.50.

Josef Garlinski, Poland in the Second World War, London: Macmillan, 1985, xxi + 387 pp., £25.00

Andreas Dorpalen, German History in Marxist Perspective. The East German Approach. London: I. B. Tauris & Co., 1985, 542 pp., £24.50.

Walter Parchomenko, Soviet Images of Dissidents and Nonconformists. New York: Praeger, 1986, xv + 251 pp., $33.95.

Soviet Armed Forces Review Annual. Vol. 9 (1984–1985). Edited by David R. Jones. Gulf Breeze, Florida: Academic International Press, 1986. x + 313 pp., $69–50.