Metastatic cancer of the urinary bladder: can it be a nonnatural death?

Deaths from metastatic carcinoma are almost exclusively viewed as wholly natural deaths. However, if it can be shown that a cancer has arisen as a result of a prior traumatic injury and the body's healing response to the injury, or treatment thereof, then in select cases, the manner of death shall reflect that of the precipitating injury. This case report is that of a woman who was rendered quadriplegic from spinal cord injury sustained in a motor vehicle crash when she was 22 years old. She died at the age of 49 years from widely metastatic squamous cell carcinoma of the urinary bladder. Her bladder cancer most likely arose from decades-long chronic irritation of the bladder epithelium by physical contact with an indwelling Foley catheter and urinary infections. Over the years, the chronic bladder irritation likely precipitated metaplastic, dysplastic, and finally neoplastic changes of the bladder epithelium, providing a link between her spinal cord injury, the indwelling Foley catheter, and her bladder cancer, engendering an accidental manner of death. The manner of death reflected the circumstances of her injury that predisposed her to the cancer that eventually caused her death.     

Ethical issues in managed care: can the traditional physician-patient relationship be preserved in the era of managed care or should it be replaced by a group ethic?

Over the last decade managed care has become the dominant form of health care delivery, because it has reduced the cost of health care; however, it has also created serious conflicts of interest for physicians and has threatened the integrity of the traditional physician-patient relationship. In this Article, Dr. Grochowski argues that the efficiencies created by managed care are one time savings and will not in the long run reduce the rate of rise of health care expenditures without a concomitant plan to ration health care. He explores the traditional physician-patient relationship and concludes: a) that while rationing of health care is inevitable, physicians must not ration care at the bedside; b) that physicians must be advocates for their patients; c) that physicians must avoid conflicts of interest whenever possible; d) that physicians must put the needs of the patient before their own self-interests; and e) that physicians must act in ways to promote trust in their relationship with patients.     

When can a DNA profile be regarded as unique?

The probability that a defendant's DNA profile is unique in a population of untyped individuals is shown to be bounded below by one minus twice the sum of the match probabilities over the population. This bound assumes that the possibility of laboratory or handling error can be neglected, and applies only when there is no non-DNA evidence in favour of the defendant. There cannot be a completely general lower bound: if there is overwhelming non-DNA evidence that the defendant is not the source of the crime stain, then that is also overwhelming evidence of non-uniqueness. Application to k-locus short tandem repeat (STR) profiles is discussed, and illustrated with calculations based on the 6-STR-locus system used in current UK casework. However, because of the problem of the non-DNA evidence, there seems to be no satisfactory way for an expert witness to address the question of uniqueness in court.     

The neurological determination of death: what does it really mean?

The recent Canadian forum's recommendations regarding "neurological determination of death" claim to have determined a "Canadian definition, criteria, and minimum testing requirements for neurological determination of death." In this review the problems with this statement are discussed. The criterion of neurological determination of death does not fulfill the definition of death, because there is continued integration of the organism as a whole. The tests for neurological determination of death do not fulfill the criterion of neurological determination of death because they do not show the irreversible loss of all critical brain functions. The forum has provided no coherent argument for why neurological determination of death should be considered death. I suggest that one cannot invoke expert opinion to clarify a criterion of death, and tests for this criterion of death, without a clear concept of what death is. The forum has clarified tests for what they call "neurological determination of death," but this is not death itself; rather, it is a neurologically devastating state. Whether this state of "neurological determination of death" is enough to justify the morality of harvesting organs prior to death is the real question. A potential solution to this question is discussed.     

A study of the psychosexual characteristics of sex killers: can we identify them before it is too late?

Thirty-three sex killers were compared to 80 sexual aggressives, 23 sadists, and 611 general sex offenders on sexual history and preferences, substance abuse crime, violence, mental illness, personality, neurological and endocrine abnormalities. Compared to other groups, sex killers started their criminal careers earlier, more often had been to reform school, were members of criminal gangs, set fires, and were cruel to animals. They tended so show more sadism, fetishism, and voyeurism. They more often collected pornography, but they did not use it in their offenses. They more often abused drugs and some suffered from drug induced psychoses. Their most common diagnosis was antisocial personality disorder, but only 15.2% met criteria for psychopathy. Sex killers showed most signs of neuropsychological impairment, grades failure, and learning disabilities. Results suggest that greater emphasis be placed on studying adolescent sex offenders and conduct disordered children which may help identify potential sex killers.     

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.     

Can a machine be used to replicate the biomechanics of human stabbing performance?

A human performance trial was conducted where the stabbing actions of 40 participants were investigated. A range of factors were assessed such as the action used when the blade shape and familiarity of the knife changed. A qualitative evaluation of these factors was presented in an earlier paper to precede the analysis of quantitative kinematic data in this paper. The data from participants was then compared to that obtained from a stabbing machine.A motion analysis system was used to measure parameters such as the joint angular displacement and absolute linear velocity at impact. Motion data was collected using a 12-camera Vicon MX motion analysis system. Results indicated that the mean absolute linear velocity of overarm stabbing actions was consistently higher than the underarm actions.Forensic textile damage examinations often involve testing of edged weapons by manually performing stabbing actions. An underlying fundamental limitation of manual simulation experiments is the natural variation inherent in human performance. Sufficient control measures can be implemented to successfully use manual simulation experiments in forensic testing and therefore this is the accepted practice. However, performance can be improved using a stabbing machine. A custom-built instrumental stabbing device has been shown to operate within the same parameters of the human participants and is therefore suitable for use in casework.     

Accuracy and reliability in sex determination from skulls: a comparison of Fordisc® 3.0 and the discriminant function analysis

Identification in forensic anthropology and the definition of a biological profile in bioarchaeology are essential to each of those fields and use the same methodologies. Sex, age, stature and ancestry can be conclusive or dispensable, depending on the field. The Fordisc(?) 3.0 computer program was developed to aid in the identification of the sex, stature and ancestry of skeletal remains by exploiting the Forensic Data Bank (FDB) and computing discriminant function analyses (DFAs). Although widely used, this tool has been recently criticised, principally when used to determine ancestry. Two sub-samples of individuals of known sex were drawn from French (n=50) and Thai (n=91) osteological collections and used to assess the reliability of sex determination using Fordisc(?) 3.0 with 12 cranial measurements. Comparisons were made using the whole FDB as well as using select groups, taking into account the posterior and typicality probabilities. The results of Fordisc(?) 3.0 vary between 52.2% and 77.8% depending on the options and groups selected. Tests of published discriminant functions and the computation of specific DFA were performed in order to discuss the applicability of this software and, overall, to question the pertinence of the use of DFA and linear distances in sex determination, in light of the huge cranial morphological variability.     

The utility of sex offender registration: a research note†

ABSTRACT

Sex offender registries are one of the more hotly debated and polarising topics in criminology. Registries are generally perceived as valuable by the public, legislators, and law enforcement. However, academics and treatment providers have largely remained critical, arguing registries are costly and ineffective. Continued support despite these claims has led some scholars to suggest that proponents are unaware of evidence, indifferent to science, and perhaps driven by emotions. Yet this conclusion denies important facts. First, statistical evidence shows that registrants are at far higher risk of committing a sex crime than the general public. Second, high-quality empirical research suggests that enacting registries is associated with significant decreases in sex offences. Third, there is prima facie evidence that registration has assisted in police investigations and prevented sexual crimes. Recognising these arguments is likely an important step towards improving the quality of debate, science, and policy on registration.     

The greater good?: issues of proportionality and democracy in the doctrine of necessity as applied in Re A

This article examines the criminal law doctrine of necessity as applied in the conjoined twins case (Re A (Children) (Conjoined Twins: Surgical Separation) [2000] 4 All ER 961). It determines that the public law principle of proportionality underlies the doctrine, but identifies the preservation of life as the guiding principle behind the Court of Appeal's use of necessity in Re A. The article is critical of this elevation of the preservation of life under the doctrine of necessity and argues for an alternative conception of necessity based upon fundamental constitutional principles such as human rights and democracy. The principle of democracy has particular pertinence to the issue of necessity because it may be endangered by this common law justificatory defence. This conflict between democracy and necessity, it is argued, further supports the need for the constitutional value of democracy to play a key role in any application of necessity in future cases.     

Exploring the age of onset and recurrence of childhood animal cruelty: can animal cruelty be learned from witnessing others commit it?

Despite recent research, few studies have examined the specific social contexts in which animal cruelty may be learned. Using data collected from 180 inmates at a medium- and maximum-security prison in a southern state, the authors seek to replicate findings from the Hensley and Tallichet study that examined the potential for the onset and recurrence of childhood animal cruelty to become a learned behavior, specifically in terms of demographic characteristics and childhood experiences with witnessing animal abuse. In the current study, those who were younger when they first witnessed animal cruelty initially hurt or killed animals themselves at a younger age. Respondents who had witnessed a family member hurt or kill animals reported engaging in recurrent animal cruelty and were older when they committed their first act of animal cruelty.