Justins v The Queen: assisted suicide, juries and the discretion to prosecute

Juries are often a crucial protection for citizens against unjust or highly controversial laws. The decision whether to proceed with a prosecution rests on the discretionary powers of prosecutors. In cases where the community is deeply divided over right and wrong, it appears that there is, at times, a transference from the public of thwarted law reform aspirations which can create difficult tensions and expectations. This case commentary considers an appeal by Shirley Justins following her conviction for manslaughter by gross criminal negligence as a result of her involvement in the mercy killing of her partner, Mr Graeme Wylie. The morally unsettled nature of the charges brought against her, her own initial plea, the directions given to the jury by the trial judge and even the basis of her appeal resulted in a convoluted and complicated legal case. Spigelman CJ and Johnson J ordered a new trial, Spigelman CJ stating that it was open for a new jury to consider (a) if Mr Wylie lacked capacity; and (b) whether there was criminal involvement by one person in another's death. Simpson J found that further prosecution on the count of manslaughter would amount to an abuse of process and that an acquittal should be entered. This case highlights how fundamentally unsettled are the publicly much debated and persistently contentious issues of euthanasia, assisted suicide, the right of a person to die a dignified death and the way their capacity in that respect should be assessed. It perhaps asks us to reconsider the role of juries and the exercise of discretion by Directors of Public Prosecutions in areas of law where the community and law-makers are deeply and intractably divided.     

Aid-in-dying: should we decriminalize physician-assisted suicide and physician-committed euthanasia?

Recent news stories, medical journal articles, and two state voter referenda have publicized physicians' providing their patients with aid-in-dying. This Note distinguishes two components of aid-in-dying: physician-assisted suicide and physician-committed voluntary active euthanasia. The Note traces these components' distinct historical and legal treatments and critically examines arguments for and against both types of action. This Note concludes that aid-in-dying measures should limit legalization initiatives to physician-assisted suicide and should not embrace physician-committed voluntary active euthanasia.     

Therapeutic response to assisted suicide request

The authors review the first publicly reported case of legal assisted suicide in the United States and discuss possible clinical responses other than assistance in suicide. Psychiatric observers have noted that acceptance of assisted suicide or euthanasia as a medical option has resulted in loss of knowledge about how to respond to suicidal ideation in the seriously ill. The authors discuss specific therapeutic interventions that may be appropriate for seriously ill patients requesting suicide.     

Euthanasia: a challenge for the forensic toxicologist

People die daily in the hospital. Mostly, they die because their illnesses were no longer treatable (natural death). Unfortunately, some people die an unnatural death, in particular, as the result of euthanasia. In contrast to the situation in most countries, in the Netherlands euthanasia is accepted by the courts under strict conditions. It can be very difficult for the legal authorities to establish whether a person has died from natural causes or from suicide, euthanasia, or murder. In addition to the pathologist and the lawyer, the toxicologist also has a number of problems in showing whether euthanasia has been carried out. These can consist of the following analytical problems: (a) interactions--the patients involved have frequently been receiving a large number of toxic and nontoxic drugs simultaneously; (b) identification--not all drugs administered are included in general screening procedures; (c) metabolites--a large number of metabolites may have accumulated toward the end of a long therapeutic regimen; and (d) determination--determination of quaternary muscle relaxants and their various metabolites, as well as other drugs, can be problematic. There are also toxicokinetic problems; because of poor kidney and liver function, low serum albumen, general malaise, and interactions between these factors and other drugs, the kinetics of a given drug can differ from normal. This makes it all the more difficult to determine whether the patient died from an accumulation of medication or from a so-called "euthanetic" drug mixture.(ABSTRACT TRUNCATED AT 250 WORDS)     

The way assisted suicide is legalised: balancing a medical framework against a demedicalised model

To date, in three European countries and three American states--i.e., The Netherlands, Luxemburg, Switzerland, and the states of Oregon, Washington and Montana--it is permitted by law for one person to assist in the suicide of another person. When comparing the legislations of these countries/states, it becomes apparent that The Netherlands, Luxemburg, Oregon, Washington and Montana have chosen a medical approach (the so-called medical model), whereas the Swiss legal framework for assisted suicide is clearly a non-medical one (the demedicalised model). The differences between these two models mainly concern two aspects: the requirement as to the capacity of the person providing assistance in suicide and the condition regarding the state of health of the person committing suicide. A closer view on the practice of assisted suicide in the depenalising countries shows that the differences are smaller than initially thought. Nevertheless, important distinctions still remain. When analysing which model is most preferable, it is concluded that an involvement of a physician is inevitable and necessary and that the requirement of a certain medical condition is needed to set a clear and objective limit.     

The alleged distinction between euthanasia and the withdrawal of life-sustaining treatment: conceptually incoherent and impossible to maintain

Richard Epstein, in his book Mortal Peril, supports euthanasia and assisted suicide and rejects the distinction between them and withdrawal treatment. In this essay, Professor Orentlicher argues that Epstein is correct in finding no meaningful moral distinction between euthanasia and treatment withdrawal, examines the reasons why the distinction has persisted in American jurisprudence, and explains why the distinction has eroded. Epstein also concludes in his book that there is no constitutional right to euthanasia or assisted suicide. Professor Orentlicher's response is that constitutionality is not the appropriate inquiry; rather, the better question is whether to recognize a right to assisted suicide once a right to euthanasia in the form of terminal sedation already exists. He answers this question in the affirmative, arguing that assisted suicide enhances patient welfare and reduces risks of abuse in a world with euthanasia.     

意思自治、交易秩序与利益平衡——南怀瑾作品著作权纠纷上诉案评析

知识产权案件的裁判,应当体现意思自治的民法基本原则、稳定交易秩序的司法导向、平衡相关方利益的价值取向。对于行为人的真实意思,应当通过行为外观探求其内心真意。著作权许可使用合同的法律性质应综合合同条款文义、著作权人之行为、代理人之权限、出版合同及其履约过程进行判断。对于代理人在著作权人授权范围之内签署的许可使用合同,其法律后果应直接归属于作为被代理人的著作权人,而不应认定为转委托。著作权人死亡后,在对其作品著作财产权归属发生争议的情况下,被许可人暂缓支付著作权许可使用费,不存在拒不支付之主观过错,因此不应认定其构成侵权。对于权利人通过合同关系行使处分权已经构建的稳定交易结构及交易秩序,应予以尊重。     

Death in homes for the aged/nursing homes from the legal medicine viewpoint

Following the death of 16 inhabitants of a nursing home within a period of 2 weeks, the prosecution ordered legal autopsies in all of the cases, which had not yet been buried or cremated, suspecting a neglect of nursing or active euthanasia respectively. Two out of a total of ten cases revealed drug overdoses which could have explained death. However, due to concurring causes of death, the evidence could not be furnished with adequate security. In the present case, the examinations helped--already in a preliminary stage of the investigations--to prevent the authorities from more expensive proceedings as well as the respective nursing home from being unjustly suspected of having committed a criminal offense.     

Exit association-mediated suicide: toxicologic and forensic aspects

The Swiss German chapter of the Exit Association provides conditional assistance to individuals wishing to end their own lives. The Exit Association advocates death with dignity and fights for the right to freely choose the timing of one's own death. According to the Swiss criminal code (articles 114 and 115), altruistic assistance to suicide is not punishable. Active euthanasia is punished by imprisonment. An individual commits active euthanasia if he or she is driven by honorable motives (e.g., pity) and causes the death of another person wishing to die who seriously and insistently requests such action. Based on our information, the preparation for suicide and its completion relies on a well-defined protocol. First, the candidate's eligibility for Exit Association assistance is verified. The candidate then writes a farewell declaration that explicitly confirms the will to terminate his or her own life. A written report describes the events during the suicide procedure. Depending on the circumstances, the investigative judge requests a forensic autopsy and toxicologic analyses. The results of the forensic investigations conducted in the cases presented here are in agreement with the scenario described in the reports of the Exit Association, namely, suicide by massive ingestion of pentobarbital.     

The new regulation of voluntary euthanasia and medically assisted suicide in the Netherlands

On 1 April 2002 the Dutch Bill 'Termination of Life on Request and Assisted Suicide (Review Procedures) Act' (Wet toetsing levensbeeindiging op verzoek en hulp bij zelfdoding) came into force. This article starts with an outline of the former legal position in The Netherlands regarding euthanasia and medically assisted suicide, followed by an explanation of the new Act. The main focus of this contribution lays on the requirements of due care, the obligation to notify euthanasia to the coroner and the revised legal position of the so-called Regional Review Commissions. Furthermore, the article considers the termination of life in the case of minors and the function and requirements of written statements of euthanasia by patients no longer capable of communication. Finally, the article gives an overview of the problems [that] may come in the future concerning the approach to euthanasia in The Netherlands.     

我国刑事和解实证分析

在构建和谐社会背景下,各地检察机关积极探索当事人和解刑事案件的宽缓处理方式,取得了良好的社会效果。但由于受现行法律框架、司法资源、考评机制以及传统司法观念的束缚,对当事人和解的刑事案件的处理,在适用范围、处理方式及相关配套措施等方面还存在一些问题。因此,应当建立与我国时代背景和法律文化相契合的刑事和解制度,包括填补立法上的缺失,明确其适用程序,并健全相关的配套措施等。     

Suicide by severing blood vessels using local anesthesia: reduced risk in extraction of HIV infected tissue using a stomacher

Authors report an unusual suicide undertaken by a medical person who after applying the local anesthetic lidocaine, opened a leg vein with a scalpel. The cause of the suicide was presumed advanced AIDS symptoms with a progressive Kaposi sarcoma and Non-Hodgkin lymphoma. For the toxicological investigation of the tissue we used the stomacher extraction system, a method not widely known in Forensic science, however, recommended for the extraction of all infectious tissues.     

Euthanasia and assisted suicide in the post-Rodriguez era: lessons from foreign jurisdictions

Euthanasia and assisted suicide are highly controversial subjects that have drawn much attention in Canada over the last two decades. This paper outlines how the Netherlands, the United States, Australia, and Canada have approached the practices. Jurisprudence, public opinion polls, legislative developments, and the positions of medical organizations and their members are included in the analysis. A number of arguments for and against the continued prohibition of the practices in Canada are evaluated. As well, information regarding the extent to which euthanasia and assisted suicide are performed in these countries is assessed. It will be shown that Canadians currently enjoy significant control over decisions concerning end of life. The principles of autonomy and beneficence provide the foundation necessary to justify lifting the prohibition of voluntary euthanasia and assisted suicide in Canada. With regard to the development of safeguards, the way in which foreign jurisdictions have dealt with both procedures is highly instructive. A qualified system of pre-authorization, unlike those adopted elsewhere, would prevent abuses from occurring and maintaining the prohibition of non-voluntary and involuntary euthanasia. Since legislators are in the best position to deal with the issues, change in the law should be made by the government, not the judiciary. Practical legislation is feasible and a proposal of what this should entail is presented.     

Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians

This is a review and evaluation of medical and public literature regarding the reported emotional and psychological effects of participation in physician-assisted suicide (PAS) and euthanasia on the involved physicians. MATERIALS AND METHODS: Articles in medical journals, legislative investigations and the public press were obtained and reviewed to determine what has been reported regarding the effects on physicians who have been personally involved in PAS and euthanasia. RESULTS AND DISCUSSION: The physician is centrally involved in PAS and euthanasia, and the emotional and psychological effects on the participating physician can be substantial. The shift away from the fundamental values of medicine to heal and promote human wholeness can have significant effects on many participating physicians. Doctors describe being profoundly adversely affected, being shocked by the suddenness of the death, being caught up in the patient's drive for assisted suicide, having a sense of powerlessness, and feeling isolated. There is evidence of pressure on and intimidation of doctors by some patients to assist in suicide. The effect of countertransference in the doctor-patient relationship may influence physician involvement in PAS and euthanasia. CONCLUSION: Many doctors who have participated in euthanasia and/or PAS are adversely affected emotionally and psychologically by their experiences.     

Understanding deliberate indifference to suicide in corrections facilities: A review of recent legal cases

The US corrections system is the largest provider of mental health care in the country. Suicide is a leading cause of death in corrections facilities with rates of inmate suicide being far higher than the national average. Suicide is an event that can lead to legal action against the facility, staff, and treating health-care providers. Some claims are based on medical malpractice. In this setting, claims may also be brought based on violations of the detainee's constitutional rights. Pretrial detainees and prisoners, alike, have a constitutional right to adequate medical and psychiatric care through the Fourteenth Amendment and Eighth Amendment, respectively. But, there is limited information on constitutional claims made against correctional health-care providers for cases of inmate suicide. To help bridge this gap, the authors conducted a search of federal legal case decisions involving claims against health-care providers for deliberate indifference to a detainee's serious illness or injury in the event of attempted suicide or death by suicide over a 5 year period from 2016 to 2021. Fifteen cases were identified. Five themes emerged from the cases, which could serve as bases for claims against health-care professionals: receiving screening, mental health assessment, treatment, documentation, and attention to facility policies. The cases and their clinical significance are summarized in this article. The materials provide an overview of the problems surrounding correctional suicides and can serve as practice pointers in the corporeal setting.     

Sex and the sacred: sterilization and bodily integrity in English and Canadian law

Through an examination of cases of non-consensual sterilization for learning disabled persons in Canada and England, this article considers the role that law plays in framing the thoughts, beliefs, and norms that fashion the ways we think about bodies, sex, gender, and sexuality. The author asks how it is that Canadian and English law, while both claiming to protect bodily integrity, have reached opposing conclusions about whether non-therapeutic sterilization can be in a person's best interests. She hypothesizes that the answer could lie in the manner in which courts have constructed the bodies of learning disabled men and women in the sphere of sexuality and reproduction. Where the overriding concern in the sterilization cases is the containment of the sexuality of a learning disabled person perceived as "out of control" or "vulnerable to seduction", sterilization is cast as a just and humane solution that will advance the welfare of the individual concerned. Conversely, where the overriding concern is the preservation of the integrity of a law committed to the principle of equality, sterilization is thought to be a violation of the bodily integrity of the person. The author shows that these two views engender very different legal and cultural discourses about best interests and bodily integrity. The debate highlighted by the sterilization cases and the commentary surrounding them reflect larger tension within legal discourse between the commitment to liberal values and the maintenance of a particular social order.     

Fifty years on: against the stigmatising myths, taboos and traditions embedded within the Suicide Act 1961 (UK)

Although assisted suicide carries a maximum of 14 years imprisonment in England, courts and juries have historically demonstrated a reluctance to convict, most specifically in relation to those travelling abroad to accompany a terminally ill person seeking assisted dying. The possibility of prosecution is still present, however, and there have recently been a number of challenges to the law on assisted dying. During the consultation period of the Coroners and Justice Act 2009 (UK) an amendment was proposed that would have legalised, among other things, assisting suicide overseas. However, it was voted down by peers who believed it to be dangerously radical. In 2008 a multiple sclerosis sufferer requested a clear policy statement, should her partner help her to seek assisted dying abroad in the future. After her application was initially rejected, Mrs Purdy was granted leave to appeal and following a favourable ruling by the House of Lords in 2009, the Director of Public Prosecutions clarified the law on assisted suicide, introducing a Full Code Test which includes the consideration of "public interest factors". Although the new guidelines are not a direct threat to the 50-year-old Suicide Act 1961 (UK), it is clearly an historic development: the latest in a series of high-profile cases and debates which have taken place over the last decade. It is suggested that English law on assisted dying continues to rely on a range of inappropriate concepts, taboos and superstitions, and it is from this perspective that the implications for future legislative reform are addressed.     

The interfaces of law and medicine.

The relationship between the legal and medical professions is improving, but many problems remain. There has been been and continues to be substantial growth in medicolegal organizations of various kinds. Better medicolegal investigative methods are being developed, and medicolegal teaching programs are on the increase. The two professions have worked together successfully on such problems as human heart transplantation and drug abuse. On the other hand, several problem areas continue to cause difficulty and friction, including medical experimentation on humans, the legal definition of death, abortion, euthanasia, and medical malpractice. The author calls on the existing medicolegal organizations to apply their expertise and influence to define and resolve these problems.     

试论相对不起诉及其不当性

随着相对不起诉制度于1996年在我国的确立,免予起诉制度在运行了十七年之后终被废止。该制度旨在追求司法效率,但却以牺牲司法公正为代价,不仅表现在对被害人与被不起诉人之间的保护失衡,而且存在着损害二者合法权益的隐患,甚至对检察机关与审判机关的公信力也产生了不同程度的减损。鉴于此,该制度的完善或存废问题值得我们进行深刻反思。     

National Security and the Press: The Government's Ability to Prosecute Journalists for the Possession or Publication of National Security Information

In 2006, then Attorney General Alberto R. Gonzales raised the possibility that journalists could be prosecuted for publishing national security information. In addition, the federal government's prosecution of two former lobbyists for the American Israel Public Affairs Committee (AIPAC) for possessing and disseminating national security information has been called an attempt by the government to prosecute individuals who behave like journalists. This article identifies existing laws under which the press could be criminally prosecuted for the possession and/or publication of national security information and describes how the courts have addressed those laws. The article concludes that while there is support for Constitutional protection for journalists in these cases, the Supreme Court of the United States is unlikely to interpret the First Amendment as protecting journalists from prosecution for possessing and/or publishing national security information. Therefore, the article contends that Congress should amend the statutes outlined herein to limit prosecution to instances when there is evidence of intent to harm the United States.