A paradigm shift for ethics committees and case consultation: a modest proposal

In conclusion, the expert-consultation model of ethics consultation is deeply imbedded in modern health care. The paradigm of consultant as expert rather than as community-enabler shapes the expectations and behaviors of healthcare personnel and institutions. This paradigm has also shaped the early stages of HEC development and ethics case consultation. It is time to shift paradigms and adopt one that derives more from the nature of ethics than from the nature of scientific medicine: the role of HECs should be to enable key professionals to carry out the ethical dimensions of patient care. When the HEC does review cases, it should be with the purpose of improving the institution, not of resolving individual cases. One consequence of this is that there will be more individual case reviews than before, but the function, emphasis, agents and locations will shift substantially. A second consequence is that the HEC will function more as an agent of social change by helping to harness the institution's resources. We judge both of these to be a welcome evolution in healthcare ethics.     

Recovering from research: a no-fault proposal to compensate injured research participants

National advisory committees have considered the obligations owed to research participants in the event of research-related injuries. These committees have repeatedly concluded that injured research participants are entitled to compensation for their injuries, that the tort system provides inadequate remedies, and that the United States should adopt no-fault compensation. But because the advisory committees have made no concrete proposals and have taken no steps toward implementing no-fault compensation, the United States continues to rely on the tort system to compensate injured research participants. This Article argues that recent legal developments and a transformation in the global research landscape make maintaining the status quo morally indefensible and practically unsustainable. Recent legal developments exacerbate the longstanding difficulties associated with the tort system as a method of compensation; nearly every injured research participant will have difficulty recovering damages, and certain classes of injured research participants--those in federal research and those abroad--are prevented from recovering altogether, resulting in substantial unfairness. In the past ten years, many of the countries substantially involved in research have mandated systematic compensation. By not mandating compensation, the United States has become a moral outlier and risks having its noncompliant research embargoed by foreign ethics committees, thereby delaying important biomedical advances. This Article examines alternative compensation mechanisms and offers a concrete no-fault compensation proposal built on systems already in place. The proposed system can be implemented in the United States and countries around the world to help harmonize various national compensation systems and to more equitably and effectively make those injured by research whole.     

Misusing informed consent: a critique of limitations on research subjects' access to genetic research results

Express denials of access to genetic research results are being drafted into consent instruments. Some commentators suggest that the principle of beneficence can justify such a denial of access. This paper provides an ethical and legal critique of the use of consent instruments to disclaim responsibility for on-going disclosure by genetic researchers. Currently, the law of torts provides only weak protection for on-going disclosure for research subjects. The most substantive rights are to be found in the law of fiduciary obligations. The author concludes that, notwithstanding arguments to the contrary, there should be a presumption of disclosure in genetic research, unless the research subject elects otherwise. The author outlines one possible exception to this general presumption.     

A survey of drug use and attitudes toward drugs among male law students and police trainees in Queensland,Australia: A research note

During first semester 1980, 96 first and last year male police students and 166 law students were surveyed about their drug use patterns and attitudes towards alcohol. Of these students, 69.3 percent drank at least once a month, 80.7 percent used coffee or tea, 23.6 percent analgesics, 3 percent antihistamines and marijuana and less than 1 percent sedatives, tranquilizers, stimulants, hallucinogens, cocaine or opiates once a month or more. Law students used caffeine and marijuana significantly more frequently than police students. On the whole, there were more similarities than differences between the two groups in terms of drug consumption. In terms of attitudes, police students felt significantly more than law students that alcoholism was caused by moral weakness and medical illness as shown in the Attitude Towards Alcoholism questionnaire. But significantly more police students (82 percent) than law students (37 percent) felt that it was important to have drug and alcohol education as part of their course of study. Also significantly more police students (58 percent) than law students (24 percent) felt that they were prepared to manage drug or alcohol problems professionally.     

Racial prejudice and support by whites for police use of force: A research note

The use of force by police in a democratic society continues to be controversial. Despite the theoretical and practical importance of police use of force, little is known about the sources of public attitudes toward it. Recent research suggests that whites' approval of police use of force may derive partly from racial prejudice against African Americans. In this paper we test this possibility with data from the 1990 General Social Survey and find that negative stereotypes of African Americans contribute to whites' support for police use of excessive force. We also address the theoretical and pragmatic significance of our findings.     

7-[125I]iodoclonazepam: purification by high-performance liquid chromatography for use in a very sensitive benzodiazepine radioimmunoassay of broad specificity

The purification of 7-[125I]iodoclonazepam by high-performance liquid chromatography (HPLC) for use in a very sensitive benzodiazepine radioimmunoassay is described. A silica column is used with a non-aqueous eluent and sequential ultra-violet and gamma-ray detection. A commercially available antiserum is used at a dilution of 1:1000. Blood samples are diluted 10-fold with buffer before analysis and only 25 microliters of diluted sample are required per assay tube. Benzodiazepines, but not the radiolabel, appear to be bound by blood proteins in competition with the antiserum and so, if undiluted blood is assayed, erroneously low results are obtained. The minimal sample requirement and the high sensitivity of the assay described here largely avoid this problem while maintaining acceptable detection limits. For diazepam, the detection limit is 2.5 ng/ml in blood or urine (after correction for the initial 10-fold dilution) and therapeutic or sub-therapeutic levels of many other benzodiazepines can be detected. In practice, the assay is reliable, simple to perform and extremely economical.     

Barcelona 2002: law, ethics, and human rights. Advancing research and access to HIV vaccines: a framework for action

In light of the continuing spread of HIV infection and the devastating impact of the disease on lives, communities, and economies, particularly in the developing world, the investment in new treatments, vaccines, and microbicides has clearly been inadequate. Efforts must be intensified to develop effective HIV vaccines and to ensure that they are accessible to people in all parts of the world. This article is a summary of a paper by Sam Avrett presented at "Putting Third First: Vaccines, Access to Treatments and the Law," a satellite meeting held at Barcelona on 5 July 2002 and organized by the Canadian HIV/AIDS Legal Network, the AIDS Law Project, South Africa, and the Lawyers Collective HIV/AIDS Unit, India. In the article, Avrett calls for immediate action to increase commitment and funding for HIV vaccines, enhance public support and involvement, accelerate vaccine development, and plan for the eventual delivery of the vaccines. The article briefly outlines steps that governments need to take to implement each of these objectives. The article also provides a menu of potential actions for vaccine advocates to consider as they lobby governments.     

Predicting juvenile delinquency: A review of correlates and a confirmation by recent research based on an integrated theoretical model

This study is an exploration of the effects of setting cases for trial in a court that permits jury trials for juveniles. Although few cases actually go to trial, cases set for trial have an impact on juveniles and the court. The study reported here is based on data from a study of 710 youths upon whom delinquency petitions were filed in a suburban court in 1980. Of these youths, 94 had cases set for trial and 7 actually went to trial.

The first part of the article gives a brief historical perspective on the juvenile right to jury trial, discusses why defense attorneys set cases to trial, and describes some of the difficulties in measuring the impact of jury trials. The second part reports on the impact of trial setting in “Suburban Court” on case outcomes and case processing time. A partial correlation analysis shows that there is no significant association between setting a case for trial and either adjudication or final disposition, even when other factors are held constant. Setting a case for trial has a significant association with long case processing times, however. Cases set for trial take almost twice as long as other cases to move from filing to adjudication.