Oregon's guidelines for physician-assisted suicide: a legal and ethical analysis

Oregon's Death with Dignity Act was first passed by a ballot initiative in 1994, but numerous judicial challenges delayed implementation of the Act. In November of 1997, following the United States Supreme Court decisions in Vacco v. Quill and Washington v. Glucksberg, which left the states' power to regulate physician-assisted suicide undisturbed, the Oregon voters upheld their law. Oregon remains the only state in the nation to authorize physician-assisted suicide. The Task Force to Improve the Care of Terminally Ill Oregonians published a Guidebook for health care providers on the Oregon Act, and the New England Journal of Medicine recently issued a special report on the first year's experience under the Act. This paper analyzes the legal context of the Oregon Death with Dignity Act, discusses the efficacy of the tenets in the Guidebook, and explores ethical issues underlying the guidelines, particularly those pertaining to the meaning of a patient's request for assisted suicide and processes supporting informed consent.     

Opinions by AAPL forensic psychiatrists on controversial ethical guidelines: a survey.

A survey was conducted of a sample of AAPL members to determine their opinions on the inclusion of controversial ethical guidelines for forensic psychiatry. Members appear to appreciate the need to consider traditional Hippocratic values as at least one consideration in their functioning as forensic psychiatrists. They appear to balance their duties to an evaluee with duties to society and the legal system and to appreciate the responsibilities of multiple agency. Support was shown for interpreting ambiguities in AAPL's current guidelines in the directions indicated by most of this survey's proposed guidelines.     

Gender, race, and formal court decision-making outcomes: Chivalry/paternalism, conflict theory or gender conflict?

A significant body of research examines the influence of offender gender on court-related decision making and typically finds that women deemed “worthy of protection” are afforded greater leniency than other offenders. There is a less developed effort to uncover the influence of victim characteristics, particularly victim gender and the interaction between offender and victim gender on formal criminal justice outcomes. Drawing from the chivalry/paternalism hypotheses, conflict theory, and gender conflict frameworks, the present research used data on a nationally representative sample of convicted homicide defendants to examine the effects of gender and race dyads on sentencing outcomes. Policy implications and future research directions are discussed.     

A cure for the Blues: resolving nonprofit Blue Cross conversions

This Article analyzes the issues involved in converting nonprofit Blue Cross organizations to for-profit status. These issues have arisen in the context of litigation regarding the "reorganization" of Blue Cross and Blue Shield of Missouri ("BCBSMo"). BCBSMo had reorganized by creating and transferring a majority of its business to a new for-profit subsidiary. Missouri consumer groups and state regulators characterized the "reorganization" as a conversion requiring BCBSMo to transfer its assets to a foundation dedicated to charitable health purposes. BCBSMo, however, denied that it had any obligation to leave behind its assets in the nonprofit sector. The BCBSMo litigation raises issues common to most conversions of nonprofit healthcare organizations, particularly conversions of nonprofit Blue Cross plans. This Article provides a road map for state regulators and the public to follow in ensuring that the public interest is fully protected in such conversions.     

Stem cell terminology: practical, theological and ethical implications

Stem cell policy discussions frequently confuse embryonic and fetal sources of stem cells, and label untested, non-reproductive cloning as "therapeutic." Such misnomers distract attention from significant practical and ethical implications: accelerated research agendas tend to be supported at the expense of physical risks to women, theological implications in a multi-faith community, informed consent for participation in research, and treatment decisions altered by unrealistic expectations.     

Cloning for therapeutic purposes: ethical and policy considerations

This essay reviews how cloning techniques may be used for therapeutic purposes, analyzes ethical implications, and makes recommendations for public policy discourse. Although cloning may bring many potential benefits, they remain uncertain. Furthermore, human embryo research is morally problematic. Therefore, alternatives to human cloning for therapeutic aims should be sought at present. In addition to central ethical issues, public discourse should maintain an emphasis on the value of the human embryo over scientific expediency, the relativity of health, and the principle of justice. Society should support the laudable mission of medical research, while also attending to the moral concerns often threatened by the promises of scientific progress.     

The terrorist mind: II. Typologies, psychopathologies, and practical guidelines for investigation

Part I of this two-part article presents a psychological and political analysis of the terrorist mind. Part II describes the major current psychological classifications and typologies of domestic and foreign terrorism. Explanations are offered in terms of our current understanding of the personality and psychopathology of terroristic violence. A heuristic model of classifying terrorism in terms of personality and psychopathology is presented. In addition to guiding further research and theory on the psychology of terrorism, this model has immediate practical application to the investigation and interrogation of terrorist suspects.     

Shame,anger, and conflict: Case study of emotional violence

This paper proposes a new theory and method for understanding emotional violence: conflict results from threats to the social bond. Protracted conflict may be a result of social-emotional separation and unacknowledged shame. A single case is used to analyze the dynamics of marital conflict. Discourse is analyzed during an actual quarrel; sequences of emotion are traced prior to moments of escalation. The results indicate that not only did anger occur during conflict, but also it was preceded by unacknowledged shame. Sequences within and between spouses alternated from emotional separation and shame, to anger, to disrespect, to further separation and shame, and so on. Interaction in this couple was marked by alienation rather than solidarity.     

Parents and medical professionals: conflict, cooperation, and best interests

Abstract This paper seeks to engage with the ideas expressed by Professor Brazier in her commentary on the Charlotte Wyatt case and to develop contemporary analysis around parental rights, notions of best interests, and shared decision-making between parents and professionals. The article begins by setting the scene in relation to parental/professional conflict and frames the discussion in the context of medical decision-making. Parental rights are then explored before the analysis progresses to how the concept of best interests has recently developed. Finally, the article investigates the benefits of compromise, cooperation, and shared decision-making as the most effective method for resolving disputes concerning children.     

Coexistence, conflict, and cooperation: public policies toward medical devices

Medical devices include thousands of products, many of which have greatly contributed to the quality of health care. As devices have proliferated, so have public policies that affect them. The federal government intervened to promote three fundamental values: safety by federal regulation, innovation through federal funding of research and development, and access by providing services under Medicare. The policies generally coexisted without conflict. However, two recent developments--the advent of cost containment and the expansion of the tort liability system--present a potentially disruptive influence on these policies, and threaten to undermine the values they serve. Because cost restraints are inevitable and the tort system provides consumer protection, the challenge for policymakers is to reconcile them with the values of safety, innovation, and access. The proposals presented here seek to promote coordination to protect those values without imposing unacceptable costs on the health care system.