Field reliability of competence to stand trial opinions: How often do evaluators agree, and what do judges decide when evaluators disagree?

Despite many studies that examine the reliability of competence to stand trial (CST) evaluations, few shed light on "field reliability," or agreement among forensic evaluators in routine practice. We reviewed 216 cases from Hawaii, which requires three separate evaluations from independent clinicians for each felony defendant referred for CST evaluation. Results revealed moderate agreement. In 71% of initial CST evaluations, all evaluators agreed about a defendant's competence or incompetence (kappa = .65). Agreement was somewhat lower (61%, kappa = .57) in re-evaluations of defendants who were originally found incompetent and sent for restoration services. We also examined the decisions judges made about a defendant's CST. When evaluators disagreed, judges tended to make decisions consistent with the majority opinion. But when judges disagreed with the majority opinion, they more often did so to find a defendant incompetent than competent, suggesting a generally conservative approach. Overall, results reveal moderate agreement among independent evaluators in routine practice. But we discuss the potential for standardized training and methodology to further improve the field reliability of CST evaluations.     

Moving Beyond Command-and-Control: Reflexivity in the Regulation of Occupational Safety and Health and the Environment

Direct or "command-and-control" regulation has had limited success in dealing with occupational health and safety and with environmental regulation. This lack of success has led policymakers to experiment with self-regulation as an alternative means of achieving the goals of social regulation. The economic subsystem fails to acknowledge its social identity and, therefore, appears to be blind to its negative performance regarding the environment and the workplace. The authors of this paper argue that moving beyond command-and-control can be feasible and desirable, at least to a certain extent, but that pitfalls are omnipresent. "Regulatory dilemmas" need to be solved, sound empirical studies need to be conducted, and a guiding theory needs to be drafted. To achieve these goals, the authors suggest use of the key concept of "reflexivity," which refers to the economic organization's relationship with itself. The practical usefulness of this theoretical concept is explored against the background of regulatory practice in the areas of occupational safety and health and the environment. It is concluded that a mode of reflexive administrative law requires a "negotiating government," which adopts a mixture of strategies and learns to cope with issues like third-party interests, access to information, and enforcement.     

Physician Participation in Executions: Care Giver or Executioner?

The "medicalization" of the death penalty has ignited a debate, by those within the medical profession and by others outside it, about the appropriateness of physicians participating in state-sponsored executions. Physicians participating as "agents" of the State in executions argue that their presence ensures a more humane execution. Opponents argue physician participation violates the Hippocratic Oath which states clearly that physicians should never do harm to anyone. How any physician, who is dedicated to "preserving life when there is hope," can argue that taking the life of a healthy person because the state commands it is in the patient's best interest, and does not conflict with the goals of medicine is beyond comprehension. Physician participation in executions is unethical because it violates the four basic principles that govern medical ethics: respect for persons, beneficence, nonmaleficence, and justice.     

Forensic pitfalls

The lives of forensic psychiatrists are complicated and subject to stressful experiences because they have elected to interact with a social system very different from their own. This article presents discussion of these frequently troublesome areas commonly encountered by forensic psychiatrists in trying to respond to the law's requests and needs without sacrificing their medical integrity: (1) legitimate definition of expertise; (2) reasonable medical certainty; (3) generally accepted standard of care. They are explored with emphasis on the exercise of self-assessment by the involved forensic psychiatrists lest their incautious application of knowledge and expertise become pitfalls of their own making.     

论法律的确定性与不确定性

崇尚法律的确定性,是西方法学界一个悠久的学术传统。20世纪以来,西方法学界关于这一问题的立场发生了根本转变,转而强调法律的不确定性。在法律运行的过程中,存在着多种不确定性因素,包括法律标准的不确定性、事实认定的不确定性、司法人员个性的不确定性和其他社会因素的不确定性等四个方面。无论是法律的确定性,还是法律的不确定性,都是相对的,而且,二者都蕴藏着一定的社会价值。     

Death of an exception or much ado about nothing

Hospitals often engage in physician recruitment in an effort to fulfill a community need for a particular medical specialty. In doing so, the hospital must comply with the regulatory requirements of the physician recruitment exception of the Stark law, which over the years has generated a great deal of discussion and perhaps confusion. The publication of the Stark II, Phase II regulations in March 2004 was supposed to provide guidance and clarity, but the new regulations have raised a number of new issues and concerns, particularly regarding the requirements imposed on recruiting arrangements involving group practices. This Article reviews the regulatory requirements of the new physician recruitment exception and addresses several of the concerns that have been raised. Specifically, it examines the new regulatory definition of the "geographic area served by the hospital," the restrictions on income guarantees when the recruited physician joins a group practice, and the prohibition on additional practice restrictions. The author concludes that, while some of these concerns are legitimate, others will have little practical implication and should not hinder the ability of hospitals to engage in reasonable, beneficial recruitment activities.     

Violence. Roots and remedies: the perspective of the forensic psychiatrist

The role of the forensic psychiatrist is described in this paper. This role is unique in that it applies the research findings of the neurologist, the neuropsychologist, the criminologist, and other behavioral specialists to courtroom proceedings. The possibility that medical malfunction such as brain damage, endocrinological problems, toxicity, infection, or neurological disorder may be associated with violent behavior is discussed. The forensic psychiatrist has several functions to perform in the courtroom. He or she must be able to assess the likelihood that any type of malfunctioning such as those mentioned may have had a part in the defendant's violent behavior, assess the defendant's state of mind at the time of commission of the crime, and determine whether the individual is competent to stand trial. The five phases of the criminal justice system are reviewed as they bear on the work of the forensic psychiatrist.     

The standard of care and expert evidence of accepted practice in medical negligence

The topic of this article is the perennial issue in medical negligence litigation of various kinds of the extent to which it is a defence to a charge of lack of reasonable care that the defendant's conduct complied with accepted professional practice. Recent English interpretations of the controversial Bolam principle are considered, before the current approach of the courts and the Health and Disability Commissioner in New Zealand is described, using case illustrations. In New Zealand expert medical opinion of accepted practice is relevant to, but not conclusive of, the standard of care. There is, however, more freedom than pursuant to the current English approach for a decision-maker to reject expert opinion of accepted practice, because he or she is able to examine not just the logical defensibility of the practice but its overall reasonableness, including where the practice involved a risk assessment on a matter of clinical judgment. A decision to reject expert opinion of accepted practice is more readily made in areas which do not involve assessment, diagnosis and treatment.     

The impact of race on the adjudication of sexual assault and other violent crimes

This study assessed whether sexual assault offenders were differently adjudicated from other violent felons and to what extent any differences in adjudication decisions were explained by the defendant's race. Five court decisions were analyzed using a weighted sample of 41,151 cases adjudicated between 1990 and 1996 that were representative of cases in the seventy-five most populous United States counties. The results did not support the hypothesis that sexual assault cases were given, on average, more leniency than less serious violent offenses, however, various adjudication decisions for the four violent offenses were moderated by the defendant's race. Interaction models showed minorities were treated more punitively compared to Whites when they were charged with an assault, robbery, or murder, but they were treated more leniently when they were charged with a sexual assault. Explanatory models that accounted for the differential processing of minorities that were disproportionately lenient or punitive, depending on the crime, are discussed.     

违约可得利益损失的确定规则

可得利益是合同法的中心关注,是当事人订立合同的目的所在,对其保护事关当事人交易的积极性和社会整体经济利益的增长,因此各国的违约损害赔偿制度对于可得利益损失普遍给予较高程度的保护。我国合同法等法律虽然明确设定了违约可得利益的概念和规则,但司法实践却表现得较为谨慎、保守甚至是消极,多数法院会因为可得利益损失的不确定性(证据不确定性和计算不确定性)而否定原告的主张。要改变我国法表达与实践脱节的现实困境,需要从程序和实体两方面确立可得利益损失的确定规则,一方面有效降低可得利益损失的证明标准,另一方面对可得利益损失的计算标准加以类型化,以有效保护非违约方的可得利益和期待利益,增强我国违约救济制度的适用性和操作性。     

The federal government and academic texts as barriers to informed consent

Informed patient consent for medical treatment is required by both law and medical ethics. Yet, both federal agencies and academicians are participating in the suppression of information about the heightened risk of breast cancer posed by oral contraceptives and induced abortion. There is historical precedent in the long-delayed acknowledgement of the smoking/lung cancer link. By law, a patient has the right to be fully informed of the nature of her medical condition and any proposed course of therapy. It is assumed that a patient will be given the complete and true scientific basis of her diagnosis and treatment, to ensure that her well-being and her autonomy in decision-making are protected. Informed consent is the process by which a patient can participate in choices about medical treatment. It originates from the legal and ethical right of the patient to direct what is done to her body, and from the ethical duty of the physician to involve the patient in her medical care. Our federal government has become a barrier to informed consent concerning oral contraceptive drugs and induced abortion.     

CHANGING THE LAWYER'S ROLE IN MATRIMONIAL PRACTICE

"In that case," said the Dodo solemnly, rising to its feet, "I move that the meeting adjourn, for the immediate adoption of more energetic remedies-"
"Speak English!" said the Eaglet. "I don't know the meaning of half those long words, and, what's more, I don't believe you do either!" And the Eaglet bent down its head to hide a smile: some of the other birds tittered audibly.
—Alice's Adventures in Wonderland
Lewis Carroll     

法医临床学与新冠疾病有关的鉴定问题及思考

2020年1月爆发新型冠状病毒,由疫情引发的各种问题引起社会各界高度重视,疫情过后,相关法律争议会有出现。本文针对疫情可能带来的法医临床鉴定相关问题予以思考,给出了法医临床学鉴定流程管理以及鉴定机构法律风险防控的基本思路。关于人身损害赔偿及工伤补偿中的伤残评定问题,作者具体梳理了7个可能相关的鉴定标准,并指出,肺功能障碍的条款是我们需要重点关注的内容。面对因疫情爆发而引发的医疗损害鉴定问题,作者认为,针对特殊时期的医患纠纷,鉴定人在评价医方的专家注意义务时,应充分考量各种影响因素,提倡对医疗行为相对宽松的处理原则,宜适用合理医师标准(即Bolam标准),来体现对医疗行业的尊重。本文针对新冠疾病疫情可能带来的法医学鉴定问题给予了建议和解决路径,旨在为疫情过后鉴定工作提供新思路。     

British Abortion Law: Speaking from the Past to Govern the Future

This paper analyses the poor alignment of the aging statutory framework and modern understandings of medical best practice in the context of abortion services. With a particular focus on medical abortion, it assesses the significant challenges that the gulf between the two poses for clinicians, service providers, regulators and the courts. Law is said to be at its most effective where there is a shared regulatory community that accepts and endorses the values that underpin it. It is suggested that the example of abortion law provides a marked example of what happens when legal norms once justified by broadly shared moral understandings, concerns for patient safety and requirements of best practice are now either unsupported by or, indeed, sit in opposition to such concerns.     

Deterrence Theory and Peers: Do Close Friends Perceive Sanction Certainty in a Similar Manner?

Although deterrence theory and social learning theory have been linked on many occasions and are compatible theoretical constructs, criminologists know very little about how the elements of deterrence operate among and between friends. The purpose of this study is to evaluate if similarities in the certainty of sanction, a main element of deterrence, are held between close friends in emerging adulthood. Using data from 1,077 friendship pairs, several confirmatory factor analyses are estimated that attempt to define a friendship-level certainty of sanction construct. Results indicate that friends do not share in common any tendency to perceive similar certainties of sanction. Not only does the certainty between friends fail to load unidimensionally, the two friends’ individual certainty constructs are nearly completely unrelated to each other. In terms of policy implications, peer-based programs targeting increases in sanction certainty tentatively appear to be unnecessary.     

知识产权法典化论证质评

在中国知识产权的立法进程中,存在“特别立法”、“单独法典”和“作为民法典的一篇”三种模式,它们基本上沿袭了世界上既有的知识产权三种立法模式。在理论界,多数学者指出,知识产权的法典化是历史发展的必然趋势。在方法论上他们多数采用的是比较、逻辑的进路;在知识资源上多数依赖的是比较法和历史史实的支撑。法典化论者有关制定知识产权法典的论证是不充分的。在中国语境下,与“特别立法”模式相比,“法典化”具有一种比较优势;但它不具有现实性。比较说来,中国当前应当制定一部《知识产权法通则》。     

论职业病诊断的医学循证与法律推定

不同于一般临床疾病的诊断,职业病诊断是归因诊断,兼具医学性、法律性的特点。《职业病防治法》第四十六条前两款对职业病诊断作出了原则性规定,其中第二款的法律推定体现了职业病诊断的立法价值取向。然而,职业病诊断标准并未高度契合法律推定条款,法律推定操作性欠佳,诊断实务中不同专家对这两款的各自作用和相互关系认识不一,法律推定的适用与否直接影响诊断结论和法律价值的个案实现。对职业病诊断中该两款的协调及法律推定的操作进行论述,以供参考。     

Goal Conflict in Juror Assessments of Compensatory and Punitive Damages

Recent tort reform debates have been hindered by a lack of knowledge of how jurors assess damages. Two studies investigated whether jurors are able to appropriately compartmentalize compensatory and punitive damages. In Study 1, mock jurors read a trial summary and were asked to assess compensatory and punitive damages in one of three conditions: (a) compensatory damages only, (b) punitive damages for the plaintiff, or (c) punitive damages for the state treasury. Results suggest that jurors who did not have the option to award punitive damages inflated compensatory damages via pain and suffering awards. Jurors were marginally more likely to award punitive damages when the plaintiff was the recipient. Mock jurors in Study 2 read a similar case summary and were asked to assess compensatory and punitive damages. Two factors were varied in Study 2: (a) egregiousness of the defendant's conduct, and (b) the recipient of any punitive damages (the plaintiff vs. a consortium of state funds). Jurors were more likely to award punitive damages when the defendant's conduct was more egregious and when the plaintiff was the recipient. The results suggest leakage between compensatory and punitive damage judgments, contrary to the law's mandate.