Males,medical mutilation and the law: some recent developments

Two recent decisions of the English Court of Appeal--Re J (Specific Issue Orders: Child's Religious Upbringing and Circumcision) [2000] 1 FLR 571 and Re A (Male Sterilisation) [2000] 1 FLR 549--raise serious issues relating to controversial matters involving law and medicine and deserve wider consideration than in their jurisdiction of origin. This article discusses the practical and policy implications of these cases and places them in the appropriate context.     

Withdrawal of life-sustaining treatment from a patient in a minimally conscious state

This column reports on a recent decision, the first in England in which a court was asked to authorise the withdrawal of artificial nutrition and hydration from a patient in a "minimally conscious state". Since the seminal decision in 1993 in Airedale NHS Trust v Bland [1993] AC 789, in which the House of Lords authorised withdrawal of artificial nutrition and hydration from a patient in a persistent vegetative state, the relatively new diagnosis of a "minimally conscious state" has been recognised. In deciding whether it was in the patient's best interests that artificial nutrition and hydration be withdrawn and withheld, the court made a key legal determination, with precedential effect, as to whether the so-called "balance sheet" approach to determining a patient's best interests, as opposed to the (discredited) "futility" principle, applies to a patient in a minimally conscious state. The merit of the former approach is that it forces explicit consideration of quality-of-life assessments in favour of and against withdrawing life-sustaining treatment. A significant pitfall of the English position, as it is currently developing, is the premium it places on accurate diagnosis, whether of vegetative state or minimally conscious state. These issues will have to be faced sooner or later by Australasian courts.     

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.     

Withdrawal of artificial nutrition in the persistent vegetative state: a continuous controversy

The withdrawal of life support from patients in persistent vegetative state (PVS) is a controversial issue, as highlighted by a continuous public debate and recent judicial decisions. In Germany, a topic of particular interest is the abatement of artificial nutrition. First, doubts have come up whether every kind of technically delivered nutrition should be rated identically or whether a distinction between feeding tubes/gastrotomies and intravenous administration should be made. Second, the question is left open whether artificial nutrition is part of basic care and as a consequence may never be discontinued, or if it has to be regarded as life-sustaining treatment which can be refused by surrogates on behalf of the nonautonomous patient. Most recently, controversial judicial decisions have dealt with the question if substituted judgement concerning abatement of artificial nutrition by surrogates or legal guardians is permitted or if the approval of a court is necessary. Forensic evidence is provided which indicates that the withdrawal of artificial nutrition in patients in the persistent vegetative state may become a contributing causative factor or even the immediate cause of death. The legal implications with regard to the above-mentioned issues of controversy are discussed.     

Natural justice and the coroner

In R v Doogan (2005) 158 ACTR 1; 193 FLR 239; [2005] ACTSC 74 the Full Court of the Australian Capital Territory Supreme Court made what is arguably thus far the most extensive Australian appellate decision on coronial law and procedure. The court made findings on the nature of coroners' inquests into fires and deaths, the ways in which the parameters of inquests should be determined and the circumstances in which the conduct of coroners and the counsel assisting them could amount to conduct which would lead the hypothetical disinterested bystander to conclude that the coroner was biased. The decision is a contextually sophisticated analysis. One of its consequences is that it will be difficult for parties to have coroners disqualified for apprehended bias. More generally, though, the decision will lend significant assistance for the recurrent difficulty of evaluating when matters sought to be traversed are outside the proper parameters of a coroner's inquest.     

Local Governance and Redistributive Policy: Explaining Local Funding for Public Defense

In many American states, public defense is provided at the county rather than state level (Langton & Farole 2009 ). Local governments have discretion over implementing and funding the right to counsel, resulting in considerable variability in programs and funding levels. Placing this issue in the theoretical context of redistributive policies and politics, we investigate decisions on funding this service across upstate New York counties. Using as a point of departure Paul Peterson's classic explication of community politics, we first model variation in funding as a function of counties' fiscal capacity, need for services, and costs of supplying legal representation. We also test Peterson's prediction that local political factors will play little if any role in budget decisions. Second, through interviews with program administrators we explore the characters of twelve defender programs in which expenditures departed from the model's predictions. We find that three factors—which we term “influence,” “infrastructure,” and “ideas"”—also vary directly with levels of funding. We conclude with a discussion of the implications of these findings for theoretical thinking about due process policies and local politics, and for policy debate over how best to ensure adequate counsel in criminal court.     

Deciding about life-support: a perspective on the ethical and legal framework in the United Kingdom and Australia

This article is concerned with the legal right of health service providers to decide whether to provide life-prolonging treatment to patients. In particular, an examination of recent decisions by the English Court of Appeal in R (Burke) v General Medical Council (Official Solicitor and Others Intervening) [2005] EWCA Civ 1003 and the European Court of Human Rights in Burke v United Kingdom (unreported, ECHR, No 19807/06, 11 July 2006) is provided. An analysis of Australian case law is undertaken together with a consideration of the limits of a patient's legal right of autonomy in relation to choosing life-prolonging medical treatment; the basis upon which such treatment can be legally withdrawn or withheld from an incompetent patient against the patient's earlier expressed wishes that it should be continued or initiated; the concept in ethics and law of a patient's best interests; and the role of courts in adjudicating disputes about the continuation of treatment in light of the recent decisions.     

Constitutional law

Recent decisions of New Zealand courts illustrate that domestic proceedings may not be effective to recognise indigenous property rights, nor to address grievances that stem from breaches of customary indigenous rights. One possibility for Māori to have their rights enforced is to consider using international law. Gains have been made in international law with regard to indigenous rights; one noteworthy decision is Mayagna (sumo) Awas-Tingni Community v The Republic of Nicaragua. In this case, a universal and generic property right was extended consistently with emerging indigenous rights to include an indigenous right to customary land tenure. This paper considers whether the International Covenant on Civil and Political Rights can carry a property right for indigenous peoples in New Zealand.     

Law, pregnancy and sport: what are the repercussions when a pregnant lady plays?

This article reflects on the issue of pregnancy and sport that was brought to the fore in Gardner v National Netball League (2001) 182 ALR 408; [2001] FMCA 50 and Gardner v All Australia Netball Association Ltd (2003) 174 FLR 452. It suggests that these cases did not provide a definitive discussion of the tortious liability implications that initially led Netball Australia to introduce a ban on pregnant players. In an attempt to fill some of these gaps, other case law that deals with liability of sporting organisations and prenatal injury is discussed. The article primarily focuses on whether the unborn child when born alive will have an action against her or his mother as a result of injury occasioned while the mother was playing sport when pregnant. This examination is undertaken in light of recent Australian tort reform as well as changes in policy direction. The article summarises the legal position of the parties involved in sport--sporting organisations, medical practitioners, other participants and the pregnant mother--and argues that, with reference to the guidelines and case law, in only a very small number of cases would liability be found against the sporting organisation or pregnant mother as a result of injuries incurred prenatally.     

Brief for bioethicists for privacy as amicus curiae supporting appellees

Amicus, an ad hoc group of philosophers, theologians, attorneys, and physicians, believe that adults should consult their doctor when making personal decisions. The doctor-patient relationship would be protected under the Constitution. In "Griswold v. Connecticut," the Supreme Court said that a state law which forbid married couples from using contraceptives was unconstitutional; that the couples should have a right to privacy. In "Roe," the Supreme Court recognized that a patient and her doctor should have privacy. In "Doe v. Bolton," the Supreme Court found that the State of Georgia was violating the patients' and physician's freedom. In "Planned Parenthood of Missouri v. Danforth," the Supreme Court said that a general informed consent provision was alright because it did not take away the abortion decision. The post- Roe state laws were ways to control doctors and patients so that a particular philosophical view could be imposed. The major question in Webster is whether personal decisions should be made by doctors and patients or the state. Both parties must agree to the decision. Section 188.205 of the Missouri law was before the Court in Webster. This section makes it illegal for public funds to be used to encourage a woman to have an abortion that wasn't necessary to save her life. There are medical conditions for which abortion is reasonable - Tay-Sachs disease, for instance. The child usually dies by 3 years of age. Without genetic screening, many at-risk couples would abort all pregnancies. 95% of all prenatal screenings are negative. State medical treatment decisions are arbitrary and impersonal. Having control over important personal decisions is necessary for freedom.     

New Jersey Appellate Division Affirms Allocation to Insured for Pre-December 2004 Insolvencies

The New Jersey Appellate Division has held that in long-tail allocation cases, the policyholder remains responsible for amounts allocable to insurers who became insolvent before December, 2004, and that the rule announced in Farmers Mutual Fire Ins. Company of Salem v. N.J.P.L.G.A. does not apply to such insolvencies because the Legislature specifically provided that the statutory amendments that formed the basis for the Farmers Mutual decision applied prospectively from their effective date. The decision confirms that for insolvencies that took place before the amendments' effective date, New Jersey's common law rule that the policyholder bears the risk of insolvencies and is responsible for shares allocable to them still applies. The Court's decision strengthens insurers' arguments that Farmers Mutual did not alter the common law rule for policies that are not subject to the 2004 amendments to New Jersey's Property-Liability Insurance Guaranty Association Act or Surplus Lines Insurance Guaranty Fund Act.     

Suing "the welfare": the diminishing immunity for child protection authorities

Until recently, child protection authorities enjoyed significant levels of immunity in respect of civil actions arising from their action or inaction. However, the tide has turned in Australia, New Zealand and the United Kingdom. The decision of Redlich J of the Victorian Supreme Court in the complex case of SB v New South Wales (2004) 13 VR 527; [2004] VSC 513 consolidates the trend in Australia with a further repudiation of the assertion that child welfare authorities should be specially advantaged. It appears that henceforth actions will regularly be able to be brought against the state by persons who have been harmed by the negligent discharge of child protection duties. In the future, plaintiffs' biggest impediment will lie in the evidentiary challenge of establishing the extent of the harm flowing from the breach of the state's duty as against the harm wrought by previous and supervening events.     

Police GPS Surveillance on Vehicles and the Warrant Requirement: “For a While I’ve Been Watching You Steady”

The global positioning system (GPS) has become ubiquitous to modern American life. The system supplies direction for travel through navigation systems as well as employee monitoring capabilities (Rosenberg Washington Journal of Law, Technology, and Arts 6:143–154, 2010). Law Enforcement has also found GPS to be a valuable tool. The technology provides a relatively cheap and highly effective way to monitor a suspect’s movement. Depending on the device, travel data can be reported in real time or be retrieved from the implanted device at intervals (Shah Journal of Law, Technology, and Policy 2009:281–294, 2009). This paper will first explore the core foundational Fourth Amendment cases that shape the use of GPS devices by law enforcement. Next, the federal circuits and state supreme courts’ decisions that have addressed the use of GPS will be reviewed. Third, the case of U.S. v. Jones (2012), which was recently decided by the United States Supreme Court, will be examined. Last, the policy implications of the current legal landscape regarding the use of GPS by police will be discussed.     

Did the PNR judgment address the core issues raised by mass surveillance?

This article looks at three main issues raised by the PNR scheme: (i) the base-rate fallacy and its effect on false positives; (ii) built-in biases; and (iii) opacity and unchallengeability of the decisions generated, and at whether the Court has properly addressed them. It concludes that the AG and the Court failed to address the evidentiary issues including the base-rate fallacy—a lethal defect. It also finds that neither the Member States nor the Commission have even tried to assess whether the operation of the PNR Directive has resulted in discriminatory outputs or outcomes; and that the Court should have demanded that they produce serious, verifiable data on this, including on whether the PNR system has led in practice to discrimination. But it also finds that the AG and the Court provided important guidance on the third issue, in that they made clear that the use of unexplainable and hence unreviewable and unchallengeable “black box” machine-learning artificial intelligence (ML/AI) systems violates the very essence of the right to an effective remedy. This means that any EU Member State that still uses such opaque ML/AI systems in its PNR screening will be in violation of the law.     

Harriton, Waller And Australian negligence law: is there a place for wrongful life?

Following the decision by the Supreme Court of New South Wales in Harriton and Waller, the controversial action for wrongful life has been thrown back into the public spotlight. This article examines the legal and public policy dilemmas arising from a wrongful life claim in light of the Court of Appeal's reasons for its decision in the jointly heard cases of Harriton (by her tutor) v Stephens; Waller (by his tutor) v James; Waller (by his tutor) v Hoolahan (2004) 59 NSWLR 694 and analyses whether there is a sound doctrinal basis for recognising the claim within the Australian tort system. It will be argued that each of the legal elements comprising the claim fall squarely within the traditional tort framework and that public policy considerations favouring recognition of the claim outweigh those raised against it.     

Order authorizing termination of certain life support systems

An elderly, severely brain-damaged patient was being ventilated and given nutrition and antibiotics intravenously in a medical center's critical care unit. Her legal guardian requested authorization to order that the respirator be withdrawn and the administration of nutrition and antibiotics be stopped. A Missouri circuit court ruled that, while public policy, as evidenced in the state's living will statute, permitted withdrawing the respirator, it apparently precluded withholding or withdrawing nutrition, hydration, or antibiotics.     

Investors’ Rights in (Crypto) Custodial Holdings: Ruscoe v Cryptopia Ltd (in Liquidation)

Ruscoe v Cryptopia Ltd (in Liquidation) is a landmark decision of the New Zealand High Court that considers for the first time in a comprehensive way whether cryptocurrencies are property at common law and to what extent account holders’ (interests in) cryptocurrencies are protected from the claims of the insolvent crypto‐exchange's creditors. The ruling relies on a body of case law from various common law jurisdictions and, to a significant extent, on the findings of the UK Jurisdiction Taskforce Legal Statement on Cryptoassets and Smart Contracts. In tackling complex areas of legal uncertainty, it provides an authoritative conceptual benchmark for future court decisions and normative initiatives.     

From impartial expert to adversary in the wake of Ake

In deciding Ake v. Oklahoma, the Supreme Court held that, when defendants demonstrate that their sanity is likely to be a significant factor at trial, the State must assure them access to a competent psychiatrist who will not only examine them but also render other assistance to the defense. There have been 28 known subsequent decisions in which appellate courts have ruled on the validity of Ake-based claims; in only four did the defendant prevail. The case nonetheless raises issues relative to the proper role of the psychiatric expert. The Supreme Court's decisions, although not introducing a new ethical topic, appear to be favoring a more adversarial posture, at least within certain parameters. I suggest that impartiality, independence, and advocacy need not be mutually exclusive concepts and that some of our traditional beliefs about what part we should play in criminal law may have to be modified and expanded.     

Analysis of age-at-death estimation through the use of pubic symphyseal data

The question of whether age parameters derived from an American population will reliably estimate age-at-death for East European skeletal populations is important since the ability to accurately estimate an individual's age-at-death hinges on what standard is used. A reference sample of identified individuals with known ages-at-death from the regions of the Former Yugoslavia (n = 861) is used to determine the age structure of victims and serves as the prior in the Bayesian analysis. Pubic symphyseal data in the manners of Todd (Am J Phys Anthropol, 3 [1920], 285; Am J Phys Anthropol, 4 [1921], 1) and Suchey-Brooks (Am J Phys Anthropol, 80 [1986], 167) were collected for n = 296 Balkan males and females and for n = 2078 American males and females. An analysis of deviance is calculated using an improvement chi-square to test for population variation in the aging processes of American and East European populations using proportional odds probit regression. When males and females are treated separately, there is a significant association among females and the population (df = 1, chi-square likelihood ratio = 15.071, p = 0.001). New age estimates for Balkan populations are provided and are based on the calculated age distribution from the Gompertz-Makeham hazard analysis and the ages-of-transition. To estimate the age-at-death for an individual, the highest posterior density regions for each symphyseal phase are provided.     

The medical provision of hydration and nutrition: two very different outcomes in Victoria and Florida

Decisions to withhold or withdraw medical hydration and nutrition are amongst the most difficult that confront patients and their families, medical and other health professionals all over the world. This article discusses two cases relating to lawful withdrawal and withholding of a percutaneous endoscopic gastrostomy tube (PEG) from incompetent patients with no hope of recovery. Victoria and Florida have statutory frameworks that provide for advance directives, however in both Gardner; Re BWV and Schindler v Schiavo; Re Schiavo the respective patients did not leave documented instructions. The article analyses the two cases and their outcomes from legal, medical and ethical perspectives.