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.     

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 In deciding whether it was in the patient's best interests that artificial nutrition and hydration be withdrawn and withheld, the court made a key legal determination, with precedential effect, as to whether the so-called "balance sheet" approach to determining a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.     

从通用化走向专门化:反思中国司法人工智能的运用

随着人工智能技术在司法领域的应用,相关研究的热度持续高涨,但仍需要探讨的是人工智能在司法实践中运用的实际情况:包括何种人工智能发挥了作用、作用何在以及为何会在有些方面产生效果而其它方面又效果不彰。总体而言,人工智能在中国司法实践中取得了一定的成效,主要体现在警务活动与司法辅助性活动中,但仍难称理想。小范围的成功是源于成熟通用人工智能技术的普适性适用,而大部分司法人工智能产品难以发挥作用是由于未结合专门司法需求展开,所投入的资金与人才资源远远不足。未来应当降低对于司法人工智能的盲目期待,将研发重心从通用领域转向司法专用领域,转变司法人工智能的投入模式,大力培养既懂法律又懂技术的专门化、复合型人才。     

行政首长应当出庭应诉吗?——在司法的技术、权能与功能之间

从司法技术的角度看,首长应诉制度存在"去专业化"之倾向,无助于提升司法的公正性。但此制度可在一定程度上缓解由于法院司法审查权能之实际不足所引发的行政诉讼之整体危机,并对行政纠纷之彻底解决有所助益,故其在当下具有一种作为权宜性策略的适行性。但是,《行政诉讼法》不宜直接规定首长应诉制度,而仅需对被告委派代理人出庭作出一般性宣示。     

Are Judicial Performance Evaluations Fair to Women and Minorities? A Cautionary Tale from Clark County,Nevada

Because voters rely on judicial performance evaluations when casting their ballots, policymakers should work diligently to compile valid, reliable, and unbiased information about our sitting judges. Although some claim that judicial performance evaluations are fair, the systematic research needed to establish such a proposition has not been done. By the use of attorney judicial performance survey data from Clark County, Nevada, this analysis shows that objective measures of judicial performance cannot explain away differences in scores based on race and sex. Minority judges and female judges score consistently and significantly lower than do their white and male counterparts, all other things being equal. These results are consistent with the hypothesis that judicial performance evaluation surveys may carry with them unexamined and unconscious gender/race biases. Future research must compare judicial performance evaluation structure, content, and execution across states in order to identify those evaluation mechanisms least susceptible to unconscious gender and race bias.     

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.     

Right to refuse treatment: impact of Rivers v. Katz

This article examines the impact of the New York court decision, Rivers v. Katz, which in June 1986 dramatically changed the state procedure for responding to involuntarily committed psychiatric patients who formally refused psychopharmacologic treatment. The court rejected the medically administered review process that had been used to respond to involuntarily committed psychiatric patients who formally refused medication, and replaced it with a judicial determination of competent and "substituted judgment" provided by the court. Post-Rivers, the rate of patients consistently refusing treatment decreased, and the time from refusal to resolution increased. The clinical, legal, and economic implications of the Rivers procedure are discussed.     

以融合正义重构人工智能司法的逻辑

我国的人工智能司法发展具有明显的突变特色,缺乏足够的制度和理论调适,广泛应用会带来司法逻辑的内在冲突。司法的社会技术特性和人工智能的自然技术特性之间具有天然的亲和性,为我国人工智能司法广泛应用提供了工具理性基础。但人工智能介入司法会带来原有社会黏合基础改变,无法完全应对司法过程的随机性和偶然性因素,并且会因为技术竞争带来新的不正义。需要扩展法律正义的蕴含,将法律正义的纯粹道德内核扩展为功利-道德内核,将司法从社会技术转换为技术-社会技术;在司法结构上设置技术-社会的双重竞争性机制,以维护基本的演化平衡;通过技术-社会互动的重构实现人工智能介入后的融合正义司法模式。     

智能司法中的伦理问题及其应对

人工智能使用于司法涉及到突出的伦理问题,智能司法与司法伦理既有紧密关系又有紧张关系.司法公正的一个很重要因素是证据的获取,证据的获取与知识智慧有很大的关联性,人工智能使用于司法在证据获取等方面具有相对于人工的以下优势:准确性、重复性、快速性、抉择性、无私性.智能司法与司法伦理的紧张关系是指智能司法可能损害司法公正:算法...     

The Costs and Benefits of American Policy‐Making Venues

Many law and policy scholars consider judges inimical to good public policymaking, and the criticisms they level on the judiciary implicitly reflect some of the concerns raised by Alexander Bickel and other critics. Despite the charge by critics that judges are institutionally ill equipped to participate in the policy‐making process and that legal processes are costly, there are reasons to believe otherwise. This article uses field interviews and three case studies of an environmental dispute in the Pacific Northwest to show that the judiciary can be an institutional venue that enhances public input, can be more inclusive than other venues, and produces positive‐sum outcomes when other venues cannot. The findings also suggest that legislative and agency policymaking are just as contentious and costly as judicial policy‐making processes.     

A New Method of Assessing Judicial Workload in Juvenile Dependency Cases

This article describes a new method for calculating judicial workload in dependency or child abuse and neglect cases. In contrast to traditional judicial workload methods, the method described herein produces estimates of judicial workload that take into account the complex role of the juvenile dependency court judge—a role that includes both on‐ and off‐the‐bench activities. The method provides workload estimates that give guidance to courts not only about the minimally sufficient judicial resources needed to accommodate current caseload needs, but also what level of judicial resources would be required to hold substantive dependency court hearings that comport with nationally recognized practice recommendations. The article reviews commonly used judicial workload methods, outlines the new method, and uses a pilot of the method as an example of how the method works in practice. Broader implications of this workload method are also discussed.     

The Influence of Personal Values on Legal Judgments

The non‐legal factors that influence judicial decisions have been the subject of extensive debate. Theoretical and empirical work has focused on factors including political ideology, activism, attitudes, and demographics. Personal values are related to these factors and are central to decision making. The study described in this article translated theories and techniques from psychological research to examine the role of personal values in judicial decision making. A novel method of assessment of value expression in legal opinions revealed a different pattern of values expressed in the majority and minority opinions of a case that divided the Supreme Court. An empirical study of legal academics extended this analysis and highlighted the significant influence of personal values on legal decisions. The value:decision paradigm provides a new framework to analyse judicial decision making, judicial division, and judicial discretion and has significant implications for judicial diversity.     

Sustaining freedom,security and justice – from terrorism to immigration

This article focuses on two areas central to sustaining freedom, security and justice: terrorism and immigration. Their inter-relationship and the instruments and measures adopted to prosecute them have significantly advanced judicial co-operation, communitisation of security, and re-assessment of the nature and requirements of EU governance in an EU committed to human rights, liberal democracy and realising sustainable freedom, security and justice. The article outlines the background to EU involvement in judicial co-operation. It then explores EU competence, instruments and measures developed to (i) combat terrorism and international organized crime; and (ii) immigration and asylum. It concludes that the inextricable linkage between the two has serious implications for future EU democratic governance. This revised version was published online in August 2006 with corrections to the Cover Date.     

司法判决与民意冲突解读

在从身份到契约的变化中,法律程序起着极为重要的作用。司法判决与民意冲突的问题在其他国家同样存在,唯对于正处于社会转型中的中国而言,各界尚对程序正义、司法独立、技术理性等缺乏足够的认识及尊重。从当前司法活动中引发的诸多误解来看,本质上是程序正义与实质正义、技术理性与大众理性、司法权与行政权、司法权与知情权的冲突问题,对其善加解读具有一定的启示意义。     

Too Many Black Men: The Sentencing Judge's Dilemma

Legal reform sometimes has unanticipated, even ironic, results. A good example is federal legislation adopted in the 1980s that was supposed to enhance equity in sentencing. Congress, like many state legislatures in this period, reduced judicial control over sentencing by adopting presumptive sentencing guidelines for all serious criminal offenses and mandatory sentences for some specific crimes. Reformers did succeed in reducing judicial discretion in the sentencing process, but racial disparities have gotten much worse. Unprecedented numbers of minorities, particularly black men, are going to jail for long terms. The situation leaves trial judges in a difficult position. They are legally bound to implement a sentencing regime that many of them believe is racially discriminatory. Herbert Jacob's work on criminal trial courts provides a framework for investigating this problem. As Jacob's organizational approach predicts, judges were initially more troubled by the diminution of their powers than by the emerging pattern of increased minority incarceration. Nevertheless, some judges have criticized the racial implications of the sentencing law, protesting in various, resourceful ways. Judicial resistance to a law on moral grounds, though rare, is significant because it represents a break in the ranks of officialdom that enhances the moral credibility of critics of the current law.     

Angels of mercy? The legal and professional implications of withdrawal of life-sustaining treatment by nurses in England and Wales

In circumstances where life-sustaining treatment appears merely to be drawing out the inevitable, it is usual practice for the healthcare team to withdraw aggressive life-sustaining measures, once agreement is reached with the patient and their family. Common law gives doctors several defences to allegations of criminality or malpractice in taking the key actions that withdraw treatment and result in the patient's death; however, the legal defensibility of nurses undertaking this role has not been explored. In the absence of a specific body of law related to nurses taking the actions that withdraw life-sustaining treatment, I discuss the probable legal response by considering parallel cases. Examining some of the circumstances in which doctors are allowed to take life, I argue that the legal dispensation by which doctors are permitted to perform these tasks rests largely on their identity as doctors rather than any distinctive feature of their activities themselves. This uniqueness means that medical law for nurses is quite distinct from that for doctors. While it may nevertheless give nurses practical exemption from the legal consequences of their actions in withdrawal, it depends upon a judicial view that nurses are instruments of doctors. This judicial position is at odds with nurses' professional responsibilities, which envisage them as independent professionals who are liable for their own actions, inviting potentially adverse consequences from their professional registrar.     

Restraint in order to feed: justifying a lawful policy for the UK

In the UK, restraining medical patients in order to provide care is widely considered to be outmoded and difficult to justify. The prevailing clinical intuition that restraining patients is generally wrong (even when restraint is essential in order to provide artificial nutrition and hydration) has prompted us to develop a policy that is compatible with common law, the Mental Capacity Act 2005 and the Human Rights Act 1998. The nature and scope of the problem are illustrated with clinical cases. These, in turn, serve to demonstrate the tension that arises between article 2, article 3 and article 8 rights, when incompetent patients are restrained in order to feed.     

GOVERNING STANDARDS OF MEDICAL CARE: State Courts Interpret the Locality Rule

This article analyzes a significant, but little researched, form of legal involvement in the medical profession—state appellate court opinions. Analyzing 100 years of state appellate court decisions on a legal rule called the "locality rule," the author presents four distinct judicial interpretations of the rule. Each has distinctive policy implications for law and medicine pertaining to the setting of standards for professional competency in medicine. Three of the judicial interpretations provide for increasing amounts of judicial deference to the professional autonomy of the medical community. A fourth interpretation within the last decade, however, upholds a judicial prerogative for establishing standards of professional competency. The author concludes that the fourth interpretation is not an aberration and signals a change in the relationship between law and medicine for the future.     

Campaigning for the Bench: The Corrosive Effects of Campaign Speech?

A new era has emerged in the ways in which candidates for state judicial office campaign. In the past, judicial elections were largely devoid of policy content, with candidates typically touting their judicial experience and other preparation for serving as a judge. Today, in many if not most states, such campaigns are relics of the past. Modern judicial campaigns have adopted many of the practices of candidates for other types of political office, including soliciting campaign contributions, using attack ads, and even making promises about how they will decide issues if elected to the bench. Not surprisingly, this new style of judicial campaigning has caused considerable consternation among observers of the courts, with many fearing that such activity will undermine the very legitimacy of legal institutions. Such fears, however, are grounded in practically no rigorous empirical evidence on the effects of campaign activity on public evaluations of judicial institutions. The purpose of this article is to investigate the effects of campaign activity on the perceived legitimacy of courts. Using survey data drawn from Kentucky, I use both post hoc and experimental methods to assess whether public perceptions of courts are influenced by various sorts of campaign activity. In general, my findings are that different types of campaign activity have quite different consequences. For instance, policy pronouncements by candidates do not undermine judicial legitimacy, whereas policy promises do. Throughout the analysis, I compare perceptions of courts and legislatures, and often find that courts are far less unique than many ordinarily assume. I conclude this article with a discussion of the implications of the findings for the contemporary debate over the use of elections to select judges to the high courts of many of the American states.     

司法是人权保障的最佳方式

司法是人权保障的最佳方式。一方面 ,它是由权利本身的缺陷所决定 ;侵权是必然发生的 ,因此救济权利成为必要。权利救济的最佳方式是司法救济。另一方面 ,它是由司法的特性所决定 ;司法具有中立性 ,司法过程是建立在正当程序基础之上的 ,以及司法判决是由合格的法庭和法官作出的。