Euthanasia: a challenge for the forensic toxicologist

People die daily in the hospital. Mostly, they die because their illnesses were no longer treatable (natural death). Unfortunately, some people die an unnatural death, in particular, as the result of euthanasia. In contrast to the situation in most countries, in the Netherlands euthanasia is accepted by the courts under strict conditions. It can be very difficult for the legal authorities to establish whether a person has died from natural causes or from suicide, euthanasia, or murder. In addition to the pathologist and the lawyer, the toxicologist also has a number of problems in showing whether euthanasia has been carried out. These can consist of the following analytical problems: (a) interactions--the patients involved have frequently been receiving a large number of toxic and nontoxic drugs simultaneously; (b) identification--not all drugs administered are included in general screening procedures; (c) metabolites--a large number of metabolites may have accumulated toward the end of a long therapeutic regimen; and (d) determination--determination of quaternary muscle relaxants and their various metabolites, as well as other drugs, can be problematic. There are also toxicokinetic problems; because of poor kidney and liver function, low serum albumen, general malaise, and interactions between these factors and other drugs, the kinetics of a given drug can differ from normal. This makes it all the more difficult to determine whether the patient died from an accumulation of medication or from a so-called "euthanetic" drug mixture.(ABSTRACT TRUNCATED AT 250 WORDS)     

How medicine mistreats the elderly

Hamstrung by biases and limited facts, doctors routinely deliver shoddy care to old people. This guide shows how to reject that medical mindset and stay healthy longer.     

From fiddle factors to networks of collusion: Charting the waters of small business crime

Small business crime has been largely ignored in American criminology; studies of nontraditional crime have focused mainly on corporate crime or on the misdeeds of employees pursuing personal gain. This paper calls for criminologists to redirect their efforts toward the systematic study of small business crime. In particular, it advocates in-depth qualitative studies that explore small business culture and opportunity structures, and that examine the networks of collusion that subvert the legitimate economy. The paper concludes with illustrations from an own story currently being shared with the author by a small businessman who participated for five years in an urban crime network that infiltrated the redistributive economy.     

Doctors under the knife

With Bill Clinton's new reforms only a month away, the health-care system is on the operating table--and the doctors are under the knife. Americans have a love-hate relationship with physicians: they like the care that doctors provide but hold them to blame for the nation's health-care mess. NEWSWEEK looks at how the culture of medicine may change, assesses doctors' fears--and examines the brave new world of HMOs.