In the Michigan Court of Appeals: People vs. Jack Kevorkian

HELD: There is no right to euthanasia within the constitutional right of privacy. Recognition of such a right to euthanasia would impermissibly expand the right of privacy and thus place the issue outside the arenas of public debate and legislative action. Such a holding would also involve the judiciary in deciding questions that are simply beyond its capacity. There is no principled basis for the court to legalize euthanasia.     

Object relations in criminal psychopaths

Although many empirical studies have documented the range and severity of problems caused by psychopaths, considerably less attention has focused on understanding its origins. Efforts to treat this potentially dangerous population have been equally frustrating, as psychotherapeutic approaches have almost always proven ineffectual. Because of the limited understanding of the psychological and interpersonal dynamics underlying psychopathy, the authors sought to assess the extent to which object relations theory could inform our understanding of psychopathy. In addition to eliciting background information, 74 men sentenced to probation following a criminal conviction were assessed using the Psychopathy Checklist: Screening Version, a clinician-rated measure of psychopathy, and were administered the BORI, a self-report measure of object relations. Results showed significant correlations between object relations dimensions, psychopathy scores, and childhood environment data. Furthermore, object relations scores added to the prediction of psychopathy even after demographic and behavioral variables were considered, suggesting that object relations deficits comprise a significant component of psychopathy. Results suggest that psychopaths harbor profound underlying psychosocial damage including intense anxiety, anger, bitterness, and resentment. Implications for interventions and future research are discussed.     

A fatality involving metaxalone

A case is presented of a 54-year-old white female found dead in a secured apartment. Postmortem toxicologic analysis of the heart blood identified acetaminophen (97 mg/L), citalopram (0.4 mg/L), gabapentin (24 mg/L) and metaxalone (21 mg/L). The metaxalone concentration is within the range of previously reported fatalities involving metaxalone. The medical examiner ruled that the cause of death was metaxalone and gabapentin intoxication and the manner of death was suicide.     

Science ethics as a bureaucratic problem: IRBs,Rules, and Failures of control

“Institutionalized science ethics” refers to the statutory, professional and institution-based ethical standards that guide and constrain scientists' research work. The primary institution responsible for implementing institutionalized science ethics is the Institutional Review Board. We examine the limitations of IRBs and institutionalized science ethics, using bureaucratic theory and, especially, theory related to the development and enactment of rules. We suggest that due to the very character of rules-based systems, improvements in IRB outcomes are unlikely to be achieved through either more or better rules or even by bureaucratic reform. Instead, we suggest that improvements in human subject protection can best be advanced through increased participation. Ours is not a call for more participation by the general public but participation, via “Participant Review Boards” of persons who are eligible, by the protocols of the research in question, to serve as subjects. This provides a level of legitimacy and face validity that cannot be obtained by IRB affiliates, even by “external representatives.” In making these points, we review a recent science ethics controversy, the KKI/Johns Hopkins lead paint study. In spite of being approved by IRBs, the study resulted in a civil lawsuit that reached the Maryland Court of Appeals. The case illustrates the limits of institutionalized science ethics and the bureaucracies created for their enactment. The case also underscores the complex and equivocal nature of the ethical guidelines established under the National Research Act. We are grateful to – for providing helpful comments on an earlier draft.     

Oral abuse of fentanyl patches (Duragesic): seven case reports

In order to increase the understanding regarding the oral abuse and potential toxicity of fentanyl patches seven cases were identified over a 3-year period where fentanyl, either alone or in combination with other factors, contributed to death following the oral abuse of Duragesic patches. The decedents comprised three females and four males with ages ranging from 20 to 51 years. Postmortem blood fentanyl concentrations were determined in all cases and ranged from 7 to 97 ng/mL. Two deaths were classified as a fentanyl overdose, three deaths were classified as a fentanyl and ethanol overdose, one death was considered a mixed drug intoxication and the remaining death was determined to be a combination of fentanyl and medical causes. These cases represent the largest reported series of deaths following the oral administration of transdermal fentanyl patches and provide detailed information on the potential for the abuse of transdermal Duragesic patches via this route. The postmortem blood fentanyl concentrations detected for each of the decedents demonstrate the potentially fatal blood concentrations that can arise after this relatively rare route of administration.