The patient who refuses medical treatment: a dilemma for hospitals and physicians

This article reviews recent case and statutory law concerning patients who refuse medical treatment. Among the special cases considered are: the competent adult patient who refuses treatment on religious or privacy grounds; the incompetent patient whose own wishes were never expressed, but whose family refuses treatment; the incompetent patient who expressed the wish not to be treated before becoming incompetent; and parents who refuse treatment on behalf of their child. It is pointed out that recent court decisions have blurred the distinctions between "extraordinary" care and "ordinary" care and between withholding and withdrawing life-sustaining treatment. Reference is made to the recent trend toward allowing the family of an incompetent patient to assert the patient's rights without court intervention either in the form of direct court order or through guardianship proceedings. Finally, the implications of these legal developments for health care institutions are discussed. A protocol pertaining to incompetent patients is proposed. Health care institutions are encouraged to develop formal policies for dealing with patients who refuse treatment, and to work with their professional associations in lobbying for legislation which will clarify the law in this area.     

Book reviews

Transborder Data Flows (Proceedings of an OECD Conference) Edited by Hans‐Peter Gassmann North Holland (Elsevier Science Publishers) 1985, US$74.00

Plastic and Electronic Money: New Payment Systems and Their Implications Patrick Frazer Woodhead Faulkner Limited 1985 £35

A User's Guide To Computer Contracting: Forms, Techniques and Strategies Davis, Allen, Bowman and Armstrong Harcourt Brace Jovanovich 1985, $75

Legal Protection of Computer Programs and Data C. Millard Sweet & Maxwell/Stevens 1985, £24

Piracy of Phonograms Gillian Davies ESC Publishing Ltd. 1986. 2nd edition. £17.95.

Biotechnology and Patent Protection—An International Review F. K. Beier, R. S. Crespi and J. Straus O.E.C.D. 1985, £5

Protecting Privacy in Two‐Way Electronic Services David H. Flaherty Mansell Publishing Company 1985, £23.50

High‐Tech Espionage Jay Tuck Sidgwick and Jackson Ltd 1980, £10.95     

Reviews

Rajan Menon, Soviet Power and the Third World. New Haven and London: Yale University Press, 1986, ix + 261 pp. £18.50.

Georgi Arbatov, Cold War or Detente? The Soviet Viewpoint. London: Zed Books, 1983. xviii + 219 pp. £16.95, $30.00 h/b; £4.95, $8.95 p/b.

Jonathan Steele, World Power: Soviet Foreign Policy under Brezhnev and Andropov. London: Michael Joseph, 1983, xii + 287 pp. £14.95.

Imre Vincze, The International Payments and Monetary System in the Integration of the Socialist Countries, The Hague: Martinus Nijhoff, 1984, ix + 185 pp. £20.50, $32.00.

M. M. Kostecki ed. The Soviet Impact on Commodity Markets, London: Macmillan, 1984, xl + 271 pp. £25.00.

Gerhard Fink ed. East‐West Economic Relations Now and in the Future: Die Ost‐West‐Wirtschaftsbeziehungen heute und morgen, Vienna: Springer‐Verlag, 1985, 100 pp. DM 34,00.

András Köves, The CMEA Countries in the World Economy: Turning Inwards or Turning Outwards, Budapest, Akadémiai Kiadó, 1985, 248 pp. £18.25.

Ger P. van den Berg, The Soviet System of Justice: Figures and Policy, Martinus Nijhoff, Dordrecht, Boston, Lancaster (series Law in Eastern Europe No. 29) 1985, xiii + 374 pp incl appendices, indices and references, £56.95, $71.50.

Eugene Huskey, Russian Lawyers and the Soviet State. The Origins and Development of the Soviet Bar, 1917–1939. Princeton: Princeton University Press, 1986, xii + 247 pp. £19.00.

David Lane, Labour and Employment in the USSR. Brighton: Wheatsheaf Books (distributed by Harvester Press), 1986, 280 pp. £28.50.

Martin McCauley and Stephen Carter, eds. Leadership and Succession in the Soviet Union, Eastern Europe and China. London: Macmillan, 1986, xiii + 256 pp. £27.50 h/b, £8.95 p/b.

Leslie Holmes, Politics in the Communist World. Oxford: Oxford University Press, 1986, xi + 457 pp. £25–00 h/b, £9.95 p/b.

Peter Kenez, The Birth of the Propaganda State: Soviet Methods of Mass Mobilization, 1917–1929. Cambridge: Cambridge University Press, 1985. xi + 308 pp. £27.50, $39.50 h/b, £9.95, $12.95 p/b.

Joseph J. Collins, The Soviet Invasion of Afghanistan: a Study in the Use of Force in Soviet Foreign Policy. Lexington, Mass.: Lexington Books, 1986, xv + 197 pp. £22.50, $31.25.

Leszek Buszynski, Soviet Foreign Policy and Southeast Asia. London: Croom Helm, 1986, 303 pp. £25.00.

William J. Kelly, Hugh L. Shaffer and I. Kenneth Thompson, Energy Research and Development in the USSR: Preparations for the Twenty‐First Century. Durham, North Carolina: Duke University Press, 1986, xvi + 417 pp. £62.50.

Gregory D. Andrusz, Housing and Urban Development in the USSR, London: Macmillan in association with CREES, University of Birmingham, 1985, xix + 354 pp. £30.00.

Jane Ellis, The Russian Orthodox Church: a Contemporary History, London & Sydney: Croom Helm, 1986. 531 pp. £27.50.

Edward Acton, Russia: The Present and the Past, London and New York: Longman, 1986, xiii + 342 pp. £17.50 h/b, £8.95 p/b.

Robert Service, Lenin: A Political Life. Vol. 1. The Strengths of Contradiction. London: Macmillan, 1985, x + 246 pp. £25.00.

Abbott Gleason, Peter Kenez and Richard Stites, eds., Bolshevik Culture. Experiment and Order in the Russian Revolution. Bloomington: Indiana University Press, 1985, xii + 304 pp., $27.50.

Josef Garlinski, Poland in the Second World War, London: Macmillan, 1985, xxi + 387 pp., £25.00

Andreas Dorpalen, German History in Marxist Perspective. The East German Approach. London: I. B. Tauris & Co., 1985, 542 pp., £24.50.

Walter Parchomenko, Soviet Images of Dissidents and Nonconformists. New York: Praeger, 1986, xv + 251 pp., $33.95.

Soviet Armed Forces Review Annual. Vol. 9 (1984–1985). Edited by David R. Jones. Gulf Breeze, Florida: Academic International Press, 1986. x + 313 pp., $69–50.     

Reviews

Terry Cox and Gary Littlejohn, eds., Kritsman and the Agrarian Marxists. (Library of Peasant Studies, No. 7), London: Frank Cass & Co. Ltd., 1984, 149 pp., £18.50.

S. G. Wheatcroft and R. W. Davies eds., Materials for a balance of the Soviet national economy 1928–1930 (with foreword by Richard Stone). Cambridge: Cambridge University Press, 1985, xxiv + 467 pp., £35.00, $59.50.

I. Birman, Ekonomika nedostach. New York: Chalidze Publications, 1983, 470 pp.

Richard F. Staar, USSR Foreign Policies After Detente. Stanford, Ca: Hoover Institution Press, 1985, xxvii + 300 pp., h/b $26.95, p/b $10.95.

John J. Maresca, To Helsinki: The Conference on Security and Cooperation in Europe 1973–1975. Durham, North Carolina: Duke University Press, 1985, xiii + 292 pp., £47.50.

Mark V. Kauppi and R. Craig Nation eds., The Soviet Union and the Middle East in the 1980s. Lexington, Mass, and Toronto: Lexington Books, D.C. Heath and Company, 1983, ix + 293 pp., £25.00.

Jonathan Haslam, The Soviet Union and the Struggle for Collective Security in Europe, 1933–1939. New York: St. Martin's, 1984, xii + 310 pp., $29.95.

Alfred L. Monks, Soviet Military Doctrine: 1960 to the Present. New York: Irvington Publishers, 1985, xii + 351 pp., $34.50.

Jeffrey D. Boutwell, Paul Doty, and Gregory F. Treverton eds., The Nuclear Confrontation in Europe. London: Croom Helm, 1985, 247 pp., £22.50.

Condoleezza Rice, The Soviet Union and the Czechoslovak Army, 1948–1983: Uncertain Allegiance. Princeton, N.J.: Princeton University Press, 1984, xiv + 303 pp. Tables. £40.40.

Vitaly Rapoport and Yuri Alexeev, High Treason: Essays on the History of the Red Army, 1918–1938. Translated by Bruce Adams. Durham: Duke University Press, 1985, xvii + 436 pp., £35.00.

Robert Conquest, Inside Stalin's Secret Police. NKVD Politics 1936–1939. Stanford, California: Hoover Institution Press, 1985, ix + 222 pp., $22.95.

Jeffrey T. Richelson, Sword and Shield. The Soviet Intelligence and Security Apparatus. Cambridge, Massachusetts: Ballinger Publishing Company, 1986, xix + 279 pp., $39.95 h/b, $16.95 p/b.

P. Marer, Dollar GNPs of the USSR and Eastern Europe. The Johns Hopkins University Press, Baltimore and London: For the World Bank. 1985, xiii + 241 pp., £20.00.

Moshe Lewin, The Making of the Soviet System: Essays in the Social History of Interwar Russia. London: Methuen, 1985, viii + 354 pp., £19.00 h/b, £8.95 p/b.

Eric P. Hoffmann and Robbin F. Laird, Technocratic Socialism: the Soviet Union in the Advanced Industrial Era. Durham: Duke University Press, 1985, viii + 228 pp. h/b £37.50, p/b £12.50.

Robert Cassen ed., Soviet Interests in the Third World. London: Sage Publications, 1985, xi + 329 pp., h/b £27.50, p/b £10.50.

Václav Havel et al., The Power of the Powerless: Citizens Against the State in Central‐Eastern Europe, Ed. John Keane, Introduction by Steven Lukes. London, Melbourne, Sydney, Auckland, Johannesburg: Hutchinson, 1985, 228 pp., £16.95.

Michael M. Boll, Cold War in the Balkans: American Foreign Policy and the Emergence of Communist Bulgaria, 1943–1947. Lexington, Ky.: The University Press of Kentucky, 1984, ix + 250 pp., £27.50.

Edward R. Girardet, Afghanistan: The Soviet War. London: Croom Helm, 1985, 259 pp., £17.95.

Henry S. Bradsher, Afghanistan and the Soviet Union. Durham: Duke University Press, 1985, viii + 384 pp., £12.95.

David W. Lovell, Trotsky's Analysis of Soviet Bureaucratization. London: Croom Helm, 1985, ix + 82 pp., £7.95.

Katerina Clark and Michael Holquist, Mikhail Bakhtin. Cambridge, Mass, and London: Harvard University Press, 1984, xi + 398 pp., £19.95.

Hans‐Georg Heinrich, Hungary. Politics, Economics and Society. London: Frances Pinter, 1986, xviii + 198 pp., £17.50.

Henry Rollet, La Pologne au XX^e Siècle. Paris: éditions A. Pedone, 1985, 603 pp., 240F.

Mieczyslaw F. Rakowski, Ein schwieriger Dialog. Aufzeichnungen zu Ereignissen in Polen 1981–1984. Mit einem Vorwort von Peter Bender. Econ Verlag. Düsseldorf‐Wien 1985. 269 pp. Index. DM. 38,00.

John Ambler, Denis J. B. Shaw and Leslie Symons eds., Soviet and East European Transport Problems. London and Sydney: Croom Helm, 1985, xix + 260 pp., £19.95.

Joan de Bardeleben, The Environment and Marxism‐Leninism: The Soviet and East German Experience. Boulder and London: Westview Press, 1985, xi + 338 pp., no price quoted.

John R. Lampe, The Bulgarian Economy in the Twentieth Century. London: Croom Helm, 1986 x + 245 pp., £25.00.

Pedro Ramet, Nationalism and Federalism in Yugoslavia, 1963–1983. Bloomington: Indiana University Press, 1984, xviii + 299 pp., $27.50.

Boris Meissner, Partei, Staat und Nation in der Sowjetunion. Ausgewdhlte Beitrage. Berlin: Duncker & Humblot, 1985, 544 pp., DM148.00.

Jiri Hochman, The Soviet Union and the Failure of Collective Security, 1934–1938. Cornell Studies in Security Affairs. Ithaca and London: Cornell University Press, 1984. 253 pp. $32.95.     

Civil commitment of the mentally ill: an overview

This article discusses historical themes that led to the civil commitment reforms of the sixties and seventies. The changes in the substantive criteria for commitment are analyzed and critiqued. The author believes that the present criteria tend to focus so specifically on various external indicia of mental illness that they render commitment difficult for many seriously ill patients. An alternative commitment scheme is discussed.