Legal aspects of withholding treatment from handicapped newborns: substantive issues

The controversy over nontreatment of handicapped newborns arises in a context of criminal and civil law, against which the current controversy has unfolded. This article examines the legal setting and background under traditional criminal and civil law concepts of nontreatment of handicapped newborns. It focuses on substantive principles of law, showing that nontreatment would be legally permitted when treatment could not be reasonably said to be in the interest of the patient involved, and that nontreatment could be considered criminal where treatment would serve patient interests. It then relates this analysis to procedural issues and the federal Baby Doe legislation and regulations that have recently emerged.     

Olanzapine concentrations in clinical serum and postmortem blood specimens--when does therapeutic become toxic?

The concentration of olanzapine (Zyprexa) was determined in 1653 clinical serum specimens during routine drug monitoring, and in 58 postmortem whole blood specimens as part of routine toxicological analysis. The analysis of olanzapine was performed by the solid-phase extraction of 1.0 mL of buffered serum or blood, followed by gas chromatography separation with nitrogen-phosphorus detection. The analysis of the clinical serum samples showed that 86% of positive serum values were within the range of 5 to 75 ng/mL, with a mean and median of 36 and 26 ng/mL, respectively. These data suggest that the concentrations of olanzapine expected during therapy may be higher than those previously reported. In 58 postmortem whole blood specimens the mean olanzapine concentration was 358 ng/mL with a range of 10 to 5200 ng/mL. Further, investigation of deaths involving olanzapine suggest that potential toxicity should be considered at concentrations above 100 ng/mL. Although the majority of the olanzapine-related deaths were associated with many other drugs, death primarily due to olanzapine toxicity was determined at concentrations in post-mortem blood as low as 160 ng/mL.     

Coordination in Youth Affairs: The Politics of Non-Decision-Making

One of the components associated with the widely heralded shift to 'new managerialism' in the public sector has been an increased emphasis on coordination between government departments as a means to enhance effective service provision. This article examines the capacity for coordination to fulfil this objective. Drawing upon a case study of coordination in youth affairs in Western Australia, the article examines the process by which the coordination mechanisms become enveloped in the 'politics of non-decision-making'. By this is meant that a set of power relationships create tensions at a number of levels — between commonwealth and state government agencies; between state government agencies and within individual agencies — which act to prevent effective decisions from being taken. The implications of this case study for the capacity of 'new managerialism' to produce effective policy outcomes in complex social policy areas is highlighted. Evidence from this study suggests that, in an era of restricted resources and heightened competition within the public sector, agencies are pushed to more clearly define their boundaries.