From Rogers to Rivers: the rights of the mentally ill to refuse medication

Many individuals with mental illness wish to avoid psychotropic drugs, a type of treatment that may relieve their symptoms only at the risk of unpleasant, even permanent, side effects. In marked contrast to the widely-held view that most patients may refuse any treatment and that even patients with mental illness may reject other psychoactive interventions such as electroconvulsive therapy and psychosurgery, the courts and legislatures have been slow to recognize any right to refuse psychotropic drugs. This Article demonstrates that many of the justifications offered for forcing patients to take unwanted medications are inadequate and that unless treatment refusals are reviewed outside mental institutions, patients' rights will rarely receive appropriate deference. The author analyzes the federal and state litigation to determine whether the courts have fashioned meaningful relief for the mentally ill. The Article concludes that two recent United States Supreme Court decisions have made it impossible for the federal courts to provide adequate protection. By contrast, several state courts have responded to the needs and rights of patients with mental illness.     

Performance and Compensation: An Analysis of Contract Damages and Contractual Obligation

Although there is an increasing body of opinion that awardsof damages for breach of contract should take account of theclaimant’s performance interest, there has been littlein the way of analysis of what the performance interest is.Commonly the concept is put forward as simply a reformulationor reconceptualization of the expectation interest, itself hithertoregarded as the one true contractual interest. Such thinkingis flawed. A closer analysis of contract doctrine shows thereto be two distinct contractual interests; in receiving performance,and in being compensated for losses caused by non-performance.Receiving compensatory damages for non-performance is not thesame as receiving performance. At present, this important differenceis not fully appreciated, resulting in a failure to developa principled approach to the claims that can be made followinga breach of contract. Recognition of this distinction forcesus to confront the fundamental question of how committed weare to the notion that contracts entail a right to performance.This article examines the distinction between these two interests,how the performance interest may be given effect by a damagesaward, and what the consequences of this analysis are for ourunderstanding of the nature of contractual obligation.     

Incidental findings in genetics research using archived DNA

Despite calls by some commentators for disclosing incidental findings in genetics research, several factors weigh in favor of caution. The technology of genetics has the power to uncover a vast array of information. The most potent argument for restraint in disclosure is that much research is pursued without consent so that the individual participant may not know that research is being conducted at all. Often the work is done by investigators and at institutions with which the person has no prior contact. Past practice is also relevant; genetics researchers historically have chosen not to disclose incidental findings, of which misattributed paternity and pleiotropic alleles such as ApoE have been the most common. Many people choose not to have genetic tests when given a choice. It may be desirable to discuss the topic of incidental findings when consent for research is obtained, but given the risk of unwanted surprise when there has been no prior discussion, the potential utility of incidental findings should be very high before they are even offered to individuals.     

The complications of controlling agency time discretion: FDA review deadlines and postmarket drug safety

Public agencies have discretion on the time domain, and politicians deploy numerous policy instruments to constrain it. Yet little is known about how administrative procedures that affect timing also affect the quality of agency decisions. We examine whether administrative deadlines shape decision timing and the observed quality of decisions. Using a unique and rich dataset of FDA drug approvals that allows us to examine decision timing and quality, we find that this administrative tool induces a piling of decisions before deadlines, and that these “just-before-deadline” approvals are linked with higher rates of postmarket safety problems (market withdrawals, severe safety warnings, safety alerts). Examination of data from FDA advisory committees suggests that the deadlines may impede quality by impairing late-stage deliberation and agency risk communication. Our results both support and challenge reigning theories about administrative procedures, suggesting they embody expected control-expertise trade-offs, but may also create unanticipated constituency losses.     

The problem of the straits

Siberian Development and East Asia. Threat or Promise? By Allen S. Whiting. Stanford University Press, Stanford, California. 1981. Pp. 276. Index, notes, maps. Price $22.50 (hardback).