The judicial role in life-sustaining medical treatment decisions.

Although there has been speculation regarding the pervasiveness and nature of judicial decisions regarding life-sustaining medical treatment (LSMT), no attempt has been made to empirically assess their prevalence or the issues they address. An exploratory study utilizing a mail survey of a nationwide random sample (N = 905) of state trial court judges was conducted to provide initial information regarding this decision-making process. Twenty-two percent of the responding judges had heard at least one LSMT case, and judicial review did not appear endemic to particular states. The number of judges hearing LSMT cases dropped from 1975 to 1981 but has increased since then. Three major issues predominate: patient competency, appointment of a surrogate decisionmaker, and resolution of the ultimate issue of forgoing LSMT. Relatively few cases either contested a prior directive's validity or involved imposing sanctions for instituting or forgoing LSMT. Although subject to different interpretations, the results suggest the courts are having a significant impact on certain aspects of the LSMT decision-making process. However, the infrequency with which any one judge is called upon to make an LSMT decision causes concern about the judiciary's ability to respond in a timely and appropriate manner. With their potential for a profound effect on the actions of health care providers, greater attention to this decision-making process is warranted.     

A unique case of congenital bilateral absence of parietal bones in a neonate

The remains of an unidentified female neonate were discovered in a field in central Missouri. Examination revealed bilateral absence of the parietal bones. A search of the literature describing similar defects suggests that the present case represents a unique condition, described here for the first time.     

Sub-Constitutional Engineering: Negotiation, Content, and Legal Value of Interinstitutional Agreements in the EU

Abstract:  This article analyses the roles and impact of Interinstitutional Agreements (IIAs) in the EU, taking into account their relationship to primary law. Concretely speaking, these roles range from (a) explicitly authorised specifications of Treaty provisions via (b) not explicitly authorised specifications of vague Treaty law to (c) pure political undertaking. Based on the distinction between the constitutional and the operational level of the political game, we challenge the assumption that IIAs usually strengthen the European Parliament. As our case study, the 1993 interrelated package of IIAs on democracy, transparency and subsidiarity, illustrates, the European Parliament is not the only institution that benefits from IIAs, especially if they lack a sufficiently precise Treaty basis. Furthermore, if Treaty provisions underlying IIAs are precise, they also tend to produce precise and thus legally relevant content. Conversely, if IIAs deal primarily with elusive concepts they are likely to be legally ambiguous or even irrelevant at all.     

Has PPS increased Medicare expenditures on physicians?

We use data from 1983 and 1985 on the volume of Medicare physician services to analyze whether Medicare's Prospective Payment System (PPS), which resulted in a significant decline in hospital spending, led to a partially offsetting increase in real expenditures for physician services. We also analyze the effect of increases in assignment rates, increasing incomes of the elderly, and other factors on real expenditures during this period. Our main conclusion is that PPS has at most a small positive effect on real physician expenditures. Because people spent less time in the hospital, Medicare physician spending declined; but because of incentives to shift radiology and other services out of the hospital, some of this decline was offset. We also conclude that the sharp increase in Medicare assignment rates over this period, along with the rising incomes of the elderly during this period, contributed to the observed growth.     

R before D: the case of post conflict reintegration in Tajikistan1

Reintegration was prioritised over demobilisation and disarmament in Tajikistan's peace process. Inadequate disarmament rates were disregarded, but integration of opposition fighters into military and law enforcement units was relatively swift. This created high levels of trust among the former fighters and commanders. The quick provision of incentives, such as comprehensive amnesties and the offer of government positions and economic assets created stakes in the peace process for a number of actors. Transitional justice was largely overlooked. In this way, the case of Tajikistan runs counter to key elements of what has been termed the ‘post-conflict reconstruction orthodoxy’. At the same time, Tajikistan is a rare example of the emergence of post-war stability. This article provides a detailed account of the DDR process and outlines the incentives that it created for the warring parties. It also assesses the emergence of spoilers and the government's counter strategies. The article concludes by highlighting the consolidation of President Rakhmonov's power since 2001, but also raises some questions regarding the viability of Tajikistan's long-term political and economic development.     

"We Live in a Country of UNHCR"—Refugee Protests and Global Political Society

Between September and December 2005 over 3,000 Sudanese refugees held a sit-in demonstration at the Mustapha Mahmoud Square in Cairo, Egypt, which is located directly across from the offices of the United Nations High Commissioner for Refugees (UNHCR). We analyze the events of the refugee sit-in as an act of global political society, one that saw people outside the realm of the political making demands for recognition and a say in the solutions being developed to relieve their plight. We argue that the sit-in at Cairo was fundamentally a disagreement between the refugees and the UNHCR over the politics of protection, care, and mobility. The article analyzes the strategies through which the refugees named their "population of care" in ways that countered the UNHCR's governmental strategies to classify the Sudanese refugee population in Cairo. We propose the concept of "global political society" as a way of thinking about global political life from the perspective of those who are usually denied the status of political beings. Global political society is a highly ambiguous site where power relations are enacted, taken and retaken by various actors, but in ways that do not foreclose opportunities for refugees to actively reformulate the governmentalities of care and protection.     

Acidic and neutral drugs screen in blood with quantitation using microbore high-performance liquid chromatography–diode array detection and capillary gas chromatography–flame ionization detection

Blood previously acidified with aqueous saturated ammonium chloride solution was extracted with ethyl acetate. The dried extract was subjected to acetonitrile–hexane partition. The acetonitrile portion was analysed for the presence of acidic and neutral drugs by HPLC–DAD (200 mm×2.1 mm I.D. microbore ODS-Hypersil column) and GC–FID (25 m narrow-bore×0.25 mm I.D. HP-5 column with 0.33 μm film thickness). The protocol was found to be suitable for both clinical toxicology (including emergency toxicology) and postmortem toxicology. At least 66 drugs of interest were unequivocally identified by RRTs (HPLC) and UV spectra (DAD) match while another 12 were unequivocally identified by double RRTs match (HPLC and GC). Quantitation was facilitated by incorporating calibration blood standards in each assay batch. The five drugs most commonly encountered in clinical blood specimens (1150 cases) were: paracetamol (47.4% of the cases); chlormezanone (6.6%), theophylline (1.74%), naproxen (1.65%) and mefenamic acid (1.56%). The following drugs were detected in toxicologically significant quantities in postmortem blood specimens (245 cases): phenobarbitone (1.22% of the cases), naproxen (0.82%), chlormezanone (0.82%), theophylline (0.82%), carbamazepine (0.41%) and paracetamol (0.41%).     

Men and women's attributions of blame for domestic violence

Attributions of blame for the first and latest episodes of violence were assessed in a sample of 139 couples who were referred to a mandatory domestic violence treatment program in the military. Use of a methodology which allows for reports of nonmutually exclusive categories of attribution from both members of the dyad revealed more complex patterns of attributions than reflected in the existing literature. In addition, there were low rates of agreement within couples as to who was to blame for the violence. Although both men and women exhibited a high frequency of blaming their partner for both episodes of violence, men were significantly more likely to blame themselves for the latest than for the first episode. Attributions of blame were related to contextual variables in both men and women. Sex specific relationships emerged. These results were discussed with specific reference to predictions derived from attribution theory and their clinical implications.