The Ethical Health Lawyer: An Empirical Assessment of Moral Decision Making

Writing in 1999, legal ethics scholar Brad Wendel noted that "[v]ery little empirical work has been done on the moral decision making of lawyers." Indeed, since the mid-1990s, few empirical studies have attempted to explore how attorneys deliberate about ethical dilemmas they encounter in their practice. Moreover, while past research has explored some of the ethical issues confronting lawyers practicing in certain specific areas of practice, no published data exists probing the moral mind of health care lawyers. As signaled by the creation of a regular column "devoted to ethical issues arising in the practice of health law" in the Journal of Law, Medicine & Ethics , the time to address the empirical gap in the professional ethics literature is now. Accordingly, this article presents data collected from 120 health care lawyers. Presenting this population with a number of hypothetical scenarios relating to how they would respond when confronting an ethical dilemma without an obvious solution or when facing a situation in which their personal values were in tension with their professional obligations, this article represents a first step toward better understanding how lawyers who practice in health care settings understand and resolve the moral discomfort they encounter in their professional lives.     

Joining it up? Health and Wellbeing Boards in English Local Governance: Evidence from Clinical Commissioning Groups and Shadow Health and Wellbeing Boards

Statutory responsibility for health care and social care has long been separated between National Health Service (NHS) bodies and local government authorities. Repeated policy attempts to promote service integration through collaboration between such authorities have achieved little. The latest of such policy interventions are the Health and Wellbeing Boards (HWBs) established by the 2012 Health and Social Care Act (HSCA) alongside a range of other organisational innovations, including Clinical Commissioning Groups (CCGs). These organisations await full legal and operational status but have begun to develop structures and processes. HWBs are intended to lead the integrated assessment of local needs to inform both NHS health and local authority social care commissioners. We undertook detailed qualitative case studies in eight CCGs during 2011–2012 and here report observational and interview data related to CCGs’ perspectives and observations of early HWB developments. We found that developing HWBs vary greatly in their structure and approach, but we also identified a number of significant issues that are familiar from earlier research into health and social care integration. These include heavy dependence on voluntary agreements to align the strategic plans of the many different new statutory bodies; a significant role for mundane organisational processes in determining the extent of effective co-operation; and problems arising from factors such as size and the arrangements of local boundaries.     

Proactive Policing: a Summary of the Report of the National Academies of Sciences,Engineering, and Medicine

This paper provides a summary of our report for the National Academy of Sciences, Engineering, and Medicine on proactive policing. We find that there is sufficient scientific evidence to support the adoption of many proactive policing practices if the primary goal is to reduce crime, though the evidence base generally does not provide long-term or jurisdictional estimates. In turn, we conclude that crime prevention outcomes can often be obtained without producing negative community reactions. However, the most effective proactive policing strategies do not appear to have strong positive impacts on citizen perceptions of the police. At the same time, some community-based strategies have begun to show evidence of improving the relations between the police and public. We conclude that there are likely to be large racial disparities in the volume and nature of police–citizen encounters when police target high-risk people or high-risk places, as is common in many proactive policing programs. We could not conclude whether such disparities are due to statistical prediction, racial animus, implicit bias, or other causes.

     

Motive,Action, and Confusions in the Debate over Hate Crime Legislation

In this article I argue that the objections against hate crimes defined as separate offenses and in terms of group animus are misguided and are based upon a mistaken view of human action that does not see motives as constituent parts of complex actions. If we are going to have hate crimes legislation, there are no good formal reasons keeping us from having distinct offenses for hate crimes or from having ones defined in terms of group animus. My goal is to clear up a number of action-theoretical confusions that have led some theorists and jurists to raise objections that draw attention away from the real crux of the debate over hate crime legislation. Initially, I defend several considerations that weigh against an understanding of hate crimes legislation as being concerned exclusively or even primarily with character, belief, or motive. These considerations in turn help undercut the related concern that hate crime legislation violates free speech protections.     

A novel FTA™ elute card collection method that improves direct DNA amplification from bloodstained concrete

Concrete is a common construction material found in residential and commercial buildings, bridges and parking lots that is a composite matrix containing aggregate held together with cement. The porous nature of concrete can make the collection and genotyping of biological fluids, such as blood, challenging. Forensic evidence can become embedded within the matrix, potentially reducing the amount of DNA available for analysis. In forensic science, “direct” amplification refers to a genotyping method that amplifies a DNA profile directly from a sample without DNA extraction, saving time and money. We investigated a novel application of Whatman? FTA? Elute cards in their ability to directly amplify PowerPlex® Fusion and Y23 profiles from minute amounts of blood that had been deposited on different concrete structures. In comparison to traditional collection methods, directly profiling blood stained construction materials using FTA? Elute cards increased the percentage loci amplified and significantly improved both allele peak height and peak height ratio while reducing allelic drop-out. FTA? Elute cards can provide a reliable, inexpensive and superior alternative to traditional methods.     

A Perspective on Errors,Bias, and Interpretation in the Forensic Sciences and Direction for Continuing Advancement*

Abstract: The forensic sciences are under review more so than ever before. Such review is necessary and healthy and should be a continuous process. It identifies areas for improvement in quality practices and services. The issues surrounding error, i.e., measurement error, human error, contextual bias, and confirmatory bias, and interpretation are discussed. Infrastructure is already in place to support reliability. However, more definition and clarity of terms and interpretation would facilitate communication and understanding. Material improvement across the disciplines should be sought through national programs in education and training, focused on science, the scientific method, statistics, and ethics. To provide direction for advancing the forensic sciences a list of recommendations ranging from further documentation to new research and validation to education and to accreditation is provided for consideration. The list is a starting point for discussion that could foster further thought and input in developing an overarching strategic plan for enhancing the forensic sciences.     

Examining the Incidence of and Time to Recidivism Within the Risk Contingency Framework: A 20-Year Follow up Study

This study examined the extent to which the contingencies risk framework (consisting of dispositional, historical, contextual, and clinical domains) predicted detected recidivism (i.e., arrest or conviction). Secondary data were extracted on 413 prisoners who underwent a psychiatric evaluation, were assessed on the risk domains, and followed up over 20 years. There were 273 (66.1%) cases of recidivism for serious offenses (e.g., assaults). Criminal career outcomes examined included: years to and the incidence of recidivism. Statistics showed that chance classification of the incidence of recidivism was 21% more accurate for the recursive partitioning than the bilinear model. These results are consistent with the contingencies risk framework, support its use over linear models, and highlight its predictive utility.     

Correlativity

In a celebrated article, published nearly a century ago, Wesley Newcomb Hohfeld endeavored to elucidate the various types of jural relations. Hohfeld’s scheme has been justly regarded as a seminal contribution to analytical jurisprudence, and has stimulated lively debate since. This Essay aims to refute one of Hohfeld’s fundamental and most influential theses: the axiom of right–duty correlativity. To do so, it employs the simplest refutation strategy in first-order logic, namely providing a valid counterexample. Part I discusses earlier attempts to do likewise, and explains why they failed. For the most part, previous illustrations of ostensibly standalone rights or standalone duties neglected relevant parties who could owe the correlative duties or hold the correlative rights, respectively. Part II puts forward a simple argument: There are abstract duties in private law that ban certain types of conduct without reference to specific victims. Those duties are not necessarily correlative with rights, although their breach may generate secondary duties with corresponding rights. In particular, tort law allows plaintiffs to recover for harm caused by breach of duty that occurred before they acquired legal personality. This is tantamount to recognizing duties that are not correlative with rights, and therefore invalidates the correlativity axiom.     

A new psychometric instrument assessing vulnerability to risk of suicide and self-harm behaviour in offenders: Suicide Concerns for Offenders in Prison Environment (SCOPE)

This study aimed to develop a new psychometric instrument to assess vulnerability to risk of suicide and nonfatal self-harm behaviour in young adult male and female offenders. In total three studies were conducted to assess the psychometric properties of the new instrument using both exploratory and confirmatory factor analysis in different samples. Participants in all three studies included a total of 1,166 young adult offenders across six Her Majesty's Prisons. The new instrument, Suicide Concerns for Offenders in Prison Environment (SCOPE), contained 28 items scoring on two subscales. The factorial structure of the new instrument initially obtained with exploratory factor analysis was subsequently confirmed in a new sample. The internal consistency of the two subscales were acceptable but the test-retest reliability coefficients were moderate. Concurrent validation with the Beck Hopelessness Scale was acceptable and SCOPE showed the ability to discriminate between those at risk and those with no known history of attempted suicide and nonfatal self-harm behaviour ( p < 0.01).     

Exposure to Intimate Partner Violence Amongst Women of Reproductive Age in Lagos,Nigeria: Prevalence and Predictors

Research on predictors of Intimate Partner Violence (IPV) in Sub-Saharan Africa is contradictory, necessitating further investigation. This study sought the prevalence and predictors of IPV among women in Lagos, Nigeria. Questionnaire data from 934 women visiting an obstetrics and gynecology clinic in Lagos were analyzed using multivariable methods. The 1 year prevalence of IPV was 29%, with significant proportions reporting psychological (23%), physical (9%) and sexual (8%) abuse. In-access to information, women’s autonomy and contribution to household expenses independently predicted IPV. The findings provide new incites for IPV prevention in Lagos with implications for further research.