Regulating medical futility: neither excessive patient's autonomy nor physician's paternalism

In the era of an aging population and escalating healthcare costs, the futility debate has become the object of extended critical attention. The issue has divided experts in relevant fields into two camps. The proponents of medical futility defend the physician's exclusive right to determine the futility of treatment and decide whether treatment should be withheld or withdrawn. On the other hand, opponents believe that a discourse of power lies at the heart of the futility debate. They believe that medical futility was constructed, in part, as a means of enhancing the physician's domination in a context wherein medical authority was threatened. This paper presents some current approaches to the futility debate and highlights positions taken by physicians and bioethicists. It concludes that establishing an operational guideline, either at hospital or national level, is a critical requirement for resolving problems posed by futility. It suggests that policies should not be based on either excessive patient's autonomy or physician's paternalism.     

“Delinquent Boys”: Toward a New Understanding of “Deviant” and Transgressive Behavior in Gay Men

Cultural criminology suggests that crime, deviance, and transgression are often subcultural in nature. For this reason, cultural criminologists often focus on the simultaneous forces of cultural inclusion and social exclusion when explaining criminal, deviant, or transgressive behaviors. This is a particularly useful bricolage for examining contemporary gay deviance and transgression—behaviors that are perhaps closely linked to (if not directly caused by) the past isolation, marginalization and/or oppression of homosexuals by Western heteronormative societies. It is also useful for understanding behaviors that are the result of marginalization and oppression from other sources, namely, the gay community itself. Using subcultural theories of deviance—such as those favored by cultural criminologists—this article explores a perspective that can be used for exploring certain forms of gay deviance and transgression. First, some of the more ostensible criminological theories that satisfy a prima facie criminological inquiry will be presented and critiqued: labeling and stigma, and resistance to heteronormativity. To these will be added a new and potentially productive way of thinking that takes into consideration rule-breaking as a form of resistance to homonormative norms, values and rules.     

Laws, Models, and Real People: Choice of Chapter in Personal Bankruptcy

It has been a central assumption in bankruptcy policy debates that financially troubled persons faced with bankruptcy will respond to economic incentives and disincentives. Two provisions of the Bankruptcy Code (Chapters 7 and 13) are most commonly used by individual debtors. Under Chapter 7 debtors agree to give up all their property (n excess of state-determined exemptions) to a trustee for sale and distribution to creditors. Under Chapter 13 debtors keep all their property but agree to pay all or part of their debts over three to five years. This empirical study of fifteen hundred consumers in three states explores whether economic incentives and disincentives are in fact the chief factors influencing choice of chapter. The analysis demonstrates that while economic factors play a part, noneconomic factors are also significant, among them intra- and interstate migration, marital status, self-employment, state of residence, and local legal culture. We conclude that to explore fully how individual decisions are made, the simplistic economic model must be replaced by a more sophisticated model that accounts for both economic and noneconomic factors.     

Photodegradation and laser desorption mass spectrometry for the characterization of dyes used in red pen inks

Photodegradation and laser desorption mass spectrometry (LDMS) is a powerful combination of methods capable of characterizing dyes found in pen inks. Rhodamine dyes in pens that contain red ink were analyzed directly from paper (no extraction step is necessary). Inks exposed to incandescent light form photodegradation products (compounds with lower molecular weights than that of the intact dye) and in some instances, photoproducts (compounds with higher molecular weights than that of the intact dye). The degradation products and photoproducts can be detected with LDMS, and the results can be used for dye identification. Advantages include: (1) the instrumental analysis takes less than a minute; (2) sample preparation is minimal; (3) LDMS is a minimally destructive technique; (4) incandescent light sources are inexpensive, safe to use, and readily available; and (5) isomeric dyes can be distinguished.     

Violence against women associated with arrests for sex trade but not drug charges

The current study was designed to examine associations between gender-based violence and arrests due to sex trade or drug-related charges among a statewide sample of incarcerated women in Rhode Island. Incarcerated women were asked to participate in brief pre- and posttest surveys of their experiences of violence, sexual risk and substance use behaviors, as part of a study on the effectiveness of a family planning program in a state correctional facility; data from pretest surveys (N=447) were used for current analyses. Logistic regression analyses adjusted for demographics were used to assess significant associations between gender-based violence variables (i.e., adolescent intimate partner violence (IPV), adult IPV, childhood sexual assault (SA), adolescent SA, and adult SA) and arrests due to sex trade or drug-related charges. Significant relationships were observed between arrests for sex trade and adult SA (OR=2.1, 95%CI=1.2-3.6), adolescent IPV (OR=2.5, 95%CI=1.5-4.1), and adult IPV (OR=1.7, 95%CI=1.1-2.6); no significant associations were observed for drug-related charges. Findings from the current study demonstrate that experiences of gender-based violence are associated with arrests for sex trade but not drug-related charges. Interventions for incarcerated women are needed to consider and address history of victimization from gender-based violence and its relation to women's historic and future sex trade involvement.