Forensic psychiatry: a subspecialty. The presidential address at the nineteenth annual meeting of the American Academy of Psychiatry and the Law

The implications of the definition of forensic psychiatry are explored, with particular reference to the field as a subspecialty of general psychiatry. The allegation of undue moral uncertainty in forensic psychiatry is denied and the moral issues are revealed to be related to the status of the underlying philosophical disputes. An outline for the organization of the forensic psychiatric assessment is presented. The charge that forensic psychiatry is not as "hard" a science as the other forensic sciences is denied. The administrative and political organizational problems facing the subspecialty are explored. The practitioners in the field are encouraged to recognize that forensic psychiatry is a subspecialty and to work for official subspecialty status. Cautious predictions about the future of the field are provided.     

Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.     

Brief for 885 law professors in support of maintaining adherence to the Roe decision

This brief opposes the overturn of "Roe v. Wade" and resists weakening "Roe's central holding" that would allow states to overturn legal abortion. The brief was written for 885 law professors. "Roe" was not a "constitutional aberration," or "an exercise of raw, judicial power." Some members of the Supreme Court seem to think that the state has "an overriding interest" in protecting fetal life. Some Court members have questioned "Roe's" trimester framework. A person's decision to abort should be done privately. If women are not free to choose abortion, they will not have equality. There is an absence of "express rights of privacy and procreational freedom" in the Constitution. "Roe" was 1 instance of the Court's recognition of constitutional rights that are not named explicitly. Historical materials are drawn on to show the link between trends in society and the "judicial recognition of unenumerated rights." The most serious questions about "Roe" deal with its trimester framework. Justice Blackmun's majority opinion said that the 1st trimester of pregnancy was personal. "Roe" said that abortions created a medical risk at the beginning of the 2nd trimester. Therefore, the government was more interested in the health of the mother at that time. The state could then regulate abortion "in ways that are reasonable related to maternal health." The start of the 3rd trimester was when the fetus was viable. The right of a woman to end her pregnancy "offends powerful moral forces." Some of "Roe's" critics had their scientific facts wrong. Medical authorities think Justice O'Connor is mistaken when she says that "Roe" is "on a collision course with itself." The 23rd to 24th week of pregnancies where the fetal organs can "sustain life outside the womb." This has not changed since "Roe" was decided in 1973, nor is it likely to in the future. Some "amici" believe that the state can never have an interest in the fetus. The state can not have an interest in the fetus distinct from the woman who will give birth to it. During previability, restricting a woman's procreational rights would not be scientifically supportable. The state does have an interest in "upholding the value of human life." "Roe" is "within the mainstream" of constitutional jurisprudence and should be reaffirmed.     

Empathic emotions and justice in society

Empathy is defined as an affect more appropriate to another's situation than to one's own. The paper (i) summarizes different modes of empathic affect arousal; (ii) shows how empathic affect may interact with social-cognitive development, to produce four levels of empathy development; (iii) suggests that causal attributions may transform empathic affect into sympathy, guilt, and empathic anger, which are major moral affects; (iv) discusses how these affects may influence moral judgment and behavior; (v) points up empathic morality's limitations and the need to embed empathy in relevant moral principles; (vi) discusses possible links between empathy and justice principles, with special focus on Rawls; (vii) illustrates the interplay of empathy, moral judgment, and justice; and (viii) suggests that moral principles may become hot cognitions.     

Aednet: A single-discipline network in a multi-national setting

The computer-mediated network is a moderately expanding phenomenon. A major reason for this growth is the need for transferring technology to developing nations. But because many of these nations are not traditional users of advanced technology and because even the purveyors are not yet fully comfortable with the networks, the medium is not being used as much as perhaps it ought to be. In establishing a multinational network, one should be careful to treat all potential users with equity and not create an informational elite. Part of the challenge of such a system is making it accessible to operatives in the field. An effective way of introducing a network is to blend it with existing technologies, keep the costs down and the quality of information up, provide a usable information-retrieval system, and pay attention to microand macro-ergonomics. The Adult Education Network (AEDNET) of the Kellogg Project at Syracuse University has started working on a next-generation computer-mediated network system. It is proposed that AEDNET involve three action groups in the project: researchers, those interested in social implications, and users.     

Introduction

The Federal Republic of Germany celebrated its fortieth anniversaryin May 1989. In spite of the devastation brought by World WarII, the division of the country between East and West, and theloss of one-fourth of its territory, the Bonn Republic was foundedunder more propitious circumstances than was its democraticpredecessa after World War I, the Weimar Republic. Togetherwith an "economic miracle" that brought about economic growthand a high standard of living. West Germany experienced a "politicalmirracle" that led to governmental stability and a system asdemocratic as any other in Europe. Federalism has contributedto this miracle, and, in contrast to the nineteenth century,is now identified closely with democracy in Germany. The articlescontained in this volume provide a broad overview of postwarfederalism in Germany, from its origins, organization, strengths,and weaknesses, to interpretations and assessments of currenttrends and developments.     

Consulting critics: A new role for academic policy analysts

It is by now widely accepted that social science research has only an indirect and general impact on public policymaking. Academic social science research, it is often argued, is antithetical to policy research: the former is animated by traditional scientific canons while the latter is specific and problem-oriented. Moreover, modern bureaucracies are now understood as political environments within which pure research will be routinely ignored if it does not serve someone's interests. For these and other reasons, social scientists are being encouraged either to eschew policy research or not to expect much influence. This article provides an alternative model of social scientists in the policy process, as consulting critics reviewing, analyzing and commenting upon substantive policy research. This model holds benefits for both scholars and clients, turns the canons of scientific inquiry into assets instead of liabilities, and responds to some of the concerns recently raised in the literature concerning the role of social science in the policy process.     

A precise method for evaluating election schemes

A previously published paper evaluated election schemes under a wide variety of election circumstances. This paper improves upon the previous work by refining the measures used to rate the election schemes and increasing the statistical significance of those ratings. With these modifications, we can now draw some new conclusions:

1. In general circumstances, the Borda System outperforms the Copeland System which outperforms Approval which outperforms Majority Rule.
2. The Maximin Rule — strongly supported by Rawls's — turns out to be a reasonable election rule if the number of election alternatives is large relative to the number of voters.
3. With two exceptions, all our election systems performed quite well given a society with highly correlated utilities.
4. Given a polarized society, a serial dictatorship was better than every other election system except Borda.

Perhaps even more importantly, we now have the possibility of conducting some cost/benefit analyses of different proposals for electoral changes.