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.     

Motivating Management: Corporate Compliance in Environmental Protection*

Based on interviews with facility managers in the electroplating and chemical industries, this study examines regulated firms’ perceptions of how various instrumental, normative, and social factors motivated their firms’ environmental actions. We found that “implicit general deterrence” (the overall effect of sustained inspection and enforcement activity) was far more important than either specific or general deterrence, and that deterrence in any form was of far greater concern to small and medium‐sized enterprises than it was to large ones. Most reputation‐sensitive firms in the environmentally sensitive chemical industry chose to go substantially beyond compliance for reasons that related to risk management and to the perceived need to protect their social license to operate. Almost half our respondents also provided normative explanations for why they complied. Overall, we conclude that there are various, often interwoven, strands that must be taken into account in understanding what motivates corporate environmental behavior, and how they play out depends very much on the size and sophistication of companies themselves and on the characteristics of the industry sector within which they are located.