The sick accused: forensic and emergency aspects in the courtroom

Evaluation of the fitness of an accused person to participate in legal proceedings is a classic forensic activity. Before the trial, the forensic expert will already assess any preexisting somatic and psychological illnesses and give a written expert opinion describing the condition of the accused at the time of the examination and assessing whether he is fit to stand trial. Nevertheless, decompensation or aggravation of a disease may occur--especially in stress situations as they are to be expected for an accused in the courtroom--so that apart from the current evaluation of the state of health of the accused, emergency treatment may occasionally become necessary in the courtroom. The article tries to answer the question how the expert can meet this challenge.     

Hearsay and Human Rights: Al‐Khawaja in the Grand Chamber

This note analyses the European Court of Human Rights' Grand Chamber judgment in Al‐Khawaja and Tahery v United Kingdom, and gives it a cautious welcome. The note suggests how English Courts might respond to the judgment and concludes by assessing justifications for strong confrontation rights and the wider political context of the Grand Chamber's decision.     

Codes of professional conduct for Australian Defence Force military physicians: evenomating the serpent?

The scandal of health professionals' involvement in recent human rights abuses in United States military detention centres has prompted concern that Australian military physicians should be well protected against similar pressures to participate in harsh interrogations. A framework of military health ethics has been proposed. Would a code of professional conduct be a partial solution? This article examines the utility of professional codes: can they transform unethical behaviour or are they only of value to those who already behave ethically? How should such codes be designed, what support mechanisms should be in place and how should complaints be managed? A key recommendation is that codes of professional conduct should be accompanied by publicly transparent procedures for the investigation of serious infractions and appropriate disciplinary action when proven. The training of military physicians should also aim to develop a sound understanding of both humanitarian and human rights law. At present, both civil and military education of physicians generally lacks any component of human rights law. The Australian Defence Force (ADF) seems well placed to add codes of professional conduct to its existing ethical framework because of strong support at the highest executive levels.     

Sudden death during prolonged religious fasting

Sickle cell trait (SCT) is estimated to occur in 6% to 10% of Africans, and the United Kingdom (UK) prevalence rate has been estimated at 3.2%. Although sudden death in sickle cell disease is well known, its occurrence in SCT is rare and requires extremes of physiological stress. We present a case of a 29-year-old black woman who died suddenly during a period of religious fasting. Her medical history was unremarkable, and there was no family history of sickle cell disease. At postmortem, she was found to be dehydrated, and macroscopically, the main abnormal findings were congested lungs and a small spleen. Histological examination revealed extensive vascular congestion with red blood cell sickling in both lungs, the liver, and the spleen. Electrophoresis on a postmortem blood sample confirmed the clinical suspicion that the patient was a carrier of SCT. The case highlights a novel scenario of SCT associated sudden death. We discuss the potential pathophysiological mechanisms that may have led to the patient's demise. We also remind pathologists to consider this diagnosis as potentially contributing to the cause of death in apparently fit young people of ethnic origin during episodes of physiological stress.     

The Public Governance of Collaborative Spaces: Discourse, Design and Democracy

This article investigates the relationship between democratic practices and the design of institutions operating in collaborative spaces, those policy and spatial domains where multiple public, private and non-profit actors join together to shape, make and implement public policy. Partnerships are organizational manifestations of institutional design for collaboration. They offer flexibility and stakeholder engagement, but are loosely coupled to representative democratic systems. A multi-method research strategy examines the impact of discourses of managerialism, consociationalism and participation on the design of partnerships in two UK localities. Analysing objective measures of democratic performance in partnerships and interpreting the discursive transition from earlier practices in representative democratic institutions we find that institutional designs for collaboration reflect different settlements between discourses, captured in the distinction between club, agency and polity-forming partnership types. The results show how the governance of collaborative spaces is mediated through a dominant set of discursively defined institutional practices.     

Governing beyond the Centre: A Critique of the Anglo-Governance School

One of the more intriguing theoretical discussions of recent years involves the concept of governance. There is now a substantial body of work concerning the way governance has affected the contribution of central government to the policy process. Possibly the most prominent and influential account of governance theory in British political science is offered by Rod Rhodes. His most recent writings have employed governance theory to explore the institutions, actors and processes of change within the core executive. His 'Anglo-governance' model has emerged as a prevalent and authoritative account of how new methods of governing have emerged in society. Significantly, it is maintained that a distinct shift has taken place in government, from a hierarchical organisation to a fragmented and decentralised entity that is heavily reliant on a range of complex and independent policy networks. There is undoubted evidence that government is a fractured institution that is dependent on state and non-state actors beyond the centre. This paper questions whether such features entail the emergence of a new form of governance. Central government is still highly resourced and has, at its disposal, a range of powers with which to retain influence over public sector agencies. Historical evidence also shows that the British polity has long been decentralised. Thus, it is difficult to see how recent developments have in any way transformed the capacities of the core executive. It seems that alternative ways of conceptualising the institutions, actors and processes of change in government are required. Recent efforts to develop 'organising perspectives', within the intellectual parameters of governance theory, offer a more 'conceptually cautious' treatment of the central state.     

Experience of a financial reforms project in Bangladesh

This article reviews the efforts of the Government of Bangladesh aimed at reforming the public sector financial management system as part of overall public administration reforms through a technical assistance project jointly sponsored by the government and the Department for International Development, Government of the UK. It has evolved through initial setbacks into a highly successful project delivering tangible outputs over the last three years, with prospects for future extension until reforms are internalized and become self‐sustaining. Attempts have been made in this article to analyse and evaluate the underlying reasons for the problems in the first year of implementation as well as the factors that contributed to the recovery of the image of the project and its continuing successes in successive phases. The article highlights the lessons learned from the project in its bad as well as good times and suggests that this experience can be of great value to those undergoing the same type of reform experiment. Copyright © 2000 John Wiley & Sons, Ltd.     

Regulatory inspection and the changing legitimacy of health and safety

The regulation of conduct via law is a key mechanism through which broader social meanings are negotiated and expressed. The use of regulatory tools to bring about desired outcomes reflects existing social and political understandings of institutional legitimacy, the meanings attached to regulation, and the values it seeks to advance. But these contextual understandings are not static, and their evolution poses challenges for regulators, particularly when they reflect political framing processes. This paper shows how inspection has been reshaped as a tool within the United Kingdom's health and safety system by changes in the meanings attached to the concept of “risk‐based regulation.” While rates of inspection have fallen dramatically in recent years, the nature and quality of inspection have also been fundamentally reshaped via an increasingly procedural and economically rational “risk‐based” policy context. This has had consequences for the transformative and symbolic value of inspection as a tool of regulatory practice.