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.     

Juvenile Criminality And Semi-Criminality: Learning From Victorian Perceptions And Responses

This article focuses on media reportage of offensive juveniles, past and present, to elicit lessons that the twenty-first century can learn from the Victorian past in terms of diversionary responses. How to prevent vulnerable juveniles sliding into dangerous criminality is a continuing preoccupation: the issue explored in this article relates to the creation of the identity of the criminal juvenile. In utilising the concept of semi-criminality to label certain types of juvenile anti-social behaviour the Victorians avoided actual criminalisation of socially offensive but, in legal terms, minor behaviours. The reasons for and negative consequences of the abandonment of this concept by the modern age are explored, including the reconceptualisation of where responsibility for juvenile offending lies in the modern era.     

Miscarriage of Justice? Postcolonial Reflections on the ‘Trial’ of the Maharajah of Baroda, 1875

This article revisits the Baroda Incident 1875, providing a detailed examination of the Enquiry or ‹trial’ for the first time, and locating that examination in the wider socio-cultural context of the nineteenth century British Empire (especially the Raj) and the exporting of the ‹British’/English legal culture to the Empire. The implications of the establishing of British principles of justice, including the value placed upon Indian-generated evidence and testimony by the courts, are explored, in order to establish the Baroda Incident as a significant miscarriage of justice. Using historical methodologies as well as postcolonial insights, it demonstrates that the concepts of justice on which the British prided themselves were intrinsincally racialised as well as gendered, with profound modern resonances. Dr. Judith Rowbotham is a Reader, School of Arts and Humanities, Nottingham Trent University.     

Competitive Liberalization,Competitive Imperialism,and Intellectual Property

Aggressive pursuit of free trade agreements (FTAs) and customs unions (CUs) by major and minor trading powers alike challenges the conventional wisdom in favor of such pursuit – competitive liberalization. An equally plausible explanation for an active bilateral and regional trade agreement policy, one which effectively de-emphasizes multilateralism, may be competitive imperialism. The protection and enforcement of intellectual property rights is one area in which new provisions, going beyond multilateral rules, are being negotiated and written into FTAs and CUs. Such provisions may yield insights into which characterization of bilateralism and regionalism – competitive liberalization or competitive imperialism – is more apt. Rice Distinguished Professor, The University of Kansas, School of Law, Green Hall, 1535 West 15th Street, Lawrence, KS 66045-7577, USA. Tel. +1-785-8649224. Fax. +1-785-8645054. www.law.ku.edu. J.D., Harvard (1989); M.Sc., Oxford (1986); M.Sc., London School of Economics (1985); A.B., Duke (1984). Marshall Scholar (1984-86). Member, Council on Foreign Relations, Royal Society for Asian Affairs, and Fellowship of Catholic Scholars. Author, Modern GATT Law (Sweet & Maxwell 2005), International Trade Law: Theory and Practice (2nd ed. 2000, 3rd ed. forthcoming 2007-08), and Trade, Development, and Social Justice (Carolina Academic Press 2003). I am thankful to my Research Assistant, Mr. David R. Jackson (B.A., George Mason University, 1992; J.D. Class of 2007, University of Kansas), for his indispensable help on this work. I also am grateful to Dr. Mohammed El Said, University of Central Lancashire (UCLAN), for his consistent support and friendship, and for what he has taught and continues to teach me about international trade and intellectual property.     

Has PPS increased Medicare expenditures on physicians?

We use data from 1983 and 1985 on the volume of Medicare physician services to analyze whether Medicare's Prospective Payment System (PPS), which resulted in a significant decline in hospital spending, led to a partially offsetting increase in real expenditures for physician services. We also analyze the effect of increases in assignment rates, increasing incomes of the elderly, and other factors on real expenditures during this period. Our main conclusion is that PPS has at most a small positive effect on real physician expenditures. Because people spent less time in the hospital, Medicare physician spending declined; but because of incentives to shift radiology and other services out of the hospital, some of this decline was offset. We also conclude that the sharp increase in Medicare assignment rates over this period, along with the rising incomes of the elderly during this period, contributed to the observed growth.     

R before D: the case of post conflict reintegration in Tajikistan1

Reintegration was prioritised over demobilisation and disarmament in Tajikistan's peace process. Inadequate disarmament rates were disregarded, but integration of opposition fighters into military and law enforcement units was relatively swift. This created high levels of trust among the former fighters and commanders. The quick provision of incentives, such as comprehensive amnesties and the offer of government positions and economic assets created stakes in the peace process for a number of actors. Transitional justice was largely overlooked. In this way, the case of Tajikistan runs counter to key elements of what has been termed the ‘post-conflict reconstruction orthodoxy’. At the same time, Tajikistan is a rare example of the emergence of post-war stability. This article provides a detailed account of the DDR process and outlines the incentives that it created for the warring parties. It also assesses the emergence of spoilers and the government's counter strategies. The article concludes by highlighting the consolidation of President Rakhmonov's power since 2001, but also raises some questions regarding the viability of Tajikistan's long-term political and economic development.     

Acidic and neutral drugs screen in blood with quantitation using microbore high-performance liquid chromatography–diode array detection and capillary gas chromatography–flame ionization detection

Blood previously acidified with aqueous saturated ammonium chloride solution was extracted with ethyl acetate. The dried extract was subjected to acetonitrile–hexane partition. The acetonitrile portion was analysed for the presence of acidic and neutral drugs by HPLC–DAD (200 mm×2.1 mm I.D. microbore ODS-Hypersil column) and GC–FID (25 m narrow-bore×0.25 mm I.D. HP-5 column with 0.33 μm film thickness). The protocol was found to be suitable for both clinical toxicology (including emergency toxicology) and postmortem toxicology. At least 66 drugs of interest were unequivocally identified by RRTs (HPLC) and UV spectra (DAD) match while another 12 were unequivocally identified by double RRTs match (HPLC and GC). Quantitation was facilitated by incorporating calibration blood standards in each assay batch. The five drugs most commonly encountered in clinical blood specimens (1150 cases) were: paracetamol (47.4% of the cases); chlormezanone (6.6%), theophylline (1.74%), naproxen (1.65%) and mefenamic acid (1.56%). The following drugs were detected in toxicologically significant quantities in postmortem blood specimens (245 cases): phenobarbitone (1.22% of the cases), naproxen (0.82%), chlormezanone (0.82%), theophylline (0.82%), carbamazepine (0.41%) and paracetamol (0.41%).