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.     

Poppy seed ingestion as a contributing factor to opiate-positive urinalysis results: the Pacific perspective.

The possible contribution of poppy seed foods to positive opiate urinalysis results, especially from foods available in the Pacific Rim area, has recently become an issue for the U.S. Army Forensic Toxicology Drug Testing Laboratory in Hawaii. To assess the likelihood of this possible contribution, seven different poppy seed food products were consumed by male and female volunteers, and urine specimens were collected at time increments up to either 24 or 72 h. Specimens were evaluated for opiates using Roche Abuscreen radioimmunoassay (RIA), and all RIA positive specimens were analyzed for morphine and codeine using gas chromatography/mass spectrometry (GC-MS). Poppy seed cake, bagels, muffins, and rolls did not contain sufficient quantities of poppy seeds to give rise to opiate positive specimens by U.S. Department of Defense (DOD) GC-MS cutoff levels (morphine = 4000 ng/mL, codeine = 2000 ng/mL), although a number of specimens were positive by National Institute on Drug Abuse (NIDA) cutoff levels (morphine and codeine = 300 ng/mL). However, ingestion of poppy seed streusel or Danish pastry led to confirmed morphine and codeine positive specimens, irrespective of the use of DOD or NIDA confirmation cutoff values. In addition, significant amounts of codeine were observed in a number of these specimens. These findings argue against the unqualified application of previously published quantitative guidelines for eliminating poppy seed ingestion as a possible cause for a positive opiate urinalysis result.     

Sub-Constitutional Engineering: Negotiation, Content, and Legal Value of Interinstitutional Agreements in the EU

Abstract:  This article analyses the roles and impact of Interinstitutional Agreements (IIAs) in the EU, taking into account their relationship to primary law. Concretely speaking, these roles range from (a) explicitly authorised specifications of Treaty provisions via (b) not explicitly authorised specifications of vague Treaty law to (c) pure political undertaking. Based on the distinction between the constitutional and the operational level of the political game, we challenge the assumption that IIAs usually strengthen the European Parliament. As our case study, the 1993 interrelated package of IIAs on democracy, transparency and subsidiarity, illustrates, the European Parliament is not the only institution that benefits from IIAs, especially if they lack a sufficiently precise Treaty basis. Furthermore, if Treaty provisions underlying IIAs are precise, they also tend to produce precise and thus legally relevant content. Conversely, if IIAs deal primarily with elusive concepts they are likely to be legally ambiguous or even irrelevant at all.     

SCHOOLS AS COMMUNITIES: THE RELATIONSHIPS AMONG COMMUNAL SCHOOL ORGANIZATION,STUDENT BONDING,AND SCHOOL DISORDER*

Research has indicated that school factors such as communal school organization and student bonding are predictive of school disorder, with greater communal organization and greater student bonding leading to less delinquency and victimization. Data from a nationally representative sample of 254 public, nonalternative, secondary schools were used to examine structural equation models representing hypothesized relationships among communal school organization, student bonding, and school disorder. The hypothesis that communally organized schools would have less disorder held true for teacher victimization and student delinquency, but not for student victimization. In addition, the hypothesis that the relationship between communal school organization and school disorder would be mediated by student bonding was supported for student delinquency, but not for teacher victimization.