Comments on the Comments

Abstract. The paper replies to Bix and Soper ( Bix 2007 ; Soper 2007 ). Bix's paper raises methodological questions, especially whether a form‐theorist merely needs to reflect on form from the arm‐chair so to speak. A variety of methods is called for, including conceptual analysis, study of usage, “education in the obvious,” general reflection on the nature of specific functional legal units, empirical research on their operation and effects, and still more. Further methodological remarks are made in response to Soper's paper. Soper suggests the possibility of substituting “form v. substance” of a unit as the central contrast here rather than form v. complementary material or other components of a unit. Various reasons are given here for not doing this. Among other things, it is also argued here that form does not, contrary to Soper's suggestion, always follow substance.     

A Desultory Defense of Democracy: OAS Resolution 1080 and the Inter-American Democratic Charter

This article evaluates the effectiveness of OAS mechanisms for safeguarding democracy through multilateral diplomacy, what some scholars have dubbed the interamerican defense of democracy regime. Drawing on a range of international relations theories, this study derives competing hypotheses about member states' responses to democratic crises in the Americas. It then analyzes all instances in which a collective response—that is, an application of Resolution 1080 or the Inter-American Democratic Charter—was debated in the OAS between 1991 and 2002. Patterns of state behavior suggest that domestic politics, rather than the structural or systemic traits of the interamerican system, best explain foreign policy responses to crises of democracy in the region. The OAS record in confronting such crises is uneven.     

Using the state to change society: The example of ‘domestic violence’

North American research on the policing of ‘domestic violence’ has been very influential among policy makers in Great Britain. In particular, research which purports to verify the deterrence value of arrest has prompted the establishment of over thirty domestic violence units in London and similar initiatives elsewhere in Britain. The paper will outline the nature of the traditional police response to ‘family violence’ in London and the nature of the experimental innovations. Changes in police practice with regard to this type of violence will be put in the context of the organizational constraints and possibilities of policing. Finally, changing police responses to domestic violence will be evaluated in terms of the debate over the possibility of using the state or its organs to achieve social change.     

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.     

Toxicological analysis of a fatal baclofen (Lioresal) ingestion

A fatality following ingestion of the drug baclofen (Lioresal) is described. Baclofen was identified in urine by gas chromatography/mass spectrometry. After derivatization with trinitrobenzene sulfonic acid, baclofen was quantitated in serum and urine by high-performance liquid chromatography. The concentration of baclofen was 17 mg/L in serum and 760 mg/L in urine collected approximately 12 h after the overdose. To our knowledge, this is only the second reported fatality involving a baclofen overdose. The previous case did not include quantitation of baclofen in any biological fluid.     

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.