Toleration without Liberal Foundations

The author's aim is to find principles grounding and limiting toleration that are sufficiently sensitive to the variety of distinct settings in which concrete problems arise, and to produce principles which can appeal both to liberals and to non-liberals. The range of settings is covered by fixing the nature of three distinct species of the genus right to toleration. Once these rights are analysed, an attempt is made to see what agreement about them can be reached by liberals and non-liberals if they have a common commitment to democracy. A definition of democracy is produced that, it is argued, liberals and non-liberals would have difficulty rejecting. It is then explored as a definition that has definite consequences over the three rights to toleration, putting the opponents before a choice: either to accept their preferred content for the right to toleration, or to support a democratic policy.     

A potentially catastrophic outcome from a false-positive urinary drug screen immunoassay

Background: Urinary drug screens are routinely administered for patients returning from leave from forensic psychiatric wards, and are required to be negative for patients to continue to use their allocated leave. Case: A 35-year-old woman took leave from her low-secure psychiatric unit. On return, her urine screened positively for 3,4-Methylenedioxymethamphetamine (MDMA). She strongly denied she had taken it; however, all her leave was cancelled. Her clinical state greatly deteriorated, and she attempted to hang herself the following day. After stabilisation of the patient and continued denial of taking MDMA, the urine was sent for toxicology analysis. In the weeks that followed, she started self-harming and deteriorated to the point of needing electroconvulsive therapy. The toxicological report came back as a false-positive due to recently started Mebeverine. Conclusion: Clinicians must be mindful that urinary drug screens are not diagnostic, but also that not being believed can be devastating, especially for long-stay forensic inpatients.