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 note on the status of discretion in police research

“Discretion” holds an unrivaled position at the core of the notional inventory employed in the study of criminal justice generally and policing particularly. Efforts to systematically define the term have been irregular and its status in the empirical literature is an ambiguous one. While spoken of as a quantitative aspect of the policing which influences behavior, measurement is rarely addressed. After sketching problems in present formulations, discretion is recast in terms of perceived job autonomy and an outline of two general constructs is contributed in hopes of renewing consideration of the potential relevance of the concept for police theory and research.