Petechiae of the baby's skin as differentiation symptom of infanticide versus SIDS

The successive killing of three siblings by their biological mother at two-year intervals is described. The children were 367 days, 75 days and 3 years old. Although sudden infant death syndrome (SIDS) or interstitial pneumonia could not be ruled out as the cause of death in the two younger children, who were killed first, the third child exhibited discrete signs of violence in the mouth and throat area which were interpreted as proof of infanticide. All three children had petechiae of the skin of the face and throat, the upper thorax, the shoulders and the mucous membranes of the mouth. None of the children exhibited signs of a disease-related hemorrhagic tendency. After the mother was convicted of murdering the three-year-old boy by smothering in combination with compression of the thorax, she confessed to having killed the other two children in a similar manner. In the absence of hemostatic disease, the presence of petechiae of the skin extending over the entire drainage area of the Vena cava superior can be regarded as evidence of an increase in pressure in the thoracic cavity secondary to obstruction of the airways with simultaneous chest compression.     

Autonomy, justice, and disability

In this Article, Professor Carlos A. Ball explores the philosophical foundations for the types of rights and benefits that our society currently provides to individuals with disabilities. The concept of autonomy places on society a moral obligation to assist individuals with disabilities when their basic human functional capabilities are impaired. The exercise of this obligation entails assisting individuals with crossing a minimum threshold of functional capabilities below which it is not possible to lead autonomous lives. In making this argument, Professor Ball responds to libertarian critics who contend that notions of freedom or liberty proscribe an activist role for government in this arena. He explains how even a libertarian state redistributes wealth in order to provide for some incapacities. Professor Ball also disputes the idea that the meeting of the needs of the disabled is enough to provide moral justification for the rights and benefits provided to individuals with disabilities. The problem with the concept of needs, Professor Ball argues, is that it fails to account sufficiently for the human good of personal autonomy.     

Oregon's guidelines for physician-assisted suicide: a legal and ethical analysis

Oregon's Death with Dignity Act was first passed by a ballot initiative in 1994, but numerous judicial challenges delayed implementation of the Act. In November of 1997, following the United States Supreme Court decisions in Vacco v. Quill and Washington v. Glucksberg, which left the states' power to regulate physician-assisted suicide undisturbed, the Oregon voters upheld their law. Oregon remains the only state in the nation to authorize physician-assisted suicide. The Task Force to Improve the Care of Terminally Ill Oregonians published a Guidebook for health care providers on the Oregon Act, and the New England Journal of Medicine recently issued a special report on the first year's experience under the Act. This paper analyzes the legal context of the Oregon Death with Dignity Act, discusses the efficacy of the tenets in the Guidebook, and explores ethical issues underlying the guidelines, particularly those pertaining to the meaning of a patient's request for assisted suicide and processes supporting informed consent.     

Advances in the diagnosis of wound vitality: a review

The diagnosis of the vital origin of wounds in many cases remains an unsolved problem for the forensic pathologist. Practical experience enables the expert to diagnose the vital or postmortem origin of wounds on the basis of macroscopic examination. In some cases, optic microscopy is used to confirm the diagnosis. In many other cases, additional more sensitive and specific markers of vitality are required. In the past 50 years, comprehensive research on this topic has resulted in a better understanding of the acute inflammatory reaction. The development and application of sensitive and specific markers through research in the areas of histochemistry, enzymology, and biochemistry has provided a partial solution to the problems involved in wound vitality diagnosis. A review of this challenging area of forensic pathology, including an explanation of these methods and markers, is presented in this paper.     

Sudden infant death, large intestinal volvulus, and a duplication cyst of the terminal ileum

A previously well 7-week-old boy was found unresponsive and cyanotic in his cot in the morning. Resuscitative attempts achieved only partial response with subsequent terminal cardiac arrest occurring later in the day. At autopsy a large intestinal volvulus was found associated with disseminated Clostridium perfringens sepsis. In addition, a duplication cyst of the terminal ileum was present. Although rare, right-sided colonic volvulus may be a cause of unexpected death in infancy. While predisposing factors to volvulus may include intestinal duplication cysts, the anatomic relation of the duplication to the volvulus must be carefully determined before a causal relation can be accepted; the cyst in this case was most likely incidental to the terminal event.