Dr. Jekyll's waiver of Mr. Hyde's right to refuse medical treatment: Washington's new law authorizing mental health care advance directives needs additional protection

Mental health care advance directives are gaining popularity nationwide. Following a growing trend, the Washington State Legislature has recently passed a law allowing patients to draft mental health care advance directives that could be irrevocable. Patients who sign an irrevocable directive essentially waive their fundamental right to refuse treatment in the future. The United States Supreme Court has held that waivers of fundamental rights must be made knowingly, voluntarily, and intelligently. However, as passed, Washington's new law contains insufficient safeguards to guarantee such a waiver. This Comment proposes that the Washington State Legislature amend this law the require two additional protections: a "rights advocate" to explain the potential waiver of rights, and a written warning in the advance directive form. These safeguards will help ensure that patients make knowing and intelligent waivers of their fundamental right to refuse treatment.     

Human bites and the risk of human immunodeficiency virus transmission.

The risk of human immunodeficiency virus (HIV) transmission following a bite injury is important to many groups of people. The first are those who are likely to be bitten as an occupational risk, such as police officers and institutional staff. Another group are represented by the victims and perpetrators of crimes involving biting, both in attack and defense situations. The possibility of these bites transmitting a potentially fatal disease is of interest to the physicians who treat such patients and the legal system which may have to deal with the repercussions of such a transmission. Bite injuries represent 1% of all emergency department admissions in the United States, and human bites are the third most common following those of dogs and cats. The worldwide epidemic of HIV and acquired immunodeficiency syndrome (AIDS) continues, with >5 million new cases last year and affecting 1 in 100 sexually active adults. A review of the literature concerning human bites, HIV and AIDS, HIV in saliva, and case examples was performed to examine the current opinion regarding the transmission of HIV via this route. A bite from an HIV-seropositive individual that breaks the skin or is associated with a previous injury carries a risk of infection for the bitten individual.     

Policy Entrepreneurs,Issue Experts,and Water Rights Policy Change in Colorado

Policy entrepreneurs can influence policy changes and decisions. These people invest their time, knowledge, and skills into promoting policies with which they agree. This paper investigates the influence that entrepreneurs had in the case of recreational water rights policy in Colorado to build a model of policy entrepreneurship. Almost 20 Colorado communities have constructed white‐water kayak courses to boost their local economies. In twelve of these communities, construction was followed by community pursuit of a new form of water right—the recreational in‐channel diversion. This case study is relevant to many areas of environmental policy and management where policies are transitioning from traditional consumptive uses of the resource to nonconsumptive uses. This policy change was not a given in Colorado communities, with recreational water rights requiring significant investments of community resources. These research findings conclude that policy entrepreneurs were influential to policy change, but the most important actors were expert entrepreneurs who hold expertise in water resource matters.     

Applying Large-Group Interaction Methods in the Planning and Implementation of Major Change Efforts

Public policy makers, planners, and managers are increasingly relying on what might be called large-group interaction methods to involve large numbers of people (from as few as eight to more than 2,000) in planning and implementing major change efforts. These methods are structured processes for engaging large numbers of people to: (1) enhance the amount of relevant information brought to bear on a problem; (2) build commitment to problem definitions and solutions; (3) fuse planning and implementation; and (4) shorten the amount of time needed to conceive and execute major policies, programs, services, or projects. Proponents of such methods claim that they provide sets of concepts, procedures, and tools that can help public and nonprofit organizations and communities deal effectively with change. On the other hand, a number of boundary conditions surround the successful use of the methods. The authors compare and contrast seven approaches most frequently used in the public sector in the United States and abroad (i.e., Real Time Strategic Change, Search Conferences, Future Searches, Strategic Options Development and Analysis, Strategic Choice, Technology of Participation, and Open Space Technology) to illustrate their comparative strengths and weaknesses and to develop an agenda for research.     

Risk and the National Industrial Recovery Act: An Empirical Evaluation

This paper examines the National Industrial Recovery Act of 1933 to see if the law helped “stabilize” the U.S. economy during the Great Depression. The test measures sample variances of the rates of return in stock price indices for six major U.S. industries as well as the overall stock market and compares those variances across five time periods. The statistics reveal that the NIRA did not reduce risks faced by these firms. Stocks for NIRA-regulated industries did not significantly decline in risk during the NIRA period, as compared with sample variance changes elsewhere during the Great Depression. The paper then interprets the results from a public choice point of view.     

GETTING THE POINT

Traditional Chinese medicine gains popularity in Zambia Anita Njobvu,who lives in Zambia’s capital Lusaka,was introduced to acupuncture therapy by her husband because her blood pressure was dangerously high.The treatment used to be rare on the African continent,but with growing awareness in countries like Zambia,an increasing number of patients are opting for the healing technique rather than conventional medicine.