Struggling through the web of impunity—The Jorge Carpio Nicolle case

Through the lens of Guatemala’s Jorge Carpio Nicolle case I analyze the mechanisms that preserve impunity in Latin American nations struggling to emerge from violent conflict and embrace, the rule of law. I reveal how the infective influence of parallel powers, the ineffectiveness of the judicial process, and obstructive legal doctrine destroy domestic efforts to prosecute those responsible for human rights violations. The Carpio case exposes the role of international courts in providing justice when domestic courts fail to do so, and it demonstrates the importance of human rights groups in pursuing this justice. The author would like to thank Roxanna Altholz, Adriana Beltran, and Soraya Long for their invaluable assitance in conducting this research.     

Competition, Productivity and the Cult of 'More is Good' in the Australian Health Care Sector

Economic policy discussions emphasise growth, the maximisation of output, efficiency and the pursuit of rational self-interest. Many policymakers, bureaucrats and managers in health care have been influenced by economists who believe that competition and the marketplace will provide maximum output and efficiency. Thus, for some, health care involves treating more and more patients for the same money. They argue for strategies such as reducing waste, lowering costs, increasing inpatient throughput and introducing competition between providers, especially hospitals, in order to stimulate productivity to achieve their aim. Yet in health care more is not necessarily good. Embracing the culture of the marketplace in a predominantly publicly funded system runs the risk of failing to distribute health care services equitably, and leads to more inappropriate and unnecessary care. An approach that merely strives to treat more patients and lower costs should be rejected in favour of a health system that values effectiveness, health outcomes, quality and the public good, and is patient-centred not delivery system-centred.     

Policy Regimes for the International Waste Trade

Among the unforeseen problems of the new industrial age has been the disposal of increasing quantities of wastes—many hazardous and toxic. Industrial chemistry has produced numerous products that, while useful, are alien to nature and resistant to biodegradation or detoxification. Growing public awareness of the possible hazards and risks involved in disposal of the residuals of industrial activities is arousing a popular demand for environmental protection. But this popular awareness depends upon public information and a degree of scientific literacy—conditions which vary widely among nations. Initial consequences are environmental regulations and restrictions respecting waste disposal in scientifically developed countries, and vulnerability among less developed countries to the export of hazardous wastes from the countries of their origin. A secondary consequence is the emergence of international waste trade as a national and international multidimensional policy problem.     

Family Representative Payeeship and Violence Risk in Severe Mental Illness

Although representative payeeship is prevalent among people with mental illness and shows promise to positively influence clinically relevant outcomes, research also suggests this legal mechanism could be implemented in ways that are problematic. The current study examined whether family representative payeeship was associated with elevated risk of family violence perpetrated by persons with severe mental illness (SMI). Data were collected every 4 months for 1 year in structured interviews with N = 245 persons with SMI who received disability benefits. Multivariate analyses showed that substance abuse, history of violence, frequency of family contact, and family representative payeeship were associated with elevated odds of family violence. Analyses also showed family contact and family representative payeeship had a cumulative effect on increasing the predicted probability of family violence (controlling for covariates such as violence history and substance abuse). The data shed light on the potential for family representative payeeship to be associated with increased risk of interpersonal conflict and violence in SMI.     

Sudden death due to asphyxia by esophageal polyp: two case reports and review of asphyxial deaths

Asphyxia, not an uncommon cause of sudden death, may result from numerous etiologies. Foreign-body aspiration and strangulation are 2 extrinsic causes. Airway obstruction may also be caused by laryngeal edema, asthma, infection, or anaphylaxis. Chronic causes of asphyxia include musculoskeletal diseases (eg, muscular dystrophy, amyotrophic lateral sclerosis), neurologic disorders (eg, myasthenia gravis, multiple sclerosis), respiratory disease (eg, emphysema, chronic bronchitis), or tumors. The manner of death in cases of asphyxiation may be natural, accidental, homicide, or suicide. For the death investigator, determining the cause and manner of death can often be quite challenging.We report here 2 cases of an esophageal fibrovascular polyp causing sudden asphyxial death, review of the literature, and discussion of other differential diagnoses in the case of asphyxial death.     

Review articles

Patrick Duncan: South African and Pan‐African by C. J. Driver Heinemann, London, 1980. xiv plus 326 pp. including illustrations, maps, notes, bibliography and indexes. £19,50.