Withdrawal of life-sustaining treatment from a patient in a minimally conscious state

This column reports on a recent decision, the first in England in which a court was asked to authorise the withdrawal of artificial nutrition and hydration from a patient in a "minimally conscious state". Since the seminal decision in 1993 in Airedale NHS Trust v Bland [1993] AC 789, in which the House of Lords authorised withdrawal of artificial nutrition and hydration from a patient in a persistent vegetative state, the relatively new diagnosis of a "minimally conscious state" has been recognised. In deciding whether it was in the patient's best interests that artificial nutrition and hydration be withdrawn and withheld, the court made a key legal determination, with precedential effect, as to whether the so-called "balance sheet" approach to determining a patient's best interests, as opposed to the (discredited) "futility" principle, applies to a patient in a minimally conscious state. The merit of the former approach is that it forces explicit consideration of quality-of-life assessments in favour of and against withdrawing life-sustaining treatment. A significant pitfall of the English position, as it is currently developing, is the premium it places on accurate diagnosis, whether of vegetative state or minimally conscious state. These issues will have to be faced sooner or later by Australasian courts.     

Linking parental incarceration and family dynamics associated with intergenerational transmission: A life‐course perspective*

Children experiencing parental incarceration face numerous additional disadvantages, but researchers have often relied on these other co‐occurring factors primarily as controls. In this article, we focus on the intimate links between crime and incarceration, as well as on the broader family context within which parental incarceration often unfolds. Thus, parents’ drug use and criminal behavior that precedes and may follow incarceration periods may be ongoing stressors that directly affect child well‐being. We also use our analyses to foreground mechanisms associated with social learning theories, including observations and communications that increase the child's risk for criminal involvement and other problem outcomes. These related family experiences often channel the child's own developing network ties (peers, romantic partners) that then serve as proximal influences. We explore these processes by drawing on qualitative and quantitative data from a study of the lives of a sample of respondents followed from adolescence to young adulthood, as well as on records searches of parents’ incarceration histories. Through our analyses, we find evidence that 1) some effects attributed to parental incarceration likely connect to unmeasured features of the broader family context, and b) together parental incarceration and the broader climate often constitute a tightly coupled package of family‐related risks linked to intergenerational continuities in criminal behavior and other forms of social disadvantage.     

Notes Toward a Theory of Ideology in Historlcal Writing on Modern Afrlca

Since the publication of her first novel Le ventre de l’Atlantique (2003), Fatou Diome, a Senegalese author who immigrated to France in the 1990s, has been regularly invited to French cultural TV programmes, in which she often criticises European foreign policy, as well as social and racial segregation. Despite her public political commitment, in several interviews, Fatou Diome argues that literature should be dissociated from politics. This article analyses Diome’s narrative techniques when depicting current social issues in her second novel Kétala (2006). In Kétala, Diome shows how Senegalese gay people and women face social violence and exclusion. Drawing on queer theory and the concept of performance, this article describes the various strategies through which marginalised identities in Kétala contest heteronormative social representations. This paper argues that Fatou Diome’s novel captures the reality through a singular poetics.