The right to die: state courts lead where legislatures fear to tread

The right to die may be among the most legally complex and culturally sensitive areas of civil rights to emerge in our time. The thorny issues associated with a terminally ill individual's right to self-determination, and the disposition of individuals who are incompetent to make right to die decisions for themselves, promises to keep all parties involved - health care professionals, medical ethicists, families, lawyers, judges, and state legislators -busy for some time to come. To this point, the state courts have taken the lead in the right to die debate, while the state legislatures have tended to drag their collective feet. This article lays the case law groundwork for right to die decision making, then goes on to assay the legislative responses to the issue that have been rendered in the fifty states.     

Medicaid and access to child health care in Chicago.

In this article we examine how increasing the reimbursement of physicians and expanding Medicaid eligibility affect access to care for children in Cook County, Illinois, which overlies Chicago. Using Medicaid claims and other data at the zip-code level, we compare the places where Medicaid children live with the places where all the physicians who treat children and those who accept Medicaid patients have their practices. Our findings suggest that the recent changes in legislation are unlikely to benefit extremely poor children, who are more likely to live in depressed inner-city areas, where there are few physicians. "Near-poor" children whose homes are dispersed throughout the county, who are now eligible for Medicaid as a result of the recent changes, are likely to see improvements in their access to care. Further changes in policy, aimed at enhancing the capacity of institutions providing care, could improve access for the children of the inner city.     

The "mini-packer" syndrome. Fatal ingestion of drug containers in Baltimore, Maryland

We report seven fatalities resulting from the ingestion of illicit drugs packaged in condoms, rubber balloons, or plastic bags which were observed in the last 4 years at the Office of the Chief Medical Examiner, State of Maryland. All the victims, with the exception of one, were men ranging in age from 19 to 37 years. There was no racial predominance. No drug paraphernalia was found at any scene. In two cases, seizure-like activity was documented. One victim had recently returned from Nigeria; therefore, Lassa fever was initially suspected. Two of the victims were "body packer" contrabanders who had just arrived from Africa. They used body cavities to hide large amounts of heroin to avoid U.S. Customs. The other five cases were "mini-packers," small-time illicit drug dealers who had swallowed a single bag of cocaine to avoid police detection. The possible mechanism of leaking or rupture of the latex container is discussed.     

Sex determination with the head of the radius

Analysis of a sample of 1108 radii corresponding to 567 black and white North Americans in the Terry Collection at the Smithsonian Institution demonstrates that the diameter of the radial head is an accurate sex discriminator for human remains. A simple "radial-head method" of sex determination consists of measuring the maximum and minimum diameters of the head and comparing such measurements with the test cutoff points. The subject is female when the maximum radial head diameter (either left or right) is less than or equal to 21 mm, and male when the maximum diameter (either left or right) is greater than or equal to 24 mm. The same decisions apply to the minimum diameters of 20 mm or less and 23 mm or more, respectively. When the maximum diameter is 23 mm or the minimum is 22 mm, the subject is more likely male; when the maximum diameter is 22 mm or the minimum is 21 mm, the subject is more likely female. The sample frequency of any one of these latter diameters is never more than 16%. Cross-validation of the method with a sample of 50 pairs of radii of the Terry Collection, different from the original specimens, resulted in 92% sexing accuracy when using the left radius singly, 94% accuracy when using the right radius singly, and 96% accuracy when using both radii jointly.     

Identification of a red "fiber": chironomid larvae

During preliminary examination of the body of a homicide victim, a peculiar red "fiber" was noticed and recovered. Initially believing this to be a carpet fiber, the item was subjected to fiber analysis. It was found to be a short coiled particle not like any known natural or synthetic fabric fiber. Subsequent examinations determined this "fiber" to be the larva of a common freshwater midge (Diptera; Chironomidae). Chironomid larvae have been observed on other bodies recovered from freshwater environments. Entomological studies of this organism have led to the conclusion that the presence of chironomid larvae indicates submersion of the body.