Causes of death of patients in an institution for the developmentally disabled

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.     

The paradoxical politics of provider reempowerment

The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.     

Constraints in the police use of force: Implications of the just war tradition

The “just war” philosophy of Cicero, St. Augustine, and St. Thomas Aquinas has had momentous and provocative implications for modern political theory. The use of force by police is one theme through which the just war tradition can be utilized to demonstrate the extent of infusion for the concept in the Western political archetype. As police become constrained in their use of force, they are bound by the concepts inherent in the philosophy of the just war doctrine. The Supreme Court, likewise, has been influenced by the philosophy of the just war tradition in many of its decisions regarding the proper use of force by police.     

Commons ignorance: the failure of environmental law to produce needed information on health and the environment

One of the most significant problems facing environmental law is the dearth of scientific information available to assess the impact of industrial activities on public health and the environment. After documenting the significant gaps in existing information, this Article argues that existing laws both exacerbate and perpetuate this problem. By failing to require actors to assess the potential harm from their activities, and by penalizing them with additional regulation when they do, existing laws fail to counteract actors' natural inclination to remain silent about the harms that they might be causing. Both theory and practice confirm that when the stakes are high, actors not only will resist producing potentially incriminating information but will invest in discrediting public research that suggests their activities are harmful. The Article concludes with specific recommendations about how these perverse incentives for ignorance can be reversed.     

The significance of pulmonary interstitial emphysema in live birth determination

The utility of pulmonary interstitial emphysema (PIE) in live birth determination is not well established. Because the distinction between live birth and stillbirth may be important in criminal proceedings, we undertook this study to investigate the relationship between the histologic finding of PIE and live birth. Sixty-six cases of infant death were retrieved and compared with 21 stillborn infants. Histologic sections of the lungs were characterized as "florid PIE," "equivocal PIE," or "absent PIE." Sixteen cases of florid PIE were identified, all in live born infants. Forty-seven cases of equivocal PIE were found in 36 live born and 11 stillborn infants. In 24 cases (14 live born infants and 10 stillborns), no PIE was identified. We examined the relationship between florid PIE in infants with sudden infant death syndrome (SIDS) or "sudden unexpected death in infancy, manner undetermined" (SUDI), and also its relationship to other variables. No association was found. The presence of equivocal PIE may be an artifact of tissue processing. Florid PIE is found only in live born infants. No correlation between the presence of florid PIE and cause of death could be determined.