“A Dignified and Caring Mother:” 1 An Examination of Munchausen Syndrome by Proxy Case Law∗

Beginning with 1990, this article identifies and comments on fifteen years of legal case law across the five national common law jurisdictions of Australia, Canada, New Zealand, the United Kingdom and the United States, addressing legal responses to Munchausen Syndrome by Proxy (MSBP). MSBP is a syndrome in which perpetrators either harm a child in their care or achieve harm through their insistence on medical tests and treatments for non-existent, fabricated or exaggerated conditions. Abuse may go on for some time, and sometimes this abuse results in the child's death. The discussion situates this body of reported cases, identified through keyword searches in the LexisNexis databases, within current academic and professional literatures. Primarily, this review finds that the open-textured attributes of syndrome evidence, coupled with the idealisation of mothering and the concomitant social revulsion and retributive impulse towards “bad mothers”, invites professionals to infuse alleged cases of MSBP with morality, gender attributions, and social judgements. While identifying and preventing child abuse is an important goal, the questions of conscious knowledge and volition in a psychiatrically disordered perpetrator and the nexus of professional expertise in attributing liability and assigning punishment and treatment options deserve a more nuanced consideration.     

Psychological Maturity of At-Risk Juveniles,Young Adults and Adults: Implications for the Justice System

While the justice system assumes adulthood is reached by the age of 18 and given the increase in the number of juveniles being tried within adult court, it is imperative to understand whether young people are as criminally culpable for their actions as adults and where differences may lie in the maturity of young people and their adult counterparts. Psychological maturity was assessed in order to gain a better understanding of culpability and responsibility in at-risk young people, 18-year-olds and 25-year-olds to determine where psychosocial maturity levels and the propensity to make antisocial decisions differ and, if so, how. At-risk young people and 18-year-olds differed from 25-year-olds in psychological maturity levels, instigating implications for future research and the trial of young people as adults.     

Supported Decision-Making: A Rights-Based Disability Concept and its Implications for Mental Health Law

This article seeks to clarify the concept of supported decision-making and to consider its major implications for mental health law. It draws on the United Nations Convention on the Rights of Persons with Disability as well as the broader literature on supported decision-making in order to distinguish some of its conceptual features and to provide an overview of relevant debate. Emerging examples of supported decision-making in legislation, policy and programming are drawn upon to demonstrate the variety of measures that might constitute practical supported decision-making in the mental health context.     

Adverse drug and device reactions in the oral cavity: Surveillance and reporting

BackgroundAccording to the U.S. Centers for Disease Control and Prevention, 48 percent of Americans (roughly 144 million people) used at least one prescribed medication in the preceding month; 11 percent used five or more. The authors describe the U.S. Food and Drug Administration's (FDA's) MedWatch program, the safety surveillance system for drugs and devices in the United States, and the dentist's role with regard to voluntary reporting of adverse effects (AEs). They also identify the most frequent AEs in the oral cavity as reported in the FDA Adverse Event Reporting System (FAERS).MethodsThe authors reviewed the literature regarding MedWatch, and they mined data in the FAERS public database for the 100 most commonly prescribed medications and their associated AEs.ResultsPharyngitis was the most common AE. Cough, dysgeusia and dysphagia also were common.ConclusionThe MedWatch program and its related databases contain useful information about AEs of pharmaceuticals and devices manifested in the oral cavity. Increased participation in the reporting of suspected adverse reactions will improve the national surveillance system and ultimately will protect patients' safety.Practical ImplicationsAs pharmaceutical consumption increases exponentially for a growing segment of the population, and as innovation in dental technology and devices flourishes, dentists have a distinct role in safeguarding patients' well-being. Promptly reporting AEs in the oral cavity improves quality of care and protects patients' well-being.     

Identifying structural barriers to an effective HIV response: using the National Composite Policy Index data to evaluate the human rights,legal and policy environment

Introduction

Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses.

Methods

Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers.

Results

Seventy-eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV-related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV-related services deserve greater attention.

Conclusions

Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in national HIV responses.     

Faudra-t-il encore des juges ?

For some time now, the idea has emerged that the development of artificial intelligence and the forthcoming opening of judicial data will make it possible, based on the analysis of past decisions, to anticipate an upcoming judicial decision. The promoters of what is called predictive justice argue that by improving the predictability of case law, it will not only secure legal action, but also promote the use of alternative dispute resolution methods. While the imminent arrival of these tools is inevitable, it is neither without danger nor without limits.     

Optimization of filtering correctors for autopilot control laws with special structures

The paper is devoted to the problem of control law optimization for marine ships, which are steered by autopilots under the action of sea disturbances, mainly determined by bias terms and high‐frequency wave components. The essence of the problem is to find a transfer function of the adjustable corrective item (filter) for the autopilot with a special structure, minimizing the functional, which characterizes the intensity of a ship's rudders action. The correspondent dynamic of a closed‐loop system provides an economical regime of the ship motion, with the aim to reduce general fuel consumption and to prevent the wear of actuator elements. A specialized approach to the filter design is proposed based on the modern H_∞ optimization theory, and its applicability and effectiveness are illustrated by the practical example of autopilot synthesis for a transport ship. Copyright © 2015 John Wiley & Sons, Ltd.     

Financial Neutrality for Living Organ Donors: Reasoning,Rationale, Definitions,and Implementation Strategies

In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation‐related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out‐of‐pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD “financial neutrality,” offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation.     

Incentivizing Authorization for Deceased Organ Donation With Organ Allocation Priority: The First 5 Years

The allocation system of donor organs for transplantation may affect their scarcity. In 2008, Israel's Parliament passed the Organ Transplantation Law, which grants priority on waiting lists for transplants to candidates who are first‐degree relatives of deceased organ donors or who previously registered as organ donors themselves. Several public campaigns have advertised the existence of the law since November 2010. We evaluated the effect of the law using all deceased donation requests made in Israel during the period 1998–2015. We use logistic regression to compare the authorization rates of the donors’ next of kin in the periods before (1998–2010) and after (2011–2015) the public was made aware of the law. The authorization rate for donation in the period after awareness was substantially higher (55.1% vs. 45.0%, odds ratio [OR] 1.43, p = 0.0003) and reached an all‐time high rate of 60.2% in 2015. This increase was mainly due to an increase in the authorization rate of next of kin of unregistered donors (51.1% vs. 42.2%). We also found that the likelihood of next‐of‐kin authorization for donation was approximately twice as high when the deceased relative was a registered donor rather than unregistered (89.4% vs. 44.6%, OR 14.27, p < 0.0001). We concluded that the priority law is associated with an increased authorization rate for organ donation.