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Neonaticide: an appropriate application for therapeutic jurisprudence?

Might therapeutic jurisprudence, a perspective that attempts to study interaction between the legal and mental health disciplines, be brought to bear effectively with respect to neonaticide, the murder of a newborn infant in the first 24 hours of its life? This is a crime that leads to sentencing that is now rarely therapeutic, rehabilitative, or corrective. An examination of the crime, its motives, and its perpetrators precedes a discussion of ways in which the mental health viewpoint in this matter might be brought to the active attention of the courts in order to promote sentencing that is appropriate to both the crime and the transgressor.

Adolescent↗

Outpatient commitment: a therapeutic jurisprudence analysis.

This article analyzes the legal and therapeutic jurisprudence considerations raised by outpatient commitment. Although older forms of outpatient commitment have both legal and therapeutic advantages, preventive outpatient commitment raises serious legal problems and potential antitherapeutic consequences that may outweigh its claimed therapeutic value. As a result, alternatives are proposed, including wider availability of community treatment and outreach and case management services, assertive community treatment, police and mental health court diversion programs, and creative uses of advanced directive instruments and behavioral contracting. Proposals also are made for how preventive outpatient commitment can be applied more therapeutically, including hearings that accord patients a sense of procedural justice and techniques designed to motivate individuals facing such hearings to agree to accept treatment voluntarily.

Advance Directives↗

Therapeutic jurisprudence and outpatient commitment law: Kendra's Law and case study.

This article considers the implications of assisted outpatient commitment laws (OPC), with specific focus on New York's "Kendra's Law" through the lens of therapeutic jurisprudence (TJ). In this article, the author offers perspectives on the relationship between involuntary civil commitment, outpatient commitment, and the concept of the "least restrictive alternative"; considers pertinent empirical research, and looks at OPC's controversial relationship to forced drugging. Here, the civil libertarian critique is briefly considered, as well as the MacArthur Research Network research. Finally, the author looks closely at Kendra's Law, providing a brief overview of the law itself, and identifying some "pressure points" and pivotal issues, and considers the TJ implications of Kendra's Law, to determine how it "fits" into the public's "take" on all of mental disability law.

Civil Rights↗

Therapeutic jurisprudence: judicial and corrections panel.

Innovative therapeutic initiatives for the treatment of persons with substance abuse problems have been implemented in the criminal justice systems of California and Arizona. Judicial perspectives and reflections on these programs reveal the multiple issues inherent in innovation and day-to-day operations, from collaboration to implementation, including attitudinal shifts, resource allocation, client issues, and the changing role of judges who practice therapeutic jurisprudence. A pioneering program of treatment for dual disorders among male offenders addresses multiple issues in the provision of psychological services in a forensic setting in California.

Arizona↗

[Development of jurisprudence concerning the medical contract in esthetic surgery].

The authors report a study of 60 years of French Jurisprudence in relation to the medical contract in cosmetic surgery. Although the obligation can only be in the form of means in the case of surgery of living tissues, a special obligation nevertheless applies when the operation is not performed as a therapeutic procedure but at the patient's wishes. It is an obligation of caution and diligence, respecting the role of proportionality in the indications and the means applied to obtain the desired objective and the safety of the patient. The application of these means will be judged by the magistrate more severely than in therapeutic surgery. A certain degree of laxity in the investigation of a causal relationship in civil law has led to the use of the concept of decreased chance of survival for the compensation of victims of serious complications occurring during cosmetic surgical operations.

France↗

[The female breast as an object of liability complaints. Analysis of relative jurisprudence].

The authors analyse the incidence of medico-legal actions that can follow surgical and irradiation treatment of tumours in the female breast under French jurisprudence, which is now well established. Also involved are cosmetic surgery and all reconstructive procedures on the breast. Attention is drawn to errors that should be avoided in order to minimise the risks of being sued. There has been according to the files that have been inspected, a drop in legal actions for surgery of the breast for growths because radical surgery has become less frequent and less extensive. On the other hand there have been more complications from irradiation or from chemotherapy that has not been well controlled and where the risks had not been properly explained to the patients before treatment started. The article brings to attention how important it is to obtain informed consent about all details including very rare complications, particularly when the indication for the operation is cosmetic or for comfort and not in order to cure disease. Finally, the authors discuss the problem of cancer eventually developing in a tumour of the breast which appears after trauma received by the breast from seat-belt compression injuries. In spite of the unclear pathological causes so far discovered, there may be cause and effect between traumatism and a tumour discovered after an interval. It is suggested that immediately after the injury a careful examination of both breasts should be undertaken using mammography and ultrasound, including the anterior wall of the thorax, so that early diagnosis is made of possible signs suggesting that a tumour would be likely to develop. This should be done in spite of the presence of a haematoma in or around the breast.

Breast↗

The Model Physician-Assisted Suicide Act and the jurisprudence of death.

A Model Statute to Authorize and Regulate Physician-Assisted Suicide was published in 1996. This article describes the Act and some of its background and effects in detail, showing that it goes further than at first appears. Specifically, the article discusses the background and basic effect of the Act, the principal provisions of the Act and their effects, the morality and jurisprudence of the Act, the argument from autonomy, and the argument from utility. The authors conclude that by ignoring the moral traditions of Western culture, and focusing only on the ethics and anthropology of autonomy and utility, the drafters of the Act justify the dehumanization of the very people the Act is supposed to benefit.

Ethical Theory↗

Partial-birth abortion: the final frontier of abortion jurisprudence.

Partial-birth abortion bans patterned after the federal bill passed by both houses of Congress are constitutional. The clear legislative definition can be easily distinguished from other abortion procedures. Abortion precedents do not apply to such bans because the abortion right pertains to unborn human beings, not to those partially delivered. Such bans are also rationally-related to legitimate state interests. Even if abortion jurisprudence is deemed to apply in the partial-birth abortion context, a ban is still constitutional under Casey because a ban on partial-birth abortions does not impose an undue burden on the abortion right.

Abortion, Eugenic↗

Therapeutic jurisprudence: integrated inquiry and instrumental prescriptions.

This paper considers the manner in which one could apply a therapeutic jurisprudence (TJ) analysis to a controversial approach to the treatment of sex offenders. Rather than attempting to resolve the difficult questions regarding this form of intervention, however, this paper uses this issue as an opportunity to examine some theoretical concerns about the nature and limits of the TJ research program. As interpreted here, TJ consists of a program of scholarship and law reform intended to promote integration of conceptual, empirical, and normative inquiry. TJ does not in itself resolve normative issues, but it promotes integrated analysis that can sharpen our ability to articulate and examine those normative concerns. TJ remains normatively neutral at the levels of value and theoretical neutrality. Prescriptively, it cannot generate principled normative prescriptions, but it can generate instrumental prescriptions. The long-term measure of the TJ program rests upon its success in promoting innovative and integrated interdisciplinary scholarship and law reform.

Humans↗

Therapeutic jurisprudence and conflicts among values in mental health law.

Therapeutic Jurisprudence provides a conceptual framework for a research agenda designed to promote development of legal rules, procedures, and roles in a manner consistent with the therapeutic mission of the mental health system. As such, it draws attention to the tension between the jurisprudential values of autonomy and well-being that permeates mental health law specifically and the law and ethics of health care generally. This article advances an analysis of these values in the context of the patient-centered approach to health care. The article endorses a priority for the deontic aspect of autonomy over well-being but allows balancing of the consequentialist component of autonomy against well-being. Finally, it applies this framework to several traditionally difficult types of cases.

Ethics, Medical↗

A teen court evaluation with a therapeutic jurisprudence perspective.

Teen court defendants were assessed on several attitudinal measures when they entered and when they completed their teen court program. Teen court volunteers and high school civics students in a control group were assessed on the same measures at two points in time that approximated the length of teen court involvement for defendants. Re-offense rates for defendants were assessed. In addition, defendants and their parents completed satisfaction surveys. The teen court experience did not significantly impact the attitudes and beliefs of either the defendants or the volunteers. The re-offense rate for defendants was 13%, which is similar to other teen court programs and less than the re-offense rate for the general diversion program in the county that was the target of the study. Since this teen court selected youth with the least serious delinquency activity (primarily shoplifting), conclusions about the program's effectiveness in reducing further offending cannot be made. Defendants and their parents reported high levels of satisfaction with their teen court experience but defendants became more alienated from institutional authority. This study did not support the teen court experience as having a generally beneficial impact on defendants or volunteers that would be expected from a therapeutic jurisprudence perspective.

Adolescent↗

The Jehovah's Witnesses' refusal for blood transfusions: the jurisprudence and the medico-legal debate in Italy.

The Jehovah's Witnesses (JWs) patient's refusal of a lifesaving transfusion creates a conflict for the physician. In Italy, we are met with a great disparity of behaviour among physicians; the JW's eventual refusal for transfusional therapy often necessitates the physician's recourse to the court. Jurisprudence has thus arrived at an analysis of the juridical value of so-called advance directives. The analysis demonstrates a noteworthy argumentative coherence and reflects a specific doctrinaire development in transfusional therapy. In fact, in Italy most of medicolegal doctrine recognizes, in the JW's blood refusal, the physician's limited position whereby, it seems, he or she must submit legally to an expressed therapeutical dissent even when the patient is in a condition of incompetence and is no longer capable of expressing his or her refusal, or else must risk an indiscriminate violation of the patient's right to religious freedom and choice. According to the Constitutional Chart, the physician's duty to respect the JW's refusal of blood transfusions is absolute in order to avoid any treatment that is in conflict with the religious faith that each patient is free to profess.

Advance Directives↗

[Jurisprudent pharmacy as a new pharmacy--feedback from litigation to pharmacy].

Risk management in the medical field is said to be entering into the third generation. By definition, the first generation covers the period until some 10 years ago when medical errors themselves used to be regarded as inconceivable and therefore as something of a taboo. The second generation is a period in which those concerned with medical treatment grappled squarely with this issue of medical errors and compiled manuals of "near miss" cases in an effort to prevent errors. After that, such an idea has come into existence that even the deepest carefulness threatens errors that could develop into the disputes among those involved. The thought of this kind has resulted in the deepening of understanding of the importance of risk management. As a result, the point of view on this issue has been getting broader to cover not only prevention of errors but also prevention of disputes. This type is called third-generation risk management. In this sense jurisprudent pharmacy or legal pharmacy, which is a kind of pharmacy that constitutes medical pharmacy, is aimed at feeding back the lessons learned from litigations to pharmacy to improve and develop it as a practical science and contributing to the realization of "patient-centered medical science."

Adverse Drug Reaction Reporting Systems↗

Neurolaw: towards a new medical jurisprudence.

Traumatic brain injuries and spinal cord injuries occur in a variety of accidents which may become the subject of civil litigation. A new field of medical jurisprudence, called neurolaw, is emerging to join health-care professionals and attorneys in a common quest to employ legal remedies to enhance the quality of life for individuals with neurological injury and their families. Presented here is a review of the underpinnings of this developing area of inquiry.

Brain Injuries↗

Therapeutic jurisprudence and the civil rights of institutionalized mentally disabled persons: hopeless oxymoron or path to redemption?

This article examines, from a therapeutic jurisprudence (TJ) perspective, the rights of institutionalized mentally disabled persons to determine whether TJ is compatible with positions advancing civil rights and liberties, and whether lawyers for such individuals should look more closely to TJ as a source of rights. It concludes (a) that despite harsh criticisms of mental disability law reform, most of the important decisions in the areas of involuntary civil commitment, right to treatment, and right to refuse treatment law have a strong TJ component and (b) that TJ analyses may be the appropriate tool to reinvigorate this area of mental disability law.

Civil Rights↗

Using therapeutic jurisprudence and preventive law to examine disputants' best interests in mediating cases about physicians' practices: a guide for medical regulators.

Therapeutic jurisprudence (TJ) and preventive law (PL) are used as two theoretical perspectives from which to examine the best interests of parties in mediation because of a dispute about a physician's practice. The focus is mediation provided by and/or for the medical regulator. The paper reviews the literature on TJ and PL, and their relationship to mediation, and demonstrates how medical regulators could benefit by working within a framework reflecting both these perspectives providing it does not involve an egregious matter. A TJ and PL framework would be of particular value in identifying cases for mediation and in evaluating resolutions to mediated disputes.

Humans↗

Paths toward reclamation: therapeutic jurisprudence and the regulation of medical practitioners.

Much about what used to be termed "disciplinary" investigations and hearings is being revisited in the modern era. Therapeutic jurisprudence enables informed and sensitive awareness to potentially therapeutic and counter-therapeutic effects of both investigations and hearings conducted by medical regulatory authorities. This article analyses key aspects of authorities' processes from the perspective of notifiers/complainants and practitioners. Using developments at the Victorian Medical Practitioners Board as a base, it addresses issues of both investigative procedures and decision-making at formal and informal hearings, as well as the ramifications of re-hearings for the integrity of peer review informed regulation. It argues that where reclamation of practitioners is possible (namely where impropriety is not of the most serious order), there is much that is constructive about a focus upon enhancement of performance and competence levels, rather than the traditional preoccupation with whether registered status needs to be affected as a result of practitioner conduct.

Decision Making↗