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Abortion and America's ethical consciousness.

America's practice of abortion is not merely a matter of medical technology but of a changing ethical consciousness. The continuing dispute over legalized abortion since the 1973 Supreme Court decision in Roe v. Wade is a conflict between two historically different ethical views of human life. This survey shows the nature and history of this conflict and its implications for America's future.

Abortion, Legal↗

[A statistical study of autopsy cases in the department of legal medicine, Hokkaido University School of Medicine, during the last 10 years (author's transl)].

The mediocolegal autopsies performed in the Department of Legal Medicine, Hokkaido University School of Medicine, during the 10-year period, 1965-1974 were 617 cases, 87 of them in newborns, 530 in infants and adults. Of cases autopsied as homicidal or suspicious deaths in infants and adults, 88.5% were recognized to be due to external causes, 9.1% to disease conditions and 2.5% undetermined. Of neonatal deaths, 10.3% were stillbirth, 78.2% live birth and 11.5% undetermined. Among the deaths due to external causes in infants and adults, 43.3% were homicidal, 7.2% suicidal, 32.6% accidental and 16.6% undetermined. Of external factors causing death, 42.9% were force, 36.8% asphyxiaton, 8.0% chemical substances and 8.0% heat. The causes of homicidal deaths inflicted with cutting or piercing instruments were circulatory disturbance, asphyxia and infection. In deaths inflicted with blunt instruments, they were mostly injuries of central nervous system and circulatory disturbance in the minority. All categories of causes of death were recognized in accidental deaths. All neonatal deaths were due to external causes. Their causes of death were mostly asphyxia and blunt force injuries of head.

Adolescent↗

Neonaticide in the city of Rio de Janeiro: forensic and psycholegal perspectives.

This is a retrospective study of mothers charged with killing their children within 24 h of birth in the city of Rio de Janeiro, Brazil. Characteristics of the mothers and the victims, the circumstances surrounding the offense, the mothers' motivation and state of mind at the time of the offense, the legal process, and follow-up data were investigated. We analyzed our cohort as two sub-groups: 26 offenses that occurred between 1900 and 1939 and were dealt with under the Brazilian Penal Code of 1890, and 27 offenses that were committed between 1940 and 1995 and were dealt with under the Penal Code of 1940. The mothers were young (mean 22.5 +/- 5.3 years), unmarried (88.2%), non-Caucasian (73.8%), and had limited formal education. They usually kept the pregnancy a secret (94.1%) and gave birth in a classified way (100%). Most victims were killed through wounding violence (77.4%). Offenders identified between the years of 1940-1995 had increased rates of literacy (chi 2 = 6.80, d.f. = 1, p = .009), a higher incidence of reported psychiatric symptoms (chi 2 = 11.82, d.f. = 1, p < .001), increased referral for psychiatric assessment (chi 2 = 3.85, d.f. = 1, p = .05), and greater frequency of cases where statute of limitations was expired (chi 2 = 3.88, d.f. = 1, p = .049).

Adolescent↗

[Fatal child neglect in East Germany 1 January 1985 to 2 October 1990. Results of a multicenter study].

UNLABELLED: No reliable data are available on cases of lethal child neglect in the area of the former German Democratic Republic. In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in the entire area of the former German Democratic Republic. RESULTS: A total of 9 cases were reported to the study center. This does not include undetected cases, whose number, though indeterminate, is probably small due to the general obligation to perform autopsies on all children dying before their 16 birthday. Just over half of all victims were less than one year old, the oldest was 3 1/2 years old. Starvation and severe dehydration were by far the most common causes of death; in half of cases these occurred in combination with hypothermia. Most often mother killed their children by neglect, either alone or together with the victim's father. In the majority of cases no close bond existed between the parents and the child. Seventy percent of the perpetrators were chronic alcoholics. All 10 of the perpetrators were sentenced to imprisonment for periods ranging from one year to life long. Mitigating circumstances were presented at the sentencing phase of the trial on behalf of 20% of those convicted. The experience of legal medical and pathological institutes in the former German Democratic Republic underscores the need to perform an autopsy on all deceased infants and young children. Only this can ensure that no cases of lethal child neglect are overlooked.

Cause of Death↗

[Child's sudden death in 20th century--hypothesis, dogmas, dead wood].

With the decline of the former main causes of death in early childhood--infections and starvation--sudden infant death syndrome (SIDS) has emerged as the most important single cause of postneonatal infant mortality. It has adopted the role of a major indicator for the standard of public health care. Despite extensive input into research, its pathophysiology has remained rather obscure. The resulting helplessness of scientists and health care professionals have lead to adherence to unconfirmed pathophysiological hypotheses and to pursuit of preventive strategies of doubtful efficacy. In this overview, the medical and technical background of five major hypotheses is being presented. A lot can be learnt from the history of their development, efforts to refute them, and the reasons for unreflected adherence to them. (1) Due to its illustrative nature, the so-called 'status thymico-lymphaticus', the theory of asphixation by an enlarged thymus, could not be eradicated although well-reknowned physicians--including the Austrian pathologist Paltauf--have repeatedly attempted to do so. (2) Assumed familiarity, an aspect which attracted the attention of pediatricians to SIDS initially has been excluded, but an increased risk of SIDS for the siblings of affected babies is still common belief. (3) The sleep-apnea-hypothesis has turned out a complete error with serious consequences, but home apnea monitors are still being widely recommended. (4) The rise of SIDS in the 80ies and its subsequent decline in the 90ies has been interpreted as the advent and successful control of an epidemic although significant numbers of cot death have been reported long before the turn of the century, and the apparent increase which paralleled the introduction of the 9th edition of the ICD code is most likely due to improved registration. (5) Finally, SIDS is still being considered a random event--ignoring all evidence of an obvious role of socioeconomical factors.

Austria↗

Denial of pregnancy: a case study and literature review.

A case is presented of a young active duty woman who experienced nonpsychotic denial of pregnancy until she precipitously delivered a healthy full-term infant. Despite the lack of prenatal care and the requirement for neonatal resuscitation, the child has apparently developed normally. The woman had no ongoing psychiatric illness. She was able to make appropriate use of medical, nursing, and social work resources to function well with her child at home. The recent literature on denial of pregnancy is reviewed, and the clinical differences between nonpsychotic and psychotic denial of pregnancy are described. Clinical management and mobilization of social support structures can improve the chances of successful clinical outcomes in nonpsychotic denial of pregnancy.

Adult↗

[Discovery of externally unremarkable case of homicide of an infant].

The court-ordered autopsy of an infant who had died 26 days after delivery unexpectedly revealed a fatal head injury. As external inspection of the body had not shown any traces of violence sudden infant death had at first been assumed. At autopsy a linear fracture of the skull and a subdural haematoma was found. Subsequent investigations showed that the father had thrown the baby into the air while playing with it, that he had failed to catch it and that it had fallen downwards heavily hitting the wooden armrest of a couch with the parietal region. As an example of a manslaughter without any external signs of trauma the case illustrates the importance of forensic autopsies in all cases of unexpected death.

Brain↗

A libertarian critique of H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics.

CONCLUSION: Although Engelhardt's The Foundations of Bioethics is an impressive work, it is plagued by problems of justification, conceptual confusion, and inconsistencies....A libertarian theory can arrive at the same basic requirements of mutual respect, autonomy, nonuse of force, and tolerance for a wide range of diverse life styles without relying on a lowest-common-denominator principle and without depriving fetuses, infants, and the mentally retarded of their status as persons. This can be done by taking a deontological approach to libertarian theory that denies that all moral beliefs are worthy of respect. Some beliefs, such as Engelhardt's belief that fetuses, infants, and the mentally retarded are nonpersons, simply fall beneath the floor of acceptable moral alternatives, even in a libertarian society, because such beliefs are based on a misunderstanding of personhood and violate the principle of mutual respect.

Abortion, Induced↗