The Supreme Court and abortion: 1. Upholding constitutional principles.
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The constitutionality of criminal prohibitions on physician-assisted death has become one of the most fascinating issues. The Supreme Court viewed a judicial injunction enforcing access to an abortion clinic as "content neutral" and not subject to heightened scrutiny under the First Amendment.
The plaintiffs in a law suit alleged that the heavy metal rock band Judas Priest, and its publisher CBS, were liable for damages to two youths who shot themselves after listening to the band's album. Crucial issues included "proximate cause" and "precipitating cause" in suicide, and the alleged role of subliminal messages. The judge ruled that although the "heavy metal" music might have had a toxic influence, the sounds and words are protected by the free speech first amendment. The influence of subliminal messages on behavior is unproven. There were many other elements in the personalities and situations of the victims to account for their self-destructive behavior.
Obscenity has been the subject of a series of court cases centered around the First Amendment, and its interpersonal effects have been studied by psychotherapists and communications theorists. But little has been written about the impact of the use of obscenity by patients in group settings to discharge their feelings and to dominate and harass staff and other patients. The authors argue that if staff are to be able to work effectively with patient populations who utilize obscenity routinely for these purposes, they must become more comfortable with its use, and to treat it as another symptom of the patients' interpersonal difficulties. Guidelines for the therapeutic use/management of obscenity on the ward are offered.
Firearms are a consumer product responsible for 38500 deaths in the United States in 1994. Like other products, firearms are advertised. In the absence of rules governing the design of firearms, regulating the way guns are advertised may be a useful public health intervention. Some gun advertisements include messages suggesting that bringing a handgun into the home is generally protective for the occupants of the home. The best available scientific information contradicts this message. Given this disjunction, regulating those advertisements may be an appropriate response. Under federal law, the Federal Trade Commission (FTC) has authority to prohibit advertisements that are "deceptive" or "unfair." Under the FTC's deception analysis, the focus is on whether consumers are misled by an advertisement. For a finding of unfairness, the FTC looks for advertisements that may cause substantial injury to consumers. Under either analysis, a strong argument can be made that firearm advertisements promising home protection are unlawful. On February 14, 1996, several organizations sent separate petitions to the FTC asking it to consider the issues raised by firearm advertisements that promise home protection. The FTC is still reviewing the information presented. There are no First Amendment or Second Amendment impediments to FTC regulation of deceptive firearm advertising under the US Constitution.
In the last decade, concerns about clergy counselors' liability for malpractice has focused on allegations of sexual abuse. Thus far, courts have not adjudicated a complaint of clergy malpractice. Their reasons have centered on concern for freedom of religion under the First Amendment. Therefore, there is a need to find another way to deal with the obvious reality that violating others' rights to satisfy one's own sexual appetites is not a valid expression of religious belief or practice. The authors, upon reviewing cases decided up to a few years ago, concluded that the complaint of breach of fiduciary duty provides a highly fitting way for courts to fairly assess complaints of sexual misconduct brought against clergy counselors. Now, the New Jersey Supreme Court has clearly recognized this complaint as an approach to the problem.
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In all, 134 elderly patients (median age 66 years, range 60-75 years) with newly diagnosed acute promyelocytic leukemia (APL) were enrolled in two successive protocols of the Italian multicenter group GIMEMA. All patients received an identical induction with all-trans retinoic acid and idarubicin; 116 (86%) entered complete remission (CR), two (2%) were resistant and 16 (12%) died during induction. After CR, 106 patients received further therapy whereas 10 did not, because of refusal (n=5) or toxicity (n=5). Consolidation consisted of three chemotherapy courses in the AIDA protocol (AIDA, 67 patients) or, since 1997, of an amended protocol including only the first cycle (amended AIDA, aAIDA, 39 patients). In the AIDA group, 43 patients (64%) completed consolidation, while seven (11%) and 17 (25%) patients were withdrawn after first and second courses, respectively; nine patients (13%) died in CR and 12 (18%) relapsed. In the aAIDA group, all patients received the assigned treatment; two patients (5%) died in CR and six (15%) relapsed. In the AIDA and aAIDA series, the 3-year overall and discase-free survival rates were 81 and 83% (P=NS), 73 and 72% (P=NS), respectively. We highlight here the frequency and severity of complications linked to intensive chemotherapy in this clinical setting and suggest that, in APL of the elderly, less intensive postremission therapy allows significant reduction of severe treatment-related toxicity and may be equally effective.
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The authors explore the difficulties present in the capacity evaluation of patients with strong religious beliefs. The article reviews the legal protection for treatment refusal on religious grounds as well as psychiatry's approach to religion. Clinical cases encountered in an urban hospital are presented to highlight how the conflicts among psychiatric, religious, and legal issues can be resolved. Suggestions are made for incorporating an exploration of religious values into the capacity assessment.
The major objective of this research was to find the appropriate mix ratio of organic amendments for enhancing diesel oil degradation during contaminated soil composting. Sewage sludge or compost was added as an amendment for supplementing organic matter for composting of contaminated soil. The ratios of contaminated soil to organic amendments were 1:0.1, 1:0.3, 1:0.5, and 1:1 as wet weight basis. Target contaminant of this research was diesel oil, which was spiked at 10,000 mg/kg sample on a dry weight basis. The degradation of diesel oil was significantly enhanced by the addition of these organic amendments relative to straight soil. Degradation rates of total petroleum hydrocarbons (TPH) and n-alkanes were the greatest at the ratio of 1:0.5 of contaminated soil to organic amendments on wet weight basis. Preferential degradation of n-alkanes over TPH was observed regardless of the kind and the amount of organic amendments. The first order degradation constant of n-alkanes was about twice TPH degradation constant. Normal alkanes could be divided in two groups (C10-C15 versus C16-C20) based on the first order kinetic constant. Volatilization loss of TPH was only about 2% of initial TPH. Normal alkanes lost by volatilization were mainly by the compounds of C10 to C16. High correlations (r=0.80-0.86) were found among TPH degradation rate, amount of CO2 evolved, and dehydrogenase activity.