"Good and bad, I defined these terms, quite clear no doubt somehow": Neuroimaging and competency to be executed after Panetti

There has been little consideration, in either the caselaw or the scholarly literature, of the potential impact of neuroimaging on cases assessing whether a seriously mentally disabled death row defendant is competent to be executed. The Supreme Court's 2007 decision in Panetti v. Quarterman significantly expanded its jurisprudence by ruling that such a defendant had a constitutional right to make a showing that his mental illness "obstruct[ed] a rational understanding of the State's reason for his execution." This article considers the impact of neuroimaging testimony on post-Panetti competency determination hearings, and looks at multiple questions of admissibility of evidence, adequacy of counsel, availability of expert assistance, juror attitudes, trial tactics, and application of the Daubert doctrine, and also considers the implications of the lesser-known Panetti holding (that enhances the role of expert witnesses in all competency-to-be-executed inquiries). It warns that the power of the testimony in question has the capacity to inappropriately affect fact-finders in ways that may lead "to outcomes that are both factually and legally inaccurate and constitutionally flawed."     

Competency to be executed: A therapeutic jurisprudence perspective

This Article analyzes the concept of competency to be executed. It examines the Supreme Court's 1986 decision in Ford v. Wainwright, discussing both its Eighth Amendment and procedural due process determinations. It then considers the standard that should be applied in determining competency in this context and the procedures that the states should utilize to insure a fair determination consistent with due process. The article then considers the perplexing problem of whether an incompetent death row prisoner may assert a constitutional or statutory right to refuse treatment designed to restore him to competency for execution, examining both the constitutional and therapeutic implications of involuntary treatment in this context.     

Sham surgery: An ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken, and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

Left ventricular assist devices: An ethical analysis

United States statistics continue to indicate that the human donor heart pool does not and will not meet the great demand for hearts. For those patients unresponsive to maximal medical therapy (approximately 60,000 patients per year), cardiac transplantation is currently their best hope for increased survival. To address the need for additional end-stage congestive heart failure (CHF) therapy options, three medical device manufacturers have developed implantable left ventricular assist devices (LVAD) which act as a pump for hemodynamic support of the patient’s diseased heart. Although LVADs have been shown to improve patient disease state prior to organ transplantation. LVADs do nothing to increase the pool of human donor hearts, and they negatively impact the United Network for Organ Sharing (UNOS) waiting list by increasing the size of the waiting pool. This paper identifies and explores the ethical challenges presented by the use of LVADs as a bridging technology for heart transplant candidates. Although LVADs raise some ethical concerns, these concerns are outweighed by the proven medical efficacy of these devices. Thus, this technology should continue to be used and further developed. This paper was written by the author while in the Masters degree progrm at Loma Linda University (Dept. of Biomedical and Clinical Ethics), 11234 Anderson Street, Coleman Pavillion, Loma Linda, CA 92354, USA. The author is currently an Ethies Fellow (pre-doctoral) in UCLA’s program in Biomedical and Research Ethics.     

The physician and the pharmaceutical detail man: An ethical analysis

The relationship between the physician and the pharmaceutical detail man is discussed. Specific emphasis is given to an analysis of the ethical implications that this relationship has for patient care.     

Sham surgery: an ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

Toward the Development of Socio-Metacognitive Expertise: An Approach to Developing Collaborative Competence

We proposed and evaluated an instructional framework for increasing students' ability to understand and regulate collaborative interactions called Co-Regulated Collaborative Learning (CRCL). In this instantiation of CRCL, models of collaborative competence were articulated through a set of socio-metacognitive roles. Our population consisted of 28 students from one urban classroom taking part in an 11-week science unit. Our research questions focused on examining the extent to which students understood and used the roles as intended to regulate collaborative interactions to address group process problems. Mixed-methods analysis of collaborative work sessions determined that (a) students generally understood the language and purpose of the roles, (b) students frequently used and accepted the roles to monitor and regulate activity, and (c) students' ability to use the roles to monitor and regulate activity improved over time. This paper contributes to our understanding of socio-metacognition and trade-offs associated to its development in classroom settings.     

An ethical dilemma: Information control in cancer care

Cancer is a group of diseases that are complicated by various treatment choices available. Information exchange between a patient and physician is critical in helping people to understand what is happening to them and what options for therapy are recommended and available. When information is not exchanged, information control by one or both of the participants occurs. Information needs to be taken into account by both health care professional and patients in making decisions during the crucial phases of care. The phases of care presented are a diagnosis, treatment, the decision, and a recurrence. Factors that influence effective information exchange among patient-provider systems are discussed.     

Intellectual property and pharmaceutical drugs: an ethical analysis

The pharmaceutical industry has in recent years come under attack from an ethical point of view concerning its patents and the non-accessibility of life-saving drugs for many of the poor in both less developed countries and in the United States. The industry has replied with economic and legal justifications for its actions. The result has been a communication gap between the industry on the one hand and poor nations and American critics on the other. This paper attempts to present and evaluate the arguments on all sides and suggests a possible way out of the current impasse. It attempts to determine the ethical responsibility of the drug industry in making drugs available to the needy, while at the same time developing the parallel responsibilities of individuals, governments, and NGOs. It concludes with the suggestion that the industry develop an international code for its self-regulation.     

An analysis of the structure of justification of ethical decisions in medical intervention

The most important distinction in value theory is the subjective-objective distinction which determines the epistemological status of value judgments about medical intervention. Ethical decisions in medical intervention presuppose one of three structures of justification — namely, an inductive approach, a deductive approach which can be either consequentialist or non-consequentialist, and a uniquely ethical approach. Inductivism and deductivism have been discussed extensively in the literature and are only briefly described here. The uniquely ethical approach which presupposes value objectivism is analyzed in detail. This method involves a purely ethical inference which moves from facts to values directly with an emphasis on reason which involves a non-logical justification (as opposed to illogical). It involves the use of natural practical arguments which have an imperative conclusion but no imperative premise and exhibit a value-requiredness between two states of affairs.