The Federal Consistency Requirements Of The Coastal Zone Management Act Of 1972: It\u27s Time To Repeal This Fundamentally Flawed Legislation

The Coastal Zone Management Act of 1972 (CZMA) was one of many laws enacted during the environmental decade spanning the late 1960s to the mid 1970s designed to bring a national focus on the protection and management of natural resources. In the case of the CZMA, the entire coastal zone of the United States, territories, and other island holdings was deemed worthy of this national interest. The CZMA was unlike the other environmental laws in two major respects: it relied on the voluntary program implementation by the coastal states, and it did not establish mandatory standards for compliance. Instead, the CZMA sought to encourage state participation through federal financial grants and the creation of a new federal consistency doctrine. The federal consistency doctrine generally requires federal agencies, applicants for federal permits, and applicants for federal project funds to be consistent with approved state management programs for activities affecting the coastal zone. Thus, a state may stall, or even stop, a federal agency activity far removed from the boundaries of the state by objecting that the activity is not consistent with the state\u27s management program and that the activity affects the state\u27s coastal zone. Although there are provisions for administrative appeal to the Secretary of Commerce to assert some exceptions to the consistency requirement, the doctrine serves as an inverse preemption of federal authority and an unnecessary burden on federal agencies and applicants. This Article will discuss the provisions of the CZMA that focus on this fundamentally flawed consistency doctrine, the court decisions that have shaped the development of the doctrine, and the key 1990 amendments to the CZMA enacted in response to the court decisions. This will be followed by a discussion of the application of the consistency requirements, with cases and consistency appeals examples that illustrate the unnecessary, unfair, and costly administrative burden imposed on federal agencies and permit applicants. CZMA\u27s federal consistency doctrine will be examined in light of Constitutional Federalism and Supremacy doctrines, plus other federal environmental laws with mandatory regulatory standards, that render the doctrine not only obnoxious, but also superfluous. Finally, this article will note the Clinton administration\u27s proposals for CZMA amendments and the controversy concerning the 1999 reauthorization bill that was introduced but not passed by Congress

Preliminary Investigation of Residual Limb Plantarflexion and Dorsiflexion Muscle Activity During Treadmill Walking for Trans-tibial Amputees

Background: Novel powered prosthetic ankles currently incorporate finite state control, using kinematic and kinetic sensors to differentiate stance and swing phases/sub-phases and control joint impedance and position or torque. For more intuitive control, myoelectric control of the ankle using the remnant residual limb dorsiflexors and plantarflexors, perhaps in concert with kinetic and kinematic sensors, may be possible. Objective: The specific research objective was to assess the feasibility of using myoelectric control of future active or powered prosthetic ankle joints for trans-tibial amputees. Study Design: The project involved human subject trials to determine whether current techniques of myoelectric control of upper extremity prostheses might be readily adapted for lower extremity prosthetic control. Methods: Gait analysis was conducted for three unilateral trans-tibial amputee subjects during ambulation on an instrumented split belt treadmill. Data included ankle plantarflexor and dorsiflexor activity for the residual limb, as well as lower limb kinematics and ground reaction forces and moments of both the sound and prosthetic limbs. Results: These data indicate that: 1) trans-tibial amputees retain some independent ankle plantarflexor and dorsiflexor muscle activity of their residual limb; 2) it is possible to position surface electromyographic electrodes within a trans-tibial socket that maintain contact during ambulation; 3) both the plantarflexors and dorsiflexors of the residual limb are active during gait; 4) plantarflexor and dorsiflexor activity is consistent during multiple gait cycles; and 5) with minimal training, trans-tibial amputees may be able to activate their plantarflexors during push-off. Conclusions: These observations demonstrate the potential for future myoelectric control of active prosthetic ankles. Clinical relevance This study demonstrated the feasibility of applying upper extremity prosthetic myoelectric signal acquisition, processing and control techniques to future myoelectric control of active prosthetic ankles for trans-tibial amputees

Molecular Determinants of Agonist Discrimination by NMDA Receptor Subunits: Analysis of the Glutamate Binding Site on the NR2B Subunit

AbstractNMDA receptors require both L-glutamate and the coagonist glycine for efficient channel activation. The glycine binding site of these heteromeric receptor proteins is formed by regions of the NMDAR1 (NR1) subunit that display sequence similarity to bacterial amino acid binding proteins. Here, we demonstrate that the glutamate binding site is located on the homologous regions of the NR2B subunit. Mutation of residues within the N-terminal domain and the loop region between membrane segments M3 and M4 significantly reduced the efficacy of glutamate, but not glycine, in channel gating. Some of the mutations also decreased inhibition by the glutamate antagonists, D-AP5 and R-CPP. Homology-based molecular modeling of the glutamate and glycine binding domains indicates that the NR2 and NR1 subunits use similar residues to ligate the agonists' α-aminocarboxylic acid groups, whereas differences in side chain interactions and size of aromatic residues determine ligand selectivity

An argument for physician-assisted suicide and against euthanasia

The article opens with the hypothesis that the default position that should guide healthcare providers when treating patients at the end-of-life is that patients opt for life. In the absence of an explicit request to die, we may assume that patients wish to continue living. Thus, the role of the medical profession is to provide patients with the best possible conditions for continued living. The article makes a case for physician-assisted suicide legislation. It examines the 'quality-of-life' argument, and the issue of the patient's autonomy and competence. It is argued that (1) quality-of-life is a subjective concept. Only the patient can conclude for herself that her quality-of-life is so low to warrant ending it, and that (2) only competent patients may request ending their lives. Patients' lives should not be actively terminated by the medical team without the explicit consent of patients. The article then probes the role of physicians at the end-of-life, arguing that medicine should strive to cater to the wishes of all patients, not only the majority of them. Physicians should not turn their backs to justified requests by their patients. Physicians are best equipped to come to the help of patients at all stages of their illness, including their end-of-life. At the same time, in ending life, the final control mechanism should be with the patient. Thus, physician-assisted suicide is preferred to euthanasia in order to lower the possibility of abuse and of ending the lives of patients without their consent and against their wishes. As matters of life and death are grave, they should be taken with utmost seriousness, requiring the instalment of ample checks against abuse and facilitating mechanisms designed to serve the patient's best interests. The article concludes with 19 careful and detailed guidelines for physician-assisted suicide. These are necessary measures designed to ensure that the best interests of the patients are served as they wished.RésuméL’article commence par l’hypothèse que la position par défaut qui doit guider les fournisseurs de soins de santé lors du traitement de patients à la fin de la vie est que les patients optent pour la vie. En l’absence d’une demande explicite de mourir, nous pouvons supposer que les patients souhaitent continuer à vivre. Ainsi, le rôle de la profession médicale est de fournir aux patients les meilleures conditions possibles pour poursuivre la vie. L’article fait un cas pour la législation du suicide assisté par un médecin. Il examine l’argument « qualité de vie », et la question de l’autonomie et de la compétence du patient. On fait valoir que (1) la qualité de vie est un concept subjectif. Seul le patient peut conclure pour lui-même que sa qualité de vie est si faible pour justifier y mettre fin, et (2) que les seul le patient compétent peut demander de mettre fin à sa vie. Il ne devrait pas être mis fin activement à la vie des patients par l’équipe médicale sans le consentement explicite des patients. L’article explore ensuite le rôle des médecins à la fin de la vie, en faisant valoir que la médecine doit s’efforcer de répondre à toutes les attentes des patients, pas seulement à la majorité d’entre elles. Les médecins ne devraient pas tourner le dos aux demandes motivées de leurs patients. Les médecins sont les mieux équipés pour venir en aide à leurs patients à tous les stades de leur maladie, y compris en fin de vie. Dans le même temps, en fin de vie, le mécanisme de réglage final doit se faire avec le patient. Ainsi le suicide médicalement assisté est préférable à l’euthanasie pour réduire les abus comme mettre fin à la vie des patients sans leur consentement ou contre leur volonté. Comme les questions de la vie et de la mort sont graves, elles doivent être prises avec le plus grand sérieux. L’article conclut sur 19 directives précises et détaillées concernant le suicide médicalement assisté. Ces mesures nécessaires visent à assurer le meilleur intérêt des patients

How the mass media report social statistics: A case study concerning research on end-of-life decisions

This is the post-print version of the final paper published in Social Science & Medicine. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V.The issue of whether it is right to be concerned about the accuracy with which mass media report social scientific research is explored through a detailed case study of media reporting of two surveys of UK doctors' end-of-life decision-making. Data include press releases, emails and field notes taken during periods of media interest supplemented by a collection of print and broadcast media reports. The case study contributes to existing knowledge about the ways in which mass media establish, exaggerate and otherwise distort the meaning of statistical findings. Journalists ignored findings that did not fit into existing media interest in the 'assisted dying' story and were subject to pressure from interest groups concerned to promote their own interpretations and viewpoints. Rogue statistics mutated as they were set loose from their original research report context and were 'laundered' as they passed from one media report to another. Yet media accounts of the research, fuelling an already heated public debate about ethical issues in end-of-life care, arguably acted as a conduit for introducing new considerations into this debate, such as the role played by sedation at the end of life, the extent to which euthanasia is practiced outside the law, and the extent of medical opposition to the legalisation of assisted dying. The expectation that accuracy and comprehensiveness should be the sole criteria for judging journalists' reports is, finally, considered to be unrealistic and it is argued that social scientists need to understand and adapted to the conditions under which mass media reporting operates if they are to succeed in introducing the findings of social research into public debates.The Nuffield Foundation, the National Council for Palliative Care, Age Concern, the Motor Neurone Disease Association, the Multiple Sclerosis Society, Help the Hospices, Macmillan Cancer Support, and Sue Ryder Care

Decisions that hasten death: double effect and the experiences of physicians in Australia

BACKGROUND: In Australian end-of-life care, practicing euthanasia or physician-assisted suicide is illegal. Despite this, death hastening practices are common across medical settings. Practices can be clandestine or overt but in many instances physicians are forced to seek protection behind ambiguous medico-legal imperatives such as the Principle of Double Effect. Moreover, the way they conceptualise and experience such practices is inconsistent. To complement the available statistical data, the purpose of this study was to understand the reasoning behind how and why physicians in Australia will hasten death. METHOD: A qualitative investigation was focused on palliative and critical/acute settings. A thematic analysis was conducted on semi-structured in-depth interviews with 13 specialist physicians. Attention was given to eliciting meanings and experiences in Australian end-of-life care. RESULTS: Highlighting the importance of a multidimensional approach, physicians negotiated multiple influences when death was regarded as hastened. The way they understood and experienced end-of-life care practices were affected by politico-religious and cultural influences, medico-legal imperatives, and personal values and beliefs. Interpersonal and intrapsychic aspects further emphasised the emotional and psychological investment physicians have with patients and others. In most cases death occurred as a result of treating suffering, and sometimes to fulfil the wishes of patients and others who requested death. Experience was especially subject to the efficacy with which physicians negotiated complex but context-specific situations, and was reflective of how they considered a good death. Although many were compelled to draw on the Principle of Double Effect, every physician reported its inadequacy as a medico-legal guideline. CONCLUSIONS: The Principle of Double Effect, as a simplistic and generalised guideline, was identified as a convenient mechanism to protect physicians who inadvertently or intentionally hastened death. But its narrow focus on the physician’s intent illuminated how easily it may be manipulated, thus impairing transparency and a physician’s capacity for honesty. It is suggested the concept of “force majeure” be examined for its applicability in Australian medical end-of-life law where, consistent with a multidimensional and complex world, a physician’s motivations can also be understood in terms of the emotional and psychological pressures they face in situations that hasten death

Physicians' experiences with end-of-life decision-making: Survey in 6 European countries and Australia

Background: In this study we investigated (a) to what extent physicians have experience with performing a range of end-of-life decisions (ELDs), (b) if they have no experience with performing an ELD, would they be willing to do so under certain conditions and (c) which background characteristics are associated with having experience with/or being willing to make such ELDs. Methods: An anonymous questionnaire was sent to 16,486 physicians from specialities in which death is common: Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Results: The response rate differed between countries (39–68%). The experience of foregoing life-sustaining treatment ranged between 37% and 86%: intensifying the alleviation of pain or other symptoms while taking into account possible hastening of death between 57% and 95%, and experience with deep sedation until death between 12% and 46%. Receiving a request for hastening death differed between 34% and 71%, and intentionally hastening death on the explicit request of a patient between 1% and 56%. Conclusion: There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude