The persistent vegetative state: legal and ethical issues

Recent advances in technology and medical expertise have enabled doctors to prolong the lives of many severely injured patients who only a few years ago would have died from their injuries. The prolongation of life by such measures has raised many legal, ethical and social issues. When in 1992 the House of Lords determined in Airdale NHS Trust V Bland that life-supporting measures, including artificial nutrition and hydration (ANH) might lawfully be withdrawn from Anthony Bland, a patient in a persistent vegetative state (PVS), attention was focused on these issues particularly as they apply to the patient in PVS. Since the PVS patient is neither competent to refuse treatment, nor is he dying or suffering, the reasons normally advanced for withdrawing life-supporting measures do not apply. In Bland, their Lordships relied on the best interests test laid down in Re F (mental patient: sterilisation) [1989] 2 All ER 545, and, with the exception of Lord Mustill, on the Bolam test (Bolam v Friern Barnet Hospital Management Committee) [1957] 1 WLR 582. This thesis examines the decision mBland and addresses some of the issues raised. The appropriateness of the best interests test as applied to the patient in PVS is explored and compared with the approach of substituted judgement employed in some other common law jurisdictions. The relevance of the Bolam test to decisions regarding the withdrawal of life-supporting measures is considered. The legal requirements for the withdrawal of ANH are discussed, together with the ethical debate and the moral dilemmas posed by its withdrawal. Finally, the question as to whether the decision in Bland is good law is addressed, and it will be argued that whilst it may be morally acceptable to withdraw ANH from some patients, as regards a patient in PVS, the moral imperative is that we should not

'POWs and purge victims: attitudes towards party rehabilitation, 1956-57'

In the wake of Stalin's death in 1953 and Khrushchev's Secret Speech three years later, many Soviet citizens hoped that past injustices would now be put right. For some, this meant the right to rejoin the Communist Party. This article explores how former party members - including many returning from the camps - sought rehabilitation in the years 1956 to 1957. Focusing in particular on the party organization in Vladimir province, the article examines the differing ways POWs and purge victims were treated, and asks how far the decisions made by the party elite in this oblast' reflected central policy or local concerns

van der Waals dispersion power laws for cleavage, exfoliation and stretching in multi-scale, layered systems

Layered and nanotubular systems that are metallic or graphitic are known to exhibit unusual dispersive van der Waals (vdW) power laws under some circumstances. In this letter we investigate the vdW power laws of bulk and finite layered systems and their interactions with other layered systems and atoms in the electromagnetically non-retarded case. The investigation reveals substantial difference between `cleavage' and `exfoliation' of graphite and metals where cleavage obeys a $C_2 D^{-2}$ vdW power law while exfoliation obeys a $C_3 \log(D/D_0) D^{-3}$ law for graphitics and a $C_{5/2} D^{-5/2}$ law for layered metals. This leads to questions of relevance in the interpretation of experimental results for these systems which have previously assumed more trival differences. Furthermore we gather further insight into the effect of scale on the vdW power laws of systems that simultaneously exhibit macroscopic and nanoscopic dimensions. We show that, for metallic and graphitic layered systems, the known "unusual" power laws can be reduced to standard or near standard power laws when the effective scale of one or more dimension is changed. This allows better identification of the systems for which the commonly employed `sum of $C_6 D^{-6}$' type vdW methods might be valid such as layered bulk to layered bulk and layered bulk to atom

The prenatal effects of the Christchurch earthquake on executive function at five years of age : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Educational Psychology at Massey University

Despite the frequency of earthquakes, particularly in New Zealand, little is known about the long-term effects that they can have on vulnerable populations, such as mothers and unborn babies. This study looks at the way in which a major earthquake can impact on neurodevelopment, specifically the executive function (EF) abilities of children five years following the disaster. The aims of this study were to determine if prenatal earthquake exposure had an effect on EF, to determine how timing of exposure influenced EF, if there were different EF outcomes for boys and girls, and how maternal perceptions of severity influenced the child’s EF. Children from two groups (mothers from Christchurch who experienced the earthquakes and mothers from Dunedin and Timaru who did not) had their EF measured by a self-administered parent questionnaire, the Behaviour Rating Inventory of Executive Function Second Edition (BRIEF 2). Maternal demographics and earthquake severity experiences were gathered through a second self-administered questionnaire. This study found that children who prenatally experienced the earthquake had significantly worse scores on the measures of emotional control and emotional regulation than the standardised average provided by the BRIEF 2. Exposure during the third trimester was associated with the most significant increases in EF compared to children exposed during the second trimester and the standardised average. In addition to emotional control and emotional regulation difficulties, Christchurch boys also exhibited significantly higher scores on the Shift scale. Results also showed that the worse someone close to the mother was injured, the higher the child’s scores on the Inhibit, Organisation, and Emotional Control scale, and the Behaviour Regulation index (BRI) were. Also, children of mothers who reported more significantly injuring themselves in the earthquake had higher Emotional Regulation (ERI) scores. Children whose mothers reported being overall extremely stressed by the earthquake had the largest mean difference in emotional control and ERI scores compared to the standardised average. Despite the small group sizes and continuing aftershocks the variations in trimester and maternal perception of stress indicates that prenatal exposure to a natural disaster does impact EF