Live or Let Die? The Court of Protection's Ground-Breaking Decision in M. v. N. (by her litigation friend, the Official Solicitor) and others [2015] EWCOP 76 (Fam.)

This case note examines the first case in which the Court of Protection authorised the withdrawal of life-sustaining nutrition and hydration from a patient in a minimally conscious state. It reflects on the judge’s stated view that the label given to the patient’s condition is not determinative, examines the significance and interpretation of the ‘best interests’ test, compares the court’s decision with that in a 2011 case with similar facts, and questions the law’s differing approaches to patients in the minimally conscious and ‘vegetative’ states. It concludes with a brief explanation of ways in which clinicians might – now and, subject to the robustness of emerging neuroimaging technology, in the future – be able to ascertain the views of people who cannot communicate in conventional ways, and expresses the hope that future judges will give priority to their patients’ wishes, to the extent that these can be ascertained

Something old, something new: busting some myths about Statutory Instruments and Brexit

Much of what law undergraduates learn about delegated, or secondary, legislation is incorrect, and this article attempts to dispel four common myths. The first myth is that deleted legislation has several forms, including Orders in Council, Orders of Council and Statutory Instruments. In fact, Orders in Council, Orders of Council, Rules, Regulations and Orders are all forms of Statutory Instrument (SI). The second myth is that delegated legislation is scrutinised by Parliament, which ensures its democratic accountability. The 18 variants of processes for making SIs involve scrutiny that has been described as: 'negligible; entirely theoretical', 'palpably unsatisfactory' and 'woefully inadequate'. The third myth is that delegated legislation is confined to technical details that MPs and peers would not understand. This is true of some SIs, but some Acts enable Ministers to make entire schemes of law, including creating crimes that attract prison sentences. The fourth myth is that the House of Lords often defeats the Commons. Responses to the 2015 Strathclyde Review show that the main risk to democracy is posed by the delegation of excessive law-making powers to the Government. The article also busts a fifth myth, beloved of Brexiteers: that the UK's exit from the EU will enable Parliament to 'take back control' of the UK's laws. The reality is that huge swathes of law-making power will pass directly to Ministers. It is vital that academics and responsible citizens understand what the forms of secondary legislation are and what each should be used for, as well as the difficulties and tensions arising from the way that it is made, and the reforms that are so urgently needed. This understanding will enable informed analysis and criticism of the executive’s use – and potential abuse – of SIs as it revels in its unaccustomed freedom from the shackles of EU law

Potential legal implications of advances in neuroimaging techniques for the clinical management of patients with disorders of consciousness

Three disorders of consciousness (DoCs) – coma, vegetative state (VS) and minimally conscious state – may render patients unable to communicate. Differential diagnosis is challenging, and numerous patients diagnosed as being in VS may be minimally conscious. DoCs are caused by illnesses or traumatic injuries likely to cause pain that will be not be treated if doctors believe patients are unconscious. Neuroimaging has detected signs of consciousness in some unresponsive people, enabling some to give consistently correct ‘yes’/‘no’ answers to questions. This establishes that such patients have a degree of consciousness, so they can be asked whether they are in pain and, if so, how they would like it to be treated. This paper characterises being misdiagnosed as being in coma or VS as mental torture, and being left in pain as inhuman treatment. It considers whether the UK has a duty under its international human rights undertakings to employ all possible techniques diagnose DoCs accurately, and to treat any pain whose existence can be ascertained. It notes the European Court of Human Rights’ pragmatism about Contracting States’ resources, and suggests that the UK’s National Institute for Health and Care Excellence would deem neuroimaging not to be cost-effective. At present, it is unlikely that the United Kingdom has a duty to undertake regular neuroimaging of all patients with DoCs. Even at the current state of knowledge, however, regular reassessment of patients with DoCs is essential in order to avoid inflicting unnecessary suffering on these extremely vulnerable people

Barriers to older adults’ uptake of mobile-based mental health interventions

Background To address increasing demand of mental healthcare treatments for older adults and the need to reduce delivery costs, healthcare providers are turning to mobile applications. The importance of psychological barriers have been highlighted in the uptake of mobile-based mental health interventions and efforts have been made to identify these barriers in order to facilitate initial uptake and acceptance. However, limited research has focused on older adults’ awareness of these applications and factors that might be hindering their use. Objective The purpose of this study was to explore the perceived barriers that older adults experience in the uptake of mobile-based mental health interventions. Methods Semi-structured interviews were conducted with a sample of 10 older adults, 50 years or older (female = 7, mean age = 68 years), who experienced periods of low mood. National Health Service applications were demonstrated to facilitate conversation and explore participants’ understanding of mental health and mobile-based mental health interventions. Thematic analysis was used to analyse the interview transcripts. Results The social ecological model was adopted as an organising framework for the thematic analysis which identified six distinct barriers to older adults’ uptake of mobile-based mental health interventions: mental electronic-health (e-health) awareness, interaction with technology, discontinuation, ‘seeing’ facilitates therapeutic alliance, incongruent role of the general practitioner and privacy and confidentiality. Conclusions Older adults experience a number of barriers to uptake ranging from the individual level to a macro, organisational level. The practical implications of these barriers are discussed such as the need for increased awareness of mobile-based mental health interventions among older adults

Development and management of high-fidelity test technology for comprehensive performance evaluation of electronic warfare systems in multi-threat environments.

This thesis addresses the key challenge of improving multi-threat RF environment simulator capability and fidelity to the level where most, if not all electronic warfare receiver performance could be adequately proven on ground-based test facilities rather than by expensive and difficult to repeat flight trials. For over 25 years the author has investigated his claim that this could be achieved, enabled by suitably enhanced RF threat simulators. The author’s technology development and management leadership has significantly influenced high-fidelity, multi-threat RF emitter scenario simulation capabilities during this period. The published works and this thesis demonstrate this claim to be justified via the many simulator technology developments he has managed to fruition, those many potential enhancements he has identified, and four further research directions he has proposed. Many prior limitations have been overcome by technological developments and the author considers it likely that most remaining ones will be overcome within the next decade, leaving only those receiver performance verification tests that can only be done in flight to be done via flight test. When taken as a whole, the 12 published works represent a significant contribution to the body of aerospace knowledge across the domains of survivability, electronic warfare systems and their test and evaluation, and radio/radar frequency threat simulation. Synthesis of those works demonstrates a coherent theme that links improved multi-threat RF environment simulation capability to more affordable, shorter and less risky receiver development programmes, which thereby also offers improved air platform survivability. The key importance of defence sector affordability is also recognised via development, described in the thesis, of a technology prioritisation assessment method to aid decision making on threat simulation fidelity enhancements. Originality is also demonstrated in the works’ and this thesis’ development of public release reference material in the sensitive topic area of electronic warfare and test and evaluation, for the education of novices of graduate level and upwards, for the advisement of technical professionals, experienced testers and academics, and for the guidance of programme managers

The ethical imperative of ascertaining and respecting the wishes of the minimally conscious patient facing a life-or-death decision.

Individuals with disorders of consciousness, and those with locked-in syndrome (LIS), have significantly impaired ability to communicate by conventional means. Although the most severely affected patients – those in coma and vegetative state (VS) – are wholly unaware of their surroundings, people in a minimally conscious state (MCS) may be, and those with LIS are, aware of their situation, and it is known that some of them wish to die. Their physical disabilities make it impossible for them to end their own lives, so they have to rely on others’ willingness to comply with their requests to be allowed to die. English judges, although expressing profound sympathy for individuals in MCS or with LIS in such circumstances, have declined to permit their assisted deaths, holding that this would breach the Suicide Act 1961. This paper reviews some significant recent advances in neuroimaging techniques that may enable some individuals who have been diagnosed as being in MCS or VS to give deliberate positive or negative answers to simple questions. This paper argues that, wherever possible, the wishes of those with who are able to communicate only via neuroimaging should be sought, should be respected and, wherever practicable, should be acted upon. To do otherwise is to infringe the last vestige of autonomy of people who have already lost their dignity, their independence and, in some cases, their desire to live

Radiative forcing and climate change

Aviation causes climate change as a result of its emissions of CO2, oxides of nitrogen, aerosols, and water vapor. One simple method of quantifying the climate impact of past emissions is radiative forcing. The radiative forcing due to changes in CO2 is best characterized, but there are formidable difficulties in estimating the non-CO2 forcings – this is particularly the case for possible aviation-induced changes in cloudiness (AIC). The most recent comprehensive assessment gave a best estimate of the 2005 total radiative forcing due to aviation of about 55–78 mW m−2 depending on whether AIC was included or not, with an uncertainty of at least a factor of 2. The aviation CO2 radiative forcing represents about 1.6% of the total CO2 forcing from all human activities. It is estimated that, including the non-CO2 effects, aviation contributes between 1.3 and 14% of the total radiative forcing due to all human activities. Alternative methods for comparing the future impact of present-day aviation emissions are presented – the perception of the relative importance of the non-CO2 emissions, relative to CO2, depends considerably on the chosen method and the parameters chosen within those methods

Biodiversity in intensive grasslands: is a compromise possible?

Peer reviewe