Communicating About Mortality in Health Decision Support: ‘What and Why and When, and How and Where and Who’

The Covid-19 pandemic has only accelerated the need and desire to deal more openly with mortality, because the effect on survival is central to the comprehensive assessment of harms and benefits needed to meet a ‘reasonable patient’ legal standard. Taking the view that this requirement is best met through a multi-criterial decision support tool, we offer our preferred answers to the questions of What should be communicated about mortality in the tool, and How, given preferred answers to Who for, Who by, Why, When, and Where. Summary measures, including unrestricted Life Expectancy and Restricted Mean Survival Time are found to be reductionist and relative, and not as easy to understand and communicate as often asserted. Full lifetime absolute survival curves should be presented, even if they cannot be ‘evidence-based’ beyond trial follow-up limits, along with equivalent measures for other criteria in the (necessarily) multi-criterial decision. A decision support tool should relieve the reasonable person of the resulting calculation burden.

In defence of our model for just healthcare systems: why an explicit philosophy is needed in addition to the law, and how Scanlon helps derive just policies

In a recent response to our paper on developing a philosophical framework to guide the design and delivery of a just health service, Sarela raises several objections. We feel that although Sarela makes points which are worthy of discussion, his critique does not undermine either the need for, or the worth of, our proposed model. First, the law does not negate the need for ethics in determining just healthcare policy. Reliance on legal processes can drive inappropriate focus on ensuring policies avoid judicial review, as opposed to ensuring they are truly just; the law affords protection against unjust policies but does not put a commitment to avoiding them at the heart of policy-making. We defend the need for Scanlonian supplementation by emphasising the practical value of adding a step based on reasonable rejection, particularly in ensuring that the views of vulnerable stakeholders are robustly considered. We discuss the similarities and differences between the work of Daniels and Sen in considering the relationship between health and opportunity, concluding that Sen’s capability approach is both valuable and compatible with our proposed model. Finally, the practical use of our model requires consideration of what constitutes a reasonable person. Our model is explicitly intended to help develop a healthcare system which is just to all its users. With this in mind, we suggest that those involved in decision-making should meet Scanlon’s definition of reasonable: they should be motivated to justify their actions to, and seek agreement with, others.

BELIEF IN WITCHCRAFT AS A MITIGATING FACTOR IN SENTENCING S v Latha 2012 (2) SACR 30 (ECG)

Supernatural belief does not sit easily with the law. Squaring such belief with legal concepts such as the reasonable person is a particularly vexing task. Nevertheless, it is necessary for the courts to take account of such belief as a fact of the South African society. Belief in witchcraft is an ongoing and widespread phenomenon, giving rise to the question whether such belief can play a role in exculpating, or mitigating the punishment of those who engage in criminal conduct as a consequence of such belief. A recurring problem for the courts is how to deal with the situation where a genuine belief in witchcraft provides the motivation for the killing of a suspected witch or wizard in order to protect or defend the interests of the accused or another person. Can such a belief mitigate punishment? This problem arose in the case of S v Latha (2012 (2) SACR 30 (ECG)).

6. Breach of duty

This chapter discusses the law on standard of care and breach of duty. To establish that the duty of care has been breached, the standard of care must first be found and then it must be decided if that standard was reached in the circumstances. The general standard of care is objective: the ‘reasonable person’ standard. Variations in the standard of care regarding children and the more skilled or professional are discussed, as are those pertaining to sport and the medical profession. Proof of breach must be established by the claimant on the balance of probabilities; occasionally with the benefit of the evidential tool of res ipsa loquitur.

4. Crimes of negligence

Negligence refers to conduct that does not conform to what would be expected of a reasonable person. Along with intention and recklessness, negligence involves a failure to comply with an objective standard of conduct; that is, all of them are forms of fault. To prove negligence, the prosecution is not required to show that the accused failed to foresee a relevant risk; it only has to establish that his conduct failed to comply with a reasonable standard. A person is negligent if he is not able to comply with an objective standard of behaviour set by the law. This chapter deals with crimes of negligence and negligence as mens rea, negligence as the basis of liability, degrees of negligence, negligence as a form of culpable fault, and negligence and capacity.

The Reasonable Person Standard: Psychological and Legal Perspectives

In criminal cases of self-defense and provocation, and civil cases of negligence, culpability is often decided with reference to how a reasonably prudent person (RPP) would have behaved in similar circumstances. The RPP is said to be an objective standard in that it eschews consideration of a defendant's unique background or characteristics. We discuss theory and evidence suggesting that in morally relevant judgments, including those involving negligence, self-defense, and provocation, the tendency to rely on the self—on one's own values and predilections—dominates considerations of the RPP. We consider subjective standards that have been proposed as alternatives to the RPP and review research on this topic. We conclude by considering avenues for future research, particularly addressing conditions in which self-standards of reasonableness are most likely to prevail. Expected final online publication date for the Annual Review of Law and Social Science, Volume 17 is October 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Personalized Law

We live in a world of one-size-fits-all law. People are different, but the laws that govern them are uniform. “Personalized Law”—rules that vary person by person—will change that. Here is a vision of a brave new world, where each person is bound by their own personally tailored law. “Reasonable person” standards would be replaced by a multitude of personalized commands, each individual with their own “reasonable you” rule. Skilled doctors would be held to higher standards of care; the most vulnerable consumers and employees would receive stronger protections; age restrictions for driving or for the consumption of alcohol would vary according to the recklessness risk that each person poses; and borrowers would be entitled to personalized loan disclosures tailored to their unique needs and delivered in a format fitting their mental capacity. The data and algorithms to administer personalized law are at our doorstep, and embryos of this regime are sprouting. Should we welcome this transformation of the law? Does personalized law harbor a utopic promise, or would it produce alienation, demoralization, and discrimination? This book is the first to explore personalized law, offering a vision of law and robotics that delegates to machines tasks traditionally performed by humans. It inquires how personalized law can be designed to deliver precision and justice and what pitfalls the regime would have to prudently avoid.

Mental Communication of Internal Speech with Communicative Associative Robot via Spectral Neurointerface

Thought communications with an associative-communicative robot are carried out through the spectral neurointerface of internal speech. Internal speech is an energy physiological process. Internal speech is vibration from the mental vibration of thought. Mental vibration of thought is a process in the mental ethereal field. The vibrations of thoughts are reflected and observed by the mind in the form of semantic sensual images. Vibrations of semantic sensual images generate vibrations of internal speech action (internal speech) in the form of language communicative and associative stereotypes which are perceived by a touch zone of a brain of Wernicke. Internal speech is a linguistic mental vibration, It is felt and becomes internally audible and drawn to attention. The perception of vibrations of internal speech is carried out through energy channels, such as the internal posterior median canal of the spine. The spectral neurointerface perceives these vibrations. Neocortex makes us a reasonable person - allows us to think and talk. The spectral neurointerface is based on the principles of biosensors, bioenergy detectors, spectral analyzers and electrocorticography for neuroimaging parts of the brain that record vibrations of internal speech, such as the lower frontal gyrus, the upper and middle temporal gyrus, the medial prefrontal cortex, the hind parts of the wedge and precline and the dark temporal region, including the posterior Internal speech activity is associated with the semantic memory of the neocortex.

Managing threats to small drinking water systems in Ontario : a risk based approach

Ultimately the goal of Justice O'Connor's recommendations from the Walkerton inquiry was "to ensure that Ontario's drinking water system deliver water with a level of risk so negligible that a reasonable person would feel safe drinking the water" (O'Connor, 2002a, 5). Following the implementation of Justice O'Connor's recommendations, concerns were raised regarding the management of small drinking water systems using the same stringent rules that were used for municipally-run water systems. Recommendations have focused on the need for risk assessment when managing the threats to small drinking water systems; however no such system has yet been developed in Ontario. A risk-based approach has been developed that would ensure drinking water protection activities are targeted to items that posed the greatest risk to water systems, resulting in more efficient protection efforts. The creation of such a risk-based program can be used to accurately identify significant threats to a water system and result in the effective management of health threats from small drinking water systems.