Supreme Emergencies and the protection of non-combatants in war

Is it ever justifiable to target non-combatants deliberately? This article assesses Michael Walzer's claim that the deliberate targeting of non-combatants may be justifiable during 'supreme emergencies', a view that has received some support but that has elicited little debate. It argues that the supreme emergencies exception to the prohibition on targeting non-combatants is problematic for at least four reasons. First, its utilitarianism contradicts Walzer's wider ethics of war based on a conception of human rights. Second, the exception may undermine the principle of non-combatant immunity. Third, it is based on a historical fallacy. Finally, it is predicated on a strategic fallacy-the idea that killing noncombatants can win wars. The case for rejecting the exception, however, has been opposed by those who persuasively argue that it is wrong to tie leaders' hands when they confront supreme emergencies. The final part of the article addresses this question and suggests that the principle of proportionality may give political leaders room for manoeuvre in supreme emergencies without permitting them deliberately to target non-combatants.

Effectiveness of screening for risk of medical emergencies in the elderly

Study objective: UK government policy mandates the introduction of 'intermediate care services' to reduce emergency admissions to hospital from the population aged 75 years or more. We evaluated one of these initiatives-the Keep Well At Home (KWAH) Project-in a West London Primary Care Trust. Design: KWAH involves a two-phase screening process, including a home visit by a community nurse. We employed cohort methods to determine whether KWAH resulted in fewer emergency attendances and admissions to hospital in the target population, from October 1999 to December 2002. Results: estimated levels of coverage in the two phases of screening were 61 and 32%, respectively. The project had not maintained records of which additional health and social care services had been delivered following screening. The rates of emergency admissions to hospital in the 9 months before screening were similar in practices that did and did not join the project (rate ratio (RR) = 1.05; 95% CI 0.95-1.17), suggesting absence of volunteer bias. Over the first 37 months of the project, there was no significant impact on either attendances at Accident & Emergency departments (RR = 1.02; 95% CI 0.97-1.06) or emergency admissions of elderly patients (RR = 0.98; 95% CI 0.93-1.05). Conclusion: the KWAH Project has been ineffective in reducing emergency admissions among the elderly. Significant questions arise in relation to selection of the screening instruments, practicality of achieving higher coverage of the eligible population, and creation of a new postcode lottery.

Nonfatal heroin overdoses in Queensland, Australia: an analysis of ambulance data

In the past decade, the utilization of ambulance data to inform the prevalence of nonfatal heroin overdose has increased. These data can assist public health policymakers, law enforcement agencies, and health providers in planning and allocating resources. This study examined the 672 ambulance attendances at nonfatal heroin overdoses in Queensland, Australia, in 2000. Gender distribution showed a typical 70/30 male-to-female ratio. An equal number of persons with nonfatal heroin overdose were between 15 and 24 years of age and 25 and 34 years of age. Police were present in only 1 of 6 cases, and 28.1% of patients reported using drugs alone. Ambulance data are proving to be a valuable population-based resource for describing the incidence and characteristics of nonfatal heroin overdose episodes. Future studies could focus on the differences between nonfatal heroin overdose and fatal heroin overdose samples.

Introduction to the practice of telemedicine

Telemedicine is the delivery of health care and the exchange of health-care information across distances. It is not a technology or a separate or new branch of medicine. Telemedicine episodes may be classified on the basis of: (I) the interaction between the client and the expert (i.e. realtime or prerecorded), and (2) the type of information being transmitted (e.g. text, audio, video). Much of the telemedicine which is now practised is performed in industrialized countries, such as the USA, but there is increasing interest in the use of telemedicine in developing countries. There are basically two conditions under which telemedicine should be considered: (I) when there is no alternative (e.g. in emergencies in remote environments), and (2) when it is better than existing conventional services (e.g. teleradiology for rural hospitals). For example, telemedicine can be expected to improve equity of access to health care, the quality of that care, and the efficiency by which it is delivered. Research in telemedicine increased steadily in the late 1990s, although the quality of the research could be improved - there have been few randomized controlled trials to date.

The UN Security Council and the question of humanitarian intervention in Darfur

This article explores the different moral and legal arguments used by protagonists in the debate about whether or not to conduct a humanitarian intervention in Darfur. The first section briefly outlines four moral and legal positions on whether there is (and should be) a right and/or duty of humanitarian intervention: communitarianism, restrictionist and counter-restrictionist legal positivism and liberal cosmopolitanism. The second section then provides an overview of the Security Council's debate about responding to Darfur's crisis, showing how its policy was influenced by both normative concerns and hard-nosed political calculations. The article concludes by asking what Darfur's case reveals about the legitimacy and likelihood of humanitarian intervention in such catastrophes and the role of the UN Security Council as the primary authorising body for the use of international force. The authors argue that this case demonstrates that for the cosmopolitan/counter-restrictionist case to prevail pivotal states need to put humanitarian emergencies on the global agenda and express a willingness to act without Council authorisation, though the question of how to proceed in cases where the Council is deadlocked remains vexed.