An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients.

In Western industrialized countries, it is well established that legally competent individuals may choose a surrogate healthcare decision-maker to represent their interests should they lose the capacity to do so themselves. There are few limitations on who they may select to fulfill this function. However, many jurisdictions place restrictions on or prohibit the patient's attending physician or other provider involved with an individual's care to serve in this role. Several authors have previously suggested that respect for the autonomy of patients requires that there be few (if any) constraints on whomever they may appoint as a proxy. In this essay we revisit this topic by first providing a survey of current state laws governing this activity. We then analyze the clinical and ethical circumstances in which potential difficulties could arise. We take a more nuanced and circumspect view of prior suggestions that patients should have virtually unfettered liberty to choose their healthcare proxies. We suggest a strategy to balance the freedom of patients' right to choose their surrogates with fiduciary duty of the state as regulator of medical practice. We identify six domains of possible concern with such relationships and suggest straightforward methods of mitigating their potential negative effects that could be plausibly be incorporated into physician practice.

A mathematical theory of stochastic microlensing. II. Random images, shear, and the Kac-Rice formula

Continuing our development of a mathematical theory of stochastic microlensing, we study the random shear and expected number of random lensed images of different types. In particular, we characterize the first three leading terms in the asymptotic expression of the joint probability density function (pdf) of the random shear tensor due to point masses in the limit of an infinite number of stars. Up to this order, the pdf depends on the magnitude of the shear tensor, the optical depth, and the mean number of stars through a combination of radial position and the star's mass. As a consequence, the pdf's of the shear components are seen to converge, in the limit of an infinite number of stars, to shifted Cauchy distributions, which shows that the shear components have heavy tails in that limit. The asymptotic pdf of the shear magnitude in the limit of an infinite number of stars is also presented. All the results on the random microlensing shear are given for a general point in the lens plane. Extending to the general random distributions (not necessarily uniform) of the lenses, we employ the Kac-Rice formula and Morse theory to deduce general formulas for the expected total number of images and the expected number of saddle images. We further generalize these results by considering random sources defined on a countable compact covering of the light source plane. This is done to introduce the notion of global expected number of positive parity images due to a general lensing map. Applying the result to microlensing, we calculate the asymptotic global expected number of minimum images in the limit of an infinite number of stars, where the stars are uniformly distributed. This global expectation is bounded, while the global expected number of images and the global expected number of saddle images diverge as the order of the number of stars. © 2009 American Institute of Physics.

Expanding Role Theory: US Responses to Hizb'allah and Iran

There are many sociopolitical theories to help explain why governments and actors do what they do. Securitization Theory is a process-oriented theory in international relations that focuses on how an actor defines another actor as an “existential threat,” and the resulting responses that can be taken in order to address that threat. While Securitization Theory is an acceptable method to analyze the relationships between actors in the international system, this thesis contends that the proper examination is multi-factorial, focusing on the addition of Role Theory to the analysis. Consideration of Role Theory, which is another international relations theory that explains how an actor’s strategies, relationships, and perceptions by others is based on pre-conceptualized definitions of that actor’s identity, is essential in order to fully explain why an actor might respond to another in a particular way. Certain roles an actor may enact produce a rival relationship with other actors in the system, and it is those rival roles that elicit securitized responses. The possibility of a securitized response lessens when a role or a relationship between roles becomes ambiguous. There are clear points of role rivalry and role ambiguity between Hizb’allah and Iran, which has directly impacted, and continues to impact, how the United States (US) responds to these actors. Because of role ambiguity, the US has still not conceptualized an effective way to deal with Hizb’allah and Iran holistically across all its various areas of operation and in its various enacted roles. It would be overly simplistic to see Hizb’allah and Iran solely through one lens depending on which hemisphere or continent one is observing. The reality is likely more nuanced. Both Role Theory and Securitization theory can help to understand and articulate those nuances. By examining two case studies of Hizb’allah and Iran’s enactment of various roles in both the Middle East and Latin America, the situations where roles cause a securitized response and where the response is less securitized due to role ambiguity will become clear. Using this augmented approach of combining both theories, along with supplementing the manner in which an actor, action, or role is analyzed, will produce better methods for policy-making that will be able to address the more ambiguous activities of Hizb’allah and Iran in these two regions.