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Decision-Making Supports and Cognitive Decline
Full text linkFor persons with a range of cognitive disabilities, supported decision-making, rooted in a human rights approach to disability, has emerged as a tool that permits them to make legally binding decisions and avoid guardianship. As supported decision-making policy has evolved in the United States, state statutes have primarily focused on formal agreements through which individuals can designate trusted supporters to assist in obtaining information, processing that information, and communicating a decision. This Article argues that supported decision-making has promise for preserving the autonomy of persons living with dementia, but that the model of a supported decisionmaking agreement embodied in the state statutes does not fully address the circumstances of those experiencing cognitive decline. The different context requires a different and broader range of supports for decisionmaking. The Article proposes supplemental policy interventions to be more responsive to the needs of people experiencing cognitive decline. These include developing a values-based planning process that combines supported decision-making with advance directives, promoting enhanced guardianship diversion services, and more explicitly requiring decisionmakin
The Harms of Expanding Physician-Assisted Suicide
Full text linkCurrently, nine states and the District of Columbia have passed laws in the U.S. to legalize and regulate the practice of physicianassisted suicide (“PAS”). Proponents initially garnered public support by portraying PAS as distinct from suicide, framing it as a rare mechanism for patients with terminal illness to achieve a peaceful death, enhance autonomy, and reduce suffering. Original state laws contained numerous eligibility requirements designed as safeguards to provide stringent limits. However, over the past few years proponents of PAS have systematically worked to expand PAS and erase these limits by increasing eligible providers, reducing waiting periods, and eliminating residency requirements. In addition to these modifications, proponents of PAS assert the U.S. should adopt more lenient models used by other countries. More than simply theoretical discussions, proponents have taken steps to challenge current laws through proposed legislation, litigation, and using clinical practice to circumvent legal requirements. This Article provides an overview of four proposed substantive changes in eligibility requirements for PAS, including: (1) permitting assistance with administration or allowing euthanasia; (2) changing the requirements around patient decision-making capacity; (3) eliminating the requirement for terminal illness; and (4) allowing PAS for mental illness. Revisiting the history of PAS, this Article provides a critical analysis of the ethical arguments behind permitting PAS and explains the harms of radically expanding PAS
Advancing Virtual Care Practices Across the Cognitive Impairment Continuum
Full text linkAs the population of older adults grows, providing high-quality, costeffective healthcare for those with cognitive impairments is an increasing priority. The COVID-19 pandemic accelerated the shift towards receiving virtual care at home through temporary Medicare flexibilities. However, the uncertainty surrounding the continuing extension of these flexibilities at the federal level and variations in reimbursement policies across the states present challenges for virtual care practices to meet the rising demand for care amid unprecedented workforce shortages. Sustainable, long-term reimbursement at the federal and state levels, a trained and integrated healthcare workforce, and adherence to recognized accreditation standards and guidelines are essential to advance the quality and safety of virtual care for cognitively impaired patients. Furthermore, reimbursement policies that incentivize investments in technology infrastructure and digital literacy outreach are needed to ensure equitable access to virtual care for all patients across the cognitive impairment continuum
Space Warfare: Do We Need Additional Treaties?
Full text linkWith the growth in counter-space weapons and military services dedicated to space, should International Humanitarian Law be expanded to address a “war in space?” This Paper will examine what a conflict in space would look like and existing laws that govern military activities in space. Ultimately, this paper will argue that International Humanitarian Law is already flexible enough to address this new venue for conflict. (Abstract from author.
A Comment on Justice Thomas’s Commas
Full text linkFor some reason, Justice Thomas has taken to inserting commas in places they don’t belong. In particular, he writes one clause of a compound sentence, followed by a comma before any conjunction, and, then he throws in a comma after the conjunction as well (as I just did—incorrectly—for illustrative purposes). Or, he begins a sentence with a conjunction and then he routinely drops a comma after the conjunction (again, as I did incorrectly). This article explains the grammatical problem—with copious citations to texts on writing—and then ponders why the Justice is doing this. One hypothetical: as a good originalist, he is following the practices of the founders, who used commas throughout the Constitution in places where the commas don’t seem helpful. We should study and generally follow the founders’ political theories, but let’s consign their use of commas to the dustbin
From Free Trade to Strategic Constraints: U.S.-Led Sanctionsand Export Controls Against Russia and China
Full text linkThis article examines the evolving role of sanctions and export controls led by the United States (U.S.) in shaping global trade dynamics, particularly in response to Russia’s invasion of Ukraine and China’s technological and military advancements. The U.S. has expanded its use of extraterritorial export control measures, particularly the Foreign Direct Product Rules, to regulate the global flow of strategic commodities, technology, and software. The study explores the extensive sanctions and export control regimes imposed on Russia following its 2022 invasion of Ukraine, including restrictions on energy, finance, and military-related technologies. The article also evaluates Canada’s parallel regulatory framework and compares its scope, enforcement, and effectiveness with that of the U.S.
Furthermore, this work delves into U.S. efforts to curb China’s technological development through semiconductor export restrictions, targeting companies, such as Huawei. This strategy has escalated trade tensions, compelling China to develop self-sufficiency in critical industries. However, the effectiveness of U.S. sanctions and trade restrictions remains uncertain. While they have caused economic strain on targeted nations, they have also fueled closer alliances between Russia and China, encouraged retaliatory measures, and strained relationships with key U.S. trade partners. Additionally, the legality of these restrictions under the World Trade Organization (WTO) obligations remains contested, with China challenging U.S. export controls as discriminatory and trade-restrictive. If the U.S.’s coercive trade policies alienate allies, disrupt global supply chains, and violate WTO commitments, they could backfire, which could hinder American businesses, isolate the U.S. from international markets, and ultimately undermine its ability to maintain technological and military supremacy
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