Re-evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses.

AIM: The criteria for diagnosing abusive head trauma (AHT) are not well defined and this condition might be diagnosed on failing premises. Our aim was to review criminal AHT cases in Norwegian courts by scrutinising the underlying medical documentation. METHODS: Cases were identified in the data registry for Norwegian courts from 2004 to 2015. Documentation was obtained from relevant health institutions. The medical co-authors first made independent evaluations of the documentation for each child, followed by a consensus evaluation. RESULTS: A total of 17 children (11 boys) were identified, all diagnosed as AHT by court appointed experts, 15 were infants (mean age 2.6 months). A high proportion (41.2%) was born to immigrant parents and 31.3% were premature. The medical findings could be explained by alternative diagnoses in 16 of the 17 children; 8 boys (7 infants - mean age 2.9 months) had clinical and radiological characteristics compatible with external hydrocephalus complicated by chronic subdural haematoma. Six children (five infants with mean age 2.1 months) had a female preponderance and findings compatible with hypoxic ischaemic insults. CONCLUSION: The medical condition in most children had not necessarily been caused by shaking or direct impact, as was originally concluded by the court experts.

Breivik--the Norwegian terrorist case.

On July 22, 2011, there were two murderous attacks in Norway. Both assaults - the bombing of governmental buildings in Oslo City center and the lethal shooting down of young members of the Labour Party on an island - were planned and accomplished by a lone perpetrator. These episodes give rise to several interesting questions. What happened really, and how could it happen? Was the perpetrator sane or insane? What was the ideological background for the attacks? It is unnecessary to discuss in any detail whether or not these acts should be categorized as terrorism. However, there is good reason to consider what these terror attacks imply for Norwegian society at large. What significance did the attacks have for Norwegian democracy, and did they have any impact on the 2013 parliamentary elections? What will be the future for the offender, both in the short term and in years to come? What will happen to the Norwegian insanity defense? These questions are addressed in this article.

[Termination of mechanical ventilation in amyotrophic lateral sclerosis]. / Avslutning av respiratorbehandling ved amyotrofisk lateral sklerose.

BACKGROUND: Mechanical ventilation may relieve symptoms and prolong life for patients with amyotrophic lateral sclerosis, but may also prolong suffering. More knowledge is needed on ethical, legal and medical aspects upon termination. MATERIAL AND METHODS: Two cases are discussed in light of relevant laws and literature, as well as the authors' own research and clinical experience. RESULTS: A patient who had first declined life-sustaining treatment eventually chose to undergo tracheostomy. He later approached a locked-in state and wanted to terminate the treatment. Another patient reported poor quality of life and wanted to die, but declined to make a statement on refusal of resuscitation in case of an emergency. He was later resuscitated from CO2 narcosis and received non-invasive ventilation. He repeated that he wanted to die, but did not decide to terminate the ventilator until he was offered palliative treatment. Both patients received morphin and anxiolytics, and died shortly after the ventilator was withdrawn. INTERPRETATION: Mechanical ventilation can be terminated in line with good medical and ethical standards, and will then usually be legal. Patients have a legal right to refuse life-sustaining treatment, but not everybody want to make decisions regarding their own death. Fear of conducting euthanasia may prolong the patient's death process and prevent adequate palliative treatment.