John Kleinig

Leading Causes of Unintentional and Intentional Injury Mortality: United States, 2000–2009

OBJECTIVES We have described national trends for the 5 leading external causes of injury mortality. METHODS We used negative binomial regression and annual underlying cause-of-death data for US residents for 2000 through 2009. RESULTS Mortality rates for unintentional poisoning, unintentional falls, and suicide increased by 128%, 71%, and 15%, respectively. The unintentional motor vehicle traffic crash mortality rate declined 25%. Suicide ranked first as a cause of injury mortality, followed by motor vehicle traffic crashes, poisoning, falls, and homicide. Females had a lower injury mortality rate than did males. The adjusted fall mortality rate displayed a positive age gradient. Blacks and Hispanics had lower adjusted motor vehicle traffic crash and suicide mortality rates and higher adjusted homicide rates than did Whites, and a lower unadjusted total injury mortality rate. CONCLUSIONS Mortality rates for suicide, poisoning, and falls rose substantially over the past decade. Suicide has surpassed motor vehicle traffic crashes as the leading cause of injury mortality. Comprehensive traffic safety measures have successfully reduced the national motor vehicle traffic crash mortality rate. Similar efforts will be required to diminish the burden of other injury.

The Concept of Desert

We have already noted that there exists a close relation between punishment and desert. Where punishment is inflicted on an innocent person, or where the punishment inflicted is out of all relation to the seriousness of the offence we need to qualify it by the use of some disvaluative adjective such as ‘undeserved’. This, as we argued, is necessary, since punishment is a moral notion, discriminating between various activities at least partly on the basis of moral considerations.

Confronting Death From Drug Self-Intoxication (DDSI): Prevention Through a Better Definition

Suicide and other self-directed violence deaths are likely grossly underestimated, reflecting inappropriate classification of many drug intoxication deaths as accidents or unintentional and heterogeneous ascertainment and coding practices across states. As the tide of prescription and illicit drug-poisoning deaths is rising, public health and research needs would be better satisfied by considering most of these deaths a result of self-intoxication. Epidemiologists and prevention scientists could design better intervention strategies by focusing on premorbid behavior. We propose incorporating deaths from drug self-intoxication and investigations of all poisoning deaths into the National Violent Death Reporting System, which contains misclassified homicides and undetermined intent deaths, to facilitate efforts to comprehend and reverse the surging rate of drug intoxication fatalities.

The Ethics of Harm Reduction

The article attempts to set harm minimization within drug settings into a larger framework of harm minimization practices. It seeks to provide a plausible account of harm reduction and then explores four ethical challenges for harm reduction strategies.

Teaching and learning police ethics: Competing and complementary approaches

There is still much confusion over the teaching of police ethics, a confusion rooted not only in uncertainty about the specific character of police ethics but also in the varied audiences and contexts for which its teaching is intended. This article attempts to separate out the main questions that the teaching of police ethics must confront and then to provide some critical evaluation of the options to which these questions give rise.

Ethical issues in substance use intervention.

This essay offers an overview of some of the ethical questions raised by governmental and medical interventions into drug use. With respect to the former, it begins with the liberal assumption that constraints on free action are to be justified by reference to its deleterious impact on others, but then qualifies that assumption by noting the social requisites of free action. With respect to medical interventions, it focuses on the codes that have been developed for treatment providers and their clients, and explores the ethical underpinnings of several of their central provisions—informed consent, privacy, confidentiality, nondiscrimination, professionalism, and accountability.

Rethinking Noble Cause Corruption

The historical background to and use of the expression ‘noble cause corruption’ to characterise certain types of police behaviour is explored. One account, in which it is understood to provide a mantle of respectability for certain kinds of police corruption is contrasted with another in which it describes a kind of corruption that is not ameliorated by its motivation. This divergence, however, points to some deeper problems and complexities in police decision-making that have not been fully acknowledged or explored in police work. These are most acute when general rules do not adequately accommodate the complexities of real-life situations.

Thinking Ethically About Needle and Syringe Programs

Accepting—for the sake of argument—our current legal policies concerning heroin use and its users, what ethical questions are raised for needle and syringe program (NSPs)? Do they weaken drug laws, send the wrong message or obscure the right message, do little to eliminate the harm of drugs, detract from alternatives, and/or constitute a counsel of despair? I suggest that in the absence of established better alternatives, NSPs constitute a morally acceptable and in some cases even desirable option despite the continued criminalization of injecting drug use. Yet they must be conceived and administered in ways that do not reinforce prevailing social prejudices.

Ready for Retirement: The Gateway Drug Hypothesis.

The psycho-social observation that the use of some psychoactive substances (“drugs”) is often followed by the use of other and more problematic drugs has given rise to a cluster of so-called “gateway drug hypotheses,” and such hypotheses have often played an important role in developing drug use policy. The current essay suggests that drug use policies that have drawn on versions of the hypothesis have involved an unjustified oversimplification of the dynamics of drug use, reflecting the interests of certain stakeholders rather than wise social policy. The hypothesis should be retired.

Punishment and Moral Seriousness.

There is no single “problem of punishment”. The activity of punishing is problematic at many levels. There are problems relating to the authority to punish, the severity of punishment, the method of punishment, and of course the moral basis for punishment. Given this, we should be surprised were we to find that all these problems could be comprehended by a single, simple rationale. Nevertheless, there is one, fundamental, underlying moral challenge posed by all punishment, and it is especially (though not exclusively) to this that the classical justifications of punishment have been primarily directed. “Retributivist” and “utilitarian” justifications, however we understand them, are, above all, responses to what I see as this central problem of punishment.