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Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilize and long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is a procedure routinely undertaken by clinicians in emergency departments for hip fracture patients, but use by paramedics at the scene of emergency calls, is not yet evaluated (1).
We undertook a randomized controlled feasibility trial using novel audited scratchcard randomization to allocate eligible patients to FICB or usual care. Paramedics are recruited and trained to assess patients for hip fracture and carry out FICB. We will follow up patients to assess accuracy of paramedic diagnosis, acceptability to patients and paramedics, compliance of paramedics and also measures of pain, side effects, time in hospital and quality of life in order to plan a full trial if appropriate. The primary outcome measure is health related quality of life, measured using Short Form (SF)-12 at 1 and 6 months. Interviews and focus groups will be used to understand acceptability of FICB to patients and paramedics. This study was funded by Health and Care Research Wales (1003).
We have developed:
• paramedic pathway to assess patients for hip fracture and FICB
• paramedic training package, delivered by Consultant Anaesthetist
• randomization scratchcards.
To date we have recruited nineteen paramedics; ten are fully trained and recruiting patients, the remainder are being trained. Fifty-four patients have been randomized and thirty-five have consented to follow-up. Thirteen 1-month and five 6-month follow-up questionnaires have been received.
This study will enable us to recommend whether to undertake a definitive multi-centre randomized controlled trial of FICB by paramedics for hip fracture to determine if the procedure is effective for patients and worthwhile for the National Health Service.
Introduction: the meanings of religious neutrality
It is often said that the state should be neutral in matters of religion, but neutrality is a problematic concept, capable of several different meanings. Despite that, the term is on the whole less problematic than ‘secular’. Several authors have noticed the differing senses of ‘secular’ when used in relation to the state (Taylor, 2009): from its original meaning denoting a division in jurisdiction between political and religious authorities (Benson, 2000) to official indifference (Rivers, 2010) or antipathy towards religion. Even in states such as France with constitutional provisions on secularity there can be considerable debate as to meaning (Laborde, 2008). Debates using the term ‘secular state’ are now so prone to terminological confusion that for the present purpose, in discussing the jurisprudence of the European Court of Human Rights (ECtHR), it is more helpful to focus on different aspects of neutrality.
Of these the least controversial perhaps is the duty of state officials to behave impartially, that is without judging between the merits of different religions and in a non-discriminatory way. Even this does not prevent controversy over whether there is scope for recognizing the religious beliefs of officials over matters of conscience in the workplace or whether to do so compromises the state’s position, as in Ladele v. London Borough of Islington (Malik, present volume). Beyond impartiality, however, conceptual controversy begins and at least four further variants can be identified, with different implications for both individuals and religious organizations. One strand stresses neutrality as the equi-distance of the state from all religions so they are treated even-handedly and none is favoured. This is often taken to entail separation of religion and state, although strictly it does not entail that. A second strand focuses on strict equality of treatment of religions by the state.
According to a book title chosen by one commentator on the UK's Human Rights Act 1998, Professor Francesca Klug, human rights are Values for a Godless Age. No doubt before the events of September 11 2001 the secularization thesis had a certain resonance. The legislation could be seen as a (very faint) shadow of that great hymn of the secular state — the French Declaration of the Rights of Man. Certainly some religious organisations feared that rather than the Human Rights Act 1998 enhancing their religious freedom it would be used against them and they therefore sought — unsuccessfully — guarantees against litigation in the form of exemptions. A decade later, the revolutionary fervour has cooled somewhat and an assessment can be made of the treatment of religious liberty under the Act to date. We now know also that the obituary notices for religious faith were premature, even in (comparatively) secular Western Europe: ‘God is Back’ as another recent book title has it. Indeed, the resurgence of a vigorous religious discourse in public life in the UK is perhaps not just a reaction to secularization but in a sense also evidence of a growing human rights culture following incorporation of the European Convention.
The focus in this chapter is on a handful of the more controversial religious liberty claims that have come before the courts since 2000. I have selected these for the range and variety or issues that they raise directly concerned with claims to manifest religious belief. These include whether Christian parents have a right that their children be educated in private schools in accordance with their religious beliefs on discipline; whether a Muslim schoolgirl has the right to wear a jilbab, contrary to the school uniform policy of her (mixed) state secondary school; whether a Hindu community can resist an order for the destruction of a diseased bullock of sacred religious significance to them; and whether orthodox Hindus should be accommodated in their wish for cremation upon an open-air funeral pyre.
The great bustard Otis tarda became extinct in the UK during the 19th century due to a combination of factors, including hunting, egg collection and changes in agriculture. In 2003 a 10-year licence was granted to begin a trial to reintroduce the species back to the UK. Here we report on the first 5 years of the trial and assess the progress made towards establishing a founder population. From April 2004 to September 2009 a total of 102 great bustard chicks were imported from Russia and 86 released on Salisbury Plain. Monitoring showed that post-release survival was 18% in the first year following release, and that mortality of released bustards was mainly attributable to predation and collisions. Estimated adult survival was 74%, although the sample size was small. All known surviving great bustards are faithful to the surroundings of the release site, returning throughout the year. A lek has been established where males have been observed displaying to females. The first nesting attempt was in 2007, and in 2009 two females aged 3 and 4 years successfully nested, fledging one chick each. Models incorporating the new demographic estimates suggest that at the end of the 10-year trial period the project can expect to have 8–26 adults as a founder population.
This article analyses recent trends in the jurisprudence of the European Court of Human Rights concerned with the right to freedom of thought, belief and religion (Article 9, European Convention on Human Rights) and the right of parents to respect by the state for their religious and philosophical views in the education of their children (Article 2, Protocol 1).1 These developments include notable decisions concerned with protection from religious persecution in Georgia, with religious education in Norway and Turkey and with the display of crucifixes in state schools in Italy. It is apparent that the European Convention religious liberty jurisprudence increasingly stresses the role of the state as a neutral protector of religious freedom. For individuals religious freedom is now also recognised to include not only the right to manifest their religious belief but also freedom from having to declare their religious affiliation. As the religious liberty jurisprudence comes of age, other significant developments, for example in relation to conscientious objection to military service, can be anticipated.
This article argues that there is a need to modernise the law governing accountability of the UK security and intelligence agencies following changes in their work in the last decade. Since 9/11 the agencies have come increasingly into the spotlight, especially because of the adoption of controversial counter-terrorism policies by the government (in particular forms of executive detention) and by its international partners, notably the US. The article discusses the options for reform in three specific areas: the use in legal proceedings of evidence obtained by interception of communications; with regard to the increased importance and scle of collaboration with overseas agencies; and to safeguard the political independence of the agencies in the light of their substantially higher public profile. In each it is argued that protection of human rights and the need for public accountability requires a new balance to be struck with the imperatives of national security.
This is the first in what is intended as a series of comments on current developments in the law concerning freedom of religion that will appear regularly in this Journal. This first survey deals with religious liberty challenges brought in the UK courts in 2007 and 2008. A subsequent survey will examine similar developments in international human rights law and especially before the European Court of Human Rights.
Non-invasive ventilation (NIV) is a standard of care for some patient groups with acute respiratory failure and a number of national and international bodies have produced guidelines. Novel uses of NIV continue to be explored, although not all trials have demonstrated successful outcomes when compared with traditional alternatives. Research in the field continues at a pace with recent reports including possible use in severe acute respiratory syndrome (SARS) and motor neuron disease. This chapter presents in three parts an overview of three related fields. The first part discusses the issues of oxygen therapy both alone and in conjunction with non-invasive support. The second part surveys the use and role of continuous positive airway pressure (CPAP), which remains a valuable alternative to ventilation. The final part focuses on NIV and includes a summary of the available evidence base, and covers some of the more practical issues of machine and patient interfaces.
In recent years, the clash between supporters of religious liberty and sexual orientation equality legislation has led to repeated battles both in Parliament and the courts. First came the clashes over the scope of exemptions in employment discrimination legislation for religious groups. The UK Regulations dealing with employment discrimination on grounds of sexual orientation give a limited exception for ‘employment for purposes of an organised religion’, which allows an employer to apply a requirement related to sexual orientation to comply with the doctrines of the religion, or to avoid conflicting with the strongly held religious convictions of a significant number of the religion's followers. A legal challenge brought to the scope of this exception was unsuccessful but, despite that, the exemption has not averted damaging findings of discrimination against the Church of England. The Bishop of Hereford was held to have discriminated unlawfully in blocking the appointment of a practising homosexual to a youth-officer post within the Church of England. The partial success of religious groups in achieving exemption was followed by defeat in the equivalent regulations dealing with discrimination in goods and services, made under the Equality Act 2006, despite the claims of Catholic adoption agencies that they would rather close than place children with same-sex couples.
Common lawyers tend to be somewhat apologetic about legal reasoning. It is not that they consider it to be an oxymoron. Rather, the subject is seen as too basic – not worthy of advanced investigation. This is perhaps because law students ‘cover’ ‘Legal Method’ at an early point in their studies and assume that, having mastered precedent and statutory interpretation, they can leave it behind in favour of more intellectually challenging topics. It is hard to imagine that a professional seminar in the United Kingdom on the topic of Legal Method would attract the involvement of virtually every senior member of the judiciary – as happened in New Zealand in 2001. Likewise, academic attention devoted to legal reasoning is marginal in comparison to substantive analysis, and is mostly reserved for ‘Jurisprudence’ (the thinking lawyer's diversion) under the guise of theories of adjudication.
However, this is an entirely appropriate focus for a study of the early impact of the Human Rights Act. It is not necessary to believe the New Labour hyperbole (in the days when ministers were still proud of the Act, rather than disowning its progeny) about the biggest legal change since Magna Carta. It is enough to acknowledge that comparing judgments before and after the Act that a major shift has occurred in their style, content and source material.
English administrative law had, prior to the Human Rights Act, failed to develop effective protection for human rights against incursions by public officials and authorities. Much of the blame for the parlous defence of civil liberties and human rights can be attributed to the judges’ sentimental attachment to the Wednesbury test as the appropriate standard for reviewing official action. Under this test, action was only reviewable if it was so unreasonable that no reasonable decision-maker would have taken it. Long criticised for its circularity, imprecision and excessive deference to the executive, Wednesbury nevertheless continues to hold considerable sway.
Its influence can be seen clearly in Brind, in which – a mere fifteen years ago – the House of Lords ruled that the Home Secretary was not legally obliged to consider the Convention right of freedom of expression when imposing restrictions on television and radio interviews with people connected with a terrorist organisation. Their Lordships considered that to hold otherwise would amount to what they described as ‘back door’ incorporation of the Convention and that they should not rush in where (at that time) Parliament had chosen not to. The Convention's relevance was limited to instances of statutory ambiguity – something which in the circumstances of the case (concerning a very wide power to give ‘directions’ to broadcasters) their Lordships were reluctant to find.