Medico-legal considerations of deaths from watersports among Caribbean tourists.

Watersports are the dominant recreational sporting activity in the Caribbean islands. The economy of many of these islands is tourist-oriented and millions of tourists take part in such sports annually with some fatalities. A total of 13 watersport-related deaths observed in the Cayman Islands over a 2-year period are presented. Complete autopsies with toxicological and histological studies were carried out in each case. Preexisting cardiovascular disease such as hypertension, coronary artery disease (or relative insufficiency) and cardiomyopathies were observed to be significant risk factors and the mean age at death was 53.7 years. Sudden cardiac deaths predominate. One fatal jet skiing accident also occurred. Tourists are advised to undergo complete medical investigations (including ECG and stress tests) prior to engaging in watersports. Drugs of abuse are to be avoided for medical reasons and insurance considerations. Watersports operators must ensure that their clients complete a medical checklist. All equipment and accessories must be functioning optimally to avoid accidents contributed to by such negligence. Consideration should be given to introducing medical tests prior to signing on their clients and there must be adequate supervision. Some form of governmental regulation and enforceable supervision is necessary.

Passive inhalation of cannabis smoke: a novel defence strategy?

Defence lawyers sometimes argue that the presence of cannabinoid metabolites in the defendant's blood or urine resulted from passive unintentional inhalation of environmental cannabis smoke. It would be useful to be able to differentiate passive inhalation from active use so as to discourage the potential abuse of this phenomenon by the defence. Four cases from two jurisdictions in which passive cannabis smoking was used as a defence are presented to illustrate this dilemma. It remains impossible to define objectively an upper limit for blood and urine levels in cases of passive inhalation of cannabis from the environment. However, a claim of passive inhalation, or indeed 'deliberate passive exposure' could be discouraged by making it an offence to place oneself in a position of being 'concerned' in the use of the drug. The onus should be on the defendant to prove that he had not attempted to extricate himself from the situation, being aware of the smoking of cannabis in his immediate vicinity; ignorance would not be an excuse.