Speech and Suicide-The Line of Legality.

While physician-assisted suicide legislation is being drafted and passed across the United States, a gray-area continues to exist in regard to the legality of a lay person's assistance with suicide. Several high-profile cases have been covered in the media, namely that of Michelle Carter in Massachusetts and William Melchert-Dinkel in Minnesota, but there is also a growing volume of anonymous pro-suicide materials online. Pro-suicide groups fly under the radar and claim to help those desiring to take their own lives. This paper aims to identify the point at which an individual or group can be held civilly or criminally liable for assisting suicide and discusses how the First Amendment can be used to shield authors from such liability.

Review of United States laws pertaining to the recovery and analysis of human skeletal remains.

Human skeletal remains (HSR) are routinely excavated from archeological contexts and analyzed by experts in human osteology. Contrarily, HSR in medicolegal contexts are usually recovered by law enforcement officers and examined by pathologists with limited osteological training. To examine legal requirements for expertise, we reviewed laws in the United States regarding the recovery and analysis of HSR from archeological sites, unmarked graves, and medicolegal contexts. Of the 50 states, 19 (38%) have laws stating that an anthropologist with osteological training should be involved in the recovery or analysis of HSR from an archeological context. Fifteen of those 16 states have laws requiring a minimum level of education to be a qualified skeletal analyst. In contrast, only one state, Texas, requires an anthropologist who handles forensic cases to have a doctoral degree. Including Texas, only eight states (16%) have laws that encourage but do not mandate consultation with a forensic anthropologist for medicolegal skeletal cases. Louisiana and Washington have state-funded laboratories, expert forensic anthropologists, and effective protocols for handling forensic cases. Due process and human rights concerns at stake in criminal cases require that those recovering and analyzing modern HSR have an equal or higher level of expertise than those working with archeological remains. Yet, legislators assume that law enforcement and pathologists are adequately trained. Because court standards demand expert testimony based on accepted methodologies and standard levels of competency, forensic anthropologists have a professional responsibility to engage with lawmakers to draft legislation to ensure proper handling of all skeletal cases.

Immune checkpoint inhibition alters the inflammatory cell composition of human coronary artery atherosclerosis.

BACKGROUND: Immune checkpoint inhibition (ICI) has emerged as a promising new approach to treat malignancy. Such therapies can result in autoimmune-related complications such as myocarditis and hepatitis. The impact of ICI on sites of preexisting chronic inflammation has been less clear. Atherosclerosis is a chronic vascular disease with a significant inflammatory component. METHODS: To determine the effect of ICI on the inflammatory infiltrate in coronary artery atherosclerotic plaques, 11 patients who had recently been treated with ICI and subsequently underwent autopsy were matched with 11 cancer patients who had not received ICI treatment. The amount of CD3+ T-lymphocytes, CD8+ cytotoxic T-lymphocytes, and CD68+ macrophages and the ratios of the various cell types in the coronary artery atherosclerotic plaques were compared. RESULTS: There was no significant difference in the absolute numbers of CD3+, CD8+, or CD68+ cells in the atherosclerotic plaques. In the plaques of the ICI-treated patients, there was a significant increase in the ratio of CD3+ cells to CD68+ cells (CD3/CD68) (P=.002) and a trend towards an increased CD8/CD68 ratio. The increased CD3/CD68 ratio in the ICI-treated patients resulted in 6 of the 11 patients having lymphocyte-predominate inflammation in contrast to the macrophage-predominate inflammation typically found in atherosclerotic plaques. CONCLUSIONS: These findings indicate that ICI alters the inflammatory composition of human atherosclerotic plaque and, thus, may influence plaque progression and/or clinical coronary events. SUMMARY: In cancer patients, treatment with immune checkpoint inhibition is associated with an altered inflammatory cell composition in coronary artery atherosclerotic plaques with an increased ratio of CD3+ T cells to CD68+ macrophages. Thus, immune checkpoint inhibition may influence plaque progression and/or clinical coronary events.