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Ending the death penalty for juveniles
Editorial
Jeffrey Coolidge
Ending the death penalty for juveniles
For the report from Amnesty International see https://www. amnesty.org/en/documents/ mde13/3112/2016/en/ For The Lancet’s Editorial on the death penalty see Editorial Lancet 2014; 383: 1184 For more about Iran’s execution toll in 2015 see https://www. amnesty.org/en/latest/ news/2015/07/irans-staggeringexecution-spree/
Last week, Amnesty International published a distressing report on the death penalty for juvenile offenders in Iran. 73 such executions have been recorded in 2005–15, mostly for murder, rape, drug-related offences, and “enmity against God”, a vaguely defined offence related to national security. Most individuals have spent, on average, 7 years on death row, after often superficial trials that relied on “confessions” extracted through threats, torture, and abuse. Many died without being informed of the right to seek retrial. The UN Convention on the Rights of the Child (UNCRC), of which Iran is a state party, prohibits the use of the death penalty for individuals younger than 18 years at the time of the crime. However, in Iran, children are judged to have full criminal responsibility once they reach puberty, defined as 15 years for boys and 9 years for girls. Such clear violation of international law, sex discrimination, and fundamental flouting of human rights are unacceptable. Although the new Islamic Penal Code in 2013 allowed judges to replace the death penalty with an alternative
punishment based on the offender’s “mental growth and maturity”, such assessments are often brief and done by officials without an adequate knowledge of child psychology. One girl was asked whether she had prayed and read the Qur’an, and whether she understood that killing is “religiously forbidden”. She was judged “not insane” and re-sentenced to death. Clearly, such piecemeal reforms are still nowhere near the long-overdue pledge that Iran undertook in 1994 when it ratified the UNCRC. The Lancet supports the abolishment of capital punishment. However, with nearly 700 executions reported between January and July, 2015, Iran continues to be one of the top five executioners worldwide, together with China, Saudi Arabia, Iraq, and the USA. More fundamental reforms to the judicial system in countries with the death penalty, and pressure from international communities, are urgently needed— not only to save the lives of at least 160 juveniles who remain on death row in Iran today, but also to abolish this inhumane practice once and for all. The Lancet
Ed Kashi/VII/Corbis
Acute myocardial infarction in women
For more on global mortality rates of women see http://www. who.int/mediacentre/factsheets/ fs334/en/ For the American Heart Association statement see Circulation 2016; published online Jan 25. DOI:10.1161/ CIR.0000000000000351
506
Cardiovascular disease is often regarded as a male disease, but since 1984, the annual mortality rate of the disease in the USA has been higher for women than for men. The disease remains the number one killer of women in the USA—and the world—despite substantial decreases in mortality rates for American women in the past decade. With a view to improving coronary heart disease morbidity and mortality for women and highlighting present research gaps, the American Heart Association has released its first scientific statement on acute myocardial infarction in women. The statement provides a comprehensive review of the pathophysiology, epidemiology, clinical presentation, treatment, and outcomes of women with acute myocardial infarction and highlights key sex-specific differences in these areas. Women’s health differs from men’s biologically and psychosocially, resulting in sex-specific differences in acute myocardial infarction. For example, women have an increased prevalence of fatalities due to plaque erosion compared with men, and although both sexes share similar risk factors for coronary heart disease, some
factors—such as tobacco use, type 2 diabetes, depression, and emotional stress—are more potent in women. Sex differences also exist in clinical presentation, with women presenting more often with atypical symptoms, resulting in detrimental consequences for diagnosis and treatment, and subsequently worse outcomes and increased rates of readmission, reinfarction, and death. Present guidelines recommend similar perfusion therapies for both sexes, although the risk of bleeding and other complications is higher in women. In the USA, women—especially non-white women—are less likely to be given the guideline-directed treatments than men. In view of the differences between the sexes, a more tailored approach to women’s treatment would be expected, but sex-specific guidelines are often restricted by an underrepresentation of female participants in clinical trials. To remedy this shortcoming, policy makers need to develop solutions to increase the participation of women in all cardiovascular clinical trials. Only with sex-specific research will we be able to separate the bias from the biology in the poor outcomes of women. The Lancet www.thelancet.com Vol 387 February 6, 2016
Jeffrey Coolidge
Ending the death penalty for juveniles
For the report from Amnesty International see https://www. amnesty.org/en/documents/ mde13/3112/2016/en/ For The Lancet’s Editorial on the death penalty see Editorial Lancet 2014; 383: 1184 For more about Iran’s execution toll in 2015 see https://www. amnesty.org/en/latest/ news/2015/07/irans-staggeringexecution-spree/
Last week, Amnesty International published a distressing report on the death penalty for juvenile offenders in Iran. 73 such executions have been recorded in 2005–15, mostly for murder, rape, drug-related offences, and “enmity against God”, a vaguely defined offence related to national security. Most individuals have spent, on average, 7 years on death row, after often superficial trials that relied on “confessions” extracted through threats, torture, and abuse. Many died without being informed of the right to seek retrial. The UN Convention on the Rights of the Child (UNCRC), of which Iran is a state party, prohibits the use of the death penalty for individuals younger than 18 years at the time of the crime. However, in Iran, children are judged to have full criminal responsibility once they reach puberty, defined as 15 years for boys and 9 years for girls. Such clear violation of international law, sex discrimination, and fundamental flouting of human rights are unacceptable. Although the new Islamic Penal Code in 2013 allowed judges to replace the death penalty with an alternative
punishment based on the offender’s “mental growth and maturity”, such assessments are often brief and done by officials without an adequate knowledge of child psychology. One girl was asked whether she had prayed and read the Qur’an, and whether she understood that killing is “religiously forbidden”. She was judged “not insane” and re-sentenced to death. Clearly, such piecemeal reforms are still nowhere near the long-overdue pledge that Iran undertook in 1994 when it ratified the UNCRC. The Lancet supports the abolishment of capital punishment. However, with nearly 700 executions reported between January and July, 2015, Iran continues to be one of the top five executioners worldwide, together with China, Saudi Arabia, Iraq, and the USA. More fundamental reforms to the judicial system in countries with the death penalty, and pressure from international communities, are urgently needed— not only to save the lives of at least 160 juveniles who remain on death row in Iran today, but also to abolish this inhumane practice once and for all. The Lancet
Ed Kashi/VII/Corbis
Acute myocardial infarction in women
For more on global mortality rates of women see http://www. who.int/mediacentre/factsheets/ fs334/en/ For the American Heart Association statement see Circulation 2016; published online Jan 25. DOI:10.1161/ CIR.0000000000000351
506
Cardiovascular disease is often regarded as a male disease, but since 1984, the annual mortality rate of the disease in the USA has been higher for women than for men. The disease remains the number one killer of women in the USA—and the world—despite substantial decreases in mortality rates for American women in the past decade. With a view to improving coronary heart disease morbidity and mortality for women and highlighting present research gaps, the American Heart Association has released its first scientific statement on acute myocardial infarction in women. The statement provides a comprehensive review of the pathophysiology, epidemiology, clinical presentation, treatment, and outcomes of women with acute myocardial infarction and highlights key sex-specific differences in these areas. Women’s health differs from men’s biologically and psychosocially, resulting in sex-specific differences in acute myocardial infarction. For example, women have an increased prevalence of fatalities due to plaque erosion compared with men, and although both sexes share similar risk factors for coronary heart disease, some
factors—such as tobacco use, type 2 diabetes, depression, and emotional stress—are more potent in women. Sex differences also exist in clinical presentation, with women presenting more often with atypical symptoms, resulting in detrimental consequences for diagnosis and treatment, and subsequently worse outcomes and increased rates of readmission, reinfarction, and death. Present guidelines recommend similar perfusion therapies for both sexes, although the risk of bleeding and other complications is higher in women. In the USA, women—especially non-white women—are less likely to be given the guideline-directed treatments than men. In view of the differences between the sexes, a more tailored approach to women’s treatment would be expected, but sex-specific guidelines are often restricted by an underrepresentation of female participants in clinical trials. To remedy this shortcoming, policy makers need to develop solutions to increase the participation of women in all cardiovascular clinical trials. Only with sex-specific research will we be able to separate the bias from the biology in the poor outcomes of women. The Lancet www.thelancet.com Vol 387 February 6, 2016