With that out of the way, let's get started! Once again, my apologies for looking at this very late; I know I said yes, and I took a bit of time than I like, so.. my bad! All are of course, my personal thoughts, and are no way set to discredit your writing other than constructive feedback!
First and foremost, I don't really get the difference between Option 1 and Option 2. Who I assumed to be a private lawyer in Option 1, versus the one that has the court system. There is not much of a difference between the options, which is not inherently a bad thing, but at the end of the day, it just seems like two official (sort of for Option 1) law-practicing folks. Maybe for Option 1, we can go with something along the line of a "self-appointed / self-learned lawyer" of sorts? This again, I am probably just blabbering because law isn't my forte!
Option 3, we could add a short line where the doctor / surgeon up there is a bit absentminded too, and so was the whole hospital. "Why, this week we only have two cases of scalpels being left inside a patient's body!"
It can happen at a terrifyingly alarming rate.
For Option 4, I don't really know why this needs a court system validity. I can think of this: "You know this is a great opportunity to purge the opposition to our government. Heck, we can even use it to keep the more rebellious members in line!"
[effect] anyone who dares oppose @@LEADER@@ soon found themselves literally brain-dead
* The tragic RL counterpart I can think of is Rosemary Kennedy. She was not necessary an opposition, but a family member of JFK that is a little difficult to work with, so to speak. This option reminds me of that - to keep anyone that bothers you as a leader to be taken away and given a lobotomy, hidden far away. This can also, in turn, leads to a follow-up issue whereby you now have a LOT more lobotomized patients, but one issue at a time!
The lack of court system could add another option - No official way to sue or go through a lawsuit, as far as my limited knowledge of law goes. So... cue a family member of the poor 21 y/o being hysterical and yelling at the doctors, and then asking you to re-establish the court system while you are at it, so that they can "sue every single @@CURRENCY_SINGULAR@@ from these people!"