Some criteria for making decisions concerning the distribution of scarce medical resources

In this paper I proceed on the assumption that moral philosophers can and should contribute to the resolution of perplexing moral problems. The ones considered here relate to decisions concerning the distribution of scarce medical resources as between those in need of treatment. I draw on considerations of egalitarianism and concern for the maximization of the use of scarce resources in the task of satisfying basic human needs (such as for good health). I propose certain principles and offer some supporting suggestions as guidelines or rules for medical decisions with a view to providing a helpful decision procedure for the various persons (doctors, community panels and so on) whose task it is to make the life-or-death decisions involved in allocating certain scarce medical resources.     

Resource management schemes

Every large management organization undergoes the cyclic progress of planning, programming, budgeting, and rating of work tasks of projects to be accomplished by priority in the light of resource constraints controlling personnel strenghts and operating funds by fiscal periods. This is true, especially of governmental departments that are commodity oriented. There must be some ultimate goal of fine grain visibility that management can attempt to achieve or at least approach in order for the functional directors within the organization structure to relate and report most readily to provide required data for proficient resource management. Two essential requirements are visibility and integrated reporting as herein prescribed. Following the ascertainment of resource requirements in the light of projected work effort, some logical procedure should be employed in the rationale of resource adjustments. The Tolerance Box technique is herein described.     

Repeat abortion

A reanalysis of the repeat abortion experience of New York City residents during July 1, 1970 to June 30, 1972 is undertaken on the basis of a probability model that generates repeat abortion ratios as a function of assumptions about fecundity, contraceptive efficiency, and exposure lengths. Tested are three hypotheses put forward by Daily et al. in a 1973 analysis: (i) the low repeat abortion ratio of .0245 is attributable in part to underreporting of registered induced abortions as repeat ones; (ii) a major part of the rise in repeat abortion ratios, from virtually zero to six percent over four consecutive six-month intervals, is explainable in terms of the rising volume of exposure time to risk of repeat abortion relative to the stream of initial abortions; and (iii) the higher abortion ratios of women in their twenties compared to those of older or younger women is ascribable to “differences in fecundity and intercourse frequency.” Support is found for the first two hypotheses, and a mixed outcome for the third.     

Dynamic Simulation as an Approach to Understanding Hurricane Risk Response: Insights from the Stormview Lab

This article investigates the use of dynamic laboratory simulations as a tool for studying decisions to prepare for hurricane threats. A prototype web‐based simulation named Stormview is described that allows individuals to experience the approach of a hurricane in a computer‐based environment. In Stormview participants can gather storm information through various media, hear the opinions of neighbors, and indicate intentions to take protective action. We illustrate how the ability to exert experimental control over the information viewed by participants can be used to provide insights into decision making that would be difficult to gain from field studies, such as how preparedness decisions are affected by the nature of news coverage of prior storms, how a storm's movement is depicted in graphics, and the content of word‐of‐mouth communications. Data from an initial application involving a sample of Florida residents reveal a number of unexpected findings about hurricane risk response. Participants who viewed forecast graphics, which contained track lines depicting the most likely path of the storm, for example, had higher levels of preparation than those who saw graphics that showed only uncertainty cones—even among those living far from the predicted center path. Similarly, the participants who were most likely to express worry about an approaching storm and fastest to undertake preparatory action were those who, ironically, had never experienced one. Finally, external validity is evidenced by a close rank‐order correspondence between patterns of information use revealed in the lab and that found in previous cross‐sectional field studies.     

1998 Annual Meeting Plenary Session: Assessing and Managing Risks in a Democratic Society

The theme of one of the plenary sessions held at the 1998 annual meeting of the Society for Risk Analysis, 'Assessing and Managing Risks in a Democratic Society,' was chosen to reflect the current debate about the best ways to integrate social, political, economic, and technical issues into fair risk management decisions. In the papers presented here, the three plenary speakers provide their perspectives on how environmental risk management decision making is—or should be—informed by democratic processes.
John D. Graham Making Sense of Risk
Robert F. Kennedy, Jr. Risk, Democracy, and the Environment
Jason Shogren Markets to Master Health and Environmental Risk
Audience Questions and Answers     

Beyond the nature/society divide: Learning to think about a mountain

Sociological efforts to understand environment-society relationships fall primarily into four conceptual categories. The first three, involving analytical separation, analytical primacy, and balanced dualism, all draw distinctions between biophysical and social aspects of human experience, with subsequent analyses being based on thesea priori distinctions. The fourth or constructivist approach questions this naturalized dichotomy, calling attention instead to mutual contingency or conjoint constitution: What we take to be physical facts are likely to be strongly shaped by social construction processes, and at the same time, what we take to be strictly social will often have been shaped in part by taken-for-granted realities of the physical world. Technology offers important opportunities for tracing these interconnections, being an embodiment of both the physical and the social. The point is illustrated with a long-term historical analysis of a specific physiographic feature—a mountain—that has undergone little overtphysical change over the centuries, but has undergone repeated changes in its social meanings and uses. Few of the changes would have been possible in the absence of the mountain's physiographic characteristics; similarly, few would have occurred in the absence of changing sociocultural definitions and possibilities. The challenge for sociology is not just to recognize the importance of both the physical and the social factors, and certainly not to argue over the relative importance of the two, but to recognize the extent to which what we take to be physical and social factors can be conjointly constituted.The paper's subtitle is intended as a tribute to Aldo Leopold and to one of his most famous essays (1949).     

Adult youth workers’ conceptions of their work in an under-resourced community in the United States

This study examined adult workers’ conceptions of their work with youth in a large, underserved, urban region in the northeastern United States. Drawing on qualitative interviews with 18 youth workers from various organizations, affiliated with a community coalition focused on substance abuse prevention, we explored how adults viewed their role of working with youth. We were particularly interested in whether these workers saw youth empowerment and collaboration with youth for community change as part of their role. Our data suggested that while workers in this study were very supportive of youth, the support and actions they provided were on behalf of rather than with them and that, in general, partnering with youth for community change was not a part of what they envisioned their work to be. While a few of the adults attempted to work more collaboratively with youth, they were clearly in the minority.     

The Strategic Management of Corporate Myths

In a new approach, which departs from traditional modes of management, highly effective leaders can use the powerful tool of organizational myths as managerial interventions to inspire, indeed control, behavior and attitudes. The authors suggest a way to analyze or ‘map’ myths, evaluate their potency, determine if the myths conflict with strategic organizational goals and, where necessary, take action to build positive and supportive myths. The myths that have been used by effective organizations are presented in support of the concepts that are advanced by the authors. This revised version was published online in August 2006 with corrections to the Cover Date.