Difficult decisions on care and services for elderly people: the dilemma of setting priorities in the welfare state

The aging of the population combined with restricted economic resources is leading to an increasing gap between care needs and care resources. The first strategy to cope with this growing disparity is often the rather non-controversial attempt to optimize the use of the resources. At some point in time, however, more crucial decisions are needed. Four levels of decision-making in the system of care services may be identified - from decisions regarding national resource allocation to decisions regarding individual users. The different conditions for making decisions and setting priorities at each level must be considered when studying the decision-making process and the consequences - including the repercussions for other levels and sectors. With Sweden as a case, four trends in decision-making can be seen: decentralization of many controversial decisions; redefining of the lines of responsibility between sectors; increasing inequality in the accessibility, cost, and quality of care; and a general lack of public discussion and debate about central welfare issues.     

Maximum and Minimum Prediction Variance for Spherical and Cuboidal Split Plot Designs

The impact of restricted randomization on the information matrix has created challenges for the computation of design optimality criteria. This article focuses on the computation of the maximum and minimum prediction variance for Central Composite (CCD) and Box–Behnken (BBD) split plot designs (SPD). The approach is to analytically determine the exact maximum and minimum prediction variance for both spherical and cuboidal second-order SPD. A particular feature of these analytical functions is that they are functions of the design parameters. Finally, the application of these analytical functions is demonstrated for a CCD SPD.     

Questioning Consilience and Autonomy in Self-Determination Theory: A Critique and Hermeneutic-Phenomenological Alternative

This paper offers a theoretical analysis of Self-Determination Theory (SDT) and its claims regarding human autonomy. Self-determination theorists have advanced a form of self-regulated, engaged behavior (i.e., autonomy), founded upon on a consilient account of human motivation that assumes multiple, hierarchical levels of organization and causation (e.g., biological, psychological, and social). Autonomy, from this perspective, is taken to emerge from underlying biological mechanisms, but also able to exert its own causal effects in the world as a unique psychological phenomenon. We contend that in theorizing this way, self-determination theorists have invoked a mixed discourse of mechanism and autonomy that leaves important questions unanswered, perhaps most importantly those concerning how autonomy as a kind of volition can fit coherently in the mechanistic account of world that they advocate. We then offer an alternative perspective based upon the work of various hermeneutic-phenomenological thinkers in philosophy and psychology. This alternative perspective conceptualizes human phenomena such as autonomy and motivation in agentic terms, emphasizing meaningful participation in possibility-laden contexts of everyday practices.