Society's search for a legal and ethical basis of physician-assisted suicide

A review of the way physician-assisted suicide (PAS) is being addressed in the United States reveals three models, each functioning out of distinctive concepts of autonomy: (1) litigation, which utilizes philosophical autonomy; (2) legislation, which utilizes political autonomy; and (3) act of conscience by a physician, which utilizes consumer autonomy. Each model raises a correspondingly distinct set of ethical questions and challenges centered around their point of reference-the judicial system, voters, or the doctor-patient relationship. In the end, however, efforts to resolve the challenge of PAS will falter if they do not go beyond these models of autonomy. Religious institutions offer a more constructive setting for facing the life and death decisionmaking of PAS. The challenge for religion is to address PAS in solidarity with sufferers, physicians, and the community, rather than retreating into iconoclastic dogmas.     

The role of demographic and economic characteristics of twelve member states of the European Union in the diversity of state support for families

"This study is based upon an international dataset comparing state support for families in fifteen countries (of which twelve are member states of the European Union).... Using multiple regression analysis, the levels of state support are explained by the principal parameters used for setting the levels of benefit, and by the demographic and economic characteristics of the countries concerned....[Results suggest] that the economic convergence of the member states is likely to promote greater similarity in their systems of state welfare support for families." (EXCERPT)     

Rethinking assimilation and ethnicity: the Chinese in Thailand

US theoretical models of assimilation of ethnic groups within a larger culture usually assume a unilinear, unidimensional process, which is simplistic, does not account for the persistence of ethnicity, and oversimplifies the process of social change. The argument is advanced that ethnic identity is both primordial and situational (a private sense that is self-maintaining, cumulative, deepening, and self-affirming). Typically, a person has one primary ethnic identity, but where ethnic boundaries overlap, there is instrumental identity. Chinese in Thailand mostly adopt Thai values, speak the Thai language, go to Thai schools, join Thai associations, and celebrate Thai religious festivals. Their secondary identity as Chinese is integrated into their associations with other Chinese and in the home through the use of the Chinese language. Their Chinese identity appears also in ancestor worship. There are symbiotic relationships between native Thais and Chinese Thais along class lines. The Chinese are known to have great financial and economic resources, while the Thais have political and administrative control. These differences with the power elites separate the Chinese from the Thais and interfere with assimilation. The power is balanced. If the Chinese gained in political and administrative power, the balance would be upset, and the interests of both groups would be threatened. The view of Whitten and Whitten acknowledges that individuals and groups act to make the best of the situation and are not merely victims of social forces. Actions are maintained and resisted. The important consideration in theory-building is not the terms of assimilation but the terms specifying the conduct of the group as a whole and as individuals in daily social interactions. The theoretical discussion focuses on border crossings, the Skinner view of the Chinese, bilingualism and cultural education, socioeconomic organizations, occupational differences, and religion, tradition, and ethnic identification.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

Net worth and the economic diversity of the elderly

Using data from the 1984 panel of the Survey of Income and Program Participation (SIPP), this article examines characteristics of the older population disaggregated by net-worth quintiles. The authors argue that income is not a sufficient measure of economic status for current policy discussions on issues such as changing Medicare co-payments, increasing the taxation of social security benefits, or means-testing under Medicaid. Net worth is a better measure of economic status, particularly for the elderly, because it represents the net value of assets accumulated over the life course. Their results indicate that there is considerable diversity in the economic status of the older population, which is masked by aggregate statistics (such as means and medians) typically used to summarize the economic status of population groups. Stereotypical views of the elderly based on such aggregates result in misdirected policy formulation. In the future, policymakers will need to formulate policies and programs using information on the distributions of income and assets among the older populations rather than relying on statistical aggregates.     

How well is debt managed by nonprofits?

Little is known about why nonprofits accrue debt, how much they owe, and whether the funds they borrow are used productively. This article distinguishes between productive, problematic, and deferred debt. Employing a data base representative of 114,726 tax-filing charitable nonprofits in the United States in 1986, it examines the pervasiveness of nonprofit debt and the relation between this debt and nonprofit financial health. The analysis finds that over 70 percent of the nonprofits hold debt, the distribution of this debt is highly concentrated, and the level of debt and leverage varies with asset size and type of activity. Nonprofits with higher leverage and absolute debt levels are financially healthier than those with lower levels. While the analysis does not determine whether financially stronger nonprofits are better able to borrow, the results support the view that borrowing in the nonprofit sector is economically efficient.