Moral principles shaping public policy on euthanasia

People's fear of enduring a prolonged, costly dying while attached to life-sustaining machines has prompted support for the legalization of active euthanasia. Four major principles--sanctity of life, prohibition against killing, autonomy, and the common good--have a bearing on the debate.     

Old and thin

Viewing an elderly patient's refusal of food from the perspective of the jain tradition of sallekhana (voluntary starvation) permits the author to reconcile her need to "do something" with her belief in the principle of patient autonomy.     

Effects of fixed costs in two-person sequential bargaining

Rubinstein (1982) considered the problem of dividing a given surplus between two players sequentially, and then proposed a model in which the two players alternately make and respond to each other's offers through time. He further characterized the perfect equilibrium outcomes, which depend on the players time preferences and order of moves. Using both equal and unequal bargaining cost conditions and an unlimited number of rounds, two experiments were designed to compare the perfect equilibrium model to alternative models based on norms of fairness. We report analyses of final agreements, first offers, and number of bargaining rounds, which provide limited support to the perfect equilibrium model, and then conclude by recommending a shift in focus from model testing to specification of the conditions favoring one model over another.     

Problems in measuring role strains and social functioning in relation to psychological symptoms

The problems that people experience in social roles can be regarded as either causes or consequences of psychological symptoms. To reflect one of these possibilities, Pearlin et al. (1981) developed measures of "role strains" which are considered sources of psychopathology. To reflect the other position, Dohrenwend et al. (1981) constructed measures of "role functioning" which are seen as consequences of psychopathology. We show that the measures developed by these two teams of investigators are similar in content and show substantial empirical overlap despite the different meanings attributed to them. In an effort to understand whether these highly correlated measures assess, "role strain" or "role functioning," we conduct an exploratory analysis of marital and housework role problems, using a small panel sample of New York City residents. Specifically, we use instrumental variables to identify reciprocal effects between psychological distress and each role area. We find that the relationship between housework role problems and distress is more consistent with Pearlin et al.'s interpretation, whereas the relationship between marital problems and distress is more consistent with that of Dohrenwend et al. Investigators interested in measuring either role strain or role functioning must bear in mind the strong possibility of contamination from the other construct.     

Assimilation vs. multiculturalism: Views from a community in France

A recent American survey of attitudes toward societal multiculturalism vs. assimilation has found surprisingly widespread support for maintaining heritage cultures not only among immigrant minority groups but also among most subsamples of majority host groups, black and white. Working-class whites are the one exception. This pilot study explores the same attitude domain in a contrasting European setting. Randomly selected samples of middle- and working-class families (a mother, father, and teenage son or daughter) from a small city in France were interviewed. As a group, they were neutral to slightly favorable to immigrants maintaining heritage cultures and languages rather than losing them through assimilation. On measures of attitudes toward specific immigrant groups, there were marked intergroup dyfferunces with Maghrebian Arabs rated leist favorably and Southeast Asians, the model immigrants, most favorably. Comparisons of subgroups of respondents who varied in terms of (a) political left-right orientation, (b) social class standing, (c) degree of religiosity, and (d) generational level provide the base for a more general discussion of cultural assimilation and multiculturalism.     

Religion: friend or foe of the aging?

Religion can be a guide in the quest of older adults for a fuller understanding of their lives and purposes as they cope with the diminishments brought about by aging.     

How to fight the regulator glut: the role of the HCFA-type survey

More and more hospitals in this country are being threatened by the removal of their Health Care Financing Authority (HCFA) Medicare Certification. A perception of competitiveness among HCFA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other organizations has heightened this concern. This unpleasant situation has provoked many hospitals to prevent any type of regulator decertification. One of the practical methods of prevention is the use of a HCFA-type survey. These surveys prepare institutions for unexpected, unarmored review by regulators and should be part of the quality improvement (QI) process even in institutions with limited resources. This article discusses the means to accomplish the HCFA-type survey. The development of the survey process involves institutional commitment, hospital policy and procedures, a department review schedule, selection of review personnel, preparation of review personnel, record keeping, and department education.     

The medical examiner and deaths in the hospital setting

There has been a perceived increase in the number of medical negligence claims in recent years. The modern metropolitan medical examiner is increasingly called upon to deal with numerous medical, legal, social, and ethical issues. Nowhere is the role of the medical examiner more important than in the investigation of deaths related to surgical, diagnostic, anesthetic, or therapeutic procedures. Medical examiners have an important role in the investigative process. Through utilization of the offices and services of the medical examiner, questions raised by families, physicians, and other hospital employees may be satisfactorily answered a priori, and litigation may therefore be averted.     

Twelve questions to ask about your outcomes monitoring system--Part I

Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost.