Symbols, rationality, and justice: rationing health care.

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.     

Ethics and the Physician-Patient Relationship

Book Reviews in This Article:
Getting Rid of Patients: Contradictions in the Socialization of Physicians . By Terry Mizrahi
Physicians and Social Change . By John Colombotos and Corinne Kirchner
Changing Values in Medicine . Edited by Eric J. Cassell and Mark Siegler
Professional Ethics and Primary Care Medicine: Beyond Dilemmas and Decorum . By Harmon L. Smith and Larry R. Churchill
Physician—Patient Decision-Making: A Study in Medical Ethics . By Douglas N. Walton
With Dignity: The Search for Medicare and Medicaid . By Sheri I. David
The Dismissal of Students with Mental Disorders. Legal Issues, Policy Considerations, and Alternative Responses .
Courtroom Toxicology . By Marshall Houts, Randall C. Baselt, and Robert H. Cravey     

ASSESSING NEIGHBORHOOD AND SOCIAL PSYCHOLOGICAL INFLUENCES ON CHILDHOOD VIOLENCE IN AN AFRICAN‐AMERICAN SAMPLE*

The present study examines the extent to which neighborhood and social psychological influences predict childhood violence among 867 African‐American youth. The results showed that neighborhood affluence was the only neighborhood‐level variable to exert a significant influence on childhood violence. Furthermore, childhood violence was significantly related to social psychological influences, such as adopting a street code, associating with violent peers, parental use of violence, and quality parenting. Overall, the findings suggested that simply living in a violent neighborhood does not produce violent children, but that family, peer, and individual characteristics play a large role in predicting violence in childhood.     

Should Abused Women's Reports of Partner Substance Abuse Be Accepted as Valid?

Current research suggests that a husband's substance abuse is correlated with severity of physical abuse and the woman's decision to leave a violent situation. Often, only the battered woman's report of abuse is available. This study compares women's reports of their partners' substance use/abuse with their partners' report using a brief measure of polydrug and alcohol abuse, the Substance Abuse Subtle Screening Inventory (SASSI) and the Conflict Tactics Scale (CTS). Data were analyzed for 25 recovery couples and 25 nonrecovery couples. The correlations for all 50 couples between the male's reported use and the female's report of her partner's use on the SASSI and the CTS were significant on all but one of the CTS scales. They ranged on SASSI from .73 to .33 and from .31 to .06 on the CTS. This suggests that the SASSI and possibly the CTS could be used as valuable tools for assessing women's reports of their partner's substance use/abuse.     

Inmates: Who occupies our jails?

The purpose of this investigation was to identify inmate personal and demographic data that may be used to further define or profile persons with a greater likelihood of being at risk for serving a jail sentence. This study was explorative. The survey administration was similar in format to that conducted by the U.S. Department of Justice. Chaplains were used as survey proctors. Pilot studies were conducted to determine the suitability of survey content. Surveys consisted of 172 items. Subjects included four hundred inmates: males comprised 88.75 percent of the sample, Caucasians 58.25 percent, Blacks 37 percent, Hispanics 3.25 percent and other 1.5 percent of the sample. Respondents ranged in age from 15 to 64 years with an average age of 30.3 years. Less than two percent of the contacted inmates refused participation in the survey. Results are presented for demographic data, select legal/criminal data, select drug and alcohol use data, employment data, health, parent/family data, education data, social data, and “other”.     

COMMUNITY ACCOUNTABILITY,MINORITY THREAT,AND POLICE BRUTALITY: AN EXAMINATION OF CIVIL RIGHTS CRIMINAL COMPLAINTS*

A growing body of evidence shows that minorities are disproportionately the targets of police brutality, but important theoretical questions about the causes of that inequity remain unanswered. One promising line of research involves structural‐level analyses of the incidence of police brutality complaints; however, existing studies do not incorporate variables from alternative theoretical explanations. Drawing on the community accountability hypothesis and the threat hypothesis, we tested the predictions of two prominent structural‐level explanations of police brutality in a study of civil rights criminal complaints. The study included cities of 150,000+ population (n = 114). The findings reveal that two community accountability variables—ratio percent Hispanic citizens to percent Hispanic police officers and the presence of citizen review—were related positively to police brutality complaints, partially supporting that perspective. Two threat hypothesis measures of threatening people—percent black and percent Hispanic (in the Southwest)—were related positively to complaints, as predicted. The relative degree of support for the two hypotheses is assessed.     

AT ARM'S LENGTH WITH DIRTY HANDS: TAXING THE AUSTRALIAN PUNTER

Abstract: Taxes on betting are a major source of revenue for Australian state governments. Specific taxes on the racing industry date from 1915. However, the revenue potential has only been tapped in all the states since the legalisation in the past 30 years of off-course betting through the state-run totalisator (TAB). The introduction of the TAB followed a long period when various states adopted different policies towards off-course betting, ranging from legalisation of bookmakers' betting shops to attempts at complete suppression. In tracing the history of these policies, the focus is on "implementation failure", or the many administrative pitfalls and obstacles that were experienced. These include insurmountable tax evasion by bookmakers, regulatory capture of betting boards by bookmakers and corruption of the law enforcement agencies. State governments also had to accommodate a range of conflicting interests, including the interests of the racing industry itself and the demands of the anti-gambling lobby. The TAB is shown to be a happy and convenient resolution of most, but not all, of these administrative and political dilemmas.