Error Reduction, Patient Safety and Institutional Ethics Committees

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. In this paper, the author endeavors to fill the gap. As noted in the Hastings Center's recent report, "Promoting Patient Safety," the occurrence of medical error involves complex web of multiple factors. Human misstep is certainly one such factor, but not the only one. This paper builds on the Hastings Center's report in arguing that institutional ethics committees ought to play an integral role in the transformation of a "culture of blame" to a "culture of safety" in healthcare delivery.     

制度伦理教育的合法性审视

制度伦理教育是指致力于使人认可、内化并践行契约伦理的教育.在我国,随着市场经济的发展,罗尔斯正义理论在教育界的影响日益深远等,它已经悄然兴起.合法性判断是对事物是否符合社会、时代发展的一个最基本的判断,所以对制度伦理教育进行合法性判断是非常必要的.道德教育合法性判断的依据包括道德伦理合法性判断的依据和道德教育方式方法合法性判断的依据.前者具体可分为民意、文化传统和超越三重依据;后者具体可分为尊重常识道德、教育者"言行一致"、旨在于使人向善、有效性四重依据.以这些依据作为评判的标准,不难发现制度伦理教育尽管有很多地方值得我们去借鉴,但它并不具有很强的合法性基础,它的兴起不能实现其已有的承诺.     

The Rise of Committees

Committees are of increasing importance in the process of EC policy-making, particularly in regulatory fields which touch upon politically sensitive issues. This article discusses the problems which have arisen due to the unforeseen emergence of committees within the institutional framework of the Community. It examines the main institutional conflicts in relation to committees and argues that parliamentary disdain for Comitology notwithstanding, the use of committees in the area of social regulation may be explained through a 'Member State-oriented' understanding of the institutional balance of powers. Committees may thus not only contribute to more effective decision-making, but may also secure a degree of subsidiarity. The increasing reliance on committees, however, might nonetheless be argued to detract from the general legitimacy of Community decision-making, especially since committees remain creatures of pragmatism. This article accordingly argues that the lack of transparency within committees, and the absence of general procedural rules upon the activities and composition of committees, should now be compensated for through the evolution of formal and generalisable procedural rules.     

Back to Basics: A Theory of the Emergence of Institutional Facts

In order to account for the mode of existence of social rules and norms, the author develops a theory of the emergence of institutional facts. Just as other kinds of institutional fact, rules and norms are meanings. Therefore, insight into the emergence of social rules and norms can be achieved by studying the recognition and the communication of meanings. Following accounts of meaning and factuality, institutional facts are characterized as unquestionable shared typifications. It is argued that, in becoming an institutional fact, a typification goes through two phases. First, it becomes a social habit. Second, this habit turns into an obligation by being objectified.     

The Emergence of Penal Extremism in California: A Dynamic View of Institutional Structures and Political Processes

This article examines legal and political developments in California in the 1970s and early 1980s that led to extreme changes in the state's use of imprisonment. It uses historical research methods to illustrate how institutional and political processes interacted in dynamic ways that continuously unsettled and reshaped the crime policy field. It examines crime policy developments before and after the passage of the state's determinate sentencing law to highlight the law's long‐term political implications and to illustrate how it benefited interest groups pushing for harsher punishment. It emphasizes the role executives played in shaping these changes, and how the law's significance was as much political as legal because it transformed the institutional logics that structured criminal lawmaking. These changes, long sought by the law enforcement lobby, facilitated crime's politicization and ushered in a new era of frenetic and punitive changes in criminal law and punishment. This new context benefited politicians who supported extreme responses to crime and exposed the crime policy process to heightened degrees of popular scrutiny. The result was a political obsession with crime that eschewed moderation and prioritized prison expansion above all else.     

Committees and Legislative Strengthening: The Growing Influence of Committees in Ukraine's Legislative Process

The Ukrainian legislature is in the process of transforming from a ‘rubber stamp’ institution of the Soviet type into an ‘institution that matters’ in a new democratic state. The practice of democratic institution building in the post-Soviet countries presents multiple examples of powerful executives who gained dominance in legislative processes. What path has Ukraine taken and what can explain its specific characteristics? This article charts the growth of committees here as a marker of legislative institutionalisation in Ukraine. The study finds that Ukrainian legislative committees defy prevalent regional trends and, contrary to expectations, have asserted independent roles. It then discusses factors that may account for this unique regional development – the role of a dual executive structure and the Ukraine party system.     

The Path of the Law Review: How Interfield Ties Contribute to Institutional Emergence and Buffer against Change

Early neoinstitutional theory tended to assume institutional reproduction, while recent accounts privilege situations in which alternative models from outside an organizational environment or delegitimizing criticism from within precipitate institutional change. We know little about institutions that persist despite such change conditions. Recent advances in sociological field theory suggest that interfield ties contribute to institutional change but under‐theorize how such ties may reinforce institutions. Extending both approaches, I incorporate self‐reinforcing mechanisms from path‐dependence scholarship. I elucidate my framework by analyzing the student‐edited, student‐reviewed law review. Despite its anomalous position relative to the dominant peer‐reviewed journal model of other disciplines, and despite sustained criticisms from those who publish in them, the law review remains a bedrock institution of law schools and legal scholarship. I combine qualitative historical analyses of legal scholarship and law schools with quantitative analyses of law‐review structures and field contestation. The analysis covers law review's entire historical trajectory—its emergence, its institutionalization and coherence of a field around it, and its current state as a contested but persistent institution. I argue that self‐reinforcing mechanisms evident in law review's ties to related fields‐legal practice, law schools, the university, and legal periodicals—both enabled its emergence and have buffered it against change.     

The Standing Committees and the Ministries

The 23rd Congress of the CPSU posed the task of enhancing the role of the supreme Soviets and defined the principal directions to be followed in solving this task. The most important of them are the further improvement in the activity of the standing committees [postoiannye komissii], which contribute to the development of socialist democracy, the improvement in the work of the supreme Soviets and the agencies of state administration, and the activization of deputies. At the first session of the seventh Supreme Soviet [sed'mogo sozyva] of the USSR, the report by N. V. Podgorny, Chairman of the Presidium of the USSR Supreme Soviet, "On Organizing the Standing Committees of the Soviet of the Union and the Soviet of Nationalities," emphasized the major role of the standing committees in social and economic development and expressed confidence that their functioning would promote the fulfillment of the tasks facing the country. (1) The seventh supreme Soviets of the USSR and of the union republics carried out a number of practical measures to implement the instructions of the party to increase the role of the standing committees.     

The Electoral Connection and Legislative Committees

This article examines whether the career needs of legislators – to be re-elected or to move on to another political post – allow us to explain the rules governing committee structures and the committee assignments individual legislators obtain. It uses the institutional variations provided by Argentina, Costa Rica, and Venezuela to test hypotheses about committee assignments and committee assignment mechanisms. It finds that incentives created by candidate selection procedures and electoral rules show some relationship to committee assignments, but with a good deal of variation across national cases and individual careers.     

鲁迅疾病叙事与中国现代生命伦理的发生

鲁迅文学中的疾病叙事不仅体现着鲁迅的医学背景、人格影响,而且灌注着鲁迅自己对生命的伦理观念。这些观念主要有三个方面的内容:一是主张安乐死,能医的就医,不能医的就帮助他死得没有痛苦;二是反对酷刑与虐杀,批判国民性中对科学的精神没有兴趣,而把聪明才智都挥洒在这种给被害人带来无穷而难忍的痛苦的虐杀与酷刑上;三是尊重残疾者但反对滥施同情,体现出肉体之小与精神之大的辩证认知。鲁迅的这种生命伦理观念既是鲁迅自身疾病纠缠的生命体验的升华,也是科学精神与生命哲学互织的结晶。鲁迅在其一生中对生命伦理现代化的思考与践行,体现出的正是他对《新青年》催生最后觉悟之觉悟即伦理觉悟的启蒙方略的主动呼应。     

The Standing Committees: Techniques of Monitoring

Note from the editors of Sovety deputatov trudiashchikhsia: Continuing the study of the functioning of Soviets, personnel of the USSR Academy of Sciences' Institute of State and Law looked into the operations of local organs of power in the Latvian SSR. Jointly with practical workers in the field, they prepared a number of scholarly recommendations, including proposals to improve the techniques of monitoring [kontrol'] by the standing committees of district and city Soviets.