Rationing care in the community: engaging citizens in health care decision making

This article examines the theoretical and practical logics of community engagement exercises in health care rationing. To evaluate such exercises in Canada, it is necessary to compare suspected rationing exercises (such as those in Nova Scotia and Saskatchewan) with clear examples of rationing. The Oregon Medicaid reform process is considered an important example of transparent and community-level rationing from which Canadian executive-driven governments can learn a few valuable lessons. While the Oregon experiment seems to have been a (qualified) success, in the Canadian context, formal citizen participation in decision making might be incompatible with social rights and present an incongruous and antagonistic pairing of executive and popular sources of authority.     

The private sector and competition in health care markets

This paper reviews the historical trends in the regulatory and competitive approaches to containment of health care costs, covering efforts in both public and private sectors. The current interest in the potential of private-sector initiatives to stimulate competition in health care insurance and provider markets is highlighted. Since neither the workings of competition in health care nor the role and impact of the private sector in stimulating such competition are well understood, the concluding section discusses important research issues surrounding these topics.     

Preference for decision control in organizational decision making

Two studies examined preference for authority or subordinate decision control in dispute resolution and allocation procedures in an organizational setting. In both studies, a marked preference for the authority/subordinate sharing of decision control was found. In Study 1, nearly one third of respondents preferred that subordinates share decision control with supervisors in both dispute and allocation situations; for several of the situations decision sharing was the modal preference. The study also found a tendency to prefer subordinate decision control in disputes but supervisor decision control in allocations. In Study 2, again the most preferred procedure was one in which subordinates shared decision control with their supervisors. The procedure high in decision sharing was rated as the one most fair. It was also rated as more likely to improve relationships among members and to result in the best decision. Some differences in preference for decision control and decision sharing depending upon social factors predominant in the setting were found.     

Parole decision making in Colorado

During the past decade parole decision making in the United States has come under severe scrutiny. One response has been for researchers to intervene and develop parole guideline matrices for use by state parole boards. The research reported here describes such an effort in Colorado. Our data were derived from the records of 292 parolees during a two year period. A systematic sampling process, taking every other docket number from the parole board's monthly eligibility lists, initially produced 1,500 potential parolees. From this list, a 20 percent sample was drawn at random. This yielded a workable guideline matrix that produced less than 13 percent variance from Colorado parole board decisions. The article discusses the procedures for developing the matrix and how it was implemented by the parole board.     

Race and the decision making of juries

The relationship between race and jury decision making is a controversial topic that has received increased attention in recent years. While public and media discourse has focused on anecdotal evidence in the form of high‐profile cases, legal researchers have considered a wide range of empirical questions including: To what extent does the race of a defendant affect the verdict tendencies of juries? Is this influence of race comparable for jurors of different races? In what ways does a jury's racial composition affect its verdict and deliberations? The present review examines both experimental and archival investigations of these issues. Though the extant literature is not always consistent and has devoted too little attention to the psychological mechanisms underlying the influence of race, this body of research clearly demonstrates that race has the potential to impact trial outcomes. This is a conclusion with important practical as well as theoretical implications when it comes to ongoing debates regarding jury representativeness, how to optimize jury performance, jury nullification and racial disparities in the administration of capital punishment.     

Juror decision making in the capital penalty trial

Two factors thought to influence jurors' penalty decisions in capital trials—the nature of the crime committed and the defense's portrayal of the convicted offender's character—were examined. Mock jurors were death-qualified and exposed to one of twelve simulated penalty trials. Each trial was comprised of one of three capital crimes and one of four defense strategies. Jurors were least punitive in robbery-murder conditions and most punitive in multiple murder conditions. A conceptual argument against capital punishment was the most effective defense; a mental illness defense was the least effective. Penalty decisions were mediated by three attributional variables: (a) juror perceptions of the defendant's volition, (b) juror perceptions of the defendant's future dangerousness, and (c) juror perceptions of the relative competency of the opposing attorneys.This article is based on the author's dissertation which received an Honorable Mention in the 1985 SPSSI Dissertation Prize competition. The research was made possible by grants from the University of California, Santa Cruz and Division 41 of the American Psychological Association. The author is indebted to Craig Haney, Elliot Aronson, and Dane Archer for their valuable suggestions and support.     

Jury decision making in the capital penalty phase

There are large bodies of research on the deterrent value of the death penalty and public attitudes towards capital punishment. However, little is known about how jurors decide whether a particular defendant should live or die. This article briefly summarizes the case law that attempts to guide the discretion of jurors in the penalty phase of capital murder trials, reviews empirical research on penalty decision making, suggests a methodological strategy for investigating the penalty phase, and identifies several promising directions for future research. Four broad categories of research are identified: the effects of guiding juror discretion, comparisons of juries that vote for life with those that vote for death, the relationship between guilt and penalty phases, and models of decision making in the penalty phase. Several testable hypotheses are proposed.     

Epistemic emotions in prosecutorial decision making

The article examines epistemic emotions as part of the emotive-cognitive processes of prosecutors’ knowledge seeking and decision making in preliminary investigation and court proceedings. Drawing on ethnographic fieldwork, interviews, and shadowing of prosecutors in Sweden, we show how emotions motivate and orient prosecutors’ inquiries and the fundamental role of the ‘certainty–doubt spiral’ for ‘doing objectivity’. In conclusion, we discuss the centrality of emotions for conscientious and well-considered decisions in legal work. The study contributes to the field of law and emotion by exploring the epistemic quality of emotions, notably the certainty–doubt spiral, in legal work.     

Reform and remembrance: the place of the private sector in the future of health care policy

Although the nation failed during the past decade to enact large-scale, structural change in government health policy, it has seen health care in the private sector remodeled dramatically during the same period. In this article I argue that a new round of equally significant changes is quite possible, this time at the hands of the national government. More specifically, I argue that for a variety of reasons, both enduring and more recently born, support for the private sector and the market in health care is relatively weak: that given likely trends in costs, demographics, and inequalities, it is likely to get even weaker; and that in the potential coming crisis of the health care system. there will be a real opportunity for seizing the agenda and winning policy battles on the part of would-be reformers pushing large-scale, public sector-oriented changes that go well beyond the recent reform efforts directed at managed care and HMOs.