Doctors and allocation decisions: a new role in the new Medicare

The role of the physician in the allocation of health care resources has come under renewed scrutiny in recent years. Doctors have always had to face the reality of scarce resources and to do their work in the context of social injustices. With the advent of Medicare and Medicaid came the rhetoric of universal access and the "right to health care." At the same time the field of bioethics was emerging and contributing ideas about other kinds of rights, such as the right to die with dignity. Physicians during this time did not see their role as that of gatekeeper, but rather as advocate for the best care for each individual patient. The 1980s has brought a new awareness of limited resources and the necessity for a rationale for allocation of resources. These social and professional shifts have confronted physicians with the need for yet another shift in their ethical stance. If they are to take part in allocation decisions, for the continued well-being of their patients and of the public health, they will need a new perspective on biomedical ethics. This role can be an ethical one for physicians providing certain criteria are met: there must be universal access to a basic minimum level of care, physicians' levels of income must not be directly related to treatment choices, there must be a closed financial system within which meaningful trade-offs can be made, and there must be an ethically acceptable framework for decision-making.     

资源配置与侵犯财产权责任制度研究——从资源配置的效果看侵犯财产权民事责任制度的设计

不同的侵权责任制度设计对资源配置的状态将产生不同的影响,侵权法应当认真考虑这种影响,要保证财产权侵权责任制度能够发挥优化资源配置的结果,一方面应当充分利用市场,通过责任制度激励当事人采用侵权救济交易解决财产权侵权纠纷;另一方面,应合理地根据侵权行为的类型配置侵权责任的形式,以保证纠纷解决机构对侵权纠纷所作的裁判能够提高资源配置的效率。     

Choosing Healthplans All Together: a deliberative exercise for allocating limited health care resources

CHAT (Choosing Healthplans All Together) is an exercise in participatory decision making designed to engage the public in health care priority setting. Participants work individually and then in groups to distribute a limited number of pegs on a board as they select from a wide range of insurance options. Randomly distributed health events illustrate the consequences of insurance choices. In 1999-2000, the authors conducted fifty sessions of CHAT involving 592 residents of North Carolina. The exercise was rated highly regarding ease of use, informativeness, and enjoyment. Participants found the information believable and complete, thought the group decision-making process was fair, and were willing to abide by group decisions. CHAT holds promise as a tool to foster group deliberation, generate collective choices, and incorporate the preferences and values of consumers into allocation decisions. It can serve to inform and stimulate public dialogue about limited health care resources.     

物尽其用与矿业权出资入股

判断资源是否得到了合理的配置，需考虑供给与需求的关系。在供给有限的前提下，合理的资源配置决定着人们的需求能够在多大程度上得到满足。不合理的资源配置决策含浪费稀缺资源，降低需要被满足的程度。就矿业权来讲，它在取得时已经发生了大量的成本消耗，再加之资源存在的有限，若将之用于出资，既是封矿藏价值的尊重，又可实现价值利用的最大化。本文试从矿业权物权理论出发，阐述矿业权出资入股符合物尽其用原则的要求。     

Social Movements and the Politics of Bureaucratic Rights Enforcement: Insights from the Allocation of Disability Rights in France

While research on legal mobilization shows how social movements contribute to the definition and implementation of rights, it remains excessively centered on litigation to the detriment of administrative rights enforcement. This article maps out how street‐level bureaucracies impact rights enforcement by distinguishing between allocation, access, and process, and analyzes how social movements intervene in these three aspects. It then focuses on allocation, using the case of French disability policy to analyze the forms of advocacy deployed by movement actors who take part in the rights allocation process at the local level. The article argues that conformity to institutional norms derives not so much from a pressure to conform as from the knowledge and experience of the limited means locally available to make rights effective. Further, it shows how advocacy is reframed from the defense of individual claims to a role of scrutiny and control of the bureaucratic allocation of rights.     

Immigration and Justice: The Allocation of Goods to Newcomers from the (Former) Soviet Union in Israel1

This paper looks at ways in which notions of membership and of just allocation were articulated in the everyday practices of a voluntary organization set up in the early 1990s to distribute clothing and household goods to newcomers from the (former) Soviet Union in Israel. Based on an ethnographic account of the distribution centre, this paper describes its underpinning ideology and demonstrates the implications of this ideology for the rules governing the allocation of goods. The paper analyzes three inter‐related axes around which notions of rules of just allocation were equivocally interpreted and implemented. The first of these axes related to the discourse of justice deemed most appropriate to the newcomers; the second to the status of the newcomers; and the third to the creation of social categories—primarily defined in ethnic terms—and the hierarchical relationships between them.     

Justification as a Process of Discovery

Legal decision-making interests theoreticians in our discipline largely in terms of how a legal decision is justified. In his book, Bruce Anderson (1996) has posited a distinction between how a decision is arrived at, on one hand, and how it is justified, on the other. Anderson seems to be suggesting that legal theory should set out to continue the work of the American realists, that is, to develop legal decision-making as a process of discovery towards a solution. In my presentation, I will be looking at legal decision-making as a process of finding or discovering knowledge. What I mean by "discovery," however, is the discovery of new scientific knowledge. (The theory of science draws a distinction between proving and discovering knowledge.) I submit that for a justification to be valid the arguments comprising it ought to fulfill the logical conditions stipulated for the discovery of knowledge. In the present paper, I also hope to share with you the main ideas of a book I am currently writing on the subject.     

Limits of guardian treatment refusal: a reasonableness standard

The debate concerning the legal and ethical bases of guardian refusal of medical treatment on behalf of incompetent patients often ignores critical distinctions among types of patients and guardians. For example, patients who have expressed preferences regarding treatment while competent are distinguishable from patients who have always lacked the competency requisite to expressing a treatment preference. "Bonded guardians," whose relationship with the patient preexisted guardianship, should have a different role in the decision-making process than "non-bonded guardians," who were strangers to the patient prior to the guardian-ward relationship. This Article proposes criteria for guardian treatment refusal on behalf of incompetent patients. Under the model for guardian decision making presented here, bonded guardians should be preferred over non-bonded guardians, and bonded guardians should be allowed discretion to make treatment choices, limited only by a standard of reasonableness policed by the courts. The Author presents legal and ethical justifications for the bonded guardian's heightened role. Finally, he considers the proper roles of health professionals, hospital ethics committees, and judges in the decision-making process.     

Modeling the Influence of Investigator Bias on the Elicitation of True and False Confessions

The aim of this study was to model various social and cognitive processes believed to be associated with true and false confessions by exploring the link between investigative biases and what occurs in the interrogation room. Using the Russano et al. (Psychol Sci 16:481-486, 2005) paradigm, this study explored how perceptions of guilt influenced the frequency and type of interrogation tactics used, suspect's perceptions of the interrogation process, the likelihood of confession, and investigator's resulting perceptions of culpability. Results suggested that investigator bias led to the increased use of minimization tactics and thereby increased the likelihood of false confessions by innocent participants. In contrast, the manipulation of investigator bias had no direct or indirect influence on guilty participants. These findings confirm the important role of investigator bias and improve our understanding of the decision-making process associated with true and false confessions.     

Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice

Clinical evidence suggests that many patients undergo surgery that they would decline if fully informed. Failure to communicate the relevant risks, benefits, and alternatives of a procedure violates medical ethics and wastes medical resources. Integrating shared decision-making, a method of communication between provider and patient, into medical decisions can satisfy physicians' ethical obligations and reduce unwanted procedures. This article proposes a three-step process for implementing a nationwide practice of shared decision-making: (1) create model integration programs; (2) provide legal incentives to ease the transition; and (3) incorporate shared decision-making into medical necessity determinations.     

Access and allocation in food governance,a decadal view 2008–2018

Achieving food security worldwide raises a number of issues with regard to the distribution of global resources. On the one hand, access to resources and ecospace is essential for individuals in order to survive; on the other hand, the allocation of the earth’s resources as well as risks and responsibilities are relevant for the global community. Yet, elements of access and allocation are various and complex, encompassing social, environmental, and economic dimensions in an increasingly fragmented global governance structure. Drawing on the multidisciplinary governance framework on access and allocation by Gupta and Lebel, this paper provides a synoptical review of the literature on food security of the past decade from the perspective of the earth system governance scholarship. This article addresses the question: what have we learnt about access and allocation issues in the area of food governance and its implications for food security? In addressing this question, this review examines how institutions, norms and power affect access to and allocation of resources. The paper draws out key trends and lessons from the literature to conclude that research needs to be sensitive to the complexity and intersectionality of food, the systemic challenges that it poses, and the broader political economy around it.

     

行政许可的性质与功能分析

认定行政许可的性质有几种观点,其中"解禁说"阐明了行政许可的本质属性。行政许可最主要的功能有三种:防止危险、合理配置资源、提供公信力证明。作为弥补市场缺陷的一种有效管制手段,行政许可有其独特的优越性,但其发生作用的领域是有限的。行政许可作为"权力之手"可能会产生某些社会问题和负面影响。     

Speed of Decision-Making as a Procedural Justice Principle

The uncertainty management theory (Lind and Van den Bos, Research in organizational behavior 24, 181–223, 2002; Van den Bos and Lind, Advances in experimental social psychology, pp. 1–60, 2002) proposes that perceived fairness decreases experienced uncertainty, and, thus, the importance of fairness is enhanced under higher uncertainty. For example, the six procedural justice principles (Leventhal, Social exchange: advances in theory and research pp. 27–55, 1980) can be seen to reduce uncertainty in the long run by producing higher quality decisions. However, the decision-making process itself also may cause uncertainty, especially when the process is prolonged. Thus, we bring the speed of the decision-making process into discussion as one justice principle. We suggest that people use speed-related information as heuristic information and substitute lacking procedures-related information by drawing inferences from the speed of the decision-making. We propose that the speed of decision-making has a twofold effect on perception of procedural fairness: very fast and very slow decision-making processes are perceived to produce more uncertainty than moderate time processes, and consequently, a moderate process is expected to be related with more positive fairness perceptions than very slow or very fast processes. The statement was further tested by examining the mediating role of procedural fairness perceptions in the relationship between speed and its one consequence, perceived legitimacy, with a survey sample (N = 846) in the context of Finnish forest policy. The analysis confirmed the hypotheses. The role of speed as a justice rule and its contribution to the uncertainty management theory is discussed.     

检察机关内设机构设置改革问题研究

检察机关内设机构,近十多年来一直是检察改革的研究热点。研究内设机构改革,应从归纳设置现状,分析其存在的问题入手,评析当下各种改革方案之优劣,通过探讨检察职权在检察机关内部的二次分解,研究设置应当遵循的六个原则。借鉴域外法治经验,按照内设机构设置三分模式改革,对于领导决策机构,重点是完善检察委员会的决策机制;对于综合管理机构,建议参考国家行政机关大部制改革模式,大幅压缩机构数量;对于业务办理机构,根据检察权分解,科学界定部门权限,按照诉讼规律适度整合职能,精简机构。     

Access and allocation in climate change adaptation

As climate change impacts become increasingly apparent, adaptation becomes increasingly urgent. Accordingly, adaptation to climate change has shifted towards the centre of attention in both policy and research. In this article, we review the last 10 years of adaptation research (2008–2018), with a focus on work within the Earth System Governance network. We use the lens of access and allocation to structure our review and examine how adaptation affects, and is affected by, access to basic needs, basic rights, and decision-making on the one hand, as well as allocation of responsibilities, resources, and risks on the other. We find that questions of justice, equity, and fairness are fundamental to all dimensions of adaptation. The access perspective, for example, suggests that we need to assess vulnerability, understood broadly, while the allocation perspective focuses on questions of responsibility for being vulnerable, e.g. when people live, or move to, hazard-prone areas exposed to climate risk. This also relates to questions of who is responsible for selecting, implementing, and funding adaptation measures. Overall, we find that the framework of “access and allocation” and its subcategories offer a detailed approach to adaptation and adaptation research, but that it is not intuitive. The notion of “climate justice” seems to resonate more with both academic and policy debates.

     

Performance measures as forms of evidence for science and technology policy decisions

Amidst current widespread calls for evidence based decision making on public investments in science and technological innovation, frequently interpreted to imply the employment of some bundle of output, outcome, productivity, or rate-of-return measures, the promises and limitations of performance measures, singly or collectively, varies greatly across contexts. The promises reflect belief in, scholarly research supportive of, and opportunistic provision of performance measures that respond or cater to executive and legislative branch expectations or hopes that such measures will facilitate evidence-based decision-making. The limitations reflect research on the dynamics of scientific discovery, technological innovation and the links between the two that even when well done and used by adepts, performance measures at best provide limited guidance for future expenditure decisions and at worst are rife with potential for incorrect, faddish, chimerical, and counterproductive decisions. As a decision-making enhancement, performance measurement techniques have problematic value when applied to the Big 3 questions of U.S. science policy: (1) what is the optimal size of the Federal government’s investments in science and technology programs; (2) the allocation of these investments among missions/agencies/and programs (and thus fields of science); and (3) the selection of performers, funding mechanisms, and the criteria used to select projects and performers.     

试论高等教育资源的有效配置及实现途径

市场作为促成教育资源供求在总量和结构上协调的因素,是教育资源有效配置的实现条件.在教育垄断市场下,教育产出进入经济系统具有较大的障碍,教育系统内部组织低效,整个教育系统失去了自组织的刺激机制,无法促进教育资源的有效供给.高等教育卖方市场的形成将不断促进教育系统的创新.教育系统也惟有在外界社会经济系统的作用下,不断地进行教育内容和方法的改革,才能在与社会经济系统的适应过程中获得发展的物质条件,在国际教育竞争中处于有利地位.在市场经济条件下,高等教育具有私人产品的性质,决定了其市场化配置高等教育资源的基本方向,但仍需依赖政府干预以纠正市场运行的偏差.     

A Gramscian Approach to Studying the Judicial Decision-Making Process

This paper applies a Gramscian analytical framework to scrutinise the judicial decision-making process. Based on two distinct research projects, the article explores how, on one hand judges in criminal courts can be identified as part of the bureaucratic machinery of the state, as ‘technicians of repression’; whereas, on the other hand, human rights judges can be distinguished as providing ‘moral and intellectual leadership’ in their production and reproduction of certain values. Some of the key questions this article seeks to answer are: What is the role of hegemony in the judicial decision-making process? To what extent are legal actors both ‘technicians of repression’ and ‘moral and intellectual leaders’? This paper uses examples from empirical research conducted at courts in Argentina and at the European and Inter-American Courts of Human Rights to identify and explore this dual role of judges as both repressive technicians and moral and intellectual leaders in neo-liberal capitalist societies.     

单位犯罪与自然人犯罪的界分

由于单位犯罪的复杂性,立法放弃了对单位犯罪的定义权,从而将认定单位犯罪的任务留给了理论和实务界。犯罪是行为,行为表现意志。反过来说,意志支配行为,意志具有根本的判定作用。所以,单位意志是判定单位犯罪的最终指标,所谓以单位名义、违法所得归单位所有、为了单位利益、单位的业务范围、由单位决策机关或者负责人决定,都是单位意志的外在表现形式,是判断单位意志的辅助标志和参考因素,与单位意志之间是现象与本质、局部与整体的关系。而判定单位意志的标准,在于单位成员的行为是否符合单位长期的业务政策、规定、操作习惯,或者具有为单位谋利的动机并经过单位决策机关或者负责人决定。     

FORENSIC ECONOMICS IN COMPETITION LAW ENFORCEMENT

This paper delineates the specialty field of forensic industrialorganization (IO) as the application of theoretical and empiricalindustrial organization economics in the legal process of competitionlaw enforcement. Four stages of that process that can benefitfrom forensic IO techniques are distinguished: detection andinvestigation; case development; decision-making and litigation;and remedies, sanctions, and damages. We survey the use of economicsin such aspects as identifying potential forms of anticompetitivebehavior, screening markets for competition law violations,determining causality, advising on appropriate remedies, andassessing antitrust damages. The paper discusses the role ofexpert economic witnesses in competition cases. It calls foran organization of forensic IO within the context of existingforensic institutes.