Leading learning and change from the middle: Reconceptualising strategy's purpose,content, and measures

When implementing a transformational global vision and mission, three problems typically confront international NGOs: aligning different levels of planning and strategy; balancing global analysis and priorities against local realities; and identifying measures that both indicate progress and promote and encourage innovation. This article reports on the efforts of CARE International's Latin America Regional Management Unit to address these problems by introducing 'reversals' to common strategic planning principles and processes. It shows middle managers in NGOs how they can lead 'from the middle', and considers 'the region' to be the nexus enabling an organisation to change and learn across multiple hierarchical levels.     

King Canute and the 'Problem' of Structure and Agency: On Times, Tides and Heresthetics

The story of King Canute (Cnut) is well known. Indeed, in perhaps its most familiar form it exists as an oral historical tradition passed from generation to generation. In this almost legendary account, King Canute is depicted as an arrogant ruler, so confident as to his own omnipotence that he takes on the forces of nature, pitting his own powers against those of the rising tide – his wet robes paying testament to his powerlessness in the face of potent material forces and to the triumph of (natural) structures over (human) agency. Or so it might seem. In this article I suggest that even in this, the simplest depiction of the story of Canute, the relationship between structure and agency is more complex and involved than it appears. This complexity is only accentuated if we turn from the legend to the historical evidence. Moreover, by reflecting on Canute's practical negotiation of the 'problem' of structure and agency we can not only gain an interesting political analytical purchase on a seemingly familiar tale, but we can also generate a series of valuable and more general insights into our understanding of the structure–agency relationship. In particular, the (various) stories of King Canute and the waves alert us to the need: (1) to maintain a clear distinction between the empirical and the ontological; (2) to resist the temptation to attempt an empirical adjudication of ontological issues (or, indeed, an ontological adjudication of empirical issues); (3) to differentiate clearly between the capacities of agents with respect to material/physical structures on the one hand, and social/political structures on the other; (4) to acknowledge the significance of unintended consequences; (5) to attend to the 'performative' dimensions of agency; and (6) to recognise the dangers inherent in an overly instrumental view of actors' motivations and intentions.     

Canguilhem: life,health and death

This paper consists of comments and reflections on the legacy of Canguilhem's work, especially in Britain. After reviewing some aspects of the reception of Canguilhem's thought in Britain, the paper defends Canguilhem's vitalist philosophy, and concludes with hints as to the political uses of Canguilhem's thought in today's bio-political age.     

Accidental death from hydromorphone ingestion

Abstract: A 15‐year‐old male orally consumed an unknown but fatal amount of sustained release hydromorphone. He was naïve to opioid use. No other drugs or alcohol were involved. The cause of death was acute aspiration‐related bronchopneumonia, secondary to hydromorphone ingestion; the manner of death was accidental. Hydromorphone and hydromorphone‐3‐glucuronide were quantified in postmortem fluids by tandem liquid chromatography–mass spectrometry. The hydromorphone concentrations in the peripheral blood, urine, and vitreous humor were 57, 4460, and 31 ng/mL, respectively. The hydromorphone‐3‐glucuronide concentrations in the corresponding three fluids were 459, 36,400, and 40 ng/mL. Hydromorphone‐3‐glucuronide accumulation probably did not contribute significantly to the opiate toxicity. The proposed minimum lethal hydromorphone blood concentration in the nontolerant user is in the vicinity of 60 ng/mL.     

Dangerous patients and duties to warn: a European human rights perspective

The recent case of David Bradley, who shot and killed four members of his family after telling his doctor he 'wanted to kill someone', has raised the question of whether a healthcare professional could ever be held liable for failing to take steps to constrain a potentially dangerous patient. Until recently, it was considered that the United Kingdom courts would be reluctant to impose a duty to protect third parties. However, the European Court of Human Rights' decision in Osman v UK--while not directly concerning healthcare professionals--has opened the door for just such a duty. When this duty will arise, and how it can be discharged, remain challenging questions. Furthermore, healthcare professionals face the unenviable task of balancing competing duties, in which the rights--and safety--of their patients must also be borne in mind.     

Contents of Volume 21 (2002)

Volume Contents

Contents of Volume 21 (2002)