Crisis of conscience: reconciling religious health care providers' beliefs and patients' rights

In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to "sensitive" services like abortion, family planning, HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers' right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White's analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients' right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal "bypass" legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.     

Attachment and social bonding in maximum and minimum security prison inmates

Attitudes towards social attachment and bonding were evaluated in groups of maximum (N = 48) and minimum (N=46) security prison inmates and compared with the attitudes of a group of 49 noncriminal college students. Three primary styles of attachment were considered: avoidant, ambivalent/anxious, and secure. It was predicted that the maximum security condition, a group hypothesized to contain a large number of lifestyle criminals, would evidence more of an avoidant style of attachment compared to minimum security inmates or a group of coliege student controls. Consistent with this hypothesis, the maximum security inmates exhibited greater avoidance in their attitudes towards relationships than subjects in the other two conditions. The implications of these results are discussed.     

New occupations,old demands: The public regulation of paraprofessionals

Like doctors, lawyers, and architects before them, many new paraprofessionals occupations are rapidly being defined and regulated, raising the time-worn questions regarding the virtues of free labor markets versus those of regulated labor markets. The trend to regulation is growing rapidly as the paraprofessionals increase in number. The new regulation may improve the quality of services that paraprofessionals provide. But the costs threaten to exceed the benefits. There are less costly ways to deal with the problems that have given rise to the demands for regulation. The success of these demands is due in part to inadequate consideration of their implications.     

Mitigating impacts of HIV/AIDS on rural livelihoods: NGO experiences in sub-Saharan Africa

HIV/AIDS is having profound impacts on livelihoods in sub-Saharan Africa. These include the deaths of working-age adults, the diversion of resources to caring, and the rupture of traditional chains of knowledge transmission. NGOs are responding by providing assistance to communities affected by the epidemic in the fields of agriculture, skills training, and microfinance, as well as by offering home care and support. A key feature of such initiatives is the focus on previously neglected groups such as women, school dropouts, and orphans. Factors of success include the use of participatory processes to identify target groups, and the involvement of local political leaders and adults trusted by young people in project activities. Challenges include improving monitoring systems, effectively disseminating lessons learned, and persuading donors, whose responses to the epidemic are currently focused on preventive and curative health services, to support livelihoods interventions as a matter of urgency.     

Book reviews

Branko Lazitch and Milorad M. Drachkovitch, Lenin and the Comintern, Volume I. Stanford, Calif.: Hoover Institution Press, 1972. (Publications Series 106.) xiii + 683 pp. $17.50.

Karl‐Eugen Wadekin, The Private Sector in Soviet Agriculture. Edited by George Karcz. Second, enlarged, revised edition of Privatproduzenten in der sowjetischen Landzoirtschaft. Translated by Keith Bush. Berkeley, Calif, and London: University of California Press, 1973. xviii + 407 pp. $17.50.

Richard H. Ullman, The Anglo‐Soviet Accord. (Vol. III of Anglo‐Soviet Relations, 1917–1921.) Princeton, N.J. and London: Princeton UP, 1972. xv + 509 pp. £7.00.

Eloise Engle and Lauri Paananen, The Winter War. (The Russo‐Finnish Conflict, 1939–40.) New York: Charles Scribner's Sons, 1973. xv+176 pp. $7.95.

Allen F. Chew, The White Death: the Epic of the Soviet‐Finnish Winter War. East Lansing: Michigan State University Press, 1971. x + 313 pp. $12.50.

Geoffrey Jukes, The Soviet Union in Asia. Sydney: Angus & Robertson, 1973. 304 pp. £2.95.

Jaroslaw A. Piekalkiewicz, Public Opinion Polling in Czechoslovakia, 1968–69. Results and Analysis of Surveys Conducted During the Dubcek Era. (Praeger Special Studies in International Politics and Government.) New York: Praeger Publishers, 1972, and London: Pall Mall Press, 1973. xxix + 357 pp. £7.75.

Deborah D. Milenkovitch, Plan and Market in Yugoslav Economic Thought. New Haven and London: Yale UP, 1971. (Yale Russian and East European Studies, 9.) x + 323 pp. $10.00. £4.50.

Robert G. Wesson, The Soviet Russian State. New York and London: John Wiley & Sons, 1972. x + 404 pp. £4.00. Condensed edition £1.95.

Joseph Nedava, Trotsky and the Jews. Philadelphia: The Jewish Publication Society of America, 1972. 299 pp. $6.00.

Joshua Rothenberg, The Jewish Religion in the Soviet Union. New York: KTAV Publishing House (for Brandeis University), 1972. (Series: Institute for East European Jewish Studies.) viii + 242 pp. $10.00.

Vladimir Petrov, Escape from the Future. Bloomington & London: Indiana UP, 1973. xiii + 470 pp. £3.75.