Advance directives in action in a regional palliative care service: "road testing" the provisions of the Medical Treatment Act 1988 (VIC)

In order to explore the usefulness and acceptability of the provisions of the Medical Treatment Act 1988 (Vic) for palliative care patients in a rural region in Victoria, Australia, between July and December 2004 patients were given information explaining the Act and the opportunity to discuss it with the research officer. Grounded theory methodology was used to evaluate client responses. Findings suggested that palliative care patients are willing to engage in advance care planning but they have to be well enough and need skilled, practical, face-to-face assistance to complete the required legal forms. Written materials alone are not adequate, but provide the opportunity for medical staff to have conversations about death and dying. Doctors and nurses should understand the provisions of the Act to assist patients and families. It is recommended that advance care planning, appropriate to the jurisdiction, be an integral part of the palliative care assessment process.     

Subsidiarity or Subterfuge? Resolving the Future of Local Government in the Australian Federal System

During Australia's centenary of federation (2001), the author, Local Government Association of Queensland and Courier–Mail newspaper surveyed 1,264 Queenslanders for their attitudes to future constitutional change, including a sample of 259 local government opinion leaders from across the state. The results of this pilot suggest ongoing political, functional and theoretical challenges surrounding the position of local government in Australia. Only 22 percent of local government respondents indicated a preference for the federal system to remain the same in another 100 years, against 70+ percent preferring significant structural change (50 percent seeking regional governments that replace the states). This higher–than–expected interest in change suggests that ongoing national reviews of the position of local government will need to reconsider federalism's values and structures from first principles, including engagement by Commonwealth and states alike with the principle of 'subsidiarity', if they are to deliver any long–term gains.     

Contract–Management Capacity in Municipal and County Governments

Under pressure to do more with less, governments across the country have moved from direct service provision to providing services by contract. Proponents argue that contracting can reduce costs and improve flexibility and customer satisfaction. Critics point to a growing number of failed contracts, arguing there are numerous pitfalls associated with contracting. Missing from these debates is a discussion of how governments' managerial capacity can improve contract performance. In this article, we identify specific capacities that governments can use to harness the promise of contracting while avoiding its pitfalls. We present analyses of data on municipal and county government contracting activities that show how governments invest in contract– management capacity in response to several internal and external threats to effective contract performance. Because government investment in contract–management capacity is uneven—that is, some governments invest in less capacity even when circumstances would call for more—our analyses may help to explain why some contract arrangements are more successful than others.     

Understanding Women in Scotland

This article explores obstacles to understanding the history and contemporary experiences of women in Scotland, and to the development of feminist research in Scotland. It is argued that explanations which invoke Scottish male chauvinism and misogyny alone are insufficient, and that the marginalization of women in Scotland is produced both by male domination within Scotland, and by English cultural and political hegemony within the UK. The article comments on the relationship of the concept of ‘Britishness’ to that of ‘Scottishness’ (and other identities within the UK) and illustrates how the frequent confusion of ‘British’ with ‘English’ serves to obscure Scottish experience. It is also argued that the place of Scotland within the British state has led to the creation of an institutional framework that disadvantages women, and a system of government that excludes women. This implies that feminist debates on the state in Britain require a specific focus on the form of the British state, and in the context of constitutional change in particular this is important for the development of future strategies. It is argued that the double marginalization of women in Scotland is not just a problem in relation to the development of feminist research, but is also a political problem in that it contributes to a degree of alienation from feminism in England. The article concludes by arguing for the necessity of recognition of difference, but also for dialogue, as the basis for feminist alliances in different parts of the UK.     

Special report on patient care. HCFA finally issues patient-dumping regulations

EMTALA has always been an especially worrisome law for providers because its requirements are both sweeping and vague, with potentially drastic penalties for violations. The new regulations remove only some of the law's vagueness. As with previous EMTALA amendments, all United States hospitals, as well as emergency department physicians and other doctors who see patients in the emergency department, should carefully review their internal policies regarding patient ++ transfers in light of the new regulations. For example, hospitals must have an internal policy for following up on suspicious transfers, as failure to detect an inappropriate transfer can now potentially result in a Medicare decertification action. Also, hospitals with specialized services (e.g., burn units or shock-trauma units) should review their policies on receiving transfer patients in light of the greater specificity of the new regulations. Finally, because of the confusing new requirements regarding ambulance services, all hospitals should review their relationships with and policies regarding, ambulance services and ambulance diversion.