Conformance to Attorney Performance Standards

Legal representation of clients facing involuntary commitment to a maximum security hospital was investigated. Eighty-nine hearings were observed during a 5-week period immediately following implementation of Attorney Performance Standards, which define minimally adequate representation. The 10 participating attorneys reported their preparation for each case, and a summary measure of advocacy was derived. Generally, attorneys engaged in all required activities that could be accomplished in a single preparatory visit to the hospital. The level of advocacy in cases where clients faced civil commitment was compared to cases where the client faced criminal commitment. The unexpected finding that the level of advocacy for civil clients was significantly lower than that for clients facing commitment under any other legal category, was discussed in light of the degree of dangerousness presented by civil clients, the effects of deinstitutionalization, and emerging social policy.     

Indexing civil commitment in psychiatric emergency rooms.

A reliable prototype index, Three Ratings of Involuntary Admissibility (TRIAD), was developed to reflect the way psychiatric emergency room clinicians apply legal criteria for involuntary commitment. The interrater reliability coefficients--Pearson's r--of the TRIAD system for rating patients are 0.94, danger-to-self score; 0.89, danger-to-other score; 0.77, grave-disability score; and 0.89, total-admissibility score. TRIAD scores accounted for 82 percent of 89 disposition decisions in two metropolitan county hospital psychiatric emergency rooms. Study results indicate that (1) psychiatric emergency room clinicians shared constructs of danger to self, danger to others, and grave disability; (2) these constructs are reliably applied in actual cases; (3) TRIAD is a valid reflection of these constructs; and (4) case disposition is predictable from the severity of the patient's status with regard to these criteria.     

Privacy and Technology: Reconsidering a Crucial Public Policy Debate in the Post-September 11 Era

In the post September 11 era, one truism in the ongoing public policy debate surrounding technology and privacy is that there is no easy solution to the increasing presence of technology in our lives. There are, however, several long-standing guiding principles. We must be wary of extending political authority to protect privacy without careful contemplation of the consequences. While it may appear that the idea of balancing technology and privacy is novel, the tension between them is informed by a broader theoretical framework that is inherent to democracy. Understanding this broader theoretical framework is helpful in identifying ways to advance the debate toward policy solutions rather than continuing a dogmatic discussion that juxtaposes technological innovation with the loss of privacy. The purpose of this discussion is not to settle the public policy debate. Instead, the aim is to consider how long-standing constitutional doctrine and the theoretical framework of democracy can lend insight into the current debate surrounding privacy and technology.     

Accounting for culture in a globalized bioethics.

How might a global bioethics account for profound cultural difference in a world marked by porous borders? The authors endorse a critical, self-reflexive bioethics, suggesting that bioethics needs to change its fundamental orientation if it is going to remain relevant and intellectually vibrant throughout the twenty-first century. Bioethics must attend to issue of social justice and public health, while seriously considering the implications of social context for medical morality. Negotiating moral consensus across cultural boundaries will be difficult, but is is more likely to succeed if we critically engage with the cultural assumptions underlying bioethics itself.     

Obtaining public input for health‐systems decision‐making: Past experiences and future prospects

Abstract: Interest in finding more effective methods for public involvement in decision‐making about health systems is more widespread than ever in Canada since significant aspects of health‐care decision‐making were devolved from provincial governments to regional health authorities. Involving the public can be risky business, however, as the accountability and legitimacy of decisions made by governing authorities are often assessed against the nature and degree of interaction that occurs with the public. Consequently, decision‐makers in a variety of policy domains routinely struggle with questions about when it is appropriate to involve the public, what the most effective means are for doing this, and how to measure their success. The authors analysed these issues by documenting the experiences of health‐systems decision‐makers in two Canadian provinces (Ontario and Quebec) with public consultation and participation over the past decade. Their findings illustrate that despite the different roles and responsibilities held by Ontario and Quebec decision‐makers, decisions to consult with their communities are driven by the same basic set of objectives: to obtain information from and to provide information to the community; to ensure fair, transparent and legitimate decision‐making processes; and to garner support for their outcomes. Decision‐makers also acknowledged the need to rethink approaches for involving the public in decision‐making processes in response to the perceived failure of past public participation and consultation processes. While these experiences have clearly left some participation practitioners feeling beleaguered, many are approaching future community consultation processes optimistically with plans for more focused, purposeful consultations that have clear objectives and more formal evaluation tinged with a healthy dose of pragmatism. Sommaire: L'intérêt que I'on porte à trouver des méthodes plus efficaces pour inciter le public à participer à la prise de décisions au sujet des systèmes de santé ne cesse de grandir au Canada depuis que les gouvemements provinciaux ont transféré aux autorités régionales la responsabilité d'importants aspects de la prise de décisions dans ce domaine. Cependant, faire intervenir le public peut être une affaire délicate, car la transparence et la légitimité des décisions prises par les autorités existantes sont souvent évaluées par rapport à la nature et au degré d'interaction qui se produit avec le public. C'est pourquoi, les décideurs dans divers domaines de politiques ont généralement de la difficultéà déterminer quand il convient de demander I'avis du public, quels sont les moyens les plus efficaces pour le faire et comment mesurer leur succès. Nous avons analysé ces questions en documentant les expériences que les décideurs des systèmes de santé de deux provinces canadiennes (l'Ontario et le Québec) avaient eues en ce qui concerne les efforts de participation et de consultation publique au cours de la derniére décennie. Nos conclusions démontrent qu'en dépit des divers rôles tenus et diverses responsabilités assumées par les décideurs de I'Ontario et du Québec, leur déision de consulter leurs communautés est guidée par les mêmes principaux objectifs: obtenir de I'information de la communauté et lui en foumir; assurer des processus de prise de déisions justes, transparents et légitimes et obtenir I'aval de leur décision. Les décideurs ont également reconnu le besoin de repenser les approches visant à faire participer le public aux processus de prise de décisions suite à I'échec perçu des expériences antérieures de participation et de consultation du public. Alors que certains partisans de la participation ont été clairement découragés par ces expériences, un grand nombre envisagent avec optimisme les processus de consultation communautaire. Ils croient que les consultations pourraient être plus focalisées et plus déterminées visant des objectifs clairs et une évaluation plus formelle et empreinte d'une bonne dose de pragmatisme.     

Sex differences in the identity formation of college students from divorced families

This study was desgined to examine gender differences in identity formation in late adolescents from divorced mother-custody families. Fifty-seven female and thirty-nine male college students ranging in age from 17 to 25 years completed the Child's Report of Parental Behavior [E. S. Schaeffer (1965) Children's Reports of Parental Behavior: An Inventory, Child Development, Vol. 36, pp. 412–482] and were interviewed using the J. E. Marcia [(1966) Development and Validation of Ego Identity Status, Journal of Personality and Social Psychology, Vol. 3, pp. 551–558] semistructured Identity Status Interview. While no differences between males and females were found in ratings of overall identity status, significantly more females were in the achieved category within the domains of occupation and attitudes toward premarital sex. Also, males perceived their mothers as significantly more accepting and less controlling than did females. The absence of the father and the altered role of the mother appear to have a differential impact on males and females who have grown up in mother-custody families. Implications of these and other findings are discussed.Received Ph.D. in Counseling Psychology from Teachers College Columbia University. Research interests include adolescent identity formation, the intersection and integration of personal and career counseling, and career development.     

Intellectualizing about the moon-ghetto metaphor: A study of the current malaise of rational analysis of social problems

The title refers to the widely held view that advanced western societies (particularly the United States) have been vastly more successful in meeting certain kinds of objectives, than others, and that rectifying this imbalance is a high priority social objective. The paper is concerned with three intellectual traditions that have purported to explain the reasons for the problem, and to provide guidance for helping with the lot of the ghetto. One of these traditions views the problems in terms of inadequate policy machinery, and the resolution in terms of better analysis feeding into the policymaking process. A second views the problem in terms of organizational structure, and searches for a solution in terms of institutional reform or redesign. Still a third tradition sees the problem as stemming from the past allocation of scientific and technical talent, and proposes a solution in terms of a significant reallocation of research and development activity. It is apparent that these traditions of analysis, neither separately nor together, have been very successful in resolving social problems. The purpose of the essay is, through examination of the intellectual traditions and their interaction with the policymaking process, to try to illuminate the nature of their weaknesses and, if possible, to see what lessons can be learned regarding how to make analysis more useful, and map out some potentially fruitful directions for intellectual exploration.The author is indebted to Graham Allison, Harvey Brooks, John Patrick Crecine, Lee Friedman, A. O. Hirschman, C. E. Lindblom, Keith Pavitt, Kenneth Warner, and Douglas Yates for helpful criticism and encouragement. The debt I owe to these intellectual colleagues goes far beyond their reactions to this paper. Many of my better ideas have been lifted from them. I could list here a number of other important influences but in a paper of this sort the author is faced with a Hobson's choice regarding footnote acknowledgements. On the one hand he could footnote all of the obvious sources and influences on particular points, in which case the footnotes would take up more space than the text. Or he can be parsimonious and be accused of stealing, without acknowledgement, other people's ideas. With apologies, and misgivings, I have opted for the second strategy both in this opening footnote and throughout the paper.