Mill and the Value of Moral Distress

People are sometimes distressed by the bare knowledge that lifestyles are being practised or opinions held which they take to be immoral. Is this distress to be regarded as harm for the purposes of Mill's Harm Principle? I argue, first, that this is an issue that is to be resolved not by analysis of the concept of harm but by reference to the arguments in On Liberty with which the Harm Principle is supported. Secondly, I argue that reference to those arguments makes it clear beyond doubt that, since Mill valued moral confrontation and the shattering of moral complacency as means to social progress, he must have regarded moral distress as a positive good rather than as a harm that society ought to intervene to prevent. Thirdly, I relate this interpretation to Mill's points about temperance, decency and good manners. I argue, finally, that my interpretation is inconsistent with Mill's underlying utilitarianism only if the latter is understood in a crudely hedonistic way.     

Death resulting from ruptured cerebral artery aneurysm: 219 cases

To characterize the demographics of ruptured cerebral artery aneurysm as a cause of death and to examine the effect of improved diagnostic and therapeutic techniques on the incidence of sudden death associated with the condition, the authors reviewed 219 autopsies performed at the Dallas County Medical Examiner's Office between 1977 and 1997 in which the cause of death was ruptured cerebral artery aneurysm. Ruptured cerebral artery aneurysms accounted for 1.5% of 15,033 natural deaths and 0.4% of all deaths (45,492) followed by autopsy during this period. The majority (56%) of cases occurred in females, with Caucasian females composing the largest group (38%). Seventy-seven percent of cases occurred in individuals between the ages of 31 and 70 years, with the highest concentration in the 41- to 50-year decade (29%). The most common location for ruptured aneurysms was the middle cerebral artery distribution (39%). Multiple aneurysms occurred in 22 (9.1%) cases. Other factors, such as medical history, coexisting disease, symptoms, activity at onset of symptoms, survival time, and toxicology results are also presented. Compared with literature reports before 1980, when ruptured cerebral artery aneurysms were reported as the cause of death in approximately 4% to 5% of sudden natural deaths, the results of this study suggest that despite improved diagnostic and therapeutic techniques during the past two decades, morbidity and mortality from ruptured aneurysms remain a significant health problem.     

Systems Ideologies and Street-Level Bureaucrats: Policy Change and Perceptions of Quality in a Behavioral Health Care System

This article examines the stability of street-level bureaucrats' negative perceptions regarding a newly implemented managed care system on quality of care and service delivery in a publicly funded behavioral health care system. Overall findings indicate that the generally negative perception of managed care did not differ between staff in the two programs, indicating a weak effect on attitudes of frontline workers. More proximal variables to the caregiver, such as service type and job title, show more influence on attitudes. The conclusion discusses the implications of these findings for practicing administrators and academic researchers.     

Presidential Party,Incumbency, and the Effects of Economic Fluctuations on House Elections, 1916–1996

There is little professional consensusregarding the effect of economic conditionson House Elections. We argue that recentwork still uses the paradigm of Party toorganize their data and tests. Given thatrecent developments in the theory ofcongress emphasize the paradigm ofIncumbency, we investigate the empiricalrelevance of that competing paradigm. Weshow that (1) Incumbency matters in a purePresidential Party Model of HouseElections, (2) Presidential Party mattersin a pure Incumbency Model, (3) Once bothParty and Incumbency are accounted for,economic conditions exert a highlysignificant and temporally stable influenceon House elections, (4) Return Rates aremore affected by economic fluctuations thanare Vote Shares, and (5) Not allPresidential Party incumbents face the samedegree of electoral accountability foreconomic fluctuations.     

RAILROAD POLICY AND INTERMODALISM: Policy Choices after Deregulation

Intermodalism is widely viewed as a promising recent development in transportation. This article examines the role played by railroads in intermodal freight transportation and the framework of public policies around whic intermodal freight movement has evolved. Intermodalism emerged because of technological, organizational, and public policy developments that contributed to its rapid growth. Deregulation of the rail industry since 1980 has led to significant restructuring through mergers and direct contracts between railroads and customers. As intermodal shipments become more important to the overall transportation system in the United States, attention will need to be given to ways in which intermodal concerns are addressed in surface transportation programs.