Abortion laws in African Commonwealth countries

This paper provides an overview of the range of current (1981) abortion laws in the African Commonwealth countries, traces the origins of the laws to their colonial predecessors, and discusses legal reform that would positively provide for legal termination of pregnancy. The authors claim that the range of these laws demonstrates an evolution that leads from customary/common law (Lesotho and Swaziland) to basic law (Botswana, The Gambia, Malawi, Mauritius, Nigeria's Northern States and Seychelles) to developed law (Ghana, Kenya, Nigeria's Southern States, Sierra Leone, and Uganda), and, finally, to advanced law (Zambia and Zimbabwe). The authors call for treating abortion as an issue of health and welfare as opposed to one of crime and punishment. Since most of the basic law de jure is treated and administered as developed law de facto, the authors suggest decriminalizing abortion and propose ways in which to reform the law: clarifying existing law; liberalizing existing law to allow abortion based upon certain indications; limiting/removing women's criminal liability for seeking an abortion; allowing hindsight contraception; protecting providers treating women in good faith; publishing recommended fees for services to protect poor women; protecting providers who treat women with incomplete abortion; and punishing providers who fail to provide care to women in need, with the exception of those seeking protection under a conscience clause. The authors also suggest clarifying the means by which health services involving pregnancy termination may be delivered, including: clarification of the qualifications of practitioners who may treat women; specification of the facilities that may treat women, perhaps broken down by gestational duration of the pregnancy; specifying gestational limits during which the procedure can be performed; clarifying approval procedures and consents; and allowing for conscientious objections to performing the procedure.     

Rational planning and responsiveness: the case of the HSAs

American government in the twentieth century has been faced with a serious value conflict between the need for rational allocation of scarce resources through planning, and the need to be responsive to a diverse society. Two ideal types of planning correspond to these two values. Rational planning emphasizes the importance of the planner's expertise in achieving the "best" path to socially defined goals. Advocacy planning emphasizes the importance of responsiveness to group interests since all planning decisions are basically a matter of value choice. Citizen participation in planning often combines elements of these two models, embodying the value conflict in planning agency procedures. Health systems agencies are examined as a typical case of such planning. Their failure to build a constituency is viewed as a consequence of role conflict reduction strategies by representatives who did not know whether to play the planner or the advocate role, and how to play either.     

Health care in Canada: patterns of funding and regulation

During the 1970s the share of health care expenditure in Canadian GNP remained roughly stable, in the range of 7-71/2 percent of GNP, in marked contrast to its escalation in most other countries (the U.S. in particular) and to previous Canadian experience. The shift to a stable pattern coincided with the completion of the Canadian system of universal comprehensive public hospital and medical care insurance. This paper explores how and why the public insurance system served to contain cost escalation. It then discusses the inadequacy of expenditure experience per se as a basis for health system evaluation--the same data will support claims of both "underfunding" and "spiralling costs." More serious questions involve the influence of alternative patterns of health care funding and delivery on the effectiveness and efficiency of care provision, and the resulting distributional patterns of care and income. A brief sketch is given of the present situation and future possibilities of Canadian health care under these heads.     

Refining the definition of death for Australian legislation

In the article Mr. Smith considers the need for reform in the area of defining when death occurs and the various approaches that exist to define death. He then analyses the stages of the developments in the various Australian jurisdictions and discusses the substantive content of the basic definition adopted and the practical implications of any enactment. The author suggests that the concept of death should be legislatively enacted in relevant pieces of legislation which call for a resolution of the question at the present time and a more general separate statement defining death should be avoided at the moment. Conceptually death should be defined as the permanent and irreversible loss of consciousness of the individual as determined by irreversible cessation of the brain stem function. The actual operational criteria of death should form the subject of a circular published by the relevant statutory health authority for the guidance of medical practitioners in relation to the specific problems they face.