Bleedings, purges, and vomits: Dr. Benjamin Rush's republican medicine, the bilious remitting yellow-fever epidemic of 1793, and the non-origin of the law of informed consent

To the consternation of many physicians, the modern law of informed consent imposes certain constraints on their actions, not least that they respect patients' decisions to redefine at will the scope of care. The consequences of this transfer of power are often a nuisance and occasionally fatal, but always a reflection of democracy's leveling march: Physicians now take orders rather than give them. However frustrating the modern preference for process over result might be, we should ask ourselves-before condemning the law's evolution-about the consequences for patients' health of a more radically democratic practice of medicine. This paper proposes to examine this question as framed by the life of Dr. Benjamin Rush, who, in addition to signing the Declaration of Independence, crafted a medical practice uniquely suited to the young Republic's presumed moral character: Self-aware sufferers would promptly identify their own maladies and courageously treat themselves. In the end, his enterprise was flawed because his democratic instincts misled not only his scientific inquiries (disease is complex, not simple) but also his practice recommendations (patients are scared, not intrepid). Reflection on Rush's failed project should give pause to those who lament the passing of paternalistic medicine, for the law's requirements, however onerous they might be, tolerably accommodate both patients' need for physicians' expertise and our democratic belief that consent is the fundamental precondition of all rule.     

Local Capitalism and Civic Engagement: The Potential of Locally Facing Firms

The twin forces of globalization and devolution have created administrative circumstances that strain the problem‐solving capacity of local governments and increase the importance of nongovernmental processes and institutions. The literature suggests that locally owned firms are more likely to engender higher levels of civic engagement critical to buttressing that problem‐solving capacity. This research adds an additional dimension, investigating to whom those firms sell and through which supply channels. Using survey results from hundreds of local firms across five study sites, this research demonstrates that locally facing firms—that is, firms that intentionally interface with community members and other local businesses—are associated with greater levels of civic and political engagement compared with locally owned firms that sell their products to customers elsewhere. Findings suggest that local governments should look beyond the local/nonlocal ownership binary to consider how private firms can be partners in serving and supporting their communities.     

Expressed‐Interest Legal Representation for Children in Substitute Care: Evaluation of the Impact of Representation on Children's Permanency Outcomes

Based on a combination of administrative data; juvenile court record review; and informed‐participant interviews of juvenile court judges, attorneys, and service providers, the current study examines the impact of the Foster Children's Project (FCP). FCP is a program that provides professional legal representation to children in substitute care. Legal representation by FCP attorneys is found to increase the rate of children's exit to adoption, leading to a higher overall rate of exit to permanence. The rate of exit to reunification is not, however, found to be affected by FCP representation. Implications for juvenile court policy and practice are discussed.

Key Points for the Family Court Community:
• The study is the first of its kind to examine the impact of client‐directed representation in cases of children in foster care through examination of Palm Beach County's Foster Children's Project (FCP), which provides professional legal representation to those in state care.
• FCP representation was found to increase the rate of children's exit to adoption, leading to a higher overall rate of exit to permanence. The rate of exit to reunification, however, remained stable.
• Research findings are based on administrative data; juvenile court record review; and interviews of juvenile court judges, attorneys, and service providers.

     

Agents and Structures: Two Views of Preferences, Two Views of Institutions

Two analytical distinct approaches to the study of domestic politics have been referred to as the "new institutionalism." The fundamental difference between the two brands of institutionalism can be seen in the way they handle the relationship between "agents" and "structures.""Structure-based" approaches to institutions give ontological primacy to structures and view agents as being constituted by them. "Agency-centered" approaches view human agents as ontologically primative and view institutions as structures that are created by goal-maximizing individuals. The two approaches are compared, with special attention given to the way they treat the preferences that actors hold. I argue that contrary to arguments made by many structure-based theorists, the agency-centered approach is capable of contributing to discussions regarding the sources of actor preferences. A limited information model of the strategic interaction between workers and capitalists is used to demonstrate ways in which the agency-centered approach can begin to make preferences endogenous.