Moral atrophy in the welfare state

The welfare state is often accused of being counterproductive: as the scope of public responsibility expands, private morality (especially altruism and benevolence) atrophies. This essay surveys psychological findings for evidence, which turns out to be broadly consistent with either of two models of moral development, each bearing distinct policy implications. The model of morally keeping in practice that is implicit in the term moral atrophy suggests the need for frequent opportunities to exercise moral skills, which would seem inconsistent with the welfare state. Alternatively, the model of moral character-building favoured by both philosophers and ordinary discourse would require only occasional reminders of one's moral principles. On this model, benevolence could usefully supplement the welfare state.     

Doctors under the knife

With Bill Clinton's new reforms only a month away, the health-care system is on the operating table--and the doctors are under the knife. Americans have a love-hate relationship with physicians: they like the care that doctors provide but hold them to blame for the nation's health-care mess. NEWSWEEK looks at how the culture of medicine may change, assesses doctors' fears--and examines the brave new world of HMOs.     

Reviews

Orlando Figes, A People's Tragedy: The Russian Revolution 1891–1924. London: Jonathan Cape, 1996, xx + 923 pp., £25.00

Hafeez Malik (ed.), The Roles of the United States, Russia and China in the New World Order. Basingstoke: Macmillan, 1997, xvi + 333 pp., £47.50.

Leszek Buszynski, Russian Foreign Policy after the Cold War. Westport and London: Praeger, 1996, xiv + 243 pp., £46.95.

Mette Skak, From Empire to Anarchy: Postcommunist Foreign Policy and International Relations. London: C. Hurst & Company, 1996, x + 340 pp., £35.00 h/b, £14.95 p/b.

Hans von Zon, The Future of Industry in Central and Eastern Europe. Aldershot: Avebury, 1996, x + 164 pp., £35.00.

Bartlomiej Kaminski (ed.), Economic Transition in Russia and the New States of Eurasia. Armonk, New York: M.E. Sharpe, 1996, xviii + 430 pp.

Ben Fowkes, The Disintegration of the Soviet Union: A Study in the Rise and Triumph of Nationalism. Basingstoke: Macmillan, 1997, xii + 273 pp., £40.00

Juan J. Linz & Alfred Stepan, Problems of Democratic Transition and Consolidation. Southern Europe, South America, and Post‐Communist Europe. London: The Johns Hopkins University Press, 1996, xx + 479 pp., £15.50.

David Lane, The Rise and Fall of State Socialism. Cambridge: Polity Press, 1996, 233 pp., £12.95.

Reneo Lukic & Allen Lynch, Europe from the Balkans to the Urals: The Disintegration of Yugoslavia and the Soviet Union. Oxford: Oxford University Press, 1996, xvii + 436 pp.

Thomas Cushman & Stjepan G. Mestrovic (eds), This Time We Knew: Western Responses to Genocide in Bosnia. New York: New York University Press, 1996, ix + 412 pp., $50.00 h/b, $18.95 p/b.

Derek Hall & Darrick Danta (eds), Reconstructing the Balkans. A Geography of the New Southeast Europe. Chichester: John Wiley & Sons, 1996, xx + 260 pp., £45.00.

Ajay Patnaik. Central Asia. Between Modernity and Tradition. New Delhi: Konark Publishers, 1996, viii + 238 pp.

Rudolf L. Tokes, Hungary's Negotiated Revolution: Economic Reform, Social Change and Political Succession, 1957–1990. Cambridge: Cambridge University Press, 1996, xxiii + 544 pp., £19.95.

John D. H. Downing, Internationalizing Media Theory, Transition, Power, Culture, Reflections on Media in Russia, Poland and Hungary 1980–95. London: Sage, 1996, xviii + 269 pp., £45.00 h/b, £13.95 p/b.

Rogers Brubaker, Nationalism Reframed: Nationhood and the National Question in the New Europe. Cambridge: Cambridge University Press, 1996, xi + 202 pp., £35.00 h/b, £12.95 p/b.

Donald P. Steury (ed.), Intentions and Capabilities: Estimates on Soviet Strategic Forces, 1950–1983. Washington DC: Center for the Study of Intelligence, 1996, xxii + 504 pp.

R. W. Davies, Crisis and Progress in the Soviet Economy, 1931–1933. Basingstoke: Macmillan, 1996, xviii + 612 pp., £65.00.

William Chase, Jeffrey Burds, S. V. Praslova, A. K. Sokolov & E. A. Tiurina (eds), Russian Stale Archive of the Economy: A Research Guide: I. Guide to Collections. Moscow: Blagovest, 1994, xx + 679 pp.

V. P. Butt, A. B. Murphy, N. A. Myshov & G. R. Swain (eds), The Russian Civil War. Documents from the Soviet Archives. London: Macmillan, 1996, xvii + 217 pp., £15.99.

Ilya Somin, Stillborn Crusade: The Tragic Failure of Western Intervention in the Russian Civil War, 1918–1920. New Brunswick, NJ: Transaction Publishers, 1996, ix + 236 pp., £21.95, $32.99.

David R. Shearer, Industry, State, and Society in Stalin's Russia, 1926–1934. Ithaca: Cornell University Press, 1996, xiv + 263 pp., £33.50 h/b, £14.95 p/b.

Peter H. Solomon Jr., Soviet Criminal Justice under Stalin. Cambridge: Cambridge University Press, 1997, xvii + 494 pp., £55.00 h/b, £19.95 p/b.

Richard G. Hovannisian, The Republic of Armenia, Volume III, From London to Sèvres, February‐August 1920, xx + 534 pp., and Volume IV, Between Crescent and Sickle: Partition and Sovietization, xii + 496 pp. Berkeley, University of California Press, 1996. £35.00 each volume.

Ian D. Thatcher & James D. White (eds), Journal of Trotsky Studies. Glasgow: Institute of Russian & East European Studies, 1993–1996, Nos. 1–4, £10.00 (Institutions), £5.00 (Individuals).

Mikhail Baitalsky, Notebooks for the Grandchildren. Recollections of a Trotskyist Who Survived the Stalin Terror, Edited and translated by Marilyn Vogt‐Downey. Atlantic Highlands, New Jersey, 1996, xviii + 447 pp.

Leopoldina Plut‐Pregelj & Carole Rogel, Historical Dictionary of Slovenia. London: The Scarecrow Press, Inc, 1996, xxvii + 345 pp., £63.65.     

Book reviews

Roland Axtmann, Liberal democracy into the twenty‐first century: Globalization, integration and the nation‐state (Manchester University Press, Manchester, 1996), 198 pp., ISBN 0–7190–4304–2 (hb), 0–7190–4305–0 (pb)

Paul Kapteyn, The Stateless Market: The European Dilemma of Civilization (Routledge, London and New York, 1996), 194 pp., ISBN 0–415–12232–5 (hb), 0–415–12233–3 (pb)

Richard Werbner and Terence Ranger (eds), Postcolonial Identities in Africa (Zed Books, London & New Jersey, 1996), 292 pp., ISBN 1–85649–415–2 (hb), 1–85649–416–0 (pb)

Mark Wheeler, Politics and the Mass Media (Blackwell, Oxford, 1997), 274 pp., ISBN 0–631–19783–4 (hb), 0–631–19784–2 (pb)

Nigel Harris, The New Untouchables: Immigration and the New World Worker (Penguin Books, London, 1995), 254 pp., ISBN 0–14–014689‐X (pb)

Gilles Kepel, Allah in the West (Polity Press, Cambridge, 1997), 273 pp., ISBN 0–7456–1557–0 (hb), 0–7456–1558–9 (pb)

Leonard Weinberg, The Transformation of Italian Communism (Transaction Publishers, New Brunswick, New Jersey, 1995), 147 pp., ISBN 1–56000–180–1 (hb)

Brian Jenkins and Spyros A. Sofos (eds), Nation and Identity in Contemporary Europe (Routledge, London, 1996), x + 294pp., ISBN 0–415–12312–7 (hb), 0–415–12313–5 (pb)

Stuart Parkes, Understanding Contemporary Germany (Routledge, London, 1997), 247 pp., ISBN 0–415–14123–0 (hb), 0–415–14124–9 (pb)     

Participatory development: an approach sensitive to class and gender

This article begins by presenting development experience gained in the Indonesian province of Irian Jaya as a means of highlighting the centrality of popular participation to the development process. Important lessons from the ongoing development work in Irian Jaya were that it is not sufficient to consult beneficiaries and then act on their behalf or to engage in a development process unless the participants understand the project's conceptual orientation and language and have the tools to assess their needs and options for constructive change effectively. Also, developers must supply participants with information about the larger economic and political context in which they are operating. The article continues with an exploration of the ways in which a focus on class and gender raises participatory development to a new level. Constraints on transformative participation are then defined as 1) the political conditions and power structures existing in the country and community, 2) administrative opposition, 3) sociocultural impediments, and 4) limitations imposed by daily life. While it may be impossible to avoid the effects of such constraints, development agents can help villagers anticipate their impact and support efforts to cope with them. Participatory development challenges the status quo by enhancing economic equity and social equality and, if effective, will engender opposition, especially when a large amount of funding is at stake. Opposition can take many forms, including ridicule or resistance and can get personal. The demand to produce quick results also creates restraints on development agents. It is concluded that the development agent must engage key sectors of the local population in the development process and nurture this participation. Development agents should act as facilitators rather than independent initiators telling people what is best for them. Development agents must become very familiar with the community to earn the trust that is needed to guide people toward self-analysis and priority-setting.     

The need to know versus the right to know: privacy of patient medical data in an information-based society

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."(1) "Safeguards to privacy in individual health care information are imperative to preserve the health care delivery relationship and the integrity of the patient record."(2) As early as the fourth and fifth centuries B.C., Hippocrates contemplated the importance of medical information to the care and treatment of patients. His oath suggests that privacy of a patient's medical information creates the foundation upon which a patient reposes trust in his or her physician. While defining the earliest version of the physician-patient privilege, the oath does not envision the extent of modern day access to healthcare information. A patient's relationship with the modern healthcare delivery system often includes a team of physicians, nurses, and other clinical support personnel. This relationship extends beyond direct caregivers and may include healthcare administrators, payor organizations, and persons unfamiliar with a patient's identity, such as researchers and public health officials. Accessing a patient's medical information links these participants to the patient's healthcare delivery relationship. The Hippocratic Oath does not contemplate such broad access, nor does it contemplate the emerging privacy crisis resulting from the application of computer technology to medical record storage and retrieval. The combination of broad access, individual privacy rights, and computer technology requires a rethinking of measures designed to protect the realities of the modern medical information society.