Symbols, rationality, and justice: rationing health care.

Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.     

Ethics and the Physician-Patient Relationship

Book Reviews in This Article:
Getting Rid of Patients: Contradictions in the Socialization of Physicians . By Terry Mizrahi
Physicians and Social Change . By John Colombotos and Corinne Kirchner
Changing Values in Medicine . Edited by Eric J. Cassell and Mark Siegler
Professional Ethics and Primary Care Medicine: Beyond Dilemmas and Decorum . By Harmon L. Smith and Larry R. Churchill
Physician—Patient Decision-Making: A Study in Medical Ethics . By Douglas N. Walton
With Dignity: The Search for Medicare and Medicaid . By Sheri I. David
The Dismissal of Students with Mental Disorders. Legal Issues, Policy Considerations, and Alternative Responses .
Courtroom Toxicology . By Marshall Houts, Randall C. Baselt, and Robert H. Cravey     

Paternity testing in a kidnapping case

A case of kidnapping involving the concept of paternity testing is described. The couple arrested and charged with kidnapping stated the child in their possession was their biological daughter. Serological tests were performed on liquid blood samples in an effort to determine if the couple could have been the biological parents of the child. Two genetic inconsistencies were discovered in the 15 blood marker systems analyzed.     

ASSESSING NEIGHBORHOOD AND SOCIAL PSYCHOLOGICAL INFLUENCES ON CHILDHOOD VIOLENCE IN AN AFRICAN‐AMERICAN SAMPLE*

The present study examines the extent to which neighborhood and social psychological influences predict childhood violence among 867 African‐American youth. The results showed that neighborhood affluence was the only neighborhood‐level variable to exert a significant influence on childhood violence. Furthermore, childhood violence was significantly related to social psychological influences, such as adopting a street code, associating with violent peers, parental use of violence, and quality parenting. Overall, the findings suggested that simply living in a violent neighborhood does not produce violent children, but that family, peer, and individual characteristics play a large role in predicting violence in childhood.     

Trade union behaviour and inter-regional variations in unemployment rates

An important problem in the political economy of the UK is that the disparity of unemployment rates across its regions is much more marked than the corresponding dispersion of wage rates. One possibility is that this is due to the attitude of trade unions to their members in different regions. If unions wish to preserve parity between members in different regions then they will value wage equality between regions over and above wage levels. This may then persuade them to overlook inter-regional productivity differences in setting wages. The price that low-efficiency regions will then pay for this desire for wage equality is higher unemployment rates.Much of the research for this paper was carried out while the author was visiting the Trade Union Economics Research Institute (FIEF), Stockholm in 1989. An earlier version of this paper was presented at a seminar there and the author is gratefully to Villy Bergstrom, Paul Chen, Douglas Hibbs, Eva Udden-Jondal and other institute members for several useful comments. Comments from Kevin Lee, John Spencer and an anonymous referee have also substantially improved the paper. The usual disclaimer applies.     

Dissecting intramural haematoma of the coronary artery with intimal tears.

A dissecting intramural haematoma of the coronary artery is an infrequent cause of sudden and unexpected death. Most cases are women and in a significant number of these women, the haematoma occurred at term to 80 days postpartum. Because the intimal rupture and communication with the lumen were not found in most of the cases, the site of rupture has been considered to be a vasa vasorum. The authors report on a case of one woman who was at a later postpartum period (106 days). The microscopic finding of the dissected coronary artery revealed two intimal tears in a section. The case showed that the dissecting intramural haematoma of the coronary artery is caused not only by the rupture of the vasa vasorum but also by the rupture of the intima.     

Should Abused Women's Reports of Partner Substance Abuse Be Accepted as Valid?

Current research suggests that a husband's substance abuse is correlated with severity of physical abuse and the woman's decision to leave a violent situation. Often, only the battered woman's report of abuse is available. This study compares women's reports of their partners' substance use/abuse with their partners' report using a brief measure of polydrug and alcohol abuse, the Substance Abuse Subtle Screening Inventory (SASSI) and the Conflict Tactics Scale (CTS). Data were analyzed for 25 recovery couples and 25 nonrecovery couples. The correlations for all 50 couples between the male's reported use and the female's report of her partner's use on the SASSI and the CTS were significant on all but one of the CTS scales. They ranged on SASSI from .73 to .33 and from .31 to .06 on the CTS. This suggests that the SASSI and possibly the CTS could be used as valuable tools for assessing women's reports of their partner's substance use/abuse.