THE WILENSKI REVIEW

Since the early 1950s a spate of large-scale inquests on government administration has swept the English-speaking world, under governments of all political complexions. The phenomenon has received no general explanation, but its continuity has had certain practical advantages. It has added to the stock of techniques for conducting inquiries. It has suggested that linking investigation with implementation may reduce the risk of "pigeonholing". It has revealed the importance of political support for essays in reform. The experience also invites, by now, some reflections upon the role of vested interests in the reform process, the impermanence and relativity of particular recipes for reform, and the constant emergence of new perspectives for appraisal of administration. Although Professor Wilenski's Interim Report * is well over a year old, his Review is still in full swing, and is worth discussing not only on its own merits but also for the way it illustrates some of these points.
* Directions for Change: An Interim Report , by Professor Peter Wilenski, Commissioner, Review of N.S.W. Government Administration, Sydney, D. West, N.S.W. Government Printer, November 1977. Pp. ix + 353. Illustrations by Patrick Cook.     

Fatalities by ingestion of propylene glycol

Propylene glycol (PG), a widely used solvent and lubricant, is thought to have low toxicity when ingested. Three cases were identified where PG, either alone or in combination with other chemical agents, contributed to death. The decedent in whom PG was the sole agent was a 32-year-old schizophrenic man with cardiomegaly and renal impairment. The blood PG concentration was 4410 mg/L at least 9.5 h following ingestion.     

The paradoxical politics of provider reempowerment

The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.     

Abortion in Australia: access versus protest

Currently in Australia anti-choice protesters' right to freedom of speech and freedom to protest is privileged over a woman's right to privacy and to access a health service safely, free from harassment, intimidation and obstruction. This article considers how this situation is played out daily at one Victorian abortion-providing clinic. The Fertility Control Clinic was thrown into the spotlight after the murder of its security guard by an anti-choice crusader in July 2001. Australian common law appears not to offer women protection from anti-choice protesters. By contrast, United States and Canadian "bubble" legislation sits comfortably with key constitutional rights. It would be a useful development if Australian governments passed legislation to ensure the rights, wellbeing and safety of Australian women accessing health services. Such legislation would be another step away from the misogynistic and androcentric values once central to our legislative framework.     

Judging capacity: paternalism and the risk-related standard

There is a strong academic and medical consensus on judging patients' decision-making capacity in accordance with the seriousness of consequent risks, and this is supported in certain areas of the law. Supporters of the risk-related standard perceive an asymmetry between the level of capacity required for consent to a treatment, and the level required to competently refuse the treatment, particularly if the probable outcome of refusal is death. Despite the intuitive appeal of the risk-related standard, its opponents propose that when the risks of treatment or treatment-refusal are high, we should not require a higher standard of capacity, but be scrupulous in ensuring that a procedural standard is observed. This article considers both standards, from the point of view of the persons, interests and principles which ethics and the law seek to protect. It argues that a risk-related standard is incoherent, that a rigorously applied procedural standard will minimise paternalistic medical interventions, and that this should be reflected in the law.     

Selective Sexual Harassment: Differential Treatment of Similar Groups of Women Workers

If male workers categorize different groups of women coworkers and, subsequently, treat them differently, the experiences of women from one of these groups would not be indicative of the experiences of women from another group. When this different treatment involves hostile environment sexual harassment of one group, but not the other, then the law must recognize the possibility of "selective sexual harassment." Without this understanding of the nuances of the workplace dynamics, a court could mistake the women of the unharassed group as representing "reasonable women" and the women of the harassed group as simply oversensitive. This paper draws on empirical data to demonstrate such a situation and advocates for a version of the "reasonable victim" standard to facilitate a closer analysis of hostile environment sexual harassment suits.     

An unusual fatality in a child due to oxycodone

An unusual fatality secondary to oxycodone in a child is reported. A 2-year-old female child was conveyed to a local hospital after exhibiting signs of rubbing of the mouth and staggering. A hospital toxicological immunoassay screen for drugs of abuse and tricyclic antidepressants was performed on a urine sample and reported as negative. She was discharged and found unresponsive the next morning. She was conveyed to a second hospital in full cardiopulmonary arrest and despite resuscitative efforts, was pronounced dead upon arrival. An autopsy was performed and postmortem specimens were submitted and screened for drugs using mainly chromatographic techniques. Quantitation was achieved by gas chromatography with nitrogen phosphorus detection. Confirmation was performed by gas chromatography/mass spectrometry. Oxycodone was the only drug detected in the following concentrations: heart blood, 1.36 mg/L; gastric contents, 7.33 mg in 33 mL (222.34 mg/L); liver, 0.2 mg/kg; and urine, 47.23 mg/L (47,230 ng/mL). In addition, immunoassay testing of the urine was positive for the opiate class of drugs. This case report demonstrates an unusual cause of death in a young child with emphasis on potential limitation in hospital urine screening tests and the importance of complete forensic toxicological testing in all child deaths.     

Etiology of pulmonary thromboembolism in the absence of commonly recognized risk factors

Pulmonary thromboembolism is an often fatal complication of venous thrombosis. Any component or combination of the components composing Virchow's triad (venostasis, hypercoagulability, and endothelial damage) increases the propensity for a thrombophilic state. Hypercoagulable states may be inherited or acquired. While the etiology in many cases may be evident either on physical examination or on evaluation of the decedent's medical history, this is often not the case. We conducted a retrospective study of cases presenting to the Jefferson County Coroner/Medical Examiner's Office in Birmingham, Alabama, who were given a diagnosis of pulmonary embolism. A search of cases within the past 23 years yielded 81 cases. An underlying cause was determined in 70 cases (86%). The remaining 11 (14%) cases had no identifiable cause. We believe that a number of these cases may represent an underlying thrombophilic disorder. Since these disorders may be of an inherited or acquired nature, the determination of an etiology may be relevant to the decedent's family. Postmortem blood analyses may in selected cases be useful and appropriate for the detection of some of these disorders. However, such analyses are not practical in all cases, with each case having to be evaluated on its own merits.