Postmodern policy analysis: Discourse and identity in welfare policy

Postmodern inquiry into the discursive construction of identity has the potential to make a distinctive, democratizing contribution to public policy analysis. More so than conventional approaches, a postmodern policy analysis offers the opportunity to interrogate assumptions about identity embedded in the analysis and making of public policy, thereby enabling us to rethink and resist questionable distinctions that privilege some identities at the expense of others. Public policy analysis can benefit from postmodernism's emphasis on how discourse constructs identity. A review of postmodernism and postmodern approaches to interrogating identity is followed by an exercise in postmodern policy analysis. Social welfare policy in contemporary postindustrial America is shown to participate in the construction and maintenance of identity in ways that affect not just the allocation of public benefits, but also economic opportunities outside of the state. Mired in old, invidious distinctions (e.g., independent/dependent, contract/charity, family/promiscuity), welfare policy discourse today helps to recreate the problems of yesterday, particularly as a critical factor in reproducing women's poverty.     

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.     

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.