A carpipramine related fatality

A fatality following ingestion of the tricyclic antidepressant carpipramine (Prazinil) and ethyl alcohol is described. Carpipramine was quantitated by high performance liquid chromatography. The concentration of carpipramine was 2.0 mg/L in blood and 0.44 mg/L in urine. Ethyl alcohol was measured by headspace gas chromatography and found to be 105 mg/dL in blood and 55 mg/dL in the urine. Quantitative analysis of stomach contents was positive for carpipramine by thin-layer chromatography. To our knowledge, this is the first reported fatality involving carpipramine.     

Medicare reimbursement for hospice care: ethical and policy implications of cost-containment strategies

In several areas of health policy, current concern over rising costs has generated considerably political support for reforms that many in the business have advocated unsuccessfully on philosophical, ethical, or humanitarian grounds for years. Thus, for example, the spiraling cost of caring for the mentally ill and the developmentally disabled in an institutional setting has breathed new life into proposals to bring these groups out into the community where they can live more independently--and more cheaply. But this overlap of quality and frugality goals is only partial. Although alliances with cost-cutters can bring reform, health policy reformers are discovering that they may have to accept a lot of bathwater along with the baby. Medicare reimbursement for hospice care, authorized by Section 122 of PL 97-248, the Tax Equity and Fiscal Responsibility Act of 1982, provides one recent example of this dilemma. This article discusses the results of a survey--conducted by the Office of the Inspector General of the Department of Health and Human Services--to discover how many hospices would seek certification for reimbursement by Medicare, how many patients would be served, and the consequences of this legislation for cost, access, and quality of service.     

Just punishments: Guideline sentences and normative consensus

The federal sentencing guidelines prescribe ranges of sentences to be given to persons convicted of felonies in the federal criminal courts. The U.S. Sentencing Commission wrote the guidelines attempting to make sentences conform to community views of appropriate punishments, along with several other criteria. Employing data from a 1994 national sample of adult Americans, designed as a factorial survey, the degree of correspondence is shown between guidelines sentences and those desired by the American public. Although at the individual level only a modest degree of concordance was found, the central tendencies of public opinion (median sentences) were found to correspond quite closely to the guidelines sentences. The major points of disagreement centered around drug trafficking crimes: the guidelines prescribed very long sentences for those crimes and distinguished sharply among trafficking in heroin, powder cocaine, and crack, whereas median sentences desired by the public were much lower and did not distinguish sharply among trafficking in those drugs. We interpret the findings as indicating that the guidelines sentences conform reasonably closely to American normative consensus concerning the sentencing of federal felons.The research reported in this article was commissioned by the U.S. Sentencing Commission. The views expressed in this article are not necessarily endorsed by the Commission. Full expositions of the findings from the national survey used are given by Rossi and Berk (1995, 1997).     

Tackling the Big Questions in Social Impact Bond Research through Comparative Approaches

Abstract

This special issue of theJournal of Comparative Policy Analysis brings together four cross-disciplinary articles representing the first concerted attempt to combine comparative approaches to extend theoretical and empirical understandings of Social Impact Bonds (SIBs). SIBs are investment-backed payment-by-results projects and have been subject to vigorous academic debate on their appropriateness and efficacy since the first SIB launched in 2010. This introduction to the special issue outlines the state of the academic literature on SIBs, identifying gaps and suggesting five big questions that do not yet have satisfactory answers: (1) What are the administrative or political problems to which SIBs respond? (2) Where and why do SIBs emerge in particular contexts? (3) What is the role of SIBs in the evidence-based policy movement? (4) Is delivering an intervention through a SIB more effective than other means and are associated costs justifiable? (5) Do SIBs catalyse wider organizational, system, or institutional changes? This introduction then summarizes the articles included in this special issue, discusses how they respond to these big questions, and suggests that further comparative research might best address remaining gaps in the literature.     

The Restricting Claims Principle Revisited: Grounding the Means Principle on the Agent–Patient Divide

In an earlier article, I introduced the “restricting claims principle” (RCP) to explain what is right about the means principle: the idea that it is harder to justify causing or allowing someone to suffer harm if using him as a means than if causing or allowing harm as a side effect. The RCP appeals to the idea that claims not to be harmed as a side effect push to restrict an agent from doing what she would otherwise be free to do for herself or others, given an appropriate account of her baseline freedom. Claims not to be harmed as a means are not in that way ‘‘restricting.’’ The original RCP relied on a counterfactual account of the agent’s baseline freedom: What could the agent permissibly do if the patient were not present? I argue here that that counterfactual baseline fails. The revised RCP relies instead on a ‘‘toolkit baseline’’: Do the patient claims concern the property the agent needs to use? This toolkit baseline reflects the different ways that agents relate to others: as fellow agents with whom they divide up the resources of the world, and as patients who might be affected by their actions. The toolkit baseline, resting on this agent-patient divide, provides a superior account of an agent’s baseline freedom, and a better account of the moral ground for the means principle