Comments on the Comments

Abstract. The paper replies to Bix and Soper ( Bix 2007 ; Soper 2007 ). Bix's paper raises methodological questions, especially whether a form‐theorist merely needs to reflect on form from the arm‐chair so to speak. A variety of methods is called for, including conceptual analysis, study of usage, “education in the obvious,” general reflection on the nature of specific functional legal units, empirical research on their operation and effects, and still more. Further methodological remarks are made in response to Soper's paper. Soper suggests the possibility of substituting “form v. substance” of a unit as the central contrast here rather than form v. complementary material or other components of a unit. Various reasons are given here for not doing this. Among other things, it is also argued here that form does not, contrary to Soper's suggestion, always follow substance.     

Making Sense of COMPSTAT: A Theory-Based Analysis of Organizational Change in Three Police Departments

COMPSTAT, the latest innovation in American policing, has been widely heralded as a management and technological system whose elements work together to transform police organizations radically. Skeptical observers suggest that COMPSTAT merely reinforces existing structures and practices. However, in trying to assess how much COMPSTAT has altered police organizations, research has failed to provide a broader theoretical basis for explaining how COMPSTAT operates and for understanding the implications of this reform. This article compares two different perspectives on organizations—technical/rational and institutional—to COMPSTAT's adoption and operation in three municipal police departments. Based on fieldwork, our analysis suggests that relative to technical considerations for changing each organization to improve its effectiveness, all three sites adopted COMPSTAT in response to strong institutional pressures to appear progressive and successful. Furthermore, institutional theory better explained the nature of the changes we observed under COMPSTAT than the technical/rational model. The greatest collective emphasis was on those COMPSTAT elements that were most likely to confer legitimacy, and on implementing them in ways that would minimize disruption to existing organizational routines. COMPSTAT was less successful when trying to provide a basis for rigorously assessing organizational performance, and when trying to change those structures and routines widely accepted as being "appropriate." We posit that it will take profound changes in the technical and institutional environments of American police agencies for police departments to restructure in the ways anticipated by a technically efficient COMPSTAT.     

A Desultory Defense of Democracy: OAS Resolution 1080 and the Inter-American Democratic Charter

This article evaluates the effectiveness of OAS mechanisms for safeguarding democracy through multilateral diplomacy, what some scholars have dubbed the interamerican defense of democracy regime. Drawing on a range of international relations theories, this study derives competing hypotheses about member states' responses to democratic crises in the Americas. It then analyzes all instances in which a collective response—that is, an application of Resolution 1080 or the Inter-American Democratic Charter—was debated in the OAS between 1991 and 2002. Patterns of state behavior suggest that domestic politics, rather than the structural or systemic traits of the interamerican system, best explain foreign policy responses to crises of democracy in the region. The OAS record in confronting such crises is uneven.     

SUPERVISING VISITS BETWEEN PARENT AND CHILD

Serious conflicts can arise when contacts between a child and a parent require supervision unless specific guidelines and objectives are clarified for all involved parties. This article discusses supervision objectives, the importance of maintaining the parent-child relationship, instances warranting recommendation for no parental contact, qualifications of the supervisor, and practical guidelines for supervision.     

The judicial role in life-sustaining medical treatment decisions.

Although there has been speculation regarding the pervasiveness and nature of judicial decisions regarding life-sustaining medical treatment (LSMT), no attempt has been made to empirically assess their prevalence or the issues they address. An exploratory study utilizing a mail survey of a nationwide random sample (N = 905) of state trial court judges was conducted to provide initial information regarding this decision-making process. Twenty-two percent of the responding judges had heard at least one LSMT case, and judicial review did not appear endemic to particular states. The number of judges hearing LSMT cases dropped from 1975 to 1981 but has increased since then. Three major issues predominate: patient competency, appointment of a surrogate decisionmaker, and resolution of the ultimate issue of forgoing LSMT. Relatively few cases either contested a prior directive's validity or involved imposing sanctions for instituting or forgoing LSMT. Although subject to different interpretations, the results suggest the courts are having a significant impact on certain aspects of the LSMT decision-making process. However, the infrequency with which any one judge is called upon to make an LSMT decision causes concern about the judiciary's ability to respond in a timely and appropriate manner. With their potential for a profound effect on the actions of health care providers, greater attention to this decision-making process is warranted.     

A unique case of congenital bilateral absence of parietal bones in a neonate

The remains of an unidentified female neonate were discovered in a field in central Missouri. Examination revealed bilateral absence of the parietal bones. A search of the literature describing similar defects suggests that the present case represents a unique condition, described here for the first time.     

Empire and Its Alternatives

The most ferocious debates are about whether the United States should be described as imperial, but in practice other countries also try to influence other countries’ domestic policies, to propagate their visions, to exert power and to stabilize areas beyond their borders that are perceived as a source of threats. While in the 1990s the winners of globalization were seen as small open states, since the turn of the millennium big powers appear to be gaining because of their ability to project political power: the United States, but also China, Russia, India, and Brazil. This makes for a greater instability and leads to the formulation of theories of realism or neo-realism. The essay concludes with an examination of alternatives to empire and the neo-imperial vision, in particular the importance of elaboration of common or shared values in helping to build a safer and more peaceful international order.     

Has PPS increased Medicare expenditures on physicians?

We use data from 1983 and 1985 on the volume of Medicare physician services to analyze whether Medicare's Prospective Payment System (PPS), which resulted in a significant decline in hospital spending, led to a partially offsetting increase in real expenditures for physician services. We also analyze the effect of increases in assignment rates, increasing incomes of the elderly, and other factors on real expenditures during this period. Our main conclusion is that PPS has at most a small positive effect on real physician expenditures. Because people spent less time in the hospital, Medicare physician spending declined; but because of incentives to shift radiology and other services out of the hospital, some of this decline was offset. We also conclude that the sharp increase in Medicare assignment rates over this period, along with the rising incomes of the elderly during this period, contributed to the observed growth.