Book Reviews

Book Review in This Article:
G ood L ife /G ood D eath : A D octor's C ase F or E uthanasia and S uicide . By Dr. Christiaan Barnard
A M atter of L ife . By Robert Edwards and Patrick Steptoe
G enetics and the L aw II. Edited by Aubrey Milunsky, M.B.B.Ch., M.R.C.P., D.C.H. and George J. Annas, J.D., M.P.H.
L egal A spects of H ealth P olicy : I ssues and T rends . Edited by Ruth Roemer and George McKray
F ederal R egulation : H ospital ATTORNEY'S DESK REFERENCE. By the American Society of Hospital Attorneys
I ndustry W age S urvey : H ospitals and N ursing H omes , S eptember 1978     

Legal anxieties and end-of-life care in nursing homes

Many persons spend their final days as nursing home residents. It has been suggested that one set of factors powerfully and unfavorably influencing the quality of end-of-life (EOL) care provided in American nursing homes involves the anxieties that nursing home providers experience regarding potential negative legal entanglements and repercussions associated with the provision of EOL care to their residents. This article critically examines the hypothesis that the quality of EOL medical care provided in nursing homes often is skewed in a perverse way because providers are driven unduly by legal apprehensions. The author offers practice and policy recommendations for trying to resolve or mitigate the tension present between legally defensive practice (real or perceived) by nursing homes, on one hand, and ethically optimal EOL care, on the other.     

IMPLEMENTING POLICY-A BUREAUCRATIC POWER PERSPECTIVE

Abstract: This paper argues that theories of organisational power which are based on the concepts of dependence and uncertainty may constitute a useful approach for explaining the manner in which government policies come to be implemented. In the intra-organisational context, studies by Crozier and Hickson demonstrate that subgroups which can control sources of uncertainty and create dependencies rise to positions of relative power within the organisation and may use this position to bargain for increased organisational rewards. Subgroups within public sector organisations that achieve power in these terms may, as their organisational reward, seek to impose particular values on policy programs carried out by the organisation as a whole. Activities in the inter-organisational context may be viewed from a similar perspective. The work of J. D. Thompson indicates that organisations can possess positions of power relative to other organisations in their task environment. In the public sector such power may be used to influence the policy programs of dependent departments. The paper then suggests that in the public sector intra- and inter-organisational theories of power may be combined to explain how subgroups can evolve into organisations in their own right and, in so doing, succeed in considerably changing the stated direction of government policy. To show how such a situation can occur, a case study of the evolution of Queensland's institutes of technology is included. The paper concludes that theories of organisational power can be of value to policy implementation theorists but require some modification to accommodate the particular characteristics of the public sector environment.     

Book Reviews

Book Review in This Article:
THE P olitics of R egulation Edited by James Q. Wilson
T he G reat B illion D ollar M edical S windle By Keith Alan Lasko, M.D.
A merican L aw of M edical M alpractice By Steven E. Pegalis, J.D., and Harvey F. Wachsman, M.D., J.D.
H idden V ictims : T he S exual A buse of C hildren By Robert L. Geiser     

Compositional analysis for identification of arson accelerants by electron ionization Fourier transform ion cyclotron resonance high-resolution mass spectrometry

Elemental compositions of each of 100 to 500 different constituents (i.e., every peak in a mass-to-charge ratio range, 50 < m/z < 300) of lighter fluid, kerosene, turpatine, gasoline, diesel fuel, and two brands of mineral spirits (and their weathered analogs) make possible direct identification of each accelerant in a experimental fire, based on electron ionization 6.0 Tesla Fourier transform ion cyclotron resonance (EI FT-ICR) ultrahigh resolution mass spectrometry. Septum injection of as little as 500 nL of accelerant into an all-glass heated inlet system yields definitive elemental compositions (molecular formulas) based on accurate (< +/-1 ppm average error) mass measurement alone. Extraction and EI FT-ICR mass analysis of fire debris from a controlled burn of a couch with simple (lighter fluid) and complex (turpatine) ignitable liquid yielded dozens of elemental compositions serving as a unique "fingerprint" for each petroleum product, despite the presence of up to 249 additional extracted matrix and pyrolysis components. Forty-five of 56 lighter fluid constituents and 126 of 133 turpatine constituents (not counting 13C-containing species) were identified in the debris from a fire staged for each respective accelerant.     

Characteristic Features of Pediatric Firearm Fatalities—Comparisons Between Australia and the United States

Abstract:  Gunshot deaths in children less than 17 years of age from Adelaide, SA, Australia (1969–2005) and from San Diego County, CA, United States (1988–2005) were compared. Forty-two pediatric gunshot fatalities occurred in South Australia (1.1 cases/year; M:F = 30:12). There were 6 accidents (14%), 14 suicides (33%), and 22 homicides (52%). In San Diego there were 185 cases ( c. 10 cases/year; M:F = 148:37). There were 6 accidents (3%), 42 suicides (23%), 130 homicides (70%), and 7 undetermined cases (4%). The incidence of homicide was significantly higher in San Diego County compared to Adelaide ( p  < 0.001), with a higher proportion of murder–suicides occurring in Adelaide. There were markedly more accidents and suicides involving males in Adelaide and a far higher number of male homicide victims in San Diego County compared to females. Rifles of 0.22-caliber were preferred weapons in South Australia, compared to handguns in San Diego County.