Technical Management in an Age of Openness: The Political,Public, and Environmental Forest Ranger

Modern bureaucracy faces trade‐offs between public and congressional input and agency expertise. The U.S. Forest Service offers an opportunity to quantitatively analyze whether an agency that is required to be more open to the public and congressional input will be forced to ignore its technical expertise in managing resources. This study uses data on 83,000 hazardous fuels reduction activities conducted by the Forest Service from 2001 to 2011. Although the results show that managers are responsive to public and congressional considerations, this has not prevented them from utilizing their technical knowledge to restore lands most deviated from natural conditions. This suggests that managers can balance responsiveness to public and political principals with technically sound management.     

Life into art and art into life: visualising the aesthetic woman or ‘high art maiden’ of the Victorian ‘renaissance’

There has been a great deal of research concerning the effect of aestheticism on men in the late nineteenth century, especially in terms of their sexuality, but its impact on women has been largely dismissed as unnecessary, as women were naturally ‘feminine’. This article examines whether ‘the self-absorption and heightened emotional life of Aestheticism’ (J.B. Bullen, 1998 [Oxford: Oxford University Press]) was tolerable in women or if it was leading to disease, decay and corruption. Aestheticism's insistence on individuality and self-discovery were to have important consequences for women, fuelling the desire for a life of their own rather than solely service to others.     

A shrinking state? Politics,economics and private health care in Thailand

This article explores the political and economic forces involved in the development of privatization policies within the health care sector in Thailand. It is suggested that many of the motivating factors behind private sector growth are outside of the health sector; the general macroeconomic environment and tax incentives have stimulated private sector expansion. Within the Ministry of Public Health a preoccupation with improving care in rural areas and an unclear policy line on the private sector has facilitated this expansion. Only recently has private sector growth come to the policy agenda. During this lag period a number of interest groups have developed. It will be difficult to overcome these entrenched interests in order to change policy direction. Meanwhile, problems of rapid cost inflation and inequity face the Thai health care system. Although this case study focuses upon the health care sector in Thailand it would appear relevant both to other sectors and to other countries. The relationship between development models based upon pro-private, pro-market tenets and the establishment of a satisfactory social policy is questioned.     

A dose of reality: assessing the Federal Trade Commission/Department of Justice report in an uninsured, underserved, and vulnerable population context

Despite the size of their report, the Federal Trade Commission and Department of Justice pay virtually no attention to tens of millions of uninsured and underinsured persons. By focusing on an increasingly rarified group of health care customers--healthy, affluent, and highly insured--the report takes on an untethered quality, with only the slightest tip of the hat to its own limitations. Furthermore, the report overstates the extent of legal constraints on the market, in particular, the degree to which the market is free to select its customers and tailor its goods and services to the best risks. By miscasting the legal context of the American health care system, the report ultimately undermines much of its potential value.     

A Leap of Faith? Sanctioning Xenotransplant Clinical Trials

Introducing a new medical technique, procedure or drug to the public via clinical trials is risky at the best of times. When the trial involves a biotechnology which holds out the promise of prolonging, if not saving, life the push to move from the laboratory to clinical trials may be hard to resist. In this article I explore whether the regulatory scheme for clinical trials in the UK is able to accommodate developing technologies by considering how the current legal and ethical frameworks determine when a procedure such as xenotransplantation should proceed to trials. In particular, I discuss whether basing our regulatory schemes on the principles espoused in the Declaration of Helsinki offer sufficient protection to those who may be affected by xenotransplant trials – the recipient, their health-care workers, close contacts and, unusually, the wider public. I question whether it is possible for a technology to be approved for clinical trials when allowing such trials may benefit the individual but ultimately negatively impact on society as a whole.     

Dr. Jekyll's waiver of Mr. Hyde's right to refuse medical treatment: Washington's new law authorizing mental health care advance directives needs additional protection

Mental health care advance directives are gaining popularity nationwide. Following a growing trend, the Washington State Legislature has recently passed a law allowing patients to draft mental health care advance directives that could be irrevocable. Patients who sign an irrevocable directive essentially waive their fundamental right to refuse treatment in the future. The United States Supreme Court has held that waivers of fundamental rights must be made knowingly, voluntarily, and intelligently. However, as passed, Washington's new law contains insufficient safeguards to guarantee such a waiver. This Comment proposes that the Washington State Legislature amend this law the require two additional protections: a "rights advocate" to explain the potential waiver of rights, and a written warning in the advance directive form. These safeguards will help ensure that patients make knowing and intelligent waivers of their fundamental right to refuse treatment.