Attitudes of people with disabilities toward physician-assisted suicide legislation: broadening the dialogue

This article presents the methods, findings, and implications of a participatory action research project that attempted to shed additional light on the debate over death with dignity (DWD) or physician-assisted suicide (PAS) legislation. In-depth, qualitative interviews with forty-five physically disabled residents of the San Francisco Bay Area, conducted by others with disabilities, revealed a wide breadth of opinions about and attitudes toward such legislation. For close to half of the participants, the desire for autonomy in making end-of-life decisions was a primary concern, yet fear that PAS legislation could violate this autonomy in various ways was a deep concern as well. Also reported were widespread accounts of disability-based discrimination and frequent expressions of fear about openly discussing positions that diverge from the official, publicly held opinions of disability leaders who oppose such legislation. The findings support those of a recent Harris poll demonstrating considerable diversity of opinion about PAS legislation among people with disabilities. The findings further suggest the need for additional research on the apparent disjunction between the diversity of attitudes held by those interviewed and the more unified position taken by many disability activists. Use of the study findings to promote greater dialogue within the community and to better position people with disabilities to take their place at the policy table also is discussed. In addition, the findings are seen as reinforcing the need for the public health community to become more engaged in this central ethical debate.     

Anomalies of the human chest plate area. Radiographic findings in a large autopsy population

Anomalies of the sternal rib ends and costal cartilages, sternal foramina, and epi(supra)sternal bones from a large, modern autopsy population have been described. Rib abnormalities (duplications, fusions, and spurs) were found in 55 of 2,016 plastron roentgenograms, sternal foramina were found in 135, and episternal bones were found in 51. Sternal foramina were significantly more common in blacks than in whites and episternal bones more common in whites than blacks; rib anomalies had no recognizable racial predilection. Rib anomalies were almost three times more common in males than females, whereas episternal bones were only slightly more common in males. Sternal foramina had no sex predilection. Episternal bones were slightly more often unilateral than bilateral and, when unilateral, were twice as often located on the left. While none of the malformations studied appeared to be of clinical significance, they are of potential forensic value in individual identification.     

DEVELOPMENTS IN NEW SOUTH WALES PUBLIC ADMINISTRATION*

There are probably more changes taking place in public administration than at any previous time. In some sectors (like health) staff are now used to change; it has become a normal part of their everyday life. In other sectors (like road transport) it is a new experience. Some changes are the latest chapter in a long and continuing story. Clear objectives, downstream autonomy and performance monitoring have been issues for as long as most public servants can remember. The fresh ingredients added by New South Wales Incorporated are the management incentives that make a direct appeal to the self-interest of senior executives, and the ideology of competitive neutrality that mimics the price signals which motivate private enterprise. The intended results are less political patronage, smaller government, more accountability, better morale and higher productivity. Stated in these terms they are unlikely to cause controversy; the current political consensus is that they would constitute worthy goals for any government. However important differences of opinion will probably emerge over the order of priority for these goals. For example, how much should higher productivity be sought if it threatens accountability or morale? There is also likely to be debate between those who want everything in place immediately, even if it means industrial strife, and those who prefer a softly-softly approach.     

Rural Senegalese Perceptions of Environmental Quality

Differences in environmental perspectives between advanced industrial and developing country nationals has both practical and policy implications for the transfer of environmentally sound technologies. This paper characterizes rural Senegalese environmental perspectives in the context of competing environmental paradigms and of their historical development. Methodological issues concerning the adaptation of items from the Health of the Planet Survey (HOPS) questionnaire (Dunlap, Gallup, and Gallup, 1993) to rural Senegal are discussed and qualitative survey results presented. Based on a stratified national sample of rural Senegalese men and women, a quantitative analysis addresses the priority concerns of rural Senegalese men and women and how they perceive the trade off between environmental protection and economic development. The paper concludes that attempts to draw valid conclusions concerning comparisons between the environmental perspectives of the publics of advanced industrial and low income developing countries must take local conditions, their historical dynamics and cultural expressions into account.