Co-Production and Health System Reform – From Re-Imagining To Re-Making

There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of post-neoliberal policy concerned with re-imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co-production, has both beneficial, but also problematic implications for the organisation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via 'choice' and 'voice' participation strategies, the question of how the more challenging approach of co-production will fare needs to be addressed. The article discusses the possibilities and challenges of system-wide co-production for health. It identifies the discourse and practice contours of co-production, differentiating co-production from other health consumer-led approaches. Finally, it identifies issues critically related to the successful implementation of co-production where additional theorisation and research are required.     

Meso‐discourses,state forms and the gendering of liberal‐democratic citizenship

This article builds upon Michel Foucault's fleeting observation that ‘the state consists in the codification of a whole number of power relations’ and that ‘a revolution is a different type of codification of these same relations’ (Held et al., 1983, pp. 312–3). Specifically, the article uses the case of Canada to argue that distinct state forms rest on particular meso‐discourses which inform a logic of governance, historical configurations of the public and private and gendered citizenships. The meso‐discourses of separate spheres, liberal progressivism and performativity (the logics of governance for the laissez‐faire state, the Keynesian welfare state and the neo‐liberal state, respectively) have coded and recoded gendered citizenships, thereby providing women and men with differential access to the public sphere and to citizenship claims. The neo‐liberal state's meso‐discourse of performativity is especially challenging for women and all equity‐seeking groups because it prescribes the ascendency of market relations over political negotiation or ethical considerations, as well as the attrition of social and political citizenship rights. Social citizenship is being eclipsed by market citizenship.     

Tarasoff in Missouri: The jurisprudence of a mental health provider's duty to warn and protect non-patients of potential risks from patients

In 1976, the Supreme Court of California issued its well-known Tarasoff Principle. From this principle, other courts found a duty to warn, and some found more than just a duty to warn, a duty to protect. As courts in other states adopted a version of the Tarasoff Principle, they issued a wide variety of third-party liability rules. In light of the dynamic, everchanging Tarasoff jurisprudence in the United States and recent relevant appellate court opinion in Missouri, a timely updated summary and update of Tarasoff-related jurisprudence in Missouri is warranted. In the present analysis, we compiled the four appellate court decisions that pertained to the questions of Tarasoff-like third-party liability in the State of Missouri: Sherrill v. Wilson (1983), Matt v. Burrell (1995), Bradley v. Ray (1995), and Virgin v. Hopewell (2001). We reviewed all legal measures for clinicians to protect nonpatients in Missouri, not just those that relate to protecting nonpatients from violence as in a Tarasof-like scenario. Thus, this paper concisely provides a compendium of such options and allows for a meaningful comparison of which legal, protective measures are mandatory and which are permissive, thereby evoking the question of whether measures of protecting nonpatients from a patient's violent acts ought to be mandatory duties or permissive application of professional judgment.     

Regulating technology: Can administrative agencies cope with technological change?

The debate over scientific issues has made a difficult transition from the scientific community to the public-polity process. The traditional view of scientists undertaking “pure” science in their laboratories did not envision government intervention into scientific and technological discovery through administrative agency regulation of risks associated with the results of such research. Yet examples of government regulation of technological risks abound as the nation grapples with nuclear power issues, new-drug testing, and environmental issues, to name a few. This paper considers whether the presently constituted regulatory apparatus is capable of responding to dramatic advances in technology in a timely and effective way. Concluding that it is not, the paper examines the circumscribing characteristics of the regulatory process. Then it discusses alternate approaches for regulating the risks posed by science and technology without doing too much violence to due process or the notion of public participation in the regulatory function.