Mass screening in low-income populations: the challenges of securing diagnostic and treatment services in a national cancer screening program

Funding for many mass screening programs for low-income and uninsured populations provides resources for screening tests, yet only rarely does it provide coverage for necessary follow-up diagnostic and treatment services. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a federally funded initiative that provides cancer screening to low-income uninsured and underinsured women, covers some diagnostic follow-up tests and no treatment services. We conducted in-depth case studies of seven state programs participating in the NBCCEDP to investigate the strategies and approaches being used to secure diagnostic and treatment services. The results suggest that the program relies on a patchwork of resources--at state and local levels--to provide diagnostic and treatment services. This includes a number of components of local safety nets, all of which are unstable and have uncertain futures. Public health disease-screening initiatives need to reconsider the feasibility of continued reliance on case-by-case appeals to the local safety net for diagnostic follow-up and treatment services.     

Entrenching Bills of Rights

The entrenchment of a bill of rights, and the consequent removalof the matters covered in the bill from the domain of the legislature,is commonly thought to constitute a transfer of power from thelegislature to the courts. Yet the simple answer to this thoughtis that, strictly speaking, no such transfer takes place, forin acquiring power to determine the content of a bill of rightsthe courts do not acquire the power to legislate that the billdenies to the legislature. The more complex response is thatwhat the courts acquire when a bill of rights is entrenchedis the power to set a constitutional agenda, a power that thelegislature may never have had and so has not necessarily lost,a power the political significance of which depends on the formand content of what is entrenched and the value and characterof the power it leaves in the hands of the legislature. In particular,the entrenchment of a project of governance (as typified bythe positive duties conventionally associated with economicand social rights) raises concerns about the power exercisedby courts that are not raised by the entrenchment of a projectof non-governance (as typified by the negative duties conventionallyassociated with civil and political liberties). Non-governancemay be objectionable, but not because the courts secure it.Governance, however, may be objectionable just because the courtssecure it.     

Provocation and Pluralism

What is the best way to reflect human diversity in the structure of the provocation defence, and similar excusatory defences in the criminal law? The House of Lords recently concluded that the right way is to allow the jury to personalise and thereby qualify the apparently uniform ‘reasonable person’ standard mentioned in section 3 of the Homicide Act 1957. In this paper we argue that this is not the right way at all. We argue that the reasonable person standard, unqualified, already accommodates the only variations between people that the law should want to accommodate in an excusatory defence. To defend this view we revive the common law's tripartite analysis of the ‘objective’ (or impersonal) issues in the provocation defence: first, was there an action capable of constituting a provocation? second, how provocative was it? and third, how much self‐control should have been exhibited in the face of it? We show that these questions each have a built‐in sensitivity to certain variations between different defendants' situations, but that this does not detract from their objectivity (or impersonality). We argue that no more sensitivity is needed in the name of human diversity, and what is more that no more sensitivity is desirable.