Journal of evaluation in clinical practice
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This paper argues that because it is a matter of dispute whether to assist suicide is ever morally right, the question whether assisted suicide should be legal should be decided independently of the moral issue and with reference to whether to assist suicide is genuinely to carry out the wishes of the person requesting it. It is then argued that it is possible to devise a set of criteria, based on those used in the Netherlands with regard to euthanasia, which would allow assisted suicide when the request is reasonable and genuine, but keep it illegal under other circumstances. ⋯ Finally, the question is raised to whether these assisted suicides should be legalized or, as at the moment in the UK, simply not prosecuted, but, as is about to happen, with the criteria for non-prosecution made explicit. It is suggested that, although it is in some ways both irrational and unjust, non-prosecution is politically easier to achieve and also more cautious as a first move.
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What kinds of evidence reliably support predictions of effectiveness for health and social care interventions? There is increasing reliance, not only for health care policy and practice but also for more general social and economic policy deliberation, on evidence that comes from studies whose basic logic is that of JS Mill's method of difference. These include randomized controlled trials, case-control studies, cohort studies, and some uses of causal Bayes nets and counterfactual-licensing models like ones commonly developed in econometrics. The topic of this paper is the 'external validity' of causal conclusions from these kinds of studies. ⋯ Many advice guides for grading policy predictions give top grades to a proposed policy if it has two good Mill's-method-of difference studies that support it. But if capacities are to serve as the conduit for support from a method-of-difference study to an effectiveness prediction, much more evidence, and much different in kind, is required. We will illustrate the complexities involved with the case of multisystemic therapy, an internationally adopted intervention to try to diminish antisocial behaviour in young people.
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In this paper we argue that policy calls for personalization or 'tailored' services derive a large part of their appeal from the way they 'fudge together' different things. Using the recent policy discourses surrounding personalization in the UK NHS as a case study we illustrate the policy 'work' that is accomplished by this vagueness and focus in on one important fudge - that between a health service tailored to people's medically defined needs and one tailored to people's wants. ⋯ We conclude that philosophical analysis is crucial for guiding the redirection of services implied by personalization discourses. The process of selecting and justifying the way in which the personalization agenda is advanced requires both an analysis of the relationships between needs and wants in human flourishing and an explicit reconsideration of the purpose of the welfare state.