Public Service

Public Service

Public Service

Public Service

Synopsis

This volume includes perspectives on public service selected from six decades of major public administration journals. Recurring themes include: motivations to enter the public service, positive and negative images of public servants and of government, conflicts between loyalty to the organization and loyalty to the public, morale, burnout, and turnover. The volume also includes cross-national analyses of the public service in other systems, proposals for rethinking public service systems, and questions as to the future of the public service. It recaptures a long, continuing debate as to the health of the public service, and in so doing suggests agendas for university research and administrative action.

Excerpt

The vast majority of Americans will die in hospitals or nursing homes, and most will pass through a state of incompetence before they die--a condition that will render them unable to make decisions about life-sustaining medical treatment. Some will be incompetent for only a few hours or days; others will spend their last months or years in a state ranging from profound confusion to complete unconsciousness. Inevitably, other individuals will be called on to make difficult decisions about prolonging the dying process and about the medical technology that will be used.

Making end-of-life decisions is a relatively recent phenomenon. In earlier times, life-sustaining treatment decisions never had to be made because medical treatment, such as it was, could do very little to prolong life when illness struck. Indeed, before the twentieth century, hospitals and doctors were just as likely to be responsible for precipitating one's demise as they were for prolonging one's life. In those days, infection was the primary cause of death, and pneumonia, influenza, and related disorders normally took their toll with some dispatch.

Today, instead of dying days or weeks after infection sets in, Americans typically die months or years after a chronic, degenerative illness is diagnosed. Thanks to modern medical technology, victims of some of the leading killers in the United States (e.g., heart disease, cancer, and stroke) may enjoy an extended period of time after illness is diagnosed, with symptoms managed so that a reasonable quality of life is maintained. Often, medical technology can stall or even reverse the disease process so that health is completely restored in a patient who would surely have died just a few decades ago.

As Mark Twain reminds us, however, there is nothing quite so sure in life as death and taxes. Though death can be forestalled, it always wins in the end, and therein lies the problem. Although medical technology often can provide patients with a good quality of life as they begin to die, it can also extend biological life even at the edge of death, when the quality of conscious life is quite low. The fact is that an aggressive use of antibiotics, tube . . .

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