Deathright: Culture, Medicine, Politics, and the Right to Die

Deathright: Culture, Medicine, Politics, and the Right to Die

Deathright: Culture, Medicine, Politics, and the Right to Die

Deathright: Culture, Medicine, Politics, and the Right to Die


James M. Hoefler is associate professor of political science and coordinator of the policy studies program at Dickinson College. He is the coauthor with Brian Kamoie of Deathright: Culture, Medicine, Politics, and the Right to Die (Westview Press 1994) and is the coauthor with A. Lee Fritschler of Smoking and Politics: Policy Making and the Federal Bureaucracy (1996).


Public policy is a curious thing, yet one might be excused for thinking otherwise since the policy process seems to be -- and often is described as -- the simple result of a straightforward transformation of public interest to government activity. Constituents -- members of the community served by government -- raise issues and express preferences through elections and interest-group activity. In response, these constituents get policy: a strategic and rational attempt to advance the public interest through government action. Nothing could be simpler. And nothing could be further from the truth about how public policy develops, especially when it comes to making policy in the right-to-die area.

We can understand right-to-die policy better if we think about the "policy forces" of restraint, activism, and mediation: pressures and stresses that push, pull, and shape policy into one form or another. Using this approach, one can understand the outcome of right-to-die policy at any given time, in any given place, as a product of a struggle -- a mediated resultant that emerges when the forces of activism overwhelm the forces of restraint, forcing mediators to act.


Consider first the policy forces of restraint. The fact that some issues are never raised as a matter of policy consideration is one of the big stories in any policy analysis, and the right to die is no exception. The forces of restraint often keep issues from percolating up to the attention of policymakers. And, just as importantly, once that percolation starts, these same forces of restraint can limit the scope and slow the speed of policy developments.

Policy change comes slowly in the United States, when it comes at all, because the forces of restraint are generally both inherent and formidable. Systemic forces of restraint have increasingly become sources of irritation for Americans. The separation of powers, bicameralism, single-member legislative districts, weak political parties, and federalism -- all potential forces of restraint -- are often at the . . .

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