Locus Of Accountability Research Articles

A Loss of Judgment: The Dismissal of the Judicial Conscience in Recent Christian Ethics

AbstractChristian ethicists have neglected conscience, understood as an individual's moral self‐awareness before a locus of accountability and judgment, over the last few decades. The aim of this essay is to suggest how this neglect came about. I draw on the work of Paul Lehmann and Oliver O'Donovan to illustrate how ethicists in the twentieth century became suspicious of conscience because of its association with the alleged ahistorical individualism of Immanuel Kant's work. I argue that a social‐historicist conception of conscience, such as H. Richard Niebuhr offered, attempts to save conscience from this suspicion. Ironically, however, Stanley Hauerwas's development of Niebuhr's historicist, communitarian approach to conscience, appears to have led to a dismissal of conscience. I conclude with a brief comment about what this dismissal has cost contemporary Christian ethics, namely the Christian tradition's basic commitment to the singularity of an individual's accountability before God.

Reflections on the Charter School Movement

Two decades ago, I learned about charter schools while strolling through a Minneapolis suburb with Ted Kolderie, a civic gadfly who was helping local legislators craft a bill that would make Minnesota the first state to permit the hybrid public schools. He wanted to combat the bureaucracy of traditional public school systems, he told me, and to encourage educators to become entrepreneurs. Today, about 4,600 charter schools spread across 39 states and the District of Columbia, educating about 1.5 million students. They've become a permanent part of the education landscape. And now the Obama Administration is making charters a cornerstone of its multi-billion-dollar federal education reform agenda. I've visited maybe 100 charter schools since my walk with Kolderie. Here's some of what I've learned: Charter schools have brought many talented people to the cause of public school improvement. This new generation of social entrepreneurs includes Ivy League graduates and Rhodes Scholars committed to helping the disadvantaged and drawn to public schooling by the independence offered by charter schools. The charter movement has also attracted bad actors more interested in enriching themselves than students. There are stories of educational failure and financial malfeasance in charter schools just as unscrupulous trade schools fed off the federal financial aid system for many years. Some contend that the nearly 500 charter school closures between 2004-05 and 2008-09 (about 2,000 charters opened during the same period) are a sign of an effective marketplace, one that rewards winners and punishes losers to a much greater degree than traditional public school systems. But, given the demand in urban centers for alternatives to traditional public schools, the closure of 500 charter schools (which, of course, is a good thing) reflects as much as anything a lack of scrutiny of charter school applications. For much of the past two decades, quantity has been a higher priority than quality in the charter school movement. Only recently has the charter community begun to make good on its original pledge of more accountability in return for more autonomy, thanks to the work of people like Greg Richmond, president of the National Association of Charter School Authorizers, who have argued, correctly, that a few bad charter schools are likely to have a much greater influence on the prospects of the charter movement than a lot of good charters. But accountability remains weak in a number of key states, and the charter world remains deeply divided over whether the locus of accountability should rest with consumers or regulators. Charter schools collectively have hardly been the salvation that many reformers had hoped. Researchers continue to debate the right traditional public school comparison groups. But it's clear there are at least as many bad charters as good ones and that, while a relative handful have produced truly outstanding results, many aren't any better than traditional public schools, and some are worse. Charter Management Organizations With over a half billion dollars in foundation funding and the financial expertise of venture-capital-like enterprises such as the San Francisco-based NewSchools Venture Fund, some four dozen nonprofit charter management organizations (CMOs) have set out to build networks of top charter schools. A decade into the experiment, they've managed to open about 350 schools with some 100,000 seats, a far cry from the 5,000 failing public schools that Secretary of Education Arne Duncan hopes to fix or replace. And many of the organizations are struggling financially and academically. It would be much less difficult for CMOs to open more high-quality and financially sound schools if they received as much public funding as traditional public schools and didn't have to find and pay for their facilities. And it would be easier for them to make their budgets work if they weren't trying to expand. …

Developments in Medicaid managed care

Some of the most important developments in the health care system are occurring in the Medicaid program. Medicaid has a natural engine for innovation since it is administered by the states, each of which has developed its Medicaid program in distinctive ways and has the power and resources of a large purchaser. The population covered by Medicaid--low income and disabled adults and chil- dren-presents many challenges; in many ways, these individuals seem perfect candidates for managed care programs that provide a point of entry, coordination of services, and a locus of accountability. Almost all states have tried some version of managed care under federally approved waivers of the ordinary rules of the Medicaid program. The challenges and opportunities resulting from the state-by-state nature of the Medicaid program provide one of the themes for this special section of the Journal of Urban Health. Medicaid operates in real time with real constraints, and states improvise their own solutions to the program's countless problems of design and administration. Yet, neither they nor the policy research community are well situated to draw lessons from their experiences. Sophisticated case studies, such as the paper of Gold and colleagues about Maryland and the safety net in this issue, are invaluable. Brodsky and Baron describe an innovative program at the Center for Health Care Strategies to enable states to learn from the experiences of each other. Somers and associates, whose work has made them familiar with developments in virtually all states, provide a broad synthesis regarding developments across the country. Questions regarding cost and quality provide the other theme for this issue.

The moral foundation of nursing

The authors argue that the moral predicament facing nurses is their not being free to be moral because they are deprived of the free exercise of moral agency. Two occurrences are needed for nurses to be free to be moral: (1) the emergence of a strong sense of professional autonomy for nurses and (2) a shift in the locus of accountability from other health care professionals to the patient. The direction urged is to view nursing ethics as reform ethics.

Second Generation Primary Nursing

Since its inception in the late 1960s, primary nursing has been the subject of much misinterpretation, as well as healthy adaptation. Over the last 15 years, the first generation of primary nursing users have shown that professional nursing is ultimately enhanced, not through changes in staffing patterns, but in the locus of accountability. The second generation primary nursing users face the challenge of developing a culture that integrates the realities of care delivery with the evolving professional status of nursing.