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This paper aims to assess administrative and clinical manager stances on health system reform. Understanding these stances will help to identify cultural differences and competing agendas between these two key health service stakeholders and contribute to developing strategies to improve organisational performance.

A qualitative methodology was used comprising in-depth open-ended interviews conducted in 2007 with 26 administrative and clinical managers who managed clinical units.

This paper provides empirical insights into the ways that administrative and clinical mangers conceive of their managerial roles in relation to health care reform and performance improvement in health services. The findings suggest that developing a hybrid clinical manager culture as a means to bridge the gap between administrative and clinical manager stances on reform objectives, while possible, is not yet being realised.

The research has relevance for health services that are experiencing organisational transformation. However, its location in one health service limits the generalisability of findings to other sites. Further research is needed to assess the opportunities for a hybrid culture to emerge as well as its effect.

While attention is predominantly directed to clinician groups as a key stakeholder in implementing health reform policies, this paper has implications for how administrative managers also structure their roles and responsibilities to create an organisational climate conducive to change. This will include strategies to support clinical managers to make the transition from a predominantly clinical, to a clinical managerial, orientation.

This paper addresses a significant problem in health service governance, namely the divide between the value stances of dual hierarchies. This problem is only now gaining prominence as a significant barrier to health reform.

This chapter provides a genealogy of the Gladue–Ipeelee principle of special consideration of Indigenous circumstances at sentencing. The principle is codified in the 1996 statutory requirement that “all available sanctions other than imprisonment … should be considered for all offenders, with particular attention to the circumstances of Aboriginal offenders” (s. 718.2e of the Criminal Code of Canada). Using the Foucaultian genealogy method to produce a “history of the present,” this chapter eschews normative questions of how s. 718.2e has “failed” to reduce Indigenous over-incarceration to instead focus on how practices of “special consideration” reproduce settler-state paternalism. This chapter addresses three key components of the Gladue–Ipeelee principle: the collection of circumstances information, the characterization of those circumstances, and finally their consideration at sentencing. Part one focuses on questions of legitimacy and authority and explicates how authority and responsibility to produce Indigenous circumstances knowledge was transferred from the Department of Indian Affairs (DIA) to Indigenous Courtworker organizations in the late 1960s/early 1970s. Part two identifies how authority shapes problematization by examining the characterization of Indigenous circumstances in the two eras, finding that present-day Gladue reports articulate an Indigenous history and critique of colonialism as the root cause of Indigenous criminalization, whereas DIA reports prior to 1970 generally characterized this criminalization as a “failure to assimilate.” Part three focuses on the structural reproduction of power relations by exploring historical continuities in judicial and executive-branch consideration of Indigenous circumstances, suggesting that the Gladue–Ipeelee principle reinscribes a colonial “mercy” framework of diminished responsibility. The author discusses how the principle operates in the shadow of Indigenous over-incarceration as a form of state “recognition” and a technique of governance to encourage Indigenous participation in the settler justice system and suggests that the Gladue–Ipeelee principle produces a governing effect that reinforces settler-state authority by recirculating colonial practices and discourses of settler superiority.

It is customary these days to denounce our society for its unconscionable neglect of the elderly, while we look back romantically to some indeterminate past when the elderly were respected and well cared for. Contrary to this popular view, old people historically have enjoyed neither respect nor security. As Simone de Beauvoir so effectively demonstrates in The Coming of Age (New York: Putnam, 1972), the elderly have been almost universally ill‐treated by societies throughout the world. Even the Hebrew patriarchs admonished their children to remember them as they grew older: “Cast me not off in time of old age; when my strength fails, forsake me not” (Psalms 71:1). Primitive agrarian cultures, whose very existence depended upon the knowledge gleaned from experience, valued their elders, but even they were often moved by the harsh conditions of subsistence living to eliminate by ritual killing those who were no longer productive members of society. There was a softening of societal attitudes toward the elderly during the period of nineteenth century industrial capitalism, which again valued experience and entrepreneurial skills. Modern technocratic society, however, discredits the idea that knowledge accumulates with age and prefers to think that it grows out‐of‐date. “The vast majority of mankind,” writes de Beauvoir, “look upon the coming of old age with sorrow and rebellion. It fills them with more aversion than death itself.” That the United States in the twentieth century is not alone in its poor treatment of the aged does not excuse or explain this neglect. Rather, the pervasiveness of prejudice against the old makes it even more imperative that we now develop programs to end age discrimination and its vicious effects.