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Fifty years ago the political scientist Robert Dahl concluded that courts are usually in sync with “the policy views dominant among the lawmaking majorities” and thus offer little help to aggrieved minorities (Dahl, 1957, p. 285). In recent years, Dahl's classic formulation has received renewed attention. This chapter uses the example of the Rehnquist Court's First Amendment decisions to analyze “regime politics” theory. On religion cases the Rehnquist Court was generally in sync with the socially conservative strain in the Republican Party, but in other First Amendment areas the pattern is far more complex, raising questions about the relationship between conservative judges and the political movements that brought them to office.

Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.

Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.

We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.

We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.

This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.

The Supreme Court's recent cross burning case – Virginia v. Black (2003) – saw dueling historical narratives. Justice O’Connor, writing for the majority, painted a history in which the Klan often burned crosses to intimidate, but also did so for other, “expressive” reasons. Justice Thomas, in dissent, related a history in which the burning cross never speaks. Interestingly, O’Connor and Thomas used many of the same historical sources. How did they reach such different results? While both O’Connor and Thomas interpreted (and stretched) the historical sources in different directions, their dispute ultimately turned on their diverging doctrinal views.

Drugs in the same therapeutic class differ in their therapeutic profile, metabolism, adverse effects, dosing schedules, delivery systems, and other features. In addition, such agents can provide backup if the initial drug sometimes fails in the development stage or in the market. The availability of a broad range of medicines enables physicians to treat with precision the individual needs of diverse patients and provides options when the first agent used is either ineffective or not tolerated. Some incremental innovations have been associated with overall cost savings. Competition among drugs in a therapeutic class drives prices down. Policies that limit research on incremental innovations may deny access to important therapies, reduce competition, and erode incentives for research.

While some of us enjoy engaging in many forms of bioethical activity, including philosophical analysis and debate, clinical ethics consultation, and empirical research, only the latter matters much to the practicing physician. Practically minded, most doctors have little concern with fine moral distinctions when faced with a patient's request for assistance in dying or a pharmaceutical company's offer to attend a product “consultation” session at a first class resort in addition to an attractive fee for participation. Physicians want to know what facts might bear on ethical questions they confront, how ethical conflicts that have an impact on patient care can be understood and resolved, and whether research reveals consistently clear, helpful findings. The following discussion offers some examples of how empirical research related to bioethical issues has provided evidence and guides for physicians at both individual-patient care and policy levels, and further reviews areas that warrant continued research attention.

Law attempts to govern life and death through the appropriation of images which give a fantasy of control over death. The functioning of the thanatopolitical state is underpinned by a perceived control over death and its representation. This means of controlling death is challenged when someone wishes to die in an untimely fashion. Death may be timely when the State engages in the officially sanctioned killing of the death penalty but not when the individual assumes such a power to decide. When an individual goes before the law to obtain a right to die, instead of confronting death, legal institutions evade the issue and instead talk about life, and its sacred and inviolable nature. Yet, in the same move, many exceptions to this sacred quality of life are carved out. One can see an example of this phenomenon in the area of Supreme Court decision making on physician-assisted suicide. In Washington v. Glucksberg the applicants had died by the time of the Supreme Court’s decision. Where did they go? Were they ever really there for the law? The Supreme Court decision attempts to recompose the notion of identic wholeness in the face of bodies associated with death and decay. It is, in other words, an attempt to arrest the process of death by composing a narrative which valorises life. The case becomes a narrative about the threat to life or, more precisely, a threat to a particular way of life. In other words, the state’s interest in preserving life becomes the interest in preserving the life of the state. The state must live on. The question then moves from being one of whether the individual applicant in a case concerning physician-assisted suicide should live or die, to one which asks should we the court live or die?

From one angle, abortion law appears to confirm the regime politics account of the Supreme Court; after all, the Reagan/Bush coalition succeeded in significantly curtailing the constitutional protection of abortion rights. From another angle, however, it is puzzling that the Reagan/Bush Court repeatedly refused to overturn Roe v. Wade. We argue that time and again electoral considerations led Republican elites to back away from a forceful assertion of their agenda for constitutional change. As a result, the justices generally acted within the range of possibilities acceptable to the governing regime but still typically had multiple doctrinal options from which to choose.

The premise that the U.S. Supreme Court never veers too far off from the dominant national political coalition (Dahl, 1957) has become widely accepted among social scientists today. To fulfill that promise, however, the confirmation process for justices must serve as a plebiscite through which the public can ratify or reject future justices based on their views. Unfortunately, modern confirmation hearings have become an exercise in obfuscation, providing little meaningful dialogue on important issues. Because conservative Republican presidents have made the lion's share of appointments in recent times, social conservatives have most often benefited from a process that has severed the link between Supreme Court nominees and the polity they must serve.