Abby Norris adjusts quickly to the college environment and develops a close friendship with her roommate, Ruth. What she does not expect is to fall in love with Jake Murphy. The two are from completely different socio-economic backgrounds, and a self-assured Jake has met his match in Abby. Combine a hilariously funny Thanksgiving weekend, a tender Valentine's Day, and a rambunctious touch-football game with passion and you will delight in this book. The couple's relationship deepens to an emotional and physical level that neither had anticipated. But constant conflicts test their love beginning with a serious cattle disease, numerous separations, substance abuse, a life-threatening automobile accident, and infidelity. Soon after they marry, Jake and Abby face more tragedy when their newborn son dies. They are ill equipped to deal with their sorrow and are unable to be of comfort to one another. Jake buries himself in farm business and Abby seeks solace in the arms of an old acquaintance. Just when life begins to seem normal, cancer rears its ugly head and death again enters their lives. A life-threatening pregnancy drives a wedge between the two when Abby refuses the doctor recommendation to end the pregnancy. A Painful Choice. Wealth and power aren't enough to sustain them as they work to restore the close personal ties with friends and reclaim the lost passion and love they once shared. Painful Choices have cost them dearly.

Under what conditions should we expect states to do things radically differently all of a sudden? In this book, David Welch seeks to answer this question, constructing a theory of foreign policy change inspired by organization theory, cognitive and motivational psychology, and prospect theory. He then "test drives" the theory in a series of comparative case studies in the security and trade domains: Argentina's decision to go to war over the Falklands/Malvinas vs. Japan's endless patience with diplomacy in its conflict with Russia over the Northern Territories; America's decision to commit large-scale military force to Vietnam vs. its ultimate decision to withdraw; and Canada's two abortive flirtations with free trade with the United States in 1911 and 1948 vs. its embrace of free trade in the late 1980s. Painful Choices has three main objectives: to determine whether the general theory project in the field of international relations can be redeemed, given disappointment with previous attempts; to reflect on what this reveals about the possibilities and limits of general theory; and to inform policy. Welch argues that earlier efforts at general theory erred by aiming to explain state behavior, which is an intractable problem. Instead, since inertia is the default expectation in international politics, all we need do is to explain changes in behavior. Painful Choices shows that this is a tractable problem with clear implications for intelligence analysts and negotiators.

More than ever, society faces painful choices in the allocation of resources for health care. How it makes these choices, and how wise they are, will determine the quality and character of health care for years to come. David Mechanic examines existing and impending dilemmas the American health care system must manage as it confronts these choices. He explores conceptual approaches to health and health care, showing how these translate into research, and defines a strategy for informed choice. The result is a masterful volume by one of our leading medical sociologists at the peak of his career. Mechanic looks at the continuing emphasis on biomedical technology in the context of growing economic, constraints, as medical care becomes more expensive and demands become greater. He examines the discrepancy between public expectations and how health care is actually provided, and points out increasing discordance between demographic trends and disease patterns and the medical system's emphasis on acute care. Of particular concern is the enormous gap between entitlements for medical care and the increasing need for long-term care. This gap is of particular concern because of the United States's enormous investment in health care, which now consumes 11 percent of the Gross National Product, Although there is no particular consensus on what is an appropriate level of investment in health, policymakers are impatient with the medical system's apparent inability to control costs, and are concerned as well about the competition for resources between health and other sectors. Mechanic examines new trends, such as managed care, and transformation of the role of those who provide health care from patient advocates to allocators of services-a crucial distinction. The choices that will have to be made in the next decades are difficult They will also be painful, but they are inevitable. The key challenge will be to respond to the anxieties of the 37 million uninsured children and adults, the growing numbers of frail elderly, and the needs of patients with serious mental illness and other chronic disabilities. All of this must be accomplished while maintaining a high level of service for the rest of the population, and without breaking the bank. To achieve this, Mechanic argues, health services must be shaped to enhance function and quality of life, and not simply in response to technological imperatives. In its profound understanding of the social and political context, in which competitive initiative, the growth of regulation, new health care systems, and approaches for making research sensitive to patients are all evident, "Painful Choices "provides a framework for responsive and meaningful policy analysis.

Japan's endless patience with diplomacy in its conflict with Russia over the Northern Territories; America's decision to commit large-scale military force to Vietnam vs. its ultimate decision to withdraw; and Canada's two abortive flirtations with free trade with the United States in 1911 and 1948 vs. its embrace of free trade in the late 1980s."--Jacket.

Reviews the issues involved in most of the principal medical-ethical dilemmas that face our society from a multidisciplinary point of view. Updated to reflect the many changes that have occurred in medical-ethical issues.