The practice of medicine should be humanitarian, in which the primary object is the relief of suffering and the interests of patients are paramount. In certain circumstances even the best of doctors might find it difficult to sustain these principles. Doctors, especially those employed by the State, may be expected to participate in aspects of corporal or capital punishment, which introduces a conflict of loyalties and subordinates the interests of individuals to those of the State. Others, in the prison or police services, may get drawn into or comply with physical abuse and torture, most commonly through failing to report incidents that come to their notice. In this paper I discuss some aspects of medicine under tension in the light of the South African experience.

We envisage a transport system producing zero emissions and sparing the surface landscape, while people, on average, range hundreds of kilometres daily. We believe this prospect of ‘green mobility’ is consistent in general principles with historical evolution. We lay out these general principles, extracted from widespread observations of human behaviour over long periods, and use them to explain past transport and to project the next 50 to 100 years. Our picture emphasizes the slow penetration of new technologies of transport, adding speed in the course of substituting for the old ones in terms of time allocation. We discuss in increasing detail railroads, cars, aeroplanes, and magnetically levitated trains (maglevs).

Political parties are one of the most important inventions of the modern world. We may not regard them as we regard electricity, television, or aeroplanes, yet they are just as much as part of our life. If parties did not exist, what would elections be like? How would parliaments conduct their business? How would we choose politicians? In short, how would we organize politics? It might be felt that we can live without parties, indeed some countries do not have them so far, but all 'advanced' modern countries have them.

The 20th-century has been the century of mass politics, and the mass parties that emerged at the beginning of this century became deeply rooted within wider society. The passing of this golden age of the party has now been marked by two distinct processes of change. On the one hand, parties have become more distant from society and more closely linked to government and the state. On the other hand, there has been a decline in the political identities of the parties, such that voters now find it increasingly difficult to distinguish between them. These changes, and the related transformation of politics into administration, have led to a growth in popular indifference to parties and to politics in general, as well as to a declining sense of engagement. Should this trend continue, it is mass spectacle rather than mass involvement that is likely to characterize the future of mass politics.

In parliamentary systems, the link between governments and the parties supporting them is typically regarded as being so strong that the expression ‘party government’ has been coined to refer to this type of relationship. Yet, in practice, there are major variations between the two ‘sides’: these relate to possible reciprocal influence on three planes, those of appointments, of policy-making, and of patronage. Contrary to what is often believed, governments often play a key part and supporting parties are forced, more or less reluctantly, to follow. This has led to doubts about the extent to which the relationship can ever be harmonious and even to the view, probably exaggerated, that it has become increasingly conflictual.

The decline in confidence in the traditional parties in Western Europe has manifested itself through the emergence of the Green parties on the Left and populist parties on the Right. Despite successes in some countries, these parties have remained small, although they have been able, respectively, to play on the growth of ‘post-materialist’ values on the Left, and of anti-immigrant sentiments on the Right. The prospects for these parties are not very good, in particular for the right-wing populist parties, which are highly dependent on the popularity of their leaders, and even for the Green parties, although these can exploit the internal divisions within Socialist parties between supporters of the ‘traditional’ Left and supporters of the ‘New’ Left.

An analysis of the motivations behind the present revival of referendum ballots in liberal democracies shows that referendums launched by governments, often politically motivated, and those launched by popular initiatives are linked to a demand for new legislation, and both illustrate the crisis of representative governments that is currently affecting these democracies. The pursuit of the increase of referendums will depend however on whether popular initiatives will or will not be introduced in the Constitutions of countries, since the great majority do not provide for it. In spite of similarities between the present political situation in Western Europe and the contexts in which popular initiatives were introduced in some countries, there is no serious ground to predict that such institutional reforms will take place in the near future. The directness of democracy is maybe more likely to increase under the effect not of referendums, but of other factors like the growing interference of polls, or the decline of intermediaries, especially parties, in the daily practice of government.

Party ‘federations’ have begun to exist in the European Union, but these are not ‘parties’ in the true sense of the word. They are beginning to exercise some influence, not just in the European Parliament but, to an extent at least, on the European Commission and on the European Council as well. However, it does remain the case that the structure of the European Union is not conducive to the setting up of real parties: elections to the European Parliament have been regarded as being, to an extent, ‘second-order’ compared with national elections, and the system as a whole is also typically regarded as suffering from a ‘democratic deficit’. What is needed is to design an institutional mechanism to facilitate competitive party government in the European Union.

The absence or near-absence of liberal traditions in Central and Eastern Europe had led to the fear that pluralistic party systems might not emerge in post-communist countries; moreover, the fact that the countries of the area had to reconstruct their political system as well as their economy and their society, rendered the challenge particularly difficult to meet. Yet viable party arrangements are now found in a number of these countries, although most parties, except on the whole the ex-Communist parties, are relatively poorly organized and have tended to lack strong and able leadership. The future remains uncertain, however, given the continuing internal problems of the parties themselves, as well as the institutional and cultural handicaps under which post-communist societies have to operate.

It is doubtful as to whether the countries of the Third World are likely to move to the kind of liberal democracy that is regarded as characteristic of the West. In particular, parties are often remaining ‘parties of the State’ and not organizations truly competing with each other. This is in part a consequence of economic globalization, as the requirements of global economic liberalization do not fit with the requirements of democracy. In such a context, clientelism around the State may be inevitable and it contributes to ensuring that the main party in the country, and indeed all parties become ‘parties of the State’, as is the case in Mexico or Malaysia and perhaps in the Ukraine and South Africa. Thus, globalization does not mean the end of the State, but possibly the end of liberal democracy.