In an era of democratic discontent, more and better participation in policy making has become a standard expectation. Yet it is rarely clear what counts as participation, and how the many practices loosely bundled under the label should be understood. This paper has a modest undergrowth-clearing objective: to examine assumptions behind competing typologies of participation, and to propose a classification framework less laden by idealist notions of democracy.

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This paper argues that public consultative procedures undertaken by governments or their public services sometimes go awry because of certain confusions as to the nature and purposes of consultation. One of the most important of these is a tendency to view consultation as an exercise in policy determination by the public rather than as public input into the representative democratic process whose ultimate use is to be defined by the elected decision-makers. The result of this confusion is a tendency to misunderstand or overestimate what public consultations can achieve, and a failure to make a distinction between occasions when such consultations are useful and occasions when they must give way to explicit political contest. Three levels of activity -the technical, the transactional and the political -are analytically distinguished along with the modes of action-response appropriate to each -in order to explain and clarify the nature of good consultative practice.

A 58-year-old female with the prior history of diabetes mellitus (DM) presented with nausea, malaise, and abdominal pain of two days duration. Also, in the past, she was treated for a necrotized rectum from a retroperitoneal infection leading to a colostomy in the left lower quadrant (LLQ) of the abdomen. The physical examination findings were highly suggestive for a parastomal hernia. As a part of her workup and treatment, the initial abdominal CT demonstrated the presence of the gastric contents into the hernia sac leading to the gastric obstruction. The patient responded well to the conservative management using nasogastric (NG) suction, intravenous (IV) line maintenance, clinical assessment, frequent vital sign monitoring, and initiating the nothing per oral (NPO) regimen. Following the successful conservative approach, the patient opted to undergo surgical treatment in the future. This case report and associated literature search represent a rare case of a parastomal hernia with protruding gastric contents, which was successfully treated with conservative management.

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