Nurses who attend patients with psychiatric disorders often encounter ethical dilemmas and experience difficulties in making the right decision. The present study aimed to evaluate the decisions of psychiatric nurses regarding their duty to warn third parties about the dangerousness of the patient, the need for compulsory hospitalization, and the competence of patients. In total, 111 nurses working in the field of psychiatry in Turkey completed a questionnaire form consisting of 33 questions. The nurses generally assessed the decision-making (...) competency of the patient correctly. However, their decisions regarding whether the patient should be compulsorily hospitalized and their understanding of their duty to warn/protect were less consistent. A significant relationship was found between the decisions of the psychiatric nurses and their work experience, them having children, and them having postgraduate education in psychiatric nursing. The nurses stated their desire to be part of the team that decided on ethical problems in psychiatry. (shrink)

Background Physical morbidity is rife among patients with serious mental illness. When they are involuntarily hospitalized and even treated, they may still refuse treatment for physical illness leading clinicians to wonder about the ethics of coercing such treatments. Research aim This survey study explored psychiatric caregivers’ perceptions on whether compulsory treatment of physical illness is legal and whether it is justifiable in patients with serious mental illness and under what circumstances. Research design A questionnaire that included two case vignettes (...) of an involuntarily hospitalized psychiatric patient with diabetes refusing treatment with insulin for various reasons. The cases differed in terms of diabetes severity. Participants answered questions regarding the appropriateness of involuntary treatment. Participants and research context Psychiatric medical doctors and nurses working in a mental health center. ( N = 89, 50 female, ages 26–66). Ethical considerations The study was approved by the Medical Centre Institutional Review Board (IRB) and the University Ethics Committee. The respondents’ anonymity was kept. Participation was voluntary and consent was obtained. Results The severity of the patient’s medical condition and their reason for refusing treatment were associated with participants’ willingness to give insulin despite patient objection [( F(1, 87) = 49.41, p <.01; ( F(1, 87) = 33.44, p <.01), respectively]. Participants were more inclined to support compulsory treatment if the patient’s refusal was “illness-oriented” (i.e. directly related to psychiatric illness). Participants presented diverse views regarding the perceived legality of compulsory treatment of physical illness in such situations (illegal 63.09%; legal 23.8%; 13% unsure). The majority (53.5%–55.3%) of those who thought it was illegal supported compulsory treatment in high-severity, illness-oriented refusal situations. Conclusions The severity of the medical condition and the reason for treatment refusal influence psychiatric caregivers’ willingness to provide compulsory treatment for physical illness in involuntary hospitalized psychiatric patients. Beyond the legal framework, ethical guidelines for these situations are warranted, while decisions should be made on a case-by-case basis. (shrink)

Drawing insights from queer theory, this essay argues for making sex a more central category in political theorists’ interpretations of Diderot’s Supplement, and also of his contributions to History of the Two Indies. The Supplement has sometimes been considered a “libertine” text for depicting Tahiti as a society where sex is open, and indeed where foreign guests are treated to sexual hospitality. This essay reconstructs how and why Diderot’s Tahitians make promiscuity public policy and why Diderot makes miscegenation central to (...) his views on how to improve colonialism morally and politically. In the end, though, the Supplement is beset by asymmetric sexual logics that erode its apparent affirmation of egalitarianism, consent, hospitality, and non-egocentric interest. Although the presentation of sexual hospitality serves to critique French imperialism, its heterosexuality is compulsory and patriarchal. Nevertheless the text unwittingly offers a glimpse of a more radical, queer model of sociability. (shrink)

Background Compulsory treatments represent a legal means of imposing treatment on an individual, usually with a mental illness, who refuses therapeutic intervention and poses a risk of self-harm or harm to others. Compulsory outpatient treatment in psychiatry, also known as community treatment order, is a modality of involuntary treatment that broadens the therapeutic imposition beyond hospitalization and into the community. Despite its existence in over 75 jurisdictions worldwide, COT is currently one of the most controversial topics in (...) psychiatry, and it presents significant ethical challenges. Nonetheless, the ethical debate regarding compulsory treatment almost always stops at a preclinical level, with the different ethical positions arguing for or against its use, and there is little guidance to support for the individual clinicians to act ethically when making the decision to implement COT. Main body The current body of evidence is not clear about the efficacy of COT. Therefore, despite its application in several countries, evidence favouring the use of COT is controversial and mixed at best. In these unclear circumstances, ethical guidance becomes paramount. This paper provides an ethical analysis of use of COT, considering the principlist framework established by Ross Upshur in 2002 to justify public health interventions during the 2002–2004 severe acute respiratory syndrome outbreak. This paper thoroughly examines the pertinence of using the principles of harm, proportionality, reciprocity, and transparency when considering the initiation of COT. Conclusion Ross Upshur’s principlist model provides a useful reflection tool for justifying the application of COT. This framework may help to inform sounder ethical decisions in clinical psychiatric practice. (shrink)

A patient with AIDS dementia was confronted and compulsorily prevented from flying out of the country before being admitted against his will to hospital. While finding this on balance justified in the circumstances the commentators raise moral questions about the levels of care in general practice and within the couple's own relationships.

Today, monitoring of patient complaints in healthcare services is being used as a tool for quality assurance systems and in the future development of services. This nationwide register study describes the number of all complaints processed, number of complaints between different state provinces, healthcare services and healthcare professionals, and outcomes of complaints in Finland during the period 2000–2004. All complaints processed at the State Provincial Offices and the National Authority for Medicolegal Affairs were analysed by statistical methods. Complaints about mental (...) healthcare were explored in greater detail. The analysis showed that the number of patient complaints increased considerably during the study period. There were changes in the number of complaints between study years in different provinces. Out of different healthcare services, an especially marked increase was seen in private healthcare. Nearly all complaints were lodged against physicians, and over half of the complaints were made because of medical error. In mental health care, patients more often complained about unsatisfactory certificates and statements and the use of compulsory hospital care. An analysis of the outcomes revealed that in mental health care complaints more seldom led to consequences. The results need to be utilised when planning interventions for advanced supervision, prevention of adverse events and patient safety in healthcare, and especially in mental health care. From the patients’ perspective, it is important to create a culture where most problem situations are handled where the treatment was provided, thus avoiding a complex complaints process. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Contingent Object of PsychiatryDavid McCallum (bio)Keywordsmental illness, dangerousness, law, genealogyWilson and Adhead’s plea that the British Government’s proposed new mental health legislation might entail a misappropriation of psychiatry’s true mission will strike a chord in numerous jurisdictions. Many European countries during the last northern summer will adopt mental health legislation that moves in the opposite direction to the United Nations Convention on Human Rights for persons with disabilities, (...) and will allow for compulsory mental health treatment. In this author’s home state of Victoria, Australia, the Mental Health Act has five criteria that must be met for someone to be made an involuntary patient in an institution or hospital, in the community, or in one’s own home (Victoria 2003, s.6). One of the criteria is that the person is judged to be at risk of danger to themselves or others. Once made an involuntary patient, one looses the right to refuse medical treatment. At present, in various parts of the world, medical practitioners are being required to assess a person’s level of dangerousness with immediate consequences for that person’s liberty.From the point of view of a historian of the human sciences, these events propel psychiatry into a dialogue with its recent past. The project of Western psychiatry is usually characterized as a breaking down of the walls of the old asylum that contained the lunatic in its dark recesses, and the subsequent unveiling of the mental patient thanks to the rational, liberatory practices of medicine. But modern psychiatry has also been shaped by the coming into being of particular conceptions of mental illness that are not all its own making. This entailed the removal over time of the mental defective and the mental deficient, the moral imbecile, the epileptic, the alcoholic, the chronically insane, and so on, from spaces in which psychiatry would seek to define it object—populations that psychiatry would determine to be “not amenable to treatment.” If we were to see this shaping in a Foucauldian sense, we would also want to include earlier eighteenth- and nineteenth-century separations of the lunatic and the criminal (Foucault 1965, 1979). Moreover, we might want to insist that the marking out of the modern mental health patient is first and foremost an administrative act—an act of separation and management within a bounded population—which then serves as a condition of possibility for the emergence of knowledges in psychiatric medicine, with the latter following rather than preceding the arrangement of bodies in the asylum/hospital.The psychiatrist in public medicine may well be encouraged to shape a new mission according to the requirements of an administration concerned with managing dangerousness. A shift in the social vocation of the psychiatric expert has been observed over several decades, and may represent a profound departure from the traditions [End Page 69] of mental medicine (Castel 1991). Those “dirty words”—risk assessment—involve new strategies where face-to-face relations between carer and cared are displaced by an activity of calculating abstract factors deemed liable to produce risk—“a transition from the clinic of the subject to an ‘epidemiological’ clinic” (Castel 1991, 282). The broad contours of this shift sees the specialist medical carer take a back seat while the manager/ administrator assumes a more autonomous role of allocating individuals into various categories of risk. It is in this sense that the psychiatrist does not make a diagnosis as such, but rather contributes to a list of factors compiled to measure a level of riskiness. Risk assessment forms part of social surveillance that dispenses with the actual presence of the carer and the cared, and provides for a form of systematic predetection rather than treatment. As Castel (1991, 288) presents it,(t)here is, in fact, no longer a relation of immediacy with a subject because there is no longer a subject. What the new preventative policies primarily address is no longer individuals but factors, statistical correlations of heterogeneous elements. They deconstruct the concrete subject of intervention, and reconstruct a combination of factors liable to produce risk. Their primary aim is not to confront a concrete dangerous situation, but to anticipate... (shrink)

Background The number of medical lawsuits in Japan was between 14 and 21 each year before 1998, but increased to 24 to 35 per year after 1999. There were 210 lawsuits during this 10-year period. There is a need for skills and knowledge related to ethics, which is as fundamental to the practice of medicine as basic sciences or clinical skills. in Japan education in ethics is relatively rare and its importance is not yet recognized. Establishing ethics education using legal (...) precedents, which has already been achieved in Western countries, will be a very important issue in Japan. In the present study, a questionnaire survey was conducted among graduate intern doctors, in order to investigate whether ethics education using precedents might have a positive effect in Japan. Methods In 2002, a questionnaire survey entitled Physicians' Clinical Ethics was carried out in a compulsory orientation lecture given to trainees before they started clinical practice in our hospital. The attendees at this lecture were trainees who came from colleges in various districts of Japan. During the lecture, 102 questionnaires were distributed, completed by attendees and collected. The recovery rate was 100%. The questionnaire consisted of 22 questions (in three categories), of which 20 were answered by multiple choices, and the other two were answered by description. The time required to complete the questionnaire was about 10 minutes. Results The recovered questionnaires were analyzed using statistical analysis software (SPSS for Windows, Release 10.07J-1/June/2000), in addition to simple statistical analysis. answers using multiple choices for the 20 questions in the questionnaire were input into SPSS. The principal component analysis was performed for each question. As a result, the item that came to the fore was "legal precedent". Since many intern doctors were interested in understanding laws and precedents, learning about ethical considerations through education using precedents might better meet with their needs and interests. Conclusion We applied a new method in which the results of principal component analysis and frequencies of answers to other questions were combined. From this we deduced that the precedent education used in Western countries was useful to help doctors acquire ethical sensitivity and was not against their will. A relationship was found between reading precedents and the influence of lawsuits, and it was thought that student participation-type precedent education would be useful for doctors in order to acquire ethical sensitivity. (shrink)

Over the past one hundred years, Catholic sexual ethics has become more hospitable to sexual bonding as a good that is distinct from procreation. However, our increasing knowledge of women’s sexual pain disorders highlights ongoing problems with official Catholic sexual ethics. This essay argues that the Catholic Church still reproduces gendered social scripts that unwittingly encourage heterosexual women to ignore their sexual pain and continue to engage desperately in intercourse, out of an exacerbated concern to satisfy male partners. These are (...) tactics that only prolong and deepen women’s sexual suffering. Further, insights about the various options for women’s healing from sexual pain concretely suggest more liberative sexual scripts: the importance of women’s non‐obligatory, embodied desire and the need to reject intercourse as the compulsory norm for all sexual activity. Ultimately, women’s experiences of having sexual pain and healing from it lead to revisions in Catholic sexual ethics at a fundamental level. (shrink)

Patients with borderline personality disorder (BPD) sometimes request to be admitted to hospital under compulsory care, often under the argument that they cannot trust their suicidal impulses if treated voluntarily. Thus, compulsory care is practised as a form of Ulysses contract in such situations. In this normative study we scrutinize the arguments commonly used in favour of such Ulysses contracts: (1) the patient lacking free will, (2) Ulysses contracts as self-paternalism, (3) the patient lacking decision competence, (4) Ulysses (...) contracts as a defence of the authentic self, and (5) Ulysses contracts as a practical solution in emergency situations. In our study, we have accepted consequentialist considerations as well as considerations of autonomy. We conclude that compulsory care is not justified when there is a significant uncertainty of beneficial effects or uncertainty regarding the patient’s decision-making capacity. We have argued that such uncertainty is present regarding BPD patients. Hence, Ulysses contracts including compulsory care should not be used for this group of patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:An Interesting Framework That Deserves to Be Developed and Used WidelyThe author reports no conflict of interests.Friesen's "Why Democratize Psychiatric Research?" is an important piece of work and makes a compelling epistemic and ethical case. As someone who has spent decades in the field of (in chronological order): survivor involvement, service user involvement, patient and public involvement and now lived experience; I am delighted when I see a robust (...) reminder of the reasons why we need to take this seriously. The author is right to stop us sleepwalking into an activity because funders expect it, psychiatry now prides itself on it, and academics write countless pieces on it. People who have not lived in a time when our involvement in research was entirely counter-cultural (or even symptomatic of a patient lacking insight) could be forgiven for thinking it was always like this.There are, however, three themes that could and should be developed from this thinking. They concern assumptions about general medicine, the institutional discrimination within psychiatry, and the significant cultural change that has occurred since the rise of the survivor movement as one of the later rights movements of the last century.Many years ago, I would have made the same argument about how psychiatry lacks the objectivity and testable biomarkers of general medicine. As I have spent more time with assorted medics, many at the top of their game, it is clear that there is much more subjectivity across much of medicine and rather than place psychiatry as uniquely needing more democratic research (a proposition I wholeheartedly endorse), I would love to see us take these arguments into medicine as a whole. Until we do this, we risk "othering" psychiatry as a whole rather than showing an area in which psychiatric patients (or survivors, or service users, or people with lived experience, as you wish) can become leaders in progressive medical thinking.A more important omission which needs significant addressing if we genuinely are to democratize psychiatric research is the racial inequality within psychiatric practice. There are many inequalities both within psychiatry and in broader society that contributes to mental health inequalities, but the experience of racialized communities, in our [End Page 139] psychiatric services has been a consistent theme. For those unfamiliar with the extent of difference between White and Black experience of UK psychiatry you need only look at the differential rates of detention under mental health legislation. National Health Service data show that people from minority ethnic groups are more likely to experience compulsory detention than their White counterparts. In 2020/21, rates of detention by ethnicity were Black or Black British: 309.4 per 100,000 people compared with White: 76.2 per 100,000 people (National Health Service Digital, 2021.)If we are to truly democratize research in psychiatry, we need to more actively engage racialized communities and ensure that they are leading and coproducing more of our research. Although this forms part of the argument in feature #3, it warrants being front and center of features #1 and #4 where the differences between Black and White are so marked.We as democratizing researchers should be carrying an anti-racist banner high and doing more to both improve our own practice and constantly challenge a psychiatry that has failed, review after review, to address this. The Whiteness and Race Equality Network, part of the Collaborating Centre for Values Based Practice1 is working hard on this theme but much more is needed.The final challenge which needs addressing, and one which certainly needs the analytical skill and clarity of thinking that Friesen has applied throughout, is the breadth and diversity of what now constitutes "lived experience" in mental health. Even if we restrict our scope to psychiatry, this is a much broader research field than when survivor research started to be taken seriously. The vast majority of survivor researchers would have spent considerable periods of time as inpatients in psychiatric hospitals, often as detained patients. None of us would have chosen to self-diagnose, most of us would have done all we could to shed our diagnostic labels, some of us find it hard to forget... (shrink)

Crisis resolution and home treatment (CRHT) teams have been introduced into mental health care in the UK because, in general, patients do not want to be admitted to hospital, treatment at home is cheaper and in the only randomized controlled trial conducted so far there was no difference in symptomatic outcome. However, because of compulsory gate-keeping by CRHT teams, some patients no longer have the option of going to hospital if they want to. This aspect of the introduction of (...) CRHT teams has not been discussed so far, but it certainly warrants further examination. Intervention through CRHT teams may in fact increase compulsory admissions and serious and untoward incidents, although this is not certain. Sufferers from psychosis are the patient group most likely to be compulsorily admitted to hospital and they are generally considered less responsible for serious and untoward incidents. Therefore, a possible solution could be to offer a choice to some patients, namely those with a psychotic disorder, on whether they want to be admitted or not. At least one should investigate what the consequences of this policy would be, if it were to be adopted in a test region. This example shows that in developing policies for rationing health care, it can be important to look at subgroups and not just at average results when determining the best course of action. (shrink)

Historically, conscientious objection has been associated with military service. Currently, however, it does not occur exclusively in response to compulsory military service. With increasing frequency, health care professionals, including those who practice in institutional settings such as hospitals and long-term care facilities, conscientiously object to providing specific medical services. This chapter provides a framework for managing conscientious objection within institutional settings. Criteria are provided for determining when refusals to provide medical services are conscientious objections. Reasons are offered for accommodating (...) conscientious objectors and for denying or limiting accommodation. A reasonable accommodation approach, which consists in five requirements, is explained and defended: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (2) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on other clinicians, supervisors, department heads, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. (5) Conscience-based refusals will be accommodated only if it will not enable invidious discrimination. (shrink)

There are very few medical ethics courses in British medical schools which are a formal part of the clinical curriculum. Such a programme is described in the following, along with the way in which the long-term curriculum committee of the University College and Middlesex Hospital Joint Medical School was persuaded to make it compulsory for first-year students. Pedagogical lessons which have been learned in its planning and implementation are outlined and teaching materials are included concerning student and course assessment (...) which should be useful for others engaged in similar work. Finally, some of the institutional obstacles facing such attempts are discussed, particularly problems concerning timetabling, different types of opposition and the consequent importance of building alliances among clinical teaching staff. (shrink)

Volume 24, Issue 7, July 2024, Page 127-128.

Volume 25, Issue 2, February 2025, Page 23-25.

Volume 25, Issue 2, February 2025, Page 145-148.

Volume 24, Issue 12, December 2024, Page 48-51.

Volume 24, Issue 12, December 2024, Page 51-53.

This study investigated subjective experiences of nine men who had been psychiatrically hospitalized upon being assessed as "dangerous-to-others-due-to-a-mental-illness." Using a phenomenological interviewing approach, researchers helped subjects construct narratives of their pre-hospitalization experiences. The research illuminated aspects of life-contexts that were shared among all or nearly all subjects: feeling ostracized and alone; struggling with longstanding and pervasive feelings of inadequacy; experiencing a sense or a fear of having little or no control or options in life; and feeling emotionally depressed, misunderstood, (...) and uncared for. Situations immediately preceding hospitalization were characterized by subjects experiencing threats to their sense of self-esteem that were of heightened intensity. In five cases, subjects reported anxiety related to self-fragmentation or becoming "nothing." Perceived threats to self-worth and self-structure were accompanied by anger and aggressive acts or impulses. In all cases, aggressive impulses and threats, and violence appeared to be in the service of self-validation and self-empowerment. In cases of violent behavior, an apparent function of the subjects' behaviors was toward self-consolidation. Based on findings, the researchers discuss implications consistent with humanistic psychology and existential psychotherapy principles and practices. (shrink)

Men who are victimized in their intimate different-sex (DS) and same-sex (SS) relationships often report not having information to help them escape their abusive situations. To overcome this lack of information, public awareness campaigns have been created. But thus far, there is no clear understanding of how these campaigns reflect theoretical principles central to improve message effectiveness and avoid undesired negative effects. This study aims to review the content of intimate partner violence (IPV) pictorial campaigns focusing on victimized men in (...) DS and SS relationships. Specifically, it aims to understand the campaigns’ global characteristics and if their content represents constructs from different theoretical models. Online search engines were used to extract pictorial campaigns in English, Spanish, and Portuguese, released up until 2019. They must have had to be promoted by a formal organization, and were coded according to a theoretically grounded taxonomy, using thematic analysis. Our results indicate that out of the 57 campaigns collected, most were aimed at men without specifying the relationship they were in (i.e., DS or SS) ( n = 22, 39%) and intended to change attitudes, beliefs, and behaviors about IPV (in line with the Theory of Planned Behavior) ( n = 47, 82%). Additionally, four campaigns adequately integrated fear appeal constructs of the Extended Parallel Processing Model ( n = 4, 7%), while 41 campaigns highlighted dissonant states in line with the Elaboration Likelihood Model ( n = 41, 72%). Following the Transtheoretical Model, most campaigns targeted victims in the Maintenance stage ( n = 52, 92%). The campaigns under analysis may prove useful for some victimized men, mostly presenting messages designed to elicit a beneficial attitude and behavior change. Our analysis highlights different limitations as well, such as the lack of information on susceptibility to IPV ( n = 13, 23%) and the effectiveness of the recommended responses that the campaigns provide ( n = 20, 38%), which may interfere with adequate fear appeal processing. Additionally, presenting more diverse victims may be beneficial, along with social norms change information regarding gender roles, violence, and help-seeking. This may guide the development of improved and tailored campaigns to better facilitate help-seeking in victimized men that mostly avoid undesired negative effects on the viewer. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of (...) ongoing intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)

IntroductionAnimal Assisted Interventions are increasingly common in pediatric care settings as a means to promote the physical, mental, and emotional well-being of hospitalized children and adolescents.ObjectivesThe aim of this work was to review published studies implementing AAIs in hospital settings and to assess the effects of AAIs on the biobehavioral response to stress and pain, social behavior, quality of life and level of satisfaction with hospitalization in children and adolescents. Stress and burden, quality of life, mood and level of (...) satisfaction with hospitalization in parents/caregivers as well as stress and burden, perception of the work environment and job satisfaction in hospital staff were also reviewed.MethodsAll published studies reporting quantitative assessments were systematically searched using PubMed, Scopus, ProQuest and Web of Science databases in accordance with PRISMA guidelines. The aim was to identify studies examining the effects of AAIs on behavioral, psychological and physiological responses to stress in children and adolescents formally admitted to a hospital for a stay, as well as in those undergoing a visit for treatments or medical examinations.ResultsOf the 350 studies screened, 21 were eligible for inclusion. Most of them focused on stress, pain, and anxiety reduction in pediatric patients, and used both physiological parameters and behavioral and psychological observations/scales. All studies employed dogs. Results show the potential of AAIs to reduce anxiety and behavioral distress in pediatric patients while acting on physiological measures associated with arousal.ConclusionAlthough further, more rigorous studies are still needed, the findings of this review may have implications for clinical practices suggesting appropriate planning of AAIs by pediatric healthcare professionals.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=178993], identifier [CRD42020178993]. (shrink)

When a child is hospitalized, the parents find themselves in an unfamiliar environment and their parental role changes. They are in a stressful and often anxiety-filled situation and it may be difficult for them to participate in decisions. The purpose of this study was to examine the extent to which parents participate in decisions during the course of events when their child is hospitalized. Thirty-five parents of 24 children (aged 5 months to 18 years) were followed by mobile observation during (...) their child’s hospitalization in a paediatric department in Sweden. Three researchers analysed field notes in three steps, using manifest and latent coding. In step 1, 119 situations that included a decision process were identified. In step 2, the situations were assessed according to a five-level scale concerning how the parents’ wishes, desires or values had been respected. In step 3, each situation was scrutinized with respect to factors influencing the extent of the parents’ participation. The results showed that parents have varying ability to be involved in decision making. Professionals need to communicate more openly with them in order to identify and satisfy their needs because some parents are unwilling or incapable of expressing them. (shrink)

Volume 24, Issue 12, December 2024, Page 71-73.

Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent (...) that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child’s view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children’s participation in decision making concerning their health care. (shrink)

Workplace stressors were identified to have critical impacts on employee creativity. However, little is known about how and when involuntary citizenship behavior (i.e., compulsory citizenship behavior, CCB)-induced stress might exert influence on employee creativity. To fill this void, the present study firstly develops a moderated mediation model to investigate the CCB—employee creativity association as well as the underling mechanism and contextual condition of this relationship. By integrating social cognitive theory such as self-efficacy theory and conservation of resources (COR) theory, (...) we propose that CCB predicts employee creativity through the mediating role of creative self-efficacy (CSE), with the individual characteristics (i.e., personality traits) of negative affect acting as a boundary condition. Using two-wave time-lagged survey data collected from a sample of 251 front-line employees in 10 manufacturing firms in Southern China, the results show that: (a) CSE mediates the negative relationship between CCB and employee creativity; (b) negative affect moderates the relationship between CCB and CSE; (c) negative affect moderates the indirect influence of CCB on employee creativity through CSE. As the level of negative affect rises, this indirect relationship is stronger. Finally, important theoretical and managerial implications and promising avenues for future research are addressed. (shrink)

John Kleinig; Compulsory Schooling, Journal of Philosophy of Education, Volume 15, Issue 2, 30 May 2006, Pages 191–203, https://doi.org/10.1111/j.1467-9752.1981.

This article examines some of the arguments proffered in objection to the introduction of compulsory voting. In particular, it addresses the notion that abstention from voting is tied to political affect, and that inequality in votes is justified. Rather than presenting the debate on the enforcement of voting as a matter of pro or contra, however, it argues that insights from both sides of the discussion can be adopted to allow for an approach that manages to integrate politically alienated (...) citizens, taking Iris Marion Young's model of inclusive democracy as a guide. (shrink)

Abstract:The number of patients with organ failure who could potentially benefit from transplantation continues to exceed the available supply of organs. Despite numerous efforts to increase the number of donors, there remains an enormous mismatch between demand and supply. Large numbers of people still die with potentially transplantable organs remaining in situ, most frequently as a result of family objections. I argue that there are no persuasive moral arguments against mandated organ retrieval from all dead individuals who meet clinical criteria. (...) However, because of continuing endemic prejudice in United States society and its healthcare system and the distrust this engenders, I conclude that proceeding with a policy of compulsory organ retrieval, even if morally unobjectionable, would not be warranted. (shrink)

Should voting be compulsory? Many people believe that it should, and that countries, like Britain, which have never had compulsion, ought to adopt it. As is common with such things, the arguments are a mixture of principle and political calculation, reflecting the idea that compulsory voting is morally right and that it is likely to prove politically beneficial. This article casts a sceptical eye on both types of argument. It shows that compulsory voting is generally unjustified although (...) there are good reasons to worry about declining voter turnout in established democracies, and to worry about inequalities of turnout as well. (shrink)

David Boonin has recently argued that although no existing theory of legal punishment provides adequate moral justification for the practice of punishing criminal wrongdoing, compulsory victim restitution (CVR) is a morally justified response to such wrongdoing. Here I argue that Boonin’s thesis is false because CVR is a form of punishment. I first support this claim with an argument that Boonin’s denial that CVR is a form of punishment requires a groundless distinction between a state’s response to a criminal (...) offense and its response to an offender’s failure to comply with the sanctions imposed for that offense. I then suggest that this argument points to a definition of punishment that not only meets Boonin’s own desiderata for a definition of punishment but also implies that CVR is a form of punishment. Finally, I argue that CVR is a form of punishment even under Boonin’s own proposed definition of punishment. -/- . (shrink)

Should voting be compulsory? This question has recently gained the attention of political scientists, politicians and philosophers, many of whom believe that countries, like Britain, which have never had compulsion, ought to adopt it. The arguments are a mixture of principle and political calculation, reflecting the idea that compulsory voting is morally right and that it is will prove beneficial. This article casts a sceptical eye on the claims, by emphasizing how complex political morality and strategy can be. (...) Hence, I show, while there are good reasons to worry about voter turnout in established democracies, and to worry about inequalities of turnout as well, the case for compulsory voting is unpersuasive. (shrink)

Would compulsory treatment or vaccination for Covid-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic. We argue that, if the permissive English approach to external constraints for Covid-19 has been justified, then there is a case for a similarly (...) permissive approach to compulsory medical interventions. (shrink)

The self-ownership thesis asserts, roughly, that agents own their minds and bodies in the same way that they can own extra-personal property. One common strategy for defending the self-ownership thesis is to show that it accords with our intuitions about the wrongness of various acts involving the expropriation of body parts. We challenge this line of defense. We argue that disgust explains our resistance to these sorts of cases and present results from an original psychological experiment in support of this (...) hypothesis. We argue further that learning that disgust is responsible for pro-self-ownership intuitions should reduce our confidence in those intuitions. After considering and rejecting some prominent “debunking” arguments predicated on disgust’s evolutionary history, we provide alternative reasons for thinking that disgust is not a reliable source of moral judgments. Rejecting the reliability of disgust as a mechanism for producing moral beliefs coheres with our considered judgments about the general kinds of considerations that are morally relevant and a range of particular moral problems. (shrink)

Despite a “spatial imaginary” which constructs Europe as a location of sexual and gender freedom (Rao, 2014), presently, twenty countries in Europe require sterilisation in order to legally recognise transgender people’s gender identities, including four of the seven countries in the INFERCIT study: Greece, Italy, Turkey, and Cyprus (but not Spain, which since 2007 does not require sterilisation for gender identity recognition [see Platero, 2008]. In Bulgaria and Lebanon no gender identity recognition for trans people is provided by law; the (...) latter lies outside the “European” region) (TGEU, 2014). Compulsory sterilisation—classified as a crime against humanity in the Rome Statute of the International Criminal Court (UN General Assembly, 1998: art. 7.1)—is widely in force against transgender people, who constitute “the only known group in Europe subject to legally prescribed, state-enforced sterilisation” (Hammarberg, 2009: 19). However, forced sterilisation of trans people is not generally conceptualised as a eugenicist or genocidal policy, in part because sterilisation is conflated with gender reassignment surgical interventions which, widely considered as that which brings transgender bodies into being, are in turn conflated with embodied transgender subjectivities. On this view, transgender individuals could not exist except through a medicalised process that, by design, precludes their “natural” reproductive capacities and is generally not accompanied by fertility preservation or the provision of assisted reproduction technologies (Plemons, 2014: 38; De Sutter et al., 2002; De Sutter, 2001). Sterilisation laws are justified through a pathologising discourse on transgender lives which constructs gender reassignment interventions as medical “treatment” of gender identity disorder (Suess, Espineira & Crego Walters, 2014: 73-76). Adopting a depathologising perspective enables us to contextualise compulsory sterilisation (which naturalises the sexually dimorphic, cisgender, heterosexual body) as a form of “gendercide” which has historically been instrumental in the imposition of a Euro-colonial binary gender system (Miranda, 2010; Lugones, 2007). The state-imposition of medical interventions on trans people not only has deleterious effects on their reproductive rights, “effectively undermin[ing] their right to found a family” (Hammarberg, 2009: 21; see OHCHR et al., 2014)—as “family” is hegemonically defined by a heteronormative and bio/ logical kinship order (Butler, 2002; van Anders, 2014). I argue that state regulation of transgender reproduction constitutes a form of institutionalised gendered violence inasmuch as it impedes transgender people’s ability to exercise inherent first-person authority over the materiality and meanings of their gendered embodiments (Bettcher, 2009; Spade, 2013). Efforts to renaturalise gender and kinship inextricably intersect (Kantsa, 2006) in the biopolitical attempt to regulate transgender embodiments and reproduction, which conditions the emerging legal recognition of transgender subjects as a rights-bearing minority (Stryker, 2014). (shrink)

Volume 19, Issue 10, October 2019, Page 88-90.