In the 1990s, Bolivia’s indigenous population mobilized to claim new political roles, and in the process, directly challenged the privileged position of economic elites within national political institutions. In response, business associations in Santa Cruz, Bolivia’s most prosperous region, began to demand regional autonomy—in contrast to the demand for authoritarianism that characterized prior generations of business elites when confronted with threatening political change. After examining Santa Cruz’ past relationship with the national government, this article explores the challenges that (...) led economic elites in the department to seek autonomy and the strategies that they have adopted in pursuit of this goal. (shrink)

This paper examines the planning process and architecture of two public psychiatric institutions built around 1900 in Trieste and Lower Austria. From 1864, the building of new asylums was the responsibility of Crown land governments, which by the end of the nineteenth century had emerged as sites of power and self-presentation by minority groups and new political parties. At the same time, the area of asylum planning was establishing itself as a branch of asylum psychiatry and promoting the idea of (...) the asylum as model settlement, contributing to social reform. I analyse the interaction of psychiatrists, architects and government officials involved in planning the two institutions in the context of Crown land governments’ self-positioning within the empire and internationally . The Trieste asylum planners were working for a government controlled by Italian nationalists, but their desire for a ‘modern’ asylum turned them towards German models. The Christian Social government in Lower Austria sought to supplant Germany as the leader in this branch of science. The spatial arrangement and visual articulation of the two asylums is interpreted in the context of the interaction of psychiatry and the politics of regional autonomy. (shrink)

In the mid-1940s, Argentina was partially isolated and ruled by a military regime. The political confrontation between the military and the scientific community as well as international pressures played a major role in the failure of the first attempts to cope with nuclear development. Only after the relationship between the military and local scientists was readjusted and control of atomic energy was placed in the hands of the Navy, and Argentina's international relations restored, did nuclear development begin to take off. (...) This paper examines the traumatic process of creating the political and institutional conditions for the reception of nuclear technology in a peripheral context. The key to shaping future policies was the decision made by Argentina's Atomic Energy Commission in April 1957 to construct its first research nuclear reactor instead of buying it as other countries such as Spain and Brazil were doing at the time. (shrink)

Patient autonomy and distributive justice are fundamental ethical principles that may be at risk in liver transplant units where decisions are dictated by the need to maximise the utility of scarce donor organs. The processes of patient selection, organ allocation and prioritisation on the wait list have evolved in a constrained environment, leading to high levels of complexity and low transparency. Regarding paternalism, opaque listing and allocation criteria, patient factors such as passivity, guilt, chronic illness and sub-clinical encephalopathy are (...) cited as factors that may inhibit patient engagement. Regarding justice, established regional, gender and race based inequities are described. The paradox whereby hepatologists both advocate for individual patients and discharge their duty of stewardship to apportion organs according to larger utilitarian principles is explored. Competing subjective factors such as physicians’ perception of moral responsibility, the qualitative nature of expert medical assessment and institutional or personal loyalty to re-transplantation candidates are described. Realistic limits of self-determination and justice are discussed, and possible future directions in terms of patient involvement proposed. (shrink)

Having been supressed and denied their rights by successive Syrian governments over the years, Syrian Kurds are now asserting a de facto autonomy. Since the withdrawal of the Syrian President's forces from the ethnically Kurdish areas in the early months of the current civil war, the inhabitants have declared a self-rule government along the lines of the Kurdistan regional government in northern Iraq. For Syrian Kurds, the creation of a small autonomous region is a dream fulfilled, albeit one (...) unrecognized by the international community. Some 15% to 17% of the Syrian population is Kurdish. Whether they can achieve statehood will depend on a reading of international law and on how the international community reacts. There are certain aspects which differentiate Kurdish self-rule in Syria from its counterpart in Iraq. View HTML Send article to KindleTo send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.Kurdish Regional Self-rule Administration in Syria: A new Model of Statehood and its Status in International Law Compared to the Kurdistan Regional Government in IraqVolume 17, Issue 3LOQMAN RADPEY DOI: https://doi.org/10.1017/S1468109916000190Your Kindle email address Please provide your Kindle email.@free.kindle.com@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. Kurdish Regional Self-rule Administration in Syria: A new Model of Statehood and its Status in International Law Compared to the Kurdistan Regional Government in IraqVolume 17, Issue 3LOQMAN RADPEY DOI: https://doi.org/10.1017/S1468109916000190Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. Kurdish Regional Self-rule Administration in Syria: A new Model of Statehood and its Status in International Law Compared to the Kurdistan Regional Government in IraqVolume 17, Issue 3LOQMAN RADPEY DOI: https://doi.org/10.1017/S1468109916000190Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation Request permission. (shrink)

This paper examines the legal and ethical problems involved in reconciling two separate rights, each of which plays a fundamental role in the current philosophical debate surrounding international relations and international law: the right to national sovereignty to which many states lay claim, on the one hand , and the right to self-determination , on the other.Refusal to grant the right of self-determination frequently leads to the violation of the human rights of nationally, ethnically, racially or religiously defined population groups. (...) In any justification of or claim to national sovereignty, and also in the claim of national minorities to autonomy, the concept of nationhood plays a decisive role. In part I of this paper, I will therefore be attempting to shed light on the history and the terminological content of the concept of nationhood, with a view to making use, in part II, of the knowledge thus gained in the search for a solution to the outlined legal and ethical problem. In this debate, I distinguish between the nation and the nation-state. It is possible to conceive nations which have no state, as well as states which serve no nation or serve several nations at once as a political forum.In resolving the question of whether nation-state sovereignty takes priority over regional autonomy or vice versa, we will also be addressing the question of the importance attributable to human rights, taken to mean individual rights, as against the collective rights of both nation-state sovereignty and regional autonomy. (shrink)

Background Respect for patient autonomy, the principle that patients are capable to make informed decisions about medical interventions, is fundamental in present-day medicine. However, if a patient’s request is medically not indicated, the practitioner faces an ethical dilemma represented by the conflict of the principles of patient autonomy, beneficence, and maleficence. Adjacent to topics such as medical assistance in dying and healthy limb amputation, this ethical dilemma also manifests in the care of the maxillofacial region (the oral cavity (...) and its surroundings), an area crucial to esthetic appearance, but also to everyday functions including mastication, speech, and facial expression, all of which are related to well-being. Our aim was to explore the manifestations and resolutions of the conflict between oral health and patient autonomy in relevant literature in order to contribute to the discourse of ethical challenges concerning patient autonomy, beneficence, and nonmaleficence. Methods We screened all journal articles discussing the researched ethical dilemma obtained from three databases. Two researchers developed a hierarchical coding scheme, where the parent and grandparent codes were designated deductively as: Case (situations involving the researched ethical dilemma), Judgement (decisions made in the ethical dilemma), and Principle (ideas, rules, propositions explaining the judgements); child codes were developed inductively. After coding the sources, we utilized thematic analysis to construct code constellations. Results Most themes identified in our sources advocated for the practitioner to choose the alternative that benefits the patient from a medical perspective, although no theme excluded the consideration of patient autonomy. Instances where respect for patient autonomy was encouraged concerned oral preventive care or when the requested intervention was expected to have an insignificant impact on oral health. Conclusions Ethical conflicts concerning patient autonomy, beneficence, and nonmaleficence have a marked presence in oral care. These conflicts arise through the issue of body modification, evident in cosmetic dentistry and requests for tooth extraction. Our sources generally support the argumentation for beneficence, despite the rise of cosmetic procedures in dentistry. (shrink)

Background: Enhancing client autonomy requires close coordination of interactional practices between nurse and client, which can cause challenges when interaction takes place in video-mediated settings. While video-mediated services have become more common, it remains unclear how they shape client autonomy in telehomecare. Research aim: To analyse how video mediation shapes client autonomy when nurses guide medicine taking remotely through video-mediated home care. Research design: This is a conversation analytic case study using video recordings of telehomecare encounters. The (...) theoretical approach draws on ethnomethodology and empirical ethics. Participants and research context: Four home-dwelling older adults and three nurses participated in the data collection; data extracts include one client and two nurses. The study was conducted in Finland. Ethical considerations: Special attention was given to protect the rights of home care clients. An ethical statement for the study was given by the Ethics Committee of the Tampere Region Findings: Video mediation complicates interacting remotely with care-relevant artefacts because of nurses’ limited visual access to the medicine and client’s need to simultaneously engage in vocal interaction and medicine taking. This can be overcome by dividing the guidance into manageable steps which invite the client to explicate their readiness to take the medicine and situating the video-mediation equipment and medicine close together. Different interactional practices and ways of situating video-mediation equipment and medicine have consequences for client autonomy. Discussion: Understanding client autonomy in digitalised settings demands empirical examination that recognises the importance of different human and non-human aspects of care that shape client autonomy. Conclusions: To harness the benefits of video-mediated home care, communication technologies’ reliance on home space and interactional practices should be recognised. Empirical ethics research is needed in order to make normative suggestions that fit a wide variety of care situation. (shrink)

The concepts of the innateness, universality, species-specificity, and autonomy of the human language capacity have had an extreme impact on the psycholinguistic debate for over thirty years. These concepts are evaluated from several neurobiological perspectives, with an emphasis on the emergence of language and its decay due to brain lesion and progressive brain disease.Evidence of perceptuomotor homologies and preadaptations for human language in nonhuman primates suggests a gradual emergence of language during hominid evolution. Regarding ontogeny, the innate component of (...) language capacity is likely to be polygenic and shared with other developmental domains. Dissociations between verbal and nonverbal development are probably rooted in the perceptuomotor specializations of neural substrates rather than the autonomy of a grammar module. Aphasiologicaldata often assumed to suggest modular linguistic subsystems can be accounted for in terms of a neurofunctional model incorporating perceptuomotor-based regional specializationsand distributivity of representations. Thus, dissociations between grammatical functors and content words are due to different conditions of acquisition and resulting differences in neural representation. Human brains are characterized by multifactorial interindividual variability, and strict universality of functional organization is biologically unrealistic.A theoretical alternative is proposed according to which (1) linguistic specialization of brain areas is due to epigenetic and probabilistic maturational events, not to genetic ”hard-wiring,” and (2) linguistic knowledge is neurally represented in distributed cell assemblies whose topography reflects the perceptuomotor modalities involved in the acquisition and use of a given item of knowledge. (shrink)

La política de desarrollo regional constituye una de las principales herramientas con las que cuenta la Administración pública para impulsar un modelo de desarrollo económico regional descentralizado en razón a las potencialidades endógenas de las diferentes regiones. Por tanto, la concreción de un modelo de política indicativa destinada a ser implementada en los territorios regionales españoles, como es el caso de Galicia, pretende ejercer de motor de arrastre para incentivar el desarrollo económico del territorio en base a sus (...) potencialidades internas. Galicia, durante mucho tiempo de su historia, ha estado padeciendo el enclavamiento territorial. (shrink)

Background: While being prepared for abortions, some women experience decisional ambivalence during their encounters with health personnel at the hospital. Women’s experiences with these encounters have rarely been examined. Objective: The objective of this study was to explore ambivalent abortion-seeking women’s experiences of their encounters with health personnel. Research design: The data were collected in individual interviews and analysed with dialogical narrative analyses. Participants and research context: A total of 13 women (aged 18–36 years), who were uncertain of whether to (...) terminate their pregnancies during the first trimester, were interviewed before and after they made their decisions. The participants were recruited at six Norwegian outpatient clinics. Ethical considerations: Approval was granted by the Regional Committee for Medical and Health Research Ethics. Findings: The ambivalent pregnant women sought to make autonomous decisions while simultaneously involving their closest confidants and health personnel in the process. The following three types of narratives of women’s experiences with encounters with health personnel were identified: the respected women; the identified women; and the abandoned women. Discussion: The findings are discussed in terms of the ambivalent pregnant woman’s autonomous responsibility in considering an abortion and how her autonomy can be enabled or impaired during encounters with health personnel. Conclusion and implication: Although the women considered themselves autonomous and responsible for their final decisions, they wished health personnel were involved in their situations. The health personnel contributed by enabling or disabling the possibility of decision-making in accordance with the women’s values. The findings indicate that health personnel who care for women considering abortions must be trained in dialogical competence. (shrink)

Background: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care. Objective: The purpose was to describe registered nurses’ experience of caring for older people in nursing homes to promote autonomy and participation. Research design: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was (...) inspired by Giorgi’s method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed. Findings: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses’ awareness of older people’s frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons’ wishes were aspects that relied on registered nurses’ trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people’s right to autonomy and participation in nursing homes. Registered nurses’ strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people. Discussion and conclusion: Awareness of older people’s frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people’s and healthcare personnel’s perspectives, to promote autonomy and participation for residents in nursing homes. (shrink)

The South Korean government’s historical efforts to introduce improved crop varieties have been ambiguously successful. State-bred rice varieties helped achieve national food production goals during the Green Revolution of the 1970s, but these varieties were highly unpopular and were abandoned soon, as the government stopped promoting them. This paper contrasts that experience with the simultaneous successful introduction of an improved variety of tangerine as a cash crop in Jeju Province. Smallholders of Jeju found space for the high-return fruit in the (...) existing land use system, including the partial conservation of agrobiodiversity without critically risking their subsistence-based food security. Citrus in general was a spatially less-demanding crop that farmers could partly co-cultivate with subsistence crops, while state-bred rice varieties occupied farmland exclusive of other varieties and rice’s double crops. Additionally, by employing political ecology, this paper asserts that the different roles of the state in introducing the two crops and the different regions were other factors behind such divergent adoption outcomes. Considering rice, the state was highly interventionist, because the government depended on rice-producing regions to “feed the nation”; with regard to non-staple-crop production in low-productivity, hard-to-develop regions like Jeju, in contrast, the government gave farmers more autonomy, thus allowing farmers to determine their own space and pace for citrus adoption. The study critically investigates the variable of spatial compatibility between a crop and the land system and sheds light on the current development mission to harmonize the cultivation of food and cash crops. (shrink)

Community initiatives to create more localized food systems ofteninclude the strategy of import substitution, i.e., increasing local foodproduction for local consumption. The purpose of this policy iseffectively to supplant some level of imported food into the region. Weargue that such action can carry social and environmental risks as wellas benefits and we have developed research parameters to measure theimpact of such strategies. Harriet Friedmann's seminal work (1991) onthe employment of import substitution by transnational corporationsprovides a framework to identify possible advantages (...) and disadvantagesof the same approach locally. We propose local autonomy and sustainabledevelopment as positive indicators of a more localized food system.Three units of analysis are proposed to measure changes in localautonomy and sustainable development as a result of import substitutionschemes: fair labor trade, equity and democracy, and environmentalstewardship. We propose that this flexible framework of analysisincreases our ability to describe the shifting and integrated balancebetween more local and more global food systems. (shrink)

Latin American social protection systems show that the fundamental ambivalence of modernity is captured by the twin notion of liberty and discipline in the context of a plurality of modes of socio-political organization. According to this understanding, this article analyses the potential of the so-called Conditional Cash Transfer programmes, which are widespread in the region, to strength or reduce personal autonomy. These programmes are promoted by claiming their virtues to reduce poverty and impose good behaviour on poor people in (...) order to improve the ‘human capital’ of future generations. However, numerous elements challenge these alleged virtues: arbitrary selection of beneficiaries, interference in people’s lives, stigmatization of recipients, inability to achieve universal coverage and act in a preventive manner with regards to urgent needs, the creation of poverty traps and informal working, etc. Taking these elements into account, this article explains how these programmes do not improve people’s autonomy and political independence. (shrink)

The primary objective of this research is to establish the extent to which small and medium-sized businesses (SMEs) in the Ha’il region benefit from a significant competitive advantage brought about by an entrepreneurial mindset (innovativeness, proactiveness, risk-taking, competitive aggressiveness, and autonomy). To achieve these objectives, the study used a questionnaire to collect data. A total of 220 SMEs in the Ha’il region were surveyed. The participants completed an online self-administered survey and used the PLS-SEM technique. The researchers found a (...) robust link between differentiation advantage and higher levels of innovativeness, proactiveness, risk-taking, competitive aggression, and autonomy. In addition, the outcomes of the survey reveal that a greater cost advantage is substantially associated with vastly greater innovativeness, proactiveness, risk-taking, and competitive aggression overall. However, cost advantage is not strongly correlated with autonomy. These findings are significant because they shed new light on how competitive advantages are formed through the entrepreneurial orientation of entrepreneurs in the Ha’il region. This is a significant theoretical contribution to the literature on entrepreneurial orientation, specifically in the context of SMEs. The findings may also be valuable in supporting SMEs in being successful by enhancing their competitiveness, as SMEs are key contributors to the development and growth of the economy. (shrink)

Most contemporary bioethicists believe that Western bioethical principles, such as the principle of autonomy, are universally binding wherever bioethics is found. According to these bioethicists, these principles may be subject to culturally‐conditioned further interpretations for their application in different nations or regions, but an ‘abstract content’ of each principle remains unchanged, which provides ‘an objective basis for moral judgment and international law’. This essay intends to demonstrate that this is not the case. Taking the principle of autonomy as (...) an example, this essay argues that there is no such shared ‘abstract content’ between the Western bioethical principle of autonomy and the East Asian bioethical principle of autonomy. Other things being equal, the Western principle of autonomy demands self‐determination, assumes a subjective conception of the good and promotes the value of individual independence, whilst the East Asian principle of autonomy requires family‐determination, presupposes an objective conception of the good and upholds the value of harmonious dependence. They differ from each other in the most general sense and basic moral requirement. (shrink)

Diversos estudios internacionales indican que los pescadores sufren diferentes problemas de salud, entre los cuales son frecuentes las enfermedades cardiovasculares, accidentes laborales, heridas, ahogamientos, estrés laboral y problemas de salud mental. Objetivo: Con el estudio se pretendió identificar el nivel de bienestar sicológico y sedentarismo de pescadores artesanales de la Región de Los Lagos, Chile. Método: Se realizó un estudio cuantitativo que consistió en la aplicación de la escala de bienestar sicológico de Ryff y la versión breve del cuestionario de (...) actividad física IPAQ a 41 pescadores artesanales con una media de edad de 53,22 años. Resultados: Los resultados indican que un 68,3 % de pescadores son sedentarios, mientras que en las dimensiones del bienestar sicológico un 22 % muestra un alto nivel de crecimiento personal, seguido de un 14,7 % que presenta un alto nivel de dominio del entorno. No obstante, un alto porcentaje de los pescadores, 34,1 %, se encuentra en un nivel bajo de crecimiento personal, seguido de un 31,7 % con bajo nivel de autonomía y un 26,8 % con bajo nivel de relaciones positivas. Conclusiones: Los datos indican la necesidad de generar acciones preventivas de promoción y tratamiento oportuno de las patologías de salud mental para evitar que se conviertan en causas directas o indirectas de fallecimiento de los trabajadores. Diverse international studies show that artisanal fishermen suffer from different health issues, among which cardiovascular diseases, occupational accidents, injuries, drowning, work-related stress and mental health problems are the most frequent. Objective: the aim of the study was to identify the psychological well-being and sedentary lifestyle levels in artisanal fishermen from Los Lagos Region, Chile. Method: this was quantitative study consisting in applying Ryff's Psychological Well-being Scale and the short form of the International Physical Activity Questionnaire to 41 artisanal fishermen, whose mean age was 53.22 years. Results: the results reveal that 68.3 % of the fishermen have a sedentary lifestyle, while in the psychological well-being dimensions 22 % of them show a high level of personal development, followed by 14.7 % who have a high level of the control of the environment. Nevertheless, there is a considerable percentage of fishermen, 34.1 %, who have a low level od personal development, followed by 31.7 % with a low level of autonomy and 26.8 % with a low level of positive relationships. Conclusions: the data reveals a need to generate preventive healthcare measures and its promotion, and ensure an opportune treatment of mental pathologies in order to avoid that those become a direct or indirect cause for the demise of workers. (shrink)

Some farmers in the Central Finger Lakes Region of New York balance their production between principles of peasant farming and capitalist farming. They struggle to extend their sphere of autonomy and subsistence production, while extended commodity production is often a response to external forces of the state and capital. This struggle, together with a quantitative increase of small farms, can be described as an instance of repeasantization. Based on inductive, empirical qualitative social research, this case study describes the economy (...) and social organization of six farms in the area under investigation and explores the applicability of the rich theory of peasant farming to agriculture in this community. Besides selling commodities to pay for many farming inputs and consumer goods, the farms produce for their subsistence and that of their community. They exchange products and services with other farms, they build networks of mutual provisioning, support, and mentorship, and try to take good care of the land. This paper shows that subsistence production and peasant culture are not restricted to the past or the Global South, but also exist as pockets of peasantness on six New York farms. The perspective applied in this paper suggests that principles of peasant farming may shape farming on other US farms, too, if we accept that these principles intersect with constrains of the larger capitalist market society in which they are embedded. (shrink)

This research examines the comparison between Qanuns and Regional Regulations (Perda) in the context of Aceh, with a focus on the uniqueness possessed by Aceh as an autonomous region. Qanuns, as the term for provincial regulations in Aceh, are formed through a collaborative process between the Governor and the Aceh Regional Representative Council (DPRA) within the framework of the Regional Legislation Program (Prolega). Aceh is recognized as having a special status based on Law Number 11 of 2006 (...) concerning the Governance of Aceh (UUPA), which grants the right and authority to independently manage government affairs, as a result of the Helsinki MoU. This research also identifies an exception to the obligation to include an Academic Manuscript in the formation of Qanuns, which is a mandate from a higher regulation, to avoid conflicts. However, challenges in the implementation of Qanuns arise due to constraints in the guidance and supervision by the government, which creates injustice for Aceh. The research methodology combines empirical and normative approaches, involving interviews and field observations to analyze the differences and specifications between Qanuns and Perdas, as well as their implications for regional governance. The research found that Qanuns in Aceh have a different formation process compared to Regional Regulations (Perdas) in other provinces, with the specifics regulated in the Law on the Governance of Aceh (UUPA). There is an exception to the obligation of an Academic Manuscript for Qanuns, which is a direct mandate from a higher regulation. Despite being granted special autonomy, challenges in the implementation of Qanuns arise due to constraints in the guidance and supervision by the central government. (shrink)

Background. Decisions to test, enrol and disclose HIV status are among the ethical challenges that may influence adherence to antiretroviral therapy (ART) and HIV care and treatment in adolescents living with HIV. In the Tanzanian setting, how parental perceptions of ethical issues affect adolescents’ adherence to HIV care and treatment is not well known.Objective. To explore parental perceptions of ethical issues in adolescent HIV care and treatment. Methods. The study employed a descriptive qualitative exploratory design and was conducted at Temeke (...) Regional Referral Hospital in Dar es Salaam Care and Treatment Centre (CTC) in the Outpatient Department (OPD). The study population were parents and non-parent caregivers of HIV-infected adolescents 10 - 19 years of age. A total of 16 persons participated in semi-structured interviews after their consent was obtained. All interviews were audiotaped, transcribed verbatim in Swahili and back-translated into English. An inductive content analysis was used, and standards of qualitative rigour applied. Results. Three qualitative themes emerged: balancing adolescents’ autonomy with parents’ desire to protect their children; parental dilemmas regarding disclosure of adolescents’ HIV status; and parental reasons for delayed disclosure.Conclusion. Participants perceived that parental authority should override adolescents’ autonomy in HIV care and treatment. Disclosure of HIV status to adolescents is a challenge to parents. Delays in disclosure often occur because parents feel guilty and because they have fears of rejection by their adolescent children. (shrink)

Television pictures of starvation and depredation are not the only way that famine and political instability in the horn of Africa have affected the United States. Many people from that region of the world are seeking political or economic refuge here, and they are exposing us to a culture that is in some ways — most notably, in the practice of female circumcision – so radically different from the prevailing American cultures that we have been stunned. They are also forcing (...) hospital ethics committees to face issues that cannot be resolved by the facile application of the settled principles that have guided those institutions for the past several years. Autonomy and multiculturalism, long the foundations of most ethics committee decision making, have started to give way to a list of formally articulated rights and wrongs – perhaps to a restatement and adoption of rules said to be based in natural law. Female circumcision, argues one newspaper letter writer, “is just a sickening display of male power disguised as legitimate dogma. (shrink)

This study examined two key dimensions of women’s status in Southern Nations, Nationalities and Peoples Region of Ethiopia based on regional data collected from five randomly selected zones and one city administration; namely, Sidama, Hadya, Gamo Gofa, South Omo, Bench Maji and Hawassa City Administration. The analysis revealed that while joint decision is fairly high, women’s independent decision making on key household domains is generally low. Significant proportions of women in the region are exposed to violence by their partners (...) ranging from insult to heavy physical injury. The fact that nearly half of the women experienced insult and close to a quarter of them faced beating is indicative of the low status of women in society. The regression analysis indicated that seven variables determine the occurrence of violent acts against women in the study area, namely household size, education, access to radio, value of children index, wealth index and level of women autonomy. On the other hand, decision making autonomy is affected by wealth status, household size, access to radio and sex preference index. Finally, the study highlighted the importance of addressing the limited technical and operational capacities to implement gender policy and legal frameworks effectively and efficiently. (shrink)

The political agreements concluded in the summer of 1981 between the main majority and opposition parties constitute a turning point in the development of Spanish regionalism. Whereas previously autonomy statutes were awarded to historic regions with strong social and cultural identities, we have now a situation where a considerable degree of self-government is also made possible for all other regions. This decision shifted the focus more to socio-economic development, thereby stimulating expectations of improvement based on regional political efforts (...) as well as on national solidarity and state assistance. The recently adopted statute of Andalucia illustrates excellently this new orientation. In this contribution an analysis is made of the institutional instruments available for regional self-government. The conclusions are quite positive with regard to the devolution of powers provided in the constitution and the different statutes. Nevertheless Spain is not evolving into a federal state system. As a more appropriate description we prefer Perez Moreno's characterisation of the existing intergovernmental relations as «autonomias integradas». (shrink)

The encroachment of globalization and demands for greater regional autonomy have had a profound effect on the way we picture Ireland. This challenging new look at the key of sovereignty asks us how we should think about the identity of a postnationalist' Ireland. Richard Kearney goes to the heart of the conflict over demand for communal identity - traditionally expressed by nationalism, and the demand for a universal model of citizenship - traditionally expressed by republicanism. In so doing, (...) he asks us to question whether the sacrosanct concept of absolute national sovereignty is becoming a luxury ill afforded in the emerging new Europe. Kearney then takes us beyond the political with chapters on the influence of philosophers such as George Berkeley, John Toland and John Tyndall and looks at some of the myths in Irish poetry and nationhood. Postnationalist Ireland provides a recasting of contemporary Irish politics, culture, literature and philosophy and will appeal to students of these subjects and Irish studies in general. (shrink)

In recent years theorists, such as Yael Tamir and David Miller, have proposed a liberal form of nationalism thereby combining two seemingly incompatible traditions of thought. Perhaps the most controversial element of their theories is the claim that national communities should be accorded with a right to political self-determination. In the article it is explained, firstly, why membership in a nation is seen as important for the individual’s well-being and, secondly, why statehood is deemed necessary for the thriving of the (...) nation. Subsequently, two problems of the liberal nationalists’ argument for political self-determination are discussed. It is argued, firstly, that national communities only need some form of regional autonomy to achieve their most important goals and, secondly, that non-national communities, e.g. religious groups, can base their demand for political sovereignity on the very same argument. (shrink)

Taking off from reflections on the relevance of traditional political ideas for a democratic order in contemporary Africa, some traits, chances, and problems of Kwasi Wiredu's model of a non-party consensual democracy are analyzed. The goal of this article is to show that a currently viable adaption and transformation of the African democratic heritage could help to consolidate Africa's multicultural societies. A central task in this process lies in the reconciliation of democracy and justice via the establishment of a consensus-oriented (...) dialogue for decision-making, a constitutional legitimation of the rule of ethnic groups, and a decentralisation of political power, so that local and regional autonomy becomes possible. (shrink)

The 1970-1971 revision of the Belgian constitution recognized the existence of three cultural communities and three geographic regions.The implementation of the constitutional provisions regarding cultural and regional autonomy led to the creation of several new subnational institutions of which the most important are the cultural and the regional Councils. Each cultural Council groups the senators and the representatives of similar linguistic group, while the regional Councils are composed of these same parliamentarians in accordance with their geographic (...) residence. These Councils may thus be seen as sub-groupings of the national Parliament.Although both are essentially advisory bodies, the cultural Councils do legislate decrees which, when enforced by the respective Ministers of Culture, have the force of law. On the other hand, the regional Councils are purely consultative assemblies, providing opinions and requesting clarifications and justifications of national decisions in the functional areas, specified by the Constitution. A ministerial committee of each region considers the Council's recommendations in enforcing national policies in the regions.The complexity of national-community-regional relations and the political discussions between the supporters of regionalization and those favoring culturalization shows the temporary nature of the present institutionalization. (shrink)

Preservation permitting patterns of developmental evolution can be reconstructed within long extinct clades, and the rich fossil record of trilobite ontogeny and phylogeny provides an unparalleled opportunity for doing so. Furthermore, knowledge of Hox gene expression patterns among living arthropods permit inferences about possible Hox gene deployment in trilobites. The trilobite anteroposterior body plan is consistent with recent suggestions that basal euarthropods had a relatively low degree of tagmosis among cephalic limbs, possibly related to overlapping expression domains of cephalic Hox (...) genes. Trilobite trunk segments appeared sequentially at a subterminal generative zone, and were exchanged between regions of fused and freely articulating segments during growth. Homonomous trunk segment shape and gradual size transition were apparently phylogenetically basal conditions and suggest a single trunk tagma. Several derived clades independently evolved functionally distinct tagmata within the trunk, apparently exchanging flexible segment numbers for greater regionally autonomy. The trilobite trunk chronicles how different aspects of arthropod segmentation coevolved as the degree of tagmosis increased. BioEssays 25:386–395, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 63.1 (2002) 129-149 [Access article in PDF] Lord Acton and "the Insanity of Nationality" Timothy Lang "I hope I need not warn you against Montalembert's declamation about Poland—He has no idea of the insanity of nationality...." Acton to Richard Simpson, 25 September 1861 The sixty-year period that culminated in the First World War witnessed a momentous transformation in the European state system. Italian (...) and German unification, the expulsion of the Ottomans from southeastern Europe, the destruction of the three remaining empires—the Austrian, German, and Russian—as casualties of the war, their replacement by a band of successor states stretching from the Baltic to the Balkans: these developments completely altered the face of Europe, as dynastic states gave way to nation-states. Looking back on this transformation once the war was over, many Europeans believed the decision to rebuild their continent on the basis of nation-states made perfect sense. To establish the principles of self-determination and democracy would contribute to peace and prosperity by solving the nationalities problem that had caused such mischief in the past. But in the 1860s, as this transformation was just beginning, the question looked very different, especially to the young John Dalberg Acton—the future Lord Acton, famous for the Cambridge Modern History—as he contemplated without benefit of hindsight the rise of the modern nation-state. 1 [End Page 129]Acton's views on the nation-state appeared in an article on "Nationality," which he wrote in 1862 for the Home and Foreign Review. 2 Nationality—today we would call it nationalism—was, Acton pointed out to his colleague Richard Simpson, a "new question in political philosophy" 3 ; and Acton's essay was a remarkably precocious treatment of the subject. In this tour de force he placed nationalism in its historical context, enabling readers to understand its significance for their own time and to see in nationalism the most potent force unleashed by the French Revolution. For Acton the Revolution had given a new direction to social protest. Whereas in the past, people had resisted oppression by calling for a return to traditional ways, now, after 1789, they demanded a new social and political order. The Revolution thus spawned protest movements of a wholly unprecedented kind. These movements were "spontaneous and aggressive," he warned. They were "popular, unreasoning, and almost irresistible." They appealed to the masses, encouraging them to be "arbitrary as well as insubordinate" and to disregard tradition, prescription, and established rights. Nationalism, with Mazzini as its representative figure, was the most formidable of these new mass movements; for it subverted the existing order by attacking the territorial arrangement and sovereignty of legitimate states, and it provided the impetus behind contemporary revolution. 4 In contrast to later generations, who may have regarded nation-states as likely to promote peace and prosperity, Acton believed that to create these states by imposing the principle of nationality would damage irreparably the Europe he knew and valued.Acton clearly appreciated the power of nationalism—and for this he deserves credit—but too much can, and has, been made of his foresight. He was disturbed by nationalism not because he was clairvoyant, not because he saw in nationalism the twentieth century's totalitarian nightmare, but rather because he was preoccupied with very nineteenth-century concerns. 5 When in 1859 Cavour and Louis Napoleon contrived their war against Austria, hoping to drive the [End Page 130] Habsburgs from Italy and capture the provinces of Lombardy and Venetia for Piedmont, they exacerbated the nationalities problem in much of southern Europe. In Italy this problem was solved by the creation of a unified nation-state. The war against Austria was the first step in the process of unification that culminated in 1861 with the founding of the Kingdom of Italy. As a result of unification, inhabitants of the Italian peninsula found themselves subject to a highly centralized state, with an administration modeled on the Napoleonic system that was adverse to regional autonomy. The Italian war also aggravated the nationalities problem in... (shrink)

Philosophy & Social Criticism, Volume 48, Issue 8, Page 1174-1196, October 2022. Most politically minded Kurds agree that their people need liberty. Moreover, they agree they need liberation from the domination they suffer from the four states that divide them: Turkey, Syria, Iraq, and Iran. What is less certain is the precise nature of this liberty. A key debate that characterizes Kurdish political discourse is over whether the liberty they seek requires the existence of an independent Kurdish nation-state. Abdullah Öcalan, (...) the jailed intellectual leader of the Kurdistan Workers’ Party, has argued that Kurdish liberty can only be achieved through liberation from the nation-state model itself. Instead of founding an independent Kurdistan, Öcalan proposes regional autonomy for the Kurds through a strictly egalitarian and directly democratic confederalism reminiscent of Murray Bookchin’s anarchist-inspired libertarian municipalism. We argue, in response to Öcalan’s approach, that employing an anarchist rejection of the state is largely mistaken. We diagnose certain historical and conceptual problems with the anarchist understanding of the state and develop the admission made in passing by certain anarchists, including Öcalan, that anarchist liberty could only be achieved after a long period of statist existence. Mostly counter to the anarchist model of non-domination, we propose a republican model of liberty and liberation, also as non-domination, that necessitates the formation of an independent state, at least in this historical period, for Kurds and hence any dominated people to count as truly free. We conclude by attempting to combine certain elements of the anarchist and republican conceptions and offer a synthetic communitarian view that could serve as a better foundation for Kurdish aspirations for liberty. (shrink)

Lectures on a spiritual, civil society in Indonesia based on Islamic ethics in the framework of regional autonomy.

The article takes up J. P. Arnason's basic theoretical assumption that the western trajectory to modernity marks only one possibility of the modern constellation and that modernity has to be pluralized. Arnason's differentiation between a civilizational paradigm and a civilizational horizon allows us to acknowledge the ambivalent perceptions of modernity prevalent in the colonial and postcolonial encounter and gives space for counter-paradigms of modernity. Through a brief discussion of Indian reflections on modernity (P. Chatterjee, J. Alam) I want to argue (...) that the aspect of agency, marginalized in the philosophical and sociological debate on multiple modernities, has to be integrated into the theory. Examples from the Indian Himalayas should show how in everyday life as well as in the course of a social movement for regional autonomy `preferred futures' are negotiated on the basis of a reflexive balancing of `traditional' and `modern' elements which are articulated and joined in a self-made present. The article ends with a plaidoyer for an anthropology of modernity. (shrink)

Sandžak has the largest Muslim Slav (Bosniak) community in the Balkans outside Bosnia–Herzegovina. In 1990, Sandžak Bosniaks organized a branch of the Party of Democratic Action (Alija Izetbegović’s party) and began to agitate for regional autonomy. During the 1990s under Slobodan Milošević’s regime, local Bosniaks became the victims of state terror that saw widespread official discrimination and the ethnic cleansing of entire villages. In spite of having a high birth rate, the Bosniak population of Sandžak declined by 7.88% (...) in the years 1991–2002 entirely because of the Milošević regime’s policies. Since the overthrow of Milošević, however, the Belgrade government has begun investing in the region’s infrastructure and economy. As a result, the situation for Bosniaks of Sandžak has improved since 2001. (shrink)

Background Interest in strengthening residents’ autonomy in nursing homes is intensifying and professional caregivers’ experience ethical dilemmas when the principles of beneficence and autonomy conflict. This increased focus requires expanded knowledge of how residents experience decision-making in nursing homes and how being subject to paternalism affects residents’ dignity. Research question/aim This study explored how residents experience paternalism in nursing homes. Research design This study involved a qualitative interpretive design with participant observations and semi-structured interviews. The interpretations were informed (...) by Gadamer’s hermeneutics. Participants and research context Eleven residents were interviewed after a period of participant observation in two nursing homes. Ethical considerations The study was performed in accordance with the Helsinki declaration. The Regional Ethics Committee (REK) permitted the researcher to perform participant observation in the nursing homes. The use of audio recordings of interviews was registered and supervised by Sikt - Norwegian Agency for Shared Services in Education and Research. The resident’s consent was assessed continuously. Three interviews were terminated for ethical reasons. Findings The resident interviews revealed that residents found it obvious for caregivers to possess the decision-making authority in nursing homes. When residents explained their views, three main themes emerged: (1) To be included even though caregivers make the decisions, (2) Surrender to dependency, and (3) Adherence to nursing home norms. Conclusions Residents submit to their caregivers and give caregivers the responsibility and function as leaders. Paternalism was experienced as dignifying in situations where it contributed to residents being able to live according to second order desires and values, and when it implied respect and appraisal of residents’ capabilities. Paternalism was experienced as debasing when residents felt left out, and when residents felt that their capabilities were underestimated. This also included their capability to withstand paternalistic influence. (shrink)

Latin American religious political thought includes colonial Spanish and Portuguese ideologies that preceded independence but have survived into the post-independence era, authoritarian ideologies supportive of military governments in the twentieth century, and progressive liberation theologies. In this article, I present a distinct tradition: a version of classical liberal thought. This tradition is skeptical of big government, opposed to caste systems, supportive of a high degree of federalism, uneasy with militarism, and supportive of democratic institutions while affirming religious social norms. This (...) ideology was developed in northeastern Brazil in the early nineteenth century by a Carmelite activist named Frei Caneca (Brother Mug), who published a newspaper titled the Typhis Pernambucano (Tiphys of the State of Pernambuco). (shrink)

This paper reflects on the presumption that there are distinct ethical differences between the supposedly ‘Anglo-Saxon liberal’ and ‘Latin (Southern European) paternalist’ ethical traditions. The predominance of the bioethical paradigm (principalism) is measured by a comparative analysis of regional moral opinion reflected in nation-state health laws. By looking at the way the ethico-legal concept figures into various national ordinances, we attempt to ascertain the extent and nature of variation (if any) between localities by exploring the understanding and application of (...) principalism’s keystone: patient autonomy. (shrink)

This paper reflects on the presumption that there are distinct ethical differences between the supposedly ‘Anglo-Saxon liberal’ and ‘Latin (Southern European) paternalist’ ethical traditions. The predominance of the bioethical paradigm (principalism) is measured by a comparative analysis of regional moral opinion reflected in nation-state health laws. By looking at the way the ethico-legal concept figures into various national ordinances, we attempt to ascertain the extent and nature of variation (if any) between localities by exploring the understanding and application of (...) principalism’s keystone: patient autonomy. (shrink)

This paper delves into the significance and challenges of Artificial Intelligence (AI) ethics and justice in terms of Common Good and Well-being, fairness and non-discrimination, rational public deliberation, and autonomy and control. Initially, the paper establishes the groundwork for subsequent discussions using the Academia Sinica LLM incident and the AI Technology R&D Guidelines of the National Science and Technology Council(NSTC) as a starting point. In terms of justice and ethics in AI, this research investigates whether AI can fulfill human (...) common interests and welfare. Taking AI injustice as an example, I analyze the practical assessment of AI regarding regional, industrial, and social impacts. Further, this paper discusses the challenges of fairness and non-discrimination in AI, specifically addressing the issue of training on biased data, discussing the acquisition of bias by AI and post-processing supervision issues, and emphasizing the importance of rational public deliberation in this process. Then, this research examines the challenges and countermeasures the rational public faces in public deliberation, such as the importance of education in STEM scientific literacy and technological capabilities. Finally, in discussing AI and autonomy, I propose a 'Human-Centered Approach’ rather than relying solely on the 'Technological Utility Maximization' brought by AI to achieve substantial AI justice. -/- Keywords: AI Ethics and Justice, Fairness and Non-Discrimination, Biased Data Training, Public Deliberation, Autonomy, Human-Centered Approach . (shrink)

Castoriadis’s encounter with autopoiesis was a decisive factor for his philosophical trajectory. Its influence can be seen on four interconnected levels of his thought: his reconsideration of Greek sources for his later interpretation of trans-regional being as self-creating; his rethinking of objective knowledge; his ventures into philosophical cosmology; and his re-evaluation of the living being, especially in light of his dialogue with Varela. In brief, Castoriadis’s engagement with autopoiesis was significant for his shift towards an ontology of radical physis. (...) His shift to radical physis does not point so much to a rejection of the project of autonomy, however, as, paradoxically, its simultaneous radicalization and relativization. (shrink)

The article analyzes the intergovernmental relations in the world and their impact on the socio-economic development of regions. Determined that the public policy of the EU aims to increase the competitiveness of each region and the level of socio-economic development of the poorest regions. For the purpose of socio-economic development to the executive branch of local government powers entrusted to implement the budget. The main feature of these activities is the accumulation of revenue to cover the costs budgeted. Established that (...) the growth and structure of income and expenditures of local budgets in different countries vary, reflecting the degree of financial autonomy of local governments and regions dependent on funds from the state budget. (shrink)

Since the regional level has become important in European politics, it is necessary to examine the specifity of the regions. This contribution is a first attempt to develop a model to measure 'regional specifity' for the ten criteria which are most often used to define regions in academic literature. A first application of the model makes clear the characteristics of those regions and gives an understanding of the process of regionbuilding as well. Most regions with a certain degree (...) of political autonomy do have a specificity on more criteria than those regions without any autonomy. These empirical data give a scientific basis to the thesis that regional specificity is constructed by regional authorities. (shrink)

Background Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge. Aim To understand nurses’ justifications for restraint use in neurosurgical care. Research design A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis. Participants and research context Semi-structured interviews with 15 nurses working in three neurosurgical (...) departments in Sweden. Ethical considerations Approved by The Regional Ethics Committee, Stockholm, Sweden. Findings The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses’ weighed the pros and cons of different alternatives. Discussion Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse. Conclusion How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect. (shrink)

There is a kernel of truth in the claim that Western, and especially Anglo-American-Australasian, normative philosophy, including that relating to the philosophy of education, is individualistic; it tends to prize properties that are internal to a human being such as her autonomy, rationality, pleasure, desires, self-esteem, self-realization and virtues relating to, say, her intellect. One notable exception is the idea that students ought to be educated in order to be citizens, participants in a democratic and cosmopolitan order, but, compared (...) to non-Western traditions, this social element is thin. What is striking about other philosophical backgrounds in the East and the South, such as sub-Saharan reflection on the proper ends of education, is that they are typically much more communitarian, and are so in ways that differ from dominant forms of communitarianism in the West. I argue that since geographical terms such as ‘Western’, ‘African’ and the like are best construed as picking out properties that are particularly salient in a region, it is fair to conclude that individualism is Western and not African, or, more carefully, that it is much more Western than it is African, and that converse remarks go for communitarianism. What this means is that, if I am correct about a glaring contrast between philosophies of education typical in the West and in sub-Saharan Africa, and if there are, upon reflection, attractive facets of communitarianism, then countries such as the UK, the US and Australia in some real sense must become less Western in order to take them on. (shrink)

Purpose – The purpose of this paper is to explore artificial moral agency by reflecting upon the possibility of a Moral Turing Test and whether its lack of focus on interiority, i.e. its behaviouristic foundation, counts as an obstacle to establishing such a test to judge the performance of an Artificial Moral Agent. Subsequently, to investigate whether an MTT could serve as a useful framework for the understanding, designing and engineering of AMAs, we set out to address fundamental challenges within (...) the field of robot ethics regarding the formal representation of moral theories and standards. Here, typically three design approaches to AMAs are available: top-down theory-driven models and bottom-up approaches which set out to model moral behaviour by means of models for adaptive learning, such as neural networks, and finally, hybrid models, which involve components from both top-down and bottom-up approaches to the modelling of moral agency. With inspiration from Allen and Wallace as well as Prior, we elaborate on theoretically driven approaches to machine ethics by introducing deontic tense logic. Finally, within this framework, we explore the character of human interaction with a robot which has successfully passed an MTT. Design/methodology/approach – The ideas in this paper reflect preliminary theoretical considerations regarding the possibility of establishing a MTT based on the evaluation of moral behaviour, which focusses on moral reasoning regarding possible actions. The thoughts reflected fall within the field of normative ethics and apply deontic tense logic to discuss the possibilities and limitations of artificial moral agency. Findings – The authors stipulate a formalisation of logic of obligation, time and modality, which may serve as a candidate for implementing a system corresponding to an MTT in a restricted sense. Hence, the authors argue that to establish a present moral obligation, we need to be able to make a description of the actual situation and the relevant general moral rules. Such a description can never be complete, as the combination of exhaustive knowledge about both situations and rules would involve a God eye’s view, enabling one to know all there is to know and take everything relevant into consideration before making a perfect moral decision to act upon. Consequently, due to this frame problem, from an engineering point of view, we can only strive for designing a robot supposed to operate within a restricted domain and within a limited space-time region. Given such a setup, the robot has to be able to perform moral reasoning based on a formal description of the situation and any possible future developments. Although a system of this kind may be useful, it is clearly also limited to a particular context. It seems that it will always be possible to find special cases in which a given system does not pass the MTT. This calls for a new design of moral systems with trust-related components which will make it possible for the system to learn from experience. Originality/value – It is without doubt that in the near future we are going to be faced with advanced social robots with increasing autonomy, and our growing engagement with these robots calls for the exploration of ethical issues and stresses the importance of informing the process of engineering ethical robots. Our contribution can be seen as an early step in this direction. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

Background: Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child’s growing autonomy are known ethical concerns that involve the whole professional team around the child’s care. Objectives: The purpose of this study was to explore healthcare professionals’ experiences of participating in ethics case reflection sessions in childhood cancer care. Research design: Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Participants and (...) research context: Healthcare professionals working at a publicly funded children’s hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. Ethical considerations: The children’s and their parents’ integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Findings: Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants’ articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. Discussion: The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Conclusion: Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child. A consolidated care approach would be valuable for both the child and the healthcare professionals because of the common care goals. (shrink)

Euthanasia and assisted suicide have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: voluntary and well-considered request; unbearable suffering without prospect of improvement; informing the patient; lack of a reasonable alternative; independent second physician’s opinion. ‘Unbearable suffering’ must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy. All EAS cases must be reported and are scrutinised by regional review committees. The purpose of (...) this study was to investigate whether any particular difficulties arise when the EAS due care criteria are applied to patients with an intellectual disability and/or autism spectrum disorder. The 416 case summaries available on the RTE website were searched for intellectual disability and autism spectrum disorder. Direct content analysis was used on these nine cases. Assessment of decisional capacity was mentioned in eight cases, but few details given; in two cases, there had been uncertainty or disagreement about capacity. Two patients had progressive somatic conditions. For most, suffering was due to an inability to cope with changing circumstances or increasing dependency; in several cases, suffering was described in terms of characteristics of living with an autism spectrum disorder, rather than an acquired medical condition. Some physicians struggled to understand the patient’s perspective. Treatment refusal was a common theme, leading physicians to conclude that EAS was the only remaining option. There was a lack of detail on social circumstances and how patients were informed about their prognosis. Autonomy and decisional capacity are highly complex for patients with intellectual disabilities and difficult to assess; capacity tests in these cases did not appear sufficiently stringent. Assessment of suffering is particularly difficult for patients who have experienced life-long disability. The sometimes brief time frames and limited number of physician-patient meetings may not be sufficient to make a decision as serious as EAS. The Dutch EAS due care criteria are not easily applied to people with intellectual disabilities and/or autism spectrum disorder, and do not appear to act as adequate safeguards. (shrink)