Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

A gravitational model is proposed that relates the terrestrially measured value of the gravitational constantG directly to the density and angular velocity of the galaxy. The model indicates a constant scalar value forG within most regions of our galaxy, but predicts thatG will be different in other galaxies and zero in intergalactic space. The model offers explanations for galactic cluster stability, discrepancies in terrestrial measurements ofG, and atomic particle stability. The model also provides a causal relationship between strong, electromagnetic, weak, (...) and gravitational interactions. The two postulates required for the proposed model reduce to two assumptions made in GRT in regions whereG is constant; these postulates are consistent with the existence of a 2.7 K blackbody background radiation. (shrink)

The status of the advanced potential solution in electromagnetic theory is analyzed and assessed. It is shown that the advanced potential solution does not violate a causality argument and that its existence in electromagnetic theory is on an exactly equal footing with the retarded potential solution. The general potential solution is thus completely symmetric. It is further shown that there is no “one-sidedness” in nature; oscillating electrons and orbiting electrons are just as good at absorbing energy as they are at (...) radiating it. These conclusions are sufficient to invalidate a number of theoretical models. (shrink)