We argue that future database systems must provide autonomy for individuals for the privacy of data they manage. We propose a design for such a system, identify challenges and problems, and suggest some approaches to these. We enunciate the reasons for informational self-determination systems, which include legal, organizational and technical issues. Our main goal is to achieve a widely-accepted realistic and practical solution in order to ensure privacy for individuals in our future world, yet without hindering business (...) and security. (shrink)

Research and practice about self-determination in the context of disability has centred on teaching skills and providing support to help people with impairments to be independent. However, limited research exists about the impact of Information and Communication Technologies, in particular social media and mobile devices, on the development of self-determination skills among people with disabilities. This paper presents the findings of a qualitative study which collected data from observations, a researcher diary, focus groups, individual interviews and (...) data from social media. The focus of the study was on young people with vision impairments who were transitioning to university life. The study found that the participants developed self-determination skills by using and adapting collaborative and interactive online tools and mobile devices according to their transition needs. This finding expands the understanding of the implications of new technologies for young people with disabilities’ personal development and the enhancement of self-determination. (shrink)

This article looks at the relevance of the concept of self-determination to psychiatric patients by studying the existence, importance and manifestations of self-determination. The data were collected by interviewing long-term patients (n = 72) in one mental health care organization, which included a psychiatric hospital and an outpatient department. Self-determination was defined in terms of the right to decision-making, the right to information, the right of consent, the right to refuse treatment, and the right (...) to be heard and taken into account. It was found that, with the exception of the right to refuse and consent, these rights are indeed present in the practice of psychiatric nursing and that they are relevant and important to psychiatric patients. The patients typically gave ethical, practical and legal reasons for a psychiatric patient's right to self-determination. The main reasons why psychiatric patients said they lacked the right to self-determination were illness and staff authority. Recommendations for educational, clinical and methodological implications for the future in nursing are discussed. (shrink)

This book proposes an alternative to the consent model which is currently at the heart of patient self-determination and which is shown here to have fundamental flaws that constrain its effectiveness. The proposed model is a property model in which the patient’s bodily integrity is protected from unauthorised invasion, and their legitimate expectation to be provided with the relevant information to make an informed decision is taken to be a proprietary right. This model enables the courts to overcome (...) the requirement to prove causation in consent cases and offers a complementary approach to patient self-determination. (shrink)

By providing an interdisciplinary reading of advance directives regulation in international, European and domestic law, this book offers new insights into the most controversial legal issues surrounding the debate over dignity and autonomy ...

This study conceptualized digital competence in line with self-determined theory and investigated how it alongside help-seeking and learning agency collectively preserved university students’ psychological well-being by assisting them to manage cognitive load and academic burnout, as well as increasing their engagement in online learning during the coronavirus disease 2019 pandemic. Moreover, students’ socioeconomic status and demographic variables were examined. Partial least square modeling and cluster analysis were performed on the survey data collected from 695 students. The findings show that (...) mental load and mental effort were positively related to academic burnout, which was significantly negatively associated with student engagement in online learning. Digital competence did not directly affect academic burnout, but indirectly via its counteracting effect on cognitive load. However, help-seeking and agency were not found to be significantly negatively related to cognitive load. Among the three SDT constructs, digital competence demonstrated the greatest positive influence on student engagement. In addition, female students from humanities and social sciences disciplines and lower-income families seemed to demonstrate the weakest digital competence, lowest learning agency, and least help-seeking behaviors. Consequently, they were more vulnerable to high cognitive load and academic burnout, leading to the lowest learning engagement. This study contributes to the ongoing arguments related to the psychological impact of the COVID-19 pandemic and informs the development of efficient interventions that preserve university students’ psychological well-being in online learning. (shrink)

he article combines Elinor Ostrom’s design principles for common-pool resources and human rights provisions, including subsequent clarifications and jurisprudence. It analyses whether stronger local self-governance, embedded in the natural resource dimension of peoples’ rights to self-determination is a recommendable approach. Two changes in understanding are noted. First, the universal approval of indigenous peoples’ right to self-determination as specified in the UN Declaration on the Rights of Indigenous Peoples. Second, the wide endorsement of the specific principle (...) of free and prior informed consent. As the exercise of peoples’ rights to self-determination is done on a collective level, it is important to have awareness of whether particularly affected and marginalized households and individuals are included or not included in the decision-making process. The article then reviews a range of new instruments adopted by the OECD and the UN for improved human rights awareness and compliance in the context of economic investments. The article finds that these instruments are still underutilized. Finally, the article identifies the role of human rights in bilateral investment treaties. It finds that there are less jurisdictional restrictions – as many treaties have a wide understanding of applicable law – than cognitive restrictions – as human rights competence is rarely sought when establishing tribunals mandated to solve investments disputes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Patient Self-Determination ActElizabeth Leibold McCloskey (bio)What are the ethics of extending the length of life? We know that we cannot artificially end life (Thou Shalt not Kill), but how about artificially extending life? Is that always good, sometimes good?... In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?... What does basic religious ethics say about this?(John C. Danforth, (...) letter to the author, 19 August 1989)The Patient Self-Determination Act, signed into law as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) last November, marks the first time that Congress has passed legislation concerning the ethics of life-sustaining medical treatment. The bill was spearheaded by Senator John C. Danforth (RMO), who has a special interest in this area. An Episcopal priest, Danforth was formerly an assistant chaplain at New York's Memorial Sloan-Kettering Cancer Center and now sits as a senior member of the Senate Finance Committee, which oversees Medicare and Medicaid. Although Senator Danforth's legislative initiative was not a result of the Cruzan case, it was in his state of Missouri that the U.S. Supreme Court case involving removal of Nancy Cruzan's feeding tube arose (Cruzan v. Director of Missouri Department of Health, U.S. Supreme Court, 58 LW 4916, 26 June 1990). From his unique vantage point, he felt it was time to craft a legislative response to some of the difficult issues surrounding prolongation of life.The short answer to Senator Danforth's questions about when to artificially extend life is simple enough: people must be free to determine that for themselves. Common law and common sense dictate such a conclusion; living will and health care proxy statutes, enacted in almost every state, codify that right. The Catholic moral tradition teaches that one is not morally obligated to use extraordinary means to prolong life, a tradition shared both by the mainline Protestant and the reform and conservative Jewish community. Yet most people are unaware of their fundamental legal right to make such decisions, and as court cases from Quinlan (In re Quinlin, 137 N.J. Super. 227, 1975) to Cruzan demonstrate, few know [End Page 163] how to make arrangements for this right to be exercised if they become incapacitated.Meanwhile, health care practices are often driven by a denial of death. When Senator Danforth and Senator Daniel Patrick Moynihan (D-NY) introduced the bill on October 17, 1989, Senator Danforth said:More and more it is arguable that we play God by subjecting people to unwanted and sometimes unnecessary treatment, treatment that unnaturally prolongs the dying process. Our health care system has become obsessed with extending life, at times neglecting the caring component of medicine and trampling on the rights of patients.(Congressional Record 1989, 135:5.13566)The American Hospital Association estimates that 70 percent of deaths now occur after a determination to withhold or withdraw medical treatment. Many of those decisions are made without the benefit of an incapacitated patient's views, yet a Harvard study revealed that 95 percent of the population would like to prepare in advance for such decisions. Only 4 percent of hospitals have a systematic method of asking patients if they have an advance directive. Family members confront painful choices in the face of uncertainty about their loved one's wishes and it can be even more painful when a family knows the patient's desires but providers and the courts act otherwise because clear evidence is lacking.The Patient Self-Determination Act is rooted in the belief that people should be given information that enables them to specify the extent of medical treatment they wish to receive should they become incapacitated. The public should be educated about applicable state laws that protect the individual's right to make such choices through the use of an advance directive.The Act moves toward that goal by promoting knowledge of state laws. It requires every hospital, nursing home, home health agency, hospice, and health maintenance organization that participates in Medicaid or Medicare to routinely give all adult patients information about advance directives. Patients will also be given information on the... (shrink)

The Patient Self-Determination Act is a fact. Finally, respect for patient autonomy has been guaranteed. At first sight, there seems little reason to object to any measure that intends to increase the autonomy of the patient. Too long, one may argue, physicians have behaved paternalistically; too often, they have been advised to change this habit. If the profession of medicine is unwilling or simply unable to grant the patient the decision-making power that is her due, the law has (...) to step in. One may add, this law in no way hinders professional autonomy; by requiring a hospital official to provide the patient with information about advance directive, the law actually reduces the work load of the physician, who is already overburdened. (shrink)

As Part of the Omnibus Budget Reconciliation Act of 1990, the Patient Self Determination Act legislates new responsibilites for healthcare facilities. The authors served as members of the California Consortium on Patient Self-Determination, and the materials produced by this group offer healthcare facilities a valuable guide for implementing the PSDA. The ACt follows a historical trend led by doctrines of informed consent and increasing patient autonomy regarding rights to accept or refuse medical treatment and to execute (...) advance directives. The requirements of the Act will influence healthcare facilities and how they communicate with patients about advance directives. Although the Act seeks to increase awareness of advance directices among all participants in healthcare interactions, it could pose major stumbling blocks to providing sensitive and humane care if certain concerns are nor addressed adequatley. The benefits of the Act could be far reaching and substantial for patients and healthcare facilities alike. (shrink)

The ethical problem of privacy lies at the core of computer ethics and cyber ethics discussions. The extensive use of personal data in digital networks poses a serious threat to the user’s right of privacy not only at the level of a user’s data integrity and security but also at the level of a user’s identity and freedom. In normative ethical theory the need for an informational self-deterministic approach of privacy is stressed with greater emphasis on the control (...) over personal data. However, scant attention has been paid on a virtue ethics approach of information privacy. Plotinus’ discussion of self-determination is related to ethical virtue, human freedom and intellectual autonomy. The Plotinian virtue ethics approach of self-determination is not primarily related to the sphere of moral action, but to the quality of the self prior to moral practice. In this paper, it is argued that the problem of information privacy should be reconsidered in the light of Plotinus’ virtue ethics and his notion of self-determination. (shrink)

In this paper the author focuses on Australian land management and in particular on the environmental management issues that could have been prompted by the High Court recognition in 1996 (in Wik Peoples v. The State of Queensland) that native title to land and pastoral leaseholdings can co‐exist. Drawing on themes of self‐determination and co‐existence, the paper looks at more specific topics such as aboriginal title to land—what has been called land rights or native title in Australia—and some (...) implications of that for land, sea and resource management. Central to this analysis are competing theories of Aboriginal land management and links between Aboriginal traditional knowledge and conservation of species. These are illustrated through the marine mammal, the dugong. The Australian debates lead to the Canadian debates and then to Scandinavia and the role of the Sami people in protection and management of the Arctic region. Issues of indigenous self determination inevitably provide an overall theme to these discussions. As a matter of global concern, the paper asks, but does not decide, whether indigenous peoples may manage fragile eco‐systems more effectively than outsiders. It maintains that what is important in this context is a broader question. This concerns how culturally inclusive land and resource management can emerge from recognition of indigenous land and human rights and how comparative developments can provide crucial cross‐jurisdictional information for future developments and opportunities in the interests of environmental conservation. (shrink)

In this article I examine the political relations between Aboriginal communities and government in the development of Australian Aboriginal health policy. How do government policymakers interpret the concept of Aboriginal self-determination? What does reconciliation mean in the context of Aboriginal health? The article is based on 12 months of ethnographic research in southeast Australia with key stakeholders in the Aboriginal community-controlled health sector as well key stakeholdes in regional, state, and national (Commonwealth) government. The research was a response (...) to the call for anthropologists to engage in ethnographic studies of colonial relations.1 I argue that although Australian health policy today is premised on community-government partnerships, contemporary relationships are still, fundamentally, rooted in and informed by Australia’s colonialist history with all of its attendant institutions, structures, and practices. (shrink)

The article is devoted to the study of the nature of consciousness within the framework of the information concept. The paper proposes a definition of consciousness as an informational environment in which an extended model of reality is realized. The process of realization of this extended model is defined as thinking. The result of thinking is information objects that form a system in the form of information environment. Information objects are reflections of the real world properties, not directly, but (...) by means of translation through a special object – a carrier of consciousness. In the case of human consciousness, such a carrier is a human being (represented in the form of his nervous system). As a result, consciousness can be qualified as a simulacrum of reality, i.e., a model of a model: an information model of the carrier of consciousness, which in turn is a means of physical modeling of the real "big" world. Possible mechanisms mediating thinking are considered. For this purpose, two new concepts are introduced: neural circuit and neurophysical pattern. An approach to the study of self-consciousness based on the localization of the consciousness carrier in the multidimensional space of states of initial real objects, as well as their reflections in the form of information objects is proposed. This localization is ensured by the presence of feedbacks. Summarizing the results of the study, the article states the following connection between consciousness, self-consciousness and subjectness: under certain conditions (when consciousness is localized in the state space of the carrier of consciousness), consciousness acquires the property of self-consciousness, a special case of which (when the initiator of changes determining localization is the carrier of consciousness) is self-consciousness endowed with subjectness. (shrink)

It has been claimed that quantum mechanics, unlike classical mechanics, allows for free will. In this paper I articulate that claim and explain how a complex physical system possessing fractal-like self similarity could exhibitboth self consciousness and self determination. I use complexity theory to show how quantum mechanical indeterminacies at the neural level could “percolate up” to the levels of scale within the brain at which sensory-motor information transformations occur. Finally, I explain how macro level indeterminacy (...) could be coupled with self determination to provide a physical system with the capacity for radically free willing. (shrink)

Federal guidelines require that informed consent be obtained from participants when they are enrolled in a research study. When conducting research with children, the guidelines utilize the term permission to describe parents' agreement to enroll their children in a study. The basic components of consent and permission are well described and identical, with the exception of the person for whom the decision to participate is being made. Beyond permission, when enrolling minor participants in research, affirmative agreement to participate in research (...) or assent must be obtained from the child participants themselves. The concept of children's assent to research, however, is poorly defined, resulting in inconsistency in its pursuit and, consequently, in its utility. The interface between cognitive development, emotional, and social development must be examined as it pertains to this special situation of decision making. For this process to meaningfully protect minors, the assent process must be clarified, decisions regarding parental veto power must be more convincingly justified, and researchers must be better educated and held accountable for the valid execution of this process. Strategies for implementing the assent process more effectively are presented. (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and (...) efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

OBJECTIVES: The subject of patient self-determination in health care has gained broad interest because of the increasing number of incompetent patients. In an attempt to solve the problems related to doctors' decision making in such circumstances, advance directives have been developed. The purpose of this study was to examine relationships between public attitudes towards patient autonomy and advance directives. SUBJECTS AND MAIN OUTCOME MEASURES: A stratified random sample of 600 adults in northern Sweden was surveyed by a questionnaire (...) with a response rate of 78.2%. The subjects were asked about their wish for control of their health care, their concerns about health care, their treatment preferences in a life-threatening situation (both reversible and irreversible), and their attitudes towards the application of advance directives. RESULTS: Numerous relationships between various aspects of self-determination in health care (desire for control, fears of over-treatment, and choice of treatment level) in general and advance directives, in particular, were found. Those who wanted to have a say in their health care (about 94%) also mainly supported the use of an advance directive. CONCLUSIONS: The fact that almost 30% of the respondents were undecided concerning their personal use of advance directives points to a lack of knowledge and to the necessity of education of the public on these issues. (shrink)

The concept of informed consent for medical treatment has been well established as a necessary element in ensuring compliance with patients' right to self determination and respect of individual au...

The Patient Self-Determination Act imposes new requirements on health care providers for informing patients of their rights to make decisions concerning their medical care. The Act is intended to, and is likely to, encourage patients and residents of certain healhtcare facilities to consider their treatment preferences in advance of incapacity and, in particular, to determine the circumstances in which life-sustaining treatment will be provided to them. However, many questions concerning how healthcare providers will implement the Act remain unanswered.

With the service-dominant logic gradually replacing the traditional commodity-dominant reason, co-creating value with consumers has become an essential marketing practice for enterprises. As a critical information carrier in enterprise marketing communication, the co-creation signal impacts co-creation observers. Enterprises are now exploring how to effectively release co-creation signals to attract most observers to participate in value creation activities actively. Based on self-determination theory, this study investigates the influence mechanism of co-creation signals on observers’ willingness to co-create and the moderating (...) role of mental simulation through the experimental method. The conclusions are as follows: The co-creation signal has a significant positive effect on the co-creation intention of observers. Self-designed co-creation signals generate more important co-creation willingness than self-produced co-creation signals; Self-determination and its dimensions mediate the relationship between co-creation signals and the observer’s co-creation willingness; and Mental simulation moderates the relationship between co-creation signal and self-determination. This study has important theoretical significance in enriching co-creation signals and mental simulation research. It also provides management implications for enterprises to release co-creation signals and optimize co-creation marketing practices effectively. (shrink)

BackgroundIn the Netherlands, Foundation De Einder offers counselling to people who wish to be able to self-determine the timing and manner of their end of life.AimThis study explores the experiences with counselling that counselees receive from counsellors facilitated by Foundation De Einder.MethodsOpen coding and inductive analysis of in-depth interviews with 17 counselees.ResultsCounselling ranged from solely receiving information about lethal medication to combining this with psychological counselling about matters of life and death, and the effects for close ones. Counselees appreciated (...) the availability of the counsellor, their careful and open attitude, feeling respected and being reminded about their own responsibility. Some counselees felt dependent on the counsellor, or questioned their competency. Most counselees collected lethal medication. This gave them peace of mind and increased their quality of life, but also led to new concerns. Few were inclined to use their self-collected medication. Counselling contributed to thinking about if, when and how counselees would like to end their life.ConclusionHaving obtained means to end their lives can offer people feelings of reassurance, which can increase their quality of life, but can also give rise to new concerns. Next to providing information on lethal medication, counsellors can play an important role by having an open non-judgemental attitude, providing trustworthy information and being available. These positively valued aspects of counselling are also relevant for physicians taking care of patients who wish to self-determine the timing and manner of their end of life. (shrink)

As of December 1991, the Patient Self-Determination Act mandated that health care institutions which receive funding from Medicare or Medicaid provide written information about persons rights to participate in medical decision-making and formulate advance directives. The PSDA required each state…acting through a State agency, association, or other private nonprofit entity develop a written description of the law of the State concerning advance directives that would be distributed by providers or organizations under the requirements of [the Act].

As of December 1991, the Patient Self-Determination Act mandated that health care institutions which receive funding from Medicare or Medicaid provide written information about persons rights to participate in medical decision-making and formulate advance directives. The PSDA required each state…acting through a State agency, association, or other private nonprofit entity develop a written description of the law of the State concerning advance directives that would be distributed by providers or organizations under the requirements of [the Act].

The signing of the 2007 UN Declaration of the Rights of Indigenous Peoples by over a hundred states is a realization of the importance of the quest of indigenous peoples to direct their present and future existence, together with the knowledge and heritage they have acquired from their ancestors which they constantly mould to survive and thrive in a contemporary world made up of competing interests that are often at odds with their physical, cultural, and spiritual survival. The paper examines (...) some of the interconnected philosophical and legal issues concerning indigenous knowledge and the indigenes' quest to safeguard their knowledge, with indigenous philosophical views given the necessary focus in analyzing these issues. It also traces how these philosophical views inform and are reflected in international documents, including the 2007 UN Declaration of the Rights of Indigenous Peoples. (shrink)

Background The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are imperative (...) in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes. Method Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection. Findings The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated. Conclusions Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care. (shrink)

The most important distinction in value theory is the subjective-objective distinction which determines the epistemological status of value judgments about medical intervention. Ethical decisions in medical intervention presuppose one of three structures of justification — namely, an inductive approach, a deductive approach which can be either consequentialist or non-consequentialist, and a uniquely ethical approach. Inductivism and deductivism have been discussed extensively in the literature and are only briefly described here. The uniquely ethical approach which presupposes value objectivism is analyzed in (...) detail. This method involves a purely ethical inference which moves from facts to values directly with an emphasis on reason which involves a non-logical justification (as opposed to illogical). It involves the use of natural practical arguments which have an imperative conclusion but no imperative premise and exhibit a value-requiredness between two states of affairs. (shrink)

A study of physicians and medical students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in medicine and their epistemological presuppositions in relationship to the subjective-objective controversy in value theory. The study revealed that most physicians and medical students tend to be objectivists in value theory, i.e., believe that value judgements are knowledge claims capable of being true or false and are expressions of moral requirements and normative imperatives emanating from an external value (...) structure or moral order in the world, but that most physicians and medical students are inconsistent in the philosophical foundations of their medical ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values. The study also revealed that most physicians and medical students think more emphasis should be placed upon medical ethics in medical education. (shrink)

A study of nurses and nursing students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in nursing and their relationship to the subjective-objective controversy in value theory. The study revealed that most nurses and nursing students tend to be subjectivists in value theory, i.e., believe that value judgments are purely personal, private expressions of one's own opinion or inner-feelings and not believe that value judgments are knowledge claims capable of being true or false (...) and therefore not expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most nurses and nursing students are inconsistent in the philosophical foundations of their ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value (...) judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

The authors address problems with “compulsory” arbitration clauses in contracts. Specifically, they note that consumers are misguided about their rights in such cases. In addition, arbitration clauses do not allow the press to cover any proceedings that may result. The arbitration clauses in contracts are written in legalese that consumers do not understand. The authors found that even university students had difficulty understanding the information in such clauses. An example of an actual case is included.

The authors address problems with “compulsory” arbitration clauses in contracts. Specifically, they note that consumers are misguided about their rights in such cases. In addition, arbitration clauses do not allow the press to cover any proceedings that may result. The arbitration clauses in contracts are written in legalese that consumers do not understand. The authors found that even university students had difficulty understanding the information in such clauses. An example of an actual case is included.

This paper deals with the problematic aspect of the reconstruction of binary relations: it includes all the questions raising the possibility or impossibility to determine a structure by gathering given substructures. It is the continuation of three studies: the first made by G. Lopez [9] in 1972 about the determination of a binary relation through the types of isomorphism of its restrictions, the second made by K. B. Reid and C. Thomassen [15] in 1976 about the strongly self-complementary (...) tournaments , the third made by C. Thomassen [16] in 1989 about the cycle space of a tournament. In the second section, we use the notion of class of difference to extend a study made in [16] to binary relations. Then, in the third section, we improve the result of this last study in the case of the tournaments. After noticing that the result of [15] inferred itself naturally from the approach developed in [9], we extend, in the fourth section, the study made in [15] to binary relations. (shrink)

People in extraordinary situations are vulnerable. As research participants, they are additionally threatened by abuse or exploitation and the possibility of harm through research. To protect people against these threats, informed consent as an instrument of self-determination has been introduced. Self-determination requires autonomous persons, who voluntarily make decisions based on their values and morals. However, in nursing research, this requirement cannot always be met. Advanced age, chronic illness, co-morbidity and frailty are reasons for dependencies. These in (...) turn lead to limited abilities or opportunities for decision-making and self-determination. Exclusion of vulnerable people from research projects would disadvantage them by not covering their needs, which would violate the ethical principles of justice and beneficence. Commonly, vulnerability is attributed to social groups. The consequence for individuals, attributed as belonging to such a vulnerable group, is that the principles of respect for autonomy, justice and beneficence are subordinated to the principle of non-maleficence, understood as avoiding the risk to cause more harm than good. In addition, group-specific attribution could lead to stigmatizing because labelling a person as deviation from a norm violates integrity. For clinical nursing research, the question arises how the protection of vulnerable people could be granted without compromising ethical principles. The concept of relational ethics provides a possible approach. It defines vulnerability as the relation between a person’s health status and the extent to which this person is dependent on the researcher and the research context. Vulnerability is not attributed solely to a person but to a situation, meaning the person is viewed in context. By combining vulnerability as a context-related and situational concept with existing approaches of informed consent, the different ethical principles can be balanced and preserved at every step of the research process. (shrink)

Owing to a genral dissatisfaction with hedonistic theories of value, a number of recent discussions have sought to identify an agent's selfinterest, individual utility, or personal welfare with what the agent most wants to do, all things considered. Two features of these accounts merit special attention for the argument in this paper. First, on such accounts any desire or aversion which persists in the face of complete information is logically relevant to the determination of an agent's self interest. (...) This includes apparently altruistic desires like a desire for another's happiness as well as more narrow and self-regarding desires like a desire to eat a good meal. Second, when the agent finds himself in a situation where he must choose between incompatible desires, his informed preference determines the act which is most in his self-interest. (shrink)

Rights, autonomy, privacy, and confidentialityare concepts commonly used in discussionsconcerning genetic information. When theseconcepts are thought of as denoting absolutenorms and values which cannot be overriden byother considerations, conflicts among themnaturally occur.In this paper, these and related notions areexamined in terms of the duties and obligationsmedical professionals and their clients canhave regarding genetic knowledge. It issuggested that while the prevailing idea ofautonomy is unhelpful in the analysis of theseduties, and the ensuing rights, an alternativereading of personal self-determination canprovide (...) a firmer basis for ethical guidelinesand policies in this field. (shrink)

In 2004, prenatal risk assessment (PRA) was implemented as a routine offer in Denmark, in order to give all pregnant women an informed choice about whether to undergo prenatal testing. PRA is a non-invasive intervention performed in the first trimester of pregnancy and measures the risk of a fetus having Down's syndrome or other chromosomal disorders. The risk figure provides the basis for action, i.e. the decision about whether or not to undergo invasive fetal testing via the maternal route (amniocentesis (...) or chorionic villus sampling), which, however, involves the risk of inducing a miscarriage. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, this paper investigates how ideals such as autonomy and non-directiveness are practised in processes of decision-making. We view such ideals as forming social practice rather than neutral instruments to reach a certain goal. Focusing on one couple's trajectory through the clinical practices of PRA and the process through which a decision is reached, we call into question the assumption that more choice and more objective information is a source of empowerment and control. We make evident how decisions are made through a complicated process of meaning-making, which emerges through the relationship between professionals, the clinical setting and the social life of the couples. In the face of complex risk knowledge, PRA users are reluctant to make choices and seek to re-install authority in the health professionals. However, when assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the fetus. It is argued that PRA performs a form of government that works not through compulsion or persuasion but through choice. An ethic of a shared responsibility for PRA and its outcome between pregnant women and health professionals would be more in agreement with how decisions are actually made. (shrink)

This descriptive study is an attempt to characterize the field known as clinical ethics, with regard to the function of humanities scholars in the clinical setting, e.g., hospitals and ambulatory care clinics. It is not a strict epidemiological study but a qualitative survey, although it reports some empirical data. Most discussions of medical humanities in the literature are conceptual analyses of particular issues, such as informed consent, abortion, confidentiality, etc. Virtually no empirical studies with data on how many clinical ethicists (...) function in what roles and with what educational backgrounds have been reported. This is the first such study of humanities scholars in clinical ethics and will be followed by companion reports of physicians and hospital chaplains who are, by self-report, involved in clinical ethics. This report is an effort to stimulate and encourage dialogue and is in no way definitive. It is a preliminary study, and other needed studies are already underway. (shrink)

Information-sharing behavior is affected by identity recognition perception. The current study aims to delve into the impact of familiarity and anonymity on information-sharing behavior, and the mediating role of intrinsic motivations on WeChat Moments. We hypothesized a mediator role of intrinsic motivations in the relationship between an individual’s perceptions and information sharing. Based on the self-determination theory, a model was created and tested using a sample of 531 frequent users. In this study, these users were asked to use (...) WeChat Moments, the most popular mobile private social networking site in China. The results demonstrate the significance of familiarity and identifiability in an interpersonal relationship, when using social networking sites. Moreover, the influence of perceived anonymity on information-sharing behavior, which is entirely mediated by intrinsic motivation has been validated from an empirical perspective. Our findings extend previous studies by showing the totally mediated effect of perceived anonymity on information-sharing behavior on WeChat Moments and the influential mechanism of intrinsic motivation. The results will inform researchers about the importance of incorporating the interpersonal structural features and intrinsic motivation of social networking sites into future studies on online information-sharing behavior. Important ways to promote attention and share information involve building a familiar relationship with communities and equipping oneself with off-line relations. Final indications for future developments are provided, with a special emphasis on the development of these findings in various social networking sites contexts. (shrink)

In 2004 prenatal risk assessment was implemented as a routine offer to all pregnant women in Denmark. It was argued that primarily the new programme would give all pregnant women an informed choice about whether to undergo prenatal testing. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, we call into question the assumption underlying the new guidelines that more choice and more objective information is a source of empowerment (...) and control. We focus on one couple's experience of PRA. This case makes it evident how supposed choices in the context of PRA may not be experienced as such. Rather, they are experienced as complicated processes of meaning-making in the relational space between the clinical setting, professional authority and the social life of the couples. PRA users are reluctant to make choices and abandon health professionals as authoritative experts in the face of complex risk knowledge. When assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the foetus. It is argued that al-though the new programme of prenatal testing in Denmark presents itself in opposition to quasi-eugenic and paternalistic forms of governing couples' decisions it represents another form of government that works through the notion of choice. An ethics of a shared responsibility of PRA and its outcome would be more in agreement with how decisions are actually made. (shrink)

Informational self-determination refers to the right or ability of individuals to exercise personal control over the collection, use and disclosure of their personal data by others. The basis of modern privacy laws and practices around the world, informational privacy has become a challenging concept to protect and promote in a world of ubiquitous and unlimited data sharing and storage among organizations. The paper advocates a “user-centric” approach to managing personal data online. However, user-centricity can be problematic (...) when the user—the data subject—is not directly involved in transactions involving the disclosure, collection, processing, and storage of their personal data. Identity data is increasingly being generated, used and stored entirely in the networked “Cloud”, where it is under control of third parties. The paper explores possible technology solutions to ensure that individuals will be able to exercise informational self-determination in an era of network grid computing, exponential data creation, ubiquitous surveillance and rampant online fraud. The paper describes typical “Web 2.0” use scenarios, suggests some technology building blocks to protect and promote informational privacy online, and concludes with a call to develop a privacy-respective information technology ecosystem for identity management. Specifically, the paper outlines four fundamental technological approaches to help assure widespread and enduring online participation, confidence and trust in the information society. (shrink)

This study investigated gender related moral reasoning in student essays containing arguments on moral issues. Undergraduate students in a medical ethics course viewed two films on morally controversial issues. The students wrote brief essays about the films which were transcribed and numerically coded to conceal the author's gender from the evaluator. Using a coding scheme originated by Lyons, the evaluator classified each essay as a justice/right essay or a care/response essay or an equal response essay. Subsequently, calculations were made to (...) determine the percentage of male authored essays that were justice/rights essays or care/response essays and the percentage of female authored essays that were justice/rights or care/response essays. The males (87.7%) tended to exhibit the justice/rights moral orientation, and the females (69.4%) exhibited the care/response moral orientation. Several different calculations were made to determine various degrees of gender related orientations also. The difference in orientation was highly statistically significant (p≤0.001). These data contribute to understanding moral orientation and development. Interpretations are given to explain some differences between the genders and help explain the traditional roles in society that males and females have played historically. (shrink)

Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients’ well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA’s cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, (...) public, west-coast clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice. (shrink)

A characteristic form of philosophical inquiry seeks to answer ‘what is x?’ questions. In this paper, we ask how philosophers do and should adjudicate debates about the correct answer to such questions. We argue that philosophers do and should rely on a distinctive type of pragmatic and meta-representational reasoning – a form of rationalizing self-interpretation – in answering ‘what is x?’ questions. We start by placing our methodological discussion within a broader theoretical framework. We posit a necessary connection between (...) epistemic methodology and metasemantics. In our view, the correct semantic assignment for a representation must be justifiable from the epistemic perspective of the subject herself, given suitable empirical information and cognitive powers. So the upshot of your own ideal, fully informed epistemic methods will determine the correct answers to ‘what is x?’ questions. The bulk of the paper is devoted to articulating and defending our rationalizing self-interpretation account of philosophical methodology. By working through a specific example, we seek to isolate the relevant inputs into deliberation and the methods for adjudicating between competing answers to a ‘what is x?’ question. We suggest that the self-interpretive methods we isolate generalize across the board as a way of identifying the real nature of familiar topics. We also explain how these methods undercut the case for a priori conceptual analysis. (shrink)

While the movement to ensure patient’s rights to information and informed consent spreads throughout the world, patient rights of this kind have yet to be introduced in mainland China. Nonetheless, China is no different from other parts of the world in that nurses are expected to shoulder the responsibility of safeguarding patients’ best interests and at the same time to uphold their right to information. This paper expounds on the principle of protectiveness grounded in traditional Chinese medical ethics concerning the (...) practice of informed consent. Nurses in China have a moral obligation to treat patients with sincerity. This notion carries a strong sense of parental protectiveness. As far as information-giving is concerned, nurses in China are ambivalent about the notion of truthfulness. The findings of an empirical study undertaken in seven Chinese cities reveal that nurses in China experience similar difficulties related to the disclosure of information as their counterparts in other parts of the world. A nurse’s narrative, the Chan case, is used to illustrate the typical difficult situation that nurses in China often encounter in looking after vulnerable patients who would like to learn more about their therapeutic regimens. The moral tension embedded in nursing practice is analysed. It is found that most nurses would prefer to tell the truth to patients, but their primary ethical justification is not that of respect for patients’ autonomy or safeguarding patients’ right to self-determination. Rather, it is basically beneficent in nature; that is, they base their decision to reveal the truth on whether or not patients will receive more relevant treatment and better nursing care. (shrink)

BackgroundThe legal and ethical guidelines of psychological professional associations stipulate that informed consent by patients is an essential prerequisite for psychotherapy. Despite this awareness of the importance of informed consent, there is little empirical evidence on what psychotherapists’ attitudes towards informed consent are and how informed consent is implemented in psychotherapeutic practice.Methods155 psychotherapists in Switzerland completed an online survey assessing their attitudes regarding informed consent. ResultsAmong the surveyed psychotherapists, there was a high consensus on important information that should be communicated (...) to patients in the context of informed consent. Almost all psychotherapists rated confidentiality and its exemptions (95%) and self-determined decision-making (97%) as important. The importance to disclose information regarding fees and the empirical effectiveness of the provided treatment, were both seen as important by more than 80% of participants. The disclosure of personal information about the therapist was rated as important by 60%. Other aspects, which are not direct components of informed consent but rather overarching goals, were also evaluated rather homogeneously: self-determined decision making of the patient was rated as important by almost all of the surveyed psychotherapists (97%). The following components were also judged as important by a majority of the participants: promotion of hope (80%) and discussion of treatment goals (93%). Most psychotherapists described the implementation of informed consent as an ongoing process, rather than a one-time event during the first session of therapy. Therapists’ age, postgraduate training, treated patient group, and setting influenced attitudes towards informed consent.ConclusionsThe present study shows that informed consent is perceived by psychotherapists as both a challenge and a resource. The implementation of informed consent in psychotherapy requires further research from a clinical and ethical perspective. (shrink)

: This article critically examines the constitution of impairment in prenatal testing and screening practices and various discourses that surround these technologies. While technologies to test and screen prenatally are claimed to enhance women's capacity to be self-determining, make informed reproductive choices, and, in effect, wrest control of their bodies from a patriarchal medical establishment, I contend that this emerging relation between pregnant women and reproductive technologies is a new strategy of a form of power that began to emerge (...) in the late eighteenth century. Indeed, my argument is that the constitution of prenatal impairment, by and through these practices and procedures, is a widening form of modern government that increasingly limits the field of possible conduct in response to pregnancy. Hence, the government of impairment in utero is inextricably intertwined with the government of the maternal body. (shrink)