The MacArthur Treatment Competence Study. II

This article reports the development and psychometric properties of three standardized and objectively scored measures, the MacArthur Treatment Competence Research Instruments. They were designed to assess abilities related conceptually to four legal standards for competence to consent to treatment: understanding, appreciation, rational manipulation (reasoning), and expressing a choice. Scoring reliability, internal consistency, intertest correlations, and test-retest correlations were examined with data from samples of hospitalized patients with schizophrenia, major depression, and ischemic heart disease, as well as matched non-ill community samples. The results indicate very good interscorer reliability and provide guidance for the use of the instruments and interpretation of their results in future research on patients' decisional abilities in treatment contexts.     

Population: malady or symptom?

The 1994 International Conference on Population and Development (ICPD) opened the dawn of a new era in discourse over population. A newfound consensus was reached between North and South which was not there during the two previous world population conferences in Bucharest and Mexico. While consensus was reached at the 1994 ICPD on the need for action, however, debate over population is far from settled. Causes of population growth, the links between population growth and economic development, and environmental degradation remain controversial topics. The authors analyze the basis of the ICPD consensus at the local, national, and global levels. They also compare the development discourse to the political discourse over population. Both discourses emphasize different aspects of a far more complex reality. The question is which discourse to choose as a basis for drawing policy recommendations. The emerging view on the way to Cairo was that consensus would be achieved on the basis of development discourse. Success on the action plan rests upon the belief that more contraceptives, more health services, and more schools will be enough to reduce fertility rates. The political discourse, however, is better than the development discourse as a basis for policy making because it stresses the need for integration rather than running the risk of exclusion. The political discourse is also more demanding.     

Testing the limits of freedom of contract: the commercialization of reproductive materials and services

This article examines the cases for and against commercializing, or "commodifying," reproductive materials and services. Using a supply/demand third-party framework, three basic scenarios in which commercial-exchange relationships may be possible--exchange of gametes and zygotes, exchange of gestational services, and exchange of fetal material--and the major parties of interest, or stakeholders, are identified. The study sketches the liberal, essentialist, and radical contingency theories that shape the debate over the commercialization of reproductive materials and services. The article then attempts to derive some basic governing principles that reflect as much common ground as possible amongst these various normative perspectives, while recognizing that complete reconciliation is impossible. Taken together, these principles are designed to reflect a strategy of "constrained commodification," where commercialization or commodification, that is, financial remuneration, plays a relatively neutral role in the utilization of reproductive materials and services. In light of these principles, the article concludes by sketching legal and regulatory regimes with respect to the exchange of gametes and zygotes, gestational services, and fetal tissue.