Autonomy, guardianship and mental disorder: one problem, two solutions

The law in England and Wales governing both the provision of medical care in the case of adults with incapacity and the provision of care and treatment for mental disorder presents serious problems for the principle of patient autonomy. The adult with incapacity has no competence either to consent to or refuse medical treatment but the law provides no statutory structure for substitute decision making on that adult's behalf. On the other hand the law does allow a person with mental disorder to be treated for that disorder despite his or her competent refusal. The nature of these inconsistencies is considered and the implications which flow from the singling out of mental disorder are examined with reference to experience in two Australian jurisdictions. The current proposals for reform of the Mental Health Act are then considered in the light of the conclusions drawn.     

Mass screening in low-income populations: the challenges of securing diagnostic and treatment services in a national cancer screening program

Funding for many mass screening programs for low-income and uninsured populations provides resources for screening tests, yet only rarely does it provide coverage for necessary follow-up diagnostic and treatment services. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a federally funded initiative that provides cancer screening to low-income uninsured and underinsured women, covers some diagnostic follow-up tests and no treatment services. We conducted in-depth case studies of seven state programs participating in the NBCCEDP to investigate the strategies and approaches being used to secure diagnostic and treatment services. The results suggest that the program relies on a patchwork of resources--at state and local levels--to provide diagnostic and treatment services. This includes a number of components of local safety nets, all of which are unstable and have uncertain futures. Public health disease-screening initiatives need to reconsider the feasibility of continued reliance on case-by-case appeals to the local safety net for diagnostic follow-up and treatment services.     

泰国北部各民族中的儒教传统

生活在泰国北部山地的泰族及其他少数民族 ,深受中国汉族的儒家信仰及传统观念的影响 ,特别是在“礼仪”、“尊卑”、“举止”上 ,都严格遵循儒家的规矩。同时 ,也用儒家的伦理道德来处理民族之间的关系。     

Why decentralize decision making? English local actors' viewpoints

Decentralized decision making has created restructuring from larger to smaller administrative units, but in many places, strays little from existing arrangements. Moves toward decentralization from central government to city‐regions, and in some areas, below city‐region scale to neighborhoods, reflect a mandate for reform. What is the nature and extent of desired reforms? Using an institutionalist lens, homogeneity and heterogeneity in local narratives about possible future reform can be surfaced. This article emphasizes the importance of understanding the role of local actors' narratives in shaping decentralized institutions. This article uses the findings from a Q‐methodology study to identify and interrogate distinctive local viewpoints on attempts to decentralize decision making in England. In a systematic empirical analysis, local actors' narratives were largely in favor of relatively minor modifications to the status quo. The findings question a conflation of decentralization with participation in decision making.