Adolescents and mental disorder: who consents to treatment?

Although English law recognises that developing adolescents may acquire the capacity to make decisions about medical treatment themselves it does not address the problem of mentally disturbed or disordered adolescents. This article examines the nature of adolescent refusal of treatment and suggests that a line be drawn between three categories of adolescent disturbance--the competent young person who refuses treatment that an adult too may refuse, the rebellious teenager whose refusal is triggered by simple teenage angst, and the mentally ill teenager whose refusal is triggered by mental illness. It suggests that adolescent autonomy needs to be more fully understood and the Mental Health Act more readily used in treating young people.     

The right to health in public health: is this a new approach?

The international human rights community has frequently reaffirmed the importance of full respect for the right to health. However, there remains a large gap between the standards set out in Art 12 of the International Covenant on Economic, Social and Cultural Rights and the situation prevailing in most countries. While there has been a substantial amount of work done to expand upon the content of the right to health, there has been little consideration of what a right to health means for public health programming generally. This article addresses this issue by considering the compatibility of the essential elements of contemporary public health programming practice with the principles contained in General Comment No 14, para 43(f) (a minimum core obligation of the right to health). The article considers that while both contemporary public health practice and para 43(f) do contain compatible elements, the right to health brings with it new elements of monitoring (through right to health indicators) and accountability, both of which will require new tools to be adopted by the public health sector.     

Why do sexual offenders refuse treatment?

Abstract

Theories of offender motivation for treatment have proposed that external factors may be as important as internal factors in creating a state of readiness for treatment. This paper reports an exploratory study of the barriers to treatment for incarcerated sexual offenders. Qualitative and quantitative analysis of interview and questionnaire data from treatment refusers and accepters suggested that refusers were less aware of the effectiveness of treatment, reported seeing negative side effects of treatment in others and felt they had a higher social status in prison which could be damaged by attending treatment. While this study does not demonstrate a causal link between these experiences and the decision to refuse treatment, it seems reasonable to suggest that take-up of treatment could be increased by more sustained efforts to build relationships with treatment refusers and by the provision of accessible information about treatment and its potential benefits.     

Obstacles to dependent health care access in Oregon: health insurance or health care?

In the 1980s, Oregon was one of a handful of "states that could not wait" for national health care reform. Oregon's chosen approach to reform was predicated on two widely accepted assumptions. First, universal access to health care is best achieved by universal access to health insurance. Second, universal access to health care could best be achieved, at least politically, by incrementally building upon the existing health care delivery and insurance system. This article questions both of these assumptions in light of Oregon's decade-long experience in trying to expand access to health care among its dependent population.     

End of life decisions and pregnant women: do pregnant women have the right to refuse life preserving medical treatment? A comparative study

In this article the practice of end of life decisions is applied to pregnant women. This is not an easy task as shown by the extensive case law and literature on the subject. The main conclusion of the article is that the pregnant woman's wishes should always be respected whatever the consequences for the foetus may be. Another position would unjustly sacrifice the woman's fundamental rights to bodily integrity and self-determination for the benefit of a non-person. The result is repeated in the situation where the woman is found to be incompetent or brain dead.