Conceptualizing nursing research with offenders: another look at vulnerability

In this article, vulnerability is examined as it applies to the conduct of nursing research with offenders. As a group, offenders present with a multitude of acute and chronic physical and mental health care needs; they are subject to discrimination, stigmatization, and marginalization; and as such, they often experience dual, multiple, or overlapping vulnerabilities. As research participants, they are especially vulnerable to coercion, as a direct consequence of their dependency status within the correctional system. Embracing a research agenda that focuses on offenders as a vulnerable population is fraught with ambiguities not generally encountered in other settings. The ethical conduct of research with vulnerable populations reflects a contemporary research problem that requires ongoing discourse within the nursing community and the health care community at large.     

European Union. Ethical considerations for clinical trials on medicinal products conducted with the paediatric population

This document has been developed by the ad hoc group for the development of implementing guidelines for Directive 2001/20/EC relating to good clinical practice in the conduct of clinical trials on medicinal products for human use, chaired by the European Commission. The document provides recommendations on various ethical aspects of clinical trials performed in children from birth up to the legal age of adulthood. This will contribute to the protection of all children who are the subject of clinical trials. As the approval of clinical trials, including ethical approval, is performed by the Member States, any recommendations on ethical aspects of clinical trials in children will also facilitate a harmonised approach to the application of the clinical trials directive across the EU, thereby facilitating the conduct of clinical trials in the EU and in whichever country the paediatric trial occurs. The protection against the risks of research in such a vulnerable population is paramount whilst this should not lead to denying them the benefits of research. Children are not small adults and there is a need to carry out specific trials that cannot be performed in adults. In general, children (minors) are unable to consent (in the legal sense) but their assent should be sought using age appropriate information. Ethics Committees need paediatric expertise to balance the benefits and risks of research in children. The lack of legal ability to consent has implications on the design, analysis and the choice of comparators used in trials, which should only be performed by trained investigators with paediatric experience. Pain, fear, distress and parental separation should be prevented and minimised when unavoidable. The neonate represents the most vulnerable of all paediatric age groups and requires even more careful review. Finally, various other aspects relating to the performance of trials in children are discussed.     

The semblance of autonomy: treatment of persons with disabilities under the Uniform Health-Care Decisions Act

This Article illuminates the dangers of the Uniform Health-Care Decisions Act, which provides a set of model rules designed to clarify and expedite end-of-life health-care decisionmaking for incapacitated patients. The uniform commissioners and many scholars who have commented on the Act have touted the legislation as a model for defending patient autonomy. As this Article will reveal, the impression of autonomy is an illusion. In fact, the Act privileges the perspectives of the able-bodied over those of persons with disabilities, endangers the autonomy of incapacitated patients, and empowers proxy decisionmakers who have incentives to terminate treatment. These risks have become all the more significant with the rise of managed-care programs that create pressures to minimize care. After highlighting the serious risks to vulnerable patients under the Uniform Health-Care Decisions Act, the Article offers alternative rules and stronger safeguards to better protect patient autonomy and defend against wrongful health-care decisions. This Article urges states seeking improved end-of-life health-care procedures to codify these or similar protections in order to avoid the lethal shortcomings of the Uniform Health-Care Decisions Act.     

A hypothetical neurological association between dehumanization and human rights abuses

Dehumanization is anecdotally and historically associated with reduced empathy for the pain of dehumanized individuals and groups and with psychological and legal denial of their human rights and extreme violence against them. We hypothesize that ‘empathy’ for the pain and suffering of dehumanized social groups is automatically reduced because, as the research we review suggests, an individual''s neural mechanisms of pain empathy best respond to (or produce empathy for) the pain of people whom the individual automatically or implicitly associates with her or his own species. This theory has implications for the philosophical conception of ‘human’ and of ‘legal personhood’ in human rights jurisprudence. It further has implications for First Amendment free speech jurisprudence, including the doctrine of ‘corporate personhood’ and consideration of the potential harm caused by dehumanizing hate speech. We suggest that the new, social neuroscience of empathy provides evidence that both the vagaries of the legal definition or legal fiction of ‘personhood’ and hate speech that explicitly and implicitly dehumanizes may (in their respective capacities to artificially humanize or dehumanize) manipulate the neural mechanisms of pain empathy in ways that could pose more of a true threat to human rights and rights-based democracy than previously appreciated.     

Group size,misinformation and unanimity influences on co-witness judgements

Researchers have typically observed the effects of co-witness influence on eyewitness pairs. However, research suggests that individuals are more likely to witness crimes in larger groups. Additionally, there is an abundance of evidence suggesting that social influence is heavily moderated by group size. Therefore, the present study aimed to gain a more accurate understanding of the risks of co-witness influence in relation to unanimity and group size effects. Participants (N = 608) viewed and discussed a CCTV footage of a fight breaking out, with co-witnesses, before giving individual statements, where they were asked to identify which person had started the fight; confederates were used to suggest that the wrong man had started the fight. Results indicated that participants were vulnerable to co-witness influence, but only when exposed to misinformation from a majority of co-witnesses. Misinformation presented by an individual confederate did not have a significant influence over the participants’ responses. This study was the first to investigate the effects of group size on blame attribution. The findings suggest that the true risks of co-witness influence may not be as high as originally predicted from research on eyewitness pairs.     

The legal ethics of pediatric research

Since the mid- to late 1990s, the scientific and medical research community has sought to increase its access to healthy children for research protocols that involve harm or a risk of harm. This move reverses longstanding policy within that community generally to exclude healthy children from such protocols on the grounds that the research as to them is non-therapeutic, that they are particularly vulnerable to research-related abuses, and that they are unable themselves to give informed consent to their participation. The research community's new posture has been supported by prominent pediatric bioethicists who have argued that unless healthy children are included as research subjects in harmful or risky research, the pediatric population will continue to suffer relative to the adult population in the extent to which it benefits from modern advances in science and medicine. In their view, it is possible for the research community to self-administer a rule that strikes a balance between protecting healthy children from research-related abuses and allowing their inclusion in cutting-edge pediatric research. In this scheme, parental consent is central to the research community's claims about child protection. This Article explores the flaws inherent in this ethics of pediatric research. Specifically, it challenges the view from ethics that the law permits parents to consent to their children's inclusion in harmful or risky research to the extent that related invasions would meet legal maltreatment standards. More broadly, it challenges the movement to increase access to healthy children for harmful and risky research on the ground that it risks two important regressions: First, in its willingness to risk harm to individual children in the interests of the group, it threatens the progress the law has made in its development of the concept of the child as an individual worthy of respect in his or her own right, a concept that imagines parents as fiduciaries and that includes strong protections against invasions of bodily integrity. Second, in its failure to assure that the burdens of non-therapeutic research are not placed disproportionately on children of lower socioeconomic and minority status, it violates the antidiscrimination principle, which has only begun to make good on its promise of equal treatment for all children. Ultimately, this Article argues that harmonization of the rules governing pediatric research with the law of child protection and parents' consent authority is the best way to assure that children are protected in the research setting in these respects and to the same extent they are otherwise in the society.     

Whither Suffering? The Potential Impact of Tort Reform on the Emotional and Existential Healing of Traumatically Injured Chronic Pain Patients

Approximately half of the state legislatures in the USA have enacted tort reform, generally focused on reducing noneconomic damages such as those awarded for pain and suffering of traumatically injured parties. Traumatic injury has been empirically associated with the development of chronic pain, which in turn has been associated with the concept of human suffering. This analysis examines the meaning of suffering within the context of traumatically induced chronic pain, recognizing that this population is at heightened risk of experiencing long-term emotional as well as physical pain. Factors contributing to profound suffering include the potential development of post-traumatic stress disorder, depression and anxiety, role/identity loss, maltreatment by a medical system generally inept in its management of chronic pain, and the negative manner in which personal injury victims are often treated by the legal system. While the American medical system struggles to identify suffering, the legal system—through tort reform—has chosen to simply ignore it, demonstrating little concern for the integrity of the vulnerable chronic pain sufferer. In doing so, the “destructed” chronic painient is further “deconstructed”. We argue that by limiting the size of settlements and jury awards, tort reform serves to potentially deny personal injury victims of a critical vehicle for finding meaning in their suffering, and accordingly limits their likelihood of achieving relief.     

Autism behind bars: a review of the research literature and discussion of key issues

Individuals with autism spectrum disorder (ASD) may experience difficulties coping at all levels of involvement in the criminal justice system. Questions remain, however, regarding the presence and type of difficulties faced by individuals with ASD in the context of incarceration within prison settings. Despite the potential impact for community safety and concerns regarding justice, these issues have received very little academic attention. The research that does exist is generally limited by poor methodology and small sample sizes. The current paper provides a brief review and discussion of the limited extant literature regarding the experiences of prisoners with ASD with the view to summarising areas of difficulties potentially faced by such individuals. It is hoped that this brief review may highlight the need for academic attention in order to inform practice and policy regarding the criminal justice response to this potentially vulnerable population.     

Commercial speech and off-label drug uses: what role for wide acceptance, general recognition and research incentives?

This article provides an overview of how the constitutional protections for commercial speech affect the Food and Drug Administration's (FDA) regulation of drugs, and the emerging issues about the scope of these protections. A federal district court has already found that commercial speech allows manufacturers to distribute reprints of medical articles about a new off-label use of a drug as long as it contains disclosures to prevent deception and to inform readers about the lack of FDA review. This paper summarizes the current agency guidance that accepts the manufacturer's distribution of reprints with disclosures. Allergan, the maker of Botox, recently maintained in a lawsuit that the First Amendment permits drug companies to provide "truthful information" to doctors about "widely accepted" off-label uses of a drug. While the case was settled as part of a fraud and abuse case on other grounds, extending constitutional protections generally to "widely accepted" uses is not warranted, especially if it covers the use of a drug for a new purpose that needs more proof of efficacy, and that can involve substantial risks. A health law academic pointed out in an article examining a fraud and abuse case that off-label use of drugs is common, and that practitioners may lack adequate dosage information about the off-label uses. Drug companies may obtain approval of a drug for a narrow use, such as for a specific type of pain, but practitioners use the drug for similar uses based on their experience. The writer maintained that a controlled study may not be necessary to establish efficacy for an expanded use of a drug for pain. Even if this is the case, as discussed below in this paper, added safety risks may exist if the expansion covers a longer period of time and use by a wider number of patients. The protections for commercial speech should not be extended to allow manufacturers to distribute information about practitioner use with a disclosure about the lack of FDA approval. Distributions of information about unapproved uses should not be acceptable unless experts consider the expanded use to be generally recognized as safe and effective based on adequate studies. The last part of this paper considers the need to develop better research incentives to encourage more testing and post-market risk surveillance by drug makers on off-label uses of their drugs. Violations of the Federal Food Drug and Cosmetic Act (FFDCA) can be considered violations of the False Claims Act, which opens the way to fraud and abuse suits. The scale of penalties involved in these suits may lead to more examination of the scope of FDA regulation and commercial speech protections. Thus this symposium's consideration of these issues is timely and important.     

Online fraud victims’ experiences of participating in qualitative interviews

Institutional Review Boards often raise concerns about qualitative research with vulnerable populations such as crime victims, and assume that research with vulnerable populations will be distressing for participants. It is therefore vital to examine whether participants do in fact experience adverse effects stemming from their participation. The existing research is clear that some members of vulnerable populations do feel distressed when they participate in research; however, in most cases, this distress is outweighed by the benefits of participation, such as a sense of having contributed to community awareness raising. This literature is, however, predominantly quantitative. In addition, it overwhelmingly focuses on violent trauma, providing no insight into participants’ experiences of research on non-violent traumatic events. The current study addresses these shortcomings by examining the research participation experiences of victims of online fraud. Specifically, an online questionnaire designed to elicit qualitative data was administered to victims of online fraud who had previously participated in a semi-structured qualitative interview. Among other findings, the study suggests that perceptions about the outcomes of research, in addition to the research process, influence victims’ satisfaction with their participation in qualitative research.     

Privacy principles,risks and harms

The protection of privacy is predicated on the individual's right to privacy and stipulates a number of principles that are primarily focused on information privacy or data protection and, as such, are insufficient to apply to other types of privacy and to the protection of other entities beyond the individual. This article identifies additional privacy principles that would apply to other types of privacy and would enhance the consideration of risks or harms to the individual, to groups and to society as a whole if they are violated. They also relate to the way privacy impact assessment (PIA) may be conducted. There are important reasons for generating consideration of and debate about these principles. First, they help to recalibrate a focus in Europe on data protection to the relative neglect of other types of privacy. Second, it is of critical importance at a time when PIA (renamed ‘data protection impact assessment’, or DPIA) may become mandatory under the European Commission's proposed Data Protection Regulation. Such assessment is an important instrument for identifying and mitigating privacy risks, but should address all types of privacy. Third, one can construct an indicative table identifying harms or risks to these additional privacy principles, which can serve as an important tool or instrument for a broader PIA to address other types of privacy.     

The Bonding Effects of Directors' Statutory Wage Liability: An Interactive Corporate Governance Explanation

Canadian corporate directors are personally liable to the corporation's employees for unpaid wages. The dominant rationale is the protection of vulnerable employees. A proposal under consideration to exonerate directors from this liability responds to claims that directors of financially troubled corporations resign prematurely, lessening the realized value potential of the firm. Scholars have also argued that a "liability chill" causes directors to make inefficient, risk‐averse investment decisions while the corporation is solvent. Paradoxically, exoneration may actually decrease the value of the firm because directors' liability for employees' wages increases efficiency in corporate governance by reducing agency costs. It serves as a bond by directors to corporate stakeholders that they will diligently restrain harmful managerial behavior.     

论医学院校科研合同的法律风险防范

加强医学院校科研合同的法律风险防范对于促进科研工作的良性发展和推动依法治校具有积极作用。这类合同有其独特的特点,本文对这类合同常见的几个法律风险予以分析并提出了相应的建议。     

Reducing crime through prevention not incarceration

This policy essay by William J. Bratton, former Commissioner of the NYPD and Chief of LAPD, provides a useful overview of the key issues involved in determining how to address crime and provides an interesting research agenda for exploring the potential impact of options that favor policing and reduce reliance on incarceration. Changing the current focus from one that presumes that increased incarceration results in crime reduction to one that works to prevent crime requires a paradigm shift of major proportions. It is worthy of consideration.     

Deportation, Detention and Medical Intervention

In the UK the foreign national prisoners who have breached immigration rules suffer deprivations from which the ordinary citizens are exempt. Their subjection to prison regimes often on pain of deportation leads to psychological illnesses that cause them long term damage. The deportation regime that arises by default under the Border and Immigration Act 2007 has made it difficult to avoid prison for the breach of immigration rules. The research published by NACRO shows that it can lead to trauma because there is duress accompanied by an uncertainty of fate. The decision by the Court of Appeal in R (Medical Justice) v Secretary of State for the Home Office (2011) has brought this issue of deporting ill patients into the limelight. There are expert reports that reveal that those foreign nationals who are refused permission to stay are at risk from psychiatric illnesses when they are detained. The findings are that the mental illnesses are particularly severe in the most vulnerable prisoners who develop symptoms of long term mental disease. It is critical for the medical professionals to consider their involvement at an early stage when they will be able to supervise and diagnose illness before there is damage. This is particularly the case as the NHS treatment is denied to prisoners who are foreign nationals which is makes it necessary to implement a strategy with local agencies to prevent the onset of debilitating illnesses.     

Do adolescent smokers know the risks?

Professor Slovic challenges Professor Viscusi by suggesting that "risk" is a term with varying meanings and the potential for misinterpretation by study participants. He distinguishes between the probability and severity of a risk, and suggests that teens who know the probability of smoking causing cancer are not aware of the severity of the experience of cancer. He goes on to note that people often perceive themselves as being less at risk than others, and observes that Professor Viscusi's study posed questions about others, instead of asking teens to assess their own risks. Thirdly, he argues that teens perceive each individual cigarette as posing a small risk even if they seem to be aware of the larger risk of smoking. Finally, since many teen smokers intend to quit, he contends, they do not see smoking as hazardous to themselves. He argues that Professor Viscusi underrates the misperception of the risks of personal addiction. Professor Slovic augments his argument with original research demonstrating that smoking teens are more likely than nonsmoking teens to perceive the short term risks of smoking as trivial.     

End-of-life decision-making, the principle of double effect, and the devil's choice: a response to Roger Magnusson

Recently, the principle of double effect has come under scrutiny by Magnusson who believes it provides a subterfuge for those who act so as to end the lives of their patients. Specifically, he argues that the conceptual distinction between foresight and intention is dubious and, moreover, renders patients vulnerable to involuntary euthanasia. At the same time, Magnusson wants to protect doctors from criminal liability when faced with (what he understands to be) a "devil's choice" between ending the life of a patient or under-treating pain. Hence, Magnusson proposes that, subject to specific conditions, a so-called "defence of necessity" be recognised through either common law doctrine or legislation. However, to safeguard this defence, he must rely on what he most wants to reject: a fundamental aspect of the principle of double effect.     

Where the Margins Meet: A Demographic Assessment of Transgender Inmates in Men’s Prisons

Drawing on official data and original interview data on 315 transgender inmates in California prisons for men, this research provides the first empirical portrayal of a prison population in California that is unique by virtue of being both transgender and incarcerated. Situated at the nexus of intersecting marginalities, transgender inmates fare far worse on standard demographic and health measures than their non‐transgender counterparts in the US population, the California population, the US prison population, and the California prison population. With the possible exceptions of partnership status and educational attainment, these factors combine to reveal that transgender inmates are marginalized in heretofore undocumented ways. At a time in which an evidence‐based approach to corrections is increasingly embraced by corrections officials in the US, this article provides the first systematic profile of transgender prisoners. It reveals they can be regarded as a special population that, from a policy point of view, raises what Minow calls “the dilemma of difference”.     

It Is Not Paranoia if People Really Are Out to Get You

Abstract

The incidence of hate crime victimization in the states has received scant attention by researchers. Nor is it always clear who feels most vulnerable to hate crime victimization and why. In this research we included hate crime victimization questions in two years (2000, 2001) of a statewide survey. Idaho is a state with a predominately White population. It has been bedeviled with an Aryan Nation's compound and its attendant racist propaganda. We found that many citizens had been the victim of hate crimes in the last year and over the course of their lifetime. Minority group members were disproportionately represented as victims of hate crime and were almost three times as likely to feel vulnerable to it, as White respondents.     

GENERAL THEORY OF SPATIAL CRIME PATTERNS*

I propose a general theory for examining the spatial distribution of crime by specifically addressing and estimating the spatial distribution of the residences of offenders, targets, guardians, and their respective expected movement patterns across space and time. The model combines information on the locations of persons, typical spatial movement patterns, and situational characteristics of locations to create estimates of crime potential at various locations at various points in time and makes four key contributions. First, the equations make the ideas involved in the theory explicit, and they highlight points at which our current state of empirical evidence is lacking. Second, by creating measures of spatial “potentials” of offenders, targets, and guardians, this theory provides a precise grounding for operationalizing spatial effects in studies of place and crime. Third, the equations provide an explicit consideration of offenders and where they might travel and, therefore, incorporates offenders into crime‐and‐place research. Fourth, these equations suggest ways that researchers could use simulations to predict stable patterns, as well as changes, in the levels of crime at both micro and macro scales. Finally, I provide an empirical demonstration of the added explanatory power provided by the theory to a study of place and crime.