When benefitting a patient increases the risk for harm for third persons — The case of treating pedophilic Parkinsonian patients with deep brain stimulation

This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation — given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.     

Patronage,Service Delivery,and Social Justice in Indonesia

This article examines how patronage networks operate in subnational governments in Indonesia paying particular attention to how they have affected human resource management (HRM) practices in education and health services. Corrupt practices were found in varying degrees in all the provincial public services studied. They were associated with patronage systems and involved illegal payments for entrance exam results, recruitment and selection, placement, promotion, and transfer. These practices had an adverse effect on the quantity and quality of service delivery and represented a challenge to social justice.

This article is related to the special issue “Contemporary Challenges for Public Sector Human Resource Management” of the International Journal of Public Administration, Volume 35, Issue 8, 2012.     

The Generational Effect in Turnout in the Swedish General Elections, 1960–2010

Recent analyses have reported a generational pattern in electoral participation both in national and the European Parliament elections which suggests that a lower voting propensity among the younger cohorts remains relatively stable over time. Based on the Swedish national election studies 1960–2010, this article examines the magnitude of generational differences in a high‐turnout context. It contributes to earlier studies by using multilevel modeling to estimate the impacts of life cycle, generation and period on turnout and by aiming to account for the generational effect with institutional‐ and individual‐level factors. The results show a fairly modest generational effect. When controlling for the proportion of party members in the electorate and the effective number of parties, the differences between generations in their propensities to vote are substantially reduced.     

Swedish rape offenders — a latent class analysis

Sweden has witnessed an increase in the rates of sexual crimes including rape. Knowledge of who the offenders of these crimes are is therefore of importance for prevention. We aimed to study characteristics of individuals convicted of rape, aggravated rape, attempted rape or attempted aggravated rape (abbreviated rape+), against a woman ≥18 years of age, in Sweden. By using information from the Swedish Crime Register, offenders between 15 and 60 years old convicted of rape+ between 2000 and 2015 were included. Information on substance use disorders, previous criminality and psychiatric disorders were retrieved from Swedish population-based registers, and Latent Class Analysis (LCA) was used to identify classes of rape+ offenders. A total of 3 039 offenders were included in the analysis. A majority of them were immigrants (n = 1 800; 59.2%) of which a majority (n = 1 451; 47.7%) were born outside of Sweden. The LCA identified two classes: Class A — low offending class (LOC), and Class B — high offending class (HOC). While offenders in the LOC had low rates of previous criminality, psychiatric disorders and substance use disorders, those included in the HOC had high rates of previous criminality, psychiatric disorders and substance use disorders. While HOC may be composed by more “traditional” criminals probably known by the police, the LOC may represent individuals not previously known by the police. These two separated classes, as well as our finding in regard to a majority of the offenders being immigrants, warrants further studies that take into account the contextual characteristics among these offenders.

Key points

• Rape, aggravated rape, attempted rape or attempted aggravated rape (rape+) are increasing in Sweden.
• The majority of those convicted of rape+ are immigrants.
• LCA identifies two classes of rape+ offenders: LOC and HOC.

     

Accountability and psychiatric disorders: How do forensic psychiatric professionals think?

Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education.     

Regulated and unregulated insider trading around earnings announcements

This paper analyses insider trading behaviour around annual and interim earnings announcements during changing legislative environments in Sweden from 1980 to 2003. Using a unique data set, we are able to explore the nature of insider trading patterns from unregulated to strongly regulated insider trading markets. We find limited evidence of opportunistic insider trading. Insiders seem to be reluctant to sell stocks before positive earnings announcements. They also tend to time their trades in conjunction with an immediate post-announcement period, i.e. “safety trading”, which becomes more evident within stronger legislation environments. Some support for contrarian trading behaviour is also found.

Private-sector development in a transition economy: The case of Vietnam

Since Vietnam introduced its Doi Moi reform policy in 1986, the development of the private sector has been a main policy concern for the government and the ruling Communist Party. The main development challenge for Vietnam is how to sustain economic growth and reduce poverty as the labour force continues to expand. It is envisaged that the private sector will play a major role in that respect. This article looks into the issue of whether the private sector can live up to widespread expectations. High and stable economic growth indicates that reforms have been consistent but also that private-sector initiatives have moved ahead of formal institutional changes. Private-sector development is new in Vietnam and starts from a low level. The public and foreign investment sectors are major players compared to the domestic private sector, which comprises many small firms. Poverty reduction has been impressive but it is only now that private-sector development is becoming an important contributor. Stemming the growth in inequality remains a challenge where the private sector's contribution to increasing public revenue has yet to materialise.