BNFL National Stakeholder Dialogue: a case study in public affairs

This case study explores the very early days of the British Nuclear Fuels Ltd (BNFL) National Stakeholder Dialogue. The dialogue is arguably the most intensive, consistent and difficult engagement with stakeholders ever undertaken by a UK company. It involves a wide range of individuals and organisations interested in or concerned about nuclear issues and aims to inform BNFL's decision‐making process around the improvement of their environmental performance in the context of their overall development. The process is designed and convened by The Environment Council, an independent third party with expertise in stake‐holder dialogue. The aim of this paper is to examine how the dialogue came about, why stakeholder dialogue was used as a process, some of the problems encountered by the process and the link that can exist between public affairs and stakeholder dialogue. Copyright © 2003 Henry Stewart Publications     

Extra information about treatment is too much for the patient with psychosis

BackgroundCase law across jurisdictions requires ever more complete disclosure of material facts when obtaining consent to treatment.AimsTo determine whether giving extra information impairs the mental capacity to make decisions about treatment.MethodThe MacCAT-T, MacCAT-FP, PANSS and GAF were administered to 88 detained forensic patients with psychosis. Two positive and two negative facts were given about each of two anti-psychotic drugs, and no treatment (twelve items). A choice was elicited. The criterion for incompetence was inability to express a choice. Two extra positive and two extra negative facts about each of the three options were given (twelve extra items) and a choice was again elicited, while repeating the MacCAT-T.ResultsGiving extra information led to a decline in the total score on the MacCAT-T. Twenty one were initially unable to make a choice (24%). After additional information, 33 were incapable (37.5%, Chi-squared p < 0.001). Those initially incapable had the lowest scores on all measures of functional capacity and GAF, with highest scores for symptoms. Those able to choose a treatment option had the highest levels of function and least symptoms. Those who became incapable had intermediate scores.ConclusionsGiving extra information made an extra 15% unable to choose. Clinical judgement must be exercised concerning the amount of information disclosed. Deciding what is material to the individual is arbitrary when so few items of information can be processed. Greater use of guardianship and independent second opinions is recommended.     

Symposium-The Challenge In The Gulf: Building a Bridge From Containment to Stability

The following is an edited text of the proceedings of a Capitol Hill conference convened by the Middle East Policy Council on March 5, 1997, in the Dirksen Senate Office Building. Michael Collins Dunn, senior analyst at the International Estimate, was the moderator/discussant.