The MacArthur Treatment Competence Study. II

This article reports the development and psychometric properties of three standardized and objectively scored measures, the MacArthur Treatment Competence Research Instruments. They were designed to assess abilities related conceptually to four legal standards for competence to consent to treatment: understanding, appreciation, rational manipulation (reasoning), and expressing a choice. Scoring reliability, internal consistency, intertest correlations, and test-retest correlations were examined with data from samples of hospitalized patients with schizophrenia, major depression, and ischemic heart disease, as well as matched non-ill community samples. The results indicate very good interscorer reliability and provide guidance for the use of the instruments and interpretation of their results in future research on patients' decisional abilities in treatment contexts.     

Population: malady or symptom?

The 1994 International Conference on Population and Development (ICPD) opened the dawn of a new era in discourse over population. A newfound consensus was reached between North and South which was not there during the two previous world population conferences in Bucharest and Mexico. While consensus was reached at the 1994 ICPD on the need for action, however, debate over population is far from settled. Causes of population growth, the links between population growth and economic development, and environmental degradation remain controversial topics. The authors analyze the basis of the ICPD consensus at the local, national, and global levels. They also compare the development discourse to the political discourse over population. Both discourses emphasize different aspects of a far more complex reality. The question is which discourse to choose as a basis for drawing policy recommendations. The emerging view on the way to Cairo was that consensus would be achieved on the basis of development discourse. Success on the action plan rests upon the belief that more contraceptives, more health services, and more schools will be enough to reduce fertility rates. The political discourse, however, is better than the development discourse as a basis for policy making because it stresses the need for integration rather than running the risk of exclusion. The political discourse is also more demanding.     

Must the show go on? The case for Theatre For Development

This article discusses the reasons for use and nonuse of folk theater for communicating development messages. Theater for Development (TFD) is a tool used by development agencies for improving the quality of life among vulnerable populations. TFD uses fiction and the "safe space" of performance to comment on reality and offer alternatives. The medium offers the opportunity to explore roles that would normally be denied in real life and to explore a community's developmental aspirations. Most TFD draws on talent from the dramatic arts that is unfamiliar with development perspectives. TFD is finally being recognized as important for cultural expression suitable for self-development. Communication is the single most important aspect in the process of development. The constraints to TFD are lack of inclusion within development policy, the lack of development artists, and most importantly, time. Groups with a history of silence, oppression, and marginalization need facilitators. The Freirean model is a consciousness raising one. Participatory theater is centuries old. The most vigorous, sustained TFD theaters are in places with deprivation, poverty, disease, and hunger. These situations are well suited to TFD as a critical intervention for change. An example from the Nigerian Popular Theater Alliance is used to illustrate consciousness raising about government provision of services. TFD allows communities to draw agendas of their own. India has a substantial tradition of Social Action Groups and street theater. TFD can reverse power relations, is not dependent on literacy, and offers an entertaining way of spreading information.