Does the Statutory Regulation of Advance Decision-Making Provide Adequate Respect for Patient Autonomy?

This paper considers advance decision-making in the context of healthcare. The common law recognition of advance decisions is contrasted with new statutory provision. This paper will examine the Mental Capacity Act 2005 framework for advance decisions and lasting powers of attorney. The ‚best interests’ test and substituted judgment as criteria for proxy decision-making are compared by application to a case example. The paper examines the statutory safeguards in respect of refusals of ‚life-sustaining treatment’ and postulates that these safeguards may render respect for autonomous advance decision-making difficult to achieve in practice.     

Integrated Deliberation: Reconciling Civil Society's Dual Role in Deliberative Democracy

Among the growing literature on deliberative democracy there are two diverging streams of thought, each implying a different role for civil society. Micro deliberative theorists, with their focus on the procedural conditions for structured fora, encourage civil society to engage in collaborative practices, usually with the state. In contrast, macro deliberative democrats, who are interested in the messy and informal deliberation in the public sphere, advocate that civil society should work discursively outside and against the state. This article explores some of the implications of these conflicting roles, taking into account two observations from deliberative practice: first, that all micro deliberative fora are surrounded and impacted by their macro discursive context, and second, that some actors in civil society are more willing and capable of deliberating than others. To conceive of deliberative democracy as an entirely micro or macro enterprise is not only unrealistic, but potentially exclusive. The article advocates for a more viable and inclusive deliberative theory; one that integrates all kinds of deliberation from the micro to the macro. To this end, public deliberation is best conceptualised as an activity occurring in a range of discursive spheres that collectively engage a diversity of civil society actors.     

Dimensions of publicness and performance in substance abuse treatment organizations.

Changes in funding, clientele, and treatment practices of public and privately owned substance abuse treatment programs, compelled in part by increased cost containment pressures, have prompted researchers' investigations of the implications of organizational form for treatment programs. These studies primarily probe associations between ownership status, patient characteristics, and services delivered and do not empirically link organizational form or structure to treatment outcomes. Data from the National Treatment Improvement Evaluation Study (NTIES) were used to study the relationship of ownership and other dimensions of publicness identified in the public management literature to patient outcomes, controlling for patient characteristics, treatment experiences, and other program characteristics. A few effects of organizational form and structure on substance abuse treatment outcomes are statistically significant (primarily improved social functioning), although the specific contributions of measures of ownership and publicness to explaining program-level variation are generally small.     

Limits to Hegemonic Influence in the Organization of American States

Although powerful states have the ability to dominate the international system to achieve their policy preferences, such dominance has limits in the Organization of American States. Even though the United States, its most powerful member state, has considerable influence over OAS actions, institutional factors also affect decisionmaking and produce more varied outcomes than one might anticipate. Adapting three different perspectives from organizational sociology, this study constructs an analytical framework to explore the impact of structural, normative, internal relational, and environmental factors on the level of U.S. influence in the OAS. Four hypotheses are tested on 30 cases of regional conflict management from 1948 to 2002. The organizational variables also reveal incentives for the United States to act multilaterally rather than unilaterally in most instances in the post-Cold War era.     

You're OK,I'm OK: The Self-Presentation of Affective Reactions to Deprivation

Two experiments compared public and private reports of affective reactions to deprivation. In Experiment 1, participants completed a questionnaire concerning their resentment about poor marks in a course; they had previously been led to believe that another participant was either angry or not angry about his/her marks. Participants' ratings of resentment were more affected by the other participant's alleged emotions in a public than in a private reporting condition. In Experiment 2, employed adults completed a questionnaire concerning their affective reactions to the lack of day care facilities available for working parents; they had previously been led to believe that the experimenter was either upset or not upset about the facilities. When respondents' answers were public, their ratings of resentment were affected by the experimenter's alleged emotions, whereas under conditions of private responding, there was no effect of the experimenter's alleged emotions. Taken together, these experiments provide initial evidence that self-presentation motives can influence reports of affective reactions to deprivation. In particular, our data show that self-presentation can induce a matching strategy whereby public expressions of resentment mirror the expressions of salient others. Two experiments compared public and private reports of affective reactions to deprivation. In Experiment 1, participants completed a questionnaire concerning their resentment about poor marks in a course; they had previously been led to believe that another participant was either angry or not angry about his/her marks. Participants' ratings of resentment were more affected by the other participant's alleged emotions in a public than in a private reporting condition. In Experiment 2, employed adults completed a questionnaire concerning their affective reactions to the lack of day care facilities available for working parents; they had previously been led to believe that the experimenter was either upset or not upset about the facilities. When respondents' answers were public, their ratings of resentment were affected by the experimenter's alleged emotions, whereas under conditions of private responding, there was no effect of the experimenter's alleged emotions. Taken together, these experiments provide initial evidence that self-presentation motives can influence reports of affective reactions to deprivation. In particular, our data show that self-presentation can induce a matching strategy whereby public expressions of resentment mirror the expressions of salient others.     

A Latent Factor Approach to Belief in a Just World and its Association with Well-Being

Social Justice Research - Drawing on justice motive theory (Lerner et al. in Berkowitz and Walster (eds) Advances in experimental social psychology. Academic Press, New York, 1976), in the present...     

KEEPING SODA IN SNAP: Understanding the Other Iron Triangle

Participants in SNAP have always been allowed to use their taxpayer-funded benefit to purchase Sugar Sweetened Beverages (SSBs). Despite an acute public health crisis surrounding the consumption of unhealthy products including SSBs, especially among the low-income citizens who also qualify for SNAP benefits, this policy has yet to be changed. Interviews with policy participants in Washington, D.C., reveal that change is being blocked by a culture of “personal responsibility” in America, plus three specific political forces: corporate lobbying primarily by the beverage and food retail industries; a desire by liberals to defend SNAP as income support for the poor even if nutrition outcomes are sub-optimal; and institutional inertia within the Department of Agriculture and the agricultural committees of Congress. In the 2018 farm bill debate, this “iron triangle” of bipartisan resistance to change was strong enough to block even a pilot study of SSB restrictions in SNAP.     

Early Adolescent Sexual Initiation and Physical/Psychological Symptoms: A Comparative Analysis of Five Nations

Although most people in developed countries experience sexual initiation during adolescence, little is known about inter-country variability in the psychosocial correlates of early initiation. Population-based samples of 15-year-olds (n = 6,111, 52% female) who participated in the Health Behaviors in School-Aged Children Study (Finland, Scotland, France and Poland, 1997/1998) or the National Longitudinal Study of Adolescent Health (United States, 1996) self-reported sexual intercourse experience and physical (headaches, trouble sleeping) or psychological (unhappiness, loneliness, sadness, moodiness) symptoms. Analyses were conducted stratified by gender. Sexual initiation prevalence and symptoms scores varied significantly across nations. In adjusted models, sexual initiation was not related to symptoms among boys in any nation, but significantly positively related to symptoms among girls in Poland and the US. Results support variability by gender and nation in the relationship between adolescents’ sexual initiation and physical/psychological symptoms. Empirically investigating specific features of national contexts that generate these differences should be explored further.