Mental Capacity and Decisional Autonomy: An Interdisciplinary Challenge

With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The terrain can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority

Why do women not use antenatal services in low and middle income countries? A metasynthesis of qualitative studies

Background: Almost 50% of women in low & middle income countries (LMIC’s) don’t receive adequate antenatal care. Women’s views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies. Methods and Findings: Using a pre-determined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMIC’s who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line of argument synthesis. We derived policy relevant hypotheses from the findings. We included 21 papers representing the views of more than 1230 women from 15 countries. Three key themes were identified: ‘Pregnancy as socially risky and physiologically healthy’; ‘Resource use and survival in conditions of extreme poverty’and ‘Not getting it right first time’. The line of argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralized, risk-focused antenatal care programmes may be at odds with the resources, beliefs and experiences of pregnant women who underuse antenatal services. Conclusions: Our findings suggest that there may be a mis-alignment between current antenatal provision and the social and cultural context of some women in LMIC’s. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences are likely to be underused, especially when attendance generates increased personal risks of lost family resource or physical danger during travel; when the promised care is not delivered due to resource constraints; and when women experience covert or overt abuse in care settings

Can Economic Empowerment Reduce Vulnerability of Girls and Young Women to HIV?

In April 2010, the International Center for Research on Women (ICRW), with support from the Nike Foundation, convened an expert meeting of researchers, program implementers, policymakers and donors to explore emerging insights into the linkages between economic empowerment and HIV outcomes for girls and young women. This report synthesizes the key insights, questions, challenges and recommendations that emerged from the meeting. It addresses two key questions:What are the links between economic status and HIV vulnerability of girls and young women?What is the role of economic empowerment in preventing and mitigating HIV among girls and young women?The report also summarizes general principles that should apply to programs and policies aiming to address the vulnerability of girls in a context of poverty and HIV

Theorizing Risk and Research: Methodological Constraints and Their Consequences

Conflict, postconflict settings, and other risky research sites are important with wide-ranging policy implications. Microlevel, field-based research lends critical insights to how conflicts work and the mechanisms behind macrolevel correlations that underpin quantitative political science. This article identifies how the risks associated with conflict and postconflict contexts influence researchers’ choices by theorizing the existence of distinct adaptive strategies. Specifically, researchers facing elevated risk generally manage it through three main strategies: outsourcing risk, avoiding risk, and internalizing risk. We argue that these strategies systematically shape and circumscribe outputs. We conclude by discussing how the relationship between risky fieldwork and what we know about conflict is poorly acknowledged. Thinking about how we manage risk should play a larger role in both our preparation for and interpretation of research, particularly in conflict and postconflict contexts

Decision-Making: A Neuroeconomic Perspective

This article introduces and discusses from a philosophical point of view the nascent field of neuroeconomics, which is the study of neural mechanisms involved in decision-making and their economic significance. Following a survey of the ways in which decision-making is usually construed in philosophy, economics and psychology, I review many important findings in neuroeconomics to show that they suggest a revised picture of decision-making and ourselves as choosing agents. Finally, I outline a neuroeconomic account of irrationality

The Neglected Harms of Beauty: Beyond Engaging Individuals

This paper explores the neglected ‘harms-to-others’ which result from increased attention to beauty, increased engagement in beauty practices and rising minimal beauty standards. In the first half of the paper I consider the dominant discourse of beauty harms – that of ethics and policy – and argue that this discourse has over-focused on the agency of, and possible harms to, recipients of beauty practices. I introduce the feminist discourse which recognises a general harm to all women and points towards an alternative understanding; although it too focuses on engaging individuals. I argue over-focusing on harms to engaging individuals is somewhat surprising especially in liberal contexts, as this harm can broadly be regarded as ‘self-harm’ (done by individuals to themselves, or by others employed by individuals to do so). The focus on engaging individuals has resulted in the neglect of significant and pressing harms-to-others in theory, policy and practice. In the second half of the paper I turn to actual and emerging harms-to-others. I focus on three particular harms-to-others as examples of the breadth and depth of beauty harms: first, direct harm to providers; second, indirect but specific harm to those who are ‘abnormal’; and third, indirect and general harm to all. I conclude that, contrary to current discourses, harms-to-others need to be taken into account to avoid biased and partial theorising and counter-productive policy-making. I advocate recasting beauty, in a parallel way to smoking, as a matter of public health rather than individual choice

The SGG risk elicitation task:Implementation and results

We propose a simple task for the elicitation of risk attitudes, initially used in Sabater-Grande and Georgantzís (2002) [SGG], capturing two dimensions of individual decision making: subjects’ average willingness to choose risky projects and their sensitivity towards variations in the return to risk. We report results from a large dataset obtained from the test and discuss regularities and the desirability of its bi-dimensionality when used to explain behaviour in other contexts.Psychometric Tests, Decision-making; Lotteries; Risk aversion.

Decision-Making: A Neuroeconomic Perspective

This article introduces and discusses from a philosophical point of view the nascent field of neuroeconomics, which is the study of neural mechanisms involved in decision-making and their economic significance. Following a survey of the ways in which decision-making is usually construed in philosophy, economics and psychology, I review many important findings in neuroeconomics to show that they suggest a revised picture of decision-making and ourselves as choosing agents. Finally, I outline a neuroeconomic account of irrationality.neuroeconomics; decision-making; rationality; ultimatum; philosophy; psychology

Ethics in Online Research; Evaluating the ESRC Framework for Research Ethics Categorisation of Risk

[No abstract][No keywords]

The epidemiological impact of antiretroviral use predicted by mathematical models: a review

This review summarises theoretical studies attempting to assess the population impact of antiretroviral therapy (ART) use on mortality and HIV incidence. We describe the key parameters that determine the impact of therapy, and argue that mathematical models of disease transmission are the natural framework within which to explore the interaction between antiviral use and the dynamics of an HIV epidemic. Our review focuses on the potential effects of ART in resource-poor settings. We discuss choice of model type and structure, the potential for risk behaviour change following widespread introduction of ART, the importance of the stage of HIV infection at which treatment is initiated, and the potential for spread of drug resistance. These issues are illustrated with results from models of HIV transmission. We demonstrate that HIV transmission models predicting the impact of ART use should incorporate a realistic progression through stages of HIV infection in order to capture the effect of the timing of treatment initiation on disease spread. The realism of existing models falls short of properly reproducing patterns of diagnosis timing, incorporating heterogeneity in sexual behaviour, and describing the evolution and transmission of drug resistance. The uncertainty surrounding certain effects of ART, such as changes in sexual behaviour and transmission of ART-resistant HIV strains, demands exploration of best and worst case scenarios in modelling, but this must be complemented by surveillance and behavioural surveys to quantify such effects in settings where ART is implemented