Autonomy and Paternalism

I wish to determine when one is justified in paternalistic interferences that override a subject’s autonomy. In order to lay the groundwork for discussing paternalistic interferences with autonomous decisions, I first consider different conceptions of autonomy, welfare, and paternalism, and determine which I mean to use. In particular, I proceed with Dworkin’s characterization of autonomy as a combination of authenticity and self-determination; Nussbaum’s capabilities theory in order to determine welfare; and a definition of paternalism as being an interference with a subject’s liberty or autonomy that is motivated exclusively by consideration for that subject’s own good or welfare. Once I have working definitions for autonomy, welfare, and paternalism, I consider arguments justifying paternalistic interferences. Because I especially wish to determine when paternalistic interferences that conflict with a subject’s autonomous decision are justified, I begin with Scoccia’s arguments for using hypothetical consent — which is based on what would maximize the subject’s welfare — to justify paternalistic acts. Using Scoccia’s argument, I consider a few cases in which concerns for welfare may justify paternalistic acts overriding the subject’s autonomy. However, hypothetical consent does not go very far in justifying paternalistic acts. Therefore, I also consider arguments justifying paternalism in cases where the subject is not necessarily fully autonomous when making or acting upon a decision. For example, Carter argues that paternalistic acts are justified if autonomy has been waived through prior or subsequent consent. Additionally, I look at justifying paternalism when the subject’s autonomy is compromised through involuntariness or incompetence

The Political Economics of California Proposition 65

1286-129

Neurosurgical experience of managing optic pathway gliomas

Background: Optic pathway gliomas (OPGs), also known as visual pathway gliomas, are debilitating tumors that account for 3–5% of all pediatric brain tumors. They are most commonly WHO grade 1 pilocytic astrocytomas and frequently occur in patients with neurofibromatosis type 1. The location of these tumors results in visual loss and blindness, endocrine and hypothalamic dysfunction, hydrocephalus, and premature death. Their involvement of the visual pathways and proximity to other eloquent brain structures typically precludes complete resection or optimal radiation dosing without incurring significant neurological injury. There are various surgical interventions that can be performed in relation to these lesions including biopsy, cerebrospinal fluid diversion, and partial or radical resection, but their role is a source of debate. This study catalogues our surgical experience and patient outcomes in order to support decision-making in this challenging pathology. Methods: A retrospective review of all cases of OPGs treated in a single center from July 1990 to July 2020. Data was collected on patient demographics, radiographic findings, pathology, and management including surgical interventions. Outcome data included survival, visual function, endocrine, and hypothalamic dysfunction. Results: One hundred twenty-one patients with OPG were identified, and 50 of these patients underwent a total of 104 surgical procedures. These included biopsy (31), subtotal or gross total resection (20 operations in 17 patients), cyst drainage (17), Ommaya reservoir insertion (9), or cerebrospinal fluid diversion (27). During the study period, there was 6% overall mortality, 18% hypothalamic dysfunction, 20% endocrine dysfunction, and 42% had some cognitive dysfunction. At diagnosis 75% of patients had good or moderate visual function in at least one eye, and overall, this improved to 83% at the end of the study period. In comparison the worst eye had good or moderate visual function in 56%, and this reduced to 53%. Baseline and final visual function were poorer in patients who had a surgical resection, but improvements in vision were still found—particularly in the best eye. Discussion/conclusion: OPG are debilitating childhood tumor that have lifelong consequences in terms of visual function and endocrinopathies/hypothalamic dysfunction; this can result in substantial patient morbidity. Decisions regarding management and the role of surgery in this condition are challenging and include cerebrospinal fluid diversion, biopsy, and in highly select cases cystic decompression or surgical resection. In this paper, we review our own experience, outcomes, and surgical philosophy

Managing the Tensions at the Intersection of the Triple Bottom Line: A Paradox Theory Approach to Sustainability Management

Corporate sustainability management encompasses multiple dimensions: environmental, social, and economic. Companies are increasingly evaluated within the public sphere, and within their own organizations, according to the degree to which they are perceived to simultaneously promote this nexus of virtues. This article seeks to explore the tensions frequently faced by organizations that strive to manage these dimensions and the role of public policy in that pursuit. A multiple–case study approach is utilized in which the authors selected case organizations according to whether they were attempting to manage the three dimensions of sustainability. The authors utilize paradox theory and a typology provided by previous research to understand the nature of the tensions that emerge in the selected case study organizations. They extend this previous work by examining the role of public policy in providing the situational conditions to make these paradoxical tensions salient, and they examine organizational responses to these conditions. Directions for firms, policy makers, and future researchers are provided on the basis of this study’s findings

Neuroendocrine morbidity after pediatric optic gliomas: a longitudinal analysis of 166 children over 30 years

Context: 50% of pediatric low-grade gliomas affect the optic pathway, hypothalamus and suprasellar areas (OP/HSGs) resulting in significant long-term neuroendocrinopathy. Objective: To dissect tumor- from treatment-related risk factors for OP/HSG-associated neuroendocrinopathy. Design: Retrospective case notes analysis of 166 children with newly-diagnosed OP/HSGs at our quaternary center between 1980 –2010 by multivariate Cox, linear and logistic regression. Results: Patients were of median (range) age 4.9 (0.2–15.4) years at diagnosis and followed up for 8.3 (0.04 –26.8) years. Despite high 20-year overall survival (81.0%), progression-free and endocrine event-free (EEFS) survival were 47.2% and 20.8% respectively. EEFS declined up to 15 years postdiagnosis, with hypothalamic involvement (p0.001) being implicated more than radiotherapy (p0.008) in earlier endocrinopathy; the reverse being true of its density (radiotherapy p0.001; hypothalamic involvement p0.006). GH deficiency (GHD) was commonest (40.3%), followed by central precocious puberty (CPP, 26.0%), gonadotropin (GnD, 20.4%), TSH (13.3%), and ACTH (13.3%) deficiencies. GHD increased with later treatment eras (p0.01), but replacement did not increase progression. CPP was associated with future GnD (p0.05). Posterior pituitary dysfunction (PPD, 7.2%) occurred in 57.9% after only biopsies or shunt procedures, and was associated with 6/13 deaths. 50.2% became obese. Tumor extent, surgery and increased endocrinopathy, rather than radiotherapy, predicted visuo-cognitive morbidity. Conclusions: This first longitudinal OP/HSG-specific study demonstrates that hypothalamo-pituitary dysfunction evolves hierarchically over decades. Tumor location predicts its speed of onset and radiotherapy its density. GnD can evolve from previous CPP, whilst life-threatening PPD can occur after any surgery. Our data suggest that recent radiation-avoiding chemotherapeutic strategies have increased GHD without improving survival

Managing the Tensions at the Intersection of the Triple Bottom Line: A Paradox Theory Approach to Sustainability Management

Corporate sustainability management encompasses multiple dimensions: environmental, social, and economic. Companies are increasingly evaluated within the public sphere, and within their own organizations, according to the degree to which they are perceived to simultaneously promote this nexus of virtues. This article seeks to explore the tensions frequently faced by organizations that strive to manage these dimensions and the role of public policy in that pursuit. A multiple–case study approach is utilized in which the authors selected case organizations according to whether they were attempting to manage the three dimensions of sustainability. The authors utilize paradox theory and a typology provided by previous research to understand the nature of the tensions that emerge in the selected case study organizations. They extend this previous work by examining the role of public policy in providing the situational conditions to make these paradoxical tensions salient, and they examine organizational responses to these conditions. Directions for firms, policy makers, and future researchers are provided on the basis of this study’s findings

Riparian buffer design tool for cropland: lotic systems

Non-Peer ReviewedRiparian areas function as a buffer between the upland and the aquatic systems. This area is unique in its structure and the services it provides intercepting non-point source (NPS) pollution from the upland. In some cases additional buffer width may be required or sought. Riparian buffer strips are a beneficial management practice (BMP) eligible for cost-shared funding under government programs. However, little information is available to assist landowners in appropriate location or design considerations. This project aims to create a riparian buffer design tool to be utilized on lotic (flowing water) systems in cropland settings. This tool will consist of a flow chart and accompanying key. The flow chart along with air photographs, soils maps and discussions with the landowner will help to determine where on the landscape a buffer should be located. The final product will include case studies and guiding documents for technical staff to utilize when assisting landowners with their riparian buffer strips

Linking Workplace Diversity To Organizational Performance: A Conceptual Framework

This article investigates the previous research of the influence of workplace diversity on organizational performance. It provides a conceptual framework of the influence of diversity on performance, integrating the literature on the potential performance benefits of diversity and potential problems of diversity. The goal of the article is to provide practitioners and scholars alike with a framework that will allow them to design diversity initiatives based on a needs assessment and empirical researc

Pride and Prejudice

All of the wit and romance of Jane Austen\u27s classic 1813 novel come to life in this refreshingly fast-paced and engaging new adaptation. Finding a husband is hardly Elizabeth Bennet\u27s most urgent priority. But with four sisters, an overzealous match-making mother, and a string of unsuitable suitors, it\u27s difficult to escape the subject. When the independent-minded Elizabeth meets the handsome but enigmatic Mr. Darcy, she is determined not to let her feelings triumph over her own good sense -- but the truth turns out to be slipperier than it seems. In a society where subtle snubs and deceit proliferate, is it possible for Elizabeth and Darcy to look beyond his pride and her prejudice, and to make the best match of all?https://digitalcommons.cedarville.edu/theatre_productions/1027/thumbnail.jp