El artículo revisa el concepto de sustentabilidad, para explicar críticamente las lógicas que han dirigido la “evolución” de la humanidad, lo que en visión del autor ayudará a definir nuevos valores que guíen la construcción de nuevas formas de vida y un nuevo estilo de desarrollo. Argumenta que el incorporar la equidad en las políticas de desarrollo sólo será posible en la medida que se pueda entender e incorporar la relación sociedad (género), medio ambiente y desarrollo, bajo criterios de sustentabilidad.

The category of expressive speech acts has traditionally proven elusive of definition in contrast to other types of speech acts. This might explain why this group of speech acts has been less researched. The present paper aims to redress this imbalance by analysing the expressive speech acts performed by two groups of university students in two educational chats, carried out in English or in Spanish, respectively. The main purpose of the study is to find out if students express their emotions (...) when interacting online and, if the use of their mother tongue or not affects their performance of expressive speech acts in terms of frequency and type. To this purpose, Weigand’s taxonomy of speech acts was followed, since it provides a more systematic delimitation of the traditional category of “expressive acts”. Her distinction between emotives and declaratives was thus applied to the dataset under scrutiny. Results show that students opt for performing declarative acts but refrain from expressing their own emotions in an educational setting. As for the use of English or Spanish, no significant differences were observed, which reveals that the use of their mother tongue does not seem to affect the kind of acts performed. (shrink)

The present work has as objective to analyse the embodied dimension of language, reviewing the conceptual issues of cognition, mind and language. Starting from the emerging of new data and knowledge that come from different disciplinary areas and taking Merlau-Ponty’s phenomenology as epistemologica..

Teleological explanations (TEs) account for the existence or properties of an entity in terms of a function: we have hearts because they pump blood, and telephones for communication. While many teleological explanations seem appropriate, others are clearly not warranted-for example, that rain exists for plants to grow. Five experiments explore the theoretical commitments that underlie teleological explanations. With the analysis of [Wright, L. (1976). Teleological Explanations. Berkeley, CA: University of California Press] from philosophy as a point of departure, we examine (...) in Experiment 1 whether teleological explanations are interpreted causally, and confirm that TEs are only accepted when the function invoked in the explanation played a causal role in bringing about what is being explained. However, we also find that playing a causal role is not sufficient for all participants to accept TEs. Experiment 2 shows that this is not because participants fail to appreciate the causal structure of the scenarios used as stimuli. In Experiments 3-5 we show that the additional requirement for TE acceptance is that the process by which the function played a causal role must be general in the sense of conforming to a predictable pattern. These findings motivate a proposal, Explanation for Export, which suggests that a psychological function of explanation is to highlight information likely to subserve future prediction and intervention. We relate our proposal to normative accounts of explanation from philosophy of science, as well as to claims from psychology and artificial intelligence. (shrink)

Recent theoretical and empirical work suggests that explanation and categorization are intimately related. This paper explores the hypothesis that explanations can help structure conceptual representations, and thereby influence the relative importance of features in categorization decisions. In particular, features may be differentially important depending on the role they play in explaining other features or aspects of category membership. Two experiments manipulate whether a feature is explained mechanistically, by appeal to proximate causes, or functionally, by appeal to a function or goal. (...) Explanation type has a significant impact on the relative importance of features in subsequent categorization judgments, with functional explanations reversing previously documented effects of [”]causal status’. The findings suggest that a feature’s explanatory importance can impact categorization, and that explanatory relationships, in addition to causal relationships, are critical to understanding conceptual representation. (shrink)

Following the “Encountering Human Rights” conference in January 2007, Emily Grabham interviewed Tania Pouwhare, a women’s rights activist working at the Women’s Resource Centre in London. Their discussion engaged with the professionalisation of activism, funding constraints and New Labour policies and their impact on immigrant women. Against a background of financial insecurity and huge demand for their services, many women’s organisations in the United Kingdom struggle to use human rights law to advance women’s rights. Nevertheless, the rhetoric of human (...) rights remains powerful within women’s activism, and law remains relevant as a potential form of ‘direct action’ and “another way of making a really big fuss”. (shrink)

Both philosophers and psychologists have argued for the existence of distinct kinds of explanations, including teleological explanations that cite functions or goals, and mechanistic explanations that cite causal mechanisms. Theories of causation, in contrast, have generally been unitary, with dominant theories focusing either on counterfactual dependence or on physical connections. This paper argues that both approaches to causation are psychologically real, with different modes of explanation promoting judgments more or less consistent with each approach. Two sets of experiments isolate the (...) contributions of counterfactual dependence and physical connections in causal ascriptions involving events with people, artifacts, or biological traits, and manipulate whether the events are construed teleologically or mechanistically. The findings suggest that when events are construed teleologically, causal ascriptions are sensitive to counterfactual dependence and relatively insensitive to the presence of physical connections, but when events are construed mechanistically, causal ascriptions are sensitive to both counterfactual dependence and physical connections. The conclusion introduces an account of causation, an "exportable dependence theory," that provides a way to understand the contributions of physical connections and teleology in terms of the functions of causal ascriptions. (shrink)

The ability to generalize from the known to the unknown is central to learning and inference. Two experiments explore the relationship between how a property is explained and how that property is generalized to novel species and artifacts. The experiments contrast the consequences of explaining a property mechanistically, by appeal to parts and processes, with the consequences of explaining the property functionally, by appeal to functions and goals. The findings suggest that properties that are explained functionally are more likely to (...) be generalized on the basis of shared functions, with a weaker relationship between mechanistic explanations and generalization on the basis of shared parts and processes. The influence of explanation type on generalization holds even though all participants are provided with the same mechanistic and functional information, and whether an explanation type is freely generated (Experiment 1), experimentally provided (Experiment 2), or experimentally induced (Experiment 2). The experiments also demonstrate that explanations and generalizations of a particular type (mechanistic or functional) can be experimentally induced by providing sample explanations of that type, with a comparable effect when the sample explanations come from the same domain or from a different domains. These results suggest that explanations serve as a guide to generalization, and contribute to a growing body of work supporting the value of distinguishing mechanistic and functional explanations. (shrink)

In the name of Husserl: nursing in pursuit of the things‐in‐themselves A perceived contradiction between the tenets of humanism and positivism secures phenomenology’s endorsement in nursing as an alternative methodology to the natural sciences. Nursing’s humanistic doctrine of valuing the individual is aligned with phenomenology in the belief that both projects investigate the subjective experiences of others. However, the belief that phenomenology opposes objectifying methods does not account for the different understandings of subjectivity that underpin various philosophic positions, such as (...) humanism, phenomenology, hermeneutics and positivism. What is not recognised in nursing inquiry is that the same characteristics which belong to humanism and are subsequently attributed as belonging to phenomenology are grounded, philosophically, in a view that separates the person from her world. But rather than examining the premises on which phenomenology and humanism are based, nurse‐phenomenologists have simply yoked them together in a mutual alliance against a common enemy — Cartesian dualism. This paper focuses on Husserl and argues that the conceptual link between nursing as a humanistic discipline and Husserlian phenomenology cannot be sustained on philosophic and methodologic grounds. Far from being mutual allies, the philosophic underpinnings of humanism and Husserlian phenomenology offer two incommensurable views on the nature of subjectivity. (shrink)

In pedagogical contexts and in everyday life, we often come to believe something because it would best explain the data. What is it about the explanatory endeavor that makes it essential to everyday learning and to scientific progress? There are at least two plausible answers. On one view, there is something special about having true explanations. This view is highly intuitive: it’s clear why true explanations might improve one’s epistemic position. However, there is another possibility—it could be that the process (...) of seeking, generating, or evaluating explanations itself puts one in a better epistemic position, even when the outcome of the process is not a true explanation. In other words, it could be that accurate explanations are beneficial, or it could be that high-quality explaining is beneficial, where there is something about the activity of looking for an explanation that improves our epistemic standing. The main goal of this paper is to tease apart these two possibilities, both theoretically and empirically, which we align with “Inference to the Best Explanation” and “Explaining for the Best Inference”, respectively. We also provide some initial support for EBI and identify promising directions for future research. (shrink)

A sample of 2,359 sixth-form pupils in Northern Ireland responded in 1998 to Greer's classic question 'Have you ever had an experience of God, for example, his presence or his help or anything else?' Religious experience was reported by 29% of Protestant males, 29% of Catholic males, 39% of Protestant females and 38% of Catholic females. Compared with earlier data these figures reveal a particularly marked decline in reported religious experience among Catholic females . The content of the reported religious (...) experience is analysed and illustrated within nine descriptive categories characterised as: help and guidance, exams, God's presence, answered prayer, death, sickness, conversion, difficulty in describing, and miscellaneous. (shrink)

This study builds on a long-established tradition within the psychology of religion concerned with the analysis and interpretation of prayer. Drawing on 917 prayer-cards le in one rural church over a sixteenth-month period, the analysis distinguishes between three aspects of intercessory and supplicatory prayer defined as reference, intention, and objective. Results of the analysis showed that only 4% of prayer requests had the prayer author as a key focus, and that there was a preference to pray for other people and (...) for world or global issues . Specific concrete issues were not included in 29% of prayer requests, but in the 71% of requests where concrete contexts were provided, 76% of these were concerned with illness, death, and conflict or disaster. Overall, there were more examples of secondary control than primary control , and primary control was found more often in requests which had the prayer author as a key focus and in the categories of illness, growth, work, relationships, and general requests. These results give rise to a number of hypotheses regarding prayers authors' perceptions of prayer and its purpose. (shrink)

Religious systems are organised semiotic structures providing people with values and rules, identities, regularity, and meaning. Consequently, a person moving out of a religious system might be exposed to meaning-ruptures. The paper presents the situation of young people who have been in Yeshiva, a rabbinic high-school, and who have to join secular university life. It analyses the changes to which they are exposed. On the bases of this case study, the paper examines the following questions: can the religious symbolic system (...) internalised by a person in a religious sphere of experience be mobilised as a symbolic resource once the person moves to a secular environment? If yes, how do religious symbolic resources facilitate the transition to a secular life? And if not, what other symbolic and social resources might facilitate such transitions? (shrink)

This article explores and critically contextualises the photographic production of heliotherapist Auguste Rollier (1874–1954), specifically the ‘patient portraits’ photographed at his Leysin sanatoria over a substantial period of four decades, c.1903–1944. It argues that these photographs, ignored in secondary literature, were particularly persuasive in communicating the natural healing powers of sunlight and through their international dissemination brought Rollier's work professional acclaim and prestige. Always presenting anonymous patients, and most often children, the images produced for Rollier's work interweave aesthetic and medical (...) interests. Whether through the aesthetics of the photograph, of the positioning and appearance of the patient's body, or of the language used to describe these, issues of beauty and harmony were significant preoccupations for Rollier and the dissemination of his heliotherapeutic practice. The article argues that these aesthetic preoccupations drove his work, that the patient's progress and final cure, and thus the therapy's efficacy, were determined by aesthetic criteria—read through the body itself and its photographic representation. This legibility, of the body and its photography, was crucial to articulating the sun's perceived natural ability to improve, heal and even ‘rebuild’ individual patients into socially and physically productive citizens. As such, the article contends, Rollier privileged image over word, conceiving the former as possessing an unequalled ‘eloquence’ to communicate the efficacy and social potential of heliotherapy. (shrink)

Assisted suicide, many argue, honors self‐determination in returning control of their dying to patients themselves. But physician assistance and measures proposed to safeguard patients from coercion in fact return ultimate authority over this “private and deeply personal” decision to medicine and society.

Traditional approaches to moral psychology assumed that moral judgments resulted from the application of explicit commitments, such as those embodied in consequentialist or deontological philosophies. In contrast, recent work suggests that moral judgments often result from unconscious or emotional processes, with explicit commitments generated post hoc. This paper explores the intermediate position that moral commitments mediate moral judgments, but not through their explicit and consistent application in the course of judgment. An experiment with 336 participants finds that individuals vary in (...) the extent to which their moral commitments are consequentialist or deontological, and that this variation is systematically but imperfectly related to the moral judgments elicited by trolley car problems. Consequentialist participants find action in trolley car scenarios more permissible than do deontologists, and only consequentialists moderate their judgments when scenarios that typically elicit different intuitions are presented side by side. The findings emphasize the need for a theory of moral reasoning that can accommodate both the associations and dissociations between moral commitments and moral judgments. (shrink)

Le terme ktitor accompagne souvent la représentation d'un acte de don dans la peinture murale byzantines et post-byzantines. Même si le terme "ktitor" a été traduit le plus souvent par "fondateur", sémantiquement et historiquement, on retrouve dans le mot le sens de possession. Les ktitores - des propriétaires modaux, offrent leurs dons, dont le destinataire final est Dieu. Les panneaux votifs de Théodore Métochite , du sebastokrator Kalojan , de Stefan Uroš III , de Mircea l'Ancien témoignent des droits, des (...) intentions et de la foi du ktitor. Avec le christianisme, le sens du don s'est inversé et out don humain n'est qu'un contre-don à Dieu pour son sacrifice premier. (shrink)

The aim of this article is to analyse Spanish conversational structure, more concretely, to investigate in depth the role of the third move, or follow-up, outside classroom discourse. Since first introduced by Sinclair and Coulthard, the follow-up move has attracted a great deal of attention, as proved by numerous studies. However, these studies have mostly focused on English while Spanish has been neglected. The present study intends to fill in this gap by analysing a corpus of 50 conversational exchanges in (...) Peninsular Spanish. The analysis is qualitative and based on Tsui’s conversational framework, which has proved methodologically useful. As results will show, the presence or absence of the third move in Spanish conversations seems to rely heavily on a gender-based distinction. (shrink)

Scientific and ‘intuitive’ or ‘folk’ theories are typically characterized as serving three critical functions: prediction, explanation, and control. While prediction and control have clear instrumental value, the value of explanation is less transparent. This paper reviews an emerging body of research from the cognitive sciences suggesting that the process of seeking, generating, and evaluating explanations in fact contributes to future prediction and control, albeit indirectly by facilitating the discovery and confirmation of instrumentally valuable theories. Theoretical and empirical considerations also suggest (...) why explanations may nonetheless feel intrinsically valuable. The paper concludes by considering some implications of the psychology of explanation for a naturalized philosophy of explanation. (shrink)

Recent expansions of federal and state law enforcement databanks to include DNA samples and profiles of innocent persons threaten individual privacy, impose unjustifiable costs on society, and may undermine our pursuit of justice. The move to permanently retain DNA from arrestees and proposals for a universal database should be vigorously opposed on matters of principle, legality, and practicality.

. On June 13, 2013, the Supreme Court issued a unanimous decision in Association for Molecular Pathology v. Myriad Genetics, holding that a naturally occurring DNA segment that has merely been “isolated” is not patent eligible, and effectively overturning a longstanding policy that had allowed for patents to be issued on thousands of human genes. Drawing largely on the expert testimony and arguments presented during the court proceedings, this paper provides an overview of the discovery and patenting of the BRCA1 (...) and BRCA2 genes at issue in the case, the impacts of gene patents on biomedical research and innovation and clinical practice, and the legal analysis presented by the plaintiffs throughout the case for how patents issued on genes violate the Patent Act and the U.S. Constitution. Finally, it discusses how the Court’s decision in this case marked an extraordinary victory not only for the plaintiffs directly involved, but more generally for women, patients, researchers, civil liberties, and the future of medicine. (shrink)

On November 2, 2004, California voters approved Proposition 69, “The DNA Fingerprint, Unsolved Crime, and Innocence Protection Act” by a margin of approximately 60 to 40 percent. Given the limited amount of information provided to voters during the initiative process, it is unclear how many of the yea-sayers were apprised of the full implications of this measure. Indeed, by voting “yes” on Proposition 69, California has elected to house the most radical and costly state criminal DNA database in the country. (...) This dangerous expansion of California's database poses tremendous threats to civil liberties and social justice while offering little, if anything, by way of increasing the safety of its citizens.Prior to November 2, California law required the permanent retention of DNA samples from felons convicted of serious, violent crimes. The new law expands the database to include DNA samples from all felons and individuals with past felony convictions - including juveniles - and, beginning in five years, all adults arrested for any felony offense. (shrink)

On November 2, 2004, California voters elected to radically expand their state criminal DNA database through the passage of Proposition 69. The approved ballot initiative authorized DNA collection and retention from all felons, any individuals with past felony convictions – including juveniles – and, beginning in 2009, all adults arrested for any felony offense. This dramatic database expansion threatens civil liberties and establishes a dangerous precedent for U.S. criminal databases.

An increasing shortage of transplant donor organs currently results in an escalating number of preventable human deaths. Xenotransplantation. the use of animal organs for transplantation into humans, is now heralded as medicine's most viable answer to the urgent and insurmountable human organ scarcity. Although claimed to be a biomedical prerogative, xenotransplantation is a cultural phenomenon - a procedure engaging both the physical and symbolic manipulation of human and nonhuman bodies, thereby transforming corporeality, identity, and culture. Biomedical and scientific discourses about (...) xenografts have obscured issues related to nonhuman animals and also could be distressful to human organ recipients, revealing that the xenograft may not be widely embraced. (shrink)

Knobe considers two explanations for the influence of moral considerations on cognitive systems: the position, and the position. We suggest that this dichotomy conflates questions at computational and algorithmic levels, and suggest that distinguishing the issues at these levels reveals a third, viable option, which we call the position.

The issue of how to incorporate the individual's first‐hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces and (...) suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in‐depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions. (shrink)

Educational policy and social sciences researchers have been studying dishonest behaviors among students for a long time. In this bibliometric study we examine the extant literature on academic dishonesty until 2017. We also analyze the specific case of the literature on plagiarism since it is arguably one of the most common academic dishonest behavior. We aim at identifying the intellectual structure of the field of academic dishonesty and plagiarism. Results show that Donald L. McCabe and Richard L. Marsh appear as (...) the most productive authors. Furthermore, Whitley, 235–274, 1998) “Factors associated with cheating among college students: A review”, and Pennycook, 201–230, 1996), entitled “Borrowing others’ words: Text, ownership, memory, and plagiarism” are the most cited publications on academic dishonesty and on plagiarism, respectively. Additionally, a strong connection between the McCabe and Treviño articles emerged from the co-citation analysis on academic dishonesty, and also a strong relationship between Pennycook, 201–230, 1996) and Pecorari, 317–345, 2003), suggesting that these articles are strongly connected. Results suggest that these are the most influential authors and articles of the field. (shrink)

ABSTRACTThe understanding of a wide array of practices related to fraud, bribery, corruption, and more widely, illicit practices have been capturing the attention of practitioners and management researchers worldwide. A substantial portion of the extant research has used university students to measure their actual or intended cheating behaviours and often studies have tested for variations across countries and cultures. We highlight some major concerns in this stream of inquiry and discuss both the definition and some inconclusive results in prior studies, (...) namely those deriving from differences in cheating behaviour across different cultural contexts. We suggest the need to examine intentionality, and further advance that intentionality may assume a reactive or a proactive essence. Depending on the social and formal contexts of different countries, both reactive and proactive intentions lead to distinct moral concerns, which we name in this work omorality or immorality. (shrink)

The new interdisciplinary field of experimental philosophy has emerged as the methods of psychological science have been brought to bear on traditional philosophical issues. Oxford Studies in Experimental Philosophy is the place to go to see outstanding new work in the field, by both philosophers and psychologists.

This article explores the hermeneutical force and flexibility of the 9/11 idiom, by identifying some ways in which it served as an interpretative framework for the attacks of 26 November 2008 in Mumbai. The idiom’s transposition to Mumbai represented, in part, a contest over American rhetorical capital. Re-territorialized as ‘India’s 9/11’, the idiom has re-signified a range of local interests, aspirations, and contests over urban space and identity in Mumbai. In this context, I examine two symmetrical developments within the civic (...) spaces of the city in the immediate aftermath. The first involves the emergence of an upwardly mobile middle class and elite as it took the form of collective survivor-spectator, appearing as a coherent, highly visible and effective public agent. The second involves an apparent suspension of competing narratives of urban terror, which in the past have been enacted through demotic violence in the form of the communal riot. The article suggests that these developments in Mumbai must be read through the city’s incorporation into an emergent narrative of ‘global’ or so-called ‘9/11-type’ terror. In the case of 26/11, the terrorist attacks were possibly understood as the exercise of ideological indifference to identity, as levelling the value and distinction of moral communities to the abject experience of sheer bodily life. (shrink)

Peroxisomal matrix proteins are synthesized on cytosolic ribosomes and rapidly transported into the organelle by a complex machinery. The data gathered in recent years suggest that this machinery operates through a syringe-like mechanism, in which the shuttling receptor PEX5 − the “plunger” − pushes a newly synthesized protein all the way through a peroxisomal transmembrane protein complex − the “barrel” − into the matrix of the organelle. Notably, insertion of cargo-loaded receptor into the “barrel” is an ATP-independent process, whereas extraction (...) of the receptor back into the cytosol requires its monoubiquitination and the action of ATP-dependent mechanoenzymes. Here, we review the main data behind this model. The peroxin PEX5 is the peroxisomal matrix protein receptor. It shuttles between the cytosol and the organelle membrane, where it gets inserted into the docking/translocation module, thus pushing the cargo-protein into the peroxisome lumen. Resetting the system involves PEX5 monoubiquitination and its extraction from the membrane by the AAA-ATPases, PEX1/PEX6. (shrink)

This article presents and reflects upon artistic artworks at the intersection of virtual and physical computer systems with wet (biological) systems, in reference to Roy Ascott’s ‘moist theory’. It is divided into two sections. The first section offers contextualization by pointing to Darcy Ribeiro’s considerations of differentiations among Brazilians, thus leading to an expectation of miscegenation that assimilates and incorporates races and beliefs in a syncretic way. To this background is added a theoretical framework based on semiotics entwined with mathematics (...) and physics from a set of authors. Both aspects are intertwined with visceral sensations and feelings which emerged from immersible field researches. Glimpses of the 1997 Xingu expedition are introduced as an example of such immersible field research to unveil aspects related with moist theory. The second section presents four case studies that illustrate all of the concepts previously mentioned. Here, syncretism is understood as a field for events that engender the artworks. These artworks are created as metaphorical journeys aimed at expressing potential shamantic experiences and configured as a set of symbiotic systems. Two of these artworks explore neural connections; their research involves computer devices that allow human interferences in the behaviours of autonomous agents in virtual reality simulations. The resultant systems are artificially alive organisms in flux with the rhythms of the autonomous programmed processes; these change each time they run within the computer, allowing the user to symbiotically interfere in the algorithmic nature of artificial ‘seeds’. These poetic realms are metaphors of the flow of life itself. Summing up, they are technoetic artworks that could only arise from the Brazilian melting pot of cultural, racial and theoretical mixtures. (shrink)

Use of electronic health records within clinical encounters is increasingly pervasive. The digital record allows for data storage and sharing to facilitate patient care, billing, research, patient communication and quality-of-care improvement—all at once. However, this multifunctionality is also one of the main reasons care providers struggle with the EHR. These problems have often been described but are rarely approached from a philosophical point of view. We argue that a postphenomenological case study of the EHR could lead to more in-depth insights. (...) We will focus on two concepts—transparency and multistability—and translate them to the specific situation of the EHR. Transparency is closely related to an embodiment relation in which the user becomes less aware of the technology: it fades into the background, becoming a means of experience. A second key concept is that of multistability, referring to how a technology can serve multiple purposes or can have different meanings in different contexts. The EHR in this sense is multistable by design. Future EHR design could incorporate multistable information differently, allowing the provider to focus on patient care when interacting with the EHR. Moreover we argue that the use of the EHR in the daily workflow should become more transparent, while awareness of the computer in the specific context of the patient-provider relationship should increase. (shrink)

We explore how principles predicting the success of a medical information commons advantaged or disadvantaged three MIC initiatives in three Canadian provinces. Our MIC case examples demonstrate that practices and policies to promote access to and use of health information can help improve individual healthcare and inform a learning health system. MICs were constrained by heterogenous health information protection laws across jurisdictions and risk-averse institutional cultures. A networked approach to MICs would unlock even more potential for national and international data (...) collaborations to improve health and healthcare. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)