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PubMedDate not supplied

Non-consensual sterilization of the adult with learning disabilities.

Community nurses may be asked for advice on sterilization operations for adults with learning disabilities by worried parents/carers. This article sets out the legal position advocated by the English courts. Sterilization for adults with learning disabilities is generally non-consensual. The courts cannot consent on behalf of the adult but can rule on the lawfulness of the operation. Cases need not be brought before the court when the operation is to be carried out to treat a specific menstrual malady and where sterilization is an incidental result. However, the Law Commission (1995) has set guidelines which recommend that such operations require a certificate from an independent medical practitioner. In operations where the sole purpose is contraception the courts will always need to be involved. Their decision on the lawfulness of the operation will be based on what is in the person's best interests which in turn will be determined by reference to standards set by a responsible body of medical practitioners.

Adult↗
PubMed2003

African widows: anthropological and historical perspectives.

Variety characterizes widows' experiences around the world and in Africa south of the Sahara. This article explores the socioeconomic and cultural contexts of African widowhood, using anthropological studies in a number of African societies, including the author's research among Abaluyia of western Kenya. Some features of African widowhood are characteristic of African women's lives regardless of their marital status: their embeddedness in kinship systems and dependence on those systems for claims to productive resources, their economic self-reliance (which does not mean prosperity), strongly gendered divisions of labor, and the pervasiveness of patriarchal gender relations. Other features are specific to widowhood, including remarriage, issues of personal autonomy, and loss of status, access to productive resources and social support. Colonial and postcolonial historical transformations, including Africa's current dire economic situation and the AIDS epidemic, are considered in relation to widows' lives. An interesting question (given the theme of this edited volume) is whether a husband' s death puts African widows "on their own again," and whether, given African systems of kinship and marriage, most African women (and indeed men, too) can ever be said to be "on their own."

Africa↗
PubMed1981

Value orientations in the intimate relationships of gay men.

A questionnaire study investigated the intimate relationships of 128 gay men. Most men said their current relationship was extremely close and personally satisfying. An analysis of their values concerning these relationships identified two distinct dimensions: dyadic attachment and personal autonomy. Relationship values appeared to be part of more general patterns of conservatism versus liberalness in men's attitudes. The importance men gave to attachment values was consistently related to features of their relationships, including love and intimacy, future expectations, sexual behavior and exclusivity, and reactions to breakups. In contrast, autonomy values appeared to have little impact on intimate relationships. Results are discussed in terms of men's sex-role socialization.

Adolescent↗
PubMed2006

Complexities in decision making for persons with disabilities nearing end of life.

Good end-of-life care requires that clinicians, families, and ethicists be aware of biases that influence patient cases, particularly in the acute care setting where the aim is primarily cure and return to optimal functional level. Persons with disabilities may pose unique challenges; their potential for quality of life is viewed through the lens of highly functional clinicians who might have a biased view of the disabled person's quality of life. The authors aim to present three categories of disability that do not claim to be absolute but rather offer clinicians and ethicists a lens through which to reflect on bias that unconsciously may influence their approach to the patient who is seriously ill and may be nearing the end of life. The categories include (a) a person who has lived with a disability from birth or early life, due to trauma or disease, and is now faced with a serious illness that requires that life-sustaining treatment; (b) the otherwise healthy person who acquires a disability through an acute event of disease or trauma and whose condition requires that life-sustaining treatment decisions be made; and (c) the person who has lived with a progressive chronic illness, such as lung or heart disease or amyotrophic lateral sclerosis, and may have gradually adjusted to disabilities imposed by the condition and now is faced with life-sustaining treatment decisions. The concept of inherent dignity (Pellegrino 2005) is suggested as a filtering lens in case consideration.

Aged↗
PubMed2005

A test of self-determination theory in school physical education.

BACKGROUND: Contemporary research conducted in the context of school physical education (PE) has increasingly embraced various tenets of self-determination theory (Deci & Ryan, 1985, 1991). Despite this increase in research attention, some postulates of the framework remain unexplored (e.g. impact of a need-supportive climate). As such, the present study sought to provide a more comprehensive test of self-determination theory. The present work also examined Deci and Ryan's claim that the motivational sequence embraced by their framework is invariant across gender. AIMS: (i) To examine a model of motivation based on the tenets of self-determination theory, and (ii) explore the invariance of the model across gender. SAMPLE: Participants were 950 British secondary school students (443 male, 490 female, 17 gender not specified) METHOD: Participants completed a questionnaire that included measures of need support, need satisfaction, motivation, positive and negative affect, task challenge, and concentration. RESULTS: Structural equation modelling (SEM) analysis revealed that students who perceived a need-supporting environment experienced greater levels of need satisfaction. Need satisfaction predicted intrinsic motivation, which, in turn, linked to adaptive PE-related outcomes. In contrast, need satisfaction negatively predicted amotivation, which, in turn, was positively predictive of feelings of unhappiness. Multisample SEM invariance testing revealed the model to be largely invariant for male and female students. CONCLUSIONS: The results of the study provide support for self-determination theory and corroborate the application of the framework to the context of school PE. Further, we largely found support for the invariance of the motivational processes embraced by self-determination theory across gender.

Adolescent↗
PubMed2003

Personality systems interactions theory and the theory of planned behaviour: evidence that self-regulatory volitional components enhance enactment of studying behaviour.

The role of volitional components specified by personality systems interactions theory in enhancing behavioural prediction was examined in a longitudinal investigation of students' studying. Participants completed measures specified by the theory of planned behaviour and questionnaire measures of 'conscious attention control', 'implicit attention control' and 'self-determination' from the volitional components inventory. Behaviour was assessed 2 weeks later. Regression analyses showed that volitional components increased variance explained in behaviour by 10-18%, after taking into account strength of motivation to study assessed by attitude, subjective norm, perceived behavioural control and intention from the theory of planned behaviour. Moreover, consistent with elements of personality systems interactions theory, moderator effects were obtained. Participants who reported self-determination, conscious attention control and implicit attention control were more likely to enact their intentions. Volitional components were also associated with increased studying among participants who perceived a low subjective norm for studying. Volitional components improved prediction of studying after accounting for past behaviour in the regression models.

Adolescent↗
PubMed2002

Self-determination and mental retardation: is there an association with living arrangement and lifestyle satisfaction?

Self-determination and lifestyle satisfaction of 80 adults with mild or medium mental retardation living in group homes or their parents' homes were examined. They were assessed in regard to self-determination, as indicated by choices made in the domestic, financial, health, social, and work domains. Lifestyle satisfaction with residence, the community, associated services, and employment was also assessed. Results show that those from group homes were lower on self-determination but higher on lifestyle satisfaction, providing support for the commitment to normalization and community inclusion to enhance lifestyle satisfaction. However, questions about the extent to which people with mental retardation are afforded decision-making opportunities and self-determined behavior remain. We suggest that service providers and caregivers should encourage and create such opportunities.

Adult↗
PubMed2000

Personal control and the ecology of community living settings: beyond living-unit size and type.

Personal control exercised by 74 adults from community living settings in Minnesota was evaluated. Comparisons between living-unit sizes or types controlled statistically for pre-existing differences in adaptive and challenging behavior. Individuals living semi-independently exercised more personal control than did residents of HCBS Waiver-funded settings, who had more personal control than persons from community ICFs/MR. Within the 1- to 5-person size range, size-related differences were detected in personal control. Using hierarchical regression, we found that personal characteristics, self-determination competencies, and environmental variables all made significant, unique contributions to predicting personal control. Path analysis also revealed that this range of variables was related to personal control. These findings strongly support an ecological approach to self-determination.

Adult↗
PubMed2005

Factors associated with outcome in community group homes.

There is evidence of considerable variability in the quality of residential services and a tendency for residents' quality of life to co-vary with ability level. Quality of life of 154 people living in 47 small community residences was assessed using 14 subjective and objective indicators. Information on setting structure, processes, and staff working methods was collected. Factors associated with resident choice, activity, and social and community well-being were modeled using multivariate regression, which controlled for the confounding effect of ability level. Few factors associated with subjective quality of life were found. Resident ability and staff attention to residents had a strong effect across objective measures. Number of residents and staff had little explanatory power. Staff working methods had an inconsistent impact.

Adult↗
PubMed1998

Implementing breast and cervical cancer prevention programs among the Houma Indians of southern Louisiana: cultural and ethical considerations.

This paper provides an overview of the ethical and cultural issues that were taken into account in planning a cross-cultural study of barriers to breast and cervical cancer screening among Houma Indian women who reside in Terrebonne Parish, Louisiana. In such cross-cultural studies, the investigators and members of the target population are from different cultural backgrounds. In planning the study, ethical principles and cultural norms were carefully specified to ensure that the welfare of the participants would be protected and potential benefits maximized. This experience with the Houma Indian Nation illustrates the need for greater participation of research subjects in the planning and implementation of studies on their behalf. An ethical, culturally sensitive approach to cancer control research is needed to address the health concerns of Native American populations.

Adolescent↗
PubMed1998

Groups as gatekeepers to genomic research: conceptually confusing, morally hazardous, and practically useless.

Some argue that human groups have a stake in the outcome of population-genomics research and that the decision to participate in such research should therefore be subject to group permission. It is not possible, however, to obtain prior group permission, because the actual human groups under study, human demes, are unidentifiable before research begins. Moreover, they lack moral standing. If identifiable social groups with moral standing are used as proxies for demes, group approval could be sought, but at the expense of unfairly exposing these surrogates to risks from which prior group approval is powerless to protect them. Unless population genomics can proceed without targeting socially defined groups, or can find other ways of protecting them, it may fall to individuals to protect the interests of the groups they care about, and to scientists to warn their subjects of the need to do so.

Cultural Diversity↗
PubMedDate not supplied

Where the action really is: Medicaid and the disabled.

Discussions of Medicaid tend to focus on low-income children and their mothers and the institutionalized elderly as the principal beneficiaries, but Medicaid spends more on the nonelderly disabled than on any other group. In the past two decades Medicaid has helped finance the deinstitutionalization of the mentally retarded and a growing proportion of the mentally ill, but implementation of the Olmstead decision has deflected advocates' attention from the more important issue of how managed care plans treat disabled Medicaid beneficiaries.

Acquired Immunodeficiency Syndrome↗