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PubMed2001

Governing the borderlands: decoding the power of aid.

This article examines aid practice, that is, the public-private contractual networks that link donor governments, UN agencies, military establishments, NGOs, private companies and others, as a relation of global liberal governance. In order to fulfil this function, such networks embody what could be called the 'securitisation' of international assistance. Based upon ideas of human security and ameliorating the effects of poverty and vulnerability reduction, aid is now seen as playing a direct security role. Rather than being concerned with relations between states, the primary aim of this security paradigm is to modulate and change the behaviour of populations within them. In doing so, it is able to exploit the opportunities afforded by privatisation. At the same time, however, aid as security is confronted by its own particular problem of 'governing at a distance'; how can calculations made by leading states be transformed into actions at the global edge when a multitude of private and non-government implementors now intervene? The article concludes by examining the contribution of risk analysis to solving this problem and, especially, the development of new contractual regimes based around technical standardisation, benchmarking and performance auditing. Through such technologies, metropolitan states are learning how to manage the public-private networks of aid practice and, as a result, to govern the borderlands in new ways.

Humans↗
PubMedDate not supplied

Ought we to sentence people to psychiatric treatment?

In principle, there seem to be three main ways in which society can react when people commit crimes under influence of mental illness. (1) The standard model. We excuse them. If they are dangerous they are detained in the interest of safety of the rest of the citizens. (2) The Swedish model. We hold them responsible for their criminal offence, we convict them, but we do not sentence them to jail. Instead, we sentence them to psychiatric treatment. (3) My model. We sentence them to jail, but offer them (voluntary) psychiatric treatment. The advantages of my model are obvious. We get a clear delineation of roles. We allow the psychiatrist to be just a doctor, not a warden. We liberate psychiatry of the objective of deciding whether people who were mentally ill when they committed criminal offences 'could have acted otherwise' -- a hopeless task. We allow that psychiatrists live up to their professional ethical code (The Hawaii Declaration). We treat psychically ill persons as 'normal', we allow them to repent their crimes, which renders easier their recovery. However, two objections to my model come to mind. First of all, is it not unfair to sentence people to jail who could not help doing what they did? And, secondly, the question of fairness set to one side, is it not inhumane to sentence mentally ill persons to jail? Is it not inhumane to the mentally ill persons themselves, and does it not mean that they will be a burden to other prisoners? In my paper I show that, if our system of criminal punishment takes a civilised form, neither of these objections carries any weight.

Child Abuse↗
PubMed1999

Medicalization as a moral problem for preventative medicine.

Preventive medicine is sometimes criticised as it contributes to medicalization of normal life. The concept 'medicalization' has been introduced by Zola to refer to processes in which the labels 'health' and 'ill' are made relevant for more and more aspects of human life. If preventive medicine contributes to medicalization, would that be morally problematic? My thesis is that such a contribution is indeed morally problematic. The concept is sometimes used to express moral intuitions regarding the practice of prevention and health promotion. Through analysis of these intuitions as well as some other moral concerns, I give an explication of the moral problems of medicalization within the context of preventive medicine.

Altruism↗
PubMed1999

The question of virginity testing in Turkey.

Pre-marital sex for a woman is regarded as wrong in my country. As a result, it is socially forbidden for a woman to engage in this act. In order to present a woman as a virgin on her marriage day, she is subjected to pressure, and put under control both by her family and societal norms. However, a man is free and never made to suffer any of the above. A woman found to be a virgin on her first night of marriage is seen as a normal person while one suspected to have lost her virginity is made to undergo a series of medical examinations to bring clarity to her situation.

Behavior↗
PubMed2000

Informed consent, exploitation and whether it is possible to conduct human subjects research without either one.

Clinical research with adults who are unable to provide informed consent has the potential to improve understanding and care of a number of devastating conditions. This research also has the potential to exploit some of society's most vulnerable members. Recently, a number of task forces and individual writers have proposed guidelines to ensure that such research is both possible and ethical. Yet, there is widespread disagreement over which safeguards should be adopted. In the present paper, I consider to what extent these disagreements can be resolved by appeal to a general account of the interests of subjects who are unable to consent and the conditions that must be satisfied for research enrollment to constitute exploitation of their inability to make their own decisions.

Adult↗
PubMed1996

Dworkin and Casey on abortion.

This article responds to two important recent treatments of abortion rights. I will mainly discuss Ronald Dworkin's recent writings concerning abortion: his article "Unenumerated rights: whether and how Roe should be overruled," and his book Life's Dominion. In these writings Dworkin presents a novel view of what the constitutional and moral argument surronding abortion is really about. Both debates actually turn, he argues, on the question of how to interpret the widely shared idea that human life is sacred. At the heart of the abortion debate is the essentially religious notion that human life has value which transcends its value to any particular person; abortion is therefore at bottom a religious issue. Dworkin hopes to use this analysis to show that the religion clauses of the First Amendment provide a "textual home" for a woman's right to choose abortion. I wish to scrutinize this suggestion here; I want to probe the precise consequences for abortion rights of such an understanding of their basis. I will argue that the consequences are more radical than Dworkin seems to realize. The other work I will examine here is the important 1992 Supreme Court decision on abortion, Planned Parenthood v. Casey. The controlling opinion in that case, written jointly by Justices Kennedy, O'Connor, and Souter, strongly reaffirmed Roe v. Wade, but also upheld most of the provisions of a Pennsylvania statute that had mandated various restrictions on abortion. The justices' basis for upholding these restictions was their introduction of a new constitutional standard for abortion regulations, an apparently weaker standard than those that had governed previous Supreme Court abortion decisions. I think there is a flaw in Casey's new constitutional test for abortion regulations, and I will explain, when we turn to Casey, what it is and why it bears a close relation to Dworkin's reluctance to carry his argument as far as it seems to go.

Abortion, Induced↗
PubMed1989

Changing trends in drug use: the second follow-up of a local heroin using community.

The first Seadown study documented the way in which police action in closing down the cohort's central point for meeting and drug distribution had effectively destroyed the long established heroin distribution network. Throughout the period of low heroin availability the social network of the cohort was preserved as members developed a whole range of alternative coping styles (displacement activities) in compensation for the enforced abstinence caused by the heroin drought. During the period of observation heroin returned to Seadown initially through a small, unstable and informal distribution co-operative and stayed in this phase until a new central meeting place had been established. Thereafter once a pyramidal distribution network developed, most cohort members were able to modify or stop their displacement activities to accommodate the re-availability of heroin.

Cohort Studies↗
PubMed1990

Changes in the control of alcohol misuse.

This paper examines use of the concept of control by policy makers, researchers, health promoters, crime preventers and therapists. It also looks at recently advocated local, 'non-control' measures which are part of the public health arsenal of prevention measures. It is argued that the broadening concerns of the public health perspective may be viewed as a part of the growth of new, more pervasive forms of social regulation and control which should be a concern for those working to reduce alcohol misuse.

Alcoholic Beverages↗
PubMed1994

Preventive strategies for alcohol-related problems.

Preventive strategies for alcohol-related problems need to be in keeping with their socio-political context. Prohibition is inappropriate except where it has widespread support within the culture. Preventive strategies focus on the population and/or high risk groups and behaviours. Primary prevention can be achieved by control policies, education and provision of alternatives. Fiscal measures are of proven value. Legislative approaches influence availability and context of drinking, such as drinking and driving. Advertising control, server training and server liability are further approaches. Encouraging the provision of alternative beverages and promoting alcohol-free environments is a further approach which should be seen as part of an integrated community response. Secondary prevention linked with early recognition of hazardous drinking at primary level is of known efficacy and would form part of a coordinated strategy.

Alcohol Drinking↗