ABSTRACTThe Belgian Euthanasia Act of 2002 (The Act), amended in 2014 to include the Minor Act (The Minor Act), has drawn international criticisms for its liberal laws and practices regarding Euthanasia. This paper is a response to allegations that the liberal laws on Euthanasia has encouraged doctors to adopt a paternalistic 2 approach towards their patients by terminating their lives without their explicit consent, i.e. engaging in Involuntary Euthanasia.3, 4, 5Although in theory, only Voluntary Euthanasia (explicit patient request and therefore consent) is permitted in Belgium 6 the allegations implied that in practice, Involuntary Euthanasia (no explicit patient request and therefore consent is given) is practiced, especially in the Intensive Care Units (ICU) in Belgium.This paper attempted to make distinctions between Terminal Sedation and Euthanasia based on current dominant discourse in Bioethics and argued that it is not Involuntary Euthanasia that is practiced in the ICU but Non-Voluntary Euthanasia or Terminal Sedation (explicit patient request and therefore consent is unavailable) is practiced based on the intent of the doctor. In presenting its arguments, this paper focused specifically on the reports it procured from its qualitative research. Finally, in order to understand if doctors in the ICU are Gods or Monsters, the paper attempted to answer four questions namely:1. Are doctors in Belgium Gods, who help end lives?2. Or are they Monsters, who help end lives?3. Or are they pre-hippocratic doctors, historically called Witch-Doctors, who are“for hire” to either “cure or to kill” with no loyalty to the Hippocratic Oath?4. Or are they mutated witch-doctors pressured to practice Euthanasia in a countrywhere the laws are perhaps fatally flawed? / Doctorat en Philosophie / info:eu-repo/semantics/nonPublished

La Belgique et la France ont notamment intégré en 2002 dans leurs systèmes législatifs respectifs une loi consacrée aux droits des patients qui met au centre du système de santé le patient et le devoir de respecter son autonomie. Partant de l’idée selon laquelle les concepts et principes ne peuvent être pensés indépendamment de la manière dont ils sont susceptibles de s’articuler au sein de la « vie ordinaire », j’ai adopté une démarche de philosophie empirique impliquant un terrain d’enquête au sein de laquelle j’ai choisi d’explorer une situation que l’on peut qualifier de limite, en portant mon attention sur la question du consentement aux soins des patients atteints de la maladie d’Alzheimer hospitalisés en gériatrie pour un événement de santé aigu. En effet, la maladie d’Alzheimer implique une diminution des capacités (notamment cognitives) des personnes qui en sont affectées, mettant ainsi l’autonomie du sujet à l’épreuve. Les spécificités liées à cette maladie, doublées du caractère aigu de la prise en charge des personnes qui en sont affectées, font de ce contexte un terrain extrêmement fécond pour examiner les significations et les limites de ce principe tel qu’il est actuellement valorisé dans le domaine des soins de santé. La réflexion proposée dans le cadre de cette thèse s’est ainsi élaborée autour d’éléments recueillis lors d’une enquête de terrain comparative (comprenant différents sites hospitaliers belges et français) spécifiquement mise en place pour les besoins de ce travail. Cette enquête s’est concentrée sur la relation entre les patients et les « soignants de proximité » (infirmières et aides-soignantes), étant donné que c’est dans le cadre de cette relation que la question de la capacité d’autonomie du sujet atteint de la maladie d’Alzheimer émerge principalement en contexte de soin à l’hôpital. En outre, cette enquête s’est en grande partie intéressée à la problématique du refus de soin des patients, ainsi qu’à celle du recours à la contrainte. En effet, c’est essentiellement dans ce type de situations que la question du respect de l’autonomie des patients et du recueil de leur consentement se pose avec le plus d’acuité dans le secteur qui nous occupe. La mise en place de ce terrain d’enquête doit être comprise comme un outil méthodologique et épistémologique ayant pour objectif de nourrir la réflexion conceptuelle, critique et normative liée à la problématique du respect de l’autonomie des patients atteints de la maladie d’Alzheimer. L’ensemble de ce travail m’a permis de développer une nouvelle conception de l’autonomie qui se distingue des réponses les plus fréquemment proposées au sein de la littérature médicale, juridique et philosophique. L’idée principale défendue ici consiste à penser que le problème relatif à la question du respect de la capacité d’autonomie des patients atteints de la maladie d’Alzheimer ne réside pas tant au niveau de la capacité propre des personnes, mais qu’elle dépend avant tout de ce que je présente comme un geste d’octroi, résultant d’un processus de co-construction collectif des professionnels de santé, marqués par des affects et des motivations qui leur sont propres / In 2002, Belgium and France implemented a law that places patients and their right to autonomy at the center of the healthcare system. Based on the assumption that concepts and principles cannot be perceived independently of the way they are likely to be implemented in “ordinary life”, I applied an empirical-philosophical approach to the research field by choosing to examine what can be described as a borderline situation, bringing my attention to the issue of consent to medical care of patients with Alzheimer’s disease hospitalized in geriatric units for an acute health issue. Indeed, Alzheimer’s disease involves a decline of the patient’s abilities (including cognitive skills), thereby jeopardizing his autonomy. The specific characteristics of the disease coupled with the acute medical care it requires single it out as the perfect ground to question the meaning and limitations of the principle and its current use in the healthcare system. The reflection proposed in this thesis is based on information gathered during a comparative field study (including various Belgian and French hospital sites) specifically set up for the purpose of this work. The research focused on the relationship between the patients and the “immediate caregivers” (nursing staff), where the capacity of autonomy of Alzheimer patients in a hospital setting is most frequently questioned. Moreover, the present study largely dealt with the issue of treatment refusal by patients as well as the use of coercion. It is indeed mainly in this type of situation that the problem of respecting patient’s autonomy and obtaining their consent is most vividly debated in the present field of study. The introduction of this research field must be seen as a methodological and epistemological tool that aims at providing further conceptual, critical and normative inputs to the issue of respect of autonomy for patients suffering from Alzheimer’s disease. This work allowed me to develop a new understanding of autonomy, which differs from the most frequently proposed responses that are to be found in medical, legal and philosophical literature. The main advocated idea here is that the question of respect of autonomy for Alzheimer patients does not lie so much in the person’s own capacity, but actually depends on what I consider a granting gesture that results from a collective construction process of health professionals, biased by their own affects and motivations

This is a book-length work of prose including fiction, creative non-fiction, with small amounts of prose poetry all focusing on the exploration of female sexuality, gender roles, relationships among men and women, and mothers and daughters. The aim of the individual pieces in this collection is to enter the cultural conversation of these issues by presenting a hybrid of genres that beg for an understanding of truth vs. fiction, and the fine line between those things when dealing with matters of the body and mind.

The purpose of this study was to examine how collegiate males and females perceived date rape and sexual assault by looking into their views on sexual scripts, consent, and alcohol in dating situations. Participants consisted of 323 male and female undergraduate students enrolled in psychology classes at a mid-south university. All participants were directed to an online questionnaire and were randomly assigned to one of four versions of a vignette where a man and a woman are at a party together. After reading their vignette, all participants answered researcher-created questions pertaining to the behavior of the people in the vignette and societal attitudes about sex and alcohol. All participants also completed shortened versions of the Acceptance of Modern Myths about Sexual Aggression scale and Sexual Experiences Survey. Results indicated that if college students believe men should take the lead in sexual encounters, they also expect the man to be persistent, even if the woman “hits the brakes.” Additionally, as many participants agreed and disagreed that alcohol plays a part for when a man rapes a woman. However, the participants did not rely on the specific nonverbal dating behaviors outlined in this study to engage in sexual activity. The relevance of these findings to current research, the implications for school psychologists working in middle and high schools, limitations, and future directions are discussed.

The purpose of this research project was to determine if there was a significant difference between women who had unplanned pregnancies and the amount of information those women received about their pregnancy options regarding parenting, adoption, and abortion, and those who were not. Additionally, the level of information about pregnancy options, and whether it would reduce termination of pregnancies was examined. The aspects explored included the information available to clients and the decision making process for women who have experienced an unplanned pregnancy. The methods for this study involved using an anonymous survey via Survey Monkey. Additionally, this study examined the importance of clients being informed and the role information plays in the social work field. A detailed examination of the research which has been conducted in pregnancy options counseling and what that counseling consists of was conducted and discussed. An overview of "Woman’s Right to Know Laws" was also addressed and what theories have an impact on what woman experience during an unplanned pregnancy. Finally, an independent samples t-test was conducted to determine if there were significant differences between groups of women who had chosen to keep and parent their child, those who chose to have an abortion, and those who chose to relinquish their child for adoption and the amount of information they received about their pregnancy options. The study found a significant difference between women who chose to parent their children and women who iv chose to have an abortion in terms of the level of information they were provided about those options. The abortion group received significantly more information about abortion than the parenting group. This may be due to the type of information received being more about cost and recovery periods versus the actual abortion procedure and mental health concerns post-abortion. Based on the findings, most women know what they will do in the case of an unplanned pregnancy and only a significant intervention will change their course of action. Based on the findings, educating women about their pregnancy options will not change their decision to keep, abort or relinquish their child for adoption. Instead, prevention efforts are more effective in preventing abortion than providing them with information.

African American men between the ages of 18-35 years are increasingly likely to die during arrests by police under the purview of procedural practices. Using procedural justice and critical race theory as the foundation, the purpose of this correlational study was to evaluate the statistical relationship between procedural justice, consent to police authority, and certain demographic characteristics including socioeconomic status and age in a large Metropolitan area in the southern United States. Survey data utilizing the Procedural Justice Inventory and Willingness to Submit to Police Authority Survey were collected from African American adult males (n = 69) and analyzed using least-squares regression. Regression analyses revealed a significant relationship between procedural justice and consent to police authority (p < .05). In addition, socioeconomic status and age did not affect the relationship between procedural justice and consent to police authority (p < .05). Implementation of recommendations for training may provide police practitioners with the basis to develop training programs to affect behavioral outcomes of police. Following these recommendations may change the systemic relationship between the community and police. The findings of this study may also serve African American males by allowing them to take an introspective look at how they may react in certain statutory situations and taking positive actions as opposed to being reactive; thereby, possibly mitigating deaths during police interaction. The implications for positive social change afford community practitioners an opportunity to develop community programs that support individuals and communities to change systemic practices that foster procedural injustice.

A presente pesquisa objetiva identificar a natureza jurídica do instituto do consentimento do ofendido para o direito penal brasileiro atual, evidenciando o papel da vítima. Para tanto, inicia-se a pesquisa com uma análise sobre o ofendido, estabelecendo sua evolução histórica, seu conceito atual, bem como os conceitos de vitimologia e vitimodogmática. Logo, aborda-se o consentimento propriamente dito, determinando seu histórico, seu conceito, seu objeto (bem jurídico disponível), seus requisitos e diferenças em relação à autocolocação da vítima em risco. Em seguida, verifica-se o estado atual da questão da natureza jurídica do consentimento. Parte-se da legislação brasileira e do entendimento doutrinário atual. Em razão da predominância do entendimento pela causa de justificação, os fundamentos histórico dogmáticos do conceito material de antijuridicidade são verificados. Ainda no campo da análise da natureza jurídica, fundamental a análise da questão da tipicidade (formal e substancial) pressuposto da antijuridicidade. Assim, analisa-se o consentimento do ofendido como causa de exclusão da tipicidade material. Tendo em vista a teoria unitária, busca-se afastar a diferenciação entre o consentimento e o acordo. Na sequência, trata-se do direito comparado. Assim, torna-se possível a análise do consentimento do ofendido no direito penal brasileiro, tendo em vista a legislação penal em vigor. / This paper aims to identify the legal institute of the need for the offended persons consent for the current Brazilian criminal law, highlighting the role of the victim. To this effect, the study begins with an analysis of victims rights, establishing their historical evolution, the current concept, as well as the concepts of victimology and victim dogmatism (a branch that studies the behavior of crime victims and their contribution to the occurrence of the event, as well as the repercussion of that participation on setting the penalty imposed on the perpetrator). Then it examines consent itself, determining its history, concept, object (alienable rights), the requirements and differences in relation to the victims self-exposure to risk. Next it describes the current state of the legal nature of the consent question based on Brazilian legislation and the interpretation of legal scholars. Because of the predominant position regarding cause for justification, dogmatic historical foundations of the material concept of material illegality are addressed. Still in the field of the legal nature, it is fundamental to analyze the question of classification of the crime (formal and substantive), which is a presupposition for illegality. Therefore, consent of the offended person is analyzed as cause to exclude the classification of the act as a crime. Based on unitary theory, I argue against the distinction between consent and concurrence. Finally, the matter is examined from the perspective of comparative law, to analyze the issue of victims consent in current Brazilian criminal law.

Access control is a significant issue in any secure computer system. Authorization models provide a formalism and framework for specifying and evaluating access control policies that determine how access is granted and delegated among particular users. The aim of this dissertation is to investigate flexible decentralized authorization model supporting authorization delegation, both positive and negative authorization, and conflict resolution. A graph based authorization framework is proposed which can support authorization delegations and both positive and negative authorizations. In particular, it is shown that the existing conflict resolution methods are limited when applied to decentralized authorization models and cyclic authorizations can even lead to undesirable situations. A new conflict resolution policy is then proposed, which can support well controlled delegation by giving predecessors higher priorities along the delegation path. The thesis provides a formal description of the proposed model and detailed descriptions of algorithms to implement it. The model is represented using labelled digraphs, which provide a formal basis for proving the semantic correctness of the model. A weighted graph based model is presented which allows grantors to further express degrees of certainties about their granting of authorizations. The work is further extended to consider more complex domains where subjects, objects and access rights are hierarchically structured and authorization inheritance along the hierarchies taken into account. A precise semantics is given which is based on stable model semantics, and, several important properties of delegatable authorization programs investigated. The framework provides users a reasonable method to express complex security policy. To address the many situations in which users may need to be granted or delegated authorizations for a limited period of time, a temporal decentralized authorization model is proposed in which temporal authorization delegations and negations are allowable. Proper semantic properties are further investigated. Finally, as an application, the thesis shows how the proposed authorization model can be used in a e-consent system on health data. A system architecture for e-consent is presented and different types of e-consent models discussed. The proposed model is shown to provide users a good framework for representing and evaluating these models. / Doctor of Philosphy (PhD)

This thesis is an exploration of professional behaviour in health care settings, using a Model of Treatment Engagement that is developed as a tool for ethics critique. The Model is tested and refined using data on: a psychiatric ???treatment??? carried out on over 1,127 occasions in a 15 - 40 bed non-acute hospital during the period 1961-1979; the problematic withdrawal of all life-support from a 37 year old man who had suffered acute brain trauma some five days previously, in a tertiary hospital in March 2000; and a clinical experiment recently proposed for the emergency setting and intended to encompass five hospitals and the NSW Ambulance Service. In each case, the Model proves useful in identifying the shift from the treatment paradigm and the ethical imperative of ensuring the patient (or his/her agent) appreciates the difference between what is proposed and what would normally be done. It reveals how doctors who dealt with the patient but did not decide on treatment contributed to ethically troublesome practice. It clarifies how having multiple doctor players in the treatment situation gave rise to the need to suppress dissenting views. Doctors who were close enough to the action to comprehend its nature, by not dissenting, reinforced the problematic choice for the actor and validated it in the eyes of observers. The lack of dissent at the level of doctors working under supervision, appeared to be a function of institutional arrangements. At the consultant level, there was evidence of pressure to concur from other consultants and indirect evidence of a fear of ostracism. The public responses in the two modern cases point to there being a strong idea in Sydney???s medical community that dissent should not be publicly displayed once a decision on how to treat has been made. I conclude there are two steps to reviewing ethically problematic treatment situations. The first consists of identifying the shift from the treatment paradigm. The second consists of establishing why the problematic choice is translated into action. The Treatment Engagement Model is put forward as a useful tool for both these analyses.

Due to the costly and technically challenging nature of genetic testing, methods have been developed to target more specifically those who are at increased risk of carrying the Hereditary Non-Polyposis Colorectal Cancer (HNPCC) mutation. HNPCC is an inherited colorectal cancer syndrome. Testing of tumour material (which has previously been removed during surgery) for features of HNPCC has been found to be an effective and economic method of identifying those at higher risk of having a mutation. Only those at higher risk of having a mutation will undergo genetic testing. This practice of “tumour testing” has become widespread. / There is currently no clarity about requirements for consent prior to testing of stored tumour tissue. The person giving consent to tumour testing does not always have an appointment with a genetics service prior to giving consent. This can be contrasted to genetic testing on blood samples where laws and guidelines state that informed consent is required prior to genetic testing and that comprehensive genetic counselling and support should be provided as part of this process. Protocols for genetic testing have been developed as a result of extensive research around the impact and implications of genetic testing. / Consumer opinion and participation through research is an important aspect of health policy and guideline development. Accordingly the purpose of this study was to contribute to such development by gaining insight into the experiences, understandings, decision making processes and opinions of those who had given consent to have their own or their relatives tumour tested. Seventeen people who had given consent for tumour testing either for themselves, or on behalf of a deceased relative were recruited through a Familial Cancer Centre and in-depth interviews conducted. The interviews were transcribed and analysed using thematic analysis. / Some participants had no memory of consenting to tumour testing. Others remembered basic concepts. Negative implications of testing were unknown or viewed as unimportant. Participants did not understand the difference between tumour testing and germline testing. Despite lack of memory or understanding participants did not want additional or more detailed pre-test information although they did want more follow-up and support after receipt of results. The decision to consent to testing was made as soon as participants were informed of the availability of tumour testing - the major reason being to provide information for the family that would aid in cancer prevention. Participants were more concerned with accessibility to testing than pre test information and counselling. / Findings in this study indicated participants made decisions heuristically rather than systematically and this as well as participants’ opinions and other decision-making research has implications for the traditional view of informed consent around genetic related decisions. This in turn has implications for policy and guidelines in the area. Implications for current practise as a result of findings from this study include ensuring participants understand negative implications of testing and follow up and support of those with negative as well as positive results to tumour testing.