With a subpoena in one hand and a donor agreement in the other, what choice should an ethical archivist make? Since the legal battle over the Belfast Project—a collection of oral histories from Northern Irish paramilitaries about their involvement in the Troubles—at Boston College erupted in 2011, such a scenario has become a reality. With U.S. attorneys demanding access in the name of truth and justice, and historians advocating denial for the sake of scholarship and honor, the archival profession is facing some troubling legal and ethical issues. Regardless of the ultimate fate of the Belfast Project, the archival field will have to adapt to a new reality. This reality will have to consider the effects of the law and oral history practices on archives. Should archives be granted privilege recognized within the legal system? Should there be oversight for oral histories? Should archives offer privacy protections for third parties? How can the archival community address these issues? This thesis will use the Belfast Project to analyze legal and ethical issues facing archivists and explore what this means for the future of the profession. / text

Civil infrastructure facilities play a central role in the economic, social and political health of modern society and their safety, integrity and functionality must be maintained at manageable cost over their service lives through design and periodic maintenance. Hurricanes and tropical cyclones, tornadoes, earthquakes and floods are paramount among the potentially devastating and costly natural disasters impacting civil infrastructure. Even larger losses may occur in the future, given the population growth and economic development accompanying urbanization in potentially hazardous areas of the world. Moreover, in recent years, the effects that global climate change might have on both the frequency and severity of extreme events from natural hazards and their effect on civil infrastructure facilities have become a major concern for decision makers. Potential influences of climate change on civil infrastructure are even greater for certain facilities with service periods of 100 years or more, which are substantially longer than those previously considered in life-cycle engineering and may extend across multiple generations. Customary risk-informed decision frameworks may not be applicable to such long-term event horizons, because they tend to devalue the importance of current decisions for future generations, causing an ethical and moral dilemma for current decision-makers. Thus, intergenerational risk-informed decision frameworks that consider facility performance over service periods well in excess of 100 years and extend across multiple generations must be developed. This dissertation addresses risk-informed decision-making for civil infrastructure exposed to natural hazards, with a particular focus on the equitable transfer of risk across multiple generations. Risk-informed decision tools applied to extended service periods require careful modifications to current life-cycle engineering analysis methods to account for values and decision preferences of both current and future generations and to achieve decisions that will be sustainable in the long term. The methodology for supporting equitable and socio-economical sustainable decisions regarding long-term public safety incorporates two essential ingredients of such decisions: global climate change effect on stochastic models of extreme events from natural hazards and intergenerational discounting methods for equitable risk-sharing. Several specific civil infrastructure applications are investigated: a levee situated in a flood-prone city; an existing dam built in a strong earthquake-prone area; and a special moment resisting steel frame building designed to withstand hurricanes in Miami, FL. These investigations have led to the conclusion that risks can and should be shared across multiple generations; that the proposed intergenerational decision methods can achieve goals of intergenerational equity and sustainability in engineering decision-making that are reflective of the welfare and aspirations of both current and future generations; and that intergenerational equity can be achieved at reasonable cost.

Recent changes in legislation and access to information, through sources such as the media, may have influenced peoples' expectations for information about their prescribed medication. As a result, health care professionals may perceive an increased pressure to provide information. A case study approach was employed to examine the sources and scope of information patients draw upon when they are prescribed oral steroids for asthma. The aim was to examine the extent to which patients can be said to exercise an `informed choice' when they take prescribed medication. The role and importance of GPs (general practitioners) in informing the choices patients make was also examined. Both qualitative and quantitative methods were employed. Interviews conducted with both patients and GPs indicated `gaps' in understanding. Although the GP was the preferred source of information, patients reported that the choices they made were based on information from a range of sources. General practitioners justified not providing information to patients so as to `protect' patients from knowledge of side effects. However, there was some awareness of the range of sources of information used by patients. A vignette technique was employed to further investigate GPs' recognition and understanding of the range of sources of information patients' use to inform the choices they make. Approximately half of the GPs who responded to the vignette recognised the influences presented. General practitioners who had been practising for a shorter period of time were significantly more likely to recognise these influences. The conclusions draw on the literature of the sociology of the professions. In spite of the way in which the Government has sought to encourage patients to act as consumers, the state has also continued to endorse GPs right to make decisions concerning the level of information to provide. If GPs do not believe it is in the interests of patients to be provided with information to make choices about their medications then the information available to patients may be limited. This will have an impact on the ease with which patients may make `medically' informed choices about their prescribed medication. Only when the communication between patients and GPs improves, will it be possible for a relationship to develop where patients may be assured of gaining information from their GP at the level they feel is appropriate to enable them to make informed choices about their medication.

Introduction: There is little empirical evidence on voluntariness of participation in clinical trials due to absence of acceptable measures and universally accepted conceptual frameworks of voluntariness. Methods: A cross-sectional study was conducted in Zimbabwe to examine participants’ motivations, levels of voluntariness and perceptions about the effect of offers, pressures and threats on decision making. One hundred participants were recruited from an ongoing diagnostic trial. Questionnaires adapted from published research, the Perceived Coercion Scale and Voluntariness Ladder were used for data collection. Results: The need to access diagnostic services and treatment for tuberculosis was the main motivation for enrolment in the trial. Participants were not coerced to particpate in the trial but were offered bus fare. The offer had no effect on their decision to enroll in the trial. Conclusion: Immediate health benefits have a key impact on participants’ decisions to enrol in a clinical trial of a diagnostic technique. A comprehensive conceptual framework together with validated tools for assessing voluntariness in African contexts should be developed. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Introduction: Citizens of developing countries are often in vulnerable situations because of illiteracy, unfamiliarity with medical interventions, effects of war resulting in famine, and extreme poverty. The health-related conditions that arise out of these situations however make research in these populations vital and increasing funding for research on diseases that affect the world 's poor is making such research possible. The resulting tension between the need for research and the possibility of exploitation of participants' vulnerability, mandates the development of reliable ways of ensuring that participants' consent is voluntary, adequately informed and well understood. The Nuremberg Code emphasises the requirement of voluntariness in informed consent by insisting that participants should be able to exercise freedom of choice without the intervention of any element of force, fraud , deceit, duress, or other forms of constraint or coercion. Aim: This study assessed research participants' understanding and voluntariness of informed consent in a clinical trial. Methods: The study design was a cross-sectional analysis of the informed consent process. It consisted of qualitative and quantitative components. It was a cross-sectional survey of 75 research participants in a malaria clinical trial using questionnaires in the from of forced-choice check lists and patient self-report to assess voluntariness and understanding of informed consent. Data were analysed using SPSS V 17. Results: All the respondents involved in the clinical trial gave consent before they were recruited. The reasons for consenting to participate in the clinical trial ranged from the opportunity to get treatment (28%), opportunity for diagnosis of ailments (32%), to prevent illness (36%) and to receive information about medical care (4%). The major benefits participants attributed to taking part in the research were the opportunity to obtain treatment (59%), diagnostic tests (35%) and education (6%). Among the research participants, 10.7% believed that they should be paid for participation and about 8% felt that payment could influence their decision to participate because it could act as a motivation. They could however not proffer an amount that they would consider significant enough to influence their decision. There was no significant association between factors that influenced participation and age (p=0.533), sex (p=0.342), education (p=0.078), religion (p=0.144) and marital status (p=0.239). Almost all (98.7%) participants claimed that they had understood the information given to them during the consent procedure and they all gave consent without consulting anybody apart from the medical personnel.The majority of respondents - 74 (98.7%) - stated that they were not allowed to go home with the informed consent document, while 1(1 .3%) of the respondents said there was no need to go home with the informed consent document. In the assessment of understanding using the forced-choice checklist, however, only 37% understood issues concerning randomization of participants and only 28.8% understood issues about compensation for research related injury. Discussion and Conclusion: In this study, the voluntariness of participants was influenced by factors related to the benefits accrued through participation. The need for participants to make free and informed choices based on adequate information given by the investigator cannot but be emphasized as a right and not a privilege. In light of the limited understanding about randomization and injury compensation identified in this study, there is a need for additional protection of vulnerable populations. This could be in the form of allowing adequate time to enable the improvement of participants' understanding of the consent form, using innovative ways of explaining complex concepts such as randomization, and providing the necessary support to facilitate participants' right to self-decision, except when they are incapable of consenting. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Background. An inherent challenge in HIV prevention studies is making sure that trial participants understand the information. This study explored trial participants’ perceptions and comprehension of the informed consent process in a pre-exposure HIV prevention study. Method. Face-to-face in-depth interviews, using a study guide, were held with twenty interviewees purposively selected from ex-participants of an HIV prevention study. Audio-recorded data were transcribed, translated, coded using NVivo 8, and analysed according to themes. Results. The participants were all women between the ages of 18 and 40. Participants felt that key information had been given during the informed consent process. Most felt that the process of obtaining informed consent was rushed with some participants citing a need for more time to make a decision regarding participation. Some participants felt pressured to sign consent forms. Some found it difficult to ask questions and mixed feelings existed on male partner involvement in the decision-making process. Conclusions: Participants experienced the consent process as rushed and most only fully comprehended study concepts with time. Their concerns necessitate the reassessment of informed consent processes in a developing world setting. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Essay 1: Traffic research shares a fundamental dilemma with other areas of empirical research in which humans are potentially put at risk. Research is justified because it can improve safety in the long run. Nevertheless, people can be harmed in the research situation. Hence, we need to balance short-term risks against long-term safety improvements, much as in other areas of research with human subjects. In this paper we focus on ethical issues that arise when human beings are directly affected in the performance of research by examining how the ethical requirements in biomedical research can inform traffic research. After introducing the basic ethical requirements on biomedical research, each of the major requirements is discussed in relation to traffic research. We identify the main areas where biomedical research and traffic research differ, and where the ethical requirements from the former cannot easily be transferred to the latter. We then point to some of the issues that need to be addressed for a systematic approach to the ethics of traffic research. Essay 2: The requirement of always obtaining participants’ informed consent in research with human subjects cannot always be met, for a variety of reasons. In this paper, research situations where informed consent is unobtainable are described and categorised. Some of these kinds of situations, common in biomedicine and psychology, have been previously much discussed, whereas others, more prevalent in for example infrastructure research, introduce new perspectives. The advancement of new technology may lead to an increase in research of these kinds. The paper also provides a review of methods intended to compensate for a lack of consent and their applicability and usefulness for the different categories of situations are discussed, thereby providing insights into one important aspect of relevance for the question of permitting research without informed consent: how well that which informed consent is meant to safeguard can be achieved by other means. Essay 3: This paper starts with the assumption that it is morally problematic when people in need are offered money in exchange for research participation if the amount offered is unfair. Such offers are called “coercive”, and the degree of coerciveness is said to be determined by the offer’s potential to cause exploitation and its irresistibility. Depending on what view we take on the possibility to compensate for the sacrifices made by research participants, a wish to avoid “coercive offers” leads to policy recommendations concerning payment for participation. For sacrifices considered compensable we ought to offer either no payment or payment at a level deemed fair, while for sacrifices deemed incompensable we always ought to offer no payment. Essay 4: It is commonly thought that transactions that are the result of voluntary gift-giving do not constitute exploitation. This paper argues that exploitation is indeed possible in such situations, by showing how gift-giving can fulfil the two commonly proposed criteria for exploitation, namely that in an interaction between two persons one receives disproportionally little and the other disproportionally much of the resulting benefits, and that this disproportion is caused by the latter making inappropriate use of a disadvantage of the former. A theoretical approach to what such inappropriate use would amount to in cases of gift-giving is lacking. The paper therefore aims at spelling out such an approach. The method of reflective equilibrium inspires this endeavour, which proceeds by testing intuitions about examples that embody a set of possible conditions. It is concluded that three of the conditions are necessary for exploitation of gift-giving, namely (1) the giver incurs a loss, (2) the recipient has aimed for the gift, and (3) the gift is undeserved. / <p>QC 20140407</p>

Darbo tikslas: Įvertinti nėščiųjų pacienčių požiūrį į informuoto sutikimo doktrinos taikymą stacionarią pagalbą teikiančioje gydymo įstaigoje. Uždaviniai: Įvertinti nėščiųjų pacienčių informuotumą apie jų teises gydymo įstaigoje. Įvertinti pacienčių požiūrį į rašytinio sutikimo davimo procedūrą. Nustatyti ryšį tarp pacienčių savo sveikatos vertinimo, išsilavinimo ir jų nuomonės apie informuoto sutikimo doktrinos taikymą. Tyrimo metodika: Atlikta anoniminė anketinė KMUK Akušerijos–ginekologijos klinikos Akušerijos skyriaus pacienčių apklausa. Buvo apklaustos 304 nėščios pacientės (atsako dažnis 84,4 proc.). Duomenų analizei naudota SPSS 10.0 statistinės analizės paketas. Rezultatai: Atlikus tyrimą paaiškėjo, jog Pacientų teisių ir žalos sveikatai atlyginimo įstatymą žinojo 76,3 proc. respondenčių. Dauguma pacienčių (98,0 proc.) tvirtino, žinančios, jog turi teisę į informaciją apie savo sveikatos būklę. 92,6 proc. respondenčių nurodė, kad buvo supažindintos su visomis procedūromis, kurios bus atliekamos įstaigoje. Dauguma pacienčių (92,4 proc.) buvo patenkintos gauta informacija iš gydytojų. Statistiškai reikšmingai didesnė dalis pacienčių tvirtino, kad suprantamą informaciją apie jų sveikatos būklę: ligos diagnozę, gydymo metodus ir gydymo eigą, gydymo prognozę ir galimus gydymo rezultatus, galimus alternatyvius gydymo metodus joms suteikė gydytojas lyginant su pacientėmis, tvirtinusiomis, jog minėtą informaciją suprantamai pateikė akušerė (p<0,001). 77,9 proc. nėščiųjų... [toliau žr. visą tekstą] / Aim of the study. To evaluate the pregnant patients’ opinion about application of the doctrine of informed consent. Objectives: 1. To evaluate knowledge of pregnant patient about their rights in the health care institution. 2. To evaluate patients’ opinion about procedure of the written consent. 3. To compare patients’ opinion about application of the doctrine of informed consent with self -assessed health and education. Methods. Anonymous survey of 304 pregnant patients (response rate – 84.4 percent) at Kaunas Medical University Clinic was carried out. SPSS 10.0 version of statistic analysis program was used to process the data. Results. Study revealed that the Law on patients‘rights and the compensation of the damage inflicted upon patients’ heath were known for 76.3% of the respondents. The majority of patients (98.0%) maintained aware about the right to information about their health status. 92.6% of respondents claimed, that they were informed about all procedure performed in the institution. The majority of patients (92.4%) were satisfied with the information delivered by the physician. Statistically significant higher part of patients maintained, that comprehensible information about their health: diagnosis, treatment, prognosis, results was delivered by the physician in comparison with the patients who emphasised that given information was provided by obstetrician (p<0,001). 77.9% of pregnant revealed being satisfied with the informed consent procedure. 22.1% of... [to full text]

Darbo tikslas. Įvertinti onkologinėmis ligomis sergančių pacientų nuomonę apie informuoto sutikimo doktrinos taikymą N sveikatos priežiūros įstaigoje. Uždaviniai. Įvertinti pacientų informuotumą apie rašytinio sutikimo doktrinos paskirtį sveikatos priežiūros įstaigoje. Nustatyti ryšį tarp onkologinėmis ligomis sergančių pacientų požiūrio į informuoto sutikimo doktrinos taikymą bei pacientų lyties ir išsimokslinimo. Nustatyti ryšį tarp pacientų pasitenkinimo gydytojų suteikiama informacija apie ligą ir jų nuomonės apie informuoto sutikimo doktrinos reikalingumą. Tyrimo metodika. N sveikatos priežiūros įstaigoje atlikta anoniminė anketinė 250 pacientų apklausa (atsako dažnis – 75,7 proc.). Duomenų analizei naudotas SPSS 13.0 statistinės analizės paketas. Diagramos ir lentelės parengtos Microsoft Excel 2003 programa. Rezultatai. Beveik pusė visų apklaustųjų (44,8 proc.) manė, kad sveikatos priežiūros įstaigoje pacientams pasirašyti pateikiamos asmens informuoto sutikimo formos paskirtis - apsaugoti sveikatos priežiūros specialistus nuo galimų pacientų pretenzijų, 35,6 proc. respondentų nuomone, informuoto sutikimo forma padeda pacientams išreikšti su jų gydymu susijusį apsisprendimą, 18,8 proc. apklaustųjų manė, kad tai formali procedūra. Didesnė dalis vyrų (34,5 proc.) nei moterų (18,4 proc.) visai neskaitė ligoninėje jiems pateiktų asmens informuoto sutikimo formų (p<0,01). Statistiškai reikšmingai daugiau respondentų, turėjusių nebaigtą vidurinį ar pradinį išsimokslinimą (24... [toliau žr. visą tekstą] / Aim of the study. To evaluate the oncology patients` opinion about application of the doctrine of informed consent in the health care institution. Objectives. To evaluate patients` knowledge about the purpose of the doctrine of informed consent at the health care institution. To identify associations between oncology patients` opinion about application of the doctrine of informed consent, patients` gender and education. To identify associations between patients` satisfaction with given information about their disease and patients` opinion about the necessity of the doctrine of informed consent. Methods. Anonymous survey of 250 oncology patients (response rate – 75.7%) in health care institution was carried out. SPSS 13.0 version of statistic analysis program was used to process the data. Diagrams and tables were prepared using Microsoft Excel 2003 program. Results. Nearly half of the survey participants (44.8%) evaluated written informed consent procedure as protection instrument to the health care specialists. More than the one third (35.6%) of the participants thought that the doctrine of informed consent helped them to express their decision, to 18.8% of the survey participants the doctrine was formal procedure. Statistically significantly bigger proportion of male (34.5%) than female (18.4%) claimed that they haven`t read the text of signed informed consent form at all (p<0.01). Statistically significantly higher proportion of respondents with the lowest level of... [to full text]

Darbe nagrinejamas informuotas paciento sutikimas medicininio gydymo kontekste, sutikimui keliami reikalavimai, teisės aktų, susijusių su pacientų teisėmis normos. / The aim of this work was to answer the legal question whether rendering of the standard consent form to the patient and signing of it can be regarded as a proper informed consent.The growing availability of medical information sources, involvement of mass media and TV programs has enabled patients to get more information about medical care, so as a consequence, informed decision making became a central topic in doctor – patient communication.