MSc (Med) (Bioethics and Health Law), Faculty of Health Sciences, University of the Witwatersrand / Parental Consent or Refusal to Consent to HIV Testing in Children The acquired immune deficiency syndrome (AIDS) continues to represent the greatest infectious threat to humans of all time. It is estimated that some 33 million people are currently infected with the causative organism, the human immunodeficiency virus (HIV). More than 2 million of these are children. The AIDS epidemic now has its epicenter in sub-Saharan Africa where 75% of deaths occur. The treatment of AIDS with antiretroviral drugs (ARVs) has changed the outcome from inevitably fatal over months to years, to a chronic but manageable condition. Adherence to treatment is essential for maintaining good health and avoiding the development of resistance. Young children with HIV infection usually obtain the virus from their infected mother at, or about the time of birth or via breast milk. Prevention of mother to child infection (PMTCT) is possible through the use of ARVs and this has resulted in a dramatic decrease in infected children in the developed world. Poor provision and uptake of PMTCT in the developing world means that many children are still being infected. In these environments, over 60% of the children who die are infected. Treating these children with ARVs will usually prevent death and return the child to a good quality of life in the family. It is necessary to test the child for infection before embarking on life-long complex treatment and this is done by testing blood or saliva for the virus or antibodies to the virus. A positive test in the child is usually a proxy for a positive test in the mother and this obviously has profound implications for her life. In all infants suspected of infection, a test is advised. In the Rahima Moosa Mother & Child Hospital about 10-15% of mothers refuse testing for their infants. These children are therefore denied the opportunity for life-saving treatment. This essay discusses the reasons why mothers may refuse HIV testing for their infants and explores the possible ethical choices and responses of healthcare workers to this refusal.

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No description available.

Esta pesquisa teve como objetivo conhecer a percepção de familiares de potenciais doadores sobre os motivos considerados para recusar a doação dos órgãos e tecidos para transplante. Para compreender a percepção dos familiares optou-se por realizar uma pesquisa qualitativa, segundo a modalidade \"estrutura do fenômeno situado\". Como forma de desvelar o fenômeno foram entrevistadas oito famílias, utilizando as seguintes questões norteadoras: \"Como foi a tomada de decisão para recusar a doação dos órgãos e tecidos para transplante do seu familiar falecido?\" e \"Quais os motivos considerados para recusar a doação?\". Após a obtenção das descrições, os discursos foram analisados individualmente, sendo feita a análise ideográfica, resgatando os seguintes temas e subtemas: \"Relatando a internação do familiar\", \"Vivenciando a perda do familiar\": \"Recebendo a informação da morte encefálica e a solicitação da doação\", \"Sofrendo com a perda do familiar\"; \"Decidindo pela recusa da doação dos órgãos\": \"Conversando sobre doação\", \"Respeitando a decisão tomada\"; \"Apresentando os motivos de recusa da doação dos órgãos\": \"A crença religiosa\", \"A espera de um milagre\", \"A não compreensão do diagnóstico de morte encefálica e a crença na reversão do quadro\", \"A não aceitação da manipulação do corpo\", \"O medo da reação da família\", \"A inadequação da informação e a ausência de confirmação da morte encefálica\", \"A desconfiança na assistência e o medo do comércio de órgãos\", \"A inadequação no processo de doação\", \"O desejo do paciente falecido, manifestado em vida, de não ser um doador de órgãos\" e \"O medo da perda do ente querido\". Buscou-se desvelar, pela análise nomotética, as convergências e divergências das unidades de significado interpretadas, em direção a estrutural geral do fenômeno. As proposições que emergiram revelaram que a essência do fenômeno \"A recusa familiar no processo de doação de órgãos e tecidos para transplante\" foi desvelada como vivenciar uma situação de choque e desespero com a internação do familiar, de desconfiança com a solicitação da doação dos órgãos, de negação da morte encefálica, de sofrimento e desgaste diante da perda do ente querido, de conflitos familiares para a tomada de decisão e de múltiplas causas para a recusa da doação / This research had as its target learn the perception of potential donator`s familiy on the considered reason for the organs and tissues donation refusal for transplant. In order to understand the family perception a qualitative research was chosen, according to the modality \"situated phenomena structure\". In way of unveil the phenomena eight families were interviewed, having these questions as a guide:\"How was the decision taken in order to refuse the organs and tissues donation for tranplant of your deceased next of kin?\" and \"Which are the reasons weight for the donation refuse?\". After getting the descriptions, the speech were individually analysed, where a ideographic analysis was taken, recovering the folowing themes and sub themes : \"Telling next of kin as in patient\", \"Witness the next of kin\'s loss\": \"Receiving the encephalic death information and the solicitation for donation\", \"Suffering the next of kin\'s loss\"; \"Taken the organs and tissues donation refuse\": \"Talking about donation\", \"Regarding the taken decision\"; \"Presenting the refusal organs and tissues donation reasons\": \"The religious belief \", \"A hope of miracle\" , \"The encephalic death diagnosis missuderstood and the believe of a reversion of the situation\", \"Disagreement on the body maneuver\", \"The worry of the family\'s reaction\", The information ineffectuality and the lack of the encephalic death confirmation\",. \"The assistance mistrust and the fear of organs market\", \"The deficiency of donation process\", \"The person\'s willing not to be an organ donator when alive\" and \"The fear of loosing the dearest next of kin\". Through out of the nomothetic analysis, the meaningfull units convergency and divergency been taken, directed to the general structure phenomena. The propositions which appeared shown that the phenomena essence \"The family refusal on the organs and tissues donation for transplant\" was unveiled as been trought a shock situation and disperation with the next of kin in patient situation, mistrust because of the organs and tissue donation requesting, the denying of encephalic death, suffering and exhausting before the loss of the beloved one, family conflicts in way of taken the decision and the multiple causes of organ and tissues donation refuse

Atsisakymo bendradarbiauti bylose taikytinų sąlygų susisteminimas ir jų ryšio su skirtingomis atsisakymo bendradarbiauti formomis nustatymas, manytina, yra esminė prielaida siekiant nubrėžti pagrįstą ribą tarp dominuojančio ūkio subjekto teisėto atsisakymo bendradarbiauti ir piktnaudžiavimo dominuojančia padėtimi. Atitinkamai magistro baigiamaje darbe, priešingai paplitusiai kazuistinei atsisakymo bendradarbiauti atvejų analizei, apibendrintai įvardijamos ir nagrinėjamos sąlygos, reikšmingos sprendžiant ar atsisakymas bendradarbiauti konkrečiu atveju laikytinas piktnaudžiavimu dominuojančia padėtimi. Magistro baigiamajame darbe patvirtinama hipotezė, kad visose atsisakymo bendradarbiauti bylose, įskaitant esminių išteklių ir atsisakymo suteikti intelektinės nuosavybės teisių licenciją atvejus, išpildytinos dvi kertinės – prašomo tiekti ištekliaus būtinumo ir konkurencijos pašalinimo – sąlygos. Daroma išvada, kad tik patenkinus šias dvi sąlygas galima tolesnė atsisakymo bendradarbiauti situacijos analizė sprendžiant, ar konkrečiu atveju ūkio subjekto atsisakymas bendradarbiauti laikytinas piktnaudžiavimu dominuojančia padėtimi. Darbe taip pat prieinama prie išvados, kad konkurencijos teisėje nėra konceptualaus skirtumo tarp esminių išteklių, atsisakymo suteikti intelektinės nuosavybės teisių licenciją ir kitų atsisakymo bendradarbiauti bylų tiek įvardijant atitinkamas bylas kaip atstovaujančias vienai iš atitinkamų doktrinų, tiek taikomų sąlygų atžvilgiu. Magistro baigiamąjį... [toliau žr. visą tekstą] / The essential premise when drawing a line between the legitimate refusal to deal by a dominant undertaking and its abuse of a dominant position is to file the conditions to be satisfied in refusal to deal cases and to understand their relations with different forms of refusal to deal. Therefore contrary to the common incidental analysis of refusal to deal cases, in this master thesis the conditions which are significant when deciding if refusal to deal in a specific case is to be considered abuse of a dominant position are identified and analyzed as a whole. In a master thesis the hypothesis is confirmed that in all refusal to deal cases, including essential facilities and refusal to licence intellectual property rights cases, two crucial conditions are to be satisfied – indispensability of an input and elimination of competition. The conclusion is drawn that only after satisfying these two conditions further analysis of a refusal to deal situation shall be carried on in order to decide if a refusal to deal by an undertaking is to be considered an abuse of a dominant position. The conclusion also drawn is that there is no conceptual distinction between essential facilities, refusal to licence intellectual property rights and other refusal to deal cases when attributing them to one of the respective doctrines and when identifying the conditions to be satisfied. Master thesis consists of two parts. First part analyses the concept of refusal to deal cases, different forms which... [to full text]

Esta pesquisa teve como objetivo conhecer a percepção de familiares de potenciais doadores sobre os motivos considerados para recusar a doação dos órgãos e tecidos para transplante. Para compreender a percepção dos familiares optou-se por realizar uma pesquisa qualitativa, segundo a modalidade \"estrutura do fenômeno situado\". Como forma de desvelar o fenômeno foram entrevistadas oito famílias, utilizando as seguintes questões norteadoras: \"Como foi a tomada de decisão para recusar a doação dos órgãos e tecidos para transplante do seu familiar falecido?\" e \"Quais os motivos considerados para recusar a doação?\". Após a obtenção das descrições, os discursos foram analisados individualmente, sendo feita a análise ideográfica, resgatando os seguintes temas e subtemas: \"Relatando a internação do familiar\", \"Vivenciando a perda do familiar\": \"Recebendo a informação da morte encefálica e a solicitação da doação\", \"Sofrendo com a perda do familiar\"; \"Decidindo pela recusa da doação dos órgãos\": \"Conversando sobre doação\", \"Respeitando a decisão tomada\"; \"Apresentando os motivos de recusa da doação dos órgãos\": \"A crença religiosa\", \"A espera de um milagre\", \"A não compreensão do diagnóstico de morte encefálica e a crença na reversão do quadro\", \"A não aceitação da manipulação do corpo\", \"O medo da reação da família\", \"A inadequação da informação e a ausência de confirmação da morte encefálica\", \"A desconfiança na assistência e o medo do comércio de órgãos\", \"A inadequação no processo de doação\", \"O desejo do paciente falecido, manifestado em vida, de não ser um doador de órgãos\" e \"O medo da perda do ente querido\". Buscou-se desvelar, pela análise nomotética, as convergências e divergências das unidades de significado interpretadas, em direção a estrutural geral do fenômeno. As proposições que emergiram revelaram que a essência do fenômeno \"A recusa familiar no processo de doação de órgãos e tecidos para transplante\" foi desvelada como vivenciar uma situação de choque e desespero com a internação do familiar, de desconfiança com a solicitação da doação dos órgãos, de negação da morte encefálica, de sofrimento e desgaste diante da perda do ente querido, de conflitos familiares para a tomada de decisão e de múltiplas causas para a recusa da doação / This research had as its target learn the perception of potential donator`s familiy on the considered reason for the organs and tissues donation refusal for transplant. In order to understand the family perception a qualitative research was chosen, according to the modality \"situated phenomena structure\". In way of unveil the phenomena eight families were interviewed, having these questions as a guide:\"How was the decision taken in order to refuse the organs and tissues donation for tranplant of your deceased next of kin?\" and \"Which are the reasons weight for the donation refuse?\". After getting the descriptions, the speech were individually analysed, where a ideographic analysis was taken, recovering the folowing themes and sub themes : \"Telling next of kin as in patient\", \"Witness the next of kin\'s loss\": \"Receiving the encephalic death information and the solicitation for donation\", \"Suffering the next of kin\'s loss\"; \"Taken the organs and tissues donation refuse\": \"Talking about donation\", \"Regarding the taken decision\"; \"Presenting the refusal organs and tissues donation reasons\": \"The religious belief \", \"A hope of miracle\" , \"The encephalic death diagnosis missuderstood and the believe of a reversion of the situation\", \"Disagreement on the body maneuver\", \"The worry of the family\'s reaction\", The information ineffectuality and the lack of the encephalic death confirmation\",. \"The assistance mistrust and the fear of organs market\", \"The deficiency of donation process\", \"The person\'s willing not to be an organ donator when alive\" and \"The fear of loosing the dearest next of kin\". Through out of the nomothetic analysis, the meaningfull units convergency and divergency been taken, directed to the general structure phenomena. The propositions which appeared shown that the phenomena essence \"The family refusal on the organs and tissues donation for transplant\" was unveiled as been trought a shock situation and disperation with the next of kin in patient situation, mistrust because of the organs and tissue donation requesting, the denying of encephalic death, suffering and exhausting before the loss of the beloved one, family conflicts in way of taken the decision and the multiple causes of organ and tissues donation refuse

Bakgrund: Mat- och dryckesvägran i livets slutskede är ett fenomen som sjuksköterskor inom palliativ omvårdad ofta stöter på. När en patient vägrar äta och dricka, uppstår frågor om hur symtomlindring och lindrat lidande bäst ska gå till, samtidigt som patientens autonomi och självbestämmande hedras. Syfte: Syftet var att belysa sjuksköterskors upplevelser och attityder kring att vårda patienter inom palliativ omvårdnad som frivilligt slutar äta och dricka. Metod: En allmän litteraturstudie med induktiv ansats utfördes. Datainsamlingen genomfördes i databaserna CINAHL, Pubmed och PsycINFO och resulterade i sju resultatartiklar. Resultat: Genom dataanalysen framträdde tre huvudkategorier: 1) Ett växande fenomen där sjuksköterskor upplever många brister 2) Sjuksköterskors attityder till patientens beslut 3) Sjuksköterskors upplevelser av att möta anhöriga. Den första kategorin lyfter sjuksköterskors upplevelser av de brister som försvårar deras möjlighet att vårda patienterna. Den andra kategorin belyser sjuksköterskors acceptans kring fenomenet. Den tredje kategorin belyser sjuksköterskors kontakt med anhöriga. Konklusion: Resultatet tyder på att sjuksköterskors upplevelser och attityder till frivillig mat- och dryckesvägran är mestadels positiva, men att sjuksköterskor efterfrågar mer information, utbildning, lagar och riktlinjer kring ämnet. / Background: Food and drink refusal at the end-of-life is a phenomenon that nurses in palliative care often encounter. When a patient refuses to eat and drink, questions arise about how symptom relief and alleviated suffering should best be done, while simultaneously respecting the patient's autonomy and self-determination. Purpose: The purpose was to illuminate the nurses' experiences and attitudes about caring for patients in palliative care who voluntary stop eating and drinking. Method: A general literature review with an inductive approach was conducted. The data collection was carried out in the databases CINAHL, PubMed and PsycINFO, which resulted in seven articles. Results: Through the data analysis, three categories emerged: 1) A growing phenomenon where nurses experience many deficiencies 2) Nurses' attitudes to the patient's decision 3) Nurses' experiences of meeting relatives. The first category highlights nurses' experiences of the deficiencies that make it difficult for them to care for the patients. The second category highlights nurses' acceptance of the phenomenon. The third category highlights nurses' contact with relatives. Conclusion: The results indicate that nurses' experiences and attitudes towards voluntary stopping of eating and drinking are mostly positive, but that nurses request more information, education, laws, and guidelines on the subject.

語言交際是人們運用語言傳遞訊息、交流感情的一種社會行為，日常生活中關於語用交際的現象很多，其中「拒絕」是常見的主題之一。影響拒絕言語行為施行的因素很多，包含了拒絕對象、目標、語境等，譬如晚輩拒絕長輩時會比同輩間的拒絕更為間接；私下場合比公眾場合的拒絕更來得直接。針對「跨文化交際」而言，影響拒絕言語行為的施行當然也包含了文化因素，不同文化的交際雙方可能因為價值觀以及對事物的解讀看法不一，因此在拒絕交際發生時會產生語用錯誤，造成交際上的誤會。 華語學習者累積的詞彙與語法隨著學習程度的提高而逐漸增加，語言技能的運用也因此漸趨成熟，但語用錯誤的發生大多是橫跨各學習程度的，即便是程度再高的學習者，也很容易發生交際上的語用錯誤。現今大部分的華語學習教材是以詞彙、句型與語法點為主要結構，雖然已經有些教材從語言能力觀點出發而規畫其結構、布局與進度，但是全面且有系統地討論專門、單一的言語行為的教材卻很少。 由於現今的華語教材以此主題來導入編寫的並不多，且現有的綜合性教材也缺乏對相關語用交際能力的介紹，忽略了學生實際語用交際的需求。學習者學習語言的目的就是能夠成熟、得體地運用於日常生活中，以達到人與人之間良好的動態交際，並達成傳遞訊息、聯絡感情的主要目的，而這種「得體」程度的表現主要來自於對目的語語用方面的瞭解程度，不僅止於詞彙、語法的學習。基於言語交際的動態性，筆者將拒絕視為一種言語行為，討論此一言語行為在華語中的語用策略及語言形式的表現，並將研究結果應用於教學層面，希望學習者能藉此增進語用交際能力，達到得體、有效率地溝通。 本論文旨在探討現代漢語交際中的拒絕現象與其延伸的相關教學研究，不僅對語用策略及語用形式作分析，也分析了現行教材的相關內容，期盼研究成果可以應用於對外華語教學層面，以便提供華語教師具體有據的教學內容與建議，並幫助外籍學生有效率地學習相關內容，提升學生實際交際運用的成果。 本論文主要以前人探討拒絕言語行為的研究成果作為基礎，透過前人的研究整理並輔以自己的實證分析把拒絕言語行為的基本組織、模式進行整理，並歸納出特定場合下使用頻率最高的拒絕模式與策略以提出教學應用。本研究主要採用調查研究法之問卷形式與內容分析法來探討以下內容：（一）語用分析—探究本文所選定之六類語境分別的拒絕策略與語言形式，依對象不同所表現的拒絕方式有何差異？（二）教材分析—分析現行教材中是否出現相關的教學內容，並歸納之中出現的拒絕語境與策略的頻率（三）教學應用—思考拒絕主題可應用的教學方式並提出相關的教學設計。藉此研究，筆者將對現代漢語的拒絕言語行為做整理歸納與分析，並對其中特殊的「間接拒絕」與「假拒絕」現象作進一步探討。接著，分析現行教材的相關教學內容並配合學生的學習需求，提出「拒絕」主題的教學設計。 研究結果歸納出了11類間接拒絕策略與5類輔助策略，並針對各語境歸納出了主要的拒絕模式。教學應用方面，主要是將研究結果編寫成教學內容，除了以各語境歸納出的拒絕模式導入對話的情景教學方法外，也思考了各拒絕策略可應用的教學方式。期盼研究成果可以應用於對外華語教學層面，除了提出相關主題教學時的應用方法外，也能提升教師的教學效率與學習者的學習成效。 / Verbal communication is a kind of social behavior which denotes activities as transferring messages or exchanging feelings by means of language. Various communicative actions appear in our daily life. Refusals are one of their most common forms. The performance of refusal speech varies greatly regarding to its objectives and contexts. The speech act of “indirect refusal”, for example, often occurs in situations where a younger person has to refuse a request of an elder one. “Direct refusal”, on the contrary, appears more in private occasions. Given the importance of context people with different cultural backgrounds easily fails to understand the more underlying pragmatic features of language. Although students of the Chinese language may gradually increase their lexical knowledge and become well-skilled in language performance, failures in decoding the pragmatic features still occur in many communicative situations. Even for advanced students understanding context poses a great challenge. Most teaching materials, however, focus on teaching vocabulary, phrases, and grammar. Some materials are designed according to various language competences. To lay focus on speech act sets, however, is still less common. The present thesis aims to analyze the speech act of refusal in Mandarin Chinese and wants to apply its results to the practical use of teaching Chinese. For the research in communicative behavior, the author collected data and results from different sources: 1. personal recordings of verbal behavior; 2. questionnaire for verbal behavior in different communicative situations; 3. theoretical discussions. First, based on the dynamic features of verbal communication, the author discusses refusal as speech act and analyzes its pragmatic strategies and linguistic structures. Different forms of refusal as indirect refusal and false refusal will be treated separately. Furthermore, the results of linguistic analysis will be applied to instructions for teaching in the hope that language learners can enhance both their communicative and pragmatic capabilities in a more efficient way. An analysis of common teaching materials is included, too. In detail, the present thesis includes four discussions: (1) Understanding the speech act of refusal: Based on previous theories the speech act of refusal will be discussed under different pragmatic perspectives. (2) Analyzing the speech act of refusal: Analyses of the pragmatic features and the linguistic structure of refusal are conducted for six different contexts. Eleven realization strategies of refusal and five supporting strategies of communicative behavior are discussed in detail. (3) Analyzing teaching materials: Frequency and methods of presenting different pragmatic features of refusal in teaching materials will be analyzed and evaluated. (4) Suggestions for teaching: Methods for teaching various speech acts of refusal are proposed according to the results obtained from the inquiries in its pragmatic and linguistic features. Examples for teaching different strategies and supporting strategies of refusal are included.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-04, page: 2059. Adviser: Ross Shegog. Includes bibliographical references.

本研究旨在探討台灣以英文為外語的國中生在拒絕時所採取的策略。資料收集由每組40位的青少年，共三組所組成。分為：以中文為母語的受試者 (NC)，以英文為外語的學習者 (EFL)，和以英文為母語的受試者 (NA)。實驗經由設計好的8個不同情境 ( 2個請求，2個建議，2個邀請，2個提供 )，分別為4種不同的拒絕的「完成對話問卷」(DCT) 來達成。距離和性別是二個控制的變項。120 位受試者的回答根據直接拒絕、間接拒絕、不拒絕、沒有回應四種拒絕策略分類。卡方檢定用來分析三組間是否有統計上的顯著差異。 結論顯示，以中文為母語的，以英文為外語的，和以英文為母語的這三組在表達拒絕時，確實有顯著差異。以中文為母語的 (NC) 和以英文為外語的 (EFL) 二組比較喜愛使用間接拒絕策略；而以英文為母語的 (NA) 這一組傾向選擇直接拒絕策略。此外，以英文為外語的 (EFL) 這組的表現常出現遵循他們母語 (L1) 的模式，雖然他們有些行為表現顯示出受到外語文化 (L2) 的影響。此外，或許由於缺乏足夠的語言能力，以英文為外語 (EFL) 的一組，在拒絕時，傾向表達過多的道歉。因此本研究建議，教師在教學上應幫助學生學習多使用綜合的拒絕策略來取代過多或不必要的道歉。根據以上的發現，本研究也提出一些在英語教學上的啟示和應用，以及對未來研究的建議。 / The purpose of the study was to investigate what strategies were employed when EFL junior high school students in Taiwan performed a refusal. The data collected from three groups of forty teenagers in each group: native Chinese speakers (NC), EFL learners (EFL), and native American English speakers (NA). The experiment was carried out through the Discourse Completion Task (DCT), which was designed to eight situations: 2 requests, 2 suggestions, 2 invitations, and 2 offers to elicit four types of refusal. Two social variables, distance and gender, were controlled. Responses from 120 participants were categorized according to refusal strategies including direct refusal, indirect refusal, non-refusal, and no response. The chi-square was employed to test the presence of statistically significant difference existing across the three groups. Results revealed that the Chinese, the EFL, and the American groups were virtually different in expressing refusals. The Chinese and EFL groups preferred to employ indirect refusal strategies, while the American group tended to select direct ones. Moreover, the performance of the EFL group frequently followed their L1's norms, although some of their behaviors were influenced by the L2's culture. Besides, perhaps due to a lack of sufficient pragmatic knowledge and vocabulary, the EFL group tended to express more regret when performing a refusal. Therefore, the present study suggests that the instructors may help learners acquire the usage of combination strategies to decline rather than utilizing verbose or unnecessary regret. Based on the findings, the study also proposed some pedagogical implications and suggestions for future research.