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In order to ensure the generalizability of clinical research studies, researchers and study sponsors are tasked with making efforts to ensure that research participants are racially and ethnically representative of the population at large. However, minorities and women continue to be underrepresented in medical research studies. To encourage participation in medical research studies, researchers are often inclined to offer compensation for study participation. However, it is vital that researchers consider the ethical implications of monetizing participation in medical research studies. The first aim of this paper is to discuss the ethical ramifications of providing compensation for research participation. Additionally, this paper will critically analyze the various ways of handling financial compensation for participation in medical research studies involving experimental drugs, devices or surgical techniques. Information for this paper was gathered by conducting a literature review and by analyzing 121 semi-structured interviews. Using an ethical framework, and supported by qualitative data from the interviews, this paper will discuss the ethical concerns that researchers must consider when offering monetary compensation in exchange for participation in medical research. Overall, the paper aims to show that in order for clinical research to be conducted ethically, we must grant potential participants the autonomy to use their own decision making framework when deciding whether or not to participate in a medical research study. While a potential participant’s decision to join a research study in exchange for financial compensation may raise concerns to some people, autonomy requires that the research institution respect each individual’s own motivations and decisions. / Urban Bioethics

Russia’s nuclear signaling since the start of the war in Ukraine has been prevalent but far fromeasy to understand. Nuclear threats are often ambiguous and vague—prompting one to wonderjust how effective they are as a coercive tool in general and in the Ukraine war in particular.The destructive potential of nuclear weapons has been described as providing nuclear states witha coercive advantage towards non-nuclear states. Not only as a tool of deterrence but as a tool ofcompellence. However, there may be certain communicative and credibility issues in the way ofsuccessful nuclear coercion. We use data of Russian nuclear signaling in the first 18 months ofthe war in Ukraine and investigate whether these signals are recognized by the Ukrainiangovernment and whether their credibility is questioned. The investigation concludes that Russiannuclear threats are recognized and that the credibility of nuclear threats are sometimesquestioned albeit not consequently. This suggests that the responses to nuclear threats may bejust as ambiguous and vague as the actual threats themselves.

Introduktion: Antalet personer i Sverige som vårdades inom slutenvård enligt lagen om psykiatrisk tvångsvård under 2022 var ungefär 12 600 personer. Tvångsvård kan endast genomföras om strikta kriterier uppfylls, inklusive ett akut och oundgängligt vårdbehov som inte kan tillgodoses frivilligt. Tvångsvård syftar till att patienter ska bli kapabla att frivilligt delta i vidare behandling, men det saknas forskning kring dess effektivitet och patientupplevelser. Syftet: Syftet med examensarbetet var att undersöka patienters upplevelser av tvångsvård på psykiatrisk vårdavdelning Metod: Examensarbetet kombinerar deskriptiv design med en litteraturöversikt och kvalitativ metodologi. Tio artiklar söktes via databaser PubMed, Psycinfo och CINAHL som sedan kvalitetsgranskades och analyserades. Salutogena modellen KASAM som har tre dimensioner: begriplighet, meningsfullhet och hanterbarhet användes som teoretisk referensram. Resultat: Analysen resulterade i två huvudkategorier. Den första var upplevelser av brist på sammanhang med underkategorierna: maktlöshet och kontrollförlust, meningslöshet, hopplöshet och hjälplöshet, maktobalans och att inte bli sedd och förlusten av autonomi och identitet. Den andra huvudkategorin var upplevelser av återvunnet sammanhang med underkategorierna: återtagandet av kontrollen, gott bemötande och nödvändig process till förbättring.  Slutsats: Resultatet visar att tvångsvård kan leda till negativa upplevelser som maktlöshet och kontrollförlust, och att vårdtiden upplevs som meningslös. Det kan även leda till positiva upplevelser och förbättra den psykiska hälsan. / Introduction: The number of people in Sweden who were hospitalized under the Compulsory Psychiatric Care Act in 2022 was approximately 12,600. Compulsory care can only be implemented if strict criteria are met, including an acute and indispensable need for care that cannot be voluntarily met. The purpose of compulsory care is to enable patients to voluntarily participate in further treatment, but there is a lack of research regarding its effectiveness and patients’ experiences. Aim: The purpose of the thesis was to investigate patients' experiences of compulsory care in psychiatric wards. Method: The thesis combines descriptive design with a literature review and qualitative methodology. Ten articles were searched through the databases PubMed, Psycinfo, and CINAHL, which were then quality assessed and analyzed. The salutogenic model Sense of Coherence (SOC), which has three dimensions: comprehensibility, meaningfulness, and manageability, was used as the theoretical framework. Results: The analysis resulted in two main categories. The first was experiences of a lack of coherence with the subcategories: powerlessness and loss of control, meaninglessness, hopelessness and helplessness, power imbalance and not being seen, and loss of autonomy and identity. The second main category was experiences of regained coherence with the subcategories: regaining control, positive treatment, and necessary process for improvement. Conclusion: The results show that compulsory care can lead to negative experiences such as powerlessness and loss of control, and that the time in care is perceived as meaningless. It can also lead to positive experiences and improve mental health.

Bakgrund När en person vårdas under psykiatrisk tvångsvård begränsas individens rätt till självbestämmande. Patienter som omfattas av tvångsvård har ofta komplexa psykiatriska tillstånd som kräver särskild omsorg för att skydda både patienten själv och andra från potentiell skada. Denna typ av vård kan vara nödvändig för personer som för tillfället inte äger beslutskompetens. Tidigare forskning pekar på att patienters erfarenheter av ofrivillig sjukhusvistelse bör beaktas och utforskas för att förbättra vårdpraxis. Syfte Att beskriva patienters upplevelser av tvångsvård inom psykiatrisk vård. Metod En systematisk litteraturöversikt genomfördes. Data samlades in genom Cinahl complete och PubMed. Urvalet bestod av elva kvalitativa och kvantitativa vetenskapliga originalartiklar publicerade mellan år 2009–2024. Materialet tematiserades och därefter diskuterades resultatet i relation till begreppet autonomi enligt Beauchamp och Childress definition. Resultat Resultatet består av tre teman: Upplevd brist på autonomi, upplevd tvångsvård kan ändra attityden, och upplevelser av vårdrelation. Patienter i psykiatrisk tvångsvård upplever ofta en brist på autonomi, vilket främst förknippas med otillräcklig information och negativa erfarenheter av tvångsåtgärder. Många känner sig ignorerade och missförstådda av vårdpersonalen. De som utsätts för flera olika tvångsåtgärder eller har dåliga erfarenheter tenderar att utveckla en negativ syn på psykiatrin Sammanfattning Det framkom att patienter inom tvångsvård oftast upplever negativa effekter, såsom förlust av autonomi och bristande kommunikation. Dessa känslor av obehag tenderade att inte bemötas tillräckligt. För att undvika sådana negativa upplevelser behöver organisatoriska brister åtgärdas genom ökad kunskap och medvetenhet. / Background When a person is under psychiatric involuntary care, the individual's right to self-determination is restricted. Patients subject to involuntary care often have complex psychiatric conditions that require special attention to protect both the patient themselves and others from potential harm. This type of care may be necessary for individuals who currently lack decision-making capacity. Previous research indicates that patients' experiences of involuntary hospitalization should be considered and explored to improve care practices. Aim To describe patients' experiences of involuntary treatment within psychiatric treatment. Method A systematic literature review was conducted. Data was collected through Cinahl Complete and PubMed. The selection consisted of eleven qualitative and quantitative scientific original articles published between 2009 and 2024. The material was thematized, and then the results were discussed in relation to the theory of autonomy according to Beauchamp and Childress' definition. Results The results consist of three themes: Perceived lack of autonomy, experienced compulsory care can change the attitude and experiences of the care relationship. Patients in psychiatric involuntary care often experience a lack of autonomy, primarily associated with insufficient information and negative experiences of coercive measures. Many feel ignored and misunderstood by staff. Those who are subjected to multiple coercive measures or have poor experiences tend to develop a negative view of psychiatry. Summary It emerged that patients in involuntary treatment usually experience negative effects, such as loss of autonomy and inadequate communication. These feelings of discomfort tended not to be adequately addressed. To avoid such negative experiences, organizational deficiencies need to be addressed through increased knowledge and awareness.

This study will endeavor to present an analysis of the process in which the National Labor Relations Board gave specific meaning to "interfere with, restrain or coerce" found in section 8(1) of the National Labor Relations Act of 1935. Under Section 8(1) of the Act, the Labor Board, subject to judicial review, has the authority to declare illegal any management procedure which in its opinion involves interference, restraint or coercion.

<p>The use of coercion in psychiatry involves clinical, legal, scientific, ethical and emotional considerations. This thesis represents an attempt to further increase our understanding of some empirical aspects of this phenomenon. </p><p>Interviews with 202 involuntarily admitted psychiatric patients and 201 voluntarily admitted patients and 295 of their next of kins were performed and analysed together with data from records and assessments made by professionals. Data was collected during two different periods of time with a compulsory psychiatric care law reform in between.</p><p>Experience of at least one coercive measure was more common amongst patients who had been committed during the most recent legislation. Otherwise there were no differences in patient experiences during the different laws.</p><p>Subjective short-term outcome was associated with having a contact person at the ward and being subjectively treated well. There were no relationships between subjective and assessed outcome or between legal status, perceived coercion at admission and subjective or assessed improvement.</p><p>The changed legislation had no clear effect on the attitudes of patients and next of kins towards coercion.</p><p>A majority of patients were able to accurately answer the question whether they had been restrained by belt or not during a specific treatment episode. Nineteen of 115 patients reported they had been restrained by belt. Eleven of these cases were true positive and 8 cases were false positive. </p><p>In conclusion, the main results were first that when it comes to issues related to psychiatric coercion there are typically considerable differences between how these are perceived and interpreted by the professional and by the patient, and second that efforts made to change the face of psychiatric coercion in the minds of patients as well as the public on part of public policymakers have had limited effects.</p>