Thesis (DClinPsychol)-Salomons Centre. BLDSC no.DX220778.

The new law of consent in Sweden came into force in 2018 and the purpose of the law has been to clarify each person's right to personal and sexual integrity. The law has both been praised and criticized by many people. This study examines and problematizes how the new law of consent is perceived by men and women and what characterizes sexual consent. A qualitative research method was used in the study whereby eight heterosexual men and seven heterosexual women of different ages were interviewed. Empirical data of the study has been analyzed with the help of theories of sexual script and gender-based power. The theoretical framework of the study has also been shaped by understandings of changeable discourses of sexuality and sexual consent. The study shows that sexual consent is a complex process as it is an aspect of intimate relations involving sexual interaction and thereby includes many gray zones. How sexual consent is exercised in practice depends on whether men and women are in stable relationships or have temporary partners. Heterosexual norms about sexuality based on gender power characterize how sexual consent is exercised. The consent process is described as quite abstract by several informants as non-verbal consent seems to be most common during the sex act.

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Vascularized composite allotransplantation (VCA) has emerged over the last two decades as a promising therapeutic option for persons who have suffered the loss of limbs or who have suffered major facial disfigurement. Despite the clear advantages of facial and upper extremity VCA in terms of function and cosmesis, VCA has elicited a great deal of ethical concern. Much of that concern is centered around whether or not persons should be exposed to the toxic side effects and possible shortening of life associated with immunosuppression as part of treatment for conditions which are not life-threatening. Ethical concern has also been raised about the vulnerability, dignity and autonomy of VCA candidates and about the justice of allocating the necessary resources to research a treatment that seems unlikely to become widely available in the foreseeable future. <br>While this dissertation will demonstrate familiarity with the technical aspects of VCA, and with the ethical issues just mentioned, its focus will be on the implications of this new therapeutic option for the manner in which consent is understood. In particular, it will argue that the nature and duration of the treatment involved in upper extremity and face transplants makes necessary some modification to the theory and practice of consent. The concept of covenant will be put forward as a resource for this modification. Covenants, as agreements which establish and maintain on-going personal relationships of mutual obligation, are both durable and flexible. Covenants, by engaging persons affectively, promote commitment and encourage the formation of strong therapeutic alliances. Such alliances are especially fitting in light of the lengthy and demanding course of VCA, from screening through surgery and years of physiotherapy, maintenance of immunosuppression and self-monitoring for signs of rejection. <br>Covenant consent is needed for VCA because it more adequately describes what is being asked of recipients and what is necessary for the treatment to succeed. It is also needed because it appropriately honors the recipients by understanding them as active partners rather than as passive patients, and as people assuming major burdens and risks while contributing meaningfully to the development of the field. The employment of covenant consent significantly strengthens the ethical justification for vascularized composite allotransplantation of faces and upper extremities by acknowledging what is actually required of patients and by creating a structure through which they are supported in carrying out their commitment through the long, arduous period of rehabilitation and beyond. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

ABSTRACT To develop a more efficient way of informing potential clinical trial volunteers of exactly what they could expect during (and after) their participation in a clinical trial as well as the sponsor’s expectations from the volunteer. A multiple choice questionnaire, which was based on the criteria as specified by Guideline 5 of the International Conference of Harmonization (ICH), was administered to 28 Volunteers after only reading the Patient Information Leaflet/Informed Consent Document (PIL/PIL/ICD), to 21 Volunteers who had read the PIL/ICD and attended a question and answer session, to 17 Volunteers who had read the PIL/ICD and attended a presentation and 19 Volunteers who had read the PIL/ICD and attended a presentation and a question and answer session. In total, 85 Volunteers completed the questionnaire. The average calculated percentage* of volunteers who had only read the PIL/ICD was 61%, 63% for Volunteers who had read the PIL/ICD and attended a question and answer session, 73% for Volunteers who had read the PIL/ICD and attended a presentation and 68% for Volunteers who had read the PIL/ICD and attended a presentation and question and answer session. In total, the average calculated percentage was 66%. Eighty four percent of the total number of volunteers answered the question on withdrawal consequence incorrectly, 43% of Volunteers answered questions on side effects incorrectly and 100% of the Volunteers answered the question on the duration of storage of samples incorrectly. Despite increasing regulatory and ethical scrutiny, deficiencies still exist in Volunteer comprehension of the research in which they participate, as well as differences in how comprehension is measured and assessed. Results indicated that any successful consent process should, at a minimum, include a visual communication mode. Concepts that are not well understood within the South-African context are withdrawal consequence, methodology such as double-blind or single blind, side effects, duration of archiving, treatment alternatives and the role of the investigator. *calculated % for each volunteer = score out of 25 x 100

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Established within the context of a severe shortage of organs and tissues for transplantation, this thesis explores whether presumed consent for cadaveric organ donation is a legitimate policy choice for Ontario. The medical, legal and social reasons underlying organ scarcity and increased demand for transplantation are examined, and the shortcomings of Ontario’s current express consent system are analyzed. The various criticisms of presumed consent are also explored, including concerns with respect to its effectiveness, level of public support and implications for personal autonomy. Although the Citizens Panel on Increasing Organ Donations recommended against enacting presumed consent legislation, it is argued that the Panel was too dismissive of this concept given a perceived lack of public support. It is concluded that presumed consent can meet the concerns of critics, and that as part of a broader strategy could significantly increase the number of cadaveric organ and tissue donors in the province.

Established within the context of a severe shortage of organs and tissues for transplantation, this thesis explores whether presumed consent for cadaveric organ donation is a legitimate policy choice for Ontario. The medical, legal and social reasons underlying organ scarcity and increased demand for transplantation are examined, and the shortcomings of Ontario’s current express consent system are analyzed. The various criticisms of presumed consent are also explored, including concerns with respect to its effectiveness, level of public support and implications for personal autonomy. Although the Citizens Panel on Increasing Organ Donations recommended against enacting presumed consent legislation, it is argued that the Panel was too dismissive of this concept given a perceived lack of public support. It is concluded that presumed consent can meet the concerns of critics, and that as part of a broader strategy could significantly increase the number of cadaveric organ and tissue donors in the province.

The notion of informed consent to medical treatment is a fundamental precept in law. It recognizes autonomy and the right to personal inviolability, irrespective of nationality, socio-economic situation and ideological orientation. A full realization of autonomy in the Nigerian legal system is severely constricted by sociological and cultural factors. Of particular concern is the impact of oppression which may arise from socialization, arbitrary disclosure practice by physicians, or as a result of legislative enactment. To remedy the elemental defects in the Nigerian Code of Medical Ethics, without addressing the impediments posed by the social environment from which a patient operates, will nuance informed consent in Nigerian health care but may not fully realize patient autonomy. A serious commitment to respecting patient autonomy may be realized through a collective effort of the State, the medical profession, the community, and patients in order to remove the impediments to full exercise of autonomy. / The thesis is the first part of a two part plan for operationalizing patient right in Nigeria