Patterns of consent: evidence from a general household survey

Summary.  We analyse patterns of consent and consent bias in the context of a large general household survey, the 'Improving survey measurement of income and employment' survey, also addressing issues that arise when there are multiple consent questions. A multivariate probit regression model for four binary outcomes with two incidental truncations is used. We show that there are biases in consent to data linkage with benefit and tax credit administrative records that are held by the Department for Work and Pensions, and with wage and employment data held by employers. There are also biases in respondents' willingness and ability to supply their national insurance number. The biases differ according to the question that is considered. We also show that modelling questions on consent independently rather than jointly may lead to misleading inferences about consent bias. A positive correlation between unobservable individual factors affecting consent to Department for Work and Pensions record linkage and consent to employer record linkage is suggestive of a latent individual consent propensity.     

‘They follow the wants and needs of an institution’: Midwives’ views of water immersion

BackgroundA midwife’s ability to fully support women’s autonomy and self-determination with respect to midwifery care is often challenging. This is particularly true of water immersion for labour and birth. However, the woman’s agency over what happens to her body and that of her unborn baby should be key considerations for maternity care provision.ObjectivesA three phased mixed-methods study was undertaken to examine how water immersion policies and guidelines are informed. Phase three of this study captured the knowledge and experiences of Australian midwives, their support for water immersion and their experiences of using policies and guidelines to inform and facilitate the practice.MethodsCritical, post structural, interpretive interactionism was used to examine more than 300 responses to three open-ended questions included in a survey of 233 midwives. Comment data were analysed to provide further insight, context and meaning to previously reported results.FindingsFindings demonstrated a complex, multidimensional interplay of factors that impacted on both the midwife’s ability to offer and the woman’s decision to use water immersion under the themes ‘the reality of the system’, ‘the authoritative ‘others’’ and ‘the pseudo decision-makers’. Multiple scaffolded levels were identified, each influenced by the wider macro-socio-political landscape of Australian midwifery care.ConclusionsThe insight gained from examining midwives’ views and opinions of water for labour and birth, has aided in contextualising previously reported results. Such insight highlights the importance of qualitative research in challenging the status quo and working towards woman-centred practice and policy.     

Working Group on Ethical Considerations in Science and Scholarship∗

Persons can be subject to involuntary treatment for mental illness or substance abuse in a variety of circumstances. The ability of such persons to give a valid informed consent for research often has been called into question, because the coercive nature of the treatment is thought to impair the voluntariness of their decision making. A careful consideration of the nature of coercion from a “moralized”; perspective focuses attention on two elements that determine the acceptability of consent: the fairness of the proposal to which consent is sought, and the moral baseline from which the proposal is made. Even when coercion is not present, disproportionate rewards offered for participation in research can impair the voluntariness of consent, as can the unintended effects of the social structure of the system in which the research is taking place. When coercion, defined as a moralized concept, is not present, however, and other conditions do not substantially impair voluntariness, consent to research legitimately may be sought from involuntarily treated populations.     

霍布斯的“同意”与卢梭的“公意”之辨析

霍布斯认为，通过订立某种社会契约，在政治共同体中，一个人可以把一个公共权威的意志看作自己的意志。这就是所谓霍布斯的“公意”。这种形式的公意也影响着人们对卢梭公意的理解，从而导致许多对卢梭公意的误解。     

Disclosing Conflicts of Interest to Research Subjects: An Ethical and Legal Analysis

In this article, I examine the ethical and legal issues related to disclosure of conflicts of interest to research subjects, and discuss some empirical studies related to the topic. I argue that researchers have an ethical obligation to disclose conflicts of interest to research subjects, provided that they take steps to help subjects understand information about conflicts of interest and how to interpret it. Researchers also may have a legal duty to disclose conflicts of interests to subjects, depending on the facts of the case and the court's interpretation of the law. To reinforce and clarify the legal obligation to disclose conflicts of interest, the federal regulations should be amended to include disclosure of conflicts of interest as one of the informed consent requirements. Institutional review boards play a key role in helping researchers to disclose conflicts of interests to subjects in an appropriate manner. Institutional review boards should approve the disclosure language in informed consent documents, and they should require researchers to disclose financial interests to research subjects, if they have any, as a condition of approval.     

The 17-Year-Old Child

SUMMARY

Recently enacted EU-legislation will affect interferences with the sexual life of adolescents across Europe in an intensity so far not known in any of the European states. The “Framework-Directive on combating sexual exploitation of children and child-pornography” will oblige all member States of the European Union to create extensive offences of “child”-pornography and “child”-prostitution, defining as “child” every person up to 18 years of age, without differentiating between five-year-old children and 17-year-old juveniles. These offences go far beyond combating child pornography and child prostitution, thus making a wide variety of adolescent sexual behaviour, hitherto completely legal in the overwhelming majority of jurisdictions in Europe, serious crimes; for instance: sex between 16-year-olds for “remuneration”, which includes invitations to cinema or to a dinner; “lascivious” drawings of a 17-year-old girl possessed by a 15-year-old boy; photographs of a 16 year-old girl in her bikini “lasciviously” exposing her pubic area, taken by her 17-year-old boyfriend on the beach; standard pornography involving younger looking 20-year-old adults or “webcam-sex” between 17-year-old-adolescents; even pictures of one's own adult spouse in “lascivious” poses, if this spouse looks younger than 18. No European jurisdiction so far has such a restrictive law. The massive criminalisation and the equation of adolescents with children caused heavy criticisms among experts but this criticism could not prevent the project from becoming law. This essay provides an analysis of the background, the legislative process and the content of the EU-Framework-Decision.     

固定效应模型对知情选择政策影响的再验证——以已婚育龄个体避孕措施选择的变化为例

利用固定效应模型对1988-2001年全国计划生育/生殖健康调查数据进行了再次分析,以量化考察知情选择政策对中国已婚育龄个体避孕措施选择的影响。研究发现,知情选择与已婚育龄个体避孕措施选择的变化之间呈现一定的因果关联。知情选择导致了育龄个体避孕措施选择的改变,表现为短效自控型避孕措施选择的可能性随着知情选择的开展在逐步升高,而长效医控型避孕措施选择的可能性在逐步降低。     

Adolescence,Sexual Aggression and the Criminal Law

SUMMARY

Criminal law and criminal policy history is perceived as an evolution of legitimation: from a morality paradigm before the Seventies of last century to a utilitarian concept of interdisciplinary enlightenment and rationality, and on to a factual paradigm of risk containment, security orientation and mere exclusion since the Nineties. However, in the area of sexual crime, and especially as far as “the protection of minors” is concerned, Western law appears to have undergone an additional paradigm change, namely in reverting to moralistic principles in disregard of scientific insight. This process, for which victimology appears to be the door opener, is reflected in legal doctrine and criminal policy, in law enforcement, in populistic media and politics. This evolutionary process is interpreted as symptomatic for a post-modern trend in the globalised society where sexual behavior on one hand is blatantly and abusively commercialised, and on the other hand, if deviant, represents the psychologically most expedient object of scapegoating and symbolic policy. The article finishes pleading for a return to the ‘project of modernity’ and to interdisciplinary studies rather than morality as a foundation for criminal policy.     

Guinea Pigs on the payroll: The ethics of paying research subjects

Regulatory bodies and scholars have traditionally conceptualized biomedical research on healthy subjects in the same way as research on patients. Guidelines and regulations have portrayed payment to a healthy subject as a potential constraint, or “undue influence,”; on the subject's free consent. In this essay we suggest an alternative way of conceptualizing research on healthy subjects, which sees the basic issue not as one of undue influence but as one of justice. Healthy subjects generally enroll in research protocols not for humanitarian reasons but for the money they will receive. Many of these protocols are conducted by profit‐driven corporations. Yet current guidelines and regulations prohibit subjects from negotiating for fair payment for the risks, discomforts and inconveniences they undergo, and IRBs are not staffed adequately to monitor the subject's safety. We propose to remedy the situation by regulating payment to healthy subjects as a labor relation.     

Informed Consent of Very Sick Subjects in Nigeria

This article highlights a number of ethical challenges I face in obtaining informed consent from very sick subjects with suspected pulmonary tuberculosis (TB). Some of the subjects with TB have an associated human immunodeficiency virus (HIV) infection. From my experience in administering informed consent and health surveys, I found the subjects to be generally mentally stable but physically exhausted. Many of the very sick subjects cough excessively and cannot tolerate a 45-minute conversation with the study staff in order for them to administer consent and conduct a survey after the routine clinical evaluation. In this situation, the administration of a qualitative consent that preserves the subject's right and autonomy becomes a challenge.