Competence and consent to research: A critique of the recommendations of the national bioethics advisory commission*

Concern about the participation of incompetent subjects in psychiatric research has grown in the last several years. In response, the National Bioethics Advisory Commission (NBAC) recommended in its recent report that all investigations involving persons with mental disorders that may be associated with cognitive impairment that may pose greater than minimal risk to subjects utilize independent assessors to verify the capacities of subjects prior to entry into the study. This recommendation poses several problems for the conduct of research and the protection of research subjects. First, it fails to target that group of subjects most likely to be at risk for incapacity. Second, it focuses on too broad a range of research projects, many of which pose little risk to participants. The substantial costs of this approach are therefore not likely to be outweighed by concomitant benefits. In place of the NBAC recommendation, the author proposes a more flexible system of capacity assessment, designed to balance the costs with a greater likelihood of achieving meaningful protection for research subjects with mental disorders.     

Biblical nationalism and the sixteenth-century states

The emergence of Protestant nations in sixteenth-century Europe was driven by the sudden rediscovery of biblical nationalism, a political model that did not separate the religious from the political. Biblical nationalism was new because pre-Reformation Europeans encountered the Hebrew Bible through paraphrases and abridgments. Full-text Bibles revealed a programmatic nationalism backed by unmatched authority as the word of God to readers primed by Reformation theology to seek models in the Bible for the reform of their own societies. Sixteenth-century biblical nationalism was the unintended side effect of a Reformation intended to save souls.     

Operational research at the National Defence Research Institute of Sweden (FOA)

This paper gives an account of an institute for applied research so as to enable comparisons to be made with other institutes: such comparisons need not be limited to defence establishments. In elaborating the methodology of the institute its local concepts are applied, a conceptualisation which has proven useful outside defence [I]. Defence methodology still creates civilian spin-off.     

Patients’ competence to consent to neurobiological research

Progress has been made defining the standards for determining subjects’ competence to consent to research: abilities to communicate a choice, understand relevant information, appreciate the nature of the situation and its consequences, and manipulate information rationally. Available data show clearly that persons with mental illness display a spectrum of decisionmaking abilities, with many performing well, but some doing quite poorly. More attention now is required to identifying the degree of capacity required for competent consent to projects with varying risk/benefit characteristics. Practical means are also required for screening for subjects with impaired capacities, attempting to improve their performance, and providing substituted consent when their deficiencies are intractable.     

Identifying the barriers and challenges to voting by residents in nursing homes and assisted living settings

To ascertain the need for and to inform development of guidelines for voting in long-term care settings, we conducted a telephone survey of Philadelphia nursing (n = 31) and assisted living (n = 20) settings following the 2003 election. Substantial variability existed in procedures used for registration and voting, in staff attitudes, and in the estimated proportion of residents who voted (29%+/-28, range 0-100%). Residents who wanted to vote were unable to do so at nearly one-third of sites, largely due to procedural problems. Nearly two-thirds of facilities indicated they assessed residents' voting capacity before the election. However, methods differed and may have disenfranchised residents who were actually competent to vote. Current procedures in many facilities fail to protect voting rights. These data suggest that rights might be better protected if election officials took charge of registration, filing absentee ballot requests, ballot completion, and trained LTC facility staff on voters' rights and reasonable accommodations.     

Fast food,happiness and the misery of behavioural science

Beginning with a journalistic criticism, written by a humanist, of studies by behavioural scientists of fast-food cues, this essay goes on to describe the nature of fast-food environments today. It then develops a critique of the underlying assumptions and methods of behavioural science as exemplified in these studies, whose basic context is the field of ‘happiness studies’. This essay argues that happiness cannot be quantified; that attempts to quantify it, though well-meaning, and generally aimed toward a critique of neoliberal utilitarianism, actually reflect neoliberal ideology. It also suggests that social thought today is a long way off from understanding the roles of sensuality in the pursuit of the good life, or for that matter the enjoyment of food.     

Fantasias of terrorism

An introduction to this special issue of the Journal for Cultural Research, this essay explains how terrorism may be said to equate to a “fantasia”, and how this fantasia has operated in different times and places. It also takes a close look at the popular fantasia promoted by the entertainment industry today, beginning with representations of the enemies of James Bond. In popular culture, terrorism is a spectre (along the lines of Ian Fleming’s SPECTRE) bent on the destruction of society, and yet it is also a sign of disorder at the heart of the very society which it attacks. Jacques Derrida’s comments on 9/11, using the metaphor of an auto-immune disorder, are pertinent. Film and television fantasias of terrorism offer critiques of the modern world order, but they offer the wrong critique.