In line with public policies, the French Association of Paralyzed People (APF) promotes the social participation of people with disabilities. This objective can be achieved both through participation in activities and participation in decision-making processes. This dual categorisation raises questions about the compatibility of logics of support and program objectives across these two facets of participation. Arising from work conducted in the context of a PhD dissertation, this article is (...) based on document analysis and 49 indepth interviews with employees, volunteers, members and users of the APF. The results highlight a tension, from the point of view of professional supports, between participation in activities and participation in decision-making. For the sake of swift and tangible results, professionals are encouraged to offer activities and services to achieve faster and more effective social participation. However, this places them in a complex, or even inextricable, position when it comes to enhancing users’ participation in decision-making. (shrink)

People with disabilities face inequalities in mental wellbeing, for which social exclusion is a contributing factor. Musical activities offer a promising but complex intervention, making impacts on a population with highly varied characteristics and needs challenging to capture. This paper reports on a mixed methods, person-centered study investigating a community music intervention for such a population. Three groups of adult service users with varied disabilities (either physical, learning, or both), took part in weekly music (...) workshops in different locations. Music staff, housing and resource center staff, as well as participants and members of their families, took part in semi-structured interviews. A quantitative measure administered by service staff was used to rate service users’ social development. Two lay researchers, both individuals with a disability contributed to all aspects of the study. Interviews were analyzed through thematic analysis. Improvements in individuals’ self-expression, confidence, mood, and social skills were consistent with previous findings. Differences in effect between centers included: Group 1, some of whom had previous experience of workshops, showed an improvement in musical skills; Group 2 showed a mixed response, some participated with enthusiasm but others chose art activities over music workshops; Group 3 had lasting positive impact, this group had very limited opportunities for music due to their rural location. Quantitative analysis showed significant increase over all groups in communication, interaction with others, and joint attention. The intervention was beneficial for participants in separate locations in similar ways, but also highlighted that context and prior experience mediated effects in distinct ways. The lay researchers enhanced the qualitative analysis by emphasizing (1) the importance of recognizing participants’ self-expression in non-verbal modes of communication and (2) the importance of having music staff with a disability to provide a positive role model. This paper proposes that mixed methods person-centered research is the most suitable approach to capture and understand the multiple and varied effects of this complex intervention for a diverse group of participants. (shrink)

Disability results from the interaction between individual and environmental characteristics (Fougeyrollas et al., 1998). The products and services offered to the consumers with disabilities are part of these environmental characteristics and play a role in the process of producing disability. For these products and services to better answer the needs of consumers and in a logic of empowerment, consumers with disabilities can participate in the design of innovative products. This is called co-design. This (...) class='Hi'>participation comes up against a number of practical (Allen, McGrenere & Purves, 2007; Brulé, Bailly & Gentes, 2015; Magnier et al., 2012) and methodological (Hendriks, Slegers & Duysburgh, 2015; Plos, 2011) obstacles. These obstacles have been studied mainly by disability, leading to managerial recommendations that are supposed to be valid regardless of the product. However, the observation of 38 cases of co-design projects at the TechLab of APF France handicap shows that this is not the case: different products bring different challenges in terms of co-design, few of which are related to disabilities. In particular, we identify three types of obstacles to co-design within product testing phases: obstacles related to the installation of the innovative product, organizational obstacles and obstacles related to the impact of products on people’s lives. We provide solutions to overcome these obstacles and maximize the participation of consumers with disabilities in product innovation processes. (shrink)

A belief in one or more superhuman or divine living things is commonly a component of religion, which may be demarcated as a collection of values, beliefs, and behaviours regarding the nature of the cosmos and existence. Many faiths have diverse beliefs, practices, and values, and there may be substantial differences even within the same religion. Many faiths offer ethical and moral principles to contribution individuals in directing difficult moral problems and making activities that are reliable with their beliefs. (...) Ethical values are beliefs or principles that govern our activities and results. Moral standards are vital for people to make moral decisions and live peacefully with one another. The moral values of beginning people are prejudiced by a variety of variables, including family, education policy, religion, and society. Young persons who regularly participate in religious groups are more inclined to exhibit beneficial features such as compassion, ethical thinking, and volunteerism. Religion gives young people a supportive and affectionate setting, training, and direction in handling significant moral and ethical challenges. According to the research result found that, religion has had a significant impact on modern culture and history, influencing philosophy, music, literature, art, and the development of social and political institutions. According to the findings, religious organizations should make an effort to build attractive and accepting environments in which young people may feel like they participate. Religious leaders should connect with youth and help them progress their own ethical standards. Furthermore, societies of religion should work with parents and educators to develop ethical behaviors and healthy principles among adolescents. (shrink)

In our country, mildly mentally disabled students are being educated in general education classes by means of integration. An individualized education program (IEP) is being prepared for these students when needed. However, the impact of BEP on students with intellectual disabilities in religious education has not yet been sufficiently discussed. The purpose of this research is to examine the impact of the IEP on the achievement of religious education of mentally disabled students and the level of religious learning (...) of these students. For this purpose, in addition to the education given in the general education class for the 6 mildly mentally disabled integration students studying in the 4th grade of primary school, 2 hours of education were carried out in the support education room per week during the education and training year. Semi-experimental study was designed according to the single-tasked multiple-start model. Education process was evaluated by Achievement Test, the Teacher Observation Form, the pre-test based on the Self-Assessment Form, post-test and retention tests. As a result, it has been seen that BEP has a positive effect on the achievement of religious education of mentally disabled students (ZEKÖ). In this framework, it has been found that students are influenced by the society, especially by their peers, when they are given time they constitute religious knowledge, they understand normal individuals religious behaviours, they are more emotional, they forget religious information that is not used in everyday life and when they accomplish they increase self-confidence and self-esteem and internalize values.SummaryPeople differ in their creation. This difference is greater in people disabled. In terms of individual traits and educational qualifications, individuals with disabilities who are severely different from their peers and who have difficulty in playing the roles they should play are evaluated in several groups. One of these groups is mentally disabled. Mentally handicapped people have various rights as normal individuals. One of these rights is the right to education. National and international laws guarantee the educational rights of individuals with intellectual disabilities. Similarly, Islam and his best practitioner, the prophet Muhammad, did not consent to the transformation of the mentally disabled into begging masses or to their isolation, but rather to integrate them into society. According to Islam, individuals with intellectual disabilities have the “capacity to acquire rights“, even if they do not have "capacity to act". This right requires them to receive an education that takes into account their differences, just like normal individuals. Because of their learning characteristics, mentally retarded students differ from their peers, therefore they cannot benefit from the educational activities organized for normal students. So, these students need a special education to ensure that the mentally disabled are successful and live in society without being dependent.Inrecent years, in our country as well as in the world, the principle of "least restricted education environment" is taken into consideration for mentally handicapped people who need special education, which approaches to co-education with their peers. This approach is tried to-be applied at all educational levels. Due to the diagnosis and evaluation in the Guidance and Research Center, a large number of mentally retarded students are placed in normal schools. These students, like other courses, take the Religious Culture and Moral Knowledge Course together with the normal students. However, depending on their learning, they have the right to receive separate training as 1-3 people at-the support training room. The instructional adaptations necessary for the education of these students made by the Guidance and Research Centers are carried out by the teacher who plays the basic role in the education of the students. One of the important elements in the education of these mentally retarded students who need special education is the individualized education program. This program is prepared by the cooperation and joint decision of all stakeholders who may contribute to student’s education. The status of the student to participate in the learning and teaching activities, the amount and the quality of the education to be received in the support education room are made within the framework of this program.One of the most important courses in the education of mentally retarded students who are educated by inclusion is the Religion Culture and Moral Knowledge course. Because this course has the potential to make serious contributions to the socialization of students and to maintain their lives independently. However, there are a limited number of studies investigating the quality of religious education at-the scientific level. Furthermore, it has not been observed that these studies have been quasi-experimental. This study aims to reveal the quality of education for the mentally handicapped students. For this purpose, it aims to determine the contribution of religious education in the support education room to the success of the student depending on the individualized education program. It also makes it possible to make conclusions about how mentally handicapped people use their mental skills to learn religion. Depending on the aim of the study, during the 2015-2016 academic year, primary school 4th grade students and 6 mentally disabled inclusion students were educated. The quasi-experimental study was designed according to the single-subject multiple-start model. The process of the education, in other words, the development of mentally retarded students towards religious learning; were evaluated by Success Test, Teacher Observation Form and Self-Assessment Form based on pre-test, post-test and retention tests.Findings of the study; Faith, worship, the prophet Muhammad, Qur’an and its commentary, are classified according to the fields of morality, religion, and culture. The post-test achievement scores of the students in all learning areas were higher than the pre-test achievement scores. This shows that religious education in the support training room based on individualized education plan contributes positively to the success of the student. The results of the retention test are close to the results of the final test. In addition, it was determined that the students were affected by the society, especially by their peers, structured the religious knowledge when given time, they understood the religious behaviors of the normal individuals, became more emotional, forgot the religious information that is not used in daily life, increased their self-confidence and self-esteem as they succeeded and internalized the values. Based on these results, the following recommendations have been developed.Support Education Rooms should be functionalized and special attention should be given to individual or group-based religious education based on the nature and objectives of the subject in these rooms.In religious education, by taking into account the performances of mentally retarded inclusion students (MHIS), the relevant dimension of religion should be given importance according to their contribution to their normal lives and they should be consistent and patient in this process.Since MHIS has different levels of learning and perception and different developmental characteristics at every stage of life, it should prioritize their proper use of their existing capacities based on their religious education, interests and curiosities.Since MHIS is influenced by the emotion dimension rather than the information dimension of religion, religious education for them should be oriented towards life, which is not academic, literal or doctrinal, but rather their life and feelings.Similar studies with different study group students must be done and the results of the study should be interpreted comparatively. 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In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a (...) procedural checklist to guide this process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

On July 2021, the UK High Court of Justice heard the Case CO/2066/2020 on the application of Heidi Crowter who lives with Down’s syndrome, and Máire Lea-Wilson whose son Aidan has Down’s syndrome. Crowter and Lea-Wilson, with the support of the disability rights campaign, ‘Don’t Screen Us Out’, have been taking legal action against the Secretary of State for Health and Social Care (the UK Government) for a review of the 1967 Abortion Act: the removal of section (...) 1(1)(d) making termination of pregnancy lawful for ‘severe’ fetal indications detected after 24 weeks' gestation. On 23 September 2021, the High Court dismissed the claim. This action came at a time when non-invasive prenatal testing (NIPT) was introduced into the NHS England Fetal Anomaly Screening Programme for the trisomies 21, 13 and 18. The implementation of NIPT has been heavily criticised, in particular by ‘Don’t Screen Us Out’ campaigners, for increasing fetal selection and discrimination of people living with disabilities. The case of Crowter and Lea-Wilson echoes debates in other European countries such as in France and Germany, where the introduction of NIPT in the public healthcare system has provoked equally vehement public reactions and discussions. The comparison between these three countries allows contextualising the public discourses around NIPT and the ground for termination of pregnancy in relation to different socio-cultural and political contexts. We examine how each country, and particularly England, deals with the conflict between the principles of promoting the rights of people living with disabilities and preserving women’s reproductive autonomy. (shrink)

Background: Relatives of intensive care unit patients who lack or have reduced capacity to consent are entitled to information and participation in decision-making together with the patient. Practice varies with legislation in different countries. In Norway, crucial decisions such as withdrawing treatment are made by clinicians, usually morally justified to relatives with reference to the principle of non-maleficence. The relatives should, however, be consulted about whether they know what the patient would have wished in the (...) situation. Research objectives: To examine and describe relatives’ experiences of responsibility in the intensive care unit decision-making process. Research design: A secondary analysis of interviews with bereaved relatives of intensive care unit patients was performed, using a narrative analytical approach. Participants and research context: In all, 27 relatives of 21 deceased intensive care unit patients were interviewed about their experiences from the end-of-life decision-making process. Most interviews took place in the participants’ homes, 3–12 months after the patient’s death. Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services and by the Regional Committee for Medical and Health Research Ethics. Findings: The results show that intensive care unit relatives experienced a sense of responsibility in the decision-making process, independently of clinicians’ intention of sparing them. Some found this troublesome. Three different variants of participation were revealed, ranging from paternalism to a more active role for relatives. Discussion: For the study participants, the sense of responsibility reflects the fact that ethics and responsibility are grounded in the individual’s relationship to other people. Relatives need to be included in a continuous dialogue over time to understand decisions and responsibility. Conclusion: Nurses and physicians should acknowledge and address relatives’ sense of responsibility, include them in regular dialogue and help them separate their responsibility from that of the clinicians. (shrink)

Medical communication in Western-oriented countries is dominated by concepts of shared decision-making and patient autonomy. In interactions with Roma patients, these behavioral patterns rarely seem to be achieved because the culture and ethnicity have often been shown as barriers in establishing an effective and satisfying doctor–patient relationship. The study aims to explore the Roma’s beliefs and experiences related to autonomy and decision-making process in the case of a disease with poor prognosis. Forty-eight Roma people from (...) two Romanian counties participated in semi-structured interviews, conducted by a research team from the University of Medicine and Pharmacy of Iasi. Participants were recruited among the chronically ill patients and caregivers. The Roma community opposes informing the terminal patients about their condition, the “silence conspiracy” being widely practiced. The family fully undertakes the right of decision making, thus minimizing the patient’s autonomy. We identified ethical dilemmas concerning autonomy, lack of patients’ real decision-making power, and paternalistic attitudes exerted firstly by the family and, on demand, by the physician. Instead, the Roma patient benefits from a very active support network, being accompanied at the hospital by numerous relatives. The patient’s right to make autonomous decisions promoted in the Western countries and stipulated by the Romanian law has diminished value in the Roma community. For the Roma, the understanding of dignity is not simply individual and personal, but it is closely related to their cultural particularities. Ignoring their cultural values could create conflicts between healthcare providers and community. (shrink)

People with mild to moderate intellectual or multiple disabilities may have serious difficulties in accessing leisure events, managing communication exchanges with distant partners, and performing functional daily activities. Recently, efforts were made to develop and assess technology-aided programs aimed at supporting people in all three areas. This study assessed a new technology-aided program aimed at helping four participants with intellectual and multiple disabilities in the aforementioned areas. The program, which was implemented following a (...) non-concurrent multiple baseline across participants design, relied on the use of a smartphone or tablet connected via Bluetooth to a two-switch device. This device served to select leisure and communication events and to control the smartphone or tablet’s delivery of step instructions for the activities scheduled. Data showed that during the baseline phase, three participants failed in each of the areas while one participant managed to access a few leisure events. During the intervention phase, all participants managed to independently access leisure events, make telephone calls, and carry out activities. These results suggest that the program might be a useful tool for helping people with intellectual and multiple disabilities improve their condition in basic areas of daily life. (shrink)

Public extension services play a key role in the implementation of strategies for rural development based on the sustainable management of natural resources. However, the sector suffers from restricted financial and human resources. Using experiences from participatory action research, a strategy for rural extension in the Amazon was defined to increase the efficiency and the relevance of external support for local resource users. This strategy considered activities initiated and coordinated by local people. Short-term facilitation visits provided continuous (...) external support for the purpose of establishing locally based planning and learning mechanisms. In collaboration with the municipality of Muaná in the Eastern Amazon, the strategy was tested in two traditional communities – Monte Moriat and Boa Esperança. Both communities recognized as most important the need to reduce their dependence on açaí (Euterpe oleracea Mart.), the principal source of food and income. This forest resource has been overexploited, seriously affecting açaí stands and diminishing the forest benefits fundamental for survival. Two local groups decided to raise chickens as a way to reduce nutritional problems and as an alternative source of income. Supported by monthly, short-term planning and evaluation visits, the groups managed to achieve significant progress in their endeavor. The groups identified (1) the control of decision-making and information, and (2) the absence of external obligations to be the greatest advantages of the development initiative. The study confirmed the potential of participatory strategies for public extension in the Amazon. Special attention was given to realistically define the role of forests for local development. However, drastic measures are necessary to smooth the way for real participation in governmental and non-governmental organizations acting in the Brazilian Amazon. (shrink)

A crucial question in relation to support designed to enable the legal capacity of people with mental disabilities concerns when support constitutes undue influence. This article addresses this question in order to facilitate the development of law and policy in England and Wales, by providing a normative analysis of the different approaches to undue influence across decisions about property, contracts, health, finances, and accommodation. These are all potential contexts for supporting legal capacity, and, in doing (...) so, the article compares approaches to undue influence that are rarely considered together. -/- Drawing on the UN Convention on the Rights of Persons with Disabilities, third sector and public body documents, and law in England and Wales, the analysis identifies six models that conceptualise undue influence in terms of: modes of influence; an overborne will; an inference from the situation; an overborne will understood as a mental incapacity; an overborne will in connection with vulnerability; and impaired discursive control. This final approach is a novel proposal for understanding undue influence. The analysis highlights key policy-relevant issues that distinguish the models, and generates a deliberative framework for navigating them, with the ‘overborne will’, ‘inference-based’, and ‘discursive control’ models identified as potentially fitting for the support context. (shrink)

Before COVID-19, dementia singing groups and choirs flourished, providing activity, cognitive stimulation, and social support for thousands of people with dementia in the UK. Interactive music provides one of the most effective psychosocial interventions for people with dementia; it can allay agitation and promote wellbeing. Since COVID-19 has halted the delivery of in-person musical activities, it is important for the welfare of people with dementia and their carers to investigate what alternatives to live (...) music making exist, how these alternatives are delivered and how their accessibility can be expanded. This community case study examines recent practice in online music-making in response to COVID-19 restrictions for people with dementia and their supporters, focusing on a UK context. It documents current opportunities for digital music making, and assesses the barriers and facilitators to their delivery and accessibility. Online searches of video streaming sites and social media documented what music activities were available. Expert practitioners and providers collaborated on this study and supplied input about the sessions they had been delivering, the technological challenges and solutions they had found, and the responses of the participants. Recommendations for best practice were developed and refined in consultation with these collaborators. Over 50 examples of online music activities were identified. In addition to the challenges of digital inclusion and accessibility for some older people, delivering live music online has unique challenges due to audio latency and sound quality. It is necessary to adapt the session to the technology's limitations rather than expect to overcome these challenges. The recommendations highlight the importance of accessibility, digital safety and wellbeing of participants. They also suggest ways to optimize the quality of their musical experience. The pandemic has prompted innovative approaches to deliver activities and interventions in a digital format, and people with dementia and their carers have adapted rapidly. While online music is meeting a clear current need for social connection and cognitive stimulation, it also offers some advantages which remain relevant after COVID-19 restrictions are relaxed. The recommendations of this study are intended to be useful to musicians, dementia care practitioners, and researchers during the pandemic and beyond. (shrink)

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with (...) respect to decision-making and their views on supported decision-making. Thirty-six interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

Background Prioritization decision-making arises when nurses encounter intricate situations that demand ethically challenging judgments about care. This phenomenon has rarely been studied in nursing homes. Prioritization decision-making may lead to instances where individuals in social and healthcare may not receive all services they need. Making prioritization decisions and awareness of their consequences can increase nurses’ workload. Aim To describe prioritization decision-making regarding unfinished nursing care in nursing homes. Research design A qualitative descriptive study conducted through individual (...) theme interviews. Participants were recruited through social media. The data was analyzed using inductive content analysis. Participants and research context Nurses ( n = 23) working in nursing homes for the elderly people in Finland. Data were collected between June 2022 and February 2023. Ethical considerations Finnish legislation does not mandate an ethical review or research permits, as the participants took part as private individuals. [ask authors to make reference here to informed consent process and anonymity] Findings Nurses stated that the need for prioritization decision-making arises from challenges associated with nurses’ engagement with person-centered care, the culture of the work community, the burden due to workload and challenges associated with the leadership. Prioritization decision-making was based on the interests of residents, striving for an efficient workflow and nurse’s personal interests. Nurses did not receive support for decision-making regarding unfinished care, and protocols for prioritization had not been established in their work communities. Prioritization decision-making and unfinished care were concealed and left unspoken. Conclusion Nursing leaders should address this hidden phenomenon, making it visible through discussions with nurses and by involving them in the development of protocols. The findings can be utilized for developing new approaches to support nurses and reduce their workload and for enhancing the quality and person-centeredness of nursing care in nursing homes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 81-85 [Access article in PDF] "What's in the Box Then, Mum?"—Death, Disability, and Dogma Sheila Colman OVERHEARD IN AN EXCHANGE between a bereaved woman and her son outside the church just prior to a funeral service: "What's in the box, then?" "Daddy." The son is in his late 30s and has a learning disability. His mother had prepared him as well as she (...) could; his father had been ill for some time and was not expected to recover. Death, and the rituals surrounding it, had been explained and it was not the first family funeral he had attended.Trying to field such childlike questions is typical of living with a person with a learning disability; trying to find the right words is difficult enough without the added pressure of personal emotional distress.The generally accepted norm in life is that a child is parented within the home until adulthood and then independence is attained. Roles may well be reversed in later life in that the "child" may find responsibilities in caring for, and making decisions for, elderly parents. Few people can stop parenting when their offspring are fledged—even though it is at arms length and any advice may be ignored. Life with a child with a learning disability is unbalanced in this respect; as carers we do not lead lives considered to be normal because our children continue to be childlike for the rest of their, and our, lives. Some of us know that our sons and daughters do not have "apparently limitless potential... to develop skills and autonomy if only they are given the right help" (but try, as a parent or carer, saying that to a professional working in the field of learning disability!) and know that the best we can hope for is mature, rather than immature, dependence.No one tells parents of a learning disabled child—or any other, for that matter—what their responsibilities to that child are. Food, warmth, love, support, and so on are givens, but it takes a conscious effort to move a child toward adulthood when it involves changes in life, for example, moving away from the family home. The debate rages; is it letting go or getting rid of?We all delight in the pleasures our children experience in childhood; we know the magic has gone from the family Christmas once realisation dawns on the youngest child. If you consider that your son or daughter has been dealt a very poor hand in life, the temptation to prolong and promote that innocence is very tempting. It is much easier to prevaricate than to admit that life has its unpleasant sides; that failure and disappointment exist: my son was a great fan of Thomas the Tank engine videos until he was in his early teens, long after it was age appropriate. I passed them onto a younger child, having told him the videos were lost. The fall-out was spectacular [End Page 81] (but fortunately short lived!) and he eventually became very interested in Formula 1 motor racing. I had to push him to grow up.For all of us, the transition from childhood to adulthood is a process, not an event. Although I agree with the professionals that the child with a learning disability should be part of any discussions concerning his or her future, if that child does not have the intellectual capacity to make informed choices, someone else has to do it. That someone else is usually a parent, but is it a parent who is prepared to let go to help that person become an adult with his or her own life away from the family home, or is it a parent who has protected and coddled the child by promising they will never have to go?Lest you think I am a particularly hard, confrontational, and unfeeling mother, I would point out that I have almost 50 years of experience of living with learning disability in the immediate family; my son is 20 but my brother... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 99-102 [Access article in PDF] Living with Contested Knowledge and Partial Jennifer Clegg and Richard Lansdall-Welfare THESE CAREFUL AND CONSTRUCTIVE comments bring grist to our mill. Before responding to them, we observe first that they offer no substantive challenge to our thesis: ambiguities associated with meaning in the disabled life make it more likely that professional service providers will make dogmatic (...) responses to bereavement, and perhaps other essentially contested topics, responses that are defended by isolationism.Some welcome ideas came from left field to refresh our thinking, such as Colman's observations on the gendered nature of care. She reminded us that although the audit from which these cases came was established to investigate bereavement in general among adults with intellectual disability, its rough and ready sampling failed to ensure the expected range of bereavement types. Somehow the bereavements constructed as relevant for audit all transpired to concern the death of mothers. Moreover, of the six relatives who agreed to be interviewed concerning these bereavements, two were stepfathers and four were sisters. Colman underlines the invisibility of care work usually done by female family members: how wise or less wise decisions create the conditions for bereavement reactions, and how changes to care arrangements following bereavement fall most heavily on them. Traustadottir (2002) discussed the way new care initiatives often put pressure on female family members and staff to do more unpaid work. For example, Circles of Support encourages them to include people with intellectual disability in their personal social networks, without considering the personal costs. Such observations have yet to emerge from the umbrella of feminist research. Separatism has served feminism well, but issues of women and care do need to find their place in mainstream reviews.Another useful reminder from Colman is that the person with intellectual disability is not the only concern to families, although only a few adult services manage to hold wider systemic factors in mind (Clegg and Burnham 2000). If the person may make naïve comments at a funeral that would devastate family members whose needs take priority, the person will be excluded.The potency of bereavement was discussed twice. Casenave suggests that because "disability is a loss experience" bereavement resonates with it, casting some doubt onto the suggestion that our thesis generalizes to other contested topics. Reinders criticizes clinicians for being purblind to the tragic. The anonymous reviewer who questioned [End Page 99] the relevance of our discussion of the quality of "presence," a quality Reinders considers highly relevant, illustrates the point better than we can. Recognizing the way clinicians have little "patience with the notion of the tragic" encourages reflection on what other human experiences fail to capture our attention.Although these are all potentially valuable directions, we focus here on comments that may enhance our ability to work without dogma. Since at least the 1980s, clinicians in intellectual disability have criticized the discipline for using linear and univariate rather than complex and multivariate theories, and for a naïve search for magic answers (reviewed in Clegg 1993). It is our contention that little has changed, and that uncertain meaning and normalization combine to create ideal conditions for dogma. Reinders' exposition of the various uses of meaning in our article and in different linguistic and historical traditions develops a vital but neglected topic in intellectual disability, which we consider in some detail. We conclude by arguing that developments require us to distance ourselves from the universality and commonality inherent to normalization, and create new ways to appreciate particularity and diversity.The gist of Reinders' complex argument appears to be that the problems we identify in managing bereavement in intellectual disability stem from a modernist understanding of meaning that is erroneous. Implicitly, those who eschew its pursuit demonstrate the greater wisdom, because neither dialogue nor activities such as reflection can generate meaning that is unattainable. If we understand his position correctly, he contrasts two principal understandings of meaning: comprehension and apprehension.Comprehension is the illusory modernist idea that humans are agents who make sense of themselves... (shrink)

In discussions of medical decision making as it applies to people with disabilities, a major obstacle stands in the way: the perceptions and values of disabled people and of many nondisabled people, regarding virtually the whole range of current health and medical-ethical issues, seem frequently to conflict with one another. This divergence in part grows out of the sense, common among people with disabilities, that their interactions with “the helping (...) professions,” medical and social service professionals, are adversarial. But those differences of opinion also stem more basically from a clash of fundamental values.This paper addresses, in historical perspective, the ways in which the status of persons with disabilities as a stigmatized minority group affects medical decision making. It also examines the efforts of disability rights activists to prevent discrimination against persons with disabilities in current medical culture. Finally, it raises questions about how the rights of people with disabilities will fare as new care standards are developed and implemented. (shrink)

The aim of the present study was to describe variations in patient participation in decisions about care planning during the final phase of life for a group of gravely ill patients, and how the different actors’ manner of acting promotes or impedes patient participation. Thirty-seven qualitative research interviews were conducted with relatives of the patients. The patients’ participation in the decisions could be categorized into four variations: self-determination, co-determination, delegation and nonparticipation. The manner in which patients, (...) relatives and caregivers acted differed in the respective variations; this seemed either to promote or to impede the patients’ opportunities of participating in the decision making. The possibility for participation seems to be context dependent and affected by many factors such as the dying patient’s personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers of the different forms of care can and want to support the wishes of the patients and relatives in the decision-making process. (shrink)

Les enfants polyhandicapés ont des besoins de soutien intenses et complexes. Souvent, ils sont dans des établissements spécialisés, avec peu d’opportunités d’apprentissage, menant une vie passive et isolée. Pour améliorer leur qualité de vie, leurs activités et leur inclusion, en particulier l’éducation inclusive, nous avons développé et expérimenté, dans le cadre du projet Européen Enablin+, une formation continue interprofessionnelle. En 2015-2017, nous avons organisé 64 cours pilotes et ateliers de formation sur 41 sujets dans huit pays européens, suivis d’un cours (...) de formation des formateurs. Sur la base d’une évaluation qualitative par les participants, nous pouvons faire les recommandations suivantes: à côté de la formation de compétences spécifiques à la profession, une formation continue devrait en premier lieu travailler à sensibiliser à la faisabilité et à la nécessité de l’inclusion aussi pour les enfants de grande dépendance. Tous les niveaux hiérarchiques du personnel, ainsi que les familles devraient être impliqués. Bien qu’enracinée dans les cadres conceptuels modernes du handicap (inclusion, qualité de vie, droits, capacités), cette formation devrait offrir un véritable apprentissage interprofessionnel basé sur des cas, une “gestion de cas” centrée sur la personne et la famille, un apprentissage réflexif sur les systèmes de croyances et les pratiques concernant activités inclusives et participation. Les formats de cours doivent être adaptés aux circonstances locales afin de permettre la participation de l’ensemble du personnel. (shrink)

This article focuses on patients' participation in decision‐making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision‐making meetings within a Foucauldian perspective. Patients' participation in decision‐making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From (...) the perspective of patients, there is a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a ‘customer’ in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision‐making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision‐making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A ‘projectification’ of the patient occurs, whereby the patient becomes responsible for his/her choices in treatment and care and the professionals support him/her with knowledge, preferences, and alternative views, out of which he/she must make his/her own choices, and the responsibility for those choices now and in the future. At the same time, there is a tendency towards de‐professionalization. In that light, participation of patients in decision‐making can be regarded as a tacit governmentality strategy that shapes the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate, and necessary idea of involving patients in their own situations from a humanistic perspective. (shrink)

In this article, we present findings from a participatory action research program in France on the exercise of human rights and supported and substitute decision-making, inspired by the United Nations Convention on the Rights of Persons with Disabilities (“CRPD”). Bringing together persons with the lived experience of disability, academics, and health and social care and support professionals, the project used the method of “experience-based construction of public problem” to transform experience into collective expertise. This (...) enabled the exploration of support that persons in vulnerable situations, whose capacity to exercise their human rights has weakened, need to make decisions in their lives and participate meaningfully in public debate. The relationship between the awareness of rights and exercise of rights is discussed. We argue for the need to balance out the positions of different contributors in participatory action research, in a reasoned manner, by recognizing the scientific and citizen-based participation of all partners. (shrink)

The educational area is a social sector where the COVID-19 pandemic impact involves making many exponential changes. In many countries, the transition from face-to-face education to on-line education implies a revolution in the hierarchy of job domains/jobs offer. Young people’s career plans may be different under the impact of internal and external factors generated by this new context. Theoretical framework revealed that under the influence of the COVID-19 pandemic, the career decision-making process becomes more difficult to assume by (...) taking into consideration the job nature, the sense of belonging, and the balance between passions and risks involved. By referring to these aspects a question arises: Will the pandemic also create a crisis in the career-making decision process for young people? The research group consisted of 108 undergraduates' from 12 grades, attending high schools from cities under 10,000 inhabitants. Hypothesis: There is a tendency to focus on training areas dominated by the practical aspects than the theoretical one as a result of the COVID-19 pandemic. We used a Romanian adapted version of the Myer-Briggs Type Indicator Questionnaire used in counseling and carrier orientation services for identification of professional interests of the students. The obtained results show that it is important for high school students to receive quality services for carrier guidance and psycho-educational support to prevent over-introversion and over-critical attitude about others and themselves, self-isolation correlated with a high level of sensing and sensitiveness. (shrink)

Ce document présente les expériences des personnes handicapées physiques dans l’accès aux prêts de microfinance. La microfinance est apparue comme un outil pour éradiquer la pauvreté et autonomiser les pauvres; cependant, y accéder est difficile pour de nombreuses personnes ayant un handicap physique. Cette étude qualitative a été menée par le biais d’entretiens approfondis semi-structurés avec vingt personnes handicapées physiques au Bangladesh pour explorer leurs points de vue sur les problèmes auxquels elles sont confrontées pour accéder à la microfinance. Les (...) données ont été collectées à la fois dans des zones urbaines et rurales et auprès de participants masculins et féminins. S’appuyant sur le modèle social du handicap, cette étude constate que les personnes handicapées physiques subissent une exclusion, une stigmatisation et des obstacles importants dans l’accès à la microfinance. Dans de nombreux cas, malgré les efforts des institutions de microfinance, le crédit n’est pas disponible pour de nombreuses personnes handicapées physiques, car elles subissent un comportement négatif et hostile de la part du personnel de la microfinance et des conditions de crédit inaccessibles. De plus, les personnes handicapées physiques ont moins de possibilités d’accéder à des services autres que le crédit, tels que l’épargne, l’assurance, la formation et les mécanismes de plainte. Pour relever ces défis, les institutions de microfinance doivent élaborer des réformes institutionnelles solides et adaptées aux personnes handicapées. Les personnes handicapées devraient être activement impliquées dans le processus d’élaboration des politiques. Cette étude partagera non seulement les expériences des personnes handicapées physiques dans le contexte des pays du Sud, mais fournira également des informations qui pourraient être utiles pour comprendre les défis auxquels d’autres personnes handicapées dans différents pays sont confrontées en termes d’inclusion financière. (shrink)

The trend to centralization of the Mizrahi narrative has become an integral part of the nationalistic, ethnic, religious, and ideological-political dimensions of the emerging, complex Israeli identity. This trend includes several forms of opposition: strong opposition to "melting pot" policies and their ideological leaders; opposition to the view that ethnicity is a dimension of the tension and schisms that threaten Israeli society; and, direct repulsion of attempts to silence and to dismiss Mizrahim and so marginalize them hegemonically. The Mizrahi Democratic (...) Rainbow [The Keshet], the most prominent proponent and representative of this trend, was established in the 1990s with the intention of being a leading civic and political body in Israeli society. While it was the Mizrahi worldview that led to selection of the organization's name and aims, their vision was to be involved in social struggle on behalf of other groups in Israeli society. Since it was established, The Keshet has aimed to function as an assertive, long-term alternative coalition exerting influence, power, and pressure on the Israeli narrative network. And, indeed, the organization has succeeded in disrupting Israeli discourse, principally, by challenging the ideological foundations of the Zionist meta-narrative. Nearing the end of the first decade of the 21st century and nearly a decade since it was established, The Keshet not only represents the most current wave of Mizrahi discourse, it has changed it to such a great degree that it is impossible to ignore its influence. Further, this alternative narrative may have significant potential to advance the internal Jewish discourse so fundamental at this time given the changing Israeli situation and regional conditions. And, while it is possible to view The Keshet and this new narrative as a continuation of the Mizrahi struggle, as a narrative The Keshet's agenda represents a post-colonial perspective and multi-cultural alternative to Zionism as a social vehicle. Amidst all of this, The Keshet continues to offer concrete proposals to change the Jewish character of the state as well as its internal and external relations. One of the primary goals of this study was to examine the rise of the Mizrahi narrative over the last two decades and the new Mizrahi discourse in Israeli society. More specifically, the study sought to attain an in-depth understanding of the central narrative created and represented by The Keshet. An additional goal was to investigate the influence of The Keshet's activity and the narrative it constructed in regard to other narratives. In particular, the study focused on The Keshet's opposition to the central Zionist narrative that infuses civic, political, and academic frameworks in Israel. Accordingly, the primary research questions investigated in the study sought to determine: What has been the influence of the Mizrahi Democratic Rainbow on the Mizrahi narrative in Israel? And, what are implications of such influence for the central Zionist narrative? Methodologically, the study was based on narrative and comparative analyses of texts from different periods of the older and newer Mizrahi narratives. The corpus included two types of texts: First, academic texts and opinion pieces, both philosophical and programmatic in nature, published in magazines, journals, books, as well as position papers; second, all of the texts published by prominent and influential figures who charted the path of The Keshet or led it organizationally and/or intellectually over the last twenty years (e. g., Yehudah Shenhav, Yossi Yona, Moshe Krief among others). All texts were examined by means of philosophical, historical and critical hermeneutic tools. This analysis revealed different levels of Mizrahi and civic discourse in Israel as well as among The Keshet's founders and leading ideologues. The study was based on a three stage process model, developed for purposes of this study, for investigation and analysis of the new Mizrahi narrative as well as other oppositional narratives, in particular opposition to the hegemonic meta-narrative. The stages are: issuing the challenge, dissolution and, liberation; that is, liberation is the measure of the ultimate success of the struggle for narrative change. Such change is not based on success in the field, but rather on a radical, fundamental reversal of thought, discourse patterns, stylistic structures, as well as forms of questioning - in this case of taken-for-granted racist mechanisms. However, the principal change is in achieving a deep, inner de-legitimization of the signifiers, categories, and reproductions of all manner of mockery that are based on immoral colonialist processes that are reinforced by regimes of fear and intimidation whose self-destruction began upon their very creation. This three stage model charts the course of the oppositional Mizrahi narrative from: accounting for the past (passing judgment on the so-called historic colonialist Zionism) to writing a new (pure Mizrahi) history and creation of a Mizrahi-Arab identity separate from the Ashkenazic, identified as Zionist. Contemporary post-colonialist discourse is integral in these stages. Such a perspective has been transformed by transitions from - binarism to hybridity, Orientalism to Occidentalism, the politics of "liberation" to "constructive" politics, from the history of consciousness to the history of change, as well as from nationalist to post-nationalist questions. Fundamentally, according to this approach, political and other struggles for the emerging narrative of Mizrahi (or Arab) history seek to centralize it in society and weave it amidst the models of multiculturalism. Undertaken in parallel, the central characteristics of all these stages are borrowed from countries in which the need for national reconciliation led to renunciation of apartheid and racist policies and historical judgment of the hegemony supported by racist leaders. In addition, these three moves were undertaken in Keshet and its ideologues by means of substantive symbolic violence directed at the hegemonic Ashkenazic discourse, which included creation of hatred of it, use of stereotypes the opposite of oppressive discourse, and adoption of an arrogant point of view toward it. This stands in stark contrast to the claims of the self-proclaimed new Mizrahi stance of a discourse established on purely ethical grounds that sought to cleanse itself of these very same oppressive elements. The model developed for and demonstrated in this study allows for analysis of oppositional narratives in which the libratory stage evolves into a form of entrapment, as appears to be occurring to the new Mizrahi discourse. This conclusion is based on the observations shared by many Keshet proponents including leading intellectuals who worked on the manifestos that were the subject of criticism from the Zionist camp. The study identified and defined the following six interwoven strata, which for purposes of explication are each discussed in a separate chapter: The first chapter presents a general theoretical discussion of the issue of the narrative and the inter-narrative struggle that has become central and applicable in various ways in the latest generation (e. g., anthropologically, hermeneutically, and philosophically). The analysis surveys different discussions in the inter-narrative struggle and locates them in the contexts, relations, and meanings derived from, representing, and indeed reproducing the narrative of national identity. The second chapter includes a historical survey of the older Mizrahi struggle that existed prior to the ascendance of the new Mizrahi narrative. Initially, Mizrahi discourse focused on expressing the ethnic protest that grew in years to follow. These feelings of discrimination and social distancing of the immigrants from Islamic countries gave birth to expressions of protest, the most prominent of which were Wadi Salib and the Black Panther Movement's various activities. The research literature contains many explanations for the exacerbation of the ethnic problem and creation of a situation that could not be ignored. The consensus academic view reached at the end of the 1970s identified a number of primary factors for this situation: the existence and extensive numbers of different ethnic groups; the relative or absolute segregation of frameworks within which members of these ethnic groups lived and acted; and the significant overlap between socio-economic status and feelings of discrimination retained by members of the Mizrahi group due years of neglect by the Ashkenazic establishment, the strengthening of Mizrahi social, cultural, and political power, as well as the emergence of a Mizrahi elite that identified with Mizrahi problems. The severe consequences of feelings of discrimination were expressed in a long series of events, such as: rioting by residents of the Rehovot Sharayim neighborhood in 1956; events of Wadi Salib in Haifa in 1959; and a chain of activities involving the Black Panthers in the 1970s. Protest was also an aspect of the "tent movement" in the 1970s and 1980s. Political activities were advanced by the Tami Movement that competed in the election for the 10th Knesset in 1981 and the Shas Movement that has continued to garner political power since being found in 1984. The 1980s and 1990s were characterized as the era of radical consciousness of Mizrahi discourse as well as by the rise to power, in consecutive order, of the political parties – Tami, Shas, and the Mizrahim HaHadashim [the New Mizrahi]. The latter party laid the foundations of the new radical Mizrahi discourse from which emerged such cultural activities as: Iton Aher [A Different Newspaper]; Bimat Kivon Aher [Another Direction Forum]; Efir'yon journal; the Halah Organization for Education in Neighborhoods, Development Towns, and Villages; Kedma; the newspaper – Patish [Hammer]; and, eventually the establishment of Keshet. The third chapter presents an examination of the materialization of the inter-narrative struggle in the case of Israel, with a specific focus on The Keshet and the new Mizrahi narrative advanced by it and intellectuals. The Keshet ideology is examined in the context of its grounding in post-colonial thought, especially that of Edward Said; the directions proposed by Ella Shohat and her followers; the central thinkers of the narrative in Israel in the last decade; and the harsh critique leveled at the Ashkenazic-Zionist narrative. The practical steps proposed for implementation within the multicultural model are also examined. Here the effort to reduce the centrality of Zionism while revealing its oppressive mechanisms was undertaken in parallel with use of these mechanisms in order to create a Mizrahi space with broad margins inclusive of alternative forms of Israeli identity in the Middle East and in conjunction with Arabs within and beyond Israel. Mizrahi traditionalism is examined in the fourth chapter in two particular respects. First, the criticism of the new Mizrahi narrative leveled by the renewed view and, second, the implications of the alternative in terms of creating a Mizrahi space that does not oppose Zionism. Rather, in opposing the post-colonialist perspective, this renewed traditionalist perspective criticizes as well as values Zionism. This space seeks to be both Jewish and Mizrahi. It does not detach itself from nationalist Zionism but rather views itself as a continuation of this tradition and, accordingly, is an effort to develop a next stage in its development. For example, an essential dimension of the traditionalist perspective, "commitment," is considered in this stage to be a fertile basis for dialogue with the past and as an anchor for contemporary interpretation of Mizrahi and other Jews' identities in Israel. The fifth and sixth chapters deal with all of the vectors of criticism directed at the new Mizrahi narrative, including its ideological foundations, philosophical stance, as well as intellectual and practical basis in the Israeli sphere in the face of Palestinian nationalism. These vectors of criticism from within and beyond The Keshet deal with issues, such as, the meaning of the movement's activities and the narrative that it offers regarding questions of Israeli identity, Israeli collective memory, and Mizrahi self-perception. At the same time, it must confront the capitalist neo-liberal narrative in a global world and thrive in a context in which it must make itself manifest amidst oppositional narratives. The final chapter presents a comprehensive, critical analysis of the new Mizrahi narrative. It does so by means of a theoretical model that examines it as an oppositional narrative – one that seeks to challenge the hegemonic meta-narrative, to dissolve the boundaries of the narrative discourse, and to propose liberation and redemption that may led to entrapment amidst a changing, a-dichotomous realities (e. g., global economic development in the face of Zionist nationalisms that display ideological strength as well as development of the sense of being an Israeli that maintains its vitality and continuity while being constituted by sectors that challenge being a Mizrahi, such as co-ethnic subjects. The Keshet's influence is dramatic and extends in a number of central directions. Its political activity and non-entry into the domains of the Israeli parliament granted the movement significant power in civic discourse and contributed to changing the persona of the Mizrahi discourse; for example, from political-party struggles over budgets and obtaining shares of the regime to changing the face of Israeli society and the centrality of the Mizrahi narrative. This change included deconstructing the Ashkenazic narrative and constructing comprehensive Ashkenazic-Zionist guilt, as evident in the Ehud Barak's request for collective forgiveness. This was accomplished through the participation of leading members of Keshet who appeared in prominent intellectual forums and engaged in lively discourse - principally in academic, social, and media domains. Such participation gave new meaning to various aspects of Israeli society while establishing different models of multiculturalism. The rise of the new Mizrahi narrative is a significant marker in the inter-narrative struggle as it represents a desire for separate or hybrid identities. And, the deep probing of the narrative constructed by leaders of The Keshet and those who identify with the movement produced a number of clear ways to distinguish it from the old Mizrahi struggle, whose history was portrayed through social protests, in a manner similar to linear vectors marked with wars and elections. The old Mizrahi struggle selected the traditional tactical struggle identified usually with social and political movements that seek to change political, social, and economic reality - from the bottom up. Their primary demand was to change decisions as well as the division of social goods and resources. Hence, this older period of struggle was not aimed at opposing the ideological foundations of the hegemonic narrative nor did it seek to undermine in a radical manner the unique nature of the state of Israel as a revolutionary solution for the problems of the Jews according to the Zionist approach, as a national home for the Jewish people, and recognition of the right to an preferred and meta-definition of Jewish nationalism. In contrast, the top down struggle advanced by the new narrative is part of an ideological movement led by the educated that is assertive and ground in post-colonialist theory. Accordingly, it was critical of the techniques and mechanisms of oppression as well as sought to attack the Zionist ideological foundations and to reveal its racist operations and the regimes that have preserved it so efficiently for many years. The uniqueness of this narrative is the intellectual offensive that continues to be advanced and, in parallel, development of the discourse struggle in Israel concerning the justification for Zionism and the concrete political proposal that Jews reject the taken-for-granted status of it as an ideology. This new narrative recognizes the historic difficulties of subversion as an emancipatory and, principally, moral effort. In addition, the new Mizrahi narrative shares the foundations and narrative of Palestinian victimization. In its radical version, the new Mizrahi narrative seeks to connect to the Palestinian narrative in order to create a new space here. According to this version, this action will take place gradually. The first stage will be characterized by opposition to Western European, Ashkenazic Zionism. The Eurocentric Zionism will surrender in the second stage, to be followed in the last stage by creation of a coalition of Jews and Arabs that will be establish through concrete actualization of the refugee status and victimization that is shared by both Palestinians and Mizrahim (whether as Mizrahim or Jewish-Arab). Not a speculative academic exercise, the goal sought by this narrative is delineate and to achieve a multicultural model in which equality, liberty, and social justice will overcome the nationalism and colonialism of either side; that is it will be neither Zionist nor Jewish. Thus, this approach stresses what is shared (e.g., acceptance of the Arab space and not a rejection of it; the legitimacy of the Arab language and culture). This is part of detachment from and historic judgment of the colonialist Zionist enterprise. This possibility includes moral elements that remove the evil and harm caused by Zionism for many years as well as inner cleansing – primarily among Ashkenazim – of attitudes towards Jews and non-Jews. Though, in this regard, it should be noted that, to date, the new narrative has not made similar claims that Palestinians undergo a similar process. The assumption seems to be that this should be tested, that the coalition proposed is a possibility that will be recognized by the Palestinians, and that they are prepared to undergo a similar, shared moral process that involves negating the state of Israel as a Jewish, Western state, a state of the Jewish people, and not only for those who live within it. These Mizrahi thinkers conducted a significant move through deconstruction and substitution of the Eurocentric narrative with a multi-cultural proposal that is optimistic and even attractively naïve. Today, they acknowledge that they did not take into account Palestinian nationalist violence directed to citizens, the traditionalist alternative, and widespread opposition within the Mizrahi community toward what is perceived to be Mizrahi seclusion. They also did not take into account the harsh criticism rendered by young and educated Mizrahim who claim that they were born into a complex, multi-dimensional, multi-layered identity that includes internalization of the language of the West and rules of the game of this complex identity. And, though they are critical of some of its values, this makes it difficult to mount internal emotional opposition to the West and to the globalization contained within this world. Hence, this more familiar world is preferred over the values of the Mizrahi-Arab alternative, particularly in regard to problems in the domains of democratic citizenship, stance taken toward women, and freedom of speech. Further, educated Mizrachim reject the post-colonialist perspective and are stridently critical of its dichotomization. They claim that such a division is irrelevant in a world in which older ideologies have collapsed and new spheres – such as cyberspace and others – are open to them in which they can present themselves with an Israeli identity that is not categorized as necessarily Mizrahi. (shrink)

Background: Since the increasingly complex structure of health care services brings many ethical problems, it is important to use different instructional technologies in the ethical education of future nurses. Aim: The aim of this study was to determine the effect of role play prepared with video support on ethical decision-making and motivation levels of nursing students. Research design: A quasi-experimental study with pretest-posttest design. Participants and research context: The research was conducted in the Nursing Department (...) of a University located in Istanbul, Turkey between October 15 and November 15, 2024. The sample of the research consisted of 3rd year nursing students. Data were collected using the Descriptive Characteristics Form, the Nursing Dilemma Test, and the Instructional Material Motivation Scale for Single-Use. Ethical considerations: Permission was obtained from Bezmialem Vakif University Non-Interventional Ethical Research Committee and the institution where the study was conducted for the implementation of the research. Written and verbal consent was obtained from all participants in accordance with the Helsinki Declaration. Findings: While there was no difference between the students’ Ethical Dilemma Test Principled Thinking pre-test and post-test scores, their Practical Consideration ( p =.005) and motivation levels ( p =.037) post-test scores were found to be higher. There was a weak but significant negative correlation between academic achievement and pre-test teaching material motivation levels (r = −0.375, p =.041). Discussion: The use of different teaching methods and techniques in ethics education in nursing is important for future nurses to find more practical solutions to the ethical problems they will encounter during patient care. Conclusion: The results of the study indicate that the use of video-supported role play can be effective in teaching ethics courses in nursing education. (shrink)

Learning disabilities are highly prevalent on college campuses, yet students with learning disabilities graduate at lower rates than those without disabilities. Academic and psychosocial supports are essential for overcoming challenges and for improving postsecondary educational opportunities for students with learning disabilities. A holistic, multi-level model of campus-based supports was established to facilitate culture and practice changes at the institutional level, while concurrently bolstering mentors’ abilities to provide learning disability-knowledgeable support, and simultaneously creating opportunities (...) for students’ personal and interpersonal development. Mixed methods were used to investigate implementation of coordinated personal, interpersonal, and institutional level supports for undergraduate science, technology, engineering, and math (STEM) students with learning disabilities. A one-group pre-test post-test strategy was used to examine undergraduate outcomes. Participants included 52 STEM undergraduates with learning disabilities, 57 STEM graduate student mentors, 34 STEM faculty mentors, and 34 university administrators and personnel as members of a university-wide council. Enrolled for two years, undergraduates were engaged in group meetings involving psychoeducation and reflective discussions, development of self-advocacy projects, and individual mentorship. Undergraduates reported improved self efficacy (p =.001), campus connection (p <.001), professional development (p ≤.002), and self advocacy (p <.001) after two academic years. Graduate student mentors increased their understanding about learning disabilities and used their understanding to support both their mentees and other students they worked with. Council members identified and created opportunities for delivering learning disability-related trainings to faculty, mentors and advisors on campus, and for enhancing coordination of student services related to learning and related disorders. Disability-focused activities became integrated in broader campus activities regarding diversity. This research explicates a role that college campuses can play in fostering the wellbeing and the academic and career development of its students with developmental learning and related disorders. It offers an empirically tested campus-based model that is multilevel, holistic, and strengths-based for supporting positive outcomes of young people with learning disabilities in STEM. Moreover, findings advance the knowledge of supports and skills that are important for self-regulating and navigating complex and multi-faceted disability-related challenges within both the post-secondary educational environment and the young adults’ sociocultural context. (shrink)

Background Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available. Aims The aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders (...) who have personal or professional experience with legally enforceable SBDs. Methods Data collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews. The data were analyzed thematically. Results Perceived benefits of SBDs included increased autonomy, improvement of the therapeutic relationship, possibility of early intervention and prevention of harm, prevention of compulsory care, reduction of the duration of compulsory care and recovery, mitigation of negative experiences around compulsory care, and guidance for professionals in providing compulsory care. Perceived risks included infeasibility of SBD instructions, difficulty in decision-making around SBD activation, limited accessibility of SBDs, disappointment of service users due to non-compliance with SBDs, and limited evaluation and updating of SBD content. Barriers to SBD completion included lack of knowledge of SBDs among professionals, lack of motivation or insight among service users, and lack of professional support for SBD completion. Facilitators of SBD completion and activation included support for SBD completion, involvement of relatives and peer experts, specification of SBD content, and evaluation of compulsory care and SBD content. The new legal framework was regarded as having both positive and negative effects on SBD implementation. Conclusions Stakeholders who have personal or professional experience with legally enforceable SBDs perceive SBDs as having important benefits and tend not to articulate the fundamental ethical concerns about SBDs which can be found in the ethics and legal literature. Instead, they perceive ethical and practical challenges that can be addressed through the implementation of suitable safeguards. (shrink)

The United Nations Convention on the Rights of Persons with Disabilities urges and requires changes to how signatories discharge their duties to people with intellectual disabilities, in the direction of their greater recognition as legal persons with expanded decision-making rights. Australian jurisdictions are currently undertaking inquiries and pilot projects that explore how these imperatives should be implemented. One of the important changes advocated is to move from guardianship models to supported or assisted models (...) of decision-making. A driving force behind these developments is a strong allegiance to the social model of disability, in the formulation of the Convention, in inquiries and pilot projects, in implementation and in the related academic literature. Many of these instances suffer from confusing and misleading statements and conceptual misinterpretations of certain elements such as legal capacity, decision-making capacity, and support for decision-making. This paper analyses some of these confusions and their possible negative implications for supported decision-making instruments and those whose interests these instruments would serve, and advises a more incremental development of existing guardianship regimes. This provides a more realistic balance between neglecting the real limits of those with mental disabilities and thereby ignoring their identity and particularity, and continuing to bring them equally and fully into society. (shrink)

BackgroundThe UN Convention on the Rights of Persons with Disabilities, and the reformed guardianship law in Germany, require that persons with a disability, including people with dementia in Alzheimer’s disease (PwAD), are supported in making self-determined decisions. This support is achieved through communication. While content-related communication is a deficit of PwAD, relational aspects of communication are a resource. Research in supported decision-making (SDM) has investigated the effectiveness of different content-related support strategies for (...) PwAD but has only succeeded in improving understanding, which, although one criterion of capacity to consent, is not sufficient to ensure overall capacity to consent. The aim of the ‘spatial intervention study’ of the DECIDE project is to examine an innovative resource-oriented SDM approach that focuses on relational aspects. We hypothesise that talking to PwAD in their familiar home setting (as opposed to a clinical setting) will reduce the complexity of the decision-making process and enhance overall capacity to consent. MethodsPeople with a suspected or confirmed diagnosis of dementia in Alzheimer’s disease will be recruited from two memory clinics (N = 80). We will use a randomised crossover design to investigate the intervention effect of the decision-making place on capacity to consent. Besides reasoning capacity, which is part of overall capacity to consent and will be the primary outcome, various secondary outcomes (e.g., other aspects of capacity to consent, subjective task complexity, decisional conflict) and suspected moderating or mediating variables (e.g., meaning of home, demographic characteristics) will be assessed.DiscussionThe results of the study will be used to develop a new SDM strategy that is based on relational resources for PwAD. If a change in location achieves the anticipated improvement in capacity to consent, future research should focus on implementing this SDM strategy in a cost-effective manner in clinical practice.Trial registration: DRKS00030799. (shrink)

The right to active participation by disabled people in academic research has been discussed at length in recent years, along with the potential for such research to function as a tool in challenging oppression and pursuing disability rights. Significant ethical, legal and methodological dilemmas arise, however, in circumstances where a disabled person loses the capacity to provide informed consent to such participation. In this article, I consider disability politics and academic research in the context of the (...) Mental Capacity Act 2005, which sets out in Anglo-Welsh law the circumstances and requirements for research participation by individuals lacking the capacity to provide informed consent. Drawing on my own perspective on research participation in relation to physical and psychosocial disability, I consider the implications of my potential future loss of capacity for my right to participate in disability-related research. I examine the barriers to such participation and suggest that partial solutions may be found in the advance decision-making and advance care-planning frameworks of the MCA 2005 and related policy, but that current legislative and policy frameworks nevertheless still curtail my rights with regard to research participation on loss of capacity to consent. In so doing, I seek to provoke debate concerning what this legislative provision means for the disability rights movement, and the possibilities and challenges it presents to the movement’s commitment to ‘nothing about us without us’. (shrink)

Background Non-invasive prenatal testing (NIPT), which can screen for aneuploidies such as trisomy 21, is being implemented in several public healthcare systems across Europe. Comprehensive communication and information have been highlighted in the literature as important elements in supporting women’s reproductive decision-making and addressing relevant ethical concerns such as routinisation. Countries such as England and France are adopting broadly similar implementation models, offering NIPT for pregnancies with high aneuploidy probability. However, we do not have a deeper understanding (...) of how professionals’ counselling values and practices may differ between these contexts. Methods In this paper, we explore how professionals in England and France support patient decision-making in the provision of NIPT and critically compare professional practices and values. We draw on data from semi-structured interviews with healthcare professionals. Results Both English and French professionals emphasised values relating to patient choice and consent. However, understandings and application of these values into the practice of NIPT provision differed. English interviewees placed a stronger emphasis on interpreting and describing the process of counselling patients and clinical care through a “principle” lens. Their focus was on non-directiveness, standardisation, and the healthcare professional as “decision-facilitator” for patients. French interviewees described their approach through a “procedural” lens. Their focus was on formal consent, information, and the healthcare professional as “information-giver”. Both English and French professionals indicated that insufficient resources were a key barrier in effectively translating their values into practice. Conclusion Our findings illustrate that supporting patient choice in the provision of NIPT may be held as an important value in common on a surface level, but can be understood and translated into practice in different ways. Our findings can guide further research and beneficially inform practice and policy around NIPT provision. (shrink)

The theme of this issue of Ethical Perspectives is the French tradition in liberal thought, and the unique contribution that this tradition can make to debates in contemporary liberalism. It is inspired by a colloquium held at the Katholieke Universiteit Leuven in December of 2008 entitled “In Search of a Lost Liberalism: Constant, Tocqueville, and the singularity of French Liberalism.” This colloquium was held in conjunction with the retirement of Leuven professor and former Dean of the Institute of Philosophy, (...) André Van de Putte, who found much inspiration in this tradition. A revised version of his valedictory lecture from the conference serves as the final contribution to this issue. Much contemporary liberal political philosophy is currently done in conversation with a line of liberal thinkers starting with John Locke, running through Immanuel Kant and John Stuart Mill, and culminating in the work of John Rawls and his followers. The reasons for the enormous appeal of this philosophical tradition are, among other things, the combination of the central role of the intuitively appealing value of individual liberty with a strong rationalistic, universalistic, and normative character. The thread running through most of these liberal theories is a commitment to what the French liberal Benjamin Constant referred to as “the liberty of the moderns,” that is, liberty in a negative sense, as a lack of interference in one’s activity from others and from government. This focus has expanded over time to include a richer body of civil, political, social, economic and cultural rights, for instance, in the work of liberal thinkers who have tried to integrate the insights of communitarian thought and discourse ethics in their work. However, the emphasis on individual liberty in the negative sense continues to be the normative and theoretical touchstone and default position for many contemporary liberal theories. The limitation of the canon of liberal thought to the aforementioned authors and themes deprives the contemporary debate of a rich source of ideas: the French liberal tradition. Montesquieu, considered to be the father of this tradition, provides a good example of how it can enrich current debates in liberal theory. Montesquieu’s work evinces a keen eye for the dynamics of power relations and the limitations of the power of the better rational argument. His insight that power can sometimes only be checked by an equal and opposing power, so that a system of separation and balance of powers is necessary in order to preserve liberty, is reflected in the foundations of most modern democracies. Montesquieu also argues that contingent environmental, historical, social and economic conditions play a dramatic role in determining what kind of government is appropriate for a particular society. On his view, ignoring these facts when framing a government can inadvertently end in despotism. Montesquieu’s observations challenge us to reexamine some of contemporary liberalism’s universalist and rationalist claims. Benjamin Constant is most famous for his distinction between two kinds of liberty: the liberty of the ancients and the liberty of the moderns. The ancient form of liberty manifested itself in the active political participation of citizens in the ancient republic. While this form of government and decision-making was suitable for small, homogeneous city-states, Constant argues that it is impracticable for large modern nation-states. Hence, the concept of modern liberty shifts to an emphasis on the rule of law and the non-interference of the state in private matters. This form of liberty is familiar to us from contemporary liberalism – and Constant cherishes this form of freedom as much as any liberal does today. However, his position is complex: he also argues that the liberty of the ancients should not be neglected. Active political participation is needed to ensure that the government is executing its duty of preserving the modern form of liberty by publicly pointing out violations. The contemporary relevance of Constant’s work is clear when we consider the alleged “democratic deficit” that plagues the EU and international institutions such as the UN, the IMF, and the World Bank. Not only does this democratic deficit threaten the modern form of liberty by placing decision-making processes out of sight of the people, it also threatens citizens’ sense of self-respect derived from self-governance. Constant’s argument for the necessity of combining the liberty of the ancients with that of the moderns provides a fruitful resource for confronting these contemporary issues. Tocqueville’s work on liberalism benefits from his opportunity to observe a society founded on liberal democratic principles – the United States of America – in action. In his Democracy in America, he examines the social consequences, both intended and unintended, of building a society on ‘the equality of conditions’, as he defines ‘democracy’. Tocqueville sees a tension between the democratic value of equality and the aristocratic value of the rule of the best. He observes that democratic societies do not necessarily choose the best leaders and instead promote mediocrity instead of virtue, talent, and excellence. Democracy also confronts citizens with the threat of ‘soft despotism’, where a government that preserves the outer signs of the liberty of the moderns nevertheless controls the behavior of its citizens in minute detail through a system of detailed rules ostensibly aimed at their welfare. This paternalism is an even more insidious threat to liberal values than the hard variety of despotism, since it is so difficult to detect and done in the name of liberal values themselves. Taking Tocqueville’s observations seriously would add complexity to attempts to theorize about the modern social-democratic welfare state. The contributions to this issue supplement and critique mainstream liberal thought and its relation to contemporary issues through a serious engagement with the French liberal tradition. Annelien De Dijn’s contribution discusses Bertrand de Jouvenel, a lesser-known 20th Century representative of the French political tradition she terms ‘aristocratic liberalism’. This tradition has its roots in the work of Montesquieu, and emphasizes the importance of intermediary bodies, most importantly the aristocracy, in providing a check to the top-down power of despotic state authorities and the bottom-up power of revolutionary leveling tendencies, both of which threaten liberty. De Dijn situates Jouvenel in this tradition, but then indicates an important difference between his thought and that of his predecessors: his most significant work, On Power, is not only on French history, but on European history. Pointing to the enthusiastic reception of this work in the Anglophone world, she suggests that the rise of totalitarianism in Europe gave the anti-totalitarian features of aristocratic liberalism a broader appeal. Valentino Lumowa’s paper concerns Constant’s classic text, The Liberty of the Ancients Compared with that of the Moderns. Lumowa argues that in order to understand Constant’s piece, we must be aware that its two parts were written under different historical circumstances and decipher the argumentative thrust inherent in the text. Following Stephen Holmes, he argues that to understand the shift Constant made in the second part of the text, we should read it within the context of the increasing influence of the ultra-Royalists in the legislature during the Bourbon Restoration. However, in contrast to Holmes, he contends that the spirit of both civic and individual freedom, which enlivens representative system, is the backbone of the text in its unity. Demin Duan’s essay investigates an apparent ambivalence between liberal and imperialist tendencies in the work of Alexis de Tocqueville, which has already drawn some attention from Tocquevillian scholars. These interpretations of Tocqueville and his writings on empire generally agree that Tocqueville stands in a recognized tradition of liberalism, which is characterized by respect for human rights, individual freedom and a sense of universal humanism. On this standard view, Tocqueville’s support of imperialism represents nothing but an unfortunate breach of his own otherwise consistent liberal thinking. Duan’s article questions this standard position. By questioning the assumption of Tocqueville’s liberalism in the first place, he tries to gauge the influence of both the old republican tradition and the new liberal perspective on his thinking. In conclusion, he argues that Tocqueville’s overall thought, especially his notion of freedom, is very much informed by an old republican tradition. His support of French imperialism could be better understood from this perspective rather than be rendered simply as a deviation from liberal norms. Pawel Marczewski’s contribution is an attempt to show that Tocqueville’s conception of liberty transcends the divisions between negative and positive aspects of freedom. He begins by juxtaposing this conception with the opposition drawn by Constant between liberty of the ancients and liberty of the moderns. While Tocqueville and Constant shared a concern for the preservation of individual rights, Tocqueville was much more reluctant to accept the modern loss of the communal dimension of liberty. He did not accept the view that jouissances privées, private pleasures, are the main compensation that the modern world has to offer for the lost ancient treasure of political participation. The essay then looks into the relevance of Tocqueville’s standpoint for current debates between liberal defenders of negative freedom and republican advocates of freedom as non-domination. Participants on both sides of the debate seem to be so devoted to showing that their particular approach provides the best guarantees against actual and possible threats to liberty that they overlook the fact that their definitions of freedom remain significantly similar. By arguing that ‘to be free is to be guided by one’s own will’, contemporary republicans, as well as their liberal counterparts, move along the lines drawn by Constant towards private pleasures. By questioning the inevitability of this turn, Tocqueville provides us with a valuable contribution to these discussions in contemporary political philosophy. Finally, André Van de Putte’s contribution, an adaptation of his emeritus speech that closed the conference on French Liberalism, appeals to Tocqueville in order to draw attention to the importance of intermediary, dialogical bodies in mitigating the implicit despotic tendencies of the democratic drive to equality. In Tocqueville’s view, the transition from the feudal corporate inequality to democratic individual equality was not a clean break. Rather, this transition is a continual process of democratization that is driven by a desire for equality, or egalité des conditions. This dissolution of distinctions of estate, class and status has the unintended consequence of concentrating the diffuse power of these entities into a centralized state, which is responsible for ensuring the equality of all under the law. This process leaves increasingly isolated and atomized individuals to face the power of a monolithic state in defense of their freedom, and moves toward a soft, paternalistic despotism. Constant’s freedom of the moderns is not sufficient to protect individuals from this centralized power. Democracy also requires the political freedom of the ancients. Van de Putte argues for a system in which atomized individuals organize themselves into intermediary bodies that, in a Montesquieuian balance of powers, can enter into dialogue with each other and the state on more equitable terms. Van de Putte’s contribution closes with a plea for a conception of democracy as a regime of dialogue. (shrink)

Motivations and decision-making styles that influence participation in biomedical research vary across study types, cultures, and countries. While there is a small amount of literature on informed consent in non-western cultures, few studies have examined how participants make the decision to join research. This study was designed to identify the factors motivating people to participate in biomedical research in a traditional Nigerian community, assess the degree to which participants involve others in the decision-making process, and (...) examine issues of autonomy in decision-making for research. A descriptive cross-sectional study was conducted with 100 adults (50 men, 50 women) in an urban Nigerian community who had participated in a biomedical research study. Subjects were interviewed using a survey instrument.Two-thirds of the respondents reported participating in the biomedical study to learn more about their illness, while 30% hoped to get some medical care. Over three-quarters (78%) of participants discussed the enrolment decision with someone else and 39% reported obtaining permission from a spouse or family member to participate in the study. Women were more than twice as likely as men to report obtaining permission from someone else before participating. More specifically, half of the female participants reported seeking permission from a spouse before enrolling. The findings suggest that informed consent in this community is understood and practised as a relational activity that involves others in the decision making process. Further studies are needed in non-Western countries concerning autonomy, decision-making, and motivation to participate in research studies. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled (...) donation after circulatory determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

The susceptibility of decision-makers’ choices to variations in option framing has been attributed to individual differences in cognitive style. According to this view, individuals who are prone to a more deliberate, or less intuitive, thinking style are less susceptible to framing manipulations. Research findings on the topic, however, have tended to yield small effects, with several studies also being limited in inferential value by methodological drawbacks. We report two experiments that examined the value of several cognitive-style variables, including (...) measures of cognitive reflection, subjective numeracy, actively open-minded thinking, need for cognition, and hemispheric dominance, in predicting participants’ frame-consistent choices. Our experiments used an isomorph of the Asian Disease Problem and we manipulated frames between participants. We controlled for participants’ sex and age, and we manipulated the order in which choice options were presented to participants. In Experiment 1 (N = 190) using an undergraduate sample and in Experiment 2 (N = 316) using a sample of Amazon Mechanical Turk workers, we found no significant effect of any of the cognitive style measures taken on predicting frame-consistent choice, regardless of whether we analyzed participants’ binary choices or their choices weighted by the extent to which participants preferred their chosen option over the non-chosen option. The sole factor that significantly predicted frame consistent choice was framing: in both experiments, participants were more likely to make frame consistent choices when the frame was positive than when it was negative, consistent with the tendency towards risk aversion in the task. The present findings do not support the view that individual differences in people’s susceptibility to framing manipulations can be substantially accounted for by individual differences in cognitive style. (shrink)

The Convention on the Rights of Persons with Disabilities (CRPD) came into force in 2008. People with disabilities, including people with psychosocial disabilities, were instrumental to its development. Article 12 and Article 14 of the CRPD, which respectively affirm the universal legal capacity and right to liberty of persons with disabilities, were viewed as key victories by disability rights movements. These provisions are particularly important for people with psychosocial (...) disabilities who are routinely subjected to human rights violations through psychiatric detainment and involuntary treatment authorized under domestic mental health legislation in many states. We aim to advance discourse surrounding the CRPD and its development by centring mad peoples’ voices and individuals with lived experience through a literature review and interviews with key disability rights advocates. Using Canada as a case study, we critically examine the implementation of the CRPD and the need to align mental health acts with our international human rights obligations. We argue that forced psychiatric interventions violate the rights of persons with psychosocial disabilities and cause inherent harm. There is an urgent need to move towards new paradigms of care that promote the dignity and autonomy of people with psychosocial disabilities. (shrink)

The historical context of mental health care in Quebec, which in recent years has given way to greater client participation in the decision-making process for which they are concerned, has reversed the previous medical conception of psychiatry. From a vision of internment, care is now adapted to the individual needs of the clientele served, even including the provision of care in the home. However, work with people weakened by mental illness is often fraught with questions (...) and sometimes contradictory ethical issues. Intensive follow-up teams in the community are a case in point. Working with a very vulnerable clientele, health workers must know how to be open and flexible in order to establish a therapeutic relationship with a clientele that is often involuntary and refractory to any form of treatment. To achieve this, they often have to get past refusals to follow-up by using various strategies derived from libertarian paternalism in order to maintain contacts that will become meaningful and allow these individuals to regain control over their lives. This sometimes-intrusive approach obviously raises its share of ethical issues, particularly regarding consent to care, and can be perceived as an infringement of fundamental rights by infringing rights to self-determination and decision-making autonomy. However, it is possible to reverse this position through a benevolent approach supported by an ethics of care that favours respect for the uniqueness of each individual by placing them at the heart of the therapeutic relationship. It is through dialogue, the place given to the other, respect for their choices, uniqueness and self-determination that it will then be possible to seek implicit consent and active participation of the user in the recovery process, even if sometimes there are binding legal measures. (shrink)

Informed consent (IC) is a key patients’ right. It gives patients the opportunity to access relevant information/knowledge and to support their decision-making role in partnership with clinicians. Despite this promising account of IC, the relationship between ‘knowledge’, as derived from IC, and the role of clinicians is often misunderstood. I offer two examples of this: (1) the prenatal testing and screening for disabilities; (2) the consent process in the abortion context. In the first example, IC is (...) often over-medicalized, that is to say the disclosure of information appears to be strongly in the clinicians’ hands. In this context, knowledge has often been a curse on prospective parents. Framing information in a doctor-centred and often negative way has hindered upon prospective parents’ decision-making role and also portrayed wrong assumptions upon disabled people more widely. In the second context, information is more often than not dismissed and, in a de-medicalized scenario, medical contribution often underplayed. The latter leads to an understanding of the dialogue with clinicians as a mere hinderance to the timely access to an abortion. Ultimately, I claim that it is important that knowledge, as derived from IC, is neither altogether dismissed via a process of de-medicalization, nor used as a curse on patients via a process of over-medicalization. None of the two gives justice to IC. Only when a better balance between medical and patients’ contribution is sought, knowledge can aspire to be a blessing (i.e. an opportunity for them), not a curse on patients in the IC context. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:502 Feminist Studies 46, no. 2. © 2020 by Feminist Studies, Inc. Jaime Madden Teaching Online: Issues of Equity and Access in Writing-centric Formats The COVID-19 pandemic has turned us all into online teachers. In the context of this crisis, we have quickly learned new technologies and the affordances of asynchronous and synchronous delivery. We have grappled with the challenges of building community and supporting active engagement, and (...) we have turned to adapting our assessment methods for the remote environment. We have done this work at traditional colleges and universities, where online teaching was formerly the purview of graduate students and adjunct instructors. Online learning can no longer be associated with those who struggle to access traditional classrooms, such as disabled students and those who attend for-profit colleges. Instead, access to online learning can now be associated with access to wealth and to health—specifically as relates to avoiding contact with the virus. In K-12 education, we have seen districts that largely enroll white students make the decision to continue online or go hybrid for the fall 2020 semester, whereas those that largely enroll students of color are returning to the classroom.1 Inequalities pervade the teaching landscape as well. Teaching is not a job usually marked as high risk, but within this environment, some 1. The work of activist and artist @bmore_radical shows how these decisions are being made in Baltimore, Maryland. See https://www.instagram.com /bmore_radical/?hl=en. Jaime Madden 503 bodies suffer at higher rates. In a recent article published in this journal, coauthors writing as the Brocher Foundation Feminist Collective describe their experience and knowledge “of the ways that academia produces sickness.”2 The authors are white and cisgender women at Anglo-American and European universities, and even though they acknowledge that they did not experience high levels of racism, classism, linguistic marginalization, and/or illness, they still found themselves—at different stages of their careers—“worn thin” in a system where “bodies are disposable.”3 Commenting on this problem in another context, disability studies scholar Alison Kafer notes that disability is “more fundamental, more inevitable, for some than others.”4 The pandemic has made this much clear: able-bodied people are “temporarily able-bodied,” and those who experience racism and classism are among the most frequently and intensely sickened. In attending to how teachers and students transition online en masse, we need to consider how we are differently positioned within institutions governed by the logics of racialized capitalism. It is important to recognize not only which students can access these online spaces but also which skills such spaces tend to reward. It is also important to ask which teachers are disproportionately impacted by the transition online. In this piece, I describe the challenges of assessment and then wrestle with broader questions of access as a scholar invested in feminist studies and disability studies. The tension in online education between its promise of access and its methods of assessment is, I argue, worthy of urgent attention. The Challenges of Assessment I have taught online courses at four institutions: two private colleges and two public universities. Good teaching and learning can undoubtedly happen across a range of spaces. In online environments, I have found that my best teaching happens in the feedback I give students. 2. Laura Bisaillon, Alana Cattapan, Annelieke Driessen, Esther van Duin, Shannon Spruit, Lorena Anton, and Nancy S. Jecker, “Doing Academia Differently: ‘I Needed Self-Help Less Than I Needed a Fair Society,” Feminist Studies 46, no. 1 (2020): 132. 3. Bisaillon, et al., “Doing Academia Differently,” 136, 140. 4. Alison Kafer, Feminist, Queer, Crip (Bloomington: Indiana University Press, 2013), 26. 504 Jaime Madden This is understandable since assessment practices are important teaching opportunities in all contexts. In online environments, and particularly in asynchronous teaching, I have found that it is while carrying out assessments of student work that my most intense teaching occurs. It is through grading and offering comments on papers and assignments that I am most directly in communication with students as their teacher. When I mark student work, I ask questions of students, I prompt them to consider how our course materials may be placed... (shrink)

BackgroundThis article is part of a study to gain insight into the decision-making process by looking at the views of the relatives of potential brain dead donors. Alongside a literature review, focus interviews were held with healthcare professionals about their role in the request and decision-making process when post-mortal donation is at stake. This article describes the perspectives of the relatives.MethodsA content-analysis of 22 semi-structured in-depth interviews with relatives involved in an organ donation decision.ResultsThree themes (...) were identified: ‘conditions’, ‘ethical considerations’ and ‘look back’. Conditions were: ‘sense of urgency’, ‘incompetence to decide’ and ‘agreement between relatives’. Ethical considerations result in a dilemma for non-donor families: aiding people or protecting the deceased’s body, especially when they do not know his/her preference. Donor families respect the deceased’s last will, generally confirmed in the National Donor Register. Looking back, the majority of non-donor families resolved their dilemma by justifying their decision with external arguments. Some non-donor families would like to be supported during decision-making.DiscussionThe discrepancy between general willingness to donate and the actual refusal of a donation request can be explained by multiple factors, with a cumulative effect. Firstly, half of the participants stated that they felt that they were not competent to decide in such a crisis and they seem to struggle with utilitarian considerations against their wish to protect the body. Secondly, non-donor families refused telling that they did not know the deceased’s wishes or contesting posthumous autonomy of the eligible. Thirdly, the findings emphasise the importance of Donor Registration, because it seems to prevent dilemmas in decision-making, at least for donor families.ConclusionDiscrepancies between willingness to consent to donate and refusal at the bedside can be attributed to an unresolved dilemma: aiding people or protect the body of the deceased. Non-donor families felt incompetent to decide. They refused consent for donation, since their deceased had not given any directive. When ethical considerations do not lead to an unambiguous answer, situational factors were pivotal. Relatives of unregistered eligible donors are more prone to unstable decisions. To overcome ambivalence, coaching during decision-making is worth investigation. (shrink)

This study investigates the association of a broad set of variables with the ethical decision making of management accountants in Libya. Adopting a cross-sectional methodology, a questionnaire including four different ethical scenarios was used to gather data from 229 participants. For each scenario, ethical decision making was examined in terms of the recognition, judgment and intention stages of Rest’s model. A significant relationship was found between ethical recognition and ethical judgment and also between ethical judgment and ethical (...) intention, but ethical recognition did not significantly predict ethical intention—thus providing support for Rest’s model. Organizational variables, age and educational level yielded few significant results. The lack of significance for codes of ethics might reflect their relative lack of development in Libya, in which case Libyan companies should pay attention to their content and how they are supported, especially in the light of the under-development of the accounting profession in Libya. Few significant results were also found for gender, but where they were found, males showed more ethical characteristics than females. This unusual result reinforces the dangers of gender stereotyping in business. Personal moral philosophy and moral intensity dimensions were generally found to be significant predictors of the three stages of ethical decision making studied. One implication of this is to give more attention to ethics in accounting education, making the connections between accounting practice and Islam. Overall, this study not only adds to the available empirical evidence on factors affecting ethical decision making, notably examining three stages of Rest’s model, but also offers rare insights into the ethical views of practising management accountants and provides a benchmark for future studies of ethical decision making in Muslim majority countries and other parts of the developing world. (shrink)

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with (...) suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.4 (2003) 393-406 [Access article in PDF] U.S. Defunding of UNFPA:A Moral Analysis Ronald M. Green Ethical decisions made inside the Beltway sometimes have global consequences. Nowhere is this more true than with respect to the decision by Secretary of State Colin Powell on 21 July 2002 to halt $34 million in U.S. funding for the United Nations Population Fund (UNFPA). Behind (...) this decision lay the forces of America's abortion politics as well as tangled issues in law and bioethics.I became involved in this debate when, in early September 2003, I served as a member of a nine-person delegation of U.S. religious leaders and ethicists that traveled to China to meet with those associated with the UNFPA program there. The delegation was assembled by Frances Kissling, of Catholics for a Free Choice, which also provided support and funding for the necessary travel and administrative services. In China, our contacts included UNFPA administrators, Chinese government officials, and ordinary villagers touched by UNFPA efforts. In the middle of its week-long stay, the delegation left Beijing in three separate groups to travel to remote provincial regions (Hubei, Gansu, and Ningxia). Our goal was to respond to the Bush administration's defunding decision by deepening our understanding of the current Chinese population program and UNFPA's relationship to it. In the course of this enquiry, I encountered challenging questions that drew on my own training in ethics in novel ways. Historical Background UNFPA is the world's largest organization providing family planning and reproductive health services. It was established in 1969 as the United Nations Fund for Population Activities. In 1987, the Economic and Social Council decided to rename it the United Nations Population Fund, but to retain the original abbreviation-acronym. UNFPA works to improve access to and the quality of family planning services in more than 140 of the poorest countries in the world. It is also very active in providing services aimed at preventing the spread of HIV/AIDS. It does not provide abortion services, but works to prevent abortion through family planning and to help countries provide services for women suffering from the complications of unsafe abortion. [End Page 393]Although UNFPA is officially an agency of the United Nations, its budget, currently about $200 million per year, comes from voluntary payments by donors, including UN member states. U.S. funding has been irregular. In 1985, the U.S. House of Representatives passed a foreign operations appropriations measure that has come to be known as the "Kemp-Kasten Amendment." This measure, which has been repassed in substantially unchanged form every year since, forbids funding for "any organization or program which, as determined by the President of the United States, supports or participates in the management of a program of coercive abortion or involuntary sterilization."1 From 1986 on, the Reagan and Bush administrations halted all U.S. funding for UNFPA activities around the world on the grounds that the agency's activities in China caused it to be involved in supporting or participating in the management of a program of coercive abortion or involuntary sterilization, and, hence, put it in violation of Kemp-Kasten.Efforts by the People's Republic of China to slow the increase of its population date from the early 1970s when, in a striking departure from classical Marxist theory, which had insisted on the positive value of added labor power and denied the need for demographic controls, the government imposed a policy of delayed marriage and birth spacing. In 1979, these efforts intensified with the advent of the "one child policy." (In fact, this name is misleading since the number of children allowed a couple varies significantly from urban to rural areas, with rural residents and members of ethnic minorities permitted to have larger families.) To implement this program, the government established a National Family Planning Commission (now National Population and Family Planning Commission) which, among other things, set up a network of family planning service centers around the country, where birth control... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Ethics and the Elderly: The Challenge of Long-Term Care by Sarah M. Moses, and: Loving Later Life: An Ethics of Aging by Frits de LangeDolores L. ChristieEthics and the Elderly: The Challenge of Long-Term Care Sarah M. Moses maryknoll, ny: orbis, 2015. 206 pp. $38.00Loving Later Life: An Ethics of Aging Frits de Lange grand rapids, mi: eerdmans, 2015. 169 pp. $19.00Today many women and men live beyond (...) the so-called third age of life and enter their eighties, the "fourth age," during which the toll of time and the growing incidence of life-limiting conditions wear down even the best-preserved of the human species. Debilitating disease and normal ebbing of human function become more concentrated in this demographic bubble. As people enter their eighties, their world tends to narrow both physically and mentally, creating a need for increasing care. Often the elderly are rendered passive and dependent, forced to cede both autonomy and dignity. They become objects with little voice, requiring greater care and increasing cash. Likewise, as the baby boom generation enters this group, those living in the fourth age make up an increasing percentage of the population. Additionally, modern models of care for the elderly, often based on efficiency and cost-effectiveness, tend to erode their human dignity. Together these factors demonstrate a growing moral problem.What to do? These two books provide valuable road maps for how to proceed. They detail the reality and moral urgency of the situation. Both offer principles from philosophical and religious traditions that outline a good moral model: one of care, compassion, dignity, and community. They draw insights from Augustine and Thomas Aquinas, Karl Barth, and Dietrich Bonhoeffer, among [End Page 214] others. Both reference the Western biblical tradition, which honors the elderly even in the face of their limitations.Although the authors offer wise and thoughtful suggestions to address this growing moral crisis, they approach the serious moral issue very differently. Sarah Moses outlines a compelling case for a new interventional model for elderly living. While her book plays some muted chords that hint at "dissertation," the melody it conveys is strikingly forte and well worth the read.She presents two concrete examples of what good interaction with the elderly might look like. One draws from the international intentional outreach and residential community (the Community of Sant'Egidio), the other is a brick-and-mortar model (the Green House Project). Using both biblical paradigms and church teaching over the centuries, Moses makes the case for treating all persons with dignity and promoting their involvement in decision making as much as possible. The scriptural message she highlights—both our duty to the elderly and the "disappointment and depression" (105) of growing old—is particularly compelling.In her examples of good long-term care, community development is important. In the Sant'Egidio model, volunteers share a common life "through gathering for prayer and various outreach services to the poor" (39). There is motivation to support elderly in their own homes, but the project promotes small, family-like resident facilities when this is not possible. The physical place is less emphasized than the relationship among various age and economic groups.The Green House Project is based in a new vision of homes for the challenged elderly. Results of the project show that not only did staff remain in their jobs longer (nursing home employment turnover is extensive) but visitation by family members increased. Even such a simple thing as a different physical model for the actual building—replacing long halls and routinization with a more home-like environment—has positive results.Moses calls on leadership in church and community to educate, to designate funds for elder care, and to look beyond the caring and the construction of good facilities. She notes how important it is to work politically to change attitudes and actions.She sees care for all dependent people as a responsibility of both the church community and society in general. This includes fostering awareness, encouraging ongoing participation of the elderly in life—including church life—and allocating public resources. Bottom line: she calls for smaller institutions, meaningful opportunities for the... (shrink)

Research is crucial to advancing knowledge about dementia, yet the burden of the disease currently outpaces research activity. Research often excludes people with dementia and other cognitive impairments because researchers and ethics committees are concerned about issues related to capacity, consent, and substitute decision-making. In Australia, participation in research by people with cognitive impairment is governed by a national ethics statement and a patchwork of state and territorial laws that have widely varying rules. We (...) contend that this legislative variation precludes a consistent approach to research governance and participation and hinders research that seeks to include people with impaired capacity. In this paper, we present key ethical principles, provide a comprehensive review of applicable legal rules in Australian states and territories, and highlight significant differences and ambiguities. Our analysis includes recommendations for reform to improve clarity and consistency in the law and reduce barriers that may exclude persons with dementia from participating in ethically approved research. Our recommendations seek to advance the national decision-making principles recommended by the Australian Law Reform Commission, which emphasize the rights of all adults to make their own decisions and for those with impaired capacity to have access to appropriate supports to help them make decisions that affect their lives. (shrink)

People with cognitive impairments often have difficulties formulating, understanding, or articulating decisions that others judge reasonable. The frequent response shifts decision-making authority to substitutes through advance directives of the person or guardianship orders from a court. The Convention on the Rights of People with Disabilities defends supported decision-making as an alternative to such forms of supplanted decision-making. But supported decision-making raises both metaphysical questions—what is required for a decision to be (...) the person’s own?—and epistemological questions: how do we know what persons judge to be their good, when they have difficulty conceptualizing and articulating? It raises practical questions, too, such as protection against risks of exploitation. This article uses a non-discrimination account of legal personhood drawn from the CRPD to explore how common features of decisions employed by people without cognitive disabilities are important in supported decision-making too. These features include prostheses, guardrails, relationships, and social contexts. (shrink)

People who are unable to make decisions about participating in research rely on proxies to make a decision based on their wishes and preferences. However, patients rarely discuss their preferences about research and proxies find it challenging to determine what their wishes would be. While the process of informed consent has traditionally been the focus of research to improve consent decisions, the more conceptually complex area of what constitutes ‘good’ proxy decision-making for research has remained unexplored. Interventions (...) are needed to improve and support proxy decision-making for research but are hampered by a lack of understanding about what constitutes decision quality in this context. A global increase in conditions associated with cognitive impairment such as dementia has led to an urgent need for more research into these conditions. The COVID-19 pandemic and subsequent necessity to conduct research with large numbers of critically ill patients has made this need even more pressing. Much of the empirical research centres on the desire to improve decision accuracy, despite growing evidence that authenticity is more reflective of the aim of proxy decisions and concerns about the methodological flaws in authenticity-focused studies. Such studies also fail to take account of the impact of decision-making on proxies, or the considerable body of research on improving the quality of healthcare decisions. This paper reports a concept synthesis of the literature that was conducted to develop the first conceptualisation of ‘good’ proxy decisions about research participation. Elements of decision quality were identified across three stages of decision-making: proxy preparedness for decision-making which includes knowledge and understanding, and values clarification and preference elicitation; the role of uncertainty, decisional conflict, satisfaction and regret in the decision-making process; and preference linked outcomes and their effect. This conceptualisation provides an essential first step towards the future development of interventions to enhance the quality of proxy decision-making and ensure proxy decisions represent patients’ values and preferences. (shrink)

Next SectionObjectives A statute enacted in 2005 modified the legislative framework of the rights of terminally ill persons in France. Ten years after the EURONIC study, which described the self-reported practices of neonatal caregivers towards ethical decision-making, a new study was conducted to assess the impact of the new law in neonatal intensive care units (NICU) and compare the results reported by EURONIC with current practices. Setting and design The study was carried out in the same two (...) NICU as in the EURONIC qualitative study. A third centre was added to increase the sample size. From February to October 2007, 19 physicians and 17 nurses participated in semistructured interviews very similar to those for EURONIC. Content analysis identified the recurring themes emerging from the interviews. Results Compared with the EURONIC results, the caregivers reported that they pay greater attention to the views of parents and provided respectful support to the neonates when life-sustaining treatment is withdrawn. Active termination of life has become exceptional. The possibility of withdrawal of treatment, the administration of sedatives to control pain even at the risk of hastening death, the emphasis on sparing parents the burden of decision, and the relative ignorance of the law were very similar to the EURONIC findings. Conclusion Both the medical and the legal regulation of practices has allowed more dialogue with the parents and more humane care for dying newborns. A new European study is necessary to investigate the possible changes in practices and attitudes also in other countries. (shrink)

In recent years in Turkey, it has been attempted to ensure that students who need special education are educated through inclusion. In the meanwhile, it became important to reveal scientifically the educational theories on which the inclusive education is based and the approach of Islam towards inclusive education that somehow has an influence on our national education policy. This study aims to examine the educational theories on which the inclusive education is based and the Islamic approach towards inclusive education. The (...) data of the study was collected by literature review. As a result, it is possible to say that the underlying theories of inclusive education are integrated education theory, cognitive democrative theory and dysontogenesis theories. In addition, although there are no specific verses for inclusive education in the Qurʾān and the Sunnah, it can be said that Islam has an positive approach to the inclusive education in general. Depending on this result, formal education should be conducted in the context of the principle of “least restricted education environment”.Summary: It is a matter of controversy about how education that increases the potential of human beings can be given to people who differ from their peers and who need special education. In recent years, there have been two prominent views in literature on this issue: The first is the ‘discriminatory’ view, which advocates that individuals with special needs should receive education in special spaces with similar students. The second is the ‘integrative view’, which states that these students should receive inclusive education with their peers. This view defends that students with special needs should be educated in separate boarding/day special education schools and special education classes within the normal schools. Recently in Turkey it is aimed to provide education to the students who need special education mostly by means of inclusion as an alternative to the first group. For this education, which is held with the claim of a less restricted environment, the conditions of the students are constantly improved with new regulations.This study aims to reveal the theories that can be the basis of inclusive education and Islam's approach to inclusive education. In this study, I will try to find answers to the following questions.1. What are the educational theories and claims that can be the basis of inclusive education?2. What are the principles of inclusive education in the Qur’an and Sunnah?This study is important in terms of revealing general opinions that may be the basis of theoretical foundations of inclusive education and examining Islam’s approach to inclusive education. The study, which was prepared by examining the English and Turkish literature available within the scope of the possibilities, was designed with theoretical analysis method. Although ‘accessibility’, which is considered among the shortcomings of theoretical studies in literature, is an important limitation for this study, the fact that it constitutes a theoretical ground for future studies and fills an important gap in the literature determines the importance of the study.Integrated education theory, cognitive democratic theory and dyontogenesis theories can be regarded as the establishing theoretical foundations of inclusive education. Integrated education theory is based on Whitehead’s philosophy of education. This philosophy sees the individual as a whole. It does not intend to make people have a profession or make money by simply using their intelligence. Instead, it helps to ensure that both the individual and society as a whole are happy by helping them to make the most of their potential. This model is based on developing emotion, mind, body, and spirituality as a whole. The distinctness and sacredness of human life and the need to know about this sacredness are the main pillars of integrated education theory. In this model all people are seen equal. According to this theory, the “natural” as well as the “beautiful” is appreciated. Therefore, no one feels bad in such an environment because of its differences. Because of the value given to them, each individual’s love of learning and ideals remain alive. The individual makes use of his/her mind to make a connection between the meaning of life and the school.Cognitive democratic theory asserts that educational arrangements should be made to prevent any feelings of alienation, oppression, and insignificance by considering different groups in education. This theory, which emphasizes the phenomenon of democracy and citizenship, aims at social cohesion in the light of epistemological principles. The theory is based on the fact that social change and change in education support each other. According to the theory, the formation of democratic citizenship is only possible if the school environment is a place where students can internalize democratic values. This is achieved by equal consideration of each segment at different levels. According to this theory, elements such as classroom environment, discipline, program, rights, participation in decisions, educational activities should be organized according to democratic values. In such an environment, different special education students find a place for themselves.Vygotsky's dysontogenesis thesis is based on his theory of social learning. His theory provides a methodological framework for inclusion in special education. The theory states that information is obtained through social communication. In this theory, knowledge is an element that is acquired together with other people rather than something that happens in the human mind. According to this theory, instead of focusing on the brain (head), where social knowledge is formed, self, mind, emotion should be included in education. Also, disability is a social deviation rather than a biological disease. Social relations and the environment mostly shape this deviation. Therefore, the abnormal child approach that has become a place in the society should be abandoned. The theory opposes the concept of mental retardation. Because mental disability should be explained by the differences in mental development. According to this theory, mental retardation is a social problem; education should be provided with appropriate methods over the examples that can be experienced in a commonplace with their peers. Distracting the student from his/her normal peers due to his/her differences, creates negative social conditions and harms his/herself.As far as I have examined, there is no direct Qur’anic verse or phrase about inclusive education for the disabled. However, there are verses regarding the integration and solidarity of the society on righteousness. Principles for inclusive education can be drawn from these verses. The Prophet valued the disabled and settled the principles on how society should treat them. He frequently visited them, enabled them to employ appropriate jobs, determined the conditions of the economic order by considering them, and dignified them with honor. In other words, he tried to make provisions to prevent the disabled from being separated from society. For example he urged Zahir bin Itban to continue trade, asked Abdullah Ibn Umm Mektum to come to community prayers, thus he sought different ways to integrate disabled people into society. These practices can be seen as a positive outlook towards the mainstreaming education of today. In the period of the four great caliphs, practices for mainstreaming education continued. (shrink)