On the person in personal health responsibility

In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car's damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes.

Self-reported awareness of the legal status of eight responsibilities of dog owners in Ireland: are dog owners different from non-dog owners?

BACKGROUND

Legislation pertaining to canine ownership in Ireland maintains a one-health perspective by establishing a minimum standard of care for dogs while safeguarding human health and wellbeing. However, public awareness of this legislation has not been measured. The goals of this study were first, to estimate and compare the level of awareness, among dog owners and non-dog owners, that eight responsibilities of dog owners are prescribed by law in Ireland. Second, to determine if gender modifies differences in awareness between owners and non-owners, and third to determine whether gender itself is independently associated with awareness of the legal specification of these dog ownership responsibilities.

RESULTS

We conducted a cross-sectional study of 679 University College Dublin employees. Exposure information included participants' dog ownership status, gender, age, and education level. Among dog owners and non-dog owners, we estimated and compared the prevalences of persons with self-reported awareness that each of eight dog ownership responsibilities are prescribed by law in Ireland: Dog fouling in a public place, the leashing and muzzling of certain breeds, holding a dog license, straying of dogs, safeguarding health and welfare of dogs, dog abandonment, prohibition on tail docking of puppies and the mandatory wearing of identification. The prevalence of awareness was low among both dog owners and non-dog owners with substantial awareness (≥ 80%) of only three responsibilities: Those pertaining to fouling, licensing and muzzling and leashing. Awareness that more than one responsibility was specified by law was also poor with only 17.9% (95% CI: 15.1-20.9%) of participants aware of all eight and dog owners essentially just as likely (54%; 95% CI: 49-58%) to be aware of more than one as non-dog owners. For most dog ownership responsibilities, differences in prevalence (PD) of awareness between owners and non-owners and females and males were trivial (PD < 10%). Similarly for most responsibilities, gender did not modify awareness PDs between owners and non-owners.

CONCLUSIONS

In this well-educated university community, self-reported awareness that these eight responsibilities of dog owners are prescribed by law in Ireland is poor with essentially no difference between dog owners and non-dog owners or males and females. Awareness was higher for those responsibilities which, when not discharged, result in direct negative consequences to humans compared to those that result in direct negative consequences to dogs. It is likely that awareness of the legal status of these eight responsibilities of dog owners among the general public in Ireland is even less than observed in this study.

Indigenous community participation in resource development decision-making: Practitioner perceptions of legal and voluntary arrangements

Indigenous nations worldwide are working with and lobbying private and public resource developers to ensure meaningful engagement in decisions tied to resource development in their territories. The diversity of approaches for engagement can be framed along a continuum, with voluntary practices at one end and legal responsibilities at the other. Given this continuum, the roles and responsibilities of various actors involved have become blurred, which leads to poor practice. In an effort to bring clarity, the aim of this research was to understand the distinctions between voluntary practices and legal responsibilities among key actors, identify how key actors understood their different roles and responsibilities, and explain the implications of these differences. In partnership with a First Nation and a public power utility in Northern Saskatchewan, Canada, we employed semi-structured interviews and group workshops with Indigenous, industry, and government actors who participate in environmental management and resource development decisions. We found that actors had distinct motivations for interacting with one another, that perceptions of voluntary practices and legal responsibilities aligned among some participants but not among others, and that participants were indeed confused about their roles and responsibilities in relation to legal requirements and voluntary engagement activities. Furthermore, we learned that clarifying the intended roles of those involved in resource development decisions would be insufficient for improving practice. This is because improved clarity may not address underlying mistrust of government by Indigenous people, or may not be possible where rights and interests are intertwined under a broad conception of Indigenous rights. Findings also suggest the need for government and industry to work with Indigenous nations as self-determining entities, rather than imposing unilateral processes upon them. Consequently, more serious scrutiny, understanding and action is needed by government and industry when employing and assessing voluntary actions and legal measures for Indigenous inclusion in resource development decision-making processes.

Mental disorder and legal responsibility: the relevance of stages of decision making

The paper discusses the relevance of decision-making models for evaluating the impact of mental disorder on legal responsibility. A three-stage model is presented that analyzes decision making in terms of behavioral control. We argue that understanding dysfunctions in each of the three stages of decision making could provide important insights in the relation between mental disorder and legal responsibility. In particular, it is argued that generating options for action constitutes an important but largely ignored stage of the decision-making process, and that dysfunctions in this early stage might undermine the whole process of making decisions (and thus behavioral control) more strongly than dysfunctions in later stages. Lastly, we show how the presented framework could be relevant to the actual psychiatric assessment of a defendant's decision making within the context of an insanity defense.

Brazilian orthodontists and the legal issues involving their professional activity: A legal and behavioral proposal

OBJECTIVE

The aim of this study was to review the use of orthodontic records (OTR's) by Brazilian orthodontists and propose a behavioral approach from a legal point of view, drawing on their interpersonal relationship with their patients.

METHODS

A statistical cross-analysis was performed to compare five groups. A sixth group was created comprising the intersection of the responses provided by the five aforementioned groups.

RESULTS

The results demonstrate that 42.2% of orthodontists require initial and final records and keep orthodontic records throughout their professional career; 13.9% duplicate the initial records and consider patients as the lawful owners of these documents; 19.5% make use of a medical history questionnaire, to be duly signed by all patients; 5.4% acknowledge that the decision to undergo treatment is ultimately the patient's, and, therefore, the alternative response "not perform the treatment" should be included in the questionnaire; 24% recognize the importance of the Consumer Protection Code (CPC), regard the provision of orthodontic services as an obligation of means; and explain to the patient the risks involved in orthodontic treatment. Among the 1,469 orthodontists researched, 0% simultaneously took into account all aspects of this study.

CONCLUSIONS

It was concluded that Brazilian orthodontists adopt a mistaken legal, professional and behavioral attitude, neglecting to build patient's orthodontic record with due care and in accordance with the law, which makes them vulnerable to patient disputes, contentious or otherwise.