"This Is a Disease" and "Disease Has No Sin": Discourse Constructions of Individuals With Obsessive-Compulsive Disorder With Regard to Being Diagnosed

Obsessive-compulsive disorder (OCD) symptoms have different cultural images in society. Deconstructive psychology studies can contribute to understanding the dominant discourse surrounding these patients, given the prevalence of OCD. The objective of this study was to investigate the discourse of participants regarding "having/receiving a diagnosis of OCD" and the function of this discourse. The research approach was qualitative and language-based, specifically employing Lacanian Discourse Analysis (LDA) perspective. The possible questions and prompts were determined along with the research team, and seven semi-structured interviews were conducted with six participants diagnosed with OCD. The interviews explored how participants referred to their diagnosis, the language they used, and the function of this discourse. The findings revealed that participants diagnosed with OCD insistently used the term "disease" to explain their peculiar and distressing situations, referring to "medical discourse" with expressions such as "This is a disease" and "This disorder." Additionally, they often utilized "religious discourse" with the statements like "Disease has no sin" and "The sick and insane are exempt from their responsibilities." The findings of the current research indicated that when individuals with OCD "receive a name" through a recognized diagnosis, they experience a sense of recognition and validation for their OCD-related problems. Consequently, individuals diagnosed with OCD tend to find "legitimacy" for their irrational or unwanted thoughts and behaviors by taking comfort from their diagnosis. This study provides valuable insights into an understanding of patients with OCD. The findings are discussed in the context of their implications for both theoretical and applied research.

Do conspiracy beliefs fuel support for reactionary social movements? Effects of misbeliefs on actions to oppose lockdown and to "stop the steal"

Pundits have speculated that the spread of conspiracies and misinformation (termed "misbeliefs") is leading to a resurgence of right-wing, reactionary movements. However, the current empirical picture regarding the relationship between misbeliefs and collective action is mixed. We help clarify these associations by using two waves of data collected during the COVID-19 Pandemic (in Australia, N = 519, and the United States, N = 510) and democratic elections (in New Zealand N = 603, and the United States N = 609) to examine the effects of misbeliefs on support for reactionary movements (e.g., anti-lockdown protests, Study 1; anti-election protests, Study 2). Results reveal that within-person changes in misbeliefs correlate positively with support for reactionary collective action both directly (Studies 1-2) and indirectly by shaping the legitimacy of the authority (Study 1b). The relationship between misbelief and legitimacy is, however, conditioned by the stance of the authority in question: the association is positive when authorities endorse misbeliefs (Study 1a) and negative when they do not (Study 1b). Thus, the relationship between conspiracy beliefs and action hinges upon the alignment of the content of the conspiracy and the goals of the collective action.

Social and Ethical Implications of Digital Crisis Technologies: Case Study of Pandemic Simulation Models During the COVID-19 Pandemic

BACKGROUND

Responses to public health crises are increasingly technological in nature, as the prominence of COVID-19-related statistics and simulations amply demonstrates. However, the use of technologies is preconditional and has various implications. These implications can not only affect acceptance but also challenge the acceptability of these technologies with regard to the ethical and normative dimension.

OBJECTIVE

This study focuses on pandemic simulation models as algorithmic governance tools that played a central role in political decision-making during the COVID-19 pandemic. To assess the social implications of pandemic simulation models, the premises of data collection, sorting, and evaluation must be disclosed and reflected upon. Consequently, the social construction principles of digital health technologies must be revealed and examined for their effects with regard to social, ethical, and ultimately political issues.

METHODS

This case study starts with a systematization of different simulation approaches to create a typology of pandemic simulation models. On the basis of this, various properties, functions, and challenges of these simulation models are revealed and discussed in detail from a socioscientific point of view.

RESULTS

The typology of pandemic simulation methods reveals the diversity of model-driven handling of pandemic threats. However, it is reasonable to assume that the use of simulation models could increasingly shift toward agent-based or artificial intelligence models in the future, thus promoting the logic of algorithmic decision-making in response to public health crises. As algorithmic decision-making focuses more on predicting future dynamics than statistical practices of assessing pandemic events, this study discusses this development in detail, resulting in an operationalized overview of the key social and ethical issues related to pandemic crisis technologies.

CONCLUSIONS

This study identifies 3 major recommendations for the future of pandemic crisis technologies.

To Report or Not to Report? A Systematic Review of Sex Workers' Willingness to Report Violence and Victimization to Police

Sex workers face high risks of violence both during and after the performance of their job, yet the prevalence and willingness to report victimization to the police is extremely low. International research on the motives of sex workers not to report violent crimes to police is scarce and fragmented. To address this knowledge gap, a systematic review was conducted to answer the following question: What reasons do sex workers articulate to explain their reluctance to report victimization to the police? After searching for peer-reviewed and grey literature in various databases, using systematic search terms, nine studies met the inclusion criteria. After thematic analysis, four main motivations for not reporting victimization emerged: (i) fear of punishment, (ii) fear of maltreatment, (iii) fear of exposure, and (iv) fear of impunity. The impact of intersectional and personal characteristics of sex workers (i.e., gender, migration status, type of sex work, etc.) were explored. The findings show that sex workers experience low levels of trust in the police which results in unwillingness to report victimization. The article argues that decriminalization of the sex industry, and action to improve procedural justice, are likely to increase the inclination of sex workers to report a crime to police.

Complaints: Mechanisms for prisoner participation?

In prisons, participatory mechanisms can foster important outcomes including fairness, legitimacy and dignity. Complaints are one significant (symbolic) mechanism facilitating prisoner participation. Ombud institutions/Ombudsmen handle complaints externally, providing unelected accountability mechanisms and overseeing prisons around the world. A fair complaints process can stimulate prisoner voice, agency and rights protection, potentially averting self-harm and violence, and facilitating systemic improvements. However, complaints mechanisms are little studied. Addressing this gap, we: i) contextualise discussion by demonstrating that prisoners' actions have directly shaped complaints mechanisms available today; ii) outline prison complaints mechanisms in the case study jurisdiction of England and Wales; and iii) provide a critical review of literature to assess whether prison complaints systems are, in practice, participatory, inclusive and fair? We conclude that complaints mechanisms hold clear potential to enhance prison legitimacy, facilitate prisoner engagement and agency, and improve wellbeing and safety. However, myriad barriers prevent prisoners from participating in complaints processes, including culture, fear, accessibility, timeliness, emotional repression, and bureaucracy. The process of complaining and experiences of these barriers are uneven across different groups of prisoners. Our article provides a springboard for future empirical research.

The importance of equity in payments to encourage coexistence with large mammals

Large mammals often impose significant costs such as livestock depredation or crop foraging on rural communities, and this can lead to the retaliatory killing of threatened wildlife populations. One conservation approach-payments to encourage coexistence (PEC)-aims to reduce these costs through financial mechanisms, such as compensation, insurance, revenue sharing, and conservation performance payments. Little is known about the equitability of PEC, however, despite its moral and instrumental importance, prevalence as a conservation approach, and the fact that other financial tools for conservation are often inequitable. We used examples from the literature to examine the capability of PEC-as currently perceived and implemented-to be inequitable. We recommend improving the equitability of current and future schemes through the cooperative design of schemes that promote compensatory equity and greater consideration of conservation performance payments and by changing the international model for funding PEC to reduce global coexistence inequalities. New and existing programs must address issues of equitability across scales to ensure that conservation efforts are not undermined by diminished social legitimacy.

The Floating Signifier of 'Safety': Correctional Officer Perspectives on COVID-19 Restrictions, Legitimacy and Prison Order

The COVID-19 pandemic continues to affect prisons internationally. Existing research focuses on infection data, meaning we do not fully understand how COVID-19 shapes frontline prison dynamics. We draw on qualitative interviews with 21 Canadian federal correctional officers, exploring how the pandemic impacted prison management. Officers suggested inconsistent messaging around COVID-19 protocols reduced institutional and officers' self-legitimacy, fracturing trust relationships with incarcerated people. Furthermore, officers suggest that personal protective equipment such as gowns and face shields took on multiple meanings. We use Lévi-Strauss' floating signifier concept to analyse how individual definitions of 'safety' informed day-to-day prison routines. We conclude by arguing that legitimacy deficits and contested definitions of 'safety' will continue to create uncertainty, impacting prison operations going forward.

"Vse (Everyone) Online?": an exploration of the evolution of the Russian Federation's digital government portal during the COVID-19 pandemic

The penetration of digital technologies in government has been met with both optimism and caution. This study seeks to contribute to this field by examining how digital government evolved during the COVID-19 pandemic. Using media reports on Russia's government services portal (Gosuslugi), it finds that authorities made the portal a centerpiece of their pandemic response by enhancing its communicative, transactional, and participatory functions. These efforts aimed to not only house public health services on Gosuslugi, but to channel financial, commercial, and communication services through it, expanding Russia's digital corporatist state. While pandemic governance infused Gosuslugi with the qualities of a surveillant assemblage, it also made the portal into a space for novel forms of civic participation. Gosuslugi's evolution in this direction was limited, however, by security concerns as well as apprehension about digital participation. These findings highlight the importance of attending to political and cultural contexts in understanding digital government. In Russia, ruling elites' unwillingness to hold competitive elections and the public's lack of confidence in the political system limit the potential of digital government, regardless of its potential to manage crises.

Legitimate or Not, Does It Really Matter? A Reading of the PDO Label's Legitimacy through Consumers' Perception

The proliferation of quality labels for the same food product questions the relevance of labeling schemes. Based on the theory of legitimacy and research on food-related consumer behavior, this study aims to examine the influence of the perceived legitimacy of a label (PDO) on consumers' perceptions of the quality and purchase intentions of the labeled product. A conceptual model was, therefore, developed to estimate the influence of four dimensions of legitimacy on the perceived quality and purchase intention of PDO-labeled cheese, French cheeses being products whose quality is traditionally linked to their regional origin. Our model was tested on a sample of 600 consumers representative of the French population. Using Partial Least Square Structural Equation Modeling, results show that for surveyed consumers, the pragmatic, regulative, and moral legitimacy of the PDO label positively influences the perceived quality of PDO-labeled cheese. Furthermore, pragmatic legitimacy has a substantial and direct influence on purchase intention, whereas both regulative and moral legitimacy influence purchase intention only indirectly through perceived quality. Unexpectedly, our findings do not show a significant influence of cognitive legitimacy either on perceived quality or purchase intention. The output of this research contributes to a better understanding of the link between a label's legitimacy, perceived quality, and purchase intention.

Gender differences in perceived legitimacy and status perception in leadership role

The present study examined the difference between women and men in perceiving leadership roles. Two experiments, one conducted online and the other in a lab, investigated the subjective experiences of Japanese men and women when they are assigned with different roles (e.g., leader vs. subordinate). Both studies revealed that women perceived their role as less legitimate when they were assigned leader role (vs. subordinate role). In contrast, men did not differ in their perceived legitimacy according to the assigned roles. This discrepancy in legitimacy perception in response to different roles between men and women accounted for a significant variance in women's lower sense of status when they were a leader (vs. subordinate), but not among men. Our study results illustrate the psychological barrier operating for women in organizations that are embedded in a cultural context in which women leaders are highly underrepresented.

Complementary and Alternative Medicine legitimation efforts in a hostile environment: The case of Portugal

This article explores complementary and alternative medicine (CAM) organisations' legitimation efforts that face extra obstacles as they are subject to more than one institutional logics (hybrids) and operate in a contested organisational space (hostile environment). CAM organisations espouse the health and market logics and their practices are questioned at an institutional level. The study is conducted in Portugal, where the legalisation of CAM therapies was a contested process over 10 years. Taking an abductive approach and drawing on qualitative interviews, the authors analyse CAM managers' efforts to legitimise their practices and build viable organisations despite hostile conditions. Contrary to prior studies of hybrid healthcare organisations, CAM organisations derive moral legitimacy from the market logic rather than the health logic. The findings show that relationships, trust-building and consumer education appear to be the primary vehicles for establishing pragmatic legitimacy. Thus, pragmatic legitimacy relies on the health logic. The market logic dominates the pursuit of moral legitimacy through financial sustainability, human capital, marketing communications and partnerships, and advocating complementarity with biomedicine. We propose a model through which organisations use pragmatic legitimacy to enhance moral legitimacy and to create recursive feedback between moral and pragmatic legitimacy on the path to cognitive legitimacy.

Who should be a science communicator? The struggle for 'legitimate' status as science communicators between Chinese scientists and citizens on a Chinese knowledge-sharing platform

Qualitative interviews with Chinese scientist science communicators (n = 15) and citizen science communicators (n = 15) on Zhihu suggest that there is a struggle between the two groups to be seen as legitimate science communicators online. Public users tried to show their enthusiasm as science communicators, integrate into the circle of science communicators and blur the boundary between scientists and themselves. The participating scientists tend to discount such activity and indicate that they are more legitimate science communicators, possessing the requisite scientific literacy and noble personal morality.

Cross-Theoretical Compliance: An Integrative Compliance Analysis of COVID-19 Mitigation Responses in Israel

To understand the question why people obey or break rules, different approaches have focused on different theories and subsets of variables. The present research develops a cross-theoretical approach that integrates these perspectives. We apply this in a survey of compliance with COVID-19 pandemic mitigation rules in Israel. The data reveal that compliance in this setting was shaped by a combination of variables originating from legitimacy, capacity, and opportunity theories (but not rational choice or social theories). This demonstrates the importance of moving beyond narrow theoretical perspectives of compliance, to a cross-theoretical understanding-in which different theoretical approaches are systematically integrated.

The co-production of normal science: A social history of high-temperature superconductivity research in China (1987-2008)

The discovery of high-temperature superconductivity (HTS) was a momentous event. This article explores the social and institutional history of HTS research in China between 1987 and 2008. Desire for a Nobel Prize shaped the Chinese state's initial push to establish the National Superconductivity Research Program. Yet, after the enthusiasm for HTS research cooled, and even after a Nobel Prize for HTS was awarded to non-Chinese scientists, financial and institutional support for the research continued. This process fostered the 'to live' ethos of science, which has replaced the Nobel Prize dream as a central mechanism of interaction between the state and science in China. Indeed, Chinese HTS research not only survived, but also produced an abundance of 'normal science' discoveries. This pattern continued after 2008, when Japanese scientists made the groundbreaking innovation of iron-based superconductivity and Chinese scientists quickly turned their attention to this sub-field. They published many papers pushing the field forward slightly, rather than making the largest scientific advances. The mutual interaction between the state and scientists underpinned this phenomenon: On the one hand, the productivity of normal science has helped to maintain state legitimacy. On the other hand, the evaluation and incentive systems, as well as deep-rooted cultural features such as officialism, utilitarianism, and the foregrounding of politics lead scientists to opportunistically pursue normal science. The state and scientists have co-produced a regime of normal science.

Experiences of Sentencing and the Pains of Punishment: Prisoners' Perspectives

Although sentencing is often described as a human process, the subjective experiences of those subject to sentencing are seldom discussed or highlighted as an important source of guidance for how sentencing might be made more fair, consistent, or proportionate. Tyler's work on the links between experiences of procedural justice and perceptions of legitimacy in the criminal justice system show that how people are treated during sentencing and/or when serving their sentence matters in that it impacts their long-term compliance with the law. However, we suggest here that it may not only be long-term compliance that is impacted; subjective experiences of imprisonment, in terms of the pains of imprisonment, may also be exacerbated for those whose experiences of the sentencing process are predominantly negative. This article draws on 37 in-depth interviews with Irish prisoners that explored their subjective experiences of their own sentencing in court and how this related to their subjective experiences of their prison sentences. Those who felt they had received unreasonably harsh or unfair sentences, or who felt they were effectively excluded from the sentencing process, were more likely to experience specific pains and increased salience of punishment. The article concludes by arguing that these findings have a role to play in educating sentencers about how their treatment of convicted persons during sentencing can have meaningful, long-term consequences on the subjective experiences of those serving prison sentences.

Is Purchase Behavior Different for Consumers with Long COVID?

COVID-19 has generated an uncertain environment, which has motivated changes in consumers' behavior globally. However, previous studies have not clarified if these effects are equally strong throughout the population. In this research, we want to analyze if there are behavioral differences between long-COVID consumers and others. For this purpose, we analyzed a sample of 522 consumers divided into three groups depending on their type of exposure to the disease: those with long COVID; ones that had recovered from COVID-19; and those that had never had COVID-19. The results show that the effect that COVID-19 has on purchase behavior differs depending on the type of exposure to the disease. In fact, those with long COVID experienced more pleasure when purchasing than other people, but they needed higher trust levels in the enterprises to purchase from them, since that reduces their perception of uncertainty. Furthermore, for long-COVID individuals, an organization's legitimacy level is even more important than for other consumer groups with less contact with the disease.

Perceiving and pursuing legitimate power

How do people perceive and pursue legitimate power? For the social sciences, this question is venerable. Yet, for cognitive science, it offers fresh and generative opportunities to explore how adults evaluate legitimacy, how children learn to do so, and what difference legitimate power makes for people's thoughts, feelings, and actions.

Filling the gaps: missing taxon names at the ranks of class, order and family

The International Code of Nomenclature of Prokaryotes (ICNP) recently underwent some major modifications regarding the higher taxonomic ranks. On the one hand, the phylum category was introduced into the ICNP, which rapidly led to the valid publication of more than forty names of phyla. On the other hand, a decision on the retroactivity of Rule 8 regarding the names of classes was made, which removed most of the nomenclatural uncertainty that had affected those names during the last decade. However, it turned out that a number of names at the ranks of class, order and family are either not validly published or are validly published but illegitimate, although these names occur in the literature and are based on the type genus of a phylum with a validly published name. A closer examination of the literature for these and similar cases indicates that the names are unavailable under the ICNP either because of minor formal errors in the original descriptions, because another name should have been adopted for the taxon when the name was proposed, because of taxonomic uncertainties that were settled in the meantime, or because the names were placed on the list of rejected names. The purpose of this article is to fill the gaps by providing the missing formal descriptions and to ensure that the resulting taxon names are attributed to the original authors who did the taxonomic work.

Marine protected areas in the context of climate change: key challenges for coastal social-ecological systems

Climate and ecological emergencies play out acutely in coastal systems with devastating impacts on biodiversity, and the livelihoods of communities and their cultural values. Marine Protected Areas (MPAs) are one of the key management and regulatory tools against biodiversity loss, playing a role in strengthening bio-cultural diversity and sustainability of coastal social-ecological systems. What is unclear though is the effectiveness of static protections under climate change as species move. Next to ecological uncertainty, regulatory uncertainty may play a role in weakening marine conservation. We asked whether MPAs are ecologically effective now and can sustain or improve to be so in the future while facing key climate and regulatory uncertainties. MPAs can support the protection of cultural values and have an impact on activities of sea-users and the sustainability of social-ecological systems. As such, questions surrounding their legitimacy under a changing climate and increased uncertainty are pertinent. We argue that MPA governance must be cognisant of the interdependency between natural and human systems and their joint reaction to climate change impacts based on an integrated, co-developed, and interdisciplinary approach. Focusing on the UK as a case study, we highlight some of the challenges to achieve effective, adaptive and legitimate governance of MPAs. This article is part of the theme issue 'Nurturing resilient marine ecosystems'.

Consensus, convergence, and COVID-19: The ethical role of religious reasons in leaders' response to COVID-19

Focusing on current efforts to persuade the public to comply with COVID-19 best practices, this essay examines what role appeals to religious reasons should (or should not) play in leaders' attempts to secure followers' acceptance of group policies in contexts of religious and moral pluralism. While appeals to followers' religious commitments can be helpful in promoting desirable public health outcomes, they also raise moral concerns when made in the contexts of secular institutions with religiously diverse participants. In these contexts, leaders who appeal to religious reasons as bases of justification for imposing COVID policies may seem to fail to show respect for the autonomy of those who lack the relevant religious commitments, and-especially when a leader herself rejects the religious commitments she makes reference to to persuade others-her appeals to religious reasons may seem to constitute ethically problematic exercises of manipulation. This essay draws on the resources of contemporary political philosophy to analyze and respond to these concerns and concludes that they are not sufficiently well-founded. To the contrary, it contends that there are good moral grounds for leaders to appeal to religious reasons as (partial) bases of justification for why followers should accept COVID policies. In the course of the argument, this essay also highlights how contemporary political theory can enrich discussions about the distinctions between coercion, manipulation, and leadership. It thereby give insight not only into the ethics of leadership but also-at least by the lights of central theories of leadership like that of James MacGregor Burns (1978)-into whether and how appeals to religious reasons can figure into genuine exercises of leadership, in contrast with mere instances of the wielding of social power.

"This changes things": Children, targeting, and the making of precision

Avoidance of civilian casualties increasingly affects the political calculus of legitimacy in armed conflict. "Collateral damage" is a problem that can be managed through the material production of precision, but it is also the case that precision is a problem managed through the cultural production of collateral damage. Bearing decisively on popular perceptions of ethical conduct in recourse to political violence, childhood is an important site of meaning-making in this process. In pop culture, news dispatches, and social media, children, as quintessential innocents, figure prominently where the dire human consequences of imprecision are depicted. Children thus affect the practical "precision" of even the most advanced weapons, perhaps precluding a strike for their presence, potentially coloring it with their corpses. But who count as children, how, when, where, and why are not at all settled questions. Drawing insights from what the 2015 film, Eye in the Sky, reveals about a key social technology of governance we have already internalized, I explore how childhood is itself a terrain of engagement in the (un)making of precision.

Authoritarian Regime Legitimacy and Health Care Provision: Survey Evidence from Contemporary China

CONTEXT

Over the last two decades a growing body of research has shown that authoritarian regimes are trying to increase their legitimacy by providing public goods. But there has so far been very little research on whether or not these regimes are successful.

METHODS

This article analyzes data from a 2012-2013 nationally representative survey in China to examine whether health care provision bolsters the Communist regime's legitimacy. Using multivariate ordinal logistic regression, we test whether having public health insurance and being satisfied with the health care system are associated with separate measures of the People's Republic of China's regime legitimacy: support for "our form of government" (which we call "system support") and political trust.

FINDINGS

Having public health insurance is positively associated with trust in the Chinese central government. Health care system satisfaction is positively associated with system support and trust in local government.

CONCLUSIONS

Health care provision may bolster the legitimacy of authoritarian regimes, with the clearest evidence showing that concrete benefits may translate into trust in the central government. Further research is needed to understand the relationship between trends in health care provision and legitimacy over time and in other types of authoritarian regime.

Legitimacy-not Justice-and the Case for Judicial Review

Sceptics of judicial review-from Jeremy Waldron to those in the Judicial Power Project-have tended to attribute to their opponents an erroneous prioritisation of 'justice' over 'legitimacy'. They claim that those who make the case for judicial review do so on the grounds that 'judges know best', and that judicial review therefore helps promote the overall justness of a state's social order-rather than on the grounds that it helps enhance the overall legitimacy of a state's authority. This article interrogates that line of attack. It explores its roots in political theory, particularly the idea that those guilty of it (such as Aileen Kavanagh) follow in John Rawls's supposed prioritisation of justice over legitimacy. And it turns to republican and later-Rawlsian thinking on these two concepts to see whether it may offer a sound basis upon which the case for judicial review can be made … legitimately.

Representation in participatory health care decision-making: Reflections on an Application-Oriented Model

Context

The involvement of lay people in health care decision‐making processes is now the norm in many countries. However, one important aspect of participation has not received sufficient attention in the past and remains underexplored: representation.

Objective

This paper explores the question of how public participation efforts in collective health care decision‐making processes can attempt to aim for legitimate representation so that those individuals or groups not present can be taken into account in the decisions affecting them. This paper argues that to make decisions that effectively address those affected, representation needs to be seen as a relevant part of any participatory setting. To support this argument, the paper outlines the concepts of participation and representation and transfers them to health care contexts.

Results

A conceptual reflection on responsiveness and the characteristics of representative actors in representative‐participatory settings is introduced, which could provide actors planning to conduct participatory health care projects with tools to reflect on the merits and possible flaws of participatory constellations.

Patient or Public Contribution

The paper contributes to improving public participation in health care decision‐making.

Citizens and the state during crisis: Public authority, private behaviour and the Covid-19 pandemic in France

How do democratic states induce citizens to comply with government directives during times of acute crisis? Focusing on the onset of the Covid-19 pandemic in France, I argue that the tools states use to activate adherence to public health advice have predictable and variable effects on citizens' willingness to change their routine private behaviours, both because of variation in their levels of restrictiveness but also because of differences in people's political motivations to comply with them. Using data collected in March 2020, I show that people's reports of changes in their behavioural routines are affected by the signals governments send, how they send them and the level of enforcement. I find that a nationally televised speech by President Macron calling for cooperative behaviour and announcing new restrictions elevated people's willingness to comply. Moreover, while co-partisanship with the incumbent government increased compliance reports before the President's primetime television address, presidential approval boosted reports of compliance after.

Authority, conformity and obedience: Applying Friedrich's theory of authority to the classics

In the conformity and obedience studies of Asch and Milgram, legitimate authority is defined as a form of power to which subjects submit irrationally. This view assumes a causative process which the subjects' behaviour is said to manifest. Furthermore, this view assumes that there is illegitimate (or malevolent) authority. Carl J. Friedrich's theory of authority as reasoned elaboration offers an alternative perspective, which reveals conceptual differences between authority and such related constructs as power and legitimacy. When these concepts are properly distinguished, a re-interpretation of the classical studies of conformity and obedience is called forth. Such an exercise produces insights into some of the discipline's most controversial, if not disturbing, results. Specifically, it leads to an understanding of laboratory conformity and obedience in rational terms.

Be Happy: Navigating Normative Issues in Behavioral and Well-Being Public Policy

Psychological science is increasingly influencing public policy. Behavioral public policy (BPP) was a milestone in this regard because it influenced many areas of policy in a general way. Well-being public policy (WPP) is emerging as a second domain of psychological science with general applicability. However, advocacy for WPP is criticized on ethical and political grounds. These criticisms are reminiscent of those directed at BPP over the past decade. This déjà vu suggests the need for interdisciplinary work that establishes normative principles for applying psychological science in public policy. We try to distill such principles for WPP from the normative debates over BPP. We argue that the uptake of BPP by governments was a function of its relatively strong normative and epistemic foundations in libertarian paternalism, or nudging, for short. We explain why the nudge framework is inappropriate for WPP. We then analyze how boosts offer a strict but feasible alternative framework for substantiating the legitimacy of well-being and behavioral policies. We illuminate how some WPPs could be fruitfully promoted as boosts and how they might fall short of the associated criteria.

Don't they understand climate science? Reflections in times of crisis in science and politics

During the 2016 US presidential election, the majority of discussion on the social website 'I fucking love science' claimed that 'climate change is a matter of science, truth and facts but "they", the deniers, do not understand the science', invoking a polarized version of the modern model of legitimation, entangled with the deficit model. This article challenges this narrative to open a dialogue space and identify criteria for dealing with the climate issue under conditions of high uncertainty and complexity. Analysis reveals how the dialogue might experience a stalemate when criticisms against this narrative are based on the need to show an inflicted harm for which this narrative can be blamed. Simultaneously, the same condition of uncertainty disarms a core principle from the modern model-that legimate action is to be based on predicting catastrophe in climate change. At stake is an essential part of the present: our praxis.

The Legitimacy of Change: Adopting/Adapting, Implementing and Sustaining Reforms within Community Corrections Agencies

Many criminal justice institutions implement evidence-based reforms. While most scholars are aware of implementation challenges, we still know relatively little about sustainability. Using longitudinal data from criminal legal staff implementing an evidence-based reform, this paper considers: What happens during the implementation of an organizational reform that affects continued use of these reforms? Guided by an organizational change framework, findings suggest sustainability aligns with key organizational goals including legitimacy, efficiency and effectiveness. While all sites saw the reformed practices as legitimate enough to initially consider adoption, two sites never adopted, four sites toyed with reform, and two sites continued to use the reform after the study was over. This paper explores sustainability and identifies legitimacy as an important factor that affects the routinization of new practices. Transformation of organizational change initiatives into routine practices should consider efforts to build legitimacy in lieu of primarily rationalizing on the values of efficiency and effectiveness.

The Strengthening Mechanism of the Relationship between Social Work and Public Health under COVID-19 in China

Social work and public health have always shared a common mission and vision in promoting human health. However, existing research tends to view social work and public health as two separate fields at both practice and policy levels, and these studies have largely neglected the consideration of how to integrate public health and social work. In the context of the COVID-19 epidemic, the link between the two has been strengthened and health social work has been given more importance. The question addressed in this article is through what mechanisms or practices the social work profession can strengthen its professional status and engage in interprofessional collaboration. Based on key informant interviews and case studies (one community and two cabin Hospitals), this study points out that three legitimacy mechanisms are needed: operationalizing policy, extending value, and completing justification. Furthermore, the future and possible limitations in relation to the development of health social work in China are discussed and specific recommendations are provided. Health social work needs to conduct practices and summarize its experiences and methods, to create a more friendly political environment by translating its results into policies that are conducive to the development of health social work through a political agenda. It needs to improve upon its practical abilities and methodologies, as well as professional education relating to professional values and ethics, in addition to identifying the deeper social needs of residents and discovering new, undeveloped areas of service. Moreover, because long-term change is difficult to justify due to China’s policy agendas, the question of whether the professional status of health social work in the post-epidemic context can be improved is something that needs to be further explored in future studies.

Social validity of work ability evaluations and official decisions within the sickness insurance system: A client perspective

BACKGROUND:

Studies of the social validity of work ability evaluations are rare, although the concept can provide valuable information about the acceptability, comprehensibility and importance of procedures.

OBJECTIVE:

The aim of this study was to explore clients’ perceptions of social validity of work ability evaluations and the following official decisions concerning sickness benefits within the Swedish sickness insurance system.

METHODS:

This was a longitudinal qualitative study based on interviews with 30 clients on sick leave, analyzed through deductive content analysis.

RESULTS:

Clients’ understanding of the evaluation was dependent on whether the specific tests were perceived as clearly related to the clients’ situation and what information they received. For a fair description of their work ability, clients state that the strict structure in the evaluation is not relevant to everyone.

CONCLUSION:

The work ability evaluations indicate low acceptability due to lack of individual adaptation, the comprehensibility varied depending on the applicability of the evaluation and information provided, while the dimension ‘importance’ indicated as higher degree of social validity. The official decision about sickness benefits however was considered unrelated to the evaluation results, lacking solid arguments and sometimes contradictory to other stakeholders’ recommendations indicating poor social validity.

What does the public want police to do during pandemics? A national experiment

RESEARCH SUMMARY

We administered a survey experiment to a national sample of 1068 U.S. adults in April 2020 to determine the factors that shape support for various policing tactics in the midst of the COVID-19 pandemic. Respondents were sharply divided in their views about pandemic policing tactics and were least supportive of policies that might limit public access to officers or reduce crime deterrence. Information about the health risks to officers, but not to inmates, significantly increased support for "precautionary" policing, but not for "social distance" policing. The information effect was modest, but may be larger if the information came from official sources and/or was communicated on multiple occasions. Other factors that are associated with attitudes toward pandemic policing include perceptions of procedural justice, altruistic fear, racial resentment, and authoritarianism.

POLICY IMPLICATIONS

When considered together with other evidence, one clear takeaway from our study is that the public values police patrols and wants officers on call, even during pandemics. Another is that people who believe the police are procedurally just are more willing to trust officers in times of crisis and to empower them to enforce new laws, such as social distancing ordinances. Our results thus support continued procedural justice training for officers. A third takeaway is that agencies must proactively communicate with the public about the risks their officers face when responding to public health crises or natural disasters, in addition to how they propose to mitigate those risks. They must also be amenable to adjusting in response to community feedback.

When Doctors strike: Making Sense of Professional Organizing in Kenya

Little is known about how the health professions organize in low- and middle-income countries (LMICs). This is particularly troubling as health worker strikes in LMICs appear to be growing more frequent and severe. While some research has been conducted on the impact of strikes, little has explored their social etiology. This article draws on theory from organization and management studies to situate strike behavior in a historical process of sensemaking in Kenya. In this way, doctors seek to expand pragmatic, moral, and cognitive forms of legitimacy in response to sociopolitical change. During the first period (1963-2000), the legacy of colonial biomedicine shaped medical professionalism and tensions with a changing state following independence. The next period (2000-2010) was marked by the rise of corporate medicine as an organized form of resistance to state control. The most recent period (2010-2015) saw a new constitution and devolution of health services cause a fractured medical community to strike as a form of symbolic resistance in its quest for legitimacy. In this way, strike behavior is positioned as a form of legitimation among doctors competing over the identity of medicine in Kenya and is complicating the path to universal health coverage.

"Following orders" as a critique on healthcare allocation committees: An anthropological perspective on the role of public memory in bioethical legitimacy

The public perception of decision-making procedures as fair processes is a central means for establishing their legitimacy to make difficult resource allocation decisions. According to the ethical framework of accountability for reasonableness (A4R, hereafter), which specifies conditions for fair healthcare resource allocation, disagreements about what constitutes relevant considerations are a central threat to its perceived fairness. This article considers how an ethical principle grounded in the public memory of past traumatic events may become the topic of such disagreements. I demonstrate this through an anthropological case study of a recent public de bate concerning an Israeli healthcare allocation committee (HAC, thereafter), which determines state subsidies for new medical technologies as part of Israel's public healthcare system. Drawing upon ethnographic fieldwork about the HAC, I show how the public memory of Adolf Eichmann's trial constitutes a bioethical problem for the committee's legitimacy. Based on Arendt's and Bauman's writings that Nazi bureaucrats' manner of "following orders" was an ethical transgression, some patients contended that the committee has a historical responsibility to question its strict adherence to bureaucratic procedures. Since the committee did not have a direct link to the events of the Holocaust, other considerations seemed to them more relevant. I then present an offer that can settle this disagreement and maintain the HAC's legitimacy according to A4R. I conclude by discussing the contribution of empirical data to models of bioethical legitimacy.

Counteracting subliminal cues that threaten national identity

In spite of their subtle nature, subliminal cues of group devaluation can have profound effects on members of targeted groups. Across three studies, we examine factors that allow people to counteract subliminal cues of group devaluation. We do this in the context of Spanish–German intergroup relations following the 2008 financial crisis. Throughout the crisis, narratives in politics and the media have drawn on national stereotypes to legitimize the economic situation in Spain. We argue that this represents a threat to our Spanish participants and that exposure to subliminal cues that reflect this threat will trigger responses that counteract this threat. Indeed, results showed that when subliminal associations legitimize the disadvantage faced by the group, our Spanish participants reversed the subliminal associations to which they were exposed. These findings show that Spanish participants are able to counteract the devaluation of their national in‐group, even when that devaluation occurs outside of conscious awareness.

Consumer Ethicality Perception and Legitimacy: Competitive Advantages in COVID-19 Crisis

The article aims to analyze the cause–effect relationship between Brand Ethicality Perception (CPE), legitimacy and purchase intention during the COVID-19 first wave, taking into consideration the mediation effect of the country of residence. Data collection was based on a survey launched during the COVID-19 lockdown in Madrid and New York. To analyze the established hypotheses and to test the multigroup analysis, we applied a structural modelling with SmartPLS. The research contributes to the field of brand management, and specifically of ethical branding, since it will analyze how stakeholders’ expectations fulfillment is key to build a consistent and valued brand meaning in crisis’ situations, demonstrating that ethical behaviors are key for gaining corporate legitimacy and, therefore, for improving business performances.

Healthcare provision inside immigration removal centres: A social identity analysis of trust, legitimacy and disengagement

The stressors of immigration detention and negative host country experiences make effective access to health care vital for migrant detainees, but little is known regarding the health experiences of this populations and the barriers to healthcare access. The present research investigates immigration detainees' experiences of health-related help-seeking in the distressing and stigmatised environment of UK immigration removal centres (IRCs), as well as staff members' experiences of providing help. Semi-structured interviews were conducted with 40 detainees and 21 staff and analysed using theoretical thematic analysis guided by the social identity approach. The findings indicate that the practical constraints on help provision (e.g. lack of time and resources, the unpredictable nature of detention) are exacerbated by the complex and conflictual intergroup relationships within which these helping transactions occur. These transactions are negatively affected by stigma, mutual distrust and reputation management concerns, as well as detainees' feelings of powerlessness and confusion around eligibility to receive health care. Some detainees argued that the help ignores the systematic inequalities associated with their detainee status, thereby making it fundamentally inappropriate and ineffective. The intergroup context (of inequality and illegitimacy) shapes the quality of helping transactions, care experiences and health service engagement in groups experiencing chronic low status, distress and uncertainty.

Trust and Compliance with COVID-19 Preventive Behaviors during the Pandemic

This study examined the role of trust in lay people's health behaviors related to the current pandemic. A total of 376 Israelis completed an online questionnaire during the second lockdown. A latent profile analysis was conducted to identify profiles of individuals based on their levels of trust in the various institutions and stakeholders examined in this study. A three-profile solution was deemed most appropriate. The largest profile (N = 178) was characterized by low levels of trust in the government, but high levels of trust in science and one's primary care provider. Next, was the generally low trust profile (N = 108), characterized by low levels of trust directed towards all stakeholders and institutes. The third profile (N = 79) was characterized by high levels of trust. Results are discussed in relation to the important role of trust in determining people's response to the current pandemic and the unique features of Israeli society.

Beyond Justice Perceptions: The Role of Interpersonal Justice Trajectories and Social Class in Perceived Legitimacy of Authority Figures

There is considerable evidence that the experience of justice is associated with perceived legitimacy of authority, but there has been no research about this association when considering past rather than current fairness. Based on the fairness heuristic theory, we tested the hypothesis that interpersonal justice trajectories positively affect perceived legitimacy of the authority; we also tested whether social class moderated this effect. Community residents (N = 111; 54 women) rated the authority's fairness on 16 consecutive weeks and rated perceived legitimacy on the 16th week. The results of latent growth modeling showed that the trajectory of interpersonal justice scores leading up to the final week significantly predicted perceived legitimacy, regardless of the current experience of interpersonal fairness. Tests of moderation showed that the legitimacy perceptions of individuals of lower subjective social class were significantly affected by interpersonal justice trajectories, whereas this was not the case among individuals of higher subjective social class. The results are discussed in terms of their implications for research on perceived legitimacy and justice, as well as their implications for understanding social class.

Social work legitimacy: democratising research, policy and practice in child protection

This article analyses the concept of legitimacy as applied to the use of power in statutory social work with children and families in the UK. It draws on literature from police studies and criminology, in which the concept is a stable one that continues to be heavily researched and analysed. Police and social workers bear comparison in respect of legitimacy because of the significant powers they use on behalf of the state with direct implications for the civil and human rights of their fellow citizens. The article defines legitimacy in theoretical terms before applying the concept to social work. Here, perceptions of fairness in the distribution of resources, the quality of treatment people receive, and the quality of decision-making are critically examined. The article then proposes a democratising agenda across the three domains of social work research, policy, and practice. Through challenging social work’s legitimacy and analysing its relationship to social democracy, it is argued that new ways may be found to realign practice with the values of human rights and social justice that are said to underpin the profession. Given the severe socioeconomic impact of the Covid-19 pandemic on many families, these questions acquire a particular urgency.

(Re)defining legitimacy in Canadian drug assessment policy? Comparing ideas over time

How do experts judge the legitimacy of technical policy processes, and do their ideas change as these processes are opened to other stakeholders and the public? This research examines the adoption of public and patient involvement in pharmaceutical assessment in Canada. It finds tensions between scientific legitimacy that prioritizes rigor and objectivity, and democratic legitimacy that values inclusion and a broader range of evidence. In response to policy change, experts incorporate new ideas about democratic inputs and processes, while maintaining scientific policy goals. The research responds to calls for more precise measurement of ideas and ideational change and more evaluation of public and patient involvement in health policy. It helps us understand the significance of, and limits to, ideational change among experts in health policy domains that are highly technical and publicly salient. Understanding the way democratic and scientific legitimacy are negotiated in policy decisions has a wide applicability in health, but is particularly relevant during a global pandemic when evidence is being generated rapidly, decisions must be made quickly, and these decisions have a significant, immediate effect on the lives of all citizens.

Coercive Measures in Psychiatry: A Review of Ethical Arguments

Introduction: Coercion is frequent in clinical practice, particularly in psychiatry. Since it overrides some fundamental rights of patients (notably their liberty of movement and decision-making), adequate use of coercion requires legal and ethical justifications. In this article, we map out the ethical elements used in the literature to justify or reject the use of coercive measures limiting freedom of movement (seclusion, restraint, involuntary hospitalization) and highlight some important issues. Methods: We conducted a narrative review of the literature by searching the PubMed, Embase, PsycINFO, Google Scholar and Cairn.info databases with the keywords "coercive/compulsory measures/care/treatment, coercion, seclusion, restraint, mental health, psychiatry, involuntary/compulsory hospitalization/admission, ethics, legitimacy." We collected all ethically relevant elements used in the author's justifications for or against coercive measures limiting freedom of movement (e.g., values, rights, practical considerations, relevant feelings, expected attitudes, risks of side effects), and coded, and ordered them into categories. Results: Some reasons provided in the literature are presented as justifying an absolute prohibition on coercion; they rely on the view that some fundamental rights, such as autonomy, are non-negotiable. Most ethically relevant elements, however, can be used in a balanced weighting of reasons to favor or reject coercive measures in certain circumstances. Professionals mostly agree that coercion is only legitimate in exceptional circumstances, when the infringement of some values (e.g., freedom of movement, short-term autonomy) is the only means to fulfill other, more important values and goals (e.g., patient's safety, the long-term rebuilding of patient's identity and autonomy). The results of evaluations vary according to which moral elements are prioritized over others. Moreover, we found numerous considerations (e.g., conditions, procedural values) for how to ensure that clinicians apply fair decision-making procedures related to coercion. Based on this analysis, we highlight vital topics that need further development. Conclusion: Before using coercive measures limiting freedom of movement, clinicians should consider and weigh all ethically pertinent elements in the situation and actively search for alternatives that are more respectful of patient's well-being and rights. Coercive measures decided upon after a transparent, carefully balanced evaluation process are more likely to be adequate, understood, and accepted by patients and caregivers.

Legitimacy in the 'secular church' of the United Nations

This article argues that how the United Nations (UN) conceptualizes legitimacy is not only a matter of legalism or power politics. The UN's conception of legitimacy also utilizes concepts, language and symbolism from the religious realm. Understanding the entanglement between political and religious concepts and the ways of their verbalization at the agential level sheds light on how legitimacy became to be acknowledged as an integral part of the UN and how it changes. At the constitutional level, the article examines phrases and 'verbal symbols', enshrined in the Charter of the 'secular church' UN. They evoke intrinsic legitimacy claims based on religious concepts and discourse such as hope and salvation. At the agential level, the article illustrates how the Secretary-General verbalizes those abstract constitutional principles of legitimacy. Religious language and symbolism in the constitutional framework and agential practice of the UN does not necessarily produce an exclusive form of legitimacy. This article shows, however, that legitimacy as nested in the UN's constitutional setting cannot exist without religious templates because they remain a matter of a 'cultural frame'.

Industry-Dominated Science Advisory Boards Are Perceived To Be Legitimate…But Only When They Recommend More Stringent Risk Management Policies

In 2017, the US Environmental Protection Agency (EPA) was criticized for two controversial directives that restricted the eligibility of academic scientists to serve on the agency's key science advisory boards (SABs). The EPA portrayed these directives as necessary to ensure the integrity of the SAB. Critics portrayed them as a tactic by the agency to advance a more industry-friendly deregulatory agenda. With this backdrop, this research examined board composition and its effect on the perceived legitimacy of risk management recommendations by the SAB. In an experiment, we presented participants with hypothetical EPA SABs composed of different proportions of academic and industry scientists. We then asked participants to rate their satisfaction with, and the legitimacy of, these boards in light of their decisions in scenarios based on actual EPA SAB deliberations. Participants perceived higher levels of satisfaction and legitimacy when SABs made more stringent risk management recommendations. While SABs dominated by industry scientists were perceived to be more strongly motivated to protect business interests, we found no effect of board composition on perceptions of satisfaction and legitimacy. These results are consistent with prior research on decision quality that suggests people use normative outcomes as a heuristic for assessing the quality of deliberations. Moreover, these results suggest that members of the public are supportive of federal SABs regardless of their composition, but only if they take actions that are consistent with normative expectations.

Understanding the Uptake of Big Data in Health Care: Protocol for a Multinational Mixed-Methods Study

Background

Despite the high potential of big data, their applications in health care face many organizational, social, financial, and regulatory challenges. The societal dimensions of big data are underrepresented in much medical research. Little is known about integrating big data applications in the corporate routines of hospitals and other care providers. Equally little is understood about embedding big data applications in daily work practices and how they lead to actual improvements for health care actors, such as patients, care professionals, care providers, information technology companies, payers, and the society.

Objective

This planned study aims to provide an integrated analysis of big data applications, focusing on the interrelations among concrete big data experiments, organizational routines, and relevant systemic and societal dimensions. To understand the similarities and differences between interactions in various contexts, the study covers 12 big data pilot projects in eight European countries, each with its own health care system. Workshops will be held with stakeholders to discuss the findings, our recommendations, and the implementation. Dissemination is supported by visual representations developed to share the knowledge gained.

Methods

This study will utilize a mixed-methods approach that combines performance measurements, interviews, document analysis, and cocreation workshops. Analysis will be structured around the following four key dimensions: performance, embedding, legitimation, and value creation. Data and their interrelations across the dimensions will be synthesized per application and per country.

Results

The study was funded in August 2017. Data collection started in April 2018 and will continue until September 2021. The multidisciplinary focus of this study enables us to combine insights from several social sciences (health policy analysis, business administration, innovation studies, organization studies, ethics, and health services research) to advance a holistic understanding of big data value realization. The multinational character enables comparative analysis across the following eight European countries: Austria, France, Germany, Ireland, the Netherlands, Spain, Sweden, and the United Kingdom. Given that national and organizational contexts change over time, it will not be possible to isolate the factors and actors that explain the implementation of big data applications. The visual representations developed for dissemination purposes will help to reduce complexity and clarify the relations between the various dimensions.

Conclusions

This study will develop an integrated approach to big data applications that considers the interrelations among concrete big data experiments, organizational routines, and relevant systemic and societal dimensions.

International Registered Report Identifier (IRRID)

DERR1-10.2196/16779

Subjective status and perceived legitimacy across countries

The relationships between subjective status and perceived legitimacy are important for understanding the extent to which people with low status are complicit in their oppression. We use novel data from 66 samples and 30 countries (N = 12,788) and find that people with higher status see the social system as more legitimate than those with lower status, but there is variation across people and countries. The association between subjective status and perceived legitimacy was never negative at any levels of eight moderator variables, although the positive association was sometimes reduced. Although not always consistent with hypotheses, group identification, self-esteem, and beliefs in social mobility were all associated with perceived legitimacy among people who have low subjective status. These findings enrich our understanding of the relationship between social status and legitimacy.

What do stress tests test? Experimentation, demonstration, and the sociotechnical performance of regulatory science

After their successful introduction during the 2007-2009 financial crisis, central bank stress tests were adopted as a fixture of international banking supervision. However, in recent years a new normal has emerged where banks are expected to pass the tests, raising questions about the tests' usefulness and legitimacy. Combining a dramaturgical interpretation of regulatory science with the idea of performativity in the sociology of finance, this article understands stress tests as a sociotechnical Goffmanian performance. With a focus on the Bank of England's program, the paper argues that the Bank's decision to make their tests "predictable" is an attempt to shore up central bank legitimacy by constraining regulatory discretion. This is accomplished through the use of calculative and procedural stage management techniques which allow the Bank to control the contingency of the testing process while demonstrating its objectivity. Nevertheless, the conclusion suggests that in the context of low levels of trust in central banks, routine declarations of "all clear" may undermine public confidence in the tests' credibility and necessity. The study draws on 20 interviews with high-level regulators, financial practitioners and other stakeholders in the Bank of England's stress tests.

Contested legitimacy for anthropologists involved in medical humanitarian action: experiences from the 2014-2016 West Africa Ebola epidemic

The growing involvement of anthropologists in medical humanitarian response efforts has laid bare the moral and ethical consequences that emerge from humanitarian action. Anthropologists are well placed to examine the social, political, cultural and economic dimensions that influence the spread of diseases, and the ways in which to respond to epidemics. Anthropologists are also, with care, able to turn a critical lens on medical humanitarian response. However, there remains some resistance to involving anthropologists in response activities in the field. Drawing on interviews with anthropologists and humanitarian workers involved in the 2014-2016 West African Ebola epidemic, this paper reveals the complex roles taken on by anthropologists in the field and reveals how anthropologists faced questions of legitimacy vis-à-vis communities and responders in their roles in response activities, which focused on acting as 'firefighters' and 'cultural brokers' as well as legitimacy as academic researchers. Whilst these anthropologists were able to conduct research alongside these activities, or draw on anthropological knowledge to inform response activities, questions also arose about the legitimacy of these roles for anthropological academia. We conclude that the process of gaining legitimacy from all these different constituencies is particular to anthropologists and reveals the role of 'giving voice' to communities alongside critiquing medical humanitarianism. Whilst these anthropologists have strengthened the argument for the involvement of anthropologists in epidemic response this anthropological engagement with medical humanitarianism has revealed theoretical considerations more broadly for the discipline, as highlighted through engagement in other fields, especially in human rights and global health.

Rethinking patient involvement in healthcare priority setting

With healthcare systems under pressure from scarcity of resources and ever-increasing demand for services, difficult priority setting choices need to be made. At the same time, increased attention to patient involvement in a wide range of settings has given rise to the idea that those who are eventually affected by priority setting decisions should have a say in those decisions. In this paper, we investigate arguments for the inclusion of patient representatives in priority setting bodies at the policy level. We find that the standard justifications for patient representation, such as to achieve patient-relevant decisions, empowerment of patients, securing legitimacy of decisions, and the analogy with democracy, all fall short of supporting patient representation in this context. We conclude by briefly outlining an alternative proposal for patient participation that involves patient consultants.

A field experiment on community policing and police legitimacy

Repeated instances of police violence against unarmed civilians have drawn worldwide attention to the contemporary crisis of police legitimacy. Community-oriented policing (COP), which encourages positive, nonenforcement contact between police officers and the public, has been widely promoted as a policy intervention for building public trust and enhancing police legitimacy. To date, however, there is little evidence that COP actually leads to changes in attitudes toward the police. We conducted a randomized trial with a large urban police department. We found that positive contact with police—delivered via brief door-to-door nonenforcement community policing visits—substantially improved residents’ attitudes toward police, including legitimacy and willingness to cooperate. These effects remained large in a 21-d follow-up and were largest among nonwhite respondents.

Despite decades of declining crime rates, longstanding tensions between police and the public continue to frustrate the formation of cooperative relationships necessary for the function of the police and the provision of public safety. In response, policy makers continue to promote community-oriented policing (COP) and its emphasis on positive, nonenforcement contact with the public as an effective strategy for enhancing public trust and police legitimacy. Prior research designs, however, have not leveraged the random assignment of police–public contact to identify the causal effect of such interactions on individual-level attitudes toward the police. Therefore, the question remains: Do positive, nonenforcement interactions with uniformed patrol officers actually cause meaningful improvements in attitudes toward the police? Here, we report on a randomized field experiment conducted in New Haven, CT, that sheds light on this question and identifies the individual-level consequences of positive, nonenforcement contact between police and the public. Findings indicate that a single instance of positive contact with a uniformed police officer can substantially improve public attitudes toward police, including legitimacy and willingness to cooperate. These effects persisted for up to 21 d and were not limited to individuals inclined to trust and cooperate with the police prior to the intervention. This study demonstrates that positive nonenforcement contact can improve public attitudes toward police and suggests that police departments would benefit from an increased focus on strategies that promote positive police–public interactions.