scholarly journals Equivalence, Justice, Injustice – Health and Social Care Decision Making in Relation to Prison Populations

2021 ◽  
Vol 6 ◽  
Author(s):  
Andrew Shepherd ◽  
Tom Hewson ◽  
Jake Hard ◽  
Russell Green ◽  
Jennifer Shaw

Prisons represent sites of singular healthcare need–characterized by high levels of distress and disorder. In many jurisdictions, practitioners are ethically charged with delivering healthcare that is “equivalent” to that available in the wider community. This claim has been much debated–yet the emergence of a global coronavirus pandemic has highlighted the arguments in a particularly stark manner. In the following conceptual analysis, we explore the emergent discourse of the coronavirus and consider its particular significance for prison healthcare decision making and the concept of equivalence. For example, both the coronavirus pandemic and practice of prison incarceration induce a sense of varied temporality: The discourse of prison is replete in this area–such as the concept of “hard time.” Alongside this, the discourse in relation to coronavirus has highlighted two competing modes of temporal understanding: The political–where the pandemic is conceptualized as has having a discrete “beginning and end”, and the scientific–where the “new normal” reflects the incorporation of the “novel” coronavirus into the wider ecology. The impact of these disparate understandings on the prison population is complex: “Locking down” prisoners–to safeguard the vulnerable against infection–is relatively simple, yet it has traumatic repercussions with respect to liberty and psychosocial health. Easing lockdown, by contrast, is a difficult endeavor and risks collision between the temporalities of prison–where “hard time” is accentuated by separation from the “real world”–the political and the scientific. Whither then the concept of equivalence in relation to a field that is definitively non-equivalent? How can practitioners and policy makers maintain a just ethical stance in relation to the allocation of resources when it comes to a politically marginalized yet manifestly vulnerable population? We argue that further debate and consideration are required in this field–and propose a framework for such discussion.

2020 ◽  
Author(s):  
Philip Scott ◽  
Elisavet Andrikopoulou ◽  
Haythem Nakkas ◽  
Paul Roderick

Background: The overall evidence for the impact of electronic information systems on cost, quality and safety of healthcare remains contested. Whilst it seems intuitively obvious that having more data about a patient will improve care, the mechanisms by which information availability is translated into better decision-making are not well understood. Furthermore, there is the risk of data overload creating a negative outcome. There are situations where a key information summary can be more useful than a rich record. The Care and Health Information Exchange (CHIE) is a shared electronic health record for Hampshire and the Isle of Wight that combines key information from hospital, general practice, community care and social services. Its purpose is to provide clinical and care professionals with complete, accurate and up-to-date information when caring for patients. CHIE is used by GP out-of-hours services, acute hospital doctors, ambulance service, GPs and others in caring for patients. Research questions: The fundamental question was How does awareness of CHIE or usage of CHIE affect clinical decision-making? The secondary questions were What are the latent benefits of CHIE in frontline NHS operations? and What is the potential of CHIE to have an impact on major NHS cost pressures? The NHS funders decided to focus on acute medical inpatient admissions as the initial scope, given the high costs associated with hospital stays and the patient complexities (and therefore information requirements) often associated with unscheduled admissions. Methods: Semi-structured interviews with healthcare professionals to explore their experience about the utility of CHIE in their clinical scenario, whether and how it has affected their decision-making practices and the barriers and facilitators for their use of CHIE. The Framework Method was used for qualitative analysis, supported by the software tool Atlas.ti. Results: 21 healthcare professionals were interviewed. Three main functions were identified as useful: extensive medication prescribing history, information sharing between primary, secondary and social care and access to laboratory test results. We inferred two positive cognitive mechanisms: knowledge confidence and collaboration assurance, and three negative ones: consent anxiety, search anxiety and data mistrust. Conclusions: CHIE gives clinicians the bigger picture to understand the patient's health and social care history and circumstances so as to make confident and informed decisions. CHIE is very beneficial for medicines reconciliation on admission, especially for patients that are unable to speak or act for themselves or who cannot remember their precise medication or allergies. We found no clear evidence that CHIE has a significant impact on admission or discharge decisions. We propose the use of recommender systems to help clinicians navigate such large volumes of patient data, which will only grow as additional data is collected.


2014 ◽  
Vol 14 (1) ◽  
pp. 33-61 ◽  
Author(s):  
Alexandru V. Roman

The last two decades have witnessed a tremendous growth in the body of literature addressing the importance and the impact of contracting and public procurement within the context of devolution of government. The austere budgetary and financial outlooks of the future suggest that the significance of the area will only continue to grow. As such, generating explanatory frameworks, within dimensions such as decisionmaking and accountability in public procurement, becomes crucial. Drawing from original research this article suggests one possible frame for understanding administrative decision-making in complex environments. Based on semi-structured interviews with public procurement specialists, the study identifies two decision-making patterns− broker and purist. It is asserted that the decision-making dynamics exhibited by administrators are contingent on their perceptions regarding environmental instability, in particular the political volatility surrounding their work.


2019 ◽  
Vol 21 (1) ◽  
pp. 152-172 ◽  
Author(s):  
Narisong Huhe ◽  
Daniel Naurin ◽  
Robert Thomson

We assess the impact of the United Kingdom’s 2016 decision to leave the European Union on the Council of the European Union, where Brexit is likely to have the clearest observable implications. Using concepts and models from the spatial model of politics and network analysis, we formulate and test expectations regarding the effects of Brexit. We examine two of the most prominent datasets on recent decision-making in the European Union, which include data on cooperation networks among member states before and after the 2016 referendum. Our findings identify some of the political challenges that Brexit will bring, but also highlight the factors that are already helping the European Union’s remaining member states to adapt to Brexit.


2020 ◽  
pp. 1248-1257 ◽  
Author(s):  
Yüksel Ürün ◽  
Syed A. Hussain ◽  
Ziad Bakouny ◽  
Daniel Castellano ◽  
Saadettin Kılıçkap ◽  
...  

PURPOSE To understand readiness measures taken by oncologists to protect patients and health care workers from the novel coronavirus (COVID-19) and how their clinical decision making was influenced by the pandemic. METHODS An online survey was conducted between March 24 and April 29, 2020. RESULTS A total of 343 oncologists from 28 countries participated. The median age was 43 years (range, 29-68 years), and the majority were male (62%). At the time of the survey, nearly all participants self-reported an outbreak in their country (99.7%). Personal protective equipment was available to all participants, of which surgical mask was the most common (n = 308; 90%). Telemedicine, in the form of phone or video encounters, was common and implemented by 80% (n = 273). Testing patients with cancer for COVID-19 via reverse transcriptase polymerase chain reaction before systemic treatment was not routinely implemented: 58% reported no routine testing, 39% performed testing in selected patients, and 3% performed systematic testing in all patients. The most significant factors influencing an oncologist’s decision making regarding choice of systemic therapy included patient age and comorbidities (81% and 92%, respectively). Although hormonal treatments and tyrosine kinase inhibitors were considered to be relatively safe, cytotoxic chemotherapy and immune therapies were perceived as being less safe or unsafe by participants. The vast majority of participants stated that during the pandemic they would use less chemotherapy, immune checkpoint inhibitors, and steroids. Although treatment in neoadjuvant, adjuvant, and first-line metastatic disease was less affected, most of the participants stated that they would be more hesitant to recommend second- or third-line therapies in metastatic disease. CONCLUSION Decision making by oncologists has been significantly influenced by the ongoing COVID-19 pandemic.


Author(s):  
Menachem Klein

This landmark volume presents vivid and intimate portraits of Palestinian Presidents Yasser Arafat and Mahmoud Abbas, revealing the impact these different personalities have had on the struggle for national self-determination. Arafat and Abbas lived in Palestine as young children. Uprooted by the 1948 war, they returned in 1994 to serve as the first and second presidents of the Palestinian Authority, the establishment of which has been the Palestine Liberation Organization’s greatest step towards self-determination for the Palestinian nation. Both Arafat and Abbas were shaped by earlier careers in the PLO, and each adopted their own controversial leadership methods and decision-making styles. Drawing on primary sources in Arabic, Hebrew and English, Klein gives special attention to the lesser-known Abbas: his beliefs and his disagreements with Israeli and American counterparts. The book uncovers new details about Abbas’ peace talks and US foreign policy towards Palestine, and analyses the political evolution of Hamas and Abbas’ succession struggle. Klein also highlights the tension between the ageing leader and his society. Arafat and Abbas offers a comprehensive and balanced account of the Palestinian Authority’s achievements and failures over its twenty-five years of existence. What emerges is a Palestinian nationalism that refuses to disappear.


Prawo ◽  
2020 ◽  
Vol 328 ◽  
pp. 109-151
Author(s):  
Leonard Górnicki

Codification Commission of the Second Polish Republic: position within the political system, organisational structure and decision-makingEstablished one hundred years ago, the Codification Commission of the Second Polish Republic initiated and prepared draft legislation dealing with private, criminal, substantive and procedural law as well as the judiciary and the legal profession. The Commission served as de facto legislator, that is lawmaker in the sociological sense, for it had a genuine impact on the content and form of legislative acts.In the article the author analyses the position of the Codification Commission of the Second Polish Republic within the legal system, on which opinions differ in the literature on the subject. He defends the thesis that is was a central state institution, the existence of which was not, however, coordinated with the political system of the Second Polish Republic. Next, he investigates the impact of the transformations of the organisational structure and decision-making methodology on the efficiency of the Commission’s codification process. He takes into account the management and administration of the Codification Commission, organisation of work in Departments, Sections Subsections, Subcommittees, role of the delegates of the Minister of Justice and delegates of ministries, finally — decision-making mechanisms, including adoption of drafts as well as work in the Sections Subsections and Subcommittees. The author concludes that the experiences of the Second Polish Republic’s Codification Commission, a central state institution of advisory nature, established for an indefinite period, demonstrate that the best solution is to entrust codification to a special, apolitical and expert codification commission, operating with a degree of independence, of internal autonomy. Within such a commission a more effective mode of operation is preparation of drafts by teams of several people and then consultation of these drafts by larger bodies.Die Kodifikationskommission der Zweiten Polnischen Republik: institutionelles System, organisatorische Struktur, EntscheidungenDie Kodifikationskommission der Zweiten Polnischen Republik, die vor hundert Jahren entstandt, hat Entwürfe von Rechtsakten aus dem Bereich des Privat- und Strafrechts des Sachen- und Verfahrensrechtes sowie betreffend die Struktur der Gerichte und der Anwaltschaft eingeleitet und vorbereitet. Sie war praktisch ein Gesetzgeber, also soziologisch gesehen ein Rechtgeber, denn sie hatte einen realen Einfluss auf den Inhalt der Rechtsakten und die Bestimmung ihrer formellen Gestalt.Der Autor analysiert zuerst den staatsrechtlichen Rahmen der Kodifikationskommission der Zweiten Polnischen Republik, der in der Fachliteratur verschieden gesehen wird. Er verteidigt die These, dass die Kommission eine zentrale staatliche Institution war, deren Bestehen mit dem strukturellen System der Zweiten Polnischen Republik jedoch nicht koordiniert war. Dann untersucht er den Einfluss der Umwandlungen der Organisationsstruktur und der Methodik der Entscheidungen auf die Effektivität des Prozesses der Kodifikation des Rechts durch die Kodifikationskommission. Er berücksichtigt also die Führungsorgane und die Verwaltung der Kodifikationskommission, die Organisation der Arbeit in den Abteilungen, Sektionen Untersektionen und Unterkommissionen, die Rolle der Abgeordneten des Justizministers und der Abgeordneten der Ministerien, und zum Schluss die Mechanismen der Entscheidungen, darunter die Beschließung der Entwürfe und die Arbeit in den Sektionen Untersektionen sowie in den Unterkommissionen.Der Autor kommt zum Schluss, dass die Erfahrungen der Kodifikationskommission der Zweiten Polnischen Republik, die eine für unbestimmte Zeit berufene, zentrale staatliche Organisation eines beratenden Charakters war, bewiesen haben, dass die beste Lösung wäre, eine speziell dazu berufene, apolitische Fachkodifikationskommission, die über gewisse Selbständigkeit und interne Autonomie verfügen würde, mit der Kodifikation des Rechts zu beauftragen. Im Rahmen einer solchen Kommission stellt eine Arbeitsgruppe, die aus ein paar Personen besteht, die Entwürfe zuerst vorbereitet und sie erst später breiteren Gremien zur Konsultation vorlegt, ein effektiveres Modell dar.


Res Publica ◽  
1970 ◽  
Vol 23 (1) ◽  
pp. 125-151
Author(s):  
Wilfried Dewachter

The Belgian polyarchy has developed into a «particracy» in which the political parties have a preponderant impact on the political decisionmaking.As in every polyarchy, the political parties fulfill a set of vital functions in the Belgian system. But that does not explain its «particratie» particularity. The particracy arises as a consequence of four factors. The parties are fixed by the «zuilen» (pillars) into an «internal-imperialistic» role. The power of the parties increased considerably, an increase of which the politization of the instruments for, and the agencies of, policy is one of the most important, together with the capability of making and unmaking issues. The impact and power of the opponents of the parties in the decision-making process have been diminished to a considerable extent. This weakening involves the king, the parliament, theadministration, the electorate, and, ultimately, the cabinet because of the growing impact of the parties on policy design and policy output as well as on the appointment of ministers. Finally, the choice of the consociational pattern of politics of accomodation by the elite indicates the instrumental function of particracy in Belgian politics.


Dementia ◽  
2018 ◽  
Vol 19 (5) ◽  
pp. 1509-1531 ◽  
Author(s):  
Joanne Brooke ◽  
Alicia Diaz-Gil ◽  
Debra Jackson

Older prisoners are the fastest growing group in the prison population, with an accelerated aging process they are at a high risk of developing dementia. However, no systematic review has explored the impact of dementia in the prison setting. The objectives of this review were to identify the prevalence of dementia in the prison setting and how prison, health and social care providers assess, diagnose, treat, support and care for prisoners with dementia. A systematic search of the literature from the following databases was undertaken: CINHAL, PubMed, BNI, PsychINFO, and MEDLINE. Search strategies were tailored for each database and included recognised Medical Subject Headings. Hand searching of prominent journals in correctional services and dementia, as well as reference lists of included papers was completed. Open Grey website was searched to identify relevant government, local council and charity publications regarding dementia in the prison setting. The appropriate Critical Appraisal Skills Programmes Checklist for all included studies was completed. Following the application of inclusion and exclusion criteria, 10 studies were included in the review. Due to the nature of the data extracted, a meta-synthesis was not possible; therefore, a thematic synthesis was completed. Three themes emerged: prevalence of dementia in the prison population, identification of older prisoner’s needs, and knowledge of correctional officers and legal professionals. The prevalence and incidence of dementia in prison populations remain largely unknown. There is a need for national policies and local strategies that support a multi-disciplinary approach to early detection, screening and diagnosis of cognitive impairment and dementia across prison settings. Alongside the development of structured prison environments, non-pharmacological interventions, continued assessment of prisoners with a dynamic care plan, and training for health, social and prison staff and prisoners.


1988 ◽  
Vol 21 (3) ◽  
pp. 539-567 ◽  
Author(s):  
Herman Bakvis

AbstractRegional ministers, it is said, have declined in importance over the past three decades. While granting the disappearance of figures whose influence spanned broad regions, this article argues that in the last cabinet of Pierre Trudeau (1980–1984) the regional minister system was to a degree revived and formalized within the context of cabinet decision-making. The impact of this system is examined with respect to regional development and employment creation programmes. To account for the renewed influence of regional ministers, attention is focussed on changes in the machinery of government and on the political and economic climate of the time. The case of one minister in particular, Lloyd Axworthy, suggests that a contemporary regional minister's success is dependent primarily on the ability to mobilize the resources of the administrative state.


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