Abstract: The past decade has been witness to an unprecedented growth in research on self-regulation. For example, of the 2,700-plus chapters, dissertations, and journal articles containing the keyword ‘self-regulation’ archived in PsychINFO, a well-used social science citation index, over 1,800 have been published since 1990 alone. It is not entirely clear whether this trend is due to a shift in the Zeitgeist or a change in semantics. Though we suspect that both are involved, the Zeitgeist in Western, industrialized nations is the likely driving force. The focus on the consumer, individual choice, and populist movements that emphasize individual and community empowerment create a context congenial to self-regulation models. These models represent efforts at maintaining a sense of individual autonomy in the face of technological changes and monopolistic, corporate conglomerates that are actually shrinking the individual’s options. Whereas the exact reason for the proliferation of self-regulation models is not clear, what is clear is that an increasing number of researchers and practitioners in the fields of health and social science are adopting concepts and principles from self-regulation theory to explain human behavior and promote behavior change in different contexts (see Boekaerts et al. (2000) for a discussion of applications in areas other than health).

Abstract: Shared decision making for advanced heart failure has become both more challenging and more crucial as duration of disease and treatment options have increased. High-quality decisions are chosen from medically reasonable options and are aligned with values, goals, and preferences of an informed patient. The top 10 things to know about decision making in advanced heart failure care are listed in Table 1. View this table: Table 1. Top Ten Things to Know Providers have an ethical and legal mandate to involve patients in medical decisions. Shared decision making recognizes that there are complex trade-offs in the choice of medical care.1 Shared decision making also addresses the ethical need to fully inform patients about the risks and benefits of treatments.2 In the setting of multiple reasonable options for medical care, shared decision making involves clinicians working with patients to ensure that patients' values, goals, and preferences guide informed decisions that are right for each individual patient. Grounded in the ethical principle of autonomy,3 judicial decisions (eg, Cruzan v Missouri Department of Health 4) and legislative actions (eg, the Patient Self-Determination Act5) have repeatedly affirmed the rights of patients or duly appointed surrogates to choose their medical therapy from among reasonable options.6 The formal process of informed consent before procedural interventions is an embodiment of this concept in that it underscores the clinician's obligation to ensure that the patient has the opportunity to be informed.3 An informed patient is one who is aware of the diagnosis and prognosis, the nature of the proposed intervention, the risks and benefits of that intervention, and all reasonable alternatives and their associated risks and benefits.7 A major purpose of a high-functioning healthcare system is to provide the resources with which an activated, informed patient can engage in productive discussions with a proactive, …

Abstract: Two multisource studies address the interactive effects of personal and contextual variables on employees' proactive behavior. In line with previous work, we find positive main effects of transformational leadership, role breadth self-efficacy, and job autonomy on employee proactive behavior (personal initiative in Study 1 and prosocial proactive behavior in Study 2). As expected, a 3-way interaction qualifies these main effects: In situations of high autonomy, transformational leadership relates positively to proactive behavior for individuals high (but not low) on self-efficacy. Vice versa, in situations low on job autonomy, transformational leadership relates positively to proactive behavior for individuals low (but not high) on self-efficacy. This pattern is found both for self-ratings and peer-ratings of employees' proactive behavior in Study 1 and for supervisor ratings of such behavior in Study 2.

Abstract: Prior research suggests that, on average, disclosing sexual identity (being “out”) yields wellness benefits for lesbian, gay, and bisexual (LGB) individuals. LGB individuals vary, however, both in how much they disclose their sexual orientation in different social contexts and in the experiences that follow from disclosure. The present research examines this within-person variation in disclosure and its consequences as a function of the autonomy supportive versus controlling character of social contexts. LGB individuals rated experiences of autonomy support and control in the contexts of family, friends, coworkers, school, and religious community, as well how “out” they were, and their context-specific self-esteem, depression, and anger. Findings from multilevel modeling revealed that LGB individuals were more likely to disclose in autonomy supportive contexts. Additionally, whereas disclosure was associated with more positive well-being in autonomy supportive contexts, in controlling contexts it was not. Practical and research implications are discussed.

Abstract: Introduction Chapter 1 The rejection of epistemic authority 1. Authority, equality, and self-reliance in the epistemic realm 2. The epistemological case for epistemic self-reliance 2.1 Mistrust of taking beliefs from others 2.2 Self-reliance and the nature of knowledge: Plato and Locke 2.3 Self-reliance and Cartesian doubt 3. The case from ethics: self-reliance and autonomy 4. Authority and autonomy in the intellectual domain 5. The value of reflective self-consciousness Chapter 2 Epistemic self-trust 1. The natural authority of the self 2. The natural desire for truth and the pre-reflective self 3. The desire for truth and the reflective self 4. Self-trust and the alternatives 5. The conscientious believer and the nature of reasons Chapter 3 Epistemic trust in others 1. Epistemic egoism 2. The need for trust in others 2.1. Why epistemic egoism is unreasonable 2.2. Epistemic egocentrism 3. Trust in others and the two kinds of reasons 3.1 The distinction between deliberative and theoretical reasons 3.2 The two kinds of reasons and parity between self and others 4. Epistemic universalism and common consent arguments Chapter 4 Trust in emotions 1. The rational inescapability of emotional self-trust 2. Trustworthy and untrustworthy emotions 3. Admiration and trust in exemplars 4. Trust in the emotions of others 5. Expanding the range of trust Chapter 5 Trust and epistemic authority 1. Authority in the realm of belief 2. The contours of epistemic authority: the principles of Joseph Raz 3. Pre-emption and evidence 4. The value of truth vs. the value of self-reliance Chapter 6 The authority of testimony 1. Conscientious testimony 2. Testimony and deliberative vs. theoretical reasons 3. Principles of the authority of testimony 4. Testimony as evidence and the authority of testimony 5. The parallel between epistemic and practical authority Chapter 7 Epistemic authority in communities 1. Epistemic authority and the limits of the political model 2. Authority in small communities 2.1 Justifying authority in small communities 2.2 Justifying epistemic authority in small communities 3. Communal epistemic authority 4. The epistemology of imperfection Chapter 8 Moral authority 1. The prima facie case for moral epistemic authority 2. Skepticism about moral authority 2.1 Skepticism about moral truth 2.2 Moral egalitarianism 2.3 Autonomy 3. Moral authority and the limits of testimony 3.1 Emotion and moral belief 3.2 Moral authority and understanding 4. Communal moral authority and conscience Chapter 9 Religious authority 1. Religious epistemic egoism 2. Religious epistemic universalism 3. Believing divine testimony 3.1 Faith and believing persons 3.2 Models of revelation 4. Conscientious belief and religious authority Chapter 10 Trust and disagreement 1. The antinomy of reasonable disagreement 2. Disagreement and deliberative vs. theoretical reasons 3. Self-trust and resolving disagreement 4. Communal epistemic egoism and disagreement between communities Chapter 11 Autonomy 1. The autonomous self 1.1 The norm of conscientious self-reflection 1.2 Autonomy from the inside and the outside 2. Attacks on the possibility of autonomy: Debunking self-trust 3. Epistemic authority from the outside 4. Self-fulfillment Bibliography Index

Abstract: The papers of this special issue have the dual focus of reviewing research, especially clinical trials, testing self-determination theory (SDT) and of discussing the relations between SDT and motivational interviewing (MI). Notably, trials are reviewed that examined interventions either for behaviors such as physical activity and smoking cessation, or for outcomes such as weight loss. Although interventions were based on and intended to test the SDT health-behavior-change model, authors also pointed out that they drew techniques from MI in developing the interventions. The current paper refers to these studies and also clarifies the meaning of autonomy, which is central to SDT and has been shown to be important for effective change. We clarify that the dimension of autonomy versus control is conceptually orthogonal to the dimension of independence versus dependence, and we emphasize that autonomy or volition, not independence, is the important antecedent of effective change. Finally, we point out that SDT and MI have had much in common for each has emphasized autonomy. However, a recent MI article seems to have changed MI's emphasis from autonomy to change talk as the key ingredient for change. We suggest that change talk is likely to be an element of effective change only to the degree that the change talk is autonomously enacted and that practitioners facilitate change talk in an autonomy supportive way.

Abstract: To identify the domains of quality of life important to people with mental health problems. A systematic review of qualitative research undertaken with people with mental health problems using a framework synthesis. We identified six domains: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. Firstly, symptoms or ‘ill-being’ were an intrinsic aspect of quality of life for people with severe mental health problems. Additionally, a good quality of life was characterised by the feeling of being in control (particularly of distressing symptoms), autonomy and choice; a positive self-image; a sense of belonging; engagement in meaningful and enjoyable activities; and feelings of hope and optimism. Conversely, a poor quality life, often experienced by those with severe mental health difficulties, was characterized by feelings of distress; lack of control, choice and autonomy; low self-esteem and confidence; a sense of not being part of society; diminished activity; and a sense of hopelessness and demoralization. Generic measures fail to address the complexity of quality of life measurement and the broad range of domains important to people with mental health problems.

Abstract: The ethics of qualitative research has long been an important topic for methodological reflection and discussion, but in recent years it has also become a prominent part of research methods ‘training’. There are several reasons for its growing salience. One is the fact that developments in bio-medicine stimulated a growth of ethical regulation in the field of health research, which subsequently spread to other areas of social inquiry. This process occurred first in the United States, but has taken place in many other countries as well, and it is a development that has particularly sharp consequences for qualitative research, because the model of inquiry on which regulatory guidelines and arrangements are based is often at odds with that approach. At the same time, the fragmentation of qualitative research into a diverse array of paradigms has generated conflicting attitudes towards what counts as ethical research practice. For instance, on top of older conflicts between those adopting what we might call moralistic versus Machiavellian stances, more recently there has been rejection of ‘liberal’ approaches to research ethics in favour of feminist, child-centred, communitarian and postmodernist ones. Another factor behind the growing concern with ethics has been increased use of the Internet as both a means and a field of qualitative inquiry and the growing use of visual data. These generate some distinctive issues about the nature of research participants, their rights and researchers’ responsibilities towards them. This text has two main aims. One is to explore different perspectives on research ethics and the controversies these raise. Too many discussions of research ethics imply a bland consensus, instead of tackling the sharply conflicting views to be found amongst researchers and among other stakeholders. The aim here is to explore the grounds for these different positions, and to engage with their implications for key aspects of the research process. There is a discussion of different forms of ethical argument - relating to intention, consequences, rights and obligations - drawing on the philosophical literature, given that these lead to potentially very different views on the part of researchers about their responsibilities: as regards to whom are they responsible, and for what. The ethical issues covered include harm, respect for autonomy, exploitation, privacy, and representation. The second aim of the book is to explore the situated character of ethical judgments: that they always take place in, and are affected by, particular contexts; and that very different conclusions may be reached depending upon the circumstances involved, for example the nature of the people being studied, in particular whether they belong to vulnerable or to powerful groups in society. Ethical judgements are examined in relation to: funding arrangements, access negotiations, data collection strategies, and the presentation and dissemination of research findings. In each of these areas, consideration of ethical issues are grounded in discussions of how they arose and were dealt with in particular studies. There is also a chapter dealing with the issue of the control and regulation of research: from contractual obligations, through the development of professional codes, to the surveillance role now being performed by ethics committees within universities and other institutions. The book aims to facilitate critical reflection on ethical issues as these arise both in the course of doing research and in assessing the work of others. Given the way that current developments are forcing ethics up the methodological agenda, this is especially important at the present stage in the development of qualitative research.

Abstract: Recent years have seen the successful development and deployment of a range of small scale renewable energy systems. Driven in part by improving technical capability and by ambitious carbon emissions reduction targets, there has been the beginning of a shift towards a more distributed energy generation model, capable of delivering a range of potential benefits, but also presenting a number of social and technical challenges. One area of society where the benefits can be seen as being both highly applicable and highly relevant is at the community level and at this scale in particular, increased levels of energy autonomy can deliver a host of social, financial and environmental benefits. Therefore, the concept of energy autonomy is widely regarded as an effective tool in the push towards sustainable development, with ‘sustainable communities' often highlighted as particularly relevant for applying its principles. Given its significance and its broad interdisciplinary relevance, the issue, and the challenges it poses, has been the subject of a significant level of research interest in recent years. This study therefore presents a state of the art review of current research relating to energy autonomy in sustainable communities and identifies a number of central issues which are regarded as being of critical importance. Demand Side Management is identified as one particular area in need of further research and development, along with the need for receptive social, political and regulatory environments.

Abstract: Background Discretionary autonomy is a key factor in enhanced patient outcomes and nurses’ work satisfaction. Among nurses,insufficient autonomy can result in moral distress. Objectives To explore levels of autonomy among European critical care nurses and potential associations of autonomy with nurse-physician collaboration, moral distress, and nurses’characteristics. By Elizabeth D.E. Papathanassoglou, RN, MSc, PhD, Maria N. K. Karanikola, RN, MSc, PhD, Maria Kalafati, RN, MSc, PhD, Margarita Giannakopoulou, RN, PhD, Chrysoula Lemonidou, RN, MSc, PhD, and John W. Albarran, RN, MSc, DPhil Methods Descriptive correlational study of a convenience sample of 255 delegates attending a major European critical care conference in 2009. Respondents completed a selfadministered questionnaire with validated scales for nurses’autonomy, nurse-physician collaboration, and moral distress. Results The mean autonomy score (84.26; SD, 11.7; range, 18-108) and the mean composite (frequency and intensity) moral distress score (73.67; SD, 39.19; range, 0-336) were both moderate. The mean collaboration score was 47.85 (SD, 11.63; range, 7-70). Italian and Greek nurses reported significantly lower nurse-physician collaboration than did other nurses (P < .001). Greek and German nurses reported significantly higher moral distress (P < .001). Autonomy scores were associated with nurse-physician collaboration scores (P < .001) and with a higher frequency of moral distress (P = .04). Associations were noted between autonomy and work satisfaction (P = .001). Frequency of moral distress was associated inversely with collaboration (r = -0.339; P < .001) and autonomy (r = -0.210; P = .01) and positively with intention to quit (r = 0.257; P = .004). Conclusions In this sample of European intensive care nurses, lower autonomy was associated with increased frequency and intensity of moral distress and lower levels of nurse-physician collaboration. (American Journal of Critical Care. 2012;21(2):e41-e52)

Abstract: Most studies in the economics discourse argue that the impact of self-employment on job satisfaction is mediated by greater procedural freedom and autonomy. Values and personality traits are considered less likely to explain the utility difference between self-employed and salaried workers. Psychology scholars suggest that entrepreneurial satisfaction also depends, at least in part, on specific values and personality traits. Utilising a large dataset derived from the 2006 European Social Survey, this study performs a complementary analysis by taking personality traits, personal values and indicators for workers’ autonomy explicitly into account. The empirical findings add further strength to economists’ argument that, net of values and personality traits, autonomy and independence are the mechanisms by which self-employment leads to higher levels of job satisfaction. These results hold true for both male and female sub-samples even when a multitude of socio-demographic characteristics, personal values and personality traits are controlled for.

Abstract: Motivational interviewing (MI) is indeed a "bottom-up" model that emerged from practical experience in the field of alcohol treatment. The original description of MI [1] suggested some links to social psychological theories, but focused on an intuitive approach in treating alcohol problems for which there was at the time no empirical support. Our subsequent volumes [2,3] have similarly focused on clinical applications without proposing an underlying theory of treatment or change. In part this reflects our own temperaments, preferring intuitive to rational-deductive ways of knowing [4,5], with a focus on the "real" world of clinical practice. We are "bottom-up" people. Much of what we have done in our careers has sprung from efforts to deal with practical problems that clinicians encounter in their daily work [6]. The world of academia, in contrast, tends to place a high premium on starting from coherent theory and rationally deriving hypotheses that will be tested to either confirm or revise the theory. This has simply never been a forte or primary scientific interest for either of us, to the dismay of some of our mentors and colleagues. We have preferred instead to move between the context of discovery and the context of justification [7] - deriving intuitive hypotheses from clinical experience, submitting them to the verification of scientific method, and then going back to the drawing board to try again. Over time, this approach may lead to the development of a higher-order theory as a byproduct [8]. The rigor of scientific method is equally important in both approaches. They differ in the source of hypotheses: intuitive experience versus rational deduction from a pre-existing theory. Both approaches have value and a long tradition in the history of science. Whether either one is in some sense superior to the other is a value judgment that we do not wish to make. The history of MI, however, does suggest potential value in beginning from clinical intuition. A large evidence base comprising more than 200 randomized clinical trials has emerged, showing positive effects (albeit inconsistent) across many health problem areas. Well before this evidence base accumulated, however, MI disseminated readily and rapidly by word of mouth among clinicians, who are drawn to it not just from the clinical trials but because, for the lack of a better term, they seem to "recognize" it. It feels intuitively sound based on their own experience. This kind of practice-based evidence is also important, and needs to be compared, tested and refined with clinical trials. Hall [9] suggested a similar two-way street in psychotherapy research with cultural minorities. Evidence-based treatments are worth trying in populations where they have not yet been tested [10], and there is also a need for scientific study of the intuitive interventions that have arisen from an indigenous culture's own wisdom and experience. So what about Self-Determination Theory (SDT) that grew up independently from MI, but bears a certain family resemblance? There may be a natural fit [11]. MI has lacked a well-developed theory to rationalize its efficacy. SDT has focused less on refining specific clinical procedures for putting it into practice. A marriage may be premature, but the flirtation is not. The three human hungers emphasized in SDT - autonomy, relatedness, and competence - are all directly addressed in MI. More than most psychotherapies, MI assumes, respects, and implicitly relies on volition to instigate self-regulation [12]. The emerging psycholinguistic "mechanisms" of MI [8,13,14] can be linked to the more general development of volition and self-regulation through language [15]. The relational component of MI also appears to be important [8], consistent with SDT. Supporting autonomy is a key element in the underlying spirit of MI. SDT and MI, it would seem, have much to learn from each other. SDT also holds promise for improving our understanding of MI. A puzzling aspect in MI clinical research is the inconsistency of its outcomes. There are many positive trials, but also an impressive number of negative trials, including some of our own [16]. SDT may help to clarify the conditions that contribute to the effectiveness of MI in practice. MI has been faulted for underemphasizing social context [17], a factor that is clearly integrated in SDT, and a well-supported theory never hurts the academic credibility of any psychotherapy. Is SDT more than just another pair of theoretical glasses through which to view the phenomena of MI? Will SDT lead to unique testable hypotheses that teach us important things about MI that we didn't already know? It remains to be seen. We do not propose to develop such a systematic integration ourselves, but we gladly offer our support to those whose aptitudes and inclinations lie in this direction.

Abstract: antoinette bargagliotti l. (2012) Work engagement in nursing: a concept analysis. Journal of Advanced Nursing68(6), 1414–1428. Abstract Aim. This article is a report of an analysis of the concept of work engagement. Background. Work engagement is the central issue for 21st century professionals and specifically for registered nurses. Conceptual clarity about work engagement gives empirical direction for future research and a theoretical underpinning for the myriad studies about nurses and their work environment. Method. Walker and Avant’s method of concept analysis was used. Nursing, business, psychology and health sciences databases were searched using Science Direct, CINAHL, OVID, Academic One File, ABI INFORM and PsycINFO for publications that were: written in English, published between 1990 and 2010, and described or studied work engagement in any setting with any population. Results. Work engagement is a positive, fulfilling state of mind about work that is characterized by vigour, dedication and absorption. Trust (organizationally, managerially and collegially) and autonomy are the antecedents of work engagement. The outcomes of nurses’ work engagement are higher levels of personal initiative that are contagious, decreased hospital mortality rates and significantly higher financial profitability of organizations. Conclusion. When work engagement is conceptually removed from a transactional job demands-resources model, the relational antecedents of trust and autonomy have greater explanatory power for work engagement in nurses. Untangling the antecedents, attributes and outcomes of work engagement is important to future research efforts.

Abstract: This chapter focuses on seven practices of autonomy support which are likely to promote two major components of the need for autonomy: (a) lack of coercion and optional choice and (b) formation and realization of an inner compass: authentic, direction-giving values, goals, and interests. A special emphasis is put on research pertaining to three autonomy supportive practices which are assumed to support formation and realization of authentic, direction-giving values, goals, and interests, whose impact on perceived autonomy was not sufficiently examined so far: (a) IVD – intrinsic value demonstration, (b) SVE – support for value/goal/interest examination, and (c) FIV – fostering inner-directed valuing processes. The autonomy supportive practices that foster the development of stable authentic values and goals might be especially important in western countries, in which postmodern moral relativism and the abundance of information and options make it particularly difficult for youth to form stable and authentic values and goals.

Abstract: In the present study, we focus on the concept of adolescent autonomy and its relation with psychosocial functioning. Specifically, we aim to differentiate between 2 prevailing conceptualizations of autonomy, that is, (a) autonomy defined as independence versus dependence and (b) autonomy defined as self-endorsed versus controlled functioning. A 2nd goal is to examine the relative contribution of each autonomy operationalization in the prediction of adolescents' adjustment (i.e., well-being, problem behavior, and intimacy). Data were gathered in a sample of 707 Belgian adolescents. Using a newly developed questionnaire, we assessed both the degree of independent decision making per se and the self-endorsed versus controlled motives underlying both independent and dependent decision making. The degree of independent decision making could clearly be differentiated from the underlying motives for doing so. Moreover, independent decision making as such showed unique associations with more problem behavior. Further, as expected, self-endorsed motives for both independent and dependent decision making generally related to an adaptive pattern of psychosocial functioning, and controlled motives were associated with maladjustment. The discussion focuses on the difference between the 2 perspectives on autonomy and on the different meaning of the motives underlying independent, relative to dependent, decision making.

Abstract: — Autonomy and relatedness are considered basic human needs that manifest differently in different cultural environments in response to contextual demands. This article conceptualizes 3 types of cultural environments—prototypical Western, urban, middle-class families; prototypical rural, subsistence-based farming families; and a hybrid milieu of urban middle-class families from non-Western environments—and proposes that autonomy and relatedness have different meanings in each type. In contexts in which individuals have a high degree of formal education (Western and non-Western middle-class families), there is an emphasis on inner states and mental representations. Western middle-class families focus on separate individuals; non-Western middle-class families focus on the family as a social unit. In contexts in which individuals have a low degree of formal education, there is a primary emphasis on social responsibilities. Different socialization strategies support adaptive frameworks in each of the 3 types of contexts: individual psychological autonomy in Western middle-class families, communal psychological autonomy in non-Western middle-class families, and action autonomy in subsistence-based farming families. All conceptions of autonomy and relatedness can be considered as universal competencies, yet they are differently emphasized in different cultural milieus due to differing contextual demands.

Abstract: The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care. This study tests whether these principles can be quantitatively measured on an individual level, and then subsequently if they are used in the decision making process when individuals are faced with ethical dilemmas. The Analytic Hierarchy Process was used as a tool for the measurement of the principles. Four scenarios, which involved conflicts between the medical ethical principles, were presented to participants who then made judgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if they were in the situation. Individual preferences for these medical ethical principles can be measured using the Analytic Hierarchy Process. This technique provides a useful tool in which to highlight individual medical ethical values. On average, individuals have a significant preference for non-maleficence over the other principles, however, and perhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specific ethical dilemmas. People state they value these medical ethical principles but they do not actually seem to use them directly in the decision making process. The reasons for this are explained through the lack of a behavioural model to account for the relevant situational factors not captured by the principles. The limitations of the principles in predicting ethical decision making are discussed.

Abstract: Previous studies show that supervisors’ autonomy-supportive style predicts greater psychological health (Baard et al. in J Appl Soc Psychol 34:2045–2068, 2004; Blais and Briere 1992; Lynch et al. in Prof Psychol Res Pract 36:415–425, 2005) and lower psychological distress (Deci et al. in Personal Soc Psychol Bull 27:930–942, 2001). The goal of the present study is to extend these results and investigate the contribution of colleagues’ perceived autonomy support in the prediction of health professionals’ work satisfaction and psychological health. The combined impact of supervisors’ and colleagues’ perceived autonomy support is also examined. A sample of 597 health professionals from the province of Quebec (Canada) completed a questionnaire, which included measures of perceived supervisors’ and colleagues’ autonomy support and outcome variables. Results confirm that supervisors’ and colleagues’ perceived autonomy support predict health professionals’ work satisfaction and psychological health. Results also show that colleagues’ perceived autonomy support adds to the prediction of health professionals’ work satisfaction, subjective well-being, and suicidal ideation above and beyond supervisors’ perceived autonomy support.

Abstract: In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter.

Abstract: A key challenge for contemporary democratic societies is how to respond to disasters in ways that foster just and sustainable outcomes that build resilience, respect human rights, and foster economic, social, and cultural well-being in reasonable timeframes and at reasonable costs. In many places experiencing rapid environmental change, indigenous people continue to exercise some level of self-governance and autonomy, but they also face the burden of rapid social change and hostile or ambiguous policy settings. Drawing largely on experience in northern Australia, this paper argues that state policies can compound and contribute to vulnerability of indigenous groups to both natural and policy-driven disasters in many places. State-sponsored programmes that fail to respect indigenous rights and fail to acknowledge the relevance of indigenous knowledge to both social and environmental recovery entrench patterns of racialised disadvantage and marginalisation and set in train future vulnerabilities and disasters. The paper advocates an approach to risk assessment, preparation, and recovery that prioritises partnerships based on recognition, respect, and explicit commitment to justice. The alternatives are to continue prioritising short-term expediencies and opportunistic pursuit of integration, or subverting indigenous rights and the knowledge systems that underpin them. This paper argues such alternatives are not only unethical, but also ineffective.

Abstract: Prior research highlights the mismatch between adolescents' growing capacities for autonomy and the limited opportunities for influence in U.S. secondary schools. Youth-led participatory research (YPAR), an approach in which young people research and advocate for change on problems of concern to them, could increase students' autonomy in secondary schools. This qualitative study of YPAR examined whether and how the intervention meaningfully affected the interactions and roles of students and adults in two distinctive urban high school settings, identifying concepts for further empirical investigation. Results suggested that YPAR enabled processes of student professionalization that led to novel student-adult “collegial” interactions, expansion of domains of student influence, and diversification of students with opportunities to influence policies and practices across these two schools.

Abstract: In the past 50 years, a marked reduction has occurred in European and North American children's freedom of movement and outdoor play. Using a structural equation model, the present study investigates the interaction between personal, environmental, and psychosocial factors that affect children's independent mobility. The study involved 313 mothers of 8–10-year-old Italian children. The results supported the hypothesized model: the age of the child, the maternal perception of social danger, and positive potentiality of outdoor autonomy were the most influential variables on children's independent mobility, measured as an index. Further, the maternal perceptions mediated the influence of the other demographic, psychosocial, and environmental variables on independent mobility.

Abstract: Standard, familiar models portray harms and benefits as symmetrical. Usually, harm is portrayed as involving a worsening of one's situation, and benefits as involving an improvement. Yet morally, the aversion, prevention, and relief of harms seem, at least presumptively, to matter more than the provision, protection, and maintenance of comparable and often greater benefits. Standard models of harms and benefits have difficulty acknowledging this priority, much less explaining it. They also fail to identify harm accurately and reliably. In this paper, I develop these problems, argue that we should reconsider our commitment to the standard models, and then merely gesture at the direction in which we might locate a superior approach, one that better accounts for the moral significance of harm and its relation to autonomy rights.

Abstract: There are important benefits to including adults with intellectual disabilities in research. Calls for their increased partici- pation in research co-occur with notable discussion about how to conduct ethically strong research with adults with intellectual disabilities, a population widely considered vulnerable in the context of research. The authors systematically researched the peer- reviewed literature on ethical practices in research with adults with intellectual disabilities to identify and analyze conceptually and empirically supported ethical approaches to research in the area of research with adults with intellectual disabilities. They conducted a thematic analysis of the 37 articles that met inclusion criteria. They identified three overarching themes: (1) guiding frameworks and approaches; (2) strategies to promote accountability to ethics; and (3) making decisions about participation, including considerations for coercion, capacity to consent, surrogate decision-making, and promoting understanding. From the review, they noted diverse recommendations for ethical research practices, characterized by a lack of consensus, entrenched tensions in value orientations, and gaps in knowledge and practice. Attention to promising strands of scholarship that emphasize attention to strengths, autonomy, dignity of risk, and a contextually based framing of consent capacity may be particularly fruitful. Similarly, bringing to the forefront the role of accommodations in promoting participation, systematically studying diverse ethical aspects of research, and identifying and considering the perspectives of persons with intellectual disabilities may represent critical next steps. They suggest that research collaborations between academics and persons with intellectual disabilities present opportunities to further strengthen the ethical integrity of research in the field. A video abstract of this article can be viewed at http://youtu.be/5Oqx02Aw3xs.