Informed consent and the use of placebo in poland: Ethical and legal aspects

The concept of informed consent was one of the most fruitful ideas that deeply changed the relationships between physicians and their patients from paternalism to respect for the personal autonomy of subjects needing professional medical care. The great progress in medicine, also involving the pharmaceutical industry, has created an increasing need to perform different clinical and experimental trials. The evolution of clinical research in the last decades has influenced strongly the design of these studies. One of the most important changes in this field has been the use of placebo groups in double-blind controlled studies. The controversies have involved not only the use of placebo when standard or proven treatment was available, but also some specific problems concerning the procedure of obtaining informed consent in such trials. This paper briefly presents the evolution of informed consent in Poland as well as different ethical and legal problems concerning informed consent and the use of placebo controls in clinical trials. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Narrating survival and change in Guatemala and South Africa: the politics of representation and a liberatory community psychology

Peace accords and international interventions have contributed to the suspension of armed conflict and the censuring of repressive regimes in many parts of the world. Some governments and their opposition parties have agreed to the establishment of commissions or other bodies designed to create historical records of the violations of human rights and foster conditions that facilitate reparatory and reconciliatory processes. This paper explores selected roles that community psychologists have played in this process of remembering the past and constructing new identities towards creating a more just future. With reference to two community groups (in Guatemala and South Africa) we show how efforts to speak out about one's own experiences of political and military repression involve complex representational politics that go beyond the simple binary opposition of silencing versus giving voice. The Guatemalan group consisted of Mayan Ixil women who, together with the first author, used participatory action research and the PhotoVoice technique to produce a book about their past and present struggles. The South African group, working within the ambit of the Truth and Reconciliation Commission and in collaboration with the third author and others, explored ways of speaking about their roles in apartheid and post-apartheid society. Although both these initiatives can be seen as moments in on-going struggles to overcome externally-imposed repressive practices that censor the voices of marginalized communities, they also serve to dispel overly romanticized notions of univocal communities now liberated to express themselves in an unmediated and unequivocal fashion. The paper discusses how each group of women instead entered into subtly nuanced relationships with community psychologists involving a continual interplay between the authenticity of their self-representational accounts and the requirements of the discursive technologies into which they were being inducted and the material conditions within their sites of struggle. In both cases the group's agenda also evolved over time, so that what emerged was not so much a particular account of themselves, or even the development of a particular voice for speaking about themselves, but an unfolding process—for the groups and for the community psychologists who accompanied them—of becoming active players in the postmodern, mediated world of self-representational politics and social struggle.     

Tribal Participatory Research: Mechanisms of a Collaborative Model

Although much social science research has been conducted within American Indian and Alaska Native (AIAN) communities, relatively little research has been conducted by or for those communities. We describe an approach that facilitates the active involvement of AIAN communities in the research process, from conceptualizing the issues to be investigated to developing a research design, and from collecting, analyzing, and interpreting the data to disseminating the results. The Tribal Participatory Research (TPR) approach is consistent with recent developments in psychology that emphasize the inclusion of community members and the social construction of knowledge. We describe the foundations of the approach and present specific mechanisms that can be employed in collaborations between researchers and AIAN communities. We conclude with a discussion of the implications of the use of TPR regarding project timelines and budgets, interpretation of the data, and ultimately the relationships between tribes and researchers.     

In Defense of Individualism

This paper offers a programmatic philosophical articulation of moral and political individualism. This individualism consists of two main components: value individualism and rights individualism. The former is the view that, for each individual, the end which is of ultimate value is his own well-being. Each individual's well-being has ultimate agent-relative value and the only ultimate values are these agent-relative values. The latter view is that individuals possess moral jurisdiction over themselves, i.e., rights of self-ownership. These rights (along with other rights individuals may come to possess) constrain the manner in which agents may pursue value. For this reason, the articulated individualism is an constrained individualism. Sketches of arguments are offered for both value and rights individualism. And it is argued that the sole legitimate function of legal/political institutions is to further delineate and protect the rights of individuals. However, the paper is also concerned to indicate why this radical moral and political individualism does not have many of the features or implications that are commonly ascribed to it. In this connection, I seek to show how this social doctrine accords with individuals' having concern for the well-being of others, with the emergence of relationships among individuals that have both instrumental and non-instrumental value, with a degree of responsibility for self and others that is often thought to be antithetical to individualism and, in general, with a flourishing of civil order.     

Young Indigenous Australians' Sexually Transmitted Infection Prevention Practices: A Community‐based Participatory Research Project

National surveillance data indicate marked differences between Indigenous and other Australians in the prevalence of many sexually transmitted infections (STIs). Young Indigenous people bear a particularly high burden of these infections. A collaboration of university researchers, Indigenous health workers and young Indigenous people conducted 45 field interviews to examine how young Indigenous Australians keep themselves healthy and protected against STIs. Our findings emphasise the complexity of health behaviours, where individuals are rarely always ‘risky’ or always ‘safe’, as well as subtle gender differences in health practices. Preventive strategies employed by the young people were contingent on beliefs and knowledge about sexual partners, the type of relationship, the context of the sexual encounter and access to condoms. Tangible strengths such as young Indigenous people's commitments to condoms and STI screening should be celebrated and bolstered to enhance their ability to protect themselves against adverse health outcomes and enhance their resilience against STIs. Focusing on strengths helps to counter the deficit model of health commonly deployed in Indigenous health research and draws attention to health issues facing young Indigenous people and their communities, without reinforcing negative stereotypes or focusing solely on individual risk behaviour. We provide concrete recommendations for health promotion and education. Copyright © 2011 John Wiley & Sons, Ltd.     

“Loving Nature” Nature’s Way: Exploring Radical Participation With Nature Through the Metaphor of Complex,Dynamic Self-Systems

The Western metaphor of self-as-identity—as a static, inherently exclusive entity—has been instrumental, historically, to our radical separation from nature, and still hampers a reviving of genuine participation with nature. Suggesting an alternative to this metaphor (informed by literacy as technology), I explore the more nature-informed metaphor of dynamic, complex self-systems, involving both natural and human subsystems. Through this latter metaphor, I re-vision radical participation with nature: in the process of perception, in epistemology/ontology, and in the ways of indigenous, oral cultures. This systems metaphor also sheds contrasting light on literacy-informed, Western ways.     

Social and political perspectives on the psychotherapy and counselling profession: Returning caravelles

The counselling and psychotherapy profession is changing. For the first time in its history, it has begun to receive substantial Government funding in the UK and it also has to contend with the principles of evidence-based practice and the policies of the New Public Management systems in many countries. This paper argues that such recent developments present challenges to the profession’s historical apolitical standpoint. More importantly, it argues that the present social and political climate offers many opportunities such as the possibility of learning from psychosocial practices in other countries. The paper will look, in particular, at what can be learned from Latin America and India where mental health care and psychological therapy have adopted grassroots involvement, health-focused approaches and innovatory therapeutic methods.     

Normative Ethics after Pragmatic Naturalism

Philip Kitcher presents an ambitious account of pragmatic naturalism that incorporates an explanatory story of the emergence and development of ethics, a metaethical perspective on progress, and a normative stance for moral theorizing. This article contends that Kitcher's normative stance is incompatible with the explanatory and metaethical components of his project. Instead, pragmatic naturalists should endorse a normative ethics that is experimental, grounded in practice, and acutely aware of cognitive and informational limitations. In particular, the ethical project would benefit from endorsing empirical work on participatory democracy for the identification of mechanisms to guide us on deep moral conflicts.     

Indigenizing CBPR: Evaluation of a Community-Based and Participatory Research Process Implementation of the Elluam Tungiinun (Towards Wellness) Program in Alaska

The process that community based participatory research (CBPR) implementation takes in indigenous community contexts has serious implications for health intervention outcomes and sustainability. An evaluation of the Elluam Tungiinun (Towards Wellness) Project aimed to explore the experience of a Yup'ik Alaska Native community engaged within a CBPR process and describe the effects of CBPR process implementation from an indigenous community member perspective. CBPR is acknowledged as an effective strategy for engaging American Indian and Alaska Native communities in research process, but we still know very little about the experience from a local, community member perspective. What are the perceived outcomes of participation in CBPR from a local, community member perspective? Qualitative methods were used to elicit community member perspectives of participation in a CBPR process engaged with one Yup'ik community in southwest Alaska. Results focus on community member perceptions of CBPR implementation, involvement in the process and partnership, ownership of the project with outcomes observed and perceived at the community, family and individual levels, and challenges. A discussion of findings demonstrates how ownership of the intervention arose from a translational and indigenizing process initiated by the community that was supported and enhanced through the implementation of CBPR. Community member perspectives of their participation in the research reveal important process points that stand to contribute meaningfully to implementation science for interventions developed by and for indigenous and other minority and culturally diverse peoples.     

Collaborative Measurement Development as a Tool in CBPR: Measurement Development and Adaptation within the Cultures of Communities

This paper describes the processes we engaged into develop a measurement protocol used to assess the outcomes in a community based suicide and alcohol abuse prevention project with two Alaska Native communities. While the literature on community-based participatory research (CBPR) is substantial regarding the importance of collaborations, few studies have reported on this collaboration in the process of developing measures to assess CBPR projects. We first tell a story of the processes around the standard issues of doing cross-cultural work on measurement development related to areas of equivalence. A second story is provided that highlights how community differences within the same cultural group can affect both the process and content of culturally relevant measurement selection, adaptation, and development.