Due Care, Not Prohibition of Expert Opinions

The scientific foundation for clinicians' opinions in child custody cases is weak, but it is both unnecessary and undesirable to exclude mental health professionals from the legal process. Avoidance of ultimate-issue opinions obviates the problems involved in expert testimony in the context of a limited research base and an ambiguous and value-laden legal standard. Psychologists may be able to contribute to legal policy-making about child custody standards, but the proper forum for doing so is probably the legislature. Even in that context, it is not clear that mental health professionals should have special standing in the public debate.     

Choices and voices: a case study of a self-advocacy group

This paper reports on one part of a study which examined the exercise of choice by adults with learning difficulties: a case study of a Members' Council within a “flagship” resource centre. The Council was a self-advocacy group set up to represent members' interests and offer advice to centre management about aspects of service delivery. Fourteen meetings of the Members' Council were tape-recorded, and interviews conducted with 12 individual members and five professionals. The members' ability to exercise choice was closely related to issues of power and control on several levels, with potential points of tension being identified. These included the contribution of different parties to constructing the agenda, the balance between “domestic” and “external” interests and the challenge to democratic decision-making arising from the differing personalities and abilities represented in the group. Certain “parameters” of choice-making had been set out by centre management, with four categories of issue emerging from the data, in relation to which the council had varying degrees of autonomy. A particular strength of the council was its independent adviser, who was skilled in achieving a delicate balance between supporting people in making informed choices without exerting undue influence. Professionals were agreed that the process of choice-making was more important than outcome, but had different views about how best to facilitate it. Both “proactive” and “non-interventionist” approaches, if taken too far, run the risk of disabling peoples' own ability to exercise choice. In the members' view outcomes, in the form of tangible achievements, were at least as important as process. In conclusion, a significant tension is identified between structure and process for “in-house” groups, indicating that while people can make important “developmental” gains from self-advocacy, “instrumental” achievements are likely to be constrained for service-based groups.     

A community based model providing services for deaf and deaf-blind victims of sexual assault and domestic violence

Deaf and Deaf-Blind women and children are at risk of being long term victims of sexual assault and domestic violence without culturally and linguistically relevant services. While Deaf and Deaf-Blind victim issues do not differ significantly from the mainstream population, relevant and accessible services have not traditionally been available to the Deaf and Deaf-Blind communities. This article proposes a strategy for providing such services based on a model developed by the only Deaf-run agency in the United States.     

A critical review of the arguments debating the role of the nurse advocate

AIMS OF THE PAPER: This paper critically reviews the arguments for and against undertaking the role of nurse advocate. BACKGROUND: Advocacy has become a popular concept in nursing literature over the past two decades. By addressing issues of power and accountability, conclusions are drawn about the risks facing nurses who would practice patient advocacy. METHODS: Review and analysis of theoretical debate. RESULTS: Empirical evidence is sparse and philosophical arguments predominate in the field of patient advocacy. Humanistic arguments that promote advocacy as a moral imperative are compelling. However, in reality nurses appear to lack the power base to comply except by covert means. Informed consent with a knowledge of the consequences of undertaking such an intervention is as relevant to the nurse as it is to the patient. CONCLUSION: Nurses need to be empowered first, if they are to empower their patients. There may however, be more suitable candidates for the role of patient advocate and nurses should recognize that they do not have a monopoly on ethical decision making.     

A Mixed-Methods Exploration of the Role and Impact of Stigma and Advocacy on Substance Use Disorder Recovery

Obstacles to intrapersonal and interpersonal growth, due to stigma and discrimination, may constitute a significant challenge to those in recovery. Engaging in recovery-related advocacy may serve as a buffer to the experience of stigma and discrimination. The purpose of this pilot study is to examine whether the perception of stigmatization is associated with common recovery measures such as recovery capital, self-esteem, and self-efficacy, as well as to explore the role of advocacy for individuals in recovery through thematic analysis. Statistically significant results suggest that individuals who believe they are stigmatized have less recovery capital and self-esteem than those who do not hold this belief. Several major themes related to the overall impact, perceived benefits, and perceived harms of engaging in advocacy emerged from the thematic analysis such as reduction in stigma, improving soft skills, service to others, and reduced ability to engage in self-care. Findings suggest that individuals who believe they are stigmatized have lower functional outcomes (recovery capital and self-esteem) and mitigating these effects may be important for future recovery success. Additionally, thematic results suggest that engaging in recovery related advocacy offers a multitude of potential benefits and positive impacts, but also may have important potential harms to consider.     

Abortion and politics in Mexico: ‘context is all’

A strong collective pro-choice mentality was recently manifested in Mexico when a legislative initiative to revoke the legal right ofrape survivor to abortion in the state of Guanajuato awakened national indignation. Pro-choice values were expressed in public opinion with such force that it sparked off the passage of liberalising law reforms in Mexico City and the state of Morelos. In this paper we trace the development of these manifestations of pro-choice views, beginning with the Democratic Revolution Party's (PRD) refusal in 1999 to modify abortion legislation within the context of penal code reform, and moving through the events surrounding the Guanajuato reform, and the pro-choice response of Mexico City and Morelos legislators. This analysis allows us to recognise the emergence of a pro-choice consciousness and to understand that when it comes to abortion, ‘context is all’.