10 resultados para Assisted suicide, religious beliefs, end-of-life decision-making, suffering and Christianity.

em Helda - Digital Repository of University of Helsinki


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The dissertation examines the role of the EU courts in new governance. New governance has raised unprecedented interest in the EU in recent years. This is manifested in a plethora of instruments and actors at various levels that challenge more traditional forms of command-and-control regulation. New governance and political experimentation more generally is thought to sap the ability of the EU judiciary to monitor and review these experiments. The exclusion of the courts is then seen to add to the legitimacy problem of new governance. The starting point of this dissertation is the observation that the marginalised role of the courts is based on theoretical and empirical assumptions which invite scrutiny. The theoretical framework of the dissertation is deliberative democracy and democratic experimentalism. The analysis of deliberative democracy is sustained by an attempt to apply theoretical concepts to three distinctive examples of governance in the EU. These are the EU Sustainable Development Strategy, the European Chemicals Agency, and the Common Implementation Strategy for the Water Framework Directive. The case studies show numerous disincentives and barriers to judicial review. Among these are questions of the role of courts in shaping governance frameworks, the reviewability of science-based measures, the standing of individuals before the courts, and the justiciability of soft law. The dissertation analyses the conditions of judicial review in each governance environment and proposes improvements. From a more theoretical standpoint it could be said that each case study presents a governance regime which builds on legislation that lays out major (guide)lines but leaves details to be filled out at a later stage. Specification of detailed standards takes place through collaborative networks comprising members from national administrations, NGOs, and the Commission. Viewed this way, deliberative problem-solving is needed to bring people together to clarify, elaborate, and revise largely abstract and general norms in order to resolve concrete and specific problems and to make law applicable and enforceable. The dissertation draws attention to the potential of peer review included there and its profound consequences for judicial accountability structures. It is argued that without this kind of ongoing and dynamic peer review of accountability in governance frameworks, judicial review of new governance is difficult and in some cases impossible. This claim has implications for how we understand the concept of soft law, the role of the courts, participation rights, and the legitimacy of governance measures more generally. The experimentalist architecture of judicial decision-making relies upon a wide variety of actors to provide conditions for legitimate and efficient review.

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The dissertation examines Roman provincial administration and the phenomenon of territorial reorganisations of provinces during the Imperial period with special emphasis on the provinces of Arabia and Palaestina during the Later Roman period, i.e., from Diocletian (r. 284 305) to the accession of Phocas (602), in the light of imperial decision-making. Provinces were the basic unit of Roman rule, for centuries the only level of administration that existed between the emperor and the cities of the Empire. The significance of the territorial reorganisations that the provinces were subjected to during the Imperial period is thus of special interest. The approach to the phenomenon is threefold: firstly, attention is paid to the nature and constraints of the Roman system of provincial administration. Secondly, the phenomenon of territorial reorganisations is analysed on the macro-scale, and thirdly, a case study concerning the reorganisations of the provinces of Arabia and Palaestina is conducted. The study of the mechanisms of decision-making provides a foundation through which the collected data of all known major territorial reorganisations is interpreted. The data concerning reorganisations is also subjected to qualitative comparative analysis that provides a new perspective to the data in the form of statistical analysis that is sensitive to the complexities of individual cases. This analysis of imperial decision-making is based on a timeframe stretching from Augustus (r. 30 BC AD 14) to the accession of Phocas (602). The study identifies five distinct phases in the use of territorial reorganisations of the provinces. From Diocletian s reign there is a clear normative change that made territorial reorganisations a regular tool of administration for the decision-making elite for addressing a wide variety of qualitatively different concerns. From the beginning of the fifth century the use of territorial reorganisations rapidly diminishes. The two primary reasons for the decline in the use of reorganisations were the solidification of ecclesiastical power and interests connected to the extent of provinces, and the decline of the dioceses. The case study of Palaestina and Arabia identifies seven different territorial reorganisations from Diocletian to Phocas. Their existence not only testifies to wider imperial policies, but also shows sensitivity to local conditions and corresponds with the general picture of provincial reorganisations. The territorial reorganisations of the provinces reflect the proactive control of the Roman decision-making elite. The importance of reorganisations should be recognised more clearly as part of the normal imperial administration of the provinces and especially reflecting the functioning of dioceses.

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In this study I discuss G. W. Leibniz's (1646-1716) views on rational decision-making from the standpoint of both God and man. The Divine decision takes place within creation, as God freely chooses the best from an infinite number of possible worlds. While God's choice is based on absolutely certain knowledge, human decisions on practical matters are mostly based on uncertain knowledge. However, in many respects they could be regarded as analogous in more complicated situations. In addition to giving an overview of the divine decision-making and discussing critically the criteria God favours in his choice, I provide an account of Leibniz's views on human deliberation, which includes some new ideas. One of these concerns is the importance of estimating probabilities in making decisions one estimates both the goodness of the act itself and its consequences as far as the desired good is concerned. Another idea is related to the plurality of goods in complicated decisions and the competition this may provoke. Thirdly, heuristic models are used to sketch situations under deliberation in order to help in making the decision. Combining the views of Marcelo Dascal, Jaakko Hintikka and Simo Knuuttila, I argue that Leibniz applied two kinds of models of rational decision-making to practical controversies, often without explicating the details. The more simple, traditional pair of scales model is best suited to cases in which one has to decide for or against some option, or to distribute goods among parties and strive for a compromise. What may be of more help in more complicated deliberations is the novel vectorial model, which is an instance of the general mathematical doctrine of the calculus of variations. To illustrate this distinction, I discuss some cases in which he apparently applied these models in different kinds of situation. These examples support the view that the models had a systematic value in his theory of practical rationality.

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Previous empirical research has shown that positive, i.e. salutogenic, psychological resources and social support, have health-promoting effects in stressful life situations. In the present study the associations between sense of coherence (SOC), dispositional optimism, partner support, psychological distress, and quality of life among cancer patients and their partners were examined. The data was collected from Helsinki University Central Hospital in 1997 2000 by self-report questionnaires approximately 2, 8, and 14 months post diagnosis. Participants in studies I-IV were 155, 123, 153, and 147 cancer patients and their partners, respectively. The sample of the present study consisted of physically relatively well-functioning patients, whose overall psychological wellbeing was generally good as compared to the healthy population. Partners in this study, however, reacted more strongly to their partners illness and treatment. The partners displayed e.g. higher levels of anxiety and depression than the patients. The results of this study indicated that cancer patients and their partners with strong SOC and who are optimistic report fewer symptoms of distress. Moreover, patients who display an optimistic attitude to life, who receive support from their partner, and who control how they express anger have a better quality of life. The findings also confirmed that the role of the partner is significant in coping with cancer. The symptoms of depression and anxiety in patients and partners were associated, and the partner s optimism seemed to protect also the patient from elevated levels of anxiety. The role of the partner was also highlighted in the couples anger-expression styles. The patients and partners tendency to inhibit anger was associated with decreased partner support and worse patient quality of life. Finally, in the present study we found substantial gender differences. For the patients, partner support was more significant for the women than for the men. Furthermore, for the female patients, the husband s tendency to openly express anger (anger-out) had a negative impact on their psychological quality of life, whereas the wives high anger-out seemed to predict good psychological quality of life in the men. Also, in this study the female partners reported higher levels of anxiety and depression as compared to the male partners. The results of the present study extend the previous literature on positive psychological resources and psychological wellbeing among cancer couples. Furthermore, these findings support the theory on SOC and optimism as health-promoting factors. However, the construct of SOC seems to include other important elements besides optimism. The findings of this study are applicable in designing new rehabilitation programmes for cancer patients and their partners.

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The aim of this study was to measure seasonal variation in mood and behaviour. The dual vulnerability and latitude effect hypothesis, the risk of increased appetite, weight and other seasonal symptoms to develop metabolic syndrome, and perception of low illumination in quality of life and mental well-being were assessed. These variations are prevalent in persons who live in high latitudes and need balancing of metabolic processes to adapt to environmental changes due to seasons. A randomized sample of 8028 adults aged 30 and over (55% women) participated in an epidemiological health examination study, The Health 2000, applying the probability proportional to population size method for a range of socio-demographic characteristics. They were present in a face-to-face interview at home and health status examination. The questionnaires included the modified versions of the Seasonal Pattern Assessment Questionnaire (SPAQ) and Beck Depression Inventory (BDI), the Health Related Quality of Life (HRQoL) instrument 15D, and the General Health Questionnaire (GHQ). The structured and computerized Munich Composite International Diagnostic Interview (M-CIDI) as part of the interview was used to assess diagnoses of mental disorders, and, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria were assessed using all the available information to detect metabolic syndrome. A key finding was that 85% of this nationwide representative sample had seasonal variation in mood and behaviour. Approximately 9% of the study population presented combined seasonal and depressive symptoms with a significant association between their scores, and 2.6% had symptoms that corresponded to Seasonal Affective Disorder (SAD) in severity. Seasonal variations in weight and appetite are two important components that increase the risk of metabolic syndrome. Other factors such as waist circumference and major depressive disorder contributed to the metabolic syndrome as well. Persons reported of having seasonal symptoms were associated with a poorer quality of life and compromised mental well-being, especially if indoors illumination at home and/or at work was experienced as being low. Seasonal and circadian misalignments are suggested to associate with metabolic disorders, and could be remarked if individuals perceive low illumination levels at home and/or at work that affect the health-related quality of life and mental well-being. Keywords: depression, health-related quality of life, illumination, latitude, mental well-being, metabolic syndrome, seasonal variation, winter.

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The purpose of this research is to draw up a clear construction of an anticipatory communicative decision-making process and a successful implementation of a Bayesian application that can be used as an anticipatory communicative decision-making support system. This study is a decision-oriented and constructive research project, and it includes examples of simulated situations. As a basis for further methodological discussion about different approaches to management research, in this research, a decision-oriented approach is used, which is based on mathematics and logic, and it is intended to develop problem solving methods. The approach is theoretical and characteristic of normative management science research. Also, the approach of this study is constructive. An essential part of the constructive approach is to tie the problem to its solution with theoretical knowledge. Firstly, the basic definitions and behaviours of an anticipatory management and managerial communication are provided. These descriptions include discussions of the research environment and formed management processes. These issues define and explain the background to further research. Secondly, it is processed to managerial communication and anticipatory decision-making based on preparation, problem solution, and solution search, which are also related to risk management analysis. After that, a solution to the decision-making support application is formed, using four different Bayesian methods, as follows: the Bayesian network, the influence diagram, the qualitative probabilistic network, and the time critical dynamic network. The purpose of the discussion is not to discuss different theories but to explain the theories which are being implemented. Finally, an application of Bayesian networks to the research problem is presented. The usefulness of the prepared model in examining a problem and the represented results of research is shown. The theoretical contribution includes definitions and a model of anticipatory decision-making. The main theoretical contribution of this study has been to develop a process for anticipatory decision-making that includes management with communication, problem-solving, and the improvement of knowledge. The practical contribution includes a Bayesian Decision Support Model, which is based on Bayesian influenced diagrams. The main contributions of this research are two developed processes, one for anticipatory decision-making, and the other to produce a model of a Bayesian network for anticipatory decision-making. In summary, this research contributes to decision-making support by being one of the few publicly available academic descriptions of the anticipatory decision support system, by representing a Bayesian model that is grounded on firm theoretical discussion, by publishing algorithms suitable for decision-making support, and by defining the idea of anticipatory decision-making for a parallel version. Finally, according to the results of research, an analysis of anticipatory management for planned decision-making is presented, which is based on observation of environment, analysis of weak signals, and alternatives to creative problem solving and communication.

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In Finland, the suicide mortality trend has been decreasing during the last decade and a half, yet suicide was the fourth most common cause of death among both Finnish men and women aged 15 64 years in 2006. However, suicide does not occur equally among population sub-groups. Two notable social factors that position people at different risk of suicide are socioeconomic and employment status: those with low education, employed in manual occupations, having low income and those who are unemployed have been found to have an elevated suicide risk. The purpose of this study was to provide a systematic analysis of these social differences in suicide mortality in Finland. Besides studying socioeconomic trends and differences in suicide according to age and sex, different indicators for socioeconomic status were used simultaneously, taking account of their pathways and mutual associations while also paying attention to confounding and mediatory effects of living arrangements and employment status. Register data obtained from Statistics Finland were used in this study. In some analyses suicides were divided into two groups according to contributory causes of death: the first group consisted of suicide deaths that had alcohol intoxication as one of the contributory causes, and the other group is comprised of all other suicide deaths. Methods included Poisson and Cox regression models. Despite the decrease in suicide mortality trend, social differences still exist. Low occupation-based social class proved to be an important determinant of suicide risk among both men and women, but the strong independent effect of education on alcohol-associated suicide indicates that the roots of these differences are probably established in early adulthood when educational qualifications are obtained and health-behavioural patterns set. High relative suicide mortality among the unemployed during times of economic boom suggests that selective processes may be responsible for some of the employment status differences in suicide. However, long-term unemployment seems to have causal effects on suicide, which, especially among men, partly stem from low income. In conclusion, the results in this study suggest that education, occupation-based social class and employment status have causal effects on suicide risk, but to some extent selection into low education and unemployment are also involved in the explanations for excess suicide mortality among the socially deprived. It is also conceivable that alcohol use is to some extent behind social differences in suicide. In addition to those with low education, manual workers and the unemployed, young people, whose health-related behaviour is still to be adopted, would most probably benefit from suicide prevention programmes.

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A lack of conceptual clarity and multivariate studies has impeded research on paranormal, superstitious, and magical beliefs. In this series of studies a new conceptual framework of these beliefs was presented. A general belief in the paranormal was shown to lead to specific paranormal, superstitious, and magical beliefs. The beliefs were defined equally as category mistakes where the core attributes of psychological, physical, and biological phenomena are confused with each other. This definition was supported by an empirical examination: Paranormal believers confused more core knowledge than skeptics. A multivariate study revealed that the best predictors of paranormal beliefs were intuitive thinking and a humanistic world view, while low analytical thinking was a less important predictor. Another study showed that women s greater belief in the paranormal compared to men was partially explained by women s higher intuitive and lower analytical thinking. Additionally, it was shown that university students were originally more skeptical than vocational school students, but university studies did not increase skepticism. The finding that paranormal beliefs mainly arise from an intuitive system, instead of a malfunctioning analytical system, explains why the beliefs do not vanish with the increase of education, scientific knowledge, and rational thinking. Religious and paranormal beliefs share important qualities and generally, they were positively related. The most religious people, however, abandoned paranormal beliefs. Religious people and paranormal believers differed from the skeptics similarly by being more intuitive, having experienced more mystical phenomena, and having peers and parents with more positive attitudes toward the supernatural. Religious people had, however, higher conservation and benevolence values than paranormal believers. The new conceptual framework presented in this series of studies integrates research on paranormal, superstitious, magical, and religious beliefs. Hopefully it will enable researchers to develop more elaborated hypotheses and theoretical statements about paranormal beliefs in the future.

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Anesthesiologists, according to some studies, are highly stressed, die at a significantly earlier age than their colleagues and the general population,and are among the leaders in physicians' suicide records. Data are,however, sparse and contradictory. The aim of this study was to discover details of the work-related well-being of Finnish anesthesiologists. In 2004, a cross-sectional postal survey including all 550 working Finnish anesthesiologists produced a total of 328 responses (60%); 53% were men. The anesthesiologists had the greatest on-call workload among Finnish physicians. Their average in-hospital on-call period lasted 24 hours (range 14 to 38). Over two-thirds felt stressed. The most important causes of stress were work and combining work with family. Their main worries at work were: excessive workload and time constraints, especially being on call, organizational problems, and fear of harming patients. On-call workload correlated with burnout. Being frequently on call was correlated with severe stress symptoms--symptoms associated with sick leaves. Women were more affected by stress than men. High job control and organizational justice seemed to mitigate hospital-on-call stress symptoms. The respondents enjoyed fairly high job and life satisfaction. Job control and organizational justice were the most important correlates of these wellness indicators. Work-related factors were more important in males, whereas family life played a larger role in the well-being of female anesthesiologists. Women had less job control, fewer permanent job contracts, and a higher domestic workload. Of the respondents, 31% were willing to consider changing to another physician's specialty and 43% to a profession other than medicine. The most important correlates for these job turnover attitudes were conflicts at the workplace, low job control, organizational injustice, stress, and job dissatisfaction. One in four had at some time considered suicide. Respondents with poor health, low social support, and family problems were at the highest risk for suicidality. The highest risks at work were conflicts with co-workers and superiors, on-call-related stress symptoms, and low organizational justice. If a respondent had several risk factors, the risk for suicidality doubled with each additional factor. On-call work-burden, job control, fairness of decision-making procedures,and workplace relationships should be the focus in attempts to increase the work-related well-being of anesthesiologists.

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Since the second half of the 20th century, cancer has become a dominant disease in Western countries, endangering people regardless of age, gender, race or social status. Every year almost eight million people die of cancer worldwide. In Finland every fourth person is expected to fall ill with cancer at some stage of his or her life. During the 20th century, along with rapid changes in the medical system, people s awareness of cancer has increased a great deal. This has also influenced the image of cancer in popular discourse over the past decades. However, from the scientific point of view there is still much that is unclear about the disease. This thesis shows that this is a big problem for ordinary people, as, according to culture-bound illness ideology, people need an explanation about the origin of their illness in order to help them cope. The main aim of this thesis is to examine the process of being ill with cancer from the patient s point of view, in order to analyse attitudes and behaviour towards cancer and its significance and culture-bound images. This narrative-based study concentrates on patients voicings , which are important in understanding the cancer experience and when attempting to make it more open within current cultural and societal settings. The Kun sairastuin syöpään ( when I fell ill with cancer ) writing competition organised by Suomen Syöpäpotilaat ry (the Finnish Cancer Patients Association), Suomen Syöpäyhdistys ry (the Finnish Cancer Union), and Suomalaisen Kirjallisuuden Seuran kansanrunousarkisto (the Finnish Literary Society Folklore Archive) was announced on the 1st of May 1994 and lasted until the 30th of September 1994. As a result, a total of 672 cancer narratives, totalling 6384 pages, were received, filled with experiences relating to cancer. Written cancer narratives form a body of empirical data that is suitable for content or textual analysis. In this thesis, content analysis is adopted in order to become familiar with the texts and to preselect the themes and analytical units for further examination. I use multiple perspectives in order to interpret cancer patients ideas and reasoning. The ethnomedical approach unites popular health beliefs that originated in Finnish folk medicine, as well as connecting alternative medicine, which patients make use of, with biomedicine, the dominant form of medicine today. In addition to this, patients narratives, which are composed of various structural segments, are approached from the folklorist s perspective. In this way they can be seen as short pathographies, reconstructions of self-negotiation and individual decision making during the illness process. Above all, cancer patients writing describe their feelings, thoughts and experiences. Factors that appear insignificant to modern medicine, overwhelmed as it is by medical technologies that concentrate on dysfunctional tissue within diseased bodies. Ethnomedical study of cancer patients writings gives access to the human side of cancer discourse, and combines both medical, and popular, knowledge of cancer. In my view, the natural world and glimpses of tradition are bound together with one general aim within cancer narratives: to tackle the illness and mediate its meanings. Furthermore, the narrative approach reveals that participants write with the hope of offering a different interpretation of the cancer experience, and thus of confronting culturally pre-defined images and ideologies.