Health care rights and NHS rationing: turning theory into practice

How should we understand the nature of patients’ right in public health care systems? Are health care rights different to rights under a private contract for car insurance? This article distinguishes between public and private rights and the relevance of community interests and notions of social solidarity. It discusses the distinction between political and civil rights, and social and economic rights and the inherently political and redistributive nature of the latter. Nevertheless, social and economic rights certainly give rise to “rights” enforceable by the courts. In the UK (as in many other jurisdictions), the courts have favoured a “procedural” approach to the question, in which the courts closely scrutinise decisions and demand high standards of rationality from decision-makers. However, although this is the general rule, the article also discusses a number of exceptional cases where “substantive” remedies are available which guarantee patients access to the care they need.

Legitimacy and rights in the EU: questions of identity

Rights as well as democracy play a crucial role in the legitimacy of the EU and constitutional patriotism has been influential in attempting to link them together. The article seeks to engage in a critique of constitutional patriotism on two fronts. First, it distinguishes between the various types of right that exist within EU law-Community, citizenship and fundamental-and then analyses the place of these rights within various political models of the EU ranging from nationalism to republicanism. It argues that constitutional patriotism does not enjoy a monopoly on rights discourse in the EU: most models of the EU see a place for rights; it is just that the type of right supported varies. Secondly, advocates of constitutional patriotism argue that EU rights generate European identity. The article questions the extent to which this is the case, arguing that identity potential varies considerably according to the type of EU right concerned.

Adaptive divergence and speciation among sexual and pseudoviviparous populations of Festuca

Pseudovivipary is an environmentally induced flowering abnormality in which vegetative shoots replace seminiferous (sexual) inflorescences. Pseudovivipary is usually retained in transplantation experiments, indicating that the trait is not solely induced by the growing environment. Pseudovivipary is the defining characteristic of Festuca vivipara, and arguably the only feature separating this species from its closest seminiferous relative, Festuca ovina. We performed phylogenetic and population genetic analysis on sympatric F. ovina and F. vivipara samples to establish whether pseudovivipary is an adaptive trait that accurately defines the separation of genetically distinct Festuca species. Chloroplast and nuclear marker-based analyses revealed that variation at a geographical level can exceed that between F. vivipara and F. ovina. We deduced that F. vivipara is a recent species that frequently arises independently within F. ovina populations and has not accumulated significant genetic differentiation from its progenitor. We inferred local gene flow between the species. We identified one amplified fragment length polymorphism marker that may be linked to a pseudovivipary-related region of the genome, and several other markers provide evidence of regional local adaptation in Festuca populations. We conclude that F. vivipara can only be appropriately recognized as a morphologically and ecologically distinct species; it lacks genetic differentiation from its relatives. This is the first report of a ‘failure in normal flowering development’ that repeatedly appears to be adaptive, such that the trait responsible for species recognition constantly reappears on a local basis.

Land, rights and the gift: the Countryside and Rights of Way Act 2000 and the negotiation of citizenship

The Countryside and Rights of Way Act came into force at the end of 2000 with,as part of its content, new provisions relating to public access to the English and Welsh countryside. In this paper we review the main elements of the Act and assess its meaning in relation to citizenship, territoriality and the place of land in English law and society. We invoke Mauss’s (1954)concept of Gift to explain the process of brokerage being made over access and rights in the countryside. In conclusion we reflect on the Act as being indicative of a wider move towards Bromley’s (1998)post-feudal scenario for land and its governance.

Access, equity and the role of rights in health care

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values-liberty and equity-can be evaluated and assessed.

Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice

Objective: There were two aims to this study: first to examine whether emotional abuse and neglect are significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women presenting to a primary care practice, and second to examine the strength of these relationships after controlling for the effects of other types of childhood abuse and trauma. Method: Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis, 1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla, 1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression analyses were conducted to examine unique contributions of emotional abuse and neglect variables on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma exposure. Results: A history of emotional abuse and neglect was associated with increased anxiety, depression, posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual abuse and lifetime trauma were also significant predictors of physical and psychological symptoms. Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure. Conclusions: Long-standing behavioral consequences may arise as a result of childhood emotional abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further trauma exposure. (C) 2003 Elsevier Ltd. All rights reserved.

A follow-up study of characteristics of young people that dropout and continue psychotherapy: service implications for a clinic in the community

Background: The paper reports the findings from a follow-up study of the factors that contribute to whether young people dropout or continue once-weekly psychotherapy at a voluntary sector psychotherapy service for young people aged 12 to 21 years. Method: The study uses data from an ongoing audit of the psychotherapy service that started in 1993; 882 young people were included in the study. Premature termination of treatment was defined as dropping out before the 21st session. Continuation in treatment was defined as remaining in therapy after 20 sessions. Measures and areas of interest used in the study include diagnostic measures, the Youth Self Report Form and Young Adult Self Report Form, demographic characteristics and treatment related information. Results: Young people who continued in treatment were more likely to be older, have anxieties about sexual and relationship issues and have higher scores on self-reported anxiety-depression. Young people who dropped out of treatment were more likely to be younger, have higher self-reported delinquency scores, have a diagnosis of hyperactivity-conduct disorder and be homeless. Conclusions: The study of treatment termination has demonstrated the value of service audit and has led to a significant change in clinical practice.

Rights, citizenship and access to the countryside

This paper presents a reading of current UK Government policy on recreational access to the countryside of England, in terms of its citizenship and rights agenda. Given the continuity of traditional forms of land tenure and occupation, it is argued that the policy is less of recognition of the changing needs of a tranisitory society than it is a revisionist menifesto for resisting external influence and change. This is particularly so in terms of recreation, where the underlying organisation of the physical environment has been appropriated to reproduce a reflection of the social order which increasingly descriminates between culturally legitimate and illegitimate uses of rural space.

Defining children's rights to work and care in Sub-Saharan Africa: tensions and challenges in policy and practice

This chapter explores the spatialities of children's rights through a focus on how children's paid and unpaid work in Sub-Saharan Africa intersects with wider debates about child labor, child domestic work and young caregiving. Several tensions surround the universalist and individualistic nature of the rights discourse in the context of Sub-Saharan Africa and policymakers, practitioners, children and community members have emphasized children's responsibilities to their families and communities, as well as their rights. The limitations of ILO definitions of child labor and child domestic work and UNCRC concerns about 'hazardous' and 'harmful' work are highlighted through examining the situation of children providing unpaid domestic and care support to family members in the private space of their own or a relative's home. Differing perspectives towards young caregiving have been adopted to date by policymakers and practitioners in East Africa, ranging from a child labor/ child protection/ abolitionist approach, to a 'young carers'/ child-centered rights perspective. These differing perspectives influence the level and nature of support and resources that children involved in care work may be able to access. A contextual, multi-sectorial approach to young caregiving is needed that seeks to understand children's, family members' and community members' perceptions of what constitutes inappropriate caring responsibilities within particular cultural contexts and how these should best be alleviated.

Children’s literature: sexual identity, gender and childhood

On the twenty-third of May 2015, Ireland became the first country to legalise same-sex marriage by popular vote. This event reversed a large part, if not all, of Ireland’s reputation for a Catholic-led conservatism concerning sexual and gender identities. I argue in this article that we can see a parallel-in-miniature to this momentous shift in something of a reversal of children’s literature’s views in this respect too, and I will concentrate on exploring what is at stake in the ways that childhood, sexual and gender identities are constructed in some recent children’s literature criticism in the light of these shifts. My interest is to consider: what is the ever-burgeoning interest in the gay, queer, cross-dressing, transsexual or transgender child precisely about? I ask this question on the grounds of not assuming that this interest in these identities arises necessarily simply out of a self-evident, progressive, liberatory impulse, and, alongside this, I also do not assume that ‘identities’ are essential, self-organised traits awaiting revelation and liberation.