Advance directives as autonomy enhancers: reality or myth?

In the last few decades there has been a wealth of literature and legislation on advance directives. As you all know, it is an instrument by which a person can express their wishes as regards what treatmentthey should be given or, more to the point, not to be given, when he is in a situation when he can not do so himself.Regulations in the western world seem to promote advance directives as a way to enhance patient¿s autonomy in thecontext of human rights, and the media has presented advance directives as another milestone in this era of selfdetermination.However, if we look closely at some of thoseregulations we will see that there are a few elements which may undermine their efficacy, shattering this nicely presentedpicture. I will focus on two elements. First, formal requirements, and secondly, certain limits or what I like to call "escape clauses".

Les divers sens de la notion d'autonomie en médecine et leur pertinence en clinique [The various senses of autonomy and their relevance to clinical practice]

Since the introduction of the principle of respect of autonomy in medical ethics, the respect of the will of the patient occupied a central place in the decision-making process. To face up to the difficulties that appeared during the application of this principle in clinical medicine, Bruce Miller proposed in the early eighties one way to clarify the significance of this notion in the field of medical practice. He showed that the concept of autonomy can be understood under four senses which deserve to be explored in case of ethical conflict. This article shows, through the analysis of a clinical situation, the relevance of the approach suggested by this author and proposes to refer to this approach in case of ethical dilemmas in clinical practice.

Unexplored aspects of bureaucratic autonomy: a state of the field and ways forward

This article first provides a selective overview of the literature on bureaucratic autonomy and identifies different approaches to this topic. The second section discusses three major sets of open questions, which will be tackled in the contributions to this special issue: the subjective, dynamic and relational nature of autonomy; the complex linkages between tasks, organizational forms, and national path dependencies on the one hand and autonomy and performance on the other hand; and the interplay between autonomy, accountability and democratic legitimacy.

A rationalist perspective on the autonomy of international sport governing bodies : towards a pragmatic autonomy in the steering of sports

International sport governing bodies (ISGBs) are built on the foundations of freedom of association and traditionally enjoy a large degree of autonomy in their decision-making. Their autonomy is increasingly confined, however, and their hierarchical self-governance is giving way to a more networked governance, in which different stakeholders exert power in different ways and in different contexts in a complex web of interrelationships. Taking a rationalist perspective on the autonomy of ISGBs, this article demonstrates that ISGBs are deploying strategies to safeguard their waning governing monopoly over international sport. Opting for an inductive approach, the authors present four possible conceptualizations of autonomy as applied to ISGBs, namely political autonomy, legal autonomy, financial autonomy and pyramidal autonomy. For each dimension, they describe the different strategies ISGBs wield in order to safeguard different dimensions of their autonomy. This article uses governance theories to hypothesize that the autonomy of ISGBs can be understood as 'pragmatic autonomy' since ISGBs only cede certain aspects of their autonomy under particular circumstances and when being subject to specific threats. Acting in a rationalist manner, they are able to keep control over governance developments in sport by using indirect and more subtle forms of governance.

Synergy Sources, Target Autonomy and Integration in Acquisitions

Determining the appropriate level of integration is crucial to realizing value from acquisitions. Most prior research assumes that higher integration implies the removal of autonomy from target managers, which in turn undermines the functioning of the target firm if it entails unfamiliar elements for the acquirer. Using a survey of 86 acquisitions to obtain the richness of detail necessary to distinguish integration from autonomy, the authors argue and find that integration and autonomy are not the opposite ends of a single continuum. Certain conditions (e.g., when complementarity rather than similarity is the primary source of synergy) lead to high levels of both integration and autonomy. In addition, similarity negatively moderates the relationship between complementarity and autonomy when the target offers both synergy sources. In contrast, similarity does not moderate the link between complementarity and integration. The authors' findings advance scholarly understanding about the drivers of implementation strategy and in particular the different implementation strategies acquiring managers deploy when they attempt to leverage complementarities, similarities, or both.

Nationalist neoliberalism? Minority Nationalism, competitiveness and the urban question

Presentation at: II IAS Annual Research Programme International ConferenceSession: Governing Regions, Lancaster Setember 17-19 2007

From "being to the self" to "become to be": on development of autonomy construction in nursing students

Objective: To understand nursing student's self-consciousness and his/her autonomy in the discipline of fundamentals of professional care in the context of a liberating pedagogical proposal. Methodology. This qualitative, case-based research in the model of Ludke and André involved 14 students participating in the discipline. Data were collected by non-participatory observation and analysis of documents. Field observation was conducted from March to July 2010 and data were collected according to the proposal of Minayo: pre-analysis, exploration of material and treatment of results. Results. We constructed two thematic units of analysis: from "being to the self" and exercise of "become to be". Conclusion. When nursing students feel more liberty, they have the opportunity to substitute the scary prospect of learning something new material to something that motivates their curiosity and leads them to become more autonomous.

Autonomy and islands: a global study of the factors that determine island autonomy

Att ett geografiskt territorium uppnår autonomi förklaras ofta av skillnad I etnicitet, språk eller religion. En region som skiljer sig i någon av dessa kulturella aspekter från övriga regioner i ett land anses därför ha större sannolikhet att utveckla autonomi. Pär M. Olausson visar i sin avhandling att kulturella aspekter inte är den viktigaste förklaringen till att vissa öar utvecklar autonomi. Kulturella aspekter är bara en del i förklaringen till varför vissa öar utvecklar autonomi medan andra förblir en integrerad del av moderlandet. Kulturella aspekter måste kombineras med andra aspekter för att utgöra en tillräcklig förklaring till skillnaden i autonomi. Bland de autonoma regionerna i världen idag utgör öar en klar majoritet. Öar anses ofta ha speciella egenskaper som gör att de skiljer sig från fastlandet. Känslan av samhörighet och gemenskap är ofta starkare på öar pga deras ofta isolerade läge vilket i sin tur anses förklara varför många öar utvecklar autonomi. Genom att studera både autonoma och icke-autonoma öar visar Olausson att autonomi kan förklaras av att ön ligger längre än 1 000 km från fastlandet eller att den skiljer sig från fastlandet i någon av de kulturella aspekterna, att den har varit ockuperad av främmande stat och därmed avskiljd från övriga landet eller utgjort en egen stat. Den viktigaste förklaringen till varför vissa öar utvecklar autonomi men inte andra är emellertid öns strategiska betydelse.

Conditions for different autonomy regimes in the world : a fuzzy-set application

Avhandlingen behandlar temat territoriell autonomi ur ett globalt perspektiv. Syftet är dels att kartlägga de territoriella autonomierna i världen och dels att visa hur en ny metod som fuzzy-set kan användas inom ämnesområdet jämförande politik. Forskningsproblemet är att försöka finna de bakgrundsfaktorer som förklarar uppkomsten av territoriell autonomi som sådant. Territoriella autonomier ses som särlösningar inom stater. Dessa regioner har erhållit en specialställning i förhållande till andra regioner inom respektive stat och även i förhållande till centralmakten i övrigt. Regionerna kan därför ses som undantag inom det enhetliga federala, regionala eller decentraliserade systemet inom en viss stat ifråga. En kartläggning visar att det finns 65 specialregioner fördelade på 25 stater i världen. De flesta av dessa utgörs av öar. Resultaten visar att det finns två vägar vilka leder till territoriell autonomi i allmänhet. Den ena vägen är en kombination av etnisk särprägel och liten befolkningsmängd, medan den andra vägen utgörs av kombinationen av historiska orsaker och geografiskt avstånd. Båda vägar är lika giltiga och förutsättningen är en demokratisk miljö.