Förutsättningarna för psykiatrisk vård oberoende av patientens vilja och patientens rättsskydd vid fattandet av vårdbeslutet

I arbetet analyseras de i mentalvårdslagen (1990/1116) stadgade förutsättningarna för psykiatrisk sjukhusvård oberoende av patientens vilja gällande myndiga patienter för vilka inte har utsetts en intressebevakare före fattandet av vårdbeslutet, samt bakgrunden till och en del av de svårigheter som förknippas med denna form av vård och härtill anknutet beslutsfattande. Problemen tillspetsas framförallt i situationer av intressekonflikt mellan patientens intressen respektive samhällets intressen. Utgångspunkten ligger främst i finländsk mentalvårdslagstiftning och rättspraxis, men för att på ett ändamålsenligt sätt kunna redogöra för bakgrunden till och förutsättningarna för dylikt förvaltningsrättsligt beslutsfattande görs även relevanta kopplingar till medicinska (psykiatriska) yrkesetiska riktlinjer och mentalvårdslagstiftning inom övriga Norden. Analysen omfattar även den Europeiska människorättsdomstolens praxis i fall som gäller frihetsberövande på basis av psykiatrisk vård, närmare bestämt artikel 5 (1)(e) i den europeiska människorättskonventionen. Patientens självbestämmanderätt, frihet och integritet är utgångspunkterna för alla slags vårdförhållanden. Dessa inbegriper bl.a. frivillighet och informerat samtycke då en person söker vård. Möjligheten att förordna en person till psykiatrisk vård oberoende av dennes vilja är ett lagstadgat undantag till dessa principer. Beslutsfattandet är bundet till strikta lagstadgade förutsättningar, vilkas bedömning kräver juridisk, men framförallt medicinsk kunskap, vilket också skapar gränser och utmaningar för de yrkespersoner som arbetar med dylika ärenden. Kombinationen av psykiatri, etik och juridik är nödvändig, men inte alltid enkel att göra, vilket märks inte minst på terminologin som tillämpas i mentalvårdslagstiftningen. I arbetet analyseras en del av den terminologi som tillämpas inom finsk och övrig nordisk mentalvårdslagstiftning. Syftet är att visa att definitionerna, tolkningarna, terminologin och synsättet på psykisk ohälsa som tillämpas inom den finländska mentalvårdslagstiftningen jämförelsevis kanske inte är de mest lämpliga eller tidsenliga. En annan svår uppgift, som framförallt lagstiftaren ställ(t)s inför, är utformningen av mentalvårdslagstiftning som är tillräckligt flexibel för att tillåta beaktande av särdragen i varje enskilt ärende, men som samtidigt är strikt nog för att förhindra godtycke och missbruk. En person som lider av allvarlig psykisk ohälsa befinner sig oftast i en ytterst utsatt position, och är ofta begränsat eller inte alls kapabel att göra en korrekt bedömning av sig själv och sin situation. Således sker den starka betoningen av patientens självbestämmanderätt på både gott och ont. Det är kanske inte alltid i en psykiatrisk patients bästa att få bestämma själv, vilket också är en av frågorna som omfattas av analysen i arbetet. Eftersom det psykiatriska vårdbeslutet till karaktären är ett (skriftligt) förvaltningsbeslut, skiljer det sig samtidigt från övrigt beslutsfattande inom vårdsektorn, vilket till största delen utgör faktisk förvaltningsverksamhet. För patienten innebär vårdbeslutet också ett administrativt frihetsberövande. Ingreppet i patientens grundläggande fri- och rättigheter är särskilt stort och upplevs ofta som mycket kränkande, och därför ställs särskilt strikta krav på iakttagande av det lagstadgade beslutsförfarandet och vårdförutsättningarna samt tillgodoseendet av patientens rättsskydd. Den offentliga hälso- och sjukvården är verksamhet som är underställd den offentliga förvaltningen, vilket innebär att de allmänna förvaltningsrättsliga rättsskyddsgarantierna är tillämpliga. I och med vårdbeslutets karaktär av förvaltningsbeslut, kan ändring i beslutet sökas genom besvär hos förvaltningsdomstolen. Dessa är också några av de frågor som behandlas i arbetet.

Viljan visar vägen till identiteten : Berättelsetyper och teman i livsberättelser av kvinnliga teologer i Svenskfinland

Forskningens utgångspunkt var att tillföra information om kvinnliga teologers liv i Svenskfinland under en period då kyrkan hade omdefinierat sin syn på kvinnor som präster. Till forskningens intresseområden hörde frågan om hur situationen hade påverkat kvinnors motivation att välja teologiska studier och yrken samt hur situationen hade inverkat på kvinnliga teologer i arbetslivet. Forskningens uppgift är att ur ett identitetsperspektiv undersöka målgruppens egna skildringar av livet som kvinnlig teolog i Svenskfinland. Forskningsfrågan delades in i två delfrågor: 1)Hur har kvinnliga teologer kommit att välja studier, yrken och arbetsplats? 2)Vad har kvinnliga teologer upplevt i sina studier och arbetsliv? Forskningens material samlades in hösten 2003 genom en förfrågan per brev och genom en tidningsnotis i tidningen Kyrkpressen. Materialet bestod av livsberättelser som kvinnliga teologer i olika yrkesgrupper hade skrivit utgående ifrån rubriken ”Mitt liv som kvinnlig teolog i Svenskfinland”. Cirka 250 kvinnor hade avlagt teologisk examen på svenska i Finland. Antalet personer som deltog i undersökningen med sin livsberättelse var 27. Materialet analyserades kvalitativt och induktivt med en narrativ analys som tog fasta på teman och berättelsetyper i olika livsskeden: val av studier, studietid, val av karriär och erfarenheter från arbetslivet. Analysresultatet var att studievalets beskrivning kunde tolkas som en valsituation där egenskaper jämfördes med yrkesrollen, som en socialisationsprocess, som ett alternativ till tidigare studieinriktning eller som en process där kvinnoprästdiskussioner, intresse för teologi och teologuppgifter fick informanten att välja teologin. Teman från studietiden handlade om studiers fördröjning, om yrkesinriktning, om studier som förberedelse för arbetslivet och om kvinnoprästdiskussionens inverkan på yrkesinriktningen. Val av arbetsplatser och yrken beskrevs utgående ifrån kvinnliga teologers förändrade position, moderskapets inverkan på karriären, en strävan att hitta en arbetsplats som passade informanten, erfarenheter från en enda arbetsplats och karriärsbyte. Lektorer tog fasta på välsignelseaktens betydelse, kyrkoherdens stora inflytande på arbetets karaktär samt hur situationen förändrades då kvinnor tilläts bli präster. För en del präster innebar prästrollen att andra människor betonade att de var kvinnor. Några informanter hade behov av stöd både från Borgå stifts ledning och från andra kvinnliga präster under den första tiden med kvinnliga präster. Till en början upplevdes ledningens stöd inte alltid som tillräckligt men det förbättrades med tiden. Informanterna berättade inte så mycket om läraryrket. Inom forskning verkade teologtiteln vara naturlig, medan informanter med erfarenhet av annat än teologyrken ibland hade stött på reaktioner på sitt yrkesval eller sin arbetsroll. Finlandssvenskheten upplevdes av olika informanter både som tryggt och inskränkt. Eventuella kontakter till finska stift upplevdes positivt även om det egna sammanhanget upplevdes som viktigt. Trivsel på arbetsplatsen orsakades av subjektiva belöningar och i en del fall av att arbetet motsvarade informantens yrkesinriktning. Att vara kvinnlig teolog innebar ibland att informantens yrkesval tolkades av andra som ett ställningstagande för någon ideologi i kvinnoprästfrågan.

Större frihet - bättre lokalt anpassad service? : Förvaltningsreformer och kommunernas service för utvecklingsstörda 1994-2000

In the beginning of the 1990s the legislation regarding the municipalities and the system of central government transfers were reformed in Finland. This resulted in a move from detailed governmental control to increased municipal autonomy. The purpose of this decentralization was to enable the municipalities to better adapt their administration and service supply to local needs. The aim of this study was to explore the effects of the increased municipal autonomy on the organization of services for people with intellectual disabilities. Did the increased autonomy cause the municipalities to alter their service supply and production and did the services become more adapted to local needs? The data consists of statistical information on service use and production, and also of background data such as demographics, economics and political elections on 452 municipalities in Finland from the years 1994 and 2000. The methods used are cluster analysis, discriminant analysis and factor analysis. The municipalities could be grouped in two categories: those which offered mainly one kind of residential services and others which had more varied mixes of services. The use of institutional care had decreased and municipalities which used institutional care as their primary form of service were mostly very small municipalities in 2000. The situation had changed from 1994, when institutional care was the primary service for municipalities of all sizes. Also the service production had become more differentiated and the municipalities had started using more varied ways of production. More municipalities had started producing their own services and private production had increased as well. Furthermore, the increase in local autonomy had opened up possibilities for local politics to influence both the service selection and methods of production. The most significant motive for changes in the service structure was high unemployment and an increasing share of elderly people in the population, particularly in sparsely populated areas. Municipalities with a low level of resources had made more changes in their service organization while those with more resources had been able to carry on as before. Key words: service structure, service for people with intellectual disabilities, municipalities, contingency theory, New Public Management

The construction of feminism in Indonesian film: Arisan 2!

Feminism in Indonesian society is related to the emancipation term that women nowadays have still been bringing up this issue. However, Arisan 2! film showed a shift in film discourse regarding the representation of cosmopolitan women in Indonesia. This research examines on how Arisan 2! film as a media portrays feminism in the society of Jakarta. Feminism in Arisan 2! film was likely to expose the liberal feminism in nowadays modern society through several issues of women’s emancipation, specifically in the areas of marriage, job, and social life.

Re-inventing the f word - it's feminism!

This article discusses approaches to feminist art practice by early career Australian women artists in the context of 'Contemporary Australia: Women', an exhibition held at the Gallery of Modern Art (GOMA), Brisbane in 2012.

Pengarna eller livet? : En kvalitativ och longitudinell studie om långtidsarbetslösa unga i ett aktörsperspektiv

Your money or your life? A qualitative follow-up study of the young unemployed from an actor perspective is a qualitative and longitudinal study following 36 unemployed young people in Helsinki over a span of ten years. The purpose of the study is to shed light on how a few young people view employment/unemployment and their lives and future, how they as unemployed perceive their encounters with society, and how society supports them. Four so-called key informants were followed at a finer level of empirical detail. They were chosen for the thematic interviews because of their different personalities, starting points and preferences. Although some differences were expected, what the results show is quite striking. The individual stories raise a number of questions about differences between young people, about society s view of the young unemployed, and about the principles behind the so-called activation policy and how society s support is distributed. The key informants descriptions underline that the group young unemployed does not consist of individuals who are alike but that life is complex, that paid work and unemployment can be perceived very differently, and that background and unofficial support can have consequences for self-perception and for ways of looking at the future, vocational choices, paid work and activation policy. Margaret S. Archer s theory of Morphogenesis and Barbara Cruikshank s theory of constructing democracies compose the study s theoretical framework. The key informants stories give a picture of a formal support system that, even though it puts part of the responsibility for unemployment on the individuals themselves, in the name of fairness and equality, treats them in an impersonal way, not giving their personal situation and wishes much weight. As a consequence, those who share the dominant values of society do well, while others who do not are faced with difficulties. The bigger the gap between society s and the individual s values, the bigger the risk to be met by little understanding and by penalties. And vice versa: Those who initially have the right values and know how to deal with authorities get heard and their opinions get accepted. The informants ask for a more personal encounter, which could improve both the atmosphere and the clients experiences of being heard. Still the risk of having a more individualistic system should be addressed, as a new system might generate new winners, but just as well give new losers. Finally, we have to ask if the so-called activation policy is looking for answers primarily to a macro-level problem on the micro-level. If it does not produce more jobs, its support for the unemployed will be insignificant. It is not enough to think about what to do at the grassroots level to make the system more functional and support job-seeking. If the current rate of unemployment endures, the quality of life of the unemployed should be addressed. A first step could be taken by placing less guilt on the unemployed. Instead of talking about activating the unemployed, discussion should be targeted at removing structural impediments to employment. If we want to have less polarisation between the those with paid work and those without, who often struggle with low incomes, we need to include the macro-level in the discussion. What does high unemployment mean in a work-based society, where the individual s self-perception and important social forms of support are linked to labour income? And what can be done at the macro-level to change this undesirable condition at the micro-level? Keywords: Unemployment, Youth, Public interventions, Activation policy, Individual actors, Qualitative, Longitudinal, Holistic, Helsinki, Finland

Gender, Politics and Democratisation in Cameroon

Gender perceptions, religious belief systems, and political thought have excluded women from politics, for ages, around the world. Combining feminist and modernisation theorists in my theoretical framework, I examine the trends in patriarchal Europe and I highlight the gender-sensitive model of the Nordic countries. Retracing local gender patterns from precolonial to postcolonial eras in sub-Saharan Africa, I explore the links between perceptions, needs, resources, education and women's political participation in Cameroon. Democratisation is supposed to open up political participation, to grant equal opportunities to all adults. One ironic feature of the liberalisation process in Cameroon has been the decrease of women in parliamentarian representation (14% in 1988, 6% in 1992, 5% in 1997 and 10% in 2002). What social, cultural and institutional mechanisms produced this paradoxical outcome, the exclusion of half the population? The gender complementarity of the indigenous context has been lost to male prevalence privileged by education, church, law, employment, economy and politics in the public sphere; most women are marginalised in the private sphere. Nation building and development have failed; ethnicism and individualism are growing. Some hope lies in the growing civil society. From two surveys and 21 focus groups across Cameroon, in 2000 and 2002, some significant results of the processed empirical data reveal low electoral registration (34.5% women and 65.9% men), contrasted by the willingness to run for municipal elections (33.3 % women and 45.2% men). The co-existence of customary and statutory laws, the corrupt political system and fraudulent practices, contribute to the marginalisation of women and men who are interested in politics. A large majority of female respondents consider female politicians more trustworthy and capable than their male counterparts; they even foresee the appointment of a female Prime Minister. The Nordic countries have institutionalised gender equality in their legislation, policies and practices. France has improved women's political inclusion with the parity laws; Rwanda is another model of women's representation, thanks to its post-conflict constitution. From my analysis, Cameroonian institutions, men and more so women, may learn and borrow from these experiences, in order to design and implement a sustainable and gender-balanced democracy. Keywords: democratisation, politics, gender equality, feminism, citizenship, Cameroon, Nordic countries, Finland, France, United Kingdom, quotas, societal social psychology.

Personporträttet som tidningsgenre : En närläsningsstudie med fokus på innehållsliga teman, berättarkonventioner och kön

The thesis The portrait interview as a newspaper genre. A qualitative close reading focussing on topical motifs, conventions of narration, and gender defines the portrait interview as a newspaper genre and analyses how the personalities in the portraits are constructed textually. The main body of material consists of 107 portrait interviews in two morning newspapers, Dagens Nyheter (published in Stockholm, Sweden) and Hufvudstadsbladet (published in Swedish in Helsinki, Finland), during two one-week periods (week 46/1999 and week 38/2002). There is also complementary material of 59 portraits from four magazines. The study is carried out within the research traditions of journalistic genre studies, gender and journalism, and critical text analysis. It is comprised of a qualitative close reading focussing on content (topical motifs or themes), conventions of narration, and gender. The methods used to carry out the study are qualitative close reading and quantitative content analysis. The analysis identifies the stylistic elements that differentiate the portrait genre from other journalistic genres, as well as from the autobiographical genre, and explores what opportunities and limitations these elements present for the inclusion of even more women protagonists in the portrait genre. The portrait interview is an exception from the critical mission of journalism in general, with its position as a genre of politeness. Since a typical characteristic of the portrait interview genre is that it pays tribute to the protagonist, the genre reveals the kind of personalities and lives that are seen as admirable in society. Four levels of portrait interview are defined: the prototype portrait, the pure portrait, the hybrid portrait and the marginal portrait. The prototype is a raw version of a portrait that fulfils the criteria but may be lacking in content and stylistics. The pure portrait does not lack these qualities and resembles an ideal portrait. The hybrid is a borderline case which relates to another genre or is a mixture between the portrait and some other genre, most commonly the news genre. The marginal portrait does not fulfil the criteria, and can therefore be seen as an inadequate portrait. For example, obituaries and caricatures are excluded if the protagonist s voice is never quoted. The analysis resulted in three factors that in part help to explain why the portrait interview genre has somewhat more female protagonists than journalistic news texts do in general. The four main reasons why women are presented somewhat more in the portrait genre than in other journalistic genres are: (i) women are shown as exceptions to the female norm when, for example, taking a typical male job or managing in positions where there are few women; (ii) women are shown as representing female themes ; (iii) use of the double bind as a story-generating factor; and (iv) the intimisation of journalism. The double bind usually builds up the narration on female ambiguity in the contradiction between private and public life, for example family and career, personal desire and work. The intimisation of journalism and the double bind give women protagonists somewhat more publicity also because of the tendency of portrait interviews to create conflicts within the protagonist, as an exception to journalism in general where conflicts are created or seen as existing between, for example, persons, groupings or parties. Women protagonists and their lives create an optimal narration of inner conflicts originating in the double bind as men are usually not seen as suffering from these conflicts. The analysis also resulted in gendered portrait norms: The feminine portrait norm and the masculine portrait norm or more concretely, professional life and family life as expectation and exception. Women are expected to be responsible parents and mediocre professionals, while men are expected to be professionals and in their free time engaging fathers. Key words: journalism, genre, portrait interview, gender, interview, newspaper, women s magazine.

Stor Anna, Liten Anna och tio andra personporträtt : Om innehållsliga och språkliga mönster i en mediegenres kvinnobeskrivningar

The aim of this licentiate thesis is to analyse how femininity is constructed in twelve portrait interviews of women in the dailies Dagens Nyheter (Stockholm) and Hufvudstadsbladet (Helsinki) in September 1996, and to explore the portrait interview as a media genre. The qualitative analysis has a feminist and constructionist perspective and is connected to critical text analysis. It was carried out on two levels: first, femininity is identified on the linguistic level by choice of words, and second on the level of content (topical motifs/themes). The portrait interview as a genre constitutes a third dimension in the analysis: The aim is not towards the identification of femininity, but rather towards the identification of the portrait interview a relatively unexplored media genre. References (Swedish: omtal) to the principal character (or protagonist) are traced mainly through reference chains which consist of names, pronouns and substantive phrases. The interviewees were referred to by their full names in Dagens Nyheter (with the exception of the oldest and youngest interviewees, both of whom were mainly referred to by their first names), while the style of reference varied more in Hufvudstadsbladet. The position of the principal character was also analysed through her relation in the text to minor characters from her working life and from her private life. These minor characters maintained their subordinate positions in all of the portraits except that of the youngest principal character, in which the subsidiary voices became at least as strong as the voice of the principal character. Three frequently-recurring topical motifs occurred in the portraits: The first involved explanations for the principal character s success divided into three categories, agent, affect and ambition, the second concerned using journeys or trips as symbols for turning points in life, and the third referred to the ambiguity in the contradiction between private (family/other private life) and public (work) life. This ambiguity is connected to the portrait interview as a text type (genre) which features conclusions at the end of portraits, which in turn is characteristic of reportage. However, the analysis showed that the conclusions of the portrait interviews often also included elements of ambiguity. This was evident in the contradictions be14 tween private and public life that arose in the portrait interviews that focused on these two spheres. The portraits that focused on the principal character s public life showed ambiguity on a more general level concerning questions about being a woman and having a profession, and they often ended with a description of some details of her private life. The women in the portraits were all constructed as being successful, in terms of having achieved direct success, reflective success or success in the form of life wisdom. The women of direct success were described as ambitious individuals with no sidetracks on their life paths, while those of reflective success were described as active heroines who had received help from different agents, who could use their affects as enriching ingredients in life, but who in the end had control over their own lives (life stories). The elderly women were constructed as having achieved life wisdom and their portraits were focused upon the past. The portrait interview as a genre is characterised by journalistic freedom (in relation to the more strict news genre), by a now room (Swedish nurum ) where the journalist meets the principal character (usually via spoken dialogue that she or he transforms into written text to be read by a mass-media audience) and by the relatively closed structure of the portrait. The portrait is relatively independent in relation to the news genre and in relation to the context of what has previously been written, what is being written at the time and what will be written in the future the principal character does not need to belong to the newspaper s usual gallery of actors. Furthermore, the principal character is constructed as being independent in relation to the subsidiary characters and other media actors. The conflict is within the principal character herself and within her life story, unlike the news genre in which equal actors are in conflict with each other. The portrait is also independent in relation to the news lifespan; the publishing timetable is not as strict as in the news genre, but is still dependent on the factors initiating the portrait. The enclosures consist of a raw analysis of two of twelve portrait interviews and of copies of all portraits.

Diabetesassocierade autoantikroppar hos barn med nydiagnostiserad typ 1 diabetes i relation till demografiska och kliniska faktorer

Syftet med studien var att undersöka sambanden mellan de diabetesassocierade autoantikropparna ICA, IAA, GADA, IA-2A och klinisk manifestation, HLA-genotyp, släktanamnes samt demografiska faktorer såsom ålder och kön hos finländska barn under 15 år med nydiagnostiserad typ 1 diabetes. Analyserna baserades på ett utdrag ur det finländska pediatriska diabetesregistret (2257 barn). Antikroppsfrekvenserna fastställdes utgående från halterna i serum. Alla barn HLA-genotypades och indelades i DR3- och DR4-positiva. Småbarnen (?5 år) hade ofta 3-4 positiva antikroppar. Äldre barn hade färre autoantikroppar men en allvarligare metabolisk dekompensering vid diagnostillfället. Diabetisk ketoacidos var vanligare hos flickor. I gruppen med endast en positiv autoantikropp var IA-2A-barnen oftare acidotiska, i övrigt påverkade inte antikroppsprofilen den kliniska bilden. Högriskgenotypen DR4/non-DR3 var associerad med IA-2A, som verkar fungera som en markör för betacelldestruktion. Det omfattande patientmaterialet gav stöd åt tidigare rapporter om samband mellan autoantikroppar och ålder, kön samt genotyp. Den allvarligare metaboliska dekompenseringen hos äldre barn tyder på att de inte diagnostiseras lika snabbt som småbarn.

Sångöversättning – någonstans mellan respekt och slagkraft

Abstract (Song translation. Balancing between respect and hit capacity): The article discusses song translation by posing questions relevant to the study, practice, and assessment of translating/translated song: Is song translation really translation? Do non-singable translations count? Can we distinguish between free and faithful song translation? Are there untranslatable (aspects of) songs? etc. Three song translations between Finnish and Swedish are analyzed in the discussion: one made for a booklet to a recording, which in spite of the evident documentary purpose is fairly singable, one that is a national transplantation, which moves the sung story to the target country but even so is fairly faithful, and one that is considered respectful to its source, became a target culture hit, but perhaps because of the subtle changes in content. Changes can be seen as caused by a particular translation brief, as manipulations negotiating a cultural difference, or as examples of how (liberally) the craft of song translation is exercised. An amateur translation of the same song, made by the article’s author, is deemed dysfunctional for having put emphasis merely on semantic accuracy and rhymes, neglecting other aspects of the craft. The article suggests that singability is a relative concept, that stylistic/intertextual values matter a great deal in song and exert significant influence on song translation, and that source and target attentions in this area can be discussed as a much variable vacillation between a stance of respect and an aim for hit capacity.

Översättningsforskning och framtidsskapande proaktivitet

Abstract (Translation studies and the possibility of future-creating proactivity): Translation researchers often and quite eagerly emphasise the practice-orientedness and usefulness of their field of knowledge as well as the proactive impact which their findings have or will have on modern translation practice. This article adopts, however, a critical view of that kind of a goal for proactive action within translation studies, and advocates a different conception and facet of proactivity. Hence, the question of future-orientedness of translation research is approached and explored from two vantage points: first, from the three Peircean modalities, namely possibility (may-be), (f)actuality (actually-is), and tendenciality (must-be or shouldbe)and second, from a futures semiotic view, according to which a future can be invented, made, or discovered.