Browsing by Subject "Autonomy"

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  • Jayanti, Anuradha; Neuvonen, Markus; Wearden, Alison; Morris, Julie; Foden, Philip; Brenchley, Paul; Mitra, Sandip; BASIC-HHD Study Grp (2015)
    Background: Medical decision-making is critical to patient survival and well-being. Patients with end stage renal disease (ESRD) are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients seek involvement in the decision-making process and factors which influence these in ESRD need to be understood. Methods: 535 ESRD patients were enrolled into the cross-sectional study arm and 30 patients who started dialysis were prospectively evaluated. Patients were enrolled into 3 groups-'predialysis' (group A), 'in-centre' haemodialysis (HD) (group B) and self-care HD (93 % at home-group C) from across five tertiary UK renal centres. The Autonomy Preference Index (API) has been employed to study patient preferences for information-seeking (IS) and decision-making (DM). Demographic, psychosocial and neuropsychometric assessments are considered for analyses. Results: 458 complete responses were available. API items have high internal consistency in the study population (Cronbach's alpha > 0.70). Overall and across individual study groups, the scores for information-seeking and decision-making are significantly different indicating that although patients had a strong preference to be well informed, they were more neutral in their preference to participate in DM (p <0.05). In the age, education and study group adjusted multiple linear regression analysis, lower age, female gender, marital status; higher API IS scores and white ethnicity background were significant predictors of preference for decision-making. DM scores were subdivided into tertiles to identify variables associated with high (DM > 70: and low DM ( Conclusion: ESRD patients prefer to receive information, but this does not always imply active involvement in decision-making. By understanding modifiable and non-modifiable factors which affect patient preferences for involvement in healthcare decision-making, health professionals may acknowledge the need to accommodate individual patient preferences to the extent determined by the individual patient factors.
  • Akintug, Hasan (Helsingin yliopisto, 2017)
    This thesis aims to provide an analysis of the decision of the Parliament of Åland to join the European Union in 1994. The chosen time frame is the period between the Korfu Summit on 24 June 1994 and the decision of the Parliament to join on 2 December 1994. While the EU process has its roots at the end of the Cold War and Finland’s membership to the Council of Europe in 1989, this timeline is chosen to emphasize the deliberative process in which Åland decided to join the European Union. The theoretical approach is discourse analysis as foreign policy analysis by Ole Waever. This rests on the post structuralist understandings of language which due to its constitutive power can be used to explain the foreign policy choices which lie upon historical and identarian legacies. This is done by analysing the relationship between the “core concepts” such as “state” and “nation” with “Europe” in which the national identity is constructed upon. This thesis aims to analyse the Ålandic decision to join the EU by using 7 parliamentary debates as primary data alongside newspaper articles to construct a chronology of the referendum process while at the same time adjusting Waever’s framework to suit the regional context of Åland. This study shows that the Ålandic EU debate took place in a context in which the Regional Parliament had to consider the choices of its immediate environment and the lack of enthusiasm of the Ålandic voter. On the pro EU camp, the prospect of EU membership was understood as new field for Åland’s external relations, an economic opportunity and further recognition of Åland’s status according to international law. The anti-EU camp drew arguments from a fear of centralisation, transferring legislative authority and concern regarding the competences of the EU in agriculture and fisheries. This study also shows that the choice of certain arguments was structured by the regional parties’ conceptualisation of Europe and the relationship between that and their conceptualisation of “autonomy” and the “people” which are in turn constructed by the two main cleavages on Åland: the autonomy policy cleavage and the urban-rural cleavage.