Debate: Involuntary treatment - not whether, but when and what else is needed.

Involuntary treatment is a complex dialectic balancing self-autonomy and the individual's right to consent to treatment with society's duty to protect those suffering from severe mental illness who are at risk of causing harm to themselves or others. When necessary, involuntary treatment should provide evidence-based and medically justified care, with sufficient oversight and due process to protect the rights of patients. Clinically, the issue is not whether involuntary treatment should ever be used, but rather what other services are needed to enhance the quality of care within comprehensive community systems of care, thus limiting or preventing the need for involuntary interventions while also improving the outcomes of individuals affected by severe mental illness.

Health Risks of Unaccompanied Immigrant Children in Federal Custody and in US Communities.

Unaccompanied immigrant children continue to arrive at the US-Mexico border and are at high risk for ongoing abuse, neglect, and poor mental and physical health. We are medical and legal experts in the fields of immigrant and refugee health, child abuse, and the legal rights of international refugee and migrant children. We provide an overview of US federal agencies with custody of unaccompanied immigrant children, a summary of medical care provided while in custody, and recent findings from the independent Juvenile Care Monitor Report mandating new custodial conditions for immigrant children while in federal custody. We provide recommendations to improve the health and well-being of unaccompanied immigrant children while in custody and once released to US sponsors. (Am J Public Health. 2024;114(3):340-346. https://doi.org/10.2105/AJPH.2023.307570).

Understanding the Legal Rights and Mental Health Needs of Unaccompanied Immigrant Children in US Government Custody and Beyond.

This article addresses the mental health rights of unaccompanied children, the ways in which the US immigration system does not sufficiently support children's mental health, and how clinicians can play a role in meeting immigrant children's mental health needs.

Global Health Impact: Human rights, access to medicines, and measurement.

Should people have a legal human right to health? And, if so, what exactly does protecting this right require? This essay defends some answers to these questions recently articulated in Global Health Impact. It explains how these answers depend on a particular way of thinking about health and the minimally good life, how quality of life matters at and over time, what various agents should do to help people who are unable to live well enough, and many other things. Moreover, it suggests some ways of improving common metrics for measuring and advancing our collective global health impact.

From moral rights to legal rights? Lessons from healthcare contexts.

Many believe the existence of a moral right to some good should lead to recognition of a corresponding legal right to that good. If, for instance, there is a moral right to healthcare, it is natural to believe countries should recognize a legal right to healthcare. This article demonstrates that justifying legal rights to healthcare is more difficult than many assume. The existence of a moral right is insufficient to justify recognition of a corresponding justiciable constitutional right. Further conditions on when it is appropriate to recognize constitutional rights are rarely satisfied in the healthcare case. And focusing on aspirational or statutory rights presents costs for those seeking to justify legal rights on the basis of corresponding moral ones while maintaining empirical challenges for justifying constitutional rights. This suggests movement from a moral right to a corresponding legal one is far from straightforward and justifies examining alternative means of realizing moral socio-economic rights such as the proposed moral right to healthcare.

Stopping the Vicious Cycle: Equitable Enforcement Strategies to Achieve Safe, Stable, and Accessible Housing for People with Disabilities.

Policy Points People with disabilities experience a vicious cycle of poverty, poor health, and marginalization partly because of the inequitable implementation and enforcement of laws, including underenforcement of civil rights and housing laws and overenforcement of punitive nuisance and criminal laws. Inequitable enforcement reflects policy choices that prioritize powerful entities (e.g., landlords, developers) to the detriment of people who experience intersectional structural discrimination based on, for example, race, disability, and income. Equitable enforcement, a process of ensuring compliance with the law while considering and minimizing harms to marginalized people, can promote health and disability justice by increasing access to safe, stable, and accessible housing.

Brain Data in Context: Are New Rights the Way to Mental and Brain Privacy?

The potential to collect brain data more directly, with higher resolution, and in greater amounts has heightened worries about mental and brain privacy. In order to manage the risks to individuals posed by these privacy challenges, some have suggested codifying new privacy rights, including a right to "mental privacy." In this paper, we consider these arguments and conclude that while neurotechnologies do raise significant privacy concerns, such concerns are-at least for now-no different from those raised by other well-understood data collection technologies, such as gene sequencing tools and online surveillance. To better understand the privacy stakes of brain data, we suggest the use of a conceptual framework from information ethics, Helen Nissenbaum's "contextual integrity" theory. To illustrate the importance of context, we examine neurotechnologies and the information flows they produce in three familiar contexts-healthcare and medical research, criminal justice, and consumer marketing. We argue that by emphasizing what is distinct about brain privacy issues, rather than what they share with other data privacy concerns, risks weakening broader efforts to enact more robust privacy law and policy.

A Teoria dos Fundamentos Morais e as eleições presidenciais brasileiras em 2018 e 2022 / The Moral Foundations Theory and the Brazilian Presidential Elections in 2018 and 2022

A Teoria dos Fundamentos Morais postula que liberais e conservadores são orientados por fun-damentos morais distintos, o que pode ser usado como estratégia de persuasão política, bem como influenciar no comportamento de voto. No presente trabalho, realizamos quatro estudos. Os participantes responderam a um instrumento online composto pelo Questionário de Funda-mentos Morais, uma medida de intenção de votos e informaram dados demográficos. Nos estu-dos foram identificados que a tendência individualizante influenciou a intenção de votos a can-didatos de esquerda, enquanto a tendência coesiva influenciou a intenção para candidatos de direita nas eleições presidenciais de 2018 e 2022. Conclui-se que a TFM é um modelo robusto para compreensão de aspectos do comportamento político brasileiro. (AU)

The Moral Foundations Theory postulates that liberals and conservatives are guided by distinct moral foundations, which can be used as a strategy for political persuasion, as well as influ-encing voting behavior. In the present paper, we carried out four studies. Participants re-sponded to an online instrument composed of the Moral Foundations Questionnaire, their in-tention to vote, to assign the position to candidates for the presidency, and their demographic data. The studies identified that the individualizing foundations influenced the intention to vote for left-wing candidates, while the binding foundations influenced the intention to vote for right-wing candidates in Brazil's 2018 and 2022 presidential elections. Therefore, the MFT is a robust model for understanding aspects of Brazilian political behavior. (AU)

O que falam as pessoas com deficiência: uma análise das barreiras e facilitadores sociais do acesso à saúde e garantia de direitos no município de Francisco Morato / What people with disabilities say: an analysis of the barriers and social facilitators of access to health and guarantee of rights in the municipality of Francisco Morato

Este trabalho teve como objetivo apresentar as barreiras e facilitadores em relação ao acesso de pessoas com deficiência (PCD) aos serviços de saúde do município de Francisco Morato. A temática da pessoa com deficiência foi priorizada pela gestão municipal por ser fundamental para garantir o direito à saúde e evidenciar as dinâmicas de trabalho em saúde presentes na Rede SUS do município. A pesquisa teve seu desenvolvimento através de entrevistas semi-estruturadas com gestores, gerentes, profissionais de saúde, usuários PCD e cuidadoras, sendo desenvolvida de acordo com os preceitos éticos. Para a realização da pesquisa foi utilizado como método a abordagem qualitativa para análise de discurso. Os temas abordados nas entrevistas geraram três categorias de análise, sendo elas Assistência à Saúde, Participação Social e Políticas Públicas da cidade de Francisco Morato. A pesquisa revelou elementos que influenciam na aparição de barreiras ou facilitadores, sendo eles as articulações entre os níveis de saúde, as práticas de acolhimento e a comunicação entre os atores sociais participantes, as relações interpessoais, a sensibilidade da gestão do município e as políticas públicas que promovem garantia de direitos.

Denegación de cambio de sexo registral: comentario al Auto del Magistrado del Registro Civil Único de Las Palmas de Gran Canaria de 18/09/2023 / [Denial of change of registration sex: comment to the Order of the Magistrate of the Single Civil Registry of Las Palmas de Gran Canaria of 09/18/2023]

El presente trabajo analiza el Auto 1045/2023, de fecha 18 de septiembre. Resolución que iba a suponer, a la postre, la denegación de la solicitud de un ciudadano que había pretendido, amparándose en Ley 4/2023, del 28 de febrero, una rectificación registral de la mención relativa al sexo, de varón a mujer, conservando su nombre. (AU)

This work analyzes Auto 1045/2023, dated September 18th. This resolution was going to result in the denial of a citizen’s request who, relying on Law 4/2023, dated February 28th, had sought a registry correction regarding gender, from male to female, while retaining his name. (AU)

Vulneración de Derechos Fundamentales por práctica de la interrupción voluntaria del embarazo en una comunidad autónoma distinta a la de residencia: comentario a la Sentencia 78/2023, de 3 de julio de 2023, del Tribunal Constitucional / [Violation of Fundamental Rights due to the practice of voluntary interruption of pregnancy in an autonomous community other than that of residence: comment on Sentence 78/2023, of July 3, 2023, of the Constitutional Court]

El presente trabajo estudia la Sentencia 78/2023, de 3 de julio de 2023, del Tribunal Constitucional, que analiza la práctica de interrupción voluntaria del embarazo en una comunidad autónoma distinta a la de residencia. La cuestión principal radica en apreciar una vulneración a la garantía de interrumpir voluntariamente el embarazo dentro de los supuestos legales, como parte del contenido constitucionalmente protegido del derecho fundamental a la integridad física y moral (art. 15 CE). (AU)

This paper studies Judgement 78/2023, of 3 July 2023, of the Constitutional Court, which analyzes the practice of voluntary termination of pregnancy in an autonomous community other than that of residence. The main question lies in assessing a violation of the guarantee of voluntary termination of pregnancy within the legal circumstances, as part of the constitutionally protected content of the fundamental right to physical and moral integrity (art. 15 CE). (AU)

Estimating the value of democracy relative to other institutional and economic outcomes among citizens in Brazil, France, and the United States.

How much do citizens value democracy? How willing are they to sacrifice their liberties and voting rights for growth, equality, or other social outcomes? We design a conjoint experiment in nationally representative surveys in Brazil, France, and the United States in which respondents choose between different societies that randomly vary in their economic outcomes (country income, income inequality, social mobility), political outcomes (democracy, public health insurance), and the level of personal income for each respondent. Our research allows us to estimate the respondents' willingness to trade off democracy for individual income (as well as other societal attributes). We find that, on average, individuals are strongly attached to democracy and a robust welfare state. They prefer to live in a country without free democratic elections only if their individual income multiplies by at least three times and in a country without public health insurance only if their individual income more than doubles. After estimating these preferences at the individual level for all respondents, we show that, although there is an authoritarian minority in all three countries, forming a nondemocratic majority (by offering more income and/or other goods to respondents) is very unlikely. Our findings imply that, contrary to a growing discussion about the crisis of democracy, liberal democratic values remain substantially robust in high and middle income democracies.

Digitalización de la comunicación y atención a personas LGBTIQ+: dos conflictos éticos emergentes para la Psicología en la Atención Primaria de Salud chilena / Digitalització de la comunicació i atenció a persones LGBTIQ+: dos conflictes ètics emergents per a la psicologia en l'Atenció Primària de Salut xilena / Digitalization of communication and attention to LGBTIQ+ people: Two emerging ethical conflicts for psychology in Chilean Primary Health Care

El artículo analiza los conflictos éticos detectados por Psicólogas/os en la Atención Primaria de Salud en Chile, centrando la descripción y análisis en los percibidos como emergentes, a través de un estudio cualitativo, tipo exploratorio-descriptivo. Dos fueron los principales conflictos identificados: a) resguardo de información sensible en ficha clínica electrónica y b) atención a personas LGBTIQ+ sin capacitación correspondiente. El estudio transparenta la importancia de visibilizar demandas incipientesen salud pública a través de las perspectivas de los propios profesionales, dotándoles de notoriedad para avanzar en su priorización y resolución. Explorar la dimensión ética es relevante para el ejercicio de la psicología contemporánea, porque da cuenta de las necesidades de la sociedad, permitiendo incluso anticiparse a ellas.(AU)

L'article analitza els conflictes ètics detectats pels psicòlegs en l'Atenció Primària de Salut a Xile, centrant-se en la descripció i anàlisi dels que es perceben com a emergents mitjançant un estudi qualitatiu de tipus exploratori-descriptiu. Es van identificar dos conflictes principals: a) la protecció de la informació sensible en els registres clínics electrònics i b) l'atenció a persones LGBTIQ+ sense la formació adequada. L'estudi destaca la importància de fer visibles les demandes incipients en la salut pública a través de les perspectives dels mateixos professionals, donant-los rellevància per avançar en la seva prioritat i resolució. Explorar la dimensió ètica és rellevant per a l'exercici de la psicologia contemporània, ja que reflecteix les necessitats de la societat, fins i tot permetent anticipar-se a elles.(AU)

The article analyzesthe ethical conflicts detected by psychologists in Primary Health Care in Chile, centering the description and analysis on those perceived as emerging, through an exploratory-descriptive qualitative study. There were two main conflicts identified: a) safeguarding of sensitive information in electronic clinical records and b) healthcare for LGBTIQ+ persons without the corresponding qualification. The study illustrates the importance of highlighting developing demands in public healthcare through the perspectives of the professionals themselves, providing the demands with notoriety in order to advance in their prioritization and resolution. Exploring the ethical dimension is relevant for contemporary psychology practice because it accounts for the needs of society, even making it possible to anticipate them.(AU)

¿Cómo afectan la Ley 8/2021 y la ley 6/2022 a la investigación biomédica desarrollada en España? / ¿Com afecten la Llei 8/2021 i la Llei6/2022 a la investigació biomèdica desenvolupada a Espanya? / How do Act 8/2021 and Act 6/2022 affect biomedical research carried out in Spain?

La implementación de la Convención de Derechos de las Personas con Discapacidad obliga a los Estados Partes a realizar reformas legales que afectan a las normas que regulan la participación de las personas con discapacidad en la investigación biomédica clínica, en especial en los ensayos clínicos con medicamentos. En España, se ha tenido que reformar el Código Civil y la Ley General de Derechos de las Personas con Discapacidad para adecuar el ejercicio de la capacidad jurídica y para garantizar la accesibilidad cognitiva. Estas reformas podrían servir como modelo de las reformas que deben implementarse en otros países.(AU)

La implementació de la Convenció dels Drets de les Persones amb Discapacitat obliga als Estats Parts a realitzar reformes legals que afecten les normes que regulen la participació de les persones amb discapacitat en la investigació biomèdica clínica, especialment en els assaigs clínics amb medicaments. A Espanya, s'ha hagut de reformar el Codi Civil i la Llei General de Drets de les Persones amb Discapacitat per adequar l'exercici de la capacitat jurídica i garantir l'accessibilitat cognitiva. Aquestes reformes podrien servir com a model per a les reformes que han d'implementar-se en altres països.(AU)

The implementation of the Convention on the Rights of Persons with Disabilities obliges the States Parties to carry out legal reforms that affect the norms that regulate the participation of persons with disabilities in clinical biomedical research, especially in clinical trials with drugs. In Spain, the Civil Code and the General Act on the Rights of Persons with Disabilities have had to be reformed to adapt the exercise of legal capacity and to guarantee cognitive accessibility. These reforms could serve as a model for reforms to be implemented in other countries.(AU)

Crime and victimization outcomes following civil rights limits to the use of compulsory treatment.

Community treatment orders (CTOs) have been associated with reduced crime/victimization-risk. Australia's ratification of the U.N. Convention on the Rights of Persons with Disabilities (CRPD) enabled patient-rights-advocacy to limit CTO-assignment to persons lacking decision-making-capacity. This effort was accompanied by a 15% reduction in CTO-utilization. Has this change affected crime/victimization-involvements of patients with schizophrenia-diagnoses? In Victoria Australia, the study considers crime/victimization-involvement among three patient-groups recruited with the same sampling-algorithm in the decade before (2000-2009, N = 14,711) and after (2010-2019, N = 10,702) CRPD-ratification. Each group is its own-control. Each group's positive-outcome across decades would be "no increase" in crime/victimization-involvement or in the ratio of the group's incident-rates to the State's. Following CRPD-ratification, first-hospitalized-patients with at least one CTO-assignment doubled their involvement in major crime-perpetrations (from 13% to 27%), non-CTO-hospitalized-patients almost doubled (from 10% to 18%), and 11% of outpatients were involved when none were before. Overall, a third (34%) were victimized-by-major-crime up from 28%, with 25% of outpatients experiencing victimization when none had before. Increases were most evident in major-crimes, led by assaults/abductions. Capacity-constraints on compulsory-treatment are associated with increases in crime/victimization-involvement, a transfer of responsibility for patients with schizophrenia-diagnoses from the mental-health-system to the criminal-justice-system, validation of dangerousness stereotypes, and growing negative family impact.