Exercise Of Self-determination Research Articles

Causal attributions regarding personal exercise goal attainment in exerciser schematics and aschematics

Key factors motivating persons to adopt and adhere to regular exercise are frequently examined but have not yet been clearly identified. Schema Theory and Attribution Theory have been shown to predict exercise and other health-enhancing behaviors. We examined the role of exercise schemata related to perceived success or failure in self-determined exercise goal and ACSM frequency guideline attainment in an adult sample. The findings supported previous exercise behavior results. Exerciser schematics exercised more frequently, for longer duration per exercise session/bout, and reported higher levels of subjective exercise intensity. Exerciser schematics had higher levels of self-efficacy and positive outcome expectancies for exercise, and were more than four times more likely to rate exercise goal attainment success than failure. Attribution internality, stability, and personal control over exercise were predictive of exerciser schemata and schematics were more likely (OR = 24.16) to meet exercise frequency guidelines. Self-schemas may provide insight into health behavior change variables.

Sustainability and the Urban Forest: An Ecosystem Services Perspective

Recently, urban forests have drawn attention due to interest in the idea that urban forests provide essential ecosystem services. Indeed, urban forests provide the benefits of a natural, cost effective system of green infrastructure: trees capture air and water pollutants, as well as provide shade, habitat, and even social structure. These services have a surprising but significant economic value, and attention to the design of urban forests can be a local means of capturing that value. From an ecosystem services perspective, the urban forest also reveals that the very existence of the nature in the urban area occurs as both a conceptual and a physical construct. That is, trees in the urban area result from intention and design. This essay argues that urban forestry is a local opportunity to engage in an exercise of self-determination and local identity. Urban forestry requires an investigation into the ties between the community's environmental, economic, and social needs, a realization of the potential of space and natural infrastructure, and a manipulation of the services provided by trees. Understanding the nature of urban forests as urban, contingent, and constructed empowers local governments to become ecosystem beneficiaries by effectively bringing nature into their communities.

Self-determination Theory and Exercise Behavior in Cardiac Rehabilitation: A Test of Mediator Variables

Self-determination Theory and Exercise Behavior in Cardiac Rehabilitation: A Test of Mediator Variables

Commentary on “A Modest Proposal for a Basic Agreement on Peaceful Cross-Strait Development” by Chang Ya-chung

This critique assesses Prof. Chang Ya-chung's draft basic agreement for cross-Strait relations by arguing that it overstates changes in Beijing's Taiwan policy, which is based on a strategy that has not seen substantial change since it was devised in the early 1990s to prevent the island's democratization leading to the exercise of self-determination. By over-estimating Taiwan's political, diplomatic, military, and economic vulnerability the proposal unnecessarily narrows down Taibei's options to the point where it has to accept Beijing's one-China principle. This merely closes off other options that Taiwan can just as readily pursue, such as continuing to develop cross-Strait relations through ad hoc solutions to practical problems or seeking more imaginative ways to create a durable modus vivendi with international support. Even more problematic is that a political framework for stability based on the principles of Chinese nationalism is unlikely to be acceptable for Taiwan's liberal-democratic politics and could thus amount to an unnecessary risk that would lead to a less durable cross-Strait status quo than that which has been maintained over the last two decades.

Initial Validity Evidence for the Behavioral Regulation in Exercise Questionnaire-2 Among Greek Exercise Participants

The present study investigated the factor structure, scale dimensionality, discriminant validity, internal consistency, simplex structure, and nomological validity of the Greek translation of the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2; Markland & Tobin, 2004 ). A total of 733 Greek exercise participants completed the translated scale to indicate their reasons for participation in structured exercise programs. Confirmatory factor analyses supported the a priori 5-factor structure with strong internal consistency for the instrument subscales. Further support was obtained for the simplex pattern as well as the nomological correlations of the translated BREQ-2 responses with self-determination theory variables. Overall, the results provided initial support for the psychometric value of the Greek translation of the BREQ-2, rendering it appropriate for continued self-determination exercise research among Greek-speaking exercise participants.

Examining Intrinsic versus Extrinsic Exercise Goals: Cognitive, Affective, and Behavioral Outcomes

Grounded in self-determination theory (SDT), this study had two purposes: (a) examine the associations between intrinsic (relative to extrinsic) exercise goal content and cognitive, affective, and behavioral outcomes; and (b) test the mediating role of psychological need satisfaction in the Exercise Goal Content --> Outcomes relationship. Using a sample of 410 adults, hierarchical regression analysis showed relative intrinsic goal content to positively predict physical self-worth, self-reported exercise behavior, psychological well-being, and psychological need satisfaction and negatively predict exercise anxiety. Except for exercise behavior, the predictive utility of relative intrinsic goal content on the dependent variables of interest remained significant after controlling for participants' relative self-determined exercise motivation. Structural equation modeling analyses showed psychological need satisfaction to partially mediate the effect of relative intrinsic goal content on the outcome variables. Our findings support further investigation of exercise goals commensurate with the goal content perspective advanced in SDT.

Substituting Authenticity for Autonomy

Choosing for incapacitated patients is a major challenge in medicine. Scholars and policy-makers have struggled for years to explain and justify various approaches to determining appropriate treatment for such patients. In this issue, Daniel Brudney makes an important contribution by clarifying a conceptual confusion in the common understanding of the substituted judgment standard. He argues that unlike decisions expressed in advance directives, decisions based on what the patient would want fail to promote self-determination. Instead, they promote authenticity. Brudney is not the first to delineate conceptual and ethical differences between treatment choices in advance directives and choices inferred from an incapacitated patient’s previous beliefs and values. The differences explain why ethical theorists and legal authorities give priority to advance directives over the substituted judgment standard. Brudney’s contribution is a novel account of why inferred treatment choices are distinct from choices expressed by patients themselves. Brudney also questions the conventional view that decisions based on substituted judgment should invariably take priority over those based on a patient’s best interests. Unlike self-determination, authenticity is a value that might be subordinated to other considerations. Brudney ties the value of authenticity to Ronald Dworkin’s notion of integrity and the wish for one’s life to have a coherent narrative. Individuals have an interest in receiving medical care that is consistent with their beliefs and values, but this is only one of several factors that determine an incapacitated patient’s best interests. On Brudney’s analysis, decision-making for patients with no advance directive may require balancing several different values, including authenticity, other elements of the patient’s best interests, and perhaps even the family’s interests. I would extend Brudney’s analysis further than he does. Though acknowledging that “even explicit statements may need interpretation,” Brudney classifies the choices expressed in advance directives as actual expressions of self-determination that should trump the other values that might influence bedside choices. But this element of his analysis conflates two types of choices that should be distinguished. In the medical setting, the paradigm case for an exercise of self-determination is the competent patient making an informed choice among different treatment options. Informed choice requires an understanding of the proposed intervention, its risks and expected benefits, and the risks and expected benefits of any reasonable alternatives. When patients lack this understanding, they cannot exercise genuine self-determination. Before losing capacity, few individuals know what treatment decisions will later emerge, much less how they would experience the relevant burdens and benefits in their incapacitated state. As a result, few advance directives are made with the understanding that underlies genuine self-determination. There are also other reasons to regard most advance directives as less than full-fledged exercises of self-determination. For one, individual beliefs and preferences change over time. It is not unusual for people in declining health to become more accepting of burdens that previously seemed unacceptable, or conversely, to reject burdens they once thought would be tolerable. Psychologists are finding that we are not very good at predicting what will be good or bad for us in the future. It is also difficult to put what are often complex ideas about quality of life and survival into simple declarations. And many advance directives are simply general statements about a person’s values and beliefs; as such, they supply no more guidance than the evidence supporting a treatment decision based on substituted judgment.

Self-Determination of Colonial Peoples – The Case of Greenland Revisited

AbstractIn 1953 Greenland, having been a Danish colony for centuries, became an integral part of the Danish realm. The General Assembly in resolution 849 recognised this change of status as an exercise by the people of Greenland of their right of self-determination. Subsequently, however, some scholars have questioned the validity under international law of Greenland's change of status, referring to non-fulfilment of certain substantive and procedural requirements of the exercise of colonial self-determination. Addressing this criticism the article concludes that, based on the norms and standards applicable at the relevant time, there is not a sufficient basis for challenging the validity of Greenland's integration with Denmark in 1953 and the General Assembly's endorsement thereof. Consequently, in legal terms, Greenland cannot today claim a continued right of external self-determination, including independence from Denmark.

Indigeneity's Challenges to the White Settler-State: Creating a Thirdspace for Dynamic Citizenship

Multiculturalism has been offered as an answer to the civil rights claims of a wide variety of ethnic and national minorities within liberal democratic settler-states. This article adds to the critiques of the appropriateness of multiculturalism in answering the self-determination claims of indigenous populations by investigating biculturalism in Aotearoa/New Zealand. Indigenous groups continue to demand greater recognition not only of sui generis claims to land and resources but also to the acceptance of indigenous philosophies and perspectives in the management of land and resources. As indigenous populations have been forced toward the edge of the state, they have been forced to reassert their cultural values in order to fundamentally reinvent the relationship between colonizer and colonized. This “reinvention” of society, coming from the edges, propelled by indigeneity, is beginning to challenge the construction of the white settler-state. These challenges occur in places, not within arbitrary, theoretical space. They also vary in scale, from the single individual acting on behalf of her community to vast land claims by indigenous peoples. This article discusses how the exercise of indigenous self-determination, observed in specific places, is beginning to transform Aotearoa/New Zealand society into a bicultural and binational partnership, altering the meaning of citizenship for both Māori and whites.

Making Medical Decisions for the Profoundly Mentally Disabled

Back to table of contents Previous article Next article Book ReviewFull AccessMaking Medical Decisions for the Profoundly Mentally DisabledJohn E. Williams M.D.John E. Williams M.D.Search for more papers by this authorPublished Online:1 Jan 2007https://doi.org/10.1176/ps.2007.58.1.149aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This book is the 15th in the Basic Bioethics series edited by Glenn McGee and Arthur Caplan. Norman Cantor, professor of law and justice at Rutgers University School of Law, contributes to this series by analyzing the legal and moral status of people with profound mental disabilities that prevent their exercise of medical self-determination. He focuses on the U.S. law that covers decisions made on behalf of profoundly disabled persons and, especially, what decision-making standards or criteria are applicable. By necessity, he also examines the ethical, moral, cultural, and political factors that apply to this special population and influence the application of these legal boundaries. All professionals who serve this population are familiar with the enormous range of interests about which decisions have to be made by and for people with profound mental disabilities. These range from daily or mundane decisions to lifestyle decisions, such as where to live or work, and life-altering medical decisions, such as whether or not to be a tissue and organ donor or a research subject and end-of-life decisions. The guiding principles for surrogate decision making are outlined in this book and help define its broad audience. The first chapter looks at the concept of personhood for people who lack the capacities of reflection, communication, and interpersonal interaction that our culture commonly associates with rights-bearing people. This basic principle of personhood entitles profoundly disabled people to enjoy full protection of their interests in liberty ( 1 ). Paramount is the right of persons with a profound disability to have a surrogate make decisions for them. Another important aspect of personhood is the entitlement to respect for dignity. These concepts are discussed as a basis for the legal and moral rights of people with profound mental disability and how their consideration imposes significant protections against unconscionable exploitation of this population. The balance of this book concentrates on serious medical and surgical decisions that affect the bodily integrity of people with profound disabilities. These include participation in medical research, abortion and sterilization, organ and tissue donation, and the withholding or withdrawal of life support. Surrogate decision making on these matters is examined not only in light of the above basic principles but also with regard to who is entitled to act as a surrogate decision maker, what standards should the surrogate should apply—substituted judgment, best interests, or some other standard—and the role that human dignity plays in shaping the fate of a patient who has a profound medical disability.Although this book is part of a series on basic bioethics, it is a well-referenced, scholarly work with copious notes and references contained in the last third of the volume for people interested in exploring further the foundations of the applicable legal concepts. This construction allows for a very readable style that students and clinicians will welcome.Cantor's book is a valuable reference not only for professionals who sit on institutional bioethics committees, but also for clinicians who serve people with profound mental disabilities and counsel their surrogate decision makers as they consider important medical issues.Dr. Williams is associate professor of pediatrics at the University of Tennessee College of Medicine, and medical director at the Arlington Developmental Center, Arlington, Tennessee.Reference1. Levy R, Rubenstein L (eds.): The Rights of People With Mental Disabilities: The Authoritative ACLU Guide to the Rights of People With Mental Illness and Mental Retardation. Carbondale, Illinois University Press, 1996Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 58Issue 1 January, 2007Pages 149-150PSYCHIATRIC SERVICES January 2007 Volume 58 Number 1 Metrics PDF download History Published online 1 January 2007 Published in print 1 January 2007

Making Medical Decisions for the Profoundly Mentally Disabledby Norman L. Cantor; Cambridge, Massachusetts, The MIT Press, 2005, 296 pages, $35

Back to table of contents Previous article Next article Book ReviewFull AccessMaking Medical Decisions for the Profoundly Mentally DisabledJohn E. Williams M.D.John E. Williams M.D.Search for more papers by this authorPublished Online:1 Jan 2007https://doi.org/10.1176/ps.2007.58.1.149aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This book is the 15th in the Basic Bioethics series edited by Glenn McGee and Arthur Caplan. Norman Cantor, professor of law and justice at Rutgers University School of Law, contributes to this series by analyzing the legal and moral status of people with profound mental disabilities that prevent their exercise of medical self-determination. He focuses on the U.S. law that covers decisions made on behalf of profoundly disabled persons and, especially, what decision-making standards or criteria are applicable. By necessity, he also examines the ethical, moral, cultural, and political factors that apply to this special population and influence the application of these legal boundaries. All professionals who serve this population are familiar with the enormous range of interests about which decisions have to be made by and for people with profound mental disabilities. These range from daily or mundane decisions to lifestyle decisions, such as where to live or work, and life-altering medical decisions, such as whether or not to be a tissue and organ donor or a research subject and end-of-life decisions. The guiding principles for surrogate decision making are outlined in this book and help define its broad audience. The first chapter looks at the concept of personhood for people who lack the capacities of reflection, communication, and interpersonal interaction that our culture commonly associates with rights-bearing people. This basic principle of personhood entitles profoundly disabled people to enjoy full protection of their interests in liberty ( 1 ). Paramount is the right of persons with a profound disability to have a surrogate make decisions for them. Another important aspect of personhood is the entitlement to respect for dignity. These concepts are discussed as a basis for the legal and moral rights of people with profound mental disability and how their consideration imposes significant protections against unconscionable exploitation of this population. The balance of this book concentrates on serious medical and surgical decisions that affect the bodily integrity of people with profound disabilities. These include participation in medical research, abortion and sterilization, organ and tissue donation, and the withholding or withdrawal of life support. Surrogate decision making on these matters is examined not only in light of the above basic principles but also with regard to who is entitled to act as a surrogate decision maker, what standards should the surrogate should apply—substituted judgment, best interests, or some other standard—and the role that human dignity plays in shaping the fate of a patient who has a profound medical disability.Although this book is part of a series on basic bioethics, it is a well-referenced, scholarly work with copious notes and references contained in the last third of the volume for people interested in exploring further the foundations of the applicable legal concepts. This construction allows for a very readable style that students and clinicians will welcome.Cantor's book is a valuable reference not only for professionals who sit on institutional bioethics committees, but also for clinicians who serve people with profound mental disabilities and counsel their surrogate decision makers as they consider important medical issues.Dr. Williams is associate professor of pediatrics at the University of Tennessee College of Medicine, and medical director at the Arlington Developmental Center, Arlington, Tennessee.Reference1. Levy R, Rubenstein L (eds.): The Rights of People With Mental Disabilities: The Authoritative ACLU Guide to the Rights of People With Mental Illness and Mental Retardation. Carbondale, Illinois University Press, 1996Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 58Issue 1 January, 2007Pages 149-150PSYCHIATRIC SERVICES January 2007 Volume 58 Number 1 Metrics PDF download History Published online 1 January 2007 Published in print 1 January 2007

Cuba mexicana: Historia de una anexión imposible

Recent scholarship has questioned the widespread notion that nineteenth-century Mexico pursued a foreign policy of survival—a policy designed to survive a brutal half-century of civil war, foreign intervention, and territorial annexation (1810–67), followed by liberal modernization unilaterally oriented toward the United States and western Europe. Instead, scholars have reexamined Mexican archival sources in the Secretaría de Relaciones Exteriores to conclude that nineteenth-century Mexican foreign policy was multilateral and surprisingly engaged with relations with other Latin American nations. Following in the footsteps of recent work on Mexican–Central American and Mexican–South American relations, Rojas has examined Mexican diplomatic sources to provide a long-range view of Mexican-Cuban relations between the early 1800s and the War of 1898 that ended Spanish colonial rule over Cuba and brought indirect U.S. rule. The result is a book that pays close attention to diplomatic and cultural ties between two areas of Latin America that shared important linguistic and political similarities, even as they were dissimilar in terms of economy, ethnicity, and race.The reader attracted by the exciting title and expecting to find an account of a Mexican attempt to annex Cuba will be disappointed. The book deals more with the complex Mexican diplomatic attempts to limit great powers in the Caribbean than with efforts to form a Greater Mexico that included Cuba. Rojas traces a careful and modest Mexican diplomacy in three long chapters dealing with New Spain’s financing of the Havana economy, Mexican policy toward Cuban independence movements, and Mexican attitudes vis-à-vis what the author calls the “Cuban nation”—a cultural construct that, according to Rojas, existed almost a century prior to the war of independence that ended in the U.S. intervention of 1898.As the author acknowledges, the Mexican government displayed an ambivalent attitude toward Cuba’s political future, balancing an abstract preference for independence against the potential of a U.S. military presence in an independent Cuba that could be harmful to Mexican national interests as construed by the governing elite. While Mexican officials discussed an outright annexation of Cuba, Rojas acknowledges that such an undertaking was always a most unlikely political project for a government that fought for the survival of the Mexican state during most of the period analyzed here. In the end, the author reinforces the scholarly consensus on Mexican policy toward Latin America in the nineteenth century. While Mexican policy makers stressed their country’s cultural ties to the rest of Spanish America and occasionally defied the imperialist ventures of the European powers and the United States, they were geopolitical realists who recognized the relative weakness of a Mexican projection over an area that was a target of intense imperial rivalry. In the same vein, in the early 1960s, the Mexican government defended the Cuban Revolution in international forums as an exercise of national self-determination, while falling in line with the United States in denouncing communism and Soviet policy. As in the 1800s, the outcome was a tepid defense of Cuban sovereignty against the backdrop of a realistic assessment of Mexico’s weak position in Great Power politics.The specialist in Mexican foreign relations will therefore find much of interest in this book, while noting the absence of any European archival material and even most English-language documents and scholarly literature. Nonspecialist readers who seek an understanding of the foreign policy of nineteenth-century Mexico will be confused by the absence of a clear thesis or even a set of conclusions at the end of the volume.

Environmental Influences on Lower Extremity Muscle Activity During Running

1227 The characteristics of deep water running (DWR) that explain a cross training stimulus to on-land running (Eyestone, Fellingham, George, & Fisher, Am J Spts Med, 21(1), 1993) are not known. Kinematics (Kilgore, dissertation 2003) and physiology (e.g., Svendenhag & Seger, MSSE, 24(10), 1992) during DWR have been studied, but there is no research investigating muscle activity during DWR or if the activity is different than cycling (CYC) relative to on-land running. PURPOSE Investigate magnitude of muscle activity during DWR, treadmill running (TMR), and cycling (CYC). METHODS Five female subjects (mean (std dev): age 26(4.0) yrs; height 1.7(0.1) m; mass 65(5.8) kg) completed TMR, DWR and CYC (on-land) conditions. Unilateral electromyography (EMG) for rectus femoris (RF), vastus lateralis (VL), biceps femoris (BF) and gastrocnemis (GA, lateral head) were recorded (1000Hz) during two levels of self-determined exercise intensity: somewhat hard (Int1) and hard (Int2). Condition order was always TMR, CYC, DWR with Int1 preceding Int2 per mode. During DWR, subjects used a high-knee technique and wore a dry-suit and flotation device (tethered to pool side). For all modes, testing began with subjects self-determining graded intensity until the target intensity was reached with data recorded across 30 seconds at the target intensity. EMG data were processed by removing DC-bias, smoothing (low-pass filter, fc = 100 Hz), and calculating the root mean square magnitude. For each muscle, a repeated measures ANOVA was used to compare EMG across mode (3 levels) and intensity (2 levels). EMG data were normalized to TMR Int1 levels for presentation. RESULTS For all muscles, there was no mode by intensity interaction (Table 1). BF and GA were more active during TMR than CYC and DWR (p<0.05). VL and RF were not different between modes. CONCLUSIONS Any potential benefits of DWR or CYC as a substitute for on-land running do not seem directly related to magnitude of muscle activity. It is conjectured that a training stimulus may be manifested within muscle activation patterns vs. magnitude.Table

Environmental Influences on Lower Extremity Muscle Activity During Running

1227 The characteristics of deep water running (DWR) that explain a cross training stimulus to on-land running (Eyestone, Fellingham, George, & Fisher, Am J Spts Med, 21(1), 1993) are not known. Kinematics (Kilgore, dissertation 2003) and physiology (e.g., Svendenhag & Seger, MSSE, 24(10), 1992) during DWR have been studied, but there is no research investigating muscle activity during DWR or if the activity is different than cycling (CYC) relative to on-land running. PURPOSE Investigate magnitude of muscle activity during DWR, treadmill running (TMR), and cycling (CYC). METHODS Five female subjects (mean (std dev): age 26(4.0) yrs; height 1.7(0.1) m; mass 65(5.8) kg) completed TMR, DWR and CYC (on-land) conditions. Unilateral electromyography (EMG) for rectus femoris (RF), vastus lateralis (VL), biceps femoris (BF) and gastrocnemis (GA, lateral head) were recorded (1000Hz) during two levels of self-determined exercise intensity: somewhat hard (Int1) and hard (Int2). Condition order was always TMR, CYC, DWR with Int1 preceding Int2 per mode. During DWR, subjects used a high-knee technique and wore a dry-suit and flotation device (tethered to pool side). For all modes, testing began with subjects self-determining graded intensity until the target intensity was reached with data recorded across 30 seconds at the target intensity. EMG data were processed by removing DC-bias, smoothing (low-pass filter, fc = 100 Hz), and calculating the root mean square magnitude. For each muscle, a repeated measures ANOVA was used to compare EMG across mode (3 levels) and intensity (2 levels). EMG data were normalized to TMR Int1 levels for presentation. RESULTS For all muscles, there was no mode by intensity interaction (Table 1). BF and GA were more active during TMR than CYC and DWR (p<0.05). VL and RF were not different between modes. CONCLUSIONS Any potential benefits of DWR or CYC as a substitute for on-land running do not seem directly related to magnitude of muscle activity. It is conjectured that a training stimulus may be manifested within muscle activation patterns vs. magnitude.Table

Words have power: (re)-defining serious emotional disturbance for American Indian and Alaska Native children and their families.

Circles of Care grantees were provided the opportunity to develop a locally relevant definition of serious emotional disturbance that would be used to define what type of emotional, behavioral, and mental disability would be required to receive services. After conducting detailed assessments of the definition in the guidance for applicants GFA and the definitions used by others in their respective states, seven of the nine grantees developed their own local, project-specific definitions through the participation of community focus groups and Advisory Councils. The six definitions for SED developed by rural grantees all included American Indian and Alaska Native concepts specific to each tribal community's culture; the urban grantee's definition was purposely focused for reaching out to non-professional members of the community. This opportunity for the communities to redefine SED not only provided each community with a definition which would be more culturally specific, but also proved to be an extraordinarily exercise in empowerment and self-determination.

Do Autonomous Exercise Regulations Underpin Different Types of Exercise Imagery?

The purpose of this study was to examine the relationship between exercise regulations varying in self-determination and exercise imagery. Female Canadian university exercise participants (N = 165) completed measures of exercise regulations and exercise imagery following an exercise class. Descriptive statistics indicated participants held more self-determined reasons for exercise participation in the form of greater endorsement of both identified and intrinsic exercise regulations, as well as reporting more frequent use of appearance related exercise imagery. Canonical correlation analysis revealed two significant canonical functions (Rc1 =. 47, Rc2 =. 30). The first function suggested that more self-determined exercise regulations were associated with both appearance and technique imagery, while the second function revealed that introjected regulation was most strongly associated with appearance-related imagery. Collectively, these data suggest that the content of exercise imagery can be understood within a theoretical framework that clarifies the functional role played by different images in exercise promotion based upon their motivational foundations.

Leadership and Self-Determination

This article briefly reviews attributes and elements identified in the literature for promoting the self-determination and self-advocacy of people with disabilities. In addition, to identify which elements of self-determination and self-advocacy are discussed as elements of effective leadership, a small portion of the general leadership literature is also reviewed. Of specific interest is determining which self-determination practices that have emerged in the literature devoted to people with disabilities also appear in the general leadership literature as essential, generic leadership practices. Conceptual distinctions are drawn among the notions of self-determination, self-advocacy, empowerment, and leadership. A number of conclusions are drawn and are supported by the review, suggesting that (a) self-determination and self-advocacy are essential to effective leadership based on the frequency with which attributes of self-determination are identified as elements of effective leadership; (b) leadership involves skills, competencies, and strategies that focus on collective action to achieve common goals, whereas self-determination and self-advocacy typically focus on individual action directed toward personal goals; and (c) effective leadership is fundamentally an exercise in collective self-determination. Recommendations to increase the focus and attention to the leadership development of people with developmental disabilities are suggested.

Use of a DNR order over family objections: the case of Gilgunn v. MGH.

After the U.S. Supreme Court's 1990 Cruzan[1] decision there is a clear consensus in our society that patients are free to decline any and all medical treatments. Still unresolved is the pressing question of physician refusal of requested life-sustaining treatment. What is involved in this issue is not only the limits, if any, on the exercise of self-determination, but the role of professional integrity and the physician's commitment “to do no harm”[2]. Despite a plethora of articles on the topic of physician refusal of ineffective or so-called futile treatment, there is still no definitive court ruling on the subject nor a consensus in the bioethics or medical communities on the issue [3]. The early legal disputes between physicians and families on refusal to provide requested treatment such as Baby L[4], Wanglie[5], or BabyK[6] did not directly confront the issue. During the trial court hearing Baby L was transferred to a physician willing to treat her as the parents requested. In Wanglie, the probate court addressed only the question of replacement of the husband as guardian. The court was not asked nor did it discuss the question of termination of treatment. Baby K, in which a federal appeals court upheld a mother's right to have ventilatory support for her anencephalic infant daughter, was decided on a narrow statutory interpretation of the Emergency Medical Treatment and Active Labor Act's requirement that a patient presenting in an emergency room with a life-threatening medical condition must be stabilized before consideration of a transfer. That court never directly addressed the dilemma faced by intensivists who are asked to provide treatment thought to be ineffective or “futile”[7]. Decision making in such cases is neither an issue of physician domination nor solely that of patient self-determination. Choices about treatment options are not exclusively scientific judgments. They are, rather, value assumptions about the nature and worth of life, and as such they belong to a broader community than medicine alone. The question is not whether but which value judgments physicians may use in determining whether to follow patient demands. It is not the personal predilections of the provider or the idiosyncratic views of the patient but the common social sense of what practices are to prevail. Those questions, as Tomlinson and Brody [8] note, signal a turn away from individual toward social conceptions of the reasonableness and worthwhileness of the proposed procedure. Giligunn v. Massachusetts General Hospital is the first case in which a jury was asked to assess the legitimacy of the values involved in a physician's refusal to attempt CPR in an elderly comatose patient with multiple medical problems for whom the physician believed the procedure would be ineffective.

U.S. Citizenship: The American Policy to Extinguish the Principle of Lakota Political Consent

In the formative years of the Lakota-American relationship, it was the expected norm of the Lakota that the United States must secure their consent prior to any U.S. policy decision which would effect the Lakota. Thus the formative years of Lakota-American interactions are replete with examples of treaties and agreements which recognized this norm of obtaining Lakota political consent. However, in the contemporary Lakota-American relationship, the historically established norm of Lakota consent is no longer a viable part of this relationship. U.S. policy decisions, which impact Lakota society, are unilaterally implemented without Lakota consent. For example, Lakota males who are eighteen must register for the U.S. military draft as a condition to receiving federal aid for education. If applying the norm of the formative years today, the United States would have to secure the consent of the Lakota that, registering for the draft is a condition that Lakota males must meet in order to receive federal aid for their education. The use of this example is important because the Lakota and the United States have already agreed on the question of federal aid for education with respect to the Lakota people. Specific provisions in a previous agreement have already committed the United States to financing the education of the Lakota people. The United States, as a condition for a peace settlement with the Lakota, agreed to the Lakota demand that the United States would provide educational facilities, personnel, and scholarships for Lakota education.1 Thus, the draft registration represents an additional condition to what the Lakota had initially agreed. The question of why Lakota consent is missing in the contemporary Lakota-American relationship is the subject of this paper. For the Lakota, political consent is an important principle in their exercise of self-determination, especially when U.S. policy decisions such as the draft registration condition for federal aid discards Lakota consent. Hence, my thesis is that the Federal policy of granting U.S. citizenship to Lakota people is, in effect, a policy to extinguish the principle of Lakota political consent by politically incorporating the Lakota into the body politic of the United States. One of the objectives of this thesis is to disclose how the political incorporation of the Lakota people into the American political system is inconsistent with the political realities of the world today. Thus this paper will discuss three topics, the history of political incorporation through U.S. citizenship, U.S. citizenship and its application to extinguish Lakota political consent, and Lakota political coexistence in the United States.

Informed consent in theory and practice

The theoretical, legal, and medical doctrines of informed consent are analyzed. The elements of informed consent include disclosure of information, competency, understanding, voluntariness, and decision-making. The doctrine is ground in deference to individual autonomy and recognition that the exercise of self-determination in matters of health is a liberty interest honored by our history and traditions. The exceptions to informed consent including emergency, incompetency, therapeutic privilege, and waiver are especially important in critically ill patients and reflect a balancing of autonomy values and society's interest in the promotion of health. Legal decisions inevitably are based on atypical physician-patient encounters and focus on a particular problem or procedure rather than on overall medical care. In addition, they often reflect an artificial view of the doctor-patient relationship. Medical decision-making is a complex, evolving pursuit of a diagnosis and proper treatment regimen. Moreover, patients are not always interested in the role assigned to them by law. A reconceptualization of informed consent doctrines utilizing sliding scale standards based on variables pertinent to each individual patient is suggested.