Individual Requests Research Articles

Magyarországi helyzetkép az alternatív gondoskodás lehetőségeiről, különös tekintettel a gyermekotthoni, nevelőszülői elhelyezésre

In this study, we compare institutional and foster care. The method chosen is a secondary analysis of statistical data. In the study, we seek to answer the question of how the number of places, the number of children, the age composition of children, the duration of placement and the type of placement vary in Hungary and in the Northern Great Plain region. We analyse data for the years 2014, 2021 and 2023 in terms of deinstitutionalisation and present the current situation of child protection care alongside the trends in institutional restructuring in recent years. A further aim of our comparative analysis is to review the number of cases of runaways from care in recent years, assuming that they occur less frequently in foster care. For the analysis, we have primarily used data for the years 2014, 2021 and 2023. In some places, the year 2020 was analysed due to data availability. We have used publicly available data series from the KSH, as well as data recorded on the basis of individual data requests according to the KSH OSAP Form 1208, which contains data provided by child protection centres based in the respective counties.

Factors affecting decisions of an HMO Drug Exemptions Committee on individual patient requests for coverage of non-formulary drugs

BackgroundIn Israel, coverage of health needs is delivered by four health maintenance organizations (HMOs), which are budgeted by the government according to the recommendations of the National Drug Formulary (NDF) Committee. For medications not listed in the NDF, individuals may request to cover the costs by the HMO Exemptions Committee (DEC). The objectives of the current study, a first of its kind, are to document the DEC decision process, to identify its components and to determine the decisions’ clinical outcome.MethodsThis retrospective cohort study included all members (≥ age 18) of the Maccabi Healthcare Service (MHS) who submitted a request to the DEC between June 2017 and December 2018. Collected data include patient demographics, clinical information and components of the decision process. Decision success (i.e., clinical outcome correlated with DEC decision) was determined by clinical outcome over at least one-year follow-up.ResultsA total of 335 requests were included. Strong evidence and rare disease were positively associated with approvals, while the availability of alternative treatments and costs were negatively associated. The majority of decisions (75%) met predicted clinical outcomes. Only estimated costs were found to be associated with decision success.ConclusionsFactors that reduce the potential costs of a requested drug are significantly associated with higher odds for drug approval, but only when the evidence supports potential benefit.

P-337 Ready for polygenic risk scores? An analysis of regulation of preimplantation genetic testing in seven European countries

Abstract Study question Would the different regulatory approaches for preimplantation genetic testing (PGT) in Europe permit the implementation of preimplantation genetic testing using polygenic risk scores (PGT-P)? Summary answer While the regulatory approaches for PGT differ between countries, the latitude for potential implementation of PGT-P seems limited in all three regulatory models. What is known already PGT allows for the testing of embryos for hereditary genetic disorders and chromosome abnormalities before implantation. Application of PGT has been seen as ethically sensitive in many European countries. An emerging development within the field of PGT, namely PGT using polygenic risk scores (PGT-P), currently brings new ethical tensions to the forefront. It is unclear whether PGT-P may be applied within the current regulatory frameworks in Europe. A clear overview of legal and practical regulation of PGT in European countries is lacking. It is important to understand current regulatory frameworks in Europe and determine whether PGT-P fits within these frameworks. Study design, size, duration The aim of this study was to provide an overview of the legal and practical regulation of PGT in seven selected European countries (Belgium, France, Germany, Italy, the Netherlands, Spain and the United Kingdom) and critically analyse the different approaches with regards to regulatory applicability and opportunities for PGT-P. Participants/materials, setting, methods We have investigated the legal and regulatory aspects of PGT by analysing legal documents, regulatory frameworks, scientific articles, and guidelines from scientific organizations and regulatory bodies to gather relevant information about each included country. The main sources of information were national laws relating to PGT. We divided the PGT regulatory approaches of the included countries into models. Main results and the role of chance The regulation of PGT differs per country and can be divided into three models. Some countries require central approval of PGT for each new indication (the medical indication model: the United Kingdom, the Netherlands), some countries evaluate each individual PGT request at the local level (the individual requests model: France, Germany), and other countries largely leave decision-making about clinical application of PGT to healthcare professionals (the clinical assessment model: Belgium, Italy, Spain). In the countries surveyed that use the medical indication model and the individual requests model, current legal frameworks and PGT criteria seem to exclude PGT-P. There might be more opportunities for potential PGT-P implementation in countries using the clinical assessment model. However, the fact that healthcare professionals and scientific organizations in Europe are generally negative about implementation of PGT-P due to scientific and socio-ethical concerns, suggests that, even if it were legally possible, the chance that PGT-P would be offered in these countries in the near future appears to be low. Limitations, reasons for caution Our analysis focuses on seven European countries. While these countries differ in their regulatory approaches to PGT, a certain diversity may be missing from our analysis. The analysis is based on publicly available information and documents, meaning certain insights into the practical regulation of PGT might be missing. Wider implications of the findings Our analysis of how PGT-P fits within current regulatory models provides guidance for healthcare professionals and policymakers in navigating the possible future implementation of PGT-P within Europe. The approach used of identifying regulatory models provides a useful way to think about the regulation of reproductive genetic technologies at large. Trial registration number Not applicable

ACADEMIC CULTURE OF FUTURE PIANISTS: INTERPRETATION OF THE ESSENCE

The academic culture of a pianist is one of the specialized forms of culture. That is due to the division of labor and the delimitation of mental and practical activity spheres. The generalization of scientific research has revealed a systematic approach to interpreting the concepts of "culture" and "academic culture." Still, no unambiguity has been found in understanding the concept of the "academic culture of the pianist." The article aims to study the essence and structure of the concept of the "academic culture of the future pianist." Research methods: theoretical analysis of scientific sources in philosophy, pedagogy, music, and piano art to identify the characteristic features in the definition of the concept of "academic culture of the future pianist," structural and logical analysis to identify the structural components of this phenomenon. It is substantiated that the academic culture of the future pianist should be understood as a socially conditioned, dynamic personal formation that is formed in the environment of a higher education institution and manifests itself in the system of formed value orientations (to musical art, to music and pedagogical activities, to the personality of students and students), a dynamic system of general (in the field of music education) and special knowledge (about the methods and methods of specific activities, including musical, performing, and piano), including musical, performing, pedagogical), skills (cognition of musical art; perception, performance, creation of music, communication with artistic samples of culture), as well as in the pursuit of creative self-realization in musical activity. It is shown that the complexity and originality of the phenomenon of the "academic culture of future pianists" determine the peculiarities of its formation simultaneously in three spaces: general cultural, general pedagogical, and musical-pedagogical, and the formation of the academic culture of future pianists takes place in an academic environment that takes into account the system of individual requests of pianists for academic education and is addressed within professional educational professional programs.

SMART MARKETING AND GLOBAL LOGISTICS NETWORKS

In the context of the global digital transformation, new communication systems are being formed based on networking and platforms, increased attention to environmental issues and social needs of the population. The purpose of the article is to identify the peculiarities of smart marketing development in the context of global logistics networks. Using the methods of system analysis, the article summarises the processes of spreading smart technologies at all stages of marketing: from smart supply to smart consumption. Graphical visualisation confirms the growth of spending on the latest information technologies in marketing strategies. The essence of the smart marketing concept is revealed: it is becoming digitised and focused on sustainable development, based on personalisation of offers and advertising, acceleration of the purchase or delivery of goods, and focuses on reasonable consumer requirements. A market for new products is emerging, with a high share of digital components, eco-friendly and organic products. Smartisation processes are transforming the logistics activities of companies. New technical solutions (big data, cloud solutions, augmented reality, drone delivery, etc.) help create competitive advantages for the company, increase the efficiency of its solutions, and significantly expand the range of opportunities: personalisation of demand, satisfaction of individual customer requests, improved communications and service, scaling up operations, deeper analysis and forecasting, and the introduction of dynamic pricing.

The logic of ‘home care time’

The study investigates temporal aspects of home care in Sweden, as experienced and interpreted by older care users. Data consists of 34 interviews with 36 care users and 15 participant observations during home visits by care staff. By focusing on care users’ recalibration of time and events, the analysis identifies a form of interpreted experience – here termed ‘home care time’ – that comprises two governing sublogics – care users’ understanding of themselves as part of the home care organisation, and care users’ empathetic understanding for care staff – where each sublogic evolved from several approaches where care users expressed time empathy, tried to increase time efficiency, or adapted to other care users. Some care users described attempts to take control and influence temporal aspects. Such attempts resulted in adjustments to services at the individual care user's request, but they were also associated with the risk of conflict between care users and care workers. The study addresses the gap in the literature, which mostly studies and theorises care from a care provider perspective. The logic of home care time identified in the study can explain why older people may say they are satisfied with services though poorly performed due to time shortages. This explanation is a corrective to stereotypes that portray older care users as docile and grateful.

ЗАБЕЗПЕЧЕННЯ НЕОБХІДНИМИ РЕСУРСАМИ ЗДОБУВАЧІВ ВИЩОЇ ОСВІТИ ПІД ЧАС ВИВЧЕННЯ НАВЧАЛЬНОЇ ДИСЦИПЛІНИ «ПСИХОЛОГІЯ» В УМОВАХ ВОЄННОГО СТАНУ

The article examines the use of educational approaches, digital technologies, software products and sources of information support for the study of the educational discipline “Psychology” in modern conditions. The purpose of the article is to review the resources for ensuring the study of the educational discipline “Psychology” and to systematize approaches that contribute to the organization of the development of individual educational trajectory of higher education students. Methodology of the article. The use of distance learning tools that ensure the development of communicative, analytical, leadership and other competencies of higher education seekers is considered. Approaches that contribute to the formation of the individual educational trajectory of a higher education students are disclosed. It has been established that practical, individual creative tasks, methodical and didactic materials, as well as where they are placed and how current and final knowledge and skills testing is organized, influence the effectiveness of the educational process in remote mode. Ways to liquidate current debt (crediting the results of non-formal education, participating in extracurricular activities, etc.) are demonstrated. Achieving program learning outcomes during the study of the academic discipline “Psychology” is presented through the introduction of interactive methods and technologies, cases, videos, presentations, including the organization of independent work. The results. Resources presented affect the formation of the individual educational trajectory of higher education seekers through: providing them with opportunities to choose the topic of qualification and coursepaper according to individual interests; implementation of academic mobility; organization of independent work using modern educational approaches, digital technologies, software products and sources of information support; completion of pre-diploma practice in accordance with individual professional interests and requests of stakeholders; participation in scientific and practical conferences, round tables, forums, open lectures, webinars. It has been proven that the placement of methodical and didactic materials in Google Classroom or Google Drive with shared access, the organization of discussions in practical classes, which affects the development of analytical, communicative, and diagnostic competencies, is effective in the process of studying psychology. The practical significance of the obtained results is that it allows to use the necessary resources for the formation of the individual learning trajectory of higher education students during the study of the educational discipline “Psychology”, taking into account the problems caused by the martial law. Key words: distance learning tools, program learning outcomes, liquidation of current debt, knowledge and skill testing, independent work, stakeholders.

All but One: Surgical Concept Erasing with Model Preservation in Text-to-Image Diffusion Models

Text-to-Image models such as Stable Diffusion have shown impressive image generation synthesis, thanks to the utilization of large-scale datasets. However, these datasets may contain sexually explicit, copyrighted, or undesirable content, which allows the model to directly generate them. Given that retraining these large models on individual concept deletion requests is infeasible, fine-tuning algorithms have been developed to tackle concept erasing in diffusion models. While these algorithms yield good concept erasure, they all present one of the following issues: 1) the corrupted feature space yields synthesis of disintegrated objects, 2) the initially synthesized content undergoes a divergence in both spatial structure and semantics in the generated images, and 3) sub-optimal training updates heighten the model's susceptibility to utility harm. These issues severely degrade the original utility of generative models. In this work, we present a new approach that solves all of these challenges. We take inspiration from the concept of classifier guidance and propose a surgical update on the classifier guidance term while constraining the drift of the unconditional score term. Furthermore, our algorithm empowers the user to select an alternative to the erasing concept, allowing for more controllability. Our experimental results show that our algorithm not only erases the target concept effectively but also preserves the model’s generation capability.

Maximizing the Success Probability of Policy Allocations in Online Systems

The effectiveness of advertising in e-commerce largely depends on the ability of merchants to bid on and win impressions for their targeted users. The bidding procedure is highly complex due to various factors such as market competition, user behavior, and the diverse objectives of advertisers. In this paper we consider the problem at the level of user timelines instead of individual bid requests, manipulating full policies (i.e. pre-defined bidding strategies) and not bid values. In order to optimally allocate policies to users, typical multiple treatments allocation methods solve knapsack-like problems which aim at maximizing an expected value under constraints. In the specific context of online advertising, we argue that optimizing for the probability of success is a more suited objective than expected value maximization, and we introduce the SuccessProbaMax algorithm that aims at finding the policy allocation which is the most likely to outperform a fixed reference policy. Finally, we conduct comprehensive experiments both on synthetic and real-world data to evaluate its performance. The results demonstrate that our proposed algorithm outperforms conventional expected-value maximization algorithms in terms of success rate.

Ready for polygenic risk scores? An analysis of regulation of preimplantation genetic testing in European countries.

Would the different regulatory approaches for preimplantation genetic testing (PGT) in Europe permit the implementation of preimplantation genetic testing using polygenic risk scores (PGT-P)? While the regulatory approaches for PGT differ between countries, the space provided for potential implementation of PGT-P seems limited in all three regulatory models. PGT is a reproductive genetic technology that allows the testing for hereditary genetic disorders and chromosome abnormalities in embryos before implantation. Throughout its history, PGT has largely been regarded as an ethically sensitive technology. For example, ethical questions have been raised regarding the use of PGT for adult-onset conditions, non-medical sex selection, and human leukocyte antigen typing for the benefit of existing siblings. Countries in which PGT is offered each have their own approach of regulating the clinical application of PGT, and a clear overview of legal and practical regulation of PGT in Europe is lacking. An emerging development within the field of PGT, namely PGT-P, is currently bringing new ethical tensions to the forefront. It is unclear whether PGT-P may be applied within the current regulatory frameworks in Europe. Therefore, it is important to investigate current regulatory frameworks in Europe and determine whether PGT-P fits within these frameworks. The aim of this study was to provide an overview of the legal and practical regulation of the use of PGT in seven selected European countries (Belgium, France, Germany, Italy, the Netherlands, Spain, and the UK) and critically analyse the different approaches with regards to regulatory possibilities for PGT-P. Between July and September 2023, we performed a thorough and extensive search of websites of governments and governmental agencies, websites of scientific and professional organizations, and academic articles in which laws and regulations are described. We investigated the legal and regulatory aspects of PGT by analysing legal documents, regulatory frameworks, scientific articles, and guidelines from scientific organizations and regulatory bodies to gather relevant information about each included country. The main sources of information were national laws relating to PGT. We divided the PGT regulation approaches into three models. The regulation of PGT differs per country, with some countries requiring central approval of PGT for each new indication (the medical indication model: the UK, the Netherlands), other countries evaluating each individual PGT request at the local level (the individual requests model: France, Germany), and countries largely leaving decision-making about clinical application of PGT to healthcare professionals (the clinical assessment model: Belgium, Italy, Spain). In the countries surveyed that use the medical indication model and the individual requests model, current legal frameworks and PGT criteria seem to exclude PGT-P. In countries using the clinical assessment model, the fact that healthcare professionals and scientific organizations in Europe are generally negative about implementation of PGT-P due to scientific and socio-ethical concerns, implies that, even if it were legally possible, the chance that PGT-P would be offered in the near future might be low. The results are based on our interpretation of publicly available written information and documents, therefore not all potential discrepancies between law and practice might have been identified. In addition, our analysis focuses on seven-and not all-European countries. However, since these countries are relevant players within PGT in Europe and since they have distinct PGT regulations, the insights gathered give relevant insights into diverse ways of PGT regulation. To the best of our knowledge, this is the first paper that provides a thorough overview of the legal and practical regulation of PGT in Europe. Our analysis of how PGT-P fits within current regulation models provides guidance for healthcare professionals and policymakers in navigating the possible future implementation of PGT-P within Europe. This project has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement no. 813707. The authors declare no conflict of interest. N/A.

Requesting mental illness workplace accommodations: the roles of perceived need and stigma

PurposeResearch related to workplace accommodation requests for employees with mental illness is scarce, though evidence suggests that these individuals often fail to request accommodations even when needed. The authors' research study aimed to address these shortcomings by (1) assessing employees' knowledge of Americans with Disabilities Act (ADA) laws and how this knowledge influences employees' perceived need for and requests of accommodations; (2) examining the relationship between employees' perceived need for accommodations and employees' workplace outcomes and (3) examining the relationship between perceived need for accommodations and employees' actual accommodation requests, as well as how stigma influences this relationship.Design/methodology/approachThe authors used two survey studies to investigate their research questions. Study 1 participants were recruited through Amazon's MTurk, and Study 2 participants were recruited through support groups for individuals diagnosed with mood disorders (i.e. depression and bipolar disorder).FindingsThe authors found significant gaps in both subjective and objective ADA-related knowledge among participants in their sample. The authors' Study 1 results also revealed an interaction between the perceived need for accommodations and accommodation requests in predicting job satisfaction and turnover intentions. When employees needed accommodations but did not request them, it resulted in worsened workplace outcomes. In Study 2, the authors aimed to identify barriers to requesting accommodations. The authors found that the relationship between perceived need for accommodations and actual accommodation requests was moderated by both public and self-stigma, thereby showing that stigma can impede individuals from requesting needed accommodations at work.Originality/valueThe authors' study sheds light on a population that has been relatively understudied in the workplace accommodations literature, namely those with mental illness. The authors first identify the perceived need for accommodations as an important factor in making accommodations requests at work, as prior work has failed to differentiate how the need for accommodations can vary across individuals. Next, the authors show how workplace outcomes (i.e. job satisfaction and turnover intentions) are negatively affected when employees need accommodations but do not request them. Finally, the authors demonstrate how both public stigma and self-stigma can reduce the likelihood that individuals request accommodations at work, even when needed.

Mentalis Muscle Reconstruction: An Innovative Technique.

The mentalis muscle is a significant component of the lower lip; its injury could impair appearance and function. This study presents a surgical strategy for treating mentalis muscle rupture to restore muscle tension and improve function. Medical records and photographs of 2 patients with mentalis muscle rupture were reviewed. After physical examinations, 3-dimensional computed topographies were conducted to evaluate chin appearance further. The surgical strategy was designed according to individual malformations and requests. Both patients injured their mentalis muscles in childhood and presented to our clinic with a concave deformity at the center of the chin and impaired mentalis muscle function. The surgical procedure involved the reconstruction of the mentalis muscle by reassembling the muscle flaps and releasing the scarred soft tissue. Both patients were satisfied with the outcome. Mentalis muscle rupture requires surgical correction. The study proposes an innovative approach that enables patients to achieve a more harmonious appearance and improve function.

Digital literacy impact on the subjective well-being of the region young population

Digital literacy is a crucial component of professional and life competence in the modern world and an important condition for the subjective well-being of a modern person. The components of digital literacy are numerous and reflect various aspects: from technical skills to the organisation of knowledge transfer, as well as communication. The younger generation acquires skills in using digital interaction content almost from preschool age. In this regard, it becomes important for future adults to assess the impact of their digital literacy level on subjective well-being, as well as on awareness of its application and improvement possibilities. The article provides analysis of a sociological study results aimed at identifying the impact of digital literacy on the subjective well-being of young people. The empirical base includes the results of an online survey conducted on the territory of Kursk and the Kursk region in October-November 2023. The sample totaled 450 respondents. Understanding young people’s ideas about digital literacy and its impact on subjective well-being will make it possible to more specifically define the necessary measures to enhance digital training, promptly meet individual or group requests when organising studying process and improving competence in the field of digital technologies.

Individuals recording clinical encounters

Background: Clinicians and their employers, concerned with privacy and liability, are often hesitant to support the recording of clinical encounters. However, many people wish to record encounters with healthcare professionals. It is therefore important to understand how existing law applies to situations where an individual requests to record a clinical encounter. Methods: We searched for and reviewed relevant legal documents that could apply to recording clinical encounters. We limited the scope by purposefully examining relevant law in nine countries: Australia, Brazil, Canada, France, Germany, India, Mexico, the United Kingdom and the United States. We analyzed legal texts for consents needed to record a conversation, whether laws applied to remote or face-to-face conversations and penalties for violations. Findings: Most jurisdictions have case law or statutes, derived from a constitutional right to privacy, or a wiretapping or eavesdropping statute, governing the recording of private conversations. However, little to no guidance exists on how to translate constitutional principles and case law into advice for people seeking to record their medical encounters. Interpretation: The law has not kept pace with people’s wish to record clinical interactions, which has been enabled by the arrival of mobile technology.

Fuzzy Logic as a Decision-Making Tool for Transport Request Selection

In the competitive transport industry, carriers strive to deliver quality service while meeting the diverse needs of their customers and their own unique characteristics. Few rail freight operators use the tools available to help them make the right decisions about what is profitable and what is not. Evaluating individual transport requests and making the right choices can lead to better service and improved profitability. To efficiently evaluate individual transport requests and make informed decisions, this paper proposes the use of fuzzy logic can be used. The paper considers 6 real transport requests and evaluates them using fuzzy logic.

ИСКУССТВЕННЫЙ ИНТЕЛЛЕКТ КАК ОСНОВА ФОРМИРОВАНИЯ ИНСТРУМЕНТОВ ПЕРСОНАЛИЗИРОВАННОЙ СТРАТЕГИИ ЦИФРОВОГО МАРКЕТИНГА

The use of artificial intelligence in almost any field of activity leads to a reduction in time for processing information, increasing the efficiency and productivity of production activities. The integration of artificial intelligence applications into marketing activities will help enterprises at various stages of the economic cycle answer the main question of the market economy of what, for whom and where to produce and sell, which will provide a competitive advantage primarily due to speed and cost reduction and flexible consideration of individual consumer requests. The purpose of the article is to explore the possibilities of using artificial intelligence to create digital marketing tools for both e-commerce retailers and manufacturers of end-use goods and business products, allowing them to flexibly respond to changing tastes and consumer preferences of the target audience.

Impact of digital transformation on public services: experience of the European Union

Based on the methodology of complex system analysis, the article examines the impact of digital transformation on public services in the context of the experience of the European Union. The purpose of the study is to analyze the constructive processes of transformation of the public administration system with electronic and digital technologies as a key factor in providing public services to the population and business. In the course of the study, methods of system analysis, methods of generalization, classification, system and structural- functional approaches, and others were used. The directions of the digital transformation of the public service provision system in the European Union have been determined: expanding the use of single electronic portals that ensure the establishment of direct connections on matters of public service provision; simplification of the procedure for using information technologies due to the development of mobile means of transmission and its processing; development of a general list of digital products as part of the provision of public services with the possibility of accelerated search for the required product; creation of experimental platforms and pilot areas for the implementation of digital technologies for the provision of public services. The prerequisites for the digital transformation of public services based on platforms are systematized, which is understood as the process of changing the institutional organization of markets under the influence of the spread of modular digital platforms and the application of platform technologies. These prerequisites include the growth of data quality and the specialization of interaction between participants. This makes it possible to consider platforms as centers for the provision of a wide range of digital services and to ensure the effectiveness of the platform implementation process by providing traditional goods with service properties, which are expressed in the involvement of the consumer in the production process and the accounting of his individual requests. Further research on the problems of digitization and digital transformation of socio-economic systems should cover the direction of expanding the use of digital platform services provided by the service integrator and the development of management methods for promising forms of organization of economic activity in the field of public services.

Method for improving the quality of service of request signals in information systems

The work notes that the request information systems are an important component of information support for air traffic control and airspace control systems. Interrogative information systems include: secondary radar systems, national identification radar systems and short-range navigation radio systems. It is shown that the characteristics of the process of servicing request signals in an aircraft transponder have a significant impact on the statistical properties of the response signal flow, which ultimately, as a consequence, affects the efficiency of the entire radar channel for transmitting response signals with an active response. It is pointed out that one of the important characteristics of the process of servicing request signals in an aircraft transponder is its correlation function, based on the analysis of which one can conclude the choice of the type of response signal flow and the structure of the aircraft transponder. This makes it possible to achieve: increasing the probability of service, increasing the probability of detecting an air object, reducing the root-mean-square error in estimating the azimuth of an air object and increasing the reliability of the transmission of flight information from the observed board of an air object. The article analyzes the possibility of improving the quality of request service by managing the flow of request signals in a network of request information systems. It has been shown that the correct choice of repetition periods of request signals in the area of joint operation of request information systems makes it possible to reduce the likelihood of interaction between individual request signals. Also, as a consequence, it makes it possible to increase the noise immunity of the interrogative information systems under consideration that are part of the specified information system.

Changing Minds About Not Can but Ought

In my presidential speech to the Association for Advancement of Behavior Therapy (now the Association for Behavioral and Cognitive Therapies) at the 1974 Annual Convention, I took the position that requests for sexual reorientation should be declined in favor of addressing the ethical and political factors that underlie the allegedly voluntary requests of gay individuals to change in a heterosexual direction. Discrimination, prejudice, and sometimes hate crimes made it highly unlikely that requests for sexual reorientation were voluntary. The personal and professional context for my change of perspective is also described as are several pedagogical and persuasive strategies I have used over the past 50 years for changing people's minds about the propriety of sexual orientation change efforts.

Access to Non‐reimbursed Expensive Cancer Treatments: A Justice Perspective

ABSTRACTWhen the cost‐effectiveness of newly approved cancer treatments is insufficient or unclear, they may not (immediately) be eligible for reimbursement through basic health insurance in publicly funded healthcare systems. Patients may seek access to non‐reimbursed treatment through other channels, including individual funding requests made to hospitals, health insurers, or pharmaceutical companies. Alternatively, they may try to pay out of pocket for non‐reimbursed treatments. While currently little is known of these practices, they run counter to a deeply held egalitarian ethos that is prevalent in many publicly funded healthcare systems. In this article, we investigate to what extent this ethos can be grounded in theories of justice, notably egalitarianism and prioritarianism. We argue that allowing out‐of‐pocket payments by patients themselves, in principle, is not unjust from the perspective of either of these theories, provided that it does not raise in‐practice justice‐based concerns, for instance by displacing more cost‐effective care, to the detriment of other patients, or by failing to treat patients equally. In contrast, we conclude that the practice of making exceptions for individual patients by health insurers or healthcare providers does run counter to the justice‐based requirements of equal treatment.