Role Of Paternalism Research Articles

Implementation of Respect for Autonomy in Hospital Services Within the Indonesia National Health Insurance System

The principle of patient autonomy forms the foundation of medical ethics. However, its exploration within the context of national health insurance systems in developing countries remains under-researched. This study aimed to evaluate respect for patient autonomy within Indonesia's National Health Insurance (NHI/JKN) system. The study using a qualitative research interview analyzed thematically. Conducted in Depok, West Java, the study involved in-depth semi-structured interviews with 18 participants, encompassing patients from first-level health facilities (FLHF), general practitioners at FLHF, specialist doctors, and management of referral hospital (RH) officers, and staff members of the JKN. The data were transcribed and analyzed using a thematic approach. The study revealed substantial underutilization of respecting patient autonomy within medical contexts under the JKN. Five themes emerged: challenges in the referral system, knowledge and information dissemination, decision-making and autonomy, quality of healthcare services, and systemic constraints and impact. These themes highlight the lack of patient awareness, restricted medical choices, the dominant role of paternalism (a system in which the government or a person in a position of authority makes decisions for other people) in healthcare decisions, and improper informed consent process. The findings suggest that the principles of beneficence and paternalism often overshadow respect for patient autonomy in the JKN system. This raises concerns about the ethical aspect of patient treatment, particularly the need for greater focus on patient autonomy and shared decision-making to align more closely with global medical ethics practices. This study contributes to understanding autonomy in national health insurance systems in developing countries. It highlights the need for systemic reforms to enhance healthcare efficiency and effectiveness while respecting patient autonomy.

Утопия и патернализм в аграрной России: традиции и современность. Часть I: конец XVII в. – 30-е гг. XX в.

The aim of the study is to show the relationship of such socio-cultural phenomena as utopia and paternalism in the history of agrarian Russia. The paper consistently provides insight into the following aspects of the study: the role of paternalism and utopia in the complex structure of economic and spiritual values of Russians in the pre-reform period (from the late 17th century to the first half of the 19th century); the transformation of the traditions of paternalism in their connection with utopian ideas in the period after the emancipation reform of 1861 and up to the 1930s. The scientific novelty of the study lies in determining how the connection between the elements of utopia and paternalism manifested itself in the context of solving key economic and socio-cultural problems of agrarian Russia. As a result, the author shows that the positive aspects associated with the rise of Russian national culture in the early 20th century could not be appreciated either by the czarist-era authorities or later by the Bolshevik leadership and eventually a real chance for the economic and socio-cultural rise of the country was missed. The research on this topic will be continued in the next publication.

Does the paternalism of founder-managers improve firm innovation? Evidence from Chinese non-state-owned listed firms

This paper investigates the impact of firm founders as top managers (founder-managers) on firm innovation. We first propose a text-based indicator of founder-manager paternalism to measure the emotional relationship between founder-managers and the firms they founded from the perspective of socioemotional wealth. We further investigate the role of founder-manager paternalism in firm innovation using a sample of non-state-owned listed firms in China during the period 2007-2017. The results show that founder-manager paternalism has a positive impact on firm innovation. Moreover, the findings indicate that higher levels of corporate governance may undermine the positive relationship between founder-manager paternalism and firm innovation.

The Development of Russian History of Technology in the 20th Century

On the 28th of February, 1932, the General Assembly of the USSR Academy of Sciences adopted a resolution on the reorganization of the History of Knowledge Commission (KIZ) into the Institute for the History of Science and Technology (IINT) of the USSR Academy of Sciences. The past 90 years have demonstrated scientific and practical importance of the new discipline, history of science and technology. Its history-of-technology component has played an important role in the development of this discipline. The article analyzes the path traveled by the history of technology as well as the most important results in engineering and technology, obtained both by the IHST researchers and their colleagues from other research and educational institutions. Considerable attention in the article is given to the early period of formation of the history of science. The impact of difficult Soviet prewar realities on science in general and on the tragic fate of IINT (the arrest of its director, N. I. Bukharin, invectives addressed to the Institute, and its shutting down) is analyzed. The author emphasizes that, during the period under study, the history of technology community continued with their research, and points out to the works of B. L. Bogoslovskii, V. V. Danilevskii (also spelled Danilevsky), A. A. Radtsig, S. T. Strumilin, and others. The organizational and administrative revival of the history of technology dates back to 1942 and is reviewed in the context of historical meeting of V. L. Komarov, President of the USSR Academy of Sciences, with I. V. Stalin, the head of state, during which it was deemed advisable to reinstate the Institute for the History of Science (IIE). What distinguished the history of technology in the second half of the 20th century was its steady, systemic development. Everything was changing: the configuration and balance of research priorities, methodological toolkit and the forms of studies, standards and themes of scientific work, staff, social context, and funding. The collective and individual monographs alternated as predominant forms of scientific output. The diversity of genres correlated closely with staff dynamics. The author focuses on the important role of paternalism of the foremost Soviet scientists in the history of technology. One of the main factors of disciplinary stability was the pursuit of new knowledge. In this context, the main theme clusters and their ideologists were: factographic, including field, studies (V. V. Danilevskii); current scientific and technological revolution (S. V. Shukhardin); technical sciences (Yu. S. Meleshchenko); and theoretical and methodological matrix of the technical world (I. Ya. Konfederatov). The author writes about today’s marketplace realities with undisguised worry for the future of the discipline. The sources used in this article are collective and individual monographs on the history of machines and technical sciences, publications in the journal “Voprosy istorii estestvoznaniia i tekhniki” (Studies in the History of Science and Technology), as well as the written and audio archive of the author who has been working at S. I. Vavilov Institute for the History of Science and Technology of the USSR (Russian) Academy of Sciences since 1971.

“Sweet Masters”: The Order of Saint Benedict and the “Good Treatment” of Slaves, Brazil, Eighteenth and Nineteenth Centuries

Objective/Context: This article aims to discuss the idea of “good treatment” given to slaves, as well as the concept of benevolence and paternalism in rural Brazilian properties, by using data on the Benedictine Congregation of Brazil, as it was the richest and most influential religious order in the country in the nineteenth century. Methodology: The documentation was analyzed based on the concept of “antidiscipline” coined by Michel de Certeau. The sources highlight a complex and efficient control network imposed on the enslaved; nevertheless, it is necessary to assess these documents (produced by the monks themselves) from a different perspective, as the daily life of slaves was marked by appropriations, tactics, bricolages, and other surreptitious forms constructed by the subordinates. This concept helps to rethink the manorial strategies of the Benedictines, which has caught the attention of many writers. Originality: Although historiography has already demonstrated that there was no such thing as “mild” slavery, several authors highlighted the ‘“soft” treatment experienced on Benedictine properties. In this context, this article discusses how and why a religious institution used discourses and practices that aimed to improve the living conditions of slaves on their farms, highlighting the role of paternalism and Christian ideals in building an efficient and long-lasting “model” of slave management, which was described by many as an example of “benevolence” and “good treatment.” Conclusions: Although writers of the nineteenth and twentieth centuries underlined and valued the “good treatment” experienced by Benedictine captives, this study demonstrates that this “sweeter” treatment was part of their slave management strategy, ensuring vegetative growth and the smooth functioning of work, with the expectation of producing obedient, disciplined, and loyal slaves. In a way, they contributed to perpetuating the image of “softer” slavery in Brazilian lands.

“Until the Day of His Death”

AbstractThis article examines postmortem inventories and notarial records from Brazilian slaveholders in southern Brazil in the nineteenth century. By discussing selected cases in detail, it investigates the relationship between “precarious masters” (especially the poor and/or disabled, widows without family, and single elderly slaveholding women and men) and their slaves and former slaves to whom they bequeathed, in their testaments and final wills, manumission and property. The article reads these documents as intergenerational contractual arrangements that connected the masters’ expectations for care in illness and old age with the slaves’ and former slaves’ expectations for compensation for their work and dedication. Following these uneven relationships of interdependence and exploitation as they developed over time, the article suggests a reassessment of the role of paternalism in Brazil during the country’s final century of slavery. More than a tool to enforce relations of domination, paternalism articulated with the dynamics of vulnerability and interdependency as they changed over the life courses of both enslaved people and slave owners. This article shows how human aging became a terrain of negotiation and struggle as Brazilian slave society transformed throughout the nineteenth century.

Macroeconomic Effects of Kazakhstan’s Anticrisis Policy: Economic Growth and Paternalism

This article contains an analysis of the ambivalent effects of the countercyclical anticrisis policy implemented in Kazakhstan in 2014–2017 when the recovery of economic growth was attended by the growing role of economic paternalism. The state provided support to all macroeconomic agents: it supported households to sustain the consumer demand, the business sector to support the accumulation of fixed capital stock, and budgets to increase public expenditures. In the authors’ opinion, in 2018 sufficiently favorable conditions will form for reducing the role of economic paternalism. The priority must be to recover the generation of population income from hired labor and entrepreneurship, growth of investment and innovative activities on the part of the business sector, and creation of equal opportunities and access to financial resources.

'Trust me, I'm a doctor': a qualitative study of the role of paternalism and older people in decision-making when they have lost their capacity.

The objective of this study was to explore whether older people want their doctors to make treatment decisions on their behalf when they no longer have capacity to do so, and their reasons for these preferences. A convenience sample of older people from two retirement villages were interviewed and asked to respond to a hypothetical vignette. Their responses were analysed using qualitative thematic methodology. Thirty-seven people (56.8% female; mean age = 83.9 years; mean Mini Mental State Examination = 26.5) participated; 73.0% indicated that they would want their doctor to make treatment decisions on their behalf. Three key themes emerged: 1) trust in the doctor-patient relationship; 2) doctor-derived factors: knowledge and expertise, professionalism, role and responsibility; 3) patient-derived factors: vulnerability, dependence and reliance, compromised autonomy. Our findings suggest that the paternalistic model within medical care can be an expectation of some older patients and if taking a paternalistic approach we should not underestimate the trust and power that is imparted to us.

When can culturally diverse teams be more creative? The role of leaders' benevolent paternalism

SummaryThe current research examines the conditions under which cross‐cultural teams can realize their creative potential—a consequence of their cultural diversity. We propose that in more culturally diverse teams, team members are less open when communicating with each other, which impairs the team's ability to elaborate on the information contributed by different members, ultimately limiting team creativity. We further theorize that leaders' benevolent paternalism, a leadership style that is particularly prevalent in East Asian contexts, can reduce the negative consequence of intercultural diversity on intercultural communication openness. On the basis of multiwave, multisource data from 48 culturally diverse teams in China, we found that perceived intercultural diversity is negatively related to intercultural communication openness, which, in turn, is positively related to information elaboration, and ultimately, team creativity. Leader benevolent paternalism attenuates the negative relationship between intercultural diversity and intercultural communication openness. These findings enrich the literature on intercultural diversity by calling attention to communication‐related obstacles.

“Seabirds Matter More Than Us!”: Understanding the Complex Exercise of CSR in the Global Shipping Industry

Within the contemporary shipping industry there is the potential for open registers to act to varying degrees as “regulatory havens”. There are also well-known challenges relating to regulatory enforcement at both port-state and flag-state levels. In this context it is particularly helpful to consider the potential drivers of corporate social responsibility (CSR) within the commercial cargo shipping industry. This paper therefore considers three case studies, to explore: supply chain pressures relating to the exercise of CSR; financial drivers of CSR; the role of paternalism in the exercise of CSR; and normative orientations towards CSR in the shipping industry. The paper concludes that on the whole, the shipping industry is more concerned to focus on the protection of the environment, in conjunction with its CSR policies, than it is to focus on the health and welfare of sea-based employees. Furthermore, it explains the reasons for such prioritization.

Public Health Regulation and the Limits of Paternalism

This Article explores the role of paternalism in regulatory efforts to improve public health, focusing mostly on obesity, but also accounting for recent developments in other public-health arenas. First, the Article describes a spectrum of interventions that regulators can implement in the public health zone, ranging from “soft” paternalism to “hard” paternalism. Second, the Article discusses the limits of these paternalistic interventions in addressing the problem of high obesity rates in America. The analysis shows that the underlying scientific and socioeconomic factors driving obesity prove difficult to confront — a difficulty further complicated by the lower tolerance that the public has expressed for regulatory interventions that diminish individual autonomy. Soft paternalism may prove too weak to address obesity — and hard paternalism may prove socially unpalatable to deploy. Third, the Article reinforces the notion that a larger pattern may have emerged with respect to the limitations of paternalistic approaches, discussing recent attitudinal shifts against marijuana prohibition and water fluoridation, as well as a wave of activism combating the refusal of food producers to enable people to make choices about consuming genetically-modified foods. The analysis concludes that the negativity associated with the reduction of personal autonomy has constrained the options of regulators already charged with solving difficult problems. Ultimately, however, narrow opportunities for intervention still exist. If regulators invest heavily in the soft paternalistic initiatives that prove effective, and the hard paternalistic opportunities that prove inoffensive, the aggregate impact on public health, though limited, may prove positive.

Redefining the Role of Paternalism in Palliative Medicine (SA511)

1.Discuss the current tension between autonomy and paternalism in select patients and families.2.Define and discuss palliative paternalism.3.Identify patients at high risk of further harm from open ended questions and unlimited care options and delineate an approach to implementing palliative paternalism with these patients. The clinical approach of the palliative medicine team must be reexamined with regard to roles of autonomy and paternalism. The tension between autonomy and paternalism is both an ethical and practical issue. Autonomy is the current “gold standard” approach to patient communication and has grown to the point that patient choice dictates care even when the choices are not possible or are medically futile. Furthermore, we have observed a trend among physicians where they avoid making difficult medical decisions by hiding behind the shield of patient autonomy. Paternalism, characterized as the antithesis of autonomy, is widely thought not to have any role in medicine. We will introduce and define a new term, palliative paternalism, and discuss its role in patient care. Palliative paternalism is an approach to communication with limited open-ended questions utilizing well-informed, discrete, concrete options during medical discussions in order to reduce confusion and suffering by avoiding futile care. Open-ended questions and unlimited care options may cause more harm in select high-risk patients: patients who are medically naïve or illiterate, have rigid or limited coping skills, belong to certain cultural groups known to mistrust the medical community, or have a history of substance abuse and/or a personality disorder. Through expert opinion and case-based examples, the University of California palliative medicine team presents a process for early identification of these high-risk patients and a general approach for implementing palliative paternalism in the medical setting. This session will conclude with a robust question and answer forum for discussing specific challenging cases and questions shared by the audience with a focus on collaborative solutions.

Long Day's Journey into Flight: Trading Worker Loyalty in the Undoing of Norton Company

This case presents the story of the sale of Norton Company, a 100-year-old, non-union manufacturing company in Worcester, MA, to the French conglomerate, Saint-Gobain in 1990. It begins by talking about the history of the company and how its paternalistic human resource policies infused in the workforce a powerful sense of loyalty and community-focus. It then considers how, in the early days of globalization and corporate takeovers, Norton's senior management was able to play on worker loyalty to the company and fear of job loss to rise up publicly and block a hostile takeover of Norton by a British conglomerate, BTR, only to be sold to a French conglomerate in a deal that was more lucrative for senior management. The case is useful for considering the role of paternalism, mystification, and the manipulation of resistance to serve management interests during the transition to a global economy in the early 1990s.

Next-Generation DNA Sequencing, Regulation, and the Limits of Paternalism

WITH THE ADVENT OF NEXT-GENERATION SEquencing technologies, the ability to quickly and relatively inexpensively learn the sequence of an individual’s entire genome will soon be available to medical practitioners, patients, and consumers. Whole-genome and whole-exome sequencing will routinely uncover both trivial and important medical results, both welcome and unwelcome. This upheaval in sequencing technology presents new challenges to implementation and regulation, forcing physicians to consider what genomics has to offer patients, clinicians, and consumers, ultimately prompting a consideration of the role of paternalism in medicine. Next-generation sequencing has already shown promise as a diagnostic tool for patients with enigmatic disorders and features that suggest a primary genetic etiology, such as a strong family history, developmental anomalies, or unusual presentations of common diseases (eg, cancer at a young age). Moreover, when evaluating disorders that can result from mutations in many different genes, nextgeneration sequencing allows simultaneous assessment of multiple genes. On the other hand, next-generation sequencing is unlikely to substantially contribute to the management of most common diseases because their multifactorial nature places an inherent limit on the utility of pure genetic analysis. In the realm of public health, the proactive identification of individuals carrying mutations that confer high risk of preventable disease could be a logical application of next-generation sequencing. For example, more than 500 000 individuals in the United States carry a Lynch syndrome–associated mutation and are at a substantially increased risk of colorectal cancer. A population approach to sequencing Lynch-associated genes in asymptomatic individuals (or in appropriate patients diagnosed with colorectal cancer with cascade testing of family members) could identify many who are unknowingly at high risk of this preventable disorder. Another emerging application of next-generation sequencing in public health is preconception screening in which prospective parents ascertain their carrier status for autosomal recessive disorders. Although such disorders are individually rare, collectively they represent a major public health issue accounting in aggregate for more than 10% of pediatric deaths. Screening tests are already commercially available for assessing carrier status of more than 100 severe autosomal recessive diseases. The policy implications of such screening are complex given that selective abortion is one way that parents deal with the realities of shared carrier status. But such testing can in principle be used to identify carrier status for any autosomal recessive (or Xlinked) disease and is bound to expand. Beyond the realms of clinical medicine and public health, some consumers (and those who would profit from providing testing) have an interest in applying genomic technology outside the traditional medical establishment. This nascent movement is exemplified by direct-to-consumer genetic testing. With the advent of genomic microarray technologies over the past several years, affordable genomic analysis quickly led to direct-to-consumer genetic testing for risk of a host of common diseases. Just as quickly, controversy ensued. Those supporting unregulated availability of such testing offerings touted the potential utility for consumers, criticizing regulatory efforts as paternalistic. Others, emphasizing unproven utility and substantial inconsistencies in test performance, called for regulation of direct-toconsumer genetic testing. In response, the US Food and Drug Administration (FDA) has clearly expressed its intention to regulate direct-to-consumer genetic testing but has yet to articulate details of envisioned regulation. Although this controversy has attracted considerable attention, it has arguably been, until now, a tempest in a teapot. There is little evidence to suggest widespread uptake of microarray-based direct-to-consumer testing by the public and few data have emerged suggesting that risk

Why Does China Participate in Intrusive Peacekeeping? Understanding Paternalistic Chinese Discourses on Development and Intervention

Why does China continue to participate in highly intrusive peacekeeping operations which, it can be argued, suspend the sovereignty of the host state and attempt to transform it into a liberal democratic, market capitalist state? This article highlights the significant role of Chinese paternalism in providing the ideological justification for intervening in states' domestic affairs. Focusing on the quasi-official annual publication, the China Modernization Report, and its discourses on development, this article contends that some Chinese discourses interpret modernization as a linear and universal process, and interpret different stages of development in distinctly hierarchical terms. This places China as superior vis-à-vis many underdeveloped states. Such notions of ‘superiority’, in turn, lead to paternalistic thinking that justifies China (and other relatively ‘developed’ states) intervening in underdeveloped states and societies in order to ‘guide’ them to the path of ‘development’.

American Democratic Interventionism: Romancing the Iconic Woodrow Wilson

There is an American foreign policy tradition in respect to military interventions in the Third World, which validates the importance of democratic ideals as central to the success of the policy. Woodrow Wilson is the founding father of this tradition. While the normative commitments of Wilson made sense in Victorian America and can probably be considered innovative for his day, the manifest lack of success in transferring democracy through military intervention leads us to question the character of Wilson’s interventions and the ideals that motivated them. This essay will consider the content of Wilson’s democratic theory and its integration into ideals of national mission and destiny; how this became the philosophical basis for policies of military intervention; the assessments offered by historians of the success of this policy; and the role of racial paternalism in legitimating the policy at the time. In a contemporary respect, we are left with the question of whether we want such a philosophy of democratic interventionism to be the basis for transferring democratic values and practices to Third World countries today.

Protecting or Empowering the Vulnerable? Mental Illness, Communication and the Research Process

People with mental illness are treated, in research, as a ‘class’ or category who are vulnerable, without always being clear why they should be treated as such, not why an individual, rather than the class, is vulnerable. The two main reasons given are lack of competence and power imbalance. Competence issues include incapacity and legislation, assessment and the impact of the illness in decisions. Power issues cover the role of mental health legislation, coercion, protectiveness and paternalism, stigma and discrimination and the ‘well’ and ‘ill’ self. These are examined within a framework of risk assessment, both to the patient and to others. Over-concern to protect the vulnerable can lead to gate-keepers preventing their inclusion in studies at various stages of the research. This denies such groups a voice in the research process. It is suggested that ethical scrutiny of research is not only to prevent harm to the vulnerable, but also to provide a framework to empower such people to take part in research. To do otherwise is to further stigmatize and marginalize them. One way forward is to look at the risk presented by different types of research, from clinical intervention trials to non-therapeutic, qualitative studies and to modify capacity and access requirements in the light of the risks presented.

The ethical implications of direct-to-consumer pharmaceutical advertising.

Direct-to-consumer marketing of pharmaceuticals increases pressure on physicians to succumb to consumer demand. The strength to withstand this pressure comes in part from acceptance of the role of paternalism in the physician-patient relationship.

The Precautionary Principle and Electric and Magnetic Fields

Current environmental regulation represents a paternalistic policy, more concerned to avoid false postives than false negatives, limiting opportunities for individuals to make choices between risk-avoidance and risk-taking alternatives. For example, many exposures to magnetic fields could be reduced at little or no cost but are not considered seriously, owing to the uncertainty of risk and the concern to avoid false positives. Even though precautionary ap proaches that focus on avoiding false negatives often do not lead to adverse economic consequences or irrational choices, such approaches usually are not taken. The value of autonomy and the proper role of governmental paternalism with respect to environmental policy need to be considered more carefully in environmental decision making.

The parents' perspective: ethical decision‐making in neonatal intensive care

Ethical debate abounds in the literature relative to treatment decisions for the high risk neonate in the intensive care nursery. A systematic examination of the parents' perspective is missing. To fill this existing gap, the ethical dimension of care was explored with 32 families of high risk newborns from a Level III nursery, using a moral conflict interview guide in order to describe their perspective. A concept of the medicalization of parenting appears to best reflect the parents' view of ethical decision-making responsibility. This concept evolved through the parents' reflection on conflict naming, content of decision-making, context of decision-making, information sharing and perception of infant status. These concerns differ profoundly from those of health professionals, philosophers, theologians and others active in this debate who cite lower limits of viability, iatrogenic effects of treatment, use of multiple invasive procedures, and the role of paternalism as ethical issues.