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Chapter 4 addresses the legal framework for valid consent to treatment and refusal of treatment, which is based on the right to autonomy (as discussed in Chapter 3). It considers situations where a person cannot give valid consent – for example, where the person is a young child or is unconscious – as well as situations where consent is not needed, such as in a medical emergency, where there is serious mental illness or where a patient needs to be restrained for their own safety. The chapter also explains the place of guardianship and advocacy, and the use of advance care directives in protecting a person’s autonomous decision-making.
Nonprofit organizations (NPOs) are often considered key actors in advocacy and social change, leading to the expectation that social workers employed in NPOs are more engaged in policy practice (PP) than their counterparts in public organizations. Drawing on the motivation–facilitation–opportunity framework proposed by Gal and Weiss-Gal, this article examines differences in social workers’ PP engagement across nonprofit and public organizational settings in Italy. Using survey data from 6,859 Italian social workers, the study distinguishes four forms of PP—internal informal, internal formal, external direct, and external indirect—and compares patterns of engagement across five organizational groups. Descriptive statistics and nested regression models examine the role of sociodemographic characteristics, political attitudes, occupational characteristics, and organizational support. The findings show that social workers employed by and working within NPOs exhibit higher engagement primarily in external–indirect PP, a form more closely associated with advocacy and collective mobilization. However, these differences are associated less with sectoral identity or organizational support for PP than with organizational opportunity structures, particularly hierarchical position and access to decision-making arenas. This article contributes to policy practice research and nonprofit studies by suggesting that the distinctiveness of NPOs in fostering advocacy-oriented engagement lies less in their mission and organizational culture than in the structural opportunities they provide practitioners. More broadly, the findings highlight the importance of organizational opportunity structures in shaping practitioners’ engagement in advocacy and policy practice and encourage future research to examine how the distribution of roles and resources within organizations interacts with welfare governance.
Awareness of the structural context of prescribing is essential for clinicians to provide appropriate care to our patients. However, there is an opportunity to move beyond this awareness and be active participants in changing the structural factors that impact health and illness. This chapter highlights examples of healthcare workers and systems addressing such structural determinants and moving toward justice. We offer ideas of how clinicians can take action, from the individual physician–patient relationship to policy-level change.
As the Association for European Paediatric and Congenital Cardiology, the largest paediatric cardiology organisation globally, we are dedicated to safeguard the health, safety, and wellbeing of children, adolescents, and adults with congenital and acquired heart disease, as well as to support the professionals who care for them across the globe. As both a scientific and ethical community, we are profoundly troubled by the devastating humanitarian consequences of armed conflicts. Across the world, we are witnessing an immense toll on civilians, particularly children, who are always the most vulnerable in times of war. The destruction of healthcare infrastructure, obstruction of access to medical care, and the severe psychological and physical trauma endured by children are deeply alarming. While the Association for European Paediatric and Congenital Cardiology does not engage in political debate, we cannot remain silent when children’s lives and futures are endangered. We stand firmly by our values of compassion, equity, and peace and voice our deep concern for all (children) affected by violence and conflict, irrespective of their country, ethnicity, nationality, or faith. We invite our members and partner societies to join in upholding the principle that every child, everywhere, deserves to grow up in peace, with access to healthcare, and to live free from violence.
This chapter explores Aboriginal and Torres Strait Islander community-controlled health services (ACCHOS) and looks at the important role they play in improving health outcomes for Aboriginal and Torres Strait Islander people. It is difficult to understand the Aboriginal community-controlled health sector of today without considering how the sector developed. This chapter therefore outlines the conception and establishment of the services and the political realities facing Aboriginal and Torres Strait Islander people at the time of their commencement. This chapter is organised around a case study of the Aboriginal and Torres Strait Islander Health Service in Brisbane, which celebrated its 50th anniversary in 2023. To complement the case study, the chapter includes an overview of the governance structures of the community-controlled sector, as this is an area that can be difficult for health professionals to understand. The scenarios, case studies and reflective questions focus on experiences that nurses and midwives might have working in an Aboriginal community-controlled health service.
Edited by
Katherine Warburton, California Department of State Hospitals, University of California, Davis, USA,Stephen M. Stahl, University of California, Riverside, USA
This chapter follows the story of Jordon, a young man with schizophrenia who becomes entangled in the criminal justice system due to his untreated illness. The narrative highlights the challenges faced by individuals with severe mental illness, the failures of the mental health system, and the impact of policy and legal structures on their lives. Through the experiences of healthcare professionals and experts in the field, the chapter explores the need for a paradigm shift in the treatment of psychosis, advocating for humane and effective care for individuals across the spectrum of illness severity. The narrative culminates in a call to action to revolutionize the treatment of psychosis in America, emphasizing the importance of understanding, compassion, and evidence-based interventions for those affected by severe mental illness.
This chapter considers the circumstances in which a person will be liable for the torts of another person. It primarily looks at the doctrines of vicarious liability (the liability of am employer for the tortious actions of an employee or a principal for the tortious actions of their agent) and non-delegable duties (the circumstances in which a duty arises which cannot be delegated to another person, such as a contractor). Note that there is often advocacy to change the legal position – to extend the legal circumstances in which liability can be extended to a third party – but also note that redefinition of relationships (such as the employment relationship) often requires adjustments in the law.
Academia, though not immediately associated with preserving humanity in war, has been instrumental in advancing international humanitarian law (IHL). Since the 1864 Geneva Convention, scholars have supported the International Committee of the Red Cross (ICRC) by promoting IHL, researching it, and helping the law develop. In a world facing 130 armed conflicts, rising polarization and dehumanization, and a paradoxical mix of interest in and disillusionment with IHL, academia’s role is more vital than ever. Despite its contributions, however, limited scholarship exists on how academia has supported the ICRC in preserving humanity in war by contributing to IHL. How has academia promoted this body of law? How has research strengthened IHL as the cornerstone legal framework that it is today? What role have academics played in its normative development? This article explores these questions, examining academia’s endeavours to promote IHL through education, advocacy and public engagement; its research efforts to consolidate IHL, clarifying it and supporting its implementation; and its contributions to IHL’s development, from involvement in treaty-making to proposing new norms. The piece also calls for reforms in IHL education to enhance its impact, advocates for multidisciplinary and ethical research focused on compliance and other pressing issues, and urges greater inclusion of academia in structures and processes aimed at developing the law. Finally, the article concludes by issuing a call to action for States, universities and academics, and outlining pathways to collectively strengthen IHL and uphold humanity in war.
Advocacy for Post-Intensive Care Syndrome (PICS) is a critical component of supporting the recovery of survivors of critical illness. Despite its importance, a shared understanding of PICS advocacy remains underrepresented in medical literature. This chapter defines PICS advocacy as an ethical commitment to patient- and caregiver-centered care, encompassing three key dimensions: supporting individuals living with PICS, promoting awareness and prevention within medical and lay communities, and advancing the science surrounding this condition. Current advocacy efforts occur across various levels, including local communities, national organizations, and global collaborations. Central to these efforts is awareness, facilitated by a growing array of educational resources such as books, podcasts, and websites. However, PICS advocacy can further benefit from large-scale public awareness campaigns modeled after successful initiatives by organizations like the American Heart Association and the American Cancer Society. These efforts could amplify public understanding and drive systemic change. Individuals are encouraged to take an active role in PICS advocacy, and this chapter offers practical strategies for engagement. By empowering individuals to champion PICS awareness and support, the healthcare community can foster a more inclusive approach to addressing this condition. Advocacy for PICS is not just a responsibility–it is an opportunity to transform care and improve outcomes for survivors and their families.
As part of a social change agenda, nonprofit organisations engage in activities that contribute to debate and influence the development of public policy. This article presents the initial findings from a study investigating whether nonprofit organisations do participate in advocacy activities and if they do, how are they advocating and engaging in public debate without risking their current and future sources of funding. The key findings from the research have identified that the extent of advocacy by the nonprofit organisations studied has not diminished. A model, built on the findings from the literature on how nonprofit organisations approach advocacy, is applied to explain the advocacy activities by the case study organisations. These nonprofit organisations are identifying what they see to be the appropriate advocacy strategies to fit their organisational objectives, policies, funding sources and resources.
Nonprofit and voluntary associations have a long history of defending the rights of their members, clients, and the public. Despite a burgeoning literature on advocacy by nonprofit organizations, few studies attempt to answer a central question: what factors influence nonprofit success in achieving the changes they aim to affect? Using original data from nearly 400 US nonprofits, we examine the extent to which they were involved in changing public policy, the nature of this engagement, and advocacy activities, organizational characteristics and relationships with others associated with reported policy change. More than three quarters of respondents reported having enacted, stopped, or modified policy. Nonprofits more often reported proactively changing policy when working in partnership and reactively stopping or modifying policy when facing opposition groups. Providing expertise and attending meetings was associated with reported policy change, whereas placing opinion ads was not.
In the 1970s, the voluntary sector acted as a key space for advocacy and support for communities that were marginalised from statutory provision. This paper explores how East London voluntary sector organisations addressed the needs of new migrant communities in this period. Drawing on data from six case study organisations, this historical study explores the dual role these organisations played in advocating for these communities and providing needed services. The findings show that in the 1970s through the 1990s advocacy and service delivery functions were closely linked rather than service delivery crowding out advocacy as has been the trend in recent decades. The findings also emphasise the importance of the creation of trusted relationships between the organisations and the communities they served.
In this article we discuss the extent to which service-delivering nonprofit organizations (NPOs) are committed to fulfill an expressive advocacy role, and we look at the advocacy strategies these organizations adopt. Furthermore, we question whether a close relationship with government compromises the NPOs’ willingness to perform these advocacy activities. Based on a large-N sample of more than 250 NPOs in the Flemish welfare sector, our research shows that the overall commitment to an advocacy role was rather low. Rather than focusing on a role as adversary of government, NPOs seek to adopt “softer” strategies such as the use of insider contacts with policy makers, the participation in umbrella organizations or building coalitions with other NPOs. Finally, we found mixed evidences concerning our initial hypotheses. Most importantly, as the dominant source of public income did not stifle the NPOs’ commitment to advocate, we found little support for a resource dependence framework.
This article explores the interplay and collaboration between refugee organization volunteers and social service professionals. On the basis of qualitative interviews and observations, we study how volunteers from Danish local refugee organizations experience their interaction with refugees and social service professionals, and how they act and perceive their role as advocates for the refugees. The purpose is to gain insight into the everyday practices and strategies of civil society organizations attempting to balance the demands and interests of stakeholders and internal legitimacy claims in a hybrid environment. In addition to providing effective refugee assistance and services, refugee organizations achieve legitimacy through professional communication, campaign work, and networking with key political actors and stakeholders. However, although it may be less visible, advocacy-oriented activities also take place in local organizations at ‘street level.’ We identified three distinct types of strategies to balance issues of autonomy in the collaborative relationship with the municipalities and simultaneously engage in advocacy activities.
This article examines the strategies used by some third sector organizations in Australia to advocate. The purpose of this article is to identify the kinds of activities that organizations in New South Wales and Queensland use to promote advocacy, the kinds of language that is used to describe these activities, and the reasons given for the particular strategies adopted. The extent to which the organizations adopt “softer” (that is more institutional forms of advocacy) rather than more openly challenging forms of activism is examined, particularly in light of a neo-liberal political and economic environment. In this analysis emergent strategies are identified that are not easily categorized as either “institutional” or “radical” advocacy. The article presents an exploratory analysis of some of the implications of the strategies adopted, in terms of their democratic effects and potential to strengthen the capacity of third sector organizations. The article is informed by the findings of a qualitative research project involving interviews with 24 organizations in the community services and environmental fields.
Empirical studies of volunteering assume that the similar individuals are drawn equally to different kinds of volunteer-using organizations. The purpose of this article is to explore the demographic predictors of volunteering for several types of advocacy-related organizations, including political parties, labor and business organizations, immigrant/refugee-serving groups, civic organizations, and environmental/animal organizations. Data from the Current Population Survey’s volunteering supplement (pooled 2006–2012) indicate that the demographic profiles of volunteers drawn to advocacy-related organizations differ in specific ways from the demographic profile of those volunteering for other types of organizations. In particular, veterans are more likely than non-veterans to volunteer for political/advocacy groups and civic organizations. Being a minority veteran is associated with volunteering for immigrant organizations and environmental/animal-related organizations. Foreign-born individuals—both US citizens and non-citizens—are more likely to volunteer for immigrant/refugee organizations than the native born. The demographic profiles of volunteers for advocacy-related organizations vary in some ways from the demographic profiles of those who volunteer for service delivery organizations.
The literature on nonprofit management has embraced the concept of “accountability” to target urgent challenges related to NGO probity and integrity, and there have been attempts in the literature to use rational-choice-based governance approaches to solve them. Although the existing principal–agent frameworks provide important insights, they are limited to the analysis of financial relationships between NGOs and donors. We contribute to the literature in developing a comprehensive rational-choice-based governance approach to analyze all stakeholder relationships of NGOs. Applying the research program of ordonomics, we unpack two fundamental interaction problems: (a) the “stakeholder dilemma” between the NGO and a single accountability holder as a one-sided social dilemma and (b) the “competition dilemma” among rival NGOs as a many-sided social dilemma. We show that improving NGO accountability in relation to intended beneficiaries, peer organizations, and the general public also requires identifying the underlying governance problem as a competition dilemma focusing on collective self-regulation as a solution.
International advocacy strategies devised for the political environment in which World Bank policy is decided are often not suitable for advocacy on broader financial policy and trade issues. Advocacy in these “new” agendas challenges prevailing models, which depict NGOs as mobilizing powerful governments and international organizations to influence a government’s behavior. The patterns of international NGO political activity are diverse, sometimes restraining the power of international rules and authorities over individual governments, and require a new or broader model.