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Case Study 5

Case Study 5
In this context, focus is on the case of Trina, a 10-year-old native American female. The child has not reported any discomfort; it is the mother who is concerned. Trina has been avoiding vegetables and fruits. She is fairly active in sports which is why her mother wonders why her body does not desire fruits and vegetables as most people do. Her body weight is 110 with her BP is 122/79. This is slightly above the upper limit of 120/80mmHg. In her case, the FMH was negative for the myocardial infarctions. However, the parents were taking medication specifically for dyslipidemia. These details are used to come up with a diagnosis analysis below.
Based on what has been reported about the patient, additional questions would be what else Trina takes that accounts for the calories she burns when she is playing soccer. These could be too sugary limiting her consumption of fruits and vegetables. The case has indicated all elements of LOCATES as follows: the location (unknown), the onset (10-year-old female), character (soccer player), associated signs (negative myocardial infarction), timing (currently ongoing), exacerbating factors (worrying BP vitals) and severity (possibly obese)
I will want to know about the history of obesity in the family given the lack of interest in vegetables and fruits yet the body weight remains 110 despite the heavy soccer practice. I will want to know more about the cholesterol level in the body of Trina. This will help to identify if she is at the early stages of obesity as per Sakata (2018). My differential diagnosis of Trina is that she may have decreased concentration, dry skin fatigue and cold intolerance based on her vitals and further observation. These are part of the hypothyroidism primary and hypothyroidism central tests in the historical and physical examinations.
The three differentials that might help me reach to the conclusion of obesity in Trina are the Free T4: being less than 5 picomoles, TSH: being more than 5 mU/L and TSH being in low normal or appropriately.
The most likely diagnosis would be that Trina is at an early stage of Obesity and other lifestyle diseases not discernible yet. I would give this child multivitamins to trigger her appetite and encourage the parents to give the child more vegetables and fruits when they are hungry while cutting down on snacks and fast foods. The medication would be multivitamins and medicines that will normalize her BP vitals as recommended by Kummet (2018). These are diuretics 2mg intake a day and beta-blockers 3mg a day.
The parents need to be educated on how to deal with such a child in terms of their eating disorder. They should not be forced to eat but can be encouraged by adding fruits and vegetables in their foods. Trina being from a native American family may not face any socio-cultural barriers with her weight management. There are no immunizations for obesity. Based on her age, she should visit the clinic after a week (Murphy, 2016). The parents and the child should be told to reevaluate their foods to make more balanced with less sugar as additional anticipatory guidance.

References
Kummet, T. D. (2018). History of Present Illness. Southwest Journal of Pulmonary and Critical Care, 16, 110.
Murphy, K. (2016). History of Present Illness. Southwest Journal of Pulmonary and Critical Care, 12, 205.
Sakata, K. K. (2018). History of Present Illness. Southwest Journal of Pulmonary and Critical Care, 16, 237.

 

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Understanding the Digestive System Essay.

Understanding the Digestive System Essay.

 

Module 2 Written Assignment 1. What are enzymes? What specifically is the role of an enzyme in digestion? Enzymes are working proteins that facilitate chemical reactions without being changed in the process. Organs of the digestive system excrete digestive juices, which contain enzymes that break the bonds of nutrients that can be absorbed. 2. Trace the path of a cheeseburger and fries through the digestive tract. Indicate each place where mechanical digestion, chemical digestion, and absorption occurs FOR EACH NUTRIENT (carbohydrates, lipids, proteins).Understanding the Digestive System Essay. Be sure to fully explain the role of EACH organ involved (including the pancreas, liver, and gallbladder). In the mouth – food is crushed and chewed by teeth (mechanical…show more content…

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The small intestine also contributes enzymes to complete the digestion process before nutrients are small enough for the cells to absorb (chemical). In the large intestine – The digestion and absorption of proteins, fats and carbohydrates are essentially complete by the time the intestinal contents enter the colon.Understanding the Digestive System Essay. Only water, fiber and some minerals remain. Only certain fibers can be broken down by bacteria (chemical digestion).The colon’s task is mostly to reabsorb water and minerals, leaving a paste of fiber and feces for excretion (mechanical) via rectum and anus. 3. How is the lining of the small intestine protected from acidic chyme entering from the stomach? The pyloric valve of the lower stomach regulates the amount of chyme that exits into the small intestine, allowing only a little at a time to exit. Also, once chyme enters the small intestine, hormonal messengers signal the pancreas to release alkaline pancreatic juice, bicarbonate, to neutralize the stomach acid that has reached the small intestine.Understanding the Digestive System Essay.

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Digestive System The human body uses various kinds of food for energy and growth. To be used, however, food must be changed into a form that can be carried through the bloodstream. The body’s process of extracting useful nutrients from food is called digestion. The digestive system of humans and other higher animals is the group of organs that changes food–carbohydrates, fats, and proteins–into soluble products that can be used by the body. Both mechanical action and chemical action are necessary to change food into products that are usable by the body. Human digestion, or the change that food undergoes in the digestive system, takes place in a long tubelike canal called the alimentary canal, or the digestive tract.Understanding the Digestive System Essay. There is good reason why the passageway used by food to travel through the body is called the alimentary canal. Just as canals are constructed to guide ships through waterways to their destinations, the alimentary canal guides food as it travels through the human body. The whole canal is lined with a mucous membrane. Digestion begins in the mouth. Here the food is cut and chopped by the teeth. The tongue helps mix the food particles with a digestive juice called saliva, which is secreted in the mouth. Saliva moistens the food so it can be swallowed easily. It also changes some starches into simple sugars. It is important to chew food thoroughly to mix it well with saliva. Thorough chewing cuts food into small pieces that are more easily attacked by digestive juices. Food should not be washed down with quantities of liquid to avoid chewing. From the mouth the food is swallowed into a transport tube, named the esophagus, or gullet.Understanding the Digestive System Essay. A flap called the epiglottis closes the windpipe while food is being swallowed. Peristalsis, a wavelike muscular movement of the esophagus walls, forces food down the tube to the stomach. Peristalsis takes place throughout the digestive tract. It is an automatic, or involuntary, action, carried out in response to nerve impulses set up by the contents of the tube. When digestion is working normally, a person is unaware of the movements of the gullet, stomach, and most of the intestine. Swallowing is a voluntary muscular action. At the end of the esophagus there is a muscular valve, or sphincter, through which food enters the stomach. This sphincter muscle keeps food in the stomach from being forced back into the esophagus.Understanding the Digestive System Essay. Peristalsis in the stomach churns the food and mixes it with mucus and with gastric juices, which contain enzymes and hydrochloric acid. These gastric juices are secreted from millions of small glands in the lining of the upper stomach walls. These glands pour about three quarts of fluid into the stomach daily. Similar glands in the small intestine also secrete enzymes and fluid. Hydrochloric acid secreted by the stomach sets up the sour or acid condition necessary for digestion. Certain remedies for indigestion are advertised as correcting this acid condition. If these remedies actually do get rid of the stomach acids it is not wise to take them. Acid is required for digestion to be properly undertaken in the stomach. The stomach churns the food into a thick liquid, called chyme, before it is passed on by peristalsis into the small intestine. Another strong sphincter muscle further mashes the chyme and has some control over the rate at which it is passed out of the stomach into the duodenum, or upper small intestine.Understanding the Digestive System Essay. The sphincter also prevents the chyme from passing back into the stomach. Little by little, as the digestive process in the stomach is completed, all the chyme is passed through the sphincter into the duodenum. This peristalsis is regulated by the autonomic nervous system. This process does not take place all at once. It continues over a period of time. From the time a meal is eaten, it takes from 30 to 40 hours for food to travel the length of the alimentary canal. Different kinds of food, depending on their components, are held in the stomach for varying lengths of time. Starch and sugar are held in the stomach for a short time only, usually no more than one to two hours.Understanding the Digestive System Essay. Protein foods are there from three to five hours. Fat foods may remain in the stomach even longer than proteins. This is why eating a heavy dinner of meat, potatoes, and gravy satisfies our hunger longer than one made up entirely of sweets or greens. Furthermore, food made up of easily digested carbohydrates passes quickly from the stomach and into the small intestine. The stomach, though important, is not considered by physicians to be essential to life. People who have had their stomachs completely or partially removed are frequently able to live by taking special foods in small quantities many times a day.Understanding the Digestive System Essay. The small intestine is then able to perform all necessary digestion. The small intestine, which is from 22 to 25 feet (6.7 to 7.6 meters) long, is the longest part of the digestive tract of humans. The main parts of the small intestine are the duodenum, jejunum, and ileum. Food remains in the small intestine for several hours. Two large glands, the liver and the pancreas, connect with the small intestine by ducts, or tubes. Through these ducts the liver and pancreas pour secretions which further aid digestion. Fluid from the pancreas is called pancreatic juice. Fluid from the liver is called bile. The pancreas is one of the most important glands in the body. It secretes up to a pint of pancreatic juice a day. This digestive fluid contains enzymes which help digest carbohydrates, proteins, and fats. One of these enzymes is trypsin, which helps digest protein foods. Other enzymes are amylase and maltase, which help digest carbohydrates. The pancreatic enzyme lipase, along with bile from the liver, helps digest fat. Bile, however, does not contain important enzymes. Bile is stored in the gall bladder, a small hollow organ located just under the liver. We could not live without the liver but the gall bladder can be removed by surgery without serious effect. The liver stores glycogen for later use by the body and furnishes clotting material for the blood. When fully digested, proteins are changed into amino acids; fat foods are changed into fatty acids; and carbohydrates are changed into sugars. These soluble food products are dissolved and then absorbed into the bloodstream through the walls of the small intestine. While food is in the small intestine it is further diluted by fluid secreted by the intestinal glands. In an adult the small intestine is about 21 feet long. By the time the diluted food products have traveled its length, most of their nutrients have been absorbed into the bloodstream.Understanding the Digestive System Essay.

The nutrition in human beings (or man) takes place through human digestive system. The human digestive system consists of the alimentary canal and its associated glands. The various organs of the human digestive system in sequence are: Mouth, Oesophagus (or Food pipe), Stomach, Small intestine and Large intestine.Understanding the Digestive System Essay.

The glands which are associated with the human digestive system and form a part of the human digestive system are: Salivary glands, Liver and Pancreas. The human alimentary canal which runs from mouth to anus is about 9 meters long tube. The ducts of various glands open into the alimentary canal and pour the secretions of the digestive juices into the alimentary canal. We will now describe the various steps of nutrition in human beings (or man).Understanding the Digestive System Essay.

1. Ingestion :

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The human beings have a special organ for the ingestion of food. It is called mouth. So, in human beings, food is ingested through the mouth. The food is put into the mouth with the help of hands.Understanding the Digestive System Essay.

2. Digestion :

In human beings, the digestion of food begins in the mouth itself. In fact, the digestion of food starts as soon as we put food in our mouth. This happens as follows: The mouth cavity (or buccal cavity) contains teeth, tongue, and salivary glands. The teeth cut the food into small pieces, chew and grind it. So, the teeth help in physical digestion. The salivary glands in our mouth produce saliva.Understanding the Digestive System Essay.

Our tongue helps in mixing this saliva with food. Saliva is a watery liquid so it wets the food in our mouth. The wetted food can be swallowed more easily. Many times we have observed that when we see or eat a food which we really like, our mouth ‘waters’. This watering of mouth is due to the production of saliva by the salivary glands in the mouth.

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The salivary glands help in chemical digestion by secreting enzymes. The human saliva contains an enzyme called salivary amylase which digests the starch present in food into sugar. Thus, the digestion of starch (carbohydrate) begins in the mouth itself. Since the food remains in the mouth only for a short time, so the digestion of food remains incomplete in mouth.Understanding the Digestive System Essay.

The slightly digested food in the mouth is swallowed by the tongue and goes down the food pipe called oesophagus. The oesophagus carries food to the stomach. This happens as follows: The walls of food pipe have muscles which can contract and expand alternately. When the slightly digested food enters the food pipe, the walls of food pipe start contraction and expansion movements.Understanding the Digestive System Essay.

The contraction and expansion movement of the walls of food pipe is called peristaltic movement. This peristaltic movement of food pipe (or oesophagus) pushes the slightly digested food into the stomach (In fact, the peristaltic movement moves the food in all the digestive organs throughout the alimentary canal).Understanding the Digestive System Essay.

The stomach is a J-shaped organ present on the left side of the abdomen. The food is further digested in the stomach.

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The food is churned in the stomach for about three hours. During this time, the food breaks down into still smaller pieces and forms a semi-solid paste. The stomach wall contains three tubular glands in its walls. The glands present in the walls of the stomach secrete gastric juice.

The gastric juice contains three substances: hydrochloric acid, the enzyme pepsin and mucus. Due to the presence of hydrochloric acid, the gastric juice is acidic in nature. In the acidic medium, the enzyme pepsin begins the digestion of proteins present in food to form smaller molecules.Understanding the Digestive System Essay.

Thus, the protein digestion begins in the stomach. Please note that the protein digesting enzyme pepsin is active only in the presence of an acid. So, the function of hydrochloric acid in the stomach is to make the medium of gastric juice acidic so that the enzyme pepsin can digest the proteins properly.Understanding the Digestive System Essay.

Another function of hydrochloric acid is that it kills any bacteria which may enter the stomach with food. The mucus helps to protect the stomach wall from its own secretions of hydrochloric acid.

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If mucus is not secreted, hydrochloric acid will cause the erosion of inner lining of stomach leading to the formation of ulcers in the stomach. The partially digested food then goes from the stomach into the small intestine. The exit of food from stomach is regulated by a ‘sphincter muscle’ which releases it in small amounts into the small intestine.Understanding the Digestive System Essay.

From the stomach, the partially digested food enters the small intestine. The small intestine is the largest part of the alimentary canal. It is about 6.5 metres long in an adult man. Though the small intestine is very long, it is called small intestine because it is very narrow.Understanding the Digestive System Essay.

The small intestine is arranged in the form of a coil in our belly. Please note that the length of the small intestine differs in various animals depending on the type of food they eat. For example, cellulose is a carbohydrate food which is digested with difficulty. So, the herbivorous animals like cow which eat grass need a longer ‘small intestine’ to allow the cellulose present in grass to be digested completely. On the other hand, meat is a food which is easier to digest. So, the carnivorous animals like tigers which eat meat have a shorter ‘small intestine’.Understanding the Digestive System Essay.

The small intestine in human beings is the site of complete digestion of food (like carbohydrates, proteins and fats). This happens as follows:

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(a) The small intestine receives the secretions of two glands: liver and pancreas. Liver secretes bile. Bile is a greenish yellow liquid made in the liver which is normally stored in the gall bladder. Bile is alkaline, and contains salts which help to emulsify or break the fats (or lipids) present in the food. Thus, bile performs two functions:Understanding the Digestive System Essay.

(i) makes the acidic food coming from the stomach alkaline so that pancreatic enzymes can act on it, and (ii) bile salts break the fats present in the food into small globules making it easy for the enzymes to act and digest them.Understanding the Digestive System Essay.

Pancreas is a large gland which lies parallel to and beneath the stomach. Pancreas secretes pancreatic juice which contains digestive enzymes like pancreatic amylase, trypsin and lipase. The enzyme amylase breaks down the starch, the enzyme trypsin digests the proteins and the enzyme lipase breaks down the emulsified fats.

(b) The walls of small intestine contain glands which secrete intestinal juice. The intestinal juice contains a number of enzymes which complete the digestion of complex carbohydrates into glucose, proteins into amino acids and fats into fatty acids and glycerol. Glucose, amino acids, fatty acids and glycerol are small, water soluble molecules. In this way, the process of digestion converts the large and insoluble food molecules into small, water soluble molecules. The chemical digestion of food is brought about by biological catalysts called enzymes.Understanding the Digestive System Essay.

3. Absorption :

After digestion, the molecules of food become so small that they can pass through the walls of the small intestine (which contain blood capillaries) and go into our blood. This is called absorption. The small intestine is the main region for the absorption of digested food. In fact, the small intestine is especially adapted for absorbing the digested food.Understanding the Digestive System Essay.

The inner surface of small intestine has millions of tiny, finger­like projections called villi. The presence of villi gives the inner walls of the small intestine a very large surface area. And the large surface area of small intestine helps in the rapid absorption of digested food. The digested food which is absorbed through the walls of the small intestine goes into our blood.Understanding the Digestive System Essay.

4. Assimilation:

The blood carries digested and dissolved food to all the parts of the body where it becomes assimilated as part of the cells. This assimilated food is used by the body cells for obtaining energy as well as for growth and repair of the body.Understanding the Digestive System Essay.

The energy is released by the oxidation of assimilated food in the cells during respiration. The digested food which is not used by our body immediately is stored in the liver in the form of a carbohydrate called ‘glycogen’. This stored glycogen can be used as a source of energy by the body as and when required.Understanding the Digestive System Essay.

5. Egestion:

A part of the food which we eat cannot be digested by our body. This undigested food cannot be absorbed in the small intestine. So, the undigested food passes from the small intestine into a wider tube called large intestine. (It is called large intestine because it is a quite wide tube).Understanding the Digestive System Essay.

The walls of large intestine absorb most of the water from the undigested food (with the help of villi). Due to this, the undigested part of food becomes almost solid. The last part of the large intestine called ‘rectum’ stores this undigested food for some time. And when we go to the toilet, then this undigested food is passed out (or egested) from our body through anus as faeces or ‘stool’. The act of expelling the faeces is called egestion or defecation. The exit of faeces is controlled by the anal sphincter.Understanding the Digestive System Essay.

Let us solve one problem now.

Sample Problem:

1 ml of very dilute starch solution (1% starch solution) is taken in a test-tube and 1 ml of saliva is added to it. After keeping this mixture for half an hour, a few drops of dilute iodine solution are added to the test-tube. There is no change in colour on adding iodine solution. What does this tell you about the action of saliva on starch?Understanding the Digestive System Essay.

Answer:

When a mixture of dilute starch solution and saliva is kept in a test-tube for half an hour, it does not produce a blue-black colour with iodine solution showing that no starch is left in the test-tube. This tells us that the action of saliva has broken down starch into some other substance which does not give any colour with iodine solution. Actually, saliva contains an enzyme ‘amylase’ which converts starch into a sugar.Understanding the Digestive System Essay.

Dental Caries :

The hard, outer covering of a tooth is called enamel. Tooth enamel is the hardest material in our body. It is harder than even bones. The part of tooth below enamel is called dentine. Dentine is similar to bone. Inside the dentine is pulp cavity. The pulp cavity contains nerves and blood vessels. The formation of small cavities (or holes) in the teeth due to the action of acid-forming bacteria and improper dental care is called dental caries. This happens as follows.Understanding the Digestive System Essay.

When we eat sugary food, the bacteria in our mouth act on sugar to produce acids. These acids first dissolve the calcium salts from the tooth enamel and then from dentine forming small cavities (or holes) in the tooth over a period of time. The formation of cavities reduces the distance between the outside of the tooth and the pulp cavity which contains nerves and blood vessels.Understanding the Digestive System Essay.

The acids produced by bacteria irritate the nerve endings inside the tooth and cause toothache. If the cavities caused by dental decay are not cleaned and filled by a dentist, the bacteria will get into the pulp cavity of tooth causing inflammation and infection leading to severe pain.Understanding the Digestive System Essay.

If the teeth are not cleaned regularly, they become covered with a sticky, yellowish layer of food particles and bacteria cells called ‘dental plaque’. Since plaque covers the teeth forming a layer over them, the alkaline saliva cannot reach the tooth surface to neutralise the acid formed by bacteria and hence tooth decay sets in. Brushing the teeth regularly, after eating food, removes the plaque before bacteria produces acids. This will prevent dental caries or tooth decay. Before we go further and discuss respiration.Understanding the Digestive System Essay.

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Social Legislation and Social Change Essay.

Social Legislation and Social Change Essay.

 

The legal system we abide by has generally served its purpose by providing order and justice in most situations that need legal obedience. However, on the premises of producing social change, the system has not proven to bring changes in society. Perhaps justification for this is explained by Clarence Darrow who argues that the law applies to and favors specific types of social classes. Robert Cover addresses how punishments from judges may counteract their purpose. Karla Fischer and her peers, along with Jackie Campbell’s “Walking the Beat Alone,” show how law has objectives to serve society, but do not supply social change and in fact hinder its progress. The film Eyes on the Prize portrayed the African American efforts in disobeying the…show more content…Social Legislation and Social Change Essay.

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However, as it is, the legal system is in place and there are further examples and reasons to prove that it does not provide social change. In author Robert Cover’s, The Violence of Legal Acts, legal decisions are under the spotlight in terms of their effects. Cover explains that the process with which a defendant goes through is in itself fairly violent (Cover 222). Sure, punishments bring justice to crimes. However, in terms of social change, the law is just offsetting its purpose. One could argue that by punishing criminals for violent crimes, is changing society. It is not changing society, it is just putting criminals in jail and ignoring the reasons they did what they did. Instead of attempting to prevent their crimes, our legal system just puts the criminals in jails. Michael McCann writes, “Legal relations, institutions, and norms tend to be double edged, at once, upholding the larger infrastructure of the status quo while providing many opportunities for episodic challenges and transformations in that ruling order.Social Legislation and Social Change Essay.
For decades now law and society theorists have been preoccupied with attempts to explain the relationship between legal and social change in the context of development of legal institutions. They viewed the law both as an independent and dependent variable (cause and effect) in society and emphasized the interdependence of the law with other social systems.Social Legislation and Social Change Essay.

In its most concrete sense, social change means large numbers of people are engaging in group activities and relationships that are different from those in which they or their parents engaged in previously. Thus, social change means modifications in the way people work, rear a family, educate their children, govern themselves, and seek ultimate meaning in life. There …show more content…Social Legislation and Social Change Essay.

(i) Institutionalization of a pattern of behavior refers to the establishment of a norm with provisions for its enforcement (such as de-segregation of public schools).
(ii) Internalization of a pattern of behavior means the incorporation of the value or values implicit in a law (e.g. Integrated public schools are ‘good’).
The extent to which law can provide an effective impetus for social change varies according to the conditions present in a particular situation. William Evan suggests that a law is likely to be successful to induce change if it meets the following seven conditions: 3
(i) Law must emanate from an authoritative and prestigious source.
(ii) Law must introduce its rationale in terms that are understandable and compatible with existing values.Social Legislation and Social Change Essay.
(iii) Advocates of the change should make reference to other communities or countries with which the population identifies and where the law is already in effect.
(iv) Enforcement of the law must be aimed at making the change in a relatively short time
(v) Those enforcing the law must themselves be very much committed to the change intended by the law.
(vi) The instrumentation of the law should include positive as well as negative sanctions.Social Legislation and Social Change Essay.

Discussions of law are often divided between two very different perspectives — what has been called the “external” and “internal” points of view. Prominent Law and Society scholars adopt a similar distinction when they call for an “outside” instead of an “inside” perspective on law. Most law schools (especially during the first year) concentrate on teaching an “inside” perspective, an internal – doctrinal framework as the model for “thinking like a lawyer.” Social Legislation and Social Change Essay.

This internal – doctrinal perspective has some similarity to the “legal formalism” and “conceptualism” that Progressives and Legal Realists had been denouncing since the turn of the century. One of the most important characteristics of the formalism of late nineteenth century Classical Legal Thought was the way in which it represented its closed, internalistic point of view as “neutral, natural and necessary.” The Law and Society movement arose as an extension of Legal Realism’s effort to criticize the dominantly internalistic point of view in Classical Legal Thought for having produced a “heaven of legal concepts” unrelated to the real world. Social Legislation and Social Change Essay.

The Law and Society perspective, like much of Legal Realism, treats law not as a closed system with an internal logic all its own but as the product of various external influences, like power, history and social, economic, and cultural influences. When Holmes proclaimed that “the life of law has not been logic; it has been experience,” he was attacking an exclusively internalistic perspective that produced false certainty by confusing legal reasoning with mathematical or geometrical reasoning

Another influence on the Law and Society movement was the Sociological Jurisprudence of Roscoe Pound. Pound had also delivered a powerful critique of late-nineteenth century classical legal thought for having lost touch with society’s needs. Pound distinguished the “law in books” from the “law in action”, and followed Holmes in deploring the increasing separation of the two.Social Legislation and Social Change Essay.

After Holmes, this was the second intellectual seed from which the twentieth century Law and Society movement was spawned. It became the basis for Pound’s own “sociological jurisprudence,” which, in turn, laid the foundation for studying why there has often existed a substantial “lag” or “gap” between social change and legal change The Brandeis Brief is the most famous application of Pound’s ideas to the actual practice of legal argument Brandeis and Justice Benjamin Cardozo were the foremost judicial proponents of Pound’s ideas (RED5). Here we should note the convergence between the anthropologists highlighting “cultural lag” and the Progressive followers of sociological jurisprudence who sought to explain “legal lag,” e.g., why law had lost touch with life — why, for example, law had often failed to respond to the shift from an agricultural to an industrial society .The idea of “legal lag” figures prominently in the opinions both in Brown v. Board of Education and the assisted suicide cases.Social Legislation and Social Change Essay.

Finally, Law and Society scholars were influenced by the Realists’ reconceptualization of legal rights . Legal Realists emphasized that the way to determine in practice whether a legal right exists is by studying what remedies the law actually allows. In contract law, for example, the Realists shifted the focus to different theories of damages (e.g., reliance vs. expectancy damages) 5.

For Lawrence Friedman “The law and society movement is the scholarly enterprise that explains or describes legal phenomena in social terms.” The work of Law and Society falls into a few broad classes:Social Legislation and Social Change Essay.

To begin with, there are studies dealing with the production or shaping of law within a given society: how concrete events, situations, expectations, thoughts, and actions impinge on “Legal” institutions and change their behavior. Where do demands on the legal system come from? What causes them? What forms do they take? Next, there are studies of the operation of the legal system itself, its internal workings, and studies of the transformation process — what happens to raw demands and raw “fact situations” when they get into the hands of legal professionals. Research on judicial decisionmaking has run into something of a dead end; but perhaps this problem is only temporary. There seems to be growing interest in legislative and administrative decisionmaking. There is also a good deal of interest in the legal profession as such. Lawyers, after all, do much of the work of translating lay demands into legal forms.Social Legislation and Social Change Essay.

Then, there is study of the impact of law. This is a difficult area. It includes the problem of communication within the legal system. After all, a norm or order is useless, unless it reaches some audience; if nobody hears the message, no impact is possible. Beyond that is the study of impact itself. This includes the tangled question of deterrence, the effect of rewards and punishments on behavior.Social Legislation and Social Change Essay.

In recent years, there have been literally hundreds of studies and reports on deterrence. The hard questions are still open: who gets deterred, and when, and how much, and why? Everybody concedes, or should concede, that impact is more than a matter of rewards and punishments. People are influenced by social roles; by family, friends, and neighbors; by religion and tradition; by ideas of right and wrong; by a mysterious something called legitimacy. How these feelings and motives arise, and what effect they have on impact, is a difficult, underdeveloped field. Here, too, it is appropriate to study the symbolic and expressive meanings of legal institutions and legal language. These meanings may ultimately affect the behavior of members of society. Finally, there is the study of feedback. Feedback is a specific form of impact; it is the way responses and behaviors curve back and affect the system itself.Social Legislation and Social Change Essay.

In their earlier work, Law and Society scholars followed the reformist goal of the Brandeis Brief in seeking to demonstrate that law needed to be bought back in touch with actual social practice. With the emergence of value-free social science, this perspective slowly blended into efforts to model social science on the natural sciences by discovering universal, scientific laws of society which assumed that law is the dependent variable, society the independent variable. The main emphasis of works premised on such a view was to demonstrate the limited autonomy or independence of law from social practices or structures of hierarchy. Law was regarded as a “mirror” or “reflection” of reality, not terribly different methodologically from some Marxist versions that treat law as derivative “superstructure” reflecting an underlying “base” of economic influences. This approach also meant that existing social practice was being uncritically set up as a norm or baseline . Many scholars incorporated the prevailing functionalism into their work, which had the apologetic effect of legitimating existing social practice on the grounds that it wouldn’t exist if it weren’t performing some legitimate social function  .Social Legislation and Social Change Essay.

Law and Society scholars were much criticized for associating themselves with value-free social science. In the 1970s, Critical Legal scholars challenged the Law and Society thinkers for a) being reductionist for failure to recognize the “relative autonomy of law;” b) engaging in apologetics — e.g., underestimating social conflict and social injustice — through the adoption of a “functionalist” methodology that tended to “explain” or “rationalize” the social function of even unjust and pathological social arrangements

But like the Legal Realists, Law and Society scholars were of two minds on the efficacy of law. During the 1960s and 1970s they engaged in a variety of programmatic or instrumental studies clearly designed to foster or improve activities such as legal services to the poor, welfare and urban renewal. Unlike the “scientists” who saw law as passively responding to social forces, “instrumental” scholars in all of these sub-fields see law as shaping behavior. Just as important, both scientists and instrumental policy scholars enthusiastically endorse the view that law is socially constructed. Lawrence Friedman, one of the founders of the Law and Society movement, maintains that belief in the socially constructed character of legal institutions is one of the central premises of the movement .Social Legislation and Social Change Essay.

 

Many Law and Society writings provide examples of legal change and evolution. There is changing social custom that produced the “silent” revolution in divorce law. Among the most important subjects involving legal change are the effects of the regulatory, welfare, bureaucratic state on the formation and application of law .Social Legislation and Social Change Essay.

Following the Realist tradition, other studies focus on the operation of law. As part of their efforts to bring the law in books back in touch with society, the Realists engaged in empirical studies of how the law actually worked (or did not work) in practice. It led to famous studies of the inefficiency of civil procedure and the organization of courtsThis approach is the direct ancestor of the many fruitful Law and Society studies of Alternative Dispute Resolution as an alternative to formal procedure.Social Legislation and Social Change Essay.

In similar manner, during the 1950s, Law and Society scholars began to undertake studies of informal, or quasi-legal, processes and their effect on law. In one of the most famous Law and Society studies of contract cases, Steward Macaulay found that there was widespread non-use of the formal processes of contract law; that informal customs and understandings often substituted for formal provisions; and that formal sanctions were often replaced by informal dispute resolution .Social Legislation and Social Change Essay.

Likewise, Law and Society scholars have recognized the central role of insurance in the process of torts settlements. One author suggests that the so-called insurance crisis of the mid-1980s was actually determined by the business cycles of liability insurance companies. Others focused on the “gap” between formal or official law and social practices. For example, H. Laurence Ross studied the process of insurance claim adjustment in Torts cases to demonstrate that “legal relationship cannot be understood as a product of formal law alone, but must be understood in terms of the interplay between the formal law and aspects of the situations in which law is applied.”.Social Legislation and Social Change Essay.

Perhaps the most famous example of the interplay between the formal law and informal dispute resolution is Mnookin & Kornhauser, “Bargaining in the Shadow of the Law: the Case of Divorce.” The authors demonstrate the way in which the formal legal rules give one or another party certain “bargaining chips” to shape the outcome of informal processes by threatening to go to court. This is similar to the way plea-bargaining in criminal cases takes place in the shadow of the criminal law; or the way torts settlements take place in the shadow of trials by jury.

The Realists’ external explanations of legal phenomena also looked to the ways in which social causes affect law observance. During the early decades of the century, such studies were especially prominent in the new field of criminology which sought to relate the type and frequency of crime to underlying social causes like poverty, immigration or social disintegrations like the breakdown of the family. Criminologists were also interested in the extent to which law actually shaped social behavior. This led to Impact Studies of the effects of legal rules on behavior. For example, during the campaign against capital punishment in the 1960s,Law and Society scholars engaged in studies to determine whether the death penalty deters murder

Even in private law, the new attention to the impact of law led scholars to study how legal rules affect behavior. Law and Society scholars are especially interested in whether legal rules have “penetrated” into public consciousness. For example, Law and Society scholars attempted to study the extent to which psychotherapists actually knew and understood the obligations required under the famous California case of Tarasoff v. Regent of the University of California that imposed certain duties on therapists to warn people threatened by their patients . Here are the questions they asked:Social Legislation and Social Change Essay.

  1. Knowledge of Tarasoff
    1. Do therapists know about Tarasoff(ans.)
    2. From which sources did therapists learn the most about Tarasoff(ans.)
  2. Tarasoff, the Reasonable Therapist and the Dangerous Patient
    1. Do therapists understand when Tarasoff applies? (ans.)
    2. Do therapists believe that they can make meaningful assessments of future violence? (ans.)
    3. Do therapists believe that other professionals would agree with their assessment of dangerousness in a given case? (ans.)Social Legislation and Social Change Essay.
  3. Tarasoff, Warnings and Confidentiality
    1. What do therapists believe Tarasoff requires: warning, reasonable care, both or neither? (ans.)
    2. What are the practices of psychotherapists regarding communicating information concerning a patient to third parties? (ans.)
    3. To the extent that therapists do warn third parties, are such warnings made contrary to the therapist’s clinical judgment? (ans.)
  4. Tarasoff‘s Impact on Behavior
    1. Do therapists believe themselves either legally or ethically obligated by the Tarasoff principle of responsibility for the physical well-being of potential victims? (ans.)
    2. Has Tarasoff influenced therapists attitudes regarding appropriate interventions in the treatment of potentially violent patients? (ans.)
    3. Has Tarasoff  discouraged therapists from treating potentially dangerous patients? (ans.)
    4. Has Tarasoff influenced therapists to warn potential victims, involuntary hospitalize potentially violent patients, or otherwise attempt to respond to the legal obligation to protect potential victims? (ans.)

While some Law and Society scholars emphasize the failure of law to affect primary behavior, others stress the unintended consequences that followed from changes in legal rules. For example, one study of the Supreme Court’s constitutional criminal procedure cases, including Gideon v. Wainwright and Miranda v. Arizona concludes that given the sociology of criminal courts and the criminal bar, these decisions “may have a long range effect which is radically different from that intended or anticipated.”.Social Legislation and Social Change Essay.

Another study outlines the unintended consequences that flowed from California’s “no fault” reform of its divorce law. Since under the previous regime property was divided between a divorcing couple according to “fault,” the authors of the reform shifted to equal distribution of marital property. One of the unintended consequences of the change: more forced sales of the family home to provide cash for each of the parties. “The result is increased dislocation and disruption in the lives of minor children (in contrast to the old law pattern in which the wife with custody of minor children was typically awarded the family home).” The study more generally seeks to show that the rule of equal property distribution will produce inequity where one of the two spouses is unequally situated at the time of divorce — for example, the older housewife without earning potential.

Finally, some of the best work in recent years has been on the legal profession — its organization, practices and culture. For example, Law and Society scholars have emphasized the mediating role of lawyers and of other legal institutions in maintaining social hierarchy. In one of the most cited Law and Society pieces, Why the “Haves” Come Out Ahead, Marc Galanter identified the structure of legal institutions as decisively affecting outcomes. In particular he distinguished between “repeat players” and “one-shooters” in litigation. “Repeat players” can adapt their settlement or information gathering strategies to the long term process of litigation.

Like all of the social sciences except economics, during the 1980s the Law and Society movement splintered into “positivist” and “hermeneutic” or “interpretive” wings.The positivists, seeking to emulate the models and experimental methods of the natural sciences, insisted that the goal of Law and Society scholars should be to produce universal laws of society modeled on the natural sciences.. By contrast, the interpretivists maintain that it is not possible to have unmediated access to reality; reality must be filtered through socially constructed categories and institutions. Hence, they maintain that it is naive of the scientists to claim that they have direct access to objective truth. The debate between the two groups also expresses an earlier conflict over whether there can be a value-free social science which is able to ignore normative questions of value or prescription in order to concentrate on descriptive studies that can claim the mantle of objectivity. The interpretivists maintain that it is impossible to isolate value questions in the process of creating a research program; that in fact value premises are imbedded in the various paradyms we use to understand the world .Social Legislation and Social Change Essay.

But as the studies explored here show there are ways to reconcile the critical impulse of the interpretivist with the empirical impulse of the positivist. As David Trubek indicates,

A vast number of questions should be explored … How, for example, do the ideas about what is the proper organization of society, encoded in legal beliefs, affect the way the legal profession behaves? How are lawyers’ views of what is possible shaped by legal ideas, and how do these views influence other actors in society? Does the fact that law draws lines between a public and a private sphere influence political struggles? Does the possibility of a legal remedy — or the lack of one — make a difference in the organization and expression of social conflict?Social Legislation and Social Change Essay.

Critical law and society scholars, in short, use the insights of critique in a careful investigation of the operation of legal consciousness at all levels of American society.

Essay on Social Legislation and Social Change – “Laws are a form of social rule emanating from political agencies”. Laws become legislations when they are made and put into force by law-making body or authority. Legislations, particularly social legislations have played an important role in bringing about social change.Social Legislation and Social Change Essay.

There are two opinions about the functions of law. The function of law, according to one view, is to establish and maintain social control. Hence the major problem of law is to design legal sanc­tions to minimise deviance and to maintain social solidarity and social order.Social Legislation and Social Change Essay.

Another view stresses the dynamic role of law. It states that the function of law is not just to maintain social order through social control. It insists that law must bring about social change by influencing people’s behaviour, beliefs and values. We shall now analyse the role of law or legisla­tion in bringing about social change.Social Legislation and Social Change Essay.

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A careful analysis of the role of legislation in social change would reveal two things. (i) Through legislations the state and society try to bring the legal norms in line with the existing social norms, (ii) Legislations are also used to improve social norms on the basis of new legal norms.

Social legislation can be an effective means of social change only when the existing social norm is given a legal sanction. No legislation by itself can substitute one norm with another.Social Legislation and Social Change Essay.

It can hardly change norms. Unaided social legislation can hardly bring about social change. But with the support of the public opinion it can initiate a change in social norm arid thus a change in social behaviour. Some examples of social legislations made in India will help us to understand this point.Social Legislation and Social Change Essay.

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A number of social legislations were made in India both before and after independence with a view to bring about social change. Some of these could achieve success while a few others still remain as dead letters. The legislations that secured public support and the support of social norms could become a great success.Social Legislation and Social Change Essay.

For example, the Hindu Marriage Act was passed in 1955 enforcing monogamy and permitting judicial separation and divorce. Though polygamy was permitted among the Hindus, majority of the people practised monogamy only. Public opinion was in favour of mo­nogamy.

For a long time social reformers agitated that Hindu marriage should be monogamous. The Hindu women also resented the second marriage by a man when the first one was alive. Those who opposed monogamy were branded as conservative, orthodox and selfish. When the Hindu Marriage Act was passed in 1955 it could get the support of the people and the opposition gradually died down.Social Legislation and Social Change Essay.

The Hindu Marriage Act of 1955 could bring about a number of social changes. The Act abolished all caste restrictions as a necessary requirement for marriage. The Hindus of all castes have the same rights with respect to marriage. Intercaste marriages are now allowed.

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The Act pro­vides for a secular outlook with respect to marriage and enables the registration of marriage. It enforces monogamy making both the sexes equal in marital affairs. It provides equal rights for both to get judicial separation and divorce on legal grounds. It treats various sects of people such as Jains, Buddhists, Sikhs, Veera Shaivas, Harijans, Girijans and many others as ‘Hindus’. Thus, it paved the way for bringing about a uniform Civil Code for all the citizens of India.

In the same way, the Hindu Succession Act of 1956 could attain success. The Act confers for the first time absolute rights over the property possessed by a Hindu woman. Both sons and daugh­ters get the right of inheritance of property because of this Act.

The Act removes the prejudice against women getting the property of the father. Since public opinion is in favour of women enjoy­ing equal rights and opportunities, the Act could be enforced easily.Social Legislation and Social Change Essay.

The Hindu Adoption and Maintenance Act of1956 has been a step toward the upliftment of the status of women. It permits the adoption of a son or a daughter. It makes the consent of the wife necessary for adopting a child. It has also given the right to the widows to adopt.

The Legislative Acts mentioned above could bring about changes in some areas of our life because they are backed by public opinion and current social norms and values. Whenever the social norms are ahead of the legal codes, it becomes necessary to bring the legal code into conformity with the prevalent social values.Social Legislation and Social Change Essay.

Sometimes dominant minority groups may cherish some ‘advanced’ values and may bring pressure upon the legislative bodies to make legislations to enforce such val­ues on masses. Such legislations become an active social force only when they are internalised by the people.

In pre-Independent India, social legislations such as — The Hindu Widow Remarriage Act of 1856, Female Infanticide Prevention Act of 1870, the Special Marriage Act of 1872 (which made marriage a civil marriage free from religious barriers), Child Marriage Restraint Act of 1929, etc., could attain success and pave the way for changes in society because they were in tune with the trends and tides of the time.

On the contrary, those social legislations that are far ahead of the social norms and values and those that lack popular support and public opinion are bound to be a failure. They may become only dead letters. Some of them may bring about changes very gradually in the long run. Some others may be simply ignored or even resisted.Social Legislation and Social Change Essay.

The Untouchability Offences Act of1955 was passed by the Parliament in accordance with the provisions of Article 35 of the Indian Constitution. It made the practice of untouchability a cognis­able offence punishable under law. (This Act was, however, substituted by the Protection of Civil Rights Act in 1976).

All the social disabilities from which the Harijans suffered have been removed legally and constitutionally. But in reality, Harijans suffer from many kinds of social disabilities especially in rural areas even today. Here the law is ahead of the social norm particularly in the villages where untouchability is still in practice.Social Legislation and Social Change Essay.

The institutionalisation of this new rule has not affected people’s ways of life. Because the majority of the village people have not yet internalised this norm. It makes clear that passing an Act is not enough to alter the social practice. A social movement educating the public through propaganda is necessary to make effective such social legislations.

Law relating to prohibition was also a grand failure for want of public support. Gandhiji launched a crusade against drunkenness. He even tried to persuade Congressmen to work for total removal of alcoholism. But right from 1937 there has been a strong opposition against prohibition. Not all the Congressmen supported it.Social Legislation and Social Change Essay.

Those who were used to liquor consumption carried on a silent wave against prohibition. All the provinces never legislated laws in favour of prohibition. Some states kept neutral while a few states enacted legislations against taking alcoholic drinks. In such states illicit distillation started as kind of “cottage industry”. Public opinion was not properly mobilised in favour of it. Hence it failed. In America also law relating to prohibition was a grand failure and hence it was withdrawn.Social Legislation and Social Change Essay.

For the same reasons as mentioned above the Hyderabad Beggary Act of1940 passed in order to prevent the beggars from begging, failed. Some other states such as Bengal, Bombay, Karnataka also made legislations for the prevention of beggary.Social Legislation and Social Change Essay.

Nevertheless, beggary continued to be prac­tised by beggars in all these states. In the same way, the Dowry Prohibition Act of 1961 which made the giver as well as receiver of dowry punishable also has become ineffective. The social norms, in other words, have not been affected by this law, and hence the society follows the social norms rather than legal norms in these fields. Mere threat of punishment will not be effective.

Such a situation produces what Festinger calls ‘ forced compliance”. So long as behaviour involves forced compliance, there is no internalisation of the new values and so there will be disobedience of the law. Forced compliance can only create a discrepancy between public behaviour and private belief.Social Legislation and Social Change Essay.

Unintended Consequences of Legislations

As Richard T. Lapiere has pointed out, one of the major tasks of the governments is to produce desired changes through legislative enactments. Hence legislations may be enacted for slum clearance, for providing assistance for the poor to construct low-cost houses, for providing social security to the labourers, handicapped persons, for providing protection to women, children, weaker section, minorities, etc. But sometimes such legislations may produce unintended consequences in society.Social Legislation and Social Change Essay.

For example, the Government of Napoleon in its efforts to keep France agriculturally self- sufficient, established subsidies for the production of sugar beets. No one anticipated or could have anticipated that this legislation would in the course of time help to make France the heaviest per capita consumer of alcoholic beverages in the whole world.Social Legislation and Social Change Essay.

In the same way, legislation in America also brought about an unintended result. The New Deal ideologists wanted to save the small single family agricultural units from the economic crisis of 1930s.

Hence they designed the agricultural parity price system to help such small growers. The ideologists could hardly foresee that the long-run effects of such legislation would be to speed up the growth of large-scale industrial agriculture and to hasten the doom of the small-scale agricultur­ists.

Legislation or any other governmental agency has its own inability to pre-determine the conse­quences of politically sponsored changes. Legislation has its own limitations in inducing significant qualitative changes by coercion.Social Legislation and Social Change Essay.

Of course, men may be deterred by coercion from doing something that they might like to do. They may be encouraged by the government to work at their trade, pursue their scientific investigations, treat sick patients, etc.

People cannot, however, in the same ways be induced either to want to be creative or to act for long in ways that are contrary to their established cultural attributes. It is for this reason the govern­mental efforts to increase national birth-rates through legal means having failed. Its efforts to establish racial equality through legislation have failed.

Similarly, no legislation can be made to make a people religious or to deprive them of an established religion; to change their sex morals, to improve domes­tic harmony, to substitute one custom with another, and so on.

Legislations can be made by govern­ments to sanction changes that have already occurred. In fact, in the long run, legislations are made for sanctioning changes. But legislations cannot be made in the social field directly. They cannot fix the course of social changes in a predetermined fashion.Social Legislation and Social Change Essay.

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The Challenge of Writing the Critical/Cultural Essay.

The Challenge of Writing the Critical/Cultural Essay.

 

Researchers have a responsibility to cause no harm, but research has been a source of distress for indigenous people because of inappropriate methods and practices.The Challenge of Writing the Critical/Cultural Essay.

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The way researchers acquire knowledge in indigenous communities may be as critical for eliminating health disparities as the actual knowledge that is gained about a particular health problem. Researchers working with indigenous communities must continue to resolve conflict between the values of the academic setting and those of the community. It is important to consider the ways of knowing that exist in indigenous communities when developing research methods.The Challenge of Writing the Critical/Cultural Essay.

Challenges to research partnerships include how to distribute the benefits of the research findings when academic or external needs contrast with the need to protect indigenous knowledge.The Challenge of Writing the Critical/Cultural Essay.

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ACCORDING TO AN ALASKA

Native saying, “Researchers are like mosquitoes; they suck your blood and leave.” This saying reflects the fact that an extensive body of health-related research has been conducted about indigenous populations around the world, but appears to have had little impact on their overall well-being.16 To improve this situation, it is important to ask why so much research has produced so few solutions.

Why are researchers viewed with skepticism by many indigenous peoples? Participatory research has often been proposed as a solution to this skepticism because it engages participants in the research process at all stages. Participatory research has been described as a

collective self-reflective enquiry undertaken by participants in social situations in order to improve . . . their own social practices.7(p5)The Challenge of Writing the Critical/Cultural Essay.

Thus, participatory research simultaneously contributes to basic knowledge in social science and social action in everyday life. Although a full discussion of participatory research cannot be presented here, even this model of research, as it is typically practiced, does not prevent the risk that indigenous ways of knowing are marginalized by the scientific and academic community.25,810 Participatory researchers need to consider the power that indigenous methods can bring to research design and to the entire research process.

We first provide a brief overview of the problems associated with research partnerships in the past to provide a context for the concerns we raise. We then describe some examples of successful research partnerships and developments in participatory research. We provide specific examples of indigenous ways of knowing that have educated us regarding the possibilities of research design. Finally, we discuss one of the continuing challenges for participatory research: how the benefits of research can be managed and distributed fairly.The Challenge of Writing the Critical/Cultural Essay.

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THE NEED FOR PARTICIPATORY RESEARCH

Recent progress has been made through the incorporation of participatory research procedures in indigenous communities.5,11 However, it is important to consider and understand the reasons indigenous people might object to the idea of partnerships with researchers—why communities are wary or apprehensive at times even when the proposed research will address an important health issue.6 Historically, research conducted on indigenous people has been inappropriate because it has often served to advance the “politics of colonial control.”2,12 For instance, in the early years of colonization in Australia, research was preoccupied with “classifying and labeling” in an attempt to “manage” Aboriginal people.12

Although unethical research that carries risks to the health and welfare of indigenous participants has generally ceased, this early approach to research led to significant distrust of researchers.2 Unfortunately, some types of inappropriate research practices have continued, largely through the use of culturally insensitive research designs and methodologies that fail to match the needs, customs, and standards of indigenous people and communities.5,6,810,13 Researchers have a responsibility to cause no harm, but even well-intentioned research has been a source of distress for indigenous people because of its implications, methods,2 and lack of responsiveness to the community and its concerns.6

The most significant impact of insensitive research is the perpetuation of the myth that indigenous people represent a “problem” to be solved and that they are passive “objects” that require assistance from external experts.3 Too often, health research documents significant issues and problems using inappropriate methods of identifying those problems, with a resulting overstatement of the negative aspects of these communities. It is no surprise that individuals and communities feel stigmatized when this research is published. No community wants to have the reputation of having the most alcoholics or the most people with mental disorders.The Challenge of Writing the Critical/Cultural Essay.

One example of the type of violations of trust perpetrated by researchers in indigenous communities is the recent Havasupai medical genetics case in Arizona.14 In the Havasupai study, blood was collected by researchers under the guise of an investigation into the genetics of diabetes. It is understood that because diabetes was a major concern to the Havasupai tribe, they granted approval for years of ongoing blood collection. Issues of informed consent provide essential context for considering this case and the subsequent violation of tribal trust. The blood samples, understood to be collected in order to determine genetic precursors of diabetes, were used in a series of additional studies to examine the genetics of schizophrenia, among other topics. Blood samples were distributed nationally to other researchers and used in tribally unauthorized research, resulting in the advance of academic careers through, for instance, dissertations and scholarly publications. For the Havasupai, however, their trust in researchers—who had been invited to assist in the process of redressing the epidemic and debilitating impact of diabetes on an American Indian community—was broken.The Challenge of Writing the Critical/Cultural Essay.

A similar example involves the Canadian Nuu-chah-nulth people, whose blood was ostensibly drawn for health research on arthritis and was used instead to establish ancestry.8 This deception has led to intense suspicion of research among the Nuu-chah-nulth people and a reluctance to engage in further research, even when it may be beneficial.

It is not surprising, given these examples, that the indigenous experience of research has been predominantly negative, both in terms of its processes and outcomes. Experiences such as these have compounded the negative attitude of indigenous peoples toward research and have reduced their willingness to participate in the research process.

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RESEARCH PARTNERSHIPS AND INDIGENOUS WAYS OF KNOWING

It is clear from these examples of inappropriate indigenous research that how we go about acquiring knowledge in indigenous communities is just as critical for the elimination of health disparities—if not more so—as the actual knowledge that is gained about a particular health problem. An important negative impact of inappropriate research methods, no matter how laudable the intent of the researchers, is that they can reduce the validity and reliability of research findings,15 thus minimizing the utility of the conclusions and wasting the time of participants.The Challenge of Writing the Critical/Cultural Essay.

According to Maori researcher Linda Tuhiwai Smith,3 academic knowledge is organized according to disciplines and fields of knowledge that are grounded in Western “ways of knowing” and are therefore inherently culturally insensitive. Western research simply interprets indigenous knowledge from a Western framework, effectively distorting reality. In Australia, indigenous researchers have claimed that Western research has

led to a continuing oppression and subordination of Indigenous Australians in every facet of Australian society to the point that there is no where that we can stand that is free of racism.4(p113)

Too frequently, the definition of what constitutes acceptable research design rests with academic researchers, for whom methods that do not conform to the “gold standard” of experimental design can be considered questionable in terms of rigor and value. To solve this problem from a statistical perspective, practitioners and researchers have recommended strategies such as oversampling and pooling of data.16,17 Although we support these recommendations, remedies also need to be sought at the level of conceptualization and research design. Researchers must begin to expose the underlying assumptions of Western research and the ways in which this research maintains oppression.18

Researchers in health and human services have recently been advised to give greater consideration to the influence of culture on their science.19 As Gergen et al. have written,

To what degree and with what effects is psychological science itself a cultural manifestation? . . . It is immediately apparent that the science is largely a byproduct of the Western cultural tradition at a particular time in its historical development. Suppositions about the nature of knowledge, the character of objectivity, the place of value in the knowledge generating process, and the nature of linguistic representation, for example all carry the stamp of a unique cultural tradition.20(p497)

From various fields of study, challenges are now arising as to how science is defined and the nature of science itself as a “cultural manifestation.” Du Bois, for example, initiated her exploration of science by stating that

Science is not “value-free”; it cannot be. Science is made by scientists, and both we and our science-making are shaped by our culture.21(p105)

Indeed, as Harding has argued, those who refuse to question the way science is practiced are avoiding the “scrutiny that science recommends for all other regularities of . . . life.”22(p56)

Given the negative impact of inappropriate research with indigenous communities, there is an urgent need for an ethical research approach based on consultation, strong community participation, and methods that acknowledge indigenous ways of knowing.5,9,10 Ensuring that the research used by researchers who work in indigenous communities is both culturally appropriate and rigorous in design is essential for (1) obtaining new knowledge and understanding in regard to health disparities and (2) evaluating interventions to eliminate these disparities. To date, much of the nonindigenous response to calls for appropriate indigenous research has been at the level of process and methodology. The participation of indigenous people has often been mere token inclusion. Further, one might assume that in applying qualitative methods, researchers will address cultural insensitivity by using methods of data collection that are in line with traditional cultures. However, questions about appropriate research methods and indigenous communities go beyond the “quantitative versus qualitative” debate and focus on the root issue of how we go about knowing.The Challenge of Writing the Critical/Cultural Essay.

As Bernal indicated, there is a distinction between methodology and epistemology that has not always been recognized.23 Epistemology is the understanding of knowledge that one adopts and the philosophy with which research is approached. This issue cannot be disentangled from history or from the social position one holds within society as a result of that history. Knowledge reflects the values and interests of those who generate it, and it is these values that then determine the methods that are used and the conclusions that are drawn. These values and world-views can lead majority cultures to disregard knowledge that is gained through another set of values and worldviews.

A long-standing and favorite example is exemplified by the Inuit whalers, who detect the presence of whales by listening for the sound of their breathing.24 In contrast to this method, the “scientific count” conducted by the International WhalingCommission included only those whales that could be seen passing from the edge of the ice. Although the Inuit methods had been criticized as being inaccurate because their counts did not match those of the International Whaling Commission, their estimates of whale numbers, based on listening to the whales’ breathing, “were verified by successive aerial surveys.”24(p28) Another good example is found in the navigational expertise of the Native Hawaiian ocean voyagers, who had perfected knowledge about sailing long before Europeans had done so.25 Native Hawaiian voyagers collected knowledge from swell patterns; currents; moon phases; surface water quality; bird migration; star, planet, and sun positions; and cloud shapes. Multiple examples exist in which indigenous knowledge and the use of indigenous ways of knowing within a specific context have produced more extensive understanding than might be obtained through Western knowledge and scientific methods.The Challenge of Writing the Critical/Cultural Essay.

The health sector might also benefit from better understanding and appreciation of indigenous ways of knowing. Working in partnership with individuals who have indigenous knowledge, skills, and abilities in the area of health might help us to minimize rates of chronic conditions or disabilities and to ensure equitable access to appropriate health and rehabilitation services.The Challenge of Writing the Critical/Cultural Essay.

The Alaska Native Science Commission (ANSC), which serves as a model for promoting participatory research and the use of indigenous knowledge, was created to bring together research and science in partnership with Native communities and to serve as a clearinghouse, information base, and archive of research involving Alaska Native communities.26 The genesis of the ANSC was the Arctic Contamination Conference held in Anchorage in 1993, where a position paper was prepared that stated the desire of the Alaska Native community to become actively involved in scientific research, to become aware and informed of science investigating Native lives and environment, and to ensure that when science is performed in Alaska, it is with the knowledge, cooperation, and understanding of the Native community.27

Importantly, the ANSC is concerned with addressing factors related to chronic illness, which can result in disability. In one example of participatory research conducted by the ANSC, residents became alarmed by high rates of cancer in their region and perceived a relationship between these rates and the presence of local military sites. They found that people’s diets increasingly included store-bought foods, soft drinks or soda water, and improperly stored canned and frozen foods. It seemed that, over the same time period, more people were dying from stomach cancer, ulcers, and other cancers.28

Although the community could not make causal attributions, this knowledge provided them with the capacity to take action. They were awarded grant funding to engage in research about food sampling, preservation, storage, and nutritional benefits and to clean up some of the military sites. The project clearly demonstrates how beneficial collaborative research can be for the people who are the focus of the research. The principles and practices of the ANSC highlight how researchers can no longer expect indigenous communities to be “compliant” with university-based research efforts and should be aware of the concerns, rights, and research protocols established by communities.The Challenge of Writing the Critical/Cultural Essay.

Another example of a participatory model that builds on indigenous knowledge is found in the work of the Canadian Institutes of Health Research (CIHR). One of the 13 founding institutes of the CIHR, the Institute of Aboriginal Peoples’ Health (IAPH), is dedicated to leading an advanced research agenda in Canadian aboriginal health. The profile of the IAPH includes support and promotion of health research that has a positive impact on the mental, physical, emotional, and spiritual health of aboriginal people at all life stages. The IAPH is the only national aboriginal or indigenous health institute in the world that is devoted to the advancement of holistic and multi-disciplinary health research for indigenous people. Canada decided in 2000 to establish such an institute not only because of its own domestic health disparities but also because of the United Nations’ call for improvements in the health of indigenous peoples. In the long term, CIHR-funded health research is expected to improve the health of Canadian aboriginal people through the active participation and involvement of aboriginal communities in setting their own research agenda and through the development of research guidelines that ensure culturally competent research that is protective of the health, safety, and human rights of aboriginal people.

Australia has recently moved one step closer to the ideal situation in which indigenous knowledge and participation are integral to the conduct of indigenous research. In the most recent revision of the National Health and Medical Research Council’s guidelines for the conduct of indigenous research,29 researchers are required to submit only research proposals that are ethically defensible against an indigenous value base rather than against Western research ethics. The document clearly outlines 6 values that have been generated by Australian aboriginal and Torres Strait Islander communities: (1) spirit and integrity, (2) reciprocity, (3) respect, (4) equality, (5) survival and protection, and (6) responsibility. Thus, depending on the views of the particular community, it may be critical that indigenous ways of knowing are fully integrated into the research design and that the research is both participatory and beneficial to the community.The Challenge of Writing the Critical/Cultural Essay.

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DECIDING WHO BENEFITS FROM INDIGENOUS KNOWLEDGE

Partnerships between academic researchers and indigenous communities must be clear regarding what, and for whom, the expected benefits are to be. For the academic researcher, there are university requirements for faculty retention or promotion; these requirements usually include professional presentations, grant proposals, books, and articles. For many who work in indigenous communities, there is the sense of contributing to the social good, community well-being, and social justice through their research. Yet there is also the conflicting sense that knowledge that has been uncovered, revealed, or shared must be protected and that the different purposes and values of community research participants must be both acknowledged and accommodated to the extent possible.30

A key issue that continues to damage the concept of research in the minds of many indigenous people is the area of intellectual and cultural property rights. Who gets credit for the knowledge that is gained from research conducted in indigenous communities? A full body of research and scholarly activity is being devoted to issues of indigenous cultural and intellectual property rights; we can but touch on this important topic here. For this discussion, however, it is important to understand that knowledge gained from indigenous communities is both local and specific to a given research effort, but it is also global in terms of history and potential impact.The Challenge of Writing the Critical/Cultural Essay.

Who “owns” the knowledge and has the right to patents or copyrights? What is the responsibility of researchers to advise indigenous people about how to protect the knowledge they have—knowledge that might benefit the larger community? A useful example comes from a Mixe local coordinator of a research project in Oaxaca, Mexico. In a published report, he revealed knowledge about a local herbal remedy for prevention of kidney stones. He stated:

There are some herbs, for example . . . I’ve been in a wheelchair for 17 years and, thanks be to God, I don’t have any kidney problems—no stones, no infections and that’s entirely due to the herbs. As you can see, if we think about what we have at hand, it can really serve us well. Because otherwise we’d always be thinking about antibiotics, about operations for gall stones.31(p109)

C.A.M. was later contacted by researchers who wanted to further explore the herbs in question. She stated that there would be a need to discuss intellectual and indigenous property rights with the Mixe owners of the knowledge. The researchers were never heard from again. However, an American Indian colleague who visited the Mixe community also recommended that the medicinal herbs should be further investigated so that people with spinal cord injuries and secondary conditions associated with kidney problems could benefit from them. Beyond those whose health might directly benefit from the herbs, it is unclear who would benefit from further investigation and who would hold the rights to the knowledge.The Challenge of Writing the Critical/Cultural Essay.

In another example, an Australian aboriginal woman advised us that her community knew through “bush medicine” how to cure cervical cancer. Who should and could benefit from this knowledge? If the knowledge became the property of research facilities, including those associated with universities, the benefit would most likely accrue to pharmaceutical companies via patents and profits; however, others in need might also benefit. What about the women in Appalachia, where cervical cancer is epidemic? Or should that particular aboriginal community that holds the knowledge be the only ones to benefit? How should their discovery be adequately recognized and protected without preventing the widespread use of a beneficial health product? This challenge is not insignificant, and the extent to which it can be resolved may influence the willingness of both indigenous communities and nonindigenous researchers to engage in partnership research in the future.The Challenge of Writing the Critical/Cultural Essay.

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CONCLUSIONS AND RECOMMENDATIONS

Some would say that indigenous communities have been “researched to death,” that researchers only take and give back nothing; there is good justification for this perception. Ultimately, those of us who serve as researchers with indigenous communities must resolve the conflict—or at least our sense of conflict—between the values of the academic setting and those of the community. We must continue to participate in conversations and seek guidance on how to deal with individual instances of intellectual and cultural property rights, indigenous rights, and academic or professional responsibilities. We need to continue to explore our understanding of knowledge, what constitutes valuable knowledge, and how it is gathered and how it is shared.The Challenge of Writing the Critical/Cultural Essay.

Acceptance of indigenous ways of knowing by nonindigenous researchers will bring with it time-consuming and fundamental changes in research methods. A major challenge to researchers who wish to work in indigenous communities is the collaborative identification of research methods, inclusive of indigenous ways of knowing, that lead to sustainable, efficacious services that redress health disparities among indigenous people without violating their rights.The Challenge of Writing the Critical/Cultural Essay.

There are no easy solutions to the challenges raised in this essay. We have reported on the efforts of work groups, symposia, summits, and institutes that are attempting to address these issues. We know that the work of local institutional review boards and community research groups produces a wealth of unpublished but critical conversations that tackle these same concerns. In the spirit of sharing what has influenced us after decades of conducting participatory research in indigenous communities, we offer the following recommendations as topics in need of further attention by those engaged in participatory research activities.

  1. Academic researchers, and the institutions that sustain them, may have to relinquish their hold on the role of “principal investigator” to facilitate truly collaborative research, seeing themselves primarily in a service role, accepting community direction regarding priorities for research, considering indigenous ways of knowing in research methods, and sharing or giving up entirely—depending on community needs and desires—the dissemination of research findings (including where, how, and if research results are published, as well as who speaks for the research team in a standard 10-minute conference presentation).The Challenge of Writing the Critical/Cultural Essay.

  2. Research sponsors must require participatory research procedures in indigenous communities and support such work through the funding of community-based positions that enable communities to be engaged in a discussion of research methods at the design table.

  3. Participatory researchers in indigenous communities need to look globally for a range of useful operational models and practices; for instance, Australia, Canada, and New Zealand have been actively addressing culturally appropriate research design in indigenous communities over the last few decades.

  4. Research sponsors who value participatory research—and, in particular, community-based participatory research—must understand that the Western-style empiricism to which they are accustomed may not be the research method of choice in indigenous communities. Research sponsors will need to view as valid—and support through funding—participatory research that uses alternative ways of knowing as a foundation.The Challenge of Writing the Critical/Cultural Essay.

  5. Using indigenous ways of knowing in research methods is different from using or benefiting from indigenous or cultural knowledge per se. Nonetheless, the use of indigenous ways of knowing to better understand a topic—to make an impact on eliminating health disparities, for instance—may lead to the exposure of indigenous knowledge and the challenges we have raised in this essay.

  6. Participatory research in indigenous communities may also involve capacity-building, which will require additional funding. Asking local community members and indigenous service providers in indigenous communities to serve on a research design development committee means removing them from their substantive roles and services. Researchers are typically funded to carry out participatory research; community participants in participatory research are typically not funded—the funding stream may need to be shared more equitably. Even though there are examples of capacity-building in participatory research (T. E. Downing, University of Arizona, unpublished data, 1995), the question remains, whose capacity needs to be built if indigenous ways of knowing are to be incorporated into the research design?The Challenge of Writing the Critical/Cultural Essay.

Finding ways to maintain trust, increase institutional support, and redefine partnership roles—but continue moving forward in participatory research—is a challenge we embrace, and we encourage others with interest in indigenous communities to accept it.

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Acknowledgments

Although we cite the relevant published professional literature throughout this essay, we also draw on our own experiences of living or working in indigenous communities in Australia, Canada, Mexico, and the United States, often using participatory research procedures. We acknowledge the many individuals in these communities through whom we gained much knowledge. We also acknowledge the experience several of us gained by participating in the 2002 Symposium of the Work Group on American Indian Research and Program Evaluation Methodology (http://www.wili.org/docs/AIRPEM_Monograph.pdf) and in the 2004 Participatory Action Research and Indigenous Ways of Knowing: Women as Researchers and Partners in Community-Based Disability and Rehabilitation Research.The Challenge of Writing the Critical/Cultural Essay.

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Notes

Peer Reviewed

Contributors
C. A. Marshall and E. Kendall led the writing of the essay. All authors contributed to the conceptualization of this work, participated in the review process, and assisted in editing the essay.The Challenge of Writing the Critical/Cultural Essay.

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