Mary Anne Bobinski
Graduate Student Supervision
Doctoral Student Supervision (Jan 2008 - Nov 2019)
No abstract available.
The current discourse around supported decision making and the Convention on the Rights of persons With Disabilities has challenged medico-legal guardianship and the mental capacity construct at its conceptual core, re-conceptualising decision-making as a skill which can be developed and/or enabled through practice and support. Two major gaps in the supported decision making paradigm have precluded a true paradigm shift, however: a failure to consider the needs of persons unable to express will or preference of any kind in relation to day to day tasks, and a failure to consider exploitation through the high-jacking of mere choices (i.e. non-genuine decisions) by others. The phenomenological nature of dementia intersects with the distinctive relationship and social contexts of old age to make these gaps especially meaningful in the context of dementia in old age. While a guardianship model that includes substitute decision-making would fill these gaps, the theoretical and practical problems associated with the current medico-legal guardianship model must be addressed. Using the methodology of pragmatic inquiry, this study proposes re-thinking adult guardianship as a response to vulnerability (the impaired performance of thinking processes in connection with an individual’s social, relationship and material contexts), and sets out a preliminary guardianship model constructed on that basis.
This thesis investigates why and how extant systems of health governance and the associated boundaries of legitimacy imposed by these systems impact on the realization of key healthcare objectives. It contends that while purporting to represent a universally valid approach to healthcare delivery, the transposed laws/institutions that underlie these governance systems are of themselves designed to address health and health systems-related problems through methods often unsuited to the unique experiential dynamics that ought to shape governance in any given society. This thesis responds to this disparity between governance regimes and societal realities by advancing dual healthcare reform initiatives. First, it espouses the concept of medical integration—consistent with the recommendations of the World Health Organization, which involves the systemic synthesis of indigenous, complementary, alternative and biomedical healthcare resources. Second, since medical integration faces legal complications—which are products of decontextualized governance systems that are incompatible with the pluralistic nature of healthcare usage/delivery in underserved populations – this thesis proposes that health equity is dependent on a new approach to governance sustained by a reformed legal process in which legal policies reflect socio-economic, geo-cultural, and political-historical dynamics. Drawing insights from Lon Fuller‘s interactional law theory and Felix Cohen‘s functional jurisprudence, this study propounds a theory of integral governance—herein denoted as Integrated Governance—which offers a legal and institutional framework for medical integration. Integrated Governance is first a theory of law centering on the institutionalization of laws that embody empirical trends and a theory of democratic governance advancing an interactive and interdependent relationship between the state, health professionals of multiple healthcare paradigms, consumers, and relevant non-state actors. The thesis applies research outcomes from two Canadian cities and four Nigerian urban and rural communities to support its contentions. By identifying in both countries prevalent clinical practices that complement trends in consumer healthcare behaviour, and highlighting disparities between these practices/trends and extant governance regimes, the research substantiates the underlying thesis of this study – that this disparity represents a failure of governance. The research further supports the thesis that governance must be restructured to produce functional healthcare institutions that address the needs of legal subjects.