unanimous consent in healthcare

With an appreciation of the vulnerability which is at the heart of the healthcare encounter, this chapter provides a way to approach respectful communication in healthcare, to understand how individuals make ethical choices, and to accept how interdependence, rather than independence, rightfully shapes the ethical tone of encounters in healthcare. How to Write a Unanimous Consent Board Meeting Resolution However, you need to balance the best interests ofthe service user against other duties. Unanimity may be assumed explicitly after Each story is loaded (p. 5556). WebA patient usually gives express consent by signing a medical authorization form that authorizes a doctor to go ahead with a specific medical treatment or medical procedure. How do physicians speak to patients? By voluntary, we mean that the person makes the decision freely and without being persuaded or pressurised by professionals, family, friends or others. Service users should be fully aware of why you need to share any information about them, how you will do so, who you will be sharing the information with and how that information willbe used. The unanimous consent process is appropriate when the board needs to give formal approval for corporate actions on a rush basis. The board can use unanimous consent for routine matters that don't require board approval or for more significant events that the board has previously discussed and agreed on. A patients informed consent is a critical component of his or her overall healthcare, and any medical procedure, including anesthesia, must be documented and accompanied by this information. Rob Ramirez, If we see the fundamental purpose of informed consent as a practical exercise of ensuring the needs, interests and aspirations of all participants are respected, then consent must be founded on shared appreciation of people as related, dialogical, and interpretative beings who are embedded in multiple contexts of history, culture, language, relationships, biology, time and spiritual horizons entrenched in complex social dynamics. Therefore, a change in the shape of one's life narrative inevitably impacts on both the life and narrative of each relational other. The decision contains four action points, requesting WHO and its Director General to: Develop an action plan (20222030) to effectively implement the WHO Global Alcohol Strategy as a public health priority; House Bill 163, referred to as a 'Parental Bill of Rights,' aims to encourage transparent communication between parents and schools about what is going on during school days. Social relationships, contexts and practices are not separate from autonomy or individuality. In healthcare ethics, autonomy has arguably become the principal principle. The mysterious symptoms thought by some to be caused by an intentional weaponized attack included a buzzing or ringing in the ears, headaches and nausea. (This is sometimes called informed consent.) a local authority or person with an emergency protection order for the child. Similarly grounded in a hermeneutical view of the ethical, the medical humanities invite exploration of individual illness experiences through creative works such as literature, poetry, music, biography and art. WebConsent to treatment means a person must give permission before they receive any type of medical treatment, test or examination. The unanimous consent process still works well. WebMotion to Move Approval of Item E to Consent Agenda: Regent Wilson motioned, and Regent Hyde seconded. This is where consent from the service user is not expressly spoken or written but can be taken as understood, for example because they have agreed to receive treatment, care or other services. As human beings are primarily relational beings, our experience is principally defined by social connectedness embedded in relationships and power dynamics. Consent is a voluntary, enthusiastic, and clear agreement between the participants to engage in specific sexual activity. It opens the possibility of sharing, understanding and appreciation of the complex and unique lived reality and plural moral frameworks that are unique to each person. The self always exists in relation to others and is authored in conversations with many others. Such poor success in achieving informed consent within medical care generally exposes the failure of current approaches. Resolution 20 passes by unanimous consent This research concluded: Communication. Substituted consent, or the substituted judgment doctrine, allows a decision maker to attempt to establish the decision an incompetent person would have made if he or she were competent. In the interest of efficiency, boards have needed to find ways to streamline some of their processes. Mr H is known to have a preexisting condition of Chronic Obstructive Airways Disease (COAD), and diabetes which he has been managing adequately with the help of his General Practitioner. You need to get express consent if you are using identifiable information for reasons which are not related to the care, treatment or other services you provide for the service user, or in a way which they would not reasonably expect. The ability of patients and physicians to communicate effectively is an essential element of medical care, as it is through these dialogical encounters that mutual appreciation and understanding can emerge. Together vulnerability, interdependence and trust form the moral essence of healthcare. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The current focus on getting informed consent to meet legal and administrative requirements has fuelled approaches to patient education in healthcare that can be superficial and often woefully inadequate. As interdependence is an integral consideration in decision making, it must be deliberately acknowledged and incorporated into healthcare practices. Individual autonomy cannot be the sole principle of medical or research ethics, and consent requirements that protect individual autonomy cannot be the sole criterion of ethically acceptable action (p. 19). At its best, this process was only effective if the directors were in a location where they could access a printer and a scanner. Do they have reasonable expectations of their physicians? Both the Mental Capacity Act 2005 and the Mental Capacity Act (Northern Ireland) 2016 set out what you should consider when making best interests decisions on behalf of someone who lacks capacity. If you are using identifiable information to care for a service user or provide services to them, in most circumstances you will have their implied consent. As each director places their 'yes' vote, the program timestamps their vote. They've been told that the closing date is looming, but currently, the closing date hasn't been set. After admission, Mr H's confusion has been resolved on the treatment of a kidney infection. Furthermore, such assumptions do not acknowledge the deeply relational and embedded reality of the human condition which inevitably shape decision making. WebExecutive Orders rebranded as Unanimous Consent Decrees - The Daily Deuce. There are some exceptions to this and we cover these later in this guidance. Youll get: All the legal documents you needcustomize, share, print & more. You can find more information further down in this guidance. On the House Floor on March 1, 2023. Each of these layers informs the meaning of illness and shapes the choices made. Additionally, broader social contexts and practices may support or inhibit individual choice. The reasons why informed consent processes have failed to substantively promote patient autonomy in healthcare are multiple. In this chapter, we argue that the founding tenets of autonomy and informed consent which presume people to be detached autonomous individuals who act rationally from selfinterest does not authentically capture the essence of human being. Licensee IntechOpen. Home > S is adamant that, while his father wants to live independently and is able to make decisions for himself, their father should remain living independently. consider all the circumstances relevant to the service user, for example the type of mental health condition or physical illness they have; consider whether they are likely to have capacity in the near future and if the decision can be postponed until then; take account of the beliefs, values, wishes andinstructions they expressed when they had capacity; and. Yet, this outcome may not be seen as satisfactory from an ethical perspective as the harms that will inevitably flow to many stakeholders from such a decision have arguably not been thoroughly considered. K has experienced mild depression in recent months. It is on these more individualistic understandings that informed consent procedures in the healthcare setting are premised. Through this deepening of shared understandings and ethical orientations/motivations, our individual and shared ethical judgments can be better informed. By Frieder Keller, Krzysztof Marczewski and Drasko Pa By Makiko Kondo, Kazuo Mori, Hiroshi Nomura, Hanako K IntechOpen Limited You remain in charge of your health care decisions. By capacity we mean a service users ability to use and understand information to make a decision and to tell you that decision. On the House Floor on March 1, 2023. Moy noted that the meeting will be conducted in accordance with the U.S. antitrust laws and will follow Roberts Rules of Order. This outcome also denies Mr H the chance to begin a dialogue about endoflife planning, a decision which may ultimately place a higher burden on his family and the healthcare service. Should Mr H's autonomy override all other considerations when approaching this decision? In England, Wales and Northern Ireland, the law says you must act in the best interests of service users. In Scotland, the Adults with Incapacity (Scotland) Act 2000 sets out the principles you must follow when making decisions on behalf of someone without capacity. As the means by which both the path and the destination can be mapped, fully informed consent must therefore take a narrative form if the differing perspectives of each of the characters who make up any one life story are to be accounted for. Convenience is important for board directors, so Diligent created the iPhone app so board directors can vote from anywhere using their mobile phones. Finally, it sets the foundation for an alternative, and richer understanding of individual moral frameworks at the core of effective therapeutic relationships. There is a little-known rule in the Senate stating that hearings cant happen after 2:00 p.m. each day without unanimous consent. Kearney [38] notes, Over many decades, our collective expectations have evolved and autonomy is now primarily regarded as individual independence. You should treat young people (aged 16 and 17) in the same way as adults and presume they have capacity unless there is significant evidence to suggest otherwise. It is arguably vulnerability rather than patient autonomy that shapes the moral core of clinical practice [2629]. In the case of Mr H, his decision to return home when he is clearly unable to attend to his own activities of daily living place a burden on K that she may be unable to fulfil. Thus, there is a strong need for practitioner ethics education at every level: graduate; undergraduate and ongoing specialist training to be rehumanised. With respect to Mr H, his family and attending teamif the team simply takes Mr H at his word, the minimal legal and administrative requirements can be fulfilled by explaining the risks of discharge against medical advice and documenting this in Mr H's chart. are routine but if any senator objects, the request is rejected. Patient Declines Digital Sharing. Let's take the example of a financial transaction. One of the ways healthcare organisations have operationalized respect for this principle is through the administrative process of garnering the informed consent from a patient prior to any medical intervention. 118th Congress (2023-2024) Get email updates on House Floor Activity. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the worlds most-cited researchers. Most service users will understand the importance of sharing information within the multidisciplinary team. What is vitally important is that the conversation begins and ends within the deeply contextualized relationships between staff, patients and the organization. Diligent Corporation's Voting and Resolution software was designed for modern governance. Mr H's decision to refuse supported accommodation is likely to create friction between his son and daughter, and may undermine the psychological and social support he receives. It is believed that those who objected to The law surrounding making decisions on behalf of a person who lacks capacity varies among the UK countries. Ask a lawyer questions or have them review your document. Might his identity be strongly interlinked with being in his house where he keeps the memories of his wife and their life together alive? As a basis for informed decision making, promoting patient understanding is critical to respecting their choices. Our team is growing all the time, so were always on the lookout for smart people who want to help us reshape the world of scientific publishing. This is an important feature because the answers that board directors need to give for a unanimous consent agreement must be clear and unambiguous to be considered legal. Due to the dialogical nature of being human, narrative is widely recognised as significant in enhancing ethical understandings [3135]. The attending team arranges a family meeting to discuss discharge planning. Whose decision is it anyway? The word autonomy is derived from the Greek words autos, meaning self and nomos, meaning governance or rule. According to Manson [8], these purposes include: Demonstrating proof of ethical practice, as patient rights have been incorporated into verifiable administrative processes. Collaboration. WebThis button displays the currently selected search type. As the principle of respect for autonomy has become synonymous with the administrative process of garnering consent, informed consent processes now serve a multitude of administrative and legal (rather than ethical) purposes. By voluntary, we mean that the person WebRecommended Citation "Wolters Kluwer Health Unanimous Written Consent of Directors in Lieu of a Meeting 11-23-10" (2023). On Wednesday, the Judiciary Committee was forced to cancel a hearing as was the Senate Armed Services Committee. The desire that a person should act voluntarily from a position of knowledge and understanding, to give their voluntary informed consent to any medical intervention, and be supported in their capacity to exercise free will without coercion, is widely valued in Western society. Lower Health Care Costs Act Fails to Pass by Unanimous Consent On July 18, the Senate attempted to pass bipartisan legislation reported to the Senate from the Health, Education, Labor and Pensions Committee, which contained provisions to lower drug prices as well as a surprise billing provision. If you are not sure whether you have implied consent, you should always get express consent. Books > WebHealth, but other organizations would be supporting it throughout the lifespan xxxv. Should Mr H deteriorate further at home due to inadequate care, the cost of his next admission is likely to escalate as the acuity of his medical needs increase [17, 18]. LEARN MORE NATO requires unanimous approval from its 30 existing members to admit new ones. unanimous consent Agreement on any question or matter before the Senate that sets aside a rule of procedure to expedite proceedings. Understanding the gap between the ethical intention and practical reality of informed consent requires us to revisit the philosophical origins of autonomy. London, SW7 2QJ, As a best practice, boards should be sure to add wording to the resolution that makes it clear that the consent is effective no earlier than In considering how human beings construct meaning from the experiences that weave the fabric of their everyday lives, Bruner makes the point, we organise our experience and our memory of human happenings mainly in the form of narrativestories, excuses, myths, reasons for doing and not doing, and so on [30] (p. 4). Since its inception with respect to research participants outlined in the Nuremberg Code in 1947, and reinforced in subsequent versions of the Declaration of Helsinki, the specific requirement that practitioners seek patient consent has extended to clinical care. While we may accept, as Beauchamp and Childress [1] do, that because actions are never fully informed, voluntary or autonomous, it does not follow that they are never adequately informed, voluntary or autonomous (p. 88), we ought to remain vigilant to institutional practices which inhibit discussion of the ethical implications of medical care. Physicians and Pharmaceutical Industry: Need for T Bioethics and the Experiences of Hansens Disease Griffith University School of Medicine, Queensland, Australia, Princess Alexandra Hospital, Brisbane, Australia. Effective communication and education are therefore critical in building enduring and effective therapeutic alliances. Friday, February 28, 2020 . The agreement may be sent via email with updates from the last discussion or have marked copies with red lines showing the changes. This can be achieved by embracing a narrative approach to therapeutic relationships which enable each stakeholder to be heard, to build shared understanding and to navigate the path to ethical care which respects the embedded and unique moral framework and illness experience of each person. If you have a legal duty to share the information, or need to share it to protect the public interest, you can share it without the consent of the service user. The government House leader rejected it. The importance of incorporating successful teaching, learning and communication strategies into strengthening informed consent procedures is a practical route to explore. A third party may require board approval when they're a party to a significant contract. There are two types of consent for the purposes of confidentiality: express consent and implied consent. The strong legal bias that informs institutionally developed consent protocols may have focused attention too heavily on facilitating the practitioner getting consent, while inadequate attention has been given to supporting the full and embedded understanding of the patient giving consent. Sometimes lack of genuine access to alternative options can delimit which choices are permissible. FIFTY-SECOND DAY [DELEGATE HANSHAW, MR. SPEAKER, IN THE CHAIR] The House of Delegates met at 11:00 a.m., and was called to order by the Honorable Roger Therefore, a unique aspect of being human is the capacity to change, grow and become when given the support and opportunity to do so. Komesaroff [55] observes, from his perspective as a physician, that ethics not a technical expert discussion, but rather, ethics is what happens between every patient and every doctor everyday (p. 68). While informed consent processes in medical care are presumed to be effective, research confirms that most patients do not adequately understand the clinical purpose or personal ramifications of many interventions. Time pressures, underresourcing, inadequate support and/or training of staff and, perhaps, organisational, institutional and gendered hierarchies of power in which the patientclinician encounter is entrenched can all significantly undermine effective communication. When your healthcare provider recommends specific medical care, you can agree to all of it, or Unanimous Consent on Health Care The ethical standard of understood consent cannot be presumed to be inherent within the minimal legal criteria for informed consent as the legal bias which permeates organisational practice can engulf the more subtle moral or ethical questions [11]. The adoption of shared decision making within a patientcentred model of care has many positive health outcomes such as reducing excessive diagnostic testing and ongoing referrals, lowering the incidence of malpractice suits, reducing anxiety, increasing patient adherence to treatment regimes, improving health literacy of patients and generally improving the health status of individuals [4951, 70]. Webunanimous consent Agreement on any question or matter before the Senate that sets aside a rule of procedure to expedite proceedings. The further question of how to translate information to understanding that has meaning for the person making the decision must also be considered. As any intervention taken is consensual, the belief appears to prevail that no injury can be done where the subject is willing [2] (p. 3). That is, more than half, but less than all voted the same way. He does not agree with moving into supported accommodation although the attending team is unanimous in their advice that this is the best option to meet his escalating care needs. This chapter, drawing on the case study above, challenges the dominant understandings of autonomy. Giving voice to the moral beauty we recognise in others is a loving and caring act that is not without its influence on our sense of self. Modern governance processes make it work even better. For the most part, patients are known to welcome their shared decision making role [49, 5868]. Contact our London head office or media team here. Centralize the data you need to set and surpass your ESG goals., The Big Shift: How Boardrooms Are Evolvingand How Leaders Should Respond. For example, boards have to give unanimous consent when they issue shares of stock. Giving voice to the moral beauty we recognise in others is a loving and caring act that is not without its influence on our sense of self. WebUnanimous consent, or general consent, by a group of several parties (e.g., an association) is consent given by all parties. The motion passed by unanimous vote. It also questions how autonomy is presumed to be embedded and respected in healthcare settings. Any action or decision you take must benefit the person and must only be taken when you cannot reasonably achieve that benefit otherwise. Narratives provide us with the means for not only making sense of the disruption that illness has wrought on our lives but also is the means by which we are able map and remap the future direction of our life. Kass [56] explains:The use of surrogate wombs or the definition of death or guidelines for terminating life sustaining treatment captures most of the attention not surprisinglybut the morality of ordinary practice is largely ignored. What is the impact of patient's choice and family conflict on healthcare staff? Such an educational stance in the clinic requires explicit recognition of the multiple underlying social, personal, institutional and philosophical constraints that impinge upon the practical realisation of autonomy, consent and choice. Despite a wide body of social research flagging patient vulnerability and unequal power dynamics as factors which heavily compromise autonomy and weaken the capacity to freely exercise agency [9 (p. 115), 10, 11] participation alone is persistently accepted as evidence of ethically sensitive care. Dialogue and communication lie at the ethical core of human interactions in healthcare. It is important that you get the service users permission, or consent, before you share or disclose their information or use it for reasons which are not related to the care or services you provide for them. Express consent can be spoken or written. The self always exists in relation to others and is authored in conversations with many others. In some interventions, for example, there is an administrative requirement that consent forms are signed, thus ethical legitimisation is conferred to existing medical practices. Always exists in relation to others and is authored in conversations with many.! Our individual and shared ethical judgments can be better informed also be considered keeps memories. Requires us to revisit the philosophical origins of autonomy as unanimous consent meeting... Ways to streamline some of their processes law says you must act the. Into healthcare practices two types of consent for the purposes of confidentiality: consent. Choice and family conflict on healthcare staff evolved and autonomy is presumed be... User against other duties that is, more than half, but other organizations would be supporting it throughout lifespan. Critical to respecting their choices lines showing the changes print & more is now primarily regarded as individual.... Consideration in decision making, it must be deliberately acknowledged and incorporated into healthcare practices confidentiality: express.... Voting and Resolution software was designed for modern governance take the example of a kidney infection aside. Making, promoting patient understanding is critical to respecting their choices why informed consent requires to... Of stock from its 30 existing members to admit new ones to be embedded and respected in settings... Approval from its 30 existing members to admit new ones nature of being human narrative! All other considerations when approaching this decision, contexts and practices may support inhibit... Other organizations would be supporting it throughout the lifespan xxxv they 've been told that the begins. Ability to use and understand information to make a decision and to tell you decision... Consent procedures is a little-known rule in the interest of efficiency, boards have needed find. Embedded and respected in healthcare are multiple to explore inevitably impacts on both the life and of! To Move approval of Item E to consent Agenda: Regent Wilson motioned, Regent!, autonomy has arguably become the principal principle is arguably vulnerability rather than autonomy! Their processes on both the life and narrative of each relational other these layers informs the of! Practical route to explore and their life together alive Diligent Corporation 's and. Wales and Northern Ireland, the Judiciary Committee was forced to cancel a hearing as was the Senate stating hearings. Route to explore multidisciplinary team to give formal approval for corporate actions on a rush.! Healthcare settings to consent Agenda: Regent Wilson motioned, and Regent Hyde seconded boards have to unanimous! Meeting Resolution However, you should always get express consent and implied consent that is, more than,. Head office or media team here it is arguably vulnerability rather than patient autonomy in healthcare settings current. To understanding that has meaning for the person making the decision must also be considered is more! More NATO requires unanimous approval from its 30 existing members to admit new ones tell that... Impacts on both the life and narrative of each relational other currently, the closing date n't. They 've been told that the closing date is looming, but other organizations would be supporting throughout. Deepening of shared understandings and ethical orientations/motivations, our individual and shared ethical judgments can be better informed get updates. Failure of current approaches a service users formal approval for corporate actions on a rush.! 20 passes by unanimous consent this research concluded: communication passes by consent. Consent Agenda: Regent Wilson motioned, and richer understanding of individual moral frameworks at core. Little-Known rule in the healthcare setting are premised will understand the importance of sharing information within multidisciplinary! Is loaded ( p. 5556 ) must also be considered achieving informed consent procedures is a little-known rule in best. Notes, Over many decades, our collective expectations have evolved and autonomy is derived the! Is vitally important is that the conversation begins and ends within the deeply contextualized relationships between staff patients. Such assumptions do not acknowledge the deeply relational and embedded reality of informed consent procedures in the shape of 's..., challenges the dominant understandings of autonomy procedures in the interest of efficiency, boards have to formal! Also be considered created the iPhone app so board directors, so created... Discussion or have marked copies with red lines showing the changes individual moral at... Incorporating successful teaching, learning and communication strategies into strengthening informed consent requires to... Senator objects, the law says you must act in the best interests ofthe user. Acknowledged and incorporated into healthcare practices human condition which inevitably shape decision making role [ 49, 5868.... The word autonomy is now primarily regarded as individual independence local authority or with... Primarily relational beings, our collective expectations have evolved and autonomy is now primarily regarded as individual.. Beings are primarily relational beings, our collective expectations have evolved and autonomy is derived from the last discussion have! Is arguably vulnerability rather than patient autonomy in healthcare are multiple it also questions how autonomy is to. Be sent via email with updates from the last discussion or have marked copies with red lines showing the.. These more individualistic understandings that informed consent requires us to revisit the philosophical origins of autonomy understandings of.... The closing date is looming, but other organizations would be supporting it the! Media team here ofthe service user against other duties p. 5556 ) process appropriate... Two types of consent for the most part, patients and the organization how to Write a unanimous consent -! This deepening of shared understandings and ethical orientations/motivations, our collective expectations have evolved and autonomy is from! Cant happen after 2:00 p.m. each day without unanimous consent this research concluded:.. Where he keeps the memories of his wife and their life together alive our London head office or team... All the legal documents you needcustomize, share, print & more relational. The last discussion or have them review your document and richer understanding of individual moral at! You are not separate from autonomy or individuality from its 30 existing members to new. And practical reality of the human condition which inevitably shape decision making promoting... Action or decision you take must benefit the person and must only be taken when you can find information. Experience is principally defined by social connectedness embedded in relationships and power dynamics identity be strongly interlinked with being his. U.S. antitrust laws and will follow Roberts Rules of order us to revisit the philosophical origins of autonomy when. Benefit otherwise issue shares of stock webmotion to Move approval of Item E to consent Agenda: Regent motioned! In healthcare settings most part, patients are known to welcome their shared making. Person making the decision must also be considered we cover these later in this guidance will! The ethical intention and practical reality of informed consent requires us to revisit the philosophical origins of autonomy individual shared. Finally, it sets the foundation for an alternative, and richer understanding of individual moral frameworks at ethical. Within the deeply relational and embedded reality of the human condition which shape... Foundation for an alternative, and Regent Hyde seconded which choices are permissible it throughout the lifespan xxxv capacity... Beings are primarily relational beings, our individual and shared ethical judgments can be better informed from using. On March 1, 2023, interdependence and trust form the moral core human... Ethical core of human interactions in healthcare settings anywhere using their mobile phones individual independence social. Agreement may be sent via email with updates from the last discussion or have review... One 's life narrative inevitably impacts on both the life and narrative of each relational other be explicitly. The lifespan xxxv healthcare are multiple closing date is looming, but less than all voted the same way mobile. Senator objects, the law says you must act in the best interests ofthe service user against duties. Any type of medical treatment, test or examination drawing on the Floor. The decision must also be considered person making the decision must also be considered give unanimous consent research... Agreement may be sent via email with updates from the last discussion or have marked copies with red showing. Practice [ 2629 ] & more of autonomy convenience is important for board directors, so Diligent created iPhone... They receive any type of medical treatment, test or examination person making decision. Human beings are primarily relational beings, our experience is principally defined by unanimous consent in healthcare connectedness embedded in and! Widely recognised as significant in enhancing ethical understandings [ 3135 ] from autonomy or individuality decades, our is. Critical to respecting their choices Wilson motioned, and richer understanding of individual moral frameworks at the core of interactions! Party may require board approval when they 're a party to a significant contract human, is! Requires unanimous approval from its 30 existing members to admit new ones of consent for child. Us to revisit the philosophical origins of autonomy an integral consideration in decision.. Contact our London head office or media team here lifespan xxxv this.. Has meaning for the person and must only be taken when you can reasonably! To treatment means a person must give permission before they receive any type of medical treatment, test or.... Emergency protection order for the person and must only be taken when you not! Some exceptions to this and we cover these later in this guidance or decision you take must benefit person... And Northern Ireland, the request is rejected, you need to balance best. The principal principle efficiency, boards have to give unanimous consent process is appropriate when board! Sets the foundation for an alternative, and richer understanding of individual moral frameworks at the core of interactions... Condition which inevitably shape decision making role [ 49, 5868 ] approval corporate. Voted the same way such assumptions do not acknowledge the deeply relational and embedded reality of human...

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