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    The law presumes that individuals are rational. But what about when the patient has neuropsychiatric impairments that hinder judgement?

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    Clinical research often excludes people with disabilities who have impaired decisional capacity, but they can be included through supported decision-making, where their decisions can be assisted by designated supporters of their choosing. This will promote equitable access to research.

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    The exclusion of people with disabilities from clinical research without appropriate justification is discriminatory, is counter to federal regulations and research guidelines, and limits study generalizability. This matter is understudied, and data on the disability status of trial participants are rarely collected or reported. We analyzed ninety-seven recent interventional protocols in four therapeutic areas registered on ClinicalTrials.gov. Eighty-five percent of protocols allowed broad investigator discretion to determine eligibility, whereas only 18 percent explicitly permitted people with disabilities to use forms of support (such as supported decision making or assistive devices) to facilitate study participation. Eligibility criteria affecting people with disabilities included exclusions for psychiatric (68 percent), substance use (62 percent), HIV or hepatitis (53 percent), cognitive or intellectual (42 percent), visual (34 percent), hearing (10 percent), mobility (9 percent), long-term care (6 percent), and speech and communication (3 percent) disability-related domains. Documented justification was provided for only 24 percent of these exclusions. We recommend greater scrutiny of study eligibility criteria, scientific or ethical justification of exclusions, and accessible study design.

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    This study aims to examine the subjective perspectives on marriage of Arabs with disabilities living in Israel. Semi-structured interviews were conducted among 15 Arabs in Israel with physical, visual impairment, and mental disorders. Themes were generated using thematic analysis. Two main recursive and intertwined themes emerged: reflections about marriage and the reality of marriage. The real-life situation feeds into social perceptions: when the disabled person sees that people with disabilities hardly marry, this increases self-stigma and the fear of rejection. Similarly, social and personal perceptions exacerbate the situation on the ground. Gender also played a key factor with women with disabilities facing more stigma and negative experiences relative to men with disabilities. The findings call for raising awareness of the marital rights of Arabs with disabilities and combating negative social attitudes towards them as first steps to creating a more accessible and inclusive environment, with particular attention to gender differences.

  • Chester A. Finn et al., How Persons with Intellectual Disabilities Are Fighting for Decision-Making Rights, 121 Current Hist. 30 (forthcoming 2022).

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    The COVID-19 pandemic resulted in many school districts in countries around the world transitioning rapidly to partial or complete remote learning. These disruptions affected all children’s education, but students with disabilities (SWDs) were particularly at-risk because of the challenges of providing accessible support and services through remote teaching programmes. We examine the experience of SWDs in 24 United States school districts of instructional and adaptation models between August 2020 and February 2021. Districts varied in their approaches to remote instruction, compensatory services and prioritising SWDs for returning to the classroom before other students. Districts also varied substantially in the information provided regarding Distance Learning Plans, changes to Individualised Education Programmes and related service delivery. This analysis underscores the need for minimal standards for meeting the educational needs of SWDs during school closures as well as for disseminating good practices on minimising the effects of disruptions in future public health crises. These results have implications for existing practices and future research in the U.S. and other countries with widely disseminated decision making surrounding educational delivery during crises.

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    Persons with disabilities have historically been subjected to egregious human rights violations. Yet despite well-documented and widespread harms, one billion persons with disabilities remain largely neglected by the international laws, legal processes, and institutions that seek to redress those violations, including crimes against humanity (CAH). This Article argues for the propriety of prosecuting egregious and systemic human rights violations against persons with disabilities as a CAH, and, in addition, asserts the necessity of ensuring the accessibility of international criminal processes to those individuals. The UN Security Council's recent acknowledgement of the enhanced risk that persons with disabilities experience during armed conflict, the growing evidence of widespread human rights violations against them, and an ongoing effort to forge a UN convention on the prevention and punishment of CAH make these arguments especially timely.

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    Individuals living with disabilities are underrepresented in the physician workforce, despite benefits of inclusion. This article describes how both ableism in admissions processes and expectations set by technical standards can perpetuate harm. The authors advocate for active attention to disability diversity and equity in medical school admissions.

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    When digital content and technologies are designed in a way that is inaccessible for persons with disabilities, they are locked out of commerce, education, employment, and access to government information. In developing areas of the world, as new technical infrastructures are being built, it is especially important to ensure that accessibility is a key design goal. Unfortunately, nearly all research on Information and Communication Technology (ICT) accessibility and innovation for persons with disabilities-whether from the legal, technical, or development fields-has focused on developed countries, with very little being written about developing world initiatives. Accessible Technology and the Developing World aims to change this, by bringing increased attention to ICT accessibility in developing areas. This book brings together a unique combination of contributors with diverse disciplinary backgrounds, including authors from well-known non-governmental organizations, significant United Nations entities, and universities in both the developing and developed world. Together, they present a unique and much needed review of this critical and growing area of work, and primarily address three core themes - the lack of attention given to innovations taking place in the developing world, the need to ensure that infrastructures in the Global South do not present barriers to people with disabilities, and the need to exercise caution when applying techniques from the Global North to the Global South that won't transfer effectively. This book will be of use to researchers in the fields of civil rights, development studies, disability rights, disability studies, human-computer interaction and accessibility, human rights, international law, political science, and universal design.

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    This article examines whether and how the circumstances of Colombian ex-combatants with disabilities were recognized in the disarmament, demobilization, and reintegration (DDR) processes in the period following the adoption of the 2016 peace agreement. Our results suggest severe procedural and substantive shortcomings during the drafting of the peace agreement and the implementation of the DDR processes that exacerbated the exclusion of ex-combatants with disabilities from available opportunities for their social, economic, and political reintegration. We conclude that a better understanding of the disabling impact of conflict and the experiences of impairment and disability could have mitigated such neglect.

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    COVID-19 has prompted debates between bioethicists and disability activists about Crisis Standards of Care plans (CSCs), triage protocols determining the allocation of scarce lifesaving care.

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    How can businesses operate profitably and sustainably while ensuring that they are applying human rights? It is possible to apply human rights while at the same time decreasing cost and making human rights contribute to profits. Yet business efforts alone are insufficient, and states must possess sufficient regulatory power to work together with businesses and investors – not only to improve human rights but also to foster development more broadly. This textbook, the first of its kind, explores all aspects of the links between business operations and human rights. Its twenty-five chapters guide readers systematically through all the particular features of this intersection, integrating legal and business approaches. Thematic sections cover conceptual and regulatory frameworks, remedies and dispute resolution, and practical enforcement tools. Ideal for courses in business, law, policy and international development, the book is also essential reading for managers in large corporations.

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    Since adoption of the Convention on the Rights of Persons with Disabilities and the interpretive General Comment 1, the topic of legal capacity in mental health settings has generated considerable debate in disciplines ranging from law and psychiatry to public health and public policy. With over 180 countries having ratified the Convention, the shifts required in law and clinical practice need to be informed by interdisciplinary and contextually relevant research as well as the views of stakeholders. With an equal emphasis on the Global North and Global South, this volume offers a comprehensive, interdisciplinary analysis of legal capacity in the realm of mental health. Integrating rigorous academic research with perspectives from people with psychosocial disabilities and their caregivers, the authors provide a holistic overview of pertinent issues and suggest avenues for reform.

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    Ethical obligations to minimize harms and maximize benefits of diagnosis and treatment of disorders without biomarkers include navigating difficult-to-measure, perhaps clinically inexplicable, symptoms. Among potential harms are public stigma, self-stigma, label avoidance, and the negative influence these stigmas have on self-esteem, quality of life, employment, and housing. Among potential benefits are patients becoming active agents in managing their illnesses, social acceptance, and access to evidence-based treatments. Ethical complexities clinicians face when trying to develop treatment plans while heeding key details from patients’ narrative accounts prompt questions about how to best adhere to evidence in understudied domains of medicine.

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    Within Israeli Muslim society, men with intellectual disabilities are likely to marry nondisabled women through arranged marriages and create families. This article explores the role of grandparents with these families from the perspective of each family’s social worker. A thematic analysis was conducted of 19 semistructured interviews with Muslim social workers serving Muslim families with intellectually disabled fathers. Consistent with cultural norms, paternal grandparents are extremely involved in the lives of these couples and hold responsibilities in many aspects of these couples’ family lives. Social workers reported that the nondisabled wives, however, viewed the engagement as intrusive and controlling. Maternal grandparents’ contributions were crucially supportive, albeit limited by Muslim cultural norms that placed households under paternal family control. Social workers had conflicted feelings regarding paternal grandparent involvement. Social workers working with Muslim fathers with intellectual disabilities should promote supportive paternal grandparent involvement and ensure that such engagement does not undermine the autonomy or well-being of the nondisabled mothers. Practice guidelines are presented.

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    "Bring your whole self to work" remains a common mantra of supporters of workplace diversity, equality, and inclusion ("DEI"). For example, disability rights advocates have long contended that hiding or downplaying one's disability from one's colleagues at work "create[s] an invisible layer of additional work for the individual" in being accepted at the job and negatively affects productivity. LGBTQ+ rights advocates have raised similar points, noting that hiding or downplaying one's sexual orientation or gender identity from one's colleagues hinders internal advancement of LGBTQ+ workers. As recently as 2019, however, a Deloitte study found that sixty-one percent of workers hid or downplayed one or more of their identities from their colleagues at work.

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    Persons with disabilities have historically been discriminated against by society, including fulfillment of the right to equal access to health care. The more egregious practices, historically as well as today, include outright denials of access to health care, involuntary sterilization, forced institutionalization, coerced treatment, and substituted decision-making. Discrimination also occurs by more insidious practices. For instance, the public health construct of DALYS (disability adjusted life years) “neutrally” devalues the lives of persons with disabilities relative to the lives of those without disabilities. Along the same lines, commonly accepted norms and practices lessen the priority of persons with disabilities for essential procedures, such as organ transplants. Moreover, clinical bias disproportionately affects some disabled people, particularly those who occupy racialized, gendered, and sexually marginalized intersections. Finally, many otherwise laudable programs, such as United Nations HIV/AIDS programming, neglected for decades to include persons with disabilities. This essay considers types of clinical bias against patients with disabilities in the context of the COVID-19 pandemic, how such stigma impairs their equal access to health care, and how the application of international human rights norms would mitigate such impacts.

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    A human rights-based approach (HRBA) to health has long been seen as an important way in which to address public health needs in a manner that is equitable and conducive to social justice. Yet the actual content of an HRBA to health remains unspecific, and therefore implementation remains heterogeneous. This situation is even more challenging in the field of mental health, where human rights considerations are particularly complex and have emerged out of a history of myriad violations. Even when research has been conducted into mental health, it has focused predominantly on the Global North, raising questions of contextual and cultural relevance. Accordingly, this study examined the issue from the perspectives of stakeholders in Kenya who consider their work or the services they use to be rights based. It explored the key principles and interventions deemed to constitute an HRBA to mental health care and psychosocial support, the perceived benefits of such approaches, and the main barriers and supports relevant for implementation. The results produced seven key principles and corresponding interventions. Among other things, it highlighted the importance of economic well-being and self-efficacy, as well as the reduction of barriers to implementation, such as stigma and lack of adequate resourcing. Two key tensions were apparent—namely, the un/acceptability of coercion and the role of traditional and faith-based modalities in an HRBA to mental health care and psychosocial support.

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    Suicide is a global problem and accurate assessment of risk for self-harm is critical. Even morally principled clinicians can manifest bias when assessing self-harm in patients with physical disabilities such as spinal cord injury (SCI). Assessment of self-harm is an obligation for health care clinicians and overestimating or underestimating risk may undermine a patient’s trust in their care, possibly leading to less engagement, increased apathy about having an interest in living, and less adherence to healthy treatment options.

  • Disability, Health, Law, and Bioethics (I. Glenn Cohen, Carmel Shachar, Anita Silvers & Michael Ashley Stein eds., 2020).

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    Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.

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    Background Family members of parents with intellectual disabilities (ID) are viewed as their main source of support. However, the existence of family involvement itself does not guarantee that such support will be beneficial. Aims This study draws on the perspectives of social workers to describe and evaluate involvement by Israeli family members (grandparents) in the lives of their adult children with ID (parents with ID) who themselves have become parents. Method A thematic analysis was conducted in 21 semi-structured interviews with social workers serving parents with ID through social service departments. Results From the social workers’ perspectives, grandparent attitudes regarding their adult children with ID procreating and parenting ranged from strong resistance to active encouragement. Two sub-themes of grandparent involvement were identified from the social workers’ perspectives: the critical role of grandparent support, and the complex relationships between grandparents and the parents with ID. Two further and interrelated subthemes emerged on the role of social worker engagement with grandparents. Conclusions Professionals should be aware that grandparent involvement can either support or undermine the parenting function of parents with ID. Social service professionals need to promote family involvement that empowers parents with ID by supporting their needs and roles, but without supplanting their primary parenting activities.

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    Family life is a near-universal condition and a fundamental human right. It can also have a significant impact on mental health, including recovery from mental health conditions. In India, families play a considerable role, representing a source of social, cultural, religious and, often, financial support. However, families can also play a stigmatising role. Aim: To examine the experiences of mental health service users (MHSUs) relating to stigma and support provided by family members and to consider ways in which family support can be improved. Method: This is a qualitative study. A total of 17 residential MHSUs at the Ahmedabad Hospital for Mental Health were interviewed. The results were evaluated using thematic content analysis. The results revealed that all 17 MHSUs considered their families to be important sources of support, while 14 of the 17 MHSUs also experienced stigma emanating from their families. A total of 11 experienced lack of knowledge, 4 spoke of prejudicial attitudes and 5 mentioned discriminatory behaviours. There were important gender differences in experiences. MHSUs mentioned needs ranging from education and peer support for family members to financial support. Families act both as sources of support and stigmatisation. Education needs are considerable, while the need for peer support for families and resources to aid families in supporting people with mental health conditions are also important considerations.

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    Purpose: United Nations human rights treaties and domestic law require social workers to support the parenting rights of persons with intellectual disabilities. Social workers are also required to protect the health and well-being of those clients’ children. This study explores the experiences, challenges, and complex attitudes of Israeli social workers regarding parenthood by their clients with intellectual disabilities. Methods: A qualitative method employed semi-structured interviews with twenty-one social workers. A thematic analysis identified major themes. Results: Social workers recognized the parental desires of clients with intellectual disabilities and acknowledged their role in supporting those individuals. Nevertheless, most of the social workers expressed negative perceptions regarding the right or capability of clients with intellectual disabilities to parent. Social workers thus felt the tension between their personal reservations and their professional duty to support these clients. Regardless of individual attitudes, social workers uniformly asserted that greater state and community support was needed to enable the parental capacity of their clients. Conclusions: In addition to increasing state and community support for parents with intellectual disabilities, additional training is needed for empowering social workers to act on behalf of these clients in Israel.

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    Purpose: United Nations human rights treaties and domestic law require social workers to support the parenting rights of persons with intellectual disabilities. Social workers are also required to protect the health and well-being of those clients’ children. This study explores the experiences, challenges, and complex attitudes of Israeli social workers regarding parenthood by their clients with intellectual disabilities. Methods: A qualitative method employed semi-structured interviews with twenty-one social workers. A thematic analysis identified major themes. Results: Social workers recognized the parental desires of clients with intellectual disabilities and acknowledged their role in supporting those individuals. Nevertheless, most of the social workers expressed negative perceptions regarding the right or capability of clients with intellectual disabilities to parent. Social workers thus felt the tension between their personal reservations and their professional duty to support these clients. Regardless of individual attitudes, social workers uniformly asserted that greater state and community support was needed to enable the parental capacity of their clients. Conclusions: In addition to increasing state and community support for parents with intellectual disabilities, additional training is needed for empowering social workers to act on behalf of these clients in Israel. Implications for Rehabilitation Social workers hold critical roles for parents with intellectual disabilities and are required to support their clients’ parenting while ensuring the health and well-being of their children. Israeli social workers balance negative or ambivalent attitudes regarding the capability of parents with intellectual disabilities against a desire to honor their duty to support these clients. State and community support for parents with intellectual disabilities must be increased. Additional training is needed for empowering social workers to act on behalf of these clients in Israel.

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    The volume features commentary from a broad range of scholars across a variety of disciplines in order to provide a comprehensive study of the legal, psychological, education, sociological, and other aspects of the CPRD.

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    The introduction of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) and General Comment 1 on Article 12 (GC1) has generated considerable debate regarding the assertion that people with psychosocial disabilities (disabilities arising from mental health conditions) always possess decision-making capacity. While there is debate over the feasibility and acceptability of supported decision-making, stakeholders interviewed for this study suggested that coercive treatment is heavily overutilized and that there needs to be more dialogue between holders of divergent positions. There are a number of important unresolved questions relating to more complex cases and to whether the right guaranteed by the CRPD is absolute and immediate or subject to limitations. Ensuring participation of all key stakeholders is essential to realizing the pluralistic vision of the CRPD, as is research focusing on implementation of supported decision-making regimes, particularly in low- and middle-income countries. Training on the provisions of the CRPD is also needed to ensure implementation, and addressing stigmatized beliefs among policy makers about the decision-making and cognitive abilities of mental healthcare users (MHCUs) is critical.

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    As of the beginning of this century, the United Nations (UN) human rights system had comprehensively elided persons with disabilities from its purview. The Convention on the Rights of Persons with Disabilities (CRPD) responded to this lacuna in 2006. The CRPD obligates States parties to mainstream disability by protecting and promoting the human rights of persons with disabilities in all policies and programs, and intersects disability with other discriminated-against populations. This Article investigates the success of the UN in mainstreaming disability throughout its human rights treaty bodies over the period 2000–2014 by comparing the seven years before and the eight years after the CRPD's adoption for six core UN treaty bodies. In doing so, the Article provides initial and unique insight into how well the UN implements human rights norms into treaty bodies, and provides a template for future research on the inclusion of vulnerable group-based rights in the UN and beyond. Despite some significant variations between treaty bodies, we find an overall dramatic increase in the quantitative incidence of disability rights being referenced. Nevertheless, a closer look into the practices of two treaty bodies shows that the human rights of persons with disabilities, while noted by those bodies, are included fully only on occasion. For the UN to truly mainstream disability (or other) human rights, those rights must go beyond mere formal references and also be substantively integrated.

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    Inclusive higher education is elusive for students with disabilities, especially in developing countries. The adoption and rapid ratification of the Convention on the Rights of Persons with Disabilities (CRPD) provides, if applied as its drafters intended, a “whole of institution” framework for its realization (CRPD Committee, 2016). Myriad legal, attitudinal, physical, and communication-based barriers limit or exclude participation. The individual impact of such discrimination is clear and carries lifelong consequences. Equally endemic are the broad societal and pedagogical effects of this exclusion. To illustrate: preventing persons with disabilities from Teacher Education courses impacts inclusive education in primary and secondary education; barring people with disabilities from academic programs in the sciences stifles innovation in assistive technology, health, and rehabilitation; and limiting access to studying the humanities hampers the emergence of disability studies as a rightful discipline. This article presents a framework for inclusive higher education in developing countries as contemplated by the CRPD. In doing so, we draw on field work conducting the first assessment of the accessibility of Egyptian public higher education to students with disabilities. We outline lessons that can be learned and pitfalls to be avoided both in Egypt and indeed for other countries in the Global South.

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    "Disability, Human Rights, and Information Technology addresses the global issue of equal access to information and communications technology (ICT) by persons with disabilities. The right to access the same digital content at the same time and at the same cost as people without disabilities is implicit in several human rights instruments and is featured prominently in Articles 9 and 21 of the Convention on the Rights of Persons with Disabilities. The right to access ICT, moreover, invokes complementary civil and human rights issues: freedom of expression; freedom to information; political participation; civic engagement; inclusive education; the right to access the highest level of scientific and technological information; and participation in social and cultural opportunities. Despite the ready availability and minimal cost of technology to enable people with disabilities to access ICT on an equal footing as consumers without disabilities, prevailing practice around the globe continues to result in their exclusion. Questions and complexities may also arise where technologies advance ahead of existing laws and policies, where legal norms are established but not yet implemented, or where legal rights are defined but clear technical implementations are not yet established. At the intersection of human-computer interaction, disability rights, civil rights, human rights, international development, and public policy, the volume's contributors examine crucial yet underexplored areas, including technology access for people with cognitive impairments, public financing of information technology, accessibility and e-learning, and human rights and social inclusion." -- University of Pennsylvania Press

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    The Convention on the Rights of Persons with Disabilities (CRPD) requires States to replace their mental health laws based on substitute decision-making for persons with mental health issues with laws based on the supported decision-making paradigm. However, the exact scope of the CRPD's mandates is currently under debate, especially in the case of persons with very high support needs. The Mental Health Care Bill, 2013, introduces supported decision-making in India in the form of advance directives and nominated representatives. This article discusses how far the Bill measures up to the CRPD's standards and highlights some of the difficulties when the support needs of the person are very high.

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    The question of why people follow the law has long been a subject of scholarly consideration. Prevailing accounts of how law changes behavior coalesce around two major themes: legitimacy and deterrence. Advocates of legitimacy argue that law is obeyed when it is created through a legitimate process and its substance comports with community mores. Others emphasize deterrence, particularly those who subscribe to law-and-economics theories. These scholars argue that law makes certain socially undesirable behaviors more costly, and thus individuals are less likely to undertake them.

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    Despite important gains in human rights, persons with disabilities — and in particular women and girls with disabilities — continue to experience significant inequalities in the areas of sexual, reproductive, and parenting rights. Persons with disabilities are sterilized at alarming rates; have decreased access to reproductive health care services and information; and experience denial of parenthood. Precipitating these inequities are substantial and instantiated stereotypes of persons with disabilities as either asexual or unable to engage in sexual or reproductive activities, and as incapable of performing parental duties. The article begins with an overview of sexual, reproductive, and parenting rights regarding persons with disabilities. Because most formal adjudications of these related rights have centered on the issue of sterilization, the article analyzes commonly presented rationales used to justify these procedures over time and across jurisdictions. Next, the article examines the Convention on the Rights of Persons with Disabilities and the attendant obligations of States Parties regarding rights to personal integrity, access to reproductive health care services and information, parenting, and the exercise of legal capacity. Finally, the article highlights fundamental and complex issues requiring future research and consideration.

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    This article examines the extent to which all 193 UN member states guarantee the rights of persons with disabilities in their national constitutions based on fundamental human rights outlined in the Convention on the Rights of Persons with Disabilities. As of May 2014, constitutions most commonly explicitly guarantee rights to persons with disabilities in education (28%), health (26%), and overall equity (24%). Fewer constitutions specifically guarantee the right to work or non-discrimination at work (18%), political rights (21-22%), or civil rights (9%) to persons with disabilities. Additionally, many constitutions permit denials of the right to liberty (19%) and political rights (22%-31%) for persons with mental health conditions. Although constitutional guarantees of rights for persons with disabilities are present in only a minority of constitutions, we find a significant increase in the inclusion of relevant provisions in constitutions adopted more recently, particularly those adopted in 2010 or later, across all regions.

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    The question of why people follow the law has long been a subject of scholarly consideration. Prevailing accounts of how law changes behavior coalesce around two major themes: legitimacy and deterrence. Advocates of legitimacy argue that law is obeyed when it is created through a legitimate process and its substance comports with community mores. Others emphasize deterrence, particularly those who subscribe to law-and-economics theories. These scholars argue that law makes certain socially undesirable behaviors more costly, and thus individuals are less likely to undertake them.

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    Credit scores have become a near-universal financial passport for Americans to meet common personal needs including employment, loans, insurance, and home and car purchases or leases. At the same time, Elizabeth Warren and others have documented the horrific economic, emotional, and health consequences of low creditworthiness for score-bearers and their families. Individuals with psychosocial disabilities (previously called mental disabilities or mental illnesses) can make disastrously poor financial decisions during the active phases of their conditions; during inactive phases they are as capable as others of making sound or poor financial decisions. Yet, in computing credit scores and selling credit reports, national and transnational credit-reporting agencies (like Equifax) do not account for the implications of psychosocial disability. Worse, evidence shows that businesses rely on these reports to predatorily target borrowers with psychosocial disabilities — and especially those who are also women and racial minorities — in deciding terms of lending, employment, and housing. In theory but not in practice, the Americans with Disabilities Act and the Fair Housing Act each prohibit discriminatory financial decisions arising from disability status, while also requiring reasonable accommodations to equalize opportunities for disabled persons. The United Nations Convention on the Rights of Persons with Disabilities (which the United States has signed) further mandates enabling the financial decision making of these individuals, but does not provide guidance on achieving this obligation. Further, despite the crucial and direct implications this situation also raises for vast numbers of Americans without psychosocial disabilities who likewise make poor credit decisions, it has not undergone legal analysis. We engage this significant gap by suggesting schemes drawn from historical and comparative contexts that could enable the creditworthiness of persons with psychosocial disabilities, and then critiquing the costs and benefits of each. In doing so, we proffer the first analysis of this issue in the legal literature and seek to stimulate future dialogue among academics and policymakers. The Article concludes with thoughts on the implications of its analyses for the broader issue of credit scoring.

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    Medical negligence evolved as an independent tort during the nineteenth century. Despite pervasive professional concerns about its ethicality, paid medical expert testimony became routine. In a manner strikingly similar to modern commentary, prominentjurists disparaged testimony for commonly relating anecdotal experience rother than scientifically derived knowledge. Also notable among cases was a dominant tendency to rule for medical practitioners when both parties presented expert testimony. Conversely, suits resolved in favour of whichever party unilaterally retained a testifying expert.