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Chapter 10 As the French Revolution became increasingly violent, there was an growing backlash in Britain against the celebration of liberty as independence. One response, popular among a number of conservative churchman, took the form of reviving the claim that all subjects have a duty of non-resistance and passive obedience. But a different although no less hostile response came from a number of self-styled ‘liberal’ legal and political writers who saw themselves as equally opposed to conservatives and revolutionaries. This group has been little studied, but the aim of this chapter is to show that they were of central importance in discrediting the ideal of liberty as independence. They accepted the Hobbesian view that most of our natural rights must be given up in the name of peace, and that the rights remaining to us as subjects of states must basically take the form of the silence of the law. Although the ideal of liberty as independence continued to be celebrated by early British socialists, the liberal writers paved the way for the explicitly Hobbesian commitments of the early utilitarians, who finally succeeded in turning the claim that liberty cannot mean anything other than exemption from restraint into a new orthodoxy.
Chapter 8 focuses on how the strand of legal argument traced in Chapter 7 was deployed by a number of pro-imperialist writers in England in reply to Price, Paine and the American colonists in 1776. The first to take up the claim that liberty is nothing other than absence of restraint were the lawyers John Lind and Richard Hey, and they were soon followed by a large number of other critics of Price, among whom the most prominent were Adam Ferguson, John Welsey and later William Paley. The chapter focuses in particular on three objections generally raised against Price’s account of liberty. The first was that his definition confuses the state of being unfree with that of merely lacking security for the liberty you possess. The second was that he connects liberty with an unviable concept of inalienable natural rights. The third was that, by defining liberty as absence of dependence, and then equating dependence with slavery, he commits himself to a morally indefensible definition of slavery. He forgets that slaves are not merely subject to the will of their masters, but that the chief horror of slavery is that they are also regarded as being their master’s property.
Chapter 7 begins with the reaction that followed from Price and Paine’s defence of the colonial cause. They agreed with the colonists that to live in dependence on the arbitrary will of someone else is what it means to be a slave, and consequently agreed that the colonists must have a natural right to free themselves from their servitude, if necessary by force. This was the moment when a large number of pro-imperial spokesmen came forward to claim that the colonists and their supporters were failing to understand what it means to speak of possessing or losing one’s liberty. They objected that we are not rendered unfree if we are merely subject to someone else’s will; we are only rendered unfree if we are restrained from acting in some particular way. Generally this definition of liberty has been seen as an invention of the late eighteenth century. But as this chapter shows, it arose out of a long tradition of legal and political argument that originated with Hobbes, Pufendorf and their followers. We already find it present in England in the early eighteenth century, and the pro-imperialist writers now brought it to the forefront of debate.
Conclusion: a reckoning. Liberty used to be defined as absence of dependence. Nowadays it is usually defined as absence of restraint. But the underlying aim of this book has been to establish that there are several reasons for thinking that the ideal of liberty as independence is to be preferred. We gain from it a better sense of how the mere fact of living in subjection -- whether or not we are restrained -- takes away our liberty. We also gain from it a more helpful way of thinking about fundamental rights. Rather than conceiving of them as universal moral claims, there may be good reasons for preferring to think of them as the creation of specific independent communities. Above all, the ideal of liberty as independence helps us to see the importance of cherishing the value of autonomy in relationships between states as well as individual citizens. It is difficult to see how the requirements of justice can be met in the absence of a commitment to the ideal of liberty as independence.
INTRODUCTION. When and why did it come about that one prevailing way of understanding what it means to be free was replaced by a strongly contrasting account that came to be no less widely accepted, and still remains dominant? The argument of the book is that, in Anglophone political theory, the change happened quite suddenly in the closing decades of the eighteenth century. Before that time it was generally agreed that what it means to be free is that you are not subject to, or dependent on, the arbitrary will and power of anyone else. Liberty was equated with independence. But by the early nineteenth century it had come to be generally accepted that liberty simply consists in not being restrained from acting as you choose. What prompted the change, the book argues, was not the imperatives of commercial society, as has often been argued. Rather it was a growing anxiety, in the face of the American and French Revolutions, about the democratic potential of the ideal of liberty as independence.
What does liberty entail? How have concepts of liberty changed over time? And what are the global consequences? This book surveys the history of rival views of liberty from antiquity to modern times. Quentin Skinner traces the understanding of liberty as independence from the classical ideal to early modern Britain, culminating in the claims of the Whig oligarchy to have transformed this idea into reality. Yet, with the Whig vision of a free state and civil society undermined by the American Revolution of 1776, Skinner explores how claims that liberty was fulfilled by an absence of physical or coercive restraint came to prominence. Liberty as Independence examines new dimensions of these rival views, considering the connections between debates on liberty and debates on slavery, and demonstrating how these ideas were harnessed in feminist discussions surrounding limitations on the liberty of women. The concept of liberty is inherently global, and Skinner argues strongly for the reinstatement of the understanding of liberty as independence.
According to conventional wisdom, a great power engaging in international retrenchment regularly incurs tremendous costs. Following its withdrawal from a commitment abroad, the argument goes, windows of opportunity emerge that rivals exploit to their benefit, thus imposing significant costs on the retrenching great power. I argue that pundits and policymakers consistently overestimate the dangers associated with strategic withdrawals: great powers can – and in the past frequently have – successfully engaged in international retrenchment without creating opportunities for their rivals to gain significant strategic benefits. To make this case, I develop a new typology of international retrenchment strategies based on the kind and degree of disengagement they entail and demonstrate that most types do not regularly pave the way for rival gains. I support my argument through a series of plausibility probes: the Soviet retrenchment from Romania in the 1950s; the US retrenchment from Korea in the 1970s; and the US retrenchment from Western Europe in the 1990s.
This is a general introduction to the book, explaining that the purpose of the book is to provide a concise but detailed explanation of the core rules of international humanitarian law. The contents of each chapter are summarised. It explains that the book looks at the major areas of IHL, putting them in historical context, so as to better understand how the law has evolved. This book also examines the current challenges for and pressures on the existing law, as IHL rules adopted in the time of cavalry and bayonets must adapt to deal with issues like drones, cyber warfare and autonomous weaponry. It notes that the third edition has been updated to reflect new developments in the law of armed conflict up to May 2023.
Edited by
Roland Dix, Gloucestershire Health and Care NHS Foundation Trust, Gloucester,Stephen Dye, Norfolk and Suffolk Foundation Trust, Ipswich,Stephen M. Pereira, Keats House, London
This chapter explores the evolving use of rapid tranquillisation (RT) through the years, examining the complexities surrounding its definition and the factors that need consideration before, during and after its administration. Every acute disturbance experienced by a patient is different and a multidisciplinary approach with good communication is key. The chapter discusses the use of covert medication in
RT, the SafeWards approach to creating engaging and meaningful ward programmes for patients, laws for governing the use of restrictive procedures, and the medications used for RT and their routes of administration along with their potential side effects.
The Mental Capacity Act (MCA) 2005 came into force in 2007 and covers England and Wales. It provides a statutory framework for anyone over the age of 16 who lacks capacity to make decisions for themselves, for whatever reason. The MCA was drafted by the Law Commission partly in response to the increased prevalence of dementia and the lack of legislation to deal with the challenges of so many people living longer and losing their ability to make decisions. It is the loss of ability to make decisions, because of the disease, which makes the key link between providing care and treatment with the application of the law. This is why the MCA is perhaps the most important of all the pieces of legislation we consider. The practical applications of the Act will be dealt with in more detail in the chapters to follow. More detailed guidance can be found in the Mental Capacity Act 2005: Code of Practice (for England and Wales), revised in 2022. We include some of the main amendments to the Code at the end of this chapter and these are also covered in the relevant sections of the book.
When undertaking any intervention for an individual, you must be mindful of the legal authority or justification for the act. By intervention, we mean the full gamut of medical treatments or any act that relates to the care or welfare of that person. In this chapter, we will first consider the general legal principles that apply in almost any setting, but we have then divided the subsequent sections based on the location where care is predominantly provided (i.e. a domestic/home situation, care home or hospital). Although this is somewhat arbitrary, it broadly correlates with the progressive deterioration of the clinical state and in the transitions from living at home, to hospital or care home and through to the end of life. It therefore allows us to consider some situation-specific questions and how the law applies in negotiating the moves between locations or care settings.
Edited by
Masum Khwaja, Imperial College of Science, Technology and Medicine, London,Peter Tyrer, Imperial College of Science, Technology and Medicine, London
The illegal killing of George Floyd led to Black Lives Matter protests around the world and energised the call for discrimination to be addressed in society. In this chapter we explore evidence of mental health inequalities in those from BAME communities and acknowledge that some groups in society, who may or may not identify as BAME, such as asylum seekers travellers and the LGBTQ+ community, also face discrimination. We mention the theory of intersectionality, racial gaslighting and the detrimental impact of austerity on health outcomes. Readers are reminded of the historical reports into the deaths of Michael Martin, Joseph Watts and David ‘Rocky’ Bennett and of the 2002 Sainsburys Centre review which identified a ‘circle of fear’. The finding of the independent review of the MHA and the recently published rapid review of ethnic health disparities by the NHS Race and Health Observatory are highlighted. NHS England and NHS Improvement’s Advancing Mental Health Equalities Strategy, the RCPsych equality action plan, and The Patient and Carers Race Equalities Framework (PCREF) are explained. Stereotyping of black males and the disproportionate use of force (including tasers), is discussed and the authors call for the implementation of mandatory training covering the nature of discrimination.
Edited by
Masum Khwaja, Imperial College of Science, Technology and Medicine, London,Peter Tyrer, Imperial College of Science, Technology and Medicine, London
Violence and aggression never present themselves in a vacuum, yet this is typically the way policymakers approach the subject, its prevention and its management. Although guidelines exist in different sectors, too often little or no consideration is given to many of the wider issues in play, particularly the use of restraint when it becomes necessary. Despite the long-standing call for a common set of guidelines, we are only now looking at the introduction of the Restraint Reduction Network training standards, and it seems that anything approaching a set of common guidelines that all settings can embrace is a long way off. The aim of any good guidance seeking to influence practices in the prevention and management of violence and aggression should be to minimise the need for any restrictive intervention but where necessary to apply techniques as safely as possible within the relevant legislative framework. Certain staff in healthcare settings need to receive training to increase the organisation’s capacity and capability to deal with potentially violent situations without recourse to external agencies, such as police, who operate to a different set of standards to those within healthcare settings and who use techniques that healthcare staff would not wish to see used in their settings.
To identify the clinical characteristics of patients receiving nasogastric tube (NGT) feeding under physical restraint. Clinicians participated via professional networks and subsequent telephone contact. In addition to completing a survey, participants were invited to submit up to ten case studies.
Results
The survey response rate from in-patient units was 100% and 143 case studies were submitted. An estimated 622 patients received NGT feeding under restraint in England in 2020–2021. The most common diagnosis was anorexia nervosa (68.5–75.7%), with depression, anxiety and autism spectrum disorder the most frequent comorbidities. Patients receiving the intervention ranged from 11 to 60 years in age (mean 19.02 years). There was wide variation in duration of use, from once to daily for 312 weeks (mode 1 week; mean 29.1 weeks, s.d. = 50.8 weeks).
Clinical implications
NGT feeding under restraint is not uncommon in England, with variation in implementation. Further research is needed to understand how the high comorbidity and complexity contribute to initiation and termination of the intervention.
Can sexual restraint be good for you? Many Victorians thought so. This book explores the surprisingly positive construction of sexual restraint in an unlikely place: late nineteenth-century Decadence. Reading Decadent texts alongside Victorian writing about sexual health, including medical literature, adverts, advice books, and periodical articles, it identifies an intellectual Paterian tradition of sensuous continence, in which 'healthy' pleasure is distinguished from its 'harmful' counterpart. Recent work on Decadent sexuality concentrates on transgression and subversion, with restraint interpreted ahistorically as evidence of repression/sublimation or queer coding. Here Sarah Green examines the work of Walter Pater, Lionel Johnson, Vernon Lee, and George Moore to outline a co-extensive alternative approach to sexuality where restraint figured as a productive part of the 'aesthetic life', or a practical ethics shaped by aesthetic principles. Attending to this tradition reveals neglected connections within and beyond Decadence, bringing fresh perspective to its late nineteenth- and twentieth-century reception.
This paper explores factors linking gender with increased perceived coercion, perceived negative pressures and procedural injustice during psychiatric admission.
Methods:
We used validated tools to perform detailed assessments of 107 adult psychiatry inpatients admitted to acute psychiatry admission units at two general hospitals in Dublin, Ireland, between September 2017 and February 2020.
Results:
Among female inpatients (n = 48), perceived coercion on admission was associated with younger age and involuntary status; perceived negative pressures were associated with younger age, involuntary status, seclusion, and positive symptoms of schizophrenia; and procedural injustice was associated with younger age, involuntary status, fewer negative symptoms of schizophrenia, and cognitive impairment. Among females, restraint was not associated with perceived coercion on admission, perceived negative pressures, procedural injustice, or negative affective reactions to hospitalisation; seclusion was associated with negative pressures only. Among male inpatients (n = 59), not being born in Ireland appeared more relevant than age, and neither restraint nor seclusion were associated with perceived coercion on admission, perceived negative pressures, procedural injustice, or negative affective reactions to hospitalisation.
Conclusions:
Factors other than formal coercive practices are primarily linked with perceived coercion. Among female inpatients, these include younger age, involuntary status, and positive symptoms. Among males, not being born in Ireland appears more relevant than age. Further research is needed on these correlations, along with gender-aware interventions to minimise coercive practices and their consequences among all patients.
Coercive measures (such as seclusion, mechanical restraint, and forced medication) during psychiatric inpatient treatment should be avoided whenever possible. Different interventions were already developed to reduce coercion, but for their effective application, it is crucial to know the risk factors of individuals and clinical situations that might be associated with coercion. Since the results of previous studies differ considerably the current study aims to fill this gap by evaluating the course of the exertion of coercion in detail.
Methods
In this study, we analyzed clinical, procedural, and sociodemographic data from patients (n = 16,607 cases) who were treated as inpatients in Switzerland’s largest psychiatric institution with 320 beds during the years 2017 to 2020. We used regression models to identify predictors for the exertion of coercion, the number of coercive measures during a treatment episode and time until exertion of the first and last coercive measure.
Results
Coercive measures are mostly used during the first days of treatment. We identified clinical parameters such as manic or psychotic episodes to be the most relevant predictors for the exertion of coercion. Cases with those disorders also received coercion more often and earlier in their treatment course than other diagnostic groups. Other promoting factors for frequency and early application of coercion were involuntary admission and factors of chronicity and clinical severity.
Conclusions
Knowing the risk factors may help to target preventive strategies for those at highest risk. In particular, interventions should focus on the critical timeframe at the beginning of treatment.
Published information provides scientific evidence that traditional, involuntary restraint techniques of research non-human primates are intrinsically a source of distress resulting from fear. It has been documented that common methods of enforced restraint result in significantly increased adrenal activity as well as significant changes in a variety of other physiological parameters. There is no scientific evidence that the animals adequately habituate to involuntary restraint. Numerous reports have been published demonstrating that non-human primates can readily be trained to cooperate rather than resist during common handling procedures such as capture, venipuncture, injection and veterinary examination. Cooperative animals fail to show behavioural and physiological signs of distress. It was concluded that the advantages of training techniques over traditional restraint techniques will have to be explored more extensively in the future for the sake of research subjects and scientific methodology.
The purpose of this experiment was to investigate the welfare of pregnant mares kept in straight stalls and given only limited exercise, conditions that are similar to those encountered in the pregnant mare urine industry. Sixteen pregnant mares (eight in each of two years) were randomly assigned to two groups: Ex (exercised in a paddock for 30 min per day) or NoEx (exercised for one 30 min period every 14 days). The horses were housed in straight (or ‘tie’) stalls for six months and had ad libitum access to grass hay. Each horse's behaviour was recorded on videotape once per week for 24 h. The major behaviours were eating hay, standing, and stand-resting (head down and one hind limb flexed). There was no difference between the behaviours or the number of foot lifts per min of the Ex and NoEx groups in their stalls. Nine of 16 mares were not observed in recumbency throughout the whole of the six-month observation period, suggesting that horses with no previous experience in straight stalls may be reluctant to lie down. Thirteen of 16 mares dropped to their knees at least once, probably when they were REM sleeping while standing. There were no significant differences between the Ex and the NoEx mares in baseline plasma Cortisol levels or in Cortisol response to ACTH. Following 30 min of exercise, NoEx mares showed an increase in Cortisol from 5.0 to 5.4 μg dL−1, whereas Ex mares showed a decrease from 4.6 to 3.6 µg dL−1. The NoEx horses that had been confined for two weeks trotted more (NoEx = 22 [6-38; median and range]% of time; Ex = 2.4 [0-8.7]%) and galloped more (NoEx = 6 [2-8]%; Ex = 0 [0-4]%) than the Ex that were released daily, but walked less (NoEx = 17 [10-26]%; Ex = 35 [20-40]%) and grazed less (NoEx = 0%; Ex = 3 [0-12]%). Confined horses show rebound locomotion — that is, a compensatory increase — when released from confinement, indicating a response to exercise deprivation.
Housing conditions can alter both the physiology and behaviour of laboratory animals. Forced-air-ventilated micro-isolation systems increase the efficient use of space, decrease the incidence of disease among laboratory rodents, and provide better working conditions for animal care staff; however, such systems can increase breeding variability and mortality. We examined the possibility that stressors associated with automated housing conditions evoke subtle changes among immune, endocrine, and behavioural parameters in mice housed in a static versus a forced-air-ventilated micro-isolation system. In addition, we assessed the effects of housing in the forced-air-ventilated micro-isolation system both with and without the use of an automatic watering system. Housing in the forced-air-ventilated micro-isolation system, using the automatic watering system, suppressed delayed-type hypersensitivity (DTH) responses, a measure of cell mediated immune function, compared with the responses of mice housed in static cages. Hypothalamic–pituitary–adrenal axis function was also altered by housing in the forced-air-ventilated micro-isolation system with the use of the automatic watering system, such that mice in this housing system had lower resting corticosterone concentrations and increased reactivity to restraint. Despite these changes in corticosterone, housing condition did not alter activity level or exploratory, anxiety-like, or depressive-like behaviours. These results suggest that investigators should carefully consider housing conditions in studies of immune and endocrine function.