Journal articles on the topic 'Attorney (D.C.)'

This study was conducted to determine the reasons that influence the decision to settle a personal injury lawsuit rather than proceed to court for a trial. Additionally, this study compared plaintiff attorneys’ and insurance company attorneys’ reasons for settlement in personal injury lawsuits to determine whether there are significant differences between the two groups. Subjects, 28 plaintiff attorneys and 57 insurance company attorneys, rated the importance of or degree of agreement with 77 statements related to their decision to settle or to recommend settlement. T tests revealed significant differences between the two groups on 31 of the 77 items. Among all 85 attorneys, the top four reasons for settlement were (a) if the opposing attorney offers realistic settlement figures, a jury trial will offer more risk than advantage; (b) settlements are an attractive alternative to a trial partly because of the high costs of litigation; (c) in deciding whether to settle, attorneys attempt to determine the probable verdict in light of the evidence; and (d) attorneys attempt to determine the value of an immediate settlement compared to the uncertainty of a trial.

Abstract The purpose of regulating any profession is to assure competent practitioners, particularly where its absence can cause irreparable harm. Regulatory “licensing” ideally achieves such assurance, while at the same time avoiding unnecessary supply constriction. The latter can mean much higher prices and an inadequate number of practitioners. Regrettably, the universal delegation to attorneys of the power to regulate themselves has led to a lose/lose system lacking protection from incompetent practice while also diminishing needed supply. The problem is manifest in four regulatory flaws: First, state bars—in combination with the American Bar Association—require four years of largely irrelevant higher education for law school entry. Most of this coursework commonly has nothing to do with law. Second, and related, these seven-years of mandatory higher education (that only the United States requires for attorney licensure) impose extraordinary costs. Those costs now reach from $190,000 to $380,000 in tuition and room and board per student—driven by shocking tuition levels lacking competitive check. Third, attorney training focuses almost entirely on a few traditional subjects, with little attention paid to the development of useful skills in most of the 24 disparate areas of actual practice (e.g., administrative, bankruptcy, corporate, criminal, family, taxation, et al.). And schools often pay scant attention to legislation, administrative proceedings, or the distinct areas of law that will be relevant to a student’s future practice. Fourth, state bars rely on supply-constricting bar examinations of questionable connection to competence assurance. In the largest state of California, the bar examination fails about 2/3 of its examinees. This system has fostered an opportunistic cottage industry of increasingly expensive preparatory courses that further raise the cost of becoming an attorney—even after 7 years of higher education. Meanwhile, the bars regulating attorneys in the respective states: a) Do not treat negligent acts as a normal basis for discipline (outside of extreme incapacity); b) Do not require malpractice insurance—effectively denying consumer remedies for negligence; c) Do not allow clients injured by malpractice to recover from “client security funds”; d) Do not require post-licensure “legal education” in the area of an attorney’s practice; e) Do not test attorneys in the area of practice relied upon by consumers—ever; and f) Respond to cost-effective, technology-centric solutions to legal problems not by regulation to assure consumer benefit, but by attempts to categorically foreclose them in favor of total reliance on often unavailable/expensive counsel. No area of state regulation has more openly violated federal antitrust law than has the legal profession. The United States Supreme Court held in 2015 that any state body controlled by “active market participants” in a profession regulated is not a sovereign entity for antitrust purposes without “active state supervision.” Yet four years later, attorneys continue to regulate themselves without such supervision, overlooking the threat of criminal felony and civil treble damage liability.

The efforts to overcome of the Corruption by law enforcement can be done by way of prevention (preventive) and prevention (repressive).The problems of this study are: Guards Team Establishment, Security Government and Regional Development in the law enforcement of corruption in the State Attorney of Purworejo. The Role of the Prosecutor as Guards Team of Security Government and Regional Development in the Prevention of Corruption in the State Attorney of Purworejo, a limiting factor of the role of the Prosecutor as Guards Team , Security Government and Regional Development in the Prevention of Corruption in the State Attorney of Purworejo and solutions.This research use socio-juridical approach and specification in this study were included descriptive analysis. The source and type of data in this study are primary data obtained from interviews with field studies Public Prosecutor in the State Attorney of Purworejo, And secondary data obtained from the study of literature relating to the theory of supervision, authority and law enforcement.Based on the results of research that Purpose of establishing of the Guards Team of Security Government and Regional Development, namely: 1) the loss of doubt the power of the budget (KPA), the power of the commitment (KDP), and implementing activities in carrying out its activities, 2) absorption of the budget properly and on time, and 3) development of Purworejo run properly and without corruption. The role of the Attorney divided into three normative role, the ideal role, and the role of factual. Inhibiting factor is the factor of its own law, law enforcement apparatus which is not widely understood rule of law, the factors supporting infrastructure and inadequate facilities, community factors and cultural factors. Solutions to overcome obstacles, namely: a) Prevention / preventive and persuasive, b) Legal Assistance; c) Coordination with APIPs and / or related agencies; d) Conduct Monitoring and Evaluation; and e) The Enforcement of Repressive Laws.Keywords: Attorney; Corruption; Role; Guard Team of Security Government and Regional Development; Crime.

The Legal Resources Centre (LRC) is a non-profit-making law centre. Its aims are to encourage belief in the value of law as an instrument of justice and to give practical effect to this goal by providing legal and educational services in the public interest. It is controlled and funded by the Legal Resources Trust (LRT) which is a South African charitable and educational trust registered under the Fundraising Act. It is supported by development agencies, corporations, charitable foundations and concerned individuals. The trustees include judges, senior advocates and attorneys. For the fiscal year April 1990 to March 1991 the trustees of the LRT approved a budget of R8.5 million for the work of the LRC's offices.The LRC was established after nation-wide consultations on the desirability of a legal resources centre produced positive feedback from a wide range of constituencies, and it became operational at the beginning of 1979. It seeks to fulfil the following purposes:(a) To provide legal representation for litigants in any court of law, tribunal or body before whom a party may be represented by counsel or attorney.(b) To conduct a programme in legal education and conduct seminars of educational value.(c) To engage in research in legal areas including all matters relevant to the effective administration of justice.(d) To publish the results of any research undertaken by it, and any material relevant to its objects.

Consumer losses due to the actions of business actors can file a lawsuit in the General Court using the legalstanding of LPKSM which has a legal entity and is registered and recognized by the government based onArticle 46 paragraph (1) letter c of the consumer protection law (UUPK). This writing aims to determinethe legal basis for the legal standing LPKSM. This research was conducted normatively using a descriptiveanalytical approach. The results of the discussion that the legal basis for the legal standing LPKSM can befound in Article 46 paragraph (1) letter c of the UUPK and Book II of the Supreme Court concerning Guidelinesfor the Implementation of Duties and Administration of Courts in Four Courts page 53 letter F concerningPower of Attorney/Deputy number 1 letter d, which is the the proxy/representative as the Plaintiff/Defendantor Petitioner in Court is “Director/manager or employee appointed from a legal entity” and is in accordancewith Meijers theory, namely the theory of juridical reality (Juridische Realiteitsleer). Legal subjects are LPKSMwhich have legal standing. An example of an LPKSM having legal standing is YAPERMA in decision no.3/Pdt.G/2017/PN.Tlg.

The community entrusts BPHTB taxes to PPAT due to the lack of tax literacy related to the method of calculation and payment procedures. This phenomenon raises the question, what is the legal responsibility of a PPAT who receives BPHTB tax deposits. Then, what is the procedure for depositing BPHTB taxes with PPAT. This study is a normative-empirical legal research with descriptive analysis. This research has concluded that the deposit of BPHTB tax payments to PPAT does not yet have legality in statutory regulations or the code of ethics of the notarial profession. PPAT has legal responsibility for carrying out tax payment deposit procedures. Violations or negligence in the process of collecting, reporting or depositing BPHTB can result in criminal, civil, administrative or code of ethics sanctions against PPAT. The stages of the procedure for depositing BPHTB tax payments by PPAT in Karanganyar Regency are: (a) the Taxpayer (client) submits an application to the PPAT; (b) The taxpayer provides a power of attorney to the PPAT to entrust BPHTB tax payments; (c) PPAT performs BPHTB calculations based on information on selling and buying prices from the client; (d) Form filling and document checking as a condition for paying BPHTB taxes to the BKD Karanganyar; (e) BPHTB payments through mechanisms in online portals; (f) Payment verification; (g) PPAT makes a deed; (h) PPAT submits documents to BPN for certificate numbering.

Abstract Objectives Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP. Method Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP. Results A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one’s only preparation or in tandem with formal preparations. Discussion Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.

Abstract This study aims to understand the correlation between the legal framework around planning for medical treatment and the intensity of care received at the end of life. Advance directives (AD) allow an individual to legally document their wishes for medical treatment and end-of-life care, and durable powers of attorney (DPOA) allow them to identify an individual to make medical decisions on their behalf in the event they are no longer able. These laws vary greatly across time, place, and in their complexity. We estimated fixed effects model, which controls for time-invariant and state-specific factors affecting end-of-life care. Our primary outcome variable is the number of inpatient hospital days during the last six months of life, sourced from the Dartmouth Atlas Project. Our explanatory variables are hand-collected state-level legal statutes including whether the state (a) has default surrogate laws, (b) recognizes the ability to create a DPOA and/or AD, (c) permits oral directives, (d) authorizes a combined AD/DPOA, and (e) provides an official registry for ADs. Preliminary findings show recognizing DPOA and AD are negatively correlated with our outcome variable (-2.6 days; Std err 0.272) as are having default surrogate laws (-0.36 days; std err 0.157). However, allowing oral directives had an opposite effect (-.46 days; std err 0.157). Neither authorized combined AD/DPOAs nor AD registries resulted with significant correlations. These findings indicate that the existence of a basic framework such as default surrogate laws and a law governing ADs are key policy features correlated with reduced intensity in end-of-life care.

Penelitian bertujuan untuk menganalisis Putusan Pengadilan Negeri Masamba Nomor 1/Pid.sus-Anak/2022/PN.MSB berdasarkan Sistem Peradilan Pidana Anak dan faktor yang menjadi penghambat penerapan Sistem Peradilan Pidana Anak di Kabuapten Luwu Utara. Penelitian ini merupukan penelitian normatif-empiris dengan pendekatan kualitatif yang dilakukan di Polres Luwu Utara, Kejaksaan Negeri Luwu Utara dan Pengadilan Negeri Masamba. Metode yanggunakan adalah studi kepustakaan, wawancara, dan dokumentasi. Hasil penelitian menunjukkan bahwa (1) pelaksanaan Putusan Pengadilan Negeri Masamba Nomor 1/Pid.sus-Anak/2022/PN.MSB dilakukan dengan tahapan (a) penyidikan oleh penyidik Anak dari unit PPA, (b) tuntutan yang dilakukan oleh Jaksa Penuntut Anak dan (c) pemeriksaan perkara oleh Hakim Anak di pengadilan dan menghasilkan putusan. Namun, pelaksaann putusan tersebut belum sepenuhnya sesuai dengan Sistem Peradilan Pidana Anak. (2) Faktor penghambat penerapan Sistem Peradilan Pidana Anak di Kabupaten Luwu Utara adalah: (a) aturan hukum yang masih memungkinkan aparat penegak hukum yang tidak bersetifikasi SPPA untuk menangani perkara Anak, (b) penegak hukum: yang terdiri dari Penyidik Anak, Jaksa Penuntut Anak, dan Hakim Anak masih kurang dan masih ada yang belum mengikuti pendidikan teknis SPPA, (c) sarana/fasilitas yang ada belum memadai, (d) masyarakat yang anak atau keluarganya menjadi pelaku tindak pidana sering kali menyembunyikan anak atau keluarganya tersebut, sering pula ada yang menghalang-halangi Penyidik dalam melakukan penyidikan perkara anak. This research aims to analyze the Decision of the Masamba District Court Number 1/Pid.sus-Anak/2022/PN.MSB based on the Juvenile Criminal Justice System and the factors that hinder the implementation of the Juvenile Criminal Justice System in North Luwu Regency. This research is a normative-empirical research with a qualitative approach that was conducted at the North Luwu Police, the North Luwu District Attorney and the Masamba District Court. The methods used were literature study, interviews, and documentation. The results of the study showed that (1) the implementation of the Decision of the Masamba District Court Number 1/Pid.sus-Anak/2022/PN.MSB was conducted with the stages of (a) investigation by the Child investigator from the PPA unit, (b) charges made by the Child Prosecutor and (c) examination of the case by the Juvenile Judge in court and produce a decision. However, the implementation of the decision is not fully in accordance with the Juvenile Criminal Justice System. (2) The inhibiting factors for the implementation of the Juvenile Criminal Justice System in North Luwu Regency are: (a) the rule of law which still allows law enforcement officers who are not SPPA certified to handle cases of children, (b) law enforcers: consisting of Child Investigators, Prosecutors Children, and Child Judges are still lacking and there are still those who have not attended SPPA technical education, (c) the existing facilities are inadequate, (d) communities where children or their families become perpetrators of criminal acts often hide these children or their families, often there are obstacles to investigators in carrying out investigations into child cases.

The research study about first to find out the reasons for the judge declaring a lawsuit unclear or obscure (obscuur libel) and second is to find out the consequences of an unclear or obscure lawsuit (obscuur libel). In this study using qualitative data analysis. The approach method in this research is to use a normative juridical approach, namely an approach that is carried out by collecting secondary data.The results of this study were (1) The reason the judge stated that a lawsuit was unclear or obscure (obscuur libel) were nine factors that caused the claim submitted by the plaintiff to be unacceptable. The nine factors are: (a) The identity of the parties (Plaintiff and Defendant). (b) The object of the lawsuit being litigated is unclear. (c) Petitum lawsuit exceeds the claim posita. (d) Power of attorney does not meet the requirements. (e) The lawsuit is filed by an underage / incapable person. (f) Claims are not filed on time. (g) Incomplete parties. (h) The court is not competent to hear the claim that is submitted. (i) The grounds of the plaintiff's rights are not clear. (2) As a result of a lawsuit is unclear or obscure (obscuur libel), then the person concerned does not accept such a decision, because the decision does not give satisfaction to what he wants from the claim as stated in the lawsuit. Because the verdict cannot be accepted in practice in the District Court based on the consideration that the plaintiff's claim is unacceptable, in fact it is a consideration regarding the subject matter of the case, namely whether the plaintiff is the owner or entitled to the suspect land, it is more appropriate to declare the claim rejected. Therefore, the plaintiff's unclear rights to the object of the lawsuit in dispute are not appropriate to be used as legal considerations to declare the claim unacceptable.

This research has the following objectives: 1) To determine the role of the Notary/Land Deed Making Officer (PPAT) in the implementation of fraud prevention in connection with the Payment of Taxes/Tax Charges for Acquisition of Land and Building Rights (BPHTB) for the Implementation of the Process Sale and Purchase based on Authorization to Sell with the Object of the Sale and Purchase of Land and Buildings. 2) To find out the factors that arise to prevent fraud against fraud in the imposition of the tax burden on the acquisition of land and building rights (BPHTB). Method used in this research is empirical juridical method. Research using the empirical juridical method is research on the effect of the law on society. This study uses primary data sources and secondary data sources. Primary data sources are sources obtained from field research, while secondary data sources consist of primary legal materials, secondary legal materials, and tertiary materials. Then the data were analyzed qualitatively. The research results show that: 1) The authority of the recipient of the power of attorney cannot be proven in real or not valid, unless it is proven by the existence of a sale-purchase agreement (PPJB) which contains the word paid. Because then it can be proven that the party is really the buyer. If it is not attached with a Sale-Purchase Deed (PPJB), it is feared that it will be misused or used by those who wish. In accordance with Article 1320 (KUHPerdata) regarding the validity of an agreement between the power of attorney and the grantor of power. Where in the process of transfer of name or request for sale and purchase certificates due to the transfer of rights to land and buildings, one of the conditions that must be fulfilled by the cliet or certificate application is the settlement of tax payments, who are burdened with taxes in the process of transferring rights to land and buildings, namely Seller and Buyer. Buyers are subject to tax burdens in the form of Fees for Acquisition of Land and Building Rights (BPHTB). So the role of the Notary/PPAT Officer is very much needed to minimize the existence of fraud that can result in losses for the Notary/Land Deed Making Official itself. 2) Preventing Factors for Notary Officers or Land Deed Making Officials (PPAT) so that there is no misuse of the power of sale and purchase of land in relation to the tax burden on the acquisition of land and building rights (BPHTB), including: a) Making a statement letter under the above hand stamp 6000, and inserted in the document; b) Photos of the parties; c) Closed-Circuit Television (CCTV); d) Fingerprints of the parties; e) Receipt in full for the sale of land which must be written by the party itself; and f) Providing a moral message to the parties so that their actions are truly honest, containing: (1) That the sale and purchase is based on the principles of good faith and propriety; (2) Sale and Purchase conducted in a clear and cash manner; and (3) Please be honest about the number of transactions.

The purpose of this study were 1) to identify and explain the authority of a judge to cancel the notarial deed as authentic evidence 2) To identify and explain the condition of the cancellation of a notary and legal consequences of the cancellation of an authentic deed. This research method is using empirical juridical approach "empirical juridical approach used to study the legislation. Specifications research used in this study is a descriptive analysis, from this study is expected to obtain a detailed and systematic description of the problem to be studied. Based on data analysis concluded that 1) Judges have authority give an assessment of a notarial deed which was used including eventually issued a verdict "cancel" the notarial deed. The authority of judges in dismissing a notarial deed in a civil case is based on the plaintiff's request wants in the lawsuit. The judge is not authorized to hear and determine a claim outside of what is included or requested by the parties in the suit so the judges to be passive. 2) The cancellation of the notary deed because of the element of achievement or objective requirements of the power of attorney and the deed of sale. As a result of the law is a) Clear and void as a result, legal acts which do not have legal effect from the occurrence of such legal acts. b) Can be canceled: legal act performed does not have the legal effect since the cancellation. c) Degraded strength of proof (UUJN): an authentic act has the strength of evidence that is complete or perfect in the proceedings, but the forces can be degraded / slowdown / downturn into a deed under the hand when in the making violation of the provisions of the requirements under laws apply. d) Subject to administrative sanctions in the form of verbal warning and a written warning light if violations.Keywords: Authority; Deeds; Notary; Authentic evidence

This article’s authors delve into, and comment on, some of the key provisions within law no. 219, passed in 2017, which came into full effect in 2018. The legislation presents several innovative aspects: (a) communication time is equated to care; (b) patients may turn down lifesaving treatments, yet doctors must put in place all suitable support processes, from a psychological standpoint as well, in order to make sure that patients make informed decisions in full awareness; (c) refusal to treatment may be expressed prior to the onset of the disease making the patient incapable, as long as the advance directive is laid out by a mentally capable adult who has been provided with all relevant medical information available as to the consequence of a refusal to undergo a given treatment; (d) artificial nutrition and hydration are tantamount to treatment; thus, they may not be carried out and kept in place in absence of valid consent; (e) patients may appoint a healthcare proxy holder, tasked with interacting with doctors and caregivers and expressing consent or refusal; (f) patient will, whether current or advance, must be complied with even under emergency or urgency conditions, provided that clinical conditions and circumstances make it possible to acquire it; (g) doctors may disregard advance directives only when specifically provided for by the law; (h) patients may not demand treatment deemed to be illegal or running counter to ethical codes or scientific evidence. The new legislation, therefore, is meant to uphold the right to exercise self-determination as well as the patient’s quality of life, yet ensuring that doctors remain fully capable of making the decisions that they are best positioned to. Summary: The Italian Parliament has for the first time regulated the issue of consent and refusal of healthcare treatments, whether currently expressed or advance. This article elaborates on recent Italian legislation that details a patient's right to consent to or refuse treatment in advance, including refusal of artificial nutrition and hydration, the duty of doctors in the event of an emergency, the shared planning treatment, the role of durable power of attorney, and advance healthcare directives.

One of the cases handled by the Central Sulawesi Regional Police Investigators was the language crimes case in cyberspace, namely insult and/or defamation cases. In handling defamation cases on social media, such as: Facebook and WhatsApp, the Central Sulawesi Police investigators involved linguists or expert witnesses to reveal the meaning of language through forensic linguistic studies. Forensic linguistics was a linguistics branch which analyzed and researches language used as a tool of evidence in courts and the legal field. The linguistic methods application to legal issues was one of the forensic linguistics functions as an applied science where various linguistic theories could be applied in the linguistic samples analysis on the investigative process. The results study showed that it’s stated in the criminal procedure evidence form (BAP). Furthermore, in determining the articles to be charged by the language crimes perpetrators, the police investigators were guided by Law Number 19 of 2016 amendments to Law Number 11 of 2008 concerning ITE (as the old paradigm). Furthermore, a joint decree (SKB) by the Communication and Information Minister, the National Police Chief, and the Attorney General would serve as a guideline for the implementation criteria for the 2021 Electronic Information and Transaction Law (as a new paradigm). The study purpose was to reveal the results of the comparative analysis of linguists who still use the old paradigm with the new paradigm for handling cases of insults and/or defamation through social media at the Central Sulawesi Regional Police. The method used was descriptive qualitative method. The data collection technique used was a documentary study. The four copies form data of the BAP results from the forensic linguistic study would be compared or compared based on the old paradigm and the new paradigm. The BAP four copies which included five cases insult and/or defamation through Facebook as referred to in Article 27 paragraph (3) in conjunction with Article 45 paragraph (3) of the Republic of Indonesia Law no. 16 of 2016 amendments to Law Number 11 of 2008 concerning electronic information and transactions, (a) Cases reported to the Central Sulawesi Regional Police based on police report number: LP/129/III/2017/SPKT, dated March 12 2017, (b) Cases reported to Central Sulawesi Regional Police based on police report number: LP/247/IV/2017/SPKT, dated May 08 2017, (c) Cases reported to Central Sulawesi Police based on police report number, LP/478/X/2017/SPKT, 28 October 2017, (d) Cases reported to Central Sulawesi Regional Police based on police report number LP/109/IV/2019/SPKT, 08 April 2019. The study results indicated that there were differences between the old paradigm and the new paradigm in determining legal policies (articles determination) on insult and/or defamation cases handling of five cases which had been handled by Central Sulawesi Regional Police investigators.

The article analyses problems of determining ways to improve the procedural procedure to protect the rights and freedoms of victim in the legal field of competitive criminal justice. The issue of improving the status of the victim, extending his rights, determining the procedure for its implementation stipulated by law, harmonization of legislation, elimination of legal conflicts, ensuring the rule of law, strengthening guarantees The rights and freedoms of the victim. Aligning the CPC of Ukraine with the Constitution of Ukraine, and coordinating it with the Civil Code of Ukraine and applicable international legal acts, we propose in the norm of the CPC of Ukraine, which determines the status of the victim, in addition to the rights established there by the law, to set out the following rights of the victim: a) to demand compensation for the moral harm caused and physical and pecuniary damages at the expense of the person guilty of the crime or persons who are financially responsible for their actions, and in cases where the person who committed the crime is not identified, for ahunok State budget; b) to respect his honor and dignity, to demand that facts of the collection, use, storage and disclosure of the degrading honor, dignity or business reputation of false information be prevented, and, if necessary, make a request for the removal of such information, raise the issue of closed court proceedings ; c) require arrest of the defendant's deposits and property and take other measures provided by law to recover the damage caused to him by the crime; d) require personal immediate examination by a forensic expert in case of personal injury or harm to his / her health; e) to use the legal assistance of a legal representative from a lawyer or other specialist in the field of law from the moment of recognition as a victim; g) have a confidential date with the legal attorney before the first interrogation, as well as the presence of a lawyer or legal representative at his first interrogation; g) to be acquainted with the decision on the appointment of forensic examination and the expert's opinion; h) to get acquainted with the case file in the suspended criminal proceedings on the grounds of not identifying the perpetrator; i) to participate directly in the examination of all evidence at the trial and to speak in court, regardless of the participation of the prosecutor. The investigator, the inquirer, the prosecutor, the court are obliged to immediately explain to the victim his procedural rights, to hand him a written document describing his rights - a declaration of the victim's rights, to immediately take the measures provided by law for ensuring the victim's rights. Prospects for further study of this problem are seen in the development of models of realization of the victims of their procedural rights at different stages of the process.

SUMMARY—Most parents who live apart negotiate custody arrangements on their own or with the help of lawyers, mediators, or other professionals. However, psychologists and other mental health professionals increasingly have become involved in evaluating children and families in custody disputes, because of the large number of separated, divorced, and never-married parents and the substantial conflict that often accompanies the breakup of a family. Theoretically, the law guides and controls child custody evaluations, but the prevailing custody standard (the “best interests of the child” test) is a vague rule that directs judges to make decisions unique to individual cases according to what will be in children's future (and undefined) best interests. Furthermore, state statutes typically offer only vague guidelines as to how judges (and evaluators) are to assess parents and the merits of their cases, and how they should ultimately decide what custody arrangements will be in a child's best interests. In this vacuum, custody evaluators typically administer to parents and children an array of tests and assess them through less formal means including interviews and observation. Sadly, we find that (a) tests specifically developed to assess questions relevant to custody are completely inadequate on scientific grounds; (b) the claims of some anointed experts about their favorite constructs (e.g., “parent alienation syndrome”) are equally hollow when subjected to scientific scrutiny; (c) evaluators should question the use even of well-established psychological measures (e.g., measures of intelligence, personality, psychopathology, and academic achievement) because of their often limited relevance to the questions before the court; and (d) little empirical data exist regarding other important and controversial issues (e.g., whether evaluators should solicit children's wishes about custody; whether infants and toddlers are harmed or helped by overnight visits), suggesting a need for further scientific investigation. We see the system for resolving custody disputes as deeply flawed, for reasons that go beyond the problem of limited science. The coupling of the vague “best interests of the child” test with the American adversary system of justice puts judges in the position of trying to perform an impossible task, and it exacerbates parental conflict and problems in parenting and coparenting, which psychological science clearly shows to be key factors predicting children's psychological difficulties in response to their parents' separation and divorce. Our analysis of the flawed system, together with our desire to sharply limit custody disputes and custody evaluations, leads us to propose three reforms. First, we urge continued efforts to encourage parents to reach custody agreements on their own—in divorce mediation, through collaborative law, in good-faith attorney negotiations, in therapy, and in other forums. Some such efforts have been demonstrated to improve parent–parent and parent–child relationships long after divorce, and they embrace the philosophical position that, in the absence of abuse or neglect, parents themselves should determine their children's best interests after separation, just as they do in marriage. Second, we urge state legislatures to move toward adopting more clear and determinative custody rules, a step that would greatly clarify the terms of the marriage contract, limit the need for custody evaluations, and sharply narrow the scope of the evaluation process. We find particular merit in the proposed “approximation rule” (recently embraced by the American Law Institute), in which postdivorce parenting arrangements would approximate parenting involvement in marriage. Third and finally, we recommend that custody evaluators follow the law and only offer opinions for which there is an adequate scientific basis. Related to this, we urge professional bodies to enact more specific standards of practice on this and related issues.

The Bazelon Center for Mental Health Law (the Center), founded as the Mental Health Law Project by a group of attorneys and mental health professionals, has been a major advocacy force promoting the civil rights of persons with mental disabilities since the 1972 New York Willowbrook litigation.Named for D. C. Circuit Court of Appeals Judge David L. Bazelon, whose opinions first articulated the principles that the mentally disabled have a right to treatment in the least restrictive alternative setting, the Center has actively pursued greater rights for the mentally disabled in housing, education, and federal entitlements such as Medicaid, as well as in treatment-related issues.

Purpose – To explain the SEC's new Compliance and Disclosure Interpretations (“CDIs”) relating to the recently adopted amendments to Rule 144A and Rule 506, which permitted general solicitation and general advertising (“general solicitation”) in all Rule 144A offerings and select Regulation D offerings under Rule 506. Design/methodology/approach – The article summarizes amended rules and recently issued CDIs, while also explaining some of their implications. Findings – The new CDIs provide a number of helpful clarifications and confirmations on aspects of the amended rules relating to general solicitation, transitioning between different types of Rule 506 offerings and investor verification under Rule 506(c). Originality/value – Practical summary of recent SEC guidance with explanation from seasoned corporate securities attorneys.

<div class="page" title="Page 1"><div class="layoutArea"><div class="column"><p><span>* </span><span>A previous versions of this article was published in C. James Newlan’s journal, T</span><span>HE </span><span>S</span><span>OCIAL </span><span>C</span><span>RITIC</span><span>, </span><span>as Ellis Washington, </span><span>Excluding the Exclusionary Rule</span><span>, 3 T</span><span>HE </span><span>S</span><span>OC</span><span>. C</span><span>RITIC </span><span>(1998), and in E</span><span>LLIS </span><span>W</span><span>ASHINGTON</span><span>, T</span><span>HE </span><span>I</span><span>NSEPARABILITY OF </span><span>L</span><span>AW AND </span><span>M</span><span>ORALITY</span><span>: T</span><span>HE </span><span>C</span><span>ONSTITUTION</span><span>, N</span><span>ATURAL </span><span>L</span><span>AW AND THE </span><span>R</span><span>ULE OF </span><span>L</span><span>AW </span><span>16-28 (2002) [</span><span>hereinafter </span><span>W</span><span>ASHINGTON</span><span>, I</span><span>NSEPARABILITY OF </span><span>L</span><span>AW AND </span><span>M</span><span>ORALITY</span><span>]. For a comprehensive legal and historical analysis regarding the integration of the rule of law, jurispru- dence, and society in modern times, </span><span>see generally </span><span>Ellis Washington, </span><span>Reply to Judge Richard A. Posner on the Inseparability of Law and Morality</span><span>, 3 R</span><span>UTGERS </span><span>J. L. &amp; R</span><span>ELIG</span><span>. 1 (2001-2002); </span><span>The Nuremberg Trials: The Death of the Rule of Law </span><span>(In International Law), 49 L</span><span>OY</span><span>. L. R</span><span>EV</span><span>. 471-518 (2003). </span></p><p><span>** </span><span>Ellis Washington, DePauw University; B.A. 1983, University of Michigan; M.M. 1986, John Marshall Law School; J.D. 1994. The author an editor at the U</span><span>NIVERSITY OF </span><span>M</span><span>ICHIGAN </span><span>L</span><span>AW </span><span>R</span><span>EVIEW </span><span>and a law clerk for the Rutherford Institute. He was a faculty member at Davenport University and member of the Board of Visitors at Ave Maria School of Law. Currently, Mr. Washington is a freelance writer and lecturer at high schools, universities, and law schools throughout America specializing in the history of law, legal and political philosophy, jurisprudence, constitutional law, critical race theory, and legal feminist theory. He also teaches composition at Lansing Community College. In addition to numerous articles, he has published three books: T</span><span>HE </span><span>D</span><span>EVIL IS IN THE </span><span>D</span><span>ETAILS</span><span>: E</span><span>SSAYS ON </span><span>L</span><span>AW</span><span>, R</span><span>ACE</span><span>, P</span><span>OLITICS AND </span><span>R</span><span>ELIGION </span><span>(1999); B</span><span>EYOND </span><span>T</span><span>HE </span><span>V</span><span>EIL</span><span>: E</span><span>SSAYS IN THE </span><span>D</span><span>IALECTICAL </span><span>S</span><span>TYLE OF </span><span>S</span><span>OCRATES </span><span>(2000, 2004); T</span><span>HE </span><span>I</span><span>NSEPRABILITY OF </span><span>L</span><span>AW AND </span><span>M</span><span>ORALITY</span><span>: T</span><span>HE </span><span>C</span><span>ONSTITUTION</span><span>, N</span><span>ATURAL </span><span>L</span><span>AW AND THE </span><span>R</span><span>ULE OF </span><span>L</span><span>AW </span><span>(2002). His article, </span><span>The Nuremberg Trials: The Death of the Rule of Law (In International Law)</span><span>, 49 L</span><span>OY</span><span>. L. R</span><span>EV</span><span>. 471-518 (2003), has received both national and international recognition and has been accepted into many prestigious archives and collections including–Chambers Library of the Supreme Court of the United States, State Museum of Auschwitz-Birkenau, The Simon Wiesenthal Center, The U.S. Holocaust Memorial Museum, The Elie Wiesel Foundation for Humanity. </span></p><p><span>*Exceeding gratitude to my friend, attorney Che Ali Karega (a.k.a. “Machiavelli”) for his antagonism, advice, ideas, source materials, and inspiration. To Arthur LaBrew, musicologist and historian, founder Michigan Music Research Center (Detroit), for his prescient comments and attention to detail on earlier drafts of the Article. To C. James Newlan, publisher of the Journal, T</span><span>HE </span><span>S</span><span>OCIAL </span><span>C</span><span>RITIC</span><span>, for being my friend, my first publisher, an intellectual, a visionary, and the first person to believe that I had ideas worthy to be published and read. </span></p></div></div></div>

The Disability and Employment Survey (DES) was constructed to assess concerns that may be experienced by people with disabilities when seeking employment, with attention paid to the concerns of racial and ethnic minorities. Consisting of 32 items, the development of the DES was informed by focus group data from a culturally-diverse sample. When reviewed by a team of disability researchers, service providers, attorneys, and advocates, the DES demonstrated adequate face validity. Reliability analysis with 279 adults with disabilities resulted in a Cronbach's alpha of .91. Principal-components factor analysis indicated that the DES is comprised primarily offour factors: (a) Job Readiness Concerns, (b) Language Concerns, (c) Environmental Concerns, and (d) Health, Financial, and Familial Concerns, with these factors accounting for 49.8% of the total variance. Employment concerns varied by participants' race/ethnicity, academic attainment, current employment status, prior work history, and monetary beneficiary status.

Since its original passage in 1975 as Public Law 94-142, the Individuals with Disabilities Education Act (IDEA) has been the cornerstone of practice in special education. This federal law has enabled all eligible students with disabilities to access a free and appropriate public education. During the past 2 years, the 104th Congress has debated vigorously some of the law's basic tenets (e.g., definition of disability, content of the individualized education plan [IEP], parental rights to attorneys, fees, discipline, and placement). The basic requirements of the law remain intact and continue to shape the scope and content of special education. This article addresses whether or not the assumptions upon which IDEA is based remain valid as we approach the 21st century. We critique these assumptions within the context of four requirements of IDEA: (a) eligibility and labeling, (b) free and appropriate public education, (c) the individualized education program (IEP), and (d) the least restrictive environment. Recommendations for changes in existing law relative to each of the above requirements are presented.

As part of its structure of cooperative federalism, the Individuals With Disabilities Education Act delegates to the states implementation, within broad specifications, of administrative adjudication systems. In light of the centrality of these systems of dispute resolution and the limited research to date, policy makers and practitioners need more current information about the variations in the state hearing and review officer systems nationwide. Based on a survey of state special education directors, this article provides an updated snapshot of due process systems in the 50 states and the District of Columbia. Key findings include the following: (a) the increased predominance of one-tier, rather than two-tier, systems, (b) a similar continuation of the gradual shift toward full-time hearing officers who are attorneys, (c) a corresponding cumulative trend toward administrative law judge agencies, and (d) common problems concerning the length of hearings, the recruitment and selection of hearing officers, and their professional development, with the attendant responses in progress focused on additional training and revised procedures. Overall, in addition to the limitations of a relatively short and structured survey, the key contextual considerations included (a) the predominance of six states that account for the vast majority of the adjudicated hearings, (b) the wide variety among the remaining states, and (c) the interplay with the other indicators of dispute resolution activity, including filings, resolution sessions, and mediation.

il Kitāb Ġarā'ib al-funūn wa-mulaḥ al-'uyūn (Libro delle curiosità delle scienze e delle meraviglie per gli occhi) è l’unico manoscritto finora conosciuto di un trattato cosmografico compilato da un autore anonimo, quasi certamente egiziano, nella prima metà dell’XI secolo d. C. Il capitolo XII del II libro è dedicato alla Sicilia e comprende una descrizione di Palermo, derivata in parte da Ibn H ˙ awqal (che visitò l’isola nel 972-73), che contiene anche nuovi materiali sulla storia e topografia di Palermo nella prima metà dell’XI secolo. Comprende anche una straordinaria mappa della Sicilia islamica che riporta un ammasso di nuovi dati topografici e toponoma stici per l’isola – e soprattutto per Palermo – attorno all’anno 1000. Questo contributo presenta la prima edizione critica e traduzione dei testi, e da un primo resoconto di questa importante fonte nuova per la Sicilia islamica.

The research titled: Application of Criminal Sanction Policy Against Crime Perpetrators of Domestic Violence, Problems of this research are: 1) How the policy formulation of the crime of domestic violence? 2) How can the application of criminal sanctions against perpetrators of criminal acts of violence in the home? 3) Constraints are faced judges in the application of criminal sanctions against perpetrators of the crime of domestic violence and efforts to overcome it? The method used in this research using normative research is descriptive qualitative analysis. This study is a literature. The results of the study using sociological juridical concluded that: 1) Policy formulatif against the crime of domestic violence set out in Chapter VIII of Act No. 23 of 2994 Article 44 of physical violence, Article 45 of the violence phisikis, Articles 46, 47, 48 on sexual violence and Article 49 of Neglection. 2). The application of criminal sanctions against perpetrators of criminal acts of domestic violence committed by the judge after going through the process of proving to the charges the prosecutor. Starting from proven facts deeds of witnesses, then the fact juridical considerations and ease further aggravating the new verdict. 3) Constraints faced by judges in the application of criminal sanctions against perpetrators of criminal acts of domestic violence are: a. ) The absence of witnesses cause hearing be postponed, so that the proceedings so that the proceedings be longer than scheduled. b.) The absence attorneys also cause hearing was postponed from the trial process has gone backwards longer than scheduled. c.) The absence of a post mortem result in the judge adjourned the hearing, to include post mortem beforehand. d.) The judge is hard to prove because there were no witnesses who saw directly, and also sometimes victims of domestic violence and perpetrators still love each other, so that judges convict when the weight will result in divorce. e) The absence attorneys also cause hearing was postponed from the trial process has gone backwards longer than scheduled. f.) The absence of a post mortem result in the judge adjourned the hearing, to include post mortem beforehand. g.) The judge is hard to prove because there were no witnesses who saw directly, and also sometimes victims of domestic violence and perpetrators still love each other, so that judges convict when the weight will result in divorce. The absence attorneys also cause hearing was postponed from the trial process has gone backwards longer than scheduled. h.) The absence of a post mortem result in the judge adjourned the hearing, to include post mortem beforehand. i.) The judge is hard to prove because there were no witnesses who saw directly, and also sometimes victims of domestic violence and perpetrators still love each other, so that judges convict when the weight will result in divorce.Keywords: Legal Policy; Crime; Domestic Violence.

Abstrak Penelitian ini dilakukan dengan tujuan untuk dapat menganalisa mengenai Dasar Pertimbangan Penyelesaian Perkara dalam Surat Ketetapan Penghentian Penuntutan Kejaksaan Negeri Musi Banyuasin Nomor Print- 1800/L.6.16/Eoh.2/12/2021. Penelitian ini akan dilaksanakan dengan menggunakan pendekatan hukum normatif dan akan berfokus kepada inventarisasi hukum positif, temuan hukum dalam kasus in concreto, asas dan doktrin hukum. Data-data dalam penelitian ini berasal dari berbagai data hukum primer dan juga sekunder. Data hukum primer dalam artikel ini berasal dari berbagai peraturan perundang-undangan yang masih relevan dengan subjek pembahasan, seperti Undang-Undang Nomor 22 tahun 2009 Tentang Lalu Lintas dan Angkutan Jalan, Undang-Undang Nomor 8 Tahun 1981 Tentang Hukum Acara Pidana dan Undang-Undang Nomor 16 Tahun 2004 Tentang Kejaksaan Republik Indonesia, serta Peraturan Kejaksaan Republik Indonesia Nomor 15 Tahun 2020 Tentang Penghentian Penuntutan Berdasarkan Keadilan Restoratif). Adapun data hukum sekunder berupa berbagai pengertian mengenai hukum dalam data primer. Hasil dari penelitian ini menemukan bahwa jaksa senantiasa bertindak berdasarkan hukum dengan mengindahkan norma-norma keagamaan, kesopanan, kesusilaan, serta wajib menggali dan menjunjung tinggi nilai-nilai kemanusiaan yang hidup dalam masyarakat, serta senantiasa menjaga kehormatan dan martabat profesinya. Penuntutan yang dilaksanakan secara independen demi keadilan berdasarkan hukum dan hati nurani. 3) Penghentian penuntutan berdasarkan keadilan restoratif dilaksanakan dengan berasaskan : (a) Keadilan; (b) Kepentingan umum; (c) Proporsionalitas; (d) Pidana sebagai jalan terakhir; dan (e) Cepat, sederhana dan biaya ringan. Sedangkan faktor yang menjadi kendala dalam penyelesaian perkara yang terdapat dalam surat ketetapan penghentian penuntutan Kejaksaan Negeri Musi Banyuasin Nomor Print-1800/L.6./16/ Eoh.2/12/2021 yaitu : 1) Faktor hukumnya sendiri (Undang-Undang), 2) Faktor Penegak Hukum, 3) Faktor Sarana Prasarana, 4) Faktor Masyarakat, 5) Faktor kebudayaan. Kata Kunci : Surat Ketetapan Penghentian Penuntutan, Lakalantas Ringan AbstractThis research was conducted with the aim of being able to analyze the Basis for Consideration of Case Settlement in the Decree of Termination of Prosecution of the Musi Banyuasin District Attorney's Office Number Print- 1800 / L.6.16 / Eoh.2 / 12/2021. This research will be carried out using a normative legal approach and will focus on the inventory of positive law, legal findings in cases in concreto, legal principles and doctrines. The data in this study comes from various primary and secondary legal data. The primary legal data in this article comes from various laws and regulations that are still relevant to the subject of discussion, such as Law Number 22 of 2009 concerning Road Traffic and Transportation, Law Number 8 of 1981 concerning the Criminal Procedure Law and Law Number 16 of 2004 concerning the Prosecutor's Office of the Republic of Indonesia, as well as the Prosecutor's Regulation of the Republic of Indonesia Number 15 of 2020 concerning Termination of Prosecutions Based on Restorative Justice). The secondary legal data is in the form of various understandings of the law in the primary data. The results of this study found that prosecutors always act based on the law by heeding religious norms, decency, decency, and are obliged to explore and uphold the human values that live in society, and always maintain the honor and dignity of their profession. Prosecutions that are conducted independently for the sake of justice based on law and conscience. 3) The termination of prosecution based on restorative justice shall be carried out on the basis of: (a) Justice; (b) Public interest; (c) Proportionality; (d) Criminal as a last resort; and (e) Fast, simple and light cost. Meanwhile, the factors that are obstacles in resolving the case contained in the decree of termination of prosecution of the Musi Banyuasin District Attorney's Office Number Print-1800 / L.6./ 16 / Eoh.2 / 12/2021 are: 1) The legal factors themselves (Law), 2) Law Enforcement Factors, 3) Infrastructure Factors, 4) Community Factors, 5) Cultural factors.

Cambodia has a bold new strategy to stimulate E-commerce and to grow the economy. The Digital Signature (DSL), Consumer Protection (CPL), and E-Commerce Laws (ECL) are important components of that strategy. The DSL provides for licensing of certifying authorities and does not prohibit other types of E-signatures. The CPL prohibits deceptive advertising and creates a consumer complaint procedure. The ECL recognizes the legal validity of secure E-documents and E-signatures, including as evidence in a court of law. The ECL states requirements of secure E-signatures and secure E-documents; E-contract rules; rules for liability of internet service providers and E-sellers; E-government provisions; E-payments services rules; and computer crimes. The ECL should be improved by: (a) recognizing electronic wills, powers of attorney, and real estate documents; (b) adding attribution rules and acknowledge receipt rules for E-contracts; (c) adding mandatory E-government; (d) adding a comprehensive computer crimes law; and (e) adding IT Courts.

Changes to U.S. immigration policy have implications for social work, owing to the ethics-based foundation of the profession. The twin purposes of this mixed-methods case study are to describe the detainment and deportation processes, and their implementation at the Stewart Detention Center in Lumpkin, Georgia (notorious for its disparately high rate of deportation); and, to discuss social work’s ethical role in relation to immigrant populations and immigration policy issues. To achieve analysis, we collected data at the Stewart Detention Center, directly observing a sample of 39 immigration court hearings across 4 separate time points between June and September of 2018. We use univariate statistics to describe the sample in terms of hearing duration, demographics of detained persons, characteristics of judge and attorney interactions, removability charges, and hearing outcomes. Our analysis includes mappings of 2 courtrooms and a thick and rich narrative description of our first trip to the Stewart Detention Center in June, 2018. Identified themes across court observations include: (a) lack of uniformity in process, (b) adoption of criminal justice norms and procedures without inclusion of protective factors, (c) layers and barriers to communication that present as isolating, and (d) a seeming emphasis placed on the voluntary departure option. We conclude with a discussion of implications for social work and respective recommendations for engagement.

Supported decision-making (SDM) has the potential to upend age-old legal regimes and belief systems throughout the world to ensure that people with disabilities both can easily access their preferred forms of assistance to make decisions and also get respect for their decisions from other people, even when they make decisions with support. This simple but powerful idea, which has already prompted many countries around the world to rethink their laws, policies, and programs, emerged in response to demands by self-advocates to make their voices heard, have greater say in their own lives, and do away with laws that get in the way. While SDM has inspired provocative thinking and meaningful changes to the benefit of people with intellectual and developmental disabilities (IDD), self-advocates expect that new laws, policies, and programs aim to give this idea “teeth.” At a time when organizations are seizing more opportunities to advance SDM, this article’s co-authors, two self-advocates and an attorney supporter, present recommendations based on their experiences with two SDM advocacy initiatives in New York and Massachusetts. Specifically, we recommend that SDM advocates focus on (a) passing laws that require other people to recognize the supported decisions of people with IDD who have SDM agreements, (b) developing SDM agreements that are easy for people with IDD to understand, (c) encouraging judges to apply SDM in guardianship proceedings, and (d) providing individualized assistance to people with IDD interested in making SDM agreements.

The Corruption Eradication Commission (KPK) has broad duties and authorities in the prevention and prosecution of corruption with the functions of investigation, investigation and prosecution. In Law Number 30 of 2002 Article 6 states that the Corruption Eradication Commission has the following duties: a. Coordination with agencies authorized to do eradicate criminal acts of corruption; b. Supervision of agencies authorized to do eradicate criminal acts of corruption; c. Carry out investigations, investigations and prosecutions of criminal acts of corruption; d. Taking steps to prevent criminal acts of corruption; and e. Monitor to the implementation of government. However, over time since its to establish, regulatory reviews of the KPK have continued to be carried out, given the increasing number of judicial reviews in the Constitutional Court regarding the position and authority of the KPK. Apart from the pros and cons, as part of the most important agenda in reforming governance in Indonesia, the presence of the KPK was motivated by the low level of public trust in law enforcement agencies (the Attorney General's Office and the Police) at that time in eradicating corruption. On the other hand, especially during the 17 years of Law Number 30 of 2002, there have been many changes in conditions, so the revision of the KPK Law is deemed necessary to determine whether efforts to eradicate corruption are in accordance with the objectives of establishing the KPK. Whether the reason for evaluating and revising the authority of the KPK is seen as a form of strengthening or weakening the Corruption Eradication Commission (KPK), is the basis for this research being carried out.

Achievements in terms of providing financing to Cooperative members are notregardlessfrom the role of Cooperative administrators and managers in terms of carrying out/implementing proceduresproviding financing (loans) to members . ProcedureProviding financing is a rule or provisionmade by the management and approved by the Supervisor which is used as a guideline for the management/managers in carrying out their duties so that they can reduce one of the financing risks, namely avoiding or reducing bad financing (problems). With the existence of procedures for providing financing, it is hoped that the financing (loan) can be returned according to the agreement or it could also mean thatprocedureProviding financing requires members who receive financing facilities topay off the financing accordinglyagreementwithgiverloanalong with profits for the cooperative in the form of Ujrah, Margin or profit sharing according to the financing agreementset.ForThat adminis trator cooperative mustoperate procedur eproviding financing (loans) so thatits membersresponsibleresponsible for the financing (loan) received and making payments in accordance with the provisions or contracts that have been mutually agreed upon. The aim of this researcher is to: (a) know the procedureproviding financing to the Kecana Ketahun Berkah Sejahtra Savings and Loans and Sharia Financing cooperative (KKBS), (b) requirementswhat must be fulfilled by Kopeasi members to apply for financingon Cooperative . Save Kencana Sharia loans and financing for a Prosperous Blessing Year (KKBS) .MethodstudyWhichused in this research is qualitative. With this type of approachused is the phenomenology of procedures for providing financing toCooperativeSave Kencana Kertahun Berkah Sejahtera (KKBS) sharia borrowing and financing (KKBS) Ketahun District, North Bengkulu Regency .Andin formant Whichuse dismember Cooperative Andand management of the Savings CooperativeBorrowing and sharia financing for Kencana Ke Tahun Berkah Sejahtera (KKBS) . The results of this research show that the procedures for providing financing inCooperativeSave KKBS Sharia loans and financing are still availablethere islackfromstandardcredit granting procedures that always pay attention to the element of prudence. Meanwhilepro blemsmain Which thereisin procedure giving creditin Cooperative Save Kencana Ketahun Berkah Sejahtera sharia loans, Ketahun District, North Bengkulu Regency are: a) A photocopy of the KTP of the spouse of the member applying for financing (husband or wife) is not required. b) A letter of approval from the partner (husband or wife) is not required. there is proof of payment of PBB (Land and Building Tax) if the member provides collateral in the form of a Certificate of Ownership (SHM) d) There is no requirement for a power of attorney to guarantee if the collateral used is still in the name of another person e) There is no weighting or scoring in the method of determining a member's eligibility. using the 5 C method .

Parents with disabilities experience discrimination within the child welfare, family law, and adoption and foster care systems. In response, there have been increasing calls for states to pass legislation prohibiting discrimination against parents with disabilities, and as of 2020, 28 states have passed or are considering such legislation. This qualitative study explored the perspectives of 19 advocates, attorneys, and legislators on barriers and solutions for passing legislation to protect the rights of parents with disabilities. Participants identified three barriers: (a) legislators’ pejorative attitudes toward parents with disabilities, (b) external opposition, and (c) legislative barriers. Participants also identified eight solutions: (a) cross-disability advocacy, (b) education, (c) relationship-building, (d) bipartisanship, (e) support from state and national organizations, (f) strong sponsors, (g) incrementalism, and (h) model legislation. Study findings should help to inform ongoing legislative advocacy to protect the rights of parents with disabilities.

Plea deals resolve the vast majority of prosecuted criminal cases in the U.S. legal system. Prosecutors hold disproportionate power in plea bargaining and have been blamed for driving punitiveness and racial disparities. Progressive prosecutors aim to reverse these trends, but little is known about how they will alter plea practices. We conducted qualitative interviews with all the assistant district attorneys (ADAs, N = 19) in a mid-sized office with a newly elected progressive DA. Interviews discussed how ADAs implemented office policies and progressive goals in plea bargaining. Prosecutors described working to implement five main progressive goals in their plea decisions: (a) dismissing low-level drug possession charges; (b) avoiding over-penalization, particularly for “victimless” crimes; (c) declining to prosecute weak cases; (d) encouraging open communication with defense; and (e) promoting racial equity. Prosecutors’ descriptions of how these goals guided case decisions illuminate how progressive prosecution may affect the criminal justice system through plea bargaining.

The labyrinth is probably the most universal trope of complexity. Deriving from pre-Greek labyrinthos, a word denoting “maze, large building with intricate underground passages”, and possibly related to Lydian labrys, which signifies “double-edged axe,” symbol of royal power, the notion of the labyrinth primarily evokes the Minoan Palace in Crete and the myth of the Minotaur. According to this myth, the Minotaur, a monster with the body of a man and the head of a bull, was born to Pesiphae, king Minos’s wife, who mated with a bull when the king of Crete was besieging Athens. Upon his return, Minos commanded the artist Daedalus to construct a monumental building of inter-connected rooms and passages, at the center of which the King sought to imprison the monstrous sign of his disgrace. The Minotaur required human sacrifice every couple of years, until it was defeated by the Athenian prince Theuseus, who managed to extricate himself from the maze by means of a clue of thread, given to him by Minos’s enamored daughter, Ariadne (Parandowski 238-43). If the Cretan myth establishes the labyrinth as a trope of complexity, this very complexity associates labyrinthine design not only with disorientation but also with superb artistry. As pointed out by Penelope Reed Doob, the labyrinth is an inherently ambiguous construct (39-63). It presumes a double perspective: those imprisoned inside, whose vision ahead and behind is severely constricted, are disoriented and terrified; whereas those who view it from outside or from above – as a diagram – admire its structural sophistication. Labyrinths thus simultaneously embody order and chaos, clarity and confusion, unity (a single structure) and multiplicity (many paths). Whereas the modern, reductive view equates the maze with confusion and disorientation, the labyrinth is actually a signifier with two contradictory signifieds. Not only are all labyrinths intrinsically double, they also fall into two distinct, though related, types. The paradigm represented by the Cretan maze is mainly derived from literature and myth. It is a multicursal model, consisting of a series of forking paths, each bifurcation requiring new choice. The second type is the unicursal maze. Found mainly in the visual arts, such as rock carvings or coin ornamentation, its structural basis is a single path, twisting and turning, but entailing no bifurcations. Although not equally bewildering, both paradigms are equally threatening: in the multicursal construct the maze-walker may be entrapped in a repetitious pattern of wrong choices, whereas in the unicursal model the traveler may die of exhaustion before reaching the desired end, the heart of the labyrinth. In spite of their differences, the basic similarities between the two paradigms may explain why they were both included in the same linguistic category. The labyrinth represents a road-model, and as such it is essentially teleological. Most labyrinths of antiquity and of the Middle Ages were designed with the thought of reaching the center. But the fact that each labyrinth has a center does not necessarily mean that the maze-walker is aware of its existence. Moreover, reaching the center is not always to be desired (in case it conceals a lurking Minotaur), and once the center is reached, the maze-walker may never find the way back. Besides signifying complexity and ambiguity, labyrinths thus also symbolically evoke the danger of eternal imprisonment, of inextricability. This sinister aspect is intensified by the recursive aspect of labyrinthine design, by the mirroring effect of the paths. In reflecting on the etymology of the word ‘maze’ (rather than the Greek/Latin labyrinthos/labyrinthus), Irwin observes that it derives from the Swedish masa, signifying “to dream, to muse,” and suggests that the inherent recursion of labyrinthine design offers an apt metaphor for the uniquely human faculty of self-reflexitivity, of thought turning upon itself (95). Because of its intriguing aspect and wealth of potential implications, the labyrinth has become a category that is not only formal, but also conceptual and symbolic. The ambiguity of the maze, its conflation of overt complexity with underlying order and simplicity, was explored in ideological systems rooted in a dualistic world-view. In the early Christian era, the labyrinth was traditionally presented as a metaphor for the universe: divine creation based on a perfect design, perceived as chaotic due to the shortcomings of human comprehension. In the Middle-Ages, the labyrinthine attributes of imprisonment and limited perception were reflected in the view of life as a journey inside a moral maze, in which man’s vision was constricted because of his fallen nature (Cazenave 348-350). The maze was equally conceptualized in dynamic terms and used as a metaphor for mental processes. More specifically, the labyrinth has come to signify intellectual confusion, and has therefore become most pertinent in literary contexts that valorize rational thought. And the rationalistic genre par excellence is detective fiction. The labyrinth may serve as an apt metaphor for the world of detective fiction because it accurately conveys the tacit assumptions of the genre – the belief in the existence of order, causality and reason underneath the chaos of perceived phenomena. Such optimistic belief is ardently espoused by the putative detective in Paul Auster’s metafictional novella City of Glass: He had always imagined that the key to good detective work was a close observation of details. The more accurate the scrutiny, the more successful the results. The implication was that human behavior could be understood, that beneath the infinite façade of gestures, tics and silences there was finally a coherence, an order, a source of motivation. (67) In this brief but eloquent passage Auster conveys, through the mind of his sleuth, the central tenets of classical detective fiction. These tenets are both ontological and epistemological. The ontological aspect is subsumed in man’s hopeful reliance on “a coherence, an order, a source of motivation” underlying the messiness and blood of the violent deed. The epistemological aspect is aptly formulated by Michael Holquist, who argues that the fictional world of detective stories is rooted in the Scholastic principle of adequatio rei et intellectus, the adequation of mind to things (157). And if both human reality and phenomenal reality are governed by reason, the mind, given enough time, can understand everything. The mind’s representative is the detective. He is the embodiment of inquisitive intellect, and his superior powers of observation and deduction transform an apparent mystery into an incontestable solution. The detective sifts through the evidence, assesses the relevance of data and the reliability of witnesses. But, first of foremost, he follows clues – and the clue, the most salient element of the detective story, links the genre with the myth of the Cretan labyrinth. For in its now obsolete spelling, the word ‘clew’ denotes a ball of thread, and thus foregrounds the similarity between the mental process of unraveling a crime mystery and the traveler’s progress inside the maze (Irwin 179). The chief attributes of the maze – circuitousness, enclosure, and inextricability – associate it with another convention of detective fiction, the trope of the locked room. This convention, introduced in Poe’s “The Murders in the Rue Morgue,” a text traditionally regarded as the first analytic detective story, establishes the locked room as the ultimate affront to reason: a hermetically sealed space which no one could have penetrated or exited and in which a brutal crime has nevertheless been committed. But the affront to reason is only apparent. In Poe’s ur-text of the genre, the violent deed is committed by an orangutan, a brutal and abused beast that enters and escapes from the seemingly locked room through a half-closed window. As accurately observed by Holquist, in the world of detective fiction “there are no mysteries, there is only incorrect reasoning” (157). And the correct reasoning, dubbed by Poe “ratiocination”, is the process of logical deduction. Deduction is an enchainment of syllogisms, in which a conclusion inevitably follows from two valid premises; as Dupin elegantly puts it, “the deductions are the sole proper ones and … the suspicion arises inevitably from them as a single result” (Poe 89). Applying this rigorous mental process, the detective re-arranges the pieces of the puzzle into a coherent and meaningful sequence of events. In other words – he creates a narrative. This brings us back to Irwin’s observation about the recursive aspect of the maze. Like the labyrinth, detective fiction is self-reflexive. It is a narrative form which foregrounds narrativity, for the construction of a meaningful narrative is the protagonist’s and the reader’s principal task. Logical deduction, the main activity of the fictional sleuth, does not allow for ambiguity. In classical detective fiction, the labyrinth is associated with the messiness and violence of crime and contrasted with the clarity of the solution (the inverse is true of postmodernist detective mysteries). The heart of the labyrinth is the solution, the vision of truth. This is perhaps the most important aspect of the detective genre: the premise that truth exists and that it can be known. In “The Murders in the Rue Morgue,” the initially insoluble puzzle is eventually transformed into a coherent narrative, in which a frantic orangutan runs into the street escaping the abuse of its master, climbs a rod and seeks refuge in a room inhabited by two women, brutally slashes them in confusion, and then flees the room in the same way he penetrated it. The sequence of events reconstructed by Dupin is linear, unequivocal, and logically satisfying. This is not the case with the ‘hard boiled’, American variant of the detective genre, which influenced the inception of film noir. Although the novels of Hammett, Chandler or Cain are structured around crime mysteries, these works problematize most of the tacit premises of analytic detective fiction and re-define its narrative form. For one, ‘hard boiled’ fiction obliterates the dualism between overt chaos and underlying order, between the perceived messiness of crime and its underlying logic. Chaos becomes all-encompassing, engulfing the sleuth as well as the reader. No longer the epitome of a superior, detached intellect, the detective becomes implicated in the mystery he investigates, enmeshed in a labyrinthine sequence of events whose unraveling does not necessarily produce meaning. As accurately observed by Telotte, “whether [the] characters are trying to manipulate others, or simply hoping to figure out how their plans went wrong, they invariably find that things do not make sense” (7). Both ‘hard-boiled’ fiction and its cinematic progeny implicitly portray the dissolution of social order. In film noir, this thematic pursuit finds a formal equivalent in the disruption of traditional narrative paradigm. As noted by Bordwell and Telotte, among others, the paradigm underpinning classical Hollywood cinema in the years 1917-1960 is characterized by a seemingly objective point of view, adherence to cause-effect logic, use of goal-oriented characters and a progression toward narrative closure (Bordwell 157, Telotte 3). In noir films, on the other hand, the devices of flashback and voice-over implicitly challenge conventionally linear narratives, while the use of the subjective camera shatters the illusion of objective truth (Telotte 3, 20). To revert to the central concern of the present paper, in noir cinema the form coincides with the content. The fictional worlds projected by the ‘hard boiled’ genre and its noir cinematic descendent offer no hidden realm of meaning underneath the chaos of perceived phenomena, and the trope of the labyrinth is stripped of its transcendental, comforting dimension. The labyrinth is the controlling visual metaphor of the Coen Brothers’ neo-noir film The Man Who Wasn’t There (2001). The film’s title refers to its main protagonist: a poker-faced, taciturn barber, by the name of Ed Crane. The entire film is narrated by Ed, incarcerated in a prison cell. He is writing his life story, at the commission of a men’s magazine whose editor wants to probe the feelings of a convict facing death. Ed says he is not unhappy to die. Exonerated of a crime he committed and convicted of a crime he did not, Ed feels his life is a labyrinth. He does not understand it, but he hopes that death will provide the answer. Ed’s final vision of life as a bewildering maze, and his hope of seeing the master-plan after death, ostensibly refer to the inherent dualism of the labyrinth, the notion of underlying order manifest through overt chaos. They offer the flicker of an optimistic closure, which subscribes to the traditional Christian view of the universe as a perfect design, perceived as chaos due to the shortcomings of human comprehension. But this interpretation is belied by the film’s final scene. Shot in blindingly white light, suggesting the protagonist’s revelation, the screen is perfectly empty, except for the electric chair in the center. And when Ed slowly walks towards the site of his execution, he has a sudden fantasy of the overhead lights as the round saucers of UFOs. The film’s visual metaphors ironically subvert Ed’s metaphysical optimism. They cast a view of human life as a maze of emptiness, to borrow the title of one of Borges’s best-known stories. The only center of this maze is death, the electric chair; the only transcendence, faith in God and in after life, makes as much sense as the belief in flying saucers. The Coen Brothers thus simultaneously construct and deconstruct the traditional symbolism of the labyrinth, evoking (through Ed’s innocent hope) its promise of underlying order, and subverting this promise through the images that dominate the screen. The transcendental dimension of the trope of the labyrinth, its promise of a hidden realm of meaning and value, is consistently subverted throughout the film. On the level of plot, the film presents a crisscrossed pattern of misguided intentions and tragi-comic misinterpretations. The film’s protagonist, Ed Crane, is estranged from his own life; neither content nor unhappy, he is passive, taking things as they come. Thus he condones Doris’s, his wife’s, affair with her employer, Big Dave, reacting only when he perceives an opportunity to profit from their liason. This opportunity presents itself in the form of Creighton Tolliver, a garrulous client, who shares with Ed his fail-proof scheme of making big money from the new invention of dry cleaning. All he needs to carry out his plan, confesses Creighton, is an investment of ten thousand dollars. The barber decides to take advantage of this accidental encounter in order to change his life. He writes an anonymous extortion letter to Big Dave, threatening to expose his romance with Doris and wreck his marriage and his financial position (Dave’s wife, a rich heiress, owns the store that Dave runs). Dave confides in Ed about the letter; he suspects the blackmailer is a con man that tried to engage him in a dry-cleaning scheme. Although reluctant to part with the money, which he has been saving to open a new store to be managed by Doris, Big Dave eventually gives in. Obviously, although unbeknownst to Big Dave, it is Ed who collects the money and passes it to Creighton, so as to become a silent partner in the dry cleaning enterprise. But things do not work out as planned. Big Dave, who believes Creighton to be his blackmailer, follows him to his apartment in an effort to retrieve the ten thousand dollars. A fight ensues, in which Creighton gets killed, not before revealing to Dave Ed’s implication in his dry-cleaning scheme. Furious, Dave summons Ed, confronts him with Creighton’s story and physically attacks him. Ed grabs a knife that is lying about and accidentally kills Big Dave. The following day, two policemen arrive at the barbershop. Ed is certain they came to arrest him, but they have come to arrest Doris. The police have discovered that she has been embezzling from Dave’s store (Doris is an accountant), and they suspect her of Dave’s murder. Ed hires Freddy Riedenschneider, the best and most expensive criminal attorney, to defend his wife. The attorney is not interested in truth; he is looking for a version that will introduce a reasonable doubt in the minds of the jury. At some point, Ed confesses that it is he who killed Dave, but Riedenschneider dismisses his confession as an inadequate attempt to save Doris’s neck. He concocts a version of his own, but does not get the chance to win the trial; the case is dismissed, as Doris is found hanged in her cell. After his wife’s death, Ed gets lonely. He takes interest in Birdy, the young daughter of the town lawyer (whom he initially approached for Doris’s defense). Birdy plays the piano; Ed believes she is a prodigy, and wants to become her agent. He takes her for an audition to a French master pianist, who decides that the girl is nothing special. Disenchanted, they drive back home. Birdy tells Ed, not for the first time, that she doesn’t really want to be a pianist. She hasn’t been thinking of a career; if at all, she would like to be a vet. But she is very grateful. As a token of her gratitude, she tries to perform oral sex on Ed. The car veers; they have an accident. When he comes to, Ed faces two policemen, who tell him he is arrested for the murder of Creighton Tolliver. The philosophical purport of the labyrinth metaphor is suggested in a scene preceding Doris’s trial, in which her cocky attorney justifies his defense strategy. To support his argument, he has recourse to the theory of some German scientist, called either Fritz or Werner, who claimed that truth changes with the eye of the beholder. Science has determined that there is no objective truth, says Riedenschneider; consequently, the question of what really happened is irrelevant. All a good attorney can do, he concludes, is present a plausible narrative to the jury. Freddy Riedenschneider’s seemingly nonchalant exposition is a tongue-in-cheek reference to Heisenberg’s uncertainty principle. Succinctly put, the principle postulates that the more precisely the position of a subatomic particle is determined, the less precisely its momentum is known in this instant, and vice versa. What follows is that concepts such as orbits of electrons do not exist in nature unless and until we measure them; or, in Heisenberg’s words, “the ‘path’ comes into existence only when we observe it” (qtd. in Cassidy). Heisenberg’s discovery had momentous scientific and philosophical implications. For one, it challenged the notion of causality in nature. The law of causality assumes that if we know the present exactly, we can calculate the future; in this formulation, suggests Heisenberg, “it is not the conclusion that is wrong, but the premises” (qtd. in Cassidy). In other words, we can never know the present exactly, and on the basis of this exact knowledge, predict the future. More importantly, the uncertainty principle seems to collapse the distinction between subjective and objective reality, between consciousness and the world of phenomena, suggesting that the act of perception changes the reality perceived (Hofstadter 239). In spite of its light tone, the attorney’s confused allusion to quantum theory conveys the film’s central theme: the precarious nature of truth. In terms of plot, this theme is suggested by the characters’ constant misinterpretation: Big Dave believes he is blackmailed by Creighton Tolliver; Ed thinks Birdy is a genius, Birdy thinks that Ed expects sex from her, and Ann, Dave’s wife, puts her faith in UFOs. When the characters do not misjudge their reality, they lie about it: Big Dave bluffs about his war exploits, Doris cheats on Ed and Big Dave cheats on his wife and embezzles from her. And when the characters are honest and tell the truth, they are neither believed nor rewarded: Ed confesses his crime, but his confession is impatiently dismissed, Doris keeps her accounts straight but is framed for fraud and murder; Ed’s brother in law and partner loyally supports him, and as a result, goes bankrupt. If truth cannot be known, or does not exist, neither does justice. Throughout the film, the wires of innocence and guilt are constantly crossed; the innocent are punished (Doris, Creighton Tolliver), the guilty are exonerated of crimes they committed (Ed of killing Dave) and convicted of crimes they did not (Ed of killing Tolliver). In this world devoid of a metaphysical dimension, the mindless processes of nature constitute the only reality. They are represented by the incessant, pointless growth of hair. Ed is a barber; he deals with hair and is fascinated by hair. He wonders how hair is a part of us and we throw it to dust; he is amazed by the fact that hair continues to grow even after death. At the beginning of the film we see him docilely shave his wife’s legs. In a mirroring scene towards the end, the camera zooms in on Ed’s own legs, shaved before his electrocution. The leitmotif of hair, the image of the electric chair, the recurring motif of UFOs – all these metaphoric elements convey the Coen Brothers’ view of the human condition and build up to Ed’s final vision of life as a labyrinth. Life is a labyrinth because there is no necessary connection between cause and effect; because crime is dissociated from accountability and punishment; because what happened can never be ascertained and human knowledge consists only of a maze of conflicting, or overlapping, versions. The center of the existential labyrinth is death, and the exit, the belief in an after-life, is no more real than the belief in aliens. The labyrinth is an inherently ambiguous construct. Its structural attributes of doubling, recursion and inextricability yield a wealth of ontological and epistemological implications. Traditionally used as an emblem of overt complexity concealing underlying order and symmetry, the maze may aptly illustrate the tacit premises of the analytic detective genre. But this purport of the maze symbolism is ironically inverted in noir and neo-noir films. As suggested by its title, the Coen Brothers’ movie is marked by absence, and the absence of the man who wasn’t there evokes a more disturbing void. That void is the center of the existential labyrinth. References Auster, Paul. City of Glass. The New York Trilogy. London and Boston: Faber and Faber, 1990. 1-132. Bordwell, David. Narration in the Fiction Film. Madison: Wisconsin UP, 1985. Cassidy, David. “Quantum Mechanics, 1925-1927.” Werner Heisenberg (1901-1978). American Institute of Physics, 1998. 5 June 2007 http://www.aip.org/history/heisenberg/p08c.htm>. Cazenave, Michel, ed. Encyclopédie des Symboles. Paris: Le Livre de Poche, 1996. Coen, Joel, and Ethan Coen, dirs. The Man Who Wasn’t There. 2001. Doob, Penelope Reed. The Idea of the Labyrinth. Ithaca: Cornell UP, 1992. Hofstadter, Douglas. I Am a Strange Loop. New York: Basic Books, 2007. Holquist, Michael. “Whodunit and Other Questions: Metaphysical Detective Stories in Post-War Fiction.” The Poetics of Murder. Eds. Glenn W. Most and William W. Stowe. New York: Harcourt Brace Jovanovich, 1983. 149-174. Irwin, John T. The Mystery to a Solution: Poe, Borges and the Analytic Detective Story. Baltimore and London: Johns Hopkins UP, 1994. Parandowski, Jan. Mitologia. Warszawa: Czytelnik, 1960. Poe, Edgar Allan. “The Murders in the Rue Morgue.” Edgar Allan Poe: The Complete Illustrated Stories and Poems. London: Chancellor Press, 1994. 103-114. Telotte, J.P. Voices in the Dark: The Narrative Patterns of Film Noir. Urbana: Illinois UP, 1989. Citation reference for this article MLA Style Shiloh, Ilana. "A Vision of Complex Symmetry: The Labyrinth in The Man Who Wasn’t There." M/C Journal 10.3 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0706/09-shiloh.php>. APA Style Shiloh, I. (Jun. 2007) "A Vision of Complex Symmetry: The Labyrinth in The Man Who Wasn’t There," M/C Journal, 10(3). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0706/09-shiloh.php>.

Content alignment of journalistic reporting about scandals in the news or social media can be analyzed by identifying frames, a process by which they are derived from the material about a particular issue (inductive frame analysis) or using a set of re-occurring frames, which has been identified and operationalized in previous studies. This research overview will describe a catalog of frames measured in news coverage and journalistic Twitter communication of various scandals in different countries (e.g., Berti, 2019, Eder, 2023, Maier et al., 2019). Field of application/Theoretical foundation Political scandals have become an everyday phenomenon in news media. They also play a significant role when analyzing journalistic news and public communication processes as they reveal specific narrative patterns. Media content analyses investigate how journalists present information about evident or uncertain misbehavior by political actors and other elites. At the same time, there is still no consensus on a definition. One of the most comprehensive definitions so far—which integrates actor-centered definitions, approaches that define political scandals through a social framework, and approaches that reject a limitation to the political-administrative sphere—comes from von Sikorski (2018), who defines such scandals as follows: “Political scandals refer to real or conjectured norm transgressions of political actors or institutions. A particular norm transgression may occur in the context of political processes or in a politician’s private life and may or may not have legal consequences (e.g., official investigation by the office of the district attorney). […] News coverage about an alleged norm transgression must be framed as scandalous (scandal frame), and the scandalous behavior has to be unambiguously condemned” (pp. 136–137). Political scandals can be described as the result of journalists publishing information about misconduct and especially (financial) corruption of political actors. Therefore, “the analysis of the reasons for scandals usually overlaps with analyses of corruption” (Tumber & Waisbord, 2004, p. 1032), making (journalistic) content about corruption of political actors also relevant for framing research. Likewise, there is no gold standard for measuring (scandal) frames. Five different, not mutually exclusive, methodological approaches have emerged in the past decades (Matthes & Kohring, 2008), while the framing of political scandals has been mainly researched with the following two measurements: First, in the sense of Entman (1993), frames can be measured by different frame elements: particular problem definition, causal interpretation, treatment recommendation, and moral evaluation. Accordingly, a frame is present if more than one of the elements is present in the analyzed content. At the same time, not all (partial) elements need to be present (Entman, 1993, p. 52). Second, frames can be measured holistically, where thematic and episodic frames are used to identify patterns (de Vreese & Lecheler, 2012). In particular, the categorization of thematic frames by Semetko and Valkenburg (2000) has been proven reliable across different issues. References/Combination with other methods The framing of (political) scandals can be analyzed in various content, such as news articles, video, audio, and postings on (digital) platforms. At the same time, there is no consensus on the standardized measurement of frames. Moreover, the analysis of frames on political scandals has not been combined with other methods but rather relied on qualitative content analysis (see Eder, pp. 176–178), while the „issue-sensitivity makes analyses drawing on issue-specific frames difficult to generalize, compare and use as empirical evidence for theory building” (de Vreese & Lecheler, 2012, p. 295). Example studies Berti, C. (2019). Rotten apples or rotten system? Media framing of political corruption in New Zealand and Italy. Journalism Studies, 20(11), 1580–1597. DOI: 10.1080/1461670X.2018.1530068 Eder, M. (2023). Politische Journalistinnen und Journalisten auf Twitter: Eine Framing-Analyse der Ibiza-Affäre im deutsch-österreichischen Vergleich [Political journalists on Twitter: A framing analysis of the Ibiza affair in German-Austrian comparison]. Nomos. DOI: 10.5771/9783748939832 Maier, J., Jansen, C. & von Sikorski, C. (2019). Media framing of political scandals: Theoretical framework and empirical evidence. In H. Tumber & S. R. Waisbord (Hrsg.), The Routledge companion to media and scandal (S. 104–114). Routledge. DOI: 10.4324/9781351173001-11 Information on Berti, 2019 Author: Carlo Berti Research question: How can different levels of corruption determine media representations of two corruption scandals in New Zealand and Italy? The author asked (a) how corruption is framed in the news media, (b) if there are relevant differences or similarities between those two countries, and (c) which different aspects of corruption and anti-corruption the identified frames make salient, unimportant, or invisible. Object of analysis: The first part of the study was based on a selected sample of news articles from four Italian and three New Zealand newspapers on the “Field scandal” and the “Expo scandal” (N = 220 articles; 134 for Italy, 86 for New Zealand). In the second part of the study, findings were integrated through a qualitative framing analysis of the print media coverage of the Corruption Perception Index in the two countries (N = 37 articles; 18 for Italy, 19 for New Zealand) over a period of twenty years (1996–2016). Time frame of analysis: Italy: May 8, 2014 to May 21, 2014 and November 28 to December 11, 2014; New Zealand: July 18, 2006 to September 10, 2006 and August 5 to August 18, 2009 Info about variables Variables: “The first frame, ‘systemic corruption’, is characterized by the use of a single case to draw generalizations on the high levels of corruption in the country. […] The second frame, ‘corruption as individual crime’, has a stronger focus on individual responsibilities of corrupt actors, juxtaposed with the integrity attributed to Parliament and/or society.” (p. 1586) Level of analysis: news article Variables and values: frame function – problem definition: Corruption as emergency, disaster, epidemic, environment, war (widespread problem); corruption as exception or integrity of the system (isolated case) frame function – causes: References to individuals accused of corruption (rotten apple(s); references to corruption networks, institutions, corrupt politics, political connivance (corrupt political system); references to a corrupt society or genetic corruption (corrupt society) frame function – moral judgment: Individual responsibilities or breach of trust (negative/ Individuals); immoral institutions, politics, parties; connivance or whitewash (negative/politics and institutions); immoral society or genetic corruption (Negative/society) frame function – solutions: Investigations, trials, arrests, convictions, expulsions (law enforcement/political punishment); reforms or introduction of ethical codes (reform); special laws, task forces (emergency measures); impossibility of efficient anti-corruption, references to previous failures (fatalism) Reliability: “Intercoder reliability (two independent coders, 26 randomly selected units of analysis) resulted in percent agreements of at least 0.8 and Cohen’s Kappa of at least 0.6 for each category. Pilot tests were used to refine the coding manual.” (p. 1585) Codebook: available upon request Information on Eder, 2023 Author: Maximilian Eder Research question: How do German and Austrian political journalists use media frames on Twitter to report on political scandals? The author asked (a) which frames political journalists use and (b) whether there are relevant differences or similarities between journalists from those two countries. Object of analysis: The study was based on a selection of 885 tweets (497 for Germany; 388 for Austria) from 149 political journalists (87 from Germany; 62 from Austria) working for print media with the most significant political relevance and national reach in Germany and Austria (N = 18). Time frame of analysis: May 17, 2019 to June 3, 2019 Info about variables Variables: Variables were derived from two previous studies on framing in the context of political scandalization (Berti, 2019; Maier et al., 2019) and were applied to the Twitter communication by political journalists. The established framing typology of Semetko and Valkenburg (2000) was also used. Level of analysis: tweets Variables and values: corruption frame: References to individuals accused of corruption (corruption as personal misbehavior); references to corrupt networks, institutions, or politics (corruption as systematic misbehavior) attack/defense frame: References to violation of norms, condemnation from others (attack of the issue); references to no violation of norms, support from others (defense of the issue) general frame: References to responsibility for issue (attribution of responsibility); references to human example, personal vignette (human interest); references to disagreement between parties, individuals, groups, and countries (conflict); references to moral messages, how to behave (morality); references to financial losses or gains, costs or expense (economics) Reliability: Overall reliability was calculated according to Holsti and Krippendorff’s α for a random sample of 90 tweets (10 percent of the total sample). The following satisfactory results were obtained: .97 (rH) and .74 rα (intercoder reliability test); .93 (rH) and .75 (rα) (intracoder reliability test). Reliability values for individual variables range from .95 to .99 (rH) and .69 to .83 (rα) (intercoder reliability test); .91 to .96 (rH) and .66 to .75 (rα) (intracoder reliability test). Such values among the threshold defined by Krippendorff (2004, p. 429) are the result of a “’one-sided distribution” (Riffe et al., 2019, p. 128). Further values can be obtained from the appendix. Codebook: in the appendix (in German) Information on Maier et al., 2019 Author: Jürgen Maier, Carolin Jansen, & Christian von Sikorski Research question: How do German print media frame a scandal? Therefore, the authors ask whether the media defends or attacks the actor involved in a scandal. Object of analysis: The study was based on a sample of print media articles on the 2011 plagiarism scandal of the German Secretary of Defense zu Guttenberg from the five most important nationwide German daily newspapers (N = 261 articles). Time frame of analysis: February 16, 2011 to March 1, 2011 Info about variables Variables: Variables describe the different framing by media outlets of the behavior from zu Guttenberg. If he “is to blame for his behavior, we call this the use of an ‘attack frame.’ If the media show sympathy for what he did, tries to explain or even to defend him, we label this strategy of coverage ‘defense frame’” (p. 108). Moreover, the authors coded explicit frames if all four frame elements, according to Entman (1993), were present in the articles; implicit frames if only two or three frame elements could be identified. No frame was coded for an article if none or only one of the frame elements is mentioned. Level of analysis: news article Variables and values: frame element – problem definition: Violation of norms and public issue (attack frame); no violation of norms and private issue (defense frame) frame element – causal interpretation: Personal fault, personality, full personal control (attack frame); external circumstances, coincidence, out of personal control (defense frame) frame element – moral evaluation: Condemnation from own camp, condemnation from opposition, condemnation from other media, condemnation from citizens (attack frame); support from own camp, support from the opposition, support from other media, support from citizens (defense frame) frame element – treatment recommendation: Support of: general/unspecific actions, resignation from office, personal punishment, defamation, a complete solving, an apology, constitution of committees, structural actions (attack frame); refusal of: general/unspecific actions, resignation from office, personal punishment, defamation, a complete solving, an apology, constitution of committees, structural actions (defense frame) Reliability: “Intercoder reliability (Holsti 1969, 140) was calculated for a random sample of 10 percent of the total sample. Reliability for the indicators of the elements of the attack and the defense frame ranges from 0.80 to 0.88.” (p. 112) Codebook: n.a. References de Vreese, C. H. & Lecheler, S. (2012). News framing research: An overview and new developments. In H. A. Semetko & M. Scammell (Eds.), The SAGE handbook of political communication (pp. 292–306). Sage. Entman, R. M. (1993). Framing: Toward clarification of a fractured paradigm. Journal of Communication, 43(4), 51–58. DOI: 10.1111/j.1460-2466.1993.tb01304.x Krippendorff, K. (2004). Reliability in content analysis: Some common misconceptions and recommendations. Human Communication Research, 30(3), 411–433. DOI: 10.1111/j.1468-2958.2004.tb00738.x Matthes, J., & Kohring, M. (2008). The content analysis of media frames: Toward improving reliability and validity. Journal of communication, 58(2), 258–279. DOI: 10.1111/j.1460-2466.2008.00384.x Semetko, H. A. & Valkenburg, P. M. (2000). Framing European politics: A content analysis of press and television news. Journal of Communication, 50(2), 93–109. DOI: 10.1111/j.1460-2466.2000.tb02843.x Riffe, D., Lacy, S., Watson, B. R. & Fico, F. (2019). Analyzing media messages: Using quantitative content analysis in research (4. ed.). Routledge. Tumber, H., & Waisbord, S. R. (2004). Introduction: Political scandals and media across democracies (Vol 1.). American Behavioral Scientist, 47(8), 1031–1039. DOI: 10.1177/0002764203262275 von Sikorski, C. (2018). The contents and effects of political scandals: A synopsis. In A. Haller, H. Michael & M. Kraus (Hrsg.), Scandalogy: An interdisciplinary field (pp. 135–154). Herbert von Halem.

Preface In the last twelve years of following copyright developments, I have witnessed an accelerating growth in the agitation over its application and increasing cries for reform. This was triggered by a mounting corporate hysteria for strengthening copyright which seems to mask other anxieties and other issues of bad faith beside the one at hand. This is in contrast with the more reasonable stance of the U.S. government in the 1980s when Congress refused to regulate video rentals and the Courts refused to cite the video recorder for ‘contributory infringement.’ In the 1990s, the Republican-controlled Congress passed several pieces of legislation extending copyright and punishing reverse engineering. Congressional giveaways and corporate shrillness has inspired a progressive movement to defend the intellectual ‘commons.’ The reality is that intellectual property is not owned by intellectuals, and so people are realising that further extensions of copyright no longer benefits the sciences and useful arts. Developments in copyright are driven by the challenges of new technologies of communication. This is a problem for the law, which does not like surprises and certainly proceeds by analogising new situations to old ones in order to build continuity. Case law (which is law that is developed by judges’ decisions and interpretations) proceeds by precedent. Yet old technologies are not the accurate precedents for new technology and this is particularly the situation today. The new technologies have a particular impact on the situation since they change not just one variable in the earlier balance of copyright, but all the variables. While the courts and the corporations have concentrated on the one variable of easy reproduction of content, we should also pay attention to how the new technologies have changed the very balance between the so-called ‘real world’ and cultural expression. The material world is now composed to a significant extent by cultural expression. We walk through physical landscapes dominated by billboards and other totems of the marketplace, while our mentalscapes are filled with trademarks and other commodity bits. This was not the case as copyright law developed; it is the case now, and the various underpinnings of copyright law have become embarrassingly ineffective in this new world. Edelman Bernard Edelman pushes back to find the moment of embarrassment. He finds it in photography. As Paul Hirst points out, ‘[Edelman’s title] Le Droit saisi par la photographie puns on the law being seized or caught by photography, surprised or caught out by it. Photography, a technical innovation developing independently of law, contradicts the existing formulations of property right in representations of things’ (Hirst 1-2). Prior to photography, representation inherently had stamps of personality that allowed such representation (painting, drawing, engraving et alia) to be easily and significantly distinguished from that part of the material world it was representing, as well as from other artistic representations (even of the same referent). The earliest French legal pronouncements on photography were reluctant to grant it copyright protection, precisely because it was thought to have no personality and to be a mechanical copy of nature. When the court did extend copyright protection to photography and admitted its personality, it was faced with how to distinguish it from the natural. The camera could no longer be interpreting as transparently reproducing the real. Edelman calls this the subjectivisation of the machine. The camera can no longer be both a transparent reproducer of the real; it has been found always to invest the real with the personality of its subject (the photographer). This has resulted in a number of ad hoc decisions to prevent ‘over-appropriation’ of the real. Anglo-American versus French Law Anglo-American writing about copyright has never wasted much time on subjectivisation of the machine. The basis of British copyright was pragmatic and economic to begin with, having originated with the Tudors’ desire to encourage printing by granting monopoly rights to printers, and to control and censor printing. The relocation of copyright ownership from printer to author in the 18th century was also an economically driven consideration reflecting the new spirit of competitive capitalism. Certainly the language of the U.S. Constitution that authorised the federal prerogative in setting copyright law was very pragmatic in its emphasis on promoting the progress of science and the ‘useful’ arts (Article 1 Section 8). The French tradition, which is somewhat paralleled by the German and those of other continental nations, was born out of a more courtly regard for the rights of genius. Although France recognised that works ‘made for hire’ were owned by the employer, it vested certain inalienable moral privileges in the real person of the artist. This legal doctrine is known as droit d’auteur. (see Ginsburg) Idea/Expression Yet the American tradition is not totally pragmatic. The balance between copyright and the First Amendment commitment to an absolute freedom of speech calls for a certain degree of abstraction. It was Thomas Jefferson who cautioned about the chilling effect copyright law might have with the spread of ideas. Fortunately in written language it was rather easy to work out that the way to protect ideas from property claims was to distinguish between the expression, which can be copyrighted, and the idea, which cannot. Siva Vaidhyanathan (109-15) goes over Judge Learned Hand’s development of the test to distinguish the idea from the expression in the 1920s and 1930s as particularly instructive for striking the balance. In Nichols v. Universal (1929), Hand develops the theme of ‘patterns of increasing generality’ as more incident is left out. At some point the abstraction is too great to be protected, since it now is more in the realm of idea then of particular expression. (45 F.2d 120) But Edelman’s work poses the question whether this works, as we move from machines of writing to machines of visual reproduction. Doesn’t Apply to Mechanical Mimetic Reproduction Photographs can be taken of the imaginary world and indeed the subjectivisation model holds that every photograph is determined by the imagination of the author. But it is commonsensical that photographs begin as traces of the material world. This is not analogous to the written word. The structural nature of language removes the written word from a direct relationship with its physical referent. Indeed, the entire linguistic turn in post-war philosophy is premised on the lack of any transparent or even determined relationship between language and things. Even in pre-war jurisprudence it was this lack of coincidence that allowed the easy split of the idea from its expression. As the expression floats above the idea, the word floats above the physical. Vincent Porter argues that in contrast to language, visual and audio recordings do not have this split, they do not float above the physical. He noted sound/image recordings have presented a problem in that they are speech acts without a language system, or in a distinction borrowed from Saussure ‘a series of paroles without a langue.’ (Porter 12) After all does a photograph fit into a grammar of images? Are there photographs that are ‘patterns of increasing generality?’ Where is the photograph that is the same idea as another photograph without being the same photograph? Is there a photograph that can do the same work as the word ‘mother?’ No. Every photograph will be of a particular mother of a particular age and particular ethnic group and the same difficulty applies even if we photograph a group of mothers or edit a montage of mothers. This has the effect of making the idea the same as the expression. If you protect one you have protected the other. At this point I was not certain how decisive an intervention these concepts could make in the current copyright ferment. Certainly the most exciting argument was the one mounted at the Berkman Institute at Harvard by several lawyers and argued before the Supreme Court by Lawrence Lessig in Eldred v. Ashcroft (2003). This presented the argument that the government had strayed from the original Constitutional mandate to allow exclusive rights only for a limited time. But as I read Lessig’s Free Culture and as I re-read Edelman, it strikes me that the idea/expression test does not adequately help the First Amendment rights of technologies of mimetic reproduction (film, audio recordings). It is that these technologies allow reproductions to easily re-enter the material world. When these reproductions do re-enter they will naturally become part of the domain of creative expression. Our artists must be allowed to freely comment on the world in which we live and the world in which we live is now visually and aurally full of copyrighted material. This image came to mind forcefully when Lessig explained the difficulties of documentarians when they film their subjects watching TV and then have to edit out the TV image rather than deal with the risk of being sued for infringement (Aufderheide and Jaszi 95-8). This image also comes to mind when reading of farmers who are not allowed to harvest their seed because they come from patented plants. But I will defer to patent philosophers on that apparent travesty of natural rights. I wish to stay focused on the argument that is the corollary of Edelman’s subjectivisation of the camera. The camera records the physical world and in turn that recording enters that world. This is to say that the genius of copyright is in the literary domain because written language never re-enters the material world. When copyright was extended beyond the literary, policy makers should have noticed that earlier tests were no longer capable of maintaining balance between our divine right to express our lives and the practical right to own our own expressions (for a limited time). The new test is almost already present in the law: it is the protection of parody from copyright infringement violation. The courts recognise that parody positions the original expression as an artifact of the world in order to comment on it. If only the policy makers could extend that view to documentarians and others who film the world and include in their film the physical fact of other videos being displayed in the world. Just as in parody they ought to consider the intent of the video makers is to comment on the original, not to plagiarise it. References Aufderheide, P., and P. Jaszi. Untold Stories: Creative Consequences of the Rights Clearance Culture for Documentary Filmmakers. 2004. 25 April 2005 http://www.centerforsocialmedia.org/rock/index.htm>. Edelman, B. Ownership of the Image: Elements for a Marxist Theory of Law. London: Routledge & Kegan Paul, 1979. Eldred v. Ashcroft, Attorney General. United States Supreme Court decision, 15 January 2003. http://www.supremecourtus.gov/opinions/02pdf/01-618.pdf>. Ginsburg, J. C. “A Tale of Two Copyrights: Literary Property in Revolutionary France and America.” Tulane Law Review 64.5 (1990): 991-1032. Hirst, P. Q. “Introduction.” In Bernard Edelman, Ownership of the Image: Elements for a Marxist Theory of Law. London: Routledge & Kegan Paul, 1979. Lessig, L. Free Culture. 2004. 8 April 2005 http://free-culture.org/get-it>. Porter, V. “Copyright: The New Protectionism.” InterMedia 17.1 (1989): 10-7. Vaidhyanathan, S. Copyrights and Copywrongs: The Rise of Intellectual Property and How It Threatens Creativity. New York: NYU Press, 2001. Citation reference for this article MLA Style Wasser, Frederick. "When Did They Copyright the World Without Us Noticing?." M/C Journal 8.3 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0507/05-wasser.php>. APA Style Wasser, F. (Jul. 2005) "When Did They Copyright the World Without Us Noticing?," M/C Journal, 8(3). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0507/05-wasser.php>.

In an article entitled "Palming the Planet", Ron Jasper, a marketing executive, is quoted describing his car trip from Seattle to Vancouver: "'The whole way up,' he says with glee ... 'I had my laptop [wirelessly connected to the office]. I was reading my e-mail. At the same time I checked my stock on this' -- he waves a new smart phone, sleek and easily palmed. 'At one point, I was talking on the phone, checking my stock on the laptop and steering with my knee'", he confided, "slightly embarrassed" by his admission. He concludes with the observation: "'These devices are making it possible for everyone to work in ways they never imagined before'". Leaving aside the obvious concerns over highway safety, I want to register the observation that Jasper's enthusiasm for the possibilities offered by his new phone and his elation over his ability to get more work done faster, are not in fact 'never-imagined' ways of working. Visions of efficiency and connectivity have been integral to the representations of communication technologies, especially the telephone, since the beginning of the twentieth century. Looking back on the images and descriptions of the telephone in the early 1900s reveals a similar fascination with the ability to transcend the mundane realities of time and space. The idea that 'faster is better' is not one born of our times, it is one that emerged and evolved out of the preoccupations of an earlier era. The contemporary obsession with faster connections and multiple function technologies is an amplification of a century-old preoccupation with speed and efficiency; just as the passion for "multi-tasking" is today's version of what a 1909 AT&T advertisement referred to as "the multiplication of power". The recurrence of similar utopic and dystopic themes seems to suggest that our hopes and fears about the possibilities of telephonic communication are regenerated with each technological advance. In this paper I explore some of the concepts which inform these representations and suggest that they function simultaneously as a critique and a celebration of the renewal of capitalism that seems to accompany technological progress. Capitalist Reveries In a speech to the New York Electric Club in 1889, Erastus Wiman, president of the Canadian telegraph system remarked: "if to accomplish things quickly, close transactions promptly, and generally to get through with things is a step toward a business man's millennium, then we must be nearing that heavenly expectation". He praises electricity, the telegraph, and the "most marvelous" telephone for making the businessman "almost divine in what he can achieve". Throughout the twentieth century, technology and technological developments have been embraced because they provided the means to radically improve speed, efficiency, and connectivity. As Wiman makes clear though, these attributes were not, and are not now, neutral or arbitrary values. Their worth is located in their application to the flow of goods, information, and ultimately to the circulation of capital. They are valuable because they facilitate a renewal of capitalism itself: the tremendous expansion of both capital and markets occurring at the end of both the nineteenth and the twentieth centuries is not unrelated to the technological developments of these eras. In the Grundrisse, Marx writes that "Capital by its nature drives beyond every spatial barrier. Thus the creation of the physical conditions of exchange -- of the means of communication and transport -- the annihilation of space by time -- becomes an extraordinary necessity for it". Improvements in the speed and flexibility of communication 'renew' capitalism because they overcome the temporal disadvantages associated with distance and facilitate the expansion of markets in geographic space. Perhaps more than any other communication technology, the telephone has encouraged and anticipated capitalism's utopic fantasies. It is no coincidence that in early advertisements, its promoters referred to the telephone as the "annihilator of time and space". Whatever other benefits the telephone came to be seen as offering, its ability to instantaneously transfer information and credit was perceived and promoted as its most perfect attribute. Linking together buyers and sellers in cities all across the country, the telephone re-organised the 'playing field' of capitalism. By making distance an increasingly irrelevant factor in the transaction of business, the telephone rearranged space and distance "to fit the rather strict temporal requirements of the circulation of capital". Time and Money According to Marx, "economy of time, to this all economy ultimately reduces itself". Wiman's celebration of the telegraph and the telephone at the New York Electric Club in 1889 is not much different than Jasper's delight with his smart phone and laptop computer as he careens down the highway towards Vancouver. Simply understood, the ability to save time translates into a saving of money but the relationship between time and money is not a straightforward one. Time and money appear as commensurate albeit inverse values because of the effect of the velocity of circulation on the accumulation of capital. They had come to be linked with the rise of wage labour and the practice of paying workers by the hour and in this sense, "money appears as measure". When in the mid-1700s Benjamin Franklin proclaimed that "time is money", and went on to explain their enigmatic relationship, he was describing more than a simple ratio. He that can earn ten shillings in a day by his labour, and goes abroad, or sits idle, one half of that day, though he spends but sixpence during his diversions or idleness, ought not to reckon that the only expense; he has really spent, or rather thrown away, five shillings besides. Franklin not only equates time spent working with money, but also proposes a conception of unproductive time as a negative cost, a tangible loss against potential profit. Following the logic of his formula, if misspent time is perceived as a deficit, time saved can be counted as a profit. This way of thinking counts all time as potentially profitable in an economic sense and confers a speculative value on time. Telephone advertising in the first decades of the twentieth century made explicit use of this formula and, in so doing, not only asserted the value of the instrument but also provided a way of imagining time in terms of its market value. The text of a 1909 advertisement reads: The mere item of time actually saved by those who use the telephone means an immense increase in the production of the nation's wealth every working day in the year ... just counting the time alone, over $3,000,000 a day is saved by the users of the telephone! Which means adding $3,000,000 a day to the nation's wealth. (Italics in original) Contemporary representations of the telephone continue to employ the idea that savings of transaction time can be accumulated and converted into working capital. In a 1990 article on mobile offices in the financial magazine Money, a Los Angeles attorney is quoted as saying that his cell phone and mobile fax machine have "added two hours to my day and 25% to my annual gross". A 1993 survey of cell phone users by Motorola reported its findings in similar terms. Those canvassed claimed that a cellular phone "added 0.92 hours to their productive working day [and] increased their own or their company's revenues by 19 percent". This kind of temporal accounting involves two basic conceptual manoeuvres which can only occur if time is 'emptied' of its social value or meaning, leaving it available to take on a new and purely economic significance. First, in order to calculate time in terms of both its actual and speculative monetary value, it must be conceived in abstract terms, the value of each minute standardised and conceived as a unit of measurement. Second, and following from the first, because now each minute of the day has the same relative monetary value, the entire 24-hour day, not just the traditional 8-hour workday, comes to be imagined as zone for commercial activity. Prior to the telephone, the partition of the day into work and family time was safeguarded by the physical separation of the business and the domestic spheres. Even the telegraph, because its use was largely restricted to the workplace, did little to challenge the partition between public and private domains. The telephone, as it became increasingly ubiquitous in both offices and homes, disturbed these boundaries and expropriated time previously reserved for rest, relaxation and social activities for all manner of commercial uses. AT&T's declaration in an ad entitled "The Always-on-Duty Telephone" (1910) that "the whole Bell System is on duty 1440 minutes a day" also must have stirred anxiety with its conclusion that "if any of these minutes are not used, their earning power is irrevocably lost". As the "1440 minute" day expanded the potential for profit, it also increased competition and established new expectations. Social Anxieties The logic of capital's never-ending drive to renew itself dictates that time saved by technology is perceived not as "free time" but as potential profit, which must be reinvested or lost. Booster though he was of modern communication technologies, Wiman could not help but observe: One would think that the ability ... to talk freely over the telephone would so facilitate business pursuits and close up transactions so quickly that it would beget leisure, rest and quiet, but such is not the case. The thirst for achievement is so great ... that the more we do, the more we seek to do. We are no more encouraged to use the extra two or .92 hours gained by the cellphone for play or relaxation than we were when the telephone first began to speed up the tempo of our lives. Anxieties about the social effects of communications technologies are not new although they rarely manifest themselves in business discourse. Today, as business and technology publications celebrate each new communications innovation, general interest and women's magazines are more often questioning the impact of cell phones, pagers, palm pilots, and portable computers on family life and mental health. It is somehow both ironic and appropriate that during both periods, concerns about the social effects of telephone -- a medium of disembodied communication -- should manifest as anxieties about its negative corporeal effects. In 1889, an account in the British Medical Journal reported a new medical condition called "aural overpressure", an affliction suffered by those who used the telephone for extended periods of the work day. The "constant strain of the auditory apparatus" by prolonged telephone use was said to be responsible for "nervous excitability, buzzing in the ear, giddiness, and neuralgic pains". The Electrical Review recounted cautionary tales of individuals driven mad by the telephone's "constant ringing". In 2000, we find Scientific American and Time investigating the possible links between cellphone use and brain tumors. Despite the consistently inconclusive findings of multiple scientific studies, the British government ruled that cellphones sold in the United Kingdom must carry health notices that warn "people to be careful about where and how long they use them", and American cellphone retailers have voluntarily begun to include "a one page health-and-safety bulletin" with all cellphones they sell. Warren Susman suggests that examining the anxieties associated with any given technology can provide useful insight into the cultural values at stake for its users. According to the scientific experts of their day, both "aural overpressure" and brain tumors are avoided by reducing the amount of time spent on the telephone, perhaps less time working and possibly more time in the pursuit of other more socially oriented activity. It is possible to look at these panics around physical and mental well-being as a reassertion of the social, of the body, a sort of return of the repressed, at those historical moments the alienating effects of capitalism are being exacerbated by the uses to which we put technology. If, as Marx writes, the "circulation of capital constantly ignites itself anew" then it seems logical that the discourses which circulate around the telephone and communications technologies will continue to renew themselves at key historical moments. Advances in telecommunications at the end of both the nineteenth and twentieth centuries have inspired similar desires and elicited comparable anxieties because they have been driven by a common motive: the search for the competitive advantage that drives both capital and technological development alike. References Adam, B. Time and Social Theory. Cambridge: Basil Blackwell, 1990. Harvey, D. The Urbanization of Capital. Baltimore: John Hopkins UP, 1985. Marvin, C. When the Old Technologies Were New. Oxford UP, 1988. Marx, K. Grundrisse. Trans. Martin Nicolaus. New York: Vintage Press, 1973. Susman, W. I. Culture as History: The Transformation of American Society in the Twentieth Century. New York: Pantheon, 1984. Citation reference for this article MLA style: Janin Hadlaw. "Plus Que Ça Change: The Telephone and the History of the Future." M/C: A Journal of Media and Culture 3.6 (2000). [your date of access] <http://www.api-network.com/mc/0012/plus.php>. Chicago style: Janin Hadlaw, "Plus Que Ça Change: The Telephone and the History of the Future," M/C: A Journal of Media and Culture 3, no. 6 (2000), <http://www.api-network.com/mc/0012/plus.php> ([your date of access]). APA style: Janin Hadlaw. (2000) Plus que ça change: the telephone and the history of the future. M/C: A Journal of Media and Culture 3(6). <http://www.api-network.com/mc/0012/plus.php> ([your date of access]).

Are male porn stars full-fledged citizens? Recent political developments make this question more than rhetorical. The Bush Justice Department, led by Attorney General John Ashcroft, has targeted the porn industry, beginning with its prosecution of Extreme Associates. More recently, the President requested an increase in the FBI’s 2005 budget for prosecuting obscenity, one of the few budget increases for the Bureau outside of its anti-terrorism program (Schmitt A1). To be sure, the concept of “citizen” is itself vexed. Citizenship, when obtained or granted, ostensibly legitimates a subject and opens up pathways to privilege: social, political, economic, etc. Yet all citizens do not seem to be created equal. “There is, in the operation of state-defined rules and in common practices an assumption of moral worth in which de facto as opposed to de jure rights of citizenship are defined as open to those who are deserving or who are capable of acting responsibly,” asserts feminist critic Linda McDowell. “The less deserving and the less responsible are defined as unworthy of or unfitted for the privileges of full citizenship” (150). Under this rubric, a citizen must measure up to a standard of “moral worth”—an individual is not a full-fledged citizen merely on the basis of birth or geographical placement. As McDowell concludes, “citizenship is not an inclusive but an exclusive concept” (150). Thus, in figuring out how male porn stars stand in regard to the question of citizenship, we must ask who determines “moral worth,” who distinguishes the less from the more deserving, and how people have come to agree on the “common practices” of citizenship. Many critics writing about citizenship, including McDowell, Michael Warner, Lauren Berlant, Russ Castronovo, Robyn Wiegman, Michael Moon, and Cathy Davidson (to name only a few) have located the nexus of “moral worth” in the body. In particular, the ability to make the body abstract, invisible, and non-identifiable has been the most desirable quality for a citizen to possess. White men seem ideally situated for such acts of “decorporealization,” and the white male body has been installed as the norm for citizenship. Conversely, women, people of color, and the ill and disabled, groups that are frequently defined by their very embodiment, find themselves more often subject to regulation. If the white male body is the standard, however, for “moral worth,” the white male porn star would seem to disrupt such calculations. Clearly, the profession demands that these men put their bodies very much in evidence, and the most famous porn stars, like John C. Holmes and Ron Jeremy, derive much of their popularity from their bodily excess. Jeremy’s struggle for “legitimacy,” and the tenuous position of men in the porn industry in general, demonstrate that even white males, when they cannot or will not aspire to abstraction and invisibility, will lose the privileges of citizenship. The right’s attack on pornography can thus be seen as yet another attempt to regulate and restrict citizenship, an effort that forces Jeremy and the industry that made him famous struggle for strategies of invisibility that will permit some mainstream acceptance. In American Anatomies, Robyn Wiegman points out that the idea of democratic citizenship rested on a distinct sense of the abstract and non-particular. The more “particular” an individual was, however, the less likely s/he could pass into the realm of citizen. “For those trapped by the discipline of the particular (women, slaves, the poor),” Wiegman writes, “the unmarked and universalized particularity of the white masculine prohibited their entrance into the abstraction of personhood that democratic equality supposedly entailed” (49). The norm of the “white masculine” caused others to signify “an incontrovertible difference” (49), so people who were visibly different (or perceived as visibly different) could be tyrannized over and regulated to ensure the purity of the norm. Like Wiegman, Lauren Berlant has written extensively about the ways in which the nation recognizes only one “official” body: “The white, male body is the relay to legitimation, but even more than that, the power to suppress that body, to cover its tracks and its traces, is the sign of real authority, according to constitutional fashion” (113). Berlant notes that “problem citizens”—most notably women of color—struggle with the problem of “surplus embodiment.” They cannot easily suppress their bodies, so they are subjected to the regulatory power of a law that defines them and consequently opens their bodies up to violation. To escape their “surplus embodiment,” those who can seek abstraction and invisibility because “sometimes a person doesn’t want to seek the dignity of an always-already-violated body, and wants to cast hers off, either for nothingness, or in a trade for some other, better model” (114). The question of “surplus embodiment” certainly has resonance for male porn stars. Peter Lehman has argued that hardcore pornography relies on images of large penises as signifiers of strength and virility. “The genre cannot tolerate a small, unerect penis,” Lehman asserts, “because the sight of the organ must convey the symbolic weight of the phallus” (175). The “power” of male porn stars derives from their visibility, from “meat shots” and “money shots.” Far from being abstract, decorporealized “persons,” male porn stars are fully embodied. In fact, the more “surplus embodiment” they possess, the more famous they become. Yet the very display that makes white male porn stars famous also seemingly disqualifies them from the “legitimacy” afforded the white male body. In the industry itself, male stars are losing authority to the “box-cover girls” who sell the product. One’s “surplus embodiment” might be a necessity for working in the industry, but, as Susan Faludi notes, “by choosing an erection as the proof of male utility, the male performer has hung his usefulness, as porn actor Jonathan Morgan observed, on ‘the one muscle on our body we can’t flex’” (547). When that muscle doesn’t work, a male porn star doesn’t become an abstraction—he becomes “other,” a joke, swept aside and deemed useless. Documentary filmmaker Scott J. Gill recognizes the tenuousness of the “citizenship” of male porn stars in his treatment of Ron Jeremy, “America’s most famous porn star.” The film, Porn Star: The Legend of Ron Jeremy (2001), opens with a clear acknowledgment of Jeremy’s body, as one voiceover explains how his nickname, “the Hedgehog,” derives from the fact that Jeremy is “small, fat, and very hairy.” Then, Gill intercuts the comments of various Jeremy fans: “An idol to an entire generation,” one young man opines; “One of the greatest men this country has ever seen,” suggests another. This opening scene concludes with an image of Jeremy, smirking and dressed in a warm-up suit with a large dollar sign necklace, standing in front of an American flag (an image repeated at the end of the film). This opening few minutes posit the Hedgehog as super-citizen, embraced as few Americans are. “Everyone wants to be Ron Jeremy,” another young fan proclaims. “They want his life.” Gill also juxtaposes “constitutional” forms of legitimacy that seemingly celebrate Jeremy’s bodily excess with the resultant discrimination that body actually engenders. In one clip, Jeremy exposes himself to comedian Rodney Dangerfield, who then sardonically comments, “All men are created equal—what bullshit!” Later, Gill employs a clip of a film in which Jeremy is dressed like Ben Franklin while in a voiceover porn director/historian Bill Margold notes that the Freeman decision “gave a birth certificate to a bastard industry—it legitimized us.” The juxtaposition thus posits Jeremy as a “founding father” of sorts, the most recognizable participant in an industry now going mainstream. Gill, however, emphasizes the double-edged nature of Jeremy’s fame and the price of his display. Immediately after the plaudits of the opening sequence, Gill includes clips from various Jeremy talk show appearances in which he is denounced as “scum” and told “You should go to jail just for all the things that you’ve helped make worse in this country” and “You should be shot.” Gill also shows a clearly dazed Jeremy in close-up confessing, “I hate myself. I want to find a knife and slit my wrists.” Though Jeremy does not seem serious, this comment comes into better focus as the film unfolds. Jeremy’s efforts to go “legit,” to break into mainstream film and leave his porn life behind, keep going off the tracks. In the meantime, Jeremy must fulfill his obligations to his current profession, including getting a monthly HIV test. “There’ll be one good thing about eventually getting out of the porn business,” he confesses as Gill shows scenes of a clearly nervous Jeremy awaiting results in a clinic waiting room, “to be able to stop taking these things every fucking month.” Gill shows that the life so many others would love to have requires an abuse of the body that fans never see. Jeremy is seeking to cast off that life, “either for nothingness, or in a trade for some other, better model.” Behind this “legend” is unseen pain and longing. Gill emphasizes the dichotomy between Jeremy (illegitimate) and “citizens” in his own designations. Adam Rifkin, director of Detroit Rock City, in which Jeremy has a small part, and Troy Duffy, another Jeremy pal, are referred to as “mainstream film directors.” When Jeremy returns to his home in Queens to visit his father, Arnold Hyatt is designated “physicist.” In fact, Jeremy’s father forbids his son from using the family name in his porn career. “I don’t want any confusion between myself and his line of work,” Hyatt confesses, “because I’m retired.” Denied his patronym, Jeremy is truly “illegitimate.” Despite his father’s understanding and support, Jeremy is on his own in the business he has chosen. Jeremy’s reputation also gets in the way of his mainstream dreams. “Sometimes all this fame can hurt you,” Jeremy himself notes. Rifkin admits that “People recognize Ron as a porn actor and immediately will ask me to remove him from the final cut.” Duffy concurs that Jeremy’s porn career has made him a pariah for some mainstream producers: “Stigma attached to him, and that’s all anybody’s ever gonna see.” Jeremy’s visibility, the “stigma” that people have “seen,” namely, his large penis and fat, hairy body, denies him the abstract personhood he needs to go “legitimate.” Thus, whether through the concerted efforts of the Justice Department or the informal, personal angst of a producer fearing a backlash against a film, Jeremy, as a representative of an immoral industry, finds himself subject to regulation. Indeed, as his “legitimate” filmography indicates, Jeremy has been cut out of more than half the films he has appeared in. The issue of “visibility” as the basis for regulation of hardcore pornography has its clearest articulation in Potter Stewart’s famous proclamation “I know it when I see it.” But as Bob Woodward and Scott Armstrong report in The Brethren, Stewart was not the only Justice who used visibility as a standard. Byron White’s personal definition was “no erect penises, no intercourse, no oral or anal sodomy” (193). William Brennan, too, had what his clerks called “the limp dick standard” (194). Erection, what Lehman has identified as the conveyance of the phallus, now became the point of departure for regulation, transferring, once again, the phallus to the “law.” When such governmental regulation failed First Amendment ratification, other forms of societal regulation kicked in. The porn industry has accommodated itself to this regulation, as Faludi observes, in its emphasis on “soft” versions of product for distribution to “legitimate” outlets like cable and hotels. “The version recut for TV would have to be entirely ‘soft,’” Faludi notes, “which meant, among other things, no erect penises and no semen” (547). The work of competent “woodsmen” like Jeremy now had to be made invisible to pass muster. Thus, even the penis could be conveyed to the viewer, a “fantasy penis,” as Katherine Frank has called it, that can be made to correlate to that viewer’s “fantasized identity” of himself (133-4). At the beginning of Porn Star, during the various homages paid to Jeremy, one fan draws a curious comparison: “There’s Elvis, and then there’s Ron.” Elvis’s early career had certainly been plagued by criticism related to his bodily excess. Musicologist Robert Fink has recently compared Presley’s July 2, 1956, recording of “Hound Dog” to music for strip tease, suggesting that Elvis used such subtle variations to challenge the law that was constantly impinging on his performances: “The Gray Lady was sensitive to the presence of quite traditional musical erotics—formal devices that cued the performer and audience to experience their bodies sexually—but not quite hep enough to accept a male performer recycling these musical signifiers of sex back to a female audience” (99). Eventually, though, Elvis stopped rebelling and sought respectability. Writing to President Nixon on December 21, 1970, Presley offered his services to help combat what he perceived to be a growing cultural insurgency. “The drug culture, the hippie elements, the SDS, Black Panthers, etc., do not consider me as their enemy or as they call it, The Establishment,” Presley confided. “I call it America and I love it” (Carroll 266). In short, Elvis wanted to use his icon status to help reinstate law and order, in the process demonstrating his own patriotism, his value and worth as a citizen. At the end of Porn Star, Jeremy, too, craves legitimacy. Whereas Elvis appealed to Nixon, Jeremy concludes by appealing to Steven Spielberg. Elvis received a badge from Nixon designating him as “special assistant” for the Bureau of Narcotics and Dangerous Drugs. Presumably Jeremy invests his legitimacy in a SAG card. Kenny Dollar, a Jeremy friend, unironically summarizes the final step the Hedgehog must take: “It’s time for Ron to go on and reach his full potential. Let him retire his dick.” That Jeremy must do the latter before having a chance for the former illustrates how “surplus embodiment” and “citizenship” remain inextricably entangled and mutually exclusive. References Berlant, Lauren. “National Brands/National Body: Imitation of Life.” Comparative American Identities: Race, Sex and Nationality in the Modern Text. Ed. Hortense Spillers. New York: Routledge, 1991: 110-140. Carroll, Andrew, ed. Letters of a Nation: A Collection of Extraordinary American Letters. New York: Broadway Books, 1999. Castronovo, Russ and Nelson, Dana D., eds. Materializing Democracy: Toward a Revitalized Cultural Politics. Durham: Duke University Press, 2002. Faludi, Susan. Stiffed: The Betrayal of the American Man. New York: William Morrow and Company, Inc., 1999. Fink, Robert. “Elvis Everywhere: Musicology and Popular Music Studies at the Twilight of the Canon.” Rock Over the Edge: Transformations in Popular Music Culture. Eds. Roger Beebe, Denise Fulbrook, and Ben Saunders. Durham: Duke University Press, 2002: 60-109. Frank, Katherine. G-Strings and Sympathy: Strip Club Regulars and Male Desire. Durham: Duke University Press, 2002. Gill, Scott J., dir. Porn Star: The Legend of Ron Jeremy. New Video Group, 2001. Lehman, Peter. Running Scared: Masculinity and the Representation of the Male Body. Philadelphia: Temple University Press, 1993. McDowell, Linda. Gender, Identity and Place: Understanding Feminist Geographies. Minneapolis: University of Minnesota Press, 1999. Moon, Michael and Davidson, Cathy N., eds. Subjects and Citizens: From Oroonoko to Anita Hill. Durham: Duke University Press, 1995. Schmitt, Richard B. “U. S. Plans to Escalate Porn Fight.” The Los Angeles Times 14 February 2004. A1. Wiegman, Robyn. American Anatomies: Theorizing Race and Gender. Durham: Duke University Press, 1995. Woodward, Bob and Armstrong, Scott. The Brethren: Inside the Supreme Court. New York: Simon and Schuster, 1979. MLA Style Russell, David. "The Tumescent Citizen: The Legend of Ron Jeremy." M/C Journal 7.4 (2004). 10 October 2004 <http://www.media-culture.org.au/0410/01_citizen.php>. APA Style Russell, D. (2004 Oct 11). The Tumescent Citizen: The Legend of Ron Jeremy, M/C Journal, 7(4). Retrieved Oct 10 2004 from <http://www.media-culture.org.au/0410/01_citizen.php>

Photo by Anna Hecker on Unsplash ABSTRACT All people deserve the legal ability to outline their care decisions in advance and expect their decisions to govern during a pregnancy. However, until advance directives govern without pregnancy exceptions, people will not uniformly retain the ability to formulate autonomous decisions about their health care planning. INTRODUCTION In the last few years, states have passed increasingly restrictive laws regarding abortion and reproductive health care. Recent legislation in Alabama effectively banned the procedure altogether, while more than a dozen states have passed or are currently in the process of enacting so-called “fetal heartbeat laws,” which ban abortion at roughly six weeks post-conception after the detection of electrical activity in what could develop into fetal cardiac tissue.[1] While courts rarely uphold outright bans and broad sweeping legislation, they garner significant media and public attention.[2] In practice, however, often smaller legislative changes that garner the least attention have the most significant impact by steadily chipping away at healthcare rights. Few people realize the ethical impact of the poorly understood legal means by which a pregnant woman has already lost her right to make autonomous healthcare decisions over her body using an advance directive in nearly every state. BACKGROUND Advance directives are one of modern medicine’s most powerful yet underused tools. Most clinicians and patients think of advance directives as being only for the elderly or terminally ill. This association stems from the 1991 Congressional Patient Self-Determination Act that requires hospitals, nursing homes, and hospice agencies receiving federal funding to inform patients of their legal right to prepare an advance directive. The 2015 announcement by the Center for Medicare and Medicaid Services (CMS) to reimburse for advance directives without requiring a diagnosis code recognizes that all adult patients can benefit from advance directives regardless of illness or life expectancy.[3] Providers should be aware of a small but significant exemption found in most state advance directive laws. This exemption, commonly known as the pregnancy clause, invalidates the advance directive of a pregnant woman, negating autonomy. The pregnancy clause can lead to treatment against medical standards of care and places private interests over public health. Advance directive statutes are frequently amended, but currently, only eight states allow patients to write their pregnancy-related wishes into their advance directive and guarantee that their instructions will be followed. Eleven states automatically invalidate advance directives during pregnancy, while 18 states permit physicians to disregard a pregnant woman’s (or her proxy’s) wishes based on the likelihood of viability, pain, and suffering, or conscientious objector clauses. Thirteen states remain silent on whether an advance directive is binding during pregnancy or have contradictory statutes.[4] Viability has no standard definition for the purposes of the clauses and viability-based pregnancy clauses can lead to the same loss of rights as pregnancy clauses that invalidate advance directives due to pregnancy without any exceptions. Many may wonder about the clinical relevance of pregnancy clauses. The likelihood that a woman will need to effectuate an advance care directive while pregnant is higher than many people would realize. This situation is most commonly assumed to occur in instances of a brain-dead pregnant woman, of which there are a few cases reported each year. But brain death and persistent vegetative states are just two reasons to look to an advance directive. Advance directives more commonly apply to patients with dementia, strong religious objections to medical care, or during cancer treatments, surgery, or acute injury with temporary loss of capacity. In surgery or acute lapses of capacity, a proxy may be asked to make decisions if complications arise. The number of women potentially affected by pregnancy clauses is significant. Each year, 75,000 pregnant women will undergo non-obstetrical surgery;[5] one in 1,500 pregnant women will be diagnosed with cancer;[6] and an estimated 250,000 Americans will exhibit early-onset Alzheimer’s symptoms between the ages of 30 and 50.[7] ANALYSIS Though pregnancy clauses are a seemingly narrow focus, they can nullify an entire advance directive and restrict care not related to the fetus. By negating entire advance directives, the clauses negate proxy appointments, allowing decision-makers other than the intended proxy. Providers and proxies are left with little guidance over who can make decisions on behalf of the patient. Many states will appoint a biological family member as the surrogate decision maker if there is no designated proxy or the directive is invalid. The outdated language and assumptions about nuclear families found in these structures could significantly impact unmarried couples, same-sex partnerships, and relationships that do not meet state-defined partnership standards where the courts may appoint someone other than the woman’s significant other even when she designated them as a proxy.[8] Members of religious groups whose doctrines prohibit certain medical therapies must be informed that if they become pregnant, their autonomous ability to decide about medical care through an advance directive and their right to freely practice religion can be voided entirely. In addition to infringing on patient autonomy, pregnancy clauses also restrict how clinicians might practice medicine by mandating medically inappropriate treatments against the provider’s recommendations. For example, Illinois’s pregnancy clause stipulates that “if you are pregnant and your health care professional thinks you could have a live birth, your living will cannot go into effect.”[9] This clause places providers in a difficult position of sacrificing their therapeutic obligation to their patients. It may require them to use futile therapy against the patient’s best interest and without regard for prolonged pain and suffering. Pregnancy clauses are void of any consideration of the best clinical interest of the patient or the fetus and instead promote conservative rhetoric that all potential fetal life is paramount. Numerous medical and chromosomal conditions are incompatible with life or present significant potential disabilities that may be accompanied by pain and suffering. The same conditions also pose risks to the mother, including death. Accordingly, the medical profession recognizes that there are instances in which it may not be in the best medical interest of the mother or the fetus to continue the pregnancy. Yet providers are seemingly required by pregnancy clauses to violate codes of conduct and subject pregnant patients and their nonviable fetuses to treatments to which other patients would not be subjected. Without evidence of a patient’s clear and convincing intentions, states have an interest in protecting life, preventing suicide, and maintaining the ethical integrity of the medical profession that could interfere with the person’s ability to refuse care.[10] The legal defense of pregnancy clauses is that the state’s interest in fetal life is sufficiently important to override the mother. As established in Planned Parenthood v. Casey (1992), however, the state’s interest only exists for fetal life post-viability.[11] Therefore, to allow the state interest to override the person’s advance directive when the fetus is not yet viable violates Casey. Individuals have a legal and ethical interest in maintaining bodily privacy, integrity, and freedom from unwanted touching. They have the right to appoint a proxy or use a directive to govern care in the case of incapacity. Even when contemplating brain death, organ donation, and whether to be cremated or buried, there is an expectation that personal wishes will govern. Honoring an advance directive allows providers to uphold the integrity of the medical profession by respecting the principles of autonomy and beneficence. Pregnancy clauses are inherently unethical as their creation was not to further the integrity of the medical or legal profession, nor protect a state’s interest in the patient’s life. In 2016, the American College of Obstetricians and Gynecologists issued a committee opinion that pregnancy is not an ethical exemption to the right of capable patients to refuse treatment.[12] The right to direct treatment while pregnant is consistent with modern medical practice, while the legislative promotion of a singular abstract interest in potential fetal life to the exclusion of all other medical and ethical considerations is not in line with the profession’s values.[13] Many pregnancy clauses are politically motivated, reflecting anti-abortion legality lobbying efforts and attempts to win over conservative voters. When Alaskan Attorney General Harold M. Brown argued the state’s pregnancy clause was unconstitutional, Governor Bill Sheffield – a Democrat in a historically red state – enacted the bill anyway. Georgia’s Governor Bill Kemp narrowly won his election, with some crediting his aggressive messaging against immigration and abortion.[14] With either advance directives, proxies, or even friends and relatives who know what the person (if not incapacitated) would have wanted, courts and legislatures should not have leeway to force care that a person, if conscious, would have refused.[15] The ability to harness advance directive law to force invasive and unwanted treatment upon a pregnant patient’s body continues to occur out of the fear of legal uncertainty. The lack of uniformity between states in their pregnancy clauses further adds to the confusion. Many advance directive statutes create a conditional proposition: if a provider acts in accordance with the carefully drawn circumstances of an advance directive, the provider is granted protective immunity from accusations of malpractice or wrongful death for that conduct. It is neither illegal nor unethical to remove a ventilator, for example, from a patient who has directed such a course of action in an advance directive. A pregnancy clause may remove that immunity making the unethical act of ignoring the directive legal, but the ethical act of following it (removing a ventilator, for example) could subject the practitioner to liability.[16] Without a pregnancy clause, providers retain the ability to both follow an advance directive and to act in the best medical interest of their patient. Pregnancy clauses create confusion over the permissibility of medical acts in an attempt to coerce providers into making decisions that violate the rights of their patients and their own ethical codes of conduct. Pregnancy clauses are a fallacy of consequentialist ethics in which the morality of the outcome justifies actions. Under consequentialist reasoning, any violation to the woman is justified if the fetus develops and results in a live birth. This reasoning is further faulty as it incorrectly assumes that mechanically ventilating an unconscious, sick, dying, or dead body will result in a live birth. Consequentialist theories should be limited to situations with predictable ends. Ethical medical providers refute consequentialism in certain contexts because it treats patients as a means to an end to produce benefit for others. In pregnancy, ignoring advance directives to achieve the chance that a fetus might survive is not justified by consequentialism. Pregnancy clauses also fail through the lens of deontological ethics in which an action must be ethical in and of itself and not based on outcomes. The choice to respect autonomy through an advance directive should be followed uniformly absent special circumstances. Proponents of pregnancy clauses may argue that pregnancy is an appropriate exception because a woman “has chosen to lend her body to bring [a] child into the world.”[17] Minnesota and Oklahoma echo this belief in their statutes, which contain an unjustified rebuttable presumption that all female patients would want life-sustaining treatment if they are pregnant.[18] Pregnancy should not abrogate the rights of a person to assign a proxy for access to an abortion or to control her medical treatment. Pregnancy exclusions are not grounded in the ethical “best interest” standards for the mother or the fetus. Instead, they are rooted in outdated expectations of female gender roles, which reaffirm a legislative assumption that a pregnancy is more morally valuable than a woman’s autonomy. CONCLUSION All people deserve the legal ability to outline their care decisions in advance and expect their decisions to govern during a pregnancy. Providers and the government do not have to approve of a person’s care decisions or values, but medical practitioners must respect a person’s right to dictate their own health narratives. With the push for more patients to execute advance directives, providers and patients must be aware that their advance directives may succumb to the authority of pregnancy clauses. Until advance directives govern without pregnancy exceptions, people will not uniformly retain the ability to formulate autonomous decisions about their health care planning. Advance directive law will continue to be hijacked by politically motivated legislators. When seeking to address inequities in healthcare laws and access, it is essential to take a closer look at not only the headline cases but also the clauses and exemptions to laws seemingly designed to benefit patients. [1] For proposed and current abortion legislation and maps, see https://www.guttmacher.org/state-policy# and Anne Godlasky, Nicquel Terry Ellis, and Jim Sergent, “Where is Abortion Legal? Everywhere, but…” USA Today, May 15, 2019, updated April 23, 2020 https://www.usatoday.com/in-depth/news/nation/2019/05/15/abortion-law-map-interactive-roe-v-wade-heartbeat-bills-pro-life-pro-choice-alabama-ohio-georgia/3678225002/ [2] https://www.guttmacher.org/state-policy# (Many bills fail in legislatures and are not enacted.) [3] Department of Health and Human Services Centers for Medicare & Medicaid Services; 42 CFR Part 405, 410, 411, 414, 425, and 495; “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016; Final Rule.” [4] DeMartino, E. S., Sperry, B. P., Doyle, C. K., Chor, J., Kramer, D. B., Dudzinski, D. M., & Mueller, P. S. (2019). US State Regulation of Decisions for Pregnant Women Without Decisional Capacity. JAMA, 321(16), 1629–1631. https://doi.org/10.1001/jama.2019.2587; Villarreal, Elizabeth. “Pregnancy and Living Wills: A Behavioral Economic Analysis.” The Yale Law Journal Forum. Vol. 128 (2019); 1052-1076. [5] “Surgery During Pregnancy.” Intermountain Healthcare: Fact Sheet for Patients and Families, (2018). https://intermountainhealthcare.org/ext/Dcmnt?ncid=520782026 [6] Basta, P. Bak, A. Roszkowski, K. “Cancer Treatment in Pregnant Women”. Contemporary Oncology, 19, no. 5 (2015): 354–360 [7] “31-Year-Old Woman Fights Alzheimer's While Pregnant.” San Francisco Globe. 9 July 2015, sfglobe.com/2015/02/19/31-year-old-woman-fights-alzheimers-while-pregnant. [8] “Health Care Proxies.” Human Rights Campaign, https://www.hrc.org/resources/health-care-proxy. [9] Illinois Department of Public Health website, Statement of Illinois Law on Advance Directives and DNR Orders, http://www.idph.state.il.us/public/books/advdir4.htm. [10] In the Matter of Karen Quinlan, 355 A.2d 647 (1976); Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990); and In re Conroy 486 A.2d 1209 (1985). [11] Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992). [12] The American College of Obstetricians & Gynecologists Committee on Ethics, Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy, (2016). [13] Lederman, Anne D. “A Womb of My Own: A Moral Evaluation of Ohio’s Treatment of Pregnant Patient’s with Living Wills”. Case W. Res. L. Rev. Vol. 45:351 (1995); 351-377. [14] Tavernise, Sabrina. “The Time Is Now: States Are Rushing to Restrict Abortion, or to Protect It.” The New York Times, 15 May 2019. [15] Cruzan. [16] Mayo, T.M. “Brain-Dead and Pregnant in Texas.” The American Journal of Bioethics, Vol. 14, no. 8 (Nov. 2014); 15-18. [17] In re A.C., 573 A. 2nd 1244 (1990). [18] Johnson, Kristeena L. “Forcing Life on the Dead: Why the Pregnancy Exemption Clause of the Kentucky Living Will Directive Act is Unconstitutional.” Kentucky Law Journal. Vol. 100 (2011-12); 209-233.

It is now almost 15 years since the world witnessed one of modern history’s most devastating terrorist attacks on the United States on 11 September 2001. Despite all its promises, the so called ‘War on Terror’ failed to combat a growing tide of violent extremism. 11 years after the US led offensive on Iraq in 2003, the rise of terrorism by non-state actors in the Arab world presents a significant concern to international security and world peace. Since 2001 Australian Muslims have consistently been called upon to openly reject terrorism committed by a minority of Muslims who adhere to an extreme interpretation of Islamic doctrine that justifies attacks on civilians both in the Arab world and abroad.The responsibility placed on Australian Muslims to actively reject terrorism comes from both official channels through government funded programs under the banner of counter terrorism and countering violent extremism and the public through the popular media. Yet, Muslims in Australia who do speak out against religiously motivated non-state terrorism find themselves in an impossible bind. They are expected to speak out as representatives of a fragmented, heterogeneous and diverse mix of communities and ideologies. Often, when they do speak out, they are viewed with suspicion and presumed to be ‘apologists for Islam’ whose claim to tolerance and the peaceful nature of Islamic doctrine purposefully ignores its true nature. Such responses render these spokespersons illegitimate- both as representatives of Muslim communities and as Australian citizens. The question “Why don’t moderate Muslims speak out against terrorism?” is often raised in the popular media in response to attacks against Western interests by jihadi groups. On 15 August 2014 an article in the Daily Telegraph by well-known conservative journalist Piers Akerman raised the question in relation to the Australian government’s announcement of increased powers for law enforcement agencies to deal with the issue of returned foreign fighters who had joined the Islamic State’s conflict in Iraq and Syria. The article, titled “It’s Time for Muslim Leaders to Speak Up” reiterated much of the construction of the silent Muslim majority that has pervaded the Australian popular media since 2001. Akerman states: “They [the Australian government] should be making it clear to Australian Muslims that they expect their leaders to speak out more vehemently against those who groom terrorists from the among the young and stupidly impressionable in their communities”. While he continues by acknowledging that Muslims in Australia are diverse in ethnicity and religious views and that the vast majority of Muslims do not support terrorism, he concludes by stating that “the few are costing the majority of Australians millions in security and those who enjoy leadership titles must accept that some responsibility attaches to their position or they should abdicate in favour of individuals who are prepared to consent to the obligations inherent in their station” (Piers Akerman). The same sentiments were expressed by Pia Ackerman in the Australian who wrote that “AUSTRALIA’S Muslim leaders need to speak out against Islamic State terrorists or risk losing their credibility and ability to reach young men attracted to the extremists’ cause” (Pia Akerman).Other responses in the popular media present a different argument. In an article titled “The Moderate Muslims Are Talking If Only You Will Listen”, David Penberthy of the Herald Sun cites examples of Muslim Australians who are speaking out including the case of prominent Sydney GP Jamal Rifi whose condemnation of terrorist activities in the Arab world has earned him death threats from members of the Islamic State (Penberthy). Yet, as Penberthy rightly acknowledges the questions “where are the moderates? Where are the decent Muslims? Are there any? Why aren’t they speaking out?” are still the most salient questions being asked of Muslims in the public sphere. For Australian Muslims at least, they are questions that pervade their everyday lives. It is these questions for example that leads Muslim women who wear the tradition head covering or hijab to challenge media representations of themselves as complicit actors in terrorism by acting as alternative sources of truth for curious co-workers and members of the broader community (see Aly, A Study).Muslim women who do not wear the hijab can face even more barriers to speaking out because they do not pass the test of ‘legitimate’ Muslims: those who fit the stereotype of the angry bearded male and the oppressed female shrouded in black. This author, who has in the past written about extremist interpretations of Islam, has faced condemnation from anti- Islamic groups who questioned her authenticity as a Muslim. By speaking out as a Muslim against the violent actions of some Muslims in other parts of the world, I was being accused of misinformed. Ironically, those who are vehemently anti- Islamic espouse the very same ideological world view and interpretations of Islamic doctrine as those Muslims they claim to oppose. Both groups rely on an extreme and minority version of Islam that de-legitimises more mainstream, nuanced interpretations and both groups claim legitimacy to the truth that Islam can only ever be violent, aggressive and oppositional.It is not just in the public and media discourses that Muslims who speak out against terrorism face being branded illegitimate. The policy response to home-grown terrorism — acts of violence carried out by Australian citizens within Australia — has, albeit inadvertently, created the conditions through which Muslims must verify their legitimate claims to being Australian by participating in the governments’ program of counter terrorism.In the wake of the 2005 London bombings, the Prime Minister met with selected representatives from Muslim communities to discuss the development of a Muslim Community Reference Group. The Group was charged with assisting the Australian Government by acting as an advisory group and by working with Muslim communities “promote harmony, mutual understanding and Australian values and to challenge violence, ignorance and rigid thinking”. This was iterated through a Statement of Principles that committed members of Muslim communities to pursue “moderate’ Islam (Prime Minister, “Meeting”). The very need for a Muslim summit and for the development of a Statement of Principles (later endorsed by the Council of Australian Governments, COAG), sends a lucid message to the Australian public that not only are Australian Muslims responsible for terrorism but that they also have the capacity to prevent or minimise the threat of an attack in Australia.In 2005, the policy response to terrorism took its first step towards linking the social harmony agenda to the securitisation of the state in the form of the National Action Plan to Build Social Cohesion, Harmony and Security. The stated purpose of the National Action Plan (NAP) notably conflated national security with social cohesion and harmony and clearly indicated an understanding that violent extremism could be addressed through programs designed to reinforce Australian values, social harmony, interfaith understanding and tolerance: “The purpose of this National Action Plan (NAP) is to reinforce social cohesion, harmony and support the national security imperative in Australia by addressing extremism, the promotion of violence and intolerance…”(Commonwealth of Australia, National Action Plan).Between 2005 and 2010, the National Action Plan provided funding for 83 community based projects deemed to meet the Plan’s criteria of addressing extremism and the promotion of violence. Of the 83 projects funded, 33 were undertaken by associations that identified as Muslim or Islamic (some applicants received funding for more than one project or in more than one round). The remaining 50 organisations funded included universities and vocational training organisations (4), multicultural social services or migrant resource centres (14), interfaith groups (3), local councils (4), ethnic organisations (specifically African, East African, Afghan, Hazara, Arabic and Pakistani), sporting clubs (4) and miscellaneous social clubs and service providers. The kinds of projects that were funded were predominantly aimed at Muslim communities, most notably youth and women, and the provision of services, programs, education, information and dialogue. Sixty five of the projects funded were explicitly aimed at Muslim communities and identified their target groups variously as: ‘African Muslim’; ‘Muslim youth’; ‘Muslim women’; ‘at risk Muslims’; ‘young Muslims’; ‘Iraqi Muslims’; ‘Lebanese Muslims’ and ‘young Muslim men from Arabic speaking backgrounds’. Seven projects were described as involving ‘interfaith’ elements, though a further 13 projects described some form of interaction between Muslim and non-Muslim communities and groups through activities such as sport, dialogue, fashion parades, workshops, art and craft programs, music workshops. 29 projects involved some form of leadership training for Muslims: youth, women and young men. Overall, the range of projects funded under the National Action Plan in the five years of its operation reflect a policy approach that specifically identifies Muslim communities (including ethno specific and new and emerging Muslim communities) as the primary target of Australia’s broader security strategy.The National Action Plan was succeeded by the Building Community Resilience (BCR) Program. Despite the positive steps taken in attempting to move the BCR program away from the social harmony policy agenda, it continued to reflect an underlying preoccupation with the assumptions of its predecessor. Between 2011- 2013 it funded 51 community based projects. Of these, 7 projects were undertaken by Islamic or Muslim associations. Ten of the projects specifically target Muslims or Muslim communities, with 6 of these being Muslim youth leadership and/or mentoring programs. The remaining 4 Muslim focussed projects include a project designed to encourage Muslim youth to build positive connections with the broader community, the development of a Common Curriculum Framework for teaching Islamic Studies in Australian Islamic primary and secondary schools, a project to address misconceptions about Islam and promote cultural understanding and the production of a DVD for schools to address misperceptions about Muslims. Notably, only one project specifically targets white supremacist violent extremism. The Australian governments’ progressive policy approach to countering violent extremism at home has disproportionately focussed on the Australian Muslim communities. In an environment where Muslims are viewed with suspicion and as having the primary responsibility as both perpetrators and gatekeepers of terroristic ideologies, Muslims in diaspora communities have been forced to make legitimate claims to their innocence. In order to do this they are required to reaffirm their commitment to Australian values, not just by speaking out against terrorism but also by participating in programs that are based on false assumptions about the nature of Muslim citizenship in Australia and the premise that Muslim Australians are, both individually and collectively, opposed to such values by virtue of their religious affiliation. In 2014 and in response to growing concerns about the number of Australians travelling to Iraq and Syria to fight alongside the Islamic State, the government made a bold move by declaring its intention to overhaul existing terror laws. The new laws would reverse the onus of proof on those who travelled to certain countries deemed to be terrorist hotspots to prove that they were not partaking in armed conflict or terrorist training. They would also give more powers to law enforcement and surveillance agencies by lowering the threshold of arrest without a warrant. The announcement of the new laws by the Prime Minister coincided with the news that the Government would abandon its controversial plans to drop section 18c from the Racial Discrimination Act which makes it unlawful to "offend, insult, humiliate or intimidate another person or a group of people" because of their race or ethnicity" (Aston). The announcement was made under the guise of a press conference on terror laws and inferred that the back down on the Racial Discrimination Act reforms were a measure to win over the Muslim communities cooperation on the new terror laws. Referring to a somewhat curious notion of “team Australia”, the Prime Minister stated “I want to work with the communities of our country as team Australia here” (Aston). “Team Australia” has since become the Government’s narrative frame for garnering public support for its proposed new terrorism laws. Echoing his predecessor John Howard, whose narrative of Australian values pervaded much of the political discourse during his term in office, Prime Minister Abbott stated in a radio interview that "everyone has got to put this country, its interests, its values and its people first, and you don't migrate to this country unless you want to join our team". He followed this statement by emphasising that "What we need to do is to encourage the moderate mainstream to speak out" (Cox).Shortly after the release of a horrific image on social media showing Australian jihadists proudly flaunting the severed heads of their victims, the Australian government reacted with an even bolder move to introduce legislation that would see the government cancelling the welfare payments of persons “identified by national security agencies as being involved in extremist conduct.” According to the Government the reforms would “enable the Department of Human Services to cancel a person’s welfare payment if it receives advice that a person has been assessed as a serious threat to Australia’s national security.”(Prime Minister of Australia) The move was criticised by several groups including academics who argued that it would not only alienate the already disenfranchised Muslim communities, but could also result in greater radicalisation (Ireland). In response to the raft of new measures perceived to be targeting Muslim communities, Australian Muslims took measured steps to voice their opposition through written statements and media releases stating that, among other things: These proposals come in the same style as those which have preceded [sic] since the Howard era. An alleged threat is blown out of all proportion as the pretext, further "tightening" of the laws is claimed necessary and rushed through, without proper national debate or community consultation. The reality of the alleged threat is also exposed by the lack of correspondence between the official 'terror threat' level, which has remained the same since 2001, and the hysterical rhetoric from government ministers. (ABC News, "Australian Muslims")Australian Muslim leaders also boycotted government meetings including a planned meeting with the Prime Minister to discuss the new laws. The Prime Minister promptly branded the boycott “foolish” (ABC News, "Tony Abbott") yet refused to acknowledge the legitimacy of the claims made in the media statements and messages by Muslim organisations that prompted the boycotts. As Australian Muslims continue to grapple with ways to legitimize their claims to citizenship, the developing discourse on national security and terrorism continues to define them as the objects of terror. Notably, the media discourse is showing some signs of accommodating the views of Muslim Australians who have found some space in the public sphere. Recent media reporting on terror activities in the Middle East has given some consideration to the voices of Muslim leaders who openly oppose violent extremism. Yet Muslims in Australia are still battling for legitimacy. Those who speak out against the hijacking of their religion by a minority who espouse a rigid and uncompromising ideology in order to justify violence often find themselves the subjects of intense scrutiny. From within their communities they are seen to be mouth pieces for an unfair and unjust government agenda that targets Muslims as objects of fear. From outside their communities they are seen to be apologists for Islam whose authenticity should be questioned if not denied. Attempts by Muslim Australians to have their voices heard through political practices that define the very nature of democracy including peaceful demonstrations, boycotts and written statements have not been taken seriously. As a result, Muslim voices in Australia are deemed illegitimate regardless of the forms or platforms through which they seek to be heard. ReferencesABC News. “Australian Muslims Denounce Proposed 'Anti-Terror' Laws”. ABC Religion and Ethics, 21 Aug. 2014. 23 Aug. 2014 .ABC News. “Tony Abbott Says Muslim Leaders 'Foolishly Boycotted' Counterterrorism Law Meeting.” 22 Aug. 2014. 24 Aug. 2014 .Akerman, Pia. “Muslim Leaders Must Speak Out against Extremists, Academic Warns.” The Australian 13 Aug. 13 2014. 20 Aug. 2014 . Akerman, Piers. “It's Time for Muslim Leaders to Speak Up.” Daily Telegraph 15 Aug. 2014. 20 Aug. 2014 .Alynne, A. A Study of Audience Responses to the Media Discourse about the ‘Other’: The Fear of Terrorism between Australian Muslims and the Broader Community. Lampeter: Edwin Mellen, 2010.Aly, Anne. “Media Hegemony, Activism and Identity: Muslim Women Re-Presenting Muslim Women.” Beyond the Hijab Debates: New Conversations on Gender, Race and Religion, eds. T. Dreher and C. Ho. Cambridge: Cambridge Scholars, 2009.Aly, Anne, and Mark Balnaves. “The Atmosfear of Terror: Affective Modulation and the War on Terror.” M/C Journal 8.6 (2005).Aly, Anne, and Lelia Green. “‘Moderate Islam’: Defining the Good Citizen.” M/C Journal 10.6/11.1 (2008). 13 April 2008 ‹http://journal.media-culture.org.au/0804/08aly-green.php›.Aston, H. “Tony Abbott Dumps Controversial Changes to 18C Racial Discrimination Laws.” Sydney Morning Herald 5 Aug. 2014. 24 Aug. 2014 .Australian Government, Attorney General's Department. Building Community Resilience Grants Program. n.d. 24 July 2014 . Commonwealth of Australia. Transnational Terrorism White Paper: The Threat to Australia. Canberra: Department of Prime Minister and Cabinet, 2004. . Commonwealth of Australia. National Action Plan to Build Social Cohesion, Harmony and Security. Canberra: Department of Immigration and Citizenship, 2006. .Commonwealth of Australia. Counter Terrorism White Paper: Securing Australia, Protecting our Community. Canberra: Department of Prime Minister and Cabinet, 2010. 19 Nov. 2011 .Cox, L. “'You Don't Migrate to This Country unless You Want to Join Our Team': Tony Abbott Renews Push on National Security Laws.” Sydney Morning Herald 18 Aug. 2014. 24 Aug. 2014 . Ireland, J. “Extremism Warning on Coalition's Move to Cut Welfare Payments.” Sydney Morning Herald 19 Aug. 2014. 24 Aug. 2014 .Penberthy, D. “The Moderate Muslims Are Talking If Only You Will Listen. Herald Sun 17 Aug. 2014 .Prime Minister of Australia. “New Counter-Terrorism Measures for a Safer Australia - Cancelling Welfare Payments to Extremists”. 16 Aug. 2014. 23 Aug. 2014 .Prime Minister of Australia. “Meeting with Islamic Community Leaders, Statement of Principles.” 23 Aug. 2005. July 2008 .

Photo by Christian Bowen on Unsplash ABSTRACT Assisted Reproductive Technology can be a beneficial tool for couples unable to reproduce independently; however, it has historically discriminated against the LGBTQ+ community members. Given the evolution and acceptance of LGBTQ rights in recent years, discrimination and barriers to access reproductive technology and health care should be readdressed as they still exist within this community. INTRODUCTION In recent years, the LGBTQ+ community has made great strides toward attaining equal rights. This fight dates back to 1970 when Michael Baker and McConnell applied for a marriage license in Minnesota.[1] After the county courthouse denied the couple's request, they appealed to the Minnesota Supreme Court. Baker and McConnell’s dispute reached the US Supreme Court. Baker v. Nelson[2] was the first time a same-sex couple attempted to pursue marriage through higher courts in the US.[3] Because the couple lost the case, Baker changed his name to a gender-neutral one, and McConnell adopted Baker, allowing Baker and McConnell to have legal protections like the ability to receive certain inheritances. Baker and McConnell received a marriage license from an unsuspecting clerk from Blue Earth County, where they wed on September 3, 1971.[4] BACKGROUND The Supreme Court’s decision left individual state legislatures the option to accommodate same-sex couples’ rights constitutionally. As a result, some states banned same-sex marriage, while others offered alternative options such as domestic partnerships. With many obstacles, such as the Defense of Marriage Act (DOMA) and President Bush’s efforts to limit marriage to heterosexual people, Massachusetts became the first state to legalize gay marriage in 2003.[5] Other states slowly followed. Finally, in 2015 the US Supreme Court made same-sex marriage legal in all 50 states in Obergefell v. Hodges,[6] marking an important milestone for the LGBTQ+ community’s fight toward marriage equality. The Obergefell v. Hodges decision emphasized that members of the homosexual community are “not to be condemned to live in loneliness, excluded from one of civilization's oldest institutions,” thus granting them the right to “equal dignity in the eyes of the law.”[7] This paper argues that in the aftermath of the wide acceptance of LGBTQ rights, discrimination and barriers to access reproductive technology and health care persist nationally. Procreation also faces discrimination. Research supports that children’s overall psychological and physical welfare with same-sex parents does not differ compared to children with heterosexual parents.[8] Some others worry about the children’s developmental health and argue that same-sex male couples’ inability to breastfeed their children may be harmful; however, such parents can obtain breast milk via surrogate donation.[9] Further concerns regarding confusion in gender identity in children raised by same-sex parents are not supported by research in the field indicating that there are “no negative developmental or psychological outcomes for a child, nor does it result in differing gender identity, gender role behavior or sexual partner preference compared to opposite-sex parents.”[10] ANALYSIS l. Desire to Procreate The American perception toward same-sex unions has evolved “from pathology to deviant lifestyle to identity.”[11] In 2001, only 35 percent of Americans favored same‐sex marriage, while 62 percent favored it in 2017.[12] The “Gay marriage generation”[13] has a positive attitude toward same-sex unions, arising from the “interaction among activists, celebrities, political and religious leaders, and ordinary people, who together reconfigured Americans’ social imagination of homosexuality in a way that made gay marriage seem normal, logical, and good.”[14] Same-sex couples’ right to build a biological family and ability to do so using modern reproductive technology is unclear. The data generated by the LGBTQ Family Building Survey revealed “dramatic differences in expectations around family building between LGBTQ millennials (aged 18-35) and older generations of LGBTQ people,”[15] which may be in part attributable to recent federal rulings in favor of same-sex couples. Three important results from this survey are that 63 percent of LGBTQ millennials are considering expanding their families throughout parenthood, 48 percent of LGBTQ millennials are actively planning to grow their families, compared to 55 percent of non-LGBTQ millennials; and 63 percent of those LGBTQ people interested in building a family expect to use assisted reproductive technology (ART), foster care, or adoption to become parents.[16] There are 15.9 million Americans who identify as LGBTQ+ (6.1 million of whom are 18 to 35 years old); thus, an estimated “3.8 million LGBTQ+ millennials are considering expanding their families in the coming years, and 2.9 million are actively planning to do so.”[17] Yet access and affordability to ART, especially in vitro fertilization (IVF) and surrogacy for same-sex couples, has not been consistent at a national level. The two primary problems accessing ART for the LGBTQ community are the lack of federal law and cost. A federal law that guaranteed coverage would address both problems. ll. ART for Same-Sex Couples All same-sex male (SSM) couples and same-sex female (SSF) couples must involve third parties, including surrogates or egg or sperm donors.[18] ART involves the legal status of “up to two women (surrogate and egg donor),” the intended parents, and the child for SSM couples.[19] While sometimes necessary for heterosexual couples using ART, an egg or sperm from someone other than the intended parents or a surrogate will always be necessary for the LGBTQ people seeking ART. ART, in particular IVF, is essential for infertile couples unable to conceive on their own. Unlike other industrialized countries (such as Canada, the United Kingdom, Sweden, Germany, and Australia), the US does not heavily oversee this multibillion-dollar industry.[20] The American Society for Reproductive Medicine does provide lengthy guidelines to fertility clinics and sperm banks; however, state lawmakers have been less active as they seem to avoid the controversy surrounding controversial topics like embryo creation and abortion.[21] As a result, states “do not regulate how many children may be conceived from one donor, what types of medical information or updates must be supplied by donors, what genetic tests may be performed on embryos, how many fertilized eggs may be placed in a woman or how old a donor can be.”[22] lll. A Flawed Definition of Infertility The WHO defines the medical definition of infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after twelve months or more of regular unprotected sexual intercourse.”[23] This antiquated definition must be updated to include social infertility to integrate same-sex couples’ rights.[24] In the US, single individuals and LGBTQ couples interested in building a family by biological means are considered “socially infertile.”[25] If insurance coverage is allotted only to those with physical infertility, then it is exclusive to the heterosexual community. Although some states, such as New York, discussed below, have directly addressed this inequality by extending the definition of infertility and coverage of infertility treatments to include all residents regardless of sexual orientation, this is not yet the norm everywhere else. The outdated definition of infertility is one of the main issues affecting same-sex couples’ access to ART, as medical insurance companies hold on to the formal definition of infertility to deny coverage. lV. Insurance Coverage for IVF Insurance coverage varies per state and relies on the flawed definition of infertility. As of August 2020, 19 states have passed laws requiring insurance coverage for infertility, 13 of which include IVF coverage, as seen in Figure 1. Also, most states do not offer IVF coverage to low-income people through Medicaid.[26] In states that mandate IVF insurance coverage, the utilization rate was “277% of the rate when there was no coverage,”[27] which supports the likelihood that in other states, the cost is a primary barrier to access. When insurance does not cover ART, ART is reserved for wealthy individuals. One cycle of ART could cost, on average, “between $10,000 and $15,000.”[28] In addition, multiple cycles are often required as one IVF cycle only has “about a 25% to 30%” live birth success rate.[29] Altogether, the total cost of successful childbirth was estimated from $44,000 to $211,940 in 1992.[30] On February 11, 2021, New York Governor Andrew M. Cuomo “directed the Department of Financial Services to ensure that insurers begin covering fertility services immediately for same-sex couples who wish to start a family.”[31] New York had recently passed an IVF insurance law that required “large group insurance policies and contracts that provide medical, major medical, or similar comprehensive-type coverage and are delivered or issued for delivery in New York to cover three cycles of IVF used in the treatment of infertility.”[32] But the law fell short for same-sex couples, which were still required to “pay 6 or 12 months of out-of-pocket expenses for fertility treatments such as testing and therapeutic donor insemination procedures before qualifying for coverage.”[33] Cuomo’s subsequent order made up for gaps in the law, which defined infertility as “the inability to conceive after a certain period of unprotected intercourse or donor insemination.”[34] Cuomo’s order and the law combine to make New York an example other states can follow to broaden access to ART. V. Surrogacy Access to surrogacy also presents its own set of problems, although not exclusive to the LGBTQ community. Among states, there are differences in how and when parental rights are established. States in dark green in Figure 2 allow pre-birth orders, while the states in light green allow post-birth parentage orders. Pre-birth orders “are obtained prior to the child’s birth, and they order that the intended parent(s) will be recognized as the child’s only legal parent(s) and will be placed on the child’s birth certificate,” while post-birth parentage orders have the same intent but are obtained after the child’s birth. [35] For instance, states can require genetic testing post-birth, possibly causing a delay in establishing parentage.[36] Although preventable through the execution of a health care power of attorney, a surrogate mother could be the legal, medical decision-maker for the baby before the intended parents are legally recognized. On February 15, 2021, gestational surrogacy – the most popular type of surrogacy in which the surrogate has no biological link to the baby – was legalized in New York,[37] but it remains illegal in some states such as Nebraska, Louisiana, and Michigan.[38] In addition, the costs of surrogacy are rising, and it can cost $100,000 in the US.[39] Medicaid does not cover surrogacy costs,[40] and some health insurance policies provide supplemental surrogacy insurance with premiums of approximately $10,000 and deductibles starting at $15,000.[41] Thus, “surrogacy is really only available to those gay and lesbian couples who are upper class,”[42] leaving non-affluent couples out of options to start a family through biological means. Vl. A Right to Equality and Procreation Some argue that same-sex couples should have the right to procreate (or reproductive rights). Based on arguments stemming from equal rights and non-discrimination, same-sex couples who need to use ART to procreate should have access to it. The need to merge social infertility into the currently incomplete definition of fertility could help same-sex couples achieve access through insurance coverage. The human right of equality and non-discrimination guarantees “equal and effective protection against discrimination on any ground.”[43] The United Nations later clarified that “sexual orientation is a concept which is undoubtedly covered” [44] by this protection. The right to procreate is not overtly mentioned in the US Constitution; however, the Equal Protection Clause states that “No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States… without due process of law.”[45] In fact, some states have abridged the reproductive privileges of some US citizens by upholding prohibitive and intricate mechanisms that deter same-sex couples from enjoying the privileges other citizens have. The Supreme Court acknowledged procreation as a “fundamental”[46] personal right, in Skinner v. Oklahoma, mandating that the reproductive rights of individuals be upheld as the right to procreate is “one of the basic civil rights of man”[47] because “procreation [is] fundamental to the very existence and survival of the race.”[48] In Eisenstadt v. Baird, the courts also supported that “the decision whether to bear or beget a child” fundamentally affects a person.[49] I argue that this protection extends to same-sex couples seeking to procreate. Finally, Obergefell v. Hodges held that the Due Process and Equal Protection clauses ensure same-sex couples the right to marriage, as marriage “safeguards children and families, draw[ing] meaning from related rights of childrearing, procreation, and education.”[50] By implicit or explicit means, these cases align with the freedom to procreate that should not be unequally applied to different social or economic groups. Yet, the cases do not apply to accessing expensive tools to procreate. As heterosexuals and the LGBTQ community face trouble accessing expensive ART for vastly different reasons, especially IVF and surrogacy, the equal rights or discrimination argument is not as helpful. For now, it is relevant to adoption cases where religious groups can discriminate.[51] The insurance coverage level may be the best approach. While the social norms adapt and become more inclusive, the elimination of the infertility requirement or changing the definition of infertility could work. Several arguments could address the insurance coverage deficit. Under one argument, a biological or physical inability to conceive exists in the homosexual couple trying to achieve a pregnancy. Depending on the wording or a social definition, a caselaw could be developed arguing the medical definition of infertility applies to the LGBTQ community as those trying to procreate are physically unable to conceive as a couple planning to become parents. One counterargument to that approach is that it can be offensive to label people infertile (or disabled) only because of their status as part of a homosexual couple.[52] CONCLUSION In the last 50 years, there has been a notable shift in the social acceptance of homosexuality.[53] Marriage equality has opened the door for further social and legal equality, as evidenced by the increased number of same-sex couples seeking parenthood “via co-parenting, fostering, adoption or surrogacy” – colloquially referred to as the ‘Gayby Boom’.[54] However, some prejudice and disdain toward LGBTQ+ parenting remain. Equitable access to ART for all people may be attainable as new technology drives costs down, legislators face societal pressure to require broader insurance coverage, and social norms become more inclusive. [1] Eckholm, E. (2015, May 17). The same-sex couple who got a marriage license in 1971. Retrieved April 08, 2021, from https://www.nytimes.com/2015/05/17/us/the-same-sex-couple-who-got-a-marriage-license-in-1971.html [2] Eckholm, E. [3] A brief history of civil rights in the United States: A timeline of the legalization of same-sex marriage in the U.S. (2021, January 27). Retrieved April 08, 2021, from https://guides.ll.georgetown.edu/c.php?g=592919&p=4182201 [4] Eckholm, E. [5] A brief history of civil rights in the United States: A timeline of the legalization of same-sex marriage in the U.S. (2021, January 27). Retrieved April 08, 2021, from https://guides.ll.georgetown.edu/c.php?g=592919&p=4182201 [6] A brief history of civil rights in the United States [7] A brief history of civil rights in the United States [8] Lee, J., & Bolzendahl, C. (2019). Acceptance and Rejection: Patterns of opinion on homosexuality in the United States and the world. Sociological Forum, 34(4), 1026-1031. doi:10.1111/socf.12562 [9] Lee, J., et al. [10] Lee, J., et al. [11] Lee, J., et al. [12] Lee, et al. [13] Lee, et al. [14] Lee, et al. [15] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [16] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [17] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [18] Mackenzie, S. C., Wickins-Drazilova, D., & Wickins, J. (2020). The ethics of fertility treatment for same-sex male couples: Considerations for a modern fertility clinic. European Journal of Obstetrics & Gynecology and Reproductive Biology, 244, 71-75. doi:10.1016/j.ejogrb.2019.11.011 [19] Mackenzie, et al. [20] Ollove, M. (2015, March 18). States not eager to regulate fertility industry. Retrieved April 08, 2021, from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry [21] Ollove, M. [22] Ollove, M. [23] World Health Organization. (2020, September 14). Infertility. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/infertility [24] Leondires, M. P. (2020, March 19). Fertility insurance Mandates & same-sex couples. Retrieved April 08, 2021, from https://www.gayparentstobe.com/gay-parenting-blog/fertility-insurance-mandates-same-sex-couples/ [25] Lo, W., & Campo-Engelstein, L. (2018). Expanding the Clinical Definition of Infertility to Include Socially Infertile Individuals and Couples. Reproductive Ethics II, 71–83. https://doi.org/10.1007/978-3-319-89429-4_6 [26] Mohapatra, S. (2015). Assisted Reproduction Inequality and Marriage Equality. Chicago-Kent Law Review, 92(1). Retrieved April 08, 2021, from https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=4146&context=cklawreview [27] Mohapatra, S. [28] Mohapatra, S. [29] Mohapatra, S. [30] Mohapatra, S. [31] Governor Cuomo announces new actions to expand access to FERTILITY coverage for same sex couples as part of 2021 Women's Agenda. (n.d.). [32] Health Insurers FAQs: IVF and Fertility Preservation Law Q&A Guidance. (n.d.). Retrieved April 08, 2021, from https://www.dfs.ny.gov/apps_and_licensing/health_insurers/ivf_fertility_preservation_law_qa_guidance [33] Governor Cuomo announces new actions to expand access to FERTILITY coverage for same sex couples as part of 2021 Women's Agenda. (n.d.). Retrieved April 08, 2021, from https://www.governor.ny.gov/news/governor-cuomo-announces-new-actions-expand-access-fertility-coverage-same-sex-couples-part#:~:text=February%2011%2C%202021-,Governor%20Cuomo%20Announces%20New%20Actions%20to%20Expand%20Access%20to%20Fertility,Part%20of%202021%20Women's%20Agenda&text=Cuomo%20today%20directed%20the%20Department,wish%20to%20start%20a%20family. [34] Leondires, M. P. [35] Assisted reproduction parentage proceedings information: Academy of Adoption and Assistive Reproduction Attorneys (AAAA). (2019, March 14). Retrieved April 08, 2021, from https://adoptionart.org/assisted-reproduction/parentage-proceedings/ [36] Assisted reproduction parentage proceedings information. [37] Governor Cuomo reminds surrogates and parents of their new Insurance rights and protections During Gestational Surrogacy. (n.d.). Retrieved April 08, 2021, from https://www.governor.ny.gov/news/governor-cuomo-reminds-surrogates-and-parents-their-new-insurance-rights-and-protections-during [38] U.S. Surrogacy Map: Surrogacy laws by state. (2020, December 23). Retrieved April 08, 2021, from https://www.creativefamilyconnections.com/us-surrogacy-law-map/ [39] Mohapatra, S. [40] Beitsch, R. (2017, June 29). As surrogacy surges, new parents seek legal protections. Retrieved April 08, 2021, from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/06/29/as-surrogacy-surges-new-parents-seek-legal-protections#:~:text=Medicaid%20does%20not%20cover%20surrogacy,and%20intended%20parents%20at%20risk. [41] Where to find surrogacy insurance? (2017, November 02). Retrieved April 08, 2021, from https://surrogate.com/intended-parents/surrogacy-laws-and-legal-information/where-can-i-find-surrogacy-insurance/ [42] Mohapatra, S. [43] International covenant on civil and political rights. (n.d.). Retrieved April 08, 2021, from https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx [44] United Nations. (2003). Human rights in the administration of justice: a manual on human rights for judges, prosecutors and lawyers. [45] U.S. Const. amend. XIV, § 1. [46] Skinner v. Oklahoma, Https://caselaw.findlaw.com/us-supreme-court/316/535.html (June 1, 1942). [47] Skinner v. Oklahoma [48] Skinner v. Oklahoma [49] Eisenstadt v. Baird, Https://www.lexisnexis.com/community/casebrief/p/casebrief-eisenstadt-v-baird (March 22, 1972). [50] Obergefell v. Hodges [51] Higgins, T. (2021, June 17). Supreme Court sides with Catholic adoption agency that refuses to work with LGBT couples. CNBC. https://www.cnbc.com/2021/06/17/supreme-court-sides-with-catholic-adoption-agency-that-refuses-to-work-with-lgbt-couples.html. [52] Bowerman, M., May, A., & Rossman, S. (2017, April 24). Should the definition of infertility be more inclusive? USA Today. https://www.usatoday.com/story/news/nation-now/2017/04/22/same-sex-couples-covered-infertility-insurance/100644092/. [53] Mackenzie, et al. [54] Mackenzie, et al.

Photo by Alexander Grey on Unsplash ABSTRACT Current studies show that about half of transgender and gender-diverse (TGD) people wish to have children in the future. TGD patients who pursue gender-affirmation interventions must be aware of the impact that various treatments can have on fertility, as gender-affirming care through medical or surgical treatment can limit or alter reproductive potential. Many medical professional societies encourage providers to educate and counsel patients about the consequences of treatment and viable options for fertility preservation (FP) as early as possible, though patients may not be aware of all the family formation methods available. There is a significant need for a tool that thoroughly details not only the various opportunities for parenthood but the perceived cost, rates of success, and risks associated with each option. A fertility decision-aid would allow for a more robust informed consent process and shared decision-making for all individuals pursuing gender-affirming care. INTRODUCTION Over 1.6 million adults and youth in the United States, or about 0.6 percent of those age 13 and over, identify as transgender, according to a report released by The Williams Institute in June 2022.[1] Current studies show that approximately half of transgender and gender-diverse (TGD) people wish to have children in the future, which aligns with the rate of cisgender individuals who desire parenthood in some form.[2] Studies on parenthood show improved quality of life and mental health in TGD adults and decreased incidence of suicide in TGD women.[3] In one study, almost half of the TGD individuals who indicated an interest in parenthood said they wanted genetically related offspring.[4] However, medical or surgical therapies can limit reproductive potential.[5] Recent findings indicate that some TGD adults who underwent medical or surgical paths to affirmation regret decisions that may have led to their inability to have genetic children. Perhaps they did not know it was an option, faced barriers to care, or were not interested at the time.[6] Many medical professional societies, including the World Professional Association for Transgender Health (WPATH), the Endocrine Society, and the American College of Obstetrics and Gynecology, encourage providers to educate and counsel patients about the consequences of treatment and viable options for fertility preservation as early as possible.[7] This paper argues that TGD patients who pursue gender-affirmation interventions must be aware of the impact treatments can have on fertility and, ultimately, parenthood and that a design tool may help them understand the risks and make informed decisions. l. Gender Affirmation Options Some TGD individuals do not use medical or surgical therapies to feel affirmed in their identity.[8] Non-medical paths to affirmation include social and legal measures.[9] These reversible paths do not impact the individual’s future fertility potential. TGD individuals can follow different paths of gender-affirming care through social, legal, medical, and surgical affirmation.[10] Social affirmation can include using gender-affirming pronouns, names, and clothing.[11] Legal affirmation can include changing the gender and name on a birth certificate and other records in states where this is permissible.[12] Social and legal affirmations are reversible and do not impact fertility potential. Medical affirmation involves the use of gender-affirming hormone therapy. Feminizing or masculinizing hormone therapy allows for the development of secondary sex characteristics that more closely align with the individual's gender identity.[13] No set regimen for treatment exists, as a patient’s goals will determine their individualized plan.[14] Some standard feminizing agents include estrogen, androgen-reducing medications, and progestins, while the common masculinizing agent is testosterone.[15] Gender-affirming hormone therapy is not currently seen as a definitive cause of infertility, as it is possible to discontinue treatment and see a noted reversal of intended effects.[16] Research findings suggest that hormone therapy should stop for a minimum of three months to reverse any treatment effects.[17] The only available data on long-term hormonal therapy use is inconsistent, based on observational studies with varying duration and doses.[18] Individuals can stop gender-affirming hormone therapy, but its lasting impact on fertility is unknown.[19] A TGD individual may choose to undergo surgical interventions that do not impact fertility. These interventions can masculinize or feminize body parts to allow a patient’s physical appearance to align with their gender identity.[20] This care could include breast augmentation for TGD women and Adam’s apple reduction or breast reduction for TGD men.[21] Other surgical interventions will impact TGD individuals’ fertility. Genital surgery for a TGD woman can include the removal of the penis and scrotum (penectomy and orchiectomy) and the construction of a vagina and labia (vaginoplasty and valvuloplasty).[22] A TGD man can have removal of the ovaries and uterus (oophorectomy and hysterectomy) and construction of a penis and scrotum (metoidioplasty, phalloplasty, and scrotoplasty).[23] Following these gender-affirming surgeries, individuals are infertile due to the removal of their reproductive organs.[24] These procedures are irreversible and directly impact reproductive capacity in TGD individuals. ll. Fertility Counseling to Explain Paths to Parenthood Patients receiving gender-affirming care should have the opportunity to learn about the various ways to achieve parenthood, including fertility preservation. Family formation methods include sexual intercourse, artificial insemination, surrogacy, and adoption or foster care.[25] These methods apply to non-TGD people as well. Patients may not be aware of the various means of family-building, so accurate and expansive fertility counseling is essential before initiating medical or surgical affirming care. The frequency with which TGD individuals receive fertility counseling and how thorough it is, is unclear. When surveyed about fertility preservation, healthcare providers reported a lack of confidence in discussing fertility preservation with patients due to gaps in their knowledge on best practices, success rates, and regret rates in patients who did not preserve fertility. They also had varied perceptions of their role in treating patients and whether they should discuss family planning.[26] Patients have reported receiving an overview of fertility options from their primary transgender-healthcare providers before being referred to reproductive specialists.[27] While this is an essential step for patients seeking more information about their opportunities for parenthood, only 16 percent of Society for Assisted Reproductive Technology member clinics share information about options for transgender individuals on their websites.[28] Providers of transgender health care do not, and may not be trained to, provide adequate counsel to patients. Patients also cannot give informed consent for fertility or gender-affirming care interventions without more information on the benefits and burdens of all available treatments. Current literature demonstrates a need for a decision aid that thoroughly details not only the opportunities for parenthood but the perceived cost, rates of success, and risks associated with each option.[29] This tool could foster a more informed dialogue between an individual and their care team. A fertility decision aid would also allow for a more robust informed consent process for all individuals pursuing gender-affirming care. Regardless of the affirmation path chosen, a TGD individual should have early and frequent conversations with their care team regarding fertility. The World Professional Association for Transgender Health (WPATH) asserts that healthcare professionals should discuss fertility preservation options before initiating gender-affirming hormone therapy or surgery. The American College of Obstetrics and Gynecology states that “fertility and parenting desires should be discussed early in the process of transition, before the initiation of hormone therapy or gender affirmation surgery.”[30] The Endocrine Society writes that “all individuals seeking gender-affirming medical treatment should receive information and counsel on options for fertility preservation prior to initiating puberty suppression in adolescents and prior to treating with hormonal therapy in both adolescents and adults."[31] These conversations are essential even if the patient is not interested in parenthood at the time. WPATH addresses the potential for regret, as cases of individuals who received hormone therapy and genital surgery and later desired genetically related children have been identified.[32] TGD patients pursuing gender-affirming care should assess their individual fertility goals to better understand the many ways to build a family. Surveys of TGD adults show that participants want to become parents in various ways. In one study, 31.3 percent of those surveyed wanted to become parents through adoption, 25 percent wanted children through sexual intercourse, 15.6 percent through surrogacy, 12.5 percent using donor sperm, 9.4 percent using a known sperm donor, and 6.3 percent through the foster care system.[33] TGD women showed a significant interest in adoption (75 percent of participants), whereas more than half of TGD men wanted to become parents through sexual intercourse or pregnancy (58.3 percent).[34] These fertility goals should be acknowledged and discussed with the care team to guide decision-making about fertility preservation. lll. Fertility Preservation Individuals who wish to share their genetic makeup with their child will usually need to speak with a reproductive specialist about fertility preservation options. They are the same as those for cisgender individuals using fertility services before cancer treatment or elective preservation.[35] For TGD adults with ovaries, this includes freezing embryos (using donor or partner sperm) or ovarian tissue.[36] While no longer viewed as an experimental treatment, professionals offer tissue freezing to few patients due to a lack of data on its safety and efficacy.[37] For TGD adults with testicles, freezing sperm and preserving testicular tissue can preserve the ability to have biological children.[38] Fertility preservation numbers for TGD adults remain low. A study showed that 76.6 percent of TGD men and 76.1 percent of TGD women considered fertility preservation, but only 3.1 percent and 9.6 percent, respectively, initiated it.[39] Success rate, cost, need for travel, and elevated risk of gender dysphoria likely lead to lower use of fertility preservation.[40] According to the American Society for Reproductive Medicine, the average cost of an IVF cycle in the US is $12,400.[41] Intrauterine insemination can range in cost from a few hundred dollars to $2,000 per cycle.[42] There are also associated costs to freeze and store sperm and eggs.[43] Insurance coverage and physical location impact the costs and how the patient bears the costs.[44] For those who do not have sufficient or any insurance coverage, fertility preservation may not be feasible. Of additional significance for this population, fertility preservation techniques can exacerbate gender dysphoria as the patient must produce gametes associated with the gender they do not recognize.[45] For TGD women, masturbating in a clinical setting or sperm banking for sperm cryopreservation can cause severe distress.[46] Furthermore, fertility preservation for TGD men can be challenging and invasive. A transvaginal ultrasound exam is a requirement for the cryopreservation of embryos and oocytes.[47] This exam can cause significant distress as the procedure does not align with their male identity.[48] Controlled ovarian stimulation cycles require two weeks of daily gonadotropin injections, and the patient is given anesthesia for oocyte retrieval.[49] Furthermore, TGD men undergoing fertility preservation must discontinue testosterone use, and menstruation can resume.[50] lV. Other Paths to Parenthood a. Adoption TGD adults can also pursue parenthood through adoption systems, though foster care is a temporary option. While almost one-third of surveyed TGD adults consider adoption a means to parenthood, cost and fear of discrimination can prevent them from following through.[51] TGD individuals have expressed a reluctance to pursue adoption due to the fear of discrimination by adoption agencies, attorneys, or families.[52] Nineteen states in the US allow child welfare agencies to refuse to provide services to LGBTQ+ families if it conflicts with the religious beliefs of the relevant people in the agency.[53] Nineteen states have no laws about discrimination during the adoption process based on sexual orientation or gender identity.[54] Only 29 states have statutory or regulatory protections against discrimination based on orientation and gender identity.[55] b. Surrogacy There are two types of surrogacies: traditional and gestational.[56] In traditional surrogacy, professionals fertilize the surrogate’s egg by the sperm of an intended parent or a sperm donor through intrauterine insemination. In gestational surrogacy, the surrogate undergoes IVF to implant the fertilized embryo.[57] Egg donation can be used for gestational surrogacy if necessary. Those considering surrogacy need to understand the specific laws in their state, as they can differ significantly.[58] c. Intercourse TGD individuals who have not undergone genital surgery can have intercourse with the intention of causing pregnancy. TGD men who have not had genital surgery can bear children. For those who have initiated hormonal therapy, limited data has been collected on the impact of gender-affirming hormone therapy on conception.[59] TGD men have gotten pregnant after discontinuing testosterone use.[60] TGD women who have not had genital surgery can have intercourse with a person with ovaries and produce sperm to fertilize an egg. Gender-affirming hormone therapy possibly affects sperm viability.[61] V. A Decision Aid to Support Informed Consent and Shared Decision Making For individuals pursuing gender-affirming care, time is of the essence when considering fertility preservation. In one review, transgender health doctors reported that most patients did not want to postpone treatment for fertility preservation procedures, even if they wanted children;[62] any delay in treatment can be distressing for those with gender dysphoria.[63] Providers face several challenges when counseling patients about fertility. The WPATH guidelines pose an ethical dilemma for transgender health providers as limited data offers guidance about discussing fertility risks and recommendations with patients.[64] For TGD patients, limited and contradictory data about fertility outcomes before, during, and after gender affirmation exists, particularly for the lasting impact of gender-affirming hormone therapy.[65] For TGD women who have taken estrogen and stopped to pursue fertility preservation, data on sperm quality is mixed.[66] The data on when normal ovarian function resumes is variable for TGD men using testosterone who have stopped to pursue fertility preservation.[67] Much data comes from the oncofertility literature, which indicates that when providers use standardized counseling practices when discussing fertility with their patients, more patients undergo fertility preservation, and patient satisfaction increases.[68] For individuals seeking gender-affirming care, there is a need for a decision aid that providers can utilize across multiple clinics and programs.[69],[70] Patients must be aware of the benefits, risks, and alternatives of any intervention to provide truly informed consent. When discussing fertility for TGD patients, this includes which fertility options are available at each stage of transition and the potential for a live birth with each option.[71] Furthermore, a decision aid would allow for shared decision-making, where the patient is an active participant and co-designer of their treatment plan.[72] Shared decision-making acknowledges the healthcare provider’s beneficence, knowledge, and experience while equally valuing the right to patient autonomy and respecting the ability of the patient to inform the provider.[73] A decision aid can help initiate the conversations between a patient and their provider that allow for a true partnership in decision-making. A recent study investigated the efficacy and impact of a web-based fertility decision aid targeted at TGD adolescents and young adults.[74] This tool, titled Aid for Fertility-Related Medical Decisions (AFFRMED), significantly increased fertility knowledge in both youth and their parents while improving youth’s perceived ability to make fertility decisions.[75] Youth participants and their parents found the tool “feasible, acceptable, and usable.”[76] This initial study was small, with only eight adolescents or young adults and seven parents participating.[77] At large, the effectiveness of the trial will be the next step in determining the legitimacy of the aid for clinical use.[78] A similar decision-making tool designed for TGD adults would also be useful. The tool can present an average range of expected costs as much variability exists and costs change over time. This tool should also include general information on what is required to pursue each path to parenthood. For example, a patient undergoing fertility preservation needs to know what steps are necessary after the cryopreservation of gametes for live birth.[79] CONCLUSION Individuals pursuing gender-affirming care must closely consider the impact of their medical and surgical care on their desire to become parents as early in their affirmation journey as possible. A decision aid can be helpful if it outlines the risks to fertility and options to preserve fertility, with the specific data necessary to make an informed choice. The tool should include the methods of fertility preservation, each step of the protocol and respective risks for each method, the expected timeline from initiation to completion, general success rates, options for remaining gamete disposition, and the average cost of treatment. This should include a list of steps to initiate the process for each method and any potential barriers or obstacles. For surrogacy, the tool should include the two types and the average cost. For intercourse, the aid should include information on risks for discontinuing gender-affirming hormone therapy and general success rates. Clinics and providers could elect to tailor the decision aid for their population to include specific information about local laws and the availability of services. With a standardized fertility decision aid, TGD individuals can have a more thorough understanding of the opportunities and limitations placed on their reproductive capacity. Healthcare providers can feel more confident that their patients have access to relevant information regarding family-building before initiating medical or surgical affirmation. This allows for a more substantial informed consent and shared decision-making process, regardless of the decision made. A trial-tested decision-making tool for TGD adolescents and young adults exists that can serve as a model for creating aid for TGD adults of all ages. A fertility decision aid designed explicitly for TGD adults of reproductive age would be invaluable to support patients and healthcare providers in transgender health. - [1] Herman, J.L., Flores, A.R., O’Neill, K.K. (2022). How Many Adults and Youth Identify as Transgender in the United States? The Williams Institute, UCLA School of Law [2] Moravek M. B. (2019). Fertility preservation options for transgender and gender-nonconforming individuals. Current opinion in obstetrics & gynecology, 31(3), 170–176. https://doi.org/10.1097/GCO.0000000000000537 [3] Moravek (2019). [4] Moravek (2019). [5] Access to fertility services by transgender persons: an Ethics Committee opinion. (2015). Access to fertility services by transgender persons: an Ethics Committee opinion. Fertility and Sterility, 104(5), 1111–1115. https://doi.org/10.1016/j.fertnstert.2015.08.021 [6] Harris, R. M., Kolaitis, I. N., & Frader, J. E.. (2020). Ethical issues involving fertility preservation for transgender youth. Journal of Assisted Reproduction and Genetics, 37(10), 2453–2462. https://doi.org/10.1007/s10815-020-01873-9 [7] Bizic, M. R., Jeftovic, M., Pusica, S., Stojanovic, B., Duisin, D., Vujovic, S., Rakic, V., & Djordjevic, M. L. (2018). Gender Dysphoria: Bioethical Aspects of Medical Treatment. BioMed research international, 2018, 9652305. https://doi.org/10.1155/2018/9652305 [8] Rafferty, J., COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, COMMITTEE ON ADOLESCENCE, & SECTION ON LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTH AND WELLNESS (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, 142(4), e20182162. https://doi.org/10.1542/peds.2018-2162 [9] Rafferty (2018). [10] Rafferty (2018). [11] Rafferty (2018). [12] Rafferty (2018). [13] Rafferty (2018). [14] WPATH (2012). [15] WPATH (2012). [16] Bizic (2018). [17] Bizic (2018). [18] Moravek (2019). [19] Finlayson, C., Johnson, E. K., Chen, D., Dabrowski, E., Gosiengfiao, Y., Campo-Engelstein, L., Rosoklija, I., Jacobson, J., Shnorhavorian, M., Pavone, M. E., Moravek, M. B., Bonifacio, H. J., Simons, L., Hudson, J., Fechner, P. Y., Gomez-Lobo, V., Kadakia, R., Shurba, A., Rowell, E., & Woodruff, T. K.. (2016). Proceedings of the Working Group Session on Fertility Preservation for Individuals with Gender and Sex Diversity. Transgender Health, 1(1), 99–107. https://doi.org/10.1089/trgh.2016.0008 [20] Cheng, P. J., Pastuszak, A. W., Myers, J. B., Goodwin, I. A., & Hotaling, J. M.. (2019). Fertility concerns of the transgender patient. Translational Andrology and Urology, 8(3), 209–218. https://doi.org/10.21037/tau.2019.05.09 [21] Cheng (2019). [22] WPATH (2012). [23] WPATH (2012). [24] Bizic (2018). [25] Tornello, S. L., & Bos, H. (2017). Parenting Intentions Among Transgender Individuals. LGBT health, 4(2), 115–120. https://doi.org/10.1089/lgbt.2016.0153 [26] Sterling (2020). [27] Sterling (2020). [28] Sterling (2020). [29] Sterling (2020). [30] Health care for transgender and gender diverse individuals. ACOG Committee Opinion No. 823. American College of Obstetricians and Gynecologists. Obstet Gynecol 2021;137:e75–88. [31] Hembree (2017). [32] WPATH (2012). [33] Tornello (2017). [34] Tornello (2017). [35] Moravek (2019). [36] Wiesenthal (2022). [37] Choi, J. Y., & Kim, T. J.. (2022). Fertility Preservation and Reproductive Potential in Transgender and Gender Fluid Population. Biomedicines, 10(9), 2279. https://doi.org/10.3390/biomedicines10092279 [38] Wiesenthal (2022). [39] Mayhew (2020). [40] Sterling (2020). [41] American Society of Reproductive Medicine. (n.d.). Is in vitro fertilization expensive? In Vitro Fertilization (IVF). Retrieved November 28, 2022, from https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/q06-is-in-vitro-fertilization-expensive/ [42] American Society of Reproductive Medicine. (n.d.). The difference between IUI and IVF - A patient education micro-video. Reproductive Facts. Retrieved November 20, 2022, from https://www.reproductivefacts.org/resources/educational-videos/videos/asrmsart-micro-videos/videos/the-difference-between-iui-and-ivf/ [43] Family Equality (2019). [44] Sterling (2020). [45] Bizic (2018). [46] Bizic (2018). [47] Choi (2022). [48] Bizic (2018). [49] Choi (2022). [50] Choi (2022). [51] Tornello (2017). [52] Brown, C.. (2021). Exploring trans people’s experiences of adoption and fostering in the United Kingdom: A qualitative study. International Journal of Transgender Health, 22(1-2), 89–100. https://doi.org/10.1080/26895269.2020.1867396 [53] Movement Advancement Project. "Equality Maps: Foster and Adoption Laws." https://www.lgbtmap.org/equality-maps/foster_and_adoption_laws. Accessed 10/28/2022. [54] Movement Advancement Project. “Equality Maps: Foster and Adoption Laws” (2022). [55] Movement Advancement Project. “Equality Maps: Foster and Adoption Laws” (2022). [56] Torres, G., Shapiro, A., & Mackey, T. K.. (2019). A review of surrogate motherhood regulation in south American countries: pointing to a need for an international legal framework. BMC Pregnancy and Childbirth, 19(1). https://doi.org/10.1186/s12884-019-2182-1 [57] Family building through gestational surrogacy. Committee Opinion No. 660. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e97–103. [58] Family building through gestational surrogacy (2016). [59] Light, A. D., Obedin-Maliver, J., Sevelius, J. M., & Kerns, J. L.. (2014). Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transitioning. Obstetrics & Gynecology, 124(6), 1120–1127. https://doi.org/10.1097/aog.0000000000000540 [60] Obedin-Maliver, J., & Makadon, H. J.. (2016). Transgender men and pregnancy. Obstetric Medicine, 9(1), 4–8. https://doi.org/10.1177/1753495x15612658 [61] Choi (2022). [62] Bizic (2018). [63] Finlayson (2016). [64] Moravek (2019). [65] Mayhew, A. C., & Gomez-Lobo, V.. (2020). Fertility Options for the Transgender and Gender Nonbinary Patient. The Journal of Clinical Endocrinology & Metabolism, 105(10), 3335–3345. https://doi.org/10.1210/clinem/dgaa529 [66] Mayhew (2020). [67] Mayhew (2020). [68] Sterling (2020). [69] Kolbuck, V. D., Sajwani, A., Kyweluk, M. A., Finlayson, C., Gordon, E. J., & Chen, D.. (2020). Formative development of a fertility decision aid for transgender adolescents and young adults: a multidisciplinary Delphi consensus study. Journal of Assisted Reproduction and Genetics, 37(11), 2805–2816. https://doi.org/10.1007/s10815-020-01947-8 [70] Sterling (2020). [71] Sterling (2020). [72] De Snoo-Trimp, J., De Vries, A., Molewijk, B., & Hein, I.. (2022). How to deal with moral challenges around the decision-making competence in transgender adolescent care? Development of an ethics support tool. 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Introduction In The X-Files episode “Humbug”, agents Scully and Mulder travel to Florida to investigate a series of murders taking place in a community of sideshow performers, or freaks. At the episode’s end, one character, a self-made freak and human blockhead, muses on the future of the freak community:twenty-first century genetic engineering will not only eradicate the Siamese twins and the alligator-skinned people, but you’re going to be hard-pressed to find a slight overbite or a not-so-high cheek bone … . Nature abhors normality. It can’t go very long without creating a mutant. (“Humbug”) Freaks, he says, are there to remind people of the necessity of mutations. His observation that genetic engineering will eradicate anomalies of nature accurately illustrates the gradual shift that society was witnessing in the late twentieth century away from the anomalous freak and toward surgical perfection. Yet this desire for perfection, which has manifested itself in often severe surgical deformities, has seen a shift in what constitutes the freak for a contemporary audience, turning what was once an anomaly into a mass-produced creation. While the freaks of the nineteenth and early twentieth century were born with facial or anatomical deformities that warranted their place in the sideshow performance (bearded ladies, midgets, faints, lobster men, alligator-skinned people, etc.), freaks of the twenty-first century can be seen as something created by a plastic surgeon, a shift which undermines the very understanding of freak ontology. As Katherine Dunne put it: “a true freak cannot be made. A true freak must be born” (28). In her discussion of the monstrous body, Linda Williams writes that “the monster’s body is perceived as freakish in its possession of too much or too little” (63). This may have included a missing or additional limb, distorted sizes and heights, and anatomical growths. John Merrick, or the “Elephant Man” (fig. 1), as he was famously known, perfectly embodied this sense of excess that is vital to what people perceive as the monstrous body. In his discussion of freaks and the freakshow, Robert Bogdan notes that promotional posters exaggerated the already-deformed nature of freaks by emphasising certain physical anomalies and turning them into mythological creatures: “male exhibits with poorly formed arms were billed as ‘The Seal Man’; with poorly formed legs, ‘the Frog Man’; with excesses of hair, ‘The Lion Man’ or ‘Dog Boy’” (100). Figure 1: John Merrick (the Elephant Man) <https://www.pinterest.com.au/pin/193584483966192229/>.The freak’s anomalous nature made them valuable, financially but also culturally: “in many ways, the concept of ‘freak,’ is an anomaly in current social scientific thinking about demonstrable human variation. During its prime the freak show was a place where human deviance was valuable, and in that sense valued” (Bogdan 268). Many freaks were presented as “human wonders”, while “their claims to fame were quite commonplace” (Bogdan 200). Indeed, Bogdan argues that “while highly aggrandized exhibits really were full of grandeur, with respectable freaks the mundane was exploited as amazing and ordinary people were made into human wonders” (200). Lucian Gomoll similarly writes that freakshows “directed judgement away from the audience and onto the performers, assuring observers of their own unmarked normalcy” (“Objects of Dis/Order” 205).The anomalous nature of the freak therefore promoted the safety of normality at the same time as it purported to showcase the brilliance of the extraordinary. While the freaks themselves were normal, intelligent people, the freakshow served as a vehicle to gaze at oneself with a sense of relief. As much as many freakshows attempt to dismantle notions of normality, they serve to emphasise empathy, not envy. The anomalous freak is never an envied body; the particular dimensions of the freakshow mean that it is the viewer who is to be envied, and the freak who is to be pitied. From Freakshow to SideshowIn nineteenth-century freakshows, exploitation was rife; as Alison Piepmeier explains, “many of the so-called Aztecs, Pinheads, and What Is Its?”, were, in fact, “mentally disabled people dressed in wild costumes and forced to perform” (53). As a result, “freakishness often implied loss of control over one’s self and one’s destiny” (53). P.T. Barnum profited from his exploitation of freaks, while many freaks themselves also benefited from being exhibited. As Jessica Williams writes, “many freak show performers were well paid, self-sufficient, and enjoyed what they did” (69). Bogdan similarly pointed out that “some [freaks] were exploited, it is true, but in the culture of the amusement world, most human oddities were accepted as showmen. They were congratulated for parlaying into an occupation [that], in another context, might have been a burden” (268). Americans of all classes, Anissa Janine Wardi argues, enjoyed engaging in the spectacle of the freak. She writes that “it is not serendipitous that the golden age of the freak show coincided with the building of America’s colonial empire” (518). Indeed, the “exploration of the non-Western world, coupled with the transatlantic slave trade, provided the backdrop for America’s imperialist gaze, with the native ‘other’ appearing not merely in the arena of popular entertainment, but particularly in scientific and medical communities” (518). Despite the accusations levelled against Barnum, his freakshows were seen as educational and therefore beneficial to both the public and the scientific community, who, thanks to Barnum, directly benefited from the commercialisation of and rising public interest in the freak. Discussing “western conventions of viewing exotic others”, Lucian Gomoll writes that “the freak and the ‘normal’ subject produced each other in a relationship of uneven reciprocity” (“Feminist Pleasures” 129). He writes that Barnum “encouraged onlookers to define their own identities in contrast to those on display, as not disabled, not animalistic, not androgynous, not monstrous and so on”. By the twentieth century, he writes, “shows like Barnum’s were banned from public spaces as repugnant and intolerable, and forced to migrate to the margins” (129).Gomoll commends the Freakatorium, a museum curated by the late sword swallower Johnny Fox, as “demonstrating and commemorating the resourcefulness and talents of those pushed to the social margins” (“Objects of Dis/Order” 207). Gomoll writes that Fox did not merely see freaks as curiosities in the way that Barnum did. Instead, Fox provided a dignified memorial that celebrated the uniqueness of each freak. Fox’s museum displays, he writes, are “respectable spaces devoted to the lives of amazing people, which foster potential empathy from the viewers – a stark contrast to nineteenth-century freakshows” (205). Fox himself described the necessity of the Freakatorium in the wake of the sideshow: New York needs a place where people can come see the history of freakdom. People that were born with deformities that were still amazing and sensitive people and they allowed themselves to be viewed and exhibited. They made a good living off doing that. Those people were to be commended for their courageousness and bravery for standing in front of people. (Hartzman)Fox also described the manner in which the sideshow circuit was banned over time:then sideshows went out because some little girl was offended because she thought the only place she could work was the sideshow. Her mother thought it was disgraceful that people exhibited themselves so she started calling the governor and state’s attorney trying to get sideshows banned. I think it was Florida or South Carolina. It started happening in other states. They said no exhibiting human anomalies. These people who had been working in sideshows for years had their livelihood taken away from them. What now, they’re supposed to go be institutionalized? (Hartzman) Elizabeth Stephens argues that a shift occurred in the early twentieth century, and that by the late ‘30s “people with physical anomalies had been transformed in the cultural imagination from human oddities or monsters to sick people requiring diagnoses and medical intervention” (Stephens). Bogdan noted that by the 1930s, “the meaning of being different changed in American society. Scientific medicine had undermined the mystery of certain forms of human variation, and the exotic and aggrandized modes had lost their flamboyant attractiveness” (274). So-called freaks became seen as diseased bodies who “were now in the province of physicians, not the general public” (274). Indeed, scientific interest transformed the freak into a medical curiosity, contributing to the waning popularity of freakshows. Ironically, although the freaks declined in popularity as they moved into the medical community, medicine would prove to be the domain of a new kind of freak in the ensuing years. The Manufactured Freak As the freakshow declined in popularity, mainstream culture found other subjects whose appearance provoked curiosity, awe, and revulsion. Although plastic surgery is associated with the mid-to-late twentieth century and beyond, it has a long history in the medical practice. In A History of Plastic Surgery, Paolo Santoni-Rugiu and Philip J. Sykes note that “operations for the sole purpose of improving appearances came on the scene in 1906” (322). Charles C. Miller was one of the earliest pioneers of plastic surgery; Santoni-Rugiu and Sykes write that “he never disguised the fact that his ambition was to do Featural Surgery, correcting imperfections that from a medical point of view were not considered to be deformities” (302). This attitude would fundamentally transform notions of the “normal” body. In the context of cosmetic surgery, it is the normal body that becomes manipulated in order to produce something which, despite intentions, proves undoubtedly freakish. Although men certainly engage in plastic surgery (notably Igor and Grichka Bogdanoff) the twenty-first century surgical freak is synonymous with women. Kirsty Fairclough-Isaacs points out the different expectations levelled against men and women with respect to ageing and plastic surgery. While men, she says, “are closely scrutinised for attempting to hide signs of ageing, particularly hair loss”, women, in contrast, “are routinely maligned if they fail to hide the signs of ageing” (363). She observes that while popular culture may accept the ageing man, the ageing woman is less embraced by society. Consequently, women are encouraged—by the media, their fans, and by social norms around beauty—to engage in surgical manipulation, but in such a way as to make their enhancements appear seamless. Women who have successful plastic surgery—in the sense that their ageing is well-hidden—are accepted as having successfully manipulated their faces so as to appear flawless, while those whose surgical exploits are excessive or turn out badly become decidedly freakish. One of the most infamous plastic surgery cases is that of Jocelyn Wildenstein, also known as “catwoman”. Born Jocelynnys Dayannys da Silva Bezerra Périsset in 1940, Wildenstein met billionaire art dealer Alec N. Wildenstein whom she married in the late 1970s. After discovering her husband was being unfaithful, Wildenstein purportedly turned to cosmetic surgery in order to sculpt her face to resemble a cat, her husband’s favourite animal. Ironically but not surprisingly, her husband purportedly screamed in terror when he saw his wife’s revamped face for the first time. And although their relationship ended in divorce, Wildenstein, dubbed “the Bride of Wildenstein”, continued to visit her plastic surgeon, and her face became progressively more distorted over the years (Figure 2). Figure 2: Jocelyn Wildenstein over the years <https://i.redd.it/vhh3yp6tgki31.jpg>. The exaggerated and freakish contours of Wildenstein’s face would undoubtedly remind viewers of the anatomical exaggerations seen in traditional freaks. Yet she does not belong to the world of the nineteenth century freak. Her deformities are self-inflicted in an attempt to fulfil certain mainstream beauty ideals to exaggerated lengths. Like many women, Wildenstein has repeatedly denied ever having received plastic surgery, claiming that her face is natural, while professing admiration for Brigitte Bardot, her beauty idol. Such denial has made her the target of further criticism, since women are not only expected to conceal the signs of ageing successfully but are also ironically expected to be honest and transparent about having had work done to their faces and bodies, particularly when it is obvious. The role that denial plays not just in Wildenstein’s case, but in plastic surgery cases more broadly, constitutes a “desirability of naturalness” (122), according to Debra Gimlin. There is, she argues, an “aesthetic preference for (surgically enhanced) ‘naturalness’” (122), a desire that sits between the natural body and the freak. This kind of appearance promotes more of an uncanny naturalness that removes signs of ageing but without being excessive; as opposed to women whose use of plastic surgery is obvious (and deemed excessive according to Williams’ “monstrous body”) the unnatural look that some plastic surgery promotes is akin to an absence of normal features, such as wrinkles. One surgeon that Gimlin cites argues that he would not remove the wrinkles of a woman in her 60s: “she’s gonna look like a freak without them”, he says. This admission signifies a clear distinction between what we understand as freakish plastic surgery (Wildenstein) and the not-yet-freakish appearance of women whose surgically enhanced appearance is at once uncanny and accepted, perpetuating norms around plastic surgery and beauty. Denial is thus part of the fabric of performing naturalness and the desire to make the unnatural seem natural, adding another quasi-freakish dimension to the increasingly normalised appearance of surgically enhanced women. While Wildenstein is mocked for her grotesque appearance, in addition to her denial of having had plastic surgery, women who have navigated plastic surgery successfully are congratulated and envied. Although contemporary media increasingly advocates the ability to age naturally, with actresses like Helen Mirren and Meryl Streep frequently cited as natural older beauties, natural ageing is only accepted to the extent that this look of naturalness is appeasing. Unflattering, unaltered naturalness, on the other hand, is demonised, with such women encouraged to turn to the knife after all in order to achieve a more acceptable look of natural ageing, one that will inevitably and ironically provoke further criticism. For women considering plastic surgery, they are damned if they do and damned if they don’t. Grant McCracken notes the similarities between Wildenstein and the famous French body artist Orlan: “like Orlan, Wildenstein had engaged in an extravagant, destructive creativity. But where Orlan sought transformational opportunity by moving upward in the Renaissance hierarchy, toward saints and angels, Wildenstein moved downwards, toward animals” (25). McCracken argues that it isn’t entirely clear whether Orlan and Wildenstein are “outliers or precursors” to the contemporary obsession with plastic surgery. But he notes how the transition of plastic surgery from a “shameful secret” to a ubiquitous if not obligatory phenomenon coincides with the surgical work of Orlan and Wildenstein. “The question remains”, he says, “what will we use this surgery to do to ourselves? Orlan and Wildenstein suggest two possibilities” (26).Meredith Jones, in her discussion of Wildenstein, echoes the earlier sentiments of Williams in regards to the monster’s body possessing too much or too little. In Wildenstein’s case, her freakishness is provoked by excess: “when too many body parts become independent they are deemed too disparate: wayward children who no longer lend harmony or respect to their host body. Jocelyn Wildenstein’s features do this: her cheeks, her eyes, her forehead and her lips are all striking enough to be deemed untoward” (125). For Jones, the combination of these features “form a grotesquery that means their host can only be deemed, at best, perversely beautiful” (125). Wildenstein has been referred to as a “modern-day freak”, and to a certain extent she does share something in common with the nineteenth century freak, specifically through the manner in which her distorted features invite viewers to gawk. Like the Elephant Man, her freakish body possesses “too much”, as Williams put it. Yet her appearance evokes none of the empathy afforded traditional freaks, whose facial or anatomical deformities were inherent and thus cause for empathy. They played no role in the formation of their deformities, only reclaiming agency once they exhibited themselves. While Wildenstein is, certainly, an anomaly in the sense that she is the only known woman who has had her features surgically altered to appear cat-like, her appearance more broadly represents an unnerving trajectory that reconstructs the freak as someone manufactured rather than born, upending Katherine Dunne’s assertion that true freaks are born, not made. Indeed, Wildenstein can be seen as a precursor to Nannette Hammond and Valeria Lukyanova, women who surgically enhanced their faces and bodies to resemble a real-life Barbie doll. Hammond, a woman from Cincinnati, has been called the first ‘Human Barbie’, chronicling the surgical process on her Instagram account. She states that her children and husband are “just so proud of me and what I’ve achieved through surgery” (Levine). This surgery has included numerous breast augmentations, botox injections and dental veneers, in addition to eyelash extensions and monthly fake tans. But while Hammond is certainly considered a “scalpel junkie”, Valeria Lukyanova’s desire to transform herself into a living Barbie doll is particularly uncanny. Michael’s Idov’s article in GQ magazine titled: “This is not a Barbie Doll. This is an Actual Human Being” attests to the uncanny appearance of Lukyanova. “Meeting Valeria Lukyanova is the closest you will come to an alien encounter”, Idov writes, describing the “queasy fear” he felt upon meeting her. “A living Barbie is automatically an Uncanny Valley Girl. Her beauty, though I hesitate to use the term, is pitched at the exact precipice where the male gaze curdles in on itself.” Lukyanova, a Ukrainian, admits to having had breast implants, but denies that she has had any more modifications, despite the uncanny symmetry of her face and body that would otherwise allude to further surgeries (Figure 3). Importantly, Lukyanova’s transformation both fulfils and affronts beauty standards. In this sense, she is at once freakish but does not fit the profile of the traditional freak, whose deformities are never confused with ideals of beauty, at least not in theory. While Johnny Fox saw freaks as talented, unique individuals, their appeal was borne of their defiance of the ideal, rather than a reinforcement of it, and the fact that their appearance was anomalous and unique, rather than reproducible at whim. Figure 3: Valeria Lukyanova with a Barbie Doll <http://shorturl.at/mER06>.Conclusion As a modern-day freak, these Barbie girls are a specific kind of abomination that undermines the very notion of the freak due to their emphasis on acceptance, on becoming mainstream, rather than being confined to the margins. As Jones puts it: “if a trajectory […] is drawn between mainstream cosmetic surgery and these individuals who have ‘gone too far’, we see that while they may be ‘freaks’ now, they nevertheless point towards a moment when such modifications could in fact be near mainstream” (188). The emphasis that is placed on mainstream acceptance and reproducibility in these cases affronts traditional notions of the freak as an anomalous individual whose features cannot be replicated. But the shift that society has seen towards genetic and surgical perfection has only accentuated the importance of biological anomalies who affront the status quo. While Wildenstein and the Barbie girls may provoke a similar sense of shock, revulsion and pity as the Elephant Man experienced, they possess none of the exceptionality or cultural importance of real freaks, whose very existence admonishes mainstream standards of beauty, ability, and biology. References Bogdan, Robert. Freak Show: Presenting Human Oddities for Amusement and Profit. Chicago and London: U of Chicago P, 1990. Dunne, Katherine. Geek Love. London: Abacus, 2015. Fairclough-Isaacs, Kirsty. "Celebrity Culture and Ageing." Routledge Handbook of Cultural Gerontology. Eds. Julia Twigg and Wendy Martin. New York: Routledge, 2015. 361-368.Gimlin, Debra. Cosmetic Surgery Narratives: A Cross-Cultural Analysis of Women’s Accounts. New York: Palgrave Macmillan, 2012. Gommol, Lucian. “The Feminist Pleasures of Coco Rico’s Social Interventions.” Art and the Artist in Society. Eds. José Jiménez-Justiniano, Elsa Luciano Feal, and Jane Elizabeth Alberdeston. Newcastle upon Tyne: Cambridge Scholars Publishing, 2013. 119-134. ———. “Objects of Dis/Order: Articulating Curiosities and Engaging People at the Freakatorium.” Defining Memory: Local Museums and the Construction of History in America’s Changing Communities. Eds. Amy K. Levin and Joshua G. Adair. Lanham: Rowman & Littlefield, 2017. 197-212. Hartzman, Marc. “Johnny Fox: A Tribute to the King of Swords.” Weird Historian. 17 Dec. 2017. <https://www.weirdhistorian.com/johnny-fox-a-tribute-to-the-king-of-swords/>.“Humbug.” The X-Files: The Complete Season 3. Writ. Darin Morgan. Dir. Kim Manners. Fox, 2007. Idov, Michael. “This Is Not a Barbie Doll. This Is an Actual Human Being.” GQ. 12 July 2017. <https://www.gq.com/story/valeria-lukyanova-human-barbie-doll>.Jones, Meredith. Skintight: An Anatomy of Cosmetic Surgery. Oxford: Berg, 2008.McCracken, Grant. Transformations: Identity Construction in Contemporary Culture. Bloomington and Indianapolis: Indiana UP, 2008.Levine, Daniel D. “Before and After: What $500,000 of Plastic Surgery Bought Human Barbie.” PopCulture.com. 7 Dec. 2017. <https://popculture.com/trending/news/nannette-hammond-before-human-barbie-cost-photos/>. Piepmeier, Alison. Out in Public: Configurations of Women's Bodies in Nineteenth-Century America. Chapel Hill and London: U of North Carolina P, 2004. Santoni-Rugiu, Paolo, and Philip J. Sykes. A History of Plastic Surgery. Berlin: Springer-Verlag, 2017. Stephens, Elizabeth. “Twenty-First Century Freak Show: Recent Transformations in the Exhibition of Non-Normative Bodies.” Disability Studies Quarterly 25.3 (2005). <https://dsq-sds.org/article/view/580/757>.Wardi, Anissa Janine. “Freak Shows, Spectacles, and Carnivals: Reading Jonathan Demme’s Beloved.” African American Review 39.4 (Winter 2005): 513-526.Williams, Jessica L. Media, Performative Identity, and the New American Freak Show. London and New York: Palgrave MacMillan, 2017. Williams, Linda. “When the Woman Looks.” Horror, The Film Reader. Ed. Mark Jancovich. London and New York: Routledge, 2002. 61-66.

Introduction The Uluru Statement from the Heart (2017) offers an opportunity for the nation to cement the foundation for prosperous Indigenous futures and meaningful reconciliation between Indigenous and non-Indigenous peoples. In this article, we discuss the theme of uniformity in relation to the “From the Heart” campaign which seeks to enact the Uluru Statement by establishing a constitutionally enshrined First Nations’ Voice to Parliament via a referendum. It is important however that we first clarify our use of the word uniform as we do not wish to suggest that all supporters of the Uluru Statement from the Heart are homogenous in their views or positioning. Far from it, the campaign aims to generate support from all walks of life, and with this, it naturally conjures diverse opinions, and at times disagreement (Pearson). Whilst unification corresponds to different persons coming together to form a collective whole – and the From the Heart Campaign can certainly be characterised in this way – uniformity refers to the uncompromising stance needed to enact the reform proposed in the Statement. In this article, we discuss how a constitutionally enshrined First Nations’ Voice to Parliament is the heart of the Uluru Statement and how the push towards a referendum requires not just a unified and united response, but one that is uniformed in its resolve – that is unwavering, steadfast, and determined in delivering its vision of a constitutionally enshrined First Nations’ Voice to Parliament. We therefore consider how images, symbols, icons, and material objects – both digital and tangible – are used to unite the campaigns’ supporters by presenting a uniformed front that advocates for constitutional reform. The Heart as Uniform and Icon Bleiker argues that icons, particularly within the digital space, are effective means of communication due to their ability to quickly disseminate messages in succinct and memorising ways that are relevant and responsive to its users’ needs (Petray; Carlson et al. ‘They Got Filters’; Fredericks and Bradfield ‘Disrupting the Colonial’). The ability of digital media to spread messages over vast distances and in ways that compress time and space, however, also means that the icons communicated through media such as memes (Blackmore; Petray; Fredericks and Bradfield ‘Co-Designing Change’) are in danger of becoming fleeting, empty, or meaningless (Fredericks and Bradfield ‘Disrupting the Colonial’; Petray; Carlson and Frazer ‘Indigenous activism’). Bleiker (9) warns that “when images are produced and circulated with ever greater speed and reach, icons can emerge in a short period. But this very proliferation of images can also lead to a situation where icons are short-lived and soon become superseded from their original setting”. Due to the fluid and often fickle nature of online culture where symbols and images are quickly adopted, transformed, repurposed, disposed, and replaced, icons are most powerful when they reflect a uniformed message, for uniforms demonstrate stability, endurance, and longevity. Uniforms therefore share some affiliation with icons in their ability to transmit messages of social significance. In their sociological study of uniforms, Joseph and Alex (719) argue that the uniform is viewed as a device to resolve certain dilemmas of complex organizations – namely, to define their boundaries, to assure that members will conform to their goals, and to eliminate conflicts in the status sets of their members. The uniform serves several functions: it acts as a totem, reveals and conceals statuses, certifies legitimacy, and suppresses individuality. The interaction of these components and the acceptance or rejection of the uniform and its associated status by the wearer are described. The use of hearts during the Uluru Statement from the Heart campaign can be likened to icons that convey uniformed messages relating to the need for constitutional reform and the creation of a First Nations’ Voice to Parliament. Repeated imagery of hearts, particularly in the colours of the Aboriginal flag – black, red, and yellow – alongside images of Uluru – an unmistakable icon of Aboriginality – has the potential to provoke political and social discussion amongst those who witness them. Online media have provided fora where information and support for the campaign has been shared, creating some uniformity amongst diverse audiences (Fredericks and Bradfield ‘Seeking to be Heard’; ‘More than a thought’). Emoticons, symbols, and hashtags have formed a type of digital uniform that has congealed ideas and helped centralise messages (Grieve-Williams), in this case in relation to the importance of the constitutional enshrinement of a First Nations’ Voice to Parliament. A heart also describes a centralised location that drives action or is seen to represent the underlying ethos of a community, movement, or object. In terms of physiology, the heart is located at the centre of a body and sustains life by pumping blood throughout the cardiovascular system. Similarly, Uluru is physically located in Central Australia, with many considering it as symbolling the geographical and spiritual heart of the nation. Whilst Uluru will always remain a part of the sacred grounds of the Anangu People (Schultz), its iconography resonates with Indigenous and non-Indigenous peoples throughout the nation, acting as a beacon for Indigenous rights and sovereignty. For the Anangu People, Uluru is a site of conflict resolution and great power (Anandakugan), making it an appropriate icon of reconciliation, Makarrata, and healing relationships between Indigenous and non-Indigenous peoples. Wearing Our Hearts on Our Sleeves Amongst other things, jewelry, art, and material objects function as communicative tools which present agreed-upon symbols and codes that represent messages that are collectively decided upon by a particular social group (Geertz; Shaw). Writing on art as a cultural system, Geertz (1488) famously observed how “it is out of participation in the general system of symbolic forms we call culture that participation in the particular we call art, which is in fact but a sector of it, is possible. A theory of art is thus at the same time a theory of culture, not an autonomous enterprise”. Langley writes on how human societies have used beads in jewelry to disseminate social information for at least 100,000 years. Throughout history, jewelry and fashion accessories have been used as visual representations of uniformity amongst activists and protestors (Gulliver). These icons aim to communicate an unwavering front which at times of protest or social upheaval often counter the icons and uniforms of opposing camps, whether the police force, military, or political rivals. The umbrella movement in Hong Kong is one visually striking example of uniformity and civil disobedience where pro-democracy messages were communicated via yellow umbrellas that contrasted the pro-establishment camp who wore blue (Radio Free Asia). The t-shirt for the Uluru campaign depicts an image of Uluru which visibly sits on the land but is also embedded below the surface of Country. Both parts collectively form the shape of a red heart. The shirt reads “We Support the Uluru Statement”, emitting the words “From the Heart”. This clever form of marketing invokes a sense of communitas amongst those who can collectively interpolate and understand its meaning (Turner). It is the shared knowledge that the statement comes “from the heart” (even though it is not written on the t-shirt) amongst those who form the collective “we” that gives the shirt a function that can be likened to a uniform. It is a visual embodiment of the Statement that seeks to “certify its legitimacy” (Joseph and Alex). Brooches and jewelry have also been used as means to provoke conversation and add social or political commentary during public engagements; often in satirical and/or ironic ways (Shaw). Former US Secretary of State Madeleine Albright, for example, famously wore a brooch of a snake after being called an “unparalleled serpent” by Iraqi state media under the Saddam Hussein regime (Becker). For Albright, brooches complemented her political agenda and became part of her “diplomatic arsenal” (Becker), which she described as effective mnemic communication that helped generate greater understandings amongst the wider public (Albright). Whilst an expression of her individuality, the jewelry delivers a uniformed statement and commentary that defines boundaries, assures goals, and seeks to eliminate conflicts or ambiguity in the messages she seeks to deliver. In this respect, it functions as part of her uniform. Similarly, when Lady Hale, the president of the UK Supreme Court, claimed Boris Johnson’s decision to prorogue parliament was unlawful in 2019, she strategically wore a spider brooch (Cochrane and Belam). The imagery was quickly seized upon by activists who interpreted it as a symbol of the government’s dysfunction, or venomous nature, and printed the design on t-shirts. The shirts sold out in less than 24 hours and presented a uniformed front that both critiqued the government and raised money for a homeless shelter (Butchart). A Gift Worth Sharing The Uluru Statement was gifted to the Australian people to affirm the campaign as one for and led by the Australian public (Synott; Appleby and Davis). The decision to disseminate the outcomes of the National Convention via a poetic and concise statement, rather than a formalised petition or legal declaration, emphasises its intent to remain accessible to the public (Davis ‘The Long Road’). The fact that it was gifted to the public instead of being “presented” or “submitted” to government signifies that it is a gesture of good faith that invites the Australian people to join the movement, whilst also placing onus on the public to accept or reject the gift that is offered and placing pressure on the government to call a referendum (Mayor). In the spirit of the Uluru Statement’s gifting, heart icons and paraphernalia are often exchanged amongst its supporters with aim of building awareness and provoking conversation. One of the authors of this paper, Professor Bronwyn Fredericks, is known for having accumulated an extensive collection of heart objects, many of which have been gifted to her. These objects range from brooches, earrings, necklaces, and other forms of jewelry to clothes, fabrics, and novelty glasses. Although the medium varies, the heart iconography and messages remain uniform. The Uluru from the Heart Campaign, however, has suffered many arrhythmias, at times speeding up whilst at others becoming really slow. After the reforms were presented to the Australian Government in 2017, the then prime minister Malcom Turnbull rejected them on account that an Indigenous Voice to Parliament was undesirable, too “radical” in nature, and unlikely to pass a referendum (Wahlquist; Brennan). A media release from the government published on 26 October 2017 declared that “the Government does not believe such a radical change to our constitution’s representative institutions has any realistic prospect of being supported by a majority of Australians in a majority of States” (Prime Minister et al.). The chief executive of the Victorian Community Controlled Health Organisation, Jill Gallagher, has commented that many politicians were too preemptive in their dismissal of the reforms; and in doing so, prevented the public from engaging in the critical discussion that is needed before a referendum (Brennan). Public discussion is now increasing after the Albanese-led Labor government announced that a referendum will be held during their first term of their government, which was formed in 2022 (Kunc). Turnbull’s rejection was also premised on the notion that the Uluru Statement, and its call for a First Nations Voice to Parliament, was too uniform in its “take it or leave it” positioning, which the government was unwilling to commit to (Prime Minister et al.). After years of having reforms and recommendations diluted or ignored by governments, and political promises and commitments dismissed (see Fredericks for an example), the Referendum Council were unapologetic in their stance that the Statement remain untouched and unmanipulated by politicians and political agendas (Referendum Council). The proposed reforms are the manifestation of Indigenous peoples’ will and desire as expressed during the regional dialogue (Anderson, Davis, and Pearson; Davis and Williams). The Final Report of the Referendum Council reads that “it is the Council’s view that there is no practical purpose to suggesting changes to the Constitution unless they are what Aboriginal and Torres Strait Islander peoples want” (Referendum Council, 5). It must be remembered that the Referendum Council was established by Malcom Turnbull in 2015, tasked with finding out what Indigenous peoples wanted to see in constitutional reform. Whilst the Turnbull government were willing to provide a forum in which Indigenous views on constitutional reform could be expressed, they were unwilling to honour their aspirations. After sharing deeply personal and at times traumatic stories of colonial harm and violence at the dialogues (Appleby and Davis), along with entertaining the idea of having greater input into parliamentary discussions, the flat-out rejection by the government was heartbreaking. Aboriginal lawyer, activist, and academic Noel Pearson spoke of the anguish caused by Malcolm Turnbull’s rejection in a Radio National interview, describing him as having “broken the hearts of the First Nations people of this country” (Brennan). Constitutional lawyer Megan Davis was with a young Indigenous law student who had participated in the regional dialogues when the interview aired (Davis ‘The Long Road’). Like many, this was the first she had heard of the Statement’s rejection. Davis recalls how “I could see her faith in the rule of law, fairness and equality – all the important characteristics of our public law system – drain from her face” (Davis, 2019). The impact of Turnbull’s rejection was described by some as “mean-spirited bastardry” (Wahlquist) and is articulated in a cartoon depicting a heart being surgically removed from Uluru (Grant). We wear heart icons as uniforms not only in support of the campaign but as a reminder of its fragility. Whilst hearts are prone to break, like all muscles it is through their tearing and growth that they become stronger. A Voice to Parliament The imagery of hearts aims to generate wider public recognition of the need to recognise First Nations’ peoples within Australia’s constitution via Voice, Truth, Treaty, and in that order (Davis and Williams; Fredericks and Bradfield ‘More than a Thought’; Larkin and Galloway). The need for a visible and uniformed campaign towards constitutional reform, however, is challenged when politicians including the former Indigenous Affairs minister Ken Wyatt (Anderson et al.) or former Greens and now independent senator Lidia Thorpe (Larkin and Maguire) question the premise that reforms such as a constitutionally enshrined First Nations’ Voice to Parliament are representative of Indigenous peoples’ will. Thorpe’s objection is based on the premise that Treaty should be sought first. Our criticism is not placed on their oppositional stance but rather on their false characterisation that it does not reflect the desire of the majority of Aboriginal and Torres Strait Islander peoples as expressed through the Uluru Dialogues. Despite seven delegates walking out on the convention in protest that it would hinder Indigenous sovereignty via a treaty (Hobbs), the 13 regional dialogues conducted by the Referendum Council and led by Indigenous leaders such as Megan Davis, Pat Anderson, and numerous others, as well as delegates at Uluru, clearly expressed a near unanimous and uniformed decision to establish an Indigenous representative body that was protected by the constitutional enshrinement (Davis ‘The Long Road’; Davis and Williams; Fredericks and Bradfield ‘We Don’t Want to’). Subsequent polling has shown strong continued majority support amongst the public for a constitutionally enshrined voice (Centre for Governance and Public Policy; Ford and Blumer; Zillman, Wellauer and Brennan; Reconciliation Australia). Past reconciliation movements have centred around the notion of restoring relationships between Indigenous and non-Indigenous peoples (Reynolds). This is problematic as colonisation in Australia was, and in many cases still is, dependent on the denial of Indigenous peoples and cultures, which was accompanied by epistemic and physical acts of violence (Moreton-Robinson; Lee, Richardson, and Ross). In 1999, then prime minister John Howard held a referendum on whether Australia should become a republic. Attached to the question was whether Aboriginal and Torres Strait Islander people should be recognised in the constitution’s preamble (Pearson, Davis, and Appleby ‘The Uluru Statement’). Despite this being rejected by Indigenous land councils and elected representatives, on account of its symbolism, Howard proceeded with the referendum which ultimately failed (Davis ‘The Status Quo’). The Recognise campaign ran from 2012 to 2017 and sought public awareness of questions relating to constitutional recognition of Indigenous peoples. This too was rejected by Indigenous communities (Maddison). Online polling conducted by Indigenous-controlled media forum IndigenousX showed that only 32.3% of its respondents supported the campaign, with many criticising what they saw as a top-down approach tailored towards the appeasement of non-Indigenous sensibilities (Latimore; Fredericks and Bradfield ‘Disrupting the Colonial’). Reconciliation Australia, the organisation that led the campaign, however, stated that it was successful in generating public awareness, which increased from 30% to 75% nationally (Reconciliation Australia). Conclusion What sets the Uluru campaign apart from its predecessors such as Recognise is that it is a grassroots initiative that emerged out of Indigenous-led consultations and dialogues with community members and stakeholders. It was conceived with awareness of the “limitations of the political class” (Davis, ‘The Long Road’) – illustrated by the ineptitude of Turnbull and other critics – and consciously spoke to the hearts of the Australian public. To ensure that different Indigenous perspectives and interest groups were represented during the National Conference, 60% of attendees were traditional owners, 20% came from Aboriginal community organisations, and 20% were individual community members (Lee, Richardson, and Ross; Davis ‘The Long Road'). The reforms of the Uluru Statement, including a First Nations’ Voice to Parliament, aim to create a framework and functioning mechanism that will help build and repair partnerships through which relationships between Indigenous and non-Indigenous peoples can improve, whilst “gaps” across a range of social outcomes can be redressed by policies led and informed by Indigenous people in accordance with national (Coalition of Peaks) and international (Synott ‘The Universal Declaration’) charters. Whilst Indigenous views are diverse, what remains uniform amongst them is that Aboriginal and Torres Strait Islander strength and power, which has always come from their voices, “are the most powerful of all” when they are together (Davis, ‘Together Our Voices’). Despite the campaigns’ critics and setbacks, our hearts continue to beat as one and our uniformed advance towards referendum remains steadfast. References Albright, Madlelaine. Read My Pins: Stories from a Diplomat's Jewel Box. 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Richardson, and Helen Ross. “The 'Uluru Statement from the Heart': Investigating Indigenous Australian Sovereignty.” Journal of Australian Indigenous Issues 23.1-2 (2020): 18-41. <https://search.informit.org/doi/abs/10.3316/informit.386298778751454>. Maddison, Sarah. “Recognise What?: Problems with the Campaign for Constitutional Recognition.” Indigenous Law Bulletin 8.24 (2016): 20-24. <https://search.informit.org/doi/10.3316/informit.164154921010339>. Mayor, Thomas. “Understanding the Uluru Statement: Taking the Invitation to the People through the Classrooms.” Journal of Professional Learning 15 (2022): 63–66. <https://search.informit.org/doi/10.3316/informit.556989742257690>. Pearson, Luke. “Social Media Amplifies Indigenous Voices, Even If They Don’t Always Agree.” ABC Radio National 29 May 2017. <https://www.abc.net.au/news/2017-05-29/luke-pearson-social-media-amplifying-indigenous-voices/8349862>. Pearson, Noel, Megan Davis, Rosalind Dixon, and Gabrielle Appleby. “The Uluru Statement.” Bar News: The Journal of the NSW Bar Association (2018): 41-48. <https://search.informit.org/doi/10.3316/agispt.20180726000224>. Petray, Theresa Lynn. "Self-Writing a Movement and Contesting Indigeneity: Being an Aboriginal Activist on Social Media." Global Media Journal: Australian Edition 7 (2013): 1-20. ———. “Protest 2.0: Online Interactions and Aboriginal Activists.” Media, Culture & Society 33.6 (2011): 923–940. <https://doi.org/10.1177/0163443711411009>. Prime Minister, Attorney General & Minister for Indigenous Affairs. Response to Referendum Council's Report on Constitutional Recognition. 2017. <https://parlinfo.aph.gov.au/parlInfo/download/media/pressrel/5596294/upload_binary/ 5596294.pdf;fileType=application%2Fpdf#search=%22media/pressrel/5596294%22>. Radio Free Asia. Walking with A Yellow Umbrella Bearing Witness to a Revolution. 2015. Reconciliation Australia. "2022 Australian Reconciliation Barometer." 2022. <https://www.reconciliation.org.au/wp-content/uploads/2022/11/Australian-Reconciliation-Barometer-2022.pdf>. ———. "Recognise Campaign Successful in Raising Awareness." 29 June 2018. 25 Nov. 2022 <https://www.reconciliation.org.au/recognise-campaign-successful-in-raising-awareness/>. Referendum Council. Referendum Council Final Report. 2017. <https://www.referendumcouncil.org.au/sites/default/files/report_attachments/Referendum_Council_Final_Report.pdf>. Reynolds, Henry. This Whispering in Our Hearts Revisited. NewSouth, 2018. Schultz, Julianne. “Whispering in Our Hearts: Time to Learn from the Past.” Griffith Review 60 (2018): 7–11. <https://search.informit.org/doi/10.3316/informit.585273018226783>. Shaw, Elizabeth. “Jewellery Is Political: Ethical Jewellery Practice.” Craft Is Political. Ed. D Wood. 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Photo by Owen Beard on Unsplash Introduction Through its professional associations and healthcare organizations, the medical community has made numerous anti-racism statements in the past year, including the American Medical Association’s (“AMA’s) Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity.[1] Converting these statements into practical change will take time and money. In addition to implementing anti-bias training and education on racism in clinical practice, the medical community should also advocate to enhance and enforce Title VI anti-discrimination laws. The current limitations on enforcement conflict with the medical community’s ethical duty to improve health equity and treat all patients with a high standard of care. Advocating for legislation that meets the standards of other civil rights laws to hold the healthcare industry legally responsible for discrimination should be part of medical professionals’ anti-racism work. Development of Civil Rights in Health Care Despite the lack of a federal constitutional right to health care, the United States does acknowledge the importance of health and health care through its laws and spending decisions. In 2010, the Affordable Care Act (“ACA”) created health insurance options for 20 million additional Americans and reduced the gap in healthcare access among populations.[2] Although it did not ensure a right to health care and it does not guarantee a right to health, healthcare access is an important element of a healthy life and broadening the reach of health insurance is a worthy goal. Outside of the ACA’s offer of affordable health insurance, only a few stakeholders have gained “weak” statutory rights to publicly funded health care such as incarcerated people, the elderly, disabled, and the very poor.[3] Yet, the adoption of the public insurance programs Medicaid and Medicare in 1965, along with Title VI of the 1964 Civil Rights Act (“Title VI”), did create some rights to sue for discrimination in health care, even for people who are not recipients of Medicaid and Medicare benefits. Under Title VI, private institutions that receive federal financial assistance are prohibited from discriminating on the basis of race, color, and national origin.[4] Initially, this civil rights legislation had a major effect on health care because more than 1000 segregated hospitals immediately integrated their facilities in order to comply with the legislation and participate in Medicaid and Medicare.[5] Medical professionals interested in anti-racist work would do well to learn the history of Title VI; grassroots support of civil rights laws in the 1960s encouraged huge steps forward in eliminating de jure segregation in health care.[6] Title VI Lacks Mechanisms to Combat Structural Racism Title VI has been less effective when addressing more subtle forms of discrimination. Despite being one of the broadest anti-discrimination statutes, Title VI has been referred to as a “sleeping giant” because its full power has not been used to great effect.[7] The ACA included some attempts to improve Title VI’s effectiveness (see below), but much more could be done. Like most civil rights laws, Title VI discrimination may be alleged as disparate treatment (intentional) or disparate impact. Disparate impact claims are challenging to prove and may involve arguments such as how moving a hospital from an inner-city area to a wealthier suburban location will have a disparate impact on the local Black population. Besides the evidentiary challenges involved in demonstrating disparate impact, such a claim fails unless the plaintiffs can prove that a reasonable explanation for the action, such as cost savings, is a pretext for discrimination.[8] Title VI claims are also challenging because of the limitation on plaintiffs, the limitation on the scope of defendants, and enforcement issues. In 2001, the US Supreme Court held that individual plaintiffs cannot sue under Title VI for disparate impact claims, requiring a federal agency to do so.[9] While hospitals and other entities are potential defendants under Title VI, individual medical professionals are not, even though approximately 40 percent of Medicaid and Medicare reimbursements now go to physician and outpatient care.[10] The primary enforcement mechanism for Title VI healthcare claims is forcing compliance with the law through the threat of withdrawal of federal reimbursement.[11] The threat of financial punishments may harm communities, however, when low-resourced hospitals lose funding or are forced to fund rehabilitation programs.[12] Inequities between hospitals in different locations currently cannot be addressed under Title VI. Recent attempts to improve Title VI have failed. In the ACA, legislators included several updates to Title VI that appeared to improve its potential as a tool for reducing healthcare inequities. Section 1557 of the ACA changed the definition of “federal financial assistance” programs to include Medicaid and Medicare Advantage, thus expanding the pool of possible defendants to include individual providers.[13] However, the Department of Health and Human Services issued an implementing rule that specifically did not include Medicare Part B, so as of now patients cannot bring suit against sue their doctors for Title VI discrimination.[14] Some authors argue that the ACA also repealed the Supreme Court decision that prevented individuals from bringing disparate impact claims under Title VI.[15] So far, however, courts still interpret Title VI as supporting private claims only for intentional discrimination.[16] Individuals can still bring disparate impact claims to the Office of Civil Rights (“OCR”) and the Federal government may take action on their behalf. Because of the lack of available private action, however, there is no robust group of Title VI attorneys developing these civil rights cases.[17] If the legislature wants to encourage private enforcement of Title VI discrimination cases, it could also add punitive and compensatory damages to the available remedies, as it did with Title VII employment discrimination cases,[18] thus empowering plaintiffs and their lawyers to seek private remedies for discrimination in health care. Private litigation could be used as an additional lever in strategic approaches to eliminating discriminatory practices and improving health equity.[19] In 2003, the Institute of Medicine’s Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care recommended that the federal government increase funding for the OCR to encourage investigations into violations of Title VI based on systemic discrimination in health care.[20] The committee saw such enforcement as a “last line” of defense against systemic racism in health care, and a way to find such suspected racism through proactive investigations. Unfortunately, the OCR continues to be “notoriously” underfunded, but future administrations may be encouraged to rectify that problem.[21] Permitting more individual lawsuits may improve Title VI by providing better enforcement mechanisms and broadening the scope of possible defendants. These litigation tools will never bring about a right to health but can reduce inequities in access to and treatment in the healthcare system. Health professionals can support such proposals as individuals and through their professional associations. Of course, not all stakeholders agree that the federal government should enforce greater access to health care; after several states brought suit, the US Supreme Court struck down the ACA provision that would have effectively required states to expand Medicaid eligibility.[22] In addition, many health professionals will object to individual Title VI lawsuits. Distinguishing between malpractice litigation and discrimination litigation will be important so that healthcare practitioners do not feel their livelihoods are threatened by Title VI. If improving health equity and combating racism is seen part of one’s ethical duty, then medical professionals should embrace a willingness to be held accountable personally, and even more importantly, as part of a healthcare organization. The AMA has a well-documented history of racism, and the organization has apologized and sought atonement. Part of that history includes a failure to support civil rights legislation in the 1960s and active opposition to Medicare, Medicaid, and the desegregation of hospital staff.[23] Notably, the National Medical Association, an African American medical association, worked hard to support civil rights laws and integration in the 1960s, but could not convince the “White” AMA to follow suit. As part of its anti-racism efforts, the AMA could work with legislators to craft appropriate changes to Title VI and take on the task of educating its membership. Health professionals should understand that the shortcomings of Title VI in eradicating racism in health care were due to decisions about and interpretations of the law which were influenced by the medical profession itself. Educating all the stakeholders about the connections between health, healthcare access, and strong enforcement of our civil rights statutes and regulations is one way that health professionals can actively engage in anti-racism work in the healthcare profession. [1] “The AMA’s Strategic Plan to Embed Racial Justice and Advance Health Equity,” American Medical Association, accessed June 25, 2021, https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justice-and-advance-health-equity. [2] “How ACA Narrowed Racial Ethnic Disparities Access to Health Care | Commonwealth Fund,” accessed March 10, 2021, https://www.commonwealthfund.org/publications/2020/jan/how-ACA-narrowed-racial-ethnic-disparities-access. [3] Aeyal Gross and Colleen Flood, The Right to Health at the Public/Private Divide : A Global Comparative Study, New York (Cambridge University Press, 2014), , 348, https://web-a-ebscohost-com.ezproxy.cul.columbia.edu/ehost/ebookviewer/ebook/ZTAyNXhuYV9fNzcwMjExX19BTg2?sid=5201c555-548f-4599-ae3d-857f6911322f@sessionmgr4007&vid=0&format=EB&lpid=lp_261&rid=0. [4] Title VI of the 1964 Civil Rights Act, § 2000d (“No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”) [5] Amitabh Chandra, Michael Frakes, and Anup Malani, “Challenges to Reducing Discrimination and Health Inequity Through Existing Civil Rights Laws,” Health Affairs (Project Hope) 36, no. 6 (June 1, 2017): 1041–47, 1042, https://doi.org/10.1377/hlthaff.2016.1091. [6] David Barton Smith, “The ‘Golden Rules’ for Eliminating Disparities: Title VI, Medicare, and the Implementation of the Affordable Care Act,” Health Matrix, 2015, Gale OneFile: LegalTrac. [7] Olatunde C. A. Johnson, “Lawyering That Has No Name: Title VI and the Meaning of Private Enforcement,” Stanford Law Review 66, 6 (June 2014): 1293-1331, at 1294. [8] Chandra, Frakes, and Malani, at 1043. [9] Alexander v. Sandoval, 532 U.S. 275 (2001). [10] Chandra, Frakes, and Malani, at 1043. [11] See 42 U.S.C. §2000d-1. [12] Chandra, Frakes, and Malani, at 1045. [13] 42 U.S.C. §18116. [14] Chandra, Frakes, and Malani, at 1045. [15] Sarah G. Steege, “Finding a Cure in the Courts: A Private Right of Action for Disparate Impact in Health Care,” Michigan Journal of Race & Law 16, 439 (April 2011): 439- 468. [16] See, e.g., Lemon v. Aurora Health Care North Inc., 19-CV-1384 (E.D. WI Feb. 22, 2021). [17] Johnson, “Lawyering That Has No Name,” at 1295. [18] Pub. L. No. 102-166, § 102, 105 Stat. 1071, 1072-72 (codified as amended at 42 U.S.C. § 1981a). [19] Sara Rosenbaum and Sara Schmucker, “Viewing Health Equity through a Legal Lens: Title VI of the 1964 Civil Rights Act,” Journal of Health Politics, Policy and Law 42, no. 5 (October 1, 2017): 771–88, 777, https://doi.org/10.1215/03616878-3940423. [20] Institute of Medicine (US) Committee On Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, ed. Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson (Washington (DC): National Academies Press (US), 2003), http://www.ncbi.nlm.nih.gov/books/NBK220358/. [21] Chandra, Frakes, and Malani, at 1045. [22] National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012). [23] Harriet A. Washington et al., “Segregation, Civil Rights, and Health Disparities: The Legacy of African American Physicians and Organized Medicine, 1910-1968,” Journal of the National Medical Association 101, no. 6 (June 2009): 513–27, https://doi.org/10.1016/S0027-9684(15)30936-6.