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Fostering security of supply in contract-based preparedness in the public sector through the proactive contracting and legal design approaches
Get PDFThe article discusses proactive contracting and legal design approaches and their role in enhancing contract-based preparedness and supply resilience in the public sector. It focuses on the impact of the COVID-19 pandemic on public procurement and supply chains, mainly in the healthcare sector in Finland. The pandemic exposed the need to prepare for unconventional threats and emphasized the importance of effective supply chain management. However, the classical legal approach and competitive tender mentality have dominated public procurement processes and contracts, limiting resilience and flexibility. PC and LD see contracts as multifaceted tools for preventing problems and promoting business success, and relationships. The article discusses tensions at the intersections of public procurement, supply resilience and proactive contracting and legal design approaches, and opportunities for enhancing contract-based preparedness. We argue that PC and LD can complement Finland's comprehensive security approach by developing an organization´s contracting and resilience capabilities to enhance contract-based preparedness.The article discusses the proactive contracting and legal design approaches and their role in enhancing contract-based preparedness and supply resilience in the public sector. It focuses on the impact of the COVID-19 pandemic on public procurement and supply chains, mainly in the healthcare sector in Finland. The pandemic exposed the need to prepare for unconventional threats and emphasized the importance of effective supply chain management. However, the classical legal approach and competitive tender mentality have dominated public procurement processes and contracts, limiting resilience and flexibility. Proactive contracting and legal design see contracts as multifaceted tools for preventing problems and promoting business success, and relationships. The article discusses tensions at the intersections of public procurement, supply resilience, proactive contracting and legal design approaches, and opportunities for enhancing contract-based preparedness. We argue that proactive contracting and legal design can complement Finland's comprehensive security approach by developing an organization's contracting and resilience capabilities to enhance contract-based preparedness
From state of chaos to the essence of the issue:Framework employing service and systemic design principles in the context of criminality
No full textThis chapter discusses the use of service and systemic design to examine and comprehensively address Norway’s issue of criminality, a complex and entangled problem that poses a significant challenge to the system. The study employs thematic analysis of retrospective, semi-structured interviews with both former and current offenders, resulting in the emergence of overarching themes for analysing qualitative data. To test and refine these themes, a process of theme validation and a participatory focus group with stakeholders were employed. Subsequently, stakeholders engaged in a co-creation process to leverage these insights for addressing the root causes through a portfolio of interventions. This method resulted in the identification of the framework that is hoped to be suited for analysing, identifying, and addressing societal challenges
The Limits of the Right to Self-Determination and Restrictions in the Somatic Care of Adult Patients
No full textVoimassa oleva tahdosta riippumatonta hoitoa ja rajoittamistoimenpiteitä koskeva sääntely ei kata kaikkia somaattisessa hoidossa esiintyviä tilanteita, joissa rajoittamista potilaan tai muiden henkilöiden suojelemiseksi on tarvittu. Tämän lainopillisen tutkimuksen tavoitteena on vastata kysymykseen, millä keinoin somaattisessa hoidossa olevan täysi-ikäisen potilaan rajoittamista koskeva sääntelyaukko voitaisiin paikata. Tutkimus jakaantuu kolmeen päälukuun. Ensimmäisessä pääluvussa analysoidaan itsemääräämisoikeuden ja rajoittamissääntelyn kehitystä 1900-luvun alusta 1990-luvulle. Tässä historiakatsauksessa tutkitaan itsemääräämisoikeuden edellytysten: suostumuksen, päätöksentekokyvyn, riittävien tietojen ja vapaaehtoisuuden ilmenemistä ja kehittymistä lääkintäkäytännössä, -etiikassa ja sääntelyssä. Somaattista hoitoa koskevan sääntelyn puuttuessa rajoittamissääntelyn kehitystä analysoidaan kulloinkin voimassa olleen tartuntatauteja, mielisairauksia, päihdehuoltoa ja kehitysvammaisten erityishuoltoa koskevan sääntelyn, eduskunnan oikeusasiamiehen (EOA) ja valvontaviranomaisen ratkaisujen kautta.Toisessa pääluvussa analysoidaan somaattisessa hoidossa olevan täysi-ikäisen potilaan itsemääräämisoikeuden rajojen ja rajoittamisedellytysten sääntelyn ja soveltamisen nykytilaa. Analysointi aloitetaan kansainvälisistä ihmisoikeussopimuksista ja niiden valvontaelinten ratkaisukäytännöstä. Perinteisesti Euroopan neuvoston ja YK:n sopimusjärjestelmien puitteissa on tietyin reunaehdoin hyväksytty potilaan itsemääräämisoikeuden rajoittaminen, tahdosta riippumaton hoito, ja henkilökohtaiseen vapauteen tai yksityisyyden suojaan kajoava rajoittamistoimenpiteiden käyttö terveydenhuollossa potilaan suojelemistarkoituksessa. YK:n vammaissopimuksen (CRPD:n) ratifioinnin ja CRPD-komitean tulkinnan myötä ihmisoikeustasolta on painetta perfektionistiseen itsemääräämisoikeusmalliin siirtymiseen, ja jopa sijaispäätöksenteosta ja kompetenssipohjaisesta suostumusopista luopumiseen. Myös vammaisiin kohdistuvasta tahdosta riippumattomasta hoidosta ja rajoittamistoimenpiteiden käytöstä tulisi luopua. CRPD:n vammaismääritelmästä johtuen vallitsevat ihmisoikeustason normi- ja tulkintaristiriidat vaikuttavat tartuntatautilakia lukuun ottamatta kaikkeen voimassa olevaan ja tulevaan rajoittamissääntelyyn.Nykytilan analyysia jatketaan kansallisesta perusoikeussääntelystä, ja perusoikeuksien toteutumista ja rajoituksia täsmentävästä potilaslain ja terveydenhuollon erityislakien sääntelystä. Perusoikeussääntely on normihierarkisesti ylemmän asteista verrattuna lailla voimaan saatettuihin ihmisoikeussopimuksiin. Perusoikeusrajoitusten tulee kuitenkin noudattaa ihmisoikeusperiaatteita. Potilaslaki ja voimassa oleva rajoittamissääntely ilmentävät kompetenssilähtöistä suostumusoppia ja solidaristista itsemääräämisoikeusmallia. Itsemääräämisoikeuden käyttäminen edellyttää potilaalta riittävää päätöksentekokykyä. Päätöksentekokyvytöntä potilasta voidaan suojella sijaispäättäjän, hoitotahdon, kiireellisen hoidon säännöksen tai tahdosta riippumattoman hoidon keinoin. Potilaslain sääntely ei ole kaikilta osin yhteensopivaa CRPD:n kanssa.Tahdosta riippumattomasta hoidosta säännellään mielenterveyslaissa, tartuntatautilaissa, päihdehuoltolaissa ja laissa kehitysvammaisten erityishuollosta. Yhteisymmärryksessä hoitaminen on pääsääntö myös tahdosta riippumattomassa hoidossa. Rajoittamistoimenpiteisiin voidaan turvautua vain, jos rajoittaminen on välttämätöntä potilaan tai muun henkilön hengen, terveyden tai turvallisuuden suojelemiseksi. Voimassa oleva rajoittamissääntely kohdistuu tartuntatautilakia lukuun ottamatta päätöksentekokyvyttömiin potilaisiin, eli CRPD:n vammaismääritelmän mukaisiin henkilöihin, joilla on henkinen tai älyllinen vamma. CRPD:n syrjintäkielto ja tätä koskeva tulkinta huomioiden rajoittamissääntely on siten vammaisia syrjivää ja sopimusloukkaus.Somaattista hoitoa koskevan rajoittamissääntelyaukon osalta nykytilaa eli rajoittamisen syitä, käytettyjä rajoitustoimenpiteitä, ja varsinaisen sääntelyn puuttuessa sovellettua muuta sääntelyä, analysoidaan eduskunnan oikeusasiamiehen ratkaisukäytännön kautta. Rajoittamistoimenpiteiden oikeutusarvioinnissa on huomioitu rikoslain oikeuttamisperusteiden soveltuminen, ja toimenpiteiden yhteensopivuus perusoikeuksien yleisten rajoittamisedellytysten kanssa. Sisällöllisiä vaatimuksia rajoittamistoimenpiteille on haettu rajoittamissääntelyä sisältävistä terveydenhuollon erityislaeista sekä lääketieteellisesti perustellun hoidon kriteereistä. EOA on myös edellyttänyt, että terveydenhuollon organisaatiot ohjeistavat rajoittamistoimenpiteiden käytöstä somaattisessa hoidossa, kun sääntelyä ei ole. Tutkimuksessa analysoidaan sairaanhoitopiireihin kohdistettuna otantana, miten terveydenhuollon organisaatiossa pystytään sääntelemätöntä tilannetta sisäisin viranomaisohjein hallitsemaan. Tutkimusaineiston perusteella rajoittamista tehdään eri terveydenhuollon toimintayksiköissä erilaisin perustein, rajoittamisedellytyksin ja sisällöin, mikä asettaa potilaat valtakunnallisesti epäyhdenvertaiseen asemaan perus- ja ihmisoikeuksien toteutumisen turvaamisen näkökulmasta.Kolmannessa pääluvussa analysoidaan potilaan itsemääräämisoikeuden ja rajoittamissääntelyn tulevaisuutta, de lege ferenda. Aluksi analysoidaan vuoden 2018 asiakas- ja potilaslakiluonnoksen sääntelymallia mahdollisten ongelmakohtien löytämiseksi. Lakiluonnoksen ratkaisut itsemääräämisoikeuden tukemiseksi ja rajoittamissääntelyksi eivät olleet kaikilta osin toimivia, eivätkä yhteensopivia CRPD:n kanssa. Vertailunäkökulmasta analysoidaan Skandinavian maiden potilaan itsemääräämisoikeutta ja somaattista pakkohoitoa koskevaa sääntelyä. Pakkohoidosta on sääntelyä Tanskassa ja Norjassa, jossa sääntelyn tavoitteena on turvata välttämätön terveydenhuolto potilaalle, rajoittaa pakon käyttöä ja turvata riittävät oikeusturvamekanismit. Sääntely on diagnoosineutraalia ja toimenpiteet intensiteetiltään lievempiä Suomeen verrattuna.Tutkimuksen johtopäätöksinä todetaan, että perus- ja ihmisoikeusnäkökulmasta somaattista hoitoa koskevalle rajoittamissääntelylle on tarve. Ihmisoikeussääntelystä aiheutuu painetta solidaristisesta perfektionistiseen itsemääräämisoikeusmalliin siirtymiseen, ja jopa sijaispäätöksenteosta ja kompetenssilähtöisestä suostumusopista luopumiseen. Potilaslaki ei teknisesti vaatisi suuriakaan muutoksia ollakseen CRPD-yhteensopiva, mutta muutos käytännön toimintaan olisi huomattava, ja johtaisi ristiriitaan biolääketiedesopimuksen (BLTS) kanssa. Rajoittamissääntelyn osalta ihmisoikeustason normi- ja tulkintaristiriidan kanssa ollaan tilanteessa, jossa CRPD:n tulkintalinjan soveltaminen johtaa Euroopan ihmisoikeussopimuksen (EIS:n) ja BLTS:n loukkaukseen ja päinvastoin. Rajoittamissääntelylle voidaan kuitenkin tutkimuksen perusteella määritellä niin EIS:n ja BLTS:n kuin CRPD:nkin kanssa yhteensopivia tavoitteita ja rajauksia. Normi- ja tulkintaristiriitojen vuoksi laaditaan kaksi rajoittamisääntelymallia: EIS ja BLTS -yhteensopiva päätöksentekokykyyn perustuva malli, ja syrjintäneutraaliuteen pyrkivä CRPD-yhteensopiva malli. Lisäksi tarkastellaan, millaiseen tilanteeseen CRPD-komitean suosittama rajoittamissääntelyn purkaminen johtaisi.The current national regulation on involuntary care and restrictive measures does not cover all somatic care situations in which restrictive measures are being used to ensure the safety of a patient or the safety of other people. The objective of this legal study is to answer the question of how the regulatory gap concerning restrictive measures in the somatic care of adult patients could be filled. The concept of restrictive measures is used here in conformity with the Finnish concept ‘rajoittaminen’, meaning physical, chemical and mechanical restraints and seclusion or isolation, and it is interchangeable with the concept of coercive measures that is common in international usage.The study consists of three main chapters. The first chapter analyzes the development of regulation on the right to self-determination and restrictive measures from the 20th century to the 1990s. This historical review examines the manifestation and development of the prerequisites for the right to self-determination – consent, decision-making capacity, adequate information, and voluntariness – in medical treatment practice, ethics and regulation. In the absence of regulation on somatic care, the development of regulation on restrictive measures is analyzed through the regulation on communicable diseases, mental health care, substance abuse care, and special care for people with intellectual disabilities that has been in force at the time in question, and through the decisions of the Parliamentary Ombudsman of Finland and supervisory authorities.The second chapter analyzes the current state of the regulation and application of the limits of and the preconditions for restricting the right to self-determination of adult patients in somatic care. The international human rights treaties and the judgements and decisions issued by their treaty bodies constitute the starting point for the analysis. Traditionally, within the framework of the treaty systems of the Council of Europe and the UN, under certain boundary conditions, imposition of restrictions on the patient’s right to self-determination, involuntary treatment, and application of restrictive measures that interfere with the patient’s individual freedom or protection of privacy in health care with the purpose of keeping the patient safe have been approved. After the ratification of the UN Convention on the Rights of Persons with Disabilities (CRPD) and following the interpretation of the CRPD Committee, from the human rights perspective, there is pressure towards a transition to the perfectionistic regime of autonomy, and even towards giving up substitute decision making and the competence-based consent doctrine. In addition, regulation on involuntary care and restrictive measures targeted towards persons with disabilities should be abolished, according to the CRPD Committee. Based on the CRPD definition of persons with disabilities, at the human rights level, the prevailing conflict of norms and interpretations influences nationally all current and future regulation on involuntary care and restrictive measures except for the Communicable Diseases Act.The analysis of the current state continues with discussion on national regulation on fundamental rights, and with Act on the Status and Rights of Patients and special health care legislation that specify the fulfillment of and also concretize the restrictions to fundamental rights. In hierarchy of norms, regulation on fundamental rights is superior to Conventions on Human Rights that are enforced by law. Restrictions on fundamental rights must, however, adhere to the Human Rights Principles. The Patient Act and the current regulation on restrictive measures reflect the competence-based consent doctrine and the solidaristic regime of autonomy. The exercise of the right to self-determination requires that the patient has adequate decision-making capacity. Patients with inadequate decision-making capacity can be protected by using substitute decision-making, an advance directive, based on the emergency treatment provision, or involuntary care protocols. The regulation provided in the Patient Act is not fully compatible with the CRPD.Involuntary care is regulated in the Mental Health Act, the Communicable Diseases Act, the Substance Abuse Treatment Act, and the Act on Special Care for People with Intellectual Disabilities. As a rule, care is provided to the patient in mutual understanding with him/her, including in involuntary care. Restrictive measures may be applied only if they are necessary to safeguard the life, health or safety of the patient or another person. The current regulation on involuntary care and restrictive measures concerns, with the exception of the Communicable Diseases Act, patients with inadequate decision-making capacity, i.e., persons with a mental or intellectual disability as defined in the CRPD. Considering the prohibition of discrimination in the CRPD and its interpretation, national regulation on involuntary care and restrictive measures constitutes discrimination against persons with disabilities and is, thus, a violation of the Convention.To address the regulatory gap concerning restrictive measures in somatic care, the current state – the reasons for restriction, the restrictive measures used, and, in the absence of legislation, other applicable regulation – is analyzed through the decisions of the Parliamentary Ombudsman. In the justification assessment concerning restrictive measures, the applicability of the justification principles in the Criminal Code and the compatibility of the measures with the general preconditions for restricting fundamental rights have been taken into consideration. Substantive requirements for restrictive measures have been sought from special health care regulation on involuntary care and restrictive measures and the criteria of medically justified treatment. The Parliamentary Ombudsman has also recommended that, in the absence of regulation, health care organizations provide internal guidelines on the use of restrictive measures in somatic care. This study, which uses a targeted sample of hospital districts, examines how health care organizations, in the absence of regulation, manage the situation by their internal guidelines. The research data indicate that different health care units employ restrictive measures based on different grounds, different preconditions for restrictions, and different restrictive measures. The Finnish hospital districts’ guidelines on restrictions in somatic care cannot guarantee equal implementation and protection of patients’ fundamental and human rights in hospitals across the country. The third chapter addresses the future of the regulation on the patient’s right to self-determination and on restrictive measures in somatic care, de lege ferenda. The analysis starts with the former proposal for a new Act on the Rights of Social Welfare Clients and Patients, which was put forward in 2018, in order to examine the regulatory model and to identify potentially problematic points. The solutions put forward in the proposal to support the exercise of and to regulate restrictions on the right to self-determination were not fully practical or compatible with the CRPD. Scandinavian regulation on the patient’s right to self-determination and coercive care in somatic care is analyzed from a comparative perspective. There is regulation on coercive treatment in somatic care in Denmark and in Norway, where the regulation aims to ensure provision of necessary health care to the patient, to restrict use of coercive measures, and to ensure adequate legal protection mechanisms. The regulation is neutral in terms of diagnosis and the intensity of the measures is lower compared to Finland.In conclusion, the study indicates that there is a need for national regulation on involuntary care and restrictive measures in somatic care from the perspective of fundamental and human rights. Human rights regulation exerts pressure to transition from a solidaristic regime of autonomy to a perfectionistic regime of autonomy, and even calls for giving up substitute decision making and the competence-based consent doctrine. In a technical sense, the Patient Act would not require extensive changes to become compatible with the CRPD, but at the level of practice, the changes would be major and would contradict the Convention on Human Rights and Biomedicine. As for regulation on involuntary care and restrictive measures, the conflict of norms and interpretations brings about a situation in which implementation of the interpretation of the CRPD leads to a violation of the European Convention on Human Rights and the Convention on Human Rights and Biomedicine, and vice versa. However, the study shows that the objectives and scope of regulation on restrictive measures can be determined in such a manner that renders them compatible with the European Convention on Human Rights, the Convention on Human Rights and Biomedicine, as well as the UN CRPD. Given the conflicting norms and interpretations, two models for regulation on restrictive measures are proposed: a model based on decision-making capacity that is compatible with the European Convention on Human Rights and the Convention on Human Rights and Biomedicine, and a model based on non-discrimination that would ensure greater compatibility with the CRPD. In addition, the study discusses the situation that would result from the deregulation on involuntary care and restrictive measures, recommended by the CRPD Committee.Keywords: autonomy, right to self-determination, coercive measures, coercive treatment, involuntary treatment, patients, fundamental rights, human rights, health care, medical care, health law, medical law<br/
Editorial:Communicating with non-humans: a new visual language
No full text• How can participation in visual communication enhance practice-based and contextual plurality between humans and non-humans?• How can education through visual arts and design facilitate understanding to improve human-non-human communication?• How can themes such as visual relationality, post-human collaboration, ethical reflexivity, material-technology interplay, and adaptive coexistence offer narratives for disseminating insights across design, art, and ecological sustainability?• How can participatory experiences between humans and non-humans be visually communicated, and what roles do digital technologies play? How can collaborations with non-humans be revealed and understood using digital technologies
Barriers and risks of socio-technical transition towards sustainable road transport in sparsely populated areas:case of Finnish Lapland
No full textDependence on road transport, private passenger cars, and related infrastructure defines mobility in sparsely populated European areas. The ambitious goal of the European Union to reach sustainability in the road transport sector has therefore strong implications for mobility and accessibility in these regions. Nevertheless, sparsely populated areas have received less attention than urban areas in sustainability transitions research.This article highlights the context-specificity of sustainability transitions through a qualitative case study. The Region of Finnish Lapland stands as an example of a sparsely populated region, where sustainability goals set in the Green Deal of the European Union are to be met in the road transport system. The aim is to (a) find out barriers, which obstruct the transition process in Lapland, (b) point out potential future risks and (c) describe, what implications this has for sparsely populated areas in Europe in general. Analysis of barriers and risks is based on 13 thematic interviews and five policy documents. The road transport in Lapland is analysed as a socio-technical system, comprising social and technical elements, while the environment is presented as the basis for the system to operate.Findings of the research indicate that the electrification of private passenger cars in sparsely populated areas is problematic and sustainable road transport cannot be reached with a single solution. Highly electrified and digitalised transport system puts sparsely populated areas in an unequal position, due to high car dependency. With sparse infrastructure, inadequate funding, lack of local know-how to fix vehicles and insufficient supply of electricity in remote environments, there is a high risk of deteriorating accessibility in these areas.It is crucial to acknowledge in policy-making that different regions follow different paths of development. This underlines the importance of finding locally suitable solutions in a global transition process and calls for further research
Indigeneity:pushing for inclusion and appropriation in the anthropocene?
No full textThis piece attempts at critically elaborating on the factor of ‘indigeneity’ in the context of internal politics as well as its obvious struggle to understand the very meaning of the phenomenon. The issue-associated practical point is argued to be looking like a matter of convenience for those who prefer engaging it into play or getting rid of it from the intra-politics whenever the phenomenon loses its leverage
Narratiiva geahčastat juoiganárbevirrui sámi oahpahusdiliin
No full textThe theme of this narrative review is the pedagogical function of yoik in Sami educational settings. The narrative review method makes it possible to examine how the pedagogical value of yoik appears in research articles. With the help of this review, the meaning of yoik can be understood in the context of learning and teaching. The search for research articles was carried out using the university library’s online search engines and databases. The search had defined criteria and requirements for the selected research articles. Pedagogical main themes and subthemes were identified through a critical examination of research articles. Information was searched for using predefined search terms within the following main topics: Yoik and teaching prerequisites for pedagogical activities and methods and children and yoik. The main condition for the search was that the articles should contain relevant information about the research topic and that the research should be useful for pedagogical yoik research. The narrative review shows that there is little research on the use of yoik in pedagogical situations.The theme of this narrative review is the pedagogical function of yoik in Sami educational settings. The narrative review method makes it possible to examine how the pedagogical value of yoik appears in research articles. With the help of this review, the meaning of yoik can be understood in the context of learning and teaching. The search for research articles was carried out using the university library’s online search engines and databases. The search had defined criteria and requirements for the selected research articles. Pedagogical main themes and subthemes were identified through a critical examination of research articles. Information was searched for using predefined search terms within the following main topics: Yoik and teaching prerequisites for pedagogical activities and methods and children and yoik. The main condition for the search was that the articles should contain relevant information about the research topic and that the research should be useful for pedagogical yoik research. The narrative review shows that there is little research on the use of yoik in pedagogical situations
Sustainable Development Goals In The Arctic:The Nexus Between Water, Energy and Food Security
No full textThis research examined the nexus between Sustainable Development Goal 2 - Ending hunger and achieving Food security for all; Sustainable Development Goal 6 – Ensuring the availability and sustainable management of Water and sanitation for all; and Sustainable Development Goal 7 - Ensuring access to affordable, reliable, sustainable and modern Energy for all.The research presented here is one of the first pan-Arctic Water, Energy, Food (WEF) nexus studies, and goes beyond the production knowledge towards concrete tools, giving both the Arctic Council and the SDWG an opportunity to be innovative in both respects. This study advances integrative thinking that reflects the interconnectedness within WEF systems in ways that will lead to the attainment of the UN Sustainable Development Goals in the Arctic and the development of a Post-2030 Development Agenda in the Arctic