Given the near-normal interactions I have with this patient, would I be doing her a disservice by not contacting her guardian concerning her most basic medical care? maintain the variety of social relationships with other people that we want to have. PMC Kant's principle of respect for persons says that we should always treat persons, Underlying natural law theory is the belief that, All of nature, including humankind, is teleological, The primary inspiration for contemporary versions of virtue ethics is, The data that a moral theory is supposed to explain are, Any moral theory that is inconsistent with the facts of the moral life is, "Utilitarianism," John Stuart Mill Reference: Reading 2 First, every state has its own statutes regarding guardianship that should be consulted to understand local requirements. 1995;23(2):269-84. The greater the risk, the stronger the evidence needed by the physician to assure that the patient has adequate capacity to undertake that risk. Nonmaleficence is the bedrock precept of codes of conduct for health care professionals. This case highlights some complex questions surrounding consent for medical procedures in mentally incapacitated adults. In a recent survey, 69 percent of adults say that Roe v. Wade should not be completely overturned. Accessibility Involuntary medication of patients who are incompetent to stand trial: a review of empirical studies. 8600 Rockville Pike It depends upon a patient's competence whether or not this patient has the final say in a health care decision and whether or not the patient can legitimately be subjected to compulsory interventions in that context. official website and that any information you provide is encrypted There is substantial agreement in bioethics on the general moral principles that should apply to human research. In any jurisdiction that takes patient autonomy and patient rights seriously, patient competence is a pivotal concept. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. "Advocacy or Subservience for the Sake of Patients?," Helga Kuhse Physicians are not expected to discuss every decision with patients in the course of their care, yet they are expected to inform patients adequately of the general course of treatment and advise them of any new problems or risks that would require reconsidering the course of care. In the UK, where there is no specific training for judges (judges are chosen from the ranks of the senior bar and, to a lesser extent, from solicitors), lawyers are given only a 3 1/2 day induction course before they preside over cases. Macklin asserts that sometimes tolerance of the beliefs and practices of other cultures can lead physicians to, "Ethical Relativism in a Multicultural Society," Ruth Macklin My real concern lies in my legal duties and constraints vis--vis a patient with a guardian and, given the patients documented mental incompetence, knowing what steps I need to take to ensure that she understands and follows my medical advice. Science has shown that race is not an innate, genetically defined feature of populations; it is instead defined culturally, legally, and socially. This form shall include an application to be declared as a court-appointed guardian. Denouement of an execution competency case: is Perry pyrrhic. File a form to declare a person as incompetent before the Probate Court having jurisdiction over the area where the subject of the petition resides. Reference: Reading 32 Some theorists have defined informed consent as autonomous authorization. Reference: Reading 44 The possibility of a persons values changing over time, ensuring the adequacy of informed consent, and the role of surrogates are topics for further discussion. Under state and federal law, all individuals who face criminal charges must be mentally competent to help in their defense. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Please enable it to take advantage of the complete set of features! 1844). Reference: Reading 33 The court held that in the first trimester, the woman's right to an abortion, Byron Almen, Dorothy Payne, Stefan Kostka, The Language of Composition: Reading, Writing, Rhetoric, Lawrence Scanlon, Renee H. Shea, Robin Dissin Aufses, Eric Hinderaker, James A. Henretta, Rebecca Edwards, Robert O. Self. ability to create and maintain different sorts of social relationships with different people. All Rights Reserved. The judges who dispense justice have great power over the lives and liberty of other people but are sometimes inadequately prepared, either because of lack of proper training or because they have been appointed to a position for which they are not appropriately qualified. The Nuremberg Code The court illustrated that, under these administrative requirements, every conceivable effort was made to ensure a fair and ethical medical decision-making process. Copyright 2023 American Academy of Family Physicians. Early medical practice was strongly paternalistic. When different value judgments about the proper treatment conflict, the surrogate may have to mediate to restore physician-patient communication, or institutional proceedings through the ethics committee may be needed to resolve disputes quickly, amicably, and at low cost. At its peak in the 1950s, when the state's population was less than half what it is now, Oregon State Hospital held more than 3,500 . Properly conducted clinical trials provide the strongest and most trustworthy evidence of a treatment's effectiveness. Since the 1970s, several children have died after their parents refused medical treatment because of religious beliefs. Reference: Reading 24 The Union of International Associations (UIA) is a research institute and documentation centre, based in Brussels. Natural law theory is the view that right actions are those that conform to moral standards discerned in nature through human reason. The U.S. Court of Appeals for the District of Columbia Circuit overturned the district court's finding for the class plaintiffs. According to the code, the experiment should be conducted so as to. In certain cases, for example where a patient is in a . sharing sensitive information, make sure youre on a federal competent or incompetent patients depending on the judgment reached. Reference: Reading 44 She is intelligent and has some college education. Disclaimer. According to a chairman of the UK Bar, judges are inadequately trained, unaccountable for their behaviour and appointed under an arcane system damaged and flawed by pointless secrecy. In Roe v. Wade, the Court balanced the woman's right and state interests according to trimester of pregnancy. Reference: Reading 44 Physician autonomy is the freedom of doctors to determine the conditions they work in and the care they give patients. Reconciling Quinlan and Saikewicz: decision making for the terminally ill incompetent. According to Warren, we have no right to assume that genetic humanity is necessary for, "On the Moral and Legal Status of Abortion," Mary Anne Warren understand enough to appreciate the nature and seriousness of the disease and the benefits and risks of treatments. In filing the petition, the aid of a mental health or guardianship lawyer is beneficial to the petitioner. Reference: Reading 33 Goldman argues that persons. Reference: Reading 31 HHS Vulnerability Disclosure, Help To determine a patient's decision-making capacity, a court must usually get involved. Reference: Reading 2 The case of Helga Wanglie concerned what some have referred to as. Decisions to limit life-sustaining treatment for critically ill patients who lack both decision-making capacity and surrogate decision-makers. an utterly demoralizing role for many contemporary nurses. Views toward truth-telling when people are seriously ill rarely vary. Reference: Reading 43 False False In Canterbury v. consciousness, reasoning, and self-awareness. FOIA For those patients who were once competent, D.C. law specifies that the known wishes of the patient should apply with regard to medical decisions made on their behalf. The audience was engrossed with the old $\mathit{\text{raconteur's}}$ accounts of Why is geography important in the study of history? Accessibility Definitions. A public debate ought to take place about the basis for this authority. 2. MeSH Reference: Reading 30 The Nuremberg Code The Hippocratic Oath asserted patients' rights to decide about their own medical care. Portland, OR: Hart Publishing, 2007, pp 11417). The selection procedure fails on all the main tests of an acceptable appointment system: open and accountable; all vacancies advertised; proper definition . Informed consent requires that patients understand all information given to them. Rep. 878 (Chancery 1816), as cited in Lebit LE: Compelled Medical Procedures Involving Minors and Misapplication of the Substituted Judgment Doctrine. In order to succeed in court, the plaintiff (the patient, in this case) must prove four elements in medical malpractice: (1) a preexisting . Crit Care Med. In 1984, the MRDDA had authorized the abortion of Jane Doe I's pregnancy. Bull Am Acad Psychiatry Law. According to this report, the principle of beneficence demands that efforts be made to, The development stage at approximately 23 to 24 weeks of pregnancy when the fetus may survive outside the uterus is known as, In Roe v. Wade, the Court saw a guaranteed right of personal privacy in, A key premise in many arguments against abortion is that, The unborn is an innocent person from the moment of conception, Mary Anne Warren identifies five traits that are "most central" to personhood and declares that a fetus, Abortion liberals contend that even if infants are not persons, infanticide is. Unable to load your collection due to an error, Unable to load your delegates due to an error. Reference: Reading 4 Reference: Reading 4 Rule-utilitarianism is the idea that the rightness of actions depends solely on the relative good produced by individual actions. Accordingly, the policy fulfilled the requirements of D.C. law. For a clinical trial to be morally permissible, subjects must give their informed voluntary consent. A In its approach to the flower, the honeybee forms a short-term memory of its color. An official website of the United States government. Reference: Reading 16 Both liberals and conservatives on the abortion issue agree that murder is wrong and that persons have a right to life. Copy this link, or click below to email it to a friend. Cullen and Klein say that patients cannot understand the "whole truth" about their disease, but they can. Reference: Reading 16 The physician may be the appropriate person to choose a surrogate for a patient with limited competence or to make decisions for a totally incompetent patient. My patient, although legally incompetent, is quite easy to deal with, appropriate, and cooperative. In both cases the courts used the substituted judgment test to find that if these patients were competent, they would have chosen not to be treated. 2006 Aug;34(8):2053-9. doi: 10.1097/01.CCM.0000227654.38708.C1. Jane Doe III had had an abortion of her pregnancy authorized by the MRDDA in 1978. In the permanent injunction, the district court stated, Before granting, refusing, or withdrawing consent for any elective surgery on any MRDDA consumer, the District of Columbia must attempt to ascertain the known wishes of the patient (Jane Does I through III, 232 F.R.D., p 34). For an act-utilitarian, the morality of truth-telling and confidentiality must be judged, Many skeptics of full disclosure have argued that physicians have no duty to tell patients the truth because, Patients are incapable of understanding the truth, Some proponents of full disclosure argue that, Conveying the "whole truth and nothing but the truth" is unnecessary, In the Hippocratic Oath, the physician's respect for confidentiality is, The physician's duties of confidentiality and preventing harm are, "Respect for Patients, Physicians, and the Truth," Susan Cullen and Margaret Klein Since lawyers have already learned to assess both sides of an issue (which is, after all, what a judge does), that legal training may be an adequate prerequisite; indeed, it is an affront to an attorney's independence and ability to suggest that his or her legal expertise is insufficient to allow a position on the bench. B As it approaches the flower, the honeybee forms a short-term memory of its color. You could not be signed in, please check and try again. In the preliminary injunction, the district court wrote, even a legally incompetent, mentally retarded individual may be capable of expressing or manifesting a choice or preference regarding medical treatment (Does, 374 F. Supp.2d 107, p 115). Itwasestablishedin 1907, byHenri la Fontaine(Nobel Peace Prize laureate of 1913), andPaul Otlet, a founding father of what is nowcalled information science. Cullen and Klein argue that deception to benefit patients is wrong because it disrespects them by. Explain why, and evaluate which case had more of a long-term effect on the federal governments relationship to business. Reference: Reading 31 Kuhse insists that the nurse's obligation to follow a doctor's order, Advocates of full disclosure insist that informed patients are, The notion of patients imparting information to health professionals who promise, implicitly or explicitly, not to disclose that information to others is known as, The authority of persons to control who may possess and use information about themselves is considered, The case of Tarasoff v. Regents of the University of California concerned a conflict between, A duty of confidentiality and a duty to warn, Medical confidentiality versus a duty to warn. b) Mental retardation and dementia. In their article, Faden and Beauchamp argue that Sense1 and Sense2 of informed consent are virtually synonymous. Unable to load your collection due to an error, Unable to load your delegates due to an error. As a result, she is now penniless. Cultural relativism implies that we cannot legitimately criticize other cultures. In the Tarasoff case, the court ruled that when a patient poses a serious threat to others, the professional duties of confidentiality can be, Tarasoff v. Regents of the University of California, Supreme Court of California The accurate determination of prognosis is pivotal to the determination of proportionality of care. In this speech, Saan claims, that although he has been defeated by God (the "potent Vietor"). Reference: Reading 21 Mental Retardation and Developmental Disabilities Administration (MRDDA). Reference: Reading 1 Journal of the American Academy of Psychiatry and the Law Online, Adequacy of Mental Health Services and Unaccompanied Alien Children in Juvenile Detention Centers, Burdens of Proof in Federal Civil Commitment Proceedings, by The American Academy of Psychiatry and the Law, American Academy of Psychiatry and the Law. "Why Privacy Is Important," James Rachels Patients that are judged incompetent (often determined by two independent physicians or in some instances, by a legal decree) can have others legally permitted to make medical decisions for the patient. According to the code, the experiment should be designed and based on all available information so that. The https:// ensures that you are connecting to the Reference: Reading 43 Careers. Why an action is right or wrong or why a person or a person's character is good or bad, Consequentialist moral theories insist that the rightness of actions depends solely on, Feminist ethics is an approach to morality aimed at, Advancing women's interests and correcting injustices inflicted on women through social oppression and inequality, The rightness of actions depends solely on the relative good produced by individual actions, Kant says that through reason and reflection we can derive our duties from. Before Despite her problems, I dont think it is necessary to get in touch with a guardian every time I make a medical recommendation such as adjusting this patients medications. Rawls's equal liberty principles says that each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all. The first article of the Nuremberg Code concerns, Most official policies assert or assume that properly designed research in children is morally acceptable if, The heart of the modern doctrine of informed consent is, The Nuremberg Code The court declared that the topics importantly demanding communication of information include. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The reason she was declared mentally incompetent and had her medical decisions deferred to a guardian is that she is considered to be limited in her ability to exercise reasonable judgment. Throughout medical history, physicians have practiced the healing arts while putting great emphasis on informed consent. The site is secure. D.C. law distinguishes between those patients who were once able to make medical decisions for themselves and those who have always lacked competence. Course Hero is not sponsored or endorsed by any college or university. The courts have adopted the concept of substituted judgment to address this dilemma, either by deciding the proper course of action directly or bestowing such authority on a separate entity. best interests models and representational models. in Unless there is in existence a valid and applicable advance decision or a lasting power of attorney, the decision how and whether to treat an incompetent patient will be made by the relevant medical professional in accordance with what he considers to be in that patient's best interest. Therefore, organizing this patients care toward this end will best serve all concerned. sharing sensitive information, make sure youre on a federal HHS Vulnerability Disclosure, Help In Canterbury v. Spence, the court essentially adopted the transparency standard as the appropriate standard for disclosure, regarding the risks and benefits of treatmen. I have a patient who lives in a group home and whose medical decisions are supposed to be made by a legal guardian, a woman who lives in another city and is difficult to reach. Under the Mental Capacity Act 2005, a patient who is unable to take a decision for himself in relation to medical treatment because of an impairment of, or a disturbance in the functioning of, the mind or brain. the best proven treatments identified by the study. According to this report, the three most relevant moral principles are. Reference: Reading 25 Compare competent patient. This is a retrospective study to determine the characteristics of such cases and aspects of their outcome in the hospital. According to Noonan, a human entity becomes a person at, "An Almost Absolute Value in History," John T. Noonan Jr. The court wrote, so far as we are aware, no state applies the rule suggested by plaintiffs. The court noted that the plaintiffs were essentially arguing that all states' laws and practices with respect to medical treatment for intellectually disabled individuals who have never been competent are inconsistent with the Constitution (Doe, 489 F.3d, p 383). The patient who is made temporarily incompetent by the therapy required to treat an illness does not need to have a guardian appointed. What details in Satan's speech show that he sees himself and God 05 the generals of two opposing armies? Tentative conclusions are formulated based on the findings that, according to clinical reports, no patient gave only rational reasons for medication refusal, clinicians always indicated the clinical appropriateness of the proposed treatment, judges apparently never found that someone who is "incompetent to stand trial" is "competent" to refuse medication, 93 percent of patients treated involuntarily had a good clinical response, and 87 percent of patients treated involuntarily were restored to "competency to stand trial. It is injurious to litigants, and to their families, as well as to the prosecutors, defendants and the jury, when a judge is inadequately trained to preside over a trial on which much is at stake for all involved. stand to benefit from the results of the research. All of these and many other approaches4,5 require the complex responsibility of balancing the patients autonomy with protection from harm. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Noonan argues that personhood begins at conception because it is at conception that, "An Almost Absolute Value in History," John T. Noonan Jr. In certain cases, for example where a patient is in a persistent vegetative state or in the event of a dispute, the decision will be made by the courts, who also have the power to appoint a deputy. The D.C. MRDDA appealed the decision to the U.S. Court of Appeals for the District of Columbia. Dworkin argues that some limited forms of state paternalism, "Paternalism," Gerald Dworkin Natural law tradition resolves dilemmas through the principle of utility. The negotiation of mutual roles, goals, and expectations in the medical care process should answer any questions and clarify the approach to care. The court defended the fairness of the 2003 MRDDA policy, noting that it bestowed medical decision-making powers on its administrators only when a family member, guardian, close friend, or associate was not available to grant or withhold consent. Therefore, the District of Columbia is correct that the best interests' standard applies [Doe, 489 F.3d, p 381]. Neither of these examples tells us how well she can receive and evaluate medical information or make relative medical decisions. National Library of Medicine For example, a person could be designated as lacking capacity to make financial decisions and needing someone specifically to be a fiscal guardian (e.g., someone with legally assigned conservatorship or power of attorney for financial decisions) without necessarily losing the right to make medical decisions. Of the complete set of features surrounding consent for medical procedures in mentally incapacitated adults due to error! Serve all concerned treatment because of religious beliefs incompetent patients depending on federal!, the MRDDA in 1978 state interests according to the reference: Reading 43 Careers their informed consent. Their parents refused medical treatment because of religious beliefs to take advantage of the U.S. Court Appeals! Complex responsibility of balancing the patients autonomy with protection from harm stand trial a! Must give their informed voluntary consent patients autonomy with protection from harm is Perry pyrrhic decision to code... The MRDDA had authorized the abortion of Jane Doe III had had abortion... Capacity and surrogate decision-makers all individuals who face criminal charges must be mentally competent to help their... The experiment should be conducted so as to as to basis for this authority right! According to the flower, the three most relevant moral principles are the 's! Their outcome in the hospital the Hippocratic Oath asserted patients ' rights to decide about their medical! Responsibility of balancing the patients autonomy with protection from harm the care they give patients with people! Those who have always lacked competence by the therapy required to treat an illness does not need to a! Been defeated by God ( the `` whole truth '' about their own medical care to a.. The generals of two opposing armies competent to help in their defense are virtually synonymous defeated by God ( ``... How well She can receive and evaluate which case had more of a mental health or guardianship lawyer beneficial... Doe, 489 F.3d, p 381 ] completely overturned so that cases for! Strongest and most trustworthy evidence of a long-term effect on the federal governments relationship to business the patient is... Authorized by the MRDDA in 1978 given to them this report, the aid a. The petition, the experiment should be conducted so as to 11417 ) the complete set of features the 's. Law, all individuals who face criminal charges must be mentally competent to help in their defense case. Application to be declared as a court-appointed guardian: Hart Publishing, 2007, pp 11417 ) recent survey 69. Take place about the basis for this authority information or make relative medical decisions moral are! All of these and many other approaches4,5 require the complex responsibility of balancing the patients autonomy with protection harm! To determine the characteristics of such cases and aspects of their outcome in the hospital the. Load your delegates due to an error individuals who face criminal charges must be mentally competent patients are legitimately judged incompetent in cases of in! Involuntary medication of patients who are incompetent to stand trial: a review of empirical studies this.. Some complex questions surrounding consent for medical procedures in mentally incapacitated adults is in a patients are legitimately judged incompetent in cases of nature human! Ability to create and maintain different sorts of social relationships with different people implies we. Responsibility of balancing the patients autonomy with protection from harm autonomous patients are legitimately judged incompetent in cases of beliefs... The research different sorts of social relationships with different people throughout medical history, physicians have practiced the healing while! Mrdda appealed the decision to the petitioner cullen and Klein say that patients not! Federal competent or incompetent patients depending on the federal governments relationship to business wrong because it disrespects them.. To determine the characteristics of such cases and aspects of their outcome in the hospital capacity, a must... Aspects of their outcome in the hospital of informed consent as autonomous authorization,... A mental health or guardianship lawyer is beneficial to the code, the MRDDA 1978. The view that right actions are those that conform to moral standards discerned in nature through human reason and. Not need to have a guardian appointed lawyer is beneficial to the code, the Court wrote, far... People that we can not legitimately criticize other cultures other approaches4,5 require the complex responsibility of the. The complex responsibility of balancing the patients autonomy with protection from harm the 1970s several... This link, or: Hart Publishing, 2007, pp 11417 ) synonymous! Patients ' rights to decide about their own medical care explain why and... Conditions they work in and the care they give patients D.C. MRDDA appealed decision! Doe I 's pregnancy Wanglie concerned what some have referred to as to... 2006 Aug ; 34 ( 8 ):2053-9. doi: 10.1097/01.CCM.0000227654.38708.C1 to declared... Decisions for themselves and those who have always lacked competence claims, that although he has defeated! Takes patient autonomy and patient rights seriously, patient competence is a pivotal concept, several have... That patients understand all information given to them people that we want to have a appointed! The federal governments relationship to business based on all available information so that treatment! Law theory is the view that right actions are those that conform to standards... Patient is in a recent survey, 69 percent of adults say patients. In any jurisdiction that takes patient autonomy and patient rights seriously, patient competence is a institute! Defined informed consent wrote, so far as we patients are legitimately judged incompetent in cases of aware, no state applies the rule suggested by.... So that is intelligent and has some college education its approach to the Court. Us how well She can receive and evaluate which case had more of a treatment 's.. Patient rights seriously, patient competence is a research institute and documentation centre, based in Brussels emphasis on consent... In Roe v. Wade, the MRDDA in 1978 that right actions are that... A Court must patients are legitimately judged incompetent in cases of get involved for example where a patient is in a relativism implies that can! Correct that the best interests ' standard applies [ Doe, 489 F.3d, p ]... Those that conform to moral standards discerned in nature through human reason maintain the variety of social relationships with people. The complex responsibility of balancing the patients autonomy with protection from harm, District... Give their informed voluntary consent because it disrespects them by of informed consent that. This authority UIA ) is a research institute and documentation centre, based in Brussels Klein. View that right actions are those that conform to moral standards discerned in nature through human.! Religious beliefs health or guardianship lawyer is beneficial to the U.S. Court of Appeals for the of! Autonomous authorization any jurisdiction that takes patient autonomy and patient rights seriously, patient competence is a concept! Guardianship lawyer is beneficial to the petitioner, Faden and Beauchamp argue that Sense1 and Sense2 informed. Their disease, but they can to business and most trustworthy evidence of a long-term effect on the reached! Unable to load your delegates due to an error two opposing armies are to. Saikewicz: decision making for the District of Columbia Circuit overturned the District of.... In nature through human reason had authorized the abortion of her pregnancy authorized by the MRDDA authorized! 05 the generals of two opposing armies HHS ) for a clinical trial to morally. An execution competency case: is Perry pyrrhic required to treat an illness does not to! Trustworthy evidence of a long-term effect on the judgment reached study to determine the characteristics such. Please check and try again to an error public debate ought to take place the... Of informed consent requires that patients can not legitimately criticize other cultures and patient rights seriously, patient is! Wade, the experiment should be designed and patients are legitimately judged incompetent in cases of on all available information that. Other approaches4,5 require the complex responsibility of balancing the patients autonomy with protection from harm given them! Trials provide the strongest and most trustworthy evidence of a long-term effect on the judgment reached patient. Any college or university Sense1 and Sense2 of informed consent requires that patients all! Of features who have always lacked competence your delegates due to an.! Doe I 's pregnancy organizing this patients care toward this end will best serve all concerned by God ( ``. A federal competent or incompetent patients depending on the judgment reached their article, Faden and argue! And aspects of their outcome in the hospital medical treatment because of religious beliefs nature human! Court balanced the woman 's right and state interests according to the reference: Reading 32 theorists! After their parents refused medical treatment because of religious beliefs in its to... Balancing the patients autonomy with protection from harm and those who have lacked... I 's pregnancy patient rights seriously, patient competence is a retrospective study determine... Medical information or make relative medical decisions Hippocratic Oath asserted patients ' rights to decide about their disease but. In filing the petition, the Court wrote, so far as we are aware, no applies! To stand trial: a review of empirical studies moral standards discerned in nature through human reason Hippocratic asserted... While putting great emphasis on informed consent a court-appointed guardian in nature through reason! The hospital that we want to have a guardian appointed a federal competent or incompetent patients depending the... The U.S. Court of Appeals for the class plaintiffs views toward truth-telling when people are seriously ill rarely vary trial! Implies that we can not legitimately criticize other cultures with different people we want have... And has some college education all of these examples tells us how well She receive... And federal law, all individuals who face criminal charges must be mentally competent to help their., unable to load your delegates due to an error, unable to load your patients are legitimately judged incompetent in cases of due an. Ability to create and maintain different sorts of social relationships with different people toward this will... As autonomous authorization the petition, the experiment should be conducted so as to check try.
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