Reference: Reading 49 The https:// ensures that you are connecting to the Declaration of Helsinki, World Medical Association Ethics is the study of morality using the tools and method of, The use of moral norms and concepts to resolve practical moral issues is called, A moral principle that applies in all cases unless an exception is warranted is, The overriding of a person's actions or decision-making for his or her own good is known as. We waited to hear if the baby was a girl or a boy with nervous anticipation. informed consent is a collaborative process between the doc and the pt. The Hippocratic Oath insists on a strong duty of truth-telling. In Roe v. Wade, the Court balanced the woman's right and state interests according to trimester of pregnancy. 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. The U.S. Court of Appeals for the District of Columbia Circuit overturned the district court's finding for the class plaintiffs. Please enable it to take advantage of the complete set of features! c) The patient s refusal of treatment. incompetent patient . Waiver Patients are legitimately judged incompetent in cases of Mental retardation and dementia Physicians are often not obligated to provide disclosure in cases of Waiver In their article, Faden and Beauchamp argue that Sense1 and Sense2 of informed consent are virtually synonymous. To determine a patient's decision-making capacity, a court must usually get involved. 8600 Rockville Pike ability to create and maintain different sorts of social relationships with different people. This site needs JavaScript to work properly. 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 any event, the physician should engage her in decision-making as much as possible and ensure that her wishes are being respected unless there is reason to believe that she is acting in a manner that is inconsistent with choices she made in the past. 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. False Itwasestablishedin 1907, byHenri la Fontaine(Nobel Peace Prize laureate of 1913), andPaul Otlet, a founding father of what is nowcalled information science. Reference: Reading 30 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. Reference: Reading 1 Physician autonomy is the freedom of doctors to determine the conditions they work in and the care they give patients. Views toward truth-telling when people are seriously ill rarely vary. answer mental retardation and dementia Unlock the answer question physicians are often not obligated to provide disclosure in cases of answer waiver Unlock the answer question The consent of an informed, competent, understanding patient cannot be legitimate unless it is given. Copy this link, or click below to email it to a friend. 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. Conservatives on the abortion issue charge that liberals' standards for personhood imply that, Cognitively impaired individuals are not persons, The Roman Catholic position on abortion incorporates, "An Almost Absolute Value in History," John T. Noonan Jr. It was concerned that the plaintiffs' proposed system of allowing lifelong incompetent patients to participate in their own medical decisions ran contrary to the status quo of each state. Involuntary electro-convulsive therapy to restore competency to stand trial: a five year study in New York State. The Bouvia ruling asserted that competent adults have a "constitutionally guaranteed right" to. Disclaimer. Ethical and legal issues in the treatment of incompetent religious. Federal government websites often end in .gov or .mil. Bull Am Acad Psychiatry Law. All religious people accept the divine command theory. In this case, stories are supplied suggesting that the patient had problems with money management (being gullible) and in not learning from negative experiences. Reference: Reading 16 Reference: Reading 33 The D.C. MRDDA appealed the decision to the U.S. Court of Appeals for the District of Columbia. The Dutch Contract of medical treatment Act is treated as an example of the latter. Reference: Reading 22 While Lord Eldon is credited with the concept of substituted judgment, it was not widely recognized in the United States until many years later (Beyleveld and Brownsword). Federal government websites often end in .gov or .mil. Accessibility Cultural relativism logically entails tolerance for other cultures. According to Macklin, most patients in the United States. According to this report, an autonomous person is an individual capable of deliberation and of. a) Waiver. a) Reluctance by the patient to undergo treatment. Denouement of an execution competency case: is Perry pyrrhic. Mental Retardation and Developmental Disabilities Administration (MRDDA). "The Refutation of Medical Paternalism," Alan Goldman An official website of the United States government. Informed consent for people with diminished capacity to consent. It is shown that in the Dutch model, health care professionals are not at the mercy of patient representatives. A Dictionary of Law , View all related items in Oxford Reference , Search for: 'incompetent patient' in Oxford Reference . Limits of guardian treatment refusal: a reasonableness standard. Two kinds of models of substitute decision-making for incompetent patients are available, i.e. However, it was clear to the court of appeals that the D.C. MRDDA utilized a variety of measures to ensure the preservation of liberty interests for those entrusted to its care. [Patient autonomy and informed consent in clinical practice]. official website and that any information you provide is encrypted According to Warren, we must distinguish between two senses of human beinghuman in the genetic sense and human in the, "On the Moral and Legal Status of Abortion," Mary Anne Warren 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. and transmitted securely. A. The selection procedure fails on all the main tests of an acceptable appointment system: open and accountable; all vacancies advertised; proper definition . "Why Privacy Is Important," James Rachels This highly controversial issue has been understudied. My comments are based on the Uniform Guardianship and Protective Proceedings Act of 1997,1 which strongly urge that guardianship be reserved for cases in which the court finds that the patients needs cannot be met by any less restrictive means. "The Belmont Report," National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research The court declined to address the class plaintiffs' individual damage claims. FOIA Although there are many instances in which incapacity can be expected to continue, this case scenario suggests that the patient should be given the chance to demonstrate her capacity, because the burden of proof is always on those who wish to remove a persons rights. On the contrary, health care professionals are supposed to judge their patients' subjective interests and may eventually overrule the representatives. Unauthorized use of these marks is strictly prohibited. determine which pleasure most experienced people prefer. Each plaintiff in the suit had been subjected to surgical procedures authorized by the MRDDA. In its decision, the court wrote that it reversed the district court's grant of summary judgment, vacated the district court's injunction, and directed the entry of judgment for D.C. and MRDDA with respect to the class plaintiffs' claims for declaratory and injunctive relief (Doe, 489 F.3d, p 384). Noddings says that ethics has been discussed largely in the language of, "Caring," Nel Noddings 2007 Jun 14;127(12):1644-7. The reason she was declared mentally . respect for persons, beneficence, and justice. The utilitarian philosopher John Stuart Mill endorsed state paternalism. Portland, OR: Hart Publishing, 2007, pp 11417). Before Judith Jarvis Thomson argues that even if the unborn is a person from the moment of conception, abortion may still be morally justified. Medical futility. For most clinical trials, randomization is unnecessary. Autonomous authorization the pt. Compared with the system for selection of senior civil servants it is deficient in: formal procedures, accountability of the people involved, and disclosure or discussion with potential recruits. You could not be signed in, please check and try again. For example, she inherited a large amount of money when her mother died, but she quickly lost her inheritance to scammers and relatives who requested large loans that were never repaid. My patient, although legally incompetent, is quite easy to deal with, appropriate, and cooperative. Reference: Reading 1 On the other hand, the New York courts have required such a high degree of certainty of what the patient would have chosen that withdrawing treatment except when there is an explicit prior . This jurisdiction has existed for over a . Reference: Reading 25 Bethesda, MD 20894, Web Policies HHS Vulnerability Disclosure, Help 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. Neither of these examples tells us how well she can receive and evaluate medical information or make relative medical decisions. in The code asserts that medical research is justified only if there is a reasonable likelihood that the populations in which the research is carried out. In this circumstance, the MRDDA was charged with making such decisions. As a last resort, the case may be referred to the courts. The https:// ensures that you are connecting to the Properly conducted clinical trials provide the strongest and most trustworthy evidence of a treatment's effectiveness. In the lawsuit, the plaintiffs alleged that the MRDDA authorized elective surgical procedures on their behalf without considering their wishes. 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. Moral theories are not relevant to our moral life. . According to Kant, if an action is to have moral worth, it must be done, "The Moral Law," Immanuel Kant and transmitted securely. A guardian is a person who is appointed, either by a court or a guardianship authority, to make decisions on behalf of an incompetent adult. Mr. Hinde, a lunatic by English definition, was ordered to pay monies from his surplus to his close relatives (Beyleveld D, Brownsword R: Consent in the Law. Natural law tradition resolves dilemmas through the principle of utility. Jane Does I, II, and III argued that the MRDDA's 2003 policy was incompatible with D.C. law, which states, Mental incapacity to make a health care decision shall be certified by [two] physicians who are licensed to practice in the District and qualified to make a determination of mental incapacity. The principle of respect for autonomy places no restraints on what can be done to an autonomous person. Specifically addressing the plaintiffs' assertion that the Constitution requires their wishes be considered, the court wrote, as we explained above, accepting the wishes of patients who lack (and have always lacked) the mental capacity to make medical decisions does not make logical sense (Doe, 489 F.3d, p 382). Reference: Reading 43 2008 Dec;14(6):714-9. doi: 10.1097/MCC.0b013e3283196319. Reference: Reading 25 Canterbury v. Spence, U.S. Court of Appeals Would you like email updates of new search results? An official website of the United States government. In another example, she was mauled on two separate occasions by the same dog, because she twice put herself in a dangerous position. The https:// ensures that you are connecting to the 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 Bookshelf In Doe v. District of Columbia, 489 F.3d 376 (D.C. Cir. The site is secure. Some reject Thomson's argument by contending that it holds only if the woman bears no responsibility for her predicament. 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. An advance directive is a legal document that speaks for you if you are, A DNR is a directive telling the medical staff to, In general, Kantian ethics views paternalism as, "Paternalism," Gerald DworkinReference: Reading 7Dworkin accepts Mill's view that society may sometimes justifiably restrict a person's liberty for purposes of. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. the anticipated results will justify the performance of the experiment. Choose the best answer for the question below. A collection of Curbside Consultation published inAFPis available athttps://www.aafp.org/afp/curbside. 18 (D. D.C. 2005); see also Does v. District of Columbia, 374 F. Supp.2d 107 (D. D.C. 2005)). HHS Vulnerability Disclosure, Help In Doe v.District of Columbia, 489 F.3d 376 (D.C. Cir. 6. 8600 Rockville Pike The fact that none of the members of the class had ever possessed medical decision-making capacity was accepted by both the plaintiffs and the defense. How might you change sentence 6 to include a participial phrase? Explain why, and evaluate which case had more of a long-term effect on the federal governments relationship to business. Why were the Spartan soldiers willing to sacrifice themselves at Thermopylae? An inactive or sham treatment is called a, Physicians who are in doubt about the relative merits of the treatments in a study are said to be, The infamous experiment to study the damaging effects of untreated syphilis in 600 poor black men is known as, A scientific study designed to test a medical intervention in humans is known as, An indispensable feature of most clinical trials is. Reference: Reading 44 The physician generally assesses the patients' competence, but sometimes the courts are involved. According to Noonan, a human entity becomes a person at, "An Almost Absolute Value in History," John T. Noonan Jr. Reference: Reading 16 They argued that the MRDDA policy, which had been amended in 2003, violated the Health Care Decisions Act, D.C. Code 21-2201 et seq. Bull Am Acad Psychiatry Law. The negotiation of mutual roles, goals, and expectations in the medical care process should answer any questions and clarify the approach to care. Probate Code 4609) Health care . Accessibility Reference: Reading 24 government site. There is substantial agreement in bioethics on the general moral principles that should apply to human research. Evaluate the Supreme Court decisions in Lochner v. New York (1905) and Northern Securities v. United States (1904). GEORGE K. DREHER, M.D., Psychiatry consultant with the Family Medicine, Residency Program, Maine Medical Center, Portland, Maine. For those whose known wishes cannot be ascertained, D.C. law specifies that the medical decision should be made with a good faith belief as to the best interests of the patient (D.C. Code 21-2210(b)(2007)). 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. In today's health care system, complete confidentiality is feasible. She is intelligent and has some college education. Since the 1970s, several children have died after their parents refused medical treatment because of religious beliefs. When a court determines that an individual lacks capacity to make decisions, it appoints a guardian with legal authority to make decisions for that person. Moral absolutism is the view that there are moral norms or principles that are valid or true for everyone. In the 1970s, courts began to insist that the adequacy of disclosure should be judged by what patients themselves find relevant to their situation. 1995;23(2):269-84. (c) Copyright Oxford University Press, 2023. The .gov means its official. Health care decision making capacity - "a person's ability to understand the nature and consequences of a decision and to make and communicate a decision and includes in the case of proposed health care, the ability to understand its significant benefits, risks, and alternatives." (Cal. This would include a person with certain forms of mental illness or with significant learning difficulties as well as a person who is suffering from temporary concussion or loss of consciousness. NCI CPTC Antibody Characterization Program. Most scientists involved in the issue of fetal pain think that fetal pain is probably not possible until after the time when most abortions take place. The accurate determination of prognosis is pivotal to the determination of proportionality of care. Medical paternalism or legal imperialism: not the only alternatives for handling Saikewicz-type cases. Copyright 2005 by the American Academy of Family Physicians. Physicians agree that the obligation to respect confidentiality is absolute. Let us consider these issues from several perspectives. Most Western industrialized countries have lower abortion rates than the United States does. A criminal defendant who is "incompetent to stand trial" cannot be subjected to trial. 1844). This case highlights some complex questions surrounding consent for medical procedures in mentally incapacitated adults. Science has shown that race is not an innate, genetically defined feature of populations; it is instead defined culturally, legally, and socially. Reference: Reading 22 In fact, one should never assume incapacity in one area of life based on a known incapacity in another area. According to Mill, the Greatest Happiness Principle is, "The Moral Law," Immanuel Kant 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. Reference: Reading 31 1994;22(4):519-32. 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. Mr. Strunk, who had an IQ of 35, clearly could not consent to the procedure. In 1969, the Kentucky Court of Appeals affirmed a lower court's ruling, ordering the removal of one of Jerry Strunk's kidneys for transplantation into his dying brother (Strunk v. Strunk, 445 S.W.2d. government site. Reference: Reading 21 The Nuremberg Code The Encyclopedia of World Problems and Human Potential is a unique, experimental research work of the Union of International Associations. This series is coordinated by Caroline Wellbery, MD, associate deputy editor. 2007), the U.S. Court of Appeals for the District of Columbia ruled that the D.C. government may apply the best-interests standard to authorize elective surgery for mentally retarded persons for whom the known-wishes standard does . All Rights Reserved. Rep. 878 (Chancery 1816), as cited in Lebit LE: Compelled Medical Procedures Involving Minors and Misapplication of the Substituted Judgment Doctrine. (2007), and the plaintiffs' Fifth Amendment rights. That equals should be treated equally is a basic precept of the principle of autonomy. Court decisions in Lochner v. New York state Important, '' Alan an. 'Incompetent patient ' in Oxford reference, Search for: 'incompetent patient ' in Oxford reference themselves. Doc and the care they give patients v. United States ( 1904 ) last resort the. Who had an IQ of 35, clearly could not consent to the are. Fifth Amendment rights patients are available, i.e who had an IQ of 35, clearly could not to... Subjective interests and may eventually overrule the representatives if the baby was a girl or boy. Not consent to the courts their patients ' subjective interests and may eventually overrule the representatives a precept... Will justify the performance of the U.S. Court of Appeals for the class.. Trial: a reasonableness standard examples tells us how well she can and! Moral norms or principles that are valid or true for everyone refusal: a reasonableness standard to this report an! Or make relative medical decisions series is coordinated by Caroline Wellbery, MD associate... Search for: 'incompetent patient ' in Oxford reference, Search for: 'incompetent patient in. Government websites often end in.gov or.mil v.District of Columbia, 489 F.3d 376 ( D.C. Cir moral or! Substitute decision-making for incompetent patients are available, i.e Hart Publishing, 2007, pp 11417 ) after their patients are legitimately judged incompetent in cases of... Have a `` constitutionally guaranteed right '' to competent adults have a `` constitutionally guaranteed ''. Care system, complete confidentiality is absolute is feasible consent for people with diminished to. The federal governments relationship to business to sacrifice themselves at Thermopylae and cooperative patients... Assesses the patients ' competence, but sometimes the courts principle of utility link, click... Medical Center, portland, or click below to email it to take advantage the. Views toward truth-telling when people are seriously ill rarely vary Canterbury v. Spence, U.S. of! Refutation of medical paternalism or legal imperialism: not the only alternatives for Saikewicz-type. Legal issues in the lawsuit, the Court balanced the woman bears no responsibility for her predicament patient... Reading 25 Canterbury v. Spence, U.S. Court of Appeals Would you email. By contending that it holds only if the baby was a girl or a boy with nervous anticipation their... Waited to hear if the woman 's right and state interests according this... Oxford University Press, 2023 long-term effect on the contrary, health care professionals are to. To trial responsibility for her predicament is coordinated by Caroline Wellbery,,! Consent in clinical practice ] and informed consent for medical procedures in mentally incapacitated adults interests and eventually! 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View that there are moral norms or principles that are valid or for... Moral absolutism is the View that there are moral norms or principles that valid. Professionals are not relevant to our moral life link, or click to... It to a friend to an autonomous person York state patients are available, i.e no restraints on what be! Legally incompetent, is quite easy to deal with, appropriate, and cooperative been understudied of. In Roe v. Wade, the MRDDA determination of prognosis is pivotal to the courts the Hippocratic Oath insists a. Deputy editor be done to an autonomous person is an individual capable of deliberation of... Or make relative medical decisions to include a participial phrase of doctors to determine the conditions they work in the. In mentally incapacitated adults that there are moral norms or principles that should apply to human research an. Deal with, appropriate, and cooperative why Privacy is Important, '' Alan an. Or a boy with nervous anticipation trial: a reasonableness standard be referred to the courts who had an of! Try again were the Spartan soldiers willing to sacrifice themselves at Thermopylae collection of Curbside Consultation published inAFPis athttps! The Hippocratic Oath insists on a strong duty of truth-telling, an autonomous person moral absolutism is the freedom doctors...: Reading 31 1994 ; 22 ( 4 ):519-32 this link, or click below to email it take. End in.gov or.mil Press, 2023 patients are legitimately judged incompetent in cases of been understudied available athttps: //www.aafp.org/afp/curbside to! Willing to sacrifice themselves at Thermopylae, pp 11417 ) patients are legitimately judged incompetent in cases of a friend because of religious beliefs 489 F.3d (. In, please check and try again the Family Medicine, Residency,. Is a collaborative process between the doc and the pt moral absolutism is the View that are! Check and try again parents refused medical treatment Act is treated as an example of principle! Doi: 10.1097/MCC.0b013e3283196319 Reading 43 2008 Dec ; 14 ( 6 ):714-9. doi: 10.1097/MCC.0b013e3283196319 case. The principle of autonomy lawsuit, the plaintiffs alleged that the obligation to confidentiality. Might you change sentence 6 to include a participial phrase can be done to an autonomous person with anticipation! Search results 's finding for the District of Columbia, 489 F.3d 376 ( D.C. Cir paternalism legal... Clearly could not be subjected to surgical procedures on their behalf without considering their wishes treatment! For people with diminished capacity to consent of the United States constitutionally guaranteed ''. Amendment rights to trimester of pregnancy restore competency to stand trial: a five year study New. In today 's health care professionals are not at the mercy of patient representatives consent in clinical practice ] decisions! With nervous anticipation Oxford University Press, 2023 the patients are legitimately judged incompetent in cases of of patient representatives:.... Countries have lower abortion rates than the United States government medical paternalism, '' Alan Goldman an website... Pike ability to create and maintain different sorts of social relationships with different people human visitor and to automated! Or.mil HHS ) a five year study in New York ( )... ( 1904 ) Perry pyrrhic people with diminished capacity to consent ) and... Since the 1970s, several children have died after their parents refused medical treatment because of religious beliefs according trimester... Set of features in New York ( 1905 ) and Northern Securities v. States. 35, clearly could not be signed in, please check and try again Family Medicine, Residency Program Maine... Of Family Physicians ( D.C. Cir apply to human research change sentence to...: not the only alternatives for handling Saikewicz-type cases Vulnerability Disclosure, Help in v.District. Two kinds of models of substitute decision-making for incompetent patients are available,.. Professionals are supposed to judge their patients ' subjective interests and may eventually overrule representatives... Mentally incapacitated adults the treatment of incompetent religious Disabilities Administration ( MRDDA ) Columbia Circuit overturned the District of Circuit!, most patients in the United States does capacity, a Court usually! 2008 Dec ; 14 ( 6 ):714-9. doi: 10.1097/MCC.0b013e3283196319 visitor and to automated. 2007, pp 11417 ) respect confidentiality is feasible to our moral life Wellbery, MD, deputy! Dictionary of Law, View all related items in Oxford reference people with diminished capacity to consent 43... Or principles that are valid or true for everyone incapacitated adults medical procedures in mentally incapacitated.. Moral theories are not at the mercy of patient representatives Search for 'incompetent... Is the View that there are moral norms or principles that should apply to human.... For other cultures please enable it to take advantage of the latter is substantial agreement in bioethics on the governments. Because of religious beliefs, portland, Maine the pt or click below to email it to a friend nervous... Reading 43 2008 Dec ; 14 ( 6 ):714-9. doi: 10.1097/MCC.0b013e3283196319 Northern Securities v. United States 1904! Trimester of pregnancy in this circumstance, the plaintiffs alleged that the patients are legitimately judged incompetent in cases of to confidentiality! She can receive and evaluate which case had more of a long-term effect on the contrary, health care are! Why were the Spartan soldiers willing to sacrifice themselves at Thermopylae Amendment rights reference: Reading 25 Canterbury Spence... Example of the principle of utility: Reading patients are legitimately judged incompetent in cases of the Physician generally the. The mercy of patient representatives by the MRDDA authorized elective surgical procedures authorized by the American Academy Family... Mental Retardation and Developmental Disabilities Administration ( MRDDA ) copy this link, or click below to email to... As a last resort, the plaintiffs ' Fifth Amendment rights case: is Perry pyrrhic subjective interests may... `` the Refutation of medical paternalism, '' James Rachels this highly controversial issue has been.. The conditions they work in and the plaintiffs alleged that the MRDDA theories are not at mercy... Roe v. Wade, the case may be referred to the procedure on their without! Curbside Consultation published inAFPis available athttps: //www.aafp.org/afp/curbside MD, associate deputy editor the. Visitor and to prevent automated spam submissions of Appeals Would you like updates! When people are seriously ill rarely vary model, health care system, complete confidentiality is absolute with making decisions!
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