Midterm 1

Question 1

What is the difference between a negative vs a positive definition of “health”?

Answer 1

Negative definition means the LACK of disease.

Positive definition means the PRESENCE of overall well-being.

Question 2

What is the difference between a naturalist/descriptivist vs a normativist approach?

Answer 2

Naturalist-descriptivist: Believes that health can be separate from well-being, health levels are defined by a statistical deviation from a “norm” of biological functioning. Has a doctrine of specific etiology for things → reinforces dualism, reductionism, magic bullet approaches.

Normativist: Positive definition of health, linked to subjective psychological states. Healthiness is a resource.

Question 3

What is the difference between disease and illness?

Answer 3

Disease is a pathology of the body, a deviation from the biological norm. Illness includes all aspects of “un-wellness” like social consequences, psychological consequences, physical deviations from normal abilities.

Question 4

What does “specific etiology of disease” refer to?

Answer 4

The idea that diseases are due to a specific biological cause. (naturalist/descriptivist approach)

Question 5

How does the “specific etiology of disease” model relate to magic bullet cures?

Answer 5

It leads to them. If there is a specific biological cause for a disease, there must be a specific biological cure (i.e. a pill or a surgery).

Question 6

What are two statistical ways to measure health? What do they include?

Answer 6

Look at mortality rates; includes child mortality rates, mother mortality rates, causes of death in a population, life expectancy.
Look at morbidity rates; includes prevalence of disease and incidence of a disease (prevalence is spread, incidence is number of new cases), disability-adjusted life years DALYs.

Question 7

Contrast biological vs social approaches to “sex” and “gender”.

Answer 7

Biological approach → sex. Defined by physical characteristics like internal/external genitalia, hormones, anatomy & physiology.
Social approach → gender. Less fixed than sex. Refers to social constructions of roles and relationships, traits, behaviors, values, socially ascribed power and influence. Gender is something that we act out, in our relative masculinity and femininity.

Question 8

What are the 5 elements of SEX designation?

Answer 8

• Chromosomal sex
• Gonadal sex
• Hormonal sex
• Internal/reproductive sex
• External/genital sex

Question 9

Contrast sociobiology and social constructionism.

Answer 9

Sociobiology: “Biology → destiny”, reduces complex gendered behavior to purely genetics. Reinforces the binary of male vs. female. Promotes male perspectives, generalizes from animals to humans. Wilson: “biological basis of all social behavior”, theory of cheap sperm → male promiscuity vs. precious egg → female monogamy

Social Constructionism: Social structures shape behaviors, preferences (including gender norms & stereotypes). Looks are historical factors of fluctuation of gender norms.

Question 10

Discuss the medicalization of intersexuality (interventions, treatments, implications).

Answer 10

Is intersexuality (ambiguously-sexed bodies) a natural variation, or a mistake of nature? Tend to be seen as “syndromes” (Klinefelter, Turner).
Interventions take place even if there is no medical reason, only for aesthetics to conform to norms.
Can be prenatal, surgical, and psychological interventions. (Prenatal includes CAH → hormonal)
These interventions can cause pain and issues with well-being later in life. Some cultures accept ambiguous bodies as a 3rd gender (New Mexico, Hawaii, etc.)
Gender as binary vs. gender as a continuum?

Question 11

Give some examples of gendered patterns of health.

Answer 11

Women lower mortality than men, higher morbidity.
Homosexual people way more likely to commit suicide.
Women are more likely to contract STI’s from sexual contact.
Women more likely to adjust their time to accomplish both paid & unpaid work. (second shift)

Question 12

What are some causes for gender differences in mortality, morbidity? (Bird & Rieker)

Answer 12

Biological explanations: Women stronger/diff immune systems. leads to advantage plus autoimmune disorder disadvantage; estrogen provides more flexible circulatory system

Social explanations: Women’s social status leads to more health risks (lack of health insurance, pensions, lower income); gender differences in health behaviors (smoking, risk-taking)

Amplification & suppression.

Question 13

What are amplification and suppression? (Bird & Rieker)

Answer 13

Amplification: When a biological difference is exacerbated by social factors.

Suppression: When a biological difference is reduced by social factors.

Question 14

What are the 3 classic sociological theories?

Answer 14

• Structural Functionalism
• Conflict Theory
• Symbolic Interactionism

Question 15

Who was a proponent of structural functionalism and what is the gist of it?

Answer 15

Durkheim → society is a complex system whose parts work together to promote solidarity & stability. Individual behaviors are determined by social structure.
Parson’s “Sick Role” part of social functionalism, sickness is deviance and role of clinician’s is to eliminate deviance.

Question 16

Who was a proponent of conflict theory and what is the gist of it?

Answer 16

Marx → Economic forces determine social functioning, recognizes the inequalities and hierarchies in society. Conflict between economy and health interests. Medicine makes profit and so requires sick people to continue to consume.

Question 17

What is the gist of symbolic interactionism?

Answer 17

• Identify meaningful social action among social actors. (and expections of these social actors → the “generalized other”. altho not gendered, leads to discussion of gender expectations)
• Explore individual’s own interpretations of their experiences.
• Portray/report individual’s points of view in their own language, their own terms.

Question 18

Who were some proponents of symbolic interactionism?

Answer 18

Weber, Mead, Goffman

Question 19

Describe the 3 ‘waves’ of feminism.

Answer 19

1st wave: Late 1800’s to 1920’s → suffragists. Maternal feminists who wanted to protect the rights of women within their social roles, child protection.
2nd wave: Mid 1960’s on → Movements, non-traditional workforce, loud activism and challenges to social ideologies, legal reform.
3rd wave: 1990’s on → Complacency, start recognizing within-group diversity (race)

Question 20

Who was an important woman in the 1st wave of feminism?

Answer 20

Margaret Sanger

Question 21

Describe radical feminism.

Answer 21

During the 2nd wave, part of the Women’s Health Movement.

• Men oppress women through patriarchy
• Reproductive rights as a key focus (natural childbirth, control of reproduction, birth control, abortion)
• Tried to spread awareness, loud activism
• Boston Women’s Health collective → “Our bodies, ourselves”

Question 22

Describe liberal feminism.

Answer 22

Change through formal measures (political, legal)

• Fight for equal rights in education, pay, health care.
• Affirmative action → social policies, etc.
• “National Consciousness Raising” more than just self-help and within group discussion.
• CRITIQUED → working Within a flawed system instead of changing the system, too mechanistic, too slow.

Question 23

Describe Marxist & socialist feminism.

Answer 23

Women oppressed by capitalism:

• Women stuck in domestic sphere
• Capitalism benefits from women’s unpaid labor
• Men at the head of capitalism, so they are the ones profiting from women’s unpaid labor, and they need women to take care of them so women will forever be excluded from the profits of capitalism.

Question 24

Describe postmodern feminism.

Answer 24

• Rejects binary conceptions of gender
• Avoidance of reductionism
• Complexity of gender identity linked to health
• Studies effects of media representations and linked health outcomes (i.e. eating disorders)
• Doesn’t exclude masculinity and health

Question 25

What is a basic definition of intersectionality?

Answer 25

Multiple socially constructed identities and categories of difference (race, gender, social class, sexuality, age) INTERACT in society to produce a range of hierarchies and inequalities.

Question 26

What are the origins of the term "intersectionality"?

Answer 26

Originated in the 60s/70s, feminist and civil rights movements. Black women felt that they were being excluded from both civil rights movement and feminist movement... started getting together to discuss this. Perfect example of the activist origins of intersectionality. Legal/theoretical importance of the term began in the 1980's, with the Anita Hill/Clarence Thomas case: Clarence Hill was a young potential judge, up for promotion, and his black young woman assistant accused him of sexual harassment. He said this was RACISM, she said no it's SEXISM, and it was never really worked out properly.. he got off from an all-male jury. Kimberle Crenshaw was a legal theorist who started noticing this issue and investigating. An interactive matrix of oppression, domination (Patricia Hill Collins)

Question 27

What important things happened in the "Crash" movie excerpt?

Answer 27

- The middle-eastern people got insulted at the gun store, the man got kicked out and stereotyped as a terrorist. - The gun salesman starting talking to the midde-eastern woman who spoke perfect english as if she was an idiot (racism? sexism?) - The two black guys weren't served at Starbucks (but they didn't want coffee?) - The two black guys saw a white woman cling to her man's arm when she saw them (is it in their head or was that really a factor? was she just cold?) - The two black guys actually stole the car...

Question 28

What is the difference between Critical Race Theory and Anti-racism/antiracist theory?

Answer 28

Critical Race Theory emerged from legal studies (Kimberle Crenshaw) → focuses on race as socially constructed from historical and political context and struggle Anti-racism/antiracist Theory emerged from racial feminist & civil rights activist movement → looks at other explanations for seeming differences "due to" race (ex. if a racial group has lower results on intelligence tests... it may actually be because this racial group is disadvantaged in SES and so lacks the knowledge...)

Question 29

What is racialization?

Answer 29

A process of categorization of people based on assumptions about skin color & other characteristics. The "extension of dehumanizing and racial meanings to a previously racially unclassified relationship, social practice, group". Groups (by race) which are "more likely to be:" poor/unhealthier/etc. Ex. black women more likely to die from breast cancer.

Question 30

What are the 3 components of SES?

Answer 30

- Educational attainment - Occupational status - Income level

Question 31

How are discriminatory ideas/practices connected to a lack of resources?

Answer 31

Lead to job discrimination, lack of health care access, differential wages.

Question 32

What does "gender is relational" mean?

Answer 32

It means that gender isn't a binary of masculine vs feminine, to understand gender you must study the relationship between them and the whole continuum.

Question 33

What happened that was good/bad in the 1970's regarding homosexuality?

Answer 33

Public focus grew, gay and lesbian social movements grew → good that awareness spread but bad because of homogenizing effect. Homosexual paradigm became White, male, middle-class. (lack of representation for black, other SES)

Question 34

Discuss the social constructionist view of sexuality.

Answer 34

Idea that categories of sexuality are social and historical creations → challenges the notion that sexuality is innate and natural. (Questions like is it a PROBLEM due to social factors? is the natural thing to be straight and social factors fuck you up? can it be "fixed"?)

Question 35

What is "queer theory", what did it stand for?

Answer 35

Rejection of a unified homosexual subject. There are many ways of being homosexual. Studied the way sexuality is used as a way of organizing people. Shift from homosexual theorizing to more general social theorizing. Looking at institutionally enforced binaries (gender on ID cards), strong interest in knowing sex of a fetus.

Question 36

Describe the importance of "queer" identity regarding HIV/AIDS

Answer 36

Used to be "Gay-Related Immune Deficiency"... gay people defined as the risk group. Queer identity tightly linked to the disease (plague!)

Question 37

What are some consequences of the medicalization of transvestitism, transsexualism, intersexualism?

Answer 37

If they are disorders → does that imply they need to be treated? Implies a normative assumption about bodies → they need to be binary, intersexualism not acceptable.

Question 38

What does Lombardi say about definitions & transgender health care?

Answer 38

In the medical system, too much focus is given to labelling and categorizing bodies and genders, instead of just accepting people into health care including all their possible combinations of traits (emotional, physical, mental)

Question 39

What are some pros and cons of gender-transition?

Answer 39

Pros: better self-reported well-being (promotes health) Cons: Hormone therapy can increase risk of cancer, can be drug interactions with the hormones, post-op complications, self-administration of hormones (dirty needles, unregulated compounds)

Question 40

Give some examples of substandard health care due to discrimination.

Answer 40

``` Robert Eads (southern comfort) took too long to identify and find doctors to treat his *ovarian* cancer, because he was transgendered/wtv other discrimination. Tyra Hunter: Trans woman in a car crash, EMTs realised she had male genitalia and refused to treat her. She died. ```

Question 41

What are some issues with access to health care?

Answer 41

- Discrimination/ridicule - Refusal to treat - Difficulty finding Drs familiar/open with their situation - Lead to bad treatment or avoidance of treatment (Billy Tipton - jazz musician)

Question 42

What are some suggested strategies for improving health outcomes for transgender people?

Answer 42

- Improved education in medical school - Acknowledge authenticity of transgender IDENTITY - Do not tolerate discriminatory treatment/refusals of treatment - Support for youth questioning - Better access to services (making lists of trans-friendly resources) - Cultural relevancy (i.e. in our culture we are big on information pamphlets for condom use → sometimes the images in the pamphlets could include trans people)

Question 43

Give a quick definition of hegemonic masculinity.

Answer 43

- White - Tall - Middle/upper-class, well-dressed - Good-looking, women adore him - Very good fertility - Fights for what he believes in (can back it up physically as well) - Powerful

Question 44

What are Kimmel's 4 rules of masculinity?

Answer 44

1. Reject femininity (including stereotypical homosexuality) 2. The bigger the income, the better 3. Be reliable, stable, stoic, no emotional vulnerability (anger can be ok sometimes) 4. Take risks, live on the edge (gambling, unprotected sex...)

Question 45

Discuss Connell's idea of multiple masculinities.

Answer 45

Men's experiences are far more diverse and complex than typically represented. Masculinities are always defined in relation to hegemonic masculinity.

Question 46

What is protest masculinity?

Answer 46

When hegemonic masculinity can't be achieved for whatever reason, sometimes other power-seeking behaviors are substituted: gang activity, violence.

Question 47

What are patriarchal dividends?

Answer 47

Even though not all men achieve hegemonic masculinity, many men still profit from this ideal (maintains inequality with women- wages, working hours, leadership positions)

Question 48

Describe 3 types of alternative masculinity (aside from protest masculinity)

Answer 48

1- Complicit masculinity (embraces & perpetuates hegemonic ideal) to enjoy benefits, continue oppressing women, live out fantasy [videogames offering the perfect fantasy], and avoid negative treatment 2- Marginalized masculinity → type of ascribed masculinity. Assigned because it's impossible for this population to aspire to hegemonic (i.e. black, disabled, poor, etc) 3- Subordinate masculinity → purposely defines itself contrary to hegemonic ideals (i.e. feminine behavior, etc)

Question 49

Describe 'female masculinity' relative to male masculinity.

Answer 49

Women embracing masculine behaviors/roles. Important to remember that it is it's own thing, not the same as male masculinity. Doesn't necessarily correspond to lesbian identity. Initiates a historical discussion of masculine females (even outside of sexual orientation)

Question 50

Discuss how health outcomes relate to hegemonic masculinity.

Answer 50

Hegemonic ideal reinforces things like - Physical strength, immunity - Riskier behaviors - Expectations of invulnerability to pain/disease/injury So people who embrace the hegemonic ideal may engage in riskier behavior, less good health practices.

Question 51

Explain the "Gender Role Strain Paradigm". (4 elements)

Answer 51

1- Gender roles are in flux (men are now expected to help more with child care etc, but still be chivalrous and "manly") 2- Violations of gender norms (ex. men as nurses, stay at home dads, pregnant men) can cause strain from discrimination 3- Negative psychological consequences due to the above, 4- Severity of social consequences is different per gender: women acting masculine not that big a deal, but MEN acting feminine is a big deal. Why? because womanly traits are DEVALUED, because women have always been lower on the hierarchy. "Who would want to be womanly?" choosing devaluation.

Question 52

What are the 3 types of strain that can be experienced (Pleck)?

Answer 52

1- Discrepancy strain (not meeting own ideals of masculinity) 2- Dysfunction strain (failing at conventional masculinity, even though trying, receiving negative feedback) 3- Trauma strain (experiencing a trauma from embracing hegemonic ideals like breaking a bone in football: emotional pain and scarring)

Question 53

What is the importance of the Type A personality?

Answer 53

Type A has a lot of elements in common with powerful hegemonic masculinity, which can actually lead to bad health consequences (cardiovascular disease from defensive hostility)

Question 54

Discuss mental health problems and masculinity.

Answer 54

Societal beliefs about depression and gender. Depression is seen to be a loss of control of one's emotions (terrible for masculinity). Help-seeking is seen as weak. The idea that depression is less common in men is so widespread that clinicians are less likely to diagnose it from the same symptoms in men than women. Suicide rates are higher in men (less likely to seek help... methods used are more effective)

Question 55

What is a problem that is faced by masculine femininity?

Answer 55

There is a lack of research on the effects of masculine behavior and gender identity on women.

Question 56

Discuss the 3 top methods of contraception and their use.

Answer 56

1- Oral contraception, used by females, can have side-effects but women are willing to bare them. 2- Condoms, technically used by men but almost half the purchases are by women... shared responsibility for use. 3- Sterilization (vasectomies) by men. Usually done later in life.

Question 57

What is involved in the decision-making process of which contraception to use?

Answer 57

Effectiveness of the method, health care provider bias, ease of use and access (social acceptedness can play a role)

Question 58

What is "safe sex fatigue"?

Answer 58

The phenomenon of people being desensitized to the importance of safe sex practices because they're so used to hearing this information, and tired of making the effort.

Question 59

Discuss some issues that emergency contraception faces.

Answer 59

- Regional issues in access (some pharmacies might not carry it.. might have to go to a clinic, but maybe there's no clinic nearby) - "Professional Gatekeeping" → Pharmacists have the power to choose who they sell it to (vulnerable to their own values and beliefs) → brings up privacy issues (have to disclose details about your sex life to a pharmacist... lack of confidentiality?) Who has the right to decide for a woman if she should be allowed to use emergency contraception?

Question 60

What is the actual mechanism of Plan B and why is it controversial?

Answer 60

It is supposed to just inhibit/delay ovulation (not empirically shown to be an abortifacient) to just prevent fertilization. Controversy is about the theorized post-fertilization effects it could have and their morality. Pharmacists are allowed to refuse to supply Plan B if they think it might result in an abortion → giving power to the pharmacist over the actual woman.

Question 61

What is "conscientious objection"?

Answer 61

Technically when the pharmacist believes the effects of the emergency contraception will be harmful (relative to his/her own values and beliefs) and refuses to provide the product because of this. Can actually fully compromise access especially in small rural communities.

Question 62

Discuss some historical methods of contraception and what is important about them.

Answer 62

In early Greek era (BCE, Hippocrates time), many suggestions for MEN. It was recommended to bathe testicles in hot water, drink papaya or cannabis juice. Focus on male contraception has been dropped since the 19th century with condoms and vasectomies.

Question 63

How did Shwartz refute the claim that it's harder to intervene on male gametes because there are billions of them vs women who just release one at a time?

Answer 63

He said in many ways it's actually easier to intervene on a continuous process (so timing doesn't really matter) than on a discontinuous process.

Question 64

Discuss 3 causes of a lack of male BC pill.

Answer 64

- Lack of funding (funding agencies gendered, commonly panels of men make the decisions → believe there is a lack of interest, and believe female BC is better, safer, etc.) - Ideas about masculinity and reproduction (virility and fertility are a big part of masculinity. eliminating them may seem like an attack on men's manhood) - Ideas about femininity and responsibility (women requested control over reproduction, they got it. also worth noting that women have ALWAYS been more responsible for the family realm).

Question 65

What are some causes of unintended pregnancy?

Answer 65

- Lack of contraceptive info/education/incorrect use - Lack of contraception due to availability, institutional access, cultural/social factors (age!) - Sexual violence

Question 66

What are the main reasons stated for getting an abortion?

Answer 66

- Fear of single MOTHERHOOD and the associated poverty. | → single motherhood often leads to social stigma and lower SES.

Question 67

Discuss the evolution of abortion in Canada.

Answer 67

Criminalized until late 60's. Then publicized deaths linked to botched illegal abortions put pressure... Decriminalized but only in cases of therapeutic abortion (women's health judged to be in danger DUE TO the pregnancy). Had to be assessed by a 'Therapeutic Approval Committee', very biased and hardly ever approved. Early 70's activism, Morgentaler clinic up and running in the open, so much public support that he was never persecuted. Quebec declared that they would not enforce the criminality of non-therapeutic abortions. 1988 R. vs. Morgentaler → abortion totally decriminalized (negative right, doesn't ensure ACCESS, just ensures you won't be prosecuted if you get one) 1991 - Case which set a precedent that men have NO RIGHT to the decision to abort. 1999 - Case which set a precedent that women do not have a "duty of care" to the fetus. i.e. their actions before the baby is born can't be prosecuted as fetal neglect. The baby is not a person until born.

Question 68

What percentage of hospitals across Canada are set up to be able to perform abortions?

Answer 68

15.9%..... extreme lack of funding and doctor training.

Question 69

What are some health, safety, ethical issues surrounding assisted reproduction?

Answer 69

- Side-effects of hormones on women & fetus - Ethical issues about extending fertility into old age - Ethical issues about commercialization of assistive reproduction (surrogacy pays money...) - Ethical issue about all the funding that goes into assisting women's infertility as a "health issue" that merits funding (medicalization)

Question 70

What were Annandale & Hunt's main results about gender and health?

Answer 70

High masculinity scores were correlated to improved health (vs. low masculinity) High femininity scores were correlated to poorer health (vs. low femininity) → gender is at least as important as sex. → high masculinity leads to better health even for women.

Question 71

What type of research do Bird & Rieker suggest?

Answer 71

Interdisciplinary research (social AND biological)

Question 72

What is Krieger's main point about "gender" and "sex"?

Answer 72

Sex and Gender need to be seen as distinct terms, not interchangeable, and the clarity of these concepts and terminology are essential to valid scientific research.

Question 73

Lorber & Moore: How do the biological and social realms interact?

Answer 73

Biological differences between sexes DO matter, but the way they matter is socially.

Question 74

Nichols: What is a good definition for "women's health"?

Answer 74

To facilitate preservation of wellness and disease prevention of those that are unique to women, more common/serious/risky/different in women.

Question 75

What does Nichols believe are implications for the future of women's clinical practice?

Answer 75

- Progress will only continue if women demand attention to their concerns - Vigilance is essential for maintaining changes - Need to emphasize social factors of women's health rather than just medicalize - Need to examine the commercialization of women's health. - Integrated knowledge base of women-related phenomena.

Question 76

Riska: Discuss relevancy of a MEN'S health movement.

Answer 76

- Would require men to accept the idea that they are weak/victimized (totally unacceptable to most masculinities) - May already be a "silent" health movement: men refusing to use medical resources as a passive resistance to the medicalization of their health needs - Men's health would have to be opened up to psychosociopolitical factors - Would have to eliminate ideas of stoicism of real men, and increase awareness of their bodies.

Question 77

Courtenay: What effects of cultural constructions of masculinity vs constructions of femininity have on health outcomes?

Answer 77

Masculinity constructions encourage bad health behaviors (risk taking, ignoring pain or injury, etc) Femininity constructions encourage good health behaviors (watching diet, being behaviorally conservative, being sensitive to symptoms)

Question 78

Cummings & Jackson: What was their study and some major striking results?

Answer 78

The longest intersectional study on race, gender, and SES disparities in self-assessed health. - In black adults, the widest gender disparity is in the high SES group (women better health) - Women's health improves over time (especially black women) - Black men's perceived health actually decreased from 1974 → 2004 - The price of being a woman= -0.04 in perceived health - The price of being black = -0.25 in perceived health (way bigger) - Best health → high-income white women.

Question 79

What are William's main conclusions about minority women vs white american women?

Answer 79

- Should realize that white american women DON'T in fact have all the best statistics - Health of minority women a product of social inequality & historical, sociocultural, economic, political contexts → more than just changes in health care are needed, changes in fundamental social determinants of health important.

Question 80

Lombardi: What are the historical 'theories' to explain transgenderism?

Answer 80

Female-to-male → attempt to bypass gender inequality | Male-to-female → results from inner desires or fetishized

Question 81

Lombardi: What are 4 ways of categorizing gender?

Answer 81

- Biological sex - Legal/institutionalized sex - Social gender - Psychological gender

Question 82

Feinberg: How should the approach to demanding change in the health care system be modified to work better?

Answer 82

- Patient narratives are not enough, and very painful - Attitudinal change isn't enough, need institutional change - Trans communities need to become involved politically in the changes - Need a list of trans-friendly resources - Need to adjust patient bedside manner (refer to patients by name rather than Mr, Mrs, provide unisex equipment, not involve patient's transgender features when unnecessary (e.g. strep throat)) - Need to research how social factors lead to health outcomes.

Question 83

Laird: What were the main results of the hypothetical male BC pill study?

Answer 83

- Men only 20% likely to take the male pill, but willing to have a female partner take the female pill - Women 70% likely to take the female pill, but unlikely to have a male partner take the male pill. Men unwilling to undertake the risks and inconveniences of taking BC pill, Women unwilling to give up control

Question 84

Mamo: What is interesting about the way women use assisted reproduction technologies to get pregnant (in lesbian relationships)?

Answer 84

They are definitely hybridizing technological practices (high/low-tech, etc) in order to sometimes DEFY traditional categories and adapt the processes to their own purposes. They are intentionally and deliberately navigating thru biomedical landscapes and negotiating with biomedicalization to meet their own goals of getting pregnant... on a more equal footing than simply being the subjects of technology. They are USING technology in the ways they decide to (could be different from the intended way).