Trust,autonomy, and advance directives

Trust has been largely ignored in contemporary bioethical discussions and also by courts of law. The favored language of autonomy, privacy, and rights is useful but insufficient to speak to moral experience, especially the experience of persons who write advance directives, but also physicians who receive such directives. The Brophy case is analyzed for its salient features, and a more central place for the concept of trust is proposed.This paper was presented at the Lehigh Valley Hospital Center Conference, Making Medical Decisions with and for Patients in Difficult Medical Circumstances, in 1988.The author has profited greatly in writing this paper from reading Nancy King'sMaking Sense of Advance Directives, to be published by D. Reidel, Dordrecht, The Netherlands.     

Some reflections on the problem of advance directives, personhood, and personal identity

In this paper, I consider objections to advance directives based on the claim that there is a discontinuity of interests, and of personal identity, between the time a person executes an advance directive and the time when the patient has become severely demented. Focusing narrowly on refusals of life-sustaining treatment for severely demented patients, I argue that acceptance of the psychological view of personal identity does not entail that treatment refusals should be overriden. Although severely demented patients are morally considerable beings, and must be kept comfortable whilst alive, they no longer have an interest in receiving life-sustaining treatment.     

Persistent vegetative state, prospective thinking, and advance directives

This article begins with a discussion of persistent vegetative state (PVS), focusing on concerns related to both diagnosis and prognosis and paying special attention to the 1994 Multi-Society Task Force report on the medical aspects of PVS. The article explores the impact of diagnostic and prognostic uncertainties on prospective thinking regarding the possibility of PVS and considers the closely related question of how prospective thinkers might craft advance directives in order to deal most effectively with this possibility.     

Using stories to assess values and establish medical directives

While still developing in Germany, a consensus has emerged in the United States on the use of advance directives for guiding future medical decision making. This article outlines three phases in the evolution of advance directive forms--the legal phase, the checklist phase, and the story phase. The story-based approach is discussed as the best method for assessing patient values and incorporating them into advance directives, and a story-based advance directive form, which has been developed and tested during the past two years, is presented.     

Eudaimonia and well-being: questioning the moral authority of advance directives in dementia

Theoretical Medicine and Bioethics - This paper revisits Ronald Dworkin’s influential position that a person’s advance directive for future health care and medical treatment retains its...     

The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

African American adolescent mothers and grandmothers: A multigenerational approach to parenting

This study is an adaptation and extension of Apfel and Seitz’s (Family Relations, 40(4), 421–429, 1991) models of adolescent parenting and adolescent-grandmother relationships to a sample of 148 African American, first-time adolescent mothers and their 6-month-old infants. The Parental Supplemental model, in which adolescent mothers and grandmothers shared caregiving, described 63% of Apfel and Seitz’s (1991) sample and 66% of the current sample. Shared caregiving was not associated with conflict in the adolescent mother–grandmother relationship. Adolescent mothers who had caregiving responsibilities and a supportive adolescent-grandmother relationship also reported competence in their parenting role. Findings provide support for Apfel and Seitz’s Parental Apprentice model, in which young mothers gain competence through direct caregiving experience in the context of a supportive relationship.     

Work values and the transition to work life: A longitudinal study

Research on career development has shown that work values play a key motivational role in job selection and career development. In the context of the current economic crisis, it is of particular relevance to examine the role of work values for employment in the transition from school to work. This longitudinal study examined the role of intrinsic (perceived importance of having a job that is interesting and matches one's own competences), rewards (having a good salary and high chance for promotion), and security (having a stable job) work values on subsequent employment status and person–job fit (how an individual's job matches one's own characteristics such as education and job preferences). Finnish participants reported their work values and background variables via questionnaire at ages 20 and 23 (Ns = 348 and 415 respectively). Intrinsic work values predicted a higher degree of person–job fit two years later. Rewards work values predicted lower chances of being unemployed; and security work values predicted higher chances of being unemployed later on. Family socio-economic status (SES) was not related to employment outcomes in this Finnish sample.     

Ideological analytics: A study of evolving world values

This study analyses ideologies in a comparative perspective. It does so by treating ideologies as normative mental systems interacting with environmental physical realities and following their evolution in the contemporary world. As a result, it exemplifies a systematic method of undertaking a diagnosis, anagnosis, and prognosis of the global ideological situation.

The study introduces a relevance tree reflecting the conceptual framework of ideological analytics. On this basis, it presents three levels of generality which contain the outline of a substantive analysis. The examples given therein illustrate the model and could serve as prototypes for more detailed studies.

Finally, the study draws the main conclusions from the above generalizations by identifying the dialectical process of ideological dynamics. This process together with the non‐linear development of social systems produce the macrohistorical cycles of world evolution. Thus, the proposed hypothesis of dialectichaos can contribute to a better understanding oïideosocial change.