Projection in surrogate decisions about life-sustaining medical treatments.

To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, suggests that surrogates' own treatment preferences may influence their predictions of others' preferences. In 2 studies (1 involving 60 college student surrogates and a parent, the other involving 361 elderly outpatients and their chosen surrogate decision maker), surrogates predicted whether a close other would want life-sustaining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more closely resembled surrogates' own treatment wishes than they did the wishes of the individual they were trying to predict. Although the majority of prediction errors reflected inaccurate use of surrogates' own treatment preferences, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projection in surrogate decision making is discussed.     

Decisions at the end of life: Catholic tradition.

Medical decisions regarding end-of-life care have undergone significant changes in recent decades, driven by changes in both medicine and society. Catholic tradition in medical ethics offers clear guidance in many issues, and a moral framework accessible to those who do not share the same faith as well as to members of its faith community. In some areas, a Catholic perspective can be seen clearly and confidently, such as in teachings on the permissibility of suicide and euthanasia. In others, such as withdrawal of nutrition and hydration, the Church does not yet speak with one voice and has not closed out the discussion. Yet, it is not in the teaching on individual issues that a Catholic moral tradition offers the most help and comfort, but in its account of what it means to lead a life in Christ, and to prepare for a Christian death. As in the problem of pain and suffering, it is the spiritual support more than the ethical guidance that helps both patients and physicians bear the unbearable and fathom the unfathomable.     

Why Susie sells seashells by the seashore: implicit egotism and major life decisions

Because most people possess positive associations about themselves, most people prefer things that are connected to the self (e.g., the letters in one's name). The authors refer to such preferences as implicit egotism. Ten studies assessed the role of implicit egotism in 2 major life decisions: where people choose to live and what people choose to do for a living. Studies 1-5 showed that people are disproportionately likely to live in places whose names resemble their own first or last names (e.g., people named Louis are disproportionately likely to live in St. Louis). Study 6 extended this finding to birthday number preferences. People were disproportionately likely to live in cities whose names began with their birthday numbers (e.g., Two Harbors, MN). Studies 7-10 suggested that people disproportionately choose careers whose labels resemble their names (e.g., people named Dennis or Denise are overrepresented among dentists). Implicit egotism appears to influence major life decisions. This idea stands in sharp contrast to many models of rational choice and attests to the importance of understanding implicit beliefs.     

End-of-life decisions: Christian perspectives.

While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions.     

Models of madness: Science and soul

The historical interplay between psychiatry and religion is placed in a contemporary context here. In their zeal to embrace new discoveries and technologies in neurophysiology, modern psychiatrists are losing sight of spiritual and cultural dimensions. From a biological perspective, there is confusion about what constitutes a cause, a concomitant, or a consequence of mental illness. Computer metaphors are being used to explain mental illness. This article examines such trends and questions whether, in the decade of the brain, psychiatry is in danger of losing its soul.     

Cognitive orientation and the prediction of decisions in a medical examination context

From the theory of cognitive orientation (Kreitler and Kreitler 1976, 1982) we derived that scores of cognitive orientation would predict the decision of women to go or not to go to a medical examination for cancer. We tested three alternative methods in addition to the standard method recommended by Kreitler and Kreitler. These four methods represent different assumptions which one can derive from the theory. On the basis of 25 interviews we developed the preliminary questionnaire of beliefs associated with the examination for early detection of cancer. The data of Study 1(N = 72) were used for item analysis as well as testing retest reliability and predicting decisions. In Study 2 (N = 142) the results could be replicated. The Likert-scales for assessing the four components of cognitive orientation proved to be highly retest reliable. Predictions of decisions could be made nearly equally well by each of the four methods derived from the theory of cognitive orientation.     

The moment of truth: Conceptualizing managerial work‐life policy allowance decisions

Organizational efforts of adopting, designing, and implementing work‐family policies converge into single, discretionary decisions of supervisors whether or not to ‘allow’ these policies to specific employees under their supervision. These decisions are referred to as allowance decisions. In order to close a theoretical gap in current work‐family literature, we present an integrated, conceptual model of managerial allowance decisions. We develop propositions regarding factors that influence a supervisor's allowance decision at three different levels of analysis and behavioural outcomes in employees. Building on organizational justice theory, moderating effects of employees' fairness perceptions of allowance decisions are discussed. Finally, we outline implications for future research and recommendations for managers in organizations.     

An analysis of the structure of justification of ethical decisions in medical intervention

The most important distinction in value theory is the subjective-objective distinction which determines the epistemological status of value judgments about medical intervention. Ethical decisions in medical intervention presuppose one of three structures of justification — namely, an inductive approach, a deductive approach which can be either consequentialist or non-consequentialist, and a uniquely ethical approach. Inductivism and deductivism have been discussed extensively in the literature and are only briefly described here. The uniquely ethical approach which presupposes value objectivism is analyzed in detail. This method involves a purely ethical inference which moves from facts to values directly with an emphasis on reason which involves a non-logical justification (as opposed to illogical). It involves the use of natural practical arguments which have an imperative conclusion but no imperative premise and exhibit a value-requiredness between two states of affairs.