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.     

A multigenerational study on the correlation of values and advance directives

The development of the Values History instrument for use in advance directive decision making has raised the question of the importance of values in eliciting advance directives. This pilot study examines the relationship between the domains of values and advance directives drawn from the Values History in three generation intrafamily triads. Significant correlations between values and advance directives were found primarily within the youngest generation. Results reveal a relatively high familiarity by the participants of the various established forms of advance directives. Also, a significant percentage of parents and grandparents was found to have signed some form of advance directive.     

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...     

Affective state and event-based prospective memory

Event-based prospective memory tasks require the realisation of a delayed intention at the occurrence of a specific target event. The present research investigates how performance in this kind of prospective memory task is influenced by the current affective state. By manipulating participants' mood during intention realisation we tested two competing models of mood effects on memory (i.e., a capacity consuming account and a processing style account). Furthermore, we manipulated the valence of the target event to investigate mood-congruency effects in prospective memory. No evidence was found for a mood-congruency effect, but the results showed that prospective memory performance increased with a sad mood. This effect is consistent with recent theories on mood-dependent processing-style regulation, postulating that a sad mood produces a more analytic and detailed processing style whereas a happy mood produces a more global and less detailed processing style.     

催眠和变更意识状态的探索与思考

如今一般大众,甚至许多心理学专业人员都把催眠状态下的意识和各种变更的意识状态统称为潜意识状态,这种提法存在着很大弊端。本文举实例论述了单就催眠状态来说也有不相同的表现利性质;同时阐述了研究具体的各种变更意识状态的表现、性质、特点及分类的重要性。     

Epistemology,critical thinking,and critical thinking pedagogy

Epistemology, critical thinking, and critical thinking pedagogy     

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.