The Patient Self-Determination Act and Advance Directives: Snapshots of Activities in a Tertiary Health Care Center

This study describes the results of a retrospective review of patients' charts who had an advanced directive (AD) and who were hospitalized in a tertiary, acute care teaching hospital. The purpose of the review was to understand from clinical, sociological, ethical and legal perspectives the nature and utility of ADs. Findings and implications of the review are discussed in terms of: patient demographics; diagnoses; quality of ADs; influence of ADs on clinical decisions; and legal aspects of ADs.     

Minds and Bodies: Human and Divine

Does God have a mind? Western theism has traditionally construed God as an intentional agent who acts on creation and in relation to humankind. God loves, punishes, and redeems. God's intentionality has traditionally been construed in analogy to human intentionality, which in turn has often presumed a supernatural dualism. Developments in cognitive science, however, render supernatural dualism suspect for explaining the human mind. How, then, can we speak of the mind of God? Borrowing from Daniel Dennett's intentional stance, I suggest that analogical reasoning regarding the mind of God be abandoned in favor of an ontologically agnostic approach that treats God as an intentional system. In this approach, God's purposive action is an explanatory feature of the believer's universe, a real pattern that informs our values and beliefs about the world and our place in it.     

DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

Measures of feeling-of-knowing accuracy: A new look at an old problem

Two ordinal measures of feeling-of-knowing performance appropriate for n × n data arrays are reviewed. Goodman and Kruskal's gamma provides a measure of association between recognition performance and feeling-of-knowing judgements. The Hamann coefficient provides a measure of agreement accuracy. The relative strengths and weaknesses of each measure are compared at length. A proof is provided, which reveals a lack of one-to-one relation between the two and suggests that they may be independent under most circumstances. It is concluded that both measures should be reported together as complementary indices as each captures a different facet of feeling-of-knowing performance. Alternative measures for gamma and the Hamann coefficient are considered and a number of recommendations are made for future research.     

“Not with me you don't”: A story of narrative practice and dissociative disorder

This paper discusses issues relating to therapeutic practice based upon the narrative metaphor. A case of someone suffering the effects of Dissociative Identity disorder is used to illustrate the difficulties that clients can experience with the “expert” knowledge conception of therapy. The value of the “respectful” and “non-expert” emphasis of Narrative Practice emerges even when the therapist believes that he or she lacks expertise in the client's apparent “condition.” Three themes emanating from the case form the basis for the discussion: the client's experience of being recruited into accepting the diagnostic label of Dissociative Identity Disorder; the effects of being forced to accept a contract to eliminate self-abusive behaviour; and the therapist's dealing with a gun in the therapy room.     

Perceiving geographical slant

People judged the inclination of hills viewed either out-of-doors or in a computer-simulated virtual environment. Angle judgments were obtained by having people (1) provide verbal estimates, (2) adjust a representation of the hill’s cross-section, and (3) adjust a tilt board with their unseen hand. Geographical slant was greatly overestimated according to the first two measures, but not the third. Apparent slant judgments conformed to ratio scales, thereby enhancing sensitivity to the small inclines that must actually be traversed in everyday experience. It is proposed that the perceived exaggeration of geographical slant preserves the relationship between distal inclination and people’s behavioral potential. Hills are harder to traverse as people become tired; hence, apparent slant increased with fatigue. Visually guided actions must be accommodated to the actual distal properties of the environment; consequently, the tilt board adjustments did not reflect apparent slant overestimations, nor were they influenced by fatigue. Consistent with the fact that steep hills are more difficult to descend than to ascend, these hills appeared steeper when viewed from the top.     

Use of a computer-controlled firearms training simulator in perception response time experiments

This paper describes the use of a custom-configured computer-controlled firearms training simulator to measure perception response (reaction) time (RT) to a stimulus in which the degree of threat presented is a manipulable variable across trials. The computer records the number of frames of videotape traversed between the point of presentation of the threat in the video stimulus and the point at which the subject responds by drawing the firearm. For the purposes of data analysis, these frame-count measures are converted to RT measurements. Example data are presented that capture perception RT at both thedraw-stimulus and thefire-stimulus points in situations for which either only one threat or more than one threat exists. Other elements, such as degree of threat and accuracy of response, provide additional data.