The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

Narrative unity and clinical judgment

Alasdair MacIntyre's recent thinking both about the concept of a practice and the existence of narrative unity in human life raises important questions about how we should view clinical medicine today. Is it possible for clinical medicine to pursue patient well-being in a society (allegedly) afflicted with what he calls ‘modernity’? Here it is argued that MacIntyre's pessimistic view of the individual in contemporary society makes his call for patient autonomy in the clinical setting pointless. Finally, recent work in gerontology is cited to make three points: first, MacIntyre's pessimism about us is too extreme; second, the concept of a ‘fictionalized’ personal history is closer to reality than either MacIntyre's notion of narrative unity or the ideas of his imagined opponent (Sartre); and finally, we should not expect clinical medicine to produce patient well-being, when this is understood narratively.     

The physician's influence on patients' choices

Although the traditional physician ethic sees nothing objectionable about the doctor's influence over patients, superficial conceptions of the patient's right to self-determination imply that this influence may be manipulative. On the contrary, there are several different lines of argument which can reconcile self-determination with the physician's influence. Nevertheless, drawing the boundaries between legitimate methods of persuasion, and manipulation or coercion sometimes proves difficult.     

Evidence for disparity change as the primary stimulus for stereoscopic processing

Subjects were able to respond to a lens-induced stereoscopic slant more quickly and more accurately when it was imposed on only part of a surface rather than on the whole surface. This shows that the presence of a stereoscopic boundary, where disparity is discontinuous, increases the efficiency of stereoscopic processing. This finding is not consistent with many current models of stereopsis.     

Typicality ratings for 893 exemplars of 93 categories

Although the typicality effect has been much studied in the semantic memory literature, typicality ratings exist for exemplars from only a very limited number of categories. This lack of ratings frequently limits the range of stimuli that can be used in investigations of the typicality effect. As an aid in stimulus construction, this paper reports typicality ratings of 893 exemplars from 93 different categories.     

Postnatal development of respiratory and vocal responses during aversive classical conditioning in cats

Respiratory rate, respiration amplitude, and vocal responses were recorded in cats of different ages during classic conditioning. Vocal responses to the conditional stimulus (CS) appeared first in 8-week-old kittens, and became prominent at older ages. An increase in respiration rate occurred after the onset of the CS in cats of all ages. Similarly, the decrease of respiration amplitude was observed at all ages, but only in 8-week-old and older subjects did this response resemble an adult pattern. In 4-week-old kittens the response was characterized by an early and brief peak, suggesting an alpha conditional response (CR). Clear and significant discrimination between a warning and a safety signal was present in both respiratory and vocal responses after the age of 8 weeks.     

Cognitive dissonance as a mechanism in vocational decision processes

This study examined changes in cognitive-dissonance-related variables during the professional training period. Differences in levels and change in satisfaction with career choice, importance of career, certainty of career decision, self-occupational perceptions, general attitude toward career, time since career decision, and past experience were observed when students who left a collegiate professional training program before program completion were compared with those who remained in the program. Data supports the validity of D. Hershenson and R. Roth's (1966, Journal of Counseling Psychology, 13, 368–370) and V. Harren's (1979, Journal of Vocational Behavior, 14, 119–133) theoretical models of vocational decision and the Assessment of Career Decision Making scale.