Legal briefing: The unbefriended: making healthcare decisions for patients without surrogates (Part 2)

This issue's "Legal Briefing" column continues coverage of recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the "single greatest category of problems" encountered in bioethics consultation. Moreover, the scope of the problem continues to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia. Unfortunately, most U.S.jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. "Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform." Most providers are "muddling through on an ad hoc basis." Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two categories define the problem of medical decision making for the unbefriended.The remaining 12 describe different solutions to the problem. The first six categories were covered in Part 1 of this article; the last eight categories are covered in this issue (Part 2). 1. Who are the unbefriended? 2. Risks and problems of the unbefriended. 3. Prevention: advance care planning, diligent searching, and careful capacity assessment. 4. Decision-making mechanisms and standards. 5. Emergency exception to informed consent. 6. Expanded default surrogate lists: close friends. 7. Private guardians. 8. Volunteer guardians. 9. Public guardians. 10. Temporary and emergency guardians. 11. Attending physicians. 12. Other clinicians, individuals, and entities. 13. Institutional committees. 14. External committees.     

A measure of racial identity in African American adolescents: the development of the Multidimensional Inventory of Black Identity--Teen

The Multidimensional Inventory of Black Identity--Teen (MIBI--T) is designed to assess the 3 cross-situationally stable dimensions (centrality, regard, and ideology) of the Multidimensional Model of Racial Identity (MMRI; R. M. Sellers, M. A. Smith, J. N. Shelton, S. A. J. Rowley, & T. M. Chavous, 1998) within teenagers. Adolescent responses (n= 489) to the MIBI--T were subjected to several analyses to evaluate the psychometric character of the measure. Findings indicated that the MIBI--T represents a valid framework for African American adolescents. Its internal structure is consistent with the conceptual framework of the MMRI, and findings support its construct validity. Results also indicate model invariance across grade level and gender, as well as suggest evidence of predictive validity. Further information about the MIBI--T and the full set of items are presented.     

Teammates On and Off the Field? Contact With Black Teammates and the Racial Attitudes of White Student Athletes1

The intergroup contact hypothesis holds that proximate, cooperative interactions on an equalized basis between Blacks and Whites can minimize Whites’ prejudice (Allport, 1954). This experiment investigated the effect of contact between White and Black high school teammates on White student athletes’ racial attitudes. Using the 1996 Social and Group Experiences (SAGE) survey (created by the authors and administered in the Fall of 1996) commissioned by the National Collegiate Athletic Association, the results indicated a significant relationship between amount of contact with Black teammates in high school and racial policy support and affect, depending on the type of sport played. White student athletes playing team sports who had higher percentages of Blacks as high school teammates expressed more policy support for and greater positive affect toward Blacks as a group than did their counterparts playing individual sports. The role of athletic experiences in changing racial attitudes is discussed.     

The mismatch effect: when testosterone and status are at odds

Why do some people strive for high status, whereas others actively avoid it? In the present studies, the authors examined the psychological and physiological consequences of a mismatch between baseline testosterone and a person's current level of status. The authors tested this mismatch effect by placing high and low testosterone individuals into high or low status positions using a rigged competition. In Study 1, low testosterone participants reported greater emotional arousal, focused more on their status, and showed worse cognitive functioning in a high status position. High testosterone participants showed this pattern in a low status position. In Study 2, the emotional arousal findings were replicated with heart rate, and the cognitive findings were replicated using a math test. In Study 3, the authors demonstrate that testosterone is a better predictor of behavior than self-report measures of the need for dominance. Discussion focuses on the value of measuring hormones in personality and social psychology.     

Legal briefing: The unbefriended: making healthcare decisions for patients without surrogates (Part 1)

This issue's "Legal Briefing" column covers recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the "single greatest category of problems" encountered in bioethics consultation. Moreover, the scope of the problem continues to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia. Unfortunately, most U.S. jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. "Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform". Most providers are "muddling through on an ad hoc basis". Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two define the problem of medical decision making for the unbefriended. The remaining 12 categories describe different solutions to the problem. The first six of these solutions are discussed in this article (Part 1). The last eight solutions will be covered in the Summer 2012 issue of JCE (Part 2). 1. Who are the unbefriended? 2. Risks and problems of the unbefriended. 3. Prevention: advance care planning, diligent searching, and careful capacity assessment. 4. Decision-making mechanisms and standards. 5. Emergency exception to informed consent. 6. Expanded default surrogate lists: close friends. 7. Private guardians. 8. Volunteer guardians. 9. Public guardians. 10. Temporary and emergency guardians. 11. Attending physicians. 12. Other clinicians, individuals, and entities. 13. Institutional committees. 14. External committees.     

Information processing bias against emotional facial expressions in social anxiety

The present study examined whether information processing bias against emotional facial expressions is present among individuals with social anxiety. College students with high (high social anxiety group; n  = 26) and low social anxiety (low social anxiety group; n  = 26) performed three different types of working memory tasks: (a) ordering positive and negative facial expressions according to the intensity of emotion; (b) ordering pictures of faces according to age; and (c) ordering geometric shapes according to size. The high social anxiety group performed significantly more poorly than the low social anxiety group on the facial expression task, but not on the other two tasks with the nonemotional stimuli. These results suggest that high social anxiety interferes with processing of emotionally charged facial expressions.     

One role or two? The function of psychological separation in role conflict

Student athletes vary in how much they view their academic and athletic role identities as separate from and interfering with each other. The authors investigated the relation of these perceptions to psychological well-being in 200 intercollegiate athletes. Measures included role separation, interference, identity, and well-being. Correlations indicated that interference related negatively to well-being, whereas viewing the roles as distinct related positively to well-being. Regression analyses of demographic and role identity variables also showed a positive association between role separation and well-being, and a significant Separation x Interference interaction. Specifically, role interference was negatively related to well-being for those who viewed the two roles as distinct but unrelated for those who did not. The buffering effects of role separation are discussed.     

Assessment of visual-motor coordination in 6- to 11-yr.-olds

The concurrent and content validity of the Rey-Osterrieth Complex Figure Test and the Beery Developmental Test of Visual-Motor Integration-Third Revision were investigated through correlational analysis. 432 children, ages 6 to 11 years, were administered both tests. Across age groups participants performed better on both measures, providing support for the similarity of the measures and their sensitivity to the development of visuomotor integration. Although analysis indicated considerable overlap in the content of the two scales, the shared variance ranged from 7% to 31%, depending on the age of the child. The Rey-Osterrieth figure is composed of overlapping squares, rectangles, triangles, and various other shapes. Given this complex combination, scores on this test reflect the examinees' visual organization and motor planning skills. On the other hand, the Beery test consists of a series of shapes which progress from simple figures to more complex ones. Because the figures become more difficult to copy, the score on this test reflects the examinees' developmental level of visuomotor ability. Despite these differences in test stimuli and interpretation of performance, the present study showed considerable shared variance in the scores of the examinees who took both tests. Finally, local norms for the Rey-Osterrieth figure using the scoring approach of E. M. Taylor (1959, adapted from Osterrieth, 1944) and including standard scores are presented for children ages 6 to 11 years.