Effects of nitrous oxide on reactions to “stress”

It has been demonstrated that exposure to the stress of a situation involving conflict or frustration may interfere significantly with subsequent learning. Behaviour under stress is characterized by experiences of “anxiety” and by widespread physiological changes. Inhalation of nitrous oxide has the general effect of reducing the extent of these symptoms.

The present investigation using insoluble and soluble problems has demonstrated that both nitrous oxide and exposure to stress impair learning; but that, when subjects are exposed to stress while under the influence of the drug, the effects of the stress on subsequent learning are abolished. It is suggested that these empirical results may be accounted for either in terms of “anxiety-reduction” or in terms of transfer effects.     

The influence of medical and legal authorities on deaths facilitated by physicians.

This study investigated whether two widely publicized cases of deaths facilitated by physicians were followed by significant peaks in mortality. In March, 1991, Timothy Quill, MD, published a controversial editorial describing the physician-assisted suicide (PAS) of his 45-year-old, female leukemia patient. In a landmark decision in December 1990, the Missouri Supreme Court allowed removal of life support for Nancy Cruzan, a comatose accident victim. Correcting for trends and seasonal fluctuations, the authors examined: (1) U.S. leukemia mortality in the period centered on Quill's editorial, and (2) mortality from accident/coma combinations in the period centered on the Missouri Supreme Court's decision on Cruzan. Female leukemia deaths rose 11.3% above the expected rate (p < .01) just after Quill's article was published. The more closely the decedent matched Quill's patient, the greater the peak, with the largest peak (33.9%) evident for female leukemia patients in their 40s, who were long-term residents of smaller communities (p < .05). Five possible explanations for the findings were assessed, leading to the conclusion that Quill's editorial elicited an increase in mortality. The involvement of physicians in this increase is supported by analysis of the Cruzan case. This showed a mortality peak of 57% for accident/coma patients following the court decision.     

The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.     

Kidney Transplants From Young Children and the Mentally Retarded

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to relieve suffering. Guidelines are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other.     

Less guilty by reason of adolescence: developmental immaturity, diminished responsibility, and the juvenile death penalty

The authors use a developmental perspective to examine questions about the criminal culpability of juveniles and the juvenile death penalty. Under principles of criminal law, culpability is mitigated when the actor's decision-making capacity is diminished, when the criminal act was coerced, or when the act was out of character. The authors argue that juveniles should not be held to the same standards of criminal responsibility as adults, because adolescents' decision-making capacity is diminished, they are less able to resist coercive influence, and their character is still undergoing change. The uniqueness of immaturity as a mitigating condition argues for a commitment to a legal environment under which most youths are dealt with in a separate justice system and none are eligible for capital punishment.     

Deaf murderers: clinical and forensic issues

Data are reported on 28 deaf individuals who were convicted, pled guilty, or have been charged and awaiting trial for murder. The unique forensic issues raised by these cases are discussed, and their clinical picture presented. A significant percentage of these deaf murderers and defendants had such severely limited communication skills in both English and American Sign Language that they lacked the linguistic ability to understand the charges against them and/or to participate in their own defense. As such, they were incompetent to stand trial, due not to mental illness or mental retardation, but to linguistic deficits. This form of incompetence poses a dilemma to the courts that remains unresolved. This same linguistic disability makes it impossible for some deaf suspects to be administered Miranda Warnings in a way comprehensible to them. This paper identifies the reasons for the communication problems many deaf persons face in court and offers remedial steps to help assure fair trials and police interrogations for deaf defendants. The roles and responsibilities of psychiatric and psychological experts in these cases are discussed. Data are provided on the etiology of the 28 individuals' hearing losses, psychiatric/psychological histories, IQs, communication characteristics, educational levels, and victim characteristics.