Ethical Obligations and Clinical Goals in End-of-Life Care: Deriving a Quality-of-Life Construct Based on the Islamic Concept of Accountability Before God (Taklīf)

End-of-life medical decision making presents a major challenge to patients and physicians alike. In order to determine whether it is ethically justifiable to forgo medical treatment in such scenarios, clinical data must be interpreted alongside patient values, as well as in light of the physician's ethical commitments. Though much has been written about this ethical issue from religious perspectives (especially Christian and Jewish), little work has been done from an Islamic point of view. To fill the gap in the literature around Islamic bioethical perspectives on the matter, we derive a theologically rooted rubric for goals of care. We use the Islamic obligation for Muslims to seek medical treatment as the foundation for determining the clinical conditions under which Muslim physicians have a duty to treat. We next link the theological concept of accountability before God (taklīf) to quality-of-life assessment. Using this construct, we suggest that a Muslim physician is not obligated to maintain or continue clinical treatment when patients who were formerly of, or had the potential to be, mukallaf (the term for a person who has taklīf), are now not expected to regain that status by means of continued clinical treatment.     

Elder Abuse: Ethical and Related Considerations for Professionals in Psychology

Elder abuse presents difficult ethical considerations that the field of psychology has yet to sufficiently address. As demographics and sociocultural factors shift in the coming decade, this deficit in ethical competence may become an increasingly serious problem. Although legal definitions of elder abuse lack uniformity and clarity, there is much room for improvement in the field of psychology. Ethical considerations most relevant to professionals in psychology draw heavily on the principles of beneficence and nonmaleficence and respect for people's rights and dignity. Professional standards of competence, discrimination, informed consent, privacy and confidentiality, and cooperation with other professionals are also critical in these considerations. A number of recommendations are made, centering around the needs for more education, frank discussion, and empirical examination of the complexities of elder abuse.     

Custody and Visitation Trends in the United States in Domestic Violence Cases

Summary

This article addresses custody and visitation trends in domestic violence cases in the United States. It defines domestic violence behaviorally, looks briefly at its prevalence, and discusses national policy statements and studies. It also examines statutory trends concerning the role of domestic violence in custody and visitation cases, including the O. J. Simpson guardianship case. Practical suggestions for litigants and judges are included. The article concludes that the way domestic violence issues are treated in custody and visitation cases is often problematic, and calls for specific reforms.     

Physical Abuse and Childhood Disability

SUMMARY

Several authors have hypothesized that children with disabilities are at increased risk for physical abuse. Such a finding would be consistent with current ecological models, which posit that certain child characteristics (e.g., behavior problems) in combination with other risk factors can lead to abuse. The paucity of research in this area makes it difficult to draw firm conclusions at this time. However, the few studies conducted suggest that child characteristics play a minor role in the etiology of abuse. Despite the lack of evidence indicating that children with disabilities are at significantly greater risk for abuse than their nondisabled peers, the presence of a disability raises some unique issues in the identification, assessment, and treatment of special needs children. This article reviews the literature linking abuse and disability as a risk factor. In addition, impediments encountered in the assessment and treatment of abused children with disabilities and their families are discussed and guidelines for practice are presented.     

Trauma Exposure and Health: A Review of Outcomes and Pathways

A growing body of literature has established robust relations between trauma and a variety of adverse physical health outcomes. In both retrospective and prospective research, adults with a history of self-reported or court-substantiated maltreatment report significantly more health concerns than those without maltreatment histories, in both clinical and community samples, whether health problems are self-reported or physician-diagnosed. Two pathways by which poor health outcomes are theorized to occur include the biological pathway, which largely implicates severe stress and subsequent dysregulations in central stress-response systems as the underlying cause of health problems, and the behavioral pathway, which suggests that health risk behaviors are largely responsible for the relations between trauma and health. This article reviews the research evaluating the relations between various types of trauma, particularly physical and sexual abuse in childhood, and three such health outcomes: pain, gastrointestinal disorders, and cardiovascular disease. Evidence to support the biological and behavioral pathways is also reviewed.     

Childhood Maltreatment Increases the Risk of Intimate Partner Violence via PTSD and Anger Personality Traits in Individuals Consulting for Sexual Problems

Childhood maltreatment is a significant risk factor for the perpetration of intimate partner violence (IPV) in adulthood. This study tested, in a clinical sample, a conceptual model suggesting that childhood maltreatment contributes to the development of anger personality traits, directly and indirectly via posttraumatic stress disorder (PTSD), and that anger personality traits, in turn, are associated with IPV. Adults consulting for sex therapy (n = 114) completed self-report measures of childhood maltreatment, PTSD, anger, and IPV. Participants were exposed to high rates of childhood maltreatment (83%). Path analysis supported the hypothesized model: Exposure to child maltreatment was associated with anger personality traits, and this association was partially mediated by PTSD symptoms. Anger personality traits were highly correlated with IPV.     

Cultural Values and Performance Appraisal: Assessing the Effects of Rater Self-Construal on Performance Ratings

Much of the prior research investigating the influence of cultural values on performance ratings has focused either on conducting cross-national comparisons among raters or using cultural level individualism/collectivism scales to measure the effects of cultural values on performance ratings. Recent research has shown that there is considerable within country variation in cultural values, i.e. people in one country can be more individualistic or collectivistic in nature. Taking the latter perspective, the present study used Markus and Kitayama's (1991) conceptualization of independent and interdependent self-construals as measures of individual variations in cultural values to investigate within culture variations in performance ratings. Results suggest that rater self-construal has a significant influence on overall performance evaluations; specifically, raters with a highly interdependent self-construal tend to show a preference for interdependent ratees, whereas raters high on independent self-construal do not show a preference for specific type of ratees when making overall performance evaluations. Although rater self-construal significantly influenced overall performance evaluations, no such effects were observed for specific dimension ratings. Implications of these results for performance appraisal research and practice are discussed.     

Personality Change in Middle Adulthood: With Focus on Differential Susceptibility

Abstract

Little attention has been paid to middle adulthood in research on personality stability and change. In addition, previous research on individual differences in personality change has not fully explained its variability. This study focused on the differential susceptibility model, which suggests that individual susceptibility interacts with environmental factors and produces variability in outcomes, and investigated individual differences in personality change with a middle adult sample. A total of 1051 Japanese middle adults (M?=?41.61?years; SD = 5.31; range 30–50?years; 534 females) participated in this two-wave short-term longitudinal study. Latent change score model analyses revealed substantial mean-level declines in Agreeableness and Honesty–Humility. Moreover, the results showed that the influences of some life events on personality change are moderated for better and for worse by individual susceptibility to one’s environment. These findings suggest that the trends of personality development may differ between Western and non-Western countries and that differential susceptibility model may play an important role in deriving individual differences in personality stability and change.     

The Importance of Religious Orientation and Purpose in Life for Dying Well: Evidence from Three Case Studies

ABSTRACT

As older adults approach the end of their lives, it is not uncommon to find a decrease in subjective well-being. However, a number of studies have indicated that elders with an intrinsic rather than extrinsic religious orientation often are able to keep a high level of subjective well-being even if they are close to death. In a previous quantitative study, only intrinsic religiosity was indirectly and positively related to subjective well-being in a sample of 103 relatively healthy older adults and 19 hospice patients (aged 61 +), mediated by shared spiritual activities and purpose in life. Extrinsic religiosity, by contrast, was indirectly and negatively related to subjective well-being. To explore in greater depth how religious orientation might influence subjective well-being at the end of life, we used the method of objective hermeneutics to examine semi-structured qualitative interviews with three older male hospice patients (aged 79, 80, and 98) on religion/spirituality and attitudes about death and dying. Results of the analyses revealed that the intrinsically religious respondent maintained his sense of cosmic purpose in life, which continued to be a source of satisfaction for him, unaffected by his terminal illness. The two extrinsically religious respondents, however, did not find solace in their religion and, hence, were unable to cope with their physical and emotional dependence and vulnerability. The findings suggest that an intrinsic religious orientation is most likely to be related to a cosmic sense of purpose in life, which facilitates subjective well-being even in the face of death.