Cognitive Transformation,Dementia, and the Moral Weight of Advance Directives

Abstract

Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients.     

Careers work in higher education in Pakistan: current practice and options for the future

ABSTRACT

In this article we examine the development of career guidance in Pakistani higher education. The article is based on a literature review supplemented with new data gathered from a review of higher education institutions' websites and five case study interviews. It considers both local and global influences as relevant contexts for understanding how the development of career guidance in Pakistani higher education is taking place. Concerns about alignment between skills supply and demand provide key drivers both for the development of career guidance and for a wider higher education reform. The practice of career guidance in Pakistani higher education is shown to be lagging behind policy and will need to be strengthened by new policy, resources and indigenous theories.     

Ordering the alternatives of a strategic plan for Valencia (Spain)

In this article we present an evaluation of the initiatives involved in a Strategic Plan for Valencia City (Spain) by applying a method to assist Multi‐Criteria Decision‐Making. The complexity of the case lies in the size of the problem, 47 alternatives and 10 criteria, as well as the need to reach a consensus on the final result. The method followed, which has been named PRES Multi‐expert, can be generalized and applied to other complex cases. Thirteen experts have participated in the process, representing different political and social groups of the City, a group of analysts, formed by three lecturers from the Polytechnic University of Valencia, and a consultant, representing the City Hall of Valencia. The PRES algorithm was used to order the alternatives developed in 1992 by Gómez‐Senent at this University. In this article we highlight the advantages of applying the Multi‐Criteria Decision‐Making Aid techniques and the importance of following a procedure to select the criteria, pondering on them and evaluating the alternatives. This procedure ensures that the parties interested in or affected by the decision take part in deciding what measures to adopt. The Multi‐expert PRES method facilitates this participation and can be adapted to different types of problems. Copyright © 2001 John Wiley & Sons, Ltd.     

The utility of the Psychopathy Checklist-Revised (PCL-R) facet and item scores in predicting violent recidivism

There is relatively limited research on psychopathy in non-Caucasian ethnic groups and even less on the utility of the Psychopathy Checklist-Revised (PCL-R) that focuses on PCL-R facet and item scores in predicting violent recidivism. In this study, we assessed the utility of the PCL-R in prospectively predicting violent versus nonviolent recidivism during an 11-year follow-up window. A high-risk sample of 451 incarcerated Korean male offenders was assessed on the PCL-R at baseline. A total of 445 were reconvicted after release (353 violent and 92 nonviolent recidivists). Psychopathy facet scores were higher in violent compared to nonviolent recidivists. Facet 2 (affective) showed the strongest effect size (Cohen's d = 0.53; Percentage change in odds = 22.6%) in predicting violent recidivism. Analyses of the four items constituting the affective facet indicated that callous/lack of empathy (Percentage change in odds = 134.4%) and failure to accept responsibility (Percentage change in odds = 94.5%) were the strongest predictors of violent recidivism. Findings are to our knowledge the first to document the utility of the PCL-R in distinguishing violent from nonviolent recidivism and highlight the role of affective impairment (particularly lack of empathy) in violent recidivism.     

The Family Intervention Program

No abstract available for this article.     

Problem definition and information provision by federal bureaucrats

Federal bureaucrats are important sources of information about policy problems. However, federal officials compete for this influence with organized interests plying their own problems and solutions. We attribute the differential agenda influence of the federal bureaucracy to efforts in Congress to construct workable problem definitions in a context of uncertainty about issues. From both behavioral and rational models of congressional decision making, we develop a theory of congressional search for information during problem definition under conditions of uncertainty. The theory presages the prominence of federal bureaucrats in this search, and especially under uncertainty. Using new data sets capturing the appearance of federal bureaucrats at congressional hearings, we find that the mobilization, prominence, and types of federal bureaucrats providing information is explainable in terms of congressional uncertainty about problem definitions.