Neuropsychological Assessment of Mental Capacity

The assessment of mental capacity to assist legal determinations of competency is potentially a growth area for neuropsychology, although to date neuropsychologists have published relatively little in this area. In this paper a systematic review of methods used to assess capacity is presented, including coverage of specialized tests and interviews used for this purpose. A neuropsychological model for conducting capacity assessments is proposed. This model involves comprehensive assessment of a wide range of cognitive abilities as well as assessment of specific skills and knowledge related to the type of capacity being assessed. The purpose of proposing this model is to stimulate further discussion and debate about the contribution neuropsychologists might make in this area.     

Autonomy gone awry: a cross-cultural study of parents’ experiences in neonatal intensive care units

This paper examines parents experiences of medical decision-making and coping with having a critically ill baby in the Neonatal Intensive Care Unit (NICU) from a cross-cultural perspective (France vs. U.S.A.). Though parents experiences in the NICU were very similar despite cultural and institutional differences, each system addresses their needs in a different way. Interviews with parents show that French parents expressed overall higher satisfaction with the care of their babies and were better able to cope with the loss of their child than American parents. Central to the French parents perception of autonomy and their sense of satisfaction were the strong doctor–patient relationship, the emphasis on medical certainty in prognosis versus uncertainty in the American context, and the sentimental work" provided by the team. The American setting, characterized by respect for parental autonomy, did not necessarily translate into full parental involvement in decision-making, and it limited the rapport between doctors and parents to the extent of parental isolation. This empirical comparative approach fosters a much-needed critique of philosophical principles by underscoring, from the parents perspective, the lack of emotional work" involved in the practice of autonomy in the American unit compared to the paternalistic European context. Beyond theoretical and ethical arguments, we must reconsider the practice of autonomy in particularly stressful situations by providing more specific means to cope, translating the impersonal language of rights" and decision-making into trusting, caring relationships, and sharing the responsibility for making tragic choices.     

Disability or end-of-life? Competing narratives in bioethics

Bioethics, and indeed much ethicalwriting generally, makes its point throughnarratives. The religious parable no less thanthe medical teaching case uses a simple storyto describe appropriate action or theapplication of a critical principle. Whilepowerful, the telling story has limits. In thispaper the authors describe a simple teachingcase on ``end-of-life' decision making that wasill received by its audience. The authors ill-receivedexample, involving the disconnection ofventilation in a patient with ALS (Lou Gherig'sDisease) was critiqued by audience members withlong-term experience as ventilation users. Inthis case, the supposedly simple narrative ofthe presenters conflicted with the lifehistories of the audience. The lessons of thisstory, and the conflict that resulted, speakcritically to the limits of simple teachingcases as well as the strengths of narrativeanalysis as a tool for the exploration ofbioethical case histories. This revised version was published online in June 2006 with corrections to the Cover Date.     

Understanding Obsessive–Compulsive Disorder: Focus on Decision Making

Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.     

The use of moral dilemmas for teaching agricultural engineers

Agricultural engineers’ jobs are especially related to sustainability and earth life issues. They usually work with plants or animals, and the aim of their work is often linked to producing food to allow people to improve their quality of life. Taking into account this dual function, the moral requirements of their day-to-day professional practice are arguably greater than those of other professions. Agricultural engineers can develop their ability to live up to this professional responsibility by receiving ethical training during their university studies, not only by taking courses specifically devoted to ethics, but also by having to deal with moral questions that are integrated into their technical courses through a program of Ethics Across the Curriculum (EAC). The authors feel that a suitable pedagogical technique for achieving this goal is the use of moral dilemmas, following Kohlberg’s theory of levels of morality (1981), with the final objective of attaining a post-conventional level. This paper examines the possibilities and limitations of using moral dilemmas as a pedagogical technique for training agricultural engineers. The cases, discussions, and evaluation used in the Agricultural Engineering Department of the Technical University of Valencia (Spain) are also presented. An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.     

The Exchange Boundary Framework: Understanding the Evolution of Power within Collaborative Decision-Making Settings

Many community decision-making bodies encounter challenges in creating conditions where stakeholders from disadvantaged populations can authentically participate in ways that give them actual influence over decisions affecting their lives (Foster-Fishman et al., Lessons for the journey: Strategies and suggestions for guiding planning, governance, and sustainability in comprehensive community initiatives. W.K. Kellogg Foundation, Battle Creek, MI, 2004). These challenges are often rooted in asymmetrical power dynamics operating within the settings (Prilleltensky, J Commun Psychol 36:116–136, 2008). In response, this paper presents the Exchange Boundary Framework, a new approach for understanding and promoting authentic, empowered participation within collaborative decision-making settings. The framework expands upon theories currently used in the field of community psychology by focusing on the underlying processes through which power operates in relationships and examining the evolution of power dynamics over time. By integrating concepts from social exchange theory (Emerson, Am Soc Rev 27:31–41, 1962) and social boundaries theory (Hayward, Polity 31(1):1–22, 1998), the framework situates power within parallel processes of resources exchange and social regulation. The framework can be used to understand the conditions leading to power asymmetries within collaborative decisionmaking processes, and guide efforts to promote more equitable and authentic participation by all stakeholders within these settings. In this paper we describe the Exchange Boundary Framework, apply it to three distinct case studies, and discuss key considerations for its application within collaborative community settings.     

Strategies in Forecasting Outcomes in Ethical Decision-Making: Identifying and Analyzing the Causes of the Problem

This study examined the role of key causal analysis strategies in forecasting and ethical decision-making. Undergraduate participants took on the role of the key actor in several ethical problems and were asked to identify and analyze the causes, forecast potential outcomes, and make a decision about each problem. Time pressure and analytic mindset were manipulated while participants worked through these problems. The results indicated that forecast quality was associated with decision ethicality, and the identification of the critical causes of the problem was associated with both higher quality forecasts and higher ethicality of decisions. Neither time pressure nor analytic mindset impacted forecasts or ethicality of decisions. Theoretical and practical implications of these findings are discussed.     

Compounding Vulnerability: Pregnancy and Schizophrenia

The predominant ethical framework for addressing reproductive decisions in the maternal–fetal relationship is respect for the woman's autonomy. However, when a pregnant schizophrenic woman lacks such autonomy, healthcare providers try to both protect her and respect her preferences. By delineating etic (objective) and emic (subjective) perspectives on vulnerability, I argue that options which balance both perspectives are preferable and that acting on etic perspectives to the exclusion of emic considerations is rarely justified. In negotiating perspectives, we balance the etic commitment to protect the vulnerable patient and her fetus from harm with the emic concern to empower a decisionally incapacitated woman. Equilibrium is best achieved by nurturing interdependent relationships that empower and protect the vulnerable woman. The analysis points to the need for better social support for mentally ill patients.     

A Cross-Cultural Comparison of Gender Factors Contributing to Long-Term Marital Satisfaction

Abstract

This article reports on the major findings of a cross-cultural study comparing long-term marital satisfaction between Caucasian couples and Chinese couples in Canada. The Dyadic Adjustment Scale was used to screen couples' marital satisfaction. In-depth qualitative interviews were conducted individually and jointly with the screened couples to explore their meanings and experiences of marital satisfaction. With the use of narrative analysis, the study illuminates how couples constructed their gender relationships to achieve marital satisfaction over a long course of thirty to thirty-six years according to their sociocultural contexts. The similarities and differences in how the two cultural groups' respondents constructed their long-term marital satisfaction are discussed in terms of: (1) household division of labour, (2) decision-making, (3) conflict and compromise, and (4) mutuality.     

Relationship between Trauma and Risky Behavior in Substance-Abusing Parents Involved in a Family Dependency Treatment Court

This exploratory study examined participants in a Family Dependency Treatment Court (FDTC), designed for substance-abusing parents whose children were removed from the home. Twenty-five participants were interviewed one year after FDTC enrollment to assess retrospectively the relationship between trauma history and risky behaviors. Treatment compliance rates were found to be high, and most participants had negative urinalysis results. Qualitative analyses revealed that approximately half of the participants attributed decreases in risky behaviors to the FDTC program. This study increases understanding of the effect of substance abuse and trauma on high-risk behaviors and might help to improve services for substance-abusing parents involved in the child welfare system. Finally, the future success of reducing child abuse and neglect and parental substance use could hinge on the partnership between judicial and substance abuse treatment through FDTCs. Findings from this exploratory pilot study should be replicated with more representative and larger samples.