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Background and ObjectivesMethods and DesignResultsConclusionsDementia-related anxiety (DRA) is the fear or anxiety about a current or future diagnosis of Alzheimer’s disease or another type of dementia. The purpose of the present study was to examine management of DRA.In semi-structured qualitative interviews, 50 community-dwelling adults (58–89 years old, M = 70.80, SD = 6.02) without dementia diagnoses reflected on their thoughts and feelings about dementia. A reflexive inductive thematic approach was used to examine ways people managed DRA.We identified five themes related to managing DRA: monitoring cognitive status (e.g., self-monitoring or objective assessment); active coping strategies (e.g., using external reminders, normalizing age-related change); interpersonal relationships and support (e.g., anticipating benefit of support from others); planning and preparing for potential outcomes (e.g., securing power of attorney, saying goodbyes); and personal responsibility to manage risk or accept diagnosis (e.g., lifestyle factors to reduce dementia risk, thereby reducing risk for burdening others).Findings suggest internal and external means for coping with DRA that are likely to vary in degrees of usefulness. We consider findings within the context of relevant, established theories, attending to potential clinical interventions for individuals experiencing DRA. [ABSTRACT FROM AUTHOR]

Given the lack of research on geographic variations in advance care planning (ACP) engagement, this study examined whether there were 1) regional variations in engagement in ACP and 2) racial and ethnic differences in ACP by regions of the United States. The sample included 2,015 Medicare beneficiaries in the U.S. from the 2012 National Health and Aging Trends Study that asked respondents about ACP engagement (i.e., discussed end-of-life treatments, had a durable power of attorney for health care, or completed a living will). Results from logistic regression analysis showed that older adults living in the West (OR = 1.66, p =.003) and the Midwest (OR = 1.39, p =.032) were more likely to engage in ACP than those living in the South. Furthermore, logistic regression analyses that examined racial and ethnic differences by region revealed that Blacks were less likely to be engaged in ACP than Whites in the Northeast, Midwest, and South. Hispanics were less likely to participate in ACP than Whites in the West and the Northeast. The findings provide an insight into disparities in ACP in different regions in the U.S., suggesting target areas for interventions to improve engagement in ACP among non-dominant racial and ethnic populations. [ABSTRACT FROM AUTHOR]

Samir Amin's critiques of both apartheid-era and post-apartheid political economy contributed to his scathing view of the crucial 'semi-peripheral' layer of the world system, a perspective typically ignored in binary formulations of Global North and Global South. Amin's 1977 article 'The future of South Africa' was among his first statements of how, using that era's dependency theory language, 'South African capital requires an outward policy of expansionism, so that ultimately, internal colonialism becomes coterminous with sub-imperialism'. Amin also labeled post-apartheid South Africa sub-imperialist because of the domination of 'monopoly capital' in the extractive-industry circuits (depleting what Marx called 'free gifts of nature') and the below-survival-level wages that have long shaped the economic structure. Two other coterminous factors were Pretoria's imposition of continent-wide neoliberalism through the New Partnership for Africa's Development and the Brazil-Russia-India-China-South Africa BRICS network – both of which proved incapable of transcending neoliberal economic policies insisted upon by contemporary imperialism. Following the BRICS 2023 Sandton summit's elite failure to advance de-dollarisation or other 'delinking' strategies, Amin would nod, knowingly, when hearing the term 'sub-imperial' to describe the bloc – and look for inspiration instead to successes of grassroots campaigners. [ABSTRACT FROM AUTHOR]

The protection of a portion of a country's land is vital for sustainable economic growth and biodiversity, though land protection also imposes important costs. States have set aside a growing proportion of their land for protection over time, with wide variation among states. What explains this variation? Theoretically, we argue that states exist internationally in dependence networks with each other and that those networks provide pathways for influence on a state's environmental choices. A state's dependence network is the other states with which it regularly exchanges valued goods. We find strong evidence that increases in protected lands among trade partners and international organization partners (both weighted by importance) increase a given state's protected lands, with substantive effects larger than domestic-level variables like democracy. This paper expands our understandings of the ways that states may influence each other on environmental policy. La protección de una parte del terreno de un país es vital para el crecimiento económico sostenible y para la biodiversidad, aunque la protección de la tierra también conlleva unos costes importantes. Los Estados han estado reservando para su protección una proporción, cada vez mayor, de sus tierras a lo largo del tiempo. Sin embargo, existe una amplia variación a este respecto entre los Estados. ¿Qué explica esta variación? De forma teórica, argumentamos que los Estados existen internacionalmente en redes de dependencia entre sí y que esas redes proporcionan diversas vías que influyen en las elecciones ambientales de un Estado. La red de dependencia de un Estado está formada por otros Estados con los cuales intercambia regularmente bienes valiosos. Encontramos pruebas sólidas de que los aumentos en el número de áreas protegidas entre los socios comerciales y entre los socios de las organizaciones internacionales (ambos ponderados por importancia) aumentan también la cantidad de áreas protegidas de un Estado determinado. Estos aumentos conllevan unos efectos sustantivos mayores que las variables a nivel nacional como la democracia. Este artículo amplía nuestra comprensión acerca de las formas en que los Estados pueden influir mutuamente en la política ambiental. La protection d'une partie des terres d'un pays est cruciale pour une croissance économique durable et la biodiversité, mais elle impose aussi des coûts importants. Au fil des années, les États consacrent une part croissante de leur territoire à la sauvegarde, mais elle varie grandement de l'un à l'autre. Comment expliquer ces différences ? Sur le plan théorique, nous affirmons que les États existent à l'international au sein de réseaux d'interdépendances qui ont tendance à influencer les choix environnementaux étatiques. Le réseau d'interdépendances d'un État regroupe les États avec lesquels il échange régulièrement des marchandises de valeur. Nous trouvons nombre d'éléments probants pour justifier qu'une augmentation de terres protégées chez des partenaires commerciaux et des organisations internationales partenaires (en pondérant les deux en fonction de leur importance) débouche sur une augmentation des terres protégées dans un État donné. Cet effet se révèle plus important que les variables nationales comme la démocratie. Cet article enrichit notre compréhension des moyens par lesquels les États peuvent s'influencer mutuellement en politique environnementale. [ABSTRACT FROM AUTHOR]

There is lack of consensus in the bioethics literature regarding the use of cardiopulmonary resuscitation (CPR) for organ-preserving purposes. In this study, we assessed the perspectives of clinicians in critical care settings to better inform donor management policy and practice. An online anonymous survey of members of the Society of Critical Care Medicine that presented various scenarios about CPR for organ preservation. The email was sent to 10,340 members. It was opened by 5,416 (52%) of members and 405 members (4%) completed the survey with few missing data. A majority of respondents (81%) answered that donation status should not influence whether CPR is performed on an imminently dying patient. There was very strong agreement (>85%) that 1) CPR should be performed on a registered donor who experiences a cardiac arrest with an unknown code status before death by neurological criteria (DNC) and 2) CPR should be performed if the patient is not a registered donor and experiences cardiac arrest but the surrogate/power of attorney (POA) has not yet been approached regarding code status and donation. When a registered donor with a DNR order experiences cardiac arrest before DNC, 98% of respondents would not perform CPR. However, after DNC, respondents were evenly divided on whether they would (49%) or would not (51%) perform CPR on a registered donor with an undocumented code status. When asked whether consent should be required for CPR for organ-preserving purposes, 39% answered "Yes" when a patient arrests before DNC and 48% answered "Yes" when a patient arrests after DNC (P = 0.2). The majority of respondents did not consider donor status relevant to CPR decisions before DNC, and virtually all would respect a DNR order in a registered donor before DNC. Respondents were divided about the need for an affirmative consent for CPR for organ-preserving purposes both before and after DNC. [ABSTRACT FROM AUTHOR]

The article deals with the validation of the internationalization imperative in higher education institutions (HEIs) of the Nordic countries. I focus on both the goals and motives behind activities supporting internationalization, but also on the manner of their habitualization and institutionalization in the practice of academic administration and organizational management. The issue of legitimization of institutional changes is addressed by means of the rationalized myths that create durable dispositions for specific practices, changes in procedures and attitudes in a given socio-political setting. I draw on empirical examples that include practical solutions and strategies developed under the conditions of semiperipheral positionality of the Nordic states. This perspective makes their internationalization policies an interesting frame of reference for other countries and the paper concludes by pointing to the latest trends that can serve either as an inspiration or a warning for other states. The Nordic countries offer an example of how institutionalizing the 'strategic gains' narrative from globalization may lead to a recalibration of an earlier knowledge regime along with attempts to change centre-periphery relations, including the reframing of priorities and rationalities of different stakeholders in higher education. [ABSTRACT FROM AUTHOR]

Gaps in health-care services for women with polycystic ovary syndrome (PCOS) are not isolated incidents. They are systemic and disadvantage women. In this study, we explored the juxtaposition of power and agency in diagnosis narratives collected from 72 Canadian women diagnosed with PCOS. Using Braun and Clarke's inductive codebook thematic analysis, three themes of power were constructed: physicians as gatekeepers, oppression as intersectional, and antagonistic provider communications, leading to emotional and cognitive impacts. Themes of agency centered on education, active resistance strategies, and collective action. Implications for these findings are discussed in relation to women's health equity. [ABSTRACT FROM AUTHOR]

Anne Lister became the owner of Shibden Hall in Halifax in 1826, when her Uncle, James Lister, died. Inheriting Shibden was the culmination of a campaign Anne Lister began as a young woman. Lister's journals reflect her thoughts concerning the actions she took to convince her uncle that she was the best choice to ensure that the Shibden estate remained in the Lister family and how she provided for Ann Walker after their commitment in 1834. The journal entries provide an insider's view of the process she engaged in to accomplish her goals. This paper will discuss the wills Anne Lister (1791–1840) and Ann Walker used in preparing for the disposition of their respective estates following their deaths. Lister used wills and other estate planning measures to protect herself and provide for others. The paper also discusses the shortcomings and missed opportunities for adequate legal advice given to Miss Lister and Miss Walker by their lawyer, his failure to consider and advise on the situations that did occur after Lister's death. Anne Lister was prolific in her instructions to her lawyer about her will, but she did not think of everything. The paper also includes a brief background on English law concerning wills, inheritance, and women's rights evolved over many centuries. Considering the various legal aspects of common law and statutes concerning who could inherit under English law, and the restrictions that existed if an owner died intestate, provide a necessary overview of the importance of planning ahead. [ABSTRACT FROM AUTHOR]

Anne Lister became the owner of Shibden Hall in Halifax in 1826, when her Uncle, James Lister, died. Inheriting Shibden was the culmination of a campaign Anne Lister began as a young woman. Lister's journals reflect her thoughts concerning the actions she took to convince her uncle that she was the best choice to ensure that the Shibden estate remained in the Lister family and how she provided for Ann Walker after their commitment in 1834. The journal entries provide an insider's view of the process she engaged in to accomplish her goals. This paper will discuss the wills Anne Lister (1791–1840) and Ann Walker used in preparing for the disposition of their respective estates following their deaths. Lister used wills and other estate planning measures to protect herself and provide for others. The paper also discusses the shortcomings and missed opportunities for adequate legal advice given to Miss Lister and Miss Walker by their lawyer, his failure to consider and advise on the situations that did occur after Lister's death. Anne Lister was prolific in her instructions to her lawyer about her will, but she did not think of everything. The paper also includes a brief background on English law concerning wills, inheritance, and women's rights evolved over many centuries. Considering the various legal aspects of common law and statutes concerning who could inherit under English law, and the restrictions that existed if an owner died intestate, provide a necessary overview of the importance of planning ahead. [ABSTRACT FROM AUTHOR]

Enduring powers of attorney (POAs) are commonly used legal instruments that enable older people to plan for asset management in the event of future incapacity. The policy objective of POAs – empowering control over money and property – are frustrated when POAs are misused to financially exploit older people. This commentary integrates theory and evidence to propose a conceptual framework for POA-facilitated financial exploitation (POA-FE). Identified risk factors include inadequate knowledge about the POA role; family conflicts; attitudes of entitlement; and lack of planning and preparation for financial decision-making. POA-FE occurs on a continuum of behavior and strategies for preventing POA-FE are suggested using strengths-based approaches for older people and their attorneys. [ABSTRACT FROM AUTHOR]

Across different countries, there is extreme heterogeneity among police systems concerning the number and types of forces, their links to political authorities and territorial organisation of control centres, their oversight mechanisms, agents' status, and their behaviours. This heterogeneity is observed despite the apparent similarity between the various functions assigned to police forces, such as law enforcement, crowd control, peacekeeping, and border protection, among others. Comparative policing is a new frontier for policing studies. Without a comparative approach, this diversity cannot be identified and integrated into testable 'middle-range theories.' At present, the main obstacle for comparative policing research is conceptual. The very concept of police is ambiguous. At the same time, a deeper understanding of the political establishment and regulation of police systems is required. Scholars require portable concepts such as accountability or decentralisation for example, as well as reliable data to address cross-country comparison. This first volume of Comparative Policing Review suggests there is some interests and indeed, a burgeoning comparative literature emerging to take up the challenge. This paper suggests the key concepts and understandings that are required if we are to effectively develop a viable comparative approach to policing studies. [ABSTRACT FROM AUTHOR]

Given the ethnic/racial disparities in end-of-life care, this study aimed to describe and identify factors affecting engagement in three types of advance care planning including informal talk, living will, and durable power of attorney for health care among ethnic/racial minority older adults. Living will refers to any written instruction about medical treatments at the end-of-life while durable power of attorney for health care allows someone to make a health care decision when an individual is incapable of making a reasoned decision. We used a subset of racial/ethnic minority groups drawn from the second wave of the National Health Aging and Trends Survey (n = 543) collected in 2012. The descriptive result showed that informal talk (60%) happened most followed by durable power of attorney for health care (30%) and living will (26.5%) completion. Multivariate logistic regression analyses found that higher education and lower preference toward life-sustaining treatment were associated with engagement in all three types of advance care planning. Having multimorbidity and U.S. born were associated with having informal talk. Non-Hispanic others were more likely to have informal talk and complete durable power of attoreny for health care to compared to Blacks. Furthermore, married older adults were more likely to complete living wills compared to those separated/divorced or never married. Our findings about different factors affecting engagement in advance care planning indicate that we may need targeted approaches to promote each type of advance care planning for ethnic/racial minority older adults. [ABSTRACT FROM AUTHOR]

As the importance of Advance Care Planning (ACP) has become well-known and accepted, health systems have begun placing more emphasis on ACP. However, many health systems still have not standardized this process, and most health systems still approach ACP in a reactive—rather than proactive—manner. This paper discusses one system's innovative approach to ACP that standardizes ACP in the inpatient and outpatient settings, while focusing on a proactive rather than reactive orientation to ACP. [ABSTRACT FROM AUTHOR]

This paper examines the status of the Rohingya in Bangladesh as refugees, the rights and protections they could be entitled to under international refugee law, and the extent of responsibility and burden sharing between the host country, refugee-producing country, and the international community to ensure their rights and durable solutions. However, these rights remain unfulfilled, which hampers the ability of Bangladesh to garner international support to create the conditions for the repatriation and rehabilitation of the Rohingya in Myanmar. [ABSTRACT FROM AUTHOR]

Powers of attorney (POA), widely used in end-of-life planning, give authority, often to relatives, to manage elders' affairs if they become incapacitated. Unfortunately, family members are frequently perpetrators of elder family financial exploitation (EFFE). To understand possible EFFE precursors, the Elder Family Financial Exploitation Survey (EFFES) collected hierarchical data (individual relatives nested within families) including respondent and elder demographics, financial exploitation details if it occurred, and family dynamics (general family functioning, fairness conflict, resource exchange patterns, entitlement attitudes, and communication/problem-solving). Multilevel logistic regression models found positive association with greater fairness conflict and entitlement attitudes, and negative association with general family function, resource exchange expectations, and communication patterns when growing up, but no association with current communication. Findings can prompt families to proactively address negative family dynamics to reduce the risk of EFFE. Results may also inform decisions about appointing other fiduciaries, e.g., trustees, and personal representatives (executors). [ABSTRACT FROM AUTHOR]

Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity, for example, through mania or severe depression. Aims: To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation. Methods: National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD. Results: A total of 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. A total of 199 (36.6%) participants knew about the MCA. A total 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney, respectively. Barriers included not understanding its different forms, unrealistic expectations and advance plans ignored by services. Conclusion: In BD, the demand for advance plans about welfare with loss of capacity was high, but utilisation of the MCA was low with barriers at service user, clinician and organisation levels. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the issues on the use of supported decision making for patients with dynamic and diminishing capacity in the healthcare setting. Also cited are how said decision making allows the legal recognition of surrogates or guardians as assistive devices, the social model of disability, and how said decision making comports with informed consent.

In the article, the authors discuss issues on supported decision making and shared decision making based on the context of possible vulnerability in patients with disabilities. Other topics include the factors that can complicate supported decision making, namely, domain specific deficits and vulnerability sources, and the case of a 40-year-old patient with neurological condition as example.

Conditionality is a powerful motivator of reforms in countries seeking membership to regional organizations, yet once the country achieves membership, the fate of the reforms becomes uncertain. In practice, while some reforms are overturned, others survive and flourish. This paper explores why some reforms survive and become effective. I argue that the emergence of a pro-reform domestic constituency, and the support of other international organizations help ensure reforms' durability, while the strength of the domestic constituency explains the variation in effective implementation. I explore these arguments empirically in Mexico and Turkey, two countries that adopted competition laws under the conditionality of NAFTA and the EU-Turkey Customs Union. The empirical analysis supports the argument that competition laws were maintained thanks to the emergence of pro-competition constituencies and the support of organizations such as the OECD, while their effective implementation has depended on the strength of domestic constituencies in the two countries. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the estate planning and advance care planning (ACP) of older adults diagnosed with Alzheimer's disease (AD) for the presence of (1) a valid will, (2) a durable power of attorney for health care, and (3) a living will. Method: We analyzed 10,273 adults aged 65 and older from the 2012 Health and Retirement Study (HRS) using multilevel logistic regression. Results: We found that a diagnosis of AD was significantly associated with the ACP variables. Older adults with AD were more likely to assign a durable power of attorney for health care and have a written living will than older adults without an AD diagnosis. However, we found no significant association between a diagnosis of AD and having a valid will. These findings were robust when adjusting for demographic and socioeconomic variables. Other factors decreased engagement in estate planning and ACP, including lower socioeconomic status, being male, and being a minority. Conclusion: Our findings suggest that a diagnosis of AD is associated with more engagement in ACP for individuals and their families, but important barriers exist for people with fewer resources. [ABSTRACT FROM AUTHOR]

Background: The aim of this review was to explore the legal, ethical, and rights issues surrounding use of the Australian My Health Record (MyHR) by people with communication disability. Method: We undertook a narrative review of the legislation and research affecting the implementation of MyHR in populations with communication disability. Results: Use of MyHR by people with communication disability will require careful consideration in relation to (a) capacity and consent; (b) roles of nominated or authorised representatives in the system; and (c) the way decisions are made in relation to the use of MyHR, including supported decision-making for people with intellectual disability. Conclusion: Legal and ethical issues in the use of MyHR by people with communication disability centre on legal rights and equal access. These issues must be addressed if people with communication disability are to have full access to their legal rights and access in exercising personal choice and control in the use of MyHR. [ABSTRACT FROM AUTHOR]

Background: Advance directives have been established as a legal document that ensures patients' wishes are followed if/when they cannot make medical decisions for themselves. The concept, advance directive, is rooted in the ethical principle of patient's autonomy. New York State recognizes three types of advance directives: New York State Health Care Proxy, Living Wills, and Do Not Resuscitate (DNR) order. A common misnomer in healthcare is the idea that advance directives are for the elderly or patients with terminal illness. As per New York State statutes, everyone older than 18-years-old should have an advance directive to avoid conflicts in times of crisis. It has been shown that most patients believe it is their physician's responsibility to initiate an advance directive discussion and residents are at the forefront of most health facilities. Objective: To assess the knowledge and attitude of internal medicine residents towards advance directive and to improve residents' skills and confidence on advance directive discussion. Design: We carried out a prospective study to assess the knowledge and attitude of the internal medicine residents towards advance directive to validate the need to implement didactic sessions and simulations. Results: Fifty out of the 75 internal medicine residents of Harlem Hospital Center participated in the study. Most of the responders indicated that they lacked sufficient knowledge in advance directive discussion and indicated that they were interested in didactic sessions and simulations related to how to help patients with advance directives. Conclusion: Our study showed that most of the residents lacked sufficient knowledge in advance directives discussions and the importance of its incorporation into residency training education. [ABSTRACT FROM AUTHOR]

Knowledge of patient end-of-life (EOL) wishes and discussions are vital for family caregivers, including children and youth who may be in caregiving roles (“young carers” or “caregiving youth”). However, little is known about caregiving youth awareness and perceptions of EOL issues. This study sought to explore caregiving youth knowledge of EOL wishes and their willingness for EOL discussions. Face-to-face interviews with 40 caregiving youth ages 10–20, who have a parent with Huntington’s disease (HD), provided information about their knowledge of the presence of their ill parent’s living will (LW) and durable power of attorney for health care (DPAHC), and willingness to talk with the parent about EOL choices and possibility of death. Less than one-half of the participants were aware of the parent’s LW or DPAHC. Content analysis revealed themes in reasons to want or not want EOL discussion with the parent: respect for the parent’s wishes, caregiving youths’ opinion not valued, and avoidance of EOL issues. Themes also included reasons to not want discussion with the parent about possibility of death: protecting the parent, parent in denial, parent not ready, and realization of the terminal outcome. Findings suggest HD patients and their caregiving youth need support for open EOL discussions, and could benefit from educational programs and support groups around EOL issues. [ABSTRACT FROM PUBLISHER]

Advance care planning (ACP) increases the likelihood patients will receive end-of-life care that is congruent with their preferences and lowers stress among both patients and caregivers. Previous efforts to increase ACP have mainly focused on information provision in the very late stage of life. This study examines whether a relationship exists between volunteering and ACP, and whether this relationship is associated with social support. The sample comprises 877 individuals who were aged 55+ in 2008, and were deceased before 2010. The sample is derived from seven waves (1998–2010) of data from the Health and Retirement Study. Logistic regression results showed that overall ACP and durable power of attorney for health care (DPAHC) were both higher (OR = 1.61 and 1.71, respectively) for older adults with volunteering experience in the past 10 years than those without such experience. Available social support (relatives and friends living nearby) was not associated with the relationship between volunteering and ACP. Other factors related to ACP included poorer health, death being expected, death due to cancer, older age, and being a racial minority. Involving older people in volunteer work may help to increase ACP. Future research is encouraged to identify reasons for the association between volunteering and ACP. [ABSTRACT FROM AUTHOR]

Following the introduction of the Patient Self-Determination Act of 1990, the Veterans Health Administration developed its own advance medical directive (AMD) policy, which most recently states that documentation is mandatory for all hospital patients in all settings. The object of this study was to assess the effectiveness of AMD documentation at a local Veterans Affairs Medical Center. AMD documentation was compared among three inpatient services: surgery, medicine, and psychiatry. Retrospective in nature, 594 inpatient cases were compared. Results revealed that, overall, the rate of AMD documentation was 37.7%. AMD documentation on surgery was statistically more frequent (45.6%) than for either medicine (33.2%) or psychiatry (34.5%). The difference between the numbers of days to AMD documentation for all three services was not statistically significant. While there was no statistically significant difference across gender, Caucasians had AMDs documented more frequently than African Americans (p <.001). Logistic regression reveals that social worker and physician intervention, not patient-specific variables, are the primary predictors of AMD incidence. Policy makers may need to consider the realities of hospital care, especially in emergency settings, and be more specific in the steps of implementation of the policy in the evenings, weekends, and holidays. True adherence to policy implementation may require hospital administrators to increase staff and educational efforts so that the concept of AMD communication and documentation is completely explained to all staff and patients. Policy should include an electronic record reminder that is renewed every 3 years and provisions for accommodating patients who arrive on weekends and holidays, with special awareness of the particular communication needs of minority groups. The study conclusions are that further inquiry is needed to understand these policy nuances to enable the Veterans Affairs Administration to improve its policies and performance in this important aspect of healthcare. [ABSTRACT FROM AUTHOR]

The article informs on the purpose of Physician's/Pennsylvania Order for Life-Sustaining Treatment. Topics discussed include practical application of the individual's legal living will for his/her personal wishes regarding end-of-life care; physicians decision-making capacity in the situation of the same; and analysis of concise and practical medical orders.

Federal agencies responsible for funding protective services to older adults are increasingly concerned with the growing incidence of financial exploitation in rural areas. The Wall Street Journal recently has reported an increasing trend of unemployed adult children migrating from urban centers to smaller rural towns and countrysides to live with their parents since 2008. This current study explores the attitudes of family caregivers regarding management of financial matters for their elderly care recipients. The major findings of the study include that adult children often (1) overestimate their parents' ability to manage their finances; (2) prefer to manage their parents' finances informally, as opposed to using legal options like power of attorney; and (3) tend to think of their parents' assets as “almost theirs.” The study concludes with recommendations on the critical need for information to help families make important decisions about helping elderly parents with their finances. This information would not only promote the use of safeguards against abuse, but could potentially provide caregivers with greater confidence and protection. [ABSTRACT FROM AUTHOR]

This study examined end-of-life planning and whether common characteristics predicted completion of these decisions. Participants in the Nebraska End-of-Life Survey were asked whether they had heard about or completed five plans: a health care power of attorney agreement, a living will, a last will and testament, funeral or burial preplanning, and organ and tissue donation. Logistic regression was used to identify predictors of these outcomes. Predictors of completing end-of-life plans, including funeral and burial preplanning, included older age, higher household income, and higher religiosity. This suggests that all of these decisions may be part of an integrated planning process at the end of life. Further, results from this study indicate that the role of religiosity, found in this study to predict both financial and health care planning, warrants further exploration. [ABSTRACT FROM PUBLISHER]

End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not “futile.” Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, “If this were not an attempted suicide, would a request to withdraw care be reasonable?” We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects. [ABSTRACT FROM PUBLISHER]

The computer revolution has had an enormous effect on all aspects of the practice of medicine, yet little thought has been given to the role of social media in identifying treatment choices for incompetent patients. We are currently living in the “Internet age” and many people have integrated social media into all aspects of their lives. As use becomes more prevalent, and as users age, social media are more likely to be viewed as a source of information regarding medical care preferences. This article explores the ethical and legal issues raised by the use of social media in surrogate decision making. [ABSTRACT FROM PUBLISHER]

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances. [ABSTRACT FROM AUTHOR]

In England and Wales, the legal framework for substitute decision-making for adults who lack capacity to make financial decisions is provided by the Court of Protection through Enduring Powers of Attorney (EPAs)and Receiverships. Little is known about the 'patients'of the Court and the capacity assessments made before implementing substitute decision-making. A sample of records (N = 800) indicated that the typical client is an older woman, living in a residential home, with limited financial resources and dementia. Of concern, formal capacity assessment was minimal: for EPAs, the data were too limited to analyse, whilst, for Receiverships, few (21.5 per cent) referred to relevant skills. Compared with other medical practitioners, psychiatrists were significantly more likely to make complex assessments. Nevertheless, none addressed fully the accepted definition of incapacity. We discuss the implications of our findings in the context of the proposals (Lord Chancellor's Department, 1999) to reform the current substitute decisionmaking framework. [ABSTRACT FROM AUTHOR]

Fifty-three senior citizens were interviewed concerning their preferences and opinions about the use of durable powers of attorney for health care decisions. This paper discusses these preferences and opinions, along with some gender differences in health care decision-making. Relatively few senior citizens contacted for this study had effected durable powers of attorney for health care decisions, in spite of the importance accorded to planning for health care. Some of the observed gender differences stem from demographic differences between older women and older men, while others appear to result from differential socialization experiences. [ABSTRACT FROM AUTHOR]

In this article the authors reflect on the ethical issues associated with witholding nonfutile medical care from patients who have attempted suicide and on the article "Withdrawal of Nonfutile Life Support After Attempted Suicide" by Samuel M. Brown, C. Gregory Elliott and Robert Paine. In the article the authors offer their opinions on medical care for patients who have attempted suicide and on several points which are raised in Brown et al.'s article.

In this article the author discusses the role that social media and the online social networking site Facebook can play in surrogate decision making in medical care and the article "Surrogate Decision Making in the Internet Age" by Jessica Berg. In the article the author offers his opinions on the benefits of using social media in medical decision making and on several points which are raised in Berg's article.

In this article the author discuses the article "Surrogate Decision Making in the Internet Age" by Jessica Berg. He is supportive of statements in berg's article which approve the use of social media in surrogate decision making in medical care and which call for additional research on the use of social media in surrogate decision making in medical care.

The article focuses on the moral and ethical issues that are raised with the disclosure of genetic testing data. In the article the authors offer their opinions on the obligation that genetic researchers have to develop a result disclosure policy and on several points raised in the article "Genomic Inheritances: Disclosing Individual Research Results From Whole-Exome Sequencing to Deceased Participants' Relatives" by Ben Chan et al.

In this article the authors focus on the moral and ethical issues raised when social media is used in surrogate decision making in medical care and on the article "Surrogate Decision Making in the Internet Age" by Jessica Berg. In the article the authors offer their opinions on the use of social media in surrogate decision making and on several points which are raised in Berg's article.

The article focuses on the moral and ethical issues that are raised with the use of social media in surrogate decision making in medical care and on the article "Surrogate Decision Making in the Internet Age" by Jessica Berg. In the article the authors offer their opinions on the use of social media in surrogate decision making and on several points which are raised in Berg's article.

In this article the author reflects on the use of social media in surrogate decision making in medical care and on the article "Surrogate Decision Making in the Internet Age" by Jessica Berg. In the article the author offers his opinions on the use of social media in surrogate decision making and on several points which are raised in Berg's article.

The article presents a case study of research on a condition linked to cognitive impairment. It involves enrolling children and adults into magnetic resonance imaging (MRI) spectroscopy of the brain and cerebral spinal fluid by lumbar puncture. The case raises the ethical questions of whether investigators can enroll adults who cannot consent in research with no benefit and more than minimal risk, and whether an agent with health care power of attorney can be allowed to decide on research.

The article discusses approaches for enrolling adults who cannot consent to more than minimal risk research in 2015. Topics covered include the acceptability of enrollment only when it is socially valuable, the question of acceptable levels of additional risks that may impair ordinary, daily lives, and the designation of individuals through power of attorney (DPA) to make research decisions for such adults. Also noted is the general acceptability of family surrogate consent on the matter.

The article discusses factors to be considered in enrolling incompetent adults in more than minimal risk research as compared with children. Topics covered include the minimal regulatory guidance for such enrollment, the legally authorized representative's (LAR) possible evaluation of an incompetent adult, and the proposal of relying on a substituted judgment on the subject's values that might honor his/her autonomy. Also noted is the latitude given to parents in enrolling their children.

The article presents a case study on the justifiable use of cognitively impaired adults in research to benefit other people. Topics discussed include the lack of specificity in federal regulation 45 CFR 46, and the resulting inconsistent practices in institutional review boards (IRB) and research opportunities. Also noted is the critical step of requiring the substituted judgment legal standard of surrogate decision making for research with cognitively impaired adults to improve consistency.

The authors reflect on the article "Withdrawal of Nonfutile Life Support After Attempted Suicide" by Samuel M. Brown et al., on the ethical issues associated with withholding medical treatment from a patient who has attempted suicide and on surrogate decision makers in medical cases. They suggest that surrogate decision makers make mistakes about medical treatment decisions all the time. They argue that surrogate decision makers are not always good at representing the wishes of patients.

The article focuses on the use of social media in medical decision making and in surrogate decision making in medical care. In the article the authors offer their opinions on the moral and ethical issues raised with the use of social media in surrogate decision making in medical care and on several points which are raised in the article "Surrogate Decision Making in the Internet Age" by Jessica Berg.

The article focuses on the use of social media in surrogate decision making in medical care and on the use of social media by people with disabilities. In the article the author offers her opinions on several points raised in the article "Surrogate Decision Making in the Internet Age" by Jessica Berg and on the need for research on the use of social media by disabled people in surrogate decision making.

In this article the authors reflect on the use of social media in surrogate decision making in medical care and on the article "Surrogate Decision Making in the Internet Age" by Jessica Berg. In the article the authors offer their opinions on the moral and ethical issues raised by using social media in surrogate decision making and on several points which are raised in Berg's article.