Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes and case law, (...) as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

State law requirements for health care advance directive documents were reviewed in every state and the District of Columbia to determine whether they are consistent and/or flexible enough to permit the utilization by the public of “universal” advance directive forms, specifically a health care power of attorney, that would be valid under every state's advance directive statutes. Such documents would have to overcome the wide variability of state legal formalities for validity. If this could be accomplished, the public would benefit (...) from having a variety of multi-state or truly universal forms available that could be used with confidence in their validity.The review found that a basic, multi-state health care power of attorney appears to be feasible in 41 States and the District of Columbia, compared to 36 states and the District in 2005. Only nine states prevent recognition of a truly universal form. Some barriers were surmountable, including differing agent and witness requirements, execution requirements, and effectiveness triggers. Other barriers were insurmountable, including mandatory forms, mandatory disclosures, and decision-specific language requirements. The strategies identified for overcoming some barriers can be used by lawyers in drafting true multi-state directives. More importantly, states should simplify state advance directive laws to facilitate a more meaningful communication model of advance care planning. (shrink)

This article details the results of a national survey conducted in 1999 of statewide laws and protocols providing for the creation and recognition of donot- resuscitate orders effective in nonhospital settings. Applicable primarily to emergency medical services personnel, most of these laws and protocols have been in existence for less than ten years, and there is little current comparative information on them. Such policies are commonly called out-of-hospital or prehospital DNR orders, although one state-Virginia-recently amended its DNR law to establish (...) a durable DNR order applicable to all health care providers and all settings. I will refer to the laws and policies examined here interchangeably as out-of hospital DNR protocols or EMS-DNR protocols. The survey produced a descriptive snapshot of such laws and protocols in effect on a statewide basis as of March 1999. (shrink)

The Physician Orders for Life-Sustaining Treatment Paradigm is designed to improve end-of-life care by converting patients’ treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. Accordingly, an observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care (...) organizations/agencies in combination with a review of relevant state law. Legal analysis of survey responses and existing laws identified several potential state legal barriers to a POLST Paradigm implementation. The most potentially problematic barriers are detailed statutory specifications for out-of-hospital DNR protocols. Other potential barriers include limitations on the authority to consent to forgo life-sustaining treatments, medical preconditions, and witnessing requirements for out-of-hospital DNR protocols. (shrink)

The present work investigates whether the hemispheric processing of both verbal and emotional stimuli, studied by means of a dichotic listening task, differs between normal high and low dissociators as assessed by the Dissociative Experiences Scale . Development, reliability and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735). Two groups of subjects , participated in the experiment. The task consisted in identifying both verbal and emotional stimulus-targets, respectively, on successive sessions. Reaction time and response accuracy (...) were registered and analysed using ANOVA . The interaction between stimuli , channel , and dissociation level reached statistical significance in terms of accuracy measures = 4.75; p < .05). Both high and low dissociators exhibited the expected right ear advantage on verbal targets. On the other hand, whereas low dissociators exhibited the expected left ear advantage on emotional targets, high dissociators failed to follow this typical pattern of hemispheric asymmetry: both hemispheres exhibited similar performances. These results confirm the hypothesis that dissociation is related to changes in hemispheric processing, specifically of emotional information. (shrink)

RésuméLa psychanalyse se pose comme savoir quant à certains aspects de l'esprit humain et comme instrument pour y apporter des changements. II y a relativement peu de travaux consacrés à la structure de ce savoir ou aux modalités ?action de cet instrument. Ce travail se propose ?examiner brièvement ce qui dans l'oeuvre du pionnier de la psychanalyse – Sigmund Freud –, ou à partir ?elle, permet ?entrevoir les réponses qui pourraient être apportées à de telles questions.

We generalize the concept of a cooperative non-transferable utility game by introducing a socially structured game. In a socially structured game every coalition of players can organize themselves according to one or more internal organizations to generate payoffs. Each admissible internal organization on a coalition yields a set of payoffs attainable by the members of this coalition. The strengths of the players within an internal organization depend on the structure of the internal organization and are represented by an exogenously given (...) power vector. More powerful players have the power to take away payoffs of the less powerful players as long as those latter players are not able to guarantee their payoffs by forming a different internal organization within some coalition in which they have more power.We introduce the socially stable core as a solution concept that contains those payoffs that are both stable in an economic sense, i.e., belong to the core of the underlying cooperative game, and stable in a social sense, i.e., payoffs are sustained by a collection of internal organizations of coalitions for which power is distributed over all players in a balanced way. The socially stable core is a subset and therefore a refinement of the core. We show by means of examples that in many cases the socially stable core is a very small subset of the core.We will state conditions for which the socially stable core is non-empty. In order to derive this result, we formulate a new intersection theorem that generalizes the KKMS intersection theorem. We also discuss the relationship between social stability and the wellknown concept of balancedness for NTU-games, a sufficient condition for non-emptiness of the core. In particular we give an example of a socially structured game that satisfies social stability and therefore has a non-empty core, but whose induced NTU-game does not satisfy balancedness in the general sense of Billera. (shrink)

Selon un lieu commun, la géographie médiévale se réduirait à une vaste parenthèse ouverte entre la fin du siècle d'or de l'Empire romain et la renaissance des grandes découvertes du XV° siècle. Mais quelle réalité s'agit-il de représenter ? Car toute représentation est tributaire, non seulement de conceptions particulières, mais aussi de moyens techniques qui ont présidé à son élaboration. Dans cet article, le lien entre la réalité et ses images, qui organise habituellement l'histoire de la cartographie, sera relâché au (...) bénéfice des représentations comme un système de signes appelé à prendre sens dans une production et une réception . L'enquête médiévale révèle l'attention des contemporains à la complexité de ces relations et représentations.According to common understanding, medieval geography would be reduced to a vast parenthesis, open between the end of the golden century of the Roman Empire and the renaissance of the great discoveries of the 15th century. But what is the reality being represented ?For every representation is tributary, not only of particular conceptions, but also of the technical capacities that preceded its elaboration. In this article, the connection between reality and its images, which habitually organized the history of cartography, will be set aside for the benefit of representations as a system, of signs called to have meaning in a production and a reception . This medieval inquiry reveals the attention that contemporaries have given to the complexity of its relations and representations. (shrink)

Originally published 1968, the book examines the ways in which the definitions of education held by different groups with power have changed since 1800 and traces which social institutions exercised the preponderant influence on the growth of the English educational system during the seminal period in which the state system was founded and grew to its present position. Especial attention is given to the influence of the ideologies of the various social classes, to the growing demands of the economy on (...) the educational system and to changes in the structure of the family. (shrink)