The concept of exceptionality: a legal farce?

How do we decide which treatments should be offered by the National Health Service (NHS) when we cannot afford to fund them all? In the absence of a positive appraisal by the National Institute for Health and Clinical Excellence (NICE), which mandates the provision of a treatment by the NHS, Primary Care Trusts (PCTs) are free to decide whether to provide a particular drug to some, or all, of their population. However, as public bodies, it is a well-established principle of Administrative Law that PCTs are not at liberty to fetter the exercise of their own discretion. They must recognise the possibility that some patients will have exceptional circumstances, and as a consequence, any general policy prohibiting the funding of a drug cannot be absolute. In the absence of statutory guidance on what might constitute exceptional, clinicians are left guessing as to whether their patients might be eligible for funding on the grounds of exceptionality. Using the context of expensive cancer drugs, I will examine the concept of exceptionality from clinical, moral, and legal perspectives, focussing particularly on the role of social factors in determining exceptionality. I will review the cases where PCTs' decisions not to fund cancer drugs were subject to legal action and argue that the courts have provided little guidance on interpreting the term exceptional, and that the concept has a limited role to play in the allocation of scarce health resources at a local level.     

Learning on the job: Studying expertise in residential burglars using virtual environments*

In this article, we describe a quasi‐experiment in which experienced incarcerated burglars (n = 56), other offenders (n = 50), and nonoffenders (n = 55) undertook a mock burglary within a virtual neighborhood. We draw from the cognitive psychology literature on expertise and apply it to offending behavior, demonstrating synergy with rational choice perspectives, yet extending them in several respects. Our principal goal was to carry out the first robust test of expertise in offenders by having these groups undertake a burglary in a fully fledged reenactment of a crime in a virtual environment. Our findings indicate that the virtual environment successfully reinstated the context of the crime showing clear differences in the decision making of burglars compared with other groups in ways commensurate with expertise in other behavioral domains. Specifically, burglars scoped the neighborhood more thoroughly, spent more time in the high‐value areas of the crime scene while traveling less distance there, and targeted different goods from the comparison groups. The level of detail in the data generated sheds new light on the cognitive processes and actions of burglars and how they “learn on the job.” Implications for criminal decision‐making perspectives and psychological theories of expertise are discussed.     

Sexually Violent Predator Evaluations: Empirical Evidence,Strategies for Professionals,and Research Directions

Several states have passed civil commitment laws that allow the precautionary detention of sex offenders who have completed their criminal sentences. Over 2,500 sex offenders have been committed across states with such statutes and several thousand more sex offenders have been evaluated. Most statutes call for an evaluation of risk by a mental health professional and, although each state statute is worded differently, three main elements common to sexually violent predator evaluations are used to guide evaluators: mental abnormality, volitional capacity, and likelihood of future sexual violence. The current article presents empirical evidence for the main tenants of these forensic evaluations, provides recommendations for evaluators in light of current limitations of evidence, and offers suggestions for future research in this area of forensic assessment.     

Rates and predictors of sexual aggression among students and non-students

The authors compared rates and predictors of sexual aggression for women attending college with those of women from the same population who were not attending college. Because it has been suggested that less parental monitoring at college may be associated with risky behaviors that contribute to sexual aggression, they also compared rates and predictors of sexual aggression for those living with parents versus not living with parents. The results showed that women living away from parents reported significantly higher rates of sexual aggression than women living with parents, regardless of student status. Logistic regression analyses showed that for student and non-student women, heavy episodic drinking and number of sex partners predicted past-year rape and/or attempted rape. The current results do not provide evidence that college is a uniquely risky environment for experiencing sexual aggression. Rather, the behaviors in which young women engage are associated with sexual aggression during this time period.     

Hope, meaning, and growth following the September 11, 2001, terrorist attacks

Positive psychologists found the increase of seven character strengths that encompass the so-called theological virtues, including hope and spirituality, in Americans after the September 11, 2001, attacks. Little is known about how they may affect post-September 11, 2001, mental health. Using multivariate analysis, this study investigated the relationship of hope and spiritual meaning with depression and anxiety in a sample of 457 students 3 months after September 11, 2001. Both characters contributed to lower levels of symptoms. In qualitative analysis, of 313 answers to an open-ended question regarding personal change, four categories emerged. The first three were consonant with other studies on posttraumatic growth (PTG), including changes in the self or behavior, relationships, and worldviews. The fourth category unique to September 11, 2001, was changes in political views. These findings offer further credence to the study of positive aspects resulting from violence-related trauma and highlight the needs for addressing the nature of traumatic events and PTG.     

Damned if they do, damned if they don't: the need for a comprehensive public policy to address the inadequate management of pain

Amy Dilcher examines the need for a comprehensive pain policy and argues that opioids--highly effective drugs for pain management--should be legally and practicably accessible to medical professionals and their patients, as and when needed to provide relief from pain. The article synthesizes a number of perspectives regarding the regulation of pain management and demonstrates that the inadequate treatment of pain stems from a multitude of barriers. After reviewing Congressional action on the topic, Ms. Dilcher concludes with recommendations for a more comprehensive pain policy that would enhance the management of pain.