Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N=469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid.     

The end of organised crime in the European Union

So much has been written—and vigorously contested—about ‘organised crime’ (OC) that the impending fall of this familiar icon may come as a shock, both to its detractors and to those who take it for granted. Yet that moment may be upon us, for reasons that this paper will explore, as the European Union shifts the vocabulary within which policies on police cooperation are articulated. A pivot of this change is the EU Council Decision on Europol, first debated by the Council in late 2006 and anticipated as applying from 2010 onwards. This will shift the scope of Europol’s work from ‘organised crime’ (attributing qualities to criminality) to ‘serious crime’ (concern with impacts and harms falling on individual and collective victims); will transfer financing of Europol to the Community budget; and so will initiate parliamentary scrutiny. These issues in security governance are explored from ‘northern’, ‘southern’ and ‘eastern’ European perspectives and in the contexts of ongoing enlargement and democratisation of the EU.

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Risk calculation and precautionary uncertainty: two configurations within crime assessment

This paper explores two configurations of thinking about crime amongst law enforcement agencies and private sector security managers: ‘risk calculation’ (concerned with everyday, calculable probabilities and impacts and their management) and ‘precautionary uncertainty’ (concerned with events that might be incapacitating, yet are not calculable by probability assessments). The paper explores their respective constituent concepts and fields of application in crime assessment, drawing upon qualitative research-in-progress in Belgium. Risk calculation, as applied to crime, starts with past data on routines that link perpetrators with targets that lack capable guardians. Precautionary uncertainty focuses on potential impacts that are highly disabling and potentially wide-spreading (contagion, knock-on effects), asking how such impacts can be contained and recovered from. Risk and uncertainty are shown to be related to ‘rational-instrumental’ and ‘deliberative-constitutive’ approaches as developed by Fisher’s work in the field of law, which offers a meta-narrative in relation to which they can be positioned. Finally, the paper asks if these two crime assessment methods should be seen as distinct or as merging. On the basis of criteria of conceptual sharpness, openness to public debate and justiciability, the authors champion the maintenance of a clear distinction between risk and uncertainty.     

Developmental Markers in Adolescence: Implications for Studies of Pubertal Processes

There is inconsistency in the outcome measures of biological and psychosocial studies using measures of puberty as a predictor. For example, some studies show that maturational timing may have differential influences (positive, negative, or no effect) depending on the specific disorder, dimension of measure, and gender. Other studies have suggested that some effects may be more directly linked to pubertal stage or hormone concentrations rather than timing per se. This study outlines several conceptual and methodological issues that may be relevant to addressing these inconsistencies, in the context of examining data from a study of maturational hormones obtained from a unique longitudinal cohort of 24 girls (age 10.0 ± 1.6 years) and 36 boys (age 10.4 ± 1.6 years) in the early part of puberty, where the developmental trajectory of these hormones were tracked annually in 65% of the sample. We explored the contributions of measures of pubertal growth and sociodemographic factors on hormone concentrations. In brief, it appears that no single measure best captures the maturational processes during puberty and suggests that multiple processes are occurring in parallel. Several conceptual and methodological implications are discussed that may guide investigators in interpreting existing studies of pubertal timing and behavior as well as in conducting future studies.