Informed consent in the electroconvulsive treatment of geriatric patients.

The past 15 years have been marked by an increasingly stringent regulatory atmosphere regarding the administration of ECT, leading to delays in treatment and declines in usage. Regulatory changes requiring judicial intervention in clinical decisions are driven by the notion that only the courts can provide adequate due process protections when legal rights and clinical need conflict. We retrospectively reviewed the documentation of the informed consent process for 62 geriatric patients receiving ECT to assess the degree to which clinicians conformed to the spirit of the informed consent doctrine in a state that allows significant clinical discretion in decisions to administer ECT to patients lacking decisional capacity. In the eight cases in which the patient's decisional capacity was questioned, we found appropriate documentation of the patient's failure to comprehend his condition or the proposed treatment, evidence of a high degree of family involvement in decision making, and extensive use of outside consultants to document decisional incapacity and the need for treatment. Evidence of family participation in decision making was present for a high percentage of cases in which decisional capacity was unquestioned. Our review demonstrated high compliance with the procedural safeguards contained in the state regulation and with the spirit of the informed consent doctrine.     

Book reviews

Daniel Pipes, Greater Syria: the History of an Ambition. New York: Oxford University Press, 1990, viii, 240 pp.

Roger Zetter (Ed.), The Odyssey of the Pontic Greeks. Oxford University Press/Refugee Studies Programme, Oxford, 1991, 111 pp., Illus. Maps.

Nikki R. Keddie and Beth Baron (Eds), Women in Middle Eastern History. Shifting Boundaries in Sex and Gender. Yale University Press, New Haven and London, 1991, 343 pp., $35/£19.95.

John L. Esposito, Islam: the Straight Path. Oxford University Press, New York, 1991, xvi + 251 pp., $21.95.

Joyce N. Wiley, The Islamic Movement of Iraqi Shias. Lynne Rienner Publishers, Boulder and London 1922. ix + 193 pp., N.P.

Joel Gordon, Nasser's Blessed Movement: Egypt's Free Officers and the July Revolution, Oxford University Press: New York and Oxford, 1992, vii + 254.

Jo‐Ann Gross (Ed.), Muslims in Central Asia: Expressions of Identity and Change, Duke University Press: Durham, 1992, xiv, 224 pp, $39.95, PB $18.95.

Louise L'Estrange Fawcett, Iran and the Cold War: the Azerbaijan Crisis of 1946, Cambridge University Press: Cambridge, 1922, XII, 227 pp., $34.95.

Mark J. Gasiorowski, U.S. Foreign Policy and the Shah: Building a Client State in Iran, Cornell University Press: Ithaca, N.Y 1992, xvi, 242 pp. $35.00.

Robert A. Lewis (Ed.), Geographic Perspectives on Soviet Central Asia, Routledge: London, 1992, XVIII, 323 pp., $69.50 U.S., $87.50 Canada.     

Book reviews

Caspian Gas. Ottar Skagen. London: Royal Institute of International Affairs, 1997, xii, 95 pp, £12.50

Ethnic Conflict in the Post‐Soviet World: Case Studies and Analysis. Leokadia Drobizheva, Rose Gottemoeller, Catherine McArdle Kelleher, Lee Walker (editors). Armonk, NY: M. E. Sharpe, 1996, xv, 366 pp, $59.95 hardback, $24.95 paperback

Contested Borders in the Caucasus. Bruno Coppieters (editor). Brussels: VUB University Press, 1996, 204 pp

The Republic of Armenia, From London to Sevres to London, February‐August 1920, Vol. III. Richard G. Hovannisian. Berkeley/Los Angeles/London: University of California Press, 1996, xx + 534, preface, illus, notes, maps, glossary, biblio, index, hardcover, £35

The Republic of Armenia, Between Crescent and Sickle: Partition and Sovietization, Vol. IV. Richard G. Hovannisian Berkeley/Los Angeles/London: University of California Press, 1996, xii + 496, illus, notes, maps, glossary, biblio, index, hardcover, £35

Historical Dictionary of Afghanistan, Second edition. Ludwig W. Adamec. Lanham, MD, USA and London, UK: The Scarecrow Press, 1997, 499 pp, chronology, bibliography, $58 hardcover

State and Tribe in Nineteenth‐Century Afghanistan. The Reign of Amir Dost Muhammad Khan (1826–1863), Christine Noelle, Curzon Press, Richmond, Surrey, 1997, 439 pp

The Hazaras of Afghanistan: An Historical, Cultural, Economic and Political Study, Sayed Askar Mousavi, Richmond, Surrey: Curzon Press, 1995, 270 pp. ISBN 0–7007–630–5

A History of Ottoman Architecture. Geoffrey Goodwin. London: Thames & Hudson, 1997, 511 pp, illus, plans, biblio, glossary, index, £27.50

Tribal Rugs. Treasures of the Black Tent. Brian W. MacDonald. >Woodbridge, Suffolk: Antique Collectors’ Club, 302 pp, illus, index, £35

Jewish Carpets. A History and Guide. Anton Felton. Woodbridge, Suffolk: The Antique Collectors Club, 1997, 199 pp, illus, biblio, index, £35

Cobalt and Lustre. The First Centuries of Islamic Pottery, Emst Grube, London and Oxford: The Nour Foundation in association with Azimuth Editions and Oxford University Press, 1996, 348 pp, illus, biblio, index, £135

China. The Silk Routes. Peter Neville‐Hadley. London and Connecticut: Cadogan Books, UK, and The Globe Pequot Press, USA, 1997, 544 pp, maps, index, £15.99/$21.95, paperback     

THE WAR ON POVERTY: MEASUREMENT,TRENDS, AND POLICY

We present a 50‐year historical perspective of the nation's antipoverty efforts, describing the evolution of policy during four key periods since 1965. Over this half‐century, the initial heavy reliance on cash income support to poor families has eroded; increases in public support came largely in the form of in‐kind (e.g., Food Stamps) and tax‐related (e.g., the Earned Income Tax Credit) benefits. Work support and the supplementation of earnings substituted for direct support. These shifts eroded the safety net for the most disadvantaged in American society. Three poverty‐related analytical developments are also described. The rise of the Supplemental Poverty Measure (SPM)—taking account of noncash and tax‐related benefits—has corrected some of the serious weaknesses of the official poverty measure (OPM). The SPM measure indicates that the poverty rate has declined over time, rather than being essentially flat as the OPM implies. We also present snapshots of the composition of the poor population in the United States using both the OPM and the SPM, showing progress in reducing poverty overall and among specific socioeconomic subgroups since the beginning of the War on Poverty. Finally, we document the expenditure levels of numerous antipoverty programs that have accompanied the several phases of poverty policy and describe the effect of these efforts on the level of poverty. Although the effectiveness of government antipoverty transfers is debated, our findings indicate that the growth of antipoverty policies has reduced the overall level of poverty, with substantial reductions among the elderly, disabled, and blacks. However, the poverty rates for children, especially those living in single‐parent families, and families headed by a low‐skill, low‐education person, have increased. Rates of deep poverty (families living with less than one‐half of the poverty line) for the nonelderly population have not decreased, reflecting both the increasing labor market difficulties faced by the low‐skill population and the tilt of means‐tested benefits away from the poorest of the poor.