Medical treatment of dementia patients at the end of life: can the law accommodate the personal identity and welfare problems?

This article considers whether two significant philosophical objections to autonomy-based legal approaches to decision-making for incompetent individuals could be accommodated by the law. These philosophical objections are known as the personal identity and welfare problems. The article first sets out the autonomy-based approaches and their objections. Next, the present legal position is briefly canvassed in a comparative vein. Finally, the article suggests how the personal identity and welfare problems might be accommodated were legislators minded to do so, by proposing specific statutory amendments to the recent English legislation on advance decisions and evaluating their viability, particularly in light of the European Convention on Human Rights.     

Motivations for becoming a police officer: Re-assessing officer attitudes and job satisfaction after six years on the street

Few studies had examined the stability of motivations for becoming a police officer over time, especially among minority and female officers. Moreover, research had not explored the links between original motivations and job satisfaction, a likely proxy measure of motivation fulfillment. The current research was a follow-up to Raganella and White (2004) who examined motivations among academy recruits in the New York City Police Department (NYPD). Using the same survey and analysis, this study re-examined motivations among officers from the same NYPD recruit class after six years on the job, and explored both motivation stability and the relationships among motivations and job satisfaction. Results suggested that motivations have remained highly stable over time, regardless of officer race/ethnicity and gender. Findings also suggested that White male officers were most likely to report low job satisfaction, and that there is a link between low satisfaction and unfulfilled motivations. Moreover, dissatisfied officers were much less likely to have expressed strong commitment to the profession through their original motivations, suggesting that low commitment up front may lead to low satisfaction later on. The article concludes with a discussion of implications for police departments, particularly with regard to recruitment and retention practices and efforts to achieve diversity.     

A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients

Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue.