Competence to consent to treatment as a psycholegal construct

The issue of whether civilly committed patients should be extended the right to accept or refuse treatment has generated much controversy and litigation during the past 15 years. In general, the current rule is that in nonemergency situations, individuals who are competent to give informed consent to treatment should be extended the right to refuse it. Obviously, the manner in which this rule is implemented partly depends on how competence to consent to treatment is defined and measured. Most researchers have implicitly assumed that an understanding of treatment information is the sole criterion of competence. It is argued that such a definition may be incomplete and is in need of reexamination. Following a review and analysis of the relevant legal and psychological literature, a comprehensive construct of competency to consent to treatment is proposed and future directions for research are discussed.     

An examination of the psychological aspects of bite marks

The intent of this paper is to present some psychological threads which appear to be operative for the perpetrator of bite marks. In the catalogue of multiple motivations, there appears to be a current theme of power, control, potency, and the attempt to have a psychological symbolization of the perpetrator's omniscient capacity for absorbing life essences. In an examination of these highly complex needs, the modern perpetrator appears to act out consistently with cultural biases coupled with immediate psychological needs which have pressed for expression. Due to a pattern of psychologically expressed ritualism, the perpetrator will often inadvertently leave important psychological clues at the crime scene. The attack style, mode of death, characteristics of the victim, etc.--these components reveal the information on the type of psychological needs that the perpetrator is trying to satisfy. In the cases of bite marks associated with violent crime, it becomes crucial to an "investigator" what type of personality characteristics are welded together to form this kind of need complex. After reviewing cases reported in the literature and after conducting psychological interviews with perpetrators, three major groups of perpetrators seem to be apparent. The first group is motivated out of an anger track, the second group is motivated out of sadistic biting, and the third is out of the more traditional "cannibal complex" motif.     

Changes in corporate organization of the health care system

Health care financing has undergone numerous structural changes over the years. Change continues while extreme growth seriously affects the health care focus. The author examines the multiclass system and health financing trends. Restructuring techniques are also discussed.