Dementia, Advance Directives, and Discontinuity of Personality

2016 ◽  
Vol 25 (4) ◽  
pp. 674-685 ◽  
Author(s):  
JOSEPH P. DEMARCO ◽  
SAMUEL H. LIPUMA
Keyword(s):  
Empirical Evidence ◽  
Personal Identity ◽  
Advance Directives ◽  
Social Contract ◽  
Advance Directive ◽  
Empirical Studies ◽  
Detailed Examination ◽  
Personality Change ◽  
Sample Sizes ◽  
Personality Changes

Abstract:We argue that an advance directive (AD) is not invalidated by personality changes in dementia, as is claimed by Rebecca Dresser. The claim is that a new person results under such personality changes, and that the former person cannot write an AD for the new person. After stating the argument against ADs in cases of dementia, we provide a detailed examination of empirical studies of personality changes in dementia. This evidence, though not strong due mainly to low sample sizes and different notions of personal identity, does not support Dresser’s position. Given the weakness in the empirical evidence, we turn to a philosophical defense of ADs based on a social contract view supporting the current interests of those writing ADs. Additionally, we argue that personality change is not equivalent to change in personal identity, as would be required by the argument against ADs in cases of dementia.

Subjectively perceived personality and mood changes associated with subthalamic stimulation in patients with Parkinson's disease

2014 ◽  
Vol 45 (1) ◽  
pp. 73-85 ◽  
Author(s):  
C. J. Lewis ◽  
F. Maier ◽  
N. Horstkötter ◽  
A. Zywczok ◽  
K. Witt ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Empirical Studies ◽  
Personality Change ◽  
Structured Interviews ◽  
Measurement Scales ◽  
Ethical Implications ◽  
Mood Changes ◽  
Personality Changes ◽  
Stn Dbs

BackgroundClinical and ethical implications of personality and mood changes in Parkinson's disease (PD) patients treated with subthalamic deep brain stimulation (STN-DBS) are under debate. Although subjectively perceived personality changes are often mentioned by patients and caregivers, few empirical studies concerning these changes exist. Therefore, we analysed subjectively perceived personality and mood changes in STN-DBS PD patients.MethodIn this prospective study of the ELSA-DBS group, 27 PD patients were assessed preoperatively and 1 year after STN-DBS surgery. Two categories, personality and mood changes, were analysed with semi-structured interviews. Patients were grouped into personality change yes/no, as well as positive/negative mood change groups. Caregivers were additionally interviewed about patients’ personality changes. Characteristics of each group were assessed with standard neurological and psychiatric measurements. Predictors for changes were analysed.ResultsPersonality changes were perceived by six of 27 (22%) patients and by 10 of 23 caregivers (44%). The preoperative hypomania trait was a significant predictor for personality change perceived by patients. Of 21 patients, 12 (57%) perceived mood as positively changed. Higher apathy and anxiety ratings were found in the negative change group.ConclusionsOur results show that a high proportion of PD patients and caregivers perceived personality changes under STN-DBS, emphasizing the relevance of this topic. Mood changed in positive and negative directions. Standard measurement scales failed to adequately reflect personality or mood changes subjectively perceived by patients. A more individualized preoperative screening and preparation for patients and caregivers, as well as postoperative support, could therefore be useful.

Are Social Expectations a Possible Mechanism for Adult Personality Change: Empirical Evidence for Social Investment Theory

2021 ◽  
Author(s):  
Yuzhan Hang ◽  
Lydia Gabriela Speyer ◽  
Billy Lee ◽  
Michelle Luciano ◽  
René Mõttus
Keyword(s):  
Young Adults ◽  
Personality Traits ◽  
Empirical Evidence ◽  
Young Adulthood ◽  
Social Role ◽  
Personality Change ◽  
Social Expectations ◽  
Social Investment ◽  
Investment Theory ◽  
Personality Changes

Objective: Personality traits change in both mean levels and variance across the life span but the mechanisms underlying these developmental trends remain unclear. Social investment theory is one of the leading theories trying to explain personality maturation, suggesting that social role expectations drive personality changes in adulthood. However, there is not sufficient empirical evidence for SIT, thus the present study tested whether social expectations can explain personality maturation in young adulthood. Methods: A pool of 257 personality items, which was not driven by a priori conceptual model of personality, was used to measure young adults’ personality trait mean levels, personality variance and socially expected level of traits from different perspectives (friends, partners and bosses/supervisors). Results: There were consistent expectations for how young adults should think, feel and behave. Personality traits under stronger social expectations have higher mean levels and lower variances than traits under lower expectations; traits with stronger social expectations show higher means at later ages; and traits’ variances increase with age. Conclusion: Our results are partially consistent with SIT, suggesting that social expectations could be a potential mechanism to explain personality changes in young adulthood.

Choosing for others as Continuing a Life Story: The Problem of Personal Identity Revisited

1999 ◽  
Vol 27 (1) ◽  
pp. 20-31 ◽  
Author(s):  
Jeffrey Blustein
Keyword(s):  
Personal Identity ◽  
Advance Directives ◽  
Advance Directive ◽  
Life Story ◽  
Treatment Decisions ◽  
Moral Authority ◽  
Psychological Continuity ◽  
Continuity Theory ◽  
Single Person ◽  
Over Time

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else.

Spotting a liar by looking for microexpressions: Challenges and Opportunities

2019 ◽  
Author(s):  
Xunbing Shen
Keyword(s):  
Empirical Evidence ◽  
Deception Detection ◽  
Empirical Studies ◽  
High Stake ◽  
Challenges And Opportunities ◽  
Cues To Deception ◽  
The Relationship

Microexpressions do exist, and they are regarded as valid cues to deception by many researchers, furthermore, there is a lot of empirical evidence which substantiates this claim. However, some researchers don’t think the microexpression can be a way to catch a liar. The author elucidates the theories predicting that looking for microexpressions can be a way to catch a liar, and notes that some data can support for the utilization of microexpressions as a good way to detect deception. In addition, the author thinks that the mixed results in the area of investigating microexpressions and deception detection may be moderated by the stake. More empirical studies which employ high-stake lies to explore the relationship between microexpressions and deception detection are needed.

Acquiring “Knowledge”—An Alternative Model

2017 ◽  
Author(s):  
Avner Baz
Keyword(s):  
Language Acquisition ◽  
Empirical Evidence ◽  
Alternative Model ◽  
Empirical Studies ◽  
First Language ◽  
Analytic Philosophy ◽  
Empirical Science ◽  
First Language Acquisition ◽  
Method Of Cases ◽  
Striking Fact

The chapter argues that empirical studies of first-language acquisition lend support to the Wittgensteinian-Merleau-Pontian conception of language as against the prevailing conception that underwrites the method of cases in either its armchair or experimental version. It offers a non-representationalist model, inspired by the work of Michael Tomasello, for the acquisition of “knowledge,” with the aim of showing that we could fully account for the acquisition of this and other philosophically troublesome words without positing independently existing “items” to which these words refer. The chapter also aims at bringing out and underscoring the striking fact that, whereas many in contemporary analytic philosophy regard and present themselves as open and attentive to empirical science, they have often relied on a conception of language that has been supported by no empirical evidence.

scholarly journals A Longitudinal Study of Retirement Transition and Advance Directive Completion

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 441-441
Author(s):  
Catheryn Koss
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Multinomial Logistic Regression ◽  
Statistical Significance ◽  
Optimal Time ◽  
Retirement Transition ◽  
Multistep Process ◽  
Study Participants ◽  
Retirement Study

Abstract Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of-life care. According to normative life course theory, retirement is a significant role change that signals a transition into the third age and its socially prescribed activities. To the extent that ACP is viewed as something to do when one reaches a more advanced stage in life, retirement may spark recognition that planning for incapacity and the end of life is now personally relevant and appropriate. This study tested whether transitioning from work to retirement prompted AD completion. The sample included Health and Retirement Study participants 65 and older who, in 2012, had no ADs and were not completely retired (N = 919). Retirement was operationalized as both a categorical status and as a multistep process. Three waves of data were analyzed using multinomial logistic regression to test associations between retirement transition and advance directive completion. By 2014, 21% had completed ADs and another 17% completed them by 2016. Those who completely retired between 2012 and 2014 were almost twice as likely to complete ADs between 2014 and 2016. Graduated increase in level of retirement between 2012 and 2014 was associated with higher odds of new AD possession in 2016, but did not reach statistical significance at p < .05. These results suggest the period following retirement may be an optimal time to encourage patients and clients who have not already done so to complete advance directives.

scholarly journals Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

2010 ◽  
Vol 2 (2) ◽  
pp. 278-282 ◽  
Author(s):  
Colleen Y. Colbert ◽  
Curtis Mirkes ◽  
Paul E. Ogden ◽  
Mary Elizabeth Herring ◽  
Christian Cable ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical School ◽  
Advance Directives ◽  
Advance Directive ◽  
Residency Program ◽  
Health Science ◽  
Science Center ◽  
Sufficient Knowledge ◽  
Significant Difference ◽  
School Curricula

Abstract Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n  =  32) and The University of Texas Medical School at Houston (n  =  27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

The Relationship Between Proof and Certainty in Mathematical Practice

2022 ◽  
Vol 53 (1) ◽  
pp. 65-84
Keyword(s):  
Empirical Evidence ◽  
Doctoral Students ◽  
Empirical Studies ◽  
Mathematical Practice ◽  
Advanced Mathematics ◽  
Mathematics Educators ◽  
The Relationship

Many mathematics educators believe a goal of instruction is for students to obtain conviction and certainty in mathematical statements using the same types of evidence that mathematicians do. However, few empirical studies have examined how mathematicians use proofs to obtain conviction and certainty. We report on a study in which 16 advanced mathematics doctoral students were given a task-based interview in which they were presented with various sources of evidence in support of a specific mathematical claim and were asked how convinced they were that the claim was true after reviewing this evidence. In particular, we explore why our participants retained doubts about our claim after reading its proof and how they used empirical evidence to reduce those doubts.

scholarly journals Diversity–disturbance relationships: frequency and intensity interact

2012 ◽  
Vol 8 (5) ◽  
pp. 768-771 ◽  
Author(s):  
Alex R. Hall ◽  
Adam D. Miller ◽  
Helen C. Leggett ◽  
Stephen H. Roxburgh ◽  
Angus Buckling ◽  
...  
Keyword(s):  
Species Diversity ◽  
Empirical Evidence ◽  
Empirical Studies ◽  
Ecological Theory ◽  
Intermediate Disturbance Hypothesis ◽  
Intermediate Disturbance ◽  
Disturbance Frequency ◽  
Theoretical Predictions ◽  
Experimental Populations ◽  
Disturbance Hypothesis

An influential ecological theory, the intermediate disturbance hypothesis (IDH), predicts that intermediate levels of disturbance will maximize species diversity. Empirical studies, however, have described a wide variety of diversity–disturbance relationships (DDRs). Using experimental populations of microbes, we show that the form of the DDR depends on an interaction between disturbance frequency and intensity. We find that diversity shows a monotonically increasing, unimodal or flat relationship with disturbance, depending on the values of the disturbance aspects considered. These results confirm recent theoretical predictions, and potentially reconcile the conflicting body of empirical evidence on DDRs.

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