Entire Transcript in Adobe Acrobat Format - National Reference ...
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257 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 them and you will be the one who is in a position to say they are able to understand the kinds of things I would be raising or not understanding it. I do not think we have to anticipate the -- but you are absolutely right. The notion of a therapeutic misconception or therapeutic confusion that arises is pervasive in human subjects research and it is probably particularly an issue with long-term relationships and particularly in relationships where there are difficulties in mental processes. DR. CHILDRESS: Diane gets the last word and then we will turn it over to Harold. We might even get in a three or four minute break here. DR. SCOTT-JONES: I just wanted to point out that on page nine and ten of the report there is a pretty good discussion of -- I am sorry. There is a good discussion of varieties in decision making impairment. I think the problem is that when we get to recommendations we lose this complexity and we make the population homogeneous again. But here the various elements that are important, including the situation itself, the particular decisions to be made, all of that is laid out here pretty well. What we need to do is to find some way to incorporate this into the recommendation and not lose these distinctions.
258 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 DR. CHILDRESS: Okay. Arturo wants to stick in one quick work. DR. BRITO: I had been raising my hand here but you could not see me. I was going to make reference to the same page, page nine, but even there the terminology is tough because I think varieties itself has a lot of implementations. A suggestion that I was going to bring up tomorrow actually because I thought it was more detailed but since we are on the topic, to refer to this section as different or differing levels of decision making ability, and then within that Jonathan, I thought, did a good job talking about the fluctuating ability and the prospective incapacity. But there is one missing here and that is progressive incapacity and progressive prospective incapacity. You refer to Alzheimer's as a perspective but it is really a progressively prospective. He does discuss under the first paragraph of chapter X where it becomes more complicated because someone put along the two or more of the categories. So I thought it was already addressed and just changing a few of the words around. But you are right, at the end we need to readdress it. DR. CHILDRESS: Good. We will work on this
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them and you will be the one who is <strong>in</strong> a position to say<br />
they are able to understand the k<strong>in</strong>ds of th<strong>in</strong>gs I would be<br />
rais<strong>in</strong>g or not understand<strong>in</strong>g it.<br />
I do not th<strong>in</strong>k we have to anticipate the -- but<br />
you are absolutely right. The notion of a therapeutic<br />
misconception or therapeutic confusion that arises is<br />
pervasive <strong>in</strong> human subjects research and it is probably<br />
particularly an issue with long-term relationships and<br />
particularly <strong>in</strong> relationships where there are difficulties<br />
<strong>in</strong> mental processes.<br />
DR. CHILDRESS: Diane gets the last word and<br />
then we will turn it over to Harold. We might even get <strong>in</strong><br />
a three or four m<strong>in</strong>ute break here.<br />
DR. SCOTT-JONES: I just wanted to po<strong>in</strong>t out<br />
that on page n<strong>in</strong>e and ten of the report there is a pretty<br />
good discussion of -- I am sorry. There is a good<br />
discussion of varieties <strong>in</strong> decision mak<strong>in</strong>g impairment. I<br />
th<strong>in</strong>k the problem is that when we get to recommendations we<br />
lose this complexity and we make the population homogeneous<br />
aga<strong>in</strong>. But here the various elements that are important,<br />
<strong>in</strong>clud<strong>in</strong>g the situation itself, the particular decisions to<br />
be made, all of that is laid out here pretty well. What we<br />
need to do is to f<strong>in</strong>d some way to <strong>in</strong>corporate this <strong>in</strong>to the<br />
recommendation and not lose these dist<strong>in</strong>ctions.