The recent Minnesota case of In re Emergency Guardianship of Albert Barnes illustrates an emerging class of cases where a dispute between a family proxy and a hospital over “medical futility” requires legal resolution. The case was further complicated by the patient’s spouse who fraudulently claimed to be the patient’s designated health care proxy and who misrepresented the patient’s previously expressed treatment preferences. Barnes demonstrates the degree of significant administrative and institutional support to the health care team, ethics consultants, and (...) futility committees that is required when a futility dispute escalates to the need for judicial resolution. An institutional futility policy, especially one that is endorsed by other regional medical centers and organizations, is an important foundation for a hospital that seeks judicial support in a dispute over medical futility in end of life care. (shrink)

Futility disputes are increasing and courts are slowly abandoning their historical reluctance to engage these contentious issues, particularly when confronted with inappropriate surrogate demands for aggressive treatment. Use of the judicial system to resolve futility disputes inevitably brings media attention and requires clinicians, hospitals, and families to debate these deep moral conflicts in the public eye. A recent case in Minnesota, In re Emergency Guardianship of Albert Barnes, explores this emerging trend and the complex responsibilities of clinicians and hospital administrators (...) seeking to replace an unfaithful surrogate demanding aggressive therapy. Use of the courts requires the coordinated commitment of significant institutional resources, management of intense media scrutiny and individual and organizational courage to enter the unpredictable world of litigation. Given the dearth of legislative guidance on medical futility, individual clinicians and institutions will continue to bear the difficult responsibility for resolution of individual futility disputes. The Barnes case illustrates how one institution successfully used the judicial system to replace an unfaithful surrogate, cease the provision of inappropriate aggressive care, and stimulate a community dialogue about appropriate care at the end of life. (shrink)

The integrative memory model combines five core memory systems with an attributional system. We agree with Bastin et al. that this melding is the most novel aspect of the model. But we await further evidence that the model's substantial complexity informs our understanding of false memories or of the development of recollection and familiarity.

The Deese/Roediger–McDermott paradigm has been used extensively to examine false memory. During the study session, participants learn lists of semantically related items, referred to as targets. Critical lures are items which are also associated with the lists but are intentionally omitted from study. At test, when asked to remember targets, participants often report false memories for critical lures. Findings from experiments using the DRM show the ease with which false memories develop in the absence of suggestion or misinformation. Given this, (...) it is important to examine factors which influence the generalizability of the findings. One important factor is the persistence of false memory, or how long false memories last. Therefore, we conducted a systemic review to answer this research question: What is the persistence of false memory for specific items in the DRM paradigm? To help answer this question our review had two research objectives: to examine the trajectory of target memory and false memory for critical lures and to examine whether memory for targets exceeded false memory for critical lures. We included empirical articles which tested memory for the same DRM lists with at least two testing sessions. We discuss the results with respect to single-session delays, long-term memory recall and recognition, remember and know judgments for memory, and the effect of development, valence, warning, and connectivity on the trajectory of memory. Overall, the trajectory of targets showed a relatively consistent pattern of decrease across delay. The trajectory of critical lures was inconsistent. The proportion of targets versus critical lures across delay was also inconsistent. Despite the inconsistencies, we conclude that targets and critical lures have a dissimilar trajectory across delay and that critical lures are more persistent than targets. The findings with respect to long-term recall and recognition are consistent with both Fuzzy Trace Theory and Associative-Activation Theory of the DRM effect. The generation of false memory with brief delays is better explained by Associative-Activation Theory. Examining the connectivity between target items, and critical lures, and the effect that has during study and retrieval, can provide insight into the persistence of false memory for critical lures. (shrink)