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The quality of relationships with clinicians during acute admission appears to be an important determinant of patients' attitudes toward treatment and adherence to medication. Enhancing such relationships may yield important clinical benefits.

Preliminary support was found for the hypotheses, but further studies are required using a range of executive, attentional, ToM, and attribution measures.

The idea of a philosophy of palliative care emerged with Cicely Saunders' vision for ‘a good death’, and was developed further with the World Health Organization (WHO) definition of palliative care. It is now being applied not only to cancer patients, but to all patients in end-of-life situations. As this palliative care approach advances, it is important to pause and comment on its effectiveness. It is a philosophy of patient care, and is therefore open to critique and evaluation. Using the Oxford Textbook of Palliative Medicine, 3rd edition as their basic reference, the authors present their argument that the palliative care approach has become too busy and over-professionalised, and that it therefore has significant weaknesses. They examine the framework of the specialty – quality of life, autonomy, dignity, patient-centredness, and the priority assigned to relatives in the remit of care – and the moral problems associated with implementing such a philosophy. The resource implications of various healthcare policies are also discussed in relation to the WHO definition. Whilst the authors defend the achievements of palliative care and those who work in the profession, they present suggestions for an alternative philosophy that prompts many ethical and philosophical questions about the future of palliative care.

Qualitative research accompanying trials illuminates and adds to the quantitative outcomes. The key to interpreting participants' accounts of the process and outcomes of this trial suggests the need to give greater emphasis to participants' past and current experience of service contact.

Research into the nature of attributional reasoning in paranoia has for the most part been restricted to questionnaire-based approaches. This fails to address the issue of whether a distinctive attributional style underpins the everyday talk of paranoid individuals. This study aimed to investigate whether attributional models of paranoid delusions applied to spontaneous attributions generated in the discourse of 12 paranoid and 12 non-paranoid speakers. Causal attributions for negative and positive life experiences were extracted from interview transcripts and rated using the Content Analysis of Verbatim Explanations (CAVE) technique. It was found that, as a proportion, paranoids made more attributions for negative events that were of an external-personal, stable and global nature (as attributional models would predict). They also made significantly more external-personal attributions for negative events and, in one of two datasets, showed a more external mean CAVE rating for negative events than the non-paranoid controls. This paper highlights important issues underlying the extraction of attributions from paranoid talk, and discusses the implications for attributional models of paranoia and future discourse-based research in this area.

The treatment decisions of competent adults, especially treatment refusals, are generally respected. In the case of minors something turns on their age, and older minors ought increasingly to make their own decisions. On the other hand, parents decide on behalf of infants and young children. Their right to do so can best be justified in terms of the importance of preserving intimate family relationships, rather than in terms of the child's best interests, although the child's best interests will most often follow from this arrangement. Nevertheless, there are and ought to be legal, ethical, and financial constraints on parental decision making.

-Decisions about cardiopulmonary resuscitation (CPR) continue to cause difficulties for healthcare professionals. Current UK guidelines provide information on the underlying principles, but do not include a clear decision framework. The resulting confusion about when and who to ask about CPR can result in an inappropriate burden being placed on patients, partners or families. A simple clinical decision framework is presented, together with the underlying principles. This framework is offered as an aid for clinicians and patients in understanding the current ethical, clinical and legal guidance on decisions about CPR. KEY WORDS: algorithm, cardiopulmonary resuscitation, clinical decisions, hospice care, learning disability, palliative care, terminal careCardiopulmonary resuscitation (CPR) is a lifeprolonging treatment, and decisions about CPR should be made according to the same principles and process as other life-prolonging treatments. Two important factors affect decisions about CPR at the time of the cardiorespiratory arrest. The first is that there is little time available for any deliberation since, if CPR is to be successful, it is imperative that it is started immediately. The second is that a collapsed patient lacks the capacity to consent to or refuse CPR. The combination of these two factors has led to the development of policies designed to make the decision about CPR in advance of the event. These are often referred to as deciding 'resuscitation status' or making a 'Do Not Attempt to Resuscitate (DNAR)' decision. The idea behind such policies is to make a CPR treatment decision when there is time for deliberation about the benefit, harms and risks of CPR, and to ascertain in advance whether the patient would wish to consent to or refuse CPR. When the patient is involved, the resulting decision is an 'advance decision' , sometimes also referred to as an 'advance statement,' 'advance directive' or 'living will' .Unfortunately, the apparently simple idea of making advance decisions regarding CPR has proved extremely difficult to implement in practice. There are several reasons for this difficulty.• There is a reluctance to appreciate that, as with other life-prolonging treatments, the justification for attempting resuscitation rests on a reasonable balance of benefit to harms and risks.• There is an obvious difficulty in making a decision about CPR treatment in advance of any knowledge about the clinical circumstances in which the future cardiorespiratory arrest will arise. This leaves professionals unable to ascertain the balance of benefit to harms and risks of CPR when the arrest occurs.• There is confusion about the role of the patient, partner or relatives in the decision.• There is a lack of appreciation by both patients and professionals that an advance decision about CPR should be implemented under the same principles, and ethical and legal guidance, as any other advance statement. Case examples illustrating confusion in clinical practiceA These case studies are based on true situations...