Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.

Electrophysiological constituents of the P100 and N170 ERP complex: De-constructing of face processing using independent component analysis and robust estimation.

The initial timing of face-specific effects in event-related potentials (ERPs) is a point of contention in face processing research. Although effects during the time of the N170 are robust in the literature, inconsistent effects during the time of the P100 challenge the interpretation of the N170 as being the initial face-specific ERP effect. The interpretation of the early P100 effects are often attributed to low-level differences between face stimuli and a host of other image categories. Research using sophisticated controls for low-level stimulus characteristics (Rousselet, Husk, Bennett, & Sekuler, 2008) report robust face effects starting at around 130 ms following stimulus onset. The present study examines the independent components (ICs) of the P100 and N170 complex in the context of a minimally controlled low-level stimulus set and a clear P100 effect for faces versus houses at the scalp. Results indicate that four ICs account for the ERPs to faces and houses in the first 200ms following stimulus onset. The IC that accounts for the majority of the scalp N170 (icNla) begins dissociating stimulus conditions at approximately 130 ms, closely replicating the scalp results of Rousselet et al. (2008). The scalp effects at the time of the P100 are accounted for by two constituent ICs (icP1a and icP1b). The IC that projects the greatest voltage at the scalp during the P100 (icP1a) shows a face-minus-house effect over the period of the P100 that is less robust than the N 170 effect of icN 1 a when measured as the average of single subject differential activation robustness. The second constituent process of the P100 (icP1b), although projecting a smaller voltage to the scalp than icP1a, shows a more robust effect for the face-minus-house contrast starting prior to 100 ms following stimulus onset. Further, the effect expressed by icP1 b takes the form of a larger negative projection to medial occipital sites for houses over faces partially canceling the larger projection of icP1a, thereby enhancing the face positivity at this time. These findings have three main implications for ERP research on face processing: First, the ICs that constitute the face-minus-house P100 effect are independent from the ICs that constitute the N170 effect. This suggests that the P100 effect and the N170 effect are anatomically independent. Second, the timing of the N170 effect can be recovered from scalp ERPs that have spatio-temporally overlapping effects possibly associated with low-level stimulus characteristics. This unmixing of the EEG signals may reduce the need for highly constrained stimulus sets, a characteristic that is not always desirable for a topic that is highly coupled to ecological validity. Third, by unmixing the constituent processes of the EEG signals new analysis strategies are made available. In particular the exploration of the relationship between cortical processes over the period of the P100 and N170 ERP complex (and beyond) may provide previously unaccessible answers to questions such as: Is the face effect a special relationship between low-level and high-level processes along the visual stream?