The Value of Life at the End of Life: A Critical Assessment of Hope and other Factors

2011 ◽  
Vol 39 (2) ◽  
pp. 215-223 ◽  
Author(s):  
Paul T. Menzel
Keyword(s):  
End Of Life ◽  
Value Of Life ◽  
Critical Assessment ◽  
Remaining Life ◽  
Brute Fact ◽  
Inherent Part

“The thing about life is that one day you’ll be dead.” Indeed. But even total and honest acceptance of this brute fact about our relationship to death does not diminish the value we see in short remaining life at the end of life. Few just “give in” and no more fight for life because death is seen as an inherent part of life. They still invest small amounts of additional life with huge value. How high may that value plausibly be? What is the value of a relatively short extension of life when death is inevitably near?

Hospitalization burden and end-of-life (EOL) care in elderly patients with glioblastoma (GBM).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 31-31
Author(s):  
Laura Donovan ◽  
Donna Buono ◽  
Melissa Kate Accordino ◽  
Jason Dennis Wright ◽  
Andrew B. Lassman ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Elderly Patients ◽  
Marital Status ◽  
End Of Life ◽  
Remaining Life ◽  
Care Services ◽  
Palliative Care Services ◽  
Race Ethnicity ◽  
Eol Care

31 Background: GBM is associated with a poor prognosis and early death in elderly patients. Prior studies have demonstrated a high burden of hospitalization in this population. We sought to evaluate and examine trends in hospitalizations and EOL care in GBM survivors. Methods: Using SEER-Medicare linked data, we performed a retrospective observational cohort study of patients aged ≥ 65 years diagnosed with GBM from 2005-2017 who lived at least 6 months from the time of diagnosis. Aggressive EOL care was defined as: chemotherapy or radiotherapy within 14 days of death (DOD), surgery within 30 DOD, > 1 emergency department visit, ≥ 1 hospitalization or intensive care unit admission within 30 DOD; in-hospital death; or hospice enrollment ≤ 3 DOD. We evaluated age, race, ethnicity, marital status, gender, socioeconomic status, comorbidities, prior treatment and percentage of time hospitalized. Multivariable logistic regression was performed to determine factors associated with aggressive end of life care. Results: Of 5827 patients, 2269 (38.9%) survived at least 6 months. Among these, 1106 (48.7%) survived 6-12 months, 558 (24.6%) survived 12-18 months, and 605 (26.7%) survived > 18 months. Patients who survived 6-12 months had the highest burden of hospitalization and spent a median of 10.6% of their remaining life in the hospital compared to those surviving 12-18 months (5.4%) and > 18 months (3%) (P < 0.001). 10.1% of the cohort had claims for palliative care services; 49.8% of initial palliative care consults occurred in the last 30 days of life. Hospice claims existed in 83% with a median length of stay 33 days (IQR 12, 79 days). 30.1% of subjects received aggressive EOL care. Receiving chemo at any time (OR 1.510, 95% CI 1.221-1.867) and spending ≥ 20% of life in the hospital after diagnosis (OR 3.331, 95% CI 2.567-4.324) were associated with aggressive EOL care. Women (OR 0.759, 95% CI 0.624-0.922), patients with higher socioeconomic status (OR 0.533, 95% CI 0.342-0.829), and those diagnosed ≥ age 80 (OR 0.723, 95% CI 0.528-0.991) were less likely to receive aggressive EOL care. Race, ethnicity, marital status, and extent of initial resection were not associated with aggressive EOL care. Conclusions: A minority of elderly patients with GBM in the SEER-Medicare database survived ≥ 6 months; hospitalizations were common and patients spent a significant proportion of their remaining life hospitalized. Although hospice utilization was high in this cohort, 30% of patients received aggressive EOL care. Despite the aggressive nature of GBM, few patients had palliative care consults during their illness. Increased utilization of palliative care services may help reduce hospitalization burden and aggressive EOL care in this population.

An Approach to Engineering Critical Assessment of Assets That Cannot Be Inline Inspected

2018 ◽  
Author(s):  
Jing Ma ◽  
Michael Rosenfeld ◽  
Peter Veloo ◽  
Troy Rovella ◽  
Peter Martin
Keyword(s):  
Fracture Mechanics ◽  
Size Distribution ◽  
Defect Size ◽  
Critical Assessment ◽  
Remaining Life ◽  
Electric Resistance ◽  
Initial Defect ◽  
Pressure Testing ◽  
Resistance Weld ◽  
Defect Size Distribution

Hydrostatic pressure testing is the most widely accepted approach to verify the integrity of assets used for the transportation of natural gas. It is required by Federal Regulations 49 CFR §192 to substantiate the intended maximum allowable operating pressure (MAOP) of new gas transmission pipelines. The Pipeline and Hazardous Materials Safety Administration (PHMSA) Notice of Proposed Rulemaking (NPRM) with Docket No. PHMSA-2011-0023 [1], proposes an additional requirement for MAOP verification of existing pipelines that: i) do not have reliable, traceable, verifiable, or complete records of a pressure test; or ii) were grandfathered into present service via 49 CFR §192.619(c). To meet this requirement, the NPRM proposes that an Engineering Critical Assessment (ECA) can be considered as an alternative to pressure testing if the operator establishes and develops an inline inspection (ILI) program. The ECA must analyze cracks or crack-like defects remaining or that could remain in the pipe, and must perform both predicted failure pressure (PFP) and crack growth calculations using established fracture mechanics techniques. For assets that cannot be assessed by ILI, however, the implementation of an ECA is hindered by the lack of defect size information. This work documents a statistical approach to determine the most probable PFP and remaining life for assets that cannot be assessed by ILI. The first step is to infer a distribution of initial defect size accumulated through multiple ILI and in-ditch programs. The initial defect size distribution is established according to the as-identified seam type, e.g. low-frequency electric resistance weld (LF-ERW), high-frequency electric resistance weld (HF-ERW), flash weld (FW), single submerged arc weld (SSAW), or seamless (SMLS). The second step is to perform fracture mechanics assessment to generate a probabilistic distribution of PFPs for the asset. In conjunction with the defect size distribution, inputs into the calculation also include the variations of mechanical strength and toughness properties informed by the operator’s materials verification program. Corresponding to a target reliability level, a nominal PFP is selected through its statistical distribution. Subsequently applying the appropriate class location factor to the nominal PFP gives the operator a basis to verify their current MAOP. The last step is to perform probabilistic fatigue life calculations to derive the remaining life distribution, which drives reassessment intervals and integrity management decisions for the asset. This paper will present some case studies as a demonstration of the methodology developed and details of calculation and establishment of database.

The Attitudes, Needs, and Requirements at End of Life in the Republic of Georgia (Comparative Analysis of Groups of Patients With Cancer and Elders)

2018 ◽  
Vol 33 (4) ◽  
pp. 252-259
Author(s):  
Nana Chikhladze ◽  
Nino Tebidze ◽  
Tamar Chabukiani ◽  
Nana Chabukiani ◽  
Nikoloz Chkhartishvili ◽  
...  
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Bivariate Analysis ◽  
P Value ◽  
Fisher Exact Test ◽  
Remaining Life ◽  
Exact Test ◽  
Elderly Individuals ◽  
The People ◽  
The Republic

Introduction: In developing a model of palliative care, the attitudes, needs, and requirements of its beneficiaries recognizing the limited remaining life expectancy need to be met. We aimed to map and compare these issues at the end of life in the groups of patients with advanced cancer and elderly individuals. Materials and Methods: The prospective study based on the analysis of semistructured interviews was conducted. Fifty individuals aged older than 85 and 50 incurable patients with advanced cancer were studied. Transcripts of interviews were analyzed qualitatively (the interviews were divided into logically completed themes, and the compliance of each with one of the levels of Abraham Maslow pyramid was determined) and quantitatively (data comparisons of 2 groups were tested in bivariate analysis using Pearson χ2 or Fisher exact test. Two-sided significance tests were used; P value of <.05 was deemed significant). Results: It was assumed that 120 themes were relevant to a certain level of Maslow pyramid. Their comparison showed small differences in the narratives of the patients with advanced cancer and elderly individuals aged 85 and older—concerning the past, present, and future terms of lives. In studied themes explicitly prevail the stories that are consistent with satisfaction of the upper levels of the hierarchy of needs and demands of Maslow: social relation (belonging), love, esteem, and transcendence. Conclusion: The attitudes, needs, and requirements at the end of life of the people are basically similar, regardless of what determined the sense of limitation of the remaining life—incurable disease or advanced age.

The Cultural Context of End-of-Life Ethics: A Comparison of Germany and Israel

2010 ◽  
Vol 19 (3) ◽  
pp. 381-394 ◽  
Author(s):  
SILKE SCHICKTANZ ◽  
AVIAD RAZ ◽  
CARMEL SHALEV
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Cultural Context ◽  
Life Support ◽  
Value Of Life ◽  
Self Determination ◽  
One Dimensional ◽  
Cultural Perspectives ◽  
Social Facts ◽  
Patient’S Autonomy

End-of-life (EoL) decisions concerning euthanasia, stopping life-support machines, or handling advance directives are very complex and highly disputed in industrialized, democratic countries. A main controversy is how to balance the patient’s autonomy and right to self-determination with the doctor’s duty to save life and the value of life as such. These EoL dilemmas are closely linked to legal, medical, religious, and bioethical discourses. In this paper, we examine and deconstruct these linkages in Germany and Israel, moving beyond one-dimensional constructions of ethical statements as “social facts” to their conflicting and multifaceted embedding within professional, religious, and cultural perspectives.

The Value of Life and the Dignity of Persons

2017 ◽  
Author(s):  
William J. FitzPatrick
Keyword(s):  
End Of Life ◽  
Human Dignity ◽  
Human Subject ◽  
Human Life ◽  
Value Of Life ◽  
Human Organism ◽  
Sanctity Of Life ◽  
Ethical Discourse ◽  
Life Issues ◽  
End Of Life Issues

Ethical discourse about end-of-life issues tends to be framed in terms of both the value or “sanctity” of human life and the importance of human dignity. This chapter argues that the notion of human dignity is more fundamental than that of sanctity of life and defends a person-centered conception of both. Such an approach contrasts sharply with views focused primarily on respecting the sanctity of the life manifested in a person, or the value of her rational capacity, or the value of the continuation of the human organism associated with her against her wishes or even after she (as an embodied human subject) is gone. Such approaches all misidentify the locus and nature of the ethical value at issue.

scholarly journals Is “end of life” a special case? Connecting Q with survey methods to measure societal support for views on the value of life-extending treatments

2018 ◽  
Vol 27 (5) ◽  
pp. 819-831 ◽  
Author(s):  
Helen Mason ◽  
Marissa Collins ◽  
Neil McHugh ◽  
Jon Godwin ◽  
Job Van Exel ◽  
...  
Keyword(s):  
End Of Life ◽  
Survey Methods ◽  
Value Of Life ◽  
Special Case

scholarly journals Can there be wrongful life at the end of life? German courts revisit an old problem in a new context

2020 ◽  
Vol 46 (5) ◽  
pp. 348-350
Author(s):  
Ulrich Pfeifer ◽  
Ruth Horn
Keyword(s):  
End Of Life ◽  
Medical Decision Making ◽  
Federal Court ◽  
Value Of Life ◽  
Medical Professional ◽  
Medical Decision ◽  
Wrongful Life ◽  
Legal Questions ◽  
Life Sustaining Treatment ◽  
Nutrition And Hydration

This article discusses a recent ruling by the German Federal Court concerning medical professional liability due to potentially unlawful clinically assisted nutrition and hydration (CANH) at the end of life. This case raises important ethical and legal questions regarding a third person’s right to judge the value of another person’s life and the concept of ‘wrongful life’. In our brief report, we discuss the concepts of the ‘value of life’ and wrongful life, which were evoked by the court, and how these concepts apply to the present case. We examine whether and to what extent value-of-life judgements can be avoided in medical decision-making. The wrongful-life concept is crucial to the understanding of this case. It deals with the question whether life, even when suffering is involved, could ever be worse than death. The effects of this ruling on medical and legal practice in Germany are to be seen. It seems likely that it will discourage claims for compensation following life-sustaining treatment (LST). However, it is unclear to what extent physicians’ decisions will be affected, especially those concerning withdrawal of CANH. We conclude that there is a risk that LST may come to be seen as the ‘safe’ option for the physician, and hence, as always appropriate.

Excavating Value of Life Cycle Based Product Returns

2013 ◽  
Vol 726-731 ◽  
pp. 2681-2686
Author(s):  
Guang Yong Yang
Keyword(s):  
Life Cycle ◽  
End Of Life ◽  
Product Life Cycle ◽  
Negative Impact ◽  
Value Of Life ◽  
Value Evaluation ◽  
The Core ◽  
Product Return ◽  
Cost Efficient ◽  
Return Value

Ecologic environment is increasingly polluted, amount of green consumers are expanding, and more countries and governments have enacted and implemented environmental protection regulations to curb firms environmental negative impact. Based on product life cycle return perspective, we divide returns into three types: beginning of life return, end of use return and end of life return. Then, we analyze return value evaluation through law of conservation and conversion of energy. Our conclusions show for between beginning of life and end of use product return, educating consumers environmental conscious and responsive collection and resell returned products measures are the core ingredients. For after end of life product return, the best strategy is that firm collects and disposes in cost efficient measures replacing consumers direct disposal.

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

2019 ◽  
Vol 28 (3) ◽  
pp. 1356-1362
Author(s):  
Laurence Tan Lean Chin ◽  
Yu Jun Lim ◽  
Wan Ling Choo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Biopsychosocial Model ◽  
Family Members ◽  
Clinical Decisions ◽  
Goals Of Care ◽  
Complex Needs ◽  
Aspiration Risk ◽  
Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

End-of-Life Issues for People Who Use AAC

2005 ◽  
Vol 14 (3) ◽  
pp. 15-19 ◽  
Author(s):  
Melanie Fried-Oken ◽  
Lisa Bardach
Keyword(s):  
End Of Life ◽  
Life Issues ◽  
End Of Life Issues
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