The Impact of Personal Expectations on Counterfactual Thinking About Life and Death Medical Decisions

2006 ◽  
Vol 28 (1) ◽  
pp. 81-89
Author(s):  
Robert J. Wellman ◽  
David B. Sugarman
Keyword(s):  
Counterfactual Thinking ◽  
Medical Decisions ◽  
Life And Death ◽  
The Impact

Étude De La Fantasmatique De Patients Soumis À La Greffe Renale

1972 ◽  
Vol 17 (1) ◽  
pp. 11-15 ◽  
Author(s):  
J. C. Crombez ◽  
P. Lefebvre
Keyword(s):  
Body Image ◽  
Renal Transplantation ◽  
Clinical Outcome ◽  
Clinical Significance ◽  
Mental Representation ◽  
Body Part ◽  
Life And Death ◽  
Excretory Organ ◽  
Complex Phenomena ◽  
The Impact

This paper is part of an ongoing study of the psychiatric aspects of renal transplantation at Notre-Dame Hospital in Montreal, and deals specifically with the clinical significance of the patient's fantasies concerning the acquisition of a kidney. Fantasy material concerning the issues of life and death, the fantasies linking the acquired organ to libidinal drives and those concerning the impact of transplantation upon body image are examined. Patients defend against anxieties concerning living and dying by denial. Fantasies are described which suggest that transplantation is experienced on the genital level as a rephallicisation of doubtful outcome, following the castrative effect of the illness and hemodialysis. It was confirmed also that the archaic mental representation of the kidney was far more encompassing than that of a mere excretory organ, and thus the vicissitudes of the process of acceptance of the grafted body part appear as very complex phenomena which can have a bearing on clinical outcome.

scholarly journals Theoretical study of the impact of adaptation on cell-fate heterogeneity and fractional killing

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Julien Hurbain ◽  
Darka Labavić ◽  
Quentin Thommen ◽  
Benjamin Pfeuty
Keyword(s):  
Cell Fate ◽  
Stochastic Dynamics ◽  
Biochemical Networks ◽  
Stochastic Bifurcation ◽  
Modeling Framework ◽  
Life And Death ◽  
Cell Fate Decisions ◽  
Wide Range ◽  
Adaptation Response ◽  
The Impact

Abstract Fractional killing illustrates the cell propensity to display a heterogeneous fate response over a wide range of stimuli. The interplay between the nonlinear and stochastic dynamics of biochemical networks plays a fundamental role in shaping this probabilistic response and in reconciling requirements for heterogeneity and controllability of cell-fate decisions. The stress-induced fate choice between life and death depends on an early adaptation response which may contribute to fractional killing by amplifying small differences between cells. To test this hypothesis, we consider a stochastic modeling framework suited for comprehensive sensitivity analysis of dose response curve through the computation of a fractionality index. Combining bifurcation analysis and Langevin simulation, we show that adaptation dynamics enhances noise-induced cell-fate heterogeneity by shifting from a saddle-node to a saddle-collision transition scenario. The generality of this result is further assessed by a computational analysis of a detailed regulatory network model of apoptosis initiation and by a theoretical analysis of stochastic bifurcation mechanisms. Overall, the present study identifies a cooperative interplay between stochastic, adaptation and decision intracellular processes that could promote cell-fate heterogeneity in many contexts.

1 The Impact of No Next of Kin Decision Makers on End-of-life Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S4-S5
Author(s):  
Ryan K Ota ◽  
Maxwell B Johnson ◽  
Trevor A Pickering ◽  
Warren L Garner ◽  
Justin Gillenwater ◽  
...  
Keyword(s):  
Critically Ill ◽  
Decision Maker ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Next Of Kin ◽  
Medical Decisions ◽  
Comfort Care ◽  
Burn Care ◽  
The Impact

Abstract Introduction For critically ill burn patients without a next of kin (NOK), the medical team is tasked with becoming the surrogate decision maker. This poses difficult ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a NOK affects treatment in burn patients. This study is the first to evaluate this relationship. Methods A retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care from a single burn center from 2015 to 2019. Inclusion criteria were age ≥18 years and mortality within 4-weeks of admission. Exclusion criteria were death from dermatologic disease or trauma. Variables collected included age, gender, mechanism of injury, length of stay (LOS), total body surface area (TBSA), revised Baux score, and the presence of a NOK. Fisher’s Exact Test and Student’s t-test were used for analysis. Results In total, 67 patients met inclusion criteria. Of these patients, 14 (21%) did not have a NOK involved in medical decisions. Table 1 shows the means and odds ratio between the two groups. Patients without a NOK were younger (p < 0.05), more likely to be homeless (p < 0.01), had higher TBSA (p < 0.01), had shorter LOS (p < 0.01), and were 5 times less likely to receive comfort care (p < 0.05). Gender and ethnicity were not statistically significant. Conclusions Patients without a NOK present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care between the two groups demonstrates a need for a cultural shift in burn care to prevent suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present. Applicability of Research to Practice We report that the absence of a NOK has a significant impact leading to a decreased initiation of comfort care in critically ill burn patients. National protocols should be created to allow burn providers to act as a surrogate to prevent prolonged suffering.

scholarly journals The Impact of Firefighter Physical Fitness on Job Performance: A Review of the Factors That Influence Fire Suppression Safety and Success

Safety ◽  
2018 ◽  
Vol 4 (4) ◽  
pp. 60
Author(s):  
Cody Morris ◽  
Harish Chander
Keyword(s):  
Human Body ◽  
Physiological Stress ◽  
Fire Suppression ◽  
Maximal Aerobic Capacity ◽  
Life And Death ◽  
Workload Capacity ◽  
Body Design ◽  
Physiological Impact ◽  
High Degree ◽  
The Impact

Purpose: The objective of this review was to analyze the physiological impact of fire suppression on the human body. Design: The literature review included studies focused on workload requirements for common firefighting tasks, effect of health status on the firefighting profession, and attempts to establish a minimum physiological workload capacity for successful performance of firefighting. Findings: The existing literature provides evidence of the high degree of physiological stress that firefighters are under during fire suppression tasks and the great degree of maximal physical capacity that firefighting often requires. Firefighters often operate close to maximal aerobic capacity while performing tasks common to the profession. This is especially true due to the added physiological stress placed on the human body while wearing personal protective equipment during firefighting. Conclusions: Future investigations are necessary to further explore markers of physiological stress during firefighting and the impact that it may have on the ability to withstand the development of disease as well as fire suppression safety. Using completion time of fire suppression tasks as a criterion of success may be an important consideration in addition to the physiological requirements of the occupation when assessing the appropriateness of an individual to be a firefighter. An important future consideration is the effect that fire suppression activities may have on reaction time in critical situations in which life-and-death decisions must be made.

Refusing Life-Sustaining Treatment after Catastrophic Injury: Ethical Implications

1996 ◽  
Vol 24 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Tia Powell ◽  
Bruce Lowenstein
Keyword(s):  
Competent Patient ◽  
Life And Death ◽  
Ethical Implications ◽  
Catastrophic Injury ◽  
Capacity Evaluation ◽  
Decision Making Capacity ◽  
Life Sustaining Treatment ◽  
Life Circumstances ◽  
The Impact ◽  
Real Patients

In theory, a competent patient may refuse any and all treatments, even those that sustain life. The problem with this theory, confidently and frequently asserted, is that the circumstances of real patients may so confound us with their complexity as to shake our confident assumptions to their core.For instance, it is not the case that one may always and easily know which patients are competent. Indeed, evaluation of decision-making capacity is notoriously difficult. Not only may reasonable and experienced evaluators, say a judge and a psychiatrist, disagree, but also a person's capacity may change from hour to hour and may extend to some decisions yet not to others. And yet it is on this subtle art of capacity evaluation that life and death decisions often turn, especially when patients decline life-sustaining treatment.An evaluation of capacity may consider the impact of serious medical or psychiatric illness, as well as the patient's life circumstances.

The Public Debate on Life and Death Choices: A Response from a Jewish Hospital Chaplain

2000 ◽  
Vol 54 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Phyllis Brooks Toback
Keyword(s):  
Meaning In Life ◽  
Oral Tradition ◽  
Hospital Chaplain ◽  
Life And Death ◽  
The Public ◽  
Modern Times ◽  
Jewish Hospital ◽  
The Impact ◽  
Different Levels

Addresses the issue of life and death choices from the perspective of a Jewish chaplain. Explores the tension between the law ( Halachah) and experience or story ( Aggadah) and the impact of that tension on lives and decisions. Cites persons and situations from biblical material, oral tradition, and modern times which illustrate the human struggle with these disputed issues. Explores different levels of pain and our understanding of and response to suffering. Invites reflection on the range of responses to pain that are humanly possible. Illustrates how meaning in life nurtures the desire to live. Claims this meaning aspect is not adequately addressed in the current dialogue. Focusses on the role of chaplains in listening and responding to persons and in helping to activate the impulse of hope. Suggests ways in which chaplains can be advocates for patients, prophetic voices within communities and institutions, and empowering of the gifts of others.

scholarly journals The Struggle Between Life and Death: A Case Study of Panapur Flood, District Saran, Bihar, India

2021 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Women Elderly ◽  
Anthropogenic Activities ◽  
Survey Result ◽  
Sampling Techniques ◽  
Wild Animals ◽  
Life And Death ◽  
Wild Pigs ◽  
History Of ◽  
The Impact

The flood is one of the natural calamities that are the outcome of anthropogenic activities by humans. It is largely defined as the overflow of water on normally dry ground. The most common reasons are overflowing of river in short span of time, breaking of dam, or heavy rainfall. The most deadly flood that occurred in the history of Panapur is the flood of 2020 which worsened the condition of the native inhabitants. The most fragile section of society was pregnant women, elderly people, children and animals. The local inhabitants experienced fear of death from very close, submerging of houses in water, rampant rainfall, snake biting, lack of drinking water and food worked as the catalyst in worsening the condition. There was the rampant destruction not only of infrastructure but also of the wildlife. Large chunk of population lost their animals in the furious flood. Dear, pig, snake, and many other wild animals washed away from the forests of Nepal to Panapur block during flood. Many wild animals lost their lives in this nature’s fury, villagers somehow managed to save lives of eight floating dear and 32 wild pigs. People left from different corona infected state to take shelter in native village in month of April and May were left disillusioned due to the flood of July 2020. As officially reported eight people washed away and died during flood. The further unrest came when the prices of fodder surged up to 14/kg. This paper studies the impact of flood on inhabitants of Panapur block, Saran district, Bihar, India. This study is based on primary survey using sampling techniques. Six villages have been selected for survey. Result have been analysed and it was found that people lost their economy, crop, shelter, pet animals, forest, dignity and humanity. They are left under the utter disillusionment. They became homeless, helpless, hopeless and health less.

Becoming Ray Bradbury

2011 ◽  
Author(s):  
Jonathan R. Eller
Keyword(s):  
Human Mind ◽  
Human Condition ◽  
Early Years ◽  
Life And Death ◽  
American Writer ◽  
Long Life ◽  
The Impact ◽  
Private Collections ◽  
Insight Into ◽  
The Human Condition

This book chronicles the making of an iconic American writer by exploring Ray Bradbury's childhood and early years of his long life in fiction, film, television, radio, and theater. It measures the impact of the authors, artists, illustrators, and filmmakers who stimulated Ray Bradbury's imagination throughout his first three decades. This biography follows Bradbury's development from avid reader to maturing author, making a living writing for the genre pulps and mainstream magazines. Unprecedented access to Bradbury's personal papers and other private collections provides insight into his emerging talent through his unpublished correspondence, his rare but often insightful notes on writing, and his interactions with those who mentored him during those early years. They also provide insight into his very conscious decisions, following the sudden success of The Martian Chronicles and The Illustrated Man, to voice controversial political statements in his fiction. The book illuminates the sources of Bradbury's growing interest in the human mind, the human condition, and the ambiguities of life and death—themes that became increasingly apparent in his early fiction. It elucidates the complex creative motivations that yielded Fahrenheit 451. Revealing Bradbury's emotional world as it matured, the book highlights the emerging sense of authorship at the heart of his boundless creativity.

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