Psychosocial versus biomedical risk factors in Kevorkian's first forty-seven physician-assisted deaths

This article examines biomedical and psychosocial data on the first forty-seven cases of physician-assisted suicide (PAS) of Kevorkian as collected by means of both a physical autopsy and a preliminary psychological autopsy. The following patterns emerge: 1) The physical condition of these PAS patients was not typical of the conditions that lead to death in the United States. 2) Consistent with the above findings, our pilot data indicate that only 31.1 percent of these patients were terminal. While 73.9 percent were described as reporting pain, only 42.6 percent were revealed at autopsy to have a specific anatomical basis for their pain. However 36 percent were described as depressed, 66 percent as having some disability, and perhaps of key importance, 90 percent expressed a fear of dependency. Most important, our pilot data suggest the possibility of large gender differences, since 3) 68.1 percent of these forty-seven PAS's are women and only 31.9 percent are men. This represents the reverse of the gender pattern for completed suicides in the United States in 1995, resembling instead the approximate pattern for unsuccessful suicide attempts. 4) Approximately 75 percent of both men and women in the above sample were described as reporting pain. Men were almost twice as likely to have had an anatomical basis for the pain and three times as likely to be terminal. Our pilot data indicate PAS women are more likely to be described as depressed and twice as likely to have had a history of previous unsuccessful suicide attempts. 5) Kevorkian's patients were older than the typical unaided suicides in America. Reported pain decreases with age as does depression; however anatomical basis for pain increases slightly with age, and no age effect emerges for terminality. 6) Approximately two-thirds of those physician-assisted suicides were at middle SES levels. History of disability was the biggest risk factor for the low SES patients and fear of dependency for the high SES patients.     

Researching "good death" in a Hong Kong palliative care program: a clinical data-mining study

This study operationalizes and assesses the percentage of "good deaths" achieved among Chinese cancer patients in a palliative care program, the profile of these patients, the relationship between patients with a good death and psychosocial factors, and the differences in background factors, and physical and psychosocial conditions between patients who experienced a good death and those who did not. Clinical data mining was the research method used. Records of deceased cancer patients between 2003 and 2005 in a palliative care unit were the sole data source. Good death was operationally defined as the patient's record indicating no pain (physical) or anxiety (psychological), and having open and honest communication with family (social) in the final assessment by the Support Team Assessment Schedule (STAS) just before death. Using these criteria, about one-fifth of patients (21.5%; 137 out of 638) experienced a good death. Those with a good death were significantly older and were in palliative care longer. Their records also indicated lower levels of constipation, insomnia, oral discomfort, and family anxiety at their first and at their final STAS assessments. Good death was positively associated with recorded indicators of fullness in life, caregivers' acceptance and support, and negatively with reported feelings of upset about changes in the course of their illness. The results heighten awareness among social workers and other healthcare professionals about the value of good death in patients in palliative care. This empirically-based awareness can foster professionals' ability to set intervention objectives to help patients in palliative care achieve this universally accepted goal.     

What Risks Do People Perceive in Everyday Life? A Perspective Gained from the Experience Sampling Method (ESM)

The experience sampling method (ESM) was used to collect data from 74 part-time students who described and assessed the risks involved in their current activities when interrupted at random moments by text messages. The major categories of perceived risk were short term in nature and involved "loss of time or materials" related to work and "physical damage" (e.g., from transportation). Using techniques of multilevel analysis, we demonstrate effects of gender, emotional state, and types of risk on assessments of risk. Specifically, females do not differ from males in assessing the potential severity of risks but they see these as more likely to occur. Also, participants assessed risks to be lower when in more positive self-reported emotional states. We further demonstrate the potential of ESM by showing that risk assessments associated with current actions exceed those made retrospectively. We conclude by noting advantages and disadvantages of ESM for collecting data about risk perceptions.     

Gender and physician-assisted suicide: an analysis of the Kevorkian cases, 1990-1997

This study examines the seventy-five suicide cases Dr. Jack Kevorkian acknowledged assisting during the period between 1990-1997. Although these cases represent a range of regional and occupational backgrounds, a significant majority are women. Most of these individuals had a disabling, chronic, nonterminal-stage illness. In five female cases, the medical examiner found no evidence of disease whatsoever. About half of the women were between the ages of forty-one and sixty, and another third were older adults. Men's conditions were somewhat less likely than women's to be chronic and nonterminal-stage. The main reasons for the hastened death mentioned by both the person and their significant others were having disabilities, being in pain, and fear of being a burden. The predominance of women among Kevorkian's assisted suicides contrasts with national trends in suicide mortality, where men are a clear majority. It is possible that individuals whose death was hastened by Kevorkian are not representative of physician-assisted suicide cases around the country, because of Kevorkian's unique approach. Alternatively, the preponderance of women among Kevorkian's assisted suicides may represent a real phenomenon. One possibility is that, in the United States, assisted suicide is particularly acceptable for women. Individual, interpersonal, social, economic, and cultural factors encouraging assisted suicide in women are examined.     

Crisis management in education: Human and legal concerns

This hypothetical situation, set in a school district which many would consider successful, posits a situation where a well-established science teacher is accused of non-professional conduct. The administration is in a dilemma. Two of the three mayors of the school district are demanding his dismissal. Several parents are concerned at the behavior of the teacher in class. The reputation of the teacher for preparing his students for the Advanced Placement examination in Biology, however, is legendary. He is constantly visited by ex-students who have been successful in the world, and consider him to be a major reason for that achievement. The law is established to serve the legitimate ends of society, to handle conflict in a structured and accepted way, and to provide reasonable solutions to difficult problems. In this situation, it is claimed that the law not only serves the interests of the district, but also of the accused teacher and his students. It is further claimed that without enforcing the law—deciding not to do anything—would result in a problem immeasurably bigger and more difficult to control.     

Quality insights of university students on dying, death, and death education--a preliminary study in Hong Kong

Death is a subject seldom studied in school and often misunderstood and feared by many people. Children often learn about death from their family and mass media. From the literature review on dying, death, and death education, it may be concluded that people are generally ignorant about the issues of death and dying. There is a need to investigate what young people, such as university students, know about death and dying, and their attitudes toward them. Eight university students were recruited for this study. Most participants have had death experiences. They seldom talked about death and loss. Some of these experiences were quite pleasant but some of them were not. Most participants addressed the need to have "life and death" education in schools at their young age. Such a need is further supported by the incidents of two participants who attempted suicide unsuccessfully when they encountered a life problem which they could not solve.     

Death: the ultimate social construction of reality

Using Berger and Luckmann's thesis (1966) on the social construction of reality as rationale, this research analyzes the death drawings of 946 university students enrolled in a Death and Dying course between 1985 and 2004 to investigate the basic constructs elicited by the word "death": dying, moment of death, after death, after life, and bereavement. Consistent with earlier research, gender, race, religion, and religiosity proved to be significant factors. As expected, personal experience with grief was strongly correlated with drawings focused on bereavement. In contrast to earlier studies, fear of death was not significantly related to a particular construct. Implications for research, education, and counseling are discussed.     

The role of attribution in how followers respond to the emotional expression of male and female leaders

We investigated how leaders' gender interacts with anger and sadness expression and followers' attributions for their emotional expression on evaluations made by followers. In a laboratory study concerning hypothetical leaders, people evaluated the competence of male and female leaders differently depending on their emotional displays (anger vs. sadness). These differences were observed only when observers made high dispositional attributions for leaders' emotional expression. Perceived leader role-based emotional expression mediated these relationships. In a field study concerning actual leaders, dispositional attributions for sadness and anger expression were negatively related to follower perceptions of the leader, and these attributions moderated the relationships between leader gender and various follower perceptions of the leader. Leader prototype fit mediated these relationships. We discuss the implications of these findings for leadership research and practice.     

Deathbed visions from India: a study of family observations in northern Kerala

This is an interview-based study of 104 families and their observations of the last weeks and days of a dying family member. Forty families reported "unusual experiences and behaviors" from the dying person in their last period of life. Thirty of these dying persons displayed behavior consistent with deathbed visions-interacting or speaking with deceased relatives, mostly their dead parents. There were six cases of reported premonitions of death and five possible confusional states with one patient reported to have had both a deathbed vision and confusional experiences. Socio-demographic factors such as gender, age, occupation, or cause and place of death were not found to be significant. Hindu patients appeared to be more likely than Muslim patients to report these experiences. Use of opiates (or not) did not appear to influence reports. The findings are discussed with reference to past studies of deathbed visions as well as their implications for the future pastoral care of dying people and their families.     

CWD Prevalence,Perceived Human Health Risks,and State Influences on Deer Hunting Participation

This study examined factors predicted by previous research to influence hunters’ decisions to stop hunting deer in a state. Data were obtained from mail surveys of resident and nonresident deer hunters in Arizona, North Dakota, South Dakota, and Wisconsin (n = 3,518). Hunters were presented with six scenarios depicting hypothetical CWD prevalence levels and human health risks from the disease (e.g., death), and asked if they would continue or stop hunting deer in the state. Bivariate analyses examined the influence of five predictor variables: (a) CWD prevalence, (b) hypothetical human death from CWD, (c) perceived human health risks from CWD, (d) state, and (e) residency. In the bivariate analyses, prevalence was the strongest predictor of quitting hunting in the state followed by hypothetical human death and perceived risk. The presence of CWD in a state and residency were weak, but statistically significant, predictors. Interactions among these predictors increased the potential for stopping hunting in the state. Multivariate analyses suggested that 64% of our respondents would quit hunting in the worst‐case scenario.     

Through the touch of god: child death and spiritual sustenance in a Hutterian colony

Nestled in more than 5,000 acres of farmland in rural South Dakota, one Hutterian colony flourishes with more than 23 families and a population of 115 people. Very little is known about the ways in which Hutterites experience traumatic infant and child death on the colony. No research studies to date have explored this topic. This is an ethnographic study that utilized extended observations of the group and both individual and group interviewing in order to create a cultural portrait specifically focusing on Hutterites experiencing traumatic child death. Observations were organized into five thematic categories: 1) details of the actual death experience; 2) emotional and physical reactions to the loss; 3) familial and communal response; 4) coping and rituals; and 5) spirituality. The role of communal mourning, ritualization, and spirituality in creating a healing milieu for bereaved families is discussed.     

Varying Risk Comparison Elements: Effects on Public Reactions

Expanding a limited empirical base on effects of risk comparisons, a pilot experiment explored how varying elements of such comparisons might influence public response. The scenario used was a hypothetical trial of an asbestos-installing firm for putting students and staff at a junior high school at "unreasonable risk," first used by Slovic et al. (1990). Study participants played the role of jurors in the trial, asked to rate the risk, the firm's guilt, whether it should be made liable for future health effects, whether the school should be occupied in its current condition, and whether the asbestos should be removed at a cost of 3 million dollars. Opportunity samples of New Jersey residents (n= 309) received information intended to vary four comparison attributes: number of dimensions of comparison; single versus multiple ways of expressing mortality; a narrative to explain and justify the risk comparison; and the hypothetical role of the participant (juror vs. parent). The dependent variable was a hazard scale constructed from four of the five postcomparison judgments. ANOVA found format variations swamped in their effect by concern about asbestos, with the absence of a narrative and the parental role being the only attributes that increased negative risk reactions. Multiple regression analyses found that multidimensionality, narrative, role, and the presence of any risk comparison at all had significant effects when these (plus death formats) were the only independent variables. However, only multidimensionality (which increased negative reactions) retained significance when asbestos concern, risk beliefs (no safe level of exposure to a carcinogen; any exposure leads to cancer), and demographic variables were added to the analysis. Concern and risk beliefs alone explained 33% of variance in hazard scores; adding demographics and risk comparison variables only raised explained variance to 36% (having children at home and being exposed to multidimensional risk comparisons raised scores; age and income lowered them). The results underline the potentially small effect of risk comparison information on risk views (at least between subjects), but offer some insight into aspects of message design left unexplored in empirical literature to date.     

Childcare involvement, job characteristics, gender and work attitudes as predictors of emotional exhaustion and sickness absence

Reports in the literature vary regarding the existence of gender differences in relation to burnout and sickness absence. To investigate this, the present study was aimed at investigating the role of several gender-relevant variables, particularly childcare obligations, job characteristics, and work attitudes in emotional exhaustion and sickness absence in 404 male and female nurses in an institution for people with learning difficulties. Questionnaires were administered reflecting demographic and job characteristics, work and non-work attitudes, and emotional exhaustion (as measured by the Emotional Exhaustion Scale of the Maslach Burnout Inventory). Female nurses were expected to report higher levels of emotional exhaustion and to be absent through sickness more often than men. Also, childcare investment, job characteristics, and (non) work attitudes were expected—via emotional exhaustion—to predict gender differences in sickness absence. It was found that women did not have higher sickness absence rates, and although a gender difference appeared in emotional exhaustion it was in the opposite direction from that predicted. For both genders, emotional exhaustion had a significant positive effect on sickness absence, and especially childcare investment and number of work hours appeared to contribute to both outcomes. These results are of interest because, despite current stereotypes, sickness absence was not higher in women, and neither were women more at risk for emotional exhaustion. In particular, load—workload as well as care load—appeared to predict emotional exhaustion and thus sickness absence.     

Are psychosocial factors associated with low-back pain among nursing personnel?

The aim of this study was to investigate whether psychosocial factors at work are related to low-back pain among nursing personnel. It was conducted as a short-term follow-up study of 200 Danish female nursing personnel, providing care for the elderly. Self-reported measures of psychosocial factors such as time pressure, emotional demands of clients, control and social support were obtained by questionnaire at baseline, while stress, physical exertion and low-back pain were reported by diary records made in two, three-day periods in the subsequent 6 months. The study examines the possible influence of psychosocial factors preceding low-back pain as well as stress and physical exertion reported simultaneously with low-back pain. Only stress was associated with low-back pain (Odds Ratio (OR)=2.3; Confidence Interval (CI)=1.3-3.9) while neither physical exertion or any of the psychosocial factors were related to low-back pain. A possible pathway connecting emotional demands of clients to low-back pain through the mediation of stress was suggested.     

GENDER DIFFERENCES IN RESPONSE TO BIG STAKES

It is commonly perceived that increasing incentives improves performance. However, the reaction to increased incentives might differ between men and women, leading to gender differences in performance. In a natural experiment, we study the gender difference in performance resulting from changes in stakes. We use detailed information on the performance of high‐school students and exploit the variation in the stakes of tests, which range from 5% to 27% of the final grade. We find that female students outperform male students in all tests—but to a relatively larger degree when the stakes are low. The gender gap disappears in tests taken at the end of high school, which count for 50% of the university entry grade. (JEL: D03, J16, I21, C30)     

Risk Comparisons, Conflict, and Risk Acceptability Claims

Despite many claims for and against the use of risk comparisons in risk communication, few empirical studies have explored their effect. Even fewer have examined the public's relative preferences among different kinds of risk comparisons. Two studies, published in this journal in 1990 and 2003, used seven measures of "acceptability" to examine public reaction to 14 examples of risk comparisons, as used by a hypothetical factory manager to explain risks of his ethylene oxide plant. This study examined the effect on preferences of scenarios involving low or high conflict between the factory manager and residents of the hypothetical town (as had the 2003 study), and inclusion of a claim that the comparison demonstrated the risks' acceptability. It also tested the Finucane et al. (2000) affect hypothesis that information emphasizing low risks-as in these risk comparisons-would raise benefits estimates without changing risk estimates. Using similar but revised scenarios, risk comparison examples (10 instead of 14), and evaluation measures, an opportunity sample of 303 New Jersey residents rated the comparisons, and the risks and benefits of the factory. On average, all comparisons received positive ratings on all evaluation measures in all conditions. Direct and indirect measures showed that the conflict manipulation worked; overall, No-Conflict and Conflict scenarios evoked scores that were not significantly different. The attachment to each risk comparison of a risk acceptability claim ("So our factory's risks should be acceptable to you.") did not worsen ratings relative to conditions lacking this claim. Readers who did or did not see this claim were equally likely to infer an attempt to persuade them to accept the risk from the comparison. As in the 2003 article, there was great individual variability in inferred rankings of the risk comparisons. However, exposure to the risk comparisons did not reduce risk estimates significantly (while raising benefit estimates), and Conflict-Claim respondents found the risk of the hypothetical factory less acceptable than No-Conflict respondents. Results suggest that neither risk comparisons nor risk acceptability claims are automatically anathema to audiences, but they may have tiny or unintended effects on audience judgments about risky situations.     

Work & stress: Information

The aim of this study was to investigate whether psychosocial factors at work are related to low-back pain among nursing personnel. It was conducted as a short-term follow-up study of 200 Danish female nursing personnel, providing care for the elderly. Self-reported measures of psychosocial factors such as time pressure, emotional demands of clients, control and social support were obtained by questionnaire at baseline, while stress, physical exertion and low-back pain were reported by diary records made in two, three-day periods in the subsequent 6 months. The study examines the possible influence of psychosocial factors preceding low-back pain as well as stress and physical exertion reported simultaneously with low-back pain. Only stress was associated with low-back pain (Odds Ratio (OR)=2.3; Confidence Interval (CI)=1.3-3.9) while neither physical exertion or any of the psychosocial factors were related to low-back pain. A possible pathway connecting emotional demands of clients to low-back pain through the mediation of stress was suggested.     

Gloomy Sunday: did the "Hungarian suicide song" really create a suicide epidemic?

The effect of art on suicide risk has been a neglected topic in suicidology. The present article focuses on what is probably the best known song concerning suicide, Gloomy Sunday, the "Hungarian suicide song." An analysis of historical sources suggests that the song was believed to trigger suicides. It was, for example, banned by the BBC in England until 2002. The alleged increase in suicides in the 1930s associated with the playing of the song may be attributed to audience mood, especially the presence of a large number of depressed persons as a result of the Great Depression. The influence of music on suicide may be contingent on societal, social, and individual conditions, such as economic recessions, membership in musical subcultures, and psychiatric disturbance. Further research is needed on art forms, such as feature films, paintings, novels, and music that portray suicides in order to identify the conditions under which the triggering of suicides occurs.     

The `Game' of Leadership: Exercise, Games, Sports, and Leadership

The relationship between leadership and sports was analyzed. Peer influence was most important, with that of teachers and parents seeming to have a second-order effect as perceived through peers. Each gender benefitted more in leadership when mentored by their own gender, especially so for women. In work settings, men reported more leadership learning and encouragement than did women. Women experienced more frustration in participating in games and sports in school, the encouragement and continued mentoring being insufficient. Harragan's 1977 thesis that the corporate world and the playing field of sports and high-level policy-making have a male schema was borne out.     

Kevorkian,Martha Wichorek and us: a personal account

In this short article, the authors describe their attempt to do suicide-prevention with a patient that ultimately died as the result of a physician-assisted suicide. Autopsy revealed no sign of physical disease but the patient's letters indicate a preoccupation with independence as the definition of life, and conviction that people who lose independence are no longer alive.