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.     

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.     

The development of the physicians' end-of-life care attitude scale

The Physicians' End-of-Life Care Attitude Scale (PEAS) was developed as an outcome measure for palliative care education. PEAS assesses the willingness of medical trainees to care for dying patients. Sixty-four Likert-type questions were created on the basis of discussions with focus groups of medical trainees, then administered to sixty-two medical students and residents. Total PEAS scores as well as personal preparation and professional role subscales (where higher scores indicated greater concern) possessed excellent internal consistency and reliability. In addition, there were substantial correlations between PEAS scores and the CA-Dying scale, a measurement of laypersons' fears about interacting with dying persons. Thus, PEAS adequately assesses the unique communication concerns of physicians in training regarding working with dying persons and their families. Correlations between PEAS scores and age were negative, while those who had experienced the death of a loved one had higher PEAS scores than those who did not. This suggests that for some persons, life experiences may lessen difficulties in dealing with dying persons, while for others, personal losses may exacerbate such concerns. The utility of PEAS in evaluating the efficacy of palliative care education as well as its potential to measure medical trainee's willingness to care for the terminally ill is discussed.     

Aggregation and Market Demand: An Exterior Differential Calculus Viewpoint

We analyze under which conditions a given vector field can be disaggregated as a linear combination of gradients. This problem is typical of aggregation theory, as illustrated by the literature on the characterization of aggregate market demand and excess demand. We argue that exterior differential calculus provides very useful tools to address these problems. In particular, we show, using these techniques, that any analytic mapping in Rⁿ satisfying Walras Law can be locally decomposed as the sum of n individual, utility-maximizing market demand functions. In addition, we show that the result holds for arbitrary (price-dependent) income distributions, and that the decomposition can be chosen such that it varies continuously with the mapping. Finally, when income distribution can be freely chosen, then decomposition requires only n/2 agents.     

LINKING PROCESS CHOICE WITH PLANT-LEVEL DECISIONS ABOUT CAPITAL AND HUMAN RESOURCES

We examine how process choice links with design decisions about capital and human resources. Our analysis confirms empirically most expected differences between process- and product-focused plants for these decisions. What is unexpected is how top-performing plants resemble other plants within the same process choice category in most respects, while distinguishing themselves on a few selected process attributes. For example, better performing process-focused plants not only achieve higher machine flexibility levels and lower overhead costs as expected, but also have more intensive preventive maintenance programs. Similarly, product-focused plants that achieve certain hallmarks of process-focused plants also enjoy superior performance.     

A cross-validation of a structural equation model of accidents: organizational and psychological variables as predictors of work safety

A study to establish a structural equation model of accidents is presented. The eight variables included in the model were those associated with accidents in previous research. The reliability of questionnaires to measure those variables and a structural equation model relating them are provided. The model explaining the occurrence of accidents was cross-validated through three Spanish samples (n=123; 182; 124).The model presented a good fit to data in two samples, while a third had unclear fit indices. Therefore, most relationships among variables did not vary among these three samples. The role of the safety variables in the model is discussed. The discussion is also focused on risk measurement difficulties commonly reported in the literature. Finally, some suggestions for future safety research with structural equation modelling techniques are provided.     

Time management as a moderator of relations between stressors and employee strain

The purpose of this study was to examine whether time management behaviours moderated relations between stressors (role conflict, role overload, work-family conflict, and family-work conflict) and strain, as measured by scores on the General Health Questionnaire. It was predicted that use of time management behaviours would be negatively associated with strain. These relations, however, were expected to be mediated by feelings of control over time. It was further predicted that the use of time management behaviours would attenuate stressor-strain relations. Data collected from 525 employed men and women indicated, as predicted, that use of time management behaviours was negatively associated with strain. These relations were partially mediated by feelings of control over time. Moderator tests failed to provide support for time management behaviour as a moderator of stressor-strain relations. Implications of findings are discussed and future directions for time management research are suggested.     

Distribution of Exposure Concentrations and Doses for Constituents of Environmental Tobacco Smoke

The ultimate goal of the research reported in this series of three articles is to derive distributions of doses of selected environmental tobacco smoke (ETS)-related chemicals for nonsmoking workers. This analysis uses data from the 16-City Study collected with personal monitors over the course of one workday in workplaces where smoking occurred. In this article, we describe distributions of ETS chemical concentrations and the characteristics of those distributions (e.g., whether the distribution was log normal for a given constituent) for the workplace exposure. Next, we present population parameters relevant for estimating dose distributions and the methods used for estimating those dose distributions. Finally, we derive distributions of doses of selected ETS-related constituents obtained in the workplace for people in smoking work environments. Estimating dose distributions provided information beyond the usual point estimate of dose and showed that the preponderance of individuals exposed to ETS in the workplace were exposed at the low end of the dose distribution curve. The results of this analysis include estimations of hourly maxima and time-weighted average (TWA) doses of nicotine from workplace exposures to ETS (extrapolated from 1 day to 1 week) and doses derived from modeled lung burdens of ultraviolet-absorbing particulate matter (UVPM) and solanesol resulting from workplace exposures to ETS (extrapolated from 1 day to 1 year).     

Mixed Levels of Uncertainty in Complex Policy Models

The characterization and treatment of uncertainty poses special challenges when modeling indeterminate or complex coupled systems such as those involved in the interactions between human activity, climate and the ecosystem. Uncertainty about model structure may become as, or more important than, uncertainty about parameter values. When uncertainty grows so large that prediction or optimization no longer makes sense, it may still be possible to use the model as a behavioral test bed to examine the relative robustness of alternative observational and behavioral strategies. When models must be run into portions of their phase space that are not well understood, different submodels may become unreliable at different rates. A common example involves running a time stepped model far into the future. Several strategies can be used to deal with such situations. The probability of model failure can be reported as a function of time. Possible alternative surprises can be assigned probabilities, modeled separately, and combined. Finally, through the use of subjective judgments, one may be able to combine, and over time shift between models, moving from more detailed to progressively simpler order-of-magnitude models, and perhaps ultimately, on to simple bounding analysis.     

Modelling Building Societies Takeovers a Non-Cooperative Game

Takeover and acquisition of corporations is awell-researched area and has been becomingincreasingly important. Much less research emphasishas been devoted to takeover activity within thegeneral area of financial services with thisparticularly the case for the building society sector.The building societies being mutual companies havespecial characteristics. The building societies andother financial mutuals like the corporations doencounter an acute agency problem. This opens up apotential application of Grossman and Hart theory oftakeovers bids as the individuals have option to freeride, securing knowledge that the regulatory processrenders their deposits de facto risk-free investment.This free-rider problem, like the corporations can beovercome by inducing hostile takeover.Some empirical studies of mergers activities withinthe building society sector have dealt with onlyintra-sectoral mergers. However, they have not lookedat inter-sectoral mergers and have not addressedefficiency issues in a general equilibrium frameworkusing game theory.In this paper I suggest a mechanism for merger at parwith sales of stocks of a corporation to organisebuilding societies' takeovers. I develop a two-stagegame between the members of building societies and theraider. Analysis of non-cooperative voting behaviourof members of Cheltenham and Gloucester buildingsociety shows that the actions of the members of thebuilding society may also give rise to less thanoptimal results as they may not be acting in their bestinterests. The members of the building society cangain if a hostile takeover is induced rather than afriendly takeover. The paper also examines the freerider problem and ex-ante efficiency in a generalequilibrium framework.