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Valuing life: a plea for disaggregation.

Each government agency uses a uniform figure to measure the value of a statistical life (VSL). This is a serious mistake. The very theory that underlies current practice calls for far more individuation of the relevant values. According to that theory, VSL should vary across risks. More controversially, VSL should vary across individuals -- even or especially if the result would be to produce a lower number for some people than for others. One practical implication is that a higher value should be given to programs that reduce cancer risks. Another is that government should use a higher VSL for programs that disproportionately benefit the wealthy -- and a lower VSL for programs that disproportionately benefit the poor. But there are two serious complications here. First, bounded rationality raises problems for the use of private willingness to pay, which underlies current calculations of VSL. Second, the beneficiaries of regulation sometimes pay only a fraction or even none of its cost; when this is so, the appropriate VSL for poor people might be higher, on distributional grounds, than market evidence suggests. An understanding of this point has implications for foundational issues about government regulation, including valuation of persons in poor and wealthy nations.

Cost-Benefit Analysis↗

The value of life and the value of life extension.

Recent developments in aging research have added new urgency to the bioethical debate concerning life and death issues, the value of life, and the reasonable limits of medicine. This paper analyzes the basic structures of the liberal and conservative components of this debate, showing that there has hitherto been inadequate analysis on both sides concerning the nature and implications of the value of life, as well as, and as distinct from the value of life extension. Classic concepts of the intrinsic or extrinsic value of life are argued to be tangential or actually irrelevant to the value of life's continuance and so to the value of life extension. An analysis of personhood is proposed which focuses explicitly upon the value of life extension to persons. This analysis shows that persons may only intelligibly be understood as processes, for whom life extension is an inalienable and fundamental value. It is further proposed that, properly understood, such an analysis may significantly narrow the liberal/conservative divide in bioethics.

Aging↗

Quality of life, values, and teamwork in geriatric care: do we communicate what we mean?

Two major forces are changing the shape of health care for the frail elderly with disabling conditions: increasing emphasis on quality of life and growing reliance on an interprofessional team-based approach to care. This article outlines a conceptual framework for organizing discussions of quality of life for elderly persons with disabilities, reviews relevant empirical research, and develops a framework for understanding the different dimensions and interpretations of this concept--particularly as it is used in communication among health care providers, and between them and their elderly patients and families. New models of health care to enhance the focus on life quality and collaborative team practice are summarized. Proposed is the development of an "empowering and reflective ethic" to achieve more effective communication about quality of life in geriatric clinical practice.

Activities of Daily Living↗

Plasma levels, half-life values, and correlation with physiologic assays for growth and immunity.

Plasma prednisolone levels have been measured hourly in children receiving a single dose of oral prednisone. Peak prednisolone levels occurred one to two hours after ingestion; half-life studies gave a mean value of 132 minutes in most children. Some children had marked variability in absorption and metabolism of prednisone. Somatomedin activity and cell-mediated immunity were inhibited by plasma prednisolone values which were achieved by single doses of prednisone of 0.5 mg/kg or higher. Monitoring prednisolone levels may be of value in identifying those children who accumulate excessively high levels on moderate dosage regimens.

Administration, Oral↗

[Internal urinary diversion in pelvic cancers and quality of life. Value of double "J" endoprosthesis].

The ureteral double pigtail stents are versatile and valued for proper urinary drainage in the setting of trauma, fistula formation, after extra-corporeal shock wave lithotripsy (ESWL) and surgical manipulations of the upper urinary tract. Also they are used for prolonged urinary drainage in patients with chronic tumor-induced ureteral obstruction, and present an exceptional patient tolerance. The authors' experience is based upon 54 patients treated for ureteral obstruction of malignant origin between January 1989 and October 1995. Complications of this method as well as the quality of life of these patients are analysed and the results compared with those of the literature. The patient tolerance was excellent. Mean survival time after ureter catheterisation was 18 months. Complete urine diversion was achieved and hydronephrosis disappeared soon after stent placement in 42 patients (80%). In addition hydronephrosis persisted in 12 cases (20%), despite orthotopic positioning of the catheter and numerous stent changes for larger caliber stents. The palliative use of the double pigtail stent when no other treatment is possible for malignant ureteral obstruction, precludes the need for ureterostomy and offers the patient a comfortable quality of life. Bladder disease is a contraindication to the use of these catheters, although their insertion is rarely impossible. In case of acute obstruction, it is better to prepare the pathway with a standard ureteral catheter, which is easier to manage. It is always possible to insert the pigtail stent after some time has elapsed.

Aged↗

The first seizure in adult life. Value of clinical features, electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence.

408 adults (age 16 and over) were followed up after their initial seizure. The actuarial risk of recurrence was highest in the early weeks. For those seen within the first week, the risk of recurrence was 52% by the end of 3 years. In univariate analysis, the only clinical variable that was associated with recurrence was the time of day at which the initial seizure occurred. There was a tendency, that did not reach statistical significance, for younger age (less than 50 years) and a family history of seizures of any type, including febrile convulsions, to be associated with recurrence. Such risk factors appear to be additive, so that the risk of recurrence at 1 year for a subject with all three factors is about three times that of a subject with none of them. Sex, type of seizure, and features of the electroencephalogram were not of predictive value. Computerised tomographic scanning revealed tumours in 3% of subjects, and these individuals were particularly likely to have recurrent seizures.

Adolescent↗

The value of life and the value of population.

"This paper first distinguishes structured and unstructured approaches to valuing life. The unstructured approach bases its valuations on people's raw preferences, whereas the structured approach imposes a theoretical framework about the structure of value. The paper recommends the structured approach. This opens the way to considering the value of adding people to the population. The paper examines a common intuition that adding people is not in itself valuable, and explains the difficulties this intuition encounters."

Behavior↗