How do we define when we die?

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Apr 5, 2018 - The QJM has catalysed a discussion, both from a clinical and philosophical perspective, on—when do we die? Schofield et al.1 previously ...

QJM: An International Journal of Medicine, 2016, 221 doi: 10.1093/qjmed/hcw039 Elements: in this Month’s Issue

ELEMENTS: IN THIS MONTH’S ISSUE

How do we define when we die? Seamas C. Donnelly Editor-in-Chief, QJM

The QJM has catalysed a discussion, both from a clinical and philosophical perspective, on—when do we die? Schofield et al.1 previously proposed a definition which focused on death occurring when ‘when the last process in the collection of bodily processes that maintain homoeostasis finally cease’. In the current issue of the Journal, Dr Emmerich argues that reducing death to the biological, as proposed by Schofield, denies an essential characteristic of being human, namely, our cognitive and psychological nature. He argues that stripping down the definition of human death to the level of a basic organism does not reflect the uniqueness of personhood and human life. We would be interested to hear your thoughts. Death is very likely the single best invention of life. It is life’s change agent. It clears out the old to make way for the new. Steve Jobs

Can we predict hospital readmissions? The Journal has been pre-eminent in recently publishing work analysing emergency admissions to our hospitals particularly with regards to defining cost and predicting outcome.2–4 We are well aware that healthcare costs are increasing annually at an unsustainable rate. A significant proportion of these costs relate to acute hospital services. With regards to cost containment, there has been increasing emphasis on predicting and reducing hospital readmission rates. In that context various clinical risk-scoring systems have been proposed to define high-risk patients with the aim of focusing interventions on this cohort. Cooksley and colleagues report on their evaluation of two such scoring systems, LACE and HOSPITAL, respectively, in over 19 000 European patients. They found that neither scoring system had significant discriminatory power to be clinically

effective in predicting hospital readmission rates for the population as a whole. With the enhanced ability of technology to potentially assess community patient wellness one would predict that combining clinical scoring systems with information from wearable technology would lead to disease specific clinically effective predictive models.

Would you like one of your photographs on the cover of the QJM? One of the traditions of the QJM is the selection from readers of submitted photographs for the monthly covers of the Journal. Continuing this tradition, we invite our readers, with an interest in photography, to consider submitting such photographs. Submitted images can be in black and white or colour and of high definition (> 300 dpi, File size < 5 MB). If photographs include people, then written consent should be obtained from all individuals. Suitable images can be submitted via email to [email protected]

References 1. Schofield GM, Urch CE, Stebbing J, Giamas G. When does a human being die? QJM 2015; 108:605–9. 2. Conway R, Byrne D, O’Riordan D, Silke B. Patient risk profiling in acute medicine: the way forward? QJM 2015; 108:689–96. 3. Cournane S, Byrne D, O’Riordan D, Fitzgerald B, Silke B. Chronic disabling disease–impact on outcomes and costs in emergency medical admissions. QJM 2015; 108:387–96. 4. Conway R, Byrne DG, O’Riordan D, Silke B. Improved outcomes of high-risk emergency medical admissions cared for by experienced physicians. QJM 2015; 108:119–25.

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