Futility in the practice of community psychiatry

The experience of futility among frontline clinicians in community psychiatry is produced by the temporal structuring of their work. All health care providers share the disposition to intervene in the course of disease. Specific notions about the course of severe mental illness are woven into the mission of Assertive Community Treatment (ACT) as well as the treatment plan, a key paperwork tool used to stage daily activities. The treatment plan demands a narrative of progress that ACT workers often find impossible to supply. The gap between the ideal of progress and the realities of practice produce distinctive kinds of demoralization. Drawing from an ethnography of a single ACT team in the United States, this article explores how clinicians encounter, articulate, and attempt to resolve such experiences of futility. It explores their practical strategies to reframe the time horizons of work and thereby restore the sense of their own therapeutic power.     

Respiratory Stimulants in Treatment of Perinatal Asphyxia

The effects of two analeptic drugs—taloximine and ethamivan—have been studied in asphyxiated fetal and newborn rabbits. In primary apnoea ethamivan reduced the time before the onset of gasping, while during gasping taloximine increased the gasp rate. In secondary apnoea neither drug initiated respiration, though most animals could be resuscitated by using intermittent positive pressure respiration. From these results it is suggested that analeptic drugs have no place in obstetric or neonatal departments.     

Futility and the obligations of physicians

It is becoming increasingly common (at least in the United States) for doctors to appeal to futility judgments as the basis for certain types of clinical decisions, such as the decision to withhold CPR. The clinical use of futility judgments raises two basic questions regarding futility. First, how is the concept of futility to be understood? Secondly, once we have a clearer understanding of futility, what role should determinations of futility play in clinical decision-making? Much of the discussion about the concept of futility has centered on the value-ladenness of futility judgments. I argue that futility determinations need to be distinguished from two other types of value-based judgments, namely, identification of the goals of treatment and treatment decisions based on an assessment of the benefits and burdens of treatment. If this distinction is sound, it suggests a very limited role for futility determinations in clinical decisionmaking, a role which should serve to promote communication between doctor and patient.     

Identification of Stimulants for Lactobacillus bulgaricus in Tomato Juice

Acid production in milk by Lactobacillus bulgaricus was stimulated by tomato juice or its serum. Preliminary purification of the stimulants involved adsorption and elution on a cation-exchange resin. Unidimensional paper chromatography in two solvent systems was employed in further isolation and purification. Identification of the stimulatory components was based on ultraviolet spectral analysis and thin-layer chromatography. The stimulants were identified as adenine and adenosine.     

Growth Stimulants in Plant Extracts for Leuconostoc citrovorum

The growth of Leuconostoc citrovorum ML 34, an isolate associated with the malo-lactic fermentation of wine, was stimulated in part by grape, orange, cabbage, and tomato juices. The stimulatory activity of tomato serum was associated with the carbohydrate fraction. Further purification of the fraction showed that fructose was the factor responsible for initiating growth. In addition to fructose, the organism required CO(2) for establishing growth. Saturated CO(2) atmosphere and catalytic amounts of fructose served as substitutes for plant extracts in a complex glucose medium.     

Medical Futility and the Death of a Child

Our response to death may differ depending on the patient’s age. We may feel that death is a sad, but acceptable event in an elderly patient, yet feel that death in a very young patient is somehow unfair. This paper explores whether there is any ethical basis for our different responses. It examines in particular whether a patient’s age should be relevant to the determination that an intervention is medically futile. It also considers the responsibilities of health professionals and the rights of family members in situations where an interventions is clearly futile.