Toward a better death: applying Burkean principles of symbolic action to interpret family adaptation to Karen Ann Quinlan's coma.

This article considers the manner that families come to accept the collapse of identity in a family member who has entered a medical crisis with no hope of returning from it. The transformation is regarded as a "right of passage" and is characterized in terms of both the conditions that bring about resistance to the passage as well as the sorts of symbolic activities that ultimately allow the transformation to occur. The theoretical source that is used to discuss both these issues is Kenneth Burke's (1969) theory of Dramatism, regarded herein as a template that guides both interpersonal action and experience. The primary text used to illustrate these points is the story of Karen Ann Quinlan, a young woman who fell into persistent vegetative state in 1975, as told by her parents. A general goal of this article is to illustrate some of the characteristics of Dramatism as a theory of interpersonal action, especially after the collapse of routine. More particularly, it is hoped that the analysis will aid health professionals in sense making and interacting with families in crisis.

The rhetoric of Kevorkian's battle.

Kenneth Burke's characterization of constitutions effectively describes the customs and values that are lived within a community, and he has well charted the dialectical process which such constitutions undergo when they actually submit to change. In this paper, the totality of thematically-relevant discursive events which arise during periods of constitutional amending are referred to, building from Bitzer, as a rhetorical situation. Using Bitzer alongside Burke, it will be shown that Jack Kevorkian's rhetorical intent, as expressed in his writings and public statements, is distinct from the rhetorical situation to which he has been assigned, illustrating the significant discrepancy between the would-be rhetorical utterances of a speaker and those utterances which have rhetorical impact. The argument will show how Kevorkian's intention to popularize obitiatry contrasts with his public image as a champion of physician-assisted dying.

Quantitative liver imaging using 131-I Rose Bengal as an index of liver function and prognosis.

A technique for assessing quantitatively hepatic function by direct measurement of liver parenchymal cell uptake of 131I Rose Bengal using a scintillation camera with a digital store and retrieval system is described. Ninety-four studies were performed on 84 patients with a variety of hepatic disorders over a two-year period, the diagnosis in each case being established by liver biopsy or laparotomy. The results were compared with the clinical, biochemical and histological assessment of the patients. A good correlation was found between the half-time for hepatic uptake of 131I Rose Bengal and the histological changes, as well as with clinical prognosis measured in terms of clinical improvement or deterioration to death. The rate of liver uptake was found to be a better index than the clearance of radioisotope from the blood and was superior to conventional biochemical investigations in both icteric and anicteric patients. The test was not shown to be of clinical value in discriminating between intra- and extrahepatic causes of jaundice. It is suggested that this technique may provide a safe and sensitive method for assessing the severity of liver dysfunction and also for monitoring clinical progress, especially in situations where liver biopsy may be unreliable or hazardous.

Deconvolution analysis of the scintillation camera renogram.

A scintillation camera with digital data store has been used to assess renal function. Analysis of the renogram by deconvolution, using an on-line digital computer, shows promise as a means of expressing renal function in terms of tubular transit times for 123I-Hippuran.