Testing our intuition.

As patients near the end of life, their spiritual and religious concerns may be awakened or intensified. Many physicians, however, feel unskilled and uncomfortable discussing these concerns. This article suggests how physicians might respond when patients or families raise such concerns. First, some patients may explicitly base decisions about life-sustaining interventions on their spiritual or religious beliefs. Physicians need to explore those beliefs to help patients think through their preferences regarding specific interventions. Second, other patients may not bring up spiritual or religious concerns but are troubled by them. Physicians should identify such concerns and listen to them empathetically, without trying to alleviate the patient's spiritual suffering or offering premature reassurance. Third, some patients or families may have religious reasons for insisting on life-sustaining interventions that physicians advise against. The physician should listen and try to understand the patient's viewpoint. Listening respectfully does not require the physician to agree with the patient or misrepresent his or her own views. Patients and families who feel that the physician understands them and cares about them may be more willing to consider the physician's views on prognosis and treatment. By responding to patients' spiritual and religious concerns and needs, physicians may help them find comfort and closure near the end of life.

Decision Making↗

PubMed2002

Multi-dimensional evaluation and ranking of coastal areas using GIS and multiple criteria choice methods.

Coastal ecosystems are increasingly threatened by short-sighted management policies that focus on human activities rather than the systems that sustain them. The early assessment of the impacts of human activities on the quality of the environment in coastal areas is important for decision-making, particularly in cases of environment/development conflicts, such as environmental degradation and saturation in tourist areas. In the present study, a methodology was developed for the multi-dimensional evaluation and ranking of coastal areas using a set of criteria and based on the combination of multiple criteria choice methods and Geographical Information Systems (GIS). The northeastern part of the island of Rhodes in the Aegean Sea, Greece was the case study area. A distinction in sub-areas was performed and they were ranked according to socio-economic and environmental parameters. The robustness of the proposed methodology was assessed using different configurations of the initial criteria and reapplication of the process. The advantages and disadvantages, as well as the usefulness of this methodology for comparing the status of coastal areas and evaluating their potential for further development based on various criteria, is further discussed.

Decision Making↗