Genetic Engineered food and animal products

genetic engineered food and animal products.
During the past decade, biotechnology companies commercialized the first generation of genetically engineered crops—primarily corn, soybeans, and cotton altered to control insects and weeds. U.S. commodity crop producers responded by planting millions of acres of these engineered crops. Because corn and soy are widely used in food processing, small amounts of engineered ingredients show up in a majority of processed food products. But most foods—the vast majority of vegetables, grains, fruits, and nuts—remain unaltered. Of the eight other engineered food plants allowed in U.S. grocery stores, it appears that only engineered canola and papaya are currently available.
Among food animals, only engineered fish are under active consideration by U.S. regulators. Other engineered plants, animals, and microbes are farther down the research pipeline but few are poised for introduction in the near future.


Recently, a second wave of biotech products began emerging—crops, mainly corn, engineered to produce pharmaceuticals and industrial and research chemicals. Several such products are already on the market and companies are seeking approval from the Food and Drug Administration of corn-based drugs and vaccines.

Scientists are concerned that engineered organisms might harm people’s health or the environment. For example, engineered crops might contaminate the food supply with drugs, kill beneficial insects, or jeopardize valuable natural resources like Bt toxins. Engineered fish may substantially alter native ecosystems, perhaps even driving wild populations to extinction.

To protect human health and the environment from engineered products, we need strong federal oversight and active citizen participation.

What Implications Does Behavioral Genetics Research Have For Society?

Researchers in the field of behavioral genetics have asserted claims for a genetic basis of numerous physical behaviors, including homosexuality, aggression, impulsivity, and nurturing. A growing scientific and popular focus on genes and behavior has contributed to a resurgence of behavioral genetic determinism—the belief that genetics is the major factor in determining behavior.
Are behaviors inbred, written indelibly in our genes as immutable biological imperatives, or is the environment more important in shaping our thoughts and actions? Such questions cycle through society repeatedly, forming the public nexus of the "nature vs. nurture controversy," a strange locution to biologists, who recognize that behaviors exist only in the context of environmental influence. Nonetheless, the debate flares anew every few years, reigniting in response to genetic analyses of traits such as intelligence, criminality, or homosexuality, characteristics freighted with social, political, and legal meaning.
What social consequences would genetic diagnoses of such traits as intelligence, criminality, or homosexuality have on society? What effect would the discovery of a behavioral trait associated with increased criminal activity have on our legal system? If we find a "gay gene," will it mean greater or lesser tolerance? Will it lead to proposals that those affected by the "disorder" should undergo treatment to be "cured" and that measures should be taken to prevent the birth of other individuals so afflicted?
There are several scientific obstacles to correlating genotype (an individual's genetic endowment) and behavior. One problem is in defining a specific endpoint that characterizes a condition, be it schizophrenia or intelligence. Another problem is in identifying and excluding other possible causes of the condition, thereby permitting a determination of the significance of a supposed correlation. Much current research on genes and behavior also engenders very strong feelings because of the potential social and political consequences of accepting these supposed truths. Thus, more than any other aspect of genetics, discoveries in behavioral genetics should not be viewed as irrefutable until there has been substantial scientific corroboration.
How do genes influence behavior?
No single gene determines a particular behavior. Behaviors are complex traits involving multiple genes that are affected by a variety of other factors. This fact often gets overlooked in media reports hyping scientific breakthroughs on gene function, and, unfortunately, this can be very misleading to the public.
For example, a study published in 1999 claimed that overexpression of a particular gene in mice led to enhanced learning capacity. The popular press referred to this gene as "the learning gene" or the "smart gene." What the press didn't mention was that the learning enhancements observed in this study were short-term, lasting only a few hours to a few days in some cases.

New System Might Increase Organ Donations

Could Changing the Way People Volunteer Increase Organ Donations?


According to a Gallup poll, 83 percent of Americans understand the benefits of organ donation and approve of the practice but only 28 percent have granted written consent to release their organs if they die. Since 1995, more than 45,000 people have died waiting for an organ donor.
Avoiding the Question
Some say the problem lies in a reluctance to make what can be a very uncomfortable decision. They say a new opt-out system, which would assume people are donors unless they specify otherwise, could dramatically increase the number of donors and save lives. A similar example lies in the do-not-call telemarketing system, where it is assumed telemarketers may call people at home unless they add their names to a do-not-call list.
But because releasing your organs to medicine after death can be such a profound decision, critics say adopting a similar opt-out system for organ donation would also introduce all kinds of ethical land mines.
Numbers from some European countries show that forcing people to confront the decision can make a big difference.
In several countries, including Austria, Belgium, France, Hungary, Poland, Portugal and Sweden, authorities assume everyone is willing to be a donor — with the approval of family after death — unless they say otherwise in written form. In those countries, 85 percent to 99 percent of people are on paper as willing donors and actual donations are higher by about 56 percent.

Troops returning home with hearing loss???

Majority soldiers and Mariens caught in roadside bombings and firefights in Iraq and Af. are coming home in epidemic numbers with permanent hearing loss and ringing in their ears. hearing damage still number 1 disability in the war. the numbers are staggering. One major explanation given is the insurgency's use of fearsome weapon the Pentagon didn't fully anticipate, powerful roadside bombs. Their blasts cause violent changes in air pressure that can rupture the eardrum and break bones inside the ear. Also, much of the fighing consists of ambushes, bombings are firefights, which come suddenly and unexpectedly, giving soldeirs no time to use their military issued hearing protection.
In addition, some servicemen on patrol resfuse to wear earplugs for fear of dulling their senses and missing sounds that can made the difference between life and death.
The Navy and Maries have begun buying and distributing state of the art earplugs, know as Quiet pro" that contain digital processors that block out damaging sound waves from gunshots and explosions and still allow users to hear everyday noises. The cost about $600 a pair.
My common is.... if there isn't a War, then we don't have to cost that money to treat this medical problem.... War doesn't create money, maybe later on for "oil", but for now, it cost more money for medical treatment...

The living will

There is no age limit for anyone to become severely ill. Anyone can be faced with a life threatening illness or an accident at any age and can become in a state that cannot speak for themselves. In such situations our life will be in the hands of others. We might be put to death when we wished to be resuscitated or we might be kept alive with life-supporting machines when we wished to be dead. A living will can save anyone from such a dilemma. With a living will we can make the final decisions for ourselves in a life ending situation without depending on others mercy.

Living will is a part of advance directives which tells the doctors what kind of care anyone wish to have in an end of life situation. The abscense of a living will can create unwanted turmoils in the families. The best examble is Terry Schiavo's case in Florida. 41 year old Terry Schiavo, after creating an intense legal conflict and a vast press coverage died in 2005 two weeks after the removal of her feeding tube which had kept her alive since 1990. There was no clear evidence for what her real wish was. The husband says that she mentioned sometimes during their married days that she never wanted to live with the help of life supporting machines. He might be true or might be lying for his own interests. He had some conflicts of personal interests in a large malpractice settlement money and also he was living with a girlfriend whom he cannot marry as long as Terry Schiavo was alive. Since she did not put anything in writing in the form of a living will only she knew what her real last wishes were. I cannot even imagine myself something like this happening to me. I do not think anyone would want to have the court to decide for their fate. With a living will anyone can make their own final decisions by themselves and also can spare their families from tearing apart trying to decide what is the best fate for them.

pro-choice and pro-life, who wins?

As the debate on abortion between the pro-choice and pro- life takes a political direction, the focus drifts from the subjects of abortion and the impact the process of abortion impresses upon the lives of the women that undergo the process to that of justifying and condemning. In a study done in Zealand and published in the Journal of Child Psychology and Psychiatry in 2006, it was established that abortion has effect on women's mental health. The researchers concluded that "Abortion in young women may be associated with increased risks of mental health problems" Even though women's rights and decision for an abortion are protected by autonomy and right to privacy, echoes of condemnation from the society may lead to a life of guilt and self-condemnation.
In the 'Aftermath of Abortion trauma', by Joanne Angelo, a research in Finland found the rate of suicide in women the year after an abortion to be nearly six times greater than the suicide rate after live birth and significantly higher than the suicide rate in the general population of women of childbearing age.
The united States in an effort to address the dynamic of the issue of abortion has put emphasis on providing women with information prior to an abortion. In some pregnancy center clinics an ultrasound is used so that the women can visualize the fetus before the abortion is done. In a clinic in North Carolina, six teenagers out of eight changed their minds when they saw the movement of the fetus. This is not without controversy as the the pro-choice view it as a way to inflict fear and guilt by the pro-life supporters. As the division between the pro-choice and pro-life continues, there are no winners, but there could be losers; the women that live with the guilt or condemnation of abortion in the rest of their lives, or those that end it all by committing suicide.

Life vs. patient vs. HMO

At the end of 2007, there is a big case in LA county. 17 years old is diagnosed hepatocarcinoma and need liver transplant, usually liver transplant isn't happened with this age. it is a rare case. All the MD agreed to do prior authorization with Cigna insurance. Cigna failed to comply with MD's request, not only one MD, all hemo& oncologist MD in addition to internal medicine, family practice, pulmonary critical care MD.After 4 months Cigna continued to deny all MD's request for all the treatment. Cancer levels start to reach to stage 3.??? Family's member start to require more attention from law maker (house representative, county supervisors, and state senator), include CMA- california medical Association.Patient passed away 1 day after Cigna's approved for her medical treatment.So, the question arrived is why insurance company is too late for approving for her medical treatment. Patient is paying insurance due very on time. The case is reaching to bioethics committees law firm in Los Angeles county.
An insurance company that initially refused to pay for a liver transplant for a 17-year-old Northridge girl who died in a hospital should face criminal charges and pay civil damages,Cigna HealthCare "literally, maliciously killed" Nataline Sarkisyan, attorney Mark Geragos told reporters in downtown Los Angeles.
Sarkisyan's 21-year-old brother, Bedros, told reporters that UCLA had a liver available for transplant, but they could not perform the procedure because of Cigna's refusal to cover it. The girl's father, Krikor Sarkisyan, held a photograph of his daughter, and with his eyes wet with tears, cried out. "They took my daughter away from me!" "The Cigna people, they cannot make people's decision if they (are) going to life or die," he said through a heavy accent. "Doctors ... they all signed the papers. ... Cigna denied it two times." Cigna insurance initially declined to pay for the transplant for Nataline Sarkisyan because her plan did not cover "experimental, investigational and unproven services," her doctors said. The denial promAbout 15 minutes into the rally, Cigna announced it would approve the transplant.pted nationwide protests, including a rally outside Cigna's Glendale offices.
CIGNA released the following statement: "Our deepest sympathies are with Nataline's family. Their loss is immeasurable, and our thoughts and prayers are with them. We deeply hope that the outpouring of concern, care and love that are being expressed for Nataline's family help them at this time."

The Moral and Ethical Physician

The moral and ethical foundation of our society has dual personalities: that which the average human being carries and that which is carried by a professional, in this specific case, by a physician.

There is a great amount of conflict as professionals to not make decisions based on our own personal morals and ethics. Instead we have to make a decision as a provider, educator, and a healer. It is our job to provide our patient with the best of our capabilities.

Always keep in mind that when a client approaches you as their physician, they have a level of dependency towards you to help with their illnesses, problems, and/or fears. If we are consistent with our professional moral principles and accepted code of conduct, then act on what you believe to be correct, but always making sure that your patient has the appropriate resources to meet their care.

As the Modern Hippocratic Oath States:

“I will not be ashamed to say “I know not, nor will I fail to call in my colleagues when the skills of another are needed. I will remember that I remain a member of society with special obligation to all my fellow human beings, those sound of mind and body as well as the infirm.”

Yenima Martin
UHSA Medical School 2008

The Impaired Medical Professional

The Impaired Medical Professional

Alcohol and drugs abuse, often categorized together as “substance abuse” and addiction, is a common problem in our society as a whole. It is prevalent among the general population and therefore it stands to reason that it would also be prevalent among various occupations within a population. Thus, all people and occupations are represented, including the health care worker.

We often think of our health care professionals, including doctors and nurses as being exemplary and above such “vices”. Although the exact figures are unknown, the medical profession suffers along with the general population in this area. In fact, the prevalence of chemical dependence for medical professionals may even exceed the public. The reasons for this may have to do with the stress of the job and the long hours worked, coupled with the relative easy access to “pharmaceutical grade” drugs, whose use do not carry the stigma of “street drugs”.

The ethical question arises when we are forced to consider what to do with such impaired medical professionals. Are such folks to be treated as common criminals that do not get a pass just because they are members of a “noble” profession? Or are they to be treated as a still valuable and “salvageable” resource, who with proper treatment can return to the medical field not only functional, but with a “unique perspective” that may serve their patients and co-workers. In order to properly answer those kinds of questions, one has to decide what chemical dependence is about. Are such chemically dependent people bad deserving censure and punishment, or are they sick needing treatment? Or is the situation even that black and white? The problem, is of course, complicated by the fact that mistakes made by a medical professional who is impaired, can cost the life of a patient and therefore, by necessity a lower tolerance is usually applied.

Fortunately, much precedent has been set in today’s work setting. There have been many impaired professionals who have been confronted with their addiction and forced (usually) or somehow coerced into treatment. Many, if not most, of these individuals have received the proper treatment and returned to the field of medicine to function productively. This return to work is almost always contingent upon joining a professional recovery organization that monitors the practitioner. Typically, meetings of the 12 step variety and random drug screens are mandatory for an extended period (usually five years), once return to work is allowed. The combination of follow up care and random drug screening has proved to cut down on the relapse rate. Therefore, with proper recognition and treatment, the impaired medical professional, who may have been scorned and summarily dismissed in earlier days, can be given a second chance. Thus, public safety is preserved and a very valuable resource in the form of a medical professional is salvaged.

Culling Embryos

So, this wonderful guy asks me out on a date. We meet at an Italian restaurant with great atmosphere in NYC and right after our appetizers reach the table he asks “Are you sickle cell trait?” Great conversation for a first date, huh? I answer no, but he continues to tell me that he really likes me and he is sickle cell trait so he needs to be sure that I’m not. Scary, I’m trying to enjoy the live music and he is planning our possible future as parents! But I assured him that I did not have the trait and sure enough we were married a year later.

For about two years the New York Times has been running a series of articles on how the genetic information we have unraveled from DNA thus far has been impacting varying levels of society. They are all very interesting – including the most recent one on how genetic testing is raising insurance cost fears in the United States (link at bottom of blog). Another trend has been the use of in vitro fertilization (IVF) techniques, not to aid infertile couples, but to allow couples to literally choose which embryo they want to keep and discard the others. There are couples who choose their baby based on very superficial characteristics, like sex, height, likeliness to be thin or eye color. I won’t discuss any those choices because I truly cannot understand how anyone can create and discard life based on eye color and feel that it is totally ok. More importantly, there are couples who feel compelled to use IVF in hopes of ensuring their offspring are free of genetic disorders that may make them sick one day. My question: when did being sick translate to mean that you don’t deserve to live or don’t deserve a chance at life?

It certainly seems to me that the further medical technological advances are made is the more disregard we have for the sanctity of life. Now that children with Down’s syndrome are able to grow into adult hood and have productive lives it chosen to abort them and try again for a “normal” baby. Very recently it was found that a severely autistic teen, labeled as mentally retarded, had somehow managed to teach herself how to type and has revealed just how intelligent she really is. Her autism just made it extremely difficult to communicate, but now via typing she has written a few papers on what it’s like having severe autism. Our notion is that people with an illness have a poor quality of life, but without even realizing it our society is saying illness takes away your right to live. One of the potential mothers’ from the article said afterwards she felt like she allowed the other embryos to drown in the ocean and chose the one who happened to be a better swimmer…

Sometimes avoiding passing on certain genetic diseases to your children is as simple as asking a few questions before getting into a relationship. Other times, it’s not that easy. A close friend of mine had sickle cell disease. Neither of his parents knew they were carriers until his first crisis when he was a toddler. He died at 19 just when he was beginning his first year of college. He didn’t have a “normal life” and everyone said that he died so young, but his life wasn’t any less meaningful then my own or anyone elses. I remember him being so vibrant and smart. Even if he was just discharged from the hospital he’d be back in church at the next service. After his funeral his mom told me that even if she knew he had this disease when she was pregnant she would have still chosen to have him regardless of how strenuous it had been on the family. This said it is often the parents who don’t want to have to deal with having a sick child why they make certain decisions. In the article I mentioned one of the fathers said he’s happy knowing that his “daughter won’t ever be sick,” that he won’t ever have to stay up all night by her hospital bed wondering if she’s going to live.

Of course there is an argument to be made for diseases that are lethal. However my opinion is that it is selfish and irresponsible to KNOW that you have an Autosomal dominant LETHAL disease like Huntington’s and still have children. It may seem harsh, but I personally would simply adopt. There are millions of children around this planet and in the United States who need a safe and supportive home. If you fall into this unfortunate situation and you want children, why not offer them yours?

Culling Embryos posted by Octavia
UHSA Medical Student

http://topics.nytimes.com/top/news/national/series/dnaage/index.html

please go through some of the articles at the above link they are very well written and present important, current and relevant issues on DNA technology, thanks.

No Food for Thought

No Food for Thought


Don’t throw away that New Year’s resolution to lose weight just yet. If law makers in Mississippi have their way, you might need to really stick to that diet if you visit their state. Legislation was recently introduced that would band restaurants from serving obese people. Bill No. 282 contains the key to the future of the obese in Mississippi. Restaurants would keep a scale there to measure your BMI and if >30, could refuse to serve an obese customer. I suppose legislators equate this to refusing alcohol to someone who has had too many drinks.

Obesity is a disease that affects approximately 60 million people in the United States. With the increase in pre-packaged foods, the increased number of fast food restaurants, and lack of activity; the number of obese people in America has had a steady rise since the 1960’s. No wonder we have an obesity epidemic in the United States. Food is everywhere-on television, vending machines and on busy roadways with potential traveling customers. Food is involved in just about every fiber of our daily lives. If you couple this with a life of sitting behind desks and cars, you have a recipe for obesity.

Well, whose fault is it? This is difficult to answer given that people are free and can make the choice to eat healthier foods. We live in culture where the environment has dictated a lack of activity. With the advancement of technology, it has made us more sedentary. We have remote televisions, elevators, and fast foods. There are even cars set up to hold our food. In addition, it is cheaper to buy a burger for a dollar versus buying a six dollar salad at the salad bar. It costs more to eat healthier.

Obesity, however, does not come without a cost. Obese people run the risk of chronic deadly conditions such as cancer, type 2 diabetes, hypertension and heart disease. So, why do we still over eat knowing that obesity can cause these conditions? And this is the question that lawmakers have probably asked themselves and the reason for the proposed bill.

Mississippi has found themselves at the top of the list of the fattest people in the country. This has happened for the third year. There has been an increase in death rates from cardiovascular diseases and cancer for which obesity was a factor. Mississippi also holds the record of being the first state to record an obesity rate at over 30%.

As a result, law makers have decided to take matters into their own hands. If this legislation is passed, it would be enacted this summer. For the restaurants that do not adhere to this law, they would be sited and probable fined. The department would monitor compliance and have the power to revoke violators' permits. "I was trying to shed a little light on the number one health problem in Mississippi," co-sponsor Republican Rep. John Read of Gautier, a former pharmaceutical company sales representative, told the Associated Press, acknowledging that at five feet, 11 inches (1.8 meters) and 230 pounds (104 kilograms), he might get the restaurant boot under his own bill.
This is certainly discrimination and stereotyping against obese people to say the least. If an obese person walks into a restaurant, will that person be stopped at the door? How do we know this person does not want to order a salad? Now we are policing people on the lowest level. Will that customer need to carry around a doctor’s note confirming they are indeed on a diet? Where will it end? Will it extend to grocery stores as well? There are many other causes for obesity. Will this individual need to carry proof that their obesity is due to steroid medications? We would just be looking at people and judging them according to their weight. So, I guess this would lead to the hiring of only skinny waiters and waitresses; which would be another form of discrimination against the obese.
There are many other ways to help obese people over come this disease besides policing their restaurant visiting habits.

Although some law makers in Mississippi state that the bill will never reach the committee and onto the floor of the legislature for a vote; just the thought that someone proposed this is very disturbing. I don’t’ believe this will be the last if this debate. As a country, we are constantly battling racial and social discrimination, but we have not come to real terms with our discrimination of over weight people. Look at how some airline companies want to charge double fair for an obese person if they require two seats. Obese people have been the target of discrimination for many years because their problem is perceived to be controllable. With a law like this, overweight people would continue to suffer across the board. The introduction of this bill this has sparked a dialogue about the obesity epidemic. However, it has given someone else the ammunition to continue the attack on the obese people of America.

Healthcare Proxy and Advance Directives

Healthcare Proxy means “appointing someone to make healthcare decisions for you in the event that you are unable to so yourself”. This has to be in writing. Appointing a healthcare proxy is a big problem for many of us and our patients. This could be due to any of several reasons. The primary one being that “nothing will happen to me”, another is that we do not like to discuss death. It can also be that we have many loved ones (especially children) that we don’t want to offend any by just appointing only one, and in some cases, we just assume that our spouse or parent is automatically our healthcare proxy. In the rare cases where one appoints a proxy, there is no documentation giving the appointed proxy legitimacy because it is not written on paper. Unfortunately, not taking the time to make this important decision and taking the necessary action brings unimaginable suffering to the patient, rips the family apart and places the healthcare practitioners in very awkward position. Many of us hope to live to ripe old age and die peacefully in our sleep, or have a massive heart attack and die instantly, while others don’t even want to think about death at all. The inevitable truth is that we all will die one way or another someday.
Advance directive on the other hand is making one’s wishes known about end-of-life care. In the rare cases that people appoint a proxy, they fail to make their wishes known and this leaves the proxy with a lot of burden as to what decisions to make. This also has ripped families apart. Make your wishes known. Do you want life support or not? Under what conditions?
I work in the medical intensive care unit in a hospital where people die in life support or under circumstances that require decisions of end-of-life issues. It is sad to witness the fights, struggle for power and even accusations that go on among family members at the bedside of a dying patient because there is no appointed proxy or advance directives. There have been cases where the spouse or one child doesn’t want to let go, but another wants to end the patient’s suffering. People accuse one another of not caring about the dying one or of wanting to torture the patient. In some cases, it becomes a power contest. Sometimes others just want to be vindictive for whatever reason. But the issue remains, that a decision has to be made as to the course of care. The question becomes, “who is making this decision for you?” Is it in your best interest?
One particular case involved a man who was separated (not divorced) from his wife for seven years. He lived with his fiancée of seven years in one state and his estranged wife lives in another. Shortly after his separation, he was diagnosed with cancer, his fiancée was with him during his treatments, remissions and relapses. In his final days, he became unconscious and was put on life support. He did not appoint his fiancée as proxy and because she was not his wife, she could not make decisions for him. The hospital has to wait for the wife who hasn’t seen this man in the seven years of his illness to make decisions for him. She wanted everything done. She never showed up at the hospital. This man had to be resuscitated each time his heart stopped (which was several) while the fiancée cried that “he never wanted any of this, please let him go”. Of course the wife’s wishes have to be carried out.
It is important that patients make these decisions when they are in good health and of sound mind. In most states, it doesn't have to involve a lawyer but it has to be signed and notorized. Find out what is acceptable in your state. Physicians are in a better position to educate their patients on this important decision. I understand how difficult it will be for a patient to go for his annual physical and his doctor is talking to him about making end-of-life decisions. However, it is a decision that has to be made and patients cannot make it unless they are aware of it. As individuals too, we have to make these decisions because physicians die too. Let us educate ourselves, our family members and most importantly our patients on the need for appointing a healthcare proxy and having advance directives in writing. It saves everyone the pain and agony of uncomfortable decisions.

ETHICAL ISSUES SURROUNDING ABORTION

Abortion is the most difficult and controversial moral topic in today’s society. Many people view abortion as a murder of unborn children. On the other hand, some people view it as freedom for women. We need to listen to both sides, even if that is difficult to do. Both sides have negative and positive moral insights, even if ultimately these insights are outweighed by the insights of the other side. There are two principal morals we need to consider; first, the moral status of the fetus. Is the fetus a person? At what age in its development does it becomes a person? Conception? First trimester? Birth? Secondly, the right of the pregnant woman, does the pregnant woman have the right to decide if she is going to carry the baby to term or not? As we consider these difficult issues, it is imperative to distinguish two other questions. Is abortion morally wrong or should abortion be illegal? These are distinct issues because not everything that is immoral is necessarily illegal. For instance, it is immoral to be unfaithful on your marriage but it is not illegal. Another argument that is usually advanced against abortion is the fact that the fetus is an innocent person. It is morally wrong to end the life of an innocent person; therefore, it is morally wrong to end the life of a fetus. Much of the debate in regard to abortion has been centered on whether the fetus is a person or not. If the fetus is a person then it has the right that belongs to persons, including the right to life. In my view, women have the right of privacy, ownership of their body, treatment, and right to self-determination. Therefore, I am not against it or for it because everyone has they own freedom and belief.

HPV VACCINE FOR CHILDREN

HPV VACCINE FOR YOUNG CHILDREN

Human papillomavirus (HPV). Vaccine is a vaccine that is focuses on certain sexually transmitted type of human papillomavirus. HPV is known to cause cervical cancer and genital worst. We have now discovered 100 types of HPV about 37 of them are caused by sexual contact. According to the centers for disease control, HPV infection is now common world wild among adults. It is estimated that at the age 50, more than 80% American women would have contacted at least one strain of HPV.

Two years ago, the Texas governor wanted to legislate a mandatory HPV vaccine for young girls in Texas, ages 10 years and above. It was a highly controversial issue in Texas. If the legislation has passed, all 6 grade girls will be vaccinated with HPV vaccine by the state. I am against the vaccination of ten years old girls with HPV vaccine, here are few of my reasons, I am against the government or the state making health care decision for our children. I think is the place of the parent to make that decision for their children. I am not against the consented adult women, for they will have no one to blame if any thing goes wrong inn the near future. What if in few years we found out we were wrong? I don’t know if we have enough statistics to prove the efficacy of this vaccine in human, or any possible side effects that may be detrimental to the young girls. I think if we are worried about the contacting the sexually transmitted disease like HPV we should have massive educational programs for children and their parents. Education can be duplicated, and no side effect it will help more children than the vaccine. If we can stop our children from having early sex that we help prevent the cervical cancer. At the age of 9, 10 the child tissue is not matured any sexual intercourse may traumatize the young tissues; the virus can easily penetrate and cause the cancer.

HPV vaccine should be given to the adult women who are responsible their own decision; the children’s health care decision should be made by the parent who is responsible for their well being. Government or state should not be making our children’s health care decisions. I do not think young people are the Wright population to focus on when the issue is controversial. We need to study the a little more on adults, may while we educate our young girls to avoid early sex, a good education program is ever lasting and can be duplicated. I also think that letting our children take vaccine at that age, we are given them the go ahead to have sex, you now protected.

Jibao L. Musa

UHSA Antigua

"SILLICON WOMB " FOR BETTER EMBRYOS.

"SILICON WOMB " FOR BETTER EMBRYOS

LONDON: A team of UK researchers will soon be conducting trials of a "silicon womb" inserted into a woman's own womb which incubates embryos to provide a more naturalenvironment. The research team led by Simon Fishel, at UK fertility group CARE Fertility, in Nottingham, UK, hopes that this new device may produce better quality embryos and reduce the need to harvest so many eggs from infertile women. Usually, a standard In Vitro Fertilisation (IVF) involves the eggs harvested from a woman to be fertilised in the lab where they are allowed to develop in an incubator for 2 to 5 days. Then the doctors pick up the healthiest embryos to be transferred into the uterus. But, the new device, developed by Swiss company Anecova, allows embryos created in the lab to be incubated inside a perforated silicon container inserted into a woman's own womb. After a few days, the doctors recover the capsule and select some embryos for implantation in the womb. The new device is a step ahead from the standard IVF that requires changing the growth medium of the embryos incubated in the lab, every few hours to provide new nutrients and get rid of waste, while the new device provides a more natural environment. The silicon capsule used measures about 5 millimetres in length and less than a millimetre in width having perforated walls with 360 holes, each around 40 microns across. When the embryos have been transfered inside, the ends of this tube are sealed and the container is connected to a flexible wire that holds the device inside the uterus. It has a thread that trails through the cervix for its recovery later on. A small trial on the device has already been conducted in Belgium and according to Fishel, the results were encouraging but not conclusive. CARE’s trial will be conducted on 40 women, each of whom will be having between 8 and 12 eggs harvested, then half their embryos incubated in the lab, and the other half inside the new device. "We will be able to directly compare the results of the in vitro and in vivo techniques," said Fishel. He also added that women will be made pregnant using only the healthiest embryos no matter which technique produced them. After 2 days, half of the devices used will be removed and the embryos will be tested for genetic defects. The rest will remain in place for 4 days, then it will be possible to assess the more mature embryos visually. According to Fishel, the new device could do away with some of the guesswork out of incubating embryos. "We don't really know the full ambient conditions of the reproductive tract. It is also a dynamic environment that changes constantly, and we can't replicate that," he said. He thought that embryos grown in the device will be more resilient, which implies that fewer eggs may need to be harvested from women to achieve a successful pregnancy. The majority of IVF techniques need the woman to stimulate egg production by taking hormones, which can sometimes lead to dangerous side-effects. However, he confessed that the Anecova capsule will not be placed exactly at the place where an early embryo would naturally develop, inside one of the fallopian tubes. An embryo normally spends around 7 days travelling down the tube towards the womb. "It's a lot closer to a fallopian tube than a plastic tray, but this new device is not an artificial fallopian tube. The trials will tell us whether the environment in the womb will do instead," said Laurence Shaw from the Bridge Centre fertility clinic in London and a spokesman for the British Fertility Society.
After reading the article, I thought what an amazing thing to do , a step further from IVF ,is it not amazing that the embryo will be placed in the capsule ,incubated and tested for genetic defects.My main concern is what the effects of the reasearch will have on the women being used .This is a newly tested techinque , I guess we all will have to wait and see how this advancement works out in the future.
This technique will further make it possible to have a higher probability of pregnancy with the capsule implant ,because it can be monitored and embryo growth can be confirmed ,vs the IVF , which in some cases the embryo does not form well after implant and another IVF is required. This silicon capsule insert is more like in vitro vs in vivo, which I think will be more cost efficent and less stressful on the woman who can go to the Doctor knowing that she has a higher probability of having the embryo form and grow to term. Verses the IVF which has a lower probability and once failed can cause severe emotional stress on the mother.

Reference:
Article from The Times Of India.

Ethical Implications of a Patient's Right to Refuse Treatment

Following the delivery of her child, a patient is bleeding heavily and her obstetrician proposed and received approval for a dilation and curettage to take out the piece of the placenta which had been retained. However the bleeding continued, consent was then sought to give the patient a blood transfusion and it was denied based on religious belief. After an emergency court hearing in which the procedure was approved by a judge, the patient received the transfusion, recovered and was discharged.
This is the case of Stanford versus Vega in Connecticut 1996. Person’s rights to refuse care or life saving treatment have been the paramount of autonomy, and great burden and moral conflict to health care personal who have sworn the oath of beneficence and nonmaleficence.
Melissa Ann Rowland in Salt Lake City is still in jail for criminal homicide with charges stemming from depraved indifference to human life and child endangerment because she refused c-section to save lives of her twin babies contrary to doctor’s advice. Although Melissa eventually consents to c-section but then it was too late, one of the babies died.
The possibility that a patient and people empowered by the patients to speak on their behalf, can refuse life saving treatment for themselves or the patient, and be allowed to do so is becoming dangerous ground for those who have taken personal and professional oaths to save lives. Most human beings are capable of making informed decisions if the are given the ability and knowledge to do so. These decisions are not always acceptable to everyone. In the case of the patient it may be a religious reason, or reason based on fear of the outcome of treatment or on a lack of consensus on the part of physicians. Whatever the reason may be, the number of patients choosing not to undergo treatment is on the rise, and mirroring that increase is the dilemma faced by healthcare providers. The underlying basis of beneficence is that a person should do right unto others and prevent harm. This principle is most sacred in a healthcare facility. However, a patient’s autonomy however crazy sounding or harmful to them is to be respected. Patient’s autonomy shall be upheld at all times. Patient consent is the principle that anyone over the age of 18 has the right to accept or decline all physical interventions, from operations and injections, to help with getting dressed. Providing that a person is competent (that they understand what is going on and the consequences of their actions) and that they are acting voluntarily, the decisions of adults about physical intervention cannot be overridden or ignored. Nurses and doctors can suggest treatment, but should answer the patient's questions and provide a balanced, full picture of the options and their consequences. In both two cases, patient’s autonomy has been severed, patient right was denied for good reasons. While there are laws that states what circumstances a person’s wishes should be respected irrespective of the outcome (permanent injury to invite all in or even death). Health care providers must battle not only their personal desires to save (or attempt to save) a patient’s life, but they must also contend with the legal parameters that govern healthcare operations. In the health care industry there is an ever increasing predicament as to a patient’s right to refuse life saving care. While the patient’s right to refuse treatment is not a new occurrence, nor is the resulting legal action that is usually taken when a patients requests are ignored. Despite the principles of deontology, kentanism and beneficence that guide health care provider, heath care providers should thrive to protect and respect patient’s right to refuse treatment.

Genetic Testing: When does life start?

Based on what you know about pre- implantation diagnosis, do you think that, given a negative outcome, destroying the other blastomeres is taking the life of the baby?

The Blastomere Biopsy is a matter of performing the procedure IVF which has been done for many years and the process is very accurate. By performing the procedure, would allow a couple the opportunity to make a more informed decision as to whether or not they want to proceed with the implantation. In addition, the only other issue with the Blastomere Biospy would probably be a Bioethical one due to the method in which the Blastomeres are disposed of, and why, if not implanted into the uterus.

If given a negative outcome, I do not think by destroying the remaining blastomeres is taking the life of a baby for various reasons. First of all, I believe life starts after the baby is born. A blastomere does not contain any cognitive processes. In addition the blastomere may contain such gross chromosome abnormalities the fetus probably could not survive pass the first trimester if implanted; therefore, leading to a spontaneous abortion. The cells have yet to become a fetus nothing has been implanted into the uterus. I view it as simple cell division in a lab and nothing else.

MALE PREGNANCY-HOW FAR SHOULD WE GO?

Male pregnancy – how far should we go?
Before enrolling into this class I never knew that there was research being done on male pregnancy. This surprised me and gave me lots of questions to contemplate. My first response was, why? If God created women with everything needed to carry out a pregnancy why interfere with nature? Who’s money will be spent on this research just to see if it can be done? Then, is it ethical and morally correct?

The Beijing doctor –doctor Chen Huanran, one of China's most-prominent sex change surgeons -- says he has developed the technology to impregnate a man, and now he wants to use his technique to help his transsexual patients have children of their own.

Chen, who works at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, said he has already lined up four men for the procedure. An internet discussion of his "male mother" project has caused hundreds of men around the country to volunteer for swollen ankles, morning sickness, and the many other joys of pregnancy. Would the procedure be safe? Aren't men missing a really important component, the uterus?
While getting a man pregnant is not quite as easy as impregnating a woman, it is just wrong. First, the man would have to be injected with female hormones to prepare him for the pregnancy. Then the embryo would be implanted, through a laparoscopy in the man's abdomen, near the omentum, a fatty, blood-rich tissue that hangs in front of the intestines. The baby would be delivered, at term via Casearan section.
I feel that it is dangerous, not only for the man, but especially for the embryo that will be implanted. What are the long term effects on human health and environment? What are the personal, social and cultural consequences? Male pregnancy is too ridiculous. It is against human nature. If a man wants a child, he can adopt one. There are so many kids that need homes. We, as health care providers, should be working to improve the quality of life. If there were no other options for having children, it might be a viable solution, but with so many more safe and proven ways for a couple to have children I can find no reason to proceed with the time, talent, medical resources and let’s not forget to mention, millions of dollars on research to fix something that isn’t broken. We surely have not run out of cancers to cure, prosthesis to develop, genetic and aging illnesses that could be prevented or cured, etc. Let’s spend our dollar for high yield, maximum impact research and discourage (i.e. cut off funds) for research that is just someone’s ticket to fame, regardless of human life.
Feb 29,2008
Sabina,R

A LOOK AT XENOTRANSPLANTATION

A LOOK AT XENOTRANSPLANTATION
End-stage organ failure is one of the most highly publicized, controversial public health issues facing the industrialized world today. There is a worldwide shortage of organs for clinical transplantation and sadly, many patients who are listed to receive new organs die while waiting.
Xenotransplantation is the transplantation of organs, tissues or cells between different animal species including humans. There have been advances in understanding the mechanisms of organ transplant rejection. Such discoveries have allowed for reasonable consideration to the usage of organs from other species, such as pigs, specifically engineered to minimize the risk of serious rejection. Also, the use of pig tissue as an alternative to human tissues will eliminate human organ shortages. Other procedures, some of which are being investigated in early clinical trials, aim to use cells or tissues from other species to treat life-threatening illnesses such as cancer, AIDS, diabetes, liver failure and Parkinson's disease.
Xenotransplantation, however, raises many novel medical, legal and ethical issues. Medical concerns partly center on organ rejection, but also include the possible risk of infection. Organisms in host animals may be transferrable to humans and crossover of disease from species to species will therefore be a risk. The effects of xenotransplantation on the human gene pool and possible long-term genetic problems offer a note of caution. Equally, any permanent alteration to the genetic code of animals is a cause for concern.
Should we develop technologies which would allow us to use the organs of other animals in human beings? There are arguments both for and against, but most people really aren't very aware of them. This is unfortunate, because the time when it will be possible to perform such transplants is fast approaching. The first xenotransplants were failures, but things are changing, and usage will be radically increased before we know and we need to be equipped to handle the debate.
There are very good reasons for seriously considering the idea of using organs from other animals. The biggest of these is the fact that almost all of the major problems involved with human-to-human transplants would be eliminated. We wouldn't need to wait until a person is nearly dead before doing a transplant.The surgery could be done earlier when the patient is healthier and has a better chance of surviving. We also would not need to wait until another person has died to find an organ, meaning we don't need to debate when someone has "really" died and when to remove their organs. Also, the transplanted organs do not have to travel several hours from person to person which means that they will be fresher and healthier. The quality of the organs would also be better. In addition, organs will be more plentiful, eliminating concerns about availability and even eliminating some of the cost. Organs for infants would become available, saving even more human lives. These considerations have room for debate and promote continuing dialogue on the ethical, moral, and economic benefits.
Given all of these benefits, is it a realistic possibility to use the organs from other animals. There have been attempts to use primate organs, but those haven't worked as well. One would think that primate organs would be the best candidates, and for a number of different reasons that might be true. However, primates are difficult, time consuming, and costly to rise. Moreover, being primates, people are uncomfortable with killing them for organs. The same is not true of pigs. Pigs breed quickly, grow quickly, and are already consumed for food in large quantities. Moreover, their physiology is close to human physiology, thus they are among the best candidates for non-human organs in large quantities and good quality. The are some health issue related to xenotransplantation of pigs. Such concerns are the transmission of many viruses that humans do not have at this point but can acquire via transplants of the pig animal organs. Consequences may include infections such as influenza, bacterial infections and retroviruses carried naturally by pigs. Here another ethical and medical question rises, “Could it mutate into something which is not neutral, as with pigs, but which is instead harmful?” Yes, that is a possibility.
We just don't know what will happen. We can't. So what do we do? We could save hundreds of thousands of lives if we are able to use pig organs in xenotransplants. We could kill millions the same way, however. How do we weigh the risks? How do we balance the interests of those who would be saved against those who might die? These questions and more create the ethical dilemma in using xenotransplantation. Until we have a consensus with the general public and the scientific world, the use of xenotransplantation will be placed on hold.

Ethics and law
February, 2008

Challenges to Medical Autonomy

Along the line of decision making doctors have always argued that the only person who can evaluate the work of a doctor is a fellow doctor. However, medical autonomy has been increasingly challenged in recent years. The effectiveness of medical treatments has been challenged as the number of court cases increase and when the cost of imdemnity insurance becomes almost unaffordable the societal consequences are far reaching.
We are at the point now when the determination of terminal illness is not soley a medical decision, but rather a hybrid medical, ethical, social, political and legal determination. It is clear that hospital admistrators/managers and health insurance companies have exerted a certain amount of control over doctors. Managers can direct funding from one medical specialty to another; or from hospitals to community-based practitioners. Challenges have also come from the professionalization of other 'paramedical' occupations, especially nursing, which has developed into a more autonomous profession with its own professors of nursing in many universities.

The medical profession is also acutely aware of how the profession as a whole is represented in factual and fictional media. Doctors may still be heroes in fiction, but intense public attention has been given to the villains. Their power to promote stereotypes,as protraying people with mental illness as violent, helps us understand how the media sometimes represent health and illness. The media has breeched taboos to put important and vital issues on the public agenda,in the case of aids, bowel and testicular cancer. It has to be credited with provoking debate on the ethics of scientific and medical developlents and keeping a focus on stem cell research. Medical practioners can with ease suggest behavioural changes to their patients based on what is 'on the news'.

Within medicine, there have been attempts to change the heirarchical structure of the profession and to embrace complimentary therapies such as homepathy and accupunture. The new strides in transgenics, gene therapy and the gamot of genetic engineering will provide many opportunities for collaborative efforts.

HUMAN CLONING: DESTINY AND RESPONSIBILITY

In the sixteenth century, the Reformed theologian John Calvin wrote this about childbirth:
Although it is by the operation of natural causes that infants come into the world ... yet therein the wonderful providence of God brightly shines forth. This miracle, it is true, because of its ordinary occurrence, is made less account of by us. But if ingratitude did not put upon our eyes the veil of stupidity, we would be ravished with admiration at every childbirth in the world.'
Four centuries later, we find that infants do not always come into the world through "the operation of natural causes." The miracle of childbirth has already moved beyond "ordinary meaning" through such procedures as in vitro fertilization. Now that we face the possibility of human life springing not from a fertilized egg but from a clone, we are making great account (some would say too much account) of this possible new way for infants to come into the world. Many people wonder whether this is indeed a miracle for which we can thank God or an ominous new way to play God ourselves. At the very least, it represents the ongoing tension between faith and science.
On the one hand, the church has sometimes taken an overly antagonistic opposition to scientific advances, so that Galileo was charged with heresy for supporting the seemingly unbiblical Copernican notion that the earth revolves around the sun. Darwin's theory of evolution (which apparently even frightened him a bit) is still opposed by some Christians who want equal time given to "creationism." Such examples remind us that the church must not assume that faith requires protection by being shrouded in ignorance. We should be able to celebrate human accomplishments, including accomplishments in genetic research, as the result of divinely bestowed gifts of knowledge and technical skill.
On the other hand, the church rightly understands that sin can lead us to use scientific advances for extremely evil purposes. We can never support the pursuit of knowledge for its own sake apart from asking serious moral questions about the implications of that which we seek to know. To date, we have not been able to keep up with the moral and legal implications of adoption, much less of the dilemmas presented by artificial means of reproduction. We certainly are not yet morally, legally, or spiritually prepared to tend to the difficult issues that would arise if human cloning became a reality.

Proper Health Care Before Money

Proper Health Care Before Money?

As I am reflecting on the present health care system of our country, the United States of America, I came down to one and only conclusion. The conclusion is that we are living in a free market economy. If it is the case, the purpose of every private health insurance or health care institution is to make money. When I say making money, I mean making money at all cost. Maybe, there is nothing wrong with that if freedom or too much leeway is given to those private institutions. Simply with the thinking of making money no matter what, I feel a burning pain in my chest. Why is it an alarming issue? Is there any issue to it? Or, am I making it more than what it is? Well, consider this! It was reported, at the beginning of 2004, nearly 50 million Americans were without health insurance, and the number kept growing higher together with increased number of unemployment.

Millions more have had only partial, inadequate health care coverage. More than eighteen thousand people die in America every year as a direct result of not having access to health care. Beyond that, it was reported that those million people who could afford to pay health insurance were paying more than $100,000 for the hospital stays for their elderly parents in their final days before they died. Four years later, the condition cannot be less alarming than before.

As a reminder to the article 25 of the Universal Declaration of Human Rights that states: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. The idea behind the article 25 is excellent on the paper, not in practice to those it tends to affect financially.

It must be understood, in every civilized country, the rule of law has to be the turning point for its people. Further, civil instructions and moral values are to be the guided accordingly. Those qualities, I may say, are to be taught and reinforced at home, school, and in public enterprises. With normal practice, we will recognize our duty to other people who breathe and have similar needs as we do. In my humble opinion, I believe, it is unethical and immoral to refuse to give medical care to a sick individual on the basis that individual does not have health insurance, or even deny health insurance to an individual because that individual has a pre-medical condition.

I, sincerely, think no one chooses to be an advocate of illnesses. It is an unfortunate course of life, everyone has to face. To conclude, as un-American I may sound, medical care to every individual needs to be top priority, not money. As the old saying, money is a good servant but is an evil master. We need to value and invest in people more than material objects we can leave in a second. And, as a powerful industrial nation, we must strive to understand that the world exists because of our existence. I do not mean to say it in a trivial way. What I am saying is that without any basic understanding of where we are and what we need to do to foster a sense a well-being in our people, all across the board, we are set to continue with the same egocentric attitude that will remain in existence for centuries to come.

Ronet Jean, MS. PT., MHC

Medical Student, UHSA

School of Medicine to the World, Antigua.

WHAT IS LIFE?

Ethics as a subject is not only very interesting but very important in this generation. The second law of thermodynamics states that the entropy of the universe is increasing. Restated, the universe has a tendency for disorderliness. Over the years, man being a component of the universe has demonstrated the truth in that law by various activities of man that has plunged the world from one catastrophe to another.
The most recent global event is the second world war which led to the death of 60 million people. Notable during that war was the scientific experiments during which people were treated as commodities. The chilling effects of that war moved world leaders, including medical doctors to hold series of meetings to prevent future occurrences .The outcome of such meetings are far reaching. It gave rise to:
1 The Geneva Convention on Human rights [http://www.un.org/Overview/rights.html]. This observed that contempt and disregard for human rights resulted in acts that are outrageous to human conscience therefore ruled that no one should be subjected to torture.
2 Three months earlier, the World Medical Association[ http://www.cirp.org/library/ethics/geneva/] adopted the Physicians' oath. The 6th verse says, '' I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity''


After the industrial revolution knowledge has increased and with it science. Science has contributed a lot in uplifting the life of individuals. However, man if left uncontrolled, like the universe, drifts to chaos. This underscores the importance of currently hot topics, in the media, scientific conferences, and labs, namely Abortion, stem cell research, cloning, genetic engineering etc Undoubtedly, if the end is of primary importance, all of them are very beneficial, however, if the means is put in question, one can say that it appears we have quickly forgotten the second world war, it appears as if we are drifting from the resolutions taken after the war and the physicians oath.
Both the Geneva convention and the World Medical Association uphold the dignity of human being. On the contrary one feels that the proponents of the above topics regard the human entity as a commodity. Also, whereas the physician oath recognizes life as starting at conception, abortionists, and perhaps embryonic stem cell researchers argue 'it is not yet human'. Where then is the place of the oath?

Another subject of concern is the subject ' life'. What is life? For more than 400 years scientists and philosophers have been asking that question. This question moved the physicist, Erwin Schroedinger in 1944 to write a book with that title. To date, nobody has an answer to it. Carl Zimmer[http://www.seedmagazine.com/news/2007/09/the_meaning_of_life.php?page=3] wrote that in a meeting hosted by the American Association for the advancement of science in 2001, entitled, “The Nature of Life.”a leading Philosopher with NASA said scientists should stop looking for the definition of life as they can't understand what life is and that either it is impossible to define life or it is trivial. To wrap up, this scientist is quoted as saying, “We don't want to know what the word life means to us. We want to know what life is," Carl Zimmer, also said that, Radu Popa stated in his book, “Between Probability and Necessity: Searching for the Definition and Origin of Life” that he came across about four hundred definitions of life in scientific literature while researching his book. Rabu Popa is quoted as saying, “"A science in which the most important object has no definition—that's absolutely unacceptable,"

From the forgone, one can summarize that scientists are confused about life and lack the capacity to determine life. If that be the case, one is surprised that they and abortionists are busy destroying the same life they know nothing about.

Concluding, I will like to draw lessons from history. Kenneth Stampp, said ''With the historian it is an article of faith that knowledge of the past is key to understanding the present. http://hnn.us/articles/1328.html “http://hnn.us/articles/1328.html ”Neglect of historical knowledge is to a nation what the loss of memory is to a man'' [ W. Stubbs, http://web.jjay.cuny.edu/~jobrien/miscellaneous/ob46.html] ''We learn from History that we never learn anything out of history''.[Hegel, http://hnn.us/articles/1328.html]. Since man has been at the center of most of the crisis the earth has faced since historical time it is best not to allow man decide on what will impact on the future. I am for the “ Modified Divine Command Theory” [http://www.iep.utm.edu/d/divine-c.htm]

Mary Chukwu

UHSA

WHAT'S THE DIFFERENCE?

Euthanasia and physician assisted suicide

What’s the difference?

In the past decade I have gained significant understanding about attitudes towards euthanasia and Physician assisted suicide in the United States, as well as the practices themselves.

One of the problems plaguing the field of euthanasia and PAS is vague and emotionally laden definitions. The term euthanasia without a qualifying phrase means voluntary active euthanasia; that is, the physician intentionally ends the patient's life at the patient's request and with the patient's full informed consent. This is the intervention that has been the subject of intense public debate and controversy. Only a few people argue for nonvoluntary active euthanasia, which is generally viewed as wrong. On the other hand, PAS refers to the physician's act of providing medication, a prescription, information, or other interventions to a patient with the understanding that the patient intends to use them to commit suicide.

The terms "passive" euthanasia and "indirect" euthanasia are occasionally heard; these are incorrect terms because they are not really types of euthanasia. Passive euthanasia is the practice of terminating life-sustaining treatments, such as respirators and artificial nutrition. I can still recall the case of the Florida woman Terry Schiavo . For centuries these practices have been deemed ethical and legal. Similarly, administering opiates or other interventions that pose the risk of death, so-called indirect euthanasia or palliative sedation, is deemed ethical. Since the discovery of ether anesthesia and hypodermic morphine in the 19th century, medical societies have endorsed their use for terminally ill patients even if the patients die from respiratory depression, as long as the intention was pain relief. Again, these are not cases of euthanasia, and the term should not be associated with them; it only confuses nonexperts like us. The question is, what is the difference? I simply cannot distinguish between the two.

For the sake of argument, I would favor permitting or legalizing euthanasia and /or PAS for the following reasons: First, it is argued that individual autonomy justifies euthanasia and/or PAS. If autonomy means that individuals have the right to pursue their own personal view of what kind of life is best, including when and how to die, then to respect autonomy requires permitting individuals to decide when it is better to end their lives by euthanasia or PAS than to continue living.

Secondly, beneficence means furthering the well-being of individuals. This also supports permitting euthanasia and/or PAS. In some cases, living creates more pain and suffering than death. In these cases, ending a painful life will actually relieve more suffering and thereby produce more good. In fact, just the reassurance of having the option of euthanasia or PAS, even if people do not use it, can provide "psychological insurance" and be beneficial.

Thirdly, in my opinion, euthanasia and PAS are not different from terminating life-sustaining treatments, which is recognized as ethically justified. In both cases, the patient consents to die, in both cases the physician intends to end the patient's life and takes some action to cause this to happen; the final result is the patient's death. If there is no difference in patient consent, physician intention, or the final result, there can be no difference in the ethical justification.

Finally, the supposed "slippery slope" that would result from permitting euthanasia and/or PAS is not necessarily likely. Some say permitting euthanasia or PAS will undermine the physician-patient relationship or lead to forced euthanasia is completely speculative and not borne out by the available data, and therefore should not govern public policy.

MOHAMED

Womb for Rent?

TAKE a sperm donor, add an egg donor, mix in appropriate lab conditions and rent a womb for nine months. That’s the recipe for a surrogate baby.

Surrogate motherhood has been a controversial practice ever since the widely-publicized "Baby M" case in 1986. That's when surrogate mother Mary Beth Whitehead fought an unsuccessful court battle for custody of the child she was paid to bear for another couple. Since then, a quiet and fundamental change has swept through the business known as "commercial surrogacy." Unlike Mary Beth Whitehead, most surrogate mothers today are not genetically related to the children they carry. That fact may increase both the number of babies born this way and the legal security of the arrangements.

Surrogacy by gestational carrier is simpler in some ways since the surrogate has no genetic link to the child. Surrogate parenthood involves expensive procedures but it is now entirely medically viable. The money that's being used when you are working toward a surrogacy arrangement isn't purchasing a child. Since no surrender of parental rights is necessary, payment for the services of a surrogate would not be in exchange for surrendering parental rights. That makes it an option for wealthy people with fertility problems and no desire, for whatever reasons, to adopt.

In the US there is no national policy regarding surrogacy. Each state has come up with their own legal approach to this relatively new method of procreation. The laws vary from making surrogacy contracts enforceable to criminalizing all forms of commercial surrogacy. In general many of the laws have been the result of cases which have gone to court which has left judges to essentially write the laws with each ruling. Those laws usually are designed to protect women from exploitation and tend not to hold genetic fathers in the same regard as birth mothers. The cases shaping laws today tend to address the issue of whether a contract can be binding can a woman sign a contract regarding custody of a child not yet conceived with informed consent, can payment be made to a woman for her reproductive services but not the final product of a surrogacy? These questions are legally and morally baffling at best and so while legislature tries to keep up with the ever changing reproductive needs of its citizens many states are left with laws which require parents to adopt their own genetic child and other such actions which at first glance seem to make little sense.

The concept of commercial surrogacy may make you uneasy. But in an ideal case, everybody concerned is happy. And, if surrogacy is a de facto industry, it needs safeguards to protect its workers, like any other industry. It needs standard, enforceable employment contracts. Otherwise, there is room for abuse and unhappiness. Above all, the best interests of the child should be the paramount issue in any surrogacy legislation and resulting surrogacy arrangement.

Ref: http://www.everythingsurrogacy.com/cgi-bin/main.cgi?Laws#general

LIFE IS NOT A BOX OF CHOCOLATES

As life progresses and with increased exposure to different environments, cultures, and value systems, it is only a natural process to ask yourself, “what do I really believe?” The answer to that question seemed so easy 12 years ago when I was living in a small southwestern Virginia town at the age of 18, fresh out of high school and on my way to change the world. There was right and wrong, black and white, donkeys and elephants. Those were the basics that would carry me through life, right??

During my undergraduate work, I was exposed to men and women from all over the country. With that came continuous heated discussions of interracial relationships, the latest political topics, homosexual rights, and all other controversial topics that typical excited, eager teenagers enjoy arguing. At that time I was openly opposed to all freedom rights of the mother. How could a woman choose to abort this wonderful creature that she developed?? Life at that point had not exposed me to hardships that many men and women face every day.

Moving to New England for three years came the cold but also a new perspective to the world of “the lefties.” Die hard Democrats. At that time I was training in various clinical offices that offered an array of diverse medical conditions. For the female population, in particular, I saw a mother battling bipolar disorder while having to feed and clothe 4 children under the age of 8 (which ultimately led to Child Protective Services removing the children from the home). I witnessed a 14 year old girl discuss her own pregnancy with her mother (whom was also pregnant at the time). I saw the physical, financial and emotional hardships one woman faced raising her only severely handicap son on her own. The list goes on. I decided at that time that I cannot save the world; however I can certainly provide some education.

When I settled in Maui, Hawaii, I started working in Family Practice/Urgent Care and attracted a younger population of patients, primarily women age 13-45. In discussing issues such as pregnancy, STD’s, child rearing and sex, it seemed the majority of younger women were not comfortable discussing their social history with their parents. Time and time again I heard, “Will my mom find out about this?” or “Do you promise you won’t tell. My parents would kill me.” The reassurance was of course given but also what was given was factual, evidence based medical information on life issues applicable to women of child bearing age.

Humans were developed in a systematic manner. Women were designed to begin child rearing as early as 9 years old. It is these biological changes that conflict with emotional and “societal” maturity. Unfortunately not all parents’ view their children as emotionally/socially inept, regardless of their biological maturity. Equally unfortunate is the discomfort seen when discussing heavy issues with women of child bearing age and their parents.

Subject bias benefits no one. Individualizing and remaining open to your patients’ social and personal concerns will establish a sense of trust and understanding between you and your patients (regardless of age). Through life’s path I have become aware of the complexity that young women, in particular, face in determining the best outcome for both themselves and their offspring. It is important as health care providers to deliver an unbiased truth of the medical facts that accompany these social issues. In this way we can allow our patients to make educated decisions about what is best for their personal wellbeing.

The Ethical Issues Surrounding Rural Health Care Delivery

Is it ethical for rural residents to be deprived of an adequate health care system?

One of the major challenges rural areas are facing is lack of physicians. Physicians are not attracted to practice in rural areas for several reasons. First, the demand for their service may not be to their satisfaction. Since the revenue of physicians is often dependent on the number of patients they see, their income will be directly affected by the lack of demand. For this reason, they much rather service areas where they are needed to maximize their value. Their goals are not to perform charity care or work in an area that will eliminate their opportunity to maximize their income. Their goal is also not to under utilize all of the skills and knowledge they acquired during the course of their training. Working in a rural area will not generate the opportunity to maximize their value and grow in their profession because the area is too scarce. It is even more challenging to have specialist and mental health providers because the demand is not evident. For this reason there is a massive shortage of specialist and mental health providers. A neurosurgeon will probably undergo at least 17 years of post secondary education. His annual salary is obviously dependent on the number of surgeries performed. In a rural area, it is vastly doubtful he will have many opportunities to utilize his skills.

A second major problem is generating funding to build a hospital. The federal government is not in the business of delivering health care. It is not economically logical to build a huge facility that will not demand a constant rotation of patients. In the past, it was difficult to attain 50% above occupancy rate in a 30-49 beds facility. There are not enough available funds to operate such a facility. A hospital cannot afford to employ doctors, nurses, technicians, nurse practitioners, physician assistant and administration staff on a daily basis if the beds are not occupied. Unlike the urban areas, there will not be enough volume of patients requiring services from doctors and nurses to compensate them. In order to operate a hospital financially, quality care and capital needs to be generated on a daily basis. It is crucial for a hospital to receive adequate amount of patients to be successful.

The United States have made some efforts to overcome some of these challenges. In 1948 they started the Hill Burton Act. This bill took federal money to build hospitals. Over 3,500 hospitals were built however many shut down due to lack of funding and problem noted above. Another method that was used is telemedicine. This was geared towards radiologist. Radiologist was able to diagnose patients using imaging studies. This method was effective because physicians were able to view these imaging away from their office. Although this method brought some resolution to the problem, it opened another drawback which was lack of physical contact with the patients. It is important that patients are physically examined and consulted by a clinician. This is just practice of good medicine. Two other ways the government made some efforts to alleviate some of these challenges were through paraprofessional and ambulatory care clinic. It was obvious patients needed to have physical contact with the physicians. These two methods were able to subsidize health care to rural area. Patients had a location to be treated and evaluated by a clinician.

The question states is it ethical for rural residents to be deprived of an adequate health care system? In my opinion, the elimination of the deficiencies is warranted. In order to eliminate the deficiencies, recruitment of more physicians who appreciate the challenge to work in rural areas is necessary. I understand the privilege that comes with being a doctor; however, the reward stills lies on providing quality care to patients in need. With the assistance from the government, special grants and scholarship can be offered to medical students, PA’s and NP’s with the commitment of servicing rural areas for a period of time upon completion of their studies. Loan repayment for licensed physicians who are willing to commit their services to a rural area is also an attractive incentive. Educational scholarships to current residents of the rural areas may generate committed providers because since they already live in these rural areas, they are more likely to stay there once they complete their education. As an alternative, I would recommend the establishment of mini care stations throughout the different communities of rural area. This has proved to be quite useful in many states because of its convenience and cost effectiveness. Care station offer basic primary care services at an affordable rate. They are usually employed by physicians and cost effective mid level clinicians and are available on a walk in and appointment basis for non emergent and semi-emergent cases. The facility is not as big and costly as a hospital but offers more than a private doctor’s office. Instead of having one big hospital, the idea of having a few mini care stations could bring better results. I would also campaign for more preventative medicine strategies. Until the shortage is resolved, the healthier the rural residents remain the less doctors, facilities and specialist will be needed. Physicians should not base their decision of where they will practice on the basis of the potential income they will generate; it should be based on the need and the difference their commitment will make in the lives of all human being. Urban or rural, rich or poor, black or white, female or male.

SPIRITUALITY AND END OF LIFE CARE

SPIRITUALITY AND END OF LIFE CARE

WE CAN HELP BY SIMPLY BEING PRESENT

Although we have not yet discussed the subject of death and end of life decision makings, I would like to take this great opportunity to address the role of the clinician and share my feelings about the ill and dying patients. A sudden death is very different from someone that is chronically ill and expecting to die. When you die suddenly you do not have time to think, feel or express any feelings about death. In the contrary, when a person knows that will die than he/she has the ability and choice to prepare spiritually, religiously and culturally.
We as health care professionals have the opportunity to assist our dying patient with their decisions by just “simply” being present and allow the patient to practice their cultural and spiritual beliefs, and if possible take place and act when appropriately along with them.
Religious, spiritual, and cultural beliefs and other practices play a significant role in the patient’s life that is seriously ill and dying. In addition to providing an ethical foundation for clinical decision making, spiritual and religious traditions provide a conceptual framework for understanding the human experience of death and dying, and the meaning of illness and suffering.
Most patients derive comfort from their religious/spiritual beliefs as they face the end of life, and some find reassurance through a belief in continued existence after physical death. However, religious concerns can also be a source of pain and spiritual distress, for example, if a patient feels punished or abandoned by God.
A common goal for the dying patient, family members, and the health care professional is for a meaningful dying experience, in which loss is framed in the context of a life legacy. Such an experience includes support for the patient's suffering, the avoidance of undesired artificial prolongation of life, involvement of family and/or close friends, resolution of remaining life conflicts, and attention to spiritual issues that surround the meaning of illness and death. Clinicians can and should help dying patients find meaning and hope through recognition of the spiritual dimension of their experience. Although they may lack the expertise to address spiritual concerns in depth, healthcare professionals should be able to discuss spirituality with their patients and identify those in spiritual distress so that appropriate referral may be made to spiritual care providers. These include chaplains, community-based clergy, spiritual directors, pastoral counselors, and culturally based healers.
An important component of spiritual care has to do with the relational aspect of the healthcare professional-patient partnership. All clinicians should strive to deliver relationship-focused care that is delivered in a compassionate, caring manner. Compassion means "to suffer with", and to render compassionate care requires a commitment on the part of the healthcare professional to be a partner with the patient in the midst of their suffering.
This means: Being fully present and attentive to the patient during the time that the healthcare professional has with that patient.
Creating an atmosphere of trust where patients and their family members can share their deepest concerns. Instead of focusing on agenda-driven conversations about treatments and outcomes, being more open to the patient and listening to his or her concerns, beliefs, hopes, fears, and dreams. The focus of care should be on the whole person, including the physical, emotional, social and spiritual aspects of the individual. Treatment plans should be formulated that incorporate what is important to the patient.
An important component of this exchange is listening fully to the patient's story: who they are, what they value, how they make decisions, who is important in their lives, what gives their lives meaning, and how they understand illness and dying. Giving voice to patients who cannot speak for themselves. This comes from either knowing the patient from previous clinical encounters, or learning enough about him or her from family, friends, and/or their spiritual or religious communities to be able to defend what is important to them, even if it conflicts with what may be the recommended evidence-based course of action.
Focusing on the inherent dignity of all people regardless of their physical condition. Providing the patient and his or her family with opportunities for closure, forgiveness, and the best quality of life that can be achieved.
Some patients may request that the healthcare professional pray with him or her. The extent to which this is possible depends on the clinical setting and circumstance and the individual beliefs of the patient and healthcare professional. Clinicians or other healthcare professionals should never feel obliged to pray with patients; some clinicians and healthcare professionals may feel comfortable with the requests, while others may not. A clinician or healthcare professional should never coerce a patient into praying or into accepting the prayers of the clinician. That could potentially violate the trust a patient places in the clinician and be outside the boundaries of legitimate medical practice.
Spiritual and religious beliefs, values, and practices play a significant role in the lives of patients who are seriously ill and dying.
Some important considerations for physicians and other healthcare professionals regarding spirituality include the following:
For patients facing the end of life, spiritual care is interdisciplinary collaborative care, and requires the participation of all members of the healthcare team. Clinicians should clarify the patient's concerns, beliefs, fears, and spiritual needs, and be sensitive to comments that may indicate spiritual distress. Active listening and supportive dialogue may help patients work through existential issues and find peace. Patients who are in spiritual distress should be referred to certified and trained spiritual care professionals such as chaplains, spiritual directors, pastoral counselors and clergy.
All clinicians should strive to deliver relationship-focused care that is delivered in a compassionate, caring manner. This includes being fully present and attentive to the needs of the patient and all aspects of the patient's suffering—the physical, emotional, social and spiritual, and creating an atmosphere of trust where patients can share their deepest concerns. Clinicians should be knowledgeable about and sensitive to the individual death practices and customs that characterize the major world faiths. Attending funeral services for patients who have died may mean a great deal to the family, but may also bring closure to the healthcare professional.

In closing, I would like to thank Linda MacDonald Glenn, my professor, teacher and inspirer who made all this possible for us to voice our feelings, thoughts and expertise to the world. In addition, thanks to all fellow classmates for being there at all times of the good, the bad and the ugly.

Furthermore, thanks to University of Health Sciences (UHSA) that brought us all together. Indeed, UHSA is education to the world and providing doctors beyond borders.

John Aidonis, BC-FNP

Medical Student, UHSA

February 25, 2008.

KEEP IT SIMPLE, PROCHOICE IS PROLIFE

PRO-CHOICE, A PRO-LIFE DECISION

KEEP IT SIMPLE

Well, this Bioethics and Law course has certainly been one of my favorites. What a wonderful opportunity to learn other health care professionals opinion on some very controversial issues and why they feel that way. Being from the South, and probably the only Republican Southern Baptist on the island has certainly put me in the middle of most of the controversy. My classmates know I am passionate about what I believe and blessed with the “gift of gab” so this course has been a wonderful outlet for me!

It would seem that no matter what the topic of the day was, our class would inevitably migrate back to “when does life begin” and how do you feel about unwanted pregnancies.

Having discussed this in great detail over the last few months and having read many profound and well written and documented details on the facts of embryology and fetal

Development, I feel I have broadened my horizons extensively. Many will wish that I had been “converted”, but know what a tough sell that would be. As passionate as I am about life, children, varying levels of different abilities of humans, and my moral believes, I am equally passionate that everyone else has that same right to their opinion and beliefs as I do. I don’t seek to change theirs and ask they not seek to change mine. Agree to disagree. Having said all of this, finally brings me to a brief point I would like to make and share with fellow students before, during and after me.

Let’s just keep it simple. We have tried so hard for so many years to convince each other that we have the correct interpretation of ethical issues, that maybe it’s time to just get back to the basics of life. A doctor came into my mother’s hospital room and put a stethoscope to her chest and waited. No heartbeat. Time of death 5:55pm. We place a stethoscope on a mothers abdomen at 3 weeks and sometimes earlier and, we can certainly use a ultrasound and visualize what is yet too faint to hear before a woman realizes she will not have another menstrual cycle and there it is, life has begun. Yes, admittedly, there are some circumstances that influence each situation, but that answer is pretty cut and dry. If we kill a caterpillar before it is a butterfly, that does not change the fact that left to develop and mature, it is and will be a complete product. Humans have to develop, that doesn’t make them nonhuman or dead. Let’s stop while it is still that simple and just go with that in almost all circumstances that would answer the first question, When does life begin, Is it killing a baby to have an abortion, and when can you abort without ending a forming life? If someone is contemplating abortion, that moment has probably already arrived and (see above instructions), pick up a stethoscope and let them decide.

Next is the right to choice. Again, let’s keep it as simple as possible. Having cleared up the above issue should make this even more simple. Unless you have no aversion to taking a life, it’s again pretty simple. Birth control if you plan ahead. Adoption or taking responsibility for your lack of planning if plan A is not in place or failed. There you go, Freedom of choice, pick one. You have the right, nay, even dare I use the word, RESPONSIBILITY?? Yes, you say there are circumstances that make it hard to imagine bringing a child into this world. Teenage pregnancy is bad, but I personally know a apple of Grandma’s eye that we can’t imagine life without now. Yes, it was hard. Yes, lives were changed forever. Yes, a life that is irreplaceable was given to us to enjoy. You deal with what you have to. I know handicaps and disabilities are hard for people to look at and imagine having to deal with 24/7. I have personally seen the look of pity in peoples eyes as they watch my beautiful, yet legally blind 7 year old struggle to play T-ball, and ride the merry-go-round, and watch Hannah Montana. But you know what? She doesn’t know she is the one with a problem. To her, everyone sees just like she does. That is all she knows. I can’t imagine life without her for sure and I will never know the countless number of people she has inspired to enjoy life. I will forever be thankful for a teenage girl that didn’t believe she could deal with a handicapped child and gave me the most precious gift I will ever receive, her child. Bless you forever.

Yes, life is hard at times, and we face decisions we can’t imagine how we will handle. You just do the right thing. Two wrongs doesn’t make a right, never was more appropriate. It will be ok. Talk to someone. Ask for help. Make an informed decision. Make a choice. Keep it simple. Life will get more complicated. Let’s let the easy stuff go and work on some really tough issues for a while.

Just a simple opinion from a country girl with a simple upbringing, but educated enough to share some information, some experience, and a shoulder if someone needed it.

Best of luck fellow physicians, Keep It Simple anytime you can!!!

Anita Turner, FNP

UHSA Med Student

Feb. 22, 2008

The New Eugenics?

Ethics frequently lags behind science because it is the explosive rate of scientific discovery that provides the raw material for ethical discourse. Yet, it is the hand of societal ethics that holds the reigns on scientific progress. Frustrating as this must seem to people suffering from disease, this relationship bestows important controls on a potentially uncontrollable situation. This was clearly illustrated to me through media manipulation at a In Vitro Fertilization (IVF) conference that I attended this week. The following quote was flashed on the screen without citation during the first click - "He who is bodily and mentally not sound and deserving may not perpetuate this misfortune in the bodies of his children...One day, however, it will appear as a deed greater than the most victorious wars of our present bourgeois era" Well that sounded reasonable enough as we were discussing Pre-Implantation Genetic Diagnosis (PGD), until the source was cited: Mein Kampf (1924), Adolph Hitler.


Although PGD is costly and reserved for Assisted Reproductive Technology (ART), the path that we are embarking upon may be treacherous at best. As parents we certainly want the best for our children. Unfortunately it is not much of a stretch from there to the following conclusion: what is best for our children is to make the best children. This may sound like a pretzel postulate, but not when you follow the thought to its conclusion, it has frightening implications for those in our society who are not "the best".

I have great empathy for those who must live their lives contending with mental and physical challenges. It seems reasonable enough to eliminate suffering if possible and we have the ability to do just that in a small but significant population for whom PGD may be utilized. I am not an advocate for eugenics, but what seems reasonable enough now could once again spiral out of control. If Hitler had the science we now have, it seems fairly likely that PGD not only would have been widely used, but most likely abused. To prevent this it is incumbent upon us to use the hand of ethics to hold the reigns of science.

Although I would like to see an end to disease and disability, the creation of a group of made to order babies would further marginalize those in our society who were not born with the benefits of a healthy body. I foresee a day when correcting genetic defects will become a matter of course. The discussion should be multifaceted and must include not only what is possible but what is advisable. A robust ethical debate is the best navigator to steer us down a moral path. There was a time when very few people even knew the gender of their unborn child. Today PGD affects very few people, tomorrow will be different.

On Hiatus -- But We'll Be Back

In case you were wondering where we went, we're just taking a well-deserved break -- waiting for the fresh new faces of students at the University of Health Sciences Antigua, "medical school to the world".

Minor's-right-to-privacy --- by Pam Haws

In the state of Alabama, the age of consent for medical treatment is 14. A 14 year old has nearly the same rights to treatment and privacy as does an adult, when it comes to health matters.

I recently brought our 15 year-old son to the large children's hospital in Huntsville, AL for an outpatient test called a barium swallow. When we checked in, the registrar totally ignored me and turned all her direction and attention to our son. She also gave him a piece of paper and said, "If you want your mother to know the results of your tests sign this paper." My son's eyes lit up with a smile when he realized that it was up to him if I could know the results of his test or not. I interjected that I was the one paying for the test and that if I don't get to know the results, then the test wouldn't be done and we'd leave right now. He signed the paper without problem.

If a parent brings their 14 year old into the office or hospital for a pregancy test or screen, it is up to the child if the parents can know the results or not. I find this very wrong. A 14 year old can also go to the the health department and get a "brown bag" full of condoms--no questions asked, get BCP, or even an abortion without her parents knowing about it legally. Yet this same child cannot vote, drive themself to the doctor, support themself financially, and barely knows enough to function in society. How can teenagers be legally allowed to make such vital decisions without parental involvement? How can they be allowed legally to hide vital information from their parents?

As concerned parents of 5 children, we care about our kids and want to be involved in our children's lives. Sometimes the restrictions we place on them seems unfair to them and they may rebel. But it is done for their "own good." Most people don't have children to just let them run wild and do eveything they want to. Everybody knows how difficult it can be to raise teenageers and giving them this control over their health could be very detrimental for rebellious or "scared" teens. I feel it is better to have laws that support a parent's role and authority until they are adults, not take away from it. (I also feel at the same time that there should be assistance for teenagers that are in an unsafe home environment where devastating disclosures might cause physical harm.)

I think most parents are concerned about their children and want to be a part of any hard decisions they may be going through. But if the parent doesn't know that they are addicted to drugs, then how can they help their child? If a 14 or 15 year old is pregnant, how can parents help their child cope or make difficult decisions when they don't even know she is pregnant? Where is the child turning to for help if not the parents--some strangers at planned parenthood or their peers? I think it is a parental right to be able to know any health issues or test results when they are living under your roof, you are providing for their sustenance, and you are responsible for their welfare.

A parent is responsible for their children, but the law allows the child to hide vital information from the parent. This does not seem logical or proper or in the best interests of a minor child. I think this law in Alabama should be changed from age 14 to at least 17, preferably to age 18 where one is normally considered "adult." How do you feel?

Maternal-Fetal Conflict

In this blog entry, I would like to address maternal-fetal conflict and personal beliefs, which many physicians encounter throughout their career. Respecting the patient’s beliefs and values is an important aspect of the medical profession. An effective therapeutic relationship between the patient and the physician is based on a bond of trust, known as fiduciary relationship.

We know that patients bring cultural, religious and ideological beliefs into their relationship with the physician. Failure to take the code of professional ethics seriously can undermine the patient’s ability to trust the physician. It may also encourage persons with non-mainstream cultural or religious beliefs to avoid seeking medical care.

In caring for pregnant women, the health of two patients, who are individually viable, must be considered. Most pregnant women will accept some risk to their own health in order to promote fetal health. However, ethical issues arise when women refuse medical therapy which could be life-saving for her fetus. Ethical principles of beneficence and nonmaleficence come into conflict when what is required to benefit one will cause harm to the other.

In general, the legal status of a fetus is determined by the pregnant woman or both parents. US courts have ruled that “a child has a legal right to begin life with a sound body and mind.” This creates a legal duty, on the part of a pregnant woman, to protect the health of her fetus. Refusals of hospitalization, intrauterine transfusion, or surgical delivery have been legally challenged on the grounds of an obligation to the fetus. Failure to fulfill that duty is subject to charges of abuse or liability for damage to the fetus.

As a physician, what would you do if maternal decisions are based on specific beliefs? Suppose your patient is a pregnant woman who presents with preterm labor, at 28 weeks gestation. Her contractions are successfully stopped with terbutaline (an asthma medication that is commonly used to treat preterm labor). However, she later states that she does not believe in medical interventions and will not follow treatment. She also tells you that God will not allow her, and that He had communicated this to her.

PATERNITY RIGHTS FOR RAPIST?

Paternity Rights for Rapist

A recent law in South Dakota, we can only assume, was passed to protect the rights of the unborn child. The South Dakota Women's Health and Human Life Protection Act (HB1215) makes it illegal for women to have abortions unless their lives are in danger; regardless of whether they were raped or victims of incest. This same law also gives that rapist or molester, parental rights once he has served his time.
What lawmakers have failed to recognize is that by their efforts to protect the child, they have taken away the rights of women; especially those who have been victimized and traumatized, and given them to criminals. More specifically, men who attack and violate women are given rights they don't need or deserve. In the end, it is the child who will suffer most. Obviously, recidivism rates among rapist were not a consideration for these lawmakers. Additionally, the pathology of the sexual preditor that makes him so dangerous is often due to his need to exert emotional control and dominance. Is this not patholotrophic for the sexual preditor.
It's sad to say, but it's another case where the rights of everyone else supersedes the rights of the person who will be most affected by the entire situation, the victimized woman. It is unthinkable that in the year 2006, a male dominated world is still controlling women's lives as if they were property. This is a personal decision that can and should only be made by the person who has to live with that decison everyday and eventually die with that decision.
Of significant note, is the bills definition of fertilization which is defined as the period in time in which the egg and sperm are united. This definition leaves questions regarding the legality of emergency contraception. Based on the physiology of the reproductive systm, an ovulating women may in fact be pregnant at the 24 hour mark. Does this mean that emergency contraception would not be an alternative for the rape victim?
Lawmakers argue on the grounds that they are advocates in defense of the innocent victims who cannot speak for themselves, the unborn fetus. However, I pose this question. Who are the advocates for the original victims, the women who suffer the humilitation and physical burden of the most emotionally devastating vicious crime? It should be a crime against humanity to make such a law that does not give a victim of a sex crime the freedom of choice.

Removal of a Ventilator

Removal of ventilator in a conscious woman due to non payor source is inhumane and unethical.

Frantz Francois

Tirhas Habtegiris (1978- December 14, 2005) was a legal female immigrant from Eritrea ( East Africa ). She was a 27 year old terminal cancer patient at Baylor Regional Medical Center in Plano, Texas. The patient was removed from the respirator because she did not have any medical insurance and her family was unable to pay the hospital bills. Ms Tirhas Habtegiris was given a ten days notice, and then , with the bills unpaid, withdrew her life support on the eleventh day despite her last wishes to allow to see her mother for the last time. Her wishes were not granted, the respirator was removed, and it took Ms. Habtegiris about 15 minutes to die.
From my perspective view I think it is very wrong from the Baylor regional medical center to decide to end up someone life because she does not have any proof of coverage. This is very wrong to give a patient only ten days to find alternate placement when your are on respirator and without any coverage. That is not sufficient time. The hospital could not even wait for the mother of the dying patient to arrive from Africa to comfort her for the last time. In this country, you do not have no money or insurance: you are nothing, you are not a human being.
This is very immoral and unethical. We are talking about a conscious woman, not in a vegetative state, removed from a ventilator, dying while knowing that she is suffocating to death, after being allowed only ten days to find alternatives. Could you imagine what it must be like to know that you are dying for fifteen minutes. Reflect on a conscious person knowing that life-givingair was being cut-off. Sit quietly for 15 minutes and contemplate how hopeless and horrifying that must feel.
Ms. Tirhas was awake , alert, and aware of what was about to happen, and her last wish was not granted. Just to allow her to die in her mother’s arms. That was very cruel.

Paying Organ Donors

In United States, it is estimated that more than 80,000 people are on organ transplant waiting list. Out of this number more than 5,000 die waiting for an organ because there are not enough organs for transplant. According to the United Network for OrganSharing (UNOS), about 16 of those on organ waiting list die every day. For the past three decades organ donation system has depended only on altruism; that is people decide to become organ donors because they are driven by the passion to help their fellow human beings. The traditional effort to get people to become donors is through education and public campaign. Organ transplantation is a big business in Medical Centers. Every transplant center wants a share of the profit. For example, the estimated cost for heart transplant during the first post transplant year is between $393,000.00 and $480,000.00. Due to the shortage of organ donors and the long list of people waiting for organ transplant the AmericanMedical Association set up a panel to study and come up with a recommendation on ways to increase organ and tissue donation. One of the recommendations suggested by some members of the panel is to offer money to living donors and to family members of dead donors. Paying people to donate organs is not ethical and not morally right. It will open doors for people to donate their organs if they are in need of money. This means a healthy person would risk his or her life for the sake of money. No study has been done to examine the quality of life of living organ donors. Financial incentives to organ donors and/or their family will lead to abuse. For example, a family member of a dying person will pressure him or her to sign on for organ donation because of the financial gain that will come after the person passes away. If money is involved, it may lead to who pays more gets the organ. This could be a recipe for people to start buying and selling organs. It will also erode the moral believe that organ donation is a gift of life and should never be bought or sold. The society as a whole and especially the medical community have moral obligation to assess potential organ donors and prohibit any donation that might arouse moral and ethical concern.

Emotional Health Responsibility

EMOTIONAL HEALTH RESPONSIBILITY

Tiffany Preer

Emotional Health ResponsibilityPlastic surgery is supposed to enhance a person’s physical features and provide the person with some sense of physical comfort. An article in the New York Times (www.nytimes.com/2006/09/26/health/26impl.html) explained the results of a Canadian study on breast implants and suicide which I found to be very interesting but quite disturbing at the same time. It states that women who opt for breast implants have a higher rate of suicide due to feelings that stem from low self-esteem. Honestly, I cannot see a direct correlation between breast implants and suicide but I do see a connection between suicide and low self-esteem. If the woman has low self-esteem when she decides to have the implants then there might be an increased risk of suicide but all women who get breast implants are not suicidal.

Women choose breast implants to physically “enhance” themselves which should result in a better feeling about one’s physical appearance and perhaps, increase a person’s self-esteem. If the surgery did not go as expected, I can see how the implants could affect her self-esteem. It is a good idea to have a psychological evaluation before plastic surgery is considered to make sure that the patient is mentally and emotional capable of safely undergoing the surgery. However, prospective patients that have been admitted to psychiatric facilities or those who have psychiatric disorders should not be deemed as poor candidates for surgery. In this case, the plastic surgeon should consult with the psychiatrist or treating physician. Should a surgeon share some of the responsibility for the patient that commits suicide after receiving breast implants? A surgeon that has addressed all of the mental and emotional complications of the procedure and has cleared the patient for surgery, does not have any responsibility to the suicide. On the other hand, a surgeon that hastily clears a patient without investigating their mental and emotional status, should share some of the responsibility toward the suicide. In my opinion, this case is like that of a physician who places a patient of a drug that knowingly affects their liver and neglects to monitor the affects on the liver which may result in serious damage to the liver and a decreased liver function. Isn’t the physician responsible then? Shouldn’t the physician have monitored the affect that the drug had on the liver on a regular basis to avoid such a result? In the latter case, the physician is definitely responsible and will probably find themselves in a malpractice suit. In the case of the plastic surgeon, I am not sure what consequences they should face but I don’t think that their medical license should be suspended or anything like that, maybe a fine would be good.

Ethical issues in whistleblowing

Blog Entry
Roland Njoh

Whistleblowing involves an individual speaking out to the general public or an individual about a situation which they think is unethical and may be causing them direct or indirect harm.
According to Fost, physicians and healthcare workers are more likely to discuss medical error with their peers than with the patient involved.

A decision to blow the whistle is often not an easy one to make. Careful consideration about career advancement opportunities and professional relationships are evaluated. The target of the accusation always suffers even though some accusations may be futile.

The author elaborates on the principle most greatly cherished by healthcare professional “Do unto others as you would have them do unto you; treat your colleagues the way you would want to be treated." He further explains the flaw of the Golden Rule by questioning the actual meaning of the word “others”, does it imply fellow physicians, or does it patent to the patient?

There will always be differences in the manner in which every healthcare provider practices but the ultimate goal is to provide patients with the best possible care available. It is the duty of every healthcare provider to be proactive on blowing the whistle when gross negligence is observed. At that point, it will be the sole responsibility of the patients to decide whether or not to file a law sue for compensation. In some cases, a law sue is imperative in other to manage the acquired disability secondary to negligence.

I agree with the author on the point that it is our ethical decision to report gross negligence to the patient involved and to make sure that such healthcare providers are given the necessary help to ensure that such an error does not happen again.

Reference:Fost Norman (2001): Ethical Issues in Whistleblowing. University of Wisconsin Schoolof Medicin. JAMA. 286:1079: http://jama.ama-assn.org/cgi/content/full/286/9/1079

Mental Illness in Children

Roselyn Burton

After reading the NY Times article Living with Love Chaos and Haley, October 22, 2006, It made me stop and think about the effects of mental health disorders in children and their families.Mental health disorders in children is a very emotional subject. Over at least 6 million are diagnosed every year. One wonders if a lot of children who have been labeled as “slow” and “developmentally challenged” don’t just have a mental disorder. These often go undiagnosed for a long time, because it is very hard for some families to face the fact that their “little girl” or “boy” could have a mental disability. Often people say these children will grow out of it and that they are just going through a phase. But this phase just never seems to end.Mostly the reality of it is that there is still a big stigma associated with mental disorders. People are embarrassed especially parents to tell friends and family that their child have a mental disorder. Because of the lack of education of the society as a whole, some people think that their child will contact this also, if they associate with these children, .as if this is something that is contagious. While others feel that it is the fault of the parents for not training their children the right way. These children tend to have outbursts at any time and shut down when they cannot handle their situation anymore. Some people tend not to understand But what is especially sad is that some “teachers” don’t understand and don’t take the time to fully understand. Not recognizing that this is a true medical condition. Also controversial is the use of drug treatment in these children. Some argue against it as tolerance develops to the drugs very easily. Drug therapy seems to work for“a little while”, while the side effects from the drugs wreak havoc on these little bodies.But one of the most gruesome problems is the effect on the families that have to live with these children. The other children in the family often begin to feel neglected and sometimes to the extent, that they begin to “thread lightly”, so as not to be a bother to their parents. Then they begin to feel that if they were not around their parents would have more time to spend with their sick sibling and sometimes try to hurt themselves. The parents then blame themselves and begin to wonder what they did wrong, to cause this to happen to their children. Even though it is not their fault. This becomes a vicious cycle.I believe more effort and funding need to be put into research for mental disorders in children and more education and awareness need to be promoted, to help erase the stigmas so that these families don’t remain isolated and these children and families can get the help they need.

Is Tort Reform a Good Idea?

Tort reform is a controversial subject and has been one of the most debated policy issues in recent times. It is a result of too many frivolous lawsuits being filed that cannot be reasonably supported under the existing legal precedent. It takes a broader rhetorical definition to describe successful tort lawsuits that are seemingly without merit, or where the judgments seem too high relative to the harm. Advocates generally argue that the present tort system is too expensive, and that the system is not even-handed because the amount of per capita tort costs varies significantly from state to state.
One common ground in the tort reform debate is the inconsistencies of the legislatures. Many want no limits of any type of private litigants. Examples when they talk about pitiful little plaintiffs victimized by doctors and hospitals and pill-makers, not to mention store owners who have slippery floors, and how “artificial” it would be for the Legislature to impose caps of any kind.
“How can a legislator say how much the life of a child is worth?” is the typical somber intonation. Truth is legislators do that all the time. And up until 20 years ago, their firm position (from which they've been forced to retreat only slightly) is that the life of a child is not worth a penny, at least if the child perishes due to the negligent act or omission of any state agency or employee.
Before 1982, “sovereign immunity” was ironclad law in the state of Mississippi. The parents of a lad struck by a speeding bread truck could sue the bakery for money damages. The parents of a lad struck by an alderman speeding in a city car would find the courthouse door locked. No suits for damages were allowed against state or local governments if the allegation was negligence.
The Supreme Court, not the Legislature, has worked to change all that. In a case decided 20 years ago, Pruett vs. City of Rosedale, the justices made clear the injustice had gone on long enough. If the state or its employees were negligent, the state should pay. Lawmakers were told to create a mechanism to do so. Cities and counties were told to do what bakeries do: Buy insurance.
None of this happened quickly, of course. The Legislature dithered and delayed and danced around, failing to pass the Mississippi Tort Claims Act for at least another decade. And guess what? When they finally did start allowing state and local governments to be sued, they included all sorts of stipulations and of course, caps. That's right. If a child is killed by the negligent act of, say, a school bus driver, the family may now get damages. But not more than the amount of the school district's insurance coverage.
So the answer to the somber question “who is deciding the value of a child's life?” Well, in Mississippi the lawmakers are, at least when the government is being sued.
And guess what else? It's still not clear, but if a private doctor cuts off the wrong leg of a patient, the sky's the limit on suing for the dastardly deed. But if the doctor is a state doctor, working at a state medical center, the damages will be “capped”.
One important perspective is that plaintiff's attorneys are real industry in many states. The Legislature, though, is all for caps and shields for themselves. But set any such limits in the real world? Not a chance. Isn't it funny how the ones who write the laws don't have to abide by them?

Right to Live

When I was in nursing school, I worked as a nursing assistant. During my last year of school, I was blessed with a private duty case, taking care of a 86 years old lady. She was full of life, though mildly fragile. She lived in an assisted living facility, never had any children, but has a niece who was her power of attorney. One faithful morning, she took a fall, laid on the floor for hours until I got there. when I found her she was oriented, in a lot of pain, but unable to ambulate. I called for help, and she was sent to the emergency room. She had suffered a fractured hip, and the niece declined surgery. From the hospital, she was then admitted to the infirmary, at the assisted living where she lived.

She had a gastrostomy tube placed due to poor eating before she left the hospital. While at the infirmary, she continued with feeding via the tube, and was slowing progressing. Then the niece came to town, and decided that all the feedings and medications should be stopped immediately. The doctor agreed, and so it was done. While taking care of this lady, I could not figure out how that could have happened. How one can come and say stop feeding a person, and so shall it be. After a week of no food, no water, just swabbing her mouth to keep it moist, I saw a human being wasting away. It was very painful for me to take care of this woman at this state. I thought to myself, if this woman had bore her own kids, this would not have happened. I didn't think this woman would want to die that way. For three weeks as this woman lingered in suffering, I wondered how this can be allowed. The fall didn't mean imminent death, surgery at her age, maybe not, but i didn't think death needed to be forced on her this way. Finally she died in suffering, and that thought hunted me for years. There was still quality of life in the woman. Bedrest, continued tube feeding, would have probably help this woman regain her strength at to some extent, but death, that was unimaginable to me.

This experience shape my life, and my thoughts in how I feel about life and death issues. Then I started working as a nurse on a vent unit where patients were taken off the vent, and die just like that. I wondered whether this was a common practice. I wondered how family could make those decision in natural vs unnatural death.

I finally gave up thinking how wrong it was to let someone die when they have certain condition until I had a 58 yrs old female with ALS as a patient. This woman planned the day she wanted to be taken off the vent, what, when and how she wanted it done. Most of all this woman stated she has had a good life, she know how her illness will progress for the worse, and she didn't want to get to that point. She loved her kids, and grand kids, and didn't want to put there lives on hold. In all my experience, this was the first time I met with such bravery. It was hard for me to accept her decision, but this woman was extremely happy about the choice she mad. She was finally taken off the vent, and she only lasted 3 hours.

Everyday, I hear people say, I will never want to live this way. My question is whose choice is it? God or man. I cannot answer this.

When I was in nursing school, I worked as a nursing assistant. During my last year of school, I was blessed with a private duty case, taking care of a 86 years old lady. She was full of life, though mildly fragile. She lived in an assisted living facility, never had any children, but has a niece who was her power of attorney. One faithful morning, she took a fall, laid on the floor for hours until I got there. when I found her she was oriented, in a lot of pain, but unable to ambulate. I called for help, and she was sent to the emergency room. She had suffered a fractured hip, and the niece declined surgery. From the hospital, she was then admitted to the infirmary, at the assisted living where she lived.

She had a gastrostomy tube placed due to poor eating before she left the hospital. While at the infirmary, she continued with feeding via the tube, and was slowing progressing. Then the niece came to town, and decided that all the feedings and medications should be stopped immediately. The doctor agreed, and so it was done. While taking care of this lady, I could not figure out how that could have happened. How one can come and say stop feeding a person, and so shall it be. After a week of no food, no water, just swabbing her mouth to keep it moist, I saw a human being wasting away. It was very painful for me to take care of this woman at this state. I thought to myself, if this woman had bore her own kids, this would not have happened. I didn't think this woman would want to die that way. For three weeks as this woman lingered in suffering, I wondered how this can be allowed. The fall didn't mean imminent death, surgery at her age, maybe not, but i didn't think death needed to be forced on her this way. Finally she died in suffering, and that thought hunted me for years. There was still quality of life in the woman. Bedrest, continued tube feeding, would have probably help this woman regain her strength at to some extent, but death, that was unimaginable to me.

This experience shape my life, and my thoughts in how I feel about life and death issues. Then I started working as a nurse on a vent unit where patients were taken off the vent, and die just like that. I wondered whether this was a common practice. I wondered how family could make those decision in natural vs unnatural death.

I finally gave up thinking how wrong it was to let someone die when they have certain condition until I had a 58 yrs old female with ALS as a patient. This woman planned the day she wanted to be taken off the vent, what, when and how she wanted it done. Most of all this woman stated she has had a good life, she know how her illness will progress for the worse, and she didn't want to get to that point. She loved her kids, and grand kids, and didn't want to put there lives on hold. In all my experience, this was the first time I met with such bravery. It was hard for me to accept her decision, but this woman was extremely happy about the choice she mad. She was finally taken off the vent, and she only lasted 3 hours.

Everyday, I hear people say, I will never want to live this way. My question is whose choice is it? God or man. I cannot answer this.

The BioEthics Cafe -- Essays from the Edge of Paradise

The Last Word

It is of interest to note that after reading an article in the New York Times, Hawaii passed a law stating the medical professional may decide if a “do not resuscitate order” should be carried out. It is usually a “do not resuscitate" order for a reason, this is the wish of the patient. Although this law was passed, I believe that if a medical professional does not respect the wish of a patient, there will be trials to determine if the decision is ethical.

When a person has an advance directive and does not want to be resuscitated, there should be specific guidelines. I don’t want to suffer through a terminal illness for years, however if I am in a car accident with a medical necklace or bracelet that says do not resuscitate and surgery may save my life, then by all means resuscitate me. This may be one of the times when the medical provider may intervene and speak with a family member and educate them on the prognosis if surgery is done.

Education is the key in understanding advance directives and there are times when a person may make a decision and not be totally aware of what the facts involved. It is our duty as health care providers to explain this to all of our patients when they come to our offices or facilities. Do you feel comfortable not resuscitating a person knowing that the may not have been properly informed when their decision was made.

Mythology and Abortion

Mythology, Abortion, and the cold hard facts.

What the heck is going on in our society? The topic of abortion is made complicated by emotionally charged discussions that are clouded with confusing and conflicting information which is misrepresented at times by the opposing sides of the debate to augment their argument or opinion. Frequently, in open forums and societal debates considerable mythology (noun: myths collectively; the body of stories associated with a culture or institution or person) appears to surround this topic. For clarification in academic fields, a myth is a sacred story concerning the origins of the world or how the world and the creatures in it came to have their present form. In saying that a myth is a sacred narrative, what is meant is that a myth is believed to be true by people who attach religious or spiritual significance to it. Use of the term by scholars does not imply that the narrative is either true or false. I recently read an article that discussed the topic of abortion on demand. I was challenged to reexamine my convictions.
The mother of all abortion debates is Roe vs Wade. In this Supreme Court decision the majority of the justices obviously sided with Roe which resulted in the legalization of abortion on demand. Yep, from conception to seconds before your first breath abortion is allowed. Many people believe erroneously that abortion is only legal in the first three month of first trimester of pregnancy. This myth was faithfully propagated in public debate by newspapers, magazines, pollsters, and others by framing the argument with the pretense “In the first trimester of pregnancy…” implying that abortion was somehow legislatively restricted in the second and third trimesters. In Roe vs Wade a window was left open to allow individual states to legislate restrictions during the second and third trimesters. However, in Doe vs Bolton the window was lost when the whole wall was knocked down. Medical determination of the health of the patient eviscerated any legal recourse.
The most startling aspect of the whole process is that the “legal precedence” was more “legal activism” then constitutional law. The concept of a “penumbra” (the gray area between light and complete shadow) of legal rights within the Bill of Rights has been recognized and used in determination of constitutional rights in many cases. The justices in defense of their positions either concurring or dissenting unquestionably recognize marriage and its particularities and uniqueness in conjugal intimacy as an entity warranting penumbral privacy protection. Dissention arose with the decision to uphold contraception rights of individuals, the court made the sweeping conclusion that abortion was a form of contraception and that abortion was a constitutional liberty. To this day Roe vs Wade is not argued or defended by its own merits but rather secondary constitutional avenues which address governmental encroachment on individual rights.
So what is the debate? Where will the cult of unrestricted “individual rights” lead its followers to worship? Will the communal cult of “responsibility of actions” who recognize no man as an island and that individual actions have a ripple effect on all humanity concede to the shady mythological god of penumbral rights who no one has seen, heard, or read? Should impregnated men (this is the future) or women be allowed to continue to terminate their progeny on demand or should some restriction on this form of birth control be implemented? Are human persons uniquely endowed with unalienable rights such as life liberty and the pursuit of happiness at any cost? Will the minority cult of “well what about in the case of ….” Continue to lead the majority of “well, yeah but something ain’t right.” As long as faithful propagators in the camps of “the individual willed that he crawl from primordial ooze therefore the individual is solely determinant of his destiny” and “the individual was created to exist in harmony in community with other persons as a prelude to his eternal destiny with the Master Planner” exist it is unlikely that the debate will subside.

Pharmaceuticals for the Elderly

I recently read an article on the New York State Department of Health website pertaining to the Elderly Pharmaceutical Insurance Coverage (EPIC). EPIC is New York State sponsored prescription plan for senior citizens who need help paying for their prescriptions. Over 360,000 seniors already belong and are saving, on average, over 80% of the cost of their medicine.

Years ago, as a young adult in college and so many others of my friends (being dropped from our parents health insurance at the age of 18), have experienced being without basic health insurance coverage, due to the high cost to obtain and maintain. Despite so many years have come and gone, there is still not enough resources allocated for young adults in this complex society, only for individuals <18>65. I think that rationing health care for the elderly might become necessary to eliminate those restrictions on health care for other groups, but would encourage conflict between generations.

In the past few years, an increasingly large share of health care is going to the elderly vs. young adult. For example the federal government spends six time as much providing health benefits and other social services to those >65 as it does to those over 18. In addition to wasteful spending of hundreds of millions on an inflated defense budget.

I think government has the social obligation and responsiblity to help the elderly live out a natural life span but not to help medically extend life beyond that point. A government system based on the above would immediately create a balance in medical care benefits for the other neglected generation.

Euthanasia

Euthanasia
Euthanasia is the practice of terminating the life of a person because they are perceived as living ahttp://www.blogger.com/i.g?invID=6937264264295004718&hl=enn intolerable life, in a painless or minimally painful way either by lethal injection, drug overdose, or by the withdrawal of life support. Euthanasia may be active or passive; and, types include physician assisted suicide, voluntary, involuntary and mercy killing. Euthanasia has both legal and ethical ramification.
Euthanasia is a controversial issue which its legality has being argued for years. For illustration, in 1997 U.S. Supreme Court ruled on a case between Washington v. Glucksberg. The question presented in this case is whether Washington’s prohibition against causing or aiding a suicide offends the Fourteenth Amendment to the United States Constitution. The court holds that it does not. Even though, the Due Process Clause protects individuals’ liberty, in addition to freedom protected by Bill of Rights. The protection includes rights to marry, to have children, to direct the education and upbringing of one’s children, to marital privacy, to use contraception, to bodily integrity, and abortion.
Euthanasia is a controversial issue because of conflicting religious and humanist views. There are a number of conflicting beliefs about euthanasia. Different aspects of euthanasia are supported by different people. Some people argue against euthanasia based on the belief that only God should choose when someone dies. However, individuals’ right to autonomy must also be examined. Autonomy is a concept found in moral, political, and bioethical philosophy. Within these contexts it refers to the capacity of a rational individual to make an informed, uncoerced decision. One can also define autonomy as the right to be self-determined. In medicine, respect for the autonomy of patients is considered obligatory for doctors and other health-care professionals. This ethical principle is also supported legally. The 1990 Patient Self-Determination Act (PSDA) encourages all people to make choices and decisions now about the types and extent of medical care they want to accept or refuse should they become unable to make those decisions due to illness. This is called advance directives. Hence, this law supports individuals’ right to autonomy including right to die.
In summary, euthanasia is one of the ethical-legal dilemmas that the society must address. Although the voice of the supporters for the movement has being soften due to conviction of Dr. Kevorkian, the issue is not about him but upholding and protecting the individuals’ right to autonomy. The Due Process Clause can also be applied, that is right to refuse unwanted lifesaving medical treatment.

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Should people sell their organs?

Growing up in a poor country I witnessed first hand people lining up at the hospital to sell their blood and organs for money to support their families. Evidently the O blood type made out the best as it is the universal donor! Even though donating blood is a much less invasive procedure and your body automatically replaces itself it still is a personal decision for each individual to make.
I admire people who are willing to take personal risks to save the lives of others, These people should be able to get a reward or payment of some kind. There are two primary arguments in favor of allowing the sale of organs. First is the fact that a person's organ belongs to them and they should be able to do with them as they wish. The second is that there is a huge shortage in organs available for transplants so if paying money for them will result in saving more lives then this can be justified.
The removal of live organs is difficult and painful for the donor. like any surgery the process itself is dangerous. It is possible the person undergoing surgery will not wake up and if they do make it through the surgery there is still a chance of post-operative infection wich could potentially kill. The donor should also be provided with proper health care and counseling before and after the organ removel.
In selling organs for money the one problem that needs to be addressed is the sale through underground markets and the donor and tehir vital organs are treated as commodities. Hown can we impose stricter regulations on theses " vendors" that are making money off the donors?

Assisted Suicide

In Depth Assisted Suicide –“The Fight for the Right to Die”, CBC News Online Sept 27 2004. CBC online September 27, 2004 at HTTP:www.cbc.ca/news/background/assisted/sucide/ is the web site.

The article discusses the age old controversy of does a person have the right to end their life. In this article, Sue Rodreges, dying already of a terminal illness, suffering and wasting away was fighting for the right to die. She fought in the Canadian courts arguing that to deny here this right was not constitutional. She based this argument around the premise that it curbed her personal life freedoms. However, this was not accepted by the Canadian supreme court and here case was lost. This court decision however, has not lead to the end of this controversy.

As the article continues, the fight for personal choice to end a life with help is becoming a well supported ideal. It is gaining support not only in Canada, but in many countries. The support is been seen that there may even be a possible motion for a change to the Canadian law as this concept has gained support.

The opponents of this fight however, argue that old frail people may be cohersed into choosing such an option for the wrong reasons. There is fear that if legal people may make the decision to end a light for as much as to limit financial debt and not for medical or personal suffering reasons. This poses a moral and legal dilemma which continues to rage on.

As this controversy rages many people have decided to help no matter the consequences of the law. This has a result of court cases which have exonerated and convicted people of aiding in assisted suicide. The outcomes of the trials have been more based on jury opinion and decision then case law.

In closing regardless what country, the controversy rages with little end in sight due to strong opposing views each with the morals of society trying to be achieved. The right answer may not exist.

Anorexia and Forced Hospitalization

Anorexia Nervosa and Forced Hospitalization

Jessica Peluso

Should a physician be allowed to hospitalize a patient suffering from anorexia nervosa against his/her will? Anorexia nervosa is a multifactorial psychiatric disorder that manifests as a very low body weight and distorted body image. More than 90% of the cases are seen in young women (typically teens to young adulthood). Long term mortality can be as high as 10% resulting from starvation, suicide or electrolyte imbalance.

Consider a young teenage girl (18 y/o) whose mother has come to you requesting your assistance in dealing with her malnourished child. The patient is described as a 5’6”, 75 pounds who was 120 pounds six months prior. The patient’s lab work reveals some electrolyte disturbances. However, the patient denies that she is anorexic and is refusing any treatment.

Of course the problem arises in determining whether autonomy should supersede beneficence. This can be a very difficult situation because the patient is refusing treatment and to enforce her into something she is unwilling to do would infringe upon her ability to exercise autonomy. However, the patient’s body (suggested by the lab work) and family are obviously crying out for help. Would it be considered assisted suicide if nothing was done to deter this behavior?

Unfortunately this situation was all too real for me and my family. I suffered from anorexia nervosa from 16-22 years old. During that time I dropped down to 75 pounds at my worst and was hospitalized three times many times with mixed emotions. I, too, never admitted to being anorexic and many times my hospitalizations provided me with ways of becoming a “better” anorexic. The fear of gaining weight was real. More importantly, though, gaining weight was a fear greater than just pounds. The fear of gaining weight for me, as for many others, meant giving up control. It was not until I learned about a “miracle” named Madelyn (my first child) that I decided to deal with this life threatening issue.

I can honestly say that I believe that the physician should have the ability to exercise his /her judgment in these situations to promote life even if it means sacrificing the patient’s autonomy. I can say that when I was wrapped up in this disease, my state of mind was altered as I believe many of these patients with similar situations are. If the provider does nothing, I believe we are allowing suicide to occur in front of our eyes. Even if it means multiple hospitalizations, I believe, life needs to be promoted so that hopefully, eventually, these patients may also be given a chance for a “miracle”.

References:

http://www.cpa-apc.org/Publications/Archives/CJP/2002/april/briefCommunicationTreatmentResistance2.asp (Accessed 10/06)

Cord Bood Banking

Cord Blood BankingCord blood is a topic of great interest to me. When I had my children I was given a pink form with numbers on it one being the medical record number the other number of a cord bank. I was told blood was collected from my newborns umbilical cord i never asked why and I was not told how important it could be. What is cord blood? It is the collection and storage of stem cells found in a newborns umbilical cor. It offers lifesaving treatments for the newborn or a family member. we see how stem cell research is a major issue that scientists are pondering with in laboratoris worldwide as couples and families try to concieve or save alredy born children all possible with cord blood banking.Cord blood is collected after the baby is born but before the placenta is delivered.A needle is injected into the umbilical vein and the blood is collected it takes about 2-4 minutes.The collected blood is stored in a cryopreservation chamber a specialized freezer where cells are stored at -196 degrees celsius ,-321 degrees F.Cord blood can be used to treat over 40 life threatening diseases including a wide range of cancers,genetic diseases, immune deficiences and blood disorders.I was drawn to this topic because earlier this week in a medical journal this topic was spoken about. Until this time i never understood the clinical importance of why the newborns blood is collected and that the number on the form is phone number if you as a parent need to access your cord blood for e.g in illness your doctor can do so with this information.

THERAPEUTIC CLONING

Imagine brain stem cell cloning from one embryo to alleviate or erradicatelon-standing pathologies which have ended a multitude of lives? What would it be like to end diabetes mellitus, leukemias, tissue dysplasias, glaucomas, immnosupressive disorders, arthitis and hypertension. For one medicine's focus would have to change.
What would it take to find enough production beta cells, abort tissue or fluid autoimmune destruction, abort optic nerve atrophy or even graft it? Or even allow for control of vasdilation and vasoconstriction of vessels thru the natural physiologic process without pharmacological aid?
The regulation of benefit for the wide variety of individuals would have to fall on a governmental agency, private agency or who would be in control of the multiple how's? How would the medical perspective influence handle patient selection? What about those transplant wating list patients with diseased organs? Reimbursement: private or public? If it would resemble anything like our present system what an oppurtnity for colossal confusion and frustation!
Mal-beneficience vs benefit to humankind. Faiths of all creeds vs the premise to benefit all. Conservatives alleging "play god " and obstruct science. Radicals advance science and aid humankind as whole. What about the middle of the these cross-roads? Are we not on top of the list as a industrialized nation? Are we not a culture with a meltdown from several other roots? And we profess the pursue of liberty and happiness to all. And if we have created human form in the laboratory already? What about pursuing technology for therapeutic cloing exclusively?
An opthalmic perspective on therapeutic cloning goes without elaborating on the idea about grafting or regenerating optic nerve fibers for open angle glaucoma. What about regenerating macular degeneration or annihilating diabertic macular edema? As sad as it is truth our patients are losing sight despite our best intentioned efforts to prevent these pathologies. Yes, of course we have pharmaceutical agnets to increase/reduce introcular flow, laser beams to interfere with the trabecular meshwork and its outpour of intraocular flow. And last but, not least we have valves transplanted to scleras to obtain a definite device to control introcular pressure. However, we are still encountering endstage glaucoma and BLINDNESS. What about our present early prophylaxis for macular degeneration: sunglasses, vitamins and wide brim head coverage. Someone tell me that therapeutic cloning for the retina would not alleviate this pathology? Our worst case scenario surgery or intravitreal injections to absorb and reduce inflammation. And diabetic retionpathy: laser vs intravitreal cortisone or other anti-inflammatory agents.
Advances, most definitely, however full resolution a dream!

Physician-Assisted Suicide vs.Euthanasia

The first thought that come to my mind " two topics one result, intentional death.By definition Physician assisted suicide refers to a practice in which the physician provides a patient with a letal dose of medication, upon the patient's request, which the patient intends to use to end his or her own life.In Euthanasia generally means that the physician would act directly,for instance by giving a lethal injection,to end the patient's life.As a health care provider since fourthteen years ago in a durable medical equipment industry, I had the opportunity to visit ( in hospital or home) a lot of patient with mechanical ventilators,enteral nutrition ( feeding tube),patient with quadriplegia that developed other problems and others with "terminal illness".But the intentional termination of life is not ethically justifiable.A degree of acceptance by the patient.Acceptance doesn't mean that the patient likes what is going on,and it doesn't mean that the patient has no hopes; it just mean that he can be realistic about the situation.A medical undrestanding of the patient's disease.One great physician does not equal great care,it takes a coordinated system of providers.Death is not usually an individual experience;it occurs within a social context of family,significant others, friends and caregivers.
I don't want to enter in some issues but arguments like respect for autonomy; justice; compassion and individual liberty are not ethically justifiable offer to physician assisted suicide and euthanasia.Furthermore,the physician's duty to alleviate suffering may,at times, for many people justify the act of providing assistance with suicide.Remember the traditional duty of the physician is preserve life and we have,as a health care providers a social and moral responsability .

My Take On The Missouri Stem Cell Initiative

By: Ray Manuel U. Paguntalan

Sunday morning as me and my family was coming out of church, my oldest daughter asked, “hey dad! What is that amendment number 2: Vote NO To Stem Cell Initiative?” After explaining to her what the stem cell is all about, my daughter (who is a very conservative person by the way) quickly dismissed the idea as absurd and unethical in the eyes of God. I too, felt the same way and somehow agreed with her …. But let’s back up a bit and think about it for a while, I asked her…… is it really?

(The nation’s eyes are focused on the senatorial race in Missouri mainly because of the two senatorial candidates who both have the stem cell issue as one of their main campaign agenda. Senator Jim Talent is anti-stem cell while Claire McCaskill is pro- stem cell. Each candidate has expressed their views and has reasons for supporting or rejecting it.)

Stem cells are primitive cells that can be manipulated and coaxed into developing into the 220 different human body cells. Scientists have found ways of developing these stem cells into most types of human cells, such as blood, brain, heart tissue, nerve cells, bones, etc. These researchers are confident that they will lead to treatments to many diseases such as bone loss, broken bones, brain damage due to oxygen starvation, severe burns, some forms of cancer , diabetes, Lou Gehrig's disease, heart disease, hepatitis, incomplete bladder control, Huntington's, leukemia, lupus, muscular dystrophy, multiple sclerosis, osteoarthritis, Parkinson's, spinal cord injuries, and stroke!

There is not much ethical concern related to the adult stem cell research as long as there is consent obtained. However, I read that stem cell lines from adults have limited usefulness compared to the stem cell line from embryos. During the time when a woman undergoes in-vitro fertilization, she is given medication to help her produce at least a dozen mature eggs which are then fertilized by sperm. She then gets 2-4 eggs implanted on her womb (2-5 days after fertilization) in the hope of getting pregnant. So what happens to the other embryos? They are frozen for future use (which I read is very expensive), used for research, or destroyed.

So if we leave the rest of the embryos to die or destroy them (which at times happen in fertility clinics), are we guilty of murder? What if we use it for research (once the stem cell is extracted, the embryo dies)? Is that also murder? This is what it’s all about anyways, right? Pro-life people give emphasis on the stem cell research as unethical, but believe or does not really argue much on the ethical issues on discarded embryos in fertility clinics. They apparently believe that leaving the embryos to die is letting it take its normal course of dying and does not constitute to murder.

I believe this is just plain hypocrisy. How can one address one as such devious act and not consider the other? One can certainly not make an excuse for one, though done with different process, the outcome is still the same. Wouldn’t you think that if someone is anti stem cell research should also be anti in-vitro fertilization? Isn’t it more prudent to go after the source than just focusing on its end results? After all, isn’t that where it all started? I guess the argument there is….
In-vitro fertilization was discovered to bring in life and can’t be seen as unethical due to its full benefits to life. So where do we actually draw the line?

After some major brainstorming, I guess I got my daughter confused. Don’t worry, I told her. I’m confused too myself. More so that I am to vote soon on this issue. I always consider myself as pro-life, but also believes in pro-choice. I guess I’ll just have to sort this thing out. After all, I have till November to figure this out.

Fetal Abuse

Fetal Abuse (blog entry by Christine W. #AI107304-9FM)

We have heard of spousal abuse, child abuse - even animal abuse. Many laws exist to protect these different victims. Most of these laws have been in practice for a number of years. I had not heard of the term 'fetal abuse' until recently. However, one could say it is a new name for an old problem.

What is society to do with a pregnant woman who will not take responsibility for the health of her unborn child? In the recent past, the majority of women that fell into this category would have been those who continued to drink alcohol even though they knew it would harm their unborn son or daughter. Now, with illegal drugs being available almost anywhere and creating new addicts on a daily basis - there are now many more ways for the pregnant woman to jeopardize the health of the fetus.

At what point should the law step in? This behavior certainly seems to quality as child abuse. Do we arrest her and put her in jail? Do we charge here with a criminal offense or just a misdemeanor? Or do we force her to participate in a rehab program?

Well, guesss what - states are already enacting laws that allow these women to be arrested. In recent months, pregnant women have been arrested and jailed in South Carolina, New Mexico, Arizona, Alabama, Colorado, Georgia, Missouri, North Dakota and New Hampshire (among other states) claiming that pregnant women can be considered child abusers even before they have given birth.

South Carolina has been the toughest so far. Their Supreme Court declared in 1997 that drug-using pregnant women can be prosecuted criminally - and sentenced to as many as 10 years in prison. The attorney general there says that he will only prosecute pregnant women that use illegal drugs - not alcohol. (However, alcohol is still the leading cause of preventable mental retardation in infants.) It was the Medical University of South Carolina in Charleston, that started a program of testing pregnant women for drug use, and turning over their findings to police. It was done as a 'last resort' because they were seeing more and more pregnant drug users.

So, will this solve the problem? Many say absolutely not. Public health and child welfare groups say that most of these women want to stop using, but cannot; and threat-based approaches will not deter women from using drugs but will only prevent them from seeking prenatal care and any voluntary treatment programs that could be abailable for them.

And then one has to consider the health risks both mother and child face if she is forced to give birth in prison. Whil researching this, I read some shocking and extremely sad stories of women giving birth in prison. Sometimes the conditions would be deplorable. Sometimes the women would be left alone by custody to have the child without help from anyone. Although international law and treaties signed by the United States prohibit the shackling of pregnant and birthing women, Amnesty International USA reports that only two states - Illinois and California - have banned this practice here at home in the United States.

So, is rehabilitation the answer? It has been around for a while. Would this problem have been worse without it? The educational materials about the dangers of drug and alcohol use while pregnant is certainly available. And we know society supports rehab programs - is there enough money out there to do this successfully though? Is education at a very early age possibly part of the solution? I wish I had the answer, or even part of it.

(I would like to acknowledge Lynn M. Paltrow; Vince Beiser; Julie Ehrlich - authors of various articles that I used for this blog.)

Ethical Issues Associated with Bariatric Surgery

John Alioche’s Blog Entry
Ethical Issues Associated with Bariatric (Weight Loss) Surgery
October 21, 2006
The United States is experiencing an epidemic of obesity. Under the widely used classification developed by the National Institutes of Health, 34% of the adult population is "overweight" (BMI 25-29.9) and another 27% meet criteria for "obesity" (BMI>30). The overall prevalence of obesity has increased more than 75% since 1980. Obesity is associated with increased type II diabetes, cardiovascular disease (especially hypertension), osteoarthritis and multiple conditions. An obesity-related process called "Syndrome X" or "metabolic syndrome" that includes insulin resistance, abdominal obesity, hypertension, and diabetes and lipid abnormalities.
Bariatric surgery is a textbook example of an area of health care calling for evidence based management of utilization and ethically guided deliberation about coverage policies. At one extreme bariatric surgery can be seen as a life saving, medically necessary intervention that potentially reverses the inevitable trend to sometimes fatal medical conditions. At the other extreme it can be seen as a technical fix for a subjectively distressing result of choices with regard to eating and exercise. The surgery has risks and represents a significant cost (approximately $15-20K). In the past year alone the number of patients that are having Bariatric Surgery has doubled.
Bariatric surgery has risk. Mortality from the surgery itself is less than 1% but post-surgical leakage into the abdomen or malfunction of the outlet from the stomach pouch can require further surgery. Vitamin deficiencies, gallstones, and osteoporosis are among the other complications that can occur. With regard to the basic objective of weight reduction the surgery is not foolproof-some patients ultimately regain the weight they lost, through varying combinations of enlargement of the stomach pouch and return to compulsive patterns of eating.
1. In a culture that is deeply conflicted in its approaches to weight and obesity, how can we best pursue the mission of "improving the health of the population we serve and the health of our society?
2. Should we seek cost effective opportunities to support "upstream" services aimed at shifting the trajectory of obesity earlier in the clinical course with the objective of reducing suffering and medical morbidity and possibly obviating the need for surgery itself? or Encourage optimal education so that members can make well-informed decisions about surgery with full understanding of and commitment to the lifelong post surgical requirements?

Children of lesser gods

I have been contemplating the value of human life, wondering if life is innately of value, or is some life more valuable than others. Is the life of the alcoholic as important or as valuable as that of the school teacher of pharmacist? Are nurses more valuable than rapist? who places value to human life, and are there different levels of humanity? Should people be ascribed value based on occupation or social contribution, education or wealth, the argument seams always to be framed in camps that are in conceptual opposition. You are either a bleeding heart liberal or a hard nose conservative but reality often times is much less polorized.

The question is how can we not label people; This I venture to say is impossible. The problem with labeling is that it has the potential to affect the quality of care that is delivered based on the value that we placed on the patient. As a human being the concept of all being equal is designed to provide the platform upon which care is provided and although this may sound great, in reality we know that there is no such thing as people being equal. Equality is a socio political construct, designed to maintain the social compact, in which people co exist feeling good about themself despite all their shortcomings. The equality philosophy is a lie. We are never equal from birth to death, we are born with different capacities to learn and grow, with different needs and desires, different strength and weakness.

As health care providers, we need to be mindful of these labels and try to find some unifying quality among patients in order that we provide compassionate care to all. This may require that we embrace a work philosophy which can sustain us through difficult and trying days, for some they may need to call upon their faith, for others, it may come from a strong desire to live up to a professional code, for in a profession in which we are at constant risk for becoming apathetic and desentisized to the suffering of those we treat. It is important that we keep a constant check of our humanity, or we may find ourselves treating some patients as though they were children of lesser gods.

Putting Judith Jarvis Thomson's argument to the test

Blog entry # 2: Elsie barthelemy

Putting Judith Jarvis Thomson’s argument to the test
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Judith Jarvis Thomson’s analogy regarding a pregnant woman’s right to unhook herself from a fetus later amended by Jane Thomas , I feel places the woman as the sole decision maker .I feel that all parties involved should equally take part in the decision making when such a drastic outcome such as “ ABORTION” is entertained.

A woman cannot conceive alone. So far, science has yet made this leap. Conception thus far is accomplished by two parties whether each one play either an active or passive role toward such an accomplishment. Even in the instance where the natural process of conceiving by sexual intercourse is bypassed to be replaced by unison of a donor egg and sperm in a Petri dish. One thing cannot be changed that is the creation of the origin of such a conception that is the starting ingredients: sperm and egg. Therefore both parties supplying the ingredients should have equal right to its product unless one decides to give up this right.

So far the argument made by both Judith J Thomson and Jane Thomas only supports the woman as the sole decision maker. The male donor/ parent must be taken into account as well. I do understand that a woman carries the unequal burden of pregnancy for 9 months in comparison to the male counterpart. This should not be the sole aspect taken into account when arguing such a controversial subject.

One can further argue that a man donating his sperm is doing so in the hope of accomplishing procreation even when the act is done in an immoral and illegal matter. Therefore shouldn ’t he be given his fair share of the right to choose to give up his right of fatherhood?

Now as far as the right of the embryo/ fetus, I still have some reservation . If one agrees with Joseph Fletcher’s 15 propositions of personhood , it would then be clear and simple to decide that indeed the product of conception at its earliest stage is untitled to any rights whatsoever . However, there is still a grey area in this issue of when to consider a person a person. The advent of ART’s definitely render this subject more and more complex…

So what is the final word then? I guess for a while , this will remain “THE” controversial subject for debate. I don’t believe we have yet seen the end of the ambivalence and confusion which exist when one is considering what the final true ethical, moral and legal decision regarding “ ABORTION” should really be. I myself am no exception to the rule………….

Criminal & Civil Liability for Failure to Follow Advanced Directives

Health care workers need to faced with both criminal and civil prosecutions for refusal to follow Advance Directives for Healthcare.

There has been alot of time and energy expended in our country on the issue of healthcare directives. The government as well as private institutions have provided many classes, seminars, and even attorneys to help individuals understand and prepare these directives. Many people, especially the elderly, agonize over the decisions as to whom they want to appoint thier attorney-in-fact and to express what their desires are. In accordance with most state laws, every patient mujst be questioned as the presence of Advanced Directives for Healthcare and must provide further information and assitance to the patient in procuring these directives if the patient requests. Why is then that we are constantly hearing about healthcare providers , primarily physicians, who are refusing to follow these documents.

I believe that physicians need to be arrested for battery and that the families of these patients need to file a civil lawsuit for the tort of committing a battery and that damages need to be paid. For example, a physician who intubates a patient in the Emergency Room after learning of an Advanced Directive requesting "No Intubation" and speaking with the Attorney - in - Fact who states No Intubation. The occurs many times when there are multiple family members who have different wishes. Even though every family member is important, we must lose focus of our patient. The reason the patient identified his or hers desires and appointed an Attorney - in - Fact is that the individual has made the decison for himself.

The definition of a battery is the wilful or intentional touching of a person against that person's will or by an object set in motion by that person. Intubation of the patient in mhy example is clearly the intentional touching of the patient against their will.

In order to intubate a patient, a practitioner must first obtain legal consent. The consent can either be expressed or implied. Neither of these types of consent would be present in this example. There woule be lack of express consent as the Attorney-in-Fact clearly did not give consent to the intubation and furthermore, this expression was consistent with those expressed in the Advanced Directive. Implied consent also would not apply here. While many procedures are performed via the doctrine of implied consent in the Emergency Room, the doctrine would be negated by the refusal of the Attorney-in-Fact to consent. If the patient came in the Emergency Room in respiratory distress and without an Advanced Directive, consent would be implied by the virtue of succumbing to the EMS system. However, the Advance Directive and POA clearly interfere from Implied Consent being necessary.

Criminal prosecution for Battery does not require that any harm occur so an argument by the offending practioner that no damage occured by extending the patient's life would not prevent a criminal finding of Battery with a sentence. The plaintiff in the civil action would be required to show damages and they may be difficult to prove in monetary terms but some degree of pain suffering would be present in these type actions.

Those who choose to work in areas where these issues are present must comply with law even if they do not agree. If they choose to disregard the law. they must be prosecuted. This will eventually affect their licensure as one of the questions we all must answer when renewing our licenses is whether or not you have been convicted of a crime other than speeding offenses.

We see everyday as healthcare providers how the HIV epidemic becomes more prominent. SInce the begining in the 1980's thousands of people have lost their lives to this epidemic. The numbers keep rising specially in Africa where screening and treatment are a matter of luxury. With this in hand we beging to question wether HIV screening should be part of a normal physical examination. The reality is that many americans do not know they have the HIV virus do to lack of screening.
The U.S Ceters for Disease COntrol and Prevention announced the recommendation to make HIV testing a standard testing for all americans as they aim to prevent further spread of the disease and prompt needed care for the estimated 250,000 americans who have AIDS but do not know. It has been found that nearly half of the new HIV infections are discovered when doctors try to diagnose another illness and turn out to have the virus. I believe that earlier screening will allow people access to life expanding therapy, and also through prevention education, learn how to avoid the transmittion of the HIV infection.
Although this is only the beginning is a very important step in the prevention and treatment of the disease, Is a very good sign that we understand that testing should not be only for high risk groups but for every sexually active individual. Although the implementation will be challanging, requiring alot of money for testing counseling, and testing.
Identififying more HIV patients however, will place an added burden on public health programs that pay for such care, some of which are facing potential cuts under a proposal before Congress. However, more diagnosis may help win more funding, people's awareness and responsability for this expanding killer.
There is also the matter of cost. Some healthcare economists say that universal screening for HIV is a t least as cost effective as test that detect diabetes, breast cancer, and other chroninc conditions because if the virus is caught early, medicines can give patienta long, productive life. However, there are others under the impression that it will add more to the already burden health system.
I will assume that many of our fellow physicians will question wether is necessary to expand testing behond high risk individuals. However, it is the beginning for the prevention and extintion of the disease. Also, a more routine testing would avoid the problem of patients not acknowledging their risky behaviors.

HPV Vaccine- A Giant Step towards Preventing Cervical Cancer

In the United States there are currently 20 million people infected with the HPV virus and an additional 6.2 million are newly infected each year. Of every 100,000 women, 8.7 will develop invasive cervical cancer and 4000 women will die each year from this disease. In the past, prevention of cervical cancer was limited to screening Pap cytology. However, a HPV vaccine has recently been approved by the FDA and has been found to be 100% effective against the most common high-risk HPV virus strains.

In my practice as a women’s health Nurse Practitioner, I have seen the burdensome treatment and anguish of pre-cancerous conditions and the tragedy of cervical cancer caused by the HPV virus. It is my opinion that all young females should be offered and encouraged to receive this vaccine. Unfortunately at the present time no state is requiring this vaccine and few health insurance policies cover this expense. This is ridiculous.

A bipartisan group of female legislators representing the State of Michigan has introduced a bill requiring all girls entering the sixth grade to be vaccinated against the HPV virus. This is the first state to consider mandatory vaccination for this virus and should receive our enthusiastic support. It is also our obligation to help educate the public of this opportunity, inform our patients of their options and to encourage their vaccination. This vaccine should lead to a substantial reduction of cervical cancer and, hopefully, to the ultimate elimination of this disease.


www.cdc.gov/std/hpv
www.cancer.org
www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html

The BioEthics Cafe -- Essays from the Edge of Paradise

The BioEthics Cafe -- Essays from the Edge of Paradise


The threat or pressure placed on physicians at the time of making a life and death decision is even more influenced by the threat of litigation. In a time of extreme stress, physicians are required to make decisions that are in the best interest of the patient and that also agree with the patient's wishes. In terms of "End of life" decisions, often every minute counts. And while the physician may have a state recognized "do not resuscitate" (DNR) order that documents the patient's wishes, there can be many members of the patient's family who surface at the 11th hour with conflicting views about what the patient wants in that situation.
For example, there was a patient in my hospital who came into the emergency room unconscious and in septic shock. She was a 76 year-old, widowed nursing home patient with four children. Her oldest daughter was her medical power of attorney. She had also signed an Advanced Directive six months prior, that stated her life not be sustained by any artificial means. She had specifically documented no intubations or CPR.
It was determined by the attending physician that this woman was in respiratory distress and needed to be intubated to prolong her life. The power of attorney, along with two other siblings reiterated the patient's wishes of no intubation. However, the physician received a phone call from the fourth sibling, her son from Washington D.C., who stated "Everything be done". The wishes of the patient and the rest of the family were not enough to convince the son to change his mind. He threatened the physician with a lawsuit.
The emergency room physician intubated the patient contrary to her wishes. While in the AICU, the intensivist would not extubate the patient because of the son's wishes despite her advanced directive. She subsequently expired 4 days later of cardiac arrest but not before a prolonged megacode to keep her alive.
Because both these physicians felt legal pressure, they did not honor the patient's Advanced Directive. They were swayed from allowing the patient to naturally pass, as per her wishes, to avoid litigation.
Unfortunately, this is becoming a trend where the DNR paperwork that comes in with a patient is not worth the paper on which it is written. While it used to be a guide that the physcian could use in directing treatment, now the patient's wishes seem to be secondary to potential legal threat. Personally, I am yet to see a physician stand up to this threat and withhold treatment in accordance with the patient's wishes. In the future it will require the hospitals and the legislature to strongly support physicians so they can provide or withhold medical care as originally intended by the patient.

Right to Die: “Mercy Killing”

Back in the old days, dying was relatively simple. Patients with untreatable illnesses opted to stay at home and live the rest of their days under hospice care. These patients wanted to live their remaining life comfortably surrounded by friends and family, then die in their own beds. These days, however, dying has become a complicated issue with the help of machines. Some people are coming up different ways of defining a “good death.” Is good death similar to the one in old days? Or is good death equivalent to be heaving out the last of breaths using respirators, dialysis machines, and force-feeding using G-tubes?

Today, most patients die in hospitals surrounded by strangers in uniforms. These strangers try their best to keep the patient alive by providing them with the best of medical machines and equipment, beds, medical staff, etc. Now, some people may find this type of death as acceptable, some however, tend to give up quickly and want to die comfortable at home. People who want to die at home may find their wishes unacceptable by family and physicians, who are entangled in a web of moral, legal and medical considerations. The main question into consideration is – should people, who want to die, request their physicians to hasten their deaths? And is it morally acceptable for physicians for physicians to do so?

This raises more questions than answers: Why decides to kill the patient? Is it the doctor? Or is it the patient (who is not always in full mental capacity)? Or is it the family members? Wouldn’t killing the patient violate the Hippocratic Oath? From a religious point of view, is it moral for one person to take the life of another person – even if the other person wants to die?

My personal point of view is that the doctor and the patient’s family (if any) decide on terminating the patient. I have first-handedly witnessed the pains of a family friend during his last stages of life. This person had a motorcycle accident and was in a vegetative state, unable to move except roll his eyes and weakly move his fingers. I noticed when a nurse was cleaning his G-tube, the patient was vigorously rolling his eyes and clenching on the bed sheet – a sign of extreme pain. The patient himself, communicating only using his eyes, wanted to die. Furthermore, the patient’s wife and doctors supported in terminating the patient, however, the patient’s sister disagreed. In the end, after dragging his life for 12 more months, the patient developed various infections in the lungs and kidneys, together with many ulcers all over the body, and died an extremely painful death. I don’t think it was worth to waste all the time and resources on a patient whose life became excruciatingly painful. So, personally, I fully support mercy killing.

Quote of the Day

To my mind, democracy is more compassionate, more harmonious, more friendly than any other system. It respects others' rights and considers others equally as human brothers and sisters. Although you might disagree with them, you have to respect their wishes.

-His Holiness the Dalai Lama From "The Pocket Dalai Lama," edited by Mary Craig, 2002. Reprinted by arrangement with Shambhala Publications, Boston, www.shambhala.com.

The Last Word

The Last Word on the Last Breath, New York Times dated October 10 presented us with the case of a 35-year old patient “ in a persistent vegetative state for 15 years…” who despite of obvious clinical deterioration was given interventions as the family requested.

Here the patient is not able to decide what he would like done. His family members have notified the medical staff of what actions are to be taken pertaining to their loved one ‘s treatment, which brings up the issue of surrogate decision. They wanted “all revival efforts” with hope. This clearly conflicts with the issue of futility in treatment and the young physician involved knew it well.

The medical staff is aware of no prevalent benefit from any further intervention for the patient based on sound physical findings. The state has no interest in prolonging the dying process based on the irreversible condition of the patient’s multiple organ failure.

The goal of treatment is to improve the patient’s condition leading to mental and physical stability. Unfortunately here it does not apply given the kidney failure, the pneumonia, the generalized infection, and the general weakening status of the body, not to mention the apparent mental deterioration without any likely recovery.

All the following could qualify as futility treatments for this patient:

1.The artificial feeding is no longer beneficial since he was losing weight;

2.Cardiac arrest is taking place;

3.The CPR will fail to resuscitate the patient;

4. The patient is not expected to regain consciousness or recover.

The family’s request for lifesaving efforts, which included CPR, does not balance with the physician’s duty to prevent unnecessary treatment on the patient. They are legally representing the patient, but at times in surrogacy issues emotions will tend to take over decisions regarding patients’ interest. The members of the family will be assured that they have authorized the medical staff to try all that was in their power to do in terms of treatments and interventions and hopefully this will prevent internal family conflicts that would make the mourning process even more difficult.

If I were this physician, I would be morally compelled to spare performing any intervention, since there is no expected recovery based on the strong clinical evidence.(Based on the AMA guidelines , another physician has to be consulted on site) . The aim of CPR, according to the American Heart Association “ …is to preserve life, restore health…” but in this particular situation there is not any “expected physiologic “improvement as evidenced by the patient’s septicemia and failing vital organs. Hospital Ethics Committees do have decision–making charts available for physicians confronted with difficult situations such as this case, and they are very helpful and simple to use. The U.S. Congress in 1985, under the “ Baby Doe Rule,” protected physicians in discontinuing any interventions aimed at prolonging a person’s life if no improvement can be foreseen. Physicians are obliged to act in their patients’ best interests at all times, let alone when aware that death is imminent and any added intervention is just prolonging death. It was time to simply let the patient be. Every individual deserves dignity and the healthcare team ought to, as always, be their patients’ best advocate in avoiding unnecessary treatment and ease suffering when all comfort treatments have been exhausted.

posted by sophie at 5:41 PM

Removal of Terri Schiavo's feeding tube violated the rights of the disabled

Theresa Marie "Terri" Schiavo (December 3, 1963 – March 31, 2005) was a woman from St. Petersburg, Florida. Her death decision was a federal matter and her husband selfishness. She was 26 when she collapsed in her home in 1990 and experienced respiratory and cardiac arrest. She remained in a coma for ten weeks. Within three years, she was diagnosed as being in a persistent vegetative state (PVS).

From my prospective view, if a person becomes incapacitated and has no written statement that expresses his/her wishes regarding health care, should the law presumes that the person wants to live, even if the person is receiving food and water though a tube. Given lack of living will, Terri Schiavo’s husband claimed that she would not want to be kept on a machine with no hope to recovery while her parents claimed that she was a devout Roman Catholic who would not wish to violate the Church’s teachings on Euthanasia. Who was in her best interest her husband who has already a girlfriend with two children out of wedlock or her parents that brought her on the earth.?

The decision of a number of Florida courts was that during two funerals earlier in her life, she discussed with her husband, brother-in-law, and sister-in-law the possibility of being profoundly disabled in the future. She indicated that she would prefer to be allowed to die naturally. It is hard to believe. She never signed a formal medical directive or a living will, which was the least thing on her mind at that age . These battles could have been avoided if Terri had had one. Perhaps the greatest effect that she has had on the American psyche is to remind citizens to consider drawing up a living will while they is still mentally alert. Otherwise, husband, brother and sister-in-law, mother and father-in-law, son and daughter-in-law or a guardian (the court) will be making decision for you.

Although, according to the Christian doctrine, death is not the ultimate evil, but eternal damnation is; to allow Terri to die would be to allow her to join with God in eternal life. Yes, but NOT when it interfered without hydration and nourishment. Pope John Paul II discussed nourishment of patients in Terri Schiavo's condition during 2004-MAR: "...the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering....we are called to provide basic means of sustenance such as food and water unless they are doing more harm than good to the patient, or are useless because the patient’s death is imminent."

Partial-birth Abortion

With the Supreme Court term beginning this past Monday, Oct. 2, it will quickly face cases on the federal law banning a procedure known as partial-birth abortion that are drawing attention from the religious community.

Court observers are eyeing two abortion cases, in which the 9^th and 8^th U.S. circuit Courts of Appeals each said the 2003 federal law banning partial-birth abortion was unconstitutional, to see if recent changes in the Supreme Court’s makeup will affect the outcome of abortion-related decisions.

In Gonzales v. Carhart, the 8^th Circuit sided with Dr. Leroy Carhart, a Nebraska abortion doctor who successfully sued to overturn that state’s partial-birth abortion ban. In 2000 the Supreme Court ruled 5-4 that the state law was unconstitutional because it lacked a provision allowing an exception in cases where the pregnant woman’s health is at risk.

Congress sought to reverse the effect of that ruling by passing a federal law banning the procedure nationwide. The bill did not include a health exception, because, the bill’s proponents argued, sufficient evidence had been heard that this particular procedure is never medically necessary.

The banned procedure involved partially delivering a live fetus and then puncturing the brain stem to kill the baby before completing the delivery. Supporters of keeping the procedure legal argue that it is usually used late in pregnancy when other abortion methods are more dangerous to the woman.

In Gonzales v. Planned Parenthood, the 9^th Circuit ruled on behalf of a San Francisco-based Planned Parenthood affiliate and its national organization that the federal law is unconstitutional because it lacks a health exception, imposes a burden on a woman’s right to choose to have an abortion and is constitutionally vague.

The legal question before the Supreme Court when it hears both cases November 8^th is whether the law is invalid because it lacks a health exception or otherwise is unconstitutional.

I believe the abortion issue is always very difficult to discuss. The main problem seems to stem from the question - When does a human being become a human being? When does life begin? Is abortion murder?

In conclusion, the basic protection which society must provide its citizens is the protection of the right to be. Our Declaration of Independence express as self-evident the truths "that all men are created equal, that they are endowed by their creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness," and that governments are instituted to secure these rights. Whether one believes in a creator or not, the responsibility of government in the matter of human life is clear. When abortion was legalized in our country, government, in effect, said that the unalienable right to life does not apply to certain beings that are, nonetheless, definitely human beings. This brings us back to the question when does life become life? For all practical purposes it made every unborn child legally vulnerable. In regards to the subject of partial – birth abortion, I believe there is no doubt that human life is being endangered. The child being aborted is a child – no questions asked.

" Don't let the bugs bite” : can genetic engineering defeat diseases spread by insects?

Reemergence of old diseases that were thought to be under control (in certain countries), was an unpleasant shock to the health care community. This illustrated an important principle that disease patterns change because of :

I. Organisms change,

II. Human activity change to create new opportunities for organisms to cause disease.

In the mid-20^th century, insecticides and other measures eliminated malaria from US and Europe. Many public health workers were optimistic over reducing the global burden of many vector-borne diseases, such as : Malaria, Chagas, Yellow fever, and Dengue fever, by spraying chemicals. With the comeback of these diseases, occurring more widely and more frequently than they have in recent decades, Frank H. Collins of the University of Notre Dame in Indiana, said in retrospect that it was naive of us to think that we could eradicate the mosquito by chemical attack. Many insect populations, especially in the tropics proved too hardy, as evident by the come back of diseases in regions that were considered free of such. Failure to control these vector-borne disease with chemicals, lead scientist to research alternate ways to target the problem.

Molecular Biologist Anthony James of University of California in Irvine has proposed; augmenting conventional measures with genetic engineering and other innovative approaches, to pare down vector population and leave others incapable of spreading disease. While controversial, the Sterile Insect Technique (SIT) has worked against disease vectors and agricultural pests.

1. Tsetse flies, the vectors of sleeping sickness, were eradicated from Zanzibar, an island of Tanzania.

2. California citrus groves were cleared of the invasive Mediterranean fruit flies.

3. Eradication of livestock parasites and flies.

SIT damages the male insects to such an extend that they can not reproduce but still compete with the wild males for mates. Entomologists are setting up research fields to study different ways to genetically modify, either the microbe or the vector insect that carry them.

Entomologist Celia Cordon-Rosales of the Universidad del Valle de Guatemala is targeting disease spreading insects, to genetically alter them or to manipulate organisms living in them. This approach remains controversial, and because the government will be tough on giving permission to release modified insects or micro-organisms in the environment, it is not too early to carry-out this project, because it involves a lot of basic research, and special precaution to ensure that potential problems with releasing the research sample, is properly secured. Cordon-Rosales' major research is with Chagas Disease. This is an insect-borne disease, that is contracted via infection with the single celled protozoa: Trypanosoma cruzi. Several insects are the vector of this disease. The bug is called “kissing” or” assassin “bug. Kissing because it has a tendency to bite people near the mouth. Chagas is prevalent in Latin America to as far North as the United States. 90 million people live in the areas where Chagas disease is endemic, 12-18 million (13-20%) people are infected of which 10-30% develop heart failure or other chronic life threatening symptoms. The mortality is approximately 50,000 people per year.

The basic research set-up is what she refers to as a ghost town, isolated from human life by fine mesh nets through which bugs can not escape. The imitation village would contain huts from straw and clay. It will be occupied by pigs in pens, and free living insects and bacteria. The mock hamlet will be encircled by a ditch, which will collect any runoff water that might permit micro-organisms to leave the site. Rosales hopes that with the results of her research project and that of her collaborators in the United States, that she will also be able to address the problem of the reemergence of Malaria, Sleeping sickness, Dengue fever and Yellow fever as well.

Posted By Ingrid Daly October 19, 2006

UHSA student Elijah Akper -- Stem Cell Debate Goes to Voters

Stem cell debate has put on a whole new face as voters are being asked to weigh job creation and potential life-saving cures against moral concerns over the destruction of human embryos in an impassioned battle over a Missouri ballot measure supporting the science. According to political analysts, the outcome of the initiative in Missouri could influence future federal and state efforts to either block or support the science. Embryonic stem cell research has gotten caught up in a tight U.S. Senate race between State Auditor Claire McCaskill (D) and incumbent Sen. Jim Talent (R), a race so tight that McCaskill has made support for embryonic stem cell research a keystone of her campaign.

Whereas Missouri is the only state with the question on the Nov. 7 ballot, the controversy over embryonic stem cell research is playing prominently in the Wisconsin governor's race and cropping up in state races scattered across the country. What is more, a few Republican gubernatorial candidates are breaking ranks with the Bush administration by running on their support for the controversial research topic. In a close state race, Wisconsin Gov. Jum Doyle (D) is using his support of embryonic stem cell research to differentiate himself from conservative challenger U.S. Rep. Mark Green (R), who opposes using human embryos for the research. Political analysts agree that Doyle's persistent, albeit unsuccessful, calls for the state Legislature to commit funds to the science give him an edge in the governor's race.

In the state of Michigan, Democratic Gov. Jennifer Granholm is waging a tough re-election bid against anti-abortion Republican Dick DeVos, who has blasted her efforts to overturn laws in the state that restrict the science. " While President Bush is building up walls in Washington to block this life-saving research, we have the opportunity to tear them down in Michigan," says Granholm in a written appeal to Michiganders to sigh a petition asking state lawmakers to repeal anti-stem cell research laws. She has argued that removing restrictions on the science would reduce health care costs and allow the state's emerging life-sciences industry to flourish.

As things are turning out, the Midwest is not the only political stage where science is colliding with religion over stem cell research. On both coasts, Republican governors up for re-election in November are touting their record of supporting the science for its medical potential and economic opportunities in a clear break with Bush admininistration policies that limit the research.
In Massachusetts, home to stem-cell leader Harvard University, both candidates for the open governor's seat have come out in support of the science. In the South, Georgia and Kentucky stem cell advocates already are taking steps to get the issue on the ballot in 2008. A statewide poll of Georgia voters found 63 percent approval for "research on stem cells taken from donated embryos from fertility clinics that would otherwise be discarded."

In July, right before President Bush vetoed a bill that would have lifted his 2001 restrictions on federal funding for embryonic stem cell research, Democratic governors from Delaware, Illinois, Iowa, Michigan, New Mexico, Oregon and Wisconsin urged Congress to push for stem cell funding. Some of those same governors continue to publicize their support for the research in their re-election bids..

Interestingly, sixty-eight percent of Americans approve of embryonic stem cell research, according to a recent NBC News/Wall Street Journal poll. Supporters include high-profile Republicans, such as Nancy Reagan, with loved ones who have suffered from debilitating diseases for which the research offers hopes of a cure.
Six states have ensured the legality of the science and committed state money to fill the gap left by the federal government's funding restrictions. So far, California has committed $3 billion for the research; Connecticut has committed $20 million; Illinois, $15 million; New Jersey, $5.5 million; Maryland, $15 million; and Massachusetts, 15 million.

While researching this topic, I had an opportunity to examine things from different view points. One such viewpoint that stand out for me is that of David Moyes of the Scottish Council on Bioethics. Moyes tries to sell us the following argument: we can't determine for certain what the moral status of an embryo is. That we as a society ought not to disregard the section of the population that ascribes infinite value to embryos and comes out against any destructive embryo stem-cell extraction and research.
The Cathilic Church, Mr Moyes and the Scottish Council on Human Bioethics are welcome to differ. Considering that he represents the Scottish Council on Human Bioethics, his choice of words is rather charged. It is misleadinig in the extreme to call embryos persons, as most embryos, even those naturally conceived, never result in babies due to the high natural rate of embryo failure. Infact stem cells are extracted around 14 days after conception. Crucially for the question of moral status: the embryos in question have no central nervous system, no brain, no capacity to suffer, they consists of a few hundred cells.
And there might still be people who think such cell accumulations ought to be called persons and they ought to be treated like you and me, but the fact of the matter is, there are not many such people as the result of the polls are now indicating. Most of us realised that these cell accumulations lack any of the dispositions that we normally accept to be necessary conditions for ascribing personhood to something.
Furthermore, as is typical of those who seek to "protect" embryos, he offers no suggestion as to what ought to be done with embryos if they were "saved" from research. It is almost certain that nothing would ever happen to them and they would remain frozen or be discarded. This would benefit the embryos in no way whatsoever, and would deny real people powerful medical treatments that Mr Moyes admits might be provided by stem cell research.

Those who seek to protect embryos would do well to give some thought to what would actually happen if they got what they wanted. I stand corrected, but in my humble opinion, we will do well to promote the stem cell research.

http://www.courierpostonline.com/pbcs.dll/article?AID=/20061004/NEWS01/610040

http://www.theherald.co.uk/features/71345.html

http://www.slate.com/id/2150545/fr/nt/

http://www.stateline.org/live/details/story?contentId=146780

A PROFESSION WITH SHARP DOUBLE EDGED SWORD

KWABENA ABRAH
Bioethics Blog Entry
UHSA 2006

A PROFESSION WITH SHARP DOUBLE EDGED SWORD

Introduction and Comparison
An OB-GYN (Obstetric and Gynecology), a branch in medicine that used to be, to my knowledge, a lucrative specialty field for many physicians in the western world, is probably losing its attraction because of increased in liability insurance and malpractice lawsuits.
Nonetheless, on the other side of the world, especially in some of the countries in sub Saharan Africa, it is rather the opposite. Both old physicians and those fresh from medical school are craving for this special branch of medicine, because this is where the money lies.

Supposedly Job description and discussion of some African Gynecologists
In some part of Africa, not only does a childless wife or woman is always get blamed for being the cause of her infertility, but also she does not command respect and dignity in the society in which she lives. She is as well treated among her kinsmen, and husband’s family as a “worthless being”. For an idea that men as well could become impotent and sterile, is of little knowledge to some of the African societies, especially those in sub Saharan.
In order to avoid emotional harassments, humiliations and embarrassment from the above three categories of people (society, kinsmen, and husband’s relatives), the women with infertility problems in this part of the world, try on tooth and nail to have their own biological children. Finally, they have to seek medical help from gynecologists who also cross-trained in infertility. The women or the couples have no choice, but to pay huge sums of money as exorbitant charges for the treatment of infertility.
One would have thought that the job description of a gynecologist is to perform a noble task such as the one stipulated above and the likes. They are also expected to treat incomplete, threatening and spontaneous abortions. Not to ignore other disorders like prolapsed cervix and uterus, removal of fibroid tissues from uterus, fallopian tubes and ovaries (total hysterectomy). Included are palp smear, and other diagnostics, which identify illnesses or disorders that are related to or associated with female genital and reproductive organs. Another important job that is supposed to be performed by or expected from a gynecologist is assisting child delivery (labor) and caesarean sections.
Besides the supposedly job description for some African gynecologists, there is another distinctive booming business of which I have termed and abbreviated “The Black-Market Commodity” (BMC), and “Real Gold Mines” (RGM) that raises an ethical question, which puzzles the public. As a matter of fact, it is on this side of the coin where many riches are acquired within a short period of time through illegal means. The said health professionals contribute to the termination or destruction of healthy pregnancy that poses no life threat to the host. There are some doctors who offer services in hospitals that are operated by their governments, and use the instruments and equipment belonging to the public to perform this unlawful act (aiding in criminal abortion).
People do wonder if the law allows these gynecologists to destroy healthy fetuses on one hand by means of causing criminal abortion, and the other hand to help infertile women become biological mothers.
In fact, the answer to the question is a big “No”: because they are not licensed to perform any none life-threatening abortions since almost all the countries in this region have laws against criminal abortions, irrespective of who is performing it.
However, as the laws are not strictly enforced; and also the easiest way for a gynecologist or a physician to become rich overnight, many of African gynecologists and even other physicians are engaged in this unacceptable and dubious transactions. To make it worse, some women in this part of the world show no remorse to submit themselves to this practice, and so criminal abortion is rampant over there.
I can set an example of a small town where I used to work as health care personnel. Even though there is no absolute or written records, yet based upon my own observations, investigations and hypothesis, a town with a population of about 30,000; one in every five women had either once or twice, or more terminated healthy pregnancy (criminal abortion) with the help of a gynecologist or a physician.
In some parts of Africa, by mere mentioning of the word abortion, sounds like pronouncing the word murder. Abortion takes to mean an offensive term, which sends a signal of indignation to the people around: thinking that it is an operation or a kind of intervention to end a pregnancy by removing a healthy embryo or fetus from a womb. At times, the procedure is badly done and leads to the death of both mother and embryo, which is quite unfortunate. As a result, in some areas, it is a taboo to hear the name “abortion.” It is quite uncomfortable and difficulties for someone to bring the word abortion in casual conversation. Hence, when another name was coined for abortion, it became widely accepted in this small town and her surroundings. The name “APPARA”, which was coined by the writer of this article, became popular and the people in the nearby towns and villages embraced it with whole heartedly. I believe the new name is still in use in those areas, and probably it has spread to the other nearby regions. I won’t be surprise to hear that the new name has spread to the entire nation and has completely replaced the old one, criminal abortion.

Defense and view points from Gynecologists and other Doctors
On the other hand, the gynecologists and physicians arguable protect their positions of engaging in this offensive business; saying that Africans have many forms of crude and unsterilized method of getting rid of unwanted pregnancy, which most often, caused a lot of health complications even resulted in death of most of the teenage girls and young ladies. They added that sometimes adult women are not exempted from being victims.
For that reason and many, they deemed it more appropriate, and healthier to offer the women more sanitary means of treatments. Moreover, these health care providers stressed that by tending to the women’s needs, they are in a way preventing premature death among the reproductive aged women, and also adding to their freedom of choice; therefore, women will have more autonomy over their bodies.
What is more, the physician emphasized that their services to their patients are not for their selfish reasons, but they are proper medical care providing to their patients to alleviate both their physical and mental suffering as well as social and economical hardships.

Summary
There is no doubt about the work of African gynecologists and/or general practitioners as a life-saving job. However, I do not side or agree with those gynecologists and physicians, who do not only practice to destroy healthy fetus for monetary gain, but also justify their deed by convincing the public that they are saving the lives of desperate young ladies who are facing difficult life-choices. I feel the self justification and self-defense by the gynecologists to cover-up their deeds is not the proper way to show compassion pertaining to women reproductive issue. To me, there is no reason to claim to save the life of young women at the expense of innocent fetuses, and my only position is that it is only done for financial reasons. For; almost every person that I know especially the Africans, believes that a human is formed the moment conception had taken place.

Conclusion
I want to conclude with the following stand point.
The work of gynecologists as well as physicians will be that of divine blessings if only they are to save lives and to restore health, but not to aid in destroying the seed of mankind.

The authenticity of this article
The writer of this article had served in various hospitals in sub-Saharan Africa and therefore, the contents of this article are based on his experiences of twenty-two years of working as a healthcare provider.

Reference:
For any question, contact the writer.
Thanks.

UHSA student post on Euthanasia -- Christine Livek

The world medical community considers both euthanasia and assisted suicide to be in conflict with basic ethical principles of medical practice. The World Medical Association, with members representing medical associations (including the American Medical Association) from eighty-two countries, has adopted strong resolutions condemning both practices and urging all national medical associations and physicians to refrain from participating in them even if national law allows or decriminalizes the practices.

Euthanasia is the act of deliberately ending the life of a patient, even at the patient’s own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness.

Physician-assisted suicide, like euthanasia is unethical and must be condemned by the medical profession. However the right to decline medical treatment is a basic right of the patient and the physician should respect such a wish of a patient.

There are basically four arguments against euthanasia and or physician assisted suicide.

They include 1) Euthanasia would not only be for people who are terminally ill 2) Euthanasia can become a means of health care cost containment 3) Euthanasia will become non-voluntary and 4) Euthanasia is a rejection of the importance and value of human life.

1) There are many definitions for the word “terminal”. Some laws define “terminal” condition as one from with death will occur in a “relatively short time.” Others state that “terminal” means that death is expected within six months or less.

Even where a specific life expectancy is referred to, medical experts acknowledge that it it virtually impossible to predict the life expectance of a particular patient. For this reason, euthanasia activists have dropped references to terminal illness, replacing them with such phrases as “hopelessly ill,” desperately ill,” “incurably ill,” hopeless condition,” and “meaningless life.”

2) Euthanasia and physician –assisted suicide could become a means of health care cost containment. “….physician-assisted suicide, if it became widespread, could become a profit-enhancing tool for big HMOs.” “…drugs used in assisted suicide cost only about $40, but that it could take $40,000 to treat a patient properly so that they don’t want the “choice” of assisted suicide…” …Wesley J. Smith, senior fellow at the Discovery Institute.

Perhaps one of the most important developments in recent years is the increasing emphasis paced on health care providers to contain costs. In such a climate, euthanasia certainly could become a means of cost containment.

This could be quite a slippery slope. The pressure to contain costs by the insurance companies and big business could try to force the medical profession to participate in euthanasia and physician-assisted suicide. Hasn’t health care gone too far already with unethical decisions regarding “cost containment”? I think so.

3) Euthanasia and physician-assisted suicide would only be voluntary, they say. Emotional and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia is considered as good as a decision to receive care, many people will feel guilty for not choosing death. Financial considerations, added to the concern about “being a burden” could be used as powerful forces that would lead a person to “choose” euthanasia or assisted suicide. Who will make the evaluation that a person is in their right mind to make such a decision. What if they are just depressed? And, if they are in severe pain, why not change their pain medication? These are all questions physicians need to be asking themselves.

4) Euthanasia and physician-assisted suicide is a rejection of the importance and value of human life. People who support euthanasia often say that it is already considered permissible to take human life under some circumstances such as self defense – but they miss the point that when one kills for self defense they are saving innocent life – either their own or someone else’s. With euthanasia no one’s life is being saved – life is only taken.

I once had a patient that was diagnosed with lung cancer. She was given about six months to live by her physician is she had no treatment and about one year to two years with treatment. She opted for treatment. Soon after the chemo began she became very ill from the side effects of the chemo. She said she just wanted to go ahead and die. She said she was suffering more than she ever thought was possible and she felt like she was a huge burden to her family. She begged to have someone help her end her life. That was four years ago. Today she is an active person in our community and loving life because she says “I live life every day to the fullest”! If her physician had helped her end her life, the patient and her family would have missed out on these last four years and whose to say how many more years she will be alive! There are miracles and they happen everyday.

History has taught us the dangers of euthanasia and that is why there are only two countries in the world today where it is legal. That is why almost all societies – even non-religious ones – for thousands of years have made euthanasia a crime. It is interesting that euthanasia advocates today think they know better than the billions of people throughout history who have outlawed euthanasia – what makes the 50 year old euthanasia supporters in 2006 so wise that they think they can discard the accumulated wisdom of almost all societies of all time and open the door to the killing of innocent people? Have things changed? If they have, they are changes that should logically reduce the call for euthanasia – pain control medicines and procedure are far better than they have ever been any time in history.

Emergency Contraception for those under 18

University of Health Sciences Antigua (UHSA) student blogger Kirti Shah comments on a previous post from the WBP blog re emergency contraception:

Recently the Government of Chile announced that they are going to provide emergency contraception to any one over 14 at no cost. What a revolutionary idea from a Catholic country. We in the U.S. now have made it available over the counter to anyone over 18 but they still have to pay. This was blocked on political grounds ( religious grounds) a number of times by questioning its safety ( rejecting all the evidence) and the usual abortion arguments.

The current law permits the pharmacist to sell it to anyone over 18. Any person over 18 can then give it to a person under 18 but a pharmacist cannot. This makes the pharmacist a policeman and potentially liable in case of some kind of a mistake. This can potentially introduce a third party in the distribution chain. We need to change this law to accommodate any minor and this would at the very least allow a health professional to advise the patient on the proper use of this medication.. The “ morning after” pill has a 89% efficacy if taken within 72 hours of unprotected sex and is more effective if taken in the first 24 hours. Reducing the waiting time should be of utmost importance.

We should clarify what emergency contraception is. It is a backup method of preventing pregnancy or reducing chances of pregnancy after unprotected sex. Examples of unprotected sex would be a broken condom, if one forgot to take birth control pill for 2 or more days ( which happens a lot) , or if one was sexually assaulted. Plan B is not RU-486 ( the abortion pill) because plan B is used to prevent pregnancy. It will not work if you are already pregnant and it will not affect an existing pregnancy. Plan B is also safe and it is a larger dose of normal birth control pill. Plan B will decrease the chances of pregnancy by 89% if taken within the first 72 hours of unprotected sex. It works better if taken within the first 24 hours after unprotected sex. When birth control pills first came out their doses were very high almost similar to plan B.

Arguments have been and will be used against plan B with misleading and false arguments and a conscious effort has to be made to educate the public. Condoms were once sold behind the counter and today they are available all over and serve a useful purpose. We cannot deny services to people who need it using false arguments and we need to loosen up the law that will free up the pharmacist or any other health care professional to be able to provide these services in good faith.

http://womensbioethics.blogspot.com/2006/09/chile-birth-control-free-for-women.html