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?
Saturday, December 09, 2006
Sunday, December 03, 2006
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.
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.
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.
Saturday, December 02, 2006
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
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?
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.
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.
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.
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.
Friday, December 01, 2006
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.
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
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.
.
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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