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...
Monday, March 10, 2008
Friday, March 07, 2008
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.
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.
Wednesday, March 05, 2008
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.
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.
Tuesday, March 04, 2008
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."
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."
Sunday, March 02, 2008
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.”
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.
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.
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.
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.
Saturday, March 01, 2008
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.
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.
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