Euthanasia is defined as the intentional termination of someone’s life by someone other than the person concerned, at the person’s request. Many people with in the advanced stages of illness will request a physician to help in a painless death. The difficulty in dealing with such requests is to ascertain what reason the request was made. Is it caused by psychological distress, or merely an insincere comment not meant to be interpreted literally as a death wish? Moral issues aside, let’s assume that euthanasia is legal, and the physician is required to respond to such death requests professionally. Discussing the topic of euthanasia with a patient is tricky, the consequences could be emotionally draining, unhelpful to hopefulness, or psychologically harmful to the patient. Another issue is the preparedness of doctors or nurses to respond to desire to die statements (DTDS). That preparedness could include legal and professional knowledge and understanding, saying the right thing at the right time, etc. These fears can lead professionals to ignore DTDSs hindering the patient’s ability to express any psychosocial concerns, thinking that the physician won’t be able to help, or is unconcerned with his/her personal well-being. Another issue regarding DTDSs is that these desires can fluctuate over time. How does a physician gauge the sincerity of such a request? Research suggests that interactions that convey empathy for the patient’s distress and active listening assist psychological adjustment, that information and comprehensive understanding about what to expect in the future promotes psychological well-being, and an opportunity to discuss feelings with a health professional reduces psychosocial distress. In light of these findings, it is important that health care professionals be adequately trained in handling DTDSs and respond to them appropriately. As I said before, I have ignored whether or not physician assisted suicide is morally right or not, my focus is to point out what difficulties arise in responding to a DTDS and what research shows can help a patient in a palliative care setting.
Leia Mais…Saturday, March 21, 2009
Stem Cell Research
Stem cell research is a controversial issue. Even in countries that allow embryonic stem cell research, strict principles and procedures have been established. These include limiting the growth of the embryo to 14 days (enough time for the primitive streak to form), informed consent for the donor, patient confidentiality, noncommercialization (i.e. you can’t pay for embryos), avoidance of conflicts of interest, limitations to therapeutic purposes, ethics reviews, and traceability to cell lines with respect to their sources. A developing procedure is able to create stem cells using a woman’s oocyte and adult stem cells which are easily harvested. This is called somatic cell nuclear transfer (SCNT). One problem with this method is that women who donate their oocytes exclusively for research are taking an unnecessary health risk. Up to 10% of the women who undergo ovarian stimulation to procure oocytes experience severe ovarian hyper-stimulation syndrome, which can be painful, lead to renal failure, cause infertility, or even death. We could view these people as research subjects, who willingly submit to risky situations, except most research subjects gain some kind of benefit in return. Physician’s fiduciary obligations would prevent recommendation of such a course of action for no benefit. Altruistic donation seems reasonable when it goes to a family member (an organ transplant for example) but is it ethical to do such for a stranger? Who in their right mind would walk up to the hospital today and donate their kidney with no particular person in mind? Even if one would donate the organ since the benefits of organ transplants are so well established, who would act co altruistically for a procedure like SCNT which has no clearly established benefits? There is a wide gap between research and therapy. Stem cell research needs to be understood as research, not as a therapy that will se immediate results. “Stem cell therapy” is still years away, so donors will not be directly influencing themselves or their loved ones. Understanding of this is important for informed consent of any potential oocyte donors.
Leia Mais…Universal Health Care
This weekend I will be studying various health care issues and posting short blurbs about them. The first one should be very familiar: Universal Health Care. Here's some thoughts:
Is health care a necessity or a luxury? Right now many consider it a luxury, one that requires sacrifice to obtain. People fear that if a universal health care system is put in place it may ruin the quality health care service provided to those fortunate enough to have health care insurance. Sure Medicare provides care for those over 65, and Medicaid for those in poverty, but has this ensured health care is available to anyone who needs it? With increasing health care costs many employers are cutting those benefits leaving many uninsured. When I am a doctor will I have to turn away sick people because they are uninsured, or will I be forced to perform an operation which will replace injury with debt and bankruptcy? Another drawback of the current system is that PPO’s and HMO’s limit the person’s access to health care. It’s not just a matter of will you receive health care, it’s a matter of where can I receive health care. The US system favors specialty doctors (secondary care physicians). This is represented by the portion of doctors that go into primary care (only 13% in the US, compare that to 66% in England). With more and more people not seeing a primary care physician (PCP) preventative medicine gets neglected, replaced by reactionary medicine. In England, the National Health Service (NHS) requires everyone to be screened by a PCP and then referred to a specialist. With everyone required to have their own general practitioner, people are better educated in preventative medicine for chronic diseases (improving health and saving tons of money). There are plenty of drawbacks to the English health care system as well, the most notorious being the long waits to see a doctor (months if not years). Unfortunately there is no direct study comparing the two systems, and until there is a fair conclusion cannot be made judging which provides better quality care.
Thursday, March 19, 2009
Jehovah Complex
It's strange how physician's are often infamously attributed with what many call a Jehovah complex. With this they don't listen very well to their patients, thinking they are the one's that went to medical school and they are the one's who know everything. Dr. House is the personification of this caricature. Now I chose long ago to pursue a career in medicine, resolving within myself to be open to others opinions and criticism. In learning the Hmong language I was forced to accept the fact that I needed to be teachable. Fluid minds are able to adapt better to new information, they are better apt to exceed in unfamiliar situations.
These observations made, I find myself slipping into a pseudo-Jehovah complex myself this semester. In all my classes I've become that kid who everyone rolls their eyes at because he raises his hand to answer every question in a smug manner (like hermione from the harry potter series). To my acknowledgment this is a new development in my personality, sure I've always considered myself bright, but never self-righteous. What catalyzed this change? I have decided my MCAT preparation is to blame. I have put more time into study this semester than ever before in my life (approx 70 hours a week). This extra mental practice has sharpened my cognitive ability, making me more alert to new material shared in class. Now don't get me wrong, I appreciate and am grateful for my new found cognitive endurance and aptitude. I am humbled at how amazing an instrument the nervous system can be, especially if one will spend the time nourishing it. However, it scares me that I could go down the path of anti-social behavior many doctors do.
I guess the purpose of this post is to remind myself, and others if they're interested, to always stay fluid. Avoid at all costs the Jehovah complex, because that mindset is potentially crippling.
Tuesday, March 17, 2009
Attack on Doctors' Moral Rights
Obama's Attack on Medical Civil Liberties
Sunday, March 15, 2009 5:23 PM
By: Newt Gingrich and Rick Tyler
Candidate Barack Obama offered a compelling but formless message of hope and change. Many Americans desiring a new national direction filled his empty rhetorical vessels with their dreams and aspirations. It worked.
But now, obliged by his office, President Obama is giving those words definition and shape bewildering even some of his most ardent supporters.
While the media remain fixated on a slumping economy that gets sicker with each punishing presidential prescription, a different set of defining and similarly freedom-diminishing policy directives emerging from the White House goes dissimilarly unnoticed.
Earlier this month, the President took the first step in rescinding a Bush administration moral conscience regulation which enforces existing legal protections against discrimination and intimidation for doctors and other healthcare professionals who invoke conscience by refusing to participate in medical procedures they believe immoral.
The rule, which was finalized last year placed no restriction upon any legal medical procedure; it simply brought the executive branch into compliance with several existing laws including:
the 1973 "Church Amendments" which protect doctors and other healthcare professionals from discrimination due to religious belief or moral conviction;
the 1996 “Public Health Service Act Amendment” which prohibits government from discriminating against individual and institutional healthcare providers who choose not to provide abortion services or receive abortion training; and
the 2004 "Hyde-Weldon Amendment” which prohibits certain federal funds going to federal and state agencies and programs that discriminate against healthcare providers who decline to offer or refer abortion services.
Simply put, these three venerable laws passed by Congress and signed by former Presidents protect doctors and nurses from being professionally threatened because they allow their conscience to dictate their professional actions.
By eliminating the enforcement of these legal protections, the Obama Administration is signaling that it intends to ignore the law and refuse to protect the civil liberties of healthcare professionals based upon religious or moral conscience. Without enforcement, healthcare personnel will have scant legal recourse for intimidation and bigotry rendering the laws intended to protect them meaningless.
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