I thought it was appropriate to talk about End of Life for the last blog in this Health Care Ethics class. There are many issues that we could talk about, from abortion to death with dignity. Surely in the news you have read about doctors who in the name of beneficence perform "mercy killings", patients in Oregon have the ability -after jumping through many loopholes- of requesting to end their life.
Where does the Hippocratic Oath fit? Should it be revised? Is it all encompassing? As I discuss this with my family and friends, I have heard many different arguments both in favor and against this topic. The only thing that pretty much everyone agrees on is that in the end, it should be the patient who decides. And even when the patient does not have a voice, the health care surrogate should try to represent the interests of the individual to the best of their knowledge.
Finally I want to talk about the importance of a living will. A living will is a document that lists your wishes in case you are not able to make a decision about your life. To put bluntly, it is a legal document that will serve as a your decision, in case you do not want to be resuscitated or if you do not want to be hooked up to life support if you are brain dead. It can be very detailed, and you can specify treatment that you do not want performed on you and it could also include specific instructions about organ donation. It is free and once again, to be respected by any court. I bring this up, because its important to take the burden away from your family. No one wants to be responsible for the decision of taking some one off life support, and by having this document you can take the burden away from your spouse or your parents. This holiday season, talk to your family, ask them how they feel about a tough situation like the one Terry Schiavo was in. Tell them how you feel, and you might be surprised by their res ponce. Take responsibility of your life, and if the unthinkable happens, don't leave them with that responsibility.
Florida Living Will
Monday, December 8, 2008
What role...
What role should spiritual care take in the Hospital setting?
Many hospitals are sponsored by religious institutions, the Methodist church, the Mormon church and the catholic church stand behind some of the most prestigious hospitals in the nation. Here in Orlando Florida hospital is the only hospital in the central Florida area to perform transplants and yes they are backed by a religious entity. And even though the care they provide is rooted on scientific research, what role should their spiritual care take in the Health Aid setting?
As I read article after article on how faith can be used as part of mental health, I am convinced that spiritual care can be an asset, even hospitals that are not sponsored by a religious denomination usually employ chaplains or people specialized in faith based relations. But, what are the boundaries of Faith Based Care?
In a journal entitled "Ethical Boundaries of Spiritual Care" the author outlines a couple of suggestions on what the boundaries should be, and all of them focus on the same principle, respecting the patient. This is my interpretation of those suggestions:
1.- In order to provide care, the provider should have an understanding of the patient beliefs.
Simply put, we cannot override the wishes of an autonomous person, we are responsible for educating ourselves, listen to what the patient has to say, and learn from their beliefs -even if we don't agree.
2.- Respect means following the patient wishes.
We can learn, listen and understand but if we don't follow patient wishes, we are infringing on their rights.
3.- Providers should not prescribe spiritual practices, nor urge patients to relinquish their beliefs.
We cannot undermine a patients belief system. If providers start to suggest practices, rituals or other forms of spiritual care, it will end up degrading the respect that medical care deserves. This in turn could damage the personal and professional integrity of the provider.
4.- Health Care Providers who care for the spiritual needs of patients should understand their own spirituality.
One cannot help in this very touchy subject if one is confused about our own belief system.
Ultimately, as said before, spiritual healing is an important part of wellness. But every provider should be aware of the fine line that spiritual care can pose.
Link to Journal:
Ethical Boundaries of Spiritual Care
Many hospitals are sponsored by religious institutions, the Methodist church, the Mormon church and the catholic church stand behind some of the most prestigious hospitals in the nation. Here in Orlando Florida hospital is the only hospital in the central Florida area to perform transplants and yes they are backed by a religious entity. And even though the care they provide is rooted on scientific research, what role should their spiritual care take in the Health Aid setting?
As I read article after article on how faith can be used as part of mental health, I am convinced that spiritual care can be an asset, even hospitals that are not sponsored by a religious denomination usually employ chaplains or people specialized in faith based relations. But, what are the boundaries of Faith Based Care?
In a journal entitled "Ethical Boundaries of Spiritual Care" the author outlines a couple of suggestions on what the boundaries should be, and all of them focus on the same principle, respecting the patient. This is my interpretation of those suggestions:
1.- In order to provide care, the provider should have an understanding of the patient beliefs.
Simply put, we cannot override the wishes of an autonomous person, we are responsible for educating ourselves, listen to what the patient has to say, and learn from their beliefs -even if we don't agree.
2.- Respect means following the patient wishes.
We can learn, listen and understand but if we don't follow patient wishes, we are infringing on their rights.
3.- Providers should not prescribe spiritual practices, nor urge patients to relinquish their beliefs.
We cannot undermine a patients belief system. If providers start to suggest practices, rituals or other forms of spiritual care, it will end up degrading the respect that medical care deserves. This in turn could damage the personal and professional integrity of the provider.
4.- Health Care Providers who care for the spiritual needs of patients should understand their own spirituality.
One cannot help in this very touchy subject if one is confused about our own belief system.
Ultimately, as said before, spiritual healing is an important part of wellness. But every provider should be aware of the fine line that spiritual care can pose.
Link to Journal:
Ethical Boundaries of Spiritual Care
Is Informed Consent Essential to Health Care Ethics?
Last month as an assignment, I was asked to debate the virtues and reasons of why Informed Consent is still essential to Health Care Ethics. I took the assignment and was very happy with the topic because I do believe that it is essential. Then after the debate was over, I started to think about the opposite side and how hard it would be to be in the "con" side of that statement.
Even though I agree that Informed Consent is essential to Health Care Ethics, I decided to look for options to Informed Consent and ask different health professionals about their thoughts.
This are my results:
The Nurse:
As a pediatric Nurse Mike O, believed that the only thing that could take over informed consent was the eduction of the Health Care Workers. With moral issues issues on the rise, he believed that by educating providers in advanced issues such as abortion and religious beliefs and the understanding and empathy, the informed consent walls that are put up could be avoided.
The Physician:
Dr. K, a third year resident was surprised by the question, and told me that the only option to informed consent would be a modified informed consent. She believed that the consent could come from peer review, and that the every decision could be made with the help of a more experienced physician. This is already done in the case of Nurse Practitioners and Physician Assistants, but the input of the patient is always required.
The Administrator:
Carl T. is part of the business team, and he deals with billing. As you might know, a procedure can only be billed if the patient consents (explicitly or implicitly) to it. He believes that if we didn't have informed consent his job would be easier, but as expensive as our health system is provider induced demand would skyrocket. The solution, to have universal Health Care. That way, costs would not be a factor in what the physician would prescribe. Money would not be an option.
As you can see, all of the Health Care professionals had ideas, but none of them were perfect. Informed Consent, even with it's imperfections is the only (for now) way that we can curb the absolute power otherwise given to the people that care for us.
Balancing Beneficence and Nonmaleficence
Beneficence is the principle of doing good, demonstrating kindness, showing compassion and helping others. In other words beneficence requires one to do good. For example resuscitating a person who is drowning, encouraging a person to quit smoking.
Nonmaleficence is the principle of not doing harm, it is not concerned with improving life, but it is centered on the idea that by not inflicting harm on others, and as a result improving the lives of others. For example stopping a medicine that is showing harm to the patient, or even not telling the truth to a patient for fear of causing emotional pain.
There are times when the balancing of the two are essential to Health Care Ethics. For example, one might not want to tell a patient about a condition because it would cause emotional pain, but by telling the person the person will be aware of the situation and seek help. Or one might want to help a person by prescribing a medication that has severe side effects, but if we measure the benefits we might find that treatment is harming the patient more than the disease.
Neither option is universal by itself, and a balance of the two should be tried to reach in complete harmony. While neither of them is perfect; with good judgement and understanding of the two the health care provider can provide the best health care as possible. The most important factor is that we cannot rely on paternalistic views when making our decisions, we value self-determination and that should be accounted when making the decision. And because of Self-Determination, informed consent is completely essential. With it, and with the consensus of the patient, a health care worker can make the best decision in the care of said patient.
Ethical Issues in Managed Care
Managed care in a nutshell sounds like an excellent idea. Paying Doctors for the managed health of the insurers. That means that instead of paying the doctor every time the patient uses their service, they get payed a fixed rate and are encouraged to keep their clients healthy.
We know that the path to fix our health care system begins with prevention; and managed care focus on that, but it has it's shortcomings. Managed Care relies on gatekeepers and protocols that might limit the selection of physicians your insurance covers; and the latest issue is the limitations imposed on experimental treatment.
In case study I read a physician "Dr. Stanley" the medical director at Springdale Health Systems, a regional managed care organization was in charge of authorizing or denying the coverage for an 8 year old with terminal cancer. His parents found out of an experimental procedure that could possibly treat their sons cancer.
Should a physician be responsible for the decisions in the continuing health of a patient? The Hippocratic oath states that a physician should "leave this operation to be performed by practitioners, specialist in this art". Should we interpret this as "a physician should always look for the physician who will treat".
Health Care Management argues that experimental procedures are expensive and most of the time are not successful. But what happens if out of fifty procedures one is successful?
Where is the beneficence on this case? Where is the greater good? Is the greater good in long term savings of resources and health care money by denying a procedure that has a very slim possibility of being successful; or is the greater good to save the life of one individual even though resources will be scarce and treatment might not be successful.
Thursday, November 13, 2008
Amendment 2 (or how we took rights away from people and love the bomb)
On November 4th we made history, we elected the first African American President of the US, and at the same time we managed to take two steps back and took away the rights of millions of Americans in the name of morality.
In Florida, California, Arizona legislation was passed to ban the marriage of homosexuals. In the case of Florida, the amendment is for the ban of any institution that is not the marriage between a man and a woman. We already have a "Marriage Protection Provision" in our Florida Constitution; which for legal purposes defines Marriage as the "union between one man and one woman" and bars the recognition of same-sex marriages from other states. The goal of Amendment 2, is to "ban gay marriage and civil unions" in our state.
And as you might imagine, this will have great repercussions. Gays and Lesbians cannot enjoy marriage tax cuts (talk about taxation without representation), spousal benefits, health care privileges, the benefits of a "will", divorce protection, adoption services and the list goes on. But wait a minute, neither can heterosexuals who do not want to get married. Good-bye common law marriage!
Why wouldn't heterosexuals marry? Many seniors do not get married, because they don't want to lose social security benefits, or just because they don't want to. In any case, why would we as citizens take away the rights of individuals? Why do we let the popular vote decide the faith of millions. Historically, the populus always takes away rights, and the courts give them back. Are you not convinced yet? Well, as this is a Health Care Ethics Blog, I will expand on Health and Marriage.
When a person loses his or her ability to make sound health-care decisions, the decision power goes to the next of kin. The "chain of command" is Spouse, Children, Parents, Relative, Friend. If no one can be contacted, the state assigns a Health Care Surrogate. Without Civil Unions, a partner that has spent many years and knows the person better than family, is demoted to "Friend", the last resort before the state intervenes. What if the family does not agree with the lifestyle of the person unable to make the decision? (this is the case with many homosexual couples) the family can deny access to hospital visits, hospice visits and even funeral visits to friends and yes, even the domestic-partner. Can you imagine not being able to see your loved one in the hospital (or for that case, one last time)?
What about Health Care Benefits? Well, Orlando Major Buddy Dyer, just announced plans to offer domestic-partner benefits for gay city employees. Will this be reverted?
In short, should we take away benefits from people simply because of their lifestyle? If a person wants to marry, we should let them. If they, they should not. But to give special privileges to people who get married, and then put limitations on whom they can marry, well that's just sad.
Lastly, here is a very sarcastic list that is being passed around the internet. Hope you enjoy.
Florida vs. Same Sex Marriage
What does Amendment 2 mean?
Six Reasons to Vote NO on Amendment 2
2. Heterosexual marriages are valid because they produce children. Infertile couples and old people cannot get legally married because the world needs more children.
3. Obviously gay parents will raise gay children because straight parents only raise straight children.
4. Straight marriage will be less meaningful, since Britney Spears's 55-hour just-for-fun marriage was meaningful.
5. Heterosexual marriage has been around for a long time, and it hasn't changed at all: women are property, Blacks can't marry Whites, and divorce is illegal.
6. Gay marriage should be decided by the people, not the courts, because the majority-elected legislatures, not courts, have historically protected the rights of minorities.
7. Gay marriage is not supported by religion. In a theocracy like ours, the values of one religion are always imposed on the entire country. That's why we only have one religion in America.
8. Gay marriage will encourage people to be gay, in the same way that hanging around tall people makes you tall.
9. Legalizing gay marriage will open the door to all kinds of crazy behavior. People may even wish to marry their pets because a dog has legal standing and can sign a marriage license.
10. Children can never succeed without both male and female role models at home. That's why single parents are forbidden to raise children.
11. Gay marriage will change the foundation of society. Heterosexual marriage has been around for a long time, and we could never adapt to new social norms because we haven't adapted to cars or longer lifespans.
12. Civil unions, providing most of the same benefits as marriage with a different name are better, because a "separate but equal" institution is always constitutional. Separate schools for African-Americans worked just as well as separate marriages will for gays & lesbians.
In Florida, California, Arizona legislation was passed to ban the marriage of homosexuals. In the case of Florida, the amendment is for the ban of any institution that is not the marriage between a man and a woman. We already have a "Marriage Protection Provision" in our Florida Constitution; which for legal purposes defines Marriage as the "union between one man and one woman" and bars the recognition of same-sex marriages from other states. The goal of Amendment 2, is to "ban gay marriage and civil unions" in our state.
And as you might imagine, this will have great repercussions. Gays and Lesbians cannot enjoy marriage tax cuts (talk about taxation without representation), spousal benefits, health care privileges, the benefits of a "will", divorce protection, adoption services and the list goes on. But wait a minute, neither can heterosexuals who do not want to get married. Good-bye common law marriage!
Why wouldn't heterosexuals marry? Many seniors do not get married, because they don't want to lose social security benefits, or just because they don't want to. In any case, why would we as citizens take away the rights of individuals? Why do we let the popular vote decide the faith of millions. Historically, the populus always takes away rights, and the courts give them back. Are you not convinced yet? Well, as this is a Health Care Ethics Blog, I will expand on Health and Marriage.
When a person loses his or her ability to make sound health-care decisions, the decision power goes to the next of kin. The "chain of command" is Spouse, Children, Parents, Relative, Friend. If no one can be contacted, the state assigns a Health Care Surrogate. Without Civil Unions, a partner that has spent many years and knows the person better than family, is demoted to "Friend", the last resort before the state intervenes. What if the family does not agree with the lifestyle of the person unable to make the decision? (this is the case with many homosexual couples) the family can deny access to hospital visits, hospice visits and even funeral visits to friends and yes, even the domestic-partner. Can you imagine not being able to see your loved one in the hospital (or for that case, one last time)?
What about Health Care Benefits? Well, Orlando Major Buddy Dyer, just announced plans to offer domestic-partner benefits for gay city employees. Will this be reverted?
In short, should we take away benefits from people simply because of their lifestyle? If a person wants to marry, we should let them. If they, they should not. But to give special privileges to people who get married, and then put limitations on whom they can marry, well that's just sad.
Lastly, here is a very sarcastic list that is being passed around the internet. Hope you enjoy.
Florida vs. Same Sex Marriage
What does Amendment 2 mean?
Six Reasons to Vote NO on Amendment 2
---------------------------------------------------------------
12 Reasons why Homosexual Marriage Will Ruin Society
1. Homosexuality is not natural, much like eyeglasses, polyester, and birth control are not natural.
2. Heterosexual marriages are valid because they produce children. Infertile couples and old people cannot get legally married because the world needs more children.
3. Obviously gay parents will raise gay children because straight parents only raise straight children.
4. Straight marriage will be less meaningful, since Britney Spears's 55-hour just-for-fun marriage was meaningful.
5. Heterosexual marriage has been around for a long time, and it hasn't changed at all: women are property, Blacks can't marry Whites, and divorce is illegal.
6. Gay marriage should be decided by the people, not the courts, because the majority-elected legislatures, not courts, have historically protected the rights of minorities.
7. Gay marriage is not supported by religion. In a theocracy like ours, the values of one religion are always imposed on the entire country. That's why we only have one religion in America.
8. Gay marriage will encourage people to be gay, in the same way that hanging around tall people makes you tall.
9. Legalizing gay marriage will open the door to all kinds of crazy behavior. People may even wish to marry their pets because a dog has legal standing and can sign a marriage license.
10. Children can never succeed without both male and female role models at home. That's why single parents are forbidden to raise children.
11. Gay marriage will change the foundation of society. Heterosexual marriage has been around for a long time, and we could never adapt to new social norms because we haven't adapted to cars or longer lifespans.
12. Civil unions, providing most of the same benefits as marriage with a different name are better, because a "separate but equal" institution is always constitutional. Separate schools for African-Americans worked just as well as separate marriages will for gays & lesbians.
Friday, November 7, 2008
Happy States, or expensive mistakes?
Is the legalization of medical Marijuana, just the legalization of Marijuana "veiled" with a medical label? And will the legalization of "Medical Marijuana", cost more than the legalization of "The Sensible use of Marijuana"?
My question is, did the the residents of Michigan vote for the legalization of medical marijuana, or for loopholes to be able to kick back and light up?
In Michigan, residents voted overwhelmingly in favor of Proposal 1 (61% in favor). The Proposal will legalize the medical use of Marijuana for patients that experience chronic pain that is not controlled with prescription drugs. It will also legalize the cultivation for personal use of Marijuana, the possession, use and paraphernalia related to the legal use of marijuana. It will also create a registry participation card that will have a fee, a tax and a renewal fee.
Voters in Massachusetts decided (65%, and almost every town) to legalize the sensible use of Marijuana. People in Massachusetts in less than thirty days will be able to posses less than an ounce of weed legally. There will not be any prosecution, penalty or citation, unless you are under the age of seventeen. If you are under the age of seventeen the penalty is a four hour course (which will include classroom and peer discussions) and community service. This mandate goes as far as protecting individuals from being discriminated for having traces of THC in their bodily fluids, that means you cannot get fired for the sensible use of Marijuana in the privacy of your own time.
These two approaches provide with stark differences to the decriminalization of Marijuana. On one side, the legalization of Marijuana for sensible personal use, the other, the medical legalization of Marijuana for pain management. Marijuana legalization is not a new subject; thirteen states already allow the personal use of Cannabis (Alaska, Arizona, California, Colorado, Maine, Minnesota, Mississippi, Nebraska, New York, Nevada, New Hampshire, Oregon and Ohio have some sort of Marijuana decriminalization provision) and the list will probably grow in the near future. But which is more responsible?
Although many residents of Michigan with chronic disease will benefit; how many of the residents in Michigan will go to a Doctor, get a couple of signatures just to get the "license"? Will this create extra costs for our already over-used health system? Are Marijuana prescriptions going to be prescribed in alarming large numbers by a few physicians? How many physicians have moral objections, and will not offer this treatment to their patients? Is our Health System not burdened enough with questions of morals and legality; and now we add more legal/moral screwballs to make it more confusing and probably (and sadly) more costly.
Or is it Massachusetts who got it right; the legalization of the Sensible use of Marijuana. No prescriptions, no shady doctor visits, no fake illnesses, no begging doctors that believe they have "higher morals" for available treatment. Just responsible citizens, who in their personal time, light up. No "medical" label attached.
Thursday, November 6, 2008
Now what?
As you might know, (unless you leave under a rock) we have a new pressident-elect.
We are amidst a great time in history, and depending on his leadership we can break through and overcome one of the greatest problems in America, or we could go the opposite way and really handicap us in the race to become once again the undisputed greatest country in the world.
I want to talk about our Health System. President-Elect Obama has a specific plan for us, and I hope it works. According to his plan, every American will have access to the same type of Health Care that Congress has -and if individuals decide that this plan is not enough- individuals can stay in the health plan that they currently have. Will it work? Only time will tell. Personally, I would rather have universal health care, but I don't believe a total reshaping of our system can happen in our lifetime.
Why is this so important? Well, a simple example is our Auto Industry. Every German car sold (that was built in Germany) has a larger margin of profit just because no German company has to pay ANY percentage of it's employees health care. On the other hand, every car built in America has attached to it's cost the percentage that the company has to pay for it's employees health insurance. In other words a smaller margin of profit. Now, multiply that by all of the products produced in the US. Is this an advantage to the socialist countries?
Do we need to reform our health care? Almost everyone (conservative or liberals) would agree. Is President-Elect Obama's solution, the best solution? Only time will tell.
We are amidst a great time in history, and depending on his leadership we can break through and overcome one of the greatest problems in America, or we could go the opposite way and really handicap us in the race to become once again the undisputed greatest country in the world.
I want to talk about our Health System. President-Elect Obama has a specific plan for us, and I hope it works. According to his plan, every American will have access to the same type of Health Care that Congress has -and if individuals decide that this plan is not enough- individuals can stay in the health plan that they currently have. Will it work? Only time will tell. Personally, I would rather have universal health care, but I don't believe a total reshaping of our system can happen in our lifetime.
Why is this so important? Well, a simple example is our Auto Industry. Every German car sold (that was built in Germany) has a larger margin of profit just because no German company has to pay ANY percentage of it's employees health care. On the other hand, every car built in America has attached to it's cost the percentage that the company has to pay for it's employees health insurance. In other words a smaller margin of profit. Now, multiply that by all of the products produced in the US. Is this an advantage to the socialist countries?
Do we need to reform our health care? Almost everyone (conservative or liberals) would agree. Is President-Elect Obama's solution, the best solution? Only time will tell.