Final Research Paper- Conclusion

There is a need to talk about the inevitable consequence of death. We will not always agree on what to do in such tragic events, yet we do need to start an honest dialogue about what is essentially, the ultimate rite of passage.
What have we learned about life, ethics, and life-sustaining treatments from the Terri Schiavo saga? Surely the biggest lesson derived from the Terri Schiavo case is that of advance care planning and its inclusion in public discourse. Even well-drafted legislation is not always able to deal effectively with the consequences of family feuding motivated by financial, religious, and political considerations. Ultimately it is the healthcare professional’s responsibility to carefully consider the patient’s healthcare wishes and convey them in a clear and timely manner.
The Terri Schiavo case opened the door for discussion of living wills in many homes across America. Husbands and wives began talking over dinner about their own end of life wishes. People were compelled to get their living wills in order and voice their wishes to their loved ones. Though the Terri Schiavo case got Americans talking about important personal issues, it is unfortunate that Terri’s life has been memorialized not by the person she was or her accomplishments, but by her controversial and sad death.

Final Research Paper-Intro

Advances in medical technology has allowed for and contributed to an increase in human life expectancy. Physician’s prognosis’ for a variety of diseases has shifted from a poor or fatal outcome to the possibility of complete or partial recovery. The ability to prolong and sustain life can be viewed as either a positive medical advancement or an open door to a multitude of ethical issues. Prolonging the life of a patient awaiting an organ transplant or a cure for a disease is ethically appropriate, if the patient’s quality of life during that time is good. However, keeping a patient alive, using a life sustaining treatment, that has a poor quality of life or resuscitating a terminally ill patient is unethical. Determining what is considered a poor quality of life, versus an acceptable quality of life, and the use of life-sustaining treatments, along with the enforcement of advanced directives have become a powerful and controversial topics in the medical field.
These issues were exemplified in the Terri Schiavo case, in which a young woman diagnosed as being in a persistent vegetative state, was thrown into the middle of a lengthy legal battle between her parents, her husband and the medical team involved with her care. Terri was twenty-six years old when she collapsed in her Florida home in 1990. Her treating physicians believed a potassium deficiency caused a heart attack in which Terri suffered catastrophic brain damage, resulting in a persistent vegetative state (PVS). A percutaneous endoscopic gastrostomy (PEG) tube was placed to provide nutrition and hydration for Terri. PEG tube feeding, which is commonly used as a life-sustaining treatment, was Terri’s only means of survival. Since the day the PEG tube was placed, a long and protracted legal battle ensued, encompassing Terri’s life, removal of her feeding tube, and bitter family disputes concerning her quality of life. In essence, the case turned into a legal battle between Terri’s husband, the medical professionals involved in her care, and Terri’s parents. Throughout the drawn-out legal proceedings, that lasted more then a decade, Terri lay in numerous long-term care facilities, possibly in pain and discomfort, possibly pain-free and comfortable, yet with a very poor prognosis (Breier-Mackie 293).

Reference:

Breier-Mackie, Sarah J. PhD, RN, APRN. “PEGs and Ethics Revisited: A Timely Reflection in the Wake of the Terri Schiavo Case.” Gastroenterology Nursing. 28 (2005): 292-297.

Today the weather man predicted rain. Of all the days to rain, it had to be today. It just wasn't fair. Today the principal of the high school was to trek across the football field to the altar to accept the blue stationery he had won. It's raining and windy and there is not a right handed person in sight. I'm not sure who's responsible for altering today's plans. Or whether or not it was the rain that affected today's ceremony. Two people were very upset about the rain so they decided to write a letter but it had little effect. Their writing skills are poor and they're citing references all wrong, except for one. The letter was just too much for your average paper carrier to hold. The mail carrier had a flat affect and began to lose his temper. He loosened his tie and screamed, "I challange you to a race around the track!" The mail man's anger effected the crowd negativily. The angry mob shouted back , "you're going to have to pay a fare for standing stationary for so long!" The crowd lost its site for the initiation rites ceremony. They didn't stick with their moral principles, so whose at fault? I don't know.

Expository or Persuasive

My research paper is certainly heading down the persuasive road. Simply because my paper revolves around ethics, gives it an argumentative feel. It's difficult to be in the medical field and not have an opinion about end of life decision making and all that it involves. Though I am attempting to be as unbiased as possible and just present the facts. I would rather give facts, figures, and explanations that allow the reader to make their own, informed decision on the matter.

With that in mind, I think my paper could also be categorized as expository. In order to explain medical terminology and certain cases involving my topic, it is necessary to include facts and information further explaining my topic.



cartoon obtained at:
http://www.research-for-real.co.uk/resources.asp

Factors Used by Physicians to Determine Code Status

The incidence of withholding and withdrawing life support from the critically ill dying in an intensive care unit has increased to 50–90% of patients in recent years. At the same time, objective prognostic information to assist in decision-making, and care of dying patients are lacking.

Deciding factors of withdrawing life support include likelihood to survive the current episode and long-term survival, patient’s age, previous cognitive function, and poor expected quality of life (QOL). Other factors comprise hematological malignancy, neurological or circulatory reason for admission, length of stay, and previous physical health.

Serious concerns have been raised concerning the validity of physicians’ perceptions of patients’ QOL, the miscommunication between patients’ and their families’ decisions, and physicians’ ability to assess prognosis correctly. Moreover, a discrepancy exists between physicians’ opinions and public opinion regarding end-of-life decision-making. In addition, long-standing interventions, and expected time of death influence the decision to withdraw life support.

Reference:
Pettila, V., T. Ala-Kokko, T. Varpula, J. Laurila, and S. Hovilehto. "On What are Our End-of-life Decisions Based?" Acta Anaesthesiologica Scandinavica 46 (2002):947-54.

Cartoon obtained at:
http://www.jwolfe.clara.net/Humour/Doctors.htm

EMT's and Out-of-hospital DNR's

EMT's (emergency medical technicians), provide rapid response and treatment to patients in cardiac arrest or with other life-threatening conditions. EMT's also transport seriously ill patients between nursing homes and hospitals. All patients are considered a Full Code (desire resuscitation and life prolonging interventions), unless the EMT's are given explicit information to the contrary. If during transport a patient requires heroic measures to save their life, it is the EMT's responsibility to perform basic and advanced life support procedures. Unfortunately, EMT's are often called for their transport services during an emergency and the patient generally doesn't have the ability to state their wishes. And many patients with advanced illnesses may not want all of the interventions offered by the EMT's.

Out-of-hospital do-not-resuscitate (DNR) orders have been developed to provide EMT's written orders regarding resuscitation. In general, out-of-hospital DNR policies specify circumstances under which EMS providers should withhold attempts at resuscitation for pulseless and apneic (breathless) patients. For example, Connecticut has a program using DNR bracelets. The program specifies that EMTs must honor these DNR orders and provides immunity from liability for honoring the order. A recent study found that 89% of a national sample of EMTs was willing to honor a state-approved DNR order.

Reference:

Schmidt, Terri, MD, MS, Susan Hickman, PhD, Susan Tolle, MD, and Heather Brooks, BS. "The Physician Orders for Life Sustaining Treatment Program: Oregon Emergency Medical Technicians' Practical Experiences and Attitudes." Journal of American Geriatrics Society 52 (2004): 1430-34.

Picture obtained at:
http://www.allposters.com/-sp/Emt-Posters_i914019_.htm

The Other Side

Though I do believe that those suffering from a terminal illness should have the right to die, I do agree with a few of this articles points on what could potentially happen in assisted suicide were legalized.

Many of the disorders leading people to suicide are treatable, such as depression, alcoholism, and stress. If suicide were legal, it would give those suffering from this problems and easier out.

An attempt at suicide is often a challenge to see if anyone out there really cares. Indeed, seeking physician assistance in a suicide, rather than just acting to kill oneself, may well be a manifestation of precisely that challenge. If society creates a "right to suicide" and legalizes "physician-assisted suicide," the message perceived by a suicide attempter is not likely to be, "We respect your wishes," but rather, "we don't care if you live or die."

Reference:

Balch, Burke, Randall O'Bannon. "Why We Shouldn't Legalize Assisting Suicide."
National Right to Life. 15 March 2007. html>.