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