Natural vs. Unnatural Death

Life, though a precious gift, does ultimately end in death. It’s with common knowledge and acceptance that any living, breathing organism will die. Death can occur in two general forms, natural or unnatural.

A natural cause of death is loosely defined as an unpredictable or extreme act of nature caused without human intervention or agency (Natural, par.1). Deaths from old age or a sudden heart attack are examples of a natural death.

An unnatural cause of death is defined as death not describable as death by natural causes. This would include such events as homicide, suicide, or accident (Unnatural, par. 1).

It's important to define both natural and unnatural causes of death when discussing medical ethics because most people would want to die of natural causes. Unfortuantly being taken off life support would fall under an unnatural cause of death because it does involve human interference. This lays the foundation for my counter claim paper. I believe it will easier to write if I follow the above arguement.

Involvement of Nurses in Physician Assisted Dying

Death is often preceded by medical end-of-life decisions. Much of the research pertaining to this topic often focuses on the physician's role in assisted dying. There is not much information about the role of other health care workers, especially that of nurses.

A study performed by a group or doctors and nurses, centered around reporting the actual involvement of nurses in medical end-of-life decisions. The research investigated how often nurses were consulted by physicians in the decision making process preceding end-of-life decisions and how often nurses participate in administering lethal drugs in end-of-life decisions.

The study found that physicians consulted at least one nurse in 52% of end-of-life decisions cases occurring in institutions, compared with 21.4% of such cases at home. Nurses administered lethal drugs in 58.8% of euthanasia cases occurring in institutions and 17.2% at home. For cases in which life was ended without the patients request because the patient was too ill to do so, the percentages were 82.7% in institutions and 25.2% for cases occurring at home. In institutions, nurses mostly administered drugs without the attendance of a physician who had prescribed the drugs.

These findings were very surprising to me. I would have thought that nurses would have been more involved in euthanasia cases occurring at home, rather than the hospitals because nurses are often more involved in the home health care setting. The journal article is obviously much longer and detailed, the above facts and figures are just the gist of it.

Reference:

Bilsen, Johan, Robert Vander Stichele, Freddy Mortier, and Luc Deliens. "Involvement of Nurses in Physician-assisted Dying." Journal of Advanced Nursing. 47.6 (2004): 583-591.

Miracle in Medicine

As I was routinely signing into my Yahoo account, a very interesting (but short) news story caught my eye on Yahoo's homepage.

Christy Lilly spent the last seven years of her life in a persistent vegetative state after suffering from a heart attack and stroke. Her mother had been taking care of Ms. Lilly at her home in Colorado Springs, Colorado. Miraculously, Ms. Lilly awoke from her vegetative state for three days this week. She spoke to the local television station and was able to see her twelve year old daughter before slipping back into a vegetative state. Her neurologist is baffled and has no explanation for Ms. Lilly's brief awareness. It was reported that Ms. Lilly had awakened four other times for shorter moments in the past.

While I'm definitely going to research this particular topic a bit more, I thought it would bring an interesting twist to my previous blogs.

Reference:

"Woman in Vegetative State Awakes, Slips." Yahoo! News. 7 Mar. 2007. 8 Mar 2007.
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An Important Case in the Field Medical Ethics

Never has the American public’s consciousness regarding life sustaining methods and the importance of advanced directives been so heightened as with the recent Terri Shiavo case. Terri Shiavo had suffered extensive brain damage in 1990 when she collapsed due to cardiac and respiratory failure possibly related to extensive dieting. She remained comatose for two and a half months and upon awakening regained a normal sleep wake cycle, yet did not respond to stimulus and was unaware of her environment. One year later, after many tests and attempts at rehabilitation she was diagnosed as being in a persistent vegetative state (PVS) (Wikipedia).

Terri, like other patients in PVS, exhibited many behaviors that could be construed as arising from partial consciousness. Grinding teeth, swallowing, smiling, shedding tears, grunting, moaning, and screaming without any external stimulus are common behaviors seen in patients in PVS (Persistent). Unable to acknowledge the need to eat or ability to be fed, Terri received a percutaneous endoscopic gastrostomy (PEG) feeding tube. The peg tube is surgically placed into the stomach through the abdominal wall, which allows the patient to be fed and hydrated. Terri was receiving the necessities of life, and could have essentially lived the average life span, yet with little quality or enjoyment.

References:
“Persistent Vegetative State.” Wikipedia, the Free Encyclopedia. 19 February 2007.
20 February 2007. http://en.wikipedia.org/wiki/Persistent_vegetative_state.
“Terri Schiavo.” Wikipedia, the Free Encyclopedia. 20 February 2007. 20 February 2007.
http://en.wikipedia.org/w/index.php?title=Terri_Schiavo&oldid=109672072.

Photo: Terri, before and after accident; obtained at: http://www.lldf.org/2_up_lg.jpg

Another Bloggers Insight

After many failed attempts at finding a blog that was even relatively close to my subject, I came across a blog posted by a gentlemen named, Derek Humphry. Mr. Humphry is the founder of ERGO- Euthanasia Research and Guidance Organization. He is a journalist that has published two bestselling books; one in the UK, and one in the US. "Final Exit" (a #1 selling book in the US) explains methods, approaches, and the means of voluntary euthanasia, physician-assisted suicide, and self-deliverance (rational suicide).

The particular entry I found interesting was dated January 19, 2006. Humphry defines different terms regarding euthanasia. He defines the following terms:
assisted suicide as helping a person to end his or her life by request to end suffering. Physician-assisted suicide is a medical doctor helping a patient to die by use of prescribing a lethal overdose of a drug. He describes the term euthanasia as a broad, generic term meaning "help with a good death." He defines a few other interesting terms.

Mr. Humphry's blog was interesting, yet incredibly biased. Which isn't surprising considering he wrote multiple books supporting euthanasia. I'm not so sure I'd reference his blog in my final paper, although one of his books may be interesting to check out. The particular blog that I referenced he lists as archival, from that blog is a link to his newly updated blog, which appears very insightful...http://blog.assistedsuicide.org/.

Reference:
Humphry, Derek. Euthanasia, Assisted Suicide, Right-to-Die, Final Exit, Hemlock Society
Founder Weblog. 25 February 2006. 1 March 2007.
<http://self-deliverance.blogspot.com/>.

Original picture obtained at:http://www.amazon.com/gp/reader/0385336535/ref=sib_dp_pt/103-6309303-4690248#reader-link

Nursing Dilemma

All too often people in the medical field find themselves dealing with the medical dilemma of the Full Code versus Do Not Resuscitate order. One article in particular that I came across details a nurses personal struggle when placed in that situation.

She had been taking care of an 80 year old man with bone cancer. He had gone into surgery to have his leg amputated, but during surgery he stopped breathing. The medical team was able to resuscitate him, but he had been without oxygen for too long and suffered anoxic brain damage. This left him confused and with limited mobility. (which is often the case when a patient is left without oxygen for a period of time) The patient, a once active man, was aware of his confusion and had become depressed. He often would state that he'd rather just die. His family thought the confusion was temporary and that he'd recover and be sent home. (again common in these situations) Unfortunately the patient declined and began to develop Cheyne-Stokes respirations. (often called the "death rattle" it's a common breathing pattern occurs when a patient is very close to dying) The nurse was in a tough situation because the doctors wanted the man to be resuscitated if he were to arrest to deter a law suit, but she felt it cruel to resuscitate a person in this condition.

The article goes on to explain that the main issue this nurse was faced with was whether or not to hold her obligation to the doctors or to the patient. In nursing school you are taught that you are there for your patients and that you must do whatever is in the patients best interest. Unfortunately the law keeps nurses from doing this at all times. The article continues to debate the sanctity-of-life principle (which states that all life is sacred and that to let life end is unethical) versus the quality-of-life principle (which focuses on quality of the patients life).

The article concludes that in order to make a decision that best benefits the patient, the medical team must consult the family and discuss what they believe the patient would want. Whether he would agree with the sanctity of life or quality of life and what he may feel is normative of a quality life.

Reference

Davis, Anne J. "To Make Live or Let Die." American Journal of Nursing. 1981. p 582. JSTOR. 13 February 2007.

Peer Review, Reviewed

February 8th, Thursday was one of our classes first peer review sessions. My group consisted of Danielle, Lindsay, Cody, and myself. I read Cody's paper first. He had written about Ben Franklin. I let him know that though he had very good information and facts, and a great introduction he needed to organize the paper Danielle's paper was about a man that had made it big in tobacco, yet sold out tobacco companies by exposing the health hazards of tobacco. Other then a few minor punctuation mistakes, the paper was very well written, well organized, informative and very close to being a final draft. Lindsay's paper about founding figures of Chinese acupuncture was very factual and interesting. I let her know to not only organize her ideas but to also give laymen definations of some of the terms she used. I pointed out a few minor spelling and punctuation errors that she warned us about before reading it. Lastly, the group reviewed my paper. I let them know ahead time that it was definatly a work in progress, and that I hadn't fully expanded on all my ideas. Cody asked me to explain my topic a bit more in detail, so I was sure to add that in my final paper. After reading my paper the some of the responses I got were to make the paper longer and to introduce Dr. Saunders full name in the beginning of the paper. These comments were taken into consideration when I wrote the final draft for this particular assignment. Overall peer review went well, and it was not only helpful to get my classmates opinion of my paper, but also to see how they wrote their papers.