Physician Assisted Suicide

At work the other day the subject of physician assisted suicide was brought up and everyone began to express their feelings on the matter. I, personally, feel neutral about the situation. It some cases I do not believe in it and in some ways I do. I thought that this would be a good subject to write about and I looked up cases on the internet when I found this article:


Debate rages in California over physician assisted Suicide

LOS ANGELES — After 10 years as the only state where physician-assisted suicide is legal, Oregon could be getting some big company.
California's Legislature is advancing a proposal modeled after Oregon's law permitting patients diagnosed with six months or less to live to take lethal pills prescribed by their doctor.
The issue has stirred emotion from the Capitol to the pulpits, with supporters casting it as a matter of personal choice and opponents saying it is an immoral compromise of the sanctity of life and a doctors' oath to do no harm.
The two sides agree on this much: If California legalizes physician-assisted suicide, it will prompt many other states to follow suit and perhaps even prepare the way for a national law.
"That's what I certainly am hoping," says Patty Berg, a Democratic assemblywoman from Eureka in Northern California who is the leading sponsor of the bill. Berg says the bill goes next to the appropriations committee. She believes it will go to a House vote before the end of this month.
"Absolutely, other states would follow," says Anthony Adams, a Republican assemblyman from Hesperia and an opponent. An assisted-suicide law in California, he says, would project to the nation "the false illusion that this is somehow a credible thing to do."
In 1994 Oregon voters by a margin of 51% approved the Death with Dignity Act, which took effect in 1997. The U.S. Supreme Court upheld the law in a 2006 ruling.
Oregon's law, as well as California's proposal, permits doctors to prescribe a deadly dose for terminal patients who are deemed by a psychiatrist to be mentally capable and have been told they have six months or less to live. Similar proposals have failed in California's Legislature before, and bills failed in Vermont and Hawaii legislatures this year.
Since the law took effect in Oregon, 292 people have committed suicide under the law, according to a report last month by the state's Public Health Division. The division says 87% of the 46 people who took their lives in 2006 had cancer.
Opponents in Oregon say the law is not used as intended. They say some people are killing themselves for reasons other than pain and suffering and that the state has little or no oversight to monitor what's going on.
"The Oregon experience has been a real ticking time bomb," said Tim Rosales, spokesman for Californians Against Assisted Suicide, which is leading the effort to defeat the proposal.
Rosales cites statistics from the state that just less than half the suicide patients cited pain as their main motivation. Most, 96%, cited loss of autonomy and joy, and three-quarters cited loss of dignity.
"These are all clear indicators of depression — indicators for anyone to commit suicide," says Rosales, who argues those patients should have been treated for those problems, not given a poison pill.
Berg says the law is working as intended and is not misused.
"We should be allowed to live or die according to our own moral code," Berg says. "The opposition comes from a very small segment of society that believes it has a … better morality than the rest of us."
If California follows Oregon, the numbers of people using the law could be much larger.
Adams says the rate of suicide in Oregon, which has a population of 3 million people, could mean more than 500 people a year would commit legal suicide among California's population of 35 million.
That possibility has turned the initiative into a major battle between powerful players, splitting what normally have been allies.
This month, Cardinal Roger Mahony, whose Roman Catholic church strongly opposes the proposal, attacked the speaker of the state Assembly, Fabian Nunez, a Catholic supporter of the assisted-suicide proposal. During a Sunday Mass, Mahony called assisted suicide "against God's law" and said Catholics "should be troubled that Fabian Nunez … has allowed himself to get swept into this other direction, the culture of death."
The California Medical Association, which represents 35,000 doctors, opposes the measure because it is in direct conflict with a doctor's ethical duties. The California Association of Physician Groups, which represents more than 150 medical organizations, supports it.
The California Hospice and Palliative Care Association, whose members provide end-of-life care, opposes the bill on ethical grounds as well. But the American Academy of Hospice and Palliative Medicine has dropped its opposition for a policy of "studied neutrality."
California is closer than ever to making it legal, both sides say. Adams, who failed in efforts to stop the bill in a committee vote last month, says Nunez's support is "a signal to the rest of us that he has the votes" needed, 41, to push it through the Assembly.
California's Republican Gov. Arnold Schwarzenegger hasn't said whether he would sign the bill.
For Tom McDonald, 77, of Oroville in Northern California, the debate couldn't be more real.
The retired electronics worker learned in January 2006 that he has melanoma, the most serious form of skin cancer. He has outlasted his doctor's estimate that he had a year to live. But he says he watched his mother suffer a painful, six-month decline before her death, and he wants to avoid a similar end.
"How many times have we heard how friends and relatives have died in their sleep? That's wonderful. That's the way I want to go," he said.
Assisted-suicide supporters say McDonald should be able to choose how he dies. Opponents disagree.
"It is about giving doctors the legal right to prescribe medicine whose only purpose is to kill people. This is an immoral act, and it has no place being legislated," Adams says.
Wesley J. Smith, an author and activist against assisted suicide, says he thinks opponents can defeat the bill. Whichever way it goes, California's actions will be watched around the world.
"It's extremely important because California is such a big state, a bellwether," he says

I dont understand why people are so misunderstanding over the situation of Physician assisted suicide. I believe yes their are situations that people are just depressed and looking for an excuse to end their lives, but I think people should be evaluated by every situation and be able to explain their situation and how they feel and if their wishes are to end their life, that is so horrible why not let them? In most of the situations 87 percent of people who commit suicide are terminally ill and I think that it is wrong for them to have the title of "suicide" when they were in a horrible situation and maybe ending their life was the only thing to do in their opinion. I understand other views on the situation such as religion and the pressure of the doctor. I only think that doctors who truly feel comfortable with performing this procedure and believe that they are doing it for the better good should be the doctors who do this. I dont think someone should do something like this if they are going to feel a horrible thing hanging over their head after they do something like this. This is one of the most controversial subjects in my opinion because its like I think its wrong but then again I think its ok, I dont know my feelings on this situation are wierd. I kind of fight with myself on my feelings of this situation. I think that people that have cruel things to say about people who make these kind of decision is wrong because everything goes by case by case bases and no one truly knows what someone is going through unless they are in the same position.

Ethics in nursing students

I got the paper on Wednesday and noticed a very interesting article that caught my eye in relation to this class. If you haven't read the article this is what its about:

Ethics test student nurses
UCF nursing graduates share advice
Karen Johnson
Published: Tuesday, March 31, 2009
Updated: Tuesday, March 31, 2009
Christina DeParis

A Creole-speaking patient is admitted to the hospital with neurocysticercosis, worms in the brain. The nurse arranges for an interpreter to go over discharge information with his family, including how to properly care for him and give him his 10 medications. The hospital’s housekeeper who speaks Creole says that they shouldn’t release the patient, because she overheard the patient’s mother saying that she didn’t fully understand what the interpreter meant.
“What do you do?” UCF alumna Brandie Hollinger asked a group of 25 students, teachers and guests in the Student Union.
Hollinger used her real-world experience as a registered nurse to illustrate the situations that test a nurse’s ethics at the first Ethics Initiative for the College of Nursing Monday night.
“Perspective is everything,” Hollinger said. “Everyone is going to look at a situation and react differently. You have to do what is best for your patient.”
“As nurses, we want to fix the world,” Hollinger said. “If it’s wrong, we want to fix it and make it right. That’s just the way it is, but whatever you do, make sure you can justify it.”
Linda M. Hennig, College of Nursing associate dean of Undergraduate Affairs, said to not let personal preferences get in the way of ethical decisions.
“Some people don’t believe in abortion, but it is legal,” she said. “You have an obligation to care for the patient.”
UCF biology major, Breanna Lee said she agreed with the speakers about separating ethics from personal beliefs.
“Just because I don’t agree doesn’t mean it isn’t proper,” she said.
Fellow UCF nursing alumnae Ronnie Brewer and Elizabeth Medina joined Hollinger in sharing their experiences.
Brewer talked about ethical issues concerning tipping a hospital worker, stealing and using feeding tubes on patients.
“When you are considering ethics in medicine, the first rule is to do no harm,” Brewer said.
“There are three H’s in ethics: head, heart and hands. Use your heart and trust your instincts and observe,” she said. Medina said the best thing you can do for a patient is to be there for them.
“Support, support, support, you want to be their go-to person,” she said.
Nurses should push their personal judgments aside. It doesn’t matter if the patient is black or white, or rich or poor.
“The reality of nursing is that there are always going to be ethical issues,” Hollinger said. “You control whether you get upset or don’t control the situation properly.”
As for the Creole-speaking patient, Hollinger did not discharge him. She said the nurses made different charts for the mother to follow and were role-playing to help her understand how to care for her son.
The Ethics Initiative’s SGA representative, Meredith Maher, said that this presentation was a wake-up call.
“Being a student nurse that is going to graduate soon, all the points helped me realize how real graduation is and how real the experiences are,” Maher said. “It’s reality, that’s nursing.”


I think the approach toward this particularly situation went very well and it is the beginning to a change of avoiding all ethical and legal issues in health care. I think that though it wasn't the duty of the housekeeper to speak up, she felt the need to help someone were she works which takes alot of courage knowing that just being a housekeeper some people might just look past what she has to say thinking that her voice doesnt matter, but it does, everyones voice matters. I think that it was a very good example to bring up to the nursing students because other than cases you hear all the time, this just happened and is a situation that was taken care of properly. They talk about personal preferences in the article and how nurses should not let them get in the way of their care for patients, I think this to be a very important and valuable fact. Although you might disagree on something as a health care provider you must always remember your obligation to the patient. Your opinions may be strong in some cases but you have to know going into the field that yes my opinion does matter in some cases but the patient comes first and those opinions may be expressed but the patients decision is final say. I think alot of people get stubborn and act in such a way that is not needed when some believes in something different then they do, that is when you take the time and stand back and look at the situation and question yourself about your career and your duty to that patient or your career. I think that it is very important in health care for your first instict to be "do no harm" that is to the patient in all aspects whether it be care or spirit, it isnt our job to criticize anyones beliefs. If you are goinng into the nursing field or anything above, you should be doing it truly for the sake of the people and to help society itself. The three H's is a good place to start following your heart because being a good person you know deep down what is the right thing to do, although your judgement may be compromised by certain things, you need to follow your heart in all walks of life. Head, use your knowledge from school and life experiences to help you in every situation. This also goes with your hands and the work that you have been through to come this far must mean something. Hands will guide your patients through the care that they need. I think that this article went very well in the treatment of the patient in showing her charts and things to help her better understand what is going on. All around the world people would have just let the patient go, letting creed and money stand in the way of their true judgement. In the end I think people should have a heart dont do untoo others what you dont want done to you. I would expect the best care therefore I would give the best care to patients, because that is what they deserve.

Last Debate

Healthcare organizations should accomodate requests for gender or culturally sensitive specials treatments. I think this statement is true and should always be true and his kind of hard to argue. Though it is hard to argue there are ways it can be done. Todays debate was ok, but in my opinion the con side kept bringing up the same things that did not make alot of sense in the first place.
The first subject brought up was a woman going to the hospital/doctor's office and the right of her to see a woman physician over a male. The con side says that this is not feasible, but when have you ever heard of a woman wanting to see a woman physician a problem. I have never came across this problem before in my life, I know when I was younger I did not feel comfortable seeing a male doctor when I was first starting to get my female check ups and I always got to see a female doctor.
The pro side brought up a very good point talking about the HOPE questions, which is something that I have never heard of before, and this really caught my eye. I thought this was a very good way to throw back and the con side for whatever they were asking. I was still kind of unsure what the terms meant fully but I look them up after the debate today and researched more about them and thought them to be a very valid source. The HOPE concepts for discussion are as follows: H--sources of hope, strength, comfort, meaning, peace, love and connection; O--the role of organized religion for the patient; P--personal spirituality and practices; E--effects on medical care and end-of-life decisions.
The con side said that doctors do not have time to accomodate every single request of the patient. I think this is not true, I may have reasonable requests and some that may not be so reasonable and it is the duty of the doctor to try to accomodate all your requests or give you a valid explanation on why they cannot.
A student also brought up a very good scenerio in class today stating: A lesbian wanted a fertility treatment and the doctor had refused, knowing that she was a lesbian, and stated it was against his beliefs. I guess there were some problems with the case stating that if he cannot make it equal to treat every patient for fertility whether they be a gay couple or not, than he should find ways to accomodate them in such a way to maybe have another physician in his practice that feels comfortable performing in certain cases. I think that doing something like having another physician is very reasonable because it helps the experiences at the practice, the business of the practice, and makes everyone happy.
The con side stated that there cannot be a physician available for every different culture and to accomodate the needs of that culture. I think that physician's today are very diverse and are of all cultures themselves and if they do not practice the wishes of their culture the physician are well rounded enough to know how to take care of the situation, and it is the choice of the patient in the end to decide if they would still like to use that doctor or not. The con side says the doctor only had about twelve minutes with each patient a day and things such as cultural and gender requests take up to much of their time. Well I sat "SO WHAT"! I pay out of my pay check every month to pay for my health care and I will ask for whatever I need and take up more than twelve minutes if I need too, dont you think you deserve the same respect?
The last point brought up that I remember was a physician treating two patients for the same procedure, should the physician be help liable for discrimination for refusing to treat one patient over the other. I find this a pretty easy question because of course if there is no reasonable explanation to why he would treat one over the other, of course it is discrimination, but there are cases in which the other patient may not be able to take likely to the procedure being performed for reasons such as health conditions.
We discussed how we are found to take number of cultural classes throughout high school, associates, bachelors, and all the way up to grad school such as elder classes, culture classes, and religion classes for all aspects around the world. So I think that no matter what a physician should be pretty well rounded on the different cultures and should know what to do in the different cases.
I know if I was a doctor I would try and take on any scenerio to the best of my ability and if I couldnt I would find someone who could and each and every experience would only better myself in my career.

Debate # 5

The debate performed on Tuesday I think went very well considering it seems like it was going to be a one-sided debate. Informed consent is still central to medical ethics. I would say of course it is very important and also very hard to argue. The con side said that cultures refuse to sign informed consent because they do not want to know what is happening to them in a procedure because of their religion. I do not understand this concept because if they want the physician treatment regardless of what is happening to them or what the outcome may be then why don't they just sign the paper and not read or listen to what is happening. If you are person who does not want to know why be offended by informed consent.
Another point was made about twenty three percent of hospitals have interpreters and what would I do if i needed one. Well I definately, in my opinion, would not recieve the procedure if I didnt know what was happening to me. I would pursue getting an interpreter so I would have an understanding of what is going on before I let anyone do any thing to me.
The opposing team says that more laws will not change anything, but how do they figure, I think the laws do alot for us now considering how the world has become, without them I think things would be alot worse. I dont believe that their should be an over abundance of laws making us not be able to be human, but yes they are need in alot of instances to regulate and make sure people know the difference between right and wrong.
A side brought up a case in were the physician states the alternatives to a performance because he/she is made too even though they do not believe in the alternatives and the patient decides to go with the alternative treatment and ends up dying, the physician is held liable. In my opinion the physician should not have done the procedure if he/she was uncomfortable with it and maybe should have referred the patient else where. If I wanted something done and the physician offered me alternatives even though he thought the original was the best, I would know how the physician felt about doing the alternatives that I was considering I would try and find someone who believes in them more and is more confident in the performance.
The con side also brought up about traditions like such in China were a girls father has to make the decision. I believe yes beliefs should be respected and considered but we do things a little different in American and I dont believe, if they made the decision to move here, that the father should have final say on the girls deicision especially if she opposes it.
The con side had to have some kind of argument even though it was very hard and I think they did well, but alot of these points brought up are very hard to argue and are there in black and white. We are American and yes we respect other countries beliefs and such, but we cannot change everything about our society to make someone from a different country feel better about their care.

Debate # 4

I was absent for Debate number four so I figured I would Blog about it and discuss my feelings PRO and CON sides. The topic was: The employment-at-will concept is still appropriate in today’s society. From my understanding the The at will concept means that an employers has the right to fire someone at any given moment for any reason. The Con side may fight that a manager firing someone for any other reason other than misconduct may result it exposure to claims for the organization. I kind of agree with the concept in some ways and some ways I dont but like the law states their are exceptions and limitations to the concept. The reasonable exceptions would be race, sex, and ethnicity or in retaliation for employee conduct that is protected. I just think that people shouldnt be able to be fired for no reason what so ever! If their is a reasonable reason for them to be fired and it can be explained. I have had a situation like this happen to me on one of the jobs I held as a teenager but it wasnt important enough to me to fight to keep it. Florida is also one of the states in which a reason does not have to be presented for letting someone go. I worked at Sonny's BBQ one time and got fired for "stealing out of the draw" and that was definately something I did not do! I wanted to fight the situation so bad because I knew it wasnt true but being such a young age it was easy for me to find another job but in an instance were it was a really important job and I thought they were firing me for rumors or dislike I would definately have something to say about it or present my opinion to someone of hier authority.
The last class I attended was about patient consent, abuse, and neglect. This subject is very simple to me because it goes between the line of right and wrong. Being a physician you should know that asking for consent to do certain things is required and you know when you are doing something wrong to your patient such as abuse or neglect. Unfortunately it happens to much in the world of health care I think people need to stop being so selfish and worry about the needs of their patient. A girl brought up a scenerio on patient consent stating a law that was passed in many states saying that if a woman gave birth by C section to her child then she can never give a natural birth after that and must always give birth through a C section. In my opinion a doctor should be able to give recommendations about doing a C section rather than a natural birth for certain cases but I dont think it should be anyone elses decision on how the baby comes out besides the mother. I dont even understand why there would be a law passed about this knowing all the other laws and ethical statements of a patient having the right to decide what happens to his/her body and the right to refuse. There have been cases where mothers have been arrested and charged for breaking the law on this because they decided to give a home birth naturally! I think this is herendous if a mom wants to give birth the way she wants to give birth it should be her decision and nobody elses.