JoJo for Judge...

HAPPY FOURTH OF JULY...THANKS TO ALL VETERANS!!!!

The Choice to Die

Eric Simpson

Public Speaking

Concept Speech

6/26/2012

The Choice to Die

     Euthanasia is a concept that has generated a great deal of controversy and media attention over the past two decades. At the core of the issue is the simple question; should an individual with a terminal or debilitating illness be allowed to choose when and how they will die? Per Merriam-Webster’s on-line dictionary, euthanasia is defined as: “the act or practice of killing or permitting the death of a hopelessly sick or injured individual in a relatively painless way for reasons of mercy” (Merriam-Webster on-line dictionary, “n.d.”, accessed 6/22/2012). Euthanasia is a deliberate act undertaken with the sole purpose of causing death. It is not the withholding of treatment, which is currently accepted as a patient’s right in all fifty states.

     Euthanasia and/or assisted suicide is currently legal in Oregon, Washington, Montana, the Netherlands, Belgium, and Luxembourg. The states of Oregon and Washington passed specific laws, while in Montana, their Supreme Court ruled that assisted suicide was in fact a “medical treatment”. Several other states have attempted to pass assisted suicide legislation, including California, Maine, and New York; however, the majority of their voters have not supported this deeply emotional concept.

     Proponents believe that there comes a time when attempts to cure are not compassionate, or in the patients best interest, and that an individual has the right to determine when and how they will die. Opponents believe that the right to die is not a constitutional right, and furthermore, is an affront to religious beliefs and the foundation of medical practice to “first do no harm”.

     Those opposed to euthanasia or assisted suicide feel that life is sacred, and that no one should legally be allowed to kill or assist in the taking of human life. There are concerns about the scruples of professionals, and how and when this choice is made. Recently there has been a great deal of debate that assisted suicide, if in fact viewed as a “medical treatment”, might be endorsed by insurance and managed care organizations. The fear is that the cost of the drugs generally utilized in assisted suicide cost between $75.00 and $100.00, whereas the cost of continued medical treatment may become astronomical. Opponents believe that the poor and the most vulnerable may find themselves without the option to live as long as they are able to.  Concern also exists around when and how lines are drawn. Opponents raise many questions. Should infants with significant birth defects be euthanized? Should the insane who suffer great emotional pain be eliminated? Who makes the boundaries? Who draws the lines? What safe guards are put in place and how are they monitored? Additional concerns lie around the term “terminal”, as there are multiple definitions.  Religious doctrines support the belief that life is a sacred gift, and is not for man to end. Active euthanasia is not supported by most medical professional organizations or by organized religion.

     The earliest American statute against assisted suicide was passed in New York. It is the Act of Dec. 10, 1828, ch20, 1828, NY. In November 1994, Oregon’s “Death with Dignity Act” passed. It was the first law that allowed physician assisted suicide. On April 3, 1997, President Clinton signed the “Assisted Suicide Funding Restriction Act of 1997” which forbids the use of federal dollars to be used toward the death of an individual.  On June 26, 1997 the Supreme Court unanimously ruled that it was not a constitutional right to die, and that states may outlaw physician-assisted suicide. In November 1998, Dr. Jack Kevorkian showed the videotaped administration of a lethal injection on the prime time television show “60 Minutes”. On November 4, 2008, Washington passed its “Death with Dignity Act”.

     Research conducted by University of Utah bioethics expert, Margaret Battin, looked at the euthanasia data from Oregon and the Netherlands ( Ethics Illustrated, A Project of Bioethics International, Article written by, Jennifer Miller, titled, “Officials Say Many Euthanasia Fears Unfounded, Published Sept. 27.2007, accessed 6/20/2012). The research focused on 10 populations including: those with disabilities, those of depressed socioeconomic status, HIV/AIDS patients, those with little education, and those with psychological issues. These populations were examined because it was believed these factors make an individual more vulnerable. Of the populations examined, only in the case of AIDS did they see more deaths. The other categories were found to be statistically less. This study was also published in the October 2007 issue of the Journal of Medical Ethics. That article additionally cited that in 2007, 456 people in Oregon received drugs to kill themselves, but only 292 actually used them. They represented 0.15% of all deaths in Oregon during that time. In the Netherlands, their definition centers on “intolerable suffering” rather than on a “terminal illness”. Of the 136,000 deaths each year in the Netherlands, about 1.7% are by voluntary active euthanasia, and 0.1% are physician-assisted suicide. The research showed that in both Oregon and the Netherlands, the majority of patients were over the age of 70, over 80% had a form of cancer, and the numbers of deaths were slightly higher in women. In 2002, research conducted in Oregon under the Physician Assisted Suicide Act cited multiple factors as contributing reasons people chose to die. Eighty-four percent of patients sought this option because they feared losing their autonomy. Eighty-four percent were also concerned about their decreasing ability to participate in enjoyable activities. Forty-seven percent were concerned about the loss of control of bodily functions.  Thirty-seven percent were concerned about burdening family, friends, and loved ones. Twenty-six percent feared they could not achieve adequate pain relief.

     In conclusion, I would like to summarize the most common arguments of those both for and against euthanasia (ProCon.org – Euthanasia, A Public not Profit website/Public Charity, “n.d.”, accessed 6/20/2012). Those who argue for the passage of euthanasia or assisted suicide legislation argue that:

·        It provides a way to relieve extreme pain.

·        It provides relief when a person’s quality of life is low.

·        It frees up medical funds to help more people.

·        It is another case of freedom of choice.

Those who oppose passage of any “Choice to Die” legislation believe:

• It devalues human life.
• It could become a means of health care cost containment.
• It is an issue that physicians and medical professionals should not be involved in.
• It has a very slippery slope when lines are being drawn.                 

Since the subject is so controversial, I believe we will continue to see this concept debated, and we may even get to vote on the matter. With that vote in mind, I now conclude by asking you, “Should individuals be given ‘the choice to die’”?

One week between tests, 25 chapters to "read" per objectives (in just one class)!!!

Just under 800 pages, approximately 72 numbered objectives, many of which have multiple subjects listed, 25 chapters, 4 days before exam, 25 items on Mrs. Barbara Miller's study guide, assignments due, lives to live, and probably jobs to work in addition to everything else that's required and what's happening or is about to, and I can't seem to clear my crystal ball enough to see "where Mrs. Gill was going"...but anyway, I'll propose an answer to #1 on Mrs. Barbara Miller's study guide in hopes that it may still be applicable (after Mrs. Michele prepares her study guide).

1. What is stranger anxiety?

And I attempt to quote: (page 87, Chapter 5, Maternal/Child Nursing, Third Edition, Emily Sloan McKinney, et. al.)

"Another important aspect of psychosocial development is stranger anxiety. By 6 to 7 months, expanding cognitive capacities and strong feelings of attachment enable infants to differentiate between caregivers and strangers and to be wary of the latter. Infants display an obvious preference for parents over other caregivers and other unfamiliar people. Anxiety, demonstrated by crying, clinging, and turning away from the stranger, is manifested when separation occurs. This behavior peaks at approximately 7 to 9 months and again during toddlerhood, when separation may be difficult (see chapter 6).
Although stressful for parents, stranger anxiety is a normal sign of healthy attachment and occurs because of cognitive development (object permanence). Nurses can reassure parents that, although their infants seem distressed, leaving the infants for short periods does no harm. Separations should be accomplished swiftly, yet with care, love, and emphasis on the parent's return. "

Journaling my Journey

Journey through Family Tree Child Development Center

            My original impression upon learning of this clinical site left me feeling a bit skeptical. Spending a day at a childcare center did not sound like a clinical experience a nursing student would be assigned. Intending to give benefit to the doubt, I suspected there might be a registered nurse on staff at the center. Upon arrival, after seeing the size of the building and learning about its maximum capacity of 153 children and its near proximity to the regional medical center, my suspicion increased to an expectation. However, I soon learned otherwise. It was then that I realized we were not there to learn how to function in a nursing capacity, but to learn more about interacting with children during assessments of human growth and development. At least I suspect that may be why we were assigned to a child care center as part of our nursing clinical experience. Regardless of the purposes of this assignment, I feel as if I have profited from this adventure.

             I learned that observation of so many children at one time could be both rewarding and extremely challenging. Nevertheless, more importantly, I learned to appreciate how uniquely different and yet at the same time very similar individuals within an age group could comparatively be. I must say though, that I was rather surprised and disappointed to learn through James’ comments, that reportedly they discourage anyone, even their staff, from picking up the children who come running to them. During our orientation, we also learned the facility caters to hospital employees as a benefit, and it is mandated to serve the public due to its subsidized childcare program. There are 15 different rooms assigned to five different age groups. The ages are broken down into infants ranging from 6 weeks to one year, walking babies from 12-24 months, toddlers from 24-36 months, preschool from 3-5 years of age, and school age from 5-11 years of age. All personnel in direct childcare are required to have attained at least an associate’s degree, and are required to complete at least 10 hours of continuing education per year, which includes first-aid and infant and child CPR. The maximum number of children to which one person may be assigned varied according to age of the child. One woman caring for the school-age children told me she could be responsible for 15 children at one time. Another lady caring for the walking babies told me she could have as many as eight at one time per Georgia’s laws or six per national guidelines. 

I could go on and on, but this week I have 25 chapters "to read" before next week's test...in just one class! So, I must go...later Y'all!

 LOVE Y'ALL!!! 

EMS

C-section

According to Maternal-child Nursing, Third Edition, by Emily Sloan McKinney, et al., ...

Indications for a cesarean section delivery include, but are not limited to:

dystocia

cephalopelvic disproportion

HTN

maternal diseases such as diabetes, heart disease, cervical cancer

active genital herpes

some previous uterine surgical procedures such as a classical incision C-section

persistent nonreassuring fetal heart rate patterns

prolapsed umbilical cord

fetal malpresentations such as breech or transverse lie

hemorrhagic conditions such as abruptio placentae or placenta previa

Sometimes performed when a vaginal birth may compromise the mother or fetus, and sometimes done as an elective procedure at the mother's request. The risks and benefits should be carefully considered and weighed when choosing which route to take. Several factors play into the increasing use of cesarean births, and not all are medically related. It is likely that  liability concerns sometimes interferes with sound judgment decisions.

Preparations prior to a cesarean birth should include preoperative teaching, signing of consent forms, laboratory studies, ultrasound evaluations, complete assessments including physical, emotional and mental status examinations, and a prior health record to include PMHx, surgical history, contraceptive history, and reproductive history. Immediate preparations will include establishment of intravenous access with a large-bore catheter and a bolus dose of IV fluids to proceed regional anesthesia, urinary catheterization, skin preparations including hair clipping, antimicrobial cleansing, and sterile prep of abdomen, administration of medications to control gastric secretions, nausea, and postoperative pain, positioning for and administration of regional anesthesia (spinal block), grounding for electrocautery, and assembly of a team of personnel to assist in the operative procedures/recovery period and in the care and possible resuscitation of the newborn. Risks include maternal risks such as infection, hemorrhage, UTI/infections, thrombophlebitis/thromboembolism, paralytic ileus, atelectasis, and anesthesia complications and risks for the infant including inadvertent preterm birth, transient tachypnea of the newborn caused by delayed absorption of lung fluid, persistent pulmonary hypertension, and injury such as lacerations, bruising, fractures or other trauma.

LABOR AND DELIVERY CLINICAL EXPERIENCE

            Again, another exemplary clinical was experienced today. Having Mrs. Brittany Faircloth lead us at Crisp Regional was ideal. She certainly was in her element. Mrs. Faircloth made us feel very comfortable, welcomed, and lucky to have her assisting with instructing us.

             Within five minutes of arriving, my clinical day began with a dynamic start, for I soon found myself in an operating room observing the preparations of a 34 year-old lady who was about to receive a repeat elective C-section. Although the room was a bit crowded with personnel and equipment, and I did not get to see as much of the spinal anesthesia administration as I would have desired, I did get to closely observe the lower uterine transverse incision and was amazed at how little bleeding subsequently occurred. The saying “timing is everything” about sums up how astonished I was at the progression of events. I arrived in the room at approximately 0805 to 0810 hours and found the patient sitting on the bed’s edge awaiting the cleansing prep and the local numbing injection. By 0815, the spinal block was apparently effective, for the patient had already been assisted to a supine position, was receiving the scalpel across her abdomen, and obviously was doing so without sensing a bit of pain. I found it grossly interesting to observe as the obstetrician incised and bypassed through multiple layers of fascia, fat, and muscles in a variety of maneuvers. At 0819, the most impressive event of the clinical day occurred when the newly born baby began profusely crying before her feet even left her mother’s uterus. I observed as the obstetrician quickly cleared the airway with bulb syringe suctioning, and then pass the loud slippery neonate to the pediatrician and his assisting nurses. I admit I was shocked at the rapid rate with which events progressed. Although still in amazement, my shock soon became dismay as I soon realized that I would not be able to see as much of the initial interventions as I would have desired. I was able to see that their assessments and interventions included drying, warming, stimulating and providing a brief trial of blow-by oxygen in order to ensure effective spontaneous respirations, oxygenation, and a warmer environment. My next mild disappointment came when baby was removed from the room and I was not invited to pursue. At the time, I supposed that I was expected to continue to observe the surgical operation, so I gratefully engrossed myself in observing their handiwork.

            It was not too long before I felt rescued, for within a few minutes I was summoned to leave the OR suite and follow Stephanie to the nursery. Excitement returned as I entered the nursery and observed students being instructed in the newborn’s maturity rating and classification assessments. Apparently, I had already missed a significant portion of those assessments, and may have crowded the area, for I was directed to return to shadowing Debbie, another nurse whom I had met during my first minutes in the unit. Debbie was another blessing, for she very politely tolerated my presence and persistent inquisitiveness, and even enlightened me with numerous knowledgeable answers to every question I posed. Every member of the unit was very helpful and appeared more than willing to extend herself in whatever way they could to provide a wonderful learning experience to each of us. Ms. Easter deserves an honorable mention as well. Thirty-one years on the unit, and she still exudes a spirit of enthusiasm and willingness to teach and inspire. I believe she is one of the blessings God has provided for me to attempt to emulate.

            In closing, I wish to mention some of the other highlights of the day. I enjoyed being able to view the chart, and wonder how future students may be afforded that informative opportunity when we go “paperless” (in respect to electronic medical records and the access issues that go along with them). I sincerely appreciate the efforts undertaken by Mrs. Faircloth to ensure that we not only had answers to all of our questions, but also to provide us with direct instructions in procedures such as newborn and fundal assessments, reading and interpreting fetal heart monitor strips, and circumcision procedures. Ms. Easter also deserves recognition for her generous efforts towards instructing us, for she certainly went the extra mile towards ensuring we were well informed. I believe every student who attends a clinical rotation there under the leadership and direction of Mrs. Faircloth (and the other unit nurses there) should feel blessed to have the opportunity, and should reap a wealthy reward of knowledge.

            I hope I have not exceeded the 150-300 word directives by too much (nearly tripled, I know…Oh, speaking of tripled, did I mention the baby had a nuchal cord that was wrapped around its neck THREE times?!!!). To be able to follow your directions from the first day of this summer semester when you said for us to “just vomit material about our experiences”, it is impossible to use so few words when my experiences have evoked such strong emotions. Thanks again for allowing me to join in this opportunity!