Tuesday, September 2, 2008

Dawn Oetjen, Medical Law & Ethics, Blog 2

Ethic Issue: Full/partial removal of the clitoris in other countries

Female Genital Mutilation (FGM) is practiced in a number of countries outside the United States. In this seemingly barbaric surgery, full or partial removal of the clitoris is performed. After the surgery, the general population views the young girl as a more beautiful and attractive prospective wife. The justification for surgery is often to prevent either intercourse before marriage or adultery by disabling a female’s ability to have sexual feelings. Despite many people’s belief that FGM is totally associated with radically Islamic groups, the procedure actually began in Africa where it is part of the culture, not a requirement of the religion. It has been estimated that 6,000 girls worldwide are forced into FGM every day.

Although the ideas shared by participants of FGM is hard for outsiders to understand or see as ethical, it should be known that secular ethics, such as this custom, vary from country to country. Even though most American women view this operation as unfair or degrading to females, this opinion is not necessarily shared by communities that partake in this particular custom. It should be understood that, in these people’s eyes, this surgery makes the female body more “god-like” and meets the “ideals of perfection” in their community.

Contrary to these customs, I believe it is unethical to perform such a surgery on a girl who does not wish to participate, but is forced to do so by her community. Now, the dilemma is how to prevent this from happening to a young girl in a poor rural village in a huge country such as Africa where resources are spread thin already. Personally, I cannot think of a logical way to alleviate or solve this problem other than raising awareness of FGM, and also, encouraging the governments of these countries to require sanitary facilities for the elected surgeries to be performed. With a more Western approach, young girls could make an informed decision with a trained doctor without feeling the pressures of their community. This idea, however, leads into an even bigger problem of how an already underfunded government, such as Africa, would go about financing such a service for these tribes who are involved with FGM. It seems to me there is no easy fix for the unfortunate girls who do not want to partake in this ancient custom.

3222 WILDCARD TOPIC

Wildcard topic: Some nursing homes’ inabilities to provide regular General Practitioner visits.

Long term care facilities are ever-improving as they try to upgrade their quality of care to provide for the rising elderly population and the soon-to-be-retired baby boomer generation. One issue that has come to the table is the irregular doctor visits that are made by residents of nursing facilities and retirement communities. Although only a small portion of the elderly population is affected by this today, it could become a bigger issue as the elderly population three-folds by 2030. I think it is unacceptable that adequate care is not provided for these individuals when signs and symptoms of illness and disease first takes place, contrary to waiting until more serious problems and even permanent injuries are sustained.

When my grandfather was in a nursing center, my grandmother had to request a special transportation service to transport him to and from his regular doctors who were not assigned to the center. Not only was this an inconvenience placed upon my grandmother, but it was also a huge expense for her since their health insurance did not cover the cost of transportation. My grandfather was able to be transported to his outside physicians and receive the special care he needed because my grandmother arranged it; however, many elders are not so lucky and sometimes develop life-threatening conditions as a result.

This issue has recently received interest as an increasing number of studies have shown that more than one-third of all hospital visits from nursing home residents could have been prevented if residents would have had access to a GP sooner. Massachusetts’ chief consumer advocate for nursing facilities, Mary McKenna, reported her opinion through her statement that often times “things get overlooked until a hospitalization is unavoidable.” However, it is a tough time to raise the quality of primary care to expectations when insurance is covering less and patients are being forced to dig deeper into their pockets. I found after researching this topic that some nursing home are starting to use telemedicine to allow residents the chance to have direct care from doctors at a moments notice. So far, it has prevented several emergency situations. Responses to videophone doctor visits have been so positively received by the medical community that it is now expanding throughout the state of Massachusetts and plans to hopefully branch into other states around the country.

I think that what has happened in Massachusetts is a great resolution to limit hiring transportation to see a doctor. Not only does it allow easy access, but it also promotes elders to speak up when they first feel something is wrong and not to worry about the process of scheduling a trip to a doctor. I can only say that I wish this technology would have been around for my grandfather, for it would had eased the burden on my grandmother, and she could had focused her energy on more important things, such as spending time with him during his final days.