Medical Dilemmas of Conjoined Twins
What is the ethical way to deal with conjoined twins? Should they be given the fighting chance to survive as a whole, should they be separated as soon as possible after birth, or should they be aborted when first noticed on an ultrasound? There have been several accounts of conjoined twins remaining together throughout their entire life; however, there have also been several accounts in which conjoined twins experience success and a better quality of life after separation operations. Yet, despite their success in surgery, do they truly live a better life when they are possibly never completely free of disability, handicaps, or mental suffering? Some argue this quality of life is not worthy of living and theses babies should be aborted.
I find conjoined twins fascinating and the procedures to separate them an amazing accomplishment to science. Many people question whether or not it is ethically right to request separation, knowing it puts children at an extreme risk for survival. Personally, I believe it is ethical to do so, because separation surgery often give these children the chance to live into their adult years, something that otherwise might not be possible, especially for those with more severe conditions. Also, it is important to note that separation procedures have a 75% success rate for at least one of the twins to survive. People against such operations should also note that these procedures are being done to significantly improve the children’s quality of life and offer some sort of normalcy to them. When I look at the gains of separation operations, they outweigh the risks; however, this varies from person to person depending upon their morals and values. Ultimately, it is the parents’ decision and right to determine the future for these children, and their final decision should never result in a doctor’s withdraw of support and guidance.
These ethical questions whether or not to separate are faced not only by the parents, but the surgeons as well. Doctors must demonstrate paternalism and offer continual guidance no matter what decision is made in the end. As a surgeon for such situations as conjoined twins, they should always honor the parent’s choice, since it is their legal right to either refuse or request medical treatment on behalf of the children. There have been cases where parents have been pushed into separation surgery against their will. In an ideal world, this should never happen; however, in many cases of conjoined twins it does occur. This demonstrates the need for these parents to know their rights and not allow doctors to overrule them if it is truly against their wishes. In cases where the twins cannot be separated and parents choose to let the children live, it is important for doctors to not pressure the parents into over-treatment. Over-treatment refers to doctors trying to break parents down in order to get consent to perform aggressive surgeries. Doctors acting in this manner would not be demonstrating trust to their clients, since their intentions would be deceptive without commitment to what the parents originally chose.
There are many types of conjoined twins, and not all can be separated. In instances where vital organs or limbs are shared or there are two heads for one body, separation is almost always impossible to perform without one twin dying. This raises the question of whether or not it is ethical to abort these types of conjoined twins, knowing their quality of their live would never be high, independence could not be gained, and the condition would cause financial and emotional hardships to the family. Abortion in these cases may seem like an easy answer, but mothers must abide by state laws on abortion periods for legal access. This can be ethically challenging, since many of these cases are not identified as conjoined twins until late in second trimester or early in the third. This conflicts with most state regulations being past the cut-off period for the procedure. In this situation, a mother’s decision to abort a child should certainly be honored; she should never be questioned by a doctor or swayed to think she is making the wrong decision, since in most cases, the mother’s best intentions would be at heart.
Personally, I don’t know what I would do if I was in the parent situation. I think the best course of action would be to use my research and inform myself on percentages of success for whatever type of conjoined twins my children were. I would also try to raise my awareness of currently living twins and learn as much as possible about their emotional and physiological well-being as well as their present and predicted struggles and obstacles. Hopefully, these facts and observations would keep me at peace with whatever decision I made. This would be extremely difficult for anyone, for not only do you have to think of yourself and how you would be affected, but you also must consider your unborn children as well.
Sunday, November 30, 2008
Thursday, November 27, 2008
LTC - WIldcard
Senior Exercising
Exercise enables us to function better and work at our potential; however, these days, senior citizens are reporting to exercise less and less each year. Reasons vary for not exercising, such as feeling inferior at the gym, not having proper transportation, and losing interest. As a result of the reduced activity, many community leaders are trying to start up exercise programs designed specifically for seniors. The easy and most convenient type of exercise is walking, not to mention, it is the safest since it is usually not as physically demanding as running or weight training. Some facilities, such as the YMCA, have started senior programs that meet early for morning coffee and exercise. Not only are such programs a good social activity, but they also give elders the motivation to get up in the morning to exercise since their friends will be there.
Exercises can have many benefits on elders, such as reducing their chances of chronic illness and conditions. The risk of osteoporosis in women can be significantly reduced with weight strengthening in combination with a good diet. Also, good exercise habits have been correlated to reduced heart disease, stroke, colorectal cancer, breast cancer and type II diabetes. Most importantly, exercise increases the average life span and fights the effects of aging, such as joint disorders, bone loss, and muscle break down.
Personally, I think future generations will not experience the same needs as today’s elders, since we are growing up in an educated and “health crazy” society. Studies report individuals with higher education have better exercise routines. I think it is important to get involved in an exercise program early in life, then it could be easier later to stay with the same routine, or modify it according to one’s needs.
Exercise enables us to function better and work at our potential; however, these days, senior citizens are reporting to exercise less and less each year. Reasons vary for not exercising, such as feeling inferior at the gym, not having proper transportation, and losing interest. As a result of the reduced activity, many community leaders are trying to start up exercise programs designed specifically for seniors. The easy and most convenient type of exercise is walking, not to mention, it is the safest since it is usually not as physically demanding as running or weight training. Some facilities, such as the YMCA, have started senior programs that meet early for morning coffee and exercise. Not only are such programs a good social activity, but they also give elders the motivation to get up in the morning to exercise since their friends will be there.
Exercises can have many benefits on elders, such as reducing their chances of chronic illness and conditions. The risk of osteoporosis in women can be significantly reduced with weight strengthening in combination with a good diet. Also, good exercise habits have been correlated to reduced heart disease, stroke, colorectal cancer, breast cancer and type II diabetes. Most importantly, exercise increases the average life span and fights the effects of aging, such as joint disorders, bone loss, and muscle break down.
Personally, I think future generations will not experience the same needs as today’s elders, since we are growing up in an educated and “health crazy” society. Studies report individuals with higher education have better exercise routines. I think it is important to get involved in an exercise program early in life, then it could be easier later to stay with the same routine, or modify it according to one’s needs.
Tuesday, November 11, 2008
LTC Blog 4 - Wildcard Topic
Topic: Beacon Hill
As our society ages, I think is important that people start looking into what types of facilities they would accept to live in if needed. Personally, I know I do not want to live in a nursing home unless I absolutely have to in order to survive, and even then, I still would rather be somewhere else. In my Aging of the Elderly class, I learned about a community of elderly people living together as neighbors called Beacon Hill. Designed with the aging in place concept in mind, Beacon Hill offers a wide variety of features for members such as: transportation to places of worship and medical facilities, assistance to doctor’s appointments, meal deliveries, maintenance to install safety features in homes as needed, emergency plan helpers, exercise programs, education programs on aging, and freedom of visitors. After researching this community, I felt that it was a great alternative to institutionalized care and could see myself being happy living in such a community in my later years.
The goal of communities such as Beacon Hill is to keep senior citizens out of nursing homes, by allowing them to live in a place of comfort and familiarity. The main services that I mentioned above are provided under a standard fee. Other services such as therapists, home aides, and personal trainers are also offered, but on an ‘a la cart’ basis. However, despite the extra cost, members pay for these select services, which are offered well under the “going rate.”
This village was started by a nonprofit organization led by retired business executives and has 340 members with ages ranging from fifty-two to ninety-eight. Members pay an annual fee of $550, but can be higher if one is living in a separate household. Although the cost for a community such as this may be high and seem impossible to provide in areas of low-income, AARP with the help of the Beacon Hill Village nonprofit group are working on designing a plan to help create more alternative care facilities like Beacon Hill. By creating a manual to distribute to willing and financially stable organizations, they hope these communities will begin to flourish across America.
I think that these communities will play an increasing role in LTC as the baby boomers hit retirement and truly begin to start thinking about their future. It will be interesting to see how the government responds to the increasing role elderly communities have, and also, if they, too, try to create something similar to Beacon Hill as an alternative to nursing facilities which demand a higher cost and provide a lower end-of-life quality.
As our society ages, I think is important that people start looking into what types of facilities they would accept to live in if needed. Personally, I know I do not want to live in a nursing home unless I absolutely have to in order to survive, and even then, I still would rather be somewhere else. In my Aging of the Elderly class, I learned about a community of elderly people living together as neighbors called Beacon Hill. Designed with the aging in place concept in mind, Beacon Hill offers a wide variety of features for members such as: transportation to places of worship and medical facilities, assistance to doctor’s appointments, meal deliveries, maintenance to install safety features in homes as needed, emergency plan helpers, exercise programs, education programs on aging, and freedom of visitors. After researching this community, I felt that it was a great alternative to institutionalized care and could see myself being happy living in such a community in my later years.
The goal of communities such as Beacon Hill is to keep senior citizens out of nursing homes, by allowing them to live in a place of comfort and familiarity. The main services that I mentioned above are provided under a standard fee. Other services such as therapists, home aides, and personal trainers are also offered, but on an ‘a la cart’ basis. However, despite the extra cost, members pay for these select services, which are offered well under the “going rate.”
This village was started by a nonprofit organization led by retired business executives and has 340 members with ages ranging from fifty-two to ninety-eight. Members pay an annual fee of $550, but can be higher if one is living in a separate household. Although the cost for a community such as this may be high and seem impossible to provide in areas of low-income, AARP with the help of the Beacon Hill Village nonprofit group are working on designing a plan to help create more alternative care facilities like Beacon Hill. By creating a manual to distribute to willing and financially stable organizations, they hope these communities will begin to flourish across America.
I think that these communities will play an increasing role in LTC as the baby boomers hit retirement and truly begin to start thinking about their future. It will be interesting to see how the government responds to the increasing role elderly communities have, and also, if they, too, try to create something similar to Beacon Hill as an alternative to nursing facilities which demand a higher cost and provide a lower end-of-life quality.
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