Topic: Experimental Case
In 2003, a two-year-old baby named Michael Daddio died of congestive heart failure. After the death of the child, the parents found out that the procedure they had initially approved for the baby to undergo was not the one doctors performed. The initial procedure would have surgically repaired the child’s congenital heart defect, having a ninety to ninety-five-percent success rate. Instead, the doctors decided to perform an experimental surgery, which put the baby at great risk and later was the blamed cause of death.
I find this case to be outrageous and absolutely defiant on the doctors’ behalf. Not only are the doctors to blame here, but the medical facility as well since it allows such behavior to occur. First and for most, doctors are supposed to honor the parents’ choice in cases where children are underage and dependent. I do not understand why any doctor would want to put a baby through a new, risky surgery, rather than an established one. Not only did doctors break ethical codes in this case, but they also broke legislation laws which grant permission and consent to such medical care.
Ethically, this case breaks the trust in the doctor-patient relationship. Trust involves confidence that a person will act with the right motives. To tell the truth and act with truth gives an individual integrity if they uphold their word. Because the doctors in this case got the parents’ consent for one thing, but acted on another, they did not uphold this family’s trust and also lost their integrity in the process. If the doctors wanted to perform the experimental surgery, they should have asked the parents for consent for that specific procedure from the beginning; that way, they would have told the truth and not acted unethically. Also, along with trust, the doctors did not exhibit fidelity in this case, since they acted in a way that was not truly committed to the family. Like so many other cases, the doctors in this case did not demonstrate a strong role of beneficence. By not “doing good” for the patient and giving the experimental procedure, the doctors also showed an inability to make good decisions on the patient’s behalf, since the experimental surgery put the baby at high medical risk and later caused the baby’s death.
Legally, when a patient signs for a procedure to be performed and it is not upheld correctly, it places the attending doctors at high danger of being sued for malpractice and negligence. By not fulfilling the doctors’ duty to care which resulted in injury to the baby, the parents would have the legal grounds necessary to charge the doctors with a form of negligence. Since the doctors breached the contract with the child’s parents, the parents could also a file a tort charge against them as well. It is understandable that sometimes accidents do occur and things do not always go as planned. But, the odds of ‘accidentally’ giving a patient another procedure, especially one which is experimental, is highly unlikely and an unacceptable behavior/action from any doctor.
Personally, I found this case to be upsetting since the baby died as a direct result of the treatment received. If I was in the parent position, I would do all in my power to insure that this would not happen to someone else’s child. Experimental procedures are necessary in order to improve science and medical research; however, they should never, in any way, be pushed upon people or performed unethically as reported in this case.
Sunday, December 7, 2008
Saturday, December 6, 2008
Ethics Blog 7
Doctor’s Roles, what Beneficence Means – Grey’s Anatomy Case
Doctors have many roles they must fill in order to help their patients and the patients’ families to the best of their ability. Not only do they need to offer solutions to problems when emergencies and illnesses occur, but they also need to provide compassion and sympathy in times when nothing else can be done to help the patient. It is important for doctors to give accurate information, but they must be careful in its delivery. Not saying they should give false hope, but they need to be aware that sometimes families or patients are not ready to face and accept all the facts that the truth entails.
I never realized all of the all ‘internal’ roles a doctor must play until last night as I watched Grey’s Anatomy. The show told the case of two young sisters who had gotten into a car accident and were bickering nonstop from the moment they entered the ER. They appeared to be fine with the exception of a few minor cuts and bruises; however, doctors later suspected the oldest of having a brain injury after her eyes began to dilate and she began to show signs of swelling. Following an emergency surgery to reduce the brain swelling/matter, she was promounced brain dead. Shortly after her family went into the room to see her, the advising doctor came in and started rattling in a tangent-like and scientific manner of why the girl was brain dead, and that there was absolutely no hope she would ever wake up, hear, or think again. Despite this traumatic period for the family, the doctor pushed the fact that the only thing the girl was now useful for was to provide her young organs, and went on to quickly request permission to allow harvesting of them as soon as possible since time was limited. Obviously, the situation was upsetting enough for the family to learn that the sixteen-year-old girl was brain dead, let alone hear that the only thing she would ever be useful for was organ donations. To have a doctor stand in the room and go off on everything that the definition of brain dead instills was completely unnecessary. It lacked compassion for the family and caused them more stress than what the current situation had already dealt them.
Doctors, by definition, are supposed to help patients and provide life saving care. A patient who is ‘lost’ (or dies) is often seen as a failure to the doctor and the staff. However, this does not mean a doctor can simple ignore the feelings of the family and skip directly to requesting permission to harvest organs. Beneficence, by definition, means to demonstrate kindness, show compassion, and help others. This requires “one to do good,” which requires knowledge in beliefs, culture, values, and preferences.
In the Healthcare Ethics and Law book, an example of beneficence can be seen through a doctor’s statement, “I am not aware of any new treatments for your illness; however, I have some ideas about how I can help treat your symptoms and make you more comfortable. In addition, I will keep you informed as to any significant research that may be helpful in treating your disease process.” Although this example could not be used in the first case since the patient was brain dead, it is important to note the method used in the latter case: the doctor told the patient that he/she was unaware of any new treatments available to help the patient’s illness, but he would do all in his power to help the patient get through it with his continued assistance. This method should have used by the doctor in the Grey’s Anatomy case mentioned earlier, except that it would have be directed towards the parents since the girl was a minor and unconcious at the time.
This is one of the many reasons I think it is so important for doctors to be well-rounded individuals. They need to know how to communicate with their patients and their families in the most appropriate manner possible to get through hard times without causing unnecessary stress. Doctors are supposed to help people, whether it is the patient or his/her family, in whatever situation it may be. Everyone wants to feel like the doctor cares about them; but, if beneficence is not upheld, it can make tough situations that much harder to deal with and accept.
Doctors have many roles they must fill in order to help their patients and the patients’ families to the best of their ability. Not only do they need to offer solutions to problems when emergencies and illnesses occur, but they also need to provide compassion and sympathy in times when nothing else can be done to help the patient. It is important for doctors to give accurate information, but they must be careful in its delivery. Not saying they should give false hope, but they need to be aware that sometimes families or patients are not ready to face and accept all the facts that the truth entails.
I never realized all of the all ‘internal’ roles a doctor must play until last night as I watched Grey’s Anatomy. The show told the case of two young sisters who had gotten into a car accident and were bickering nonstop from the moment they entered the ER. They appeared to be fine with the exception of a few minor cuts and bruises; however, doctors later suspected the oldest of having a brain injury after her eyes began to dilate and she began to show signs of swelling. Following an emergency surgery to reduce the brain swelling/matter, she was promounced brain dead. Shortly after her family went into the room to see her, the advising doctor came in and started rattling in a tangent-like and scientific manner of why the girl was brain dead, and that there was absolutely no hope she would ever wake up, hear, or think again. Despite this traumatic period for the family, the doctor pushed the fact that the only thing the girl was now useful for was to provide her young organs, and went on to quickly request permission to allow harvesting of them as soon as possible since time was limited. Obviously, the situation was upsetting enough for the family to learn that the sixteen-year-old girl was brain dead, let alone hear that the only thing she would ever be useful for was organ donations. To have a doctor stand in the room and go off on everything that the definition of brain dead instills was completely unnecessary. It lacked compassion for the family and caused them more stress than what the current situation had already dealt them.
Doctors, by definition, are supposed to help patients and provide life saving care. A patient who is ‘lost’ (or dies) is often seen as a failure to the doctor and the staff. However, this does not mean a doctor can simple ignore the feelings of the family and skip directly to requesting permission to harvest organs. Beneficence, by definition, means to demonstrate kindness, show compassion, and help others. This requires “one to do good,” which requires knowledge in beliefs, culture, values, and preferences.
In the Healthcare Ethics and Law book, an example of beneficence can be seen through a doctor’s statement, “I am not aware of any new treatments for your illness; however, I have some ideas about how I can help treat your symptoms and make you more comfortable. In addition, I will keep you informed as to any significant research that may be helpful in treating your disease process.” Although this example could not be used in the first case since the patient was brain dead, it is important to note the method used in the latter case: the doctor told the patient that he/she was unaware of any new treatments available to help the patient’s illness, but he would do all in his power to help the patient get through it with his continued assistance. This method should have used by the doctor in the Grey’s Anatomy case mentioned earlier, except that it would have be directed towards the parents since the girl was a minor and unconcious at the time.
This is one of the many reasons I think it is so important for doctors to be well-rounded individuals. They need to know how to communicate with their patients and their families in the most appropriate manner possible to get through hard times without causing unnecessary stress. Doctors are supposed to help people, whether it is the patient or his/her family, in whatever situation it may be. Everyone wants to feel like the doctor cares about them; but, if beneficence is not upheld, it can make tough situations that much harder to deal with and accept.
Ethics Blog 6
Special Request based on religion, gender, or culture
America prides itself for promoting the individual. As citizens we grow up to recognize and accept that everyone is different, whether it is by religion, race, gender, or culture. Personally, I think it is important for an individual’s special request to be upheld in order for us to honor the patient’s rights as being a unique individual, a part of America’s melting pot. I do not think it is too much for patients to want an African-American male doctor for a black elderly patient. However, I do not think it the responsibility of a Health Organization to be able to accommodate every single adult that makes a special request. First of all, it would be unpractical with doctor shortages, and secondly, it would be almost impossible for providers to bear the cost of staffing a wide-array of doctors. For this reason, I believe it is up the individual to shop around for the doctor they want and fulfills their personal requirements and standards.
In class, we started talking about special requests people can make for cultural or religious reasons, such as female circumcision. In these cases, I think it is important to recognize although not many people in America perform female circumcision, there is nothing wrong with it having the procedure done if the individual wants it. It is important for medical organizations and doctors to realize that cultures are different, and even though Americans do not practice the same rituals as other countries in tattooing, FGM, or body mutation, it needs to be known that these are not meant to be “bad” procedures. An example of this is in the Islamic culture, where women who go through FGM are often seen as more ‘beautiful’ and carry more wife characteristics than those who do not go through the procedure. However by this, I am not saying that all doctors should be forced to learn how to perform such surgeries or procedures that go against their own personal beliefs or standings. I am merely stating that if someone wants to go through such a procedure or have special request, they should have the right to seek a doctor that will honor their request.
However, with such controversial procedures, I think that it is important that children are not involved. A child’s life should never be placed in danger because of a parent’s special request made based upon a religious or cultural view. Another case example was a few years back when a young child was stung by a bee and had a severe allergic reaction. Today, such allergic reactions can be cured with a shot; however, the child’s parents were scientologists and requested to withhold any invasive medical procedures. The child later died from the reaction. In such situations, I would hope that an emergency court session would be ordered to allow the doctors and medical professionals legal access to the patient to prevent an otherwise inescapable death.
Ethically, patients have the choice to decide what they want. However, not all cases are black and white and the question is often where to draw the line between what is acceptable and what is not. Should children be victims of their parents’ beliefs and not be provided care? Also, it is important to remember the ethical roles a doctor must fulfill from signing the Hippocratic Oath, which is to always work in the best interest of the patients and honor their decisions and requests, even if they do not agree. Yet, in situations of emergency or in cases where the patient may not fully understand the consequences of their condition, it is necessary for an ethic court to be ordered. Although I have never been in a situation where a special request has affected my outcome, I recognize the importance this issue has on a healthy doctor-patient relationship.
America prides itself for promoting the individual. As citizens we grow up to recognize and accept that everyone is different, whether it is by religion, race, gender, or culture. Personally, I think it is important for an individual’s special request to be upheld in order for us to honor the patient’s rights as being a unique individual, a part of America’s melting pot. I do not think it is too much for patients to want an African-American male doctor for a black elderly patient. However, I do not think it the responsibility of a Health Organization to be able to accommodate every single adult that makes a special request. First of all, it would be unpractical with doctor shortages, and secondly, it would be almost impossible for providers to bear the cost of staffing a wide-array of doctors. For this reason, I believe it is up the individual to shop around for the doctor they want and fulfills their personal requirements and standards.
In class, we started talking about special requests people can make for cultural or religious reasons, such as female circumcision. In these cases, I think it is important to recognize although not many people in America perform female circumcision, there is nothing wrong with it having the procedure done if the individual wants it. It is important for medical organizations and doctors to realize that cultures are different, and even though Americans do not practice the same rituals as other countries in tattooing, FGM, or body mutation, it needs to be known that these are not meant to be “bad” procedures. An example of this is in the Islamic culture, where women who go through FGM are often seen as more ‘beautiful’ and carry more wife characteristics than those who do not go through the procedure. However by this, I am not saying that all doctors should be forced to learn how to perform such surgeries or procedures that go against their own personal beliefs or standings. I am merely stating that if someone wants to go through such a procedure or have special request, they should have the right to seek a doctor that will honor their request.
However, with such controversial procedures, I think that it is important that children are not involved. A child’s life should never be placed in danger because of a parent’s special request made based upon a religious or cultural view. Another case example was a few years back when a young child was stung by a bee and had a severe allergic reaction. Today, such allergic reactions can be cured with a shot; however, the child’s parents were scientologists and requested to withhold any invasive medical procedures. The child later died from the reaction. In such situations, I would hope that an emergency court session would be ordered to allow the doctors and medical professionals legal access to the patient to prevent an otherwise inescapable death.
Ethically, patients have the choice to decide what they want. However, not all cases are black and white and the question is often where to draw the line between what is acceptable and what is not. Should children be victims of their parents’ beliefs and not be provided care? Also, it is important to remember the ethical roles a doctor must fulfill from signing the Hippocratic Oath, which is to always work in the best interest of the patients and honor their decisions and requests, even if they do not agree. Yet, in situations of emergency or in cases where the patient may not fully understand the consequences of their condition, it is necessary for an ethic court to be ordered. Although I have never been in a situation where a special request has affected my outcome, I recognize the importance this issue has on a healthy doctor-patient relationship.
Thursday, December 4, 2008
Ethics Blog 5
Ethical Case
I was watching a show on Discovery Health the other night about two identical twin boys, Bruce and Brian Reimer, born in Canada. The twins both suffered from phimosis, so their pediatrician offered the simple solution of circumcision to correct the problem. What was supposed be a routine produce went drastically wrong; Bruce’s entire penis was accidentally burned off. After this, bizarre things started to occur as the Reimers’ pediatrician recommended them to specialist at John Hopkins. The specialist, Dr. Money, told the parents Bruce would “be unable to have normal sexual relations or get married” and “have to recognize that he is incomplete, physically defective, and that he must live apart” without his penis. The only solution he offered was to raise Bruce as a girl. After brainwashing the parents to agree, Bruce received a bilateral orchidectomy and was transformed into a “girl” named Brenda. The twins grew up attending therapy sessions, which were actually gender reassignment experiments. Brenda/Bruce often resisted annual trips to John Hopkins to receive hormone treatments. Despite this twin never taking to re-sex identification, Dr. Money continued to make positive reports back to the parents so they would stay with the program.
I found this case to be disturbing. Although the parents were trying to practice beneficence by doing what they thought was best for their child, they unfortunately were heavily swayed by Dr. Money’s not-so-good advice. Dr Money violated his ethical code of doing no harm, not only to his patient, but to Brenda/Bruce’s family as well. He also did not exemplify nonmaleficence, as he saw the children struggling, yet continued to inflict pain on the twins. Later, documentation was released which provided evidence to support the fact that Dr. Money was purposely conducting a “modern day mad scientist experiment,” in which he was studying plasticity of gender.
In this case, one bad decision was continually followed by another, for not only were the principles of justice, paternalism, and autonomy violated to the children, but also the moral codes such as compassion, conscientiousness, discernment, and kindness. However, the two most important morals I found to be broken in this case were Dr. Money’s trustworthiness and respect toward the Reimer family. Not only did the doctor lie about his true intentions, experimentations, and the results, but he also forced the children to do and say things against their will which resulted in sexually abusing Brenda/Bruce, and ultimately affecting both the twins emotionally and psychologically. Respect was violated throughout this case, seen clearly in the doctor’s dissaproval of Brenda/Bruce no longer wanting to participate in the treatment and disregard of Brenda/Bruce’s feelings.
In the end, the truth destroyed the Reimer family. This case was absolutely horrible, and I doubt that it would happen in modern times because of high regulations and protective laws. I could never imagine a person doing such a terrible thing, let alone Mr. Money, a doctor, continuing this for personal enjoyment and satisfaction. Brian (the twin always known as a boy) suffered severe depression for years after finding out the truth about his brother and eventually committed suicide. Soon after, Bruce (earlier known as Brenda) died of a drug overdose, with suicide as the suspected cause. Both their children’s deaths left the Reimer parents heartbroken with pain and regret, in which they claimed to be a victim until their own deaths.
I was watching a show on Discovery Health the other night about two identical twin boys, Bruce and Brian Reimer, born in Canada. The twins both suffered from phimosis, so their pediatrician offered the simple solution of circumcision to correct the problem. What was supposed be a routine produce went drastically wrong; Bruce’s entire penis was accidentally burned off. After this, bizarre things started to occur as the Reimers’ pediatrician recommended them to specialist at John Hopkins. The specialist, Dr. Money, told the parents Bruce would “be unable to have normal sexual relations or get married” and “have to recognize that he is incomplete, physically defective, and that he must live apart” without his penis. The only solution he offered was to raise Bruce as a girl. After brainwashing the parents to agree, Bruce received a bilateral orchidectomy and was transformed into a “girl” named Brenda. The twins grew up attending therapy sessions, which were actually gender reassignment experiments. Brenda/Bruce often resisted annual trips to John Hopkins to receive hormone treatments. Despite this twin never taking to re-sex identification, Dr. Money continued to make positive reports back to the parents so they would stay with the program.
I found this case to be disturbing. Although the parents were trying to practice beneficence by doing what they thought was best for their child, they unfortunately were heavily swayed by Dr. Money’s not-so-good advice. Dr Money violated his ethical code of doing no harm, not only to his patient, but to Brenda/Bruce’s family as well. He also did not exemplify nonmaleficence, as he saw the children struggling, yet continued to inflict pain on the twins. Later, documentation was released which provided evidence to support the fact that Dr. Money was purposely conducting a “modern day mad scientist experiment,” in which he was studying plasticity of gender.
In this case, one bad decision was continually followed by another, for not only were the principles of justice, paternalism, and autonomy violated to the children, but also the moral codes such as compassion, conscientiousness, discernment, and kindness. However, the two most important morals I found to be broken in this case were Dr. Money’s trustworthiness and respect toward the Reimer family. Not only did the doctor lie about his true intentions, experimentations, and the results, but he also forced the children to do and say things against their will which resulted in sexually abusing Brenda/Bruce, and ultimately affecting both the twins emotionally and psychologically. Respect was violated throughout this case, seen clearly in the doctor’s dissaproval of Brenda/Bruce no longer wanting to participate in the treatment and disregard of Brenda/Bruce’s feelings.
In the end, the truth destroyed the Reimer family. This case was absolutely horrible, and I doubt that it would happen in modern times because of high regulations and protective laws. I could never imagine a person doing such a terrible thing, let alone Mr. Money, a doctor, continuing this for personal enjoyment and satisfaction. Brian (the twin always known as a boy) suffered severe depression for years after finding out the truth about his brother and eventually committed suicide. Soon after, Bruce (earlier known as Brenda) died of a drug overdose, with suicide as the suspected cause. Both their children’s deaths left the Reimer parents heartbroken with pain and regret, in which they claimed to be a victim until their own deaths.
Ethics Blog 4
Ethical Issue: FDA Experiment for children
A few years ago, a heavily debate topic was whether or not the FDA should have allowed healthy children to be drugged for scientific research. In this particular study, healthy children between the ages of nine and eighteen would receive a single ten milligram dose of dextroamphetamine, a drug commonly used in Adderall. The goal of this study was to compare those children with ADHD to those without, and also, to gain information about how their brains function differently. Families were given a cash incentive of $570 to have their healthy child participate. When reviewed by the FDA subcommittee, the vote on approval was split.
Although this study had been done nearly twenty years ago, it was performed without regard to current ethical codes or legislation. Many FDA board members thought the experiment’s intentions in expanding knowledge of the drug was a great idea, but it ultimately failed to ethically acknowledge the participating children’s rights. Thus, the study was never approved.
I became interested in this case because it involved children – a different age population than what we normally discuss in class. If this study had been approved, it would have possibly violated the children’s right of autonomy if they participated against their will. Also, I wondered how it would have been right to conduct the study, knowing that most children between ages nine and eighteen would have been unable to fully comprehend the extent of this experience, especially the younger ones. By not understanding the study, they possibly could have been totally unaware that the drug taken could cause temporary insomnia, poor appetite, or hallucinations.
Although parents or researchers could explain the experiment to the child, information, such as possible side effects, could have been withheld, creating an issue of trustworthiness between the child and parent or child and researcher. Since a cash incentive was offered, I feel as if the study was trying to appeal to the parents, who researchers knew would possibly force their child to participate in order to reap the monetary benefit. Also, it goes down to the question if it is fair to drug a healthy child, just to see what will happen and how they compare to a child with a condition, such as ADHD. In this case, I think the answerto the question is no. I understand that researchers want to expand their knowledge in this area of science, but there has to be a safer, more ethical, way of doing so. I am glad the board did not approve this study, for children have ethical rights as well, even if they are not of age. Researchers would never submit an unwilling adult to participate in a study only because his/her spouse wanted it. In my opinion, this experiment would have taken advantage of the participants, healthy children, with their lack of knowledge about the details of the experiment and the possible side effects of the drugs, totally to benefit of the research company.
A few years ago, a heavily debate topic was whether or not the FDA should have allowed healthy children to be drugged for scientific research. In this particular study, healthy children between the ages of nine and eighteen would receive a single ten milligram dose of dextroamphetamine, a drug commonly used in Adderall. The goal of this study was to compare those children with ADHD to those without, and also, to gain information about how their brains function differently. Families were given a cash incentive of $570 to have their healthy child participate. When reviewed by the FDA subcommittee, the vote on approval was split.
Although this study had been done nearly twenty years ago, it was performed without regard to current ethical codes or legislation. Many FDA board members thought the experiment’s intentions in expanding knowledge of the drug was a great idea, but it ultimately failed to ethically acknowledge the participating children’s rights. Thus, the study was never approved.
I became interested in this case because it involved children – a different age population than what we normally discuss in class. If this study had been approved, it would have possibly violated the children’s right of autonomy if they participated against their will. Also, I wondered how it would have been right to conduct the study, knowing that most children between ages nine and eighteen would have been unable to fully comprehend the extent of this experience, especially the younger ones. By not understanding the study, they possibly could have been totally unaware that the drug taken could cause temporary insomnia, poor appetite, or hallucinations.
Although parents or researchers could explain the experiment to the child, information, such as possible side effects, could have been withheld, creating an issue of trustworthiness between the child and parent or child and researcher. Since a cash incentive was offered, I feel as if the study was trying to appeal to the parents, who researchers knew would possibly force their child to participate in order to reap the monetary benefit. Also, it goes down to the question if it is fair to drug a healthy child, just to see what will happen and how they compare to a child with a condition, such as ADHD. In this case, I think the answerto the question is no. I understand that researchers want to expand their knowledge in this area of science, but there has to be a safer, more ethical, way of doing so. I am glad the board did not approve this study, for children have ethical rights as well, even if they are not of age. Researchers would never submit an unwilling adult to participate in a study only because his/her spouse wanted it. In my opinion, this experiment would have taken advantage of the participants, healthy children, with their lack of knowledge about the details of the experiment and the possible side effects of the drugs, totally to benefit of the research company.
Sunday, November 30, 2008
Ethics Blog 3
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.
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.
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.
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