End-of-life Essay Example for Free

End-of-life Essay End-of-life care is a form of medical treatment which is usually provided for terminal illnesses, when the condition is no longer curable and every effort should be made at improving the quality of life rather than increasing the duration of life. Cancer is one condition which is incurable during the advanced stages. End-of-life usually does not involve provision of anticancer treatment but concern for lowering the physical symptoms (especially pain so that the patient is comfortable), addressing the psychosocial issues and the spiritual concerns, so as to improve the quality of life. Often an ethical dilemma exists at the situations under which end-of-life care should be started. The need to provide end-of-life care arises out the physician’s obligation to ensure that the patient can live and die with dignity, compassion, comfort and respect. Two of the cases which demonstrate the physician’s obligations to the patients were the Ann Quinlan case (1976) and the Cruzan V. Harmon case (1988) (Meisel, 2005 Rekel, 2007). In the Quinlan case, Ms. Quinlan suffered irreversible damage to the brain cortex and was left in a permanent vegetative state. She required ventilator support, artificial nutrition and artificial hydration to maintain her medical and nursing care. She could be kept alive for any duration, but this was morally not required and not in the patient’s best interest. The physician’s refused to remove ventilator support and hence the family had to go to the New Jersey Court. The court in the landmark decision permitted to remove ventilator support as it was not in the patient’s best interest. The court had said that although the patient was in a permanent vegetative state and did not have to ability to make a decision about withdrawing ventilator support, it did not mean that she could not exercise her choice and give her decision. The decision-making could be made by a surrogate who would be doing so in the best interest of the patient. In the Roe vs. Wade case, the court gave the decision that the patient could control their medical treatment and had the right to make decisions. In the Cruzon case, after the ventilator was removed, the patient survived for about 10 years. The Missouri court in this case did not follow the advice of the parent’s on removing life-saving support. The court said that all measures should be done in best interest of the patient, and if there were not clear evidence of the patient’s wishes, then the legal guardian should be acting in the patient’s best interest. The court said that even if there was a need to prolong life through ventilator support, if there was no evidence that the patient’s best interest would be fulfilled. In the case Westchester County Medical Ctr (1988), the New York court said that there had to exist clear and convincing evidence whenever important decisions had to be taken by the surrogate (Meisel, 2005 Rekel, 2007). Some of the common ethical issues regarding medical treatment have been ‘beneficence’ and ‘non-maleficence’. The physician should do treatment that benefits the patient and does not cause more harm. They should help reduce the suffering and help the patient to return to health. However, in the end-of-life issues, the patient would be dying due to the terminal cancer condition, and using life-sustaining treatment would not have any potential benefits, as it would prolong life, but not improve the quality. In this case medical treatment is doing lot harm than benefits, and hence using it would be inappropriate. However, a clear judgment has to be made in the clinical-decision making and one of the most important issues is whether the patient has made the intention of withdrawing all the life-saving treatment and instead goes into palliative care (in which symptomatic treatment would be provided so as to improve the quality of life during the last few days). Having the patient make this decision is based on another ethical principle known as ‘autonomy’. The patient has the right to choose or disregard whichever treatment he/she wants as the have the right to control any act that is done with their body (Walker, 1999 Meisel, 2005). Implications of risk management – †¢ Mainly with the use of opioids to manage pain (especially from its prolonged use) †¢ Clinical practice guidelines and protocols should be followed to ensure the greatest amount of benefits for the patient in the form of improved quality of life and lowered discomfort levels (Hoffman, 1998). The right to autonomy of the patient should not be disregarded under any circumstance. The patient has the right to choose palliative treatment or reject it based on their own choices. The patient may also want to undergo curative treatment for cancer even though the survival rate may be low. The patient should be informed of the benefits, risks, options, outcome and costs of all forms of treatment available. The physician should answer all the queries the patient has of all the available forms of treatment. No treatment should be done against the will and intention of the patient. If the patient is not able to make a reasonable decision as they may not be legally competent, then the surrogate (including the family member or a legal guardian) of the patient should make a decision on the patient’s behave, keeping in mind the clear interests of the patient (Walker, 1999, Meisel, 2005 Rekel, 2007). There may be a lot of competing loyalties between the patient and the organization:- †¢ The organization may try to keep the interest of the patient in mind and may do all that it can to reduce sufferings, improve the quality of life and ensure a peaceful end †¢ The organization may demonstrate a greater opinion towards anticancer treatment as it would involve higher costs (even though it is not beneficial to the patient anywhere) †¢ Even though the patient can benefit to a reasonable extent from anticancer treatment, the organization may force end-of-life care on the patient, as the family members have provided consent. In this case the family members would be having conflicting interests with the patient and may want a faster end to the patient. To prevent any conflicting interest of other parties, it is important that any decision made regarding use of anticancer treatment of initiation of end-of-life care should be clearly justified and documented through evidence-based findings. An ethical approach should be initiated to ensure that all issues are sorted out keeping the patient’s interest in mind:- †¢ The physician should ensure maintaining autonomy of the patient at all stages †¢ If the patient is not competent enough to make a decision by himself, decision-making should be done by the surrogate keeping in mind the patient’s interest and choices †¢ It is the obligation of the physician to ensure that the patient lives †¢ The patient’s competence needs to be determined so that a reasonable decision can be ensured †¢ The patient has to be informed of all the alternative choices available at all the stages †¢ In case of diagnosis of a terminal illness, confirmation should be taken from two physician’s (second opinion) †¢ In case of terminal illness, and the patient choice palliative care, efforts should be made at all stages to improve the quality of life (through symptomatic treatment of physical problems, addressing the psychosocial and spiritual issues), rather than on prolonging life The other issues which need to be addressed include:- 1. Active Euthanasia – This is legal in only a few states of the world including Netherlands and Belgium. The patient should make a reasonable decision, and should be a native from that state in which euthanasia is legalized. The physician himself would take the active step of ending the patient’s life. The patient should be diagnosed with a terminal illness 2. Physician-Assisted Suicide – This has been legalized in the US state of Oregon, PAS has been legalized. The patient would perform the active step of ending life and the physician would merely assist the patient. The patient should be diagnosed with a terminal illness (in which death would be certain within 6 months). The patient should be legally competent to make a reasonable decision (Rekel, 2007). References: Hoffmann, D. E. (1998). Pain Management and Palliative Care in the Era of Managed Care: Issues for Health Insurers†, Journal of Law, Medicine Ethics, 26(4), 267-289. http://www. aslme. org/research/mayday/26. 4/26. 4c. php Meisel, A. (2005). Ethics, End-of-Life Care, and the Law: Overview, Retrieved on August 16, 2008, from Hospice Foundation Website: http://www. hospicefoundation. org/teleconference/books/lwg2005/meisel_jennings. pdf National Cancer Institute (2002). End-of-Life Care: Questions and Answers, Retrieved on August 16, 2008, from NCI Website: http://www. cancer. gov/cancertopics/factsheet/Support/end-of-life-care Rekel, R. (2007). Rakel: Textbook of Family Medicine, 7th ed, Philadelphia: Saunders Elsevier. Walker, R. M. (1999). Ethical Issues in End-of-Life Care, Cancer Control, 6(2):162-167. http://www. medscape. com/viewarticle/417700_1

Harry Potter :: Free Essay Writer

Harry Potter ‘Harry Potter and the Goblet of Fire’, written by J.K. Rowling, is an excellent example of a modern novel that uses medieval influences extensively. Many of the novel’s characters are based on medieval ideas and superstitions. The settings in the book resemble old medieval towns as well as castles. The book is also full of medieval imagery such as knights in armour, carriages etc. Whilst there is no time travel involved in the novel, the medieval period is used to such an effect that the reader is encouraged to ignore the fact that the book is set in the present. People in the medieval era were quite superstitious. They believed in fictional characters such as witches and wizards. ‘Harry Potter and the Goblet of Fire’ is a novel based on the existence of witches and wizards in secret communities. The medieval period is well known for the hierarchy of society. The society consisted of landlords and their servants. This medieval element was brought into the story in the form of house elves. House elves are little creatures that work for the wizarding communities that have no rights and are unable to use any magic: â€Å"The tiny creature looked up and parted its fingers, revealing enormous brown eyes and a nose the exact size and shape of a large tomato†¦it was†¦unmistakably a house-elf, as Harry’s friend Dobby had been. Harry had set Dobby free from his old owners, the Malfoy family.† (p88) The novel also incorporates fictional animals that medieval people believed to be real. These include creatures such as dragons, trolls and three-headed dogs: â€Å"Dragons. Four fully grown, enormous, vicious-looking dragons were rearing on their hind legs inside an enclosure fenced with thick planks of wood, roaring and snorting- torrents of fire were shooting into the dark sky from their open, fanged mouths, fifty feet above the ground on their outstretched necks.† (p286) People living in the medieval era created stories about creatures such as these and heroes that defeated them. In this way ‘Harry Potter and the Goblet of Fire’ uses medieval influences. The settings used in ‘Harry Potter and the Goblet of Fire’ are typical of those found in literature of the medieval period. The opening scene is set in a very typical present day suburban street. The following scene is set at the ‘Hogwarts Castle’. A castle is a very typical medieval image used in a lot of medieval literature.

Berkeley in the Sixties

The movie Berkeley in the 60's archives how an extremely minute set of undergraduates who sought to discover politics going into the Open Speech and Anti-War activities. Opening early on in the decade as the Management of the Institution of higher education of California at Berkeley makes a decision to forbid tables where associations approved out flyers, the Liberated Speech Movement was a minute grouping of citizens concerned in protecting the first amendment of the Constitution.The Academy Management took this as an insult to their power, and as the Management tried to warm up their muscles, their events just appeared to support the fire of the association. The point is that if the Management hadn't completed this core of a very little angry group is enough to stand up for their rights, the huge level communal transformation that happened in the United States and one could dispute in western society, most likely wouldn't have occurred for fairly an extended time perhaps not at all .These dispute showed what a grass roots group could do. It assisted the civil rights association and initiated the Women’s and Anti-War movements. This happened all because the Head of the University of California couldn't accept a little thing. People who were actually instrumental in the movements performed most of the film narration. They emerge to be extremely open about what was sensible and what was not. Not everybody who took part was of a solitary mind. Several were more fundamental than others.Some saw the progress demeaning into a useless mob and left to get concerned in the major remains of American politics. If each and every movie has characters the faction itself was one. It started out very alert. The public concerned was by and large upper middle class white kids. They were very naive. When they complained, they advanced the protest from a position of principles. Any limit on speech was objection. Afterward, as more people came together, the impracticality st arted to demean.Not everyone in the crowd was basically there to protect the original amendment. Some decided they had the authority to re-organize the world to their fondness. Problem like People's Park had nothing to do with open speech, but where more of loosen of the demonstrator's own opinionated influence. As this happens we see the quality of the movie transform. It's simple to get after someone who was thrown in a police car for conversing; it's harder when you notice them whirling over cars and basically stealing land.This deterioration from the interior principles into a mob appears to shade many of the current protests. People like to maintain the tag â€Å"Grass Roots† without essentially making it. What is absent from the movie is the other point of view, the view of the management. Anybody in a place of power counting Governor Ronald Regan is highlighted as an adversary of democratic system. The filmmakers bringing the picture as one 25 years after the faction, emerges to not have completed the effort to discuss the conflict.If they had, they did, they made no cite of it. Still, as a documentary of a point of analysis of a period, Berkeley in the 60's accomplishes something. Even If you were not there, you would at least recognize the students' point of view. This perhaps is biased in the students' support, but it is educational, and does keep your concentration the whole time. This is a huge way to educate history. Bibliography ? Yahoo Movies, Berkeley in the Sixties. Retrieved on Friday February 16, 2007 from http://movies. yahoo. com/shop? d=hv&cf=info&id=1800178336

Cause And Effect Of A Marriage Fail - 851 Words

Cause and effects of a marriage fail? â€Å"Two are better than one, because they have a good return for their labor. 10 If either of them falls down, one can help the other up. But pity anyone who falls and has no one to help them up. 11 Also, if two lie down together, they will keep warm. But how can one keep warm alone? 12 Though one may be overpowered, two can defend themselves...† (Ecclesistes, I 9-12) I am not marriage and what I think now could change when I would be on this situation, nevertheless I throw this question on Facebook, and this is what I got from my friends and family that are marriage, or in a relationship at the moment. After the background of the people who answered this question I summarized, and made a classification to explain the causes and effects of a marriage fail, in my classification there are two kind of factors for a marriage fail: Internal and external, and the effects of this derived from psychological disorders to the affected. Internal factors are all kind of thinks that couples can control inside of the relationship directly to the marriage, like actions, and attitude. Three of my friends answered to my question like that: Lack of love, â€Å"communication and respect†, and Does not have a balance to solve the problems†, are some of the reasons that marriage fail. I decided to include all of these reasons for lack of love: as we know love is a strong feeling of affection, or attraction for something or for a person, could be good orShow MoreRelatedWhy Marriages Fail880 Words   |  4 Pages Cause/Effect Critical Response Essay Anne Roiphe, Why Marriages Fail â€Å"Happily ever after† and â€Å"Till death do us part†, expressions such as these are losing their meaning due to increasing divorce rates. Close to one-half of all marriages are destined for divorce, which is the cause of 42 percent of children growing up in single parent homes. 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