VIEWS: 8 PAGES: 5 POSTED ON: 9/19/2011
1 Annotated Bibliography Annotated Bibliography Callahan, D. (2002). Curing, caring and coping. America, 194, 12-16. This article addresses the economic and medical implications that will be of concern as our elderly population grows. Callahan points out that we will have increased ethical dilemmas with our elderly because we are finding ways to prolong their lives. Callahan addresses the President’s Council on Bioethics Report and to what extent it addresses our aging society. The use of Living Wills was high lighted as a vehicle for people to state their wishes regarding medical treatment; however, their flaws counter their effectiveness. Society needs to be more proactive and address how we are going to provide for our aging. We need to make Advance Directives more user friendly and secure ways in which they will be followed. Cantor, M.D. (2000). Improving advance care planning: Lessons from POLST. Journal of the American Geriatrics Society, 48(10). A study revealed that advance directives are often times ignored. Possible explanations as to why the advance directive is often ignored include the ambiguity of the phrase “level of medical intervention” and the fear that the patient may have changed their mind about the level of care they desire. Suggestions to improve adherence to advance directives include standardizing advance directives, training for clinicians to discuss with clients the level of care they would like to receive in various circumstances, a system where the doctor can easily access the client’s documentation of their wishes, and doctors’ confidence that the directive is an accurate reflection of the client’s wishes. The article concedes that as death grows closer the client often times wishes to add additional comfort measures to their directive. The points in this article are well taken. Although the idea of an advance directive is an excellent one, it does little good to have one if your doctor is scared to follow your wishes. Discussions with your doctor about the level of care you desire is a step that the client can take to make sure their wishes are carried out. Capron, A.M. (1995). Abandoning a waning life. The Hastings Center Report, 25, 24-26. The legal battle of when it is acceptable for physicians to remove life sustaining support still has no victor. This article examines the case of a patient who experienced severe complications as the result of an injury. The family held fast that all medical efforts should be made. A battle ensued between the medical staff and the family of the patient. Specific definitions and the desire of the patient made this case difficult. Proper mediation was not available to properly resolve the case. A resolution of the doctor’s role and power in situations like this one need to be further examined through the legal system. 2 Annotated Bibliography Doctors should be allowed to make decisions about what type of care that clients do and do not receive based upon their education and experience. However, they should be required to consult an ethics committee if their decision is not congruent with the family’s feelings. Davis, L.J. (2006). Life, death, and biocultural literacy. The Chronicle of Higher Education. This article focuses on trying to define identity. The question is what is the identity of someone who is on life support, suffering from the late stages of Alzheimer’s, or that of an embryo. This article asserts that the only way to make decisions about the ambiguous states of identity is to have biocultural literacy. Being aware of all the nuances that play into a particular issue is biocultural literacy. Those nuances include such things as scientific facts, historical contexts and cultural contexts. Biocultural literacy allows people to fully examine the issue from all perspectives and thus able to make an intelligent, informed decision. In doing this three things must be followed. 1. communicate facts, not opinions, 2. be consistent with definitions and willing to challenge inconsistent positions, and 3. be leery of the pull of identity politics. The issue of what is life and where it ends and begins must be operationally defined. If this doesn’t happen there will always be a stand-off. However, it is unlikely that the left and right will ever see eye to eye on such a hot topic. Glick, H.R., Cowart, M.E., Smith, J.D. (1995). Advance medical directives in U.S. hospitals and nursing homes: The implementation and impact of the patient self- determination act. Politics and the Life Sciences, 14, 47-59. This article discusses the legal requirements of the patient self-determination act such as letting the client know their rights to make decisions and providing impartial care. These requirements still offer flexibility to the client and the government. The article provides split predictions about the patient self- determination act. Those predictions include having little effect and the opposite, having a large impact. Findings, based upon the development of information about PSDAs, how clients are informed, and ways in which PSDAs influence advance directives. The article also discusses the need for options other than advance directives due to the characteristics of different groups. Court decisions need to be less permissive. By being less permissive, clear and accurate interpretations can be made. Henry, M. Update on end-of-life issues in Utah. Utah Bar, 19(1), 6-10. Two cases about end-of-life have become salient in Utah. Utah’s law states that it’s citizens have the right to make written directives and can expect dignity and 3 Annotated Bibliography privacy. Weighing personal goals with medical intervention becomes the foremost task. Being educated about the diagnosis and the factors associated with it is also important. Forms of advance directives are also discussed. The article suggests that current laws be modified to better fit with today. This article suggests education and involvement as a way to compensate for the lag in policy change. It is important that individuals prepare themselves for the decisions and obstacles they and their family members will face at the end of life. Educating themselves on the options available to them is an important part in making those decisions. Hickman, S.E., Hammes, B.J., Moss, A.H., Tolle, S.W. (2005). Hope for the future: Achieving the original intent of advance directives. The Hastings Center Report Special Report. S26-S30. Advance directives goals have not been reached. Only 20 to 30 percent of American adults have an advance directive. The short comings and limitations of advance directives are multi-faceted and include such aspects as not understanding the document, the examples are too vague, vague requests for care, assuming that the client’s wishes have not changed, not viewed as part of the clinical care, failure to recognize cultural variations, lack of instruction for surrogates, and surrogate determination. Alternates to advance directives and program modifications have been made in an effort to address these issues. Each part of the system must work together to ensure that the client’s wishes are realized. The system must be overhauled in an effort to ensure client’s requests are met. Kaufman, S. R., Shim, J. K. & Russ, A. J. (2004). Revisiting the biomedicalization of Aging: Clinical trends and ethical challenges. The Gerontologist, 44, 731-738. This article addresses how medicine and medical technology advancements are allowing us to live into advanced age. The advancements in medical procedures are progressive and in some cases conflicting with a person’s right to choose their treatment. Complicated heart and kidney surgeries are being performed on those persons that are in their 90’s. Ethics are raised in this article that address how we are to deal with the elderly whose lives we are prolonging. This article makes an excellent point about how will our society deal with frail elderly lives that we have kept alive through medical advancements. Our society will become inundated with the elderly population in the coming years and needs to be developing economic strategies on how we can afford their care. I wonder what price we will pay for our push for advancements in the medical field. Mianowany, J. (2002). When advanced directives don’t say enough. Kiplinger’s Retirement Report, 11, 16. 4 Annotated Bibliography This article was written by a young man who speaks about the ineffectiveness of his father’s living will. The writer explains that his father’s living will did not address a complicated medical condition that his father encountered and could have left him vulnerable to being kept alive by tubes. This was an excellent article that speaks of how living wills can fail us in certain medical situations. We must not stop by merely completing an advance directive; rather we must have thorough communication with our loved ones on when and how we want our medical care. Marshall, P.A., (1995). The SUPPORT study who’s talking? The Hastings Center Report, 25. Modern medicine is governed by physicians. There is little discussion between doctors and patients in regards to the type of treatment they would prefer to receive. Often times, nurses acts as go betweens for the doctors and clients. In a study, nurses were asked to talk with patients about their end of life wishes and share that information with a doctor. However, this proved to be an ineffective way to have patient’s wishes recognized. Again, this is due to physicians’ seat of power within medicine. The way in which medicine is necessarily delivered (quick and efficient) makes it difficult for the patient and the physician to discuss the clients needs and wishes. At the same time, it is difficult for the physician to respect those wishes because normally their sole purpose is to save lives. Outside forces, like family members, may also make it difficult for the physician to follow the patient’s directions. Overall, Americans still find it very difficult to face their own death even though it has become part of mass media. It is essential that doctors respect the wishes of their patients despite their own fears and worries. How death is experienced should be at the patient’s discretion. Murray, T.H., Jennings, B. (2005). The quest to reform end of life care: Rethinking assumptions setting new directions. Hastings Center Report, 35(6), S52-S57. The goal of this article was to revisit the issue of advance directives while providing lessons on how end of life should be handled. The article discusses numerous issues that do not support advance directives. Such issues include the mental stress it puts on the client, the impact the death has on the client’s family members, and incongruence with various cultures. Instead of focusing on individual needs and request they recommended that the system itself be reformed to fit most of the situations and most of the people. They suggest that a mid-point between using all interventions and none be found. They suggest that advance directives become more family oriented and take into consideration those left behind. Mediation is viewed as a way to help families make critical decisions. 5 Annotated Bibliography Although much of the article was negative, it did concede that individual’s denial of impending death lose the power they have over their death by not taking appropriate actions. Having an advance directive can allow the individual to die on their own terms. The idea that the family is just as important as the individual who is dying is ridiculous. Although it may be tremendously difficult for family members to lose a loved one, it is also tremendously difficult, painful, and frightening to be poked and prodded only to die soon after. Nathan, R. (2006). Straight talk about dying. Medical Economics, 83(5). According to this article, sometimes the best thing a doctor can do for her client is to talk with them about death, not provide treatment. Often times the cost of treatment is extremely expensive and the result is still death. This task of passing from one phase to the next would be made easier for everyone if more clients had their wishes documented. When their wishes go undocumented then the burden is shifted to the grieving family, who may request that all possible measures be taken. The writer of the article asserts that we should all have a living will to prevent these problems from occurring. Everyone should have a living will. It is irresponsible to believe that you will evade death. It is also irresponsible to put your family in the position to make such hard decisions. Sadd, S.J. (2005). Living wills: Validity and morality. Vermont Law Review, 30(1). The validity and morality of living wills are examined within this article. It examines living wills relation to the law and its evolution; moving from essential suicide to a liberty in court cases. The article defines what a living will is, along with other basic concepts related to this topic. The advent of technology has made the issue of the right to die more complex than ever before and making this a difficult matter for both families, individuals, and the legal system. It also examines the flip side of the right to die coin by advocating that people be able to choose what type of treatment they receive. In line with article, it is sad to think that Americans died today because they could not get access to the medical care they needed and wanted. Everyone should be given the right to live and die in the way they see fit.
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