...Legal Case Study This study is about a 41 year old woman whose name is Terri Schiavo. She was in a persistent vegetative state for 15 years with a brain injury before she died on March 31, 2005. This paper discusses her 15 year ordeal, the effects of it on her husband and family, Terri’s right to die, and the importance of end of life choices. We discuss the ethical and legal issues involved in the decision making of this case. Her husband and family disagreed on how to handle her situation, whether or not to remove her feeding tube. Even though their Terri was in both of their best interest, they could not agree on, would removing the feeding tube be killing her or letting her die? Ethical Importance Terri had left no written instructions as to what her wishes might be if she were no longer able to make her own medical decisions. The only thing that the court and her family had to go on was what her husband and family remembered her saying in conversation over the years. The memories of her husband and family were very different. In the beginning of this ordeal they both agreed that everything should be done for Terri’s survival because at that time there was hope. After a while, when Terri did not appear to be changing, or getting better, her husband believed that the quality of life that Terri had was not the quality that she would have wanted had she been able to voice her opinion. “Michael Schiavo said his wife had said that she would never want to be...
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...The Schiavo Perspective on End-Of-Life Care The Schiavo case showed that most Americans believe that end-of-life issues should not be decided by politicians. ABSTRACT: Americans have reached consensus that (1) people have a right to refuse lifesustaining medical interventions, and (2) interventions that can be terminated include artificial nutrition and hydration. The one unresolved issue is how to decide for mentally incompetent patients. Only about 20 percent of Americans have completed living wills, and data show that family members are poor at predicting patients’ wishes for life-sustaining care. But despite court cases and national consensus that these are private and not legislative matters, the Schiavo case is unlikely to change practices except to increase the number of Americans who complete living wills. Remember 197 6? That was the year the United States was engaged in the case of Karen Ann Quinlan, the first so-called right-to-die case.1 When Quinlan was twenty-one years old, she ceased breathing for two fifteen-minute periods while at a party. In the emergency room her pupils were nonreactive, and she was unresponsive to deep pain stimuli. She was placed on a respirator, and a year later she was respiratordependent, in a persistent vegetative state, and receiving nutrition through a feeding tube. After consulting his priest, Quinlan’s father requested that the respirator be discontinued, but her physician refused, and a series of court cases ensued...
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...Legal Ramifications of the Schiavo Case This article discusses the importance of Advance Directives and the development of the patient self-determination act of 1990 demonstrates the importance that the government places on a person’s right to make their own health care decisions. In the act, congress decided consumers had the right to make their own health care choices or appoint someone who can make that decision for them if they can no longer speak for themselves. It was deemed important enough that CMS (Center for Medicare and Medicaid Services) mandated that all hospitals, home health and hospice agencies, skilled and long term facilities who receive their funds, are mandated to inform patients of their rights under state law to execute advance directives. The article discusses the legal mechanisms for consent or refusal of treatment including: living wills, durable power of attorney for health care and medical directives. The legal ramifications of the Terri Schiavo case was that there was no health care directive executed by her other than a conversation with her husband in which she stated she would not want to have her life prolonged if she was in a persistent vegetative state. Without a health care directive, after three years the decision to remove artificial nutrition and hydration was made by her husband (legal guardian). Terri’s parents and siblings disagreed and thus began a judicial, legal, ethical and media circus. The parents and siblings deemed the removal...
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...Running head: FIGHTING FOR DEAR LIFE: AN ETHICAL CASE STUDY ON Fighting for Dear Life: An Ethical Case Study on Terri Schiavo Catherine Grace Bautista Adventist University of Health Sciences Ethical and Legal Issues in Healthcare HTCA543 Dr. Stanley Dobias February 24, 2015 1 FIGHTING FOR DEAR LIFE: AN ETHICAL CASE STUDY ON 2 Introduction Death is inevitable. However, for some of us, we fail to express our final wishes to our loved ones and this more often than not ends in conflict. In the United States, it is necessary for an individual to have a living will since this provides answers to end of life issues that would be in question. The story of Terri Schiavo was a case study worthy of note given that concerns or conflicts about end of life care have never been a source of familial dispute in my native country, the Philippines. Her 15-year saga brought about several questions that correspond to moral, ethical, and legal issues. Terri Schiavo’s end of life issue has now set a treacherous precedent for all vulnerable Americans, especially those who are in the marginalized sector: the disabled, those who have terminal illnesses, those who can no longer speak for themselves, and perhaps one day even to those who are indigent and unable to pay for costly health care. These individuals may become gradually compelled to make the choice to die and “get out of the way” notwithstanding their true wishes. Early Years Therese Marie Schindler was born...
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...The Main purpose of this case summary asked by our CEO Felicia Larue is to give a brief on the patient situation and to ensure that her rights of are preserved and the risks to the hospital are minimized. Been paralyzed refers to patients that needs the use of the latest available procedures for psychotherapeutic work, comatose and treatment for different states of consciousness. Patients in comatose states like Lydia have been traditionally considered as victims of neural pathological procedures that overcome cognitive and communicative functionalities. While the latest procedures on spinal cord injuries suggest that patients may display spaces of consciousness on the worst persistent vegetative states. Is very common that disputes arise over the treatment of patients that had been unresponsive through injury or illness for certain time lapse. Families get torn between the final decision because for some to end the “artificial life” is the alternative to stop the “suffering”. Cases such as Terri Schiavo can last years on court on a back and forth demand. Medical examination reveals apparently irreversible brain damage in a persistent vegetative state since 1990. Her husband and her family went to court battle to decide if the feeding tube should be removed. Finally her husband prevailed in court on 2005 and Schiavo died in March 2005.Others with firm beliefs wait for the miracle. Doctors in England and Belgium (Owen et al., 2005) found signs of life in a “damage” brain of...
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...The Ethics for Nurses in Medically Assisted Suicide Physician-assisted suicide also known as PAS, is a controversial topic everywhere; some believe if a patient is terminally ill then it should be permissible while others believe it is against their beliefs and religion to commit any type of suicide. Physician-assisted suicide is when a patient requests the help of digesting a lethal drug to quicken their death (United States Physician Assisted Suicide Law Summary and Law Digest par. 1). The most common patients to request assisted suicide are patients with cancer and AIDs. Active euthanasia is sometimes also considered physician-assisted suicide because it results in death from someone purposely doing something to the patient causing them to die; such as being injected with poison. Passive euthanasia is the withholding of a medical treatment for a patient, which is legal, but many come to be disagreed upon. Withholding food and water, turning off machines, and failing to resuscitate are prime examples of passive euthanasia (United States Physician Assisted Suicide Law Summary and Law Digest par. 1). There are currently three states that permit physician-assisted suicide, Washington and Oregon. On October 27, 1997, the Death with Dignity Act was passed in Oregon. The Death with Dignity Act states that an Oregonian that is terminally-ill has the right to voluntarily, self-administrate lethal medications with a prescription from their physician. On March 5, 2009, Washington passed...
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...The Terri Schiavo case is fraught with religious, political and sociological factor influencing this drama. At the very base of this case is the question as what is meaningful life and or even life itself and when does that cease to exist. For many this is a religious belief which is deeply personal and different for each person. Who has the ability to decide this question, when a person is incapacitated and can’t make the decision for herself moves this into the the sociologic area. Terri’s parent and husband stood at odds as to the answer to this question and since Terri had no living well or medical power of attorney the decision ultimately fell to the Court. According to Florida state law in patient incapable of making decisions fall under the jurisdiction the guardianship court. In an attempt...
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...Running Head: INTENT AND IMPACT OF PUBLICITY-ORIENTED LEGAL CHALLENGES TO PHYSICIAN-ASSISTED SUICIDE. Intent and Impact of Publicity-Oriented Legal Challenges to Physician-Assisted Suicide Elena Mikhaylov Student Keller Graduate School of Management – Online HS542 Keri Bahar February 2012 Introduction The word Euthanasia originated from the Greek language: eu means “good” and thanatos means “death”. In Ancient Greece it meant literally "the good death". The term euthanasia normally means that the person who wishes to commit suicide must initiate the act. The Oxford English Dictionary Online (2nd edition, 1989; online version Sep. 2011) provides the following definitions of euthanasia: "A gentle and easy death...[T]he means of bringing about a gentle and easy death... However, in today’s society term euthanasia includes both voluntary and involuntary termination of life. Euthanasia has many meanings. Except for involuntary euthanasia, all these terms are closely related because the victim requests the action. The only difference is who is actually committing the act, Voluntary euthanasia is a help to mentally competent person to die through the assistance of others and can be divided in two categories. Passive Euthanasia means causing the death of a person by withdrawing some form of support and letting nature take its course. For example: removing life support, stopping medical procedures, stopping food and water and allowing the...
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...JAMES F. LAWRENCE, & SUZANNE O. GRESLE Medical University of South Carolina, Charleston, SC, USA Abstract Tube feeding can be an appropriate and effective means of providing nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves. Keywords: Enteral feeding, tube feeding, ethics, persistent vegetative state, dementia...
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...Callie Yager Haley Stoner English 1302 22 April 2015 The Powerful Mercy of Euthanasia Euthanasia is defined as the merciful killing of one in extreme pain or circumstance. For many years euthanasia has been viewed as a way out, against religious and moral perspectives, and many are afraid that if it were to be completely legal in all of the United States then citizens would certainly abuse this right. However, the four states that have legalized it, Oregon, Vermont, Washington, and Montana prove these opinions to be false. Especially in Oregon the Death with Dignity Act set the precedent for Euthanasia legislature by setting limitations on who or who could not be considered to actively take their own life. These limitations included a minimum age of 18 years, a diagnoses of six months to live or less, two oral recommendations from physicians at least fifteen days apart and one written recommendation from a physician before the patient could be qualified for active Euthanasia. These guidelines made the practice of Euthanasia more practical to Americans. In a study conducted by Public Agenda, Gallup Organization, in the year 1950 only twenty-six percent of Americans supported assisted suicide and that number more than doubled in 2003 to seventy-two percent. These information alone proves the progressiveness of this form of mercy, this form of choice that euthanasia gives to those suffering. Euthanasia has many forms and is a positive act for those in extreme pain, it gives...
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...Abstract Research into trends concerning medical futility reveal that aggressive treatment at the end of life is not equating to better outcomes (Colello 2008). In fact, not only is it providing no benefit, all too often it imposes unnecessary pain and suffering. In the case of patients who lack decision making capacity and do not have an advance directive, families are often approached by nursing staff and asked “Do you want us to do everything?” or if they would prefer a Do Not Resuscitate status (DNR), meaning CPR will not be initiated if breathing or the patient’s heart were to stop. This sends a confusing message to families, that there is something worthy of offering their loved ones; when the reality is, there is nothing worthwhile left to offer. More often than not, despite a grim prognosis for the patient and the possibility of being in a persistent vegetative state (PSV), families routinely choose this option, largely because an informative conversation has never taken place as to the implications of these decisions. This is an issue which can no longer be overlooked. It is costing our nation dearly, both ethically and fiscally. As Americans, it is high time that we come to terms with our mortality and accept the reality that death awaits us all. Denial will not make it less likely to occur. As such, in an effort to promote awareness of this issue and the detrimental impact it has on patients and society as a whole, the following will define and explain the various...
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...from professional dictation to patient directed healthcare. An emphasis on the treatment of disease, which was highly successful in the past, is not the answer for today's healthcare needs. Today, patient education is the primary focus with the emphasis on prevention of disease by screening for risk factors and encouraging patients to practice behaviors that foster good health. In the past patients would seek medical care only after symptoms had developed that interfered with their lifestyle. Todays’ trend reflects patients taking a proactive approach to preventing a disease after they have been exposed to the education through mass media such as commercials, the internet, or brochures obtained from clinics or physicians’ offices. With the advances in technology medical professionals are able to reach far more people than in the past. This technology has given professional nurses the ability to encourage more patients to improve their health while fostering positive behavioral changes, referred to as health promotion. Health promotion is defined as the process of empowering patients to improve their health while fostering behavioral, cognitive and emotional activities as to advocate health and well-being of the population as a whole (Edelman & Mandle, 2010). Lifestyle choices and motivation both play a major role in positive patient outcomes. As stated by Edelman & Mandle (2010), “Primary care providers, including nurse practitioners and other advanced practice nurses, now attempt...
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...Kericho, Kenya , Tel +254 722224577, Email: symomash@gmail.com ETHICAL DILEMMAS FACING NURSES ON END-OF-LIFE ISSUES BASED ON CONFERENCE PROCEEDINGS HELD IN ELDORET, KENYA ABSTRACT Problem Statement: A conference to discuss on ethical dilemmas is thought to be a good way of airing out issues. It is unfortunate that at times a patient in our care may die no matter what we do. Profound ethical questions on end of life issues confront the medical personnel as they watch and wait helplessly. This paper touches on ethics, law, social and public policy as they affect nursing practice. Setting: This is a conference proceedings report augmented with a case study of Nelly from a local setting and compares it with two others from elsewhere which were also presented during the conference. Conference was organized by Federation of African Medical Students Associations (FAMSA), Eldoret 2011. The author was a presenter and discussant. This paper is a compilation of the ideas, inspirations and reflections of the significant sessions and also fulfills some of the recommendations resulting from the distinguished panelists. Objectives: - i) To explore ethical dilemma issues on end of life which have a heavy bearing on Nurses and other health care providers. ii) To explain euthanasia as it relates to...
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...Research Proposal Running head: RESEARCH PROPOSAL 1 Research Proposal Kathryn Keiper Duke University School of Nursing Research Methods N307-01 Dr. Carla Gene Rapp Apr 20, 2005 Research Proposal Table of Contents 2 Introduction……………………………………………………………………………….3 Review of the Literature…………………………………………………………………..4 Purpose……………………………………………………………………………………8 Methods……………………………………………………………………………………9 Design and research questions…………………………………………………….9 Sample……………………………………………………………………………..9 Survey instrument……………………………………………………..…………10 Research procedures……………………………………………………………..10 Informed consent and IRB approval……………………………………………..11 Strengths and Weaknesses……………………………………………………………….11 Timeline and Cost Considerations……………………………………………………….12 Conclusion……………………………………………………………………………….13 Concept Model………………………………………………………………..Appendix A Sample Questions……………………………………………………………..Appendix B References……………………………………………………………………………….18 Research Proposal Research Proposal Introduction Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However...
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...Policy Research on Access to Quality Basic Education For Muslim Learners The views, statements, and opinions contained in this report are of the author's alone and are not intended as USAID recommendations, conclusions or statements of USAID policy. Table of Contents List of Tables………………………………………………………………. Page i List of Illustrations…………………………………………………………. ii Acknowledgements………………………………………………………… iii Abbreviations and Acronyms ………………………………………...…… iv Glossary …………………………………………………………………… vi Executive Summary .……………………………………………………… vii Chapter 1. Introduction A. B. C. D. E. F. G. Background and Rationale…………………………………….. Objectives of the Study………………………………………… Sample Selection and Data Collection………………………… Research Design……………………………………………….. Data Analysis and Procedure………………………………….. Scope and Limitations of the Study …………………………… Significance of the Study ……………………………………… 1 9 10 11 12 14 14 Chapter 2. Trends in Access Policies from 1987 to 2007 A. National Laws Governing Access to Basic Education………… …………………………………………... B. Non-legislated Policies on Access to Basic Education……………………………………………………… C. Access Policies of the Philippine Department of Education…. D. Implications of Philippine Access Policies to Muslim Learners in Basic Education …………………………….…… 15 23 26 36 Chapter 3. Key Findings on Access Barriers to Quality Basic Education for Muslim Learners A. Access Barriers to Quality Basic...
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