Decision Making in End of Life of Newborn Care

Decision Making in End of Life of Newborn Care Shared decision making at the end of life of newborn care Introduction: Neonatal intensive care for extremely low birth weight infant is expensive and most of the time there is disagreement between the Neonatologist and the family to make the best decision in the best interest of the patient. There is a reported incidence of pre-term delivery of low-birth-weight (PLBW) babies of 37% of all live births in Pakistan To resuscitate the extremely low birth weight (ELBW) baby or withhold treatment is an ethical issue is frequently faced by health professionals. Situation: A baby boy with 22 weeks gestational age, weighing 0.7 kg was shifted from labor room to Neonatal Intensive Care Unit (NICU). The baby was the fourth preterm newborn of her mother and was breathing spontaneously. The Neonatologist decided not to resuscitate the baby as there is minimum chance of survival. The parents were not involved in the process while the decision is made. Within one hour, the infant started gasping and his condition deteriorated, he could not maintain his struggle to breathe spontaneously and eventually expired. Analysis In the scenario the doctor decided not to resuscitate the infant because of gestational age that is 22 weeks and weight 7kg. In- fact the doctor decided based on risk and benefits of the treatment and probability of morbidity and mortality of the child. Singh (2003) claims that when the death of an infant is unavoidable or probability to live with neuromotor disabilities is more, the decision to withhold treatment is justified. Akhtar (2010) stated that use of advance technology results in prolonging death of patients rather than giving them comfort. The doctor also used paternalism approach to protect the infant from possible suffering that is prolonging death process. Moreover, the doctor also perceived since the parents are emotionally involved with the infant therefore, they cannot take appropriate decision. In addition, the intention of the doctor was the appropriate utilization of scarce resources that are medicine, technology and employee. In public sector hospital all these r esources are limited. Ahmed and Shaikh (2008) stated that health budget has always been low and remains around 0.6% of the total GDP of the country. However, to ignore the legitimate autonomy of the parents was ignored, and they were not granted discretion in decision making. As the baby was precious and if the parents can afford the treatment, their wish should be respected. Ethical principle beneficence is in conflict Beneficence. Health care professionals have an obligation to promote health and avoid harm. This principle involves these elements: (1) one ought not to harm; (2) one ought to prevent harm; (3) one ought to remove harm; (4) one ought to promote good. The most important and easiest to practice is doing not harm. Harm to be prevented is discomfort, suffering, disease and its interventions. The good to be promoted is health. The principle of beneficence implies an obligation to assess benefits against harm. If any treatment cause more harm to infant compare to benefit than comfort of the infant should be priority based on this principle. Decision makers are also obligated to assess benefits of the treatment to infant and cost of the treatment and consequences In this paper my stance is Neonatologist can make better decision for ELBW infants as they are more knowledgeable and experienced. Argument Resuscitating ELBW infants is less beneficial compared with harm In general the treatment outcomes of ELBW infants are very poor therefore, the expenditure of valuable resources must be utilized wisely. Stolz (1998) study findings revealed that median age of ELBW at death was 2 days and 60% of the infants died at the age of 4 days. Moreover, mean charges to produce one survivor were estimated for infant weighing Beauchamp and Childress (2001) suggested that the decision should be make based on principle of utility that produce maximum positive value for maximum people. The action chosen by the doctor was that maximum infants can be benefitted within the available resources. Therefore, the cost of care can be better spend on larger pool of infants who have better chances of survival. It can be saved by setting standards and denying care to ELBW infants whose survival is uncertain. Guideline for the responsible utilization of intensive care as cited in Lorenz (2005) proposed that providing intensive care treatment to infants whose gestational age is below 23 weeks would not be beneficial. Hack et al. (2000) study revealed the result that Very-low-birth-weight participants had a lower mean IQ and higher rates of neurosensory impairments. Thus, the quality of life of ELBW infants who survived after treatment is not good. Counterargument Parents are legitimate decision maker and they should be involved in making decision It is careless and irrational to ignore or exclude the parents, they should be taken in confidence while making medical decision making. It is also important to consider special protection of the infant who don’t has the capacity to express his wishes. Therefore, the parent’s interest should be honored but importantly assisted. Autonomy of the parents are not respected beside the fact that they have the capacity to decide and make own plan of action. According to Burkhardt and Nathaniel (2008) autonomy denotes liberty to make personal decision. It is also claimed that health professionals violate the autonomy when they believe the right and rational course of action is the one that is match with their standards otherwise they are labeled as incompetence. Theory of justice implies fairness in treatment. In most of the health care ethics, the most focus principle is distributive justice that is distribution of goods and services. Nathaniel n Burkhardt (2008) Parents argued that their ELBW infants should be treated as other human being. Their small baby also has the equal rights to attain health services as other normal infants have. It is the responsibility of health professionals to make fair decision for infants who have never attained decision making capacity. Moreover, the wish of the parents to treat may be considered based on libertarian theory. Burkhardt and Nathaniel (2008) maintains that it is the right of the parents to ask for treatment for the infant based on the material principal capacity to pay for treatment to improve health. Recommendations Care of ELBW is quite expensive and their survival is uncertain therefore, policies regarding care of the preterm related to gestational age and weight should be formulated and implemented on priority. Moreover, to improve antenatal service is a better and cost effective option to solve the problem. In addition, pregnant women who are at risk of preterm delivery should be counseled and taken in confidence for the possible consequences of the treatment. Boyle (2014) Suggested that during counseling parents should be provided information regarding risk of death and disabilities as consequences of the treatment, so that the can make better decision in the best interest of the infant and family. Health care professionals are decision makers can help the family to make adequate decision making References Ahmed, J., Shaikh, B. T. (2008). An all time low budget for healthcare in Pakistan.Journal of the College of Physicians and Surgeons Pakistan,18(6), 388. Akhtar, J. (2010). Living wills in health care: A way of empowering individuals.JPMA. The Journal of the Pakistan Medical Association,60(3), 240-242. Beauchamp, T. L., Childress, J. F. (2001). Principles of biomedical ethics. (5th ed.). New York: Oxford University Press. Burkhardt, M. Nathaniel, A. (2008). Ethics and Issues in Contemporary Nursing (3rd ed.) Australia: Delmar. Hack, M., Flannery, D. J., Schluchter, M., Cartar, L., Borawski, E., Klein, N. (2002). Outcomes in young adulthood for very-low-birth-weight infants.New England Journal of Medicine,346(3), 149-157. Joy Catlin, A. (2000). Physicians neonatal resuscitation of extremely low-birth-weight preterm infants.Neonatal Network: The Journal of Neonatal Nursing,19(3), 25-32. Singh, M. (2003). Ethical and social issues in the care of the newborn.The Indian Journal of Pediatrics,70(5), 417-420. Stolz, J. W., McCormick, M. C. (1998). Restricting access to neonatal intensive care: effect on mortality and economic savings.Pediatrics,101(3), 344-348.

H.G. Wells The Time Traveler Essay -- Wells Time Traveler Essays

H.G. Wells' The Time Traveler H.G. Wells lived at the turn of the century. During this time, there was a huge gulf between the rich and poor. â€Å"The Time Traveller’s† socialist tone highlights the injustices of the British class system. Well’s protagonist, imagines the future to consist of a perfect society, where everyone is equal and technology is extremely advanced. This view is based on mankind’s continual advances during his lifetime, so he assumes we will continue to advance in the future. â€Å"The Time Traveller† reflects H.G Well’s opinions about mankind, and acts as a warning for what could happen in the future if society does not embrace equality and humanity. When the Time Traveller arrives in the future, he notices the â€Å"little people† which are later known as the â€Å"Eloi.† They are all extremely alike in appearance. They all wear tunics of the same material, have â€Å"the same hairless visage† and the same curly shoulder length hair. The men have the same physic as the women as there is no need to carry out any physical work. He immediately thinks that this is communist society especially as they all live, eat and sleep together in one large building. They are all equal in every aspect of their lives. He believes that the Eloi are living off the work of others and are therefore, part of an â€Å"automatic organisation.† The Eloi profiting from the success of previous generations when humans learnt to control and harness nature. However, as now there is no-one left to control it, nature is slowly taking back the world and turning it wild again. Wells obviously believes communism is the best solution for the whole world. Therefore, when the Time Traveller arrives in the future he sees what he wants to see.... ... â€Å"Can you return imagine a crab as large as yonder table!† There is still life but absolutely no intelligence, this is the descent back to the sea: there appears to be no life away from the water on the land. The further forward in time he travels, the more obvious life forms decrease, until there is absolutely nothing he can see, this is the final stage of mans descent back to the sea. The Time Traveller has many theories throughout his journey, he wants to believe that the future will be socialist and more technologically advanced but he finds the human race to be in a severe decline. He also realises that the class distinction present in his society has exacerbated and humans have evolved into two separate sub-species. â€Å"The Time Traveller† is Well’s warning for the future; if society is to continue in its present vein it will eventually self-destruct.

High Protein Diet and Gastric Bypass Surgery Essay

There are two very common approaches to weight loss management. Gastric bypass surgery is a trend many are opting for. A high protein diet has similar results; however, it takes more willpower to achieve desired results. This essay will provide the pros and cons to each choice. Diets higher in protein and moderate in carbohydrates along with diet and exercise are thought by experts to reduce blood fats. * Can cause health problems, such as pre diabetes and diabetes. * Decrease blood glucose for pre diabetics and diabetics. Researchers concluded that a 15 percent increase in protein ( a caloric ratio of 30% protein, 20% fat, and 50% carbohydrate); with a constant carbohydrate intake can result in significant weight loss. * Participates in the study ate 441 fewer calories. * Reported greater satisfaction, less hunger, and lost weight. The high protein diet also helps lean tissue while burning fat for fuel. * Reported feeling less hungry and increased energy. * You will be changing your focus toward protein and limiting your carbohydrates. Gastric bypass surgery makes changes to your digestive system to help you lose weight. * You will have to follow a strict diet for about 12 weeks beginning with liquids, then progressing to solid foods. * Frequent medical checkups to monitor your weight loss e.g. ( blood tests and various exams). Gastric bypass surgery is very expensive. * Can cost anywhere from $15,000.00 to $25,000.00 * There are many options available to people who do not have insurance to pay for this surgery. This method of weight loss can improve or resolve conditions with the guidance from your medical treatment team. * Increase probability of all needs for medications in a diagnosed type 2 diabetes patient. * Loss of high blood pressure and high cholesterol 70-80% in patients. In conclusion, both high protein diet and gastric bypass require lifelong changes. A strong support system will increase your ability to maintain your desired results.

Dogs Encourage Better Health Essay - 1334 Words

The young royals, Prince William and Duchess of Cambridge Kate Middleton, created headlines last week by revealing the name of their new puppy. Not mentioned in the multitude of stories is how the dog’s presence can affect the health of the future King and Queen. The latest addition to the Royal family, Lupo a four-month-old black cocker spaniel, is an ideal choice of pet for more than his inability to inherit the throne. Medical studies around the world have concluded dogs encourage better health, and adopting a dog statistically boosts the life expectancy of the monarchial pair. Not only is a dog man’s best friend, but Rover’s presence could be better than an apple a day for you. Dog owners worldwide enjoy longer lifespans on average,†¦show more content†¦The ownership of a dog can also lead to increases in physical activity and facilitate the development of social contacts, which may enhance both physiological and psychological human health in a more indirect manner. Studies in Germany, Australia, and China point to dog ownership as sound public policy. An examination of Chinese women (men were excluded) reported increased exercise, fewer doctor visits, and diminished use of sick days at work when a dog is present in the home. Australian and German dog owners were found to use free governmental health services less than the general populace. Pet owners in those countries made approximately 12 to 15% fewer annual doctor visits than their petless peers. German pet owners spent 32% fewer nights in a hospital. The benefits appeared particularly strong for elderly people, the population group with the worst constitutions and heaviest use of health services. The economic benefit was substantial, approximating savings in health expenditure of $5.59 billion for Germany and $3.86 billion for Australia annually. As with everything in life, age can be a relevant or limiting factor to owning a dog. 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