Module Assignment #6 - "Medical Ethics"
“Every flower returns to sleep with the earth.”
― Suzy Kassem,
Rise Up and Salute the Sun
The Writings of Suzy Kassem
6.1 - Overview
Medical Ethics
The purpose of Homework Assignment #6 is to: (a) provide you with an appreciation of the many components of medical ethics and dying in a technological age, and (b) to provide you with "hands on experience" in learning more about medical ethics, informed consent, and euthanasia.
6.2 - Using The Internet To Conduct Psych Research
Researching Thanatology
Theme - For completing this "Internet Research Project," you are to seek out one of the following: (a) a scientific journal article, (b) a national media article or, (c) a Website that discusses, provides a fact sheet, or reports other such findings.
Task - Using one or more of the above resources, discuss some aspect of medical ethics. Topics might include treatment options, informed consent, organ donor issues, fetal tissue use, abortion, assisted suicide, or euthanasia. Your report is to be in the form of a "discussion paper" of at least one to two typed, single-spaced pages.
You are urged to use the Internet exclusively, though you may use Doyle Library or other such "land-based" resources.
Death and Dying Resources Links to an external site.
Doyle Library (Click on Articles &Databases)
The link below will take you to a "Medical Ethics" video clip. The clip is actually a "trailer" for a History of Medical Ethics Course. The course is taught by Dr. David Jones of Harvard. It is just a few minutes, but gives you some interesting insight to why the subject matter is so important to us all. Enjoy.
Medical Ethics
Links to an external site.
6.3 - Psychology Based Websites
Using Internet Tools To Learn About Death and Dying
Task - For the following psychologically oriented Website, report back what you learned from exploring any one of the many sub-categories listed. A typed, single-spaced page--sharing what you learned and what your reactions were, is required.
Professor's Favorite Section: Click on "Ethical Issues"
Death and Dying Resources Links to an external site.
6.4 - Reading Assignment - Chapter 6
Title - End-of-Life Issues and Decisions (Medical Ethics)
Your primary textbooks include The Last Dance (10th ed.) by Lynne Ann DeSpelder and Albert Lee Strickland (New York: McGraw, 2014) and Grieving Days, Healing Days, by J. Davis Mannino (San Francisco, California: TeddyBear Publishing, 2013).
Primary Readings
As you read Chapter 6, "End-of-Life Issues and Decisions," you should keep in mind the following key questions and core concepts.
Content Overview
1. As medical technologies evolve and assume greater importance in health care, individuals are confronted by situations that involve difficult ethical issues.
2. Autonomy, beneficence, and justice are ethical principles that apply to decision making in health care.
3. Informed consent requires that the patient is competent, understands the treatment options, and freely and voluntarily makes choices.
4. The high-profile cases of Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo have provoked public debate about dying in an era of sophisticated medical technology.
5. Terms describing various cognitive states--such as coma, minimally conscious, and vegetative--have become part of public discourse regarding medical ethics.
6. Physician-assisted death is permitted by legislation enacted in Oregon and Washington and by court ruling in Montana.
7. In 2013, the Vermont senate passed and the governor signed the "Patient Choice and Control at End of Life Act," adding Vermont to the list.
8. Physician-assisted suicide is increasingly an issue for national debate and legislative initiatives. In 1994, Oregon voters passed the Oregon Death with Dignity Act, making that state the first to legalize aid-in-dying. In March 1998, an elderly woman with breast cancer became the first known person to die under the law, having taken a lethal dose of barbiturates prescribed by her doctor.
9. The Patient Self-Determination Act, enacted into law by Congress in 1990, requires health care providers who receive federal funds to give information to patients concerning advance directives.
10. Euthanasia (a "good" or gentle and painless death) encompasses a range of medical decisions: choosing to withhold a particular treatment; withdrawing artificial life support or nutrition and hydration; administering high doses of pain medication that have the "double effect" of hastening death; providing a terminally ill person with the means to end his or her own life; and actively assisting in causing death (as in the case of a lethal injection administered by a physician).
11. Right-to-die advocates view euthanasia as a basic human right, an alternative to needless suffering. Opponents argue that it is often difficult or impossible to obtain a patient's clear consent to euthanasia, that there is always a risk of faulty diagnosis, that a timely cure may be found, that palliative care can ease pain and discomfort, and that opening the door to euthanasia will inevitably lead down a "slippery slope" toward inhumane and unethical practices.
12. Neonatal intensive care frequently involves painful decisions with respect to life-sustaining medical interventions.
13. Advance directives such as living wills and durable powers of attorney for health care provide a means for individuals to express their wishes about the use of life-sustaining treatment.
14. A will is a legal document expressing an individual's wishes and intentions with respect to the disposition of his or her property after death.
15. Probate is the legal process whereby a will is proved valid and an estate is distributed to its beneficiaries; it is conducted by an administrator or executor under supervision of a court.
16. Life insurance and other death benefits provide funds to survivors who have been named by the decedent as beneficiaries or who are otherwise entitled to the proceeds from such benefits.
17. End-of-life issues and decisions involve personal and cultural values and they affect public policies and the lives of individuals and families.
Chapter Objectives
1. To explain how the ethical principles of autonomy, beneficence, and justice apply to medical ethics.
2. To assess the challenges of informed consent and self-determination.
3. To evaluate the ethical issues involved in physician-assisted death and euthanasia.
4. To define the Rule of Double Effect.
5. To explain how issues regarding competency affect ethics decisions in cases involving infants or comatose patients.
6. To appraise one’s own death in terms of advance directives.
7. To understand the various designations (DNR, CPR, CMO) to inform medical staff of one's desires.
8. To identify the types, content, and purposes of wills.
9. To explain the processes of inheritance and probate and to evaluate the consequences of dying intestate.
10. To assess the value to survivors of a comprehensive estate plan.
11. To be aware of end-of-life issues and decisions.
Key Terms and Concepts
advance directive
allowing to die
artificial nutrition and hydration
autonomy
beneficence
beneficiary
bequest
cardiopulmonary resuscitation (CPR)
codicil
coma
comfort measures only (CMO)
death benefit
Death with Dignity Act
do not resuscitate (DNR)
double effect
durable power of attorney for health care
end-of-life care
estate
ethical will
ethics
executor
extraordinary measures
Five Wishes
futile treatment
health care proxy
Hippocratic oath
informed consent
intestate succession
justice
life insurance
life-sustaining treatment
living trust
living will
minimally conscious state
neonatal intensive care
passive euthanasia
Patient Self-Determination Act
Physician Orders for Life-Sustaining Treatment (POLST)
physician-assisted death
probate
prognosis
right to die
slippery slope
substituted judgment
surrogate
terminal sedation
testator
vegetative state
viatical settlement
will
withholding vs. withdrawing treatment
Questions For Guided Study and Evaluation
1. Evaluate the roles of autonomy, beneficence, and justice in medical decision making.
2. Name the three principles of informed consent.
3. Describe changes in the climate of truth telling since the 1950s.
4. Evaluate the importance of the patient–caregiver relationship, including the impact of medical paternalism.
5. Describe how communication skills can help caregivers meet the needs of families of dying patients.
6. Name five strategies that staff members may use when responding to a patient’s desire to discuss death.
7. Evaluate the options of care for hopelessly ill patients, attending to ethical considerations.
8. Summarize the court decisions in the United States that involve physician-assisted suicide (PAS).
9. Assess each side of the issue of euthanasia and construct a convincing position statement for each.
10. Develop a position on the question of a seriously deformed infant’s right to life, and discuss its ramifications.
11. Summarize the contents and purposes of an advance directive.
12. Explain the stipulations typically found in the Durable Power of Attorney for Health Care.
13. Take a stand on the living will that will allow you to support or refute each of the letters to the editor reprinted in the text.
14. List and describe three legal stages with respect to the financial affairs and other legal matters pertaining to a terminally ill patient.
15. Assess the psychological, social, and economic value of preparing a will.
16. Explain what type of information is generally included in a will and define the term codicil.
17. Describe in detail what is meant by the word probate.
18. Discuss the duties of the administrator or executor of an estate.
19. Summarize common practices regarding intestate succession.
20. Summarize the benefits of including life insurance as part of estate planning.
21. Describe a situation wherein a viatical settlement might be of value to an individual or a family.
Task 6.4 - In the section above entitled: "Questions For Guided Study And Evaluation," briefly discuss any two questions you wish. Be sure to have enough length and quality to properly respond to each question.
Related Link -
Among the natives of the Solomon Islands, the dead were place upon a shallow coral reef for the sharks to eat. Among the North American Inuits may be found the practice of placing the corpse in a small igloo thus preserving the frozen body forever--unless of course a big old white polar bear should happen by. And among the Australian aboriginals, the dead were often and simply placed in the trees. What a waste of resources these examples present. How about organ donation?
The following link takes you to a series of discussions on "organ donation" and some of the legal considerations.
Task - Provide a reaction response to what you discovered and learned at these website(s).
Organ Donation Links to an external site.
Practice Quiz - Chapter #6
In this section you will find a practice quiz for each assigned textbook chapter in The Last Dance. The quiz is presented in a link below.
Psych 56 - Chapter #6 Quiz - "End of Life Issues..."
6.5 - "Grieving Days, Healing Days" - The Workbook
Learning Through "Hands-On" Doing
Overview
Grieving Days, Healing Days, is an interactive workbook written by Dr. J. Davis Mannino, 2013 (Formerly, Boston: Simon & Schuster, 1996). It is required for this course, because specific pages in the workbook are assigned as part of each homework assignment that you chose to complete.
Assignments to complete in Grieving Days, Healing Days will be listed in this section for each of the 16 homework assignments. Generally speaking, assignments are due by the assigned date. This workbook is loaded with readings, exercises, and activities that will enhance your learning of many important topics in the study of death and dying --- a field that is better known as "thanatology."
It is also important to remember that certain workbook pages will be required reading for assignments that you choose to complete. Therefore, always review and read workbook readings for each of the homework assignments you choose to complete as part of the course requirement. Choose assignments that fulfill your overall course requirement from GDHD.
Workbook Reading Assignment
1. Review Grieving Days, Healing Days, and become familiar with it.
2. At minimum, read and complete ANY THREE of the following assignments in Grieving Days, Healing Days. This only applies to those HW assignments you are completing as part of the course requirement. They may also be credited towards your overall course workbook requirement as well. Please note that all online homework assignments must, at minimum, still be read and reviewed.
The Importance of Dying, p. 90
The Good Death for You, p. 120
Moral Dilemmas, p. 137
Morality -- Who Lives, Who Dies!, p. 138
Euthanasia Debate, p. 139
Judge and Jury, p. 140
Hospital Ethics Committee, p. 141
Euthanasia: Who Dies, p. 143
6.6 - Course Discussion Board
Module #6 - Thought Provoking Question (TPQ) or Article
Overview - The purpose of a course discussion board is to allow students and professor an opportunity to interact about topics of common interest. A discussion board is also a fine tool to share commonly asked questions, answers, and concerns.
You are urged to use the message board, when you have questions that you think others may wish to know; when you have technical questions or answers that others may wish to know, and to share other useful tidbits with each other. I want each of you to become familiar with the message board system.
Once you have composed your thoughts and written them down in a word application program [i.e., Microsoft word] --- with grammar and spell check---you follow through with posting (copy and pasting) them. Remember, to be sure you also post your comments in the appropriate place in the task boxes that links later in this assignment. You only do this if you are also submitting this ENTIRE assignment as one of your required four online assignments for this course.
Task - In each class module, there will be one thought-provoking course related question or article for which discussion is expected from students. While not always directly related to assigned readings, they have important course-wide implications. You are expected to respond to each TPQ by the end of each class module's deadline Be sure to place the question/article module number (#) in the "subject line" so your classmates will know which module topic you are addressing.
Since there is only one "thought-provoking question or article " (TPQ) due per module during the regular semester, a minimum response of 250 to 500 words is required for each message board TPQ posting. Also, students need to post a TPQ for EACH of the 15 online assignments.
This Assignment's Thought Provoking Question (TPQ) or Article
The following link is a graded assignment for the TPQ. (1) Click on the link below, (2) read the TPQ or article, and then (3) respond in the student posting area provided at the end of the article.
Thought Provoking Reading #6 - "As Old As The Hills ..."
6.7 - Death: A Personal Understanding: Video #5: Fear of Death and Dying
Overview
Welcome to a new video feature for my online course.
It is a very fascinating series by the world-renowned Annenberg Media Series. This video instructional series on death and dying is intended for college classrooms and adult learners. It is a 10 part series of half-hour video programs that focus on death and its many facets.
Gain a greater understanding of death and dying through case studies and moving personal stories of people facing their own death or the death of a loved one. This series explores a wide range of North American cultural perspectives on death within the context of current issues, including AIDS, death by violence, suicide, assisted suicide, hospice care, end-of-life decision making, and how children react to death. Leading authority Robert J. Kastenbaum guides you sensitively through these topics. This series is appropriate for courses in allied health, psychology, sociology, religion, and death studies.
Directions
When you arrive at the website, click the video icon you wish to view that says "VoD" [Video on Demand] and then when the "pop-up box" opens, click on the start arrow. Keep in mind that with "streaming videos," some of the film [buffering] must load so it can take up to a minute to load and sometimes it helps if you click on the start arrow again in the "pop-up box." Once you get the hang of it, you will find they all work the same, though with some quirky moments at times. You can also click on an icon in the video box allowing you to enlarge the video as to fill your entire screen. Just click on the "esc" button on our keyboard to leave the "large view" format.
Closed Captioning Note: For my students with disability challenges, there is a "closed captioning" option with this series. As you watch this video, after start up, click in the upper right hand side of the screen and you will see a icon that shows whether the captioning is on or off. To turn it on, click on it and you will see the on off switch change. I find I like watching the videos with captioning on as I have some hearing problems and I can catch everything everyone is saying especially if they are not talking clearly.
Video #5 - Fear of Death and Dying
Despite the centuries-old human struggle to "domesticate" death, the moment itself often remains frightening. A man diagnosed with AIDS and a woman dealing with recurrent cancer discuss how physical pain and fear of what may happen next affect their views of the future. An older couple explains the rational motives, and the emotional difficulties, behind their decision to prepare an "advance directive."
Task
When done reviewing the assigned video, prepare a thorough reaction statement at the "Blue Book" section link described further down at the end of this assignment.
"Death: A Personal Understanding" - The Series Link Links to an external site.
6.8 - Assignment #6 "Blue Book" Responses
Composing Your Responses To Assignment #6 in Module #6
Overview - For each course module there is a major homework assignment that must be completed. Each of these module homework assignments has several tasks. Some entail reading, some include exploring and reviewing websites, reviewing videos, and still others involve written tasks --- work that must be submitted for review and/or grading.
Responses to "tasks" must be sent on time or you will either fail the assignment or be severely penalized. Late homework assignments are perceived as both a student who is "absent from class" and "late with work." Please always maintain a backup copy of all your written work. Glitches occur in online technology-based education, but ultimately it is your responsibility to maintain adequate backup of all work submitted. You are also encouraged to compose your work within a word-processing application and then "copy and paste" into "task boxes." This is so you may avail yourself of spell and grammar check options provided in most modern word processing software.
Please be aware that all submissions are automatically received by the course "gradebook," where they will be evaluated by your professor for acceptance, rejection, or acceptance with penalty. So make sure your work is received promptly. Much the same way that attendance is determined by you presence in the traditional classroom at the regularly scheduled class time, so too is attendance determined by your prompt submission of assignments while enrolled in an online course. Furthermore, arriving to class without homework or with incomplete homework is also perceived in the same manner with an online course. Accordingly, you are encouraged to submit you weekly work prior to deadlines, to avoid computer glitches, "downtime," and other "technological spills and inconveniences."
Directions - Each numbered task box listed below corresponds with tasks described in each module's homework assignment. Usually, tasks outlined on this webpage require written reactions and/or responses.
Be sure to follow directions carefully and precisely when completing each task. "A word to the wise!" Minimal work receives a minimal grade. For example, if a task asks that you provide a written paragraph or two, and you provide just that, then you have provided only minimal work. Simply said, minimal work is "C" work. Well thought out writing that exceeds both excellence and minimal length (word count) and quality requirements is, generally speaking, graded higher and indicative of a "good and solidly motivated student." However length in of itself does not assure quality either, so learn to strike a balance. Good luck!
Particulars - Remember this module is due by a certain date or will be penalized. Overly late assignments may NOT be accepted at all, and at minimum, marked down. The discretion of the professor rules in all such matters. Was your assignment "Online and Ontime?" Before beginning this first homework assignment be sure you understand the word count and quality requirements (1500 to 3000 words depending on grade desired). See Grading Policy in Course Basics at the Course Syllabus for further information regarding requirements and grading of module submissions.
Module Assignment #6 "Blue Book" [Graded Responses Go Here]