Module Assignment #6 - Medical Ethics

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 Electronic 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 "Advanced Directives"

Death and Dying Resources Links to an external site.

6.4 - Reading Assignment - Chapter 7
"Facing Death: Living with Life-Threatening Illness"

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 7, "Facing Death: Living with Life-Threatening Illness," you should keep in mind the following key questions and core concepts.


CONTENT OVERVIEW

1. When life-threatening illness is made to seem taboo, it creates difficulties in communication and hampers social support.

2. Life-threatening illness is costly, personally as well as socially and spiritually.

3. The adaptive response to losses associated with life-threatening illness changes as circumstances change.

4. The response to illness is shaped by personality, family patterns, and social environment.

5. Four primary dimensions in coping with life-threatening illness are physical, psychological, social, and spiritual.

6. The awareness contexts relative to dying patients, families, and caregivers include closed awareness, suspected awareness, mutual pretense, and open awareness.

7. The manner in which individuals cope with life-threatening illness is described in terms of Elisabeth Kübler-Ross’s pioneering stage-based approach as well as more recent task-oriented, phase-oriented, and pattern-oriented approaches.

8. Maintaining coping potency in the face of life-threatening illness requires access to both inner and external resources.

9. The options for treatment of serious illness vary according to the illness and ongoing developments in medical knowledge; withholding or discontinuing treatment may also be an option.

10. Alternative therapies encompass adjunctive or complementary therapies, as well as unorthodox therapies.

11. Pain management is an essential component of a comprehensive treatment plan.

12. Studies of the dying trajectory distinguish two main types: (1) a lingering trajectory whereby death takes place gradually and over an extended period of time, and (2) a quick trajectory whereby death is the outcome of an acute medical crisis.

13. The social role of a dying patient differs between cultural groups and among individuals and families.

14. Being with someone who is dying is often a precious and intimate experience.


OBJECTIVES

1. To list representative personal and social meanings of life-threatening illness.

2. To describe and assess patterns of coping with life-threatening illness.

3. To identify and assess treatment strategies for life-threatening illness.

4. To assess the benefits and risks of complementary and alternative therapies.

5. To summarize essential strategies for pain management.

6. To distinguish among various dying trajectories.

7. To explain the factors influencing the social role of the dying patient and to create an ideal model.

8. To acknowledge the feelings of being with someone who is dying.


KEY TERMS AND CONCEPTS

active dying
acute pain
adjuvant therapy
biopsy
cancer
chemotherapy
chronic pain
closed awareness
complementary and alternative medicine
coping potency
coping strategies
defense mechanisms
ethnomedicine
five stages
life review
life-threatening illness
magical thinking
metastasis
middle knowledge
mutual pretense
object of hope
open awareness
pain management
placebo
prognosis
remission
social death
suffering
suspected awareness
symbolic healing
terminality
total pain
trajectory of dying
unorthodox treatment
visualization


QUESTIONS FOR GUIDED STUDY AND EVALUATION

1. Identify the personal and social costs of life-threatening illness.

2. Describe possible reactions of the patient, friends, and family to news of a life-threatening diagnosis.

3. Compare the four patterns of family interaction identified by Glaser and Strauss.

4. Appraise the Kübler-Ross stage-based model of coping with dying versus Corr’s model of coping dimensions, Weisman’s task model, Rando’s patterns approach, and Doka’s phase model.

5. Suggest at least five different ways of coping with life-threatening illness.

6. Assess the comparative benefits of surgery, radiation therapy, and chemotherapy in treating cancer and describe how each functions to eradicate cancer cells.

7. Evaluate the role of complementary and alternative therapies in an overall treatment plan.

8. Identify and give examples of three basic approaches to pain management.

9. Compare and contrast three distinctive dying trajectories.

10. Describe and give examples of social support for people with life-threatening illness.

11. Differentiate the social role of dying patients from that of patients who anticipate recovery.


RELATED LINK

John Webster keenly noted, "I know death has ten thousand several doors for men to take their exits." Indeed how we die, is nearly as important to many, as when we die.

The following link allows you to download a "Caregiver Assessment" pdf file. Caregivers can be so concerned about taking care of their loved ones, that they lose sight of their own health and well-being. This helpful questionnaire was developed by the American Medical Association to ask the caregiver "How are you doing?"

Task - Provide at minimum, a half-page, typed, and single-spaced reaction to what you discovered and learned at this Website.

caregivertooleng.pdf

STUDY FLASHCARDS

in this section you will find a practice quiz for each assigned textbook chapter in The Last Dance. The quiz is presented in the form of "Flashcards." You can even control some of the options in using these "Flashcards" quizzes. If this is your first time using "Flashcards," take a few minutes to experiment with them so as to maximize your benefit from their use.

Psych 56 - Chapter #7 Quiz - "Facing Death"CATE quizzes/tests/exams must be separately migrated to Canvas

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.

This Assignments's Task

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 Message Board
This Week's Thought Provoking Article

Overview - The purpose of a course message board is to allow students and professor an opportunity to interact about topics of common interest. A message 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 must then click on the "Message Board" icon in the "Navigational Toolbar" and 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 follows later in this assignment IF you are also submitting this ENTIRE assignment as one of your required four online assignments for the semester.

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 related to assigned readings, they have important course-wide implications. You are expected to respond to each question by the end of each class module. Be sure to place the question/article 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 200 to 225 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 or Article #6

As Old As The Hills: Why We Grow Old and Die

It’s better to be over the hill than under it, my grandmother use to say. Our slippery slope decline in life is further compounded by the anguish of its recognition. Although the gray mare ain’t what she use to be, at least she doesn’t know it. We humans are the only species that lives each day knowing that this day could in fact also be our last day. Being on the backside of forty, and the short side of time, no one is more aware of time, aging, and the grim reaper than me. But why do we grow old and die? First, I’ll give you the bad news, and in the next article, "The Golden Years: Good as New!," I’ll give you the good news. So don’t despair.

So why do we age and fade? For starters, healthy elderly persons who do not develop any serious diseases eventually undergo irreversible fatal declines at about 100 years of age. In essence, death comes about in much the same way as an ancient barn house collapses under its own weight and the strong winds of time. Until the end of the nineteenth century, very few scientists spent much time on aging issues because they were trying to just figure a way to get people to midlife. It wasn’t until the early 1900’s when antibiotics and maternity care pushed the envelope of life into the sixth decade, that the science of aging, called gerontology emerged. Prior to the 1960s the belief was that it was the body that imposed the death sentence on body cells and therefore life. But biologist Leonard Hayflick declared the party over when he showed that cells divide and re-divide only finite amount of times and than die off. We’re kind of like tulip bulbs folks, the first few years they look great but each succeeding year they begin to whimper in the sunlight and finally fade into the still and dark. Scientists conclude that life is contingent on cell division. We now know that the lifespan of cells is genetically programmed and environmentally influenced. It’s the old "Nature Nurture" story, a question of form versus function. By age 75, more cells have died than been renewed. In fact cell counts declines by about 30%. Let’s take a look at what happens to some of the key body systems.

The Skin System, which is really our space suit for life, begins to show age lines and age spots not from age itself, but from the constant bombardment of ultraviolet ra-diation. We know this by observing in the elderly, the difference between overall skin and buttock skin not exposed to sun. The process is akin to having a tired worn out Sunday suit. After awhile its frayed and tattered look give way to splits down the seam.

Nervous System. At birth a baby is born with all the brain cells it will ever have. The newborn brain contains about 100 billion neurons, as many cells as stars in the Milky Way. From that point on they begin dying. The rate excels after age 30. When they die they are not replaced. By age 80, our brains weight about 7% less than they did in our prime. Some areas of the brain that handle higher cerebral cor-tex functions lose as much as 45% of their cells.

Cardiovascular System. The heart is the only organ that grows bigger with age. Bigger, in this case is not better. Heart enlargement is a dangerous situation where cardiac muscle is replaced by fat. The heart loses bout 1% of its reserve pumping capacity each year after age 30. Other declines in this system are equally depressing.

Respiratory System. As lung tissue ages, it becomes less elastic and less able to inflate and deflate. The lungs take in less oxygen, thus providing less oxygen for the vital red blood cells that depend upon it. This affects cough reflex and ability to clear lung mucus build up. In a sense we become like old inefficient gas-guzzling auto engines choking on our own fumes.

Musculo-Skeletal System. Along with other system breakdowns, so too does this system decay, with osteoporosis and loss of bone mass continuing with age. The process is worse in women than in men. Drops in estrogen and human growth hormone levels affect both men and women. This process affects calcium levels, muscle decline, and bone mass. Sitting around doing nothing increases the loss of bone and muscle mass.

Digestive System. This system seems to hold up the best, which is good and bad. It is bad because an efficient digestive system leads to fat build-up in an otherwise in-active body. The good news is that it works well enough to keep you alive. In other words you get to watch all your other systems break down as you age and get fat. Other problems include gallbladder and liver declines. These lead to gallstones and slow down in drug and alcohol metabolism.

Immune System. One of the most noticeable declines in the immune system is in the thymus, a small gland in the neck, which seems to educate and regulate how T-cells coordinate a body’s defense against enemy microorganisms. The B-lymphocytes is another major cellular defense system. Its job is to attack with pincer-like molecules called antibodies. With age, they begin screwing up whom they actually attack. Often, like a drunken battleship sailor, the B-cells attack our own bodies, giving rise to such autoimmune diseases as arthritis. The ability to clone new T and B cells also deteriorates with age.

Reproductive System. By middle age, a woman’s reproductive clock is fading fast. Her ovaries, which contain about two million ova at birth, have already dwindled down to about 400,000 by puberty. By age 50, most of these ova have been absorbed or shed, and only a few remain. Those that do remain are at high risk for genetic defects such as Down’s system. The sex hormones, estrogen, progesterone, and testosterone decline with age for both men and women. Sperm production declines in tandem with decreased testosterone levels, as well as in number and quality of sperm. Changes in hormone levels increases the prostate size in men, causing pressure on the urethra and making urination more difficult. The kidneys require more water to process and excrete waste and the bladder declines in capacity to hold this waste. For the most part, having a second bathroom moves from luxury to necessity.

Sensory System. As we all most likely know from observing older family and friends, the five major senses dim with each passing decade like a dimmer switch on the down slide. It is a time of reading glasses, an age-related symptom called presbyopia, from the Greek words "elder eye." Our hearing fades due to loss of nerve cells conducting signal passage. First to go are the high-pitched ranges fol-lowed by the low-pitched ranges. Taste buds in our gustatory receptors trail off making extreme taste-range treats like ice cream and chocolate elderly favorites, though these taste extremes may also affect elderly digestion as well.

So what are we baby boomers to do? Give up, curl up, and dry up like prunes in the sun? Actually, there is much we can do to grow gracefully into our tomorrow’s. In the next article, we’ll cross over that old as the hills landscape and catch a glimpse of where the grass is always greener and younger. Come with me to "The Golden Years: Good As New."

[References: Much of the data source on bodily system decline was found in: Merz, B. (1992, October). Why we get old. Harvard Health Letter. Cambridge: President and Fellows of Harvard College, pp. 9-12; McCue, J. D. (1995), and The naturalness of dying. Journal of the American Medical Association, 273, 1039-1043.

Miller R. A. (1994). The biology of aging and longevity. In: Hazzard W. R., Bierman, E. L., Blass, J. P., et al, (eds.). Principles of Geriatric Medicine and Gerontology. (3rd Ed.). Boston: McGraw-Hill, pp. 3-18.

Nash, M. J. (1997, February 3). Fertile minds. Time.

Schmidt, K. F. (1993, March 8). Old no more. U. S. News & World Report, pp. 66-70.]


This article is by J. Davis Mannino and originally appeared in the community newspaper We The People. All Rights Reserved by the author.
CATE Message Lists are not available in Canvas

Once you have composed your "thoughtful response," you may wish to go directly to the "Message Board" to review other students' comments, responses, and discussion as well as your own. That link is found in the "Navigational Toolbar" at top of the course webpage. Just click on the icon that says: "Message Board."

6.7 - Death: A Personal Understanding
Video #5: Fear of Death and Dying

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 Note: 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. 



TASK: When done thoroughly reviewing this video prepare a reaction statement (about 250 words) in Task Box 6.7 (located at the end of this webpage).

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. 

"Death: A Personal Understanding" - The Series Link

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."


"Death: A Personal Understanding" - The Series Link Links to an external site.

6.8 - Automated Task Assignment Page
Compose This Week's Assignment Tasks Here

Overview - Each week there is a homework assignment that must be completed. Every homework assignment has several tasks. Some entail reading, some include exploring and reviewing Websites, 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 penalized. Assignments that are repeated or late will result in a "warning," after you submit them, advising you they were late or are a repeated submission--this is automatically done. Late homework assignments are perceived as both "absent from class" and "late work." Please always maintain a backup copy of all your written work. Glitches occur in 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" it to this page. 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 shown as either a "grade" " or checked in" by the presence of a check mark. Exceptions include late or repeated submissions, which must first be evaluated by your instructor for acceptance, rejection, or acceptance with penalty. So make sure your work received is promptly. Much the same way that attendance is determined by you presence in the traditional classroom at the regularly designated 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 week's homework assignment. Usually, tasks outlined on this automated page require some written reaction or response.

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 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!

Module #6 - Psych 56CATE quizzes/tests/exams must be separately migrated to Canvas

Copyrighted 1999 - 2016 - Dr. J. Davis Mannino - All Rights Reserved - DrMannino@aol.com

Assignment Feedback Form - Online Psych 56CATE quizzes/tests/exams must be separately migrated to Canvas

Distance Education office at Santa Rosa Junior College, Santa Rosa, CA USA