In Massachusetts, the 2012 election ballot contained a controversial question that got some people’s attention. The question was whether people were for or against the concept of physician assisted suicide. The idea of this was very unfamiliar to many people. What physician assisted suicide is, is when a doctor gives a terminally ill patient medication to help them end their life, if that is what they so choose. Many people are against this idea, however, there are also many people that are for this. There are many the see the good in this concept and how it can benefit the medical field. Physician assisted suicide, although controversial, can benefit many patients if utilized in the appropriate way.

The concept of physician suicide dates back to the early 1900’s. In that time, they were known as “Euthanasia societies.” (Deathwithdignity.org, 2016) Over the years, these societies gained momentum as people learned more about terminally ill diseases. In the 90’s however, there was some controversy when a Dr.Kevorkian famously assisted several of his patients in committing suicide. (Pickert, 2009) These acts came under scrutiny, because doctors take a Hippocratic Oath. In that Hippocratic Oath, doctors specifically agree not to give any lethal drugs to patients or to advise the use of any lethal amount of a drug.

However, all of those negative things aside, there are many potential benefits to physician assisted suicide. The purpose of this practice is to relieve the terminally ill of their pain, and to give them another option besides hospice care. Although hospice care is a good option, some of these terminally ill patients can live for years, in a lot of pain, with no options for treatment. Some people seek hope in the concept of physician assisted suicide, when they have no other options. Although many terminally ill patients are on hospice care, that option isn’t for everyone. If that doesn’t work, there really aren’t many other options. If this “death with dignity” was an option, it could be a positive for a lot of people.

Some people may be worried that it would be overused, however hopefully if a concept like physician assisted suicide was ever implemented, there would be tons of regulations to prevent misuse from occurring. If something like this ever came to be, I would hope that doctors would have a list of criteria that patients would have to meet to even qualify for this. For example, if a patient is terminally ill, has explored several other options, and is certain that this is the decision for them, before even being considered as a candidate for such a treatment.

The way that the “death with dignity” works, is that the doctor writes a prescription for a lethal dose of a drug. The patient then fills that prescription at their pharmacy, and takes the medication when and wherever they choose to do so. The doctor doesn’t actually administed the medication to the patient, contrary to popular belief. (Virtualhospice.ca, 2015)

This was the case with Brittany Maynard, who was 29 years old and had terminal brain cancer. (“Brittany Maynard, 29, Kills Herself Under Oregon’s ‘death with Dignity’ Law | US News | The Guardian”) She moved to Oregon to be able to receive treatment of “death with dignity,” and did so all before turning 30. She had a husband, and a family. However, she also knew what she wanted. She experienced frequent seizures and was frequently in pain. For her, she decided that dying was the right decision, and it was her decision to make. She took the prescribed medication and died at home, surrounded by her family.

In conclusion, although not all people may be in favor of physician assisted suicide, or “death with dignity,” for some people, it is definitely the right decision. It can be a last resort, for the terminally ill. It can end extreme suffering, and pain. For some, it may just be a miracle.

 

 

 

Works Cited

 

“Brittany Maynard, 29, Kills Herself Under Oregon’s ‘death with Dignity’ Law | US News | The Guardian.” The Guardian. Guardian News and Media Limited, 3 Nov. 2014. Web. 12 May 2016.

 

“Physician-Assisted Suicide and Euthanasia: Introduction | Topics Articles | Canadian Virtual Hospice.” Canadian Virtual Hospice. Canadian Virtual Hospice, 2015. Web. 12 May 2016.

 

Pickert, Kate. “A Brief History of Assisted Suicide – TIME.” TIME.com. Time Inc., 3 Mar. 2009. Web. 12 May 2016.

 

“Chronology of Assisted Dying.” Death With Dignity. Death with Dignity, n.d. Web. 12 May 2016.

 

http://www.nhpco.org/history-hospice-care

http://www.nejm.org/doi/full/10.1056/NEJMsa1408705#t=article

Hospice care is something that most people are more or less familiar with. Most people associate the term with the type of care that people receive when they are about to die, or so sick that no other treatment is possible for them. Although this is more or less true, there is much more to hospice care than that. Hospice care as we know it in modern times was first introduced by a doctor named Dame Cicely Saunders, who treated the terminally ill. The first hospice center was created in London. Hospice care has advanced greatly over the course of the 1900’s, and nowadays patients are even able to have hospice care come to them, staying in their own homes while visiting nurses visit them on a daily or weekly basis. These services have proven to greatly improve the quality of life in patient’s final days.

In “Letting Go,” Atul Gawande tackles the topic of addressing what doctor’s should do when they know they can’t save a terminally ill patient’s life. In medicine, knowing when to tell a patient that you can’t save them is a very sensitive and controversial topic. With modern medicine, there are so many things that can be done to prolong a person’s life. However, if you’re prolonging a person’s life, are you actually making their life better, or just longer?

Gawande starts the article by introducing you to a patient named Sara. Sara is 39 weeks pregnant when she finds out that she has lung cancer through a chest X-ray. The doctor’s deliver Sara’s baby to get treatment started as soon as possible. Sara is 34 and has never been a smoker in her life. Her and her husband are eager to start treatment, and are hopeful. However, after several tests and scans, Sara’s doctor, Dr.Marcoux, realizes that her cancer may be worse than they thought. The cancer is not responding to any of the treatments they have tried, which is a bad sign. The more treatments that are tried, the less likely a cancer is to respond to treatment. Dr.Marcoux does not know how to tell Sara that her prognosis does not look good. It is clear at this point in the article that Gawande is trying to show how even doctor’s aren’t always sure how to break the news to patients that they are dying. Most of the article follows Sara and her battle with her cancer.

At this point in the article, Gawande begins to point out some statistics. He mentions how in the past, terminal illnesses killed people in a matter of days. However, with modern medicine, we are able to keep people alive for weeks, months, even years longer than they would have hundreds of years ago. This is all due to the technology we have access to now. But it comes at a cost and we are all paying for it. As Gawande points out in his article, “Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.” These numbers are a real eye-opener. So much money is being pumped into keeping people alive, but the question that is proposed is, what is the quality of their lives? Many of these terminally ill patients are being kept alive on ventilators with breathing tubes and feeding tubes and can’t eat or breathe or even go to the bathroom on their own. They aren’t even functioning people but yet so much money is being spent to keep them alive, but is this a quality life?

Gawande then shifts his focus in the article to hospice care, which is a big jump from the previous topic of keeping people alive on machines. The doctor follows a hospice nurse on her rounds to visit patient homes and check on them. It brings a new light to hospice, because normally when you think of hospice, you think of a hospital with beds and elderly people in beds, slowly dying. You don’t think of people in the comfort of their own homes, comfortably living their lives. However, it explains that although their are many patients on hospice, not all of them have accepted that they are going to die. Some of them have no choice. Some of them don’t want to die. Some of them have accepted their fate though. In this section of the article, Gawande mentions are firefighter in his mid-40’s who was recently diagnosed with inoperable pancreatic cancer, he had a very short time to live. He and his wife were very understanding of the diagnosis, and responded very well to hospice care. He spent the time that he had left in the comfort of his own home with his own family, and eventually died peacefully, surrounded by his loved ones. For those who are accepting of their diagnosis, hospice has proven to be a wonderful option.

Now and then the article shifts back to Sara, and Gawande gives us an update on her. Each update is worse, however. Her health rapidly declines, and although they know that the expirimental drugs are unlikely to work, she and her family never seem to give up hope. The doctor’s are so doubtful of Sara’s survival, but they let her try these new drugs anyway, maybe as a way to make her feel better. I believe that although the doctor’s had the patient’s best interest in mind, letting her try all of these experimental drugs that they knew weren’t going to work is just a waste of insurance money as a way to pacify the patient. I understand that the family is willing to try anything to try to help Sara get better, but if the doctor knew that the treatment wasn’t going to work, then why bother trying the treatment? As stated in the article, this seems to be something that happens everywhere, as something to pacify sick patients. People are afraid of dying, and it seems as though a lot of doctors are almost afraid to tell their patients that they are going to die.

Eventually, Sara did give in to her battle. A bout of pneumonia caused an infection so bad that she just gave up. She took the antibiotics but stated that she didn’t want anymore invasive treatments. Her family eventually agreed with her decision and she eventually died in the hospital.

Gawande’s article was very well written and a very good read, summarizing very thoroughly a lot of the problems with modern medicine and also the benefits of hospice care. His article goes to great lengths to make the concept of hospice care seem much more comforting than it has previously come across. Hospice and palliative care have long been associated with the idea of death and the very ill. However, this article shows a lighter side of hospice care. Although it is inevitably a sad ending for most patients, the hospice nurses go to such great lengths to make sure their patients are happy and comfortable. It makes it almost personal, knowing that that could be me one day, or that that could be my mother one day in hospice care. Reading this article made me optimistic that everyone can receive such amazing care if they are to ever be in a situation where they need to be placed in hospice care.

His article also put into perspective the great lengths the medical field is going to keep sick patients alive. We are keeping a lot of patients alive, but at what cost? It’s true that a lot of people are afraid to face their diagnoses, and the insurance companies are cashing in on our fears. An article from the New England Journal of Medicine states that “Between 2000 and 2012, the percentage of Medicare decedents using hospice doubled (from 23% to 47%) and hospice expenditures quintupled (from $2.9 billion to about $15.1 billion).” A lot of money is spent keeping people alive. I think that the author hit a lot of great points about how people’s money is being used inappropriately and although it’s probably the unpopular opinion, I agree with the point Gawande was hinting towards. People are being kept alive much longer than necessary solely for the sake of their loved ones, and the quality of their life isn’t taken into account at all. I think that this is wrong, and judging by the mood of the article, it seemed as if the author did as well. A lot of people are kept alive for a long time on machines solely for the benefit of their families knowing that they’re alive. Everyone has a hard time letting go.

For my research paper argument topic, I’m not exactly sure what my topic should be. However, I did come up with a few ideas that I hope to get feedback on. Possible topics for argument include:

Doctor assisted suicide, is it acceptable? is it not acceptable?

Abortion, do women have the right to choose what happens to their own body?

 

I think this is a well written article. The only thing I wasn’t sure of is whether or not David Epstein was the author of it based on the way he was introduced, also what was the name of your article? Besides those things, I think you explained what your article was about very nicely. I got a pretty good understanding for how the athletes try to use the red blood cells to their advantage. Also, I agree with your point that hard work goes so much further and is so much more respectable than taking steroids and “cheating” to get ahead.

In “Letting Go,” Atul Gawande tackles the topic of addressing what doctor’s should do when they know they can’t save a terminally ill patient’s life. In medicine, knowing when to tell a patient that you can’t save them is a very sensitive and controversial topic. With modern medicine, there are so many things that can be done to prolong a person’s life. However, if you’re prolonging a person’s life, are you actually making their life better, or just longer?

Gawande starts the article by introducing you to a patient named Sara. Sara is 39 weeks pregnant when she finds out that she has lung cancer through a chest X-ray. The doctor’s deliver Sara’s baby to get treatment started as soon as possible. Sara is 34 and has never been a smoker in her life. Her and her husband are eager to start treatment, and are hopeful. However, after several tests and scans, Sara’s doctor, Dr.Marcoux, realizes that her cancer may be worse than they thought. The cancer is not responding to any of the treatments they have tried, which is a bad sign. The more treatments that are tried, the less likely a cancer is to respond to treatment. Dr.Marcoux does not know how to tell Sara that her prognosis does not look good. It is clear at this point in the article that Gawande is trying to show how even doctor’s aren’t always sure how to break the news to patients that they are dying. Most of the article follows Sara and her battle with her cancer.

At this point in the article, Gawande begins to point out some statistics. He mentions how in the past, terminal illnesses killed people in a matter of days. However, with modern medicine, we are able to keep people alive for weeks, months, even years longer than they would have hundreds of years ago. This is all due to the technology we have access to now. But it comes at a cost and we are all paying for it. As Gawande points out in his article, “Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.” These numbers are a real eye-opener. So much money is being pumped into keeping people alive, but the question that is proposed is, what is the quality of their lives? Many of these terminally ill patients are being kept alive on ventilators with breathing tubes and feeding tubes and can’t eat or breathe or even go to the bathroom on their own. They aren’t even functioning people but yet so much money is being spent to keep them alive, but is this a quality life?

Gawande then shifts his focus in the article to hospice care, which is a big jump from the previous topic of keeping people alive on machines. The doctor follows a hospice nurse on her rounds to visit patient homes and check on them. It brings a new light to hospice, because normally when you think of hospice, you think of a hospital with beds and elderly people in beds, slowly dying. You don’t think of people in the comfort of their own homes, comfortably living their lives. However, it explains that although their are many patients on hospice, not all of them have accepted that they are going to die. Some of them have no choice. Some of them don’t want to die. Some of them have accepted their fate though. In this section of the article, Gawande mentions are firefighter in his mid-40’s who was recently diagnosed with inoperable pancreatic cancer, he had a very short time to live. He and his wife were very understanding of the diagnosis, and responded very well to hospice care. He spent the time that he had left in the comfort of his own home with his own family, and eventually died peacefully, surrounded by his loved ones. For those who are accepting of their diagnosis, hospice has proven to be a wonderful option.

Now and then the article shifts back to Sara, and Gawande gives us an update on her. Each update is worse, however. Her health rapidly declines, and although they know that the expirimental drugs are unlikely to work, she and her family never seem to give up hope. The doctor’s are so doubtful of Sara’s survival, but they let her try these new drugs anyway, maybe as a way to make her feel better. I believe that although the doctor’s had the patient’s best interest in mind, letting her try all of these experimental drugs that they knew weren’t going to work is just a waste of insurance money as a way to pacify the patient. I understand that the family is willing to try anything to try to help Sara get better, but if the doctor knew that the treatment wasn’t going to work, then why bother trying the treatment? As stated in the article, this seems to be something that happens everywhere, as something to pacify sick patients. People are afraid of dying, and it seems as though a lot of doctors are almost afraid to tell their patients that they are going to die.

Eventually, Sara did give in to her battle. A bout of pneumonia caused an infection so bad that she just gave up. She took the antibiotics but stated that she didn’t want anymore invasive treatments. Her family eventually agreed with her decision and she eventually died in the hospital.

Gawande’s article was very well written and a very good read, summarizing very thoroughly a lot of the problems with modern medicine. We are keeping a lot of patients alive but at what cost? It’s true that a lot of people are afraid to face their diagnoses. A lot of money is spent keeping people alive. A lot of people are kept alive for a long time on machines solely for the benefit of their families knowing that they’re alive. Everyone has a hard time letting go.

Ethnography Final Draft

Subject(s): Coworkers
Location: Doctor’s office
Monday mornings, everyone shows up for 8am, ready to start their work week just like every other week. Monday’s are always rough in the office, as no one is quite ready for the weekends to be over. In a doctor’s office, everyone needs to be ready for their day. My coworkers walk into work, a few of which are usually still grumpy as they haven’t had their morning coffee yet. Everyone starts their day off slowly. A few conversations can be heard about the weekend that has just passed. A few complaints about the weekends can also be heard usually. The smell of coffee fills the break room and begins to travel down the hallway. Once the initial Monday blues wear off and everyone has had their coffee, the mood begins to brighten in the office.

It’s a very small office. The staff consists of two medical assistants, one check in girl, one check out girl, two providers, an office manager and a phlebotomist. Each with their own specific personality, after a few days of observation you would get to know each person in a different and unique way. Working in such a small group can be a very valuable experience, and we often act more like a family than a group of coworkers, though we all have our good days and bad days.

The office itself is small. Clean, newly painted tan walls line two small hallways and a total of 10 rooms, accompanied with a forest green accent wall in each exam room. The carpets are a little outdated, no one is a big fan of the zigzagged dark brown and puke green pattern that covers the floors, unfortunately there isn’t much that can be done about it! However, aside from the carpets, the staff has brightened the place up with plants and pictures from tropical vacations carefully hung along the walls in the hallway to draw in our patients’ attention.

If you sit in silence you can hear the constant buzz of all of the unique sounds of the office. Phones are constantly ringing left and right, conversations with can always be heard with patients, orders being called out by doctors and the nurse practitioner. If you look around you can observe many things too. Medical assistants are always zooming by each other to bring in patients, or to administer vaccines. The office manager can often be seen walking up and down the hallway, always on the move.

Bringing in the patients is a constant routine that the other medical assistant and I have gotten down to a science. Each of the two providers is assigned one medical assistant, and once an encounter slip is dropped into the appropriate provider’s bin, we know that we have a patient and it’s our cue to bring the patient in and begin the process of getting them ready to see the doctor.             “Mary” I call in my first patient of the day, there’s only one patient in the waiting room so she stands and walks into the office from the waiting room. “Can you please verify your date of birth for me please?” I ask the patient, who scoffs at me because I know who she is, but I ask anyway because it’s my job to verify all of her information! Not all patients are friendly.

Mary gives me her date of birth and I proceed to get her height and weight and take her into the room where I ask her to sit up on the blue exam table, which will probably still be cold since she’s the first patient of the day. She tells me that she’s here for anxiety. A lot of our patients come in for anxiety. I procure her blood pressure and pulse and verify her medical history in the computer and update all of her information. I leave the room and mumble a quick “have a nice day.” The patient intake process is more or less the same throughout the day, with a few variations here and there.

Many different personalities merge together in such a small office, everything usually works together in perfect harmony. The office manager, however, is definitely the queen be. She is the glue that holds the mold together. If anything goes wrong, she is the one that everyone turns to. Some days the coworkers may butt heads, but this is to be expected in such a close knit office – tensions do rise from time to time. This is rare, though. Usually, everyone can be seen joking and laughing. The office has learned to balance their jobs without taking them too seriously.

One thing that was observed was how well everyone can work together in an emergency. On one particular day in the lab during this week, a patient fainted. The lab door is usually closed so the phlebotomist has a buzzer that she rings in an emergency. When we hear the chimes we know exactly what to do. The two medical assistants, the office manager, and the nurse practitioner open the door and see that a patient is on the verge of fainting.

“Courtney, quick go grab some water and the automated blood pressure cuff!” the nurse practitioner quickly tells me as she runs into the lab.

“Okay, I’m on it!” I tell her, and quickly run to the back to grab a cold glass of water for the patient. As I’m running back, I grab the automatic blood pressure cup.

As I walk back into the lab the patient is white as a ghost, my manager has a wet paper towel on his head and neck. The nurse practitioner is using a small flashlight to check the patient’s pupils. He is sweating very heavily. I place the glass of water in his hand and immediately wrap the blood pressure cuff around his arm.After assessing the patient and making sure that he was okay, he regains some of his color after a few minutes. Per protocol, we then take the patient to one of the exam rooms via wheelchair to have him lay down for a few minutes and check his vitals three more times. We have dealt with patients fainting many times and at this point we all know our role in this situation.

My doctor’s office is like a well oiled machine. Everything works together in perfect harmony. If one little thing is off in the office, then the whole thing is out of whack. Everyone in this particular office does an amazing job at their assigned task and even at taking on some extra tasks. It’s amazing to see how well a group of people can work together and a happy office environment, even when things aren’t perfect.