Category Archives: Society

Criminal Justice, Emergency Management, Emergency Medical Services, Politics, Public Health

Critical Incident Leadership

The skills needed to lead and manage an incident within the command structure of an incident management team are broad and far-reaching. Though individual skills, traits, or attributes are not particular enough to manifest leadership (Zaccaro, Kemp, & Bader, 2004), two important skills that I have identified from my experience and from the text of Walsh et al. (2012), one of which I possess and the other could be enhanced or improved, are a wide breadth of acquired knowledge of the particular spheres of public safety, including operations of emergency and normalcy, and a particular political will that endeavors to ensure favor from most subordinates while carrying out the capacity of management (U.S. Department of Homeland Security, 2008).

Of the latter, I could certainly appreciate a need to remain favored and liked throughout the management of an emergent incident; however, the respect that is earned by the end of any successfully managed crisis is worth more to me than blind politicking, and I have no use for elected office unless that office has a use for me. I do understand how, if I managed to cultivate my political will, it might be easier to find resources and more willing accomplices to alleviate the tasks at hand, though I still wrestle with the notion of neighbors owing neighbors in times of emergent crisis.

To speak of the former is to identify acquired skill and knowledge that I can portray in solid foundation. Having been trained by some of the leaders in the field of disaster management as a member of their team, in both leadership and subordinate roles, I have the confidence to direct subordinates to the task at hand safely and efficiently while being directed or counseled (however my office might fall within a command structure). More important than being knowledgeable, though, is knowing when you require more knowledge. I am never afraid or apprehensive of my limitations, and I will always ask for assistance when needed.

It is interesting to discuss the traits and abilities needed by leaders in order to lead (U.S. Department of Homeland Security, 2008; Walsh et al., 2012); however, none of the literature can substantiate that any one particular trait or skill is particular to or required by a leader, or that it is found lacking in a follower (Zaccaro, Kemp, & Bader, 2004). So long as I am willing to take charge when needed and have the necessary knowledge to direct appropriate actions, I feel that I will continue to perform well in command positions, that is, until someone more adept avails themselves to the task.

References

U.S. Department of Homeland Security. (2008, January). National response framework. Retrieved from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Zaccaro, S. J., Kemp, C., & Bader, P. (2004). Leader traits and attributes. In J. Antonakis, A. T. Cianciolo, & R. J. Sternberg (Eds.), The nature of leadership (pp. 101-124). Thousand Oaks, CA: Sage.

Emergency Management, Emergency Medical Services, Health Care, Politics, Public Health, Society

Critical Incident Response Plans

The possibility of a large-scale event threatening the health and safety of a large number of residents in Connecticut is sizable. Emergency response plans (ERPs) need to be in place to address concerns including epidemic/pandemic disease, the intentional or accidental release of a hazardous material, contamination of the food and/or water supply, and other incidents that might threaten the 3.4 million residents and could result in mass casualties. For this reason, the State of Connecticut Department of Public Health (DPH; 2005) has developed an ERP to guide the department in the event of a catastrophic threat the lives and safety of the residents of Connecticut. Additionally, the State of Connecticut has developed a State Response Framework, much like the National Response Framework, in order to allow for a modulation of an incident from a local level to a state or federal level (State of Connecticut, Department of Homeland Security, 2010; U.S. Department of Homeland Security, 2008). The ability of an incident response to grow and shrink as an incident dictates follows the natural progression of incidents starting and ending locally, whether involving state or local responses at any time during the response (Walsh et al., 2012).

The ERP (DPH, 2005) that guides the DPH allows for representation in the state EOC while forming a modular incident management team (IMT) to staff the DPH emergency command center. The DPH IMT is designed not only to support the state EOC when activated, but also supports the various local incident commands as a public health and medical service resource. In keeping with the modular aspects of the incident command philosophies and the state and national response framework, the DPS ERP becomes a valuable resource for both initiating a response to a significant threat to the public health and safety and allows for an expert resource when other incidents of magnitude, but not necessarily public health in nature, require or benefit from the availability of public health experts.

One criticism I do have, however, is that the plan (DPH, 2005) does not address the provision of emergency medical services (EMS). For some time, there has been much confusion as to where EMS falls in the realm of emergency service functions. EMS, for many jurisdictions, is a function of the fire department and may fall under the direction of ESF #4, firefighting, especially as many EMTs and paramedics are cross-trained to fight fire. However, ambulances are not firefighting apparatus. As ambulances do transport the ill and injured, perhaps EMS falls to ESF #1, transportation. This is unlikely, though, as the primary need is not the transportation provided but the care rendered. Public health and medical services, ESF #8, seems to me to be the logical category for EMS to fall under, but EMS has an expanded role that also fits ESFs #9, #10 & #13 (search & rescue, oil & hazmat response, and public safety & security, respectively), as well as the aforementioned ESFs #1 and 4. This lack of initial categorization may allow flexibility in the deployment of EMS personnel and equipment, but it could also lead to ineffective deployment strategies resulting in a shortage of EMS in one area and overutilization in another.

References

State of Connecticut, Department of Homeland Security. (2010, October). State response framework. Retrieved from http://www.ct.gov/demhs/lib/demhs/telecommunications/ct_state_response_framework_v1_oct_10.pdf

State of Connecticut, Department of Public Health. (2005, September). Public health emergency response plan: Emergency Support Function #8 Public health and medical services. Retrieved from http://www.ct.gov/ctfluwatch/lib/ctfluwatch/pherp.pdf

U.S. Department of Homeland Security. (2008, January). National response framework. Retrieved from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Academia, Emergency Management, Health Care, Public Health, Society

Public Health Risks in the 21st Century

Within the next 30 years, I foresee a significant public health risk of viral pandemic, a concern outlined in the recently published CISIS commission report (Fallon & Gayle, 2010). According to many, the next significant pandemic to be a global threat will occur anytime between now and 70 years (Gostin, 2004; Monto, Comanor, Shay, & Thompson, 2006; Ravilious, 2005; Smil, 2008; Tapper, 2006; Taubenberger, Morens, & Fauci, 2007). Although many scientists have their focus on influenza as the most probable for pandemic exposure, other novel virii, such as SARS, HIV, et al., have the facets to make them just as potentially significant (Gostin, 2004; Smil, 2008; Tapper, 2006). Regardless of the particular pathogen, history has shown pandemics to create and environment of negative net effects to humanity. According to Billings (1997) and Ravilious (2005), the Spanish influenza pandemic of 1918, caused by a mutated avian flu strain, claimed between 20-million and 40-million lives in a single year (Monto et al., 2006; Taubenberger et al., 2007). Spreading quickly along major international trade routes, the Spanish flu infected many servicemen returning from duty at the end of World War I. As these infected servicemen returned and celebrated the armistice in crowds of people, a severe strain on the public health system in the United States was unknowingly developing. Considering the hypervirilence and increased mortality (2.5%, compared to the typical 0.1%) caused by the 1918 Spaish flu, the world’s economy was in turmoil (Billings, 1997). As most of the American workforce was recently embroiled in overseas combat duty, upon their return they must now face the possibility of infection, an inability to work, and possible death.

Monto et al. (2006) outline a useful model of surveillance techniques that would not only be useful in detecting and improving response to influenza outbreaks, but it would certainly help to detect any new significant diseases that could be a public health risk and threaten a population or society. Additionally, Taubenberger et al. (2007) focuses on learning the biology of the influenza virus to predict the possibility of outbreak and, thus, pandemic potential. Coupling these two approaches makes sense to both identify potential pathogens and use surveillance techniques to track and direct responses to mitigate actual outbreaks as they occur. These efforts, however, should be directed by an organization that values independant operation, impartiality, neutrality, and universality, just a few of the principles of the Red Cross and Red Crescent movements (International Federation of Red Cross and Red Crescent Societies, 2010). Adoption of these principles will allow valuable health information to flow freely to other entities positioned to respond appropriately without regard to local politics, ensuring a just and equitable solution to help to mitigate the potential for great harm.

References

Billings, M. (1997/2005). The influenza pandemic of 1918. Retrieved from http://virus.stanford.edu/uda/

Fallon, W. J. & Gayle, H. D. (2010). Report of the CISIS commission on smart global health policy: A healthier, safer and more prosperous world. Washington, DC: Center for Strategic & International Studies.

Gostin, L. O. (2004). Pandemic influenza: Public health preparedness for the next global health emergency. The Journal of Law, Medicine & Ethics, 32(4), 565-573. doi:10.1111/j.1748-720X.2004.tb01962.x

International Federation of Red Cross and Red Crescent Societies. (2010, July). Haiti: From sustaining lives to sustainable solutions – the challenge of sanitation. Geneva, Switzerland: Author.

Monto, A. S., Comanor, L., Shay, D. K., & Thompson, W. W. (2006). Epidemiology of pandemic influenza: use of surveillance and modeling for pandemic preparedness. Journal of Infectious Diseases, 194(Suppl. 2), S92-S97. doi:10.1086/507559

Ravilious, K. (2005, April 14). What a way to go. The Guardian. Retrieved from http://www.guardian.co.uk/science/2005/apr/14/research.science2

Smil, V. (2008). Global catastrophes and trends: the next fifty years. Cambridge, MA: The MIT Press.

Tapper, M. L. (2006). Emerging viral diseases and infectious disease risks. Haemophilia, 12(Suppl. 1), 3–7. doi:10.1111/j.1365-2516.2006.01194.x

Taubenberger, J. K., Morens, D. M., & Fauci, A. S. (2007). The next influenza pandemic: Can it be predicted? Journal of the American Medical Association, 297(18), 2025–2027. doi:10.1001/jama.297.18.2025.

Academia, Health Care, Public Health, Society

Leadership & Character

Juxtaposing Two Renowned Leaders of Health

When considering leadership in health care, I think first of how that leadership has affected health care in particular. Being a leader in health care does not guarantee great impact; however, an effective leader can have great impact over a large scope. This is how I framed my search to find two leaders in health care to highlight in this paper.

The first leader of health care that I will discuss is Clara Barton. According to Chambers (2002), Barton, independent to a fault, has been described as having a persuasive power about her. A fairly timid girl, Barton had self-image problems growing up that were at times debilitating; however, it seemed that as long as her interest was in helping others Barton performed selflessly, with heroism and bravado usually reserved for men during the time. Barton, a school teacher, found herself in the middle of the Civil War caring and tending to the soldiers on the battlefield. Dubbed the angel of the battlefield, Barton would not cease in caring for the soldiers even under enemy fire.

Barton, according to Chambers (2002) was not a very effective manager, but she could convince anyone to do anything that she needed to get done, it was said. Barton presents with a leadership style that is transformational (Robbins & Judge, 2010). She sees a need and immediately works to fill the void, inspiring others to do the same. Barton was ultimately responsible for founding the American Red Cross, a neutral organization that today responds to over 67, 000 disasters per year providing medical supplies, food, and housing in order to promote health equity even during wartime. Barton was a socialized charismatic leader, and her accomplishments are truly inspirational (Robbins & Judge, 2010).

The second leader of health care, more so in death than in life, that I chose to discuss is Johns Hopkins. Most people are familiar with Johns Hopkins Hospital and Johns Hopkins University, but it might be surprising to know that these namesakes were only made possible by the posthumous gift of $7-million from Hopkins’s estate (Herringshaw, 1901; “Johns Hopkins,” 1891). Hopkins started life from an affluent family, but a choice to free the family’s slaves forced Hopkins out of his formal education to help on the family tobacco farm. Since leaving the family farm, it seemed, by all accounts, that Hopkins had an innate ability for business (“Johns Hopkins,” 1891). Hopkins became very successful in business early in his lifetime, and he always tried to return his good fortune to the community. This innate ability for business, along with his unwavering business ethics, would seem to make Hopkins a likable and well-respected leader, possibly invoking a sense that he was born with these traits (Borgatta, Bales, & Couch, 1954; Cawthon, 1996; Robbins & Judge, 2010). It was in the spirit of community leader that Hopkins fulfilled his final philanthropy by funding an orphanage, a university, colleges, and a hospital that to this day is world-renowned. Johns Hopkins was an authentic leader (Robbins & Judge, 2010).

Whether a leader is naturally born with certain traits or learns behaviors from their environment, what matters most is that they be prepared to lead when the time comes. Without the onus of personal responsibility, no true leaders can exist.

References

Borgatta, E. F., Bales, R. F., & Couch, A. S. (1954). Some findings relevent to the great man theory of leadership. American Sociological Review, 19(6), 755-759. doi:10.2307/2087923

Cawthon, D. L. (1996). Leadership: the great man theory revisited. Business Horizons, 39(3), 1-4. doi:10.1016/S0007-6813(96)90001-4

Chambers, L. (2002). Fearless under fire. Biography, 6(4), 64-67, 96-97.

Herringshaw, T. W. (Ed.). (1901). Johns Hopkins. Herringshaw’s encyclopedia of American biography of the nineteenth century. Retrieved from http://books.google.com/

Johns Hopkins. (1891). The national cyclopaedia of American biography (Vol. 5). Retrieved from http://books.google.com/

Robbins, S. P. & Judge, T. A. (2010). Leadership. Essentials of Organizational Behavior (pp. 159-180). Upper Saddle River, NJ: Pearson Prentice Hall.

Academia, Health Care, Public Health, Society

Determinants of Health – Mental Illness

When attempting to solve many of the issues relevant to public health, it is essential to understand the factors that contribute to disparities across various ethnic, racial, cultural and socioeconomic boundaries (Satcher & Higginbotham, 2008). In northeastern Connecticut, however, health disparities are primarily related to the socioeconomic strata, as much of the population is Caucasian and there are identifiable health disparities within this group (U.S. Census Bureau, 2002, 2008; U.S. Department of Health and Human Services, 2009). The disparity that I will focus on in this paper is mental illness.

According to Adler and Rehkopf (2008), unjust social disparity leads to greater health disparity, but what is unjust about social disparity? Adler and Rehkopf continue to describe efforts of researchers to evaluate how socioeconomic status, both, in conjunction with and independent of race or ethnicity, contribute to health disparities. There exists a significant difference in the manner in which different cultures approach mental health needs (Hatzenbuehler, Keyes, Narrow, Grant, & Hasin, 2008). Whites, who are more prone to suffering mental health issues, according to McGuire and Miranda (2008), preferring to seek professional care while Blacks are more likely to opt for self-directed care. Though Wang, Burglund, and Kessler (2001) tell of mental health treatment disparities between Whites and Blacks, in their study, 14 times more Whites responded than Blacks which may suggest that Whites are more apt to discuss mental health issues and Blacks might not unless they are motivated by extrinsic factors, such as poor care or the impression thereof. As long as Blacks are not prevented or discouraged from seeking care, there is no injustice in choosing self-care; however, it may not be the most effective option. Cultural awareness on the part of health care providers who may have an opportunity to provide health education to Blacks may alone increase the utilization of mental health services among the Black demographic.

More importantly, mental illness often exists in the presence of poverty and the lack of education. Much of the literature, such as Schwartz and Meyer (2010), seems to make the implication that low socioeconomic status is a causative risk-factor for mental illness, yet the literature also makes the distinction that one of the lowest groups on the socioeconomic ladder, Blacks, have a lower incidence, overall, of mental illness. This may be true in some instances; however, it is more likely that mental illness may be the proximal cause for an afflicted person’s socioeconomic status, especially if the illness manifested early enough to interfere with the person’s education.

More research needs to be undertaken to identify effective programs that aim to mitigate bias of mental health conditions within the community. As mental health disorders lose their stigma, more people who suffer from mental health issues will be able to seek care comfortably and unafraid, leading to increased treatment rates and increased synthesis within the community. This synthesis alone would alleviate much of the socioeconomic burden. Additionally, we need to shift our focus and strive to fix health issues locally, not nationally or globally. The world is comprised of a network of communities of individuals. Impacting the individual is the first step to affecting positive social change. Focusing on individual health will ultimately impact community, national, and global health.

The U.S. Health care system is overtaxed in caring for people with mental illness. According to Insel (2008), we need to refocus our efforts on providing care for mental illness to reduce the enormous indirect costs estimated at $193.2-billion per year. A viable solution in addressing mental illness as a health disparity, I feel, lies in understanding the manner that mental illness causes lower socioeconomic status which, in turn, causes risk of disparate care. Programs designed to aim for situational mitigation instead of mental health recovery will be less costly, more effective and, overall, more ideal. There will still be an obvious and great need for treatment and recovery programs, but with mitigation, I posit that they will be more effective, also.

References

Adler, N. E. & Rehkopf, D. H. (2008). U.S. disparities in health: descriptions, causes, and mechanisms. Annual Review of Public Health, 29(1), 235-252. doi:10.1146/annurev.publhealth.29.020907.090852

Hatzenbuehler, M. L., Keyes, K. M., Narrow, W. E., Grant, B. F., & Hasin, D. S. (2008). Racial/ethnic disparities in service utilization for individuals with co-occurring mental health and substance use disorders in the general population. Journal of Clinical Psychology, 69(7), 1112-1121. doi:10.4088/JCP.v69n0711

Insel, T. R. (2008). Assessing the economic costs of serious mental illness. American Journal of Psychiatry, 165, 663-665. doi:10.1176/appi.ajp.2008.08030366

McGuire, T. G. & Miranda, J. (2008). New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Affairs, 27(2), 393-403. doi:10.1377/hlthaff.27.2.393

Newport, F. & Mendes, E. (2009, July 22). About one in six U.S. adults are without health insurance: Highest uninsured rates among Hispanics, the young, and those with low incomes. Gallup-Heathways Well-Being Index. Retrieved from http://www.gallup.com/poll/121820/one-six-adults-without-health-insurance.aspx

Satcher, D. & Higginbotham, E. J. (2008). The public health approach to eliminating health disparities. American Journal of Public Health, 98(3), 400–403. doi:10.2105/AJPH.2007.123919

Schwartz, S. & Meyer, I. H. (2010). Mental health disparities research: The impact of within and between group analyses on tests of social stress hypotheses. Social Science and Medicine, 70, 1111-1118. doi:10.1016/j.socscimed.2009.11.032

U.S. Census Bureau. (2002). Census 2000. Retrieved from http://www.ct.gov/ecd/cwp/view.asp?a=1106&q=250616

U.S. Census Bureau. (2008). Population estimates: Annual estimates of the resident population by age, sex, race, and Hispanic origin for counties in Connecticut: April 1, 2000 to July 1, 2008 [Data]. Retrieved from http://www.census.gov/popest/counties/asrh/files/cc-est2008-alldata-09.csv

U.S. Department of Health and Human Services. (2009). Community health status indicators report. Retrieved from http://communityhealth.hhs.gov/

Academia, Health Care, Public Health, Society

Community Health: How Healthy is My Community?

I currently reside in Windham County, Connecticut. Windham County is primarily rural with one community, Willimantic, comprising most of the urban demographic. Windham County is functionally divided in half (north to south) in regards to health and hospital services. Primarily, Windham Community Memorial Hospital serves the west and Day Kimball Hospital serves the east. Accordingly, the eastern and western portions of the county may not be representative of each other, yet both are represented as a singular group when considering county-based statistics. This is a shortcoming of county-based statistics. In this instance, Willimantic, in the western portion of Windham County, may negatively affect the statistics of towns like Killingly, Pomfret, and Putnam, in the eastern portion of the county, due primarily to an increase in impoverished populations residing in Willimantic (U.S. Census Bureau, 2002). Additionally, data is lacking for a number of measures, according to the Community Health Status Indicators Project Working Group (2009), but continuing efforts will be made to increase reporting over time.

According to the U.S. Census Bureau (2008) and the U.S. Department of Health and Human Services (2009), the population of Windham County is 117,345 and is predominantly white (94.3%) with the remaining (5.7%) divided among, in order of predominance, Hispanics, Blacks, Asians and Pacific Islanders, and American Indians. The particularly vulnerable populations identified are adults age 25 and older who do not hold a high school diploma, are unemployed, are severely disabled and unable to work, suffer major depression, or have recently used illicit drugs. The uninsured rate in Windham County is well below the 16% national average at 9.5% (Newport & Mendes, 2009; U.S. Department of Health and Human Services, 2009).

Windham County fares equal or better in most measures, at least within the margin of error; therefore, I feel that Windham County, though not exceptionally healthy, is better than most and striving to meet the national standards (U.S. Department of Health and Human Services, 2009). For example, though the incidence of cancer and subsequent death resulting remains higher than peer counties, Windham County falls well within the expected range of death measures and exceeds peer counties in homicide, stroke, suicide, and unintentional injuries. Windham County also falls below the national standardized target for both stroke and coronary heart disease deaths. Infant mortality and birth measures seem representative of peer counties. Windham County also meets or exceeds environmental standards in all cases except for two reports of E. coli infections. There were also reports of five cases of Haemophilus influenzae B, two cases of Hepatitis A, and three cases of Hepatitis B — the only unexpected cases of infectious diseases reported. Pertussis incidence was limited to 25% of expected cases.

Windham County is not exceptional, but living here gives me the sense that the focus is on preventative care rather than acute care, which might explain how the health goals are being achieved overall. The report from the U.S. Department of Health and Human Services (2009) is in agreement.

References

Community Health Status Indicators Project Working Group. (2009). Data sources, definitions, and notes for CHSI2009. Retrieved from http://communityhealth.hhs.gov/

Newport, F. & Mendes, E. (2009, July 22). About one in six U.S. adults are without health insurance: Highest uninsured rates among Hispanics, the young, and those with low incomes. Gallup-Heathways Well-Being Index. Retrieved from http://www.gallup.com/poll/121820/one-six-adults-without-health-insurance.aspx

U.S. Census Bureau. (2002). Census 2000. Retrieved from http://www.ct.gov/ecd/cwp/view.asp?a=1106&q=250616

U.S. Census Bureau. (2008). Population estimates: Annual estimates of the resident population by age, sex, race, and Hispanic origin for counties in Connecticut: April 1, 2000 to July 1, 2008 [Data]. Retrieved from http://www.census.gov/popest/counties/asrh/files/cc-est2008-alldata-09.csv

U.S. Department of Health and Human Services. (2009). Community health status indicators report. Retrieved from http://communityhealth.hhs.gov/

Academia, Clinical, Culture, Emergency Medical Services, Health Care, Politics, Public Health, Society

Physician-assisted Suicide

I have always maintained that the best thing that I have ever done for a patient was to hold their hand as they died; however, there are few scenarios that I can posit where I would ever cause the death of another, and I would never do it in my capacity as a medical professional. In the State of Connecticut, assisting a patient in their suicide is illegal (Kasprak, 2003; Saunders & Smith, 2010). Saunders and Smith (2010) describe the use of “semantic ploys” (para. 3) in arguing for physician-assisted suicide and how the court deemed the “issue rests with the legislature, not with the court” (para 4).

Two states have laws permitting physician-assisted suicide, Oregon and Washington (Death with Dignity Act, 1997; Death with Dignity Act, 2008). The other 48 states either have laws forbidding assisted suicide, such as Connecticut, rely on common law, or have no laws permitting or forbidding the practice (Kasprak, 2003). Personally, my thoughts on the matter are clearly reflected in my opening statement. More compelling, however, is a recent discussion on the discontinuation of implanted cardiac devices in patients with a desire to “refuse continued life-sustaining therapy” (Kapa, Mueller, Hayes, & Asirvatham, 2010, p. 989). Many of the respondants to this study viewed the discontinuation of pacemakers akin to physician-assisted suicide, whereas less felt the termination of cardioverter-defibrillator therapy was an ethical issue. Oddly, lawyers indicated less problems discontinuing therapy than did physicians.

There are conditions that are so intractably painful and wrought with suffering that I would not even consider thinking less of a person suffering such a malady who took their own life. Death, for many people, is a fear beyond fear, and for a person (of considerable sound mind) to choose death as a viable alternative to such suffering, I commend their bravery and choose not to judge them negatively. No physician or other health care provider should cause the death of a person directly, but acknowledging the patient’s will to die is another matter. In lieu of providing a chemical means of ending life, a physician could, in my mind, counsel a patient on the means and methods that might be viewed as more effective and humane than other means which might result in unwanted suffering. I do believe that a person has the right to choose an alternative to a surely painful and agonizing death, regardless of the presence of depression. If a person is suffering from depression because of a terminal illness that is causing physical suffering, it is hard to imagine this person will resolve the depression before succumbing to the causal disease process. In these cases, the person has the right to choose a more dignified death. For those cases where the person is incapacitated and cannot make health care decisions, I feel that any friend or family member, or a consensus of available friends and family members, should be able to make the decision to continue or discontinue life-sustaining measures. Even if the decision is wrong for the patient, most of the time the decision is for the benefit of the family and friends and lacks medical relevance aside from resource management, though there are spiritual, emotional, and moral considerations that the next of kin may face which are no less relevant.

Personally, I grant any person permission to end my life if they see me engulfed in flame or if taken on the battlefield by an enemy known for public torture. Beyond these two circumstances, I will always choose to live so long as I have my thoughts. I have heard some people intimate that they would wish to die if they were conscious but perpetually paralyzed (i.e. locked-in syndrome); however, I am not so sure that I would want to die just for lacking the ability to communicate with others. I would want to view the world, though, perhaps by television or radio. I am too curious as to what comes next for the world. As we interfere with the dying process, it does make sense that we address the morality in which we do this. It does not seem right to have brain dead patients connected to ventilators and feeding tubes forever. It’s Orwellian.

References

Death with Dignity Act of 1997, O.R.S. 127.800 et seq. (1997).

Death with Dignity Act of 2009, R.C.W. 70.245 (2008).

Kapa, S., Mueller, P. S., Hayes, D. L., & Asirvatham, S. J. (2010). Perspectives on withdrawing pacemaker and implantable cardioverter-defibrillator therapies at end of life: Results of a survey of medical and legal professionals and patients. Mayo Clinic Proceedings, 85(11), 981-990. doi:10.4065/mcp.2010.0431

Kasprak, J. (2003, July 9). Assisted suicide (OLR Research Report No. 2003-R-0515). Retrieved from http://www.cga.ct.gov/2003/olrdata/ph/rpt/2003-R-0515.htm

Saunders, W. L. & Smith, M. R. (2010, June 21). Assisted-suicide advocates fail in Connecticut. National Review Online. Retrieved from http://www.nationalreview.com

Academia, Health Care, Society

Henrietta Lacks

Grady (2010) offers the circumstances of Henrietta Lacks for discussion as it pertains to medical ethics. Henrietta Lacks was a young woman who succumbed to cervical cancer in the early 1950s at Johns Hopkins Hospital (Grady, 2010; Sorrell, 2010). Grady describes Henrietta Lacks and her family as “poor, with little education and no health insurance” (para. 10), yet she was cared for and her cancer was treated with radium, the standard treatment of the day. Despite treatment, Henrietta passed away. During the course of her treatment, however, a small sample of cancer cells were removed from her cervix for testing, and they continue to be tested to this day (Grady, 2010; Sorrell, 2010). Additionally, this line of cells, now known as the HeLa cells, has become commercialized, as they are bought and sold for millions on the biomedical research market (Grady, 2010).

Assuming no consent was given by Henrietta or her family, this raises a few questions. Did the physicians at Johns Hopkins have a right to these cancer cells? Did they have a right to transfer ownership to third parties? Does the estate of Henrietta Lacks require royalties be paid when others profit from what amounts to a donation to the public domain?

No person can own another person (or, a part thereof). This is consistent with the moral society of the United States. However, Henrietta Lacks presented herself to Johns Hopkins hospital with the express desire to rid herself of the cancer cells causing her illness. This alone could mean that the cells are refuse and able to be salvaged, and according to Fost (2010), this is agreed to be the law of the land. Fost describes the circumstances surrounding the HeLa cells as normal course of medical business, and I agree for the most part: “If tissue removed during an operation is about to be thrown out with the garbage and has no identifying information, it should be permissible to use it for research without the patient’s consent” (2010, para. 1). In this case, however, the researchers later approach the Lacks family to obtain DNA samples to discriminate between HeLa cell cultures and non-HeLa cell cultures. This mere fact offers evidence that the tissue is identifiable with Henrietta Lacks and her lineage, and I feel, as does Fost, that this is where the researchers erred, in asking for continued support of the cells by obtaining further comparative specimens for analysis yet not clarifying the misconceptions of the family. The researchers should not have requested further tissue (i.e. blood) donation without obtaining informed consent from the donors. Further, the cell line were given a name representative of Henrietta Lacks, HeLa, and she was named as the donor and widely known as such throughout the biomedical research community. Ergo, there were certainly identifying data linking Henrietta Lacks to the specimen.

Remuneration

Certainly under normal circumstances the cells should be made available for research purposes, but they should not be sold for profit, only for the costs of storage and maintenance. Any tissue freely used for medical science should be in the public domain. Further, if a specimen is found to have financial worth, I feel that the custodial researchers should set aside a royalty account allowing a small percentage of the proceeds to be returned to the donor’s estate. I also feel that if researchers have any special interest in further donation, then those donors should be offered remuneration for their donation which should be commensurate to the gains assumed to be made by their donation.

I find no issue with how the cancer cells were used initially, however, the sample should not have been attached in name to the donor. Though not required, it would have been nice if the researchers provided a royalty to the estate of Ms. Lacks, however, to thank her for her contribution to medicine and science.

References

Fost, N. (2010). A cell’s life: The immortal life of Henrietta Lacks. Issues in Science and Technology, 26(4), 87+. Retrieved from http://ic.galegroup.com.ezp.waldenulibrary.org

Grady, G. (2010, February 1). Second opinion: A lasting gift to medicine that wasn’t really a gift. The New York Times. Retrieved from http://www.nytimes.com

Sorrell, J. M. (2010). First do no harm: Looking Back to the Future [Editorial]. Journal of Psychosocial Nursing & Mental Health Services, 48(9), 2-3. doi:10.3928/02793695-20100730-07

Academia, Culture, Emergency Medical Services, Health Care, Society

Codes of Ethics

Of the three ethical codes presented by Lewis and Tamparo (2007), I align myself most with the Principles of Medical Ethics: American Medical Association (AMA). The AMA promotes honesty, integrity, compassion, respect, and most importantly, responsibility. In all manners of occupation, it is virtuous to remain honest; this is paramount in medicine. Physicians, nurses, paramedics, and other health professionals may make mistakes during their career, and it is important that these mistakes be corrected as soon as possible and understood to promote practices that may minimize the same mistake from happening. Honesty leads to integrity. Integrity is a hallmark of professionalism and, in conjunction with honesty, promotes trust. Having compassion and respect for patients regardless of political, societal, economic, or other divisions allows a provider to actually care for his or her patients rather than just deal with them. As a paramedic, I try to be as trustworthy and caring as possible to each and every patient I see. Ultimately, I understand my responsibility to my community, to fellow clinicians and technicians, to patients, and to myself. I hold ultimate responsibility for my actions and inactions, and I take care to not let these adversely effect the perception others hold of me as a professional. The AMA expects this of all physicians, and as an extension of the physicians I work for, I must strive to meet the same demands.

The Hippocratic Oath is dated in its language and demands. Though the oath can be approached as symbolism, the metaphor can be lost on some. I appreciate the Hippocratic Oath for what it is (a foundation for the ethical practice of medicine), but contemporary words, meanings, and application serve me better.

I find the Code of Ethics of the American Association of Medical Assistants lacking in context, applicability, and substance when adopted for paramedicine, my chosen occupation; therefore, I do not align as well with this code as I do with the previously mentioned codes of ethics.

Codes of ethics provide baseline philosophies that serve to direct the actions of groups. By ascribing to such, the professional belonging to such a group allows the code to guide moral judgments when the answer is unclear. In medicine, this is especially true. Medical professionals deal with life and death decisions which stretch the boundaries of personal moral beliefs. By ascribing to a notion of a slightly higher directive than one’s self, the professional can remove his- or herself from the situation with more clarity and less bias.

My personal ethics are bound by a sense of personal liberty and the responsibility of that liberty. Without responsibility, there are no consequences. Without consequence, there is no learning. I like to learn so that I may be the best paramedic that I can to the next patient in my care. For me, it is always about the next patient; they deserve the best that I can offer.

References

Lewis, M. A. & Tamparo, C. D. (2007). Codes of ethics. In Medical law, ethics, and bioethics for the health professional (6th ed.; pp. 241-243). Philadelphia, P.A.: F. A. Davis.

Academia, Health Care, Society

Understanding Cultural Disparities

Social programs are just that… social. In fact, the basis of any social program is to take part in society, both philanthropists and recipients. I think that we have forgotten what it means to be social. I like to think of a well-designed social program as an invitation extended to a marginalized community to partake in society as an equal member. Only when we see ourselves as equal in title and domain can we ever think to overcome racial and ethnical biases (not to mention other more generic stereotypes).

The Lakota Nation has certainly met with strife, both on and off the various reservations. I have always understood that they have unique problems stemming from our early misunderstandings and stereotypes of savage people. In fact, not all of us were victim to this view. It was the Iroquis, after all, after whom we modelled our constitutional governement, and it was a majority of the tribes of every Nation that have assisted us in battle even when feeling oppressed.

The Cheyenne River Sioux are affected by a poor economy, including poverty, elevated rates of unemployment, and a stagnant workforce. In addition, many Native Americans living on reservations are also prone to mental disorders, such as depression, substance abuse, and suicide. Native Americans certainly have it tough, and though many are able to find their way within and without the majority culture, whether through acculturation or community-wide boons such as gaming and resource development, many falter.

The fact that Native Americans are genetically prone to alcoholism, are sociologically prone to depression, and are overall prone to health disparities, suicide, and homicide reveals that there needs to be a solid and comprehensive approach to their problems. The Cheyenne River Sioux, however proud they might be of their culture, are not immune.

So, how do I help? First, examining the cultural and genetic aspects of Native Americans in the context of substance abuse allows me to educate myself on cultural specifics that may assist me in treating a Native American patient. Also, understanding their plight allows me to consider them politically, even from afar.

As much as I would like to hop on a plane (actually, I would probably drive, anyway) and assist the Cheyenne River Sioux hands-on, it is not practical. I do believe in charity, but I certainly do not have the resources to make a meaningful contribution. I will, however, remain a proponent from within the majority culture. I believe awareness of the problems that they face will be a key in allowing others to offer them the assistance to rise above their plights to seek happiness.