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LEGAL ASPECTS IN TAKING CARE OF ELDERLY AND DISABLED PEOPLE: THE LIVING WILL

admin — Wed, 22 Sep 2010 10:19:26 +0000

There are many people who fear becoming old and ‘senile’ because once they become mentally frail they will no longer be able to tell people what their wishes are, especially in relation to medical treatment. Currently the position is that doctors dealing with the mentally frail are governed by what is known as ‘good medical practice’: because the person concerned cannot give consent, measures are taken ‘in their best interests’. Most teams of professionals dealing with the elderly in the UK would discuss the dilemma with the person’s family, although the latter have no legal force to sway the doctors one way or the other (enduring powers of attorney specifically exclude medical matters). ‘Good medical practice’ may mean that a person undergoes an operation or is given some form of treatment that his family and friends know would have been refused had the person been competent.

In the United States there has been legislation in many states to try to insist on the autonomy of the person under consideration being paramount, and to do this the person must make a statement basically saying how far he would like doctors to go in the event of him/her becoming incapable of giving informed consent. Obviously such a statement must be made before any brain damage has occurred. This statement is called a living will and describes a form of anticipated consent. The following is an example of a living will:

It is my express wish that if I develop an acute or chronic cerebral illness which results in a substantial loss of dignity, and the opinions of two independent physicians indicate that my condition is unlikely to be reversible, any separate illness which may threaten my life should not be given active treatment.

In the USA this is a legally binding document, but this is not the case in the UK. The above example is only one type of document that could be drawn up; some people would perhaps want to refuse life-support machines or mutilating operations but would want antibiotics or other ‘invasive’ medical treatments. The UK is certainly different in its treatment of the very mentally frail and few doctors here would deem it appropriate to put someone with advanced dementia onto life-support machines or subject them to major operations without much thought and significant benefit to the individual. Good medical practice, however, still leaves important decisions in the hands of comparative strangers whose moral and ethical values may differ markedly from the person they are treating.

That is not to say that good practice does not currently allow for the extremely mentally frail with other severe illness to die pain free and with dignity. The British Medical Association (BMA) was initially reluctant to acknowledge the need for living wills, and in the 1980s its Ethics Committee reported they were quasi-legal documents that could arouse fear in some people. The debate has continued, however, and new impetus has been given to the topic by the large numbers of people affected by AIDS. The Terrence Higgins Trust, a leading AIDS charity, has produced its own living will and distributes copies free of charge. Because HIV-related diseases and AIDS affects a predominantly younger population than dementia, it has focused attention away from age and onto the point at issue, personal autonomy. The latest statements from the BMA encourage debate on the issue. It is a topic arousing Parliamentary interest with a view to giving it some legal status as is now the case in the Netherlands.

The need for discussion around this very important topic is evident. I feel very strongly that many people would contemplate writing a living will because currently many institutions caring for the elderly mentally frail are so under-funded and under-staffed that the reality of life in these places fills many people with dread.

In such circumstances, however, a living will coming into effect must never be used to decrease the funding to this vital part of the health service merely because of a cynical anticipated lack of demand later. The living will debate is only valid if more resources are placed into this sector so that the reality for the elderly mentally infirm in care is of excellent architecture with enviable surroundings, single rooms with bath and toilet, and sufficient care staff properly trained to ensure life with dignity. A living will for intercurrent illness would then truly enhance a person’s autonomy.

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HOW TO SURVIVE YOUR DOCTOR: LAXATIVES AND LAXETTES

admin — Wed, 22 Sep 2010 10:16:56 +0000

Laxatives

The terms laxative, cathartic, aperient and evacuant are synonymous. Laxatives may be differentiated by the gentility or severity of their mode of action. High fibre is a gentle laxative and as a bulking agent high fibre produces a voluminous soft motion which encourages normal reflex bowel activity.

Soap like emollients such as Coloxyl soften the bowel motion and allow the retention of water. Liquid paraffin is tasteless, non digestible oil which is said to act by lubricating the bowel and increasing the water contents of bowel motions. There is some suggestion that liquid paraffin is associated with a slightly higher risk of colorectal cancer.

The more aggressive group of laxatives includes Durolax (Bisacodyl), castor oil, Cascara, Sennakot (Senna), rhubarb and Laxettes (Phenolphthalein). Ideally sufferers of constipation should start their attack on recalcitrant bowels with high fibre and add an emollient such as Coloxyl, if the problem persists. In stubborn but intermittent cases of constipation a large dose of Agarol is nearly always effective. Agarol is a mixture of Paraffin Oil and Phenolphthalein.

Laxettes

Laxettes are a brand of chocolate which acts as a laxative. The active ingredient is Phenolphthalein, which causes the large bowel to secrete copious quantities of water and to contract spasmodically. Laxettes are often used in the management.

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CHILD’S HEALTH/EAR, NOSE AND THROAT DISORDERS: EAR WAX

admin — Thu, 21 May 2009 07:11:54 +0000

Wax is normally secreted by glands which lie in the ear canal. When first secreted it is soft and colourless, but with exposure to air becomes hardened and acquires a brown colour. Its function is to act as a filter for the ear, trapping particles of dust and dirt when they enter the ear canal. Usually the actions of chewing and the constant renewal of the ear canal’s lining ensures that wax is moved outward. Sometimes a build up of wax can block the ear canal, and may cause discomfort or interfere with hearing. Earwax can be softened by placing 2 drops of paraffin oil in the ear for 3 consecutive nights. Never use a cotton bud to remove wax inside the ear canal, as this can easily cause damage by pushing the wax deeper inside the ear. Some children may have to use ear drops on a regular basis to prevent a build up of wax. The doctor may sometimes have to use a special syringe to flush out wax that is blocking the ear.

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THE NEWBORN BABY: RESPIRATORY DISTRESS SYNDROME (RDS)

admin — Tue, 19 May 2009 06:30:51 +0000

Respiratory distress syndrome refers to breathing difficulty experienced by many premature babies, due to underdevelopment of their lungs. The earlier a baby is born the more likely he is to suffer from RDS. Babies born at 28 weeks have a 70% chance of developing RDS. This figure drops to around 10% for babies born at 34 weeks gestation.

Cause

Because the lungs of premature babies are immature they do not produce a substance called surfactant, which lines the lung surface and prevents collapse of the smallest airways (alveoli) used for oxygen exchange. This substance starts being produced when the baby is around 28 weeks gestation.

Clinical features

A baby suffering from RDS will have difficulty breathing, having to work very hard with each breath. His chest may be drawn in and he will grunt when he tries to breathe out.

Investigations

Diagnosis of RDS is usually confirmed by chest X-ray.

Treatment

Babies with RDS require highly specialised treatment in a special care nursery. They will be nursed in a humidicrib and will require oxygen administered through a special hood. Sometimes they will require oxygen through a tube passed into their windpipe, and some babies may be hooked up to a special breathing machine (ventilator) for days or even weeks. Artificial surfactant is also now available, and this helps those babies with respiratory distress due to immature lungs.

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YOUR MARITAL HEALTH/THE MOST OFTEN ASKED QUESTION: WILL I, DOES ANYONE, GET OVER THE TERRIBLE SCARS OF THE

admin — Mon, 18 May 2009 12:59:21 +0000

ABUSE?

”When I read about sexual abuse, I knew it was the same for

me. Will I, does anyone, get over the terrible scars of the

abuse?”

ANSWER: No, nobody “gets over” them, but one learns to put them to work in favor of a new intimacy. Those who have suffered abuse learn the contrast between sharing and abusing, and they seem all the stronger for the pain, for they have seen both sides of the issue. They have felt the guilt, self-blame, and anger of sexual abuse and learned the contrast between that and the love, trust, and safety of sex in marriage. Just as someone who never has been really sick may never fully know what it is to be very healthy or at least fully appreciate and value health every day, so it is with sexual abuse. You have seen and felt the pain, so the joy and freedom is all the more valued.

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THE JOY OF PERFECT HEALTH: POLLUTION OF THE ENVIRONMENT

admin — Mon, 18 May 2009 09:25:42 +0000

Many species of birds, marsupials, mammals and other animals on our planet become extinct every year.

The main reason for their extinction is that their organisms cannot cope with the increasing levels of pollution in their food and their environment.

Nature gives us a fair warning. If we keep polluting our planet, it may soon be our turn.

So far into our “civilised evolution” we continue to develop more and more diseases, allergies etc. and have increasing difficulty maintaining good health.

However, when we understand the reasons for this, we have a choice. Rather than waiting for governments and the industry to do something about it, WE THE CONSUMERS should make a choice first.

No industry will produce articles consumers do not want.

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INFLUENZA – GREAT PANDEMIC

admin — Fri, 15 May 2009 09:33:57 +0000

There is some confusion about influenza and this may come about because many people talk about the flu when what they are referring to is the common cold or other mild respiratory infections.

Real influenza is certainly not a mild illness. Epidemics and pandemics (that is, a worldwide epidemic) of influenza have spread even in ancient times.

The great pandemic of 1918-1919 claimed an estimated 20 million people, more than died in the Great War.

Influenza is caused by a virus of which there are three sub-groubs, À, Â and Ñ. Ñ virus is rarely isolated and does not cause epidemic influenza. Â virus may cause epidemics which tend to be milder than those caused by A virus and it is this last which causes the pandemics.

The incubation is short, some two to three days. The onset of the infection is abrupt with fever, headache, malaise, shivering and severe aches and pains in the limbs and back.

This is followed by a dry cough, a sore throat and other symptoms of a respiratory infection.

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ANTIBIOTICS – GENERAL INFORMATION

admin — Fri, 15 May 2009 07:45:58 +0000

It can be taken every eight hours (three times a day) and, because this is easier, more people are likely to take it properly. Ampicillin is marketed as Penbritin and Austrapen, and amoxycillin as Mox-acin and Amoxil.

The tetracyclines are a group of bacteriostatic antibiotics produced from a number of moulds. They have a wide range of activity against many organisms which are insensitive to penicillin.

These drugs are also active against some of the larger viruses and related organisms which fall between bacteria and viruses in their characteristics.

Bacteria are organisms with a cell wall containing the active ingredients of the cell. They are capable of independent reproduction.

Viruses are smaller particles without a cell wall and consisting mainly of RNA or DNA, proteins which make up the nucleus of cells and which contain the genetic material.

Viruses can reproduce only inside cells of the host but bacteria can be grown in the test tube, if suitable nutrient is available. A virus can grow only in a suitable cell culture, where it reproduces itself inside a living cell.

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WILD PLANT POISONING

admin — Tue, 28 Apr 2009 11:29:02 +0000

As more and more people take up wilderness river rafting as a means of getting back to nature, the number of plant poisoning cases has been on the increase. Ingestion of the water hemlock plant (known as Cicuta douglasii), the Western Journal of Medicine (142:637) reports, has recently been responsible for the deaths of several river rafters in Oregon and Idaho.

This plant closely resembles the wild carrot or parsnip. It has large fleshy roots with a smell so strongly suggestive of carrots and celery that people are tempted to taste them.

Unfortunately, however, the water hemlock is one of our most poisonous wild plants and can bring on convulsions, collapse, and death, all within an hour or two after one has taken a small bite of its root.

About the only method of treating hemlock poisoning available in the wilderness is the induction of vomiting, but, without an emetic such as syrup of ipecac, this can be very difficult. Campers, therefore, should always be prepared for such emergencies by carrying a reliable emetic in their packs.

In emergencies, a useful trick that can save lives from poisoning, according to the Journal, is to make up an emetic by mixing a tablespoonful of liquid dish soap in eight ounces of water.

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HEATSTROKE AND CHILDREN

admin — Tue, 28 Apr 2009 09:34:49 +0000

Heatstroke is a sudden, uncontrolled rise in body temperature. Heatstroke occurs when the body is exposed to excessive heat but cannot replace the body fluids lost through perspiration. If the lost fluids are not replaced, dehydration (depletion of total body fluids) occurs and leads to a decrease in blood volume.

At this point the body has to decide whether to supply the diminished amount of blood to the internal organs or to the skin; since the internal organs take priority, they will receive the blood. At the same time, the body loses its ability to sweat. The situation now becomes critical for two reasons: the body cannot now produce enough sweat, so the evaporation of sweat on the skin cannot cool the body; and the skin is now being deprived of the blood supply that insures that excess heat can be released through the skin. The lack of blood supply to the skin and the inability to sweat together cause the body to overheat.

If it is not treated quickly and correctly, heatstroke can cause permanent brain damage or death. When there is loss of blood volume, which can mean there is not enough blood to circulate through the body, the victim goes into shock. Also, at high temperatures the blood cannot clot properly, and this can result in blood leaking from the vessels into body organs.

Heatstroke most often strikes athletes or other people who do strenuous work in hot weather. People who have had heatstroke once are more likely to suffer another attack if they return to strenuous exercise within a week. Lack of water, excessive sweating, vomiting, or diarrhea all increase the body’s susceptibility to heatstroke.

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