The Choice for Your Professional Career: Nurse vs Doctor

My introduction to this thread is very simple. It's a question: If you were or are looking for a professional career, which profession would you select of these two options, either to become a nurse or to become a doctor? And then, why would you select one over the other? ..Maurice.

Obama: Hospital Patient: New Visitation and Decision Rights

It has finally come. Yesterday U.S. President Barack Obama wrote a Memorandum requesting that the Secretary of Health and Human Services create a regulation to federal law which requires that all hospitals who receive money from the government for Medicare and Medicaid must allow all hospital patients to have the visitors whom they request regardless of "race, color, national origin, religion, sex, sexual orientation, gender identity, or disability." In addition, "to guarantee
that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients' representatives otherwise have the right to make informed decisions regarding patients' care." This means that no longer will a same-sex partner be prevented from visiting their ill hospital mate by a hospital regulation or decision. That means that no same-sex partner who was directed in a patient's legal advance medical directive to make medical decisions for the patient will be denied that power and the decisions accepted by the hospital from a family member.

Why did this order take so long to arrive? And what ethical or humanistic argument can one make to counter this Memorandum? ..Maurice.

THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release April 15, 2010
April 15, 2010
MEMORANDUM FOR THE SECRETARY OF HEALTH AND HUMAN SERVICES
SUBJECT: Respecting the Rights of Hospital Patients to
Receive Visitors and to Designate Surrogate
Decision Makers for Medical Emergencies
There are few moments in our lives that call for greater
compassion and companionship than when a loved one is admitted
to the hospital. In these hours of need and moments of pain and
anxiety, all of us would hope to have a hand to hold, a shoulder
on which to lean -- a loved one to be there for us, as we would
be there for them.
Yet every day, all across America, patients are denied the
kindnesses and caring of a loved one at their sides -- whether
in a sudden medical emergency or a prolonged hospital stay.
Often, a widow or widower with no children is denied the support
and comfort of a good friend. Members of religious orders are
sometimes unable to choose someone other than an immediate
family member to visit them and make medical decisions on their
behalf. Also uniquely affected are gay and lesbian Americans
who are often barred from the bedsides of the partners with whom
they may have spent decades of their lives -- unable to be there
for the person they love, and unable to act as a legal surrogate
if their partner is incapacitated.
For all of these Americans, the failure to have their wishes
respected concerning who may visit them or make medical
decisions on their behalf has real consequences. It means that
doctors and nurses do not always have the best information about
patients' medications and medical histories and that friends and
certain family members are unable to serve as intermediaries
to help communicate patients' needs. It means that a stressful
and at times terrifying experience for patients is senselessly
compounded by indignity and unfairness. And it means that all
too often, people are made to suffer or even to pass away alone,
denied the comfort of companionship in their final moments while
a loved one is left worrying and pacing down the hall.
Many States have taken steps to try to put an end to these
problems. North Carolina recently amended its Patients' Bill of
Rights to give each patient "the right to designate visitors who
shall receive the same visitation privileges as the patient's
immediate family members, regardless of whether the visitors are
legally related to the patient" -- a right that applies in every
hospital in the State. Delaware, Nebraska, and Minnesota have
adopted similar laws.

My Administration can expand on these important steps to ensure
that patients can receive compassionate care and equal treatment
during their hospital stays. By this memorandum, I request that
you take the following steps:
1. Initiate appropriate rulemaking, pursuant to your
authority under 42 U.S.C. 1395x and other relevant provisions
of law, to ensure that hospitals that participate in Medicare
or Medicaid respect the rights of patients to designate
visitors. It should be made clear that designated visitors,
including individuals designated by legally valid advance
directives (such as durable powers of attorney and health care
proxies), should enjoy visitation privileges that are no more
restrictive than those that immediate family members enjoy.
You should also provide that participating hospitals may not
deny visitation privileges on the basis of race, color, national
origin, religion, sex, sexual orientation, gender identity, or
disability. The rulemaking should take into account the need
for hospitals to restrict visitation in medically appropriate
circumstances as well as the clinical decisions that medical
professionals make about a patient's care or treatment.
2. Ensure that all hospitals participating in Medicare or
Medicaid are in full compliance with regulations, codified at
42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee
that all patients' advance directives, such as durable powers
of attorney and health care proxies, are respected, and that
patients' representatives otherwise have the right to make
informed decisions regarding patients' care. Additionally,
I request that you issue new guidelines, pursuant to your
authority under 42 U.S.C. 1395cc and other relevant provisions
of law, and provide technical assistance on how hospitals
participating in Medicare or Medicaid can best comply with the
regulations and take any additional appropriate measures to
fully enforce the regulations.
3. Provide additional recommendations to me, within
180 days of the date of this memorandum, on actions the
Department of Health and Human Services can take to address
hospital visitation, medical decisionmaking, or other health
care issues that affect LGBT patients and their families.
This memorandum is not intended to, and does not, create any
right or benefit, substantive or procedural, enforceable at
law or in equity by any party against the United States, its
departments, agencies, or entities, its officers, employees,
or agents, or any other person.
You are hereby authorized and directed to publish this
memorandum in the Federal Register.
BARACK OBAMA
# # #

Looking Back at Terri Schiavo 5 Years Later

It’s now 5 years since the death of Terri Schiavo and one wonders whether it is of value to remember another “Terri Schiavo Day Anniversary”. Though the political attention to Terri has faded and the legal battle of the case has been resolved , the name and the moral and ethical conflict still lingers on, particularly refueled by the recent publicity regarding the United States bishops and their revision of the Catholic Religious Directive #58 regarding hydration and nutrition and, of course, the health reform law recently passed and signed. I found three articles which give different perspectives as one looks back at the Terri Schiavo story.

Kathi Ruse writing in the Washington Times still feels that the America public were misguided if they really concluded, as indicated by the polls, that Terri should be allowed to die.

Reverend Jason Poling writing in the Baltimore Sun writes about being surprised that the same people who felt that the wishes of the Terri’s parents trumped the decision of the husband regarding Terri’s medical care were the ones who “ordinarily defend the traditional understanding of marriage--- people who in the course of pastoral ministry and teaching emphasize to couples (and their parents) the importance of 'leaving and cleaving,' , who encourage couples to work out their problems rather than running to their parents, who really do believe that the two become one.”

Finally, Matt Sedensky writing for the Associated Press comments that while the Terri Schiavo case brought to attention of the American public the necessity for people to write out their wishes for end of life care in an Advance Disrective, there was little change in the numbers of people filling out these forms (20-30%) comparing before and after her death.

..Maurice.

When Should Doctors Retire?

OK, here is the question I would like to put to my visitors: when should doctors retire from practice and the treating of patients? The matter of when to retire is becoming a more important issue in the United States where healthcare reform associated with increasing medical coverage for previously uncovered public is going to require more physicians available for their care. Of course, most decisions to retire are made by physicians themselves based on health issues or emotional or physical burn-out or their desire to spend more time with their family or other life pleasures. However, should this be a judgment only made by the doctor or should rules be set by patients, politicians, courts (that is by society) and directed to medical regulatory boards for enforcement?

If there is no age set by law, should there be? At what age? If compulsory retirement is set by society and there is no specific age set, what other criteria should society use to say to the doctor “it’s time for you to begin another life”? If the doctor is not frankly demented then should retirement be triggered by the number of malpractice suits or the number of complaints to medical boards by patients, serious professional ethical or legal issues or failure to pass some tests of proficiency and knowledge periodically required to be taken? If a doctor does not fully meet the minimal test scores, would that automatically mean “you’re out” or could doctors still participate in medical care but with lesser degrees of responsibility? Should all such triggers be considered final or should doctors always be considered able to be rehabilitated?


And finally, is a “retired doctor” of any value to society?

Any answers? ..Maurice.