People who work with young children, or in child protective services Lawyers and paralegals Administrators of all types of community programs or their sponsoring organizations Non-professional line staff home health aides, overnight staff at residential facilities and shelters In some states, many of these people -- medical personnel, mental health workers, social workers, educators and others who work with children and youth -- are legally considered mandated reporters.
Solutions to cut dramatic rises in Medicare spending on the elderly and decreasing the burden we leave for the future generation are; using futility as criteria in limiting inappropriate care, promoting the use of advance directives and spending healthcare money wiser by the development of value based healthcare.
The prolongation of life is ultimately impossible, but in the end, should it be the ultimate goal?
Sometimes it prolongs suffering. The reason the elderly use such a large amount of medical resources is obvious, they are likely to have more health problems and need more care. There is a solution to this issue; costs can be reduced by considering futility as criteria, promoting the use of advance directives and spending healthcare money wiser by developing a value based healthcare system.
Twenty eight percent of all Medicare spending is used on caring for people in the last year of their life and twelve percent is spent on the final two months Fischbeck. This presents a significant problem for our government.
As baby boomers age, the dependency ratios will change from about four working people per retired person paying into Medicare, to two and a half Callahan. To keep the Medicare benefits at the level they are now, it would require a significantly large tax increase that families would not be able to handle Callahan.
Is it fair for the younger generation to bear the cost for the older generation? So, how do we deal with this? What is the right thing to do? A starting point to the resolution of this issue would be to look at medical futility in the treatment of the elderly and the ethics surrounding it.
Medical futility is defined as when medical interventions would not offer the patient any significant benefit. There are two types of medical futility: Quantitative and Qualitative Jecker.
Quantitative futility is when the medical intervention most likely will not benefit the patient Jecker. The direction of care is looking at evidence-based data to support that the outcome is futile.
An example would be in a study done by Dr Rubenfeld and Dr Crawford in Not one out of patients who had a bone marrow transplant on a mechanical ventilator who developed hepatic failure, renal failure, hemodynamic failure, and lung injury survived. They concluded that an accurate prediction of death could be made in the first four days with patients meeting these criteria Rubenfeld.
The problem with this is that in treatment for the elderly, there is no defined consensus as to the statistical evidence for treatment to be considered futile Poncy. Qualitative futility is when the intervention will produce an outcome of poor quality of life Jecker.
An example would be when a ninety five year old man, who was very active in the community, falls, hitting his head, resulting in a very large subdural bleed of his brain, pushing his brain to one side. Comatose, with a dilated pupil, he shows signs of brain herniation, which indicates impeding death.
If surgery is done to evacuate the hematoma, he may live, but his quality of life would be very poor.
He may be vegetative and unable to return to an active life. The common sense notion of futility is the most logical for containing exorbitant healthcare costs.
This is futility as a valued choice. There is a time for all of us when death or disability should come naturally and life should not be extended by medical interventions.A concern that is often raised in regard to bartering in psychotherapy is income tax considerations. The concern is that those involved in bartering may choose not to report the income in their tax filing.
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This entry outlines some of the different possible kinds of organ sale, briefly states the case in favour, and then examines the main arguments against.