Right To Life
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1. I think the staff RN’s comments are beyond inappropriate and actually quite callous. Unless this nurse has gone through a similar situation herself, she has no idea what the parents are going through. I’m sure the decision to withdraw nutrition and hydration from their newborn was far from an easy decision. Baby Sherman was born with an Apgar score of 0 and hypoxic injury to all her organs. This leaves VERY little chance of success. According to the Baby Doe rules, withdrawing treatment is permissible under 3 circumstances.
- i) The infant is chronically and irreversibly comatose;
- ii) The provision of such treatment would merely prolong dying, not be effective in ameliorating or correcting all of the infant’s life-threatening conditions, or otherwise be futile in terms of the survival of the infant; or
- iii) The provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane.
Under these rules, withdrawing nutrition and hydration is actually the most humane decision. Although Baby Sherman was able to be weaned from the ventilator, she has remained unresponsive. As long as the physicians and nurses are in agreement that treatment would be “virtually futile” and only prolong inevitable death, withdrawing is not the wrong decision. The parents are not being selfish in any way by accepting that. I would remind the staff RN of the Baby Doe rules to show that the parents are not merely being selfish. I would also remind her that as a nurse she needs to remain understanding and empathetic of her patients and their families.
2. Withdrawal of nutrition and hydration is a difficult and controversial subject especially when it comes to pediatric patients. The American Academy of Pediatrics (AAP) “supports allowing the withholding and withdrawing of a medical intervention when the projected burdens of the intervention outweigh the benefits to the child,” (Diekema & Botkin, 2009, p. 813).
I think the case of Baby Sherman is particularly challenging for the healthcare professionals involved as they need to not only be advocates for Baby Sherman, but also respectful of the parents’ autonomy. If a staff RN approached me to share his or her comments on the case, I would first respond by letting him or her know that I understand the concern, but that the parents are the primary decision makers for the child. We should trust that the parents are using the best interest standard in making this decision and that they are “sacrific[ing] their personal goals for their child in favor of the child’s needs and interests,” (Butts & Rich, 2016, p. 168).
I think it is important to be mindful of how stressful and agonizing it is for the parents to make a life-or-death decision for their child. I would also note that only a small number of infants with an “Apgar score of 0 at 10 minutes have been reported to survive with a normal neurologic outcome,” (“Women’s Health Care Physicians”).
If the staff RN was still concerned about the parents’ decision and did not think that they were acting in the best interest of their child, I would remind him or her that it is also his or her responsibility to advocate for Baby Sherman. I would share with him or her the principles that should be followed to override parental autonomy, including evaluating the “severity of the child’s condition and the direct harm to the child that could result from nontreatment,” (Butts & Rich, 2016, p. 170). I would encourage him or her to consult an interdisciplinary team of healthcare professionals and also to involve an ethics committee if they have not already been consulted. The ethics committee should also consider seeking input from ethicists who practice pediatric care (Butts & Rich, 2016, p. 175)
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1. Why does severe swelling result when lymphatic vessels are blocked or damaged?
Lymphatic obstructions are blockages in the drainage “pipes” of the lymphatic system (Healthline, n.d.). The lymphatic system is essentially a collection of nodes connected by veins that drain fluid and waste product away from body tissues. A partial or full blockage can cause swelling as the fluid builds up and is unable to drain in whole or part. This swelling is called lymphedema. When born with this condition, it is often genetic, and called primary lymphedema. If this condition is developed later in life, it is called secondary lymphedema. The swelling is often chronic and requires lifelong treatment. This can be treated at home with compression therapy or may require manual drainage if compression is ineffective.
2. When you cut your finger, which line of defense is compromised? Why do we cover a wound with a bandage?
When you cut your finger, the first line of defense against pathogens is compromised. The skin, along with the mucous membranes, is a continuous surface barrier comprised of a multi-layered, strong endothelium and sebaceous glands which prevent invasion and growth of pathogens. When the surface barrier is punctured, we must cover the wound with a bandage in order to temporarily replicate the protective qualities of the skin and prevent pathogens from entering while the wound heals.
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3. After reading both articles, I am both happy for the new labels but also disappointed that it was not designed in a more user-friendly way. I do believe that it is a great step that the government is addressing the issue and is able to make updates, as minor those updates may be. The New York Times article made a great point that the consumers the changes are being made for are the people who are most likely not reading the label and that there are many people who are not educated enough to even understand the measurements or what the ingredients stand for.
One of the aspects of the new label that I think will be beneficial is the increased serving size for the different types of food. For example, a whole 20 oz of soda (the whole bottle) will now be the actual serving size, instead of it saying (8 oz) and then expecting the consumers to either only drink 8oz or to do the math to multiply that number my 2.5. I also think it changing where the sugars are found and splitting it up into natural sugars vs. artificial is beneficial.
What I feel they need to have done is change some of the language or measurement choices. Instead of using grams, use teaspoons. Instead of listing that you are in taking calories by the number (which I think they should still do) but they should post the percentage of how much of those calories they are in taking out of their daily intake. Or list that its not healthy to have more that one serving of this food because its sugar content is too high for your daily intake.
I think that the new labels may deter people from eating certain foods if they are the kind of people who look at labels but a lot of people don’t and I think they need to have a better way of describing what foods are healthy vs. not. I’m not sure if this looks like having a color-coded label with different colors representing nutrition levels, or if we should follow the European model of having a certain number of dots representing the health level. There needs to be an easier way to understand you may be eating something very unhealthy for you.
4. I really appreciate all of the small changes that the FDA made to the nutrition facts label. Increasing the font of the most important pieces of information like calories and serving size is a great way to emphasize them and hopefully help customers take notice. The altering of the serving size to the increased ‘normally consumed’ amount is a nice step – especially because it easily informs the person the food the exact nutritional information for the amount that they are consuming.
The new label has the ability to greatly aid those who read it in making informed decisions about their food choices; however, the label is ignored by many people. The individuals who do take the time to investigate the label and discover what is in their food, nutrients and ingredients, will surely benefit, but making the font larger and restricting the layout of the nutrients will be futile if the table is ignored. I would never happen, but putting the label on the front of the packaging would be a sure way to have the label be more visible. Manufactures would fight that decision with all of their might because they would never want to be forced to include a black and white graphic on packaging that they have paid exuberant amounts of money to grab customers’ attention and establish a recognizable brand. The new, streamlined description of a typical 2,000 calorie diet should help with comprehension, but I wonder if there is a way to establish a base line for what a typical amount of calories is. By including that a typical apple is expected to have X calories, consumers may be able to compare foods to see how calorie dense the food is.