Autonomy, Capacity and Dignified Death

Autonomy, Capacity and Dignified Death Summary: The Council of Europe protects the right of people in terminal phase or dying, to self-determination. But only if the patient is competent, you can make independent decisions about their health. The capacity will be assessed by doctors to consider as valid informed consent. Keywords: Personal Autonomy; Mental Competency; Right to Die; Decision making; Bioethics; Informed consent; Validation Studies. Manuscript The doctor-patient relationship, nowadays, follows the clinical method â€Å"focused on the patient† where the physician has a double task, understand the patient and understand the disease, in this context are key exploring the experience of illness, shared decision making and the search for agreements to which the patient is able to take responsibility for their own salud1. In this manner, it could be considered the patient medical encounter as a meeting of experts, Doctors are experts in medical science and patients are experts in their lives. And this is because modern ethics has transformed the maximum standard Hippocratic â€Å"aegroti salud suprema lex† in â€Å"aegroti voluntas suprema lex†, that is, now is not the health of the sick the supreme law because it is his will (Sass)2. The emergence of the value of personal autonomy has profoundly changed the values of the clinical setting, it must now adapt to the individuality of the sick person. In a democr atic society, respect for the freedom and autonomy of the person must be kept during the illness and fully achieve the process of death3. Ten years ago, on October 19, 2005, the General Conference of UNESCO adopted the Universal Declaration on Bioethics and Human Rights4, which states, in Article 5, it must respect the autonomy of the individual in relation to the power to make decisions. The exercise of this right leads us to define and protect the ideal of a dignified death, and that is if all human beings aspire to live with dignity, die with dignity is also part of a dignified life. Among the fundamental contents of the ideal of death with dignity that enjoy consensus, is the right of patients to receive comprehensive high-quality palliative care. Recommendation 1418/1999 of the Parliamentary Assembly of the Council of Europe, 5 Protection of human rights and dignity of the terminally ill and dying in Article 9, paragraph B, protects the right of the terminally ill or dying to s elf-determination, and also recommends taking steps to ensure that health decision, which elects the patient or their family may be respected, including the rejection of a specific treatment measures. It also recognizes that a death wish of a terminally ill or dying person cannot in itself constitute a legal justification for actions to end his life. In Spain is not authorized euthanasia or assisted suicide and other actions are considered good practice to record the living will to make decisions about the refusal of treatment, the limitation of life support and palliative sedation. With this in mind, we asked if a sick person is able to make a decision about their health, sick people are able to make that decision and at that particular moment? If we believe in informed consent as an ongoing process, communicative, dialogic (spoken), deliberative and conservative, we need a patient with capacity made (competition) to make decisions about the nature of his illness, the effects of it and the risks and benefits of diagnostic and therapeutic procedures, requesting approval to undergo any them6. Thus the purpose of informed consent is obtained; We talk about guaranteeing the rights of patients, empower, protect the patient from unwanted treatment and help you make the right decisions about health care, so that they are correlated with their personal values. The capacity to which we refer is the competition that the doctor can and should evaluate in the clinical practice and is what we call capacity of made or natural7. It is a psychological and clinical concept, defining the psychological skills needed to take, here and now, a certain decisià ³n8. Only if the patient is competent, you can make independent decisions about their health9, therefore, assess the ability of the patient is in fact a fundamental requirement in the process of informed consent. Capacity is the ability of the person to understand the situation it faces, the values that are at stake, the pos sible courses of actions and expected consequences for, then take express and defend a decision that is consistent with their own values. It varies over time, if mental status changes, also capacity10. The Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the application of biology and medicine, the Council of Europe, commonly called the Oviedo Convention, in force since 1 January 200011, in articles 6, 7, 17 and 20 deal with the problem of lack of capacity to consent freely. Thus, the most important ethical argument of the obligation to assess the competence or ability of a patient is the principle of nonmaleficence, for those actions that may cause physical or moral harm to persons should be avoided. And so maleficent will allow the patient natural inability to take decisions, which can cause health damage, such as preventing the patient able to exercise its autonomy to decide. There is also the obligation of beneficence, optimize the part icipation of the incompetent patient in decision-making, by all possible means, to reverse, if possible, your disability, or provide information so that you can participate in the decision the extent possible9. Evaluating and determining the ability to make a medical decision a patient is a task that involves an enormous ethical and legal responsibility. Codes of ethics widely collected an ethical obligation to professionals for consider the patients competence. Historically, the doctors has enjoyed considerable social recognition, for determine the capacity. However, the use of standardized tools for assessment of competence is vital, given that informal evaluations by doctors depend on the idiosyncrasies of each and therefore would be little fiables12. This is the same problem that arose in the United States in the late seventies, when American physicians began systematically applied in clinical practice informed consent. After more than thirty years in this line, it is considered what the best tool available, in health care, for the assessment of the ability to make medical decisions is the Aid to capacity evaluation (ACE)13. Its literal translation would help to assess capacity. Understood the term capacity, from the perspective of bioethics, as a synonym for competence in decision-making. For this, the ACE evaluates the understanding of information, and the ability of the patient to say and communicate a particular medical decision. The ACE is validated in the initial work of Etchells et al, in adult patients who needed to make an informed consent treatments or diagnostic procedures, such as endoscopies performing, transfusion, etc. The ACE evaluates recognition the disorder of convivence and the understanding of informed consent (Etchells at al., 1999)14. It was developed in Ontario, Canada, where these two standards are relevant to the current legislation. Recently, it has been adapted and validated to Spanish (Moraleda et al15), both diagnostic and tre atment processes to make decisions about their disease. The ACE is a semi-structured interview assessment that addresses seven facets of the capacity for real and concrete medical decision assesses the ability to understand (1) the medical condition, (2) treatment, (3) and treatment alternatives (4) the option of refusing treatment; the ability to perceive the consequences of (5) to accept treatment and (6) deny treatment; and (7) the possibility that the patient is in a context of hallucinations, delusions or depression, which can significantly interfere in their decision making. The questions in the first four areas assessed the capacity of understanding. Questions 5 and 6 explore the reasoning. And in the seventh area of mental pathology situations which clearly affect the ability clarified. See Table 1. This tool is considered highly reliable and has a sensitivity of 81% and a specificity of 90%, comparing the judgment of expert medical interview conducted with ACE. Some of the advantages of ACE are its realization in a short time and that is adapted to the clinical case and the specific treatment of each patient. The health professional provides all the information as possible to the patient, and values its ability asking open-ended questions about the decision to take, alternatives, possible consequences, and the possibility of rejecting the offer option. Scores are not added together, to interview the patient about his decision, aspects of understanding of information and the ability of the patient to decide and communicate a particular medical decision are evaluated. This type of semi-structured interview requires a basic training by the professional and helps to classify the patient into one of the following four categories: capable, probably capable, probably incapable or incompetent. And in turn, these four results are divided into two: the incapable of making that decision would be unable and the others are capable. The cut is made according to the criteria of patient autonomy. The principle of respect for persons, of Kantian origin, is based on the dignity of the person, is its moral autonomy, and therefore freedom. It requires that every human being are regarded autonomous and free, imposing respect for their dignity and self determination. Therefore they must be respected their decisions if a person is able, competent and adequately informed. And likewise, this principle requires the development of legal mechanisms for the protection of individuals where these attributes were limited, as in the case of patients classified as permanently incapable. Traditionally, the principle of autonomy is expressed in all its value, it must be considered that an autonomous action must meet three conditions: intent, knowledge and absence of external control. Diego Gracia16 added a fourth condition: authenticity. If an act is intentional, if it has been made with full understanding and without control or external undue influence, but is not consistent with the value system and attitude toward life, typical of who performs it, is not an authentic act, and therefore, it is not t ruly autonomous. The interview with the ACE is a very useful tool, but to doubtful cases or more complex decisions are recommended to complete the interview with other evaluation measures that will help us reduce uncertainty in determining the ability of a patient to a medical decision. In case of incapacity consent is granted of representation. It is considered that an individual is unable if it is not able to make a particular decision at a particular time, at the discretion of the physician responsible for the care, or physical or mental condition and does not allow him to take charge of their situation. Moreover, it is considered that a patient is disabled when a judge has determined this, as stated in Article 199 of the Civil Code, in Spain. And in the case of minors, the consent of the representation will be required when the minor patient (over 12 or 16 years, depending on the decision and under 18 years of age), it is not intellectually or emotionally capable of understand t he scope. With minors, the mission is to demonstrate the maturity, unlike what happens with adults. With the adults is necessary evaluate the clinical disability as it is supposed to be able. Diego Gracia17 recommended that the assessment of mental capacity must be reasonable and reasoned, assessing the circumstances, previous medical history, current psychopathological assessment, family and social support, patient values, and the foreseeable consequences of the decision to take. In certain cases it may be useful the use of a semi-structured interview (ACE) to review the decision-making skills. In case of failure, the use of deliberative method can be helpful to assess each case. Determining the ability of fact (capacity), before taking a decision, in the processes of decision making, it is a habit that all doctor should include in their daily work, is an improvement in the organization and management of resources because it means improving the principles of bioethics with our most fragile patients.

Explain the Main Difficulties That are Faced During Overseas Study Essay

As Australian universities have obtained popularity in the worldwide zone, the number of overseas students has been increased progressively. Accompanying with the overseas study trend, numerous difficulties that are faced during the overseas study appeared. To be specified, the term â€Å"overseas study† in this essay can be defined as students from those non-English speaking countries, especially Asian countries, receive the tertiary education in Australian universities. There are many difficulties can be encountered during the overseas study, some of which are the barrier of language, the new mode of education and the difference of culture. Firstly, the general problem in the overseas study is the language barrier. Although the language abilities of overseas students have been tested and verified by the language tests such as IELTS or TOEFL, there are still some obstacles in the English usage for academic purpose and daily communication. For instance, on campus lectures, tutorials, consultations and discussions are normally conducted in English, so there can be a huge number of technical terms that have never been heard by those international students. It may cause inaccurate understanding of some certain problems. The fast-talking and the use of slang during off campus everyday life such as the purchase of food, clothes and other necessities can also make a confusing. Therefore, academic or special usage of English can lead to some trouble in understanding as the incomprehension of English usage of those overseas students. The second difficulty that can be faced during the overseas study is completely different mode of learning. As differences of education widely exist among countries and also the gap between elementary education and tertiary education is generally concerned, overseas students will face two huge changes while receiving education abroad. To give an example, in many Asian countries, the study style before college is more like being driven or in another word, passive, whereas the tertiary education undertaken in Australian universities is more inclined to an independent process. As a consequence, the lack of motivation and automaticity can be shown on some overseas students that the education of those students may not be continued. Thirdly, the difference of culture is considered as one of the main difficulties that can be faced during overseas study. Culture varies from country to country, and the culture difference between Asian countries and Australia is tremendous. The hard adaption of culture difference should be made. For example, the food culture, the clothing culture and the religious culture can be quite different. A lot of Asian students used to have lunch as the main meal, however, in Australia, supper is regarded as the main meal. Hence, overseas study can be hard when spending time and energy on making adaption of these differences. In conclusion, the three main difficulties that are faced during the overseas study are the barrier of language due to the incomprehension of some specific terms and usage in English; the entirely different way of learning which depends on the independence; the huge difference of disparate culture which can be hard to be adapted. Of the three difficulties, the culture difference is the toughest because it is hard for an international student to adjust himself from a background to a wholly unlike one.

History and Development of St. Peter Lifeplan Essay

Francisco à ¢Ã¢â€š ¬Ã…“Tatayà ¢Ã¢â€š ¬Ã‚  Bautista had learned to deal with lifeà ¢Ã¢â€š ¬Ã¢â€ž ¢s hardship at an early age. He lived in a small farmland and worked as a carpenter and farmer in San Mateo and dreamt of a better future after a dayà ¢Ã¢â€š ¬Ã¢â€ž ¢s work sitting on top of a carabao. He grew up into a man fiercely determined to succeed. His triumphs over the impediment that he encountered and his immeasurable trust in God were his source of strength and guidance as he worked his way up making his dream a reality. B. Planning Stage Being the known carpenter in their place, the family members of the person who passed away asked him to make casket because during that time, only those who belong to well-known and wealthy families could afford to buy caskets from the casket manufacturing companies. Mr. Bautista saw the discrimination between those who belong to the poor and wealthy families with regards to the quality of funeral services they get when they die. So when he got a small capital to start with, he and his beloved wife Basilisa à ¢Ã¢â€š ¬Ã…“Nanayà ¢Ã¢â€š ¬Ã‚  Roque-Bautista founded St. Peter Life Plan, Inc. in Pampanga to cater to the needs of the the poor at the price they can afford. Upon the establishment of their business, they have the following information: VISION The St. Peter Group of Companies are Death Care Experts, the choice of every Filipino in the delivery of world-class Death Care services à ¢Ã¢â€š ¬Ã¢â‚¬Å" a progressive partner in nation building. MISSION As Death Care Experts and responsible citizens, we commit to improve the quality of life of St. Peterians, their stakeholders and the Filipino people. VALUES The key to the long-term success of St. Peter is how well every member of the organization embraces their Corporate Values. * God-centered à ¢Ã¢â€š ¬Ã¢â‚¬Å" As St. Peterians, they are prayerful, sincere, moral and committed in promoting the Word of God, enjoying, loving and consistently modelling a true St. Peterian way of life. * Excellence à ¢Ã¢â€š ¬Ã¢â‚¬Å" Equipped with a winning attitude and resolved to be the best, they commit to achieve peak performance and to stretch their limits through personal and professional development in order for them to offer all they do for the glory of God. * Teamwork – St. Peterians are supportive, assertive, reliable and open to diversity. They build enthusiasm and draw their energies from each other. Their sense of family unites them to become Death Care experts. * Integrity – They are committed to be honest, transparent, credible and to do what is right before God and the country. They are what they value. * Customer Service â₠¬â€œ They serve each other. They believe that everyone is a customer. It is their commitment to the plan holders, internal and external partners to be reliable-prioritizing their needs and to innovate their services. * Employee Satisfaction – Engaging their employees, associates, colleagues and partners to bring out the best in them. They are committed to care for their employeeà ¢Ã¢â€š ¬Ã¢â€ž ¢s welfare, growth and development for that brings about a solid sense of proprietorship and pride in what they do. * Professionalism – As St. Peterians, they are objective, disciplined, ethical, respectful, fair and just in all their dealings. They present themselves well in their appearance and words. II. GROWTH AND DEVELOPMENT The incessant efforts and fortitude of Francisco Bautista bore fruit when he established another company which later on provide world-class Death Care Service- the St. Peter Memorial Chapels, Inc. The main location of the said business is located at No. 296 Quezon Avenue, Roxas District, Quezon City. St. Peter Life Plan, Inc. continued to grow until it became known nationwide. They established high-class buildings with complete facilities on different regions and provinces of the country in order to give the satisfaction-maximizing services to their customers. They hired more employees with higher salaries than before to manage their businesses and branches. With over 40 years of experience in Death Care on 2005, St. Peter Life Plan, Inc. had branches and mortuary tie-ups, or affiliations with funeral service companies in every major city and key areas all over the Philippines. It led the industry by ranking first in gross sales in the life plan category of the pre-need industry selling over 25,000 plans in 2003. On April 27, 2010, the St. Peter Mega Chapel in Cebu City was launched. It is the newest and one of the largest funeral complex in Visayas. It is strategically located at the New Imus Street near Ayala Cebu Centre. This Mega Chapel is a spacious and fabulous building with an ambiance which is close to a 5-star Hotel and features amazing architectural designs and a relaxing atmosphere. It features spacious and elegant viewing rooms, a caske showroom and a state-of-the-art crematorium that uses hi-tech and eco-friendly cremation machines. A room which can hold more than 350 visitors, St. Peter Mega Chapel can be an alternative reception venue for any occasion. With its excellent facilities and genuine customer service, ST. Peter Chapels is truly world-class. Since its inception in 2006, a total of two hundred ninety four St. Peterian Embalmers have passed the Embalmerà ¢Ã¢â€š ¬Ã¢â€ž ¢s Licensure Examination through the Embalmerà ¢Ã¢â€š ¬Ã¢â€ž ¢s Licensure Program of St. Peter Chapels. It aims to professionalize the embalming profession not only in every St. Peter Chapels but also in the Philippine DeathCare Service industry. III. THE PRESENT SITUATION St. Peter now operates three (3) elite memorial chapels in the heart of commercial district of Quezon City, Cebu City and Davao City which have been providing professional and traditional services to the public for over 42 years. Currently, there are more than 200 St. Peter Chapels ready to serve the public with superior quality memorial services nationwide. St. Peter Life Plan Inc. has also St. Peter Cremation Plan now with the office located at Quezon City. St. Peter Chapel is one of the seven distinguished winners of the 2012 Asian Funeral Expo (AFE) Awards, the premier award for the funeral industry across the Asia-Pacific region. Saint Peter Life Plan, Inc. continues to excel in its role in society as being The DeathCare Experts, by maintaining its leadership in the DeathCare industry and in product development in the market such as Customized At-Need and Pre-Need Packages, Death Event Management and similar Pre-Need Plans. On top of its superb DeathCare services, St. Peter Chapels is also known for its innovative value-added services collectively referred to as the St. Peter eServices, specially: 1. eBurol (online viewing), 2. eLibing (online interment)à ¢Ã¢â€š ¬Ã¢â€ž ¢ 3. Timeless Tribute (life-story audio-visual presentation) and, 4. St. Peterà ¢Ã¢â€š ¬Ã¢â€ž ¢s Gate (memorial networking site). The St. Peter Group of Companies always strive to provide reliable and outstanding DeathCare services not just for the Filipino but also for any nationality who will be needing immediate services anytime and anywhere in the Philippines. The St. Peter Group of Companies continues to support its employees by providing them opportunity for their professional growth and development. The Management Development Program (MDP), dubbed as à ¢Ã¢â€š ¬Ã…“Unlad Talentoà ¢Ã¢â€š ¬Ã‚ , is designed to help St. Peter employees to better understand the business environment and further sharpen their knowledge, skills and attitude towards different areas of management. MDP is a ten-month long program of courses in the Masters of Business Administration curriculum and is facilitated by Mr. Albert Buenviaje, Dean of the Ateneo Graduate School of Business and also the St. Peter MDP Program Director. This year, fifty participants from various St. Peter Chapels and offices nationwide were carefully selected to undergo this learning opportunity. As part of the companyà ¢Ã¢â€š ¬Ã¢â€ž ¢s value for employee satisfaction, a new healthcare program was launched to respond to the needs of SPLPI employees to face family illnesses safely and with confidence. All employees will continue to receive exactly the same health benefits with the bonus of access to safe and affordable healthcare benefits for their qualified dependents. The company takes care of hospital bills. St. Peter Life Plan, Inc. is taking another step forward to help eliminate the effects of El NiÃÆ' ±o and greenhouse gases. St. Peter, with the support of Green Earth Foundation, Inc. (GELFI) launches à ¢Ã¢â€š ¬Ã¢â€ž ¢Ãƒ ¢Ã¢â€š ¬Ã¢â€ž ¢Soul Treesà ¢Ã¢â€š ¬Ã¢â€ž ¢Ãƒ ¢Ã¢â€š ¬Ã¢â€ž ¢ a carbon off-setting program which aims to plant new trees and save our environment. This program represents their care for Mother Nature with strong commitment to protect it. It aims to further provide public awareness on the importance of a holistic approach to agro forestry and community development through actively engaging in re-forestration most especially to areas most impacted by deforestation. St. Peter employees and officers take part in planting a total of 70,000 trees in Luzon as the Soul Trees Project begins. Another St. Peter initiative to reduce carbon dioxide emission is the conversion of their Suburban hearses from Petrol to Liquefied Petroleum Gas (LPG) operated engines. ST. Peterians also actively advocate Earth Hour à ¢Ã¢â€š ¬Ã¢â‚¬Å" a global event organized by World Wide Fund. It encourages households and businesses to turn off their non-essential lights and other electrical appliances for one hour to raise awareness towards the need to take action on climate change. IV. FUTURE PLANS The company dreams to continue their success and prosperity for decades to come. At this point in time, St. Peter Life Plan, Inc. plans to expand the business by adding more branches all over the Philippines to extend and further improve their services to every Filipino home. V. FINDINGS Basically, St. Peter Life Plan Inc. now has four kinds of business: The Life Insurance Plan; the Casket Manufacturing Business which is located in Pampanga; the St. Peter Chapels that provides funeral services; and the Crematory business. Based on the previous information, St. Peter Life Plan, Inc. began as a small business operated by a carpenter-farmer named Francisco Bautista. From a small business, it evolved into a larger business and became a company. It became known from the different places in the Philippines and became more successful and progressive.

The Versailles Peace Settlement and its Failure to Secure...

The Versailles Peace Settlement and its Failure to Secure British Foreign Policy Interests 1) British Foreign Policy interests at the time Peace - Britain had everything to lose and nothing to gain from a war. Balance of Power – Best insurance against renewal of war. Global interests rather than just continental. Preservation of empire Preservation of navy – had best navy fleet. Remain on good terms with USA – expenses. Britain needed to be defended – Security of UK - Protection of trade routes - Defence of the empire - Co-operate in defence of British allies. 2) The main aims of the Versailles settlement Make it so that Germany could not gain power (military or other)†¦show more content†¦After its loss of life in world war one, although a victor, Britain did not have the resources or expenses to enter into another war, therefore it had everything it had left to lose and very little, possible nothing to gain. Staying out of any major conflict was also a good idea for Britain, especially with the USA because Britain did not have the finances to support a conflict. The best way to stop the renewal of war was to keep a balance of power; this is a realist theory in international relations. In parliamentary politics, a balance of power refers to the position held by one party, or a coalition, whose support of a minority parliament, can give a major party enough votes to be able to form a stable government. This can be achieved either by the formation of a coalition government, or by voting with the party in power to prevent its defeat. Britain also needed to be defended both i nternally and externally. The trade routes that Britain used were mainly through france and Germany into other neighbouring countries, without this entry, Britains trade would decrease, meaning unemployment and reduced customer demand. 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