Health Care

8) Sources ……………………………………………………………… 16 ) HISTORY Modern Western medicine has been practiced in Cuba by formally trained doctors since at least the beginning of the 19th century and the first surgical clinic was established in 1823. Cuba has had many world class doctors, including Carlos Finlay, whose mosquito-based theory of yellow fever transmission was given its final proof under the direction of Walter Reed, James Carroll, and Aristides Agramonte. During the period of U. S presence (1898–1902) yellow fever was essentially eliminated due to the efforts of Clara Maass and surgeon Jesse W. Lazear.

In 1976, Cuba’s healthcare program was enshrined in Article 50 of the revised Cuban constitution which states “Everyone has the right to health protection and care. The state guarantees this right by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease.

All the population cooperates in these activities and plans through the social and mass organizations. Cuba’s doctor to patient ratio grew significantly in the latter half of the 20th century, from 9. 2 doctors per 10,000 inhabitants in 1958, to 58. 2 per 10,000 in 1999. In the 1960s the government implemented a program of almost universal vaccinations. This helped eradicate many contagious diseases including polio and rubella, though some diseases increased during the period of economic hardship of the 1990s, such as tuberculosis, hepatitis and chicken pox.

Other campaigns included a program to reduce the infant mortality rate in 1970 directed at maternal and prenatal care. 1. POST-SOVIET UNION The loss of Soviet subsidies brought famine to Cuba in the early 1990s. In 2007, Cuba announced that it has undertaken computerizing and creating national networks in Blood Banks, Nephrology and Medical Images. Cuba is the second country in the world with such a product, only preceded by France.

Cuba is preparing a Computerized Health Register, Hospital Management System, Primary Health Care, Academic Affairs, Medical Genetic Projects, Neurosciences, and Educational Software. The aim is to maintain quality health service free for the Cuban people, increase exchange among experts and boost research-development projects. An important link in wiring process is to guarantee access to Cuba’s Data Transmission Network and Health Website (INFOMED) to all units and workers of the national health ystem. 2) PRESENT | | | | |WHO health statistics for Cuba | |[Source: WHO country page on Cuba] | |Life expectancy at birth m/f: |76. 0/80. (years) | |Healthy life expectancy at birth m/f: |67. 1/69. 5 (years) | |Child mortality m/f: |8/7 (per 1000) | |Adult mortality m/f: |131/85 (per 1000) | |Total health expenditure per capita: |$251 | |Total health expenditure as % of GDP: |7. 3 | Rank |Countries | |Statistic |Date of | | |surveyed | | |Information | |125 |167 |HIV/AIDS adult prevalence rate |0. 10% |2003 est. | |162 |175 |Fertility rate |1. 66 (children/woman) |2006. | |153 |224 |Birth rate |11. 9 (births/1,000 population) |2006 est. | |168 |226 |Infant mortality rate |6. 04 (deaths/1,000 live births) |2006. | |129 |224 |Death rate |6. 33 (deaths/1,000 population) |2005. | |37 |225 |Life expectancy at birth |77. 23 (years) |2006. est | |17 |99 |Suicide rate |18. 3 per 100,000 people per year |1996. | 3) COMPARISON OF PRE- AND POST-REVOLUTIONARY INDICES |Cuba: Public health 1950-2005 | |  |Years | | | 1. HEALTH INDICATORS AND ISSUES Cuba began a food rationing program in 1962 to guarantee all citizens a low-priced basket of basic foods.

As of 2007, the government was spending about $1 billion annually to subsidise the food ration. The ration would cost about $50 at an average grocery store in the United States, but the Cuban citizen pays only $1. 20 for it. The ration includes rice, legumes, potatoes, bread, eggs, and a small amount of meat. It provides about 30 to 70 percent of the 3,300 kilocalories that the average Cuban consumes daily. The people obtain the rest of their food from government stores (Tiendas), free market stores and cooperatives, barter, their own gardens, and the black market.

According to the Pan American Health Organization, daily caloric intake per person in various places in 2003 were as follows (unit is kilocalories): Cuba, 3,286; America, 3,205; Latin America and the Caribbean, 2,875; Latin Caribbean countries, 2,593; United States, 3,754. The table below shows the relative seriousness of communicable diseases, non-communicable diseases (e. g. , heart disease and cancer) and injuries, in various parts of the world. Data is from the World Health Organisation and is for year 2004. Distribution of years of life lost by cause (%) | |Place |Communicable |Non-communicable |Injuries | |Cuba |9 |75 |16 | |World |51 |34 |14 | |High income countries |8 |77 |15 | |United States |9 |73 |18 | |Low income countries |68 |21 |10 | | | |Source: World Health Organisation. World Health Statistics 2009, Table 2, “Cause-specific | |mortality and morbidity”. | Like the rest of the Cuban economy, numerous reports have shown that Cuban medical care has long suffered from severe material shortages caused by the US embargo. The ending of Soviet subsidies in the early 1990s has also affected it. While preventive medical care, diagnostic tests and medication for hospitalized patients are free, some aspects of healthcare are paid for by the patient.

Items which are paid by patients who can afford it are: drugs prescribed on an outpatient basis, hearing, dental, and orthopedic processes, wheelchairs and crutches. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge. 2. SEXUAL HEALTH • According to the UNAIDS report of 2003 there were an estimated 3,300 Cubans living with HIV/AIDS (approx 0. 05% of the population). In the mid-1980s, when little was known about the virus, Cuba compulsorily tested thousands of its citizens for HIV. Those who tested positive were taken to

Los Cocos and were not allowed to leave. The policy drew criticism from the United Nations and was discontinued in the 1990s. Since 1996 Cuba began the production of generic anti-retroviral drugs reducing the costs to well below that of developing countries. This has been made possible through the substantial government subsidies to treatment. • In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest in the world. The UNAIDS reported that HIV infection rates for Cuba were 0. 1%, and for other countries in the Caribbean between 1 – 4%. Education in Cuba concerning issues of HIV infection and AIDS is implemented by the Cuban National Center for Sex Education. According to Avert, an international AIDS charity, “Cuba’s epidemic remains by far the smallest in the Caribbean. ” They add however that … new HIV infections are on the rise, and Cuba’s preventive measures appear not to be keeping pace with conditions that favour the spread of HIV, including widening income inequalities and a growing sex industry. At the same time, Cuba’s prevention of mother-to-child transmission programme remains highly effective. All pregnant women are tested for HIV, and those testing positive receive antiretroviral drugs. • In recent years because of the rise in prostitution due to tourism, STDs have increased. 3. 3 EMBARGO

During the 90s the ongoing United States embargo against Cuba caused problems due to restrictions on the export of medicines from the US to Cuba. In 1992 the US embargo was made more stringent with the passage of the Cuban Democracy Act resulting in all U. S. subsidiary trade, including trade in food and medicines, being prohibited. The legislation did not state that Cuba cannot purchase medicines from U. S. companies or their foreign subsidiaries; however, such license requests have been routinely denied. In 1995 the Inter-American Commission on Human Rights of the Organization of American States informed the U. S. Government that such activities violate international law and has requested that the U. S. ake immediate steps to exempt medicine from the embargo. The Lancet and the British Medical Journal also condemned the embargo in the 90s. A 1997 report prepared by Oxfam America and the Washington Office on Latin America, Myths And Facts About The U. S. Embargo On Medicine And Medical Supplies, concluded that the embargo forced Cuba to use more of its limited resources on medical imports, both because equipment and drugs from foreign subsidiaries of U. S. firms or from non-U. S. sources tend to be higher priced and because shipping costs are greater. The Democracy Act of 1992 further exacerbated the problems in Cuba’s medical system. It prohibited foreign subsidiaries of U. S. orporations from selling to Cuba, thus further limiting Cuba’s access to medicine and equipment, and raising prices. In addition, the act forbids ships that dock in Cuban ports from docking in U. S. ports for six months. This drastically restricts shipping, and increases shipping cost some 30%. 3. 4 MEDICAL STAFF IN CUBA According to the World Health Organization, Cuba provides a doctor for every 170 residents, and has the second highest doctor to patient ratio in the world after Italy. Medical professionals are not paid high salaries by international standards. In 2002 the mean monthly salary was 261 pesos, 1. 5 times the national mean. A doctor’s salary in the late 1990s was equivalent to about US$15–20 per month in purchasing power.

Therefore, some prefer to work in different occupations, for example in the lucrative tourist industry where earnings can be much higher. The San Francisco Chronicle, the Washington Post, and National Public Radio have all reported on Cuban doctors defecting to other countries. 3. 5 BLACK MARKET HEALTHCARE The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba’s burgeoning black market economy, sometimes termed “sociolismo”. According to former leading Cuban neurosurgeon and dissident Dr Hilda Molina, “The doctors in the hospitals are charging patients under the table for better or quicker service. ” Prices for out-of-surgery X-rays have been quoted at $50 to $60.

Such “under-the-table payments” reportedly date back to the 1970s, when Cubans used gifts and tips in order to get health benefits. The harsh economic downturn known as the “Special Period” in the 1990s aggravated these payments. The advent of the “dollar economy”, a temporary legalization of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans was able to obtain medications and health services that would not be available to them otherwise. 4) CUBA AND INTERNATIONAL HEALTHCARE In the 1970s, the Cuban state initiated bilateral service contracts and various money-making strategies.

Cuba has entered into agreements with United Nations agencies specializing in health: PAHO/WHO, UNICEF, the United Nations Food and Agriculture Organization (FAO), the United Nations Population Fund (UNFPA), and the United Nations Development Fund (UNDP). Since 1989, this collaboration has played a very important role in that Cuba, in addition to obtaining the benefits of being a member country, has strengthened its relations with institutions of excellence and has been able to disseminate some of its own advances and technologies Cuba currently exports considerable health services and personnel to Venezuela in exchange for subsidized oil. Cuban doctors play a primary role in the Mission Barrio Adentro (Spanish: “Mission Into the Neighborhood”) social welfare program established in Venezuela under current Venezuelan president Hugo Chavez.

The program, which is popular among Venezuela’s poor and is intended to bring doctors and other medical services to the most remote slums of Venezuela, has not been without its detractors. Operacion Milagro (Operation Miracle) is a joint health program between Cuba and Venezuela, set up in 2005. Human Rights Watch complains that the government “bars citizens engaged in authorized travel from taking their children with them overseas, essentially holding the children hostage to guarantee the parents’ return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics. ” Doctors are reported to be monitored by “minders” and subject to curfew.

The Cuban government uses relatives as hostages to prevent doctors from defecting. According to a paper published in The Lancet medical journal, “growing numbers of Cuban doctors sent overseas to work are defecting to the USA”, some via Colombia, where they have sought temporary asylum. Cuban doctors have been part of a large-scale plan by the Cuban state to provide free medical aid and services to the international community (especially third world countries) following natural disasters. Currently dozens of American medical students are trained to assist in these donations at the Escuela Latino Americana de Medecina (ELAM) in Cuba. 4. 1 HEALTH TOURISM AND PHARMACEUTICS

Cuba attracts about 20,000 paying health tourists, generating revenues of around $40 million a year for the Cuban economy. Cuba has been serving health tourists from around the world for more than 20 years. The country operates a special division of hospitals specifically for the treatment of foreigners and diplomats. Foreign patients travel to Cuba for a wide range of treatments including eye-surgery, neurological disorders such as multiple sclerosis and Parkinson’s disease, cosmetic surgery, addictions treatment, retinitis pigmentosa and orthopaedics. Most patients are from Latin America, Europe and Canada, and a growing number of Americans also are coming.

Cuba also successfully exports many medical products, such as vaccines. By 1998, according to the Economic Commission for Latin America and the Caribbean, the Cuban health sector had risen to occupy around two percent of total tourism. Some of these revenues are in turn transferred to health care for ordinary Cubans, although the size and importance of these transfers is both unknown and controversial. At one nationally prominent hospital/research institute, hard currency payments by foreigners have financed the construction of a new bathroom in the splanic surgery wing; anecdotal evidence suggests that this pattern is common in Cuban hospitals. 5) ALTERNATIVE HEALTHCARE

Economic constraints and restrictions on medicines have forced the Cuban health system to incorporate alternative and herbal solutions to healthcare issues, which can be more accessible and affordable to a broader population. In the 1990s, the Cuban Ministry of Public Health officially recognized natural and traditional medicine and began its integration into the already well established Western medicine model. Examples of alternative techniques used by the clinics and hospitals include: flower essence, neural and hydromineral therapies, homeopathy, traditional Chinese medicine (i. e. acupunctural anesthesia for surgery), natural dietary supplements, yoga, electromagnetic and laser devices.

Cuban biochemists have produced a number of new alternative medicines, including PPG (policosanol), a natural product derived from sugarcane wax that is effective at reducing total cholesterol and LDL levels, and Vimang a natural product derived from the bark of mango trees. 6) MEDICAL RESEARCH IN CUBA The Cuban Ministry of Health produces a number of medical journals including the ACIMED, the Cuban Journal of Surgery and the Cuban Journal of Tropical Medicine. Because the U. S. government restricts investments in Cuba by U. S. companies and their affiliates, Cuban institutions have been limited in their ability to enter into research and development partnerships, although exceptions have been made for significant drugs. In April 2007, the Cuba IPV Study Collaborative Group reported in the New

England Journal of Medicine that inactivated (killed) poliovirus vaccine was effective in vaccinating children in tropical conditions. The Collaborative Group consisted of the Cuban Ministry of Public Health, Kouri Institute, U. S. Centers for Disease Control and Prevention, Pan American Health Organization, and the World Health Organization. This is important because countries with high incidence of polio are now using live oral poliovirus vaccine. When polio is eliminated in a country, they must stop using the live vaccine, because it has a slight risk of reverting to the dangerous form of polio. The collaborative group found that when polio is eliminated in a population, they could safely switch to killed vaccine and be protected from recurrent epidemics.

Cuba has been free of polio since 1963, but continues with mass immunization campaigns. In the 1980s, Cuban scientists developed a vaccine against a strain of bacterial meningitis B, which eliminated what had been a serious disease on the island. The Cuban vaccine is used throughout Latin America. After outbreaks of meningitis B in the United States, the U. S. Treasury Department granted a license in 1999 to an American subsidiary of the pharmaceutical company SmithKline Beecham to enter into a deal to develop the vaccine for use in the U. S. and elsewhere. 7) ANALYSIS In 2006, BBC flagship news programme Newsnight featured Cuba’s Healthcare system as part of a series identifying “the world’s best public services”.

The report noted that “Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority” The report stated that life expectancy and infant mortality rates are nearly the same as the USA’s. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK’s. The report concluded that the population’s admirable health is one of the key reasons why Castro is still in power.

A 2006 poll carried out by the Gallup Organization’s Costa Rican affiliate — Consultoria Interdisciplinaria en Desarrollo (CID) — found that about three-quarters of urban Cubans responded positively to the question “do you have confidence to your country’s health care system”. In 2001, members of the UK House of Commons Health Select Committee travelled to Cuba and issued a report that paid tribute to “the success of the Cuban healthcare system”, based on its “strong emphasis on disease prevention” and “commitment to the practice of medicine in a community”. CUBA’S COMPREHENSIVE HEALTH PROGRAM: 1. Confronting the Real Disaster • Direct long-term medical care • Applying lessons from Cuban experience On-the-ground training of local personnel • Development and sharing of research • Academic training for Cubans at international sites • Trilateral cooperation • Scholarships for medical education • 29 countries involved (21 in Africa) 2. Direct Medical Services – Strengthening Health Systems • Bilateral government accords, identify needs • Bolster public health infrastructure, capabilities • Shared financial responsibility • Mainly remote, rural postings • Individual commitment/institutional commitment • Numbers of professionals enough to make a difference 3. Challenges and Opportunities – Bolstering Local Public Health Systems OpportunitiesChallenges ___________________________________________________________________ SustainabilityFrustration with local infrastructure Increase understanding locallyBend to local opinions Long-range perspective, understandingVulnerable to govt changes, political will Horizontal model, broad presenceIntegrate vertical programs Increase staffing for health systemCreate felt need in population Broad skill setMismatched, narrow skill set 4. Training Professionals for Global Health • At least 100,000 new doctors by 2015 • Second Latin American Medical School • Cuba has founded 11 medical schools and 2 nursing schools abroad • Cuban professors teach in a dozen others 5. Health Equity & Cooperation: Challenges They Face $$ Resources |Lacking |Wise use (still lacking…) | |Goals |Disease driven |Healthy people driven | |Programs |Silos |Blankets | |Models |Stand-alone |Building health systems | |Priorities |Donor driven |Effective local leadership | |Investments |In buildings |In people | |Reach |Pilot programs |Scaling Up | |Way |Independent |Real cooperation | |Movement |Band aids |Change | 8) SOURCES • The World Health Organisation, and its regional branch, the Pan American Health Organization, publish regular reports as well as making data available on the web. • World Health Organisation, World Health Statistics 2009 consists mostly of tables (. df format) of health indicators, for most countries, for selected years between 1990 and 2008. World Health Organisation, National Accounts Series consists of statistics on the financing of health care in various countries. Cuba tables covers years 1995-2007. • Pan American Health Organisation, Health situation in the Americas: Basic Indicators 2008. Table of health indicators for countries, one datum from a recent year (2000-2008) for each indicator. Pan American Health Organisation, Health in the Americas 2007 is primarily a text report; also contains tables. First section is on the region as a whole, second section is reports on individual countries, including Cuba.

Assisting skills The role of the heath care assistant in maintaining a safe and hygienic environment for client. Comprehensive description of clients needs. My client is 77 year old man with diabetes. He lives with his wife. My client is weak and depressed. He smokes cigarretes knowing that he is not allowed, he dont go out and the man is always grumpy. I dont know to much about him cause he never really talks but watch TV. He doesn’t have a children but his wife looks after him.

My task is to assist him with the shower, get ready all his toiletries beforehand, help him to leave his walker outside the door, make sure his feet is looked after well, make sure he wears a fresh, clean clothes every time after his shower. Accurate identification of assistance required. As my client has reduced vision and weakness I help him with his morning shower. My task is to make sure he is safely washed, I observe everything corectly and report everything in the book for the nurse.

My client use elderly walker with seat so everywhere he walks he is safe to sit down and rest for while even if it’s only short distance in the house. In the bathroom he sits on the chair and there is non slip bathroom mat as well. He has a very tick glasses because of his reduced vision. Gentleman has to take injections every day which gives him his wife. When I visit my client I make sure my hands are washed and I wear disposable apron and glows. I take my client to the bathroom which is nice and warm.

He walks with his walker till there. I make sure all things out of his way so he don’t bump into something hard cause he might not feel the pain that can worn him to a serious injury. In the bathroom my client first brush his teeth. For man hygiene I check if his toothbrush is changed every three months and he has a soft one cause hard one toothbrush can tear gum tissue which might bring to infection. For the man safety I make sure that shower is warm not hot cause that could dry out his skin which is not safe for diabetic. I use mild hower gel If there is any scratches on my client’s skin I use soft soap and water to wash it off not alcohol or antiseptic hygiene creams. After his shower I put moisturising cream on my client’s skin. “People with diabetes are more susceptible to foot problem but spending some time carying of their feet on regular basis can help keep them healthy (G. Gardner, Dolores 2011)”. I keep my client’s feet clean every day. I wash it daily with soft flannel and mild soap. I dont leave the man in shower too long cause too long soaking in the water only causes skin dry out more.

I use soft towel to completely dry his feet remembering to dry between each and everyone of his toes. I never use moisturiser between his toes. I put lotion only on the tops and bottoms of his feet. For my clients hygiene he wears every day clean socks, mostly 80% catton or wool which helps to absorb sweat and feet can breath. I always talk true everything I do so my client is in understanding about everything. The client has been complaining about asthma so I have forwarded this to the nurse and she has arranged doctor appointment for my client.

Clear recommendations on effective course of action to better meet client’s needs. My client is very grumpy man and he always say he dont want to do anything and he dont need anything. In the mean time he tries to do as much as he can himself. In the shower I wash his back and I look after his feet cause he cant lean down. All I can respect his with to do everything as quick as I can and get him out from shower as soon as I can. I always listen the gentleman cough as he is smoker and its unaccepted for a diabetic. I remind him that he should stop smoking.

When he brush his teeth I have a look in the sink in case he has been spitting out blood to make sure his mouth hygiene is right. I observe his skin while shower is there any red spots, swolling, scratches. I pay big attention on my clients feet, I look for blisters, cuts, scratches, calluses, corns, ingrowing toe nails or signs of infection. Also I look for white, moist, wrinkly skin especially between toes. If there is any hot spots it could be underlying infection or inflamation. I would report this to the nurse strait away. I always cover my client with clothes as soon as he is out his shower respecting his ignity. I’m glad when my client tries to do as much as he can himself and always courage him to stay that way cause that keeps his self esteem. I always repect his privacy closing all blinds before shower. As my client is shy in front to me I respect his privacy and wash him quick but properly in the mean time. I always ask him does he has noticed any changes in his body since we last met. Evidence as reflection as a result on work experience. After my research I discovered that very important is to look after my clients feet if he is diabetic.

Cant miss out one bit. I learned that diabetics has much more than only low sugar levels and there is few types of diabetes. After my discovery about this illness I care about client with much more attention on smaller details which I would not know before. Trying to be a better healthcare assistant I have to develop my ability to let my client to make decisions and choice because its too easy to take care too much and take control not noticing that I take away my clients independence and self-woth. I have to promote independence as much as I can.

Other quality is smile. It’s so important to dont get sad face just looking at the client. If client is grumpy carer need strenght to dont get the same. Sometimes its difficult cause I know I go to my client with best intention but seems client doesn’t appriciate. That’s where is need to learn to be strong and still smile and hope that my smile will make my client positive. References. Shoback edited by David G. Gardner, Dolores 2011, Greensparks basics ; clinical endocrinology (9th ed). New York McGrawhill Medical ppChapter 17.

Contract Law Presented by Kerra Bazzey Contract Law Formation of a Contract Terms of a Contract Discharge of a Contract Remedies for Breach of a Contract Formation of a Valid and Enforceable Contract Offer Acceptance Consideration Intention to Create Legal Relations Privity of Contract Capacity to Contract Must not be illegal or contrary to public policy Formation of a Contract A contract is an agreement which creates legal rights and obligations between the parties to it. It is formed when the parties reach agreement on the essential features of the bargain.

Offer – a statement made by a party which manifests an intention to be bound on precise terms. The person who makes an offer is known as the offeror or the promisor. The person to whom the promise is made is the offeree or the promisee. Bilateral contracts – most common form of contract – here there is an exchange of promises. Unilateral contracts – commonly known as an ‘if’ contract – here the promise is one-sided as the offeror alone makes a promise. Elements of an Offer (i) An offer can be made to an individual, a group of persons or to the public at large.

An offer to the public at large can only be made where the contract is a unilateral one. (ii) An offer should not be vague. Where on the face of it an offer appears to be vague, but the parties have had prior dealings or are operating in a particular trade, then the courts will imply certain terms and conditions to conclude that a statement that initially appeared vague is in fact sufficiently certain. (iii) A response in request to clarification on price or a request for more information is not an offer. Elements of an Offer Consider the following exchange: – H: “Will you sell us your farm called Bumper Hall Pen? Fax me the lowest price”? F: “Lowest price for Bumper Hall Pen is $1,200,000. 00”. -H: “We agree to buy Bumper Hall Pen for $1,200,000. 00 asked by you”. – F never replied to this. H argued there was a valid contract. -The court held that F’s statement was not an offer. – It was merely a response to a request for information which showed the lowest price that F would have been prepared to charge in the event that he chose to sell the Bumper Hall Pen. – H’s last communication could therefore not be regarded as an acceptance. Elements of an Offer (iv) If a person declares that he intends to so something, that statement of intention is not an offer.

If someone acts based on what was declared, and the person who made the declaration does not carry out the act he stated he would, but the person who acted based on what was said suffers a loss, the person who suffered the loss cannot bring an action against the person who made the declaration. This is because there was never any offer so there was nothing to be accepted. Consider the following case: – An auctioneer advertised in the newspaper that he would be holding a sale of office furniture. – A broker commissioned to buy office furniture travelled from far to attend the sale but all the furniture was withdrawn. The broker sued the auctioneer for his loss of time and expenses. – Can he recover for his loss of time and expenses? – No. – The court would hold that an intention to do something does not constitute an offer geared towards create a binding contract. Invitations to Treat Invitation to Treat An offer must be distinguished from an invitation to treat. An invitation to treat is an invitation to someone else to make an offer. It is not an offer because there is no intention to be legally bound. It is an invitation to negotiate. There are 4 categories of invitations to treat – advertisements in a newspaper display of goods on a shelf – auction sales – invitations to tender Invitation to Treat Advertisements As a general rule, an advertisement in a newspaper is not an offer. It is an attempt to induce offers. This general rule is displaced where the advertiser by his word or conduct shows a clear intention to be bound, as is often the case in the unilateral contract. Display of Goods on a Shelf A store owner who displays goods on a shelf with the price attached does not make an offer. He is merely inviting the public to make an offer to buy the goods at the price stated. Auction Sale

The general rule is that in an auction sale, when the auctioneer invites bids, this is not an offer but an invitation to treat. When the bidder responds with a bid, he is in fact making an offer and the auctioneer is then free to accept or reject this. Invitation to Treat Invitation to Tender Generally a request to tender will be considered as an invitation to treat. Any tender document which is submitted in response to this request is an offer and the invitee of the tender is then free to accept whichever offer he chooses. Termination of an Offer (i) Revocation or withdrawal of an offer by the offeror (ii) Counter offer (iii)

Lapse of time (iv) Death (v) Non-fulfilment of a condition precedent Termination of an Offer (i) Revocation – A revocation is a withdrawal of an offer. An offer can be revoked at any time before it is accepted because there is no binding contract before acceptance. An offer cannot be revoked after it has been accepted. A revocation must be communicated to the offeree to be effective. If it is not, and the offeree accepts, there will be a contract. Termination of an Offer Consider the following: By letter dated 1st October, A offered to sell goods to B. – B received the offer on 11th October and immediately accepted by fax. Prior to that, on 8th October A wrote a letter revoking the offer. He mailed this and B received it on 20th October. – Is there a contract? – Yes. The court would hold that the revocation came too late and was not effective until it had reached B. A contract was made when B faxed his acceptance. Termination of an Offer The revocation does not have to be communicated to the offeree by the offeror himself. It is enough if the offeree learns of the revocation from a source which he believes to be reliable. A mere request for additional information does not destroy an offer. Consider the following example:

A offered to sell B goods at $100,000 per ton and stated that the offer would remain open until Monday. – Early on Monday B telephoned A and asked him to indicate whether he would accept ‘$100,000 per ton for delivery over two months or if not, the longest limit he would give. In other words, he was asking whether he could buy the goods on credit. Termination of an Offer – A did not respond. – On Monday afternoon B contacted A to accept the offer and found out that A had sold the goods to a third party. – Was there is breach of contract? – Yes. – The enquiry was not a counter offer but a request for further information.

A’s offer had not been terminated. Termination of an Offer Counter Offer Lapse of Time Where an offer is stated to be open for a specified time only, once that time expires and the other party has not responded, then the offer automatically ends. If no time is stipulated, the offer may lapse after a reasonable time. Death Where the offeror dies before the offer is accepted by the offeree, the offer is terminated. If the offer is accepted before the offeror dies, it may be enforceable against the estate if it is not of a personal nature. Elements of a Valid Acceptance Acceptance

A contract can only exist when there is consensus ad idem, that is, a meeting of the minds. This is where the acceptance merges with the offer. An offeror can prescribe that the acceptance must occur in a particular manner, eg by post or hand delivered or by telephone. An acceptance to an offer is only effective if it is communicated to and received by the offeror. If something impacts upon the ability of the offeror to receive word of the acceptance, for example, because of interference on the phone line or because the offeree is unable to speak clearly, then there is no contract.

Elements of a Valid Acceptance Silence does not amount to acceptance. Consider the following example. B placed a house with an auctioneer to find a buyer. Subsequently A began to negotiate directly with B for the purchase of the house. The only outstanding matter was the question of the price. A stated “if I do not hear from you I shall assume that the house is mine at $X. ” When B heard this he told the auctioneer not to sell the house. In error, the auctioneer sold it to another person. A sued in conversion (a tort alleging wrongful disposal of property).

Although B’s actions suggested that he was in effect accepting B’s offer, the court held that there was no contract because he never communicated this acceptance to A. His silence did not amount to acceptance. There was therefore no contract. Elements of a Valid Acceptance An acceptance of an offer must be absolute and unqualified. If it does not accept all the terms of the contract as originally set out, it will be a rejection of the offer. Where the offeree introduces a new term which the offeror never mentioned he introduces a counter offer.

A counter offer effectively puts an end to the original offer and it cannot be accepted later. Example – A offers to sell a house to B for $1,800,000. 00. B asks A whether he will accept $1,500,000. This request by B is a counter offer which has effectively brought the original offer to an end. There is therefore nothing open for B to accept and A is free to sell to a 3rd party. Acceptance When a counter offer is accepted then its terms and not the terms of the original offer become the terms of the contract. Example B and M agreed to enter into a formal contract after a series of negotiations.

M sent the terms of the contract to B for signature. B signed the agreement but amended it by inserting the name of an arbitrator who would be used to settle any disputes. The contract was never formally executed but each party acted in accordance with the agreed terms. When a dispute arose under the contract, B sought to argue that there was no binding contract. The court held that the insertion of the name of the arbitrator was in fact a counter offer. Once M took delivery of goods in accordance with the terms of the contract, its conduct amounted to an acceptance of the counter offer. Acceptance Subject to Contract’ means that the parties do not intend to bind themselves until a formal document has been drafted and signed. The effect is no rights or legal obligations are imposed on either party. Acceptance The Postal Rule A distinction is drawn between an acceptance through instantaneous means and one in a contract by post. The post office rule constitutes the post office as an agent of the offeror. It states that when an acceptance is placed under the lawful control of the post office, it is effective even without actual physical delivery to the offeror. The postal rule applies to acceptance only and not to offers.

Acceptance Consider the following example: A posted an offer to B on 2nd September. That letter contained a clause which stated that A expected a response by the post. The letter was incorrectly addressed and reached B on the 5th September. B sent off a letter at once agreeing to all the terms contained in the offer. On the 8th September, A not having heard from B, sold the item to a third party. Was there a breach of contract? Yes, because a contract had been completed on the 5th September when B posted the letter of acceptance. The post office was the agent of A, the offeror and had received the acceptance on his behalf.

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO). Nowadays, this is one of the global issues that experts are trying to solve on how they can help each individual to attain this stage, which in the end they across of finding ways on how an individual will be able to achieve this goal. That is through immunization. Immunizations are used to protect the human body against preventable diseases. Immunizations are usually given in the form of a shot or vaccine.

When one gets immunized, the body develops the ability to fight off a given disease. Immunizations safeguard the body from illnesses and death caused by certain infectious diseases. Some immunizations are given to prevent a single disease, while others will take care of two or three diseases. Immunizations help control infectious diseases that were once common. They have reduced, and in many cases, eliminated, diseases that routinely killed or harmed infants, children, and adults.

However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not immunized. Children need immunizations to protect them from dangerous childhood diseases. How can this be possible for everybody? That was answered by World Health Organization, when they initiated the Expanded Program on Immunization in May 1974 with the objective to vaccinate children throughout the world.

Ten years later, in 1984, the WHO established a standardized vaccination schedule for the original EPI vaccines: Bacillus Calmette-Guerin (BCG), diphtheria-tetanus-pertussis (DPT), oral polio, and measles. Increased knowledge of the immunologic factors of disease led to new vaccines being developed and added to the EPI’s list of recommended vaccines: Hepatitis B (HepB), yellow fever in countries endemic for the disease, and Haemophilus influenzae meningitis (Hib) conjugate vaccine in countries with high burden of disease.

In 1999, the Global Alliance for Vaccines and Immunization (GAVI) was created with the sole purpose of improving child health in the poorest countries by extending the reach of the EPI. The GAVI brought together a grand coalition, including the UN agencies and institutions (WHO, UNICEF, the World Bank), public health institutes, donor and implementing countries, the Bill and Melinda Gates Foundation and The Rockefeller Foundation, the vaccine industry, non-governmental organizations (NGOs) and many more.

The creation of the GAVI has helped to renew interest and maintain the importance of immunizations in battling the world’s large burden of infectious diseases. The current goals of the EPI are: to ensure full immunization of children under one year of age in every district, to globally eradicate poliomyelitis, to reduce maternal and neonatal tetanus to an incidence rate of less than one case per 1,000 births by 2005, to cut in half the number of measles-related deaths that occurred in 1999, and to extend all new vaccine and preventive health interventions to children in all districts in the world.

In addition, the GAVI has set up specific milestones to achieve the EPI goals: that by 2010 all countries have routine immunization coverage of 90% of their child population, that HepB be introduced in 80% of all countries by 2007 and that 50% of the poorest countries have Hib vaccine by 2005. In each of the United Nations’ member states, the individual national governments create and implement their own policies for vaccination programs following the guidelines set by the EPI.

Setting up an immunization program is multifaceted and contains many complex components including a reliable cold chain system, transport for the delivery of the vaccines, maintenance of vaccine stocks, training and monitoring of health workers, outreach educational programs to inform the public, and a means of documenting and recording which child receives which vaccines.

At the local level, implementation of the health care delivery system has been given greater responsibility to the local government Unit (LGU) by virtue of the Local Government Code of 1991, the Magna Carta for health workers for Republic Act 7305 in 1992, and the barangay health workers benefits in Incentives Act of 1995. The latter act provides for training volunteer workers as well as minimal incentives to convince them to help run barangay health station or centers. This volunteer will assist in clerical tasks and minor health procedures, such as weighing and measuring patients and malnutrition mitigating activities.

However, this workers do it in this context that the study was conceptualize the results of the study may provide an assessment of the status of the health care delivery system and immunization status of children whose ages are 0 to 12 months old in Barangay San Juan- San Ramon of Municipality of Camaligan, Camarines Sur. The research finding can be a basis and inputs to the Local Government Units of Camaligan and Barangay San Juan- San Ramon in planning and implementation of barangay health care delivery system.

Furthermore, allocation of Local Government Units (LGUs) budget or expenditure priority can also be guided towards a more responsive allocation level of health services. Results of the study may also contribute towards awareness building and educating the barangay residence about preventive health care. In terms of capacity building, the Local Government Unit (LGU) and the National Government will be given one basis for their technical support and training program for the health care workers to better improved the capacity to perform their jobs.

After all, an empowered and well trained social health care work force will improved the delivery of community health care and reduce the number of children from preventable illnesses such as measles, malaria, diarrhea, malnutrition, and acute respiratory infection. Providing care for the children is really important. They will live to grow into adulthood and eventually become the future adult citizens. To ensure a productive future for these children, they must be protected from heavy childhood diseases which can be prevented through immunization.

Presidential Decree No. 996 stated about “providing for compulsory basic immunization for infants and children below 8 years of age”. Immunization is one of the most important preventive management that should be done and given to infants in the first few months of his life. Estimates reveal that diphtheria, pertussis, tetanus, poliomyelitis, tuberculosis, and measles are responsible for the deaths of about 5 million children every year in developing countries.

These diseases are preventable through immunization with a handful of vaccines that can be given within the first year of a child’s life. Immunization has been recognized and accepted as one of the most important components in the prevention and control of communicable diseases. Immunization is a basic health service; therefore it is integrated into the healthcare delivery service of the ministry of health. With the assistance of UN children’s fund and WHO, the ministry of ealth launches the expanded program on immunization objective of reducing the morbidity and mortality rates of the EPI mentioned by increasing the proportion of fully immunized children in their first year of life. The researchers are fully aware and knowledgeable about the immunization that will provide maximal immunity to Expanded Program on Immunization diseases before a child’s first birthday. The respondents are well exposed to immunization activities for they have volunteered and participated in the community’s activity program. Thus, they can well undertake the study.

Palliative care is the advanced care of patients who are terminally ill and are closer at their lives’ end. Symptom management, pain management, and the provision of social, spiritual and psychological support are carefully given by the practitioner, or by the one who is giving care to the sick person. Palliative care achieves to meet the goal of giving the best quality of life that they can give to the patient and to the patient’s family. Palliative care aims to impart to the patients that dying is a normal process that people undergo once in their lives. Practitioner offers support to patients to be able to live actively until the time of their death. And they aim to provide a system that will help the family cope during the patients’ illness and in their bereavement (“Palliative Care Explained “).

The Sea Inside in a Nurse’s perspective

The movie talks about the life of a quadriplegic. The main character Mr. Ramon Sampedro was a ship mechanic in his younger days. After the tragedy Ramon became bedridden because he restrains himself from being imprisoned by a wheelchair; he believed that being imprisoned by a wheelchair will be just imprisoning him with the scraps of his past. He was a man who had his own perspective and depicted life as his own, and that he had the right to end his life. He, Ramon Sampedro, was the only Spaniard who had requested for Euthanasia (Blaser, Jan. 5, 2005).

Among the people who have taken care of Ramon was Manuela his sister-in-law, his father, his older brother Jose, and Gene. His legal counsel Julia gave him sympathy, she listened to Ramon’s sentiments and Ramon listened to her sentiments as well. This is because they share the same perspective that they wanted to “die with dignity.”

The movie provided a general assessment of Palliative care. Each of Ramon’s family members gave justification to the concepts of Palliative care in general. Although there were some concepts of palliative care that were not given justification because Ramon doesn’t have his own nurse to do the Nursing care plan. Nursing care plan includes assessment; subjective and objective, nursing diagnosis, planning, interventions and evaluation. In Ramon’s case, assessment should have been done regularly. Subjective data includes information directly from the patient’s feelings while objective datas are those measured and observed by the physicians. After initial assesment, a problem list should be made consisting possible reasons that affects the patient’s well being qlike family problems, medical diagnosis and many others.

Diagnosis comes when the collected datas relates to a certain illness or disease. In planning of interventions to be used, the preparation should be specific, attainable, measureable, realistic and time-bound. Intervension are the methods to be used in order to meet the goals in planning. It includes what medications to be applied, possible surgeries, etc. Every intervension has a rationale like why a nursing action should be done and what is its basis. And lastly, evaluation are written reports about the improvement of patient or the contrary. In evaluation it is stated whether the goals in planing is met, partially met, or not met (By Jane Urie).

As shown in the movie, Ramon didn’t want to be loved because he believes that a person undergoing his illness would be creating misery to the person that loves him. This implies that Ramon is having psychological and emotional distress and should have been assessed by a physician to be able to bring him back to life. However, in Julia’s case it was shown that she had undergone observations and treatments when she developed a disease called Cadasil due to her series of strokes, therefore palliative care was well addressed.

Pain control for instance was well established in the movie because there was a scene when Ramon was given tranquilizer to stabilize him. Although there was an error in giving him the medication, because if the medication was given by a nurse the nurse should have only given him an exact dosage of the tranquilizer, just one tablet not three. As a nurse exact dosage or amount of medicine should only be given to a patient to prevent overdose and complications.

The conflict of the story is about the ethical and moral issues of Euthanasia. Today, euthanasia has been legalized. It was being applied in cases of hopelessness in the recovery of the patient. “Eu” means good and “thanator” means death, euthanasia therefore means good death or mercy killing. There are different classifications euthanasia: voluntary, non-voluntary, involuntary, assisted, euthanasia by action, and euthanasia by omission. In voluntary, the patient was the one who requested his death. In non-voluntary, the person who has been killed made no request and gave no consent. In involuntary, the patientmade an expressed wish to the contrary.

Assisted Euthanasia is perform with the assistance of the physician or the relatives of the patient. Euthanasia by action makes use of lethal injection while euthanasia by omission is the process wherein the patient is no longer being provided with his needs like food, water, medication, etc. The reasons why it is being practiced are to diminish unbearable pain, the right to commit suicide, and the belief that people should not be forced to stay alive (“Voluntary Euthanasia ” Apr 18, 1996).

Ramon wanted to die. He said “Well, I want to die because I feel that a life in this condition has no dignity.” In the case of Ramon, who is quadriplegic, refusing to live shows that he was experiencing fatigue, depression, anxiety, and Dyspnea (maybe due yo lack of ventillation). Ramon believed that dying is an unevitable part of a man’s life and it is just normal to die. Due to his own beliefs Ramon passed a petition about legalizing suicide or the right to die.

A paraplegic priest visited him to discourage his intention of suicide. His brother, Jose, also agrees with the priest and the church’s belief that suicide is immoral, that only God has the right to decide whether an individual should live or die. They believe that God has His reasons and purpose why a person still lives. It was Him wo gave you life, so it is also his decision to take it back. Thereof, this situation talks about morality (“The Sea Inside,”). As for the health providers, it also brings a great controversy whether to practice  Euthanasia or not. Health providers were trained to cure not to kill. And assisting a suicide contradicts the profession with the duty of “do no harm”.

From the movie itself, cultural considerations and individual considerations was well established. There was a clear observation that the people around Ramon did not want to consider his attempt of killing himself. Ramon as an individual had also been given consideration; although his beliefs of death was unjust they still did not oppose to him because they considered his own perceptions and did not want to oppress his rights as an individual. For a nurse, I would consider his beliefs because it was his right but I would not help him accomplish his death.

The tragic part of the story is that his family was well oriented and they have accepted that death is coming to Ramon. There was a scene in the movie wherein his father said “what’s worse having your son die on you, is the fact that he wanted to”. It only shows that he had accepted the death of his child but he had not accepted the fact that his son wanted to die.

Ramon’s family had actually given him quality care and unconditional love. Although these were really not enough especially in the case of Ramon. From a nurse’s point of view, the care that the family could have been improved if there is a plan of care that was established. Ramon had supposedly had a life that is worth living. His family loved him and took care of him, he had a book published, two women were linked to him and the sympathy of the nation was on him but he refused all these and exchanged it to death. He had exchanged all the beautiful things he had in life because he justified his life as his.

For years Ramon had actually internalized that death is in his hands and that he had the right to end his life. Generally speaking, Ramon had actually lived a life that is not worth living because he restraints himself from having so. As a nurse, I could have implied to Ramon that his life is worth living and that he need not to worry that he will be a big burden to his family and to the people he loved while he is living. It is not a nurse’s job to kill but rather to nurture.

References

1. Blaser, A. (Jan. 5, 2005). Bizzaro Breathing Lessons [Electronic Version] from http://www.ragged-edge-mag.com/reviews/blaserseainside.html.
2. By Jane Urie, B., MRPharmS, Helen Fielding, MSc, MRPharmS, Dorothy McArthur, MSc, MRPharmS, Moira Kinnear, MSc, MRPharmS, Steve Hudson, MPharm, FRPharmS, and Marie Fallon, MD, FRCP. Palliative care [Electronic Version] from http://www.pjonline.com/Editorial/20001021/special_feature/palliative_care_603-614.html.
3. Palliative Care Explained [Electronic Version] from http://www.ncpc.org.uk/palliative_care.html.
4. The Sea Inside [Electronic Version] from http://www.boxofficeprophets.com/tickermaster/listing.cfm?TMID=1556.
5. Voluntary Euthanasia (Apr 18, 1996).

Nail Biting Do you constantly find yourself biting your nails off for no reason at all? Or have you ever thought about the damages caused by nail biting? Many people do not realize and know that there are medical affects and explanations for nail biting. Adults usually do not find themselves with this bad habit because nail biting is most common among kids and teens but mainly more within guys than girls. However regardless of gender or age nail biting can lead to unwanted consequences caused by stress, nervousness, or hunger. Unwanted consequences mainly consist with dental complications such as the chipping of your teeth.

For most people, chipping a tooth is the only negative effect that biting your nails might have on your teeth. In fact, the book Pediatric Dentistry by Pinkham states: There is no evidence that nail biting can cause dental change other than minor enamel fractures. Nail biting can also cause a gap between your two front teeth. If the nail biting habit begins when the child is very young, it has been reported to cause a gap between teeth. In addition causing gaps between your teeth can cause the roots of your teeth to become weaker. Nail biting during braces has been shown to cause root resorption.

Last but not least nail biting can cause gingivitis. For example in the case report of a nine-year-old boy whose father called the dental office to describe his son’s complaint of swelling of the gums surrounding the top front tooth. The patient came to the office the same day. The initial clinical examination revealed swelling of the gingival. During discussion with the parent and patient, the dentist noted that the patient’s fingernails were bitten off. The patient and parent confirmed a habit of nail biting. Therefore the dentist removed from the gums a piece of nail that was compressed in.

Nail biting can cause many dental complications however, what causes people to bit their nails? Many doctors and psychologists state that medical and psychological situations cause nail biting to occur without even realizing it. For example nail-biting is a common stress-relieving habit. Stress is that feeling you get when you’re really worried about something. There are general factors that can lead to stress such as threats which include physical threats, social threats, financial threats, fears, and uncertainty. Therefore a common way people to react to stress is nail biting.

A child or even an adult uses nail biting as a coping mechanism to relieve stuffed emotions. It has been documented that some people bite their nails in their sleep, sometimes wholly. This has been linked to stress while dreaming. Secondly, nervousness also leads to nail biting. When people are nervous, they fidget. Fidgeting involves moving with excitement. Hands, legs and other parts of the body make quick movements, with no particular aim. This is a reflex movement, initiated by the subconscious mind. This is a reaction to a tense situation. We do not know what to do but we know that we have to do something.

Nail biting is one way of the body’s response to the call for doing something. Children sometimes face an unpleasant situation. They commit a mischief and are caught. When they are confronted by their parents or teachers, they just stand biting their nails. This is a defense mechanism to prevent the children from doing an absurd act that could make the matter worse. Thirdly, as simple as this may sound, it has been revealed that some people who suffer from biting on their nails complains that they will only do so when they are feeling extremely hungry.

Some will even go as far as to say that when they are hungry and they chew on their fingernails, they will get a soothing, as well as a comforting feeling that will sometimes drive away the hunger sensation. Several treatment measures may help you stop biting your nails. For example keeping your nails trimmed and filed, taking care of your nails can help reduce your nail-biting habit and encourage you to keep your nails attractive. Also try substituting another activity, such as drawing, writing when you find yourself biting your nails.

Substituting nail biting can reduce the chances of getting dental complications. However it is important to keep in mind that psychological factors contribute to the bad habit of nail biting which is stress nervousness or hunger. These factors should be considered in stopping the reoccurrence of nail biting. http://www. nail-care-tips. com/nail-biting. php http://www. ehow. com/about_5097901_reasons-nail-biting. html http://www. tellinitlikeitis. net/2009/04/nail-biting-causes-consequences-cure-how-to-stop- biting-your-nails. html http://www. webmd. com/healthy-beauty/guide/stop-nail-biting-tips

There are many types of ethical dilemmas that plague the medical field but never is a dilemma more important than when dealing with life and death. In situations such as these, one must follow their own moral compass. When the case involves an entire hospital going against their religious mandates for the life of a woman, the decision becomes that much more difficult. This paper will analyze the situation one Phoenix hospital found themselves in and the repercussions it suffered because of it decision. St. Joseph’s Hospital and Medical Center in Phoenix, Arizona is a hospital internationally recognized for their neurology department. They have treated high profile patients such as Brett Michaels and Muhammad Ali, but neither has gained the hospital quite the publicity as a woman seeking treatment in November 2009. Alongside neurology, St. Joseph’s Hospital also has a noted obstetrics department and this is where the woman was treated. In late November 2009, a terminally ill woman came to the obstetrics unit suffering from pulmonary hypertension. She was 11 weeks pregnant.

During the course of diagnosis, it was found that the pregnancy was exacerbating her illness by worsening her hypertension to the point of placing the patient in immediate danger of death. Doctors determined the only course of action to save the woman was to abort her pregnancy. With St. Joseph’s being a Catholic hospital, this decision went against their guidelines. The decision was taken before an ethics committee which decided to proceed with the procedure. The rationale for the committee’s choice was that they were seeking specifically “to save the woman’s life, not to end the pregnancy. (Clancy, 2010, p. 1) As a result of performing the procedure, the hospital was stripped of its Catholic status. The problem identified in this situation can be posed in one question; does the religious affiliation of a hospital have the right to dictate the care of a patient? Had the ethics committee gone the other way and decided not to abort the pregnancy, this would have prohibited the woman’s right to live. One should take into account that the patient sought treatment at a Catholic hospital and she should have been aware of their belief system.

However one doesn’t know if the patient came to this specific hospital because of its Catholic mission or whether she had no choice in the matter. In either case, is it not a hospitals first duty to provide the best care possible for their patients? The best care for this patient was to abort her pregnancy but the guidelines of the hospital would rather have seen the patient die trying to save both. My personal values and ethical position in this case lead me to side with the hospital. I have always been a proponent of the pro-life ideal and this instance is no exception.

The principles I advocate for the strongest are respect for the patients autonomy and beneficence. Keeping these principles in mind, the patient made an informed decision about her care and the hospital needed to respect that decision. As far as beneficence, the cost to benefit ratio was analyzed and a conclusion was reached that benefited the patient most. Utilitarianism is a theory I would apply to this case. Doing the greatest good for the greatest amount of people and saving those you can save.

Sometimes the end does justify the means. This not to say that religion plays no part in treating patients, but it is my firm belief that if the Catholic guidelines had prohibited the patient to receive the abortion, two lives would have been lost. When making a serious choice in a case like this, it is important to factor in alternate resolutions. The first alternate resolution is the most obvious and would have had the highest priority; transfer the patient to a facility that has no abortion restrictions.

This would have been the best case scenario; however the patient was not stable enough to be relocated and may have died in transit. Another alternate decision would have been to attempt to wait out the patient’s condition and treat her medically. Do to patient confidentiality, the specifics of the patient’s condition are not known. Based on the testimony of doctors at St. Joseph’s, the woman was in critical condition and had this approach been followed, the consequences would have been fatal to both mother and child. This information makes medical management the lowest in alternative priority.

When faced with difficult ethical dilemmas, it is best to have a plan of action to assist in decision-making. A step by step approach often works best because it allows the decider to breakdown a stressful choice into workable parts. First one must identify the problem and ask the appropriate questions: What? Who? How? The second step is to identify one’s own personal values toward the dilemma. The third, fourth and fifth steps include coming up with reasonable alternative, examining them and then predicting the possible outcomes of those decisions.

In the sixth step, one should prioritize the alternative choices to better identify the most acceptable one. The seventh step is where the final decision is made based on all the information gathered and a plan is created. The plan is then implemented in the eighth step. The final ninth step is when one evaluates the end result and determines if the decision made was the right thing. In evaluation of this particular ethical dilemma, the right thing was done. The decision to forsake the values of Catholicism to save the woman’s life was the right thing to do.

The hospital agrees and therefore lost its Catholic status because they stated that they would have made the same choice again. (Kurtz, 2010) Dealing with ethics can be a tricky thing to navigate which is why it is paramount to have a good sense of one’s own moral compass. This is not the last dilemma this hospital will face but following solid ethical values and principles, they should feel confident in their ability to provide the best care to the patients they treat.