Health Resources

Walker, L.A. (1987, November 29). Seven of the toughest decisions a doctor may face. Parade Magazine.

OVERVIEW

Today’s teenagers want to discuss bioethics. This article will get a discussion going. "Technology, the sorcerer’s apprentice, has brought us incredible good, yet we’re confronted with more confusion than ever before." The author cites the anxiety of many doctors, the increase of medical insurance premiums and medical lawsuits. Issues found mostly in ponderous textbooks are here presented in a way that challenges youthful consideration. A clergyperson, lawyer, and doctor will make this a very significant discussion.

• "How do you decide when it’s time to pull the plug?" Brain-dead patients have recovered—even when the family has asked that they be allowed to die in dignity. Others in comas for long periods of time have come back to normal life. Recovered patients and family are now glad for efforts to preserve life. On the other hand, many have suffered terrible loss of dignity—at high financial cost to hospitals and family. Who and how are we to decide? How do religion and the legal system advise doctors and families?
• "What do you do when insurance companies won’t allow ample hospital time?" Dr. Jennifer Gordon of Boston Children’s Hospital says, "Some patients might be fine in the hospital after three days for a certain procedure. But some who aren’t ready to be released go home and get sicker. Then they have more complications and far more suffering. It’s crazy."
• "Who gets the one available kidney: a 45-year-old woman or a 53-year-old man?"
• "How do you feel about abortion?" One doctor admitted: "I don’t know what I would do if I knew my wife was carrying a severely retarded child."
• "What happens when patients do not want to know they have cancer?" Sometimes neither partner in a marriage will face the reality of a terminal disease. It is painful when a husband denies and refuses to discuss his wife’s cancer.
• "What about in vitro fertilization?" How far should we go in allowing people the power to choose a suitable parent for their child?
• "What do you do with a baby so handicapped there is no hope of it leaving the hospital?" Dr. Gordon describes one such case: "Each shift had as its aim keeping her (an infant with virtually no brain function or hope of survival) alive for 12 more hours, yet the entire pediatrics house staff secretly wanted her to die. In this case, medical intervention was an extremely destructive force (on divorced parents and medical staff)." This one child in a vegetative state cost the hospital hundreds of thousands of dollars. "And yet," Dr. Gordon continues, "I know that other children and adults with potential for perfectly normal lives couldn’t get care because they couldn’t afford it. All the money the hospital might have used to absorb those costs was spent on one child." On the other hand, some homes have been greatly blessed in caring for such a special child who defies medical predictions of early death and lives happily for many years.

IMPLICATIONS

1. Curious and idealistic young people are deeply interested in such issues. They want to develop an adequate life ethic, and such discussions help them to move from "privatistic" and relativistic morality to universal principles that stick.
2. Adolescent morality can become confused oversimplifications and a "black and white approach" to complex issues. Thoughtful consideration of these issues demonstrates the greys of so many real situations. It can develop a necessary tolerance for other viewpoints.
3. There are several goals of such discussions:

• To develop a sense of compassion toward those in need.
• To develop thoughtful skills of analysis.
• To become involved in meaningful service projects.

Manning, A. (1999, June 21). Adult-type diabetes increasingly strikes obese kids. USA Today, pp. 1D-2D.

OVERVIEW

According to Robin Goland of the Columbia Presbyterian Center in New York, there are two types of diabetes, and the adult type is increasingly appearing in children:

Five to 10 years ago, virtually all diabetes in the pediatric age group was Type 1 (insulin-dependent most often beginning in children of normal weight at about the age of 12).

Type 2 diabetes, which affects 90% of the nearly 16 million Americans with diabetes, typically begins in the 40s or 50s and is associated with obesity. Excess body fat promotes insulin resistance, in which the body doesn’t use insulin efficiently.

Goland’s study was one of four reaching the same conclusion. The others were two Canadian studies and one at the University of California, San Diego. Goland commented on her findings (from a study of 21 children, 10-17, all overweight and all but one with a strong family history of diabetes):

Twenty percent of pediatric patients with (newly diagnosed) diabetes are Type 2. That’s a big change. Figuring out why this is happening is a huge public health issue because diabetes, if undiagnosed or poorly controlled, has significant complications.

The complications referred to are blindness, kidney failure, heart attack and stroke. Goland warns that we may see these complications in younger and younger children.

Most of the 21 children studied by Goland were from minority groups and all had a characteristic skin lesion called acanthosis nigricans, "a velvety black raised area on the back of the neck or in skin folds, which is associated with insulin resistance."

(This mark is) unusual in adults, but more frequently observed in children. Based on our findings, I would consider screening overweight kids with a family history of diabetes or this skin condition. I’m worried that we’re not catching enough of them.

QUESTIONS FOR REFLECTION AND DISCUSSION

1. Do you consider this an important public health issue? How are serious public health risks to be determined?
2. Have you had experience with diabetes or been with someone who has? What have you learned and what is your main concern?
3. Do you think improving children’s general health is an important deterrent to diseases like diabetes?

IMPLICATIONS

1. Because some diseases get most of the attention, others may be less noted and under-treated and prevented.
2. Those who teach or work with children and young people should be aware of diseases sometimes not disclosed or not even known about.