Death Flashcards
Learn about Dying
Death
How has death reduced in Dev Nations?
- Increased Average Life Expectancy due to better medicine
- Lots of eliminated diseases ⤇ 54% ☟ Mortality from 1900 ➨ 2010
- ☝︎ Hygiene
- ☝︎ Healthcare access
- Lower Childhood Mortality
Death
Why do Men die before Women?
- Bigger Risks
- Increased heart disease risk
- ☟social connection and going to doctor
- ☝︎ suicide success
Death
What determines longer lifespan
- Height: Shorter = Better
- Ethnicity
- Socioeconomic Status: Higher = Better
QOL Old People
Why is it low and what does it cause?
- Disabilities, Loneliness
- Most healthcare costs ain US
Death
How has life span decreased?
- No universal Healthcare
- ☝︎Obesity and correlating diseases
- ☝︎Childhood Mortality
- ☝︎OD deaths
Medical Advances
What advances have increased life span?
- Artificial feeding
- Dialysis
- Cardiopulmonary Bypass (CPB)
- Mechanical Ventilation
- Defibrilation and Artifical Pacemaker
Med Advances
Why are they bad?
- Lasts a few years and is expensive
Dead
Definition
- 60s: Brain, Lungs, Heart Stopped
- But aft 60s, could continue heart beating w/o brain and lungs
- Cardiopulmonary Failure Definition: Stop Breathing / Heart Stops Beating
Dead
How and why is a heart harvested?
- Needs to be beating for transplant
- Gotten from brain dead individual
Dead
Harvard Brain Death Committee
- 1968
- Brain Death = Irreversible Coma
- 4 Criteria for brain death:
- Unreceptivity and unresponsivity to external stimuli
- No movements or breathing
- No reflexes: Fixed, dilated pupil, no reaction
- Flat EEG
- Losing Identity = Death
Coma
What is it?
- Loss of conciousness
- Closed Eyes
- No pupil response
- Not awakened by talk or touch
- Breathing on own but irregular
- Decreased brain function
- Usually less than several weeks
- Like Anesthesia
- NOT SLEEP
Coma
What causes it?
- Medically-Induced: ☟O2 needs
- Illness
- Injury
- Aneurysm
- Blocked Artery
- Diabetes
- Alcohol and Drugs
- Drowning
Coma
How is it evaluated?
- Levels of Coma
- Levels of responsiveness
- Rancho Los Amiogo Scale (while emerging)
- Glasgow coma scale: 3(worst) ➞ 15 (while in coma)
Coma
Coma vs Vegetative State
- Awake but unresponsive
- Often emerge from deeper coma into vegetative coma
- No response to stimuli
Coma
What is a Vegetative State
- Last > few months→ most irreversible → Permanent (>12 mo)
- Very poor outcome
- Deep unconsciouness and unawareness
- wakeful but profound unresponsiveness
- Non-functional cerebral cortex
Coma
What can people in vegetative state do?
- Eyes may follow
- Laugh or cry without reason
- Grind teeth, swallow, smile, shed tears, grunt, moan, scream
- No external stimuli
Coma
Persistent Vegetative State
- Feeding tube/ intervenous feeding can keep alive
- Previously would have starved to death
Coma
Recovery
- Depends on Case:
- Diabetes = quick
- Drugs and alcohol = quick
- Brain = long/never
Drugs
Drug abuse impacts
- Addiction
- Medical: Neurotixicity. AIDS, Cancer, Mental illness
- Social
- Economic: $3.73 Triilion
Drugs
Addiction Definition
- Continuing, compulsive use of a substance that occurs despite negative consequences to the user
Drugs
What does it affect/is affected by?
- Young brains more susceptible: brain “molds” around activity
- Multiple factors:
- Biology / Genes: Mental Health
- Environmental: Trauma
- Brain Mechanisms
Drugs
Why take drugs?
- Feel Good: Novel feelings, sensations, experiences
- Turns into Feeling Better: Lessen anxiety, worries fears, depression, hopelessness
Addiction
Affected Brain Regions
- Activate Nucleus Accumbens: Motivation + pleasure ➞ drugs activate: CRAVING SENSATION
- Activate Ventral Tragmental Area (VTA): pleasure center with lots of connections to N.A. ➞ RUSH SENSATION
- Depressed Frontal Cortex: Worse decision making and altered memories
- Serotonin and Dopamine increased
Addiction
Olds and Milner Experiment
- Animal Model for addiction in humans
- How it was conducted
1. Put electrode in NA
2. Rate stimulated with pedal- Pressed many times per hour
- Did it while starving and dehydrating themselves
- Activated and sought activation even with negatvie consequences
Addiction
Taking drug for first time
- First consumption leads to activation skyrockets quickly and depresses NA ➟ feeling awful
Addiction
∆FosB
- Addiction Chemical
- Takes extremely long for levels to decrease
- Affected by genetic history: Increases ∆FosB at higher increments
Addiction
Addiction with Genetics
- Fewer dopamine receptors ➞ Increased addiction
- Introverts lower risk for addiction, extroverts opposite
Addiciton
Addiction with Environment
- Stress
- Early abuse
- Witnessing violence
- Those around you using
- More use when in bad circumstances vs good ones: Cages vs rat park
Opioids
Order of highest OD Deaths
- Synthetic
- Psychostimulants
- Cocaine
- Prescription Opioids
- Heroin
- Benzodiazapines
- Antidepressants
Opiates
Poppy Seed Opiates
- Morphine and Codeine
- Opium comes from poppy seed as a highly addictive narcotic drug
- Natural morphinone/codeinone
Opiates
How they work
Activates/ Mimics endorphins ⇒ Pain relief
Opiates
Three OD Waves
- Wave 1: 1990s: rise in Prescription Opioid deaths
- Wave 2: 2010: Rise in Heroin Deaths
- Wave 3: 2013: Synthetic Pain Killers Deaths
Opiates
Misusers
- 11.4 million / 4.2% of the population = Rx Pain Reliever Misusers
- 886,000 = Heroin
- 562,000 = Both
Opiates
Triplicate vs Nontriplicate System
- Trip: ensuring Monitoring drug prescriptions
Opiates
Heroin
- 1897: Synthesized by Bayer
- Tried to make morphine into codine, but accidentally made heroin
- Binds to heroin receptors and goes through BBB quickly
- Intravenous Injection
Opiates
Heroin Effects
- Slows down circulation
- Depresses bowel activity
- Suppresses cough reflecxes and slows down breathing
- Sedation and dizziness
- Irregular periods and lost interest in sex
Opiates
Fentanyl
- 50-100x potent vs Heroin
- Mixed with alcohol and rise in effects
Opiates
Narcan
- Competitive antagonist
- Binds to opioid receptor
- Shields from further OD by not allowing other opioids to bind
John Stuart Mill: The Rickety Bridge
What is it?
If a rickety bridge exists, what is the government’s role in the matter?
1. Sign?
2. Close the bridge?
3. Do nothing?
John Stuart Mill: The Rickety Bridge
Case Study #1: Tobacco
- 1999-2007: US vs Philip Morris
- Used RICO Act(Racketeering Law)
- Prohibited ad words and corrective statements on addiction
- Billions for health damage
Case Studies for John Stuart Mill: The Rickety Bridge
Government Possible Roles For Case #1
- Raise age restrictions: similarities to alcohol
- Raise taxes on cigarettes: harder to smoke + rethink economic choices
- Ban smoking in all public areas: Go against freedom
- Make cigarettes illegal everywhere for everyone
- Keep the law as it is
Case Studies for John Stuart Mill: The Rickety Bridge
Government Possible Roles For Case #2
- Raise age restrictions: similarities to alcohol
- Raise taxes on cigarettes: harder to smoke + rethink economic choices
- Ban smoking in all public areas: Go against freedom
- Make cigarettes illegal everywhere for everyone
- Keep the law as it is
Case Studies for John Stuart Mill: The Rickety Bridge
Government Possible Roles For Case #3
- Move off Schedule I: must research but can’t on Schedule I
- Legalize recreational & palace high taxes and age restrictions like tobacco
- Keep the laws as they are: states may vary
Case Studies for John Stuart Mill: The Rickety Bridge
Government Possible Roles For Case #4
- Ban them - addiction therapy,
- Invest in research for new drugs - people in need,
- Prohibit advertising drugs to consumers
- Prohibit online pharmacies
- Public education efforts
Case Studies for John Stuart Mill: The Rickety Bridge
Case #2: Vaping
- July 2020: 758 lawsuits against Juul and others
- Deceptive Marketing
- Bleeding in brain
- Lung injuries/deaths
Case Studies for John Stuart Mill: The Rickety Bridge
Case #3: Marijuana
- 1970 Controlled Substances Act, Schedule I (on par with heroin)
- Gonzales v. Raich (2005)
- Supremacy clause ⇒ National laws > State Laws
- Patchwork of laws: ☝︎ Ignored by Pres and fed govt
Case Studies for John Stuart Mill: The Rickety Bridge
Case #4: Opioids
- 25% misuse, 10% addiction, 5% transition to heroin
- 2016-17: doctor shopping
- One doc: 500,000 doses
- Lawsuit against internet pharmacies and doctors
- Mallinckrodt, Insys, Purdue bankruptcies
Medical Decisions for Minors
Big conflict
- Minor’s bodily autonomy/ QOL vs Parent’s responsibility as ward
- Also determined by how necessary the treatment is and if ther are alternatives
- Age of child to determine their autonomy
