quiz 4

Question 1

death and dying in america

Answer 1

• 3 major studies paint a grim picture of the experience of dying
  Field and Cassel (1997), Last Acts (2002), SUPPORT (1995)
• Half of DNR orders are written within 2 days of death
• Disparity between the way people actually die and the way they want to die

Question 2

the need for palliative care

Answer 2

• Late 1800s
  Little to offer patients beyond easing symptoms
  Most died at home cared for by family within days of illness onset
• Early to mid 1900s
  Healthcare shift from comfort to cute
  Death became equated with medical failure

Question 3

Cause of death
- Demographic and social trends

Answer 3

Early 1900s –> Current
Medicine’s Focus: Comfort -> Cure
Cause of Death: Infectious Diseases ->
Communicable Diseases
Chronic Illnesses
Death rate: 1720 per 100,000
(1900) ->
800.8 per 100, 000
(2004)
Average Life
Expectancy:
50 -> 77.8
Site of Death: Home -> Institutions
Caregiver: Family -> Strangers/Health Care Providers
Disease/Dying
Trajectory:
Relatively Short -> Prolonged

Question 4

experience of dying

Answer 4

4-Dimensional
- Physical
- Social
- Psychological
- Spiritual
4 paths for Death
- Slow decline, periodic crises
- Sudden, unexpected cause
- Lingering, expected death
- Steady decline, short terminal phase

Question 5

barriers to quality care at end of life

Answer 5

Failure to acknowledge the limits of medicine
Lack of training for healthcare providers in discussing dying
Hospice/palliative care services are poorly understood
Rules and regulations
Denial of death
Inadequate pain/symptom management

Question 6

what is hospice?

Answer 6

Delivery system that provides palliative care for patients with limited life expectancy who require comprehensive medical, psychological, and spiritual support
“Hospice” is from the middle ages and used to designate way-stations for pilgrims traveling to Holy Land

Question 7

what does hospice include?

Answer 7

Interdisciplinary care
(Volunteers, physicians, counselors, social workers, spiritual/bereavement counselors, hospice aids, therapists, nurses – surround patient and family (main team))
Medical appliances and supplies
Drugs for symptom and pain relief
Short-term inpatient and respite care
homemaker/home health aide to relieve caregiver burden
Counseling, spiritual care, bereavement services
Volunteer services
Number of hospices has increased by 13.4 % since 2014

Question 8

what is palliative care?

Answer 8

Philosophy of care and an organized structure that improves quality of life for patients and families facing a life-threatening illness. Focuses on prevention and relief of suffering
In 2000, only 632 hospitals had palliative care programs. Now more than 80% of large US hospitals offer CAPC
Patient and family as unit of care and they set goals, their education and support is focus
Attention to physical, psychological, and social & spiritual needs
Interdisciplinary team approach
Extended across illness and care settings
Continues after death with bereavement support
Bothe curative and life-prolonging care might be offered with palliative care (unlike hospice)

Question 9

what does palliative care do?

Answer 9

Addresses suffering
(Physical, psychological, spiritual/existential)
Improves quality of life
(assess/manage pain and other symptoms)
Provides a team approach to care
(Patient and family decide what THEIR goals are (not the healthcare team))
Promotes excellent communication, allowing patient and family to make good decisions about care

Question 10

4 dimensions of care for quality of life

Answer 10

• Physical
  (Functional ability, strength/fatigue, sleep and rest, nausea, appetite, constipated, pain)
• Psychological
  (Anxiety, depression, enjoyment/leisure, pain distress, compassion fatigue, happiness, feat, cognition/attention)
• Social
  (Financial burden, care giver burden-respite care, roles and relationships, affection/sexual function, appearance)
• Spiritual
  (Hope, suffering, meaning of pain, religiosity, transcendence)

Question 11

role of nurses in palliative care

Answer 11

Some things cannot be “fixed”
Use of therapeutic c pressure
Comfort care (pain, secretion, wounds, constipation)
Administration of medicines, therapy
Patient, family needs

Question 12

payment for hospice

Answer 12

Medicare
Medicaid
Most private loans

Question 13

payment for palliative care

Answer 13

Philanthropy
Free-for-service
Direct hospital support

Question 14

hospice medicare eligibility criteria

Answer 14

patients doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with life expectancy of 6 months or less, if the disease runs its normal course
The patient chooses to receive hospice care rather than curative treatments for his/her illness
The patient enrolls in a Medicare-approved hospice program

Question 15

hospice vs palliative

Answer 15

hospice: Patient is considered “terminal” with less than 6 months to live
patient/family chooses NOT to receive aggressive, curative care
Focuses on “comfort” versus “cure”
Expenses are covered by Medicare, Medicaid, and most private health insurers

palliative: Ideally begins at the time of diagnosis of a serious illness
No life expectancy requirement
Can be used to complement curative care
Expenses are covered by philanthropy, fee-for-service, direct hospital support
For pediatric patients, care is provided through mandates from the Affordable Care Act

Question 16

what is palliative care committed to?

Answer 16

Providing interdisciplinary care that promotes attention form a variety of healthcare professionals (nurse, physician, social worker, chaplain, speech pathologist, medical librarian, etc) using a team approach
Promoting the family as the unit of care

Question 17

how much more does it cost if i choose palliative care?

Answer 17

2008 study
There was a savings of $1696 in direct costs per admission ($279/day), compared with usual care (for those who were discharged from the hospital)
There was a savings of $4908 in direct costs per admission ($374/day) compared with usual care (for patients who died in hospital)
WHY THESE LOWER COSTS?
Fewer laboratory/diagnostic tests and medications were ordered, less intensive care admissions

Question 18

findings on end of life care

Answer 18

• Incentives under fee-for-service Medicare result in more use of services (hospital days, intensive care, emergency care), more transitions among care settings, and late enrollment in hospice, all of which jeopardize the quality of end-of-life care and add to its costs.
• The establishment of specialty practice in hospice and palliative medicine is a major improvement in the education of health professionals. Three problems remain: (1) insufficient attention to palliative care in medical and nursing school curricula; (2) educational silos that impede the development of interprofessional teams; and (3) deficits in equipping physicians with sufficient communication skills.

Question 19

how do healthcare professionals cope and avoid burnout?

Answer 19

Dehumanize their patient’s suffering
Share their distress at team meetings and seek their social support to avoid compassion fatigue
Active relaxation when away from work: exercise, hobbies, sports
Find satisfaction and meaning in end of life

Question 20

right to die?

Answer 20

Death will dignity laws exist in some states that allow the terminally ill patient to decide how and when to end their life if their suffering becomes unbearable.
In those states patients can legally request and receive prescription medication from a physician that will lead to their death in a peaceful, human and dignified manner
NOT LEGAL IN PA

Question 21

overview of hospice vs palliative care

Answer 21

Palliative care addresses quality-of-life concerns, in addition to medical care
Family is part of care
Hospice is comfort, not curative, care
Importance of interdisciplinary approach to car

Question 22

Risk society, Global Vulnerability and Fragile Resilience; Sociological View on the Coronavirus Outbreak

Answer 22

Health approaches to covid has become politicized on a global scale (not good)
Coronavirus are a large family of viruses running form the common cold to more severe disease such as middle east respiratory syndrome and severe acute respiratory syndrome
12/8/2019 starting in China and spreading to 30+ countries
US public health approach (2 week quarantine to “flatten the curve”)
Enhance the capacity of clinics and hospitals
Strict quarantine of infected patients
Handwashing and cough etiquette campaigns
Most important consequence from pandemic, creation of social anxiety worldwide
Risk society, part of our daily life, systematic way of dealing with hazards and insecurities induced and introduced by modernization itself
Due to “reflexive modernization” – unintended and unforeseen side-effects of modern life backfire on modernity, questioning the very basis of its definition
Vulnerable societies: inability of people and societies to
Social interactions, institutions, cultural values
Want to manage conflicting opinions, quelling societies paranoia, insecurities
Sterile society: a society safe from hazards and
Antimicrobial resistance (AMR) cause directly linked to human behavior in the environment, human behavior is killing our own race and world

Question 23

COVID 19 & Sociology – Social Disaster

Answer 23

Authoritarian lockdowns but other countries defended “freedom” and “the economy” which caused huge spikes in cases
Women in DV relationships would be stuck in the home
Employment and market demand collapsing in previously successful businesses, etc.

Question 24

COVID 19 & Sociology – Sociology

Answer 24

Timeline of COVID was/is similar to the HIV/AIDS pandemic where governments sabotaged the person-to-person interaction practices that are the effective ways to stop an infectious disease agent and instead they produced a torrent of lies and hostile fantasies designed to divert blame, create confusion and disempower their citizens
there exists a sociology of disasters, but it mainly examines disasters AFTER the fact to improve emergency management – and here we are in the midst of it and management is a large part of the disaster
Sociology as we know it is not very good in handling a historical moment, unpacking a conjuncture, let alone grasping a radically new situation like this

Question 25

COVID 19 & Sociology – Practices

Answer 25

The current epidemic has been little recognition of local initiative. Prevention campaigns have been overwhelmingly top-down in organization and quite authoritarian in tone
Urban gay environment developed safe sex stageties
Ebola epidemic used same strategies as AIDS – West African communities worked out the epidemiology of the outbreak and created prevention strategies that sustained, rather than disrupted, local ways of life

Question 26

Words/Actions that eroded trust in CDC

Answer 26

fear-driven rhetoric and political intimidation aimed at the apolitical search for objective science and data
disdain of facts, science and public health

Question 27

Government response to Covid-19 was too slow and insufficient to stop spread, Swedish commission finds

Answer 27

The commission also contended that it had taken “far too long” to build sufficient testing capacity as, at first, only targeted groups, such as healthcare staff, were able to get tested.
Sweden embarked on a no-lockdown strategy with tighter restrictions added during later waves of the pandemic. The country had recorded around 15,000 deaths from the virus, substantially more than its Nordic neighbors who locked down quickly.
the model as more business friendly, and some predicted naturally developing herd immunity would eventually slow the spread of the virus

Question 28

Conrad Medicalization Ch 1

Answer 28

In the Sociology of Deviance & Social Control, we witness the historic evolution that goes:
Sin → Crime → Illness
Medicalization is the process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorders.
Conrad’s point is to understand the social underpinnings of the expansion of medical jurisdiction and the social implications of this development, so it is the viability of the designation rather than the validity of the diagnosis that is of greater sociological concern

Question 29

Conrad Medicalization Ch 1 con.

Answer 29

Agents of Social Control
Police Officer
Priest
Physician
Judge
Social factors that contributed to the process of Medicalization
faith in science, rationality and progress
increased prestige of the medical profession
Americans’ love of individual and technological solutions
The humanitarian trend
Medicalization is NOT a one-way, unidirectional process. It is bi-directional.
Holistic health and alternative medicine are often considered steps toward the “De-medicalization” of a condition or illness.
Today, all sorts of life problems are being medicalized, or forces are working toward Medicalizing them.

Question 30

Conrad Medicalization Ch 1 con. – Effects of the Corporatization of US Medicine

Answer 30

By the 1980s, medical authority had eroded, and health policy shifted from Access to Cost control and Managed Care
In the 1980s, doctors remained dominant in the process of medicalization, and were joined by Patients, Pharmaceutical Companies and Insurance Companies
“Third Party Payers” are Insurance companies.
Medical Markets – as a model – include Advertising, designer drugs, and the standardization of medical services into “product lines”.
SSRIs (Selective Serotonin Reuptake Inhibitor) among most prescribed psycho-active drugs, and include Paxil and Prozac.
Paxil was the beginning of the “depression market” of drugs.
Diagnoses such as Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD) are representative of this.
Diagnostic & Statistical Manual of Mental Disorders (DSM)
DSM-IV recognized Social Adjustment Disorder (SAD) and Generalized Anxiety Disorder (GAD) as “illnesses / disorders,” leading to a new era where Medicalization begins to market diseases.
Marketing diseases and then selling drugs to treat those diseases is now common in the “Post-Prozac” era.
There have been backlashes against this, however.
2002 – Federal judge ordered temporary halt to Paxil ads over the claim that Paxil is not habit forming.
“The case of Paxil demonstrates how pharmaceutical companies are now marketing diseases, not just drugs.” (p.19)
“Ask your doctor if [x] is right for you”

Question 31

Conrad Medicalization Ch 2 – Testosterone

Answer 31

Conrad’s discusses the Medicalization of Masculinity, as depicted in the examples of Andropause, Baldness, and Erectile Dysfunction (E.D.).
This happened partially by design, partially by accident.
Viagra has been biggest success
↑ Direct to Consumer (“DTC”) advertising.
More of women’s life experiences are medicalized than men’s.*
↑ Sociocultural Construction of the Body as a realm of inquiry, considering the demand for products dealing with the Aging process and the body as an “artifact”.
The bodily production of Testosterone naturally declines with advancing age.
1889 – endocrinologist, Charles Edouard Brown Sequard makes the connection between testosterone and aging.
His findings sparked interest in medical treatments for aging within both lay & scientific communities.
Researchers more interested in masculinity than femininity.

Question 32

Conrad Medicalization Ch 2 – Andropause

Answer 32

While Menopause includes the loss of fertility as the primary pathological event in its definition, Andropause does not include declines in fertility in its definition.
ANDROPAUSE (pp. 30-31)
Testosterone (T) Therapy emerged and has gained some momentum.
Provides hope for men
Provides media interest
Provides potential profit
It is estimated (in the Conrad book) that approximately 15 million American men take Testosterone supplements.
However, medicine is not confident about the safety and efficacy of Testosterone therapy.

Question 33

Conrad Medicalization Ch 2 – Baldness

Answer 33

Losing one’s hair (going bald) – or “androgenetic alopecia” – is a normal or common bodily occurrence, and is usually a symptom of an underlying disease or condition.
The male hormone dihydrotestosterone causes hair follicle to produce fine, unpigmented hair common in baldness.
“Androgenetic Alopecia becomes a medical condition when hair loss is excessive.”
Rogaine (p. 37)
Propecia (pp.38-39)
The psychological effects of baldness are one of the main justifications for treating it as a ‘disease,’ however.

Question 34

Conrad Medicalization Ch 2 – Erectile Dysfunction

Answer 34

E.D. used to be known or characterized as: Male impotence or Sexual dysfunction
In 1992, Erectile Dysfunction (E.D.) was officially recognized as a Biogenic and NOT a Psychological problem.
Viagra story dominates here.
Before Viagra, there were other medical treatments such as penile surgery, implants, and injections.
March 1998 – FDA approves Viagra (sildenafil citrate) as a treatment for E.D.
Viagra was the first non-invasive medical treatment for male sexual dysfunction.
With aging population (“baby-boomers”), there was (is) a natural market.
According to our Conrad book, it is estimated that the prevalence of E.D. in the US affects 10 – 20 million men.
The key to Viagra’s (and later Cialis’s and Levitra’s) success included:
DTC advertising
Focusing on sexual enhancement
Focusing on E.D.
In the case of Erectile Dysfunction, Viagra De-stigmatized erectile dysfunction.

Question 35

Conrad Medicalization Ch 3 – ADHD

Answer 35

For Attention Deficit/Hyperactivity Disorder (ADHD), most of the criticism has been about the overdiagnosis and treatment of middle-aged men. (Special emphasis on pp. 66-69.)
In the case of ADHD, we witnessed the increasing role of Lay Groups in promoting Medicalization. The Lay promotion of adult ADHD promoted self-diagnosis, contradicted labeling theory, and blurred the lines between social control agents and deviants.
Biotechnology, Consumers, and Managed Care have changed the forces behind Medicalization.
It is estimated that for every dollar ($1) spent on DTC advertising the pharmaceutical industry makes $4.20 in sales.
Managed Care came to dominate the US healthcare delivery system because of market-driven costs.

Question 36

Conrad Medicalization CH 7 & 8

Answer 36

Physicians – though having lost ground to Consumers, Insurers, and the Biotech industry are still the gate-keepers of the Medicalization process.
Big Pharma – the Pharmaceutical companies – are the new, major force in the process.
Again, DTC has been key.
Three most widely recognized drugs (p. 135): Paxil, Viagra, and Claritin.
Pharmaceutical companies BOTH invest in and profit from Medicalization.
Unlike the capitalist Managed Care systems, socialized medicine doesn’t require pre-approvals, doesn’t constrain doctors or patients, and frees limits on all types of care.
Managed Care affects Medicalization by what they don’t cover!
Managed Care has commercialized medicine and pushed profits over patient care.
Medicalization in the New Millennium (pp. 142-145) – Quotes.
Lifestyle Orientation arguments have included:
Gay, Lesbian, Bisexual and Transgender (GLBT)
Anorexia
Obesity
Medicalization has increased and the powerful forces involved are fueling its expansion.

Question 37

Conrad Medicalization CH 7 & 8 con.

Answer 37

Conrad’s concerns include: over-medicalization with no end.
Two Important Points:
Conrad does NOT argue whether or not given problems are “really” medical. He says he doesn’t have the ability or desire to adjudicate that. Conrad’s claim is simply that these problems are not inherently medical, but have become medicalized, with significant social consequences.
Conrad does NOT deny that there may be some extreme cases of problems that have a biological or physiological basis, but that does not necessarily mean that all cases of that problem have a biological basis.
The benefits of Medicalization include:
Harm reduction
Blame reduction
Increased life opportunities

Question 38

Conrad Medicalization CH 7 & 8 con.

Answer 38

The Pathologization of Everything
Critical concern with widespread Medicalization:
The transformation of many human differences into pathologies.
(e.g. Gattaca) – virtually any human difference is susceptible to being considered a form of pathology, a diagnosable disorder, and subject to medical intervention.
Great danger: “…transforming all difference into pathology diminishes our tolerance for and appreciation of the diversity of human life.”
“One of the ironies of our culture is that no matter how much health is improved (as evidenced by decreased mortality rates, increased life expectancy, and improved health care), the reporting of health problems continues to rise.”
“Americans have also come less tolerant about minor physical symptoms and uncomfortable body states and thus have become important advocates for Medicalization.”
Medical Definitions of Normality
Why should medicine define what’s “normal”?
Is it reasonable to expect to keep erections, hair, and fertility until death?
Is it reasonable that kids shouldn’t “get wound up”? Or that they should be treated with medications if they “act out” or “challenge authority”?
“What is worrying … is that the pharmaceutical companies have an investment in creating these new norms in order to market their products.”

Question 39

Conrad Medicalization CH 7 & 8 con.

Answer 39

The Expansion of Social Medical Control
Social Control (of Deviance) is necessary in functional societies. Sin- Crime- Illness.
Medical Control is expanding, and so is “Medical Surveillance”. Increased monitoring of individuals can be good and/or bad. We have “ill”, “potentially ill”, and are moving to “genetic susceptibility”.
Medical Control includes: therapies, medicines, surgeries, and changes in behavior, changes in body or psychic state of individuals.
Social Implication of increased Medical Control:
More forms of behavior are no longer deemed the responsibility of the individual. – “The Medical Excuse”
Another is: “The Individualization of Social Problems”– Where the focus is on the individual rather than the social context.
Some “pockets of resistance” to Medicalization covered:
The Gay Rights movement successfully pushed for the de-medicalization of homosexuality.
The Disability Rights movement transformed their condition from medical problems to societal problems.
According to Conrad, it is unlikely that DTC advertising will subside.
In our current risk society – characterized by obsessions with insurance and security – people may not have symptoms, but still their condition may still be medicalized.
The forces Medicalization – pharmaceutical companies, doctors, insurance companies, patients, etc. – do not recognize aging as inevitable and untreatable by medicine.
By and large, there is not agreement among medical professionals, physicians and scientists around the world about most of the Medicalized human conditions discussed in the Conrad book.