Planned Parenthood, Women's Health Issues, Nurses could rule the US

tewdles, RN · Apr 17, 2012

Good to see so many people on the same page with patient directed care. They should be allowed to decline any and all treatment or intervention. I feel that we should be addressing advanced directives and end of life choices at every patient encounter...either inpatient or outpatient...for every patient but especially for those who have chronic diseases.

alpha omega · Apr 19, 2012

And not only for end-of-life, tewdles, but patient-directed care is appropriate for for all stages. Patients need to be very savvy about health, and health care choices. We have a lot of good information in the internet right now, but some of it is bunk, and as nurses we can help direct our patients to good, competent websites, and show them how to evaluate the accuracy of what they're reading (ex: is it a site trying to sell you a supplement, do they have peer reviewed articles to back up their claims).

tewdles, RN · Apr 20, 2012

nicurn, you aren't expounding on my logic in the least. you are making a totally baseless assumption.
pmfb, i understand abortions are performed whether legal or not, but this does not even begin to address my questions about inherent value of human beings. just because something is done anyway does not mean our nation should make it legal or advocate for it. that's just ridiculous.
haldol, i never once compared this to "someone being on trial for murdering a fetus" and i have no clue where you got that. ??? do people actually read these posts?
to answer your question, if morphine is used solely as a comfort measure to allow someone very near death some relief, i of course agree with that. it is when a nurse or a doctor decides the person is near enough to death to give them a lethal dose of morphine to stop respiration that i begin to have major issues. i have seen it happen many times and it is wrong. it is a very gray area because the patient is so near death anyway, so it almost always goes unnoticed and would be impossible to prove. it is not a health care provider's right to knowingly administer an amount of morphine they know will stop respirations. human beings deserve to die a natural death regardless of their disease process. i know it is tough to gauge the amount of morphine that will shut down respirations but i have witnessed hospice nurses knowingly give too much to "end the suffering." again, not their call.

that is not hospice care. those health professionals are breaking the law. if you have witnessed a hospice nurse breaking the law and practicing outside of his or her scope did you report it to proper authorities? and how do you know that you witnessed hospice nurses (plural, really) knowingly give "too much" with the goal of "end the suffering".

i'm just going to go out on a limb here and say...hooey. you have likely made some assumptions here (you cannot possibly know what the hospice nurse is thinking or knowing in that moment unless said hospice nurse shares that with you). that is your own opinion of hospice care but is not a reflection of actual hospice pracitice and has no place in this discussion, imho.

tewdles, RN · Apr 20, 2012

In my post I referred to nurses or doctors choosing to give lethal doses to "end suffering". You said "what's wrong with ending someone's suffering?" - you made direct reference to my post, which was specific to giving a lethal dose of morphine. If you didn't mean ending someone's life (like I was saying) you should have made that clear. I agree that at times hospice seems to be carrying out an agenda - as though they have a secret pact to over-drug people at the end of life. I don't believe they do it because it gives them some evil pleasure - I believe they do it because they believe it is "the right thing to do." I just don't agree with them, that they should have that right, or authority, to end someone's life. This is all speculation so I'm not accusing anyone of anything.

Your posts reflect a rather plain ignorance and bias about hospice in the USA...

everwonder_y · Apr 23, 2012

[color=#2d2d2d]first of all, contraception is already low cost. oc is about $20 per month, condoms about $1 each. but that's not really the point.
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[color=#2d2d2d]second, if they roll back the hhs mandate, all the contraception won't magically disappear. it will still be there on the shelves for those who choose to buy it(with their own money).
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[color=#2d2d2d]thirdly, this whole "debate" was created out of thin air by this administration to fuel their own agenda. before the hhs mandate, employers had the right to offer contraceptives through their health insurance or not. an employee who didn't like it was free to find another job with an employer who was more in line with their way of thinking. there were still choices and nobody was forced to act against their religious beliefs. then obama decied to stir up the pot, and have us all fighting amongst ourselves. now, people are screaming for something that was never guaranteed in the first place. i wonder how many people realize they are being used and manipulated? how many people have any idea how this violation of the first amendment can very quickly lead to other violations?
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[color=#2d2d2d]fourth, what right does anybody have to reach into my pocket and take my hard earned money to subsidize their sex life?
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[color=#2d2d2d]i take responsibility for my own sexual activity. i'm not asking anybody to do something i'm not willing to do myself. i walk my talk.

this is not at all accurate, 28 states already mandate contraceptive coverage by employer sponsored health plans.

http://www.guttmacher.org/pubs/tgr/07/2/gr070206.pdf

^^this is from 2004, since then 8 more states mandated contraceptive coverage to the 20 listed in the publication.

institutions that operate in primarily faith based capacities and serve people of that faith are mostly exempted ( though 8 states do not exempt churches).

institutions that do not operate primarily in faith based capacities and serve people of all faiths are not exempted. (e.g. catholic affiliated hospitals and universities)

wages, health benefits and 401k benefits are components of an employee's compensation package. an employer can not dictate how an employee spends their wages, uses their health benefits or invests in their 401k. this is would be a massive over-reach!

your religious liberty ends where your swinging bible hits another person. religious liberty of individuals supersedes that of religiously affiliated institutions.

ps

mandated maternity coverage (mandated by the pregnancy discrimination act of 1978) is also subsidizing other peoples' sex life by your logic.

subee, MSN, CRNA · Apr 23, 2012

Alpha Omega: You're scaring me. According to your logic, you shouldn't reach into your pocket and give any of your "hard-earned" (mine isn't?) money, to the children who become the issue of unprotected sex? How do you feel about paying for their school lunches, food stamps, free clinics, ER visits and for many, their incarcerations after a life-time of abuse? Avoiding unwanted pregnancy is a MEDICAL NEED - people's lives are ruined by unwanted pregnancies, including the lives of the offspring. AO, for your own good, examine how you have become so hard-hearted and punitive. It will do you a world of good and provide you with more peace.

alpha omega · Apr 23, 2012

Oh jeez, here we go with the “you’re scaring me” rhetoric. Too bad people on this site can’t sit down like grown-ups and discuss issues without the name calling and emotional appeals and snide remarks about other peoples religious faith.

everwonder_y: There are 8 states that mandate this coverage, without exceptions. It’s still an unjust law.

subee: answer this. If people aren’t using contraceptives now, which are free (under title x and other programs) or cheap, as I explained before, what makes you think they’ll use them if the hhs mandate goes through?

This is still all about the First Amendment.

subee, MSN, CRNA · Apr 23, 2012

I don't think any mandate will get people to behave any better or differently . My only point is that I have to pay for a lot of medical expenses for other people that I believe are unethical. But I know that I can't pick and choose which things I want to pay for and which ones I don't because I don't believe that my vision of what's right or wrong trumps someone else's opinion.

oYou have to pay for someone else's contraceptive pills (PCO anyone?) and I have to pay for $36,000 chemotherapy drug proven to extend one's life for 28 days. Or for resuscitating an 18 week fetus condemning them to a short brutish life or a longer one in an institution on a ventilator until death. And I pay for the prison bills for the unwanted and uncared for children (I know..actually volunteered in prison for 7 years). I pay for lots of stuff I don't want to pay for but who am I to say whether it's right or wrong? I have no idea what G_d thinks. HeShe doesn't tap me on the shoulder to tell me what's right and wrong.

everwonder_y · Apr 23, 2012

Oh jeez, here we go with the “you’re scaring me” rhetoric. Too bad people on this site can’t sit down like grown-ups and discuss issues without the name calling and emotional appeals and snide remarks about other peoples religious faith.

I don't see name calling or emotional appeals, just rebuttals using facts.

So you object to the 8 states that don't allow churches to be exempt, but what about the 28 states that don't exempt religious affiliated institutions that operate primarily in NON-faith based capacities and serve people of all faiths? You know, exactly the same criteria that the HHS mandate followed and was in place starting first with Maryland in 1998?

everwonder_y · Apr 23, 2012

If people aren’t using contraceptives now, which are free (under title x and other programs) or cheap, as I explained before, what makes you think they’ll use them if the hhs mandate goes through?

The HHS preventive care provisions is based in value-based insurance design. That is that high value services like cancer screenings, immunizations, family planning, cholesterol and hypertension screenings, etc, services that prevent more costly treatments should be covered with no cost-sharing.

P reventive Care Provisions under the PPACA

Contraceptives are getting the most exposure, but the preventive care provisions include a lot more than that.

Health insurers are on board because it levels the playing field so to speak. In the US most people change insurance companies every 2-5 years, there is little incentive for insurers to encourage cost-saving preventive care where the benefit is likely realized years later by another company. This way people can hop around from company to company but still be guaranteed the same access to preventive care and all insurance companies realize the benefit.

A ssessing the Evidence of Value-Based Insurance Design

alpha omega · Apr 24, 2012

There is a difference between professional ethics and moral ethics. Professional ethics are the way a particular profession carries out its mission. Moral ethics are based in natural law.

I totally understand recognizing the futility of recussitating an 18weeker or heroic measures to a person with a terminal illness. But there are different levels of wrongness. The heroic measures you mentioned aren’t designed to kill, but to attempt to save life. It may be futile, but it’s still directed at livesaving.

On the other hand in the abortifacient devices that would be mandated under hhs are aimed at taking life.

According to the National Conference of State Legislatures website (2012), 28 states have contraceptive mandates. 20 of them have appeals processes for faith-based institutions to be exempt from these mandates. 8 states have no apparent appeals process.

Again, the HHS mandate is about an attempt to dismantle the First Amendment. Forcing health care providers to participate in actions against their conscience is a major overreach for the Federal Government. It is not a referendum on any particular religion’s teachings.

PS. Erm, fear is an emotion (as in “you’re scaring me”). Therefore, that was an emotional appeal. And yes the remark about God tapping somebody on the shoulder is definitely snide.

MunoRN, RN · Apr 25, 2012

There is a difference between professional ethics and moral ethics. Professional ethics are the way a particular profession carries out its mission. Moral ethics are based in natural law.

You lost me with the "professional" vs "moral" ethics comparison. Both professional and personal ethics have a basis in morals, which in turn are based in natural law and other principles. Personal ethics come from ones own morals, while professional ethics must consider and incorporate the morals and ethics of others.

I totally understand recognizing the futility of recussitating an 18weeker or heroic measures to a person with a terminal illness. But there are different levels of wrongness. The heroic measures you mentioned aren't designed to kill, but to attempt to save life. It may be futile, but it's still directed at livesaving.

By definition, if it's futile then it's not directed at lifesaving.

On the other hand in the abortifacient devices that would be mandated under hhs are aimed at taking life.

Perhaps you could clarify this.

According to the National Conference of State Legislatures website (2012), 28 states have contraceptive mandates. 20 of them have appeals processes for faith-based institutions to be exempt from these mandates. 8 states have no apparent appeals process.
Again, the HHS mandate is about an attempt to dismantle the First Amendment. Forcing health care providers to participate in actions against their conscience is a major overreach for the Federal Government. It is not a referendum on any particular religion's teachings.

PPACA makes no requirements of health care providers to prescribe contraception, only for insurers to cover preventative care, which includes contraception, without a surcharge.

PPACA does not inhibit a person's ability to practice their religion. I think people forget that preserving someone's right not to practice your religion is also freedom of religion.

In terms of "forcing health care providers to participate in actions against their conscience", welcome to healthcare, I participate in care that goes against my conscience nearly daily.