Study Prompt Assignment 26 Being Mortal II PDF

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Univ 291 section 2 Dr. Hollingshaus and Dr. Wood Study Prompt Assignment 26

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Being Mortal (ch.3-ch. 6) by Atul Gawande 1. Gawande discusses a number of different types of care facilities for the elderly. Three of these are the poorhouse, nursing homes, and assisted living facilities. a. Explain why poorhouses emerged and also the problems with poorhouses.  Poorhouses emerged for the poor who had no other options left. These institutions housed all types of people- elderly, immigrants, the mentally ill… These poorhouses would put the people to work for their stay, and often would not have hygienic or healthy living conditions. Elderly people (as well as everyone else) would receive inadequate nutrition and care, and would be susceptible to diseases. b. Explain why nursing homes emerged and also the pros and cons of nursing homes.  The growing prosperity of our nation (and many others) has enabled nursing homes to emerge, guaranteeing even the poor good shelter and proper nutrition and care. They emerged more out of a medical problem- with the growth of hospitals, people began to send their elderly and sick to hospitals. However, the problems the elderly face are not entirely fixable. As the number of elderly people in hospitals grew, the nation decided to create specialized places for these people to go and ‘recover’. However, nursing homes are mere shadows of the residents’ real homes – we need somewhere that genuinely feels like home to be happy. Nursing homes also impose more structure and supervision than we are used to. c. Explain why assisted living facilities emerged and also the pros and cons of nursing homes.  Assisted living facilities emerged to help those who don’t want to be confined in a nursing home but who want to keep living somewhat independently. They were originally intended to eliminate the need for nursing homes altogether. These facilities impose less control over the people involved than nursing homes while still providing the care that they need. The residents have control over their schedules and their diet, with a nurse on site and a way to get emergency help. In chapter four, Gawande discusses Abraham Maslow’s theory of human motivation and also (more extensively) Laura Carstensen’s research on human emotional experiences. d. Provide an overview of Maslow’s theory.  Maslow presents a ‘hierarchy of needs’ that describe levels of needs humans have in order to live a ‘good life’. These needs are presented in a pyramid- at the bottom are physiological needs (health, nutrition, safety). The next level is the need for love and belonging (emotional needs). The next level is our desire for growth (intellectual needs), and finally there is the desire for self-fulfillment through pursuit of moral ideas and creativity (moral needs). e. Provide an overview of Carstensen’s research.  Carstensen tracked the emotional experiences of about 200 people over the years of their lives. The result showed that people actually show more positive emotions as they age, contrary to popular belief. She also though that this change in needs and desires had to do with perspective. She conducted an experiment with terminally ill people of all ages and healthy people. The responses they gave toward the activities they would like to pursue were different in the healthy group, but in the terminally ill group, the young and elderly gave similar answers. f. How does Carstensen’s research disagree with Maslow’s theory?

 Maslow’s hierarchy of needs is somewhat static, and doesn’t change with age or social station. Carstensen’s research asserts that perspective matters when allocating a hierarchy of needs- we tend to focus on the highest level when we’re young and healthy, but when our days are numbered we tend to focus on personal relationships (the second level). 2. Bill Thomas asserts that there are “Three Plagues” of nursing homes. a. What are the three plagues?  boredom, loneliness, helplessness b. What does Thomas do at the Chase Memorial Nursing Home to combat these three plagues?  put green plants in every room, create a vegetable and flower garden, bring in animals c. What does his experiment teach us about what it is to live the good life?  having a purpose to life and things to look forward to can be more effective than medication. 3. In chapter five, Gawande presents two concepts of autonomy—the second of which comes from Ronald Dworkin. a. Describe each theory.  autonomy as free action (living completely independently without coercion and limitation), and autonomy as retaining the freedom to be the authors of our lives (shaping our own lives according to some sense of character and interest) b. Explain how they differ from each other.  the first theory asserts that autonomy is being completely free of all coercion- we are free to do whatever we want, even if it may harm us or even if we are not physically capable of doing so. The second is a slightly narrower definition. The second defines autonomy as the ability to shape our own lives according to our limitations and abilities (the freedom to stay consistent to our own beliefs and character) 4. In chapter six, Gawande presents what he calls “a difficult question”: “When should we try to fix and when should we not?” He then provides quite a few case studies that explore this question. Choose three case studies and for each: summarize the study and also explain how it engages with the question. a. Case study 1  Sara Monopoli had a case of severe lung cancer that spread throughout her entire body during her pregnancy. She is an example of a ‘fighter’, someone who continues to try new treatments with slim chances of working when it is most probable that they will not help with her problem. Her situation perfectly illustrates the difficulty of the question. She continues with her treatments in the hopes of gaining a couple of years of life, but in reality there is no way of knowing whether the treatments will really deliver. With an incurable disease like lung cancer, it may be more probable to stop the treatments and focus instead on living as comfortably as possible in the last days of one’s life. b. Case study 2  In the case of Nelene Fox, she was diagnosed with breast cancer and appealed to her insurance company to pay for a new, radical treatment. However, the healthcare company denied her request (and rightly so- it was shown not to have any benefit for patients). Her husband sued the company and won. This shows that people are more inclined to fight for their lives even if fighting will decrease their overall happiness and chances of survival. If Nelene Fox had not tried to extend her life through a radical treatment but had focused on spending her last days comfortably, she might have had a better experience. c. Case study 3

 Related to Nelene Fox’s case, an insurance company called Aetna attempted something different- they increased hospice options for critically ill patients instead of reducing aggressive treatment options. The results showed that the patients visited the emergency room less, and their use of hospitals and intensive-care units dropped by more than two thirds (overall costs dropped by almost a quarter). The difference was in the discussion the patients had with people who understood their condition and wanted to help them better navigate these last days. In this case, ‘trying to fix’ worked, but not in the sense that we often think of....