Choice two of the following ” What do you think ” statements and write one page of each of them.

What Do You Think?Conception in the 21^st century

More than 30 years ago, Louise Brown captured the world’s attention as the first testtube baby—conceived in a petri dish instead of in her mother’s body. Today, assisted reproductive technology is no longer experimental; it is used more than 160,000 times annually with American women, producing more than 60,000 babies (Centers for Disease Control and Prevention, 2013). Many new techniques are available to couples who cannot conceive a child through sexual intercourse. The best-known technique, in vitro fertilization, involves mixing sperm and egg in a petri dish and then placing several fertilized eggs in the mother’s uterus, with the hope that they become implanted in the uterine wall. Other methods include injecting many sperm directly into the fallopian tubes or a single sperm directly into an egg.

means that a baby could have as many as five “parents”: the man and woman who provided the sperm and egg; the surrogate mother who carried the baby; and the mother and father who rear the baby.

New reproductive techniques offer hope for couples who have long wanted a child but have been unable to conceive, and studies of the first generation of children conceived via these techniques indicates that their social and emotional development is normal (Golombok, 2013). But there are difficulties as well. Only about one third of attempts at in vitro fertilization succeed. What’s

The sperm and egg usually come from the prospective parents, but sometimes they are provided by donors. Typically, the fertilized eggs are placed in the uterus of the prospective mother, but

sometimes they are placed in the uterus of a surrogate mother who carries the baby to term. This

more, when a woman becomes pregnant, she is more likely to have twins or triplets because multiple eggs are transferred to increase the odds that at least one fertilized egg will implant in the mother’s uterus. (An extreme example of this is “Octomom,” a woman who had octuplets following in vitro fertilization.) She is also at greater risk for giving birth to a baby with low birth weight or birth defects. Finally, the procedure is expensive—the average cost in the United States of a single cycle of treatment is between $10,000 and $15,000—and often is not covered by health insurance.

These problems emphasize that although technology has increased the alternatives for infertile couples, pregnancy on demand is still in the realm of science fiction. At the same time, the new technologies have led to much controversy because of complex ethical issues associated with their use. One concerns the prospective parents’ right to select particular egg and sperm cells; another involves who should be able to use this technology.

Pick your egg and sperm cells from a catalog? Until recently, prospective parents have known nothing about egg and sperm donors. Today, however, they are sometimes able to select egg and sperm based on physical and psychological characteristics of the donors, including appearance and race. Some claim that such prospective parents have a right to be fully informed about the person who provides the genetic material for their baby. Others argue that this amounts to eugenics, which is the effort to improve the human species by allowing only certain people to mate and pass along their genes.

Available to all? Most couples who use in vitro fertilization are in their thirties and forties, but many older women have begun to use the technology. Some of these women cannot conceive naturally because they have gone through menopause and no longer ovulate. Some argue that it is unfair for a child to have parents who may not live until the child reaches adulthood. Others point out that people are living longer and that middle-aged (or older) adults make better parents. (We discuss this issue in more depth in Chapter 13.)

What do you think? Should prospective parents be allowed to browse a catalog with photos and biographies of prospective donors? Should new reproductive technologies be available to all, regardless of age?

What Do You Think?When juveniles commit serious crimes should they be tried as adults?

Traditionally, when adolescents under 18 commit crimes, the case is handled in the juvenile justice system. Although procedures vary from state to state, most adolescents who are arrested do not go to court; instead, law enforcement and legal authorities have considerable discretionary power. They may, for example, release arrested adolescents into the custody of their parents. However, when adolescents commit serious or violent crimes, there will be a hearing with a judge. This hearing is closed to the press and public; no jury is involved. Instead, the judge receives reports from police, probation officers, school officials, medical authorities, and other interested parties. Adolescents judged guilty can be placed on probation at home, in foster care outside the home, or in a facility for youth offenders.

Because juveniles are committing more serious crimes, many law enforcement and legal authorities believe that juveniles should be tried as adults. Advocates of this position argue for lowering the minimum age for mandatory transfer of a case to adult courts, increasing the range of offenses that must be tried in adult court, and giving prosecutors more authority to file cases with juveniles in adult criminal court. Critics argue that treating juvenile offenders as adults ignores the fact that juveniles are less able than adults to understand the nature and consequences of committing a crime. Also, they argue, punishments appropriate for adults are inappropriate for juveniles (Steinberg et al., 2009).

What do you think? Should we lower the age at which juveniles are tried as adults? Based on the theories of development we discussed, what guidelines would you propose in deciding when a juvenile should be tried as an adult?

What Do You Think? Does marriage education work?

The Healthy Marriage Initiative really focused a great deal of attention on ways to lower the divorce rate (Fincham & Beach, 2010). One approach endorsed by many groups, called marriage education, is based on the idea that the more couples are prepared for marriage, the better the relationship will survive over the long run. More than 40 states have initiated some type of education program. Do they work?

Most education programs focus on communication between the couple; the programs provide general advice, not specific ways to deal with a couple’s issues. Because only a minority of couples currently attend a marriage education program, there is plenty of room for improvement. Several religious denominations have their own version of marriage education programs; the Catholic’s Pre-Cana program is one example.

There are numerous challenges to more extensive community-based marriage education programs. For example, in some cases, the education programs were originally developed to address poverty (Administration for Children and Families, 2010). Many couples cohabit and are less likely to attend marriage education programs even though there is little evidence that cohabitation improves communication skills between the couple (Fincham & Beach, 2010). As a result, versions of marriage education programs are being adapted for younger adults (who, if they marry while young, have a much higher risk for divorce) and for single adults (to teach them about communication skills). In addition, programs timed at key transition points (e.g., engagement) have also been developed (Halford, Markman, & Stanley, 2008).

Rather than intervene with couples before they marry, some programs target already-married couples (O’Halloran et al., 2013). One of the best known of these programs is Worldwide Marriage Encounter.

Research to date shows that these skills-based education programs have modest but consistently positive effects on marital quality and communication (Cowan, Cowan, & Knox, 2010; O’Halloran et al., 2013). Perhaps not surprisingly, couples who report more problems at the beginning of the program appear to benefit most.

These positive outcomes are resulting in a broadening of the approaches used by marriage educators to topics beyond communication. How these programs develop and whether more couples will participate remain to be seen. What does appear to be the case is that if couples agree to participate in a marriage education program, they may lower their risk for problems later on.

What do you think? Would you be willing to participate in a marriage education program?

What Do You Think? Do women lean out when they should lean in?

Sheryl Sandberg is unquestionably successful. She has held some of the most important, powerful positions in some of the most recognizable technology companies in the world. When she published her book Lean In: Women, Work, and the Will to Lead in 2013, she set off a fierce debate. Sandberg claimed that there is discrimination against women in the corporate word. But she also argued that an important reason women do not rise to the top more often is due to their unintentional behavior that holds them back. She claimed that women do not speak up enough, need to abandon the myth of “having it all,” must set boundaries, need to get a mentor, and must not “check out of work” when thinking about starting a family.

The national debate around these topics raised many issues: Sandberg’s ability to afford to pay for support may make her points irrelevant for women who do not have those resources; her husband’s ability and willingness to share in child rearing and household chores may make her arguments irrelevant for single parents; she was “blaming the victim”; no one ever puts men in these situations of having to choose; and so on.

Does Ms. Sandberg have a valid point to make? Do men and women differ in how they approach careers? Are the differences she notes inherent in men and women, or are they learned? What support systems that are currently missing need to be put in place? What do you think?

What Do You Think? How long would you want to live?

We have considered evidence that average longevity has increased significantly over the past century. This means that there have never been as many older adults alive at one time than there are right now, and this will only increase during the next several decades at least.

Getting older brings with it many positives (in terms of experience, well-being, and other things people enjoy in life) and negatives (especially biological and physical changes, as we will see).

This raises an important question for current generations: How long do you want to live? What, for you, would be the optimal length of life? For some people, the optimal length of life is the number of years they can continue to live independently and well. For others, it’s as long as their life has meaning.

What is it for you? What are the things that help you define your answer? What do you think?

What Do You Think? Reforming Social Security and Medicare

Few political issues have been around as long and are as politically sensitive as those that concern making Social Security and Medicare fiscally sound for the long term. The basic issues have been well known for decades: The present method for raising and distributing revenues in Social Security and Medicare are not sustainable (Social Security and Medicare Boards of Trustees, 2013). Because Social Security and Medicare are based on current workers paying a tax to support current retirees, the looming funding problems depend critically on the worker-to- retiree ratio. This declining ratio places an increasing financial burden on workers to provide the level of benefits to retirees that people have come to expect. Because of this declining ratio, unless major structural changes are made, the Social Security and Medicare systems are headed toward bankruptcy in the foreseeable future, requiring significant reductions in benefits to match expenditures with revenues (Social Security and Medicare Board of Trustees, 2013). So it’s no wonder that young and middle-aged adults have little faith that Social Security or Medicare will be there for them.

Potential solutions to these problems differ. Because Social Security is essentially an income assurance program, there appear to be more options with it. Among the possibilities proposed over the years are:

Privatization: Various proposals have been made for allowing or requiring workers to invest at least part of their money in personal retirement accounts managed by either the federal government or private investment companies. Another option would be to allow individuals to create personal accounts with a portion of the funds paid in payroll taxes.

Means-test benefits: This proposal would reduce or eliminate benefits to people with high incomes. • Increase the number of years used to compute the benefit: Currently, benefits are based on one’s history of contributions over a 35-year period. This proposal would increase that period to perhaps 40 years.

Increase the retirement age: The age of eligibility for full Social Security benefits is increasing slowly to age 67 in 2027. Various proposals have been made to speed up the increase, to increase the age to 70, or to connect the age at which a person becomes fully eligible to average longevity statistics.

Adjust cost-of-living increases downward: Some proposals have been made to lower those increases given to beneficiaries that result from increases in the cost of living.

Increase the payroll tax rate: One direct way to address the coming funding shortfall is to increase revenues through a higher tax rate.

Increase the earnings cap for payroll tax purposes: This proposal would either raise or remove the cap on income subject to the Social Security payroll tax (the maximum taxable earnings for Social Security was $117,000 in 2014).

Make across-the-board reductions in Social Security pension benefits: A reduction in benefits of 3% to 5% would resolve most of the funding problem.

None of these proposals for Social Security has universal support. Many proposed solutions would significantly disadvantage certain people—especially minorities and older widows—who depend almost entirely on Social Security for their retirement income (Polivka, 2010). Nevertheless, a range of options continues to be discussed.

In contrast, fixing Medicare is more difficult (Davis, 2013). As a health care entitlement program, Medicare must pay for all medically necessary covered benefits for enrollees; except for constraints placed on the program by the health insurance financing mechanism, there are no limits on overall Medicare spending. That leaves the only viable approaches based on (1) further restructuring of the health care system to manage costs better, (2) restructuring of the funding mechanisms including both the Medicare taxes on wages and the premiums and co-pays, or (3) some combination of both.

Solving the funding problems facing Social Security and Medicare will become increasingly important in the next few years. What do you think should be done to stabilize them?

What Do You Think? The Marlise Munoz case

On November 26, 2013, Erick Muñoz, a firefighter in a town near Dallas, came home to find his wife, 33-year-old Marlise, lying on the kitchen floor after experiencing a blood clot in her lungs. She was rushed to John Peter Hospital in Fort Worth, where she arrived alive but not breathing. Within two days, she was declared brain dead. She had made it clear that she did not wish to be left on life support; so her husband and parents informed the physicians in the intensive care unit of their desire to act on those views and asked the physicians to disconnect her from the machine. The physicians refused. Why? Marlise was 14 weeks pregnant, and the physicians believed that a Texas law prohibiting the removal of life support from a pregnant patient trumped the patient’s and family’s clear wishes.

What followed was a legal battle pitting an individual’s and her family’s wishes not to have life prolonged by machine in the case of brain death and the belief that Texas law makes those desires irrelevant in certain cases, essentially requiring that such patients be kept alive on machines. At the core of the debate was the law, initially passed in 1989 and amended in 1999, that states that a person may not withdraw or withhold “life-sustaining treatment” from a pregnant patient. People agreed that the law was aimed at situations in which the pregnant woman was in a coma or persistent vegetative state and “alive” under the laws pertaining to the definition of death. At issue was whether the law also applied to women who were declared brain dead. The hospital decided that it did; Marlise’s family argued that it did not.

Laws such as the one in Texas are common; at least 31 states have laws restricting the ability of physicians to terminate life support for terminally ill pregnant women, irrespective of what those women or their families want. The Texas law requires that life support be maintained no matter how far into the pregnancy the woman is.

Marlise’s case raised several issues for medical ethicists. Many pointed out that if she is brain dead, then she cannot be a patient, and physicians cannot be compelled to treat a deceased person. Others pointed out that because Marlise was dead and the fetus had not reached the point of being viable outside the womb, then there was no hope for the fetus. Still others argued that even if the chances for the fetus to survive to viability were remote, the fetus’s rights to that chance supersede the dead mother’s and her family’s.

On January 24, 2014, Texas state judge R. H. Wallace, Jr., ruled that Marlise, by then 22 weeks pregnant, could be disconnected from life support. The judge agreed with the family’s argument that the hospital had erred in its application of the Texas law. Medical records also indicated that the fetus was “distinctly abnormal” and suffered from hydrocephalus (an accumulation of fluid in the brain) as well as a likely cardiac problem. Because the hospital decided not to appeal the ruling, Marlise was taken off the machine on January 26.

Marlise’s case raises numerous issues about the rights of individual patients, their families, and the unborn. Whose rights are more important? What happens if there is a conflict? Can a state overrule end-of-life decisions that reflect deep personal and religious convictions? How do medical personnel respond if they are required to keep all pregnant women on life support? Are there public obligations to cover the medical expenses in such cases?

What do you think? Should Marlise Muñoz have been removed from life support?

Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.

Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sle…

To prepare for this Assignment:

Review this week’s Learning Resources, including the Medication Resources indicated for this week.

Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.

The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/… will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

• At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
• Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

Which decision did you select?

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
• Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

The Decision Tree Assignments are based on interactive case studies that allow you to explore pharmaceutical options and make decisions centered on the client’s needs.   You will be asked to make three decisions concerning the medication to prescribe to a client in the assigned scenarios.  At each decision point, you must evaluate all options before selecting your decision and moving through the rest of the exercise. The rationale for your decisions must be supported with a minimum of five academic resources from the primary and secondary literature. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Your 5-paper will be written on the interactive case study entitled, Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.  This case can be found in the week 8 folder under the Resources tab. https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/…Click on Required Media to expand the case. If your first draft is more than 5 pages, you should consolidate your writing.  In my experience, papers greater than 5 pages in length are repetitive and/or contain extraneous information that is not part of the required content.  Part of this exercise is to learn how to sift through the literature and extract the pertinent information.  Failure to do so may result in point deductions for issues with clarity.  The final draft that you submit must follow the format endorsed by the nursing program, and this paper must address the required content outlined in the grading rubric and instructions.  The required format is illustrated in the writing template.  The writing template and grading rubric can all be found under the Assignment tab in the week 8 folder.  The formal instructions, my notes on grading, and the late policy are shown below:

• Assignment #2:  Decision Tree
• Introduction to the case (1 page)
• You must briefly summarize the case. You must also highlight the specific patient factors that will impact your decision making when prescribing medication for this patient.  Please note that background information on the diagnosis, diagnostic criteria, or diagnostic testing is NOT required.  It is assumed that you know this; therefore, you should devote yourself to summarizing the case and highlighting specific patient factors that will impact your decisions rather than discussing the aforementioned items.  After all, you only have one page (or less) to cover the required information.  
• Be aware that the writing template and grading rubric require your introduction to end with ONE sentence that is your thesis statement.  See the writing template for format and the grading rubric for details on how you are graded on this statement.

Body of your document

The body of your document should contain three sections that are labeled as follows:  decision #1, decision #2, and decision #3.  Each section should address the topics below.  In your writing, you should be concise, clear, and thorough.  Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit. 

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. *In order to receive full credit here, your ethical considerations must be clearly identified as such.  You can identify them in one of two ways:  (1)  You can identify them within each section.  For example, “My ethical considerations are….”  (2)  Or you can identify them separately in a new section labeled “Ethical Considerations.”  This new section should be inserted after the section entitled Decision #3 and before the Conclusion section.  Either one of these options is acceptable.

Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.  *See Decision #1 for more information.

Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.  *See Decision #1 for more information.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. As stated in the writing template, “The conclusion section should recap the major points of your paper. Do not introduce new information in this paragraph.”

Required Readings (click to expand/reduce)American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC43881…
Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-s…
Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-s…
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470
Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740Medication Resources (click to expand/reduce)U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/in…
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

alprazolam

amitriptyline

• amoxapine
• amphetamine

desipramine

diazepam

doxepin

• eszopiclone

flunitrazepam

flurazepam

hydroxyzine

• imipramine
• lemborexant
• lorazepam
• melatonin
• methylphenedate

modafinil

armodafinil

carnitine

• clomipramine
• clonazepam
• nortriptyline
• pitolisant

ramelteon

sodium oxybate

solriamfetol

• SSRI’s
• temazepam
• trazodone
• triazolam

trimipramine

wellbutrin

zaleplon

• zolpidem

Write a book review for “Cutting for Stone by Abraham Varghese” using the book review resources and outline in the “PowerPoints, Readings and Videos” folder for this week’s module.

• At a minimum you will want to provide a summary and a critical evaluation of the book. Use the resources provided in this module to select the areas/or questions you want to address and then develop your outline prior to writing the review.
  • The summary should not be the major part of the review but does need to establish the background for the book and identify the author’s thesis (purpose) for writing the book.
  • The critical evaluation should include your thoughts, reactions and responses to the book. This should include your evaluation of how well the author met or did not meet the thesis of the book and your evaluation of selected elements of the book. You do not have to write about every event or character in the book. However, you will want to make a connection in your book review to the Global Health themes that we’ve discussed throughout the course
• Minimum number of words for this assignment is 1,500 single spaced. Less than 1500 will have point deductions, more is acceptable
• Use APA style for both in text citation and in the reference section
• Cite all sources of information or data used in your review that are not your own
• If you quote from the book under review, simply follow the quotation with the page number(s) in parentheses.
  • • For example: The author argues that “American women seem to have preferred careers over parenting” (p. 345).
    • Quotes that go over three lines in length should be single-spaced in a “block quote” format with the page citation at the end of the block quote.
    • If you have to cite other sources for quotations or facts, use APA citation style.
    • Reviews should be written in a formal manner. As with other written assignments, be sure to avoid using colloquialisms (“a lot” or “etc.”), contractions (“cannot” instead of “can’t”) and avoid using the first person (I, you, we, us).
• Include references at the end of your report – especially the main book being reviewed.

https://www.newyorker.com/magazine/2010/08/02/lett…

https://www.nytimes.com/2016/02/07/magazine/should-a-man-have-told-his-mother-in-law-that-she-was-dying.html?_r=1

http://www.pbs.org/wgbh/frontline/film/being-mortal/

QUESTION 2

Response Post

Read one of your peer’s arguments for or against the “Claim” and provide a brief critique of their argument. Is their argument for against the claim clear and understandable? Why or why not? Do they show a clear understanding of the metaphors they selected and do the metaphors they selected provide appropriate support to their argument? Why or why not? The minimum number of words for the response is 200.

Amber Bates

Metaphors and other figures of speech are critical and important in explaining or describing an illness or disease.

COLLAPSE

Top of Form

Are metaphors and other figures of speech critical and important in explaining or describing an illness or disease? I think in most situations they are. Metaphors are used to help describe a situation in a more people friendly way (Napolitano,2019). A metaphor can also help a patient relate to the disease or condition in a way that is relatable to most people. Medical conditions and disease process can be quite extensive. The information is not easy for anyone to just pick up and understand. In the book, Illness as a Metaphor getting cancer is described as a scandal to one’s life, and that the patient is “invaded” by alien cells (Sontag, 1978). Cancer is at the very core an abnormal growth of cells that invade healthy cells. Describing cancer as an invasion of the body from alien cells can help a patient relate to what is occurring. Some examples of how metaphors can help people understand a complex medical subject are found in the book Cutting For Stone.

In the Chapter “The Missing Finger” the author uses this metaphor, “The orange dye transformed the digits into an oversized lollipop” ( Verghese, 2016 pg 26). The metaphor creates a picture even for the non-medical professional of what it looks like when antiseptic is used. Normally you would only picture this if you had worked in an operating room prior to reading this story. The author gives a metaphor that everyone, including non-medical people, can visualize creating a better understanding of the situation. Another metaphor Found in Chapter nine, “More Blood! For God’s sake pour it in” ( Verghese,2016 pg116) . This metaphor immediately provides an image of blood needing to be poured in, like a pitcher pouring water into a cup. This allows the reader to understand the severity and importance the blood plays in the situation. Importance and understanding are the exact reasons we use metaphors to help educate our patients in healthcare.

In my own career I use metaphors to help a patient visualize what is occurring in their body. I feel the better a patient understands, relates, and connects to the illness the more compliant they are. For example, when I am dealing with a patient who has or is newly diagnosed with diabetes, I often describe what is happening in their blood stream using a visual of a straw and thick sugar water. Many patients with diabetes do not fully understand that elevated blood sugars can affect any organ in the body that blood touches. I once had a diabetic who had visual troubles related to prolonged uncontrolled diabetes. They did not understand how their vision was harmed because they had high blood sugar. I explained, like thick sugar water can become slow and sluggish in a narrow straw clogging at the smallest meeting point, the same is for your blood vessels and elevated sugar. I would ask them to picture adding more and more sugar to a small amount of water. What happens over time the water is sludge and easily can clog an opening like a straw. It is harder to suck the water because it has become so thick. The same thing occurs in the tiniest blood vessels in diabetes. They eye, kidney, heart, and feet are damaged because they have smaller blood vessels it becomes harder for them to suck the oxygen and nutrients needed from the blood for function. Explaining the disease process in a way that anyone can see and relate to makes it easier to understand.

Diabetics are also more at risk for infections, my metaphor for this is because bugs like sugar. When a patient can visualize that their elevated sugar is actual creating the food for the virus or bacteria, they are more likely to be complaint and better at managing their disease because who wants to have bug food? Educating our patients in a way they understand is providing great care.

I think all healthcare providers know the more educated our patients are the better the outcomes. Now there are always outliers to any plan. Although I feel that metaphors are critical and important for education and better outcomes, some diseases do not allow for this process. An example of this is autism. Many autistic patients take everything very literally, so a practitioner must be acutely aware of how they explain and discuss things to them. Like the metaphor in Illness as a metaphor, “In cancer the patient is “invaded” by alien cells” (Sontag, 1978). The autistic patient might think an alien is coming to invade their body. In this situation it would not be helpful to our patients. As health care professionals we need to be aware of the type of patient we are educating and talking to when we decide to use metaphors.

Health care is never a one sided plan works for everyone. It is knowing your patient and being able to adaptively use different communication skills to serve the one you are caring for. While I do think in most situations’ metaphors are a great tool to help increase a patient understanding of the disease process, I recognize that not always is it the tool required, such as in autism.

References

Napolitano, S. (2019, February 28). Metaphors in healthcare: To better comprehend and to improve awareness. MedicinaNarrativa.eu. Retrieved April 14, 2022, from https://www.medicinanarrativa.eu/metaphors-in-heal…

Sontag, S. (n.d.). illness as metaphor. Sontag, S. (1978) illness as metaphor. McGraw-Hill Ryerson Ltd., Toronto. – references – scientific research publishing. Retrieved April 14, 2022, from https://www.scirp.org/(S(351jmbntvnsjt1aadkozje))/…

Verghese, A. (2016). Cutting for stone: A novel. Alfred A. Knopf

Bottom of Form