Practice of Do Not Resuscitate, Pros and Cons - Essay Example

10 February 2008 Practice of "Do Not Resuscitate Pros and Cons The aim of sociological research is to investigate and describe social life, social values and traditions, population and social variables. Practice of "Do Not Resuscitate" involves legal, ethical and clinical decisions. A medical decision not to resuscitate a patient in the event of a cardiac arrest (on the grounds that the patient's condition is 'medically hopeless') may be supported by an established body of medical opinion, but nevertheless be deemed morally unsound or even illegal, or both. For this type of research longitudinal research, historical research and survey research will be used (Baker and Strosberg 29). Different types of research can be used in order to distinguish the main conditions and attitudes of the population and medical staff. There are some cases where a medical decision to cease treatment accords with moral principles but may nevertheless invite legal censure as in the case of withholding unduly burdensome life-prolonging treatment from severely disabled newborns or severely brain-injured adults. Longitudinal Research 'describes what can be defined as the minimum common denominator of a family of those methods which tell us about change at the individual micro level" (Ruspini 3). The advantage of longitudinal data is that it suggests important cross-cultural differences in the presence of flat affect while methodological questions remain as to precisely how flat affect was assessed. The cross-cultural variation in emotional experience and expression generally and in "Do Not Resuscitate" patients specifically render the culturally valid assessment of flat affect a complicated undertaking. A medical decision to continue treating a patient may accord with a reasonable body of medical opinion, be legal (as in cases where patients have been deemed rationally incompetent under a mental health act), yet be quite unethical if the patient has expressly stated a wish not to be treated, and if this expressed wish, contrary to popular medical opinion, is not 'irrational' (Baker and Strosberg 22). Death is of particular cultural and sociolinguistic concern insofar as the language and ethnicity of the individual conducting the psychiatric assessment may differ from those of the patient. Certainly a desire to die can be expected to vary substantially in relation to culturally constituted capacities such as self, agency, motivation, and the meaning of purposeful action. "longitudinal research is often undertaken precisely in order to identify social change and its correlates" (Bryman 71). In addition to the usual methods of cross-tabulations, comparisons of means between groups, correlation and regression analysis, there are some special methods that are particularly useful for the analysis of longitudinal data. The following are special methods which can be used to analyze data from our longitudinal studies: (a) age, period, and cohort analysis; (b) change graphs; (c) residual change analysis; and (d) longevity difference (Devine and Heath 63). A cross-sequential design is necessary to separate out the effects of age, period, and cohort. The essential steps are: first, the data must be arranged so that the time interval between times of measurement must equal the number of years in each birth cohort; second, each of the three types of differences must be measured: longitudinal (difference between earlier and later measurements on the same cohort), cross-sectional difference between cohorts at the same point in time), and time-lag (difference between earlier measurement on an older cohort and later measurement on a younger cohort); third, inference about the effects contained in these differences are based on the fact that each difference is composed of two effects: longitudinal difference equals age plus period; cross-sectional difference equals age plus cohort; and time-lag difference equals period minus cohort (Bryman 73). If there are no significant differences it is usually safe to infer that there are no age, period, nor cohort effects. If there are two significant differences, it is usually safe to assume that there is one and only one of the three effects present: the one which is common to the two significant differences (Devine and Heath 92). If there are three significant differences, there may be two unequal effects present or three effects present, and outside evidence or theory is necessary to distinguish these two possibilities. Finally, the theoretical causes of any inferred effects need to be determined. Age effects may be due to biological, psychological, and/or social-role changes with age. Period effects may be due to changes in the environment, measurements, and/or practice. Cohort effects may be due to genetic shifts and/or the interaction of specific historical situations with the cohorts at specific ages (Bryman 74). The main limitation is time required for data collection. A major problem in longitudinal analysis is the best way to measure individual changes with aging. A number of statisticians have pointed out the problems of using simple change scores, i.e., the difference between an earlier and later score (Devine and Heath 91). A solution to both of these problems is the method of residual change analysis. In this method a regression analysis is performed in which the score on the second administration of the measure is the dependent variable, and the score on the first administration is the first independent variable. This has the effect of controlling for initial level, thus eliminating the effects of regression to the mean, as well as reducing the measurement error caused by the doubling of errors in a change score (Bryman 78). Survey Research will help to collect personal data about the patients, analyze their attitudes towards "Do Not Resuscitate" order and perception of death. The most comprehensive and systematic study of why people prefer this order can be based on a national surveys. Usually, when people are asked why they prefer to use "Do Not Resuscitate" order, about two-thirds give involuntary reasons such as poor health, being "too old". Of these reasons, poor health or being "too old" is the most frequent. In short, feelings of depression, hopelessness, apathy and despair can undermine in very significant ways a person's ability to make sound autonomous choices (Devine and Heath 81). The question remains, however, of whether these feelings and a possible associated diminution in the ability to make sound autonomous choices are of a nature that justifies paternalistic intervention to prevent a person suiciding - including using invasive procedures to resuscitate who has attempted suicide. The short answer to these questions is that intervention may not only be justified, but may even be required, in the interests of both promoting a person's autonomy and saving a worthwhile life. When the various demographic characteristics associated with "Do Not Resuscitate" order are analyzed, it is clear that age is by far the single most important variable. It alone doubles the amount of variance explained, even after all other demographic variables are taken into account. This means that the tendency for older population to die cannot be explained away by the association of age with illness, lack of education, marital status, or other factors (Bryman 61; Baker and Strosberg 71). The main limitations of this method are high level of subjectivity and involvement of medical staff in decision-making. Typically, an NFR directive directs that: 'in the event of a cardiac arrest, neither basic nor advanced life support measures will be instituted by physicians, nurses, or other hospital staff' A decision not to resuscitate a person is popularly thought to flow from a medical judgment concerning the irreversible nature of that person's disease and their probable poor or hopeless prognosis. Also, such retrospective estimates are known to be less accurate than current estimates (Devine and Heath 99). Historical Method will help to compare historical data obtained during 1970s and 1990s. An intelligent choice of facts must be made according to principles or standards of value. The significance of material for the sociologist's purpose depends on various factors. A designedly informative history will not hesitate to topics, data, statistics, discussions of evidence on controverted points that would confuse or weary the general reader. A person without proper criteria for evaluating the information that reaches him from the outside, runs the risk of a thousand deceptions and errors. This is especially the case when the information presents itself through the medium of print. This tendency must be resisted if truth and error are not to have equal claims on the mind. Newspaper readers, especially, have to learn when and how far to suspend assent. They have constantly to put the principles of evidence to use. Historical research will help sociologist to identify and compare occupational levels of the aged and younger persons (Devine and Heath 114). Historical method may therefore be defined as "a systematic body of principles and rules designed to aid effectively in gathering the source- materials of history, appraising them critically, and presenting a synthesis (generally in written form) of the results achieved" (Devine and Heath 76). Over the past two decades, anthropologists have been instrumental in shifting the research focus on undernutrition to the level of the household. It is in the household where demographic and socioeconomic constraints translate into the specific behaviors that determine which individual will be undernourished and which will not. The problem is that this type of directive is usually given by a doctor in an attempt to 'avoid over-treatment and CPR (cardiopulmonary resuscitation) abuses', particularly in cases involving hopelessly ill patients 'who would be otherwise hopelessly revived' (Humphry and Wickett 1986, p. 209). NFR is thus a form of NFT, and probably is the most common NFT directive given in health care contexts. Historical research will help to analyze and compare main trends and social changes in attitudes of medical staff and patients towards "Do Not Resuscitate" order. "Foucault's approach was to take a broad-brush historical approach to the study of discourse. Discourse analysts, in integrating insights from CA, results in a much more fine-grained analysis" (Bryman 379). The main limitation of this research method is lack of historical data and analyses obtained during 1970s. Also, it will be impossible to check the statistical data and its variations. Analogy can aid historical investigation: first, by revealing new aspects and relations of facts, by bringing out points of disagreement even more so than of agreement; secondly, by opening up new problems, suggesting new hypotheses and affording new data for proof by induction; finally, by bringing to light a relation of dependence between two things, on the principle that "similar things are related in origin" (Dooley 92). This principle finds frequent application in historical reasoning as well as in everyday life. Sociologists use it by a certain necessity of nature, as we do the principle of causality; but it is easily misapplied. One or more of the possibilities that condition a problem can be and often are overlooked, with faulty analogy as a result. Erroneous applications of the principle in question are repeatedly met with, especially in the fields of history and sociology (Bryman 82). In sum, the patient's autonomous wishes may not have been established before the medical decision was made, or the patient's legally valid consent may not have been obtained to withhold cardiopulmonary resuscitation in the event of a cardiac arrest. Sociologists can use different research methods to investigate this problem. The researcher can investigate number of people (patients) using this order, their attitudes towards life and death, and target population. Erroneous judgments often result from the fact that the evidence on which they are based is vitiated by false play of the imagination. The role of sociologist is to test a hypothesis and use several methods to prove its validity and scientific values. Works Cited Baker, R., Strosberg, M. A. Legislating Medical Ethics: A Study of the New York State Do-not-resuscitate Law. Kluwer Academic Publishers, 1995. Bryman, A. Social Research Methods. Oxford University Press, 2004. Devine, F., Heath, S. Sociological Research Methods in Context. Palgrave Macmillan, 1999. Dooley, D. Social Research Methods. Prentice Hall; 4 edition, 2004. Ruspini, E. Introduction to Longitudinal Research (Social Research Today. Routledge. Read More