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Update December 2017


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Update by Natrakorn Paewsoongnern
 
 
 

Doctor's Consultation  by Dr. Iain Corness

 

Update Saturday, Dec. 9 - Dec. 15, 2017

Living Wills – and Euthanasia!

A year ago, I wrote on Living Wills, but with the legalization of euthanasia in the state of Victoria in Australia in November this year, I felt I must re-run the item from one year ago.

A couple of years ago, there was a small paragraph in one of the Bangkok English language daily papers, reporting on the fact that Living Wills were now accepted as being legal in Thailand. I cheered as I read it. It was ‘about time’, in my opinion.

However, there is confusion in the minds of many people, as to what a “Living Will” actually is and what it covers. First off, it is not euthanasia. I repeat, it is not euthanasia. Borrowing from the Mayo Clinic in the US, it states on their website “This written, legal document spells out the types of medical treatments and life-sustaining measures you do and don’t want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation.” The important words to note are “life sustaining” and “resuscitation”. Neither of these concepts imply medically assisted suicide.

Once again from the Mayo Clinic, “Injury, illness and death aren’t easy subjects to talk about, but by planning ahead you can ensure that you receive the type of medical care you want, to take the burden off your family of trying to guess at what you’d want done.”

Remember that we are talking about terminal situations here. Not situations from which it would be reasonably expected that you will recover and still have a good quality of life. A fractured hip when you are 90 is a serious situation, but provided you are healthy otherwise, then it would be expected that you would recover. You might need a stick for a while, but you would still be able to have a beer with your mates or whatever your pursuits were before the incident. In other words, the expectancy of a reasonable quality of life is there.

However, if you are in the terminal phase of metastatic cancer, which has progressed despite treatment, the future quality of life is not there. Artificially prolonging life under that situation is then covered by the Living Will.

As an example, note the following:

The Living Will is made while in sound mind. It is not something you scribble out while lying in God’s waiting room. An example of a Living Will. “Being of sound mind and understanding all the implications, I ask that this document be brought to the attention of any medical facility in whose care I happen to be, and to any person who may become responsible for my affairs.

“This is my ‘Living Will’ stating my wishes in that my life should not be artificially prolonged, if this sacrifices my Quality of Life.

“If, for any reason, I am diagnosed as being in a terminal condition, I wish that my treatment be designed to keep me comfortable and to relieve pain, and allow me to die as naturally as possible, with as much dignity as can be maintained under the circumstances.

“As well as the situation in which I have been diagnosed as being in a terminal condition, these instructions will apply to situations of permanently unconscious states and irreversible brain damage.

“In the case of a life-threatening condition, in which I am unconscious or otherwise unable to express my wishes, I hereby advise that I do not want to be kept alive on a life support system, and I do not want resuscitation, nor do I authorize, or give my consent to procedures being carried out which would compromise any Quality of Life that I might expect in the future.

“I ask that you are sensitive to and respectful of my wishes; and use the most appropriate measures that are consistent with my choices and encompass alleviation of pain and other physical symptoms; without attempting to prolong life.

Now those are only examples. The Bangkok Hospital Pattaya has a pro forma Living Will, which is also repeated in the Pattaya City Expats website, I believe.

The message is that a Living Will is not euthanasia, and that you must lodge it, before you need it!


Update Saturday, Dec. 2 - Dec. 8, 2017

Influenza and the WHO

I am no great lover of the World Health Organization (WHO). To make Zimbabwe’s despot the ambassador?? I do also believe that the WHO “needs” epidemics to generate funding, to keep going.

So let’s look at some “killer” epidemics. We should not forget the panic with the Swine flu (also H1N1) a few years ago. Bulletins from the WHO every day added to the panic. The word “pandemic” instills fear and even hysteria.

Where WHO let itself and us down was WHO did not tell the media that the immediate danger of viral infections has two requirements – how easily it passes from one host to another and how lethal is the ensuing infection.

The ‘pandemic level 6’ only referred to the contagious nature of the virus and H1N1 is certainly highly contagious. However, with only around 4000 deaths in the world from that 2009 Swine Flu virus, just how lethal was it, when the seasonal flu kills 36,000 people each year just in the US alone, and 200-300 people in Thailand? Read those numbers again – 200-300 people from the seasonal flu in Thailand! That’s from the “nothing out of the ordinary” flu!

Right, what can you do about avoiding a full-blown influenza infection this year? Quite simply, flu vaccination can keep you from getting sick from flu. Protecting yourself from flu also protects the people around you who are more vulnerable to serious flu illness. That’s the contagious nature again.

Flu vaccination can help protect people who are at greater risk of getting seriously ill from flu, like older adults, people with chronic health conditions and young children.

Flu vaccination may also make your illness milder if you do fall ill.

Flu vaccination can reduce the risk of more serious flu outcomes, like hospitalizations and deaths.

A recent study showed that flu vaccine reduced children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74 percent during flu seasons from 2010-2012.

One study showed that flu vaccination was associated with a 71 percent reduction in flu-related hospitalizations among adults of all ages and a 77 percent reduction among adults 50 years of age and older during the 2011-2012 flu season.

Flu vaccination is an important preventive tool for people with chronic health conditions. Vaccination was associated with lower rates of some cardiac events among people with heart disease, especially among those who had had a cardiac event in the past year. Flu vaccination also has been shown to be associated with reduced hospitalizations among people with diabetes (79 percent) and chronic lung disease (52 percent).

Vaccination helps protect pregnant women and their babies for up to 6 months after they are born. One study showed that giving flu vaccine to pregnant women was 92 percent effective in preventing hospitalization of infants for flu.

Other studies have shown that vaccination can reduce the risk of flu-related hospitalizations in older adults. A study that looked at flu vaccine effectiveness over the course of three flu seasons estimated that flu vaccination lowered the risk of hospitalizations by 61 percent in people 50 years of age and older.

There are special vaccination instructions for children aged 6 months through to eight years of age as some children require two doses of influenza vaccine. Children in this age group who are getting vaccinated for the first time, as well as some who have been vaccinated previously, will need two doses. Your child’s health care provider can tell you whether two doses are recommended for your child.

A complicating factor comes with the annual make-up of the actual vaccine itself. Since the viral strains dominant in any particular year can change, this does mean you should top up your immune status with an annual jab.

In some quarters there is still resistance to influenza immunization as well as the childhood vaccinations, but to be honest, I cannot understand why. Sure, there are risks involved with immunization, but those risks are very, very small compared to the risks in getting the flu.

I do get more than a little tired of the “facts” being bandied about on the social media on the subject of immunization. Right from the outset let me tell you that immunization does not cause autism.


HEADLINES [click on headline to view story]

Living Wills – and Euthanasia!

Influenza and the WHO
 

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