Question for Discussion #10 – A Hard Decision

Instructions:

Read the scenario and perspectives given below. In your post, explain what you think is the most ethically justified course of action. Use material from the text or lectures to help explain and support your view.

Scenario:

Mario is a 30-year-old male who has been severely injured in a motorcycle accident. Mario has sustained extensive neurological damage, including the loss of higher brain function. He is being kept alive in an intensive care unit (ICU) by means of life-sustaining treatment that includes the use of a ventilator, feeding tube, and various intravenous medicines. In the room with Mario are his girlfriend, Johanna, and his parents, Troy and Wendy. Mario lives with Johanna and they have a child together, Agnes, age 4. However, since Mario does not have documented medical power of attorney and because he and Johanna are not married, state law holds that his parents have the authority to make medical decisions on his behalf.

Mario’s doctor, Eula Ellis, comes into the room to examine Mario and explains to the family that he is in a persistent vegetative state (Links to an external site.) (PVS)

https://www.merckmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/vegetative-state-and-minimally-conscious-state

 and that Mario is unlikely to recover. Gently reinforcing this last point, Dr. Ellis explains that the treatment Mario is receiving is keeping him alive, but it will not lead to any cure or recovery. Wendy points out that Mario sometimes opens his eyes and blinks when there is a loud noise. She wonders if that means that there is hope that he recover. Dr. Ellis says that, sadly, that’s not the case. These actions from Mario are brain stem activity – automatic biological responses – and are common with PVS. What made Mario Mario will not come back.

Dr. Ellis asks the family to consider what Mario would want. She suggests that they consider authorizing the withdrawal of all life-sustaining treatment so that Mario can die a “natural death”. A few hours after Dr. Ellis leaves, another doctor, Marcus Horton, and a social worker, Dawn Cunningham, enter the room and ask to speak with the family. Dr. Horton explains that he and Ms. Cunningham are part of the hospital’s Organ Procurement Team. They express their sorrow for what has happened to Mario. They ask the family to consider donating Mario’s organs so that other lives can be saved.

Perspectives:

Mario: The prevailing scientific view holds that Mario is not aware of his circumstances. He might have enough sentience to react to some stimuli such as light and sound. It is uncertain if he feels pain or suffering. Mario is incapable of communication.

Dr. Ellis: Having seen several tragic cases like this, Dr. Ellis believes that keeping Mario alive on life-sustaining treatment is futile. He will die. The family might need some time to come to grips with this difficult decision, but the sooner they make it, the better. Bodies typically don’t do well when they are kept alive for long and Dr. Ellis has seen some very difficult cases in which families kept patients like this alive for months.

Johanna: She is heartbroken. She is wondering what she will tell Agnes and how she will raise Agnes on her own. She worries that Mario is suffering. They had such hopes for their lives, and now he is so broken. She just wishes that he could be at peace.

Agnes: Johanna’s mother is caring for Agnes at the moment. She knows that something is happening and that people are upset. At four years-old, Agnes is just reaching the age where she can comprehend that death is irreversible. When Mario dies, she will be able to recognize that this is final and she will grieve.

Wendy: Mario’s parents are people of faith. They have participated in prayer circles through their church for people who have faced serious health challenges. Wendy believes that miracles can happen. She’d like to call upon the prayer circle at her church. Besides, she saw Mario’s eyes open and turn toward her when spoke. Doctors don’t know everything; they’re not God. She’s offended that Dr. Horton came by so quickly. Organ donation can wait until after they give prayer a chance.

Troy: He is facing the loss of his heir – his contribution to the future. Like Wendy, Troy would like to involve the church prayer circle. God determines when people die, right? Troy is also mad that those vultures came in looking for Mario’s organs. Those doctors would rather sell him than try to save him.

Marcus Horton and Dawn Cunningham: This is the worst part of the job – when families are reeling from the shock of what happened to a loved one who was perfectly healthy just hours ago. They realize that they come across as ghouls but timing is everything when it comes to organ donation. Organs don’t remain viable for long. Stopping life-sustaining treatment has to be coordinated with the harvesting of organs, and that has to be coordinated with the transport and transplantation of those organs. If the family is thinking about withdrawing treatment, then they also need to weigh organ donation in that decision. It’s a hard thing to ask of them, but other lives can be saved.

Discussion Assignments have the following objectives:

1. Identify and describe key concepts presented in textbook reading material, video lectures, and other assigned content.
2. Draw connections between assigned content material and practical areas of interest.
3. Explore ideas in philosophical depth beyond the presentation of course material.
4. Draw connections between philosophical discourse and one’s practical life.
5. Engage in respectful philosophical conversation.
   1. This objective will be measured according to replies posted to other students or to professors.

When completing discussion assignments, please remember:

• Your main post should take a minimum of 300 words. Explain and support what you say.
• Any sources that you use must – including textbook and video lectures – be cited and referenced responsibly. (APA)
• You should post at least two substantial replies to other participants.
• Please refer to the syllabus and grading rubric for more guidance.

  

Throughout history, technological advancements have appeared for one purpose before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment. But technology—new and repurposed—will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be or how the next new idea for applying existing technology can benefit outcomes.

In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.

To Prepare:

• Reflect on the Resources related to digital information tools and technologies.
• Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
• Reflect on current and potential future trends, such as the use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking,      or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

The Assignment:

1. Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice.

2. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. 

3. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. 

4. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. 

5. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.

Think of an organization you have worked for or one with which you are very familiar.  Diagnose the need for change and present a plan to transform the organization, utilizing Kotter’s 8-Step Approach. You will need to research the Kotter 8 Step Change Model extensively. You are encouraged to first review the Kotter’s Eight Step Leading Change Model (Links to an external site.) article. You may select any organization or department where you work or where you have previously worked; however, you are strongly encouraged to diagnose one problem area in the company. Attempting to diagnose an entire company is not feasible, and you will become bogged down.

If you choose a company similar to Walmart to analyze, select just one area that you think needs improvement. For example, Walmart is now very strong in online shopping, yet there are still glitches in the system. Delivery times are often late, the packaging method has problems, and some products come from unknown vendors that Walmart does not guarantee. We may know this from personal experience, but that is not enough. Statements, opinions, and experiences must be supported with valid sources. There are many articles online that you can review easily and quickly.

Your sources for this paper must include research for the company you choose, a valid source for the Kotter model, and your textbook. You are encouraged to read as many articles as you can find and contact the University of Arizona Global Campus librarians for guidance. There is bias, missing or incorrect information, and contradictory material in most Internet material. The amount of material can be confusing, but wade through it and question everything.

Include the following sections headings and additional sections as needed:

Introduction

Company Overview

Diagnosis

Kotter’s 8-Step Approach

Conclusion

The Final Paper for the course must be submitted to the instructor by 11:59 p.m. of the time zone in which you reside on the last day of the class.

Writing the Final Paper

The Final Paper

Must be eight to ten double-spaced pages in length (not counting the title page and references) and formatted according to APA Style (Links to an external site.) resource.

Must include a title page with the following:

Title of paper

Student’s name

Course name and number

Instructor’s name

Date submitted

For further assistance with the formatting and the title page, refer to APA Formatting for Word 2013 (Links to an external site.).

Must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear thesis statement that indicates the purpose of your paper.

For assistance on writing Introductions & Conclusions (Links to an external site.) as well as Writing a Thesis Statement (Links to an external site.), refer to the University of Arizona Global Campus Writing Center resources.

Must address the topic of the paper with critical thought.

Must end with a conclusion that reaffirms your thesis.

Must use at least five scholarly sources in addition to the course text.

The Scholarly, Peer-Reviewed, and Other Credible Sources (Links to an external site.) table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment.

Must document any information used from sources in APA Style as outlined in the University of Arizona Global Campus Writing Center’s APA: Citing Within Your Paper (Links to an external site.) guide.

Must include a separate references page that is formatted according to APA Style as outlined in the University of Arizona Global Campus Writing Center. See the APA: Formatting Your References List (Links to an external site.) resource in the University of Arizona Global Campus Writing Center for specifications.

Davy Jones provides the following information for Davy Jones’ Nautical Tours, Inc, a C corporation which he operates with his business partner, William Turner. 

You’re required to prepare a Form 1120 U.S. Corporation Income Tax Return, an 1120 Statement 1 – Other Deductions, and an 1120 Schedule G – Information on Certain Persons Owning Stock  Davy Jones’ Nautical Tours, Inc, is operated by David K. Jones (SSN 000-00-0000) and William W. Turner (SSN 111-11-1111).

They are each 50% common shareholders in the business.  Principal Business or Professional Activity Code; 114110 Principal business; Charter fishing tours Employer Identification Number 867530950  Business address     1008 North Harbor Drive    San Diego, CA 92103      Home address (David K. Jones) 8700 Lake Murray Blvd #2 San Diego, 92119 

•The cash accounting method and GAAP are utilized  •The business was incorporated on January 1st, 2012  

•Wages consist of $25,000 paid to one employee and $15,000 to another  

•Officer’s Compensation; $42,000 payments to each officer, Jones and Turner.  •None of this compensation is claimed on Form 1125-A (Cost of Goods Sold).  •There is no preferred stock  

•Depreciation expense; The Jolly Roger was purchased for $850,000. The depreciation on the income statement is book depreciation and will differ from what is actually used on Line 20 Depreciation of form 1120. The boat is depreciated using the Modified Accelerated Cost Recovery System (MACRS), half year convention, is in its 4th year of service and the 10-year recovery period is used. Utilize Publication 946 How to Depreciate Property to calculate the correct depreciation amount to enter on the 1120 Line 20 (Form 4562 is not required). Locate Table A1 in the Appendix to calculate the tax-deductible depreciation.   

•Interest expense is interest paid on the loan for the boat; the boat loan is considered nonrecourse  

•Insurance payments were made to cover liability for guests and for the boat  

•Payroll taxes; FICA and FUTA payments made on behalf of employees and corporate officers  

•Travel was purely for business purposes  

•Parking fines are tickets Jones received for parking illegally  

•Lease expense was paid to Honda Motors for his mother’s car lease, who is not involved in the business in any way  

•Estimated payments; The Corporation made four quarterly estimated tax payments of $1,000   They’d like any overpayment refunded to them.  Davy Jones’ Nautical Tours, Inc. 2016 Income Statement    

Revenue   $400,950.00     

Wages   ($40,000.00)    

Officer’s Compensation   ($84,000.00)    

FICA   ($9,486.00)    

FUTA   ($169.00)    

Depreciation   ($85,000.00)    

Interest   ($43,900.00)    

Advertising   ($6,350.00)    

Supplies   ($23,795.00)    

Legal fees   ($6,940.00)    

Insurance   ($26,700.00)    

Boat slip rental   ($33,010.00)    

Travel   ($6,250.00)    

Office expense   ($7,940.00)    

Parking fines   ($1,350.00)    

Lease expense   ($3,650.00)    

Net Profit   $22,410.00     

Davy Jones’ Nautical Tour, Inc    

2016 Balance Sheet      1/1/2016   12/31/2016    

Cash   $15,500.00    $15,500.00     

Boat   $850,000.00    $850,000.00     

Accumulated Depreciation   ($255,000.00)   ($340,000.00)    

Total Assets   $610,500.00    $525,500.00            

Loans   $525,000.00    $417,590.00     

Equity Investment   $50,000.00    $50,000.00     

Retained Earnings   $35,500.00    $57,910.00     

Total Equity + Liability   $610,500.00    $525,500.00    

You will be required to fill out and submit the following forms: 

•1120 U.S. Corporation Income Tax Return  

•1120 Statement 1 – Other Deductions   

•1120 Schedule G – Information on Certain Persons Owning Stock

Your paper should be written in the third person taking the individual out of the writing and avoiding pronouns such as I, we, my, our (first person) and you, yours, your, us, we (second person). You should deal with facts and not opinions, thus providing citations within your paper and on your reference page. Focus on the subject itself and not on your feelings about the subject. The use of the third person retains a formal tone in your writing. The use of first and second person can make a document seem more casual. The paper should be complete and the main body should be 1000-1500 words in length (excluding cover page, abstract, references, etc.). Utilize APA Style format and references. 

Grading

• Format of your Paper (10pts):
• Abstract (10 pts):
  • Word limit:  100 words.
  • Short summary of the main ideas of the entire paper. 
• Introduction (10 pts):
  • Word limit:  150 – 300 words.
  • Describe why you are interested in the particular health topic that you are focusing on in your paper.  Give a short background on your health topic, being sure to identify:  what organ system(s) is involved; a general cause for the health condition (or the purpose for the technology); what you see as the importance of learning about this topic; the prognosis for someone with this condition (or the opportunity for using this technology). 
• Detailed Information (50 pts – see breakdown below):
  • Word limit:  200 – 300 words
  1. Common Signs and Symptoms (10)
     1. List the most common symptoms
     2. What does a person experience or feel who has this disease?
     3. Here would be a good place to include information you learn from interviewing someone who has had this disease or who knows someone who has had the disease
  2. How this relates to what you learned about the organ system (10)
  3. Causes (10)
  4. Diagnosis, Treatment, and Prevention (10)
  5. Prognosis (and Complications, if applicable) (10)
     1. Can people die from this disease?
     2. If so, do they usually die, sometimes die, or only rarely die?
     3. Can the treatments completely get rid of the disease?
     4. Or do they only manage the symptoms?
     5. Are there any problems that occur from this disease that never go away? For example, are people sometimes crippled or brain-damaged, or is their immune system weakened?
• Discussion (10 pts):
  • Word limit:  200 – 300 words
  • Share your opinions on what you learned about this condition.  What’s the take-home message you want to give your readers? 
• References (10 pts, 2/citation + 4 for format)
  • Minimum of 3 primary research citations.