The pandemic of COVID-19 emerging globally showed weaknesses of the healthcare systems worldwide. The rapid spread of the unknown virus, lack of medical equipment, and protection tools put constant stress on medical workers. During the time of the global pandemic, the priorities of healthcare workers changed from providing the needs of patients to keeping public health as well as the safety of physicians as the main concern (Wanchoo, 2020). Moreover, the overwhelming situation related to coronavirus aggravated by the global crisis, which occurred due to global lockdown. Soon it became obvious that an adequate ethical regulation could improve the situation (Wanchoo, 2020). This paper will conduct COVID-19 pandemic’s case as a main ethical issue and revise sub-issues occurred during the pandemic. The ethical issue related to duties of physicians and their rights, scarce resources management, and deficit of personal protective equipment will be solved by appealing on healthcare ethical principles namely, autonomy, beneficence, justice, non-maleficence, veracity, and trust.
The first sub-issue related to the duties and rights of healthcare workers was common during the last outbreak of the virus. Dr. X knows that it is his direct responsibility to cure patients and help them overcome the virus, but he has retired parents and a one-year-old daughter, who live with him in one apartment. The deficit of resources, unclear treatment in protocols, constantly changing information, and virulence of diseases lead to panic among his colleagues (Wanchoo, 2020). He wants to leave his occupation to keep his family safe. The dilemma is that if he could refuse to work and neglect direct responsibilities. According to Wanchoo (2020), the rights and duties of healthcare workers are not specified in some countries. However, as stated by healthcare ethics physicians could not ignore their direct responsibilities during the emergency. Doctor X may concern about the risk and future consequences put on himself and his family. He worries about the situation he or his family member needs medical facilities will they access to them.
The solutions suggested are the practical methods used by the healthcare workers during the pandemic. Firstly, every healthcare facility should create an ethics committee to state policies and standards (Wanchoo, 2020). Secondly, communication channels such as video chats should be open supporting the mental well-being of healthcare workers (Wanchoo,2020). Wanchoo (2020) points out that due to work overload, stress, anxiety, and lack of sleep increase mental health issues observed among healthcare workers. The communication channels without personal contact should help to solve the problem by giving moral support. Thirdly, healthcare workers should have a guarantee of access to medical equipment and facilities in case of infections (Wanchoo, 2020). The ethical principle of reciprocity, which prioritizes the physician’s life, is applied here. Lastly, the recruitment of trainees or retired staff should be held to lessen the burden provided on healthcare workers (Wanchoo, 2020). Talking about Dr. X’s case, as he could not refuse to complete his work, he should be supplied by all the above-mentioned conditions and restricted from contact with his family to stay safe.
Another sub-problem during the explosion of the virus was the scarcity of resources such as hospital beds, ventilators, and medicine. Turning back to Dr. X, let us consider the following example. Two patients, 80 years old man with chronic heart diseases and pancreatitis and 30 years old woman without any special considerations delivered to the hospital. Both suffer from a severe form of COVID-19 and require lung ventilations. The deficiency of the ventilators leads to the difficult decision to choose one of them. A stalemate situation requires quick actions to save one of these lives, otherwise, both will die. The ethical principle about the distribution of the resources that says that all patients regardless of age, sex, gender, ethnicity should have equal access to medical assistance, unfortunately, could not be applied in this case (Wanchoo, 2020). As stated by Wanchoo (2020) the main criteria of selection in this term are saved life years, hence, priority should be given to younger patients. Considering Dr. X’s dilemma, it would be relevant to provide 30 years old woman with a ventilator, rather than 80 years old man. The woman has good chances to survive compared with 80 years old man not only because of younger age but an absence of chorionic diseases as well. A similar situation was observed in Italy during the 2020 spring virus outbreak. At that time older generation refused equipment for young people.
Shortage of PPE (Personal Protective Equipment) also turned to be problematic during the pandemic. The crisis related to gowns, face masks, gloves, and face shields put the healthcare workers at great risk. Imagine Dr. X is assigned to regulate the problem of PPE deficit and needs to find a possible solution. One option is logical, production of PPE should be increased to rise supply (Wanchoo, 2020). Moreover, Wanchoo (2020) states that demanding equipment from non-health organizations is also possible. Another option offered by Dr. X could be restricting non-emergency or elective surgeries directing useful supply to the treatment of coronavirus.
To conclude, it could be said that the solution to the sub-dilemmas of coronavirus is a complex decision implemented in real-world conditions. COVID-19 pandemic considered as the main issue of investigation of this paper. Dr. X is an example of a healthcare worker faced with a confusing dilemma as well as representation of all medical personal, who struggled with COVID-19 last year. The healthcare workers’ problems including help in case of emergency, the choice between two lives, and the provision of equipment are investigated using healthcare ethical principles.
Wanchoo, J. (2020). Ethical Issues Related to Coronavirus Disease. Clinical Synopsis of COVID-19, 237–249.
Aspects Of Narcolepsy
Narcolepsy is a rare and unique condition that affects the sleep patterns of a person suffering from it, which disrupts their sleep-wake pattern. The prevalence of this condition in the western states is approximately 200-500 cases per million inhabitants. However, the highest prevalence is in Japan, where 1,600 individuals per million are diagnosed with narcolepsy (Basetti et al., 2019). Hence, narcolepsy seriously impairs the day-to-day functioning of an individual. Despite the severity of this condition, current research and pharmacological development do not fully explain the cause and ways of treating narcolepsy, and only symptomatic treatments are available. This paper will summarize five scholarly articles on the topic of narcolepsy.
Summary of Literature on Narcolepsy
Narcolepsy is a condition characterized by daytime sleepiness and weakness during the night (Kornum et al., 2017). This means that a person with narcolepsy has a disrupted sleep pattern when compared to the norm, which is daytime activity and sleepiness at night. Basetti et al. (2019) describe this condition as a dysfunction of orexin neurons located in the lateral hypothalamus, while Mahoney et al. (2019) state that it is a result of the selective loss of orexin neurons. This dysfunction causes people to lose control ver their sleep-wake patterns and results in uncontrollable urges to fall asleep. Hence, the anger of narcolepsy is that an individual may fall asleep while performing routine tasks such as driving or cooking.
Narcolepsy has been known for a while, however, the first scholarly description of this condition dates to 1877s, where Westphal, Gélinau, and Fischer describe symptoms such as excessive sleepiness and loss of muscle tone after experiencing strong emotions (Basetti et al., 2019). Interestingly, these publications point to one characteristic of cataplexy not discussed in other scholarly resources reviewed in this paper, which is the perseverance of consciousness. Hence, during an episode, individuals with this condition cannot control their muscles, but they can think and comprehend the events and objects around them.
This condition is chronic, and no treatment that would address its development is currently available (Kornum et al., 2017; Basetti et al., 2019). Moreover, narcolepsy patients report experiencing sudden attacks of sleep, which is when an individual falls asleep randomly, regardless of their intent. In some cases, narcolepsy causes a person to experience hallucinations or cataplexy. The acronym CHESS and CRASH is used to describe all the symptoms of this condition (Kadiyala, 2020). CHESS refers to “cataplexy, hallucinations, excessive daytime sleepiness, sleep paralysis, and sleep disruption” (Kadiyala 2020, p. e100109).
Apart from the CHESS assessment, narcolepsy is diagnosed via biomarkers. Basetti et al. (2019) state that the following are usually used during diagnostics: “polysomnography findings of sleep-onset rapid eye movement (REM) sleep, periods (SOREMPs), positivity for HLA-DQB1, (refs15,16) and orexin deficiency in cerebrospinal fluid (CSF)” (p. 519). In addition, to diagnose narcolepsy, clinicians may choose to observe an individual’s behavior in a clinical setting, to prove the symptom of daytime sleepiness, as well as use “sleep-onset rapid eye movement (REM) periods during multiple sleep latency testing (MSLT)” (McCall & Watson, &, p. 1099).
Another important condition is that the clinician should ensure that other potential causes of sleepiness are rolled out. For example, they must ensure that this patient does not have sleep apnea, chronic lack of sleep or ensure that their medication is not the cause of the symptoms. Considering the need to eliminate other potential causes of sleepiness, narcolepsy may be difficult to recognize and diagnose and requires physicians to pay particular attention to other potential causes of sleepiness, apart from orexin deficiency.
Although narcolepsy itself is problematic for a patient because they cannot control their sleep patterns and adjust them to those accepted within the society, there are other issues such as social stigma that accompanies the disease (Kornum et al., 2017).
Other issues include obtaining an education or maintaining a job, which is difficult for these patients since their sleep patterns are different. Since narcoleptic patients may suddenly fall asleep or lose muscle tone, they cannot perform the tasks that other individuals can, especially if they require strong focus and attention. Kornum et al. (2017) also report the economic effect of narcolepsy because the inability to get an education or a job due to the condition adversely affects the financial status of these individuals. Hence, patients with narcolepsy suffer from social stigma and economic difficulties as a result of their condition.
Considering the evident problem of uncontrolled weakness and sleepiness, the ability to complete routine tasks for narcoleptic patients is impaired. According to McCall and Watson (2020), driving may be dangerous for narcoleptic patients because it often triggers cataplexy, which means that the individuals lose control of their vehicles. Hence, these patients should be hyper-aware of this potential danger and avoid driving if they think it might trigger a strong emotional response. This is because cataplexy is triggered by emotions, for example, fear or anxiety due to driving (McCall & Watson, 20220).
Moreover, although there currently are no guidelines for providers on how to address driving safety issues with narcoleptic patients, McCall and Watson (2020) recommend using self-repots. For example, assessing whether an individual has fallen asleep while driving previously, the cases of near misses, and actual crashes can help a provider determine whether it is safe to allow this person to continue driving. Considering this, patients with narcolepsy should be cautious about intensive tasks that require strong focus due to the potential consequences of them experiencing cataplexy or sleepiness.
Narcolepsy is divided into two subcategories, which are narcolepsy one and narcolepsy 2 (Kornum et al., 2017). Patients with type 1 suffer from comorbid cataplexy, which is a sudden loss of muscle tone. Type 2 narcolepsy is more difficult to diagnose, and it is usually an exclusion diagnosis, which is used when other causes of symptoms were disproven. Moreover, type II narcolepsy is still not studied extensively, which means that there are many areas of the unknown with this condition. However, Basetti et al. (2019) argue that the classification should be reviewed since there are several borderland conditions that have some similarities to narcolepsy but also some distinct differences.
There are several hypotheses regarding the causes of narcolepsy. According to Kornum et al. (2017), it is the result of an “autoimmune destruction of the hypocretin-producing neurons in the hypothalamus” (p. 1). However, to this day, there is no evidence to support this hypothesis. Basetti et al. (2019) argue that the deficiency of orexin neurons is a result of environmental, genetic, and immune-related factors, a combination of which causes the deficiency of these neurons.
Mahoney et al. (2019) hypothesis that narcolepsy is an autoimmune condition that is caused by T-cells. Under this hypothesis, the T-cells attack orexin neurons, which results in their selective loss and subsequent disruption of the sleep-wake pattern. Despite having several hypotheses about the development of narcolepsy and advancements in understanding this condition made within the last twenty years, it remains to be understudied.
The treatment for narcolepsy is currently unavailable, nor can this condition be prevented. However, patients may receive medication that relieves some of the symptoms (Kornum et al., 2017). These medications adequately address the symptoms and are safe for the individuals taking them. Basetti et al. (2019) state that stimulants and anticataplectics are used to address narcolepsy symptoms. Among interventions that can reduce some risks connected to narcolepsy, McCall and Watson (2020) recommend scheduled naps and avoiding performing a task that requires concentration after alcohol, meals, or sedatives. This approach can help a patient control some of their narcolepsy symptoms, although it will not mitigate them completely.
In conclusion, narcolepsy is a serious chronic condition that affects the sleep-wake pattern of a person suffering from it. Narcolepsy is rare because it impacts only from 200 to 500 individuals within a million inhabitants of a Western nation. However, its symptoms are severe, and they drastically affect the patient’s lives. For example, individuals may experience loss of muscle tone while remaining conscious or suddenly fall asleep while performing some task.
The current paper suggests that narcolepsy, its causes, and potential treatment require more research since the researchers currently do not fully comprehend the mechanism of narcolepsy’s development. Moreover, this affects the potential for treating narcolepsy because currently, patients can only use symptomatic treatment with stimulants and anticataplectics. More research is needed to determine the causes and ways of treating narcolepsy.
Bassetti, C., Adamantidis, A., Burdakov, D., Han, F., Gay, S., & Kallweit, U. et al. (2019). Narcolepsy—Clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nature Reviews Neurology, 15(9), 519-539. Web.
McCall, C. A., & Watson, N. F. (2020). Therapeutic strategies for mitigating driving risk in patients with narcolepsy. Therapeutics and Clinical Risk Management, 16, 1099–1108. Web.
Mahoney, C., Cogswell, A., Koralnik, I., & Scammell, T. (2018). The neurobiological basis of narcolepsy. Nature Reviews Neuroscience, 20(2), 83-93. Web.
Kadiyala P. K. (2020). Mnemonics for diagnostic criteria of DSM V mental disorders: A scoping review. General Psychiatry, 33(3), e100109. Web.
Kornum, B., Knudsen, S., Ollila, H., Pizza, F., Jennum, P., Dauvilliers, Y., & Overeem, S. (2017). Narcolepsy. Nature Reviews Disease Primers, 3(1), 1-10. Web.
Life Insurance: Types, Value Of Money
Life insurance can be defined as the contract between the insurer and the person owns the policy. Some countries include some events like bills and death expenses are included in the premium policy. The insurer is bound to pay some money incase an even happens to occurs. If the insurer enters the contract he pays an annual or monthly amount known as premium. If an event occurs the benefit is paid to the beneficiaries. The insurance only considers the people who are included in the life policy. If any kind of event happens the people who are insured are the only ones who are considered since it’s a contract between two parties, i.e. the policy owner and the insurer.
The only person allowed to pay for the policy is only the policy owner and he also acts as the guarantee. They don’t consider the insurer as being party to the contract since he acts as a participants. In life insurance, the insurer plays different roles compared to the roles of the policy owner. They sometimes seem to be the same but they are totally different. The owner appoints the beneficiary although he is not entitled to the policy. If the beneficially happens to revoke the insurance contract, any changes that comes along must be agreed upon by the beneficiary. This means that the owner has the right to change the beneficiary unless the beneficiary chooses to change or withdraw the policy. The changes might include the cash value borrowing or policy assignments.
In life insurance there are special requirements which are found in it. If the person commits suicide within a given period of time, this type of section is highly considered. If the application is misrepresented by the insured is considered as part of nullification. In most of the states in the US feel that the period of contestability cannot be more than two years. The insurer will be considered to have a legal right to follow the claim relating to misrepresentation and ask additional information before denying the claim or accepting to pay only if the insured passes on within the mentioned period. In life insurance the face amount on the policy is the one that the insurer is paid if he dies and it’s still the original sum paid by the policy when the policy happens to mature.
In most of the cases life insurance and life assurance always go together. In life any of the events is most likely bound to happen. In life insurance they are only events that are bound to happen e.g. floods, theft, fire they come unexpectedly causing a lot of damage. The events that are covered life assurance they are events that one is sure they are going to happen in future e.g. death.
Types of insurance
Life assurance is basically divided into two categories, permanent and temporary.
- Temporary insurance is also known as term insurance; this type of life insurance does not accumulate cash value since it covers for a specified term of years and for a specified premium. The premium is termed as pure as it covers and buys protection in the events of death only. The only major areas which are considered in this term insurance are only the length of coverage, face amount which caters for protection or death benefits and the premium which is going to be paid.
- Permanent; this type of insurance remains contact until the policy matures. If the owner is not in a position to pay the premiums on time, the policy becomes outdated or the policy lapses. The law defines that any type of policy cannot be cancelled by the insurer for any reason, not unless signs of fraud are detected in the application. If there is any cancellation there is specific time given which is normally two years. There are three types of permanent insurance;
- Whole life insurance; in this type of insurance the cash value is included in the policy guaranteed by the company since they provide a level premium. The advantages of this insurance are that the whole life is guaranteed cash value, fixed and known annual premiums, and death benefits. We can also see that the disadvantages of whole life insurance are that the internal rate of return in the policy is usually not competitive with other savings. They also don’t have flexibility in there premiums.
- Endowments; endowments are considered to more expensive in terms of annual premiums compared with the rest of the insurance policies. Comparing with whole life or universal life the period of endowment is shortened and it has earlier dates. In this policy the cash value is built up inside the policy. The face amount has the death benefits at a specific age. The age in which it starts is known as the endowment age. The endowment insurance is usually paid at a specific period e.g. 15 years or if the insured is living or dead.
- Universal life coverage; this is a new insurance cover which plans to offer a permanent insurance cover which has flexible premiums payments affordable for everyone with quality higher internal rate of return. This insurance has a cash account which is increased by the premium. The interest is paid within the policy and it also recorded and credited at the rates decided by the company.
- Accidental death; this is a limited insurance and it only covers the insured when they pass away because of an accident. These accidents might be in form of injury, they don’t cover any death that might occur due to heath problems or any type of suicide. The policies are less expensive because they only cover death compared to other life insurances. The benefits are much better because they not only cover accidental death but they also benefit those who have lost their limbs and also their bodily functions e.g. hearing and sight.
- Limited-pay; in this type of permanent insurance all its premiums are paid over a specified duration of time. There are no extra premiums which are due to keep the policy in force.
When you come to look at life insurance there are actually two main functions which make it operate fully. They include cash function and mortality function. In mortality function the premium of everybody else covers the death benefits of anybody who die within a given period of time. In cash function age varies meaning that the policy matures and endows the face value of the policy depending on sate and company.
Time value of money
This concept refers to any type of interest that one happens to receive from any kind of payment. This is a present formula which is the core formula for the time value of money. All the formulae are derived from the formula below;
The present value (PV) formula has four variables
PV value at time=0
FV value at time=n
I rate of compounding
N number of periods
Summing the contributions of FV the value of the cash flow you will get the cumulative value
Present value of growing perpetuity if it grows at different fixed rates you easily determine the value at looking at the following formula. There are various qualifications and modifications for this valuation application. It’s not easy to find a growing perpetual annuity with a true perpetual cash flow or fixed rates.
When you want to calculate the value of the regular savings deposit in future, you first calculate the present value of a stream of deposits of $1,000 every years for 20 years earning an interest of 7%. (Steven A. Finkler, 1992)
Calculating the value at a duration of 20 years
This formula can be put together into a single formula.
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