“Begin at the beginning,” the King said, very gravely, “and go on till you come to the end: then stop.” ― Lewis Carroll, Alice in Wonderland

This is the last post for the “Professional Ethics course” this post suppose to reflect everything I have learned and accomplished during these six weeks.

I would like to start by stating that I am very lucky to take part in this course with such a multi diverse, international and smart group of people. During the last six weeks I got  the opportunity to practice my English writing, which is important as a new non-native speaker resident in an English speaking environment. Furthermore, I had the opportunity to explore the web for  ethical issues, which are always in the news and are highly important for day to day life as well as for my work as a PT. I also, wrote a blog, for the first time in my life. Ultimately, I got to read everyone’s intriguing posts and opinions about the different subjects. Each of us brings his own culture, customs and ideas to his ethics post. So yes, this course definitely answered my expectations.

I have learned so much during the course, about the laws and cultures of my  home country, my  residence country as well as the reality in other countries as it reflects from my fellow participants’ posts. I also learn about using blogging as a way to reflect my ideas and share them with the world, I think overall it was an interesting and enjoyable experience. It was very interesting to discover the similarities and differences between different countries. However, the most important  thing I earned from taking this course is the realization that we are all human beings and for that manner “equal”, we all have DNA which is  more than 99% identical  , we think, we live, we love (and unfortunately hate) and yet each of us has is own world of customs and meaning and the same subject can be viewed from very different perspectives. Nonetheless I found out that some things are the same all over the world and that two people share the same profession can get to the same conclusions even though they came from different places. It was very interesting to see how people react differently about different subjects. While I thought dealing with issues as EQUALITY and TORTURE was hard, others had trouble dealing with EUTHENASIA. This course reminded me the importance of diversity and how wonderful, yet complicated the world we live in.

My practice changes every day, with any experience I have. Any person I meet changes me a little bit. I think that I will take to my practice the knowledge I have to respect any person\patient regardless his race, sex and opinions. I will try from now on to listen more carefully to any patients and not to judge. I believe not judging is crusial in order to supply the best treatment. These are all issues I know and try to live by, but this course made them more clear.  

 “What we need to do is learn to respect and embrace our differences until our differences don’t make a difference in how we are treated.” 
— Yolanda King

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Euthanasia=Good Death

After two weeks of struggling with hard subjects, this week’s subject is very clear to me. I have a strong and solid opinion about euthanasia (which mean good death in Greek). I believe every person is responsible for his own life including the decision whether to stay alive or die. I believe that life are NOT always worth living and if an adult  decides in clear mind he doesn’t want to live anymore no matter what is the reason he can take his own life and commit suicide.

There are situation as terminal illness or paralysis that a person cannot commit suicide by his own and thus need assistance from others. In situations like that the law should empose physicians to help him . There is no doubt that a law like that should be very strict regarding what exactly is a clear mind and about the exact procedure a person who wants euthanasia should go through. That point is crucial  in order to prevent murder of innocent people in the name of euthanasia. I think the right to die is equal to the right to live and it is part of our basic rights as human being, which every free man is entitled to. However, we need to remember that there are terminally ill patients who want to live until they breathe their last breath one example is this 17years American teenager who suffered from terminal cancer.http://intentblog.com/my-last-days-17-year-old-zach-sobiech-dies-of-cancer-but-not-before-becoming-a-rock-star/  . But when someone whether terminally ill, severe disable or mentally ill doesn’t want to continue living it should be his right to take his own life and if he is not capable of doing so healthcare should provide him  assistance.

I went on and checked what the law has to say about euthanasia in my current state and in my home country. This is the law in Maryland  http://euthanasia.procon.org/view.resource.php?resourceID=5075 which does not allow assisted suicide but the penlty is very mild.  This is what the law has to say all over the U.S http://euthanasia.procon.org/view.resource.php?resourceID=000132. Only 4 states Have Legalized Physician-Assisted Suicide.

 In Israel there is a law called “law for the dying patient” The law distinguishes between three clinical stages: a patient is ill but not terminally, meaning he has more than six months to live, at that case the law prohibit to avoid life saving medical treatment. Dying Patient, who has less than six months to live at that case the law allows to avoid life saving medical treatment as CPR, dialysis, chemotherapy and surgery if the patient does not want them. However, maintanance of existing diseases is obligatory. In the other hand, when a “dying patient” want his life prolong and seeks medical treatment against the opinion of his doctor, the doctor should respect his will. Patient in terminal stage, which  has no more than two weeks to live and  suffered considerably have the right to  decide that he does not want his life prolonged, the law requires to avoid supported treatment. There are several  explicit prohibitions action by the law:

“The law doesn’t permit  making any action, including medical treatment which deliberate to kill, or which most likely will cause death, whether it is made out of kindness and compassion or not, at the request of terminally ill patients or other person. ” (Translation of Section 19 of the law)

 “The law doen’t permit making  any action, even if it is a medical treatment, that involves suicide assistance, whether it is made out of kindness and compassion or not, at the request of a dying patient or other person.” (translation of Article 20 of the Law).

To conclude the law permit passive euthanasia but not an active one. I think most governments don’t legislate active euthanasia because death is frighten and there are many they forces either way.

If a person like Tony Nicklinson  wants to end his life and is not able to do so by himself I think the law should be changed in order to allow him to get help with his suicide. Claiming that allowing him to die will danger other disable people is ridiculous because the law should definitely consider a person free will and there are many severely disable people who wants to continue living and finds meaning in their life despite their physical condition and if the law would clearly determine who is entitled to euthanasia nobody will be in danger.

 

Finally, I personally, don’t believe in the existence of god, but even if I would. When Mr Nicklinson got his stroke in 2005 wasn’t  “god” intention that he will die at that moment? The modern medicine allows people to live longer and survive terrible illness. For some people like my 85 years old grandma who stays alive thanks to 3 times a week dialysis, it is amazing because she still finds meaning in her life and  wants to keep on living them, however in the saint of those  who finds no reason to stay alive and maintain their suffer, assistant suicide should be legal.    

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The Valueblity\Vulnerablity of Human Rights

This week I find myself struggling with the post.  Why do I find it so difficult to handle? Because I’m a citizen of a country in an endless war, and in a war, I think the rules are a little bit different. I struggle because I want to be a good ambassador of my country but in the other hand I want to be true to my beliefs. I end up with a post that raises more questions than answers.

Do I believe that some lives are more valuable than others? My first answer is definitely no, every life worth living and who am I to decide one life are more valuable than others. But…

Is the life of one Israeli soldier worth 1027 Palestinian prisoners?

Gilad Shalit is a former Israeli soldier who was kidnapped/captured by the Hamas on the border between Israel and Gaza Strip on June 25th 2006. He was held up in Gaza for 5 years until a deal had been made to release 1027 Palestinian prisoners from the Israeli jail in exchange for his return (most of them terrorists and some had killed innocent people) in 18TH of October 2011 Shalit returned to Israel. During those 5 years there was a debate in Israel whether the Israeli government should release terrorists who might return to “practise” terror and  kill more people. So the question is even more complicated whether the life of one Israeli soldier worth risking many others?In the Tractate Sanhedrin (an important Jewish source) there is a proverb “who saves one life, raise  like he saved the whole world”, which mean all are equal and deserve to be saved. Later on (around 3th century PC) in the Babalian Mishnah (another important Jewish source) the proverb was changed to “who saves one life of an Israeli, raise like he saved the whole world”. Suprisngly the debate on the wording is still going on. So does the life of people from my tribe and family (or for that matter your tribe\family) are more valuable to me?. In the IDF (Israeli Defense Forces) the answer is yes. Soldiers are taught to kill as many enemy soldiers as needed in order to save one solider from their party. (As I claimed before in a war the rules are a little bit different). In biology, the view of the selfish gene (as suggested by Richard Dawkins) saving someone from your family mean saving a big part of your genetic load, thus resulting in increasing the

 spreading of your genes. Perhaps, we don’t like to think of ourselves as animals but basically the rules of nature still apply to us (the book “The human instinct“ is highly recommended).

 

Is torture O.K?

What do we mean when we say torture? Is  only physical torture consider torture or is mental torture is torture as well?

Basically, it’s not OK to torture, but what about situations like
Wendy raises in her post, is it OK to torture a man in order to try  saving the life of many others? Is it effective? Will it really solve the problem? In  the movies  soldiers and terrorists  are trained to resist torture and never tell their secrets. However, in reallife we have no clowe on how the  secret services works, what are there methods and if torture is effective and nessecary for them to perform their job. I do think all people no matter what they do and who they are, deserve human rights but I also feel I’m lacking the knowledge and not in a place to judge torture that meant to prevent wars. Remember, we trust the secret servises to protect us and we blaim them when something go wrong, thus, we also need to trust them to use the lowest torture needed in order to preforme their job. The questoin is who supervise them to do so?  

 To conclude, life is never black or white, the gray scale is very wide. There is one soldier who got to go back home after 5 long years in capture while in exchange 1027 prisoners came back to their families in the other side. Does it mean he worth more than they do? or  just that his government was willing to pay a high price for his life and for his freedom?  Al Qaeda is  a global militant Islamist organization who threatens the life of many people all over the world, if the only way to stop them is torture, then maybe torture is ok in these particular situation, but is torture really going to end the Islamic war against the western world? And who is responsibale to set the limit between situation that it is right or wrong to use torture? 

I wish we could live happily ever after but life is more complicated than that, Thus until utopia will raise, sometimes there is a need for radical action in order to prevent radical action.

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Equal in what respect?

Are we all created equal?

I have a really big problem with “equality”. What does EQUALITY really mean?? Does it mean that we are all a like ? Does it mean we can all do the same things? By such definition I don’t   believe we are all equal and we certainly not created equally (as suggested by the USA constitution). Each person  born with his own genetic load that enable him  different capabiltis. It maybe un politically correct to say  but, yes, I think there are groups of people which as a group in average are better in some fields than other groups (and there are even biological proofs to that). This article summarized it better than I could http://www.wnd.com/2013/03/are-we-all-really-equal/. You know what, I think it’s great that we are not  created equal. I think the world would be a boring place  if we were all equal. Most of the world  great inventions created by a collaboration between non equal individuals.

Do all human beings deserve to be equal by the law?

  states that “All are equal before the law and are entitled without any discrimination to equal protection of the law.” This has been stated in the  Universal Declaration of Human Rights and known as the Equality Under the Law Principale. I would  like to add that all people  deserve equal opportunity and equal rights. Looking on equality that way, I strongly believe in it. Everyone with no matter of  races,   gender, sexsual orientation, religion, special needs and any other maniority group should suffers from discrimination. I’m against any type of discrimination, not because we are all  born equal but because each of us is a special human being with his own strengths and weaknesses. In utopic world I wish each  person could contribute his own specialty to the soceity, which will create an amazing world. We are not equal but it doesn’t mean  that one is better than the other. We are just different, with different abilities, various opinion and virable preferences. I think that most societies that tried to live in absolute equalty failed. A good example for that is Communism in the former USSR and in the Israeli Kibbutz which, in one of them I was born.The Kibbutz was an “experimental” type of settlement in the early days of Israel. The kibbutz was a collective settlement where property was collective and everyone had to work as much as they could and got equal return (what they needed). But what seems like an utopic society at first, turn up to be a place where some people exploited the situation to work less and get more, while others worked really hard and left with nothing. Most of the Kibbutzim collapsed in the 1980’s , the society was left with no money but with many debts. Today  most of The kibbutzim are still existing but only as small non collaborative villages.

Does everyone really equal by law?

Unfortunately, my answer to that question is clear. No. I live in Baltimore city, which consider itself multi-diverse city but do all different populations of the city really live together? Most certainly no. as a new resident, I tried to study the city and can not notice that there are areas  with only African Americans, while some mostly white and in others nobody speaks English only Spanish/Chinese/Yidish. Does a child who grew up in a neighborhood with 93% African American and a child who grew up in a white rich suburb just 30 minutes drive away get equal opportunity? Will they get the same medical treatment? in his recent interview for the New York Times president Obama said that “social mobility is part and parcel of who we were as Americans” (and I would had part of any modern soceity). He said that the “social mobility” is damaged in the last few years which is a big problem”. I am asking if it was ever exists?

ImageThis is my beautiful red head exploring Baltimore’s multi-diverse playgrounds

  Do I struggle to provide equal care?

 No douts that I am struggling to provide the best and most appropriate care to any patient. I believe any patient deserves to be treatedAgain the question arises what exactly is equal care? That I don’t believe all patients need equal care. Any patient is an individual with his own needs and I try to adjust the treatment to suites my patient the best. I have respect to any person with any opinion, as I believe any opinion has the right to be heard. I believe we are meant to be different, one from each other as individuals and as a group.  We should respect anyone and any group and treat them all like we would like to be treated.

I will be honest enough to admit that there are some cases that I don’t provide the right treatment. It could happen for so many reasons, I might not understand the mentality of the person, I might have prejudices, which I’m not aware of and there are people whom their beliefs make it  hard for me to treat but I really try to neglect these kind of interruptions.

I’ll conclude with someone else words: “We are all equal in the fact that we are all different. We are all the same in the fact that we will never be the same. We are united by the reality that all colors and all cultures are distinct & individual. We are harmonious in the reality that we are all held to this earth by the same gravity. We don’t share blood, but we share the air that keeps us alive. I will not blind myself and say that my black brother is not different from me. I will not blind myself and say that my brown sister is not different from me. But my black brother is he as much as I am me. But my brown sister is she as much as I am me.” 
― C. JoyBell C.

 

 

 

 

 

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“Morality, like language is an invented structure for conserving and communicating order” (Jane Rule)

When this week started I had some ideas about MORALITY whom I considered “the facts”. The more I read, watched some videos and thought about this abstract word I have more questions and my so called facts are no longer facts.

So here are some of my questions:

  •  Is there such a thing as absolute international morality? 
  • How do we get our moral codes and beliefs, can we choose them? Can we change them?
  •  Is it even possible to treat everyone equally regardless of their beliefs, morality and actions?

But first thing first, what is morality? After a long week of doubts I decided to adopt this definition,: Morality is a value system that the  society accepts willingly, in order  to be able to live within society without causing any damage to its members. I think that the sentence “without causing any damage to its members’” calls for defining what is damaged and who  considered members. I decided not to put right and wrong in my definition because I believe “right” and “wrong” are relative.

And now for some answers:

  •  I don’t believe there is such thing as international morality. I think one’s morality is a combination of culture, education and character.  Let’s take murder for example, I think most people from most cultures believe murder is immoral, but what exactly is murder? Some believe abortion is murder while others disagree. In some cultures vendetta is considered a moral act while others will argue there is no difference between vendetta* to murder. Another example I adopted from a TED lecture I recently watched but I will present it differently: it’s about how women in some countries, some religions dress. A few years ago Sarkozy’s government in France issued a regulation declare it is forbidden for students on schools property to cover their heads and face.. I remembered being shocked  at the time that a democratic government of a free modern country  doing such thing. The reaseon is that in the society I grew-up, the way a woman dresses is heron choice. I studied with lots of Jewish  and Moslem religion women in Israel who choose to cover theirself as part of their beliefs, nobody force them to dress like that.
  • Our morality or at list my morality is a combination of my formal and informal education and the culture I grew up in. I think religion or atheism  might be another important factor in a person’s morality. Growing up in a society where the religion is part of the culture, I decided that religion cannot be separated from culture so by were saying culture I mean also nation, religion, race and so on. 
  • Can we choose our moral? I believe a very small part of our moral is chosen. Morality is so deeply inserted into our value scale from such a young age that we have a very small choice. Yes even in the modern free world. Every society has its moral codes and those codes are being taught since a child is born. Can someone change his moral when moving to different culture/country? It’s a hard question for me to answer, I think one might pretend at first and in time might adopt some of his new society morality.
  •  What about health care professionals? In Israel there is a law of  patient rights and one of the most important part of this law says:” any  Clinician or facility are not allowed to discriminate between patients on grounds of religion, race, sex, nationality, country of origin, sexual orientation, age or other such grounds” (free translation from Hebrew). I deeply agree and think we should treat any patients no matter what his morality and beliefs are. The only exception is when our life as the health professional is in danger or when we get harassment by the patient. Even in these severe cases the patient still has the right to receive a treatment but by another clinician. But the question remains whether we give the same treatment to different people with different morality? I believe each patient gets a different treatment, depending on many factors among them are the connection between the patient\therapist, the patient willingness to be treated, the patient beliefs and even his personal appearance. I definitely set my self’s a goal to give each patient best and right treatment regardless of his beliefs and actions. I truly hope I’m succeeding in doing that in most cases, but I know sometimes I fail.

To conclude, a person’s morality is load carried up from home and society. Morality is a set of beliefs that guide us how to act in different situation and how our surrounding should response. The fact that each therapist comes with his own morality perspective and yet we all need to follow certain common guidelines and treat many people that have different set of morality Is a serious dilemma. In some cases the patients morality is so different from our own that we definitely wouldn’t choose them as friends but still they are our patients and our duty is to provide them the best treatment we can. How should we deal with this dilemma? I think we need to actively remind ourself not to judge our patients, to remember to focus on our job  and be modest enough to remember our morality is not the only one out there.    

 

*Vendatta- a private feud in which the members of the family of a murdered person seek to avenge the murder by killing the slayer or one of the slayer’s relativeImage

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Empathy is Balance

Definition: Empathy is the ability to identify the emotional state of others and empathize with. This is an emotional process, which also incorporated cognitive components. People often tend to define empathy as the ability of a person to put himself in the shoes of another person temporarily, but not out of sympathy and control connection. Meaning: “the ability to feel others without giving up equity.” (Traditions of compassion from religious duty to social activism, Khen Lampert at Al, Hampshire; New York , 2006).

According to the Philosopher Edith Stein Empathy is the “overall experience of foreign consciousness.”

I want to start this post by telling you about a former colleague of mine.  A physical therapist for almost 40 years that used the same methods for years. The amazing thing about her was how she understood patients like no one else I ever workd with. She instinctively knew how to reach them. Her patients normally got better much faster than other therapist’s patients. Her success rates were outstanding. She used to listen carefully and patiently to any patient and after they finished their story she would normally say “I understand and I’m going to make you better” and this was exactly what she did. It’s not that she was the most knowable and professional physical therapist I ever knew, but all her being was companion and empathy. Watching her and hearing her talks to patients made me change my point of view. It inspired me to become a Better therapist and maybe even a better person (so can empathy be taught?!). As a young ambitious physical therapist, I felt like I need to try any method I learned at school and was anxious to learn more and more. While watching her and others and gaining more experience I came to an important realization, which I wasn’t  completely taught at school. I understood we treat a person and not just low back pain or knee replacement. A patient  is a person, which brings with him to therapy the fight he just had with his wife or the child he lost to cancer. I think that the patients’ mood, hopes and motivation are crucial for the treatment success and I believe empathy is the first step to help a patient become accessible for the treatment and cure himself.

Can someone be a good therapist without the ability to emphtize? I don’t think so. I believe that in order to treat a person the therapist must be more than a talented technician knowing the names of all the bones and treatment methods. He needs to reach the patients and in order to do so the therapist must show empathy.An example of that is the new evidences showing that chronic pain is sustained even when the damage to the affected tissue is completely repaired.  The combination of the person’s thoughts and believes are believed to be responsible for that pain. These researches revels that treat the person  by listening with companion and empathy and try to understand where the pain comes from may help to his physical situation as well. The mind and body are connected, thus without empathy to treat the mind  we won’t be able to help the body.

On the other hand, can someone be a good therapist with only empathy and no knowledge? My answer will be no as wellLike everything in life Balance is important and I think empathy is the balance between complete identification to only look at a person’s illness. I think as therapists we must have this balance. Emotion is important but we must use our emotion wisely and together with the knowledge we acquire.

I sent the “Cleveland clinic” video to a couple of my health professional  friends and ask them what they think about it. The most common answer was it is important to remember who are the persons we treat nonetheless it is important to distinguish ourself from them and I very much agree with that. I can’t as, a therapist,  feel everything my patients feel, I can’t put myself completely in their shoes because I’ll end up emotionally exhausted and won’t be able to treat anybody. Moreover, sometime we have the wiser look, knowing what is best for the patients.  Again, it is all going back to Balance and for me this balance is the meaning of empathy. Doing what I know is right for the patient together with good explanation and encouragement.

Last, but not least, expectations for this course: I enjoy learning and I believe every person I meet educate and enrich me.. Participate in the  course where I get to read everyone’s thoughts and comments are exciting for me. I hope to absorb many new ideas and gain knowledge about the different ethical problems and solutions in different nations.

 

 

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Why am I here

Hi,
My name is Noam. I’m an Israeli physiotherapist, I did my bachelor degree in physical therapy at the Ben Gurion university of the Negev in Beer Sheba which located in the south of Israel. I graduated in 2010 and worked for two years in an outpatient clinic focused on orthopedic and vestibular patients. Four months ago my husband and I packed two suitcases and one beautiful one year old daughter and moved across the world to Baltimore Maryland in the U.S. My husband is doing his post doc fellowship on brain aging and I’m in a process of getting a local license.
The last four months were intense with exciting adventures of exploring our novel environment and culture. Surprisingly, even though Israel and the U.S are both western countries, there are many differences in everyday life. Some adventures were great while others were quite annoying. However, overall it is an interesting experience. By now we have started to settle down and almost have a place we can call home again.
I absolutely love my profession, the interaction with so many personality types, the challenge of diagnosing and the satisfaction of watching a patient improve. It has been a year since I left my last workplace, first due to maternity leave and then due to our relocation. I really miss working as a physiotherapist and hopefully within a year I’ll get a local license and will be able to carry out the work I miss.
Not working as physiotherapist allows me to be a full time mother. This is an amazing “job”, probably the hardest I ever preformed (and I worked on the farm as a young adult). Watching my baby girl growing into a toddler and see both my husband and myself in her is inspiring. However, after a full intense year of being only a mother and a wife I need some more challenges.
I think anyone who works with people, nonetheless treats patients must have a good perspective of ethics. The therapist- patient interaction is complex and full of ethics dilemmas, the level of transparency, to what extent being attentive to the patient and even how to talk to him. People are diverse in their nature , thus, dealing with them is a complex issue. What the therapist thinks is best for the patient is not always what the patient himself think he needs. In my opinion pre-thinking about solutions to as many of these ethical problems will improve my function as a therapist and will make me a better team worker.Furthermore, I find it is an intriguing subject.
I’m looking forward to gain new knowledge and new insight about professional ethics.
Noam

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