Ethical and legal level of counseling

Ethical and legal level of counseling 1. The concept of ethics and legal Ethics is generally defined as a philosophical discipline that is concerned with human conduced and moral decision making (Van Hoose, 1985). Ethics are normative in nature and focus on principles and standards that govern relationship between individuals, such as those between counselors and clients. Morality, however, involves judgment or evaluation of action. It is associated with such words as good, bad, right, wrong ought, and should (grant, 1992). Counselors have morals, and the theories counselors employ have embedded within them moral presuppositions about human nature that explicitly and implicitly question first What is a person and second, what should a person be or become? (Christopher, 1996) For improving the ethical and legal level of counseling, first, the counselor needs to understand what the word ethical means. Before the first counseling session, the counselor should realize how important about making good professional decisions that are both ethics and legal while being helpful to his or her clients. According to the Websters New World Dictionary (1980), it means 1. having to do with ethics; or of conforming to moral standards, 2. conforming to professional standards of conduct. Notice that these two definitions are distinctly different. This first is a personal phenomenon that is, what is moral is decide most often by individuals. In contrast, the second encompasses behaviors that are considered ethical by some professional group. In the mental health profession, that group could be the American Counseling Association (ACA), or the American Psychological (APA), just to name a few. 2. The development of codes of ethics for counselors The first counseling code of ethics was developed by the American Counseling Association (ACA) (Then the American Personnel and Guidance Association, or APGA) based on the original American Psychological Association code of ethics (Allen, 1986). The initial ACA code was initiated by Donald Super and approved in 1961 (Callis Pope, 1982). It has been revised periodically since that time. The ACA also produces A Practitioners Guide to Ethical Decision Making, video conferences on resolving leading-edge ethical dilemmas (Salo Hamilton, 1996), and an Ethical Standards Casebook (Herlihy Corey, 1996). The ACAs latest ethics code is entailed a Code of Ethics and Standards of Practice. This code is one of the major signs that counseling has developed into a mature discipline because professions are characterized, among other things, by a claim to specialized knowledge and a code of ethics. In the CAC, ethics standards are arranged under topical sectional headings. They contain material similar to that found in many other ethical codes, yet they are unique to the profession of counseling. 3. Following the Guideline for Acting Ethically For improving the higher level of the ethics of counseling, the counselors should follow guideline for acting ethically. Swanson (1983) lists guidelines for assessing whither counselors act in ethically responsible ways. The first is personal and professional honest. Counselors need to operate openly with themselves and those with whom they work. Hidden agendas or unacknowledged feelings hinder relationship and place counselors on shaky ethical ground. One way to overcome personal and professional honest problems that may get in the way of acting ethically is to receive supervision (Kitchener, 1994). The second guideline is acting in the best interest of clients. This ideal is easier to discuss than achieve. At times, a counselor may impose personal values on client and ignore what they really want (Gladding Hool, 1974). At other times, a counselor may fail to recognize an emergency and too readily accept the idea that the clients best interest is served by doing nothing. The third guideline is that counselors act without malice or personal gain. Some clients are difficult to like or deal with, and it is win these individuals that counselors must be especially careful. However, counselors must be careful to avoid relationships with likable clients either on a person or professional basis. Errors in judgment are most likely to occur when the counselors self-interest becomes a part of the relationship with a client (Germaine, 1993). The final guideline is whether counselors can justify an action as the best judgment of what should be done based upon the current state of the profession (Swanson, 1983). To make such a decision, counselors must keep up with current trends by reading the professional literature; attending in-service workshops and conventions, and becoming actively involved in local, state, and national counseling activities. The ACA Ethical Standards Casebook (Herlihy Corey, 1996) contains examples in which counselors are presented with issues and case studies of questionable ethical situations and given both guidelines and questions to reflect on in deciding what an ethical response would be. Each situation involves a standard of the ethical code. As helpful as the casebook may be, in many counseling situations the proper behavior is not obvious (Gladding, 2001). For example, the question of confidentiality in balancing the individual rights of a person with AIDS and society s right to be protected from the spread of the disease in one with which some counselors struggle. Likewise, there are multiple ethical dilemmas in counseling adult survivors about what to do in a given situation, it is crucial for counselors to concern and talk over situations with colleagues, in addition to using principles, guidelines, casebooks, and professional codes of ethics. 4. Counselor Competence and Referral The ACA Code of Ethics (1995) clearly states that Counselors must practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. The APA Ethical Principles (1992) makes a similar statement and adds that: Psychologists provide services, teach, or conduct research in new area or involving new techniques only after first undertaking appropriate study, training, supervision, and consultation from person who are competent in those areas or techniques. The ethical standards are quite clear regarding what a counselor should do if he is not competent to treat a certain client problem. His first and best choice is to make an appropriate referral. If there is no one to whom he can refer (which would be an exception rather than a common occurrence), then it is incumbent on he to educate himself through reading books and journal articles on the presenting problem and to seek supervision of his work with the client. The counselor has the responsibility for the welfare of the client; therefore, it is his professional duty to obtain for that client the best services possible be it from him or from a professional colleague. Clients are not subjects for your trial and error learning but deserve the best professional care possible. One of counselors responsibilities is to recognize his or her strengths and weaknesses and to offer services only in the areas of his or her strengths. Defining a counselors areas of component usually involves critical and honest self-examination. Calling this subjective component an internal perspective, Robinson and Cross caution counselors to do everything possible to gain the skills and knowledge based to the profession. Counselors need to stretch their skills continually by reading and attending to new and developing trends, through attaining postgraduate education, and through attending seminars and workshops aimed at sharpening and increasing both knowledge and skill bases. All counselors must take full responsibility for adhering to professional codes of conduct that address the concepts of proper representation of professional qualifications, for providing only those services for which they have been trained, and for seeking assistance with personal issues that are barriers to providing effective service. Regardless of the area of the area of service being discussed, counselors are the first-line judge of their professional competence. Although credentialing bodies, professional organizations, and state legislatures may set standards for practice, the counselor must be the most critical evaluator of his or her ability to provide services. This often becomes quite a challenge when ones living dependents on having clients who will pay for service. In fact, the ethical is not always the easy choice. 5. Improving Ethics Decisions Making in Counseling The making ethics decision is the crucial key for achieving a higher level of the ethics of counseling. Ethics decision making is often not easy yet is a part of being a counselor. It requires virtues such as character, integrity, and moral courage as well as knowledge (Welfel, 1998). Some counselors operate from personal ethical standards without regard to the ethical guidelines developed by professional counseling associations. They usually function well until faced with a dilemma for which there is no apparent good or best solution (Swanson, 1983). At such times, ethical issues arise and these counselors experience anxiety, doubt, hesitation, and confusion in determining their conduct. Unfortunately, when they act, their behavior may turn out to be unethical because it is not grounded in any ethical code. The researchers found five types of ethical dilemmas most prevalent among the university counselors they surveys there: a. confidentiality, b. role conflict, c. counselor competence, d. conflicts with employer or institution, and e. degree of dangerousness. The situational dilemmas that involved danger were the least difficult to resolve and those that dealt with counselor competence and confidentiality were the most difficult. The surprising finding of this study, however, was that less than over-third of the respondents indicated that they relied on published professional codes of ethics in resolving dilemmas. Instead, most used common sense, a strategy that at times may be professionally unethical and at best unwise. It is in such types of situations that need to be aware of resources for ethical decision making, especially when questions arise over controversial behaviors such as setting or collecting fees or conducting dual relationships (Gibson Pope, 1993). Ethical reasoning, the process of determining which ethical principles are involved and then prioritizing them based on the professional requirements and beliefs, is also crucial (Lanning, 1992). In making ethical decisions, counselors should take actions based on careful, reflective thought about responses they think are professionally right in particular situations (Tennyson Strom, 1992). Several ethical principles relate to the actives and ethical choices of counselors: Beneficence (doing well and preventing harm), Non malfeasance (not inflicting harm), Autonomy (respecting freedom of choice and self-determination), Justice (fairness), and Fidelity (faithfulness or honoring commandments) (Herlihy, 1996). All these principles involve conscious decision making by counselors throughout the counseling process. Of these principles, some experts identify non malfeasance as the primary ethical responsibility in the field of counseling. Non malfeasance not only involves the removal of present harm but the prevention of future harm and passive avoidance of harm. It is the basis on which counselors respond to clients who may endanger themselves or others and why they respond to colleagues unethical behavior. 5.1 Educating Counselors in Ethical Decision Making Ethical can be improving in many ways, but one of the beat is through course offering that are now required in most graduate counseling programs and available for continuing education credit. Such courses can bring about significant attitudinal changes in students and practicing professionals, impairment, and multiculturalism (Coll, 1993). Because ethical attitudinal changes are related to ethical behavioral changes, courses in ethics on any level are extremely valuable. Van Hoose (1979) conceptualizes the ethical behavior of counselors in terms of a five-stage developmental continuum of reasoning: Punishment orientation. At this stage the counselor believes external social standards are the basis for judging behavior. If clients or counselors violate a societal rule, they should be punished. Institutional orientation. Counselors who operate at this stage believe in and abide by the rules of the institutions for which they work. They do not question the rules and base their decisions on them. Societal orientation. Counselors at this stage base decisions on societal standards. If a question arises about whether the needs of society or an individual should come first, the needs of society are always given priority. Individual orientation. The individuals needs receive top priority at this stage. Counselors are aware of society needs and are concerned about the law, but they focus on what is best for the individual. Principle (conscience) orientation. In this stage concern for the individual is primary. Ethical decisions are based on internalized ethical standards, not external considerations. As Welfel and Lipsitz (1983) point out, the work of Van Hoose and Paradise is especially important because it is the first conceptual model in the literature that attempts to explain how counselors reason about ethical issues. It is heuristic (i.e., research able or open to research) and can form the basis gor empirical studies of promotion of ethical behavior. Several other models have been proposed for educating counselors in ethical decision making. Based on Gumaer and Scott (1985), for instance, offer a method for training group workers based on the ethical guidelines of the association for specialists in group work. This method uses case vignettes and Carkhuffs three-goal, model of helping: self-expectation, self-understanding, and action. Kicherner (1986) proposes an integrated model of goals and components for an ethics education curriculum based on research on the psychological processes underlying moral behavior and current thinking in applied ethics. Her curriculum includes counselors to ethical issues, improving their abilities to make ethical judgments, encourage responsible ethical actions and tolerating the ambiguity of ethical decision making (Kitchener, 1986). Her model and one proposed are process oriented and assume that counselors do not learn to make ethical decisions on their own. Pelsma and Borgers (1986) particularly emphasize the how as opposed to what of ethics that is, how to reason ethically in a constantly changing field. Other practitioner guide for making ethical decisions are a seven-step decision making model based on a synthesis of the professional literature, a nine-step ethical decision-making models follow based on critical-evaluative judgments and seven other models created between 1984 and 1998 (cottone Claus, 2000). These ethical decision-making models follow explicit steps or stages and are often used for specific areas of counseling practice. However, through empirical comparisons and continued dialogue, the effectiveness of the models may be validated. In addition to the models already mentioned the ACA Ethics Committee offers a variety of educational experience. For example, members of the committee offer learning institutes at national and regional ACA conferences. In addition, they publish articles in the ACA newsletter. Finally, to promote counseling practices, the committee through ACA publishes a type counselors guide entitled: What you should know about the ethical practice of professional counselors, which is on the ACA website as well as printed (Williams Freeman, 2002). 6. Focus on Clients Rights When clients enter a counseling relationship, they have a right to assume that you are competent. In addition, they have certain rights, known as client rights, as well as responsibilities. These rights have their foundation in the Bill of Rights, particularly the first and fourth amendment of the constitution of the United States, which are freedom of religion, speech, and the press and right of petition and freedom from unreasonable searches and seizures, respectively. The concept of confidentiality, privileged communication, and informed consent are based on the fourth amendment, which guarantees privacy. Privacy has been defined as the freedom of individuals to choose for themselves the time and the circumstances under which and the extent to which their beliefs, behaviors, and opinions are to be shared or withheld from others (Corey et al., 1988). 6.1 Improving Confidentiality and Privileged Communications The concept of privacy is the foundation for the clients legal right to privileged communication and counselors responsibility to hold counseling communications confidentiality is a professional concept. It is so important that both the APA (1992) Ethical principles and the ACA (1995) Code of Ethics each devote an entire section to confidentiality. However, a clients communications are not confidential in a court of law unless the mental health professional is legally certified or licensed in the state in which he or she practices. Most states grant the clients of state-certified or licensed mental health professionals (such as psychologists, professional counselors, and marriage and family therapists) the right of privileged communications. This means that clients, not counselors, have control over who has access to what they have said in therapy and protects them from having their communications disclosed in a court of law. In order for communication to be privileged, counselors should follow four conditions. First, the communication must originate in confidence that it will not be disclosed. Second, confidentiality must be essential to the full and satisfactory maintenance of the relationship. Third, in the opinion of the greater community, the relationship must be one that should be sedulously fostered. Finally, injury to the relationship by disclosure of the communication must be greater than the benefit gained by the correct disposal of litigation regarding the information. If as a counselor can claim these four conditions, then his clients communications are not only confidential, but they are also privileged and, therefore, are protected from being disclosed in a court of law. One must remember, however, that there is always a balance between a clientss right to privacy and societys need to know. Despite the importance given to confidentiality and privileged communication, pope, and Keith-Spiegel (1987) reported that 62 percent of psychologists in a national survey indicated that they had unintentionally violated a clients confidentiality and 21 percent had intentionally violated a clients confidentiality. These alarming statistics suggest that mental health professionals are at risk for violating this core ethical principle. Therefore, all mental health professionals need to be aware of the professional standards regarding confidentiality, the professional is guilty of breaching the confidentiality. Secretaries are considered extensions of the certified or licensed mental health professionals to which they are accountable. 6.2 Improving Informed Consent The ACA (1995) Code of Ethics is very specific with respect to what should be disclosed to clients in order for them to give informed consent: When counseling is initiated, and throughout the counseling process as necessary, counselors inform clients of the purposes, goals, techniques, procedures, limitations, potential risks and benefits of services to be performed, and other pertinent information. Counselors take steps to ensure that clients understand the implications of diagnosis, the intended use of tests and reports, fee, and billing arrangements. Clients have the right to expect confidentiality and be provided with an explanation of its limitations, including supervision and treatment team professionals; to obtain clear information about the case records; to participate in the ongoing counseling plans; and to refuse any recommended services and be advised on the consequences of such refusal. If a counselor is asked by a client to disclose to a third party information revealed in therapy, have the client sign an informed consent form before making any disclosure. The counselor may be surprised to learn that counselor are not even permitted to respond to inquiries about whether they are seeing a person in therapy even the clients name and status in counseling are confidential, unless the client has granted permission for this information to be released. One exception is when the client is paying for the services through an insurance company. This automatically grants the insurance company limited access to information regarding the client. The client needs to be made aware of the parameters of the information that will be shared with the insurance company prior to beginning therapy. Again, it is evident how important it is to have potential clients sign an informed consent form before they become clients. 6.3 Improving Clients Welfare All the preceding discussion rests on the permission rests on the premise that the counselors primary obligation is to protect the welfare of the client. The preamble to the APA (1992) Ethical Principles specifically states that it has as its primary goal the welfare and protection of the individuals and groups with whom psychologists work. A similar statement is made by ACA (1995) Code of Ethics: the primary responsibility of counselors is to respect the dignity and to promote the welfare and of clients. Dual relationships, counselors personal needs have already been discussed; attention now needs to be given to the third concern. An additional set of guidelines comes into play when a counselor is doing work or working with a couple or family. In a group setting, special issues include qualifications of the group leader, informed consent when more than the group leader will be participating in therapy, the limits to confidentiality and to privileged communication when third parties are present in therapy, and understanding how individuals will be protected and their growth nurtured in a group situation. Unlike individual counseling, clients who want to be involved into a group experience need to be screened before being accepted into a group. This screening not only ensures that the client is appropriate for the group but also protects other group members from a potentially dysfunctional group member. It is evident that client welfare, whether in individual therapy or in group work, rests squarely on the shoulders of the counselor. The counselor must be cognizant of the various aspects of the counseling relationship that can jeopardize the clients welfare and take the steps necessary to alleviate the situation. Robinson Kurpius and Gross offer several suggestions for safeguarding the welfare of each client: Check to be sure that you are working in harmony with any other mental health professional also seeing your client. Develop clear, written descriptions code of what clients may expert with respect to therapeutic regime, testing and reports, recordkeeping, billing, scheduling, and emergencies. Share your professional code of ethics with your clients, and prior to beginning therapy discuss the parameters of a therapeutic relationship. Know your own limitations, and do not hesitate to use appropriate referral sources. Be sure that the approaches and techniques used are appropriate for the client and that you have the necessary expertise for their use. Consider all other possibilities before establishing a counseling relationship that could be considered a dual relationship. Evaluate the clients ability to pay and when the payment of the usual fee would create a hardship. Either accept a reduced fee or assist the client in finding needed services at an affordable cost. Objectively evaluate client progress and the therapeutic relationship to determine if it is consistently in the best interests of the client. Improving the Ethics of Counseling in Some Specific Situations Counselors should check thoroughly the general politics and principles of an institution before accepting employment because employment in a specific setting implies that selves in institutions that misuse their services and do not act in the best interests of their clients, they must act either to change the institution through educational or persuasive means or find other employment. The potential for major ethical crises between a counselor and his or her employer exists in many school setting. School counselors are often used as tools by school administrators. When the possibility of conflict exists between a counselors loyalty to the employer and the client, the counselor should always attempt to find a resolution that protects the rights of the client; the ethical responsibility is to the client first and the school lore other setting second (Huey, 1986). One way school counselors can assure themselves of an ethically sound program is to realize that they may encounter multiple dilemmas in providing services to students, parents, and teachers. Therefore, before interacting with these different groups, school counselors should become families with the ethical standards of the American school counseling association, which outlines counselors responsibilities to the groups with whom they work (Henderson, 2003). One of the most common situations of counseling is about the family and marriage. The reason is that counselors are treating a number of individuals together as a system, and it is unlikely that all members of the system have the same goals. To overcome potential problems, Thomas (1994) has developed a dynamic, process-oriented framework for counselors to use when working with families. This model discusses six values that affect counselors, clients, and the counseling process: (a) responsibility, (b) integrity, (c) commitment, (d) freedom of choice, (e) empowerment, and (f) right grieves. Then, when a counselor faces the counseling of family or marriage, he or she should try to follow this framework. The use of computers and technology in counseling is another area of potential ethical difficulty. The possibilities exist for a breach of client information when computers are used to transmit information among professional counselors. Other ethically sensitive areas include client or counselor misuse and even the validity of data offered over computer links. In addition, the problem of cyber counseling or web counseling that is, counseling over the internet in which the counselor may be hundreds of miles away is fraught with ethical dilemmas. Thus, the national board of certified counselors has issued ethical guidelines regarding such conduct. Other counseling settings or situations with significant potential for ethical dilemmas include counseling the elderly, multicultural counseling, working in managed care, diagnosis of clients, and counseling research (Jencius Rotter, 1998). In all of these areas, counselors face new situations, some of which are not addressed by the ethical standards of the ACA. For instance, in working with older adults, counselors must make ethical decisions regarding the unique needs of the aging who have cognitive impairments, a terminal illness, or who have been victims of abuse. In order to do so, counselors may apply principle ethics to these situations that are based on a set of obligations that focus on finding socially and historically appropriate answers to the question: What shall I do? In other word, Is this action ethical? They may also employ virtue ethics, which focus on the character traits of the counselor and nonobligatory ideals to which professional aspire. Rather than solving a specific ethical question, virtue ethics are focused on the questions: Am I doing what is best for my client? Counselors are wise to integrate both forms of ethics reasoning into their deliberations if they wish to make the best decisions possible. In making ethical decisions where there are no guidelines, it is also critical for counselor to stay abreast of current issues, trends, and even legislation related to the situation they face. In the process, counselors must take care not to stereotype or otherwise be insensitive to clients with whom they are working. For instance, a primary emphasis of research ethics is, appropriately, on the protection of human subjects in research. In the area of research in particular, there are four main ethical issues that must be resolved: a. informed consent, b. coercion and deception, c. Confidentiality and privacy, and d. reporting the results. (Robinson Gross, 1986) All of these areas involve people whose lives are in the care of the researcher. Anticipation of problems and implementation of policies that produce humane and fair results are essential. 8. Improving the Legal Aspects of Counseling Counselors must follow specific legal guidelines in working with certain populations. But counselors may often have considerable trouble in situations in which the law is not clear or a conflict exists between the law and professional counseling ethics. Nevertheless, it is important that providers of mental health services be fully informed about what they can or cannot do legally. Such situations often involve the sharing of information among clients, counselors, and the court system. Sharing may be broken down into confidentiality, privacy, and privileged communication. Confidentiality is the ethical duty to fulfill a contract or promise that the information revealed during therapy will be protected from unauthorized disclosure. Confidentiality become a legal as well as an ethical concern if it is broken, whether intentionality or not. It is annually one of the most inquired about ethical and legal concerns received by the ACA Ethics Committee including dilemmas regarding right to privacy, clients right to privacy, and counselors avoiding illegal and unwarranted disclosures of confidential information (Williams Freeman, 2002). Privacy is an evolving legal concept that recognizes individuals rights to choose the time, circumstances, and extent to which they wish to share or withhold personal information. Clients who think they have been coerced into revealing information they would not normally disclose may seek legal recourse against a counselor. Privileged communication, a narrower concept, regulates privacy protection and confidentiality by protecting clients from having their confidential communications disclosed in court without their permission. It is defined as a clients legal right, guaranteed by statute, that confidences originating in a therapeutic relationship will be safeguarded (Arthur Swanson, 1993). Most states recognize and protect privileged communication in counselor-client relationships. As opposed to individuals, the legal concept of privileged communication generally does not apply in group and family counseling (Anderson, 1996). However, counselors should consider certain ethical concerns in protecting the confidentiality of group and family members. One major difficulty with any law governing client and counselor communication is that laws vary from state to state. It is essential that counselors know and communication to their cli

Mpf System

In 2011, Hong Kong people aged up to 65 and above total for 13 per cent of the population that is a rapidly growing in ageing population. The ratio is evaluated to increase in 19 per cent by 2021 and will up to 30 per cent by 2041. According to this investigation, the Hong Kong Government first introduced the MPF concept in 1995 to assure that every citizens working in Hong Kong prepare the financial provision while they are retirement.In August 1995, Hong Kong Government announced a major stage in enacting the Mandatory Provident Fund Schemes Ordinance (â€Å"MPFSO) (Chapter 485, Laws of Hong Kong) to provide a formal project of basic retirement protection. The MPFSO submits the framework for the building a system of privately managed, employment-related MPF schemes for members of the workforce to form financial benefits for retirement.The MPFA was settled on September 17, 1998 to regulate, monitor and direct the operation of the MFP system. There is only about one-third of the wor kforce of 3. 4 million people had some join of retirement protection before the achievement of the Mandatory Provident Fund System in December 2000. But now, closely to 90 per cent of the working population are already joined in retirement protection.There is a large and elderly population without enough savings will enhance a huge burden on the society if the number of ageing people rises up. MPF is build mainly to support the basic retirement protection to the working population by saving. The main feature of this system include coverage all employees and self-employed people who are over 18 and under 65 years old, not including specifically exempt under the MPFSO, are included by the MPF system.An employee and his/her employer are both needed to contribute five per cent of the employee’s monthly relevant income as mandatory contributions for and in respect of the employee, subject to the minimum and maximum relevant income levels for contribution purposes. An employee if e arning below the minimum level of relevant income (HK$6,500 per month or HK$78,000 per year) is not forced to give but may they can elect to do so by way of making voluntary contribution.Despite of the employee’s choice, the employer must contribute five per cent of the employee’s relevant income. The purpose of maximum standard of relevant income for contribution is generally at $25,000 per month or $300,000 per year. Both employers and employees can also due voluntary contribution in excess of the statutory mandatory amount. Self-employed persons also need to contribute five per cent of their relevant income as mandatory contributions, depend on the minimum and maximum standard of their relevant income for contribution purposes.As the beginning of the MPF System in December 2000, the MPF legislation has been reviewed in the light of operational experience in order to strengthen the efficiency and effectiveness of the system continuously. With the enactment of the MPF Schemes (Amendment) Ordinance 2012 on June 21, 2012, a statutory regulatory control to enhance the regulation of the sales and marketing programmers of MPF intermediaries will be in place on November1, 2012 and the Employee Choice Arrangement will be announced on the same day.Further initiative are being undertaken to strengthen the MPF System, including the development of proposals to enhance flexibility in withdrawing MPF benefits. MPF fees and charges have come down slowly as a result of MPFA’s contribution to streamline administrative procedures, enhance fee transparency and expand the market competition. According the Employee Choice Arrangement in place, we all hope that the management handling charges would be reduced in future.

Parkinsons term paper Essay

Parkinson’s disease is characterized as a degenerative disorder of the central nervous system which is understood to persist and continually worsen over time. It is the second most common neurological disorder. Parkinson’s disease affects approximately one million people within the United States. This disorder progresses slowly and is unique in the sense that Parkinson’s disease can be caused by genetics among other things. Parkinson’s disease is well known for its characteristic tremors, stiffness, and difficulty with speech in the patients it affects. Parkinson’s disease is caused by diminishment of the substantia nigra in the tegmentum which controls motor functions within the body. This disease is classified as a basil ganglionic disorder which causes a breakdown of dopamineric neurons in the substancia nigra, located in the midbrain. The substancia nigra is composed of neuromelanin which pigments the substancia nigra and gives it its darker cha racteristic. The neuromelanin also connects to the motor cortex which is responsible for one’s motor control and balance. The chemical dopamine is created in the substantia nigra. The basil ganglia receives inputs from the motor cortex, the association cortex, and the substancia nigra. The basil ganglia then sends messages to the motor cortex by way of the thalamus. With Parkinson’s disease, the nigral neurons are damaged, which causes the neuromelanin to be free to move into the adjacent tissue where it is phagocytosed and moved away by macrophages. This degenerative process not only destroys the process of creating dopamine, but it also causes the pigmentation of the substancia nigra to change and become lighter in appearance. The lack of dopamine-related input from the substantia nigra negatively changes the equilibrium of the output from the basil ganglia to the motor cortex. This alteration in the equilibrium then causes the symptoms related to Parkinson’s disease. The d irect cause of Parkinson’s disease remains a medical mystery, but many factors can participate in determining whether one is susceptible to developing Parkinson’s disease in  the future. The exposure to specific toxins in the environment and various environmental factors has the possibility of playing a role in those who were diagnosed with Parkinson’s disease. Another possible cause of Parkinson’s disease is the role of one’s genetics. It is found that certain mutations can give rise to Parkinson’s disease, although this is uncommon. The brains of patients with Parkinson’s disease change as the disease progresses. Lewy bodies are microscopic markers that characterize the presence of Parkinson’s disease within a patient. They are abnormal microscopic protein deposits that form in the brain and play a role in disrupting the brain’s normal functions. This disruption causes deterioration. Lewy bodies contain A-synuclein which is a protein that cells cannot break down. Early indicators of Parkinson’s disease include tremors or shaking which can reside in one’s finger, thumb, hand, lip, or chin, though shaking is normal after extensive physical activity, injury, or may be due to medications. If one’s handwriting begins to appear smaller over a short period of time, it could be a warning sign of Parkinson’s although one should not base their self-diagnosis upon handwriting, for handwriting can change as one advances in age, but this happens over time and not suddenly. A loss of smell in specific foods can be an indicator, but a loss of smell can also be related to the possession of the common cold or the flu. Another early sign may be sudden movements while sleeping such as falling out of the bed or kicking and punching. It is important to understand that people on occasion may experience difficulty sleeping. Chronic stiffness can be a sign, but this symptom can also be caused by an injury or arthritis. If one is experiencing constipation on a daily basis, this can be considered a sign of Parkinson’s disease, although a lack of fiber in one’s diet or medications can determine the moving of one’s bowels. Having recently possessed a soft o r low voice is an indicator unless one has a chest cold or other virus. If one has the appearance of a masked face, a blank stare that persists, or undergoes a long duration of time without the action of blinking, these may be precursors to having Parkinson’s disease. Feeling dizzy or fainting can be signs of low blood pressure and may be connected to Parkinson’s disease along with the inability to stand up straight. There are many Parkinson’s-related symptoms that are known today. The most obvious of symptoms is a resting tremor. A shaking, or tremor, normally starts in one’s  limb, and it is often located on a hand or fingers. This resting tremor usually stops when the patient is voluntarily moving the limb affected by the tremor. A â€Å"pill-rolling† tremor is common and is characterized by one rolling one’s thumb and forefinger. These tremors can be noticed when the limb is even at a relaxed state. Due to the tremors and inability to control certain motor functions, writing can become difficult for patient s with Parkinson’s disease. It is noted that when writing, those effected with Parkinson’s disease posses handwriting that is characteristically small. Bradykinesia, or a slowing of movement, can be present. Parkinson’s disease has the ability to cause one to move slower which can make simple every-day tasks a challenge. With bradykinesia, one’s steps may become smaller in distance when being mobile, and one’s feet may begin to drag when walking. Excessive muscle tone or hypertonia may be prevalent in patients with Parkinson’s disease and will manifest itself as stiffness or rigidness which causes pain and a loss in one’s range of motion. Parkinson’s disease patients may experience posture impairment and balance, for a patient’s posture can become stooped, and balance can be lost. Patients diagnosed with Parkinson’s disease may experience a loss in their autonomic functions which include and are not limited to smiling, swinging one’s arms while walking, and blinking. This loss in autonomic function caused a select number of patients to stop using their hands while speaki ng in normal conversations. Speech changes can affect those living with Parkinson’s disease. One may speak out of rhythm in such a way that it may sound soft, quick, hesitant, monotone or slurred. Diagnosing Parkinson’s disease is not a simple process, for a test for Parkinson’s disease does not yet exist. In order to be diagnosed with Parkinson’s disease, a neurologist must first obtain a detailed medical history of the patient being diagnosed, a review of the patient’s signs and symptoms, a physical examination, and a neurological examination. Tests to exclude other conditions may be ordered to ensure proper diagnosis of the disorder. Once a patient has undergone sufficient testing and examining, the doctor may prescribe the patient the medication carbidopa-levodopa, which is a Parkinson’s disease medicine. If the patient improves considerably while on the medication, this often confirms a Parkinson’s disease diagnosis.  There exists a wide-range of treatments for patients that suffer from Parkinson’s disease from drug treatments to surgical treatments. The pharmacologic approach for those with Parkinson’s disease aims to increase the lack of dopamine in the patient’s basil ganglia. L-dopa or Levodopa is a drug that can cross the blood-brain barrier. The brain can convert this drug to dopamine. Carbidopa can also be prescribed to patients afflicted with Parkinson’s disease. Carbidopa is a decarboxylase inhibitor and, when taken with levodopa, can aid levodopa from converting to dopamine outside of the brain. The combination of medications allows for more levodopa to reach the brain which ultimately increases the brain’s supply of dopamine. These two medications decrease the side effects which are caused by an increased amount of dopamine outside of the brain. They reduce the supply of â€Å"free† dopamine from residing outside of the brain. An excess of dopamine outside of the brain could result in low blood pressure, vomiting, and nausea. Other medications include dopamine agonists which directly stimulate nerve receptors inside of the brain which are usually stimulated by dopamine. In contrast to the medication levodopa, dopamine agonists do not convert into dopamine but rather behave like dopamine. Dopamine agonists are utilized in patients that are in the early stages of Parkinson’s disease and may be added to a treatment plan along with levodopa in the later stages of Parkinson’s disease. It may also be added when levodopa alone cannot sufficiently manage the patient’s symptoms or when the patient has severe motor fluctuations. Side effects associated with levodopa-carbidopa include dizziness upon rising, confusion, nausea, movement disorders, and hallucinations. Side effects commonly associated with dopamine agonists are vomiting, nausea, and orthostatic hypotension. Surgical treatment options are available for those who suffer from Parkinson’s. These surgical treatments are intended to control symptoms related to Parkinson’s disease patients who do not positively respond to medications. One of the surgical treatments crea tes a lesion in specific portions of the thalamus within the midbrain which become overactive in Parkinson’s disease. A reversible procedure that can be used on patients diagnosed with Parkinson’s disease is deep brain stimulation, or DBS. With this procedure, electrodes are implanted into exact locations. These locations are treated then with pulses of electrical currents. Why deep brain stimulation works is unknown. Medical  experts believe that the current could be activating, affecting, or inhibiting synaptic transmission onto neurons in the vicinity of the electrodes. The future prospects for a cure for Parkinson’s disease are promising, for the medical community has begun to identify the genetic causes linked to Parkinson’s disease. This allows the medical community to expand animal models of Parkinson’s disease. These will be highly useful in the process of understanding the pathogenesis of the disease and will be useful in further testing the neuroprotective therapies which can potentially aid in the fight against the progression of Parkinson’s disease. A different potential approach in the future would be to engage in the replacement of lost neurons via transplantation, which would be highly difficult and tedious. Overall, Parkinson’s disease is well on the way to being better understood and through this und erstanding scientists will be able to directly identify the source of this disease and eventually find a method that directly cures this disease. References Etiology. (n.d.). Merriam-Webster. Retrieved March 13,2014, from http://www.merriam-webster.com/dictionary/etiology Welcome to the Purdue OWL. (n.d.). Purdue OWL: APA Formatting and Style Guide. Retrieved March 13, 2014, from https://owl.english.purdue.edu/owl/resource/560/01 Parkinson’s: Symptoms & Types. (n.d.). WebMD. Retrieved March 13, 2014, from http://www.webmd.com/parkinsons-disease/guide/parkinsons-symptons-types Parkinson’s disease. (n.d.). Complications. Retrieved March 13, 2014, from http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/complications/con-20028488 Parkinson’s Disease. (n.d.). Parkinson’s Disease. Retrieved March 13, 2014, from http:// courses.washington.edu/conj/bess/parkinsons.html Nisipeanu, P. (n.d.). Parkinson’s Disease: Diagnosis and Clinical Management. Adverse Effects of Dopamine Agonists. Retrieved March 13, 2014, from http://www.ncbi.nih.gov/books/NBK27800/ Levodopa Medicines for Parkinsonâ€⠄¢s Disease. (n.d.). WebMD. Retrieved March 13, 2014, from http:// www.wbmd.com/parkinsons-disease/levodopa-medications-for-parkinsons-disease Dopamine Agonists for Parkinson’s Disease. (n.d.). WebMD. Retrieved March 13, 2014, from

How Process Has Worked So Well For Me Essay - 1178 Words

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