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Hemophilia
Case

A 24-year-old white man has a diagnosis of hemophilia at the age of about 5 to 6 years. He has recently visited the hematology clinic for the follow-up after hospitalization for an accidental knife cut that caused excessive bleeding. The patient has a history of excessive bleeding from tooth extraction, excessive bruising since childhood and the upper gastrointestinal bleeding in the past three years. He has reported chronic pain of his joints and ankles and denied hemarthroses. The patient has given reports about the episodes of excessive bleeding treatment by use of factor VIII and fresh frozen plasma (Remor, 2013).

The patient has the FVIII deficiency (hemophilia A) which is a common type of hemophilia that affects about 5, 000 males at births. The disease approximately affects about 25, 000 people in the United States. Individuals with hemophilia suffer from deficiencies in clotting factor. The mild hemophilia bleedings problems do mainly occur after surgery, trauma and injury. The condition can accompany some symptoms. Almost 25% of the population with hemophilia has the mild deficiency. Those with moderate hemophilia experience bleeding episodes after minor injuries and may lead to spontaneous episodes of bleeding. The server hemophilia happens after trauma, injury and surgery. It has the spontaneous bleeding into muscles and joints characteristics. Recurrent bleeding of the joints also known as hemarthrosis causes hemophilic arthropathy that causes disability at a very young age (Department of Genetics 2015).

Causes

Hemophilia is a disease happening as a result of gene mutation, and it is a genetic disease. About 70% of hemophilia cases are inheritable from parents. However, the other 30% of patients do not have the family history. In such cases, the main cause of the condition is by a spontaneous gene mutation during the fertilization stage. Hemophilia is also a condition that is linked to sex since the FIX and FVIII geneses are found on the X chromosome. It is the chromosome X that determines the gender of the baby. Thus, the condition’s clinical manifestation has a link to sex. Therefore, females may not express the bleeding symptom like the males (McPhee, & Hammer, 2012).

Pathophysiology
The main source of factor VIII (FVIII) production is thought to be from the reticuloendothelial and the liver system. Transplantation of the liver can correct FVIII deficiency to persons with hemophilia. It is because of the increasing cases of individuals with mild hemophilia having progressive liver diseases. Thus, it is an indication that the liver is the main site for FVIII synthesis (Cayir, Yavuzer, and Sayli, 2014).

The RNA messenger for FVIII is also detectable in spleen and liver among other issues. Studies indicate that the production of FVIII in cells lines that are transferable show that after synthesis the FVIII shifts to the endoplasmic reticulum lumen. It is then within other protection that functions in regulating secretion. It particularly regulates the immunoglobulin binding protein in which it has to dissociate in a process that depends on energy. The FVIII’s signal peptide cleavage, as well as oligosaccharides, also takes place in the endoplasmic reticulum. The calnexin, chaperone proteins, and calreticulin, enhance both FVIII degradation and secretion. Regarding genes, the location of the FVIII (F8C) is at the X chromosome arm at Xq28 region. This gene becomes large comprising of 25 intones and 26 exons. A mature FVIII will have about 2332 amino acids. FVIII deficiency is as a result of gene inversion that causes disrupt to the FVIII gene. The disruptions are insertions, point mutations, and deletions. The low levels of FVIII happen as results of external FVIII gene defects (Huether, &McCance, 2012).

1. Discuss the legal rules and regulations on assisted suicide: one state legalizes the assisted suicide, and the other state does not.

In the United States, Oregon and Washington have legalized physician-assisted suicide. This law established by states provides citizens in the state with a right to assisted suicide commonly known as ‘death with dignity.’ In these states, physicians are empowered to aid patients to end their life and have been provided with a legal excuse to a charge of assisted suicide. The law in these states gives specific conditions when and under what circumstances a patient can be allowed to get assistance to end their life. Some of the requirements include that the patient is expected to die within a specified period and that the procedure must follow certain consent guidelines.

In states where there is no law legalizing physician-assisted suicide, an individual or a physician is guilty of promoting suicide attempt when they intentional leads to or assists another person attempt suicide.

2. Discuss the legal issues on assisted suicide (e.g., 2nd-degree murder).

The legal issues arising from physician-assisted suicide is that doctors can be charged with second-degree murder as they would be killing or aiding in the death of a patient intentionally. The legal perspective of homicide is described by the act of bringing about their death or assisting in ending their life, which is the act of assisted suicide. In care facilities, a legal issue arises when a doctor whose responsibility is to do good, aids in the death of a patient who requests assistance to commit suicide. The doctor may be charged and found guilty of assisting another person to commit suicide.

3. Discuss the ethical issues of assisted suicide (e.g., right to die).

Various ethical issues arising from traditions of nursing and medicine have led to opposition of assisted suicide by nursing and medical organizations. The patient’s in care facilities have a right to know their prognosis to make decisions concerning the implementation of life-prolonging treatment. Although patients have a right to make a decision about what they want, the ethical issue that arises is whether they are mentally competent and can make properly informed end of life decisions about their condition. Also, an ethical issue that arises from a patient who has a right to die and seeking to end their life since they are suffering is whether the suffering should be viewed according to the patient’s view or considered in other people’s perspective. An ethical issue on assisted suicide on an individual who has a right to die is whether the approach used is widely acceptable.

4. Shall the person (i.e., a family member) be charged a crime (e.g., murder), who has provided any kind of assistance to another person’s suicide?

A family member who provides any kind of assistance to another individual so as to assist end their life is guilty and may be charged with a crime of manslaughter. The crime is that the person purposely aids another commit suicide regardless of whether the patient was willing or made own decision to end their life. The kind of assistance may include giving advice on how to end life, giving a book that provides guidelines on suicide or even providing pills or medicine or other physical means that causes death.

5. Your feedback and solutions to the issues of assisted suicide, legal and ethical

The subject of assisted suicide whether by a family member or an organization or a physician raises sharp contrasting opinions. Individuals commit or have thoughts of committing suicide for various reasons that range from ending the suffering caused by terminal illnesses or other problems. Governments and states should formulate and enforce laws that prohibit assisted suicide without proper guidelines or advice. The individuals seeking advice on assisted suicide or those who want to commit suicide should have adequate knowledge of the outcome of their actions. Federal and state government should also increase assistance to patients who are suffering or have pain due to some illness.