Tuesday, January 20, 2009


Autism has many prominent characteristics, which help to identify the disorder, but its origin and cause are a mystery to the medical community. How can an ever increasing population of people diagnosed with autism reach a state of independent living when its cause is not yet known? What is known about the disorder has been gathered from observation and theories. With this information people with autism can be treated.

According to the Diagnosis and Statistical Manual of Mental Disorders an individual must exhibit at least six characteristics of Autistic Disorder to be diagnosed. These characteristics include two impairments in social interaction, impairment in communication, repetitive behaviors, signs of the condition must be seen before the age of three, and the disorder cannot be better explained by the criteria for Rett’s disorder or Childhood Disintegrative Disorder. (American Psychiatric Association, 2000). Impairments in social interaction can be described as the lack of attention one gives to his/her peers, lack of eye contact, or the child being unattached or indifferent to his/her parents. Impairments in communication can include a total lack of spoken language, selective mutism, and echolalia. Repetitive behaviors include the inability to adjust to change, abnormal interests for objects (such as a spot on an object or the texture of the object rather than the object itself), or repetitive and constant hand twisting (American Psychiatric Association, 2000; Fletcher-Janzen, 2000). Other characteristics of Autistic Disorder, though not recognized by the DSM-IV-TR criteria, include giftedness (musical talent, abilities in mathematics, or an outstanding memory), self-injury (more prominently seen in those who are nonverbal), and irregular sensory sensitivity (Burack, 2001).

Tests that have been used to help determine if a person has Autistic Disorder include the Childhood Autism Rating Scale (CARS: 15 item test that has been said to wrongly classify children), the Autism Behavior Checklist (ABC: test mainly used by teachers), and the Gilliam Autism Rating Scale (GARS: to be used on those age 3-22, items on this test are in correlation to the criteria set by the DSM-IV) (Burkhardt, 2001). Statistics show that approximately 75 percent of those diagnosed with autism are also mentally retarded. Some researchers believe that this statistic may be inaccurate, because of the lack of more appropriate testing (Burack, 2001). Many of the conventional tests used to assess mental abilities focus on language skills, but this is in many ways the root of the Autistic Disorder. So an individual may develop an increase in understanding through the years, yet not be able to express himself/herself through language; thus still being diagnosed as mentally retarded. Many become disheartened and lose hope of advancement with this diagnosis.

There has been an increase in reported cases of autism over the years. Studies show that an average of 5 cases per 10,000 individuals are diagnosed with autism (APA, 2000). The DSM-IV also reports that cases can range from 2 to 20 cases per 10,000 individuals (APA, 2000). Autistic Disorder is much more prevalent in males than females, approximately four to five times prevalent. On the other hand, the DSM-IV states that mental retardation is more common and severe in females.

Theories of the cause of autism have been varied to include theories about genetics, vaccines, neurological abnormalities, environment, and many more. Around the time Kanner more clearly identified autism, it was believed that environment was the cause of the disorder observing a cold demeanor in at least one parent (Burkhardt, 2001). Treatment for this theory was the removal of the child from the home. One recently popular theory has been looking into childhood vaccines, especially vaccinations for measles (MMR), but with further research no relationship has been concluded (National Immunization Program, 2003).

“Education, both directly of children, and of parents and teachers, is currently the primary form of treatment in autism.” This statement is one of the challenges mentioned in Educating Children with Autism (2001). With legislation like IDEA, or the Individuals with Disabilities Act, families of disabled children are able to seek education appropriate to help treat the child’s disorder. Families are not always guaranteed these services so many have to look to the courts for help (National Research Council, 2001). IDEA states that every child with a disabilities has the right to not only an education, but also an individualized education plan, which is unique to this law (National Research Council, 2001). A panel of qualified administrators, educators, and experts in the field creates an IEP, or individualized education plan.

A behavioral approach is the preferred choice when educating children with autism since behavior can cause many of the problems faced in the classroom (Fletcher-Janzen, 2000). An education program should exhibit strong child-teacher interaction and positive reinforcement for appropriate behavior. The curricula should address respondent and operant learning, as well as all phases of learning (such as learning concepts, being able to perform tasks after periods of time, and becoming a more independent learner) (Fletcher-Janzen, 2001). A good program will also have a strong relationship with parents and the community, even offering programs and support. Early intervention is also essential to education, and a child with autism should be enrolled into a program as soon as possible.

The educator of children with autism must be attentive to the needs of the student, adjusting curricula as need be. The educator must have knowledge of curricula, materials, and management. An educator must also believe and expect that the student can learn (Burkhardt, 2001).
Education doesn’t cease outside the classroom so parents must also acquire skills to continue the lessons learned in school. The nature of the Autistic Disorder states that the child has difficulty applying concepts from one situation to another making parental involvement that more essential (National Research Council, 2001). A training course aforementioned in previous paragraphs could be the best way to ensure continuous education.
When dealing with special education assumptions must be thrown out, and students must be given funding for a complete education leading to independent learning (National Research Council, 2001).

Characteristics of the Autistic Disorder may be common and at times clear to identify, but the fact still remains that autism is a mystery. So far, the medical community can only speculate on the disorder’s origin and that is why education is so vital to the treatment of the Autistic Disorder. Even before education, parents must be sure that the diagnosis is correct and rule out neurological damage.

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Aissted Suicide

Assisted suicide is a widely argued ethical issue. A lot of the debate on this subject stems from either different viewpoints of when this act is appropriate, or what the resulting consequences would be if such an act were ever permissible. The point mostly debated between opposing sides is life-worth. What constitutes a life worth living and who is to ultimately decide this? The main problem with this question is that suffering cannot be measured unless one is to endure that same suffering themselves. The view that life is a special gift bestowed by God is held highly by many religions and it is of most importance to them when the debate on assisted suicides arises. A gift from God should not be tampered with let alone destructed.

Although the number of ethical issues involved is endless I will be focuses on three points. The first point in this introduction into the ethics of assisted suicide will involve the psychologically vulnerable and the elderly. The second ethical issue to be mentioned will be the presence and/or lack of a definition for a terminal illness. The last point is concerned with the human will to power and how this creates a problem should assisted suicide be permissible. These ethical issues, although strong convictions on their own, can lead to slippery slope arguments and must be looked at very carefully. In addition depending on the standpoint that one would take, these arguments have both strengths and weaknesses.

Many people fear the process of aging. They become unable to continue the same lifestyle that they once had and they often are more ill and have to be looked after by family or others. The same can be said about the psychologically vulnerable who quite often have to depend on someone else to live as functional a life as possible. In this case we have two instances where people are being dependant on others. Although they are not living the way they desire, is there reason for them to be able to end their lives? Is the lack of happiness in someone’s life considered suffering?
Just like there is no definition for suffering, problems arise when someone states that they wish to offer assisted suicide only to those categorized as having a terminal illness. What is terminal? The category seems to be expanding all over the world in order to include certain cases. Once again, people are trying to decide what quality of life is of their interest to prolong. Is Diabetes a terminal illness? It can be according to some of the guidelines, however, what about those who have Diabetes and lives normal productive lives without having to rely on anyone else.
Last, but not least we have the issue regarding the human will to power. This issue involves the temptation and enjoyment in exercising power over others. There is no higher power than to have power over someone’s life. Allowing assisted suicide could quite possibly get in the way of protecting lives of people that should otherwise be protected.

It has already been mentioned that the ethical issues that have been discussed can easily lead to slippery slope arguments when involved with assisted suicide. A slippery slope argument is such that if you allow “a” then “b” will follow and the slide to “c, d,e” and so is inevitable. This is why critics of assisted suicide feel that “the removal of the taboo against assisted suicide will lead to the destructive expansions of the right to kill the innocent”. ( Kluge p.379). In other words theses issues that may seem simple to some are actually quite complex and must be looked at from every angle. If not looked at carefully, there will be people falling through the cracks. Let’s take a look at the dangers regarding the three issues that have already been mentioned.
As I have already mentioned the majority of psychologically vulnerable patients and the elderly have to rely on others to live functional lives. They have been almost programmed by society to feel as though they are “useless burdens on younger, more vital generations”. The reason that this issue can result in a slippery slope argument is because if society allowed the option of “self-deliverance” than these patients who already feel helpless would wonder why not to take advantage of it. They are being given the choice to remain completely dependent on someone else or to relieve this person and at the same time ultimately comforting themselves. Resisting this choice may even be seen as others as selfish. (Kluge). It is society that it making them feel as though they are burdens and if in addition to this they also allow assisted suicide then they are basically saying that these certain patients can “live if they wish but the rest of us have no strong interest in their survival”.

The next issue that critics say is a slippery slope is the expanded definition of terminal illness. This has become a problem because courts continue to broaden the definition to allow certain cases and now there are too many examples that fall under the terminally ill category. If assisted suicide were permissible there would have to be very strict guidelines and the definition used would have to be a very narrow definition. Otherwise there is going to be a lot of people who fall under the umbrella of terminally ill who are not. Assisted suicide should not have to be an option for these specific people, but it will act as an outlet for their caretakers. It’s somewhat similar to the cases involving the psychologically vulnerable and the elderly.

Through looking at these issues and seeing how they can be slippery slope arguments it is simple to see that critics of assisted suicides are not necessarily spending their time arguing that it is wrong, but they are simply voicing their concerns about the consequential actions that would inevitably follow.

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