Sunday, November 21, 2010

A response to the irresponsible South Australian government

A dying man explains why euthanasia is so dangerous | Herald Sun Andrew Bolt Blog

Associate Professor Nicholas Tonti-Filippini is a bio-ethicist in Melbourne, who well known for his stance in the cause for the right to life. What has been unknown is that this man has for many years been fighting illnesses that have led him to the point where he is now - a dying man. He has been receiving palliative care for his pain but has gone as far as he can go.

Despite this pain and knowledge that he is dying, Nicholas Tonti-Flippini remains a strong advocate against the introduction of voluntary euthanasia. This time the threat is in South Australia. He has written a very strongly worded letter to Mike Rann, the South Australian Premier, setting out his reasons against those who continue to advocate euthanasia on demand. Here are some of the reasons:

Facing illness and disability takes courage and we do not need those euthanasia advocates to tell us that we are so lacking dignity and have such a poor quality of life that our lives are not worth living.
I would like to record my own view that it would not benefit seriously ill South Australians, particularly those who are terminally ill and suffering intractably, if the Voluntary Euthanasia Bill became law.  The current legal situation in South Australia, while not perfect, does provide a measure of protection against the terminally ill being regarded as a burden.  As a chronically ill person I know well what it is to feel that one is a burden to others, to both family and community, how isolating illness and disability can be, and how difficult it is to maintain hope in the circumstances of illness, disability and severe pain, especially chronic pain. 

For several years, until I objected, I received from my health insurer a letter that tells me how much it costs the fund to maintain my health care.  I dreaded receiving that letter and the psychological reasoning that would seem to have motivated it.  Each year I was reminded how much of a burden I am to my community.  The fear of being a burden is a major risk to the survival of those who are chronically ill.  If euthanasia were lawful, that sense of burden would be greatly increased for there would be even greater moral pressure to relinquish one’s hold on a burdensome life. 

The proposal to make provision for a terminally person who is suffering to request, and a doctor to provide, assistance to die makes it less likely that adequate efforts will be made to make better provision for palliative care services.  Legalised euthanasia would give those responsible for funding and providing palliative care a political “out” in that respect.

In Australia, too little is done to make adequate palliative care available to those who need it:
• Current entry requirements for palliative care usually exclude people with chronic pain and is often limited to people who are in the last stage of cancer with a prognosis of less than eight weeks;
• The pharmaceutical subsidies for the more effective forms of pain relief are often restricted to cancer patients;
• People living outside major cities have little access to palliative care facilities. 
• Few doctors are adequately trained to provide palliative care.
• Such palliative care services as exist are chronically underfunded and struggle to provide the complex range of services that are needed to assist a person to live with pain and disability.
• Most pain clinics are over subscribed and have long waiting lists.  For people who are left suffering, such waiting is unconscionable.

If euthanasia is a legitimate option with a determined structure, such as was the case in the Northern Territory for a brief period, and is now proposed for South Australia, then life for the chronically seriously ill would become contingent upon maintaining a desire to continue in the face of being classified as a burden to others.  Essentially the Bill involves setting up a category for people whose lives may be deliberately ended.  Their protected status as a member of the South Australian and Australian communities depends on a contingency.  Passage of the Bill would imply that our community considers that our continued survival depends on us not succumbing to the effects of pain and suffering, depends on us not losing hope.

I have lifted what I see as the most important points being, but I do suggest that you read the whole thing on the Andrew Bolt blog.

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Friday, January 23, 2009

The MSM & Co get it wrong about Teri again

After all this time one would think that politicians and the MSM would try to get it right concerning the circumstances of Teri Schiavo's disability. What is really disturbing is that there are politicians and MSM who continue to claim that it was morally right to starve and dehydrate this woman to death - even though she was not dying at the time.

This time the controversy surrounds a bronze award to a member of Dobson's Family Institute because he opposed a person who represented the scum known as Michael Schiavo:

Olbermann rehashed the "far right" end of the Terri Schiavo controversy on the January 6 edition of Countdown, awarding the bronze (or "Worse" person in the world) to the Dobsonian theocrats:

The bronze tonight to Tom McCluskey, vice president of James Dobson‘s lobbying outfit Family Research Council, protesting the nomination of Thomas Perrelli by the president-elect to become the number three man at the Justice Department. Why? Because Perrelli was one of the lawyers who represented Michael Schiavo as he tried to end the Gothic nightmare induced by the far right, as he struggled to have a court order enforced to remove the breathing tube from his wife, Terri, whose brain function has ceased.

The careers of Senate Majority Bill Frist and his House counter-part Tom Delay crashed in large part because they took this private tragedy into Congress and exploited it politically, even as 70 percent of this country told them to stop their cynical manipulation of this beleaguered family. Now these Dobsonian theocrats are protesting an appointment at the Justice Department because the man was on the morally and legally correct side of the debate.

I doubt that the careers of either politician went down the tube just because of this controversy. There were other issues involved, but hey let's just give the continued false impression about the thoughts of a nation that has been so misled by a mainstream media that is at the beck and call of the euthanasia enthusiasts. Let's just forget about the fact that this case concerned a woman who had a severe brain injury, and let's just forget that her adulterous husband refused to allow her to have physiotherapy. Everything that would have allowed her to gain some freedom and independence was denied to her because this adulterous man wanted her dead.

It is also forgotten by these people that there is a shadow cast over how Teri ended up in this particular state. No one has bothered to completely investigate all of the circumstances. Instead investigations have been stymied by Schiavo supporters. Why? I can give it a guess as to why there is such an effort - it is because this case was seen as a watershed that would allow others to legally murder their spouses, partners or so-called loved ones.

As an example, after Teri was legally murdered through dehydration and starvation there was a case involving a little girl who had been bashed by her step-father. The mother of the child was willing to kill her and asked the state to intervene. The step-father, the one who bashed her, fought to save her life. The initial judgement went against Hayley Poultre's life, but the death sentence was not carried out. Why? First of all, no one had given young Hayley enough time to come out of her coma. Instead of giving a prognosis of revival the doctors had been too keen to give up on the child. Second, Hayley stunned everybody by coming out of the coma. Her stepfather's later actions saved her from going through a most excruciating death.

The MSM has done everyone a very big disservice because of their support of an adulterous, and abusive husband. If any of the reporters had bothered to get off their backsides and do investigative journalism, and by that I mean investigating all of the circumstances surrounding the collapse of Teri Schindler-Schiavo, instead of being so lazy that they accepted without question what they were being told, then they should have been on the side of a woman who was the victim of abuse by her adulterous and abusive husband.

So let's give a bronze cheer to Olbermann for being the worst of the worst due to his ignorance regarding the Schiavo case.

Wednesday, October 17, 2007

Determining a brain-injured patient's prognosis

This is an article from the New Yorker about brain scans of persons in low conscious and/or vegetative states; that there may be quite a bit going on in there:

Silent Minds

What scanning techniques are revealing about vegetative patients.

by Jerome Groopman October 15, 2007

Ten years ago, Adrian Owen, a young British neuroscientist, was working at a brain-imaging center at Addenbrooke’s Hospital, at the University of Cambridge. He had recently returned from the Montreal Neurological Institute, where he used advanced scanning technology to map areas of the brain, including those involved in recognizing human faces, and he was eager to continue his research. The imaging center was next to the hospital’s neurological intensive-care unit, and Owen heard about a patient there named Kate Bainbridge, a twenty-six-year-old schoolteacher who had become comatose after a flu-like illness, and was eventually diagnosed as being in what neurologists call a vegetative state. Owen decided to scan Bainbridge’s brain. “We were looking for interesting patients to study,” he told me. “She was the first vegetative patient I came across.”

For four months, Bainbridge had not spoken or responded to her family or her doctors, although her eyes were often open and roving. (A person in a coma appears to be asleep and is unaware of even painful stimulation; a person in a vegetative state has periods of wakefulness but shows no awareness of her environment and does not make purposeful movements.) Owen placed Bainbridge in a PET scanner, a machine that records changes in metabolism and blood flow in the brain, and, on a screen in front of her, projected photographs of faces belonging to members of her family, as well as digitally distorted images, in which the faces were unrecognizable. Whenever pictures of Bainbridge’s family flashed on the screen, an area of her brain called the fusiform gyrus, which neuroscientists had identified as playing a central role in face recognition, lit up on the scan. “We were stunned,” Owen told me. “The fusiform-gyrus activation in her brain was not simply similar to normal; it was exactly the same as normal volunteers’.”

Excited by this result, Owen resolved to try to conduct brain scans of other vegetative patients in the Cambridge area. Since 1997, he has studied several dozen people, though he decided to use speech sounds rather than photographs to stimulate their brains. (Owen was concerned that showing images of faces might not be a reliable way to test recognition, since the eyes of vegetative patients often wander. “We shifted to auditory responses because you can always put a pair of headphones on the person and know that you are transmitting sound,” he said.) Three years ago, he began using a functional MRI (fMRI) scanner, which is faster than a PET scanner, capturing changes in blood flow in the brain almost as they occur. The patients’ brains were scanned while they listened to a recording of simple sentences interspersed with meaningless “noise sounds.” The scans of some of the patients showed the same response to the sentences as scans of healthy volunteers, but Owen wasn’t sure that the patients had understood the words. “So we went the next step up the cognitive ladder, to look at comprehension,” he said.
Psycholinguists have shown that when we hear a noun at the beginning of a sentence we tend to associate the word with its most common meaning. For example, Owen said, most people hearing a sentence that begins, “The shell was . . .” think of an object typically found at the beach. But if the sentence is completed by the phrase “fired at the tank,” the listener quickly corrects himself, a process that is evident on a brain scan. “You can actually see it happening and image it on the scanner,” Owen said. “The beautiful thing about the psychological task is that we just do it automatically. When you play ambiguous sentences, areas in the inferior frontal lobe and in the posterior temporal lobe become activated, and these areas are very important for speech comprehension. They show that you understand the meaning of the word: it’s not just about perceiving speech; it’s about decoding. Your brain somehow appreciates that there are two meanings to a word like ‘shell.’ ”

Owen eventually identified two vegetative patients whose brains showed the same activity in response to ambiguous sentences as the brains of healthy volunteers. He also took brain scans of healthy physicians, who were presented with the ambiguous sentences while under general anesthesia. Owen found that, as the effects of the anesthesia increased, the physicians showed less activity in the brain regions associated with comprehension. “That, of course, is in keeping with our personal experience of consciousness, which is that as you sort of drift into sleep you understand less and less of what is around you,” he said. (An article about this experiment appears this week in PNAS, the journal of the National Academy of Sciences.)
Owen’s final experiment was the most ambitious: a test to determine whether vegetative patients who seemed able to comprehend speech could also perform a complex mental task on command. He decided to ask them to imagine playing tennis. (“We chose sports, and tried to find one that involved a lot of upper-body movements and not too much running around,” he said.) First, he took brain scans of thirty-four healthy volunteers who were instructed to picture themselves playing the game for at least thirty seconds. Their brains showed activity in a region of the cerebrum that would be stimulated in an actual match. “This was an extremely robust activation, and it wasn’t difficult to tell whether somebody was imagining tennis or not,” Owen said. He then repeated the experiment using one of the vegetative patients, a woman who had been severely injured in a car accident. The woman had to be able to hear and understand Owen’s instructions, retrieve a memory of tennis including a conception of forehand and backhand and how the ball and the racquet meet and focus her attention for at least thirty seconds. To Owen’s astonishment, she passed the test. “Lo and behold, she produced a beautiful activation, indistinguishable from those of the group of normal volunteers,” he said. (Another vegetative patient, a man in his twenties, also passed the test, though Owen, having learned that the man was a soccer fan, asked him to imagine playing that sport instead of tennis.)
In September, 2006, Owen, along with Martin Coleman, a neuroscientist at Addenbrooke’s, and four other researchers, published an article about the tennis experiment in Science and ignited a vigorous debate. In letters to the journal, some neurologists argued that the woman must have been misdiagnosed a claim that Owen disputed. “She fulfilled all of the internationally agreed-upon criteria, and there wasn’t anything that she did that would lead anybody to say she wasn’t vegetative,” he told me. “Now, naturally, in hindsight she wasn’t vegetative; she was actually conscious. It’s a very interesting issue, because it means that she was in fact misdiagnosed, but not misdiagnosed in the sense that somebody made an error. Clearly, she is consciously aware of things around her. So something is missing in the diagnostic criteria.”
For decades, doctors assumed that patients who have been diagnosed as vegetative lack any capacity for conscious thought. Most are previously healthy people who suffered a traumatic brain injury, or oxygen deprivation after a heart attack or stroke, and have been regarded more or less as zombies: patients whose bodies continue to function sometimes for decades but whose minds are incapable of willed activity. (The term “vegetative” was proposed in 1972, by Bryan Jennett, a neurosurgeon, and Fred Plum, a neurologist, who chose it based on a definition in the O.E.D: “an organic body capable of growth and development but devoid of sensation and thought.”) In the occasional newspaper stories about someone who suddenly recovered consciousness after spending years in a vegetative state, the event was invariably described as a medically inexplicable “miracle.” The Mohonk Report, a paper prepared by a group of experts in brain injury and presented to Congress last year, cited estimates suggesting that there are approximately thirty-five thousand Americans in a vegetative state and another two hundred and eighty thousand in a minimally conscious state a less severe condition, in which patients show erratic evidence of deliberate behavior, such as responding to a simple command or focusing on a person or an object for a sustained period. Because insurers typically won’t pay for rehabilitation, on the assumption that such patients are unlikely to improve, most are given little in the way of therapy. “These people with brain trauma are out of our view,” Joseph Fins, an internist and medical ethicist at Weill Cornell Medical College, in Manhattan, and a member of the Mohonk group, told me. “We ignore them, and we sequester them in places where we can’t see them, usually in nursing homes.”
According to several American and British studies completed in the late nineties, patients suffering from what is known as “disorders of consciousness” are misdiagnosed between fifteen and forty-three per cent of the time. Physicians, who have traditionally relied on bedside evaluations to make diagnoses, sometimes misinterpret patients’ behavior, mistaking smiling, grunting, grimacing, crying, or moaning as evidence of consciousness.


Doctors can also miss signs of consciousness in vegetative patients, according to the British and American studies. Ten months after Owen and his colleagues completed the tennis experiment with the vegetative woman, she was brought back to the imaging center and placed in an MRI machine. “We were absolutely dismayed, because we scanned her and there was nothing,” Owen recalled. The team tested the woman again the next day. This time, in response to a command to play tennis, her brain showed normal activity in the regions that mediate arm movements. Owen now repeats scans for each patient, conducting them twice a day for three days. Patients with brain injuries have “seriously impaired attention capabilities and their levels of general arousal are likely to be shot,” he said. Recent research by Owen and other neuroscientists may eventually help make diagnoses more accurate, but it is not yet clear how the new brain-scan data will affect the medical understanding of consciousness.

As Owen put it, “The thought of coma, vegetative state, and other disorders of consciousness troubles us all, because it awakens the old terror of being buried alive. Can any of these patients think, feel, or understand those around them? And, if so, what does this tell us about the nature of consciousness itself?”

Owen’s article in Science was accompanied by an editorial by Lionel Naccache, a neurologist at the Hôpital Pitié-Salpêtrière, in Paris, who called the results of the tennis experiment “spectacular.” “Despite the patient’s very poor behavioral status, the fMRI findings indicate the existence of a rich mental life, including auditory language processing and the ability to perform mental imagery tasks,” Naccache wrote.


 Yet he cautioned against drawing general conclusions about vegetative patients from a single case, and asked, “If this patient is actually conscious, why wouldn’t she be able to engage in intentional motor acts, given that she had not suffered functional or structural lesion of the motor pathways?” Prompted by questions like this, Naccache and several of his colleagues are conducting brain-imaging experiments with the goal of identifying objective indicators of consciousness, and thus enabling doctors to better evaluate patients who are unable to communicate their awareness of themselves or their environment.

We assimilate information unconsciously all the time; at any given moment, we process thousands of stimuli, of which we pay attention to only a few. As you read this sentence, you may not be aware of the birds singing in the back yard, but your brain has analyzed the sound and concluded that it poses no threat to you. In the past several decades, scientists have uncovered particularly dramatic examples of unconscious processing. In the early seventies, researchers at M.I.T. studied four patients who had experienced trauma to an area of the brain involved in vision and had been found to have a condition that was later called “blindsight.” These patients’ eyes functioned normally, but they did not perceive much of what was in their field of vision. When the researchers flashed a light at the patients and asked them to describe what they saw, the patients reported that they had seen nothing. Yet the researchers noticed that their eyes often located the source of the light. In a second experiment, a blindsight patient was shown pictures of faces displaying happiness, sadness, anger, and fear. The patient said that he could not see the faces, yet he was frequently able to correctly identify the emotions. The researchers concluded that, despite the patient’s injuries, pathways in his brain had been preserved which allowed him to process at least some visual data, even though he wasn’t consciously aware of doing so.

In the early nineteen-hundreds, the Austrian neurologist Hermann Zingerle described patients who, because of tumors or other abnormalities of the parietal lobe on the right side of the brain, ignored the left side of the body and objects in the left field of vision. (The right side of the brain controls awareness of the left side of the body.) For example, some of these patients would shave only the right side of their faces, since they were unaware of their left cheeks. In the nineteen-eighties, researchers determined that patients who had the syndrome ­now called “neglect”­ could process some objects in the left field of vision. In one experiment, a patient was shown two pictures of a house. The images were identical except that, in one, flames were emerging from a window on the left side of the façade. The patient said that she couldn’t see any difference between the images, but, when she was asked which house she would want to occupy, she almost always chose the one that was not on fire. “This is more complex than blindsight, because it means that the patient was unconsciously able to interpret and understand the symbolic meaning of the pictures,” Naccache said. “It is a powerful experiment to demonstrate that unconscious perception and unconscious cognition can reach upper levels of the brain.”

From these and other recent experiments, including his own, Naccache and his research team are developing a working medical definition of consciousness. “When we are conscious, the key property is our ability to report to ourselves or to others the content of the representations when I say, for example, ‘I am perceiving a flower,’ or the fact that I am conscious of speaking with you now on the telephone,” Naccache told me. “You have patients who are conscious, or who are able to make reports, but you can prove that some stimuli escaped their conscious reports, as in the case of blindsight or neglect. You can study the neural fate of these representations by showing that, even if the stimuli were not reported by the subject, they were still processed in the brain.” He added that, in the case of Owen’s vegetative patient who imagined playing tennis, it’s impossible to know whether she reported the event to herself which would suggest that she is capable of conscious thought or whether, as in the case of the blindsight and neglect patients, she had no subjective awareness of the experience. However, Naccache believes that consciousness also requires an ability to sustain a representation over time, which Owen’s patient clearly was able to do. “In assessing apparently vegetative patients who are unable to speak, and thus report, the direction of research should be to look for sustained representation,” he said. “If we can prove by neuro-imaging techniques that this person is able to actively maintain a given representation during tens of seconds, it provides strong evidence of conscious processing.”

Naccache has recently incorporated a third neurological feature into his definition of consciousness: broadcasting. In a person who is conscious, he explained, information entering the brain is processed in a few areas and then distributed or broadcast to many others. “It’s as though there is a kind of ignition in the brain, and then information is made available to a very rich number of regions,” Naccache told me. “And that makes sense, that the information is initially represented locally and then made available to a vast network, because the person has this ability to maintain the representation within the network for a long time.”

In 2005, Naccache conducted an experiment whose outcome suggested the importance of broadcasting as a marker of consciousness. First, he and his research team presented a series of words to three epileptic patients, who had had electrodes implanted temporarily in various brain regions, in an effort to locate the source of their seizures. The electrodes enabled doctors to record the activity in a given region. Some of the words, such as “blood” and “rape,” were chosen for their negative emotional connotations. The rest of the words, which included “chair” and “house,” were considered neutral. Each word was shown to the patients for twenty-nine milliseconds and then replaced with an image of a geometric figure, such as a rectangle. The patients reported seeing only the geometric figures. However, Naccache’s team discovered that in each patient the amygdala, a brain structure that is associated with strong negative emotions, such as fear, displayed much more activity in response to the negative words than to the neutral words.

“The picture we have now is that, unconsciously, many areas of the brain can process information, and that unconscious representation can be very abstract and very rich much more than neuroscientists thought some decades ago,” Naccache said. “But now we can begin to identify some limits of unconscious cognition. The activation picked up by the electrodes is not only evanescent but restricted to the amygdala and a few other regions, without broadcasting and amplification through the brain.”


 Owen’s tennis-playing patient may have been broadcasting information during the experiment, Naccache said, though he added that he is uncertain whether her diagnosis should be upgraded from vegetative to minimally conscious. Moreover, he said, brain-scan research cannot yet tell us much about such a patient’s prospects for improvement.

The J.F.K. Johnson Rehabilitation Institute, in Edison, New Jersey, is among the world’s largest centers for the treatment of brain injuries and one of the few places where patients suffering from disorders of consciousness participate in research studies and receive innovative therapy. In 2002, Joseph Giacino, a neuropsychologist at the institute, was the co-chair of the Aspen Work Group which was made up of experts in brain injury and helped formulate the criteria for diagnosing a minimally conscious state. “I think the rehabilitation field was ahead of the curve in understanding that there were subpopulations of patients who were not in a coma, were not in a vegetative state, but really were not conscious, at least in the way we think about normal consciousness,” Giacino told me. “In the medical literature, these patients were lumped together with everybody else.”

The techniques that Giacino uses to diagnose patients require no sophisticated technology. He recalled making rounds at the institute with two eminent neurologists and stopping at the bedside of a woman who had had a brain hemorrhage. The neurologists examined the woman, who lay with her eyes half closed and did not respond to the doctors’ commands. The neurologists concluded that she was in a vegetative state. “So I sort of sheepishly said, ‘Let me show you what happens when we stimulate her,’ ” Giacino recalled. He had been using a technique called “deep-pressure stimulation,” which involves squeezing a patient’s muscles with force and precision.

Giacino started with the woman’s face and worked his way down to her toes, pinching her muscles between his fingers. As he explained, the nerve endings of the muscles send impulses to the brain stem, which relays them to other brain structures and rouses the patient to consciousness. “I did a cycle of deep-pressure stimulation, and within a minute or so she was talking to us,” Giacino said. “The neurologists were flabbergasted.” The woman was able to say her name and her husband’s name, and answer simple questions, such as “Is there a cup at your bedside?” After a few minutes, however, she became unresponsive again.

The woman had what Giacino calls a “drive disorder,” in which a patient is unable to speak, move, or, possibly, think unless physically stimulated by touch. Doctors believe that such disorders are caused by damage to the limbic lobes or to other parts of the brain that trigger and sustain behavioral responses. Some patients with drive disorders respond to drugs that increase brain levels of dopamine, a neurotransmitter that is associated with arousal.

 “Imagine if the woman were in a nursing home,” Giacino said. “Somebody would stop by for three minutes, check her bedpan, and present simple commands like ‘Squeeze my hand,’ ‘Close your eyes,’ and ‘Open your mouth.’ She is not going to do any of those things, but she clearly had a significant amount of preserved function. It had to be harnessed externally.”

At J.F.K. Johnson, patients with drive disorders receive behavioral and drug therapy. (Some patients improve, but prospects for recovery are largely determined by the extent and nature of the damage to the drive system.)

Since 2002, the institute has been experimenting with using brain scans to assist with diagnoses. Giacino cited the case of a male patient whose condition had been diagnosed as vegetative but who appeared to have strong emotional responses to people around him. “If a nurse came in to do his care, it looked like he was screaming silently,” Giacino recalled.

“His mouth would be wide open, and he had an agonized, contorted face, like the one in Edvard Munch’s painting ‘The Scream.’ The expression would occur if there was a lot of noise around him, or if he was being physically handled, but then his mother would come into the room, lower the lights, talk with him in a soothing voice, and it would just go away.”

When doctors scanned the man’s brain, they discovered that portions of the right hemisphere involved in emotional processing were intact. (Other parts of the right hemisphere were damaged.) “This shows you how treacherous diagnostic assessment can be,” Giacino said. “One can retain one piece of a network but be disconnected from other structures and other networks, so that there is almost no subjective awareness associated with this complex behavior. I’ve seen other patients with other behaviors that seem to be outside the scope of a vegetative state. Then you image them and you find out some circuits are still relatively preserved, while most of the rest of the brain is not.”

However, brain-scan technology has also helped doctors identify one patient at J.F.K. Johnson as a candidate for an experimental therapy. The patient, a thirty-eight-year-old man who suffered a head injury and had been living in a nursing home for six years, arrived at the institute in 2004. He appeared to be minimally conscious; he occasionally mouthed single words when prompted, but he was unable to respond reliably to simple questions, or to chew and swallow. (He had a feeding tube.) In 2001, PET and fMRI scans had been taken of the man’s brain, and, according to Giacino, one of many researchers involved in the case, “the findings were totally unexpected. The PET scan showed little metabolic activity, but the fMRI scan showed that the region of the cortex involved in processing language functioned in a fairly normal way.”

The researchers speculated that, because of damage to the man’s frontal lobe, thalamus, and brain stem areas involved in regulating arousal the nerve signals in his brain were muted. As Nicholas Schiff, a neurologist at Weill Cornell Medical College who led the study of the man’s brain, put it, “It’s as if a radio were turned to such a low volume that you couldn’t hear the music distinctly.” He added, “The scans confirmed our expectation that this patient had a greater capacity for language than he demonstrated.”

In August, Schiff, Giacino, Joseph Fins, and Ali Rezai, a neurosurgeon at the Cleveland Clinic, along with twelve other researchers, published an article about the case in Nature. The researchers described implanting electrodes in the man’s thalamus, which, by stimulating the brain tissue, had enabled him to regain considerable physical and mental function.

 “Deep brain stimulation can promote significant late functional recovery from severe traumatic brain injury,” they wrote. When the electrodes were turned on in the man’s thalamus, his speech improved, his movements became more fluid, and he was able to chew and swallow. When the researchers turned off the electrical stimulation, the man soon relapsed. He is now being given regular doses of electrical stimulation and is able to speak in short sentences and to chew and swallow. The researchers concluded that the case “challenges the existing practice of early treatment discontinuation” for minimally conscious patients who show some “interactive behaviors.”

Few vegetative or minimally conscious patients ever recover fully, and many are unlikely to improve. (Some neurologists estimate that an adult who has been vegetative for six months following a traumatic brain injury has only a twenty-per-cent chance of regaining consciousness.)

For the past three years, Schiff and Fins have been studying the brain of Terry Wallis, a forty-three-year-old man in rural Arkansas who had been the subject of national news stories in 2003, when it was reported that he had begun to speak after spending nineteen years in a nursing home, in a minimally conscious state. Schiff and Fins contacted Wallis’s family and offered to help him obtain medical care during his recovery, and to use brain scans to document his progress.

 In 1984, Wallis, a nineteen-year-old truck mechanic, had been in a car accident and sustained a severe brain injury; he was also paralyzed. Wallis’s father had asked the nursing home to arrange an evaluation of his son by a neurologist, but was told that such an assessment was too expensive and, in any case, would not be useful.

In 2003, when Wallis began to speak, he received twelve weeks of physical therapy, which was covered by Medicaid, but the Arkansas Department of Health and Human Services rejected his request for further treatment, concluding that he had not made sufficient progress.

 One day, in 2005, Fins, who had contacted Wallis’s congressman to solicit his help in obtaining additional medical care for Wallis, asked Mrs. Wallis for her son’s Social Security number. “I was on the phone, and Mrs. Wallis said to Terry, ‘What’s your Social Security number?’ ” Fins recalled. “He gives his number, and I write it down. And I said, ‘Mrs. Wallis, was that Terry?’ And she said, ‘Yup. The first time he told us his Social Security, we thought he was wrong. But we looked it up, and he was right.’ ”

Fins was astonished. Not only has Wallis recovered memories from his life before the accident but, Fins said, “he is picking up American culture. He now knows the song ‘Bad boys, bad boys, what are you gonna do.’ Why is that important? It’s important because that song didn’t exist in 1984, so Terry is laying down new memories. It shows sustained improvement.”

 In 2006, Schiff arranged for Wallis to be taken to Weill Cornell Medical College, where he examined his brain using a sophisticated technique called diffusion tensor imaging, which assesses the number and health of axons, long fibres that transmit nerve impulses from one brain cell to another. The scans suggested that the axons in Wallis’s brain were growing and forming new connections a finding that contradicts the long-standing assumption that a damaged brain is incapable of healing after such a lengthy period.

 “We need to do longitudinal studies, to see if these kinds of changes are accruing over time, whether they happen frequently or infrequently, and what their association with the patient’s level of function is,” Schiff told me. In some cases, he speculated, the brain may sometimes be able to bypass an injured area and devise novel ways of connecting axons. Still, he went on, much about Wallis’s recovery and the neurological developments that are driving it - remains a mystery. “After nineteen years, Terry spoke a few words, but within seventy-two hours he recovered fluent, expressive, and receptive language,” Schiff said.

Kate Bainbridge, the first vegetative patient that Adrian Owen studied in Cambridge, has also made considerable progress, recovering the use of her arms, and much of her mental function, although she is unable to walk. She still has difficulty talking, and uses a letter board to communicate with people who are not used to her speech. “Most scans show what is wrong with your brain, which doctors need to know,” Bainbridge wrote to me in an e-mail. “But Adrian Owen’s scans show what is working. I say they found parts of my brain were working. It really scares me to think what might have happened to me if I had not had the scans. They show people it was worth carrying on even though my body was unresponsive.”

Friday, October 05, 2007

Pair face trial over euthanasia

Two Sydney women have denied that they either murdered an Alzheimer's victim, or they aided and abetted his suicide.

Shirley Justins, 59, and her friend, Caren Jenning, 74, were arraigned today in the NSW Supreme Court.

They both pleaded not guilty to murdering former Qantas pilot Graeme Wylie, who was the 71-year-old partner of Justins.

They also pleaded not guilty to the alternative charge of aiding and abetting the suicide of Mr Wylie, who left an estate worth about $2.5 million.

He died of a lethal dose of the barbiturate drug Nembutal on March 22 last year, at the home he shared with Justins at Cammeray on Sydney's north shore.

Justice Graham Barr continued the women's bail and set down their trial for May 5.

The trial, before Justice Michael Adams, is expected to last about four weeks.

An earlier court hearing was told police alleged Jenning travelled to Mexico in March last year and returned home with the drug, which is only available to vets in Australia.

Swiss authorities had allegedly rejected an application in November 2005 for Mr Wylie to take his own life in Switzerland, where euthanasia is legal.

Police also contended that Mr Wylie's will had been changed a week before his death to favour Justins.

Since the trial has been set for May 5 next year, it would be wrong of me to make any comments that might in any way prejudice the case. However, it does seem strange that one of the women travelled to Mexico in March last year and that she returned home with the barbiturate, Nembutal. Both women are associated with the Voluntary Euthanasia society.

What is really suspicious is that Mr. Wylie's will was changed a week before his death to favour Shirley Justins. This is something that a jury will have to seriously consider when dealing with all of the facts of this case.

Voluntary euthanasia is not legal in this country, and it is possible for people to manipulate a situation, such as someone having Alzheimer's Disease, in order to gain financial advantage. On the surface this appears to be the case.

Thursday, September 13, 2007

Doctors support drugs to speed newborn deaths

Doctors support drugs to speed newborn deaths |

This is a very concerning report because it shows that doctors are forgetting their own Hippocratic oath, by even considering such a course of action. If this is the way that they are thinking it is a real worry if the situation for the child is not as bad as the doctor claims:

ONE in three medical specialists is prepared to break the law by using painkillers or sedatives to hasten the death of a baby born with a severe life-threatening disability.

An anonymous survey of neonatologists in Australia and New Zealand also found almost half were willing to use medication to speed up death in critically ill newborns for whom further treatment was considered hopeless.

Peter Barr, a senior physician at the Children's Hospital at Westmead, Sydney, who conducted the study, said the desire to alleviate a baby's pain and suffering sometimes outweighed doctors' concerns about the law.

"This was a self-reporting questionnaire where neonatologists responded to hypothetical situations, so we don't know exactly what they do in practice, but we know what their preferences are," Dr Barr said. "They were presenting their views, knowing that they were not lawful." 

While neonatologists commonly withdraw or withhold treatment in newborns with a terminal disease or severe disability, it is illegal to use medication to hasten a person's death.

However, doctors reported that they would prefer to use painkillers or sedation to hasten death rather than withholding oxygen or nutrients.

"For example, if further medical treatment has been deemed therapeutically non-beneficial or overly burdensome, then neonatologists may consider it more compassionate and humane to purposefully hasten death unlawfully with analgesia-sedation than, for instance, to forgo gastric tube feeding, which may be lawful," the study found.

"Hence neonatologists seem to support the moral notion that it is sometimes 'better to kill than let die' - even though the former is unlawful and seem not to respect the 'sanctity of life'." Dr Barr also discovered there was a link between doctors' personal fear of death and their ethical beliefs.

"Neonatologists who said that they were prepared to hasten death when death was inevitable had a greater of fear of death than those who thought that it was unacceptable," Dr Barr said.

"Fear of the dying process and premature death may unconsciously motivate these neonatologists to do what they can to ease the baby's suffering and hasten their death, and that takes priority over the legal implications."

University of Queensland professor of medical ethics Malcolm Parker said doctors who chose to break the law were motivated by compassion.

"It's never easy for clinicians faced with that situation but I'm sure they feel compelled in very severe cases to do what they believe is the most humane thing," he said.

It is alleged that the doctors who chose to break the law by giving the babies sedatives are "motivated by compassion", but is this a false compassion. What is disturbing though, is that the withdrawal of a gastric feeding tube is considered lawful and the use of sedatives is considered illegal. Yet, the withdrawal of the gastric feeding can in fact cause a very cruel death, and this is still something that is euthanasia. The patient has not died naturally if starved and dehydrated to death. I can understand that these baby doctors would not want to see a baby face such an horrendous death, which would then probably motivate their actions. However, I am not sure that this is real compassion. It remains euthanasia.

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Nurse suspected of mercy killing of 97 year old woman

Nurse suspected of mercy killing |

This story was posted in February and I have not seen anything further. The hospital had ordered toxicology tests on the woman who died mysteriously. She was 97 years old. Perhaps she died of natural causes after all.

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Monday, August 27, 2007

Doctor cleared of misconduct charge | Health |

Doctor cleared of misconduct charge | Health |

This is a case of baby euthanasia. The doctor has been cleared by the medical board of misconduct, but the morality applied by the British medical board in this case might be open to question. On the surface it is hard for a non-professional to recognize infant euthanasia at work. It is necessary to look more closely at the wording related to the incident to see that what the doctor did, even if he thought that he was helping the baby because of its pain was morally reprehensible.

In such a case I find it hard to know where to draw the line. The baby was dying and it was distressed and the doctor chose to give it medication that worked as a muscle relaxant. The dose of medication was sufficient to kill the baby. It really is a very fine line and I do not applaud the actions taken by this doctor.

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Saturday, November 11, 2006

Doctors: let us kill disabled babies - Sunday Times - Times Online

Doctors: let us kill disabled babies - Sunday Times - Times Online

It started with the demand to make the pill more freely available to women. Then women demanded the right to kill their unborn babies without facing murder charges; next came the cries in favour of voluntary euthanasia. Now, the doctors have begun the campaign to kill disabled babies.

The Royal College of Obstetricians and Gynaecology has put forward the proposal to kill via euthanasia seriously disabled newborn babies. It seems that they want to play God. This kind of decision making brings the U.K. closer and closer to following the eugenics of pre-war Germany.

The excuse for promoting the murder of disabled babies, is that of the emotional and financial hardship of bringing up the sickest babies. It seems that the doctors who are making this proposal have not heard of a sick baby having any form of quality of life.

In part they have stated:

“A very disabled child can mean a disabled family,” it says. “If life-shortening and deliberate interventions to kill infants were available, they might have an impact on obstetric decision-making, even preventing some late abortions, as some parents would be more confident about continuing a pregnancy and taking a risk on outcome.”

The submission that the college gave to the Nuffield Council of Bioethics states in part:

“We would like the working party to think more radically about non-resuscitation, withdrawal of treatment decisions, the best interests test and active euthanasia as they are ways of widening the management options available to the sickest of newborns.”

The euthanasia of newborn infants is illegal in the U.K. However, as a result of this submission the college has succeeded in having euthanasia of the newborn to be considered. The college wants the "mercy" killing of newborn babies to be debated by society.

The problem with this proposal is that the doctors who have already been killing newborns that they see will not have a quality of life, have already stepped onto the slippery slope of evil. At the present time euthanasia of newborn infants is permitted in the Netherlands for a range of incurable disorders. However, where does one draw the line? Even if some of the illnesses are incurable at the present time, that does not mean that there will not be cures in the near future.

If the euthanasia of very sick newborn infants was permitted, then parents would face the inevitable pressure to kill their children, even if this is against their own moral and religious principles. We already see the way in which pressure is being placed upon very young girls to abort their babies. I am certain that similar pressures will be placed upon the already stressed parents.

There is nothing worse for expectant mothers and fathers than learning that their child has some form of illness. It is worse when the baby is alive right up until the time that he is due to be born, and then due to the incompetence of the medical staff, the baby fails to be born alive. (a member of my family lost her son as a result of the incompetence of the doctor where she had been booked to have her baby). How unbearable then, if a child is born with a weak heart, and the doctor then puts pressure on the parents to allow him or her to kill the child because of the financial cost of the care for the child. This is an alarming development.

I hope that the U.K. will have the good sense not to permit such an atrocity to happen. The U.K. needs to review its attitude regarding abortion on demand, because too many children are being killed in the womb. This proposal is untenable, and should be resisted by all potential parents.

Terri Schiavo's Former Husband Michael Campaigned for Losing Candidates

Terri Schiavo's Former Husband Michael Campaigned for Losing Candidates

Despite Michael Schiavo's bravado regarding his pledge to fight against all pro-life candidates in the elections who attempted to save Terri, the candidates who got his endorsement failed in the elections.
From Colorado to Florida, Schiavo's endorsement has been the kiss of death. It seems that at least in Colorado Schiavo's kiss of death has been good news for the pro-life campaign. Schiavo had attended a debate in late October, and he had hurled abuse at the pro-life candidate. She won the election.

Jim Davis had sought Michael Schiavo's endorsement in Florida for the role of governor. Charlie Crist was the successful candidate.

Michael Schiavo endorsed the extreme left candidate Ned Lamont. Joe Lieberman, who was one of the congressmen who voted to help the Schindlers, and who lost the Democrat's endorsement, has been returned to the Congress as an independent.

The good news here is that the pro-life candidates were successful and that means that the American Congress will continue to have a balance so that the Culture of Death that has been gaining in popularity amongst the extreme left wing of the USA will not be able to fully implement their policies. The bad news, of course, is that the Democrats have gained control of the Congress.