Tag: coma

Bioethics Blogs

Burke and Wills: Why We Might All Fear the Judgment in Charlie Gard

The Case of Donald Wills

Donald Wills is a self-made man. He is billionaire British banker who has taken an interest in technology. He believes the Singularity is near and wishes to live as long as possible. He completes an advance directive to use his money to keep him alive at all costs, should he become ill and unable to express his wishes. He tells his wife about these desires.

Donald develops a rare condition where the mitochondria in all his cells stop working. The mitochondria are power packs for every cell. Donald’s muscles stop working and he is admitted to a famous London hospital and has to be put on a breathing machine. His brain is affected- he suffers fits which need to be controlled by medication. There is no known cure and he is going downhill.

Doctors call in his wife and explain his dismal prognosis. “It is,” they say, “in his best interests to stop this burdensome treatment in intensive care. He will never regain normal brain function but he is conscious at times and feels pain. He should be allowed to die with dignity.” After all, Donald is 75.

Donald’s wife, Melanie, is shattered. But she goes on the internet to see if anything can be done. She knows this is what Donald would want. She finds a world expert at a world class centre in Boston who has trialled a new treatment, X, on ten patients and has obtained significant results in one of them. She calls the expert and he tells her there is some chance of some improvement in her husband but it is low.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Jahi McMath – Evidence that She Is Now Alive Considered by Court Today

Later today (California time), is a hearing on the Motion for Summary Adjudication of Plaintiff Jahi McMath’s First Cause of Action for Personal Injuries, filed jointly by all defendants (“Defendants”) on March 23, 2017.


Judge Stephen Pulido has posted his tentative ruling. I have pasted that below.   



Defendants and for Plaintiffs McMath et al. (“Plaintiffs”) shall be prepared to address, among other things, the following: 



(1) The supporting and opposition papers are “heavy” on discussion of the various medical diagnoses and opinions but “light” on discussion of the applicable legal standards for the court to apply. For example, though Defendants include a collateral estoppel argument, there is only one paragraph addressing it on the last page of Defendants’ memorandum, with a single case cite as to the general application of collateral estoppel, and this issue is not identified in the Notice of Motion. Is this a separate basis of the motion, and if so, have Defendants given proper notice of this? Which facts in the Separate Statement of Undisputed Material Facts (“UMF”), if any, are material to this issue? 



(2) The Notice of Motion states that the motion “is made on the grounds that Jahi McMath lacks standing to sue for personal injuries because she was pronounced deceased in accord with California law in December 2013. The undisputed material facts establish that no mistakes were made in the determination of McMath’s brain death in December 2013, and the diagnosis of McMath’s brain death was made in accord with the accepted medical standards required by California law.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Brain death: experts divided on how death is defined

Pdf logoSome authors, as Bernat reports in his article, have come to classify brain death unscientifically, illogically, even treating it as a legal fiction

In the November 2014 issue of the American Journal of Bioethics, see HERE (1), Professor James L. Bernat reflects on where the concept of brain death is headed. The reason for this is the fact that there is still reticence as regards this concept in the public and academic spheres. Professor Bernat refers to two recent cases in which the diagnosis of brain death led to clinical-ethical-care problems that emerged in the media and public opinion.   One of these is the case of Jahi McMath, a child who suffered severe anoxic encephalopathy, as a result of which she developed symptoms consistent with a diagnosis of brain death. Jahi’s parents refused to accept the diagnosis of death and requested that the patient’s treatment is maintained, as they did not consider her dead. The second case is that of Marlise Muñoz, a pregnant patient, also declared brain dead and whose physicians decided to maintain life support measures (connection to a respirator, and maintenance of other treatments), based on the fact that the survival of the foetus was at stake. Marlise’s family asked that these support measures be withdrawn since Marlise was considered clinically and legally dead.

Persistence of controversy in brain death criterion

The persistence of controversies in relation to the concept of brain death is striking, although it is over 40 years since the birth of this concept of death of the person, published in the Journal of the American Medical Association (JAMA) in 1968 (2).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

20 Years of Death with Dignity in USA

The nation’s first “death with dignity” law turns 20 this year.  Since the six other states have affirmatively legalized medical aid in dying.


A new analysis published in JAMA Oncology is taking a look back at how the law has been utilized in Oregon since it went into effect in 1997. 

  • Total Usage – A total of 1545 prescriptions were written, and 991 patients died by using legally prescribed lethal medication. 
  • Age & Gender – Of the 991 patients, 509 (51.4%) were men and 482 (48.6%) were women. The median age was 71 years (range, 25-102 years). 
  • Increase – The number of prescriptions written increased annually (from 24 in 1998 to 218 in 2015), and the percentage of prescription recipients dying by this method per year averaged 64%. 
  • Diagnoses – Of the 991 patients using lethal self-medication, 762 (77%) recipients had cancer, 79 (8%) had amyotrophic lateral sclerosis, 44 (4.5%) had lung disease, 26 (2.6%) had heart disease, and 9 (0.9%) had HIV. 
  • Mental Health Screening – Of 991 patients, 52 (5.3%) were sent for psychiatric evaluation to assess competence. 
  • Race & Hospice – Most (953; 96.6%) patients were white and 92.2% were in hospice care. 
  • Insurance & Education – Most (118, 92.2%) patients had insurance and 92 (70.8%) had at least some college education. Most (94%) died at home. 
  • Duration – The estimated median time between medication intake and coma was 5 minutes (range, 1-38 minutes); to death it was 25 minutes (range, 1-6240 minutes). 
  • Complications – Thirty-three (3.3%) patients had known complications. 
  • Motivation – The most common reasons cited for desiring PAD were activities of daily living were not enjoyable (89.7%)

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Two Words Can Soothe Patients Who Have Been Harmed: We’re Sorry

When Donna Helen Crisp, a 59-year-old nursing professor, entered a North Carolina teaching hospital for a routine hysterectomy in 2007, she expected to come home the next day. Instead, Crisp spent weeks in a coma and underwent five surgeries to correct a near-fatal cascade of medical errors that left her with permanent injuries

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

How This Young Woman’s Tragic Night Out Changed Our View of Death

February 20, 2017

(New York Post) – On April 14, 1975, 21-year-old Karen Ann Quinlan partied with friends at a New Jersey bar, mixing gin and tranquilizers along the way. By the end of the night, she collapsed and fell into a permanent coma, igniting a firestorm that changed the way Americans looked at death. Quinlan sparked the right-to-die movement and came “to define modern death, more so than any other person in history,” according to the new book “Modern Death: How Medicine Changed the End of Life” by Dr. Haider Warraich.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Creative Minds: Interrogating a Master of Disguise

Monica Mugnier

When I volunteered several years ago as a physician in a small hospital in West Africa, one of the most frustrating and frightening diseases I saw was sleeping sickness. Now, an investigator supported by the NIH Common Fund aims to figure out how this disease pathogen manages to evade the human immune system.

Monica Mugnier’s fascination with parasites started in college when she picked up the book Parasite Rex, a riveting, firsthand account of how “sneaky” parasites can be. The next year, while studying abroad in England, Mugnier met a researcher who had studied one of the most devious of parasites—a protozoan, spread by blood-sucking tsetse flies, that causes sleeping sickness in humans and livestock across sub-Saharan Africa.

From her British colleague, Mugnier learned that after a tsetse fly infected with Trypanosoma brucei bites a person, the invading parasitic protozoans cloak themselves in a dense coat of molecules called glycoproteins. When the human immune system detects T. brucei, it marks the protozoans with antibodies that target them for destruction. However, T. brucei possesses the ability to evade such destruction by sweeping off the antibodies and disguising itself in a new set of glycoproteins. This immunological “cat and mouse” game can go on for years. Eventually, the parasite crosses the blood-brain barrier, triggering excessive sleep and life-threatening seizures and coma.

Using a gene-expression approach that she helped to adapt to T. brucei, Mugnier extrapolated that the parasite runs through the 2,000 or so genes that code for its glycoprotein disguises in a matter of months [1].

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

A Matter of Life and Death

Guest Post by Professor Lynn Turner-Stokes

Re: A matter of life and death – controversy at the interface between clinical and legal decision-making in prolonged disorders of consciousness

In an article published in the JME, I highlight the confusion that exists amongst many clinicians, lawyers and members of the public about decisions with withdraw life-sustaining treatments from patients in permanent vegetative and minimally conscious states.

Recent improvements in acute care for patient who have suffered catastrophic brain injury undoubtedly save lives. However, some patients who would otherwise have died now survive but remain profoundly disabled. Many patients experience a brief period of unconsciousness (or ‘coma’) lasting a few days or weeks. However, an unfortunate few with very severe brain injury remain in a vegetative and minimally conscious state (VS/MCS) for many months – or in some cases permanently.

Unfortunately the lay press, and even much of the medical literature, tends to conflate VS/MCS with coma, but they are in fact very different. Coma is a state of ‘unrousable unresponsiveness’ from which the patient cannot be awakened. It rarely persists for more than a few days or weeks, as the large majority of patients will either die or start to regain consciousness. Patients in VS or MCS are awake, but have either very limited awareness of themselves and their environment (MCS), or none at all (VS). With supportive treatment, many will live in these states for a decade or more.

Patients in VS/MCS are unable to make decisions regarding their care and treatment. The Mental Capacity Act 2005 (MCA) provides a framework for clinicians to make ‘best interests’ decisions for them, working with family members to take into account the patient’s own likely wishes, values and beliefs.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

BioethicsTV (January 2-6, 2017): Violating promises, coma v. PVS, transplant evaluation, and whether to abort

by Craig Klugman, Ph.D.

Pure Genius (Season1; Episode 10- 1/5). In this episode, Dr. Channarayapatra is working with a patient in lung failure. Due to exposure to toxins dumped in the ground beneath her neighborhood, the patient’s lung tissue is disintegrating. Bunker Hill hospital is attempting to build the world’s first implantable, artificial lung but has not had success. With her lung function decreasing, the patient may soon face one of two options: death or ECMO—a process where a machine oxygenates her blood outside of the body. The viewer is told that ECMO can only be used for a maximum of two weeks. The patient tells Channarayapatra in no uncertain terms that she does not want to be on ECMO. Channarayapatra promises that she will not put the patient on ECMO. However, when the crisis appears and the patient’s lungs fall apart, Dr. Channarayapatra goes back on her promise and begins ECMO.

There are three concerns with this scenario. First, a doctor should never make a promise to a patient that she or he cannot keep. Second, a doctor should keep promises made to patients. Third, if a competent and capacitated patient has clearly rejected an invasive medical treatment, then the patient’s right to refuse consent and to reject that intervention must be honored, even if it results in the patient’s death. Otherwise, the physician commits a battery by touching a patient without permission and also violates the patient’s autonomy.

Of course, this being a show where the ends always justify the means, an artificial lung is created and implanted in the patient (without any animal or preliminary human testing of course).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Ethics and law of stem cell treatment of diabetes

Many people support in various ways medical research, which they perceive as urgent in view of the needs of various patient groups. But patients typically won’t benefit from research unless the results are translated into development of medical products.

Type 1 diabetes is an incurable disease that requires daily life-sustaining treatment and strict dietary rules. Disease onset usually occurs at an early age.

In Sweden, about 50 000 people have this form of diabetes and of these around 8 000 are children. In type 1 diabetes, the immune system attacks the insulin-producing cells. Without insulin the body cells cannot use glucose for energy, and the sugar level in the blood rises. Energy is recovered instead from fat and protein, which causes waste products that can cause diabetic coma and attacks on vital organs.

Today, diabetes is treated with daily insulin injections, or by using an insulin pump. This requires continuous measurement of blood sugar levels, as incorrect doses of insulin entails risks and can be life-threatening. It is not easy to live with diabetes.

An alternative treatment, which is still at the research stage, is to generate new insulin-producing cells using human embryonic stem cells. The insulin-producing cells detect blood sugar levels and regulate the secretion of insulin. In order not to be attacked by the immune system, the transplanted cells are encapsulated in a protective material. It may become easier to live with diabetes.

But research alone doesn’t treat diabetes. Encapsulated insulin-producing cells need to be produced and made available also to patients; not only to research participants.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.