Tag: sedatives

Bioethics News

1 in 6 Americans Takes a Psychiatric Drug

December 13, 2016

(Scientific American) – Moore and Mattison found that nearly 17 percent of adults in the U.S. reported filling at least one prescription for a psychiatric drug in 2013. Antidepressants were the most common type of psychiatric drug in the survey, with 12 percent of adults reporting that they filled prescriptions for these drugs, the study said. In addition, 8.3 percent of adults were prescribed drugs from a group that included sedatives, hypnotics and anti-anxiety drugs, and 1.6 percent of adults were given antipsychotics, the researchers found.

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

Prevalence of self-harm reflects our social isolation by Chris Millard

Since the late 1980s growing numbers of mental health professionals and media commentators in Britain and the USA have been concerned with a behaviour labelled as ‘self-harm’, ‘deliberate self-harm’ or ‘self-injury’. It is often seen as a secret or hidden practice, and it is almost always ‘on the rise’, especially among adolescent females. Most commonly it refers to self-cutting or self-burning, performed in order to relieve intolerable emotional tension or numbness.

In contrast, during the 1960s and ‘70s, the term ‘self-harm’ generally referred to somebody ‘crying for help’ by taking an overdose (self-poisoning). Now, it predominantly means regulating emotional tension by self-cutting or -burning. The ratio of cutting to overdosing in hospital statistics hasn’t changed very much, remaining around eight or nine to one in favour of self-poisoners. Why, in such a short space of time, have popular self-harm stereotypes shifted so dramatically?

The first thing to acknowledge in the face of this shift is that self-harm hasn’t always meant what we think it means. In the very recent past in Britain, ‘self-harm’ did not conjure up images of blood and cutting, but medication and overdosing. The ways in which we understand self-harm are both relatively recent and incredibly narrow.

This goes against some ideas of self-harm as timeless and almost mystical, which link it to religious self-flagellation, bloodletting, and even Tibetan tantric practices and the Passion of Christ – all of which focus on, or involve bleeding.

The term ‘deliberate self-harm’ was proposed in 1975 (as a new label) at a hospital in Bristol. It was used to describe a group of patients where 92 per cent had poisoned themselves (mostly with prescription or over the counter medication).

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

Disability and dungeons in Philadelphia

Linda Watson   

Here’s another reminder – if you needed one — that caring for people with disabilities requires constant vigilance. Especially if they have no family ties, too often they are invisible to the government systems which are meant to protect them.

This sordid story comes from Philadelphia. Linda Weston was sentenced this week to life imprisonment for murder in aid of racketeering, kidnapping, sex trafficking and involuntary servitude. She and her associates imprisoned several disabled persons in dungeons in basements, attics and closets so that they could collect their disability cheques. The people were kept in the dark, starved, beaten and prostituted. Their food was laced with sedatives to keep them quiet. When food ran low, they had to eat human waste. Two of the victims died. This went on for ten years before some of the victims were discovered in 2011.

“Her future years in federal prison will be paradise compared to the conditions she imposed on her victims,” the sentencing judge said.

Amongst the many disturbing aspect of this story is that Linda Weston had served already served time for a similar crime. In 1981 Weston was sentenced to eight years in prison for starving a man to death after he refused to support Weston’s sister’s unborn child.

 Philadelphia was not the only city where her small gang operated. There were also dungeons in Killeen, Texas, Norfolk, Virginia, and West Palm Beach, Florida.

The group targeted mentally challenged individuals who were estranged from their families. Once they moved in, Weston became their representative payee with Social Security and began to receive their disability benefits and in some instances, their state benefits. 

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

Nonconsensual withdrawal of nutrition and hydration in prolonged disorders of consciousness: authoritarianism and trustworthiness in medicine

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness (PDOC) in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration (CANH). This withdrawal is deemed necessary because patients in PDOC can survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests.

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

Relaxed about dying?

“Now we must wait, wait. These hours…. The gurgling starts again — but how slowly a man dies! …By noon I am groping on the outer limits of reason. …every gasp lays my heart bare.” Erich Maria Remarque, All Quiet on the Western Front

In Remarque’s novel, the agony of the German soldier, witnessing the slow death of an enemy combatant, is heightened by his own guilt (the narrator had stabbed another soldier in self defense). However, his powerful evocation of distress (and guilt) at witnessing a slow dying is very close to the expressed concerns of parents and clinicians who are watching the death of a child.

In such circumstances would it be ethical for doctors to give drugs to stop a child’s gasping breathing?

New Dutch guidelines, described recently in the journal Pediatrics, specifically permit this option. In the Netherlands, in this situation, doctors will sometimes give the child a “muscle relaxant”. These are drugs that paralyse the child’s muscles. They stop the child’s breathing, consequently ending the child’s gasping, but also ending their life.

Why would such steps be needed? To understand this it might be helpful to describe what happens when someone (child or adult) dies.

When a child is in the last phase of dying, they lapse into unconsciousness. Their breathing often becomes irregular. They sometimes stop breathing and then start again after a long pause. Often children start to take deep, infrequent “gasps” that gradually become further and further apart, before stopping completely.  Such gasps are thought to be a basic (subconscious) reflex, arising deep in the brain-stem.

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.