Tag: unconsciousness

Bioethics Blogs

Aid in Dying Court Appeal Comes to New York Court of Appeals May 30; Strong, Diverse and Growing Support in Amicus Briefs

The right of terminally ill, mentally competent adults to achieve a more peaceful death is at stake in Myers v. Schneiderman, now before the New York Court of Appeals, NY’s highest state court.  Oral arguments will be held in Albany on May 30.


The appeal seeks to reverse lower court decisions that dismissed the case prior to trial.  The case seeks to establish the right of terminally ill patients to receive a prescription for medication which they can self ingest to achieve a peaceful death if confronted by suffering they find unbearable.


Wide support for the plaintiffs is demonstrated by a multitude of amicus briefs submitted to the court by diverse parties representing patients and their loved ones, medical, religious and civil liberties organizations as well as national legal associations.  Two of these organizations are supporting the legalization of aid in dying as an amicus for the first time.


Kathryn Tucker, Executive Director of End of Life Liberty Project, and co-counsel in the case, said, “We are very pleased to see a large number of important voices joining us in seeking reversal of the lower court dismissal of the case. It is especially interesting to note the appearance of new voices not previously involved in aid in dying cases.”


Ms. Tucker noted, “Two new ‘friends’ of end of life liberty are stepping forward in Myers. For the first time in a case seeking to establish access to aid in dying, a state chapter of the National Academy of Elder Law Attorneys (NAELA) is participating as an amicus in support of patients and physicians.

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

Aid in Dying Court Appeal Comes to New York Court of Appeals May 30; Strong, Diverse and Growing Support in Amicus Briefs

The right of terminally ill, mentally competent adults to achieve a more peaceful death is at stake in Myers v. Schneiderman, now before the New York Court of Appeals, NY’s highest state court.  Oral arguments will be held in Albany on May 30.


The appeal seeks to reverse lower court decisions that dismissed the case prior to trial.  The case seeks to establish the right of terminally ill patients to receive a prescription for medication which they can self ingest to achieve a peaceful death if confronted by suffering they find unbearable.


Wide support for the plaintiffs is demonstrated by a multitude of amicus briefs submitted to the court by diverse parties representing patients and their loved ones, medical, religious and civil liberties organizations as well as national legal associations.  Two of these organizations are supporting the legalization of aid in dying as an amicus for the first time.


Kathryn Tucker, Executive Director of End of Life Liberty Project, and co-counsel in the case, said, “We are very pleased to see a large number of important voices joining us in seeking reversal of the lower court dismissal of the case. It is especially interesting to note the appearance of new voices not previously involved in aid in dying cases.”


Ms. Tucker noted, “Two new ‘friends’ of end of life liberty are stepping forward in Myers. For the first time in a case seeking to establish access to aid in dying, a state chapter of the National Academy of Elder Law Attorneys (NAELA) is participating as an amicus in support of patients and physicians.

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

An Accidental Expert

 

Guest Post: Derick Wade

Back to the Beside: Making Clinical Decisions in Patients with Prolongued Unconsciousness

In 1994, not long after the Bland judgement, I was telephoned one day by the office of the Official Solicitor. “Was I familiar with the vegetative state, and if so would I be prepared to see two people for them?”  I could reasonably honestly answer that I was familiar with it – one sees people left unconscious long after brain injury in my line of work.  I did not claim expertise, and nor was I asked.  I said “yes, to both questions.” and was sent relevant guidelines, and instructions.  With practice I improved, and I wrote my first article on the matter with one of the Official Solicitors, published in the BMJ.  I also saw one case who was definitely not vegetative (and two very well know experts had said that she was); the case has been written up with a ten year follow-up (not by me).

In about 2000, having seen about fifteen or more cases for the Official Solicitor and various NHS hospitals, the next chance event occurred.  Talking one evening with my family about my work, my elder daughter asked me what I thought about the ethics of withdrawing food and fluid.  I replied something like “Well, I have never really thought about it.” which horrified her, and surprised me (though research suggests that actually I am quite normal in that regard, as doctors usually consider matters clinically, not ethically).  Anyway, I decided to research the issue and wrote another article, which was also published in the BMJ. 

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

Law, Perception, and Cultural Cognition Near the End of Life

My colleague Kathy Cerminara has published the following article in the Washburn Law Review: “Law, Perception, and Cultural Cognition Near the End of Life.”  From the introduction:

In the
decade since Schiavo, neuroscience has developed in leaps and bounds, paving
the way to further questions about the “fact” of a VS diagnosis.
Neuroscientists have begun reporting success in using brain imagery to capture
the structure and function of the brains of patients with disorders of
consciousness, such as VS. 

Tools such as functional magnetic resonance imaging
(“fMRI”) and electroencephalograms (“EEGs”) suggest that the clinical
diagnostic criteria used to determine whether a patient is in a VS may be
flawed. Such flaws may result in some diagnoses that are arrived at correctly
yet are factually inaccurate, indicating that a patient is in a VS when he or
she is actually in a minimally conscious state (“MCS”).

Neurologist Dr. James Bernat
has noted, “[t]he public has become both fascinated by states of
unconsciousness and skeptical of the ability of clinicians to diagnose them
correctly, treat them properly, and issue prognoses accurately.”

This
skepticism opens up space for discussion into which we must proceed cautiously
because of the potential to read these studies as support for opinion in the
guise of fact. Ms. Schiavo’s brother, Bobby Schindler, for example, has
described fMRI techniques as demonstrating that “an ‘unscientific, inaccurate’
diagnosis of unresponsive patients [in VS] is being used as a ‘criterion to
kill.’” 

Yet, neuroscientists
themselves caution that their research is not advanced enough to accurately
describe such diagnoses as unscientific or inaccurate, even if public opinion
or social consensus favored the use of them “to kill.”

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

“Knockout” Head Injuries Linked to Parkinson’s, But Not Alzheimer’s

July 15, 2016

(Scientific American) – A large-scale analysis of three separate studies published this week in JAMA Neurology found no association between unconsciousness-causing traumatic brain injuries (TBI) and Alzheimer’s disease or general dementia—but it did find a strong association between TBI and Parkinson’s disease. “I can’t decide if the positive or negative findings are more surprising,” says one of the study’s investigators, physician and Alzheimer’s researcher Paul Crane at the University of Washington. The positive association his team found between Parkinson’s and TBI was not entirely novel, but Crane says the magnitude of the link was unexpected. The researchers found the risk of Parkinson’s rose threefold for people whose head injuries had caused them to go unconscious for more than an hour.

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

Special Issues! Biomedicalization in Brazil; Life after Biopolitics by Anna Zogas

April brings many special issues! We’ve already highlighted themed issues on insurance and digitized health, and here are two more themed issues to know about: this month’s História, Ciências, Saúde-Manguinhos is on The Biomedicalization of Brazilian Bodies: Anthropological Perspectives, and the current South Atlantic Quarterly is about Life After Biopolitics. Enjoy!

História, Ciências, Saúde-Manguinhos

The Biomedicalization of Brazilian Bodies: Anthropological Perspectives (open access)
Ilana Löwy, Emilia Sanabria

This special issue brings together work on the “biomedicalization” of Brazilian bodies, examining the way biomedical techniques are taken up across the divergent structural constraints afforded by private and public health in Brazil. Biomedicalization – or “technoscientific interventions in biomedical diagnostics, treatments, practices, and health to exert more and faster transformations of bodies, selves, and lives” – forms an assemblage that is both global and highly local. Our aim is to interrogate this phenomenon from Brazil.

The authors, writing from Brazil, Europe, and North America, share a long-standing commitment to analyzing the specific local biologies – and local politics – of Brazilian approaches to health and the body. They probe the incursion of biomedical technologies within richly depicted social worlds, revealing quotidian violence (particularly where women’s bodies are concerned), exceptional forms of care within conditions of precarity, and the intersections of kinship, class, work, and the symbolic capital afforded by biomedical consumption in Brazil. They share a commitment to critically engaging with biomedical conceptions of disease and illness, destabilizing the body as a stable referent (implicitly grounded in a biomedical ontology), analyzing health as a deeply relational, situated, and political process.

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

Why defining death leaves me cold

by John Banja, PhD

*Editor’s note: In case you missed our annual Zombies and Zombethics (TM) Symposium entitled Really, Most Sincerely Dead. Zombies, Vampires and Ghosts. Oh my! you can watch our opening keynote by Dr. Paul Root Wolpe by clicking on the image below. We recommend starting at 9:54 min.


Two weeks ago, I attended a panel session on brain death at the annual conference of the American Society for Bioethics and Humanities. Forgive the bad pun, but the experience left me cold and …lifeless(?). The panel consisted of three scholars revisiting the more than a decade old conversation on defining death. Despite a standing room only crowd, there was utterly nothing new. Rather, we heard a recitation of the very familiar categories that have historically figured in the “What does it mean to be dead?” debate, e.g., the irreversible cessation of cardio-respiratory activity, the Harvard Brain Death criteria, the somatic integration account, the 2008 Presidential Commission’s “loss of the drive to breathe,” and so on. I walked out thinking that we could come back next year, and the year after that, and the year after that and get no closer to resolving what it means to be dead.

Dr. Banja in his natural habitat.

I’d suggest that the reason for this failure is the stubborn persistence of scholars to mistake a social practice, i.e., defining death, for a metaphysical event. Philosophers who insist on keeping the “defining death” conversation alive are invariably moral realists: They mistakenly believe that death is an objectively discernible, universally distributed, a priori, naturally occurring phenomenon that philosophical reasoning and analysis can divine.

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

Flibanserin and Feminism

Adriane Fugh-Berman and Alessandra Hirsch consider the sexist roots and implications of flibanserin.

__________________________________________

On August 18th, 2015, the U.S. Food and Drug Administration (FDA) approved Sprout Pharmaceuticals’ flibanserin (brand name Addyi), commonly called “female Viagra.” Flibanserin had previously failed to achieve FDA approval for “Hypoactive Sexual Desire Disorder” on two separate occasions. The third time was the charm. Less than 48 hours after approval, Valeant Pharmaceuticals International, Canada’s largest company by market value, acquired Sprout for one billion dollars.

This may be the first drug approved through a public relations campaign. The FDA had rejected flibanserin in 2010 and 2013, because the purported benefits of this libido-boosting drug did not outweigh the substantial risks. At an FDA Advisory Committee meeting in June 2015, no new data on benefits were presented, but new data on risks raised serious concerns about sudden prolonged unconsciousness and serious interactions with drugs and alcohol. Given these new data, what convinced a government regulatory body to approve this drug?

The answer is: A brilliant, misleading public relations campaign by Sprout Pharmaceuticals and its public relations firm, Blue Engine Message and Media. “Even the Score” accused the FDA of sexism by claiming that there are 26 FDA-approved sexual dysfunction drugs for men and zero for women. In fact, the FDA has approved eight drugs for sexual dysfunction in men and three for women – and (until now) had never approved a single libido-boosting drug for either men or women.

How feminist is the company?

Sprout’s entire board of directors is male except for Cindy Whitehead, who replaced her husband as CEO several months ago (perhaps because the company realized it had a credibility problem crying sexism with only men in charge).

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

How should a Catholic hospice respond to patients who choose to voluntarily stop eating and drinking in order to hasten death?

The Linacre Quarterly is the official publication of the Catholic Medical Association (distinct from the larger Catholic Health Association).

In a recent issue, Maureen Cavanagh published “How should a Catholic hospice respond to patients who choose to voluntarily stop eating and drinking in order to hasten death?”  Cavanagh is Manager of Ethics Services for St. Peter’s Health Partners in Albany, New York.

This is her abstract:  ”The practice if voluntarily stopping eating and drinking (VSED) in order to hasten death poses a unique problem for the Catholic hospice. Hospice staff may be confronted with patients already on their service who decide to pursue this option for ending their lives. Patients not on hospice service who are contemplating VSED are often advised to contact hospice for symptom palliation associated with the process if VSED.”

“Intentionally hastening death not only violates the sanctity if human lift and the Ethical and Religious Directives the Catholic hospice is bound to uphold. but it also runs counter to the general philosophy that hospice neither hastens nor postpones death. At the same time, hospice programs have a strong philosophy of non-abandonment of patients. This article will analyze the ethical issues from the perspective of the Catholic tradition and suggest strategies for the Catholic hospice to respond to this group if patients.”

Stanley Terman shared his response to Cavanagh’s article:  ”The author’s position is clear: Life always has value and the intent to die is always wrong. Voluntarily stopping eating and drinking to hasten dying thus violates Catholic principles. It also violates the stated philosophy of hospice—to neither hasten nor postpone death.”

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.