Skip to comments.Brain-damaged woman must be given 'wake-up' pill, orders judge
Posted on 11/20/2006 1:49:59 PM PST by presidio9
A judge has rejected a family's plea that a 53-year-old woman in a vegetative state should be allowed to die.
He has ordered instead that she should be given a drug that could wake her up.
Theoretically the patient could then spend the rest of her life severely disabled and aware of her condition.
Sir Mark Potter, president of the High Court Family Division, says the woman should be given zolpidem, a common sleeping pill.
It has been used before on victims of severe brain damage who have then regained consciousness.
The woman, who cannot be named, suffered a massive brain haemorrhage on holiday in August 2003 and has been diagnosed as in a persistent vegetative state.
Sir Mark ruled that doctors should try giving her the drug before a final decision has to be made on whether to stop giving her food and water artificially, and let her die.
His decision was supported by the Official Solicitor Laurence Oates who represents PVS patients when their families seek permission to allow them to die.
A spokesman said Mr Oates, who has now retired, thought the woman should be given zolpidem to test if she could 'wake up.'
He said: "It was a very difficult case, but Mr Oates believed that before anyone is allowed to die every test possible should be carried out."
Sir Mark is believed to have also heard evidence from experts who look after severely brain-damaged patients.
It is the first time a ruling has been made to keep a PVS patient alive in order to use the drug. The case follows new Government guidelines, revealed by the Daily Mail on Saturday, which tell doctors they risk being put on trial for assault if they refuse to allow patients who have made 'living wills' to die.
The Lord Chancellor told the medical profession that those who do not follow the wills could face jail or big compensation claims in the court.
In a guide to Labour's Mental Capacity Act, which comes into operation next spring, Lord Falconer said living wills must be enforced. PVS patients are described as 'awake but not aware'. Unlike patients in a coma their eyes are open but they see nothing and are not conscious of their surroundings.
They breathe normally but have no swallowing reflex and have to be kept alive by artificial feeding and hydration.
In 1993 the courts sanctioned the withdrawal of feeding from Tony Bland, a 21-year-old brain-damaged survivor of the Hillsborough football ground disaster.
The case went to the House of Lords where law lords ruled it was in his best interests to be allowed to die and said doctors could lawfully stop artificial feeding because they would not be killing him, but withdrawing treatment.
Since then the High Court has sanctioned the withdrawal of food and drink from dozens of PVS patients when doctors, families and the Official Solicitor have agreed that death was in the patient's best interests.
The case of Terri Schiavo, whose husband fought a seven-year battle in Florida before she was allowed to die last year, heightened the debate in the U.S.
THE NEW LEASE OF LIFE DRUG Zolpidem has been used in South Africa with amazing results. One recipient is 32-year-old Miss X, who cannot be named for legal reasons. She suffered four cardiac arrests and hypoxia - a lack of oxygen to the brain - after contracting septicaemia four years ago.
Without the pill, she can barely stand, her arms are in spasm and she cannot speak, although her intelligence has not been affected. But after being given a dose of the drug she can stand up, stretch to her full height and clap her hands.
The left side of her face is no longer drooping and her eyes sparkle. She smiles broadly and can even use a keyboard to communicate with people, telling them how she now hopes to speak again.
Aware doesn't necessarily mean communicative. There's a huge difference.
Look where Kennedy woke up.
If I were a judge, and a family said "Potential treatment? One that will show beyond doubt whehter she's really gone or not? No thanks, we'll just starve her," I'd be mighty suspicious.
Generally, if one of these cases is in court it's because there's some doubt what the person wanted.
No, refusing treatment is not euthanasia or anything remotely like it. The two should not be confused, even to make a point.
Certainly you should have that person's permission before you put them in that situation but I dont agree you shouldnt do it. Someone has to be able to make a decision, the one you pick should be capable of doing it .Once you know how the victim feels it should cause no lasting remorse to accede to their will.
Because life has been cheapened selectively. Some of these posts I've read... really disturb my heart. It used to be in the medical profession we would preserve life....no matter what the cost. Otherwise, why would we have spent so many billions on research......trying to find cures?
Those who advocate "food and water" as a treatment...wanting it removed to extinguish those who are inconvenient, probably squeal to high heaven themselves.... if made to miss their lunch by an hour or two.
Yeah, but you'll never see me protesting outside of your hospital room. I'm scared to death I might see you outside mine.
According to who? Where did you read that? Can you support that idiotic statement?
The "P" stands for "Persistent". By definition, they have no chance of recovery.
Are you an authority?
According to who? Where did you read this? This article makes no reference to what you're describing.
It is a fact. It is the definition of PVS. The "P" stands for "Persistent".
"... but sometimes, yes, sometimes, they do."
They never, no, never, do. If the patient regains consciousness, then they weren't PVS.
"I'm scared to death I might see you outside mine."
Probably not. I support the judges' decision in this case. PVS is not the same thing as brain dead. Brain dead is just that, NO brain activity. In PVS patients, EEG's show a high level of brain activity. BIG difference.
Then they were misdiagnosed as PVS.
"When food and water is defined as "artificial life support"; so that it can be withheld from PVS patients"
No one is saying it must be withheld. Do you have a problem calling a ventilator "artificial life support"? Do you think people call a ventilator "artificial life support" so it can be withheld?
"is one of the most frightening thing"
What's frightening is that you would be willing to watch 10 curable people die for lack of resources that a severly brain damaged PVS patient is using. And you'd feel noble about it.
No. But if you continue to misrepresent what I said, I might change my answer.
Make sure that's in your Living Will. You have every right to demand that your family bear the emotional and financial burden of taking care of your severely brain damaged body as long as science allows.
This is about you. Remember that.
How about that? WIKI confirmed what I said. That makes me look like an authority, now doesn't it?
Not in the consciousness area. That portion of the brain IS dead.
Ah, I see. You think that "vegetative state" and "persistent vegetative state" mean the same thing.
Not that we easily allow a misdiagnosis of any other illness.
I am saying that, by definition, PVS is permanent. If it's not permanent, then it's not PVS. It's something else.
I simply fear that the euthanazia mindset inevitably proceeds from right-to-die, to duty-to-die, and I don't think that's right. You make good points though. And I went through this with my mother, that's why it's personal to me.
Interesting post and discussion.
Will that be regular or drip grind, sir? "
And that sometimes even strongly held opinion changes as result of experience - my MIL, who eventually declined months or years of what seemed to be a reasonable quality of life started the process in a keep me alive no matter what frame of mind, and I'm sure there are plenty of examples of people who went the other way.
There's a form I got a while back on the net thats instructive in this regard, it has a list of mental states You have been declared brain dead, You are conscious but can no longer recognize your loved ones; and so on across the top, and a list of medical interventions You have gangrene, and you foot must be amputated or you will die, You must be placed on a ventilator or die, but it may be possible to remove it later across the top.
You check a box at each intersection to elect or decline treatment.
This really helps to remove such questions from the theoretical and place them in a real world context: If I have dementia and I can no longer recognize my loved ones, and I get pneumonia, do I what aggressive treatment, or just palliative care?
IMO a lot of difficulty for ourselves, our decision makers, and medical professions - would be avoided if we all had advance directives based on this sort of decision making process.
Sorry to hear about you mother - my wife and I have been through three of these, both in-laws and my father, and it's never easy.
See above, posted to myself by mistake.
"Declining it's continued use, for myself, if the improvement effected was only from a "vegetative state" to a "cognitively severely disabled state", and declining its use entirely if such improvement was then likely to be used as a justification to keep me alive in such a state."
Yup...I agree 100%.
You're trying to use logic and reason. That doesn't work on pro-life fanatics. They use a different rule book.
I agree with you. There is no point in keeping someone's body alive if the "person" inside is gone. Why have an empty shell take up valuable resources that could be used to actually save a life?
With regards to the "Nazi" picture...we're not talking about killing retarded people, we are talking about letting someone who is essentially already dead finish the dying process.
"That portion of the brain IS dead."
And your authority to state that is?
"A brain-dead individual has no electrical activity and no clinical evidence of brain function on physical examination (no response to pain, absent cranial nerve reflexes (pupillary response (fixed pupils), oculocephalic reflex, corneal reflexes), absent response to the caloric reflex test and no spontaneous respirations). It is important to distinguish between brain death and states that mimic brain death (eg. barbiturate intoxication, alcohol intoxication, sedative overdose, hypothermia, hypoglycemia, coma or chronic vegetative states). Some comatose patients can recover, and some patients with severe irreversible neurologic dysfunction will nonetheless retain some lower brain functions such as spontaneous respiration, loss of both cortex and brainstem function. Thus anencephaly, in which there is no higher brain present, is generally not considered brain death, although it is certainly an irreversible condition in which it may be appropriate to withdraw life support."
From post 70:
RP: Neither will recover. Both are on artificial life support. Neither has consciousness or ever will again.
OFF: This is your opinion. It is not fact.
If it were fact, then patients in a PVS would never regain consciousness, but sometimes, yes, sometimes, they do. You've made a blanket statement and try to apply it to all cases.
Now here is the response (115):
OFF: "If it were fact"
RP: It is a fact. It is the definition of PVS. The "P" stands for "Persistent".
OFF: "... but sometimes, yes, sometimes, they do."
RP: They never, no, never, do. If the patient regains consciousness, then they weren't PVS.
It sounds like you believe that ALL patients who are diagnosed as PVS must be in an irreversible condition based on the definition. Yet, you concede that "if the patient regains consciousness, then they weren't PVS." In other words, you rightly conclude that sometimes doctors DO misdiagnose this condition.
What is being discussed (IMHO) are the pros and cons to administering a drug to a patient that might help determine whether this patient is truly in an IRREVERSIBLE condition. Up until this discovery, there was little hope that these patients could be reversed. Legally, there appears to be a boundary on whether or not it is ethical to allow someone to die by withholding treatment if the condition can be reversed (which would also mean that the patient had been misdiagnosed).
Furthermore, in post 129 you argue that PVS is permanent, yet in your earlier post 115 you say that the "P" stands for persistent. Which is it? Permanent and persistent are two words that could be synonyms, but in truth, there is a matter of degree in definition. "Permanent" does mean irreversible, yet "persistent" has a bit of the unknown about its reversibility. There is a quality about the word "persistent" that indicates a description of the condition up to a certain point, but does not with complete certainty indicate what the future of the conditions holds.
It is my understanding that this condition (PVS) first was called "persistent" and then over time, "permanent" became introduced into the diagnosis. I believe this was a purposeful move by pro-euthanasia movement, with the support of doctors like Dr. Ronald Cranford and other "bio-ethicists". IMHO, because the diagnosis can (now) result in the loss of life, whether or not the patient would want that, it is a diagnosis that needs to be looked at (and revised) quite urgently. Otherwise, there should not be such a rush to discontinue "erring on the side of life", which is the way society has handled questions like this for quite some time.
So, I assume based upon what you wrote that you pro-abortion because the family knows better than the rest of us what is best for the baby and that this should actually be the conservative view of such matters.
And you also believe that estranged adulterous spouses should have preference over blood relations.
"There is actually a SANE JUDGE out there (unfortunately, he's in England)!"
I still don't like the idea of any judge of any kind being the one who has to decide cases like this.
Judges are not doctors.
Starvation/dehydration should never be used....period.
pvs is not well understood, and is misdiagnosed over 40% of the time.
These people are brain-damaged, not brain dead.
If they don't meet the criteria for brain death, they should not have to suffer dehydration.
I don't like judges being involved either, but if they must be, I would far prefer that it be a judge who prefers to give medicine a chance rather than inhumanely killing someone off.
"I don't like judges being involved either, but if they must be, I would far prefer that it be a judge who prefers to give medicine a chance rather than inhumanely killing someone off."
It is preferable...but it never should have gotten to the courtroom
It is the medical community who should understand that pvs is not a rock solid diagnosis. The medical community should understand there is no way to truly test a person's self awareness.
So their claims to a "peaceful" death through dehydration are just wishful thinking.
Dehydration should not be allowed.
Terminal patients who truly are dying will naturally refuse food and water at the end of their life...but to actively dehydrate someone who is not dying is murder.
Thank you, sir.
Yeah, paralyzed people don't really want to live, or be professors of physics and mathematics at Cambridge or anything. :p
"Have the lawyers hijacked the word?"
You could say so. It's legal to abort a " fetus" -- it's illegal to kill a "baby". A lot hinges on the semantics in this case.
I haven't heard of that. I have heard of minimally conscious state (MCS) but not MPVS. What is that?