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Brain-damaged woman must be given 'wake-up' pill, orders judge
Daily Mail ^ | 11/20/06 | LUCY BALLINGER

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.


TOPICS: Constitution/Conservatism; Extended News; Miscellaneous; United Kingdom
KEYWORDS: ambien; awakenings; moralabsolutes; terrischiavo; zolpidem
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To: CindyDawg

Aware doesn't necessarily mean communicative. There's a huge difference.


101 posted on 11/20/2006 11:20:13 PM PST by ReignOfError
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To: GourmetDan
She can always make her own choice to die of thirst and starvation, but at least it's her decision and not yours. But that's kind of the point, eh?

Direct hit!

102 posted on 11/20/2006 11:20:40 PM PST by Mr. Silverback (Welcome Freepers! Pull up a groove and get fabulous!)
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To: Tennessee_Bob

Look where Kennedy woke up.


103 posted on 11/20/2006 11:25:30 PM PST by azhenfud (The fool hath said in his heart, There is no God.)
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To: billbears

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.


104 posted on 11/20/2006 11:26:02 PM PST by Mr. Silverback (Welcome Freepers! Pull up a groove and get fabulous!)
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To: Drango
Does anyone care what the 53-year-old woman wants done? This is her call and as she cannot speak, her spouse if she has one makes the call...then her family. The courts, the church, the rabble on FR should have no say.

Generally, if one of these cases is in court it's because there's some doubt what the person wanted.

105 posted on 11/20/2006 11:36:43 PM PST by Mr. Silverback (Welcome Freepers! Pull up a groove and get fabulous!)
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To: M. Dodge Thomas
She chose not to, and essentially "euthanasized" herself.

No, refusing treatment is not euthanasia or anything remotely like it. The two should not be confused, even to make a point.

106 posted on 11/20/2006 11:44:26 PM PST by Mr. Silverback (Welcome Freepers! Pull up a groove and get fabulous!)
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To: wagglebee; presidio9
Pinged from Terri NOVEMBER Dailies

8mm


107 posted on 11/21/2006 2:58:36 AM PST by 8mmMauser ("We will not be silent. We are your bad conscience. The White Rose will give you no rest.")
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To: ichabod1

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.


108 posted on 11/21/2006 4:09:34 AM PST by sgtbono2002 (The fourth estate is a fifth column.)
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To: Onelifetogive
Why is it if a baby is "allowed to die" of starvation or dehydration, society is outraged (unless doctors help, of course - Baby Doe), but allow a comatose person to starve, you're a hero?

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.

109 posted on 11/21/2006 4:32:44 AM PST by LaineyDee (Don't mess with Texas wimmen!)
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To: swmobuffalo
"I am sincerely glad I'm not related to you and you have no chance of ever being involved in a life changing decision that would pertain to me."

Yeah, but you'll never see me protesting outside of your hospital room. I'm scared to death I might see you outside mine.

110 posted on 11/21/2006 5:23:13 AM PST by robertpaulsen
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To: swmobuffalo
"PVS patients have a chance at recovery."

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.

111 posted on 11/21/2006 5:26:37 AM PST by robertpaulsen
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To: bjs1779
Godwin's Law lives!
112 posted on 11/21/2006 5:28:09 AM PST by robertpaulsen
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To: robertpaulsen
From wikipedia: Some authorities insist that PVS is an irreversible condition and therefore conclude that these recoveries involve cases in which there was not truly PVS.

Are you an authority?

113 posted on 11/21/2006 5:28:26 AM PST by palmer (Money problems do not come from a lack of money, but from living an excessive, unrealistic lifestyle)
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To: Ohioan from Florida
"Ambien has been given to PVS patients, and its administration is bringing about the return to awareness that is being described with some degree of success."

According to who? Where did you read this? This article makes no reference to what you're describing.

114 posted on 11/21/2006 5:30:59 AM PST by robertpaulsen
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To: Ohioan from Florida
"If it were fact"

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.

115 posted on 11/21/2006 5:35:00 AM PST by robertpaulsen
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To: robertpaulsen

"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.


116 posted on 11/21/2006 5:38:31 AM PST by swmobuffalo (The only good terrorist is a dead terrorist.)
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To: USFRIENDINVICTORIA
"Several PVS patients have already recovered."

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.

117 posted on 11/21/2006 5:44:41 AM PST by robertpaulsen
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To: robertpaulsen
According to who? Where did you read this? This article makes no reference to what you're describing.

Ambien is a trade name of zolpidem. The article talks about zolpidem being administered to people in vegitative states to "wake them up". What was your question, exactly?
118 posted on 11/21/2006 5:45:14 AM PST by beezdotcom
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To: greccogirl
"Since I cannot feed myself, should then I be "allowed" to die?"

No. But if you continue to misrepresent what I said, I might change my answer.

Cool it.

119 posted on 11/21/2006 5:47:31 AM PST by robertpaulsen
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To: robertpaulsen
Then they were misdiagnosed as PVS.

Agreed. However, if this issue accomplishes nothing else, it may convince people to not so easily allow a misdiagnosis of PVS.
120 posted on 11/21/2006 5:51:33 AM PST by beezdotcom
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To: ReignOfError

okkkkkkkk


121 posted on 11/21/2006 5:51:50 AM PST by CindyDawg
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To: ichabod1
"I want all possible treatment to save my life if I'm injured."

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.

122 posted on 11/21/2006 5:52:13 AM PST by robertpaulsen
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To: palmer
"Are you an authority?"

How about that? WIKI confirmed what I said. That makes me look like an authority, now doesn't it?

123 posted on 11/21/2006 5:56:34 AM PST by robertpaulsen
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To: robertpaulsen
No, it says some authorities insist PVS is permanent. Are you one of those authorities?
124 posted on 11/21/2006 5:59:13 AM PST by palmer (Money problems do not come from a lack of money, but from living an excessive, unrealistic lifestyle)
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To: swmobuffalo
"In PVS patients, EEG's show a high level of brain activity."

Not in the consciousness area. That portion of the brain IS dead.

125 posted on 11/21/2006 5:59:40 AM PST by robertpaulsen
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To: robertpaulsen

No


126 posted on 11/21/2006 6:00:50 AM PST by CindyDawg
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To: beezdotcom
"The article talks about zolpidem being administered to people in vegitative states to "wake them up"."

Ah, I see. You think that "vegetative state" and "persistent vegetative state" mean the same thing.

127 posted on 11/21/2006 6:02:01 AM PST by robertpaulsen
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To: beezdotcom
"it may convince people to not so easily allow a misdiagnosis of PVS."

Not that we easily allow a misdiagnosis of any other illness.

128 posted on 11/21/2006 6:04:36 AM PST by robertpaulsen
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To: palmer

I am saying that, by definition, PVS is permanent. If it's not permanent, then it's not PVS. It's something else.


129 posted on 11/21/2006 6:06:50 AM PST by robertpaulsen
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To: robertpaulsen
Permanence in PVS is only by the insistence of some authorities. Obviously others disagree. Are you an authority or do you have some other justification your belief?
130 posted on 11/21/2006 6:09:25 AM PST by palmer (Money problems do not come from a lack of money, but from living an excessive, unrealistic lifestyle)
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To: robertpaulsen
Not that we easily allow a misdiagnosis of any other illness.

I'm sure that you know this happens all the time, with both major and minor illnesses. Otherwise, who would ever bother with "a second opinion"?

PVS (and yes, I *DO* know the difference with and without the 'P') is just one of those conditions where the patient has little inclination or ability to question a possible misdiagnosis. Therefore, it's up to the family to assume that role; some families are just better equipped than others to do this.
131 posted on 11/21/2006 6:13:07 AM PST by beezdotcom
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To: robertpaulsen
I am saying that, by definition, PVS is permanent. If it's not permanent, then it's not PVS. It's something else.

Yes, it's MPVS...a condition that seems to be on the rise, but the increasing numbers probably just reflects less willingness on the part of people to accept the original diagnosis of PVS...
132 posted on 11/21/2006 6:17:55 AM PST by beezdotcom
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To: M. Dodge Thomas

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.


133 posted on 11/21/2006 7:16:18 AM PST by ichabod1 (Democracy = Anarchy)
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To: presidio9

Interesting post and discussion.

life


134 posted on 11/21/2006 7:16:27 AM PST by PGalt
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To: Dallas59
"One Kilo of Zolpidem coming up.

Will that be regular or drip grind, sir? "

135 posted on 11/21/2006 7:30:04 AM PST by Erasmus (I finally figured out that my life has a purpose--as a cautionary example to others.)
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To: M. Dodge Thomas
One of the things which always strikes me is that you can find individuals and families (and medical professionals) who have gone through these experiences and reached quite different conclusions.

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 that’s 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.

136 posted on 11/21/2006 8:21:52 AM PST by M. Dodge Thomas
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To: ichabod1
And I went through this with my mother, that's why it's personal to me.

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.

137 posted on 11/21/2006 8:34:22 AM PST by M. Dodge Thomas
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To: M. Dodge Thomas

"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%.


138 posted on 11/21/2006 8:36:18 AM PST by TampaDude (If you're not part of the solution, you're part of the PROBLEM!!!)
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To: robertpaulsen

Robert,

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.


139 posted on 11/21/2006 8:48:22 AM PST by TampaDude (If you're not part of the solution, you're part of the PROBLEM!!!)
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To: robertpaulsen

"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."

http://en.wikipedia.org/wiki/Brain_death


140 posted on 11/21/2006 10:11:47 AM PST by swmobuffalo (The only good terrorist is a dead terrorist.)
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To: robertpaulsen
Just so we don't get confused on who said what and when, I am providing the relevant posts in their entirety.

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.

141 posted on 11/21/2006 10:12:59 AM PST by Ohioan from Florida (The only thing necessary for the triumph of evil is for good men to do nothing.- Edmund Burke)
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To: billbears

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.


142 posted on 11/21/2006 10:19:40 AM PST by wagglebee ("We are ready for the greatest achievements in the history of freedom." -- President Bush, 1/20/05)
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To: wagglebee

"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.


143 posted on 11/21/2006 10:24:57 AM PST by Scotswife
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To: Scotswife

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.


144 posted on 11/21/2006 10:27:19 AM PST by wagglebee ("We are ready for the greatest achievements in the history of freedom." -- President Bush, 1/20/05)
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To: wagglebee

"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.


145 posted on 11/21/2006 10:37:28 AM PST by Scotswife
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To: M. Dodge Thomas

Thank you, sir.


146 posted on 11/21/2006 10:55:45 AM PST by ichabod1 (Democracy = Anarchy)
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To: pabianice

Yeah, paralyzed people don't really want to live, or be professors of physics and mathematics at Cambridge or anything. :p


147 posted on 11/21/2006 11:03:55 AM PST by Constantine XIII
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To: scrabblehack

"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.


148 posted on 11/21/2006 12:00:27 PM PST by USFRIENDINVICTORIA
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To: beezdotcom
"Yes, it's MPVS..."

I haven't heard of that. I have heard of minimally conscious state (MCS) but not MPVS. What is that?

149 posted on 11/21/2006 1:12:52 PM PST by robertpaulsen
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To: robertpaulsen
"Then they were misdiagnosed as PVS."

The condition is called "persistent", not "permanent" for a reason -- the reason being that no one is certain that it is permanent.

Even if your definition of PVS were correct; so that a person with PVS cannot ever recover -- so what? The issue here is whether or not the woman should be administered a pill, which might wake her up. If it works, then it's obvious that her condition (whatever it was) was not permanent.

"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?"

Actually, someone is demanding that the food and water be withheld -- otherwise there wouldn't be a court case. If you think food and water are "artificial life support"; please tell us all who should be kept on this life support and who should be taken off?

"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."

You're twisting things again -- the name of the logical fallacy you're using is: "begging the question". The question is: "is this patient capable of any recovery?". You have simply assumed that the answer is "no"; then you jump from that conclusion to red herrings about curable people dying from lack of support.

If she gets the pill and recovers -- then she'll stop being a burden on the health care system.

If she gets the pill and doesn't recover -- the system is out the cost of one pill.

I don't feel "noble" about this. It's a complicated issue. Utilitarianism is helpful -- but, insufficient to make any moral or ethical judgments. No matter what philosophies you chose to bring to bear -- you first need to start from a basis of facts, consistent definitions, and simple logic.
150 posted on 11/21/2006 1:12:54 PM PST by USFRIENDINVICTORIA
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