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

Misdiagnosis of Permanent Vegetative State. A little too tongue-in-cheek, perhaps...
151 posted on 11/21/2006 1:19:35 PM PST by beezdotcom
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To: USFRIENDINVICTORIA
"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?"

You first -- if you think a ventilator is "artificial life support", please tell us all who should be kept on this life support and who should be taken off?

152 posted on 11/21/2006 1:30:41 PM PST by robertpaulsen
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To: Ohioan from Florida

Someday I'll get over it : )


153 posted on 11/21/2006 4:34:43 PM PST by bjs1779
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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.

That's not such a bad idea. i would think most living wills would accommodate that - i.e., try anything as long as there's a chance of near full recovery. if no chance, then no heroic measures. I wouldn't consider Ambien a particularly heroic or expensive measure, however.

And Flowers for Algernon/Charlie are the best illustration I've seen thus far of what this phenomenon entails.

154 posted on 11/21/2006 4:44:29 PM PST by Spyder
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To: robertpaulsen
"You first -- if you think a ventilator is "artificial life support", please tell us all who should be kept on this life support and who should be taken off?"

Yes -- if the person is brain dead. Dead people should be taken off (subject to their clearly stated will for such eventualities).

Now -- are food and water "artificial life support? Is withholding food and water until someone dies the same as "letting them die" -- or is it more like killing them? Who would you deny food and water to?
155 posted on 11/21/2006 4:46:20 PM PST by USFRIENDINVICTORIA
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To: USFRIENDINVICTORIA
"Now -- are food and water "artificial life support?"

Yes, if given by a surgically implanted feeding tube.

"Is withholding food and water until someone dies the same as "letting them die" -- or is it more like killing them?"

If the food and water is being delivered by a surgically implanted feeding tube, then withholding food and water until someone dies is the same as "letting them die".

"Who would you deny food and water to?"

Me? No one.

But I would withhold food and water if it was being delivered by a surgically implanted feeding tube, if I was their caregiver, and if they had requested I do so under certain conditions to allow them to die.

Why do you ask? Why is this about me and what I would do? Just being nosy?

"Dead people should be taken off (subject to their clearly stated will for such eventualities)."

But if they're PVS or severly brain damaged they shouldn't, even if their will clearly states they want this?

156 posted on 11/21/2006 5:19:29 PM PST by robertpaulsen
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To: robertpaulsen
Godwin's Law lives!

I didn't post that directly to you. But, since you are showing everyone how eager you are to kill innocent people like the Nazi's did, I don't understand your point.

157 posted on 11/21/2006 5:20:26 PM PST by bjs1779
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To: robertpaulsen

"Why do you ask? Why is this about me and what I would do? Just being nosy?"

Good point -- why should I care?


158 posted on 11/21/2006 5:22:17 PM PST by USFRIENDINVICTORIA
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