Disability, Chronic Conditions and Rehabilitation

Your eyes will be discontinued: what are the long-term responsibilities for implants?

by Anders Sandberg

What do you do when your bionic eyes suddenly become unsupported and you go blind again? Eliza Strickland and Mark Harris have an excellent article in IEEE Spectrum about the problems caused when the bionics company Second Sight got into economic trouble. Patients with their Argus II eyes found that upgrades could not be made and broken devices not replaced. What kind of  responsibility does a company have for the continued function of devices that become part of people?

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Cognitive snobbery: The Unacceptable Bias in Favour of the Conscious

There are many corrosive forms of discrimination. But one of the most dangerous is the bias in favour of consciousness, and the consequent denigration of the unconscious.

We see it everywhere. It’s not surprising. For when we’re unreflective – which is most of the time – we tend to suppose that we are our conscious selves, and that the unconscious is a lower, cruder part of us; a seething atavistic sea full of monsters, from which we have mercifully crawled, making our way ultimately to the sunlit uplands of the neocortex, there to gaze gratefully and dismissively back at what we once were.  It’s a picture encoded in our self-congratulatory language: ‘Higher cognitive function’; ‘She’s not to be blamed: she wasn’t fully conscious of the consequences.’: ‘In the Enlightenment we struck off the shackles of superstition and freed our minds to roam.’ Continue reading

Urgency, Delayed Decision-making and Ethics in the Court of Protection

By Dominic Wilkinson, 24th June 2021

cross post from the Open Justice Court of Protection Project

On 11th June 2021,  I was a public observer (via MS Teams) of a case in the Court of Protection: Case No. 1375980T Re GU (also blogged about by Jenny Kitzinger here).

The case was (though I did not know it beforehand) related closely to issues that I have written about over a number of years (for example hereherehere ). It was an urgent hearing before Mr Justice Hayden concerning clinically-assisted nutrition and hydration (CANH) for a 70 year old man, GU, who has been in a prolonged disorder of consciousness for seven years.

I have read the judgments from many similar cases in the UK, from the first ever case concerning a feeding tube for a vegetative patient heard in (what is now) the Supreme Court in 1992 (the case of  Tony Bland, injured in the Hillsborough football stadium disaster), through to the most recent Supreme Court case of Re. Y, at which the court ruled that it is not mandatory to bring cases concerning CANH-withdrawal to court unless there is disagreement about best interests, or the decision is finely balanced (report here). I’m also familiar with the judgments in other jurisdictions (e.g. Schiavo in the USA,  Lambert in France) and have been involved in deliberation in clinical ethics committees about cases with similar features.

Yet, this was my first time hearing open deliberations in the Court of Protection. It was a fascinating and thought-provoking experience. Continue reading

Is Life-Sustaining Treatment Being Lawfully Withdrawn From Patients In Prolonged Disorders Of Consciousness? Nobody Seems To Know

By Charles Foster

From the time of the decision of the House of Lords in Airedale NHS Trust v Bland (1993) until the decision of the Supreme Court in An NHS Trust v Y (2018) (which I will refer to here as ‘Y”) it had been understood that the withdrawal of life-sustaining treatment (typically clinically assisted nutrition and hydration – ‘CANH’) from patients in a vegetative state should be endorsed by the court. Over the years, this practice had been extended to cover such withdrawals in Minimally Conscious States too.

In Y, the Supreme Court held that there was no requirement for court review or endorsement. Why? Continue reading

Press Release: Tafida Raqeeb

Professor Dominic Wilkinson, Professor of Medical Ethics, University of Oxford. Consultant Neonatologist

 

This morning, the High Court judgement around medical treatment for five-year old Tafida Raqeeb was published. Tafida sustained severe brain damage from bleeding in the brain eight months ago. Her parents wish to take her to a hospital in Italy to continue life support, while the doctors at the London hospital caring for her believe that it would be best to stop life support and allow Tafida to die.

 

Justice MacDonald concluded today that life sustaining treatment for Tafida must continue and her parents should be allowed to take her to Italy. Continue reading

Press Release: Tafida Raqeeb, International Disagreement and Controversial Decisions About Life Support

by Dominic Wilkinson @Neonatalethics

 

This week the legal case around medical treatment for five-year old Tafida Raqeeb has begun in the High Court. She sustained severe brain damage from bleeding in the brain seven months ago. Her parents wish to take her to a hospital in Italy for further treatment, while the doctors at the London hospital caring for her believe that it would be best to stop life support and allow Tafida to die.

 

In a previous press release, I addressed several common questions about the case:

  • This seems to be another case like that of Charlie Gard and Alfie Evans. How common are cases of disagreement in the medical care of children?
  • Why do disagreements occur?
  • Why don’t parents have the final say about treatment?
  • Who is right in Tafida’s case, her parents, or the doctors?

 

There appear to be two central questions in her case –

  1. Is there any realistic chance of her condition improving if life-support continues?
  2. If Tafida’s condition does not improve, should treatment to keep her alive continue, or should it stop (particularly, if her parents do not give permission to withdraw treatment)?

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Press Release: Tafida Raqeeb, Medical Ethics, and Difficult Decisions

by Professor Dominic Wilkinson, consultant neonatologist, Professor of Medical Ethics, University of Oxford.

 

 

In September, the high court will hear a legal challenge relating to the medical care of five-year old Tafida Raqeeb. She has been in intensive care since suffering a severe stroke in February this year. The doctors apparently believe that there is no chance of Tafida recovering, and believe that the machines keeping Tafida alive should be stopped, and Tafida allowed to die. Her parents do not accept this, and wish to take Tafida overseas for continued treatment in the hope of her improving.

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Abolish Medical Ethics

Written by Charles Foster

In a recent blog post on this site Dom Wilkinson, writing about the case of Vincent Lambert, said this:

If, as is claimed by Vincent’s wife, Vincent would not have wished to remain alive, then the wishes of his parents, of other doctors or of the Pope, are irrelevant. My views or your views on the matter, likewise, are of no consequence. Only Vincent’s wishes matter. And so life support must stop.’

The post was (as everything Dom writes is), completely coherent and beautifully expressed. I say nothing here about my agreement or otherwise with his view – which is comfortably in accord with the zeitgeist, at least in the academy. My purpose is only to point out that if he is right, there is no conceivable justification for a department of medical ethics. Dom is arguing himself out of a job. Continue reading

Withdrawing Life Support: Only One Person’s View Matters

Dominic Wilkinson, University of Oxford

Shortly before Frenchman Vincent Lambert’s life support was due to be removed, doctors at Sebastopol Hospital in Reims, France, were ordered to stop. An appeal court ruled that life support must continue.

Lambert was seriously injured in a motorcycle accident in 2008 and has been diagnosed as being in a persistent vegetative state. Since 2014, his case has been heard many times in French and European courts.

His wife, who is his legal guardian, wishes artificial nutrition and hydration to be stopped and Vincent to be allowed to die. His parents are opposed to this. On Monday, May 20, the parents succeeded in a last-minute legal appeal to stop Vincent’s doctors from withdrawing feeding, pending a review by a UN Committee on the Rights of Persons with Disabilities.

Lambert’s case is the latest example of disputed treatment for adult patients with profound brain injury. The case has obvious parallels with that of Terri Schiavo, in the US who died in 2005 following seven years of legal battles. And there have been other similar high-profile cases over more than 40 years, including Elena Englaro (Italy, court cases 1999-2008), Tony Bland (UK 1993) Nancy Cruzan (US 1988-90) and Karen Ann Quinlan (US 1975-76). Continue reading

In Praise Of Dementia

By Charles Foster

Statistically there is a good chance that I will ultimately develop dementia. It is one of the most feared conditions, but bring it on, I say.

It will strip me of some of my precious memories and some of my cognitive function, but it will also strip me of many of the neuroses that make life wretched. It may (but see below) make me anxious because the world takes on an unaccustomed form, but surely there are worse anxieties that are dependent on full function – such as hypochondriacal worries, or the worry that comes from watching the gradual march of a terminal illness. On balance the trade seems a good one. Continue reading

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