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Dominic Wilkinson

DON’T PANIC

It has been an extraordinary week in the financial markets of the
world. With the collapse of major international financial institutions,
and governments forced to intervene by propping up ailing insurers or
authorising the merger of banks, newspaper headlines have competed to
convey the scale and significance of the crisis. But there is a
difficult line for newspaper editors and sub-editors to tread between
accurately reflecting the enormity of the market upheavals, and
contributing to the crisis. Should newspapers be censored, or censor
themselves at times of great market sensitivity or do they have a duty
to their readers to speak the truth?

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Testing choices: weighing up risks of death and Down syndrome for fetuses

In the Observer yesterday, researchers from a major disability charity
have claimed that the risks of screening for Down syndrome during
pregnancy have been underestimated. The researchers suggest that for
every 3 fetuses with Down syndrome that are detected by screening 2
unaffected fetuses miscarry as a complication of the testing process.
Should screening be stopped? If screening continues how should
prospective parents weigh up this risk?

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Radical organ retrieval procedures

I wrote recently
about the controversial news that surgeons in Denver had taken organs,
including the hearts, from newborn infants who had died in intensive
care.
In recent years the retrieval of organs from patients whose hearts have
stopped (so-called donation after cardiac death, DCD) has become more
popular. In part this is because of the problem that there is a
shortage of organ donors who are brain dead. It is also because of the
recognition that when patients die after removal of life support, their
organs may still be viable for transplantation.

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When the heart stops: harvesting organs from the newly (nearly) dead

In the New England Journal of Medicine yesterday, doctors from Denver reported on three controversial cases of heart transplantation from newborn infants. These cases are striking for several reasons. They were examples of so-called ‘donation after cardiac death’ (DCD), an increasingly frequent source of organs for transplantation, but done very rarely in newborns. They are controversial because the transplanted organs were hearts that were ‘restarted’ in recipients after they had stopped in the donor. Transplant surgeons waited only a relatively short period after the donor’s heart had stopped (75 seconds) before starting the organ retrieval process. These transplants raise serious questions about the diagnosis and definition of death.

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Activists and acts of mercy

In Germany this week, and in Australia recently, there has been public
concern and significant media attention about the actions of euthanasia
activists. A former government official and lawyer, Roger Kusch, went
public in Germany with a video of an elderly woman who he had helped to
die. In Australia, Phillip Nitschke has been criticised for his
involvement and subsequent comments about the death of Graeme Wylie a
man suffering from Alzheimer’s disease whose partner and close friend
have been found guilty of manslaughter.

Opponents of euthanasia have used these cases to argue against liberalisation of laws on assisted suicide or euthanasia.

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When autonomy trumps sense: the costs of refusal to allow withdrawal of life support.

In Canada this week, an 84 year old man died after 9 months of treatment
in an intensive care unit. He had severe brain damage and multi-organ
failure, but his family sought a legal injunction to prevent doctors in
the intensive care unit from withdrawing life-support. Over the course
of his long intensive care stay, intensive care beds at a major trauma
centre were closed so that nurses could used instead to support his
care, and three doctors resigned from the hospital in protest at being
required to provide what they felt was ‘unethical’ treatment.

Read More »When autonomy trumps sense: the costs of refusal to allow withdrawal of life support.