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Bioethics

Persistent Vegetative State and Futility: Should Communication by fMRI Change the Law?

Earlier this month, I discussed Adrian Owen’s research using fMRI scanners to communicate with patients who appeared to be in a Persistent Vegetative State (PVS) . By interpreting brain activity in Canadian PVS and minimally conscious patients, the researchers claim that patients can not only answer questions, but even lay down new memories.

The question of how this new research will affect patients diagnosed with PVS or minimally conscious patients is already being tested in court. Yesterday, the Vancouver Sun  reported on the case of Kenny Ng, a minimally conscious patient following a major car crash 7 years ago. Mr. Ng’s wife, Lora, wishes to withdraw hydration and nutrition. According to her lawyers, Doctors advised this course of action shortly after his car accident, but, hoping for an improvement, Mrs Ng had initially refused. After 7 years with no outward signs of improvement, Mrs Ng has asked for nutrition and hydration to be removed, ending his life. However, Mr. Ng’s parents and siblings argue that Owen’s research is “exactly what Kenny has been waiting for over the last seven years”, and that he should be kept alive so he can be assessed for inclusion in Owen’s trials.

If the decision is made in favour of the family, as Thaddeus Pope highlights, it will represent a major change to previous US and Canadian case law.

Owen has made a major scientific breakthrough. However, it is not clear that the discovery of consciousness means that the treatment should not be withdrawn. Paradoxically, the discovery of consciousness in very severely brain-damaged patients may provide more reason to let them die. Although functional neuroimaging is likely to play an increasing role in the assessment of patients in a vegetative state, caution is needed in the interpretation of neuroimaging findings.

Read More »Persistent Vegetative State and Futility: Should Communication by fMRI Change the Law?

Brian Earp on Anti-Love Drugs

In the final Uehiro Seminar of 2012, Brian Earp provides an absorbing analysis of the science and ethics of anti-love biotechnology. You can listen to the seminar here.

While some personal distress as a result of love may be an important means of self-development, certain forms of love may be particularly perilous. Examples given by Earp include an older person’s sexual love for a child, incestuous love, and the love that prevents an abused spouse from leaving their partner. In these cases love can become like an ‘interpersonal heroin’ – an individual may recognise the harm their love is causing them, but be unable to stop feeling it.Read More »Brian Earp on Anti-Love Drugs

The Liverpool Care Pathway in the News: Even by the Mail’s Standards, this is Low

(Cross-posted from the Journal of Medical Ethics blog)

The Liverpool Care Pathway provides a rubric for managing the care terminally ill as they approach death.  A helpful pamphlet explaining what it is and what it does is available here.  Ideally, I’d quote the lot; but for the sake of efficiency, I’ll make do with an edited quotation:

What is the Liverpool Care Pathway (LCP)?

The LCP is a pathway/ document that outlines this best care, irrespective of your relative/ friend’s diagnosis or whether they are dying at home, in hospital, in a hospice or a care home.

Medication/ treatment

Medication will be reviewed and any medication that is not helpful at this time may be stopped and new medication may be prescribed so that if a symptom should occur there would be no delay in responding.

It may not be possible to give medication by mouth at this time, so medication may be given by injection or sometimes if needed, by a continuous infusion by a small pump called a Syringe Driver, which will be tailored to individual needs.

It may not be appropriate to continue some tests at this time; these may include blood tests or blood pressure and temperature monitoring.

The staff should talk to you about maintaining your relative’s/ friend’s comfort; this should include discussion regarding position in bed, use of a special mattress and regular mouth care. You may want to be involved in elements of care at this time.

Diminished need for food and drink

Initially, as weakness develops, the effort of eating and drinking may simply have become too much and at this time help with feeding might be appreciated.

Your relative/friend will be supported to take food and fluids by mouth for as long as possible.

When someone stops eating and drinking it can be hard to accept, even when we know they are dying. It may be a physical sign that they are not going to get better. Your relative/friend may neither want or need food and/or drink and decisions about the use of artificial fluids (a drip) will be made in the best interests of your relative/friends for this moment in time. This decision will be explained to you and reviewed regularly.

This can be paraphrased further: medically futile treatment may be withdrawn; the main criterion for administering drugs will be symptom alleviation rather than life extension; some testing may be discontinued; it’s possible that there’ll come a point when artificial nutrition and hydration are no longer in the patient’s best interest, and they might be withdrawn if and when that point is reached.

None of this is particularly cheery; but death rarely is. Read More »The Liverpool Care Pathway in the News: Even by the Mail’s Standards, this is Low

Don’t tax the fat!

by Rebecca Roache

Dr Philip Lee, Conservative MP for Bracknell and a practising GP, today suggested that people whose lifestyle choices lead to medical problems should have to contribute towards their healthcare costs. He apparently highlighted type 2 diabetes – which can be brought on by an unhealthy diet, being overweight, and lack of exercise, although some people are genetically disposed to it – and is quoted in the Huffington Post as saying, ‘If you want to have doughnuts for breakfast, lunch and dinner, fine, but there’s a cost’.

At first glance, the idea that those who lead unhealthy lifestyles should bear the burden of their own resulting health problems seems fair. But there are serious problems with this idea. Let us consider two of them.Read More »Don’t tax the fat!

A Dyslexic boy in a Trojan horse

‘Come in’, said the Well Known Educational Psychologist. We did. ‘Please sit down’, she said, and we did. She didn’t waste time, and quite right too. We wanted to know.

‘Tom and I have had a very interesting afternoon.’ That sounded bad.

‘He’s a very able child indeed’. That sounded worse, because it came with the emphatic pause that always indicates a big ‘but’.

In the pause I wondered why we’d done this. Why we’d taken a little boy out of the woods and out of his playground to have someone fumble inside his head with blunt tools: indices, probes, inventories, and assumptions about normality.

‘He’s quite dramatically dyslexic, I’m afraid.’ My wife shared her fear. There was a lot of it sloshing around. ‘But his IQ is so high that he’ll be able to use lots of coping strategies. And he’s still very young: there’s lots that can be done.’ And she told us what it was. Regulations could be invoked, tribunals could be convened, cards could be flashed, phonemes could be chanted. He could be imprinted like other children. It would just take longer. It would be hard work, for Tom and for us, but there was every reason to be hopeful of a ‘good result’.

And what the hell did that mean? I asked myself. I was too polite to ask her. I didn’t want a result. I wanted my son.Read More »A Dyslexic boy in a Trojan horse

The Bad Seed: Facts and Values in the Study of Childhood Antisocial Behaviour

Podcast of Uehiro Seminar given by Gwen Adshead ‘The Bad Seed’ was a popular 1954 novel in which a well brought up young girl begins to manifest behaviour characteristic of a criminal psychopath. As the plot develops, the girl’s mother discovers that her own mother was a serial killer who was executed when she was herself a… Read More »The Bad Seed: Facts and Values in the Study of Childhood Antisocial Behaviour

Growing Babies: The Ethics of Artificial Wombs

Earlier this year, scientists published a study that detailed the successful use of an artificial uterus to bring shark embryos to term. Once ‘birthed’ the shark pups showed no detrimental effects as a result of having gone through development in an artificial setting.

Research such as this ignites interest in the possibility of creating artificial wombs for the purpose of human reproduction. After all – artificial hearts, kidneys and lungs are all available and becoming increasingly sophisticated. It is surely only a matter of time before artificial wombs, capable of growing and developing a foetus outside the human body, are technologically feasible.

This raises the question of whether we should promote research aimed at shifting the location of foetal development to outside the human body. As a way of approaching some of the issues surrounding this prospect let’s consider a hypothetical scenario.Read More »Growing Babies: The Ethics of Artificial Wombs

Do we want “genetically modified children”? Yes, of course!

The agency that regulates fertility treatment and embryo research in the UK, the Human Fertilisation and Embryology Authority (HFEA), has asked for public views on two possible new forms of fertility treatment that promise to prevent the transmission of mitochondrial diseases to children. These diseases can be extremely severe, leading to (among other things) diabetes, deafness, progressive blindness, seizures, dementia, muscular dystrophy, and death.

Read More »Do we want “genetically modified children”? Yes, of course!

Could there be a Third Way for Criminal Psychopaths?

Last week, Steven Farrow was convicted of murdering a grandmother and a vicar. 77 year old Betty Yates was stabbed in the face. He had planned to crucify the vicar but had left behind his hammer an nails, instead covering his dead body in pornographic DVDs, party poppers and condoms. Though Farrow is likely to spend the rest of his life in jail, the family members questioned why he had been free in the first place.

Read More »Could there be a Third Way for Criminal Psychopaths?

Nine to five philosophers

Owen Barfield was lunching in C.S. Lewis’s rooms. Lewis, who was then a philosophy tutor, referred to  philosophy as ‘a subject’. ‘”It wasn’t a subject to Plato”, said Barfield, “It was a way.”’1 It would be dangerous for a modern professional philosopher to say that her philosophy was her ‘way’. I can well imagine the… Read More »Nine to five philosophers