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Amnesia and remorse: how much should we expect?

Photograph: Filip Klimaszewski / Agencja Gazeta

When people do bad things – especially when they cause a lot of harm to others – we usually hope that they will experience something like remorse: that they will feel horror at the thought of what they did to the person harmed, that they will resolve to avoid causing similar harm in the future, and that they will be motivated to apologise and offer reparation, where possible. Penal systems in some jurisdictions deem remorse so important that it is considered a valid reason to mitigate the amount of punishment the offender receives. But, what happens to our expectations for emotion if the person cannot remember committing the offence; if he feels so detached from it that it is as if he did not commit it? An interesting case from Poland raises this question.

Maciej Zientarski was a celebrity driver on a TV programme similar to our Top Gear. On the 27th February 2008, accompanied by his motor journalist friend, he was given a Ferrari to test drive. The test drive didn’t end well. CCTV cameras captured footage of the car being driven at speeds of between 140-150kph along a 50kph road, serial over-taking, and the eventual head-on smash into the pillar of a bridge above. The motor journalist died at the scene but the driver, remarkably, just about survived. Read More »Amnesia and remorse: how much should we expect?

Abortion and the cognitively impaired mother

It will be interesting to watch the reception of a recent Court of Protection case, as yet unreported, in which a woman with profound learning difficulties was found to have capacity to decide not to terminate her pregnancy.

As so often, the case decided nothing new. But it is a timely reminder of the trite but often overlooked principle that capacity is not an all or nothing thing. The question: ‘Does she have capacity?’ is always dangerously incomplete. The correct question is always ‘Does she have capacity to decide X?’

There was no doubt that she did not have capacity to manage many aspects of her affairs. She was in the bottom 1% of the population so far as intellectual function was concerned. Deputies were appropriately appointed. But, so far as the continuation of her pregnancy was concerned, so what?

It was decided as a matter of fact that she had capacity to decide whether or not to continue with, or to terminate, the pregnancy. And that meant that the Court of Protection had no jurisdiction to decide the matter. No best interests determination could lawfully be made.Read More »Abortion and the cognitively impaired mother

Salt in the Wound, or the Sweetest Thing? On Placing Legal Limits On the Sugar, Salt and Fat Content of the Foods We Eat.

Last week, in the light of the UK’s growing obesity problem, the shadow health secretary Andy Burnham called for a debate on the question on whether a legal limit ought to be introduced on the amount of sugar,salt and fat that manufacturers can put into the foods that we eat, particularly those foods aimed primarily at children. In calling for such a debate, Mr Burnham pointed out that the obesity epidemic can no longer be ignored, given the challenges that widespread obesity will raise for the NHS. Furthermore, he suggested that the current government’s ‘responsibility deal’ , which aims to tackle the obesity problem by collaborating with food manufacturers to improve food content and labelling,  is simply not working.Read More »Salt in the Wound, or the Sweetest Thing? On Placing Legal Limits On the Sugar, Salt and Fat Content of the Foods We Eat.

Turning the Camera Around: What Newtown Tells Us About Ourselves

On the morning of December 14th, 20-year old Adam Lanza opened fire within the halls of Sandy Hook Elementary School in Newtown, Connecticut, killing 20 children and six adult staff members before turning his gun on himself. In the hours that followed, journalists from every major news station in the nation inundated the tiny town, and in the days that followed, the country as a whole started down a familiar path characterized best by the plethora of ‘if only-isms’.

It began in the immediate hours following the shooting: if only we had stricter gun control laws, this wouldn’t have happened. This is perhaps an unsurprising first response in a country that represents 4.5% of the world’s population and 40% of the world’s civilian firearms.[1] Over the next few days, as a portrait of the shooter began to emerge and friends and family revealed that he was an avid gamer, a second theory surfaced in the headlines: if only our children weren’t exposed to such violent video games, this tragedy never would have occurred.[2] [3] And just in the past few days, public discourse has converged on the gunman’s mental health, the general conclusion being that if only we had better mental health services in place, this wouldn’t have happened.[4][5] (The National Rifle Association [NRA] even tried to jump on board, suggesting that “26 innocent lives might have been spared” if only we had an armed police guard in every school in America.[6] They seem to be the only ones taking themselves seriously.[7])Read More »Turning the Camera Around: What Newtown Tells Us About Ourselves

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?

“HoboJacket – An Ethical Analysis”

Last week, a website created by MIT student Jin Pan attracted the ire and moral condemnation of media commentators. The website was called ‘Hobojacket’. Its purpose was to give college students a novel way in which to ridicule members of rival colleges; the idea was that people would use the website to pay for jackets bearing a rival college’s logo, jackets which would then be donated to the homeless. This, it was claimed by Pan, would show the “true value” of a degree from the rival college, in (what one must tragically presume) was believed by Pan to be an amusing fashion.Read More »“HoboJacket – An Ethical Analysis”

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!

Abortion and the Senseless Death of Savita Halappanavar

On Wednesday morning, several media outlets, including the Irish Times, the BBC, and the CBC, reported that Savita Halappanavar, a Hindu woman living in Ireland, had died from blood poisoning after doctors in a Galway hospital refused her request to abort the fetus that she was told she was miscarrying.

We do not yet know all of the facts of the case. Several inquires are being conducted. We do, however, learn this much from media reports. Ms. Halappanavar was 17 weeks pregnant. On October 21, she presented at a hospital in Galway complaining of back pain. Upon examination, she was told that she was having a miscarriage, and that it would soon be over. This did not happen. Instead, her ordeal continued for several more days. After a full day of “severe” pain carrying a child that was certain to die, Ms. Halappanavar asked that her pregnancy be terminated. Physicians were reported to have said that since they were in Ireland and the fetus had a heart beat they could not terminate the pregnancy. (In Ireland, the unborn have a constitutional right to life.) Ms. Halappanavar continued to suffer for a further two and a half more days before her fetus died and was removed from her body. By this time she was quite ill. She was then transferred to an Intensive Care Unit but she did not recover, dying some days later on October 28of complications due to septicaemia (blood poisoning.)Read More »Abortion and the Senseless Death of Savita Halappanavar