Disability, Chronic Conditions and Rehabilitation

Non-resisted suicide and depression

by Dominic Wilkinson
October 6, 2009

In late 2007 a young woman with a history of depression and several previous suicide attempts presented to an emergency department following an overdose. She gave doctors a copy of her living will, written 3 days previously, in which she made it clear that she wanted no measures to be taken to save her life. Earlier this week Roger Crisp and Julian Savulescu argued separately in this blog that the wishes of competent patients to end their lives should be respected. But if we believe that suicide can be rationally sought, and should sometimes not be resisted, should this include those who have been diagnosed with depression?

A change of heart

by Dominic Wilkinson
July 30, 2009

Earlier this week fourteen-year old Hannah Jones received a heart transplant. This is eight months after Hannah hit the news for her refusal to have the surgery. There was much debate in the media (including this blog) at the time about whether or not teenagers should be allowed to refuse life-saving treatment, though overall there was a lot of support for Hannah’s decision.

But in the last week Hannah has apparently changed her mind, and elected to have the surgical procedure. What is the significance of this for the decision to go along with her earlier choice? Hannah might well have died in the last 8 months, in which case she would never have had a chance to rethink her position on transplants. Does the fact that she has now changed her mind give us more reason, in future, to overrule similar patients who are declining live-saving treatment?

Shining monkey, sadistic conclusion?

by Anders Sandberg
May 28, 2009

Japanese researchers have genetically modified marmoset monkeys, and demonstrated that the modification can be inherited by their offspring. The modification was the standard green fluorescent protein making the monkey's glow green under UV light, a marker to demonstrate that the modification worked (BBC shows a picture of their feet glowing "an eerie green", while the picture in Nature's News and Views shows the cute monkeys in normal light and the original paper shows both). The long-term aim is to be able to produce transgenic primates that could act as disease models for humans – many conditions do not map well onto mice and rats. But is it acceptable to introduce heritable illness conditions into animals?

Overruling parents and allowing infants to die

by Dominic Wilkinson
March 27, 2009

Over the weekend a nine-month old infant, baby ‘OT’, died following a court ruling that allowed doctors to remove life support. As discussed in a post last week, his parents had wanted treatment to continue, but the court ruled that the hospital could withdraw the breathing machine that was keeping OT alive and allow him to die.

Life or no-life on the ventilator: the argument from parental freedom

by Dominic Wilkinson
March 11, 2009

In the High Court this week, parents of nine-month old infant OT are fighting a request by doctors to turn off the infant’s life support. The infant has been on a breathing machine since 3 weeks of age, and apparently has severe brain damage. This case has obvious echoes with the highly publicised case of Charlotte Wyatt, and the earlier case of baby MB. In both those instances courts ruled in the parents’ favour and life support was continued.

The Lost Genius objection to pre-natal testing for autism

by Dominic Wilkinson
January 8, 2009

In an opinion piece on the BBC website this week Professor Simon Baron-Cohen has questioned the wisdom of adopting pre-natal screening for autism, raising the possibility that it would prevent the existence of future great mathematicians. This is a variant of a common objection to pre-natal testing or to genetic enhancement.

Travelling for Treatment

by Mark Sheehan
October 29, 2008

A BBC report today suggests that “many” UK couples are going overseas to choose the sex of their children. What seems most odd about this is that in some cases they go to places where sex selection is illegal.

What is interesting here is the fascination with what people do when they go overseas or why they go overseas. There are a whole range of stories about Britons going overseas to get things that they cannot get in the UK – or cannot get in the UK as cheaply. The obvious examples are sex selection, assisted suicide or treatments not available on the NHS.

Finding holes in the brain: to test or not to test for Creutzfeldt-Jakob?

by Anders Sandberg
October 21, 2008

A new test for carriers of variant Creutzfeldt-Jakob disease is under development, but it raises an ethical problem: should we test for untreatable deadly illnesses? And might it reduce the amount of blood donations?

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

by Dominic Wilkinson
September 15, 2008

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?

The point of death

by Janet Radcliffe Richards
August 5, 2008

The Guardian yesterday reported the death of the man who had been so tragically shot in Antigua, with his wife, three weeks after their wedding. It began like this:

"Ben Mullany, the newlywed who was shot on honeymoon in Antigua in an attack that killed his wife, Catherine, died in hospital in Wales yesterday after his life support machine was switched off. The 31-year-old trainee physiotherapist, who had suffered a fractured skull and had a bullet lodged in the back of his head, was flown back to Britain while in a coma on Saturday. Tests carried out when his condition stabilised after the 24-hour journey established he was brain dead."

This is a familiar way of describing such happenings, even among clinical professionals. Brain death is pronounced, so the life support machine is switched off, and the patient dies. The clear implication is that brain death is not death. The machine is still keeping the patient alive, and it is switching off the machine that causes real death.