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Coma Confusion Resolved

Coma Confusion Resolved

Back in November, I blogged about the case of Rom Houben, a man who after more than two decades in what was apparently a persistent vegetative state was found to be conscious. Following the newspaper reports of the time – as I noted at the time, I had nothing to go on except newspaper reports – I described it as a case in which the locked-in state was misdiagnosed as vegetative state. These mistakes do, tragically, occur. But we now know that Rom Houben is not in the locked-in state at all. The diagnosis of locked-in state was made on the basis of the use of facilitated communication, a technique in which someone is supposedly helped to communicate. Usually the facilitator guides the hand of the person they aim to help; the idea being that they can compensate for the muscular weakness by sensitively interpreting the person’s movements. Facilitated communication became notorious in the 1990s, when it was found that in most cases in which it was used (mainly to communicate with severely autistic individuals) the facilitators were producing the message. The test is simple: put headphones in both the facilitator and the person they are trying to help, and ask them questions simultaneously. Sometimes both receive the same questions, sometimes they receive different questions. The finding is that answers are always to the questions asked of the facilitator (obviously the fact that the facilitators have gladly participated in this research is good evidence of their sincerity. How we can mistake our own movements for someone else’s is a fascinating question, explored interestingly by Daniel Wegner in The Illusion of Conscious Will).

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Climate scientists behaving badly? Part 5: virtue in testimony.

We now consider a couple of testimonial virtues.

Sincerity of testimony

There has been reason to be worried about the sincerity of public testimony by climate scientists for twenty years, ever since Professor Schneider of Stanford (now a senior member of the UN’s IPCC) said that scientists should ‘offer up scary scenarios, make simplified dramatic statements, and make little mention of any doubts we might have’. So the recommendation is to give us distorted presentations of the science aimed at achieving the political effects the scientists deem best. For scientists to testify thus is a serious derogation of their epistemic duty towards us. On the contrary, we should be able to rely on scientists to tell us the true state of the science on an issue irrespective of the political import. Furthermore, to offer testimony distorted in this manner is to make an illicit power grab, based in an abuse of their role as experts, in which they seek to substitute their judgement of what should be done for ours.

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What is the most moral way to use embryos?

By: Francesca Minerva

Reading this news  about a couple that donated two embryos to another sterile couple, I started to ask myself if embryo donation is really the most moral way to use embryos. Some people, indeed,  suggest that this choice is the one that people who take into account human life should take. We read “The concept of donating embryos to other couples got a push eight years ago under President George W. Bush, who dedicated federal funding to promote, in his terms, “embryo adoption.” The federal funding has since increased to $4.2 million. Now, Georgia has passed the nation's first state law symbolically recognizing embryo adoption”. I am especially skeptical about two issues connected to embryo donation.

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Ending It, in Paternia

In the Republic of Paternia there has, of late, been a vigorous debate on the question of whether the law should change to permit marital separation in some circumstances. Some desperate Paternian couples have been illegally travelling abroad to engage in marital separations in Switterland (where they are permitted for now, though the Switts are becoming uncomfortable with their country’s renown for so-called “separation tourism”). Some of these couples have been dragged through the Paternian courts on their return. Sympathetic juries have often chosen to acquit, recognizing that their situations had become unbearable, that they had separated consensually, and that legal enforcement of their cohabiting marital relationship would only have prolonged their suffering. Moreover, prosecutors in Paternia have for a long time only selectively prosecuted cases of marital separation that illegally took place abroad.

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Renaming a Disorder

What’s in a name? Quite a lot, considering the huge commotion over proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Almost a thousand pages long, this psychiatric bible is
used all over the world to classify and diagnose mental patients – it’s
the definitive authority on that nebulous concept known as “normal”.
The implications of any revisions are tremendous, and the American Psychiatric Association, publisher of the manual, has attracted support as well as harsh criticism.
Could these revisions actually cause more harm than good? I’m not sure,
but I want to explore the implications of just one of the proposed
revisions – that concerning EDNOS, or “Eating Disorders Not Otherwise Specified.”

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The worth of a life and a life worth living

There has been a lot of discussion about health care rationing in the North American media over the last year, much of it hysterical and barely coherent. A number of respected ethicists have tried to make the case for rationing, including Peter Singer in the New York Times last year, and recently John Freeman.

This week Newsweek Science Editor Sharon Begley asked ‘What is a Life Worth?’ drawing on a recent study presented at the American Society for Maternal-Fetal Medicine meeting. Begley noted

“This is the kind of news that unleashes hysteria about "death panels" and "health-care rationing," but here goes: an analysis of genetic screening for an incurable, untreatable disease called spinal muscular atrophy shows that it would cost $4.7 million to catch and avert one case, compared with $260,000 to provide lifetime care for a child born with it. So here's the question: do we say, "Damn the cost; it is worth any price to spare a single child the misery of being unable to crawl, walk, swallow, or move his head and neck"—or do we, as a society, put on the green eyeshades and say, "No, sorry, we can't afford routine screening"?”

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Court compels woman to go to bed

Jacob M Appel writes in the Huffington Post  that Samantha Burton was 25 weeks pregnant when she ruptured her membranes and started contractions. There was a risk of infection and premature birth, risking her health and the life of her unborn child. It could also risk the health of her future child who may survive but be disabled.                                                                                                             
Burton was ordered rest in hospital for the remainder of her pregnancy. She wanted to go home but wasn't allowed to leave.

The hospital successfully went to court forcing Burton to comply. 

Three days later she had an emergency cesarean, but the baby was stillborn.

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The Racist Shopper

By: David Edmonds

The Equality Bill is currently making its way through the two unequal chambers of the British parliament.  It’s radical and wide-ranging and the debate about it has been heated, but the most interesting contribution has come from the upper chamber, the House of Lords.  In a thoughtful speech, Bhikhu Parekh, a political theorist, advanced an argument in support of positive action.  He said that in some circumstances one’s sex could in itself be a qualification for a post.

Take a hospital whose obstetrics and gynaecology department is all-male. Many women would like to be seen by a female gynaecologist, but there is none. A vacancy occurs. We have two candidates, a male and a female, with equal medical or academic qualifications and equal professional experience. The woman doctor could be appointed, either as a form of positive action, or by simply saying that the needs of the organisation require that her gender is an important part of the qualification itself. In other words, what is called positive action here is not simply an add-on in a situation where there is equality of qualification or experience, rather it is built into the structure of the assessment criteria themselves, so that she is appointed because she has an additional qualification, by virtue of her gender, which others do not have.
 

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Easing the passing: Death booths, misrepresentations and the ‘Ugh factor’

Death is in the air. To stop us being engulfed by the ‘silver
tsunami’,  Martin Amis urges the
construction of euthanasia booths, and encourages the elderly to go to them for
a martini, a medal and a pharmaceutical nudge into the void. Terry Pratchett
talks cosily about ‘shaking death by the hand’ as he sits on his lawn, Tallis
on his IPod, drinking some modern Socratic hemlock washed down with vintage
brandy. He and his backers in the euthanasia industry shrewdly propose death
tribunals who, having heard evidence about individual cases, would sign or
withhold a death warrant. Such tribunals, they say, would obviate the risk that
vulnerable people might opt unacceptably for euthanasia. The opinion polls
consistently indicate considerable public support for a change in the law
against assisted suicide. The opponents of assisted dying are caricatured as
reactionary bigots, probably fuelled by otiose, antediluvian religious
prejudice: people who care more about some dogma of the sanctity of life than
about pain, fear, despair and autonomy. The crusade for assisted dying is a
campaign by the modern and enlightened against the mediaeval  and  benighted.

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Brain imaging and PVS: How excited should we be?

How exciting is the new research on the consciousness of patients diagnosed as in a persistent vegetative state (discussed here)? From a scientific point of view, this is an important piece of research. The ability to respond to yes/no questions is surely a reliable indicator of consciousness; once we have identified patients who can pass this test, we can begin to conduct other tests, to see whether the results correlate. We can begin to see whether the evidence of electrical activity in the brain in response to words or to physical discomfort reflect consciousness or are merely indicators of unconscious activity.  The new research also might have great diagnostic value. But we must be careful not to overinterpret the results.

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