"History is philosophy teaching by example." (Lord Bolingbroke)

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Wednesday, May 24, 2006

Way Off-Topic, But Perhaps of Interest. . .

My husband and I took the updated versions of our wills and health directives to our lawyer last week.

We are both retired physicians, so the health directive - the part where you indicate how you wish to be treated when you became terminal, with no hope of recovery - was of some interest to both of us. We both want to receive pain relief as if we were fully conscious and in pain, and while we would have nutrition withdrawn, we do not want hydration withdrawn.

Just in case there is pain, pain medication can ease the discomfort of hunger more easily than the severe discomfort of dehydration. It would take longer to die, but since our state does not permit euthanasia (unless you're a convicted murderer, of course), it would be our choice to die as comfortably as possible.

We well remember the Terri Schiavo case, where a young woman lay in a persistent vegetative state for several years before all life support was withdrawn. We saw copies of her brain scans, and there was no doubt that she was beyond recovery. Her brain was shrunken, and the anatomy was abnormal and indistinct.

However, with fluids and nutrition, she was alive, and according to her parents, appeared minimally aware of, and responsive to, her surroundings. The videos we all saw on TV were said to be several years old, so it was hard to say how she actually appeared then.

Her parents wanted to have custody of their daughter so that they could continue to care for her, at their expense. As we all know, the court refused to allow them to do this, and gave the responsibility for her fate to her husband. He chose to withdraw nutrition and hydration, and Terri died about two weeks later.

To me, it seemed as if the court considered Terri's husband as her owner, and legally, she became no more important than a piece of inanimate property. If there had been no one else willing to care for Terri, then perhaps we could understand why, after several years of declining function, it would not be totally inappropriate to withdraw support and allow her to die; had Terri lived not very many decades ago, she would have died long before, because the means to keep her alive over the long term, even though low-tech, were not available then.

But the technology to maintain her was available to her, and her parents were willing to care for her at their own expense. Given that in her state, someone had to care for her if she were to survive, I thought that it would not be inappropriate for the court to transfer the responsibility for her care to a willing volunteer.

It is all but certain that nothing would have come of it; Terri had already had very advanced rehabilitative efforts, and her condition was declining in spite of every effort made on her behalf. But if someone volunteered to relieve her husband of that encumbrance, it seemed a reasonable thing to allow.

Why not?

The parents kept saying they wanted to try again, try longer, and try harder. It was their hope that "something" would appear on the scene to help their daughter. Almost certainly, they did not truly think that there would be any real recovery, but they would have had the satisfaction of knowing that every effort had been made, thus erasing any doubts, and might have been able to say goodbye to their daughter with some peace.

It seemed highly unlikely at the time, but as the old saying goes, you never know about the "something." I found the following piece of some interest, and thought you might too:

Groundbreaking Study Finds Drug Arouses People from a Permanent Vegetative State

Terry Vanderheyden

SPRINGS, South Africa, May 23, 2006 ( – South African researchers have discovered a medication that temporarily arouses patients from a permanent vegetative state.
Scientists Ralf Clauss, now practicing nuclear medicine in the UK, and Wally Nel, in family practice in South Africa, found that Zolpidem, an insomnia drug, effectively restored consciousness to three individuals who were all in permanent vegetative states for at least three years before commencing the trial. After administering the drug, which the doctors have been doing every morning for three years, the three individuals all “wake up” to varying degrees, answer simple questions and engage in activities like watching television.

Their findings, published in the most recent issue of the journal NeuroRehabilitation, describe the confirmed permanent vegetative states of two motor vehicle accident patients and one near drowning patient. Drs. Clauss and Nel stated that, according to accepted measures of cognitive function – the Rancho Los Amigos Cognitive score – their level of consciousness was dramatically improved from a range of I-II before to V-VII after the drug.

According to BBC News coverage, patient L had been in a vegetative state for three years, showing no response to touch and no reaction to his family. After Zolpidem, he was able to talk to them and answer simple questions. Patient G was also able to answer simple questions and catch a basketball. Patient N had been ‘constantly screaming,’ but stopped after being given the drug when he started watching TV and responding to his family.

Dr. Clauss told the BBC that “For every damaged area of the brain, there is a dormant area, which seems to be a sort of protective mechanism. The damaged tissue is dead, there’s nothing you can do,” he explained. “But it’s the dormant areas which ‘wake up’.”


  • At Thu May 25, 05:30:00 PM PDT, Blogger Elmer's Brother said…

    yes why not err on the side of life.

  • At Thu May 25, 06:01:00 PM PDT, Blogger Cubed © said…

    Absolutely. We all die of something, after all, and we don't have magic wands or anything, but where's the harm in letting someone who wants to give it a try go ahead and do it?

    Terri might not have been able to benefit, but even so, had she remained alive long enough for her parents to try some new development like that, the peace and resolution it would have brought to them would have made it all worth while.

    In a way, I hope they never hear about this development.

  • At Fri May 26, 04:41:00 AM PDT, Blogger Eleanor © said…

    Regardless of one's philosophy toward maintaining a person's life in a permant vegetative state, this points out the necessity for having an up-to-date legal instrument that gives decision-making powers to someone you trust to carry out your wishes.

    Each state has different provision and the instruments go by different names: health-care surrogate, durable power of attorney for health care, living will, etc. Be aware that the provisions written in one state won't necessarily transfer to another. Be sure to update to the legal instrument of the locality in which you live. in other words, check it out with a lawyer in your locality.

    This is not a plug for the legal profession, but your health and estate could suffer if you don't...Common sense!

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