Persistent Vegetative States

February 22, 2010 at 1:13 pm | Posted in Uncategorized | 1 Comment
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 I lied. I said I would make a new prediction on Sunday, but here it is Monday and I’m only just now doing it…

My prediction grows out of an article by Benedict Carey in the February 3 Health section of the New York Times. It concerns  a scientific discovery about people in persistent vegetative states. The article reports that a 29-year-old patient apparently in a persistent vegetative state in a clinic in Liege, Belgium, has been responding to yes-no questions presented via an MRI. 

The piece draws on an article in the New England Journal of Medicine  and indicates the limits of the findings.  The study:

“does not suggest that most apparently unresponsive patients can communicate or are likely to recover. The hidden ability displayed by the young accident victim is rare, the study suggested. …Nor does the finding apply to victims of severe oxygen depletion, like Terri Schiavo, the Florida woman who became unresponsive after her heart stopped and who was taken off life support in 2005 during an explosive controversy over patients’ rights. …Moreover, experts said the new test was not ready for wide use; serious technical challenges remain to be worked out. …The hidden ability displayed by the young accident victim is rare…”

Despite all these qualifications, the article suggests this new limited two-way channel opens up a world of ethical challenges. “We know (the patients ) are responding, but they may not understand the question,” an ethicist at Weil Cornell Medical College observed.“Physicians and society are not ready for ‘I have brain activation, therefore I am,’ ” another physician added.

So here’s my prediction: before very long, the Vatican, or the US Catholic bishops, or certainly some of those bishops, will use this study to argue that everyone in a persistent vegetative state must be kept alive by artificial means. In point of fact, Pope John Paul II already more or less made such an argument, asserting  that not to use artificial feeding and hydration to keep patients alive constitutes “passive euthanasia.” In his 2004 papal allocution, “Care for Patients in a Permanent Vegetative State,” the Pope stated, “Administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.”  (Continue reading; do not pause to consider what it means that something artificial is always natural.)

As the Jesuit ethicists Peter Clark argues, however, this position is a clear reversal of Catholic teaching on the question dating back at least to the 16th century and perhaps to Thomas Aquinas. Clark writes, “Traditional moralists made a clear distinction between allowing to die and direct killing or euthanasia. The former was always morally permissible; the later was forbidden. Allowing to die included the refusal of nutrition and hydration if they were considered burdensome and nonbeneficial to the patient.”  

Clark  also points out that such a revision of traditional teaching, forcing Catholics to use extraordinary means to keep alive those who would not survive by ordinary means, places on them potentially extreme moral, legal and financial burdens. These include the obligation to provide expensive care not covered by health insurance or that violates a “do not resuscitate” order;  another danger is that those who previously did not sustain a loved one by extraordinary means will now fear that they murdered him or her. Finally, in a country where more than 40 million people are uninsured or underinsured, the investment of billions of dollars a year in artificially prolonging the lives of those in persistent vegetative states is ethically troubling at best. (Clark, “Tube Feeding and Persistent Vegetative State Patients: Ordinary or Extraordinary Means” Christian Bioethics 12: 43-64, 2006).

Nonetheless, I predict that some branch of the institutional Roman Catholic Church will, probably in the near future, use the recent study to restate its claim that the use of “natural” artificial  means to keep alive those in a persistent vegetative state is a moral obligation. Stay tuned.

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A Prediction Fulfilled

February 20, 2010 at 10:58 am | Posted in Uncategorized | 4 Comments
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I frequently make predictions about the future. This is a no-fee activity, aimed primarily at my long-suffering spouse. “Keith, mark my words,” I announce. “One of these days…”

One such prediction of the future occurred during our extended stay in California. Non-Californians may not grasp that the initiative system there makes public life extremely challenging, not to say impossible. Groups of citizens funded by God knows who can, by collecting a certain number of signatures, place an initiative on the ballot. And if this initiative is  passed, it becomes law and can be reversed only by another initiative. Doing so takes mucho time and money.

One such initiative was Prop 13. Passed in 1978, it reduced property taxes by 57% and put rigid limits on future property tax increases except when properties change hands. The California public school system (a significant part of which was supported by property taxes) was third in the nation in 1978. Now it’s forty-seventh.

One day I was looking out the window at the street on which we lived in Berkeley and thinking about Prop 13 and general attitudes toward taxes in California. “Keith,” I said, “At the rate things are going, there will be a pothole in the street in front of this house, and the good people of California will say ‘That’s your pothole. You fix it.'”

Well, it’s happened. More or less; we no longer live in California, and the fulfillment of my prediction occurred in yet another state, but these are mere details. Thanks to a Colorado law that requires any tax in any municipality to be approved by voters, the good citizens of Colorado Springs have of late been rejecting the taxes  proposed by city leaders  to remedy looming budget deficits. The result: massive cuts in public services. This includes a zero budget allotment to the agency that maintains and repairs streets.  

My advice to you, dear reader, is to get yourself a shovel and start  stockpiling  asphalt. The Tea Party loons are massing even as we speak. The pothole you fall into may be your own.  (Thanks, Flannery.)

Tomorrow: a prediction about the Vatican and those in “persistent vegetative states.”

A Technological Marvel

February 7, 2010 at 4:48 pm | Posted in Uncategorized | Leave a comment
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As anyone who knows me well can testify, I am a technological marvel. Some months ago, I attempted to download (is that the word?) the Weather Channel homepage onto my computer so that I could just click the icon and see the weather whenever I wanted it. 

Something went wrong, though. The homepage got stuck. It asked me to tell it my zip code, and I did, but the next step would never occur. Instead,  every time I turned on my computer there appeared this big blue blob thing with a request in the middle of it for my zip code. I would write in the zip code and click, but the blob would never go away. 

After some months I got really tired of this so I asked my husband if he could please get rid of the blob for me. He worked on it for a while and said it was  gone. The next time I turned on the computer I got a message that asked me to click that I agreed to the Weather Channel requirements. I refused, and then, the next time I turned on my computer, there it was again. 

Finally one day it occurred to me to try agreeing to the requirements. I clicked the accept command and presto! The Weather Channel homepage was on my computer. It had taken about six months for me to achieve this. At last I could check the temperature hour by hour. This all made me very happy.

But then something else happened: the Weather Channel home page includes an audio track (is that the right phrase?). The sound of thunder and lightning. When I’m sitting at the computer, or in the kitchen making a cup of tea, suddenly, a storm with thunder and lightning ensues. I have no idea why. Maybe the rest of the time it’s sunny out but the Weather Channel doesn’t communicate that part. I didn’t realize that I was signing on for thunder and lightning. Maybe I’ll ask Keith if he can get rid of it…

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