Sunday, 2 June 2013

Liverpool Care Pathway - The Moral Minefield That Is Defining Death

When is a person not a person? When they are a 'former person' and lack 'personhood' and when death is a process, not an instant.

"How dead do you have to be?"

Is Hassan a 'former person'; does he lack personhood?

Those are classifications proposed to permit that someone's body may be farmed for body parts.

In 1984, 19-year-old Terry Wallis was thrown from his pick-up truck in an accident near his Massachusetts home.

He was found 24 hours later, in a coma suffering massive brain injuries. Doctors described his condition as being in a “minimally conscious” or a “permanent vegetative state” and gave little hope he would ever improve.

For 19 years, his family kept faith. Then, in 2003, he started to speak.
Wallis’ father said his son is now able to make jokes. 
“That was something he wasn’t able to do early in his recovery,” Jerry Wallis said. “He now seems almost exactly like his old self. And he very often tells us how glad he is to be alive.”
Terry’s family had to fight for him and stood by him. Hassan’s family are fighting for him, but what odds are set against them!
- National Post

 The usual technique of euthanasia is when a doctor administers a lethal injection to a patient. However, when a doctor withdraws life-sustaining nutrition and fluid from a comatose or sedated patient, is this not a form of slow euthanasia?  
- Paul Russell

Its the Same The Whole World Over

It's the same the whole world over,

It's the doctors wot decide, 
Who gets and don't get treated,
Who gets left until they've died.

A Rogue, By Any Other Name...

"The issue of whether or not the provision of nutrition and hydration to patients should be considered as medical treatment and, therefore, subject at some level to the discretion of doctors, has received some good press lately.

In Canada, the Euthanasia Prevention Coalition (EPC) fought a legal battle, alongside the family of a comatose patient Mr Hassan Rasouli, to prevent medical staff in a Toronto hospital from removing life-sustaining nutrition and hydration from Mr Rasouli.

An Ontario court subsequently ruled that doctors are required to obtain the consent of either the patient or a substitute decision-maker (such as the patient’s guardian) before withdrawing life-sustaining interventions." – Careful!

Hassan Rasouli, who recently started reacting after being in vegetative state at Sunnybrook Hospital, photographed with his daughter Majgan and wife Parichehr Salasel at the hospital on Bayview Ave.,Toronto 24, 2012, - Hassan Rasouli, who recently started reacting after being in vegetative state at Sunnybrook Hospital, photographed with his daughter Majgan and wife Parichehr Salasel at the hospital on Bayview Ave.,Toronto 24, 2012, | Fernando Morales/The Globe and M

Vegetative patient now able to give ‘thumbs up,’ fuelling debate over life support

From Wednesday's Globe and Mail

A hospital patient deemed vegetative is now able to make a “thumbs up” gesture – a sign to family that he is aware, but not yet strong enough to persuade doctors to drop a recommendation to withdraw life support.
The symbol marks a dramatic turn for Hassan Rasouli, 60, who until recently was in a persistent vegetative state. An affidavit filed with Canada’s top court says he’s now minimally conscious, and doctors’ reports say he can “voluntarily control” certain behaviours – suggesting he may be aware but trapped in a paralyzed body.
This new diagnosis seems certain to inflame an already divisive ethical debate about who decides to withdraw life support. And it raises the discomfiting notion – the stuff of relatives’ nightmares – of a patient being aware but unable to communicate when the machines are turned off.
The Globe And Mail 

The Globe and Mail

A duty of care
While in hospital, Rasouli acquired meningitis that collapsed him into what doctors called a “permanent vegetative state.” Within weeks of the surgery, Sunnybrook physicians began pressing the Rasouli’s family to impose a “do not resuscitate” order.
Gradually, the physicians threatened to make the decision unilaterally, the family alleges.
Salasel, a trained physician in her native Iran, denied the physicians’ diagnosis, insisting that her husband continued to show physical responses to questions.
The dispute took a dramatic turn last year when the hospital upgraded Rasouli’s condition to “minimally conscious.”
“For me, he is conscious because he understands what I am saying to him and he responds to me,” Salasel said outside of the courtroom, describing how her husband holds up his fingers in response to queries and communicates with his eyes.
Mojgan, a graduate student in Toronto, says her father has become “the representative of the value of life.”
“I know he wants to be alive,” she told reporters. “He got infected in the hospital. So the health care team, the doctors, the health care practitioners, they are responsible (for) what they have done to my father.”
Hodder cited statistics indicating a third of patients in such a state make a “marked recovery” and that those in a permanent vegetative state can be misdiagnosed nearly 30 per cent of the time.

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