Reviving injured brains
There's a paper in Nature this week detailing how doctors used an implant to increase the level of brain function in a man in a minimally conscious state. (Coverage from News@Nature, NYT, others). This is exciting news, but it does raise a few questions:
-As some of the coverage has asked: Are we stepping into an ethical gray area by doing experimental procedures on people who are not able to consent?
-Every few months there's some kind of report about doctors finding a new way to prompt, revive or observe activity in the brain's of people who otherwise would be in the little-or-no-hope category. Should these research developments push us to view the status of people in unconscious states differently?
-This most recent development was observed in only one patient, but it will get a lot of spread in the press (as a lot of these stories do). How should doctors and ethicists approach the conversations that will inevitably come up now with the families of patients in these states? How do you help families balance hope and reality?
-Greg Dahlmann
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None of these are really new questions. There was a big push several years ago to make it easier to "enroll" such patients into research that would be of no direct benefit to them.
Your last two questions are not new either, just underexplored. Just 6 years ago, the California Supreme Court shot down attempts to increase the ability of conservators to deny lifesaving medical treatment to incapacitated people in the Robert Wendland case. 43 bioethicists supported the contention that conservators should have the right to order withholding of artificial nutrition and hydration, even against the objects of the person under conservatorship. Two ethicists from AMBI signed onto that brief.
Finally, we have had a couple of really alarming stories of "rush to judgment" in the past few years. Both Haleigh Poutre in Massachussetts and Jesse Ramirez in Arizona narrowly escaped death -- attempts to withhold feeding tubes were initiated within weeks after their respective injuries. Only court contests bought these people time to show recovery within a pretty well-accepted time period.
These are things that get lots of discussion within the disability community. For some reason, they don't seem to interest ethicists.
- by Stephen Drake on Aug 2, 2007 at 1:32 PM | link
Balancing hope with reality is the challenge patients and families face when confronted with most medical issues. Actually, knowledgeable people face this question every morning, but the intensity of medical issues sends the message in bold letters. If evidence based medicine is the rule of the day, shouldn't patients and/or family members be given the same statistical data health professionals have before they are asked to make a decision?
Onehealthpro
- by Onehealthpro on Aug 6, 2007 at 8:27 AM | link