Palliative Sedation Not = To Terminal Sedation/Euthanasia

Wesley J. Smith: The pro-euthanasia crowd intentionally and wrongfully conflates palliative sedation – that is sedating a dying patient at the end of life who is experiencing intractable pain or symptoms – with both euthanasia – fast killing the patient – and terminal sedation – slow killing the patient by inducing coma and withdrawing food and water. A good piece in the Journal of Pain & Palliative Care Pharmacotherapy (201 2;26:30-39) shatters that lie. First, it notes that in palliative sedation, the point is to use the least amount of sedative to accomplish the needed palliation. From “Review of Palliative Sedation and Its Distinction From Euthanasia and Lethal Injection:”

Ideally, the level of palliative sedation is provided in a fashion that is titrated to a minimal level that permits the patient to tolerate unbearable symptoms, yet the patient can continue to periodically communicate…The three most common levels of providing PS include mild, intermediate, and deep. When mild sedation is used, the patient is awake and the level of consciousness is lowered to a somnolent state, withverbal or nonverbal communication still possible. With intermediate sedation, the patient is asleep or stuporous and can still be awakened to communicate briefly. The third level is deep sedation, which refers to the patient being near or in complete unconsciousness and does not communicate verbally or nonverbally. Besides regulating the degree of sedation, palliative sedation may also be provided intermittently or continuously…

The points to take away from the above are 1) palliative sedation is individualized to the patient’s needs, 2) the point isn’t to end the life of the patient, and 3) levels of sedation may vary in the same patient from time to time. In contrast, euthanasia kills the patientwith a lethal injection. And “terminal sedation” is merely the imposition of coma and withdrawing artificial nutrition and hydration, sometimes without actual medical need and/or to make it easier for care givers–as in the much abused Liverpool Care Pathway in the UK.

Facing up to the Ethical Dilemmas in the Healthcare Debate

Time: Who decides how much to do? Does everyone deserve the same care? Is medical progress always a good thing? Is there ever a case for discouraging the development of a technology that is socially disruptive?

Researchers replicate Alzheimer's disease neurons with stem cells

FoxNews: To create the neurons, the researchers extracted fibroblasts—cells from the skin—of two patients with familial Alzheimer’s, two patients with sporadic Alzheimer’s and two people with no known neurological problems. The researchers then reprogrammed the fibroblasts into stem cells, which then differentiated into working neurons. The neurons may prove to be a crucial tool for studying the causes of Alzheimer’s, as well as developing and testing drugs to treat the disease.

Mayo Study: Withdrawing LVAD Support Is Ethical

Mayo Study: Withdrawing LVAD Support Is Ethical - Health Blog - WSJ: High-tech medical devices can raise tricky ethical questions — just consider the left ventricular assist device (LVAD). The pricey device essentially takes over the function of the left ventricle, helping a heart to continue beating when it would otherwise fail. But what happens when patients become very, very sick and are essentially being kept alive by the LVAD? Is turning off the device more akin to euthanasia or taking someone off a ventilator?

LVADs make some clinicians uncomfortable for several reasons, they write — the device seems almost like a replacement part than outside assistance, for example. Researchers write, though, that withdrawing LVAD support isn’t the same as assisted suicide or euthanasia because there’s no “new pathology” introduced to cause death. Death, when it comes (all 14 patients died within a day of turning off the device), is due to the underlying heart failure, they write. So assuming patients or their representative know the consequences of deactivating the device, clinicians should honor their wishes.

The Ethics of Discontinuing Dialysis

Lewis M. Cohen, MD, examines the true story of two renal nurses at Baystate Medical Center (Springfield, MA) who were investigated for murder in 2001 after a nursing assistant accused them of causing the death of a patient. The patient was a woman in her 60s with multiple comorbidities; she and her family chose to stop her dialysis treatment and continue with palliative care only. The nursing assistant approached the district attorney's office with her allegations, and a full murder investigation was launched. Renal & Urology News

Shame on the MS Society

The American Multiple Sclerosis Society issued the following statement regarding "Embryonic Stem Cell Lines Available for Federally Funded Research":

The National Multiple Sclerosis Society urges Congress to support the Stem Cell Research Enhancement Act of 2007 (H.R.3 and S.5) at all levels of the legislative process. The legislation would increase the number of approved embryonic stem cell lines that can be used in federally funded research by allowing new lines to be generated from embryos that have been donated for research purposes by people using the services of in vitro fertilization clinics, while establishing important ethical protections.

[Translation: The MS Society was/is just itching to get their hands on stem cells at the cost of human life generated artificially by perverse science.] Mark Pickup

The disappearing disabled

The thinking behind eugenics isn’t very difficult to understand. People are different in many ways. Some of these differences are socially and medically acceptable, others are not. We need more people with socially acceptable traits, fewer people with undesirable traits. There are two ways to do this. One, we passively encourage people with undesirable traits not to reproduce, but this takes a long time to reduce the undesirable population. Two, we actively take steps to eliminate those with undesirable traits by whatever means we can. Historically, that has meant sterilization, abortion, laws banning people with undesirable traits from marrying or reproducing, and the killing of so-called defectives. MercatorNet

Cerebral Palsy Stem Cell Trial Begins

U.S. scientists say they are starting a clinical trial to determine whether stem cells from umbilical cord blood can help children with cerebral palsy.
Medical College of Georgia researchers said their study represents the first such U.S. Food and Drug Administration-approved clinical trial. The study will include 40 children age 2-12 whose parents have stored cord blood at the Cord Blood Registry in Tucson, AZ. OfficialWire

First U.S. stem cells transplanted into spinal cord

For the first time in the United States, stem cells have been directly injected into the spinal cord of a patient. Doctors injected stem cells from 8-week-old fetal tissue into the spine of a man in his early 60s who has advanced ALS, or amyotrophic lateral sclerosis. . . . These particular stem cells -- which came from the spinal cord of an 8-week-old fetus -- are neural stem cells, which have the ability to turn into different types of nerve cells. These are not the same stem cells as the controversial human embryonic stem cells, which destroy the embryo when the stem cells are removed. CNN

Editor: Are they hoping to slip one past us, as though the 8-week-old fetus isn't being destroyed. Oh right, it's aborted first. Not "controversial?" I don't think so. See What About Fetal Tissue Harvesting?

What lies beneath

The debate — OK, the shouting match — we are having over "health-care reform" is about many things, including cost, who gets help and who does not and who, or what, gets to make that determination. Underlying it all is a larger question: Is human life something special? . . . The bottom line is not the bottom line. It is something far more profound. Our decisions regarding who will get help and who won't are about more than bean-counting bureaucrats deciding if your drugs or operation will cost more than you are contributing to the U.S. Treasury. Cal Thomas

What and when is death

The President’s Council on Bioethics has taken up this question in a recently published report entitled Controversies in the Determination of Death. At stake in the report is the moral status of those human beings who are “suspended at the threshold.” These are human beings who have suffered the worst sort of injury to the brain, but who, with technological support, retain ambiguous signs of life. The brain injury leaves them in a state of incapacitation significantly more profound than that associated with the “persistent vegetative state,” the condition associated with the cases of Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo. The name given to their injury is “brain death,” or sometimes “whole brain death.” The President’s Council suggests a more neutral term: “total brain failure.” Calling the condition by this name does not pre-judge the question of whether the patient so diagnosed is alive or dead. The New Atlantis

Ethics on Value of Life the Dilemma for Health Care Reform

Oncologists often face the questions about life and death often because they deal with a disease, cancer, that kills many people. Some therapies promise only to give a few extra months of life. Some of those therapies are painful, invasive, or debilitating. The ethical concerns about cost of a procedure vs. the length of time it can prolong a person’s life is an issue many physicians face with their patients. So how does a doctor make those choices? Digital Journal

British grandmother oldest stem cell donor

Erica Henderson, 75, has been allowed to transfer her cells to Paul Hallowes despite being too old under medical guidelines. He would have died without the stem cell therapy but despite having three children and five grandchildren a suitable donor could not be found. Mr Hallowes was told he had just two years to live until doctors discovered his sister was a 'perfect match' for the procedure. Telegraph

Organizations supporting embryonic stem cell research

Michigan Right to Life has compiled a helpful list of organizations that have expressed support for human embryonic stem cell research. Information comes from three sources: policy statements, membership in coalitions that lobby for the research and signatures on letters expressing public support for the research. Some organizations listed also contribute funding for embryonic stem cell research. Stem Cell Research Cures

Sadly, the list includes popular and well-known organizations such as: Alliance for Aging Research, ALS Association, Alzheimer's Association, American Cancer Society, American Federation for Aging Research, American Heart Association, American Parkinson's Disease Association, Paralyzed Veterans of America, Parkinson's Action Network, Parkinson's Disease Foundation, and many, many more.

Bioengineering Graft Could Lay Ground for Organ Growth

A roll-your-own blood vessel, grown in the laboratory from a person's own cultured cells, works well in kidney dialysis patients, making it the first complex bioengineered tissue part built without synthetic components. The technique may someday be used to grow internal organs as well, researchers say. NewScientist Health

Couples Forced Into Abortions or Have Disabled Child as NHS Refuses to Fund Tests

Couples with serious genetic conditions in their family have been forced to face the agonising decision to bring up a disabled child or terminate a pregnancy because the NHS is refusing to pay for testing, experts said. Telegraph.co.uk

Eschew Enhancement: Memory-Boosting Drugs Should Not Be Made Available to the General Public

In an effort to provide Alzheimer's and schizophrenia patients with better, safer medicines, biotech and big pharma have embarked on drug discovery programs targeting multiple cognitive mechanisms. For patients suffering from these diseases, the new drugs have the potential to improve cognitive function over a longer term than available treatments, which fade in effectiveness over time. Yet given the leaky and lucrative electronic trade in prescription drugs, it's likely that these medicines will also be available to healthy people who hope to benefit from them as well. MIT Technology Review

Who Are You To Say?

Taken at face value, the "Who are you to say?" question challenges one's authority to judge another's conduct. It says, in effect, "What authorizes you to make a rule for others. Are you in charge? Are you the police or the king or something?" This challenge miscasts my position. I don't expect anyone to obey me simply because I say so. I'm appealing to reason, not asserting my authority. Challenging me misses the point. I'm not commanding, but persuading. It's one thing to force beliefs; it's quite another to state those beliefs and appeal for them. Stand To Reason

Brain Death: Can It Be Resuscitated?

Why is a patient with a destroyed brain considered dead rather than moribund and irreversibly comatose? The world has been grappling with this question for the past four decades with little success. The recently released white paper of the President’s Council on Bioethics is in many respects a refreshing, thoughtful, and comprehensive reexamination of this complex topic. The Hastings Center

Paramedics Told: 'Let Accident Victims Die if They Want To'' in New Row Over Patient Rights

Health Service paramedics have been told not to resuscitate terminally-ill patients who register on a controversial new database to say they want to die. It has been set up by the ambulance service in London for hundreds of people who have only a few months to live so that they may register their 'death wishes' in advance. UK DNR Registry. As Wesley Smith points out here, the title is missleading. This is speaking of a DNR (Do Not Resuscitate) request for terminal patients - which is perfectly ethical and in line with Hospice's standard of care for end-of-life - and not and act to deliberately hasten death (euthanasia/physician-assisted suicide).