Respect for patient autonomy and the right of individuals to make their own healthcare decisions where possible lies at the core of the recent Mental Capacity Act 2005. The Act gives statutory authority to “Advance Decisions” (ADs) – enabling people to communicate their healthcare decisions in advance of losing the capacity to do so (e.g. due to coma or dementia). This is increasingly important when new medical technologies mean it is now possible keep people alive for years or for decades in permanent vegetative or minimally conscious states (i.e. with no – or virtually no – awareness of themselves or their environment).
The Supreme Court of Canada heard the case of Toronto patient Hassan Rasouli Monday, which centres on the complex and often deeply painful issue of who should decide end-of-life care. With an aging demographic, increased life expectancy and ever more sophisticated technological interventions, these kinds of cases will almost certainly become more frequent. This is a welcome chance for the country’s highest court to clarify how end-of-life treatment should proceed when a physician and a patient’s family disagree.
Although DJ's condition is in many respects grim, I am not persuaded that treatment would be futile or overly burdensome, or that there is no prospect of recovery. (a) In DJ's case, the treatments in question cannot be said to be futile, based upon the evidence of their effect so far. (b) Nor can they be said to be futile in the sense that they could only return DJ to a quality of life that is not worth living. (c) Although the burdens of treatment are very great indeed, they have to be weighed against the benefits of a continued existence. (d) Nor can it be said that there is no prospect of recovery: recovery does not mean a return to full health, but the resumption of a quality of life that DJ would regard as worthwhile. The references, noted above, to a cure or a return to the former pleasures of life set the standard unduly high.
A woman left with irreversible brain damage and diagnosed as being in a permanent vegetative state is to be allowed to die with dignity after a judge dismissed reports by two “shocked” therapy assistants that she may have repeatedly whispered the word "die". Mr Justice Roderic Wood, sitting in the Court of Protection in London, ruled that "J", 56, who suffered a catastrophic heart attack in September 2010, is in a permanent vegetative state (PVS) "with no sense of awareness and no prospect of recovery".
ROMA - I punti salienti della legge sul testamento biologico approvata oggi alla Camera, che per il varo definitivo dovrà tornare al Senato, sono almeno due: le dichiarazioni anticipate di trattamento non sono vincolanti per i medici ed escludono la possibilità di sospendere nutrizione e idratazione, salvo in casi terminali. Inoltre, sono applicabili solo se il paziente ha un'accertata assenza di attività cerebrale.
On the face of it, the decision by a High Court judge in the case of M is no surprise - few would have expected a ruling to allow a patient with any level of consciousness and feeling to die. But a closer inspection of the 76-page judgement shows that Mr Justice Baker did not find his decision a straightforward one.
We aim to improve the medical care and understanding of disorders of consciousness following an acute insult such as coma, vegetative state, minimally conscious state or locked-in syndrome. Coma Science Group Cyclotron Research Center & Neurology Dept University of Liège
The Neuromedia Corner aims to share news and stimulate an effective dialogue about the state of the art of neuroscience technologies, their risks and benefits and the associated ethical and social issues. The Neuromedia Corner is an idea of the bid - Brains in Dialogue project.
In this article, I consider whether the advance directive of a person in minimally conscious state ought to be adhered to when its prescriptions conflict with her current wishes. I argue that an advance directive can have moral significance after its issuer has succumbed to minimally conscious state. I also defend the view that the patient can still have a significant degree of autonomy. Consequently, I conclude that her advance directive ought not to be applied. Then I briefly assess whether considerations pertaining to respecting the patient's autonomy could still require obedience to the desire expressed in her advance directive and arrive at a negative answer.
Scientists have been able to reach into the mind of a brain-damaged man and communicate with his thoughts. The research, carried out in the UK and Belgium, involved a new brain scanning method. Awareness was detected in three other patients previously diagnosed as being in a vegetative state. The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world. Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. The scientists used functional magnetic resonance imaging (fMRI) which shows brain activity in real time.
What if those coma patients thought to be beyond help could actually hear what we are saying? Could feel when pushed and prodded? Could respond to doctors, if only they could see the signs? A new group of neuroscientists thinks it has proved we can communicate with these “locked-in” patients – though not everyone believes them