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Euthanasia? What choice for yourself?

Started by , Apr 01 2005 06:09 AM

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75 replies to this topic

#61 cyric

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Posted 15 July 2005 - 12:13 AM

The fact of the matter remains, when you're brain dead, there is NO coming back. Who the hell would want to live like a vegetable?! I certainly would want the plug pulled on me. If I had any debilitating mental disorder that meant I had the IQ of a boiled potato, I would want to die, that's for sure. And none of that dehydration stuff either, I'd want lethal injection. Just my opinion.

#62 FutureQ

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Posted 15 July 2005 - 02:55 AM

As to not knowing where permanent memory is stored. I'm sorry but you are mistaken.

I don't dispute that memory is encoded in the spatiotemporal conformation of a three dimensional network of synapses and their biochemical modulators. What is contentious is what is more commonly known as the localization problem (1), that is, where specifically in the cortex long term memory exists. Furthermore, how redundant is the arrangement of memory storage? In other words, can memory be stored in more than one locus? These questions have not been answered as yet. What we do know is that ischemia-induced brain damage can be repaired and that function can be recovered (2). What we can speculate about are the effects of large scale replacement of cortex via stem cell based regeneration. Personally, I suspect that memory is not specifically localised in one region but may have a fractal nature (3) by being reflected in more than one representation and one locus. This is supported by studies where substantial amounts of brain damage have yielded minimal impact to the patient and by studies where trauma induced memory loss was been shown to be mostly recoverable given sufficient time.

the loss of so much brain material as Terri had lost must mean that the identity that was Terri Schiavo was gone

How can you be so sure? Such a conclusion would only follow if we conclusively knew where and how memory was stored. There is much about brain function we do not yet know.

what was of concern here, the original person's wishes

I agree. In order to make such a decision, however, one must be suitably informed. Can you say with confidence that PVS is irreversible? In fact PVS has difficulty being defined (4) and more difficulty with being accurately diagnosed (5). In the face of such dramatic advances in regenerative medicine soon to be made available by stem cell therapeutics how can one responsibly rule out the prospect of some recoverability of long term memory?

I say that it is only possible to suggest PVS as irreversible based on pre-stem cell medicine.

Do you think Terri Schiavo would have chosen such a fate?

I believe that were she privy to information such as is found at Imminst she would not have agreed (if what her husband says is true) to be euthanised. I believe she would have wished her husband to get on with his life and be happy and let science and medicine do what they could when the time was right. But end her life - because of the amount of brain tissue lost - no.

We do not yet know how much of a PVS patient's long term memory can be salvaged by stem cell regeneration.

In the near future, the doctors responsible for this decision - and I hope they are still around - will probably say, just like the many who made bad choices before them, that they were governed by the light they had available. What I find disturbing is that the same darkness of ignorance should cloud the vision of so many here.

(1) Annu Rev Psychol. 2005;56:1-23.
In search of memory traces.
Thompson RF.

(2) J Cereb Blood Flow Metab. 2005 May 25
Reappearance of hippocampal CA1 neurons after ischemia is associated with recovery of learning and memory.
Bendel O, Bueters T, von Euler M, Ove Ogren S, Sandin J, von Euler G.

(3) J Neurosci. 2001 Feb 15;21(4):1370-7.
Long-range temporal correlations and scaling behavior in human brain oscillations.
Linkenkaer-Hansen K, Nikouline VV, Palva JM, Ilmoniemi RJ.

(4) NeuroRehabilitation. 2004;19(4):381-9.
Permanent vegetative state: usefulness and limits of a prognostic definition.
Borthwick CJ, Crossley R.

(5) Lancet Neurol. 2004 Sep;3(9):537-46.
Brain function in coma, vegetative state, and related disorders.
Laureys S, Owen AM, Schiff ND.

Every single bit of this that you wrote is meaningless and I'm am simply nonplussed that you do not see why.

You can argue all you want about locus of memory 'within the cortex' and actually I'd be happy to agree with you on all points!

What you fail to recognize is that her CORTEX was gone!

How on Earth can any point about where within the cortex that memory may reside be of any use when she had no cortex remaining!?

I'm done with this.

FQ

#63 cyric

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Posted 15 July 2005 - 03:13 AM

Memory is not stored in any one place. A lab experiment was done on mice. They trained them all to do something (I forget what). There were 12 mice, and for each, they removed a small portion of the brain from a different section (one section for each mouse, not all sections for all mice). And they still performed the task (how ever clumsily), leading them to realise that memory doesn't have a centre of storge (anything to specifically contain all memories).

#64

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Posted 15 July 2005 - 03:37 AM

Every single bit of this that you wrote is meaningless and I'm am simply nonplussed that you do not see why.

You would be less confused if you read the autopsy report for yourself - carefully - taking particular note of the section associated with the Neuropathology Macroscopic Description at pages 3-4.

You can argue all you want about locus of memory'within the cortex' and actually I'd be happy to agree with you on all points!

What you fail to recognize is that her CORTEX was gone!

How on Earth can any point about where within the cortex that memory may reside be of any use when she had no cortex remaining!?

The frontal cortex (associated with higher cognitive functions) and medial thalamus (associated with transmitting sensory information - like pain) were relatively well preserved. The cerebral cortex pyramidal neurons (carry messages from the brain to voluntary muscles) were largely absent. It suggests her brain was capable of some rudimentary cognition and pain perception without the ability to communicate - rather insidious don't you think?

I'm done with this.

Promises, promises.

#65

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Posted 22 July 2005 - 02:57 AM

With prior knowledge that TS had an MRI some 5 months after the onslaught of her condition, stated by prometheus elsewhere on the web one day before starting this poll and thread, prometheus repeatedly lied here about something he already knew was false. That strongly suggests that prometheus was intentionally misleading members of this forum.

Be careful here Chip - you are accusing me of lying. I don't mind you arguing that I was mistaken, that I should not have sounded so absolutist that she never ever had an MRI when according to her medical record she did have 1 MRI scan 5 months after her injury. But for you to continuously accuse me of lying is out of line. At the time that these discussions took place the consensus was that she never had an MRI. People of greater standing in the community than myself including politicians stated on record that she never had an MRI scan. The very autopsy report does not make mention of it and only states why she could not have one. Are all these people liars too?

My contention was and remains today that TS should have been permitted an MRI scan, more specifically an fMRI scan (technology which was not available when she sustained her injury) during the period when her diagnosis was being most critically reviewed and whose findings would weigh heavily in a diagnosis of PVS. As you recall the judge made a decision not to permit an MRI. Even considering that an MRI had been conducted almost 15 years ago, don't you think it should have been permitted if it helped clarify the diagnosis? A lot can happen in 15 years from the possibility of some brain regeneration to more advanced methods of performing and clinically interpreting MRIs.

I realize it must be difficult for you to realize that your quest has been quixotic, that your perception of me as some nefarious right-wing fascist could well be a delusion. But you're going to have to accept the reality that I'm not. So why don't you give it a rest and let's move ahead, each of us to the best of our abilities, to help solve the disease of death.

#66

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Posted 22 July 2005 - 05:23 AM

I did not say I was mistaken I said that I don't mind you arguing your case in this way. So if this is something you wish to argue, which is fair enough, show me the dates and contents of the posts that have given you this impression.

#67

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Posted 22 July 2005 - 06:34 AM

This is what I said at that Blog, Chip.

March 30th, 2005 at 1:37 am
With a womans life on the line and conflicting evidence from both sides, some updated testing (e.g. PET, MRI or fMRI) would help clear the air rather than this morbid wait for the woman to die in order for an autopsy to be performed. It is disturbing that Judge Greer is being so inflexible when it comes to conducting these additional tests when the record states that the last CT scan was performed in 2000 and the last MRI in 1990. The brain, like any other organ is capable of some regeneration, and contrary to the dogma for many years, neural stem cells have been identified to exist in the adult human brain.

I am appaled to see the Terri’s family begging the husband to relase her in their charge. I see no reason why he should not immediately do this.

I can see that you're right - there are at least two occassions where I have said that TS never had an MRI when in fact she had one in 1990. It was an fMRI scan that in fact she never had. Thank you for making this clear. I stand corrected.

That, however, does not make me a liar, Chip. A liar is a person who deliberately falsifies, fabricates and deceives. When I was arguing my point on what I felt was an ill-founded decision my focus was drawn on the basis for the diagnosis and the Judge's persistence not to perform any further diagnostics. I may have allowed myself to become myopic since this subject was very emotionaly charged.

* If you wish to discuss my views on SENS please initiate a new thread and I will be happy to accomodate you.

#68

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Posted 22 July 2005 - 06:47 AM

What about the claim that the TS case was one of euthanasia? If it was and that is tantamount to murder according to Florida law then by claiming it is a case of euthanasia you are supporting the contention of others profligating on the web that the case was one of judicial murder.

That's right. In my view it constitutes Judicial murder. The Judge refused to entertain an updated diagnosis, particularly using a never before perfomed fMRI scan. The Judge by allowing her husband's wish to enforce dehydration caused the death of TS. The Judge did this without, in my view, full use of the available spectrum of diagnostic methods. Therefore, in my view again, the judge was negligent. This is my opinion Chip. I could be wrong but that's how I feel about it. I don't think the Judge did enough to explore all the possibilities. I've seen the legal system go through hoops when it comes to preventing an execution of a convicted child rapist and killer but I did not see the same degree of exhausting all options in the case of TS.

#69

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Posted 22 July 2005 - 07:31 AM

The attack against SENS is the same as this attack against a person having control over their own destiny.

I think you are beating a dead dog here, Chip. There is really no more to say on the matter of MRI's, fMRI's and TS. In respect to any other concerns that you have about my competence as an Advisor I suggest you address them to the Directors who will be happy to hear them. Perhaps you could post something on your website or another board if you feel you must continue but I think ImmInst has had enough of this discussion.

Once again if there are any matters on the science or policy of SENS that you wish to debate with me please initiate a new topic.

#70

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Posted 22 July 2005 - 08:33 AM

I don't know about that one Chip. I'll get back to you.

#71

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Posted 22 July 2005 - 09:35 AM

Euthanasia is defined as assisted suicide in the Thesaurus. I would think suicide means it is the patients' wish.

BTW, that's a great idea Chip - why don't you contribute to Wikipedia!

#72

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Posted 23 July 2005 - 03:10 AM

Days of dehydration and starvation don't seem to meet that mark.

No they do not in my view either, but the induction of death by dehydration appears to be practiced in nursing homes in the US. In the Netherlands where euthanasia is legal death is induced by lethal injection. Apparently death by dehydration is a revolting and horrible way to die, taking as long as 2 weeks whilst the body undergoes tremendous physiological adaptations to conserve water for brain and heart function. On the other hand in some terminally-ill end-stage cancer patients whose senses have been distorted by the disease they cannot tolerate any food or water outside of IV administration.

Here is an interesting excerpt from an article by Wesley J. Smith of the Weekly Standard:

At age 33, Kate Adamson collapsed from a devastating and incapacitating stroke. She was utterly unresponsive and was diagnosed as being in a persistent vegetative state (PVS). At the urging of doctors, who believed she would never get better, her nourishment was stopped. But midway through the dehydration process, she began to show subtle signs of comprehension, so her food and water were restored.

Adamson eventually recovered sufficiently to author "Kate's Journey: Triumph Over Adversity," in which she tells the terrifying tale. Rather than being unconscious with no chance of recovery as her doctors believed, she was actually awake and aware but unable to move any part of her body voluntarily. (This is known as a "locked-in state.") When she appeared recently on "The O'Reilly Factor," host Bill O'Reilly asked Adamson about the dehydration experience:

O'Reilly: When they took the feeding tube out, what went through your mind?

Adamson: When the feeding tube was turned off for eight days, I thought I was going insane. I was screaming out in my mind, "Don't you know I need to eat?" And even up until that point, I had been having a bagful of Ensure as my nourishment that was going through the feeding tube. At that point, it sounded pretty good. I just wanted something. The fact that I had nothing, the hunger pains overrode every thought I had.

O'Reilly: So you were feeling pain when they removed your tube?

Adamson: Yes. Oh, absolutely. Absolutely. To say that — especially when Michael [Schiavo] on national TV mentioned last week that it's a pretty painless thing to have the feeding tube removed — it is the exact opposite. It was sheer torture, Bill.

O'Reilly: It's just amazing.

Adamson: Sheer torture . . .

In preparation for this article, I contacted Adamson for more details about the torture she experienced while being dehydrated. She told me about having been operated upon (to have her feeding tube inserted in her abdomen) with inadequate anesthesia when doctors believed she was unconscious. Unbelievably, she described being deprived of food and water as "far worse" than experiencing the pain of abdominal surgery, telling me:

"The agony of going without food was a constant pain that lasted not several hours like my operation did, but several days. You have to endure the physical pain and on top of that you have to endure the emotional pain. Your whole body cries out, 'Feed me. I am alive and a person, don't let me die, for God's Sake! Somebody feed me.'"

But what about the thirst, I asked:

"I craved anything to drink. Anything. I obsessively visualized drinking from a huge bottle of orange Gatorade. And I hate orange Gatorade. I did receive lemon flavored mouth swabs to alleviate dryness but they did nothing to slack my desperate thirst."

Apologists for dehydrating patients like Terri might respond that Terri is not conscious and locked-in as Adamson was but in a persistent vegetative state and thus would feel nothing. Yet, the PVS diagnosis is often mistaken — as indeed it was in Adamson's case. And while the courts have all ruled that Terri is unconscious based on medical testimony, this is strongly disputed by other medical experts and Terri's family who insist that she is interactive with them. Moreover, it is undisputed that whatever her actual level of awareness, Terri does react to painful stimuli. Intriguingly, her doctor testified he prescribes pain medication for her every month during the course of her menstrual period.

#73

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Posted 23 July 2005 - 03:30 AM

You have agreed with others that the main judge in the lower court of jurisdiction was guilty of judicial murder. Would you then have to consider the supreme court of Florida as also being judicial murderers because they upheld the lower decisions?

I can't say for two reasons: one I have not read the statement and related testimonies of the Florida supreme court in this matter and two, I am venturing outside my field of expertise (I am not a reader of law). Despite the latter deficiency I formulated my opinion on Judge Greer's dehydration enforcement based on researching his decision rationale and associated testimonies. I could see no reason why he did not permit more testing when - ignoring for a moment that this woman's life was at stake - it would have served at the very least to keep a country already polarised on so many fronts from being polarised further. It was a bad call on so many different levels, but what offended me the most was that he did not support such a decision by rigorous scientific method.

What do you think should be done with murderers? Who should bring them to justice and how? Seems to me if we are talking about "judicial murder" the powers that must be brought to bear to punish the guilty must be nonjudicial. Who does what, vigilantes, the military, the legislature, the executive branch, who and what?

If you're talking about bad calls in the judiciary, I think - I hope - that their decisions will haunt them till the end of their days.

#74 susmariosep

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Posted 23 July 2005 - 10:51 PM

Euthanasia and assisted suicide and suicide.

If I may, as a man in the street, here are my thoughts about euthanasia, assisted suicide and suicide.

There are always at any time in mankind's history a very great majority of mankind that wants to live and continue living notwithstanding the most inhospitable of situations they find themselves in.

However there is always a number who opt to depart from life quickly, easily and painlessly, and economically in all respects of saving money, trouble, and time of other people and the community.

These latter people should be allowed to effect self-enacted departure without any kind of hindrances from the state.

And doctors and others who believe in assisted suicide, I think their advocacy should be better and more effectively directed toward the dissemination of information on the merits of self-effected departure or death, and the instructions on how to DIY (do it yourself), quickly, easily and painlessly, and economically in all respects to other people and the community, their time, trouble, and money.

I myself opt for self-effected departure and I would like to organize a society of such fellow minded people, for our mutual encouragement and instructions on the optimal manners of effecting self-departure, as I said, quickly, easily and painlessly, and economically in respects of time, trouble, and money of other people and the community.

As regards euthanasia in the case of sick people who can continue in a mockery of living, doctors and family members are doing that all the time when the ones suggest to the others that no medical remedies available can improve the morbid condition of the patient, or that improvement could be possible but only with enormous cost, time, and trouble to the family, and these latters agree and allow doctors to stop all medications and pull off all plugs from the patient.

That's why I can't accept all these endless controversies about keeping Terri Schiavo alive or letting her die in peace.

An aside: I see, Chip and Prometheus are into a more academically and professionally suited mood, a good sign. Now, if they would just let bypass be bypass: now that they know with whom they are dealing when they interact on issues which both care for and about strongly.

Humor respite only. Hahaha and hehehe.

Susma

#75

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Posted 24 July 2005 - 01:01 AM

these endless controversies about keeping Terri Schiavo alive or letting her die in peace.

Not so controversial for an intelligent person..

- TS was not terminally ill - she had undergone extensive brain damage, her other organs were in reasonable health

- the clinical diagnosis was conflicting - professional neurologists could not reach a consensus on PVS (the court appointed ones did find PVS the ones engaged by the family did not)

Not so controversial for an Immortalist..

- there is no such thing as "letting one die in peace" - this is a meaningless romanticization to minimize guilt on the part of the living - death is a revolting, painful, irreversible process that every living thing fights against with all the resources that can be mastered - preferable to say die painlessly by merit of a massive dose of barbituates - but where does one draw the line, and knowing what we do as Immortalists (stem cell regenerative therapeutics just around the corner, escape velocity within 50-100 years, etc) is it not wrong to permit such extinction of life without taking all responsible counter-measures to preserve life until suitable treatments become available?