Wednesday, April 06, 2005

Bioethics for Dummies

My March 30 post notwithstanding, I've become interested enough in the Schiavo controversy that I dragged myself over to a brown bag lunch hour discussion of the case on Monday. It was sponsored by Duke University's Institute on Care at the End of Life.

The discussion didn't touch much on the political and media aspects of the Schiavo phenomenon. The speakers were pretty circumspect, and to me were partly taking an opportunity to give their standard rap on palliative care at a time when public interest in their field is high. They discussed the importance of a living will or advance directive, AND of discussing your wishes with loved ones (there is potential for court challenges even with the existence of a document), AND of being careful when you assign power of attorney (a spouse or other loved one may be too overwrought to carry out your wishes effectively).

The lead speaker at the meeting, Dr. Payne (don't bother, he's heard them all), happens to be a neurologist as well as a theologian, and so could comment substantively on Ms. Schiavo's condition. He had grabbed Ms. Schiavo's CAT scan off the Internet (it's widely circulated due to all the legal and media wrangling) and used it in his PowerPoint file. Dr. Payne did hedge, saying he couldn't diagnose someone he hadn't examined. But the scan seemed to illustrate his definition of a persistent vegetative state, where the brain stem is intact but the cortex has died. The strongest statement of opinion Dr. Payne made was one of condemnation of Senator-Doctor Bill Frist, who contradicted Ms. Schiavo's doctors based on his viewing of a brief video clip of her.

One aspect of Ms. Schiavo's case that I didn't know was that she was bulimic, and purging may have led to the cardiac arrest that caused her brain injury. The folks at the meeting ruminated on the idea that feeding Terri was a desperate mission for her parents. Significantly, though, in light of the emotional pleas of the Save Terri crowd not to "starve her to death," Dr. Payne commented that his experience even with dying patients who are conscious, is that they don't ask for food or water, beyond what they need not to have a dry mouth.

In my job I get some wonderful opportunities to attend lectures and discussions. This one was not among the best ones. Most of these are not directly applicable to my job duties--I owe big thanks to my supervisors who give me a lot of latitude to "raise my awareness" of issues I may never have to do or say anything about. The least I ought to do with these experiences is blog about them, I figure. I plan to do some make-up posts about other talks I've heard in the past few months.

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