Abortion Discussion, Part Trois

oscarBravo

Hell's bloody bells.

With assistance from her lawyer, over the course of the next few days, AJ would learn that in addition to the anonymous phone calls that had been made to the clinic while she and her daughter waited for her procedure, people unknown to AJ had faxed her daughter’s personal information—her name, medical information, and even her social security number—to countless numbers of doctors, police, and other strangers in at least two states, without AJ’s knowledge or consent. She would discover that her daughter had been picked up from school and driven across the state border by a person that AJ did not know. And before the saga was resolved, AJ would even find out that an attorney she’d never heard of had purported to represent her daughter, and had sent threatening letters to the abortion clinic, directly interfering with her daughter’s medical treatment.

https://rewire.news/article/2016/03/30/anti-choice-activists-using-bogus-legal-threats-trick-teens-signing-away-abortion-rights/

ProfessorPlum

oldrnwisr wrote: »

No, the idea that you would make this woman the subject of a speculative scientific experiment is what is sickening. We don't conduct experiments like this on humans. This is not Tuskegee. There is no prospect for a 14 week foetus to be born alive. The earliest recorded successful preterm birth is 21 weeks, 5 days and the medical consensus is against providing intensive care at before 23 weeks. However, the doctors in this case wanted to experiment on a brain-dead woman, turning her into a biological incubator against the expressed wishes of her next of kin and while her family were trying to cope with the loss, including two young children.
This case highlights the very worst in medical ethics and the idea that a risky experiment with no scientific merit would be conducted without informed consent is perverse in the extreme. It's the very reason we have ethical guidelines in the first place.

The doctors really didn't want to do any such thing. They did however worry very much that they would be on the wrong side of the law if they failed to 'defend' the unborn's right to life. It was the doctors who argued that the whole sorry mess was beyond medicine and nothing short of a grotesque experiment. Their ethics allowed them to argue in court that it was in both the mother's and child's best interests that life support be withdrawn, and that is what the court ultimately decided. Like it or not, doctors have to practice inside the law, even if that law is at times ridiculous.

Also to note, your preterm stats refer to a child ex utero, ie already born, and are not applicable in this case where the foetus was in utero. There are cases in the literature where healthy babies have been born to brain dead mothers, although brain dead from 15 weeks is pushing the boundaries, and this unfortunate woman's injuries made the whole thing completely unviable ( - just to be a bit pedantic. )

The Randy Riverbeast wrote: »

And yet a person has to sign up to donate their organs.

Just to be devils advocate here, you don't need to sign up to donate your organs, the decision falls to you next of kin. Having a donor card or such just clarifies your intentions, but it's not binding.

oldrnwisr

ProfessorPlum wrote: »

The doctors really didn't want to do any such thing. They did however worry very much that they would be on the wrong side of the law if they failed to 'defend' the unborn's right to life. It was the doctors who argued that the whole sorry mess was beyond medicine and nothing short of a grotesque experiment. Their ethics allowed them to argue in court that it was in both the mother's and child's best interests that life support be withdrawn, and that is what the court ultimately decided. Like it or not, doctors have to practice inside the law, even if that law is at times ridiculous.

Yes, you're right, apologies. I was going from the preliminary reports into the matter but I've read through the case transcript in full and you're right, the testimony of all clinical personnel advocated in favour of discontinuing support during the case. However, I wasn't actually referring to the trial in my statement above but rather to the misguided clinical decision to maintain somatic support in the first place from 8th December through the 26th. That decision was wrong although it's clear from the case transcript that this decision was borne out of a worry about the legal situation as you say. I suppose if you ever wanted a single reason why the 8th Amendment is a bad idea, this is it.


P.P. vs. HSE 2014 [IEHC] 622

ProfessorPlum wrote: »

Also to note, your preterm stats refer to a child ex utero, ie already born, and are not applicable in this case where the foetus was in utero. There are cases in the literature where healthy babies have been born to brain dead mothers, although brain dead from 15 weeks is pushing the boundaries, and this unfortunate woman's injuries made the whole thing completely unviable ( - just to be a bit pedantic. )

Yes, but the literature on this is, well, thin on the ground to say the least. A systematic review of cases between 1982 and 2010 was published in 2010 (and cited in the trial above) found just 30 cases of somatic support being provided to brain dead pregnant women in this time. There were only 3 cases at or before 15 weeks, which resulted in intrauterine death, spontaneous abortion and one live birth. One success in 30 years is not a basis on which to make a clinical decision like the one in this case. This is why I cited the ex-utero stats. Extreme cases make for bad decisions, whether that's science, medicine, law etc.

One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-

ProfessorPlum

oldrnwisr wrote: »

Yes, you're right, apologies. I was going from the preliminary reports into the matter but I've read through the case transcript in full and you're right, the testimony of all clinical personnel advocated in favour of discontinuing support during the case. However, I wasn't actually referring to the trial in my statement above but rather to the misguided clinical decision to maintain somatic support in the first place from 8th December through the 26th. That decision was wrong although it's clear from the case transcript that this decision was borne out of a worry about the legal situation as you say. I suppose if you ever wanted a single reason why the 8th Amendment is a bad idea, this is it.


P.P. vs. HSE 2014 [IEHC] 622




Yes, but the literature on this is, well, thin on the ground to say the least. A systematic review of cases between 1982 and 2010 was published in 2010 (and cited in the trial above) found just 30 cases of somatic support being provided to brain dead pregnant women in this time. There were only 3 cases at or before 15 weeks, which resulted in intrauterine death, spontaneous abortion and one live birth. One success in 30 years is not a basis on which to make a clinical decision like the one in this case. This is why I cited the ex-utero stats. Extreme cases make for bad decisions, whether that's science, medicine, law etc.

One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-

On the first point, I don't think it's fair to say the initial decision was wrong - given that it took the court several sittings and much expert testimony to arrive at the right decision. I'll give you 'over prudent' at a stretch! As today's article shows, it is now stated clearly in law that doctors must refer to the courts in similar cases. So I can't see how you can say the doctors were wrong.

On the second point - I'm not for one minute advocating the situation as a good thing. But it's only fair to be correct in the information given. The study you've linked as well as others was debated during the case and its findings were part of the reason that the decision was arrived at. But there is protocol for sustaining an unborn, and it can and is done, ethically, when the circumstances are right. This was not, ever, one of those cases.

On the 8th Ammendment, yep, be done with it. Should never have been inserted, and we've seen time and time again why it needs to go.

oldrnwisr

ProfessorPlum wrote: »

On the first point, I don't think it's fair to say the initial decision was wrong - given that it took the court several sittings and much expert testimony to arrive at the right decision. I'll give you 'over prudent' at a stretch! As today's article shows, it is now stated clearly in law that doctors must refer to the courts in similar cases. So I can't see how you can say the doctors were wrong.

On the second point - I'm not for one minute advocating the situation as a good thing. But it's only fair to be correct in the information given. The study you've linked as well as others was debated during the case and its findings were part of the reason that the decision was arrived at. But there is protocol for sustaining an unborn, and it can and is done, ethically, when the circumstances are right. This was not, ever, one of those cases.

On the 8th Ammendment, yep, be done with it. Should never have been inserted, and we've seen time and time again why it needs to go.

I think we're pretty much on the same page wrt this case so I don't mean to argue but I would like to clarify my reasoning a little as to my choice of words in my previous posts.

Regarding the first point I said that the decision was wrong. There are two reasons for that. Firstly, the doctors gave IMO undue consideration to legal wrangles in what should have been a clinical decision. Secondly, about the clinical decision itself (and this is related to the second point and preterm stats) there is no reason to believe based on what is typically found that a foetus of that gestational age would have any prospect for survival even with somatic support. The only thing that comes close to a medical justification is a single birth in 1989. That's not sufficient evidence IMO. That's why I termed the decision wrong but you're right over prudent might be a more generous term given the situation.

Cabaal

http://www.bbc.com/news/world-us-canada-35931103

Republican presidential candidate Donald Trump has called for "some form of punishment" for women who have abortions, if it becomes illegal.

Only the high court, not the president, has the power to overturn Roe v Wade and make abortion illegal.

Once a Democrat, Mr Trump has been criticised for supporting abortion rights in the past.

Democratic front-runner Hillary Clinton has been an outspoken critic of Mr Trump's stance on women's issues.

"Just when you thought it couldn't get worse. Horrific and telling," said Mrs Clinton after his latest comments.

Once again he's talking ****e just for media attention

Republican leaders have expressed concern about Mr Trump's prospects in the general election because polls show that the New York businessman is extremely unpopular with female voters.

No ****!
This hopefully will piss more women off

ProfessorPlum

oldrnwisr wrote: »

I think we're pretty much on the same page wrt this case so I don't mean to argue but I would like to clarify my reasoning a little as to my choice of words in my previous posts.

Regarding the first point I said that the decision was wrong. There are two reasons for that. Firstly, the doctors gave IMO undue consideration to legal wrangles in what should have been a clinical decision. Secondly, about the clinical decision itself (and this is related to the second point and preterm stats) there is no reason to believe based on what is typically found that a foetus of that gestational age would have any prospect for survival even with somatic support. The only thing that comes close to a medical justification is a single birth in 1989. That's not sufficient evidence IMO. That's why I termed the decision wrong but you're right over prudent might be a more generous term given the situation.

I think we're very much on the same page on this. I certainly agree with the substance of your argument.

Unfortunately, because of the 8th, advance healthcare directive legislation, and the POLDP act, doctors do have to be preoccupied with the law under which they practice. Doctors also have to put what could be described as undue weight on the life of the unborn, as required by the constitution. I can see how you feel this should simply have been a clinical decision, but every clinical decision has to be made with the law in mind. If a doctor intends to practice outside the law, he'd better have a very good reason for it. In the case in point, it was not an emergent situation, there was time to reflect, and having consulted the inhouse legal team, the course of action was decided on.
There are lots of decisions that doctors need to make that are conflicted between law and best clinical practice. It is not uncommon to go to the courts for guidance.
However, we have managed to excessively legalise a part of medicine that really does not need to be. There are more than a few examples of this in the recent past.

frostyjacks

Every day my respect and admiration for the Donald grows stronger, and every day the enemy gets weaker.

eviltwin

frostyjacks wrote: »

Every day my respect and admiration for the Donald grows stronger, and every day the enemy gets weaker.

Oh you are in favour of punishment for women who have abortions too are you?

One eyed Jack

frostyjacks wrote: »

Every day my respect and admiration for the Donald grows stronger, and every day the enemy gets weaker.

What enemy?

Trump is nothing more than an amateur wind-up merchant, so your admiration for him comes as no surprise.

Absolam

oldrnwisr wrote: »

No, the idea that you would make this woman the subject of a speculative scientific experiment is what is sickening.

YOu can reserve your bile so; I never said I'd make a woman (never mind this one) the subject of a speculative scientific experiment. I said I for one would be perfectly happy to ignore the wishes of a dead person if it could save the life of a living one.

oldrnwisr wrote: »

We don't conduct experiments like this on humans. This is not Tuskegee. There is no prospect for a 14 week foetus to be born alive. The earliest recorded successful preterm birth is 21 weeks, 5 days and the medical consensus is against providing intensive care at before 23 weeks. However, the doctors in this case wanted to experiment on a brain-dead woman, turning her into a biological incubator against the expressed wishes of her next of kin and while her family were trying to cope with the loss, including two young children.
This case highlights the very worst in medical ethics and the idea that a risky experiment with no scientific merit would be conducted without informed consent is perverse in the extreme. It's the very reason we have ethical guidelines in the first place.

I believe the doctors in this case wanted to turn the life support off, but weren't sure that they were legally allowed to if it would result in the death of the foetus. It was a few years ago, but I can't recall any talk of experimentation, only of extraordinary measures. And extraordinary measures are what we would generally expect doctors to take if it might result in saving a life that would otherwise be lost, are they not?
Anyways, Prof Plum seems to have covered that facts of the case in his post.

To the crux of the point though (and you may want to pull out that sick bag again here); as far as I'm concerned the wishes of a corpses next of kin should count for nothing against the life of a child. Had there been a chance that the child could have been delivered safely, a desire to bury a corpse should not have a say against that, regardless of how emotively you couch it.
Medical advances are constant, what was impossible is now commonplace, so when Doctors are at a point where they think there is a reasonable possibility (not even a probability) of saving a life by using a corpse as an incubator, I think they should use their best judgement to do so. In the case discussed so so long ago the High Court said it was within the Doctors remit to decide to discontinue life support if they found no possibility of effecting a live birth; that was a good decision. When Doctors find there is a possibility of effecting a live birth, it will be a good decision to take whatever measures are necessary to do so, regardless of any other uses people want to put the corpse to.

Absolam

Cabaal wrote: »

Ignoring the wishes of a dead person and the dead persons NOK & family....ain't you just classy.

Dear me... should I care about killing someone, or whether Cabaal thinks I'm classy. Decisions Decisions.......
As ad hominems go, that one really only a merits a 'Must Try Harder' I'm afraid.

Cabaal wrote: »

Sure why allow abortions for suicidal women when we can just leave them kill themselves and try keep them alive like biological incubators against everyone's wishes.

That's a great argument. It does sound rather like something you've made up that you wish someone would say so you can argue against it...... but I imagine the rejoinder is spectacular, eh?

Cabaal wrote: »

You've cracked it Absolam, if only you cared about actually human beings as much as you claim to care about a 14 week fetus I'm sure the world would be a better place.
:rolleyes:

Perhaps if only you cared about a living foetus as much as you claim to care about the wishes of a dead corpse, the world would be a better place? Maybe I have cracked it!

Absolam

volchitsa wrote: »

So is Absolam now advocating for the systematic removal of all usable organs without the consent of the person or the Next of Kin? Think how many lives could be saved.
Or is it only pregnant women whose consent is not required in order for their bodies to be exploited by society for the supposed good of others?
Somehow I think I can guess the answer to that. :rolleyes:

Well... somehow I think you can make the answer up, anyways :rolleyes:

Absolam

Cabaal wrote: »

Nah, he'd never want that, sure that would be barbaric and it would ignore people's religious beliefs if you cut them open and took organs without consent and against their religion. (it could also affect men!!)
But using a women's body as a biological incubator when she's dead against wishes of husband/family/partner/wife, thats perfectly fine!
:rolleyes:

This is brilliant... I don't even need present my own ideas, Cabaal and volchitsa (as usual) can just make them up for me, and amazingly come up with cunning arguments to defeat me.

Genius :rolleyes:

Absolam

The Randy Riverbeast wrote: »

And yet a person has to sign up to donate their organs.

I think someone else picked up on on that but more anon...

The Randy Riverbeast wrote: »

What if the doctors are wrong? When it comes to FFA the doctors are incompetent according to some people so how can they say there is no chance? If trained medical professionals can't be trusted how can we trust a judge?

In that particular case the Judges trusted the Doctors, didn't they? At least, they said it was up to the Doctors to decide. If Doctors are wrong, and kill people as a result, I'm pretty sure there are already processes for that sort of thing, if Doctors are wrong and inadvertently save someones life, I don't think there'd be lots of complaints. I'm not really sure what you're asking here to be honest; according to some people the government are using fluoride to control our minds and doctors are controlled by big pharma. If that's the case how can we trust anyone at all?

Absolam

frag420 wrote: »

Curious to know if you would you ignore the wishes of someone who said they do not want their organs transplanted if it meant saving another life?

Well, if it were my choice, then yes, I would. As long as they were dead, obviously. Just in case someone wants to jump on the absence of that specification in your question.

frag420 wrote: »

Say one of your parents expressly said that they did not want their organs removed if they die yet there is a chance their heart or liver could save a strangers life, would you allow them to be cut open on the chance it could save a strangers life? Would you go against your parents direct wishes in this instance?

Yep. I hope (in fairness, I know) my parents know better than not to donate any organs if it would save a life, but yes, I would go directly against their express wishes and donate their organs to save a life if the choice were mine. That may make me lacking in class in Cabaals eyes, but I can totally live with that.`And as a result, someone equally lacking in class might too.

And for the sake of throwing a cat of the same stripe amongst a bunch of pigeons, if someone were to suggest legislating to make organ donation mandatory for all viable life saving organs, I think I'd support it. Work away... bearing in mind any further discussion might attract ire for being off topic (though now I think of it, surely corpses as incubators is also off topic) so maybe should be moved to it's own thread.

frostyjacks

eviltwin wrote: »

Oh you are in favour of punishment for women who have abortions too are you?

If people break the law, they should be punished. Same for people who advocate or encourage the breaking of laws.

PopePalpatine

frostyjacks wrote: »

If people break the law, they should be punished. Same for people who advocate or encourage the breaking of laws.

It must rankle you so much that the Magdalenekazetten are no more.

Cabaal

frostyjacks wrote: »

If people break the law, they should be punished. Same for people who advocate or encourage the breaking of laws.

Good to know, we can start by prosecuting people that incite hatred to other groups and religions I suppose.

We need to call a spade a spade as regards Muslims. No more immigration unless they renounce their religion

I dislike the catholic church as an organization, but I wouldn't for a second demand people renounce it as their faith. The hate is strong with you.

One eyed Jack

One eyed Jack wrote: »

What enemy?

Trump is nothing more than an amateur wind-up merchant, so your admiration for him comes as no surprise.

He's very very much a professional wind-up merchant!

eviltwin

frostyjacks wrote: »

If people break the law, they should be punished. Same for people who advocate or encourage the breaking of laws.

And for what, the greater good of society or something? It's got nothing to do with upholding the law and everything to do with punishing and shaming women simply because you don't agree with them.

oldrnwisr

Absolam wrote: »

YOu can reserve your bile so; I never said I'd make a woman (never mind this one) the subject of a speculative scientific experiment. I said I for one would be perfectly happy to ignore the wishes of a dead person if it could save the life of a living one.

There was no bile. I mirrored your use of the term sickening to make a point. If it could reasonably be demonstrated that a life could be saved then I would agree. But that was not the case in P.P. vs HSE so there's no point in making that argument in relation to this case. In fact the only takeaway from this case is that the constitution is not the appropriate tool for making decisions on abortion. A poor clinical decision was made in this case because doctors were afraid of legal consequences. That's not a situation that should happen.

Absolam wrote: »

It was a few years ago, but I can't recall any talk of experimentation, only of extraordinary measures. And extraordinary measures are what we would generally expect doctors to take if it might result in saving a life that would otherwise be lost, are they not?

Extraordinary measures are one thing but this case went far beyond any kind of therapeutic measure. There was no expectation that somatic support could have been continued to a point where a successful delivery was possible. There was no support in the literature for taking such an action and therefore continuing somatic support was an experiment. Fortunately we have guidelines about these kinds of things. Guidelines which state:

"All patients must always be treated with respect for their dignity." (5.1)

"Providing medical treatment necessarily involves some degree of risk. However, you must ensure as far as possible that the services and treatments you provide are safe and comply with the standards of the profession." (18.1)

"As a doctor, you play an important role in assisting patients, families and the community in dealing with the reality of death. In caring for patients at the end of life, you share with others the responsibility to take care that the patient dies with dignity, in comfort and with as little suffering as possible." (22.1)

"There is no obligation on you to start or continue a treatment, or artificial nutrition and hydration, that is futile or disproportionately burdensome, even if such treatment may prolong life. You should carefully consider when to start and when to stop attempts to prolong life, while ensuring that patients receive appropriate pain management and relief from distress." (22.2)

"You should respect the right of patients to refuse medical treatment or to request the withdrawal of medical treatment. You should also respect a patient's Advance Healthcare Plan (also known as a living will). Further guidance is provided in paragraphs 40 and 41." (22.3)

"You should ensure that informed consent has been given by a patient before any medical treatment is carried out. The ethical and legal rationale behind this is to respect the patient's autonomy and their right to control their own life. The basic idea of personal autonomy is that everyone's actions and decisions are their own. Therefore, the patient has the right to decide what happens to their own body." (33.1)

"Where an adult patient is deemed to lack capacity to make a healthcare decision, you should take reasonable steps to find out whether any other person has legal authority to make decisions on the patient's behalf. If so, you should seek that person's consent to the proposed treatment." (34.5)

"As part of the informed consent process, patients must receive sufficient information, in a way that they can understand, to enable them to exercise their right to make informed decisions about their care. This refers to the disclosure of all significant risks or substantial risks of grave adverse consequences." (35.2)

The Medical Council's ethical guidelines are very detailed and touch on this case in a number of ways which make it clear that a situation as in the P.P. case should never have happened for reasons including, but not limited to, those outlined above.

Furthermore, in Appendix A of the guidelines under the heading "Information for patients prior to giving consent" the guidelines stipulate:

"for each option, explanations of the likely benefits and the probabilities of success and discussion of any serious or frequently occurring risks and lifestyle changes which may be caused or required by the treatment;"

"advice about whether a proposed treatment is experimental"


Guide to Professional Conduct and Ethics for Registered Medical Practitioners.

The doctors in this case (although they made their decision out of concern of the legal situation) opted to pursue a treatment which a) compromised the dignity of the patient in death, b) had no prospect of success and c) was carried out against the express wishes of the next of kin. The ethical guidelines make it clear that this should not have happened. Unfortunately the 8th Amendment interefered and not for the first time or, I suspect, the last.

Absolam wrote: »

To the crux of the point though (and you may want to pull out that sick bag again here); as far as I'm concerned the wishes of a corpses next of kin should count for nothing against the life of a child. Had there been a chance that the child could have been delivered safely, a desire to bury a corpse should not have a say against that, regardless of how emotively you couch it.

Firstly, if you think I'm being emotive you're right. Bad science is unethical and it's something I feel strongly about. However, as much as there might be emotive language in the post, I doubt that it could be construed as an appeal to emotion.

Secondly, we have Advanced Healthcare Plans, living wills and DNRs for a reason. We also have principles of informed consent and the right to refuse treatment for a reason. Absolutist positions have no place in debates like this. All factors must be considered including the patient's wishes or those of their next of kin.

Absolam wrote: »

Medical advances are constant, what was impossible is now commonplace, so when Doctors are at a point where they think there is a reasonable possibility (not even a probability) of saving a life by using a corpse as an incubator, I think they should use their best judgement to do so.

OK, firstly, what kind of possibility 1 in 100, 1 in 1,000,000, 1 in 10,000,000. How do you determine reasonable?

Secondly, yes, the doctors should use their best judgement. That is the point. However, the doctors didn't in this case. Instead they demurred because of concerns regarding the 8th Amendment.

Absolam

oldrnwisr wrote: »

There was no bile. I mirrored your use of the term sickening to make a point. If it could reasonably be demonstrated that a life could be saved then I would agree. But that was not the case in P.P. vs HSE so there's no point in making that argument in relation to this case. In fact the only takeaway from this case is that the constitution is not the appropriate tool for making decisions on abortion. A poor clinical decision was made in this case because doctors were afraid of legal consequences. That's not a situation that should happen.

As I'm sure you're aware I was mirroring Cabaals use of the term to make a point....
I didn't argue that there was a reasonable chance of saving a life in this case; I replied to Cabaals comment on what he found sickening to put any family through. Nor can I see how you take anything away from the case about the Constitution not being the appropriate tool for making decisions on abortion; the Constitution is the basis of any prohibition on abortion, and whilst abortion was not discussed in this case, the Constitutional is a fundamental part of any such discussion.

oldrnwisr wrote: »

Extraordinary measures are one thing but this case went far beyond any kind of therapeutic measure. There was no expectation that somatic support could have been continued to a point where a successful delivery was possible. There was no support in the literature for taking such an action and therefore continuing somatic support was an experiment. Fortunately we have guidelines about these kinds of things. Guidelines which state:<...>The Medical Council's ethical guidelines are very detailed and touch on this case in a number of ways which make it clear that a situation as in the P.P. case should never have happened for reasons including, but not limited to, those outlined above.

I'm going to sidestep that particular gish gallop with the note that none of what you've quoted deals with their obligation to the unborn, which is probably why, lacking guidelines, they found themselves seeking a High Court decision on whether they were doing the right thing with regard to the life of the unborn child. The Court (correctly, in my opinion) left it up to the Doctors, in the best interest of the unborn child to decide whether to withdraw somatic support, with the Courts authorisation.

oldrnwisr wrote: »

The doctors in this case (although they made their decision out of concern of the legal situation) opted to pursue a treatment which a) compromised the dignity of the patient in death, b) had no prospect of success and c) was carried out against the express wishes of the next of kin. The ethical guidelines make it clear that this should not have happened. Unfortunately the 8th Amendment interefered and not for the first time or, I suspect, the last.

Well no, they didn't. The Doctors wanted to discontinue somatic support; it was the hospital legal team that was overly cautious about the legal ramifications. And the Court determined that in that particular case, it was within the Doctors remit to make the decision. As I said, the guidelines you quoted say nothing about maintaining life support for an unborn child, so if you want to point to a lack, it's in the guidelines.

oldrnwisr wrote: »

Firstly, if you think I'm being emotive you're right. Bad science is unethical and it's something I feel strongly about. However, as much as there might be emotive language in the post, I doubt that it could be construed as an appeal to emotion.

I think the 'while her family were trying to cope with the loss, including two young children.' is absolutely an appeal to emotion, yes. But we're not talking about bad science here, we're talking about untested (at the time) legal ground. If it were possible to preserve the life of the child, the Doctors would have had an obligation (both legal and moral) to do so; and the legal team were unsure whether in this particular case withdrawing somatic support would leave them legally exposed. The High Court decided the Doctors could decide it was in the best interests of the child, but I don't think anyone doubts that eventually there will come a time when it won't be, and the correct (both legally and morally) course of action will be to maintain somatic support. At that time, just as in 2014, it will (quite rightly) be the life of the child that the Doctors will be required to save, rather than the dignity of the corpse.

oldrnwisr wrote: »

Secondly, we have Advanced Healthcare Plans, living wills and DNRs for a reason. We also have principles of informed consent and the right to refuse treatment for a reason. Absolutist positions have no place in debates like this. All factors must be considered including the patient's wishes or those of their next of kin.

Oh sure, all of those things should be considered. But none of them ought to be allowed to override another persons rights, like their right to life.

oldrnwisr wrote: »

OK, firstly, what kind of possibility 1 in 100, 1 in 1,000,000, 1 in 10,000,000. How do you determine reasonable?

Oh, I wouldn't even consider determining what's reasonable; that's a Doctors job. If the Doctors don't think they have a reasonable chance of saving someones life, whether it be the foetus inside a corpse, a car crash victim or a cancer sufferer, I've no issue with them making the decision to stop making further life saving efforts. That's part of what they're trained for.

oldrnwisr wrote: »

Secondly, yes, the doctors should use their best judgement. That is the point. However, the doctors didn't in this case. Instead they demurred because of concerns regarding the 8th Amendment.

As I've said, I don't think that was the case. As I recall, and I admit it was some time ago, the Doctors believed (after a point) that further efforts would not suffice to bring the child to term, and it was the legal team that wouldn't allow somatic support to cease, because of their concerns regarding their exposure under the relatively recent POLDPA which had made it an offence to intentionally destroy unborn human life. That's not an entirely unfounded concern in the circumstances, to be fair, whether it was the concern of the legal team or the Doctors. And now we have jurisprudence which, in those circumstances, allays those concerns.

So now Doctors (and their hospital legal teams) know that the Courts won't consider them to have intentionally destroyed an unborn human life if, in those circumstances, any form of live birth will not be possible.

ProfessorPlum

Absolam wrote: »

I believe the doctors in this case wanted to turn the life support off, but weren't sure that they were legally allowed to if it would result in the death of the foetus. It was a few years ago, but I can't recall any talk of experimentation, only of extraordinary measures.

Well, there was much talk of experimentation. I recall two of the expert witnesses referring to the ongoing support for NP as amounting to experimentation.

From the judgment linked earlier by oldrnwisr:

Dr. Peter Boylan (consultant obstetrician): "This form of somatic maintenance is still relatively experimental."

Dr. Frances Colreavy (consultant in intensive care medicine): "In (her) view, continuing the somatic support was not appropriate and amounted to “experimental medicine”."

Absolam wrote: »

And extraordinary measures are what we would generally expect doctors to take if it might result in saving a life that would otherwise be lost, are they not?
Anyways, Prof Plum seems to have covered that facts of the case in his post.

No, we would generally not expect doctors to take extraordinary measures to save a life. It will greatly depend on the circumstances of each individual case, and be largely dependant on the extent of the measures, the likelihood of a successful outcome, interms of both survival, but more importantly quality of life, and of course the wishes of the patient and/of next of kin.

Just because doctors can saves lives, doesn't mean they should.

Absolam wrote: »

When Doctors find there is a possibility of effecting a live birth, it will be a good decision to take whatever measures are necessary to do so, regardless of any other uses people want to put the corpse to.

This is simply not true. A 'live birth' is not the holy grail. There is a huge weight put on the likely condition of the baby when dealing in foetal and neonatal medicine. For example, and on the extremes of the issue, in some areas, vigorous intensive care is not given as routine to premature infants below a cut off - which can be as high as 26 weeks. The rational behind this is because many of these infants don't survive, but also because many more of those that do have significant morbidity.

Unfortunatley, in Ireland because of the 8th amendment, it seems that a live birth is indeed the holy grail. Little weight is to be put on the condition of the child once born. The Miss Y case where a healthy foetus was forced to be born at 24 weeks by cesarian section illustrates this perfectly. There was no weight put on the right of that child to health or quality of life, just to life at the time of his birth.

Absolam

ProfessorPlum wrote: »

Well, there was much talk of experimentation. I recall two of the expert witnesses referring to the ongoing support for NP as amounting to experimentation. From the judgment linked earlier by oldrnwisr: Dr. Peter Boylan (consultant obstetrician): "This form of somatic maintenance is still relatively experimental." Dr. Frances Colreavy (consultant in intensive care medicine): "In (her) view, continuing the somatic support was not appropriate and amounted to “experimental medicine”."

Weren't those expert witnesses in the Court case, not Doctors involved in the care of the patient? Which is to say, the notion that "the doctors in this case wanted to experiment on a brain-dead woman" which I was replying to (and which you yourself disagreed with) was unfounded, as you yourself said. Perhaps I should have said the Doctors themselves didn't talk of experimentation, though others did after the fact

ProfessorPlum wrote: »

No, we would generally not expect doctors to take extraordinary measures to save a life. It will greatly depend on the circumstances of each individual case, and be largely dependant on the extent of the measures, the likelihood of a successful outcome, interms of both survival, but more importantly quality of life, and of course the wishes of the patient and/of next of kin. Just because doctors can saves lives, doesn't mean they should.

Really? I would expect doctors to take extraordinary measures to save a life. And I think if they can save lives, they should.

ProfessorPlum wrote: »

This is simply not true. A 'live birth' is not the holy grail. There is a huge weight put on the likely condition of the baby when dealing in foetal and neonatal medicine. For example, and on the extremes of the issue, in some areas, vigorous intensive care is not given as routine to premature infants below a cut off - which can be as high as 26 weeks. The rational behind this is because many of these infants don't survive, but also because many more of those that do have significant morbidity.

We seem to simply be at odds of opinion I'm afraid; I wouldn't say that a live birth is a holy grail, but I would say it will be a good decision to take whatever measures are necessary to do so.

ProfessorPlum wrote: »

Unfortunatley, in Ireland because of the 8th amendment, it seems that a live birth is indeed the holy grail. Little weight is to be put on the condition of the child once born. The Miss Y case where a healthy foetus was forced to be born at 24 weeks by cesarian section illustrates this perfectly. There was no weight put on the right of that child to health or quality of life, just to life at the time of his birth.

I take your point; there are those who would consider potential quality of life in order to decide whether a life should be ended. Personally, I agree with people making that decision on their own behalf, but not on behalf of others. So in circumstances such as the Y Case I would agree with the decision to take a chance on a compromised quality of life over the destruction of life.

oscarBravo

oldrnwisr wrote: »

In fact the only takeaway from this case is that the constitution is not the appropriate tool for making decisions on abortion.

This is a drum we need to keep beating. The constitution is no place for complicated legislation. When people argue against repealing the 8th amendment with the question "what would you replace it with?" the answer is simple: legislation.

oldrnwisr

Absolam wrote: »

Nor can I see how you take anything away from the case about the Constitution not being the appropriate tool for making decisions on abortion; the Constitution is the basis of any prohibition on abortion, and whilst abortion was not discussed in this case, the Constitutional is a fundamental part of any such discussion.

Absolam wrote: »

Well no, they didn't. The Doctors wanted to discontinue somatic support; it was the hospital legal team that was overly cautious about the legal ramifications. And the Court determined that in that particular case, it was within the Doctors remit to make the decision. As I said, the guidelines you quoted say nothing about maintaining life support for an unborn child, so if you want to point to a lack, it's in the guidelines.

Absolam wrote: »

As I've said, I don't think that was the case. As I recall, and I admit it was some time ago, the Doctors believed (after a point) that further efforts would not suffice to bring the child to term, and it was the legal team that wouldn't allow somatic support to cease, because of their concerns regarding their exposure under the relatively recent POLDPA which had made it an offence to intentionally destroy unborn human life. That's not an entirely unfounded concern in the circumstances, to be fair. And now we have jurisprudence which, in those circumstances, allays those concerns.

I have grouped these three points together because they are all dealt with in the court transcript I have previously linked to. Contrary to your assertion highlighted in the second point above, it was not the legal team who made the decision to continue somatic support, rather it was the doctors who made the decision in the absence of advice from the legal team. The court transcript notes:

"He was told by the medical staff that, for legal reasons, they felt constrained to put his daughter on life-support because her unborn child still had a heart beat."

"A study of the notes brought home that the doctors in the Dublin hospital were clearly concerned, having regard to the mother’s pregnancy, not to do anything that would “get them into trouble from a legal point of view and were awaiting legal advice”."


As for the Constitution, it is the current legislative environment that caused the doctors to act the way they do. A legislative environment which has its roots in the 8th Amendment. So although this case doesn't deal directly with abortion, it is the side effects of the 8th Amendment which caused legal uncertainty in this matter which caused distress to the patient's family.

Absolam wrote: »

I'm going to sidestep that particular gish gallop with the note that none of what you've quoted deals with their obligation to the unborn, which is probably why, lacking guidelines, they found themselves seeking a High Court decision on whether they were doing the right thing with regard to the life of the unborn child. The Court (correctly, in my opinion) left it up to the Doctors, in the best interest of the unborn child to decide whether to withdraw somatic support, with the Courts authorisation.

You're right, there isn't a reference in what I've quoted to the unborn. I wasn't speaking about the unborn. I was talking about the responsibilities had in relation to the patient (i.e. the mother), responsibilities which extend (from Article 22.1 above) unto death. Those are the responsibilities that you wish to ignore for the sake of a possibility of a live birth.

However, this is not a gish gallop. This isn't a multitude of minor arguments. The quotes are examples of the ethical requirements doctors must consider in the care of their patient (i.e. the mother).

Absolam wrote: »

I think the 'while her family were trying to cope with the loss, including two young children.' is absolutely an appeal to emotion, yes.

No, it wasn't. An appeal to emotion typically takes the form:

Favourable emotions are associated with X, therefore X is true.

That is not my argument. Instead I was pointing out that the distress being caused to the relatives of the patient by undertaking the course of treatment is a valid and necessary consideration.

Absolam wrote: »

But we're not talking about bad science here, we're talking about untested (at the time) legal ground.

We are talking about bad science here. As shown by ProfessorPlum, the treatment was experimental. You don't experiment on patients without their informed consent (as detailed in the guidelines above).

Absolam wrote: »

But none of them ought to be allowed to interfere with another persons rights, like their right to life.

As ProfessorPlum has explained, it is not all about a live birth at all costs. Consideration must be given as to what kind of life that would be. There is a significant level of disability in children born very prematurely (i.e. <30 weeks) which must be considered in a decision like the one in this case.

Premature babies study shows survival rates on rise (The Guardian)

"However, although an extremely premature baby's chances of survival have risen, the same research also found the proportion of such infants who experience severe disability as a result has not changed. That stood at 18% in 1995 and was 19% in 2006, according to the research."

Neurocognitive outcome after very preterm birth

Absolam

oscarBravo wrote: »

This is a drum we need to keep beating. The constitution is no place for complicated legislation. When people argue against repealing the 8th amendment with the question "what would you replace it with?" the answer is simple: legislation.

Gosh, I hardly think "The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right." is complicated legislation.

The POLDPA, that's moderately complicated legislation I suppose, if not terribly complicated compared to some. But if you want legislation it's there, and can be as complicated as necessary.

But perhaps the simple answer would more likely be: legislation that doesn't do what the 8th does; protect the right to life of the unborn. After all, how can legislation enacted and repealed by various governments according to their whims possibly be as secure as a Constitutional guarantee enacted by the people?

oldrnwisr

Absolam wrote: »

Weren't those expert witnesses in the Court case, not Doctors involved in the care of the patient? Which is to say, the notion that "the doctors in this case wanted to experiment on a brain-dead woman" which I was replying to (and which you yourself disagreed with) was unfounded, as you yourself said. Perhaps I should have said the Doctors themselves didn't talk of experimentation, though others did after the fact

Just to clarify one point here, when I said that

"the doctors in this case wanted to experiment on a brain-dead woman"

the point that ProfessorPlum disputed (which I acknowledged) was that "wanted" had nothing to do with it. The doctors didn't want to continue somatic support but felt that they had to.

You, on the other hand are disputing my use of the term experimentation. It absolutely is experimentation. This was mentioned by two of the expert witnesses in the trial and I have also linked to the scientific literature to show that this is the case. The use of somatic support in this case had no prospect for success and had no support from previously published research. Therefore it was experimental.

ProfessorPlum

oldrnwisr wrote: »

Just to clarify one point here, when I said that

"the doctors in this case wanted to experiment on a brain-dead woman"

the point that ProfessorPlum disputed (which I acknowledged) was that "wanted" had nothing to do with it. The doctors didn't want to continue somatic support but felt that they had to.

You, on the other hand are disputing my use of the term experimentation. It absolutely is experimentation. This was mentioned by two of the expert witnesses in the trial and I have also linked to the scientific literature to show that this is the case. The use of somatic support in this case had no prospect for success and had no support from previously published research. Therefore it was experimental.

^^^^ Thank you. That was also my point, which Absolam seems to have missed. Not a 'big picture' kind of guy, maybe.