Medical negligence
Claudia Carr in Beginning Medical Law, 2015
This chapter discusses how incompetent patient take decision on their own interest where end of life issues are concerned. A distinction is now made between patients in a persistent vegetative state, and those in a minimally conscious state. A patient with minimally conscious state (MCS) is defined as having severely altered consciousness in which minimal but definite behaviour evidence of self or environmental awareness is demonstrated. This chapter presents a human rights act 1998 to enforce the patients right to die. It ensures people to understand the judgment of Airedale NHS Trust v Bland and its subsequent application. The chapter also ensures people to understand the issues relating to withholding or withdrawing treatment from a patient in a persistent vegetative state. It appreciates the complexity of end of life issues.
Organ Transplants and Anencephalic Infants
David Lamb in Organ Transplants and Ethics, 2020
Anencephalic infants are considered as valuable sources for organ procurement because, apart from neurological malformation, other organs are regarded as suitable for transplantation. Anencephalic infants are not dead according to brainstem or whole brain criteria for death. Non-voluntary live organ donation is only sanctioned for infants and incompetents who are close family members and then only with regenerating tissues or double organs such as kidneys, and sanctioned with reference to a legal fiction that the living infant donor will have future psychological benefit from the survival of the older relative. According to existing moral and legal guidelines anencephalic infants have legal rights according to their status as persons. As such, removal of organs is illegal whilst they are alive. One alternative to a redefinition of death in terms of higher brain formulations, which would include spontaneously breathing persistent vegetative states as well as anencephaly, is to define the latter as a special moral and legal category such as ‘brain absent’.
Letting Die or Assisting Death: How Should the Law Respond to the Patient in a Persistent Vegetative State?
Kerry Petersen in Intersections: Women on Law, Medicine and Technology, 2019
Scotland’s highest civil court addressed a similar situation in the case of Law Hospital NHS Trust v. The Lord Advocate and Others . In this case, clinical diagnosis of persistent vegetative state was made in respect of Mrs Janet Johnstone, who had attempted suicide. From the perspective of the persistent vegetative state patient and even in the face of a considerable number of UK cases which have seemed to many commentators to call such rights into question, however, irrelevant. In endorsing the Court of Appeal’s judgement, a number of strategies were applied by their Lordships and a number of concerns expressed. The problem confronting both the Court of Session and the House of Lords, of course, was that, although they could competently pronounce on civil liability, albeit by bringing different legal traditions and principles to bear, neither court was authorized to issue guarantees concerning criminal liability, since they are civil courts.
Residual auditory function in persistent vegetative state: a combined pet and fmri study
Published in Neuropsychological Rehabilitation, 2005
Adrian M. Owen, Martin R. Coleman, David K. Menon, Ingrid S. Johnsrude, Jennifer M. Rodd, Matthew H. Davis, Karen Taylor, John D. Pickard
In recent years, a number of studies have demonstrated an important role for functional neuroimaging in the identification of residual cognitive function in persistent vegetative state. Such studies, when successful, may be particularly useful where there is concern about the accuracy of the diagnosis and the possibility that residual cognitive function has remained undetected. Unfortunately, functional neuroimaging in persistent vegetative state is extremely complex and subject to numerous methodological, clinical and theoretical difficulties. Here, we describe the strategy used to study residual auditory and speech processing in a single patient with a clinical diagnosis of persistent vegetative state. Identical positron emission tomography studies, conducted nine months apart, revealed preserved and consistent responses in predicted regions of auditory cortex in response to intelligible speech stimuli. Moreover, a preliminary functional magnetic resonance imaging examination at the time of the second session revealed partially intact responses to semantically ambiguous stimuli, which are known to tap higher aspects of speech comprehension. In spite of the multiple logistic and procedural problems involved, these results have major clinical and theoretical implications and provide a strong basis for the systematic study of possible residual cognitive function in patients diagnosed as being in a persistent vegetative state.
Detecting Residual Cognitive Function in Persistent Vegetative State
Published in Neurocase, 2002
Adrian M. Owen, David K. Menon, Ingrid S. Johnsrude, Daniel Bor, Sophie K. Scott, Tom Manly, Emma J. Williams, C. Mummery, John D. Pickard
Despite converging agreement about the definition of persistent vegetative state, recent reports have raised concerns about the accuracy of diagnosis in some patients, and the extent to which, in a selection of cases, residual cognitive functions may remain undetected. Objective assessment of residual cognitive function can be extremely difficult as motor responses may be minimal, inconsistent, and difficult to document in many patients, or may be undetectable in others because no cognitive output is possible. Here we describe strategies for using H 2 15 O positron emission tomography activation studies to study covert cognitive processing in patients with a clinical diagnosis of persistent vegetative state. Three cases are described in detail. Of these, two exhibited clear and predicted regional cerebral blood flow responses during well-documented activation paradigms (face recognition and speech perception) which have been shown to produce specific, robust and reproducible activation patterns in normal volunteers. Some months after scanning, both patients made a significant recovery. In a third case, blood flow data were acquired during a speech perception task, although methodological difficulties precluded any systematic interpretation of the results. In spite of the multiple logistic and procedural problems involved, these results have major clinical and scientific implications and provide a strong basis for the systematic study of possible residual cognitive function in patients diagnosed as being in a persistent vegetative state.
The PLEXUS Parameters: Results of the ‘PLEXUS Conference’
Published in Brain Injury, 1991
Presentations by experts at an international conference on coma and persistent vegetative state (PVS) identified 32 parameters of varying prognostic significance that can be determined in this patient population. These parameters are tabulated for heuristic purposes and to summarize a portion of the information exchanged at this conference.
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