Terri Schiavo

[Tex]

Originally Posted by Archaea

Well if my insurance wants to pay for it, then that's great, or if my estate can and does, but if you expect the taxpayers to do it, given the odds against such an event, then no.

so if the benefit is 1 in 100,000 cases might be found, and you are asking the government to spend $200,000,000.00 to save that one life, it doesn't make a whole lot of sense.

Who said anything about the taxpayers funding it? As I said to Waters, anyone can make up numbers.

I'm curious if this case gives anyone pause, specifically concerning the Schiavo case, but also just generally. Does this case cause anyone to re-examine their right-to-die position?

Originally Posted by MikeWaters

could you ask a more vague question please?

It's not vague at all. It's actually quite simple. What's the test worth to you?

[MikeWaters]

Originally Posted by Tex

Who said anything about the taxpayers funding it? As I said to Waters, anyone can make up numbers.

I'm curious if this case gives anyone pause, specifically concerning the Schiavo case, but also just generally. Does this case cause anyone to re-examine their right-to-die position?



It's not vague at all. It's actually quite simple. What's the test worth to you?

Have all the wrongful convictions caused you to give up your position on the death penalty, or life in prison?

1) I don't know what test they did
2) I don't know how sensitive or specific the test they did is (probably neither do they)
3) I operate in the realm of limited resources, not the GOP fantasy land of no taxes, unlimited spending.

[Archaea]

Originally Posted by MikeWaters

Have all the wrongful convictions caused you to give up your position on the death penalty, or life in prison?

1) I don't know what test they did
2) I don't know how sensitive or specific the test they did is (probably neither do they)
3) I operate in the realm of limited resources, not the GOP fantasy land of no taxes, unlimited spending.

I agree Mike.

My supposition only arose that these rare occurrences often are referred to in times per 100,000 and in the more rare, times per million.

But of course we don't know how frequent the nightmare was or could be averted by this unknown "test".

[MikeWaters]

Originally Posted by Archaea

I agree Mike.

My supposition only arose that these rare occurrences often are referred to in times per 100,000 and in the more rare, times per million.

But of course we don't know how frequent the nightmare was or could be averted by this unknown "test".

the test performed was probably a functional MRI. Where tests can be administered to patient, and you can see what parts of the brain "light up".

As far as I know, they are not typically used for clinical purposes--usually just research purposes.

[MikeWaters]

Laureys is the guy quoted in the article I read.

Neuroradiology. 2009 Oct 28. [Epub ahead of print]
Neuroimaging after coma.

Tshibanda L, Vanhaudenhuyse A, Boly M, Soddu A, Bruno MA, Moonen G, Laureys S, Noirhomme Q.

Coma Science Group, Cyclotron Research Center, University and University Hospital of Liège, Sart-Tilman, B30, Liège, Belgium.

Following coma, some patients will recover wakefulness without signs of consciousness (only showing reflex movements, i.e., the vegetative state) or may show non-reflex movements but remain without functional communication (i.e., the minimally conscious state). Currently, there remains a high rate of misdiagnosis of the vegetative state (Schnakers et. al. BMC Neurol, 9:35, 8) and the clinical and electrophysiological markers of outcome from the vegetative and minimally conscious states remain unsatisfactory. This should incite clinicians to use multimodal assessment to detect objective signs of consciousness and validate para-clinical prognostic markers in these challenging patients. This review will focus on advanced magnetic resonance imaging (MRI) techniques such as magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI (fMRI studies in both "activation" and "resting state" conditions) that were recently introduced in the assessment of patients with chronic disorders of consciousness.

PMID: 19862509 [PubMed - as supplied by publisher]

[Tex]

Originally Posted by MikeWaters

Have all the wrongful convictions caused you to give up your position on the death penalty, or life in prison?

1) I don't know what test they did
2) I don't know how sensitive or specific the test they did is (probably neither do they)
3) I operate in the realm of limited resources, not the GOP fantasy land of no taxes, unlimited spending.

I really don't know how you got off on the "GOP fantasy land" blather. There's nothing in the article about the GOP, taxes, or unlimited spending, so you're just deflecting.

Given how dogmatic you get when discussing the death penalty, I would expect that you'd be at least as vigorous in defending innocent life, trapped in a coma. I'm surprised to find you making excuses based on cost.

[MikeWaters]

I could change my mind if it were shown to me that such cases were not extremely rare.

I despise mental midgets like Sarah Palin and her death-panel rhetoric.

[Tex]

Originally Posted by MikeWaters

I could change my mind if it were shown to me that such cases were not extremely rare.

I don't understand this thinking. Why does the (assumed, not proven) relative rarity of the condition make it okay to let such a person die?

[MikeWaters]

Originally Posted by Tex

I don't understand this thinking. Why does the (assumed, not proven) relative rarity of the condition make it okay to let such a person die?

There are many reasons to "let" someone die:

1) Because of limited resources.
2) Because death is natural.
3) Because a lifetime of being hooked up to machines in a vegetative state is not natural.
4) Because we have to have ethically-reasoned ways of letting people pass on.

One might argue that because we have found a person buried alive, that we ought to mandate a system whereby someone buried in a coffin can notify us that he/she is "not dead yet." Sure it's costly, but it could save another life.

You may thing this is preposterous, but in the 19th century many coffins had such mechanisms. Of course, the analogy is not perfect, the government wasn't paying for these coffins--the costs were not shared in the same way that many of our current medical costs are.

Just because modern medicine can do something, does not mean it should be done.

Let's say we develop an artificial kidney from some kind of biological matrix. Great. Many people die due to a lack of kidney. Average lifespan on dialysis is 10 years. But bummer, the new kidney costs $10 million. Is the cost worth the benefit? Are the Texes of the world willing to pay 5% more income tax to pay for this? Even if they are, does this make good sense?

In medicine there is this thing called "Number needed to treat." The concept is this--what is the number of people you have to treat with intervention X to get benefit Y. Let's say the number needed to treat among depressed patients with a modern anti-depressant is 5. You have to threat 5 depressed patients with the anti-depressant to get 1 patient who has significant benefit. We are not blown away by its efficacy, but we think it's worth paying for and proceeding with treatment. What if the number needed to treat is 100? Are we willing to treat 99 people who get no benefit, so that 1 person can?

In the case of coma, let's say we have a fMRI test that is designed to detect consciousness among these comatose patients. But the NNT (number needed to treat) is 2000. We have to subject 2000 patients to this test in order to ferret out one case where someone benefits. Sure it's expensive, but what's the harm, you say, fMRI doesn't have medical risks. But what if the test has equivocal results for many patients--a patient doesn't meet the pre-determined threshold for "consciousness" (let's call it 60% positive on the test). Now all patients less than 60% are potentially in a quandry, and it is difficult to interpret what it means. And then families decide to extend life, with no real chance for benefit, causing them to linger over a longer time before they die, wasting resources, inappropriately increasing hope and expectations. You may have saved one person, but you have caused a lot of harm and grief along the way.

This is why the PSA test has been thrown in the trash. Sure it can save lives, but it causes so much morbidity and grief, that it is not worth doing the test.

Anyway, I hope this makes some sense, and I'm not talking out of my butt.