Euthanasia... ever justified?

[galtgulch]

I once took a tour of a place called the West Seneca State something and in it were housed babies who were suffering from advanced and untreatable conditions such as hydrocephalia in which the head was grotesque in its size with damaged brain to the point that there was no hope that the child would ever be human.

One little girl had been a normal child but had an episode of viral encephalitis and it had destroyed the parts of the brain necessary for cognition, speech, etc and she was severely profoundly impaired.

I will not go on with other examples. The point is that these kids, and there were large rooms filled with cribs in rows and files filled with hydrocephalics, microcephalics, etc, who were cared for, fed, changed, bathed, but there was no hope for them to ever have what we would call a human existence or the attainment of a volitional conceptual consciousness. They had become wards of the State of New York and would be cared for for as long as they lived.

I encountered another sad case while I was working in a County Hospital in Buffalo NY. A nurse had mistakenly given a Morphine injection meant for a grown man with severe bone pain from metastatic cancer in his bones, to a male of about 18 years of age. This poor fellow had been cared for at home by his mother since birth but had suffered brain damage from anoxia at birth and was profoundly retarded, paralyzed, blind, deaf, dumb and non communicative.

The Morphine caused his respirations to slow to dangerous rate and an anesthesiologist was called to intubate the fellow and breath for him until medication to counter the effect of the Morphine could take effect.

The mother stood by stoically and said nothing. I was not in a position to inquire anything of her but I wondered what her life must have been like to care for this virtually subhuman creature for eighteen years who was unable to respond and had no hope of attaining status as a human being.

I could only wonder whether any part of her hoped that this unforseen situation might release her from an unrewarding burden. I imagine that her religious beliefs played a role in her devotion.

My point is that I think that the option in such cases should be euthanasia as a decision to be made by the parent, primarily the mother, under circumstances where there is no reason to hope their newborn will ever be able to attain a normal cognitive state.

Sometimes these conditions can be diagnosed intrautero these days in which case an abortion would be an option. I am talking about cases after birth.

We are more "humane" with horses, dogs and pet cats and put them out of their misery. I know it is tough to know where to draw the line.

galt

[Barbara Branden]

Galt, I agree that we often treat our pets more humanely than we treat human beings. And I do think that if a child will never be capable of anything like normal functioning, then euthanasia can be justified.

But -- and it's a big "but" -- I am convinced that the decision should only be made by the parent or parents in conjunction with medical doctors under very specific and objective laws, and never by the State alone. I am very uneasy at the prospect of giving the State the power to decide when and if a citizen should die, even if that citizen is an infant whose brain is essentially gone. Today it might be a brain-dead child, tomorrow a political prisoner judged to be hopelesssly insane because of his beliefs.

For the same reason, I am uneasy about the death sentence for criminals. It isn't that I doubt that some people well deserve to be put to death for their crimes, but I again am wary about giving the State the power of life and death.

Barbara.

[Barbara Branden]

I was about to present an example of an instance where euthanasia is sometimes recommended but cannot be justified -- when I realized the example can just as well serve as an orgument for euthanasia.

A psychiatrist friend once told me a story that haunts me still whenever I think of it. When he was a young intern, he visited a State mental hospital, making the rounds of patients who had had lobotomies. For those of you too young to remember or know about lobotomies, they were an incredibly savage method of dealing with people who were believed to be hopelessly insane and usually were violent. The surgeon -- I am not making this up -- inserted a ice pick into the brain of the patient and swirled it around for a few minutes. At the end of the surgery, the patient was a passive, compliant vegetable, no longer a problem for his "caretakers". (Apparently one of the Kennedy sisters, later believed only to have been retarded, was subjected to this horror.)

My friend told me, with a shudder, that as he sat at the bedside of one of these pathetic, speechless creatures, he looked directly into the man's eyes. "My God, " he said, "there was someone there! I was looking into eyes that perceived -- that knew!" My friend -- his name is Peter Breggin -- became a crusader against lobotomies and was almost single-handedly responsibe for having them outlawed.

Should one have recommended euthanasis for such patients or not?

Barbara

[Michael Stuart Kelly]

This is somewhat tangential, but pertinent.

I was watching Larry King today while he interviewed Bill Clinton. He asked Clinton what he thought of the recent Supreme Court Ruling upholding the abortion procedure ban. (See the following story, for example):

High Court Upholds Curb on Abortion

by Robert Barnes

Washington Post

April 19, 2007

This procedure (intact dilation and evacuation) is gruesome. It entails partially delivering the baby and crushing its skull.

But Clinton, of all people, said something extremely intelligent about this. First he said that a bill for this ban had crossed his desk twice when he was President and twice he had vetoed it. Here was his reason.

This procedure was only used in cases where the fetus had hydrocephalia (hugely enlarged head with hopelessly damaged brain) and rarely at any other time. This manner assured the best health for the mother.

Clinton went on to say that the Supreme Court ruling was not only politically motivated (and he stressed that), but that it was not even a victory for the pro-lifers. The fact is that in cases of hydrocephalia, other abortion procedures leave the mother barren. She is unable to bear children anymore, whereas the banned procedure not only was vastly less dangerous to the mother, it left her reproductive system intact. He also said the ruling was unfair since it only penalized doctors, but left the woman legally immune.

What a mess. The Supreme Court makes an unfair ruling, the antiabortion people claim a victory that in effect undermines them and Bill Clinton makes full sense about it.

Go figure.

Michael

[Brant Gaede]

There is a lot of unofficial euthanasia. Sometimes it is best to let things be.

--Brant

[galtgulch]

>>>"My friend -- his name is Peter Breggin -- became a crusader against lobotomies and was almost single-handedly responsibe for having them outlawed.

Should one have recommended euthanasis for such patients or not?"<<<

Hello Barbara,

I once encountered a young woman who had been "treated" as a young teenager with a lobotomy, not of the ice-pick swirl variety you mention, but one which just cut certain connections between the frontal and the parietal lobes of the brain I believe. She had been engaging in incessant obsessive compulsive ritualistic behaviors which totally incapacitated her. The lobotomy worked well and she was able to continue her schooling and ultimately was able to hold down a job.

It is a shame that Dr. Breggin used the power of the State to prohibit doctors and patients to use a procedure which might be advantageous under certain limited conditions. Another example of the tragedy of the lack of separation of the State and the interactions of consenting individuals.

galt

[Barbara Branden]

I once encountered a young woman who had been "treated" as a young teenager with a lobotomy, not of the ice-pick swirl variety you mention, but one which just cut certain connections between the frontal and the parietal lobes of the brain I believe. She had been engaging in incessant obsessive compulsive ritualistic behaviors which totally incapacitated her. The lobotomy worked well and she was able to continue her schooling and ultimately was able to hold down a job.

It is a shame that Dr. Breggin used the power of the State to prohibit doctors and patients to use a procedure which might be advantageous under certain limited conditions. Another example of the tragedy of the lack of separation of the State and the interactions of consenting individuals.

galt

The procedure you describe is vastly different than the one I discussed, since the young woman was not turned into a vegetable.

You would not, I assume, object to someone using the power of the State to prohibit murder. There are, after all, some things that the State should do. I believe Dr. Breggin was quite correct in demanding the outlawing of a medical procedure that permanently destroyed the life of mental patients.

Barbara

[Ellen Stuttle]

For those of you too young to remember or know about lobotomies, they were an incredibly savage method of dealing with people who were believed to be hopelessly insane and usually were violent. The surgeon -- I am not making this up -- inserted a ice pick into the brain of the patient and swirled it around for a few minutes.

Factual correction: I don't think the method of using an ice pick was ever used. The procedure was called a pre-frontal lobotomy. My father (who was an orthopedic surgeon) described to me how it was done, and I don't recall anything I ever read about lobotomies indicating a different procedure. The implement was like a thin, very flexible spatula. It was inserted through the occipital orbit. The eyelid of each eye in turn was lifted and the implement was inserted over the top of the eyeball through the opening into the brain; then the implement was briefly swirled. Very inexact as to the pathways severed. The results could vary quite a bit depending. To have used an ice pick would have required either destroying the eye (if going in through the eye route) or cutting open the skull. But in the latter case, areas of the brain which weren't the target areas would have been damaged as well, since the target areas are underlying ones, not on the brain surface.

Ellen

___

Edited April 23, 2007 by Ellen Stuttle

[Barbara Branden]

Ellen, thanks for the correction. My memory is that ice picks were used, but that may have simply been the way the procedure was talked about in the media, rather than an exact description.

Barbara

[Chris Grieb]

In the 80th there was a movie made about the life of the actress Francis Farmer. Ms Farmer was a movie actress in 30ths and 40ths who had many problems. She fought with her mother who would commit to the Washington state mental hospital. She had lobotomy there which made her almost a dead person even before she died. Lobotomies were thought of as the cure all for almost all mental problems during the 40ths and 50ths.

Edited April 26, 2007 by Chris Grieb

[BaalChatzaf]

In the 80th there was a movie made about the life of the actress Francis Farmer. Ms Farmer was a movie actress in 30ths and 40ths who had many problem. She fought with her mother who would commit to the Washington state mental hospital. She had lobotomy there which made her almost a dead person even before she died. Lobotomies were thought of as the cure all for almost all mental problems during the 40ths and 50ths.

My Aunt Miriam (alahavah shalom), suffered from schizophrenia in the early 1940's. She had to be institutionalized and there were no treatments at all except restraint. No medicine, no drugs. The only 'treatment' was prefrontal lobotomy. After it was done, Aunt Miriam was quiet alright, very quiet. She had virtually no initiative. Whatever was suggested she did. I remember playing gin rummy with her both before and after the operation. She could still beat me right and proper but she was not the same person. It was very weird and disturbing. She still remained institutionalized until her death in 1968. I and my sister were here only living relatives at that time. She had no one else. My brother-in-law and I filled in the grave (per custom). Very weird, very sad. Under the circumstances and conditions that existed it was either lobotomy, constraint in a straight-jacket (quite literally as she tore at her own flesh) or permanent sedation which would have killed her for sure much sooner than she died of natural causes. A tough situation, but that was the way it was.

Ba'ak Chatzaf

[Martin Radwin]

Thomas Szasz is a great libertarian hero for, among his many other achievements, exposing the evils committed by the psychiatric profession in actively participating in such abominations as lobotomy. The fact that this was such an accepted practice until fairly recently is truly horrifying. Despite the many areas in which liberty has declined in the last several generations, the fact that psychiatric justified brain mutilation is now generally recognized as the barbarism that it is shows that, in at least some important respects, liberty has greatly increased.

Martin

[Robert Jones]

Psychiatry began as a sceintific attempt to discover the source of mental afflictions previously ascribed to demonic possession. However, some of the "treatments" and practices of early psychiatry were just as gruesome and barbaric as any mental asylum run by the church.

Thomas Szasz stands towards the end of a long line of rational scientists who realize that compassion for the mentally ill is just as deserved as compassion for "normal" citizens.

However, a lurking evil today is that we are going on two generations of society's creative minds, particularly boys, poisoned with the virtual lobotomies produced by Ritalin, Luvox, Straterra, and -- when they reach adulthood -- Prozac. The majority of the people on these drugs are put on them with the flimsiest of medical examinations because the pharmaceutical manufacturers push it on the population through pediatricians and school counselors, just to make a buck. The unholy trinity of drug reps, public schools and lazy medical professionals (who get kickbacks for prescribing the medicine, this is a fact substantiated to me by a number of MDs I have spoken with) is almost as evil a sin as lobotomizing patients.

[Martin Radwin]

Psychiatry began as a sceintific attempt to discover the source of mental afflictions previously ascribed to demonic possession. However, some of the "treatments" and practices of early psychiatry were just as gruesome and barbaric as any mental asylum run by the church.

Thomas Szasz stands towards the end of a long line of rational scientists who realize that compassion for the mentally ill is just as deserved as compassion for "normal" citizens.

However, a lurking evil today is that we are going on two generations of society's creative minds, particularly boys, poisoned with the virtual lobotomies produced by Ritalin, Luvox, Straterra, and -- when they reach adulthood -- Prozac. The majority of the people on these drugs are put on them with the flimsiest of medical examinations because the pharmaceutical manufacturers push it on the population through pediatricians and school counselors, just to make a buck. The unholy trinity of drug reps, public schools and lazy medical professionals (who get kickbacks for prescribing the medicine, this is a fact substantiated to me by a number of MDs I have spoken with) is almost as evil a sin as lobotomizing patients.

Yes, this is one among many examples of unholy alliances between private and governmental entities. The pharmaceutical industry undoubtedly makes big bucks off these drugs, and the government schools are obsessed with controlling the behavior of bored kids, mostly boys, who don't adapt well to being expected to sit still as their desks for hours every day. At least, the damage done via these drugs is not as bad or as irreversible as lobotomy.

It's no coincidence that my wife and I decided to send our daughter to a private Montessori school, even though we live in an area that is famous for its supposedly excellent public schools. At the private Montessori school she attends, they've somehow never felt the need to administer Ritalin or any other drug to any of the kids. And the kids are doing just fine.

Martin

[Robert Jones]

Psychiatry began as a sceintific attempt to discover the source of mental afflictions previously ascribed to demonic possession. However, some of the "treatments" and practices of early psychiatry were just as gruesome and barbaric as any mental asylum run by the church.

Thomas Szasz stands towards the end of a long line of rational scientists who realize that compassion for the mentally ill is just as deserved as compassion for "normal" citizens.

However, a lurking evil today is that we are going on two generations of society's creative minds, particularly boys, poisoned with the virtual lobotomies produced by Ritalin, Luvox, Straterra, and -- when they reach adulthood -- Prozac. The majority of the people on these drugs are put on them with the flimsiest of medical examinations because the pharmaceutical manufacturers push it on the population through pediatricians and school counselors, just to make a buck. The unholy trinity of drug reps, public schools and lazy medical professionals (who get kickbacks for prescribing the medicine, this is a fact substantiated to me by a number of MDs I have spoken with) is almost as evil a sin as lobotomizing patients.

Yes, this is one among many examples of unholy alliances between private and governmental entities. The pharmaceutical industry undoubtedly makes big bucks off these drugs, and the government schools are obsessed with controlling the behavior of bored kids, mostly boys, who don't adapt well to being expected to sit still as their desks for hours every day. At least, the damage done via these drugs is not as bad or as irreversible as lobotomy.

It's no coincidence that my wife and I decided to send our daughter to a private Montessori school, even though we live in an area that is famous for its supposedly excellent public schools. At the private Montessori school she attends, they've somehow never felt the need to administer Ritalin or any other drug to any of the kids. And the kids are doing just fine.

Martin

This is also my experience from five years teaching in the Catholic schools in San Antonio -- I've only known of one of my students (out of hundreds) who was prescribed ritalin. When kids got out of line, they got demerits. When they got too many demerits they went on academic or behavioral probation. If they still screwed up, they got da boot.

[Chris Grieb]

Robert; I suspect the parents when they received the first demerit notice applied negative incentives to ensure there was not a second. The parents did not want there hard-earned tuition money going to no good use.

[John Dailey]

~ Anyone seen A Fine Madness (Sean Connery, would you believe, during his avoid-type-casting-as-'Bond' period)?

~ Plotwise, the 'icepick' method is irrelevent, but, clearly explained by a supercilious advocate-of-the-time character. Of course an actual 'icepick' wouldn't have been used by dignified and skilled professional PH.D's; besides, they'd also have a different official name for it.

~ Barbara's description was accurate (as Ellen's), but she used the incorrect tool-name. Anybody know what that tool was really named (I don't think 'spatula' fits either; they're a bit too large for occipital orbs)?

~ The thing is (I speak from experience) 'behavioural-problem' peoples who need imprisoned-caretaking ARE dangerous to the caretakers, whether the 'on-hands' ones or the analyzers. What was barbaric 'back when', is so only with hindsight.

LLAP

J:D

Edited May 1, 2007 by John Dailey

[Michael Stuart Kelly]

Here is the Wikipedia article on it:

Lobotomy

From the article:

Freeman, without the support of Watts, later developed a version that reached frontal lobe tissue through the tear ducts. In his transorbital lobotomy, a mallet is used to force a surgical instrument akin to an ice pick through the thin layer of skull at the top of the eye socket. The pick is then wiggled to damage the frontal lobe. This technique could be performed in a doctor's office rather than in an operating room, and required only a few minutes to perform. Freeman advocated this procedure for patients with even fairly mild symptoms. He personally performed the operation on thousands of people and promoted the idea of lobotomy as a casual procedure, claiming it would one day be as common as dental work.[1]

[1] El-Hai, J. (2005) The Lobotomist. ISBN 0471232920

Howard Dully receiving his "ice pick" lobotomy Dec. 16, 1960

I will try to find the name of the surgical instrument.

Michael

[Michael Stuart Kelly]

Here is more information (and don't forget the rubber mallet they used to hammer the icepick):

Icepick (From the article:)

Walter Freeman used icepicks in what have been termed "icepick lobotomies", also known as a transorbital lobotomy, effectively hammering an icepick into the patient's brain with a rubber mallet via the eye's tear duct. He later developed the orbitoclast to replace the icepick.

Surgical icepicks (original image from here)

Orbitoclast (Unfortunately I have been unable to locate a picture. From the article:)

An orbitoclast is a surgical instrument used for performing transorbital lobotomies. It was invented by Walter Freeman. Its close resemblance to an ice pick resulted in the procedure being dubbed the "ice pick lobotomy".

Leucotome (From the article:)

A leucotome is a surgical instrument used for performing lobotomies. It was created by Nobel-winning Portuguese neurologist Egas Moniz in 1937.

Physician Walter Freeman used the leucotome in many of his operations in place of an icepick,[citation needed] his original instrument of choice, but the leucotome commonly broke off inside the patient's skull when subjected to the stresses involved in Freeman's technique. It was replaced by the orbitoclast.

A Leucotome (Image originally from here.

Here is another article on The Leucotome.

Here is an first-hand account article about lobotomies: 'My Lobotomy': Howard Dully's Journey

Howard Dully holding one of Dr. Walter Freeman's original ice picks, January 2004. (Original image and caption from here.)

Dr. Walter Freeman operating on a patient, c. 1950. (Original image and caption from here.)

(Original image from here.)

Here are some more articles for the curious.

More than one way to skin a cat (Do not click unless you have a strong stomach.)

The History of Lobotomy

Controversial Psychosurgery Resulted in a Nobel Prize

Michael

[Fran]

It's no coincidence that my wife and I decided to send our daughter to a private Montessori school, even though we live in an area that is famous for its supposedly excellent public schools. At the private Montessori school she attends, they've somehow never felt the need to administer Ritalin or any other drug to any of the kids. And the kids are doing just fine.

Thanks for posting this. I'd love to do an experiment where children who are taught with their needs in mind are compared with typical schools (controlling for class size, social demographics, etc), to see just how many children attending needs-based schools end up as 'problem' children, i.e. those with supposedly ADHD etc.

I once watched a program with Tony Buzan (author of Mind Mapping) and he took a dozen failing children and taught them how to 'use their heads' with mindmaps etc. Independent psychologists tested the children's abilities before and after. Some of the children had improved so much, one psychologist admitted that if she hadn't done the testing herself, she would have been convinced the data was flawed.

Teach children with the child in mind rather than simply administering crowd control, and 'problem' children don't materialise. It's incredibly dull for a mighty curious six-year-old to sit still at a desk all day.

[Martin Radwin]

It's no coincidence that my wife and I decided to send our daughter to a private Montessori school, even though we live in an area that is famous for its supposedly excellent public schools. At the private Montessori school she attends, they've somehow never felt the need to administer Ritalin or any other drug to any of the kids. And the kids are doing just fine.

Thanks for posting this. I'd love to do an experiment where children who are taught with their needs in mind are compared with typical schools (controlling for class size, social demographics, etc), to see just how many children attending needs-based schools end up as 'problem' children, i.e. those with supposedly ADHD etc.

I once watched a program with Tony Buzan (author of Mind Mapping) and he took a dozen failing children and taught them how to 'use their heads' with mindmaps etc. Independent psychologists tested the children's abilities before and after. Some of the children had improved so much, one psychologist admitted that if she hadn't done the testing herself, she would have been convinced the data was flawed.

Teach children with the child in mind rather than simply administering crowd control, and 'problem' children don't materialise. It's incredibly dull for a mighty curious six-year-old to sit still at a desk all day.

Fran,

Thanks for your reply. There's probably no need to do the experiment you suggested, because the comparative data between standard government schools and good, child-centered private schools should already exist.

The percentage of children labeled as ADHD and put on psychoactive drugs such as Ritalin in government schools is a matter of public record, at least for some school districts. I recall reading that this percentage is outrageously high and has hugely increased over the last couple of decades. Comparative data on good private schools should not be hard to find. As far as I know, the private Montessori school that my daughter attends has never administered such drugs to its students, and I would expect this to be true of other good, child-centered private schools as well. And I don't think that the kids going to her school are on average any different than kids attending government schools, a large percentage of whom are being given these drugs in order to control their behavior. Government schools are organized for the benefit of the school bureaucracy, administrators, and, to a lesser extent, teachers. Kids are their last priority.

Martin

[Fran]

Kids are their last priority.

Hi Martin,

Thanks for the insights I gained from your reply.

It saddens me but I think the kids are their last priority. I think this stems from making it a law that children have to attend school. Once children are forced to do something, the schools don't have to put the effort in to be wonderful, enjoyable places, so that children would want to attend.

It also screws up the whole dynamic. There are few other businesses where if the customer (children) doesn't get his or her needs met, the customer gets the blame (not intelligent enough, etc), rather than the business.

Fran

[galtgulch]

Martin and Fran,

My wife taught for many years in an expensive private school in central massachusetts. On occasion she did encounter a student who had been diagnosed with ADHD and his private psychiatrist, not the school, did prescribe a central nervous system stimulant.

My wife told me that she had seen the child before and after the medication and did observe profound improvement in their behaviour and academic performance. i only post this to dispell the notion that private schools which are child centered would not have to deal with children with the condition because of their orientation and priorities.

I happen to believe that the condition is overdiagnosed and overtreated. I expect that children with the Defiant, noncompliant child syndrome, untreated, often are misdiagnosed with ADHD and given Ritalin, Adderal or Concerta.

I will not ask what all this has to do with Euthanasia but I am glad that you found each other to discuss whatever you like here. No kidding.

galt

[John Dailey]

Mike:

~ Thanx for that fascinating info!

~ "Thousands", huh? Why do I consider that an under-estimation?

~ I now have a suspicion re an explanation for all the great Senators, Congressman and Presidents who've been elected the last few decades...not to mention quite a few governors and school-board decision-makers.

~ Sharon Stone could've learned a lot from this...especially for her 'sequel.'

LLAP

J:D

[John Dailey]

Galt:

~ I agree with Fran about the basic 'bottom line' prob...and its social effects. Compulsory schooling leaves no worth-talking-about 'accountability' applicable to the school decision-makers.

~ Further, when it is 'they' who influence/advocate/decide about which kids 'need' behavioural-prob medications, and not the parents+doctor, worse probs develop...for the parents and kids; when otherwise, as you've described, usually the kids are helped.

LLAP

J:D