Let incompetent patients starve, says Victorian judge
Legal guardians have won the right to withdraw feeding tubes to allow seriously ill and unconscious patients to starve to death after a landmark decision by the Victorian Supreme Court. In a case involving a 68-year-old Melbourne woman known as BWV, Justice Stuart Morris ruled that it was wrong to regard artificial hydration and nutrition as natural food and drink. Rather, he said, they should be regarded as an artificial life-support system. The provision of food and drink to Mrs BWV, who suffers from a rare form of dementia called Pick's disease and who has no prospect of recovery, was only "postponing the natural process of dying".

The woman's husband and her six children supported the application for withdrawal of food and hydration which had been lodged on her behalf by the Public Advocate. They testified that the woman had consented to refusal of treatment while she was still conscious.

The decision was welcomed by some palliative care experts because it gives greater precision to the definition of "medical treatment" and "palliative care" in Victorian law. It is bound to affect treatment of non- competent patients across Australia. Justice Morris, however, stressed that he was not making new law, but only interpreting Victoria's 1988 Medical Treatment Act in light of the intentions of Parliament when it framed the legislation. There are few legal precedents for his decision in Australia and he relied heavily upon the controversial Bland case in the UK.

The Public Advocate, Mr Julian Gardner, says that the case is about withdrawal of treatment and not euthanasia. However, the application for guardianship was lodged with the assistance of the president of the Voluntary Euthanasia Society of Victoria, Dr Rodney Syme. The facts of the case were also originally established with the help of evidence from Dr Syme about the woman's condition -- although his link to the VESV was not stated. The VESV later used Mrs BWV as one of three case studies in a submission about the Medical Treatment Act.

Despite the publicity given to the case of Mrs BWV, key medical facts were overlooked by the media. Amongst them is that feeding through a feeding tube in the stomach is a normal procedure which is not uncomfortable and which can continue for years without ill effect. It was actually inserted while the woman was still able to walk around. And although Mrs BWV is not mentally competent, her eyes still follow a moving object. A doctor who examined her did not believe that she was "fully insensate".

The Catholic Church and Right to Life Australia said that the decision put the lives of vulnerable people at risk. Right to Life president Margaret Tighe said that it was "not an act of love to kill somebody by dehydration and starvation". The Catholic Archbishop of Melbourne observed that the State Parliament had never intended that elderly, handicapped and unconscious people who are not dying should be deprived of food and water.

Their concerns were highlighted by a report this week on a "dementia epidemic" which is facing Australia (see below). Ageing baby boomers and longer life expectancy will, it estimates, swell the numbers of dementia sufferers from 162,000 to half a million by 2040. ~ The Age, May 28, 30; Australian, May 30; court decisions.  

"I am a person, not a disease": Down's syndrome woman
Three people with Down's Syndrome and their supporters disrupted the International Down's Syndrome Screening Congress at Regents College in London on May 19. The conference organisers had refused to let them speak, but when they arrived, two of them were given the stage. The protest coordinators, whose slogan is "nothing about us without us", called it "a major new step in the debate about genetics, eugenics and the rights of disabled people".

One of the protesters, Anya Souza, told conference delegates in a prepared speech: "I can't get rid of my Down's Syndrome. But you can't get rid of my happiness. You can't get rid of the happiness I give others either. It's doctors like you that want to test pregnant women and stop people like me from being born. You can't abort me now, can you?" ~ Human Genetics Alert, May 30  

Half of Dutch euthanasia cases go unreported
Although euthanasia is legal in the Netherlands, just over half of Dutch doctors failed to fulfill their legal responsibility to report cases, a government-commissioned report has revealed. Researchers say that the low figure is cause for dissatisfaction but not concern. They also deny that the figures are evidence for the existence of a slippery slope because vulnerable people such as children, the elderly and the demented are rarely involved.

Amongst the findings of a team headed by Paul van der Maas from Erasmus Medical Centre and Gerrit van der Wal, of Amsterdam Free University Medical Centre are:

• Between 1996 and 2001, reports of cases of euthanasia increased from 41% of the estimated cases to 54%.
  
• There were an estimated 3,500 cases of euthanasia in 2001, representing 2.5% of all deaths. In 1995, they were 2.4% of all deaths.
  
• The total number of requests for euthanasia remained the same, at about 9,700, of which 39% were accepted by doctors.
  
• The number of cases where a doctor ended a patient's life without an explicit request remained the same -- around 900.
  
• Reporting has increased most among GPs, from 44% to 60%. Among nursing home doctors and hospital consultants, it has increased far less. GPs carry out 77% of euthanasia cases.

~ BMJ, May 31; Expatica, May 23  

Master switch for cell differentiation found
Japanese and UK scientists have identified a gene which allows embryonic stem cells to multiply indefinitely. The discovery brings scientists closer to being able to turn ordinary cells into stem cells without destroying embryos. The scientists have christened the master gene "nanog" after the mythological Celtic land of the ever young. The research, published in the journal Cell, was conducted by Austin Smith at the University of Edinburgh and Shinya Yamanaka of the Nara Institute of Science. The researchers cautioned that they still need to conduct research on human embryos to unlock the secrets of embryonic growth.

The scientists say that there is much to learn about how stem cells maintain their pluripotency -- their ability to become any cell -- and they have yet to identify the signal which tells nanog to turn on early in an embryo's life. ~ Washington Post, May 30

Frozen embryos contest their grandmother's will
The New South Wales Supreme Court is being asked to determine whether a frozen embryo has inheritance rights. An unnamed woman has left about $1 million to the children of her son and daughter-in-law "who shall survive me and attain the age of 25 years". Her son is contesting the will, based on the meaning of the word "survive".

Two children were born before her death in 2000, and two afterwards through IVF procedures. Two embryos remain frozen. Mr Justice Peter Young, in preliminary remarks, said that he would rely upon the traditional meaning of the word "survive" -- that the children had to be alive at the time of her death. This, he said, excluded the two children who were frozen embryos at the time of the grandmother's death and the two embryos which are still frozen. ~ Sydney Morning Herald, May 29  

Hormone replacement therapy a "disaster"
Following a study in the Journal of the American Medical Association which claims that hormone replacement therapy increases rates of dementia amongst over-65 women, an Australian journalist has accused drug companies of "a gross failure of public health regulation". Washington-based Ray Moynihan contends that HRT, a drug made by Wyeth made to relieve menopausal symptoms which has become one of the biggest-selling drugs of all time, has been a global disaster. Recent studies have shown that it is associated with increased risks of breast cancer, blood clots, heart attacks and strokes as well. An article in the New England Journal of Medicine reported earlier this month that it delivered no significant health benefits.

According to Moynihan, the scientists who conducted the dementia study are concerned that Wyeth secretly briefed selected medical societies about these results to prepare a PR campaign to counter the bad news. "Just a few years ago," writes Moynihan, "medical specialists considered HRT such a wonder drug that they would gladly have put it in the drinking water." Wyeth is now vigorously defending 70 court cases in the US over HRT. ~ The Age, May 28  

Cut back on perks, says World Medical Association
No individual doctors should receive direct payment from commercial companies to cover travel expenses, accommodation at conferences or compensation for their time, say proposed guidelines from the World Medical Association. The guidelines also try to limit drug companies' control of the content of conferences and urge full disclosure of financial links with drug companies. Companies should offer doctors only gifts of nominal value which relate to their work. Charles Medawar, director of an independent consumer research group in the UK, criticised the proposals as naïve. He warned that if doctors were not sponsored to attend meetings, 90% of conferences would fail. ~ BMJ, May 31  

Dementia epidemic to hit Australia
Longer life expectancies and an army of aged baby boomers will triple the number of Australians suffering from dementia. A report prepared by Access Economics for Alzheimer's Australia says that there will be half a million people with dementia by 2040, compared to 162,000 at the moment. Dementia is already the second-largest cause of disability after depression and will become the largest by 2016.

The report also says that dementia is the most expensive mental health item in Australia, costing $3.2 billion this year, a figure which will nearly double by the end of the decade. By mid-century, dementia costs may exceed 3% of GDP, up from nearly 1% now. The average length of time a person will live with dementia is 10 to 14 years. ~ The Age, May 28; Access Economics  

IN BRIEF: Australian caesareans up ; Dignitas dispatches another Briton; German surgeon suspended