On Bioethics

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VEGETATIVE STATE OFTEN MISDIAGNOSED

Doctors should use extreme caution in pulling the plug on patients in a vegetative state, according to reports presented at the European Neurological Society.Around 40% of patients in a Belgian study were wrongly diagnosed as being in a vegetative state when they were minimally conscious. And 10% of minimally conscious patients were actually communicating functionally. Furthermore, they found a strong tendency to underestimate levels of consciousness in brain injury patients. The level of misdiagnosis has not decreased in the last 15 years, says Dr Steven Laureys, from the University of Liège, in Belgium.

About one-fourth of patients who arrive at hospital in an acute vegetative state have a good chance of recovering a significant proportion of their faculties. And up to a half will regain some level of consciousness. Younger patients usually have a better prognosis.

People suffering traumatic brain injuries have a much better chance of some recovery. Some 70% of those with traumatic injuries were restored to some level of consciousness. People with non-traumatic injuries, such as oxygen deprivation, fared much worse. Only 36% in the study achieved comparable recovery.

“Our data show that acute vegetative state is certainly not rare among patients admitted to intensive care”, says Dr Laureys. “What is important to note is that it may be transient and that the prognosis for patients with impaired consciousness depends to a great extent on the nature of the brain damage.”

The study thus concluded that many doctors’ diagnostic skills remain poor and the level of misdiagnosis has not decreased in the last 15 years. “The study showed how very hard it is to disentangle the minimally conscious state from the vegetative state”, says Dr Laureys. ~ News-Medical.Net, Jun 20  

EGG MARKET GROWS IN US

The average payment in the US for egg donation was US$4,217, according to a recent article in the journal Fertility and Sterility. However, at least one centre told the authors that it paid $15,000 for eggs and stories abound of college students being paid tens of thousands of dollars. The American Society of Reproductive Medicine has set guidelines which stipulate that payments of $5,000 or more “require justification” and that payments over $10,000 are not appropriate.

No one is comfortable with payments for eggs, an invasive and uncomfortable process at best, and painful and dangerous at worst. Little research has been done on the long-term effects of fertility drugs.

Bioethicists also worry whether the allure of dollars to cover college fees or credit card bills might cloud young women’s judgement. “We hear about egg donors being paid enormous amounts of money, $50,000 or $60,000,” Josephine Johnston, of The Hastings Center told the New York Times. “How much is that person actually giving informed consent about the medical procedure and really listening and thinking as it’s being described and its risks are explained?”

The problem is that without compensation, women are unlikely to donate eggs, either for fertility treatment or for research. “I just completed an outreach initiative to 21 institutions across the state that we’ve funded,” Dr Geoffrey Lomax, of the Institute of Medicine, said. “No one has had an egg donated specifically for research.” ~ New York Times, May 15