British court rules one-year-old should be starved to death

[El_Machinae]

I'm trying to determine if there is any actual science behind the "his brain has dissolved so he can't experience pain so there is no suffering to be ended" line of reasoning. I can't find any support for this countering premise that pain is entirely confined to the brain, so it seems like nothing more than a convenient claim on a position that is just "not provably wrong" rather than a position that has any reason to accept as right.

I think I understand.

In the course of your research, you're going to become involved in the spinothalamic tract (the names in neuroanatomy often make sense once you crack the language. This pathway goes from the spine to the thalamus). Now, there are many types of pain, but most of nociception eventually ends up in the thalamus (which is inside the brain, but is kind of a gatekeeper between the cortex and the rest of the body). Near as anyone can tell, 'consciousness' is contained within the interactions between and within the thalamus and the cortex.

So, there are two ways to prevent a noxious stimulus from 'causing pain'. One is to literally interrupt the pathway. If that interruption is 'higher up the stream' than the reflex action, then you can still have a pain reflex without actually experiencing pain. The second is to not have a functioning cortex (or thalamocortex system).

Now, evolutionarily speaking, 'reflexes' are buried deep in our neurodevelopment. A bazillion and one animals have amazing hardwired reflexes built into their early development. This is why we can breathe so quickly after we're born. They also develop earlier during fetal development than functions associated with actual cognition. You need a cortex to experience pain. You need lower systems to respond to painful stimuli.

Because of the importance of nociceptive reflexes, I'd not be surprised if those pathways were also more hardy (for lack of a better word) as they travel up the brain into the cortex itself. The articles talk about how heavily degrades Alfie's thalamus was, but I wouldn't know (and doubt the neurologists would know, either) which areas of the thalamus were being degraded preferentially. I'd certainly not bet against 'pain' being one of the last to go, if we were to place different thalamic functions on some type of spectrum of likelihood.

 

[Traitorfish]

I was talking about what policy should be, which might have affected how children like Alfie are treated. It wasn't about Alfie himself.

Alfie Evans suffered from a degenerative condition of almost unprecedented severity. It's unlikely that any policy is going to be so comprehensive to have readily covered this case. It would always revert to "well, what do the doctors have to say?", and that's precisely the path that was taken.

The actual question is the right of the hospital to appeal to the courts over the head of next of kin, and for the courts to enforce, which isn't really specific to children or to similar conditions, because the same principles would apply in any situation in which the patient is physically or legally incapable of making decisions for themselves. The fact it involved a child and a parent make that debate more emotionally charged, but that's really it.

 

[Timsup2nothin]

Thanks, @El_Machinae

 

[dutchfire]

The actual question is the right of the hospital to appeal to the courts over the head of next of kin, and for the courts to enforce, which isn't really specific to children or to similar conditions, because the same principles would apply in any situation in which the patient is physically or legally incapable of making decisions for themselves. The fact it involved a child and a parent make that debate more emotionally charged, but that's really it.

Frankly, as an adult you should probably write down your wishes for what to do for you in such a situation, much like you should make your wishes regarding organ donation clear. (Assuming your jurisdiction allows this.)

 

[Timsup2nothin]

Frankly, as an adult you should probably write down your wishes for what to do for you in such a situation, much like you should make your wishes regarding organ donation clear. (Assuming your jurisdiction allows this.)

I agree in principle, but there is a very real practical problem here. It is impossible to predict and plan a response for every situation. As an example...

My personal inclinations point towards a DNR (do not resuscitate) that would make clear that I don't want to spend days, months, or years lingering in a hospital bed hooked to a ventilator. However, I do electrical work. Last year I took a pretty hard jolt right in the chest (yes, I was particularly stupid that day) and found myself really listening hard out of concern for whether my heart was beating. If it had not been there is no reason to think that if an appropriately equipped paramedic had happened along and promptly restarted it I'd have suffered any long term consequences. Fortunately there was a comforting thump from down in my chest and I went on about my day.

So, right there I saw that I need a "DNR unless..." because there's no reason I should die for a moment of stupidity that could be recovered from.

My suggestion is that everyone should find an appropriate person and document them as your medical power of attorney. This person needs to be someone who knows you well enough to have a very good chance to figure out what you would want in whatever unpredictable situation you may be in, balancing possibility of recovery, how complete a recovery is likely, and a bunch of other complex factors. They need to be able to figure this out, and you need to prepare them for the task. They also need to be able to set aside their own, probably emotional, motivations. They also need to be able to stand up to not only medical policies that may cut against what you want but also the probably emotionally driven ideas about what to do from other people in your life.