The letter below is self explanatory.  I am forwarding it to the list (with
Ms Spanker's knowledge and approval) and have undertaken to forward to her
any response you good folks may care to make.
Dennis.
+++++++++++++++++++++++++++
Dennis Greene 50/dx 37/ onset 32
There's nothing wrong with me that dealing with PD won't fix!
email - [log in to unmask]
Website - http://members.networx.net.au/~dennisg/
(most recent update -Nov 5, 1999)
+++++++++++++++++++++++++++

Dear Mr. Greene,

I've been enjoying your website. In particular, it helps me better
understand the nature of the disease  and the "real" ways it affects a
person's life.

I have a question I hope you may be able to answer. From what you know
of the disease generally, what, if anything are the cognitive effects  of
Parkinson's ? Stuff I read sometimes says "no effect identified ",  or says
"not in the early stages...". What's the scoop?

The reason I ask, has to do with  a legal case  I was analysing for our law
commission last year. It was describing the ways that  the law is involved
in "older adults' personal relationships."  In this particular Canadian
case, a husband and wife  ( Mr. and Mrs. S. ) went to a major health clinic
to have his condition assessed (his condition had been deteriorating).  They
lived  out in the country, and  the clinic was in the city.

Mr. and Mrs. S. were in their late 70s. Mr. S. has  had Parkinson's disease
for at least 20  years, and a bunch of other health problems more recently.
At the health clinic,  the doctor in charge  wants to put a "do not
resuscitate order" (DNR) on Mr.S.'s chart. Mrs. S. was adamantly  against
this.  The Dr. backs off for the moment.

[ Normally you ask patients what they want in terms of treatment, none
treatment, as long as they are mentally competent.  If they are not, they
you normally go to their  "proxy" or "substitute decision maker"

At this time, Mr. S. has a lot of trouble communicating  because of the
Parkinson's disease. In the following months, the Dr. continues to try to
persuade Mrs. S. that there should be a "DNR" order for her husband. [little
mention in the case of whether or how hard  the doctor tried talking with
Mr. S.]    Later, doctors orders a tracheostomy-- now Mr. S. can't
communicate his wishes at all.  Mrs. S. objects to that operation too.

Doctors "leap frog" her-- and  they go to the Public Trustee to have  a
protective order placed on Mr. S.-- now they don't have to talk to Mrs. S.
at all.
A DNR order is placed on the chart.  Mrs. S. goes to court  to get an
injunction to get the DNR  order removed from her husband's chart.

Mrs. S. spends countless hours a day at hospital with her husband and says--
" listen I spend all this time with my husband, I can communicate with him
and I know what he wants. " Doctors and nurses basically suggest  "you are
silly old woman who really haven't come to terms with your husband's
condition.  He can't communicate with you or he doesn't understand what's
going on ...You are just afraid of being alone... We know what's best for
him and he should not be resuscitated if he goes into cardiac arrest" (I'm
paraphrasing and editorializing)..


The Issues

This case really bothers me for a lot of  reasons-- I really see a lot of
older people's rights being trounced upon in health care because they are
seen as "less valuable" or "not worth the effort".

Mr. S. was ignored in this whole process-- doctors appear to have assumed
he was not mentally capable of expressing his wishes, largely because he
could not communicate; so they leapfrogged over him and went to his wife;
and when she didn't give them the answer they wanted, they leapfrogged over
her to go the Public  Trustee, who basically said to the doctors "You decide
what's best"...



But that brings me back to my question : From what you know of the disease
generally, what, if anything are the cognitive effects  of Parkinson's
disease on the person?  Does it leave some people mentally impaired at some
stage. Or are the thoughts still in there and they can't get out? I'm
wondering  if  the one of classic  signs of Parkinson's  ( blank expression)
could easily be misread as  "not being all there."






Charmaine Spencer
Gerontology Research Centre
Simon Fraser University
2800-515 West Hastings  Street
Vancouver, B.C.
p: 1-604-291-5047
f: 1- 604-291-5066
email: [log in to unmask]