I just read Dennis Greene"s web page and I have to say this: I have never
read a more understandable report in all my research. I can understand 99.9
percent of it and I intend to research the rest. THANK YOU DENNIS. Shirley
-----Original Message-----
From: Dennis Greene <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Thursday, January 27, 2000 1:45 AM
Subject: PD / cognative ability / and the law


>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]