>The letter below is self explanatory.  I am forwarding it to the list (with
>Ms Spencer's knowledge and approval) and have undertaken to forward to her
any response you good folks may care to make.

>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.
snip
>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."

the moral and ethical aspects of medical practice are long debated.
Hippocrates decided: 'First, do no harm.'

this sums it up. yet, the ambulance attendants are going to use every
tool they have to resuscitate even if there is no pulse and the body
is not really warm. The hospital often will determine dead on
arrival, but insurance does not cover many emergency cases. Stephen
Hawking could not communicate without his computer. His prominence in
physics has saved him from death by pneumonia and lack of normal
physical function.

there is no way of determining when a person is of benefit to society
any longer. My mother has Alzheimer's disease apparently. she has
been cared for in a nursing facility for several years. what is left
of her is useless to all known healers. her frugality and my father's
left enough for her caretaking for who knows how long. she laughs
again - sometimes but mostly at small children, but cannot say
anything understandable. she will not be there at all soon. she
became 90 years old last December but is most of the time now tied
with cloth to keep her in the wheelchair.

Since the government nor the doctor never see her,she will be there
as long as the money lasts. she apparently does not feel pain from
the deterioration of her body functions. she is always diapered to
reduce the mess.

even though i care about her, i cannot make that known. do we do harm
to society to live in such a manner? to prolong the 'life' of the
species if individuals have money is considered a waste by the doctor
who has no competence in curing those who are useless because they
have survived via help from others. not many of us feel competent to
decide about terminating the terminally ill. we are born helpless and
we die helpless if no one cares effectively. maybe the shell that is
all that remains of my mother should be sustained, but i do not think
so. feeling helpless regarding her deterioration was 'hard' for me.
her will to live after my father died was never rekindled. she denied
acceptance of his death until she forgot him and everything that she
knew essentially.

those of us with PD can have such depression, also. my genes have
strong possibility of both diseases. my greatest depression was the
death of my only daughter when hit by a car. some months of not
caring whether i lived or died may well have brought me into
exhibiting PD symptoms. i am not demented, but i know my instant
recall is less than it used to be. my will to live is strong most of
the time.

back to the question that is asked: doctors are not competent at law
and lawyers are not either if they once lie. there is no reason to
put the choice into the court. in fact, morality is reserved to god
by most cultures and not even the culture knows but individual by
individual, we are sovereign and there are no Kings, Lords,
Patriarchs who can decide for us. the doctor must obey the laws and
the lawyers must know that each of them is not empowered any better
than i am or you are. chances are that my ex-father in law did not
know he was alive for the last six months or so - he was totally
incommunicado in a 'bed'. there were no tests to measure any brain
function. i did not go pull the plug for Tony. i did not talk to him
about his wishes before he died. if i had known his wishes, i would
have felt uncomfortable about doing it. i doubt i would have actually
done the deed.

cognition may be the criterion of choice, but precedent is the usual
'game' of law interpretation. law does not have jurisdiction over
individuals except where allowed by the lawmakers. unfortunately,
competence in knowing what is right and wrong is not the ultimate
goal. the privilege of Kings ruling in court (sorry, they prefer
Court) should have disappeared upon our declaration of independence.
there should be nothing but peers. practicing medicine and practicing
law gets confused when getting power of life and death - or just
wealth and money.

when should the cognition of children be measured to determine DNR?
only if they become senile? we are all children - cognitive to some
degree.
--
Ron Vetter 1936, '84 PD dz
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http://www.ridgecrest.ca.us/~rfvetter