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>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 mailto:[log in to unmask] http://www.ridgecrest.ca.us/~rfvetter