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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]