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Friday, July 16, 2010

Saved by the blink of an eye

Last October, Richard Rudd, who is 43 years of age and has two teenage daughters, was severely hurt in a motorbike crash. He was kept breathing by a ventilator. He seemed completely paralysed and non-responsive. His family remembered him saying he wouldn’t want to live in such a state and gave permission for the medical team to switch off the ventilator.

He was in Britain’s leading brain care unit at Addenbrook’s Hospital in Cambridge, under the care of Prof. David Menon. Prof. Menon held open Richard’s eyelids and asked him could he move his eyes, and when he did, a lifeline of communication for Richard was opened. Using eyes right for yes and left for no the language therapist was able to establish that he was able to understand and remember, and eventually he was able to signal clearly that he did not want the ventilator to be switched off.

The discussions and feelings of the family and medical team were the subject of a BBC documentary Between Life and Death and it is a ‘must see’ for anyone concerned about the decisions such cases raise.

Prof. Menon explains that Richard is not ‘brain dead’ but has a form of paralysis termed ‘locked-in syndrome’, the condition that is described so well in the book The Diving Bell and the Butterfly by Elle editor, Jean-Dominique Bauby, who suffered a similar paralysis, later made into a a film with the same name in 2007, which follows the marginal recovery that enabled him to dictate the book.

The BBC documentary raises all kinds of disturbing questions. In the background is the troubling issue of money. Long term care is very expensive so as a society we need to be clear and strong in resisting any ideology providing rationalisations for the deliberate taking of human life. A disturbing issue in the documentary is the suggestion that the medical team is not asking for the families permission to switch off the ventilator, that they, the medical experts will decide what the appropriate treatment is, and that the family is only giving them information about what the patient’s wishes might have been. This implies that basic care, like feeding and assistance to breath is a treatment.

More to the fore in the documentary are the arguments for deliberately ending the lives of helpless people because they have no quality of life. Early in the documentary, his father says Richard has no quality of life, he is making no responses, that he’d said he wouldn’t want to life like that. But in time he is able to move his eyes and his father accepts that he is now able to smile. And he chose not to have the ventilator switched off. Towards the end of the documentary, his father reconsiders his earlier view. It’s all hypothetical, he said, imagining how you think you’d feel if you were in a similar situation. But now he has seen his son’s eyes light up when they are conversing together, and he smiles. When you find yourself in that situation, his father said, the will to live kicks in. And about the decision to switch off the ventilator when his is not brain dead after all, ‘you probably have no right to do that.’

If society is not willing to put the resources into respecting life in its most vulnerable moments, then how will the breakthrough advances and discoveries ever be made – Richard was completely unresponsive at first for months, but then he began to respond, and as the film The Diving Bell and the Butterfly shows, people working with patients in this condition invent ways to enhance the communication. Respect for life at risk is where the developments happen.

Click here to watch eight minutes of the BBC documentary which includes Richard’s father responding to his son’s wish not to be taken off the ventilator

By 2020, 24 million Chinese men will be 'bare branches', unable to find wives

Gendercide is in the news again. The current issue of Time (19th July 2010) has a piece by Hannah Beech reflecting on the scale and the unanticipated consequences of the Chinese government’s one-child policy.

In Chinese culture a principal source of a man’s self-esteem is his ability to marry and found a family, and bear children, thereby becoming a fruitful ‘branch’ of the family ‘tree’. But in ten years time, the mutual reinforcement of the Chinese government’s compulsory one-child policy and the cultural discrimination against baby-girls will leave 24 million Chinese men as ‘bare branches’, that is, unable to find women with whom to found a family.

Ms Beech observes that China’s fertility rate at 1.6 births per woman is ‘well below the normal replacement rate of 2.1’. But ‘the country is also saddled with one of the planet’s worst gender imbalances, largely as a result of women aborting female fetuses due to a traditional preference for male offspring.’ And why are Chinese women destroying their girl babies – ‘the pressure to bear a son is all the greater in China precisely because many families are limited to just one child.’

This is having a huge unintended side-effect – ‘by 2020 there will be at least 24 million ‘bare branches’ – men destined to stay single because there are not enough wives to go around.’ And this in turn is likely to lead to escalating criminal trafficking in women.

A second unforeseen outcome of the Chinese compulsory one-child policy is a radical unbalancing of the age-structure that puts China’s economic development at risk. Beech notes that ‘factories are now facing shortages of young skilled labour.’

A third never forecast social crisis coming down the tracks for China from this ill-judged and unjust social policy concerns the elderly. As there are fewer people being born and not enough women to go around for the forming of families, there are going to be more elderly people to maintain and less workers to maintain them. ‘By 2050, one-third of Chinese will be elderly.’ And the pension support for the elderly is very poor in urban areas and immeasurably worse in rural areas.

The situation is actually far worse than Beech acknowledges but it is encouraging to find that a significant awareness of the nature of the crisis and its scale is percolating into the mainstream international magazines.


Read Time Magazine article here