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Human Dignity in the Vegetative StateDr Peter Au-YeungChairman, Diocesan Committee for BioethicsChairman of the Organizing Committee, 14 th AFCMA Congress ImmediatePast Master, The Guild of St. Luke, St. Cosmas & St. Damian Hong KongThe vegetative state is a condition of patients with severe brain damage in whomcoma has progressed to a state of wakefulness without detectable awareness. Whenthe condition has remained for a long time and recovery is not predicted to occur, itis then termed persistent vegetative state (PVS).A number of high profile cases across the world have led to significant shifts ofopinion in the proper treatment of PVS persons. Karen Quinlan was taken off theventilator in 1976, succumbing from pneumonia eventually in 1985. Nancy Cruzanhad her feeding tube removed in 1990 and died days later. The landmark Britishcase is that of Tony Bland, a victim of asphyxiation at the Hillsborough disaster(1989). After years of PVS, the courts finally approved the removal of his feedingtube in 1993. One of the most high profile cases of all was that of Terri Schiavo, whocollapsed in 1990 and remained in PVS ever since. After years of legal wrangling,permission was granted by the Courts to remove her feeding tube in 2005.Discontinuation of ventilation in cases with hopeless prognosis is not controversialas such extraordinary or disproportionate means of therapy are not morallyobligatory. Withdrawal of artificial nutrition and hydration (ANH) is not licit, as tubefeeding is proportionate and obligatory basic care.But discontinuation of ANH is not the worst assault on the worth and human dignityof PVS persons. Concerns over the shortage of organs for transplants have led someto urge for a higher brain definition of “death”, which allows organ harvesting inPVS patients.Asian Federation Of Catholic Medical Associations 14 th AFCMA Congress 2008Programme abstracts21
14 th AFCMA Congress 2008 Asian Federation Of Catholic Medical AssociationsYouth, sex and condoms –What the facts really tell usDr. John HuiImmediate Past Master, The Catholic Medical Guild of SingaporeA Cochrane review concluded that, with consistent use (ie used all the time), condomsare about 80% effective in reducing the risk of HIV infection. 1 The June 2004 Bulletin ofthe World Health Organization noted that with consistent use of the condom, the risk ofacquiring chlamydial infection was reduced by about 26 percent, and that for gonorrhoeaby 62 percent. 2 The evidence for risk reduction afforded by the condom in ulcerative STIssuch as chancroid and syphilis is less assuring. This is largely due to the fact that genitalulcer diseases, like syphilis, can occur in both male and female genital areas that arecovered or protected by a latex condom, as well as in areas that are not covered. 3It has to be emphasized that the condom can only provide risk reduction of HIV/STItransmission when it is used consistently and correctly. In reality, however, use of thecondom is typically inconsistent. 4Reports have shown that teenagers are relatively poor users of both barrier (condom)and hormonal contraceptives. The 2004 Lancet consensus emphasized the important ofprioritizing messages by calling for a delay of sexual debut in youth or for the return toabstinence in those who are having causal sex. 5References:111222Weller S, Davis, K. Condom effectiveness in reducing heterosexual HIV transmission. The Cochrane Database ofSystematic Reviews 2002, Issue 1. Art. No.: CD003255. DOI: 10.1002/14651858.CD003255.Bulletin of the World Health Organization Vol. 82 Number 6 Genebra June 2004.333 CDC fact sheet on syphilis accessed on 11/9/2007 at http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm#protect,444555James Shelton et al, Partner reduction is crucial for balanced approach to HIB prevention. British Medical Journal,Vol 328, 10 April 2004, 891-893.Jokin Irala, Sexual abstinence education. What is the evidence we need? British Medical Journal (BMJ), 20 Aug2007.22 Programme abstracts
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