Belgium Passed Bill Allowing Child Euthanasia

Previously this year, I wrote an article on the proposal for children's euthanasia by lethal injection within Belgium. This month (13th February), the bill allowing euthanasia for terminally ill children of any age, has been passed. By a vote of 86 to 44 with 12 abstentions, the lower house of Parliament approved the law which had previously been passed by the country’s Senate. Belgium will become the only country in the world to legalise euthanasia at any age, with both patient and parental consent. There are several conditions to the law:

• Patient must be conscious when making decision 
• Request must be approved by the parent and medical team
• Illness must be terminal, with no sign of improvement 
• Patient must be in great pain with no treatment available to alleviate their distress
• Psychologists must test children to confirm they understand what they are requesting

Opponents to the new law, argue that children should not be forced to make such a difficult decision. Furthermore Belgium has palliative care, which is considered to be the best within Europe, therefore the pain and difficulties for terminally ill children should be managed without euthanasia. 

The same bill, legalising child euthanasia, would also make euthanasia legal to adults suffering with the early stages of dementia. The patient would have to write a written declaration, that they wish to be euthanised if their health deteriorates, for example someone who is diagnosed with Alzheimer's. Previously, anyone could write declaration to be euthanised if health deteriorates, under the circumstances of irreversible coma and the written consent to have been written within the previous five years. The new bill would abolish the time limit for the consent to be written, as well as extending the conditions to early stages of dementia, as well as an irreversible coma. 

References:

http://www.bbc.co.uk/news/world-europe-26181615  

http://www.sbs.com.au/news/article/2014/02/17/controversy-belgium-approves-child-euthanasia

http://www.patientsrightscouncil.org/site/belgium/

http://life.nationalpost.com/2013/10/31/belgium-moves-to-make-euthanasia-legal-for-children-dementia-patients/

Schizophrenia

Schizophrenia is a chronic, severe and disabling psychological disorder affecting 1 in 100 people. It is sometimes described as a psychotic illness, where the patient may not be able to distinguish thoughts from reality. It is thought to be an inheritary disease, the risk is therefore higher if a first degree relative is affected, although the likelihood is less if a second degree relative (aunt, uncle, cousin) is affected, it is still higher than the risk for the rest of the population.  The highest risk is for identical twins; the likelihood of being affected is 40-65% for one twin, if the other has schizophrenia.

 Although unknown, the cause is thought to be caused by unbalanced levels of neurotransmitters, dopamine and serotonin. It has also been proven that the differences in brain structure and distribution of brain cells has been seen in some patients with schizophrenia. The risk is increased by abnormal growth of a baby whilst within the womb, including low birth rate and reduced head circumference. Any complications during pregnancy are thought to increase the risk, for example if the foetus is exposed to virus, bleeding or onset diabetes for the mother. During birth, and emergency caesarean section or lack of oxygen may increase the risk. Later on in life, stress and drug abuse can onset schizophrenia in those already vulnerable.

All symptoms are psychological; the main two are Hallucinations and delusions. Hallucinations, the most common type is where patients may hear voices other people do not hear. Other types of hallucinations include seeing objects or people, which are not there.  Delusions cause patients to believe other people are reading their minds, controlling their thoughts, or plotting harm to them. Further example of delusions is where they believe they are someone else. These symptoms make it difficult to hold a job or to care for themselves.

Treatment includes; antipsychotic medications, psychosocial medications, rehabilitation, family education, cognitive behavioural therapy and self help groups. Treating the condition is difficult because the cause is unknown, the medications and other types of treatments available are to ease the symptoms of schizophrenia and provides patients with the resources to live an everyday life.

References:

http://www.bmj.com/content/335/7610/91

http://www.nhs.uk/conditions/schizophrenia/Pages/Introduction.aspx

http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml?utm_source=publish2&utm_medium=referral&utm_campaign=www.kpbs.org

Crohns and colitis

Crohn's disease and colitis are often referred to together as inflammatory bowel disease (IBD.) Crohns is a chronic inflammatory disease of the intestines. It can affect the digestive system from mouth to the anus, and can causes breaks within the linings of both the small and large intestine. Whereas ulcerative colitis only typically affects the colon (large intestine) and inflammation caused by Crohns may be in patches, whereas inflammation due to ulcerative colitis is continuous.

Crohn’s disease is a non-contagious disease but the cause of it is unknown although it is suspected to be due to a bacterial infection and can be genetically inherited.  Within a patient with IBS the immune system is chronically activated by any molecules, not just harmful such as bacteria, viruses and fungi. It is this continued abnormal activation which results in chronic inflammation and ulceration. The gene NOD2 is thought to be responsible for the abnormal activation of the immune system; it is this gene which can be inherited. The symptoms and severity vary among patients and symptoms can fluctuate in periods of remission (inactivity) and relapse (activity.)  Symptoms include abdominal pain, diarrhea and rectal bleeding. In crohn’s disease pain is commonly experienced in the lower right abdomen and in colitis the lower left of the abdomen.

Neither Crohns nor Colitis has a cure, but there is medication available to induce remissions and maintain them whilst reducing side effects. Anti-inflammatory agents such as corticosteroids and antibiotics are often used. With most of the drugs there a negative side effects, such as with corticosteroids there is increased risk of acne, weight gain, cataracts, depression and high blood pressure. The biggest side effect with corticosteroids is aseptic necrosis; this is a condition in which there is death and degeneration of the hipbone.  Sometimes surgery is used as treatment to divert digestive waste away from the inflamed colon, such as a ileostomy; during this operation the ileum is disconnected from the colon and re-routed through a hole made in the abdomen, through which an external bag is attached to collect waste products. Usually after several months when the colon has recovered, the stoma (gap in abdomen) is closed and the ileum reattached to the colon.

References:

http://www.medicinenet.com/crohns_disease/article.htm
http://www.nhs.uk/Conditions/Crohns-disease/Pages/Treatment.aspx
http://www.nhs.uk/Conditions/Crohns-disease/Pages/Treatment.aspx
http://www.columbia-stmarys.org/Crohn_vs_Ulcerative_Colitis