bulletFrom coma to motherhood: Badly hurt woman goes home to new daughter
bulletEU rule will allow medical research on handicapped
bulletTougher rules on when to let coma victims die

 "but technically, the doctors can't tell you when. . . . someone will come out of a coma"

The Seattle Times Company  Nation & World : Thursday, March 22, 2001


From coma to motherhood: Badly hurt woman goes home to new daughter
By Selwyn Crawford The Dallas Morning News

DALLAS - Shannon Kranzberg gave birth to a girl, but it was more than a week before the 18-year-old knew she was a mother. 

The Garland, Texas, woman was about five months pregnant when a car accident Nov. 16 left her in a coma with a brain injury. Doctors initially were unsure whether she or her baby would
survive.

While still in a coma, Kranzberg went into labor and gave birth prematurely Jan. 14. She delivered the child naturally and came out of the coma about a week later.

"I just woke up and the baby was there," Kranzberg said last week. "She's my hero," Michael Kranzberg said of his wife. "She's just awesome."

Doctors say it's rare for a woman in a coma to give birth, even rarer if the delivery is natural.

The miracle doesn't stop there.

Now doctors will discharge Kranzberg from the Baylor Institute for Rehabilitation so that she can join 2-month-old Alexis, who went home from Methodist Medical Center shortly after birth.

Michael Kranzberg, 21, remembered how bleak their lives looked that November morning, when a car broadsided his wife's vehicle on an Arlington, Texas, street as she drove to her college classes.

"The universal thing the doctors kept saying was, `We'll have to wait and see,' " he said. "Everything was kind of up in the air. Everybody knew that she would" eventually come out of the coma, "but technically, the doctors can't tell you when."

Doctors told Michael Kranzberg that although his wife was in a coma, the baby remained healthy. They discussed the possibility of performing a Caesarean section, but he asked them to wait.

Almost two months after the accident, Shannon Kranzberg developed a staph infection that apparently triggered her labor.  Again, her husband said, he resisted suggestions the baby be
delivered by Caesarean section.

After 10 hours of labor, Kranzberg, who had miscarried twice, gave birth to Alexis.

Because the baby was two months premature, she weighed only 4 pounds, 12 ounces.

Mom and daughter came through the high-risk delivery in fine shape. Dad fainted in the delivery room.  "It seems like it worked out," said neurologist Gregg Shalin. "A lot of the mechanisms involved in delivery are somewhat automatic."

The doctor said Kranzberg still has some weakness on her left side that prevents her from holding Alexis. But the Kranzbergs said they are just happy for a second chance. And Michael Kranzberg said he hopes others will be inspired.

"I just want to say to people who are in our position that you've just got to keep the faith," he said. "You can't get beat down."

Source:http://archives.seattletimes.nwsource.com/cgi-bin/texis/web/vortex/display?slug=coma22&date=20010322&query=coma

The above news, brings to mind two other articles as follows: Archive titled "EU rule will allow medical research on handicapped" and Tougher rules on when to let coma victims die

UK News Electronic Telegraph Monday 7 April 1997 Issue 682

EU rule will allow medical research on handicapped

A NEW European convention will allow medical research to be conducted on people who cannot consent to it, even in cases where it does not benefit them. The subjects could include children, people in a persistent vegetative state, and those with mental handicaps. Anti-euthanasia campaigners yesterday condemned the convention's provisions and groups for the handicapped dismissed its safeguards as inadequate. 

Medical sources, however, insisted its terms were reasonable. The Council of Europe Convention on Human Rights and Biomedicine was signed by 21 countries - but not Britain - last week.

It allows research on people who cannot consent, as long as it is research into their own "condition, disease or disorder" that could help others with the same problem. Dr Peggy Norris, chairman of Against Legalised Euthanasia - Research and Teaching, described it as "creeping euthanasia". "We have got to protect people who cannot give consent because they are very vulnerable and we have to be civilised enough to look after them," she added.

The document specifies that any research on non-consenting subjects should "entail only minimal risk and minimal burden for the individual concerned", for example taking a blood sample, but apped dismissed the safeguard. Klaus Lachwitz, secretary general of the International League of Societies for Persons with Mental Handicaps, said: "Unless these provisions are adequately defined, this protection is meaningless."

Lord Ashbourne, a Conservative peer who has asked questions in the House of Lords on the subject, said: "Doctors do research for the most laudable reasons, but sometimes they go too far. What they are trying to do is get the door open a chink, and once it's open a chink they can kick it wide open.

This came up with the Human Fertilisation and Embryology Bill back in 1990. They got the door open then and now we have got all sorts of things going on." Britain did not sign up to the convention last week because of the election but Health Department officials said it would be considered by the next government. Medical sources said its provisions were entirely reasonable, and similar to the Royal College of Physicians' current guidelines.

They said many discoveries had been possible only by allowing research on non-consenting people. David Morton, professor of biomedical science and ethics at the University of research would be acceptable. "I think there are very special instances where it would not be unreasonable to consider using people in a permanent vegetative state in one way or another," he said.

Prof Morton, who is also a vet, called for a national ethics committee to be set up. He said animals in Britain had better protection than people when it came to research. 8 April 1996: Patients in coma 'could be used for research'

SOURCE UK News Electronic Telegraph Monday 7 April 1997 Issue 682

Tougher rules on when to let coma victims die

By David Fletcher, Health Services Correspondent

Life support dilemma for family NHS plans first surrogate birth

INTERNATIONAL guidelines on how to diagnose and possibly rouse patients in deep coma are being drawn up by British doctors as evidence mounts that some patients are aware of their surroundings even though they cannot communicate.

It follows the case of Mark Newton, 28, who was unconscious for six months after a diving accident but who disclosed on recovery that he knew what was going on around him even though he could not respond.

Four years later, he is still in a wheelchair but sufficiently recovered to take a course of studies at Portland College, Nottingham, a college for disabled students.

The guidelines are being prepared by doctors at the Royal Hospital for Neuro-Disability in south London, the leading hospital for the treatment of brain damaged and coma patients.

Dr Keith Andrews, medical director, estimates that about 15 out of 80 patients diagnosed as being in persistent vegetative state have been brought out of it over the past two years.

He is preparing a report for the British Medical Journal later this year that will re-open the debate about whether patients can be allowed to die - ie have nutrition withdrawn - when they are judged to be in irreversible vegetative state. It is an issue that divides doctors.

The British Medical Association believes that no one should be diagnosed as being in persistent vegetative state in less than a year.

Dr Vivienne Nathanson, of the BMA, said that, even if a vegetative state was diagnosed after a year, it was still too soon to ask the courts to consider ending a life.

But she insisted that with proper safeguards there were circumstances in which it was safe and right to go to the courts - as in the case of Tony Bland who was in a vegetative state for four years after the Hillsborough football disaster in 1989.

"We know from long experience with coma patients that they can appear to be deeply unconscious yet remember things that have been said to them or done to them afterwards," she said.

"It may be that some patients who appear to be in a vegetative state may also have a degree of awareness and it is vital that nothing is done in a hurry. The biggest diagnostic tool we have in assessing persistent vegetative state is time."

She said that some patients might eventually come out of the deep coma but they were unlikely to recover in the sense of being restored to the way they were before the injury which caused their coma.

Dr Peggy Norris, chairman of Alert, the anti-euthanasia organisation, said it could never be right deliberately to end the life of someone in such a state, irrespective of whether or not they were aware of their surroundings.

She said: "It is a scandal that food and fluids should be withheld from anyone as a means of causing their death.

"If someone is dying, it is perfectly ethical to withhold medical treatment if is it failing to help them to recover but food and drink are not medical treatment.

"If that is withdrawn, people are being starved to death and that can never be right."  That view was challenged by Dr Richard Nicholson, editor of the Bulletin on Medical Ethics, who said putting a tube down someone's throat to enable them to take food and water did amount to medical treatment.

"Withdrawing that tube is allowing nature to take its course which had otherwise been prevented in the first place by insertion of the tube."

Nuala Scarisbrick, trustee of Life, the anti-abortion organisation, said the case of Mark Newton was a "terrible warning" to those who supported euthanasia of deep coma victims.

Persistent vegetative state is used to describe an indefinite deep coma. Although the eyes may be open and occasional random movements of the head and limbs may occur there are no other signs of consciousness.

Patients do not respond to being spoken to, touched or pinched and only their basic functions, breathing and heartbeat, are maintained.

Source http://www.telegraph.co.uk:80/et?ac=000147274643790&rtmo=aC556XBJ&atmo=rrrrrrrq&pg=/et/96/2/13/ncoma13.html

 

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