Friday, December 29, 2017

The Human Brain and Human Mind

Dr Ruwan M Jayatunge 

The Human Brain
The human brain is a very complex organ. The human brain is largely interconnected. Brain controls all   mental   and physical functions. The human brain is primarily composed of neurons, glial cells, neural stem cells, and blood vessels. An average human brain contains about 100 billion neurons.  There are as many as 1,000 trillion synaptic connections in the brain.  Approximately 20% of the blood flowing from the heart is pumped to the brain. It uses 20% of all the oxygen we breathe. The brain is the central organ for adaptation to experiences (McEwen, 2016).

The brain is considered as the control center of the body. Human thought is controlled by the brain.  The brain is an electrochemical organ using electromagnetic energy to function (Beyo, 2011).

The largest part of the brain is the cerebrum which contains the cerebral cortex. The cerebrum directs the conscious or volitional motor functions of the body. Furthermore it controls planning, memory, and sensory integration.

The brain is divided into two hemispheres,-the left and right hemispheres.  The right hemisphere is known as the creative side of the brain, while the left hemisphere is the logical or analytical side of the brain.  Two hemispheres communicate with one another with corpus callosum. This bundle of nerve tissue contains over 200 million axons.

The lateralization of brain function is the tendency for some neural functions or cognitive processes to be more dominant in one hemisphere than the other. Language is considered to be one of the most lateralized human brain functions. Left hemisphere dominance for language has been consistently confirmed in clinical and experimental settings and constitutes one of the main axioms of neurology and neuroscience (Riès et al.,2016). 

Right hemisphere characteristics include creativity, the ability to see patterns, spatial awareness, and the understanding of how things relate to one another in different contexts. The absence of verbal and visual memories for early childhood and traumatic events relates to their right brain nonverbal retention and storage. The memories are unconscious, emotional, somatic behavioural and timeless. Right hemisphere damage can cause serious disruptions to verbal communication (Abusamra  et al, 2009).

The brain has four lobes. The brain’s frontal lobe is responsible for functions such as reasoning, problem solving, judgment, impulse control. The Parietal Lobe is involved in processing pain and touch sensation. The temporal lobe is involved in auditory sensation. The occipital lobe is located at the back portion of the brain and is associated with interpreting visual stimuli and information.

The human brain has three major components: the cerebrum, the cerebellum and the brain stem. The brainstem which includes the medulla, the pons and the midbrain, controls breathing, digestion, heart rate and other autonomic processes.The cerebrum is the largest portion of the brain. Cerebrum is associated with higher brain function such as thought and action.

The Cerebral Cortex is the outermost layer of the cerebral hemisphere which is composed of gray matter. The cerebral cortex is a complex structure   (Agirman,  2017). The mammalian cerebral cortex contains numerous anatomically and functionally distinct areas arrayed in a complex mosaic across the cortical sheet (Van Essen et al., 1998). The Cerebral cortex plays a key role in memory, attention, perception, cognition, awareness, thought, language, and consciousness (Kandel et al., 2000). 

The neocortex is the largest part of the cerebral cortex which is the outer layer of the cerebrum. The neocortex involved in higher-order brain functions such as sensory perception, cognition, generation of motor commands (Lodato,  2015).  Semantic memories appear to be stored in the neocortex, specifically the anterolateral temporal lobe of the neocortex (Carlson,  2013).

Among the other brain structures the amygdala helps the body responds to emotions, memories and fear. The amygdala plays an important role in the computation of internal reward signals (Mormann et al.,2017). Amygdala is the storage for the memories associated with emotional events. It is the center of the emotional memory. In addition amygdala is involved in the modulation of memory consolidation and social interaction. The ventromedial prefrontal cortex region of the brain  is responsible for regulating emotional responses triggered by the amygdala.

Many researchers believe that amygdala may be responsible for the emotional reactions of PTSD patients. Overstimulated amygdale can cause many PTSD symptoms. Psychological trauma usually increases activity in the amygdala. In severe anxiety the size and connectivity of the Amygdala changes drastically. Morey and colleagues (2012) found the association between a smaller amygdala volume and PTSD.

The hippocampus is vital for learning memory and spatial navigation. The hippocampus is critical for the formation of new memories and spatial orientation. According to Eichenbaum and Cohen (1993) hippocampus plays an important role in the experienced events (episodic or autobiographical memory).

PTSD patients have decreased gray matter volume in the hippocampus. In addition reduced hippocampal volume can be seen in PTSD. Following the reduced hippocampal volume patients loses the ability to discriminate between past and present experiences or correctly interpret environmental contexts.

The hypothalamus region of the brain controls mood, thirst, hunger and temperature. The neocortex or rational brain is important to develop language, abstract thought, consciousness and imagination. The hypothalamus has a central neuroendocrine function.

The reticular formation is a comprehensive network of nerves found in the central area of the brainstem. The reticular formation is important in somatic motor control, cardiovascular control, Pain modulation and Sleep and consciousness. The reticular formation regulates the shift between sleep and wakefulness.

The Cingulate Gyrus is located in the medial side of the brain between the cingulated sulcus and the corpus callosum. The region participates in the emotional reaction to pain and in the regulation of aggressive behavior. The anterior cingulate gyrus is important in self-regulation(Posner, 2007).

Insula is a vital human brain structure. It is a small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe (Craig 2009). Insula is important in awareness of our own body. The anterior insular cortex   is implicated in a wide range of conditions and behaviours, from bowel distension and orgasm, to cigarette craving and maternal love, to decision making and sudden insight (Craig 2009). Garavan (2010) believes that insula plays a key role in drug craving.

The Human Mind
There is a popular notion that states - As humans we live in our Minds. The mind is the organized totality of an organism's mental and psychological processes, conscious and unconscious. Mind does not end in the brain and brain is the liaison between mind and body (Tan, 2007). Mind is not a physical object but the mind is infinite. According to some scholars the mind is a set of cognitive faculties. The British evolutionary biologist, Sir Julian Huxley expressed that brain alone is not responsible for mind.   The mind is also portrayed as the stream of consciousness where sense impressions and mental phenomena are constantly changing (Karunamuni &Weerasekera , 2017).   
Theory of mind is the ability to attribute mental states to self and others in order to understand and predict behavior. It involves the distinction between the real world and mental representations of the world (Duverger  et al.,2007). The mind is a set of cognitive faculties including consciousness, perception, thinking, judgment, and memory.  Human mind is the result of the brain activities and has a conscious as well as a subconscious side. The human mind is   built on the physical scaffolding of the brain. Human mind is shaped by natural selection and sexual selection (Pinker, 1997). According to the psychomotor theory, the human mind may be an emergent property of the motor system, expressed by human language (Tan, 2007).

Our mind is our own creation. John Milton emphasized that the   mind is its own place and in itself can make a hell of heaven or a heaven of hell. If we view the mind as software, and the brain is obviously the hardware.

The Buddha explained that the mind is exceedingly subtle and is difficult to be seen. It attaches on whatever target it wishes. The mind moves about so fast it is difficult to get hold of it fully. It is swift. It has a way of focusing upon whatever it likes. The mind is capable of travelling vast distances - up or down, north or south, east or west - in any direction. It can travel to the past or the future. It roams about all alone. The Buddha viewed mind as a non-physical phenomenon which perceives, thinks, recognizes, experiences and reacts to the environment. The Buddha further stated that mind is the ultimate cause of everything in this world.

Sigmund Freud developed a topographical model of the mind, whereby he described the features of the mind’s structure and function. Freud used the analogy of an iceberg to describe the three levels of the mind. Furthermore Freud analyzed the human psyche in terms of three elements, which he calls, the Id, Ego, and Super Ego. 

Carl Jung believed that the human psyche was composed of three components: the ego, the personal unconscious, and the collective unconscious. Jung concluded that the collective unconscious is formed by instincts and archetypes that are symbols, signs, patterns of behavior, and thinking and experiencing, that are physically inherited from our ancestors. 

The American, logician, mathematician, and philosopher Kurt Gödel argued that human mind is a Turing machine. For Kurt Gödel human mind was fully algorithmic.
The Cognitive Psychologist Steven Pinker expressed that human mind is a naturally selected system of organs of computation. Steven Pinker states that cognitive psychology has shown that the mind best understands facts when they are woven into a conceptual fabric, such as a narrative, mental map, or intuitive theory. Disconnected facts in the mind are like unlinked pages on the Web: They might as well not exist. 
The spiritual author Eckhart Tolle affirms that boredom, anger, sadness, or fears are   conditions of the human mind.  He further states that the mind is a superb instrument if used rightly. Used wrongly, however, it becomes very destructive. 

Mind -Brain Connection
The mind vs. brain debate has been going on since before Aristotle ( Sarich, 2013). Brain" refers to the "machine" made of neurons and glia; "mind" refers to the products of that machine including conscious thought, as well as emotions, perceptions and unconscious thought (William Harris). The mind is the manifestations of thought, perception, emotion, determination, memory and imagination that take place within the brain. The mind is where experiences are collected and then expressed in other words the mind is a storehouse of information. Mind is that it is the space and time in which thought and feeling exists. Some consider mind as pure vibrating energy. The Nobel prize laureate Neils Bohr’ once stated; there is “an indivisible wholeness, an unanalyzable wholeness.  It is assumed that large-scale quantum coherence is necessary to understanding the brain and mind (   Sarich, 2013).  The concept of mind shows that a human being has a corporeal body and a mind, that is, a range of psychological capacities (Bennett, 2007).

According to western medical science there is no anatomical entity known as mind. However Sigmund Freud used the term "psyche” to describe the mental process. It is suggested that the history of the concept of mind shows that a human being has a corporeal body and a mind (Bennett, 2007). According to Pandya (2011) mind is responsible for one’s thoughts and feelings, the seat of the faculty of reason or the aspect of intellect and consciousness experienced as combinations of thought, perception, memory, emotion, will and imagination, including all unconscious cognitive processes. Pinker (2003) hypothesized that the mind is a complex system composed of many interacting parts. The Indian Philosopher E.S Krishnamoorthy states that mind is a virtual entity.  The British Neurologist John Hughlings Jackson called the prefrontal cortex as the organ of mind.

In his famous book , “ The Tell-Tale Brain: A Neuroscientist's Quest for What Makes Us Human” the Neuroscientist V.S. Ramachandran writes :How can a three-pound mass of jelly that you can hold in your palm imagine angels, contemplate the meaning of infinity, and even question its own place in the cosmos? Especially awe inspiring is the fact that any single brain, including yours, is made up of atoms that were forged in the hearts of countless; far-flung stars billions of years ago. These particles drifted for eons and light-years until gravity and change brought them together here, now. These atoms now form a conglomerate- your brain- that can not only ponder the very stars that gave it birth but can also think about its own ability to think and wonder about its own ability to wonder. With the arrival of humans, it has been said, the universe has suddenly become conscious of itself. This, truly, it the greatest mystery of all.

Wednesday, December 27, 2017

සිංහල කඩයකින් බඩුවක් ගන්න ගිය විට මුදලාලි සහ ගෝලයෝ


1) පොඩ්ඩක් ඉන්ඩ බලලා කියන්නං
2) අන්න අරයගෙන් අහනවද ?
3) ගන්නවනම් විතරක් බලන්ඩ දෙන්නං
4) ඒක ඉවරයිනේ ; කෝ අනිත් එක්කෙනා මොනාද ඔයාට ඕනෙ?
5) ඒවනම් නෑ මේක තමයි තියෙන්නේ ගන්නවනං මේක ගන්ඩ
6) දන්නේ නෑ බොස් ගෙන් තමයි අහන්ඩ ඕනේ. බොස් දවල්ට කන්ඩ ගිහින් 
7) බොස් ඉන්න වෙලාවක එන්ඩ
8) අපි ලඟ ඕක නෑ . තියන තැනක් දන්නෙත් නෑ
9) බලන්ඩකො පිටකොටුව පැත්තේ
10) එව්වනං දන්නේ නෑ මේක තමයි තියෙන්නේ
11) මිල ගනන් දන්න මිස් අද නෑ හෙට එන්ඩ

Tuesday, December 26, 2017

A street walker

They call me a street walker
But I haven’t committed any crime
They say I am immoral
All I know is I am feeding my hungry children
They query the whereabouts of my husband
They don’t know that he is six feet under
They ask why you can’t do a decent job
I said of course I did until my boss asked me to get in to his car
They question my morals
But they forget that the boss could fire me
Furthermore ethics and morality do not feed my children
They say I am indecent
Values and decency do not keep my children warm
They talk about all good things and criticize bad elements like me
But they offer no solution, give no hope
So I am powerless and empty
I know I am unacceptable
But I have no option
I am hollow and desolate
Inside and out

Dr Ruwan M Jayatunge 

Sunday, December 24, 2017

මගේ කවිය

මහතානෙනි ඔබගේ ගමන හරි 
ඒ මග යන්න අතරමං නොවී
උකුස්සෙකුගේ දෙනෙතින්
සිවලෙකුසේ මානසයෙන්
වෘකයෙකුගේ ගිජුකමින්
යොදාගන්න බුද්ධාගම
ආරක්‍ෂක වලල්ලක් සේ
මිශ්‍ර කරන්න ඔබගේ අදහස්
යෝජනා සංකල්ප පිඹුරුපත්
බුද්ධාගම සමග මාන්තරව යන සේ
බුද්ධාගම සමග මිශ්‍ර කල විට
ඕනෑම කූට ව්‍යාපාරයක්
විකිණිය හැකියි ඕසෙට මේ ර​ටේ
මේ න්‍යාය සිතට ගන්න
ඔබගේ අදහස් ප්‍රශ්න කරන්නන්ට චෝදනා කරන්න
බෞද්ධ විරෝධීන්; මිත්‍යා දෘෂ්ටිකයන්
කුම්භාණ්ඩයන්, අසුරයන් එන්ජීඕ කාරයන් කියා
ඩොලර් ගැනත් කියන්න
පොදු මිනිසුන් ආශයි තමන්ට නැති
ඩොලර් ගැන කතා කරන විට
ඔවුන් නොදකිති ඔවුන් ගේ පසුපසින්
පිල්ලි යවන රුපියල් සත
බෞද්ධ විරෝධීන් ලෙස
විකල්ප අදහස් දරන්නන් ලේබල් කරන්න
එවිට ලේසියි ඔවුන්ව විනාශ කරන්න​
මතවාදීව සහ ශාරීරිකව
මෝඩ අනුගාමිකයන් ලවා
දැන් සිටම අරඹන්න ඔබගේ දේශපාලන වියාඍතිය
එකතු කරන්න සමාජ ප්‍රාග්ධනය ලාභ ජනප්‍රියතාව
අමතන්න හැඟීම් වලට
බුද්ධියට නොව ආවේග වල​ට
දේශප්‍රේමය ගැන කථා කරන්න
පීතෘ භූමිය ගැන කඳුළු සලන්න
සෑම රෝගයක් වසංගතයක්ම
දේශපාලනීකරණය කරන්න
කතා කරන්න කුමන්ත්‍රණ ගැන
අපගේ මිනිසුන් ආසයි බයයි
අසන්නට කුමන්ත්‍රණ ගැන
කියන්න රෝග වසංගත
බටහිර කුමන්ත්‍රණ කියා
පිටු දකින්න විචාර බුද්ධියෙන් යුතු පිරිස්
ඔවුන් භයානකයි වෙඩි බෙහෙත් සේ
මොට කරන්න විචාර බුද්ධිය රටේ
අවිචාරවත් මැට්ටන් වැඩිවූ තරමට
ලෙහෙසියි ගමන ඔබේ
වපුරන්න මිත්‍යාව සැමතැන
පත්තර ගුවන් විදුලිය රූපාවාහිනිය මගින්
කවන්න ජනතාවට පිදුරු
උන් හරකුන් බැවින්
හදාගන්න ඔබගේම කල්ලියක්
විචාර බුද්ධියෙන් අඩු අන්තවාදයට බර
ඔබ වෙනුවෙන් ප්‍රතිවාදීන්ට අපහාස කරවන්න
ප්‍රතිවාදීන්ව අවශ්‍ය වුවහොත් විනාශ කරන්න
ඔබගේ අවශ්‍යතා වෙනුවෙන් කඩේ යැවීමට
නමුත් මතක ඇතිව ඉවත් කරන්න ඔවුන්ව
කන්ද නැගගත් පසු දැහැටි කූරු සේ
ලාංකික ජනතාව මෝඩයි ; ආවේගශීලියි
විචාර බුද්ධියෙන් තොරයි රැවටෙන සුළුයි
හරවා ගන්න එය ඔබගේ වාසියට
අනාගත ආයෝජනයට ලාභදායක​
යොදාගන්න පලිහක් සේ බුද්ධාගම
ඔබගේ දේශපාලන ගමනට
ආවේගශීලී නොවන්න නලීන් සේ
සූක්‍ෂම වන්න ; සතුරන්ට පහර දෙන්න
මෝඩ විචාර බුද්ධියෙන් තොර අනුගාමිකයන් ලවා
එවිට ඔබට හැකියි වගකීමෙන් මිදෙන්න
මකා දමන්න මා වැනි කවියන් අමතක නොකොට
පටලවන්න විද්‍යාව සමග
අන්ධ විශ්වාස මිත්‍යා අදහස්
ඒවාට අනුපාන ලෙස යොදාගන්න
බුදුදහම සහ බොදු සංස්කෘතිය
එවිට මහානායකලාත් රැවටීම පහසුයි
පලඳන්න අතේ පිරිත් නූල් ඝනකමට
බැහැ දකින්න මහා නායකලා
අට පිරිකර සමග
කියන්න ඔවුන්ට ආගම ජාතිය
විනාශයි මේ සිංහලයාගේ අවසානයයි කියා
ආමන්ත්‍රණය කරන්න ජාතිකත්වයට
හිට්ලර් කලාක් මෙන්
කියන්න අප වටා සතුරු බළඇණි
සිටිති උන් අපව විනාශ කරන මාන බලමින්
ගොඩනගන්න බිය සමාජය වටා
පෙන්වන්න ඔවුන් අනාරක්‍ෂිතයි
අණතුර දොරකොඩ ලඟයි
මව් බිමේ අවසානයයි මේ කියන්න
ගොඩ නගන්න මතයක්
ඔවුන් සහ අප කියා
බැහැර කල යුතුයි අනෙකාව
ඌ අපගේ සතුරෙක් නිසා
නිති පතා මෙය කියන්න මන්තරයක් සේ
මිනිසුන් ගේ සිත් සතන් වලට කා වැදෙන්න
එවිට තැතිගත් මෝඩ ජනතාව
එක් රැස් වෙයි ඔබ වටා
කියන්න විසඳුම ඇත්තේ ඔබ අත පමණි
මමයි දියසෙන් කුමාරයා කියා
මතකද ධර්ම රාජ්‍යකට කියා සෝම හිමි
විකුණා පාර්ලිමේන්තු සැප වැළඳීමට ගිය පිරිස්
ඒ වාගේ වස විසෙන් තොර ධර්ම රාජ්‍යකට කියා
අරඹන්න ඔබගේ දේශපාලන ව්‍යාපෘතිය
කෙමෙන් කෙමෙන් අල්ලා ගන්න බලය
රඳවාගන්න එය අත්ලේ තදින් ගුලි කොට
තමන්ට රාජ යෝගයක් තිබේය කියන්න
විශ්වාස කරාවි එය ගෙරි සරක් ජනතාව
උපයාගන්න ලාභාංශ දේශපාලනයෙන්
දෙවියන් ගේ කැඳ විකුණා
මුදල් උපයා ගත් ලෙසට මාගම
විඳින්න මෙලොව සැප එරියස් සමග
කුහන පනික්කියා මෙන්

වෛද්‍ය රුවන් එම් ජයතුංග 

Friday, December 22, 2017

ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමා ගේ නික්ම යාම

ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමා නික්ම ගිය බව මට දැණුම් දුන්නේ  මිත්‍ර ශ්‍රී කරුණානායක විසිනි. ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමා මගේ ගුරුවරයෙකු වූ අතර මම 2000 වසරේදී එතුමා යටතේ මනෝ විද්‍යා උපදේශනය හැදෑරුවෙමි. 

මම වෘත්තියෙන් වෛද්‍යවරයෙකු බව දැනගත් විගස එතුමා කිව්වේ "  Doctors are bad counsellors  " කියාය​. එය නම් සත්‍යකි. බොහෝ වෛද්‍යවරු උපදේශනය නොව සාමාන්‍යයෙන් රෝගීන්ට මූලික සවන් දීමවත් නොකරති. මේ නිසා  මර්වින් ප්‍රනාන්දු පියතුමා ගේ ප්‍රකාශය මට අවලාදයක්  නොව මාර්ගෝපදේශනයක් විය​. එබැවින් මම උපදේශනය විශය එතුමා යටතේ හොඳින් හැදෑරුවෙමි.  අද දිනයේ මම මනෝ චිකිත්සනය සම්බන්ධයෙන් ආචාර්‍ය උපාධිය හදාරන අතර මා මේ තත්වය දක්වා ගෙන ආ ගුරුවරු අතර ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමාද එක් අයෙකු බව කියන්නේ ගෞරව පූර්වකවය​. 

ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමා බොහෝ දැන උගත් පුද්ගලයෙකු විය​. එතුමා ගේ දැණුම අතිශය විශාලය​. එසේම මර්වින් ප්‍රනාන්දු පියතුමා මානුෂික ගති ගුණ වලින් අනූන වූ අයෙකි විය​. කතෝලික පූජකයෙකු වූවද ආගම් අන්තවාදය එතුමා බැහැර කොට තිබුනේය​. මා බෞද්ධයෙකු  වූවද එතුමා මාව දුටුවේ තවත් මනුෂ්‍යයෙකු ලෙසටය​. මම එතුමාගෙන් බොහෝ දේවල් උගත්තෙමි.එසේම  පරාර්ථය එතුමාගේ ජීවිතයේ එක් අංගයක් විය. නිතරම අනුන්ට උපකාර කිරීමට එතුමා සූදානම්ව සිටියේය​. 

ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමා ඉතා සරළ පුද්ගලයෙකු විය​. රාජ මාලිගා මෙන් පන්සල් අසපු සාදාගෙන  (හොරෙන් අල්ලාගත්) අලි ඇතුන් විළංගු දාගෙන බාහු භාණ්ඩිකව ජීවත් වන අපගේ සමහරක් මහා නායකලාට මර්වින් ප්‍රනාන්දු පියතුමා ගෙන්   අල්පේච්ඡතාව පිළිබඳ බොහෝ පාඩම් ඉගෙන ගැනීමට තිබුණි.

ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමා ජීවත්ව සිටි කාලයේදී නිසි ගරු බුහුමණක් කිරීම සඳහා මට අවශ්‍යතාව තිබුණි. මේ නිසා 2005 වසරේදී මා විසින් ලියන ලද මනෝ විද්‍යාත්මක උපදේශනය සහ මනෝ ප්‍රතිකාරය යන ග්‍රන්ථය මා විසින් පුද කලේ හාරිස්පත්තුවේ ආරියවංශාලංකාර හිමියන්ට සහ ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමාටය.  

ආචාර්‍ය මර්වින් ප්‍රනාන්දු පියතුමා නික්ම යාම කිතුනුවන්ට  පමණක් නොව  මනුෂ්‍යත්වය අගයන සියළු දෙනාටම සංවේගය දනවන්නකි. 

වෛද්‍ය රුවන් එම් ජයතුංග 

Thursday, December 21, 2017

The Brooklyn Bridge

I will meet you near the Brooklyn Bridge  
Come to me with a red rose  
Remember baby I love you
Do not throw my love away   

If you stop loving me  
The birds will sing no more  
The sun will turn in to a black hole   

Without my love  You might  feel devastated  
You will never meet such a sensational love   
Tell me baby Will you wait for me  near the Brooklyn Bridge  
Expecting my love day and night   

When you are waiting for me  
You can see the running water  
The time is passing minute by minute   
I will be there for you soon   

See how strong is the Brooklyn Bridge 
That can stand for ages  
My love for you is even stronger   

I will bring my love  
I will comfort you baby 
You are my cherry blossom    

When the sun rises  
You can see Manhattan  
Remember baby 
Do not take my love to the other side   

Remember Disco 2001 Space Oddesy  
The exotic night with disco lights  
I was dancing with you   
I can still hear Barry Gibb’s voice   

I was holding you 
 I could feel your body warmth  
When the DJ started spot light dancing  
I looked in to your eyes   

When our eyes met  
You smiled with me  
Then our lips met for a breathtaking kiss 
Your fingers softly touched my neck     

I never met a girl  
Who could bring me happiness and joy 
I never knew what the love is Until I met you   

We met at the Brookline Bridge  
You took my arm  
Then we started slowly walking  
Until the end of time   

Dr Ruwan M Jayatunge 

Tuesday, December 19, 2017

Euthanasia: Political, Social and Health Dilemma


 DrRuwan M Jayatunge M.D.

You don’t need to kill the patient to kill the pain –Dr. Andre Bourque University of Montréal

Euthanasia or assisted suicide is a controversial topic that is defined as deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering. Today several countries have legalized euthanasia and some view it as a human right. Those who support euthanasia point out that the importance of personal autonomy and self-determination, the right of every human being to have his / her wishes respected in decisions involving his / her own body and the recognition of every human being is in principle, master of his/ her own destiny.

In 2002 Holland became the first country in the world to legalize euthanasia and in 2003, 1626 cases were officially reported from Holland. The Dutch euthanasia law gives doctors immunity from prosecution if they help to kill patients over the age of 12 who are suffering unbearably from incurable conditions and who have repeatedly requested euthanasia.

Euthanasia Guidelines in Holland
The Dutch laid out narrow guidelines for doctors: The patient, who must be suffering unbearably and have no hope of improvement, must ask to die. The patient must clearly understand the condition and prognosis and a second doctor must agree with the decision to help the patient die.

Euthanasia in Belgium
Belgium legalized euthanasia in 2002, but the laws seem to encompass assisted suicide as well. Since its legalization eight years ago, euthanasia now accounts for 2 per cent of deaths in Belgium - or around 2,000 a year. Two doctors must be involved, as well as a psychologist if the patient’s   competency is in doubt. The doctor and patient negotiate whether death is to be by lethal injection or prescribed overdose.

Oregon Death with Dignity law
In 1994, voters in the state of Oregon approved a ballot measure that would have legalized euthanasia under limited conditions. Under the Death with Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria. In order to qualify for physician-assisted suicide, a person must be an Oregon resident, 18 years of age or older, must have decision-making capacity, and must be suffering from a terminal disease that will lead to death within six months.
Forced Euthanasia
A number of reports indicate that some medical practitioners have abused the legal privilege of euthanasiaand reinforced depressive patients to select euthanasia as an option. A study found that a high proportion of deaths classed as euthanasia in Belgium involved patients who did not ask for their lives to be ended. In 1990 government sponsored surveys found that 0.8% of all deaths in the Netherlands were euthanasiadeaths that occurred without a request from the patient. In a 1995 study, Dutch doctors reported ending the lives of 948 patients without their request.

Passive Euthanasia
Although euthanasia is illegal in many countries passive euthanasia (withhold treatment and allow a patient to die) is being practiced. This is unethical and described as a malpractice. The American Medical Association emphasizes that the intentional termination of the life of one human being by another is contrary to that for which the medical profession stands. Human life has an absolute value and it is inhuman for a medical practitioner to terminate it.

Mrs. H a resident from North York Ontario Canada witnessed the agonizing death of her grandmother who suffered a stroke. When she was admitted to the …….hospital the doctors said that she would not recover. After several days the nasal feeding was discontinued. Mrs. H was near her semi-conscious grandmother all the time and the grandmother responded to her time to time by blinking the eyes. After removal of nasal feeding tube she was starving and I could see tears in my grandmother’s eyes. She was dying but the process was accelerated by discontinuing nasal feeding that led to an agonizing death says Mrs. H

Mrs. VXXX   a resident from Colombo Sri Lanka  underwent the same experience when her 92 year old mother was admitted to the ……… hospital. She was diagnosed with a benign ovarian tumor and had numerous age related complications. During her stay at the hospital she was only given Brufen  and Vitamin B. Doctors and Nurses often said that she had lived her years and taken no significant efforts to improve her condition. She was prematurely discharged and after two weeks she died at home. What worries me is not my mother’s medical condition but the attitude of the medical staff says Mrs. VXXX.  

Mr. XXX a resident from Negombo   met with a road traffic accident and admitted to the ……………….. Hospital- Intensive Care Unit. He was unconscious throughout and was on a life support. By the 8th  day his condition remained unchanged.  The medical staff decided to remove him from the life support system in order to accommodate another patient who was diagnosed with Guillain–Barré syndrome. After removing Mr. XXX from the life support system less than 24 hours he passed away. His son who is a doctor now believes that his father was not given a fair chance at the hospital to recover.

Passive Euthanasia: My Personal Experiences in the Sri Lankan Hospitals

Unfortunately I observed passive euthanasia in a number of Sri Lankan Hospitals. The first experience I witnessed was in 1994 during my internship appointment at the Matale   Base Hospital.

A 10 year old school boy was brought to the surgical ward following head injury that was caused by a road traffic accident on the Palapathwala road.  I was the house officer who gave primary care for this unconscious child. I immediately realized trepanation of the skull had to be done to evacuate the intracranial hemorrhage that was pressing the vital centers in the brain. The Senior House Officer too agreed with me. This operation is called performing a Burr Hole and had to be done by a Consultant Surgeon. I immediately called the Operation Theater and said we may need the theater facilities to treat a boy with a head injury.  

Then I called my Consultant Surgeon who had just finished the evening ward round. The time was about 3.40 pm and he was preparing to go home.  The Consultant Surgeon was annoyed that I called the operation theater. He ordered me to give diazepam 5 mg intravenous to the child even without seeing the patient. Again I asked Sir are we going to do a Burr Hole to stop the subdural hematoma. This time he responded to me in very dry language and asked me to give diazepam and monitor the child and maintain the head injury chart. I was powerless and did exactly what he ordered. Then the Consultant Surgeon left for home.
I observed the poor child until midnight. Several times he went in to seizures. Since we were given unofficial instructions not to transfer patients to the Kandy hospital at night, by the Surgeon we had no way of sending the child to the Kandy Teaching hospital for special management.  The Surgeon did not respond to our calls that night. So we waited and prayed for his life. At around 1.30 am the child died. According to my opinion we could have saved this child if the Surgeon did the surgery or allowed us to transfer the child to the Kandy Hospital. When I look back at this incident after 18 years I feel that the Consultant Surgeon who was supposed to give us knowledge, ethics, and leadership did nothing but forced us to perform passive euthanasia.

I was trained in Anesthesia by Dr. Priyangani Ariyarathne - Consultant Anesthetist at the North Colombo Teaching Hospital in 1999. I worked in the ICU and in the operation theaters at the North Colombo Teaching Hospital for about a year and observed that when the medical staff get new acute patients to the ICU they sometimes remove the life support systems of the old patients and fix it to the new patients. Due to lack of beds at the ICU the medical staff was compelled to do it. But still I had mixed feelings about this unorthodox practice.

When the Ja Ela bomb exploded on the December 18, 1999, that killed General Lucky Algama, hundreds of patients were brought to the Colombo North Teaching Hospital. The individuals who were critically injured were admitted to the ICU. There was a young man who was on the life support system following organophosphate poisoning and the medical staff removed him from the life support system and his bed was given to a bomb victim. Without the ventilator and other life support system the young man died the following day. One can always argue that the first patient became ill as a result of self-induced poisoning and second patient became a victim of a terrorist act. But my question was who are we to decide their fate and the duration of their life span.

When I was working at the Chilaw   hospital I had the opportunity of working at the ICU and I saw this life support removal occurring there too. Once we had a snake bite case and in order to accommodate him the doctors removed another patient who was in the ventilator with Dengue hemorrhagic fever.  The snake bite case survived and the dengue patient died. Again it became a dilemma for me. So instead of working at the ICU I decided to work in the Operation Theater.

Over the years I witnessed how some of my colleagues became indifferent to human lives.  I remember one Doctor at the Negombo   hospital who was against giving blood transfusions to the severely anemic alcoholic patients. These people are alcoholics and they deserve to die without wasting medical resources he openly stated. Another PHO (Pediatric House Officer) told me that when he suspects cerebral palsy in newborns he cuts off the oxygen supply to them. I am doing a favor to the child and the parents, so they are free of life long suffering with a disabled child he told me with confidence. I became so disgusted and replied that it was illegal, a crime and under the Hippocratic Oath he was violating professional ethics. I do not know whether he stopped this unethical practice after my brief lecture.

Euthanasia Declines in the quality of care
Euthanasia devalues human life; in the long run euthanasia can become a means of health care cost containment. In Holland legalized euthanasia has led to a severe decline in the quality of care for terminally-ill patients. Dr. Els Borst  the former Health Minister and Deputy Prime Minister who guided theeuthanasia law through the Dutch parliament recently admitted that medical care for the terminally-ill had declined since the law came into effect.

Euthanasia and Murder
According to the Criminal Code a person commits homicide when, directly or indirectly by any means, he causes the death of a human being. In this context euthanasia is mealy a murder. The main aim of the medical practitioners should be focused on improving and enhancing the care of the patient. Under the Hippocratic Oath, medical practitioner cannot engage in euthanasia.

Dr. Jack Kevorkian alias Dr. Death
Dr. Jack Kevorkian is a pathologist who actively support of voluntary euthanasia. He designed a so called death machine (thanatron) that was used by several terminally ill patients to commit suicide. He had helped more than 130 terminally ill people end their own lives. In 1994, he faced murder charges in the death of Thomas Hyde, who suffered from a terminal nerve illness. He was convicted of second-degree murder. Some experts consider Dr. Jack Kevorkian is highly obsessed with mercy killings and gradually lost the human touch. Instead of promoting health as a doctor Dr. Jack Kevorkian promoted death. 

Harold Shipman
The British doctor Harold Shipman murdered 215 of his patients using the drug Diamorphine over a period of 20 years. He killed an average of one patient a month during his medical career. Young Shipman observed the painful death of his mother who suffered from a terminal cancer. In the later years he killed mainly elderly women who were suffering from various illnesses. He was an addictive serial killer who may have believed that he was helping the patients to end their suffering. Shipman hanged himself in January 2004 while in the custody.

NAZI Movement and Euthanasia
Those who support euthanasia should study what the NAZI s did in Germany and in their occupied countries. The NAZI s widely used euthanasia as a social cleansing method. First, they exterminated the mentally ill and disabled Germans. Subsequently they extended euthanasia as a political tool. NAZI s used the medical practice to propagate racial supremacy. Dr. Josef Mengele alias the angel of death used to do horrible experiments euthanizing men women and children. NAZI genocide machine started fromeuthanasia and it ended up with the Final Solution. During the Hitler’s regime, 6 million Jews were terminated.

Before the advances in medical science diseases like leprosy, syphilis etc. were considered as incurable and relatives often performed mercy killings to end the suffering of the patients. Today the doctors are struggling with terminal cancer and sometimes suggest euthanasia as a temporary answer. The future advancements in the medical science would bring viable solutions to many incurable diseases andeuthanasia would be considered as an outdated, inhuman and unprofessional form of practice. 

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