Human eye

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The human eye

1. posterior chamber 2. ora serrata 3. ciliary muscle 4.

ciliary zonules 5. canal of Schlemm . pupil !. anterior chamber ". cornea #. iris 1$. lens corte% 11. lens nucleus 12. ciliary process 13. con&unctiva 14. inferior obli'ue muscle
15. inferior rectus muscle 1 . me(ial rectus muscle 1!.

retinal arteries an( veins 1". optic (isc 1#. (ura mater 2$. central retinal artery 21. central retinal vein 22. optic nerve
23. vorticose vein 24. bulbar sheath 25. macula 2 . fovea 2!. sclera 2". choroi( 2#. superior rectus muscle 3$. retina

)he human eye is an organ *hich reacts to light for several purposes. +s a conscious sense organ, the eye allo*s vision. ,o( an( cone cells in the retina allo* conscious light perception an( vision inclu(ing color (ifferentiation an( the perception of (epth. )he human eye can (istinguish about 1 million colors.-1. /n common *ith the eyes of other mammals, the human eye0s non1image1forming photosensitive ganglion cells in the retina receive the light signals *hich affect a(&ustment of the size of the pupil, regulation an( suppression of the hormone melatonin an( entrainment of the bo(y cloc2.

General properties
)he eye is not properly a sphere, rather it is a fuse( t*o1piece unit. )he smaller frontal unit, more curve(, calle( the cornea is lin2e( to the larger unit calle( the sclera. )he corneal segment is a si%th of the unit,-citation nee(e(. it is typically about " mm 3$.3 in4 in ra(ius. )he sclera constitutes the remaining five1si%ths5 its ra(ius is typically about 12 mm. )he cornea an( sclera are connecte( by a ring calle( the limbus. )he iris 6 the color of the eye 6 an( its blac2 center, the pupil, are seen instea( of the cornea (ue to the cornea0s transparency. )o see insi(e the eye, an ophthalmoscope is nee(e(, since light is not reflecte( out. )he fun(us 3area opposite the pupil4 sho*s the characteristic pale

optic (is2 3papilla4, *here vessels entering the eye pass across an( optic nerve fibers (epart the globe.

[e(it] Dimensions

+ human eye )he (imensions (iffer among a(ults by only one or t*o millimeters. )he vertical measure, generally less than the horizontal (istance, is about 24 mm among a(ults, at birth about 1 61! mm. 3about $. 5 inch4 )he eyeball gro*s rapi(ly, increasing to 22.56 23 mm 3appro%. $."# in4 by the age of three years. 7rom then to age 13, the eye attains its full size. )he volume is .5 ml 3$.4 cu. in.4 an( the *eight is !.5 g. 3$.25 oz.4

[e(it] Components
)he eye is ma(e up of three coats, enclosing three transparent structures. )he outermost layer is compose( of the cornea an( sclera. )he mi((le layer consists of the choroi(, ciliary bo(y, an( iris. )he innermost is the retina, *hich gets its circulation from the vessels of the choroi( as *ell as the retinal vessels, *hich can be seen in an ophthalmoscope. 8ithin these coats are the a'ueous humor, the vitreous bo(y, an( the fle%ible lens. )he a'ueous humor is a clear flui( that is containe( in t*o areas: the anterior chamber bet*een the cornea an( the iris an( e%pose( area of the lens5 an( the posterior chamber, behin( the iris an( the rest. )he lens is suspen(e( to the ciliary bo(y by the suspensory ligament 39onule of 9inn4, ma(e up of fine transparent fibers. )he vitreous bo(y is a clear &elly that is much larger than the a'ueous humor, an( is bor(ere( by the sclera, zonule, an( lens. )hey are connecte( via the pupil.-2.

Intestine
From Wikipedia, the free encyclopedia
Jump to: navigation, search /n human anatomy, the intestine 3or bowel4 is the segment of the alimentary canal e%ten(ing from the stomach to the anus an(, in humans an( other mammals, consists of t*o segments, the small intestine an( the large intestine. /n humans, the small intestine is further sub(ivi(e( into the (uo(enum, &e&unum an( ileum *hile the large intestine is sub(ivi(e( into the cecum an( colon.-1.

tructure and function

)he structure an( function can be (escribe( both as gross anatomy an( at a microscopic level. )he intestinal tract can be broa(ly (ivi(e( into t*o (ifferent parts, the small an( large intestine. :rayish1purple in color an( about 35 millimeters 31.5 inches4 in (iameter, the small intestine is the first, measuring to ! meters 32$623 ft4 long average in an a(ult man. Shorter an( relatively stoc2ier, the large intestine is a (ar2 re((ish color, measuring roughly 1.5 meters 35 ft4 long on average. -2. ;eople *ill have (ifferent size( intestines accor(ing to their size an( age. )he lumen is the cavity *here (igeste( foo( passes through an( from *here nutrients are absorbe(. <oth intestines share a general structure *ith the *hole gut, an( are compose( of several layers. :oing from insi(e the lumen ra(ially out*ar(s, one passes the mucosa 3glan(ular epithelium an( muscularis mucosa4, submucosa, muscularis e%terna 3ma(e up of inner circular an( outer longitu(inal4, an( lastly serosa.

)he general structure of the intestinal *all +long the *hole length of the gut in the glan(ular epithelium are goblet cells. )hese secrete mucus *hich lubricates the passage of foo( along an( protects it from (igestive enzymes. =illi are vaginations of the mucosa an( increase the overall surface area of the intestine *hile also containing a lacteal, *hich is connecte( to the lymph system an( ai(s in the removal of lipi(s an( tissue flui( from the bloo( supply. >icrovilli are present on the epithelium of a villus an( further increase the surface area over *hich absorption can ta2e place. )he ne%t layer is the muscularis mucosa *hich is a layer of smooth muscle that ai(s in the action of continue( peristalsis an( catastalsis along the gut. )he

submucosa contains nerves 3e.g. >eissner0s ple%us4, bloo( vessels an( elastic fibre

*ith collagen that stretches *ith increase( capacity but maintains the shape of the intestine. Surroun(ing this is the muscularis e%terna *hich comprises longitu(inal an( smooth muscle that again helps *ith continue( peristalsis an( the movement of (igeste( material out of an( along the gut. /n bet*een the t*o layers of muscle lies +uerbach0s ple%us. ?astly there is the serosa *hich is ma(e up of loose connective tissue an( coate( in mucus so as to prevent friction (amage from the intestine rubbing against other tissue. @ol(ing all this in place are the mesenteries *hich suspen( the intestine in the ab(ominal cavity an( stop it being (isturbe( *hen a person is physically active. )he large intestine hosts several 2in(s of bacteria that (eal *ith molecules the human bo(y is not able to brea2 (o*n itself. )his is an e%ample of symbiosis. )hese bacteria also account for the pro(uction of gases insi(e our intestine 3this gas is release( as flatulence *hen eliminate( through the anus4. @o*ever the large intestine is mainly concerne( *ith the absorption of *ater from (igeste( material 3*hich is regulate( by the hypothalamus4 an( the reabsorption of so(ium, as *ell as any nutrients that may have escape( primary (igestion in the ileum.

!rain
From Wikipedia, the free encyclopedia
Jump to: navigation, search )his article is about the brains of all types of animals, inclu(ing humans. 7or information specific to the human brain, see human brain. 7or other uses, see <rain 3(isambiguation4.

+ chimpanzee brain )he brain is the center of the nervous system in all vertebrate, an( most invertebrate, animals.-1. Some primitive animals such as &ellyfish an( starfish have a (ecentralize(

nervous system *ithout a brain, *hile sponges lac2 any nervous system at all. /n vertebrates, the brain is locate( in the hea(, protecte( by the s2ull an( close to the primary sensory apparatus of vision, hearing, balance, taste, an( smell. <rains can be e%tremely comple%. )he cerebral corte% of the human brain contains roughly 15633 billion neurons, perhaps more, (epen(ing on gen(er an( age,-2. lin2e( *ith up to 1$,$$$ synaptic connections each. Aach cubic millimeter of cerebral corte% contains roughly one billion synapses.-3. )hese neurons communicate *ith one another by means of long protoplasmic fibers calle( a%ons, *hich carry trains of signal pulses calle( action potentials to (istant parts of the brain or bo(y an( target them to specific recipient cells. )he brain controls the other organ systems of the bo(y, either by activating muscles or by causing secretion of chemicals such as hormones. )his centralize( control allo*s rapi( an( coor(inate( responses to changes in the environment. Some basic types of responsiveness are possible *ithout a brain: even single1celle( organisms may be capable of e%tracting information from the environment an( acting in response to it.-4. Sponges, *hich lac2 a central nervous system, are capable of coor(inate( bo(y contractions an( even locomotion.-5. /n vertebrates, the spinal cor( by itself contains neural circuitry capable of generating refle% responses as *ell as simple motor patterns such as s*imming or *al2ing.- . @o*ever, sophisticate( control of behavior on the basis of comple% sensory input re'uires the information1integrating capabilities of a centralize( brain. Bespite rapi( scientific progress, much about ho* brains *or2 remains a mystery. )he operations of in(ivi(ual neurons an( synapses are no* un(erstoo( in consi(erable (etail, but the *ay they cooperate in ensembles of thousan(s or millions has been very (ifficult to (ecipher. >etho(s of observation such as AA: recor(ing an( functional brain imaging tell us that brain operations are highly organize(, *hile single unit recor(ing can resolve the activity of single neurons, but ho* in(ivi(ual cells give rise to comple% operations is un2no*n.-!.

Functions
7rom an organismic perspective, the primary function of a brain is to control the actions of an animal.-5#. )o (o this, it e%tracts enough relevant information from sense organs to refine actions. Sensory signals may stimulate an imme(iate response as *hen the olfactory system of a (eer (etects the o(or of a *olf5 they may mo(ulate an ongoing pattern of activity as in the effect of light1(ar2 cycles on an organism0s sleep1*a2e behavior5 or their information may be store( in case of future relevance. )he brain manages its comple% tas2 by orchestrating functional subsystems, *hich can be categorize( in a number of *ays: anatomically, chemically, an( functionally.

Functional subsystems
)he most straightfor*ar( *ay to categorize the parts of the brain is anatomically, but there are also several *ays to sub(ivi(e it functionally. Cne of the most important of these is on the basis of the chemical neurotransmitters use( by neurons to communicate *ith each other. +nother is in terms of the *ay a brain area contributes to information processing: sensory areas bring information into the brain an( reformat it5 motor signals sen( information out of the brain to control muscles an( glan(s5 arousal systems mo(ulate the activity of the brain accor(ing to time of (ay an( other factors.

"ancreas

From Wikipedia, the free encyclopedia

Jump to: navigation, search 7or other uses, see ;ancreas 3(isambiguation4. )his article is about the bo(ily organ. 7or culinary use of animal pancreas, see S*eetbrea(.

Pancreas

1: @ea( of pancreas 2: Dncinate process of

pancreas
3: ;ancreatic notch 4: <o(y of pancreas 5: +nterior surface of

pancreas
: /nferior surface of

pancreas
!: Superior margin of

pancreas
": +nterior margin of

pancreas

#: /nferior margin of

pancreas
1$: Cmental tuber 11: )ail of pancreas 12: Buo(enum

:ray0s +rtery

sub&ect E251 11## inferior pancreatico(uo(enal artery, superior pancreatico(uo(enal artery, splenic artery pancreatico(uo(enal veins, pancreatic veins pancreatic ple%us, celiac ganglia, vagus-1. pancreatic bu(s ;ancreas

=ein Ferve ;recursor >eS@

Borlan(sGAlsevier ;ancreas )he pancreas is a glan( organ in the (igestive an( en(ocrine system of vertebrates. /t is both an en(ocrine glan( pro(ucing several important hormones, inclu(ing insulin, glucagon, an( somatostatin, as *ell as an e%ocrine glan(, secreting pancreatic &uice containing (igestive enzymes that pass to the small intestine. )hese enzymes help to further brea2(o*n the carbohy(rates, protein, an( fat in the chyme.

Contents
-hi(e.

1 @istology 2 7unction o 2.1 An(ocrine o 2.2 A%ocrine o 2.3 ,egulation 3 +natomy of the ;ancreas o 3.1 ;osition o 3.2 ;arts o 3.3 <loo( Supply 3.3.1 +rterial Supply 3.3.2 =enous Brainage o 3.4 ?ymphatic Brainage 4 Biseases of the pancreas 5 @istory Ambryological (evelopment ! /n animals " )he ;ancreas in ;opular Hulture # +((itional images 1$ ,eferences

[e(it] Histolo#y
Dn(er a microscope, staine( sections of the pancreas reveal t*o (ifferent types of parenchymal tissue.-2. ?ightly staining clusters of cells are calle( islets of ?angerhans, *hich pro(uce hormones that un(erlie the en(ocrine functions of the pancreas. Bar2er staining cells form acini connecte( to (ucts. +cinar cells belong to the e%ocrine pancreas an( secrete (igestive enzymes into the gut via a system of (ucts. tructure $ppearance Function ?ightly staining, large, @ormone pro(uction an( secretion /slets of ?angerhans spherical clusters 3en(ocrine pancreas4 Bar2er staining, small, berry1 Bigestive enzyme pro(uction an( ;ancreatic acini li2e clusters secretion 3e%ocrine pancreas4

[e(it] Function
)he pancreas is a (ual1function glan(, having features of both en(ocrine an( e%ocrine glan(s.

[e(it] %ndocrine
>ain article: An(ocrine pancreas )he part of the pancreas *ith en(ocrine function is ma(e up of appro%imately a million-3. cell clusters calle( islets of ?angerhans. 7our main cell types e%ist in the islets. )hey are relatively (ifficult to (istinguish using stan(ar( staining techni'ues, but they can be classifie( by their secretion: I cells secrete glucagon3increase :lucose in bloo(4, J cells secrete insulin 3(ecrease :lucose in bloo(4, K cells secrete somatostatin 3regulatesGstops I an( J cells4, an( ;; cells secrete pancreatic polypepti(e.-4. )he islets are a compact collection of en(ocrine cells arrange( in clusters an( cor(s an( are crisscrosse( by a (ense net*or2 of capillaries. )he capillaries of the islets are line( by layers of en(ocrine cells in (irect contact *ith vessels, an( most en(ocrine cells are in (irect contact *ith bloo( vessels, by either cytoplasmic processes or by (irect apposition. +ccor(ing to the volume The Body, by +lan A. Fourse,-5. the islets are Lbusily manufacturing their hormone an( generally (isregar(ing the pancreatic cells all aroun( them, as though they *ere locate( in some completely (ifferent part of the bo(y.L

[e(it] %&ocrine
>ain article: A%ocrine pancreas /n contrast to the en(ocrine pancreas, *hich secretes hormones into the bloo(, the e%ocrine pancreas pro(uces (igestive enzymes an( an al2aline flui( 3referre( to as pancreatic &uice4, an( secretes them into the small intestine through a system of e%ocrine (ucts in response to the small intestine hormones secretin an( cholecysto2inin. Bigestive enzymes inclu(e trypsin, chymotrypsin, pancreatic lipase, an( pancreatic amylase, an( are pro(uce( an( secrete( by acinar cells of the e%ocrine pancreas. Specific cells that line the pancreatic (ucts, calle( centroacinar cells, secrete a bicarbonate1 an( salt1rich solution into the small intestine.- .

[e(it] 'e#ulation
)he pancreas receives regulatory innervation via hormones in the bloo( an( through the autonomic nervous system. )hese t*o inputs regulate the secretory activity of the pancreas. Self-Inject in 25 Easy Steps

1. Wash your hands (with a disinfectant/anti-bacterial soap).

2. Lay out your vial of testosterone, needle(s) and/or syringe, alcohol wipes, and tissue on a clean surface (e.g. a clean towel, paper towel, etc). . !it down and get co"fy. #. !ecure the lure-loc$ on the fit on the syringe. %. &nseat/loosen the cap fro" the needle--leave the cap on loose until ready to draw the testosterone. 'e"e"ber to never touch the needle( ). Wipe off the *nipple+ on the top of the vial with an alcohol wipe. ,. 'e"ove the cap of the needle without touching the needle or the needle touching anything. -raw 1cc of air into the syringe by pulling bac$ on the plunger. .. &p-end the testosterone vial. /. 0nsert the needle through the center of the neoprene nipple. 11. With the needle tip i""ersed 02 the fluid, slowly depress the plunger, pushing all of the air into the oil (you3ll see the bubbles). 11. 4fter all the air is out of the syringe, slowly pull bac$ on the plunger until the proper a"ount of testosterone is drawn into the syringe. (2ot everyone3s dosage is the sa"e. 5hec$ your prescription or consult with your physician or phar"acist for the correct a"ount. !o"e will in6ect "ore than 1cc, so"e less.) 12. 7ou "ay need to *pu"p+ the plunger to get a co"plete fill. 4s long as you don3t re"ove the needle, you can let the fluid go in and out as "uch as needed. 1 . When you have the correct a"ount in the syringe, gently pull the needle out of the vial. 1#. -raw a s"all a"ount of air into the syringe--one very s"all bubble. 1%. !lip the needle bac$ into the cap if you want to ta$e a brea$ before in6ecting. (0t3s really i"portant not to touch the needle itself at any point.) 1). 8ic$ an in6ection site on your thigh or buttoc$s. 7ou3ll want to alternate sites, so re"e"ber which site you last in6ected. 9or your thigh, target the spot by placing one hand 6ust about/at your $nee and the other at your hip--the area in between is pretty "uch fair ga"e. :he best area is the outer part of the ;uad, so stay to the outside of the "idline of your thigh, but not too far to the outside/underside. :he buttoc$s is slightly "ore tric$y < both to reach and to isolate the e=act spot. :al$ to your physician or nurse about the e=act location. 1,. 5leanse the in6ection site with an alcohol wipe. Wipe in a circular "otion, to a circu"ference of about 2 inches surrounding the in6ection site. 4llow the s$in to dry to prevent the alcohol fro" being introduced into the "uscle as the needle is inserted, causing pain or burning. 'e"e"ber not to touch the area 6ust cleansed with the alcohol wipe. 1.. &ncap the needle -- re"e"ber not to touch the needle or the swabbed area on your thigh. :he air bubble should be near the plunger end of the syringe. 1/. >o to it and stic$ it in( 9ast, slow - it doesn3t "atter. 8ierce the s$in at a /1 degree angle. 0t "ust go through the subcutaneous tissue/fatty tissue and deep into the "uscle. 21. 0f using a 1? needle, stop about 1/.? fro" the base@ if using a 1.%? needle, stop about 1/#? fro" the base. (:his is true for averaged siAed bodies. :al$ with your physician about the appropriate needle length for your body.)

21. 4fter the needle has been inserted, aspirate by holding the barrel of the syringe steady with your nondo"inant hand and by pulling bac$ on the plunger with your do"inant hand. 7ou3ll see so"e air bubbles in the testosterone. 0f there3s 6ust air/clear fluid--no blood--then it3s o$ to proceed. 0f there is blood either push the needle in or pull bac$ a little and pull bac$ on the plunger again, or pull the needle out and start over. 22. Bolding the syringe steady, in6ect the testosterone steadily and slowly by depressing the plunger until all of the testosterone is in6ected. :he air bubble in the syringe should follow the testosterone and will *pac$+ the testosterone down into your "uscle. :here will be a slight a *pop+ as the bubble leaves the syringe. 2 . 8ull the needle out -- again, slow or fast depending upon your preference. (0 thin$ it3s usually best to pull out slow-sounds dirty, doesn3t itC() !o"eti"es the in6ection site "ay bleed a little when you withdraw the needle, 6ust be prepared to apply so"e gentle pressure with so"e clean tissue(s). 2#. !lide the needle bac$ into the cap. ('e"e"ber -D 2D: reseat the cap by pressing the tip of the cap towards the needle3s point.) 2%. -ispose of your needles properly in a sharps container.

How (o "erform Cardiopulmonary 'esuscitation )C"'*

By Rod Brouhard, About.com Guide Updated March 29, 2010 About.com Health's isease a!d "o!ditio! co!te!t is re#ie$ed by our Medical Re#ie$ Board %ee More About&

'irst aid trai!i!( 'irst aid tech!i)ues cpr

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,here is !o substitute 'or lear!i!( cardiopulmo!ary resuscitatio! 6"-R7, but emer(e!cies do!'t $ait 'or trai!i!(. ,hese i!structio!s are 'or conventional adult CPR. 8' you'#e !e#er bee! trai!ed i! "-R a!d the #ictim collapsed i! 'ro!t o' you, use ha!ds.o!ly "-R. 3or +ids, use the 'ollo$i!( (uideli!es& 8!'a!t "-R 'or +ids u!der 1 year. "hild "-R 'or +ids 1.9 years old. 5ot e#ery "-R class is the same. ,here are "-R classes 'or healthcare pro'essio!als as $ell as "-R classes 'or the layperso!. Be'ore you ta+e a "-R class, ma+e sure the class is ri(ht 'or you. ,hese are the steps to per'orm adult "-R&

Difficulty: 0asy Time Requi ed: "-R should start as soo! as possible Here's Ho$& 1. Stay Safe! ,he $orst thi!( a rescuer ca! do is become a!other #ictim. 3ollo$ u!i#ersal precautio!s a!d $ear perso!al protecti#e e)uipme!t i' you ha#e it. Use commo! se!se a!d stay a$ay 'rom pote!tial ha:ards. 2. "ttempt to #a$e victim. Bris+ly rub your +!uc+les a(ai!st the #ictim's ster!um. 8' the #ictim does !ot $a+e, call 911 a!d proceed to step ;. 8' the #ictim $a+es, moa!s, or mo#es, the! "-R is !ot !ecessary at this time. "all 911 i' the #ictim is co!'used or !ot able to spea+. ;. %e&in escue ' eat(in&. 4pe! the #ictim's air$ay usi!( the head. tilt, chi!.li't method. -ut your ear to the #ictim's ope! mouth& o loo+ 'or chest mo#eme!t o liste! 'or air 'lo$i!( throu(h the mouth or !ose o 'eel 'or air o! your chee+ 8' there is !o breathi!(, pi!ch the #ictim's !ose< ma+e a seal o#er the #ictim's mouth $ith yours. Use a "-R mas+ i' a#ailable. Gi#e the #ictim a breath bi( e!ou(h to ma+e the chest rise. *et the chest 'all, the! repeat the rescue breath o!ce more. 8' the chest does!'t rise o! the 'irst breath, repositio! the head a!d try a(ai!. =hether it $or+s o! the seco!d try or !ot, (o to step >. >. %e&in c(est comp essions. -lace the heel o' your ha!d i! the middle o' the #ictim's chest. -ut your other ha!d o! top o' the 'irst $ith your 'i!(ers i!terlaced. "ompress the chest about 1.1?2 to 2 i!ches 6>.@ cm7. Allo$ the chest to completely recoil be'ore the !e1t compressio!. "ompress the chest at a rate e)ual to 100?mi!ute. -er'orm ;0 compressio!s at this rate. @. Repeat escue ' eat(s. 4pe! the air$ay $ith head.tilt, chi!.li't a(ai!. ,his time, (o directly to rescue breaths $ithout chec+i!( 'or breathi!( a(ai!. Gi#e o!e breath, ma+i!( sure the chest rises a!d 'alls, the! (i#e a!other. Remember, i' the chest does!'t rise o! the 'irst breath, repositio! the head be'ore you (i#e the seco!d breath.

A. Pe fo m )* mo e c(est comp essions. Repeat steps @ a!d A 'or about t$o mi!utes. B. A'ter 2 mi!utes o' chest compressio!s a!d rescue breaths, stop compressio!s a!d rechec+ #ictim 'or breathi!(. 8' the #ictim is !ot breathi!(, co!ti!ue chest compressio!s a!d rescue breaths. 9. /eep (oi!( u!til help arri#es. ,ips& 1. 8' you ha#e acces to a! automated e1ter!al de'ibrillator, attach it to the #ictim a'ter appro1imately o!e mi!ute o' "-R 6chest compressio!s a!d rescue breaths7. 2. "hest compressio!s are e1tremely importa!t. 8' you are !ot com'ortable (i#i!( rescue breaths, still per'orm chest compressio!sC ;. 8t's !ormal to 'eel pops a!d s!aps $he! you 'irst be(i! chest compressio!s . 45', %,4-C Dou are!'t (oi!( to ma+e the #ictim a!y $orse. "ardiac arrest is as bad as it (ets. >. =he! per'ormi!( chest compressio!s, do !ot let your ha!ds bou!ce. *et the chest 'ully recoil, but +eep the heel o' your ha!d i! co!tact $ith the ster!um at all times. @. 3or more i!'ormatio! o! these steps (o to the 0mer(e!cy "ardiac "are 60""7 Guideli!es 'rom the America! Heart Associatio!.

C"' !asics
Har(iopulmonary resuscitation 3H;,4 is a first+aid techni,ue use( to 2eep victims of car(iopulmonary arrest alive an( to prevent brain (amage *hile more a(vance( me(ical help is on the *ay. H;, has two #oals: 2eep bloo( flo*ing throughout the bo(y 2eep air flo*ing in an( out of the lungs 8hile the mo(ern emergency room has high1tech e'uipment an( an arsenal of (rugs to help treat victims of car(iopulmonary arrest, H;, is a simple techni'ue that re'uires little or no e'uipment. 8hat you (o is pretty basic: <lo* into the victim0s mouth to push o&y#enated air into the lungs. )his allo*s o%ygen to (iffuse through the lining of the lungs into the bloo(stream. Hompress the victim0s chest to artificially re+create blood circulation. @ere are the steps that ma2e up H;,:

Photo courtesy of University

of Washington

/t soun(s pretty simple, but as you can see above, H;, must be performe( in a specific, timed se,uence to accurately mimic your bo(y0s natural breathing pattern an( the *ay your heart pumps. 8hen someone collapses right in front of you, your first reaction is often sheer terror. <ut *hile you0re panic2e( an( unable to act, valuable minutes are slipping a*ay. )o counter this, many organizations such as the $merican Heart $ssociation an( the $merican 'ed Cross offer classes that train you in H;, an( basic first ai( an( give you hands+on practice to hone your H;, s2ills. )hen, if you are confronte( *ith an emergency situation, you are prepare( to &ump into action.

C"' tep+by+ tep

Hhec2ing for a ;ulse
Cardiopulmonary arrest means that both heart and lungs have stopped working properly, so it would make sense to check and see whether a victim is breathing and whether or not their heart is beating. However, current CPR guidelines don t re!uire a layperson to check the victim s pulse before starting CPR. Why is this" #he answer is that the average person has a lot of trouble finding and determining pulse accurately. #hink about how difficult it can be to find your own pulse, and then imagine trying to repeat the process on an unresponsive person. $f someone is not breathing, their heart is already in danger of !uitting %if it hasn t already& due to lack of o'ygen. (ince the first steps in CPR address the victim s respiratory state, you can try and get them breathing again right away. #hen, you can check for a pulse. (kipping an initial pulse check simplifies CPR and saves valuable time) every minute that you delay starting CPR reduces the odds that the victim will survive by *+,- percent.

8hat shoul( you (o to help a seemingly unconscious victimM )he first thing you0ll *ant to (o is to figure out *hether or not the victim is really unconscious. Just li2e you *ere trying to get them out of be(, you shoul( call out to them, tap them, an( #ently shake them to try an( provo2e a response. Nou also shoul( chec2 to see if they are breathing. /f you try an( perform H;, on someone *ho is not in car(iopulmonary arrest, you can actually hurt themO

/f you can0t rouse them, the very ne%t thing to (o is have someone call -.. so that professional parame(ics *ill be on their *ay to the scene *hile you are performing H;,. )his is very important, because, *ith the e%ception of cho2ing, H;, (oesn0t a((ress the un(erlying causes of car(iopulmonary arrest. /t is only meant to buy time until the victim can get intensive me(ical care. +fter you0ve calle( for me(ical assistance, you nee( to be#in C"'. /n or(er for H;, to *or2, the victim must be lying on his or her bac2 on a flat surface. /f the victim is face1 (o*n, gently roll the person to*ar( you *hile ma2ing sure that you support their nec2. Cnce the person is on their bac2, you can then use the +merican @eart +ssociation0s /$!Cs of C"'/ to gui(e you through the rest of process: 1. $irway: clear obstructe( air*ays 2. !reathin#: perform mouth1to1mouth breathing 3. Circulation: start chest compressions 8e0ll tal2 about each of these steps in (etail in the follo*ing section.

How C"' Works

by +nn >ee2er1C0Honnell

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Inside this $rticle

1. 2. ;. >. @. A. /ntro(uction to @o* H;, 8or2s Har(iopulmonary +rrest H;, <asics H;, Step1by1Step )he +<Hs H;,0s ,ole in ,escue B. H;, an( /nfectious Bisease 9. ?ots >ore /nformation

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9. See all 7irst +i( articles

@ealth =i(eos

>ore @ealth =i(eos R

(he $!Cs
@ere0s a summary of ho* you might perform H;, on a non+responsi2e adult )(here is actually a different procedure used to sa2e infants and youn# children*3 )o learn all about H;, in (etail, so that you coul( actually practice an( perform this life1saving act, you shoul( sign up for training from an organization li2e the +merican ,e( Hross.

+ is for +ir*ay
8hen you pass out, your ton#ue rela&es, an( it can roll bac2 in your mouth an( bloc2 your *in(pipe. <efore you can start H;, on an unconscious person, you0ll probably nee( move their tongue out of the *ay. @ere0s ho* to clear a blocked airway: 1. ;lace the palm of your han( across the victim0s forehea( an( push (o*n gently. 2. 8ith the other han(, slo*ly lift the chin for*ar( an( slightly up. 3. >ove the chin up until the teeth are almost together, but the mouth is still slightly open. (iltin# the head back an( liftin# the chin move the tongue out of the air*ay. +t this point, you shoul( chec2 again for breathing. /f the victim is chokin# on something, you may see their chest heave as they try to breathe, but you *on0t be able to feel or hear air being e%hale(. Nou0ll have to ta2e additional measures to clear out *hat0s bloc2ing their *in(pipe, inclu(ing: 1. Hompressing the ab(omen *ith forceful thrusts. )his creates pressure that forces the ob&ect up an( out of the *in(pipe. 2. )rying to manually (islo(ge the ob&ect *ith your fingers. Cnce this is (one, you have to chec2 for signs of breathing again. Just clearing out the *in(pipe may sometimes be enough to allo* the victim to start breathing on their o*nO /f the victim starts breathing an( moving aroun( on their o*n, you can stop H;,. /f this (oesn0t happen, you0ll have to help them breath, by provi(ing mouth+to+mouth resuscitation.

< is for <reathing

Nour lungs have one main function: remove carbon (io%i(e an( ta2e up o%ygen. Formally, the muscles in your chest contract an( e%pan( your chest cavity, allo*ing your lungs to fill up *ith air. C%ygen an( carbon (io%i(e (iffuse across the immense surface area of your lungs. 7inally, your chest muscles rela%, an( you e%hale. 3)o learn more about lungs, see @o* Nour ?ungs 8or24. 'escue breathin# uses your lungs to force air into the victim0s lungs at regular intervals. )he timing of each breath 3about 1.5 to 2 secon(s per breath4 mimics normal breathing. @o*ever, the process is much more li2e blo*ing up a balloon than real breathing. Nou inhale (eeply, form a ti#ht seal *ith your mouth over their mouth, an( e&hale strongly to push air out of your mouth into theirs. <ecause you also pinch the

victim0s nostrils close(, the air has no*here to go e%cept (o*n into the lungs, *hich e%pan( as they fill *ith air. >outh1to1mouth breathing is har( *or2. Formally, *hen you inhale, the chest muscles (rive the process. /n artificial respiration, you0re *or2ing against the victim0s rela&ed chest muscles. 8hen the chest muscles are rela%e(, the chest cavity is small, 2eeping the lungs in a deflated state. +s a rescuer, you have to e%hale forcefully into the victim0s mouth for 1 to 2 secon(s to overcome this resistance. +s the lungs fill *ith air, the victim0s chest is pushe( up at the same time5 you can actually see it rise. 8hen you remove your mouth from the victim0s an( brea2 the air seal, their chest falls an( once again (eflates the lungs. +s in normal breathing, this results in air being e%hale( from the victim0s mouth. Boes air e%hale( from someone else0s mouth really provi(e enough o&y#en to save an unconscious personM Formally, the air you inhale contains about 2$ percent o%ygen by volume, an( your lungs remove about 5 percent of the o%ygen in each breath. )he air you blo* into a victim0s mouth thus contains about .4 to .5 percent o&y#en, *hich is more than enough to supply their nee(s. +fter you0ve given the victim t*o breaths, you then chec2 to see *hether or not they have a pulse an( *hether they are able to breathe on their o*n. )his *ill (etermine *hat you (o ne%t. If the 2ictim 3 3 3 you should /s breathing an( has a stop H;,, an( stay *ith them until help pulse arrives. /s not breathing an( has a pulse @as no pulse continue rescue breathing. begin chest compressions, alternating *ith rescue breathing.

H is for Hirculation
/f the victim0s heart is not beating, all your breathing efforts are for naught5 the o%ygen that you0re getting into their circulation isn0t going any*hereO Cnce again, you have to ta2e over for a failing organ. )his time you essentially become a surro#ate heart to pump o%ygenate( bloo( out to the rest of the victim0s bo(y. @o* can you have any effect on bloo( flo* from outsi(e of the bo(yM +ll it ta2es is your han(s an( some strength. )he steps are simple: 1. Sneeling by the victim, place the heel of your han(s one atop the other about .4 to ." inches 31 to 2 cm4 from tip of the breastbone. 2. Dsing the *eight of your bo(y, push the victim0s chest (o*n. Nou shoul( compress their chest 1 to 2 inches 32.54 to 5.$" cm4. 3. @ol( in this position for half a secon(, then rela% for half a secon( 4. ,epeat steps t*o an( three 2# more times. 5. :ive the victim t*o rescue breaths as you (i( before to (eliver more o%ygen to the bloo(. . ,epeat steps 1 through 5 three more times, then chec2 for a pulse. /n reality, all you are (oing is s'ueezing the heart bet*een the breastbone an( the bac2bone to force bloo( out. Hompressing the chest creates positi2e pressure insi(e the chest that pushes o&y#enated blood out of the heart through the aorta. 7rom here, it travels to the brain an( then on to other parts of the bo(y, (elivering o%ygen for

cellular respiration. 8hen you rela%, the pressure insi(e the victim0s chest subsi(es. Beo%ygenate( bloo( moves bac2 into the heart from the veins.
Int oduction

3re)ue!tly the e)ui!e practitio!er e!cou!ters situatio!s i! $hich a! alter!ate 'orm o' e1ter!al coaptatio! is desirable i! the ma!a(eme!t o' i!Euries o' the lo$er limb. ,raditio!al 'iber(lass casts are ideal 'or pro#idi!( ri(id coaptatio! i! most cases but do !ot allo$ access to the so't tissues o' the limb a!d typically re)uire replaceme!t e#ery ;FA $ee+s. A ba!da(e cast is a reusable 'orm o' a traditio!al cast that mai!tai!s ri(id stabili:atio! o' the limb yet is ame!able to 're)ue!t remo#al a!d resetti!( $ith the primary ad#a!ta(e o' allo$i!( the cli!icia! access to the u!derlyi!( so't tissues. ,he most commo! i!dicatio!s 'or the use o' the ba!da(e cast i! our practice are 'or the ma!a(eme!t o' se#ere so't tissue i!Euries 6i.e., te!do! laceratio!s, e1te!si#e $ou!ds o#er areas u!der te!sio!7 a!d 'or selected orthopedic i!Euries. =e also use the ba!da(e cast routi!ely as a 'orm o' temporary e1ter!al coaptatio! 'or horses reco#eri!( 'rom (e!eral a!esthesia a'ter u!der(oi!( i!ter!al 'i1atio! 'or lo$er limb 'ractures. "ase selectio! is #ery importa!t $he! decidi!( i' a ba!da(e cast has ad#a!ta(es 'or case ma!a(eme!t o#er traditio!al casti!( methods. 8' i!stability o' the lo$er limb e1ists, it is imperati#e that the horse ca! com'ortably a!d sa'ely sta!d duri!( the ba!da(e cha!(es $ithout compromisi!( the i!te(rity o' the repair.
+et(ods

8! most cases, a ba!da(e cast is i!itially co!'ormed to the limb $hile the horse is u!der (e!eral a!esthesia a!d i! associatio! $ith a sur(ical repair o' the i!Eury. ,he ba!da(e cast ca! be applied i! a sta!di!( horse althou(h this is less desirable. 1. A li(ht sterile dressi!( o' co!'ormi!( (au:e is placed o#er the i!cisio! or $ou!d. 2. ,$o or three pieces o' thi! sheet cotto! are (athered to(ether a!d rolled ti(htly arou!d the limb a!d secured $ith a roll o' bro$! (au:e. ,he 'oot is i!cluded. 3ollo$ $ith a roll o' Getrapa to ma+e a smooth ba!da(e. ;. -lace a strip o' orthopedic 'elt arou!d the pro1imal ca!!o! bo!e a!d secure. %toc+i!et is usually !ot !ecessary. >. Apply o!e roll o' casti!( 'oamb arou!d the limb a!d 'ollo$ $ith the desired !umber o' rolls o' 'iber(lass casti!( material. 8!corporate the 'oot a!d shape as you $ould a traditio!al cast. -ro#ide ade)uate rei!'orceme!t to the bottom o' the 'oot to i!sure lo!(e#ity o' the cast.
1@0 2000 ? Gol. >A ? AA0- -R4"00 85G%

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Proceedings of the /nnual Convention of the //0P 1---

@. Optional: -re.cut the cast $ith cast cutters alo!( the medial a!d lateral aspects 6lea#e the bottom o' the 'oot i!tact7 a!d the! $rap ti(htly $ith uct.tape the e!tire le!(th o' the limb 'or reco#ery 'rom a!esthesia. A. 8' the cast $as precut, ru! a scalpel blade do$! throu(h the (roo#es to release the tape a!d remo#e $he! a ba!da(e cha!(e is desired. 8' !ot precut, bi#al#e the cast u!der mild sedatio! a!d restrai!t a!d pull the cast apart, li'ti!( the 'oot out o' the bottom. B. ,e!d to the i!cisio! or $ou!d a!d replace the ba!da(e, ma+i!( sure to $rap 'irmly so that the limb $ill 'it bac+ i!to the cast. -lace the bi#al#ed cast bac+ o! the limb a!d apply duct tapeHa! assista!t may be re)uired to hold the t$o pieces ti(htly to(ether $hile the tape is bei!( applied.
Results and Discussion

All horses ha#e (e!erally tolerated a ba!da(e cast as they $ould a traditio!al cast a!d ha#e rarely sho$! discom'ort. "ast sores ha#e bee! !e(li(ible due to the amou!t o' paddi!( pro#ided by the ba!da(e material. *e!(th o' time o' use has ra!(ed 'rom ;F12 $ee+s $ith ba!da(e cha!(es per'ormed e#ery ;F> days depe!di!( upo! the dema!ds o' the particular i!Eury. ,he most commo! problems e!cou!tered $ith the cast are premature $eari!( o' the bottom o' the cast a!d occasio!al di''iculty i! re'itti!( the cast i' ba!da(e material has bee! applied too loosely. 3or ma!a(eme!t o' so't tissue i!Euries i! our practice, the ba!da(e cast has bee! a #ery use'ul adEu!ct i! the treatme!t o' e1te!sor a!d 'le1or te!do! laceratio!s, ope! $ou!ds o' the 'etloc+ a!d paster! Eoi!ts, se#ere ru!.do$! laceratio!s, a!d lar(e chro!ic (ra!ulati!( $ou!ds. 4rthopedic i!Euries ma!a(ed $ith a ba!da(e cast i!clude 'etloc+ Eoi!t sublu1atio!s, se#eral cases o' i!ter!al 'i1atio! $hich re)uired re(ular $ou!d care, a!d t$o cases o' pre#iously repaired ca!!o! bo!e 'ractures that subse)ue!tly became u!stable i! the postoperati#e period. 8! these t$o cases, (e!eral a!esthesia 'or cast applicatio! $as u!desirable a!d pre#iously made ba!da(e casts $ere applied i!stead. 3or lo$er limb 'ractures repaired $ith i!ter!al 'i1atio! 6i.e., 'ractures o' the distal ca!!o! or pro1imal 'irst phala!17, a (e!eric ba!da(e cast is 'itted a!d applied to the limb 'or a!esthetic reco#ery a!d A reusable bi#al#ed ba!da(e cast. the! remo#ed shortly therea'ter. ,hese casts ha#e
8!itial splitti!( o' the ba!da(e cast 'or 'uture use. AA0- -R4"00 85G% ? Gol. >A ? 2000 1@1

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bee! pre#iously co!structed a!d are tailored to 'it each i!di#idual by the amou!t o' ba!da(e material placed u!der!eath. ,his method o' coaptatio! 'or reco#ery has bee! used success'ully a!d sa'ely i!

appro1imately ;00 cases i! our practice $ith !o u!to$ard e''ects.

Conclusion

8! summary, a ba!da(e cast o''ers the cli!icia! the ad#a!ta(es o' ri(id e1ter!al coaptatio! yet allo$ 'or the opportu!ity to pro#ide care to the so't tissue structures o' the limb. Additio!ally, a ba!da(e cast ca! be a cost.e''icie!t method o' pro#idi!( e1ter!al immobili:atio! 'or reco#ery o' selected cases 'rom (e!eral a!esthesia.

Eut(anasia

0utha!asia is the deliberate +illi!( o' a perso! 'or the be!e'it o' that perso!.

8! most cases eutha!asia is carried out because the perso! $ho dies as+s 'or it, but there are cases called eutha!asia $here a perso! ca!'t ma+e such a re)uest.
.o ms of eut(anasia

,he di''ere!t types o' eutha!asia, some o' $hich may be see! as more or less acceptable depe!di!( o! your outloo+.

Forms of euthanasia
0utha!asia comes i! se#eral di''ere!t 'orms, each o' $hich bri!(s a di''ere!t set o' ri(hts a!d $ro!(s.

$cti2e and passi2e euthanasia

8! acti#e eutha!asia a perso! directly a!d deliberately causes the patie!t's death. 8! passi#e eutha!asia they do!'t directly ta+e the patie!t's li'e, they Eust allo$ them to die. ,his is a morally u!satis'actory disti!ctio!, si!ce e#e! thou(h a perso! does!'t 'acti#ely +ill' the patie!t, they are a$are that the result o' their i!actio! $ill be the death o' the patie!t. Acti#e eutha!asia is $he! death is brou(ht about by a! act . 'or e1ample $he! a perso! is +illed by bei!( (i#e! a! o#erdose o' pai!.+illers. -assi#e eutha!asia is $he! death is brou(ht about by a! omission . i.e. $he! someo!e lets the perso! die. ,his ca! be by $ithdra$i!( or $ithholdi!( treatme!t& /it(d a#in& t eatment: 'or e1ample, s$itchi!( o'' a machi!e that is +eepi!( a perso! ali#e, so that they die o' their disease. /it((oldin& t eatment: 'or e1ample, !ot carryi!( out sur(ery that $ill e1te!d li'e 'or a short time. ,raditio!ally, passi#e eutha!asia is thou(ht o' as less bad tha! acti#e eutha!asia. But some people thi!+ acti#e eutha!asia is morally better.

6oluntary and in2oluntary euthanasia

Golu!tary eutha!asia occurs at the re)uest o' the perso! $ho dies. 5o!.#olu!tary eutha!asia occurs $he! the perso! is u!co!scious or other$ise u!able 6'or e1ample, a #ery you!( baby or a perso! o' e1tremely lo$ i!telli(e!ce7 to ma+e a mea!i!('ul choice bet$ee! li#i!( a!d dyi!(, a!d a! appropriate perso! ta+es the decisio! o! their behal'. 5o!.#olu!tary eutha!asia also i!cludes cases $here the perso! is a child $ho is me!tally a!d emotio!ally able to ta+e the decisio!, but is !ot

re(arded i! la$ as old e!ou(h to ta+e such a decisio!, so someo!e else must ta+e it o! their behal' i! the eyes o' the la$. 8!#olu!tary eutha!asia occurs $he! the perso! $ho dies chooses li'e a!d is +illed a!y$ay. ,his is usually called murder, but it is possible to ima(i!e cases $here the +illi!( $ould cou!t as bei!( 'or the be!e'it o' the perso! $ho dies.

Indirect euthanasia
,his mea!s pro#idi!( treatme!t 6usually to reduce pai!7 that has the side e''ect o' speedi!( the patie!t's death. %i!ce the primary i!te!tio! is !ot to +ill, this is see! by some people 6but !ot all7 as morally acceptable. A Eusti'icatio! alo!( these li!es is 'ormally called the doctri!e o' double e''ect.

$ssisted suicide
,his usually re'ers to cases $here the perso! $ho is (oi!( to die !eeds help to +ill themsel#es a!d as+s 'or it. 8t may be somethi!( as simple as (etti!( dru(s 'or the perso! a!d putti!( those dru(s $ithi! their reach.

$r#uments a#ainst euthanasia

,his pa(e sets out the ar(ume!ts a(ai!st allo$i!( eutha!asia. "ould eutha!asia e#er be sa'ely re(ulatedI =ould le(alisi!( eutha!asia ha#e +!oc+.o! e''ectsI

72er2iew of ar#uments a#ainst euthanasia

8t's possible to ar(ue about the $ay $e'#e di#ided up the ar(ume!ts, a!d ma!y ar(ume!ts could 'all i!to more cate(ories tha! $e'#e used.

%thical ar#uments
0utha!asia $ea+e!s society's respect 'or the sa!ctity o' li'e Accepti!( eutha!asia accepts that some li#es 6those o' the disabled or sic+7 are $orth less tha! others Golu!tary eutha!asia is the start o' a slippery slope that leads to i!#olu!tary eutha!asia a!d the +illi!( o' people $ho are thou(ht u!desirable 0utha!asia mi(ht !ot be i! a perso!'s best i!terests 0utha!asia a''ects other people's ri(hts, !ot Eust those o' the patie!t

"ractical ar#uments
-roper palliati#e care ma+es eutha!asia u!!ecessary ,here's !o $ay o' properly re(ulati!( eutha!asia Allo$i!( eutha!asia $ill lead to less (ood care 'or the termi!ally ill Allo$i!( eutha!asia u!dermi!es the committme!t o' doctors a!d !urses to sa#i!( li#es

 0utha!asia may become a cost.e''ecti#e $ay to treat the termi!ally ill Allo$i!( eutha!asia $ill discoura(e the search 'or !e$ cures a!d treatme!ts 'or the termi!ally ill 0utha!asia u!dermi!es the moti#atio! to pro#ide (ood care 'or the dyi!(, a!d (ood pai! relie' 0utha!asia (i#es too much po$er to doctors 0utha!asia e1poses #ul!erable people to pressure to e!d their li#es Moral pressure o! elderly relati#es by sel'ish 'amilies Moral pressure to 'ree up medical resources -atie!ts $ho are aba!do!ed by their 'amilies may 'eel eutha!asia is the o!ly solutio!

Historical ar#uments
Golu!tary eutha!asia is the start o' a slippery slope that leads to i!#olu!tary eutha!asia a!d the +illi!( o' people $ho are thou(ht u!desirable

'eli#ious ar#uments
0utha!asia is a(ai!st the $ord a!d $ill o' God 0utha!asia $ea+e!s society's respect 'or the sa!ctity o' li'e %u''eri!( may ha#e #alue Golu!tary eutha!asia is the start o' a slippery slope that leads to i!#olu!tary eutha!asia a!d the +illi!( o' people $ho are thou(ht u!desirable

,op

$#ainst the will of God

Reli(ious people do!'t ar(ue that $e ca!'t +ill oursel#es, or (et others to do it. ,hey +!o$ that $e ca! do it because God has (i#e! us 'ree $ill. ,heir ar(ume!t is that it $ould be $ro!( 'or us to do so. ,hey belie#e that e#ery huma! bei!( is the creatio! o' God, a!d that this imposes certai! limits o! us. 4ur li#es are !ot o!ly our li#es 'or us to do $ith as $e see 'it. ,o +ill o!esel', or to (et someo!e else to do it 'or us, is to de!y God, a!d to de!y God's ri(hts o#er our li#es a!d his ri(ht to choose the le!(th o' our li#es a!d the $ay our li#es e!d.

(he 2alue of sufferin#

Reli(ious people sometimes ar(ue a(ai!st eutha!asia because they see positi#e #alue i! su''eri!(. o$! throu(h the ce!turies a!d (e!eratio!s it has bee! see! that i! su''eri!( there is co!cealed a particular po$er that dra$s a perso! i!teriorly close to "hrist, a special (race. Pope John Paul II: Salvifici Doloris, 1984

(he reli#ious attitude to sufferin#

Most reli(io!s $ould say somethi!( li+e this& =e should relie#e su''eri!( $he! $e ca!, a!d be $ith those $ho su''er, helpi!( them to bear their su''eri!(, $he! $e ca!'t. =e should !e#er deal $ith the problem o' su''eri!( by elimi!ati!( those $ho su''er.

(he nature of sufferin#

"hristia!ity teaches that su''eri!( ca! ha#e a place i! God's pla!, i! that it allo$s the su''erer to share i! "hrist's a(o!y a!d his redeemi!( sacri'ice. ,hey belie#e that "hrist $ill be prese!t to share i! the su''eri!( o' the belie#er. -ope Joh! -aul 88 $rote that 28t is su''eri!(, more tha! a!ythi!( else, $hich clears the $ay 'or the (race $hich tra!s'orms huma! souls.2 Ho$e#er $hile the churches ac+!o$led(e that some "hristia!s $ill $a!t to accept some su''eri!( 'or this reaso!, most "hristia!s are !ot so heroic. %o there is !othi!( $ro!( i! tryi!( to relie#e someo!e's su''eri!(. 8! 'act, "hristia!s belie#e that it is a (ood to do so, as lo!( as o!e does !ot i!te!tio!ally cause death.

Dyin# is #ood for us

%ome people thi!+ that dyi!( is Eust o!e o' the tests that God sets 'or huma! bei!(s, a!d that the $ay $e react to it sho$s the sort o' perso! $e are, a!d ho$ deep our 'aith a!d trust i! God is. 4thers, $hile ac+!o$led(i!( that a lo#i!( God does!'t set his creatio!s such a horrible test, say that the process o' dyi!( is the ultimate opportu!ity 'or huma! bei!(s to de#elop their souls. =he! people are dyi!( they may be able, more tha! at a!y time i! their li'e, to co!ce!trate o! the importa!t thi!(s i! li'e, a!d to set aside the prese!t. day 'co!sumer culture', a!d their o$! e(o a!d desire to co!trol the $orld. "urtaili!( the process o' dyi!( $ould de!y them this opportu!ity.

%astern reli#ions
%e#eral 0aster! reli(io!s belie#e that $e li#e ma!y li#es a!d the )uality o' each li'e is set by the $ay $e li#ed our pre#ious li#es. ,hose $ho belie#e this thi!+ that su''eri!( is part o' the moral 'orce o' the u!i#erse, a!d that by cutti!( it short a perso! i!ter'eres $ith their pro(ress to$ards ultimate liberatio!.

$ non+reli#ious 2iew
%ome !o!.reli(ious people also belie#e that su''eri!( has #alue. ,hey thi!+ it pro#ides a! opportu!ity to (ro$ i! $isdom, character, a!d compassio!. %u''eri!( is somethi!( $hich dra$s upo! all the resources o' a huma! bei!( a!d e!ables them to reach the hi(hest a!d !oblest poi!ts o' $hat they really are.

%u''eri!( allo$s a perso! to be a (ood e1ample to others by sho$i!( ho$ to beha#e $he! thi!(s are bad. M %cott -ec+, author o' The Roa !ess Travelle , has $ritte! that i! a 'e$ $ee+s at the e!d o' li'e, $ith pai! properly co!trolled a perso! mi(ht lear! ho$ to !e(otiate a middle path bet$ee! co!trol a!d total passi#ity, about ho$ to $elcome the respo!sible care o' stra!(ers, about ho$ to be depe!de!t o!ce a(ai! ... about ho$ to trust a!d maybe e#e!, out o' e1iste!tial su''eri!(, at least a little bit about ho$ to pray or tal+ $ith God. " Scott Pec#

(he nature of sufferin#

8t is!'t easy to de'i!e su''eri!( . most o' us ca! decide $he! $e are su''eri!( but $hat is su''eri!( 'or o!e perso! may !ot be su''eri!( 'or a!other. 8t's also impossible to measure su''eri!( i! a!y use'ul $ay, a!d it's particularly hard to come up $ith a!y obEecti#e idea o' $hat co!stitutes u!bearable su''eri!(, si!ce each i!di#idual $ill react to the same physical a!d me!tal co!ditio!s i! a di''ere!t $ay. ,op

anctity of life
,his ar(ume!t says that eutha!asia is bad because o' the sa!ctity o' huma! li'e. ,here are 'our mai! reaso!s $hy people thi!+ $e should!'t +ill huma! bei!(s& All huma! bei!(s are to be #alued, irrespecti#e o' a(e, se1, race, reli(io!, social status or their pote!tial 'or achie#eme!t Huma! li'e is a basic (ood as opposed to a! i!strume!tal (ood, a (ood i! itsel' rather tha! as a mea!s to a! e!d Huma! li'e is sacred because it's a (i't 'rom God ,here'ore the deliberate ta+i!( o' huma! li'e should be prohibited e1cept i! sel'.de'e!ce or the le(itimate de'e!ce o' others

We are 2aluable for oursel2es

,he philosopher 8mma!uel /a!t said that ratio!al huma! bei!(s should be treated as a! e!d i! themsel#es a!d !ot as a mea!s to somethi!( else. ,he 'act that $e are huma! has #alue i! itsel'. 4ur i!here!t #alue does!'t depe!d o! a!ythi!( else . it does!'t depe!d o! $hether $e are ha#i!( a (ood li'e that $e e!Eoy, or $hether $e are ma+i!( other people's li#es better. =e e1ist, so $e ha#e #alue. Most o' us a(ree $ith that . thou(h $e do!'t put it i! philosopher.spea+. =e say that $e do!'t thi!+ that $e should use other people . $hich is a plai!

0!(lish $ay o' sayi!( that $e should!'t treat other people as a mea!s to our o$! e!ds.

We must respect our own 2alue

8t applies to us too. =e should!'t treat oursel#es as a mea!s to our o$! e!ds. A!d this mea!s that $e should!'t e!d our li#es Eust because it seems the most e''ecti#e $ay o' putti!( a! e!d to our su''eri!(. ,o do that is !ot to respect our i!here!t $orth. ,op

(he slippery slope

Ma!y people $orry that i' #olu!tary eutha!asia $ere to become le(al, it $ould !ot be lo!( be'ore i!#olu!tary eutha!asia $ould start to happe!. =e co!cluded that it $as #irtually impossible to e!sure that all acts o' eutha!asia $ere truly #olu!tary a!d that a!y liberalisatio! o' the la$ i! the U!ited /i!(dom could !ot be abused. =e $ere also co!cer!ed that #ul!erable people . the elderly, lo!ely, sic+ or distressed . $ould 'eel pressure, $hether real or ima(i!ed, to re)uest early death. !or $alton, %hairman, &ouse of !or s Select %ommittee on "e ical 'thics loo#in( into euthanasia, 199) ,his is called the slippery slope ar(ume!t. 8! (e!eral 'orm it says that i' $e allo$ somethi!( relati#ely harmless today, $e may start a tre!d that results i! somethi!( curre!tly u!thi!+able becomi!( accepted. ,hose $ho oppose this ar(ume!t say that properly dra'ted le(islatio! ca! dra$ a 'irm barrier across the slippery slope.

6arious forms of the slippery slope ar#ument

8' $e cha!(e the la$ a!d accept #olu!tary eutha!asia, $e $ill !ot be able to +eep it u!der co!trol. -ropo!e!ts o' eutha!asia say& 0utha!asia $ould !e#er be le(alised $ithout proper re(ulatio! a!d co!trol mecha!isms i! place octors may soo! start +illi!( people $ithout botheri!( $ith their permissio!. -ropo!e!ts say& ,here is a hu(e di''ere!ce bet$ee! +illi!( people $ho as+ 'or death u!der appropriate circumsta!ces, a!d +illi!( people $ithout their permissio! Gery 'e$ people are so lac+i!( i! moral u!dersta!di!( that they $ould i(!ore this disti!ctio! Gery 'e$ people are so lac+i!( i! i!tellect that they ca!'t ma+e the disti!ctio! abo#e

 A!y doctor $ho $ould i(!ore this disti!ctio! probably $ould!'t $orry about the la$ a!y$ay Health care costs $ill lead to doctors +illi!( patie!ts to sa#e mo!ey or 'ree up beds& -ropo!e!ts say& ,he mai! reaso! some doctors support #olu!tary eutha!asia is because they belie#e that they should respect their patie!ts' ri(ht to be treated as auto!omous huma! bei!(s ,hat is, $he! doctors are i! 'a#our o' eutha!asia it's because they $a!t to respect the $ishes o' their patie!ts %o doctors are u!li+ely to +ill people $ithout their permissio! because that co!tradicts the $hole moti#atio! 'or allo$i!( #olu!tary eutha!asia But cost.co!scious doctors are more li+ely to ho!our their patie!ts' re)uests 'or death A 1999 study 'ou!d that doctors $ho are cost.co!scious a!d 'practice resource.co!ser#i!( medici!e' are si(!i'ica!tly more li+ely to $rite a lethal prescriptio! 'or termi!ally.ill patie!ts K*rch+ Intern+ "e +, ,-11-98, p+ 9.4L ,his su((ests that medical costs do i!'lue!ce doctors' opi!io!s i! this area o' medical ethics ,he 5a:is e!(a(ed i! massi#e pro(rammes o' i!#olu!tary eutha!asia, so $e should!'t place our trust i! the (ood moral se!se o' doctors. -ropo!e!ts say& ,he 5a:is are !ot a use'ul moral e1ample, because their actio!s are almost u!i#ersally re(arded as both crimi!al a!d morally $ro!( ,he 5a:is embar+ed o! i!#ou!tary eutha!asia as a deliberate political act . they did!'t slip i!to it 'rom #olu!tary eutha!asia 6althou(h at 'irst they did prete!d it $as 'or the be!e'it o' the patie!t7 =hat the 5a:is did $as!'t eutha!asia by e#e! the $idest de'i!itio!, it $as the use o' murder to (et rid o' people they disappro#ed o' ,he u!i#ersal horror at 5a:i eutha!asia demo!strates that almost e#eryo!e ca! ma+e the disti!ctio! bet$ee! #olu!tary a!d i!#olu!tary eutha!asia ,he e1ample o' the 5a:is has made people more se!siti#e to the da!(ers o' i!#olu!tary eutha!asia Allo$i!( #olu!tary eutha!asia ma+es it easier to commit murder, si!ce the perpetrators ca! dis(uise it as acti#e #olu!tary eutha!asia. -ropo!e!ts say& ,he la$ is able to deal $ith the possibility o' sel'. de'e!ce or suicide bei!( used as dis(uises 'or murder. 8t $ill thus be able to deal $ith this case e)ually $ell ,o dress murder up as eutha!asia $ill i!#ol#e medical co.operatio!. ,he !eed 'or a co!spiracy $ill ma+e it a! u!attracti#e optio!

Ma!y are !eedlessly co!dem!ed to su''eri!( by the chie' a!ti. eutha!asia ar(ume!t& that murder mi(ht lur+ u!der the cloa+ o' +i!d!ess. * % /ra0lin(, /uar ian 1221 ,op

De2alues some li2es

%ome people 'ear that allo$i!( eutha!asia se!ds the messa(e, 2it's better to be dead tha! sic+ or disabled2. ,he subte1t is that some li#es are !ot $orth li#i!(. 5ot o!ly does this put the sic+ or disabled at ris+, it also do$!(rades their status as huma! bei!(s $hile they are ali#e.

(he disabled person8s perspecti2e

-art o' the problem is that able.bodied people loo+ at thi!(s 'rom their o$! perspecti#e a!d see li'e $ith a disability as a disaster, 'illed $ith su''eri!( a!d 'rustratio!. %ome societies ha#e re(arded people $ith disabilities as i!'erior, or as a burde! o! society. ,hose i! 'a#our o' eu(e!ics (o 'urther, a!d say that society should pre#e!t 'de'ecti#e' people 'rom ha#i!( childre!. 4thers (o 'urther still a!d say that those $ho are a burde! o! society should be elimi!ated. -eople $ith disabilities do!'t a(ree. ,hey say& All people should ha#e e)ual ri(hts a!d opportu!ities to li#e (ood li#es Ma!y i!di#iduals $ith disabilities e!Eoy li#i!( Ma!y i!di#iduals 3ithout disabilities do!'t e!Eoy li#i!(, a!d !o.o!e is threate!i!( them ,he proper approach to people $ith disabilities is to pro#ide them $ith appropriate support, !ot to +ill them ,he )uality o' a perso!'s li'e should !ot be assessed by other people ,he )uality o' li'e o' a perso! $ith disabilities should !ot be assessed $ithout pro#idi!( proper support 'irst

7pposition to this ar#ument

%upporters o' eutha!asia $ould respo!d that this ar(ume!t i!cludes a !umber o' completely misleadi!( su((estio!s, a!d re'ute them& yi!( is !ot the same as !e#er ha#i!( bee! bor! ,he debate is !othi!( to do $ith pre#e!ti!( disabled babies bei!( bor!, or pre#e!ti!( people $ith disabilities 'rom becomi!( pare!ts 5obody is as+i!( 'or patie!ts to be +illed a(ai!st their $ishes . $hether or !ot those patie!ts are disabled

 ,he eutha!asia procedure is i!te!ded 'or use by patie!ts $ho are dyi!(, or i! a co!ditio! that $ill (et $orse . most disabilities do!'t come u!der that cate(ory ,he !ormal procedure 'or eutha!asia $ould ha#e to be i!itiated at the patie!t's re)uest isabled people $ho are !ot me!tally impaired are Eust as capable as able.bodied people o' decidi!( $hat they $a!t -rotectio!s $ill be i! place 'or patie!ts $ho are me!tally impaired, $hether throu(h disability or some other reaso! 8t is possible that someo!e $ho has Eust become disabled may 'eel depressed e!ou(h to as+ 'or death, $hich is $hy a!y proposed system o' eutha!asia must i!clude psycholo(ical support a!d assessme!t be'ore the patie!t's $ish is (ra!ted All people should ha#e e)ual ri(hts a!d opportu!ities to li#e, or to choose !ot to (o o! li#i!( ,op

"atient8s best interests

A serious problem 'or supporters o' eutha!asia are the !umber o' cases i! $hich a patie!t may as+ 'or eutha!asia, or 'eel obli(ed to as+ 'or it, $he! it is!'t i! their best i!terest. %ome e1amples are listed belo$& the dia(!osis is $ro!( a!d the patie!t is !ot termi!ally ill the pro(!osis 6the doctor's predictio! as to ho$ the disease $ill pro(ress7 is $ro!( a!d the patie!t is !ot (oi!( to die soo! the patie!t is (etti!( bad medical care a!d their su''eri!( could be relie#ed by other mea!s the doctor is u!a$are o' all the !o!.'atal optio!s that could be o''ered to the patie!t the patie!t's re)uest 'or eutha!asia is actually a 'cry 'or help', implyi!( that li'e is !ot $orth li#i!( !o$ but could be $orth li#i!( i' #arious symptoms or 'ears $ere ma!a(ed the patie!t is depressed a!d so belie#es thi!(s are much $orse tha! they are the patie!t is co!'used a!d u!able to ma+e se!sible Eud(eme!ts the patie!t has a! u!realistic 'ear o' the pai! a!d su''eri!( that lies ahead the patie!t is 'eeli!( #ul!erable the patie!t 'eels that they are a $orthless burde! o! others the patie!t 'eels that their sic+!ess is causi!( u!bearable a!(uish to their 'amily the patie!t is u!der pressure 'rom other people to 'eel that they are a burde! the patie!t is u!der pressure because o' a shorta(e o' resources to care 'or them

 the patie!t re)uests eutha!asia because o' a passi!( phase o' their disease, but is li+ely to 'eel much better i! a $hile %upporters o' eutha!asia say these are (ood reaso!s to ma+e sure the eutha!asia process $ill !ot be rushed, a!d a(ree that a $ell.desi(!ed system 'or eutha!asia $ill ha#e to ta+e all these poi!ts i!to accou!t. ,hey say that most o' these problems ca! be ide!ti'ied by assessi!( the patie!t properly, a!d, i' !ecessary, the system should discrimi!ate a(ai!st the opi!io!s o' people $ho are particularly #ul!erable. "hochi!o# a!d collea(ues 'ou!d that 'leeti!( or occasio!al thou(hts o' a desire 'or death $ere commo! i! a study o' people $ho $ere termi!ally ill, but 'e$ patie!ts e1pressed a (e!ui!e desire 'or death. 6 %hochinov &", Tatar0n D, %linch JJ, Du (eon D+ $ill to live in the terminall0 ill+ !ancet 19994 ),4: 81568197 ,hey also 'ou!d that the $ill to li#e 'luctuates substa!tially i! dyi!( patie!ts, particularly i! relatio! to depressio!, a!1iety, short!ess o' breath, a!d their se!se o' $ellbei!(.

7ther people ha2e ri#hts too

0utha!asia is usually #ie$ed 'rom the #ie$poi!t o' the perso! $ho $a!ts to die, but it a''ects other people too, a!d their ri(hts should be co!sidered. 'amily a!d 'rie!ds medical a!d other carers other people i! a similar situatio! $ho may 'eel pressured by the decisio! o' this patie!t society i! (e!eral ,op

"roper palliati2e care

-alliati#e care is physical, emotio!al a!d spiritual care 'or a dyi!( perso! $he! cure is !ot possible. 8t i!cludes compassio! a!d support 'or 'amily a!d 'rie!ds. "ompete!t palliati#e care may $ell be e!ou(h to pre#e!t a perso! 'eeli!( a!y !eed to co!template eutha!asia. Dou matter because you are you. Dou matter to the last mome!t o' your li'e a!d $e $ill do all $e ca! to help you die peace'ully, but also to li#e u!til you die. Dame %icel0 Saun ers, foun er of the mo ern hospice movement ,he +ey to success'ul palliati#e care is to treat the patie!t as a perso!, !ot as a set o' symptoms, or medical problems. ,he =orld Health 4r(a!isatio! states that palliati#e care a''irms li'e a!d re(ards dyi!( as a !ormal process< it !either haste!s !or postpo!es death<

it pro#ides relie' 'rom pai! a!d su''eri!(< it i!te(rates the psycholo(ical a!d spiritual aspects o' the patie!t.

9akin# thin#s better for patient, family and friends

,he patie!t's 'amily a!d 'rie!ds $ill !eed care too. -alliati#e care aims to e!ha!ce the )uality o' li'e 'or the 'amily as $ell as the patie!t. 0''ecti#e palliati#e care (i#es the patie!t a!d their lo#ed o!es a cha!ce to spe!d )uality time to(ether, $ith as much distress remo#ed as possible. ,hey ca! 6i' they $a!t to7 use this time to bri!( a!y u!'i!ished busi!ess i! their li#es to a proper closure a!d to say their last (oodbyes. -alliati#e care should aim to ma+e it easier a!d more attracti#e 'or 'amily a!d 'rie!ds to #isit the dyi!( perso!. A sur#ey 6U%A 20017 sho$ed that termi!ally ill patie!ts actually spe!t the #ast maEority o' their time o! their o$!, $ith 'e$ #isits 'rom medical perso!!el or 'amily members.

piritual care
%piritual care may be importa!t e#e! 'or !o!.reli(ious people. %piritual care should be i!terpreted i! a #ery $ide se!se, si!ce patie!ts a!d 'amilies 'aci!( death o'te! $a!t to search 'or the mea!i!( o' their li#es i! their o$! $ay.

"alliati2e care and euthanasia

Good palliati#e care is the alter!ati#e to eutha!asia. 8' it $as a#ailable to e#ery patie!t, it $ould certai!ly reduce the desire 'or death to be brou(ht about soo!er. But pro#idi!( palliati#e care ca! be #ery hard $or+, both physically a!d psycholo(ically. 0!di!( a patie!t's li'e by i!Eectio! is )uic+er a!d easier a!d cheaper. ,his may tempt people a$ay 'rom palliati#e care.

:e#alisin# euthanasia may reduce the a2ailability of palliati2e care

%ome 'ear that the i!troductio! o' eutha!asia $ill reduce the a#ailability o' palliati#e care i! the commu!ity, because health systems $ill $a!t to choose the most cost e''ecti#e $ays o' deali!( $ith dyi!( patie!ts. Medical decisio!.ma+ers already 'ace di''icult moral dilemmas i! choosi!( bet$ee! competi!( dema!ds 'or their limited 'u!ds. %o ma+i!( eutha!asia easier could e1acerbate the slippery slope, pushi!( people to$ards eutha!asia $ho may !ot other$ise choose it.

When palliati2e care is not enou#h

-alliati#e care $ill !ot al$ays be a! ade)uate solutio!& Pain: %ome doctors estimate that about @M o' patie!ts do!'t ha#e their pai! properly relie#ed duri!( the termi!al phase o' their ill!ess, despite (ood palliati#e a!d hospice care Dependency: %ome patie!ts may pre'er death to depe!de!cy, because they hate relyi!( o! other people 'or all their bodily 'u!ctio!s, a!d the co!se)ue!t loss o' pri#acy a!d di(!ity

 0ac$ of (ome ca e: 4ther patie!ts $ill !ot $ish to ha#e palliati#e care i' that mea!s that they ha#e to die i! a hospital a!d !ot at home 0oss of ale tness: %ome people $ould pre'er to die $hile they are 'ully alert a!d a!d able to say (oodbye to their 'amily< they 'ear that palliati#e care $ould i!#ol#e a le#el o' pai!.+illi!( dru(s that $ould lea#e them semi.a!aesthetised ,ot in t(e final sta&es: 4ther people are (rate'ul 'or palliati#e care to a certai! poi!t i! their disease, but a'ter that $ould pre'er to die rather tha! li#e i! a state o' helpless!ess a!d distress, re(ardless o' $hat is a#ailable i! terms o' pai!.+illi!( a!d com'ort. ,here should be !o la$ or morality that $ould limit a cli!ical team or doctor 'rom admi!isteri!( the 're)ue!t dosa(es o' pai! medicatio! that are !ecessary to 'ree people's mi!ds 'rom pai! that shri#els the spirit a!d lea#es !o time 'or spea+i!( $he!, at times, there are #ery 'e$ hours or days le't 'or such commu!icatio!. Dr+ Davi Ro0, Director of the %entre for 7ioethics, %linical Research Institute of "ontreal ,op

Fears about re#ulation

0utha!asia oppo!e!ts do!'t belie#e that it is possible to create a re(ulatory system 'or eutha!asia that $ill pre#e!t the abuse o' eutha!asia. ,op

It #i2es doctors too much power

,his ar(ume!t o'te! appears as 'doctors should !ot be allo$ed to play God'. %i!ce God ar(ume!ts are o' !o i!terest to people $ithout 'aith, it's prese!ted here $ith the God bit remo#ed. octors should !ot be allo$ed to decide $he! people die& octors do this all the time A!y medical actio! that e1te!ds li'e cha!(es the time $he! a perso! dies a!d $e do!'t $orry about that ,his is a di''ere!t sort o' decisio!, because it i!#ol#es shorte!i!( li'e octors ta+e this sort o' decisio! all the time $he! they ma+e choices about treatme!t As lo!( as doctors reco(!ise the serious!ess o' eutha!asia a!d ta+e decisio!s about it $ithi! a properly re(ulated structure a!d $ith proper sa'e(uards, such decisio!s should be acceptable 8! most o' these cases the decisio! $ill !ot be ta+e! by the doctor, but by the patie!t. ,he doctor $ill pro#ide i!'ormatio! to the patie!t to help them ma+e their decisio!

%i!ce doctors (i#e patie!ts the i!'ormatio! o! $hich they $ill base their decisio!s about eutha!asia, a!y le(alisatio! o' eutha!asia, !o matter ho$ strictly re(ulated, puts doctors i! a! u!acceptable positio! o' po$er. octors ha#e bee! sho$! to ta+e these decisio!s improperly, de'yi!( the (uideli!es o' the British Medical Associatio!, the Resuscitatio! "ou!cil 6U/7, a!d the Royal "olle(e o' 5ursi!(& A! A(e "o!cer! dossier i! 2000 sho$ed that doctors put o 5ot Resuscitate orders i! place o! elderly patie!ts $ithout co!sulti!( them or their 'amilies o 5ot Resuscitate orders are more commo!ly used 'or older people a!d, i! the U!ited %tates, 'or blac+ people, alcohol misusers, !o!. 0!(lish spea+ers, a!d people i!'ected $ith Huma! 8mmu!ode'icie!cy Girus. ,his su((ests that doctors ha#e stereotypes o' $ho is !ot $orth sa#i!( ,op

"ressure on the 2ulnerable

,his is a!other o' those ar(ume!ts that says that eutha!asia should !ot be allo$ed because it $ill be abused. ,he 'ear is that i' eutha!asia is allo$ed, #ul!erable people $ill be put u!der pressure to e!d their li#es. 8t $ould be di''icult, a!d possibly impossible, to stop people usi!( persuasio! or coercio! to (et people to re)uest eutha!asia $he! they do!'t really $a!t it. 8 ha#e see! . . . A8 % patie!ts $ho ha#e bee! totally aba!do!ed by their pare!ts, brothers a!d sisters a!d by their lo#ers. 8! a state o' total isolatio!, cut o'' 'rom e#ery source o' li'e a!d a''ectio!, they $ould see death as the o!ly liberatio! ope! to them. 8! those circumsta!ces, subtle pressure could bri!( people to re)uest immediate, rapid, pai!less death, $he! $hat they $a!t is close a!d po$er'ul support a!d lo#e. evi ence to the %ana ian Senate %ommittee on 'uthanasia an *ssiste Suici e

(he pressure of feelin# a burden

-eople $ho are ill a!d depe!de!t ca! o'te! 'eel $orthless a!d a! u!due burde! o! those $ho lo#e a!d care 'or them. ,hey may actually be a burde!, but those $ho lo#e them may be happy to bear that burde!. 5o!etheless, i' eutha!asia is a#ailable, the sic+ perso! may pressure themsel#es i!to as+i!( 'or eutha!asia.

"ressure from family and others

3amily or others i!#ol#ed $ith the sic+ perso! may re(ard them as a burde! that they do!'t $ish to carry, a!d may put pressure 6$hich may be #ery subtle7 o! the sic+ perso! to as+ 'or eutha!asia. 8!creasi!( !umbers o' e1amples o' the abuse or !e(lect o' elderly people by their 'amilies ma+es this a! importa!t issue to co!sider.

Financial pressure
,he last 'e$ mo!ths o' a patie!t's li'e are o'te! the most e1pe!si#e i! terms o' medical a!d other care. %horte!i!( this period throu(h eutha!asia could be see! as a $ay o' relie#i!( pressure o! scarce medical resources, or 'amily 'i!a!ces. 8t's $orth !oti!( that cost o' the lethal medicatio! re)uired 'or eutha!asia is less tha! N@0, $hich is much cheaper tha! co!ti!ui!( treatme!t 'or ma!y medical co!ditio!s. %ome people ar(ue that re'usi!( patie!ts dru(s because they are too e1pe!si#e is a 'orm o' eutha!asia, a!d that $hile this produces public a!(er at prese!t, le(al eutha!asia pro#ides a less ob#ious solutio! to dru( costs. 8' there $as 'a(eism' i! health ser#ices, a!d certai! types o' care $ere de!ied to those o#er a certai! a(e, eutha!asia could be see! as a lo(ical e1te!sio! o' this practice.

$r#uments in fa2our of euthanasia

,his pa(e sets out the ar(ume!ts i! 'a#our o' allo$i!( eutha!asia i! certai! cases. %hould $e accept that eutha!asia happe!s a!d try to re(ulate it sa'elyI o people ha#e the ri(ht to arra!(e their o$! deathsI

72er2iew of ar#uments in fa2our of euthanasia

Ar(ume!ts i! 'a#our o' eutha!asia ca! be bro+e! do$! i!to a 'e$ mai! cate(ories&

$r#uments based on ri#hts

-eople ha#e a! e1plicit ri(ht to die A separate ri(ht to die is !ot !ecessary, because our other huma! ri(hts imply the ri(ht to die eath is a pri#ate matter a!d i' there is !o harm to others, the state a!d other people ha#e !o ri(ht to i!ter'ere 6a libertaria! ar(ume!t7

"ractical ar#uments
8t is possible to re(ulate eutha!asia eath is a pri#ate matter a!d i' there is !o harm to others, the state a!d other people ha#e !o ri(ht to i!ter'ere 6a libertaria! ar(ume!t7 Allo$i!( people to die may 'ree up scarce health resources 6this is a possible ar(ume!t, but !o authority has seriously proposed it7 0utha!asia happe!s a!y$ay 6a utilitaria! or co!se)ue!tialist ar(ume!t7

"hilosophical ar#uments
0utha!asia satis'ies the criterio! that moral rules must be u!i#ersalisable 0utha!asia happe!s a!y$ay 6a utilitaria! or co!se)ue!tialist ar(ume!t7 8s death a bad thi!(I

$r#uments about death itself

8s death a bad thi!(I ,op

'e#ulatin# euthanasia
,hose i! 'a#our o' eutha!asia thi!+ that there is !o reaso! $hy eutha!asia ca!'t be co!trolled by proper re(ulatio!, but they ac+!o$led(e that some problems $ill remai!. 3or e1ample, it $ill be di''icult to deal $ith people $ho $a!t to impleme!t eutha!asia 'or sel'ish reaso!s or pressurise #ul!erable patie!ts i!to dyi!(. ,his is little di''ere!t 'rom the positio! $ith a!y crime. ,he la$ prohibits the't, but that does!'t stop bad people steali!( thi!(s. ,op

"eople ha2e the ri#ht to die

Human bein#s ha2e the ri#ht to die when and how they want to
8!...cases $here there are !o depe!da!ts $ho mi(ht e1ert pressure o!e $ay or the other, the ri(ht o' the i!di#idual to choose should be paramou!t. %o lo!( as the patie!t is lucid, a!d his or her i!te!t is clear beyo!d doubt, there !eed be !o 'urther )uestio!s. The In epen ent, "arch 1221 Ma!y people thi!+ that each perso! has the ri(ht to co!trol his or her body a!d li'e a!d so should be able to determi!e at $hat time, i! $hat $ay a!d by $hose ha!d he or she $ill die. Behi!d this lies the idea that huma! bei!(s should be as 'ree as possible . a!d that u!!ecessary restrai!ts o! huma! ri(hts are a bad thi!(. A!d behi!d that lies the idea that huma! bei!(s are i!depe!de!t biolo(ical e!tities, $ith the ri(ht to ta+e a!d carry out decisio!s about themsel#es, pro#idi!( the (reater (ood o' society does!'t prohibit this. Allied to this is a 'irm belie' that death is the e!d.

'eli#ious ob;ections
Reli(ious oppo!e!ts disa(ree because they belie#e that the ri(ht to decide $he! a perso! dies belo!(s to God.

ecular ob;ections

%ecular oppo!e!ts ar(ue that $hate#er ri(hts $e ha#e are limited by our obli(atio!s. ,he decisio! to die by eutha!asia $ill a''ect other people . our 'amily a!d 'rie!ds, a!d healthcare pro'essio!als . a!d $e must bala!ce the co!se)ue!ces 'or them 6(uilt, (rie', a!(er7 a(ai!st our ri(hts. =e should also ta+e accou!t o' our obli(atio!s to society, a!d bala!ce our i!di#idual ri(ht to die a(ai!st a!y bad co!se)ue!ces that it mi(ht ha#e 'or the commu!ity i! (e!eral. ,hese bad co!se)ue!ces mi(ht be practical . such as ma+i!( i!#olu!tary eutha!asia easier a!d so putti!( #ul!erable people at ris+. ,here is also a political a!d philosophical obEectio! that says that our i!di#idual ri(ht to auto!omy a(ai!st the state must be bala!ced a(ai!st the !eed to ma+e the sa!ctity o' li'e a! importa!t, i!tri!sic, abstract #alue o' the state. %ecular philosophers put 'or$ard a !umber o' tech!ical ar(ume!ts, mostly based o! the duty to preser#e li'e because it has #alue i! itsel', or the importa!ce o' re(ardi!( all huma! bei!(s as e!ds rather tha! mea!s. ,op

7ther human ri#hts imply a ri#ht to die

=ithout creati!( 6or ac+!o$led(i!(7 a speci'ic ri(ht to die, it is possible to ar(ue that other huma! ri(hts ou(ht to be ta+e! to i!clude this ri(ht.

(he ri#ht to life includes the ri#ht to die

,he ri(ht to li'e is !ot a ri(ht simply to e1ist ,he ri(ht to li'e is a ri(ht to li'e $ith a mi!imum )uality a!d #alue eath is the opposite o' li'e, but the process o' dyi!( is part o' li'e yi!( is o!e o' the most importa!t e#e!ts i! huma! li'e yi!( ca! be (ood or bad -eople ha#e the ri(ht to try a!d ma+e the e#e!ts i! their li#es as (ood as possible %o they ha#e the ri(ht to try to ma+e their dyi!( as (ood as possible 8' the dyi!( process is u!pleasa!t, people should ha#e the ri(ht to shorte! it, a!d thus reduce the u!pleasa!t!ess -eople also ha#e obli(atio!s . to their 'rie!ds a!d 'amily, to their doctors a!d !urses, to society i! (e!eral ,hese obli(atio!s limit their ri(hts ,hese obli(atio!s do !ot out$ei(h a perso!'s ri(ht to re'use medical treatme!t that they do !ot $a!t But they do pre#e!t a patie!t ha#i!( a!y ri(ht to be +illed But e#e! i' there is a ri(ht to ie, that does!'t mea! that doctors ha#e a ut0 to #ill, so !o doctor ca! be 'orced to help the patie!t $ho $a!ts eutha!asia.

(he ri#ht not to be killed

,he ri(ht to li'e (i#es a perso! the ri(ht !ot to be +illed i' they do!'t $a!t to be. ,hose i! 'a#our o' eutha!asia $ill ar(ue that respect 'or this ri(ht !ot to be +illed is su''icie!t to protect a(ai!st misuse o' eutha!asia, as a!y doctor $ho +ills a patie!t $ho does!'t $a!t to die has #iolated that perso!'s ri(hts. 4ppo!e!ts o' eutha!asia may disa(ree, a!d ar(ue that allo$i!( eutha!asia $ill (reatly i!crease the ris+ o' people $ho $a!t to li#e bei!( +illed. ,he da!(er o' #iolati!( the ri(ht to li'e is so (reat that $e should ba! eutha!asia e#e! i' it mea!s #iolati!( the ri(ht to die.

(he ri#hts to pri2acy and freedom of belief include a ri#ht to die

,his is the idea that the ri(hts to pri#acy a!d 'reedom o' belie' (i#e a perso! the ri(ht to decide ho$ a!d $he! to die.

(he %uropean Con2ention on Human 'i#hts #i2es a person the ri#ht to die
5ot accordi!( to Britai!'s hi(hest court. 8t co!cluded that the ri(ht to li'e did !ot (i#e a!y ri(ht to sel'. determi!atio! o#er li'e a!d death, si!ce the pro#isio!s o' the co!#e!tio! $ere aimed at protecti!( a!d preser#i!( li'e.

%n#lish law already acknowled#es that people ha2e the ri#ht to die
,his ar(ume!t is based o! the 'act that the %uicide Act 619A17 made it le(al 'or people to ta+e their o$! li#es. 4ppo!e!ts o' eutha!asia may disa(ree& ,he %uicide Act does!'t !ecessarily ac+!o$led(e a ri(ht to die< it could simply ac+!o$led(e that you ca!'t pu!ish someo!e 'or succeedi!( at suicide a!d that it's i!appropriate to pu!ish someo!e so distressed that they $a!t to ta+e their o$! li'e. 0utha!asia oppo!e!ts 'urther poi!t out that there is a moral di''ere!ce bet$ee! decrimi!alisi!( somethi!(, o'te! 'or practical reaso!s li+e those me!tio!ed abo#e, a!d e!coura(i!( it. ,hey ca! )uite reaso!ably ar(ue that the purpose o' the %uicide Act is !ot to allo$ eutha!asia, a!d support this ar(ume!t by poi!ti!( out that the Act ma+es it a crime to help someo!e commit suicide. ,his is true, but that pro#isio! is really there to ma+e it impossible to escape a murder char(e by dressi!( the crime up as a! assisted suicide. ,op

:ibertarian ar#ument
,his is a #ariatio! o' the i!di#idual ri(hts ar(ume!t. 8' a! actio! promotes the best i!terests o' e#eryo!e co!cer!ed a!d #iolates !o o!e's ri(hts the! that actio! is morally acceptable

 8! some cases, eutha!asia promotes the best i!terests o' e#eryo!e i!#ol#ed a!d #iolates !o o!e's ri(hts 8t is there'ore morally acceptable

7b;ections to this ar#ument

4ppo!e!ts attac+ the libertaria! ar(ume!t speci'ically by claimi!( that there are !o cases that 'it the co!ditio!s abo#e& people sometimes thi!+ thi!(s are i! their best i!terests that are !ot morally acceptable ,he ar(ume!ts that eutha!asia is i!tri!sically $ro!( 'it i! here people are sometimes $ro!( about $hat's i! their best i!terests people may !ot realise that committi!( eutha!asia may harm other people eutha!asia may depri#e both the perso! $ho dies a!d others o' be!e'its eutha!asia is !ot a pri#ate act . $e ca!!ot i(!ore a!y bad e''ects it may ha#e o! society i! (e!eral ,op

9edical resources
%uthanasia may be necessary for the fair distribution of health resources
This ar(ument has not 8een put for3ar pu8licl0 or seriousl0 80 an0 (overnment or health authorit0+ It is inclu e here for completeness+ 8! most cou!tries there is a shorta(e o' health resources. As a result, some people $ho are ill a!d could be cured are !ot able to (et speedy access to the 'acilities they !eed 'or treatme!t. At the same time health resources are bei!( used o! people $ho ca!!ot be cured, a!d $ho, 'or their o$! reaso!s, $ould pre'er !ot to co!ti!ue li#i!(. Allo$i!( such people to commit eutha!asia $ould !ot o!ly let them ha#e $hat they $a!t, it $ould 'ree #aluable resources to treat people $ho $a!t to li#e. Abuse o' this $ould be pre#e!ted by o!ly allo$i!( the perso! $ho $a!ted to die to i!titiate the process, a!d by re(ulatio!s that ri(orously pre#e!ted abuse.

7b;ections to this ar#ument

,his proposal is a! e!tirely pra(matic o!e< it says that $e should allo$ eutha!asia because it $ill allo$ more people to be happy. %uch ar(ume!ts $ill !ot co!#i!ce a!yo!e $ho belie#es that eutha!asia is $ro!( i! pri!ciple. 4thers $ill obEect because they belie#e that such a proposal is $ide.ope! to abuse, a!d $ould ultimately lead to i!#olu!tary eutha!asia because o' shorta(e o' health resources. 8! the e!d, they 'ear, people $ill be e1pected to commit eutha!asia as soo! as they become a! u!reaso!able burde! o! society.

,op

9oral rules must be uni2ersalisable

4!e o' the commo!ly accepted pri!ciples i! ethics, put 'or$ard by 8mma!uel /a!t, is that o!ly those ethical pri!ciples that could be accepted as a u!i#ersal rule 6i.e. o!e that applied to e#erybody7 should be accepted. %o you should o!ly do somethi!( i' you're $illi!( 'or a!ybody to do e1actly the same thi!( i! e1actly similar circumsta!ces, re(ardless o' $ho they are. ,he Eusti'icatio! 'or this rule is hard to 'i!d . ma!y people thi!+ it's Eust a! ob#ious truth 6philosophers call such truths sel'.e#ide!t7. Dou 'i!d #ariatio!s o' this idea i! ma!y 'aiths< 'or e1ample 2do u!to others as you $ould ha#e them do u!to you2. ,o put it more 'ormally& A rule is u!i#ersalisable i' it ca! co!siste!tly be $illed as a la$ that e#eryo!e ou(ht to obey. ,he o!ly rules $hich are morally (ood are those $hich ca! be u!i#ersalised. ,he perso! i! 'a#our o' eutha!asia ar(ues that (i#i!( e#erybody the ri(ht to ha#e a (ood death throu(h eutha!asia is acceptable as a u!i#ersal pri!ciple, a!d that eutha!asia is there'ore morally acceptable.

(his alone does not ;ustify euthanasia

,his is sou!d, but is !ot a 'ull Eusti'icatio!. 8' a perso! $a!ts to be allo$ed to commit eutha!asia, it $ould clearly be i!co!siste!t 'or them to say that they did!'t thi!+ it should be allo$ed 'or other people. But the pri!ciple o' u!i#ersalisability does!'t actually pro#ide a!y positi#e Eusti'icatio! 'or a!ythi!( . (e!ui!e moral rules must be u!i#ersalisable, but u!i#ersalisability is !ot e!ou(h to say that a rule is a satis'actory moral rule. U!i#ersalisability is there'ore o!ly a !ecessary co!ditio!, !ot a su''icie!t co!ditio! 'or a rule to be a morally (ood rule. %o, other tha! sho$i!( that o!e pre.co!ditio! is met, u!i#ersalisibility does!'t ad#a!ce the case 'or eutha!asia at all.

How similar can situations be<

0#ery case is di''ere!t i! some respect, so a!yo!e $ho is i!cli!ed to ar(ue about it ca! ar(ue about $hether the particular di''ere!ces are su''ice!t to ma+e this case a! e1ceptio! to the rule.

=ni2ersal e&ceptions to uni2ersal rules

4ddly e!ou(h, the la$ o' u!i#ersalisability allo$s 'or there to be e1ceptio!s . as lo!( as the e1ceptio!s are themsel#es u!i#ersalisable. %o you could ha#e a u!i#ersal rule allo$i!( #olu!tary eutha!asia a!d u!i#ersalise a! e1ceptio! 'or people $ho $ere less tha! 19 years old. ,op

%uthanasia happens anyway

%uthanasia happens + better to make it le#al and re#ulate it properly
%ou!ds a bit li+e 2murder happe!s . better to ma+e it le(al a!d re(ulate it properly2. =he! you put it li+e that, the ar(ume!t sou!ds #ery 'eeble i!deed. But it is o!e that is used a lot i! discussio!, a!d particularly i! politics or rou!d the table i! the pub or the ca!tee!. -eople say thi!(s li+e 2$e ca!'t co!trol dru(s so $e'd better le(alise them2, or 2i' $e do!'t ma+e abortio! le(al so that people ca! ha#e it do!e i! hospital, people $ill die 'rom bac+street abortio!s2. =hat lies behi!d it is Utilitaria!ism& the belie' that moral rules should be desi(!ed to produce the (reatest happi!ess o' the (reatest !umber o' people. 8' you accept this as the basis 'or your ethical code 6a!d it's the basis o' ma!y people's ethics7, the! the ar(ume!ts abo#e are per'ectly se!sible. 8' you do!'t accept this pri!ciple, but belie#e that certai! thi!(s are $ro!( re(ardless o' $hat e''ect they ha#e o! total huma! happi!ess, the! you $ill probably re(ard this ar(ume!t as cy!ical a!d $ro!(.

$ utilitarian ar#ument for euthanasia

3rom a utilitaria! #ie$poi!t, Eusti'yi!( eutha!asia is a )uestio! o' sho$i!( that allo$i!( people to ha#e a (ood death, at a time o' their o$! choosi!(, $ill ma+e them happier tha! the pai! 'rom their ill!ess, the loss o' di(!ity a!d the distress o' a!ticipati!( a slo$, pai!'ul death. %omeo!e $ho $a!ts eutha!asia $ill ha#e already made this compariso! 'or themsel#es. But utilitaria!ism deals $ith the total huma! happi!ess, !ot Eust that o' the patie!t, so that e#e! eutha!asia oppo!e!ts $ho a(ree $ith utilitaria!ism i! pri!ciple ca! claim that the !e(ati#e e''ects o! those arou!d the patie!t . 'amily, 'rie!ds a!d medical sta'' . $ould out$ei(h the be!e'it to the patie!t. 8t is hard to measure happi!ess obEecti#ely, but o!e $ay to test this ar(ume!t $ould be to spea+ to the 'amilies a!d carers o' people $ho had committed assisted suicide. 4ppo!e!ts ca! also ar(ue that the !et e''ect o! the $hole o' society $ill be a decrease i! happi!ess. ,he o!ly $ay to approach this $ould be to loo+ at cou!tries $here eutha!asia is le(al. Ho$e#er, as !o t$o cou!tries are ali+e, it seems impossible to e1tricate the happi!ess or u!happi!ess resulti!( 'rom le(al assisted suicide, 'rom a!y happi!ess or u!happi!ess 'rom other sources. 0#e! i' you a(ree $ith the utilitaria! ar(ume!t, you the! ha#e to deal $ith the ar(ume!ts that su((est that eutha!asia ca!'t be properly re(ulated. ,op

Is death a bad thin#<

Why ask this ,uestion<

8' death is !ot a bad thi!( the! ma!y o' the obEectio!s to eutha!asia #a!ish. 8' $e put aside the idea that death is al$ays a bad thi!(, $e are able to co!sider $hether death may actually sometimes be a (ood thi!(. ,his ma+es it much easier to co!sider the issue o' eutha!asia 'rom the #ie$poi!t o' someo!e $ho $a!ts eutha!asia.

Why is death a bad thin#<

=e te!d to re(ard death as a bad thi!( 'or o!e or more o' these reaso!s& because huma! li'e is i!tri!sically #aluable because li'e a!d death are God's busi!ess $ith $hich $e should!'t i!ter'ere because most people do!'t $a!t to die because it #iolates our auto!omy i! a drastic $ay ,he 'irst t$o reaso!s 'orm +ey poi!ts i! the ar(ume!ts a(ai!st eutha!asia, but o!ly i' you accept that they are true. ,he last t$o reaso!s $hy death is a bad thi!( are !ot absolute< i' a perso! $a!ts to die, the! !either o' those reaso!s ca! be used to say that they $ould be $ro!( to u!der(o eutha!asia.

"eople don8t usually want to die

-eople are usually ea(er to a#oid death because they #alue bei!( ali#e, because they ha#e ma!y thi!(s they $ish to do, a!d e1perie!ces they $ish to ha#e. 4b#iously, this is !ot the case $ith a patie!t $ho $ishes to die . a!d proper re(ulatio! $ill $eed out people $ho do !ot really $a!t to die, but are as+i!( 'or other reaso!s.

6iolation of autonomy
A!other reaso! $hy death is see! as a bad thi!( is that it's the $orst possible #iolatio! o' the the $ishes o' the perso! $ho does !ot $a!t to die 6or, to use philosophical la!(ua(e, a #iolatio! o' their auto!omy7. 8! the case o' someo!e $ho oes $a!t to die, this obEectio! disappears.

!ein# dead, 2ersus not ha2in# been born

%ome people say that bei!( dead is !o di''ere!t 'rom !ot ha#i!( bee! bor! yet, a!d !obody ma+es a 'uss about the bad time they had be'ore they $ere bor!. ,here is a bi( di''ere!ce . e#e! thou(h bei!( dead $ill be !o di''ere!t as a! e1perie!ce 'rom the e1perie!ce o' !ot ha#i!( yet bee! bor!. ,he idea is that death hurts people because it stops them ha#i!( more o' the thi!(s that they $a!t, a!d could ha#e i' they co!ti!ued to li#e. %omeo!e $ho ma+es a re)uest 'or eutha!asia is li+ely to ha#e a bad )uality o' li'e 6or a bad pro(!osis, e#e! i' they are !ot yet su''eri!( much7 a!d the

+!o$led(e that this $ill o!ly (et $orse. 8' that is the case, death $ill !ot depri#e them o' a! other$ise pleasa!t e1iste!ce. 4' course, most patie!ts $ill still be lea#i!( behi!d some thi!(s that are (ood& 'or e1ample, lo#ed o!es a!d thi!(s they e!Eoy. As+i!( 'or death does !ot !ecessarily mea! that they ha#e !othi!( to li#e 'or& o!ly that the patie!t has decided that a'ter a certai! poi!t, the pai! out$ei(hs the (ood thi!(s.

"'o tion is the termi!atio! o' a pre(!a!cy by the remo#al or e1pulsio! 'rom the uterus o' a 'etus or embryo, resulti!( i! or caused by its death.K2L A! abortio! ca! occur spo!ta!eously due to complicatio!s duri!( pre(!a!cy or ca! be i!duced, i! huma!s a!d other species. 8! the co!te1t o' huma! pre(!a!cies, a! abortio! i!duced to preser#e the health o' the (ra#ida 6pre(!a!t 'emale7 is termed a therapeutic a8ortion, $hile a! abortio! i!duced 'or a!y other reaso! is termed a! elective a8ortion. ,he term a8ortion most commo!ly re'ers to the i!duced abortio! o' a huma! pre(!a!cy, $hile spo!ta!eous abortio!s are usually termed miscarria(es. =orld$ide >2 millio! abortio!s are estimated to ta+e place a!!ually $ith 22 millio! o' these occurri!( sa'ely a!d 20 millio! u!sa'ely.K;L =hile mater!al mortality seldom results 'rom sa'e abortio!s, u!sa'e abortio!s result i! B0,000 deaths a!d @ millio! disabilities per year.K;L 4!e o' the mai! determi!a!ts o' the a#ailability o' sa'e abortio!s is the le(ality o' the procedure. 3orty perce!t o' the $orld's $ome! are able to access therapeutic a!d electi#e abortio!s $ithi! (estatio!al limits.K>L ,he 're)ue!cy o' abortio!s is, ho$e#er, similar $hether or !ot access is restricted.K>L Abortio! has a lo!( history a!d has bee! i!duced by #arious methods i!cludi!( herbal aborti'acie!ts, the use o' sharpe!ed tools, physical trauma, a!d other traditio!al methods. "o!temporary medici!e utili:es medicatio!s a!d sur(ical procedures to i!duce abortio!. ,he le(ality, pre#ale!ce, a!d cultural #ie$s o! abortio! #ary substa!tially arou!d the $orld. 8! ma!y parts o' the $orld there is promi!e!t a!d di#isi#e public co!tro#ersy o#er the ethical a!d le(al issues o' abortio!. Abortio! a!d abortio!.related issues 'eature promi!e!tly i! the !atio!al politics i! ma!y !atio!s, o'te! i!#ol#i!( the opposi!( pro.li'e a!d pro.choice $orld$ide social mo#eme!ts 6both sel'. !amed7. 8!cide!ce o' abortio! has decli!ed $orld$ide, as access to 'amily pla!!i!( educatio! a!d co!tracepti#e ser#ices has i!creased.K@L

(ypes

A 10.$ee+.old 'etus remo#ed 'rom a >>.year.old 'emale dia(!osed $ith early.sta(e uteri!e ca!cer #ia a theraputic abortio!. ,he uterus 6$omb7, i!cluded the 'etus.

pontaneous
Mai! article& Miscarria(e %po!ta!eous abortio! 6also +!o$! as miscarria(e7 is the e1pulsio! o' a! embryo or 'etus due to accide!tal trauma or !atural causes be'ore appro1imately the 22!d $ee+ o' (estatio!< the de'i!itio! by (estatio!al a(e #aries by cou!try.KAL Most miscarria(es are due to i!correct replicatio! o' chromosomes< they ca! also be caused by e!#iro!me!tal 'actors. A pre(!a!cy that e!ds be'ore ;B $ee+s o' (estatio! resulti!( i! a li#e.bor! i!'a!t is +!o$! as a 2premature birth2. =he! a 'etus dies i! utero a'ter about 22 $ee+s, or duri!( deli#ery, it is usually termed 2stillbor!2. -remature births a!d stillbirths are (e!erally !ot co!sidered to be miscarria(es althou(h usa(e o' these terms ca! sometimes o#erlap. Bet$ee! 10M a!d @0M o' pre(!a!cies e!d i! cli!ically appare!t miscarria(e, depe!di!( upo! the a(e a!d health o' the pre(!a!t $oma!.KBL Most miscarria(es occur #ery early i! pre(!a!cy, i! most cases, they occur so early i! the pre(!a!cy that the $oma! is !ot e#e! a$are that she $as pre(!a!t. 4!e study testi!( hormo!es 'or o#ulatio! a!d pre(!a!cy 'ou!d that A1.9M o' co!ceptuses $ere lost prior to 12 $ee+s, a!d 91.BM o' these losses occurred subcli!ically, $ithout the +!o$led(e o' the o!ce pre(!a!t $oma!.K9L ,he ris+ o' spo!ta!eous abortio! decreases sharply a'ter the 10th $ee+ 'rom the last me!strual period 6*M-7.KBLK9L 4!e study o' 2;2 pre(!a!t $ome! sho$ed 2#irtually complete Kpre(!a!cy lossL by the e!d o' the embryo!ic period2 610 $ee+s *M-7 $ith a pre(!a!cy loss rate o' o!ly 2 perce!t a'ter 9.@ $ee+s *M-.K10L ,he most commo! cause o' spo!ta!eous abortio! duri!( the 'irst trimester is chromosomal ab!ormalities o' the embryo?'etus,K11L accou!ti!( 'or at least @0M o' sampled early pre(!a!cy losses.K12L 4ther causes i!clude #ascular disease 6such as lupus7, diabetes, other hormo!al problems, i!'ectio!, a!d ab!ormalities o' the uterus.K11L Ad#a!ci!( mater!al a(e a!d a patie!t history o' pre#ious spo!ta!eous abortio!s are the t$o leadi!( 'actors associated $ith a (reater ris+ o' spo!ta!eous abortio!.K12L A spo!ta!eous abortio! ca! also be caused by accide!tal trauma< i!te!tio!al trauma or stress to cause miscarria(e is co!sidered i!duced abortio! or 'eticide.K1;L

Induced
A pre(!a!cy ca! be i!te!tio!ally aborted i! ma!y $ays. ,he ma!!er selected depe!ds chie'ly upo! the (estatio!al a(e o' the embryo or 'etus, $hich i!creases i! si:e as it a(es.K1>L %peci'ic procedures may also be selected due to le(ality, re(io!al a#ailability, a!d doctor.patie!t pre'ere!ce. Reaso!s 'or procuri!( i!duced abortio!s are typically characteri:ed as either

therapeutic or electi#e. A! abortio! is medically re'erred to as therapeutic $he! it is per'ormed to& sa#e the li'e o' the pre(!a!t $oma!<K1@L preser#e the $oma!'s physical or me!tal health<K1@L termi!ate pre(!a!cy that $ould result i! a child bor! $ith a co!(e!ital disorder that $ould be 'atal or associated $ith si(!i'ica!t morbidity<K1@L or selecti#ely reduce the !umber o' 'etuses to lesse! health ris+s associated $ith multiple pre(!a!cy.K1@L A! abortio! is re'erred to as elective $he! it is per'ormed at the re)uest o' the $oma! 2'or reaso!s other tha! mater!al health or 'etal disease.2K1AL

9ethods
Gestatio!al a(e may determi!e $hich abortio! methods are practiced.

9edical
Mai! article& Medical abortio! 2Medical abortio!s2 are !o!.sur(ical abortio!s that use pharmaceutical dru(s, a!d are o!ly e''ecti#e i! the 'irst trimester o' pre(!a!cy. Kcitatio! !eededL Medical abortio!s comprise 10M o' all abortio!s i! the U!ited %tatesK1BL a!d 0urope.Kcitatio! !eededL "ombi!ed re(ime!s i!clude methotre1ate or mi'epristo!e, 'ollo$ed by a prosta(la!di! 6either misoprostol or (emeprost& misoprostol is used i! the U.%.< (emeprost is used i! the U/ a!d %$ede!.7 =he! used $ithi! >9 days (estatio!, appro1imately 92M o' $ome! u!der(oi!( medical abortio! $ith a combi!ed re(ime! completed it $ithout sur(ical i!ter#e!tio!.K19L Misoprostol ca! be used alo!e, but has a lo$er e''icacy rate tha! combi!ed re(ime!s. 8! cases o' 'ailure o' medical abortio!, #acuum or ma!ual aspiratio! is used to complete the abortio! sur(ically.

ur#ical
A #acuum aspiratio! abortio! at ei(ht $ee+s (estatio!al a(e 6si1 $ee+s a'ter 'ertili:atio!7. 1: Am!iotic sac 2: 0mbryo ): Uteri!e li!i!( 2: %peculum 5: Gacurette 3: Attached to a suctio! pump 8! the 'irst 12 $ee+s, suctio!.aspiratio! or #acuum abortio! is the most commo! method.K19L "anual Gacuum aspiratio! 6MGA7 abortio! co!sists o' remo#i!( the 'etus or embryo, place!ta a!d membra!es by suctio! usi!( a ma!ual syri!(e, $hile electric #acuum aspiratio! 60GA7 abortio! uses a! electric pump. ,hese tech!i)ues are comparable, a!d di''er i! the mecha!ism used to apply suctio!, ho$ early i! pre(!a!cy they ca! be used,

a!d $hether cer#ical dilatio! is !ecessary. MGA, also +!o$! as 2mi!i. suctio!2 a!d 2me!strual e1tractio!2, ca! be used i! #ery early pre(!a!cy, a!d does !ot re)uire cer#ical dilatio!. %ur(ical tech!i)ues are sometimes re'erred to as '%uctio! 6or sur(ical7 ,ermi!atio! 4' -re(!a!cy' 6%,4-7. 3rom the 1@th $ee+ u!til appro1imately the 2Ath, dilatio! a!d e#acuatio! 6 O07 is used. O0 co!sists o' ope!i!( the cer#i1 o' the uterus a!d emptyi!( it usi!( sur(ical i!strume!ts a!d suctio!. ilatio! a!d curetta(e 6 O"7, the seco!d most commo! method o' abortio!, is a sta!dard (y!ecolo(ical procedure per'ormed 'or a #ariety o' reaso!s, i!cludi!( e1ami!atio! o' the uteri!e li!i!( 'or possible mali(!a!cy, i!#esti(atio! o' ab!ormal bleedi!(, a!d abortio!. "uretta(e re'ers to clea!i!( the $alls o' the uterus $ith a curette. ,he =orld Health 4r(a!i:atio! recomme!ds this procedure, also called sharp curetta(e, o!ly $he! MGA is u!a#ailable.K20L 4ther tech!i)ues must be used to i!duce abortio! i! the seco!d trimester. -remature deli#ery ca! be i!duced $ith prosta(la!di!< this ca! be coupled $ith i!Eecti!( the am!iotic 'luid $ith hyperto!ic solutio!s co!tai!i!( sali!e or urea. A'ter the 1Ath $ee+ o' (estatio!, abortio!s ca! be i!duced by i!tact dilatio! a!d e1tractio! 68 P7 6also called i!trauteri!e cra!ial decompressio!7, $hich re)uires sur(ical decompressio! o' the 'etus's head be'ore e#acuatio!. 8 P is sometimes called 2partial.birth abortio!,2 $hich has bee! 'ederally ba!!ed i! the U!ited %tates. A hysterotomy abortio! is a procedure similar to a caesarea! sectio! a!d is per'ormed u!der (e!eral a!esthesia. 8t re)uires a smaller i!cisio! tha! a caesarea! sectio! a!d is used duri!( later sta(es o' pre(!a!cy.K21L 3rom the 20th to 2;rd $ee+ o' (estatio!, a! i!Eectio! to stop the 'etal heart ca! be used as the 'irst phase o' the sur(ical abortio! procedureK22LK2;LK2>L K2@LK2AL to e!sure that the 'etus is !ot bor! ali#e.K2BL

7ther methods
Historically, a !umber o' herbs reputed to possess aborti'acie!t properties ha#e bee! used i! 'ol+ medici!e& ta!sy, pe!!yroyal, blac+ cohosh, a!d the !o$.e1ti!ct silphium 6see history o' abortio!7.K29L ,he use o' herbs i! such a ma!!er ca! cause seriousHe#e! lethalHside e''ects, such as multiple or(a! 'ailure, a!d is !ot recomme!ded by physicia!s.K29L Abortio! is sometimes attempted by causi!( trauma to the abdome!. ,he de(ree o' 'orce, i' se#ere, ca! cause serious i!ter!al i!Euries $ithout !ecessarily succeedi!( i! i!duci!( miscarria(e.K;0L Both accide!tal a!d deliberate abortio!s o' this +i!d ca! be subEect to crimi!al liability i! ma!y cou!tries. 8! %outheast Asia, there is a! a!cie!t traditio! o' attempti!( abortio! throu(h 'orce'ul abdomi!al massa(e.K;1L 4!e o' the bas relie's decorati!( the temple o' A!(+or =at i! "ambodia depicts a demo! per'ormi!( such a! abortio! upo! a $oma! $ho has bee! se!t to the u!der$orld.K;1L Reported methods o' u!sa'e, sel'.i!duced abortio! i!clude misuse o' misoprostol, a!d i!sertio! o' !o!.sur(ical impleme!ts such as +!itti!(

!eedles a!d clothes ha!(ers i!to the uterus. ,hese methods are rarely see! i! de#eloped cou!tries $here sur(ical abortio! is le(al a!d a#ailable.K;2L

Health risks
%ee also& Health ris+s o' u!sa'e abortio! Abortio!, $he! le(ally per'ormed i! de#eloped cou!tries, is amo!( the sa'est procedures i! medici!e.K;;LK;>L 8! such setti!(s, ris+ o' mater!al death is bet$ee! 0.2F1.2 per 100,000 procedures.K;@LK;ALK;BLK;9L 8! compariso!, by 199A, mortality 'rom childbirth i! de#eloped cou!tries $as 11 times (reater.K;9LK>0LK>1LK>2LK>;LK>>L U!sa'e abortio!s 6de'i!ed by the =orld Health 4r(a!i:atio! as those per'ormed by u!s+illed i!di#iduals, $ith ha:ardous e)uipme!t, or i! u!sa!itary 'acilities7 carry a hi(h ris+ o' mater!al death a!d other complicatio!s.K>@L 3or u!sa'e procedures, the mortality rate has bee! estimated at ;AB per 100,000.K>AL

Physical health
%ur(ical abortio! methods, li+e most mi!imally i!#asi#e procedures, carry a small pote!tial 'or serious complicatio!s.K>BL %ur(ical abortio! is (e!erally sa'e a!d the rate o' maEor complicatio!s is lo$K>9L but #aries depe!di!( o! ho$ 'ar pre(!a!cy has pro(ressed a!d the sur(ical method used.K>9L "o!cer!i!( (estatio!al a(e, i!cide!ce o' maEor complicatio!s is hi(hest a'ter 20 $ee+s o' (estatio! a!d lo$est be'ore the 9th $ee+.K>9L =ith more ad#a!ced (estatio! there is a hi(her ris+ o' uteri!e per'oratio! a!d retai!ed products o' co!ceptio!,K@0L a!d speci'ic procedures li+e dilatio! a!d e#acuatio! may be re)uired.K@1L "o!cer!i!( the methods used, (e!eral i!cide!ce o' maEor complicatio!s 'or sur(ical abortio! #aries 'rom lo$er 'or suctio! curetta(e, to hi(her 'or sali!e i!stillatio!.K>9L -ossible complicatio!s i!clude hemorrha(e, i!complete abortio!, uteri!e or pel#ic i!'ectio!, o!(oi!( i!trauteri!e pre(!a!cy, misdia(!osed?u!reco(!i:ed ectopic pre(!a!cy, hematometra 6i! the uterus7, uteri!e per'oratio! a!d cer#ical laceratio!.K@2L Use o' (e!eral a!esthesia i!creases the ris+ o' complicatio!s because it rela1es uteri!e musculature ma+i!( it easier to per'orate.K@;L =ome! $ho ha#e uteri!e a!omalies, leiomyomas or had pre#ious di''icult 'irst.trimester abortio! are co!trai!dicated to u!derta+e sur(ical abortio! u!less ultraso!o(raphy is immediately a#ailable a!d the sur(eo! is e1perie!ced i! its i!traoperati#e use.K@>L Abortio! does !ot impair subse)ue!t pre(!a!cies, !or does it i!crease the ris+ o' 'uture premature births, i!'ertility, ectopic pre(!a!cy, or miscarria(e.K;>L 8! the 'irst trimester, health ris+s associated $ith medical abortio! are (e!erally co!sidered !o (reater tha! 'or sur(ical abortio!.K@@L

9ental health
Mai! article& Abortio! a!d me!tal health

5o scie!ti'ic research has demo!strated that abortio! is a cause o' poor me!tal health i! the (e!eral populatio!. Ho$e#er there are (roups o' $ome! $ho may be at hi(her ris+ o' copi!( $ith problems a!d distress 'ollo$i!( abortio!.K@AL %ome 'actors i! a $oma!'s li'e, such as emotio!al attachme!t to the pre(!a!cy, lac+ o' social support, pre.e1isti!( psychiatric ill!ess, a!d co!ser#ati#e #ie$s o! abortio! i!crease the li+elihood o' e1perie!ci!( !e(ati#e 'eeli!(s a'ter a! abortio!.K@BL ,he America! -sycholo(ical Associatio! 6A-A7 co!cluded that abortio! does !ot lead to i!creased me!tal health problems.K@9L %ome proposed !e(ati#e psycholo(ical e''ects o' abortio! ha#e bee! re'erred to by a!ti.abortio! ad#ocates as a separate co!ditio! called 2post. abortio! sy!drome.2 Ho$e#er, the e1iste!ce o' 2post.abortio! sy!drome2 is !ot reco(!i:ed by a!y medical or psycholo(ical or(a!i:atio!.K@9LKA0LKA1L

Incidence
,he !umber o' abortio!s per'ormed $orld$ide has deceased bet$ee! 199@ a!d 200; 'rom >@.A millio! to >1.A millio! 6a decrease 'rom ;@ to 29 per 1000 $ome! bet$ee! 1@ a!d >> years o' a(e7.K;L ,he (reatest decrease has occurred i! the de#eloped $orld $ith a decrease 'rom ;9 to 2A per 1000 $ome! i! compariso! to the de#elopi!( $orld $hich had a decrease 'rom ;> to 29 per 1000 $ome!.K;L 4' these appro1imately >2 millio! abortio!s 22 millio! occurred sa'ely a!d 20 millio! u!sa'ely.K;L ,he i!cide!ce a!d reaso!s 'or i!duced abortio! #ary re(io!ally. %ome cou!tries, such as Bel(ium 611.2 per 100 +!o$! pre(!a!cies7 a!d the 5etherla!ds 610.A per 1007, had a comparati#ely lo$ rate o' i!duced abortio!, $hile others li+e Russia 6A2.A per 1007 a!d Giet!am 6>;.B per 1007 had a hi(h rate. ,he $orld ratio $as 2A i!duced abortio!s per 100 +!o$! pre(!a!cies 6e1cludi!( miscarria(es a!d stillbirths7.KA2L

!y #estational a#e and method

Histo(ram o' abortio!s by (estatio!al a(e i! 0!(la!d a!d =ales duri!( 200>. A#era(e is 9.@ $ee+s. 6le't7 Abortio! i! the U!ited %tates by (estatio!al a(e, 200>. 6 ata source& "e!ters 'or isease "o!trol a!d -re#e!tio!7 6ri(ht7 Abortio! rates also #ary depe!di!( o! the sta(e o' pre(!a!cy a!d the method practiced. 8! 200;, 'rom data collected i! those areas o' the U!ited %tates that su''icie!tly reported (estatio!al a(e, it $as 'ou!d that 99.2M o' abortio!s $ere co!ducted at or prior to 12 $ee+s, 10.>M 'rom 1; to 20 $ee+s, a!d 1.>M at or a'ter 21 $ee+s. 90.9M o' these $ere classi'ied as ha#i!( bee! do!e by 2curetta(e2 6suctio!.aspiratio!, ilatio! a!d curetta(e, ilatio! a!d e#acuatio!7, B.BM by 2medical2 mea!s 6mi'epristo!e7, 0.>M by 2i!trauteri!e i!stillatio!2 6sali!e or prosta(la!di!7, a!d 1.0M by 2other2 6i!cludi!( hysterotomy a!d hysterectomy7.KA;L ,he Guttmacher 8!stitute estimated there $ere 2,200 i!tact dilatio! a!d e1tractio! procedures i! the U.%. duri!( 2000< this accou!ts 'or 0.1BM o' the total !umber o' abortio!s per'ormed that year.KA>L %imilarly, i! 0!(la!d a!d =ales i! 200A, 99M o'

termi!atio!s occurred at or u!der 12 $ee+s, 9M bet$ee! 1; to 19 $ee+s, a!d 1.@M at or o#er 20 $ee+s. A>M o' those reported $ere by #acuum aspiratio!, AM by O0, a!d ;0M $ere medical.KA@L *ater abortio!s are more commo! i! "hi!a, 8!dia, a!d other de#elopi!( cou!tries tha! i! de#eloped cou!tries.KAAL

!y personal and social factors

A bar chart depicti!( selected data 'rom the 1999 AG8 meta.study o! the reaso!s $ome! stated 'or ha#i!( a! abortio!. A 1999 a((re(ated study, 'rom 2B cou!tries, o! the reaso!s $ome! see+ to termi!ate their pre(!a!cies co!cluded that commo! 'actors cited to ha#e i!'lue!ced the abortio! decisio! $ere& desire to delay or e!d childbeari!(, co!cer! o#er the i!terruptio! o' $or+ or educatio!, issues o' 'i!a!cial or relatio!ship stability, a!d percei#ed immaturity.KABL A 200> study i! $hich America! $ome! at cli!ics a!s$ered a )uestio!!aire yielded similar results. KA9L 8! 3i!la!d a!d the U!ited %tates, co!cer! 'or the health ris+s posed by pre(!a!cy i! i!di#idual cases $as !ot a 'actor commo!ly (i#e!< ho$e#er, i! Ba!(ladesh, 8!dia, a!d /e!ya health co!cer!s $ere cited by $ome! more 're)ue!tly as reaso!s 'or ha#i!( a! abortio!.KABL 1M o' $ome! i! the 200> sur#ey.based U.%. study became pre(!a!t as a result o' rape a!d 0.@M as a result o' i!cest.KA9L A!other America! study i! 2002 co!cluded that @>M o' $ome! $ho had a! abortio! $ere usi!( a 'orm o' co!traceptio! at the time o' becomi!( pre(!a!t $hile >AM $ere !ot. 8!co!siste!t use $as reported by >9M o' those usi!( co!doms a!d BAM o' those usi!( the combi!ed oral co!tracepti#e pill< >2M o' those usi!( co!doms reported 'ailure throu(h slippi!( or brea+a(e.KA9L ,he Guttmacher 8!stitute estimated that 2most abortio!s i! the U!ited %tates are obtai!ed by mi!ority $ome!2 because mi!ority $ome! 2ha#e much hi(her rates o' u!i!te!ded pre(!a!cy.2KB0L %ome abortio!s are u!der(o!e as the result o' societal pressures. ,hese mi(ht i!clude the sti(mati:atio! o' disabled people, pre'ere!ce 'or childre! o' a speci'ic se1, disappro#al o' si!(le motherhood, i!su''icie!t eco!omic support 'or 'amilies, lac+ o' access to or reEectio! o' co!tracepti#e methods, or e''orts to$ard populatio! co!trol 6such as "hi!a's o!e.child policy7. ,hese 'actors ca! sometimes result i! compulsory abortio! or se1.selecti#e abortio!.

=nsafe abortion
%o#iet poster circa 192@, promoti!( hospital abortio!s. ,itle tra!slatio!& 2Abortio!s per'ormed by either trai!ed or sel'.tau(ht mid$i#es !ot o!ly maim the $oma!, they also o'te! lead to death.2 Mai! article& U!sa'e abortio! =ome! see+i!( to termi!ate their pre(!a!cies sometimes resort to u!sa'e methods, particularly $here a!d $he! access to le(al abortio! is restricted. ,he =orld Health 4r(a!i:atio! 6=H47 de'i!es a! u!sa'e abortio! as bei!( 2a procedure ... carried out by perso!s lac+i!( the !ecessary s+ills or i! a! e!#iro!me!t that does !ot co!'orm to mi!imal medical sta!dards, or

both.2KB1L U!sa'e abortio!s are sometimes +!o$! collo)uially as 2bac+. alley2 abortio!s. ,hey may be per'ormed by the $oma! hersel', a!other perso! $ithout medical trai!i!(, or a pro'essio!al health pro#ider operati!( i! sub.sta!dard co!ditio!s. U!sa'e abortio! remai!s a public health co!cer! due to the hi(her i!cide!ce a!d se#erity o' its associated complicatio!s, such as i!complete abortio!, sepsis, hemorrha(e, a!d dama(e to i!ter!al or(a!s. 8t is estimated that 20 millio! u!sa'e abortio!s occur arou!d the $orld a!!ually a!d that B0,000 o' these result i! the $oma!'s death.K;L "omplicatio!s o' u!sa'e abortio! are said to accou!t, (lobally, 'or appro1imately 1;M o' all mater!al mortalities, $ith re(io!al estimates i!cludi!( 12M i! Asia, 2@M i! *ati! America, a!d 1;M i! sub.%ahara! A'rica. KB2L Althou(h the (lobal rate o' abortio! decli!ed 'rom >@.A millio! i! 199@ to >1.A millio! i! 200;, u!sa'e procedures still accou!ted 'or >9M o' all abortio!s per'ormed i! 200;.KB;L Health educatio!, access to 'amily pla!!i!(, a!d impro#eme!ts i! health care duri!( a!d a'ter abortio! ha#e bee! proposed to address this phe!ome!o!.KB>L

History
23re!ch -eriodical -ills.2 A! e1ample o' a cla!desti!e ad#ertiseme!t published i! a! 19>@ editio! o' the 7oston Dail0 Times. Mai! article& History o' abortio! 8!duced abortio! ca! be traced to a!cie!t times.KB@L ,here is e#ide!ce to su((est that, historically, pre(!a!cies $ere termi!ated throu(h a !umber o' methods, i!cludi!( the admi!istratio! o' aborti'acie!t herbs, the use o' sharpe!ed impleme!ts, the applicatio! o' abdomi!al pressure, a!d other tech!i)ues. ,he Hippocratic 4ath, the chie' stateme!t o' medical ethics 'or Hippocratic physicia!s i! A!cie!t Greece, 'orbade doctors 'rom helpi!( to procure a! abortio! by pessary. %ora!us, a seco!d.ce!tury Gree+ physicia!, su((ested i! his $or+ Gy!aecolo(y that $ome! $ishi!( to abort their pre(!a!cies should e!(a(e i! e!er(etic e1ercise, e!er(etic Eumpi!(, carryi!( hea#y obEects, a!d ridi!( a!imals. He also prescribed a !umber o' recipes 'or herbal baths, pessaries, a!d bloodletti!(, but ad#ised a(ai!st the use o' sharp i!strume!ts to i!duce miscarria(e due to the ris+ o' or(a! per'oratio!. KBAL 8t is also belie#ed that, i! additio! to usi!( it as a co!tracepti#e, the a!cie!t Gree+s relied upo! silphium as a! aborti'acie!t. %uch 'ol+ remedies, ho$e#er, #aried i! e''ecti#e!ess a!d $ere !ot $ithout ris+. ,a!sy a!d pe!!yroyal, 'or e1ample, are t$o poiso!ous herbs $ith serious side e''ects that ha#e at times bee! used to termi!ate pre(!a!cy. uri!( the medie#al period, physicia!s i! the 8slamic $orld docume!ted detailed a!d e1te!si#e lists o' birth co!trol practices, i!cludi!( the use o' aborti'acie!ts, comme!ti!( o! their e''ecti#e!ess a!d pre#ale!ce.KBBL ,hey listed ma!y di''ere!t birth co!trol substa!ces i! their medical e!cyclopedias, such as A#ice!!a listi!( 20 i! ,he "a!o! o' Medici!e 6102@7 a!d Muhammad ib! Qa+ariya ar.Ra:i listi!( 1BA i! his &a3i 610th ce!tury7.

,his $as u!paralleled i! 0uropea! medici!e u!til the 19th ce!tury.KB9L K9ee :uotation to #eri'yL uri!( the Middle A(es, abortio! $as tolerated a!d there $ere !o la$s a(ai!st it.KB9L A medie#al 'emale physicia!, ,rotula o' %aler!o,K90L admi!istered a !umber o' remedies 'or the Rrete!tio! o' me!strua,S $hich $as sometimes a code 'or early aborti'acie!ts.K91L -ope %i1tus G 61@9@F907 is !oted as the 'irst -ope to declare that abortio! is homicide re(ardless o' the sta(e o' pre(!a!cy.K92L Abortio! i! the 19th ce!tury co!ti!ued, despite ba!s i! both the U!ited /i!(dom a!d the U!ited %tates, as the dis(uised, but !o!etheless ope!, ad#ertiseme!t o' ser#ices i! the Gictoria! era su((ests.K9;L 8! the 20th ce!tury the %o#iet U!io! 619197, 8cela!d 619;@7 a!d %$ede! 619;97 $ere amo!( the 'irst cou!tries to le(ali:e certai! or all 'orms o' abortio!.K9>L 8! 19;@ 5a:i Germa!y, a la$ $as passed permitti!( abortio!s 'or those deemed 2hereditarily ill,2 $hile $ome! co!sidered o' Germa! stoc+ $ere speci'ically prohibited 'rom ha#i!( abortio!s.K9@LK9ALK9BLK99L

ociety and culture

$bortion debate
,his sectio! needs additional citatio!s fo #eri'icatio!4 -lease help impro#e this article by addi!( reliable re'ere!ces. U!sourced material may be challe!(ed a!d remo#ed. ;9ovem8er 1228<

-ro.choice acti#ists !ear the =ashi!(to! Mo!ume!t at the March 'or =ome!'s *i#es i! 200>. 6le't7 -ro.li'e acti#ists !ear the =ashi!(to! Mo!ume!t at the a!!ual 2009 March 'or *i'e i! =ashi!(to!, ". 6ri(ht7 Mai! article& Abortio! debate 8! the history o' abortio!, i!duced abortio! has bee! the source o' co!siderable debate, co!tro#ersy, a!d acti#ism. A! i!di#idual's positio! o! the comple1 ethical, moral, philosophical, biolo(ical, a!d le(al issues is o'te! related to his or her #alue system. ,he mai! positio!s are o!e that ar(ues i! 'a#or o' access to abortio! a!d o!e ar(ues a(ai!st access to abortio!. 4pi!io!s o' abortio! may be described as bei!( a combi!atio! o' belie's o! its morality, a!d belie's o! the respo!sibility, ethical scope, a!d proper e1te!t o' (o#er!me!tal authorities i! public policy. Reli(ious ethics also has a! i!'lue!ce upo! both perso!al opi!io! a!d the (reater debate o#er abortio! 6see reli(io! a!d abortio!7. Abortio! debates, especially pertai!i!( to abortio! la$s, are o'te! spearheaded by (roups ad#ocati!( o!e o' these t$o positio!s. 8! the U!ited %tates, those i! 'a#or o' (reater le(al restrictio!s o!, or e#e! complete prohibitio! o' abortio!, most o'te! describe themsel#es as pro.li'e $hile those a(ai!st le(al restrictio!s o! abortio! describe themsel#es as pro. choice. Ge!erally, the 'ormer positio! ar(ues that a huma! 'etus is a huma! bei!( $ith a ri(ht to li#e ma+i!( abortio! ta!tamou!t to murder. ,he latter

positio! ar(ues that a $oma! has certai! reproducti#e ri(hts, especially the choice $hether or !ot to carry a pre(!a!cy to term. 8! both public a!d pri#ate debate, ar(ume!ts prese!ted i! 'a#or o' or a(ai!st abortio! access 'ocus o! either the moral permissibility o' a! i!duced abortio!, or Eusti'icatio! o' la$s permitti!( or restricti!( abortio!. ebate also 'ocuses o! $hether the pre(!a!t $oma! should ha#e to !oti'y a!d?or ha#e the co!se!t o' others i! disti!ct cases& a mi!or, her pare!ts< a le(ally married or commo!.la$ $i'e, her husba!d< or a pre(!a!t $oma!, the biolo(ical 'ather. 8! a 200; Gallup poll i! the U!ited %tates, B9M o' male a!d ABM o' 'emale respo!de!ts $ere i! 'a#or o' le(ali:ed ma!datory spousal !oti'icatio!< o#erall support $as B2M $ith 2AM opposed.K99L

$bortion law
Mai! article& Abortio! la$ %ee also& Reproducti#e ri(hts 8!ter!atio!al status o' abortio! la$& *e(al o! re)uest *e(al 'or mater!al li'e, health, me!tal health, rape, 'etal de'ects, a!d?or socioeco!omic 'actors *e(al 'or or ille(al $ith e1ceptio! 'or mater!al li'e, health, me!tal health, rape, a!d?or 'etal de'ects 8lle(al $ith e1ceptio! 'or mater!al li'e, health, me!tal health a!d?or rape 8lle(al $ith e1ceptio! 'or mater!al li'e, health, a!d?or me!tal health 8lle(al $ith !o e1ceptio!s 5o i!'ormatio! Gertical stripes 6#arious colours7& 8lle(al but u!e!'orced Be'ore the scie!ti'ic disco#ery i! the !i!etee!th ce!tury that huma! de#elopme!t be(i!s at 'ertili:atio!,K90L 0!(lish commo! la$ 'orbade abortio!s a'ter 2)uic+e!i!(2, that is, a'ter 2a! i!'a!t is able to stir i! the mother's $omb.2K91L ,here $as also a! earlier period i! 0!(la!d $he! abortio! $as prohibited 2i' the 'oetus is already 'ormed2 but !ot yet )uic+e!ed.K92L Both pre. a!d post.)uic+e!i!( abortio!s $ere crimi!ali:ed by *ord 0lle!borou(h's Act i! 190;.K9;L 8! 19A1, the -arliame!t o' the U!ited /i!(dom passed the 4''e!ces a(ai!st the -erso! Act 19A1, $hich co!ti!ued to outla$ abortio! a!d ser#ed as a model 'or similar prohibitio!s i! some other !atio!s.K9>L ,he %o#iet U!io!, $ith le(islatio! i! 1920, a!d 8cela!d, $ith le(islatio! i! 19;@, $ere t$o o' the 'irst cou!tries to (e!erally allo$ abortio!. ,he seco!d hal' o' the 20th ce!tury sa$ the liberali:atio! o' abortio! la$s i! other cou!tries. ,he Abortio! Act 19AB allo$ed abortio! 'or limited reaso!s i! the U!ited /i!(dom 6e1cept 5orther! 8rela!d7. 8! the 19B; case, Roe #. =ade, the U!ited %tates %upreme "ourt struc+ do$! state la$s ba!!i!( abortio!, ruli!( that such la$s #iolated a! implied ri(ht to pri#acy i! the U!ited %tates "o!stitutio!. ,he %upreme "ourt o' "a!ada, similarly, i! the case o' R. #. Mor(e!taler, discarded its crimi!al code re(ardi!( abortio! i! 1999, a'ter ruli!( that such restrictio!s #iolated the security o' perso! (uara!teed to $ome! u!der the "a!adia! "harter o' Ri(hts a!d 3reedoms. "a!ada later struc+ do$! pro#i!cial re(ulatio!s o' abortio! i! the case o' R. #. Mor(e!taler 6199;7+ By co!trast, abortio! i! 8rela!d $as a''ected by the

additio! o' a! ame!dme!t to the 8rish "o!stitutio! i! 199; by popular re'ere!dum, reco(!i:i!( 2the ri(ht to li'e o' the u!bor!2. "urre!t la$s pertai!i!( to abortio! are di#erse. Reli(ious, moral, a!d cultural se!sibilities co!ti!ue to i!'lue!ce abortio! la$s throu(hout the $orld. ,he ri(ht to li'e, the ri(ht to liberty, the ri(ht to security o' perso!, a!d the ri(ht to reproducti#e health are maEor issues o' huma! ri(hts that are sometimes used as Eusti'icatio! 'or the e1iste!ce or abse!ce o' la$s co!trolli!( abortio!. Ma!y cou!tries i! $hich abortio! is le(al re)uire that certai! criteria be met i! order 'or a! abortio! to be obtai!ed, o'te!, but !ot al$ays, usi!( a trimester.based system to re(ulate the $i!do$ o' le(ality& 8! the U!ited %tates, some states impose a 2>.hour $aiti!( period be'ore the procedure, prescribe the distributio! o' i!'ormatio! o! 'etal de#elopme!t, or re)uire that pare!ts be co!tacted i' their mi!or dau(hter re)uests a! abortio!.K9@L 8! the U!ited /i!(dom, as i! some other cou!tries, t$o doctors must 'irst certi'y that a! abortio! is medically or socially !ecessary be'ore it ca! be per'ormed. 8! "a!ada, a similar re)uireme!t $as reEected as u!co!stitutio!al i! 1999. 4ther cou!tries, i! $hich abortio! is !ormally ille(al, $ill allo$ o!e to be per'ormed i! the case o' rape, i!cest, or da!(er to the pre(!a!t $oma!'s li'e or health. A 'e$ !atio!s ba! abortio! e!tirely& "hile, 0l %al#ador, Malta, a!d 5icara(ua, $ith co!se)ue!t rises i! mater!al death directly a!d i!directly due to pre(!a!cy.K9ALK9BL Ho$e#er, i! 200A, the "hilea! (o#er!me!t be(a! the 'ree distributio! o' emer(e!cy co!traceptio!. K99LK99L 8! Ba!(ladesh, abortio! is ille(al, but the (o#er!me!t has lo!( supported a !et$or+ o' 2me!strual re(ulatio! cli!ics2, $here me!strual e1tractio! 6ma!ual #acuum aspiratio!7 ca! be per'ormed as me!strual hy(ie!e.K100L 8! places $here abortio! is ille(al or carries hea#y social sti(ma, pre(!a!t $ome! may e!(a(e i! medical tourism a!d tra#el to cou!tries $here they ca! termi!ate their pre(!a!cies. =ome! $ithout the mea!s to tra#el ca! resort to pro#iders o' ille(al abortio!s or try to do it themsel#es. K101L 8! the U%, about 9M o' abortio!s are per'ormed o! $ome! $ho tra#el 'rom a!other state.K102L Ho$e#er, that is dri#e! at least partly by di''eri!( limits o! abortio! accordi!( to (estatio!al a(e or the scarcity o' doctors trai!ed a!d $illi!( to do later abortio!s.

e&+selecti2e
Mai! article& %e1.selecti#e abortio!

%o!o(raphy a!d am!ioce!tesis allo$ pare!ts to determi!e se1 be'ore childbirth. ,he de#elopme!t o' this tech!olo(y has led to se1.selecti#e abortio!, or the tar(eted termi!atio! o' 'emale 'etuses. 8t is su((ested that se1.selecti#e abortio! mi(ht be partially respo!sible 'or the !oticeable disparities bet$ee! the birth rates o' male a!d 'emale childre! i! some places. ,he pre'ere!ce 'or male childre! is reported i! ma!y areas o' Asia, a!d abortio! used to limit 'emale births has bee! reported i! "hi!a, ,ai$a!, %outh /orea, a!d 8!dia.K10;L 8! 8!dia, the eco!omic role o' me!, the costs associated $ith do$ries, a!d a commo! 8!dia! traditio! $hich dictates that 'u!eral rites must be per'ormed by a male relati#e ha#e led to a cultural pre'ere!ce 'or so!s.K10>L ,he $idespread a#ailability o' dia(!ostic testi!(, duri!( the 19B0s a!d '90s, led to ad#ertiseme!ts 'or ser#ices $hich read, 28!#est @00 rupees K'or a se1 testL !o$, sa#e @0,000 rupees K'or a do$ryL later.2K10@L 8! 1991, the male. to.'emale se1 ratio i! 8!dia $as s+e$ed 'rom its biolo(ical !orm o' 10@ to 100, to a! a#era(e o' 109 to 100.K10AL Researchers ha#e asserted that bet$ee! 199@ a!d 200@ as ma!y as 10 millio! 'emale 'etuses may ha#e bee! selecti#ely aborted.K10BL ,he 8!dia! (o#er!me!t passed a! o''icial ba! o' pre.!atal se1 scree!i!( i! 199> a!d mo#ed to pass a complete ba! o' se1.selecti#e abortio! i! 2002.K109L 8! the -eople's Republic o' "hi!a, there is also a historic so! pre'ere!ce. ,he impleme!tatio! o' the o!e.child policy i! 19B9, i! respo!se to populatio! co!cer!s, led to a! i!creased disparity i! the se1 ratio as pare!ts attempted to circum#e!t the la$ throu(h se1.selecti#e abortio! or the aba!do!me!t o' u!$a!ted dau(hters.K109L %e1.selecti#e abortio! mi(ht be a! i!'lue!ce o! the shi't 'rom the baseli!e male.to.'emale birth rate to a! ele#ated !atio!al rate o' 11B&100 reported i! 2002. ,he tre!d $as more pro!ou!ced i! rural re(io!s& as hi(h as 1;0&100 i! Gua!(do!( a!d 1;@&100 i! Hai!a!.K110L A ba! upo! the practice o' se1.selecti#e abortio! $as e!acted i! 200;.K111L

0P-4%8,8G4 5 e&o +endel

:regor Johann >en(el 3July 2$, 1"22[.] 6 January , 1""44 *as an $u#ustinian priest an( scientist, *ho gaine( posthumous fame as the figurehea( of the ne* science of #enetics for his stu(y of the inheritance of certain traits in pea plants. >en(el sho*e( that the inheritance of these traits follo*s particular laws, *hich *ere later name( after him. )he significance of >en(el0s *or2 *as not recognize( until the turn of the 2$th century. )he in(epen(ent re(iscovery of these la*s forme( the foun(ation of the mo(ern science of genetics.[>]

!io#raphy
Me!del $as bor! i!to a! eth!ic Germa! 'amily i! Hei!:e!dor' bei 4drau, Austria! %ilesia, Austria! 0mpire 6!o$ Hy!Tice, ":ech Republic7, a!d $as bapti:ed t$o days later. He $as the so! o' A!to! a!d Rosi!e Me!del, a!d had o!e older sister a!d o!e you!(er. ,hey li#ed a!d $or+ed o! a 'arm

$hich had bee! o$!ed by the Me!del 'amily 'or at least 1;0 years.K;L uri!( his childhood, Me!del $or+ed as a (arde!er, studied bee+eepi!(, a!d as a you!( ma! atte!ded the -hilosophical 8!stitute i! 4lomouc i! 19>0F19>;. Upo! recomme!datio! o' his physics teacher 3riedrich 3ra!:, he e!tered the Au(usti!ia! Abbey o' %t ,homas i! Br!o i! 19>;. Bor! Joha!! Me!del, he too+ the !ame Gre(or upo! e!teri!( mo!astic li'e. 8! 19@1 he $as se!t to the U!i#ersity o' Gie!!a to study u!der the spo!sorship o' Abbot ". 3. 5app. At Gie!!a, his pro'essor o' physics $as "hristia! oppler.K>L Me!del retur!ed to his abbey i! 19@; as a teacher, pri!cipally o' physics, a!d by 19AB, he had replaced 5app as abbot o' the mo!astery.K@L Besides his $or+ o! pla!t breedi!( $hile at %t ,homas's Abbey, Me!del also bred bees i! a bee house that $as built 'or him, usi!( bee hi#es that he desi(!ed.KAL He also studied astro!omy a!d meteorolo(yK@L, 'ou!di!( the 'Austria! Meteorolo(ical %ociety' i! 19A@.K>L ,he maEority o' his published $or+s $ere related to meteorolo(y.K>L

%&periments on "lant Hybridi?ation

Gre(or Me!del, $ho is +!o$! as the 2'ather o' moder! (e!etics2, $as i!spired by both his pro'essors at u!i#ersity a!d his collea(ues at the mo!astery to study #ariatio! i! pla!ts, a!d he co!ducted his study i! the mo!astery's t$o hectareKBL e1perime!tal (arde!, $hich $as ori(i!ally pla!ted by the abbot 5app i! 19;0.K@L Bet$ee! 19@A a!d 19A; Me!del culti#ated a!d tested some 29,000 pea pla!ts 6i+e+, -isum sati#um7. ,his study sho$ed that o!e i! 'our pea pla!ts had purebred recessi#e alleles, t$o out o' 'our $ere hybrid a!d o!e out o' 'our $ere purebred domi!a!t. His e1perime!ts led him to ma+e t$o (e!erali:atio!s, the *a$ o' %e(re(atio! a!d the *a$ o' 8!depe!de!t Assortme!t, $hich later became +!o$! as Me!del's *a$s o' 8!herita!ce. Me!del did read his paper, 01perime!ts o! -la!t Hybridi:atio!, at t$o meeti!(s o' the 5atural History %ociety o' BrU!! i! Mora#ia i! 19A@. =he! Me!del's paper $as published i! 19AA i! -roceedi!(s o' the 5atural History %ociety o' BrU!!,K9L it had little impact a!d $as cited about three times o#er the !e1t thirty.'i#e years. 65otably, "harles ar$i! $as u!a$are o' Me!del's paper, accordi!( to Jacob Bro!o$s+i's ,he Asce!t o' Ma!+7 His paper $as critici:ed at the time, but is !o$ co!sidered a semi!al $or+.

:ife after the pea e&periments

A'ter Me!del completed his $or+ $ith peas, he tur!ed to e1perime!ti!( $ith ho!eybees, i! order to e1te!d his $or+ to a!imals. He produced a hybrid strai! 6so #icious they $ere destroyed7, but 'ailed to (e!erate a clear picture o' their heredity because o' the di''iculties i! co!trolli!( mati!( beha#iours o' )uee! bees. He also described !o#el pla!t species, a!d these are de!oted $ith the bota!ical author abbre#iatio! 2Me!del2. A'ter he $as ele#ated as abbot i! 19A9, his scie!ti'ic $or+ lar(ely e!ded as Me!del became co!sumed $ith his i!creased admi!istrati#e respo!sibilities, especially a dispute $ith the ci#il (o#er!me!t o#er their attempt to impose special ta1es o! reli(ious i!stitutio!s.K9L At 'irst Me!del's $or+ $as reEected,

a!d it $as !ot $idely accepted u!til a'ter he died. At that time most biolo(ists held the idea o' ble!di!( i!herita!ce, a!d "harles ar$i!'s e''orts to e1plai! i!herita!ce throu(h a theory o' pa!(e!esis $ere u!success'ul. Me!del's ideas $ere redisco#ered i! the early t$e!tieth ce!tury, a!d i! the 19;0s a!d 19>0s the moder! sy!thesis combi!ed Me!delia! (e!etics $ith ar$i!'s theory o' !atural selectio!. Me!del died o! Ja!uary A, 199>, at a(e A1, i! Br!o, Mora#ia, Austria. Hu!(ary 6!o$ ":ech Republic7, 'rom chro!ic !ephritis. ":ech composer *eoV Ja!WTe+ played the or(a! at his 'u!eral. A'ter his death the succeedi!( abbot bur!ed all papers i! Me!del's collectio!, to mar+ a! e!d to the disputes o#er ta1atio!.K10L

'edisco2ery of 9endel8s work

omi!a!t a!d recessi#e phe!otypes. 617 -are!tal (e!eratio!. 627 31 (e!eratio!. 6;7 32 (e!eratio!. 8t $as !ot u!til the early 20th ce!tury that the importa!ce o' his ideas $as reali:ed. By 1900, research aimed at 'i!di!( a success'ul theory o' disco!ti!uous i!herita!ce rather tha! ble!di!( i!herita!ce led to i!depe!de!t duplicatio! o' his $or+ by Hu(o de Gries a!d "arl "orre!s, a!d the redisco#ery o' Me!del's $riti!(s a!d la$s. Both ac+!o$led(ed Me!del's priority, a!d it is thou(ht probable that de Gries did !ot u!dersta!d the results he had 'ou!d u!til a'ter readi!( Me!del.K2L ,hou(h 0rich #o! ,scherma+ $as ori(i!ally also credited $ith redisco#ery, this is !o lo!(er accepted because he did !ot u!dersta!d Me!del's la$s.K11L ,hou(h de Gries later lost i!terest i! Me!delism, other biolo(ists started to establish (e!etics as a scie!ce.K2L Me!del's results $ere )uic+ly replicated, a!d (e!etic li!+a(e )uic+ly $or+ed out. Biolo(ists 'loc+ed to the theory, e#e! thou(h it $as !ot yet applicable to ma!y phe!ome!a, it sou(ht to (i#e a (e!otypic u!dersta!di!( o' heredity $hich they 'elt $as lac+i!( i! pre#ious studies o' heredity $hich 'ocused o! phe!otypic approaches. Most promi!e!t o' these latter

approaches $as the biometric school o' /arl -earso! a!d =.3.R. =eldo!, $hich $as based hea#ily o! statistical studies o' phe!otype #ariatio!. ,he stro!(est oppositio! to this school came 'rom =illiam Bateso!, $ho perhaps did the most i! the early days o' publicisi!( the be!e'its o' Me!del's theory 6the $ord 2(e!etics2, a!d much o' the discipli!e's other termi!olo(y, ori(i!ated $ith Bateso!7. ,his debate bet$ee! the biometricia!s a!d the Me!delia!s $as e1tremely #i(orous i! the 'irst t$o decades o' the t$e!tieth ce!tury, $ith the biometricia!s claimi!( statistical a!d mathematical ri(or, $hereas the Me!delia!s claimed a better u!dersta!di!( o' biolo(y. 8! the e!d, the t$o approaches $ere combi!ed as the moder! sy!thesis o' e#olutio!ary biolo(y, especially by $or+ co!ducted by R. A. 3isher as early as 1919. Me!del's e1perime!tal results ha#e later bee! the obEect o' co!siderable dispute.K10L 3isher a!aly:ed the results o' the 32 6seco!d 'ilial7 ratio a!d 'ou!d them to be implausibly close to the e1act ratio o' ; to 1.K12L 4!ly a 'e$ $ould accuse Me!del o' scie!ti'ic malpractice or call it a scie!ti'ic 'raud Hreproductio! o' his e1perime!ts has demo!strated the #alidity o' his hypothesisHho$e#er, the results ha#e co!ti!ued to be a mystery 'or ma!y, thou(h it is o'te! cited as a! e1ample o' co!'irmatio! bias. ,his mi(ht arise i' he detected a! appro1imate ; to 1 ratio early i! his e1perime!ts $ith a small sample si:e, a!d co!ti!ued collecti!( more data u!til the results co!'ormed more !early to a! e1act ratio. 8t is sometimes su((ested that he may ha#e ce!sored his results, a!d that his se#e! traits each occur o! a separate chromosome pair, a! e1tremely u!li+ely occurre!ce i' they $ere chose! at ra!dom. 8! 'act, the (e!es Me!del studied occurred i! o!ly 'our li!+a(e (roups, a!d o!ly o!e (e!e pair 6out o' 21 possible7 is close e!ou(h to sho$ de#iatio! 'rom i!depe!de!t assortme!t< this is !ot a pair that Me!del studied. %ome rece!t researchers ha#e su((ested that 3isher's criticisms o' Me!del's $or+ may ha#e bee! e1a((erated.K1;LK1>L

/(at is Pa $inson6s Disease

Retur! to 8!de1 Retur! to Alphabetical "o!te!ts =hat 8s -ar+i!so!'s iseaseI

Abraham *ieberma!, M. .

-ar+i!so!'s disease 6- 7 is a pro(ressi#e disorder o' the !er#ous system. =ith a! a!!ual i!cide!ce o' appro1imately 20 !e$ cases per 100,000 people, the pre#ale!ce is 200 cases per 100,000 people or 0.2M. ,here are 1,000,000 or more people $ith - i! the U!ited %tates< more patie!ts tha! $ith multiple sclerosis, amyotrophic lateral sclerosis, muscular dystrophy a!d myasthe!ia (ra#is combi!ed. - is (e!erally a(e.speci'ic< it is estimated that appro1imately 1M o' the populatio! o#er a(e A0 has - . ,he occurre!ce o' - arou!d a(e A0

su((ests the disease may be time.loc+ed to certai! a(e.related cha!(es i! the !er#ous system. Ho$e#er, - does occur i! you!( people. Appro1imately 10M o' all patie!ts de#elop symptoms be'ore a(e @0. ,his su((ests that i! additio! to a!y cha!(es related to a(i!(, there are speci'ic cha!(es related to the disease. - is characteri:ed by 'our mai! 'eatures& ri(idity or sti''!ess o' the arms, le(s or !ec+< tremor, usually o' the ha!ds< brady+i!esia or slo$!ess a!d reductio! o' mo#eme!t< a!d postural i!stability 6loss o' bala!ce7. 4ther symptoms may accompa!y the mai! 'eatures, i!cludi!( depressio!, deme!tia or co!'usio!, postural de'ormity, speech a!d s$allo$i!( di''iculty, drooli!(, di::i!ess o! sta!di!(, impote!ce, uri!ary 're)ue!cy a!d co!stipatio!. =he! ri(idity, tremor, slo$!ess o' mo#eme!t a!d loss o' bala!ce domi!ate, $he! the course o' the disease is slo$ $ith disability occurri!( 10 to 20 years a'ter dia(!osis, a!d $he! there is !o ob#ious cause, the! the co!ditio! is re'erred to as idiopathic - . -atie!ts $ith the abo#e 'eatures, o! post.mortem e1ami!atio!, sho$ loss o' the dar+, pi(me!ted !euro!s 6!er#e cells7 i! t$o areas o' the brai!& the substa!tia !i(ra 6lati! 'or 2blac+ substa!ce27 a!d the locus ceruleus 62blue substa!ce27. ,he dead a!d dyi!( cells co!tai! *e$y bodies. =hile *e$y bodies are 'ou!d i! other diseases, the dia(!osis o' idiopathic - ca! o!ly be made $ith certai!ty i' *e$y bodies are 'ou!d i! the substa!tia !i(ra a!d locus ceruleus a'ter death. -aralleli!( the loss o' !er#e cells i! the substa!tia !i(ra is the loss o' dopami!e, a chemical $hich carries messa(es 'rom o!e !er#e cell to a!other. ,he loss o' dopami!e is most mar+ed i! that part o' the brai! called the striatum 6or 2stripped substa!ce27. ,he striatum co!sists o' t$o parts& ,he caudate !ucleus a!d the putame!. -rimary treatme!t o' - co!sists o' (i#i!( le#odopa 6i! the U.%. #ia %i!emet or a (e!eric 'orm thereo'7, $hich is co!#erted to dopami!e i! the substa!tia !i(ra a!d the striatum, a!d replaces the missi!( dopami!e. -atie!ts $ith idiopathic - usually respo!d $ell to le#odopa. 8! 'act, a success'ul respo!se to le#odopa co!'irms the cli!ical dia(!osis o' - . =he! early i! the disease there is a mi1ture o' the mai! 'eatures $ith other symptoms< $he! the course o' the disease is rapid $ith mar+ed disability occurri!( $ithi! 'i#e years< or $he! there is !o respo!se to le#odopa, the co!ditio! is called -ar+i!so! isease -lus 6- X7. ,he term 2- X2 e!compasses a !umber o' disorders i!cludi!( -ro(ressi#e %upra!uclear -alsy 6-%-7, "ortico.Basilar e(e!eratio! 6"B 7 a!d Multi%ystem Atrophy 6M%A7. Multi%ystem Atrophy i!cludes the %hy. ra(er %y!drome 6% %7, %triato!i(ral e(e!eratio! 6%5 7 a!d 4li#o-o!to"erebellar Atrophy 64-"A7. ,he - X disorders di''er 'rom idiopathic - i! that, althou(h there is a loss o' !er#e cells i! the substa!tia !i(ra, the mai! cha!(es occur else$here. ,hou(h symptoms may resemble - , *e$y bodies are !ot 'ou!d i! these disorders.

,here are also a !umber o' disorders $ith par+i!so!ia! 'eatures 'or $hich the cause is +!o$! a!d $hich ha#e a #ariable rate o' pro(ressio! a!d respo!se to le#odopa. ,hese disorders are re'erred to as -ar+i!so! %y!drome 6-%7 a!d i!clude multiple small stro+es a!d poiso!i!( by ma!(a!ese, carbo! mo!o1ide a!d cya!ide. -% also i!cludes pu(ilistic par+i!so!ism, a disorder o' pro'essio!al bo1ers $ho recei#e multiple blo$s to the head a!d i! $hom symptoms pro(ress e#e! a'ter they stop 'i(hti!(. -u(ilistic par+i!so!ism a''ected Jac+ empsey, Joe *e$is a!d, more rece!tly, Muhammad Ali. 8! additio! to the abo#e disorders, $hich are perma!e!t, there are se#eral dru( i!duced -ar+i!so! disorders that are re#ersible o! stoppi!( the dru(. ru(s that cause -% i!clude tra!)uili:ers such as chlorproma:i!e 6,hora:i!e7, 'luphe!.:i!e 6-roli1i!7 a!d haloperidol 6Haldol7. 8! additio!, dru(s such as metochlopramide 6Re(la!7 a!d prochlorpera:i!e 6"ompa:i!e7, used to treat !ausea but similar to the tra!)uili:ers, may also cause -%. ,hese dru(.i!duced disorders are !ot associated $ith a loss o' !er#e cells i! the substa!tia !i(ra a!d di''er 'rom the perma!e!t -% associated $ith the !er#e to1i! M-,- $hich does result i! loss o' !er#e cells i! the substa!tia !i(ra.

Dia&nosis ,he dia(!osis o' - is based o! 'i!di!( a combi!atio! o' ri(idity, tremor, slo$!ess o' mo#eme!t a!d lac+ o' bala!ce. ,he patie!t is o'te! brou(ht to the physicia! by the spouse a!d may !ot e#e! be a$are o' a!y symptoms. ,he patie!t's lac+ o' a$are!ess may represe!t de!ial or a real i!ability to percei#e the physical symptoms or depressio!. "omputed tomo(raphy 6",7 or ma(!etic ima(i!( 6MR87 are use'ul i! e1cludi!( other causes o' symptoms such as tumors or multiple small stro+es. MR8 is especially use'ul i! e1cludi!( shri!+a(e o' the brai!stem a!d cerebellum, co!ditio!s that may be associated $ith some o' the - X disorders.

P ima y .eatu es =hile seldom the mai! symptom, ri(idity is o!e o' the 'our primary symptoms a!d is e1perie!ced as a sti''!ess o' the limbs. 8! - , ri(idity is (reater i! the limbs $hereas i! - X, ri(idity is (reater i! the !ec+ a!d tru!+. ,remor, at rest, is usually the earliest a!d most promi!e!t symptom o' - , a!d is prese!t i! appro1imately B0M o' patie!ts. 8t is usually the symptom that bri!(s the patie!t to the doctor. -atie!ts $ith tremor usually ha#e a lo!(er a!d more 2be!i(!2 course tha! patie!ts $ithout tremor. ,he tremor, i!itially, ca! i!#ol#e o!e side more tha! the other a!d the ha!ds more tha! the 'eet. ,he tremor is usually prese!t $he! the limbs are resti!(< $he! the patie!t is seated $ith his?her ha!d supported or $he! the patie!t is $al+i!(

$ith ha!ds ha!(i!( loosely. ,he tremor usually stops $he! the muscles are acti#ated. 3or some patie!ts, the tremor may be more promi!e!t $he! mai!tai!i!( a posture 6postural tremor7. 4ccasio!ally the tremor may i!crease duri!( mo#eme!t 6+i!etic tremor7 or the tremor may be promi!e!t duri!( $riti!( 6$riti!( tremor7. -ostural or +i!etic tremor are more commo! i! 0sse!tial ,remor 60,7 tha! i! - . %e#eral types o' tremor ca! coe1ist i! - i!cludi!( resti!(, postural, +i!etic a!d $riti!( tremor. Brady+i!esia is the most disabli!( symptom o' - . Brady+i!esia i!cludes slo$!ess a!d loss o' mo#eme!t, delays i! starti!( to mo#e, 're)ue!t stoppa(es o' mo#eme!t, 'ati(ue a!d i!ability to per'orm t$o mo#eme!ts at o!ce, e.(. s$i!(i!( the arms $hile $al+i!(. ,he - patie!t $ho is brady+i!etic di''ers 'rom the patie!t $ho is $ea+ or paraly:ed. =ea+!ess or paralysis is a! i!ability to mo#e because o' a lac+ o' po$er. ,he - patie!t has e!ou(h po$er to mo#e, but ca!!ot mo#e rapidly. -ostural i!stability results 'rom impairme!t o' the bala!ce re'le1es that are respo!sible 'or correcti!( e)uilibrium i! respo!se to positio!al cha!(es. 8! - , as a result o' postural i!stability, patie!ts 'all easily. -ostural i!stability may be e1perie!ced $he! a patie!t attempts to tur! or e!ter a door$ay. ,he disturba!ce i! $al+i!( i! - is characteri:ed by short steps a!d results 'rom a combi!atio! o' ri(idity, brady+i!esia a!d postural i!stability. "lic+ here 'or %ymptoms o' -ar+i!so!'s.

Seconda y .eatu es %eco!dary 'eatures may !ot be disabli!( a!d occur i! less tha! @0M o' patie!ts. Ho$e#er, seco!dary 'eatures li+e speech a!d s$allo$i!( di''iculty ca! become disabli!(. eme!tia, characteri:ed by disorie!tatio!, co!'usio! a!d memory loss, occurs i! appro1imately ;0M o' patie!ts $ith - . 8ts pre#ale!ce i!creases $ith a(e a!d may be related to Al:heimer isease 6A 7. ,he deme!tia o' may be a((ra#ated by treatme!t $ith le#odopa a!d other dru(s, especially a!ticholi!er(ic a!d ama!tadi!e. ,he psychiatric side e''ects o' a!tipar+i!so! dru(s i!clude a! e1cited, co!'usio!al state $ith delusio!s or halluci!atio!s. epressio! is 're)ue!t i! - , occurri!( i! @0 to B@M o' all patie!ts. 8! @0M o' these patie!ts, the depressio! is se#ere e!ou(h to re)uire psycholo(ical co!sultatio! or treatme!t $ith a!tidepressa!t dru(s. epressio!, i! - , may be either a reactio! to ha#i!( a chro!ic ill!ess or it may be caused by a chemical imbala!ce. %upporti!( the idea that depressio! is a chemical imbala!ce are obser#atio!s that depressio! may precede the other symptoms a!d that there may be !o relatio!ship bet$ee! the se#erity o' the depressio! a!d the se#erity o' - .

3acial mas+i!( results 'rom a combi!atio! o' brady+i!esia a!d ri(idity o' the 'acial muscles. isappeara!ce o' 'acial mas+i!( may be the earliest si(! o' success'ul treatme!t. %peech di''iculty may i!clude a decrease i! #olume, a te!de!cy 'or $ords to ru! to(ether a!d slurri!(. ,he speech di''iculty may #ary 'rom sli(ht to mar+ed. %ome de(ree o' s$allo$i!( di''iculty is prese!t i! ma!y patie!ts, but se#ere s$allo$i!( di''iculty is u!commo!, thou(h it may occur i! late - . %peech a!d s$allo$i!( di''iculties result 'rom a combi!atio! o' ri(idity a!d brady+i!esia i! the muscles o' the throat a!d mouth. 4ther seco!dary symptoms i!clude& rooli!( a!d oily s+i! are commo! symptoms but are !ot disabli!(. i::i!ess, i! - , is related to a drop i! blood pressure o! sta!di!( a!d may be a((ra#ated by le#odopa a!d dopami!e a(o!ists. %hort!ess o' breath results 'rom a combi!atio! o' chest $all ri(idity a!d ab!ormal, dru(.i!duced muscle mo#eme!t. Uri!ary problems occur i! - , usually ta+i!( the 'orm o' ur(e!cy. 8! elderly me!, such ur(e!cy is more li+ely to result 'rom a! e!lar(ed prostate. "o!stipatio!, a commo! symptom i! the elderly, is 're)ue!t i! - a!d may be $orse!ed by dru(s, especially a!ticholi!er(ic a!d ama!tadi!e. 8mpote!ce, a!other commo! symptom o' the elderly, is also 're)ue!t i! - . %ymptoms o' bur!i!( or cold se!satio!s, muscle cramps a!d Eoi!t pai!s also occur i! - . ,he (old sta!dard 'or co!'irmi!( the dia(!osis o' idiopathic - is 'i!di!( *e$y bodies i! the !er#e cells o' the substa!tia !i(ra a'ter death. Appro1imately B@M o' patie!ts $ho are dia(!osed $ith - are 'ou!d, a'ter death, to ha#e *e$y bodies. ,he i!#erse o' the abo#e is that 2@M o' patie!ts $ho are dia(!osed as ha#i!( typical - are 'ou!d, a'ter death, !ot to ha#e *e$y bodies. ,his mea!s that althou(h *e$y bodies are, at prese!t, the best mar+ers 'or - , their prese!ce 6or abse!ce7 is still !ot co!clusi#e. At least A0M o' the !er#e cells i! the substa!tia !i(ra a!d 90M o' the dopami!e i! the striatum must be lost be'ore the 'irst symptoms o' appear. ,his i!dicates that the process o' - , as disti!ct 'rom the reco(!i:ed disease, is o!.(oi!( 'or ma!y years be'ore it is dia(!osed. ,he idea that there are a lar(e !umber o' seemi!(ly 2!ormal2 people $ho ha#e - a!d $ho may, i' they li#e lo!( e!ou(h, de#elop - symptoms, challe!(es physicia!s to de#elop methods 'or ide!ti'yi!( these people so that treatme!t to slo$ pro(ressio!, $ith dru(s such as sele(ili!e 60ldepryl7, ca! start be'ore - becomes ob#ious. "lic+ here 'or seco!dary symptoms.

Cause

Research o! the cause o' - ce!ters o! $hy the !er#e cells i! the substa!tia !i(ra a!d locus ceruleus die early $hile !er#e cells i! other areas are !ot a''ected. ,he prese!ce o' pi(me!t 6!euromela!i!7 i! these !er#e cells may pro#ide clues si!ce the pi(me!t i! these cells is deri#ed 'rom dopami!e. A! u!reco(!i:ed e!#iro!me!tal to1i! 6similar to M-,-7 or a (e!etic de'ect may accelerate the loss o' pi(me!t. As !er#e cells die throu(hout the course o' - , ide!ti'yi!( the cause a!d halti!( the pro(ress is a research priority. Gi#e! ho$ commo! - is a!d ho$ easily it ca! be reco(!i:ed, it is surprisi!( that the 'irst descriptio! o' - $as i! 191B. ,his su((ests that it may be related to a! e!#iro!me!tal to1i!, a product o' the i!dustrial re#olutio!. 8' e!#iro!me!tal to1i!s are respo!sible 'or - there should be #ariatio!s i! the occurre!ce o' - i! di''ere!t areas o' the $orld. ,he occurre!ce o' - is similar i! most =ester! cou!tries, but less i! the Mediterra!ea! cou!tries, Japa! a!d "hi!a. Althou(h there are !o (eo(raphical clusters that $ould u!e)ui#ocally establish a! e!#iro!me!tal cause, there is e!ou(h supporti#e data to e!coura(e the co!ti!uatio! o' e!#iro!me!tal studies. 4!e obser#atio! li!+i!( e!#iro!me!tal to1i!s to - is a lo$er i!cide!ce o' ci(arette smo+ers amo!( - patie!ts. ,his su((ests there may be a substa!ce i! ci(arette smo+e that protects a(ai!st a! e!#iro!me!tal to1i!. A!other obser#atio! li!+i!( e!#iro!me!tal to1i!s to - is the hi(her occurre!ce o' - i! rural areas, $here more herbicides a!d pesticides are used tha! i! urba! areas. 8' - is i!herited, such a te!de!cy mi(ht be re#ealed i! studies o' t$i!s. 8! a study o' >; pairs o' ide!tical t$i!s a!d 19 pairs o' !o!.ide!tical t$i!s, i! $hich o!e o' the t$i!s had - , it $as 'ou!d that i! o!ly o!e ide!tical t$i! pair did both t$i!s ha#e - . ,hus, the 're)ue!cy o' - i! ide!tical t$i!s $as similar to $hat $ould be e1pected by cha!ce alo!e. 4ther studies also 'ailed to re#eal a! i!creased occurre!ce o' - i! 'amilies. 3or a lo!( time, the!, it $as belie#ed that $hate#er the role o' (e!etics $as, it $as subtle. Rece!tly, appreciati!( that there may be a lo!( delay i! the appeara!ce o' the symptoms o' - , a!d usi!( tech!i)ues such as positro! emissio! tomo(raphy 6-0,7 to detect - be'ore it ca! be reco(!i:ed by a physicia!, the assumptio! that - is !ot i!herited is bei!( )uestio!ed. =hile the e1act role o' (e!etics is u!+!o$!, it is more importa!t tha! pre#iously suspected. ,he maEor 'i!di!( li!+i!( - to e!#iro!me!tal to1i!s is the ide!ti'icatio! o' the chemical M-,- as a cause o' a perma!e!t disorder similar to - . ,he role o' M-,- sur'aced i! 19BB, $he! par+i!so!ism de#eloped i! a you!( ma!. Althou(h !o cause 'or the disease could be 'ou!d, dru(s $ere suspected. ,he patie!t committed suicide a!d his autopsy re#ealed loss o' !er#e cells i! the substa!tia !i(ra. %ubse)ue!tly, r. =illiam *a!(sto! ide!ti'ied se#eral patie!ts $ith par+i!so!ism $ho had also bee! usi!( dru(s that co!tai!ed M-,-. ,his obser#atio!, a!d subse)ue!t obser#atio!s by *a!(sto! a!d Bur!s that M-,- caused par+i!so!ism i! mo!+eys,

re#olutio!ed thi!+i!( about - . =hether M-,- or similar compou!ds play a role i! causi!( - is !ot +!o$!. ,he study o' M-,-, ho$e#er, has led to !e$ i!si(hts i!to - a!d i! 'ormulati!( strate(ies 'or halti!( its pro(ress. ,he #irus that caused e!cephalitis 6sleepi!( sic+!ess7 also caused symptoms resembli!( - . ,his disorder is described i! the boo+ a!d mo#ie by 4li#er %ac+s& 2A$a+e!i!(s.2 ,he par+i!so!ia! symptoms caused by the #irus appeared, i! some, duri!( the actual epidemic 61919 to 192A7 $hile 'or others, symptoms appeared se#eral years later& -ost e!cephalitic par+i!so!ism. ,he #iral disease pro(ressed more slo$ly tha! - . 8! the substa!tia !i(ra, there $as (reater loss o' !er#e cells, but $ithout *e$y bodies. Althou(h other #iruses ca!, thou(h rarely, cause par+i!so!ism, ma!y studies ha#e 'ailed to re#eal a #irus as the cause o' idiopathic - . -ro'essio!al bo1ers $ho recei#e multiple, se#ere blo$s to the brai! may de#elop a -ar+i!so! %y!drome that is pro(ressi#e. %e#ere head i!Euries $ith prolo!(ed coma ca! result i! a #ariety o' mo#eme!t disorders i!cludi!( -ar+i!so!'s %y!drome. ,he mea! a(e o' o!set o' - is A0 years. ,hus, thou(h !ot applicable to you!(.o!set patie!ts, a(e.related cha!(es may be importa!t i! loo+i!( 'or the cause o' - , i!cludi!(& A(e.related losses o' !er#e cells a!d pi(me!t i! the substa!tia !i(ra that pea+ at a(e A0. %i!ce the pi(me!t may protect the dopami!e co!tai!i!( !er#e cells 'rom the e''ects o' M-,-, to1i!s or 'ree radicals, the loss o' pi(me!t may predispose the brai! o' older people to - . A(e.related loss o' dopami!e i! the striatum. Althou(h the distributio! o' the a(e.related dopami!e loss i! the striatum is di''ere!t 'rom the loss i! - , the a(e.related dopami!e loss, coupled $ith the disease.related dopami!e loss, may ma+e the older brai! more #ul!erable to - . A(e.related i!crease i! the amou!t o' the e!:yme MA4.B. ,he i!crease i! brai! MA4.B may promote the 'ormatio! o' to1ic 'ree radicals. A(e.related i!crease o' brai! iro! a!d a! e#e! (reater i!crease o' iro! i! - . Brai! iro! is u!detectable at birth, (radually i!creasi!( throu(h the 'irst three decades a!d co!ce!trati!( i! the substa!tia !i(ra a!d (lobus pallidus. Brai! iro! remai!s stable u!til the si1th or se#e!th decade $he! there is a 'urther i!crease, particularly i! the striatum. 8ro! is absorbed throu(h the (ut a!d tra!sported i!to the brai! by a protei! called tra!s'erri!. 8ro! is stored $ithi! the support cells 6(lia7, $here it is bou!d to a!other protei!, 'erriti!. =he! iro! is bou!d to protei! it is harmless. =he! iro! is !ot bou!d it is reacti#e a!d promotes the 'ormatio! o' 'ree radicals. %e#eral reports i!dicate that the i!creased iro! i! - is 'ree. Althou(h there is e#ide!ce that the i!creased iro! has a role i! - it is possible that the i!creased iro! i! is a seco!dary phe!ome!o!.

Diso de s Simila to PD ,here are se#eral disorders $hich, at o!e time or a!other i! their course, may be mista+e! 'or - . ,hese disorders may be(i! di''ere!tly 'rom - , pro(ress more rapidly a!d respo!d poorly or !ot at all to le#odopa. ,remor at rest is usually !ot part o' these disorders. %ome o' these disorders, especially the - X disorders, may be disti!(uished 'rom - by the prese!ce o' i!creased iro! i! the striatum o! MR8. =hile it is probable that these disorders $ill be sho$! to ha#e causes di''ere!t 'rom - , it is co!cei#able that, ultimately, they may be sho$! to ha#e the same cause. P o& essive Sup anuclea Palsy 7PSP8 -%- be(i!s at about the same time as - . 8t is o!e o' the more commo! - X sy!dromes, $ith a! occurre!ce appro1imately 1M o' - . -%pro(resses more rapidly tha! - $ith disability occurri!( a'ter ; to 10 years. -%- be(i!s $ith 'alls, eye mo#eme!t ab!ormalities a!d slurred speech. ,remor is usually abse!t. "lic+ here 'or more i!'ormatio!. +ultisystem "t op(y 7+S"8 ,here are se#eral disorders $hich, $he! $ell de#eloped, are easily disti!(uishable 'rom - . ,hese disorders are called Multisystem Atrophy 6M%A7 because, u!li+e i! - , more tha! o!e system de(e!erates. ,he %hy. ra(er %y!drome, %triato.5i(ral e(e!eratio! a!d 4li#o-o!to"erebellar Atrophy are o'te! (rouped u!der Multisystem Atrophy. S(y-D a&e Synd ome ,he mai! 'eature o' the %hy. ra(er %y!drome is di::i!ess o! sta!di!(, $ith a! occasio!al patie!t actually blac+i!( out. ,his results 'rom a drop i! blood pressure o! sta!di!( a!d re'lects a loss o' to!e o' the blood #essels that re(ulate blood pressure. Ma!y patie!ts $ith - e1perie!ce di::i!ess o! sta!di!(, but it is !ot as se#ere as i! the %hy. ra(er %y!drome. ,he %hy. ra(er %y!drome is much less commo! tha! - . 8t appears at appro1imately the same a(e but pro(resses more rapidly. St iatoni& al De&ene ation 7S,D8 %5 is the disorder most commo!ly mista+e! 'or - . %5 is characteri:ed by ri(idity, brady+i!esia a!d impaired bala!ce, but there is rarely a tremor. -atie!ts $ill respo!d poorly to le#odopa. -livoPontoCe e'ella "t op(y 7-PC"8 4-"A ide!ti'ies a (roup o' disorders $hose commo! 'actor is a loss o' !er#e cells i! the brai!stem a!d cerebellum. ,here are i!herited a!d !o!.i!herited 4-"A%. isease o!set ra!(es 'rom u!der 1 year i! 'amilial 4-"A to B0 years i! !o!.'amilial 4-"A. ,he course is #ery slo$ 'or 'amilial 4-"A, but more rapid 'or !o!.'amilial 4-"A. Essential T emo 7ET8

0, is usually a disorder o' the elderly but it may be(i! at a!y a(e. 8t is slo$ly pro(ressi#e a!d ca! usually be disti!(uished 'rom - 'airly easily. 0, may i!#ol#e the head, #oice a!d ha!ds, but usually spares the le(s. 8t is usually e)ual o! both sides o' the body a!d disappears $he! the limbs are rela1ed, the opposite o' the tremor i! - . 0, may i!crease duri!( speci'ic acti#ities such as $riti!(, dri!+i!( a!d eati!(. 0, is i!herited i! ;0 to @0M o' patie!ts. ,he relatio!ship o' 0, to - is u!clear. %ome - patie!ts, i!itially, may be dia(!osed $ith 0,. =ithi! 2 to @ years other - 'eatures usually appear. "lic+ here 'or more i!'ormatio! o! ,remor. Dystonia ysto!ia re'ers to either a sustai!ed repetiti#e mo#eme!t, that may be slo$ or rapid, or a sustai!ed posture. ysto!ia may occur as a separate disease e!tity i! $hich it ca! be (e!erali:ed, se(me!tal or 'ocal, or it may occur as a symptom o' a!other disease such as - . 3ocal dysto!ia a''ects a si!(le body part a!d i!cludes blepharospasm 6eyelid muscle spasm7 a!d crampi!( o' the ha!ds or 'eet. 3oot crampi!( may, i! you!( people, occur as the 'irst symptom o' - or may occur duri!( le#odopa treatme!t. ,he i!te!sity o' dysto!ia ca! be i!'lue!ced by acti#ities such as $al+i!(, ru!!i!(, tal+i!( or cha!(i!( positio!. D u& Induced +ovement Diso de s %ome dru(s are especially li+ely to cause mo#eme!t disorders. ,hese i!clude dru(s that a''ect the dopami!e system, i!cludi!( stimula!ts such as amphetami!e, methylphe!idate 6Ritali!7 a!d cocai!e< dru(s that mimic le#odopa such as bromocripti!e a!d per(olide< a!d dopami!e bloc+ers, or !euro.leptics, such as phe!othia:i!es& ,hora:i!e, %tella:i!e a!d "ompa:i!e. Also li+ely to cause mo#eme!t disorders are the butyrophe!o!es& Haldol a!d the a!ti!ausea dru( metoclopramide 6Re(la!7. %timula!t dru(s a!d le#odopa ca! cause dys+i!esias. *e#odopa related dys+i!esias parallel the se#erity o' the u!derlyi!( - a!d the amou!t a!d duratio! o' le#odopa treatme!t. ys+i!esias are less li+ely to occur $ith dopa.mi!e a(o!ists. ,remor may be caused or a((ra#ated by ma!y dru(s i!cludi!( steroids, a!ti.asthma dru(s, ca''ei!e, lithium, !icoti!e, thyroid hormo!es, certai! a!ti.depressa!t dru(s a!d a!tico!#ulsa!t dru(s such as #alproic acid 6 epa+oate7. Alcohol may both lesse! a!d a((ra#ate tremors.
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