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235 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 in people with severe depression that is refractory to other medications because you want to see if a different area of the brain is involved because that might eventually lead to new drugs but it is not going to benefit that particular patient and the test, which is getting a fancy x-ray, may scare them. It is hard for me to imagine how you do that research if you say it is only going to be on people who have given a research advance directive or whatever you call it. Realistically we are not going to do that research. If we are willing to say that we do not care, we are not going to do that research and accept the downstream consequences that is okay. But I think to say that, you know, we can make this -- I mean, I would like to believe we can make it happen because we are going to be committed, we are going to realize it is important and we are going to mobilize the activists, I am not sure it is going to happen. MR. CAPRON: Would you be of the view that Eric expressed that the statement you have just made is an empirical statement that ought to at least be studied before we reach the conclusion negative to the use of the directives? In other words, if you are saying that this is a requirement which is a veiled way of stopping all
236 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 research not of benefit, that is a disturbing claim. I am not convinced of it. DR. EMANUEL: I think that has to be the presumption, Alex, given the history and the burden -- I agree with you. We need to have empirical studies. It is an issue of fact. It is an issue of fact but the history of the use of advance directives has to suggest to you that it is unlikely and that the burden of proof is, you know, quite -- MR. CAPRON: I mean, because in most states you do not need an advance directive to get appropriate end of life care and if you do not get appropriate end of life care it is for reasons other than the fact that you do not have an advance directive. DR. LO: Alex, wait. New York is a state and Missouri is a state where that is -- legally you need an advance directive to get life sustaining treatment withheld or withdrawn generally. MR. CAPRON: No, you do not. You need clear and convincing evidence of your views which does not include an advance directive. DR. LO: Okay. But most people do not -- (Simultaneous discussion.) DR. LO: Most people --
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<strong>in</strong> people with severe depression that is refractory to<br />
other medications because you want to see if a different<br />
area of the bra<strong>in</strong> is <strong>in</strong>volved because that might eventually<br />
lead to new drugs but it is not go<strong>in</strong>g to benefit that<br />
particular patient and the test, which is gett<strong>in</strong>g a fancy<br />
x-ray, may scare them.<br />
It is hard for me to imag<strong>in</strong>e how you do that<br />
research if you say it is only go<strong>in</strong>g to be on people who<br />
have given a research advance directive or whatever you<br />
call it. Realistically we are not go<strong>in</strong>g to do that<br />
research. If we are will<strong>in</strong>g to say that we do not care, we<br />
are not go<strong>in</strong>g to do that research and accept the downstream<br />
consequences that is okay. But I th<strong>in</strong>k to say that, you<br />
know, we can make this -- I mean, I would like to believe<br />
we can make it happen because we are go<strong>in</strong>g to be committed,<br />
we are go<strong>in</strong>g to realize it is important and we are go<strong>in</strong>g to<br />
mobilize the activists, I am not sure it is go<strong>in</strong>g to<br />
happen.<br />
MR. CAPRON: Would you be of the view that Eric<br />
expressed that the statement you have just made is an<br />
empirical statement that ought to at least be studied<br />
before we reach the conclusion negative to the use of the<br />
directives? In other words, if you are say<strong>in</strong>g that this is<br />
a requirement which is a veiled way of stopp<strong>in</strong>g all