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Ethics briefings
  1. Veronica English,
  2. Danielle Hamm,
  3. Caroline Harrison,
  4. Julian Sheather,
  5. Ann Sommerville
  1. BMA Ethics Department; ethics@bma.org.uk

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    South Dakota vote against abortion ban

    On 7 November 2006 voters in the South Dakota referendum rejected a state-wide abortion ban, thus repealing a law that subjected doctors to a minimum of 5 years imprisonment and a US$5000 fine if convicted of performing an abortion for any reason other than to save a women’s life.

    As mentioned in previous Ethics briefings,1 it had been widely reported that the law, approved by the State Legislative in February 2006, was a deliberate effort to provoke a direct challenge to the 1973 Roe v Wade Supreme Court Judgement and subsequently overturn a women’s constitutional right to abortion. Instead, however, opponents of the ban took to the streets to collect the requisite 16 728 signatures for a state-wide referendum.

    FINANCIAL INCENTIVES AND CONFLICTS OF INTEREST IN NHS REFORM

    NHS providers in the UK are examining controversial guidelines developed in the US to drive down the costs of individual episodes of care. Known as the ‘Milliman’ guidelines, they cover all aspects of care and treatment, ranging from whether specific treatments are appropriate, to the lengths of time patients should spend in chairs postoperatively.2 In the US, their guidelines in relation to lengths of stay in hospital have been widely criticised. Recommendations that older patients with cataracts in both eyes should only receive surgery in one and suggestions that mastectomies can be performed on an outpatient basis have been particularly controversial. Given the commitment to massively increasing the role of the private sector in the delivery of NHS care, the extent to which these guidelines will be implemented in the UK remains an open question. Under the NHS reforms in England, the government has introduced a tariff—a fixed price for specified treatments—with the intention of encouraging health care providers to deliver treatment at costs below tariff and thus to generate revenue. In the US, plans have been put forward …

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