eLetters

403 e-Letters

  • Briggs versus Briggs [2016] EWCOP 53: The clash of the ‘sanctity of life’ and the ‘third- party determination’ of the best interests

    To The Editor

    Kitzinger et al argued in favor of applying “the ‘holistic’ approach outlined in the Briggs judgment” to ascertain, in Court and ‘on the floor’, what in accordance with the Mental Capacity Act 2005 (MCA) ought to be considered a patient’s best-interest assessment.[1] In Briggs versus Briggs [2016] EWCOP 53 , “all parties were required to address the question of [Paul Briggs’s] ‘best interests rather than seeking to apply the standard of ‘substituted judgment’.”[2] Authors correctly pointed out that the MCA mandates, next to consideration of a person’s past and present wishes and feelings, values and beliefs, the inclusion of other relevant circumstances, i.e., diagnosis, prognosis and ‘sanctity of life’. Kitzinger et al postulated that this holistic approach to the best interest standard not only should be the preferred pathway over that of the ‘substituted judgment’ standard, but, if widely accepted, would make a positive contribution to “the texture and quality of best-interest decision making about these patients [with disorders of consciousness] ‘on the ground’”.[1] They further highlighted the significance of the Briggs judgment because of “the great weight [Mr Justice] Charles J gave the person’s own views, even when set against ‘sanctity of life’.”

    There are theoretical and practical problems with Kitzinger et al’s position.

    First, it is incorrect to describe the Briggs case as the clash of ‘sanctity of life’ and ‘self-determinat...

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  • Care or Kill?

    Rivera Lopez in his astounding article [1] proposes the duty to kill and is happy not to consider the counter arguments, but just follow his line of thought!!
    He is among those prepared to cross the line of taking a life or at least consider such acts in theory. His view demonstrates a very restricted outlook on life, seeing nothing beyond the concrete. It seems a bit drastic or simplistic to get rid of problems by getting rid of the people who have them. If treatment or life itself is burdensome, it can be lightened in many more caring ways. As a GP, I see what a dying person can give to others and the intangible benefits of suffering; in bringing of the family together, acknowledging the heartbreak and drawing out good in others by accompanying and self-giving. I have also seen destruction of the joy in a family by suicide and the feeling of failure among those left behind. Human dignity is found in being supported and loved, not being killed.
    Another consideration is that we do not know how those who cross the line will bear up psychologically after many years of this justified killing. Doctors in Ontario, where euthanasia has been permitted by law last year, are backing out as they find that they “go through one experience and it’s just overwhelming, it’s too difficult, and those are the ones who say, ‘take my name off the list. I can’t do any more.’ ” [2] Are we prepared to risk making killing part of the medical practice and wait to see the damage?

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  • Is it conscientious objection at all?

    This is a thought provoking paper but I wonder if it is founded on a false premise. It strikes me that a conscientious objection only applies if the surgeon has an obligation to undertake a cosmetic surgery procedure. If there is no obligation they are simply declining to carry out the procedure. Presumably this may be because the surgeon decides the procedure is not in the best interests of the patient. Since the surgeon is primarily an expert in physical, bodily function they should base their judgement of best interest on those grounds. Of course, if this reasoning is sound, fewer cosmetic procedures should perhaps be performed than currently are.

  • The Rights of Terrible People
    susanne stevens

    There are surely situations where responses of disgust and other reactions to extreme violence must be respected. How much they effect the justice system as well as the medical professionals' ability to act strictly according to laws and ethical guidelines is probably difficult to investigate. The case of Peter Sutcliffe - a violent mass murderer in UK is not quite the same scenario as the article describes but it is...

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  • Prostitution is not justified by sexual "needs": an alternative to full legalisation
    Nathan Hodson

    Earp and Moen demonstrate the absence of a relevant difference between the use of prostitutes by disabled people and by shy, ugly, libidinous, able-bodied people, and the impossibility of circumscribing the latter[1]. This is incorporated into a case for the full legalisation of prostitution based on: (a) the absence of a justification for its prohibition; and (b) the "needs" it meets. We posit that (b) misrepresents pro...

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  • Kissing Paediatric Patients
    P K Coulson-Smith

    From the beginnings of our lives as doctors, we are taught about professionalism. Professionalism encourages and enables doctors to maintain focus on the patient's needs and treatment.

    Kissing a child oversteps the boundary of professionalism. Such contact shifts thinking from the patient to the professional and meets the professional's emotional needs rather than the patient's.

    Physical contact with p...

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  • Medical aid in dying in Quebec and Canada: facts matter
    Michele Marchand

    As an active participant in the debate that took place in the province of Quebec concerning medical aid in dying (MAID), I would like to take the liberty of commenting on an article by Udo Shuklenk published recently in your journal: "Canada on course to introduce permissive assisted dying regime". In my view, some of the factual information given in this text needs more precision.

    First of all, the chronology...

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  • Response to Holland
    Derick T. Wade
    Dear Sir, I thank Dr Holland for his commentary [1] on my article [2]. I am replying to correct a possible misunderstanding he may have about the brain in people with prolonged disorders of consciousness.

    He argues that there are people who are definitely permanently unaware without fluctuation because they have no brain, citing "Tony Bland, whose higher brain had effectively liquefied'". I assume that he bases this statemen...

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  • Proposed FGM 'compromise' illuminates medical complicity with non-therapeutic fee-paying surgery on infants
    Susan Bewley

    The JME's peer reviewers failed to press the clinical issues before publication of this flawed paper(1). The unoriginal idea of a 'ritual nick' performed by health professionals in a harm limitation approach to female genital mutilation (FGM) was proposed by the American Academy of Pediatrics back in 2010(2), who rapidly replaced their statement(3) in the face of worldwide condemnation(4) by the World Health Organisation...

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  • Ethical Discrimination?
    susanne stevens

    A properly worded consent form must make risks transparent but if the person has not even been asked to participate, discrimination is too easily slipping in. Even giving the reason as duty of care can be mis/used to eliminate some people - but their participation may be valuable as well as ethical. There can be an unconscious bias to avoid difficulties for researchers but discrimination will miss opportunities for the...

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