eLetters

432 e-Letters

  • The real danger lies with doctors acting in a way that is not in the best interest of the patient

    Dr Anthony-Pillai is wrong to argue that the BMA and Royal College of Physicians’ guidance on decisions about clinically-assisted nutrition and hydration (CANH) is dangerous in overlooking the symptomatic benefit that CANH can provide.

    Our guidance, which was developed over a period of 18 months, in conjunction with a range of medical, legal, and ethical experts, is professional guidance, setting out the process that needs to be followed in order to comply with the law and good practice. We are clear that the guidance should be read in conjunction with the most up-to-date clinical guidelines when reaching a decision, and that any significant divergence from established practice must be justified. It is the clinical guidance which is the most appropriate home for discussion on assessing and responding to symptomatic distress. For patients who are in a prolonged disorder of consciousness (PDOC), this will be the clinical guidelines on PDOC from the Royal College of Physicians – who were the joint authors of our guidance. (These guidelines are currently under review by the RCP’s PDOC guideline development group following recent changes to the law. The updated version is expected to be published in early 2020.)

    We do not, as Dr Anthony-Pillai suggests, only “implicitly acknowledge” that CANH can provide symptomatic benefit. We explicitly state at the outset, in determining the scope of the guidance, that “clinical benefit” encapsulates not just prolonging some...

    Show More
  • Keep it Simple: Conscientious Objection

    It is possible to over think and over analyse the issue of conscientious objection (CO).
    CO is a right derived from the human right to Freedom of Conscience, religion and belief.

    Human rights are personal.
    They belong to each individual person.

    It is not possible to be impersonal or impartial when one's human rights are threatened.

    Human rights are invisible when they are respected.
    When they are denied they become visible.

    The Health (Regulation of Termination of Pregnancy )Act 2018 in Ireland has excluded me and other
    healthcare workers from our human right to Freedom of Conscience and the derivate right of CO.
    Doctors and nurses (and their students and trainees) in Ireland are the only healthcare workers with the legal right to CO in this Act.

    I am an Irish pharmacist.
    I value my human rights.
    Freedom of conscience is my right as a human being.
    CO is my right as a human being.

    This is personal.
    This is very simple.

  • About "terminally ill"

    The article assumes that discerning a category of terminally ill persons will be done fairly readily, with some minor controversy that can be ignored. This is not the case. Most of us now will die after a long period of decline, from any of a long list of illnesses and conditions associated with aging. The mean length of self-care disability for persons who make it to 65 years old is about 2 years. We built the concept of a 6 month prognosis on the experience with certain highly fatal cancers, where the usual time from onset of a clearly fatal course to death was well under 6 months. This trajectory is not the experience of persons dying with various causes of frailty, as most of us will experience. We will know that our Parkinson's or Alzheimer's or frailty (or whatever) will worsen through to death, but the timing of the dying will depend mostly on rather random events - an infection, a fall, or some such event when we have so little resilience. Another way to look at it is to try to define the statistical meaning of a prognosis of less than 6 months. Is it 51% likely to die within 6 months, or 91%, or 99%? To many people, this sounds like a silly set of questions, but the difference in the population made "eligible" for PAD (or hospice) is more than 1000-fold at each of these thresholds. And the "error rate" at 1 or 2 years is very different for different illnesses. A person who has a 51% chance of dying within 6 months from a ne...

    Show More
  • Re: It is never lawful or ethical to withdraw life-sustaining treatment from patients with prolonged disorders of consciousness

    Abstract

    Foster considers that is it not ethically nor lawfully acceptable to withdraw life-sustaining treatment from patients with Permanent Disorder of Consciousness(1) (PDOC). Though we agree the proposition has strong grounds to be made, we conclude that stating this to be the case “under any circumstances” may be oversimplifying the issue. We look at the case of W v M 2011 where withdrawal of life-sustaining treatment was denied and compare it to the cases of Airedale NHS Trust v Bland 1993 and Briggs v Briggs 2016 in which it was deemed legal to withdraw life-sustaining treatment from PDOC patients on the grounds of best interests. We also discuss some points in which Beauchamp and Childress’s ethical principles regarding ‘non-maleficience’ and ‘respect for autonomy’ do not align with Foster’s view, such as advanced directives and treatment side effects.

    Withdrawal of life-sustaining treatment is unlawful

    Foster makes a strong argument regarding the ambiguity surrounding the issues of removing life-sustaining treatment. Cases such as W v M 2011(2) exemplify how this uncertainty has affected the legal stance on this issue. M had suffered from a non-traumatic brain injury resulting in a ‘minimally conscious state’ (MCS), with intermittent periods of awareness. Though M was still left with the ability to have joyful experiences, she also had to endure periods of significant pain. Previously, M had expressed her wishes to never be wholly dependent o...

    Show More
  • Horrifying!

    There should be legal barriers to putting a human embryo in anything but a human female, and it should be the same for the woman that supplied the egg. There should also be legal barriers to making eggs from XY people and sperm from XX people.

    Of course it’s not discrimination to forbid making embryos unethically, where there is no right to. It is a supportable basis to restrict procreation. It wouldn’t be medicine to make a transgender woman pregnant or make her eggs, that’s not healthy. It’d be commerce, and unhealthy. PS: there are no "women" with XY chromosomes (!)

  • Ethical complexities in assessing patients’ insight

    It is generally agreed in most jurisdictions that all competent patients must be fully informed about any proposed treatment, including medications, and have the absolute right to either consent to or refuse treatment. This introduces the dread word “competent” that is often mistakenly taken as being required as a demonstration of insight. It is also often assumed that a person suffering a condition such as schizophrenia is incapable of insight. The Supreme Court of Canada, in 2003, in Starson v. Swayze laid this one to rest. The appellant knew that he had schizophrenia, its nature and effects, and was appealing a decision of a lower court that he should be forcibly given antipsychotic medication on a continuing basis. He argued that he had the right to decide for himself when he should take the medication and when he could avoid it so that he could work without the thought-numbing effect of the drug. His profession required clear thinking.
    The court found for him, noting that he knew the nature of his condition and was capable i.e. competent to make these decisions for himself. He had, in other words, insight.

  • Bawa-Garba - no-one wins in this scenario

    Nathan Hodson is quite correct in his conclusions that the rulings in the awful situation of Dr Hadiza Bawa-Garba are not good news for doctors, but I am not convinced that the analysis starts in the right place. Most of the focus in the article (and almost everywhere else) is on what the GMC has done following the decision of the MPTS not to strike Dr B-G off the register, and, in general, the opinion is that the body shoud not have done what it did. In my opinion, this is the wrong place to start - questions should be asked about how a relatively routine error led to a conviction at all.

    As a lecturer in medical law and ethics, I find it strange in the extreme that a) the police felt that they should forward this to the Crown Prosecution Service (CPS) for prosecution, b) that the CPS went forward with the prosecution, and c) that the jury found Dr B-G guilty given the evidence available. Whilst the final part will remain a complete mystery because the law requires that what happens in the jury room must not be divulged, there is need to examine the decisions that led from a tragic but not remarkable incident in a hospital to a cause-celebre which has ruptured both public and professional trust in the GMC, and the law of gross negligence manslaughter. At the very least, there should be an appeal heard into Dr Bawa-Garba's convictions, but really there needs to a full and frank investigation into how this case ever got through the courtroom door. There was no...

    Show More
  • Self-centered and utterly shameful

    What a self centered world we have become, it is a shame that you cannot see the most basic principals of human life for what they really are. This is beyond the argument of abortion, this is murder. To engage in a sexual act is to take the risk of creating a child, a human, and in every sense of the word, that being is a person. Such a decision is yours to make, but should you procure a child, intended or not, wanted or unwanted, burden or no, that child is placed in your care. You can choose to give that child to another through adoption if you truly are unable, but to resort to such measures to save yourself a little possible remorse is just disgusting. Imagine the remorse knowing that you took your child, whom you will inevitably think of years down the road as the article speculates, and did not even give them the chance for life, instead, you killed them. An irreversible decision that was never yours to make. Life is precious, yet so often in this world where we in the name of "betterment of society" we choose to take advantage of the most innocent of children, and place their needs far below our wants. It is sick and shameful. Each person is of value, it is not something a parent or any other can choose to give or take away, it is inherent and a basic human right. As is life. We can make excuses to justify any action if we are twisted enough, but such things always have been and always will be wrong.

  • Irish pharmacists and conscientious objection

    In the footnote to his article Dr Finegan makes reference to the debate in Ireland over conscientious objection in the context of any legislation tabled pursuant to the abortion referendum in 2018. Dr Finegan intended his counter-arguments to apply to GPs and other healthcare professionals who he rightly states are significantly part of a public health service.

    As an Irish pharmacist I wish to draw attention to the lack of provision for conscientious objection for pharmacists in the final Health (Termination of Pregnancy) Bill 2018. In Ireland only doctors and nurses have the protection of their right to conscientious objection in the legislation. Pharmacists and other healthcare professionals are excluded.

    My human right to freedom of conscience, religion and belief is not provided for or protected in the Health (Regulation of Termination of Pregnancy) Bill 2018. Conscientious objection is a right derived from the right to freedom of conscience, religion and belief.

    There was no pre-legislative scrutiny of this Bill and the human rights implications for pharmacists and other healthcare professionals do not appear to have been considered.

    Conscientious objection is not provided explicitly in the Pharmaceutical Society of Ireland (PSI) , Code of Conduct for Pharmacists (2009). There is no mention of freedom of conscience, religion and belief and/or conscientious objection. There was no explicit mention of freedom of conscience, religi...

    Show More
  • Euthanasia - an Australian's view

    Dear Sir or Madam,

    Euthanasia? All life is terminal!

    Regarding this controversial topic you may be interested in my, Australian, views on the matter:-
    While I appreciate that the Hippocratic Oath in effect stipulates physicians should “do no harm”, this is not the end of the matter.

    To only allow (or disallow) a “terminally” ill person to decide when they wish to end their life is looking at this problem from the wrong end. It is not if they are ill, terminally or otherwise, but a person’s quality of life – their perception of that quality, which should be the main issue.

    Recall and understand that all life, repeat ALL life, is terminal – we cannot escape the end. It is terminal! Sooner or later we all die – ill or not. Palliative care, however well administered, will not halt this process. Furthermore it is impossible to accurately determine the exact time or date in the future as to when a person may die. So to stipulate a time or date (in Australia six months is suggested), sometime in the future which may determine whether or not a person is “allowed to die” is regrettable, to say the least.

    Why should anyone have to “live” according to another person’s expectations? We have no “right” to interfere. It is not our life; it is not our choice.

    We, and by “we” I include all humans, were presumably born to live in the world. Now if a human being decides, for whatever reason, that the life he or she is currently experiencing...

    Show More

Pages