57 e-Letters

published between 2016 and 2019

  • Professional interpreters are human beings

    Interpreting and translation are unregulated activities in most countries, yet interpreters and translators perform challenging work in sensitive domains, such as medicine. Interpreters and translators rarely have access to ethical infrastructure and the function and ethical boundaries of ‘interpreting practice’ are not widely known .

    Translators or interpreters do not cease being human beings with human rights, when they enter their profession. All human beings, including interpreters, possess human rights and human freedoms. Conscientious objection is a right derived from the human right to freedom of conscience. Human beings (interpreters) are not machines; machines, when maintained, are on the whole very predictable and reliable. Interpreters like other human beings can be creative, self-aware, imaginative and flexible in their thinking.

    Limitations exist in workplaces that cannot allow for a variety of opinions, thoughts, beliefs and conscientious positions.

    Moral distress is a wide spread problem for health care providers in a range of acute and community health care settings. The understanding of moral distress may differ depending on the extent to which the problem is located in individual and/or systemic /structural factors. Healthcare staff members (as human beings) react in various ways when ethically/morally challenged: they may withdraw from ethically challenging situations; change their position; and/or continue to raise object...

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  • Healthcare staff wanted. No one with a conscientious objection need apply?

    Help wanted. No Irish need apply.


    Are we to expect the following?

    Healthcare staff wanted. No one with a conscientious objection need apply.

  • Reflection

    While I must agree the analogy of the siamese twins do provide a better understanding of some of the issues dealt with by Thomson there is one fatal law not addressed with this analogy. In law of evidence it must always be considered whether the probative value of evidence outweighs the possible prejudice using said evidence could hold. Applying that to this scenario it can be argued that the person attached to the unconscious violinist has an understanding a a frame of reference to what life was like before the incident, what life is like during the attachment and what life could be like after attachment. There is thus a clear understanding of what is being sacrificed and the changes forward this will have. The same can be said for a pregnant woman contemplating abortion. She knows what life was life before pregnancy what life is like during pregnancy and what changes to except after the birth of the child, thus enabling her to make an informed decision. The same can however not be said for the siamese twins as Elizabeth has no framework to base the standard of her life on. Elizabeth only knows what life is like attached to Catherine as she has never been independent of her. Elizabeth can thus not make an informed decision as she has no idea what life will be like without Catherine (she could become depressed for the loss of a loved one she has known her entire life, or she could end up regretting her decision much later on in life when it is too late [if a woman gets an...

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  • 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...

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  • 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...

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


    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...

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  • 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...

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