Medical ethics

Margaret McCartney

I do love the internet: at home and also at work, where I can find things faster, often, than searching through a textbook (filing not being my strong point.)

The pros and cons of using the internet for diagnosis have been noted and an interesting recent perspective in the New England Journal of Medicine  – Untangling the Web – Patients, Doctors, and the Internet – makes the point well. Information has to be good.

Margaret McCartney

The BMJ noted the blog post  – The long arm of pharmaceuticals and PR – about generic drugs and asked for a piece on it – Generic drugs: protest group was not quite what it seemed

In case anyone is interested there is also a review - Suicide Watch – published on the BMJ of an amusing Dan Rhodes book called Little Hands Clapping – on the subject of a suicide museum.

Margaret McCartney

Martin Amis has called for “euthanasia booths” on every street corner. “There should be a way out for rational people,” he told the Sunday Times Magazine.

Sir Terry Pratchett, another bestselling author, who himself has early Alzheimer’s, campaigned in a recent lecture for the right to end life with medical assistance. He has offered to be a “test case” before a “euthanasia tribunal”, saying that no one should stand in the way of someone who has decided to die. “The tribunal would be acting for the good of society as well as that of the applicant,” he said.

Continue reading ‘First, do no harm’

Clive Cookson

An intriguing announcement about “unethical conduct” from Swedens’ Karolinska Institute, one of Europe’s top biomedical research centres.

Harriet Wallberg-Henriksson, president of the institute, has dismissed Karl Tryggvason as Dean of Research “after it emerged that he exercised undue influence over how funds were allocated to leading professors”.

Tryggvason’s alleged misconduct included sending a letter from his private email address to the chair of the independent evaluation committee responsible for allocating funds from Karolinska’s “prominent professors programme”. This email, suggesting “worthy recipients of the funds”, was then circulated to committee members.

“I take such unethical conduct very, very seriously,” Wallberg-Henriksson said.

In addition to his removal as research dean, Tryggvason may face additional sanctions “pending further investigation,” the institute said.

Tryggvason is a distinguished clinical biochemist, with an international research staff of about 30. He is also a member of the Nobel Assembly that chooses the medicine laureates, and a cofounder of two biotech companies, BioStratum and NephroGenenex.

Clive Cookson

Margaret McCartney wrote about the placebo effect on this blog earlier in the week, in the context of the Commons Science committee recommending that the NHS should not pay for homeopathy.

Coincidentally The Lancet has a fascinating long review of placebos, looking at the clinical evidence and ethical considerations.

The authors, led by Damien Finniss of the University of Sydney, point out that placebo effects are “genuine psychobiological events” which can be produced in both laboratory and clinical settings.

A key conclusion is that there are many different placebo effects, depending on circumstances.

Margaret McCartney

The NHS ”Distinction Award” Scheme was set up as a way to reward hospital consultants for being extra-good.

If they wrote books, set up services, pioneered, discovered or whatever, then there was the possibility, after the decision of a closed-door committee, of an award (at levels 1-8, then the shiny upper echelons of bronze, silver, gold and platinum).

At the top end of the scale (and I should say that these are the minority of awards) they are worth just above £70,000. That’s on top of basic wages.

Margaret McCartney

A nurse in Glasgow has been suspended, pending an investigation about photographs of patients, having surgery, being posted on Facebook. Not very nice, we may think.

Nurse suspended for putting photographs of patients taken during operations on Facebook

What I find just as concerning though is the reaction of the Chair of the Patients Association in Scotland, Margaret Watt: “Any nurse caught doing this should be sacked, if not sectioned. Putting pictures of patients in hospital on the internet is a gross breach of their human rights and dignity – the worst I have ever heard of.”

Spot the absolutely inane, anarchic and thoroughly degrading reference to mental illness there. Is this really the kind of attitude that should belong to one in such a position?

Margaret McCartney

It used to be seen as embarrassing, extravagant, foolish. But improving your looks under the surgeon’s knife has now passed the stage of social unorthodoxy to become something acceptable, appealing – even fun. Just think of the rise of Botox parties, where a nurse wielding the syringe will come to you (and the host gets a discount).

In Los Angeles, studies of women found that more than two-thirds of respondents were interested in having cosmetic surgery. In the UK, a study of female university students showed that low body mass index, lack of body appreciation and media influence were predictors of a desire for cosmetic surgery. Indeed, one US study links watching TV makeover shows with a more favourable attitude towards cosmetic surgery, as well as an increased pressure to try it. This does not necessarily prove cause and effect, but it does raise the question of how people acquire enthusiasm for these procedures.

The remainder of this article can be read here. Please post comments below.

Margaret McCartney

The last few days have seen an outpouring of criticism in broadsheets and tabloids alike, mainly directed at the doctors who did not act to reverse the overdose Kerrie Wooltorton took.

There is no doubt that the doctors involved felt deeply uncomfortable in this position, and sought advice from a variety of others, but the overwhelming problem was that this lady’s express written and, apparantly, verbal, wishes were that she was not to be treated actively for the overdose.

I’ve written recently about how I oppose legal assisted suicide, which does not exist currently in the UK, but is under debate. But this is different. Competent adults can decline medical intervention. If there is “incompetence”, either temporary, or permanent, then there are ways in which someone can be protected, e.g. under mental health laws or guardianship to ensure safety. But – again – competent adults can decline medical treatment. Doctors have no right to force, coerce, cajole or dictate treatment to another.

I can only imagine how painful the episode has been for family, friends, and how distressing it must have been for the staff looking after her. But this was not “assisted suicide”. It was in full compliance with the law as it stands.

Margaret McCartney

The UK General Medical Council has today published new guidance on conifdentiality for doctors. From reading press reports over the weekend, I had thought that there had been dramatic changes. But having read it, I realise this is not so.

The right to confidentiality has never been absolute, but there has never been any doubt that breaking it can only be done in specific circumstances where the danger to others or the public is high enough to justify it.

One example is driving. If someone is medically unfit to drive, and persists in doing so despite advice to the contrary, the doctor should inform others. In practice this is made easier by the DVLA, who have clear guidance on what to do. In many cases, when the doctor tells the patient that they must report their driving against advice to the DVLA, the patient agrees to tell them him/herself.

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Margaret McCartney is a Glasgow-based GP and FT Weekend columnist. She started writing for the Life and Arts section in 2005 and moved to the magazine in 2008. She also has her own blog: www.margaretmccartney.com/blog

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow

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