Pondering

I was out for a drinks session (mamak that is) with the gang yesterday. It's a coincidence that everyone's got back this particular week. But nonetheless, great to meet up with everyone else.

Gossips, cuss words, profanities went round the table as usual (ok, ok exaggeration). But at times, I do feel that the type of conversation that we have certainly does not reflect our intelligence (if we do have any). :P Yup, we talk crap most of the time :)

Anyway, amidst the crap, I was asked which practice area I am eyeing. It's a pretty straight-forward question for me as I've decided upon Medical Law a couple of years ago: maybe 2+ years. Yup, that explains the MA thingy. So yup, IF I manage to get through the doors of CLP, there are a couple of firms which I've set my eyes on. So we shall see....

I was (and am STILL often asked) what is it that I see in this particular field. Potential's the word I'ld often answer.

Yup, I'd to admit that its a pretty low-profile field in Malaysia and sad to say, due to the Healthcare structure in Malaysia, practice is mostly confined to medico-legal cases i.e. negligence - patients suing doctors, and doctors trying to save their arses situations.

I love handling medical negligence cases. But, at the same time, I'd realised during my MA period and my CLP days, that I'm actually more intrigued with the policy making part of it. Or, as VCKY puts it,

I'ld like to do a Margot.

(Hmmm... I won't mind having a Rodney beside me too!)

But well, judging from the healthcare structure in our country, much remains to be seen. We won't be fighting for reproductive rights for homosexuals, a patient's right to euthanasia, refusal of treatment (ala Jehovah's witness - But, I've came across one such case in Malaysia thus far). Pro-abortion ideas would be shot down. Creation of Chimera embryos for research would definitely draw chaotic remarks.

Oh well, I think it will be neigh time before I could actually dream of getting involved in such issues and ideas. May years of change and evolution is required before such ideas are to be accepted in our society. Or maybe we need to be a member to the ECHR (European Court of Human Rights) before such dreams of mine become reality. But the truth is right now, its more fiction than fact...

So yes, one has to be realistic. If at all I'd end up practicing in this area, medical negligence would be my bread and butter.

And I'm often asked which 'side' (if there's any) I'd be on in a medical negligence case. Patients, or doctors?

I often answer jokingly that I'd go whereever the money is. But this remark often draws flak from others. Hence, over the years I'd learnt not to make such 'daft' remarks to people who do not appreciate them.

So seriously, I'd initially aimed to fight for patients. Poor man, oppressed, subject to sub-standard treatment from a negligent doctor. Hence, sue sue sue!!!! Get some dosh i.e. $$$$ outta the pockets of such rich doctors. That's what this bird-brain of mine initially thought.

But upon further study, I'd come to realise that I do have a soft-spot for doctors. Humble ones that made a genuine mistake by no fault of their own. A medicial negligence suit is very damaging psychologically and reputation wise. So why not help defend them? They ought to be accorded due protection and not to be cast into a typical mould, which the society automatically cloaks them with,

Doctors make so much money, so who's the patient supposed to run to in event where injury's caused to them?

It's very true. But who's gonna protect such doctors who acted bona fide?

And I quote from the Hippocra(i)tes Oath;

"I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation...

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous...

With purity and with holiness I will pass my life and practice my Art...

Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves...

While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!"

And also the Physician's Oath from the Declaration of Geneva 1948 (amended in August 1968)

"At the time of being admitted as a member of the medical profession:
I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;

I will practice my profession with conscience and dignity; the health of my patient will be my first consideration;
I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity;
I make these promises solemnly, freely and upon my honor."

Yeah, I know these Oaths all seem wishy washy. But honestly speaking, no reasonable doctor, in accordance to the Bolam standard would act against the basic principles of medical practice (or should I say humanity?).

No sane doctor would have intentionally intended to cause any harm to their patients. So in a way, they need protection too!

Anyway, despite all this pondering that I've done. I am still undecided.

And yes, people often find it difficult to fathom why I take such an interest in such an unpopular pratice this area in Malaysia. I often tell them, that I see 'hope' and potential in this area. To which I am always encourage to think of corporate practice.

Well, yes, money is good in the corporate and commercial side of things. But I'll die looking through M&As everyday, JVAs, due dilligence... Shoot me!

I need something that puts me in touch with humanity. Criminal law might me my 2nd option, but I'm having problems convincing Mum about that. And at the same time, I don't think I have a heart of steel to betray my conscience at times. Though, one must hold on to the innocent until proven guilty mantra.

Oh well, decisions, decisions, decisions....

-LV-

One Fine Day

As I was driving back down South for the mother of all exams tomorrow (Monday).

“Tham, I've got a question for you. You free to talk now?”

“Errmmm… yeah. What’s up?”

“I’ve got a patient here, XXXX overdose.”

“What’s that??”

“Oh, alright... Got a patient here, admitted for overdose. Claims her husband’s got an affair with her sister-in-law who’s 14.”

“Uh huh?”

“What you reckon? Should I report it to the police?”

“So you’re trying to nail the fella down for statutory rape right? But then it’s only hearsay. Did she see the ‘act’ herself? Allegations of affair does not necessarily mean XXXX (censored for the benefit of those who are below 18), though it normally does. What does your supervisor say?”

“Supervisor says she's not gonna report it. But yeah, the patient claims she saw them XXXX.”

At this point, my senses and rationality came back to me. The issue at hand is on confidentiality.

Man, She's asking whether or not she has an obligation to report the alleged rape. Why on earth did I go on a frolic of establishing statutory rape, the factum and evidential issues? *Alamak!*

“Right. Think you should let her know of the options and leave it to her to decide on whether or not to make the report.”

___

Sigh! Such a straightforward medical ethics issue, yet I read way beyond the lines! I think I’m getting an overdose of CLP; Evidence and Criminal Procedure.

Lesson learnt: Don’t over-analyse matters.

-LV-

I'm Happy Now, Even If I Die

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Gotcha!!!!!
No, not it's not me, folks... Sorry!!! :P

Anyway, it's yet another Jehovah's witness-blood transfusion saga http://www.thesun.co.uk/sol/homepage/news/article1018355.ece

The fine line between law and medical ethics; between compelling treatment and respect for autonomy.

How do we distinguish?

-LV-

When Is It Wrong To Kill?

Yup, I've reached the chapter on "Killing" - euthanasia, abortion and infanticide in Singer's book, "Writings on an Ethical Life".

I was wrong to have mentioned initially that he shares opposing views to Harris on the ethics/philosophy. As I read on through the earlier chapters of his book, it dawned upon me that Singer's concept of practical ethics does not run faraway from Harris's concept of rational intuition.

For instance, Singer in the chapter entitled "When Is It Wrong To Kill" proceeds to address the following issues:

- The concept of personhood
- The moral justifications for killing (i.e. euthanasia, abortion and infanticide)

Both Singer and Harris proceed to address the concept of personhood, and then utilize their conception of "persons" in order to justify their arguments for killing.

They both begin with the same arguments. That the concept of personhood is determined by consciousness, ability to communicate and to express ourselves. But Harris in his book, "The Value of Life" goes on further to assert that one main quality that sets us apart as a more 'superior race' than animals is our ability of self-recognition. And I find this to be the pivotal point to the concept of personhood.

The basic 'criterias' as laid down above to establish personhood must be considered cumulatively. Firstly, consciousness as a pre-requisite is important, but not conclusive. It is important as it would justify the ethical arguments for euthanasia. Consciousness refers to our ability to be aware of our surroundings, and experience the ups and downs of life. Hence, often, when decisions are made to withdraw treatment from PVS (permanent vegetative state) patients, healthcare professionals, ethicists and more importantly the patient's family members resort to this argument; that Andrew is no longer conscious, and kept alive only by machines. He no longer has a chance of regaining consciousness again. Hence, it would be in his best interest to withdraw treatment. This is perhaps the ground taken by the courts in deciding in favour of withdrawal of treatment in the case of Tony Bland who was involved in the Hillsborough disaster in 1980s???.

But, this justification taken alone would not be sufficient to justify euthanasia. Animals are also conscious beings, so what makes us so special as humans? Why would it be morally tenable to kill a chicken for dinner tonight, but not to kill Jacob, our elderly next door neighbour instead?

This brings us to the next point - ability to communicate and of self-expression. Human beings are able to express their feelings, wants and needs by means of language. But, this alone would not be sufficient to establish our claim to the right to life as persons. Animals, likewise have their own means of communication and self expression. Sally the dog may bark when she is angry, growl when she is pissed and whimper when she is afraid of lightning. Buck the horse may neigh when it's read to mate. All these are forms of 'self-expression' and such ability to communicate is not solely confined to human beings.

I may speak English, him in Malay, her in French. But we're all persons. Hence, it can be seen that the fact that someone else does not speak a language than is understandable by others, it does not make the individual less human. So the two criteria of consciousness and communication are insufficient to justify arguments in favour of the ethical righteousness of euthanasia. I may speak in English and Bob the dog would not understand a single word I say, and similarly Bob may growl, grunt and bark and I would not understand a single 'word' it says too! Does this justify euthanasing Bob (on assumption that it ends up in a PVS stage one day) merely on the basis that it speaks 'alien language'? Well, English, Malay and French may be 'alien' to Bob too! But we're both able to express ourselves in a language only we understand. Hence, criteria for personhood number 2 does not justify an overriding interest in favour of humans.

At this point, Harris makes this pivotal point. In that our ability of self-recognition and self-awareness makes us humans. We have a concept of 'self' and as such, it would be wrong to do anything in violation of our conception of our individualism. Put a baby in front of the mirror, and it would be able to recognise him/herself. In contrast, put a tiger in front of the mirror and it'll probably ram through it, shattering the mirror into pieces.

Therefore, I am of the opinion that this, would amount to the cut-off point in the determination of personhood and to justify killing.

As persons, they would have the concept of 'self' and as PVS patient's lack this general conception of 'self', it would be morally euthanise them. The lack of 'personhood' in them renders it morally tenable to euthanise as they are no longer able to live life as they desire. As they lack the requisite concepts of personhood, euthanasia cannot be equated to killing. It should instead be viewed as means to ease the passing of a 'former person'. This was the ratio behind the decision in the Bland case in which the judges held that, (in my own words)

"...Tony is no longer the boy he used to be. What he is now is a shadow of his former self and as such, it would be in his best interests to withdraw treatment..."

This is true as one who is not a "person" would be no longer have the ability to value their existence. And as such, euthanasia does not amount to a violation of their purported human rights. Therefore, killing is morally and ethically tenable.

This would perhaps explain the morality behind killing Sam the chicken for dinner instead of Roger your next door neighbour.

I certainly hope that I would not be put into any such position in the future as I readily admit that I am sure that my considerations would be very very different.

Some things are easier laid down in theory than in practice.

-LV-

On Autonomy

Taking a break from my books. Hence, this...
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The recent decision of with regards to the recent Malaysian case brought forward by a Jehovah's witness against the UMMC has got me thinking about the doctrine of autonomy.
Yup, it's gotten me excited as I never thought that this would happen here!!!! We're taking babysteps towards the European Court of Human Rights (ECHR)!!! *wishful thinking*

1. There is a strong and pressing need to uphold and to respect a patient's wishes.
2. Yet, at the same time, there is a need for the courts and the healthcare profession to respect the santity of life.

Jehovah's witnesses are a 'sticky category' to handle. They refuse blood products. Hence, many may refuse a life-saving operation or blood transfusion. Undoubtedly, doctors are clearly in favour of saving lives. But, are they content to sit back and watch the patient die despite having provided them with sufficient advice regarding the pros and cons of the refusal of e.g. an elective C-section?

Should the doctors and courts respect their autonomous wishes or should they act in favour of preservation of life, with disregard to the patient's religious views?
___

The following is an exerpt taken from my essay entitled,
“Belatedly, English judges now recognise and endorse patients’ rights to make their own choices about medical treatment”.
___

As individuals, we appreciate and value our right to make decisions concerning our daily lives. We relish the opportunity to live our lives as we deem fit. However, as far as medical treatment is concerned, is appears that the courts seem to be more keen on paying lip service to this principle. Whilst it appears to straightforward within the normal context of doctor-patient relationship, the harsh realities that befall certain categories fall foul of applying the autonomous principles. For example, pregnant women and Jehovah’s witnesses.

The Basics

In the usual course of things, all patients are presumed to be competent unless proven otherwise. The test for competence is set out in Re C; [1] a patient is considered competent if he is able to take in, retain, believe and weigh the given information, and subsequently make an informed decision based on his understanding of the medical information and advice given.

The dicta of Lord Scarman in Sidaway v Bethlem Royal Hospital Governors [2] adopted an ‘informed consent’ approach. A doctor must disclose information that a reasonable patient would like to know, due to respect for autonomy. Therefore, doctors are now duty bound to disclose information significant to assist the patients in making an informed choice. This in return, represents a higher degree of acknowledgement towards patient autonomy. Even so, it is not absolute.

The Uphill Battle

Doctors could and would always rely on the defence of therapeutic privilege.[3] So long as the disclosure of any information poses a risk of psychological damage or harm to the patient, the withholding of the information or the provision of certain medical treatment is justified. It is undoubtedly easier for the doctor to hold a patient incompetent rather than for a patient to prove his alleged competence in our society which places emphasis on medical opinions.

We face an uphill battle in upholding autonomy!

Pregnancy & Religion

As far as pregnant women and Jehovah witnesses are concerned, the courts always seem to favour beneficence to autonomy. This is regrettable, but true. In this particular area, the courts despite having endorsed this principle do not seem to be applying what they have rubber-stamped. Autonomy is a farce!

Firstly, all medical decisions concerning pregnant women must be taken, having considered two sets of interests; that of the mother and of the unborn child. How are we to balance both sets of interests? And the situation is further complicated in instances of Jehovah’s witnesses where believers often decline the receipt of any blood products. The general position as held in the UK is that so long as there is an express declaration by the patient stating his/her refusal to accept such blood products, the doctors are to respect such wishes.

However, in reality, how many doctors/healthcare professionals would be willing to stand back, with their arms folded and watch their patients die? Would courts be so daring as to uphold autonomy at the expense of one's life. Realistically speaking, upholding the autonomous decisions of patients is nothing more than a moral ideal.

The Practice: By Courts and Healthcare Practitioners

A myriad of previous decisions have ruled out any independent right of life of the foetus. In C v S and in Paton v UK, both cases held that the unborn foetus has no right of its own.[4] As it is entirely dependent on its mother, the decision of a pregnant woman (if competent) must be respected even if it means that the life of the foetus would be endangered as a result.[5] So long as the pregnant woman is competent, her decision ought to be respected even if it may be unconventional and unacceptable according normal social standards.

Life is not a bed of roses. All is well when the patient submits to the recommended course of treatment. But, when she refuses, the doctors (and often courts) would endeavour all means possible in their attempts to provide what they seem to be the best and appropriate treatment to their patients. As such, when a pregnant woman refuses consent for a life-saving Caesarean section, their decision would often be challenged on grounds of incompetence. The fact that she is a Jehovah's witness further acts to the medico-legal/bio-ethical confusion.

Despite specific endorsements towards the autonomous rights of pregnant women in Re MB (An Adult: Medical Treatment) and St. George’s Healthcare Trust v S, such approach is clearly out of favour with medical professionals and the courts. Notwithstanding the competence and the autonomous wishes of the mother, judges favour the preservation of the life of a child.

In almost each case, the justifiability of judicial decisions is often based on the notion of best interests. Doctors and courts often see this as a backdoor to overrule autonomy. Arguments may be based on the far-fetched notion that having carried the child to term, it is in the mother’s best interests to have the child delivered. It would definitely have been her primary intention, and but for her diminished capacity (i.e. labour pains and complications that may have affected her rational thinking), she would not have refused any treatment that would have risked her child’s life. And as the courts are in favour of the preservation of lives it is of no surprise that they find no difficulties of buying this argument.

For instance, in Re MB, the patient exhibited clear signs of fluctuating capacity. She had expressly consented to the operation only to withdraw it at the very last minute on numerous occasions due to her fear of needles. In this case, the court held that she was incompetent as she was unable to weigh the information given. Nonetheless, it was in her best interest to undergo a Caesarean section. Both parents wanted their child to be born, but for the mother's needle phobia.[6] Likewise, in Re L¸ the patient’s extreme needle phobia amounted to an involuntary compulsion that diminished her ability to weigh the information sufficiently in order to make a well-informed choice.[7] Admittedly, both cases do little to champion autonomy. Rather, it seems sanction medical decisions that are strongly based on the notion of best interests.[8] Hence, paternalism.

The Conclusion

Sadly, but true, the courts might be reluctant to admit that they still favour the doctrine of sanctity of life. Thus, they act to protect the life of the child, at the expense of the mother’s autonomy; all under the pretence of best interests. It is therefore without a doubt that autonomy in this particular area is nothing but a farce.

Having said that (and before I am shot by the courts and medics), medical paternalism is not necessarily a bad thing. At times, patients do need a certain amount of assistance when their rational judgments seem to be blurred by a host of other factors. Thus, the courts and healthcare professionals have an inherent duty to protect them from making mistakes that they would potentially regret later on. But when should they cease to protect?

Yes, upholding autonomy is a moral ideal, but would the preservation of the santity of life justify the overruling of such ideals?

I am still in a bind.


-LV-
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[1] Re C (Adult: Refusal of Treatment) [1994] 1 All ER 819
[2] Sidaway v Bethlem Royal Hospital Governors [1985] 1 All ER 643 (HL)
Harrington, J. Privileging the Medical Norm: Liberalism, Self-Determination and Refusal of Treatment (1996) 16 LS 348 at p. 352 - 353
[3] Sidaway v Board of Governors of the Bethlem Royal Hospital op. cit.
Mason, J.K., Mason and McCall Smith’s Law and Medical Ethics, 7th ed.,
(Oxford: Oxford University Press, 2006), p. 402
[4] C v S [1987] 1 All ER 1230, Paton v UK [1980] 3 EHRR 408
[5] Re MB (An Adult: Medical Treatment) [1997] 2 FCR 541 at p. 553
[6] Mason, op. cit., p 380
[7] Kirkland J. in Re L as quoted in Re MB
[8] Ibid.

Chimera Embryos

Something to think about this weekend.

BBC News: Brown Urges Embryo Support; 18 May <http://news.bbc.co.uk/2/hi/uk_news/politics/7406773.stm>

BBC Health: Q&A Hybrid Embryos; 19 May <http://news.bbc.co.uk/2/hi/health/6233415.stm>

BBC News: MPs Back Embryo Hybrid Research; 19 May <http://news.bbc.co.uk/2/hi/uk_news/politics/7407589.stm>

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A touch-and-go write-up of the 'Chimera Debate'
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The planned Bill and subsequent amendments to the HFEA (Human Fertilisation and Embryology Act 1990) to allow for the cultivation and use of Chimera hybrids in genetic research has sparked an intense bioethical-legal debate. In essence, a animal + human embryo will be created, for research purposes and the UK Parliament is lobbying to pass a Bill (Bills - i.e. a proposed law. Once tabled and passed, it will become an Act) on this.

I did a short topic on this during my Philosophy classes last year. If I recall correctly, John was all for allowing the use of Chimera hybrids for purposes of genetic research. And I do agree with the use of such hybrids purely for research purposes.

"What are chimeras?", some may ask. In essence, or rather in Wikipedia terms

"... a chimera is an animal (in zoological terms) that has two or more different populations of genetically distinct cells that originated in different zygotes.

Chimeras are formed from four parent cells (two fertilized eggs or early embryos fuse together) or from three parent cells (a fertilized egg is fused with an unfertilized egg or a fertilized egg is fused with an extra sperm). Each population of cells keeps its own character and the resulting animal is a mixture of mis-matched parts. An analogy is two jigsaw puzzles cut using an identical cutter, but with different pictures. A single puzzle can be made out of the mis-matched parts, but the completed puzzle will show parts of both pictures..."

http://en.wikipedia.org/wiki/Chimera_%28genetics%29

Under the draft Bill, chimera hybrids would be created in order to address the shortage of human embryos for research purposes. This opens up doors to possible findings and discovery of cures for genetically linked diseases e.g. Parkinsons, Alzhemier, MND (Motor-Neuron Disease). Proposed amendments to the HFEA (Human Fertilisatio and Embryology Act 1990) would allow for use of such hybrids on condition that these hybrids would be destroyed after 14 days.

What are the concerns about the work?
Opponents say this is tampering with nature and is unethical. Critics say they are repulsed by the idea and there must be no creation of an animal-human hybrid. It is already illegal to implant human-animal embryos in the womb or bring them to term.

Exerpt from BBC Health: Q&A Hybrid Embryos

http://news.bbc.co.uk/2/hi/health/6233415.stm

But then, IF the HFEA is amended to allow for the use of such chimera hybrids, there would definitely be parties who are bound to find loop-holes within the legislation and perhaps attempt to push the limits. This poses many dangers; most strikingly the haunting possibility of the birth of a human + animal progeny.

"We think there is nothing illegal, immoral or unethical about this. While we understand the concerns, we think they are largely founded on misinformation. People think we are generating some sort of hybrid animal. This is just cells, just for science. No animal is ever going to be created."

http://news.bbc.co.uk/2/hi/health/6233415.stm

How do we (and will we ever be able to) effect a successful mechanism of control over these mad-scientists???

Will they NOT be tempted to further push the boundaries???

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Further exerpts from BBC Health: Q&A Hybrid Embryos; 19th May 2008:
http://news.bbc.co.uk/2/hi/health/6233415.stm

What does the law say?

Although ministers felt the Human Fertilisation and Embryology Act 1990 needed updating as science had moved on significantly, they were initially cool on the idea of creating human-animal embryos.

However, they bowed to pressure from scientists, who argued a ban would hamper medical research.

In addition, the House of Commons Science and Technology Committee carried out an inquiry into the proposals and concluded that the creation of hybrid embryos was necessary for research and that there should not be a complete ban.
(I agree, but there is definitely a pressing need for a strict enforcement mechanism.)

A draft bill published in May 2007 allows for the creation of human embryos that have been physically mixed with one or more animal cells.

Will the bill become law?
(If the House is able to by-pass and find a way through the religious oppositions, the Bill would certainly be good law in no time. But, how would one tackle such highly sensitive issues? There are already strong oppositions going against the use of human embryos for research (mainly based on arguments that it is wrong to create an embryo knowingly that it wouldn't be afforded any opportunity of growing past the 10 day (or is it 14 day) stage, and now, creation of hybrid embryos? Are they any less human than 'normal embryos'?)

Opponents are determined to block the proposals. Several leading members of the Catholic Church have described them as immoral.

In his Easter sermon, Cardinal Keith O'Brien, leader of the church in Scotland, described the legislation as a "monstrous attack on human rights, human dignity and human life".

A significant number of MPs, including several Catholic members of the Cabinet, are also reported to have serious concerns about the legislation, leading to speculation of high profile resignations...

Some 200 medical charities have urged MPs to support legislation allowing the creation of animal-human embryos. And Labour peer and fertility expert Lord Winston has accused the church of misleading the public over the issue.

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Question:
Is there really a need for the creation of what some term as "Frankenstein Hybrids"? Or would we be able to find a better ethical alternative to this?

In whatever decision that will be made, there is a need to thread with utmost caution.

Perhaps, the pressing consideration would be, if we allow for the creation of Chimeras now, how and where do we possibly draw the line in the future? There is a danger of the opening of floodgates and a free-fall to oblivion. And mad scientists would be keen on capitalising on loopholes and if not, finding justifications for their reasons for e.g. going beyond the 14 day permitted limit.

How do we control????


-LV-
*more answers to the above question in my new post. Off to read now!

Diploma: e-Learning

I've stumbled upon this page....

"One of the World Medical Associations e-learning courses which are produced in cooperation with the Norwegian Medical Association." (or so, it claims)

http://lupin-nma.net/

I don't know much about the authenticity of this 'course'. But they claim to award you a Diploma at the end of the course. And its FREE!!! Too good to be true, honestly. Hence, I dare say its some ciplak thingy.

It's (supposedly) meant to cater for healthcare professionals and upon completing my 1st case study, I realised the reasons why. The questions/cases are so different from that I usually do for my medico-legal case studies.

e.g.

Dr. P, an experienced and skilled surgeon, is about to finish night duty.

A young woman is brought to the hospital by her mother, who leaves immediately after telling the intake nurse that she has to look after her other children. The patient is bleeding vaginally and is in a great deal of pain.

Dr. P examines her and decides that she has had either a miscarriage or a self-induced abortion. He does a quick dilatation and curettage and tells the nurse to ask the patient whether she can afford to stay in the hospital until it is safe for her to be discharged. Dr. Q comes in to replace Dr. P, who goes home without having spoken to the patient.

What do you think of Dr. P's behaviour?

(Source: http://lupin-nma.net)

These are more 'life-like' situations.... and certainly more fun to toy with! ;)


Not that I'm interested in the Certificate/Diploma or whatever..... But well, I'm just taking it for fun.... To take a break from my CLP notes. Medico-legal stuff is always refreshing!

Give it a try if you're bored ppl...

-LV-
*die! need to brush up on my legal principles... I'm still weak la....

My Reply

Dear SW,

My reply (in blue) to our *ahem* academic debate....

(1) You mentioned about a patient who is heavily dependent on drugs and machines for survival. There are major differences between an ‘omission’ act like withdrawing the consumption of drugs and switching off the life- machine, compared to a ‘killing with an action’ like asking someone to strangle him or stab him till death. The patient in the first category is allowing the ‘disease’ or ‘illness’ itself to kill him ‘naturally’ by withdrawing from any external help for survival, which is in some sense similar to a cancer patient who refuses to undergo chemotherapy (and we don’t usually call that ‘euthanasia’). But the latter is equivalent to a suicidal act by deliberately accelerated the process of dying. The two forms of ‘euthanasia’ would need separate discussions regarding the different ethical issues attached to them.
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I totally agree with you on this point as I have 'jumped the gun' in my discussion about euthanasia. I deliberately omitted to discuss both active and passive euthanasia. Well, blog post... not thesis writing... so malas a bit mah! Btw, thanks for the clear definition.....

(2) You mentioned also that ‘euthanasia’ is different from an express sanction of suicide. Let consider a hypothesis example of this teenager who is an outcast from his societies, despised by all people in his surroundings and find life extremely meaningless and hence decided to commit suicide. Applying your three ‘reasons’ of why euthanasia should be allowed: (a) the teenager should be given the choice to live the life he desires, including ending it; (b) he is deprived of his means of communications (though in a different sense) in that he is an outcast and no one is willing to listen to him, and (c) he understands the nature and consequences of his action. Question: should he be allowed to take his own life away?
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YES
So long as he is competent, his wishes should be respected.
Autonomy triumphs.

(3) There are some conflicts between the second and third reasons that you mentioned. I wonder how a competent adult manage to express his desire to die if he is not able to communicate. And if he is able to express such desire, it means that he is still able to express his own feelings, and hence according to your second reason, his life is not meaningless. So he shouldn’t be allowed to die.
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In this context, I am therefore proposing for healthcare practitioners to give rise to living wills and perhaps, to a certain extent allow for PAS (physician assisted suicide). The individual, in giving rise to his wish for euthanasia (in the future), would do by means of a living will. Don't think that there's a conflict in my arguments as such. Expression of feelings and intention is done when he had 'testamentary capacity', so as to allow for PAS in the future.

The main purpose of wills (as we learnted from our Wills & Probate lectures... if we managed to stay awake ;) ) is to give rise to the intention of the testator upon the occurence of an event. In giving rise to this intention, so long as one has testamentary capacity, the individual's intentions as to how his property is to be divided amongst the intended beneficiaries ought to be respected, and not questioned.

Likewise, in giving rise to PAS, the individual's wishes would be documented. And when his condition reaches the point when he no longer wishes to continue on living, the physician ought to invoke the said living will and administer a dose of lethal injection so as to ease his passage.....

-LV-
PS: Not really thinking straight right now, so arguments might be a bit patchy and all over the place... We shall battle it out in class tomorrow! :P

To Kill or Not To Kill?

"Please End My Suffering Now"

(http://thesun.co.uk/sol/homepage/news/article852585.ece) (The Sun UK, 27th February 2008)

Should the decision lie in your hands, would you have granted Chantal Sebire her plea for euthanasia?

-LV-

PS: SW, still owe you a reply to your previous comments..... In the midst of it.... Not really up to it these days... Quite depressed and demotivated...

Would You Choose to Die?

Euthansia; or in some cases referred to as 'mercy killing' often brings about mixed reactions from different sections of the society. I had an opportunity to reconsider this issue recently and am still of the view that competence is the key.

An interesting point that I recall from my Philosophy classes is that some individuals may contend that life is a gift from God. And as such, we have no right to request for it to be ended, no matter what.

But, should anyone of us be put in this unfortunate position of suffering from a severely debilitating illness, without any hopes for cure but only a slow road to death; would you think differently? You will gradually lose control of your bodily functions, and although able to think and reason, are unable to express your wants and needs. You lose your ability to earn a living and as a result of this illness are heavily dependant on machines and drugs to sustain life. Your family is unduly burdened with your sky-high medical bills. You are not able to do anything, but sit or lie down and watch the hours/minutes/seconds tick by everyday. Would you then champion for the right to end your life?

I must stress at this point that, I am not an advocate for euthanasia per se. But, I believe in autonomy and competence. And all these would inevitably tie in with the right to euthanasia, abortion and to refuse medical treatment. So long as a competent person decides to end his life due to the severely debilitating illness, his/her decision should be respected. *period*

Why? You may ask.
Three simple answers.

Regardless of whether we consider our lives to be that of ourselves alone or that which is 'on loan' from God. We will be the ones who would inevitably live these lives. Therefore, it is only rightful that we are allowed to live the lives we desire. Should we decide to soldier on with the effects of the illness, so be it. Should we decide to end our lives at a certain point, so be it.
BUT
This is by all means, not to be taken as an express sanction of suicide. Though the end results to suicide and euthanasia are similar, they are by all means, different sides of a coin.
Put in simple words; "Your life, Your choice"

Secondly, taking a leaf out from John Harris's book, "The Value of Life". Life is only meaningful when one is aware and able to communicate. Language is used as means of expressing one's feelings. It need not be spoken and comprehensible to each and every person. The inability to communicate is then synonymous to a life devoid of meaning, so says John. (I just love attending his lectures, though I bet people like Iain would surely be gunning for his head for his arguments above). Put into context, this argument may seem academic at first glance. But upon further consideration, I find it increasingly comprehensible; reasons of which I decline to talk about further at this point.

Would it be easier to turn off the ventilators of a person in PVS in comparison to a patient who is suffering from a severely debilitating disease? Think, Diane Pretty and her fight for the right to die.

And lastly, he/she is fully competent i.e. understands the nature and consequence of his/her actions. IF we respect a 5 year old's decision to have an apple instead of an orange, why should we treat a 60 year old's decision not to be trapped in a battle with a severely debilitating disease? I think it is neigh time for us to respect Living Wills and DNR orders.

Opinions please....

-LV-

Straying Away from Bolam?

Finally, after 3 months of toiling and slaving over countless journals, research and feedback. This is the end product; 100 pages of it, 14 494 words (16 743 words, with footnotes).


And, this is what I reckon the easiest 10pounds the University of Manchester has ever ripped off from their students. Soft binding with an acetate (aka plastic cover) and a black coloured piece of manila card, all bound together by some glue and black masking tape acting as the spine. *voila* 10pounds (per copy) here we come!!! But well, poor students do not have a choice anyway...

(The end product, University of Manchester; September 2007)

-LV-

(Bored...)