Health professionals have an ethical duty

The British Medical Association (BMA) recently published guidance from its medical ethics committee on decision making concerning the withholding and withdrawing of life-prolonging medical treatment. It is a very thoughtful and thought-provoking document, the ramifications of which go far beyond the immediate situation it is addressing. The authors are clearly well aware of this.When considering a doctor’s ethical response to “contemporaneous requests for life-prolonging treatment” made by competent patients, the committee observes: “Although patients’ wishes should always be discussed with them, the fact that a patient has requested a particular treatment does not mean that it must always be provided.” They advance four propositions in support of this conclusion, namely: “(a) Health professionals are not obliged to provide any treatment which cannot produce the desired benefit”. “(b) There is no obligation to provide any treatment which is clearly contrary to an individual’s health interests. A life-prolonging treatment may, for example, prolong life but result in severe pain or loss of function so that overall it produces severe harm to the patient”. “(c) Except in an emergency situation, doctors are not obliged to treat contrary to their conscience (though they may be obliged to make an appropriate referral)”. “(d) Where resources are limited, it is inevitable that some patients will not receive all of the treatment they request even though such treatment could be potentially beneficial to them”. Towards the end of their commentary on the last of these propositions, they observe: “Health professionals have an ethical duty to make the best use of the available resources and this means that hard decisions must be made. Whilst this is a much broader issue than can be discussed thoroughly in this document, it is clear that doctors are not obliged to comply with patients’ requests for treatment when they make inequitable demands on scarce resources”. Later they come back to this issue in the context of patients who have lost or never attained competence. In that connection they observe: “Existing guidelines and court judgments have insisted that non-treatment decisions for people who lack the ability to make or communicate decisions should be based on considerations of benefit to the patient and not cost. It is obvious, however, that money spent caring for irreversibly and severely brain-damaged patients is money which cannot be used to treat other patients. This is an issue which needs to be acknowledged and addressed on a national scale as part of the debate on rationing and prioritising resources”

How economics could extend the scope of ethical discourse

Ethical discourse is typically inconclusive, and with good reason. But this inconclusiveness is a distinct disadvantage when it comes to helping publicly accountable policy-makers in the health care system provide an ethical justification for their decisions. It is suggested that instead of ending with platitudinous statements such as that a balance has to be struck between the rival ethical considerations, empirical research should be undertaken to elicit the quantitative trade-offs that the affected general public would be prepared to accept when striking this balance. In the expected absence of any consensus, it is further suggested that the views of the median person be taken as the best approximation to the group view. Finally it is argued that, far from this quantitative approach lacking humanity by treating individuals as “mere statistics”, it shows greater compassion than the proponents of those approaches whose fellow feeling can only be stirred by information pertaining to identified individuals

The conservation equations for multicomponent gas mixtures in arbitrary coordinate systems

The conservation equations for multicomponent reacting gas mixtures are generally given only in Cartesian or orthogonal curvilinear coordinate systems. Actually, the conservation equations are easily expressed in an arbitrary coordinate system. We present the general equations in tensor notation and then indicate the simplifications which arise for orthogonal curvilinear coordinates

Catégorisation et stigmatisation policières á Sheffield au milieu du XIXe siècle [Numbering crimes and measuring space: policing Sheffield in the mid-nineteenth century]

The city in the nineteenth century was often defined as a place of crime: yet from within, the its authorities sought to represent crime as something external to it. The presentation of the criminal statistical returns of the English city of Sheffield can be shown to be distorted in several ways, all of which were consistent with the project of rendering the criminal as firmly 'other'. The town's returns followed the national requirement of establishing numbers of 'resident criminals' and their haunts, but it also went beyond this. Information about residence, ethnicity and literacy was presented in a way that tried to set a boundary between the 'true' city and the people in it who were deemed to be committing the majority of crime. The tactic of labelling was pursued in an effort to symbolically isolate a discrete 'criminal class'. In addition, the mania for sub-division of certain sorts of crime replaced worryingly large numbers of total crimes committed with reassuringly small numbers of crimes that fell into small sub-categories. The returns were a conscious project to create an image of an incorruptible and professional police force successfully securing and thus separating the city from a crime threat that was mainly external, 'alien' or safely under surveillance

Antidepressants in pregnancy and breastfeeding

Copyright © 2007 Australian Prescriber Reproduced with permission from Australian Prescriber The document attached has been archived with permission from the publisher/copyright holder.Maternal depression and anxiety during pregnancy and the early years of an infant's life cause substantial problems to the mother, her infant and her family. Suicide is an ever-present risk with depression along with adverse effects on infant growth and birth weight. Balancing these risks against accumulating evidence of the effects of selective serotonin reuptake inhibitors on the fetus and infant presents a challenge to the treating doctor. Careful explanation to the woman and her partner of the risks of both the condition and the treatment, using a biological, psychological and social treatment approach, is likely to provide the most benefit.Anne Sved William

Vortex Fluctuations in the Critical Casimir Effect of Superfluid and Superconducting Films

Vortex-loop renormalization techniques are used to calculate the magnitude of the critical Casimir forces in superfluid films. The force is found to become appreciable when size of the thermal vortex loops is comparable to the film thickness, and the results for T < Tc are found to match very well with perturbative renormalization theories that have only been carried out for T > Tc. When applied to a high-Tc superconducting film connected to a bulk sample, the Casimir force causes a voltage difference to appear between the film and bulk, and estimates show that this may be readily measurable.Comment: 4 pages, 5 figures, Revtex 4, typo correctio

Apparatus for electrolytically tapered or contoured cavities

An electrolytic machining apparatus for forming tapered or contoured cavities in an electrically conductive and electrochemically erodible piece is presented. It supports the workpiece and an electrode for movement relatively toward each other and has means for pumping an electrolyte between the workpiece and the electrode