Assisted Suicide

 

assisted suicide

The BMA and the key medical royal colleges remain opposed to assisted dying. It is claimed by supporters of assisted suicide that they are out of step with the public, 80% of whom are in favour. According to polls they may also be out of step with the doctors they represent. A BMA poll asked whether doctors agreed that assisted dying should be made legal in defined circumstances. 55% agreed or strongly agreed with the proposition. Forty three per cent were against.

An editorial in the BMJ last week stated  ‘Ultimately legalisation for assisted dying will be a decision for UK society. The job of the BMA will be to contribute to the debate, not find itself sidelined because of its implacable opposition. Its members, and our patients, deserve better.’ It was recommended that doctors are polled again as there seems to have been a shift in medical opinion and the BMA and colleges take a neutral stance on the issue.

Assisted suicide is in the news a lot and is often the subject of ethical scenarios at medical school interviews.

1.‘Thou shalt not kill’ is one of the oldest moral commands. It has been a key part of medical ethics for centuries. The original Hippocratic oath states ‘I will give no deadly medicines to anyone if asked, nor suggest any such counsel.’ Many religious people contend that only God has the right to give or take life.
2. Those that are infirm may be pressurised to die or made to feel selfish or a burden if there was this option.
Slippery slope arguments. The ‘slippery slope’ argument holds that if assisted suicide was practised for people like Mr Nicklinson [a man with locked in syndrome who was refused help to kill himself and eventually had to starve himself to death] then it would become acceptable to allow it for less clear cut cases and eventually you may end up with a situation as in Nazi Germany where those deemed to be defective were killed.

assisted suicide - the slippery slope
4. With good pain control and counselling, suffering will be minimised.

Arguments for assisted suicide:
1. The person’s right to autonomy, control over his or her life. According to polls most people in the UK feel that they should be able to have some control over when and how they die. In many philosophical traditions ‘egoistical suicide’ [death for one’s own reasons such as to avoid pain] is considered selfish and wrong. However the aim of ‘altruistic suicide’ which is carried out for the love of others or for the religion [eg Jesus praises a man who lays down his life for others [John 15;13] ] is more acceptable to most religions. It can be argued that someone who wishes to die in order not to be a burden is following the same principles.
2. Some, such as Debbie Purdy, who had multiple sclerosis, have argued that if her husband faced prosecution for helping her to commit suicide she would travel to Dignitas earlier while she could do so alone. However if the law permitted her to have help she would delay dying.
3. Even with the best palliative care [treatment of the dying] suffering and pain are common. Dr Ann McPherson, who set up the charity and website ‘Teenage Health Freak’ and supported a change in the law on assisted dying, died from pancreatic cancer. Her daughter wrote in the BMJ ‘our mum died slowly and in pain. …The law needs to change to allow terminally ill but mentally competent people the right to a more dignified death than my mum’.

Euthanasia
Active euthanasia is when death is brought about by an act – for example when a person is killed by being given a deliberate overdose of pain-killers.
Passive euthanasia is when death is brought about by an omission – i.e. when someone lets the person die. This can be by withdrawing or withholding treatment. Eg stopping a ventilator.
Active euthanasia is illegal while passive euthanasia is legal. ‘Thou shalt not kill but need’st not strive officiously to keep alive.’ [Arthur Clough 1850’]. It has been argued that often the moral difference between acts and omissions is tiny. The Catholic Church for example sees no difference between the two – ‘The act or omission which, of itself or by intention causes death in order to eliminate suffering constitutes a murder.’ [Catechism of the Catholic Church] NB In common language euthanasia is often used to mean active euthanasia.

What society thinks is usually reflected in the laws of a country. Assisted suicide is presently illegal but the view of the general population seems to be shifting with about three quarters of the population now reportedly backing assisted suicide. This is reflected by the lack of prosecutions of those helping loved ones go to Dignitas [the clinic offering assisted suicide in Switzerland].‘The law has a stern face but a kind heart’ is how Baroness Finlay described the present situation. However Lord Falconer has said:
‘No one has the stomach to enforce the current law, because it is inhumane and further provides no protection for the vulnerable. The threat [of prosecution] forces some people to die alone and earlier than otherwise for fear of what may happen to those who accompany them.’

The Director of Public Prosecutions was asked by Debbie Purdy a multiple sclerosis sufferer under what circumstances her husband would be not be prosecuted if he helped her travel to Dignitas. He produced a set of guidelines in 2009 in which he stated that the patient had to have shown that they had come to a ‘clear, settled and informed decision’ to commit suicide and that the loved one who aided them was entirely motivated by compassion.

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Medical Manslaughter – Bawa Garba

 

 

One of the pictures posted on News about #Bawa Garba

Doctors are outraged.  Thousands of medics have signed petitions, last weeks BMJ talked about a culture of fear and blame,a prominent cardiologist has referred himself to the GMC and suggested others to do the same. The GMC responded by emailing all registered doctors and the heath secretary today promised to order an urgent review in to the issue of medical manslaughter. Why?

The GMC went to the high court to erase Hidiza Bawa Garba a junior doctor training in paediatrics from the medical register. She was convicted of medical manslaughter for the death of Jack Adcock a small 6 year old boy. The Daily Mail took it further and demanded that she be jailed.

A look behind the cover story shows however that there were a catalogue of alarming facts which to an unsafe working environment in which mistakes could happen to the best of doctors. She had just come back from 13 months maternity leave and had not had an induction, she was unfamiliar with the hospital and the 6 wards on four different floors she was supposed to cover. She missed the hand over ward round that morning because she had to attend to a cardiac arrest and was therefore  completely unfamiliar with the patients. The consultant on duty that day was absent [he was lecturing on a different site] as was the other registrar, she paediatric SHO had been told to go down to the lab for a few hours and collect results as the hospital IT system was not working . She was doing the work of  4 doctors. She had not eaten or drunk anything all day.  Jack’s parents had given the little boy a drug, enalapril without telling the medical staff, it was not written up on the drug chart and it was not recorded. It lowers blood pressure and made it more likely that he went into cardiac arrest. Dr Bawa Garba wrongly mistook Jack for another boy because he had changed beds and thought he was not for resuscitation so halted it after a few minutes [this however was not thought to have made a difference. Jack was already too far gone.]

Professions concerned with safety such as pilots and medics talk about the Swiss Cheese model where a catalogue of  problems leads to a disaster. Normally the holes in Swiss cheese do not line up but occasionally they do. It is not usually a single error made by one person but problems in the environment and therefore changes in the environment and checks and balances can lead to improved safety. Air safety has improved substantially using this attitude.

The judgment of the senior judges in this case has caused confusion and outrage. Justice Ouseley acknowledged that Bawa Garba  ‘before and after the tragic events was a competent, above average doctor’ but also stated that the events were something she had been trained to cope with.  He shows a complete misunderstanding of the work of doctors. No amount of training can enable you to do 4 doctors work. My job in paediatrics involved being on call and covering 4 wards [the labour ward, post natal ward, neonatal unit and casualty]  . I clearly remember one day when  I was the only paediatrician in the hospital and was treating a severe asthmatic finding it hard to breathe  when a 16 year old girl was brought in unconscious [later found to have had a subarachnoid brain haemorrhage] and I was fast bleeped to also attend a baby who had just been born and was not breathing all within minutes.  I hoped things had improved but sadly the NHS seems to be being squeezed and shortages are common. Justice Ouseley, you cannot be in 3 different places at the same time.

What is also concerning is that as doctors we are encouraged to reflect on how we can improve our performance. It seems that Dr Bawa Garna’s reflections were used as evidence against her. This has led to calls to boycott the reflective portfolio that all trainees write and doctors some doctors are stating that in this current culture it is unwise to admit mistakes. Consultant cardiologist Peter Wilmhurst, a prominent campaigner for transparency and safety in medicine has referred himself to the GMC because he says that over four decades of practice he must have made mistakes some of which would have led to the deaths of patients, and he has encouraged other doctors to do the same. Doctors now fear that they will be made scapegoats when systems fail. Hence the campaign #I am Hadiza.

 

 

Baby’s life-support ‘can be stopped’

 

Isaiah Haastrup and aunt

Doctors can stop life-support treatment to a brain-damaged 11-month-old against his parents’ wishes, a High Court judge has said. Isaiah was born with brain damage after a difficult birth during which his brain was starved of oxygen. King’s College Hospital wanted to give only palliative care to Isaiah Haastrup because he needed continuous ventilation and showed no awareness of his surroundings because of his severe brain damage and felt continuing ventilation was   “not in his best interests”.

Isaiah’s mother, Takesha Thomas said ‘I see a child who is injured. He needs love. He needs care. I have it. I can give it,” talking about his life she said  ”To say it is so poor, it is not worth living, that is not right. It is not their decision to make.”

Parents often believe they have the right to decide what happens to their child. However that is not strictly true in law and according to medical ethics doctors have a duty to do what they think is best for their patient, the child. If it is an emergency they may treat the patient against the wishes of a parent for example. When ever possible if there is time however they will make a child a ‘ward of court’ and a judge will decide.

Barrister Fiona Paterson, representing King’s College Hospital NHS Foundation Trust, said nobody could understand the pain and suffering Isaiah’s parents had endured. However, she said overwhelming medical evidence showed stopping treatment was best for Isaiah.

Mr Justice MacDonald said he passed his ruling that Isaiah’s life support should be switched off  with “profound sadness”.

Children and consent;This case raises ethical issues of consent and autonomy. Adults have autonomy and the right to make bad decisions for themselves. Steve Jobs of Apple refused to have surgery for his pancreatic cancer when it was first diagnosed, preferring macrobiotics and positive thinking despite the pleas from his doctors and family to have the standard conventional treatment [he later fully embraced what ever medicine could offer him and underwent two liver transplants]. Seven year old children do not have autonomy so usually their parents are regarded as being guardians of their best interests. However when this seems not to be the case, doctors/hospitals can apply to court and the child can be made a ‘ward of court’ and decide what is in the child’s best interest. The court has to decide what would be in the child’s best general interest not necessarily the child’s medical best interest.  So this is usually only done for severe life threatening illnesses. For example I know of a case of a Jehovah‘s witness boy who was recommended a blood transfusion but whose parents refused it. The boy was instead given iron injections [which are notoriously painful] over several months  because although a transfusion was in the boy’s medical best interest it was thought that this would endanger how his parents felt about him and injections would be in his overall best interest.

Blue Monday and resilence

stress-and-depression

Today is ‘Blue Monday’ supposedly the most depressing day in the year – originally thought to be the 3rd Monday in January. It was probably first suggested by Cliff Arnail. His equation has six factors:  debt (d), time since Christmas (T), weather (W), low motivational levels (M), the feeling of a need to take action (Na) and time since failing our new year’s resolutions (Q).

blue monday equation

Although I am not sure how scientific this all is it certainly seems to fit in what we see as GPs and counsellors seem to be busiest and booked up in January.

Of course stress is not limited to just one day a year. It is just that it seems to peak about now. Christmas often brings us face to face with realities of family life [divorce lawyers have their busiest month], credit card bills start arriving and the optimism of the New Year and new year resolutions start fading.

For students, January often means mid-year exams.  Students have left the cosiness of home where they have usually been looked after and return to essay deadlines, exams, doing their own cooking and cleaning etc. First years have got over the excitement of starting University and second and third years have the pressure of knowing that all marks contribute to their degree grades. The short days and the darkness make it hard to get up in the morning and to motivate yourself. Some people do suffer from SAD, seasonal affective disorder where a lack of light can lead to depression.

Stress, anxiety and depression are very common anyway. A new report published a couple of days ago by ICM claims that 55% of interviewees said that stress caused by their employment has an adverse effect on their mental health and day to day life. As a GP 1 in 4 of my consultations are about stress, anxiety and depression. That is far more than any other condition, including all respiratory infections such as ear, throat and chest infections combined!

Medical Schools repeatedly remind interviewers that students and doctors who fail and cause concern do so, not because they are not clever but usually because of stress and a lack of ‘emotional resilience’. The medical course is long, intensive, full of exams and students and doctors constantly see distressing events. Empathy is important but it is always important to keep a professional distance and take care of yourself.  Therefore many candidates if not most, will be asked questions on how they cope with stress or how do they think that they would manage a heavy workload and extra curricular activities.

By now you should have evolved ways of learning, dealing with exams,managing your workload  and developed ways of relaxing. To avoid feeling overwhelmed some people make lists, it is important to prioritise tasks,delegate or even cross off tasks further down your list.  It is difficult but sometimes necessary to be assertive and to speak to people who have unrealistic expectations; for example a teacher who seems to ‘forget’ that you have other subjects apart from hers. Managing time effectively, (using travelling time to read the student BMJ or this blog for example!) is important. Demonstrating self discipline e.g. by getting up early before school for rowing practice would be worth mentioning. It is also important to have ways to unwind. Exercise is a great way of burning off stress hormones and boosting endorphin levels, as is music and singing. True friendships areinvaluable and bring a sense of self worth. And anyone having difficulties should seek help as soon as possible and realise there is no shame attached to this.Macho – ‘I can cope’, ‘soldier on’ attitudes are very much frowned upon.

Winter Crisis

A and E images 2

ambulances outside hospital  A and Es which are full of patients waiting to be found beds on already full wards

With winter comes the cold and therefore more illness. This puts a strain on the NHS. The NHS has a budget of £116.4 billion annually, this is only 8.5% of the UK’s GDP and is much less than the amount that is spent by the other G8 countries. For example, France and Germany spend 11.5% of their GDP on healthcare, this is almost 50% more than the UK. The USA spends over double this amount spending 18% of its GDP. With the strain of what many would consider to be an inadequate  budget on the NHS and the demand for healthcare increasing, winter brings many problems and pressures.

In the NHS bed occupancy is high. The UK has 2.61 beds per 1000 people compared with 6.1 in France and 8.1 in Germany per thousand people. Bed occupancy runs over 90% in the UK, this means that in the busy winter months it often runs over 100% causing patients to be left in trolleys in corridors or transported hundreds of miles to find a suitable bed far away from families and friends.'I only got up for a drink of water, and a queue's formed next to my bed.'

A problem is ‘bed blocking’. This is the long-term occupation of hospital beds, usually by elderly people, due to shortage of residential and nursing home places. Councils often have to fund such places and carers at home and their budgets for social services have been cut. While the patient is being looked after by the NHS that patient is not a drain on their budget. Many propose combining health and social care so there are no longer separate budgets and there is better coordination.

General practice is at present underfunded and there is a shortage of GPs. GP workload has gone up and GPs now carry out 50% more consultations than they did 10 years ago this still does not satisfy demand and getting a GP appointment is difficult and some people go to A&E instead. 90% of all treatment in the NHS occurs in general practice. A decrease in capacity of 10% in general practice can lead to an increase in the A&E departments of 50 -100%.

In winter  infectious diseases such as flu and pneumonia  are more common. Heart attacks and strokes are also more common in winter due to the extra stress the cold can put on the body. There has been an increase in reported flu cases over the last couple of weeks.

The NHS like any healthcare system in the West is under pressure due to increasing medical technology and expectations, an ageing population and obesity.  The NHS generally does well, the World Health Organisation and The Commonwealth Institute (a well regarded American think tank) have both recently declared the NHS to be the most egalitarian and efficient healthcare system in the world but of course it is under pressure particularly in winter and the gaps become more apparent.

 

Goodbye 2017

Image result for science march

There was a depressing start to 2017. It felt that science was had been given a shove backwards. Science itself  seemed under attack. Politicians in Britain declared that ‘People have had enough of experts’ and Donald Trump tweeted ‘Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases!’  Robert Kennedy Jr, a prominent vaccine conspiracy theorist was appointed to chair a commission on “vaccination safety and scientific integrity”.  Scientists, medics and statisticians who actually understood data, it seemed had no place.  The new anti vaccine film ‘Vaxxed’, directed by discredited anti-vaccine activist Andrew Wakefield who was struck of for fraudulent research and unethical behaviour was given publicity by major channels such as Fox News.

Image result for science march

 

The Trump administration carried out the the freezing of research grants, and a gag order was placed on scientists in the EPA regarding dissemination of their research findings. In February 2017, William Harper a Trump science adviser with described  climate science as “really more like a cult” and its practitioners “glassy-eyed” This led to the Science March on April 22nd  to protest against ‘The misrepresentation and exclusion of scientific knowledge in policy decisions.’

Image result for science march

CRISPR-Cas9

Despite the bad start to the year and despite politicians, scientists have made astonishing progress. We seem to be on the cusp of amazing advances in the field of genetics. Research and techniques such CRISPR-Cas9 has made the transformation out of the lab and in to clinical practice and genetic disease are being conquered at a breathtaking rate.

Image result for embryo editing crispr

Haemophilia A

Image result for haemophilia a

This disease is caused by a genetic defect that means those affected do not produce a protein – factor 8 needed to stop bleeding. They need expensive injections with factor factor 8 twice weekly and suffer painful bleeding in to joints and skin and gut frequently. Thirteen patients were given the gene therapy at Barts Health NHS Trust. All are now off treatment with 11 producing near-normal levels of the protein.

Sickle Cell

Image result for sickle cell anaemia

A French teenager’s sickle cell disease was reversed using similar treatment to change his DNA. A virus was used to infect the bone marrow with new, correct instructions so it made healthy red blood cells. So far, the therapy has worked for 15 months.

Butterfly Children

These children have junctional epidermolysis bullosa – a genetic condition in which the epidermis [top layer of skin] does not stick to the dermis. This leaves skin as fragile as a ‘butterfly’s wings’. Few children live past their teens. Hassan was being treated with palliative care. A piece of his skin was taken, its DNA was repaired in the laboratory and the modified skin grafted back on. After nearly two years, the new skin appears completely normal.

Bubble Baby Syndrome cured

Three babies are born each year in the UK with an immune deficiency condition which leave them at constant risk of developing life-threatening infections. If left untreated, infants need to be kept isolated from the outside world, which is why the condition is known as “bubble baby syndrome” and usually die before school age.

NICE has agreed that NHS will fund gene therapy for the first time, with a £500,000 treatment for “bubble baby syndrome” produced by GlaxoSmithKline. One treatment is enough to produce a life long cure.

Embryo editing

Image result for embryo editing crispr

 

Scientists have, for the first time, successfully freed embryos of a piece of faulty DNA that causes a deadly heart disease to run in families. 10,000 of different genetic disorders  are passed down the generations . The US and South Korean team allowed the embryos to develop for five days before stopping the experiment. Gene editing Crispr was used to make precise changes to the genetic code. Its applications in medicine are vast and include the idea of wiping out genetic faults that cause diseases from cystic fibrosis to breast cancer.

Huntingtons

This autosomal dominant genetic disorder lead dementia, movement disorder and death.  The disease is caused by an aberration in a section of DNA called the huntingtin gene. The error corrupts a healthy protein and turns it into a killer of brain cells. Epigenetics – is the science of the reading of genes. What makes cells to read some genes and ignore others. Epigenetic manipulation has been used to silence the huntingtin gene by blocking the messages it sends to the cell’s protein-making factories. This could be the first treatment to slow or prevent any degenerative brain disease. UCL is conducting trials at the National Hospital for Neurology and neurosurgery in London. 46 patients had the drug injected into the fluid that bathes the brain and spinal cord [cerebrospinal fluid].  This human trial showed the drug was safe, well tolerated by patients and crucially reduced the levels of huntingtin in the brain.

Truly exciting – what will 2018 bring?

 

 

 

The Drunk Consultant.

 

depressed doctor

You are a junior doctor and your consultant [your boss, the head of your team] arrives for the morning ward round smelling of alcohol. You confront him and he confides in you that he was drinking because he was upset because his wife left him the day before and asks you not to tell anyone. How would you handle this situation?

It is important to consider this scenario from the view point of all involved.

Your consultant’s point of view: He is going through a difficult period in his personal life and now by coming to work in this fashion he is jeopardising is career and standing in the hospital. However it is much better that he takes sick leave, the stress as well as the drinking would make it hard to concentrate and mistakes which in medicine can have terrible consequences are almost bound to happen. He should not feel that it is a weakness to seek help, we are all vulnerable and there are services such as occupational health, BMA counselling services that are available free of charge to doctors. It is important that he has insight and does not worsen his situation by trying to ‘soldier on.’

The hospital/NHS point of view:  The hospital has a reputation to protect and will be sued for any mistakes made. If the consultant is off hand or rude this may lead to complaints. It certainly cannot have its staff coming to work intoxicated. However the consultant is a very skilled, experienced member of its workforce and has given many years of loyal service so be treated with empathy and compassion. He should be encouraged to use the counselling services available and given time off work but it should be made clear that coming to work in this manner is unacceptable.

The patient’s point of view: – the most important. Patients have the right to be treated safely and courteously by attentive staff  that have their full wits about them. Medicine has the potential to cause serious harm as well as good.

Your view point: As a junior doctor your consultant is your team leader, mentor and teacher. He will also be the person who will give you a reference for future jobs. It is therefore important to still treat him with respect and courtesy. He as a person going through a difficult time deserves sympathy and empathy. However you have a duty to your patients and patient care and safety trumps all – ‘make the patient your first concern.’ It would be going against the GMC rules and probably hospital policy if you tried to cover up, even if no one came to harm. It may be the first time you have seen him like this but other occasions may have occurred and there may be a repeating pattern.

You should ensure that your consultant stops working, that he goes home [by taxi, does not drive]. That all patients he has seen have their notes reviewed, that you inform the relevant authority and seek help with that day’s work.

A GP in your pocket!

cherry picking

Cherry picking – to selectively choose the easiest or most desirable

Smart phones are being used for most things. You do not need to visit a bank nowadays, most financial transactions can be done online so why not use your phone instead of visiting your doctor? Numerous private companies have already started offering GP consultations online. Babylon is one that has ‘teamed up with the NHS ‘ and can offer patients the choice to register with them and have their consultations funded by the NHS.

We already have ‘private providers’ working along side traditional suppliers for many aspects of health care. The NHS already pays for private companies to offer scans, physiotherapy services and funds private hospitals to carry out operations to shorten waiting lists. These private providers are often accused of cherry picking patients. For example most private hospitals providing NHS operations have exclusion criteria and will not treat the very elderly, the mentally ill and those with complex medical conditions. These will be left for traditional hospitals to treat. Treatments attract an ‘item of service payment’ so a patient with complex medical problems who may take twice as many days to recover from a hip replacement will attract the same fee as a fit younger patient. Private providers have been accused of cherry picking the easier more profitable patients. Babylon’s GP at hand service states that a consultation will not cost the NHS any more than one at a traditional surgery. However it is younger, fitter, more educated patients who do not require an examination that are likely to consult so they are likely to be attracting the easier patients with simpler problems.

There is a lack of GPs. These companies will employ a lot of GPs, who will consequently do less work for the NHS which may pay them less and provide them with more complex more stressful work. This would exacerbate the NHS GP workforce crisis. GP and journalist Margaret McCartney fears that it may ultimately derail our health service. “These schemes may mean that you end up having to wait even longer to see your NHS GP, as the workforce becomes more depleted,”

The NHS was founded to provide ‘free and equal health care for all’. Margret McCartney states.  ”These companies are essentially using market forces to determine access to GPs rather than need. GPs working in these companies will probably make more money and have a less stressful career. However, patients are far less likely to benefit. This might work in your favour if you are basically healthy, need a one-off appointment and have the money to pay to put yourself in the front of the queue. But if you have an ongoing condition, or multiple or complex needs, the research shows that your care will be better if you have continuity and are looked after by a team that can care for you holistically.”

 

Good luck in the BMAT ! Some more Essays.

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People injured whilst participating in extreme sports should not be treated by a publicly funded health service. Explain the reasoning behind this statement. Suggest an argument against this statement. To what extent, if any, does the statement justify a change in public attitudes to personal risk taking?

The statement states that people who voluntarily take risks with their health because they participate in extreme sports such as sky diving cannot expect tax payers to pay for their medical care if injured. It is a statement regarding social justice[fairness] because health systems such as the NHS are cash limited so that funds spent on such people will mean that less money is available for treatment for others. In a private or insurance based health system people who take risks would probably have to pay a higher premium.

A person’s autonomy has to be respected. They have a right to decide how to live their life and to do extreme sports if they wish. It is important to be non judgemental and act in the best interests of that patient which means treating injuries. If those participating in extreme sports are denied medical treatment for their injuries a slippery slope may be created in which those suffering from illnesses which may be in part also ‘self inflicted’ such as smoking or obesity related diseases may in future also find themselves excluded from state funded treatment.

At present ethical principles held by most, including the medical profession would value the principles of autonomy and beneficence over the idea that in doing so we would not be fair to others. The statement does put a valid argument to change attitudes to personal risk taking however because of the reasons outlined in paragraph two I disagree with a change of attitudes in this ‘rights versus responsibility debate.’

 

There is money to be made by not curing a disease. 

We spend a lot of money on our health services.The NHS is the biggest employer in this country. The NHS budget is about £120 billion per annum , this is about 8-12% of GNP per annum for most European countries. In the US it is over 18% of GNP per annum. In US today anyone in workforce works about 6- 7 weeks a year to create resources they will then ‘consume’ as health care. Pharmaceutical companies have grown to be the immensely successful giants that they are by providing treatments for long term conditions such as diabetes and hypertension. Long term conditions generate a lot of money for the payment of health workers and for drug companies e.g The treatment of diabetes costs over 10 billion [10% of the NHS budget]a year in the UK. Pharmaceutical companies spend a lot of money on new treatments for diabetes because the financial rewards are so great.

It is unethical and extremely rare for doctors and scientists to withhold ‘cures’ in order to carry on treating the patient. I do not believe conspiracy theories that ‘big pharma’ has cures for conditions but does not want to release them. However when scientists apply for research grants pharmaceutical companies with their enormous R and D budgets will look with more interest at research which is likely to lead to profitable drugs rather than cures which would limit the need for their drugs. The need to generate a profit for share holders may be counter productive  in the quest for cure. In my opinion there it is sad but probable that businesses will focus on treatment rather than cures. Pharmaceutical companies have provided major breakthroughs in the past [eg Sir James Black discovered B blockers and then Tagamet] but over reliance will be detrimental. We face a world threatened by increasing  antibiotic resistance.  Dame Sally Davies the Chief Medical Officer as called on governments to fund research as there is not much incentive for drug companies to fund antibiotics that are just usually taken for a few days while a new blood pressure pill may be taken continuously every day by a patient. Dame Sally said action was needed to overcome this “market failure” and stated that this should be taken up by the ‘Innovative Medicines Initiative’ – an EU funded body whose aim is to promote the development of new medicines. Bill Gates has poured a lot of money into the research of drugs which can cure diseases in the third world where drug companies would not be able to recoup costs. He has also supported GAVI a charity which funds vaccine research to prevent illnesses in the first place. The new rota virus vaccine which kills many children in the developing world has been funded in this way.

We need charities, university research departments and governments to also carry out research, particularly into cures because over reliance on pharmaceutical companies would probably mean more money is spent on research into treatments rather cures.

More BMAT essays.

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a glorious enterprise

 

Science is a great and glorious enterprise-the most successful, I argue, that human beings have ever engaged in. To reproach it for its inability to answer all the questions we should like to put to it is no more sensible than to reproach a railway locomotive for not flying or, in general, not performing any operation for which it was not designed.
What do you understand about the statement above? Explain why it may be argued that science should be expected to answer all the questions that are put to it. Discuss giving examples, the extent to which science has its limits.

Answer

Science has made astonishing progress in increasing our knowledge about how the Universe works. However as the writer points out there are other forms of knowledge as well as the observational and deductive logic that science relies on. A person will use emotional knowledge to tell him whether he likes a piece of music or a painting. The quote tells us critics who complain that science does not have all the answers are right but that does not detract from the value of scientific work.

In an increasingly secular world many people see science as replacing religion. People are attracted to the open values of science and its evidence based approach. They feel that scientific methods could be applied to other forms of knowledge such as psychology and economics. The involvement of science in fields such as the arts has led to the expectation that eventually science will tell us everything, even such matters as why we are attracted to certain people as humans are just products of their biology.

Science will always have limits. Every new discovery will lead to many more questions. In a near infinite universe we cannot know everything. ‘The greater the island of knowledge the longer the shoreline of uncertainty’. Science cannot tell us how to resolve an argument, how to love or what is right or wrong. Empathy, [emotional knowledge] and ethics are different but important forms of knowledge. Science can be used in good or bad ways, for example the germ theory of disease can be used to prevent transmission of disease or in biological warfare. Scientific development should always be within an ethical framework.

We Don’t Live in a World Of Reality, We live in a World of Perception. What do you understand the above statement to mean? Provide examples of how we live in a world of reality and how we live in world of perceptions. What is the common ground between reality and perception.

 

Blind men and the elephant

Answer

Descartes, the famous philosopher imagined a world controlled by an evil demon creating false illusions; he concluded that the only way he could be sure that he existed was because he could think. The film, the Matrix, was based on this idea.  Our view of the world is limited by our perception. Our vision, often regarded as our most important sense only detects a narrow range of electromagnetic wavelengths. Our other senses are similarly limited.

We live in a world of reality to the extent that our senses do not seem to lie. If I touch my desk it feels solid and occupies the space my vision tells me it does. When I call my sister she does hear me. This tells me that we do live in a world of reality. However science tells me that my desk is made up of atoms with enormous spaces between them and even within the atoms there is much more space than solid. Are my senses deceiving me by making it appear solid? We all know of examples of when perception is completely misleading such as in mirages.

It is important to realise that our picture of the Universe is limited by the perception of our senses. We only perceive a small fraction of the Universe. In the old story of the blind men and the elephant, one blind man felt the tail and declared it to be like a snake, another leg and said it was like a tree and so on. All of them were right but all were also wrong. We are stumbling around in the Universe in a similar blind way, reality and perception come together at times but we rarely see the full picture.