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This manual is designed to provide teaching modules on medical ethics for health care professionals in developing countries. The author acknowledges that, although there are common themes, their medical ethical dilemmas are often quite different from those which occur in developed countries and the approach needs to be somewhat less Western in orientation. Emphasis is properly given to topics such as AIDS/HIV and the status of women and children which create special local problems. Although universal principles of medical ethics are affirmed, care is taken to avoid the trap of imposing “our” views and solutions on “their” situations. As a teaching aid the manual is well constructed, starting with the enunciation of general principles, followed by comment and a series …

In the late Romantic age, demands for political change converged with thinking about the end of the world. This book examines writings by Lord Byron, Mary Shelley and their circle that imagined the end, from poems by Byron that pictured fallen empires, sinking islands, and dying stars to the making and unmaking of populations in Frankenstein and The Last Man. These works intersected with and enclosed reflections upon brewing political changes. By imagining political dynasties, slavery, parliament, and English law reaching an end, writers challenged liberal visions of the political future that viewed the basis of governance as permanently settled. The prospect of volcanic eruptions and biblical deluges, meanwhile, pointed towards new political worlds, forged in the ruins of this one. These visions of coming to an end acquire added resonance in our own time, as political and planetary end-times converge once again.

In this age of increasing diagnostic aids, the role of clinical skills is in danger of becoming less important. Hospital assessments are driven by complex blood, laboratory, and radiological investigations, with diagnosis often led by clinical pathology rather than clinical examination. The ‘pan-investogram’ is often unleashed early rather than clinical assessment determining the appropriate and carefully selected investigations. Results are perceived as objective whereas clinical examination findings are thought more subjective and less reliable. I recall a 19-year old woman presenting one Monday morning with right iliac fossa pain (RIF) and some rebound and guarding, but no vomiting. There was no relevant gynaecological history, which can often muddy the waters, but I did arrange some immediate blood tests. She was asked to return to surgery …

The most commonly implanted medical device is also the leading cause of infection acquired in healthcare settings. Can the Foley catheter be improved on, asks John Havard, after 80 years largely unchanged

Despite the rhetoric about using less paper in the NHS, it seems to be getting worse.1 The GP2GP service was set up to transfer patient notes electronically when patients move practice. We have been told that 92% of GP practices use GP2GP, file sizes are being increased, and we should not have to print paper copies. However, …

Cyril William Holmes Havard blamed his first name on the bishop who christened him in 1925. “William” or “Bill” was always his usual name, but his insightful parents realised that the initials WC could cause problems at school. Both his parents were special in their own ways. His mother, Aimee, was English and came from an entrepreneurial family of tin platers in Llanelli. As a very young woman she was one of the first ever female drivers for the Ministry of Munitions in the first world war. In her later years, she had a speedboat and took to flying lessons in her 70s. His father was born to Welsh farming stock in Brecon and was actually the second William Thomas Havard, as his older brother had died in childhood, like other siblings. He went into the church and served in France during the first world war as a chaplain, something he never talked about. He did, however, earn a …

EDITOR—The agreement of the recent meeting organised by the European Group on Medical Ethics—that there should be more dialogue between rich and poor countries on cross cultural ethical issues—is long overdue.1 Experts on medical ethics in the developed world have consistently ignored conditions under which health care is provided in developing countries when making recommendations on ethical codes and guidelines, with the result that medical ethics is given little attention in their medical schools and may not be taught at …

David Gullick had been head of school and captain of rugby at Taunton school before he went to Guy’s, where he played rugby to a high standard for its XV, one of the best of the well known of the teams in the hospitals cup. After joining a general practice in Stevenage, he helped to found its rugby club and qualified as a referee, after which he officiated on most Saturday afternoons during the season. But his active participation in the game that he loved so much came to a premature end in the mid-1950s, when he was stricken by rheumatoid arthritis with painful and debilitating swelling of his joints, which he bore with typical stoicism, and had to endure for the rest of his life. In 1958, when he could no longer continue in general practice, he applied for the post of medical assistant secretary on the headquarters staff of the BMA, to which he was appointed from an exceptionally large field of more than 60 applicants. For the next 20 years he commuted almost daily to Tavistock Square, but he was never heard to complain about the discomfort that this must have caused him. David had begun to take an active interest in BMA activities as soon as he entered general practice and he was elected to several committees at both local and national levels. Between 1949 and 1958 he represented his division at every annual …

The UNs Habitat II conference held in Istanbul Turkey among intergovernmental groups was mired in debate over issues such as womens equal rights to inheritance and the term "reproductive health." Major issues were ignored such as changes in disease patterns in urban developing country populations and the consequences of 3 billion women entering their reproductive years within the next generation. The issues of the 500 million women who want to control the spacing of their children and lack of access to family planning education and information were ignored. The author highlights the process whereby a few states obstruct the issue of adolescents access to sex education and family planning services while the incidence of sexually transmitted diseases among adolescents and HIV infection is increasing particularly in developing countries and specifically in sub-Saharan Africa. Only a small number of states objected to womens equal rights to inheritance but the conference agenda was focused on this issue. The improvement in the welfare of mankind is dealt with in one conference and in succeeding conferences the same objections are raised again by a small number of states. Semantic arguments over wording are repeatedly focused on which leaves little time for negotiating effectively on major issues.

Womens health issues which received scant attention at the first three UN world conferences on women gained recognition when the 1987 Safe Motherhood Conference highlighted the numbers of women dying annually from pregnancy-related causes. Since then the 1993 World Conference on Human Rights the 1994 International Conferences on Population and Development (ICPD) and the 1995 Social Summit have recognized that women have a right to the highest attainable standard of health that reproductive health includes sexual health and that womens health affects poverty unemployment and levels of social disintegration. By late 1995 the Commonwealth Medical Association convened a group known as "Advocacy for Womens Health" that has met regularly to promote a comprehensive gender-sensitive and human rights approach to womens health and to comment on draft documents for various conferences. This group prepared for the Fourth World Conference on Women with regional and inter-regional "roundtable" meetings and had a significant impact on the health content of drafts of the Platform for Action. The draft Platform for Action was finalized by the US Commission on the Status of Women with 40% of the text (including all references to "gender") bracketed to indicate a lack of consensus. The introductory Beijing Declaration and its proposed amendments failed to mention womens health and the text of the Platform for Action would create problems in the field of reproductive health. Indeed the draft contains questionable terms such as "feticide" that cloud abortion issues. Re-enforcement of the Cairo consensus on providing reproductive health information and services and government commitment on the protection of womens rights to health is necessary.

The purpose of this lecture is to review the justification for legal interference in physicians' clinical decisions and the consequences of that interference to patients. Discussion covers contraception, abortion, negligence, and defensive medicine. Contraception is normally interpreted as the prevention or inhibition of fertilization or of implantation of the fertilized ovum in the uterus. The extra corporeal or in vitro fertilization program has raised the question of the legal and ethical status of the fertilized ovum before implantation. This is turn has raised questions about contraceptive devices or procedures whose purpose it is to prevent the implantation of a fertilized ovum, of which the IUd is the most common in use in the UK. Congressman Doonan of California moved to amend the US Constitution to provide that "life begins when a sperm cell fertilizes an egg." It may be assumed that this amendment is designed to prevent unacceptable experiments on spare embryos, but the consequences to family planning could be enormous unless some exception is included in favor of IUDs inserted for purposes of contraception. This leads to the issue of abortion and a reminder that until the 19th century it was not regarded as a crime in English common law to abort a fetus before "quickening" had occurred, as this was the point at which the embryo was regarded as having been animated. The Offenses Against the Person Act of 1861 established the current criminal offense of induced abortion to which the Abortion Act of 1967 now provides a defense. Recent developments in life support mechanisms have created difficulties over the extent to which such measures should be employed in the management of children born with life threatening abnormalities. A draft bill has been introduced requiring doctors to take all possible steps to feed defective neonates with life threatening abnormalities who are experiencing serious feeding problems. This means that these infants would have to be force fed irrespective of their prospects of survival and suffering which this will cause them and their parents. Clinical decisions have been most seriously affected by recent developments in the law of negligence. 1 of the main reasons for this has been the unsatisfactory way in which the adversary system of law ldeals with expert evidence. Attempts have been made to provide courts of law in the UK an agreed statement on expert medical matters, there is a long way to go before reaching the position achieved in many civil law countries on the continent of Europe where the experts recognized by the court hammer out an agreed upon opinion through scientific discourse and without the restrictions of evidentiary rules which are aimed more at the establishment of facts than the validity of scientific opinion. Those who attack the medical profession as being paternalistic and authoritative in making clinical decisions involving life and death fail to realize that the easy way out for the medical profession is to treat every case, however hopeless, with the full technology available, disregarding the patient's and family's interests, the costs in resources, and ignoring the stark reality of the problem.

The importance to public health authorities of the mortality and morbidity from child pedestrian accidents is reviewed and attention is drawn to the inadequate state of the available information on morbidity from such accidents. The need to improve the existing statistics is emphasized and the contribution which can be made by epidemiological studies is discussed in the light of the available evidence concerning the human and environmental factors influencing the risk of mortality and morbidity from such accidents. Attention is drawn to the need for public health authorities to become more actively involved in the prevention and control of child pedestrian accidents. The importance of countermeasures being based on proven epidemiological studies is emphasized and it is suggested that countermeasures should be subjected to the same degree of preparation and evaluation as is accorded by public health authorities to other high-risk groups in the population.

Source: Masters Abstracts International, Volume: 40-07, page: . Thesis (M.A.)--University of Windsor (Canada), 1986.