ETHICAL DILEMMAS
Doctors and the death penalty
Doctors who participate in torture should think about this: the government currently in power will not always be in power.1 A similar problem exists in the United States with respect to doctors’ participation in capital punishment. The state of
North Carolina requires a doctor to monitor “the essential body functions of the condemned inmate.” Recently, the North Carolina
State Medical Board voted to sanction any member who participated in an execution in his or her capacity as a doctor. The
Department of Corrections successfully challenged this, stating that it was interference in the justice system. The case is
now under appeal, but it definitely has a chilling effect on doctors who would try to stand up against an unethical law. (This
is a response to the version on bmj.com.)
Rebecca A Drayer clinical instructor University of Rochester Medical Center, Rochester, NY 14625
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- Miles SH. Doctors’ complicity with torture. Student BMJ 2008;16:344. (October.) http://student.bmj.com/issues/08/10/editorials/344.php
SEPSIS
Essential reading
This article on sepsis is essential reading for prospective doctors everywhere.1 When I left medical school I had little idea about the causes, diagnosis, or management of sepsis. I knew how to diagnose and manage other common life threatening illnesses, such as pulmonary embolism, myocardial infarction, and exacerbations of chronic obstructive pulmonary disease, but I had never heard of sepsis, and I did not appreciate how quickly it could make patients unwell.
In my first set of night shifts I saw a patient who had severe sepsis, and I had no idea what the matter was. Thanks to my
seniors the patient received appropriate treatment but still died within 12 hours.
Since then I have treated eight patients for sepsis, about half of whom have died. During the same period I have only seen
one myocardial infarction and four or five pulmonary embolisms.
The first acutely unwell patient you see when you are a qualified doctor is likely to have sepsis. All medical students should
ensure that they have read and understood this article.
David King foundation year 2 doctor St James’ University Hospital, Leeds
davidanthonyking@gmail.com
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- Haji-Michael P, Cove M. Sepsis. Student BMJ 2008;16:298. (October.) http://student.bmj.com/issues/08/09/editorials/298.php
DRUG ADVERTISING
Using doctors to spread the word
Another form of drug advertising is perhaps more worrying than advertisements in medical journals—peer to peer advertising.1 The drug industry scours the medical profession for consultants and specialists who support heavy use of its products. It
pours money into building these doctors’ reputations. These doctors are helped with research projects; elected onto the boards
of institutions and health advisory panels that are funded by drug companies; promoted in the media; and have countless articles
ghostwritten for them.
It is often difficult to tell which prestigious doctors have been through this mill because the boundary between unbiased
and biased opinion is often invisible. It is important to know that this is going on. Here in Australia we have many health
guidelines that are different to those advised by the UK National Institute for Health and Clinical Excellence, and I think
this is because of drug company influences that are not adequately recognised.
Ben Judd general practitioner Australia
juddbenjamin@hotmail.com
Student BMJ 2008;16:383 | 10
- Martell J. Buy me, I’ll change your life. Student BMJ 2008;16:350-1. (October.) http://student.bmj.com/issues/08/10/life/350.php
HEALTH INEQUITIES
Markets cannot ensure equity
Three inequalities that are inherent in health care are three basic reasons why “health shouldn’t and can’t be a tradeable
commodity.”1
Firstly, there is unequal risk in health care. Ten per cent of patients, elderly and chronically ill people, need 75% of the
care. Secondly, social inequality translates into unequal health outcomes. In other words health has a strong social gradient.
If health care were a basic human right we would have to ensure health equity. If people who have the least resources have
also the most need of care, then solidarity and not commercial gain should be the basis of health care. Solidarity means a
transfer of resources from rich to poor, from healthy to sick and from young to old. Solidarity clashes with the market.
Thirdly, inequality in information is the disparity in information between doctor and patient, or information asymmetry. Health
is not an ordinary product for consumption in which customers (patients) themselves can simply choose, for example, which
drug against hypertension they will take. It is the doctor who chooses and prescribes. Being fully informed is a condition
for optimal working of the market—therefore, patients can never be customers. The market will always fail to ensure health
equity. (This is a response to the version on bmj.com.)
Dirk Van Duppen general practitioner Doctors for the People, Grouppractice, Antwerp, Belgium
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- Davey Smith G, Krieger N. Tackling health inequalities. Student BMJ 2008;16:342-3. (October.) http://student.bmj.com/issues/08/10/editorials/342.php
Blogspot
Read more and leave your comments at http://blogs.bmj.com/bmj
Sue me, please
Siddhartha Yadav blogs on the violence that relatives of patients inflict on Nepalese doctors: “Over the past five years such
incidents have been occurring at regular intervals. As rightly mentioned in the article, high expectation from a doctor is
one of the prime reasons for violent behaviour on the part of relatives of a patient. Doctors are seen as God in the Nepalese
society. The popular belief is that they can treat and cure any condition. Hence nothing can and should go wrong after a patient
is brought to a hospital. And if it does, it is because the doctor did not try hard enough.”
Admissions to medical school
Eva Brencicova, a medical student from Germany, argues that the admissions process to medical school is not fair: “The procedures
of admissions to medical school are extremely varied around the world. Yet they seem to have one thing in common—success is
considered a huge deal. At the next family reunion you are bound to have enchanted relatives patting you on the back, dropping
comments about how you make them proud . . . My own experiences of the admissions process to medical school in Germany have
been far from positive.”
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LETTERS
Sue me, please
(Blog, November 2008)
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Pradip Kumar Chapagain
(December 1st, 2008)
Medical Student,third year, Maharajgunj campus, IOM, Nepal im_pradip@hotmail.com
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Dr Siddhartha yadav has pointed out truly why there is increasing violence in Nepal in medical field and against the doctors.
It is due to high expectations of people to the doctors and also it is due to the feeling of mobocracy and lawlessness that is prevalent in the country. But what doctors must also realise is there is a effective communication gap between the doctors and the patient party. Doctors fail to realise that many such incidents can be prevented if patients are counselled well regarding their treatment and limitations of the therapy. Also Doctors must be honest in telling their abilities rather than hiding their then inability.
But doctors are not alone the culprit. Patient parties and relatives have seen a number of incidence that if they use threat and violence, they can get a large sum of money as compensation(I'd like to say it ransom). And also the government whose duty is to provide security to people haven't been able to. So anyone can beat anyone. Why would doctors be spared? And if you see the court it is so overloaded that it takes a decade for a judge to come to a decision about the case. So no one bothers to walk that roadless path. Why not use a shortcut that seems to rather fruitful? So there is a increase in violence. Also i feel that people of Nepal are filled with agitations due to long standing political instability, underdevelopment and many a times they are laid low by politicians. So one can feel increasing violence in the behaviour of these innocent people.
But humans are the one who can communicate even in the time of war and death. So I hope with a better communication between the Doctors and Patients these incidents can be minimised.
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