Appeal in Irish "right-to-die" case

The report is cold comfort for WHO. In local needs". Concern was expressed, too, that criticism in recent is in the finding years study said, over "coordination and the "The general justified, study says: proliferation of meetings, workshops and number of large visiting delegations from WHO and other programmes, compartmentalization of the organization, overlaps donors". For countries of extremely limitin mandates between programmes and ed human and financial resources, particimultiplicity in interests among many pating in this flurry of international actors are not conducive to rational and activity took up valuable time and effort, efficient management processes". governments becoming overburdened by It noted that, at the January meeting of multiple, even conflicting, demands. Prothe executive board, the WHO secretariat tecting countries against this was seen by asserted-on the basis of a report from the study as the particular merit of the IOC, which works on the principle that only one group-that the reform process was ahead of schedule, and that the board development is the produce of local: "commended the progress made in implecapacities and the fact that there are no mentation of the recommendations on universal prescriptions". : global change". Several members had : Though few delegates could have seen the study before the discussion of the ICO commented, however, that although considerable effort and resources were being at the end of the assembly’s first week, the devoted to the exercise, "the outcome had unit’s programme was adopted by acclato be real change, not just reports". mation. Seldom had the Assembly witNevertheless the report had good words nessed such unanimity. : for specific WHO programmes, such as : The extrabudgetary-funding study also that against the main tropical diseases, struck a note of warning: and coordination are honourable words in and in particular for the Division of Intensified Cooperation with Countries (ICO) organizations, but seldom costed and budand peoples in greatest need. While geted for, and consequently considered as an additional cost diverting time and focus regarding this unit as possibly "a seed of change, a catalyst for improved WHO away from programme priorities and what is : considered as rewarding for staff careers". coordination", it also made the point that Others please note. low-income countries, the main recipients of WHO activities, "have voiced frequent complaints of bureaucratic inertia, manifested in slow and cautious response to Alan McGregor

Appeal

"Cooperation

;

Ireland’s abortion information : :

Irish GPs can now provide pregnant patients with the names and addresses of abortion clinics in the UK under new legislation signed into law last Saturday. The day before, in a landmark judgment, the Irish Supreme Court had found that the bill (see Lancet March 18, p 718), which had been attacked by both pro-life and pro-choice groups, was not in breach of the Constitution. Under the new Act, doctors are allowed : to give a mother all the necessary informa: tion to enable her to make an informed decision about her pregnancy, provided it : does not amount to advocacy or promotion of termination. Doctors are precluded from actually referring pregnant : : women to abortion clinics abroad. The : patient, having decided to seek an abortion, must make the appointment with the clinic herself. However, doctors can provide any medical, surgical, or clinical: records relating to the woman to colleagues in the relevant clinic once the : woman has decided to have the abortion. But doctors who decide in conscience that they cannot provide information on abortion to women are not obliged to refer the patient to a colleague who will. The new: Act also bans doctors and anyone else . who provides abortion information from: having any financial links with pregnancytermination services.:

;

;

1296

The some

legislation, months ago,

when first was

proposed strongly attacked

the pro-life movement, which claimed that it facilitated abortion. Women’s and other groups, on the other hand, maintained that it did not go far enough and were particularly angry at the prohibition : on doctors’ referrals. Now the Irish College of General Practitioners has created a storm by providing its members with a price list of UK abortion clinics as part of its guidelines aimed at explaining the new law. The chairman of the College, Dr Michael Coughlan, said that doctors had to have some idea of the cost of abortions since expense could be a important issue-perhaps even a : deciding factor-for some women. Although legal in Ireland in certain limited circumstances, abortion is not available in any of the country’s hospitals. Up to 1992, abortion was believed to be against the Irish constitution. However, after the case of a 14-year-old rape victim, the courts found that terminations were permissible in cases where there was deemed to be a real and substantial risk to the life (as distinct from the health) of a mother, which could be avoided only by an abortion. However, successive governments have shied away from structures to allow for the introduction of abortions in Irish hospitals. :

by

establishing

Martin Wall

die"

in Irish

"right-to-

case

The Irish government is

to challenge a ruling allowing a family to withdraw crucial life-support feeding from a braindamaged patient. The Irish attorney general is to appeal to the Supreme Court on the "right-to-die" judgment this week. The judgment is also to be challenged by the institution that has been caring for the

court

in recent years. In the High Court earlier this month the family were given authorisation to withdraw a gastric feeding tube from the patient, a woman in her early 40s. But the court placed a stay on the order for three weeks to allow for any appeal. The family’s application to allow the patient to die was opposed by her doctors as well as by the institution concerned, which has not been named publicly. However, other doctors supported the family in their High Court case. Both sides in the case also produced conflicting evidence from moral theologians on whether the patient, who needs continuous nursing, should be allowed to die peacefully. The High Court was told that the woman has been in a vegetative state for over 20 years. When she was 22 the woman underwent a minor gynaecological operation. The Court heard that during the procedure the patient had a violent reaction to an anaesthetic. She had three heart attacks resulting in brain damage. The court was told that the woman cannot speak, eat, move, feel, or communicate. The High Court judgment-which was the first of its kind in Ireland-has created a sensation in Irish medical and legal circles. It has been pointed out that Irish doctors regularly switch off patients’ lifesupport machines but this is the first time that they have been asked to withdraw woman

feeding. Some in the Irish pro-life movement condemned the judgment which, they feared, could open the way to euthanasia in Ireland. Euthanasia is banned under Irish law and is also explicitly opposed by the ethical guidelines of the medical profession’s governing body, the Irish Medical Council. The Irish Medical Council’s ethics committee will discuss the implications of the High Court’s ruling at a meeting this week. The Irish Hospital Consultants’ Association, which is implacably against euthanasia, said that the Irish medical profession was reluctant to play God with a patient. "Legal and Church opinion has varied but the conclusion is that doctors do not have to use extraordinary measures to prolong life. The question is, what are these measures?", the Association’s secretary general, Mr Finbar Fitzpatrick, said.

Martin

Wall