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Australian doctor puts euthanasia under spotlight
POLICY AND PEOPLE
Northern Ireland resists extending abortion Act
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oliticians from the unionist and nationalist parties in Northern Ireland joined forces on June 20 to block any extension of the 1967 British Abortion Act to the North where terminations are allowed on a restricted basis. Only half the Members of the Legislative Assembly turned up for the debate, although the public gallery was filled to capacity. The motion to reject any extension was proposed by the Democratic Unionists Party (DUP) and passed without a recorded vote. Terminations are allowed in the North in limited cases, including when the pregnancy could jeopardise the woman’s life; when the mother is mentally handicapped; where there is proven contact with rubella; or where there is a substantial genetic risk of the child being born mentally handicapped. Consequently, only 77 terminations were done in Northern Ireland in 1997–98. However, more than 2000 women from the North, a fifth of them under 20-years-old, go to Britain every year to have an abortion. Jim Wells of the DUP opened the debate and said that it was essential that “legalised carnage” was not permitted in the North: “Every 24 h in hospitals in England, Scotland, and Wales an average of 530 human beings are legally killed and disposed of under powers granted by the 1967 Abortion Act.” Joan Carson of the Ulster Unionist party, who opposed the motion, said, “abortion is here whether we agree with it or not . . . In a survey, 11% of general practitioners stated they had experience of seeing women who had been involved in an amateur abortion”. Carson also asked if those supporting the motion were planning to ban the morning-after pill. Sinn Fein’s Mitchell McLaughlin added that, “some doctors [in Northern Ireland] prescribe emergency contraception for patients who do not normally use their practice, while others will not prescribe it at all. Accident and emergency departments are not required to provide emergency contraception, and many do not. Inconsistency in the application of resources is an issue that should be addressed”. Karen Birchard
52
Australian doctor puts euthanasia under spotlight he Voluntary Euthanasia Society of Victoria, Australia, stated on June 20 that the provision of “terminal sedation” to a terminally ill patient, which hastens death while relieving pain, does not cause an unnatural death. Their statement comes in the wake of Victoria’s state coroner’s decision not to have an inquest into the case of a patient who received “assistance” from his doctor in hastening his death. Some weeks ago, long-time euthanasia activist, Rodney Syme, reported the death of one of his patients to the state coroner, Graeme Johnstone. According to Syme the man had cancer which had spread to his brain, lungs, and ribs and had decided to hasten his death by ceasing to eat and drink. Syme agreed to provide palliative sedation and two and a half days later the man died. The coroner was advised that the
T
cause of death was probable dehydration (on clinical grounds) and bronchopneumonia following sedation in a man with metastatic melanoma. The coroner concluded that an inquest, therefore, was unnecessary. Symes also asserted that it was now legal for a doctor to assist a person in their effort to die from dehydration. These conclusions were deemed inappropriate by the coroner, as there had been no formal finding in the case. However Syme is determined to pursue this course of action. He has more cases waiting for a determination by the coroner, whose outcomes may be slightly more controversial. These cases are currently waiting for reports from palliative care experts. If these deaths are suspected to be unnatural then there will be further investigations. Bebe Loff
Germany halts tick-borne encephalitis vaccination cause febrile convulsions in young ermany’s Federal Agency children, in this age group, the risks for Sera and Vaccinations of vaccination outweigh the potenat the Paul Ehrich Institute in tial benefits.” Langen, Germany, The Health has recommended ministry says that that vaccinations Rights were not granted suspension of against tickto include this image in the vaccine borne encephalitis electronic media. Please programme is (TBE) in children refer to the printed a preventative under 3 years old measure as it is be halted. journal. not known how The TicoVac often the febrile vaccine (Baxter convulsions have AG, Vienna, occurred after a Austria), which is TBE vaccine has been suspended vaccine dose. currently the only TBE is caused by a flavivirus and approved vaccine against TBE, has transmitted to humans by infected caused high fever in very young chilticks—in endemic areas, such as the dren. TicoVac was approved for vacdensely forested regions in central cination against TBE in Germany in Europe and Asia, 1–5% of ticks are August, 1999, and the first batches infected. After an incubation period were used in February, 2000. Since of 7–14 days the disease manifests then there have been several hunitself as a flu-like syndrome with dred reports of high fever after use in fever, headache, and vomiting. After very young children. In March the a symptom-free interval of 1–3 vaccine manufacturer recommended weeks 6–10% of patients develop a that only half a dose of the vaccine meningo-encephalitis—rarely a should be given. But more cases myelitis. This may last a few months have been reported which has led to and patients recover spontaneously. the suspension. However there is a 1–2% risk of perAccording to the director of the manent neurological damage and Paul Ehrlich Institute, Professor mortality of patients. the disease is Johannes Löwer, young children are diagnosed by measuring specific not at risk from TBE when vacciantibody-titres in serum. A specific nated. “TBE is very rare in children therapy is not available. under 4 years old. Moreover, the disease does not cause any permanent damage. [But] as high fever can Wim Weber
G
THE LANCET • Vol 356 • July 1, 2000
For personal use only. Not to be reproduced without permission of The Lancet.
Northern Ireland resists extending abortion Act
P
oliticians from the unionist and nationalist parties in Northern Ireland joined forces on June 20 to block any extension of the 1967 British Abortion Act to the North where terminations are allowed on a restricted basis. Only half the Members of the Legislative Assembly turned up for the debate, although the public gallery was filled to capacity. The motion to reject any extension was proposed by the Democratic Unionists Party (DUP) and passed without a recorded vote. Terminations are allowed in the North in limited cases, including when the pregnancy could jeopardise the woman’s life; when the mother is mentally handicapped; where there is proven contact with rubella; or where there is a substantial genetic risk of the child being born mentally handicapped. Consequently, only 77 terminations were done in Northern Ireland in 1997–98. However, more than 2000 women from the North, a fifth of them under 20-years-old, go to Britain every year to have an abortion. Jim Wells of the DUP opened the debate and said that it was essential that “legalised carnage” was not permitted in the North: “Every 24 h in hospitals in England, Scotland, and Wales an average of 530 human beings are legally killed and disposed of under powers granted by the 1967 Abortion Act.” Joan Carson of the Ulster Unionist party, who opposed the motion, said, “abortion is here whether we agree with it or not . . . In a survey, 11% of general practitioners stated they had experience of seeing women who had been involved in an amateur abortion”. Carson also asked if those supporting the motion were planning to ban the morning-after pill. Sinn Fein’s Mitchell McLaughlin added that, “some doctors [in Northern Ireland] prescribe emergency contraception for patients who do not normally use their practice, while others will not prescribe it at all. Accident and emergency departments are not required to provide emergency contraception, and many do not. Inconsistency in the application of resources is an issue that should be addressed”. Karen Birchard
52
Australian doctor puts euthanasia under spotlight he Voluntary Euthanasia Society of Victoria, Australia, stated on June 20 that the provision of “terminal sedation” to a terminally ill patient, which hastens death while relieving pain, does not cause an unnatural death. Their statement comes in the wake of Victoria’s state coroner’s decision not to have an inquest into the case of a patient who received “assistance” from his doctor in hastening his death. Some weeks ago, long-time euthanasia activist, Rodney Syme, reported the death of one of his patients to the state coroner, Graeme Johnstone. According to Syme the man had cancer which had spread to his brain, lungs, and ribs and had decided to hasten his death by ceasing to eat and drink. Syme agreed to provide palliative sedation and two and a half days later the man died. The coroner was advised that the
T
cause of death was probable dehydration (on clinical grounds) and bronchopneumonia following sedation in a man with metastatic melanoma. The coroner concluded that an inquest, therefore, was unnecessary. Symes also asserted that it was now legal for a doctor to assist a person in their effort to die from dehydration. These conclusions were deemed inappropriate by the coroner, as there had been no formal finding in the case. However Syme is determined to pursue this course of action. He has more cases waiting for a determination by the coroner, whose outcomes may be slightly more controversial. These cases are currently waiting for reports from palliative care experts. If these deaths are suspected to be unnatural then there will be further investigations. Bebe Loff
Germany halts tick-borne encephalitis vaccination cause febrile convulsions in young ermany’s Federal Agency children, in this age group, the risks for Sera and Vaccinations of vaccination outweigh the potenat the Paul Ehrich Institute in tial benefits.” Langen, Germany, The Health has recommended ministry says that that vaccinations Rights were not granted suspension of against tickto include this image in the vaccine borne encephalitis electronic media. Please programme is (TBE) in children refer to the printed a preventative under 3 years old measure as it is be halted. journal. not known how The TicoVac often the febrile vaccine (Baxter convulsions have AG, Vienna, occurred after a Austria), which is TBE vaccine has been suspended vaccine dose. currently the only TBE is caused by a flavivirus and approved vaccine against TBE, has transmitted to humans by infected caused high fever in very young chilticks—in endemic areas, such as the dren. TicoVac was approved for vacdensely forested regions in central cination against TBE in Germany in Europe and Asia, 1–5% of ticks are August, 1999, and the first batches infected. After an incubation period were used in February, 2000. Since of 7–14 days the disease manifests then there have been several hunitself as a flu-like syndrome with dred reports of high fever after use in fever, headache, and vomiting. After very young children. In March the a symptom-free interval of 1–3 vaccine manufacturer recommended weeks 6–10% of patients develop a that only half a dose of the vaccine meningo-encephalitis—rarely a should be given. But more cases myelitis. This may last a few months have been reported which has led to and patients recover spontaneously. the suspension. However there is a 1–2% risk of perAccording to the director of the manent neurological damage and Paul Ehrlich Institute, Professor mortality of patients. the disease is Johannes Löwer, young children are diagnosed by measuring specific not at risk from TBE when vacciantibody-titres in serum. A specific nated. “TBE is very rare in children therapy is not available. under 4 years old. Moreover, the disease does not cause any permanent damage. [But] as high fever can Wim Weber
G
THE LANCET • Vol 356 • July 1, 2000
For personal use only. Not to be reproduced without permission of The Lancet.