- Email: [email protected]
UK medical research
practice at the time. The public, howWithdrawal of treatment in perceived the appeal as a closing PVS of scientific ranks (Nature 1992; 367: Prof Jean-Pierre Allain, the haematologist1 304). : In the UK the Official Solicitor often has sentenced to prison in connection with: On Monday, Dr Francoise Barrea key role in controversial medical and transfusion-associated HIV infection in Sinoussi of the Pasteur Institute and Prof social legal cases. Now that two important France (see Lancet 1992; 340: 1087) is . test cases have been decided,1,2 the Official Jean-Claude Gluckman of the Pitienow eligible for release but, on his lawyers’ Solicitor has issued practice directions Salpetriere Hospital, Paris, were in Camadvice, he is not applying for it. The prowith regard to applications for the termibridge, UK, to clarify for doctors and cedure includes an appearance before a scientists there any doubts about the nation of artificial feeding and hydration magistrate’s court. In view of the strong1 events of 1984-85. Barre-Sinoussi and for patients in a persistent vegetative state public anger about how HIV-contaminatGluckman had been close observers of the (PVS).3 The procedure will in virtually all ed blood was used in France in 1984-85, events then and had been recruited by cases require the agreement of a High the lawyers believe that the media publiciAllain to join an expert panel in 1985 to Court Judge. It is similar for application ty likely to accompany the court appearrecommend measures to prevent spread of relating to sterilisation of mentally incomance would have an adverse effect on HIV : petent women. through blood transfusion. Allain’s appeal, now approved for hearing: The appeal is expected to be held after Diana Brahams by the Supreme Court. There had been the elections to the European parliament, public fury early this year when doctors 1 and his colleagues in the haematology 1 [1993] 1 All ER 821 at 833; see Brahams D, Lancet 1993; 341: 428. and scientists appealed to President Mit- : department in Cambridge hope that he 2 [1994] 2 All ER 403; see Brahams D, Lancet terrand for a pardon (see Lancet Jan 22, will be able to resume his duties by Octo1994; 343: 286. p 228) on grounds that the actions ofber. ; 3 Harris PM. Withdrawal of medical
J-P Allain’s appeal
rent
ever, had
Allain and the other doctors who faced tri- : al with him had been in keeping with cur- Vivien Choo
for PVS patients: practice note. London: Official Solicitor’s Office, 1994. treatment
Medical School in Hammersmith. Some schemes designed to provide for longerterm careers in research and to retrain The UK government’s science policy women scientists have been introduced. launched a year ago (see Lancet 1993; The postgraduate science training scheme 341: 1441 and 1469) is already having an is under review. : important impact on the Medical The Wellcome Trust, another large Research Council’s strategy, says Sir Dai funder of medical research, saw its income Rees, MRC secretary in this year’s Corporise during 1992/93 by C74 million to rate Plan and Scientific Strategy.’ : 198 million. It spent 135 million supIn 1992-93 the areas receiving the porting medical science (compared with largest support were cancer (20%) and 87 million in 1991/92) and c6million neuroscience and mental health (19%). supporting work on the history of mediAllocation between fields, says the MRC, cine z5million). Its director Dr Bridget is science-led (rather than finance-led), Ogilvie says in her report that the purwhich means that firm predictions cannot chaser/provider split within the health serbe made about future (ie, 1996-97) supvice is having serious consequences on port for particular fields of science, but no clinical research because efforts to provide substantial shift between sectors is expectservices as cheaply as possible have put ed. A new strategy for clinical trials means enormous demands on senior medical staff that in future the portfolio will include with responsibility for clinical training and larger but fewer trials; applicability of the research. The recommendations of the : NHS research task force, chaired by Prof results will carry increased weight. The Clinical Research Initiative estabA Culyer, which are expected to be made lished in 1990 has so far led to the setting public soon, will be crucial, she says. : up of eight centres in which biological and Vivien Choo clinical scientists are brought together to tackle important health problems and the 1 Medical Research Council. Corporate Plan replacement of the Clinical Research Cenand Scientific Strategy. 1994. tre at Harrow by the new Clinical Sci2 Wellcome Trust. 1993 Annual Report. ences Centre at the Royal Postgraduate 1994. Pp 256.
UK medical research
demand for the drug and thus could be deemed to be promotional material, and that the firm was opposed to The French Commission on Control of of the book. : The Commission remains concerned Drug Advertisements has concluded that: the bestseller Listening to Prozac by Peter that fluoxetine and other antidepressants Kramer is not a marketing ruse by the might be used inappropriately for a manufacturers of fluoxetine. The book has widening range of indications and will be been thought to contribute monitoring weekly the sales of these to US sales of fluoxetine (see Lancet April drugs. Should such a trend emerge, the authorities and Lilly will intensify their 9, p 865). Lilly France had, however, education programme on fluoxetine for already written to the book’s publishers, : pointing out the regulatory constraints on doctors.
Bestseller not
drug ad
publication
considerably
advertising prescription-only drugs, that the book
was
likely
to
encourage
public
Jean-Michel Bader
The Medical Ethics Committee of the British Medical Association issued guidelines in July, 1993, noting that current methods of diagnosing PVS are not infallible. "Such a diagnosis should not be considered confirmed until the patient has been insentient for at feast 12 months. Before then, as soon as the patient’s condition has been stabilised, rehabilitative measures such as coma arousal programmes should be trrstituted," the practice note says. An application to the High Court should follow the procedure laid down for sterilisation cases, that having been the subject of an Official Solicitor’s practice note of May, 1993. The case should normally be heard in chambers and the judgment given in open court. The application would seek relief In the following form: "it is declared that despite the inability of X to give a valid consent, the plaintiffs and/or the responsible medical practitioners: (i) may lawfully discontinue all life-sustaining treatment and medical support measures designed to keep X alive in his existing persistent vegetative state including the termination of ventilation, nutrition and hydration by arttftciat means;. and (ii) rnay lawfully discontinue and thereafter need not furnish medical treatment to X except for the sole purpose of enabling X to end his life and to die peacefully with the greatest dignity and the least distress." . The applicants, the practice note says, "may be either the next of kin or the relevant area health authority/NHS trust (which in any event ought to be a party). The views of the next of kin are very important and should be made known to the court in every case". The Official Solicitor should be invited to act as guardian ad litem. <* At least two neurological reports, one commissioned by the Official Solicitor, would be required and other evidence—eg, on rehabilitation or nursing care-may be necessary. . Where the patient has previously expressed his or her views, in writing or otherwise, the High Court has the power to determine the effect on future medical treatment of any such advance directive. The precedents here show that the patient’s previously expressed views "will always be a very important component in the decisions of the doctors and the court". * Members of the Official Solicitor’s legal staff are prepared to discuss PVS cases (and sterilisation ones too) before proceedings have been issued. The telephone number is 071-911 .
7127.
1353
J-P Allain’s appeal
rent
ever, had
Allain and the other doctors who faced tri- : al with him had been in keeping with cur- Vivien Choo
for PVS patients: practice note. London: Official Solicitor’s Office, 1994. treatment
Medical School in Hammersmith. Some schemes designed to provide for longerterm careers in research and to retrain The UK government’s science policy women scientists have been introduced. launched a year ago (see Lancet 1993; The postgraduate science training scheme 341: 1441 and 1469) is already having an is under review. : important impact on the Medical The Wellcome Trust, another large Research Council’s strategy, says Sir Dai funder of medical research, saw its income Rees, MRC secretary in this year’s Corporise during 1992/93 by C74 million to rate Plan and Scientific Strategy.’ : 198 million. It spent 135 million supIn 1992-93 the areas receiving the porting medical science (compared with largest support were cancer (20%) and 87 million in 1991/92) and c6million neuroscience and mental health (19%). supporting work on the history of mediAllocation between fields, says the MRC, cine z5million). Its director Dr Bridget is science-led (rather than finance-led), Ogilvie says in her report that the purwhich means that firm predictions cannot chaser/provider split within the health serbe made about future (ie, 1996-97) supvice is having serious consequences on port for particular fields of science, but no clinical research because efforts to provide substantial shift between sectors is expectservices as cheaply as possible have put ed. A new strategy for clinical trials means enormous demands on senior medical staff that in future the portfolio will include with responsibility for clinical training and larger but fewer trials; applicability of the research. The recommendations of the : NHS research task force, chaired by Prof results will carry increased weight. The Clinical Research Initiative estabA Culyer, which are expected to be made lished in 1990 has so far led to the setting public soon, will be crucial, she says. : up of eight centres in which biological and Vivien Choo clinical scientists are brought together to tackle important health problems and the 1 Medical Research Council. Corporate Plan replacement of the Clinical Research Cenand Scientific Strategy. 1994. tre at Harrow by the new Clinical Sci2 Wellcome Trust. 1993 Annual Report. ences Centre at the Royal Postgraduate 1994. Pp 256.
UK medical research
demand for the drug and thus could be deemed to be promotional material, and that the firm was opposed to The French Commission on Control of of the book. : The Commission remains concerned Drug Advertisements has concluded that: the bestseller Listening to Prozac by Peter that fluoxetine and other antidepressants Kramer is not a marketing ruse by the might be used inappropriately for a manufacturers of fluoxetine. The book has widening range of indications and will be been thought to contribute monitoring weekly the sales of these to US sales of fluoxetine (see Lancet April drugs. Should such a trend emerge, the authorities and Lilly will intensify their 9, p 865). Lilly France had, however, education programme on fluoxetine for already written to the book’s publishers, : pointing out the regulatory constraints on doctors.
Bestseller not
drug ad
publication
considerably
advertising prescription-only drugs, that the book
was
likely
to
encourage
public
Jean-Michel Bader
The Medical Ethics Committee of the British Medical Association issued guidelines in July, 1993, noting that current methods of diagnosing PVS are not infallible. "Such a diagnosis should not be considered confirmed until the patient has been insentient for at feast 12 months. Before then, as soon as the patient’s condition has been stabilised, rehabilitative measures such as coma arousal programmes should be trrstituted," the practice note says. An application to the High Court should follow the procedure laid down for sterilisation cases, that having been the subject of an Official Solicitor’s practice note of May, 1993. The case should normally be heard in chambers and the judgment given in open court. The application would seek relief In the following form: "it is declared that despite the inability of X to give a valid consent, the plaintiffs and/or the responsible medical practitioners: (i) may lawfully discontinue all life-sustaining treatment and medical support measures designed to keep X alive in his existing persistent vegetative state including the termination of ventilation, nutrition and hydration by arttftciat means;. and (ii) rnay lawfully discontinue and thereafter need not furnish medical treatment to X except for the sole purpose of enabling X to end his life and to die peacefully with the greatest dignity and the least distress." . The applicants, the practice note says, "may be either the next of kin or the relevant area health authority/NHS trust (which in any event ought to be a party). The views of the next of kin are very important and should be made known to the court in every case". The Official Solicitor should be invited to act as guardian ad litem. <* At least two neurological reports, one commissioned by the Official Solicitor, would be required and other evidence—eg, on rehabilitation or nursing care-may be necessary. . Where the patient has previously expressed his or her views, in writing or otherwise, the High Court has the power to determine the effect on future medical treatment of any such advance directive. The precedents here show that the patient’s previously expressed views "will always be a very important component in the decisions of the doctors and the court". * Members of the Official Solicitor’s legal staff are prepared to discuss PVS cases (and sterilisation ones too) before proceedings have been issued. The telephone number is 071-911 .
7127.
1353