Choice and responsibility in the NHS

In Defence of Professional Judgement

A judgement is an assertion made with evidence or good reason in a context of uncertainty. In psychiatry the uncertainty is inherent in the professional context, and the evidence derives from the academic literature and scientific studies as they are applied to a specific patient. The nature of the uncertainty and the factors which should inform professional judgement are explored. Professional judgement is currently facing two serious challenges: an obsession with numbers, which comes from within medicine, and the 'patient choice' agenda, which is politically inspired and comes from outside medicine. This paper strives to defend professional judgement in the clinic against both challenges.

Assisted suicide and voluntary euthanasia: role contradictions for physicians

It is widely assumed by the general public that if assisted suicide (AS) or euthanasia (VE) were legalised doctors must be essentially involved in the whole process including prescribing the medication and (in euthanasia) administering it. This paper explores some reasons for this assumption and argues that it flatly contradicts what it means to be a doctor. The paper is thus not mainly concerned with the ethics of AS/VE but rather with the concept of a doctor that has evolved since the time of Hippocrates to current professional guidance reflected in healthcare law. The paper argues that the most common recent argument for AS/VE--that patients have a right to control when and how they die--in fact points to the involvement not of doctors but of legal agencies as decision makers plus technicians as agents.

As novas tecnologias da informação e o consumismo em saúde

Uma ampliação dos conceitos de consumo tem se deslocado na direção de processos sociais até agora não contemplados por categorias tradicionais. A presente revisão analisa a aplicação dos conceitos clássicos sobre consumismo às práticas recentemente identificadas no campo da saúde, como o fenômeno da cibercondria. O desafio teórico se refere à dificuldade de extrapolação das perspectivas econômicas do consumismo às questões do auto-cuidado no contexto das tecnologias de informação e comunicação (TICs). Procura-se compreender o fenômeno da mercadorização do cuidar-de-si sob o imperativo da auto-responsabilização em saúde. São identificadas e descritas as novas identidades consumidoras em vista das inauditas questões acerca dos aprimoramentos técnicos a modificar a natureza do auto-cuidado. Conclui-se que a saúde é consumida como vitalidade decomposta em artefatos de comercializar no contexto de uma nova bioeconomia - não mais ligada à idéia de emulação e posse, e sim a novas formas de perceber-se e cuidar-se perante múltiplos riscos e novas definições do que é ser humano.

Ethical and legal issues in end-of-life care

The doctor has a responsibility to develop and maintain an effective approach to ethical decision making and the skills to implement the correct moral action. At the heart of this process is the experience and knowledge of particular conditions and their outcomes, alongside excellence in communication skills and working with colleagues.

The ethical basis of making decisions about cardiopulmonary resuscitation

This article outlines the clinical ethical concerns around decision making regarding cardiopulmonary resuscitation and how they resulted from lack of clarity in the formulation of the previous guidance. It then reviews new guidance and discusses its wider implications for doctors and patients.

[Combined use of bucolome and pyrazolone derivatives (II). Complex formation due to interaction between bucolome and pyrazolones]

We have already reported that bucolome (BCP), a non-steroidal anti-inflammatory agent, potentiates significantly the analgesic and antipyretic effects of pyrazolones which are substituted by alkylamino group at 4-position of the pyrazolone ring. Physical and quantum chemistry were applied to the mechanism of this synergistic action. The solubility of BCP was markedly increased in proportion to elevation of aminopyrine (AM) concentration, but not by a combination with isopropylantipyrine (IP). The binding of BCP to bovine serum albumin was slightly inhibited by AM, but not by IP. The mixture of AM and BCP in aqueous media generated optical absorption in the ultraviolet differential spectrum, due to the charge transfer interaction. The results of the infrared or NMR spectrum demonstrated the formation of a hydrogen binding in non-aqueous media between BCP and AM. From the calculation of the charge on an atom, the energy of the highest occupied molecular orbital and the frontier electron density, BCP is considered to be a good electron acceptor. The beta-units of Mho of pyrazolones were found to correlate with the potentiation coefficient of analgesic activity in combination drugs. These results suggest that the complex formation between BCP and pyrazolones is an important factor for the synergism of action and is due to the charge transfer interaction and the hydrogen binding of both molecules.