Category Archives: Health

Bouncy Castle Case

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Sam Harris was injured while playing on a bouncy castle when he was 11 years old (in 2006). He was accidentally kicked in the head by a 15-year-old and now needs round the clock treatment.

The bouncy castle had been hired by Catherine and Timothy Perry for their triplets’ tenth birthday party. Sam got on to it after asking Mrs Perry for permission. He had earlier been playing football in an adjoining field with his father who was also made a defendant in the case which was brought by Sam through his mother, Janet Harris.

The case against Mr Harris was dismissed but the Perrys were held liable for not supervising the children properly especially in light of the fact that the castle came with instructions not to allow rough play on it or mix children of different sizes.

The High Court has given the Perrys permission to appeal. If an appeal is not pursued, Sam is to receive an interim payment of £100,000.

HIV+ Mother gets Custody of Child

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Justice Gita Mittal of the Delhi High Court said, “There is no law which can deprive a mother of her child because of AIDS,” in a case where a woman’s in-laws tried to deprive her of the custody of her child after the death of her husband.

The woman, Sunita Verma, had apparently contracted the virus before her marriage. Not too surprisingly, her in-laws, Ram Gopal Verma and his wife Phoolwati, decided to say that she should not be given custody of the child because she was of ‘bad character’ and would have bad influence on the child.

The Court does not appear to have said that that fact was immaterial. It merely pointed out that the virus could be transmitted by a blood transfusion.

I can’t help but wonder what would have happened if it had been irrefutably proved that the woman had been involved in a pre-marital relationship.

Sunita Verma is, however, scheduled to have the custody her child handed over her.

http://www.expressindia.com/latest-news/HIV-mother-cant-be-deprived-custody-of-child/305198/

Never Events

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Never Events have been in the US news for a while now. They are creations of health insurers and, as the name suggests, events which should never have happened had the patient had better medical care. They are also events which insurers will not pay for having treated : the hospitals which are responsible for the Never Event having occurred are expected to pay for its treatment.

The Wall Street Journal reported that following the lead of the Federal Medicare programme, ‘Aetna Inc., WellPoint Inc. and other big insurers were moving to ban payments for care resulting from serious errors, including operating on the wrong limb or giving a patient incompatible blood’.

It isn’t entirely clear how this would work in practice though.

As some doctors have pointed out, it may not actually be possible to prevent Never Events ever happening, and insurers certainly haven’t done anything in the way of creating guidelines on how to prevent them.

As one doctor says, “In 2007, WellPoint was ranked as the 35th largest corporation in America and had revenues of more than $56 billion. In 2007, Aetna was 85th on the Fortune 500 with more than $25 billion in revenues. With such vast amounts of resources, why haven’t WellPoint or Aetna funded a study or created some guidelines for healthcare providsers showing us how to prevent these “never events” 100% of the time?” [2]

What they have in essence done is found a way to cut their own costs while talking about ‘patient safety’.

Links:
[1] http://online.wsj.com/article/SB120035439914089727.html?mod=WSJBlog
[2] http://whitecoatrants.wordpress.com/2008/04/07/more-on-never-events/

Against Pro-ana Sites

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The National Assembly — the lower house of the French parliament — has unanimously passed a bill that makes publicly inciting extreme thinness illegal whether in magazines, advertisements or on websites. The bill was proposed by Valérie Boyer who belongs to the ruling conservative UMP party and under it, those who incite others to deprive themselves of food to an excessive degree can be fined up to 30,000 euros or, if the person dies, sentenced to up to three years in prison.
The bill will go to the Senate within a few weeks.

It remains to be seen if the bill will actually help curb anorexia nervosa should it become law.

Sources:
[1] http://www.guardian.co.uk/world/2008/apr/15/france.fashion
[2] http://www.chicagotribune.com/news/nationworld/sns-ap-france-fashion-anorexia,1,7093355.story
[3] http://www.timesonline.co.uk/tol/news/world/article3715030.ece

Woman with Disability Raped, Denied Liberty

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James Chalmers says, “The Times also devotes attention to the Mental Welfare Commission’s scathing “Justice Denied” report on the case of Ms A, a 67 year old woman with a learning disability who appears to have been the subject of repeated assaults which have led not to criminal proceedings against her alleged assailants, but instead to subjecting Ms A to a “protective regime that effectively deprives her of much of her liberty”. The Times report is not online, but there is a BBC News story online, and a summary of the report can be downloaded from the Commission’s website.” [1]

There were no prosecutions because she wasn’t considered to be a reliable witness due to her disability.

According to the BBC report, “She was sexually assaulted by five men over the past decade – none of whom have ever been prosecuted, despite the attacks being reported to police. … Four of these incidents, all of which were reported to the police and the fiscal, involved one man.” [2]

The report on the Commission’s site says:

“The UN Convention on Rights of People with a Disability places a duty on State Parties to ensure effective access to justice for adults with a learning disability on an equal basis with others. For a number of complex reasons, this did not appear to have happened for Ms A. …

We are satisfied that Ms A is protected from further risk of assault. However, we do have serous reservations as to the lawfulness of certain aspects of her current care plan. …

The levels of protection that have been put in place mean that she is barely allowed outside her flat without an escort. We believe that this level of restriction requires an appropriate legal intervention and the safeguards that would accompany it. It was generally acknowledged that Ms A was most at risk from a small number of identified men. The fact that these men were not prosecuted has left Ms A at greater risk. Management of these risks has been through highly restrictive care arrangements. If the people who Ms A claimed (and others believed) had assaulted her had been brought to justice, her safety would be less compromised and these restrictions less necessary. …

It is difficult to escape the conclusion that different standards were applied to Ms A because she had a learning disability.” [3]

Links:
[1] criminalletters.blogspot.com/2008/04/very-bad-news-day.html
[2] news.bbc.co.uk/1/hi/scotland/7349900.stm
[3] mwcscot.org.uk/web/FILES/Publications/Justice_Denied_Summary_FINAL.pdf 

Abortion

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The US Supreme Court legalised abortion on January 22, 1973, thirty-five years ago and the sharp differences of opinion which then existed about the morality of abortion continue to exist.
Countries where abortion is illegal and cannot be performed without the consent of the woman concerned alone scare me quite simply because not having that right means that the woman loses a significant amount of control over her own body and her own life. And no, it’s not about being pro-abortion, it’s not about being stupid and requiring to have one performed due to sheer carelessness or negligence but about being able to make choices since no one can know what’s best in any particular situation but the people involved. Not government and not priests.
Many abortions in the developed world may be the result of irresponsibility. That isn’t true in the developed world though; few women have access to any form of contraception and fewer still are in a position to be able to ensure that they don’t become pregnant. Making abortion illegal does very little apart from forcing people to have children whom they often can’t support or forcing them to have illegal abortions.
I was once told by a friend, a devout Roman Catholic, that he believes that abortion is always wrong because he believes that life is sacred. I believe that abortion is sometimes an ethically viable option because, like him, I too believe that life is sacred. There are few things worse than to create a child whom you cannot support, whom you can’t love, who you know will die a gruesome early death because of some genetic problem or who you know will never be treated with even the slightest amount of dignity by the people in your world.
Thankfully, the Indian Medical Termination of Pregnancy Act seems to agree with this.

Section 3. When pregnancies may be terminated by registered medical practitioners:
(1) Notwithstanding anything contained in the Indian Penal Code (45 of 1860), a registered medical practitioner shall not be guilty of any offence under that Code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act.
(2) Subject to the provisions of sub-section (4), a pregnancy may be terminated by a registered medical practitioner, -
(a) Where the length of the pregnancy does not exceed twelve weeks if such medical practitioner is, or
(b) Where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two registered medical practitioner are, of opinion, formed in good faith, that -
(i) the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or
(ii) there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities to be seriously handicapped.
Explanation 1 – Where any pregnancy is alleged by the pregnant woman to have been caused by rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman.
Explanation 2 – Where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the anguish caused by such unwanted pregnancy may be resumed to constitute a grave injury to the mental health of the pregnant woman.
(3) In determining whether the continuance of a pregnancy would involve such risk of injury to the health as is mentioned in sub-section (2), account may be taken of the pregnant women’s actual or reasonable foreseeable environment.
(4)(a) No pregnancy of a woman, who has not attained the age of eighteen years, or, who, having attained the age of eighteen years, is a lunatic, shall be terminated except with the consent in writing of her guardian.
(b) Save as otherwise provided in clause (a), no pregnancy shall be terminated except with the consent of the pregnant woman.
Addendum:
I just came across this line by a 17 year-old girl: “I feel like we’re all survivors of abortion.” It left me horrified.
What amazes me most about this (and other issues related to women’s rights) is the number of teenagers and young women who advocate turning the clock back. My generation seems to be far more conservative than my parents’; in my own family, I know that my mum is far more liberal than me. Nonetheless, I don’t understand women who say that women shouldn’t have rights such as this, or that domestic violence should not be made a crime etc. Perhaps those who take their rights for granted have absolutely no understanding of what it is like to have to live without those rights.

The Medical Termination of Pregnancy Act, 1971

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In India, abortion is legal under the Medical Termination of Pregnancy Act, 1971. What is illegal is sex selective abortion.

The Medical Termination of Pregnancy Act extends to the whole of India except the State of Jammu and Kashmir and provides for the termination of certain pregnancies by registered Medical Practitioners. The termination of a pregnancy by a person who is not a registered medical practitioner is an offence punishable under the Penal Code.

Under Section 2 (d), a ‘registered medical practitioner’ means a doctor who possesses any recognized medical qualification as defined in Section 2 (h) of the Indian Medical Council Act, 1956, whose name has been entered in a State Medical Register and who has such experience or training in gynaecology and obstetrics as is prescribed by rules made under the Medical Termination of Pregnancy Act.

Notwithstanding anything contained in the Indian Penal Code, which contains several sections that make inducing a miscarriage an offence, registered medical practitioners are not held to be guilty of any offence the Penal Code or any other law, if they terminate any pregnancy in accordance with the provisions of the Medical Termination of Pregnancy Act.

A registered medical practitioner may terminate a pregnancy which does not exceed twelve weeks if he thinks in good faith that the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or that there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities to be seriously handicapped.

In determining whether the continuance of a pregnancy would involve such a risk of injury to health, account may be taken of the pregnant women’s actual or reasonable foreseeable environment.

If the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, not less than two registered medical practitioner must share this opinion for the abortion to be legal.

If a pregnancy is alleged by a pregnant woman to have been caused by rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman.

If any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the anguish caused by such unwanted pregnancy may be resumed to constitute a grave injury to the mental health of the pregnant woman.

A pregnancy can be terminated only with the consent of the pregnant woman. However, in all cases where the pregnant woman is a minor or is a lunatic, the consent in writing of her guardian must be obtained for the abortion to be performed.

Abortions can be performed only at:
(a) a hospital established or maintained by Government, or
(b) a place which the Government has approved for the purpose of performing abortions.

The requirements which relate to the place where an abortion may be performed, the length of the pregnancy and the opinion of not less than two registered medical practitioners, do not apply to any abortion by a registered medical practitioner in emergencies where an abortion is immediately necessary to save the life of the pregnant woman. Also, in such situations, the provisions of the Act which require the doctor to have experience of or training in gynaecology and obstetrics do not apply.

The Central Government may, by notification in the Official Gazette, make rules (subject to modification by Parliament as laid down in the statute) to carry out the provisions of the Act.

The State Government may, by regulations:
(a) require doctors’ opinions as to the need of abortions to be certified by them
(b) require any doctor who terminates a pregnancy, to intimate such termination to the Chief Medical Officer of the State
(c) prohibit the disclosure, except to such purposes as may be specified in such regulations, of intimations given or information furnished in pursuance of the regulations.
Any person who wilfully contravenes or wilfully fails to comply with the requirements of any of the State Government’s regulations is liable to be punished with a fine which may extend to one thousand rupees.

No suit or legal proceedings lie against any doctor for any damage caused or likely to be caused by anything which is in good faith done or intended to be done under the MTP Act.