Euthanasia for children in Belgium

Last year I wrote about the euthanasia of a 44 year old Belgian transsexual, Nathan Verhelst, which you can find in my blog here. Although Belgium first legalised the right to euthanasia for adults in 2002, recently its Senate voted to extend the law to children who are terminally ill, and suffering unbearable physical pain. Many Belgians support this new draft bill as they believe those children must have the right to decide about their own end of life, but there are also opponents against it, who see it as a slippery slope.

Paediatrician and supporter of the bill, Dr Gerlant Van Berlaer, says, ‘We are not playing God – these are lives that will end anyway. Their natural end might be miserable or very painful or horrifying, and they might have seen a lot of friends in institutions or hospitals die of the same disease. And if they say, “I don’t want to die this way, I want to do it my way,” and that is the only thing we can do for them as doctors, I think we should be able to do it.’

However, Christian Democrat senator, Els Van Hoof, disagrees, and fought successfully to restrict the bill to children with terminal illness suffering unbearable physical pain. ‘In the beginning they presented a law that included mentally ill children,’ she says. ‘During the debate, supporters of euthanasia talked about children with anorexia, children who are tired of life – so how far does it go?’

You can read more about it in this BBC magazine article here. You can also hear more about it by listening to BBC Radio 4′ s The Report – Right To Die programme here.

It certainly raises some difficult ethical questions, and I can understand why euthanasia is illegal in Britain. However, in the Netherlands, euthanasia is already legal for children over the age of 12, if they have the consent of their parents, and if the Belgian bill is passed in the lower house of parliament, Belgium will be the first nation in the world to lift all age restrictions. 

 

Manchester Medical Student – a worldwide internet hit

I read in the Independent news here the other day about a medical student, Tom Leach, who has won an award for his medical blog.

“One day I went into the library and there was a queue for the photocopier where people were copying my notes,” said Dr Leach. So, in 2009, he decided to create a website, almostadoctor.com. He originally only shared his medical lecture notes online with his fellow medical students at Manchester University, but they passed them onto others and soon his website became so popular with medical students around the world that it has now been voted by medical professionals as a global industry innovator, alongside Ben Goldacre and Sir Bruce Keogh.

Now it is used by thousands of students, with hundreds of articles, blogs and course notes contributed from students and doctors around the world.

Dr Leach, now 26 and working in Australia, said: “It’s like the Wikipedia of medicine, with doctors as editors to verify the content, but it’s written in a simple way.”

You can find his blog here.

 

From 2013 to 2014…

2014 is a big year for me; I have my A Levels, I’ll be turning 18, learning to drive and hopefully I’ll be off to medical school. But first I want to reflect on 2013, and some of the things I got up to on my journey to medical school…

I had great fun at Medlink in January, starting the year meeting like-minded people and experiencing university life. I came home even more motivated to study medicine and so I began to write this blog, which you can also follow here.

In February I was selected to visit Auschwitz with the Holocaust Education Trust. It was such a memorable and interesting but moving trip, which made me realise how important it is to always act with integrity.

I also travelled down to Southampton for a week to shadow a consultant Cardiologist. I really enjoyed experiencing day-to-day life in a hospital, and it was interesting to compare it to my work experience in a hospital in Malawi. I saw how much teamwork is involved and the variety medicine brings every day, but  I also saw firsthand the long hours and large workload it involves, as I was lucky enough to stay with the consultant’s family.

As you will have noticed I have a big interest in malaria, and in March after being inspired by the characters in Mary and Martha, I decided to write to my MP about increasing the Global Fund to fight malaria. I didn’t expect to get a reply, but surprisingly I received an invitation to a Parliamentary World Malaria Day meeting at Westminster. I was so excited but I had an even bigger surprise when I was asked to prepare a speech about my experience of malaria, and so nervously I agreed…

In April I travelled to Westminster for the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases. I had to introduce the event by talking about the importance of fighting against malaria, which was quite scary in front of so many experts. Thankfully it went down well and I could relax and enjoy the rest of the evening, which I was so honoured to be a part of. Later on in the year I heard that it had been a success as the UK pledged 1 billion pounds for the Global Fund’s fight against Malaria, HIV and TB. I wanted to do more for Malaria No More, so later that month I took part in the Live Below the Line challenge and lived on only £1 a day to raise money and awareness.

In May and June most of my time was taken up revising for my AS Levels, but I took some weekends off to look around universities on their Open Days. I also began writing my personal statement, anxious to get it out of the way before my busy summer.

July began with a week in Dartmoor on my Gold Duke of Edinburgh expedition. It was exhausting but I had so much fun with our team. We overcame a lot of challenges together, and got along really well despite the difficulties we faced.
I then travelled down to London for some work experience with Alan Dangour at the London School of Tropical Medicine, which was really interesting and I enjoyed doing some research and then presenting it.
I also had a week’s work experience on the Aspiring Doctor’s programme at Stafford Hospital. It showed me the diversity medicine offers, as I shadowed different health professionals in many different specialties, but the highlight was a morning in surgery watching an open bowel operation. I really enjoyed the teamwork, practical element and communication involved. The surgeon was very good at explaining everything he was doing.
I also really enjoyed spending a lot of time volunteering at Katharine House Hospice. I’ve been lucky enough to get to know some of the patients and I’ve learnt that sometimes a smile and a chat can help people to feel so much better. Surprisingly I also learnt how to Bollywood dance, and demonstrated it to the patients with a dance teacher!

In August I travelled down to Southampton to stay with a consultant Nephrologist and shadowed her for a week at Portsmouth and Southampton hospitals. It was a great experience and I really enjoyed being able to talk to lots of patients, as well as medical students and healthcare professionals. A highlight was spending an afternoon in theatre with a Navy anaesthetist, who took time to teach me about his work.

After a welcome holiday in Portugal, I took my UKCAT test, which was quite scary as when I walked in, a girl came out crying, but thankfully it wasn’t half as bad as I had expected.

I sent off my UCAS application in September and I heard back in October with my first invitation for an interview. I was so excited and in return for blogging about it, I was offered a free place on the Success in Medicine Interview Course the day before my interview. It was a really useful course, which gave a lot of advice about the interview and put me at ease with practice scenarios, and their feedback afterwards was very helpful.

In November I was delighted to get another invitation for an interview, and I felt a lot more confident after my first interview. I’m now busy studying for my mocks and waiting to hear from universities about whether or not I’ve been successful. Hopefully this time next year I’ll be at medical school, looking back on another great year.

Malaria No More’s 2013 Highlights

I’m really proud of the part I have played in the 2013 highlights for Malaria No More, helping to halve the child death rates from malaria. This year I’ve taken part in their Live Below the Line challenge, raising money and awareness about malaria. In April I gave a presentation at Westminster for World Malaria Day, which you can read about by clicking on the link below. Here’s a copy of their letter to me:

Dear Megan,

What a way to end the year! We heard last week from the World Health Organization that child death rates from malaria have been halved since 2000.  This is a truly remarkable achievement and you really have played a part in making this happen.

Here at Malaria No More UK we have pulled together our 2013 highlights  – please take a look by clicking here and see what you’ve helped us to achieve. I’m eager to hear your best bits and have handpicked a few of my own below.

Mary and Martha kicking off the year with a considerable buzz.  The TV film, written by Richard Curtis and inspired by our Special Ambassador Jo Yirrell, powerfully conveyed how no parent anywhere should lose their child to a preventable disease. It moved and influenced many of you along with public and political audiences across the world.  We have just made a five minute film narrated by Jo, telling her own story and her support for Malaria No More UK.  Please do watch and share it here.

The UK pledging a record £1 billion to the Global Fund to fight AIDS, TB and Malaria. We’ve been working hard to encourage the UK to take a leadership role as a driving force in the global malaria campaign.  This Global Fund pledge has the potential to save a life every three minutes and to deliver 32 million mosquito nets.

Forging and developing exciting partnerships. We’ve been working with a number of committed businesses and their customers – not least GSK’s Panadol and Jack Wills – to help end malaria deaths. The year is ending on a high as we celebrate the fifth year of our partnership with ITV’s I’m A Celebrity… Get Me Out Of Here! and as the staff at Deutsche Bank in the UK prepare to support us as a Charity of the Year for 2014. To everyone in these organisations we offer a heartfelt ‘thank you’.

Celebrating the support of people up and down the UK.  Our donors, fundraisers and awareness raisers across the country have been making an immense contribution.  Whether you have been living on £1 a day for Live Below the Line or donating the funds that save lives, we are so grateful to you.

Supporting a new initiative saving thousands of children’s lives in Northern Nigeria. We are proud to continue funding cutting edge malaria prevention, diagnosis and treatment programmes in Africa.  In Nigeria malaria takes a devastating toll. This year we are supporting a life saving new treatment there to protect the most vulnerable young children – and we are continuing to support the eventual elimination of malaria from Namibia.

Take a look here at our 2013 highlights!

With renewed thanks from myself and the team and wishing you a joyful and relaxing Christmas,

I’m a celebrity …. get rid of malaria now!

This weekend I’ll be watching the final of I’M A CELEBRITY, Get Me Out Of Here!
Don’t forget that every time you vote to keep your favourite celebrity in the jungle, you are donating 15p to Malaria No More. It costs less than £1 to provide lifesaving treatment to a child so your support really will make a difference towards a world where no child dies from malaria. 

image from http://news.coral.co.uk/wp-content/uploads/2013/11/ImaCeleb.jpg

Government publishes ‘blueprint for trustworthy’ NHS

Today Jeremy Hunt outlined the measures that the government are going to take following the Francis Report into the Mid-Staffs scandal at Stafford Hospital. You can read about them here.

Some of them are outlined below:

• Hospitals will have to publish details of whether they have enough nurses on wards. From April, patients will be able to see the numbers on a new national safety website.

• Hospitals will have to produce quarterly reports on how they are handling complaints and clearly set out how patients can raise them.

• There should be a legal duty of candour on organisations to be open and honest about mistakes.

• A criminal offence of wilful neglect to hold staff to account.

• A “fit and proper person’s test” so managers who have failed in past will be barred from taking up posts.

• A care certificate to ensure healthcare assistants and social care workers have the right skills and training.

• Every patient should have the names of a responsible consultant and nurse listed above their bed.

However, some people do not think the government has done enough and that the legal duty of candour should include all errors – at the moment the government has only said it will apply to mistakes that cause death or severe harm although it is going to consider whether to extend that to include moderate harm. Also, the inquiry wanted the duty of candour to apply to individuals not just organisations.

The Francis Inquiry made 290 recommendations in total. The government has claimed it has accepted all but nine of them. However, of the 281 recommendations the government says have been met, one in four have not been accepted in full. For example, the inquiry called for a system of registration for healthcare assistants, but the care certificate being introduced falls short of that.

However, Robert Francis QC said he was happy that the government’s response was a “comprehensive collection of measures”.

 

Success In Medical School Interview Course

On Sunday I travelled to London for the day for a course in how to succeed at a medical interview. The Success in Medical School Interview course was held in a hotel in Paddington and I arrived at 9.30am, in time for a coffee before we started. There were several other people on the course, some graduates and undergraduates, as well as a friend of mine.

We covered key interview techniques including selling ourselves, our motivation for medicine, and the duties and qualities of a doctor. After lunch we practised communication skills and challenging interview questions, before going over some MMI style questions, such as medical ethics, law, data interpretation and hot topics. We finished around 4.30pm, after discussing the finishing touches, such as body language, dress code and confidence techniques, and were given a certificate for attending.

photo 2

I was really impressed with all the course materials we were given, and that the organisers had tailored it to specific things we’d requested before it started; eg I asked for practice with data interpretation and role play for my MMI interview. Overall I found the course very useful, and I’d recommend it especially if you live close to London, and feel you need some advice and feedback before your medical interview. Dr Ting and Mr Qiu, who organised the course, were both very professional and experienced, and I’d like to thank them both.

Funny video about multiple mini interviews (MMIs) for medical school!

When I was looking up MMIs on the internet, I found this video on youtube, which is a spoof about the medical admissions process, made for the McGill Med/Dent Talent Show in 2011. I thought it was really funny, and it helped me to put the interview in perspective and not to worry too much about it…..

Surgeon jailed for negligence & nurse found guilty of mis-conduct

Yesterday David Sellu, a consultant surgeon, was jailed for 2 and a half years for manslaughter after he failed to act quickly enough to examine and operate on a patient he had diagnosed with a rupture in his bowel. The judge said that the surgeon should have prescribed antibiotics and looked at abdominal scans earlier. Although there was a chance that the patient would die even if he had received treatment, the risks were increased by the delay in action.

Elizabeth Joslin, a lawyer for the Crown Prosecution Service, said: ‘David Sellu’s care fell far below the expected standard, with terrible consequences. Prosecution of doctors for gross negligence manslaughter is rare and the threshold for criminal prosecution is high, but this doctor’s actions were not mistakes or errors of judgment, but negligence so serious that he has now been convicted of a criminal offence.

You can read more about the case in the Guardian here

I thought it was quite interesting that also in the news this week, Janice Harry, chief nurse at Stafford Hospital between 1998 and 2006, was given a 5 year caution, but was still found fit to practice for her part in the Mid-Staffs scandal.

A Nursing and Midwifery Council panel heard that during some night shifts, a single nurse was looking after 17 patients on a ward. It said Mrs Harry should have been focused on staffing levels but she was distracted by ‘training, targets and other matters‘.

The panel told her ‘you had effectively closed your mind to your direct operational responsibilities and had limited yourself to the strategic role. You had the professional responsibility for every nurse in the Trust….you had in the past placed patients at risk of harm.

You can read more about the case here

I think that both these cases show how important it is that doctors and nurses should always put the patient first, and I think it is a good thing that there are stricter controls in place now to ensure that bad practice does not happen in the future. However, it has made me realise just how big a responsibility medicine is, and I will have to make sure that I am always focussed on the patient first and not distracted by other things like targets. I also think it shows how important it is for everyone involved in caring for a patient to work as a team, and to report anything that falls below standard.

Another Invitation for Interview!

I’m really happy because I just heard today that I’ve been invited for an interview at one of my other medical school choices. It’s at the end of this month, so not too far away. This one is more of a traditional interview with a panel of 2 interviewers and will last about 20 minutes, while the first one is MMI (multiple mini interviews) with 6 stations each lasting 6 minutes. I hope I hear from my other choices soon too.

Yesterday I had a mock interview at school, with three of my teachers. It was really good practice and I got some good feedback. They gave me some role play questions, some ethical dilemmas and some traditional questions. I was quite nervous and my mouth went dry really quickly, so I’ll make sure that I take a bottle of water with me for the real thing! I didn’t realise how long 6 minutes is until I had to pretend I’d hit the interviewer’s car and had to role play what I’d do. Some of the answers I gave were too long though, so I’ll have to try to time them better.

image from http://img.allvoices.com/thumbs/image/609/609/93594083-medical-ethics.jpg

The Student room have posted information about what to expect at interviews at all the different medical schools. You can see what to expect here.

Here are some good interview questions that I found on the web. They have all been asked at medical school interviews recently.

Interview with Dr Robert Newman, MD, MPH, Director of the Global Malaria Programme, World Health Organisation

Recently I asked Dr. Robert Newman, MD, MPH, Director of the Global Malaria Programme at the World Health Organisation, a few questions about malaria.

This is what he said:

Me: Drug and insecticide resistance, lack of global funding, and poor testing and treatment facilities in many infected areas are some of the obstacles to eradicating malaria, but which one gives you most cause for concern?

Robert Newman: While all of these issues are concerning, the greatest threat to continued success in the control and elimination of malaria is financial rather than biological. While there has been a massive increase in international funding for malaria, from less than 200 million USD annually to nearly 2 billion USD today, that total still falls far short of the more 5 billion USD annually that are required to scale up life-saving malaria interventions.

That said, parasite resistance to antimalarial medicines, and mosquito resistance to insecticides are also major threats to success. In the past, the spread of resistance to chloroquine in Africa was responsible for major increases in child mortality on the continent. We now have resistance to artemisinins that has emerged in the greater Mekong Subregion. For the time being, this is restricted to four countries (Cambodia, Myanmar, Thailand, and Viet Nam) but given population movements in Asia and the world, the geographic scope of the problem could widen quickly.

Insecticide resistance has been detected in 64 of the 99 countries with ongoing malaria transmission. This affects all classes of insecticides that are used in malaria vector control, and has had the worst impact on the pyrethroids, which are the only class used on insecticide-treated nets. While vector control tools remain effective in most settings, this issue needs to be addressed urgently to prevent a global resurgence of the disease.

WHO has released global plans on the management of these two biological threats (The Global Plan for Artemisinin Resistance Containment and the Global Plan for Insecticide Resistance Management). If adequate funding were available, both challenges could be fully addressed.

Me: I read recently that the UK has pledged £1 billion over the next 3 years for the Global Fund, which is really good news for the fight against malaria. What do you think is the most positive news in the fight against malaria today?

Robert Newman: The most positive news today is the steady decline in malaria cases and deaths that have occurred over the past decade. The unprecedented scale up of life-saving malaria interventions, including long-lasting insecticidal nets, indoor residual spraying, diagnostic testing, and effective antimalarial treatment (especially with artemisinin-based combination therapies or ACTs as they are known) has resulted in an estimated 26% decline in malaria mortality rates globally, and a 33% decline in the WHO African region.

Malaria interventions saved an estimated 1.1 million lives over the past decade; this is a tremendous achievement. But the gains are fragile, and history shows us just how quickly malaria can resurge if funding is decreased or stopped. A decade of progress can be undone in one or two malaria transmission seasons.

Me: Do you think you will see a world without malaria in your lifetime?

Robert Newman: I do believe that I will see a world without malaria in my lifetime, but this requires a few assumptions to be met:

a) that I have a long life (as I think global malaria eradication is probably 40 years away)

b) that political and financial commitment to control, eliminate, and ultimately eradicate malaria continues

c) that innovative tools continue to be developed that allow us to stay ahead of the mosquito and the parasite, and

d) that overall development continues, especially in Africa.

I am optimistic that these assumptions will be met, and I believe that human beings are capable of amazing things when we dedicate ourselves to solving a challenge and then work together to get there.

I’d like to thank Dr Newman for his generous time in answering these questions for me. I first met Dr. Newman when I went to the APPMG at Westminster to give a presentation about malaria for World Malaria Day in April. This is what he said afterwards: ‘I very much enjoyed meeting you… during the All-Party Parliamentary Malaria Group meeting earlier this year, and I was so impressed with what you said, and the way you delivered it.’

You can read my presentation on the APPMG website here, and read what the other speakers said here.

Success in Medicine Interview Course

In about 3 weeks time I have an interview for medical school, which I’m really excited about (and a little bit nervous).

To help me prepare I’m going on the Success in Medicine Interview Coursewhich you can read about here. 

It is a one day intensive course, including mock interview questions, interview techniques and current medical issues. The course looks really interesting and helpful, especially because you are given individual feedback to improve your performance.

I’m looking forward to going, and I’ll let you know what it’s like.  

Ada Lovelace Day

Today is Ada Lovelace Day, a worldwide event to promote female role models in the STEM subjects (Science, Technology, Engineering and Maths). Ada Lovelace Day encourages people to talk about women scientists and engineers that have inspired them, with the hope that more women will be encouraged to work in these areas. You can read more about it in this Guardian article.

Ada Lovelace was the world’s first computer programmer in 1842, well before computers were even invented. Her friend, Charles Babbage came up with the idea for an Analytical Engine and he asked Ada to translate his lecture notes for him from French to English. However, she did much more than that.

Suw Charman-Anderson, the founder of Ada Lovelace Day, said: ‘Ada wrote what is essentially a computer program. She wrote a description of how the machine could be programmed using punched cards to calculate Bernoulli numbers, a complex series of numbers. She broke the process for calculating the numbers down into small formulae and then she described how you would code those formulae into punched cards, so it could be worked out by the machine. She understood that the Analytical Engine could actually be used, given the right algorithms, to create music or to create art.’

Ada’s mother was responsible for making sure she had an education in maths and the sciences, after her father, the poet Lord Byron, left them when Ada was only a month old. Sadly, Ada died of cancer of the uterus, aged just 36, and her work wasn’t recognised until much later after her death. Now she is recognised as being more than 100 years ahead of her time.

You can read more about her here.

Since I became interested in studying medicine, I have learnt about the historical role of women in medicine, such as Elizabeth Garrett Anderson, the first female British doctor, Florence Nightingale and Marie Curie. During the past year, I’ve shadowed two really good female doctors, Kirsty Armstrong and Sue Heyes, who have both shown me what women can achieve in medicine now, here and in Malawi, and I can’t wait to become a doctor and hopefully inspire others like they inspired me.

Read about more inspiring women in science, technology, engineering and maths here.

Ethics of Euthanasia

This week I was shocked to read a BBC news article about the euthanasia of a 44 year old Belgian transsexual, who was so unhappy with his sex change that he wanted to die. Two doctors made the necessary decisions that he was within his rights to choose euthanasia, saying: ‘Patients must be capable of deciding for themselves. They must be conscious and have to give a “voluntary, considered and repeated” request to die.’

Nathan Verhelst was legally killed on September 30th. I wonder if he might have felt differently in a few months, if he had had more counselling and psychological help.

One of the things I found particularly shocking about this case was that it didn’t make the headlines. In Belgium, euthanasia is not very controversial and MPs there are even now deciding whether to lower the age limit to make euthanasia available to under-eighteens. You can read more about that in The Independent news article here.

I believe that this could be the start of a very slippery slope. Can a child make the decision whether it is better for them to live or die? Do the child’s parents have the right to decide to kill their child, even if it is for humane reasons?

It is questions like these which make me glad that euthanasia is illegal in this country. I feel especially strongly about it, having visited the death camps at Auschwitz, where euthanasia was taken to horrifying extremes.

Since the Harold Shipman case, there are now much better regulations in place to ensure that doctors can’t kill their patients, and doctors have to be revalidated every 5 years to ensure they are doing the best for their patients.

As a doctor, I would always want to do the best for my patients without causing them harm. However, I know that I shall have to make some difficult ethical decisions, such as whether or not to withdraw treatment for a terminally ill patient (Extraordinary medical care), or whether to give a drug to relieve pain, knowing that it might cause the patient to die sooner (the Doctrine of Double Effect).

You can find out more on this BBC ethics website which sets out the arguments for and against euthanasia and assisted suicide really clearly.

 

New vaccine against Malaria

I heard on the radio this morning that trials of a new malaria vaccine in several African countries have shown really positive results. I also read an article in the Guardian which explained that 941 cases of malaria were averted for every 1000 children vaccinated and that the vaccine against malaria could be introduced into some of the world’s worst-hit countries in 2015.

This is really exciting news because malaria is such a huge problem with about 219 million cases worldwide and about 660,000 deaths every year so a vaccine will help to save many lives, along with existing preventions and treatment. This vaccine against malaria has also broken new medical ground as the first vaccine against a parasite, so it could lead to developments against other parasites too.

The General Medical Council and Tomorrow’s Doctors

The General Medical Council have recently published a news article about the failure to prosecute 4 doctors who held management positions at Stafford Hospital, because of a lack of evidence against them.

They are currently working with the Department of Health: ‘…to see what more can be done to increase appropriate accountability when things go wrong. In particular we have been exploring a number of changes to our powers to make our fitness to practise procedures more effective. We want to be able to hold doctors to account where they have harmed patients or put them at risk, even if they have subsequently shown insight and can claim they are no longer a risk to patients. We also want to have a right of appeal against panel decisions by the Medical Practitioners Tribunal Service – this would allow us to act when we believe the panel has been too lenient. We hope these changes will form part of the Law Commission’s current wide ranging review of the law governing the regulation of health care professionals.

You can read the article here.

The GMC also sets standards for teaching, learning and assessment and they have issued a document called Tomorrow’s Doctors for medical students which sets out the knowledge, skills and behaviours that medical students must learn at UK medical schools and be able to demonstrate.  

image from http://www.gmc-uk.org/Tomorrow_s_Doctors_1011.jpg_49300474.jpg

Latest research on the long-term effects of malaria

Chris Moxon, clinical lecturer at Liverpool University, has just published a study in the Journal of Infectious Diseases that shows there may be a link between repeated bouts of malaria in children and a greater likelihood of them becoming ill later in life with other illnesses like cardiovascular disease (read more in this LSTM article).

This is because their blood vessels become inflamed when they have malaria, and they may remain inflamed throughout their life making them leaky and susceptible to blocking with fat. He suggests the possibility of treating the children with statins in the future to help reduce the inflammation, and prevent further disease.

I was particularly interested in this study which was carried out on 190 children in Blantyre, Malawi, because I used to live there, and my brother also caught malaria while we were there.