Should the UK switch to an opt out organ transplant system?

In the UK there is currently an Opt in organ donation system. This is where people have to actively sign up to a register to donate their organs after death. In opt-out systems, organ donation will occur automatically unless a specific request is made before death for organs not to be taken. However, there is much deliberation over whether the current policy should remain in place or be changed.

For living people, the ability to control what happens to their bodies is acknowledged to be a fundamental right of all competent adults. Patient autonomy is a key legal and ethical concept that is so highly regarded that it even allows competent adults to refuse life prolonging treatment. (Somerville 2012) So why should we threaten this autonomy with something morally unjustifiable even if a policy sounds medically desirable? Patient autonomy may not be respected because they may be unaware of the changes put in place. If this is the case, then the consent by which the government are taking the organs is not informed and therefore is it justifiable to remove a person’s organs when they have not expressly said they want this to be done. This would go against the human tissue act 2004 because there is not the appropriate level of consent. A human’s relationship with their body can be hugely important to the value of their lives which places deontological constraints onto what others should be able to do with our bodies after we die. Furthermore, a lot of people have interests that survive their deaths including their faiths so ignoring these interests could be a showcase of disrespect and potentially cause posthumous harm. (Glannon W 2003)

On the other hand, the most attractive and persuasive facet of an opt out system is the potential increase in donation rates; it is assumed that there is a positive correlation between opt out systems and a rise in donation. More than 6,500 people in the UK need a transplant, but a shortage of donors means that around 3,500 transplants are carried out annually.  The British Medical Association recently recommended an opt out scheme with safeguards as the best method of improving organ donation rate. (BMA 2012) As we have found through medical experience, a transplanted organ has the ability to save someone’s life, and can also improve the quality for life for many. Despite the success of these surgeries, there is still not enough organs to meet the demands of the National Health Service. So why wouldn’t we operate an opt out scheme if it meant a better quality of life for many people?

If most people are donors, supply may exceed the demand for the organs. If this does occur, how do we distinguish between the organs which are donated? This would mean valuing one person’s body higher than someone else’s. In addition to this what would happen to the organs which are not used. Organ removal without the expressed wish from a deceased patient who hadn’t considered that they would need to ‘opt-out’ could be very distressing and upsetting for family members too.

Subsequently, it’s said that most recipients would prefer their donated organs to come from someone who had made a deliberate decision to donate. However, all statistics indicate that many more people are prepared to donate their organs after death than are registered as potential donors. With this new system, it saves people from the inconvenience of having to register, as they are automatically put forward for organ donation. Those who have strong opinions still do have the option to opt out, and will be made easy to do so, however it is slightly inconvenient, which may sway people to not do it, meaning more organs for the NHS, meaning more lives can be saved. Therefore an opt out policy should be enforced.

Another argument against Opt out schemes is that the pressure from society/positive stigma associated with organ donation may deter people from choosing to opt out even if this was their wish. If they were made to feel selfish this may put people off expressing their right to choose what happens to their body. It creates social tensions example, if a terminally ill person opts-out they may be made to feel selfish; highlighting a sudden inadequacy of right to refuse. This is unfair. A person should have the right to decide what happens to their body, whether it be for the greater good or not. Therefore an Opt out system is highly unethical.

An argument for opt out organ donation, is that a dead body is an inanimate object and has no use. Although it may hold sentimental value, once somebody has died, they do not longer require their working organs. If a person has viable and working organs when they decease, why would these be wasted? The dead body is incapable of feeling, thus there is no pain involved. Doctors are also competent to respect the cadaver’s body, meaning that the person would still be looked after, and receive good medical treatments, even when they’re deceased.

Another argument against the opt out system is that it could threaten individual rights in a number of ways, particularly with the conflict of interests between care of the dying and those waiting for organs in a way that the state could gain unwarranted control and ‘exploit’ donors. Moreover, there is fear that the new system could be misused, such that donation procedures could be implemented before patients are confirmed dead or that less effort will be made to keep patients alive if their organs could help younger patients awaiting transplantation and medical professionals may consequently hasten death. Along with fears that their bodies will be mutilated. This goes against the ethical law of non-maleficence. If an organ is removed before a person is pronounced dead, it harms the patient. (Automatic organ donation: The pros and Cons, 2016)

To counteract this, Doctors go through 5 years of intense medical training, before they start working as a Junior Doctor. This is an adequate amount of time for the people to learn and appreciate ethical laws, and become competent Doctors. It is extremely unlikely that a Doctor would ‘hasten death’. Therefore we should not worry about the ability of our Doctors, as they are fully aware of medical laws and know the consequences of not acting in the best interests of the patient.

To conclude, I believe that the UK should not change to an opt out system. In an ideal situation individuals should make a positive choice to donate tissues or organs after their death for the benefit of others without coercion or manipulation. I also feel that donating your organs after death is a valiant thing to do; if everyone were to donate their organs it wouldn’t be as much of a good deed, therefore possibly increasing the number of people who would opt out, as it would be seen as devalued, and pointless. Therefore I think we should keep the current system, however we should raise the awareness of organ donation, as the benefits from it are really important within the health service.

 

 

Automatic organ donation: The pros and cons (2016, 12 ,8) Retrieved from the Week: http://www.theweek.co.uk/35635/automatic-organ-donation-the-pros-and-cons

English, V Sommerville A Presumed consent for transplantation: a dead issue after Alder Hey? A journal of Medical Ethics 2003;29:147-152

BMA, Building on Progress: Where next for organ donation policy in the UK?‟ (February 2012, BMA Medical Ethics Committee) 69.

Glannon W Do the sick have a right to cadaveric organs? Journal of Medical Ethics 2003;29:153-156.

The 4 Pillars Of Ethics

With exams over, now it’s time to focus on the UKCAT and personal statement. Shortly followed by that, thinking about the interview. A key piece of knowledge for the interview is the 4 pillars of ethics, which is what I’ll be explaining today.

Autonomy

Beneficence

Non-Maleficence

Justice

Autonomy

‘Freedom from external control or influence; independence’

Autonomy basically means that the patient has full control over the treatment they receive. As long as they’re conscious and mentally able to make a decision, the Doctor cannot impose a treatment on the patient.

Beneficence

‘(Of a person) generous or doing good.’

Beneficence is when Doctor, has a duty to promote the best course of action for the patient. It must be considered whether the that treatment is compatible with the patient’s individual circumstances, does the treatment meet the patient’s expectations, and if the treatment resolves the patients medical condition.

Non- Maleficence

‘A principle of bioethics that asserts an obligation not to inflict harm intentionally.’

In order to be non maleficence, the medical professional must put no harm on the patient. Things to consider are the patient’s dignity and respect, risk factors to the patient, do you as a medical professional have the skills to perform the procedure in question.

Justice

‘The quality of being fair and reasonable.’

Is the medical procedure in question legal, also that no one is unfairly disadvantaged when it comes to access to healthcare. An important factor to think about is whether something affects another person’s human right, and whether it favors one group of people over another.

Thank you.

 

 

 

 

The Future of the NHS

2018 is the year in which the national health service turns 70. With 2016 being labelled as the ‘Armageddon of the NHS’ stated by the bbc, it was clear that in 2017 the structure and course of the NHS had to change.

This information has been taken from the executive summary of the 5 year plan for the NHS.

The most commonly form of NHS treatment given to the public is through General Practices. With waiting times on the rise, it has been published that within the next 5 years 3,250 general practitioners are going to me recruited.  Also the access and availability of GP appointments is looking to be improved. By march in 2019 the whole country will benefit from access to GP appointments later on in evenings and at weekends. In order to carry this task out, funding for primary care is going to increase by £2.4 billion.

As most of you will know Theresa May has abolished the current mental health act. This a great step forward in the acknowledgement of mental health issues. The current treatment of mental health is poor, with thousands going without the help they need. In order to combat this the NHS has proposed to give 60,000 more people getting treatment. Also as mental illness is becoming more common in children and teens, 35,000 more young people shall receive treatment. This will be implemented by recruiting 800 mental health specialists within the next two years.

By 2030 it is estimated that 30 million people will have/have had suffered from some form of cancer. The NHS proposed that next year 5000 extra people a year will survive from cancer. Currently it is a lengthy 62 day stint that people with worrying symptoms related to cancer go through from referral to diagnosis. This is worrying as cancer grows quickly meaning that precious time is taken away from these people, when they could be receiving treatment. The NHS aims to cut this period down to 28 days by 2020. To make these changes a huge £94 million is planned to be spent over the next 18 months to make these changes.

These are only a few of the many changes that the NHS wishes to carry out. There are many more on the NHS England website if you are interested.

Thankyou.

The Uses Of Barium Sulfate In Medicine

Slightly different post this week- I recently did a school project on the uses of Barium Sulfate within medicine. I have cited the sources below incase you would like to do some further reading.

Barium sulfate is an odorless, insoluble white powder used in order to ingest and then for it to be used as a contrasting agent in X-raying the digestive tract. It is also used in various manufacturing applications and mixed into heavy concrete to serve as a radiation shield. [1] Barium is a heavy metal, it’s a water-soluble element and highly toxic. [3]

Unlike visual light, x rays pass straight through objects. Which is not useful for viewing organs in the body, as organs and tissues are a lot less dense than bones thus they do not show us on x rays as the rays pass straight through. [2] Therefore we use an artificial contrast called barium sulfate.

 

As Barium sulfate is ingested, it is extremely useful for investigating the digestive tract. [2] Barium ions are opaque to X- rays and can absorb X-rays more strongly than other compounds. In order to produce the liquid suspension of Barium sulfate that is given to the patients to ingest, water is added to the powder. The patients will be asked to drink the liquid before the test; barium molecules will go through the digestive system and cover all the lining of the system, that procedure is called barium meal. When air is introduced to expand the gut after the meal has been ingested, really detailed pictures of the bowel lining can be produced, using the thin layer of barium. Small tumors and ulcers can be diagnosed in this way. Whilst the liquid flows through the digestive system, X-Rays will be taken, and the shapes of the coated organs can be clearly seen, to look for problems in the digestive system. [3]

 

Barium is only highly toxic if it is in a water soluble salt. Barium sulfate is ok to use as it is insoluble in water meaning it forms a suspension not a solution in water. If it forms a solution it wouldn’t be useable as it would be absorbed into the body which leads to barium poisoning.  Barium poisoning can cause vomiting, colic, diarrhoea, tremors and paralysis. [4]

 

Common side effects of ingesting Barium sulfate include:  bloating, constipation, nausea and vomiting, tightness in the chest and troubled breathing. [5]

 

To conclude, Barium Sulfate is incredibly important in medicine as it is the only way that that digestive system can be examined medically without invasive surgeries. It only has few minor side effects however it is to be used with caution due to the risk of barium poisoning which can be extremely dangerous for the patient.

Source Appendix

 

[1]Harvard Catalyst Barium Sulfate”. Harvard Catalyst. N.p., 2017. Web. 29 Apr. 2017.

[2]Barium Sulfate Used In X-Rays. prezi.com. N.p., 2017. Web. 29 Apr. 2017.

[3]YMCICHEM – B- Why Is Barium Sulfate Safe To Use For X-Rays Of The Digestive System Even Though Barium Ions Are Poisonous?. Ymcichem.wikispaces.com. N.p., 2017. Web. 29 Apr. 2017.

[4]”Barium”. Education in Chemistry. N.p., 2017. Web. 29 Apr. 2017.

[5] Barium Sulfate Side Effects In Detail – Drugs.Com”. Drugs.com. N.p., 2017. Web. 29 Apr. 2017.

The Different Types Of Breast Cancer

Breast cancer is cancer that starts in the tissues of the breast.  In the US 40,000 women die of this cancer each year. Before I begin this post, even though breast cancer is extremely uncommon in teen girls as their breasts are still developing it is important to self examine or at least learn how to self examine from age 17 and learn what feels normal, as if someone is unfortunate enough to get breast cancer, it increases the likelihood of it being caught quickly.

Some forms of breast cancer can be due to issues with hormones. These hormones being oestrogen and progesterone. Oestrogen is the primary female sex hormone as well as a medication. It is responsible for the development and regulation of the female reproductive system and secondary sex characteristics. Progesterone is another female sex hormone which is used to stimulate the uterus to prepare for pregnancy.

One type of breast cancer is oestrogen receptor (ER) positive. This type of breast cancer is sensitive to estrogen and may respond to hormone therapy. There is then Progesterone receptor (PR) positive. This type of breast cancer is sensitive to progesterone and may respond to hormone therapy. Finally there is Hormone receptor (HR) negative. This type of cancer doesn’t have hormone receptors, so it won’t be affected by treatments aimed at blocking hormones in the body.

With the first two types mentioned, the hormones link to cancer as the cancerous cells have receptors that feed on those hormones. Which in turn stimulates the receptors causing the cell to grow.

The treatment for estrogen and progesterone receptor positive types is by using hormones.  These may inhibit or stop the production of these hormones. The most common hormone therapy drug is tomoxifen. Which blocks oestrogen receptors in the cells. Hormone inhibitors on the other hand cut off the cancer cells food supply causing them to die, however it is to be noted that these are only used in post menopausal women.

Thank you for reading.

New Study Shows Women Aren’t The Only Ones Who Can Use Contraception

Gynecology is one of my favorite specialties in medicine. I find it fascinated how the vagina, uterus and ovaries can do such an amazing thing: reproduction. However women aren’t the only things needed for conception, obviously a male is needed too.

sperm

For years, it has been a woman’s job to protect against unwanted pregnancies using birth control and tracking our cycles. However there has recently been a change in events.

A new research study suggests that Men can take birth control shots to prevent pregnancy in their female partners. Researchers are still working to perfect the combination of hormonal contraceptives to reduce the risk of mild to moderate side effects, including depression and other mood disorders.

The hormones contained within the shot work on lowering the sperm count in males.

In the study the men were given injections of 200 milligrams of a long-acting progestogen called norethisterone enanthate (NET-EN) and 1,000 milligrams of a long-acting androgen called testosterone undecanoate (TU) for up to 26 weeks to suppress their sperm counts. The hormones were effective in reducing the sperm count to 1 million/ml or less within 24 weeks in 274 of the participants. The contraceptive method was effective in nearly 96 percent of continuing users. Only four pregnancies occurred among the men’s partners during the efficacy phase of the study.

However the injections gave some side effects that made 20 men leave the study. The men reported side effects including injection site pain, muscle pain, increased libido and acne. Also many mood disorders were reported such as depression.

Despite these side effects more than 75 percent of participants reported being willing to use this method of contraception at the conclusion of the trial.

This shot is not available yet but hopefully within a couple years, this may be an option for contraception.

Thankyou.

Drug Re purposing for Rare Diseases

Medicine is always changing, reforming and altering. In order to provide the best patient care there needs to be new innovation every day, or else not everybody’s needs will be satisfied.

You may wonder what I mean by ‘needs be satisfied’. Well withing British medicine the word ‘needs’ can be extremely broad. However in relation to today’s topic it means from the normal, common diseases to the rare uncommon diseases.

nrclinonc.2015.169-f1

In the EU if 1 in 2000 people have a particular disease, in order for it to be classified as rare. Also in the UK 3.5 million people live with rare diseases, and due to their rarity, can be chronic and life threatening. Sadly, at the current rate of development, it would take 500 years to formulate new drugs for all of these diseases. However there is something else we can do to speed up this process.

nm.3595-F1

Drug re purposing is discovering new uses for approved drugs to provide the quickest possible transition from bench to bedside. It works in two ways:  identification of candidate drugs and testing of their effect.  Prior knowledge about drugs and re purposing studies has helped us to follow these two steps.

Re purposing studies have allowed us to form intelligent drug screens, which specifically target a small set of drugs thought to act on the relevant pathway.

For example, the re purposing of one of the first monoclonal antibodies which has been re purposed from cancer into multiple sclerosis, acting to effectively boost the immune system to protect against the disease’s degenerative effects.

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After a re purposing opportunity is identified, the second major component of a re purposing study is the proof of concept. This is the completion of rigorous preclinical and clinical trials to test the effect of the candidate drug in the patient population. This rigorous testing process will hopefully help us cure more diseases than we could have ever dreamed of.

A massive advantage of using re purposed drugs is that its using known substances, that has been shown to be absorbed by the body and also more importantly, safe for human consumption. This means it saves time and money dramatically.

Thankyou.

 

Work Experience 101: Hospital Work Experience

From Tuesday 28th of February until Thursday 2nd March I was given the amazing opportunity to do 3 days of work experience at Derby Royal Hospital on the ‘Hospital Experience Program for Potential Medical Applicants’ AKA HOSPEX.

This work experience was very challenging for me. Although I was only observing, finding my way around the hospital and being thrown into an unfamiliar environment with people I have never met before was amazing growth for me. Overall I gained so much confidence from the experience as I had to be completely independent.

On the first morning, I was thrown straight in to shadowing a consultant in the renal department. I found it so interesting looking at all the dialysis machines and then doing ward rounds. The Doctors that I was following were all very nice, and they asked me some medical questions, to help me engage into the rounds. For example I got asked ‘How do we know this patient is internally bleeding?’. Honestly I had no idea. I then realized the patient had a really high heart rate and extremely low blood pressure, which to my surprise was actually one of the indicators. This was my first time being surrounded by ALOT of blood. I had no clue how I was going to react. I didn’t think I was squeamish at all, however after about 15 minutes of observing bloods being taken, I felt slightly weird. So I went for a walk outside and then I was completely fine. The consultant told me the first time that he was surrounded by blood he felt extremely squeamish but now as a consultant, it doesn’t bother him at all. From this, I learnt that it is completely fine to not be ‘ok’ with the practicality of being a Doctor at first. The sense of normality comes over time,  also surgery and other things involving blood seem less strange as Doctors are in absolute love with what they’re doing.

I was involved in two theatre sessions whilst I was there. One was removing calcification from the femoral artery, and the other was a fistula repair. Getting into the scrubs was so exciting, and I realized whilst watching the surgery that medicine is right for me and I am completely determined to do it. I was intrigued by all the different roles in the surgical team, and also completely shocked at how calm and relaxed the atmosphere was. Obviously I acknowledge that not all surgeries are like this- however the surgeons were calm and chatting to me as they operated.

I also spent time on a cardiac care unit. I learnt there that fluidity is so important in a medical team; as well as good teamwork. Every role is vital, from the consultant for medical care to the lady who does the tea and coffee rounds for wellbeing and comfort of the patients. Fluidity is important as it prevents patients waiting too long for treatment. If it wasn’t fluid, nothing would get done. Patients would be waiting hours to be taken to operations after they have been prepped, and even the well needed cups of tea would come at the wrong times. In metaphorical terms, a medical team must work as a well oiled machine.

Throughout the experience I learnt a lot about myself. The key thing I learnt is that, I am independent. I loved finding my way around the hospital and making sure I was on time (and time management is tricky for me, as I always find myself late) , confident when speaking to the consultants and making sure I was in the right place at the right time to see all sorts of medical procedures. Also I learnt that my imperfections as an aspiring medic are common and absolutely fine. For example, being squeamish when seeing blood for the first time. Imperfections exist for us to either sort them out, or accept them. I learnt that we do not progress in our skill unless we have imperfections to be fixed. However that one is to be taken with a pinch of salt, as if you have more serious imperfections and make big mistakes, that is not good.

Thank you for reading.

Research Shows ‘One Too Many’ Can Cause Fatal Heart Risk

Alcoholism. How common is it? It is extremely hard to answer that question. As many alcoholics live through their drinking abuse in silence. However just take this statistic: on average, it is estimated that the lives of five other people will be harmed when one individual becomes addicted to alcohol.

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According to Government statistics, more than 1.4 million people are dependent on alcohol in the UK. 33,000 people die each year due to alcohol-related incidents or associated health problems. Alcohol is involved in 15% of road accidents, 26% of drownings, and 36% of deaths in fires. A quarter of accidents at work are drink-related.

Realistically, every body loves and enjoys a drink from time to time, however when this becomes excessive, it can cause problems.

By definition cardiovascular disease  generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Thus possibly leading to death. In the UK it is estimated that 2.3 million people suffer from heart disease. New research examines the link between arterial stiffness – a significant indicator of cardiovascular health – and alcohol consumption over time.

The research was conducted by Darragh O’Neill, Ph.D., who is an epidemiological researcher at University College London in the United Kingdom. He found a link between heart disease and alchol. He found that overconsumption of alcohol can lead to stiffness of the arteries occurs when the walls of the blood vessels lack elasticity, which can negatively impact the artery’s response to variation in blood pressure.

Consistent moderate drinkers at risk were defined as those who consumed between 1-112 grams of ethanol per week, so less than the 14 units. One U.K. alcohol unit is roughly the equivalent to a shot of whiskey or half a pint of beer. So when thinking about it in terms of a night out, that is 7 pints of beer or about 11-14 shots.

Interestingly, after the longditudinal study it was found that after adjusting for several factors including BMI, heart rate, and arterial pressure, the associations were not significant for women, even though 73 percent of the study participants were men. By no means does this mean women are free to drink as much as they like, as there are many other health risks alcohol can lead to.

After vigorous research, they also found that alcoholism could lead to aging of the arteries.

The researchers finally concluded that excessive drinking can increase risk of cardiovascular disease, especially in men. They also found that constant heavy drinking can affect the arteries, thus interfering with blood flow. So I can conclude from this, that maybe its about time people really started looking into how MUCH they are actually drinking.

Thankyou.

 

Work Experience 101: Residential Care Home

In January, I began my work experience in a local care home. Since then for a few hours each week I have been volunteering at the care home, and joining the care assistants with their day to day jobs.

Before this I had never worked in a care home before. I had no clue what to expect, as the grandparents I have left aren’t in care homes, but in residential villages, which means they have a lot more independence that a care home resident. At first I was nervous, as the care home is small and there are not many care assistants and above all things I was scared the residents wouldn’t like me! However that was completely the opposite of the actual truth; the residents were all so lovely and just accepted me as a normal care assistant.

As I am only 17 and not qualified I am not allowed to take part in any personal care activities, however my activities include, helping to make tea, talking to and interacting with the residents, helping them move around the care home safely (giving assistance when getting up and down into chairs) and observing drugs rounds.

So far I have learnt a lot at the care home. Something, really special I learnt was that even in old age, despite many health problems and lists of medications that some of the residents have, it is still possible for happiness to exist. I learnt this through my various conversations with the residents. For example some of the residents like to know about what I do at school, how my friends are and comically the question I get asked most often is if I have a boyfriend or if any boys are catching my eye, which always brings a smile to my face. These may feel like simple things to converse about, but the engagement in the conversation and the smile on the resident’s face when we talk about these things really is special. I have learnt that the elderly find happiness in the simplest of things which is truly inspiring. Consequently, I believe that is an attribute that we all should aspire to have.

Even though I thoroughly enjoy my work, the experience has taught me what it is like to interact with someone that has dementia first hand. It is a harsh truth that dementia can reduce a person’s quality of life, thus it has taught me that awareness must be raised for types of dementia in the elderly. Also, in care homes, it is not uncommon for residents to come and go quickly. It is a sad thing to acknowledge however it is one of the realities of being human, that one day we will eventually die, whether we want to or not. When a member of the elderly is put into a care home, or a hospice, my experience has taught me that it is important to favor increasing the quality of life not the quantity of it. I learnt this through seeing a resident who had severe dementia, diabetes, and was very immobile due to other health problems. When her time came it was sad however the reassurance that I (and I’m sure the family) found was that the resident had a poor quality of life when they were alive, and maybe death was not such a bad thing for them.

Something I learnt about myself on this care home experience is that I love communicating with the residents which could be applied to real life patients. I was really interested in getting insight into the daily struggles and stresses that some people face with dementia, and the resilient approach to life, which was displayed by some of the residents. This has further inspired my pursuit of a medical career.

I absolutely love working in the residential home, and I am finding it so valuable, and it spurs on my inspiration and dream to study medicine.

Thank you.