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  • Title: The influence of the law on clinical decisions affecting life and death.
    Author: Havard JD.
    Journal: Med Sci Law; 1983 Jul; 23(3):157-65. PubMed ID: 6633202.
    Abstract:
    The purpose of this lecture is to review the justification for legal interference in physicians' clinical decisions and the consequences of that interference to patients. Discussion covers contraception, abortion, negligence, and defensive medicine. Contraception is normally interpreted as the prevention or inhibition of fertilization or of implantation of the fertilized ovum in the uterus. The extra corporeal or in vitro fertilization program has raised the question of the legal and ethical status of the fertilized ovum before implantation. This is turn has raised questions about contraceptive devices or procedures whose purpose it is to prevent the implantation of a fertilized ovum, of which the IUd is the most common in use in the UK. Congressman Doonan of California moved to amend the US Constitution to provide that "life begins when a sperm cell fertilizes an egg." It may be assumed that this amendment is designed to prevent unacceptable experiments on spare embryos, but the consequences to family planning could be enormous unless some exception is included in favor of IUDs inserted for purposes of contraception. This leads to the issue of abortion and a reminder that until the 19th century it was not regarded as a crime in English common law to abort a fetus before "quickening" had occurred, as this was the point at which the embryo was regarded as having been animated. The Offenses Against the Person Act of 1861 established the current criminal offense of induced abortion to which the Abortion Act of 1967 now provides a defense. Recent developments in life support mechanisms have created difficulties over the extent to which such measures should be employed in the management of children born with life threatening abnormalities. A draft bill has been introduced requiring doctors to take all possible steps to feed defective neonates with life threatening abnormalities who are experiencing serious feeding problems. This means that these infants would have to be force fed irrespective of their prospects of survival and suffering which this will cause them and their parents. Clinical decisions have been most seriously affected by recent developments in the law of negligence. 1 of the main reasons for this has been the unsatisfactory way in which the adversary system of law ldeals with expert evidence. Attempts have been made to provide courts of law in the UK an agreed statement on expert medical matters, there is a long way to go before reaching the position achieved in many civil law countries on the continent of Europe where the experts recognized by the court hammer out an agreed upon opinion through scientific discourse and without the restrictions of evidentiary rules which are aimed more at the establishment of facts than the validity of scientific opinion. Those who attack the medical profession as being paternalistic and authoritative in making clinical decisions involving life and death fail to realize that the easy way out for the medical profession is to treat every case, however hopeless, with the full technology available, disregarding the patient's and family's interests, the costs in resources, and ignoring the stark reality of the problem.
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