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Julian Sheather

Julian Sheather and Vivienne Nathanson: Todd Akin, rape, and “doctors”

3 Sep, 12 | by BMJ

Vivienne Nathanson

According to the historian Tony Judt, the Red Army, after raping and brutalising its way across Europe in the closing stages of the Second World War, left behind, in Germany alone, somewhere between 150,000 and 200,000 “Russian babies.” These figures, he writes, “make no allowance for untold numbers of abortions, as a result of which many women died along with their unwanted foetuses.” Recently, asked his views on whether abortion should be banned even if the pregnancy resulted from rape, Todd Akin, a US Republican congressman running for the Senate, replied that such pregnancies were “really rare.” Despite being a member of the House Committee on Science he stated that “from what I understand from doctors…if it’s a legitimate rape, the female body has ways to try to shut the whole thing down.” It is tempting just to leave those juxtaposed sentences standing there, to permit the fatuity of that last statement to speak for itself, but the more you think about it the more the buried assumptions in it, the more the meretricious misuse of science and morality clamour for a voice.

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Julian Sheather: Doping in sport—thoughts on another Olympic legacy

16 Aug, 12 | by BMJ

Every once in a while I dust off my old road bike and head out onto the North Downs to take in a few hills. Panting up a short sharp rise is about as close to elite athleticism as I get—and it is not unusual for me to get off and push. It is from these foothills that I look across to the distant Himalaya of Olympic sports. Draw a veil over the grubby politics, forget about the ticketing problems—I only got three in the end, for the men’s volleyball—inure yourself to the corporate takeover: the heart of the matter surely lies in that look upwards—here is a kind of human excellence at its fullest reach, perhaps the one excellence that in these egalitarian times we are permitted to contemplate without misgiving. This is what a human being at full stretch is capable of. more…

Julian Sheather: Anders Breivik and the social uses of psychiatry

16 Jul, 12 | by BMJ

I have been gripped by the trial of Anders Breivik and was intrigued to see the BMJ hosting a Maudsley debate this week about, loosely speaking, Breivik’s “sanity.” The debate ran under the headline question of whether fanaticism is a form of madness which gave a slightly odd spin to the proceedings. As Tom Fahy hints, given that few football fans are incarcerated in secure institutions I am not sure fanaticism in and of itself is necessarily the problem. If political and religious fanaticism are the real problems—mortal threats to the west—then what follows if fanaticism is diagnosed as a mental disorder? What advantage, analytical or practical, could it possibly bring? Can medicine really help frame this debate? more…

Julian Sheather: Happy-ology

12 Jul, 12 | by BMJ

It is possibly the oldest of all philosophical questions. Although academic specialisation has tended to brush it to the wings—embarrassed perhaps by the sheer indeterminate unwieldiness of it—the question of what constitutes a good or flourishing life and how we can live one will not, for good human reasons, go away. And if academic philosophers have tended to ignore it, politicians, particularly liberal ones, have often been embarrassed by it. For if there is such a thing as a good life, rather than just an infinite variety of lives each of them good according to its lights, then surely society has some role, however attenuated, in promoting it? And this can give liberals a headache. To give a domestic example, should I acquiesce in my son’s decision to forego school today in favour of spending fourteen hours playing Halo—should I see it as the autonomous expression of a legitimate lifestyle choice—or am I justified in telling him that if he doesn’t haul his backside off the sofa I’ll throw his X-box out the window? more…

Julian Sheather: Vulnerable adults, coercion, and the inherent jurisdiction of the High Court

3 Jul, 12 | by BMJ

In law, the capacity to make a specific decision has a binary quality. Somewhat like a light it is either on or off, you either have it or you don’t and there are no intermediate states. Yes capacity can fluctuate, the bulb can wink on and off, but at any one time we either have the ability to make a specific decision or we do not. For strong liberty promoting reasons, the law is jealous of the right of adults to make decisions. This is reflected in the legislation around incapacity: it imposes an obligation on those assessing capacity to make all reasonable efforts to enhance it; the burden of proof of incapacity also falls on those who assert it. more…

Julian Sheather: Autonomy and the anorexic patient

21 Jun, 12 | by BMJ

There was extensive media comment this weekend about the Court of Protection’s decision to authorise the force-feeding of a seriously anorexic former medical student with a critically low BMI. The woman, referred to only as “E,” is 32 and following sustained sexual abuse as a child has suffered from an eating disorder since she was 11. Without urgent medical treatment, including involuntary feeding, she will die. She has had four episodes of treatment in specialist eating disorder units and one in an alcohol treatment unit. With great reluctance, E, her parents, and the professionals involved in her care came to the conclusion that all available treatment options had been exhausted. She was transferred to a community hospital for palliative care and put on an “end of life” care pathway. After five weeks on the pathway, her Local Authority bought her case to the Court of Protection concerned that it needed further investigation. more…

Julian Sheather: Autonomy and the right to refuse life-sustaining treatment

19 Jun, 12 | by BMJ

The recent case of a young Jehovah’s Witness in a sickle cell crisis refusing essential blood products and being allowed to die confirms what should by now be widely known: a competent and informed adult has a right to refuse medical treatment even where the refusal will result in his or her death. Although there were some concerns that the young man’s choice was being influenced by his mother, also a Witness, an independent doctor confirmed that he had capacity and was making a free choice. A clear restatement then of established law: outwith mental health legislation a doctor providing treatment in the face of a competent adult refusal is effectively assaulting the patient. As Lord Donaldson stated in an influential judgment Re:T: more…

Julian Sheather: The fifth horseman of the apocalypse?

7 Nov, 11 | by BMJ Group

During the years when the Book of Revelations was being laid down, some time apparently in the first century AD, human populations were likely, with some exceptions, to be small, imperilled, and surrounded by a seemingly infinite planet. Officially at least, on October the 31st this year the population of the earth reached seven billion. And there are times when, psychologically at least, the planet seems to have shrunk to the size of a smartphone. As I blogged here following a recent BMJ conference, climate change looks set to release all four horseman of the apocalypse. Population growth might well be the fifth. more…

Julian Sheather: Apocalypse tomorrow

18 Oct, 11 | by BMJ Group

There are four horsemen of the apocalypse: conquest, war, famine (or pestilence) and death, and climate change will unleash all of them. I was at a BMJ conference recently that explored some of the health and security impacts of climate change and these grim riders were everywhere to be seen. Put simply, climate change will alter the distribution of human necessities like food and fresh water. Green places will become barren, rivers will run dry. The need to secure access to these basic goods will drive people to war. Add to this the death toll from severe weather events – droughts, hurricanes, floods – and changing distributions of infectious disease vectors and you can feel the heat of the breath of the horses on your neck. more…

Julian Sheather: Making health decisions in advance – how best to avoid your worst nightmare?

23 Sep, 11 | by BMJ Group

On coming into force, the Mental Capacity Act (MCA), by deftly drawing together common law and permitting, via new powers of attorney, the nomination of substitute health decision makers, looked set to move practice in anticipatory decision making into a new era. The MCA is certainly a good act. It is supported by principles, focuses on the interests of the incapacitated adult, and creates obligations on would be decision makers to ensure adults exercise any residual capacity. That it would also make unambiguously legible the law relating to advance directives and permit the delegation of decision making powers in health and welfare suggested it would also provide welcome additional support to patient autonomy. Our decisions, it made clear, will be able to reach beyond our declining capacity. more…

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