Surrogacy and the law in the UK.

Surrogacy is a method of assisted reproduction in which a woman bears a child on behalf of a couple or individual with the intention of handing over care of the child to the intending parent(s) at or soon after birth. The law surrounding surrogacy is complex for healthcare professionals, surrogates and intending parent(s) to navigate. This review article summarises the laws and potential legal complications of surrogacy in the UK. While altruistic surrogacy is permitted, commercial surrogacy is outlawed in this country. Both traditional and gestational surrogacy may be performed and UK law now also permits surrogacy for same sex couples, unmarried couples and single individuals as intending parent(s). Legal parenthood of the child is transferred from the surrogate to the intending parent(s) via application for a parental order between 6 weeks and 6 months after birth. Legal complications include time restrictions for parental order applications and breaches of reasonable payments to surrogates.

Surrogacy and the law in the UK.

Surrogacy is a method of assisted reproduction in which a woman bears a child on behalf of a couple or individual with the intention of handing over care of the child to the intending parent(s) at or soon after birth. The law surrounding surrogacy is complex for healthcare professionals, surrogates and intending parent(s) to navigate. This review article summarises the laws and potential legal complications of surrogacy in the UK. While altruistic surrogacy is permitted, commercial surrogacy is outlawed in this country. Both traditional and gestational surrogacy may be performed and UK law now also permits surrogacy for same sex couples, unmarried couples and single individuals as intending parent(s). Legal parenthood of the child is transferred from the surrogate to the intending parent(s) via application for a parental order between 6 weeks and 6 months after birth. Legal complications include time restrictions for parental order applications and breaches of reasonable payments to surrogates.

Gender in healthcare: a practical approach.

Transgender law is complex and developing. Increasing general practitioner referrals for gender dysphoria without sufficient resources for specialist units have left gaps in transgender healthcare. Surveys repeatedly find transgender patients have lower satisfaction with healthcare experiences, stating doctors have a poor understanding of their needs. Meanwhile, waiting times for referrals remain high.This review article outlines UK laws and guidelines relevant to trans healthcare, including practical advice for clinicians. Current issues are explored, including the referral process for gender dysphoria.Transgender law is continually evolving; currently, individuals require a diagnosis of gender dysphoria to legally change gender. However, the gender on NHS records can be changed without legally changing gender.Clinicians may find support from the General Medical Council for this area. Specifically, guidance exists for including trans patients in screening programmes relevant to their assigned sex at birth. Similarly, advice exists for ensuring the privacy of patients' gender history.

Reforming DoLS: liberty protection safeguards.

From April 2022, current Deprivation of Liberty Safeguards (DoLS) will be replaced by Liberty Protection Safeguards (LPS). This review article outlines key information about these changes for patients, carers and healthcare professionals, for whom a deprivation of liberty may be relevant.Deprivation of liberty occurs within healthcare settings when someone's freedoms are limited in order to meet their care needs and lack capacity to consent to these arrangements. DoLS, enacted in 2009, ensured that patients deprived of liberties in care settings have similar rights to patients held under the Mental Health Act 1983. However, DoLS have been extensively criticised and considered unfit for purpose, therefore are being replaced by LPS.LPS intend to provide a more robust protection to a wider group of vulnerable people. This includes changes to patient age, transferability between a wider range of care settings, a reduced number of assessments for authorisation and less frequent reauthorisations.

BET 2: prophylactic antiemetic use in immobilised adult trauma patients.

A short-cut review was carried out to establish whether prophylactic antiemetic agents reduce the incidence of vomiting in immobilised patients who have suffered trauma. A total of 137 papers were found using the reported searches, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that prophylactic use of antiemetic agents in trauma patients may reduce the likelihood of vomiting some 5-12-fold.

The extent to which chaperone policies are used in acute hospital trusts in England.

OBJECTIVE: To determine whether the Ayling Inquiry's recommendations (2004) concerning chaperone policy implementation in acute hospital trusts in England has been implemented. METHODS: A quantitative questionnaire based on the Ayling Inquiry was posted to medical directors of all acute hospital trusts in England during December 2005 to March 2006 to determine whether their trusts had implemented the inquiry's recommendations by 1 December 2005. The same questionnaire was resent between December 2007 and March 2008 to determine whether their trusts had implemented the inquiry's recommendations by 1 December 2007. RESULTS: The total response rates were 59.4% and 47.7% for the first and second cohorts, respectively. The percentage of trusts having a chaperone policy increased from 41.3% in December 2005 to 56.5% in December 2007. By the end of 2007, 17.3% had accredited training for chaperones, 57.7% had a management lead and 71.2% of trusts formally investigated a breach of the chaperone policy, the latter being a fall from 88.4% in December 2005. Informing patients verbally of the policy was the most common method of distributing the information in both cohorts. By 1 December 2007, 50.0% of trusts did not use any resources towards their chaperone policy. Of the trusts without a chaperone policy by 1 December 2007, 52.5% intend to start a policy. CONCLUSION: Despite a public inquiry, only a small majority of acute trusts in England have a chaperone policy in place, which may have severe medico-legal repercussions in the future. Commencing a chaperone policy is a must for acute trusts and regular auditing necessary to ensure recommendations be maintained.

Mikkel Hindhede (1862-1945): A pioneering nutritionist.

The 150th anniversary of the birth of the Danish nutritionist Mikkel Hindhede (1862-1945) fell on 13 February 2012. He was brought up in a farming family and despite family traditions he chose an academic path and became a medical doctor in 1888 and he was ahead of his time and emphasized a healthy life style rather than polypharmacy. He was convinced that the Danish population ate far too much meat and investigated and debated this matter frequently. In 1910, the Danish government allocated Hindhede a laboratory to study human nutrition where he carried out several nutritional experiments on humans. Even though his research contradicted previous theories and met opposition, he had great societal influence. Hindhede's work was the reason that Denmark focused on feeding the Danish population with harvest products and therefore had to slaughter herds of cattle and pork during the food crisis of the First World War (1914-1918). According to his calculations, this may have prevented 6300 deaths in the war. Moreover, Hindhede's work later influenced both national and international nutrition policies.

In what ways can human skeletal remains be used to understand health and disease from the past?

Disease and illness in previous generations can be investigated using palaeopathology. This article describes the commonly used techniques in palaeopathology, includes examples of how such techniques are able to formulate data on a variety of health issues that occurred in the past and suggests how these data can be relevant today.

A description of the methods used to obtain information on ancient disease and medicine and of how the evidence has survived.

This paper summarises the common modalities that are available for researching ancient medicine and disease as well as explaining how some of these sources have survived to modern day. These are explained under the three broad headings of palaeopathology, artefacts, and texts. The descriptions use a variety of examples from ancient societies including in the Bronze Age, Babylonia and Assyria, ancient Egypt, ancient Greece, and ancient Rome to help explain these modalities. In addition, a review of the advantages and disadvantages of using these tools is included to help current and future historians in stimulating future research in this fascinating area.

A biography of William Tuke (1732-1822): Founder of the modern mental asylum.

William Tuke was a 19th-century reformist and philanthropist notable for his work in mental health. He was known for his strict self-discipline and judicious manner. He was also a firm believer in the Quaker faith and actively supported the group and employed many of their principles in his work, especially in his chef d'oeuvre, The Retreat, established in 1792, a mental asylum in York. Possibly catalysed by the very public mismanagement of King George III's 'madness', he pioneered the use of moral treatment, a new humane method of treating mental illness. This focussed on allowing patients to live in a community, partake in daily activities and not be subjected to the brutality of the commonplace asylum, all of which were very rare in the treatment of lunatics at that time. Described as 'The Period of Humane Reform', his work coincided with the emergence of similar approaches in France, most famously by Philippe Pinel (1745-1826) and his pupil Jean Esquirol (1772-1840) in Paris. Tuke eventually went on to aid in the reform of the law with regards to asylums.

Sir Archibald Hector McIndoe (1900-1960) and the Guinea Pig Club: the development of reconstructive surgery and rehabilitation in the Second World War (1939-1945).

This article discusses the work of pioneering surgeon Sir Archibald McIndoe and particularly his reconstructive surgery and patient-centred approach during the Second World War. It also covers how this affected the lives of his patients and the subsequent formation of the Guinea Pig Club.

A short clinical review of vaccination against measles.

Major epidemics of measles are again in the news across the UK because of our failure to maintain population herd immunity. This situation has occurred primarily because of a loss of public confidence in the measles, mumps and rubella (MMR) vaccine, which was never restored following the Wakefield debacle, and a lack of awareness of the potential morbidity and mortality associated with measles. This article provides healthcare professionals with a succinct overview of important clinical aspects of measles and also describes the history of measles vaccination in the UK. Restoration of herd immunity will require higher public acceptance of the MMR vaccine in the context of recognition that measles remains an important infection. While achievement of this appears to be challenging, recent UK-based research suggests that it can be ascertained.

A short history on pacemakers.

Artificial pacemakers have taken part or possibly driven many developments in cardiac science and medicine and are therefore a very important story to remember. This 300-year journey of discovery has been contributed to by experts from across the Globe. The essential foundation of knowledge such as basic electrophysiology and applied electrotherapy was built in the 18th century and is now academically and socially accepted. This line of inventions and research has seen: early use of meta-analyses, the initial coming together of medical or bioengineering and the concept of cardiac monitoring--now a mainstay in the hospital care of a patient. In the 21st century pacemaker developments are no longer solely about reducing mortality but improving morbidity. Design developments reduce: discomfort, additional surgeries and invasive procedures. New energy sources have become lighter, smaller and with a longer life span.

Testing the test: an analysis of the MRCGP Applied Knowledge Test as an assessment tool.

The new membership examination of the Royal College of General Practitioners (MRCGP) has been in existence since autumn 2007. The MRCGP assessments aim to assure the RCGP of the competence of a general practitioner specialty trainee (GPST). Once the MRCGP is obtained, the GPST is then able to apply for a certificate of completion of training (CCT) from the General Medical Council (GMC). The MRCGP demonstrates the commonly described educational theory model of Miller's pyramid (see Figure 1). The Applied Knowledge Test (AKT), as the name suggests, aims for more than mere recall and arguably is at the 'knows how' level. Current literature suggests that the 'shows how' level constitutes competency-based assessment rather than performance. In the MRCGP, this takes the form of Clinical Skills Assessment (CSA). The level of 'does' is assessed via workplace-based assessments. These are performed throughout the three years of GPST training. They also take into account that the skill of performance incorporates not only competence, but also a combination of other influences mentioned in the Cambridge model for delineating performance and competence. This article will focus on the AKT. It is a three-hour 200-item multi-choice question (MCQ) examination that covers the three broad domains described in Box 1. The questions are in one of three formats: single best answer, extended matching questions and completion of algorithms. Literature exists that looks at the characteristics of a good assessment system. However, it is the work of van der Vleuten that is widely cited. He suggested that validity, reliability, educational impact, cost-effectiveness and acceptability must all be considered when constructing an assessment. I will now focus on the AKT in relation to each of the factors.

History and ethics of hand transplants.

Hand transplantation is a form of composite tissue allotransplantation, whereby the hand of a cadaveric donor is transferred to the forearm of an amputee. The aim of such a procedure is to achieve better outcomes in terms of functionality and appearance when compared with prosthetics. The microsurgical techniques required have been well established for many years. In addition, advances in immunosuppressive therapy have meant that hand transplantation is a feasible therapeutic option. However this is not a life-saving procedure, requiring lifelong antirejection treatment with potentially serious side-effects. Hand transplantation is therefore a controversial concept with ethical, financial and psychological implications that need careful consideration. Before this treatment can be fully accepted, further research is still required; this should be directed towards achieving immunological tolerance, while minimizing costs and potential side-effects of post-transplant therapy.

Sir Geoffrey Marshall (1887-1982): respiratory physician, catalyst for anaesthesia development, doctor to both Prime Minster and King, and World War I Barge Commander.

Sir Geoffrey Marshall was a remarkable, hard-working man who helped in the development of anaesthesia and respiratory medicine. Both were in someway helped by his military experiences in World War I, first when working on an ambulance barge and then in the Casualty Clearing Stations researching the increasing problem of surgical shock. Among a multitude of high-ranking medical posts he also acted as Physician to King George VI and Sir Winston Churchill when they developed respiratory conditions.

History of Medicine student selected components at UK medical schools: a questionnaire-based study.

OBJECTIVES: To determine the current status of History of Medicine student selected components (SSC) at UK medical schools. This includes the frequency, methods of delivery, assessment, and evaluation of such courses. DESIGN: An 18-item questionnaire was created, piloted, and then sent electronically in January 2010 to participants pertaining to their History of Medicine SSC provision as of 1 January 2010. Initial non-responders were re-sent the questionnaire in February 2010. SETTING: All UK medical schools. PARTICIPANTS: The History of Medicine SSC lead or overall SSC lead at each UK medical school were contacted to ascertain their History of Medicine SSC provision. MAIN OUTCOME MEASURES: Percentages of History of Medicine SSCs for each objective characteristic were obtained as well as general descriptive data. RESULTS: Fifteen of the 32 medical schools in the UK offer a History of Medicine SSC. Eleven medical schools (offering a total of 12 SSCs) completed the questionnaire (response rate 73.3%). Eight different teaching methods are used within the SSCs. Medical professionals most frequently deliver the teaching, which most frequently covers the 20th and 21st centuries. Four assessment methods are used among the SSCs, the most common being a group presentation. Questionnaires are the most frequent method of evaluation. There are several factors limiting the provision of some current SSCs, most commonly a lack of staff, teaching facilities, and available time within the curriculum. CONCLUSION: History of Medicine is being delivered more frequently in UK medical schools than when previously researched 40 years ago. However, the subject is still offered in a minority of the medical schools. This study offers useful information to consider for the development of current and potential new History of Medicine SSCs.