Michael King (standing) with Elspeth and colleagues Michael King had been working as a surgeon in a day care ward in Worthing for two years when he began to get itchy feet. While “the work was rewarding and I was my own boss within limits,” he was yearning for a greater challenge. His wife, Elspeth, and two pre-teen daughters, Fiona and Sheenagh, “would welcome a more adventurous life,” he wrote in his unpublished memoirs. Elspeth spotted an advertisement in The BMJ for a surgeon at the Queen Elizabeth Central Hospital in Blantyre, the industrial and commercial capital of Malawi. King spoke to the chief surgeon in post, Jan Borgstein. He then consulted Sam Bhima, the first black doctor in Nyasaland, as Malawi was called before independence, who happened to be working at Worthing Hospital. Bhima had been forced to flee his homeland because of his links to Malawi’s opposition and told King about the country’s “difficult political and health situation.” Malawi had won independence from the British in 1964—12 years before the Kings’ arrival—and was governed by Hastings Kamuzu Banda, a British trained doctor, who had become increasingly repressive. While there had been some investment in the health service since independence, care for the population of five million was patchy. There was a handful of government and privately run hospitals and only around 100 doctors, the …
{"title":"Michael King: general surgeon who spent 30 years working in Malawi","authors":"Anne Gulland","doi":"10.1136/bmj.r359","DOIUrl":"https://doi.org/10.1136/bmj.r359","url":null,"abstract":"Michael King (standing) with Elspeth and colleagues Michael King had been working as a surgeon in a day care ward in Worthing for two years when he began to get itchy feet. While “the work was rewarding and I was my own boss within limits,” he was yearning for a greater challenge. His wife, Elspeth, and two pre-teen daughters, Fiona and Sheenagh, “would welcome a more adventurous life,” he wrote in his unpublished memoirs. Elspeth spotted an advertisement in The BMJ for a surgeon at the Queen Elizabeth Central Hospital in Blantyre, the industrial and commercial capital of Malawi. King spoke to the chief surgeon in post, Jan Borgstein. He then consulted Sam Bhima, the first black doctor in Nyasaland, as Malawi was called before independence, who happened to be working at Worthing Hospital. Bhima had been forced to flee his homeland because of his links to Malawi’s opposition and told King about the country’s “difficult political and health situation.” Malawi had won independence from the British in 1964—12 years before the Kings’ arrival—and was governed by Hastings Kamuzu Banda, a British trained doctor, who had become increasingly repressive. While there had been some investment in the health service since independence, care for the population of five million was patchy. There was a handful of government and privately run hospitals and only around 100 doctors, the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew W Bradbury, Jack A Hall, Matthew A Popplewell, Lewis Meecham, Gareth R Bate, Lisa Kelly, Jon J Deeks, Catherine A Moakes
Objective To determine which primary endovascular revascularisation strategy represents the most clinically effective treatment for patients with chronic limb threatening ischaemia who require endovascular femoro-popliteal, with or without infra-popliteal, revascularisation. Design Three arm, open label, pragmatic, multicentre, randomised, phase 3 superiority trial (BASIL-3). Setting 35 UK NHS vascular units. Participants Patients with chronic limb threatening ischaemia who required endovascular femoro-popliteal, with or without infra-popliteal, revascularisation. Interventions Participants were randomly assigned (1:1:1) to femoro-popliteal plain balloon angioplasty with or without bare metal stenting (PBA±BMS), drug coated balloon angioplasty with or without bare metal stenting (DCBA±BMS), or drug eluting stenting (DES) as their first revascularisation strategy. Main outcome measures The primary outcome was amputation free survival defined as time to first major amputation or death from any cause. Secondary outcomes included the composite components of the primary outcome, major adverse limb events, major adverse cardiac events, and other prespecified clinical and patient reported outcome measures. Serious adverse events were collected up to 30 days after the first revascularisation procedure. Results Between 29 January 2016 and 31 August 2021, 481 participants were randomised (167 (35%) women, mean age 71.8 years (standard deviation 10.8)). Major amputation or death occurred in 106 of 160 (66%) participants in the PBA±BMS group, 97 of 161 (60%) in the DCBA±BMS group, and 93 of 159 (58%) in the DES group (adjusted hazard ratios: PBA±BMS v DCBA±BMS: 0.84, 97.5% confidence interval 0.61 to 1.16, P=0.22; PBA±BMS v DES: 0.83, 0.60 to 1.15, P=0.20). No differences in serious adverse events were reported between the groups. Conclusions Neither DCBA±BMS nor DES conferred significant clinical benefit over PBA±BMS in the femoro-popliteal segment in patients with chronic limb threatening ischaemia undergoing endovascular femoro-popliteal, with or without infra-popliteal, revascularisation. Trial registration ISRCTN registry ISRCTN14469736 Requests for data should be directed to the corresponding author. Participant level data will be made available within six months of publication. Requests will be assessed for scientific rigour before being granted. Data will be anonymised and securely transferred. A data sharing agreement might be required.
{"title":"Plain versus drug balloon and stenting in severe ischaemia of the leg (BASIL-3): open label, three arm, randomised, multicentre, phase 3 trial","authors":"Andrew W Bradbury, Jack A Hall, Matthew A Popplewell, Lewis Meecham, Gareth R Bate, Lisa Kelly, Jon J Deeks, Catherine A Moakes","doi":"10.1136/bmj-2024-080881","DOIUrl":"https://doi.org/10.1136/bmj-2024-080881","url":null,"abstract":"Objective To determine which primary endovascular revascularisation strategy represents the most clinically effective treatment for patients with chronic limb threatening ischaemia who require endovascular femoro-popliteal, with or without infra-popliteal, revascularisation. Design Three arm, open label, pragmatic, multicentre, randomised, phase 3 superiority trial (BASIL-3). Setting 35 UK NHS vascular units. Participants Patients with chronic limb threatening ischaemia who required endovascular femoro-popliteal, with or without infra-popliteal, revascularisation. Interventions Participants were randomly assigned (1:1:1) to femoro-popliteal plain balloon angioplasty with or without bare metal stenting (PBA±BMS), drug coated balloon angioplasty with or without bare metal stenting (DCBA±BMS), or drug eluting stenting (DES) as their first revascularisation strategy. Main outcome measures The primary outcome was amputation free survival defined as time to first major amputation or death from any cause. Secondary outcomes included the composite components of the primary outcome, major adverse limb events, major adverse cardiac events, and other prespecified clinical and patient reported outcome measures. Serious adverse events were collected up to 30 days after the first revascularisation procedure. Results Between 29 January 2016 and 31 August 2021, 481 participants were randomised (167 (35%) women, mean age 71.8 years (standard deviation 10.8)). Major amputation or death occurred in 106 of 160 (66%) participants in the PBA±BMS group, 97 of 161 (60%) in the DCBA±BMS group, and 93 of 159 (58%) in the DES group (adjusted hazard ratios: PBA±BMS v DCBA±BMS: 0.84, 97.5% confidence interval 0.61 to 1.16, P=0.22; PBA±BMS v DES: 0.83, 0.60 to 1.15, P=0.20). No differences in serious adverse events were reported between the groups. Conclusions Neither DCBA±BMS nor DES conferred significant clinical benefit over PBA±BMS in the femoro-popliteal segment in patients with chronic limb threatening ischaemia undergoing endovascular femoro-popliteal, with or without infra-popliteal, revascularisation. Trial registration ISRCTN registry ISRCTN14469736 Requests for data should be directed to the corresponding author. Participant level data will be made available within six months of publication. Requests will be assessed for scientific rigour before being granted. Data will be anonymised and securely transferred. A data sharing agreement might be required.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James C Jeng, Jarone Lee, Mark Ervin, Tehnaz P Boyle
Tactical nuclear weapons pose a threat to life and health that we cannot ignore Overt threats to strike with nuclear weapons are rising with alarming frequency.12 Geopolitical attitudes have shifted since the Cold War, when nuclear threats drove de-escalation, prompted arms control negotiations, lowered alert postures, and reduced weapon stockpiles. This trend has now reversed. Only one nuclear arms control treaty remains in place.3 The US, Russia, and China are racing to modernise and expand nuclear arsenals.456 Rising isolationism and decreased international engagement and cooperation diminish the ability to deter nuclear attacks. Nuclear armed nations with ongoing border hostilities, such as Russia and the Democratic People’s Republic of Korea, now emphasise their nuclear capability and threaten first strike or reprisal actions,57 tempting non-nuclear nations to consider developing their own weapons.8 Historically, the “mutually assured destruction” doctrine was described as deterring the use of nuclear weapons on the basis that any nuclear attack would lead to a counterattack where both aggressor and defender would be annihilated.4 However, monitors of current conflicts contend that the risk of lower yield (1-10 kiloton) “tactical” nuclear weapon use is increasing, as they have hypothetical value in warfare and nuclear armed states …
{"title":"Healthcare after a nuclear strike","authors":"James C Jeng, Jarone Lee, Mark Ervin, Tehnaz P Boyle","doi":"10.1136/bmj.r319","DOIUrl":"https://doi.org/10.1136/bmj.r319","url":null,"abstract":"Tactical nuclear weapons pose a threat to life and health that we cannot ignore Overt threats to strike with nuclear weapons are rising with alarming frequency.12 Geopolitical attitudes have shifted since the Cold War, when nuclear threats drove de-escalation, prompted arms control negotiations, lowered alert postures, and reduced weapon stockpiles. This trend has now reversed. Only one nuclear arms control treaty remains in place.3 The US, Russia, and China are racing to modernise and expand nuclear arsenals.456 Rising isolationism and decreased international engagement and cooperation diminish the ability to deter nuclear attacks. Nuclear armed nations with ongoing border hostilities, such as Russia and the Democratic People’s Republic of Korea, now emphasise their nuclear capability and threaten first strike or reprisal actions,57 tempting non-nuclear nations to consider developing their own weapons.8 Historically, the “mutually assured destruction” doctrine was described as deterring the use of nuclear weapons on the basis that any nuclear attack would lead to a counterattack where both aggressor and defender would be annihilated.4 However, monitors of current conflicts contend that the risk of lower yield (1-10 kiloton) “tactical” nuclear weapon use is increasing, as they have hypothetical value in warfare and nuclear armed states …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"175 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Students should not feel they have to abandon their medical career because of a lack of financial support while at medical school The BMA recently published survey data that found 43% of UK medical students out of 3500 surveyed have considered taking a break or leaving their course entirely because of financial difficulties.1 As a graduate entry medical student who has taken time out of my course due to financial pressures, I think it is clearer than ever that increased financial investment is necessary to support the future of our NHS workforce. With the rising cost of living, both student finance and the NHS bursary are proving to be insufficient to meet students’ everyday expenses, but the latter is particularly meagre. In the second year of medical school, graduate entry students transition from being funded by Student Finance England to an NHS bursary. For students on standard entry medical courses, this switch happens in their fifth year of study. This change was introduced so that the NHS could directly fund healthcare students, a scheme brought about to incentivise studying medicine, but while it …
{"title":"If we want to invest in our future NHS workforce, then studying medicine should be affordable","authors":"George Webster","doi":"10.1136/bmj.r366","DOIUrl":"https://doi.org/10.1136/bmj.r366","url":null,"abstract":"Students should not feel they have to abandon their medical career because of a lack of financial support while at medical school The BMA recently published survey data that found 43% of UK medical students out of 3500 surveyed have considered taking a break or leaving their course entirely because of financial difficulties.1 As a graduate entry medical student who has taken time out of my course due to financial pressures, I think it is clearer than ever that increased financial investment is necessary to support the future of our NHS workforce. With the rising cost of living, both student finance and the NHS bursary are proving to be insufficient to meet students’ everyday expenses, but the latter is particularly meagre. In the second year of medical school, graduate entry students transition from being funded by Student Finance England to an NHS bursary. For students on standard entry medical courses, this switch happens in their fifth year of study. This change was introduced so that the NHS could directly fund healthcare students, a scheme brought about to incentivise studying medicine, but while it …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A collaborative dialogue between clinician and patient can make a huge difference to patient experience, writes Stephanie O’Donohue It is vital that patients feel safe and supported when accessing gynaecology services. There are many excellent healthcare professionals driving forward improvements in gynaecology care, but we know that traumatic experiences continue to occur.12 Patient accounts relating to procedures such as intrauterine device insertions or hysteroscopies are evidence of this. We have heard patients describe unbearably high levels of pain, exacerbated by the absence of any forewarning from medical professionals. Many have felt their pain was dismissed or ignored and that they were sent on their way without due concern, compassion, or follow-up. These negative experiences can have a damaging, long lasting effect on the relation between patients and the healthcare system and can leave patients feeling fearful of attending other important health appointments. Being invited for a routine smear test or other invasive gynaecology procedure is unlikely ever to be met with enthusiasm, but a collaborative and empowering approach can …
{"title":"Empowering patients is key to improving gynaecology experiences","authors":"Stephanie O'Donohue","doi":"10.1136/bmj.r358","DOIUrl":"https://doi.org/10.1136/bmj.r358","url":null,"abstract":"A collaborative dialogue between clinician and patient can make a huge difference to patient experience, writes Stephanie O’Donohue It is vital that patients feel safe and supported when accessing gynaecology services. There are many excellent healthcare professionals driving forward improvements in gynaecology care, but we know that traumatic experiences continue to occur.12 Patient accounts relating to procedures such as intrauterine device insertions or hysteroscopies are evidence of this. We have heard patients describe unbearably high levels of pain, exacerbated by the absence of any forewarning from medical professionals. Many have felt their pain was dismissed or ignored and that they were sent on their way without due concern, compassion, or follow-up. These negative experiences can have a damaging, long lasting effect on the relation between patients and the healthcare system and can leave patients feeling fearful of attending other important health appointments. Being invited for a routine smear test or other invasive gynaecology procedure is unlikely ever to be met with enthusiasm, but a collaborative and empowering approach can …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Some English words are more euphonious than others, and there are many lists of words that their collectors have labelled “the most beautiful words in English.” I have analysed 372 of these and have described their characteristics, summarising the important features that result in their being considered beautiful. Fifteen of them may be regarded as the most beautiful of all, appearing as they do in the largest numbers of lists: aurora, effervescent, elixir, eloquence, ephemeral, epiphany, ethereal, gossamer, halcyon, mellifluous, onomatopoeia, quintessential, serendipity, sonorous, and surreptitious. Eighteen words on the list have some medical relevance: bibliotherapy, depigmentation, effervescent, eidetic, elixir, embrocation, emollient, euphoria, hallucinate, histamine, kakorrhaphiophobia, lassitude, melancholy, narcissist, nexus, oleander, olfactory, and panacea. In a 1955 lecture titled English and Welsh, inaugurating the O'Donnell Lectures, J R R Tolkien asserted that “most English-speaking people ... will admit that cellar door is ‘beautiful’, especially if dissociated from its sense (and from its spelling). More beautiful than, say, sky, and far more beautiful than beautiful.” The O'Donnell Lectures were established to promote interest in how the English language had been influenced by Celtic languages, and the phrase “cellar door” contains elements that are common in Welsh phonology.1 This observation, however, was not novel to Tolkien. It had been expounded in the 1903 novel Gee Boy by Cyrus Hooper, where it was attributed to an earlier, albeit unidentified, author: “He even grew to like sounds unassociated with the meaning, and once made a list of the words he loved most, as doubloon, squadron, thatch, fanfare (he never did know the meaning of this one), Sphinx, pimpernel, Caliban, Setebos, Carib, susurro, torquet, Jung frau . He was laughed at by a friend, but logic was his as well as sentiment; an Italian savant maintained that the most beautiful combination of English sounds …
{"title":"When I use a word . . . The most beautiful medical words","authors":"Jeffrey K Aronson","doi":"10.1136/bmj.r376","DOIUrl":"https://doi.org/10.1136/bmj.r376","url":null,"abstract":"Some English words are more euphonious than others, and there are many lists of words that their collectors have labelled “the most beautiful words in English.” I have analysed 372 of these and have described their characteristics, summarising the important features that result in their being considered beautiful. Fifteen of them may be regarded as the most beautiful of all, appearing as they do in the largest numbers of lists: aurora, effervescent, elixir, eloquence, ephemeral, epiphany, ethereal, gossamer, halcyon, mellifluous, onomatopoeia, quintessential, serendipity, sonorous, and surreptitious. Eighteen words on the list have some medical relevance: bibliotherapy, depigmentation, effervescent, eidetic, elixir, embrocation, emollient, euphoria, hallucinate, histamine, kakorrhaphiophobia, lassitude, melancholy, narcissist, nexus, oleander, olfactory, and panacea. In a 1955 lecture titled English and Welsh, inaugurating the O'Donnell Lectures, J R R Tolkien asserted that “most English-speaking people ... will admit that cellar door is ‘beautiful’, especially if dissociated from its sense (and from its spelling). More beautiful than, say, sky, and far more beautiful than beautiful.” The O'Donnell Lectures were established to promote interest in how the English language had been influenced by Celtic languages, and the phrase “cellar door” contains elements that are common in Welsh phonology.1 This observation, however, was not novel to Tolkien. It had been expounded in the 1903 novel Gee Boy by Cyrus Hooper, where it was attributed to an earlier, albeit unidentified, author: “He even grew to like sounds unassociated with the meaning, and once made a list of the words he loved most, as doubloon, squadron, thatch, fanfare (he never did know the meaning of this one), Sphinx, pimpernel, Caliban, Setebos, Carib, susurro, torquet, Jung frau . He was laughed at by a friend, but logic was his as well as sentiment; an Italian savant maintained that the most beautiful combination of English sounds …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stark inequalities exist in the number and distribution of ethnic minority doctors in specialty roles, writes Sethina Watson In my region, including me, I know of only three black anaesthetists who have trained in the past 10 years. In England and Wales, only 22 of 2649 (0.8%) resident anaesthetists are black—down 40% from 2014.1 We are seeing the same trend in other specialties too, resulting in fewer ethnic minority doctors on the specialist register.1 We are doing our patients a disservice by not ensuring the workforce represents the population it serves. Recent data from the General Medical Council show that for the first time there are more ethnic minority doctors than white doctors in our workforce.2 Diversity is one of the NHS’s greatest assets, with international medical graduates and ethnic minority doctors contributing a great deal. But scratching this veneer of apparent diversity reveals huge inequalities in the specialties and roles in which …
{"title":"We need to face uncomfortable truths about diversity in our medical workforce","authors":"Sethina Watson","doi":"10.1136/bmj.r293","DOIUrl":"https://doi.org/10.1136/bmj.r293","url":null,"abstract":"Stark inequalities exist in the number and distribution of ethnic minority doctors in specialty roles, writes Sethina Watson In my region, including me, I know of only three black anaesthetists who have trained in the past 10 years. In England and Wales, only 22 of 2649 (0.8%) resident anaesthetists are black—down 40% from 2014.1 We are seeing the same trend in other specialties too, resulting in fewer ethnic minority doctors on the specialist register.1 We are doing our patients a disservice by not ensuring the workforce represents the population it serves. Recent data from the General Medical Council show that for the first time there are more ethnic minority doctors than white doctors in our workforce.2 Diversity is one of the NHS’s greatest assets, with international medical graduates and ethnic minority doctors contributing a great deal. But scratching this veneer of apparent diversity reveals huge inequalities in the specialties and roles in which …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bonnie Venter, Frank J M F Dor, Mary Ryan, Avi Sewpaul, Stephen Potts
International experience could inform UK law, regulation, and clinical practice Organ donation after physician assisted dying has the potential to increase the availability of lifesaving organs while respecting the wishes of dying patients and their families. However, legal, regulatory, clinical, and ethical challenges need to be carefully navigated. Belgium, the Netherlands, Canada, and Spain permit voluntary euthanasia through intravenous drugs administered by professionals and have the most experience of subsequent organ donation. Several hundred cases have been reported in practice developed in response to patient requests. Voluntary euthanasia was established in Belgium and the Netherlands decades ago, while in Canada, medical aid in dying (MAID) has expanded rapidly since it was legalised in 2016. In Quebec, organ donation after MAID increased from 4.9% of deaths to 14% between 2018 and 2022.1 In jurisdictions that allow donations after voluntary euthanasia, good medical outcomes have been reported for kidney,2 liver,3 lung,4 and, in one case, heart transplantation.5 Organ retrieval must occur in a controlled hospital environment, such as intensive care, within minutes of death being confirmed. Voluntary euthanasia usually occurs nearby in the hospital, although initial sedation at home before transfer to hospital is possible.6 …
{"title":"Organ donation after assisted dying","authors":"Bonnie Venter, Frank J M F Dor, Mary Ryan, Avi Sewpaul, Stephen Potts","doi":"10.1136/bmj.r318","DOIUrl":"https://doi.org/10.1136/bmj.r318","url":null,"abstract":"International experience could inform UK law, regulation, and clinical practice Organ donation after physician assisted dying has the potential to increase the availability of lifesaving organs while respecting the wishes of dying patients and their families. However, legal, regulatory, clinical, and ethical challenges need to be carefully navigated. Belgium, the Netherlands, Canada, and Spain permit voluntary euthanasia through intravenous drugs administered by professionals and have the most experience of subsequent organ donation. Several hundred cases have been reported in practice developed in response to patient requests. Voluntary euthanasia was established in Belgium and the Netherlands decades ago, while in Canada, medical aid in dying (MAID) has expanded rapidly since it was legalised in 2016. In Quebec, organ donation after MAID increased from 4.9% of deaths to 14% between 2018 and 2022.1 In jurisdictions that allow donations after voluntary euthanasia, good medical outcomes have been reported for kidney,2 liver,3 lung,4 and, in one case, heart transplantation.5 Organ retrieval must occur in a controlled hospital environment, such as intensive care, within minutes of death being confirmed. Voluntary euthanasia usually occurs nearby in the hospital, although initial sedation at home before transfer to hospital is possible.6 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Black women in the UK are still more likely to die in childbirth than their white counterparts. Samara Linton explores why—and what’s being done to improve outcomes The UK has one of the lowest maternal mortality rates in the world, but black women are still twice as likely as white women to die from pregnancy related causes.1 Historically, this disparity has been as high as fivefold, kickstarting initiatives such as Five X More to push for improved maternal outcomes in black women.23 Despite improvements in recent years, racial inequalities stubbornly persist. Marian Knight, professor of maternal and child population health at the National Perinatal Epidemiology Unit, leads MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries), which investigates the deaths of women and babies who die during pregnancy or shortly after pregnancy in the UK. She tells The BMJ , “Women from different ethnic groups are dying from the same causes but at disproportionately greater numbers. “Maternal mortality is the tip of the iceberg: we know that these disparities exist for morbidity as well as mortality. We actually need to be looking at morbidity to see progress and see how changes in services or different interventions can actually make a difference.” In the UK, Asian women and those from mixed ethnic backgrounds also face a higher risk of maternal death than their white counterparts. Similar inequalities are seen in the US, where black women die from pregnancy related causes at nearly twice the rate of white women.4 “There are clinical factors, there are social determinants, and there is racism: structural, cultural, and interpersonal,” says Ranee Thakar, president of the UK’s Royal College of Obstetrics and Gynaecology. “I think it’s difficult to quantify which one has more of a role to play, but we have …
{"title":"Why are black women still more likely to die in childbirth?","authors":"Samara Linton","doi":"10.1136/bmj.r226","DOIUrl":"https://doi.org/10.1136/bmj.r226","url":null,"abstract":"Black women in the UK are still more likely to die in childbirth than their white counterparts. Samara Linton explores why—and what’s being done to improve outcomes The UK has one of the lowest maternal mortality rates in the world, but black women are still twice as likely as white women to die from pregnancy related causes.1 Historically, this disparity has been as high as fivefold, kickstarting initiatives such as Five X More to push for improved maternal outcomes in black women.23 Despite improvements in recent years, racial inequalities stubbornly persist. Marian Knight, professor of maternal and child population health at the National Perinatal Epidemiology Unit, leads MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries), which investigates the deaths of women and babies who die during pregnancy or shortly after pregnancy in the UK. She tells The BMJ , “Women from different ethnic groups are dying from the same causes but at disproportionately greater numbers. “Maternal mortality is the tip of the iceberg: we know that these disparities exist for morbidity as well as mortality. We actually need to be looking at morbidity to see progress and see how changes in services or different interventions can actually make a difference.” In the UK, Asian women and those from mixed ethnic backgrounds also face a higher risk of maternal death than their white counterparts. Similar inequalities are seen in the US, where black women die from pregnancy related causes at nearly twice the rate of white women.4 “There are clinical factors, there are social determinants, and there is racism: structural, cultural, and interpersonal,” says Ranee Thakar, president of the UK’s Royal College of Obstetrics and Gynaecology. “I think it’s difficult to quantify which one has more of a role to play, but we have …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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