LAW X Medicine - The Global Youth Review

THE GLOBAL YOUTH REVIEW

LAW X MEDICINE

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LAW X MEDICINE The Global Youth Review

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Welcome to the rst edition of NLCS’ newest publication: LAW X. We began this magazine with a desire to create a global youth law review. Although law is not a subject included in the school curriculum, it is still vital to our understanding of the world; Law is inevitably entangled with the fabric of society, of which we will be the future.With this magazine we wished to give students from our NLCS family, an opportunity to explore how the law is relevant and present in many different elds. Therefore, each edition of LAW X will be in conjunction with another subject/theme. For the rst issue we have chosen LAW X MEDICINE.

We wanted our writers to delve into the intricacies of law and medicine and how each one in ltrates the other, whether that is discussing issues of abortion, medical malpractice or euthanasia. Moreover, as we continue to live through the pandemic, the crossover between the legal eld and medicine seemed more appropriate than ever. We are so incredibly proud of our writers, and we hope to engage more of you in our next issue, LAW X TECHNOLOGY.

Students from Y10-13 from both NLCS London and NLCS Dubai have written for this edition, with plans to expand to NLCS Jeju in the upcoming issue. Our articles cover a wide range of issues, cases and countries. Also interspersed between articles, we have included four brief medical malpractice cases, designed to refocus your attention in the overlapping worlds of Medicine and Law. This magazine has been such a joy to establish and we hope you enjoy reading the very rst edition of LAW X.

- Zahra Ahmad and Megan Grewal, Year 12 NLCS

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Editors Welcome!

CONTENTS How Does Healthcare Globalisation Affect Critically Ill Children ? .....5 Is Pleading Insanity a ‘Get out of Jail Free’ Card? .........................................8 Medical Malpractice Case #1 ...............................................................................12 How did the 1989 Children Act affect Medical Ethics? .............................13 Weight Loss : Fact vs Fiction ...............................................................................15 Medical Malpractice #2..........................................................................................17 Psychology and the Criminal Justice System, Jenkins vs USA ...............18 Euthanasia and the Hippocratic oath ............................................................20 Euthanasia and the Law .......................................................................................24 Medical Malpractice #3 ........................................................................................28 Medical Malpractice #4 ........................................................................................29 Legal framework for Mental Health insurance in the US and its Deficits ........................................................................................................................30 Medical Negligence Law .......................................................................................33 The Case of Re B (A Minor)..................................................................................35 Medical Malpractice #5 ........................................................................................38 Track and Trace Privacy Law .............................................................................41 The WHO’s response to COVID-19, Successes and Failures...................44 Should the Government impose a duty on The People to take the Coronavirus Vaccine? ...........................................................................................46 The Shipman Inquiry ............................................................................................49 Abortion Laws in Poland .....................................................................................56 Should Cannabis be Legalised for Medicinal Purposes? ........................58

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Prescription Drug Prices: Who is Responsible? ..........................................61

How Does Healthcare Globalisation Affect Critically Ill Children ?

By Anya Vaghani, Year 12 North London Collegiate

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espite the increasing knowledge concerning healthcare and medicine, care for critically ill children can be extremely

complex for all parties involved in the upbringing of the child and their recovery, namely the family and the relevant medics or healthcare professionals. The increasing developments of parents interjection and assertion of making decisions for their children can present challenges to the treatment of the child, and especially, the law.

The challenge of globalisation, which is the process of interaction and integration among people, companies and governments worldwide, is becoming evident in the law surrounding children’s medical treatment. One of which being the Internet, which many parents rely on for information as a knowledge base, which can be unreliable and the accuracy of the data can be imprecise. The establishment of social media and the emotional effect it can have on people polarises disputes and provides misinformation.

In English and American Law, it states that in a decision affecting a child, the best interests of the child are a primary consideration, and the welfare of the children is the paramount consideration in any decision. In English law, when lawfully making decisions, neither the parents nor the medical supervisors can lawfully make decisions for

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a child in isolation. The courts are required to intervene in disagreements about children’s medical treatment.

Globalisation is the process by which the world is becoming increasingly interconnected as a result of massively increased trade and cultural exchange, and the production of goods and services have risen. While globalisation has concurrently been viewed as an opportunity and a challenge in healthcare, for the poorer countries, the presumed benefits of healthcare globalisation is not always prevalent. Inequalities in healthcare access is damaged by the overwhelming economic and political barriers to accessing healthcare, and little facilities available.

As we have seen in constitutional commentary and some political responses to the COVID-19 pandemic, health policies may follow or even reinforce trends already apparent in health consumerism in

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perceiving health as a matter for autonomous choice rather than physical need. Furthermore, the mood and opinions of the public sphere can play a role in intensifying disputes between families of critically ill patients and healthcare supervisors.

The potential of social media publicising medical cases has become very popular. The case of eight month old Charlie Gard was very popular. He suffered a rare and fatal genetic disease, for which his parents were investigating experimental treatment. After experiencing numerous seizures damaging his brain, the hospital obtained permission from the courts to remove life support. His parents opposed this and wanted to transfer him to a US specialist who would provide the treatment they preferred.

Once they publicised the case on social media, it became well known and resulted in the collection of funds from online donations.

Additionally, international figures like the Pope and President Donald Trump intervened which broadcasted it further. Charlie’s parents eventually lost their case but it gave precedent to more similar cases, as well as social, political and religious activism via the Internet. The use of social media heightens emotional responses for cases on a global scale and can potentially make a child a commercialised symbol for globalised psychological confrontations.

Similarly, the use of crowdfunding highlights the way in which globalisation raises challenges to decision making for critically ill children.

The process of globalisation presents huge challenges not only to the law as it refers to healthcare, but arguably nations as well. The law has a significant role to play, both in an academic context as the

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research must take place, but also in practice by responding to the impacts of challenges in a suitable manner advocating for justice and reform.

Is Pleading Insanity a ‘Get out of Jail Free’ Card?

By Hayat Alibhai, Year 12 North London Collegiate School Dubai

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leading innocent by reason of insanity is a practice originating back in the 1840’s, a practice is recognised as an

excuse defence rather than a justification defence. The English court recognised insanity as “the witness who do not have reason whereby they can choose the good from the evil”. As clearly that definition would lack sufficient detail in modern day, the definition of an insane criminal is one that admits ownership of the crime(s) but lacks culpability due to their mental illness.

If a criminal chooses to plead insanity, a psychiatric exam must be conducted prior to the trial through government paid forensic psychologists.

Ideally, psychiatrists are forbidden to assert their opinion on whether they believe the criminal was in a state of mental insanity at the time of committing the crime, that burden falls upon the defendant.

Psychiatrists are only limited to providing a mental medical

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diagnosis at the time of the trial. But, how sure can one be that the criminal was undergoing mental anguish at the time of the crime?

The M’Naghten defence plea is one of the four pleas that may appeal for pleading innocent by reason of insanity, which requires the criminal to be diagnosed with a mental defect or disease in conjugation with an inability to know that the action was illegal or wrong. For example, Person X is suffering from a severe form of multiple personality disorder and therefore harms their child due to their multiple personality taking control of their mind. The child loses excessive amounts of blood and is now pronounced dead due to blood loss. Person X later files a police report saying that they harmed their child when experiencing a personality switch but, in that moment, did not recognise its repercussions. By law, person X is viable to plea insanity by the M’Naghten defence plea, however, to what extent does mental health overshadow our ability to control impulses? The American Bar Association often refers to the

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M’Naghten defence plea as a defence when you have no other option. The mockery made of this plea is indicative of the reputation it has.

Baltimore defence attorney Cristina Gutierrez argues that these cases are simply for show and publicity as they are “crimes that are bizarre within themselves”. The principal argument is answering the question of whether the criminal was aware of their wrong-doings at the time? The ambiguity of the requirements of this plea make it an emotional based argument, one that a defendant can easily argue that the accused is insane, and in an environment such as the court room, where emotion is an integral part of being a lawyer, one can simply convince the judge that insanity is the route of this case.

Additionally, the limitation of the psychiatrist, the professional in this situation, being unable to comment on whether they believe the criminal was experiencing a mental episode is baffling. Following the Hippocratic oath, that limits psychiatrists from imposing one’s personal beliefs, shouldn’t the mental health profession be able to comment on whether the accused is guilty or not, from a medical perspective? The prime responsibility of a lawyer is to argue their side, even with limited evidence, and placing the responsibility of convincing the judge that the accused is insane on them is irrational and absurd.

The law itself utilises the words “wrong” and “know”. The word “wrong” has moral implications, posing the question of is wrong a moral or legal obligation? If a person is suffering from a severe mental illness, does that necessarily mean that their cognitive function is the sole reason as to why they would commit such a

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crime? Are mental health patients exempt from experiencing will and emotion?

Pleading insane is not a get out of jail free card, but it is one of the many questionable methods of where the law attempts to deal with medical issues.

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Medical Malpractice Case #1 FAILURE TO OBTAIN BLOOD TYPE

Pictured above is an inside look into one of the most prestigious medical facilities in the U.S, Duke University Hospital.

In 2003 the medical practice was under fire for their irresponsible behaviour surrounding the organ transplant of a 17 year old girl, Jesica Santilian, when performing a heart and lung transplant without checking the blood type of the patient.

Jesica suffered severe brain damage and went into a coma, her body shut down, at which point the healthcare workers finally realised they made a mistake. To make matters worse, they covered this mistake for eleven days, exacerbating Jesica’s brain damage, reaching a fatal point. Jesica passed away, and the doctor took responsibility.

There are now courses in Jesica’s name, detailing the sufficient checks needed before continuing with an organ transplant, and the surgery remains one of the top eight organ transplant surgeries in the United States.

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How did the 1989 Children Act affect Medical Ethics?

By Alexandra Morgan, Year 12 North London Collegiate

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he Children Act 1989 was instrumental in ensuring the safety of children living in the UK, introducing measures such as the regulation of care for children and ensuring that

court cases involving children are conducted without any potentially detrimental delays.

However, the Children Act poses multiple new dilemmas when we consider medical ethics involving children, and the most pertinent question stemming from that being how far legal courts should respect a child or their guardian’s wishes for them to refuse medical treatment. At first the answer may appear to be obvious – a court should ensure that a child receives potential life-saving treatment, even if this treatment was previously refused by them or their parents. The argument forms when we begin to consider both the moral and religious implications, why this ethical dilemma is still so prominent in our societies today.

In the UK, a child aged 16 or over is able to consent to their own treatment, whereas those under the age of 16 will require the consent of their parents if they are to have medical treatment, unless the child is considered to be ‘Gillick competent’ (i.e. prove that they have a full awareness of the treatment and provide sound reasons for why they are consenting/refusing it). However, even though children do have these basic rights when it comes to medical treatment, it can be overrun in courts on the basis of the Children

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Act, as refusing potential live-saving treatment can be seen to jeopardise the welfare of the child, which the Act aims to protect.

We must initially consider why a child might be refusing treatment, and what the implications may be if their wishes were ignored. Ian McEwan’s 2014 novel ‘The Children Act’ follows a judge who is faced with the dilemma of whether she should rule that a male seventeen year old Jehovah’s Witness should have a live-saving blood transfusion, even though he refuses treatment on the basis that his religion forbids it. His parents also back his decision, showing how they believe that refusing this treatment would be the most loving action for their son. However, the boy’s right to refuse treatment was eventually overruled by the Children Act and he was forces to have the treatment anyway. Although his life was saved, we are able to see the moral and social implications this had, suggesting why the Children Act and medical ethical often come into conflict.

Although we have seen how the refusal of treatment from children may stem from both moral and religious roots, Ian McEwan’s novel also raises multiple other questions concerning children and medical ethics. Firstly, should a court really overrule a child’s right to dictate what they do with their bodies? And secondly, is it really fair that a court can force a seventeen-year-old to have treatment, but an eighteen-year-old will not face the same legal challenges if they refuse treatment? These two questions reside in both courts and hospitals alike, and while the decision of the court wholly depends on situation the child is in, the common law system that the UK adopts often refers to previous rulings of similar cases to come to their final decision, and ultimately boils down to one key question. Is the right of the child to choose or the welfare of the child more

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important? As we have seen previously, these two factors are not mutually exclusive, which is why no distinct answer can be given in response.

Weight Loss : Fact vs Fiction

By Anagha Sreeram, Year 10 North London Collegiate

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n the UK, the weight loss industry is worth over 2 billion pounds, with more people aiming to lose weight each year. In fact, last

year 48% people who made new year’s resolutions said that their resolution was to lose weight. While some people aim to lose weight to avoid medical illnesses such as type-2 diabetes and heart diseases, many do so due to low body confidence. 1 in 5 adults in the UK lack this confidence and girls as young as five are conscious about this.

Unfortunately, there are many fraudulent companies which take advantage of the craving of a ‘miracle’ solution, slimming nothing

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but people’s bank balances. This article will discuss how certain companies take advantage of this lack of confidence, why some people must lose weight and the healthiest way to do so.

Why do people want to lose weight? Many aim to do so for avoiding vulnerability to diseases, while many do so for acceptance into society. An example of the former is to avoid heart disease.

Cholesterol is a fatty plaque which can be caused by the consumption of too much fatty food and can block arteries which restrict oxygenated blood flow to the heart as well as other parts of the body, known as atherosclerosis. This loss of blood circulation limits aerobic respiration, which requires oxygen, causing the build up of lactic acid. This is especially problematic for the heart or the depravation of oxygen, causing heart disease. However, the latter example is generally caused by influences of social media, television and stereotypes.

According to the NHS, the best way to lose weight is to eat regular, healthy meals with plenty of water and minimal alcohol, as well as regular exercise. Note that all of this can be done with no special pills or medication and nothing extra needs to be bought in order to achieve this. Moreover, it is also interesting how no ‘genuine reviews’ are needed to prove this, and no significant weight loss goals are promoted- this is just a way to stay healthy, no matter what body size or condition, and comes with the benefit of losing weight.

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Medical Malpractice #2 VIOLATION OF PRIVACY, GYNAECOLOGY In 2014, a medical malpractice and violation suit was filed after it was found that Dr Nikita Levy had secretly taken inappropriate pictures and videos of patients without their consent when coming in for a gynaecology check up at John Hopkins Hospital. He had worked at the hospital for over 25 years, and when the police finally raided Levy’s home, they found more than 1,200 videos and 140 pictures of women.

He was able to take these pictures and videos of patients over the years, using a recording device imitating a pen.

Levy was charged criminally and committed suicide days after his arrest warrant was issued. John Hopkins Hospital agreed to a settlement of one hundred and ninety million dollars to the 8,000 plaintiffs, ranging in-between north of a million dollars to 28,000 dollars to each plaintiff.

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Psycholo y and the Criminal Justice System, Jenkins vs USA

By Neesha Murale, Year 11 North London Collegiate

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n the world of criminal law as well as criminal justice, forensic psychologists bring forth behavioural research to the courtroom

to support the case at hand, and this plays a very large and extremely significant role in the field of criminal justice. Often, their main role is punishing and preventing crimes and the word forensic is literally defined

as, ‘the scientific method for investigation of

crime’. Therefore, forensic psychology is literally translated as the merger of law and psychology.

People that tend to work in this department have the excruciating, but nevertheless thought provoking job of trying to figure out why certain people commit crimes, what type of people commit a crime, what are the trends in the crimes they commit and most crucial of them all how to prevent these people from committing the crimes.

This works in conjunction with the judicial system, and works well in terms of mistakenly charging people of wrongful convictions.

The contribution of psychology to the criminal justice system has been extremely vital, especially in terms of comprehension and accountability, why some criminals are served harsher sentences than others for relatively similar crimes. Once psychological reasoning can be applied, it can evidently be seen as one of the driving forces behind the punishments, consequences and the law.

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From the initial stages of a trial, testimony from eyewitnesses are crucial in framing a case, as the evidence comes from recollection of the incident. The theory behind this is that it is easier to recall the thoughts if the environment is a replica of the crime scene; this is due to the reasons that it heightens the emotions similar to that of when the eyewitness was at the crime. It is said that shock, fear and being disturbed and being on that same emotional level brings back the memories more distinct and clearer. Perceptions, clothes, smell and other visible aspects can also similarly affect the eyewitness’ report. However, psychologists tend to state that these reports may not always be 100% accurate as other things can hinder these memories and they can impact this.

The psychological aspects in court cases can be outlined to its fullest in the pivotal case, Jenkins vs USA, a trial for housekeeping, assault and intent to rape (1974).

The defendant was presented the testimony of three clinical psychologists in support of insanity. All three testi ed based on their personal experiences and contact with the defendant and after a thorough review of his case history they came to the conclusion that the defendant was suffering from Schizophrenia. It was also stated that after further discussion it was said that the crimes and the mental illness were in relation to each other.

However, it wasn't until 1962 that psychologists were permitted by the US court to investigate further into this case. In the original case the defendant - Vincent E Jenkins, had mounted to an insanity and the psychologists evidence was overruled. However, when the case was appealed it was then said that psychologists had the correct education and profession to conclude a decision and

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Thanks to the Jenkins case, the APA program was formally nalised and used as an essential tool for using the appropriate psychological research in criminal cases. It has now been used in 200 federal and state cases ranging from child abuse, hospital rights, disabilities and sexual orientation

Euthanasia and the Hippocratic oath

By Nuha Kidwai, Year 10 North London Collegiate School Dubai

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he Hippocratic Oath, otherwise known as the core of medical practice; is a pledge made by physicians to uphold

specific ethical standards within medical practice, such as doctorpatient confidentiality and non-maleficence. In numerous regions, physicians are required to take the Hippocratic oath, and violating the oath’s principles has repercussions of suspension of medical practice or arrest.

However, as of recent, opinions of whether

euthanasia is compatible with the Hippocratic oath has begun to vary, and now, many have begun to question whether euthanasia and physician assisted suicide truly violate the principles of the Hippocratic oath, which has been undertaken by over 6 million doctors worldwide.

Most arguments which state that euthanasia violates the Hippocratic oath, and is thus unethical, due to it breaching the basis of medical ethics solely revolve around the two principles of the oath. The first principle of the oath states ‘first, do no harm’. Through delivering

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diagnose the illness. From that point, psychologists have had the correct procedures to testify about mental illness in criminal cases.

euthanasia or physician assisted suicide (PAS), a doctor has to administer a lethal drug, consisting of Pavulon, which causes muscle paralysis and respiratory arrest, potassium chloride to cause asystole and midazolam to sedate the patient. This administration of lethal drugs, as well as violating the clause of ‘I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan’ within the

oath, causes maleficence, as it does harm by causing the body’s organs to deteriorate and simply by taking a human life, thus violating the oath. Further, upon the ideas of beneficence and nonmaleficence, through providing euthanasia and physician assisted suicide, doctors violate beneficence as they are ultimately killing and exterminating a human life. The argument of euthanasia and PAS

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violating the Hippocratic oath, and thus the foundational medical ethics, demonstrate that euthanasia and PAS is unethical, and is therefore justified in being illegal in numerous countries such as the United Kingdom. Yet, it is evident the arguments which contend euthanasia as unethical due to it violating the Hippocratic oath, are limited in number, obviously outdated, and fail to see euthanasia through other perspectives.

Modern arguments, which are more widely accepted, clearly demonstrate that the Hippocratic oath is not violated through euthanasia and PAS and is thus ethical. Firstly, although outdated arguments suggest euthanasia and PAS does harm, as it terminates a human life and ceases the human body from functioning, it is moreso evident that euthanasia and PAS do not harm, and instead do good, therefore following, and not violating the Hippocratic oath.

This is because euthanasia and PAS are used in conditions where there is terminal suffering, and even palliative care has failed to enable the patient to withstand the pain they experience. Therefore, euthanasia and PAS aids to prevent the elongation of a patient’s suffering, and to stop patient’s from experiencing further complications as their conditions worsen. Most euthanasia patients are already determined to die in a short period of time, and thus euthanasia and PAS aids to prevent the painful final stages of terminal illnesses. This demonstrates that aiding a patient in euthanasia or PAS is ‘doing no harm and doing good’ as it assists in preventing the patient from experiencing further pain and suffering.

This does good for the patient, by ending their suffering, and does not harm, as it prevents the patient from gaining complications within the final stages of their life. This signifies that euthanasia and

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principles within the oath. Finally, and the most obvious argument, is the question of whether the Hippocratic oath; seen as the centre of medical justice, which was created 2400 years ago should even be abided by today. This is because using the oath, which was created at a time of extremely limited medical development, would be an inappropriate standard for evaluating medical policies today.

Many aspects of the oath, such as not doing surgery have already been eliminated. Therefore, surely the oath should not even be placed into consideration when evaluating the ethics of euthanasia?

These arguments clearly highlight that euthanasia does not violate the oath, and even if it does so, the Hippocratic oath should not be of enough relevance to prevent euthanasia and PAS.

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PAS do not violate the Hippocratic oath, and instead abide by the

Wholly, as time has progressed, more regions have begun to abandon the use of the Hippocratic oath due to its lack of relevance to modern day society, and in turn, have hosted more progress towards euthanasia and physician assisted suicide, due to a stronger belief in its ethics. But there is still progress to make, and eventually, we hope to see a time where it will be accepted that the only humane choice in a euthanasia and PAS scenario, is to enable individuals who are suffering to have the right to decide to end their suffering.

Euthanasia and the Law

By Ruby Qureshi, Year 10 North London Collegiate

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aw in medicine. Perhaps not the most obvious link or intertwining, but so apparent in everyday life, and so often

missed. I would like to talk about a rather obvious case of law in medicine that has been debated for so many years, giving my take on the topic of euthanasia, as well as the medical and ethical laws that surround it. Euthanasia, defined as ‘the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma’ has been fought against, fought for and overall argued about for so long now. Going from the definition alone, to me, it sounds obvious that this is a perfectly ethically moral and smart thing to do. Painless killing, a suffering patient, what could be the reason that some may reject the idea so thoroughly. From a medical standpoint it is widely known that doctors would always want the best for the patients, so is euthanasia always the case? And

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if so, is it morally right or acceptable for a doctor’s view on the

subject to prolong a patient’s endless suffering?

Christopher Cowley argues that we have ‘misunderstood the special nature of medicine and have misunderstood the motivations of the conscientious objectors.’ In my opinion, we have not. In the Netherlands recently, three euthanasia cases involving women with psychiatric conditions and dementia are under investigation.

Prosecutors confirmed that the deaths, in 2017 and 2018, were being investigated for potentially breaching strict conditions in the 2002 law that allows people in the Netherlands to ask a doctor to help them die. Dutch euthanasia laws require patients to be experiencing unbearable suffering, with no prospect of improvement, and to have a voluntary sustained wish to die; doctors must also seek a second independent opinion. According to a report by the Dutch Regional Euthanasia Committees, prosecutors are investigating a doctor for

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failing to treat the case of a woman with ‘due diligence’. A woman in her 70s with depression had been operated on for abdominal problems when surgeons found evidence of lung cancer, leading her to approach a doctor and speak her concern about her experiencing unbearable psychological suffering and wanted euthanasia. Her doctor’s colleague took on the case, however the review committee reported he failed to obtain a second opinion from an independent psychiatrist, as is required. Was this intentional, due to him not believing that her case was worth a second opinion or merely a mistake on his part? Judging from the state of the woman from a medical standpoint, it can be argued to be the latter.

And so the question reappears, is it morally right or acceptable for a doctor’s view on the subject to prolong a patient’s endless suffering?

With the Netherland’s strict yet precautious laws in place, it is evidently not legally acceptable. Yet in countries with no or less

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strict laws on the matter, is a punishment or sentence for the doctor the morally right thing to do? This doctor’s personal moral views led to a woman, who had been living daily with an unimaginable amount of pain, not being treated the way the law required, having to carry on her unbearable suffering for a prolonged amount of time.

In countries with less developed laws surrounding the topic of euthanasia, you must wonder how many of these situations go unnoticed or most likely not cared about.

Perhaps these questions of if it is morally right for a doctor’s view to prolong the suffering of a patient will never be fully known or answered, but from my point of view, euthanasia is a choice by the patient who is obviously suffering from some form of pain daily.

Doctors, although having years of medical training, do not reserve the right to decide a person’s life and continuation of suffering based on their own moral opinions.

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Medical Malpractice #3 MEDICAL MALPRACTICE CASES THROUGH THE YEARS The first recorded instance of medical malpractice was in 1164 in England, when a doctor supposedly prescribed ‘unwholesome medicine’. This case was documented as Everad V. Hoskins.

Though this may have been the first documented Medical Malpractice case, Stratton V. Swanlond in 1374 was one of the first and most instrumental in laying the foundations and precedents for following cases, and many believed it to establish the first instance for a breach of care.

The defendant had a deformed hand, and was guaranteed by the physician that it would be fully repaired. She emerged from the extremely painful ordeal (without anaesthesia) with little to no repair on her hand, and filed for medical malpractice. The case established a relationship between the patient and the doctor, but was thrown out due to filing errors

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Medical Malpractice #4 LEAVING INSTRUMENTS INSIDE THE PATIENT In Arizona, a man on life support in an assisted living facility was being tampered with by the employees. After his death many types of foreign objects were found in his stomach, including plastic bags, ketchup packets and candy wrappers. The employees were red and the case was settled for $11 Million.

In 2008, a man left a ten-inch retractor in the lower abdomen of his patient, which remained unnoticed until his daughter pointed out the abnormal shape poking through his ribs. After asking another surgeon about it, the patient was told he needed immediate surgical help, and the instrument was removed. The case was settled for an undisclosed amount A 36-year-old female patient underwent surgery after discovering a cyst in her liver. Three years later, she excreted a part of surgical forceps left in her colon, which migrated to the anus. In order to extract the remaining part of the forceps, the patient underwent surgery, and was able to remove the instrument. It had since blackened and left irreparable damage to her vital organs

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Legal framework for Mental Health insurance in the US and its De icits

By Tanisha Malhotra, Year 11 North London Collegiate

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ental health essentially refers to the overall well-being of a person, but mental health conditions are becoming

increasingly common in America. In 2018, over 43 million Americans suffered from mental health conditions and 30.4 million persons of all ages were uninsured. The lack of affordable mental health care has had a great hand in the severity of the problem.

While there are number of reasons why mental health conditions are affecting so many people, the lack of access to mental health care services and a shortage of affordable providers has been a big cause. To find the root of this problem, first we must look at mental health law in America.

It is true that the number of Americans that have been receiving treatment has increased, the primary reason being the Affordable Care Act (ACA). It is made up of the Patient Protection and Affordable Care Act and its amendment, the Health Care and Education Reconciliation Act of 2010, and it covered mental health under the 10 Essential Health Benefit categories, along with substance abuse disorder services. It amended the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which legally required all large-group insurance plans to cover mental health services in parity with medical/surgical treatment. The ACA expanded parity in mental healthcare for those with plans from individual or small group markets, expanded access

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to mental health care and the Medicaid program, and has allowed more Americans to become insured with mental health coverage.

The individual impact is also beneficial for those who already had mental health insurance because it became illegal for insurers to write policies that charged higher copays or deductibles for mental health coverage, and they couldn’t set limits on how much they will pay for this care.

But those wishing to receive mental health care services have a more difficult time because insurance companies interpret the claims more rigidly. Many advocate legal groups find that insurance companies can circumvent the parity protection offered by the ACA by imposing strict standards of medical necessity. Oversight by federal and state governments, even when the law allows them to clearly define medical necessity, has given insurance providers the power to exclude or deny mental health coverage. This essentially means that if the insurance company doesn’t deem the client’s mental health treatment as a necessity, which is usually based on their own internal criteria and has the potential to be discriminatory against vulnerable populations.

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Since patients have these roadblocks, the conditions of some go untreated, or they attempt to go out of network to receive treatment.

For the latter, their average cost-sharing payments increases, which usually leads to patients stopping treatment due to financial concerns before it is complete, or safe to do so. Those who can’t afford it look for other plans, such as Non-ACA-compliant plants that are offered outside ACA marketplaces, which are cheaper. They include short-term plans, association health plans, fixed indemnity plans, and etc. Though their price is lower, the risk is much greater because they usually involve hidden cost and limited coverage, resulting in high medical bills. Thus, a number of factors that prevent Americans from receiving affordable mental health services.

This is troubling since the percentage of adults with a mental illness who are uninsured increased for the first time since the passage of the Affordable Care Act (ACA) this year. Especially now, in the midst of a global pandemic, the mental health of Americans is in jeopardy.

A screening conducted by the MHA saw the number of people screening for anxiety increase by 93% between January and September 2020, compared to the statistics from 2019. There was also a 62% increase in those screening for depression. Youth are particularly vulnerable to depressive disorders, and the rates of suicidal ideation are high, especially for LGBTQ+ children. The problem becomes even greater in scale when we take into account the ongoing court case Texas v. United States, where the Supreme Court is deciding on whether it should hear a case which seeks to strike down the ACA’S individual mandate and the fallout could result in millions losing coverage and cost protections. The Trump Administration backed the plaintiffs, so the outcome of the recent US election on the court case could have an impact. That being said,

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definitions in order to protect the mental health of America.

Medical Negligence Law

By Ansuhree Bhattacharjee, Year 10 North London Collegiate

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efore the 20th century, cases for medical negligence were uncommon and almost unheard of. However, cases such as

Donoghue v Stevenson and Bolam v Friern Hospital Management Committee established a strong foundation for Medical Negligence Law and changed the course of medical law dramatically. Prior to the 20th century, a legal suit against a doctor or manufacturer would have to be based on breach of a contract. Although this helped doctors resolve disputes over trading and other arrangements, it did not benefit the relationship between the manufacturer and the doctors with their consumer or patients.

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now is a crucial time, and law makers must be stricter in their

In 1932, a case named Donoghue v Stevenson changed this. Mrs Donoghue was drinking ginger beer from an opaque bottle, purchased by her friend, when she found the remains of a decomposing snail sitting at the bottom of her bottle. As a result of this, she suffered severe gastroenteritis and other health related consequences. The case was brought forward before senior judges in the House of Lords. Due to the contractual system, medical negligence could only be invoked if the plaintiff had an existing contract with the manufacturer, which it did not. Due to the severity of the situation, the judges agreed that no contractual relationship was required as the manufacturer is obliged to take responsibility for its products. The result was a majority 3 : 2 decision in favour of Donoghue.

Using Christ’s parable of the Good Samaritan, Lord Atkins declared the statement, "The rule that you are to love your neighbour becomes in law you must not injure your neighbour; and the lawyer's question " Who is my neighbour?" receives a restricted reply. You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour. Who then in law is my neighbour? The answer seems to be persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions which are called in question."

In 1957, an equally important case followed, titled Bolam v Friern Hospital Management Committee. During electro-convulsive treatment for his mental illness, the claimant suffered hip fractures as a result of falling off the couch. He argued that he should have

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received relaxant drugs or alternatively should have been warned of the risks. Not having received this, he took the case to court.

The judges decided that the claimant is not negligent simply because their doctor shares a different opinion and that is not for a judge to decide which of two different approaches to treatment is correct and should be left for medical professionals. As they had collectively decided that the doctor was not in breach of duty, the House of Lords composed the Bolam Test "a medical professional is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art . . . Putting it the other way round, a man is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion who would take a contrary view.

This emphasised the importance of consulting medical professionals and also helped shaped medical negligence law.

The Case of Re B (A Minor)

By Keira Cummings, Year 12 North London Collegiate

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he case of Re B (a Minor) referred to a child born with Down’s Syndrome and an intestinal blockage that was likely

to cause death if the obstruction was not relieved. An operation was required for the child’s survival; however, the child may have died within a few months of the operation or lived another 20 or 30 years. The parents refused to consent to the operation, believing it to be kinder to the child to die than live as physically and mentally disabled. The child was made a ward of court by a local authority,

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which, as defined by Thomson Reuters Practical law, is “a child under the supervision of and protected under the inherent jurisdiction of the High Court.” A surgeon decided that the wishes of the parents should be upheld and therefore the authority sought an order allowing other named surgeons to carry out the operation.

The question of the case was based on the welfare of the child; would it be in the best interests of the child to undertake the surgery, rather than whether the wishes of the parents should be respected.

The court ruled in favour of the NHS appeal, stating that if the surgery were a success, the child would be able to live the average life span of a person with Down’s Syndrome.

The judges presiding over the case were Dunn LJ and Templeman LJ, who both sympathised with the difficult decision the parents had had to make. However Templeman stated that the decision was now in the hands of the court and was “whether the life of this child is demonstrably going to be so awful that in effect the child must be condemned to die, or whether the life of this child is still so imponderable that it would be wrong for her to be condemned to die.”

This case has been cited in several others such as Re A (Minors) (Conjoined Twins: Medical Treatment); also Re A (Children) (Conjoined Twins: Surgical Separation) CA 22 September 2000. This case considered twins born conjoined and medically both were unable to survive as one was dependent on the vital organs of the other. The doctors requested the court’s approval to separate the twins, which would lead to the death of one. The parents, who were devoutly Roman Catholic, resisted this. The court’s opinion was that the views of the parents were lesser than the duty of the court to protect the child, so therefore the choice had to be based on the

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doctrine of necessity. The requirements for the doctrine of necessity are, according to Sir James Stephen, “(i) the act is needed to avoid inevitable and irreparable evil; (ii) no more should be done than is reasonably necessary for the purpose to be achieved; (iii) the evil inflicted must not be disproportionate to the evil avoided.”

Another is that of Re J (a Minor) (Wardship: Medical Treatment) CA 1 October 1990, which involved a severely epileptic premature child who had suffered severe and permanent brain damage at birth. His life expectancy was undetermined, although certainly short, and he was not expected to live past late adolescence. The question was whether, if he suffered the need to go on a ventilator, as he had previously had to, the medical staff would re-ventilate him if he stopped breathing. Lord Donaldson of Rymington MR, the presiding judge for the case, referred to Re B, stating that it comes “very near to being a binding authority for the proposition that there is a balancing exercise to be performed in assessing the course to be adopted in the best interests of the child.” However, he disagreed that Templeman LJ’s distinction on the matter being based on the words “demonstrably so awful” should be used as a general measure in all cases.

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Medical Malpractice #5 THE CAUSE OF JOAN RIVERS’ DEATH

By Saba Hashemian, Year 12 North London Collegiate

Joan Alexandra Molinsky, better known as Joan Rivers, was an American comedian, actress, writer, producer and television host. Having appeared on programmes such as Fashion Police, Drop Dead Diva and The Late Show, she was noted for her controversial, outspoken and acerbic nature.

In September of 2014 however, Joan died, following a procedure for the treatment of voice changes and acid reflux.

Initially, the medical examiner’s office ruled her passing as a ‘therapeutic complication’, implying that her death was an accepted possible outcome of the procedure. This conclusion primarily ruled out any concern regarding medical error or malpractice, however an inquiry into her death revealed discrepancies surrounding the true cause of her fatality.

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It was discovered that an official autopsy was never performed, despite the request of Joan’s family, and therefore there was no medical explanation for the sudden lack of oxygen. Instead, the report was attributed to her medical history and a non-invasive physical examination, ruling her death as a ‘therapeutic complication’.

Rivers had been treated at Yorkville Endoscopy on Manhattan’s Upper East Side by Dr Lawrence Cohen. In November, health authorities released a report on the clinic, highlighting an extensive list of errors, including a failure to ‘identify deteriorating vital signs and provide timely intervention’. Such negligence caused a withdrawal of the clinic’s Medicare certification, meaning that it could no longer receive payments from Medicare and Medicaid for patients 65 and older.

However, by March, the certification was reinstated as the clinic was back in compliance with Medicare policies.

Following the one-year anniversary of Joan’s death, Jane Hardey, Yorkville’s media manager issued a statement, affirming that ‘Yorkville is fully licensed’ and that ‘the physicians directly responsible for Ms. Rivers’ care are no longer affiliated with Yorkville in any way’. The clinic doctor Dr Lawrence Cohen resigned from Yorkville following the uproar sparked by Rivers’ death. Cohen carried out the endoscopy procedure on Rivers and according to the negligence lawsuit

by Melissa Rivers, also took a photo of her while she was unconscious on the operating table. This was denied by Cohen

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and his lawyer confirmed that he had ‘never stopped practicing’ despite his responsibility for Rivers’ death.

Dr Gwen Korovin, Rivers' personal doctor, is also still practicing in New York, despite not being authorised to practice at Yorkville. According to the lawsuit, she conducted an unauthorised laryngoscopy on Rivers. The lawsuit also asserts that Korovin left the operating room while other medical personnel were trying to revive her.

Rivers’ daughter, Melissa Rivers filed a negligence lawsuit in January, suing Yorkville and was compensated an undisclosed ‘substantial’ amount.

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Track and Trace Privacy Law

By Nitya Kapadia, Year 12 North London Collegiate

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ovid-19 has affected 2020 in unprecedented ways. The rush for the vaccine, the need to social distance, rules for wearing

masks; last year, these terms would have made no sense to the general population. This year, these are the topics that swarm our everyday lives. In the midst of this, in finding a way to battle the virus and its effects, the UK government adopted the Track and Trace programme, in order to minimise the spread of the virus. However, in a technologically advanced world, where data is the newest and most precious commodity, there is an argument that the Track and Trace system will be an infringement upon our privacy, begging the question, can Track and Trace co-exist with the laws that protect our privacy?

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Privacy Law, by definition, refers to the laws that deal with the regulation, storing and use of personally identifiable information, such as an individuals healthcare information or financial information. In 2018, the EU established the General Data Protection Regulation, otherwise known as the GDPR. Every time you open a new website, it will ask for your confirmation for cookies or if they can store your data; this is a direct consequence of the GDPR. To implement this in the UK, the Data Protection Act was passed. This ensures that all information will be used fairly, lawfully and transparently.

The Track and Trace system, developed by the NHS, requires a person to input the locations they have visited, and people they have met. With this information, when someone has tested positive for the virus, it allows authorities to contact people who have been exposed to the virus, mitigating its effects.

One of the main purposes of the Data Protection Act is to protect sensitive information such as race, ethnic background, political opinions, biometrics and religion. The Track and Trace system does not infringe upon any of these. In fact, in the EU, geo-location data is not considered to be sensitive data. Whilst it may be deemed as intrusive, and so it requires an individual’s consent, in the context of a crisis, there are less obstacles to overcome.

Furthermore, there is the argument that all the information that is collected by the system is already shared in our increasingly connected world. Social Media accounts know our close friends and our relationships, online shopping history records our addresses

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and services such as Uber remember our frequently visited locations.

However, there are legitimate concerns that it will infringe upon our privacy. A group consisting of more than 20 MPs from four different parties have expressed concerns over Track and Trace, and are urging Elizabeth Denham, the information minister, to change the programme after the government admitted to not conducting the legally required assessment of its privacy concerns. These worries have been substantiated by the fact that the programme has led to three data breaches, including email mishaps and unreacted personal information being shared.

Combatting Covid-19 relies on one crucial component; trust between the public and the government. A failure to keep this level of trust can have disastrous consequences upon how we carry on this battle against the virus. While the answer to the question of whether the Track and Trace system does infringe upon our rights or not is a

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grey area, a lesson to be learned is that there needs to be communication between the public and the government.

The WHO’s response to COVID 19, Successes and Failures.

By Humza Ahmad, Year 10 North London Collegiate Dubai

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n the 31st of December 2019 the Wuhan Municipal Health Commission made a public announcement on cases of ‘viral

pneumonia’ in Wuhan, People's Republic of China, catching the attention of the WHO, who immediately requested information on the reported cases from the Chinese authorities. This request was accepted on the 3rd of January when Chinese officials provided information on the cluster of unknown cases. The case developed when, on the 10th of January, the WHO reported that the Chinese authorities have correctly determined that this new outbreak was caused by the coronavirus and later became a worldwide pandemic.

Many people currently criticise the response and effectiveness of the WHO in reacting to the outbreak of coronavirus due to a number of factors, namely misinformation spread about the virus as well as acting at a remarkably slow speed, causing the deaths of many individuals and an astronomical increase in the number of cases during this period.

However, alongside criticisms of the WHO’s response, many people chose to praise the organisation, taking on advice needed to attempt to sedate the virus, as well as the resources they provided while doing so.

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It is widely accepted that the WHO quickly acted upon this new virus by informing countries across the world on prevention, surveillance, containment, treatment, coordination among other factors. Whilst being criticised for its slow reaction, it is undeniable that they provided useful documents and videos, spreading information through social media platforms such as Twitter and various other public announcements that undoubtedly equipped people with knowledge and some understanding on this deadly virus.

The WHO worked with health workers, attempting to prevent them from catching the virus while being able to recognise symptoms and provide treatment to those in need. Alongside this information, the WHO supplied countries with over 101 million masks and shipped personal protective equipment to over 172 countries, aiding the prevention of the spread of COVID-19. With the limited information available to them and the constant pressure for them to understand and combat this virus, many believe their efforts to be adequate.

Others suggest that the spread of misinformation by the WHO was inexcusable, as they initially announced the outbreak of the virus as ‘pneumonia’ and not the coronavirus. They were also late to advise people to begin wearing masks, an official statement came out in early June. However, early June is when the COVID-19 was known to be spread as a droplet infection, therefore making masks necessary.

Furthermore, the US Department of Health was quick to criticise the WHO, suggesting that the use of masks was not necessary, then choosing to reverse their decision. Being a highly polarised and influential nation, the United States had the ability to create trends, and if the WHO had been stronger at the outset of declaring this

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pandemic as a larger issue, there is evidence to suggest that there would definitely be less people against wearing masks in the US. However, it is important to note that the trend of ‘not wearing masks’ and disregarding information given by the WHO was consistently endorsed by the President of the United States, Donald Trump, who has since caught the virus himself, therefore asserting the notion that, rather than non-governmental organisations having an impact on policy and individual opinion, leaders of Nations had to take a stronger stance against the Coronavirus.

This can be seen from the firm response from New Zealand, as well as eight other countries who have reported no new coronavirus cases as of the 17th of December It is clear to see that the WHO, while having power and research teams to back its decisions, cannot do more than advise nations and leaders of nations, as well as provide resources to those who need it.

Should the Government impose a duty on The People to take the Coronavirus Vaccine?

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By Katie Pannick, Year 11 North London Collegiate

ovid-19 is undeniably the biggest health, economic and social crisis that this country has faced since WW2. With the recent

developments regarding vaccination, the question of whether this vaccination should be mandatory arises. It is not unusual for the state to intervene when it comes to the safety of the people, and there is a general legal principle that, when appropriate, the state requires people to take certain precautions regarding health,

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regardless of whether they want to or not. For example, everyone is required to wear seatbelts when in a car, and helmets when on a motorcycle. These are precautions that, like the coronavirus vaccine, protect not only those directly injured in the event, but also prevent damage being done to society at large from medical costs and other financial burdens. The coronavirus, like car and motorcycle accidents, inflicts a burden on society, as seen in the recent hospital crisis with a lack of hospital beds, doctors and equipment to treat other patients due to the influx of Covid-19 patients.

Another example of state intervention for the wellbeing of a nation, is the Public Health Act, which gave ministers the power to require people to isolate if they have an infectious disease. This creates a clear comparison to the question of the mandatory legislation of vaccinations, with the difference in this case being that people taking a vaccination are not yet infectious, whereas those affected by this cause in the public health act are. This mandatory isolation has

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greatly assisted in reducing the spread of coronavirus, and therefore leads one to believe that mandatory vaccinations would have the same effect.

The vaccination is undoubtedly safe and effective, as it has gone through several rounds of testing. There are very strict standards it must pass before being released to the public. There will always be people who doubt this safety and are reluctant to take the vaccine.

However, in this case the question is not whether the vaccine is safe enough to release, but whether making it mandatory would be the best way to persuade people to take it. For the law to compel people in this context may not be the most effective way to do so, as many will defy this law, which poses problems of enforcement, as the government has never faced something like this. To avoid all of this, it seems to be a better alternative to try to gradually persuade the population to take the vaccination, through advertisements, photos of celebrities taking the vaccine, or other forms of persuasion. This gentler method should be tried first, before any mandatory legislation, as e n c o u r a g i n g p e o pl e rather than forcing them to t ake the vacc ine would not result in the same acts of defiance. As long as the vast majority of the population have immunity due to v a cc i n e , t h i s le ave s rooms for some to not

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be vaccinated, as there would still be herd immunity. Therefore, the ‘anti-vaxxers’ that are vehemently against vaccination could refrain from being vaccinated, which would diminish the problem of enforcement and what to do with those who don’t comply with the rules that the mandatory legislation of the COVID-19 vaccine would bring.

Overall, the government does have the right to make the vaccine mandatory, as they intervene on other matters of health in the best interests of the population. If necessary, mandatory legislation would be most effective as a last resort, in case not enough people take the vaccine. It would be far more sensible to first use methods of persuasion and advertisements to encourage rather than force people to take the vaccine, as this works better than simply fining people, or ultimately even sending them to prison.

The Shipman Inquiry

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By Mukampikai Sathees, Year 12 North London Collegiate

he power that a doctor holds when entrusted with the lives of their patients can lead them to develop a ‘God

complex’ in which they believe that they have the right to decide who should live and who should die. This was the case with Harold Frederick Shipman, an English general practitioner who is believed to be the UK’s most proli c serial killer.

Shipman was born in January 1946 in Nottingham. He was particularly close to his mother and so losing her to lung cancer when he was just seventeen a ected him severely. It is believed

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that through his career, Shipman attempted to process his trauma by re-living the last year he spent with his dying mother.

After graduating in 1970, Shipman began working as a preregistration house ranks o cer at the Pontefract General

In rmary. The in rmary saw a higher than usual death rate during Shipman’s training period and nurses recalled seeing empty injection packets lying in the rooms of the deceased

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patients. Although no-one questioned it at the time, if any of these deaths were murders, they lined up with Shipman’s later modus operandi (often shortened to M.O., it is someone's habits of working, particularly in the context of business or criminal investigations, but also more generally). Shipman may have injected his patients with morphine, remembering how it eased his mother’s pain, despite her terminal condition, and an accidental overdose may have shown him that morphine could be used to kill without consequence and thus permanently remove their pain.

Shipman had tried morphine himself and claimed he ‘didn’t care for it’. However, he did develop a pethidine addiction whilst working at the in rmary and so when o ered a job as an assistant general practitioner in 1974, he went out of his way to handle them by o ering to re-organise records and dispose of outdated pharmaceuticals. He quickly realised no one else was tracking the disposal of the pharmaceuticals and so he began overprescribing pethidine to his patients so that there would always be excess pethidine for his personal use. A lethal dose of pethidine to someone with no tolerance is 500mg but by 1975, Shipman was taking 600mg daily and his co-workers had no clue. However, a pharmaceutical company noted the vast amount of pethidine they were supplying to his workplace and contact the Home O ce. The investigation led to Shipman and although all signs suggested pharmaceutical abuse, he was left with a warning. However, his addiction continued, and the side e ects grew worse. In 1975 he was diagnosed with idiopathic

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they believed he was guilty of theft, forgery, and drug abuse and when he admitted, he was forced to resign and enter a rehabilitation centre. The authorities were also alerted and Shipman was charged with 82 criminal counts for unlawful drug possession and prescription forgery. He plead guilty to 8 and was ned ÂŁ600 and asked to pay compensation to the NHS. However, his medical licence was not revoked as there was no evidence his patients had been harmed by his drug abuse and he had appeared to have made a full recovery after just three months in the rehabilitation centre. In 1976, his case was fully closed.

In October 1977, he began working again as a GP in Hyde. The only remaining consequence of his drug abuse was that he was not legally allowed to carry controlled substances on his person.

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epilepsy. By September 1975, his colleagues confronted him as

Just 10 months into his new job, Shipman made his second con rmed murder, most likely by morphine overdose. He listed the patients cause of death as coronary thrombosis and in their grief, the family never questioned it. Shipman also listed the deaths of many of his other elderly patients as pneumonia, respiratory failure, and myocardial infarction – perhaps to mislead the coroner.

He followed a distinct modus operandi. He would visit a patient at home, inject them with narcotics to ease their pain, ensure the death appears natural and then turn on the replace, to speed up the body’s decomposition which causes complications e.g., when assessing a speci c time of death. The pattern resembled the last days he spent with his dying mother.

Shipman was

nally arrested on 7th September 1998 after

murdering 81-year-old Kathleen Grundy. Despite her age, she was in good health and Shipman’s visit was only for a routine blood test but instead of drawing blood, he injected a lethal dose of morphine. When she was found dead the next morning, Shipman certi ed that she had died of old age. However, her daughter grew suspicious when she found that her mother’s will had been changed and now left £400,000 to Shipman. Mrs Grundy’s body was later exhumed, and morphine was found in her system. Another eleven bodies were also exhumed, and Shipman was charged and convicted with 15 counts of murder and 1 of forgery.

On 1st February 2000, the Secretary of State for Health announced that an independent private inquiry would take place

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in Shipman’s activities. The inquiry was chaired by Dame Janet Smith DBE and its ndings were released in a total of six reports.

It investigated 618 deaths took approximately 2500 witness statements. The report con rmed that Shipman had killed at least 215 but possibly as many as 260. In January 2004, he was found hanging in his cell in Wake eld Prison.

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Law X Crossword!

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Abortion Laws in Poland

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By Emilia Ord, Year 11 North London Collegiate

oland has a contentious history in regards to abortions and women’s rights. In 1956 under Communist rule, Poland

legalised abortion in cases where the woman had "difficult living conditions". This alteration in the law brought about huge change since the previous law only allowed a woman to terminate her pregnancy if it resulted from a criminal act. The new legislation which permitted terminations under less stringent criteria meant that women from countries where abortions were restricted, such as Sweden, travelled to Poland to carry out safe and accessible abortions. This is a rather stark contrast to the state of reproductive health in Poland today.

After the fall of Communism in 1989 the new democracy formed was heavily reliant on the Catholic Church for support. Consequently, the Church has undeniably imprinted its ecclesiastical values on legislation passed by the government, notably laws regarding reproductive freedoms and homosexuality. Therefore, Poland is one of the few countries in the world to backtrack on lenient legislation and revert back to harsher abortion policies, as in 1993 they removing the clause "difficult living conditions" as ground for an abortion. The stance of the Church on abortions is pro-life, citing the sanctity of life as a key reason why abortions are unjustifiable.

In 2016 the right-wing conservative government in Poland attempted to completely ban abortions, in retaliation 30,000 people went on strike across the country to protest against the law. Three days after

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this herculean effort, lawmakers voted against the new law and it did not pass. Poland and Malta are still the only EU member states that have highly restrictive laws on abortion. Many Polish people want to adopt a more secular system of government like that of most of the EU.

Recently in the media, there has been a lot of focus upon the abortion protests in Poland which were precipitated by the ruling in October 2020 that abortion due to foetal defects was unconstitutional. Abortion, according to the new law, will only be permissible in Poland in the case of rape, incest or a threat to the mother’s life which constitutes approximately 2% of legal abortions conducted in recent years.

These vast protests highlight changing public opinion in Poland, as swathes of people -mostly young women- are supporting pro-choice ideologies which counter those of the Church. The marches are also indicative of a more fundamental schism: many of these protesters want separation of the Church and State. It seems that in Poland, the Church is beginning to lose its influence as a poll conducted last year by IBRiS research discovered that fewer than 40% of Polish people trusted the church, compared with 58% in 2016.

These protests also draw on power from the global “Me Too” movement which brought gender equality to the forefront, yet the

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key difference here is that these protests are directly attacking politics. They are hard to ignore with such huge turnout despite COVID-19 and harsh police retaliations. Indeed, they threaten to drastically change Poland’s structure of power, because they call for greater equality and inclusion of women and minorities in policy making rather than the patriarchal system which is currently in place.

Should Cannabis be Legalised for Medicinal Purposes?

By Ria Patel, Year 12 North London Collegiate

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annabis is a psychotropic drug that stems from a cannabis plant and is used predominantly for recreational purposes.

However, as many studies and investigations have suggested, there

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has been an overwhelming amount of evidence that points to the pain relief properties of the drug. It has been proven by the National Institute for Health and Care Excellence (NICE) that cannabis can minimise the symptoms that patients experience.

Over recent years there have been demands for governments to legalise the use of cannabis for medicinal purposes. Globally, countries have adopted differing regulations regarding the legalisation of cannabis; some states have opted for legalising its recreational and medicinal usage, some have only chosen to legalise its medicinal practices and some states have refused to legalise any form of cannabis and instead those involved in such substances will be severely punished due to the draconian laws.

Those who oppose the use of cannabinoids argue that the drug leads to a slippery slope effect as it is considered a gateway drug to far more harmful substances. People also claim that it can lead to patients facing an addiction as people become reliant on the psychoactive effects which the THC accounts for. However, due to the fact that the proportion of CBD is far higher than that of THC, it means that there are less psychoactive effects, signifying that the use of cannabis in medicine would be regulated more than its counterpart that is being sold illegally.

Moreover, supporters of using cannabis to ease pain argue that it is a safer alternative to using painkillers, which a myriad of research has also suggested. Pain killers can be addictive, which can cause many complications such as gastrointestinal issues, blindness, allergic reactions, organ failure, or internal bleeding. There is a possibility that it could even end fatally due to an overdose. Medical cannabis allows for patients to be able to reap the benefits by controlling the

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symptoms one endures without the added concern regarding addiction, overdose, or serious side effects which could be identified with a pharmaceutical drug. Pain killers like Morphine or Oxycodone contain opioids, which can be addictive and fatal, insinuating that it is a riskier alternative.

The legalisation of cannabis will automatically lead to regulation but it does not necessarily mean that there will be an increase in the recreational use of the drug. Despite the absence of an approval of the FDA in the US, state legislatures have allowed the use of cannabis and CBD for medical treatment in 33 states. The legislatures require a recommendation or prescription from a licensed physician by law and since its introduction in Colorado, the state has seen a rapid decline in the illicit cannabis market. People looking for cannabis, as a means of pain relief, are often forced to turn to the black market.

By legalising the drug, it would also result in a decrease in activity on

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the black market, which could reduce violence associated with it as well as improve the tax structure surrounding the product. Boosting the industry leads to industrial growth, allowing for the more employment via the distribution and the cultivation of the drug, more jobs surrounding research and development and in terms of legal changes and agreeing on the official legal framework. Not only could it bring medical benefits but benefits to communities by providing employment. Therefore, cannabis should be legalised as the benefits outweigh the risks and concerns associated with the drug.

Prescription Drug Prices: Who is Responsible?

By Talya Samji, Year 12 North London Collegiate

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rescription drug prices in America are known to be significantly higher than other OCED member states and

there has been much debate over who should be held accountable for the exponentially rising prices. Whilst many argue that the pharmaceutical companies are responsible for the increase in prescription drug prices, other believe that it should be within the government’s role to control and regulate prices to make them affordable for the 130 million Americans that require them in their daily lives. During the run up to the Presidential Election, 62% of Americans said that healthcare is the most or second-most important issue. As a result of the high prices of prescription drugs, people are forced to ration their medication which can be life

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threatening or even travel to Canada because they are unable to afford the medication in America.

Figure 1 shows spending per capita on drugs of a variety of countries, showing America to be drastically ahead of other countries

In United States, laws state that drug patents can be extended if the drug is slightly altered or changed, implying that the drug does not need to be improved to apply for an extension of the patent. The majority of drug patents in America are owned by the three leading pharmaceutical companies Eli Lilly, Novo Nordisk, and Sanofi Aventis. The Washington Post in 2018 found that "78% of drugs ‌ with new patents were not new drugs", highlighting that pharmaceutical manufacturers are not improving medicines, only slightly altering the drug to block out competition; this strategy is called 'evergreening'. Not only does this result in reduced competition, not stimulating to the economy, but it means also that

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when one company raises prices, the other two follow, which results in millions of Americans spending an unsustainable amount of money on medication which they need to survive.

Whilst pharmaceutical companies acknowledge that the price of prescription drugs has gone up, they do not think that they are reason it has. They blame PBMs (Pharmacy Benefit Managers), their role is difficult to explain, but the easiest moniker to give them is middlemen, although PBMs dislike that term. They negotiate with health insurance providers to determine how much a customer should pay, but often it cheaper for a customer to purchase the medication 'out of pocket' instead of having their health insurance provider to pay for a portion. As they determine the actual price the majority of customers pay, it is easy to see why many think that they are responsible for the increase in drug prices.

Finally, in July of 2020, after much time of declaring that the cost of prescription drugs is too high and pledging to bring them down, President Trump announced and Action Plan to lower drugs costs for patients. This was enacted in late September, the HHS (Health and Human Services) and the FDA (Food and Drug Administration) stated that this Action Plan is "to help provide safe, effective, and more affordable drugs to American patients as part of the Safe Importation Action Plan, fulfilling the aspect of the July Executive Order on drug pricing to complete the rulemaking to allow states to import certain prescription drugs from Canada." (FDA) This legislation "describes two pathways to provide safe, lower cost drugs to consumers." The first would save money by allowing companies to import drugs from Canada that are FDA approved and the second would also allow the import of FDA approved drugs that are the

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same as the US versions. However, this Safe Important Action Plan does not deal with the issue of either pharmaceutical companies or PBMs  These two pathways would make America more reliant on other nations for something so basic which America should be able to produce cost effectively and sell at a reasonable price similar to other OCED countries. Perhaps the Trump administration could have been more creative and 'hands-on' when lowering drug costs.

This issue is very close to many Americans' hearts and might not be dealt with so eagerly at the start of Biden's administration because of the Covid-19 pandemic, and Biden and Xavier Becerra (Biden's elected Health Secretary) will have to decide what to prioritise.

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