Going to extremes

doi:10.1136/bmj.39385.488796.47

BMJ 2007;335 (3 November), doi:10.1136/bmj.39385.488796.47

Editor's Choice

Going to extremes

Tony Delamothe, deputy editor

tdelamothe{at}bmj.com

A lot can go wrong between conception and that last, failedattempt at cardiopulmonary massage, but it's the two extremesof life that seem most fraught. To my knowledge, no cardinalsor archbishops have opined on Lyme disease (doi: 10.1136/bmj.39363.530961.AD)or sepsis (doi: 10.1136/bmj.39346.696620.AE), but they've hada lot to say on abortion and end of life decisions.

Never out of the news and courts in the United States (doi:10.1136/bmj.39384.487326.4E), abortion is firmly back on thepolitical agenda in the United Kingdom. As Jonathan Gornallpointed out earlier this year, the core aim of anti-abortionistsis the complete abolition of abortion, except where it's a matterof life or death for the mother (BMJ 2007;334:285). Given theimpossibility of repealing abortion laws in developed countries,their focus has moved to chip-chipping away at the upper legaltime limit for abortions. In the UK, they've proposed bringingit down from 24 to 20 weeks. Last year, that would have meant2500 fewer fetuses being aborted in England and Wales, or 1.2%of the total. The British Medical Association, the Royal Collegeof Obstetricians and Gynaecologists, and the Royal College ofNursing all maintain that the upper limit should remain at 24weeks. So does the UK government (doi: 10.1136/bmj.39381.521481.DB).

For the conceptus, surviving to birth isn't the end of the struggle:the Modern Parent is lying in wait. In "The Baby Shambles" DesSpence looks back to a golden age when "having children involvedtwo teenagers falling in love, having sex, then being forcedto marry at the age of 20 . . . The children tumbled out, andparents just muddled through." (Cue something by Dolly Parton.)Now we have "stagnant pools of poisonous introspection in whichwe are all drowning, cold dark pools fed by television programmes,magazines, and so many expert books." Spence's prescription:"tell parents to throw all the parenting theories into life'swheelie bin, to raise their heads and trust intuition, and evenenjoy being parents again" (doi: 10.1136/bmj.39384.481308.59).

From the good enough parent to the good enough death: must attemptedcardiopulmonary resuscitation always be part of it? Not if thepatient doesn't want it, says the BMA, Royal College of Nursing,and the Resuscitation Council in updated guidelines (doi: 10.1136/bmj.39384.681829.DB).Nor if the most senior clinician in charge of the patient'scare, after due consultation, can't see the point. Sanity breaksout.

Resuscitation is presumably the last thing on the minds of healthcareprofessionals ministering on death row in Texas. There, condemnedprisoners are invited to make a last statement which, alongwith their photograph and convictions, is published on the websiteof the Texas Department of Criminal Justice. Brendan Kelly andSharon Foley examined the central themes and psychological constructsof the last statements made by 100 prisoners. It is interestingenough that these statements should read like suicide notes—butthen the authors turn the spotlight on themselves: why werethey, Irish psychiatrists, doing the study? To what extent shouldthey permit their views about capital punishment to shape thewriting of their paper? In their personal view (doi: 10.1136/bmj.39378.691296.3A)they say the things about "state sponsored killing" they censoredfrom their research paper.