Minerva

Venous thromboembolism is the leading cause of maternal death in Britain, and a review in the British Journal of Obstetrics and Gynaecology (1999;106:756-66) says that women with a family history of thromboembolism should be screened early in pregnancy for the known inherited types of thombophilia.

Reoperation is recommended for patients with persistent abnormalities after surgery for hyperparathyroidism, but a report from the Mayo Clinic (Archives of Surgery 1999;134:699-705) notes that the results of repeat operations have not improved in the past 20 years despite the introduction of sestamibi parathyroid subtraction scanning and intraoperative hormone monitoring. In 124 patients having repeat surgery at the clinic, the cure rate was only 88%—whereas it was 99.5% in patients having surgery for the first time.

In the current discussion of euthanasia one example from the past is Sigmund Freud, who endured 30 surgical procedures for his cancer of the mouth between 1923 and 1939. Early in the course of the illness he agreed with his personal physician that he would want help with dying (Archives of Internal Medicine 1999;159:1521-5). When Freud's suffering became intolerable he asked his doctor to remember their agreement; he went into a terminal coma after …