Editor's Choice

Going to extremes

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39385.488796.47 (Published 01 November 2007) Cite this as: BMJ 2007;335:0
  1. Tony Delamothe, deputy editor
  1. tdelamothe{at}bmj.com

    A lot can go wrong between conception and that last, failed attempt at cardiopulmonary massage, but it's the two extremes of life that seem most fraught. To my knowledge, no cardinals or 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 had a 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 the political agenda in the United Kingdom. As Jonathan Gornall pointed out earlier this year, the core aim of anti-abortionists is the complete abolition of abortion, except where it's a matter of life or death for the mother (BMJ 2007;334:285). Given the impossibility of repealing abortion laws in developed countries, their focus has moved to chip-chipping away at the upper legal time limit for abortions. In the UK, they've proposed bringing it down from 24 to 20 weeks. Last year, that would have meant 2500 fewer fetuses being aborted in England and Wales, or 1.2% of the total. The British Medical Association, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Nursing all maintain that the upper limit should remain at 24 weeks. 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” Des Spence looks back to a golden age when “having children involved two teenagers falling in love, having sex, then being forced to marry at the age of 20 . . . The children tumbled out, and parents just muddled through.” (Cue something by Dolly Parton.) Now we have “stagnant pools of poisonous introspection in which we 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's wheelie bin, to raise their heads and trust intuition, and even enjoy being parents again” (doi: 10.1136/bmj.39384.481308.59).

    From the good enough parent to the good enough death: must attempted cardiopulmonary resuscitation always be part of it? Not if the patient 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's care, after due consultation, can't see the point. Sanity breaks out.

    Resuscitation is presumably the last thing on the minds of healthcare professionals ministering on death row in Texas. There, condemned prisoners are invited to make a last statement which, along with their photograph and convictions, is published on the website of the Texas Department of Criminal Justice. Brendan Kelly and Sharon Foley examined the central themes and psychological constructs of the last statements made by 100 prisoners. It is interesting enough that these statements should read like suicide notes—but then the authors turn the spotlight on themselves: why were they, Irish psychiatrists, doing the study? To what extent should they permit their views about capital punishment to shape the writing of their paper? In their personal view (doi: 10.1136/bmj.39378.691296.3A) they say the things about “state sponsored killing” they censored from their research paper.

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