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Law and Ethics and Medicine: How do they relate?

by YPU Admin on July 21, 2016, Comments. Tags: Law, medicine, Research, university, and UoM

Introduction

Hello, my name is Jessica Azmy and I am a medical student at the University of Manchester. This year I am taking a year away from my medical studies and studying for a Masters in Healthcare Law and Ethics, before returning to my final year of medical school. I will hopefully then graduate as a doctor!

In Depth

It may seem strange to be completing a Masters at this stage and I never imagined when I started Medicine that this is something I would do. During medical school I was intrigued by the relationship between the law and medical practice because it seemed to be relevant in all areas. I often found doctors referring to what the law does and does not allow and wanted to explore this further. I am really interested in certain areas such as the law determining whether children can or cannot refuse medical treatment that doctors feel is best for them. The main aim is to consider what the law currently says and what it should say, if we lived in an ideal world. Of course doctors need to know the law to avoid being taken to court, if something goes wrong!


What the law should say comes down to fundamental questions which are captured by the ethics part of my course. For example, the reason why doctors must always ask whether we agree (consent) to medical treatment is because we are human beings that have the ability to decide for ourselves what we want. The exploration of why doctors should act in certain ways and whether it is right or wrong to take a particular course of action is a constant source of debate and there is rarely one ‘correct’ answer. This is what I like most because it makes me consider my own views and learn to argue these in a way to persuade other people to agree with my argument. Some of the areas I have considered include organ donation and whether this should or should not be a choice, whether scientists should be able to experiment on humans, and the problems arising from creating human-animal hybrids (mixture of human and animal tissue).

What’s the point?

With constant advances in science and technology creating new possibilities in healthcare there is a need to consider what we should and shouldn’t allow. How would you feel if you could choose the characteristics of your future child – their hair colour, eye colour and even intelligence? Do you think everyone should be an organ donor? Should doctors be allowed to end the life of a patient who is suffering terribly? Should doctors ever keep information from patients to prevent upsetting them? These are some of the pressing questions that ethics aims to address! The issues are often on the news making what I am studying even more relevant and interesting.

I am not sure what type of doctor I want to be in the future but the best thing about law and ethics is that it is relevant to all areas of medical practice and will hopefully help me with whatever speciality I go into. I hope to also use my Masters to teach future medical students about the law and perhaps offer advice in legal cases involving doctors.

Going further

To explore a wide range of ethical dilemmas in science visit:

http://www.beep.ac.uk/content/1.0.html

For a greater look at the ethics surrounding gene technology:

http://www.beep.ac.uk/content/457.0.html

To look at what is involved in creating human-animal hybrids (mixing human and animal tissues):

http://www.bbc.co.uk/ethics/animals/using/hybridembryos_1.shtml

Watch this video for a general introduction to ethics (not specific to science):

https://www.youtube.com/watch?v=vAuv0HujFbc

Really interesting video comparing ethics in science and arts and giving more information on why we make decisions:

https://www.youtube.com/watch?v=NO4mgCDtMXs&ebc=ANyPxKo8q0_849gLcXpPdKXw1t5vLgBlb1B-7rnzhJTjbOldWhebYT-Dpg3N7M3YTrysw2s7y3aD9RB_99TdaFjtCfkamFPsOw


 

The Muddy Waters of Medical Humanitarianism

by YPU Admin on May 26, 2016, Comments. Tags: Humanitarianism, medicine, postgraduate, Research, and UoM

Introduction

My name is Ciaran Clarke and I am studying a masters in Humanitarianism and Conflict Response (HCR). My background is far removed from the history, international relations, and sociology which forms a large part of my degree. In fact, despite studying a postgraduate degree, I am still an undergraduate! I am studying the Masters between my fourth and fifth year of undergraduate medicine.

This is known as intercalation and is traditionally pursued by medics who want to study one aspect of science in greater detail, such as physiology or pharmacology. Manchester Medical School is particularly unique in the breadth of options available for intercalation. However, the HCR Master’s degree stood out for me. I have always wanted to undertake medical humanitarian work, but the multitude of issues surrounding this field have always left me feeling uneasy. I felt that the HCR Masters would give me an opportunity to grapple with these issues and develop a better understanding of how medical aid can be delivered effectively.

In Depth

The Masters programme has been incredibly rewarding, particularly for someone coming from a science degree. The complexity of humanitarian aid has been unveiled to me, going to a depth of understanding which I never imagined reaching. This has included asking myself questions which have never before crossed my mind, such as – is providing aid always good? A year ago I would have likely said yes, but through studying disciplines such as history, ethics and public health I have come to realise that no straightforward answer exists. For instance, there are instances of aid being used to extend conflicts, when it has fallen into the ‘wrong’ hands and been sold on a black market and provided funds for armed forces.

One of the great things about the Masters is the wealth of experience I have been surrounded with. It is difficult not be inspired when you turn up on a Tuesday morning and your lecturer starts telling you about his recent United Nations meeting or her trips to war torn parts of northern Sri Lanka to provide medical assistance. As a postgraduate taught (PGT) degree, for two thirds of the year my days are a mix of lectures, seminars and private study. After handing in my essays in May, I will then have the remainder of my degree free for my dissertation.

My dissertation gives me the opportunity to study one aspect of humanitarianism in real depth. My current focus is on the development of sustainable healthcare systems following humanitarian crises. Medical aid has often been directed towards specific diseases such as HIV/AIDS, Polio, Malaria or Tuberculosis, this is known as a vertical approach. While this can tackle specific diseases, when the money dries up it is unlikely that a robust healthcare system will remain. But many of the countries that have require medical aid have limited infrastructure and trained personnel for developing an all-encompassing or ‘horizontal’ approach. The question remains, how do we approach healthcare development in a sustainable manner without spreading resources so thin that they don’t have any effect? It seems that a compromise between the two needs to be reached!

The greatest challenge for me has been learning to adapt to a completely novel set of disciplines. Getting my head around and then critiquing theories of learning, international relations and in depth history articles has been a very different challenge to memorising the signs of liver failure!

Going forward, I still hope to undertake medical aid work in the future, but the Masters has made me realise that I must wait until I am a relatively independent practitioner. Therefore, I will continue on my medical training, hopefully pass my finals and then start as a junior doctor in 2017!

Going Further

For those of you who want to find out more about the incredible staff at HCRI then click this link

Medicins Sans Frontieres (Doctors Without Borders) website http://www.msf.org.uk/

An overview on the current state of the ‘humanitarian system’ http://www.alnap.org/what-we-do/effectiveness/sohs

The full range of intercalation options open to medical students at UoM http://www.mms.manchester.ac.uk/study/why-study-medicine-manchester/intercalation/

For an insight into some of the problems with aid watch the film “The Trouble with Aid” (2012) 

 

Research for the British Heart Foundation

Introduction

Hey I’m Claire, a second year PhD student here at the University of Manchester looking at how the cardiovascular system, the heart and blood vessels, works. With cardiovascular diseases being the leading cause of death worldwide, contributing to over 30%, research into the heart and blood vessels is very important.

The heart is an amazing organ. Working as a pump, the heart beats one hundred times a day to move twenty three thousand litres of blood around the body. This job is hugely important as the movement of blood around the body not only delivers oxygen and nutrients but also removes waste.

So, for the heart to do a pretty good job it must continuously pump in a regular pattern.  When the heart begins to beat strangely - too fast, too slow or in an odd rhythm- things begin to go wrong. These abnormal heart rhythms are called arrhythmias and are the focus of my work.

In depth

How common are arrhythmias? Very! The chances of you knowing someone who has an odd heartbeat is highly likely. In the UK alone, one million people experience a heart rhythm problem every year, making it one of the top 10 reasons people go to see a doctor. Arrhythmias also play a part of half of heart failure deaths, so understanding how they develop is crucial to tackle the major heart disease problem.

What causes abnormal heart rhythms? Arrhythmias are really complex and can be affected by many things including diseases, your lifestyle choices but also your genetic makeup. Your genes are the codes which decide your unique characteristics, acting as a sort of blueprint or set of instructions. Now your genes not only decide how you look, but they also influence your chances of developing certain diseases, including arrhythmias.

So my research aims to identify certain genes or codes which make your heartbeat irregular, hoping to uncover why some people are more likely to get odd heart rhythms.

How do I look into a role of a gene in the heart’s natural rhythm? I mess around with the genetic blueprint of heart cells in both human and animal cells.

Animal models can be controversial to use, but are hugely important in science research. They allow me to look at the bodily effect of gene by removing a gene from the heart of a mouse- something which I defiantly couldn’t do in a human!! Comparing normal mice with those who have a certain gene missing from there heart, I see how that specific genetic instruction affects how the heart pumps blood. Therefore, I can see if having or not having a single gene can make you more or less likely to get an abnormal heart rhythm!

Can this help fight cardiovascular disease?  By knowing how our genetic makeup affects our chances of getting heart diseases, can help us not only identify the people who are most at risk but may also help in developing  new drugs and treatment for abnormal heart rhythms and even heart failure!

Why I do it? While I may not have always loved science at school, I have always been fascinated by the world around us, especially how our amazingly intricate bodies work and what happens when things go wrong in diseases. As mentioned, cardiovascular disease is a major health problem. Being able to be part of the fight against it is truly rewarding and astounding.

Like a lot of scientists, the main thing that attracted me the world of science research is the excitement of the unknown, knowing that no one has ever done what I am doing is an amazing feeling!

Going further

I hope you are now fascinated by the world of science research and the cardiovascular system! Here are some ways to further delve into the area I am studying -

My work is kindly funded by the British Heart Foundation, and there website is great for learning more about the different conditions and what research they do.

·  Here you can find out lots of basic facts about the heart:

·  http://www.bhf.org.uk/heart-health/how-your-heart-works.aspx

·  This section explains more about abnormal heart rhythms:

·  http://www.bhf.org.uk/heart-health/conditions/abnormal-heart-rhythms.aspx

·  And here is a link to information about some of the other research they support: http://www.bhf.org.uk/research/our-heart-research/our-researchers.aspx

I am part of the Institute of Cardiovascular Science at Manchester. Here is the link to their page when you can find out more about the research going on and how you can get involved through further study: http://www.cardiovascular.manchester.ac.uk/


 

Social media as a learning tool

Introduction

My name is Laura, and I am taking a year away from being a medical student to complete a masters in Health Care Ethics and Law. Medical schools call this year out an "intercalation year" and offers it to all medical students interested in earning an extra science-related degree on top of their current medical degree. In my fourth-year at medical school, I started a research project to explore how medical students used social media to achieve their learning goals. Is there a place for social media in an academic institution at all? Can social media actually benefit students rather than be a distraction? This was what I wanted to find out. Right now, the study has gone international with medical schools as far as Australia, North America, Saudi Arabia and many more taking part!


In Depth

I think it is safe to say that most of you are on some sort of social media website, whether that is Facebook, Twitter, Instagram etc. At the very least you will have heard of them. Mostly they are used for leisure purposes, but could they also offer some learning benefits?

For a while now, higher education institutions have adopted social media technology as a means of delivering curricula. Medicine is a discipline that has only just started to look into this possibility. Our research study has identified several ways in which social media is currently used to facilitate curricula delivery and supplement independent learning:

-  Creating Facebook groups with peers to extend small group seminar discussions to the online world

-  Sharing of academic resources and journals via social media

-  Fast, effective communication channels between peers and lecturers irrespective of classroom hours and physical location

-  Following hastags on Twitter appropriate to the subject they are learning

-  Searching YouTube videos for practical procedure demonstrations or tutorials

-  Instagram-like applications available to doctors and medical students where they can share and discuss pictures of clinical examination findings, blood test results, chest x-rays, electrocardiograms, MRI/CT scans etc.

-  Using interactive twitter feeds in classrooms to answer students' questions and encourage participation

The list could go on. The body of research literature available to date indicates there are positive outcomes to the implementation of social media technology into the medical curriculum which outweighs any drawbacks - increased motivation and engagement with study material, increased likelihood of seeking academic support, improved exam scores, improved confidence with the subject and better knowledge retention. The study is still ongoing and the next phase will involve investigating whether attitudes towards social media use in medical education differs between countries or cultures. 


Going Further

To find out more about studying medicine at undergraduate level or doing an intercalation year, see:

Manchester Medical School http://www.mms.manchester.ac.uk

Intercalation year http://www.mms.manchester.ac.uk/about-us/whymanchester/education/intercalation/


 

Exercise as a form of treatment for mental illness

Introduction

My name is Joe and I’ve just begun the 2nd year of my PhD in Medicine. I am researching how we can use physical exercise to improve people’s mental health. Specifically, I work with young people (from 18 years onwards), who are experiencing serious mental health problems for the first time in their lives – a condition which is referred to as “First Episode Psychosis”. I am investigating whether specially designed physical exercise routines can help people with First Episode Psychosis to feel healthier; in the body, and also in the mind. 


In Depth

What is First Episode Psychosis

First Episode Psychosis is the first 5 years of any ‘psychotic disorder’, such as Schizophrenia. This affects around 1 in 100 people, and most often starts around the age of 18. The most recognisable symptoms of first-episode psychosis are hearing voices, seeing things which other people cannot see (hallucinations), delusional beliefs and paranoia. Along with these, there are often less obvious symptoms of people severely lacking in motivation, feeling depressed, withdrawing from society and becoming reclusive.

Current Treatment

The most common treatment for first-episode psychosis is antipsychotic medications: There are tablets that sufferers can take which greatly reduce the symptoms of hearing voices, delusions etc. However, people taking these tablets often relapse within a few years, or need higher and higher doses overtime for them to remain effective. Furthermore, antipsychotics do not help with the symptoms of social withdrawal and inability to feel motivated. Unfortunately, it is these unseen symptoms which can really prevent people from living a happy and fulfilling life.

What do I Investigate?

I am investigating whether we can use physical exercise for first-episode psychosis, as an extra treatment for all the different types of symptoms so that they need fewer medications and feel better overall in life. To do this, people with first-episode psychosis are sent to me from their mental health service. I design them a special exercise routine and then take them to the gym twice-per-week for 10 weeks to train with them. In the exercise sessions, we do running, rowing and cycling to work on their fitness, and also weight training to work on the muscles. Past research has shown that these sorts of training can make people feel better, happier and more motivated – even in normal healthy people. It has never been tried for First Episode Psychosis (even though these are the people who may need it most!).

To see if it has worked, we score peoples’ mental health using a psychiatric interview before they start the 10 weeks of training, and then score them again after the 10 weeks to check if they have improved. I also look at peoples’ physical health, fitness, social life and brain functioning, as exercise is known to be able to help with these things too. If proven effective, exercise may eventually become part of NHS treatment programs for first-episode psychosis, and be available to any young person who is in need of treatment, like a new form of therapy! 


Going Further

If you want to know more about first-episode psychosis in general, such as what causes it, what it does, here is a great place to start: http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/psychosis/first_episode_psychosis_information_guide/Pages/first_episode_psychosis_information_guide.aspx

For more information about my specific experiment, you can find the full details of the clinical trial here: http://www.controlled-trials.com/ISRCTN09150095/

If you’re interested in which physical exercise can improve mental health, this article goes through many different ways in which it may do this:
http://www.huffingtonpost.com/2013/03/27/mental-health-benefits-exercise_n_2956099.html