Drug control, human rights, and the right to the highest attainable standard of health: a reply to Saul Takahashi

A recent article in this journal challenged claims that a human rights framework should be applied to drug control. This article questions the author’s assertions and reframes them in the context of socio-legal drug scholarship, aiming to build on the discourse concerning human rights and drug use. It is submitted that a rights-based approach is a necessary, indeed obligatory, ethical and legal framework through which to address drug use and that international human rights law provides the proper scope for determining where interferences with individual human rights might be justified on certain, limited grounds.

Valuation 'accuracy' within the Right to Buy process

Based on surveys undertaken with local authorities and valuers who provide the valuations on which purchase prices for local authority houses under the Right to Buy are based, this paper reports on research which aims to establish the reasons for the differences between the initial valuations provided by the local authority valuers and those provided by the District Valuer on appeal. The paper reports on the reasons why tenants appeal the initial valuation and discusses issues of valuation accuracy, uncertainty and the different and imperfect data available to valuers employed by the organisations involved, as well as the factors within the valuation process, including the absence of any requirement to agree a value, which contribute to the different outcomes.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

Right-to-left shunt determination in dog lungs under inhalation anesthesia with rebreathing and non-rebreathing system

OBJETIVO: Comparar a formação de shunt venoso-arterial em pulmões de cães submetidos a anestesia geral inalatória utilizando-se sistemas de anestesia com e sem reinalação, com fração inspirada de oxigênio de 0,4 e 0,9, respectivamente. MÉTODOS: Empregaram-se 20 cães induzidos com tiopental sódico (30mg/kg) e mantidos com sevoflurano (3%) e alocados em dois grupos (n=10); os animais de GI foram ventilados com modalidade controlada em sistema semifechado, sem reinalação, F I O2 = 0,9, e os de GII, com modalidade controlada, sistema semifechado, com reinalação e F I O2 = 0,4. Os atributos analisados durante o experimento foram: freqüência cardíaca, pressão arterial média, shunt pulmonar venoso-arterial, hematócrito, hemoglobina, pressão parcial de oxigênio arterial, pressão parcial de oxigênio no sangue venoso misto, saturação de oxigênio no sangue venoso misto, pressão parcial de dióxido de carbono arterial e pressão de vapor de água nos alvéolos (P VA). RESULTADOS: A P VA foi significativamente maior em GII. A análise estatística dos valores encontrados de shunt mostrou que GI e GII apresentaram diferenças significativas, sendo que os resultados de GI são maiores que os de GII em todos os momentos avaliados. Já a análise de momentos dentro de um mesmo grupo não demonstrou diferenças. CONCLUSÃO: O sistema de anestesia sem reinalação com F I O2 = 0,9 desenvolveu maior grau de shunt pulmonar venoso-arterial que o sistema de anestesia com reinalação e F I O2 = 0,4. A umidificação dos gases em GII contribuiu para diminuir o shunt.

Access to housing and direct housing subsidies: some Latin American experiences

Includes bibliography

Mortgage loans and access to housing for low-income households in Latin America

Includes bibliography

Ablation of the ability to control the right-to-left cardiac shunt does not affect oxygen uptake, specific dynamic action or growth in the rattlesnake Crotalus durissus

The morphologically undivided ventricle of the heart in non-crocodilian reptiles permits the mixing of oxygen-rich blood returning from the lungs and oxygen-poor blood from the systemic circulation. A possible functional significance for this intra-cardiac shunt has been debated for almost a century. Unilateral left vagotomy rendered the single effective pulmonary artery of the South American rattlesnake, Crotalus durissus, unable to adjust the magnitude of blood flow to the lung. The higher constant perfusion of the lung circulation and the incapability of adjusting the right-left shunt in left-denervated snakes persisted over time, providing a unique model for investigation of the long-term consequences of cardiac shunting in a squamate. Oxygen uptake recorded at rest and during spontaneous and forced activity was not affected by removing control of the cardiac shunt. Furthermore, metabolic rate and energetic balance during the post-prandial metabolic increment, plus the food conversion efficiency and growth rate, were all similarly unaffected. These results show that control of cardiac shunting is not associated with a clear functional advantage in adjusting metabolic rate, effectiveness of digestion or growth rates. © 2013. Published by The Company of Biologists Ltd.