Sterilisation of young, competent, and childless adults.
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Adult↗
Biomedical subjects
Martin Lupton
Publications and source records attributed to Martin Lupton.
Informed consent: can a patient ever be fully informed?
PURPOSE OF REVIEW: The National Health Service Litigation Authority has issued a warning about the process of asking a patient for their consent prior to a medical procedure. This warning was issued in the light of the case of Chester v. Afshar. For the first time in English law the courts have appeared to state that failure to give a patient adequate information about a procedure is negligent per se. This article briefly examines the history of consent since the famous case of Bolam and reviews the recent legal commentary on the case of Chester. It will also consider a proposed solution to the question 'What is adequate information?' RECENT FINDINGS: The medicolegal literature traces the change in the legal test used to determine whether a patient has been adequately informed. It charts the evolution of a 'prudent patient' test and suggests ways in which medical practitioners might adequately fulfil their duty to inform patients properly. SUMMARY: Since the case of Chester v. Afshar it has become harder for a doctor to escape a charge of negligence if they have given inadequate information at the time of asking a patient for their consent to undergo a medical procedure. It is in everyone's interests - doctor and patient - to make the process of consent transparent and to an agreed national standard.
Humans↗
Cardiac disease in pregnancy.
Congenital heart disease in pregnancy is increasingly common because of the advances in surgery and medical therapy which have taken place over the last 30 years, which means that more affected women are surviving into the reproductive age. Antenatal counselling needs to be tailored to the specific lesion, with pulmonary hypertension and cyanotic disease presenting a risk of maternal mortality of up to 50%. The use of anticoagulants in women with artificial valves presents a particular challenge, heparin being safer for the baby and warfarin for the mother. Peripartum cardiomyopathy and Marfan's syndrome may be less dangerous than once thought. The risk of congenital heart disease in the fetus is increased, from twice to 20-fold, depending on the nature of the mother's lesion. Care throughout pregnancy and in the puerperium should be multidisciplinary and include cardiologists, obstetricians and midwives with experience of such cases, preferably in a tertiary centre.
Anticoagulants↗