Gatentekst GOD
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Doctors are playing God
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Doctors were right to ..1.. a liver transplant to a 15-year-old girl who had taken the drug
ecstasy, a judge ruled yesterday. But Michelle Paul’s ..2.. might have been saved if she
had been given an early test for liver failure.
Giving judgement after an eight-day fatal accident inquiry in Aberdeen, sheriff Graeme
Warner said that doctors at the Edinburgh Royal Infirmary’s liver unit made their decision
not to ..3.. Michelle on medical, not moral grounds despite claims by the girl’s mother and
grandmother that she had been rejected because of a family ..4.. of drug abuse.
But sheriff Warner criticized doctors at Aberdeen Royal Infirmary, where Michelle was first
admitted, for failing to carry out the ..5.. liver function test. She was transferred to the
Edinburgh unit only when her condition deteriorated and it became obvious she was
suffering from liver failure. By then it was too late for a transplant and she died on 27
November 1995 – 23 days after taking half a tablet of ecstasy at a rave near her home.
Some years ago my father had a coronary bypass operation for heart disease. The first
question the surgeon asked when assessing him was, “How old is your youngest child ?“
The ..6.. message was that patients with young families to care for would get priority. My
father , who ..7.. had a nine-year-old daughter, got his operation in four weeks, although
he had been told the waiting list was four months. That seemed to me then – in 1981 –
and seems to me now a ..8.. way to proceed. Of course I am biased. For all I know
someone else on the waiting list died, because the surgeon, the most eminent in his field
at the time, helped my father to jump the ..9...
Michelle Paul, the 15-year-old Aberdeen girl who suffered liver failure after taking half an
ecstasy tablet, was denied a liver transplant, because someone else was judged to be in
greater need. Yesterday Aberdeen’s Sheriff’s court ruled that the decision was made on
medical, not ..10.. grounds. The transplant surgeon, Dr. Hilary Sanfey, and her
colleagues at Edinburgh Royal Infirmary had to tell the court that Michelle had suffered
..11.. brain damage.
But Dr. Sanfey ..12.. that social problems such as drug taking had to be taken into account
when considering which patients were suitable for transplant. Success is not ..13.. when
the transplanted patient, with newly inserted organ, is discharged from hospital.
There follows a strict ..14.. regime of drugs and medical tests that must be followed ..15.. if
the organ is to last. Doctors have to make a judgement about whether the patient is
capable of following such a regime. Is that a medical or a moral ..16..?
There is intense debate about these matters within transplant units - and beyond them. Sir
David Carter, the chief medical officer of Scotland and former director of the liver unit at
Edinburgh Royal Infirmary to which Michelle Paul was admitted, said last year that a
background of drug or alcohol abuse in a patient “coloured the thinking” of surgeons
assessing them. Alcoholics would be ..17.. to stop drinking for at least six months before
their case for a transplant would be considered, he said.
Sir David Carter was asked if this did not ..18.. to playing God. His response was ..19.. : “I
think that’s inevitable if you practise medicine. We are making ..20.. decisions that affect
life and death all the time. Part of the calculation of ..21.. and ..22.. involves the setting to
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which the patient returns and the ability they have to ..23.. medically and socially with the
pressures.”
Few doctors are prepared to speak as frankly as Sir David Carter but all know that social
..24.. frequently intrude into medical decisions. Doctors have a responsibility to use limited
NHS resources to the best effect. Sometimes, as in my father’s case, a decision whether
or not to treat (or how soon) has ramifications ..25.. the immediate patient.
The judgements ..26.. clearly moral when doctors attempt to assess the social worths of
patients rather than limiting themselves ..27.. to calculating the benefit treatment can
bring. This was the charge levelled by ..28.. grandmother, Margaret Pirie, who asked the
doctors who had refused her granddaughter a transplant why the former Rangers and
England soccer star, Jim Baxter, whom she described as an “ex-alcoholic football player”,
had been entitled to two liver transplants. Mrs Pirie claimed, in effect, that the doctors had
rejected Michelle because she was a drug user with no social ..29.. who had brought her
problems on ..30... The refusal of treatment on such grounds is ..31.. unacceptable.
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Opties gatentekst GOD
1
A
B
C
Deny
Give
Allow
2
A
B
C
Liver
Life
Live
A
B
C
Transplant
Allow
Refuse
A
B
C
D
Refusal
Background
Tradition
Illness
3
4
5
14
A
B
Voluntary
Lifelong
15
A
B
Rigorous
Rigorously
16
A
B
Decision
Answer
17
A
B
Invited
Required
18
A
B
C
Need
Have
Amount
19
A
B
Unclear
Instructive
A
B
C
Unusual
Normally
Routine
20
A
B
Clinically
Clinical
A
B
Unstated
Outspoken
21
A
B
Finances
Risks
A
B
C
Later
Than
Then
22
A
B
Benefits
Possibilities
8
A
B
Wrong
Humane
23
A
B
Live
Cope
9
A
B
Queue
Rope
24
A
B
Benefits
Judgements
10
A
B
Financial
Moral
25
A
B
Beyond
For
11
A
B
Irreversible
Slight
26
A
B
Become
Were
12
A
B
Said
Admitted
27
A
B
A
B
C
Strictly
Strict
Michelle’s
Michelles’
Michelles
6
7
28
13
A
B
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Guaranteed
Necessary
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29
A
B
Benefits
Standing
30
A
Herself
31
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B
Others
A
B
Clearly
Obvious