Friday, 2 August 2013

A momentous day, and a question of Consent

I can’t start this posting without first mentioning my huge pride in my little sister, Becca.
On Wednesday, Becca is due to marry Ron, a wonderful man who everyone in the family adores. Now you might imagine that for the last weeks leading up to the wedding she has been focussing on all the planning for such a momentous event. In fact, she has been sitting university exams in architecture, and excelling: scoring in the top ranks of her year-group including a recent 100%. And as if that’s not enough, she decided to make her own wedding dress, because life just isn’t sufficiently busy.
But her trailblazing isn’t new. Becca was the first member of our family to make aliyah, about 5 years ago, and being our here without family, and initially without a job, had the most challenging time of it. She showed it could be done, which was no small part in encouraging the rest of us to give it a go.

I wanted to find a link to the other thing I’ve been thinking about, but I can’t so apologies for the clash in theme.

The question I had was why is there such a difference in attitudes in consent in the UK vs. Israel?

I first noticed this when I opened a bank account. In Jerusalem, I was asked to sign about 13 pages of forms, each one with dense text. When I asked what I was signing, or for an English copy, I never got a proper answer, except that it is necessary to get an account. I know that in the UK we do also sign saying “we have read the terms and conditions”, but that seems less frightening than signing 13 pages individually, each confirming that I giving away some other right.

This would all be no more than an intellectual curiosity, except that I’ve found it’s started to affect how I explain anaesthesia to patients at work.

So compare the way one surgeon tried to consent my patient, in the theatres reception:
“You want anaesthesia? Please sign here.”
(handing patient a page of dense A4 text listing all the risks of GA, including everything from pain to Malignant Hyperthermia and Death) the way the nice young British immigrant doctor (Yours Truly) put it:
“Now to explain what will happen in the OR. (explanation of arriving, getting oxygen mask, IV line and drugs to go to sleep, followed by wake up in the Recovery Ward).

“I have here the anaesthetic consent form. It lists all the very rare things that can occasionally happen under GA. I know it may sound frightening but anaesthesia is extremely safe nowadays.

“If after the operation you feel pain or nausea please let us know and we will give you extra medicines to help with that. Other than that, the much rarer things that occasionally happen in anaesthesia are:
Damage to teeth
Aspiration of vomit
Damage to Lungs;
Allergies to medication
One in several thousand remember their surgery despite GA
One in 250,000 don’t wake up from anaesthesia, which is extremely rare.

Do you have any questions or anything I can explain better?
If you’re happy to go ahead, would you mind signing here and dating here.”

By the end of this, the patient is starting at my wide-eyed (literally. Do you know that people’s eyes genuinely do go wide when they are afraid?)

They all sign, but I never feel that I have eased their medical journey.

I have tried different wording; being humorous; likening the odds to crossing the street (which is a bit of a lie, I have no idea what the one-off risk of crossing a road, but I suspect it is actually less than 1:250,000). None of this works for me. They all seem petrified.

Is it a kindness to put them through this? And will it ultimately make any difference? After all, they are signing the same document that includes these risks and more. In other words, can ignorance be bliss?

I will keep experimenting with other ways of saying the same thing, and who knows, maybe some day I’ll find the magic formulae for an informed, confident and happy patient.

Friday, 1 February 2013

UN Human Rights Commission Report

Just read this article in Ha'aretz about the new UN report on the settlements:

It is undoubtedly true that the UN Human Rights Commission is a joke. That it is full of countries with atrocious human rights records, and that it is more than a little bizarre the way that it focusses on Israel, rather than far more serious violations elsewhere.

However, there is still the possibility that they occasionally will speak the truth.

The settlements are unfortunately a breach of international law, because you are not allowed to transfer your population into "occupied territory". Israel has no choice but to consider the territory to be "occupied" because we don't can't extend the vote to the hostile palestinian population, but to call it Israel and not give them the vote would be true apartheid.

Worse than that: settlements seem to be the only weak spot Israel has with regards to the International Criminal Court (this was pointed out to me by an Israel lawyer friend). The ICC only intervenes if the local country's legal system is unwilling or unable to investigate a case. We have shown that we can prosecute our politicians (normally for fraud or rape), that we can prosecute soldiers in the cases of them violating human rights, but the courts have never looked at the legality of *all* settlements, and are unlikely to be able to do so. So the ICC is in a strong position to step in.

In the end, I am confident we will solve the problem in the West Bank, and withdraw from most of it:
We may do it through a negotiated settlement, having found a "partner" who can deliver.
We may do it because our conscience as a people compels it.
We may do it under pressure from foreign governments and international bodies, friendly and less friendly.
We may do it due to some economic and social boycott, similar to that seen against South Africa.
We may do it in the face of a serious uprising, unwilling to pay the cost in lives, as we did in Lebanon.

I hope for my country sake that we pick our time well, and leave under the best possible circumstances.

Shabbat Shalom