Whose right to choose?
1
609 to the 1967 Act it was estimated that some 100 000 backstreet abortions were performed every year, often with fatal or other disastrous outcomes. Women in Ireland have the opportunity to go to the UK so there is no call for widespread clandestine practice in their country. Instead, each year several thousand women go in stealth and secrecy to the UK for abortions not allowed in Eire, and the pro-life lobby has been encouraging the Irish courts to ban all counselling and assistance with a view to procuring abortions abroad. However, last October, the power of the Irish courts to ban the supply of addresses with a view to obtaining abortions in the UK was challenged in the European Court. The decision of Mr Justice Costello to impose a travel ban purported to dispose of the EC requirement on freedom of travel by drawing analogies with the right of EC countries to refuse entry to Scientologists or those with criminal convictions thought likely to re-offend (eg, "undesirable aliens"). However, this analogy does not bear scrutiny in the context of a woman travelling from one EC member state to another which is happy to receive her. In last year’s European Court case the Irish Government did not dispute the statement made to the court that it did not prohibit a pregnant woman from exercising her right to travel and receive services of termination of pregnancy abroad and that its ban on provision of abortion information did not extend to measures to restrict the movement of pregnant women. Thus last month’s Irish High Court ban on travel was not only oppressive, cruel, and beyond the requirements of Irish law, but it was also in conflict with EC law. The precise reasons for the Irish Supreme Court’s decision have not yet been released. A reference for further guidance by the European Court is probable. Diana Brahams Noticeboard Return to Lamaze? What factors determine the pain experienced by women during labour? Lowe! questioned 165 women at term gestation and found that the two major predictors of both sensory and affective pain in the first stage of labour were the degree of confidence they had in their ability to handle the delivery and the severity of their period pain. The adverse predictive influence of dysmenorrhoea might reflect a similar mechanism modulating uterine activity in both menstruation and labour. Pain in the second stage of delivery depended largely on concern about the outcome of the pregnancy and a fear of the pain that might be endured. An understanding of these types of anxiety should enable intervention to limit the need for analgesia and anaesthesia. Lowe’s data seem to offer support for those who advocate the Lamaze technique. This method of psychoprophylaxis involves abdominal and pelvic floor exercises, relaxation and breathing techniques, and comfort aids. To increase confidence about, and reduce fear of, the outcome of pregnancy- which the Lamaze technique intends to do-is the logical step that follows from Lowe’s work. Whatever method is adopted, a greater emphasis on this aspect of pregnancy is certainly justified. 1 Lowe NK Critical predictors of sensory and affective pain during four phases of labor J Psychosom Obstet Gynecol 1991; 12: 193-208 Whose right to choose? The risks that certain religious views pose to public health are highlighted by a series of pertussis outbreaks in Massachusetts, USA.1 Between 1981 and 1988, the incidence of whooping cough increased in the US from 05 cases per 100 000 to 1-4 cases per 100 000. The increasing rates of infection reflect parental concern about the safety of the pertussis vaccine and a malpractice-driven overinterpretation of the guidelines for medical contraindications. Four outbreaks (113 patients in all) that took place among school communities are described in the latest report. In one school, 24 cases came from families who had adopted macrobiotic diets and claimed religious exemption from immunisation. In another group, the attack rate among those who were unvaccinated on similar religious grounds was 3-3 times greater than in children who were vaccinated. State immunisation laws allow exemption for both religious and philosophical reasons, but these may be inappropriate because they have been applied only to the pertussis vaccine. 1. Etkind P, Lett SM, MacDonald PD, Silva E, Peppe J. Pertussis’s outbreaks in groups claiming religious exemptions to vaccinations. AJDC 1992; 146: 173-76. Of moose and men and motor cars The moose (Alces alces), or elk as it is called in Europe, is the largest living deer. An average male moose weighs 450 kg, stands 180 cm high at the shoulder, and causes quite a bump when hit by a moving vehicle. In Newfoundland, Canada, in 1987-88 there were 661 motor-vehicle accidents involving a moose (3% of all motor- vehicle accidents in that period), resulting in injuries to 133 people and 3 fatalities. The health-care cost (in Canadian dollars) of moose-vehicle accidents was$377 000. Most injuries were to the head, neck, and upper extremities, and were minor. However, patients involved in a secondary collision (other objects hit after hitting, or avoiding, the moose) had more injuries to the thoracolumbar spine, abdomen, or chest, and all the deaths were in this group. Injuries to moose were not recorded. The legs of a moose are long, giving it a high centre of gravity-thus when hit by a car the animal’s body tends to fly up into the car’s windscreen, resulting in the characteristic pattern of injuries seen in moose-vehicle collisions. Most accidents involving moose were in the summer and autumn, and shortly after sunset. In Sweden, where moose are also a driving hazard, the car company Volvo has come up with a way of avoiding night-time collisions. They propose fitting cars with headlamps that emit ultraviolet radiation-apparently moose fur fluoresces naturally in ultraviolet light.2 1. Rattey TE, Turner NE. Vehicle-moose accidents in Newfoundland. J Bone Joint Surg Am 1991; 73A: 1487-91. 2. Anon. The night nders of the black lights. Economist 1992; 322: 100 (Jan 18). The bicycle age "Pedestrians should be given priority and cycle bells rung, or a shout given in a considerate way to alert them when necessary".1 The pecking order of London traffic is too fierce for such niceties. With bizarre clothing, helmet, and mask the urban cyclist, so long a victim himself, today hurtles down marked cycle lanes like some medieval knight but without the gallantry, jousting with the humble foot soldier. Miraculously only five pedestrians were killed by cyclists in the UK in 1989. The British Medical Association has discovered the bicycle and finds it good. And so it is: environmentally friendly and healthy, but potentially dangerous if advice is not heeded. A BMA steering group (what else?) presents a strong argument for two-wheeled non-motorised transport and covers all the ground from cycle maintenance to air pollution. We are also told three different ways of making a right turn, a manoeuvre in which the BMA itself has lately demonstrated smooth political skill. Much advice was sought from the Netherlands where there are many bikes and few hills. The university city of Cambridge is bicycle laden and gradient-free too, but some local worthies there are fed up with that mode of transport and would restrict it. If cycling is to fit comfortably into urban transport in the 21st century a lot of rethinking will have to be done, as this report shows-and that may mean addressing the non-illuminated three-abreast brigade that so worry the burghers of Cambridgeshire. 1 British Medical Association Cycling: towards health and safety. Oxford and New York Oxford University Press. 1992 Pp 159. £5.99 ISBN 0-192861514.
Transcript of Whose right to choose?
609
to the 1967 Act it was estimated that some 100 000
backstreet abortions were performed every year, often withfatal or other disastrous outcomes. Women in Ireland have
the opportunity to go to the UK so there is no call forwidespread clandestine practice in their country. Instead,each year several thousand women go in stealth and
secrecy to the UK for abortions not allowed in Eire, and thepro-life lobby has been encouraging the Irish courts to banall counselling and assistance with a view to procuringabortions abroad. However, last October, the power of theIrish courts to ban the supply of addresses with a view toobtaining abortions in the UK was challenged in the
European Court.The decision of Mr Justice Costello to impose a travel ban
purported to dispose of the EC requirement on freedom oftravel by drawing analogies with the right of EC countries torefuse entry to Scientologists or those with criminal
convictions thought likely to re-offend (eg, "undesirablealiens"). However, this analogy does not bear scrutiny in thecontext of a woman travelling from one EC member state toanother which is happy to receive her.
In last year’s European Court case the Irish Governmentdid not dispute the statement made to the court that it didnot prohibit a pregnant woman from exercising her right totravel and receive services of termination of pregnancyabroad and that its ban on provision of abortion informationdid not extend to measures to restrict the movement of
pregnant women. Thus last month’s Irish High Court banon travel was not only oppressive, cruel, and beyond therequirements of Irish law, but it was also in conflict with EClaw.The precise reasons for the Irish Supreme Court’s
decision have not yet been released. A reference for further
guidance by the European Court is probable.Diana Brahams
Noticeboard
Return to Lamaze?
What factors determine the pain experienced by women duringlabour? Lowe! questioned 165 women at term gestation and foundthat the two major predictors of both sensory and affective pain inthe first stage of labour were the degree of confidence they had intheir ability to handle the delivery and the severity of their periodpain. The adverse predictive influence of dysmenorrhoea mightreflect a similar mechanism modulating uterine activity in bothmenstruation and labour. Pain in the second stage of deliverydepended largely on concern about the outcome of the pregnancyand a fear of the pain that might be endured. An understanding ofthese types of anxiety should enable intervention to limit the needfor analgesia and anaesthesia. Lowe’s data seem to offer support forthose who advocate the Lamaze technique. This method of
psychoprophylaxis involves abdominal and pelvic floor exercises,relaxation and breathing techniques, and comfort aids. To increaseconfidence about, and reduce fear of, the outcome of pregnancy-which the Lamaze technique intends to do-is the logical step thatfollows from Lowe’s work. Whatever method is adopted, a greateremphasis on this aspect of pregnancy is certainly justified.
1 Lowe NK Critical predictors of sensory and affective pain during four phases of laborJ Psychosom Obstet Gynecol 1991; 12: 193-208
Whose right to choose?The risks that certain religious views pose to public health are
highlighted by a series of pertussis outbreaks in Massachusetts,USA.1 Between 1981 and 1988, the incidence of whooping coughincreased in the US from 05 cases per 100 000 to 1-4 cases per100 000. The increasing rates of infection reflect parental concern
about the safety of the pertussis vaccine and a malpractice-drivenoverinterpretation of the guidelines for medical contraindications.Four outbreaks (113 patients in all) that took place among schoolcommunities are described in the latest report. In one school, 24cases came from families who had adopted macrobiotic diets andclaimed religious exemption from immunisation. In another group,the attack rate among those who were unvaccinated on similar
religious grounds was 3-3 times greater than in children who werevaccinated. State immunisation laws allow exemption for bothreligious and philosophical reasons, but these may be inappropriatebecause they have been applied only to the pertussis vaccine.
1. Etkind P, Lett SM, MacDonald PD, Silva E, Peppe J. Pertussis’s outbreaks in groupsclaiming religious exemptions to vaccinations. AJDC 1992; 146: 173-76.
Of moose and men and motor cars
The moose (Alces alces), or elk as it is called in Europe, is thelargest living deer. An average male moose weighs 450 kg, stands180 cm high at the shoulder, and causes quite a bump when hit by amoving vehicle. In Newfoundland, Canada, in 1987-88 there were661 motor-vehicle accidents involving a moose (3% of all motor-vehicle accidents in that period), resulting in injuries to 133 peopleand 3 fatalities. The health-care cost (in Canadian dollars) ofmoose-vehicle accidents was$377 000. Most injuries were to thehead, neck, and upper extremities, and were minor. However,patients involved in a secondary collision (other objects hit afterhitting, or avoiding, the moose) had more injuries to thethoracolumbar spine, abdomen, or chest, and all the deaths were inthis group. Injuries to moose were not recorded. The legs of a mooseare long, giving it a high centre of gravity-thus when hit by a carthe animal’s body tends to fly up into the car’s windscreen, resultingin the characteristic pattern of injuries seen in moose-vehiclecollisions. Most accidents involving moose were in the summer andautumn, and shortly after sunset. In Sweden, where moose are also adriving hazard, the car company Volvo has come up with a way ofavoiding night-time collisions. They propose fitting cars with
headlamps that emit ultraviolet radiation-apparently moose furfluoresces naturally in ultraviolet light.2
1. Rattey TE, Turner NE. Vehicle-moose accidents in Newfoundland. J Bone Joint SurgAm 1991; 73A: 1487-91.
2. Anon. The night nders of the black lights. Economist 1992; 322: 100 (Jan 18).
The bicycle age"Pedestrians should be given priority and cycle bells rung, or a
shout given in a considerate way to alert them when necessary".1The pecking order of London traffic is too fierce for such niceties.With bizarre clothing, helmet, and mask the urban cyclist, so long avictim himself, today hurtles down marked cycle lanes like somemedieval knight but without the gallantry, jousting with the humblefoot soldier. Miraculously only five pedestrians were killed bycyclists in the UK in 1989. The British Medical Association hasdiscovered the bicycle and finds it good. And so it is:
environmentally friendly and healthy, but potentially dangerous ifadvice is not heeded. A BMA steering group (what else?) presents astrong argument for two-wheeled non-motorised transport andcovers all the ground from cycle maintenance to air pollution. Weare also told three different ways of making a right turn, a
manoeuvre in which the BMA itself has lately demonstrated smoothpolitical skill. Much advice was sought from the Netherlands wherethere are many bikes and few hills. The university city of
Cambridge is bicycle laden and gradient-free too, but some localworthies there are fed up with that mode of transport and wouldrestrict it. If cycling is to fit comfortably into urban transport in the21st century a lot of rethinking will have to be done, as this reportshows-and that may mean addressing the non-illuminatedthree-abreast brigade that so worry the burghers of
Cambridgeshire.
1 British Medical Association Cycling: towards health and safety. Oxford and NewYork Oxford University Press. 1992 Pp 159. £5.99 ISBN 0-192861514.
