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  1. Withholding treatment from the dying common in Netherlands

    Withholding of treatment for elderly patients is quite common in the Netherlands, a new study reveals.

    Researchers said their findings did not suggest medical decisions to withhold treatment were driven by "ageism" - a finding that would trigger charges of euthanasia.

    They say that doctors who withhold treatment wanted to avoid futile treatment and give patients "comfort and respect."

    The findings, in the Journal of Medical Ethics, could cast new light on the impact of assisted suicide liberalisation on Dutch medical practice.

    Researchers studied the deaths of some 6,600 patients. Some 40% were over the age of 80 and a third involved people aged between 65 and 79.

    They asked doctors involved in the care of the patients about decisions on end of life care.

    Treatment was withdrawn or withheld in 37% of cases - including 42% of those over the age of 80.

    The study found the most common treatment to be halted involved artificial feeding and fluids - and the second most common treatment was antibiotics. This was twice as common among the over 80s as among the youngest patients.

    In 72% of cases doctors said there was no chance of improvement and, in 62% of cases, doctors said prolonging treatment was futile.

    Doctors said that in 56% of cases there was no discussion with patients, stating in most cases the patient did not have the capacity to do this.

    Researcher Dr Roeline Pasman, of the VU University Medical Centre, Amsterdam, said: “Based on our results, we cannot assume that age related differences in withholding/withdrawing treatment are the result of ageism.

    “In fact, our findings indicate that care for older people is focused on providing comfort and avoiding burdensome treatment, suggesting better acceptance that these patients are nearing death."

    Journal of Medical Ethics 21 April 2015 [abstract]

  2. Student loans may hit women doctors hardest

    Most British doctors will not complete repayments of the student loans they accumulate, researchers say today.

    Many medical students will have accumulated loans of more than £80,000 by the time they graduate.

    Under the current loans system, graduates pay 9% of their salary above a level of £21,000 a year for 30 years.

    While doctors are expected to make substantial repayments, the report in BMJ Open finds the size of loans taken out by medical students will be hard to repay.

    And gender differences in earnings mean that women doctors are least likely to repay the loans.

    Researcher Dr Ravinder Vohra, an academic surgeon at Birmingham University, says doctors earning the most will pay back the least - as they will finish loan repayments early and pay the least interest.

    Under current earnings levels, full-time male doctors would pay £57,303 over 20 years to pay off debts while women doctors would pay £62,000 over 26 years, Dr Vohra says.

    Dr Vohra writes: “It seems reasonable that these repayment variations may actually exist across many graduate careers in the UK.

    “It is also apparent that at the current level of fees, even small changes in the student loan contract will have substantial implications for lifetime wealth across different income groups, across male and female graduates, and on the sustainability of the student loans system.”

    The lifetime cost to English students of borrowing to invest in a medical degree: a gender comparison using data from the Office for National Statistics. BMJ Open [abstract]

  3. Student loans may hit women doctors hardest

    Most British doctors will not complete repayments of the student loans they accumulate, researchers say today.

    Many medical students will have accumulated loans of more than £80,000 by the time they graduate.

    Under the current loans system, graduates pay 9% of their salary above a level of £21,000 a year for 30 years.

    While doctors are expected to make substantial repayments, the report in BMJ Open finds the size of loans taken out by medical students will be hard to repay.

    And gender differences in earnings mean that women doctors are least likely to repay the loans.

    Researcher Dr Ravinder Vohra, an academic surgeon at Birmingham University, says doctors earning the most will pay back the least - as they will finish loan repayments early and pay the least interest.

    Under current earnings levels, full-time male doctors would pay £57,303 over 20 years to pay off debts while women doctors would pay £62,000 over 26 years, Dr Vohra says.

    Dr Vohra writes: “It seems reasonable that these repayment variations may actually exist across many graduate careers in the UK.

    “It is also apparent that at the current level of fees, even small changes in the student loan contract will have substantial implications for lifetime wealth across different income groups, across male and female graduates, and on the sustainability of the student loans system.”

    The lifetime cost to English students of borrowing to invest in a medical degree: a gender comparison using data from the Office for National Statistics. BMJ Open [abstract]

  4. WHO plans global emergency force

    The World Health Organisation is to take new steps to be ready for epidemics of new diseases, it announced yesterday.

    Its plans include a global health emergency workforce, promising a "rapid and effective" response to outbreaks.

    Its proposals emerged after months of soul-searching and criticism of delays in reacting to the west African Ebola epidemic.

    It said it would be strengthening International Health Regulations and see to ensure all countries had minimum capacity to comply with these and be prepared for outbreaks.

    WHO said world leaders should remain vigilant about new disease threats, calling for a high level of surveillance to prevent another Ebola epidemic.

    It called for public-private partnerships and innovative financing to invest in research and development for neglected diseases.

    A WHO statement said: "We have learned that new diseases and old diseases in new contexts must be treated with humility and an ability to respond quickly to surprises.

    "Greater surge capacity contributes to a flexible response."

    The statement went on: "We do not know when the next major outbreak will come or what will cause it. But history tells us it will come. This means investing domestically and internationally in prevention and in essential public health systems for preparedness, surveillance and response."

 

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