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Medical ethics, Result of feedback from MMI course, Challenges Facing The…

- - - - Addressing non-maleficence, it is important for a Doctor to prevent any harm, so considering harm to both the mother and the foetus is important in the discussion of abortion.
        
        It is also important to consider the sanctity of life and some, based on this principle, may disagree with abortion. But it is quite subjective.
        
        As with all consultations, confidentiality must be upheld in the case of abortions. It is always helpful to consult the GMC’s ethical guidelines in cases like this.
  - - - Whatever the patient’s decision might be, Doctors must continue to provide the best care in the patient’s best interests. Always be clear that you would adhere to the GMC’s guidelines.
  - - - Risks of the situation:
        
        For example, if you confront the student, they may react negatively. The student may have received permission from someone to do this (unlikely but possible), and such an incident could also damage ties between the teaching hospital and the Medical School.
        
        Acknowledge what your authority is and therefore how you should approach the situation. You are not a Doctor, nor are you a faculty member. So you need to approach the student in a calm and supportive manner, and not threaten them with negative outcomes.
        
        Example answer:
        
        “I would encourage the student to see the danger of their actions and to come clean about what they have done. I would make an effort to support them emotionally with any difficulties that may have led them to do such a thing in the first place. If the student refused to come clean, I would then approach a faculty member and discretely report the situation.”
  - - - However, the NHS has limited resources. In an ideal world, all treatment would be funded for all patients, but unfortunately this is simply not feasible. Thus, making decisions about resource allocation is not optional.
        
        The ethical theory of utilitarianism deals with the best way to maximise the use of resources for the greater good of society. The question is therefore: why shouldn’t smokers receive funding for treatment?
        
        Some may believe that their illness is self-inflicted, and therefore such patients are less ‘worthy’ of funding than those who had no control over their disease. However, this does not take into consideration the complex psychosocial factors that lead to smoking.
        
        It is well known that smoking is more common amongst the lowest socioeconomic groups. Would such a funding decision simply serve to further worsen the health inequalities that already exist in society?
  - - - The first step would be to report the mistake. The best way to do this is to actually talk to the colleague who has made the mistake and encourage them to report it themselves. This should be done in a non-confrontational way, making it clear that it is a matter of patient safety and continual professional development, rather than a personal attack.
        
        However, if you do not feel comfortable doing this, or if the colleague refuses to report their own mistake, then you must escalate the situation to a senior colleague.
        
        The NHS wants to encourage candour and transparency in the work environment, and this relies on non-threatening policies around errors, based on openness and continual development, rather than blame and punishment.
        
        GMC guidelines have a specific section on ‘Raising and acting on concerns about patient safety’. Since this is a common theme for interview questions, it is a good idea to be familiar with this.
  - - - The deontological ethical theory states that Doctors have a duty of care to their patients. This could be interpreted to mean that Doctors should never strike, as no matter what it is they want, they should put their patients first.
        
        Conversely, it could be argued that the duty of care to patients is dependent on an ethical duty of self-care. Detrimental effects on Doctors’ personal welfare will have a direct detrimental effect on patient safety, and so in this context, striking may be justified.
  - - - In 1998, Andrew Wakefield and colleagues published a paper in the journal The Lancet. Wakefield's hypothesis was that the measles, mumps and rubella (MMR) vaccine caused a series of events that include intestinal inflammation, entrance into the bloodstream of proteins harmful to the brain, and consequent development of autism.
        
        In 2002, Wakefield and coworkers published a second paper examining the relationship between measles virus and autism. The authors tested intestinal biopsy samples for the presence of measles virus from children with and without autism. Seventy-five of 91 children with autism were found to have measles virus in intestinal biopsy tissue as compared with only 5 of 70 patients who didn't have autism.
        
        Flawed because:
        1) Measles vaccine virus is live and attenuated. After inoculation, the vaccine virus probably replicates (or reproduces itself) about 15 to 20 times. Measles vaccine virus is likely to be taken up by specific cells responsible for virus uptake and presentation to the immune system (termed antigen-presenting cells or APCs). Because all APCs are mobile, and can travel throughout the body (including the intestine), it is plausible that a child immunized with MMR would have measles virus detected in intestinal tissues using a very sensitive assay. To determine if MMR is associated with autism, one must determine if the finding is specific for children with autism. Therefore, children with or without autism must be identical in two ways. First, children with or without autism must be matched for immunization status (i.e., receipt of the MMR vaccine). Second, children must be matched for the length of time between receipt of MMR vaccine and collection of biopsy specimens. Although this information was clearly available to the investigators and critical to their hypothesis, it was specifically omitted from the paper.
        2) Because natural measles virus is still circulating in England, it would have been important to determine whether the measles virus detected in these samples was natural measles virus or vaccine virus. Although methods are available to distinguish these two types of virus, the authors chose not to use them.
        
        Flawed because: (part 2):
        3) The method used to detect measles virus in these studies was very sensitive. Laboratories that work with natural measles virus (such as the lab where these studies were performed) are at high risk of getting results that are incorrectly positive. No mention is made in the paper as to how this problem was avoided.
        4) As is true for all laboratory studies, the person who is performing the test should not know whether the sample is obtained from a case with autism or without autism (blinding). No statements were made in the methods section to assure that blinding occurred.
        
        Flawed because:
        1) About 90% of children in England received MMR at the time this paper was written. Because MMR is administered at a time when many children are diagnosed with autism, it would be expected that most children with autism would have received an MMR vaccine, and that many would have received the vaccine recently. The observation that some children with autism recently received MMR is, therefore, expected. However, determination of whether MMR causes autism is best made by studying the incidence of autism in both vaccinated and unvaccinated children. This wasn't done.
        2) Although the authors claim that autism is a consequence of intestinal inflammation, intestinal symptoms were observed after, not before, symptoms of autism in all eight cases.
      - Some arguments for making vaccination mandatory are that it allows for eradication of diseases (e.g. polio, smallpox, etc). Generally, vaccines are highly safe and effective. You could also mention the concept of herd immunity.
        
        As vaccination rates decline, the number of infectious diseases increases (e.g. when Andrew Wakefield released his study in 1998, incorrectly linking the MMR vaccine and autism, the rates of vaccinations decreased and the incidence of measles increased).
        
        While the evidence against vaccinations is scarce, some people argue against making vaccinations mandatory because they believe that the government should not be able to control such health-related decisions.
        
        It could also be considered that if people are afraid of needles or react badly to them, they shouldn’t be forced to get vaccinated.
        
        There may be alternatives to mandatory vaccinations such as educational interventions which teach children and adults how important vaccines are.
- - - - 3) Deontology: The stark difference between right and wrong, also known as duty- based ethics. Deontology contradicts consequentialism in that it doesn’t matter what the outcome is if something is inherently unethical. e.g. If we consider the same example from part i, deontology dictates that it is fundamentally unethical to lie, so the surgeon should tell the patient the truth that they are going to die.
  - - - Charlie Gard background info:
        
        Seemed healthy at birth, but a month later his parents noticed that he was unable to support himself or lift his head which was something that infants his age were capable of doing.
        
        He was unable to gain weight despite a regular feeding programme and as a result was transferred to Great Ormond Street Hospital.
        
        He was later diagnosed with MDDS, which is caused by a mutation RRM2B gene.
        
        He inherited this disease because both his parents were carriers of the recessive gene. Charlie’s brain, heart, liver, kidneys and his ability to breathe were severely affected. He also had congenital deafness and epilepsy.
        
        Charlie suffered from severe progressive muscle weakness, which meant that he couldn’t move his arms or legs or breathe unaided.
        
        He was unable to open his eyes, which were not developing properly
        
        The potential treatment:
        
        A High Court ruling recommended that Charlie’s life support be stopped.
        
        After the ruling, neurologist Dr Hirano offered to continue treatment in the US. Dr Hirano claimed there was a 10% chance that treatment could improve the baby’s condition – despite never meeting Charlie in-person.
        
        Experts at Great Ormond Street Hospital feared the treatment wouldn’t help and would only prolong his suffering.
        
        More about the treatment:
        
        It’s called nucleoside bypass therapy.
        
        It was untested on human or animals with RRM2B-related MDDS – but it has been shown to have some positive effects on test subjects with other mitochondrial conditions.
        
        It had been used in 18 cases already – but Charlie’s condition was far more advanced.
        
        All of the other cases involved people who suffered from a mutation in the TK2 gene, not the RRM2B gene, which is a different form of mitochondrial DNA depletion.
        
        The patient must ingest compounds needed to develop new DNA strands which their body could not otherwise produce.
        
        There was no evidence to suggest that the treatment would be able to cross the blood-brain barrier and resolve Charlie’s brain damage.
        
        The ending:
        
        Charlie's parents believed, as did their supporters, that it was their parental right and responsibility to give their child any and all life-saving treatment they could.
        
        They made an appeal to stop his life support being switched off, so they could take Charlie to the US. The appeal was denied when it was taken to the Supreme Court, and their appeals were further denied at the European Court of Human Rights.
        
        It was concluded that Charlie was probably “being exposed to continued pain, suffering and distress” and that undergoing experimental treatment with “no prospects of success… would offer no benefit”.
        
        He died on 28th July 2017, aged 11 months old, after his life support was removed.
      - Alfie Evans background info:
        
        Alfie Evans suffered from a degenerative neurological condition.
        
        He was admitted to hospital in December 2016 after suffering seizures and remained a patient there.
        
        His parents wanted to fly Alfie to Rome for further treatment, but the Alder Hey Children’s Hospital described the decision as “futile, unkind and inhumane.”
        
        At 23 months old, the courts ruled for his life support to be removed.
        
        Impact on the NHS and UK Law:
        
        The Royal College of Paediatrics and Child Health (RCPCH) believes that such cases are “traumatic and distressing”, and this could lead to difficulties in recruitment and retention of vital NHS staff.
        
        Charlie Gard’s parents are advocating for a change in the law in order to prevent other parents from going through a similar court case. They want judges to ask whether the parents’ choice of treatment would cause significant harm, and if not, they should be allowed to test their options.
        
        The change would allow independent medical mediators to get involved in any disagreements as early as possible, which aligns with new advice from RCPCH.
        
        The ethical dilemmas:
        1) Autonomy: A competent patient refuses it.
        
        In Charlie’s case, his parents acted on his behalf due to his age and mental state.
        2) Distributive justice: Expected benefit is insufficient to justify public resources being used
        
        The National Institute for Health and Care Excellence (NICE) recommends treatment at £30,000 or less per Quality-Adjusted Life Year (QALY).
        
        Nucleoside bypass therapy was fairly inexpensive, but the cost of ongoing intensive care was estimated at £150,000. Furthermore, Dr Hirano’s best possible outcome was 10%, giving Charlie a shortened lifespan with a severe disability.
        
        The quality of Charlie’s potential adulthood life was estimated at 0.3 of a possible 1.0, due to the severity of his disabilities.
        
        When you multiply that over 50 years, you get 15 Quality Adjusted Life Years (QALYs).
        
        The likelihood of the treatment working, however, was estimated at only 10%, reducing the QALYs to 1.5.
        
        At a cost of £150,000, the cost per QALY for Charlie’s treatment was £100,000 – over three times the advisory limit.
        
        However, the money was raised privately, so the funds were illegible for redistribution. The legitimacy of the distributive justice argument is uncertain.
        
        The ethical dilemmas (part 2):
        3. Treatment is not actually the best thing for the patient
        
        This is why the parents’ appeals were rejected.
        
        The High Court concluded that the success was too low to justify the trauma that Charlie would experience.
        
        The success of the procedure also wouldn’t have meant a sufficient quality of life.
        
        This was a controversial decision and Dr Hirano argued that a slight chance was better than none.
        
        One of the responses to the decision was that treatment should be given in order to have better insight and improve the chances of successful treatment for the next MDDS patients.
        
        As the court rules only in the interest of the child in question, this is unlikely to influence a judge’s decision.
    - - From November 2018 specialist Doctors in England, Wales and Scotland can prescribe cannabis-derived medicine in exceptional circumstances. It was the first change to the law on medicinal cannabis, which had been in place since 1971.
        
        Certain cannabis-derived products have been reclassified as Schedule Two.
        
        This means they have a potential medical use and can now be legally prescribed in cases of children with rare, severe epilepsy, adults with vomiting/nausea from chemotherapy, and adults with muscle stiffness caused by MS – if other treatments have failed.
        
        Key things to be aware of:
        
        In 2019, the NHS provided only 18 prescriptions for cannabis-related medications.
        
        Many campaigners who fought to get cannabis oil available for those with serious medical conditions feel let down. A report has concluded that families’ hopes were unfairly raised when the law changed last year, and products remain unlicensed due to lack of research.
        
        The NHS published a report detailing the key barriers to accessing medicinal cannabis.
        
        Key patient: Billy Caldwell:
        
        In 2017 Billy was prescribed cannabis oil by his GP. This was the first prescription of cannabis oil in the UK – but the GP received a letter from the Home Office saying he must not renew the prescription or would face serious consequences. That’s because the oil contains low amounts of THC, which is illegal in the UK.
        
        His mother travelled to Toronto to pick up medicinal cannabis and this was confiscated.
        
        Billy wasn’t weaned off the medication, and he suffered seizures. He was admitted to hospital, where Doctors struggled to keep the seizures under control.
        
        There was a huge public outcry and, due to mounting pressure, the Home Office decided that Billy would be allowed the cannabis oil as a special measure.
        
        A hospital trust was given a special license to administer doses to Billy, which meant a daily four-hour round-trip for the family. His mother described it as being under hospital arrest.
        
        Billy was later getting a prescription from a private paediatric neurologist in London, but this meant flying to England every few weeks to collect more oil.
        
        In 2019, Billy was ultimately awarded a lifelong medicinal cannabis prescription on the NHS, in a decision that could pave the way for more patients to receive the treatment in the future.
        
        Key Patient: Alfie Dingley:
        
        Another high profile case about medicinal cannabis was that of Alfie Dingley.
        
        His condition improved when he was prescribed cannabis in Amsterdam, and it was predicted that his seizures would fall from 3,000 a year to just 20 on this medication. His family eventually moved there because they couldn’t get the medication in the UK.
        
        His mother became the first person to be granted a special license to import medicinal cannabis back to the UK.
        
        Alfie has since become tolerant to his medication and needs a new strain – but his mother said it would take months to get access to this.
      - The handling of Covid-19
        
        How Did COVID-19 Reach The UK?:
        
        Scientists have combined large-scale data and genomic sequencing to map the lineage of different strains of COVID-19, to get an understanding of which countries the virus came from.
        
        They found that a third (34%) of transmission lineages came from Spain, 29% from France, and 14% from Italy. It’s important to note that the results are preliminary and the research hasn’t been peer-reviewed.
        
        Government Response and Lockdowns:
        The First Lockdown:
        
        On 23rd March, Boris Johnson announced via a live television broadcast that strict lockdown measures were now being introduced to protect the NHS and to mitigate any further viral spread.
        
        These measures meant you could only leave your home to shop for food and medicine, take one form of exercise a day, or care for a vulnerable person. The lockdown was enforced by law, under a stay-at-home order which was initially due to last for three weeks and to start from 26th March.
        
        On 15th April, Northern Ireland extended their lockdown period until 9th May; and on the 16th Dominic Raab followed suit. At the time the announcement the recorded UK deaths had reached 13, 729 and the number of confirmed cases exceeded 100,000, at 103,093.
        
        Lockdown started to be lifted from May 10, when people were told to stay alert instead of stay at home. In June, shops began to re-open.
        
        The Second Lockdown – November 5 to December 2, 2020:
        
        The second lockdown was announced in November and scheduled to last a month. The big difference from the first lockdown was that schools, colleges and universities were allowed to stay open – and you were permitted to meet one other person outdoors while remaining socially distant.
        
        The government hoped that this would drive infections down enough that people could gather for Christmas. That didn’t happen: plans to allow three households to mix over a five-day period were scrapped with just a few days’ notice. Households in tier four couldn’t mix, and the rest of the country was permitted to mix on Christmas Day alone.
        
        The Third Lockdown – January 6, 2021:
        
        Just a month after the second lockdown, the UK was put into its third. The announcement was made on Monday 4th January, when schools, colleges and universities were told to close after some re-opened following the Christmas break. GCSE and A-Level exams were also cancelled, with teacher assessment replacing them.
        
        On the day the lockdown came into force, the daily COVID-19 death toll exceeded 1,000 for the first time since April 2020. The government also reported 62,322 new COVID-19 cases that day.
        
        Question: Did The UK Government Handle The Pandemic Well?:
        
        Sweden used herd immunity
        
        A YouGov poll showed that three million adults had gone hungry in the first three weeks of lockdown, with 1.5 million going an entire day without eating
        
        Doctors were told to wash and reuse PPE if stocks were running low
        
        Johnson said we had moved past the peak of the disease on April 30th 2020
        
        The UK death toll became the highest in Europe on May 5th.
        
        The Dominic Cummings scandal undermined public trust in the government
        
        The damning criticism from Dr Richard Horton, editor of The Lancet – and many others
        
        In December, 57% of people said they didn’t trust the government to stop the spread of COVID-19
        
        2 more items...
        
        Abortion
        
        Under the 1967 Abortion Act, abortion is legal in England, Wales and Scotland up to 24 weeks of the pregnancy in most cases.
        
        An abortion may only legally be carried out if two Doctors agree that continuation of the woman’s pregnancy will negatively impact her physical or mental health, or that of her existing children.
        
        An abortion is legal after 24 weeks if the woman’s life is at risk due to the pregnancy, the child will be born with a severe disability or there is a risk of grave physical and mental injury to the woman – although this is generally safer if carried out earlier in the pregnancy.
        
        The Legal Debate:
        
        There is significant legal debate surrounding abortion, which centres around the point in time at which abortion is allowed.
        
        This debate centres around beliefs about when the foetus becomes a living organism, and thus when abortion becomes murder. Some people believe that abortion at any point in the pregnancy is murder.
        At the other end of the spectrum, others argue that abortion is acceptable at any point during the pregnancy as, until the child is born, they do not consider it to be alive.
        
        Northern Ireland and Abortion Rights:
        
        Until October 2019, abortion was illegal in Northern Ireland, unless the woman’s life was at risk or if continuing with the pregnancy would cause serious physical or mental health effects to the woman.
        
        The criminalisation of abortion in Northern Ireland dated back to 1861, although it was amended in 1945 to allow abortions under the above circumstances, and was debated several times over the years. Rape, incest and fatal foetal abnormalities were not grounds for legal abortion in Northern Ireland.
        
        In 2017, the UK government allowed Northern Irish women to access NHS-funded abortions in Great Britain, when previously women had to pay for the procedure themselves.
        
        In May 2018, the Republic of Ireland voted overwhelmingly to overturn their abortion ban in an abortion referendum. The Northern Ireland Human Rights Commission brought an appeal to the Supreme Court in early 2018 over the legality of the abortion law in Northern Ireland, but it was rejected.
        
        In May 2018, Northern Ireland voted in a referendum to make abortion legal with 66.4% of voters voting to amend the constitution so that abortion could be legalised. In October 2019, abortion was decriminalised and became lawful in Northern Ireland.
        
        The new framework for lawful abortion services – The Abortion Regulations 2020 – came into effect on 31st March 2020. Under the new regulations, termination of pregnancy is allowed:
        
        unconditionally prior to 12 weeks.
        
        up to 24 weeks when continuing the pregnancy would risk mental or physical injury to the woman or girl that is greater than the risk of terminating the pregnancy.
        
        after 24 weeks when there is substantial impairment to the foetus, including when death is likely before, during or shortly after birth.
        
        Termination must only be carried out by registered medical professionals – however, those using abortion pills purchased online will not be prosecuted, and health professionals are no longer under any duty to report their patients’ use of abortion pills.
        
        1 more item...
        
        Euthanasia
        
        Euthanasia, sometimes known as ‘mercy killing’, refers to ending a patient’s life who is suffering from an incurable and/or painful disease, or is in an irreversible coma.
        
        There are two types of euthanasia that you should know about:
        
        Active euthanasia: When the acting person deliberately intervenes to end someone’s life. For example – a Doctor injecting a patient who has terminal cancer with an overdose of muscle relaxants to end their life would be considered active euthanasia.
        
        Passive euthanasia: Where a person causes death by withholding or withdrawing treatment that is necessary to maintain life. For example – withholding antibiotics from someone who has bacterial pneumonia.
        
        We can also categorise euthanasia as:
        
        Voluntary euthanasia: Where euthanasia is carried out at the request of the person who dies.
        
        Involuntary euthanasia: When the patient who dies wants to live but is killed anyway (normally called manslaughter or murder).
        
        Assisted suicide: The only difference between this and euthanasia is the person who actually performs the final act. In assisted suicide, the physician intentionally gives the patients the means to take the lethal medication themselves. For active euthanasia, the physician is the one who commits the act that directly causes death i.e. by injecting lethal drugs.
        
        Assisted dying: This is a sub-term of assisted suicide but is only used in the context of when a patient who is already dying, i.e. terminally ill, asks for help to die. Assisted dying is not usually used in the context of bringing about the deaths of patients who are not already dying (for example, paralysed patients or those who have found out that they have developed a condition in the future i.e. Huntington’s Disease).
        
        1 more item...
        
        Organ donation
        
        Challenges With Organ Donation:
        
        The demand for organs is significantly larger than the supply, which means there is a waiting list for organ transplants. There are currently around 7,000 people on the UK Transplant Waiting List. In 2020/21, over 470 patients died before they could receive a transplant.
        
        Only a small proportion of deaths (e.g. death from stroke or brain injury) allow for organ donation, because many types of death (e.g. circulatory death in which the organs are starved of blood) do not leave viable organs for use. With improved road safety and vehicle manufacturing, fewer deaths are resulting from brain death nowadays, meaning there is a growing shortage of organs for donation. Demand also exceeds supply because matches need to be as close as possible to ensure a successful transplant.
        
        An additional challenge is that the BAME community typically experience longer waiting times for organ transplant, because there is a lack of suitable organs from BAME donors. In 2020, when approached about organ donation in hospital, 39.5% of BAME families agreed to support donation going ahead, compared to 69% of white families. Many of the BAME families had not discussed organ donation with their relatives and/or had concerns about whether organ donation aligned with their religious beliefs.
        
        BAME --> Black, Asian, Minority, Ethnic
        
        Opt-in System:
        
        With an opt-in system, Doctors can only use a person’s organs after death if that person signed up to an organ donation register during their life.
        
        One of the biggest problems with an opt-in system is that many potential donors either don’t register or are unaware that they have the option to register. When England had an opt-in system (pre-2020), research showed that 80% of people supported organ donation in principle but only 38% had opted in, so the support didn’t translate into a high number of potential donors.
        
        Those in favour of an opt-in system argue that this type of consent (informed consent) is the most valid and ethical, because people have explicitly agreed to donating their organs and nothing is being assumed.
        
        1 more item...
- - - - Antiviral drugs (1960s):
        
        Terrible viruses such as small-pox, influenza and hepatitis have ravaged many human populations throughout history. Unlike the sweeping success of antibiotics in the late 1930s and 1940s, the development of antivirals did not really take off until the 1960s.
        
        This was mostly due to the structure of a virus, which was a core of genetic material surrounded by a protective protein coat that hides and reproduces inside a person’s cells.
        
        As the virus information is so protected, it was difficult to treat them without damaging the host cell.
        
        Over the years antivirals have improved significantly, and work by blocking the rapid reproduction of viral infections, and some can even stimulate the immune system to attack the virus.
        
        The development of effective antivirals has been significant in treating and controlling the spread of deadly virus outbreaks such as HIV/AIDS, Ebola and rabies.
        
        Stem cell therapy (1970s):
        
        The incredible potential of stem cells was discovered in the late 1970s, when they were found inside human cord blood.
        
        Two specific characteristics make stem cells remarkable: they are unspecialised cells that can renew themselves through cell division even after being inactive, and under certain conditions can be used to make any type of human cell.
        
        This discovery has enormous potential and stem cell therapy has already been used to treat leukaemia and other blood disorders, as well as in bone marrow transplantation.
        
        Research is currently ongoing to use stem cells to treat spinal cord injuries and a number of neurological conditions such as Alzheimer’s, Parkinson’ and strokes.
        
        However, due to the ethical issues surrounding the use of embryonic stem cells, researchers are likely to face many obstacles when developing stem cell-based therapy.
        
        Immunotherapy (1970s):
        
        Immunotherapy, a treatment that stimulates the immune system to fight off a disease, has been in the making for over a century.
        
        The story began in the 1890s with the experimental work of William B. Coley who injected inactive bacteria into cancerous tumours, achieving remission in some patients.
        
        However, it is only in the last 40 years that serious progress has been made in immunotherapy, particularly in respect to treating cancer.
        
        In the 1970s, antibody therapies were developed and in 1991, researchers produced the first cancer vaccine which was approved by the FDA in 2010. In the last decade, immuno-oncology has become one of the most revolutionary cancer therapies in existence.
        
        Artificial intelligence (21st century):
        
        Having been in gradual development since the turn of the century, artificial intelligence has already produced impressive technologies that have significantly altered the healthcare landscape.
        
        Life science companies and research institutions are teaming up with pioneering technology giants such as Google, IBM and Apple, and emerging AI start-ups like OpenDialog, to create more effective ways to deal with diseases and care for patients.
        
        The current applications of AI in healthcare are broad, from disease diagnosis and drug discovery to personalised treatment plans, patient monitoring, and human-like chatbots.
        
        Furthermore, the technology is being applied by many life sciences companies to optimise processes in a way that continues to accelerate the pace of change.
        
        Anesthesia:
        
        On October 16, 1846, Morton prepared a young patient for the surgical removal of a large mandibular tumor.
        
        Makes it possible to have procedures that would be too painful or stressful to have while awake.
        
        Vaccines:
        
        Dr Edward Jenner created the world's first successful vaccine. He found out that people infected with cowpox were immune to smallpox.
- - - - Cons:
        
        CAMs can also cause side-effects, are often not effective in treating symptoms, and often don't have any effect on your underlying illness.
        
        May not be performed by medically trained professionals
- - - - Doctors And Dentists:
        
        While there has been progress in raising the number of Medical School students in the last few years, and also progress towards the government’s 2019 manifesto commitment to recruit 50,000 more nurses by 2024/25, there has been less progress in ensuring access to GP appointments and Dentists.
        
        A report from the King’s Fund has found that the government’s target of 6,000 more GPs by 2024/25 is likely to be missed, as well as the commitment to fund 26,000 more healthcare workers to ease pressure on GPs.
        
        A June 2022 analysis by the Health Foundation found that there is a current shortage of 4,200 fully qualified GPs in England. This is projected to increase to 8,800 by 2030. This shortage has meant difficulties in patients seeing their GP in a timely manner, and has therefore likely had an impact on the number of patients presenting to emergency wards.
        
        Staff shortages → long hours and increased responsibilities
- - - - Arguments against:
        
        Affects pillar of justice, where those with wealth are able to access private care but others may not be.
        
        May have a negative impact on those who have chronic or congenital illnesses, requiring more expensive care.
        
        Resources may not be shared equally, and certain patients may be prioritised.
        
        Private healthcare may be more financially focused than patient-centered.