Things have changed in reproduction control as well. When our mothers were having children the only thing they had available to them was the pill and rhythm method where today they have many more advanced options that are much more reliable than the pill our mothers took. Some of the methods are Depo shots, Norplant(in countries other than the US), better formulated birth control pills, the morning after pill, IUD, the patch, and an abortofactant RU 486 which is good up to 9 weeks into pregnancy.

With all of these elective choices is it practical to still have surgical abortive methods? I would say yes, but that they need to be limited to some extent. I think there is a point in time that a woman has made her choice to have or not have the baby. At some point in time the child´s interest has to be considered as a separate person and not just as a part of the mother. The question is at what stage in pregnancy does that happen?

With Roe the court said that all pregnancyin the first trimester should be the choice of the mother as to if she terminates or not. I agree with this decision. The mother should have an election to terminate her pregnancy up to 12 weeks into the pregnancy. All cases of rape should end with the woman being offered the option to take the emergency contraceptive that is available. The first 9 weeks should be via RU 486 and if an abortion is chosen the patient needs to be counseled as to what reproductive protections are available and statistical risks of HIV as well as other diseases. Between 9-12 weeks of course a person would need to have an abortion via surgical methods which are more risky and the person also should be counseled on those risks. Girls under the age of 18 and living at home should always have the permission of her parents, because of the risks to her in a surgery. It is after that 12 weeks that things become a little more difficult. The court has said that regulation can occur after the 1sttrimester of pregnancy. I believe that after 12 weeks a mother has made her choice, even in the case of rape. My only exception to this stage in pregnancy is when birth defects come out. It is between the stages of 12-20 weeks gestation that ultrasounds are done. By the time a woman reaches 16 weeks she should know most of the situations that result in incompatible life for a child or severe birth defects. After the stage of 16 weeks I think that the restrictions should be to saving the life of the mother or if the child is incompatible with life. At that stage a mother should be offered the chance to give natural birth and let nature take its course so that the mother can spend a few precious moments with her child instead of in a cold setting where the child is surgically removed from her. Having a child that will die at birth is very difficult and I think we should take great care to be sensitive to that. However, if the mother still chooses to just have an abortion, she should be allowed to do that up to 20 weeks. After the 20 week gestation it is much more suitable to let the mother give birth with the exception of a child that would require a C section, only in that case should an abortion occur after 20 weeks of gestation instead of a natural delivery with a do not resuscitate order attached.

My personal beliefs are that all life is sacred and precious and should be treated as such. However, I know that I cannot force someone to believe as I do. However, from a medical standpoint I think we can force a point in time when a person has made their decision and must live with it excluding a few exceptions to the rules. My positions do not come from a religious standpoint as I do not hold a ´christian´belief system, but that said as a person who has extensive medical knowledge I hold my position from a life situation. I would have held that a person should have the right to choose and never would have understood if 17 years ago I had not given birth to a child at six months into my pregnancy. My son was so tiny and precious and he has grown into quite a handsome young man over the years. Almost all pregnancies after 24 weeks have a very good chance of survival and each day that passes in the gestation period after that milestone gets a better chance of survival.

What are your thoughts? By Ix Chel, Newsvine

The most prevalent opportunistic infection in lung transplant recipients is cytomegalovirus (CMV), a virus that often has mild effects but can be life threatening for organ transplant recipients. The standard preventative therapy for lung transplant patients is treatment with up to three months of valganciclovir. But even with this therapy, the majority of lung transplant recipients develop CMV infections within a year of their transplant.

The Duke researchers wanted to test the safety and efficacy of extended treatment.

“We found that 12 months of oral valganciclovir (Valcyte, manufactured by Roche) was extremely effective and led to a dramatic reduction in the rate of CMV infection and disease,“ said Scott Palmer, MD, MHS, scientific director of the Lung Transplant Program at Duke. “We also showed that there was no increased or added toxicity with the extended course of treatment.”

“In addition, the study examined viral resistance mutations and demonstrated that extended therapy did not lead to increased drug resistance, a potential concern with longer courses of treatment,” Palmer added.

Palmer and his colleagues conducted a double-blind, placebo-controlled, randomized study at 11 centers in the United States. They compared the effect of extending the standard three-month therapy for preventing CMV to 12 months. The results are published in the June 15 issue of the Annals of Internal Medicine.

The study was comprised of 136 participants who completed three months of oral valganciclovir and then 66 received an additional nine months of placebo and 70 received an additional nine months of oral valganciclovir.

CMV infection was present in 64 percent of the short-course group compared to 10 percent of the extended-course group. CMV disease, or pneumonia caused by CMV virus, occurred in 32 percent of the short-course group and was reduced to 4 percent in the extended-course group.

“Preventing CMV is important because it can directly lead to pneumonia or a viral syndrome, but CMV prevention is even more important because we think CMV is a risk factor for chronic long-term rejection,” Palmer said.

In February, Palmer and his colleagues published research in the American Journal of Respiratory Critical Care Medicine that showed CMV in a patient’s transplanted lungs significantly increases the risk for rejection and leads to worse survival.

“It’s not good enough to say we have drugs to treat CMV, we have to prevent our patients from ever getting CMV,” Palmer said.

Currently, only 50 percent of lung transplant patients survive five years after transplant, according to Palmer.

“If we want to improve patient outcomes and make them more comparable to other organs, we have to reduce these infections and the complications that come with them,” he said.

Palmer and his team conducted their research based on the idea that there is a critical period after transplant when patients are at high risk of developing CMV.

“It looks like three months is too short, and if we stop the therapy then, the patients will still be at risk. But, maybe 12 months is enough for most patients.”

Palmer and his team also evaluated the patients six months after the treatment ended to ensure they had not just delayed the onset of CMV disease. They found that CMV disease remained extremely low in the 12-18 month window.

“Twelve months of the drug valganciclovir appears to be effective in preventing CMV disease and is not associated with any increased risks or complications. So, I believe most physicians will switch to the extended therapy.” PhysOrg

All mothers-to-be should be weighed regularly during pregnancy to help combat the many dangers to women’s and babies’ health from maternal obesity, a group of medical experts is urging.

The National Obesity Forum (NOF) – an influential group of doctors and nurses specialising in weight problems – wants ministers to introduce the change because excessive weight gain among expectant mothers is becoming such a serious problem.

“A pregnant woman should have her weight monitored regularly during pregnancy at all antenatal appointments with midwives, GPs and obstetricians, because every risk of pregnancy, both to the mother and to the baby, is increased with maternal obesity,” Dr David Haslam, the NOF’s chairman, told the Observer.

“Obesity in pregnant women can lead to all sorts of problems, including the death of the mother, or the death of the baby through stillbirth or the baby having foetal abnormalities, or the woman suffering pre-eclampsia or gestational diabetes, or needing a Caesarean section because either she or the baby is too big,” he added.

Piling on the pounds in pregnancy beyond the recommended amount can be dangerous, Haslam said. “The risk of rapid weight gain in pregnancy is that every single complication of pregnancy gets worse for both the mother and the baby. The benefits of regular weighing of women would be enormous. It would create awareness of the problem and lead to measures being put in place to reduce the risk.” For example, if a pregnant woman was gaining excess weight, a dietician could start giving her advice on her diet and level of physical activity, said Haslam, who is a GP and also a hospital doctor specialising in obesity medicine at the Luton and Dunstable Hospital in Bedfordshire.

At the moment women in England have their height and weight taken when they have their first antenatal appointment, the so-called “booking visit”, in order to indicate their Body Mass Index (BMI). Only those with a high BMI are usually checked after that.

Many women would find the idea upsetting, patronising or offensive, admitted Haslam. “Yes, women will undoubtedly think this is intrusive, but that’s ridiculous because this would be being done for medical reasons, to protect the health of the mother and baby. It’s possible that some women will be against this, and they would have the right not to stand on the scales. But they would be foolish to refuse,” he added. “To refuse to be weighed would be to deny the clinician the tools of his trade to ensure a healthy outcome to the pregnancy.”

The NOF’s stance has divided medical opinion. Dr Anne Dornhorst, an expert in diabetes and pregnancy at Imperial College London and a doctor at the capital’s Hammersmith Hospital, said she understood why Haslam and the NOF were urging firmer action to counter maternal obesity. She pointed to the Centre for Maternal and Child Enquiries’ reference to “substantial evidence that obesity in pregnancy contributes to increased morbidity and mortality for both mother and baby”.

That includes evidence that 35% of women who die in childbirth are obese – they had a BMI of at least 30. About 30% of pregnant women are overweight or obese.

Obese women spend 4.83 more days in hospital than other new mothers. Babies whose mothers are obese are also 3.5 times more likely to need to be admitted to a neonatal intensive care unit.

“There’s a large body of thought out there that childbirth is completely natural and shouldn’t be medicalised. But we know that obesity is a danger for the pregnancy and that it influences the baby’s growth and risk of obesity in later life,” said Dornhorst, who favoured regular weighing of all overweight and underweight expectant mothers rather than all pregnant women.

But Janet Fyle, midwifery adviser to the Royal College of Midwives, said it would be “counter-productive” to change the current practice because women with very high BMIs were already identified and given extra monitoring if necessary.

A spokeswoman for the Royal College of Obstetricians and Gynaecologists agreed, saying: “Obesity is identified as a risk factor at time of booking and a referral is made appropriately. As per the National Institute for Heath and Clinical Excellence (NICE) antenatal care guidelines, there is no compelling evidence for routine weighing of all women at every visit.”

Pregnant women, parents and toddlers are the targets of a new government healthy lifestyles campaign, launched last week, called Start4Life. It involves promotion of breastfeeding and advice on when to start babies on solid food. But the NOF believes that far more extensive measures are needed.

In 2008 NICE, which advises the NHS on what treatments and procedures are worthwhile, said only mothers-to-be whose weight might lead to medical complications should be assessed regularly. Two of NICE’s working groups are currently investigating problems associated with weight and pregnancy, one on weight gain during pregnancy, the other on weight loss after pregnancy. It will distil their advice into a new set of guidelines for NHS staff to follow in a few months’ time.

A Department of Health (DH) spokesman ruled out introducing routine regular weighing. “NICE antenatal care guidelines state that normal weight and height should be measured at the booking appointment and the woman’s body mass index should be calculated. The guidelines say that repeated weighing during pregnancy should be confined to circumstances in which clinical management is likely to be influenced,” he said. By Denis Campbell, The Guardian

“My dear Schur,” he said, “you certainly remember our first talk. You promised me then not to forsake me when the time comes. Now it is nothing but torture and makes no sense any more.” In consultation with Freud’s daughter, Anna, Schur acceded to Freud’s request and gave the first injection of three centigrams of morphine. In the early morning of September 23, 1939, Freud died.

Tomorrow, also September 23, after the Debbie Purdy case, the Director of Public Prosecutions is expected to publish new draft guidelines about the circumstances under which it might prosecute those who assist (as Schur and Anna Freud did) someone to commit suicide. Except that these new guidelines will apply only to those who travel to a jurisdiction where assisted suicide is legal. In Britain it is not. Seven decades later the actions of Freud’s doctor and beloved daughter — actions occasioned by compassion and love — will still be illegal.

In July even such limited reform as was suggested by Lord Falconer of Thoroton to the laws forbidding assisted suicide abroad was defeated in the House of Lords. During the debate, an opponent, Lord Walton of Detchant, an 87-year-old former neurologist, repeated a convenient classification. If, in attempting to cure or alleviate pain, a physician were to shorten life, that would be all right, “but the intention must not be to kill”. This was a principle “that had served the medical profession well over many years”.

Perhaps so, but not because of its honesty. Schur would have been better off (under Walton’s law) had Freud said nothing about his wishes and had no conversation taken place with Anna. Then he could have operated in the shadows, free from the suggestion that he had intended to carry out Freud’s request, and deliberately ended his life. A lie would have been safer than the truth.

It isn’t surprising, when you think about it, that many of us increasingly favour Schur over Lord Walton. Past ambiguities about what you could and couldn’t do tended to favour those whose job it was to interpret them — usually the priestly classes of the professions. But over the years we have come increasingly to believe that our judgments about ourselves, albeit as informed by some experts, have a sovereign quality. We have gradually applied this to our clothing, our sexual existences, our capacity to choose and change partners, our fertility, our spiritual beliefs — and now, inevitably, to our deaths. The choice to do as Freud did, to say: “I want to die now, please help me,” is no more or less than the choice that I want for myself. And even that understates it, I realise, because it is the choice that I now demand.

The sheer amount of life available to us in the West might explain some of this trend: 100 years ago most men my age were dead. The Office for National Statistics projects that a boy born in 2006 will live, on average, to be 88.1, and a girl 91.5. Fending off death is no longer the constant struggle it once was — and perhaps exercising autonomy over the circumstances of one’s departure looms larger. Maybe we are just more aware of the possibilities.

So why should we not have the right to determine, within reason, when and how we die? Some religious people will say, in essence, because God says so. But one may observe that sometimes God so invoked seems to have served mankind well (as over opposition to eugenics) and sometimes badly (as over, say, family planning). Church folk will forgive me for addressing some of the more secular objections raised in July’s Lords debate.

First there was the point made by Lord Mackay of Clashfern, that “any proposal to alter the current position involves a judgment that a certain kind of life, or a certain span of life, has become unworthy of support from [the] principle [of the sanctity of life]”. To which I reply: “No, it doesn’t.” What a proposal might do is to permit the liver of a life to decide its value — not Lord Mackay, me or the Archbishop of Canterbury.

Second came the argument primarily advanced by Baroness Campbell of Surbiton, that permitting assisted suicide sent a message to the “disabled and terminally ill” that their lives were somehow second-rate. “Is this really the future we wish to offer those who become terminally ill?” she demanded. But this essentially requires that some people forgo a concrete right of self-dominion for the sake of a speculative (and avoidable) impact on others. If society made decisions on this basis, we would choose who was and who wasn’t permitted to have and bring up children.

Third, and related, was the contention, advanced by many, from the Bishop of Exeter to Baroness Kennedy of The Shaws that the law ought not to be changed because people would either feel “pressured into dying” or actually would be pressured into dying.

Both said that the “vulnerable” might be insufficiently robust to resist the die-soon atmospherics emitted by relatives, knowingly or not. “People who have not led assertive lives, exercising their own choices,” the Bishop said, without any obvious irony, “have often internalised the notion that others know best … Are we to offer them the ultimate opportunity to give way to the will of those around them?” Or are we to demand that they bend to our will, instead?

Now, the predicted malign effects can happen, although, as Baroness Warnock pointed out, “being vulnerable is not a judgment that one ever makes about oneself. To be classified as vulnerable is to be regarded from a great height by lawyers or doctors, above all, or nurses.” But there are obviously things that society can do to mitigate such problems, if it chooses.

Consequently, as a matter of principle, none of these hypothetical possibilities can overcome the right of a suffering Sigmund Freud, who had thought more about life than a convocation of bishops or a dinner of lawyers, to ask a Max Schur — in effect — to kill him; or the right of his doctor and his daughter to be free from the risk of prosecution for having had the love to agree. By David Aaronovitch, The Times.

A group of experts in liver disease will propose the change despite a shortage of organs. Under current guidelines, candidates for new livers have to show they can abstain from drink, usually for six months, before doctors approve a transplant.

The proposed lifting of the ban follows the death in July of Gary Reinbach, 22, from Dagenham, east London. He had severe alcohol-induced liver disease. Reinbach’s doctors believed only a transplant could save him but he was too ill to leave hospital and prove he could stay sober.

A panel of doctors working for the liver advisory group has been swayed by a trial in Lille, northern France, involving 18 alcoholics with liver disease who had not been well enough to show they could remain sober before their transplants.

Fifteen were still alive six months later compared with 44% of patients who had not received a new organ. The patients who received the transplants did not start drinking again.

Next month the liver advisory group will be asked to approve a similar trial in Britain. Dr Alexander Gimson, chairman of the group, is in favour of the change but said that it would be opposed by other patients waiting for a liver transplant. There are 268 patients waiting for a liver; 91 died on the waiting list last year. By Sarah-Kate Templeton, The Times.