Dominick Price

New protocols have been developed for donors after circulatory death involving early assessment of donor status and premortem supporting treatment in appropriate cases where there is evidence that the patient wished to be an organ donor. These donors are now making an increasingly marked impact on overall deceased donor numbers in the UK. Donors after brainstem death, on the other hand, are much less buoyant yet require the same flexibility in approach in order to improve rates of donation and to realize the wishes of potential deceased organ donors to the proper requisite extent

Citizens' juries are commended as a new technique for democratising health service reviews. Their usefulness is said to derive from a reliance on citizens' rational deliberation rather than on the immediate preferences of the consumer. The author questions the assertion of critical detachment and asks whether juries do in fact employ reason as a means of resolving fundamental disagreements about service provision. He shows that juries promote not so much a critically detached point of view as a particular evaluative framework suited to the bureaucratic idiom of social welfare maximisation. Reports of jury practice reveal a tendency among juries to suppress by non-rational means the everyday moral language of health care evaluation and substitute for it a system of thought in which it can be deemed permissible to deny treatment to sick people. The author concludes that juries are chiefly concerned with non-rational persuasion and because of this they are morally and democratically irrelevant. Juries are no substitute for voting when it comes to protecting the public from zealous minorities

Objectives - To explore the wvay ethical principles develop during a medical education course for three groups of medical students - in their first year, at the beginning of their penultimate (fifth) year and towards the end of their final (sixth) year. Design - Survey questionnaire administered to medical students in their first, fifth and final (sixth) year. Setting - A large medical school in Queensland, Australia. Survey sample - Approximately half the students in each of three years (first, fifth and sixth) provided data on a voluntary basis, a total of 385 students. Results - At the point of entry, minor differences were found between medical students and first year law and psychology students. More striking were differences between male and female medical students, suggesting early socialization had a substantial impact here. Conclusions - Results indicate that substantial changes in attitude have developed by the beginning of fifth year with little change thereafter. Gender difference persisted. Some difference in ethical attitudes were found when groups of different ethnic backgrounds were compared. The impact of a move to a graduate medical course, which gives high priority to ethics within a professional development domain, can now be evaluated