Sunday, 7 January 2018

Of pirates, parole and prescriptions; we are our choices

I thought a lot about the notion of choice[s] this past week. There were plenty of stories to stimulate my thinking and choose from. For example, we all had the choice of having a flu vacation and giving ourselves protection from the deadly H3N2 influenza strain. H3N2 is likely to trigger the worst UK flu season in 50 years. If you chose not to have the vacation, read this; or the story that you can now choose to have a healthy full English breakfast thanks to nitrite free bacon. The WHO warns that bacon cured with nitrites is as dangerous for our health as asbestos, and smoking – due to the carcinogenic nitrosamines produced when ingested - see here.

I also caught up on the story of Michael Afanasyey, an environmental engineer, studying at the Delft University of Technology. He claims to be a ‘priest’ for the Church of the Flying Spaghetti Monster. It’s an organisation that ridicules organised religions (you can read more about the so called Church here). Afanasyey is taking the University to the Dutch Institute of Human Rights after they refused to allow him to defend his PhD thesis wearing an outfit of his choice, a pirate’s costume. Pirates play a significant part of the satirical religion. The so called ‘believers’ claim there is an inverse correlation between the number of pirates in the world and global warming.

There was yet another story last week about global warming denier, Donald Trump and his mental health state. The origins of the story appear to have stemmed from the publication of Michael Wolff’s book ‘Fire and Fury’, an account of Trumps first year as US president. The book claims to have captured life inside the Whitehouse, and the sometimes very erratic and unpredictable behaviour of the president. His behaviour has increasingly become the focus of alarm and concern over his mental state. Current UK media commentary includes discussion around whether Trumps forthcoming medical examination will include a mental health element, and if so will this determine whether he is fit for office.  

Although there is a presidential convention that all US presidents undergo an annual medical examination, actually there is no rule or law that requires this. It will be Trumps choice to take the examination, as it will be to release all or none of the results to the public. Even then it would be incredibly difficult for the Vice-President (and the majority of the cabinet) to evoke the 25th Amendment and deem Trump physically or mentally ‘unable to discharge the powers and duties of his office’.  Deciding whether someone’s behaviour and actions are the consequence of a mental illness or not has been a long standing problem.

Way back in 1843, a man named Daniel McNaughton attempted to assassinate the then UK Prime Minister, Sir Robert Peel. He accidently killed his secretary, Edward Drummond instead. Following a lengthy criminal trial, McNaughton was acquitted of his actions because he was deemed ‘insane’ and could not be held accountable for his actions. It was an outcome that caused a great deal of public anger and concern. I imagine the anger was similar to the public anger seen following the news last week that John Worboys was to be released on parole from his prison sentence. 9 years ago he was convicted of raping 19 women, but its believed he may have raped up to 100 women. In the McNaughton case the public outcry resulted in the establishment of the so called McNaughton Rules. These were 5 questions that attempted to redefine what ‘insanity’ was. They have been used internationally in various modified forms since this time.

I hope the public outrage over the release of Worboys also results in changes in the way in which the perpetrators of rape and sexual assault are treated by the criminal justice system. Likewise, I hope that current sex offender treatment and rehabilitation programmes continue to be regularly evaluated in terms of their effectiveness. The organisation Rape Crisis (see here) remind us that approximately 85,000 women and 12,000 men are raped in England and Wales every year (approximately 11 adult rapes every hour). Nearly 500,000 adults are sexually assaulted every year, and 1 in 5 women aged 16 – 59 have experienced some form of sexual violence since the age of 16. Only 15% of those who have experienced sexual violence choose to report this to the police. It maybe that Worboy has served his sentence, and will be strictly monitored while on licence, but for his victims there will be no parole from where they find themselves after what it was he did to them.

The saddest story about choice I read last week was undoubtedly that of the inquest into the death of Megan Robertson. Megan was a normal 15 year old who liked make up, music, going out with friends, had a great sense of humour. According to her mum she could be ‘bolshie and an absolute madam - when things didn’t go her way she would slam doors like all 15 year olds’. Megan lived with frontal lobe epilepsy, which meant for her she experienced very frequent nightly epileptic seizures. She struggled with the side effects of the medication she was prescribed to manage this condition. In the weeks leading up to her death, she decided to only take 3 of the 7 doses she should have been taking. Megan had great support from her family, from a specialist nurse and a neurologist. All had spent time discussing with Megan the possible consequences of her choices and decisions about managing her condition. Further investigations into her condition were offered, which Megan chose not to take up. 

Her post-mortem revealed that Megan had an underlying (and unknown) abnormal heart condition which might have caused her death regardless of whether she had been suffering a seizure or not. Her death is very sad. Might it have been avoided? I don’t know. Some might say that aged just 15, Megan wasn’t fully competent and able to make the choices she made. I don’t know that either. As Jean-Paul Sartre said, ‘we are our choices’. I do know that as I read Megan's story my thoughts were, and remain with her family and their sad loss of a daughter, and sister.