Ethical decisions at the edge

Medicine grows incrementally in its ability to treat patients and at the growing edge it poses problems about the appropriateness of treatments that are different from those where good practice conforms to widely agreed standards. The growth of access to medical knowledge and the diversity of contemporary theoretical and clinical medicine have spawned deep divisions in the profession and divergent opinions about what constitutes reasonable care. That hallmark of acceptable practice is also under pressures from the threat of litigation, a highly commercialised contemporary medical environment, patient demands based on medical journalism and the internet and the exponential growth of bio-medical technology. Patient empowerment can result in complaints arising in new and complex areas and expert opinion can often differ markedly depending on where on the medical spectrum the experts are aligned. This column lays out some broad-brush principles to assess the adequacy of medical advice in such a climate.     

Understanding the essential principles of landlord and tenant laws in Nigeria through judicial decisions

Tenancy relationships in Nigeria are largely regulated by statutes. Most of the provisions of these statutes to lawyers and other stakeholders are susceptible to inconsistent interpretations. In recent times, the courts in Nigeria have taken steps to look beyond the law books and give flesh to areas in tenancy matters where there seem to be inadequacies in the provisions of the laws. In doing this, the courts have come up with some legal principles that the relevant statutes do not explicitly provide for, but arguably flow from the provisions of such statutes – a good example being the principle that a tenant who contests ownership with the landlord loses right to statutory notice to quit. Terms such as ‘landlord’ and ‘tenant’ are not as simple as they appear, especially considering the statutory definitions given to them by some of the tenancy statutes in Nigeria – particular attention is given in this regard to Tenancy Law of Lagos State 2011. This paper considers the intricacies of the definition of and relationship between the landlord and the tenant as provided in statutes and as interpreted by overtime by courts in Nigeria. The paper analyses the nature of the relationship between the landlord and the tenant as may be conceived and disambiguates the scope of law of a landlord and tenant relationship in Nigeria.     

Palliative pain therapy at the end of life and forensic medicine issues.

An 83-year-old woman with a history of Alzheimer's disease and breast cancer died at home while receiving palliative pain therapy with oral morphine from her family for metastatic breast cancer. Allegations of mistreatment were made, and this case was ultimately referred to the Office of the Chief Medical Examiner, State of Maryland. An autopsy failed to identify any injuries or residual cancer, leaving no anatomic explanation for the pain that had been presumed to be metastatic breast carcinoma involving bone. The blood free morphine concentration was 5,200 ng/ml, and the total morphine concentration was 15,000 ng/ml. This case demonstrates the challenges and difficulties in forensic medicine when faced with the interpretation of toxicologic results at the end of life.