Otara Market, The Occidental

Otara Market
I'm not really a NZ-market kinda person, but I forced myself to go yesterday despite not sleeping the whole freaking night (2nd or 3rd time this week alr - I'm really gonna change this bad habit!)! And I knew it was the wrong choice once I was walking out. I was quite tired and sleepy and cold and lazy but nonetheless braved the winds and walked to the bus-stop to meet YC. And guess what? We missed the bus and got to wait for another 45minutes in the cold. And we paid $10.60 for a round trip to some morning market which I don't understand whats the hype bout it anyways. The only thing I got out of it was cheap veg, but considering the transportation fare, its not really THAT cheap. YC came over for awhile to transfer movies into my laptop and despite how tired I was, I couldn't help it but show her the good stuff I found on youtube! Argh! Thats my current obsession and its gonna be my downfall. After which, slept for 12 hours..and when I woke up today, I felt as if I've slept so much that I can go on not sleeping for the rest of the following week.

The Occidental
Feeling a lil guilty I decided to mug a lil and came across a very very interesting case which I would elaborate later. Supposed to do grocery shopping with Grace today but it was raining so we decided not to and knowing that I wouldn't have the time to do it next week, I've to really make use of whats left in my fridge, which is like...very little haha. But anyways, met Cheryl for dinner at the Occidental which is like a pub/restaurant kinda place with a live band. I have heard a lot about it - how good the mussels are blah blah. Someone once told me the serving is huge and its for 2. But, don't know why we ordered one each and hell! It was huge! One freaking pot (1kg of mussels) with a bowl of fries. We thought we could do a take-away but the manager said we can't because thats their company's policy. Cheryl was damn pissed and insisted that she was gonna bring it back no matter what. 'Theres always a way', she said. I thought she was kidding but NO! She was dead serious. Her mom gave me this bottle of kaya with a plastic bag wrapped around it and so, she ingeniously decided to use that. I was laughing my ass of..my god.. I was like, if we get caught, we are so dead man! I was telling her that I can't get a criminal conviction else I can never practise law. I know this ain't serious enough to result in a criminal conviction but its just humiliating to get caught taking mussels away in a freaking plastic bag. (Not using 'stealing' cause we paid for it) And so to accomplish her desire to prove her point that no one's gonna stop us from taking whats rightfully ours, I was supposed to keep a look out for the waitresses. Occasionally I've to pretend to 'search' for something in the bowl so that the waiter won't take it away and expose our plastic bag. After getting all the shells out and mussels into the plastic bag, the next challenge was to smuggle it into my bag, which was my job. So I just took it and put it inside and she stared at me in horror - you are so not discrete. We quickly paid the bill and left. I'm so not gonna go back there again! If they've a CCTV and they would be thinking - stupid asians!

Auckland Area Health Board v Attorney-General

I really like how the judge ruled in this case. I summarized it...I kinda agree with what he said, what do you think?

Facts
•Mr L is not what is called ‘brain dead’ – but brain is unable to communicate with his body or brain or vice versa
•No prospect of recovery, no therapeutic or medical benefit in continuing artificial ventilation
•If artificial ventilation is discontinued, L will suffer an almost immediate cardiac arrest and quickly but painlessly die
•Full support from Mrs L
•Doctors seeking confirmation that they would not be prosecuted – come to court seeking a declaration that what they wish to do is not unlawful

Issue
•Whether the doctors’ action in withdrawing the artificial ventilation (AV) support system from L would make them guilty of culpable homicide
•Whether the doctors would be in breach of ss151 and 164

Analysis

The Sanctity of life
•NZ BOR emphasizes the role of the law in preserving life but there are qualifications of this
•S11 BOR – everyone has the right to refuse to undergo any medical treatment
•Nancy B v Hotel-Dieu de Quebec
•Held that the use of a respirator to sustain ‘life’ was a medical treatment, but that the discontinuance of that treatment at the patient’s request would not constitute a criminal act
•Constantly keeping the patient on the respirator without her consent constituted an intrusion and interference which violated her person
•Problem arises when life passes into death but obscurely – enormous advances made in technology and medical science
•Whether life-support system is being used to sustain life or being used to defer death

The ‘living dead’
•With the advances in technology and medical skills – medical profession has rejected the notion that death is to be equated with the cessation of a person’s heartbeat – instead, it is preferred to adopt the concept of ‘brain death’
•Brain-stem death- whole of the brain has been severely destroyed and the critical functions responsible for supporting brain activity have been irretrievably lost – but breathing and heartbeat can be mechanically induced

Interpreting s151
•S151 – seeks to ensure that those who have the care of one who cannot care for him or herself supply that person with the necessaries of life

Cause of death?
•Issue – whether the withdrawal of AV would be the cause of L’s death
•Essentially – ask whether the doctor was under a duty to continue the life-support system – or had a ‘lawful excuse’ for discontinuing it
•If doctor is not under a legal duty to continue life support system – or has ‘lawful excuse’ – he has not legally caused the death of patient
•Proceed on to answer these 2 questions to determine cause of death:
The duty to provide the necessaries of life
•Medical intervention which is construe to be a necessary of life is medical intervention necessary to prevent, cure or alleviate a disease that threatened life or health
•Question – whether a AV is to be construed as a necessary of life? – no absolute answer, depend on the facts
•Provision of AV may be regarded a necessary of life where it is required to prevent, cure or alleviate a disease that endangers health or life
•However –if the patient is surviving by virtue of the mechanical means which induces heartbeat and breathing and is beyond recovery – do not consider that the provision of AV can be properly construed as necessary of life – patient has passed the point of ‘life’ – and the obligation contemplated by the section is otiose
•But this would not be the case if AV has a therapeutic or medical advantage in that it may enable a patient to live long enough to recover from the illness
•Mr L’s case – no prospect of any improvement – AV serves no purpose – cannot be regarded as a necessary of life

Lawful excuse
•Even if doctors are under a duty to provide – for purpose of s151, they would not be acting without ‘lawful excuse’
Doctors have lawful excuse to discontinue ventilation when there is no medical justification for continuing that form of medical assistance – continuation of AV may be lawful, but it does not make it unlawful to discontinue it if it accords with good medical practice
• Good medical practice – best interests of the patient, encompass the prevailing medical standards, practices, procedures, traditions which common general approval within the medical profession, specialist opinions, agreement, consultation with medical profession’s recognized ethical body, patient’s family approval
•Decision to withdraw L’s AV is supported by others and extensive tests have been carried out – assurance of good medical practice
•Physician has no duty to continue treatment, once it has proved to be ineffective – although there may be a duty to provide life-sustaining machinery in the immediate aftermath of a cardio-respiratory arrest, there is no duty to continue its use once it has become fertile in the opinion of qualified medical personnel
•Doctor must never do anything actively to kill his patient but he is not bound to fight for the patient’s life forever
•Natural death has not lost its meaning or significance, it may be deferred but not postponed indefinitely
•What is involved is not just medical treatment but medical treatment in accordance with the doctor’s best judgment as to what is the best interests to his patient
•Mr L – death is merely being deferred

S164 – Acceleration of death
•Has little or no application to this case
•Significant difference between hastening the death of a living person who may be nevertheless be terminally ill and discontinuing a life-support system which is artificially prolonging the manifestations of ‘life’
•If the doctor withdraws AV in accordance with recognized and approved medical opinion – does not act unlawfully

Decision
•Withdrawal of AV is not the cause of death as a matter of law if and when one or other of the 2 primary conditions are met – that is doctor is not under a duty to provide AV as part of necessaries of life OR has a lawful excuse for declining to do so
•Both questions then turn on whether or not the doctor has followed good medical practice and the guidelines or procedures which have been laid down
•Declaration issued