c4VC Cream/Suppositories Antimicrobial COMPOSITION/DESCRIPTION AVC Cream Each tube contains:
Sulfanilamide.15.0% Allantoin.2.0%
Aminacrine hydrochloride.0.2% with lactose, ma water-miscible base made from propylene glycol, stearic acid, diglycal stearate, and trietbanolamine; buffered with lactic acid to an acid pH. AVC Suppositories Each suppository contains: Sulfanilamide.1.05 g. Aminacrine hydrochloride.0.014 g. Allantoin.0.14 g. with lactose, in a base made from polyethylene glycol 400. polysorbate 80, polyethylene glycol 4000, and glycerin; buffered with lactic acid to an acid pH. AVC Suppositories have an inert gelatin covering, which dissolves promptly in the vagina. ACTIONS-AVC is a vaginal preparation combining the complementary antimicrobial action of aminacrine hydrochloride and sulfanilamide. Bacteria, trichomonads, an, Candida, alone or in combination, respond to AVC, even in the presence of organic matter. Sulfanilamide, proved over many years, is highly effective against the pathogenic bacteria commonly associated with vaginitis; it is believed to block certain metabolic processes essential for the growth of micro-organisms of this type. Aminacrine hydrochloride, a highly ionized acridine derivative, is an effective antimicrobial agent with minimal side effects. Its spectrum of bactericidal activity is wide and includes many Gram-positive and Gramnegative organisms, as well as trichomonads and fungi. Aminacrine hydrochloride is thought to act by interfering or competing with certain hydrogen ions in microbial enzyme systems; thus the growth of invading organisms is inhibited. These ingredients are combined in a specially compounded base; the presence of surface active agents promotes the spreading of the medication. Buffered to the pH of the normal healthy vagina, AVG cream and suppositories help provide an environment which, although hostile to the invading pathogens, favours restoration of Doderleins bacilli, the acid-producing organisms normally present in the vagina. INDICATIONS AND CLINICAL USE-For the treatment of vaginitis and cervicitis. Also or the prevention or control of infection following cauterization, conization, or other surgical procedures of the female genital tract. CONTRAINDICATIONS-AVC should not be used in patients known to be sensitive to the sulfonamides. PRECAUTIONS-As with all sulfonamides, the usual precautions apply. Patients should be observed for manifestations such as skin rash, or other evidence of systemic toxicity, and if these develop, the medication should be discontinued. ADVERSE REACTIONS-Although some absorption of sulfanilamide may occur through the vaginal mucosa, systemic manifestations attributable to this drug are infrequent. Local sensitivity reactions such as increased discomfort or a burning sensation have occasionally been reported following the use of topical sulfonamides. Treatment should be discontinued if either local or systemic manifestations of sulfonamide toxicity or sensitivity occur. DOSAGE AND ADMINISTRATION-l applicatorful (about 6 g.) or 1 suppository intravaginally once or twice daily. Improvement will offen be apparent within a few days, but treatment should be continued until pathogens have been eliminated or a clinical cure or remission is achieved. Adequate control or eradication of Candida and trichomonads usually requires prolonged treatment. Exacerbation may occur during the menses; for such infections it is therefore advisable to continue the applications for a minimum of 1 month, or through 1 complete menstrual cycle. Douching with a suitable solution may be recommended for hygienic purposes. A pad maybe used to protect underclothing if necessary.
DOSAGE FORMS
AVC Cream: 4 ounce tube with applicator 1 ounce tube with 4 disposable applicators (Hospital Package) AVC Suppositories: Box of 15 with inserter STORAGE-Keep at room temperature. Avoid excessive heat. Initial Printing September, 1972
THE WM. S. MERRELL COMPANY Division of Richardson-Merrell (Canada) Ltd., Weston, Ontario. M9L 1R9 ED
4-181
Printed September, 1974.
sibility of the father and of society at large. This is fundamental and laws are made for this reason. Yet there are indications for therapeutic abortion. In outlining these one must distinguish between pregnancies that are normal and pregnancies that are pathologic. Pathologic means that the process is a hazard to the health of the mother or the fetus (and this is not restricted I. RAY, MB, BS, DPM, MRC PSYCH to life hazard). Schizophrenia may be Psychiatric department reactivated and puerperal psychosis Union Hospital Moose Jaw, Sask. may become worse with each delivery. Depression, however, as a clinical enReference tity during pregnancy is extremely rare 1. SINGER I, ROTENBERG D: Mechanisms of liand there is no such diagnosis as a pregnancy depression. Yet the majority thium action. N Engi J Med 289: 254, 1973 of indications for abortion are listed as depressions; the public knows this Unwanted pregnancy and abortion and abuses it. It does not require much To the editor: I would like to comment skill to differentiate a true depression on the articles concerning unwanted from sadness or grief resulting from a pregnancy and abortion in the Novem- frustrating situation. If it is a depression one has to treat the depression, ber 16 issue of the Journal. The medical and moral implications not the pregnancy. We are using the of abortion are matters of concern to wrong diagnosis to escape from a difthe medical profession, and its respon- ficult decision. To justify an abortion one must be sibilities to the public cannot be evaded by attempts to pass them on to lawyers, sure that health will be permanently philosophers or theologians. Any rea- damaged, as in a patient with chronic sonable consideration of abortion can- nephritis or one at risk of heart failnot ignore a philosophy of life, an4 ure. If the woman will be unable to rear the fruitless struggle between the opposing groups of anti- and proabor- the child, it can be adopted. If one is tionists must be avoided. The problem certain that a fetus will cause intrauterine damage one is justified to abort. is polarized when it should not be. A common error made by physicians If the infant at birth has a gross defect is that they assume a responsibility that is clearly pathologic I do not that is not theirs. When a healthy wom- believe that one needs to prolong its an becomes pregnant it is her respon- life. I also do not see why a woman sibility and it is certainly not the duty who is raped must carry a pregnancy of the physician to terminate the preg- that was enforced upon her in a pathonancy. She can try to blackmail him logic act. To me it is hardly disputable that with threats of suicide, of criminal abortion by incompetent people or of the life of a human being begins at having an unwanted child. The medical conception and that growth follows one profession does not resist these pres- continuous line from that conception to the development of a full personalsures sufficiently. The influence of "lack of love" on ity. It is a completely arbitrary decision the personality of a child is well known, to establish a reference point at 3 but it is brutal and false to use this months or later in pregnancy when the argument as reason for an abortion. fetus acquires a human facial appearMillions of children, wanted and un- ance, or at birth or at 1 year of age, wanted, may be exposed to extreme in order to determine when one can lack of love and no one can predict abort or kill this life. For our growth who will be loved and who will not. and survival we remain dependent on It depends on a character trait of the our environment in varying degrees mother. Abortion on the grounds of but not in any essentially different deconvenience, because the pregnancy grees. Each stage needs a specific endoes not fit into the living pattern that vironment or communication. The lack of guiding principles has she has programmed, is an easy way out in a society where frustrations are created a very disturbing situation. A most disturbing thought is that those overcome through denial or escape. Another error is the view that preg- who are unwanted can be disposed of. nancy is the sole responsibility of the This happened to the Jews in Nazi woman and that the decision to termi- Germany and it happens in all totalinate it is therefore up to her. But a tarian states. In our free democracies society's existence can only be main- it is forbidden to discriminate against tained through pregnancies and there- any group on racial, religious or other fore the pregnancy is also the respon- grounds, yet we are on the road to
nerve excitation, synaptic transmission and neuronal metabolism. Alteration in ion transport or distribution or inhibition of adenyl cyclase may produce the effects seen in our patient.1 Lithium carbonate may have caused the initial cerebral dysrhythmia with minor seizures that gradually improved as brain cells acquired tolerance to the lithium ion.
CMA JOURNAL/FEBRUARY 22, 1975/VOL. 112 419
ruthless discrimination against the most defenceless group. Throughout history, people were first dehumanized, not regarded as people, then used or killed. Another consequence of lack of principles is that quality gives way to quantity. We become alarmed by the "epidemic" proportions of abortions; we talk about percentages as if we were talking about cattle. We seek stricter laws and supervision to reduce the "rate". I believe that if we do a morally right procedure it is irrelevant whether 10 or 1000 abortions are performed. Yet the literature is full of this concern with numbers and percentages. It is not difficult to find examples of the paradoxic situation in which in one room of a hospital a battle is being fought to maintain the life of a braindamaged infant or an infant with gross congenital defects, while in an adjoining room a healthy life is being disposed of because it is unwanted by one person. Teenagers who indulge in sexual activity without being mature enough to raise a child or even use preventive measures also cannot put the responsibility for their pregnancy on the shoulders of physicians. But it is the responsibility of their parents, the society and the medical profession to teach them the responsibility that goes with sexuality. Physicians' attention must be focused on preventing the occurrence of those situations in which abortion may be justifiable. If we advocate abortion for the sake of convenience we shall be encouraging the development of a generation of irresponsible people with a cynical view of the beginning of human life. The Oath of Hippocrates should serve as a means of drawing the members of the medical profession together irrespective of religious or philosophical differences. As it is now, we are the passive onlookers of a debate between fanatically rigid groups. c.w. KOK, MD 524 Crescent Rd. NW Calgary, Alta.
Accidental hypothi.rmia To the editor: I read with interest the case of the 5-year-old boy who survived cold water immersion for 30 minutes (Can Med Assoc J 111: 1330, 1974). Dr. Hunt is to be commended for his prompt and effective measures, which undoubtedly saved the boy's life. The relatively small body mass of a 5-year-old exposed to cold water (as opposed to air) would be conducive to rapid loss of body heat. His heavy winter clothing no doubt greatly modified this loss. However active the diving reflex may have been on immersion, undoubt-
edly the degree of hypothermia recorded on arrival in hospital contributed significantly to the diminished responses of the cardiovascular, respiratory and central nervous systems noted on first examination. The problems of safe rewarming whether to attempt it before reaching hospital and what type of supportive therapy to use en route - are matters that concerned Dr. Zingg and myself when we were preparing our review of "Cold injury in civil disaster" (Can Med Assoc J 87: 1196, 1962). We recommended rapid rewarming by immersion in warm water until a body temperature of about 320C was reached for patients so hypothermic that physiologic rewarming mechanisms are abolished and there is a serious risk of cardiac arrest. Continued vigorous external rewarming beyond that temperature was considered to carry a risk of "overshoot" or "rewarming shock". Since physicians usually face this problem as an unexpected emergency situation with which they have had no previous experience and since the prognosis from accidental hypothermia in young healthy people by immersion in cold water is better than the first clinical impression, I would like to reinforce the reminder Dr. Hunt has given us. J.A. HLDES, MD Director, Northern medical unit Medical College 753 McDermot Ave. Winnipeg, Man.
The irritable colon To the editor: "The irritable colon" by W. G. Thompson (Can Med Assoc J 111: 1236, 1974) is an extremely well written and worthwhile article. As the author points out in the introductory paragraph, countless names have been coined for this entity. Many of these terms imply that the motility disorder is confined to the colon. Previous studies1. suggest that such may not be the case. Until this issue is resolved, it would seem that the name "irritable bowel syndrome" is perhaps more appropriate. The occasional patient with the diarrheal form of the syndrome is extremely difficult to control. In such a case, particularly when narcotics are being considered, a trial of cholestyramine may be worth while.4 F.G. SAIBIL, MD, FRcPtcJ Division of gastroenterology Sunnybrook Medical Center University of Toronto Toronto, Ont.
References 1. HOLDSTOCK DJ, MssJEwlcz JJ, WALLER SL: Observations on the mechanism of abdominal pain. Gut 10: 19, 1969 2. FRIEDMAN G, SAIBIL FG: Gastric and small bowel motor function in the irritable bowel syndrome. Gastroenterology 62: 749, 1972 3. HARvEY RF, READ AE: Effect of cholecystokinin on colonic motility and symptoms in patients with the irritable-bowel syndrome.
Lancet 1: 1, 1973
420 CMA JOURNAL/FEBRUARY 22, 1975/VOL. 112
4. SCHAPIRO RH, HEIZER DW, GOLDFINGER SE
Ct al: Cholestyramine: responsive idiopathic diarrhea. Gastroenterology 58: 993, 1970
Age of consent To the editor: In 1974 in Ontario a regulation in the Public Hospitals Actt was revised to allow a patient 16 years of age to give consent for a procedure to be carried out on himself within a public hospital. Under section 39, subsection 0(a), the minister of health has been given the power to set the requirements to be satisfied for "obtaining a valid consent for any surgical operation, diagnostic procedure or medical treatment, the method of obtaining such consent, the conditions under which such consent may be dispensed with and specifying the age or ages at which and under what conditions a patient may give a valid consent for surgical operation, diagnostic procedure or medical treatment to be performed on himself". In recent months much confusion has arisen over the validity of this authority, especially as it relates to the law of torts. It is obvious that the only purpose of the Public Hospitals Act is to protect the "institution" against civil litigation and not to protect the physician. In other words, what constitutes a valid consent for the hospital does not necessarily hold true for the physician. He is still liable because three conditions must be present before any consent is legally valid (if this is indeed possible): (1) the patient must be fully informed, (2) the patient must be legally competent and (3) the consent must be freely given. Whereas in the Venereal Diseases Prevention Act,2 section 21, the age of 16 is deemed to be sufficient to give consent for the purpose of treatment by the attending physician, no such release from liability is present in the Public Hospitals Act, nor is there meant to be. The Canadian Medical Protective Association has made it clear to all its members that there is no common-law precedent for a 16-year-old patient giving consent for a surgical procedure to be performed on himself; hence, it has been recommended that a parent or guardian sign for the 16-year-old patient (under nonemergency conditions). Since the new regulation to the Public Hospitals Act has come into effect (and I personally believe that this should have been a decision of Parliament as a whole, reflecting the peoples' wishes, and not just the opinion of the minister and his advisers) abortions are being carried out on 16-year-old patients without the physician knowing exactly what his legal position is with respect to the possibility of civil action being brought against him by the parents or guardians of these children.
Sulfanilamide.15.0% Allantoin.2.0%
Aminacrine hydrochloride.0.2% with lactose, ma water-miscible base made from propylene glycol, stearic acid, diglycal stearate, and trietbanolamine; buffered with lactic acid to an acid pH. AVC Suppositories Each suppository contains: Sulfanilamide.1.05 g. Aminacrine hydrochloride.0.014 g. Allantoin.0.14 g. with lactose, in a base made from polyethylene glycol 400. polysorbate 80, polyethylene glycol 4000, and glycerin; buffered with lactic acid to an acid pH. AVC Suppositories have an inert gelatin covering, which dissolves promptly in the vagina. ACTIONS-AVC is a vaginal preparation combining the complementary antimicrobial action of aminacrine hydrochloride and sulfanilamide. Bacteria, trichomonads, an, Candida, alone or in combination, respond to AVC, even in the presence of organic matter. Sulfanilamide, proved over many years, is highly effective against the pathogenic bacteria commonly associated with vaginitis; it is believed to block certain metabolic processes essential for the growth of micro-organisms of this type. Aminacrine hydrochloride, a highly ionized acridine derivative, is an effective antimicrobial agent with minimal side effects. Its spectrum of bactericidal activity is wide and includes many Gram-positive and Gramnegative organisms, as well as trichomonads and fungi. Aminacrine hydrochloride is thought to act by interfering or competing with certain hydrogen ions in microbial enzyme systems; thus the growth of invading organisms is inhibited. These ingredients are combined in a specially compounded base; the presence of surface active agents promotes the spreading of the medication. Buffered to the pH of the normal healthy vagina, AVG cream and suppositories help provide an environment which, although hostile to the invading pathogens, favours restoration of Doderleins bacilli, the acid-producing organisms normally present in the vagina. INDICATIONS AND CLINICAL USE-For the treatment of vaginitis and cervicitis. Also or the prevention or control of infection following cauterization, conization, or other surgical procedures of the female genital tract. CONTRAINDICATIONS-AVC should not be used in patients known to be sensitive to the sulfonamides. PRECAUTIONS-As with all sulfonamides, the usual precautions apply. Patients should be observed for manifestations such as skin rash, or other evidence of systemic toxicity, and if these develop, the medication should be discontinued. ADVERSE REACTIONS-Although some absorption of sulfanilamide may occur through the vaginal mucosa, systemic manifestations attributable to this drug are infrequent. Local sensitivity reactions such as increased discomfort or a burning sensation have occasionally been reported following the use of topical sulfonamides. Treatment should be discontinued if either local or systemic manifestations of sulfonamide toxicity or sensitivity occur. DOSAGE AND ADMINISTRATION-l applicatorful (about 6 g.) or 1 suppository intravaginally once or twice daily. Improvement will offen be apparent within a few days, but treatment should be continued until pathogens have been eliminated or a clinical cure or remission is achieved. Adequate control or eradication of Candida and trichomonads usually requires prolonged treatment. Exacerbation may occur during the menses; for such infections it is therefore advisable to continue the applications for a minimum of 1 month, or through 1 complete menstrual cycle. Douching with a suitable solution may be recommended for hygienic purposes. A pad maybe used to protect underclothing if necessary.
DOSAGE FORMS
AVC Cream: 4 ounce tube with applicator 1 ounce tube with 4 disposable applicators (Hospital Package) AVC Suppositories: Box of 15 with inserter STORAGE-Keep at room temperature. Avoid excessive heat. Initial Printing September, 1972
THE WM. S. MERRELL COMPANY Division of Richardson-Merrell (Canada) Ltd., Weston, Ontario. M9L 1R9 ED
4-181
Printed September, 1974.
sibility of the father and of society at large. This is fundamental and laws are made for this reason. Yet there are indications for therapeutic abortion. In outlining these one must distinguish between pregnancies that are normal and pregnancies that are pathologic. Pathologic means that the process is a hazard to the health of the mother or the fetus (and this is not restricted I. RAY, MB, BS, DPM, MRC PSYCH to life hazard). Schizophrenia may be Psychiatric department reactivated and puerperal psychosis Union Hospital Moose Jaw, Sask. may become worse with each delivery. Depression, however, as a clinical enReference tity during pregnancy is extremely rare 1. SINGER I, ROTENBERG D: Mechanisms of liand there is no such diagnosis as a pregnancy depression. Yet the majority thium action. N Engi J Med 289: 254, 1973 of indications for abortion are listed as depressions; the public knows this Unwanted pregnancy and abortion and abuses it. It does not require much To the editor: I would like to comment skill to differentiate a true depression on the articles concerning unwanted from sadness or grief resulting from a pregnancy and abortion in the Novem- frustrating situation. If it is a depression one has to treat the depression, ber 16 issue of the Journal. The medical and moral implications not the pregnancy. We are using the of abortion are matters of concern to wrong diagnosis to escape from a difthe medical profession, and its respon- ficult decision. To justify an abortion one must be sibilities to the public cannot be evaded by attempts to pass them on to lawyers, sure that health will be permanently philosophers or theologians. Any rea- damaged, as in a patient with chronic sonable consideration of abortion can- nephritis or one at risk of heart failnot ignore a philosophy of life, an4 ure. If the woman will be unable to rear the fruitless struggle between the opposing groups of anti- and proabor- the child, it can be adopted. If one is tionists must be avoided. The problem certain that a fetus will cause intrauterine damage one is justified to abort. is polarized when it should not be. A common error made by physicians If the infant at birth has a gross defect is that they assume a responsibility that is clearly pathologic I do not that is not theirs. When a healthy wom- believe that one needs to prolong its an becomes pregnant it is her respon- life. I also do not see why a woman sibility and it is certainly not the duty who is raped must carry a pregnancy of the physician to terminate the preg- that was enforced upon her in a pathonancy. She can try to blackmail him logic act. To me it is hardly disputable that with threats of suicide, of criminal abortion by incompetent people or of the life of a human being begins at having an unwanted child. The medical conception and that growth follows one profession does not resist these pres- continuous line from that conception to the development of a full personalsures sufficiently. The influence of "lack of love" on ity. It is a completely arbitrary decision the personality of a child is well known, to establish a reference point at 3 but it is brutal and false to use this months or later in pregnancy when the argument as reason for an abortion. fetus acquires a human facial appearMillions of children, wanted and un- ance, or at birth or at 1 year of age, wanted, may be exposed to extreme in order to determine when one can lack of love and no one can predict abort or kill this life. For our growth who will be loved and who will not. and survival we remain dependent on It depends on a character trait of the our environment in varying degrees mother. Abortion on the grounds of but not in any essentially different deconvenience, because the pregnancy grees. Each stage needs a specific endoes not fit into the living pattern that vironment or communication. The lack of guiding principles has she has programmed, is an easy way out in a society where frustrations are created a very disturbing situation. A most disturbing thought is that those overcome through denial or escape. Another error is the view that preg- who are unwanted can be disposed of. nancy is the sole responsibility of the This happened to the Jews in Nazi woman and that the decision to termi- Germany and it happens in all totalinate it is therefore up to her. But a tarian states. In our free democracies society's existence can only be main- it is forbidden to discriminate against tained through pregnancies and there- any group on racial, religious or other fore the pregnancy is also the respon- grounds, yet we are on the road to
nerve excitation, synaptic transmission and neuronal metabolism. Alteration in ion transport or distribution or inhibition of adenyl cyclase may produce the effects seen in our patient.1 Lithium carbonate may have caused the initial cerebral dysrhythmia with minor seizures that gradually improved as brain cells acquired tolerance to the lithium ion.
CMA JOURNAL/FEBRUARY 22, 1975/VOL. 112 419
ruthless discrimination against the most defenceless group. Throughout history, people were first dehumanized, not regarded as people, then used or killed. Another consequence of lack of principles is that quality gives way to quantity. We become alarmed by the "epidemic" proportions of abortions; we talk about percentages as if we were talking about cattle. We seek stricter laws and supervision to reduce the "rate". I believe that if we do a morally right procedure it is irrelevant whether 10 or 1000 abortions are performed. Yet the literature is full of this concern with numbers and percentages. It is not difficult to find examples of the paradoxic situation in which in one room of a hospital a battle is being fought to maintain the life of a braindamaged infant or an infant with gross congenital defects, while in an adjoining room a healthy life is being disposed of because it is unwanted by one person. Teenagers who indulge in sexual activity without being mature enough to raise a child or even use preventive measures also cannot put the responsibility for their pregnancy on the shoulders of physicians. But it is the responsibility of their parents, the society and the medical profession to teach them the responsibility that goes with sexuality. Physicians' attention must be focused on preventing the occurrence of those situations in which abortion may be justifiable. If we advocate abortion for the sake of convenience we shall be encouraging the development of a generation of irresponsible people with a cynical view of the beginning of human life. The Oath of Hippocrates should serve as a means of drawing the members of the medical profession together irrespective of religious or philosophical differences. As it is now, we are the passive onlookers of a debate between fanatically rigid groups. c.w. KOK, MD 524 Crescent Rd. NW Calgary, Alta.
Accidental hypothi.rmia To the editor: I read with interest the case of the 5-year-old boy who survived cold water immersion for 30 minutes (Can Med Assoc J 111: 1330, 1974). Dr. Hunt is to be commended for his prompt and effective measures, which undoubtedly saved the boy's life. The relatively small body mass of a 5-year-old exposed to cold water (as opposed to air) would be conducive to rapid loss of body heat. His heavy winter clothing no doubt greatly modified this loss. However active the diving reflex may have been on immersion, undoubt-
edly the degree of hypothermia recorded on arrival in hospital contributed significantly to the diminished responses of the cardiovascular, respiratory and central nervous systems noted on first examination. The problems of safe rewarming whether to attempt it before reaching hospital and what type of supportive therapy to use en route - are matters that concerned Dr. Zingg and myself when we were preparing our review of "Cold injury in civil disaster" (Can Med Assoc J 87: 1196, 1962). We recommended rapid rewarming by immersion in warm water until a body temperature of about 320C was reached for patients so hypothermic that physiologic rewarming mechanisms are abolished and there is a serious risk of cardiac arrest. Continued vigorous external rewarming beyond that temperature was considered to carry a risk of "overshoot" or "rewarming shock". Since physicians usually face this problem as an unexpected emergency situation with which they have had no previous experience and since the prognosis from accidental hypothermia in young healthy people by immersion in cold water is better than the first clinical impression, I would like to reinforce the reminder Dr. Hunt has given us. J.A. HLDES, MD Director, Northern medical unit Medical College 753 McDermot Ave. Winnipeg, Man.
The irritable colon To the editor: "The irritable colon" by W. G. Thompson (Can Med Assoc J 111: 1236, 1974) is an extremely well written and worthwhile article. As the author points out in the introductory paragraph, countless names have been coined for this entity. Many of these terms imply that the motility disorder is confined to the colon. Previous studies1. suggest that such may not be the case. Until this issue is resolved, it would seem that the name "irritable bowel syndrome" is perhaps more appropriate. The occasional patient with the diarrheal form of the syndrome is extremely difficult to control. In such a case, particularly when narcotics are being considered, a trial of cholestyramine may be worth while.4 F.G. SAIBIL, MD, FRcPtcJ Division of gastroenterology Sunnybrook Medical Center University of Toronto Toronto, Ont.
References 1. HOLDSTOCK DJ, MssJEwlcz JJ, WALLER SL: Observations on the mechanism of abdominal pain. Gut 10: 19, 1969 2. FRIEDMAN G, SAIBIL FG: Gastric and small bowel motor function in the irritable bowel syndrome. Gastroenterology 62: 749, 1972 3. HARvEY RF, READ AE: Effect of cholecystokinin on colonic motility and symptoms in patients with the irritable-bowel syndrome.
Lancet 1: 1, 1973
420 CMA JOURNAL/FEBRUARY 22, 1975/VOL. 112
4. SCHAPIRO RH, HEIZER DW, GOLDFINGER SE
Ct al: Cholestyramine: responsive idiopathic diarrhea. Gastroenterology 58: 993, 1970
Age of consent To the editor: In 1974 in Ontario a regulation in the Public Hospitals Actt was revised to allow a patient 16 years of age to give consent for a procedure to be carried out on himself within a public hospital. Under section 39, subsection 0(a), the minister of health has been given the power to set the requirements to be satisfied for "obtaining a valid consent for any surgical operation, diagnostic procedure or medical treatment, the method of obtaining such consent, the conditions under which such consent may be dispensed with and specifying the age or ages at which and under what conditions a patient may give a valid consent for surgical operation, diagnostic procedure or medical treatment to be performed on himself". In recent months much confusion has arisen over the validity of this authority, especially as it relates to the law of torts. It is obvious that the only purpose of the Public Hospitals Act is to protect the "institution" against civil litigation and not to protect the physician. In other words, what constitutes a valid consent for the hospital does not necessarily hold true for the physician. He is still liable because three conditions must be present before any consent is legally valid (if this is indeed possible): (1) the patient must be fully informed, (2) the patient must be legally competent and (3) the consent must be freely given. Whereas in the Venereal Diseases Prevention Act,2 section 21, the age of 16 is deemed to be sufficient to give consent for the purpose of treatment by the attending physician, no such release from liability is present in the Public Hospitals Act, nor is there meant to be. The Canadian Medical Protective Association has made it clear to all its members that there is no common-law precedent for a 16-year-old patient giving consent for a surgical procedure to be performed on himself; hence, it has been recommended that a parent or guardian sign for the 16-year-old patient (under nonemergency conditions). Since the new regulation to the Public Hospitals Act has come into effect (and I personally believe that this should have been a decision of Parliament as a whole, reflecting the peoples' wishes, and not just the opinion of the minister and his advisers) abortions are being carried out on 16-year-old patients without the physician knowing exactly what his legal position is with respect to the possibility of civil action being brought against him by the parents or guardians of these children.
