Public Health The Journal of The Society of Community Medicine (Formerly the Society o f Medical Officers of Health) Volume 93
Ntonber 1
Jamtary 1979
The Right to Take Risks? Society has become obsessed with the quest for safety. Our Legislators, have made it an offence to ride a motor cycle without wearing a crash ihelmet. Through the Tire Precautions Act 1971 and the Health and Safety at Work Act 19"14 they have given considerations of safety a degree of precedence over quality of life, job .satisfaction, and economic viability which is likely to damage the national interest. The press make so much of every incident where people have failed to return from a fell walk, boating trip, or potholing expedition, and so much time and money is spent on rescue searches, that anyone who takes the least risk with his own life is made to feel guilty and is branded as anti-social. Because in the event of fire, lifts may be put out of action by power failure, the handicapped who cannot negotiate stairs are barred from access to many public buildings, and forced to lead more restricted and less satisfying lives that their disability need dictate. In the N.H.S. money required to meet urgent health care needs has to be diverted into vain attempts to achieve complete safety for the patients who would be in the premises if and when there was a serious conflagration. Yet serious hospital fires are relatively rare events, and the amount of suffering which could be relieved if the money currently being siphoned off to pay for fire precautions were diverted to this purpose is considerable. Given the choice between early and effective care combined with a one in 10,000 risk o f death or injury by fire, or a prolonged wait for the same treatment with only a one in 500,000 risk of death or injury by fire, the public would almost certainly opt for the former. Complete safety is not achievable. It is always possible to identify further risks and devise new ways of minimizing them. Every newly appointed fire officer or safety officer feels obliged to prove to his employers that he is keen and capable; that hecan spot dangers which his predecessor had failed to appreciate. Consequently he finds it necessary to make new and often expensive demands. Management seldom has the courage to ignore such demands because although the probability o f fire may be very low, they would undoubtedly be severely criticized and their future career prospects would be permanently blighted by the wit,e'h hunt which would follow a fire which led to loss o f life. Currently proposals by the Howie Committee on the subject of safety in hospital pathology laboratories, and by the Health and Safety Executive on Notification of Occupational Ili Health are out for consultation and discussion. Both of these if implemented would be extremely costly to the N.H.S. Neither would contribute one iota to the quality l
2
Editorial
of patient care. Both would tend 'to impair job satisfaction for N.H.S. staff, Such small gains in safety as would result would be very dearly bought, In cost-effectiveness terms they should be non-starters. They exist because bodies were established for the purpose o f producing them. Ultimately, though possibly in attenuated form, we will be obliged to adopt many of their recommendations. All material o f h~man or animal origin is potentially dangerous. It may contain unsuspected pathogenic micro-organisms, There is evidence o f the existence of various "stow viruses" Which d o not show their presence for m a n y years. There are strong grounds for suspecting that some of the Leukaemias, and some cancers including Hodgkin's disease and Burkitt's lymphoma may all be of infective origin. There is strong evidence to suggest that Multiple :Sclerosis ma.y be o f viral origin. The transfer to a special laboratory o f material from patients suspected or known to be .infected with some pathogen such as Hepatitis B antigen as advocated by the Howie Committee will result in greater care being exercised in fhe handling o f those particular specimens, It is likely, however, also to result in a tendency by staffto relax precautions in the rest o f the laboratory. It may be, therefore, that the Howie .recommendations could even do more harm t h a n good. All biological materials should be handled with care. Technicians handling them should be well instructed as to the known and suspected hazards and how to protect 'themselves. They should be allowed to take some responsibility for their own .safety, and permitted to decide for themselves the extent of risk they are prepared to take. We all resent it when other people force us to do things which we might willingly undertake if we understood the reasons for doing them and were free to decide for ourselves. Sir Thomas Legge was dealing with very different circumstances when he devised his famous axiom! i n those days industrial employers could sack at an hours notice without giving reasons. There was no social security, and labour felt insecure. To achieve high productivity and so retain their jobs men ignored risks. As Legge pointed out, unless management .enforced atl safety precautions, the men -sere powerless to protect themselves. Today the pendulum has swung to the other extremity of its arc. "'Unless labour agrees, management is powerless" might be today's axiom ! Even in the social and recreational fields society's unhealthy preoccupation with safety is damaging. The need to take risks and so prove their manhood seems to be inherent in the normal adolescent male. Primitive societies devised formal ordeals or tasks for this purpose. In our own culture there used to be traditions o f adolescent risk taking which varied according t.o social class from climbing up walls o f University College buildings to ritual ordeals o n the factory floor at the end of an apprenticeship, and including duelling, climbing and a host o f other more or less hazardous and adventurous activities. Society, however, nolonger tolerates the taking offisks by young men. It seems likely that, deprived ofsocialIy acceptable ways of meeting their basic need for risk, ~hey turn to less desirable alternatives. Much of the current increase in crime may be the result. Acts o f vandalism, the "'gang war" between "'Mods and Rockers" o f a few years ago, the activities o f "Hells Angels", and even some thefts o f motor vehicles, burglaries and other kinds o f offence may all be expressions of the basic desire for risk and adventure or excitement, and the need to prove their manhood. Society should review its priorities. Weneed, perhaps, to decide whether to allow, and even help, young people to take certain kinds of risk unless we really prefer the risk o f muggings and street violence to those o f boating, caving o r hang-gliding. A rule that the individual had a right to risk his own life provided h e did not inconvenience others, might well enhance the quality o f life for all o f us, provided the rules for calling out search and rescue teams were modified. Many people led happier and more fulfilling lives during the war when danger abounded, despite the hardships and uncertainties o f those days, than
The right to take risks ?
3
they ,do in our more affluent peace-time society. Perhaps it is not only for the adolescent that a touch o f danger lends spice to life? The farmers solution to the problems o f aggression from young male animals is castration. It is cheap and effective, but inappropriate to the human situation. Since we cannot change the biological needs of the i.ndi,~,idual, ought we not .to ensure that society facilitales their fulfilment?
International Congress of Neurotoxicology Will be held in Varese (l~aly) on 27-3~) September 1979 and will include "sessions on the ,following: (1) Toxic ~eactions of the nervous system to environmental and industrial chemica'Is (2) Advances in the biology of Alcohol (3) Therapeutic agents as C.N.S. Toxicants (4) Selected aspects of clinical and experimental Neurotoxicology A limited number of communications will be considered by the Scientific Committee provided abstracts are received before 30 April. Further details are available from: Professor L. Manzo, Department o f Pharmacology, P.zza Botta 10, University of Pavia, 27100---PAVIA, Italy.
Ntonber 1
Jamtary 1979
The Right to Take Risks? Society has become obsessed with the quest for safety. Our Legislators, have made it an offence to ride a motor cycle without wearing a crash ihelmet. Through the Tire Precautions Act 1971 and the Health and Safety at Work Act 19"14 they have given considerations of safety a degree of precedence over quality of life, job .satisfaction, and economic viability which is likely to damage the national interest. The press make so much of every incident where people have failed to return from a fell walk, boating trip, or potholing expedition, and so much time and money is spent on rescue searches, that anyone who takes the least risk with his own life is made to feel guilty and is branded as anti-social. Because in the event of fire, lifts may be put out of action by power failure, the handicapped who cannot negotiate stairs are barred from access to many public buildings, and forced to lead more restricted and less satisfying lives that their disability need dictate. In the N.H.S. money required to meet urgent health care needs has to be diverted into vain attempts to achieve complete safety for the patients who would be in the premises if and when there was a serious conflagration. Yet serious hospital fires are relatively rare events, and the amount of suffering which could be relieved if the money currently being siphoned off to pay for fire precautions were diverted to this purpose is considerable. Given the choice between early and effective care combined with a one in 10,000 risk o f death or injury by fire, or a prolonged wait for the same treatment with only a one in 500,000 risk of death or injury by fire, the public would almost certainly opt for the former. Complete safety is not achievable. It is always possible to identify further risks and devise new ways of minimizing them. Every newly appointed fire officer or safety officer feels obliged to prove to his employers that he is keen and capable; that hecan spot dangers which his predecessor had failed to appreciate. Consequently he finds it necessary to make new and often expensive demands. Management seldom has the courage to ignore such demands because although the probability o f fire may be very low, they would undoubtedly be severely criticized and their future career prospects would be permanently blighted by the wit,e'h hunt which would follow a fire which led to loss o f life. Currently proposals by the Howie Committee on the subject of safety in hospital pathology laboratories, and by the Health and Safety Executive on Notification of Occupational Ili Health are out for consultation and discussion. Both of these if implemented would be extremely costly to the N.H.S. Neither would contribute one iota to the quality l
2
Editorial
of patient care. Both would tend 'to impair job satisfaction for N.H.S. staff, Such small gains in safety as would result would be very dearly bought, In cost-effectiveness terms they should be non-starters. They exist because bodies were established for the purpose o f producing them. Ultimately, though possibly in attenuated form, we will be obliged to adopt many of their recommendations. All material o f h~man or animal origin is potentially dangerous. It may contain unsuspected pathogenic micro-organisms, There is evidence o f the existence of various "stow viruses" Which d o not show their presence for m a n y years. There are strong grounds for suspecting that some of the Leukaemias, and some cancers including Hodgkin's disease and Burkitt's lymphoma may all be of infective origin. There is strong evidence to suggest that Multiple :Sclerosis ma.y be o f viral origin. The transfer to a special laboratory o f material from patients suspected or known to be .infected with some pathogen such as Hepatitis B antigen as advocated by the Howie Committee will result in greater care being exercised in fhe handling o f those particular specimens, It is likely, however, also to result in a tendency by staffto relax precautions in the rest o f the laboratory. It may be, therefore, that the Howie .recommendations could even do more harm t h a n good. All biological materials should be handled with care. Technicians handling them should be well instructed as to the known and suspected hazards and how to protect 'themselves. They should be allowed to take some responsibility for their own .safety, and permitted to decide for themselves the extent of risk they are prepared to take. We all resent it when other people force us to do things which we might willingly undertake if we understood the reasons for doing them and were free to decide for ourselves. Sir Thomas Legge was dealing with very different circumstances when he devised his famous axiom! i n those days industrial employers could sack at an hours notice without giving reasons. There was no social security, and labour felt insecure. To achieve high productivity and so retain their jobs men ignored risks. As Legge pointed out, unless management .enforced atl safety precautions, the men -sere powerless to protect themselves. Today the pendulum has swung to the other extremity of its arc. "'Unless labour agrees, management is powerless" might be today's axiom ! Even in the social and recreational fields society's unhealthy preoccupation with safety is damaging. The need to take risks and so prove their manhood seems to be inherent in the normal adolescent male. Primitive societies devised formal ordeals or tasks for this purpose. In our own culture there used to be traditions o f adolescent risk taking which varied according t.o social class from climbing up walls o f University College buildings to ritual ordeals o n the factory floor at the end of an apprenticeship, and including duelling, climbing and a host o f other more or less hazardous and adventurous activities. Society, however, nolonger tolerates the taking offisks by young men. It seems likely that, deprived ofsocialIy acceptable ways of meeting their basic need for risk, ~hey turn to less desirable alternatives. Much of the current increase in crime may be the result. Acts o f vandalism, the "'gang war" between "'Mods and Rockers" o f a few years ago, the activities o f "Hells Angels", and even some thefts o f motor vehicles, burglaries and other kinds o f offence may all be expressions of the basic desire for risk and adventure or excitement, and the need to prove their manhood. Society should review its priorities. Weneed, perhaps, to decide whether to allow, and even help, young people to take certain kinds of risk unless we really prefer the risk o f muggings and street violence to those o f boating, caving o r hang-gliding. A rule that the individual had a right to risk his own life provided h e did not inconvenience others, might well enhance the quality o f life for all o f us, provided the rules for calling out search and rescue teams were modified. Many people led happier and more fulfilling lives during the war when danger abounded, despite the hardships and uncertainties o f those days, than
The right to take risks ?
3
they ,do in our more affluent peace-time society. Perhaps it is not only for the adolescent that a touch o f danger lends spice to life? The farmers solution to the problems o f aggression from young male animals is castration. It is cheap and effective, but inappropriate to the human situation. Since we cannot change the biological needs of the i.ndi,~,idual, ought we not .to ensure that society facilitales their fulfilment?
International Congress of Neurotoxicology Will be held in Varese (l~aly) on 27-3~) September 1979 and will include "sessions on the ,following: (1) Toxic ~eactions of the nervous system to environmental and industrial chemica'Is (2) Advances in the biology of Alcohol (3) Therapeutic agents as C.N.S. Toxicants (4) Selected aspects of clinical and experimental Neurotoxicology A limited number of communications will be considered by the Scientific Committee provided abstracts are received before 30 April. Further details are available from: Professor L. Manzo, Department o f Pharmacology, P.zza Botta 10, University of Pavia, 27100---PAVIA, Italy.
