Robert Wheeler

When describing the risks of surgery to a patient, there is a common and mistaken supposition by surgeons that there exists a numeric threshold of improbability beyond which there is no need to disclose. Where should the line be drawn?

The incidence of appendicitis has its peak between 12 and 18 years of age. It is one of the commonest, and familiar, emergency surgical conditions in this age group, but it appears to be difficult to diagnose, since it is one of the most frequent causes of litigation on the basis of ‘missed diagnosis’. This paper explores why appendicitis should pose such difficulties to clinicians.

People under the age of 18 with cancer sometimes require treatments that render them infertile. It may therefore be necessary, during the brief interval between diagnosis and the commencement of cancer treatment, to offer them the opportunity to produce sperm, through masturbation, for cryopreservation. The article provides a framework for justifying this as a clinical activity, and avoiding it being construed as a sexual activity under the terms of the criminal law. Of equal importance, the article puts into place measures to ensure that this clinical activity is entirely consistent with the safeguarding principles of child protection.

Paediatric and neonatal surgery is the smallest of the nine surgical specialties, with fewer than 120 consultants in the United Kingdom. The national arrangements for children's surgery, and some of the difficulties these create, are described. Illustrations of some frequent and recurring areas of paediatric surgical practice that frequently lead to claims are provided.

This article in the series describes how UK law and medical ethics have evolved to accommodate developments in organ transplantation surgery. August committees have formulated definitions of the point of death of the person which are compatible with the lawful procurement of functioning vital organs from cadavers. Some of the complexities of dead donor rules are examined. Live donors are a major source of kidneys and the laws that protect them are considered. Financial inducements and other incentives to donate erode the noble concept of altruism, but should they be unlawful?

This paper reviews the legal rules that govern the way surgeons deal with human tissues during the course of diagnosing and treating their patients. The topic is dominated by the Human Tissue Act 2004, which was enacted in September 2006; thus, the article applies specifically only to England, Wales and Northern Ireland, since Scotland has separate legislation (Human Tissue (Scotland) Act 2006). Although the Human Tissue Act 2004 was built largely upon a plethora of legal principles that were developed throughout the Commonwealth and in the US, some of the principles underlying it will be equally familiar and applicable to surgeons across the world. Much everyday clinical activity falls outside the remit of the Act, and depends both upon other statutes, and on common law rules, principally those relating to consent.