Summer in Yale

4 August 2010 '“ Kettles, duvets and a fresh perspective

I'm back. Back at my desk. Back with my beloved kettle and fridge. Back to duvets and cold rain and time recording and Stylist magazine on a Wednesday. And I'm very happy to be so. That said, I completely recommend a sabbatical to anyone who has something to sabbate from. It gives you perspective, confidence and a more circumspect approach to your work and daily life (if you manage to separate the two).

To complete the circle and to go back to the unerring Wikipedia, apparently the Latin, Greek and Hebrew (just to be thorough) derivations of a 'sabbatical' identifies it as a 'ceasing'. The Bible at one point (although it is not known for its consistency) commands you leave the fields on the seventh year. So, technically a year is the proper time frame, but for me two months was perfect. Anymore and I would have had to get a restraint order self-imposed against my favourite calorific donut joint.

At Yale I learnt the theory, the open-ended questions and dreamt up difficult situations. At Hempsons I am back to learning the practical application, closing the open-ended problems and solving ready-made dilemmas. I think the two go hand in hand and neither the academic nor the practitioner should curl a lip to the other. When I started at Yale I felt going to lectures for the sake of learning a wonderfully luxurious experience but towards the end I yearned for reality. However, sabbaticals need not be academic, they can simply be doing your daily grind in a new location, a placement at a client, a potential client, writing a book'¦ stop what you're doing, start doing it somewhere else and, just like that, you have sabbated (Americans love making up words and so do I).

I'm not going to deny that the first day back was a little trying: I slept in, couldn't find my summer work clothes, got off at the wrong floor, forgot how to answer the phone and generally felt that my previously gel-like work swimming pool had turned into a setting consistency in my absence. But, as each day passes the old routine kicks back in and but for '“ here I go, legal expressions are spurting out of me '“ this strange feeling of calm broadness I don't feel like I ever left.

Go on, Google something-ethics or something-courses, go on, find one, write a proposal to your boss, smile sweetly and go.

While I will be blogging along for the rest of my training, from this Yale-focused episode and in my best BBC-English, thank you for listening and until next time.

20 July 2010 '“ Dunkin Donuts and, err, risk assessment

I have been in the US for seven weeks and so with a heavier heart I must start my final blog from this Ivy-clad institution.

First thing's first: while learning huge amounts on bioethics, law and America, there are a few bad habits that need to be addressed before returning home. When in a taxi back to the hellhole graduate dorm I have started barking: 'Four-twenty Temple Street' rather than: 'Please would you take me to four hundred and twenty etc.' My stickler of a father will not be amused. You find yourself battling the language for about two attempts, then relent to stop the terrifying driver, shopkeeper etc. rolling his/her eyes and asking you to move out o' the way.

Then there are Dunkin Donuts' iced coffee and glazed namesakes. It started as a mere social enquiry '“ every morning the lecture room is filled with the aforementioned combo and in every train station a 'Dunkin' queue spills onto the main concourse regardless of the hour. I once prided myself on a healthy disregard for fast food, but the combination of a non-existent kitchen and a pledge to submerge myself in the American way led me shiftily into one of the 20 outlets in New Haven. The coffee is drinkable but it's the donuts that are best: soft, doughy circles of comforting joy. Never ever try one. Certain things in life should never be tried for fear of addiction (if nothing else). My list has recently been updated: drugs, smoking, marathon running, and now Dunkin Donuts. I have kept well clear of the first three throughout my 26 years but the new DD addiction just snuck up on me. But apart from a few Americanisms and guilty pleasures (s'mores is another one '“ think biscuit, melted marshmallow and chocolate) I will return to work relatively unscathed in August.

The continuing theme of many lectures is to question everything and to realise how every human endeavour is connected, dependent and causal on one and other. As an example, I had a truly eye-opening lecture on risk assessments last week. Don't yawn, it's true. A risk assessment is an organised process used to describe and estimate the likelihood that a population will be harmed on exposure to a specific substance. Still awake? Keep with me. The lecturer explained that the process is 'hypothetical, conditional, subjective and uncertain' and as such open to manipulation.

When carrying out a dose-response experiment, data is not collected ad infinitum, so extrapolation of the experimental data is often required. Once a line is established, the levels of acceptable and significant risk to a population can be inferred '“ terrifyingly a highly subjective practice. There is an innumerable number of curves that could fill the gaps at the ends of a graph and as such a policy is required to guide the extrapolation decision. It is that policy which is highly politicised by drug companies or industries; where the curve lies may result in billions of dollars changing hands in government, industry and lawsuits.

The lecture last week covered the process to determine the permissible exposure limit (PEL) to benzene, the prototypic human carcinogen. Before the development of synthetic rubber during WWII the US imported natural rubber from trees. Pliofilm (a type of food wrapper) was made from natural rubber imports. The natural rubber was turned into a powder and dissolved in a mixture of benzene and hydrochloric acid. It was then poured on a bed of water where the benzene evaporated leaving a thin film of rubber used to wrap food and, later, munitions. Eventually, following the synthetic rubber discovery, the Plioform factories were shut down in the 1970s. However, because of the almost sole use of benzene in the factories, they provided a useful basis on which to study benzene's carcinogenic properties. As a result, 748 benzene-exposed workers were studied. And here comes the crux '“ the results from this small, uncontrolled cohort now provide the basis of the US and many international benzene regulations.

Seven of the workers suffered from rare myeloid leukaemia. This represented a ten-fold increase from that expected from US epidemiological data. As a result the US National Institute for Occupational Safety and Health (NIOSH), an agency to ensure safe working conditions thorough research, information, education and training, recommended that the permissible exposure limit of benzene be decreased to 1ppm from 10ppm. A year later in 1977, the Occupational Safety and Health Administration (OSHA), responsible for developing and enforcing workplace health and safety regulations, issued its first emergency standard requiring the same. Petroleum companies sued OSHA and the court agreed with them, overturning the emergency standard for a lack of evidence.

In 1978, OSHA then proposed a permanent standard but again the 5th Circuit '“ the Court of Appeal in the US federal system is divided geographically into 11 'Circuits' '“ overturned the proposition for a lack of evidence. The OSHA had failed to document 'substantial evidence of discernable benefits' in reducing the exposure limit to 1ppm. Instead there was a simple faith that less was better. In 1980, the Supreme Court upheld the 5th Circuit's decision and stated that 'safe is not equivalent to risk-free', both being highly subjective constructs and not enough to ground regulations.

In 1985, OSHA again proposed the permanent benzene 1ppm standard. Little essential content was changed in the proposed standard bar a risk assessment chapter based on the figures from the Plioform study. The standard was accepted without controversy and is now the source of benzene PEL regulation. Interestingly, our lecturer explained that the figures do not make much sense. Acute myeloid leukaemia is a very rare condition, but the extrapolations made by the study would mean that up to 15 per cent of a workforce would die from the condition at 10ppm, an arguably unrealistic extrapolation. The effect of a small and uncontrolled study and seemingly inaccurate extrapolation now dictates industry regulations and subsequent exposure lawsuits.

The moral of the story is: if there is a logical basis to a risk assessment more often than not no one will challenge it. Risk assessment is a hypothetical subject based upon assumptions and no more. Indeed it is now impossible to carry out a follow up US study on the effects of benzene as a result of the standard. Any studies are now focused in China and India where the arbitrary 1ppm cut off has not been 'discovered'.

While perhaps a longwinded story, it has a relevance to law '“ risk assessments are a tool for organising an argument where the decisional aspects are unknown. A risk assessment requires the writer to be knowledgeable about the underlying assumptions, which will always be present if the data is not directly observable. Indeed it is vital to examine both sides' assumptions before embarking on an argument as to the merits of your case. The requisite skills are clearly also required in legal wranglings. And there is one final interesting paradox: the law requires a certainty that science can often not provide and so the uncertainty is glossed over for the sake of a concrete answer, just look at how the DSM-IV-TR for psychiatric diseases is used in litigation.

Over the past seven weeks my assumptions have been challenged and I have refreshed my ability to think laterally. As a trainee lawyer it is often a challenge to keep on top of the fast-flowing legal concepts and practical considerations only mentioned in passing at law school. But by having the opportunity to take a step back and look at the bigger picture halfway through my training contract I will return with a much wider and more critical approach to my daily work. Indeed, the examples in the risk assessment lecture made me reflect deeply on my perhaps childlike deference to accepted standards and may even make a gentle sceptic of me. A quality which, I think, may be needed in the legal world.

Hmm, it is mid-afternoon, I have an essay to write and am in want of a cream tea '“ maybe I will succumb 'one last time' to the donut call. Anyway, I am still here and as the slogan goes: 'America runs on Dunkin'''¦

PS '“ my ever expanding list of English joys: not having to shower in flip flops, using a kettle, buying refrigerated food, family, a temperature below 95ºF, English supermarkets, English accents, understanding how much things cost, friendly taxi drivers, pubs, not locking myself out of my bedroom, friends, my job, authentically old buildings, duvets, proper chocolate'¦

PPS '“ did you know that Yale has the largest collection of British art outside the UK thanks to wealthy ex-alumnus Paul Mellon? It has been a real haven in this not so new town and I thoroughly recommend it if you ever make the journey.

5 July 2010 '“ Not the Club Med

I arrived in America on Memorial Day and have just celebrated Independence Day. The former is to commemorate fallen American soldiers and the latter is to celebrate America's freedom from us. So, in memory of these two days plus some fascinating lectures over the last two weeks I think we should discuss soldiers and prisoners.

Post-traumatic stress disorder (PTSD) first entered the medical language in 1980. Twenty per cent of individuals exposed to combat will suffer from PTSD so it is not surprising that medical research is focused in the military. This week a psychologist spoke about his research at the SERE (Survival, Evade, Resist and Escape) School. Army recruits at risk of kidnap and interrogation are sent on this two-week 'camp' (Club Med it is not) to be exposed to food deprivation, torture, interrogation and combat (actually, perhaps there are similarities). Given the controlled environment, SERE is an excellent and fairly unique means of studying stress reactions. One study demonstrated that Special Forces Operatives have higher level of a substance called Neuropeptide-Y (NPY) in their bloodstreams during interrogation in comparison to 'non-special' colleagues. NPY decreases the amount of stress hormone cortisol and enables both a faster recovery from stress and a better coping mechanism. As a result, research is now focused on whether there is a possible link between NPY and PTSD, whether stress resilience can be predicted, bolstered up, and whether PTSD can be better predicted and measured.

Interestingly, because of the lack of confidentiality of military medical records, many recruits are unwilling to take part in the research in case the results affect their future career, healthcare or benefits (see below). Nonetheless, a better understanding of PTSD will be helpful not only in the military but also in the general medical and litigation worlds.

Whether you have PTSD or not the US Veterans Association will provide soldiers with healthcare and benefits. Honestly, why there was '“ and still is '“ such a fuss about Obama's 'socialist healthcare' is an enigma. Through the combination of Medicare (the 65 plus), Medicaid (the poor), the VA (the soldier/ex-soldier) and prisoners, a very significant chunk of the US already use public healthcare quite happily. However, as a result of the VA's dual healthcare-benefit role there is a negative reinforcement where more illness equals more money and as such there are ongoing arguments about whether a condition was pre-existing. Sound familiar? Therefore, there are wide-ranging potential benefits of research into a more objective method of diagnosing psychiatric status than is currently available.

On a separate army point, back home the Supreme Court has held that the Human Rights Act 1998 does not apply to British soldiers fighting abroad (unless on a British army base or hospital). In order for the Act to apply to British citizens, the UK must have legal and physical control over the persons and area. While there are recognised exceptions and the ability to make extensions of this understanding of 'jurisdiction', deployed troops has now been held as not one of them. It was judged unlikely that the post-WWII 1951 contracting parties intended for such an impractical extension. As a result, UK soldiers will only have recourse against the state for, for example, the article 2 right to life, when at home or within a foreign camp or hospital gates. This talk of physically restricting rights leads us nicely onto the discussion of prisoners.

In the US there are state prisons and federal prisons (depending on who made up the crime). So, following a terrifying lecture by a prison doctor, here are my top tips should you end up in the US criminal justice system:

1. If you have the choice, opt for a federal prison every time, they are much nicer apparently.

2. Definitely, definitely do not do anything remotely offensive in Texas '“ chain gangs are still very much in vogue.

Like veterans, prisoners in the US get free 'healthcare' (one imagines due to the lack of any other viable option). However, in the largest group-action prison lawsuit, it was alleged that Californian prison officials inflicted cruel and unusual punishment by being deliberately indifferent to the prisoners' healthcare needs. In 2002 the case was settled on the condition that the California Department of Corrections overhauled its policies, procedures and healthcare funding arrangements. As such, an 'order to show cause' was issued in May 2005 requiring proof of progress. Unfortunately, the overseeing federal judge described the medical treatment as 'horrifying' and 'shocking' with widespread medical malpractice and neglect. In October 2005 a court-appointed receiver declared the state prison system 'broken beyond repair' '“ not surprising given a 2005 report that one inmate died every six to seven days in a California prison due to grossly deficient medical care.

Sadly, California is not alone. A Connecticut-based prison doctor described the practice of wardens denying medical care as a form of extra-judicial punishment. Diabetic and missed your shift in the laundry? No insulin for you. This is said in the context of the Eighth Amendment that allegedly protects all persons from cruel and unusual punishment. Indeed, in 1974, the Supreme Court concluded that a "deliberate indifference to the serious medical needs of prisoners is an unnecessary and wanton infliction of pain".

Back home, a 2004 report commissioned by the British Medical Association found that on occasion prison governors could also interfere with care. However, this conflict was addressed by the transfer of healthcare control from the Prison Service and into the hands of the Department of Health (see below). Back in the US, prison law is a combination of both state and federal law (Federal Quirk Alert) but neither seems to work or interact very well. Indeed, a case currently in the US Supreme Court is focused on the hierarchy of federal and state powers with respect to reducing overcrowding in Californian prisons.

Prison health policy was transferred from the Prison Service to the Department of Health in England and Wales in 2000, while full healthcare budgetary and administrative control was transferred by April 2006. This means that for all publicly funded prisons the NHS commissions the healthcare. Earlier this year a joint Care Quality Commission and Inspectorate of Prisons report held that while improvements have been made in the adult system, more are needed. Indeed, 2010 has seen prison healthcare providers having to adhere to a tougher system of statutory registration and must apply to the CQC for a licence.

Right, on that cheery note my canker sore needs some attention. Canker sore in Independent-American apparently means a mouth ulcer, although I just checked with NHS Direct (doctor boyfriend) that canker sore also means mouth ulcer in very-happy-not-to-be-responsible-for-G-W-Bush-English. So when next in need of some Bonjela why don't you go into Boots and ask in a loud voice for some canker cream... Doesn't it just roll off the tongue?

(This blog entry is for my major brother-in-law, minor sister (size only) and very mini niece.)

24 June 2010 - The 'hands off' approach to assisted reproduction laws... and hunting for the elusive kettle

Week three in the house. For an unashamedly wealthy institute, Yale definitely has something to learn about living standards. The poor intellectual stereotype just doesn't wash when surrounded by shiny 'Yale' emblazoned 'dust carts'.

I was laughed at when enquiring pre-trip if duvets are supplied. It turns out I should have carried on questioning. In the windowless bathroom mould creeps over the communal showers and the ceiling is covered in sagging damp. The latter is apparently from the effects of a poor Korean girl setting off the upstairs sprinkler system '“ imagine 1940s black stagnant water waking you up one morning'¦ The bedroom is similar on the damp front and the 'curtains' leave something to be desired. Imagine office blinds, the ones where you pull a cord so that they rotate to 'shut out the light'. Fat chance. I only have about half the slats and only a quarter of those respond to the cord.

But for me lack of sleep is fine if managed by tea. However, the sum total of the kitchen is an oven and a filthy microwave. That's it. No fridge or kettle. As a result I have walked to every potential shop in central New Haven asking for a kettle leaving mild confusion in my wake. Doughnut makers? Oh yes. Chip pans? Oh yes. Saucepan? Oh yes (if you buy the 13-piece set). Kettle? A what? Er, no. If only I had heeded to my mother's attempts to inspire musical greatness and I could have taken out my frustration on the beautiful baby grand. Allegedly a common common room feature. The priorities of a piano over curtains, kettles and fridges could be seen as artistic bohemia, but to be honest I bet if he were around today Chopin would also have issues putting finger to keyboard without a morning cup of something hot or cold.

Despite the materialistic hardships, I still love the course. It has been a very interesting two weeks and I am torn between the charming ophthalmologist who has dedicated swathes of his career to returning sight to impoverished lands, versus the oddities of US stem cell research and assisted reproduction laws. For legal relevance, I will back the latter. However, the ophthalmologist was fascinating and do comment if you would like further details about the struggles faced; e.g. lack of medical records, reliable power supplies and communist party censorship.

As is becoming clearer and clearer, the federal system is very 'hands off' in ethically challenging areas. Unlike back home where both stem cell research and assisted reproduction are governed by statute (Human Fertilisation and Embryology Acts 1990 and 2008), out here the federal government (like a parent) merely controls by funding. Sure you can mix human and animal gametes, carry out human cloning and create embryos in a dish, but who pays for it is another matter. Since Obama took office, federal funding is now provided on all stem cell lines created from IVF 'spare embryos' (but not for the actual destruction of the embryos). However, should you wish to research stem cell lines derived from cloning or human admixed embryos with private funding (Harvard has roughly $900m) the only restriction is your imagination. This does, however, have a slight location disclaimer '“ should you live in Louisiana a fertilised egg has legal 'personhood' and any destruction is murder (bar a carve out for the constitutional abortion right). In contrast, go left by four states to California and you will find $300m in state funding for the stem cell research excluded from federal funding. The aim is to increase California's competitiveness in the global research market. In contrast to the free-for-all out here, back home the HFEA 1990 and 2008 provide for clear top-down regulation of the creation and use of human embryos in vitro, which after much debate does include the possibility of mixing human and animal gametes.

Assisted reproduction is an area of science that is also practised in a legal vacuum in the US. Fifteen states have passed laws that require health insurance to cover infertility treatment (most include IVF), while the remainder 35 are silent on the matter. As a result, in those 35 states there is the increased incentive to have a multiple birth '“ two, or even six, for the price of one (remember the octuplet mum Nadya Sulman in 2009)? Indeed, the lack of regulation assists such couples. In contrast, in England and Wales NICE has set out the guidelines for NHS funded IVF. How the recommendations are applied does vary from PCT to PCT although there is a drive from the Department of Health for the NICE three cycles to be offered to all qualifying women in the future. While there is much grumbling back home about postcode cycle number lottery, at least there is a lottery.

Unlike the HFEA's 1990 (as amended) prohibition on the use of pre-implantation sex selection for social reasons, there is no such limit in the US. As with all assisted reproduction, the only regulation is voluntary and clinic-based with most practitioners agreeing that sex selection for 'family balancing' is valid. If you have a girl apparently it is right that you should be able to test the sex of your embryo and only implant boy embryos. As a result of such possibilities, some commentators have suggested that America has a 'liberal eugenics policy'.

Finally, creation of a human embryo for implantation still requires a human egg. Back home, egg donors may only be paid expenses and a limited amount of lost earnings (£250). In contrast, in America there is an open market with adverts appearing in the local papers that specify, for example, an egg donor with an athletic build, high SAT scores, Jewish descent, blond and 5'5'' plus. The price paid is not regulated with figures often seen around the $35,000 mark.

It is late and time to shut my 'curtains' and microwave a final cup of Coffee-Mate tea'¦

10 June 2010 - A Welshman and colonial clergymen

It has been quite a week. After a car, plane, taxi, train, and another taxi ride I arrived in a beautiful university town on the New England coast.

'Colonial clergymen' established Yale in the 1640s. Not only does the university resemble our Oxbridge, but it was inspired by the collegiate system and the European belief of a liberal education. Furthermore, the name 'Yale' originates from a Welshman, Elihu Yale, who made a donation to the college that included a portrait of King George I and 'nine bales of goods'. I feel quite at home.

A week of bioethics has left me in a state of academic fervour. The five lectures and four seminars last week were incredibly fascinating and not only for the content. The American way is notably different from ours. The students are far more confident and happy to question the most eminent lecturers, while the lecturers are inspiring but shall we say 'overly superior' in their teaching. My undergraduate degree was at Cambridge, and, while it may have inspired the architecture of Yale, the self-effacing intellect did not make the journey. There seems to be a constant battle between overconfident students and enthusiastic but perhaps on occasion dismissive teachers.

I have learned so much this week that an overview of some points is the only way I can tame my enthusiasm:

1. In a criminal trial in the States the defendant may chose to dismiss the jury and have the judge decide the matter. This ability is most often used in emotive cases where the defendant believes that the jury may not be motivated by reason; for example, in child paedophilia cases. An interesting point which, while going against the entrenched English tradition, made me consider the value in those complex cases where the most attentive jurors could not be blamed for lethargy. For example, the recent Dr Erin case where drugs names were bandied about in a most confusing scenario, yet their interaction was vital to the verdict.

2. Each state has its own regulatory hoops for doctors. Therefore, should you be a 25-year-long experienced gynaecologist in Wyoming and wanting to move to a practice in Texas you would have to sit the Texan state exams regardless of your experience. This made me reflect on the recent well-publicised case of Dr Ubani, a German GP who fatally administered a significant overdose of a painkiller to an out-of-hours patient. In the inquest the coroner called for a review of how EU agreements over the recognition of doctors apply in the UK. Freedom of movement of workers within the EEA is an established right. However, as one means of weeding out cases like Dr Ubani, the GMC is carrying out a consultation on whether there should be a five-year revalidation for all doctors. A clever way of checking incoming doctors, as in the States.

3. A number of points have been raised this week with respect to the healthcare reform. The recently passed Federal Bill will require every citizen to buy health insurance, with federal subsidies for the poor. One lecturer, Jacob Hacker, explained that he lobbied for a 'public option' of insurance. This was aimed at increasing competition and checking the current monopoly of the private insurers. The aim of creating competition harks to the continuing goal to create an internal market within our own NHS. We aim to improve quality and cost effectiveness, while out here the aim is to increase basic cover in a cost-effective way. Most personal bankruptcies result from inadequate health insurance. This is a problem that we thankfully rarely face, especially given the recent relaxation of the laws on topping-up NHS drugs. This will stop cancer patients being kicked out of the system should they choose to buy drugs not supplied by their PCT.

4. There is already a public health insurance option for those Americans over 65: Medicare. As a perverse result, long-term public health is an irrelevance to private insurers. The private firms gamble that they will not be picking up the obesity and cancer bill which ordinarily matures after the public option kicks in. An interesting contrast to the lifelong responsibility of the NHS and the UK government's drive for long-term public health. However, in acknowledgment of the significant fast-food related diagnoses, the healthcare reform requires calorie content to be displayed in a standard way in fast-food chains over a certain size. This federal drive to create a single standard was supported by the suppliers, for if no nationwide standard were set then there would be 50 different standards for nationwide chains to reach. An interesting quirk of the federal system.

I could write much more on this week's findings, but the ethics of research on human subjects is calling; if you do not know about it, Google 'Tuskegee''¦

20 May 2010 - Packing the suitcase

Sorority clubs, frat parties, 80s-bouffant-when-harry-met-sally hair are all awaiting me when I leave the closeted confused state of a trainee to spend two months at Yale this summer. Hmm.

I work at Hempsons, a law firm that advises the healthcare sector. I chose to train in this area after taking a course in medicine, law and ethics while at Cambridge. During that course, I became aware of the can of social and moral worms my previous years as a bioscience undergraduate had been silently throwing up. So began my interest in bioethics. Then five years later as a new trainee solicitor I made a pitch to Hempsons that understanding the ethics surrounding healthcare, its law and policy, could only be a good thing for a wannabe healthcare lawyer. Luckily, I was met with enthusiasm and so I now sit surrounded by my wardrobe preparing to leave for two months of USA-style bioethics.

When explaining my impending trip, Yale and 'close to New York' get most very jealous, but 'bioethics' is greeted by a glazed nodding vacancy. Therefore, a definition by the unerring authority Wikipedia might help: 'Bioethics is the philosophical study of the ethical controversies brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, philosophy, and theology.'

I think 'broad' is an understatement, and two months far too short if we go by that definition. The Yale Interdisciplinary Centre for Bioethics is rather fuzzy, explaining that the centre 'focuses its attention on bios or life, and the way we have helped, broken and abused it'.

Perhaps this will be my first challenge '“ as a science graduate turned trainee lawyer, I find clear statements of fact a lot more appealing than more perhaps 'humanitarian' and ethereal concepts. Nonetheless, I will be writing a bi-monthly blog on this website to give solicitors an account of the benefits of a solicitor-to-be '“ although I hope my findings will stretch to full-blown solicitors '“ attending a course not in law but on the environment in which law is practiced. Having signed up to seminars on law and bioethics, I will aim to give an account of some issues discussed, contrasting our legal and ethical system to that of the States. I also hope to touch on life in Yale and report on any anthropological investigations carried out, first stop to find a jock'¦