The arrangement of medical services in Brazil is more akin to that of the USA than the UK. Private practice predominates but with a safety net of state funded hospitals. The majority of doctors working in state hospitals have contracts for 20 hours per week and are very poorly paid and they often have two or three jobs to compensate. These usually include working in a private clinic for part of the week and perhaps doing a period of on-call at another hospital. Some state hospitals are unable to fill vacant posts and there are frequent television reports of casualty departments having to close due to a lack of medical staff.

Living in London one gets used to seeing teenagers living rough on the streets, sleeping in shop doorways, and begging for money. Similarly in São Paulo and other large cities in Brazil homeless and destitute children are a common sight, but there are several striking differences. First, in Brazil there are many more of them, they are noticeably younger and they are often seen doing some form of job or ‘bicos' to earn money, such as cleaning shoes or car windows, ‘guarding’ cars, and selling small items, e.g. sweets, fruits and flowers. Another important difference is the danger to which these children are exposed. There have been frequent reports, some of which have reached the international media, of street children being massacred by vigilantes (some of whom have links with the police).

On 30 November 1993 a nine year political debate on euthanasia closed; the first chamber of the Dutch parliament ratified the law on undertaking, including euthanasia regulations. This political step concluded, for the time being at least, a legal, public, political and medical debate, which started in 1973, when a medical doctor was convicted for performing euthanasia on her mother. In a first effort in 1983, parliament failed to legalise euthanasia. In 1989 a new government introduced an initiative to improve the existing law in this regard. As a part of the process, empirical data on the extent of euthanasia in The Netherlands were required. Therefore, the Minister of Justice installed a committee. Its findings have been reported nationally and internationally (van der Maas et al, 1991a, 1991b); about 2,300 euthanasia cases in 1990, being 1.8% of all deaths. These empirical findings reduced the uncertainties about the extent of euthanasia, thereby providing a sound basis for the parliamentary decision-making process. Although by the current law euthanasia and assisted suicide still remain illegal, under strict guidelines for behaviour provided by the Ministry of Justice in November 1990 and distributed among physicians in January 1991, euthanasia can be exempted by the public prosecutor from criminal punishment on the basis of the ‘opportunity’ principle, this being the opportunity for the public prosecutor not to bring all reported crimes to court (Letter of the Minister of Justice to Parliament, 1990).

Recent years have seen considerable progress in understanding the genetic basis of many diseases. There has also been a welcome and informed public debate regarding the ethical and social implications of genetic research, including predictive testing of adult onset illnesses. The UK Huntington's Prediction Consortium, a forum open to scientists, clinicians and representives from patient organisations, has established protocols for testing and has facilitated development of clinical genetic services. It has been suggested that the Huntington's disease experience might prove informative for other conditions, and a meeting was held on 5 January 1994 at the Institute of Psychiatry, London, to discuss recent research findings and possible genetic testing in Alzheimer's disease (AD). Professionals from a number of disciplines took part along with representatives of the Alzheimer's Disease Society. It was decided to form a consortium that would meet regularly and produce guidelines for future clinical applications of possible genetic tests.

In 1973 Professor D.L. Rosenhan published his classic paper ‘On Being Sane in Insane Places' (Rosenhan, 1973). In this study eight ‘normal’ researchers presented themselves on 12 separate occasions to a range of psychiatric hospitals in the USA. These ‘pseudopatients' complained of one symptom only, that of hearing a voice saying ‘empty’, ‘hollow’ and ‘thud’. No other psychiatric symptoms were described; the pseudopatients gave their own ‘normal’ personal histories and after admission to hospital the researchers ceased simulating any symptoms and apart from taking notes on their experiences acted normally.