Two queueing theorists of Ghent University investigated why queues at restrooms are invariably longer for ladies than for men. Time and time again. What are the main causes for this disparity? And how can it be overcome? Moving to unisex toilets, it appears from this study, may reduce waiting times for women from over 6 minutes to less than a minute and a half. Already a symbol for transgender equality, unisex toilets can hence boast excellent figures when it comes to reducing waiting times. Or, how transgender-friendliness may help in battling female-unfriendly toilet culture.
In the last couple of years, several new biobanks have been established to enable the study of health developments of people and their families over their entire lifetime. This paper reviews the legal and ethical implications of a loss of decision-making capacity by research subjects in long-term research associated with large biobanks.
Hannah Jones has refused the heart transplant that could save her life. But is a 13-year-old too young to make that decision? Or is she the only person who can?
Typically anorexia nervosa is diagnosed as a condition of teenage girls where the rates of mortality and morbidity are very high and recovery rates very low. This chapter discusses the condition as experienced in Australia by older women who have either lived with anorexia during adolescence and as young women or who have been diagnosed later in life. The discussion traverses issues of consent to treatment or its refusal, capacity to provide consent, and the application of human right protections arising from various human rights instruments.
Advance decisions and proxy decision-making in medical treatment and research 13 November 2007 June 2007 This guidance covers the law and ethical issues involved in competent individuals making advance decisions about their later medical treatment and proxy decisions about medical treatment made by other people on behalf of adults who lack mental capacity. When they are mentally competent, patients decide for themselves whether or not to accept the medical treatments recommended by health professionals. This guidance is about what happens when that mental ability to make a valid decision is lost.
The following guidance is for PCTs, local authorities, hospitals and care homes to support them understand and fulfill their statutory obligations under the Mental Capacity Act Deprivation of Liberty Safeguards legislation.
The aim of this guideline is to inform health and social care professionals on how best to manage advance care planning (ACP) in clinical practice. At the core of current health and social care are efforts to maximise individuals’ autonomy, promote patient-centred care, offer choice and the right to decide one’s own treatment or care. This can be difficult to achieve when an individual has lost capacity – the ability to make their own, informed decision. ACP is one method of enhancing autonomy, not only where an individual has lost capacity, but also by focussing discussion on the individual’s values and preferences throughout the time they are in contact with health or social care professionals. Whilst ACP has been used for some time in North America, there has been relatively little experience in the use of ACP in the UK. This set of concise evidence-based guidelines has therefore been prepared to guide practitioners.
This site explains how the law now allows people to make decisions to refuse treatments including those that sustain life. Many people want to achieve a natural and dignified death, this is one way to help achieve it. This is a free and non-profit NHS website. We suggest people enter the site using the relevent menu section (above). Many people benefit from looking at both sections.
The issue in this case is not uncommon. P is an adult who has an unresolved medical condition, in this case epilepsy. His primary carer, however well motivated, does not accept the diagnosis nor the treatment proposals. P may object to treatment (whether his own view or prompted by his carer). In order to determine what is in P's best interests, since he cannot decide for himself, it is necessary to observe him, and not to rely upon what is relayed about his condition by his carer. To that end, a period in hospital for assessment and treatment is necessary.
A fundamental aspect of the Mental Capacity Act 2005 (MCA) is the statutory endorsement of a functional approach to capacity. In principle, this requires a separate assessment of capacity in respect of each decision to be made. Most capacity assessments take place at a non-judicial level, and, outside of day-to-day decisions, the most common assessors are likely to be healthcare professionals. This paper investigates the practical operation of the capacity assessment process at both judicial and non-judicial levels. It asks whether the process can deliver on the MCA's goal of preserving maximum decision-making freedom, while, at the same time, providing an appropriate degree of protection. It argues that assessors who are not legally trained encounter signific
Doctors were forced to allow a young woman to die as she had made a "living will" requesting no medical help if she attempted suicide. They would have risked breaking the law by treating Kerrie Wooltorton, 26, of Norwich, an inquest heard. Miss Wooltorton wrote her living will in September 2007, asking for no intervention if she tried to take her own life.
More than 700,000 people in the UK currently suffer from dementia, and nearly 500,000 friends and family members act as carers for people with dementia. Our rapidly ageing population means that these numbers are likely to double in the next forty years. While we are getting to understand better the causes of the disease, and diagnostic and treatment options are improving, we are still a long way from prevention or cure. Meanwhile, these people and their families, healthcare staff and care workers face difficult ethical dilemmas on a day-to-day basis. An exploratory workshop was held in March 2007, and the Nuffield Council set up a Working Party in December 2007 to examine the ethical issues raised by dementia. Following a public consultation and meetings with stakeholders including people with dementia, carers, health professionals and other members of the public, a report with recommendations for policy makers was published on 1st October 2009.
Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of "personality disorder" is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, in itself, a therapeutic intervention.
In 2006 the University Hospital of Lausanne (CHUV) introduced an institutional directive specifying the conditions for assisted suicide, in accordance with professional guidelines and the recommendation of the Swiss National Advisory Commission on Biomedical Ethics that every acute care hospital take up a position on this subject. Methods: 18-months follow-up analysis of patient requests and application of the directive by hospital staff. Results: Of the 54000 patients hospitalised between January 1, 2006, and June 30, 2007, six requests were recorded, all within the first 7 months after introduction of the directive and in the context of severe and life-threatening diseases. However, only one of the six patients, living in a nursing home belonging to the hospital, died by assisted suicide. The time distribution of requests seems to be associated with initial media coverage of the assisted-suicide directive’s introduction.
Following advance directives in emergencies throws up some complicated problems, as Stephen Bonner and colleagues found. We asked an emergency doctor, a medical defence adviser, and an ethicist what they would do in the circumstances
Sir Terry Pratchett has said he's ready to be a test case for assisted suicide "tribunals" which could give people legal permission to end their lives. The author, who has Alzheimer's, says he wants a tribunal set up to help those with incurable diseases end their lives with help from doctors. A poll for BBC One's Panorama suggests most people support assisted suicide for someone who is terminally ill.
In this article, I consider whether the advance directive of a person in minimally conscious state ought to be adhered to when its prescriptions conflict with her current wishes. I argue that an advance directive can have moral significance after its issuer has succumbed to minimally conscious state. I also defend the view that the patient can still have a significant degree of autonomy. Consequently, I conclude that her advance directive ought not to be applied. Then I briefly assess whether considerations pertaining to respecting the patient's autonomy could still require obedience to the desire expressed in her advance directive and arrive at a negative answer.
Doctors will be allowed forcibly to sedate the 55-year-old woman in her home and take her to hospital for surgery. She could be forced to remain on a ward afterwards. The case has sparked an intense ethical and legal debate. Experts questioned whether lawyers and doctors should be able to override the wishes of patients and whether force was ever justified in providing medical care.
A cancer patient who has a phobia of hospitals should be forced to undergo a life-saving operation if necessary, a High Court judge has ruled. Sir Nicholas Wall, sitting at the Court of Protection, ruled doctors could forcibly sedate the 55-year-old woman - referred to as PS. PS lacked the capacity to make decisions about her health, he said. Doctors at her NHS Foundation trust had argued PS would die if her ovaries and fallopian tubes were not removed. Evidence presented to Sir Nicholas, head of the High Court Family Division, said PS was diagnosed with uterine cancer last year.
We aim to improve the medical care and understanding of disorders of consciousness following an acute insult such as coma, vegetative state, minimally conscious state or locked-in syndrome. Coma Science Group Cyclotron Research Center & Neurology Dept University of Liège
A majority of surveyed Flemish physicians appear to accept physician-assisted dying in children under certain circumstances and favour an amendment to the euthanasia law to include minors. The approach favoured is one of assessing decision-making capacity rather than setting arbitrary age limits. These stances, and their connection with actual end-of-life practices, may encourage policy-makers to develop guidelines for medical end-of-life practices in minors that address specific challenges arising in this patient group.
Medical end-of-life decisions are frequent in minors in Flanders, Belgium. Whereas parents were involved in most end-of-life decisions, the patients themselves were involved much less frequently, even when the ending of their lives was intended. At the time of decision making, patients were often comatose or the physicians deemed them incompetent or too young to be involved.
The 30-year-old, known only as SB, could die without emergency treatment for aplastic anemia, a condition in which her bone marrow does not reproduce enough new blood cells. The Court of Protection has now ruled that doctors can restrain SB and force her to undergo the arduous but potentially life-saving treatment, which is administered through a vein in the heart and lasts for five days. SB has been detained under the Mental Health Act. Family Division judge Mrs Justice Hogg ruled that the patient did not have the capacity to make up her own mind over whether to undergo the treatment.
A high court judge in England has ordered that doctors can force a woman without the capacity to decide for herself to have lifesaving treatment for aplastic anaemia. Mrs Justice Hogg made the ruling in the Court of Protection after an unnamed NHS trust applied to the court with the backing of the Official Solicitor, who looks after the interests of those lacking capacity. The judge said the 30 year old woman, named only as SB, who is detained under the Mental Health Act, has a serious psychiatric disorder and lacks the capacity to decide for herself whether or not to have the potentially lifesaving treatment.
A controversial court that still holds its hearing in private will decide tomorrow whether a pregnant woman with learning difficulties should be forcibly sterilised once she gives birth. Health workers from a local NHS trust and council, who cannot be named for legal reasons, have asked the secretive Court of Protection to decide whether the woman should be forced to have her fallopian tubes cut to stop her falling pregnant again.
Increasing understanding of the brain and associated advances in technologies to study it will enable improved treatment of neurodegenerative diseases & mental illnesses. But these advances will also increase our insights into normal human behaviour and mental wellbeing, as well as giving the possibility of other enhancement, manipulation, and even degradation of brain function. These developments are likely to provide significant benefits for society, and they will also raise major social and ethical issues due to wide ranging applications. Brain research is likely to have implications for a diverse range of public policy areas such as health, education, law, & security. More broadly progress in neuroscience is going to raise questions about personality, identity, responsibility, & liberty. Brain Waves explores the potential & the limitations of neuroscience insights for policymaking, as well as the benefits and the risks posed by applications of neuroscience and neurotechnologies.
Early in 2011, Illinois joined the ranks of states that recognize civil unions between both same-sex and opposite-sex couples. The law gives partners in these unions “the same legal obligations, responsibilities, protections and benefits as are afforded or recognized by the law of Illinois to spouses.” Despite the fact that Illinois and most other states still reserve marriage for opposite-sex couples, the option of civil unions will make it easier for some couples to make health care decisions for one another should one of them become incapacitated. Surrogate decision-makers for health care are a significant topic for everyone, but the issue has special resonance for same-sex couples because the law in most jurisdictions excludes same-sex couples from the benefits that marriage and some civil unions confer in those health care decisions. Timothy F. Murphy, "Surrogate Health Care Decisions and Same-Sex Relationships," Hastings Center Report 41, no. 3 (2011): 24-27.
A woman with "severe" anorexia who wanted to be allowed to die is to be force fed in her "best interests" by order of a High Court judge. Mr Justice Peter Jackson declared that the 32-year-old from Wales, who cannot be identified, did not have the capacity to make decisions for herself. He made public his judgment on Friday after making the ruling last month.
A lawyer who advised doctors that they must let a 22-year-old Jehovah's Witness die even though he wanted to live has spoken of the agonising scenes before the young man's death.