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.
Recent research has shown the advantages for children’s welfare of open fetal surgery over postnatal treatment for myelomeningocele. However, a balance must be struck between complications of premature birth risked by prenatal surgery & the long-term advantages for affected children’s health, including mobility & neurological capacity. Risks for women are repeated surgery for intervention & delivery. The research raises legal & ethical questions about how fetal interests should influence women’s choices, & whether women may decline interventions in their pregnancies that offer their children lifelong advantages. Beyond fetal interests & women’s preferences are state interests in fetal life, which have been expressed in judicially authorized cesareans. Underlying issues are the nature of fetal interests, contrasting entitlements to care from their mothers of fetuses & born children, healthcare providers’ responsibilities toward fetuses, & duties to pregnant women.
With the capacity of doctors to intervene in pregnancy increasing, the likelihood for conflicts between doctors and hospitals and pregnant women is also increasing. Yet our jurisprudence has failed to clarify the bounds of pregnant women’s autonomy. Indeed, this jurisprudence is marked by confusion, leaving courts in the dark as to how to resolve these conflicts. Therefore, it is useful to carefully enunciate the rights and interests at issue in forced medical care of pregnant women. This includes 1) the distinction between the right to refuse medical care of oneself and the lack of a right to refuse consent to necessary medical care of others, 2) the right not to be forced to rescue others, and 3) the nature of the exceptions to these rights. Careful delineation of these concepts reveals that forced medical care of pregnant women lacks justification when these principles are consistently applied.
A central tenet to much ethical argument within medical law is patient autonomy. Although we have seen a welcome move away from a system governed by largely unchecked paternalism, there is not universal agreement on the direction in which medical law should advance. Competing concerns for greater welfare and individual freedom, complicated by an overarching commitment to value-pluralism, make this a tricky area of policy-development. Furthermore, there are distinct understandings of, and justifications for, different conceptions of autonomy. In this paper, we argue that in response to these issues, there has been a failure by the courts properly to distinguish political concepts of liberty and moral concepts of autonomy.
Both medical and legal commentators contend that there is little legal risk for administering life-sustaining treatment without consent. In this Article, I argue that this perception is inaccurate. First, it is based on an outdated data set, primarily damages cases from the 1990s. More recent plaintiffs have been comparatively more successful in establishing civil liability. Second, the published assessments focus on too-limited data set. Even if the reviewed cases were not outdated, a focus limited to civil liability would still be too narrow. Legal sanctions have also included licensure discipline and other administrative sanctions. In short, the legal risks of providing unwanted life-sustaining treatment are not as rare, meager, and inconsequential as often depicted. In fact, sanctions for administering unwanted treatment are significant and growing.
The landmark decision of Gillick v West Norfolk Area Health Authority was a victory for advocates of adolescent autonomy. It established a test by which the court could measure children's competence with a view to them authorising medical treatment. However, application of the test by clinicians reveals a number of ambiguities which are compounded by subsequent interpretation of Gillick in the law courts. What must be understood by minors in order for them to be deemed competent? At what point in the consent process should competence be assessed? Does competence confer on minors the authority to refuse as well as to accept medical treatment? These are questions which vex clinicians, minors and their families. A growing number of commentators favour application of parts of the Mental Capacity Act 2005 to minors. In this paper, the limitations of this approach are exposed and more radical reform is proposed.