The book strives for as complete and dispassionate a description of the situation as possible and covers in detail: the substantive law applicable to euthanasia, physician-assisted suicide, withholding and withdrawing treatment, use of pain relief in potentially lethal doses, terminal sedation, and termination of life without a request (in particular in the case of newborn babies); the process of legal development that has led to the current state of the law; the system of legal control and its operation in practice; and, the results of empirical research concerning actual medical practice.
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.
The National Ethics Council has intensively discussed the issues involved in dealing responsibly with dying. It has perused a large volume of material, obtained expert opinions, consulted with doctors and other medical specialists, and held meetings in Augsburg and Münster at which it exposed itself to public debate. The outcome is enshrined in the Opinion now presented. Self-determination and care at the end of life continues the examination of the themes addressed in the Opinion The advance directive published in June 2005. The present analysis, in conjunction with the clarification of terminology here proposed, may facilitate interpretation of the recommendations set out in that Opinion.
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.
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.
Seriously ill children under 16 may be forced to take life-saving medical treatment against their wishes - but only after their maturity and viewpoint have been carefully considered, the Supreme Court of Canada has ruled.
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.
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.
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.
This End of life guidance covers three main issues: contemporaneous and advance refusal of treatment; withholding and withdrawing life-prolonging medical treatment; assisted dying - euthanasia and assisted suicide.
A terminally-ill 13-year-old girl has persuaded a hospital to abandon legal action that could have forced her to have a potentially life-saving heart transplant against her will. Hannah Jones, who suffers from a rare form of leukaemia, told doctors that she believed the treatment was too risky and that she would prefer to enjoy her remaining days in the company of family and friends. But in complex right-to-die case, her local hospital began High Court proceedings to temporarily remove her from her parents' custody to allow the transplant to go ahead.
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.
'Living wills' that stipulate exactly how a person wants to die should be drawn up with absolute clarity, a judge has ruled after concluding a 67-year-old man with motor neurone disease had made a "valid decision" to refuse treatment.
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.
DOCTORS made an urgent plea to the Supreme Court yesterday to help save the life of a Jehovah's Witness girl dying of leukaemia. Justice Richard White ordered the girl, 4, receive treatment, including a blood transfusion to which her parents had objected on religious grounds. Paediatric oncologist Dr Petra Ritchie, right, said without treatment the girl "will die . . . I would say in weeks". Dr Ritchie said that the girl, who was diagnosed with cancer of the blood and bone marrow on Monday, had a 90 per cent chance of survival if she received treatment immediately. Doctors had this week advised she needed a potentially life-saving blood transfusion but her parents objected on religious grounds. The parents' opposition prompted the hospital to petition the court saying that, without treatment, the girl would die in a matter of weeks.
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.
A High Court judge has ruled in favour of an NHS trust that force feeding would not be in the "best interests" of an anorexic woman. Mrs Justice King, at the Court of Protection in London, heard that the 29-year-old woman, who weighs about 3st 2lb (20kg), does not wish to die. She ruled "all reasonable steps" should be taken to gain the woman's co-operation, without "physical force".
When your time comes to die, you probably hope that you will be surrounded by loving family members and friends who will support you and help you leave this earth at peace with one another. Sadly, for 28 year-old SungEun Grace Lee, who is dying in a Long Island hospital, Rather than suffer a slow, miserable death, Grace has requested that doctors take away the life support. After determining that she was mentally competent, doctors at North Shore University Hospital in Manhasset, N.Y., prepared to shut off her life support. But her parents did not agree.
A cancer-stricken woman fighting a right-to-die battle against her parents won the backing of an appellate court Friday, which ruled that the 28-year-old bank manager from New York City who is paralyzed as a result of a brain tumor may decide her own fate. The emotional case has been playing out in Grace SungEun Lee’s room at North Shore University Hospital on Long Island, and on a Facebook page, Save Grace SungEun Lee, created by those who sided with family members desperate to keep Lee on life support. As word of the appellate court’s decision spread Friday, the page was swarmed with comments from people arguing for and against it, underscoring the passionate debate that surrounds the issue of individuals’ rights to choose death over terminal illness.
Doctors have been given permission to perform potentially life-saving cancer surgery on a woman who has a "delusional belief" she does not have the disease. A judge at the Court of Protection in London ruled that the treatment would be lawful and in the best interests of the 61-year-old, who suffers from chronic schizophrenia.
A lady has cancer of the uterus. She could be cured by a potentially life-saving operation. However, because of other co-morbidities and other factors there is a considerable risk that she could die during the operation or in the post-operative recovery period. She herself lacks the capacity to make an informed decision, but she denies that she has cancer at all and opposes and is resistant to the operation. The medical team at the hospital consider that she would benefit from the operation and would like to perform it. The lady's three adult sons all strongly desire that she should have the operation and feel that the potential benefit outweighs the risk. The Official Solicitor, who acts as her litigation friend, considers, in a phrase, that it is too risky. The question for the court is whether, balancing all the relevant factors, it is in her overall best interests to have the operation or not.
Clinical criteria for PVS will clearly need to be revised in the light of this information. However, this research does not answer deep ethical questions about what should be done. These patients have profound brain injuries and their lives are extremely restricted. How will we evaluate their desires? What should we do if they wish to die? We will still need to do the ethical work to evaluate the implications of what they want, particularly whether they wish to live or die. This is one step towards an answer to the question of how we should care for people with severe brain injuries, but it is not the solution. Not only do we need to know what they want, we also need to know how limited medical resources should be fairly distributed and what constitutes a rational desire to die.
Sally Roberts, 37, is opposed to her son Neon receiving radiotherapy treatment for a brain tumour, and disappeared with him on Sunday. Police launched a nationwide hunt for the pair after they disappeared from Tiverton, Devon. They were found by officers in Sussex. Devon and Cornwall police said: "Emergency protection care has been put in place and Neon's welfare will be considered in the High Court." Mrs Roberts was in the middle of a court battle with the child’s father Ben Roberts, an IT consultant, from Knightsbridge, London, who agrees with doctors that Neon’s chances of survival will be greatly increased with treatment. Mr Justice Hogg, at the High Court, took the unusual step to relax reporting restrictions to allow identification of the child as doctors said that without speedy treatment his chances will be "dramatically reduced".
A judge has postponed a decision on whether a mother should be allowed to prevent her son from receiving radiotherapy for brain cancer. Sally Roberts, 37, has been told seven-year-old Neon could die if he did not receive the treatment. She said she feared the treatment could do long-term harm. At the High Court in London, Mr Justice Bodey said he would rule at a hearing beginning on 18 December - unless agreement could be reached beforehand. During the Saturday morning hearing, he said that although he had intended to rule on the matter, developments had "changed the medical landscape".
The Parliamentary Assembly, referring to its Resolution 1859 (2012) on protecting human rights and dignity by taking into account previously expressed wishes of patients, commends the Committee of Ministers for its foresighted and timely adoption of both the Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (Oviedo Convention, ETS No. 164) and Recommendation CM/Rec(2009)11 on principles concerning continuing powers of attorney and advance directives for incapacity.
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 mother of a teenage girl who died from anorexia has called for hospitals to change the way they treat young people as they become adults. Vickie Townsend's daughter, Laura Willmott, died from complications caused by the eating disorder. Townsend told an inquest that as the former public schoolgirl approached her 18th birthday, medical staff stopped informing her of her daughter's progress.
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.
An international leader in bioethics, Peggy [Battin] explored the right to a good and easeful death by their own hand, if need be, for people who were terminally ill, as well as for those whose lives had become intolerable because of chronic illness, serious injury or extreme old age. She didn’t shy away from contentious words like “euthanasia.” In the weeks after the accident, Peggy found herself thinking about the title character in Tolstoy’s “Death of Ivan Ilyich,” who wondered, “What if my whole life has been wrong?” Her whole life had involved writing “wheelbarrows full” of books and articles championing self-determination in dying. And now here was her husband, a plugged-in mannequin in the I.C.U., the very embodiment of a right-to-die case study.
New report finds half of dying Britons are not dying well At a pivotal time for end of life care in Britain the need for advance care planning is reinforced Divided in Dying, a new report from charity Compassion in Dying, finds that almost half of those who have lost someone close to them through a short or long illness, feel their loved one died badly (45%). In cases where the dying person had recorded their end of life wishes, relatives and friends are more likely to report that they had a good death (58%). Alongside recording end of life wishes (19%), better communication between the doctor and their loved one (39%), co-ordination of care (33%) and being able to die in a place of their choice (31%) were also identified as key aspects which could have improved the situation for the person who died in a bad way. Compassion in Dying surveyed over 2400 British adults who were asked to recall the experience of the last relative or close friend who died.
25th July 2013: The Mental Capacity Act (MCA) made Advance Decisions to refuse treatment legally binding in statutory law in 2005, and Compassion in Dying has been providing free information on end of life and Advance Decision forms since 2010. A new study, which looked at in excess of 200 calls to Compassion in Dying, found that a major barrier to patients exercising choice was doctors’ failure to engage with patients about their Advance Decision and the lack of systems in place to record them. Two callers reported considering a ‘DNR tattoo’ as a way of addressing this problem. The study also found women (84% of callers) are more likely than men (16%) to make their wishes known at the end of life. Professor Sue Wilkinson, author of the report and Professor of Feminist and Health Studies in the Department of Social Sciences at Loughborough University said: “This study has led to a number of recommendations for Compassion in Dying, and more broadly for the integration of Adva...
This is an application by a NHS Trust for declaratory relief in respect of a man (whom I shall call "Dr. A") who is on hunger strike in the Trust hospital. The relief sought by the Trust is in short a declaration : (i) that he lacks capacity to litigate and to make decisions in respect of his nutrition and hydration; and (ii) that it is lawful for the Trust to administer artificial nutrition and hydration.
Respect for patient autonomy and the right of individuals to make their own healthcare decisions where possible lies at the core of the recent Mental Capacity Act 2005. The Act gives statutory authority to “Advance Decisions” (ADs) – enabling people to communicate their healthcare decisions in advance of losing the capacity to do so (e.g. due to coma or dementia). This is increasingly important when new medical technologies mean it is now possible keep people alive for years or for decades in permanent vegetative or minimally conscious states (i.e. with no – or virtually no – awareness of themselves or their environment).
A court in Australia has ruled that a 17-year-old Jehovah’s Witness cannot refuse a life-saving blood transfusion despite his claim he would rip the tube out of his arm.
Judge approves forced Caesarean for mentally-ill woman Doctors have been granted permission to perform an urgent Caesarean section on a mentally-ill woman with diabetes. High Court judge Mr Justice Hayden gave specialists at the Royal Free London NHS Trust approval after a five-hour hearing at the Court of Protection. He said the decision was "draconian" but necessary because the mother's life may be in danger. The woman, 32, who is 32 weeks pregnant, was deemed unable to make the decision over how to give birth. The ruling, late on Friday, came after doctors applied for permission to carry out the delivery in order that the patient's "unstable mental state" could be treated. A specialist from the trust told the Court of Protection in London, which specialises in issues relating to the sick and vulnerable, that their priority was "keeping this woman alive".