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Law and Ethics in Nursing and

Health Care

Judith Hendrick Senior Lecturer in Law

Oxford Brookes University

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CONTENTS

LIST OF CASES 1X

LIST OF STATUTES XV

PREFACE XVll

1. AN INTRODUCTION TO LAW AND ETHICS 1 What is law? 1 What makes the law valid? - the relationship between law and

morality 3 Classification of law 6 Sources of law 11 What is ethics? 16 Ethical theories 17 Ethical principles and rules 21 ?

Law and ethics - a comparison 23 References 27

2. AUTONOMY AND CONSENT 29 Introduction 29 Case 2.1: Bella's treatment 29 Case 2.2: John's consent 29 Case 2.3: Helen's autonomy 30 Autonomy 30 The law of consent 38 Case Study 2.1: Bella's treatment - a discussion 49 Case Study 2.2: John's consent - a discussion . 50 Case Study 2.2: Helen's autonomy -a discussion 52 Law and ethics - a comparison 53 References 55 Further reading 57

3. RESPONSIBILITY, ACCOUNTABILITY AND NEGLIGENCE 58 d,

Introduction 58

,I Case 3.1: How responsible is Lisa for Paul's accident? 58 t Case 3.2: Should Ayeesha question Pat's decision? 58

Ut Case 3.3: Who is accountable - Anne or Patsy? 59 :r'

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CONTENTS

Beneficence and non-maleficence 59 Responsibility and accountability - moral and professional

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Legal responsibility and accountability 67 'Negligence 67

Dispute settlement outside the courtroom - complaints and disciplinary proceedings 80

Case study 3.1: Lisa's responsibility - a discussion 81 Case study 3.2: Ayeesha's dosage dilemma - a discussion 83 Case study 3.3: Anne's accountability -: a discussion 84 Law and ethics - a comparison 85 References 86 Further reading 88

4. CONFiDENTIALITY AND MEDICAL RECORDS 89 Introduction 89

CaseA.1: How much of Winnie's information should Rebecca treat as confidential? 89

Case 4.2: Can Laura justify her breach of confidentiality? 90 Case 4.3: Should Beryl breach John's confidence? 90 Case 4.4: Should Claire speak out? 91 Case 4.5: Must Len's right to privacy be respected? 91 Confidentiality 91 Justification for confidentiality 93 Exceptions to the duty of confidentiality 96 Remedies for breach of confidentiality 105 Medical records 105 Children and confidentiality 107 Confidentiality and people with mental health and learning disabilities' 107

Case study 4.1: Winnie's information - a discussion 108 Case study 4.2: Laura's breach of confidentiality - a discussion 110 Case study 4.3: Beryl's breach of confidence - a discussion 111 Case study 4.4: Kathy's possible abuse - a discussion 112 Case study 4.5: Len's right to privacy - a discussion 113 Law and ethics - a comparison 114 References 115 Further reading 117

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5. JUSTICE AND ACCESS TO HEALTH RESOURCES

Introduction Case 5.1: Has Carol a legal right to treatment? Case 5.2: How can Arundhati divide her time and care fairly?

Issues of definition Justice - an introduction

Theories of justice Practical approaches Resources and the law Case study 5.1: Carol's legal right to treatment - a discussion Case study 5.2: Arundhati's division of time and care -

a discussion Law and ethics - a comparison

References Further reading

6. BIRTH AND ITS REGULATION

Introduction Case 6.1: Does Katie have the right to reproduce? Case 6.2: Can Luisa be forced to have a caesarean section?

Abortion Surrogacy Pregnancy and childbirth Case study 6.1: Katie and Mary's surrogate relationship-

CONTENTS

118 118 118 118 119 121 124 127 131 137

139 141 142 143

144 144

144 145 145 154 158

a discussion 164 Case study 6.2: Luisa's caesarean section - a discussion 166 Law and ethics - a comparison 167 References 169 Further reading 170

7. MENTAL HEALTH 171 Introduction 171 Case 7.1: Can Jane be force fed? 171 Case 7.2: Should Alva be sterilized? 172 Defining mental illness and mental disorder 172 Ethical justifications_ for compulsory intervention 175 The Mental Health Act 1983 177 Treatment outside the Mental Health Act 1983 - the 'best

interests' test 186

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CONTENTS

Case study 7.1: Force-feeding J ane - a discussion Case study 7.2: Sterilizing Alva - a discussion Law and ethics - a comparison

References Further reading

8. RESEARCH

Introduction

Case 8.1: Is Jessica's consent valid? Case 8.2: What role does Valerie have?

Case 8.3: Michael's consent to a drug trial Types of research Ethical principles

Ethical codes and professional guidelines Research ethics committees

Legal regulation of research

Case study 8.1: J essica' s consent - a discussion Case study 8.2: Involving Emile in research and Valerie's role -

a discussion Case study 8.3: Michael and the drug trial - a discussion

188 190 192 194 195

196 196 197 197 198 198 199 201 202

204

209

211 213

Law and ethics - a comparison 214 References 216

9. DEATH, DYING AND THE INCURABLY ILL PATIENT 218 Introduction 218

Case 9.1: Roger's DNR order - is it ethical and legal? 219 Case 9.2: Kylie's terminal illness - can treatment be withdrawn? 219 Case 9.3: Steve's advance directive - is it valid? 219 Definitions 220 Ethical considerations 221

The law and euthanasia 229 Case study 9.1: Roger's DNR order - a discussion 237 Case study 9.2: Switching off Kylie's ventilator - a discussion 239 Case study 9.3: Steve's advance directive - a discussion 241 Law and ethics - a comparison 242 References 244

Further reading 245

INDEX 246

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INDEX

Cases and statutes have not been indexed, see separate lists on pages ix-xv. Page f . indicate figures. re erences In italics

Abortion 144, 145-6, 167-8 fetal rights . legal aspects 149

moral aspects 146-9 maternal rights

legal aspects 151-2 moral aspects 150-1

paternal rights legal aspects 153 moral aspects 152-3

third party rights legal aspects 154 moral aspects 153-4

Access to health care see Resource allocation Accident and emergency departments

duty in emergencies 72 unconscious patients and consent 45

Accountability 58, 62-3, 65-6 case studies 58-9, 81-5 comparison of law and ethics 85-6 complaints 80 disciplinary proceedings 80-1 see also Negligence law; Responsibility

Act utilitarianism 19 Active euthanasia 220, 226, 230 Acts and omissions doctrine 226-8

legal aspect 234-5 Acts of Parliament 11-12 Adams, Dr Bodkin 236 Adoption 156 Advance directives/statements 241-2 AIDS 101,104,113-14,132 Allocation of health resources see Resource

allocation Alva's sterilization (Case Study 7.2) 172,190-

2 Alzheimer's Disease Society 212 Anarchy, State, and Utopia (Nozick) 127 Anne's accountability (Case Study 3.3) 59, 84-

5 Anorexia nervosa 185, 188-90 Antipsychiatry movement 174,183 Appeal courts 10 Arundhati's division of time and care (Case

Study 5.2) 118-19, 139-41 Assisted suicide 220 Atkins, Lord 85 Autonomy 22,24,29,30-1

and birth abortion 150-1

246

pregnancy and childbirth 159,162,166 surrogacy 155

case studies 29-30, 49-53 children and 36-8, 52 comparison of law and ethics 53-5 and confidentiality 94 and euthanasia 221-2 limited autonomy and paternalism 35-6 limiting factors 35 and mental illness 175, 192-3 and research 200 respect for autonomy, an absolute pri . I '

34-5,49-50 nClp e.

respect for autonomy, practical implicati 32-4 ons

see also Consent law Ayee

5sha's dosage dilemma (Case Study 3.2) 8-9,83

Balcombe Lord 46, 135 Battery (trespass to the person) 41 Beauchamp T.L. 22-3, 33-4 Bella's treatment (Case Study 2.1) 29,49-50· Beneficence 22,58,59-61,81

and confidentiality 94 relationship with non-malficence 61-2 and research 199-200

Benefit 60, 224 see also Beneficence

Bentham, Jeremy 4,17-18 Beryl's breach of confidence (Case Study 4.3)

90-1,111-12 'Best interests' of patients 234

at the end of life 224-5,230-3,240,243 and consent 45,54 physical treatment of mentally ill or mentally

handicapped patients 186-7, 193 Bills

process to become Acts of Parliament 11-12 types of 12

Binding precedent system 14 Bingham, Sir Thomas 103,136 Birth 144

abortion 145-6 fetal rights 146-9 maternal rights 150-2 paternal rights 152-3 third party rights 153-4

case studies 144-5, 164-7 comparison of law and ethics 167-9

pregnancy and childbirth 158 legal aspects 160-4 moral aspects 158-60

surrogacy 154-5 legal aspects 157-8 moral aspects 155-7

Birth plans 162-3 Blame 58,85 Bland, Anthony 218, 229, ~3~ BMA (British MedIcal AssocIatIon)

QUidance on end of life tr,eatment 224, 225, o 237,238,241,242 guidelines on confidentiality 95, 101

Bolam test 74-5 Boyes, Lillian 236 Brain-stem death 221 Breach of duty 73-4

accepted practice at time of incident 76 deviation from 76-7

differences of opinion on standards 75-6 and inexperience 77 legal standard of care 74-5 proof of 77-8 and right to health care 134

British Medical Association see BMA Brown L], Stephen 135 Browne-Wilkinson, Lord 235

Caesarean sections 158, 159-'-60, 166, 185 Candour, duty of 71-2 Capacity see Competency Cardiopulmonary resuscitation (CPR) 237 Care see Duty of care Carol's legal right to treatment (Case Study

5.1) 118, 137-9 Case law 13-14, 24 Categorical imperative 20 Causal responsibility 63-4 Causation (negligence claims) 78-80, 86 CERES (Consumers for Ethics in Research)

210 Child abuse 113 Childbirth and pregnancy

case study 145, 166-7 legal aspects 160

birth plans and manner of birth 162-3 paternal rights 163-4 prenatal injury 160-2

moral aspects 158-60 see also Birth

Children and autonomy 36-8,52 and confidentiality 107 and consent 46-8, 52-3 effects of surrogacy 156-7

incurably ill 239-40 prenatal injuries 160-2 and research 205-7, 211

Childress, ].F. 22-3,33-4 Choice, patients' 34

see also Autonomy Christian traditions 20, 24, 146, 225 Civil courts 7, 9 Civil law 6, 24 Clinical Negligence Protocol 80

INDEX

Code of Practice on Openness in the NHS 107 Code of Professional Conduct (UKCC 1992)

16,23 . and accountability 66, 81, 84 and beneficence 59 and confidentiality 92, 97 and conscientious objection 154 and non-malficence 61 and responsibility 64, 65

Codes of practice 16, 24, 26, 85 and research 201-2

Coleridge, Lord Chief Justice 23 Committee Stage of a Bill 11 Committees of enquiry 12 Common law 13-14 Commons, House of 11,12 Communication and autonomy 32 Compensation

for negligence 68, 79 and right to treatment 134

Competency 49,53-4 and autonomy 34

children 52 and consent law 43-4

children 46-8, 52 and research

adults 205 children 205-7 incompetent adults 207-8,211

Complaints 80 Compulsory intervention (mental illness) 171

case studies 171-2,188-92 ethical justification 175

of compulsory treatment 183 protection of others 175-6 protection of self 176-7

legislation 181, 193 admission for assessment 181, 182 admission for treatment 181-2 compulsory treatment 183-6 emergency admission 182

Concept of Law, The (Hart) 1 Conception 147 Confidentiality 89

case studies 89-91, 108-14 and children 107,112-13

247

INDEX

comparison of law and ethics 114-15 ethical approach 91-2 exceptions to duty of 96-7

legal 100-5 professional 97-100

justification for ethical sources 93-5 legal sources 95-6

legal approach 92-3 medical records 105·,:7 and people with mental health and learning

disabilities 107-8 remedies for breach of 105 and research .200-1

Confidentiality and Disclosure of Health Infor­mation (BMA 1999) 95, 101

Confidentiality: An Elaboration of Clause 9 of the Second Edition of the UKCC's Code of Conduct (UKCC 1987) 92, 95, 96, 98, 109

Confidentiality: Use of Computers, Position Statement (UKCC 1992) 92

Conscience 153 Conscientious objection 153-4 Coilsent 29, 32

and birth 162 and confidentiality 97, 101 and research 200, 204-5, 206, 208-9, 210-

11,212-13,214 see also Autonomy; Competency

Consent law 24,38-9 and birth 162-3 case studies 29-30,49-53 comparison law and ethics 53-5 competency 43-4,50 effective and voluntary obtaining of consent

39-40,50 exceptions to principle of consent

children 46-8; 52-3 unconscious or incompetent adults 45

information disclosure 40,-3, 51 refusal of consent 48-9

Consequences, intended and foreseen 228-9, 236

Consequentialism 17 and confidentiality 93 and justice 124 and women and abortion 151 see also Utilitarianism

Consumers for Ethics in Research (CERES) 210

Contract law 7, 24, 67 and confidentiality 96

Contractarian theory of justice 125-7 Coroners' courts 11 Corrective justice 122

248

County courts 9, 11 Court of Appeal 8,9, 10 Court of Human Rights, European 9 11 Court ofJustice, European 9,11,15' ,15 Court system 7-11 8 9 14 Cox, Dr Nigel 229: 236' CP.R .(Cardiopulmonary resuscitation) 237 Cnmmal courts 7,8 Criminal law 6,7,24 Crown Court 8,10

Death and dying 218-19 case studies 219-20,237-42 comparison of law and ethics 242-3 defining death 221 ethical considerations

arguments for and against euthanasia 221-4

'double effect' principle 228-9 end of life decision-making 224-5 killing or letting die? 226-8 prolonging life 225-6

euthanasia 220 legal approach

double effect principle 236-7 legal duties at the end of life 230-3 prolonging life 233-4 to euthanasia 229-30 withdrawing/withholding treatment 234-6

Declaration of Helsinki 201 Delegated legislation 13 Denning, Lord 70, 76, 77-8, 134, 154 Deontology 19-21

and confidentiality 93-4 and justice 124-5

Department of Health guidance on confidentiality 93, 98, 113 on information disclosure 33 on research 202,204,207,209,211,212

Devlin, Lord 5 Direct liability 70 Directives, Ejlropean 15 Disciplinary proceedings 80-1 Discrimination

and euthanasia 223 and mental illness 175

Disease 120-1 prevention 131-2

Distributive justice 122, 123 DNR ('do not resuscitate') orders 219, 237,

238 Donaldson, Lord 38,45, 71 'Double effect' principle 228-9,236-7,243 Drugs

administration of 83, 84 psychotropic 184

randomized controlled trials (RCTs) 213-14

Duty of care 59-60, 69-71, 86 at the end of life 225,230,239-40 duty of candour 71-2 duty in emergencies 72 duty to be extra vigilant 72-3 duty to keep up to date 71 see also Breach of duty

Dworkin, Ronald 23-4

ECT (Electroconvulsive therapy) 184-5 Edgell, Dr. 103 Egalitarianism and justice 124-7 EIs (executive instructions) 16 Electroconvulsive therapy (ECT) 184-5 Emergency situations

and consent 45 duty in 72

Employers and disciplinary proceedings 81 liability for negligence 70

Enforcement of Morals, The (Devlin) 5 Equality and justice 122, 125, 126, 141 Equity 15, 95 Ethics 16-17

ethical principles and rules 21-3 ethical theories 17

deontology 19-21 utilitarianism 17-19

and law in health care 23-7 Eugenics 190 European Court of Human Rights 9, 11, 15 European Court of Justice 9, 11, 15 European Directives 15 European law 14-15 European Social Charter (1961) 131 Euthanasia 220, 242

ethical argurr;tents for and against 221-4 law and 229-30 see also Death and dying

Executive instructions (EIs) 16

Fairness see Justice Family law 7 Fathers

rights and abortion 152-3 rights and pregnancy and childbirth 163-4

Fault principle 85 Felicific calculus 18 Feminism and abortion '150 Fetal rights

during pregnancy and childbirth . 158-9, 160-1

legal aspects of abortion 149-50 moral aspects of abortion

a potential life? 148-9 right to life 146 what is a person? 146-7 when does life begin? 147-8

Fidelity rule 94 Fiduciary relationships 51, 94-5 First Reading of a Bill 11 First-instance courts 10 Force-feeding 188-90 Futility, concept of 25, 136,237-8

INDEX

Genetic information and confidentiality 105 Gillick-competence (children) 47,52-3,205-6 GMC (General Medical Council) guidance on

confidentiality 114, 115 Goff, Lord 230, 235 Green Papers 12 Groundwork of the Metaphysic of Morals

(Kant) 20 Guide to Consent for Examination or Treatment

(DoH) 33 Guidelines for Professional Practice (UKCC

1996) 16 accountability 66, 81 beneficence 59-60 confidentiality 92,95,97,98,99, 107 conscientious objection 154 information disclosure 32,50 patients' preferences 34 research 199 responsibility 64, 84 truthfulness 33

Harm 61 and research 199-200 see also Non-malficence

'Harm principle' 5,31,175 Hart, H.L.A. 1, 5-6 HCs (Circulars) 16 Health 121 Health promotion 131-2 Health Service Commissioner 80 Health service guidelines (HSGs) 16 Health-care resources 119-;20

see also Resource allocation Hedonistic utilitarianism 18-19 Helen's autonomy (Case Study 2.3) 30,

52-3 Helsinki, Declaration of 201 High Court 8, 9, 10 HN 104,113-14

. screening tests 51 House of Commons 11,12 House of Lords 8,9, 10, 11-12 HSGs (health service guidelines) 16 Human rights

249

INDEX

European Convention of 11, 15, 94, 103, 133

and reproduction 164 sanctity of life 233 see also Rights

Humanhood 146-7,148

Ideal utilitarianism 19 Illness 120-1 Implied consent 97 Incurably ill patients 218-19

case studies 219"'::20,237-42 comparison of law and ethics 242-3 ethical considerations

arguments for and against euthanasia 221-4

'double effect' principle 228-9 end of life decision-making 224-5 killing or letting die? 226-8 prolonging life 225-6

euthanasia 220 legal approach

'double effect' principle 236-7 legal duties at the end of life 230-3 prolonging life 233-4 to euthanasia 229-30 withdrawing/withholding treatment 234--6

Infertility 155, 164, 165 Informal patients (mental illness)

admission 179-80 detaining 180

Information disclosure 54 and auto~omy 32-3, 50 legal control 40-3,51 and research 208-9,209-10 risk disclosure 33 see also Confidentiality; Medical records

Information impaiJment 35 Informed consent 29,32,54

see also Autonomy; Consent 'Informed participants' (in research) 200, 208 Injunctions 105 International Covenant of Civil and Political

Rights 1966 233 Invasive research 198-9 Involuntary euthanasia 220·

Jane being force-fed (Case Study 7.1) 171-2, 188-90

Jehovah's Witnesses 40, 47, 48, 49 Jessica's consent to research (Case Study 8.1)

197,209-11 John's consent to tests (Case Study 2.2) 29-30,

50-1 Judaeo-Christian traditions 20, 24, 146, 225 Judge-made law 13-14

250

Judges 14,24 influences on their decisions 25

Judicial precedent system 14 Judicial reviews 134 Justice 3,22,118,121-2,141

and equality 122, 141 and merit 122-4 practical approaches 127-31 and research 201 theories of 124-7 see also Resource allocation

Kant, Immanuel 19-21 and autonomy 31

Kathy's possible abuse (Case Study 4.4) 91, 112-13

Katie & Mary's surrogate relationship (Case Study 6.1) 144-5, 164-6

Kylie's terminal illness (Case Study 9.2) 219 239-41 '

Labelling theory 174 Laura's breach of confidentiality (Case Study

4.2) 90, 110-11 Law

classification 6-7 the court system 7-11 defining 1-2 and ethics in health care 23-7 functions 2-3 and justice 3 relationship with morality 3-6 sources of

common law 13-14 European law 14-15 legislation 11-13 other sources 15-16

Law Commission 12 and advance directives 241 and determining 'best interests' 188 and determining competency 44 and research 207-8,212

Learning disabilities, people with .0 and confidentiality 107-8 treatment of 186, 193

ethical issues 186-7 legal issues 187-8

Legal positivism 4 Legal system 2 Legislation

primary 11-12 secondary 13

Len's right to privacy (Case Study 4.5) 91, 113-14

Libertarian theory of justice 127 Life

quality of 225, 226, 232, 233, 240 right to 145, 146,225 sanctity of 146, 223, 225-6, 233

Lifestyle and right to health care 123, 138-9 Lisa's responsibility (Case Study 3.1) 58, 81-2 Living wills 241 Llewellyn, Karl 3 Locke, John 146 Lords, House of 8,9,10,11-12 LRECs (local research ethics committees) 202-

4,204 Luisa's caesarean section (Case Study pp??)

145, 166-7

Macroallocation of health resources 119 Magistrates' courts 8,9, 10-11 Masturbation 121 Maternal rights

and abortion legal aspects 151-2 moral aspects 150-1

during pregnancy and childbirth legal aspects 160, 162-3 moral aspects 158-60

Medical records 78, 83, 96, 105-7 Medical Research Council (MRC), research

guidelines 201,207,211,212,216 Medical success and resource allocation 128,

129 Medical treatment of incurably ill patients

221,224,225,228,230-3 withdrawing/withholding treatment 234-5,

237-9, 239-40 Men see Fathers Mental disorder, defining 173-4,178 Mental handicaps, people with

and confidential,ity 107-8 and research 207 treatment of 186, 193

ethical issues 186-7 legal issues 187-8

Mental illness 121, 171 case studies 171-2,188-92 comparison of law and ethics 192-3 defining 172-4, 178 and discrimination 175 ethical justification for compulsory inter-

vention 175 compulsory treatment 183 protection of others 175-6 protection of self 176-7

legislation 177-9 compulsory admission 181-3, 193 compulsory treatment 183-6 informal admissions 179-80

physical treatment 186-8

INDEX

and research 207,211-12,216 Mental impairment 35,178-9,182,211 Mental Incapacity Research Committee 208,

212 Merit and justice 122-4 Michael's consent to drug trial (Case Study

8.3) 198,213-14 Mill, John Stuart 5, 17, 18

and autonomy 31,175 and children's autonomy 37

Moor, David 229 Moore, G.E. 19 Morallaw 20 Morality

and ethics 16 relationship with law 3-6

Mothers see Women MRC (Medical Research Council), research

guidelines 201, 207, 211, 212, 216 MRECs (multicentre research ethics

committees) 204 Mustill, Lord 72,233

National Health Service (NHS), legal framework 133-4

Natural law doctrine 4 Need 125, 127-8, 131, 140, 141 'Need to know' and confidentiality 97-8,

101 Negligence law 58, 67

case studies 58-9, 81-5 comparison of law and ethics 85-6 and confidentiality 95-6 elements in negligence claims

breach of duty 73-8 causation 78-80 duty of care 69-73, 82, 83, 84

increase in number of cases 67-8 and information disclosure 42-3 purpose of 68-9 and research 202,205 and right to health care 134 see also Accountability; Responsibility

'Neighbour principle' 13-14, 69, 85, 86 NHS Executive 16 Non-invasive research 199 Non-malficence 22,58,61, 81, 83

and confidentiality 94 relationship with beneficence 61-2 and research 199-200

Non-therapeutic research 198, 216 benefits to patients 200 and information disclosure 208, 209 patient competency and 205, 206, 207,

211-12 and proxy consent 212-13

251

INDEX

Non-voluntary euthanasia 220, 222 Nozick, Robert 127 Nuremberg code 196, 201 Nurse-patient relationship 95, 115

Outcomes of treatment and resource allocation 128-9

Passive euthanasia 220, 226, 230, 235 Paternal rights

and abortion 152-3 .andpregnancy and childbirth 163-4

Paternalism 'and autonomy 35-6, 54 and mental illness 176~7, 193

Patient advocates 5'0 Patient-nurse relationship 95, 115 Patient's Charter 29, 127 Persistent vegetative state (PVS) 229, 230,

231,232-3,235,239 Personhood 146-7, 148 Placebos 213, 214 Police enquiries and confidentiality 101-2 Potentiality argument and right to life 148-9 Precedent system 13-14 Preferences, accepting patients' 34 Pregnancy and childbirth 144, 158, 168-9

legal aspects 160 birth plans and manner of birth 162~3 paternal rights 163-4 prenatal injuries 160-2

moral aspects 158-60 see also Birth

Primary liability 70 Principles, ethical 21-3 Privacy

and research 20-1 right to 94

Private Bills 12 Private law 6 Private member's Bills 12 Promotion of the Rights of Patients in Europe

(WHO) 133 Protection and Use of Personal Information

(DoH 1996) 93,98,113 Proxy consent 45,46,48,206-7,210-11 Psychopathic disorders 179, 182 Psychosurgery 184 Psychotropic drugs 184 Public Bills 12 Public interest and confidentiality 98-100, 102 Public law 6 PVS (persistent vegetative state) 229,. 230,

231,232-3,235,239

QALYs (quality-adjusted life years) 129-30,142

252

Qual~ty of life 225,226,232,233,238 QuasI-law 15-16 ,240

Rachels, J. 227 Randomized controlled trials (RCTs) 213-14 Rationality 54-5 Rationing 118, 120, 136 Rawls, John 125-7 RCM see Royal College of Midwives RCN see Royal College of Nursing RCTs (randomized controlled trials) 213-14 Reasonableness, concept of 64 Records, medical 78,83, 96, 105-7 Report Stage of a Bill 11 res i~s; loquitur ('the thing speaks for itself')

Research 196~7

case studies 197-8,209-14 comparison of taw and ethics 214-16 ethical codes and professional guidelines

201~2, 215-16 ethical principles 199-201 ethics committees 202-4 legal regulation 204-5

competency 205-8 information disclosure 208-9

types of . 198-9 Resource allocation 25, 118, 119

cas.e studies 118-19,137-41 comparison of law and ethics 141-2 and health 121 health-care resources 119-20 . and illness and disease 120-1 justice and 121-4 justice theories 124-7 and the law 131

health promotion and disease prevention 131-2

right to health care 13 2-7 practical approaches

maximization of welfare 129-31 need 127-8 outcome of treatment 128-9

rationing 120 Responsibility 58, 62-3

case studies 58-9,81--:5 causal .. 63-4 comparison of law and. ethics 85-6. individual Jor own health 138

. role 64-'05 .. ... . .. see also .Accoluii'ability; Negligence law

. Rights abortioh and . fetal rights .146-'9 . maternal rights 150-2

paternal rights 152-3

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third party rights 153-4 legal right to health care 132-7, 137-9 right to die 222 right to life 145, 146,225 see also Human rights

Risk disclosure of 33 and research 200

Roger's DNR order (Case Study 9.1) 219, 237-9

Role expansion 65 Role responsibility 64-5 Royal Assent for a Bill 12 Royal College of Midwives (RCM)

and autonomy 166 and conscientious objection 154 and surrogacy 165

Royal College of Nursing (RCN) and DNRs 237 and research 199, 201, 210, 211, 215

Royal College of Paediatrics and Child Health guidelines on incurably ill children 239

Royal Commissions 12 Rule utilitarianism 19 Rules 1

ethical 21, 23 primary and secondary 1-2

Rules and Regulations 13

Sanctity of life 146, 223, 225-6, 233 Scheff, Thomas 174 Schizophrenia 174, 184 Scope of Professional Practice (UKCC 1992)

61,65 Second Reading of a Bill 11 Sectioning 181

see also Compulsory intervention Self-determination 25,30,38

see also Autonomy; Consent law Sentience 147 Severe mental impairment 178 Siegler, M. 96-7 Standards 26, 64 Standards for Administration of Medicines

(UKCC 1992) 16, 83, 84 Standards of care 74-5, 82, 85-6

see also Breach of duty; Duty of care Standards for Records and Record Keeping

(UKCC 1993) 83 Statutes 11-12 Statutory Instruments 13 Sterilization 164, 190-2 Steve's advance directive (Case Study 9.3)

219-20, 241-2 Subordinate legislation 13 Subpoenas 102

INDEX

Suicide 230 assisted 220, 230

Surgical implants 184 Surrogacy 144, 154-5, 168

case study. 144-5, 164-6 legal aspects 157-8 moral aspects 155-7

Szasz, Thomas 174

Taylor, Lord 232 Teleological theories see Consequentialism Terminally ill patients see Incurably ill patients Therapeutic research 198, 216

benefits to patients 199-200 and information disclosure 208, 209 involving children 205,206,211 patient competency and 205,206,207

Third Reading of a Bill 11 Thomson, Judith Jarvis 151 Tort law 6, 67 Treatability test, mental illness 182 Trespass to the person (battery) 42 Trust 95, 115 Truthfulness 33, 55

duty of candour 71-2 Tuskegee study 196

UKCC 16,23 and accountability 66, 80-1, 84 and beneficence 59, 59-60 and confidentiality 92, 95, 96, 97, 98, 99,

107,109 and conscientious objection 154 and information disclosure 32,50 and non-malficence 61 and patients' preferences 34 and research 199 and responsibility 64, 65, 84 and truthfulness 33

Utilitarianism 17-19 and justice and resource allocation 124, 129

Valerie's role involving Emile in research (Case Study 8.2) 197,211-13

'Veil of ignorance' and justice 126, 126-7 Vicarious liability 70 Voluntariness and consent 33-4 Voluntary euthanasia 220,222 Voluntary patients 179

Warnock Report (1985) 12, 157 White Papers 12 Williams, Alan 129 Winnie's information (Case Study 4.1) 89-90,

108-10 W olfenden Report 5

253

INDEX

Women and abortion

legal aspects 151-2 moral aspects 150-1

and pregnancy and childbirth legal aspects 160, 162-3

254

moral aspects 158-60 and surrogacy 155

World Health Organisation 133 Written consent 39 Wrongful birth actions 162 Wrongful life actions 161

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